September O&P Almanac

GET TO KNOW PDAC’S ADVISORY ARTICLES P.10

MEET THE 2024 AOPA AWARD WINNERS P. 24

TRANSFORMATIONS: UNIQUE PARTIAL-HAND SOLUTION P. 32

Outcomes Measures Matter

Tips for building a more robust OM program P.16

THIS JUST IN: THREE NEW HCPCS CODES TAKE EFFECT OCT. 1 P.14

Mark your calendars September 3–6, 2025, for an ideal combination of top-notch education and entertainment at the 108th AOPA National Assembly in Orlando, FL, at the Orange County Convention Center (OCCC).

EARN CE CREDITS

EXHIBITS EDUCATION NETWORKING

AOPAASSEMBLY.ORG

More O&P facilities are embracing evidence-based practice as the U.S. healthcare landscape shifts toward value-based care. Experienced clinicians share strategies for expanding outcomes measures programs within facilities and discuss new technologies that facilitate the process.

By CHRISTINE UMBRELL

Learn about three new HCPCS codes that take effect Oct. 1, and find out which two orthotic codes were recently updated.

Some of the brightest minds in O&P were recognized during the AOPA National Assembly in Charlotte, North Carolina, when AOPA bestowed prestigious awards to recognize clinical, digital, business, advocacy, and lifetime achievement excellence.

By DEBORAH CONN

AOPA Contacts

A world where orthotic and prosthetic care transforms lives.

Board of Directors OFFICERS

President

Mitchell Dobson, CPO

Hanger Clinic, Austin, TX

President-Elect

Rick Riley

O&P Boost, Bakersfield, CA

Vice President

Kimberly Hanson, CPRH Ottobock, Austin, TX

Treasurer

Chris Nolan

Össur, Foothills Ranch, CA

Immediate Past President

Teri Kuffel, JD

Arise Orthotics & Prosthetics, Spring Lake Park, MN

Executive Director/Secretary

Eve Lee, MBA, CAE

AOPA, Alexandria, VA

DIRECTORS

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

Adrienne Hill, MHA, CPO(L), FAAOP Kennesaw State University, Kennesaw, GA

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

James Kingsley

Hanger Clinic, Oakbrook Terrace, IL

Lesleigh Sisson, CFo, CFm OrthoPro of Carson City Carson City, NV

Matt Swiggum Proteor, Tempe, AZ

Linda Wise

Fillauer Companies, Chattanooga, TN

Shane Wurdeman, PhD, CP, FAAOP(D) Research Chair

Hanger Clinic, Houston Medical Center, Houston, TX

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

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

Office: 571-431-0876

Fax: 571-431-0899

AOPAnet.org

AOPA Staff

EXECUTIVE OFFICES

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

Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

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

MEETINGS & EDUCATION

Ashley Vande Bunte, CMP, director, meetings and education, 571/431-0860, avandebunte@AOPAnet.org

Kelly O’Neill, CEM, assistant director, meetings and exhibitions, 571-431-0852, kelly.oneill@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS

Joy Klapp, director of communications and membership, 571-431-0817, jklapp@AOPAnet.org

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

Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org

AOPA Bookstore: 571-431-0876

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

O&P ALMANAC

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

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

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

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

Christine Umbrell, editorial/production associate and contributing writer, 703-662-5828, cumbrell@contentcommunicators.com

PUBLISHER EVE LEE, MBA, CAE

EDITORIAL MANAGEMENT CONTENT

COMMUNICATORS LLC

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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.

ADDRESS CHANGES

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Copyright © 2024 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.

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Share your message with AOPA membership— approximately 9,000 orthotic and prosthetic professionals, facility owners, and industry personnel. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net. Learn more at bit.ly/24AlmanacMediaKit.

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Happenings

RESEARCH ROUNDUP

TEAM USA

BRINGS HOME PARALYMPIC MEDALS

Team USA won a total of 105 medals during the 2024 Summer Paralympic Games in Paris, including 10 gold medals each in track and swimming events.

Gold 36

Silver 42 Bronze 27

SOURCE:

Women With Limb Loss Challenged By Perspiration, Footwear

Researchers at the Minneapolis VA Health System, led by Nicole Walker, MS, CPO, conducted a qualitative evaluation of the experiences of women veterans with limb loss in regard to their perceptions around participation in social roles. Via focus groups and discussions, the researchers discovered that participants struggled with specific challenges.

Participants reported issues with heat and sweat within their prosthesis, at times experiencing “slipping” and “sliding” due to sweat buildup and the need to doff their prostheses to dry and clean them. Some women had discontinued activities when their liners filled with sweat. Participants tried to limit sweat via antiperspirants, botulinum toxin injections, and thin absorbent garments designed to be worn under the liner, but most desired more effective technologies and strategies for managing sweat.

The research team also found that women veterans have varying perceptions of “self” after amputation, sometimes experiencing frustration and self-consciousness as well as feelings of “withering away.” Maintaining and exhibiting independence and self-sufficiency was of great importance to the participants. In addition, most women indicated they

ABANDONMENT RATES DIFFER BY RACE, GEOGRAPHY

Non-Hispanic Black veterans who live in a rural area, with and without major depressive disorder, are more likely to abandon their prosthesis and less likely to achieve advanced mobility, compared with Non-Hispanic White and Hispanic individuals.

SOURCE: “RACIAL

encounter challenges in finding appropriate footwear for their prostheses.

“Rehabilitation professionals providing care to women veterans with lower-extremity amputations should prioritize optimizing participation when selecting interventions and prosthetic components,” said Walker. She notes that women desire care that incorporates their gender identity into decision making, so “rehabilitation care teams should become educated about and engage in gender-aware healthcare practices.” The study was published in August in Prosthetics and Orthotics AMPUTEE

Hip Muscles Impact Prosthesis Users’ Walking and Balance

Amid growing evidence that hip strength plays a critical role in the safety and efficiency with which lower-limb prosthesis users walk, researchers Andrew Sawers, PhD, CPO, and Stefania Fatone, PhD, BPO(Hons), conducted a study to evaluate the relationship between isometric measures of residual and intact limb hip strength and walking and balance performance. They recruited 14 transtibial and 14 transfemoral unilateral prosthesis users as study participants to determine whether residual and/or intact limb isometric hip strength was associated with walking speed, endurance, and balance.

Residual limb hip extensor strength was found to be the primary hip strength determinant of transtibial prosthesis users’ walking speed and endurance. Among transfemoral prosthesis users, however,

intact limb hip abductor strength was found to be the only isometric measure of hip strength that explained a significant proportion of walking speed and endurance.

Results suggest that prosthetic users’ walking and balance performance may depend on different hip muscles as well as different facets of hip strength.

“The ‘intact leg strategy’ adopted by transfemoral prosthesis users may be due to a variety of prosthesis and biomechanical factors that limit the efficiency with which transfemoral prosthesis users can exploit the strength of their residual limb hip muscles while walking,” the researchers noted. “Amputation level-specific hip strength interventions may therefore be required to improve walking and balance performance in unilateral transtibial and transfemoral prosthesis users.” The study was published in PM&R in August.

AMPUTATION PREVENTION

AHA Publishes Roadmap

To Reduce Risk of PADRelated Amputation

The American Heart Association (AHA) has developed guidelines to promote early diagnosis and treatment of peripheral artery disease (PAD) as well as coordinated patient care from a multidisciplinary team to prevent amputations and other cardiovascular complications. The guidelines, which were published in the AHA journal Circulation and the Journal of the American College of Radiology, provide detailed diagnostic and treatment recommendations for asymptomatic PAD, chronic symptomatic PAD, and two more severe forms of the disease. The guidelines support prescribing medications that prevent blood clotting and lower blood pressure and blood glucose levels to help prevent amputation.

By the Numbers

O&P HONORS

SACHS NAMED WOMAN OF THE YEAR

Orthotic Prosthetic Group of America presented the 2024 O&P Woman of the Year award to Sheryl Sachs, MSPO, CPO, during the AOPA National Assembly. Sachs, a clinician and residency mentor at Dankmeyer Inc., volunteers and advocates for the profession and its patients via AOPA, So Every BODY Can Move, the American Academy of Orthotists and Prosthetists, and the National Commission for Orthotic and Prosthetic Education. Also nominated were Justi Appel, PhD, CO, BOCP, LPO; Jenna Calomeris; and Sara Peterson, PhD, CPO, LPO, FAAOP(D).

CBO Publishes 10-Year Health Insurance Projections

From left: Jenna Calomeris; Sheryl Sachs, MSPO, CPO; and Sara Peterson, PhD, CPO, LPO, FAAOP(D)

IN MEMORIAM

H.E. “Ted” Thranhardt, CPO(E), passed away in late June. Thranhardt served the O&P profession throughout his lifetime, working at Hanger Orthopedic Group, now Hanger Clinic, from 1958 until 2010. He was honored with AOPA’s Lifetime Achievement Award during the 2002 AOPA National Assembly in Chicago.

“Ted Thranhardt left a lasting impact on Hanger and the entire O&P profession,” said James Campbell, PhD, senior vice president and chief clinical officer at Hanger Inc. “From his thoughtful leadership during his notable tenure at national organizations like AOPA, the American Academy of Orthotists and Prosthetists, and the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, to playing an instrumental role in the evolution of Hanger’s success, Ted’s vision, passion, and commitment to the field will forever be remembered. We will honor his legacy and 50-plus years of dedication to the O&P community by continuing to advance the field and keeping patient outcomes at the forefront of everything we do.”

Steve Kramer, CPO, passed away in June at the age of 81. He was highly involved in the American Academy of Orthotists and Prosthetists; the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, serving as an examiner for many years; and AOPA.

Kramer, who lost his leg above the knee during a motorcycle accident when he was 17, attended the O&P program at Northwestern University. He worked for Hanger in Chicago in the 1960s, then became a partner in Universal Orthopedic; he eventually bought out the other partners, making him the sole owner.

After eventually selling Universal Orthopedic, Kramer founded Woodfield Orthopedic in 1985, which he ran until 2000, when he sold the business to his son, Brett Kramer, CPO, LPO. “We worked side by side for 15 more years until he eventually retired as I sold the company to Scheck & Siress in 2015,” said Brett Kramer, who continues to work for Hanger Clinic in South Barrington, Illinois. “His legacy lives on through me.”

PEOPLE

Mark Fowble has joined Allard USA’s sales team.

Fowble, who has a degree in business management and was a kicker for the North Carolina State University football team, has worked in the medical sales industry since the mid 1990s. Fowble has excelled in selling a wide array of medical products, including equipment and supplies for physician offices, hospital equipment, safety software, and injectables.

“We are excited to welcome Mark to the Allard family,” said Kelly Millard, Allard director of sales. “His proven track record and passion for medical sales will undoubtedly strengthen our team and enhance our ability to serve our clients.”

Adam Miller has been named vice president (VP) of government relations at VGM & Associates, effective Sept. 1. “From the very beginning of my time at VGM, I have had the privilege to travel across the country with and learn from VGM’s government relations team,” said Miller. “I am excited and humbled to transition to the role of VP of government relations and directly join the fight alongside our members.”

Miller previously held the role of president of OPGA, a division of VGM & Associates. In his new capacity, Miller will lead strategic engagement with VGM communities, aligning policy and practice with national initiatives.

Regina Weger has been appointed chief customer officer at OPIE Software. Weger brings with her a wealth of experience and a distinguished 30-year career in the O&P field.

Weger currently serves on the board of directors for the National Association for the Advancement of Orthotics and Prosthetics and is a former senior vice president for Hanger Inc. As chief customer officer, Weger will oversee the entire customer lifecycle journey.

BUSINESSES

The Hanger Foundation announced it will partner with five universities as part of the 2024-2025 Hanger Foundation Diversity Scholarship Program. The program was established in 2021 to help recruit underrepresented students into the O&P profession.

The O&P masters’ programs at Alabama State University, Kennesaw State University, Northwestern University, Salus at Drexel University, and University of Pittsburgh will award a two-year scholarship to students to help supplement the cost of their degree.

In addition to receiving a scholarship, all recipients will be offered a two-year mentorship with the option of pursuing a residency at Hanger Clinic. Students can apply directly through the MSPO program at their respective universities. For details, visit hangerfoundation.org/impact/scholarships

PREMIUM PRODUCT COLLECTION

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BY DEVON BERNARD

PDAC Primer

Examining coding verifications and advisory articles

With the recent expansion of codes that require prior authorization as a condition of payment, more codes now require mandatory written coding verification from the Pricing, Data Analysis, and Coding (PDAC) contractor. This month’s Reimbursement Page examines the PDAC and two key functions of the PDAC’s role in providing correct coding guidance: coding verifications and advisory articles.

What Is the PDAC?

Since late 2018, Palmetto GBA LLC has served as the PDAC contractor. Palmetto performs three main functions in this capacity:

• It establishes and distributes pricing files for items and services categorized as durable medical equipment, orthotics, prosthetics, and supplies (DMEPOS)

• It provides data analysis to identify utilization patterns of Healthcare Common Procedure Coding System (HCPCS) codes to help support the functions and duties of the Unified Program Integrity Contractors or any other state or federal agencies

• It conducts HCPCS coding verification to establish coding guidance for specific items or services to provide manufacturers and suppliers guidance on the proper use of HCPCS codes; this

guidance on proper coding sometimes leads to the PDAC submitting code applications and requesting the creation of new HCPCS codes, such as with the new code L1681 in 2023.

PDAC Coding Verification

Coding verification may be a voluntary process wherein manufacturers request a Medicare-approved coding decision for their product or service. However, a coding verification also may be mandated by a policy article or other durable medical equipment Medicare administer contractor (DME MAC) announcement as a requirement for payment. It is the

duty of the PDAC to review these products and requests to provide the appropriate HCPCS code for Medicare billing.

Ten categories of O&P services and 75 HCPCS codes require PDAC coding verification as a condition of payment. The largest category is spinal orthoses [cervical, thoracolumbosacral (TLSO), and lumbosacral (LSO)], which includes 48 different HCPCS codes/orthoses. All of the categories and a detailed breakdown by HCPCS code are included in the sidebar on page 12.

The newest items added to the mandatory PDAC review list in 2024 include K1007, L1843, L1951, L8701, and L8702. The mandatory coding verification for K1007 (bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or

without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors), L8701 (powered upper-extremity range-of-motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated), and L8702 (powered upper-extremity range-of-motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) became effective for claims with a date of service on or after June 1, 2024.

The effective coding verification date for L1843 (knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric),

medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise) and L1951 (ankle-foot orthosis, spiral, [Institute of Rehabilitative Medicine type], plastic or other material, prefabricated, includes fitting and adjustment) is for claims with a date of service on or after Dec. 1, 2024.

The L1843 and L1951 are also two of the newest codes subject to prior authorization for claims with dates of service on or after Aug. 12, 2024. The other new codes subject to the Aug. 12, 2024, prior authorization implementation date—L0631, L0637, L0639, and L1845—already required PDAC coding verification.

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HCPCS Codes Requiring PDAC Coding Verification

Therapeutic Shoes for Person With Diabetes

A5512

A5513

A5514

Spinal Orthoses, Prefabricated

L0174

L0450

L0452

L0454

L0455

L0456

L0457

L0458

L0460

L0462

L0464

L0466

L0467

L0468

L0469

L0470

L0472

L0480

L0482

L0484

L0486

L0488 L0490

L0491

L0492

L0625

L0626

L0627

L0628

L0629

L0630

L0631

If you provide a product or item described by one of the codes listed in the sidebar or above and the PDAC has not made and published a coding verification, your claim will be denied as incorrect coding. How can you check and see if a product or item has received a published PDAC coding verification? Palmetto maintains the Durable Medical Equipment Coding System at www4.palmettogba.com/pdac_dmecs/ as well as the Product Classification List (PCL). The PCL is your official record for all O&P items with a current and past PDAC coding verification.

Suppliers should note that for customfabricated spinal orthoses (cervical, TLSO, LSO) and custom-fabricated therapeutic shoe inserts that are fabricated in house and delivered directly to your patients, PDAC verification would not be mandated. However, you must be able to provide a list of the materials you used in the fabrication and a description of your fabrication process if requested. You must be able to demonstrate that your methods meet the standards and definitions found in the

L0632

L0633

L0634

L0635

L0636

L0637

L0638

L0639

L0640

L0641

L0642

L0643

L0648

L0649

L0650

L0651

Knee Orthoses

L1832

L1833

L1843

L1845

L1851

L1852

Ankle-Foot/ Knee-Ankle-Foot Orthoses

L1906 L1951

L2006

K1007

Upper-Limb Orthoses L3906

L8701

L8702

A

DMEPOS Quality Standards, Appendix C. This exemption of the PDAC coding verification may not apply to other items, unless it is stipulated in policy or other directive or interpretation.

Note that once a request for coding verification—whether voluntary or mandated—has been received and PDAC publishes its decision, the coding verification then becomes binding for Medicare purposes. Any claims submitted to Medicare must be coded according to the PDAC coding verification, and claims for items that

Lower-Limb Prostheses

L5856

L5857

L5858

L5969

L5973

L5980

L5987

Upper-Limb Prostheses

L6715

L6880

Surgical Dressings

A6545

Functional Electrical Stimulator

E0770

are coded in conflict with a PDAC coding verification will be denied as incorrect coding. Besides being binding for billing purposes, it should also be noted that PDAC coding verifications are normally productand model-specific; when viewing the PCL, check the product and model information as well, and not just the code or manufacturer.

PDAC Advisory Articles

In addition to providing coding guidance, PDAC conducts extensive data analysis to identify utilization patterns, or scenarios that cause high error rates. When PDAC notices a pattern of incorrect coding or billing, it will often publish, in corroboration with the DME MACs, advisory articles to provide clarification, education, or guidance regarding the proper coding for specific products or for a specific group of HCPCS codes.

A full list of the PDAC advisory articles is available on the PDAC website, dmepdac.com, under the “Topics” tab. As with traditional Local Coverage of Determinations (LCDs) and policy articles, the PDAC advisory

articles contain a revision history. When reviewing the advisory articles, check the revision history for any updates or changes. Examples of three different types of PDAC advisory articles include the following:

1. “Lymphedema Compression Treatment Items—Correct Coding and Billing”: First published in December 2023 and revised in March 2024, this article is a good example of the DME MACs and PDAC releasing important information and guidance when no current LCD or policy article exists. This article lays out and reinforces the legislation that created the new Medicare benefit category for compression garments—for example, providing scenarios when custom compression garments may be provided, and that it is acceptable to provide a patient with garments for both daytime and nighttime use. For a full recap of the lymphedema compression garment benefit category, visit the Reimbursement Page published in the January 2024 O&P Almanac. Other examples of advisory articles creating de facto policies would be the advisory articles for upperextremity orthoses (“Correct Coding of Elbow, Shoulder, Shoulder-ElbowWrist-Hand, and Shoulder-Elbow-WristHand-Finger Braces”) released in 2021, the robust but retired article for upperextremity prostheses.

2. “3D-Printed Orthotic Devices—Correct Coding”: Released in February 2024, this article is an example of the PDAC and DME MACs releasing guidance on an issue about which they had received numerous inquiries then determined it needed to be officially addressed, thus

creating a policy or guidance. This article states that 3D printing, or additive manufacturing, is an acceptable alternative to traditional custom fabrication, if the method used meets the definition of custom fabricated in the DMEPOS Quality Standards, Appendix C.

3. “Custom-Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf (OTS) Code—Correct Coding”: This may not be the newest advisory article, but it is one that is very important to review and is an example of providing information beyond what is found in LCDs and policy articles. Published March 12, 2021, this article focuses on HCPCS code descriptors for prefabricated items that only include the term “includes fitting and adjustment” and do not mention “off the shelf” or “customized to fit.” However, it also addresses other orthotic HCPCS codes that don’t have a corresponding OTS code. In 2014, CMS introduced a series of HCPCS code pairs that included both an OTS version and a version that requires custom fitting by an individual with appropriate expertise and or training—a customized-to-fit or custom-fitted version. A total of 51 orthotic HCPCS codes did not have their descriptors changed and continued to simply state, “prefabricated, includes fitting and adjustment” or didn’t mention the type of fitting at all, or did not have a corresponding OTS HCPCS code. The advisory article indicates that these 51 HCPCS codes are to be appropriately classified as custom-fitted orthoses, and therefore may only be used to describe orthoses that require customization and/or

modification by a certified orthotist or other properly trained individual at the time of fitting. The article then explains that if you deliver an orthosis described by one of these 51 codes, and it is delivered as OTS, without customization and/ or modification, it must be billed using the appropriate not-otherwise-specified code (L1499, L2999, L3999). So, when you are providing one of these 51 codes, such as L1932, document the custom fitting occurring at the time of delivery. The documentation should be detailed and not simply state, “Footplate was trimmed.” If no custom fitting, fabrication, or modifications were required, use the appropriate miscellaneous code.

In time, it is possible that these announcements may be incorporated into official Medicare LCDs and policy articles. A prime example is the “Custom-Fitted Orthotic HCPCS Codes Without a Corresponding OTS Code—Correct Coding” announcement. It was first released in March 2021 and was officially incorporated into policy in December 2023. However, note that PDAC advisory articles, even if they are not immediately incorporated into Medicare medical policies, carry the same weight as published coding verifications, and suppliers are expected to be aware of them and follow them as soon as they are published.

PDAC plays an important role in creating and publishing clarifying information related to correct coding and billing of O&P services delivered to Medicare patients. This information may sometimes go beyond what is found in Medicare LCDs and policy articles, and in some cases, provide information when no LCD or policy article exists. Because this information may impact your claims, you must be aware of and review the PDAC advisory articles and the PCL on a regular basis to maintain full compliance with approved Medicare coding and billing practices.

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

Orthotic Updates

New codes and code changes take effect Oct. 1

CMS has released its final determinations from the First Biannual 2024 Healthcare Common Procedure Coding System (HCPCS) code application meetings.

The final determinations resulted in three new HCPCS codes:

• L1006—Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps, and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L1653—Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf

• L1821—Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf.

In addition, CMS announced two code verbiage changes to L1652 and L1820 (changes in bold):

• L1652—Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

• L1820 —Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.

The new codes and code changes will be active and valid for claims with dates of service on or after Oct. 1, 2024.

Questions? Contact Joe McTernan, AOPA’s director of health policy and advocacy, at jmcternan@AOPAnet.org, or Devon Bernard, AOPA’s assistant director of coding and reimbursement, at dbernard@AOPAnet.org

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OUTCOMES MEASURES MATTER

Implementing or expanding an OM program? Early adopters offer guidance.

As the U.S. healthcare landscape accelerates its shift toward value-based care, it’s time for O&P clinicians and business owners to take stock of their commitment to collecting and analyzing outcomes measures (OMs). Over the past several years, many facilities stepped up their OM game, but “the percentage of facilities that are collecting and using them to the extent that they should be is extremely low,” says Tyler Klenow, MSPO, MBA, CPO, FAAOP, senior clinical research associate at Ottobock Healthcare and past chair of the Outcomes Research Committee for the American Academy of Orthotists and Prosthetists.

Leveraging OMs to document patient progression has clear benefits: “They help with diagnostics; they help you determine patients’ needs; they help you understand whether you’re providing the level of care that you think you’re providing” in an objective manner, explains Klenow.

NEED TO KNOW:

f Some O&P facilities have established clearly defined processes and procedures for capturing and analyzing outcomes measures (OMs), but others lack robust OM programs that enable evidence-based practice.

f Adopting OM strategies offers advantages in terms of diagnostics, objective decision making, and patient compliance.

f Both patient-reported and performance-based measurement tools are necessary to inform a comprehensive OM program—but there is no onesize-fits-all set of measures.

f Facilities can use aggregated OM data that demonstrates how particular segments of their patient base have improved with their care to inform conversations with payors and referral sources.

f Smaller facilities that can demonstrate the value they provide via promising OM data and reports can gain an advantage in negotiations with payors over facilities that don’t have comparable data to share.

f Several new technologies, such as advanced activity monitors and augmented-reality systems, may assist facilities in their OM programs.

Revised Lower-Limb LCD Requires Ongoing Documentation

Several clinicians agree that outcomes measurement (OM) data was key to the revision of the Lower-Limb Prosthesis Policy Local Coverage of Determination (LCD) implemented in September 2024. The revision, which allows for coverage of microprocessor technologies for some K2-level limb loss patients, came after objective data was submitted, including 10 years of research and outcomes data demonstrating the benefits of advanced technologies for K2 patients by Ottobock’s research team, according to Tyler Klenow, MSPO, MBA, CPO, FAAOP, senior clinical research associate at Ottobock Healthcare.

“One of the driving forces behind the LCD was having OM data to show that” modern technologies helped K2-level ambulators, says Kathleen Carroll, MS, MSPO, CPO, FAAOP, Hanger’s outcomes program specialist. “It grants access to a whole new group of people, and the net benefit will be huge,” she says. “But, there will be some people who will not benefit in the ways we would expect—for example, due to advancement of a comorbid condition—and we will need to be able to explain why.”

Going forward, it will be critical to collect data to demonstrate that the LCD change was a viable decision and that the K2 patients who are covered for microprocessor devices have better outcomes, now that the LCD is in place. “The LCD puts the

“If we don’t have measurements in place for what we’re doing, how can we know that the [devices and adjustments] we’re making are actually improvements for our patients?” adds Dennis Clark, CPO, founder of Clark & Associates O&P Inc. “We always have a sense of how well we’re doing with our patients, but we need to be able to measure things in a common way so we can share the information. We can’t be afraid to be measured for what we do.”

In addition to driving appropriate patient care, “we also need to think about outcomes from a business perspective,” says Fanny Schultea, MS, MSEd, CPO, LP, FAAOP(D), an assistant professor at Baylor College of Medicine’s O&P master’s program and executive director of the O&P Foundation for Education and Research. In a competitive payor climate, “we must strive to measure quality to move in the direction of a value-based model (see sidebar on page 22), and to show payors and policymakers our value.”

Klenow agrees: “You can’t say your clinicians are ‘the best’ at something

emphasis on falls and prevention of falls for a K2 beneficiary to receive coverage,” says Klenow. “So, it needs to be documented that” patients who received approval for advanced devices have a history of falls, or fear of falling. He notes that some standardized tests have assessments related to fall risk, such as the Activities-Specific Balance Confidence test, the 10-meter walking test, and the Timed-Up-and-Go, as well as the Patient-Specific Functional Scale (PSFS) and Fear of Falling Scale. “Putting all of that information together” can assist a clinician in determining that a patient will benefit from microprocessor technology but also will help demonstrate that the LCD change was warranted.

Klenow advises clinicians to expect a greater emphasis on the distinction between K1 and K2 level ambulators. Before the revised LCD, “we were always trying to prove that patients” met K3 requirements if microprocessor technology was warranted, he explains. “Now, there may be emphasis on K1 versus K2, and we’ll need to demonstrate that patients will be out in the community and really need the technology.” He suggests taking OMs and documenting patients’ abilities via the PSFS, recording activities of daily living perhaps via the PLUS-M, and demonstrating and documenting social participation.

if you don’t know” how or where your clinicians are achieving comparatively better results.

Document Your OM Policy

It’s not enough to sporadically take a few outcomes measures and add them to patient files. Klenow suggests that facilities institute formal policies regarding OMs. That’s particularly important, he says, because “as an organization gets larger, you lose some oversight. Using a specific set of outcome measurements gives you standardizations and sets expectations, so everyone is providing a similar level of care.”

“The power of OMs comes from having consistency in collection,” agrees Kathleen Carroll, MS, MSPO, CPO, FAAOP, Hanger’s outcomes program specialist in the Department of Clinical and Scientific Affairs. Carroll, who is responsible for the development, implementation, and education regarding the O&P outcomes collection process at Hanger, emphasizes the importance of collecting data over a defined period, so you can determine whether the orthotic or prosthetic intervention is truly effecting change. “OMs help you capture the full story of a patient’s journey and can help develop plans of care.”

Tyler Klenow, MSPO, MBA, CPO, FAAOP

Kathleen Carroll, MS, MSPO, CPO, FAAOP

Dennis Clark, CPO

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Kathleen Carroll, MS, MSPO, CPO, FAAOP, right, works with a patient who is completing the Berg Balance Scale, a 14-item objective measure that assesses static balance and fall risk in adults.

Klenow recommends mandating that certain outcome measures be taken by all clinicians, with a schedule that aligns with patient progression. “Have a universal policy that will collect, for example, four specific measures at each appointment,” he suggests. Some employees will likely embrace the new approach willingly, but there will be others who “won’t do it unless you tie measures to incentives,” such as annual reviews or incentive bonuses.

For practitioners who are laggards on the innovation curve, Klenow suggests implementing procedures that relieve some of the burden from the clinician—by making greater use of patientreported outcomes and involving administrative staff or assistants in the process. “But also show them the value and reasoning behind your program and share what your organization will be doing with the data.”

Choose Appropriate Measures

Both patient-reported and performance-based measurement tools are necessary to inform a comprehensive OM program, but no one-size-fits-all set of measures exists for all facilities. “While the alignment of measures with patient goals is important, administering them consistently to be able to show change over time is key,” explains Carroll.

She suggests tailoring a “toolbox of specific outcomes measurements” that your facility regularly collects, so it “becomes routine and part of the everyday process.” There may be several different toolboxes to use, depending on the type of patient: lower-limb prosthesis users, lower-limb orthosis users, etc. “Then engage everyone in the office” to ensure staff help implement the defined outcome measurement tools during appointments.

Add Your Data to the LLPR

“We all need to participate in the Limb Loss and Preservation Registry (LLPR), so that the next time a damaging LCD is proposed, the profession will have the data in our pocket to push back,” says Tyler Klenow, MSPO, MBA, CPO, FAAOP, senior clinical research associate at Ottobock Healthcare.

The LLPR was created to collect data nationally for the acquired and congenital limb difference and limb preservation populations, for both upper and lower extremities. This collaborative data hub accumulates valuable data, integrating hospital, prosthetist, orthotist, and patient-reported outcomes data to produce a comprehensive view of patient care. The registry provides hospitals and O&P providers the opportunity to work together and revolutionizes management of patient care for healthcare professionals, insurance companies, and patients. Since its inception, the LLPR has grown quickly. As of June 2024, 10 participating hospital systems and 23 participating O&P practices were providing data to the LLPR from 221 locations throughout the U.S. Data from nearly 500,000 unique patients

and nearly 12 million episodes of care are housed in the registry, according to a summary of a presentation on the LLPR given at OTWorld. The registry has partnered with OPIE, OPSolutions, and Nymbl to make exporting the uniform data elements convenient. It is designated a Federal Risk and Authorization Management Program (FedRAMP) moderate impact level secure database. Providers push their data to the registry—the LLPR does not access a provider’s electronic medical records system.

Using data from the LLPR, practitioners and clinical leaders can evaluate treatment options and care plans to improve and maximize patient function; set meaningful, realistic, and consistent goals and objectives with patients and the care team; access insights that can lead to earlier care interventions and predictive indices; and critically assess the care provided compared to regional and national benchmarks. Subscription plans offer varying levels of benchmarking, progress, and performance. For more information, visit llpr.org

Use outcomes measures that are easiest to collect and compare against other data—“such as outcomes tools that are found in O&P software packages,” suggests Clark. “Then you can compare how your group is doing in managing specific types of amputations with similar comorbidities.”

Of the patient-reported outcome tools, the Prosthetic Limb Users Survey of Mobility (PLUS-M) and the Orthotic Patient-Reported Outcomes–Mobility (OPRO-M) are popular among O&P facilities and were developed by researchers at the University of Washington. “These are super accessible, available online, and specific to the patient populations we work with,” says Carroll.

As for performance-based OM tools, there are also dozens to choose from. Some of the most widely accepted versions include the Timed-Up-and-Go (TUG) and the two-minute walk test, as well as other timed and distance walking tests. “These can help provide context for how a patient’s perceived mobility translates into a realworld setting,” says Carroll.

Many outcomes assessments have been integrated into the software platforms facilities already use, says Carroll, which makes it easier for small facilities to develop OM programs. Several platforms feature the PROMIS tool—the Patient-Reported Outcomes

Measurement Information System—a set of person-centered measures that evaluate and monitor physical, mental, and social health. Administering measures digitally reduces some of the time required to capture the data.

Sharing OM data with patients in-clinic can have a motivating effect. “Providing information back and showing their improvement—especially if you can frame it in the context of your other patients—a lot of patients find that very valuable,” says Klenow. He also encourages clinicians to take videos while patients engage in performance-based measures to share with patients, explaining it spurs lower abandonment rates and higher patient satisfaction rates. Videos can be replayed in real time for the patient, then analyzed after the appointment for practitioner convenience.

Carroll agrees that outcomes measures “motivate patients” when they see their scores improving over time. And, if a patient scores lower than they expected, the objective data can help clinicians identify areas to improve. “We can look to see where they’re having trouble—for example, are they having difficulty on uneven terrain? Is there a suspension concern? Do they need to go to PT to improve their endurance? Do we need to switch out a component?” notes Carroll. “Our goal is to provide the best clinical care, and part of that care includes measuring and documenting how our patients are progressing toward their goals.”

Objective measures also are valuable when discussing client care with the referring physician: “You can celebrate successes together or facilitate conversations when additional care is needed,” says Carroll. Facilities can use aggregated OM data that demonstrates how particular segments of their patient base have improved with their care to inform conversations with payors and referral sources. Klenow points specifically to fall prevention data as an area of focus: “Falls are huge in healthcare due to the high costs associated with them, so if you can show that your patients are falling less, that’s critical.”

O&P OM experts are encouraging facilities to join the Limb Loss and Preservation Registry and add their data to the comprehensive

repository to contribute information that will help inform future care decisions and protocols (see sidebar on page 20).

Align Practices

Some larger O&P facilities have taken the lead on implementing OM programs. Hanger, for example, has had a “robust” program for lower-limb prosthetic patients in place for several years, says Carroll. Hanger plans to continue expanding its OM program to standardize OM collection and analysis for adult lower-limb orthosis users, scoliosis patients, upper-limb prosthesis users, and more. “We envision a comprehensive program” that covers a wide range of O&P patients.

Klenow insists facilities of all sizes can benefit from standardized OM programs—as “a very small investment can go a long way.” For patient-reported outcomes, he says facilities can follow the lead of

When Data Provides Relevant, Real-Time

Feedback

During the 2024 AOPA National Assembly, researchers shared a case study via poster presentation focusing on a 48-year-old left transtibial amputee and Paralympic athlete that examined the differences in daily activity patterns between workdays and holidays. Over a 29-day period, the participant’s activity was monitored using an ankle pedometer, revealing distinct variations in mobility, active time, and activity intensity levels, according to Vanessa Carvalho, CPO, a clinical specialist at Adapttech and one of the researchers.

“Results showed that workdays featured higher mean daily steps and longer active durations, with activity patterns being more consistent and routine. Conversely, holidays exhibited greater variability in step counts and activity durations, with a significant increase in high-intensity activities,” says Carvalho. Specifically, holidays had a higher average step cadence and more time spent in high-intensity activities compared to workdays.

“These findings underscore the importance of considering the contextual differences in prosthetic users’ daily routines when evaluating their activity profiles,” Carvalho says. “The study suggests that accurate assessment of a prosthetic user’s potential should take into account the variations between structured workdays and more flexible holidays to avoid misinterpretation of activity patterns and to enhance clinical decision-making in prosthetic rehabilitation,” and demonstrates that the integration of real-world data with current outcomes measures “could provide continuous insights into patients’ functional performance, potentially leading to improved rehabilitation outcomes.”

Vanessa Carvalho, CPO

physician offices and invest in a HIPAA-compliant online platform that enables patients to fill out questionnaires before appointments or while in the waiting room. “Once the patients complete the questionnaire, the information goes straight into an EHR record” and is immediately visible to the clinician. “This also facilitates the appointment programming process—a clinician can structure conversations during the appointment” based on questionnaire responses.

Clinicians who prefer a more hands-on approach can ask probing questions during appointments, accompanied by performance-based measures, Klenow explains. In fact, many performance-based measures are tasks clinicians already do—for example, watching patients walk. So, recording the information is not really an added burden. “Look for measures that align with the things your practice already emphasizes” and build your program around that.

Smaller facilities that can demonstrate the value they provide via promising outcomes measurement data and reports can gain “an advantage in negotiations” with payors over facilities that don’t have comparable data to share, says Klenow. “Facilities can use the information either to get in-network with a payor or to negotiate a rate with a hospital.”

Some of the most useful outcomes information can come from the simplest data. Klenow suggests including measurement tools that capture adverse events, falls and fall prevention, and other medical events that a patient experiences (such as heart attacks and strokes). He also recommends documenting goal setting and whether/how quickly patient goals are achieved. O&P professionals generally “do a good job of discussing goals with our patients,” he says, “but we don’t always document them.”

Apply New Tech

Several new technologies are available, or on the horizon, that will assist facilities in their OM programs. Klenow suggests trialing biofeedback-type augmented reality systems, such as the TRAZER system, which assesses, tracks, and measures vital movement to provide data on the performance of the brain and body. This technology and similar systems “may generate scores that patients can see in real time,” he says, and are currently in use at some physical therapy (PT) clinics, “so your patients could use them during their PT appointments and then the practitioner could review the feedback with them.”

Advanced activity monitors that keep track of patient movement in real time can provide feedback to healthcare professionals via downloadable reports. Vanessa Carvalho, CPO, a clinical manager at Adapttech, recently conducted an online survey to gauge OM usage among O&P professionals. Those who do collect OMs, according to the survey, spent 25% of their time doing so, mostly through traditional tests such as distance walk tests, timed walking tests, and similar tools. So, activity monitors could be a significant timesaver, reducing the burden on clinicians to conduct some of the OM tests, explains Carvalho. Advanced activity monitors can provide real-time details on speed of walking, cadence, number of steps per day, maximum walking distance, and falls, she says.

An option offered by Clark’s company, OPOS1, offers a low-profile wearable sensor that integrates with a patient’s prosthesis or orthosis to collect objective data. The system integrates with a mobile

Add More Value to Your Practice With OM

V = Q/$

Outcome measurements are an essential component of the numerator in the value equation: Value = Quality/Cost. Fanny Schultea, MS, MSEd, CPO, LP, FAAOP(D), shared that message during the session “Finding the Evidence: EvidenceBased Practice Is the Value Proposition” at this month’s AOPA National Assembly in Charlotte. Schultea emphasized that outcomes measures are the basis of evidence to determine quality—a prerequisite for determining value.

Larger O&P companies are implementing strategic systems and processes to collect outcome measurements and publish some of their analyses in a way that smaller practices could learn from, she says. “Smaller companies can demonstrate their value, too, if they understand how. They don’t have to copy the larger companies per se,” she says; using standard frameworks, smaller companies can identify the specific outcomes measures that capture quality given their location, patient demographics, and available resources.

“Smaller practices, too, have the ability to become empowered through their own assessment of value by driving quality through evidence-based practice and continual process improvement,” she explains. “Breaking down the guiding principles in the process is a good start. Turns out, the value of O&P is found in the evidence, through cost, outcomes, and patient experience.”

app used for wireless data recording, transmission, and visualization. The product is currently being validated at the Motion Analysis Lab at the Mayo Clinic. “During testing, we came in at 96% accuracy on compliance,” Clark says.

The benefit of accruing data from wearables is that they can aggregate “true, real-world data that doesn’t require operational time” in the clinician’s facility, says Clark. “You know exactly how much they’re wearing it and how much they’re walking. This shows the value of what we do.”

These advanced activity monitors will be particularly useful as newer prostheses and orthoses hit the market: “We’ll have to show the value of new technologies with data,” says Clark.

“Our profession is growing and expanding, and we’re doing all of the right things,” adds Clark. With more OMs and analysis, “we’ll be telling our story more completely with data. I’m excited for our profession.”

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

Fanny Schultea, MS, MSEd, CPO, LP, FAAOP(D)

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O&P ELITE

AOPA honors impactful O&P professionals with clinical, business, advocacy, and achievement awards

BY DEBORAH CONN

The brightest minds in O&P convened in Charlotte, North Carolina, this month to take part in the 2024 AOPA National Assembly—and honor the stars of the O&P profession. Some of the most exciting moments of the premier O&P conference occurred when AOPA bestowed prestigious awards to recognize high-achieving individuals and presentations: the Thranhardt Awards, the Digital Education Award, the Legislative Advocacy Awards, the AOPA Lifetime Achievement Award, and the Hamontree Business Education Award. Here, this year’s honorees share highlights from their work and their careers, including key research findings, advocacy success stories, and timely business advice.

Renowned Researchers

Each year, the Thranhardt Award is presented to individuals committed to advancing orthotic and prosthetic research and education. This award was established by a gift from J.E. Hanger in memory of the late Howard R. Thranhardt. For 2024, the authors of two impactful presentations were honored: Andreas Kannenberg, MD (GER), PhD, and Shane Wurdeman, PhD, CP, FAAOP(D), for “Assessing Outcomes with Microprocessor Knee Utilization in a K2 Population: Findings from a Clinical Trial of 107 Individuals With Above-Knee Amputation,” and Tyler Klenow, MSPO, MBA, CPO, FAAOP, and Russell Lundstrom, MS, for “Reduction in Falls and FallRisk With Increased Walking Speed Found Following One Year of

Thranhardt Award Winners Tyler Klenow, MSPO, MBA, CPO, FAAOP; Russell Lundstrom, MS; Andreas Kannenberg, MD (GER), PhD; and Shane Wurdeman, PhD, CP, FAAOP(D)

C-Brace® Use: Interim Results From the C-Brace® Registry.”

Kannenberg, executive medical director at Ottobock North America, and Wurdeman, vice president of scientific affairs at Hanger Inc., began planning their study in 2020, when it was unclear if Medicare would expand coverage of microprocessor-controlled prosthetic knees (MPKs) to K2 patients. “Our goal was to further add to the body of evidence for the benefits of MPKs in the K2 [limited community ambulation] population, and especially to address criticism of payors on the existing evidence back then,” says Kannenberg.

According to Wurdeman, “the impetus from Hanger came out of a meeting in early 2019 at CMS in Baltimore, where we discussed the current state of the evidence for lower-limb prosthetic care. The individuals from CMS were very clear that while the evidence was good, they wanted randomized controlled trials with participants that were their ‘target demographic’: over age 65 with greater representation of vascular/diabetes etiology.”

The study enrolled 107 patients with unilateral above-knee amputation and K2 mobility at more than 80 Hanger Clinic locations. All were using nonmicroprocessor knees (NMPKs) in their daily lives. Patients were randomly assigned to one of two study groups: The first group continued to use their NMPKs, and the second received the microprocessor knee Kenevo after a baseline assessment of outcomes measures. Study staff contacted patients every month to ask about falls, near falls, and adverse events. Hanger Clinic assessed the primary outcomes of Fear of Falling Activity Avoidance Behavior and the secondary outcomes of falls and near falls, risk of falling, physical function and mobility, quality of life, cognitive function, and gait performance after six and 12 months.

Kannenberg and Wurdeman presented the study’s 12-month results during their Thranhardt presentation; however, the study is still running, and the same outcomes will be assessed every year over the next four years, according to Kannenberg. “Our study has shown that patients in the MPK group reduced fear-of-fallingrelated activity avoidance, experienced fewer falls and near falls,

and benefited from reduced risk of falling, whereas the patients in the NMPK group did not,” he notes. “In contrast, the patients in the NMPK group demonstrated significant declines in quality of life and cognition over 12 months that were not seen in the patients using an MPK. These are important results that add yet-unknown facts and aspects to the body of evidence for MPKs that should help convince commercial payers to follow.”

Both Kannenberg and Wurdeman point to the benefits of collaboration in bringing this study to fruition. “While there are times when competition is necessary to drive innovation,” says Wurdeman, “the ASCENT K2 trial is an example of advancement through competition.”

In the second 2024 Thranhardt presentation, Klenow and Lundstrom shared their research findings related to an advanced orthosis. When Ottobock’s C-Brace® came to market in 2012, it was so innovative that it had no pathway to reimbursement. Patients had to pay for the device themselves or go through the Department of Veterans Affairs. Lundstrom, director of clinical research and services at Ottobock in North America, had run a registry for defibrillators when he worked at Medtronic, and he envisioned a similar project for Ottobock to gather real-world safety and effectiveness data on the use of the device.

The C-Brace Registry launched in 2015, and clinics began signing on to share their results. When this analysis was conducted in October 2023, 51 O&P facilities in the U.S. and Europe were participating, with 91 subjects enrolled and 42 completing the primary endpoint of one year. “Use of the C-Brace resulted in improvements in fast walking speed and balance confidence, while reducing falls and fall risk,” says Klenow, senior clinical research associate and project manager of the registry for the past two years.

“We recruit sites that will be fitting multiple C-Braces in a year to participate,” he explains. “Those sites recruit subjects they are fitting through the normal course of care. We see patients for a baseline data collection—how they function in their current orthosis or without one—and we do a follow-up six months after the C-Brace is delivered and annually for up to three years.”

Kannenberg

Lundstrom

Wurdeman

Klenow

At each visit, patients follow a brief protocol, including a 10-meter walk test, Timed-Up-and-Go test, and manual muscle and range-ofmotion tests. They also respond to 30 survey questions regarding pain, balance issues, goal setting, falls, adverse events, and general quality of life. “Every time we see them, we also have them wear a step monitor for two weeks to see their level of activity,” says Klenow.

The registry was key in obtaining an L code for reimbursement, he notes, and last year, reimbursement for the C-Brace increased. The data continues to inform improvements in the device. “We will continue to gather information,” says Klenow. “We are already looking at how manual muscle tests could show that even subjects with lower muscular control or activation at the hip can use the C-Brace effectively. We are also looking specifically at bilateral users and how they’re doing, as well as those with acute spinal cord injury. As our sample increases—we have 125 participants now—we will expand our research.”

Digital Trendsetter

The third annual Hans Georg Näder Digital Education Award, established in 2022 by a gift from Ottobock Healthcare in honor of Professor Hans Georg Näder and his contributions, went to Joshua Steer, PhD, for his presentation, “Insights Into Transtibial Prosthetic Socket Design From Expert UK Clinicians’ Digital Records.” Steer led a collaborative effort to gather information about how prosthetists address socket design across a range of patient demographics and limb shapes. Several organizations participated in the study, including his own startup company, Radii Devices; the University of Southampton; and Opcare, a large O&P services provider in the United Kingdom.

“We had done a previous study on residual limb shapes, so the next step was socket design, to see what approaches prosthetists used for different individuals,” he says. The study examined 163 pairs of limb-surface 3D scans and CAD/CAM sockets, determining that socket designs varied along a range of patellar tendon-bearing and total surface-bearing principles.

“We examined every individual change with more granular detail than has ever been done before,” he says. “As a result of this research, we are now applying these learnings within riiForm, our software for prosthetic fitting, toward using this data to support clinicians in reducing the time it takes to achieve a well-fitting socket for their patients.”

Inspirational Advocates

AOPA awarded two dedicated and results-driven O&P advocates with Legislative Advocacy Awards this year: Thomas DeGree and Sheryl Sachs, MSPO, CPO.

DeGree was an elementary school teacher and, along with his husband, a restaurant owner in Minneapolis, when he ran for the Minnesota House of Representatives in 2012. Although he lost the election, DeGree found the experience valuable for connecting with people in government. “So I decided to leave teaching and start working for a lobbying organization focused on educational policy and funding,” he says.

Just as his educational background influenced his early lobbying efforts, the loss of his right leg below the knee in 2019 steered him toward advocating for individuals with limb loss. Working with a dedicated team, DeGree played a key role in passing a state bill in Minnesota that mandates private-sector orthotics and prosthetics health coverage equal to or exceeding that provided under Medicare, including coverage for athletic and water legs.

“We held a rally at the [state] capitol with a mobility clinic during the session, so people could see the importance of athletic legs,” DeGree explains. “We had 7- and 8-year-old kids speak about how important their athletic legs were to them, and that moved a lot of legislators.”

Jeff Erenstone (left) and Hans Georg Näder Digital Education Award Winner Steer

Joshua Steer, PhD

Legislative Advocacy Award Winners Thomas DeGree and Sheryl Sachs, MSPO, CPO

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Sachs, for her part, became interested in advocacy in 2015 when Medicare released a draft Local Coverage of Determination proposing drastic changes to coverage for lower-limb prostheses. Since then, she has been a voice for her patients and has come to play an integral role in the So Every BODY Can Move (SEBCM) initiative.

Maryland was the sixth state to pass legislation as part of SEBCM— and Sachs contributed immensely to the process: securing primary bill sponsors, organizing advocates from across the state, gathering and submitting written testimony, and testifying at bill hearings. “I also led meetings with members of the House and Senate Committees, and letter-writing campaigns for medical professionals, O&P professionals, and patients across the state to voice support for the legislation,” she says. “Even after our bills were signed into law [mandating coverage of a secondary activity-specific prosthesis for physical activity for individuals with both commercial insurance and state Medicaid], I have continued to communicate with policymakers in hopes they will continue to become allies to people with limb loss, limb difference, and mobility impairments.”

Sachs helped form a coalition of advocates and policymakers to introduce additional legislation. “The new bill, which we plan to introduce next legislative session, would expand similar coverage for activity-specific orthotic devices,” she says.

“As clinicians, I feel that it is our collective responsibility to advocate for our patients to ensure that we can provide them with proper care,” adds Sachs. “That sometimes means advocating for their needs to policymakers.”

Lifetime Contributor

Larry Word, CPO, FAAOP, was honored with AOPA’s prestigious Lifetime Achievement Award. During his expansive career as an orthotic/prosthetic clinician, Word has spent decades giving back to the profession he loves. He spent eight years on the Board of Directors of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), four of which were on the Executive Committee and one year as president; served as an orthotic examiner for 25 years; and served on the boards of both the Georgia and Mississippi state O&P associations.

Word trained as an orthotist through the U.S. Army, where he served at Walter Reed National Military Medical Center in Maryland and at Brooke Army Medical Center in Texas. He returned to school for prosthetics at Northwestern and worked for Hanger Inc. for about 15 years. In 2006, the O&P department at Mississippi Methodist Rehabilitation Center called. Word, his wife, and his daughter moved to Hattiesburg, Mississippi, where he was clinical manager of the O&P clinic for nine years. He then transferred to the Flowood, Mississippi, clinic, where he has served as the department’s senior clinical manager for the past nine years.

Word credits this award to several factors. “Longevity plays a big role,” he says. “I was raised to believe that if you work long enough and hard enough at any endeavor, something good is likely to happen. I’ve gotten to know many good people and made some friends along the way, and that in turn has created many opportunities to volunteer my time and whatever talents I have.

“I’ve also been lucky to work for people who allowed me to take the time to do volunteer work, and I am grateful to my employers for that. My family has also been very supportive, even though it meant that I would be gone a lot.”

Word notes that being on the ABC Board of Directors forced him to overcome his natural introversion. “Folks there encouraged me to step out of my comfort zone, to do things I wouldn’t ordinarily aspire to. A lot of people—many of them good friends—encouraged me over the years.”

Business Standouts

The Sam E. Hamontree Business Education Award recognizes the best business papers submitted for presentation at the AOPA National Assembly. Four nominees presented their work as part of this year’s Hamontree competition: Ernst W. Bastian, CO; David Holzman, CFA; Mike Schlesinger; and Ashlie White, MSHLS, MA.

AOPA President Mitchell Dobson, CPO; Sachs; and Rebecca Snell

Dobson and Lifetime Achievement Award Winner Larry Word, CPO, FAAOP

Bastian created his presentation, “Can a Small Fish Make a Splash in a Big Pond?” to share his experience as a small O&P business owner and offer words of wisdom to likeminded clinicians. Bastian launched his solo practice, Wolverine Orthotics Inc., in 1995, and his company continues to thrive.

Owning your own practice can offer several benefits, Bastian notes: “You have full responsibility and control over the decisions you make,” he says. “You don’t have to ask anyone what kind of device to make, and as a result, decisions are almost instantaneous.” As a sole practitioner, patients get to see the same clinician every time, “and the continuity is invaluable.”

Bastian discussed some strategies that helped him stay in business for three decades. “We always say ‘please’ and ‘thank you.’ One year my daughter was helping out, and she wrote 250 thankyou notes by hand to our referral sources,” he says.

Starting a business is definitely a big commitment, he warns. “You are never really away from it—it becomes part of your life. But for many of us, that is one of the advantages.”

Holzman, a chartered financial analyst, spoke on “How Mergers and Acquisitions Are Changing the O&P Landscape and What Independents Should Consider When Developing a Transition Plan.” Holzman has 10 years of experience advising owners of small and medium-sized businesses on how to prepare for the transition of their business. As vice president of mergers and acquisitions at Hanger Inc., Holzman has spent the past five years working directly with O&P business owners to facilitate their ownership transition and to understand the evolving independent O&P provider landscape.

“The O&P industry is a mature industry that has been going through significant consolidation,” he notes. “It is important for all industry participants to understand how that consolidation impacts their business, as well as their own transition plans. Furthermore, it is crucial for O&P business owners to understand how to plan for a transition for when they are ready for the next chapter.”

Holzman’s presentation explained the magnitude by which consolidation is affecting the O&P landscape and how changes may impact what the industry looks like in the future—including the formation of larger providers with more resources, making it difficult for smaller independent providers to compete without specialization or another form of differentiation. He shared specific reasons that owners transition their businesses, what factors they should consider when determining the right person or group to transition their business to, and the specific actions owners should take to prepare for a transition.

Schlesinger, a business consultant, offered his expertise and advice during “Beyond the Sales Price, Top 10 Key Steps for Owners To Understand and Consider for an Efficient and Successful Transaction.” Observing how O&P facility owners struggled with selling their companies, Schlesinger realized many were unaware of or underestimated the importance of several crucial steps involved in the process.

He encouraged attendees to prepare for a sale, even if it is not imminent; to clarify expectations of both parties; to understand the impact a sale will have on all stakeholders, including staff; and to ask others who have sold their business for lessons learned and referrals to legal, tax, and advisory services.

“Sellers have to realize how much time it takes to sell a business,” he notes. “They can mitigate this commitment by having a trusted employee assist in the process, or by utilizing an outside accountant, or an advisor.”

Schlesinger warned business owners about typical pitfalls in sales transactions. “Lack of compliance is a common reason a transaction might be delayed or not even close.” Other challenges may include changes in financial performance over the duration of the sale process and faulty communication between buyers and sellers. “Something will go wrong during the four- to six-month process,” he predicts, “and it is important that there is a strong relationship between buyer and seller to resolve any issues that arise.”

White, chief strategy and programs officer at the Amputee Coalition, shared findings of a landmark study during her presentation, “Prevalence of Limb Loss and Limb Difference in the United States: Implications for Public Policy,” which won the Hamontree Award during the Assembly. Traditionally, O&P companies and the research community have relied on outdated and incomplete data to define their value propositions in funding proposals, research manuscripts, marketing materials, and policy initiatives, according to White.

Hamontree Award Winner Ashlie White, MSHLS, MA

David Holzman, CFA

Ernst W. Bastian, CO

Mike Schlesinger

To rectify this discrepancy, the Amputee Coalition commissioned a study by Avalere Health that includes incidence and prevalence data for the limb difference population. “In looking at the big picture, I’m most interested in how this data can be used alongside data being collected by the Limb Loss and Preservation Registry and an upcoming Government Accountability Office report to create meaningful public policy initiatives that improve comprehensive healthcare access for the population,” White says.

In one key finding, the study revealed that 33% of all individuals who lose a limb will lose a second limb. “How can we improve existing policies to increase opportunities for healthcare interventions between that first amputation and the second amputation?” White asks.

Having more granular information about the population impacted by O&P coverage and access policies, as well as the broader disability policy space, is vital to achieving policy goals that improve the lives of all individuals who are missing limbs.

Access the Award-Winning Presentations

If you missed the Thranhardt, Digital Education, Hamontree, or other important presentations during the 2024 AOPA National Assembly, there’s still time to review the sessions. Content from the conference is available virtually until between Oct. 1 and Nov. 30 for registered participants.

Earn CE credits by reviewing the sessions. Log in at aopaassembly.org, or contact assembly@aopanet.org with questions.

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

2024 Student Poster Award Winners

Two talented students were honored for their meritorious scientific papers submitted for presentation as a poster at the 2024 AOPA National Assembly.

Caitlin Bowman Martwinski, MSPO, a resident at Children’s Healthcare in Atlanta was awarded the Otto and Lucille Becker Student Poster Award, given to the best orthotic abstract submitted, for “Development of a Children’s Book Intervention to Increase Pediatric Orthotic Device Compliance and Improve Peer Attitudes Towards Disability for 3-12 Year Olds.”

Abrar Alamri, MSPO, PT, and doctoral candidate at the University of Pittsburgh, was awarded the Edwin and Kathryn Arbogast Student Poster Award, given to the best prosthetic paper submitted, for “Prosthetic Users’ Survey (OPUS) Scores in Lower Limb Prosthetic Users Across Multiple Follow-ups: A Retrospective Analysis.”

New Award To Debut in 2025

During the 2024 AOPA National Assembly, Hanger Inc. and AOPA announced the creation of the Dr. James H. Campbell Commitment to Outcomes Award. The award was created to honor Hanger Senior Vice President and Chief Clinical Officer Jim Campbell, PhD, CO, FAAOP, for his exceptional contributions to the O&P field, and as part of Hanger’s commitment to advance the science of care across the profession. The inaugural award is slated for presentation at the 2025 AOPA National Assembly in Orlando.

“Jim’s impact to the O&P profession has been transformative, driving a focus on the importance of clinical outcomes,” said Pete Stoy, Hanger chief executive officer. “Because of his instrumental efforts, clinical success is measured by the quality of patient care and the outcomes that are delivered. There’s no doubt the profession is better because of Jim’s commitment to excellence.”

As part of establishing the annual award, Hanger will donate $100,000 to AOPA, with the recipient being determined by the AOPA Board of Directors following a formal nomination process. The award will recognize an individual who has made significant and outstanding contributions to the field through exceptional dedication to achieving the best clinical outcomes for patients.

“AOPA is honored to partner with Hanger to award the Dr. James H. Campbell Commitment to Outcomes Award,” said AOPA Executive Director Eve Lee, MBA, CAE. “Dr. Campbell truly is a visionary, and bestowing this award on others who make similar substantial contributions to the field will only further the profession and its impact on those it serves.”

Every year, the award recipient will receive a $3,000 honorarium, in addition to fully paid airfare, accommodations, and registration at the AOPA National Assembly. More information about the recognition will be available on AOPA’s website in spring 2025, when the nomination process opens.

Jim Campbell, PhD, CO, FAAOP

Orlando County Convention Center

Abrar Alamri, MSPO, PT (left) and Caitlin Bowman Martwinski, MSPO

Giving a Grip

Tennessee clinician creates two unique solutions for upper-limb patient

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 Dan Smoker, CP, BOCO, LPO, PRN, a Tennessee clinician who provided a creative solution for a patient with partial hand loss.

Earlier this year, Dan Smoker, CP, BOCO, LPO, PRN, met Steve, a 64-year-old electrician with a recent partial hand amputation. Steve’s amputation, however, was caused by his second job as a farmer, during an accident with a corn picker. “He was missing digits 2, 3, 4, and 5,” recalls Smoker, who is clinic manager at Victory Orthotics and Prosthetics in Johnson City, Tennessee.

Steve arrived at Victory O&P seeking a simple solution to allow him to hold objects and to oppose his thumb on his injured—and dominant—hand. Smoker spent time determining Steve’s specific needs and identifying goals, then designed two perfect solutions to empower him to continue his work as both an electrician and a farmer—far exceeding Steve’s initial expectations.

First-Hand Knowledge

Smoker’s extensive experience and training provided him with just the right expertise to design an appropriate prosthesis for Steve. After completing high school, Smoker trained to become a physical therapy assistant and earned his PTA credentials. He worked as a PTA for eight years, then met Glenn Crumpton, CPO, while working collaboratively with one of Crumpton’s patients. At the time, Crumpton was president of Alabama Artificial Limb and Orthopedic Services.

“Glenn asked me if I had ever considered a career change and encouraged me to become a prosthetist,” Smoker recalls. He went to work for Crumpton—a recipient of AOPA’s Legislative Advocacy Award in 2019—as a technician, finished his

Smoker fit Steve, a patient with partial hand amputation, with a durable prosthesis so he can continue his work as an electrician.

Dan Smoker, CP, BOCO, LPO, PRN

undergraduate coursework, then attended the O&P program at Northwestern University’s Prosthetics-Orthotics Center (NUPOC). “I graduated from NUPOC in 2003 and worked at Artificial Limb until three years ago,” he says.

Smoker now works at Victory O&P, which is part of the ForMotion clinic global network. He treats both orthotic and prosthetic patients of all ages and enjoys leveraging some of the newest technologies with traditional approaches. He also takes pride in training the young clinicians that take on residency at his facility. Over the years, Smoker has taken a special interest in upper-extremity patients. “I like working outside the box, and being creative in making a device that works” for a particular upper-extremity patient, he says.

Leveraged Solutions

After his amputation, Steve learned to do a lot of things using only his sound arm and hand—but he wanted to expand his abilities, particularly at work, so he sought Smoker’s clinical expertise.

To assist Steve in performing all of his daily tasks and achieving his professional goals, Smoker created a device utilizing a wrist orthosis and a piece of aluminum stock during Steve’s second clinical visit. Steve was very impressed as he needed something to oppose his thumb against to twist wire nuts.

The wrist splint features a piece of aluminum stock secured onto the wrist area so Steve can hold objects and make use of his

opposable thumb. He completes most of his work activities with this device.

Smoker also fit Steve with a Naked Prosthetics prosthesis with GripLock digits because Steve requested an extremely durable solution. “He knows he’s very hard on things” due to his tasks on the farm and as an electrician, and the prosthetic device can withstand heavy usage. Four prosthetic digits are prepositioned and locked into place on the device; the digits have a lock-release mechanism and are manually controlled. The device features a silicone inner sleeve that locks into place as well as a carbon frame that fits snugly around his hand. Steve chooses to use this prosthesis for many ADLs, grooming, mowing the lawn, and other activities around the home, says Smoker.

Steve works with a physical trainer to make sure he protects his sound arm and gain strategies to avoid over-using his sound

side. He also has learned to do one-handed pushups at the gym.

In addition to providing physical solutions to Steve, Smoker has been a supportive ear—for example, explaining to him that he should never be ashamed of his injury or his prosthesis. He devotes a great deal of his professional time to ensuring Steve’s devices fit well and meet his needs. “Follow-up appointments are important to see what we can trouble-shoot,” Smoker explains. “We talk about social issues” as well as his prosthetic needs. “I like seeing him every other week.”

Since his amputation, “Steve’s had to relearn a lot of tasks” using either his nondominant arm or his prostheses, says Smoker. The best part of providing clinical care, according to Smoker? “Steve expresses a lot of excitement when he learns something new.”

Steve uses his prosthesis to help climb onto the back of a bucket truck for his work as an electrician.

Smoker also designed a wrist splint for Steve that features a piece of aluminum stock secured onto the wrist area.

FACILITY:

Orthotic & Prosthetic Solutions

OWNER: D’Andre Mostella, MSOP, CP

LOCATIONS: Baton Rouge, Shreveport, and Grenta, Louisiana; Flowood, Mississippi; and Mobile, Alabama

HISTORY: Five years

Entrepreneurial Spirt

Southern facility reaches patients via six locations and mobile vans

Like many of his peers, D’Andre Mostella, MSOP, CP, discovered orthotics and prosthetics while pursuing another career path in healthcare.

“I knew I wanted the medical field, and I had worn a brace during college,” he recalls. “I wanted to go to school for physical therapy (PT), but as I was working as a rehab tech, I was exposed to O&P and changed course.” Mostella got a job as an orthotic fitter and then went to school for prosthetics.

After completing his O&P education and working in the profession for four years, Mostella opened his own facility in Baton Rouge, Louisiana, at the end of 2019. “I had owned a gym before I went to prosthetics school, and I liked being an entrepreneur,” he says.

The country’s COVID-19 shutdown in March 2020 presented challenges to the fledgling facility, but in some ways it gave Mostella time to settle in. “Nonurgent amputations were considered elective, so everything slowed down,” he recalls. “It let me get a slower start, to hone in on the finer details, and to make sure that when we did open again, I’d be ready to go.”

Why Am I an AOPA Member?

“AOPA has been a part of the O&P community for a long time. It’s a place I can come to find any changes in coding or reimbursement. And there are always educational tools I can use to better myself and my staff.”

—D’Andre Mostella, MSOP, CP

Today, O&P Solutions has six practitioners among a total of 30 employees spread over six offices in Louisiana, Mississippi, and Alabama. The practice treats all ages and provides a full range of orthotic and prosthetic devices. One of the facility’s strong points is its use of mobile vans to reach patients who are unable to come into the office. “We cover the entire states of Louisiana and Mississippi with our vans that travel to patients’ homes,” explains Mostella. Each van has a small mobile lab, in addition to a lab in each facility and a larger one in Baton Rouge.

As a result, the practice has a much lower number of missed appointments. “We have a strong follow-up program, where we regularly check in with patients to make sure they are successfully using their device,” he says. “We try to catch any issues early on so that a small problem doesn’t turn into a bigger one. … We will even accompany patients to their PT appointments.”

Mostella is enthusiastic about new technologies. The practice has multiple 3D printers for test

sockets and clinicians with significant experience in 3D printing.

The facility started a nonprofit amputee support group that meets in three locations. The group accepts all individuals with limb loss—not just O&P Solutions patients—and welcomes family members and caregivers as well. “It’s a safe space to ask questions,” says Mostella. “I also take them on outings, like bowling.” Other charitable efforts include donating devices and time to the One Step Closer Foundation and providing services to patients without insurance.

Two patient success stories that stand out for Mostella include treating a mechanic with an above-knee amputation who felt he couldn’t wear a prosthesis. “He hopped around on crutches for years, but then he started having problems on his good side,” Mostella says. “He heard about us, and we got him walking without assistance. He is now working full time.” Another patient with quadrilateral below-knee and below-wrist limb loss still works at his chicken farm, walking with assistive devices. “We first did myoelectric prostheses because of his work, but we had to go back and put in body-powered devices, which are working better for him.”

As an African-American clinician, Mostella notes the low percentage of Black practitioners in the industry. “It was harder to break in,” he says. “I went to an HBCU [historically Black college/ university] for prosthetic school, and I was the only African American in the class.” He is active in the International African-American Prosthetics & Orthotics Coalition and has mentored four clinicians at O&P schools.

“This is a great field,” he says. “You see people whose day-to-day lives change drastically as they realize that an amputation is not the end of their life, but the start of a new one. I never get tired of the joy of seeing people regain their mobility.”

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

Owner D’Andre Mostella, MSOP, CP, observes a patient as he walks.

Orthotic & Prosthetic Solutions has a fabrication lab in each of its six locations.

THE COMPLETELY REDESIGNED

Not just a 3.0

Redefining the Ankle Experience

It actually feels like you have a leg. Feels a lot lighter, very comfortable. When I stand still, I balance very easily. It’s like a part of you and you’re not scared.”

For the first time in all the different prostheses and feet I have tried, and I have tried so many, it felt like I had my leg back again. The Kinterra is life changing. It has inspired me.”

Retired Car Salesman Francisco M.

Behavioral Therapist Tarsha N.

Member Spotlight

OWNER:

Why

Am

I an AOPA Member?

“AOPA strengthens the O&P profession through education and research that changes lives. The organization brings together key leaders and top professionals in the field—those are the people who have the knowledge and information that is invaluable to our industry.”

—David Collins, CO

BY DEBORAH CONN

The Eqwal Group

TLOCATIONS: West Yarmouth, Massachusetts, and Louisville, Kentucky

HISTORY: 33 years

Nighttime Solutions

Central fabrication firm offers nocturnal scoliosis braces and more

he founder of Spinal Technology, Jim Tierney, specialized in the design, fabrication, and fitting of spinal bracing at Children’s Hospital in Boston. He launched Spinal Technology in 1991 to leverage the latest technology and research to improve the standard for high-quality spinal orthoses.

The central fabrication company serves O&P facilities throughout the United States and around the world. Spinal Technology’s 100 employees are located at its headquarters in West Yarmouth, Massachusetts, and at another facility in Louisville, Kentucky.

The company offers custom-fabricated scoliosis, spinal, and hip braces. Its most popular product is the Providence Nocturnal Scoliosis® orthosis, which treats lumbar, thoracic, double major, and thoracolumbar curves. “Because it is used at night, we can treat more aggressively, and patients are more compliant,” notes David Collins, CO, clinical development executive. “We’ve achieved as high as a 98% correction with the Providence.”

The company manufactures a full range of scoliosis braces in addition to the Providence, including a Bostonstyle brace meant to be worn full time, Chêneau- and Wilmington-style braces, a low-profile Milwaukee brace, and a brace for kyphosis. All use CAD/CAM technology, which the company adopted in 1995.

Other products include custom spinal and hip braces, including thoracolumbosacral orthoses (TLSOs) and lumbosacral orthoses (LSOs). “Our Flex Foam® series is used for a range of diagnoses, from neuromuscular issues to postsurgical issues,” says Collins. “Our soft custom TLSO fits patients comfortably when they are more compromised. We also make a custom TLSO bivalve and LSO bivalve, both with anterior openings available.”

Clients include physicians and orthotists at patient-care facilities and trauma centers. “Most of our customers are sending measurements from a Providence® board or 3D scanning tool,” explains Collins. “The scanning systems allow us to take the very precise measurements they send and edit them through computer-aided design. Our team looks at the scan and builds the design for the brace mold. There’s much less room for error, and we have the manufacturing process down to a science.”

Spinal Technology maintains a library of more than 7,000 molds so the company can augment and adjust existing molds without starting from scratch each time. “If we don’t have the right size, our computeraided carvers can create a new brace mold that will fit the measurements exactly,” Collins says.

The company is owned by Eqwal, an international corporation that specializes in orthopedic 3D acquisition systems, 3D printing software, and milling machines and robotics. Eqwal also is the parent company of Qwadra, which represents the merger of CAD/CAM specialists Rodin 4D, TechMed 3D, and Vorum. “We were already customers of Vorum and TechMed, so now we are all under the Qwadra umbrella,” Collins explains.

In Louisville, Spinal Technology is located about 10 minutes away from UPS Worldport. “As a result, we can get a brace out in 24 hours,” Collins notes. “We have folks working different shifts, so if we get an order by 8 p.m., we can fulfill it that night and the facility can receive it the next day.”

The firm supports several charitable organizations, including Scoliosis-US, a nonprofit that supports young people with scoliosis and their healthcare providers, as well as Higgy Bears, a nonprofit that donates stuffed animals wearing scoliosis braces to children and teens undergoing treatment. Recently, staff donated braces and accompanied Shriners on a medical mission to Guatemala through the World Pediatric Project. During the visit, practitioners conducted 23 surgeries and fit young patients for braces.

Collins has seen the rapid growth of technology in orthotics and says Spinal Technology is ideally placed to take advantage of new developments. “We used to have big scanners that had to be connected to computers on wheels,” he notes. “Now all that technology is on our phones. Eqwal and Qwadra are two of the largest players in scanning tech right now, and we have good access to the most precise and cutting-edge technology through them. We will all benefit from that moving forward.”

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

Spinal Technology offers a full range of scoliosis braces as well as custom spinal and hip braces.

David Collins, CO, clinical development executive

National Assembly Content Online

Log on before the Nov. 30 deadline

Did you miss the 2024 AOPA National Assembly in Charlotte, North Carolina? Did you attend the Assembly but miss some key sessions and want to learn more? AOPA brings the education to you—virtually—starting Oct. 1 and ending Nov. 30. Learn on your own schedule—access is included with Full Conference Registration. Visit aopaassembly.org.

Boost Your O&P Business Skills

Level up your O&P business acumen! Core courses for the Certificate in O&P Business Management are now open. AOPA and the University of Hartford Barney School of Business have partnered for the past several years to offer this certificate. The comprehensive program offers a series of business and management courses to provide O&P business owners and managers, clinicians, manufacturers, and distributors an opportunity to explore crucial business challenges. Topics include finance, sales and marketing, business operations, reimbursement policies, and management.

In 2025, all of the core courses, run by the University of Hartford, will be available online, asynchronously. They opened Aug. 26 and close Dec. 11. Electives, offered through AOPA, are available online, on demand. Electives are available in all areas of learning, with more courses expected to be added in 2025.

Graduates of the certificate program in 2025 will be awarded their certificates during the 2025 AOPA National Assembly Awards Ceremony in Orlando, Sept. 3-6, 2025, and will be publicly recognized in O&P Almanac

This unique leadership experience provides an opportunity to gain fresh insights, learn new tools, and acquire proven techniques for developing better business practices. Learn more and enroll in the Certificate in O&P Business Management program at aopanet.org/ certificate-in-op-business

Don’t Miss AOPA’s Next Coding & Billing Seminar

Take part in the event Nov. 18-19 in Alexandria, Virginia

Sign up for the 2024 in-person AOPA Coding & Billing Seminar, slated for Nov. 18-19. You’ll learn how to get claims paid, survive audits, collect interest from Medicare, and file successful appeals. Earn CEs! Visit AOPAversity online at bitly.aopaversity for details and to register. For questions regarding seminar content, email Devon Bernard at dbernard@aopanet.org

Attendees have said:

I’ve learned more in the past few days than I’ve learned in the past year.

All practitioners should attend this conference so they can learn to document the correct way and ensure compliance.

The speakers are very knowledgeable and helpful. This is my second time at a seminar and I’m still learning so much.

Welcome New AOPA Members

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.

Idaho Prosthetics & Orthotics

2595 Channing Way Idaho Falls, ID 83404

208-523-9000 idahoprosthetics.com

Jared Lamph, CPO Patient-Care Facility

Insoles.ai 741 W. Main Street Peoria, IL 61606

309-306-3696

insoles.ai

Amit Bhanti, CPO, LO Supplier Startup

Myers & Associates Orthotics & Prosthetics

445 Walnut Street, Ste. 109 Richardson, TX 75081 214-494-0855

Mindi Salinas, BOCPO, LPO Patient-Care Facility

OneCare Health LLC

534 River Crossing Drive, Ste. 102 Fort Mill, SC 29715 717-808-6966

Raja Marimuthu, MD Supplier Startup

Prime Ortho LLC

230 U.S. Highway 206, Ste. 3 Flanders, NJ 07836

201-943-3900

theprimeortho.com

Cory Ayer, CP, LP, COA Supplier Startup

Vessl Prosthetics Inc. 99 Bowman Drive Ilderton, Ontario N0M2A0 Canada 519-476-6410 vesslpro.com

Sydney Robinson, MSc Supplier Startup

KiddieFLOW™

KiddieFLOW™, Allard USA’s extension to our pediatric AFO line, was introduced in response to clinician requests for an orthosis with more foot plate flexibility. 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 transition (flow) throughout the gait cycle.

For more information, contact customer service at 888-678-6548 or info@allardusa.com and request your free teddy bear tape measure!

Precision Fit With Mt Emey® Custom Shoes

Embrace the comfort of custom-fit with Mt Emey®’s Custom Shoe (Medical) Program. Our precise 3D scanning captures your unique foot contours, promising a perfect fit without the wait or waste. From stylish athletics to roomy comfort designs, our handcrafted shoes adapt to your needs. Satisfaction guaranteed before payment. Plus, qualified wholesale accounts receive a free 3D scanner. Step into the Mt Emey difference— where every shoe is made for you.

College Park’s NEW Icon Microprocessor Knee

The Icon microprocessor knee offers a user-friendly experience for patients and clinicians. Featuring responsive sensors, streamlined setup, and the intuitive Stride Studio app, this dynamic knee was designed to enhance user confidence. Clinicians can easily access all adjustments, custom modes, and more in Stride Studio. Our team has developed proprietary technology to put the Icon in a league of its own—providing remarkable accuracy, response time, and weight savings. Equipped with a long-lasting battery and IP68 rating, the Icon is the versatile solution for low to high activity users. Vist college-park.com

Coyote Air-Locks

Increase suction suspension even more with the new air expulsion valve release button for all Coyote Air-Locks. Sold separately.

• Air expulsion built into the release button

• Retrofittable to all Air-Locks

• Quiet expulsion

• Increases negative pressure in the socket.

For more information, contact Coyote at 208-429-0026 or visit coyote.us

The Drop-In Lock Special

Buy three Air-Lock Drop-In locks and get a free Air-Lock Drop-In fabrication dummy. It’s a savings of $180.

The New Air-Lock Drop-In is:

• Lighter

• Stronger

For more information, call 1-888-937-2747 or visit emeys.com

• Better seal

• Tighter fit.

Designed as a drop-in lock for 3D-printed sockets. With the dummy, it can also be used for laminating and thermoforming sockets.

For more information, contact Coyote at 208-429-0026 or visit coyote.us

Hersco 3D Printing

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.

Introducing the 6Y112 Skeo Sealing TT Liner.

This new, innovative liner offers transtibial patients exceptional comfort and peace-of-mind. Featuring a silky-smooth surface, it simplifies cleaning as well as the donning and doffing process. Visit shop.ottobock.us for more info.

RUSH Feet

You’ve been asking and we have listened! All RUSH feet are now available in sandal toe options, including all the RUSH EVAQ8 series.

This expansion opens a world of footwear possibilities, including sandals or flip flops, while enjoying the same exceptional performance and confidence of RUSH feet.

With the full line available in sandal toe, there’s more choices for everyone to explore. More choices for pure satisfaction, step after step. Visit us.proteorusa.com

Learn more today!

Turbomed Foot Drop AFOs

Turbomed’s leading line of foot drop ankle-foot orthoses sit completely outside the shoe for an invisible, painless support that will follow you as long and as far as you want. 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. Each model takes minutes to assemble and is easily transferrable to most shoes, boots, and sandals through an innovative lace clip design.

The Xtern Summit is the lightest model, has the most 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!

Learn & Earn

October 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; abcop.org/contact-us

October 1–November 30

Virtual 2024 AOPA National Assembly Education Available. Visit aopaassembly.org

October 18–19

PrimeFare Central. Renaissance Hotel and Convention Center, Tulsa OK. In-Person Meeting. Contact Cathie Pruitt at 901-359-3936, primecarepruitt@gmail.com, or visit primecareop.com

November 18–19

AOPA In-Person Coding & Billing Seminar. Alexandria, VA. To register, visit aopanet.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

Share Your Calendar Event

September 3–6

AOPA National Assembly. Orlando. For more information, visit AOPAnet.org

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If

Progress and Proclamations

Legislative advances in Alabama, Delaware, Mississippi, Missouri, and Pennsylvania

Alabama

House Bill (HB) 131, enacted in May 2024, requires that on or after Sept. 1, 2024, providers of durable medical equipment, prosthetics, orthotics, and supplies in Alabama that wish to claim applicable sales tax exemptions must maintain a certificate of exemption from the Alabama Department of Revenue. Additional information is available at the Alabama Department of Revenue site: revenue.alabama.gov/ sales-use/tax-exempt-entities/

Delaware

Senate Concurrent Resolution 147, passed in the state of Delaware April 26, 2024, recognizes April as Limb Loss and Limb Difference Awareness Month. The bill was championed by State Rep. Mike Smith and State Sen. Brian Pettyjohn.

Mississippi

HB 477, which would establish the Medicaid fee schedule at a level equivalent to 100% of the prevailing Medicare rural fee schedule, failed to advance out of the Medicaid Appropriations Committee. The bill was ultimately unsuccessful; however, it laid important groundwork for future efforts to increase the Medicaid fee schedule in Mississippi.

Missouri

A group of orthotic and prosthetic practitioners in Missouri have officially established the Missouri Association of Orthotics & Prosthetics (MAOP). The organization’s articles of incorporation state its purpose to promote quality orthotic, prosthetic, and pedorthic care and to educate the general public and legislative/regulatory bodies on the values provided by Missouri’s certified

So Every BODY Can Move

Most state legislatures are currently adjourned, but work continues behind the scenes to advance the So Every BODY Can Move (SEBCM) initiative. SEBCM seeks to create equitable and life-changing access to prosthetic and orthotic care for physical activity.

In addition to the eight states where SEBCM legislation has been enacted, several states introduced bills during the 2024 legislative session.

The month of July saw the successful completion of the 28 X 28 challenge, which supports the goal of the passage of SEBCM -related legislation in 28 states by

practitioners and accredited facilities. AOPA looks forward to working closely with MAOP on legislative and regulatory issues that impact O&P professionals in Missouri.

Pennsylvania

House Resolution 299, adopted April 16, 2024, established April as Limb Loss Awareness Month in Pennsylvania. The effort was led by Rep. Robert Matzie and included support from 15 co-sponsors.

the start of the 2028 Paralympic Games in Los Angeles. This campaign raised more than $92,000, and participants logged almost 30,000 miles of physical activity over 28 days. Support for this powerful movement continues to grow.

AOPA and its partners at the Amputee Coalition; the National Association for the Advancement of Orthotics and Prosthetics; and the American Academy of Orthotists and Prosthetists look forward to supporting SEBCM ’s future success. Visit the SEBCM website at soeverybodycanmove.org to learn more.

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