September 2022 O&P Almanac by AOPA

Prior Authorization of Orthoses NationwideExpands P.14 ColoradoImpactMakesAdvocacyanin P.50 SEPTEMBER 2022 The Magazine for the Orthotics & Prosthetics Profession SPECIAL SECTION: 2022 AOPA NATIONAL ASSEMBLY EXHIBITOR PREVIEW P.34 EXPANDING IMPLANT OPTIONS MEANS PROSTHETISTS WILL TREAT MORE PATIENTS WITH BONE-ANCHORED PROSTHESES P.22 CONNECTIONSDIRECT This Just In: Limb Loss GoesPreservationandRegistryLive P.20

Forwww.AOPAassembly.orgmoreinfoandtoregister,visit: FOLLOW US @AmericanOandP THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS. Registration Is Open! NEW! Stellar partnership with the Texas Society of Orthotic and Prosthetic Professionals (TXSOPP) NEW! Innovative two-day education track on O&P Digital Care and Post Mastectomy Care. NEW! The O&P Experience Zone—A fun interactive event in the Exhibit Hall featuring patient success stories and their clinician caregiver. NEW! Digital O&P Care Showcase A Who’s Who line up of experts presenting the most relevant Customizableeducation. meeting experience to ﬁt your needs Earn over 100 CE Credits. Join us September 28-October 1, 2022, for an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX. REGISTRATIONOPENNOW! WE CAN’T WAIT TO SEE YOU! San Antonio Earn up to 100+ CE Credits MEMBERSHIP HAS ITS BENEFITS Members save up to $300 on Assembly Registration

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STORYCOVER contents FEATURES DEPARTMENTS | COLUMNS Views From AOPA Leadership ........ 4 Supporting children with limb loss AOPA Contacts 6 How to reach staff Numbers 8 At-a-glance statistics and data Happenings 10 Research, updates, and industry news People & Places 12 Transitions in the profession Reimbursement Page 14 Full Implementation What you need to know about expanded prior authorization of orthoses Opportunity to earn up to two CE credits by taking the online quiz. Member Spotlight ................................ 52 n Bulow Orthotic & Prosthetic Solutions n Joint Active Systems AOPA News............................................... 55 AOPA advocacy, announcements, member benefits, and more Welcome New Members 55 Marketplace 56 Careers ......................................................... 61 Professional opportunities Ad Index 62 Calendar 63 Upcoming meetings and events State By State ..........................................64 State legislature calendars SEPTEMBER 2022 | VOL. 71, NO. 8 Glenn Matsushima, CPO, FAAOP 50 Meet an O&P business owner who has advocated for the profession in many ways, including recent efforts to build a state-specific O&P coalition in Colorado. O&P ADVOCATE P.11 20 | THIS JUST IN Data Debut Find out what types of information are being aggregated for the new Limb Loss and Preservation Registry, and learn how you can contribute. By Michael Coleman 36 | Assembly Sponsors Find out what the Assembly sponsoring organizations plan to showcase at their booths. 42 | Exhibitor Directory See the full list of companies exhibiting at the 2022 AOPA National Assembly. 22 | ConnectionsDirect O&P facilities should expect to see more individuals who have undergone osseointegration surgery, as several implants are in FDA trials and one is already approved for some transfemoral patients. Hear from experts on a multidisciplinary team that has treated dozens of these patients, and learn some of the nuances of fitting patients with implants. By Christine Umbrell SPECIAL SECTION: 2022 AOPA National Assembly 34 | Intersection at the Exhibit Hall Learn about new events and opportunities planned for the Exhibit Hall floor. IntegrumPHOTO: 2 SEPTEMBER 2022 | O&P ALMANAC

For the active users with foot drop When less support is needed during stance phase More flexibility – greater ROM

Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX

Our plan is to bring this initiative to other states. Every child with limb loss or limb difference deserves to be able to participate in recreational activities with their peers. But they can only do so if they have access to the best clinical care—care that you, our members, enable and provide. If you are interested in bringing So Kids Can Move to your state, contact AOPA at advocacy@AOPAnet.org

To kickstart and help promote awareness of the So Kids Can Move initiative, we joined forces with Forrest Stump, a nonprofit advocacy organization dedicated to promoting equitable access to physical activity for individuals with disabilities, during its annual awareness and advocacy event in August. On August 26 and 27, Forrest Stump’s team of 12 physically challenged “athlete-advocates,” a VI guide, and a prosthetist/orthotist ran 200 miles in 36 hours at the Hood To Coast (HTC) Relay. They ran with one message: People with disabilities deserve the right to exercise, but lack of insurance coverage of medically necessary prosthetic and orthotic care—and other assistive devices—prevents equitable access to participation in physical activity. Building on HTC and Forrest Stump’s presence in the Pacific Northwest, we will target the states of Oregon and Washington first.

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VIEWS FROM AOPA LEADERSHIP

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, 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 info@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.

DIRECTORS

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

ADDRESS CHANGES

July 26, the 32nd anniversary of the Americans With Disabilities Act, So Kids Can Move will educate states about how recreational prostheses are medically necessary for children. The goal is to expand access to prosthetic care for kids, ensuring that they have the right prostheses for their multifaceted needs. The model for this new approach is Maine’s successful legislative advocacy effort that requires health plans to cover a recreational prosthesis for children under the age of 18 beginning in 2024.

Loss/Difference

President Dave McGill Össur Americas, Foothill Ranch, CA President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Vice President Mitchell Dobson, CPO Hanger, Austin, TX

John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY

I N THE APRIL Views From AOPA Leadership column, I discussed how AOPA is committed to state-based advocacy. The So Kids Can Move initiative is an exciting new approach to ensuring appropriate access to prosthetic healthcare services at the state

4 SEPTEMBER 2022 | O&P ALMANAC

Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net Visit bit.ly/AOPAMedia2022 for advertising options!

Launchedlevel.on

OFFICERS

Copyright © 2022 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.

To learn more about So Kids Can Move, check out our August AOPA Advocacy in Action webinar

Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL Linda Wise Mount Sterling, OH Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX

Treasurer Rick Riley Xtremity, Denver, CO Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA

Board of Directors

Dave McGill is president of AOPA.

Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN

How AOPA Is Supporting Kids With Limb

So Kids Can Move addresses several of our strategic priorities. First, it communi cates the importance of O&P care to the public. No one would reasonably argue that children with limb loss or limb difference should be excluded from physical activities that their peers can enjoy. However, many people fail to understand that without appropriate prosthetic devices and care, these children are functionally excluded from those opportunities. Second, it drives collaboration by creating strategic relationships, both inside and outside of the O&P profession. We are proud to partner with both the National Association for the Advancement of Orthotics and Prosthetics and the American Academy of Orthotists and Prosthetists on this initiative. As we work to achieve our objectives, we will also partner with AOPA members in Maine on their successful legislative effort. And we will build new part nerships with a range of stakeholders in every state where So Kids Can Move launches, including legislators and health plans.

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

Jeffrey M. Brandt, CPO Brandt Ventures, LLC, Chester Springs, PA

built for professionals by professionals OFFER YOUR PATIENTS BETTER CONTROL & GREATER COMFORT Rigid footplate design reduces pressure on the distal limb improving skin integrity Modular molded inner boot design for maximum adjustability Longer toe lever offers improved balance and stability Dynamic ultra lightweight carbon fiber design Provides energy return, maximizing push off Most dynamic and adjustable partial foot prosthesis PARTIAL FOOT PROSTHESIS Steve Tillges CPO, PrePregLPOSpecialist Coming to AOPA 2022? Visit #TeamTillges at booth 637!

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

330 John Carlyle St., Ste. 200 Alexandria, VA 22314

Timishia Bannister, membership coordinator, 571/431-0835, tbannisterAOPAnet.org

equitable access • Providing

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

professional excellence • Supporting

HEALTH POLICY AND ADVOCACY

by: • Fostering

orthotic

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

MEMBERSHIP & COMMUNICATIONS

Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

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

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

Nicole Ver Kuilen, manager of public engagement, 571/431-0836, nverkuilen@AOPAnet.org

AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org

Susannah Engdahl, PhD, manager, health policy and research, 571/431-0843, sengdahl@AOPAnet.org

Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org

Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

MEETINGS & EDUCATION

strengthen the orthotic

Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571/431-0852, kelly.oneill@AOPAnet.org Kristen Bean, digital meetings specialist, 571/431-0876, kbean@AOPAnet.org

patients. Our Vision A

and improve the

Our Mission

Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com Statement trusted partner, advocating for and serving the orthotic and prosthetic community relationships with decision makers to ensure education that promotes research that informs equality to and prosthetic profession lives of world where and prosthetic care transforms

Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org

lives. 6 SEPTEMBER 2022 | O&P ALMANAC

AOPA CONTACTS

AOPA Bookstore: 571/431-0876

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O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org

Joe McTernan, director of health policy and advocacy, 571/431-0811, jmcternan@AOPAnet.org

ADDRESS CHANGES

innovative care • Advancing

To experience the benefits of the Flex Sleeve for yourself, contact your prosthetist. ALPS GEL SUCTION SUSPENSION SLEEVE Eases bending and reduces bunching behind the knee. 30° PRE-FLEXION Black or beige 2 COLOR OPTIONS Provides maximum comfort and high performance for medium and high-activity users. ALPS FLEX SLEEVE (SFX) T: 727.528.8566 | 800.574.5426 | F: 727.528.8862 www.easyliner.com | info@easyliner.com NEW SIZES NOW AVAILABLE! For more information and sizing, scan the code!

ServicesHumanandHealthofDepartmentU.S.Policy,HealthofOfficeEvaluation,andPlanningforSecretaryAssistant2022,”EarlyinLowAll-TimeReachesRateUninsured“NationalSOURCE:SOURCE : National Health Interview Survey’s Health Insurance Coverage Reports, 2000-2021

Americans With Health Insurance National uninsured rate reaches an all-time low “State-specific analyses using the CommunityAmericanSurvey show that the largest changes in the uninsured rate for low-income adults between 2018 and 2020 generally occurred in states that recently expanded Medicaid.” —“National Uninsured Rate Reaches All-Time Low in Early 2022” 11.8% Uninsured rate in early 2022 1.0 Million Children have gained health insurance coverage since 2020 3.7% Uninsured rate in early 2022 14.5% Uninsured rate in late 2020 4.1 Million Adults have gained health insurance coverage since 2020 4.5% Decrease in uninsured rate among those with incomes below 100% of the federal poverty line (FPL) 2.0% Decrease in uninsured rate among those with incomes between 200% and 400% FPL 0.6% Decrease in uninsured rate among those with incomes between 100% and 200% FPL 0.5% Decrease in uninsured rate among those with incomes above 400% FPL 6.4% Uninsured rate in late 2020 O&P facilities may be seeing fewer patients without health insurance than in years past. In the first quarter of 2022, the uninsured rate among U.S. residents of all ages hit 8%— the lowest rate ever recorded by the National Health Interview Survey—according to a new report from the U.S. Office of Health Policy. DROP IN UNINSURED ADULTS 18-64 DROP IN CHILDRENUNINSURED UPTICK IN COVERAGE UNINSURED BY INCOME LEVEL, Q1 2021 – Q1 2022 NUMBERS National Uninsured Rate, All Ages, 2020-Q1 2022 (41.3M)14.9% (48.3M)16.0% (26.4M8.0%)18161412108%6%4%2%0%%%%%% 2022 ACA 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20142015 20162017 2018 20192020 2021 Q1 ETakesect ETakeARPsect 8 SEPTEMBER 2022 | O&P ALMANAC

• A more expeditious, convenient and satisfying clinical pathway for transtibial patients • A unique socket “Preform” that is injection molded using a proprietary carbon fiber reinforced polymer • You can heat, vaccuum form, trim and assemble the XtremityTT in 60-minutes and make heat gun adjustments in 10-minutes • No layup, no lamination, no carbon dust. Reduce employee exposure to hazardous materials • The most tested definitive socket, ever One FabricationSocketDefinitiveHour XtremityTT is new thermoformable definitive socket technology that will enhance your patient’s experience and your clinic’s efficiency. XtremityTT replicates the durability and functionality of carbon fiber laminated sockets while achieving the benefits of adjustable sockets. www.Xtremity.com970.429.4203See us at the AOPA National Assembly, Booth 909. Send email inquiries to hello@xtremity.com Watch video about XtremityTT

UK Design Team Develops BreathPowered Prosthesis

The prevalence of low back pain among individuals with lower-limb loss is higher than in the general population, according to a new study by researchers at the University of Genova in Italy. The research team created an online questionnaire to gather details regarding back pain from indi viduals who have lower-limb amputation, then studied the responses of 239 participants. More than 80% of respon dents reported experiencing low back pain postamputation (82%), and 70% reported experiencing low back pain in the past year. Respondents who also reported prob lems in the nonamputated leg also were more likely to experience low back pain. The findings were published in August in Spine journal.

The team discovered a significant relationship between percent deficit of knee extension strength and heart rate at a fast walking speed. They also found that percent deficit knee flexion strength related to rating of perceived exertion at slow and moderate walking speeds. The researchers concluded that strength retention of the residual knee flexion and extension musculature is important in improving functional outcomes. The study was published in July in Gait Posture

Led by Jeroen Bergmann, PhD, associate professor of engineering science and director of Oxford Healthtech Labs, the researchers developed a lightweight hand that can be attached to the wearer without cable attachments. To use the device, users regulate their breathing to power a small purpose-built Tesla turbine that can control prosthetic finger movements. Minimal main tenance and training are required, according to the researchers. Bergmann’s team is working closely with LimbBo, charity in the United Kingdom for children with mobility issues, and Mobility India, a nonprofit organization, to improve the prototype. The study was published in April in the journal Prosthesis

Low Back Pain Common in Limb Loss Population

The researchers observed participants as they completed metabolic testing at three standard ized speeds and studied maximum isokinetic knee flexion and extension strength for both residual and sound limbs. They watched as participants completed a two-minute walk text, timed stair ascent test, and four-square step test.

Researchers at the University of Oxford unveiled a low-cost prosthetic hand that can be pow ered and controlled by the user’s breathing. The hand may be suited for children and individuals in low- and middle-income countries, according to the research team.

10 SEPTEMBER 2022 | O&P ALMANAC

The orthosis with the heel plug reduced the overall means of average pressure, peak pressure, and pressure contact area in the hindfoot while tending to increase these mea surements in the midfoot and forefoot. “This is an important finding because offloading in the hindfoot is critical in pathol ogies such as plantar fasciitis to decrease pain and increase function,” according to the researchers. The study was pub lished in August in Prosthetics and Orthotics International Strength of Residual Knee Impacts Function

Strength retention within the knee of the residual limb is an important factor in functional outcomes of individuals with unilateral tran stibial amputation, according to researchers from the VA Puget Sound Healthcare System and University of Maryland. The research team, which included Elizabeth Russell Esposito, PhD, conducted an observational study of 14 subjects with traumatic amputation to explore how knee flexor and extensor strength in the residual limb impacts functional outcome measures, such as walking energetics and performance metrics.

RESEARCH ROUNDUP Study Compares Orthoses With and Without Heel Plugs

Custom-made foot orthoses with heel plugs are more effective than regular custom-made foot orthoses in off loading plantar pressures in the hindfoot while increasing pressures in the midfoot, according to researchers from Western University in Ontario, Canada.

Happenings

The researchers assembled 14 healthy participants who were asked to wear two different custom-made foot orthoses. Both orthoses were made with the same materials and specifications, but one replaced traditional hard material under the heel with a softer blue PORON plug added for cushioning. The team recorded plantar pressures during treadmill walking for both devices in a running shoe, and aggregated data on average pressure, peak pressure, and pressure contact area on the hindfoot, midfoot, and forefoot.

PATIENT PREFERENCES

The full report is available on the Amputee Coalition website.

SOURCE: “Acute Arterial Occlusions in COVID-19 Times,” Annals of Vascular Surgery

SOURCE: “Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the U.S. Department of Veterans Affairs,” Federal Practitioner

HAPPENINGS

Amputation Trends at the VA In 2019, the Department of Veterans Affairs (VA) provided care to 96,519 veterans with amputation, and half—46,214—hadaboutatleast one major limb amputation, defined as an amputation at or proximal to the wrist or ankle. The majority of veterans with amputation treated within the VA have limb loss resulting from disease processes, such as diabetes mellitus and peripheral vascular disease.

VETERAN VIEWPOINTS

Better Sleep, Exercise Top Priorities Among Individuals With Limb Loss

The survey found that the ability to exercise is a “top” physical and mental health priority for respondents (26%). Other priorities include improved sleep (17%), strength and balance (15%), improved assistive device/comfort (14%), and access to a prosthesis (13%).

AOPA, over the past several months, has been working diligently with key staff members at the durable medical equipment

COVID CONSEQUENCES Amputation More Frequent Among ALI WithPatientsCOVID COVID-19 has a worse prognosis among patients with acute limb ischemia (ALI), with higher rates of limb loss and overall mortality relative to non-COVID patients. In a recent study, individuals with ALI and COVID-19 had a 61% limb salvage rate, compared to 90% among individuals with ALI and without COVID-19.

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appealaableofficialsandMAC(DMEadministrativeMedicarecontractorsMACs),theDMEmedicaldirectors,high-rankingCMStofindareasonsolutionandprovidepathwayforsupplierstotheserejections, especially for those who may have missed their timely filing windows. The DME MAC medical directors recently informed AOPA that the issue has been resolved, and that they will be contacting the affected suppliers and provide them with directions on how to resubmit and/or appeal their claims.

More than half of individuals with limb loss and limb difference would like more information about techniques for better sleep (55%), and nearly half would like more information on com prehensive care services (49%) and peer support groups (48%). Another 40% desire information about rehabilitation services, and 38% would like information related to nonopioid pain treatment. These findings were identified in a survey from the Amputee Coalition of more than 1,700 individuals with limb loss and limb difference, designed to identify the physical and mental health priorities and challenges of this demographic. The resultant report, “Largest Survey of People With Limb Loss and Limb Difference Demonstrates Actionable Ways To Improve Care,” shares insights from the U.S. limb loss population.

AOPA members who continue to have questions or concerns regarding this issue should contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org

CODING CORNER CO-261 Claim Rejections Resolved

Several AOPA mem bers had reported having an issue with select beingprostheticlower-limbclaimsrejectedwith the remark code CO-261 (the procedure or service is inconsistent with the patient’s history). Since the claims were rejected and not denied, the claim could not be appealed; it could only be fixed and resubmitted. However, there was no information or directions provided as to what was “inconsistent,” and how it could be fixed. This inability to fix/appeal the claims also was causing some members to miss their timely filing window.

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PROFESSIONALSChancelorGray has been named the new Midsouth district manager for Allard USA. Gray’s previous experience includes medical sales with J&J and Depuy Synthes, as well as some time as an orthopedic scrub technician. He looks forward to serving the O&P community in the Midsouth region.

“The expansion of these two leaders is a continuation of our plans across all Hanger businesses to focus forward on Chancelor Gray Meghan Smith Michael Oros, CPO, LPO, FAAOP Wil Townsend

Kids Can Move will start by targeting Oregon and Washington. The goal is to have them become the first states, following Maine, to cover recreational prostheses for children. After piloting this effort in Oregon and Washington, AOPA and NAAOP plan to expand this initiative to other states to see this same policy enacted.

Congratulations to AOPA’s Advocate of the Month

PEOPLE & PLACES strategic growth, innovation, and clinical differentiation,” said Vinit Asar, Hanger presi dent and CEO. “We are fortunate to have a leader in Michael with a strong clinical back ground and commitment to outcomes who will be focused on our critical Patient Care segment. Similarly, the strategic importance of Kate’s role has never been more significant as we invest in supply chain to enable a better clinician and patient experience.”

ANNOUNCEMENTS AND TRANSITIONS

In his new role, Oros will provide day-to-day management of clinical operations. Oros is an O&P industry veteran with more than 30 years of experience, 24 of which were at Scheck & Siress, where he joined as a lab manager and clinician before serving as corporate vice president, president, and eventually CEO. Oros joined Hanger Clinic in 2020 as regional vice president through the acquisition of Scheck & Siress and was promoted to zone vice president in January 2021. Means joined as Hanger’s chief supply chain officer in January 2022. She has more than 15 years of experience in global supply chain and logistics, specializing in transitioning businesses and leading teams to sustainable excellence. Prior to joining Hanger, Means led McKesson’s 3PL operations, where her team partnered with pharmaceutical manufac turers, providing optimal warehousing and distribution solutions for their products and patients. Kate Means

has partnered with the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) and American Academy of Orthotists and Prosthetists in launching a new initiative called So Kids Can Move. This is an aware ness-raising, state-based policy initiative to expand access to recreational prostheses as medically necessary healthcare for children on a state-by-state basis. The movement will expand access to the health and social benefits of physical activity for children who need appropriate, evidence-based prosthetic care to do Soso.

The Board of Certification/Accreditation (BOC) has announced two new additions to its staff: Wil Townsend and Meghan Smith As BOC’s operations manager, Townsend is responsible for supporting the direction, strategy, and day-to-day business operations for the organization. He also manages key vendor partnerships and provides leadership to ensure effective operational controls and systems are in place. Townsend leads the information technology and facility man agement functions of the organization.

Smith began her career in the hospitality industry with Starwood/Marriott and Hilton, working in guest services and hotel management before transitioning to the sales and marketing department as an event planning manager. She also has held positions with Alliance Marketing Partners, Lyfebulb, and Awin. “We are pleased to welcome Wil and Meghan to BOC,” said BOC President and CEO Claudia Zacharias. “We look forward to their fresh perspective and expertise as we continually strive to enhance our operations and customer communications.”

Michael Oros, CPO, LPO, FAAOP, has been named Hanger Clinic president and has been appointed to Hanger’s Senior Leadership Team (SLT). Additionally, Kate Means, Hanger chief supply chain officer, has been appointed to the SLT. Both leaders will continue to report to Pete Stoy, Hanger’s chief operating officer.

Smith is BOC’s digital marketing manager. She joins the organization with more than seven years of management and marketing experience and is responsible for implementing the organization’s marketing strategy to improve communi cation with key stakeholders and customers to elevate brand awareness among target audiences through digital channels.

AOPABUSINESSES

AUGUST 2022: Laurie Johnson Hanger ClinicLaurie Johnson Visit AOPA on Facebook to see each Advocate of the Month.

Townsend joins the organization with more than 25 years of large-scale operations management experi ence, most recently working as facilities manager for Baltimore’s Hippodrome Theatre. Previously, he held the role of general manager for Regal Entertainment Group for more than two decades.

Is it time to go BACK TO THE FUTURE In the Treatment of Back Pain IT’S NOT COMPLICATED! 1 2 3 4 5 6 NO OPIOIDS! NONADDICTIVE! NONINVASIVE! PROVEN RELIEF! COSTEFFECTIVE! PATIENT CONTROLLED! Educate your prescribers about rigid spinal bracing fitted by Orthotists. For more information visit www.bremergroup.com, see us at AOPA Booth #1015, or call 800-428-2304. VertAlign protected under U.S. Patent No. 5,718,670 VertAlign® is a registered trademark of The Bremer Group Company. Copyright, 2022, The Bremer Group Company. All rights reserved. 22-BREMERG-3619 SEP The Bremer Group Company 11243-6 St. Johns Industrial Parkway So. Jacksonville, FL 32246 T: 904-645-0004 F: 904-645-0990 bremergroup@bremer.netFAX Embracing Excellence

Full Implementation Expansion of prior authorization for orthoses extends to all states next month

Editor’s Note—Readers of Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80%, and AOPA will transmit the information to the certifying boards.

CMS ANNOUNCED IN JANUARY

Understanding Prior Authorization for Orthoses

ImagesGettyIMAGE: 14 SEPTEMBER 2022 | O&P ALMANAC

The process for submitting a prior authorization request, receiving an affirmative or nonaffirmative response, and submitting a claim for orthoses is similar to the process for lower-limb prostheses, which most O&P providers are familiar with. However, there are some differences. First, the turnaround time from submission to receiving a prior authori zation decision has been cut in half: 10 business days for lower-limb prostheses, but five business days for orthoses.

P.18

the expansion of Medicare prior authorization to include five orthotic Health Care Common Procedure Coding System (HCPCS) codes: L0648, L0650, L1832, L1833, and L1851. Phase II of the orthotic rollout began July 12— meaning that prior authorization for the five orthotic codes is currently active in Arizona, California, Florida, Georgia, Illinois, Kentucky, Maryland, Michigan, Missouri, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, andPhaseWashington.III—the final phase—will begin next month, on October 10, and will include all remaining states and territories. Suppliers or suppliers with patients in the Phase III states and ter ritories may begin to submit their prior authorization requests September 26.

Second, the validation period of how long an affirmative prior autho rization response is valid, or the time frame a supplier has to deliver an item, is reduced: 120 calendar days for lower-limb prostheses, but 60 calendar days for orthoses.

The last difference is the ability to suspend or bypass the prior authori zation process if there is an emergent care issue. When there is an immediate need to provide an orthosis to stabilize an injured or unstable spine or knee, and the patient cannot wait for the traditional two-day expedited review process because the delay in care would risk the health or life of the patient, the Medicare prior authorization require ment will be suspended. Claims for emergent-need orthoses that would otherwise require Medicare prior authorization must be submitted with an ST modifier. The ST modifier allows claims to be processed immediately, without a prior authorization, but all claims submitted with the ST modifier will be subject to a prepayment review. We have learned some other important information during the first two phases of the prior authorization process for orthoses. CGS, the durable medical equipment Medicare admin istrative contractor (DME MAC) for jurisdictions B and C, has provided a list of some of the more common reasons they are noticing for nonaffir mative prior authorization requests.

REIMBURSEMENT PAGE

By DEVON BERNARD

Reimbursement

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To be considered valid, the WOPD must have been created and dated within the proper time frame, and must have five key elements:

• Order date, which is typically when the order is created/written

Just as with the WOPD, a face-to-face encounter became a condition of payment for the L0648, L0650, L1832,

Some of the nonaffirmative responses can be categorized as technical reasons. The specific tech nical reasons identified by CGS include missing/invalid written orders prior to delivery (WOPD), no documen tation of face-to-face encounters, and missing or improper signatures.

• Name or National Provider Identifier number of the treating practitioner (physician, nurse practitioner, physician assistant, etc.)

Prior Authorization Expansion

• Description of the item, including any and all supply items and accessories or options; this description could be a brief narrative or general description, it could be the appropriate HCPCS code(s) and/or the HCPCS code narrative, or it may be the brand name or model number of the items

Face-to-Face Encounters

As of April 13, 2022, the five orthotic HCPCS codes identified for prior authorization are required to have a WOPD as a condition of payment. However, providing a copy of your order with your prior authorization request also is required—which by default means that you had a WOPD on file.

• Signature of the treating practitioner (they don’t need to date the order when they sign, but a signature is required).

REIMBURSEMENT PAGE ImagesGettyIMAGE: 16 SEPTEMBER 2022 | O&P ALMANAC

WOPDs

In addition, with the WOPD, the treating practitioner must document and communicate to you, the supplier, that they have had a face-to-face encounter with the patient within the six months before the date on the written order.

The following five orthotic Health Care Common Procedure Coding System codes were added to Medicare prior authorization Jan. 22, 2022: L0648: Lumboacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacro coccygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0650: Lumbosacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L1832: Knee orthosis, adjustable knee joints (uni centric or polycentric), positional orthosis, rigid sup port, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1833: Knee orthosis, adjustable knee joints (uni centric or polycentric), positional orthosis, rigid support, prefabricated, off-the-shelf L1851: Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or poly centric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf.

• Identification of the patient/ beneficiary, such as their name or Medicare ID number

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The CGS announcement also makes mention that some prior authorizations are being nonaffirmed because medical necessity has not yet been established, primarily when the orthosis is being ordered for postsurgical care, i.e., the surgery has not yet taken place. If the brace is needed following surgery and the patient will remain an inpatient in the hospital, don’t forget the brace would then be the hospital’s responsibility and you would not bill Medicare—so you would not need a prior authorization. If you are providing the brace following a surgery in an outpatient setting, or the patient is being dis charged after the surgery, you would then need to do a prior authorization request. However, you could not do it until the surgery has occurred because that is when the medical necessity is established. In these cases, you may consider using the ST modifier.

As we get closer to full implementation of prior authorization, make sure you are addressing and updating your policies and procedures to avoid some of these common reasons for nonaffirmed prior authorization requests. Devon Bernard is AOPA’s assistant director of coding and reimburse ment 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.

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REIMBURSEMENT PAGE 18 SEPTEMBER 2022 | O&P ALMANAC

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L1833, and L1851 on April 13, 2021. This means that a treating practitioner (medical doctor, doctor of osteopathic medicine, nurse practitioner, physician assistant, etc.) must have a face-to-face encounter, or an approved telehealth visit, with a beneficiary within the six months prior to completing the WOPD. What constitutes a valid face-to-face encounter? First, the encounter must occur within six months prior to the physician, or other eligible professional, writing the order. Second, the encounter must be used to gather both subjective and objective information associated with diagnosing, treating, or managing a clinical condition for which one of the orthoses is being ordered. Third, all subjective and objective findings and notes must be documented in the pertinent sections of the patient’s medical record. Finally, all of these notes must be properly dated and signed, as all medical record documentation must be signed/authenticated and dated by the person who made the entry, and the signature should be legible. If the treating physician or eligible practitioner that conducted the faceto-face encounter did not write the order for the orthosis, the ordering individual must verify that a qualifying face-to-face encounter occurred within the six months prior to the date of their order. Part of this verifica tion includes documentation of the qualifying face-to-face encounter. Missing, Conflicting, or Incomplete Information CGS provided two examples for non affirmative decisions for knee orthoses L1832, L1833, and L1851 relating to doc umentation: The documentation didn’t show or support that the patient has had a recent injury or a surgical procedure on the knee; and/or the documentation did not show an objective description of joint laxity for knee instability. These reasons are not surprising, as they reflect the results of recent Target, Probe, and Educate (TPE) audits by Noridian, the DME MAC for jurisdictions A and D. TPE audit results showed 93% and 63% error rates for select knee orthoses, including L1832, L1833, and L1851, and the pri mary reason for the errors was the medical record documentation did not demonstrate knee instability by examination of the beneficiary or an objective description of joint laxity. It is likely that these high error rates and prior authorization nonaffirmative responses are the result of the knee orthoses being used to treat osteoar thritic knees, where there may be a lack of measurable joint laxity. If you are using one of these select knee orthosis codes for these purposes, you may want to consider having the patient sign an advanced beneficiary notice. However, not all the nonaffirmative responses may be the result of pro viding braces to treat osteoarthritic knees, so we will review the policy requirements to provide the L1832, L1833, and L1851. These braces are covered under two specific instances:

• The patient has one of the qualified diagnoses, and also has had a recent surgery or injury to the knee, and it does not require an objective description of joint laxity. In such a case, be sure that documentation can show and point to a recent surgery or injury. There is no defined time limit in policy for what is considered recent, so it will be up to you to defend or prove that the injury or surgery was recent.

Whichever test is used, the test and the results must be mentioned in the record of the physician or other eligible practitioner.

• The patient has one of the required qualifying diagnoses, the patient is ambulatory, and there is an objective description of joint laxity. In these cases, you will want to be sure that it is documented that the patient is ambulatory, and that some type of objective testing for joint laxity has occurred and the results are placed in the record. The knee orthosis policy provides the examples of a varus/valgus test or an anterior/ posterior drawer test, but these are not the only types of tests that would be accepted. Some other acceptable tests may include the posterior sag (Godfrey’s) test, pivot shift test, apprehension (Fairbanks) test, as well as the Lachman’s test.

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The new Limb Loss and Preservation Registry provides a framework for O&P data analysis and evidence-based patient care

Building the Registry

By MICHAEL COLEMAN

This Just In Join the Registry O&P facilities are called to partic ipate in the newly launched Limb Loss and Preservation Registry. Learn more and join at www.llpregistry.org.

Kenton Kaufman, PhD, PE, a Mayo Clinic professor of biomedical engineering, professor of ortho pedics, and the W. Hall Wendel Jr.

Data Debut

OWNERS AND PRACTITIONERS at O&P facilities seeking big-picture information about the health outcomes of individuals with limb loss and limb difference are about to get some longawaited help. The first U.S. Limb Loss and Preservation Registry quietly launched in March but will soon get a big promotional push. The registry will help close a gaping hole in the O&P profession’s collective wisdom, which previously limited practitioners’ ability to review and assess current research in their quest to provide patients with the best evidence-based care. Before now, many of the available statistics were more than two decades old, and longi tudinal data had never been collected. That’s all about to change. The new registry, created and managed by the Mayo Clinic with $5 million in seed money from the National Institutes of Health (NIH) and the Department of Defense (DOD), offers O&P practitioners the first quality registry of data on those who have lost limbs, or struggled to preserve limbs, and their health outcomes with or without pros theses. The registry, which already contains data on 37,000 patients, compiles vital information about advances that make a difference in the care of people with limb loss and limb difference. If prosthetists and ortho tists embrace this new opportunity and provide the data necessary for the registry to flourish, its founders expect the amount of available data to grow by leaps and bounds in the coming years. Studies have shown that at least 1.7 million people—or one out of 190 Americans—are living with limb loss. That number is predicted to double by 2050.

ImagesGettyPHOTO: 20 SEPTEMBER 2022 | O&P ALMANAC

Michael Coleman is a contributing writer to O&P Almanac.

O&P ALMANAC | SEPTEMBER 2022 21

How It Works Danielle Melton, MD, a physiatrist at the Texas Health Science Center McGovern Medical School in Houston and a member of the panel that will unveil the registry at the National Assembly, has been pushing for its creation for years. “I have several amputee clinics, and I have a pretty large patient population, and a lot of what I have to do is justify medical necessity for prosthetic devices,” Melton says. “We think we know that we’re getting [patients] the right therapy and the right prosthetic device, and they’ll ultimately have better outcomes. But quite frankly, we don’t have the information to back that up. When we have peer-to-peer evaluations with medical directors of insurance companies, they’ll always ask for that information, and we can’t give it to them.”

for the indi viduals involved in caring for amputees to be united in a common goal that will benefit everyone,” Kaufman adds. “It’ll benefit the patients; it’ll benefit the providers; it’ll benefit the manu facturers; and it’ll benefit payors. Everybody benefits—we just need to participate.”Theimpetus for participation is clear. The registry will include hospital amputation data from U.S. adults and children, updates from O&P providers about the care patients receive, and information from patients about their outcomes. Within five years, the data will help patients and their providers better decide what choices to make based on a specific set of circum stances, with data analytics helping to predict each patient’s functional status. The hope is that the data will lead to breakthroughs not only in patient care, but prosthesis innovation. The registry will contain data about lower- and upper-extremity amputees, according to Kaufman: “Upper extremity is small in terms of volume, but large in terms of impact.”Theregistry also may provide information that will lead to payors approving devices that might other wise be rejected because of a lack of information about their necessity and effectiveness. In addition, researchers studying diseases and conditions that contribute to limb loss, such as vascular disease and diabetes, will have access to the registry.

The NIH and DOD are funding the registry’s creation and its first five years of operation, and there is no per-patient cost to enroll patients. Kaufman, Melton, and other registry advocates encourage O&P care providers to enroll all of their relevant patients. After five years, O&P providers will need to pay for a subscription to cover the registry’s costs. “The more partici pants we have, the more information we have, and the more valuable the data,” Kaufman explains, adding that, ultimately, the cost to O&P providers will depend on the number of partici pants in the registry. “Obviously, if we can spread it over a large number, the costs will be low.”

“We’ve been talking about evidencebased care for well over a decade, and this registry is the best way to get evidence to support the care that’s provided because we can now aggre gate large volumes of data,” Kaufman says. “With large volumes of data, you can see trends. We have [information about] components that are used, but there’s very little evidence to support what’s being used or the plans used to provide care, or even the amputations that are “Thisperformed.isanopportunity

Jeffrey Brandt, CPO, founder of Ability Prosthetics and Orthotics, says the registry, if widely adopted by O&P clinics around the country, can help transform the industry.

“My belief is that this will start to provide, once we translate the infor mation in the registry, a framework for true evidence-based care in clinical practice,” says Brandt, who also is on the panel at the Assembly. “It’ll give a clearer understanding of our impact as providers and give us an opportunity to really show that what we do for patients has a valuable impact.”

Musculoskeletal Research Professor, was the driving force behind the new registry. He will join a panel of experts to discuss this major industry breakthrough at the 2022 AOPA National Assembly in San Antonio. Kaufman describes the new registry as a “lightning strike” for the industry.

Eric Mollaret, a transfemoral amputee and recipient of the OPRA™ Implant System, enjoys the ordinary, simple and everyday freedoms that many take for granted.

As implant options expand, prosthetists should prepare to see osseointegrationhavepatientsmorewhoundergone

22 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

By CHRISTINE UMBRELL

Connections

• Approximately 2,000 individuals worldwide, and 500 who live in the United States, have undergone osseointegration (OI) surgery to attach a prosthesis via implant.

MORE THAN 500 individuals with limb loss residing in the United States have undergone osseointegra tion (OI) surgery to achieve direct skeletal attachment of a prosthesis to their residual limb via implant, accord ing to estimates from the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). This number is expected to increase at a fast pace as more implants receive recognition by the Food and Drug Administration (FDA). As awareness of and demand for OI grows, more prosthetists will need to effectively treat this patient population.

The procedure can be both lifechanging and transformative for a segment of the limb loss population, many of whom cannot comfortably wear sockets. “We are reestablishing a person’s normal gait symmetry, instead of accommodating a person’s loss of a limb,” explains Jason Stoneback, MD, chief of the Orthopedic Trauma and Fracture Surgery Service and director of the University of Colorado Hospital Limb Restoration Osseointegration Team.Stoneback has performed more than 60 primary OI surgeries and more than 100 OI-related surgeries as part of a multidisciplinary team at the University of Colorado over the past five years, and he has watched most patients return to a more normal gait using a prosthesis without a socket. He explains it this way: “A high-level trans femoral amputee typically gets flexion contractures and abduction contrac tures” when using a traditional socket, because using a socket “is not a normal way for a person to hold their limb,” Stoneback says. Prosthetists typically make a socket “to fit over the deformity to allow that person to bear weight.”

NEED TO KNOW

• The OI market is expected to expand in the United States: The OPRA Implant system received FDA approval for individuals with transfemoral amputation in late 2020; the VA began offering the OPRA system for some patients in January 2022; and several other implants are currently in FDA trials and expected to hit the market soon.

• Only 0.03% of the limb loss population currently has implants—so prosthetists will continue to design socket-suspended prostheses for the vast majority of their patients.

• OI is not for everyone, but it can be life-changing for a segment of the limb loss population, including some for whom sockets are problematic.

IntegrumPHOTO:

• Successful OI journeys rely on a multidisciplinary team approach—the surgical team focuses on the implant and stoma, while the prosthetist fits, aligns, and maintains every component from the abutment distally.

O&P ALMANAC | SEPTEMBER 2022 23 COVER STORY

Benefits and Limitations

OI made its American debut in late 2013, when a nurse from the Las Vegas area became the first patient to undergo OI surgery in the United States. For the next several years, the procedures were limited due to FDA device restrictions. Many early surgeries were performed as part of clinical trials approved by are expected to hit the market soon. Of course, many U.S. patients continue to undergo OI surgeries via HDE and by travelingStonebackoverseas.regularly performs surgeries with press-fit implants under the FDA custom device exemption and with the OPRA implant under FDA’s full market approval for trans femoral patients. “I do both so I can offer the best option for each patient, depending on their anatomy,” he says. His team also sees patients suffering from complications from OI surgeries initially performed elsewhere within the U.S. and abroad, including patients with infections or soft tissue issues. “As our team has gained more experience, we have developed the ability to take on extremely complicated cases,” including individuals who need bone-grafting or lengthening procedures before OI.

MDStoneback,JasonPHOTOS: 24 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

Two types of implant devices can be used in OI procedures. Screw-fixation implants utilize a threaded cylindrical design and are applied through a two-stage surgery. Press-fit implants are similar to common artificial knee and hip joints and can be performed in a single-stage surgery.

Jason Stoneback, MD

Stoneback meets with a transfemoral patient after his osseointegration surgery.

Stoneback and his team at University of Colorado evaluate a transfemoral OI patient.

the FDA through an Investigational Device Exemption to collect safety and effectiveness data. Some other patients received OI surgeries under the Humanitarian Device Exemption (HDE) that allows medical devices that are not otherwise FDA-approved for marketing to be used in limited circum stances without requiring evidence of effectiveness. In addition, more than 200 Americans traveled to Australia or European countries to have the procedure.ButOIis gaining in popularity, and the market is “about to explode in the United States,” according to Jeffrey Cain, MD, a family doctor at the University of Colorado and an Amputee Coalition board member who has OI implants in both legs.

With osseointegration, “instead of accommodating a deformity, we underaccommodate it to stretch out contractures and reestablish normal anatomic alignment,” Stoneback explains. “We’re reharnessing their normal skeletal alignment and making them bionic—returning them to a normalized symmetric gait pattern.”

In late 2020, the FDA approved the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA™) Implant System, a screw-fit device, for individuals with above-knee ampu tation. In January 2022, the Veterans Health Administration began offering the OPRA Implant System for use in some patients with transfemoral ampu tation—for example, those who have experienced amputation due to trauma or cancer and for those who have or are anticipated to have rehabilitation problems with a socket-suspended prosthesis. Currently, several other press-fit implants are in FDA trials and

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OI offers several advantages for the individuals who qualify for the procedure, according to Christopher Hoyt, CP, director of osseointegration at Rise Prosthetics and lead prosthetist on the University of Colorado Hospital Limb Restoration Osseointegration Team. Those bene fits include “optimal skeletal control, anatomical alignment, repeatability in donning, and zero pistoning—goals we strive for in every socket fitting but cannot always achieve,” Hoyt says. Additional advantages may include no range-of-motion limitation, sitting/ Jeffrey Cain, MD cycling comfort, more natural heat dissipation, elimination of friction and perspiration issues, ability to wear a shower prosthesis to wash and maintain stoma hygiene, and elimina tion of follow-up appointments due to limb volume changes, says Hoyt. In addition, most OI patients gain osseoperception—where the prosthesis “feels” more like part of the body, aiding in proprioception and balance. For above-knee patients, “studies have shown patients with OI wear their prostheses longer, walk further, and use less energy compared to traditional sockets, because OI improves biome chanics and allows use of hip muscles in a more anatomic way,” says Cain.

While OI is a viable solution for some limb loss patients, it’s not for everyone. Prosthetists should under stand who might be—and who won’t be—a good candidate.

• In an earlier study, a research team at OGA studied a cohort of 10 patients with diabetes who underwent osseointegration, six of whom relied on a wheelchair before OI. “Any surgery for a diabetic is risky and OI is no different; these patients are not free of complications, but they are all doing very well, living full active, mobile lives,” except for one subject who died for unrelated reasons, says Nikki Grace-Strader, director of North American operations at OGA. “The improved quality of life and mobility may also in turn provide a protective effect against their underlying diabetic conditions.” The study was conducted in 2017 and is available at https://doi. org/10.1016/j.apmr.2017.08.025

While still in its infancy, osseointegration—and its advantages—are starting to be documented:

So why is OI such an important advancement?

• Researchers at the Osseointegration Research Center at the University of Colorado Hospital recently conducted a case series study of four patients with lower-limb amputation who were scheduled to undergo unilateral transfemoral prosthesis osseointegration (OI). Each patient received a press-fit implant that was implanted by the same surgeon, Jason Stoneback, MD, in two stages. At 12 months post-OI, Stoneback’s team found that, compared to baseline with socket prostheses, patients with osseointegrated prostheses demonstrated reduced lateral trunk bending, pelvic obliquity, and rotation toward the amputated limb during the standto-sit task. This was accompanied by increased amputated limb hip ﬂexor, abductor, and rotator muscle forces. In other words, improved lumbopelvic movement patterns and stabilizing muscle forces when using an osseointegrated prosthesis indicate that the implanted prosthesis type likely reduces the risk of the development and/or progression of overuse injuries, such as low back pain and osteoarthritis. The researchers attributed the increased muscle hip muscle forces to the increased load transmission between the osseointegrated prosthesis and residual limb. The study was published in August in Clinical Biomechanics

• An April 2022 study by researchers at the University of Sydney and the Osseointegration Group of Australia (OGA) analyzed outcomes of 93 patients with transfemoral amputation and press-fit osseointegrated prostheses treated in several facil ities worldwide. The researchers found that all 93 patients continue to use their OI-attached prosthesis, with outcome measures indicating significant improvements—although several adverse events, including 19 implant revisions, eight periprosthetic fractures, and 43 surgical debridements, were reported. Results were published in Orthopaedic Proceedings from the British Limb Reconstruction Society Annual Meeting.

The Right Candidate

• In a study published in June in European Journal of Trauma and Emergency Surgery, researchers conducted a retrospective comprehensive analysis between February 2017 and December 2018 of 36 patients with socket-suspended prostheses and 33 patients treated with transcutaneous osseointegrated pros thetic systems. They concluded that the OI patients showed “significantly higher scores for mobility and satisfaction.”

26 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

Research Demonstrates Benefits of Osseointegration

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Cain's X-rays postosseointegration, and showing alignment

Cain traveled to Australia nearly six years ago for OI surgery on both legs.

“Patients that stand to benefit most from OI are those with challenging residual limbs, such as short transfem oral limbs, large-volume limbs where skeletal control is poor, and limbs that cannot tolerate a socket interface due to poor skin integrity or partic ular nerve conditions,” says Hoyt. “If a patient goes to a prosthetist who creates a well-fitting socket, and the patient continues to have problems wearing a prosthesis, then that patient may be a candidate for OI.” But before moving forward with OI, “multiple other health and psychological-related factors should be considered”—which is why patients at University of Colorado work closely with a multidis ciplinary team before being approved forAmputeessurgery. with extremely short residual limbs, patients who weigh more than 275 pounds, and patients involved in high-impact activities are not good candidates for OI, according to Hoyt. “We highly recommend that high-impact activities be discouraged” after OI surgery, due to risk of fracture. “Patients will need to be able to accept some limits if they are going to be good candidates for implant procedures,” adds Cain who says that patients are advised to avoid hightorque, high-impact activities, such as running or Candidatesskiing.also should understand all of the risks associated with the surgery, which may include skin penetration, site/stoma pain, periimplant fractures, infection, breakage, risk of need for removal, and more, says Stoneback. And some people with certain medical conditions simply cannot handle the surgery. “We are still in the stages of figuring out what medical conditions may prevent patients from having an optimal outcome,” Stoneback says.

O&P ALMANAC | SEPTEMBER 2022 27 COVER STORY

While silicone and gel liners allow a little room for play, “OI alignment is even more critical than with traditional sockets. Even minor misalignment after OI can cause joint problems and pain,” says Cain. Hoyt agrees that dynamic alignment is key. As the prosthetist on University of Colorado’s multidisciplinary team, he works closely with both OI patients—who travel from all over the country—and their local prosthetists to ensure patients’ prosthetic needs are met. “The surgical team deals with the Hoyt uses FaceTime with a pros thetist to explain how to adjust and tighten bone-anchored prostheses.

Christopher Hoyt, CP implant and stoma, while the prosthe tist fits, aligns, and maintains every component from the abutment distally,” he explains.Presurgery, Hoyt often discusses current device options with the patient’s local prosthetist and ensures the patient arrives with components that will work well post-OI, such as a microprocessor knee and a foot with a torque absorber. Postsurgery, “the pros thetist’s role can now focus on dynamic alignment, optimal componentry, and maintenance,” rather than socket-fitting hand skills, he says. After completing the three-week intensive rehab period at University of Colorado postsurgery, patients typically return home using bilateral forearm crutches for another three to four weeks, says Hoyt. As patients become more proficient at walking postsurgery, local prosthetists “become dynamic alignment specialists.” Hoyt frequently uses FaceTime or calls patients’ local prosthetists to ensure an optimal continuum of care, and to discuss the maintenance and adjust ability of connectors for OI patients. While some prosthetists are nervous when seeing their first OI patients, treating these patients “is often easier than they expect,” he says. It’s important that prosthetists

Prosthetist Participation

Cain advises prosthetists inter ested in treating OI patients to do their homework now to prepare for the influx of patients that is coming. “If you are going to include care of patients post-OI,” he says, “you will need to take classes to learn the different methods of alignment and considerations for componentry.”

Similar to patients with socketsuspended prostheses, OI patients view their prosthetist as the go-to person for questions, concerns, and emergency adverse events, says Hoyt. “We are rare, long-term healthcare providers who take the time to listen, problem-solve, and make ourselves available at some of the craziest hours.”

As an OI patient, Cain says the direct bone connection now allows him to feel “every rub or tweak or toe-off from my prostheses. Componentry choice matters a lot, and it is important to include torque and shock absorption after OI.”

MDStoneback,JasonCP;Hoyt,ChristopherPHOTOS:

28 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

A patient who has undergone osseointegration at the University of Colorado engages in 3D motion capture analysis. understand componentry needs post-OI. One of the downsides of osseoperception is that some patients become hypersensitive, and may not be able to tolerate bumps and vibrations—particularly in the first few weeks postsurgery. Prosthetists should “choose optimal componentry that won’t aggravate those with enhanced osseoperception,” Hoyt says.

Prosthetists need to be educated on OI, says Cain. “Your patients are going to start asking about osseointegra tion,” he says. “You’ll need to be able to explain the implant surgery, who is a good candidate, and the potential risks and benefits.” Being fit with the appropriate pros thesis post-OI is extremely important, says Cain, who notes that the prosthe tist’s contribution to the care team is often under-recognized.

“OI is not the right answer for every amputee,” says Grace-Strader, “but it should be an option—and ampu tees and clinicians should be able to make informed decisions.”

Jeffrey Cain, MD

30 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

Osseointegration may not be for everyone, but “it can be transformative for the right patients with lower-limb loss,” says Jeffrey Cain, MD, a family doctor at the University of Colorado who underwent the procedure on both legs nearly six years ago. After losing both lower limbs from an accident 25 years ago, Cain successfully used traditional prostheses with sockets for nearly two decades—but then nerve compression issues led to pain with his prosthetic devices that limited him to only a few minutes of standing or a block of walking. Seeking a solution, Cain spent two years consulting multiple prosthetists, ortho pedic surgeons, and rehabilitation physicians without success. He tested dozens of sockets and liners, tried different suspen sion systems, physical therapy, and nerve injections, and even acupuncture and Chinese herbs—all to no avail. Rather than resign himself to a life in a wheelchair, he complications—heosseointegration.discoveredAfterconductinghisownreviewofosseointegrationresearchandarisk/benefitanalysis,CaintraveledtoAustraliatoundergotheprocedurewiththeOsseointegrationGroupofAustralia(OGA).Hehadsingle-stagesurgerywithpress-fitimplants.Hissurgicalrecoveryincludedwasamong the 30% of patients who experience a skin infection and the 10% who develop a deep tissue infection and required surgical debridement, he says. But he eventually healed and was able to be fit with prostheses. How did Cain’s life change post-implant surgery? His wheel chair is now gathering dust. He is no longer in constant pain; no longer searches out a place to sit down every time he enters a room; doesn’t have to carry extra sleeves, liners, and lotion everywhere he goes; and with osseoperception can even “feel the snow crunch under my feet.” Like Cain, Nikki Grace-Strader, the 2022 Breece Fellow at the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) and director of North American opera tions at OGA, calls her osseointegration journey transformative. Grace-Strader, who also has a spinal cord injury, lost her leg above the knee six years ago. She was hopeful that her first traditional prosthesis would return her to full mobility—but that was not the case.

Patient Perspectives

“You need to have movement in the lumbar spine to use socket technology [effectively], and I don’t,” she says. Using a socket, she could manage a maximum of 2,000 steps on her best days—and strategi cally planned out each step to maximize her thanNow,changing,”thetoGrace-Straderlearningsomemovements.AfterconductingresearchandaboutOI,traveledAustraliatoundergoprocedureatOGA.“Itwaslife-shesays.shewalksmore5milesmostdays, which “wouldn’t have been possible without OI,” and takes part in other activities she had given up before her surgery. Since her OI procedure, she has spent a great deal of time with her prosthe tist, particularly because alignment is so critical with implants. “If I am a millimeter out of alignment, I feel it in my neck and teeth—it is like walking around with a rock in your shoe, or wearing shoes with different heel heights, and you are very sore by the end of the day,” Grace-Strader says. She also notes that, because she is more active, she needs to replace her prosthetic foot much more frequently—about once a year.

Grace-Strader recently took part in NAAOP’s Hill Day, visiting members of Congress to advo cate for the Medicare O&P Patient-Centered Care Act, S 2556/HB 1990—and dropping off one-page issue briefs to educate lawmakers about OI. “We just want to get everyone to start thinking about OI,” to set a foundation for the coming years when more consumers choose to undergo the procedure and will want health insurance companies to reimburse for implants.

Grace-StraderNikkiMD;Cain,JeffreyPHOTOS:

MADE IN US A www.coyote.us/kleenaire Made by Better FiltersEliminatesPriceOdorsAirborneParticles New Mini Kleenaire See you in San Antonio TX @ AOPA Booth 917 New Medical Grade Filter Reduces Spread of Viruses ®

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com

Hear More on OI at the Assembly Don’t miss the session “Osseointegration in the forStates—ProstheticUnitedImplicationsTodayandTomorrow,” which will take place Thursday, September 29, at 10:30 a.m. during the 2022 AOPA National Assembly. Jason Stoneback, MD; Christopher Hoyt, CP; and Jeffrey Cain, MD, will share updates on osseointegration and discuss the critically important role of the prosthetist in the success of the patient after osseointegration.

CPHoyt,ChristopherPHOTO: Christopher Hoyt, CP, works with a patient who has undergone OI.

32 SEPTEMBER 2022 | O&P ALMANAC COVER STORY

Hoyt and Stoneback can see a future where there are many more implant choices, and where patients who are not good candidates for sockets may receive an OI surgery as their primary amputation surgery—including individuals with very high transfemoral amputations and those with very large-tissue-volume residual limbs, as well as patients with transhumeral amputations. In the meantime, creating wellfitting sockets remains a priority for prosthetists. “Osseointegration in the U.S. is in its infancy, limited by the number of implants available as well as third-party payor reimbursement,” explains Hoyt. He estimates there are approximately 2,000 OI patients, in the world, “which is only 0.03% of the amputee population,” he says. “That means 99.97% of patients are still using sockets. That number will increase as we demonstrate that benefits outweigh the risks, but there will still be plenty of socket patients for prosthetists to see.

The Future of OI As OI gains ground in the United States, more people may be able to successfully use their prostheses. However, ensuring coverage by payors is challenging. “As pioneers in OI fitting, we must also be pioneers in billing/ reimbursement,” says Hoyt. “One would think that if the surgical procedure is covered by the insurer, then the specialized OI connector would be covered as well. Unfortunately, Medicare has approved some; denied others; and partially paid for the rest.” Hoyt also hopes that as more research regarding the safety of the proce dure is completed, more insurers will be willing to reimburse.

“Osseointegration is here to stay, but limited in the number of candidates,” Hoyt concludes. He encourages pros thetists to “focus on quality, intelligent design for your socket-suspended clients, and be knowledgeable and prepared to care for the OI patients you encounter.”

Your Everyday Ambulator Dynamic AFO Strut ® MADE IN US A www.coyote.us/dynamicstrut See you in San Antonio TX @ AOPA Booth 917

Intersection at the Exhibit Hall MEET THE EXHIBITORS, SPONSORS, AND SPECIAL EVENTS PLANNED FOR THE TRADE SHOW FLOOR DURING THE 2022 AOPA NATIONAL ASSEMBLY Assembly36 Sponsors Meet the exhibitors that have signed on as title sponsors for the 2022 AOPA National Assembly Exhibitor42 Directory Access a complete, alphabetical listing of the exhibitors and their booth numbers 34 SEPTEMBER 2022 | O&P ALMANAC

EXHIBIT HALL HOURS

WEDNESDAY September 28 5:30 – 7:30 p.m. THURSDAY September 29 9 a.m. – 6:30 p.m. FRIDAY September 30 9 a.m. – 2 p.m.

Wednesday, September 28 5:30 – 7:30 p.m.

O&P ALMANAC | SEPTEMBER 2022 35

Friday, September 30

The O&P Digital Care Showcase will debut at noon on Saturday, October 1. This new hands-on event computer-baseddemonstrates3D design software tools utilizing a provided prosthetic and/ or orthotic patient case, including the patient file, a 3D scan, and a positive model. Exhibitors will present a fabricated mold, device, or 3D print at the end of the showcase. In between visits to the trade show floor, you’ll be able to participate in top-notch education and learn about cutting-edge research in O&P—and really think about the future of the profession. Attend sessions in the Prosthetic, Orthotic, Pedorthic, Technical, and Business Tracks to hear the latest clinical break throughs and to soak in practical tips to run your business in a more efficient, safe, and patient-friendly manner. And don’t miss two new educational tracks this year: the O&P Digital Care Track and the Postmastectomy Track. With so many special events scheduled for this year’s in-person AOPA National Assembly, plan to set aside several hours to browse the Exhibit Hall aisles, meet with repre sentatives from exhibiting companies, and interact with like-minded O&P professionals from across the world. Keep these O&P Almanac pages handy as you navigate the conference.

THE EXHIBIT Hall at the 2022 AOPA National Assembly will host the largest gather ing of O&P professionals and stake holders in nearly three years. The Henry B. Gonzalez Convention Center in San Antonio is “the place to be” as clinicians, business owners, educators, researchers, manufacturers, and stake holders from across the O&P spectrum unite in person. Assembly-goers will appreciate the opportunity to navigate the trade show floor as they mingle and catch up with colleagues—while getting up-close-and-personal with the latest and greatest O&P products and visiting with representatives of manufacturing companies.

The Exhibit Hall at the AOPA National Assembly in San Antonio serves as the headquarters for O&P professionals seeking to experience the intersection of technology + humanity. Plan to spend plenty of time on the trade show floor September 28–October 1, browsing hundreds of exhibits and demonstrations. Meet up with old friends and forge new partnerships during the special events scheduled to take place on the Exhibit Hall floor throughout the Assembly. Don’t miss the Welcome to San Antonio Reception, scheduled for 5:30 p.m. on Wednesday, September 28. Attendees will enjoy refreshments, door prizes, and more, while supplies last. New this year, don’t miss the O&P Experience Zone on Thursday, September 29, beginning at 5 p.m. This unique event will feature patient success stories and demonstrations and will showcase how the certi fied prosthetist or orthotist and the O&P device work together to restore lives. This event will enable exhibi tors and caregivers to work together

Thursday, September 29 5 – 6:30 p.m.

Don’t Miss These Special Events in the Exhibit Hall

webEASY-TO-USEportal

Traditional BBQ Luncheon

WELCOME BACK!

MISS A SESSION? CAN’T MAKE IT TO SAN ANTONIO? That’s OK—if you miss a session you wanted to attend, or if you cannot travel to San Antonio for the AOPA National Assembly, AOPA will bring the education to you—virtually— starting October 17 and ending December 17. Learn on your own schedule! to create amazing outcomes. The O&P Experience Zone will be held in conjunction with a traditional Assembly happy hour, and is included with your full conference registration.

2022 EXHIBIT HALL

O&P Experience Zone Exhibitor Happy Hour

and

and Entertainment

Welcome to San Antonio Reception

SPONSORS PREVIEW THEIR EXHIBITS FOR THE AOPA NATIONAL ASSEMBLY

36 SEPTEMBER 2022 | O&P ALMANAC

Alps South Booth 628

Area of Specialty: Prosthetic liners and sleeves St. Petersburg, Florida easyliner.com

Title Sponsors

We will be showcasing the signifi cant value ALPS brings to the O&P community. Through research and innovation, cost-effective manu facturing strategies, and extreme production efficiency, we can design and deliver superior products for the least possible cost, providing maximum value to amputees, pros thetists, and orthotists worldwide. We are incredibly excited to be back at AOPA’s National Assembly in San Antonio this year. We look forward to speaking with all attendees and becoming stronger together.

2022

Area of Specialty: Lower- and upperlimb prosthetics and bracing and supports Foothill Ranch, California ossur.com/en-us Visit the Össur booth to preview the newly launched CTi3 knee brace, with enhanced construction carbon composite frames, an Accutrac® hinge that closely follows the knee’s anatomical movement, and elevated comfort with a balance of cushion and ventilation. You can also experience first-hand how Össur Solutions can help improve your clinical care and patient satisfaction, and grow your business.

Össur Americas Booth 528 & 522

Ottobock Booth 514

Area of Specialty: Full-service provider for prosthetic and orthotic products Austin, Texas ottobockus.com Ottobock has been pushing the boundaries of innovation for more than 100 years. As the O&P industry evolves, we continue to work alongside our customers to produce effective, innovative solutions for patients. From C-Leg to C-Brace, and every piece in between, innovation wouldn’t happen without you. This year, we’re honored to celebrate 25 years of C-Leg, which has led to over 100,000 users walking confidently thanks to Ottobock’s gamechanging microprocessor technology. Looking ahead to a digital future, Ottobock is paving the way for highly customizable, time-efficient solutions that support users wherever they go. We hope you’ll join us on this adven ture at the Assembly. SPONSOR DIAMOND SPONSORS

we’re Exhibiting DOUBLE DIAMOND

American Board for Certification in Orthotics, Prosthetics, and Pedorthics Booth 638 Area of Specialty: Certifying agency for orthotics, prosthetics, and pedorthics Alexandria, VA ABCop.org The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) will showcase the ABC certifying programs and the benefits these programs have on the profession. The Assembly marks the debut of ABC’s Career Awareness Initiative informing Gen Z of the benefits and rewards of an orthotic, prosthetic, and pedorthic career.

The Board of AccreditationCertification/(BOC)isexcited to reunite with practitioners in the O&P community at this year’s AOPA Assembly! On the Exhibit Hall floor, we’ll be sharing information about BOC credentials for businesses and professionals. We accredit O&P providers and mastectomy boutiques, as well as offer certifications for professionals who want to become orthotic and mastectomy fitters. With products that align with this year’s new Postmastectomy Care Track, BOC looks forward to being part of conversations that lead to enabling professionals to offer more complete care to their patients.

Board of AccreditationCertification/ Booth 1004 Area of Specialty: Accreditation for busi nesses and certification for professionals Owings Mills, Maryland bocusa.org

GOLD SPONSORS 2022 TITLE SPONSORS O&P ALMANAC | SEPTEMBER 2022 37

SILVER SPONSORS

PROTEOR Booth 332 Area of Specialty: Lower-limb prosthesis technology Tempe, Arizona proteorusa.com PROTEOR is excited to introduce the PROTEOR Quattro Microprocessor knee, the newest addition to our microprocessor portfolio. Expect more from your MPK—Quattro features patented valve technology, the lowest MPK build height, custom modes, water submersion rating, no service interval requirement, and customized stumble recovery resistances. Pair your Quattro with one of PROTEOR’s new vertical shock feet, Freedom ALLARD USA Booth 1008

2022 TITLE SPONSORS 38 SEPTEMBER 2022 | O&P ALMANAC

Area of Specialty: Orthotics and prosthetics Rockaway, NJ allardusa.com This year, Allard USA celebrated its 25th Jubilee of the ToeOFF®. The company is excited to be showcasing some innovative new Allard anklefoot orthoses (AFOs) as well as its new central fabrication line. Allard USA has extended its pediatric line with KiddieFLOW™ in response to clinician requests for a more flexible pediatric AFO. Allard’s SHORT line of AFOs includes updated strapping and MikroFIX™ as well as now being available in a BlueROCKER® SHORT version.Andfinally, on the prosthetic side of the business, Allard is happy to introduce the iFIT Transfemoral immediate-fit, adjustable socket, giving those with limb loss the mobility they deserve. Fillauer Booth 532 Area of Specialty: Prosthetics, orthotics, and fabrication equipment Chattanooga, Tennessee fillauer.com It will be like Christmas in September at the Fillauer booth! The Fillauer elves (engineering and production teams) have been super busy this past year, and their helpers are excited to show you all their new waterproof toys (prosthestic devices). Starting at the GOLD SPONSORS Shockwave or RUSH ROGUE 2. Other products in the MPC portfolio include the Kinnex 2.0 ankle, Plie 3 knee, and ALLUX 2 knee. We look forward to seeing everyone and showing you the advanced technology the extensive PROTEOR portfolio has to offer! Spinal Technology Inc. Booth 828 Area of Specialty: Spinal orthotics West Yarmouth, Massachusetts spinaltech.com It’s going to be hot in San Antonio, so stop by Booth 828 and cool off with some amazing giveaways. While you’re there, take advantage of our new S.T.O.P off-the-shelf brace pricing just for AOPA 2022. We also recently announced our new North American Preferred Partnership with Vorum, and our teams will be offering demonstra tions of their new Luma 3D Scanner at our booth. In addition to all that, we will have the latest samples on hand to discuss—and even information on the newest programs we are launching in 2023. Stop by for your sneak peek!

Cailor Fleming Insurance Booth 816 Area of Specialty: General and profes sional liability, property, healthcare, D&O insurance, and cyber coverages for the O&P industry as well as Medicare bonds Boardman, Ohio CailorFleming.com Cailor Fleming has been working with and supporting the O&P commu nity for more than 25 years. We are extremely proud to say that we have the exclusive endorsement of AOPA. Over the course of the past year, we released the all-new AOPA Affinity Health Plan. This year, we are pleased to bring back the Relaxation Station to San Antonio. Stop by the booth, chat with us, and register for your time to relax!

A game changer solution for foot drop The XTERN is the only dynamic AFO for foot drop totally affixed outside the shoe to maximize comfort, prevent skin breakdown and rubbing injuries to the foot. Its flexibility helps keep maximal ankle range of motion and calf muscle strength. turbomedusa.comUSA Think outside the shoe ® PDAC Validated (L1951) sleekLightweight,NoreturnAmazingdesignSymmetricalVersatileAdaptableenergyskincontactdesign

new innovative thermoformable transtibial definitive socket system that supports faster, easier, safer, and more environmentally sustain able fabrication. The XtremityTT Socket System can be heated, custom vacuum-formed, trimmed, and assembled in one hour. Attendees will have the opportunity to learn about the company and its tech nology from Maynard Carkhuff, Xtremity’s president and CEO; Board Chairman Bob Kerrey, a recipient of the Congressional Medal of Honor for heroism in combat; and other members of Xtremity’s leadership and sales team. Prosthetists can partici pate in interactive socket heating and molding demonstrations.

To order visit surestep.net or call 877.462.0711

SMO AFO INDY 2 STAGE

SILVER SPONSORS TITLE SPONSORS 2022 40 SEPTEMBER 2022 | O&P ALMANAC

O&P Almanac Registration Area Area of Specialty: O&P news and information Alexandria, Virginia op-almanac-magazineaopanet.org/publications/ AOPA and O&P Almanac staff look forward to connecting with Assembly attendees and learning what’s top-ofmind for today’s O&P professionals. The O&P Almanac booth will feature current and past issues of AOPA’s O&P Almanac magazine. Stop by to pick up a copy and learn about earning continuing educa tion credits by reading. This exceptional “orthosis within an orthosis” allows for the SMO to be locked into the AFO, or it can be easily removed to be used independently. This allows children to work through a variety of transitional skills without impeding normal muscle function.

See the difference the Indy 2 Stage can make! Watch the progress one patient made utilizing the versatility offered by the Indy 2 Stage. top of the list (body) is the new Motion Arm®, followed by the new small Taska™ Hand, the new, medium-sized JAWS, and the new Criterian Plus. At the foot of the list are the new Motion Foot SLX® and the new AllPro XTS. We look forward to seeing you in San Antonio … ho ho ho! Xtremity Booth 909 Area of Specialty: Thermoformable transtibial sockets Denver, Colorado xtremity.com Medical Creations Inc., doing busi ness as Xtremity, will showcase its

Our Providence® Nocturnal Scoliosis Brace provides positive patient outcomes Spinal.Tech/Outcomes 508 957 8287 Scan to see more positive outcomes In Brace (Supine)Out of Brace Visit us at BoothAOPA #828

On the following pages is a look at the companies exhibiting at the 2022 AOPA National Assembly. find company names, booth numbers, and website information for each exhibitor. Use this guide to get to know this year’s exhibitors and plan your visit to Exhibit Hall.

the

Exhibitors as of September 2, 2022 = New Exhibitor for 2022 Bold = Member of AOPA  2PD Limited Booth: 1232 2pd.co.uk  3D O&P Booth: 844 fikesbraceandlimb.com Acor Orthopaedic, LLC Booth: 937 acor.com Adapttech Booth: 1228 adapttech.eu  Booth:Adaract1224 adaract.com Aether Biomedical Booth: 545 aetherbiomedical.com AliMed Inc. Booth: 802 alimed.com



GOLD SPONSOR American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) Booth: 638 ABCop.org  American Breast Care Booth: 1022 americanbreastcare.com American Central Fabrication Booth: 925 CertifiedLimbandBrace.com American Prosthetic Components LLC Booth: 833 americanprostheticcomponents.com  Amoena USA Corp Booth: 807 amoena.com  Amparo Prosthetics Inc. Booth: 1024 amparo.world Amputee Coalition Booth: 944 amputee-coalition.org

You’ll

Exhibitor Directory 2022 42 SEPTEMBER 2022 | O&P ALMANAC

DOUBLE DIAMOND SPONSOR Alps South LLC Booth: 628 easyliner.com Alternative Prosthetic Services Inc. Booth: 232 alternativeprosthetics.com American Academy of Orthotists & Prosthetists (AAOP) Booth: 642 oandp.org

SILVER SPONSOR Allard USA Booth: 1008 allardusa.com AllClaim by Ottobock Booth: 423 shop.ottobock.us  Allied Plastics Supply Booth: 608 alliedoandpsupply.com

GOLD SPONSOR Board of Certification/Accreditation (BOC) Booth: 1004 bocusa.org  Booth:BrainRobotics1019 brainrobotics.com The Bremer Group Company Booth: 1015 bremergroup.com

Bulldog Tools Inc. Booth: 815 bulldogtools.com

 BioStep Inc. Booth: 1037 biosteportho.com

Apis Footwear Company Booth: 800 emeys.com

GOLD SPONSOR Cailor Fleming Insurance Booth: 816 cailorfleming.com

Cascade Orthopedic Supply LP Booth: 822 cascade-usa.com

CBS Medical Billing & Consulting LLC Booth: 804 cbsmedicalbilling.com Coapt LLC Booth: 801 coaptengineering.com College Park Industries Booth: 632 college-park.com

EXHIBITOR DIRECTORY O&P ALMANAC | SEPTEMBER 2022 43

Bionic Prosthetics & Orthotics Group Booth: 1220 bionicpo.com BioSculptor Corp. Booth: 1033 biosculptor.com

Aspen Medical Products Booth: 241 aspenmp.com Becker Orthopedic Appliance Co. Booth: 614 beckerorthopedic.com

Anodyne Booth: 927 anodyneshoes.com

BLUEWAVE Technologies Inc. Booth: 1039 clinic.mybluewave.com

ARTech Laboratory Inc. Booth: 1138 artechlab-prosthetics.com

 Blackfin Biomechatronics LLC Booth: 238 blackfinmt.com Blatchford Booth: 509 blatchfordus.com

OPAlmanac_September2022.indd 2 3/7/2022 11:37:59 AM

Comb O&P Booth: 932 combscan.com Comfort Products Inc. Booth: 335 comfortoandp.com Coyote Prosthetics & Orthotics Booth: 917 coyote.us Curbell Plastics Inc. Booth: 1117 curbellplastics.comoandp Cypress Adaptive LLC Booth: 1000 cypressadaptive.com  Danmar Products Inc. Booth: 1017 danmarproducts.com DAW Industries Inc. Booth: 722 daw-usa.com DJO is Now Enovis Booth: 1018 DrComfort.com DME MAC Medicare Contractors Booth: 840 cgsmedicare.com Drew Shoe Corp. Booth: 240 drewshoe.com  Elevate Dynamics Booth: 745 elevatemovement.com  Ethnocare Booth: 945 ethnocare.ca  Extremity Trauma and Amputation Center of Excellence (EACE) CFI Booth: 644 Centers-of-Excellence/EACEhttps://health.mil/Military-Health-Topics/ Fabtech Systems Booth: 1122 fabtechsystems.com

EXHIBITOR DIRECTORY 44 SEPTEMBER 2022 | O&P ALMANAC

Impulse Technology LLC Booth: 339 impulse-technology.com Infinite Biomedical Technologies Booth: 1216 i-biomed.com Integrum Inc. Booth: 741 integrum.se  International Booth:Prosthetic-OrthoticAfrican-AmericanCoalition(IAAPOC)641

SILVER SPONSOR Fillauer Booth: 532 fillauer.com FIOR & GENTZ GmbH Booth: 544 fior-gentz.us Booth:FIT360934 Fit360LTD.com FLO-TECH® Orthotic & Prosthetic Systems Inc. Booth: 1115 1800flo-tech.com  Booth:Formlabs1038 formlabs.comindustriesmedical Friddle’s Orthopedic Appliances Inc. Booth: 916 friddles.com Glaze Booth:Prosthetics645 glazeprosthetics.com Grace Prosthetic Fabrication Inc. Booth: 805 gpfinc.com Hanger Inc. Booth: 905 hanger.com HP 3D Printing Booth: 1036 industriesorthotics-prosthetics.htmlhp.comus-enprinters3d-printers

iaapoc.org  International Institute of Orthotics and Booth:Prosthetics736 iiofoandp.org Invent Medical USA LLC Booth: 838 inventmedical.com ISPO Booth:Mexico1134 ispomexico.org  JF Enterprises Inc., Celia Ruiz Booth: 1116 celiaruizusa.com Kinetic Research Inc. Booth: 701 KineticResearch.com KISS Technologies LLC Booth: 539 kiss-suspension.com Knit-Rite Inc. Booth: 504 knitrite.com  Koalaa Ltd. Booth: 940 yourkoalaa.com LaunchPad O&P Booth: 819 launchpad-op.com Life-Like Laboratory Booth: 743 lifelikelab.com Limbs for Life Foundation Booth: 1118 limbsforlife.org Lindhe Xtend Inc. Booth: 234 lindhextend.com  Lubrizol 3D Printing Solutions Booth: 744 HealthcareOrthotics-and-Prostheticslubrizol.com3D-PrintingMarkets MD Orthopaedics Booth: 821 mdorthopaedics.com

npdevices.com THE CONDUCTIVE TIP IS A VAILABLE ON ALL DEVICES. Naked Prosthetics now oﬀers four ﬁnger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger. Nick wears four MCPDrivers.© 2022 Naked Prosthetics All Rights Reserved.

Össur Americas Inc. Booth: 528 & 522 ossur.com/en-us

DIAMOND SPONSOR

Ottobock Booth: 514 shop.ottobock.us  Ovation Medical Booth: 242 ovationmed.com Paceline Inc. Booth: 809 paceline.com PEL Booth: 832 pelservice.com  Penta Medical Recycling Booth: 1136 pentaprosthetics.org PLS Pedorthic Lab Specialty Booth: 939 pedorthiclab.com PMT Booth:Corp.904 pmtcorp.com  PodoPrinter BV Booth: 842 podoprinter.com Point Designs Booth: 1214 pointdesignsllc.com GOLD SPONSOR PROTEOR Booth: 332 proteorusa.com Protosthetics Booth: 1034 protosthetics.com  Prudential Billing & Consulting Booth: 742 prudentialbilling.org PSYONIC Inc. Booth: 1127 psyonic.io

Monetek LLC Booth: 922 monetek.com Naked Prosthetics Booth: 901 npdevices.com National Commission on Orthotics & Prosthetics (NCOPE) Booth: 640 ncope.org  Neuros Medical Booth: 1119 neurosmedical.com

Mecuris GmbH Booth: 1132 mecuris.comen Medex International Inc. Booth: 1128 medexinternational.com Mile High Orthopedics Lab Booth: 1044 milehighorthoticslab.com

New Step Orthotic Lab Inc. Booth: 914 newsteporthotics.com Nymbl Systems Booth: 734 nymbl.healthcare.com

OP Solutions Booth: 541 opsolutions.us OPAF and The First Clinics Booth: 436 opaffirstclinics.org Open Bionics Booth: 345 openbionics.com OPIE Software Booth: 716 opie.software Orfit Industries America Booth: 1026 orfit.com  Orthobroker BV Booth: 338 orthobroker.com Orthofeet Inc. Booth: 1125 orthofeet.com Orthomerica Products Inc. Booth: 810 orthomerica.com Orthotic & Prosthetic Group of America (OPGA) Booth: 728 opga.com Orthotic Holdings OHI Booth: 434 ohi.net Osseointegration Group of Australia Booth: 337 osseointegration.org  OssKin Ortho Inc. Booth: 442 osskin.com

DIAMOND SPONSOR

SILVER SPONSOR O&P Almanac Registration Area O&PAOPAnet.orgEDGE/Amplitude Booth: 843 opedge.com  O&P Insight (DBA Prosthetic Center of Excellence) Booth: 920 oandpinsight.com and lvbionics.com O&P1 Booth: 440 oandp1.com

EXHIBITOR DIRECTORY 46 SEPTEMBER 2022 | O&P ALMANAC

info@cypressadaptive.com888-715-8003 An Extension of Yourself One Valve Does It ALL! MADE IN THE USA Upper Limb Pediatric Below Knee Above Knee Compact, Low Profile Auto-Expulsion Valve for Upper and Lower Limb Applications Part Nr./Ref: CA100-MV Aria™ UniversalMiniValve Removable Insert Allows for Limb Assessment and Pull-in Donning

GOLD SPONSOR Spinal Technology Inc. Booth: 828 spinaltech.com SPS Booth: 508 spsco.com ST&G USA Corp. Booth: 906 stngco.com SteeperUSA Booth: 700 steeperusa.com

EXHIBITOR DIRECTORY 48 SEPTEMBER 2022 | O&P ALMANAC

PVA Med Booth: 936 pvamed.net  Quantum Medical Supply Booth: 943 nocostshoes.com  Booth:QuickFoot1226 quickfoot.co  Radii Devices Ltd. Booth: 941 radiidevices.com rcai Booth: 1114 rcai.com Renia GmbH Booth: 438 renia.com Booth:Roboticom342 roboticom.us Rodin 4D Booth: 837 rodin4d.com Royal Knit Inc. Booth: 923 royalknit.com  SPENTYS Booth: 1121 SPENTYS.com

 Booth:Step-On-Hellas643 step-on.net Steps of Faith Foundation Booth: 1133 stepsoffaithfoundation.org Surestep Booth: 710 surestep.net Taika3D Inc. Booth: 938 taika3d.com  TalarMade Ltd. Booth: 341 talarmade.com Tamarack Habilitation Technologies Inc. Booth: 1016 tamarackhti.com Techmed 3D Inc. Booth: 1035 techmed3d.com  Texas Department of Licensing And Regulation (TDLR) Booth: 902 tdlr.texas.gov  Texas Society Of Orthotic And Prosthetic Professionals (TXSOPP) Booth: 900 txsop.orghome.html Thermo-Ply Inc. Booth: 738 thermoplygel.com  Thrive Orthopedics Booth: 845 thriveorthopedics.com Tillges Technologies Booth: 637 tillgestechnologies.com  Titan O&P Fabrications Booth: 921 titanopfab.com Top Shelf Orthopedics Booth: 935 topshelforthopedics.com Thuasne USA/Townsend Design Booth: 604 thuasneusa.com Trend Booth:Medical343 trend-med.com  TriOx Innovations LLC Booth: 244 cleanwithross.com Turbomed Orthotics Inc. Booth: 703 turbomedorthotics.com Ultraflex Booth: 1218 ultraflexsystems.com  Unlimited Tomorrow Booth: 610 unlimitedtomorrow.com  Victoria Hand Project Booth: 1040 victoriahandproject.com Booth:VNTC 239 vntc.me Vorum Booth: 928 vorum.com Waystar Booth: 841 waystar.com WillowWood Booth: 538 willowwood.com SILVER SPONSOR  Xtremity Booth: 909 xtremity.com

1236 West Southern Avenue #101, Tempe, AZ 85282 • #HumanFirst855.450.7300shop.proteorusa.com Denise Hoffmann An Entirely NEW Walking Experience VERTICAL SHOCK FOOT

O&P companies early this year, “and there has been an agreement that we need to have an organized effort at the state level to understand what is going on in government, and to have an ear and voice to help our patients to receive appropriate care for their disabilities,” he says. “Everyone thought it was a good idea, but no one had the time or energy to set this up. At the end of the day, my skills and position allow me to bring people together—but not being a Colorado resident, the next step [was organizing] a group of regis tered Colorado voters to go forward.”

“I have seen it in the past, and these issues and problems that we had to deal with are following history.” Understanding these patterns, “we felt that we needed to be proactive and have a voice for our profession in the state.” He began talking to other Colorado

50 SEPTEMBER 2022 | O&P ALMANAC

O&P ADVOCATE

The result is the newly formed Rocky Mountain Orthotic & Prosthetic Coalition (RMOPC), whose mission is to serve people with disabilities and limb differences with prosthetic and orthotic care. RMOPC also seeks to serve as an advocate for the limb loss population, and to help demonstrate that this population is a productive group in the workforce community. “For this coalition, we need to include the people that we serve, the disabled population, and not just look at their physical disability but also improve their mental well-being,” Matsushima says. RMOPC will hold its inaugural meeting this month in Denver.

Glenn Matsushima, CPO, FAAOP, helped launch a state-level O&P group to advocate on behalf of patients and the profession

ADVOCACY SHOULD BE “BASED on the people who use our devices.”

Matsushima, a clinician and O&P business owner based out of California, has distinguished himself as an O&P advocate ready to do the work to help fight for fair reimbursement for

Corralling SupportersColorado

The O&P Advocate column focuses on individuals who go above and beyond to advocate on behalf of the O&P profession. Here, you will get to know colleagues and O&P stakeholders who champion issues of importance to O&P practitioners, business owners, and patients, and who foster relationships with decision makers to ensure equi table access for individuals with limb loss and limb impairment.

O&P consumers. Owner at Prosthetic & Orthotic Group (P&O Group) in California and Agile Orthopedics in Colorado, Matsushima also is involved in OPNN—Orthotic Prosthetic National Network. His broad range of work frequently alerts him to mat ters of concern to both clinicians and patients—and sparked his involvement in launching a state-level organization for O&P stakeholders in Colorado. Creating a Coalition Matsushima recently identified a growing need for a unified O&P voice in Colorado, where he says demand for O&P care is increasing. In working closely with clinicians in Colorado to navigate reimbursement challenges, he felt a pull to aggregate O&P voices. “With the [O&P patient popula tion] growth in Colorado, the issues of this exponential population are very similar to what happened in Southern California 10 to 15 years ago,” he says.

So says Glenn Matsushima, CPO, FAAOP, who has played a pivotal role in leading efforts to ensure quality care for orthotic and prosthetic consumers in Colorado. He believes O&P professionals should advocate on behalf of their patients— rather than their devices—“because we treat the person and are concerned with both their physical and mental health.”

Matsushima teamed with Kristen Thessing, CPO, at Cranial Kids in Colorado Springs in the effort, assisted by AOPA staff. Several local and state O&P companies worked together to write a position paper to present to the Medicaid management company.

Fighting for Change

Matsushima has had a long history in O&P and in advocating on behalf of the profession and his patients. He began his career several decades ago, after initially planning to work in physical therapy. During his undergraduate studies, he began working with people with disabilities and was exposed to O&P—sparking his decision to pursue O&P studies. Matsushima completed the O&P program at California State University of Dominguez Hills in 1984 and has enjoyed working in the field ever since.

Matsushima loves all the tech nological advances in the field and integrates CAD 3D design whenever he can. Over the years, he has specialized in upper-extremity prosthetics, sco liosis orthoses, and cranial remolding orthoses. He also has been on the committees of many O&P organizations, including committees of AOPA; the American Board for Certification for Orthotics, Prosthetics, and Pedorthics; the National Commission on Orthotic and Prosthetic Education; and multiple manufacturer boards. He has played important roles in the O&P PAC and the AOPA L-Code Committee, and he has traveled to Washington, DC, to take part in the AOPA Policy Forum. In another significant advocacy undertaking, Matsushima has helped the O&P community in Colorado, with the assistance of AOPA, address reim bursement problems related to cranial remolding orthoses. A few months ago, Medicaid unilaterally reduced the reim bursement by 45%, he explains. “This was overturned with the help of AOPA,” he recalls, “but if we [hadn’t fought], this it would have been detrimental to patients with cranial deformities.”

One Step at a Time When he is not at work or assisting in O&P advocacy, Matsushima enjoys surfing and spending time with his wife and five children in California. He enjoys downtime im Colorado in addition to his home state. “I am an ocean guy. If Colorado had a beach with waves, I would live there.”

O&P ALMANAC | SEPTEMBER 2022 51

O&P ADVOCATE

As a result, the cranial remolding policy was overturned—a win for O&P patients as well as the profession.

Future advocacy goals include working with the Colorado group to identify pain points with the state and to aggregate information related to state government plans. Along the way, he will take advocacy one step at a time: “It is very hard to change the world,” says Matsushima, “but to start, if we can change just a little part of the world for the better, things can get done.”

Complicated Cases

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

MEMBER SPOTLIGHT

The facility works with a local amputee support group and spon sors events such as baseball games. Its marketing efforts include word of mouth and nurturing relationships with referral sources. Recently, Latham has ventured more into social media, noting that the younger population will read reviews and seek out information online.

ATTHEW BULOW, CP, who lost his leg to cancer at an early age, founded Bulow O&P Solutions in 2006 in Nashville, Tennessee. The practice expanded to other states, and in 2011, Bobby Latham, CP, and his office manager, Anna Wilson, launched a Bulow facility in West Columbia, South Carolina.Today, the South Carolina office has five employees, including Latham and Alex Hedquist, CPO; Wilson; a resident from Baylor University; and an intern from the University of South Carolina. The facility focuses on prosthetics, and its small size is a big benefit, according to Latham. “A lot of places pride themselves on get ting big,” he says. “We are just the opposite. We like a manageable size, where we can provide great care and a place for patients to feel at home.” Latham says his facility has become known for serving hardto-fit limb loss patients. One example is a recent patient who had suffered a motorcycle accident when he was 18 that resulted in a fused femur and crushed pelvis. “He had an 8-inch femur, but he couldn’t flex his hip, so we needed to treat him as if he had a hip disarticulation. We fit him with an Ottobock Helix hip and a C-leg, and after 18 years of using crutches, he is now walking everywhere,” reports Latham. This case, and others, have contributed to the facility’s reputation as effective with short above-knee amputations and hip disarticulations, he notes. “Another patient, Ky Sawyer, came to us with a traumatic below-knee amputation,” says Hedquist. Sawyer had been playing football his whole life, and after his injury in 2016, he wanted to return to playing with a prosthesis. “When we saw him, the residual limb was ulcerated and bleeding. After a series of fittings, he felt well enough to play semi-pro.” Hedquist incorporated a removable custom knee brace to increase Sawyer’s stability while playing, and because his insurance would not cover a sport leg, Hedquist designed a leg that was suitable for daily life as well as football. “Ky told us that the leg has survived two seasons of gridiron football, Olympic lifting seven days a

Bulow Orthotic & Prosthetic Solutions DEBORAH

South Carolina facility sees its fair share of patients with challenging amputations week, and chasing three kids around,” says Hedquist. “He said, ‘That’s more than three years of serious abuse— it’s the best socket I’ve ever had.’”

Underlying all their work is the joy in changing patients’ lives, says Hedquist. “We love taking com plicated cases and helping those patients achieve their goals.”

Latham and Hedquist build all devices in their lab. “We have no techs; we do it all ourselves,” Latham says. “If something is not exactly right with the alignment, we can collaborate on small changes in fab to really dial it in.” He does not typ ically use scanning and CAD/CAM, saying, “We do most sockets by hand—it gives us the most control.”

52 SEPTEMBER 2022 | O&P ALMANAC

SolutionsProsthetic&OrthoticBulowPHOTOS:

While Bulow headquarters in Nashville assists with securing insurance and supplier contracts and handles accounts receivable, the South Carolina office handles its own marketing and all aspects of patient care. The facility recently expanded into a 2,800-square-foot space with three patient rooms, 22-foot parallel bars, stairs, a treadmill, and a fabrication lab.

The practice is committed to education, regularly hosting interns from the University of South Carolina and residents from Baylor University. “Over the last five years, two of our interns went on to prosthetic school, and one is finishing his residency,” says Hedquist. “We enjoy teaching the next generation of clinicians, and we’ve trained 16 students so far.”

FACILITY: Bulow Orthotic & Prosthetic Solutions LOCATION: West SouthColumbia,Carolina

In a state-of-the-art lab, Alex Hedquist, CPO, makes minor adjustments to a patient’s socket.

Bulow South Carolina utilizes many different tools—like the BOA dial—to manage hardto-fit patients. Patients Jay and Victor show off their new hip disarticu lation prostheses.

CONN M

OWNER: Matthew Bulow, CP HISTORY: 12 years

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JOINT ACTIVE SYSTEMS, or JAS, was founded by Boris Bonutti and his brother, Peter Bonutti, MD, an orthopedic sur geon. Peter noted that his patients’ recovery was often limited by the number and frequency of physical therapy sessions permitted and the devices available for home use in theAccording1980s. to Boris Bonutti, president of the company, his brother believed the best model to increase range of motion was manual stretching performed by therapists. “He wanted to mimic the mechanical forces of manual traction, so he began working with therapists, orthotists, design engi neers, and physicians to develop a device that mimics those loading conditions,” says Bonutti. “Patients were recommended a protocol that used the device three times a day to provide static progressive stretch.”

Today, the company has 92 employees. It markets through 50 indepen dent distributors with more than 300 sales represen tatives across the United States and customers in 40 countries worldwide. JAS offers orthoses plus dynamic and SPS range-of-motion devices for major joints from the shoulder to toe. The company services a broad customer base, from orthotists to physicians, surgeons, and therapists treating range of motion. “JAS also has a very important diversification into direct patient care,” says Bonutti.

“JAS was founded on clinical research, and that hasn’t stopped,” adds Ed Coffin, vice president of sales and marketing. “We often collaborate with orthopedic and rehabilitation centers as well as O&P specialists. Currently, we have more than 30 published peer-reviewed clinical studies.” King anticipates increased use of 3D scanning and computeraided design and manufacturing as costs decrease. “We’re seeing improvement in the precision and accuracy of the software, which makes it more attractive to use,” he says. “We do use 3D printing now for prototyping any part of our operation.

JAS has a strong sense of community involvement, and it gives every employee eight hours annually to volunteer at community organizations and charities. “We’re also involved in a local high school program that allows seniors to participate in a company startup,” says Bonutti. “They produce a product, fabri cate it, and market it to learn how businesses are formed. And we fund other charity organizations, such as the annual holiday ‘Shop With a Cop’ program.” Bonutti and four others started a 501(c)(3) nonprofit that funnels donations to active-duty soldiers in the National Guard who are in need.

“Everyone at JAS takes pride in the ability to develop unique solutions for complex problems,” says Bonutti. “The one thing that is paramount is that we are always trying to improve the quality of life for our patients. We always have the patient’s outcome in mind.”

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

SUPERIOR DESIGN. PROVEN OUTCOMES. JASPRODUCTSKNEE LINES AVAILABLE: JAS SPS, JAS DYNAMIC, & JAS EZ JAS PRO/SUPJASMCPJASJASELBOWANKLE JAS TOE 54 SEPTEMBER 2022 | O&P ALMANAC

Bryan King, CPO, LPO, pro vides a full range of patient care at JAS facility located within a hospital-based orthopedic center. The National Commission for Orthotic and Prosthetic Education accredits the JAS facility as a residency site in addition to being accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics for both patient care and central fabrication. As the O&P world continues to use and refine technology, King expects a rise in smart tech that can collect functional data and monitor compliance, particularly as reimbursement increasingly requires outcome measure ments. “We are developing

Unique Solutions for Complex Problems

with a patient COMPANY: Joint Active Systems OWNER:

The first JAS product was an elbow orthosis, which was the subject of a prospective randomized study of 20 patients, published in 1994 in Clinical Orthopaedics and Related Research. “The results of the study showed an overwhelming improvement over conventional treatment options, which con vinced us we needed to make this available to the broader patient community,” says Bonutti. “We began to develop a complete line of products for major joints in the body. Our work began in a business incubator, and in 1998, we launched JAS as a separate corporation.”

SystemsActiveJointPHOTOS: MEMBER SPOTLIGHT Joint Active Systems By DEBORAH CONN

Company offers orthoses and products to improve consumers’ range of motion compliance monitors,” he says. “We’re field-testing apps where you can download data to smart phones. We want to streamline it so practitioners can access useful data that’s easy to understand.”

Bryan King, CPO, LPO, Boris Bonutti LOCATION: Effingham, Illinois 24 years www.jointactivesystems.comphone:800.879.0117fax:217.347.3384info@jointactivesystems.com

O&P ALMANAC | SEPTEMBER 2022 55

Join AOPA for the final AOPAversity webinar of 2022! As the year comes to an end, AOPA experts will highlight the updates and changes in potentialandfromreimbursement,policy,andcodingtheprevious12monthsprovideinsightsintochangesin2023.

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UPCOMING WEBINARS

Supplier Startup

NEW MEMBERS October ProstheticsClinicians’12Corner—

1 Madison Street, Ste. A4 East Rutherford, NJ 800/879-227607073-1605

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First Steps Prosthetics & Orthotics 9400 Lakeview Pkwy., Ste. 121 Rowlett, TX 214/501-405075088 firststepspando.com Sean Kim, CPO Patient-Care Facility J&J Artificial Limb & Brace 11411 W. Bernardo Court San Diego, CA 92127 858/613-0958 jandj.org Jason Freidman, CPO Patient-Care Facility Jameson Prosthetics 1407 Ashley River Road Charleston, SC 29407 Ben843/936-1642Jameson, CP Patient-Care Facility

November 9 The Do’s and Don’ts of Gift Giving Start preparing for the holiday season! When and how is it appropriate to give gifts to your patients and referral sources? This webinar reviews the rules surrounding gift giving and shares important steps to remain compliant.

JOIN AOPA EXPERTS for the most up-to-date information on specific topics during these onehour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to provide the most reliable business information and CE credits for your staff at a single office location. Visit education/monthly-webinarswww.AOPAnet.org/ for details and registration

Join AOPA for the final Clinicians’ Corner of 2022. Learn tips, tricks, and insights while earning scientific credits.

Signinformation.up now for expert guidance on hot topics—and start earning CE credits

AOPAversity Webinars

December 14 Year End Review & What Is Ahead

Bionic Skins LLC 10 Water Street, Ste. 410 Lebanon, NH Troy603/678-826003766Turner Supplier Startup BiomechatronicsBlackFin LLC 1635 Foxtrail Drive, Ste. 354 Loveland, CO 80538-9086 Clint970/440-3244Accinni Supplier Startup Ethnocare 191 Rue QuébecRichelieuQCG1R 4W3 418/934-5669Canada ethnocare.ca Louis-Philippe Garneau Supplier Startup

THE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Associ ation (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qual ifications and requirements of membership.

TriOx Innovations LLC 5140 Moundview Drive Red Wing, MN 55066-1100 Chris800/309-5431Shimek

Prosthetic ConsultationXpert 3000 Astoria Pines Circle Las Vegas, NV 89107-3223 Dale612/810-1100Berry,CP, LP, FAAOP Supplier Consultant Rogue Prosthetics LLC 1821 W. Frank Ave. Lufkin, TX BOCP,Sheri936/225-333975904-3105L.Hatt,BOCO,LPO Patient-Care Facility

biodynamictech.com Felix Garcia or Corey Ayer, CPO Patient-Care Facility VRAI Prosthetic Care 719 N. 2nd Street Longview, VA 75601 Edgar903/553-1040DeLaFuente, BOCP Patient-Care Facility

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The Becker GEO™ is a prefabricated, carbon-composite evaluation orthosis used to assess the benefit of an ankle-foot orthosis on ankle and knee stability. Please contact our customer service depart ment today for more information. Visit BeckerOrthopedic.com.

Boston Orthotics & Prosthetics eLearning Center is pleased to offer seven online courses. You can take advantage of this new training option from anywhere, including your home. With our new eLearning Center, you can stay connected with the most up-to-date technology and techniques with Boston O&P. Students, residents, certified orthotists, physical therapists, and other allied health professionals are welcome to register for our courses. CEUs are provided upon completion of the course. Questions? Contact Jim Wynne, CPO, FAAOP, at jwynne@bostonoandp.com

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ALPS' VIP is an air expul sion integrated pump for creating elevated vacuum in prosthetic sockets. The VIP stabilizes the residual limb, minimizing volume fluctu ation throughout the day, thereby reducing pistoning and increasing comfort. Top features and benefits include: Two (red)vacuuminterchangeablelevels:highandlow(green) battery hoses and preserves residual limb skin Provides better proprioception and socket stability. To learn more about ALPS’ VIP, visit www.easyliner.com or call 727/528-8566 or 800/574-5426.

Newly designed children’s foot orthotics feature semirigid extended heel cup in UCBL style for extra ankle control and support. The orthotic is covered with antimicrobial fabric top liner for effective moisture and odor control. They come in W width and sizes starting at T4-T13, Y1-Y6. Retail packaging and all sizes are in stock for immediate delivery. For free display samples, call 888/937-2747. Wholesale accounts only.

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In response to clinician requests for an orthosis with more foot plate flexibility, Allard USA has extended its pediatric AFO line with KiddieFLOW™. KiddieFLOW™ allows for better control of foot positioning in late swing, which aids in stability during stance. FLOW models offer increased range of motion in the sagittal plane and a smoother transi tion (flow) throughout the gait cycle. For more information, contact customer service at 888/678-6548 or info@allardusa.com and request your free Product Selection Guide!

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Coyote QUIK GLUE 50 cc or 220 cc. Now available in 30-, 60-, and 90-second set times.•Great for attaching componentry Multiple repair uses

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It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and pro tection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work.

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Freedom Kinnex 2.0 Microprocessor Ankle/Foot System by PROTEOR Designed for my real life...without compromise. The Kinnex 2.0 is the only MPA with all these features: • 30-degree ROM available in the first step • Full-length carbon fiber footplate for energy return • Split keel/heel for M/L terrain adaptation • Dynamic and manual locks • Heel height adjustment (barefoot to 2 in.) • Programming and patient apps (iOS and Android) • IP67 rated (full water submersion) • No service Forrequirement.intervalmoreinformation, visit FreedomKinnex.com. 58 SEPTEMBER 2022 | O&P ALMANAC

Mecuris is a digital services provider for O&P professionals. Mecuris translates traditional craftsmanship into an intuitiveto-use software that allows the creation of customized orthopedic devices flexibly online. The software is offered in a freemium model on the web-based Mecuris Solution Platform, helping clinics to streamline their business and optimize resources for the best patient care. See how to best combine traditional with digital work flows in a free webinar while earning CEUs in the process. For more information go to www.mecuris.com/en

CPO benefits: • Easier and faster fitting • Custom made to the patient • Thermoformable material for patientspecific customizations • Less patient visits are needed to achieve a good fitting result • Less effort for socket fit adaptations • Easy alignment optimization. User benefits: • Adjustable socket for limb volume variations • High wearing comfort • Secure hold in the socket with magnetic distal liner connection • Low product weight thanks to lightweight construction • Easy donning and doffing, even when seated • And more! Scan the QR code to learn more!

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The Propulsion® prepreg Partial Foot Prosthesis is engineered by our clinical orthotic and prosthetic practitioners for our own patients, so we’re positive that our dynamic, ultra lightweight, adjustable, and modular designs using cutting-edge carbonfiber materials will provide your patients with the stability, balance, and energy they need in every step. Propulsion braces are built for professionals, by professionals—gain better control and greater comfort. To learn more, visit TeamTillges.com or call us at 1-855-4TILTEC.

O&P ALMANAC | SEPTEMBER 2022 59

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The Xtern, a Life-Changing Solution for Foot Drop Patients by Turbomed Orthotics Say goodbye to your painful and stiff in-shoe orthosis! This revolu tionary brace, specifically designed for people suffering from foot drop, has one thing in mind: movement. The Xtern sits entirely outside the shoe (and, to add to that, to any shoe!), and is so flexible that it allows maximal range of motion and calf muscle strength. No more rubbing injuries or skin breakdowns: You’ll barely notice it’s there. Walking, running, mountain climbing, skiing? Not a problem!

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The Vista Ankle is a universal single-axis prosthetic ankle joint designed for elevated vacuum applications. The vacuum is generated from the ankle movements of plantarflexion and dorsiflexion during the gait cycle. The barb fitting for the vacuum hose con nection is located inside the proximal tube clamp of the ankle, protecting it from damage. The distal female pyramid adapter is compatible with a wide range of prosthetic feet. The Vista Ankle is cost effective, low maintenance, and lightweight (13 oz/385 g) and has a weight limit of 275 lbs/125 kg. For more information, contact us at www.cypressadaptive.com, 888/715-8003.

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60 SEPTEMBER 2022 | O&P ALMANAC

ProComp® Carbon Infused Polypropylene Composite Composite Material Science = Improved Fabrication Processing = Enhanced Clinical Performance ProComp® is produced in a high-pressure laminating process that infuses discontinuous carbon fiber into homopolymer propylene. The patented prepreg composite sheeting is compatible with standard drape-encapsulation or bubble vacuum thermoforming. Finishing techniques are standard. Four standard gauges are available for both orthotic and prosthetic applications. Eligible for double L2755 application in thermoplastic AFOs and appropriate prosthetic addition codes. For more information, visit www.fabwithprocomp.com Contact Gary G. Bedard, CO, FAAOP(D), managing principal, Rhode 401 LLC, at 650/773-3730 or email garyb@fabwithpro comp.com “I designed this composite to allow you to transition from plastic to composite thermoforming.”

• Modular Components: The prefabricated S.T.O.P. (Spinal Trauma Orthotic Positioning) braces are made up of a series of modular components that offer a combination of trunk support and ease of fitting

Professionals Job

Opportunities for O&P Location Key: Hire employees and promote services by placing your classified ad in the O&P Almanac Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or number, cardholder and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right listings

name,

for space and style considerations. North Central - PacificInter-MountainSoutheastNortheastMid-Atlantic O&P Almanac Careers Rates Color Ad Special Member Nonmember 1/4 Page ad $482 $678 1/2 Page ad $634 $830 Listing Word Count Member Nonmember 50 or less $140 $280 51-75 $190 $380 76-120 $260 $520 121+ $2.25 per word $5 per word ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org Job Board Member Nonmember 50 or less $85 $280 For more opportunities, visit: http://jobs.AOPAnet.org. CAREERS WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com Put AOPA to for YOU! As an AOPA member, some of the benefits you’ll enjoy include: Strong, strategic advocacy for your O&P profession and patients Free Ask the Expert consultation for your coding, billing and audit questions Convenient access to earn CEs online, on-demand in AOPAversity Join Us! For more information on membership, or to join, call 571/431-0810 or email bleppin@AOPAnet.org AOPA is centered on YOU. Let us support you. www.AOPAnet.org O&P ALMANAC | SEPTEMBER 2022 61

A large number of O&P Almanac readers view the digital If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

issue—

No orders or cancellations

MasterCard

to edit calendar

Coyote Prosthetics & Orthotics 31, 33 800/819-5980 www.coyote.us

Danmar Products 32 800/783-1998 www.danmarcranial.com & www.danmarproducts.com

Company Page Phone Website

Allard USA 3 866/678-6548 www.allardusa.com

Cailor Fleming Insurance 25 800/796-8495 www.cailorfleming.com Cascade Dafo Inc. 43 800/848-7332 www.cascadedafo.com

Cypress Adaptive 47 888/715-8003 www.cypressadaptive.com

Ferrier Coupler Inc. 51 810/688-4292 www.ferrier.coupler.com

ALPS South LLC 7 800/574-5426 www.easyliner.com Amfit 19 800/356-3668 www.amfit.com Apis Footwear Company 27 888/937-2747 www.apisfootwear.com Becker Orthopedic 29 800/521-2192 www.beckerorthopedic.com

Flo-Tech O&P Systems Inc. 35 800/356-8324 www.1800flo-tech.com

Hersco 15 800/301-8275 www.hersco.com

Naked Prosthetics 45 888/977-6693 www.npdevices.com

Spinal Technology Inc. 41 800/253-7868 www.spinaltech.com

The Bremer Group Company 13 800/428-2304 www.bremergroup.com

Mecuris 17 4989200057340 www.mecuris.com

Proteor USA 49 855/450-7300 www.proteorusa.com

Surestep 40 877/462-0711 www.surestep.net

Tillges Technologies 5 855/484-5832 www.tillgestechnologies.com

TurboMed Orthotics 39 888/778-8726 www.turbomedorthotics.com

Xtremity 9 970/429-4203 www.xtremity.com

Advertisers Index AD INDEX

For Job Seekers: Job searching is easy with the pane-view job search page. Set up job alerts, upload your resume or create an anonymous career proﬁle that leads employers to you. Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email. For more information on recruitment options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565 Log in at jobs.aopanet.org to get started!

For Employers:

Finding your next job or hire just got easier with the AOPA Career Center.

Ottobock C4 800/328-4058 www.professionals.ottobockus.com

AOPA_PrintAd.indd 1 8/19/21 8:02 PM AOPA NEWS CAREERS 62 SEPTEMBER 2022 | O&P ALMANAC

ESP LLC 1 888/WEAR-ESP www.wearesp.com

Fillauer 53 800/251-6398 www.fillauer.com

CALENDAR 22

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, card holder name, 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.

For information on

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

May 19–20

December 14 Year-End Review and What Is Ahead. 1 PM ET. Register at www.AOPAnet.org. 2023

Board of

November 9–11 New Jersey Chapter of American Academy of Orthotists and Prosthetists (NJAAOP) Meeting. Atlantic City, NJ. For more information, visit www.njaaop.org/annual-meeting

Orthotic & Prosthetic Innovative Technologies Conference. Minneapolis, MN. For updates, check our website at optech.ucsf.edu. Email cme@gillette childrens.com to be added to conference mailing list

TOP QUALITY ORTHOTIC, PROSTHETIC AND PEDORTHIC EDUCATION AND CE CREDITS FROM THE ORGANIZATION THAT KNOWS O&P. Register at www.AOPAnet.org

AOPA National Assembly. Indianapolis, IN For more information, visit www.AOPAnet.org. Start earning your credits today!

Certiﬁcation/Accreditation O&P ALMANAC | SEPTEMBER 2022 63

October 12 Clinicians’ Corner—Prosthetics. 1 PM ET. Register at www.AOPAnet.org

Monthly Webinar

Questions?contacteducationcontinuingcredits,thesponsor.Email info@AOPAnet.org.

POMAC’s One-Day Pedorthic, Orthotic, and Prosthetic Program. The Marriott New York LaGuardia Airport Hotel (across from LaGuardia Airport), East Elmhurst, NY. Contact Drew Shreter at 800/946-9170, ext. 101, or dshreter@pomac.com for more details. Monthly Webinar

September 6–8

October 15

November 9 The Do’s & Don’ts of Gift Giving. 1 PM ET. Register at www.AOPAnet.org

Let us share your next event!

Calendar Rates 2022 September 28–October 1 AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org

Become an AOPA State Rep. If you are interested in participating in the AOPA State Reps network, email smiller@AOPAnet.org

Special Sessions

The majority of states convene their leg islatures in the beginning of the calendar year and adjourn one to six months later, creating a relatively small window to pass bills. Ten states/territories, including the U.S. Virgin Islands and the District of Columbia, meet throughout the year; in these legislatures, lawmaking is a

Session Length and Frequency

MinnesotaNEWS

Why It Matters With the majority of states only holding active sessions for a few months a year, or even every other year, lawmakers tend to prioritize a small number of bills and move them quickly through the legis lature to be enacted into law. Thus, it’s important to know your state’s legislative calendar and plan ahead, to ensure that you have enough time to build coali tions, get your policy priorities heard by the right legislators, and introduce bills as early as possible. Knowledge of statelevel legislative cadence goes a long way in effective advocacy, and AOPA is standing by to assist you with these efforts. To learn more about the legisla tive process in your own state, contact Sam Miller at smiller@AOPAnet.org.

Medicaid’s Lower-Limb Policy has been updated with several changes: • K levels are now aligned with Medicare. • Microprocessor ankles and microprocessor knees are now covered for level K3 and above.

On occasion, legislatures are called into what’s known as a “special session” to address a pressing policy challenge.

Is Your State Legislature in Session?

As a result of advocacy from a group of providers, including AOPA President-Elect Teri Kuffel, JD; Charles Kuffel, MSM, CPO, LPO, FAAOP; and Kimberly Hanson, CPRH, Minnesota

64 SEPTEMBER 2022 | O&P ALMANAC

Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjust ments, state association announce ments, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org /resources/co-op

Knowledge of state-level legislative cadence is critical to effective advocacy

Aside from the good news out of Minnesota, there is little to report regarding state-level policy develop ments. The reason? Most state legisla tures are out of session, meaning that no bills are being drafted or voted on by lawmakers. The 10th Amendment of the Constitution grants states the right to set their own legislative calen dars, and as a result, each statehouse conducts its lawmaking differently.

To read the full updated LowerLimb Policy, visit the Minnesota page of the AOPA Co-OP.

• Previously unlisted codes for multiaxial ankles with swing-phase active dorsiflexion features, as well as vacuum suspension systems, have been added to the fee schedule—the former for level K3 and above, and the latter for level K2 and above.

LEGISLATIVE CALENDARS 101

STATE BY STATE

STATE POLICY

near-full-time job. Conversely, Montana, North Dakota, Nevada, and Texas convene every other year, and will not be conducting any lawmaking in 2022.

Examples of challenges that have warranted state-level special sessions this year include budget appropriations, federal COVID spending, state/federal redistricting, and taxation issues.

EARNING CERTIFICATEYOURIS AS EASY AS 1 2 3 1. Sign up with AOPA for the program 2. Select and complete within 4 years • 4 core courses from UHart’s Barney School of Business Online • 4 elective courses through AOPA 3. Graduation ceremony at the National Assembly A comprehensive certificate program for business owners, managers, and practitioners of O&P patient care facilities, O&P manufacturers and distributors to explore crucial business challenges as they relate to O&P. Are you ready to take your career and your business expertise to new heights? The all new Certificate in O&P Business Management can help you do just that! EARNING YOUR CERTIFICATE IS AS EASY AS 1-2-3 1. Sign up with AOPA for the program 2. Select and complete within 4 years • 4 core courses from UHart’s Barney School of Business - Online • 4 elective courses through AOPA 3. Graduation ceremony at the National Assembly Visit bit.ly/AOPACP to sign up for the certificate program. AREAS OF LEARNING HEALTHCARE OPERATIONS Learn techniques for planning, design, operation, control, and improvement of the processes needed to operate your business efficiently. MANAGEMENTHEALTHCARE Increase your knowledge and skills to better manage multiple, individual, and team priorities. FINANCE Learn business financial management concepts and perspectives for Healthcare Today, Business Models, Accounting & Finance Pillars, and Strategic Decisions SALES AND MARKETING Learn the functions of marketing along with a variety of tools and approaches to personal selling along with the many digital marketing tools available. 5 Areas of Learning include: This joint certificate program will provide you with: • Basic business acumen • Practical knowledge to apply immediately to your work • Techniques for developing better business practices • How to think about improving your company’s returns To complete the certificate program, you must register and complete one core course and one elective course from each of the four areas of learning within a four-year period Certificate in O&P Business Management AREA OF LEARNING CORE ELECTIVES OperationsHealthcare Healthcare Operations for O&P Professionals MedicareMastering ManagementHealthcare Healthcare Management for O&P Professionals Elective Finance Financial Management for O&P Professionals Elective Sales Marketingand Sales and Marketing for O&P Professionals Elective Questions? Contact info@AOPAnet.org

September 2022 O&P Almanac

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