November 2011 O&P Almanac

OP

The American Orthotic & Prosthetic Association

NOVEMBER 2011

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

BETTER ORTHOSES

ONE STEP AT A TIME Dynamic pressure management systems improve pedorthic outcomes, but cost remains a barrier

The Latest in Pedorthic Manufacturing SPECIAL: 2011 Foot-Care BUYERS’ GUIDE 2011 AOPA National ASSEMBLY RECAP

The New C-Leg®.

Confidence in the next step.

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PROSTHETIC SOFT-SOCK®

HUGGER TOP SOFT-SOCK® WITH 3-D TOE SHAPE

New Colors!

New Hugger Top provides a more tailored fit, reduces rolling and bunching and helps maintain sock placement.

Also features a new 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.

Patented Hemispherically knit three-dimensional distal shape.

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For more information contact Knit-Rite at 800-821-3094 or e-mail customerservice@knitrite.com.

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O&P Almanac CONTENTS

NOVEMBER 2011, VOLUME 60, NO. 11

COLUMNS

COVER STORY

16

20 Step by Step

By Anya Martin Because of costs and reimbursement issues, dynamic pressure measurement systems are found mostly in university settings, but researchers are using them in ways that ultimately benefit the clinician.

FEATURES

28 Keeping Pace in Pedorthic Manufacturing

By Anya Martin Manufacturers respond to time and money pressures by creating inexpensive, user-friendly technology to increase practice volume and give practitioners more control over the manufacturing process.

34 SPECIAL: 2011 Conference Recap Changing Tomorrow, Today

At the 2011 AOPA Assembly, a record number of attendees participated in highlevel clinical and business education sessions, got an up-close look at cuttingedge devices, and learned about the issues affecting the future of their business.

38 SPECIAL: 2011 Foot-Care Buyers’ Guide Don’t miss the sixth annual resource, packed with the latest pedorthic products and services meeting all your foot-care needs.

Reimbursement Page Using the PECOS system to your advantage

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

50

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

63

AOPA Membership Applications

64 Jobs

Opportunities for O&P professionals

72 Calendar

Upcoming meetings and events

74

Ad Index

76

AOPA Answers Expert answers to your FAQs

Want a Taste of O&P History?

Get your fill at www.oandplibrary.org/op— a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

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.

NOVEMBER 2011 O&P ALMANAC

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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, MBA, MSOD, 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 NOVEMBER 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

Facts and Figures in Foot Care Pedorthists Perform Patient-Care Work Most Often…

Orthoses Most Often Fit Device…

Percentage of Time Spent Fitting Devices

Percentage of Primary Work Completed

DEVICE

TASK Clinical Pedorthic Patient Care

36%

Orthoses

41%

Footwear

Retail-Pedorthic Services

20%

Administration

17%

Pedorthic Fabrication

14%

Continuing Education

6%

Other

7%

30%

Pre-fabricated Inserts

11%

Shoe Modifications

9%

Retail*

9%

*Note: Indicates device fitted not due to a prescription, medical condition.

Source: American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. Practice Analysis of Certified Pedorthists, 2009

Source: American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. Practice Analysis of Certified Pedorthists, 2009

..... .....

7:10

The ratio of women who developed bunions, hammer toe, or other foot deformities in 2006.

Percentage of certified pedorthists who worked in a privately owned, singlelocation retail setting in 2009.

25%

1868 The year Charcot foot was first described.

2 million The approximate number of patients treated for plantar fasciitis in 2010.

2,694 The total number of ABC-certified pedorthists as of 2010.

90%

The percentage of people with rheumatoid arthritis who develop symptoms related to the foot or ankle.

Sources: American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. Annual Report 2010; American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. Practice Analysis of Certified Pedorthists 2009; American Orthopaedic Foot and Ankle Society 2001, 2006, 2010; “Charcot Foot: The Diagnostic Dilemma,” American Family Physician, 2001 6

O&P ALMANAC NOVEMBER 2011

Experience Our Commitment

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Wave Spring Heel- provides stable progression and fluid transition from heel-strike to toe-off via the unique heel rocker design

Low Profile Design- 4” clearance and lightweight structure (13.2 oz for 26cm) facilitate wide utilization for low to moderate activity users ( weighing up to 275 lbs)

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© 2011 SPS. SPS and Experience Our Commitment are trademarks of SPS. All other trademarks are properties of their respective owners. All rights reserved.

Service: 800.767.7776 x3 Fax: 800.869.7776 www.spsco.com

SUPPORT TO THE MAX! VERTAMAX wraps around and contours to your patient’s torso to provide unparalleled anterior-posterior support.

Simple to manage soft fabric adapts to your specific patient’s configuration for a perfect anatomic fit. VERTAMAX is ideal for patients’ that require super-soft comfort while remaining virtually undetectable under clothing.

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In the News www.fda.g

ov/re gulat

orysc ience

ry g Regulato Advanc in DA F t Sc ience a

C PLAN A STRATEGI

Photo: National Institute of Biomedical Imaging and Bioengineering

AUGUST

Goldfarb’s research team with the prosthetic leg (left to right): Huseyin Atakan Varol, Michael Goldfarb, and Frank Sup.

Bionic Leg Mimics Natural Gait Vanderbilt University researchers have created a lower-limb prosthetic leg that allows amputees to walk without the leg-dragging gait caused by some prosthetics. This device successfully mimics natural movement, scientists say. It is the first prosthetic with powered knee and ankle joints that operate in unison.

“With our latest model, we have validated our hypothesis that the right technology was available to make a lower-limb prosthetic with powered knee and ankle joints,” says Michael Goldfarb, director of the Vanderbilt Center for Intelligent Mechantronics.

“Our device illustrates the progress we are making at integrating man and machine.”

The prosthetic uses computer, sensor, electric motor, and battery technologies to power its bionic capabilities. It comes equipped with sensors that monitor its user’s motion. It also has

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O&P ALMANAC NOVEMBER 2011

microprocessors programmed to predict what the user is trying to do and operate the device in ways that facilitate those movements.

Amputees use 30 to 40 percent less of their own energy to operate the bionic leg, which weighs just 9 pounds—less than the average human leg. Other key features of the device include a quiet motor and an anti-stumble sensor that will lift the leg up to clear an obstruction and plant the foot on the floor.

The bionic leg is the result of a seven-year research effort. The project was initially funded by a seed grant from the National Science Foundation, followed by a development grant from the National Institutes of Health. The university has patented key aspects of leg’s design and has granted exclusive rights to Freedom Innovations to bring the device to market.

2011

TMENT U.S. DEPAR

H OF HEALT

SERVIC ES AND HUMAN

ADMINISTR AND DRUG U.S. FOOD

ATION

FDA Spurs Innovative Device Creation The U.S. Food and Drug Administration (FDA) released its “Strategic Plan for Regulatory Science,” calling for a sweeping modernization of the process used to develop and evaluate products critical to the nation’s health, economy, and security.

These new guidelines, written for government regulators, manufacturers, and research and development groups, are intended to speed the clinical trail process and bring innovative devices to market sooner.

“New technologies provide unprecedented opportunities to prevent and cure disease and to grow our high-tech economy,” says FDA Chief Scientist Jesse Goodman, MD. “This plan will help turn advances in science into products that benefit people and help FDA assure that happens more quickly and safely.”

The strategic plan describes the FDA’s intent to enhance the process for developing and evaluating promising new products and materials to be used in fields such as cell therapy, tissue engineering, genomics, personalized medicine, advanced computing, and information technology.

Product News!

Masterflex Color Material: - permanently elastic thermoforming film

Dimensions: - sheet size 1.115 x 900 mm - available in 2 mm and 4 mm thickness

Colours:

Item-No.

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111P264/...

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Application range: - shoe insoles - water-resistant splints and supports - for hand (metacarpus) splints or forearm splints - in arm prosthetics - for foot prostheses (e.g. according to Bellmann) - prostheses sockets Euro International, Inc. 5906 Breckenridge Pkwy Suite G. Tampa, FL 33610

neon yellow

light blue

neon green

blue

green

dark blue

neon pink

black

light red

silver

red

golden

dark red

Temperature for thermo-molding: - 120 – 135°C, e.g. in Infrared Oven (50M25), with Flat Bed Oven (55M1) or Convection Oven (50M4)

Processing vacuum: - very low - 20 % vacuum performance – measured by a vacuum device, Vacumat Plus (168P50)

Insulation to model: - Nylon Stockinette (95P2) - Silicone Spray (116P11)

Helpful hints: - finely woven Heat Protective Gloves (12P12) - short distance from oven to model - clean Teflon-sheeting on heating panel, no talcum powder - perforate welded-on reinforcments to avoid air pockets

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In the News

Muscles may be able to adapt instantly to changes in the environment without any intervention from the brain, according to new research from Kiisa Nishikawa, a Northern Arizona University biology professor, and an international team of collaborators.

These findings may change fundamental views of muscle movement while powering a new approach to designing prosthetics.

“It turns out that our bodies are interacting with the environment all the time, and our muscles can manage that interaction in a smart way without any intervention from the brain,” says

TRANSITIONS

Hanger Prosthetics & Orthotics announced the following new hires: • Andrew Domb, CPO • Warren Nelson, CO • Doug Siggins, CO • Nathan Watt, CO.

O&P ALMANAC NOVEMBER 2011

elasticity of muscle. To demonstrate the concept, Nishikawa and her team built a physical model that captures all non-linear properties of muscle that allow it to adapt instantaneously to changes in the environment.

The implications of the research run deep in the world of movement neuroscience and hold promise for the burgeoning field of bionics, exoskeleton robotic suits, and prosthetics.

The practical applications of these findings extend to “any device worn by humans where ultimate control comes from the human brain,” Nishikawa says. “The potential to improve those devices using this idea is good because the human brain expects its actuators to be muscles, so if you make them work like muscles, it’s bound to be more comfortable, efficient, and stable.”

PEOPLE IN THE NEWS

Hanger Orthopedic Group Inc. appointed Vinit K. Asar as president and chief operating officer. Asar joined the company in December 2008 as executive vice president and chief growth officer.

Hanger also named Kenneth W. Wilson as president and chief operating officer of its orthotic and prosthetic distribution business unit, Southern Prosthetic Supply.

12

Nishikawa, lead author of the study.

“There’s never been a model that explained how muscles are able to do that until now.”

The study about “spring-loaded muscles” appears online in Proceedings of the Royal Society B, and lends credence to the theory that the body and muscles have many passivedynamic properties, and the brain’s role is not to interfere with the passive dynamics.

Arms and legs are full of tendons, but heads and jaws only have a few small and short tendons. Nishikawa theorized that a “spring” inside the actual working unit of muscle was needed to power those smaller muscles. She argued that the protein Titin functions as a molecular spring, which is responsible for the passive

Robert E. Dulberg, C.Ped, L.Ped, joined the staff of Comfort Life Medical Supplies. He will be responsible for filling all footwear, shoe, orthotic, molded-shoe, and footwearmodification prescriptions.

The International Paralympic Committee hired Dimitrije Lazarovski as its snow sports manager, responsible for overseeing Alpine skiing, cross-country skiing, and biathlon.

Ability Prosthetics & Orthotics Inc. hired the following practitioners: • Richard Colvin, BOCP • William Haynes • Joyce Hess, C.Ped • Brian Kaluf • Anjali Wayman • William Woslum, CO.

OPAF awarded the 2011 Dale Yasukawa Memorial Scholarship to Adam McFarlane, a student at the Northwestern University ProstheticsOrthotics Center (NUPOC) and an orthotic resident at Clark & Associates in Waterloo, Iowa. McFarlane was selected from a panel of applicants who are currently enrolled full-time at NUPOC.

The University of Michigan Orthotics and Prosthetics Center, in Ann Arbor, Michigan, announced that Kevin Hickey, Megan Krause, Cameron Lehrer, and Adrienne O’Day have been accepted to its residency program. Katherine Johnson has received a prosthetic fellowship.

Otto Bock HealthCare promoted Scott Schneider to regional president of North America. He takes over for retiring president and CEO for Otto Bock North America Bert Harman.

Illustration: Theodore A. Uyeno, Valdosta State University

Muscles May Function Independently of Brain

n

In the News

CMS Gains Tool in Fight Against Fraud For the first time, CMS has the ability to use real-time data to spot suspicious claims and providers and take action to stop fraudulent payments before they are paid.

Since July 1, CMS has been using predictive modeling technology to analyze claims. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis.

“Predictive modeling is a revolutionary new way to detect fraud and abuse, integrating effective and timely actions with protections and savings for Medicare and taxpayers,” says Peter Budetti, director of CMS’ Center for Program Integrity.

Provider of information technology

TRANSITIONS

BUSINESS IN THE NEWS

The American Board for Certification in Orthotics, Prosthetics & Pedorthics Inc. recently published ABC Facility Accreditation Standards Compliance Guide—a resource to guide facility owners through the accreditation process. The Compliance Guide is available only to current ABC-accredited facilities and accreditation applicants. The publication details each of the 141 facility accreditation standards and offers tips and suggestions for compliance.

College Park Industries launched a re-designed website on September 12.

Comprehensive Prosthetic and Orthotics acquired DJ Peters Orthopedics. The two practices will merge under the Comprehensive Prosthetics and Orthotics name and will continue to provide patient care to the Bloomington and Normal, Illinois, areas.

14

O&P ALMANAC NOVEMBER 2011

solutions, Northrop Grumman, is deploying algorithms and an analytical process that look at CMS claims–-by beneficiary, provider, service origin, or other patterns—and identify potential problems and assign an “alert” and

“risk scores” for those claims. CMS will review problem alerts to help it prioritize claims for additional review and assess the need for investigative or enforcement actions.

In related news, on September 7, the Justice Department announced charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billings. The charges came as a result of an eight-city investigation led by the Medicare Fraud Strike Force, a multi-agency team of federal, state, and local investigators. This is the highest amount of false Medicare billings from a single takedown in Strike Force history.

The Bob Woodruff Foundation awarded a $100,000, one-year grant to Disabled Sports USA (DS/ USA) to benefit wounded military service members in Florida, Texas, and California. Specifically, the grant will fund sports-rehabilitation programs at DS/USA chapters and military hospitals and provide training on traumatic brain injury and post-traumatic stress to DS/ USA chapters nationwide.

Software company Autodesk named nonprofit Illinois Prosthetic Technologies as the Autodesk Inventor of the Month for August.

The company was selected for its use of Autodesk Inventor 3D mechanical design software to develop an affordable and easily fitted prosthetic arm for transradial amputees—particularly those living in developing nations.

The Orthotic & Prosthetic Assistance Fund Inc. and The First Clinics have partnered with Shriners Hospitals for Children to offer First Volley Adaptive Tennis Clinics for patients and families across the country.

Otto Bock Healthcare is now the sole owner of Canadian company Neurostream Technologies, which specializes in the development and commercialization of products for patients suffering from neurological, neuromuscular, or movement disorders.

Ray Tegerstrand’s Orthopedic Appliance was honored with the Bridge Award from The Redding Chamber of Commerce’s Awards of Distinction Ceremony. This award recognizes family-owned or operated businesses whose policies and practices have a positive impact on the business and community.

IOM Vague on O&P as Essential Health Benefit The Institute of Medicine (IOM) released its long-awaited report recommending how the Department of Health & Human Services (HHS) should decide what to include as part of the essential health benefits package and other factors for consideration. It does not offer any clear guidance on whether O&P devices will be considered an essential health benefit.

The words “orthotics” and “prosthetics” do not appear in the body of the 297-page report, which HHS contracted IOM to create. However, they are referenced in the appendices under some comparisons to what is covered by health-insurance plans. Prosthetics appear to be covered by most insurer plans, but there is some vacillation in understanding of “orthotics” (and fewer orthotic devices universally covered in

existing plans). References to the term seem to discuss shoes than rather than customized orthopedic bracing. Within the body of the report, however, there are clearer references to habilitative aids to help restore keys functions, including mobility.

Other key takeaways and recommendations from the IOM report include the following: • The essential health benefit decision should focus on what is included in a typical small employer health plan to help ensure affordability.

• Medical necessity should be a prerequisite for anything to be included.

• Evidence-based practice and comparative effectiveness research should be a key determinant in considering potential ongoing re-assessments of and additions to

the essential health benefits.

Several references, including specific mentions of habilitative and rehabilitative services, recognize the need to avoid discrimination in the essential health benefits against persons with disabilities and under-served individuals with special needs.

Next, HHS will most likely draft a regulation to provide a more specific definition of essential health benefits.

HHS may ask for public input about the decision via town hall meetings and written proposals. AOPA and the Amputee Coalition participated in a patient-advocacy listening session on October 18. AOPA will provide comments to HHS about the IOM report, as well as monitor, participate in discussions, and inform members about ways they can provide feedback. a

W NE IGN S E D

NOVEMBER 2011 O&P ALMANAC

15

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Reimbursement Page

By Kathy Dodson

Give PECOS a Chance Sure, the system has had its drawbacks, but it can be a practical time-saver

G

ranted, our history with the Provider Enrollment, Chain, and Ownership System (PECOS) is not good. First came threats to deny Medicare claims for using prescriptions from physicians not registered in PECOS, then deadlines were set and withdrawn, and now there’s an unknown future date for such denials.

Let’s hope enough time has passed that the majority of physicians will be in the system once the CMS finally turns the edit on, so claims denials will be minimal.

But the PECOS system also has a good side that could benefit O&P facilities: DMEPOS suppliers, including O&P, can use the system to enroll as a biller in Medicare, make changes to their enrollment information, see what information they have already submitted, and reduce the time it takes to process enrollment changes.

In a nutshell, PECOS is an automated system for submitting the Medicare enrollment form, the 855S. Any time 16

O&P ALMANAC NOVEMBER 2011

you would normally submit this form—to enroll in Medicare, to re-enroll when necessary, to change your practice address, or to update the services you provide—you could use PECOS. According to CMS, using the system will speed up the processing of applications from 60 days to about 45. It also will allow you to track the progress of your application and review the information on your enrollment application at any time. This would have come in handy a few years ago when everyone needed to know what services their facility had told CMS they would provide, to determine whether accreditation requirements applied to them.

Once your facility is in PECOS, you’ll be able to look this up online.

How Do I Sign Up? Of course, because this is Medicare, signing up is a little more difficult than it should be. But if you follow the appropriate steps, you should be successful. Here’s how.

Step 1: Register your authorized official. For security reasons, before you can begin to use PECOS, you must register and authenticate the person who will use PECOS on your facility’s behalf. To do this, go to https:// pecos.cms.hhs.gov, which is the PECOS Identification and Access system (PECOS I&A).

Note that your authorized official, or AO, must meet the requirements found on the 855S form, Section 15, which states that the AO must be the official to whom you have granted the legal authority to enroll your company in Medicare, to make changes and updates to its status, and to commit the organization to abide by Medicare statutes, rules, and regulations.

The AO must create a PECOS user ID and password as part of registration and supply CMS with the requested information. At this point, the CMS External User Services (EUS) Help Desk will verify the information and approve the AO. Once you have completed the I&A process, the AO can use PECOS. Step 2: Register any secondary users. Although the AO is the person who is authorized to submit information and make changes, you may designate another company employee to carry out this responsibility. If you choose to have a second person authorized, that person should follow the same steps, going to the PECOS I&A website, creating a user ID and password, and providing information to CMS about the employer organization.

This secondary user also must download and print the Security Consent Form, which must be completed, signed, and dated by

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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the AO and mailed to the CMS EUS Help Desk, which then approves the secondary user. The AO will be notified by email that the secondary user has been approved.

Additional secondary users have to register just as the AO and secondary user did, but a new Security Consent Form is not necessary. Once enrolled as a PECOS user, a person may submit an enrollment application, view current enrollment information, and submit changes to this information.

This registration process may take several weeks, so if it is urgent that you submit an updated 855S for any reason and you have not started the PECOS enrollment process, submit a paper 855S to ensure timely processing.

Note that once the online 855S is complete, you will transmit it electronically to the NSC. Step 3: Submit an enrollment application (855S). Now that you are registered, you can submit an 855S form online.

First, log onto PECOS at https:// pecos.cms.hhs.gov.

From the “My Home” or “My Enrollments” screen, select either an initial enrollment or an existing enrollment option, depending on what you want to do. To enroll a new company or new branch, select initial enrollment; to change the address of an existing office, select existing enrollment. Once you have made a selection, the system will ask you only the questions pertaining to that selection.

At this point, an “Enrollment Overview” page appears, showing what task you are about to do and asking you to confirm that this is correct.

Once you verify or correct the task, proceed through the screens, providing the information requested. It’s a good 18

O&P ALMANAC NOVEMBER 2011

idea to gather the information you need to complete the form before you begin, as the system will time-out if it has been idle for 15 minutes. If you have to go search for a document, you may lose what you have already completed unless you have saved the application. You will need the same information as you would to complete a paper 855S form.

When you’re finished entering data, the system will check your entries to make sure that all data have been entered. You will be given the option of printing a copy of the application, and you should do this to keep a hard copy for your files. The system will also show you a list of any hard copy documents that must be submitted with the application to the National Supplier Clearinghouse (NSC). These might include such items as the Electronic Funds Transfer Authorization Agreement.

Finally, the system will prompt you to print the two-page Certification Statement, which corresponds to Section 14 on the paper 855S form. It must be signed and dated by the AO of the company and mailed to the NSC as soon as possible, but ideally within one week of submitting the online 855S. Any hard copy supporting documentation that is required must accompany this Certification Statement. The legal date of your submission is the date the NSC receives an appropriately completed Certification Statement, so it is important to provide this, and any other required hardcopy documents, in a timely manner. Your application cannot be processed until this document is received.

Note that once the online 855S is complete, you will transmit it electronically to the NSC. Do not also mail a hard copy of the 855S, as this will delay your application processing.

You will receive an email from the NSC indicating that the application has been successfully transmitted.

Once your electronic application is submitted, it will be locked and you won’t be able to edit it, unless for some reason it is electronically returned by the NSC.

Step 4: Check the status of your application. Once you have submitted an application, you can log onto PECOS to check the status of processing, but not until 15 days after you submitted the form electronically.

The status of your application will be reported in one of the following ways: • Submitted. Your application has been successfully submitted to the NSC. Remember that processing cannot begin until the NSC receives the Certification Statement in the mail.

• In process. The NSC is reviewing the application.

• Returned for corrections. The NSC has returned the application to you for correction. It must be corrected and returned to the NSC within 30 days of the request. If you miss this deadline, your application will be delayed and may be denied or rejected.

• Resubmitted. You have resubmitted a corrected application.

• Final status. The enrollment application has been processed and the final status is indicated: approved, denied, rejected, withdrawal of application in process, or voluntary withdrawal from Medicare.

What Can’t PECOS Do? A couple of functions cannot be accomplished through the PECOS system. You cannot change the legal name of your business, nor can you change its SSN/TIN. You also cannot change the structure of the business— for example, from a corporation to a sole proprietorship.

So try the PECOS system out. While it’s not mandatory, you may find that once you’re enrolled, it saves you time and gives you some quick answers to your questions about enrollment status. a’

Kathy Dodson, formerly senior director of government affairs, is a consultant for AOPA. For questions about this column, contact Joe McTernan at jmcternan@AOPAnet.org.

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Photo: Tekscan, Inc.

DESIGN BET T ER FOOT OR T HO SES

Tekscan mat systems are one type of dynamic pressure measurement system available today.

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O&P ALMANAC NOVEMBER 2011

COVER STORY

By ANYA MARTIN

Step S

ince he joined Harrisburg, Pennsylvania-based First Choice Rehabilitation Specialists six years ago, Ryan Smuro, PTA, C.Ped, has been routinely using in-shoe dynamic pressure measurement systems for patients with diabetes and a wide range of foot, ankle, and gait-related problems.

Mapping locations of elevated plantar pressure provides an objective baseline to understand exactly how a new patient walks or whether a current orthotic is addressing biomechanical issues, such as reducing the pressure on diabetic ulcers, Smuro says. The measurements help him determine if an over-the-counter orthosis might be appropriate. If not, they help guide him in designing a custom one—and ultimately allow him to test whether the solution leads to patient improvement.

The key word for Smuro is “validation,” and his clinical experience has led him to a strong belief that every pedorthic practice could benefit from measuring dynamic pressure. But he realizes that his practice is one of only a few using this tool.

“As far as I’m aware, there are not many [practitioners] using any system of any kind to evaluate whether orthotics are working the way they are supposed to,” Smuro says. “The only feedback they get is the patient’s subjective feedback,

whether they still have pain or whether the orthotics are comfortable of uncomfortable. But do we really know that we are changing the mechanics of the gait?”

Pedorthists aren’t likely to disagree about the value of pressure measurement, but they’ve come to accept an inconvenient truth: They cannot justify the high cost of the technology because insurers, including Medicare, do not pay for pressure testing. Some insurers don’t cover custom insoles at all, and Medicare reimbursement rates are only $81.22 per pair, with an annual limit of three, plus one pair of depth-inlay or customized shoes.

For these reasons, dynamic pressure measurement systems are found mostly in university settings, but researchers are using them in a wide range of ways that ultimately benefit the clinician. These uses include quantifying the systems’ value in custom orthotic design, testing their efficacy (sometimes in response to a clinician’s requests), predicting and preventing injury, and using the devices as teaching tools.

Clinicians also will want to keep an eye on some promising alliances between researchers, makers of dynamic pressure measurement devices, and custom orthotics manufacturers that are making a case for new reimbursement rates.

NOVEMBER 2011 O&P ALMANAC

21

Dynamic pressure measurement systems are available in two types.

The first is a mat or pressure platform on which the patient stands or walks barefoot. The second is an in-shoe sensor that assesses plantar pressures when a patient walks with a shoe, custom insole, or other orthosis.

Mat systems are less expensive. For example, systems by Tekscan start at $3,995. In comparison, a Missouri State University (MSU) research team paid about $32,000 for PEDAR insole technology and $2,000 each for two extra insoles developed by Munichbased Novel GmbH, says James M. Hackney, assistant professor in the physical therapy department. The initial investment was paid for by a research grant, but now the university is able to use the system for additional studies and some additional insoles have been purchased through an internal grant.

Ryan Smuro, PTA, C.Ped

Mats and in-shoe measurement systems, as well as force plates, have their strengths and weaknesses, and deciding which one to use ideally should be based on what is being tested, Hackney says. For example, a mat system was used for testing fall-injury risk of obese children attending a weight-loss summer camp

by Jeffrey Ross, DPM, MD, assistant clinical professor of medicine at Baylor College of Medicine in Houston, and chief of Ben Taub Hospital’s diabetic foot clinic. Ross’ mat testing predicted which children would suffer an injury at impressive rates of 83 percent and 90 percent, he reported in a paper presented at the July 2010 annual

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O&P ALMANAC NOVEMBER 2011

Mat systems produce scans that provide static and dynamic pressure measurement of gait.

meeting of American Podiatric Medical Association in Seattle.

In contrast, insole testing has been crucial for Hackney’s research, including one study he calls a great example of a productive clinicianresearcher partnership. In this instance, clinicians who could not afford a pressure measurement system leveraged a university relationship to test an orthotic intervention they developed to off-load pressures caused by metatarsalgia.

The outsole modification, called the Hunt Metatarsal External Shoe Cut-Out (HMESC), was developed by Gary C. Hunt, PT, DPT, OCS, C.Ped, and other clinicians at the Meyer Center for Wellness and Rehabilitation at CoxHealth, a Springfield, Missouribased hospital. Patients reported reduced pain, but the MSU team also documented a decrease in average peak pressure of 120.8 ± kPa (kilopascals) and ±69.0 kPa (standard deviation) per step measured under the metatarsal head when walking with the HMESC as opposed to without it.

“This represents a pressure reduction of about 17.5 pounds per square inch,” Hackney says. An average of 38.3 days after starting orthotic use, patients showed 13.3 points of improvement on the Lower Extremity Functional Scale (LEFS), according to a 2010 article in the Journal of Prosthetics & Orthotics.

James M. Hackney, PhD

Limited by length to capturing pressures while standing in place or taking a few steps, mats cannot capture the effect of rapid, continuous movement, such as jumping, running, or dancing, Hackney says. Also both mat and insole systems only measure vertical force, so a force plate would be needed to capture vector components in all three dimensions and has a much higher sampling rate, he adds. But force plates have similar drawbacks to the mat, although they are less portable, and need to be flush with the surrounding surface when used for a dynamic application—“either mounted into a floor or within a built-up walkway,” Hackney says.

He recently conducted several studies on the topic of dance biomechanics. For example, ballet dancers perform leaps and landings in slippers fitted with insole sensors to test the potential of a force-absorbing dance surface to reduce injury risk. Hackney also is using a force

Photo: Tekscan, Inc.

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plate for data collection in a current study supported by a private grant from dance flooring systems manufacturer Harlequin Floors.

“Which type of system you use depends on the experimental question, but mats don’t tell us what is going on between foot and shoe, nor can you get data about movement taking place over a large area,” Hackney says. “If you are really interested in influencing pressure or force through footwear, [in-shoe sensors] are a great application.”

Peter R. Cavanagh, PhD, DSc

“What we learn from [dynamic pressure measurement], for example, is where the focal areas of pressures are, and what type of foot it is functionally,” says study co-author Peter R. Cavanagh, PhD, DSc, now Boon for Diabetics professor and vice chair for research Some researchers and clinicians in the department of orthopedics and say the two types of measurement sports medicine at the University system are best employed in tandem. of Washington Medical Center in For example, a Cleveland Clinic study Seattle. “Is the foot high-arched, or is used a pressure mat to provide a it a flat foot? It gives you the dynamic baseline measurement for foot-ulcer compliment to your physical exam.” risk in diabetic patients, then used A mat or pressure platform in-shoe sensors to test the efficacy of assessment has to be performed an orthosis to off-load pressure on carefully, he adds, because diabetics ulcers. According to results published generally should not walk barefoot for in the May 2008 issue of Diabetes Care, fear of exacerbating lesions. “In-shoe researchers found that off-loading was testing, however, remains crucial significantly greater when both foot because a foot could be found to have shape and pressure data were used very high pressures while walking to design custom insoles, rather than barefoot, but the patient could have using shape alone, as is standard in a great footwear intervention that most pedorthic practices. modifies those pressures and attenuates risks,” “What we learn Cavanagh says. from [dynamic Indeed, one of pressure the most powerful measurement], for applications of example, is where dynamic pressure the focal areas measurement of pressures systems may are, and what be for diabetic type of foot it patients, especially is functionally.” considering that the chronic disease is on —Peter R. Cavanaugh, PhD, DSc a rapid rise. Because patients with diabetic neuropathy have no or limited feeling in their feet, they cannot tell you when they feel relief, Cavanagh says.

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O&P ALMANAC NOVEMBER 2011

In a study of Swedish patients published in Diabetes Medicine (2009), he and a group of colleagues found that pressures need to be reduced to about 200 kPa to prevent re-ulceration. However, individual diabetic patients are unique in their pressure distribution, so custom orthoses are the only way to effectively address ulcer risk, Cavanagh says, noting he addressed clinician frustrations about this quandary in a presentation and ensuing discussions at this year’s Diabetic Limb Salvage Conference in Washington, D.C., September 22-24.

“We treat patients by guesswork, and there are many areas of medicine where that simply would not be acceptable,” Cavanagh supports. “We look at the foot, give the patient a shoe, and simply guess that we might have done something that might have modified plantar pressures within the shoe, but we have no idea whether it worked until the patient either ulcerates or remains healed.”

Entrepreneurial Efforts Cavanagh is one of the co-founders of DIApedia, a State College, Pennsylvania-based research and development company that has developed the TrueContour custom insole, designed to prevent diabetic ulcers using surface modifications that combine foot shape and plantar pressure. DIApedia is currently using pressure testing in its National Institutes of Health-sponsored clinical trial to test the TrueContour’s efficacy to prevent ulcer reoccurrence.

Presently in the enrollment phase, the three-year study hopes to involve about 286 patients at 10 clinics nationwide.

The TrueContour insole meets Medicare’s therapeutic footware criteria for a diabetic insole and is already available, but DIApedia’s hope is to use clinical evidence to build a case for a new Medicare product code and possibly a new CPT code that would include pressure testing, says Tim Hurley, president of DIApedia.

“We believe that by bringing pressure analysis into this product we have an advanced product, which, based upon offloading results, would warrant a different code,” says Hurley. “We feel that the inclusion of plantar pressure data is essential for effective insole design and, in particular, for the population of diabetics that don’t have protection sensation in their feet.

It’s really the driving force behind this technology.”

Beyond the obvious health benefits for patients, preventing diabetic ulcers certainly would seem to be much more cost-effective for Medicare. Cost estimates for ulcer treatment ranged from $17,500-$27,987 in 1999 and 2004 studies referenced in the Cleveland Clinic findings.

Charles Malacaria

At a time when health care is abuzz with talk of the need for evidencebased care to bring escalating costs under control, DIApedia is not the only company recognizing the power of linking pressure mapping to a more effective orthotic product for diabetics.

Boston, Massachusetts-based Tekscan recently announced a partnership with Amfit Inc., in Vancouver, Washington, a well-known provider of computerized custom foot orthotic equipment, products, and services. Now pressure data from a Tekscan mat system interfaces with Amfit’s software, which collects and analyzes a 3D digital visual scan of the foot, then allows the clinician to design an insole and ready it for production—either at the company’s lab or with one of Amfit’s in-house fabrication systems. The goal of the merged offering, which is already available, is to give practitioners a seamless, easy way to design an insole that more completely addresses the needs of the diabetic

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O&P ALMANAC NOVEMBER 2011

foot, says Jeff Davis, a senior software engineer at Amfit.

“In a common scenario, you would place a metatarsal pad to offload pressure points identified as high risk,” he explains. “With the software, you can do that onscreen and see how it works to relieve the pressure before you ever produce an insole.”

The partnership should help Tekscan to expand its pressure mapping product into more orthotic practices, says Charles Malacaria, vice president of business development.

Evidence-Based Applications Diabetes is not the only area where dynamic pressure measurement is being combined with other diagnostic scans to support specific orthotic interventions. For example, CT scans and dynamic plantar pressure analysis (involving a combination of platform/ mat and in-shoe pressure testing) were used to design and assess eight custom dynamic pedortheses for a small cohort of five young patients with idiopathic clubfoot (average age 6 years) at Children’s Hospital of Wisconsin.

The study showed significant improvement in overall dynamic pressure for the children after two years of using a CAD-designed orthotic to shift the abnormal center of pressure (COP) trajectory toward that of a normal dynamic pressure distribution, to provide an alterative treatment for ambulatory children following Posenti casting, says Xue-Cheng Liu, MD, PhD, professor, Department of Orthopaedic Surgery, Medical College of Wisconsin, who led the research team along with

Robert Rizza, PhD, in the Milwaukee School of Engineering’s Department of Mechanical Engineering. Initial results were published in the August 2010 issue of the Journal of Medical Devices.

“It’s an encouraging beginning,” says Liu, who also is director of the Musculoskeletal Functional Assessment Center, Pediatric Orthotic Division at Children’s Hospital of Wisconsin. “We can capture the dynamic pressure changes which reflect the bony alignment changes, along with the CT scan or other scan to capture the geometry. These two parameters provide 3D geometry information, as well as information about how the force is changing, which allows us to develop new computer-assisted design to manufacture orthotics.”

Xue-Cheng Liu, MD, PhD

The next step is to determine whether the change in pressure also leads to a change in functional outcome and abnormal bony alignment, something that will require a long-term study with a larger cohort of patients, Liu says. His department has submitted an NIH grant to fund a multicenter study to evaluate currently developed clubfoot orthotics. A team including Liu and Rizza also have

received a Rehabilitation Engineering Research Center (RERC) grant for another study to use pressure mapping again next year to develop a computer model to assess and develop a new type of orthotic for pediatric patients with flat feet.

The presence of dynamic pressure measurement systems in universities does more than simply facilitate research, however. At the Georgia Institute of Technology, the systems have become valuable teaching tools to help students in the Master of Science in Prosthetics and Orthotics program understand how orthosis design can redistribute pressures and affect treatment objectives, says Géza F. Kogler, PhD, CO, research scientist and director of the Clinical Biomechanics Lab in the School of Applied Physiology.

For example, early in the program, before students have any substantial textbook knowledge of how orthoses perform, Kogler pairs them up and

Géza F. Kogler, PhD, CO

tasks them with finding a way to reduce and redistribute pressure away from the first metatarsal area of a “pseudo subject” (i.e., classmate) with flat insole as a base with an added pressure redistribution feature they design. No molds are allowed, only a hand evaluation and a pressure measurement tool to evaluate how successful the students were in solving the problem. Students present their findings as though they were preparing a scientific paper and are given one opportunity to make a change to the orthosis.

“The problem-based learning exercise allows students to understand that there are quantifiable ways to influence pressure on the bottom of the foot, as well as providing the student with an appreciation of how a clinician can manipulate the foot with a foot orthosis,” Kogler says.

In other words, even if the high price tag means they do not use pressure measurement systems in their clinical practice, this next generation of orthotists and prosthetists know that hard data support the impact that orthotic adjustments can make, Kogler says.

“That’s one of the reasons we incorporate plantar pressure measurement into our program early—so that students will learn to measure and quantify and think clinically in terms of a numeric value instead of a ‘guess.’” a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.

NOVEMBER 2011 O&P ALMANAC

27

Keeping

PACE Pedorthic in

Manufacturing

BY ANYA MARTIN

Bleeding-edge technologies from across the pond help practitioners improve the prescription and production of custom orthotic insoles

P

roducing a good product in less time and at lower cost—that’s a top goal in today’s economy.

And it’s just as true of the custom orthotics field as any other business.

At the first annual Custom Orthotic Insoles Technology Forum, held May 19-20, 2011, at the University of Bath in England, the message was clear: Manufacturers and researchers are responding to time and money pressures with cheaper, more userfriendly technology to increase practice volume and lab output and put more control over the manufacturing process in the hands of practitioners. Three topics generated considerable buzz at the conference: 3D digital scanners, open-source 3D digital printing, and cryogenic machining of soft materials.

3D Digital Scanning The concept of hand-held 3D digital imaging for custom orthotics is hardly new, but it hasn’t been common among U.S. orthotic practitioners, who might

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O&P ALMANAC NOVEMBER 2011

be uncertain about cost-effectiveness and nervous about parting with triedand-true devices, such as plaster casts or foam boxes.

The basic technology, developed in the 1990s by a New Zealand firm called Applied Research Associates, was used by special-effects company WETA Digital to create digital representations of detailed clay models of orcs, trolls, and other creatures for battle scenes in the “Lord of the Rings” movie trilogy.

Digital scanners also have been used for years by prosthetic socket manufacturers to scan stumps and create a socket from an automated fabrication process based on the digital scan, says Jerome Rifkin, CEO and CTO of Tensegrity Prosthetics Inc. The number of orthotic and podiatry practices with in-house scanners remains small, but the momentum is mounting as practitioners see good examples of how 3D digital scanning can increase workflow and patient satisfaction, says Larry Huppin, DPM,

“Pouring plaster of Paris to create positive molds, modifying these molds, and then allowing them to dry prior Jerome Rifkin

to pressing took time. With digital

medical director of ProLab Orthotics in Napa, California, who also has a podiatric medical practice in Seattle.

His view is seconded by Maida Koller, vice president of sales for Delcam North America, whose headquarters in Birmingham, England, hosted the U.K. forum. Four years ago, Delcam’s CAD/CAM (Computer-Aided Design/ —PHILIP WELLS, BSC (HONS) PODIATRY Computer-Aided Manufacturing) orthotic solutions were still in beta-test, she says, but last year its North American division generated $1 million in sales revenue of orthotics Scans or Casts? solutions, and worldwide “The more orthotics annual sales increased by more you do,” he concludes, On the lab side, digital scans are than 300 percent. “the more value it has in not superior to casting, but they At the 2011 AOPA National time savings.” reduce storage and make duplication Assembly, September 19-22 in Huppin estimates easier and more accurate, says Philip Las Vegas, Koller says orthothat some 20 different Wells, BSc (Hons) Podiatry, technical tists lined up to learn about 3D scanners are now support manager at Salts Techstep the Delcam 3D digital scanner available, and three in Birmingham, England. “The main and its companion software, of the top models for cost incurred with plaster models OrthoModel and OrthoMill. efficiency and image was storage, and we could only keep Maida Koller “The majority of people we quality range in price them for 12 months,” he explains. “If a spoke to were not using any software, from about $2,900 to $6,500. In addition patient then needed a second pair after and some were doing an enormous to purchase cost, practitioners also this period, we would have to start amount by hand,” she says. “They need to budget for a computer or from the beginning. Digital storage spent a lot of time [at our booth] and laptop to run the software (most means that we keep the digital version asked a lot of questions.” units work well with a less than of the cast forever with the digital files Huppin says he has seen a $700 computer, Huppin says), staff of the insoles.” moderate increase in orthotic output training, and maintenance costs. A 2007 After adopting a digital system, since acquiring a Sharp Shape scanner Australian cost-benefit study calculated Salts Techstep was able to expand for his Seattle practice four years that optical scanning was 36 percent to its monthly insole production from ago. Casting a foot with plaster and 93 percent less expensive than 50 to 1,000 pairs, Wells clean-up requires about 15-20 minutes, taking and shipping a plaster says. Most clinicians but digital scanning takes less than cast when considering podiastill send plaster casts, two minutes, and the scan can be sent trist hourly rate, materials, but digital processes electronically to a lab with a mousepackaging, and postage. But save significant time. click. A practitioner can maintain more the research, conducted by “Pouring plaster of Paris control and ensure accurate casting by Craig Payne, DipPod, MPH, to create positive molds, taking the image himself, rather than a senior lecturer in podiatry modifying these molds, perhaps assigning the casting task at Latrobe University in and then allowing them to another less trained staff-member, Melbourne, did not consider to dry prior to pressing says Huppin. capital costs. took time,” Wells adds.

Larry Huppin, DPM

methods, we can scan, design, and mill a

pair of insoles in under 30 minutes.”

NOVEMBER 2011 O&P ALMANAC

29

“With digital methods, we can scan, design, and mill a pair of insoles in under 30 minutes.”

Digital technology also has increased customer satisfaction because of the reliability and repeatability of the process. It even allows the lab to produce emergency orthotics in 24 hours if needed, Wells says. “Less than 1 percent of orders are returned for adjustments or errors made,” he adds.

The founders of Commerce City, Coloradobased Mile-High Orthotics Laboratory were so convinced of the improved service digital technology would bring that they budgeted it into their start-up costs, says President Greg Armstrong.

Mile-High was in profit

within three months and paid off its digital investment in eight months, he adds.

Armstrong encourages his customers to purchase 3D digital scanners not just for these reasons, but also because of patient satisfaction. In other words, Greg Armstrong the patient can better visualize the problems that require the orthosis and what the orthosis will do to help correct them. That combination of understanding and wow-factor also inspires them to recommend your practice, Armstrong says.

Selecting a 3D Digital Scanner

C

urrent 3D digital scanners differ in which measurements of the foot they capture. Larry Huppin, DPM, medical director of ProLab Orthotics in Napa, California, suggests asking manufacturers the following questions to ensure their product can provide the information to meet your clinical needs: • Can the scanner capture a completely non-weight-bearing cast?

• Does the foot touch the scanner, plate, or ground when the image is captured? (To produce a completely non-weight-bearing cast, it shouldn’t.)

• Does it capture all three dimensions of the plantar aspect of the foot?

• Does it capture the posterior heel to allow frontal plane correction of the orthosis (balancing forefoot to rear foot)?

• Are you limited to one lab if you use this scanner?

• What training and customer support does the company provide?

Practitioners who have been holding off until the technology matures don’t need to worry about their device rapidly becoming outdated by new developments, Huppin says. “Like all technology, it never stops moving, but it’s safe to jump on the train at this point,” he says. “You’ll be fine [with a well-chosen device] for several years and probably longer.”

In fact, when listing advances to recent models of scanners, companies now talk more about user-friendliness, customer service, work-flow improvements, and educational add-ons than about technological advances in speed or accuracy.

At Delcam, a key goal is to make the software as simple and seamless as possible so you don’t need to be highly skilled to run it, says Maida Koller, vice president of sales for Delcam North America. Barcoding is being incorporated into the company’s digital workflow software to allow both clinician and lab to easily track whether a scan and prescription has been received by the lab, and where it is in the manufacturing or shipping process, she adds.

“We look at the total solution, not just any particular step in the solution, and what we can do to make it easier for people,” Koller says.

In another example, the upcoming Version 4 of PAL Health Technologies’ XtremityOne will expand its educational resources, including live-action and animated videos which practitioners can share with patients on such topics as preventing and managing diabetic ulcers through footwear, says Sarah Freeman, marketing manager.

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O&P ALMANAC NOVEMBER 2011

3D Digital Printing Since 2004, a team of mechanical engineers from the University of Bath’s engineering department has been refining a flexible and comparatively low-cost 3D printer dubbed the RepRap, or “replicating rapidprototyper.” Like other CAD/CAM devices, it uses a digital image to build a 3D end-product by rapidly stacking thin horizontal cross-sections of molten plastic. But a key trait that separates the RepRap from the rest of the pack is that it not only can manufacture and replicate a custom orthotic insole, it can literally replicate itself by printing most of its own parts, too.

The RepRap is much less expensive than its competitors because the user builds the technology from opensource, free instructions, downloadable at www.reprap.org; the software to run the device also is open-source. Even with picking up a few extra parts at a hardware store, the end price is just $781 (€500 at press-time exchange rates). While the RepRap currently is too small to manufacture custom orthotics, Chris Hanton, a University of Bath mechanical engineer graduate student, has made developing a suitably-sized device the goal of his senior thesis project.

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“Being able to provide on-demand and onsite precision manufacturing capability allows the customer to see their shoe sole or insole being produced, but also provides the clinician/fabricator full manufacturing control.”

—VIMAL DHOKIA

Building your own 3D printer from scratch might seem daunting, but Hanton says practitioners shouldn’t be intimidated. He thinks many will embrace being more hands-on because they will better understand not only Chris Hanton how the machine works but also how it can be modified to reflect their unique practice needs. The open-source aspect facilitates information-sharing between users.

“If you or anyone else makes a modification to the RepRap machine design, there is an obligation to publish the new design online for other members of the RepRap community to benefit from as well,” Hanton explains.

“This works just as well in reverse. If you’re trying to modify your RepRap machine and can’t quite figure out a particular problem, you can ask the RepRap community for help.”

Hanton first recognized the RepRap’s potential for custom orthotics during a Delcam summer internship. When asked to develop

32

O&P ALMANAC NOVEMBER 2011

a solution to automatically flip insole material 180 degrees in the middle of the machining process, he realized that the RepRap’s 3D printing technology eliminated the problem, allowing the manufacture of complex shapes. As a result of his discovery, Delcam has sponsored Hanton’s senior project to optimize RepRap for orthotics use.

“Orthotists who want more control over the production of their insoles would be inclined to invest in the RepRap technology because it is affordable and would eventually enable their patients to walk in, get their feet scanned, go off for a walk around town and get a coffee etc. while the orthotist prints the insole, come back in an hour, and collect their freshly printed pair of insoles,” Hanton says.

In theory, cutting out the lab might save money, but the practitioner Vimal Dhokia

would still have to weigh the costs in time and money of learning to use the machinery or employing additional staff, Hanton says. But, he adds, a big benefit to either practitioner or lab would be the ability to easily, inexpensively, and rapidly increase production volume exponentially.

“The great thing about RepRap technology is if you want to expand your RepRap technology machine factory, instead of making product (in this case insoles), you set all of your machines to make more RepRap machines,” Hanton says. “After one production run, you have double the number of machines you started with.

The second run you have four times, the third you have eight, and so on.”

Cryogenic Milling Another exciting research project, led by Vimal Dhokia, research engineer, and Stephen T. Newman, professor of innovative manufacturing technology, has developed a cryogenic manufacturing process for orthotic insoles and outsoles. The work is being done at the University of Bath’s Innovative Manufacturing Research Centre, which specializes in the complete life cycle of products—from design and design knowledge management through to processes and inspection—including significant work in hip, knee, and ankle joint replacements.

Simply put, low-density elastomers are frozen rapidly to facilitate direct and precise computer numerical control (CNC) milling. “The research came about as a result of the difficulty in rapidly producing fully personalized shoe soles using present state-of-the-art methods,” says Dhokia, a Knowledge Transfer Fellow who holds an engineering doctorate in the fledgling specialty of Cryogenic Sculptured Surface Machining of Elastomers.

Because typical rapid prototyping methods build the insoles and outsoles by stacking thin horizontal cross sections, Dhokia says, it works well with stiffer

materials but the process cannot accommodate the soft conforming properties needed for athletic shoes.

“The cryogenic CNC machining process allows for dual-sided, highly detailed products to be directly manufactured without the need for complex expensive molds,” he says. “Moreover, it can be used on a variety of different very low-density polymers such as EVA, Neoprene foams, and polyurethanes, to name a few. In general, it provides a real step change in which such materials can be processed, both rapidly and precisely.”

Leicester-based Soletec Systems Ltd. already has used the cryotechnology to produce personalized dual-sided EVA insoles and diabetic slipper shoes. The value of cryogenic machining, however, isn’t simply in being able to sculpt these more flexible materials. While the current three-axis machine is large, Dhokia is working to develop a user-friendly desktop cryo-mill for convenient use

directly in a practitioner’s office. In other words, as with the RepRap, the orthotist could take a 3D digital scan and generate the prescribed orthotic, precisely controlling the desired design parameters.

“Being able to provide on-demand and onsite precision manufacturing capability allows the customer to see their shoe sole or insole being produced, but also provides the clinician/fabricator full manufacturing control,” Dhokia says. “The applications are potentially limitless and range from insoles through to fully personalized race helmets.”

Dhokia hopes to have a fully working prototype of the desktop solution completed within a year.

Technological advances such as cryogenic milling and 3D imaging and printing hold great potential for producing custom orthotics inexpensively and quickly. Use of these innovative processes is not yet widespread, but the movement is gaining momentum as practitioners

see the positive results these improvements can bring. a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.

EDITOR’S NOTE: The second annual Custom Orthotic Insoles Technology Forum will be held July 12-13, 2012, at the University of Salford in Manchester, England.

For more information, visit www. orthotics-technology-forum.com.

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33

y a d o T

CHANGING TOMORROW

AOPA’s 2011 National Assembly challenges practitioners to evolve and embrace a brave new world of patient care

W

ith change comes opportunity for advancement. At the 2011 AOPA National Assembly, a record-breaking group of more than 2,200 attendees packed The Mirage Hotel and Casino in Las Vegas for a deep dive into the new business models, regulations, and patient-care best practices that are shifting the orthotic and prosthetic landscape.

Despite a difficult economic and regulatory forecast and other uncertainties, the O&P industry has many reasons to be optimistic. Technological innovations are improving patient care, and collaborative lobbying efforts to stave off detrimental federal legislation have been successful. Yet, this is no time to be complacent, say

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O&P ALMANAC NOVEMBER 2011

experts who called upon participants to adopt new business strategies, learn new technologies, and get involved in grassroots advocacy in support of the O&P community and its patients.

“If we do not advocate for ourselves and the industry on Capitol Hill and in our state capitals, who will?” asks AOPA President Tom DiBello, CO, FAAOP, while honoring W. Clint Snell, CPO, with the Legislative Advocacy Award. Snell received the award for his tireless campaigning on behalf of O&P patients at the federal and state levels.

“Seize the future by building relationships,” Snell told the audience.

His message of participation to effect change echoed throughout the five-day event. Here are some highlights.

Vegas Shines Although this year’s AOPA National Assembly featured hard-hitting clinical and business educational sessions, by no means was it all work and no play for attendees. A mix of new social events and perennial favorites gave participants the opportunity to make new connections and catch up with their industry peers.

• Congratulations to Harry Layton, CPO, LPO, who was the winner of the $10,000 Give-Away—an all-expense paid trip for two to Hawaii. The contest was sponsored by Arizona AFO and Branier Orthopedic. Tickets sold for the prize benefitted AOPA’s government relations outreach.

• The 2011 Thranhardt Golf Classic took place at the Royal Links Golf Club, recognized as the “Best Course in Las Vegas” by the Las Vegas Review Journal. For the third consecutive year, OPAF and AOPA’s Capitol Connection co-sponsored the event to benefit the OPAF and Capitol Connections’ work on behalf of O&P. • This year’s Happy Hour took place on the floor of the exhibit hall.

Attendees and their guests were treated to hors d’oeuvres and beverages sponsored by the exhibitors. While there, attendees tried their luck on a giant slot machine using tokens passed out during the education and general sessions. Several participants took home an assortment of prizes, including Apple iPads.

• The exhibit hall also was the scene for Snell O&P’s Centennial Celebration. Along with a champagne toast and birthday cake, the anniversary party featured an above-the-knee amputee Elvis impersonator who serenaded several generations of the Snell family and attendees.

• The fourth annual O&P PAC Wine Tasting and Auction, hosted

by Anita Liberman-Lampear, MA, and her husband Alan, offered participants the chance to learn about and taste a variety of wines from around the world. The silent and live wine auction raised more than $32,000 to benefit the O&P PAC.

Changing Outlooks From the effects of health-care reform and other regulations to new revenue-generating business models, practitioners have been hearing about the unprecedented change sweeping the industry for some time now. But for many, the hardest part about adapting to these new realities is taking the first step.

In her inspirational keynote address,

Melissa Stockwell, CP and above-the-knee amputee, discussed the importance of embracing unexpected challenges and persevering.

She explained how losing her leg to a roadside bomb in Baghdad gave her life direction.

After recovering from her injury, she received two Medals of Honor from the U.S. military and eventually achieved her dream of being a competitive athlete. (She was named 2010 World

Champion in the Paratriathlon.) Later, she earned her degree in O&P and has carved out a fulfilling career as a certified prosthetist practicing at AOPA member Scheck & Siress.

“When I look at my life, I can honestly say that I’ve done more with one leg than I ever could have imagined doing with two,” Stockwell told the packed room of attendees.

“Life is short and it is strange…and it’s the twists and turns in life, and how we handle them, that make us who we are.”

NOVEMBER 2011 O&P ALMANAC

35

Changing prevailing mind-sets might be a tougher challenge, however, especially when it involves caring for a nontraditional patient population.

During the “Veterinary Healthcare in O&P” general session, a panel of experts discussed the pros and cons of running an animal-only O&P clinic and the trends driving the increased need for quality pet care. Confronted by declining reimbursement rates and increased costs of doing business, practitioners may need to consider leaving their comfort zone to expand their business and revenue base.

“We understand biomechanics, we understand physiology and anatomy, and this puts us in a good position to work with animal orthotics and prosthetics,” said Jim Alaimo, CP, and one of the session’s speakers. The industry is growing, he pointed out, and is expected to be a $33 billion market by 2014. “There are more geriatric pets out there. Because veterinary care is so much better [than it used to be], dogs are living longer, and owners are expecting humanquality care for them.”

Changing Technologies The two-hour “Robotics—From Research to Reality” session, which discussed robotic prototypes, powered prosthetics and orthotics, biomechatronics, and other innovative technology, offered participants a look at the products they could be offering patients in the future.

The integration of body and machine is a reality. “The best analogy I have [to describe the lab of Homayoon Kazerooni, PhD, one of the session’s speakers] is if you were able walk into the fictional lab of Tony Stark from Iron Man…that

36

O&P ALMANAC NOVEMBER 2011

2011 AOPA Award Winners Howard R. Thranhardt Award Maria Gerschutz, PhD; Edward Neumann, PhD, PE, CP, FAAOP; and Carmen Hawkins, PhD AOPA Lifetime Achievement Award Robert E. Arbogast and Rudolf B. Becker, III Second Annual Sam E. Hamontree, CP, Business Education Award Bret Bostock, CO Ralph R. “Ronney” Snell, CPO, FAAOP, Legislative Advocacy Award W. Clint Snell, CPO First Annual Otto and Lucille Becker Award Tyler Manee, MSPO First Annual Edwin and Kathryn Arbogast Award Chrysta Irolla visualization of seeing these exoskeletons hanging from the rafters truly opened my eyes for what the potential is for the future,” says Gary Bedard, CO, FAAOP, who introduced the session.

But learning didn’t just happen in the educational sessions; many Assembly participants flocked to the exhibit hall for a look at emerging O&P devices, hands-on demonstrations, manufacturers’ product preview sessions, and practitioners’ poster presentations.

More than 180 exhibitors from around the world took part in this year’s expo, showcasing everything from gait analysis equipment and in-house fabrication tools to infant cranial orthoses and compression

garments. Exhibitors also used their time to strike up meaningful conversations with attendees, answering any questions they might have about the leading-edge products presented.

“Exhibiting allows us to showcase new product and gives us the opportunity to listen to suggestions of attendees,” says Jerome Klein, CO, C.Ped, and director of pedorthics for Aetrex Worldwide.” This interaction helps us with our product development for the future.”

Many exhibitors noted an increased practitioner interest in high-tech, niche devices.

“I had a very interesting discussion with two lower-limb prosthetic athletes who are not users of upper-limb prosthetic technology but were very interested in how [it] differs from lower-limb technology and what is involved in learning how to use it,” says Karl Lindborg, CPO and clinical business development manager for Touch Bionics. “These two individuals… push their lower-limb technology to the limit and were curious how our hand operates, how the myoelectric signals are used, and how the hand is programmed to get into specific features.”

As the attendees of the 2011 National Assembly found out, the O&P industry can look forward to exciting, if challenging, times. But with continued education about the innovative and lifechanging products that are becoming more and more available each day, O&P professionals can be confident in the knowledge that they will continue to have a positive effect on their patients and their communities. And that’s a message the industry can take to Capitol Hill and the state capitals. a

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2011 BUYERS’ GUIDECARE TO FOOT CARE 2011 BUYERS’ GUIDE TO FOOT

2011 FOOT CARE

BUYERS’ GUIDE to

The annual one-stop resource for O&P foot-care products and services

CONTENTS 39

Courses and Workshops

39

Digital Imaging Applications

39

Footwear

39 Custom Footwear

40 Diabetic and

Extra-Depth Footwear

42

Insoles

44

Lower-Limb Devices and Orthoses

48

Socks

38

O&P ALMANAC NOVEMBER 2011

SPS

Alpharetta, GA 800/767-7776, x3 www.spsco.com

Digital Imaging Applications TechMed 3D

750 Chemin Olivier, Ste. 201 Levis (Quebec), Canada G7A 2P7 855/832-4633 www.techmed3d.com TechMed 3D TechMed 3D is a high technology company specializing in body measurements technologies and digital imaging applications. MSoft, the main application, is the most powerful product to digitalize the body from the head to the toes, and can help pedorthists to design, modify and fit shoes and foot orthoses from the tip of the finger with a minimal formation. Fast, effective, portable, reliable, and extremely easy-to-use tool, MSoft allows clinics to see more patients each day, achieve greater measurement consistency, enjoy the benefit of digital archiving, and improve diagnostic success. We are located in Levis (Quebec) Canada.

Contact us at 418/836-8100 or toll-free 855/8324633 or visit www.techmed3d.com.

2011 BUYERS’ GUIDE TO FOOT CARE

Courses and Workshops

Footwear CUSTOM FOOTWEAR ACOR Orthopaedic, Inc.

18530 S Miles Pkwy Cleveland, OH 44128 800/237-2267 www.acor.com

American Shoe Corp.

Brooklyn, NY 866/620-7463 www.americancustomshoes.com

Apis Footwear Company 2239 Tyler Ave South El Monte, CA 91733 888/937-2747 www.bignwideshoes.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.

Arizona AFO

Mesa, AZ 877/780-8382 www.arizonaafo.com

Bio Prosthetic Orthotic Lab Inc.

Ashburn, VA 703/726-4092

BioSculptor Corporation

Hialeah, FL 305/556-6164

Branier Custom Molded Shoes

Sebring, FL 877/524-0639 www.branier.com

NOVEMBER 2011 O&P ALMANAC

39

2011 BUYERS’ GUIDE TO FOOT CARE

Jerry Miller Shoes

36 Mason St. Buffalo, NY 14213 800/435-0065 www.jerrymillershoes.com

Footwear DIABETIC AND EXTRA-DEPTH FOOTWEAR

Jerry Miller Shoes Introducing the $129 custom molded shoe! Jerry Miller Shoes has announced a new line of affordable custom-molded shoes for the active foot-care patient.

The collection of incredibly comfortable Simply Jerry™ custom-molded shoes are a perfect fit for patients with arthritis, post polio, Charcot or digital amputation who may fall outside the eligibility requirements of the Therapeutic Shoe Bill. Simply Jerry™ low shoes are fully accommodating for hammertoes, bunions, edema and hypersensitive feet. All styles feature lightweight construction; Jerry Miller’s exclusive weightbearing system to protect sensitive areas for maximum comfort; stretchable, breathable Medi-Flex fabric for accurate fit, function and flexibility; choice of regular lace or Velcro with D-Ring closure; black sports fabric interior lining; and one ¼” pink, ¼” white combination plastazote insert.

For more information call 800/435-0065 or visit www.jerrymillershoes.com.

Kingsley Manufacturing Co.

Costa Mesa, CA 949/645-4401 www.kingsleymfg.com

Lawson Medical LLC

Virginia Beach, VA 866/631-6311

Levy & Rappel

Saddle Brook, NJ 973/478-6511 www.levyandrappel.com

PEL Supply Co.

Cleveland, OH 800/321-1264 www.pelsupply.com

SPS

Alpharetta, GA 800/767-7776, x3 www.spsco.com

Vorum Research Corporation Vancouver, BC 800/461-4353 www.vorum.com

40

O&P ALMANAC NOVEMBER 2011

ACOR Orthopaedic, Inc.

18530 S Miles Pkwy Cleveland, OH 44128 800/237-2267 www.acor.com

Acor continues to offer its own brand of X-Static® silver lined shoes, but we have increased our Diabetic and Extra-Depth Footwear choices with the addition of the Drew, OrthoFeet, and Hush Puppies brands. Any of these shoes can be returned with Free Return Shipping, and No Restocking Fees. See our catalog for hundreds of shoes from Acor, Drew, OrthoFeet, and Hush Puppies as well as Acor’s extensive line of foot orthotics. Acor is one-stop shopping for all of your diabetic footwear needs.

Acor “For Every Walk of Life™”

Aetrex Worldwide Inc.

Teaneck, NJ 800/526-2739 www.foot.com

AliMed Inc.

Dedham, MA 800/225-2610 www.alimed.com

Apis Footwear Co.

El Monte, CA 626/448-8905 www.bignwideshoes.com

Bio Prosthetic Orthotic Lab Inc.

Ashburn, VA 703/726-4092

Branier Custom Molded Shoes

Sebring, FL 877/524-0639 www.branier.com

Cascade Orthopedic Supply Inc.

Chico, CA 800/888-0865 www.cascade-usa.com

CrocsRx

Niwot, CO 303/848-7399 www.crocsrx.com

Toll free # 1-888-937-2747 Call for catalogs or free samples

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2239 Tyler Ave. South El Monte, CA 91733 Tel: 1-888-937-2747 Fax: 626-448-8783 www.bignwideshoes.com

2011 BUYERS’ GUIDE TO FOOT CARE

Dr. Comfort

Mequon, WI 800/556-5572 www.drcomfortdpm.com

Freeman Manufacturing Co.

Sturgis, MI 269/651-2371 www.freemanmfg.com

Kingsley Manufacturing Co.

Costa Mesa, CA 949/645-4401 www.kingsleymfg.com

Knit-Rite Inc.

Kansas City, KS 800/821-3094 www.knitrite.com

M.J. Markell Shoe Co. Inc.

Yonkers, NY 914/963-2258 www.markellshoe.com

PEL Supply Co.

Cleveland, OH 800/321-1264 www.pelsupply.com

Orthofeet Products from PEL Supply Orthofeet Diabetic Shoes and Inserts, offering the “ultimate comfort and protection,” are now readily available from PEL Supply, featuring: • Seamless protective lining • Ultra soft fabric, padded with (shown is Orthofeet 1/8” foam 415 Men’s Tie-Less • Non-binding upper Lace in Black Leather) construction design • Stretchable shoes eliminate pressure points, enhance comfort.

• Orthotic friendly • Straight footbed seat allows orthotics to function properly without distortion • Ergonomic-Stride™ sole • All Orthofeet shoes designed with true Toe-Spring design to alleviate stress at forefoot, help propel foot forward • Advanced functional designs • Revolutionary closures include Tie-Less Lace, Easy Slip-On and Two-Way Strap systems • Fisherman sandals with stretch—unique elastic upper design offers loose fit across forefoot to alleviate pressure on swollen feet.

For more information about the full line of Orthofeet products call PEL at 800/321-1264, fax 800/222-6176, or email customerservice@pelsupply.com.

42

O&P ALMANAC NOVEMBER 2011

SoleTech Inc./Advance Footwear

Salem, MA 800/225-2192 www.advancefootwear.com

SPS

Alpharetta, GA 800/767-7776, x3 www.spsco.com Additional 20% off in the Big Shoe Event Now through December 31, 2011, SPS is offering an additional 20% off all Answer 2 and SureFit brand shoes. With over 80 styles of men’s, women’s and children’s shoes to choose from, you are sure to score big savings on your favorite models. This limited time offer includes the new Answer 2 accommodative footwear, Speed Lacers & Hi-Tops for children and Synchronized Walking Shoe for adults. Speed Lacers have a unique combination of lace-up entry with Velcro closure, while the new Hi-Tops provide extra ankle support & double depth for moderate swelling. The Synchronized Walker is a mild rocker shoe designed to meet patient’s stability needs while standing at midstance, yet provide increased propulsion to ease smoothly into roll-over and toe-off. All Answer2 shoes accommodate AFOs or KAFOs without modification.

Call SPS Customer Service at 800/767-7776, x3 for more information on the specific styles included in this limited time offer.

ACOR Orthopaedic, Inc.

18530 S Miles Pkwy Cleveland, OH 44128 800/237-2267 www.acor.com

Aetrex Worldwide Inc.

Teaneck, NJ 800/526-2739 www.foot.com

AliMed Inc.

Dedham, MA 800/225-2610 www.alimed.com

2011 BUYERS’ GUIDE TO FOOT CARE

Insoles

The Fillauer Companies Chattanooga, TN 800/251-6398 www.fillauer.com

Preformed TFC Foot Orthotics

by Fillauer: • Pre-formed for better fit on heel • ¾ length • May be easily adjusted • Remoldable carbon composite • Extremely durable and tough • May be easily customized to a patient’s model • Available in 5 sizes For more information contact customer service at 800/251-6398 or visit www.fillauer.com.

ALPS

St. Petersburg, FL 800/574-5426 www.easyliner.com

American Shoe Corp.

Freeman Manufacturing Co.

Sturgis, MI 269/651-2371 www.freemanfg.com

Brooklyn, NY 866/620-7463 www.americancustomshoes.com

AMFIT Inc.

Vancouver, WA 360/573-9100 www.amfit.com

Apis Footwear Co.

El Monte, CA 626/448-8905 www.bignwideshoes.com

JMS now offers

Branier Custom Molded Shoes

Sebring, FL 877/524-0639 www.branier.com

Cascade Orthopedic Supply Inc.

JMS Plastics, your leading supplier of orthotics materials, now offers Ortho Feet, the leading supplier of therapeutic shoes.

Dr. Comfort

More than 70 styles of men’s and women’s shoes available for immediate delivery.

Chico, CA 800/888-0865 www.cascade-usa.com

Mequon, WI 800/556-5572 www.drcomfortdpm.com

Euro International Inc.

Tampa, FL 800/378-2480 www.eurointl.com

JMS Plastics for all your orthotics needs.

Call 800-342-2602 or visit us online www.jmsplastics.com NOVEMBER 2011 O&P ALMANAC

43

2011 BUYERS’ GUIDE TO FOOT CARE

INSOLES (CONTINUED) Kingsley Manufacturing Co.

Costa Mesa, CA 949/645-4401 www.kingsleymfg.com

Knit-Rite Inc.

Kansas City, KS 800/821-3094 www.knitrite.com

Lower-Limb Devices and Orthoses ACOR Orthopaedic, Inc.

Virginia Beach, VA 866/631-6311

Lawson Medical LLC

18530 S Miles Pkwy Cleveland, OH 44128 800/237-2267 www.acor.com

Levy & Rappel

AliMed Inc.

Saddle Brook, NJ 973/478-6511 www.levyandrappel.com

Dedham, MA 800/225-2610 www.alimed.com

M.J. Markell Shoe Co. Inc.

Allard USA Inc.

Yonkers, NY 914/963-2258 www.markellshoe.com

Rockaway, NJ 888/678-6548 www.allardusa.com

PEL Supply Co.

American Shoe Corp.

Cleveland, OH 800/321-1264 www.pelsupply.com

Brooklyn, NY 866/620-7463 www.americancustomshoes.com

Silipos Inc.

Anatomical Concepts Inc.

Niagara Falls, NY 800/229-4404 www.silipos.com

Poland, OH 800/837-3888 www.prafo.com

SoleTech Inc./Advance Footwear

Arizona AFO

Salem, MA 800/225-2192 www.advancefootwear.com

SPS

Alpharetta, GA 800/767-7776, x3 www.spsco.com

Vorum Research Corporation Vancouver, BC 800/461-4353 www.vorum.com

Mesa, AZ 877/780-8382 www.arizonaafo.com

Becker Orthopedic Appliance Co.

Troy, MI 248/588-7480 www.beckerorthopedic.com

Bio Prosthetic Orthotic Lab Inc.

Ashburn, VA 703/726-4092

Boston Brace International Inc.

Avon, MA 508/588-6060 www.bostonbrace.com

44

O&P ALMANAC NOVEMBER 2011

Tamarack ShearBan®

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Look at this diverse selection of products – brand new, as well as proven performers – available from PEL. Because we stock the most popular, best performing products from hundreds of product manufacturers, we’ll most likely have the product you want – often for same day shipment.

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2011 BUYERS’ GUIDE TO FOOT CARE

LOWER-LIMB DEVICES AND ORTHOSES (CONTINUED) Cascade Orthopedic Supply Inc.

Chico, CA 800/888-0865 www.cascade-usa.com

Cascade Dafo Inc.

Ferndale, WA 800/848-7332 www.cascadedafo.com Cascade Dafo, Inc. created the original DAFO® (Dynamic Ankle Foot Orthosis) in 1985. Today they manufacture the most complete system of pediatric lower-extremity bracing in the industry, including custom and prefabricated devices. Cascade believes better mobility gives all children a wider range of experiences, greater success in their activities, and more control over their lives. To that end, the company is committed to providing innovative orthoses unmatched in quality, fit, and function—complete with a full 90-day warranty. At Cascade Dafo, product design, technical support, education, and research and development have a sole focus: helping kids lead healthier, happier lives.

College Park Industries Inc.

Fraser, MI 800/728-7950 www.college-park.com

Introducing the new Celsus K2 Foot from College Park Brand new for 2011! Bringing College Park’s innovative composite technology into the K2 market, the Celsus combines proven durability with controlled stability. Its balanced design and natural motion provide smooth, stable transitions. The perfect lightweight design promotes confidence and security for lower impact patients.

Key Features include: • Smooth proportional response with integrated spring technology (iST) • Low profile design • High weight limit of up to 136 kg (300 lbs) • Maintenance free design • Sandal toe feature • Same-day, custom built to order For more information, call 800/728-7950 or visit www. college-park.com.

46

O&P ALMANAC NOVEMBER 2011

DeRoyal Industries Inc.

Naples, FL 888/938-7828 www.deroyal.com

The Fillauer Companies Chattanooga, TN 800/251-6398 www.fillauercompanies.com

Freeman Manufacturing Co.

Sturgis, MI 269/651-2371 www.freemanmfg.com

Friddle’s Orthopedic Appliances

Honea Path, SC 800/528-9339 www.friddles.com

Kingsley Manufacturing Co.

Costa Mesa, CA 949/645-4401 www.kingsleymfg.com

Knit-Rite Inc.

Kansas City, KS 800/821-3094 www.knitrite.com

MD Orthopaedics

Wayland, IA 877/766-7384 www.mdorthopaedics.com

Med Spec (ASO)

Charlotte, NC 704/573-4040 www.medspec.com

Medequip Inc.

San Juan Capistrano, CA 949/443-4414

M.J. Markell Shoe Co. Inc.

Yonkers, NY 914/963-2258 www.markellshoe.com

New Options Sports

Dallas, TX 800/872-5488 www.newoptions-sports.com

OPTEC

Lawrenceville, GA 888/982-8181 www.optecusa.com

HANDMADE AND CUSTOM FIT TO PROVIDE SUPERIOR CONTROL FOR ALL SIZES AND STANCES.

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without the need for articulating joints. See Orthomerica.com/ditto for more information.

Restorative Care of America Inc.

2011 BUYERS’ GUIDE TO FOOT CARE

LOWER-LIMB DEVICES AND ORTHOSES (CONTINUED)

St. Petersburg, FL 800/627-1595 www.rcai.com

Orthomerica Products, Inc.

Townsend Design

Orlando, FL 877/737-8444 www.orthomerica.com

Bakersfield, CA 661/837-1795 www.townsenddesign.com

Orthomerica® Products Inc.’s New Spectrum Slim™ Orthomerica® Products Inc. is pleased to introduce the new Spectrum Slim™ a valuable addition to our latest Spectrum™ AFO product line. This slimmer and sleeker, eye-catching gauntlet is designed to allow your patients a greater range of shoe options. The Spectrum Slim™ is ideal for patients that find standard gauntlets a challenge to get into a shoe. Its low profile design makes donning and doffing much easier for the patient, and its soft leather offers maximum comfort. The Spectrum Slim™ is available in black or tan leather or black or white synthetic material.

For more information, call Orthomerica at 877/7378444 or visit www.orthomerica.com.

Dedham, MA 800/225-2610 www.alimed.com

Comfort Products Inc.

Trace, Trim and Walk Away!

The new WalkOn Trimable and the WalkOn Flex AFO’s by Otto Bock HealthCare offer high quality with quick customization. You now have a choice of support coupled with the simplicity of shaping the footplate with scissors, allowing you to deliver personalized solutions to your patients wherever they are. Providing a symmetrical and fluid gait pattern with a natural heel strike and good energy return, the new AFO’s also give your patients the additional benefit of encouraging outward rotation of the foot during heel strike.

To learn more, contact your sales representative at 800/328-4058 or visit www.ottobockus.com.

O&P ALMANAC NOVEMBER 2011

AliMed Inc.

Chico, CA 800/888-0865 www.cascade-usa.com

Plymouth, MN 800/328-4058 www.ottobockus.com

48

Aetrex Worldwide Inc.

Teaneck, NJ 800/526-2739 www.foot.com

Cascade Orthopedic Supply Inc.

Otto Bock HealthCare

Dijon Cedex, France 011/33-380-784-285 www.proteor.com

Socks

El Monte, CA 626/448-8905 www.bignwideshoes.com

Foothill Ranch, CA 800/233-6263 www.ossur.com

PROTEOR

Cincinnati, OH 513/271-4594 www.truform-otc.com

Apis Footwear Co.

Össur Americas Inc.

®

Truform Orthotics and Prosthetics

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Croydon, PA 800/822-7550 www.comfortoandp.com

CrocsRx

Niwot, CO 303/848-7399 www.crocsrx.com

The Fillauer Companies Chattanooga, TN 800/251-6398 www.fillauercompanies.com

PEL Supply Co.

Cleveland, OH 800/321-1264 www.pelsupply.com

Kingsley Manufacturing Co.

PEL Supply Offers Core-Spun by Therafirm® Core-Spun by Therafirm® Gradient Compression Socks for men and women look and feel like a soft, comfortable everyday socks, yet they offer the added benefit of true gradient compression. The ultra-stretchy yarns make the socks easier to put on and the added thickness makes the socks more comfortable for all-day wear. Comfortable and cool, these Core-Spun compression socks are made using CoolMax® yarns or X-STATIC®/ polyester yarns to provide superior comfort and moisture-wicking technology. These fibers wick moisture away from the skin to the exterior of the sock, moving the moisture up and out of the foot area. The result is a sock that effectively controls moisture and odor.

For more information about Core-Spun by Therafirm® Gradient Compression Socks—or any other Therafirm® products—call your friendly PEL Supply customer service rep at 800/321-1264, fax 800/2226176, or email customerservice@pelsupply.com.

Registered customers may order online at www.pelsupply.com.

Costa Mesa, CA 949/645-4401 www.kingsleymfg.com

Knit-Rite Inc.

Kansas City, KS 800/821-3094 www.knitrite.com SmartKnit® Seamless Socks SmartKnit® Seamless Socks are ideal for diabetic, arthritic and sensitive feet. Core-spun, high-stretch fibers HUG your feet comfortably like a protective second skin reducing risks from wrinkling and bunching. Patented SmartKnit® socks are truly seamless to eliminate pressure points found in other diabetic or traditional socks. Non-Binding Halo-Top™ fits comfortably to minimize indentations. Superior moisture wicking fibers and antimicrobial to inhibit odor in the sock help to keep feet dry and healthy. Enhance the effectiveness of recommendations for protecting patients’ feet with foot display and detailed patient brochures, explaining the important role diabetic socks play in management of diabetes.

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

2011 BUYERS’ GUIDE TO FOOT CARE

Freeman Manufacturing Co.

Sturgis, MI 269/651-2371 www.freemanmfg.com

Royal Knit Inc.

Lees Summit, MO 800/664-5648 www.royalknit.com a

OPTEC

Lawrenceville, GA 888/982-8181 www.optecusa.com

NOVEMBER 2011 O&P ALMANAC

49

n

AOPA Headlines AOPA WORKING FOR YOU

One Step Ahead AOPA’s Board of Directors identifies priority initiatives to outpace the changing health-care field

Thomas V. DiBello, CO, FAAOP, AOPA 2011 president speaks to attendees of the 2011 National Assembly.

E

very business with a strategic plan has to regroup, rethink, and reinvigorate the plan’s direction, execution—or both.

AOPA has kept members abreast of big picture strategies that have guided AOPA since the emergence of 11 initiatives sparked by the 2007 member survey. Updated by the 2010 member survey, those 11 initiatives have been combined, completed, or no longer considered a priority because of changing circumstances. The 2010 member survey confirmed most conclusions about threats and opportunities derived from the 2007 study.

Armed with that updated information, the AOPA Board at its summer 2011 meeting took another look at the big picture and fine-tuned the priorities. Board members selected the following five strategic initiatives for the highest level of priorities: • Tying quality to financial outcomes (develop more data similar to the cost-effectiveness study) • Ensuring O&P is included as essential health benefit • PAC and GrassTops • Competitive bidding • Educating members on new delivery model (ACOs, consumer-driven healthcare) Within weeks of the Board meeting, however, CMS announced off-the-shelf orthotics will not be included in 50

O&P ALMANAC NOVEMBER 2011

Round 2 of competitive bidding. That doesn’t diminish the importance of competitive bidding as an issue for our field; it merely takes some pressure off for now. Nothing prevents CMS from taking another look at competitive bidding for OTS orthotics in the future. All of the persuasive arguments that AOPA developed in concert with the O&P Alliance and directed at CMS are still valid and can be revisited. Most important of these was the list of 10 OTS orthotics and “worst case scenarios” compiled by AOPA President, Tom DiBello, CO, FAAOP, and submitted to CMS. They conclusively demonstrate the requirement for a qualified orthotist to fit and provide the final device to avoid patient harm.

Further concerns about the huge need for growing AOPA’s financial resources to meet the challenges of the new health-care environment prompted an additional “5b” priority: enhancing AOPA revenue.

Steps were taken in Las Vegas to jumpstart the new revenue growth top priority via 2012 dues refinements and by launching a “Member Get-A-Member” campaign, which incentivizes current members to recruit their peers. Each member who recruits a new member to join AOPA will receive a rebate, equal to 10 percent of the new member’s dues, that can be distributed or applied as a credit against their own 2012 or 2013 dues. It’s a huge win-win for all because AOPA members can be the catalyst to make sure everyone is helping finance the massive lobbying and

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further with AOPA and others regulatory education efforts from the O&P field as part of that will be needed to avoid the decision-making process at any disasters as the new HHS. The DOL study reported regulations and decisions like a 49 percent prevalence of O&P “essential benefit” definitions coverage in employer health are developed. plans—far below results from two The first priority of tying other studies reporting a 75 percent quality to financial outcomes prevalence. A recent Institute of will deliver initial results when Medicine report commissioned the cost-effectiveness study

by HHS reported that prosthetic commissioned by the Amputee coverage is offered in 86 percent of Coalition and funded by AOPA the plans underwritten by major is completed within the next insurers according to a study few weeks. Experts in the field, provided by Mercer, a global Dobson DaVanzo Associates, human resources consulting firm. secured authorization from CMS That’s good news for prosthetics, to access Medicare 2009 paid but sadly there was no mention of claims data for patients with the orthotic coverage. same diagnoses. These claims are The third priority, regarding the being reviewed and separated O&P Political Action Committee into two groups. Patients who and its efforts to support received timely O&P treatment campaigns of those legislators who and subsequent costs incurred share our same concerns about comprise the first group. The Health and Human Services Secretary Kathleen Sebelius. patient care, is a big factor in any second group is made up of public policy effort mounted by the O&P field. Of the 27 patients with the same diagnoses who did not receive timely recipients of PAC donations in the last election cycle, 24 were and appropriate O&P treatment and their subsequent costs. elected. Some of those legislators have joined in bipartisan Other state-level studies related to Medicaid payments introductions of two important legislative proposals: H.R. show timely and appropriate O&P intervention avoids more 1958, the O&P Medicare Improvements Act, and S. 773, the costly co-morbid conditions that often develop from lack Insurance Fairness for Amputees Act. of mobility and other conditions. This cost-effectiveness The fourth priority—competitive bidding—may not study will be the first study at the national level to track two have the urgency today that it did when the Board included cohorts of patients with the same diagnoses and the subseit as a top priority, but it remains a concern that needs quent costs for those with and those without O&P treatment. close monitoring.

As such, it represents groundbreaking research that will be How the new patient-driven marketplace for health care a template for much-needed future research for the O&P will affect O&P patient care is a very important fifth priority field. That need is now turning into a survival challenge for that will play out over the next several years as parts of the O&P as payers increasingly demand conclusive proof of why Affordable Care Act are implemented. Accountable care various treatments or devices resolve patient issues in the organizations are just one piece of that puzzle’s impact on most cost-effective manner.

O&P that is still unclear. Bundled payments are another The second priority being pursued by AOPA and the challenging change in terms of O&P impact.

O&P Alliance is mounting a strong effort to convince Health All of these top-tier priorities directly or indirectly affect and Human Services (HHS) Secretary Kathleen Sebelius to patient care and the ability of the O&P community to deliver include O&P in the definition of “essential benefits.” This the quality care that has been our professional hallmark. is another make-or-break-it issue. Not being included AOPA and the entire community must join together to press raises huge questions about the availability and proper for favorable actions on all these fronts. Your participation reimbursement O&P patient care in the future. through writing letters to Congress, visiting with your Secretary Sebelius has responded to a letter from AOPA legislators, volunteering on campaigns tasks, and keeping President Tom DiBello, CO, FAAOP, that criticized a flawed informed will be vital in the months and years ahead. a Department of Labor Study (DOL) by offering to consult

52

O&P ALMANAC NOVEMBER 2011

n

AOPA Headlines

States Find Strength in Numbers with ‘State Rep’ Group

R

apid changes on the state and national legislative fronts during the past several months have spurred increased cooperation between AOPA and state organizations. Events such as cuts in Medicaid have led state organizations to contact AOPA for help. These situations are not isolated to just one or two locations, nor are they unique. Critical challenges in one locale can make a state organization feel alone. But if it is happening in one state, it’s usually also happening somewhere else.

This experience has taught us that we are much stronger united than we are working as individuals. But to work together, we must create a more efficient mechanism to communicate with each other. To accomplish this goal, AOPA is asking states to join together and share experiences. The first step was inviting individuals who have distinguished themselves as leaders in their states to act as links between their state and AOPA. This “state rep” group had it first face-to-face meeting during the 2011 AOPA Policy Forum. At the second meeting, held at the 2011 AOPA National Assembly in Las Vegas, the state representatives decided to inform AOPA members via O&P Almanac of the group’s creation.

Next—the important part—the state representatives will provide monthly bullet-point updates on current O&P-related events in their states. These updates will be distributed to all AOPA members, giving them the opportunity to stay current on events taking place in their own areas as well as nationwide.

The following people have agreed to be representatives for their state:

ALABAMA Steven Blackwell, CPO\L, FAAOP Shoals Orthotics & Prosthetics Inc. 256/764-8673 sab@hiwaay.net

ARKANSAS Frank Snell, CPO, LPO, FAAOP Snell Prosthetic & Orthotic Laboratory 501/664-2624 FESnell@aol.com

COLORADO Bill Beiswenger, CPO, FAAOP Abilities Unlimited Inc. 719/520-9700 bbeiswenger@auiop.com

HAWAII Rodney Pang, CPO Honolulu Orthopedic Supply Inc. 808/596-2588 honoluluorthopedic@hawaii.rr.com

Glenn Crumpton, CPO, C.Ped Alabama Artificial Limb & Orthopedic Service Inc.

CALIFORNIA Kevin Calvo, CPO, FAAOP Bionics Orthotics & Prosthetics 858/270-9972 bionics@sbcglobal.net

DELAWARE John Horne, CPO, LPO, C.Ped Independence Prosthetics-Orthotics, Inc. 302/369-9476 jhorne@independencepo.com

IDAHO Robert Miller, CPO Kootenai Prosthetic Orthotic Service Inc.

ALASKA Steve Foy, CPO, FAAOP Northern Orthopedics ARIZONA Frank Bostock, CO, FAAOP Hanger P&O, Inc. 602/776-0112 fbostock@hanger.com

54

O&P ALMANAC NOVEMBER 2011

Jeff Collins, CFO Cascade Orthopedic Supply Inc. 530/879-1580 jcollins@cascade-usa.com Ralph Nobbe, CPO Nobbe Orthopedics Inc. 805/687-7508 ralph@nobbeorthopedics.com

FLORIDA Dino Scanio, CPO Shriners Hospital for Children GEORGIA Jim Young, Jr., CP, LP, FAAOP Amputee Prosthetic Clinic 478/747-5678 joylegs@aol.com

INDIANA Bernie Veldman SureStep IOWA Rod Cheney, CPO, FAAOP American Prosthetics & Orthotics Inc. 515/224-0537 rodc@apoinc.com

KANSAS Doyle Collier, CP Knit-Rite 913/281-4600 dcollier@knitrite.com

NEW JERSEY Robert Silvestri, CPO, LPO JFK/JRI Prosthetic & Orthotic Lab 732/248-0774 rsilvestri@solarishs.org

KENTUCKY Tom Watson, CP Tom Watson’s Prosthetic & Orthotic Lab Inc. 270/684-6128 twatsonlab@aol.com

NEW MEXICO Deane Doty, CPO Active Life Inc.

MARYLAND Charles Dankmeyer, CPO Dankmeyer Inc. 410/636-8114 cdankmeyer@gmail.com Mark Hopkins, MBA, CPO, PT Dankmeyer Inc. 410/636-8114 markshopkins@aol.com MASSACHUSETTS Keith Cornell, CP, FAAOP Cornell Orthotics & Prosthetics Inc. 978/922-2866 keithlegs@aol.com MICHIGAN Ted Trower, CPO, FAAOP A-S-C Orthotics & Prosthetics 517/784-1142 ted@amputee.com MINNESOTA Teri Kuffel, Esq. Arise Orthotics & Prosthetics Inc. 763/755-9500 ariseop@aol.com MISSISSIPPI Rick Psonak University OrthopedicsP & O Division MISSOURI Tom Malone, COO Orthotic & Prosthetic Lab Inc. 314/968-8555 tmalone@oandplabinc.com NEVADA Melinda Lisle OrthoPro of Reno

NEW YORK Marita Dorsch Carozza, CP, FAAOP OPRM 607/643-0002 ma1218@aol.com NORTH CAROLINA Richard Gingras, CPO, BOCOP Level Four Othotics & Prosthetics 336/397-2165 rgingras@triad.rr.com PENNSYLVANIA Jon Leimkuehler, CPO, FAAOP Union Orthotics & Prosthetics Co. 412/621-2698 jon@unionoandp.com Eileen Levis Orthologix, LLC 215/244-4100 eileen@orthologix.com TENNESSEE John (JR) Reynolds, CPO Reynolds Prosthetics & Orthotics Inc. 865/980-9600 jhrcpo@aol.com TEXAS Mark Kirchner, CPO, LPO MK Prosthetic & Orthotic Services 210/614-9222 mkirchner@mkprosthetics.com

WASHINGTON Sanjay Perti, CPO Douglass Certified Prosthetics & Orthotics Inc. 206/363-7790 sanjayperti@mail.com Chelsey Pullman, CPO, LPO Center for Prosthetics Orthotics Inc. 425/454-4276 cpullman@cpo.biz WEST VIRGINIA Mark Gorman, CPO Morgantown O & P Center Inc. 304/598-0528 mgtnop@comcast.net

O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2011 test standards.

The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics

VERMONT John Ficociello, CPO Yankee Medical Inc. 802/863-4591 jnf@yankeemedical.com VIRGINIA J. Douglas Call, CP Virginia Prosthetics Inc. 540/366-8287 dcall@virginiaprosthetics.com

If you would like to learn more or become more involved, please contact your state representative listed above. If your state does not have a state representative, contact Eileen Levis, the Pennsylvania state rep.

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NOVEMBER 2011 O&P ALMANAC

55

n

AOPA Headlines

AOPA Meets with HHS After IOM Releases Essential Health Benefits Guidance

Date ★

SEPTEMBER 6-9, 2012

Save the

H YNE S CO N V EN T I ON C EN T ER, BOS T ON

★

which were entered into official record. The O&P representatives also explained the potential detriment to patients if the more sophisticated devices were not available to them.

Three HHS decision-makers attended the meeting, including Nancy DeLew, associate deputy assistant secretary for health policy, Office of the Assistant Secretary for Planning and Evaluation, who met with AOPA on August 4. O&P representatives included AOPA Executive Director Tom Fise, the O&P Alliance General Counsel Peter Thomas, and AAOP Executive Director Peter Rosenstein.

According to Fise, the HHS officials understood the arguments for better differentiation of orthotics in terms of customized orthopedic bracing for patients with limb impairment arising from chronic health conditions (e.g., MS, cerebral palsy, and spina bifida). However, the need to advocate for the medical necessity of O&P devices and care doesn’t end here. AOPA will continue to create, and take advantage of, opportunities to re-enforce these appeals for O&P’s inclusion in the essential health benefits package and keep members apprised of those meetings.

Mark your calendar to attend the country’s largest, oldest, and essential meeting for orthotic, prosthetic and pedorthic professionals.

The

Visit www.AOPAnet.org for updates on events and education.

56

O&P ALMANAC NOVEMBER 2011

Placee!

To B

S P E A K E R S • E D U C AT I O N • E X H I B I T S • S P O N S O R S • N E T W O R K I N G

After the October 7 release (see page 15) of the Institute of Medicine’s (IOM) long-awaited report to Department of Health and Human Services (HHS), AOPA participated in a public listening session on October 18 with HHS officials, including some who met with AOPA on August 4 to discuss the prevalence of O&P coverage and prospects for inclusion of O&P among essential health benefits. AOPA availed itself of this opportunity to clarify some vague and broad comments in the IOM report about orthotics, says AOPA Executive Director Tom Fise.

In the meeting, AOPA offered arguments about distinguishing customized orthopedic bracing from items such as wrist bands, shoe inserts, and durable medical equipment.

O&P representatives educated officials on the topic of customized orthoses by explaining the difference between basic over-the-counter products that can be bought at a pharmacy and the types of customized orthoses (from shoe inserts to customized bracing) used for the long-term care of patients with chronic diseases and limb impairment. AOPA President Tom DiBello, CO, FAAOP, provided examples,

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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.

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n

AOPA Headlines

Medicare May Face Major Spending Cuts In August, President Obama signed a bill raising the U.S. debt limit to meet the nation’s fiscal obligations. The immediate impact of the increase is to reduce discretionary spending programs by $900 billion over the next 10 years.

Defense, Medicare, Social Security, and Medicaid are not being considered during this first round of cuts. In the long-term, however, Medicare may face $276 billion to $480 billion in spending cuts over the next 10 years—which could affect O&P users.

Under this current phase, the president and the Department of the Treasury may raise the debt limit in two steps: to $400 billion immediately and to $500 billion later this year. Medicare premium changes or other savings chargeable to beneficiaries will not be considered during these cuts, so the portion extracted from Medicare would be made up entirely of cuts to provider payments.

The United States has to pay $500 billion in Medicare cuts to cover part of the cost for health-care reform legislation; the total Medicare-provider cuts could approach $1 trillion over the next 10 years.

A congressional “super committee” has been charged with identifying additional deficit reductions of $1.2 billion to $1.5 billion. These cuts, due to be announced by late November,

could be through any combination of spending cuts and revenue increases that the committee decides, with the intention of meeting reduction goals in 10 years.

In reality, the committee will probably try to identify savings of an additional $1.2 trillion, since the savings in interest from not borrowing that amount comes to another $300 billion saved, bringing the total reduced deficit to the total goal of $1.5 trillion. If the committee fails to reach an accord (or if its agreed-on recommendation is rejected by lawmakers), then the $1.2 trillion in cuts would be extracted from cuts to government spending, supposedly in proportion to the portion each category of costs accounts for as a percentage of the federal budget. Medicaid and Social Security are not being considered for these “back-up” cuts.

It may be hard for this committee to reach an agreement, and if it doesn’t, roughly 50 percent of the total savings, or $600 billion, would come from the defense budget. Medicare would be the next largest target, at somewhere between 23 percent to 40 percent of the total cuts. This means spending cuts to Medicare could be between $276 billion to $480 billion over the next 10 years.

AOPA will continue to keep members abreast of developments in budget-cuts negotiations.

Expert Coding Advice 24/7

24/7

at www.LCodeSearch.com •

•

•

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

Log onto LCodeSearch.com and get started today.

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

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

This exclusive service is available only for AOPA members.

Not an AOPA member? GET CONNECTED

Manufacturers: Get your products in front of AOPA members!

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

Visit AOPA at www.AOPAnet.org

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O&P ALMANAC NOVEMBER 2011

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 Headlines

FDA 510(k) Possible FDA Policy Changes May Affect Manufacturers Currently, many O&P devices are exempt from the FDA 510(k) clearance process, also known as Premarket Notification. The FDA is considering altering the 510(k) clearance process, however, so these exemptions may be subject to change—either through internal rule changes or modifications to the current process, or by legislative changes, such as mandating the creation of an integrated pre- and post-market regulatory framework that replaces the current 510(k) clearance process that allows devices to get to market.

If the FDA chooses to rework the existing 510(k) clearance process or to adopt a new pre- and post-market regulatory framework, it has the potential to affect devices covered under the process and most O&P devices that currently are exempt from 510(k) clearance.

Springfield, Illinois - State Capitol

Illinois Veterans Prostheses Bill Signed into Law Illinois House Bill 3315, sponsored by state Rep. Rosemary Mulligan (R-65th district) and designed to help veterans acquire prostheses, was signed into law on Aug. 16.

It will take effect on Jan. 1, 2012.

The law directs the Illinois Discharged Service Member Task Force, created within the U.S. Department of Veterans Affairs, to investigate the availability of prostheses offered to Illinois veterans. The task force also is responsible for reviewing the effects of post-traumatic stress disorder, homelessness, disabilities, and other issues facing Illinois veterans re-entering civilian life after active-duty stints.

AOPA’s First PSA Reaches 57 Million AOPA teamed up with the Amputee Coalition to produce a television public service announcement (PSA) that addresses the move in state governments to strip O&P coverage to Medicaid beneficiaries. An estimated 57 million viewers have seen the PSA on major cable channels nationwide, according to AOPA’s PR consultant, The PlowShare Group.

While the PSA is appearing primarily on TV stations, it also aired on the Clear Channel SpectaColor Megatron in New York City’s Times Square this past June. This

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O&P ALMANAC NOVEMBER 2011

appearance was supported by an Otto Bock HealthCare grant.

AOPA is hosting a video of the PSA at www.

LimbsAreEssential.org. A “Take Action” advocacy page on www.aopanet.org allows interested parties who support O&P to send a letter to their state and federal legislators urging them to join the fight to protect citizens with mobility impairments.

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AOPA Headlines Federal Agencies Question Medicare Paid Claims The Department of Health and Human Services and the Office of the Inspector General issued a report describing suppliers’ questionable billing practices on lower-limb prostheses and the extent to which Medicare improperly paid claims for these prostheses.

The following are some key facts from the report: • Between 2005 and 2009, Medicare spending for lowerlimb prostheses increased 27 percent, from $517 million to $655 million.

2005 2009

$517 MILLION

$655 MILLION

• During the same years, the number of Medicare beneficiaries receiving lower-limb prostheses decreased by 2.5 percent, from almost 76,000 to about 74,000.

• Medicare paid 4,575 suppliers for lower-limb prostheses in 2009.

• Approximately 36 percent of those 4,575 suppliers accounted for 92 percent of the $655 million billed for lower-limb prostheses.

AOPA Audio Conference Addresses Kickbacks and Gift-Giving As the holiday season approaches, join AOPA on November 9 for an AOPAversity Mastering Medicare Audio Conference, “Happy Holidays: Gifts and Kickbacks in O&P.” The one-hour audio conference addresses concerns about referral source gift-giving and the Medicare rules that govern gift-giving polices.

The audio conference will cover these topics: • acceptable gifts for referral sources • acceptable gifts for patients • federal anti-kickback regulation prohibitions • the difference between doing something nice and doing something illegal.

The cost of participating is $99 for AOPA members and $199 for nonmembers. 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/2011-telephone-audio-conferences.

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NOVEMBER 2011 O&P ALMANAC

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AOPA Headlines

Special Thanks to Our O&P PAC Contributors 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*: John Allen, CPO Anne M. Anderson Michael F. Angelico Robert E. Arbogast Thomas Bain, BOCPO, LPO Gino Banco, PhD Johnny E. Baskin, CP Rudy Becker, Sr. Lawrence J. Benenati, CFo Kel M. Bergmann, CPO Devon Bernard Frank Bostock, CO Jeffrey M. Brandt, CPO Robert N. Brown, Sr., FAAOP, CPOe Carey A. Bunch, CO Michael Burton Erin Cammarata, CTO Marty Chalfin, C.Ped Brent A. Cheney, CO Doyle Collier, CP Ken Cornell, CO Thomas E. Dalsey Martin Diaz, BOCO Nicholas Diaz Noreen Diaz Lesley DiBello Kathy Dodson Joe Drompp, CO Marc Dufour, CO Christine Erbacher Jim Fitzpatrick Norbert Fliess, CP Steven Q. Foy, CPO Frank Friddle, Jr., CO Jeff P. Fussner, CPO

David Garcia Richard Gingras, CPO Carey Glass, CPO, FAAOP, LPO Lou Goldstein Catherine Graf, JD April Groves, CO Susan M. Guerra, RN, CFO Elizabeth A. Hammer, BOCO, CFO Michael E. Hamontree Natalia Hanavan Sprague Hanavan, CPO Don Hardin Robert Hartson, CPO Dennis Haun, CPO Elden Henry-Pottinger, BOCO Donna C. Hinnant, CP William Holzwrath, CPO Russell J. Hornfisher Ross Huebner, CO, CTO Joseph R. Hunter, CPO Joseph T. Huntsman, MBA, MA Maurice A. Johnson, CO, BOCO, C.Ped Tami Jones Randy Kamin, CTP John M. Kenney, CPO, FAAOP Thomas F. Kirk, PhD Alfred E. Kritter, CPO, FAAOP Teri Kuffel, JD Randy S. Lacey Ronald G. Lanquist, CO Anthony Layton, CPO Harry Layton, CPO, LP Jon Leimkuehler, CPO Ivan Letner, CP

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.

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O&P ALMANAC NOVEMBER 2011

Alan Lett, CPO Eileen Levis Michael A. Lewis, CPO, LPO Alan Lampear Anita Liberman-Lampear, MA Pam Lupo, CO Ann Mantelmacher Dwayne M. Mara, CP, BOCP Stuart Marquette, BOCP, CO Brad Mattear, CFo Kevin C. Matthews, CO, LO Mike Mattingly, CPO Mark Mazloff John S. McAtee, CP Tom McGovern Clint McKinley Joe McTernan John W. Michael, CPO Ted Muilenburg, CP Lana Nassan Sander Nassan, CPO, FAAOP Brian C. Neep, CPO Ralph Nobbe, CPO Michael H. Oros, CPO John J. O’Sullivan, LPO Tom Padilla, CPO Rodney M. Pang, CPO Curt Patton, CPO Jason Pawelsky Sterling K. Phillips, CP, LP, FAAOP Laura Riedel, CPO Jerome Rifkin, MSME Rick Riley Daniel Rinella, CO Tim Riordan, CPO

John A. Roberts, CPO Richard Rocco, Jr., CPO Brad Ruhl William Sampson, CP Ronald Sanders, CP Scott Schneider Terry L. Shaw, CPO, BOCPO, FAAOP David S. Sisson, BOCO, CP Jay Sleeth, CPO Sean D. Snell Ted Snell, CP William Clint Snell, CPO Alice Stride, CPO, LPO Michael V. Tange, CPO Kimberly Thomas, CFm Pamela S. Veldman Frank M. Vero, CPO George Villarruel, CP Cherylon Vinyard Benjamin C. Walker, BOCP Jack Walker Thomas H. Watson, CP Jim Weber, MBA Joe Whiteside, CO Steven R. Whiteside, CO, FAAOP Scott Williamson, CAE, MBA Bryan Wilson Connie Withers Darlene Wnek Ann Yamane, CO Jon Yanke, CPO James O. Young, Jr., CP, LP, FAAOP Claudia Zacharias, MBA, CAE

In order 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 October 3, 2011 and includes only donations received between July 28, 2011 and October 3, 2011. Any donations received or made after October 3, 2011 will be published in an upcoming issue of the O&P Almanac.

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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

Access Prosthetics LLC

Lake Area Prosthetics & Orthotics

2633 Development Dr., Ste. 10 Green Bay, WI 54311 920/471-1451 Fax: 920/569-2939 Category: Patient Care Facility Brian Schmidt, CO

505 W. College St. Lake Charles, LA 70605 337/474-2989 Fax: 337/474-2996 Category: Patient Care Facility Ronnie Bias, CPO, C.Ped.

Allen Orhtopedic Labs Inc.

Ortopedia Ortiz Hermanos S.A. DE C.V.

1375 S. Eliseo Dr., Ste. G Greenbrae, CA 94904 415/925-1333 Fax: 415/925-1444 Category: Patient Care Facility Leslie Allen, CP

American Orthotics & Prosthetics 3714 Tibbets St., Ste. 104 Riverside, CA 92506 951/367-6702 Fax: 951/367-7789 Category: Patient Care Facility David Sulis, CPO

Certified Prosthetics & Orthotics LLC

Belgica 578 Col. Moderna Guadalajara, Jalisco 44600 Mexico +52-33-3826-9649 Fax: +52-33-3826-9599 Category: International Carmen Vazquez

Parker Hannifin Corp.

6035 Parkland Blvd.

Cleveland, OH 44124 216/896-2175 Category: Supplier Level 1 Doug Santee

Progressive Orthopedics

1620 25th St., Ste. A Greeley, CO 80634 970/356-2123 Fax: 970/352-4943 Category: Affiliate Parent Company: Certified Rehab Services Inc., Fort Collins, CO

4224 Ohio St. San Diego, CA 92104 619/280-9174 Fax: 619/280-9286 Category: Patient Care Facility Gerardo Guzman, CP

Certified Rehab Services Inc.

2145 University Park Dr., Ste. 100 Okemos, MI 48864 517/349-3130 Fax: 517/349-8887 Category: Patient Care Facility Jan Stokosa, CP, FAAOP

1709 Heath Pkwy.

Fort Collins, CO 80524-2718 970/482-7116 Fax: 970/498-9529 Category: Patient Care Facility Jason Bradshaw, CO

iWalk Inc. 4 Crosby Dr. Bedford, MA 01730 781/761-1560 Fax: 866/537-7801 Category: Supplier Level 1 Tim McCarthy

Stokosa Prosthetic Clinic

Team O’Neill Inc. 10336 W. Coggins Dr., Ste. B Sun City, AZ 85351 623/875-6683 Fax: 623/875-9472 Category: Patient Care Facility William O’Neill, Jr., CPO a

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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 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

- Northeast - Mid-Atlantic - 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 NOVEMBER 2011

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

Certified Prosthetist/Orthotist, Certified Prosthetist, Board Eligible/ Certified Orthotist Southern Maine Do you want to be more than a number? We are a terrific, patient orientated company looking for some awesome practitioners. Is this you? Our well established, O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity.

Learn more about joining our team of dedicated specialists by contacting:

O&P Ad 1111 C/O: The O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

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 Frisco, CO Belleville, IL Indianapolis, IN Quincy, IL

Urbana, IL Philadelphia, PA Houston, TX San Antonio, TX Wilwaukee, WI Parkersburg, WV

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

Jackson, MS Elmira, NY Oneonta, NY Waukesha, WI

Prosthetist / Orthotist Springdale, AR Tucson, AZ American Canyon / Fairfield, CA Beverly Hills, CA Denver, CO Hollywood, FL Naples, FL Tamarac, FL West Palm Beach, FL Griffin, GA Macon, GA Dubuque, IA Indianpolis, IN

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

Certified Pedorthist Denver, CO Belleville, IL Roseburg, OR

Portland, OR Tacoma / Renton, WA

NOVEMBER 2011 O&P ALMANAC

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Jobs Inter Mountain

Certified Orthotist, Certified Prosthetist (licensed or eligible) Houston, TX Energy capital of the world; voted first in Texas and third in the U.S. 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 Phone: 512/777-3814 • Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Certified Orthotist, Certified Prosthetist/ Orthotist Tucson, Arizona Are you excited about coming to work every day? Excited about the improvements you can make in others’ lives?

Want to be a part of a team that values education and professional advancement? Want to be part of a group that will change the field of orthotics and prosthetics? Do you want to be at place where business is never usual? We are looking for energetic practitioners who possess great communication, organization, and patient care skills in the following positions: CO or CPO. We offer a very competitive benefit and salary package, along with relocation assistance and the opportunity to work for a company that can provide security from being the oldest O&P patient care company in the world. If you have been looking for the good life and a great company to work for, visit www.hanger.com/careers.

Contact, in confidence:

Sharon King Phone: 512/777-3814 • Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers 66

O&P ALMANAC NOVEMBER 2011

Certified Prosthetist/Orthotists Frisco, Colorado If you love the outdoors and love to ski, five major ski resorts—Copper Mountain, Breckenridge, Keystone, Vail, and Arapahoe Basin, as well as the magnificent Lake Dillon— are nearby! World-class fishing; hike the 14ers. Management experience is a plus! We are looking for an energetic Orthotist/Prosthetist who possesses great communication, organizational and patient care skills. You will even receive a one-year ski pass to Vail/Summit! We offer a very competitive benefits and salary package, along with relocation assistance and the opportunity to work for a company that can provide security from being the oldest O&P patient care company in the world. If you have been looking for the good life and a great company to work for.

Contact, in confidence:

Dana Johnson Phone: 303/996-3717 Fax: 303/233-6390 Email: dajohnson@hanger.com www.hanger.com/careers

Certified Orthotist or Certified Prosthetist (licensed or eligible) San Antonio, TX Seventh largest city in the U.S. and second largest 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:

Sharon King Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

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Inter Mountain

Jobs

Southeast

Prosthetic and Orthotic Technician Salt Lake City, Utah Salt Lake City, the capital of Utah and known as “Crossroads of the West” is close to the western part of the country for numerous outdoor sports, very family oriented, magnificent mountain views, museums…too much to mention! If you are looking for a great place to work and live, don’t miss this opportunity. We are searching for someone who possesses excellent communication and organizational skills and has two+ years of O&P experience. Salary commensurate with experience and skill level. Relocation assistance is available.

Contact, in confidence:

Sharon King Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

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

HELP SHAPE BABIES’ LIVES! Full-Time & Part-Time Positions Available Be part of a unique career opportunity treating babies up to 24 months of age.

If you are growing bored of traditional orthotics, Cranial Technologies may be the place for you. We are currently looking for a unique part-time or full-time orthotist to work for a unique company. Our clinicians bring a love of treating patients, a desire to do the highest quality work, a passion for more than collecting a paycheck and a need to make a difference.

At CranialTech, you’ll use your pediatric skills (or learn some new ones) in a niche orthotic area. You’ll focus on treating infants with plagiocephaly using the DOC Band® and see visible, measurable changes in 2 to 3 weeks.

CranialTech clinicians receive 3 months of training by Senior Clinicians, competitive salary and full benefits. There’s minimal paperwork and no weekends or evenings.

NOW HIRING ORTHOTISTS IN: Charlotte, NC | Orange, CA

Check out the details at cranialtech.com/careers or call (866) DOC-BAND!

NOVEMBER 2011 O&P ALMANAC

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Jobs Pacific

Board Eligible Orthotist, Board Eligible Prosthetist, Prosthetic Resident, Orthotic Resident, Certified Fitter Los Angeles-area We are a well-established orthotics and prosthetics company serving Los Angeles and surrounding areas who has immediate openings for motivated individuals who are interested in a wide variety of patients. We are looking for someone who can help us continue to grow while ensuring unsurpassed patient satisfaction. We offer a competitive salary and benefit package, Salary is commensurate with experience. Note: Assignment requires local traveling and will be reimbursed. Please fax resume to:

Fax: 310/828-7067

Certified Prosthetist/Orthotist

Certified Prosthetist/Orthotists Northern California Do you dream of earning six figures? Receiving a significant sign-on bonus and to work 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, 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:

Beverly Hills, California Head for the Santa Monica Mountains, enjoy the beautiful weather, or rub elbows with the stars…even visit Rodeo Drive! We are searching for a well-rounded Prosthetist/ Orthotist, preferably someone with great organizational and communication skills along with excellent patient care experience. We offer a very attractive salary and benefit package, which includes relocation assistance, unequalled educational opportunities and a sign-on bonus. Ready to make a change? Join the Hanger Team! If interested, please contact, in confidence:

Sharon King Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Sharon King 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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O&P ALMANAC NOVEMBER 2011

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Date H

SEPTEMBER 6-9, 2012

North Central

Jobs

Certified Prosthetist Michigan Amputee Associates is looking for an ABC-certified clinician to provide prosthetic-only care on an unsurpassed level in Michigan. Prosthetist needs to possess the knowledge and confidence to provide complete prosthetic care beginning with pre-operative evaluation, amputation surgery, healing, wound care, and continuing through all prosthetic and follow-up care. Prosthetist will practice directly in the surgeon’s office, operating room, and hospital setting. This is an innovative practice model that provides complete care from “amputation to ambulation.”

Please contact Chantelle at:

The

Email: c.arabie@amputeeassociates.com www.amputeeassociates.com

Visit www.AOPAnet.org for updates on events and education.

Placee!

To B

Orthotist/Prosthetist ABC Certified Cultural

Consider the advantages of living in Albuquerque, NM, a picturesque, modern city with a wealth of social and recreational amenities. An exceptional lifestyle and rewarding career.

What could be better?

You make patients feel comfortable emotionally as well as physically!

Along with your technical expertise, you have a true gift for inspiring confidence in patients by educating them to assure their success with their new devices. That highly personalized approach is important to us at the University of New Mexico Hospitals.

UNMH is the only teaching hospital with the only Level 1 Trauma Center in NM. In addition to being the state’s only Stroke Certified Center, we are also the first in NM to be designated as a Pathway to Excellence Organization, recognized by Consumer Reports as one of the nation’s Top 3 Hospitals for conservative care, cited by Nursing Professionals magazine among the 2009 Top 100 Hospitals to Work For and honored by Working Mother magazine as one of the 6 Best Companies for Hourly Workers. We were just ranked #16 in Training Magazine’s Top 125 Training Organizations – a true testament to our emphasis on continuing education. We are also currently pursuing MAGNET status.

In this role, you will be responsible for providing and overseeing individual patient assessments, formulation and implementation of a treatment plan as well as follow-up and practice management. This will include technical fitting and fabricating casts and orthotics, inspecting devices manufactured by internal or external sources to ensure adherence to specifications, and supervising and training orthotic technicians and other staff as requested. You will remain on-call on a stand-by basis to ensure daily coverage.

Candidates need a Bachelor’s Degree in Orthotics or a Bachelor’s Degree with post-graduate certification in Orthotics by the American Board for Certification in Orthotics and Prosthetics. In addition, 3 years of directly related experience is essential.

Apply online at: http://hospitals.unm.edu/jobs/ and refer to Req #11293851.

Scan QR Code or go to www.facebook.com/UNMHospitals At UNMH everything is attainable.

Nothing is out of reach.

EOE

NOVEMBER 2011 O&P ALMANAC

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Jobs Mid-Atlantic

Linkia Director, Clinical Services Rockville, MD The director clinical services is a certified clinician (CO, CP or CPO) responsible for clinical and quality management programs including: professional review of orthotic & prosthetic services (PROPS), utilization review accreditation commission (URAC) accreditation, quality management committees, and credentialing. Directly reporting to the director, clinical services are PROPS program director, senior manager credentialing and URAC coordinator. This individual is directly responsible for coordinating quality management program and meeting URAC accreditation requirements. Performs all duties of the chief case reviewer for PROPS. Works with direct reports to create and implement work flows to meet efficiency requirements; write standard operating procedures for all functions of responsibility and support organizational goals.

Essential Functions: • Ensures policies, practices, & procedures comply w/ administrative, legal & regulatory requirements • Participates in developing and implementing Linkia’s strategic direction for clinical operations and programs • Performs all duties of chief case reviewer—PROPS program clinical lead • Consult with all constituents (internal and external) as clinical expert • Oversee credentialing and compliance functions • Coordinates quality management program and documents—QI/UM/credentialing plan, QI indicators, QI committees • Write SOPs for all areas of responsibility as appropriate • Performs other duties as assigned Required Skills & Abilities: • Demonstrated ability to lead & manage through influence & change • Strong interpersonal skills emphasizing flexibility and diplomacy • Exceptional presentation and public speaking skills • Strong analytical and creative problem solving skills • Ability to prioritize and manage multi-task functions • Knowledge of Microsoft Office Suite • Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written) and interpersonal skills

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O&P ALMANAC NOVEMBER 2011

Required Credentials: • 5-10 years clinical experience as certified orthotist and/or prosthetist clinician (CO, CP or CPO) • Education: BA/BS • 3-5 years supervisory/management experience preferred If interested, please contact in confidence:

Jim Gillette Hanger Orthopedic Group Email: JGillette@hanger.com www.hanger.com/careers

Certified Prosthetist/Orthotist Philadelphia, PA Culture, arts, history and architecture…not to mention cuisine! Philly has it all! It is the country’s fifth-largest city comprised of art museums and galleries, serious shopping, all four major sports, University of PA. And, 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:

Sharon King Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

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

NOVEMBER 2011 O&P ALMANAC

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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

$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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O&P ALMANAC NOVEMBER 2011

■■ NOVEMBER 9 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5-6 pm 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. To register, call 800/220-6670 or visitt www. ultraflexsystems.com.

■■ NOVEMBER 9 WillowWood Tips and Techniques: New Jersey AAOP Chapter Annual Meeting. Atlantic City, NJ. This workshop touches on the operation and fabrication techniques for several suspension options, including LimbLogic® VS. The Alpha® Family, including the Alpha Silicone Liner, will be discussed as will the functional and adjustment capabilities of prosthetic feet.

■■ 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.

■■ 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 12 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9-10 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic ResponseTM (ADRTM) technology. Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems. com.

■■ DECEMBER 7 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5-6 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic ResponseTM (ADRTM) technology. Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems. com.

■■ NOVEMBER 17 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. Presenter: Jim Rogers, CPO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ DECMBER 7 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. Visit www.willowwoodco.com.

NOVEMBER 17-18 WillowWood: Existing OMEGA® Tracer® Users Prosthetics and Orthotics 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.

■■

■■ NOVEMBER 29 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon-1 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic ResponseTM (ADRTM) knee and ankle technology. To register, call 800/220-6670 or visit www.ultraflexsystems.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: 11/17/2011. Contact 877/665-5443. Visit www. willowwoodco.com.

n

■■ 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: 11/17/2011. Contact 877/6655443. 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.

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: 12/29/2011. 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.

MAY 17-19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association Annual Meeting at Peppermill. Hotel Reno, NV. Best CEU credit value available! Contact Steve Colwell at 206/440-1811, Sharon Gomez at 530/5214541, or visit www.wamopa. com.

■■

■■ 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, TN. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

■■

■■ SEPTEMBER 6-9 AOPA National Assembly & 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.

Calendar

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.

Motion Control

SUPERCOURSE SPRING 2012 FEBRUARY 22 – MARCH 2, 2012

at Motion Control Headquarters, Salt Lake City, Utah • 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 Spring 2012 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

NOVEMBER 2011 O&P ALMANAC

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Ad Index

COMPANY

PAGE

PHONE

WEBSITE

Allard USA Inc.

13

888/678-6548

www.allardusa.com

ALPS

31

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics

17

703/836-7114

www.abcop.org

Apis Footwear

41

888/937-2747

www.bigwideshoes.com

Arizona AFO

25

877/780-8382

www.arizonaafo.com

Becker Orthopedic

75

800/521-2192

www.beckerorthopedic.com

BOC International

61

877/776-2200

www.bocusa.org

Cailor Fleming Insurance

53

800/796-8495

www.cailorfleming.com

College Park Industries Inc.

19 , 37

800/728-7950

www.college-park.com

Complete Professional Office Services

33

810/629-6424

www.oandpoffice.com

DAW Industries

1

800/252-2828

www.daw-usa.com

Dr. Comfort

5, C3

800/922-3580

www.drcomfort.com

Euro International

11

800/378-2480

www.eurointl.com

Ferrier Coupler Inc.

27

800/437-8597

www.ferrier.coupler.com

JMS Plastics

43

800/342-2602

www.jmsplastics.com

KISS Technologies LLC

59

410/663-5477

www.kiss-suspension.com

KNIT-RITE

2

800/821-3094

www.knitrite.com

Med Spec

15

800/582-4040

www.medspec.com

Motion Control

51

888/696-2767

www.utaharm.com

OPTEC

8, 9

888/982-8181

www.optecusa.com

Orthomerica Products

47

800/446-6770

www.orthomerica.com

Orthotic and Prosthetic Study and Review Guide

55

www.oandpstudyguide.com

Össur Americas Inc.

C4

800/233-6263

www.ossur.com/active

Otto Bock HealthCare

C2

800/328-4058

www.ottobockus.com

PEL Supply Company

23, 45

800/321-1264

www.pelsupply.com

SPS

7

800/767-7776, x3

www.spsco.com

®

FEATURED NEW AOPA CAMPAIGN

AOPA Member-Get-A-Member Campaign TAke 10% or More oFF Your 2012 Dues Every major membership organization in the world has found their current members to be their most successful growth partners.

And there has to be something in it for the current member!

GROWING FOR

THE FUTURE CLUB

74

O&P ALMANAC NOVEMBER 2011

You, as an AOPA member, are invited to join our Growing for the Future Club. For each new member company you sign up who designates you as their recruiting member, AOPA will discount your current 2012 renewal by 10%. Get 10 new members and enjoy your 2012 AOPA benefits for free. The 10% discount per new member applies to company members signed up who pay the full 2012 dues of $1,745. For affiliates signed up at $305 each, AOPA will provide a credit of $30 against 2012 dues. You may also use the earned discount as a credit when you purchase any AOPA product, service or seminar.

Find out MORE HUGE BENEFITS—to enroll in the club and receive your Growing for the Future membership marketing kit, email scuster@AOPAnet.org and we’ll take it from there. You can help make it happen!

For Better Outcomes, Reach for ShearBan®

e v i t a r e c l U Pre”Hot Spot” First Consultation Diagnoses* 10+ yr. history of recurring ulceration on right foot;Multiple ray amputations due to ulcers

After ShearBan Treatment Ulcer healed within 11 weeks of treatment with ShearBan; Patient remained ulcer-free over 2 years later.

Friction management technology proven to protect skin against friction blisters, calluses and foot ulcers.

Apply directly to footwear, insoles or orthotic devices – wherever skin is susceptible to damage from friction & shear. Choose from 8” x 12” sheets for custom trimming, or Pre-cut ShearBan Oval patches for easy peel & stick installation.

Visit shearban.com to download & watch the presentation, “Friction Management for Neuropathic Foot Problems” Upon completing a short online self-assessment, qualifying O&P practitioners, assistants and technicians will receive 2 PCE units. * Case study courtesy of Charles Kuffel CPO, FAAOP • Arise Orthotics and Prosthetics, Inc.

For more information about ShearBan®, contact Becker Orthopedic: Phone (248) 588-7480 • Toll free (800) 521-2192 To locate an O&P distributor worldwide, visit BeckerOrthopedic.com © 2010 ShearBan is manufactured in the USA by Tamarack Habilitation Technologies

Design is the difference

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AOPA Answers

Billing and Bookkeeping Answers to your questions regarding Medicare records and PDAC coding 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: A:

For Medicare purposes, what is considered an acceptable signature?

Medicare considers the following to be acceptable forms of a signature on all types of medical records: handwritten, electronic, faxed copies, and initials. However, each one of these signature methods has some caveats. Handwritten signatures are acceptable, as long as they are legible.

Electronic signatures are acceptable, as long as they can be tied to an individual—such as a password and PIN code system—and cannot be altered. With faxed signatures, keep in mind that Medicare can request a copy of the original signature; so whenever possible, it is a wise idea to retain the original signature. If you are using initials as a substitute for a signature, the initials must be above a typed or printed full name, and they must be legible.

Q:

Medicare is requesting copies of our records, and we realized the practitioner forgot to sign his entries, are these now considered invalid entries?

A:

Medicare requires that if any part of a patient’s record is to be used in the processing of a claim, it must have an appropriate signature. If the practitioner forgot to sign an entry in the patients chart, you may submit an attestation statement along with the chart to collaborate the entry. In other words, you may send a statement that says that the information in the medical record was entered by the practitioner and is accurate.

When using an attestation statement, the statement must clearly identify which patient the statement refers to, and the statement must be signed and dated by the individual who made the entry into the medical record. The attestation statement is only to be used to verify the individual who entered specific information into the medical record and cannot be used to add additional information to that record.

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O&P ALMANAC NOVEMBER 2011

Q:

Which devices currently require a Pricing, Data Analysis and Coding Contractor (PDAC) coding verification to be billed to Medicare?

A:

Not all O&P devices require PDAC verification in order to be billed to Medicare. Only three policies have a requirement that a device be reviewed, verified, and listed on the PDAC website: • The Spinal Orthosis policy requires that all customfabricated and prefabricated LSOs and TLSOs be reviewed and listed.

• The Knee Orthoses policy requires that any device described by code L1845 be verified and listed.

• The Therapeutic Shoe policy requires that off-the-shelf diabetic shoes, custom inserts, and heat-moldable inserts be verified and listed.

The following items also are required to be verified and listed on the PDAC website, if they are to bill to Medicare: • pneumatic knee splints described by code L4380 • cervical collars described by code L0174 • functional electrical stimulators described by code E0770.

Q:

If we provide custom-fabricated LSOs, TLSOs, and diabetic inserts and do the fabrication in-house, are we required to submit these products to the PDAC for review?

A:

No. If you are providing these customfabricated items to your patients, and you fabricated the items in-house (and didn’t use a manufacturer or a central fabrication site), then you are not required to submit these items to the PDAC for review. However, you must be able to provide upon request a list of the materials used and a description of your fabrication process. a

Many of Your Patients Are Already Wearing Compression Hosiery…

Why are you referring them elsewhere?

Scan this QR Code to See Our Guarantee at drcomfort.com or Call Us at 877.728.8444

...And Even More of Them Should Be! From A Family of Comfort 800.992.3580 www.drcomfort.com ©2011 Dr. Comfort All Rights Reserved

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INTRODUCING ÖSSURACTIVE. An interactive website dedicated to helping your patients live a more active, healthy lifestyle. we have collaborated with experts like Paralympic Gold Medalist Marlon shirley to create a community with your patients in mind.

This convenient, easy-to-use resource is a one-stop-shop for fitness tools and tips for any activity level. find the information your patients need to live a longer, healthier life. n

AK and BK-specific exercise videos

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Training advice

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nutritional recommendations

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feedback & insight from Team Össur and other members of the amputee community

Help your patients start living a healthier lifestyle today!

Visit www.OSSUR.COm/ACTIve.

Scan the tag with your Smartphone to learn more about ÖssurActive: 1. Go to http://gettag.mobi 2. Get the free app 3. Scan the tag

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www.ossur.com/active ©2011 Össur. All rights reserved.