September 2023 O&P Almanac

TEAM O&P

Modern, collaborative care means partnering with a wider variety of allied healthcare professionals

2023 AOPA National Assembly

20 TEAM O&P

CHRISTINE UMBRELL

30 INSPIRATIONS AND INNOVATIONS

Motivational speeches, presentations on the latest O&P technologies and research, product showcases, and exciting networking opportunities greeted thousands of O&P stakeholders during the 2023 AOPA National Assembly in Indianapolis. Our photo feature from the premier event highlights some of the sessions and activities that resonated with attendees this year.

By MICHAEL COLEMAN

EXCEEDING

Prosthetist Erik Schaffer, CP, who sees patients from all over the world, shares his most inspiring patient-care experience: treating Ilysa Winick, who embraces life with four prostheses after losing all of her limbs in 2016.

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Views From AOPA Leadership

What Will You Do With Your Minutes?

The following is from AOPA President Teri Kuffel, JD,’s address during the AOPA Annual Business Meeting at the 2023 National Assembly.

Board of Directors

OFFICERS

President

Teri Kuffel, JD

Arise Orthotics & Prosthetics, Spring Lake Park, MN

President-Elect

Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

Vice President

Jeffrey M. Brandt, CPO Brandt Ventures, Exton, PA

Immediate Past President

Dave McGill Össur Americas, Foothill Ranch, CA

Treasurer

Rick Riley

Bakersfield, CA

Executive Director/Secretary

Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS

Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL

Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX

Kimberly Hanson, CPRH Ottobock, Austin, TX

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

James Kingsley

Hanger Clinic, Oakbrook Terrace, IL

Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV

Linda Wise

Fillauer Companies, Chattanooga, TN

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)

Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

I want to begin by sharing a poem by Benjamin E. Mays, PhD, a pioneering civil rights leader. He was a great influencer of Martin Luther King Jr.:

I have only just a minute. Only 60 seconds in it. Forced upon me, can’t refuse it. Didn’t seek it, didn’t choose it. But it’s up to me to use it. I must suffer if I lose it. Give account if I abuse it. Just a tiny little minute but eternity is in it.

It seems like only a minute has passed since the 2022 Assembly in San Antonio when Dave McGill handed me the gavel.

I’d like to recap how AOPA has used its minutes wisely this past year advocating for you, our members, and for your patients and the community of individuals we are all privileged to serve.

Let’s start with that national initiative So Every BODY Can Move. In the summer of 2022, AOPA and its partners—the National Association for the Advancement of Orthotics and Prosthetics, the Amputee Coalition, and the American Academy of Orthotists and Prosthetists—launched So Every BODY Can Move (formerly So Kids Can Move). This movement seeks to ensure that O&P activity-based devices are covered by insurance so O&P providers can obtain these devices for their patients and submit for reimbursement. With AOPA’s help, this legislation was enacted in four states in 2023–Arkansas, Colorado, Illinois, and New Mexico. In addition, five states–Indiana, Massachusetts, Minnesota, New Jersey, and New Hampshire–have joined the movement, introducing legislation in 2023, and more than 20 other states are currently working to bring legislation to their states in 2024. At this point, we expect a dozen bills to be introduced next year. Our goal is passage of these bills in 28 states by 2028 [the year the Paralympic Games come to the United States], at which point we can start the move to secure legislation at the federal level.

I am proud to say that in my spare minutes I have been helping to lead the efforts in Minnesota. It takes a village. Our coalition includes the Minnesota Society of Orthotists, Prosthetists, & Pedorthists; Wiggle Your Toes (an amputee nonprofit); our legislators; our lobbyist; and our extended O&P community of facility owners, healthcare professionals, families, and friends. Like the several states before us, we are working together to move legislation that creates broader coverage and more equitable access to O&P care, including activity-specific devices.

This past year, AOPA has spent valuable minutes assisting its members in several other states with various issues on the legislative and policy fronts.

In New York, updates to the Medicaid fee schedule were instituted for the first time in almost 20 years, resulting in an overall increase and the addition of 35 Healthcare Common Procedure Coding System codes to the existing fee schedule.

In North Carolina, Medicaid improvements for coverage of cranial remolding orthoses were requested and are now in the process of being finalized.

And, in Oregon, we saw the reimplementation of insurance fairness.

All of these efforts have resulted in improved coverages and payments for O&P care and devices, which in turn helps us AOPA members.

On the federal level, AOPA has spent many minutes on the Medicare O&P Patient-Centered Care Act, which has been introduced in the U.S. House of Representatives.

We streamlined the bill from its previous iteration to focus on the issues most important to the O&P profession and our patients, ensuring Medicare beneficiaries have access to custom-fitted and custom-fabricated orthoses when a replacement is necessary due to: a

A world where orthotic and prosthetic care transforms lives.

change in patient condition or clinical needs; an irreparable change in the condition of the orthosis; or a repair cost that is in excess of replacement. We continue this important work and expect the bill’s introduction in the Senate any day now.

Moving to the regulatory front, AOPA was instrumental in the recission of the Medicare correct guidance for upper-extremity prostheses, and AOPA’s continued collaboration will be key. The retirement of the correct coding guidance is a crucial step in working toward the development of proper guidance that will ensure adequate access to clinically appropriate, medically necessary upper-extremity prosthetic care for Medicare beneficiaries.

Also, AOPA assisted with the recent Medicare rule that now includes powered orthoses and exoskeletons in the “brace” benefit category. This inclusion creates a pathway for Medicare coverage of new technologies.

I hope you can see how AOPA’s minutes have been spent hard at work, and how our advocacy efforts are returning real benefits for members and your patients.

I talked in detail about the work AOPA is doing at the state and federal advocacy levels to support you, and I want to encourage you to use some of your minutes to support the advocacy issues that are important to you. The more collective minutes we spend on our advocacy initiatives, the more support there will be for the O&P profession and improving the lives of the patients and the community of individuals we are privileged to serve.

This past year, we’ve also put our minutes to good use getting ready for this Assembly! It has been thrilling to get a chance to speak with so

Views From AOPA Leadership

many of you over the past few days. It is exciting and energizing to be here together, and I hope you feel the same way about the sessions you have attended and your meetings with colleagues this week.

We know your time is precious, and AOPA is here to support you by saving minutes. We also know there is more we can be doing, so please continue to reach out; we want to hear from you.

It has very truly been my honor to serve as AOPA’s president this past year. Serving in this role has allowed me to spend many productive minutes helping support AOPA membership, with the main goal to help move our profession forward. I have no doubt that all these minutes will be some of the most precious and fulfilling in my professional career.

None of what has been accomplished this past year would have been possible without the support of my esteemed colleagues on the AOPA Board, AOPA’s dedicated staff, our members, and our extended O&P community. So, thank you all—for your minutes, your efforts, and your support!

Very Truly Yours,

Teri Kuffel, JD

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Teri Kuffel, JD, is president of AOPA.

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AOPA Contacts

Our Mission

AOPA staff and volunteers are committed to our mission of being a trusted partner, advocating for and serving the orthotic and prosthetic community by:

• Fostering relationships with decision makers to ensure equitable access.

• Providing education that promotes professional excellence.

• Supporting research that informs innovative care.

• Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

Our Vision

A world where orthotic and prosthetic care transforms lives.

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

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

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

EXECUTIVE OFFICES

Eve Lee, MBA, CAE, executive director, 571-431-0807, elee@AOPAnet.org

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HEALTH POLICY AND ADVOCACY

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

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

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

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

MEETINGS & EDUCATION

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MEMBERSHIP & COMMUNICATIONS

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AOPA Bookstore: 571-431-0876

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

O&P ALMANAC

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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.

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Copyright © 2023 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

ADVERTISE WITH US

Engage the profession today. Reach AOPA’s membership with more than 10,694 subscribers. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net

Learn more at bit.ly/23AlmanacMediaKit

Proud Partner of the Limb Loss and Preservation Registry (LLPR)

Cailor Fleming is proud to offer new and existing customers a discount on premiums (5-15%) to O&P Providers who participate in the LLPR. Discounts to be applied at renewal or at the beginning of the policy year.

The LLPR is the first quality registry for hospital systems and prosthetic/orthotic practices for creating a collaborative database that focuses on acquired and congenital limb difference, as well as limb preservation, populations.

RESEARCH ROUNDUP

Unilateral Patients May Overload Sound Limb

Recognizing that lower-limb prosthesis users experience high rates of joint pain and disease, including osteoarthritis, in their sound limb, researchers at Vanderbilt University conducted a study examining lower-limb loading of transtibial prostheses during several common activities.

Led by doctorate student Rachel Teater, the research team studied the actions of eight individuals using unilateral transtibial prostheses. Participants were asked to squat; lift a 10-kg box; and perform sit-to-stand using three different chair heights. The researchers observed and studied peak vertical ground reaction forces, peak knee flexion moments, and ranges of motion. The study

Nearly 40% Report Weight Gain Postamputation

Researchers from the Department of Defense recently studied weight gain and loss trends among younger veterans to better understand weight change patterns two years postamputation.

The research team, which included Elizabeth Russell Esposito, PhD, and Shawn Farrokhi, PT, PhD, conducted a retrospective cohort analysis of 931 young service members with unilateral or bilateral lower-limb amputation. The sample was predominantly male (96%) with a mean age of 27. The majority had served in the Army (59%) and had unilateral amputation distal to the knee (76%). More than threequarters of subjects’ amputations were attributed to blast injuries.

At two years postamputation, 58% of subjects maintained a stable weight; 38% had gained weight; and 4% had lost weight. Individuals with bilateral limb loss were more likely to have lost weight, compared to those with unilateral limb loss. Individuals whose amputation was caused by non-blast-related trauma were more likely to be in the stable weight group compared to those with amputations caused by blasts or disease. Those younger than 20 years old were more likely to experience weight gain, compared to older service members.

“More than half the cohort maintained a stable weight for two years after amputation, and more than a third experienced weight gain during the same time frame,” reported the researchers. “Changes in body weight can present distinct challenges for these individuals who often wish to retain their prior level of function. An improved understanding of the myriad of factors that can influence weight change after amputation may help rehabilitation teams better target strategies for early intervention.” The study was published in the September/October Military Medicine

subjects overloaded their sound limb for all tasks, according to the researchers. They recorded greater peak ground reaction forces by 36-48% for the intact limb compared to the prosthetic limb, and greater peak knee flexion moments by 168-343% for the intact limb compared to the prosthetic limb.

“This asymmetric loading may lead to an accumulation of damage to the intact limb joints, such as the knee, and may contribute to the development of osteoarthritis,” reported the researchers in Clinical Biomechanics in July. “Prosthetic design and rehabilitation interventions that promote more symmetric loading should be investigated for these tasks.”

Prosthesis Use Improves Public Perception of Individuals With Limb Loss

Young adults generally hold positive attitudes toward individuals with upper-limb loss who use prostheses in terms of perceptions of competence, warmth, and functional abilities, according to a new study from researchers at University of Central Florida. The team sought to evaluate attitudes of young adults toward individuals with upper-limb amputation and discovered more favorable reactions toward those who used prostheses.

The researchers surveyed 469 young adults, who rated pictures of individuals with and without amputation and with and without prostheses after reading a background scenario. Using a semantic differential for competence and warmth and a scale of functional ability, the researchers found that individuals with upper-limb loss who used prostheses were rated with higher competence and ability than those without prostheses. Individuals using higher-tech prostheses rated higher for ability than those wearing body-powered devices. In addition, individuals with upperlimb loss who were female rated with lower competence and ability, and higher warmth, regardless of limb loss status.

“Our research shows that young adults generally hold positive attitudes toward individuals with amputations of the upper limb when they use prostheses in terms of perceptions of competence, warmth, and functional abilities,” reported the researchers. “However, traditional stereotypes persist for those who do not use prostheses.” The study was published in Rehabilitation Psychology

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FAST FACT PAIN COMMON AMONG LIMB LOSS PATIENTS

In the United States, 95% of patients report experiencing some amputationrelated pain, with 80% reporting phantom pain and 68% reporting residual limb pain.

INSURANCE INSIGHTS Employer-Based Plans Will Remain Largest Source of Health Insurance

Officials from the Congressional Budget Office (CBO) predict that employment-based coverage will remain the predominant source of health insurance throughout the next decade, continuing the current trend.

Among the under-65 population in 2023, employment-based insurance covers 57.3%, Medicaid and the Children’s Health Insurance Program cover 30.6%, the subsidized marketplace covers 5.2%, and “other” categories cover 5.8%. Approximately 8.3% are uninsured.

CBO found that people with incomes less than 150% of the federal poverty level are more likely to be uninsured than individuals with higher incomes. Higher-income individuals are more likely to be insured via employmentbased plans.

DIABETES DOWNLOAD AMPUTATION RISKS AMPLIFIED

Patients with diabetes mellitus have a 30 times greater lifetime risk of undergoing an amputation when compared to patients without diabetes—costing the U.S. healthcare system more than $4.3 billion annually. SOURCE:

PEDIATRIC O&P

Premiums for private plans are expected to grow over the next 10 years: CBO projects that private health insurers’ spending on per enrollee private health insurance premiums will grow by 6.5% in 2023, an average of 5.9% during the 2024–2025 period, an average of 5.7% during the 2026–2027 period, and an average of 4.6% during the 2028–2033 period. The CBO study was published in Health Affairs

MARKET WATCH Growth Predicted for O&P Industry

The O&P market will experience a compound annual growth rate of 6.1% between 2022 and 2027, according to a market analysis report published by Technavio. This growth will be driven by advances in O&P technologies, such as sensors, microprocessors, and artificial intelligence, according to the report authors. More devices that allow for continuous monitoring and customization for data collection and analysis are expected to be introduced to the market over the next few years. North America will account for approximately 38% of the growth, according to Technavio.

The orthotics market is expected to grow faster than the prosthetics market, said the researchers, with growth driven by an aging population,

sedentary lifestyles, and increasing numbers of sports injuries.

Technavio noted that market growth could be impeded by the high costs associated with O&P devices. They found that O&P suppliers are forming strategic alliances and partnerships and are participating in mergers and acquisitions to enhance their presence in the market.

PHYSICAL ACTIVITY BENEFITS CHILDREN

“Sports and recreational activities offer physical and psychological benefits to children with limb absence. …

Facilitators that exist include advancements in prosthetic design and technology, increased opportunities, and physical and social benefits. Barriers … include prosthesis failure, stigma, and high costs.”

SOURCE:

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WOMEN IN THE PROFESSION OPGA Names 2023 Woman of the Year

Nikki Grace-Strader was honored with the 2023 O&P Woman of the Year Award by the Orthotic Prosthetic Group of America (OPGA) during the AOPA National Assembly Sept. 7.

Grace-Strader, who is director of North American operations for Osseointegration International, overcame challenges as an amputee to become a dedicated advocate and leader in osseointegration education in the O&P field. In her current role, GraceStrader offers support to individuals with limb loss worldwide. By offering guidance, resources, and shared experiences, she assists individuals in navigating the process of exploring and obtaining osseointegration surgery. “I am truly honored to receive the Woman of the Year Award from OPGA and to be given the chance to represent women in the O&P profession,” she said.

O&P By the Numbers

“On behalf of OPGA, Össur Americas, and the Woman of the Year Selection Committee, we wish Nikki a sincere congratulations on being selected as the 2023 O&P Woman of the Year,” said Adam Miller, president of OPGA. “From Nikki’s time as a Breece Fellow to now, we have all gotten to witness firsthand her tireless advocacy for the O&P community and the patients it serves. Nikki’s selflessness, passion, and commitment are what this award is all about.”

The O&P Woman of the Year Award, sponsored by Össur and presented by OPGA, a division of VGM & Associates, is open to all women who work in the orthotic and prosthetic profession. The Selection Committee reviews nominations and selects finalists by considering the nominees’ contributions throughout their careers to patients, the community, and the O&P profession.

Consumers Rate U.S. Healthcare System

The “EY Global Consumer Health Survey 2023” examined healthcare consumers’ views on value and found that U.S. consumers appreciate some aspects of current care but see room for improvement in other areas.

OPGA Director of Community Development Denise Doyle; 2023 O&P Woman of the Year Nikki GraceStrader; OPGA President Adam Miller; and AOPA President Teri Kuffel, JD, during the AOPA National Assembly

MAKING YOUR FOOTPRINT SMALLER

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IN MEMORIAM

Doyle Collier, CP, passed away August 7 at the age of 67 in Overland Park, Kansas.

Collier began his O&P career at the age of 17, eventually attending Northwestern University for O&P training and becoming a certified prosthetist.

Most recently, Collier worked at Decker Integrated Orthotics & Prosthetics and was technical director at Knit-Rite until his retirement in December 2020. He previously worked for Hanger Orthopedic Group and Rehab Designs of America. He is survived by his wife, Sheila Collier, and two daughters.

PEOPLE

The Orthotic and Prosthetic Activities Foundation (OPAF) Board of Directors held a special vote to elect two new members, Mabio Costa and Charissa “Chris” Doerger, CP, PT, simultaneously appointing them to executive positions. Costa is president-elect and will shadow Travis Young, CPO, current OPAF president, throughout this transitional process.

Sam Hale has been promoted to vice president, product development and education, at Fillauer Cos. Hale has been with Fillauer for the past 10 years and has a clinical background that assists him in driving innovation, research outcomes, and process improvements at the company. In addition to leading the development and engineering teams, Hale will oversee Fillauer’s education program with a focus on digital learning.

Linda Wise has been promoted to vice president, sales and marketing, at Fillauer Cos. Wise, who also serves on AOPA’s Board of Directors, joined Fillauer in 2022. With more than 14 years in the O&P profession, Wise will lead the sales specialist, marketing, and customer experience teams, with a focus on elevating the customer experience and Fillauer brand.

BUSINESSES

The Orthotic and Prosthetic Group of America (OPGA) has announced its support for the So Every BODY Can Move initiative, an initiative led by AOPA, the National Association for the Advancement of Orthotics and Prosthetics, and the American Academy of Orthotists and Prosthetists. OPGA’s collaboration aims to address the pressing issue of inadequate insurance coverage that hinders thousands of individuals from embracing physical activity and mobility. OPGA supported the 198-mile, 36-hour “Hood To Coast Relay” August 25-26. This event serves as a platform to raise awareness and vital funds that will drive the movement for disability rights and fuel the ongoing legislative changes across the nation.

“We strongly believe that physical activity is a right, not a privilege,” said Adam Miller, president of OPGA. “Our support of So Every BODY Can Move reflects our dedication to ensuring that all individuals, regardless of their physical abilities, have the means to live active and fulfilling lives.”

Sam Hale

Linda Wise

Doyle Collier, CP

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IT’S ALL ABOUT FUNCTION.

BY DEVON BERNARD

Clinical Interpretation

Know the rules for communicating with deaf or hard-of-hearing patients

From time to time, AOPA receives questions about the rules and responsibilities of a facility when communicating with patients who may have hearing, vision, or speech impairments. Questions frequently arise regarding when an interpreter is required and who is required to pay for the interpreter.

This month’s Reimbursement Page explains some of the guidance regarding interpreters during clinical appointments.

What Does ADA Say?

The Americans With Disabilities Act (ADA) outlines the rules that govern when an interpreter is required and who is required to cover the costs.

At its core, ADA is divided into five sections—called titles—designed to address

or relate to different aspects of everyday public life. Title III answers questions about a facility’s requirement to use interpreters. Title III, Nondiscrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities, prohibits private places of public accommodation, including hotels, restaurants, and your office, from discriminating against individuals with disabilities and sets the building standards for accessibility. This title also directs these businesses to make reasonable modifications to their normal daily operations when serving people with disabilities. In addition, Title III requires businesses to take the required and necessary steps to communicate effectively with customers with vision, hearing, and speech disabilities.

Specifically, Section C, Part 360.303, of Title III, Auxiliary Aids and Services, answers the relevant questions. This section states, in a nutshell, that you have a duty to make available or provide appropriate aids or services when they are needed to ensure effective communication with people who are deaf or hard of hearing.

Several aids and services are considered appropriate, and each one has its own merits and faults. The one you use depends on your situation.

Some options are more complex than others. Examples of appropriate aids and services include written materials/ exchange of written notes, computer-aided transcription services, and video remote interpreting services. Another option is a qualified interpreter, defined as someone

“who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.” An individual does not need to be certified to meet this definition unless you live in a state that requires the use of certified individuals.

In most cases, family members, friends, and companions would not be considered qualified interpreters. This is because they will be emotionally involved or could have interests that conflict with the patient’s— and thus would be unable to interpret “effectively, accurately, and impartially.” In addition, using family members, friends, or companions as interpreters can cause problems when it comes to maintaining patient confidentiality. Although a family member, friend, or companion is not considered a qualified interpreter, such an individual could be deemed “acceptable” in certain scenarios—for example, in an emergency.

Which Interpretation Method To Choose?

So how do you know which method to use?

That will depend on the effectiveness of the communication required. The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the patient’s normal and preferred method of communication.

For example, if the patient is in the office simply to set up an appointment, has some general questions, or is there for a follow-up appointment, you may be able to rely on notes, brochures, or a similar method. However, if the patient is there for their first fitting or the appointment requires a full exam and testing, then notes may not be adequate to explain the situation or allow the patient to ask complex questions. In this case, an interpreter may be required, or you may need to select a different method with which the patient is comfortable.

Also, think about the patient’s normal means of communication and what preferences they may have. Understand that there are different types of sign language, so you would need to determine the method used by your patient. In other cases, the patient may not use sign language at all.

In addition, the patient may have experience with all of the auxiliary aids and services you offer but may prefer one method over the other.

The patient may have a strong preference or may demand that you provide an interpreter; however, you are not always required to provide the method preferred by the patient. Consider their preference and try and accommodate their choice to ensure lines of effective communication, but remember that the final decision rests with you, as long as the method chosen results in effective communication.

In addition, you are not required to provide a particular auxiliary aid or service if it causes an undue burden to your business, according to ADA. An undue burden can be something that involves significant difficulty—for example, hiring an interpreter on short notice—or expense. An undue expense doesn’t solely mean the interpreter is more expensive than the item/service you are providing; an undue expense considers your overall financial resources and overall expenses.

Note that you may request or require advance notice from patients and individuals requesting interpreters or any of the other possible aids and services. However, you may not require excessive or abusive advance notice. Advance notice requirements must be reasonable and should be based on the actual time needed to find and hire a qualified interpreter or to locate

alternate aids or services. However, you also must be able to accommodate walkins or immediate requests to the best extent possible.

Who’s Responsible for Payment?

According to ADA, the business is required to pay for whichever auxiliary aid or service you and your patient elect to use. Paying for the interpreter, auxiliary aid, or service is considered part of doing business. If you are a small business and are required to pay for one or more auxiliary aids or services, consider speaking with an accountant as tax breaks may be available.

The examples provided above primarily deal with patients who are deaf, but the same rules and guidelines would apply to patients who are blind, who are vision impaired, or who may have some other communication or speech disabilities that would require specialized auxiliary services or aids.

If you have specific questions about the ADA and your responsibilities, consider speaking with an attorney or visiting the ADA website, ada.gov

The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the patient’s normal and preferred method of communication.

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

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TEAM O&P

Each year, advances in orthotic and prosthetic technology propel the O&P profession forward. As new technologies allow for even more options, and devices become more complicated by integrating sensor and AI-driven technologies, the importance of a multidisciplinary approach to care becomes more pronounced. Moving forward, optimal patient outcomes will in many cases depend on the teamwork between the prosthetist/orthotist and patient—as well as the primary care physician,

NEED TO KNOW:

f With orthotic and prosthetic technological innovations and surgical options multiplying, a multidisciplinary approach to patient care becomes critical for optimal outcomes.

surgeon, physical therapist, occupational therapist, nurse practitioner, psychologist, dietitian, and other members of an allied health team.

“A multidisciplinary approach is important because the best patient care requires collaborative input from specialists from various healthcare roles,” explains Brian Heckathorn, CPO, Hanger Clinic area director in Massachusetts. “Understanding each other’s strengths and how we can work together to achieve a goal leads to better patient outcomes.”

f O&P professionals who are integrated into teams benefit from exposure to the most modern surgical techniques, rehabilitation strategies, and educational opportunities from the various specialized fields.

f Hospital-affiliated O&P professionals work in teams on a regular basis, frequently collaborating with surgeons, physical therapists, occupational therapists, and clinical research coordinators.

f More recently, psychologists, social workers, child life specialists, and even therapy dogs have been added to multidisciplinary teams.

f For those O&P professionals in private practice, forming collaborations with allied healthcare professionals may be more challenging—but clinicians seeking to provide optimal patient care cannot operate in a silo.

f A multidisciplinary approach is only as good as the communication that accompanies it—each member must be willing to remove their ego and listen to suggestions from others to provide balanced and collaborative treatment approaches and solutions.

O&P clinicians partner with a variety of allied healthcare professionals—surgeons, PTs, child life specialists, therapy dogs, and more—to improve patient outcomes

Brian Heckathorn, CPO

Physician Perspective: The Prosthetist-Physician Partnership

Whitney Pratt, MD, PhD, specializes in physical medicine and rehabilitation for the Indiana University School of Medicine. In her role in leading the institution’s amputee clinic—which she founded at the hospital eight years ago—she emphasizes the importance of teamwork in providing appropriate care for patients. “While we don’t have a dedicated prosthetist in the clinic, I’ve been educated by a lot of great prosthetists,” she says.

Pratt, who spoke at the 2023 AOPA National Assembly, says that prosthetists are not included in the clinic at Indiana University, but they are pulled in as part of the care team after a patient selects a prosthetist to work with. “We are a public institution, and I want to be unbiased” in recommending an appropriate prosthetist, says Pratt. “Not every O&P provider is a good fit for every patient,” she says, noting that the goal at is to ensure patients choose the clinician that best meets their individual needs. “We have lists by region of various providers, and we educate the patient to make the decision.”

After a patient chooses a prosthetist, the collaboration begins, says Pratt. “Some prosthetists attend therapy center sessions, and there will be some back-and-forth” between the rehab team and the prosthetist.

Prosthetists and orthotists reap professional benefits as well: “Working as part of a multidisciplinary team is an amazing opportunity for O&P professionals to keep up with the most modern surgical techniques, rehabilitation strategies, and other educational opportunities and options from the various specialized fields,” adds Heckathorn. “Input like this makes us all better.”

Pratt emphasizes the importance of working closely on patient documentation. “Some surgeons and family physicians don’t understand all of the documentation needed” for a prosthetist to do their job appropriately and receive proper reimbursement, she says. She encourages prosthetists to develop relationships with physicians who look out for their patients, and who are willing to learn the nuances of O&P documentation.

Pratt offers several suggestions for prosthetists when working with physicians:

• “Work closely together,” for the good of the patient. “Have regular communication with the physician,” and don’t be discouraged when documentation moves slowly. “Communication can be challenging in a world where we still use fax machines.”

• When the approval process is slow, “don’t throw each other under the bus regarding documentation.”

• If you have several patients with the same physician, consider scheduling a standing phone call with that physician. “Patients appreciate knowing that their prosthetist is in good communication with their physician, and that they’re on the same page.”

Ideal patient outcomes depend on ample communication and frequent patient visits, adds Pratt. “I tell new patients that all O&P companies have the same equipment and most of the same skills,” she says, “so they should look at how the facility will follow up with them, and make sure they’ll schedule appointments a few weeks postdelivery to check in.”

Regarding O&P patient care specifically, “there is a compelling consensus in the literature that early intervention and execution of treatment by a multidisciplinary team is the most effective approach to amputation prevention,” Garibaldi adds. “These teams also allow for more rapid return to function following amputation.”

For O&P clinicians who work within a hospital setting, a multidisciplinary approach can be organic. But even those in private practice can find ways to partner with allied health professionals for the benefit of the patient.

Organized Hospital Settings

Orthotists and prosthetists affiliated with hospitals understand collaborative care. Many hospitals create multidisciplinary-focused services or clinics that include O&P clinicians.

Matthew Garibaldi, MS, CPO

Research also suggests the value of a team approach, according to Matthew Garibaldi, MS, CPO, director of the Orthotic and Prosthetic Center at University of California, San Francisco (UCSF). While these studies are not abundant, “the literature demonstrates that multidisciplinary teams reduce hospital length-of-stay, readmission rates, and hospital costs,” Garibaldi says. “This is of great importance to executive leadership, who in turn facilitate team-based care by providing funding opportunities and space allocation to healthcare professionals.”

At UCSF, for example, “we’ve developed a number of multidisciplinary O&P-related services, such as the limb deformity service, osteointegration clinic, and the functional limb service,” says Garibaldi. “Our role on these teams is to provide clinical insight, education, guidance, and recommendations… and of course, clinical care.”

Whitney Pratt, MD, PhD

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After a recent restructuring, his institution added more members to certain cross-discipline teams, integrating psychologists, nurse practitioners, and clinical research coordinators.

Don Virostek, CPO, LPO, administrative director of O&P at Scottish Rite for Children in Dallas, leads the O&P department within the hospital. There, O&P providers “attend and staff numerous clinics,” including spina bifida, cerebral palsy, and scoliosis clinics, he says.

When treating patients, Virostek may work with a pediatrician, a physical therapist, an occupational therapist, a dietitian, a therapeutic recreation team member, and even a therapy dog named Margo—a more recent addition to the team.

“We work hand-in-hand” with other healthcare providers in treating children, and the involvement depends on the patient, explains Virostek. For example, “with spina bifida patients, we work closely with dietitians, who help patients with their dietary needs and ways to manage their weight,” he explains.

For scoliosis patients, orthotists join forces with physicians, nurse practitioners and PTs at Scottish Rite to ensure compliance with bracing and exercise protocols. Many patients work with the hospital’s PTs to complete Schroth scoliosis-specific exercises, a program that uses exercises customized for each patient. “We have to work closely to share progress and concerns, and to ensure the best

outcomes,” says Virostek. “Patient compliance is extremely important to overall success of bracing.”

Cooperation is just as important for prosthetic pediatric patients, says Virostek. For this population, his team commonly works with PTs as well as psychologists, who can offer coping mechanisms.

Licensed child life specialists have taken on a greater role within the team in recent years, according to Virostek, particularly when a calming influence is needed. Child life specialists “help make our job easier,” he says. “When we have a child who’s struggling or anxious, the child life department really helps us, especially during alignment and fitting when a child wants to run around,” he says. “They’ll help calm the child down and walk in a more consistent manner so we can evaluate their gait and make the appropriate adjustments.” Child life specialists also assist when working with scoliosis patients, by giving advice on brace wear at home and school, and by offering suggestions when patients’ wear times are down, as monitored by iButton thermal sensors.

From a patient perspective, the most popular team member is Margo, the therapy dog at Scottish Rite. Therapy dogs “are very helpful with anxious patients and allow us to do our job while they’re focusing on the dog,” Virostek says. Scottish Rite added dogs as full-time team members about three years ago, after clinicians noted how well patients responded to volunteer therapy dogs that made occasional visits. Now Margo makes rounds with her caretaker throughout the day, “and it makes patient visits less stressful.”

Margo, the therapy dog at Scottish Rite for Children in Dallas, has become an important part of the care team, assisting in calming anxious patients.

Don Virostek, CPO, LPO

Therapy dogs “are very helpful with anxious patients and allow us to do our job while they’re focusing on the dog.”

—DON VIROSTEK, CPO, LPO

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Expanding the Multidisciplinary Approach to Camp

Collaborative care isn’t beneficial only in the facility setting—it can also benefit children when they’re away at camp.

Children’s Healthcare of Atlanta (Children’s) hosts several week-long camps for pediatric patients with different types of diagnoses, including Camp No Limb-itations, a one-week camp designed for children with limb loss or difference. Several members of the multidisciplinary care team at Children’s attend the overnight camp, including prosthetist Richard Welling, MSPO, CPO, and therapist Jill Cannoy, PT, DPT, PCS. Cannoy serves as one of the camp counselors, and Welling is part of the medical staff at the camp.

Physical therapists, occupational therapists, child life specialists, music therapy professionals, medical staff, nurses, and even support dogs play a role at the camp, joining forces to make the camp possible for participants.

Private Practice Settings

Identifying potential partners and forging mutually beneficial collaborations can be more challenging for private O&P clinics that don’t have built-in teammates. But finding ways to create alliances is essential for patients—and can help prosthetists and orthotists do their own jobs better.

“Multidisciplinary care is critically important regardless of your setting,” says Garibaldi. “Prosthetists and orthotists simply cannot operate in a silo if they want to provide optimal care for their patients.”

Assembling a team starts with the patient. Heckathorn’s local Hanger Clinic team partners with various healthcare organizations to host virtual and in-person clinics, which the patient, family, and prosthetist are welcome to attend. “These visits are very comprehensive evaluations of the needs of the patient,” he explains. “At the summary of each visit, the patient is presented with a recommended action plan and timeline. The prosthetist functions as a consultant and provides input on how we can best manage our part of the patient-care plan.”

In addition to the orthotist or prosthetist, the team of healthcare professionals Heckathorn works with may include plastic/reconstruction surgeons, orthopedic surgeons, vascular surgeons, physical medicine and rehabilitation practitioners, physician assistants, physical therapists, occupational therapists, and case managers. “It is truly a collaborative visit,” he says. “Following the patient’s case recap and physical evaluation by all professionals involved, there is a very lively dialogue while keeping a patient-centric focus.”

Teamwork can have impressive results for patients, too. For example, during a recent amputee clinic visit, “a physiatrist collaborated with me to discuss a previous intervention with a similar patient in which we utilized a custom gel liner and hydraulic ankle foot—which vastly improved that patient’s comfort and mobility,” Heckathorn recalls. “The physical therapist in attendance also happened to be involved in the previous patient’s case and

contributed her feedback about those successful changes and how it related to specific exercises in their therapy program.”

Heckathorn explains that for smaller O&P facilities that may not have formed large collaborative teams, “a good multidisciplinary team doesn’t limit their plans or thought processes to the people who are in the room. Instead, they extend the approach to all available resources that can help meet the needs of the patient.”

He also encourages all members of collaborative healthcare teams to educate each other on the latest advances in their own specialties. “Each encounter gives us a unique opportunity to share advanced techniques, resources, and offerings,” he says. “At times, this leads to opportunities for continuing education where we can take a deeper dive.

“The field of prosthetics is continually changing, and it is our responsibility to educate these teams on specialized component technology and treatment strategies,” Heckathorn adds. “By doing this, it will allow the other team members to enhance their support to future patients.”

Powerful Interactions

At Children’s Healthcare of Atlanta (Children’s), which comprises three hospitals in the Atlanta area, a multidisciplinary approach is critical for the Limb Difference Program. Richard Welling, MSPO, CPO, a prosthetist on the Limb Difference Team, works closely with PTs, orthopedic surgeons, orthopedic physicians, hand and upper-extremity surgical specialists, and more.

At Children’s, “where an orthopedics office is, you’ll find an O&P facility next door,” says Welling, so patients can be seen by both specialists on the same day. In addition to surgeons and PTs, Welling and his team regularly consult with child life specialists, music therapy practitioners, and—as at Scottish Rite—a therapy dog.

Richard Welling, MSPO, CPO

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“There are a lot of opportunities for us to tell the same message, but each in our own way,” explains Welling. “Each part of the team takes their opportunity to work with the family and the patient” as the patient progresses through the amputation and rehabilitation processes.

The multidisciplinary approach is only as good as the communication that accompanies it. Welling works on a team with two other prosthetists, plus therapist Jill Cannoy, PT, DPT, PCS, and communication is of highest priority. Welling and Cannoy shared some aspects of their multidisciplinary approach during the 2023 AOPA National Assembly.

“Jill, myself, and the other prosthetists meet daily to discuss patients, based on who’s been seen or who needs to be seen,” says Welling. When problems arise with patients, “we discuss whether it’s a prosthetic/alignment problem or a therapy problem” and proceed accordingly.

The prosthetists and Cannoy communicate closely with surgeons, committing to a monthly call to discuss ongoing and upcoming patients. Several orthopedic surgeons participate in the calls. “We always discuss what ‘function’ is and what ‘quality of life’ means for each patient,” says Cannoy. “That may differ from the perspective of a surgeon or a pediatrician,” she adds. Cannoy and Welling remind team members that beyond making it to school, most pediatric patients also want to participate in sports and have individualized activity goals.

Cannoy and Welling also may offer input when families are considering limb lengthening surgical procedures or amputation for infants with missing tibias or short femurs. Because of new techniques over the past five years, more families are choosing limb lengthening—at least initially. But rather than prosthetic care, those children require orthotic intervention postsurgery.

Welling and Cannoy want to see more collaboration with both psychologists and social workers in the future, and they hope these professionals will become more involved members of the multidisciplinary team—primarily because many young O&P patients require expanded services and resources at school. “Social workers have the connections at the different school systems and the community resources” to advocate for patients, says Welling.

The multidisciplinary team at Children’s also involves peer counselors, says Welling. “We try to make peers available to children who are about to undergo amputation,” he says. Immediately postamputation, “patients can feel trapped in darkness, and can’t see the light—but a peer who has been through it before” can more effectively offer hope than can a clinician who does not have limb loss, he says.

“Peers can also teach them skills and explain, ‘This is how I do it,’” says Cannoy.

True Listening

Collaboration is advantageous—but it’s important to have the right mindset when consulting with other healthcare professionals on behalf of a patient. “Removing your ego is the biggest thing,” says Welling. “You can’t have to be ‘right.’ You have to be willing to listen to a therapist.”

Listening to other team members when there are conflicting opinions can lead to better outcomes, adds Garibaldi: “Conflict within multidisciplinary healthcare teams does occur, but professional disagreement leads to critical discourse,” he says. “These exchanges are healthy for the team and ultimately lead to improved care. However, when power dynamics become imbalanced and members of the team feel unheard and/or ostracized, rebuilding of the team may be necessary.”

For O&P clinicians that have seen first-hand the benefits of a collaborative approach, they note that the patients are the true “winners” when teamwork’s at play. “Patients leave each appointment knowing they are being heard, their needs are important, and with a defined timeline for their care and rehabilitation,” says Heckathorn. “Collaborative care teams emphasize that they will support the patient throughout their entire journey, and that can be so reassuring.

“While there are many dependent factors,” adds Heckathorn, “having a shared sense of awareness and access to individual actions plans can result in various efficiencies and improved patient outcomes.”

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

Heckathorn, right, believes a multidisciplinary approach to care leads to patients feeling supported throughout their rehabilitation journey.

Jill Cannoy, PT, DPT, PCS

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INSPIRATIONS AND INNOVATIONS

O&P stakeholders enjoyed a fast-paced educational and networking experience during the 2023 AOPA National Assembly in Indianapolis

Over four days in early September, Indianapolis became the center of the O&P community as1,800 practitioners, manufacturers, educators, and innovators participated in a dynamic and deeply informative 2023 AOPA National Assembly.

The Assembly’s theme—“Driving Innovation”—represented the birthplace of the legendary Indianapolis 500 auto race and dozens of conference sessions that focused on the exciting innovation occurring across the modern O&P industry. The best and brightest leaders and thinkers in O&P helped educate participants in orthotic, prosthetic, and pedorthic business practices; cutting-edge osseointegration procedures; tips for billing and operations; the use of high-tech data to improve care; and much more.

Josh Sundquist, a Paralympic ski racer, comedian, and bestselling author, set the Assembly’s tone by delivering a rousing and inspirational keynote speech to kick off the first full day of programming. Diagnosed with a rare form of bone cancer at age 9 and given a 50% chance to live by doctors,

AOPA President Teri Kuffel, JD, cut the ribbon to start the festivities and begin “Driving Innovation” at the 2023 AOPA National Assembly in Indianapolis.

Sundquist spent a year in chemotherapy treatments before undergoing amputation of his left leg. He conquered cancer by age 13 and took up ski racing with the goal of making the U.S. Paralympic Ski Team for the 2006 Paralympic Games in Torino, Italy. After his first coach told him he had a one-in-a-million chance of making the team, Sundquist promptly replaced that coach and decided to write the letters “OMT” on the tips of both of his skis. The letters stand for “One more thing, one more time.” With this simple but powerful motto in mind, Sundquist kept practicing his skiing—and eventually won that spot on the 2006 Paralympic Team. He said the “OMT” motto is one that O&P professionals can all adopt.

“Maybe my chances were very low of making the Paralympics, but I didn’t want to look back and wonder, ‘What if I had dreamed a little more? What if I had gone a little harder?’” Sundquist explained. “One more thing, one more time for athletes has many applications—one more rep in the gym or one more round on the training course. But for you in the O&P business, I wonder what you think about when you hear that?”

The 2023 Hans Georg Näder Digital Education Award went to “The Impact of Sensor Technology on Bracing Outcomes for Knee Osteoarthritis: A Randomized Clinical Trial,” by Andrew McDaid, BE(HONS), PhD (middle left), and Freeborn Mondello, DPT (middle right), presented by Jeff Erenstone, CPO (far left), and Andreas Kannenberg, MD (GER), PhD (far right).

Marty Carlson, MS, CPO, FAAOP (D) (above left), and Össur Kristinsson (middle), were honored with the AOPA Lifetime Achievement Award.

A group of advocates in New Mexico were honored with the 2023 Legislative Advocacy Award in recognition of their efforts on the So Every BODY Can Move initiative in their home state.

Keynote Speaker Josh Sundquist, a Paralympic skier, comedian, and author, entertained and motivated Assembly participants during the Opening General Session.

Abigail Citterman from Northwestern University was awarded the Edwin and Kathryn Arbogast Student Poster Award for “Transcutaneous Electrical Nerve Stimulation at the Wrist as a Method to Restore Sensory Feedback for Individuals With Partial Hand Amputation.”

Two presentations were honored with Thranhardt Awards: “Upper-Extremity Myoelectric Interface and Control Methodologies,” by Matthew Wernke, PhD (far left), and “Microprocessor Stance and Swing Control Orthosis for Patients Dependent on a KAFO for Walking,” by Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) (middle left) and Andreas Kannenberg, MD (GER), PhD (middle right), presented by AOPA Clinical Co-Chair Tyler Klenow, MBA, MS, LPO, CPO (far right)

Yasir Aljahani from University of Pittsburgh was awarded the Otto and Lucille Becker Student Poster Award for “Reasons for AFO Abandonment by Children in Saudi Arabia.”

In addition to hundreds of innovative O&P products and technologies, the 2023 Exhibit Hall featured a performance by members of the Indiana University Wheelchair Adaptive Team and a remote-control race car challenge.

One of the most popular sessions at this year’s Assembly was “The 2023 Ultimate Guide to Bone-Anchored Limb Prosthetics,” led by Christopher Hoyt, CPO (above right) ; Kimberly Hoyt, CP; Jon Holmes, CP, PT (above left) ; and Haris Kafedzic, MPO, CPO.

Manufacturers’ Workshops included Next-Generation 3D Scanning Intelligence—Foot Measurements With or Without a SensorStructure

Other educational sessions proved similarly inspiring.

A panel on 3D printing in prosthetics explored common concerns about adopting the technology, as well as its clinical applications. Jeff Erenstone, CPO, co-founder of Operation Namaste, said he’s embracing the technology when it makes sense for his patients and business model, but he’s not ready to totally abandon more traditional approaches to care.

“I’m looking at where can I use something digital…and where can I use the tried-andtrue because it works really well,” Erenstone explained. “Every one of the projects I do, I look at using a little bit of the new and a little bit of the old.”

Brent Wright, CP, a clinician at EastPoint Prosthetics and Orthotics experienced in 3D printing, urged more collaboration among experts across the O&P field—including prosthetists, engineers, researchers, and others—to advance the industry. “Let’s all work together to come up with better clinical outcomes using our expertise in the various arenas,” said Wright.

A half-day workshop on osseointegration—a growing trend in the U.S. in which a metal implant is directly anchored to

the bone and attached to a prosthetic limb—challenged participants to rethink the future of patient care. The husbandand-wife team of Christopher Hoyt, CPO, CP, and Kimberly Hoyt, CP, of BioDesigns, and Jon Holmes, CP, PT, of Holmes Prosthetic Center, walked attendees through the basics of the surgery, patient care, componentry, and billing. In addition, real-life beneficiaries offered an up-close vantage point to see the results and shared testimonials about how the procedure has changed their lives.

Meanwhile, patient outcomes and measurement were the topic of multiple session conversations, including a symposium focused on practical application of outcomes to justify medical necessity, reimbursement, and clinical decision-making. Kicking off the conversation, Tyler Klenow, MSPO, MBA, CPO, FAAOP, senior clinical research associate, Ottobock Healthcare, challenged attendees to rethink concerns about administrative burdens when collecting outcome data.

“We as clinicians often say, ‘I don’t have enough time for it’, right? And I would propose … that this is not true because we already do the stuff, we just don’t write it down.”

The Sam. E. Hamontree Business Education Award was created to recognize the best business papers submitted for presentation at the AOPA National Assembly. This year’s nominations included “Nine Nuances of ‘99’ Codes… a Payer’s Perspective,” by Dale Berry, CP, FAAOP, LP (left), and “Clinical Quality Improvement as a Foundational Business Strategy,” by Gerald Stark, PhD, MSEM, CPO, LPO, FAAOP(D) (right)

Another session popular among attendees was “Using Outcome Measures to Justify Medical Necessity, Reimbursement, and Clinical Accountability in Real Life,” presented by Andreas Kannenberg, MD (GER), PhD; Tyler Klenow, MSPO, MBA, CPO, FAAOP; Jason Kahle, MSMS, CPO, LPO, FAAOP; and Jason Highsmith, PT, DPT, PhD, CP, FAAOP.

Attendees also enjoyed the session, “Smart Components: The Continuum of Data From Patient to Policy,” presented by Todd Farrell, PhD; Andreas Kannenberg, MD (GER), PhD; Levi Hargrove, PhD, MScE; Bart Phillips, MS; and Blair Lock, MScE.

The O&P Digital Showcase offered a hands-on opportunity for attendees to learn more about the newest technologies.

Klenow went on to offer tips for efficiently incorporating data collection into clinicians’ daily routine, as other speakers provided insights on the perspectives of payors and physicians.

Panelists in another session shared riveting insights from working in developing and war-torn nations to provide low-cost, life-changing humanitarian O&P care. Jack Richmond, CPOA, CFo, research and development advisor at Allard and former CEO of Amputee Coalition, said 35 million people around the world need access to prosthetic care but can’t get it. Richmond helped lead the design of a low-cost wooden below-theknee prosthetic system targeting amputees in remote villages. Over a couple of days, locals are trained to fit the device, which can last for several years under constant use.

“I just want to encourage you all to think outside the box,” Richmond said. “Let’s find some solutions. Let’s break down those barriers around the world.”

Blair Lock, MScE, CEO and co-founder of Coapt, a firm that specializes in advanced pattern recognition myoelectric control technology for upper-limb prosthetics, was among the speakers who participated in several panels that focused on the use of cutting-edge data to improve O&P care, billing, and other facets of the business. He struck a similar theme of innovation and inspiration.

“I think we could all agree that it’s a very lucky time to be working and developing in this industry in this new era of data,” Lock said. “It’s a very lucky time to be in O&P and to do something really beneficial.”

Those are just a few of the meaningful conversations that went on in Indianapolis. Rounding out the educational sessions, a bustling Exhibit Hall full of the latest O&P products and services and several networking opportunities allowed attendees to visit with colleagues and make connections for future collaborations— including meeting back up at next year’s Assembly, slated for Sept. 12-15 in Charlotte, North Carolina.

Editor’s Note: Content from the 2023 AOPA National Assembly is available virtually until December 20. View cuttingedge clinical and business sessions, download handouts—and earn CE credits! Login at AOPAassembly.org, or contact Assembly@AOPAnet.org with questions.

AOPA Membership Meeting

(Left) Mitchell Dobson, CPO, FAAOP, president-elect; and Teri Kuffel, JD, president, AOPA

(Right) AOPA Leadership

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Exceeding the Benchmarks

New York prosthetist shares the extraordinary experience of treating a determined patient with quadrilateral limb loss

In each issue of O&P Almanac, the Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Erik Schaffer, CP, who teamed up with a patient with quadruple amputations to complete a fast-paced rehabilitation and conquer ambitious goals.

Erik Schaffer, CP, sees patients from all over the world at A Step Ahead Prosthetics in Hicksville, New York, but his most inspiring patient is Ilysa Winick. She “overcomes adversity at the highest level every single day,” says Schaffer, who has been her prosthetist since she lost all of her limbs in 2016. Contemplating his entire patient base, “nothing makes me prouder than watching” Winick get stronger each day, he says.

For the past seven years, Schaffer has spent countless hours and a great deal of energy keeping up with Winick’s aspirations, ensuring he fits her with components that allow her to do more before breakfast than most people do the entire day, he says. Despite wearing four prosthetic devices selected and fit by Schaffer, Winick “has absolutely zero limitations, other than the ones the technology sets for her.”

Grateful and Resolute

Winick, who is a mother of two boys, ages 13 and 11, lives in the Tribeca neighborhood of New York City and is founder and owner of a prep school in the city. In June 2016, she unexpectedly contracted a near-fatal blood infection that led doctors to induce a monthlong coma. To save her life, surgeons amputated her arms at the transradial level and her legs below the knee. The infection also caused end-stage renal failure, for which Winick eventually required a kidney transplant. Given a survival rate of less than 10%, Winick recovered from her infection grateful to be alive—and ready to be fit with prostheses as quickly as possible.

It’s not uncommon for some patients to become dispirited postamputation and to lose hope for the future—even after losing just one limb. But that was not the case for Winick. “Nothing was going to keep

Ilysa Winick, with her sons, was fit by Erik Schaffer, CP, with four prostheses after a near-fatal blood infection led to quadruple limb loss.

Erik Schaffer, CP

her down. ‘Can’t’ is not in her vocabulary,” Schaffer says. Over the years, he has fit nearly 100 quadrilateral limb loss patients with prostheses, but “I’ve never seen anyone like Winick.”

Once she was cleared for prostheses, Winick requested an “aggressive” timeline for fitting and delivery; she wanted to walk at a wedding. Surprised at Winick’s commitment to walking on prostheses so quickly, Schaffer was determined to assist her in her journey. She still had open wounds, so Schaffer had to design and fit her wounds with bandages protected by special antibacterial socks, and silicone locking liners. She was walking in her FlexFoot systems in just two weeks. “She barreled through the rehabilitation process,” he says.

The initial fittings were complicated. Before her transplant, Winick was on dialysis several times a week, which triggered massive swelling. But Schaffer accommodated both Winick’s schedule and her body weight fluctuations to ensure successful fittings.

Winick also requested to be fit with prosthetic hands at the same time as she received her lower-limb prostheses, recalls Schaffer—and she figured out how to use them in no time. “Within five minutes of putting on bilateral below-elbow prostheses [myoelectric multiarticulating devices], she was eating by herself.”

Her Best Life

Fortunately, says Schaffer, Winick was in great shape at the time of her amputations: She had adhered to a six-day-a-week gym regimen prior to the infection. In the hospital postamputation, she created a workout for herself to strengthen her forearms and help prevent muscle atrophy.

She quickly learned to use the prostheses all day, from the moment she gets

up—usually at 5 a.m.—until she goes to bed. She wears her prostheses in the shower, and she has learned to don all of her prostheses by herself without assistance. “The hardest part is the liner,” explains Schaffer, so he designed systems for easy donning.

Using her prostheses, Winick can perform all of the regular activities of daily living, including feeding herself, brushing her teeth, washing her face, putting on makeup, using a laptop, and holding cups. Beyond that, she completes the typical “mom tasks,” including making her children’s meals, driving a car without assistive devices, taking her kids to school and back, volunteering as a room parent, and more. Returning to those parental tasks were “privileges” rather than chores, according to Winick. She also spared no time in returning to her full-time job at the prep school.

As Winick tried more complicated tasks and engaged in new activities, she consulted with Schaffer, who helped her adapt and add componentry necessary to achieve her goals. He eventually switched her lowerlimb devices to Fillauer XTSs. “She started out with systems that had covers that looked like her [limbs preamputation], and high-heel adjustable feet, but she no longer wears covers,” he says.

Winick continues to work out to stay fit, with the assistance of her prostheses.

Winick wears her prostheses all day long and easily traverses stairs and uneven terrain.

She learned to work out at the gym, ride a bicycle with her prostheses, travel around the world, and much more. “She is the most inspiring person on the planet,” says Schaffer. He recalls that when she first tried skiing with prostheses, she was adamant that she did not need assistance. “She only used a disabled snow instructor on the first day, then went out on her own after that.”

The excessive wear-and-tear on her prostheses is a problem for Winick, so Schaffer spends a lot of time fixing her devices and ordering replacement parts. “I probably see her more than any other patient because of this,” he says. “She comes in two to four times per year just to work on her lower-extremity devices,” Schaffer says. She also makes frequent visits to adjust or replace her upperlimb componentry, which includes three quick-disconnect hands per side. To prevent delays, Schaffer keeps several thousands of dollars’ worth of replacement

parts on consignment from the manufacturer—just for Winick.

She appreciates her current devices but is hopeful that manufacturers will produce more durable prostheses for individuals who wear them all day. “The hardest part for her to overcome is the mechanics,” Schaffer says. “Despite all of our skills as clinicians and her determination, there are no terminal devices that accomplish all of her needs.”

PHOTO CREDITS: A STEP AHEAD PROSTHETICS/ILYSA WINICK

Winick has traveled across the globe (above) and engages in many recreational activities, including skiing (right)

Schaffer credits his front-office and billing staff for securing proper reimbursement for much of Winick’s componentry, although some of the extras are not covered. “At the beginning, her insurance carrier denied her items because [the payor was] not used to quadrilateral patients,” says Schaffer. “But our office is well-versed in how to educate insurers, and we offer a lot of documentation” explaining medical necessity.

Optimal Outcomes

Thinking about Winick, Schaffer says, “I’ve never seen anybody take such control of their life.” While she spends a lot of time participating in activities that many limb loss patients would never even consider, “her biggest accomplishment is being able to take care of her family and be a mom,” says Schaffer.

As a prosthetist who has dedicated hundreds of hours to Winick’s rehabilitation and mobility journey, Schaffer says

the experience has been emotional. “It’s a deep relationship because we have to talk about everything,” he says. “We have some deep conversations.”

“We learn from all of our patients,” adds Schaffer. “From an economical point of view, the materials and components will never be reimbursed,” given the extra time devoted to her care, “but [the experience] has allowed me to continue to grow as a caregiver and medical professional. I am better equipped to help all patients because of Winick,” he says. Winick “never looks back—she only goes forward,” Schaffer adds. “If she can do it, anybody can do it.”

DO YOU HAVE A TRANSFORMATIVE PATIENT-CARE EXPERIENCE YOU’D LIKE TO SHARE WITH O&P ALMANAC READERS? Contact Editor Josephine Rossi, jrossi@contentcommunicators.com, with your story to be considered for an upcoming profile.

PHOTO CREDIT: A STEP AHEAD PROSTHETICS/ILYSA WINICK

Winick appreciates the ability to be able to take care of her family and be a mom.

HISTORY: 22 years

East Coast Access

Facility staffs O&P specialists and partners with area hospitals

Bobby Siverd was introduced to the O&P world by his uncle, Stephen Siverd, CPO, one of three owners who established Coastal Prosthetics and Orthotics in Norfolk, Virginia, in 2001. The younger Siverd began working in the fabrication lab one summer during college, and he soon became a full-time employee. His interest in the field grew: He earned his orthotics certificate at Northwestern University, completed his residency at Coastal P&O, and became certified in 2009.

After six years, Siverd became a partner at Coastal P&O. He eventually purchased the business, along with his wife, Brittany, who serves as administrative executive.

Coastal P&O has five offices: one each in Chesapeake and Newport News, Virginia; two in Virginia Beach, Virginia; and one in Elizabeth City, North Carolina. The clinical team includes four CPOs, three COs, two residents, and a certified orthotic fitter/pedorthist. Each clinician brings a specialty to the table: Siverd focuses on pediatric patients, while others specialize in scoliosis, upper-extremity prosthetics, and cranial remolding helmets.

Outgrowing its original office in Norfolk, Coastal moved its main office to Chesapeake in 2019, building a custom facility that houses a central fabrication laboratory. The practice embraces new technology and incorporates scanning technology into its work, including Orthomerica’s Star Scanner and five Spectra Scanners, which capture 3D images for use with cranial remolding helmets, scoliosis bracing, and prosthetics. Patients also benefit from more advanced devices, when appropriate. “We recently fit a couple of prosthetic patients with the new Xtremity socket,” says Brittany Siverd. “We can fit those more quickly with fewer appointments.”

Coastal P&O’s practitioners are on call 24 hours a day, seven days a week, for several local hospitals, including the Sentara healthcare system, Portsmouth Naval Hospital, and the local children’s hospital, Children’s Hospital of the King’s Daughters (CHKD). One of Coastal P&O’s Virginia Beach offices is located within the CHKD building.

Before the COVID-19 pandemic, Coastal P&O hosted the Go Baby Go program developed by a professor at

the University of Delaware. The program provides children with cerebral palsy and other mobility issues battery-powered Power Wheel cars that have been modified to allow them to move independently. “We took applications and selected four to six [patients] each time,” explains Siverd. “Twice a year, we would purchase the cars, and local high school and college students would help adapt them, with assistance from local physical therapists. The children would be able to take the cars home and work with their own PTs to learn how to use them.”

The facility also works with CHKD on its community events. Among them is a Halloween party for children with mobility issues. “It’s difficult for the children to go trick-or-treating in their neighborhoods. Instead, we participate in an event where local groups put a number of cardboard houses they have decorated in a large indoor space, and the kids are able to use assisted mobility devices to move from one to the next to get their treats,” says Brittany.

Coastal P&O recently hosted its first annual prosthetics performance clinic, open to any individual with limb loss. The facility teamed with Proteor to host an open house where patients could try different knees, ankles, and feet. “One woman was thrilled to find a new foot that allowed her to go back to work as a nurse,” recalls Brittany.

These community outreach efforts provide a forum for Coastal P&O to give back to the community while marketing the facility’s services. The Siverds have found that word of mouth is an effective way to reach new partners and patients.

The company’s slogan, displayed on a wall in the main facility, is “Helping today’s patients step forward into a better tomorrow.” Looking at Coastal P&O’s “tomorrows,” the Siverds’ focus is not on growth, necessarily, but on “perfecting what we have,” says Siverd. “We will continue to follow emerging technologies and adopt them when appropriate, and we will continue to be a residency site because we want to employ and help teach the future of the field.”

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

FACILITY: Coastal Prosthetics and Orthotics

Bobby Siverd, CO, works with Mike Hays, CO, in the lab.

Coastal P&O hosted the Go Baby Go program to provide battery-powered cars to children with mobility issues.

A clinician works with a prosthetic patient.

OWNER: Bobby Siverd, CO, and Brittany Siverd

LOCATION: Virginia Beach, Newport News, and Chesapeake, Virginia, and Elizabeth City, North Carolina

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BY DEBORAH CONN

LOCATIONS: Montreal, Quebec, Canada

HISTORY: Three years

Air Expansion

Canadian company targets fluctuating volumes with transtibial adjustment system

Avery personal story led to the creation of Ethnocare and its first product, a transtibial flexible sleeve that integrates a new type of adjustment system, called the Overlay™. Twelve years ago, Line Boivin lost both her legs below the knee due to sepsis. Her son, Louis-Philippe Garneau, watched her struggle to find prostheses that fit comfortably and didn’t cause pain or injury.

“We decided to find a solution,” he says. “The main problems were the changing volume of the residual limb and the heat that built up in the socket.” Garneau approached a fellow student in product design at Laval University in Quebec City, Marc-Antoine Malouin. The two decided to start a business “to make a real impact,” says Garneau. A third founder, mechanical engineer Vincent Breton, soon joined the team, which now comprises 15 employees.

The company’s name, Ethnocare, derives from the human-centered approach and ethnological methodologies applied to care that the three used in designing the Overlay, according to Garneau. The system is a retrofit solution that transforms traditional sockets into adjustable ones. It is made of a breathable fabric and features an adjustable air expansion system, fitting over the liner and into the socket. Because air is a compressible fluid, “it will only go where it will be needed, resulting in a more uniform pressure inside the socket,” notes Garneau. “The fact that we use air, creating a cushioning effect for the comfort of the user, is a unique approach.”

The product goes up to 15-ply in volume compensation, which is accomplished with an initial thickness of about 2-ply, so there is no buildup of material in the popliteal fossa, Garneau says. “It gives much more support to the residual limb, resulting in less movement in the socket.” Using the device “is a way to reduce pain and enhance the comfort and mobility of the user.” Garneau knew the team had succeeded when his mother gave her stamp of approval.

The Overlay first entered the market in Canada earlier this year and is now available in the United States. The device is designed to be appropriate for transtibial amputees who experience volume fluctuations. It is compatible with most existing liners,

types of sockets, suspension sleeves, distal fixations, and passive and active vacuum systems, according to Garneau.

The company partners directly with patient-care facilities and distribution channels in Canada, the United States, Asia, and Europe, and it works with clinical sites to research new products. “We want to make sure our devices meet the needs not only of patients, but of clinicians as well,” he says. Ethnocare provides online training and presentations to explain the details of the product, but Garneau says extensive training is not required because the Overlay is a retrofit product that works with existing sockets. “We want to make sure the clinicians understand all the safety considerations,” he says, “but it is very simple to use.”

The team is working on several devices, among them a transfemoral version of the Overlay. “Our mission is to empower people with physical limitations to reach their full potential,” Garneau notes. “And we don’t want to limit ourselves to prosthetics; orthotics is also an interesting market for us.”

Garneau views the evolution of O&P technology with great interest. “Over the past five to 10 years, it has been driven by a combination of factors, including digital tech, artificial intelligence (AI), and materials science,” he says. “The integration of these and sportswear technology can be translated into the O&P field to create a more seamless interface with the body.” He believes that new technologies, such as 3D printing and scanning, enable more personalized care and better fitting devices. “Algorithms and AI can predict and adapt to users’ movement in real time, using sensors for better feedback, and making products more responsive.”

Garneau also notes that augmented and virtual reality can help patients with training during the rehab process. “As a company, we want to be on the forefront of these changes,” he says. “We are investing in research and development to take advantage of new technology, materials, and AI to make our products more user-friendly, durable, and comfortable.”

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

A patient wearing an Overlay

Ethnocare founders LouisPhilippe Garneau, Marc-Antoine Malouin, and Vincent Breton

OWNERS: Louis-Philippe Garneau, Marc-Antoine Malouin, and Vincent Breton

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The 2023 Illustrated Guide is now available! Purchase this easy-to-use digital guide, featuring the Healthcare Common Procedure Coding System codes for orthotics, prosthetics, and shoes. The 2023 Illustrated Guide is a digital product; you will receive a PDF file to view digitally or print on your own.

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Welcome New AOPA Members

Manometric B.V.

Loire 124

2491 AJ Zuid-Holland

The Hague, Netherlands manometric3d.com

Robin Jones, MSc International Company

Quantum Prosthetics & Orthotics LLC

9050 W. 81st Street, Ste. 300 Justice, IL 60458 312-300-4472 quantumpo.com

Vikram Choudhary, CPO Patient-Care Facility

Rehab Engineering LLC 1719 Mahan Drive Tallahassee, FL 32308 850-656-3599

rehabengineeringllc.com

Jeffrey R. Fredrick, CPO Patient-Care Facility

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

Ypsilon® FLOW ½ & ToeOFF® FLOW 2 ½

FLOW AFOs are Allard’s newest generation of AFOs fabricated with a new proprietary formula that offers increased range of motion in the sagittal plane and smoother transition (flow) throughout the gait cycle. The footplate is shaped to allow more clearance for the forefoot in the shoe toe box. Plus, both Ypsilon® FLOW ½ and ToeOFF® FLOW 2 ½ are designed to accommodate lower shoe heel heights, fitting more shoe styles.

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Children’s Foot Orthotics by Apis

Newly designed children’s foot orthotics feature a semirigid extended heel cup in UCBL style for extra ankle control and support. The orthotic is covered with an 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.

PROSTHETIC LOCKS WHATEVER LIFE BRINGS

Prosthetics & Or thotics

Sand, Mud, & Water Resistant

Coyote Prosthetic Locks

Coyote® makes the all-terrain vehicles of prosthetic locks. They are sand, mud, and water resistant. The Air-Lock and Easy-Off Lock are airtight dual-suspension pin systems that minimize pistoning through suction to create added comfort. These locks are also available as drop-in locks for 3D-printed sockets. Coyote® has a line of zero-clearance locks and low-clearance locks that are designed to be comfortable and hold up to the elements, also to minimize pistoning, and rotation. Coyote’s locks are tough enough for extreme activities and comfortable enough for everyday use. For more information, contact Coyote® at 208-429-0026 or visit coyote.us

The Original Preflexed Suspension Sleeve

ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement.

For more information, call ESP LLC at 888-932-7377 or visit wearesp.com

Ethnocare™: Overlay™

The Overlay uses air to manage the changes in below-knee limb volume. It is composed of a thin breathable fabric sleeve with an integrated air expansion system that can be adjusted by the wearer for daily personalized comfort. The Overlay goes over the liner and inside the socket. A silicone print design inside the Overlay ensures a snug fit with the liner and prevents slipping.

For more information, contact us at clinics@ethnocare.ca or go on our website ethnocare.ca

Naked Prosthetics

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Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800-301-8275, for a free sample.

offers four finger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger.

™

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The Xtern Line: A Step Up for Foot Drop By Turbomed Orthotics

Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function.

The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

SHARE YOUR UPCOMING EVENT WITH O&P PROFESSIONALS

Contact Bob Heiman at bob.rhmedia@comcast.net

September 1–31

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at abcop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit abcop.org/contact-us

September 20–November 20

AOPA National Assembly. Virtual education available online. For more information, visit aopanet.org

October 13–14 (Note Corrected Dates)

PrimeFare Central. Tulsa Renaissance Hotel and Convention Center. In-Person Meeting. Contact Cathie Pruitt at 901-359-3936, pruittprimecare@gmail.com; or Jane Edwards at 901-487-6770, jledwards88@att.net For more information, visit primecareop.com

November 8–10

New Jersey AAOP Annual Meeting. Harran’s Resort, Atlantic City, NJ. Visit njaaop.org

Live and Online/On Demand CEs

The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/Diabetic_Series_LMS_List

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Full-year series: AOPA member $790; Nonmember $1,999 Individual webinar: AOPA member $79: Nonmember $199 Register for the series at My AOPA Connection

Share Your Calendar Event

September 12–15

AOPA National Assembly. Charlotte, NC. For more information, visit aopanet.org

Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at bob@rhmedia.comcast.net or learn more at bit. ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder 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.

Policy Changes

New rules in Arizona, Illinois, and Ohio

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 adjustments, state association announcements, 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 AOPAnet.org/resources/co-op.

Arizona

Arizona Medicaid’s reference system has removed age limitations to allow the provision of prostheses to enrollees younger than 4 years old, in alignment with pediatric policy that indicates no age limit, as long as care is medically necessary and appropriate. This is a developing story, and AOPA will provide updates as the situation evolves and documentation is published.

Illinois

House Bill (HB) 1384, which requires that medically necessary reconstructive services that are intended to restore physical appearance be covered by state commercial plans and Medicaid, was signed into law by Gov. JB Pritzker in mid-July. The bill takes effect Jan. 1, 2025.

Ohio

The Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board has introduced rules regarding state licensure requirements. These changes explain the process of obtaining a license through unique and

The Latest From So Every BODY Can Move

Here are the most recent developments in the So Every BODY Can Move initiative, which advocates for a policy solution rooted in dignity and justice by empowering state-by-state legislative action, expanding access to medically necessary orthotic and prosthetic care for physical activity.

Illinois: Senate Bill 2195, which requires commercial plans in the state to cover orthoses and prostheses intended for physical activity for enrollees of all ages, has been signed into law by Gov. JB Pritzker as of early August. The bill will take effect Jan. 1, 2025.

exceptional circumstances and eliminate references to temporary licenses and supervision.

The rules are intended in part to implement the provisions of HB 509, which was passed in 2021 and eliminates temporary

Massachusetts: House Docket 4491, which requires that state commercial plans, public employee plans, and Massachusetts Medicaid provide coverage for activityspecific devices, including repair and replacement, was introduced in late July. Steve Slawinski, CO, FAAOP, clinic director at Boston Orthotics and Prosthetics, and Maggie Baumer, JD, president of the National Association for the Advancement of Orthotics and Prosthetics, assisted in the effort.

licenses for orthotics, prosthetics, and pedorthics.

For more information on these and other state developments, visit the AOPA Co-OP or contact Sam Miller at smiller@AOPAnet.org

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