October 2011 O&P Almanac

OP

The American Orthotic & Prosthetic Association

OCTOBER 2011

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

ETHICS

AND YOUR BUSINESS

Navigating challenges of modern O&P care

BILATERAL UPPER-LIMB Patient Care Will You PARTICIPATE IN MEDICARE?

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O&P Almanac CONTENTS

OCTOBER 2011, VOLUME 60, NO. 10

COLUMNS

COVER STORY

16

Reimbursement Page Advice to guide your decision to participate—or not—in Medicare

36

Facility Spotlight Kenney Orthopedics

DEPARTMENTS

4

AOPA Contact Page How to reach staff

6

At a Glance Statistics and O&P data

10

In the News Research, updates, and company announcements

40

AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

20 Ethics and Your Business

By Anya Martin Rapidly changing technology, health-care reform, and today’s rocky economy can pose ethical challenges for O&P professionals. Example scenarios and tips from experts will help guide your decision-making process, protect you from legal dilemmas, and ultimately allow you to better serve your patients.

48

AOPA Membership Applications

50 Marketplace

FEATURES

28 When Both Arms are Gone

By Jill Culora Caring for bilateral upper-limb amputees is challenging for both practitioners and the patients. But equipped with an understanding of the individual patient’s needs, practitioners can fit a highly functional prosthetic device that meets patient expectations.

Products and services for O&P

54 Jobs

Opportunities for O&P professionals

60 Calendar 63

Ad Index

64

AOPA Answers Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

OCTOBER 2011 O&P ALMANAC

3

OP Almanac

AOPA CONTACT INFORMATION

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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES

MEMBERSHIP AND MEETINGS

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

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org

Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com

AOPA Bookstore: 571/431-0865

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Teresa Tobat, editorial/production assistant, 703/914-9200 x33, ttobat@strattonpublishing.com

GOVERNMENT AFFAIRS Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

PUBLISHER Thomas F. Fise, JD EDITORIAL MANAGEMENT Stratton Publishing & Marketing Inc. ADVERTISING SALES M.J. Mrvica Associates Inc. DESIGN & PRODUCTION Marinoff Design LLC PRINTING Dartmouth Printing Company

BOARD OF DIRECTORS OFFICERS President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX Vice President Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

DIRECTORS Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Rick Fleetwood, MPA, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix LLC, Philadelphia, PA Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Mahesh Mansukhani, MBA Össur Americas, Aliso Viejo, CA

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION SERVING THE O&P FIELD FOR MORE THAN 90 YEARS

Renew the Easy Way With AOPA ONLINE PAY Login to pay your dues and update your membership directory information at:

www.aopanetonline.org/profile 4

O&P ALMANAC OCTOBER 2011

Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL

EASY! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE

Copyright 2011 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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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At a Glance

A Review of Upper-Limb Amputations, Prosthetics Injury Accounts for Majority of Upper-Limb Amputations…

Transhumeral Most Common Upper-Limb Amputation…

Location of Amputation

Amputation Etiology 83.2%

Injury Other

15.9%

38.3%

Transhumeral Transradial

30.8%

Infection

8.4%

Partial Hand

Gangrene

7.5%

Wrist Disarticulation

5.6%

Vascular Disease*

3.7%

Fingers

4.7%

*Note: Vascular disease category does not include diabetes.

Source: “Prosthesis use in persons with lower- and upper-limb amputation,” Journal of Rehabilitation Research & Development, 2008

1:3 24

The ratio of upperlimb to lower-limb amputations in 2002.

The average number of days per month upper-limb amputees reported using their prostheses in 2008.

1912 The year the split hook, considered to be one of the first upper-limb devices, was patented.

14.0%

Source: “Prosthesis use in persons with lower- and upper-limb amputation,” Journal of Rehabilitation Research & Development, 2008

10%

The percentage of upper-limb amputees who were wrist and hand amputees in 2002.

27-56%

Percentage range of upper-limb amputees who used a prosthesis in 2008.

10,000 The number of upper-extremity amputations that occurred in 2009.

Sources: “A survey of the satisfaction of upper limb amputees with their prostheses, their lifestyles, and their abilities,” Journal of Hand Therapy, 2002. Amputee Coalition 2009; “Limb amputation and limb deficiency: epidemiology and recent trends in the United States,” Southern Medical Journal, 2002; “Prosthesis use in persons with lower- and upper-limb amputation,” Journal of Rehabilitation Research & Development, 2008 6

O&P ALMANAC OCTOBER 2011

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In the News

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O&P ALMANAC OCTOBER 2011

by thinking about it. That technology noninvasively taps into the user’s neural network using a cap of electrodes that read electrical activity on the scalp via electroencephalography (EEG). The team plans to combine this EEG information with real-time data about blood-oxygen levels in the user’s frontal lobe using functional near-infrared technology.

“The idea is to provide a range of sensory feedback that can be integrated by the user, much like able-bodied individuals integrate a variety of tactile, kinesthetic, and force information from nerves in their skin and muscles,” says Contreras-Vidal.

“This truly unique team has been given the opportunity to help solve the challenging problem of brainto-machine interface,” says Brent Gillespie, University of Michigan’s co-investigator on the project. “Sensory feedback, especially haptic feedback, is often overlooked, but we think it’s

University of Michigan researcher Brent Gillespie uses a prototype device that provides sensory feedback when the user’s prosthetic hand moves an object.

the key to closing the loop between the brain and motorized-prosthetic devices.

These results indicate that we stand a very good chance to help amputees and also help others who may be suffering from motor impairments.”

Alessandro Presacco, a graduate researcher at the University of Maryland, adjusts a noninvasive EEG headset worn by Steve Graff, a PhD student. Creator of the headset, Maryland’s Jose Contreras-Vidal, observes on the right.

Photo: University of Maryland

Four U.S. universities are embarking on a four-year project, supported by a $1.2 million grant, to design a noninvasive prosthetic arm that users can control directly with their brains and will allow them to feel what they touch. The researchers say much of the technology has already been proven in small-scale demonstrations.

“The investigators on this grant have already demonstrated that much of this is possible,” says Marcia O’Malley, a co-principal investigator from Rice University, one of the universities participating in the effort. “What remains is to bring all of it—noninvasive neural decoding, direct brain control, and tactile sensory feedback— together into one device.”

A grant from the National Science Foundation’s Human-Centered Computing program will support the efforts of engineering researchers from Rice University, the University of Michigan, Drexel University, and the University of Maryland.

The team plans to incorporate technology that feeds both tactile information from the prosthetic fingertips and grasping-force information from the prosthetic hand via a robotic exoskeleton and touchpads that vibrate, stretch, and squeeze the skin where the prosthesis attaches to the body.

O’Malley and her co-investigators on the project have previously demonstrated technology that allows amputees to correctly perceive and manipulate objects with a prosthetic gripper based on sensory feedback provided to the remaining portion of their limbs.

In addition, University of Maryland researcher José Contreras-Vidal has already demonstrated technology that allowed test subjects to move a cursor on a computer screen simply

Photo: Rice University

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In the News TRANSITIONS

PEOPLE IN THE NEWS

President Obama bestowed amputee and Army Sgt. 1st Class Leroy Petry with the Medal of Honor on July 12. Petry is only the second active-duty service member since the Vietnam War to live to accept the nation’s highest military honor. He lost his hand to a grenade during a 2008 combat operation in Afghanistan, and his prosthesis allowed him to stay in the Army Rangers as he recovered.

Despite his injury, Petry re-enlisted in the Army for eight more years, for a total of 20 years of service.

He has been deployed eight times, with two tours in Iraq and six in Afghanistan.

Producer and director Daria Price of Out on a Limb, a documentary about advances in the science of prosthetics, launched a crowd-funding campaign via the website www.indiegogo.com to raise funds for post-production expenses to finish the film.

Inventor and design professional in the electrical and electronic manufacturing industry, Mark Stark, won one of Popular Science magazine’s 2011 Inventions of the Year awards for an electronics-free articulating hand that he designed and developed. Stark’s invention was featured on the June 2011 cover of Popular Science.

12

O&P ALMANAC OCTOBER 2011

Photos: TECNALIA

The Orthotic & Prosthetic Group of America appointed Todd Eagen as its director of sales.

ArmAssist is a mobile-based device that is connected to the user through a prosthetic that measures the movements of the shoulder and elbow and aims to aid in telerehabilitation efforts.

Robotic Prosthetics Aid in Telerehabilitation Researchers in Valencia, Spain, have created a robotic-prosthetic device and videogame software platform to assist in telerehabilitation efforts for people with neuromuscular disabilities, such as stroke victims. The project aims to use a fusion of prosthetic and videogame technology to provide patients with an increased quality of rehabilitative care.

Designed by FIK, a business initiative devoted to studying disability, ArmAssist is a mobile-based device that is connected to the user through a prosthetic that records and measures the movements of the shoulder and elbow. ArmAssist’s mobile base is connected to a computer that synchronizes the patient’s arm movements to a

videogame developed for upper-limb rehabilitation.

Patients play videogames wearing a prosthetic device that is remotely linked to a computer that records and analyzes their movements. The videogame exercises are designed to improve the user range of motion, force, and distance. Users also can play puzzle, memory, and solitaire games, which are intended to motivate patients by training them over a long period of time. Doctors will monitor improvement via quantitative game results.

ArmAssist is in clinical trials. During this time, researchers will assess its effectiveness and discover what obstacles may arise from rehabilitating a patient at home.

Dennis Amtower, CPO

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In the News Senate Pushes Availability of Next-Gen Devices to Service Members

The U.S. Senate passed an amendment on July 21 to help American service members and veterans receive advanced prosthetics more quickly. The amendment passed by a vote of 97-2.

Introduced by Sen. Kelly Ayotte (R-New Hampshire), the amendment requires that the secretary of Veterans Affairs send Congress a comprehensive plan detailing a strategy and

TRANSITIONS

BUSINESS IN THE NEWS Active Life Orthotics and Prosthetics, and its sister company Aqua Life Wellness Center, hosted two adaptive aquatic programs for those with physical challenges at their facilities in Albuquerque.

The Amputee Coalition recently partnered with CaringBridge—a company that provides people experiencing health challenges with complimentary websites to connect with their family and friends. For more information, visit www.CaringBridge.org/ AmputeeCoalition.

Bevans Custom Orthopedics opened its first custom foot orthotic central lab in Moline, Illinois.

National Pedorthic Services Inc. relocated its St. Louis patientcare facility to Creve Coeur, Missouri. The company also relocated its Pewaukee, Wisconsin, and Milwaukee patient-care facilities to Brookfield, Wisconsin.

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O&P ALMANAC OCTOBER 2011

timetable to make the next generation of advanced prosthetics available to injured service members and veterans.

“Our wounded warriors have sacrificed so much, and they deserve the very best available care and treatment for their injuries,” says Ayotte.

The secretary also has until late October to submit a report to the Senate and House Committees on Appropriations, Armed Services,

and Veterans Affairs addressing the challenges that delay delivery of these prosthetics to service members and veterans. a

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Reimbursement Page

By Devon Bernard, AOPA government affairs department

Medicare Decision Time Is it in your best interest to keep your current provider status?

the remaining 20 percent coinsurance directly from the patient. Providers who accept assignment on a claim may not collect more than the full Medicare allowable for any given Healthcare Common Procedure Coding System (HCPCS) code.

It’s not a choice to make lightly because you won’t have another chance to change your status until the next open enrollment period.

T

o participate, or not to participate? That’s the question you may be asking yourself as the end of the year approaches.

When the Medicare open enrollment period begins, you will have the opportunity to change your participation status. As a DMEPOS supplier you must decide every year whether to enter into a participation agreement and become a participating provider with Medicare, or not enter into an agreement and become a nonparticipating provider.

This important decision could have an impact on your business. You must carefully consider what’s in the best interest of your business before you elect to maintain your current Medicare participation status or to change your status for the upcoming year. It’s not a choice to make lightly because you won’t have another chance to change your status until the next open enrollment period.

16

O&P ALMANAC OCTOBER 2011

What Is the Choice?

What does it mean to be a participating provider for Medicare? The term “participating provider” in no way refers to whether you wish to be part of the Medicare program. By virtue of obtaining a Medicare supplier number, you are part of the Medicare program.

Medicare participation is actually an advance agreement, using CMS Form 460, between a Medicare provider and the Medicare program to automatically accept assignment for all Medicare claims.

So, by choosing to be a participating provider with Medicare, you agree to accept assignment on all Medicare claims you submit. By accepting assignment, you agree to accept the Medicare allowable for any given item or service you provide as payment in full. With assigned claims, Medicare will forward its payment—80 percent of the approved allowed amount—directly to you, the provider. You may then collect

If your company wants to accept assignment on a Medicare claim, do you have to be a participating member of Medicare? No, you can elect to become a nonparticipating member, and you may make a claimby-claim decision on whether to accept assignment. However, that decision to accept or not accept assignment on a claim-by-claim basis means you cannot accept assignment on one claim line and then not accept assignment on another line in the same claim.

By choosing to be a nonparticipating provider, you also have the ability to collect your usual and customary charge from the patient.

You do not have to accept Medicare’s allowable as payment in full at the time of service. This flexibility to choose or not choose assignment and collect your normal charge is especially useful for items that may have low Medicare allowables, such as therapeutic shoes.

Keep in mind, some risks are associated with not accepting assignment for a claim. For one, you must still submit the claim on the patient’s behalf. Medicare will make payment directly to the patient, and the patient is not obligated to use the Medicare payment to pay you for the service or item provided.

Also, the decision to not accept assignment does not relieve you from meeting Medicare policy criteria, nor does it eliminate your financial liability should the claim be denied as not medically necessary (NMN).

If the claim is denied as NMN and you don’t have a signed Advance Beneficiary Notice on file, you must refund any money you may have previously collected from the patient.

In short, your decision to be a Medicare participant or a nonparticipant hinges on how you want to handle the assignment of Medicare claims.

Why Participate?

In making your decision, you should weigh the pros and cons of both choices.

Besides having your payments sent directly to you by Medicare, here are a few other advantages to becoming a participating provider with Medicare: • Your company’s name and contact information will be listed in the Medicare provider directory. That means any Medicare beneficiary in your area will be able to find you with ease.

• Any claims involving a MediGap supplement policy will be auto– matically crossed over by the DME MACs. • All decisions involving whether to accept assignment or not have already been made for you, which may be a benefit in terms of efficiency.

Besides having the Medicare payment sent directly to the patient if

you choose not to accept assignment, there are a few other disadvantages to being a nonparticipating provider. The main disadvantage is not being listed in the Medicare provider directory.

Also, any Medigap claims will not be automatically processed.

How Do I Change Status?

Now that you understand some of the pros and cons of being a participating or nonparticipating provider for Medicare, how do you change your status?

Before the open enrollment period begins, usual around mid-November, you should receive a notification letter from the National Supplier Clearinghouse (NSC) informing you of your current participation status. It also will inform you that if you wish to change your status, you must do so before December 31.

If your company has a participation agreement in effect for 2011 and you

OCTOBER 2011 O&P ALMANAC

17

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Reimbursement Page

wish to be a nonparticipant for 2012, you must submit written notice to the NSC informing them that you no longer wish to be a participating provider. The letter, which must be received by Dec. 31, 2011, should be sent to this address: National Supplier Clearinghouse P.O. Box 100142 Columbia, SC 29202-3142 The letter must have an original signature by your company’s authorized representative—that is, the person on file with the NSC as an authorized individual. If you are not sure who is on file as your authorized individual(s), review your most recent Medicare enrollment application, the CMS 855S form.

If, however, you are currently enrolled in Medicare as a nonparticipating provider and you wish to change your company’s status to participating, you must complete a Medicare Participation Agreement for 2012. The NSC must receive this AOPA PRESENTS

agreement no later than Dec. 31, 2011.

You may download the CMS 460 form from the CMS website at www.cms.gov/CMSForms/CMSForms/list. asp#TopOfPage.

If you don’t wish to change your participation status for 2012, simply do nothing and your status will remain the same.

But how do you elect your participation status when you open a new location or become a Medicare supplier for the first time? It depends on your situation: • If you open a new location under your existing tax ID number, that location will have the same participation status as all other locations under that tax ID. • If you open a new location under a new tax ID number, that location will be considered nonparticipating.

• If you wish to become a participating provider, you will have 90 days from when you receive your supplier number to fill out the CMS 460 form.

Whether you choose participating or nonparticipating, your status cannot be changed until the next open enrollment period.

Remember, there is no wrong or right decision regarding Medicare participation. You must make your decision based on what is best for your business. Some of your contracts with private payers may require you to be a participating member with Medicare, so if you choose to become a nonparticipating member, be sure you have examined all the ramifications.

One last thing to keep in mind: Your status is tied to your tax ID—not to the physical location. If you have several locations operating under the same tax ID, they must all be participating or nonparticipating—it’s all or nothing. a

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

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Visit AOPA at www.AOPAnet.org 18

O&P ALMANAC OCTOBER 2011

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Ethics

and Your Business Doing the best for patients in a brave new world of patient care

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O&P ALMANAC OCTOBER 2011

COVER STORY

By ANYA MARTIN

L

ike any health-care professionals, orthotists and prosthetists should care first and foremost about doing their best for their patients. Exactly how to do that, however, isn’t always clear. Rapidly changing technology, the pressures of making ends meet in a difficult economy, the uncertainties of health-care reform, and a federal government more eager to collect revenue by enforcing ethicsrelated laws—all of these forces pose new challenges for today’s O&P professionals.

Two Classic Scenarios Many of the ethical dilemmas O&P practitioners and other health-care professionals face entail decisions about coding and billing and rules and regulations, says Thomas DiBello, CO, FAAOP, AOPA president and manager

of Houston-based Dynamic O&P LLC, a subsidiary of Hanger Prosthetics and Orthotics. And issues can become cloudy when a clinical decision has a direct impact on practice revenue— especially in a tight economy, when reimbursements don’t keep up with rising costs.

DiBello cites a possible scenario: A physician refers a patient, asking whether it’s time for a new device.

“You’re having a slow month, the device is approaching the point in time when it will need to be replaced, so you suggest that it should be replaced and justify it in your own mind based on the fact that you’re saving the patient an unnecessary return visit,” he says. “That’s probably not an ethical decision, and I think those types of situations can arise in a whole variety of different ways on a regular basis throughout a practice.”

Many of the ethical dilemmas O&P practitioners and other health-care professionals face entail decisions about coding and billing and rules and regulations.

—Thomas DiBello , CO, FAAOP

OCTOBER 2011 O&P ALMANAC

21

––Thomas Gavin, CO, LO

Ethics also can come into play in another common scenario, says Thomas Gavin, CO, LO, practice manager and national spine director for Hanger. Say an orthotist or prosthetist disagrees with a physician about what device will achieve the best patient outcome, he says. Here’s where you ask yourself, “Are you a clinician providing a device, or are you a businessperson providing a service?

A businessperson might fill [the prescription] even if he feels it’s not what’s best for the patient.”

This dilemma doesn’t have to create a contentious argument, Gavin suggests. Instead, it should trigger an open-minded discussion and debate between two parties with the same goal. If it’s a doctor who has been referring patients for a long time, such conversations are easier because both parties already have established a level of camaraderie and trust in each other’s opinions. In other words, he adds, relationship-building pays off in such situations.

Even if you know the referral source well, be prepared to gently educate the doctor about your reasons for recommending an alternative, Gavin advises.

He prepares himself to discuss biology and biomechanics in such situations if the device he recommends costs more, Gavin explains that cost isn’t just a matter of dollars but also the physical

22

O&P ALMANAC OCTOBER 2011

cost to the patient. While a moreexpensive brace may cost more up front, it may save money down the line if the less-expensive brace doesn’t do the job or is so cumbersome the patient doesn’t wear it as prescribed.

“In scoliosis,” Gavin notes as an example, “the greatest risk is failure because you’re talking a very costly and very risky surgery.”

Practitioners also need to be open to the possibility that the physician has a solid reason for prescribing a particular device to treat a unique circumstance.

“I have to be careful in the physician discussion,” he says. “Is it because they don’t know the difference, or is it because I don’t know the difference?”

For more guidance on routine ethics dilemmas, DiBello suggests consulting the American Board for Certification’s (ABC) Code of Professional Responsibility, written ethical standards specific to the profession. At 17 pages, the code includes detailed information on distinguishing ethics, custom, and law, and breaks down potential ethical issues into three categories: responsibilities to the physician or referral source, responsibilities to the patient, and responsibilities to colleagues and the profession.

Other issues covered include appropriate use of credentials, concern about patient care by other health-care

professionals, and rules and procedures by which a practitioner may lose ABC credentials. The code is available on the ABC website, www.abcop.org.

The Technology Dilemma Technology is advancing more rapidly than ever, and that creates potential new ethical dilemmas for practitioners. Obviously, you shouldn’t fit the latest technology just because it’s new, but you shouldn’t hesitate to recommend new technology when it can help a patient, says Jeffrey M. Brandt, CPO, founder and COO of Gettysburg, Pennsylvania-based Ability Prosthetics & Orthotics. Brandt considers not only keeping up with the latest technology and treatment methods an ethical responsibility, but also educating patients, referral sources, and payers about its potential benefits.

Brandt cites two examples of patients who were not well served.

One Ability patient had been seen in three other facilities and always fitted with a conventional hand prosthesis, but when he asked whether he could benefit from new technology, other practitioners downplayed its relevance and did not tell him he would be a great candidate for the i-Limb, a new, fully articulating prosthetic hand.

Another patient received a separate ankle brace and, a few months later, a knee brace from a noncredentialed

Photo: Tom Gavin

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A businessperson might fill [the prescription] even if he feels it’s not what’s best for the patient.”

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“There are times when we say to a patient, ‘We don’t know how to do it, but we’re willing to learn. Would you be willing to learn with us?”

––Jeffrey M. Brandt, CPO

orthotist at an orthopedic practice seeking to expand into O&P. When his limb deformity was still not being adequately controlled, that orthotist told him there was nothing more he could do. The patient did his own research, found Ability, made an appointment, and was prescribed a knee-ankle-foot orthosis.

“Practitioners ought to be trained in every single device, and if [you] don’t feel competent and comfortable providing what is best for the patient, either refer the patient elsewhere or advance your career and learn how [to handle such situations],” Brandt says. “There are times when we say to a patient, ‘We don’t know how to do it, but we’re willing to learn. Would you be willing to learn with us?’ ” Because the latest technology may not yet have an approved Medicare L-code, willingness to apply new technology goes hand in hand with a responsibility to have a thorough knowledge of the Medicare and

insurance approval and appeal processes. “Patients can be denied the very best care or best product because maybe the practitioner doesn’t know how to get it paid for and instead relies on certain devices that he knows are approved,” Brandt says, “or maybe because he believes a rumor that using a miscellaneous code is not a good idea.”

At Ability, practitioners are encouraged to be fierce patient advocates with insurers. “If you can justify the product through your clinical experience, you need to open the case with the insurance company, and you need to do the hard work,” he says. Ability documents justification for a device in detail every step of the way and has been known to appeal cases all the way up to the administrative law judge for Medicare.

Keep in mind, however, that how much you bill for a miscellaneous code also is an ethical decision, Brandt says. Don’t bill too small an amount

“A lawyer can provide not only guidance but [also] a written opinion you can rely upon as defense if the transaction is ever called into question.”

––David McGill

24

O&P ALMANAC OCTOBER 2011

just because you’re afraid you won’t get paid otherwise, but on the other hand, you need to bill to ensure a fair profit because Medicare and insurers are building a library of data that later could become an industry standard.

The Law on Kickbacks Some ethical issues are not just a matter of doing the right thing but have legal implications—from heavy fines to jail time—if you make a wrong choice. Two of the prime federal laws that govern ethical practice—the Anti-Kickback Law and the False Claims Act—have been around for a long time. But the government has increased enforcement of both in recent years, cautions David McGill, vice president of legal affairs for Össur Americas.

In general, the Anti-Kickback Law was designed to prevent clinical decision making from being influenced by monetary gain, McGill says.

However, he has been surprised at how many O&P practitioners think that it doesn’t apply to them because they are not doctors or licensed health-care professionals.

While the Anti-Kickback Law creates both civil and criminal liability not only for the entity/individual offering the kickback but also for the entity/individual receiving it, practitioners may not be sensitive to their risk because the U.S. Justice

The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. Call 703-836-7114 or go online at www.abcop.org Find us on Facebook. www.facebook.com/abcopp

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Staying Inside the Anti-Kickback Law

Not sure whether the federal government may see a transaction as a kickback? Start with these questions: • Meals with a single customer. Are they only occasional? Are they very modest in price? They should be.

• Samples. How many? Is that number reasonable or excessive for a practitioner to get a feel for a new product and help deliver something of value in an affordable way to a customer? What’s the size of your practice? For some items, 10, 20, 30 units or even more could be OK for a large practice, but if the item is a more expensive high-tech prosthetic product with a very limited target patient, five samples may be a lot, especially for a small practice.

• Educational events. Are they truly just educational? The days of a company giving away iPods to store “clinically relevant information” are over. And educational events need to be purely educational with all monies supporting training.

• Charitable support for activities organized by a practitioner. If you’re hosting a golf event to raise money and ask a manufacturer for a donation, make sure the check goes not to you, but straight to an actual 501(c)3 nonprofit organization.

Source: David McGill, Össur Americas

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O&P ALMANAC OCTOBER 2011

Department has historically chosen most often to prosecute the former.

However, that has changed in recent years, with an increased focus on both parties involved.

Also, in the past, penalties tended to be against huge medical device manufacturers outside of O&P. The classic case, McGill describes, was a company that paid customers as consultants who did not consult on anything except giving preference to their products. He says, because of a giant budget deficit and the high costs associated with health care, the government is increasingly looking for any method to recoup dollars.

In other words, just because there hasn’t been a major Anti-Kickback enforcement case in O&P yet, he says, that doesn’t mean practitioners and manufacturers should think they are not at risk. A new wariness is becoming widespread in the healthcare professions, as witnessed by dramatic cutbacks on giving away even inexpensive pens, note pads, and T-shirts.

McGill advises evaluating carefully before accepting any kind of gift or compensation. (See sidebar at left for questions to ask on certain common gifts.) Ask yourself how you would feel if news of the exchange appeared on the front page of The New York Times, he says. Or consult the Advanced Medical Technology Association’s Code of Ethics on Interactions with Health Care Professionals, available at www. advamed.org. AOPA will offer a teleconference, “Happy Holidays! Kickbacks and Gifts in O&P,” on Nov. 9, 2011, focusing on how to judge whether gifts to referral sources could be interpreted as kickbacks. (AOPA also adopted a voluntary Code of Interaction With Healthcare Professionals in 2009. It is available upon request to info@AOPAnet. org or click on the Resources button on AOPA’s website www.AOPAnet.org.)

If you are really uncertain about where the lines are drawn or uncomfortable with your understanding of the Anti-Kickback Law, consult a lawyer, McGill says. “A lawyer can provide not only guidance but [also] a written opinion you can rely upon as defense

if the transaction is ever called into question,” he adds. “People don’t like to call an attorney, but the amount of money you’re going to spend preventively to stay on the right side of the law is much less than the alternative. The downside is enormous.”

The Law on False Claims When it comes to the False Claims Act, remember it doesn’t apply just to knowingly submitting a false claim to Medicare or Medicaid. It also can mean willful disregard or ignorance of payment rules, McGill says.

Enforcement of False Claims Act provisions has increased significantly since 2008 because of the potential to recover costs, he adds, and the government is looking for new and creative ways to enforce it. Keep in mind also that electronic billing makes it easier to spot statistical anomalies and that the False Claims Act gives legal protection and financial benefits to whistleblowers.

Despite significant financial penalties that multiply for habitually billing with an erroneous code and significant incentives for employers to become whistleblowers, very few O&P practitioners think to look at False Claims Act liability when conducting risk assessments, McGill says. An August 2011 report, “Questionable Billing by Suppliers of Lower Limb Prostheses,” by the Office of the Inspector General of the Department of Health and Human Services, indicates that submitted rates for prosthetic devices have drawn attention and are being scrutinized.

“It’s equally plausible that with microprocessor knees, microprocessor ankle-foot systems, and powered prosthetics hitting the marketplace, the cost of health care has simply gone up,” McGill says. “But whatever the cause, you should assume that your claims are being scrutinized closely, and you have to be certain that the codes you use to bill for devices are the right ones.

Because ultimately at the end of the day, the only person that will be held responsible is you.” a

Protecting Against Charges Under the False Claims Act Will inappropriate billing open you to federal scrutiny?

Check this advice:

• Ensure that codes match 100 percent accurately to what was delivered to the patient, and don’t unbundle items that should be billed together.

• For claims to Medicare or other government payers, review the codes listed by the Pricing, Data, Analysis, Coding Medicare (PDAC) for the product at issue (if the PDAC has reviewed it). If you bill a device that’s out of line with the PDAC, ignorance probably won’t be a defense.

• Use AOPA’s LCodesearch.com to search codes by product or manufacturer. Products may not have been PDAC-verified, but at least your coding is supported by a panel of experts.

• Consult other experts through AOPA and get written opinions.

• Document your rationale. A reasonable, well-supported argument as to why you used a particular code may be enough to defuse the government’s contention that you made a false claim.

Source: David McGill, Össur Americas

Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.

OCTOBER 2011 O&P ALMANAC

27

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When Both Arms Bilateral upper-limb amputees face enormous challenges, but O&P practitioners can ease their progress

Y

our brain’s motor and sensory areas devote the most space to controlling body parts that require precision and control, such as your thumbs, fingers, and hands. Take away a hand, and you’ll lose one of your body’s finest motor tools—one you use not just for grasping and lifting but also for talking, gesturing, and touching. Take away both hands, and you undergo a significant whole-body impairment that represents an enormous life change.

That’s what a bilateral upper-limb

amputee faces. Compounding the situation are the facts that 92 percent of these amputees lose their limbs in traumatic circumstances, most are men between the ages of 16 and 44, and most are family breadwinners.

“Bilateral upper-limb amputation is a profound loss,” says Jack Uellendahl, CPO, Hanger Prosthetics and Orthotics. “The ability to perform basic and routine tasks such as eating and self-care becomes difficult or impossible without assistance.”

OCTOBER 2011 O&P ALMANAC

29

For these patients, prosthetics function as important tools in achieving activities of daily living—not just as assistive devices. And that means treating a bilateral upper-limb amputee requires an evaluating and fitting approach like few others.

Bilateral amputees do not have the option of compensating for inadequate prostheses by using their remaining arm. “Bilaterals have to use a prosthesis as a dominant hand and generally do all things with their prosthesis,” says Uellendahl, who has authored a chapter on bilateral upper-limb prostheses in the Atlas of Amputations and Limb Deficiencies (AALD).

“Due to the inability to duplicate the diverse and complex functions of the human arm,” he says, “prosthetic systems should be viewed as tools, with each component being best suited for certain uses.”

Evaluating Patients The first step in evaluating a patient is to identify what category that patient fits into, says David Rotter, CPO, clinical director of prosthetics at Scheck and Siress. Because of their unique needs, new users, previous users, and congenital and traumatic patients are approached differently.

“I’m very aware of all the different components and options and different ways to construct things—that’s not the important thing,” says Rotter. “The important thing is to understand the person—where they are coming

“Our job is to not get in the way of what they can already do. Sometimes fitting a children’s elbow on an adult, or a prosthesis otherwise two sizes too small, is totally appropriate for the congenital patient’s needs.”

––David Rotter, CPO

from—and nurture the process along, to not give them unrealistic expectations, but to give them a tool that they can actually use, that is useful to them, and that they have a positive experience with.”

When evaluating new users, Rotter says the prosthetist should try to dispel any misconceptions about device capabilities so that expectations are more in line with the true capabilities of the devices.

New users and traumatic or congenital patients. As the majority a group of bilateral upper-limb amputees, these patients often arrive at the clinic with unrealistic expectations about how technologically advanced upperextremity prostheses really are.

“People have an idea, probably from media reports, that bionic hands are more advanced than they actually are,” says Uellendahl. “Most people who acquire an amputation assume that they should have hands and not something that doesn’t look like a hand. Very often they assume that the technology exists to very adequately replace their hands, which isn’t really the case.”

Previous users. This group already has a general sense of what devices can do for them, so the prosthetist should focus on their past experiences, what they liked or didn’t like and why, and what their goals are.

Congenital previous users are a special group, Rotter says. In a sense, they aren’t really amputees. They were born limb deficient and adapted themselves when their brains and bodies were most plastic—when they were growing up. Age-appropriate prostheses are often not well suited for this group.

“I’ve seen instances where people were fit with a prosthesis that absolutely took away the function that they already had because the arm length encumbered the patient. That’s a failure,” he says. “Our job is to not get in the way of what they can already do.

Sometimes fitting a children’s elbow on an adult, or a prosthesis otherwise two sizes too small, is totally appropriate for the congenital patient’s needs.”

Working as a Team Because of the complexity of bilateral upper-limb loss, experts recommend an evaluation and rehabilitation approach that involves a whole team of professionals. This holistic approach generally includes a surgeon, physiatrist, prosthetist, occupational therapist, 30

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Practitioners who have experience evaluating and fitting bilateral upper-limb amputees have this advice: • BUILD A PREPARATORY PROSTHESIS. This technique, widely used by upper-limb prosthetic specialists since the mid 1980s, involves fitting a patient quickly in a very adjustable manner over two to three days.

“The goal is to get the patient using the prostheses immediately so the prosthetist can appreciate those changes that need to take place to enhance meaningful function,” says Chris Lake, CPO, FAAOP, Lake Prosthetics and Research, and chair of the American Academy of Orthotists and Prosthetists’ Upper Limb Prosthetics Society. “The preparatory fitting provides the opportunity to carefully consider and incorporate input from the patient, family, therapist, and other team members. This opportunity is lost when the prosthetist moves directly into definitive prostheses. While it may take more time in the beginning, it saves a lot of time in the end. Most important—the patient outcome is greatly improved,” he says.

•

CONSIDER A WRIST-FLEXION UNIT. These devices allow patients to flex inward to get closer to their bodies. They are highly-recommended for bilaterals for independence in toileting, bathing, and feeding themselves. Robert Wagner, BOCP, upper extremity specialist with Wright and Filippis, suggests a flexion wrist on the dominant side and a locking wrist on the other side.

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• MITIGATE HEAT RETENTION. People with multiple limb amputations are missing large portions of surface area of their skin and are often hot all of the time. Increase ventilation in the prosthesis by adding windows, vent holes, or selective openings to allow air in. Wicking socks work well too, says David Rotter, CPO, clinical director of prosthetics at Scheck and Siress.

• ADDRESS DURABILITY AND CLEANING. Cables snap and electric arms break, so it’s essential that bilateral upper-extremity patients have a backup set of arms. Harnesses absorb body oils and odors and are difficult to remove and clean. Rotter suggests building harness liners using underamour fabric that can be easily removed and placed in the wash.

• CONSIDER LACK OF TACTILE SENSATION. Bilateral prostheses cannot provide tactile sensation, so many wearers like to be able to get out of their prosthesis to feel with their residual limb. “This requires the fit to be loose enough to allow easy removal and then easy donning. The prosthesis generally hangs on the harness as the user feels the environment with their exposed skin,” says Jack Uellendahl, CPO, Hanger Prosthetics and Orthotics.

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O&P ALMANAC OCTOBER 2011

physical therapist, psychologist, nurse, social worker or hospital case manager, family, friends, and sometimes a home-modification specialist. Access to other amputees with similar limb loss is invaluable.

“Your prosthetic role is just one part of what this person must go through during the rehabilitation process,” says Chris Lake, CPO, FAAOP, Lake Prosthetics and Research, and chair of the American Academy of Orthotists and Prosthetists’ Upper Limb Prosthetics Society. “Typically, bilateral upper-limb patients are not like lowerlimb patients who may have time to prepare for amputation weeks or months in advance. Often, the upperlimb patient experiences a sudden trauma resulting in the need for an emergency amputation.

“Bilateral upper-limb amputees can present with psychological issues such as post-traumatic stress disorder.

Research suggests that psychological treatment can have a dramatic effect on whether or not a person uses their prostheses and whether or not they can successfully cope and adjust,” he says. “There’s a psychological component that we have not consistently recognized but is influential to our successful treatment of this patient population. We should help direct the patient and family to resources that can help with this component.”

Bilateral upper-limb amputations that are the result of trauma are often accompanied by other medical issues, such as brain injury, visual loss, hearing loss, and nerve and vascular damage, any of which will make a complex evaluation even more difficult.

In the AALD, Uellendahl writes that, in making evaluations, prosthetists should consider the patient’s • cognitive level • mechanical aptitude • family life • occupation • hobbies • self-image • residual limb length, strength, and range of motion, including scapulothoracic motion.

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Throughout the evaluation process, the prosthetist should carefully consider the advantages and disadvantages of various components and control options as they relate to the specific individual and that person’s goals,” says Uellendahl.

It’s also important for the evaluation plan to remain flexible throughout the entire rehabilitation process, he says, as prosthesis

Resources Functional Restoration of Adults and Children With Upper Extremity Amputations, by Robert Meier III, MD, and Diane Atkins, OTR, comes highly recommended, as does Jack Uellendahl’s chapter on bilateral upper-limb prosthetics in the Atlas of Amputations and Limb Deficiencies.

For patients, a DVD by bilateral amputee Art Heinze includes practical solutions and daily living tips. Reach Heinze at artheinze@gmail.com.

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O&P ALMANAC OCTOBER 2011

configurations will change as the patient’s needs and abilities are better realized and progress.

In all cases of acquired arm amputation, Uellendahl says, it’s advisable to fit a prosthesis as soon as possible—preferably within 30 to 90 days. Fitting upper-limb prosthetic devices during that ”golden period” is more likely to lead to optimal acceptance and use.

Selecting and Fitting When Art Heinze lost the better part of both arms in a sawing accident at age 19, he became fixated on cosmetic hands as a pathway to returning to normal life.

“I thought, ‘Gee, if I had two artificial hands, then no one would know that I had a disability and I could get by pretty well,’” says Heinze, a trans-radial and transhumeral amputee who lives in Thief River Falls, Minnesota. It’s little wonder he thought it was “cruel” that his prosthetist fitted him with hooks, telling him he needed to learn to use the hooks first before they would talk about artificial hands.

Heinze, a retired occupational therapist who is now 71, never got those hands. “If I had one good hand, then maybe I would have gotten the [artificial] hand, but being a double amputee, the hook is so much more functional,” he says.

Bilateral below-elbow amputee Jeff Gaines, 45, of Hendersonville, Tennessee, says he couldn’t wait to trade up to a myoelectric prosthesis with a cosmetic hand after first being fitted for six months with body-powered hooks. “I didn’t have any muscle control problems, so the myoelectrics were much easier to use function-wise, and they look more natural,” says Gaines.

These different experiences demonstrate that every bilateral patient has different needs and goals when it comes to function and cosmetics.

But generally, the higher the level of amputation on the arm, the more paramount function becomes.

Uellendahl’s philosophy is to select different kinds of terminal devices so clients have the benefits or features of each, giving patients a wider variety of tasks they can achieve. Often his bilateral patients will have a bodypowered prosthesis on one side and an electric-powered one on the other.

“Each device might be better suited for certain types of activities and not for others,” he says. “For example, an electric hand can provide a lot of

force because of the surface area of the hand and is sometimes is better for stabilizing an object. But a bodypowered hook is generally better for fine manipulation because you can see what you are doing and have good control over that hook because you are using your own motions to open and close the hook.”

In the case of high-level fittings, upper-limb experts will fit the dominant side first (generally, the side with the longer remaining limb) in order to avoid gadget overload.

“If you fit people with too many things that they have to control, they become frustrated and it becomes difficult for them to operate,” says Uellendahl. When that happens, he has waited weeks or even months before proceeding to the second fitting.

Addressing Problems Amputees who wear body-powered prostheses often experience shoulder problems as a result of the constant use of their shoulders. Robert Wagner, BOCP, upper-extremity specialist with Wright and Filippis, suggests backing off on the number of rubber bands used. Heinze even suggests cutting the bands in half and subtracting or adding bands until a comfortable tension is achieved. Alternative devices, such as myoelectric ones, could also be considered.

Sometimes a prosthesis does not meet expectations. “A successful prosthetic treatment begins with the prosthetist understanding the patient’s expectations and needs.

This understanding combined with a thorough discussion of all the prosthetic options applicable to the patient presentation increases the likelihood of a successful fitting,” says Lake. “Many times an unsuccessful fitting is related to the patient not being a part of the decision making process.” Prevent this by first updating your own knowledge, so you can better educate the patient and address their expectations. This leads to a better working relationship between the prosthetist and patient.

Experienced practitioners advise identifying and focusing on the patient’s most important goal. Getting back to work might not be the highest activity on a new bilateral amputee’s list. Be sure to take the time to really find out what activities the person is most concerned about not being able to do. Lake says “that addressing those needs determined to be most important by the patient can lead to better success in other aspects of treatment including vocational and self-care related activities.”

Finally, remember that the family should empower, not enable. Families often rush to the amputee’s side and take over many of that person’s activities of daily living. While this may be necessary in the beginning, it is not an optimal long-term solution.

Encourage family members to empower their loved one by helping

that person develop the skills to become independent. This will have a positive influence on the person’s selfesteem and family dynamics. Families gain the necessary skills to empower by working with a psychologist or social worker.

The loss of both arms represents a special challenge for patient and practitioner alike. But an understanding of the individual patient’s needs, coupled with a tailored education process, can result in a high level of functionality. Still, even though artificial limb technology will continue to improve and evolve, the bilateral amputee will always require special attention and care. a

Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@ gmail.com.

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Facility Spotlight

By Deborah Conn

Man With a

Mission

Personal tragedy sparked a career of service to others at Kenney Orthopedics Founder of Kenney Orthopedics Mo Kenney, CPO, FAAOP, with prosthetic patient Darlene Bowles.

FACILITIES:

Kenney Orthopedics

LOCATIONS:

Lexington, Mt. Sterling and London, Kentucky; Indianapolis, Indiana

OWNERS:

John M. “Mo” Kenney, CPO, FAAOP

HISTORY:

10 years in business

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O&P ALMANAC OCTOBER 2011

J

ohn “Mo” Kenney decided on his career path when he was 7 years old. That’s when a car accident left him a below-knee amputee. He determined then to “help other people in the same predicament.”

Kenney studied orthotics and prosthetics at Northwestern University and served his O&P residency with Hanger Orthopedics, where his career progressed as that company grew. After about 12 years with Hanger in a variety of locations, Kenney opened his own facility in Lexington, Kentucky.

“I’ve heard it said that if you care about people, success will follow,” says Kenney. “It certainly happened that way for us.”

Building a Team Today, Kenney Orthopedics (KO) has three facilities in Kentucky and one in Indiana. Among KO’s 30 employees, eight are ABC-certified practitioners.

The six-person technical staff includes two ABC-certified assistants.

KO’s main facility in Lexington is one of four units in a professional-office complex. A fabrication lab accounts for about half the facility’s 5,000 square feet; the remainder holds two full gait labs and two fitting rooms. Each of KO’s other offices has two gait labs as well, with the exception of the smallest facility, in London, Kentucky, which has one. Every office occupies at least 2,000 square feet.

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Each facility is self-sufficient, performing its own fabrication, billing, and administrative functions. Kenney spends most of his time in Lexington, but visits the other offices about once a week. He estimates that the practice is evenly divided between orthotic and prosthetic care and sees patients of all ages, from children to elderly adults.

All four KO offices are managed by a partner with an ABC CPO credential.

“Each of my partners has a unique attribute,” he says. “Together, as a team, we can conquer any problem.”

Serving Others

Top left: Kenney Orthopedics patient Imojean Goodlett with Todd Schaffhauser and Dennis Oehler, marketing professionals who work with KO, at its quarterly “Amputee Walking School.”

Top right: Founder of Kenney Orthopedics Mo Kenney, CPO, FAAOP, with his daughter Jaden.

Lower: Kenney Orthopedics employee Casey Thomas, CO, scanning a patient for an AFO.

38

O&P ALMANAC OCTOBER 2011

Kenney has a strong sense of mission, which is reflected in his facility’s humanitarian work. Kenney and a team of other professionals have twice visited Zhitomir, in northern Ukraine, to work with children affected by the Chernobyl nuclear explosion. In addition to purchasing prosthetic and orthotic devices for the children, KO receives component donations and then modifies them to fit. Kenney has participated in volunteer missions to sites in Mexico and other countries as well.

At home, Kenney Orthopedics handles many indigent cases and cares for a number of referrals from nonprofit agencies. “We try to help out the best we can,” Kenney says. “We don’t turn anyone away.”

Periodically, KO sponsors a “walking school” for amputees and care providers who can earn continuing education credits by taking part in the clinics. KO patients and their families

can participate free of charge. The clinics, taught by elite Paralympic amputee athletes, focus on stretching and strengthening exercises and teaching a running gait for above- and below-knee amputees.

One goal is to raise the awareness of amputees and health-care professionals about sports and recreational opportunities for the disabled.

In addition to his practice, Kenney serves as president of the American Board for Certification in Orthotics and Prosthetics. His facility “is rather strict about following ABC accreditation standards,” says Kenney, who points out that Medicare requires only 30 standards for suppliers, whereas ABC has 142 for accredited O&P facilities.

Looking Ahead Kenney has plans to expand his business, but, he says, “My concern is that we have enough qualified practitioners to support another office.”

Nearly all of the firm’s new hires have held KO residencies accredited by the National Commission on Orthotic & Prosthetic Education. Kenney will not take on more than two residents a year, however. “It’s not fair to them or to us,” he says.

As for succession planning, Kenney is in his early 40s and has not had a chance to plan for the future. “I know an exit strategy is important; however, I still enjoy going to work every day,” he says.

Still, the practice could become a family affair down the road. Kenney and his wife, a physical therapist, have two children—12-year-old Nicholas and 7-year-old Jaden. This year, Nicholas started working in the lab to explore his possible interest in a future with the family practice. a

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

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AOPA Headlines AOPA WORKING FOR YOU

AOPA Survey Reports on Pay and Policy Compare your business to this snapshot of the O&P industry today

W

hat does the O&P industry look like today? The 2011 AOPA Compensation and Benefits Report provides a snapshot of compensation levels and policies in the O&P community. The report is based on 2010 data from 135 responding companies, representing 1,050 full-time locations and 68 part-time locations.

Although it reflects only the practices of the respondents, the report most likely bears a close resemblance to general industry patterns. Read the findings here—as well as in the complete report—to see how your business compares.

Company Profiles Responding companies averaged $4,108,857 in revenue, but the median revue was $2,171,000—that is, half of the responses were from companies with revenues above the median, and half were from those with revenues below. The companies fell into four revenue categories: • up to $1 million in revenue—20.8 percent • $1 to $2 million—26.4 percent • $2 to $5 million—36 percent • more than $5 million—16.8 percent.

A breakdown by employees shows that 10.9 percent of the companies had fewer than five employees in 2010; 34.9 percent had five to 10; 27.1 percent had 10 to 20 employees; and 27.1 percent had more than 20 employees.

What did these employees do in the business? More than one third—37 percent—were nonowner practitioners, a group that includes licensed or certified orthotists, prosthetists, pedorthists, and fitters. The next largest group was office administration and marketing staff, accounting for 36.4 percent of the workforce. Technicians made up 19.90 percent; nonclinical owners/managers, 1.8 percent; and owner practitioners, 2.8 percent. Practitioner assistants and extenders accounted for only 1.4 percent, and the remaining 0.7 percent of the workforce was classified as “other.”

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O&P ALMANAC OCTOBER 2011

As for the legal form of the business, S-Corps led the list at 51.5 percent, and C-Corps were next at 19.7 percent.

Another 19.7 percent were classified as “other,” which could include the LLC and LLP legal entities. Finally, partnerships accounted for 5.3 percent of responding companies, and sole proprietorships comprised 3.8 percent.

On the basis of sales categories as a percentage of gross sales or billings, prosthetics topped the list with 48.6 percent.

Orthotics came a close second with 42.4 percent. The remaining categories were pedorthics, 4.9 percent; other, 3.2 percent, and DME, 0.9 percent.

REVENUE CATEGORIES

$2 to $5 million

$1 to $2 million

36% 16.8%

26.4%

20.8%

More than $5 million

Up to $1 million

Compensation The highest level of compensation in all responding firms went to ABC-certified prosthetists and orthotists, who earned a median of $91,384. But the level of remuneration varied according to size of facility. The study reports earnings for those working in facilities with $1 million in sales, $1 to $2 million, $2 to $5 million, and more than $5 million. CPOs did best in the smaller firms, typically earning about 3.5 percent more than the number reported for all firms. The BOC-certified prosthetist was the next highest earner at $91,070.

Licensed—but noncertified—orthotists earned about $20,000 less that certified orthotists, and the pattern was even more striking for prosthetists. Licensed, noncertified prosthetists earned almost $32,000 less than their ABC-certified colleagues.

Median earnings of marketing personnel were $50,500 in firms with $2 million to $5 million in sales and $61,000 in firms with sales of more than $5 million. These were the only size firms for which sufficient data are available.

More than four in 10 companies—42.9 percent— provided fully paid medical insurance for employees, 45.9 percent split the payment between employee and the company. Only 1.5 percent reported that medical insurance was fully paid by the employee, and 5.3 percent reported that they did not provide any medical insurance.

Insurance for dependents was different, with 32.8 percent fully paid by the employee, 41.2 percent split between the company and employee, and 11.5 percent fully paid by the company. Dependent coverage was not provided by 9.2 percent of the companies. Several respondents noted that premium payment varied by type of position. Life insurance and dental insurance were the next two most prevalent benefits offered.

In conjunction with the research firm Industry Insights, AOPA conducts the survey on operating performance and compensation every two years on odd numbered years. In even numbered years, only the operating performance survey is conducted. For members, the reports—a total of 140 pages— are priced at $185 each for hard copy and $95 each for the electronic version. Nonmember prices are $325 for the hard copy and $185 for the electronic version. Order online from the AOPA Bookstore, www.AOPAnet.org.

Participants in the survey receive not only a free copy of the survey results but also a custom company performance report showing their results in comparison to a peer group of companies of similar size and in similar locations. They also are eligible to reserve a time slot for a personal consultation from Industry Insights.

A big “thank you” to the O&P professionals who took the time to complete the detailed eight-page survey. Taken together, the information they provided is a real contribution to the field—and a valuable resource for individual practitioners. a

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About the Survey The 2011 AOPA Compensation and Benefits Report, along with the operating performance figures reported in the August O&P Almanac, provides this information, plus detailed compensation data on 20 positions commonly found in O&P patient-care facilities. The data are reported by revenue size, community size, and business type. Most positions are reported first by minimum, average, and maximum average base salary range and then by total compensation, including any bonus payments. Average years of experience in each of the reported groups also are provided. Detailed information on benefits enables AOPA members to see how they stack up in the increasingly competitive market for top talent.

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OCTOBER 2011 O&P ALMANAC

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AOPA Headlines

AOPA Addresses Competitive Bidding Questions

HIPAA 5010 Transition Deadline Approaching

Many O&P facilities recently reached out to AOPA regarding mixed messages they received about the possibility of CMS including off-the-shelf orthotics in future competitive bidding. However, CMS did not include orthotics and prosthetic devices in its Round 2 competitive bidding announcements.

AOPA will continue to monitor the ongoing policy changes and keep members updated as CMS has authority to review and change the product list in the future.

In less than six months, all Health Insurance Portability and Accountability Act (HIPAA) covered entities (suppliers, health plans, clearinghouses, billing services, etc.) will be required to use the new HIPAA 5010 format for all HIPAA-covered electronic transactions (claims submissions, remittance notices, claim status requests, etc.). If you do not switch to the HIPAA 5010 format before Jan. 1, 2012, you will experience delays in processing your claims with both Medicare and private payers. The current 4010 format will not be accepted after Jan. 1, 2012.

CMS has created a checklist and a readiness assessment tool to help you during this transition. To view the checklist, visit www.cms.gov/Versions5010andD0/Downloads/ w5010PvdrActionChklst.pdf.

To view the readiness assessment tool, visit www.cms.gov/ Versions5010andD0/Downloads/Readiness_1.pdf.

Legislators Fight Against Medicaid Overhaul Forty-one Senate Democrats signed several letters opposing House Republicans’ proposed Medicaid overhaul, ensuring the proposal won’t get enough votes to clear a filibuster hurdle.

One letter to President Obama, spearheaded by Medicaid defender Sen. Jay Rockefeller (D-West Sen. Jay Rockefeller Virginia), garnered 37 signatures. It states that the senators will oppose proposals to cap federal spending on Medicaid, a program whose current spending fluctuates with need. Four other senators wrote separate letters to the president.

Electronic Data Interchange (EDI) Standards:

Transition to Versions 5010 and D.0 Provider Action Checklist for a Smooth Transition This checklist can be used to assist you to transition smoothly to Versions 5010 and D.0. The column on the left identifies actions required by you. The column on the right offers suggested questions to ask: 1) your vendors, clearinghouses, billing services, and payers; and 2) yourself regarding data reporting requirement changes, workflow modifications, staff training needs, and testing with your trading partner.

Required Actions

□ Engage vendors early

□ Communicate with

clearinghouses, billing services, and payers

Elements Software vendors are not covered entities; and therefore, they are not responsible for compliance. However, vendors are critical to provider compliance and any interruption in vendor implementation of compliant products will delay end-to-end testing.

Some questions to ask your vendor(s): • Will you upgrade your current system to accommodate Versions 5010 and D.0 transactions? ◦ Will the upgrade include acknowledgement of transactions 277CA and 999? ◦ Will the upgrade include a “readable” error report produced from 277CA and 999 transactions?

• What is the time frame for when you will be capable of supporting Version 5010 transactions exchange?

• Will you be able to support both Version 4010A1 and Version 5010 transactions exchange concurrently?

• When will the current system accommodate both the data collection and transactions conduction for Versions 5010 and D.0?

• When will the upgrades be available?

• Will there be a charge for the upgrade?

• When will the software installation to the systems be completed?

• Will the transition be completed before the January 1, 2012 compliance date?

• Will there be sufficient lead time to test the new software before the January 1, 2012 compliance date?

Based on the vendor’s responses to the questions above, evaluate the impact to routine operations and begin planning for training and transition.

Contact clearinghouses or billing services and health insurance payers early to learn about their implementation plans.

Some questions to ask your clearinghouses, billing services, and payers: • Will you be upgrading your systems to accommodate Versions 5010 and D.0 transactions?

• When will the upgrades be completed?

• Will you change your fees for Versions 5010 and D.0 transactions?

• How will we need to register in order to conduct 5010 transactions?

• When can we send you our test transactions to ensure the system works correctly?

Based on the responses to the questions above, you will know if your clearinghouses and billing service can continue to support your business. This information will assist you with planning budget needs and help develop a time frame for testing and implementation.

1

Arizona Medicaid Program Cuts O&P Services Arizona’s Medicaid program began denying health-insurance coverage to childless adults on July 8, Capitol Media Services reported.

These cuts included a denial of coverage for orthotic services and microprocessor prostheses to Medicaid recipients over the age of 21.

An estimated 100,000 residents will be affected in this first year alone. With federal approval now in place, Arizona will start denying coverage to childless adults who are below the federal poverty line— defined as a single person who earns less than $10,890 annually.

Arizona provided health-insurance coverage to those residents for Gov. Jan Brewer a decade, but Gov. Jan Brewer (R) argued that the state can’t afford the Medicaid program. She expects the change to save taxpayers $190 million and cut 100,000 beneficiaries from the program in the first year. AOPA has collaborated with Arizona AOPA members to repeal these cutbacks.

The change will not strip health-insurance coverage from childless adults already receiving it, Capitol Media Services reported. However, new applicants will be turned away.

42

O&P ALMANAC OCTOBER 2011

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION

Business OptimizatiOn analysis tOOl (boAT) AOPA’s largest and most successful members use the BOAT and you should also.

the Boat will help you:

Provide access to the new Create

BudgeTs

AOPA Patient satisfaction survey (required by certifying bodies).

OPC data you submit will automatically populate your BOAT site providing valuable historical information

This AmAzing Profit Booster is free for AoPA MeMbers.

Participate in the annual Operating Performance and Compensation survey (OPC) —which provides you with a personal benchmark comparison study.

examine the

fInAnCIAl fITness of your business

Help you identify and

TrACk your finances

understand your competition, market conditions and referral sources

And MuCH MOre!

You will have access to your own secure and confidential account on the BOAT which will contain your company’s reported data and is specifically tailored to help O&P business owners manage their business for greater profit and quality patient care.

If you do not already have a BOAT account, contact AOPA’s BOAT partner, Michael Becher, Industry Insights, (614)389-2100 x 114 or mbecher@industryinsights.com, to enroll today.

n

AOPA Headlines

Developing Medicare Billing Compliance Plans Do you know the difference between fraud and abuse?

Do you have a billing compliance plan in place? If not, join AOPA on October 12 for an hour-long telephone audio conference, and learn how to develop a billing plan and understand the importance of maintaining compliance.

The DME MACs and the Office of Inspector General are closely examining the billing practices of O&P facilities.

With this added scrutiny, a well-designed, effective billingcompliance plan is paramount for any successful O&P business. Ensuring your compliance practices are sound may prevent unnecessary audits.

Final Advanced Coding and Billing Seminar of 2011 Don’t miss out on the third and final Coding and Billing seminar of 2011 on October 24 and 25 at the Sheraton Inner Harbor in Baltimore. Register early to receive the room rate of $159 per night.

At this seminar, AOPA experts will provide the latest information to help O&P practitioners and office-billing staff alike learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts and colleagues. This two-day event features break-out sessions tailored to both groups, to ensure material is appropriate to each.

Practitioners will cover • general coding principles • hands-on coding of specific devices • proper coding for repairs and adjustments • reimbursement for unlisted codes • mutually exclusive codes that should not be billed together.

Administrators will cover • updated Quality and Supplier Standards • strategies for handling appeals and denials • strategies for handling unique billing situations • documentation requirements • Medicare as secondary payer.

44

O&P ALMANAC OCTOBER 2011

An AOPA expert will address the following during the audio conference: • the elements of an effective billing compliance plan • where to find help with your plan • how the plan can mesh with other compliance requirements (HIPAA, accreditation, etc.)

• how to communicate the plan’s standards and procedures to employees • ways to enforce the compliance plan.

The cost of participating is just $99 for AOPA members ($199 for nonmembers), and any number of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent.

Register online at https://aopa.wufoo.com/forms/2011telephone-audio-conferences.

A NEW AOPAversity OPPORTUNITY!

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AOPA is proud to announce the formation of a new Business Management Certificate program. The AOPAversity O&P Business Management Certificate is a comprehensive certificate program that will offer a series of business

PRACTICES

and management seminars to provide business owners, managers and practitioners of O&P patient care facilities, O&P manufacturers and distributors an opportunity to explore crucial business challenges—from finance, sales and marketing to business operations, reimbursement policies and management.

■ DEVELOP BETTER BUSINESS

■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY

Get started today!

1.

Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/

The AOPA Business Management

2.

Select and complete four required core modules and four elective modules within three years.

skills that are fundamental to the

3.

Complete a Module specific quiz for each program.

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Participants that successfully complete the program with be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.

Certificate Program addresses success of an O&P business.

www.AOPAnet.org

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AOPA Headlines

PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • • • • • • •

Kel Bergmann, CPO Don DeBolt Thomas DiBello, CO, LO, FAAOP Mike Fenner, CPO, BOCPO, LPO Bert Harman Russell Hornfisher Eileen Levis Tom Wessel.

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and help elect those individuals who support the O&P community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org. *Due to publishing deadlines this list was created on July 28, 2011, and includes only donations received between July 20, 2011, and July 28, 2011.

Any donations received or made after July 28, 2011 will be published in an upcoming issue of O&P Almanac.

Texas state capital building

AOPA Issues Statement Opposing Texas Medicaid Cuts In an effort to support Texas in its fight against Medicaid cuts, AOPA has issued a statement emphasizing how proposed cuts to O&P could hurt the state budget. The Texas Health and Human Services Commission held hearings on July 12 to consider a reimbursement cut of 12.5 percent to O&P in the state’s Medicaid budget throughout fiscal years 2011 and 2012.

AOPA submitted the following statement emphasizing that this type of cut harms the fiscal health of the state: “Anyone who understands the realities of health care in the U.S. realizes that states cannot simply cost shift budget dollars to providers without detrimental results, e.g., showing up in emergency rooms, adding to the uncompensated care burdens for hospitals and physicians.”

AOPA has been supporting the Texas Orthotic and Prosthetic Association and will continue to update members about potential O&P cuts in the state.

46

O&P ALMANAC OCTOBER 2011

Oregon state capital building

Oregon Legislature Approves Medicaid Changes With the intent to consolidate care and reduce costs, the Oregon Senate overwhelmingly passed legislation imposing monumental changes to the Oregon Health Plan, the state’s Medicaid program. By coordinating physical, mental, dental, and substance abuse services, the state hopes to save an estimated $240 million by the end of the 2011-2013 biennium—a potential model for reducing health-care costs nationwide.

House Bill 3650 aims to consolidate the managed-care plans that currently administer the Oregon Health Plan into regional coordinated-care organizations designed to better manage chronic conditions and preventive care.

The bill passed the Oregon Senate by a vote of 22-7. Seven Republicans voted against the bill. The Oregon House passed the bill by a vote of 59-1.

For more about this topic, visit www.thelundreport.org.

Simple As :

1.

3.

2.

Visit www.kiss-suspension.com or Call 410-663-KISS (5477) Š 2011, U.S. Patent, Patent Pending Worldwide KISS is a registered trademark

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AOPA Applications

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.

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

At the end of each new supplier member listing is the supplier level associated with that company.

Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million

Acme Orthotic & Prosthetic Labs Inc.

Louisiana Rehab Products

1840 E. 71st Street Chicago, IL 60649 773/363-0400 Fax: 773/363-5462 Category: Patient Care Facility Michael Lewis, CPO

2424 Williams Boulevard, Ste. C Kenner, LA 70062 504/468-6100 Fax: 504/468-6109 Category: Patient Care Facility Brian Moore, CPO

Anchor Orthotics & Prosthetics

Northern California Medical Inc./dba Comfort Sleeves

3530 Auburn Boulevard, Ste. 6 Sacramento, CA 95821 916/484-0685 Category: Patient Care Facility Terry McDonald, CO

Bio Dynamic Technologies Inc. 523 E. 73rd Street New York, NY 10021 800/879-2276 Fax: 800/866-8011 Category: Patient Care Facility Felix Garcia

Bracemasters International LLC 5075 S. Emmer Drive New Berlin, NJ 53151 262/797-9771 Fax: 262/797-9795 Category: Supplier Level 1 Lisa Falcon

Center for Independent Rehabilitative Services Inc. 937 Coffee Road Modesto, CA 95355 209/549-1000 Fax: 209/845-2847 Category: Patient Care Facility Eddie Rogers, CPO

J. E. Hanger of Montreal Ltd. 5545 Saint Jacques Street W. Montreal, QC H4A 2E3 Canada 514/489-8213 Category: International Louise Dineen

48

O&P ALMANAC OCTOBER 2011

3814 Auburn Boulevard, Ste. 75 Sacramento, CA 95821 916/979-9729 Fax: 916/971-9393 Category: Patient Care Facility Matt Dittrich, CPO

Opcare Ltd. Ability House Nuffield Way Abingdon, Oxon OX14 1RL England +44-1235-55-2855 Category: International Dominic Hannett

Superior Medical Equipment Plus LLC 821 Clearwater Largo Road N. Largo, FL 33770 727/461-5278 Fax: 727/447-2950 Category: Patient Care Facility Roy Ghozali, CPO

Tensegrity Prosthetics Inc. 908 Main Street, Ste. 111 Louisville, CO 80027 303/666-7722 Fax: 303/362-8616 Category: Supplier Level 1 Jerome Rifkin, CTO a

We were with Rothschild’s Orthopedic.

Every step of their way.

ROTHSCHILD’S ORTHOPEDIC Rothschild’s Orthopedic locations are among the many BOCaccredited facilities making a difference to patients every day.

Background: Rothschild’s Orthopedic has been family owned and operated for 33 years.

Achievements: The Rothschilds hold three U.S. patents in prosthetic and orthotic devices. They own a fabrication facility and six patient care facilities.

Impact: Thousands of patients, orthotists, and prosthetists have benefited from their focus and ingenuity in thermoplastic design and fabrication techniques.

Service: Thousands of physical therapists, students, and other health care professionals have attended their prosthetic and orthotic educational classes and seminars.

“

I am proud to say our facilities are BOC accredited.

”

BOC is proud to have walked alongside Rothschild’s Orthopedic on their journey.

How can we walk with you?

BOCusa.org/profiles

O&P Certification

877.776.2200 | 410.581.6222

DMEPOS Accreditation

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Marketplace

APIS

• Precision gait matched for out-ofthe-box performance • Available in gold or silver • Weight limit up to 275 lbs (125 kg), three-year warranty • Same-day, custom built-to-order.

For more information, call 800/7287950 or visit www.college-park.com.

At Apis, we are committed to using the expertise and experience of our skilled CPO and certified pedorthists to deliver quality products that offer satisfying solutions for a variety of footwear problems. Whatever the situation—hard-to-fit width and length, charcot, edema, bunion, hammer toes or shoe modification—you name it, we have the products to accommodate each and every situation that practitioners see every day. We aim to relieve the pain of your patients and increase your bottom line.

For more information, call our friendly customer service representatives at 888/937-2747.

KISS TRAINERS––DYNAMIC FLEXIBLE KEEL STUBBIE FEET BOOTH #818

COLLEGE PARK’S SOLEUS® TRUE ENERGY IN MOTION The Soleus® offers a dynamic heel that allows for smooth, seamless transition between heel strike and toe-off.

Involving the entire foot in absorbing and returning energy, the Soleus’ four-spring system accommodates moderate to the most active lifestyle.

The multi-composite design and wide platform heel affords stability, durability, and comfort on various terrain. Key features include: • Synchronized control throughout the stance phase • Superior terrain compliance

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KISS Trainers combine phenomenal balance and ease of use. Patients feel stable while confidence training using these flexible keel “stubbie” feet.

Constructed of highly durable, flexible material that dynamically stores energy, these feet are of professional quality and ready-to-use. Bilateral above-knee amputees especially save time and energy while training, and all patients can use KISS Trainers for in-home ambulation. KISS Trainers: Part #: CMP27/A. For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com.

HUGGER TOP SOFT-SOCK® WITH 3-D TOE SHAPE, NEW COLORS! New Hugger Top Soft-Sock provides a more tailored fit, reduces rolling and bunching, and helps maintain sock placement. This sock also features our patented hemispherically knit three-dimensional distal shape. The new distal end shape provides improved fitting qualities and comfort over the traditional flat knit envelope shape of prosthetic socks.

Hugger Top Soft Socks are available in

white, pink, and black in a polyester/ Lycra blend. These moisture-wicking fibers move moisture away from skin and help inhibit odor in the sock. Soft Socks feel soft and cuddly worn next to the skin, and Lycra provides stretch and excellent fitting qualities.

For more information, contact Knit-Rite at 800/821-3094 or email customerservice@knitrite.com.

NEW FROM MOTION CONTROL: NEW TRIAD PREAMP

• Three mounting options • Water-resistant case • High-interference rejection • Gain adjustments on preamp • Compatible for use with: ✔✔ Utah Arm 3 & 3+ (kit: p/n 4050214) ✔✔ Utah Hybrid Arm (kit: p/n 4050214) ✔✔ ProControl Systems (kit: p/n 4050216) ✔✔ Otto Bock electrode cables.

For more information, call 888/6962767, email info@UtahArm.com, or visit www.UtahArm.com.

EURO INTERNATIONAL

VERTAMAX- PDAC APPROVED L0627

Euro International’s new “Orthotic Bandage Care Catalog” by Streifeneder ortho. production features among other new and exciting products, the CoxaSupport.fix, a hip-joint orthosis designed to assist patients in different modes of actions (e.g. stabilization of the hip joint and the limitation of rotation, allowing an early mobilization for a speedier recovery and healing process.)

With a motion limitation in two levels, an adjustable flexion/extension from 0 degree–120 degrees in 15 degrees steps, along with abduction/adduction separately adjustable, the device also supports controlled motion sequences and therefore reduces the risk of luxation.

The CoxaSupport.fix is used for the following indications: luxation prophylaxis, femoral head-resection (Girdlestone-resection), conservative therapy, e.g. of coxarthrosis, and postoperative care just to name a few. The device is available in small, medium, and large for size-adjustable hip and femoral circumferences as well as for patients taller than 5 ft 7 in.

For more information, call 800/3782480 or visit www.eurointl.com.

VertaMax is designed and manufactured utilizing dense elastic material which provides significantly more compression than those conventionally used for lumbar supports. Vertamax provides unparalleled anterior-posterior support, abdominal support, perfect anatomic fit, ease of donning and doffing, and soft comfort. Abdominal compression can be increased or

decreased with the fastening tabs. The adjustable anterior and posterior plastic panels contour and conform to patients of all shapes, sizes, and lordotic curves with no heat molding necessary. Your patients will appreciate the streamline design that is virtually undetectable under clothing.

Contact Optec USA for all your bracing needs at 888/982-8181 to speak with our customer service team or check out our website at www.optecusa.com.

DYCOR Renewing Independent Lifestyles HD‐FDS Foot

Dycor’s new Heavy Duty FDS energy‐returning prosthetic foot (HD‐FDS, L5981) is designed specifically for unassisted ADL (K3).

Keel deflection specifications are determined by computing Body Mass Index (BMI). Multiply the weight of your client in pounds by the foot size in centimeters. The HD‐FDS foot is recommended when the resulting value is between 7,500 and 10,000. Complete weight (including EVA foot shell and titanium pyramid) is between 6‐16 ozs., depending on weight and foot size.

The FDS foot is a non‐ stocked, customized product. Please allow 3 working days for processing. For additional information, contact Dycor’s technical service department.

Dycor – 800.794.6099 www.dycormfg.com OCTOBER 2011 O&P ALMANAC

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INTRODUCING OPTEC USA’S NEWEST PRODUCT Combining comfort and support that is out of this world! Galaxy LSO LP is part OPTEC USA’s newest line of spinal braces.

The brace features our patented CROSSOVER closure system, as well as durable polyurethane panels with a comfortable, removable liner.

The Galaxy’s anterior opening design provides easy donning and doffing, and the adjustable strap length ensures a comfortable fit for your patients.

OPTEC’s Galaxy LSO LP is approved

by PDAC for L0627 coding.

Contact Optec USA for all your bracing needs at 888/982-8181 to speak with our customer service team or check out our website at www.optecusa.com.

NEW! RE-DESIGNED E-MAG ACTIVE KAFO—TAKE A STEP IN THE RIGHT DIRECTION! New feature allows patients to temporarily deactivate the locking function—great for biking or physical therapy! The integrated, low-profile joint provides the best in electronic stance control and helps patients achieve a more active lifestyle. Simple onboard programming helps the E-MAG Active calibrate itself to the user’s unique gait pattern, adding a whole new dimension of functionality for people who previously have had limited bracing options, such as a locked knee or manual

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device. Help your patients get back into the swing of things with the E-MAG Active!

Call your local sales representative to learn more at 800/328-4058.

THE NEW RE-FLEX SHOCK™ BY ÖSSUR: WORK HARD. PLAY HARD. Össur announces the new Re-Flex Shock, the ultimate in vertical shock absorption and dynamic energy return for active patients.

With a design originating from Össur’s Re-Flex VSP, the original and unparalleled vertical shock foot, Re-Flex Shock offers all the benefits of its predecessor, and much more! Featuring increased energy return, improved durability, easier fitting and finishing, and the EVO feature for smoother walking, this foot takes vertical shock feet to the next level and is the ideal solution for amputees who demand the ultimate in performance and comfort.

For more information, visit our website at www.ossur.com or call 800/233-6263.

HELIX3D HIP—THE SHAPE OF THINGS TO COME The Helix3D Hip Joint takes advantage of a ground breaking design to create a more natural, threedimensional hip movement. Its polycentric design improves toe clearance and provides three-dimensional movement that mimics the movement of the human pelvis. And the hydraulic provides greater stability every step of

the way. The results for your patient are dramatic—greater stability and less compensatory movements to make every step more stable and confident.

To find out more about how you can get your patients into Helix3D today, call 800/328-4058 or visit www.ottobockus.com.

MODULAR COMPONENT SERIES FROM PEL

Becker Orthopedic has enhanced their comprehensive line of orthotic components by adding a new modular series of knee-joint options. Providing locked (1017), ratchet lock (1018), and stance control (9005/9006) options, this modular series—available from PEL Supply—offers versatility and ease in the fabrication of your orthosis. To further complement their modular line, Becker now offers Slim Line Modular Ankle Joints available with a 3/4 inch or 5/8 inch recess to accommodate their A and B size modular knee joint uprights. Available in both stainless steel and aluminum, the SLM-2825 is the perfect addition to their modular line.

For more information on the Modular Component Series—or any other innovative orthotic components from Becker Orthopedic, call PEL Supply at 800/321-1264, fax 800/2226176, or email customerservice@pel supply.com. Register and order online at www.pelsupply.com.

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FREE TRIAL ON SEATTLE LP FOOT FROM PEL SUPPLY

CORELINE® TRI-PANEL KNEE IMMOBILIZER NOW AVAILABLE

NEW ALPHA LINER FROM WILLOWWOOD

The Seattle LP Foot is Trulife’s first lowprofile, highactivity foot.

Available from PEL Supply with a free 60-day patient trial (*ask for details—some restrictions apply), the Seattle LP foot from Trulife offers: • Dynamic keel • C-shape replicates true, anatomical plantar flexion • Full length, split keel for stability on uneven surfaces • Removable, low-profile foot shell • Ideal for amputees with long residual limbs.

For more information on the Seattle LP foot—as well as the full line of Trulife products—contact any helpful PEL customer service specialist at 800/321-1264, by fax 800/222-6176, or email customerservice@pelsupply.com.

With optimumized features and best clinical practices in mind, the CoreLINE Tri-Panel Knee Immobilizer has been launched and is in stock.

It has an adjustable three-piece design that accommodates multiple circumferences.

The lightweight aluminum posterior, medial, and lateral stays are malleable to conform to the contours of the knee. Side panels can be repositioned to optimally locate the medial and lateral stays as needed for improved fit. The posterior stay is sewn in, while the lateral and medial stays removable.

CoreLINE® has expanded its product offerings to include a range of new orthotic products included in its Debut Fall Catalog. All SPS customers received a copy with the new 2011 Prosthetic Catalog. For additional copies please contact SPS Customer Service at 800/767-7776, x3.

WillowWood’s newest member of the Alpha family of liners is the Alpha Silicone Liner. The proprietary platinumcured, medical-grade silicone is designed for comfort and performance. Alpha Silicone Liner benefits include: • A custom blend of silicone with Vitamin E and skin conditioners for a non-greasy and non-tacky surface • One-way stretch select fabric controls pistoning without using a distal matrix • A flexible knee panel provides enhanced knee flexion • Retrofits with thermoplastic elastomer liners with a progressive profile • Offered in Locking and Cushion.

Alpha Silicone Liners will be available Nov. 1, 2011. For information, please call 800/848-4930 or visit willow woodco.com. a

Expert Coding Advice

> > >

at www.LCodeSearch.com

The O&P coding expertise you’ve come to rely on is now available whenever you need it.

Match products to L codes and manufacturers— anywhere you connect to the Internet.

This exclusive service is available only for AOPA members.

24/7

MANUFACTURERS: Get your products in front of AOPA members!

Contact Joe McTernan at 571/431-0811 or jmcternan@AOPAnet.org.

Log onto LCodeSearch.com and get started today.

Contact Michael Chapman at 571/431-0843 or mchapman@AOPAnet.org.

OCTOBER 2011 O&P ALMANAC

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Jobs

INCREASE EXPOSURE AND SAVE!

Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

- Northeast - Mid-Atlantic

Mid-Atlantic Certified Prosthetist/Orthotist Philadelphia Culture, arts, history and architecture…not to mention cuisine! Philly has it all! It is the country’s fifth-largest city composed of art museums and galleries, serious shopping, all four major sports, University of Pennsylvania. And, you can’t forget the Philly cheese steak! If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more. If interested, please contact, in confidence:

- Southeast - North Central - Inter-Mountain - Pacific Use our map to find which region you fit into!

CLASSIFIED RATES Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

JOB BOARD RATES Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

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O&P ALMANAC OCTOBER 2011

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Southeast Certified Orthotist, Certified Prosthetist/Orthotist South Carolina Seeking experienced CO/CPO for a privately owned, multilocation company with a reputation for excellent patient care.

Candidates must be self-motivated, team players, and have a passion for providing quality patient care. We are centrally located in scenic upstate South Carolina, which offers convenient access to mountains, beautiful lakes, and coastal regions. Competitive salary and benefits package offered.

Send resumes to:

Fax: 864/855-9331 Email: scot@advancedpro.biz

Prosthetic Technical/Clinical Services Specialist Irvine, California Freedom Innovations, a leading manufacturer of high technology lower-limb prosthetic devices, is looking to expand our technical/clinical team. Freedom Innovations is a rapidly growing company that is pushing the boundaries of prosthetic technology. We currently provide advanced technology carbon-fiber prosthetic feet, as well as the industry leading Plié 2.0 microprocessor controlled knee. We also have a robust R & D pipeline of high technology products for the future. Candidates will have the opportunity to be part of an industry respected team of professionals. We are seeking a high achiever with excellent clinical and technical skills who is a problem solver and can work well in a fast paced environment. This position will provide technical assistance and education to customers and employees, while also acting as a clinical liaison with the engineering department for product development. Freedom’s products are manufactured in the United States and sold worldwide in 39 countries.

Requirements include candidates that are a Certified Prosthetist or Board Eligible, minimum of 3 years experience in prosthetics, excellent verbal and written skills. The position will be based at our corporate headquarters in Irvine California. We offer an excellent compensation and benefits package. Please e-mail your resume to:

kcollier@freedom-innovations.com

CO or CPO Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations.

Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

Discover Marshfield, Wisconsin & enjoy:

• Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

ABC Certified in Orthotics & Prosthetics and 3 years of experience required.

Experience in Pediatrics would be helpful.

Join us and see how your career can shine.

To apply, please visit:

www.marshfieldclinic.jobs Reference Job Number MC090202 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

AVAILABLE POSITIONS Orthotist Springdale, AR Tucson, AZ Orange, CA Denver, CO Belleville, IL Urbana, IL

Indianapolis, IN Philadelphia, PA Spartanburg/Union, SC Houston, TX Parkersburg, WV Milwaukee, WI

Prosthetist American Canyon / Fairfield, CA Port St. Lucie / Melbourne, FL Jackson, MS

Elmira, NY Oneonta, NY Pittsburgh, PA Austin, TX Waukesha, WI

Prosthetist / Orthotist Springdale, AR Tucson, AZ American Canyon / Fairfield, CA Denver, CO Lafayette, CO Hollywood, FL Naples, FL West Palm Beach, FL Griffin, GA Dubuque, IA Indianapolis, IN

Bangor, ME Baltimore, MD Brooklyn, NY Elmira, NY Oneonta, NY Tallmadge, OH Bend, OR Portland, OR Salem, OR Lancaster, PA Houston, TX San Antonio, TX

Certified Pedorthist Denver, CO Belleville, IL Portland, OR

Roseburg, OR Pittsburgh, PA Tacoma / Renton, WA

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Jobs Pacific

Certified Orthotists, Certified Prosthetist/Orthotists Northern California Do you dream of earning six figures? Receiving a significant sign-on bonus and working for the oldest and one of the most-respected orthotic and prosthetic patient-care companies in the world? Are you looking for security? In addition to the above, we offer competitive benefits, worldclass education fair, the latest technology, and a family of over 1,000 practitioners in addition to the support of HR, sales/marketing, accounting, etc. Our core values are: • Integrity • Clinical and operational excellence • Unsurpassed customer satisfaction • Flexible and entrepreneurial operations • Creativity and innovation • Shared success.

If you have the skills, drive, and ambition…let’s talk!

Contact, in confidence:

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Certified Pedorthist Seattle/Tacoma, Washington

Certified Orthotist Modesto, California Growing western states O&P business seeking a certified pedorthist in Seattle/Tacoma, Washington, and a certified orthotist in Modesto, California. Unlimited business opportunities available in an expanding local market. Competitive salary, benefits, and profit sharing as the business grows.

Interested parties should email inquiries/resume to:

Email: jwiley@pacmedical.com Fax: 888/853-0002

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Northeast Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing.

Send resume to:

O&P Ad 0611, O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-8099

Certified Prosthetist/Orthotist Nashua, New Hampshire We are expanding our business into the New Hampshire area and are looking for a dynamic individual with excellent communication and patient-care skills who can provide competent, comprehensive care to our patients. We can offer a very competitive salary/benefit package along with relocation assistance and signing bonus potential.

Management skills would be a plus! Send resume to:

O&P Ad 1011, O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Director of Education • Össur Academy—Americas Location: Foothill Ranch, CA • Function: Americas Marketing • Reports to: VP of Marketing

About Össur The power to provide patients a life without limitations starts here Össur is in the business of improving people’s mobility. A leading global company in non-invasive orthopaedics, we deliver advanced and innovative technologies within the fields of prosthetics, braces, supports and compression therapy.

Experience and dedication

Our work

Determined to restore maximum biological function to those in need, Össur has more than thirty years’ experience in the design and production of high-tech orthopaedic devices. Our newest platform is Bionic Technology by Össur—a precise fusion of artificial intelligence and human physiology that is transforming the technological landscape.

Our work, however, is as much about people as it is about products. Their comfort, confidence and rehabilitation are central to our endeavors. We never forget that every time we develop a product or service, we are helping someone else to build a better life.

What better business to be in.

Job Description Basic Function: The Director of Ossur Academy leads all of the Americas internal and external education resources and programs for both Prosthetics and Bracing and Supports. This person is responsible for the development of the education portfolio and competencies that will allow us to effectively execute our strategy of delivering highly innovative products with the requisite education that optimize patient outcomes. As Ossur endeavors to deliver value beyond innovative products, Ossur Academy will build the requisite programs to enhance our customer’s business proficiency as exemplified by our new reimbursement training seminar.

Responsibilities: • Understanding and alignment with the business strategy to deploy resources accordingly • Clear development plan for academy team members.

• Support new hire and continued education of Össur employees.

• Develop the technology platforms used to deliver measure and analyze impact of all education programs • Develop effective communication channels with sales, R&D and other departments, ensuring full cross-functional execution of education programs and events.

• High level of clinical and product competence.

• Industry leadership through representation at industry groups and associations.

• Guidance to the management team in areas related to the B&S and Prosthetics industry.

• Coordinates on-site arrangements for all regional meetings and education events • Adhere to Company’s code of conduct • Adhere to Company Values–Honesty–Frugality–Courage • Perform other duties as requested

Qualifications:

Knowledge and Skills: • CPO with demonstrated clinical and leadership skills • Clinical and business background in both B&S and P • Demonstrates skill in team building and management • Strong project management skills • Able to analyze and design organizational structures and processes • Establishes collaborative relationships across multiple functions • Technological competence and enthusiasm for Össur products and services. (RHEO, Proprio, Power Knee)

• Effective in public presentations • Knowledgeable about technical report writing • Involvement in research in B&S or P. • Able to conduct budget development and analysis • Understands systems analysis and design • Embraces technology as a tool to deliver and manage education Education and Work Experience: • Bachelor’s degree or equivalent experience.

• Certified in Prosthetics, Orthotics or Both.

• At least (10) years’ related experience.

Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Individuals may need to sit or stand as needed. May require walking primarily on a level surface for periodic periods throughout the day. Reaching above shoulder heights, below the waist or Lifting as required to file documents or store materials throughout the work day. Proper lifting techniques required. May include lifting up to 25 pounds for files, computer printouts on occasion.

Equal Employment Opportunity

Össur is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Össur encourages women, minorities, disabled individuals, and veterans to apply.

Please send resumes and career inquiries to: Craig Colligan • Manager, Recruiting • ccolligan@Ossur.com • Website: www.Ossur.com

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Jobs Inter-Mountain

Certified Orthotist or Certified Prosthetist (licensed or eligible) San Antonio Seventh-largest city in the United States and secondlargest in Texas. San Antonio is home to five Fortune 500 companies; regional headquarters to other large companies such as Kohl’s, Nationwide Mutual Insurance, Chase Bank, Toyota, AT&T, QVC, and Lockheed Martin; Brook Army Medical Center; the Center for the Intrepid; the South Texas Medical Center; home to one of the largest military concentrations in the U.S. employing over 89,000; San Antonio Spurs! San Antonio is blessed with museums, Six Flags, Sea World, and Splashtown San Antonio. And, we must mention the Tex-Mex cuisine at many fine restaurants. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more! To apply for this position, please contact, in confidence:

Certified Orthotist, Certified Prosthetist (licensed or eligible) Houston Energy capital of the world; voted first in Texas and third in the United States for “Best Places for Business and Careers”; known for the youngest population in the nation; the Houston Livestock Show and Rodeo; ZZ Top, Lyle Lovett, Clint Black, Hilary Duff, Blue October; NASA’s Lyndon B. Johnson Space Center; many parks and outdoor venues!

Considered by many to be one of the premier practices in the country, this position will challenge the successful applicant with a broad exposure to a diverse patient population. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more! To apply for this position, please contact, in confidence:

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

O&P Almanac Online

Reading the O&P Almanac has never been easier!

• Access advertiser Websites by simply clicking on the hotlinks • Access content with the click of a mouse or the touch of a smart phone • Easily email your favorite articles to colleagues • Save articles as PDFs! Go to www.AOPAnet.org, click on ‘O&P Almanac Online’ today!

For more information, contact Steven Rybicki at 571/431-0835 or srybicki@AOPAnet.org.

For advertising information, contact Dean Mather at 856/768-9360 or dmather@mrvica.com.

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CPO Naples, South West Florida

CPO West Palm Beach, South Florida

Florida State licensed or eligible in both Prosthetics and Orthotics

Florida State licensed or eligible in both Prosthetics and Orthotics

Picture yourself relocated in the heart of beautiful West Palm Beach, Florida, where the climate year round averages 78 degrees. Enjoy the luxuries of outdoor living, including, BBQs, golfing, fishing, theater, and many more. West Palm Beach is located within 2.5 hours from Disney World in Orlando, and 1.5 hours from the Port of Miami, where you can catch your cruise to the Caribbean hassle free.

Imagine living in paradise, year round, surrounded by the warmth and beauty of the Gulf of Mexico, transitioning your career and skills into a well-established, successful clinical practice.

Yes, it’s true, and a reality. We have the opportunity of a lifetime for the right individual.

Our West Palm Beach-practice has been servicing the Palm Beach community for more than 20 years. Our practice’s new state-of-theart facility offers a full complement of services.

Our needs: • Integrity and clinical and operational excellence.

• Unsurpassed customer satisfaction.

• Flexible and entrepreneurial spirit.

• Creative and innovative.

• Demonstrates shared success.

• Demonstrates clinical competence.

• The ability to inspire and move others to become effective leaders.

• A leader and mentor with an inclusive style, whose former colleagues and referrals want to keep in touch.

• Someone who can turn a vision into reality.

• Demonstrates personal effectiveness.

We are searching for a candidate who possesses the following qualities: • Integrity and clinical and operational excellence.

• Unsurpassed customer satisfaction.

• Flexible and entrepreneurial spirit.

• Creative and innovative.

• Demonstrates shared success.

• Demonstrates clinical competence.

• The ability to inspire and move others to become effective leaders.

• A leader and mentor with an inclusive style, whose former colleagues and referrals want to keep in touch.

• Someone who can turn a vision into reality.

• Demonstrates personal effectiveness.

What’s in it for you?

• Enhance your career by capitalizing on Hanger’s multiple business units: SPS, SPS National Labs, SureFit, Dosteon Solutions, Innovative Neurotronics, Linkia, Accelerated Care Plus, CARES, clinical services, and many more.

• The opportunity to use the sum of your life’s experience and knowledge to expand a successful clinical practice. The opportunity to capitalize on the strengths and resources of a national company.

• Job security for you and your family.

• Join the Naples team that is ready to be mentored, encouraged, and developed for future career opportunities. Join an organization with a reputation of more than 150 years of international, national, and local prosthetic and orthotic recognition. We offer a very attractive compensation/benefits package that recognizes your experience, past performance, and future potential.

What's in it for you?

• Continuing education programs, career opportunities, and development.

• The opportunity to use the sum of your life’s experience and knowledge to expand a successful clinical practice.

• Enhance your career by capitalizing on Hanger’s multiple business units: SPS, SPS National Labs, SureFit, Dosteon Solutions, Innovative Neurotronics, Linkia, Accelerated Care Plus, CARES, clinical services, and many more.

• Job security for you and your family.

• Join an organization with a reputation of more than 150 years of international, national, and local prosthetic and orthotic recognition.

• A very attractive compensation/benefits package that recognizes your experience, past performance, and future potential.

Visit: http://www.hanger.com/careers

Visit: http://www.hanger.com/careers

Please forward cover letter, resumé, and salary requirements to: Sharon King Phone: 512.777.3814 sking@hanger.com

Please forward cover letter, resumé, and salary requirements to: Sharon King Phone: 512.777.3814 sking@hanger.com

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Calendar

2011 ■■

PROMOTE EVENTS IN THE O&P ALMANAC

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Member Nonmember Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00

per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634

■■ OCTOBER 3-6 Applied Technology Institute (ATi) Orthotic Fitter School.

Baltimore Four Points by Sheraton. Independent, comprehensive course to prepare for certification exam.

Approved entry-level school

by NCOPE and BOC, and for continuing education by ABC, BOC, and NATA. Contact Lois Meier at 888/265-6077, email lois@kasseledu.com, or visit www.kasseledu.com.

$678 $830

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

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

For information on continuing education credits, contact the sponsor.

Questions?

Email srybicki@AOPAnet.org.

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■■ OCTOBER 3-5 The New England Chapter AAOP Continuing Education Seminar. Warwick, RI. Crown Plaza Hotel. For more information, visit www.oandp. org/membership/chapters/new_ england/.

O&P ALMANAC OCTOBER 2011

■■ OCTOBER 12 AOPA Audio Conference: “Developing Your Medicare Billing Compliance Plan.”

To register, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.

■■ OCTOBER 12 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8–9 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ OCTOBER 12-16 Skills for Life 3: Bilateral Upper-Limb Loss Workshop.

Denver Renaissance Hotel.

US Member Society-ISPO, Amputee Services of America, and the Amputee Coalition.

For more information, visit www.usispo.org/skills_for_life. asp.

■■ OCTOBER 15 Arizona AFO Inc.: The Custom AFO Workshop.

San Jose, CA. Learn L-Coding, AFO selection, hands-on casting, footwear/ modification, and ideas for marketing to referral sources. The $150 fee includes lectures, handouts, and lunch.

Approved for 6.5 ABC/7 BOC CEUs. To register, call 877/780-8382, ask for the “Workshop” or email education@arizonaafo.com.

■■ OCTOBER 18 WillowWood: Discover LimbLogic® VS via WebEx, 1:30 pm ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/2.5 BOC. To register online, visit www.willowwoodco.com.

■■ OCTOBER 19 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

Credits: 2.5 ABC/2.5 BOC. To register online, visit www. willowwoodco.com.

■■ OCTOBER 20-21 Two Day RCR Workshop.

Boise, ID. A comfortable hands-on format of the RCR Transtibial socket design.

The RCR socket increases patient comfort, rotational control, and range of motion.

Workshop features the fitting of suction pin suspension as well as vacuum pin suspension. Contact Miranda Johnson, Coyote Design & Mfg., at 208/429-0026.

■■ OCTOBER 20-22 The North Carolina/South Carolinia Chapter AAOP Annual Meeting. Charlotte.

Ballantyne Resort. For more information, visit www.oandp. org/membership/chapters/north_ carolina/.

OCTOBER 21-23 National Pedorthic Services, Hands-on Custom Foot Orthosis Fabrication Course.

Milwaukee. 18.25 CEPUs. Contact Nora Holborow at 414/438-6662 or visit www.npsfoot.com or email nholborow@npsfoot.com.

■■

OCTOBER 22 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 9-10 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. Call 800/2206670 or register at www. ultraflexsystems.com.

■■

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Calendar

■■ OCTOBER 25 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Call 800/2206670 or register at www. ultraflexsystems.com.

■■ NOVEMBER 2 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 8–9 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ OCTOBER 27 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology.

Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ NOVEMBER 9 AOPA Audio Conference: “Happy Holidays: Kickbacks and Gifts in O&P.” To register, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.

■■ OCTOBER 27-28 WillowWood: Existing OMEGA® Tracer® Users Orthotics and Prosthetics Course. Mt. Sterling, OH. Advanced course covers OMEGA Scanner use, modifying orthotic and prosthetic shapes, and review of custom liner, cranial, and spinal software. Must be current OMEGA Tracer facility to attend. Credits: 14.25 ABC/15.5 BOC. Visit www.willowwoodco.com.

OCTOBER 28-29 The Academy’s One-Day Seminar Certificate Programs, The Effect of AFOs on Balance AND Prosthetic Management of Multiple Limb Deficiency.

Hilton Chicago O’Hare. For more information, visit www. oandp.org/education/seminars/ one-day/.

■■

■■ NOVEMBER 9-11 The New Jersey Chapter AAOP Meeting. Atlantic City.

Bally’s Hotel & Casino. For more information, visit www. oandp.org/membership/chapters/ new_jersey/.

NOVEMBER 12 The Academy’s 6th Annual Golf Invitational. Scottsdale, AZ. Contact Manisha Bhaskar at 202/380-3663, x210, or mbhaskar@oandp.org.

■■

NOVEMBER 19 Arizona AFO Inc.: The Custom AFO Workshop.

Phoenix. Learn L-Coding, AFO selection, hands-on casting, footwear/modification tips, and ideas for marketing to referral sources. The $150 fee includes lectures, handouts, and lunch.

Approved for 6.5 ABC/7 BOC CEUs. To register, call 877/780-8382, ask for the “Workshop” or email education@arizonaafo.com.

■■

■■ DECEMBER 8 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline: November 17.

Contact 877/665-5443 or visit www.willowwoodco.com.

■■ DECEMBER 8-10 Rehabilitation Institute of Chicago: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management.

Chicago. Featuring Elaine Owen. Application for 21.25 ABC Credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.

Motion Control

SUPERCOURSE FALL 2011 OCTOBER 24 - 28, 2011

at Fillauer Facility, Chattanooga, TN • In-depth training of Utah Arm / U3+ / Hybrid / ProControl2.

• Hands-on experience with UI-software - bring your laptop.

• CEUs: 34 (estimated) awarded by ABC.

Overview of: NEW LI-Ion Battery for Utah Arm / U3+ / Hybrid NEW Electric Wrist Rotator NEW TRIAD Preamps Plus an overview of the NEW & EXCITING Motion Foot from Motion Control

The Fall 2011 SuperCourse is a 5-Day Course = $1,350.00 For more information or to register for the SuperCourse email: info@UtahArm.com

Motion Control, Inc. 115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801/326-3434 • FAX: 801/978-0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

OCTOBER 2011 O&P ALMANAC

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Calendar

■■ DECEMBER 9 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting.

Fabricate sockets following recommended techniques for airtight socket designs.

Credits: 9.75 ABC/9.75 BOC. Registration deadline: November 17. Contact 877/665-5443 or visit www. willowwoodco.com.

■■ DECEMBER 14 AOPA Audio Conference: “Are You Ready for the New Year? 2012 New Codes and Policies.” To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.

ate ★

e the D ★ Sav

SPEAKERS • EDUCATION • EXHIBITS • SPONSORS • NETWORKING

BOSTON E

TH

E AC PLTO BE!

HYNE S C ONV E NTION CEN T ER , B O S T O N

Join Us Next Year!

Mark your calendar and join us at the AOPA 2012 National Assembly and NE AAOP Chapter Combined Meeting September 6-9, 2012, at the Hynes Convention Center in Boston. THE PLACE TO BE. For information about AOPA scan the QR Code with a code reader on your smartphone.

Visit our website at www.AOPAnet.org.

62

O&P ALMANAC OCTOBER 2011

2012 ■■ JANUARY 19-20 WillowWood: Alpha Seminar.

Mt. Sterling, OH. Course breakdowns the Alpha family of products, identifies best clinical applications of liners, discussion of liners for vacuum suspension, and the latest in suspension systems.

Includes brief review of TPE liner benefits and fitting assessment. Credits: 12.75 ABC/12.25 BOC. Registration deadline December 29.

Contact 877/665-5443.

■■ FEBRUARY 16-18 PrimeFare West Regional Scientific Symposium 2012.

Salt Palace Convention Center, Salt Lake City. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

■■ MARCH 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x208 or dragusa@oandp.org.

■■ JUNE 4-6 LAOP: Annual Educational Conference. Hilton Riverside, New Orleans. Earn up to 13 credits in O&P and administrative tracts. Come enjoy summer family fun, unique city culture, cuisine and all that jazz. Contact Sharon at 504/464-5577, laymansh@yahoo.com or visit www.laop.org.

■■ JUNE 15-16 PrimeFare East Regional Scientific Symposium 2012. Nashville Convention Center, Nashville. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

■■ SEPTEMBER 6-9 AOPA National Assembly & AAOP NE Chapter Combined Meeting. Boston.

Hynes Convention Center.

The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting. Please plan to join us for this significant event.

Exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. To register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

2013 ■■ FEBRUARY 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ SEPTEMBER 18-21 O&P World Congress.

Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet. org. a

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Ad Index

COMPANY Advanced O&P Solutions Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics Anatomical Concepts Inc. Apis Footwear BOC International Cailor Fleming Insurance College Park Industries Inc. DAW Industries Dr. Comfort DYCOR Euro International KISS Technologies LLC KNIT-RITE Motion Control OPTEC Orthotic and Prosthetic Study and Review Guide OssurÂŽ Americas Inc. Otto Bock HealthCare PEL Supply Company SPS

PAGE 17 13 33

PHONE 866/914 AOPS 888/678-6548 800/574-5426

WEBSITE www.aopsolutions.com www.allardusa.com www.easyliner.com

25 35 37 49 39 19 1 5, C3 51 7 15, 47 2, 23 31 8, 9

703/836-7114 800/837-3888 888/937-2747 877/776-2200 800/796-8495 800/728-7950 800/252-2828 800/556-5572 800/794-6099 800/378-2480 410/663-5477 800/821-3094 888/696-2767 888/982-8181

www.abcop.org www.prafo.com www.bigwideshoes.com www.bocinternational.org www.cailorfleming.com www.college-park.com www.daw-usa.com www.drcomfortdpm.com www.dycormfg.com www.eurointl.com www.kiss-suspension.com www.knitrite.com www.utaharm.com www.optecusa.com

41 C4 C1 28 11

800/233-6263 800/328-4058 800/321-1264 800/767-7776 Ext. 3

www.oandpstudyguide.com www.ossur.com www.ottobockus.com www.pelsupply.com www.spsco.com

Statement of Ownership, Management and Circulation (required by U.S.P.S. Form 3526) 1. Publication Title: O&P Almanac 2. Publication No.: 1061-4621 3. Filing Date: 9/12/11 4. Issue Frequency: Monthly 5. No. of Issues Published Annually: 12 6. Annual Subscription Price: $59 domestic/$99 foreign 7. Complete Mailing Address of Known Office of Publication (Not Printer): American Orthotic & Prosthetic Association, 330 John Carlyle St., Suite 200, Alexandria, VA 22314 8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not Printer): Same as #7 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor: Publisher: Thomas F. Fise, address same as #7. Editor: Josephine Rossi, Stratton Publishing & Marketing, Inc., 5285 Shawnee Road, Suite 510, Alexandria, VA 22312. 10. Owner (Full Name and Complete Mailing Address): American Orthotic & Prosthetic Association, same as #7 11. Known Bondholders, Mortgagees, and Other Security Holders Owning 1 Percent or More of Total Amount of Bonds, Mortgages, or Other Securities: None. 12. The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During the Preceding 12 Months. 13. Publication Name: O&P Almanac 14. Issue Date for Circulation Data Below: September 2011

15. Extent and Nature of Circulation: a. Total number of Copies (Net Press Run) b. Paid and/or Requested Circulation

(1) Paid or Requested Outside-County Mail Subscriptions

(2) Paid In-County Subscriptions

(3) Sales Through Dealers and Carriers, Streeet Vendors,

Counter Sales, and other non-USPS Paid Distribution

(4) Other Classes Mailed through the USPS c. Total Paid and/or Requested Circulation d. Free Distribution by Mail

(1) Outside-County as Stated on Form 3541

(2) In-County as Stated on Form 3541

(3) Other Classes Mailed through the USPS e. Free Distribution Outside the Mail f. Total Free Distribution g. Total Distribution h. Copies Not Distributed i. Total (Sum of 15g and h) Percent Paid and/or Requested Circulation

Avg. No. Copies Each Issue During Preceding 12 Months

Actual No. Copies of Single Issue Published Nearest to Filing Date

16,330

17,122

15,020 0 0

14,937 0 0

0 15,020

0 14,937

0 0 0 363 363 15,383 947 16,330 98%

0 0 0 2,146 2,146 17,083 39 17,122 87% OCTOBER 2011 O&P ALMANAC

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AOPA Answers

Best Foot Forward Answers to your questions regarding therapeutic and orthopedic shoes AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.

Q:

Can a patient receive a pair of therapeutic shoes in November and again the following January?

A:

Yes, the patient is eligible to receive a new pair of shoes in the next calendar year, because the Medicare benefit for therapeutic shoes is based on a calendar year. But, the benefit is not automatic. The medical need for the new shoes must be established before Medicare will pay for them.

Q. A:

Will Medicare cover repairs to therapeutic shoes?

Yes, Medicare policy states that repairs to therapeutic shoes are covered and should be billed using A5507, which states “for diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth inlay shoe or custommolded shoe, per shoe.”

However, keep in mind that the A5507 counts toward the total amount of insets/modifications the patient is eligible to receive within one calendar year.

For custom therapeutic shoes, Medicare will cover two additional inserts or two modifications. For an off-the-shelf therapeutic shoe, Medicare will cover three inserts or three modifications. Any quantities of inserts/modifications beyond the allowed two or three (depending on the type of shoe) are considered noncovered, and the patient would be responsible for payment.

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O&P ALMANAC OCTOBER 2011

Q: A:

Do I have to accept assignment when providing shoes to a Medicare patient?

Q. A:

How do I bill for a custom orthopedic shoe that is attached to a brace?

If you have agreed to be a participating provider, you are required to accept assignment for all Medicare claims. If you elect not to be a participating provider in the Medicare program, you may choose to accept assignment or not accept assignment on an individual claim basis.

Medicare policy states that if a custom shoe is necessary for the brace to function properly, it must be coded as L3649, “orthopedic shoe, modification, addition or transfer, not otherwise specified.” When using the L3649, your claim must include a narrative describing the item and its medical necessity. Don’t forget the KX modifier. a

Visit www.AOPAnet.org today!

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CALL (800) 233-6263 OR VISIT OSSUR.COM TO LEARN MORE.

©2010 Ossur. All rights reserved. Össur is a registered trademarks of Össur. Re-Flex Rotate and EVO are trademarks of Össur.