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The Magazine for the Orthotics & Prosthetics Profession


Preparing for Prior Authorization P.18

Tips for Supplier Standard Compliance P.36

TIME for



State by State P.60

This Just In: AOPA To Analyze OIG Report on Orthotic Payments P.20


































PP. 19 & 39





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JAN UARY 2020 | VOL. 69, NO. 1



Welcome to 2020—a brand new year, and a good time to re-evaluate your facility and make the needed changes to be successful in the coming decade. O&P Almanac helps you build a better practice by offering strategies for change management and investigating the increased focus on O&P research initiatives.

22 | How To Change Thinking about constructing new processes and procedures to position your facility for success? Whether you want to collect more outcome measures, or you are seeking other changes to bolster your business for the future, follow these eight steps for facilitating change.









28 | Proving Our Worth


20 | This Just In A Second Look

After the October release of a report from the Office of the Inspector General on Medicare allowable amounts for certain back, knee, elbow, and wrist orthoses, AOPA plans a more comprehensive analysis of the findings. The association will conduct individual analysis of each Healthcare Common Procedure Coding System code discussed in the report, the current and historic O&P provider market share of each code, and the potential impact a reimbursement reduction may have on each code.



As the profession evolves from trial and error to evidence-based practice, clinicians are dramatically changing how they do business. An uptick in outcome measures data, an influx of O&P investigators, and increased funding will lead to a pool of studies that will be instrumental to payors in making coverage decisions—to the ultimate benefit of O&P patients. By Christine Umbrell

“Some people said I couldn’t be a model… They were wrong!” Paola Antonini - Model


© Össur, 11.2019


PRINCIPAL INVESTIGATOR Matthew “Matty” Major, PhD..... 40 Meet a research health scientist affiliated with the Jesse Brown VA Medical Center and Northwestern University Feinberg School of Medicine, who focuses his O&P investigations on clinical biomechanics and rehabilitation engineering.

DEPARTMENTS Views From AOPA Leadership......... 6 Future of the Medicare O&P Patient-Centered Care Act

AOPA Contacts.......................................... 8 How to reach staff

Numbers...................................................... 10 At-a-glance statistics and data


Research, updates, and industry news

People & Places........................................16 Transitions in the profession

COLUMNS Reimbursement Page.......................... 18

Off and Running

[ 2020 Essential Coding and Billing Seminars

The future of prior authorization, competitive bidding, and more

[ Medicare 101 Seminars

CE Opportunity to earn up to two CE credits by taking the online quiz.


Compliance Corner............................... 36

Supplier Standard Compliance Tips

[ AOPAversity Webinars


National Supplier Clearinghouse shares common errors CE Opportunity to earn up to two CE credits by taking the online quiz.


P.13 Member Spotlight................................ 44 n


Friddle’s Orthopedic Appliances New Life Brace and Limb


AOPA News.............................................. 48 AOPA meetings, announcements, member benefits, and more

O&P PAC Update .................................. 50 Welcome New Members.................... 51 Careers.........................................................52 Professional opportunities

Marketplace..............................................54 Ad Index...................................................... 57 Calendar......................................................58 Upcoming meetings and events

State By State.......................................... 60 P.44 4


News from Illinois, Indiana, and North Carolina






We Have a Bill! What Next?

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


N THE DECEMBER Views From AOPA Leadership column, I wrote about the road to differentiation—the need for O&P to ensure we are recognized as distinct from durable medical equipment in order to preserve the profession and provide quality care to patients. I wrote that to do this, we needed to double down on our legislative efforts. The introduction in the U.S. House of Representatives of the Medicare O&P Patient-Centered Care Act (HR 5262) right before Thanksgiving is a big step forward down this road. This bipartisan legislation would improve access to, and quality of, orthotic and prosthetic care received by Medicare beneficiaries while simultaneously combatting fraud and abuse. Specifically, this bill would: • Restore congressional intent by revising the overly expansive regulatory interpretation of the meaning of “off-the-shelf” orthotics to clarify that competitive bidding may only apply to orthoses that require minimal selfadjustment by patients themselves, not the patient’s caregiver or a supplier. • Distinguish the clinical, service-oriented nature in which O&P is provided from the commodity-based nature of the durable medical equipment benefit. • Reduce the likelihood of waste, fraud, and abuse in the Medicare program by prohibiting the practice of “drop shipping” of orthotic braces that are not truly “off-the-shelf” (i.e., subject to minimal self-adjustment by the patient him- or herself).

During most of 2019, AOPA and our partners worked hard to get this bill introduced. We spent time strategizing how to make it more patient focused, spent time educating members of Congress about the issue, and spent time making slight language tweaks to ensure we accomplished as much as we could with the bill. We worked closely with Hill staffers, proactively addressing any issues that would create legislative obstacles when trying to pass the bill once introduced. Wherever possible, we crossed all the T’s and dotted all the I’s. It is likely that as you read this column there will have been movement with the bill. Hopefully, we will have a Senate version. Or better yet, it will have been included as part of a larger healthcare package that moved at the end of the year and will now be law. We will of course take time to celebrate this achievement, but we’ll quickly get back to work, to get ourselves further down the road of differentiation. Healthcare will continue to be in flux as our country seeks better solutions to cost, delivery, and coverage, and we need to continue the push for federal policies that protect O&P businesses and preserve patient access to quality care. To do this, as well as move all our legislative and regulatory priorities forward, we need your advocacy efforts. Stay tuned for updates from AOPA on actions you can take. Also, plan to join us May 5-6 in Washington, D.C., for the 2020 AOPA Policy Forum. It is our opportunity to have our voices heard, to raise the issues our businesses and patients experience, so we can continue to provide quality care. Thank you for your efforts, as getting a piece of legislation introduced is no easy feat. Thank you also for continuing to advocate for the profession and its patients. Together we can continue to improve the lives of those living with limb loss and limb impairment. Jeffrey Lutz, CPO, is president of AOPA.



Board of Directors OFFICERS President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA President-Elect Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Vice President Dave McGill, JD Össur Americas, Foothill Ranch, CA Immediate Past President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA DIRECTORS J. Douglas Call, CP Virginia Prosthetics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN Rick Riley Span Link International, Bakersfield, CA Linda Wise WillowWood, Mount Sterling, OH NONVOTING MEMBERS Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX Eve Lee, MBA, CAE Executive Director/Secretary American Orthotic and Prosthetic Association, Alexandria, VA


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

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met. EXECUTIVE OFFICES


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

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org COMMUNICATIONS, MEMBERSHIP & MEETINGS Joy Burwell, director of communications and marketing, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 8


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

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

STRATEGIC ALLIANCES Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2020 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac20 for advertising options!

It’s all about

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Uninsured Rate Begins To Rise New data from the U.S. Census Bureau indicates growing numbers lack insurance

The overall rate of insured individuals in the United States is on a slightly downward trend, according to recently released data from the U.S. Census Bureau. Here’s a look at the numbers of insured for those of varying ages, by those with a disability, and by state.




8.5 Percent

5.5 Percent

Percentage of people without health insurance at any point in 2018, compared to 7.9 percent in 2017

Percentage of uninsured children under the age of 19 in 2018, compared to 4.9 percent in 2017

67.3 Percent

Percentage of individuals with private health insurance

34.4 Percent *Some people may have more than one type of coverage during the calendar year.

44.7 Percent

Percentage of this population with health insurance in 2018, compared to 88.5 percent with no disability

53.9 Percent

Percentage of this population with private health coverage, compared with 74.9 percent with no disability

Percentage of this population with public coverage, compared with 16.0 percent with no disability

*The U.S. Census Bureau includes ambulatory, hearing, and cognitive disabilities in this category.



(Civilian noninstitutionalized population)

In 2018, Massachusetts had the lowest uninsured rate (2.8 percent), and Texas had the highest (17.7 percent) WA MT











! !





! !














! ! ! ! ! !





























Percent without health insurance coverage




Age *Denotes a statistically significant change between 2017 and 2018 at the 90 percent confidence level. SOURCE: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement.



A state with a circle around its abbreviation expanded Medicaid eligibility on or before January 1, 2018. SOURCE: U.S. Census Bureau, 2018 American Community Survey, 1-Year Estimates.

SOURCE: “Health lnsurance Coverage in the United States: 2018, U.S. Census Bureau, November 2019.

Percentage of individuals with public coverage

90.4 Percent


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Early Spinal Patterns in Younger Children May Predict Future Scoliosis Saba Pasha, PhD, a researcher at Children’s Hospital of Philadelphia (CHOP), has completed a study identifying patterns of spinal curvature among younger children that may develop into scoliosis by adolescence. The study by Pasha, director of orthopedic engineering and 3D musculoskeletal imaging at CHOP, could serve as a first step in developing methods to prevent scoliosis, according to her team. Pasha used computer simulations to investigate how elastic rods—models of children’s spines—change shape in response to mechanical loading. She designed the study by borrowing concepts from researchers who simulate how DNA molecules and proteins change their structure in response to various factors. Pasha studied the spinal X-rays of 129 adolescents with and without scoliosis. She studied 2D patterns of the X-rays, called sagittal spinal profiles, and used those patterns to

create S-shaped elastic rods in the computer simulations. She then applied simulated mechanical forces to observe how those rods deformed in 3D shapes. By studying the rods in models of subjects both with and without scoliosis, she found strong evidence that the shape of a person’s sagittal profile can be a leading cause of scoliosis. “This was the first study to quantitatively explain how variation in spinal patterns may lead to the spinal deformities seen in scoliosis, and may eventually guide us to early interventions for children at risk,” said Pasha, adding that follow-up studies are needed to determine whether the spinal shapes seen in images from younger patients could be developed into a risk-assessment tool to predict likelihood of scoliosis during the teen years. She theorized that it may be determined that wearing an orthosis at a younger age could prevent scoliosis from developing. The study was published in the November 11 issue of Nature Scientific Reports.

Researchers Investigate Hands-Free Crutch Preferences Lauren Schimandle used an iWALK 2.0 after sustaining a Lisfranc injury


discomfort using the hands-free single crutch. “The results of the current study in our relatively healthy cohort found that foot and ankle patients who were non-weight-bearing preferred the hands-free single crutch over standard axillary crutches,” said the researchers. “They experienced less physiologic demand as well as discomfort and perceived less exertion.” The hands-free device offers an alternative for patients with lower leg injuries or illnesses, including foot and ankle fractures, calf muscle strain, Achilles tendon ruptures, and below-knee amputation. The researchers concluded that further research is needed to help establish clinical practice guidelines and educate providers to prescribe assistive devices “based on individual patient physiological and environmental needs.”

PHOTO: iWalkFree


Non-weight-bearing foot and ankle patients requiring crutches preferred using a new type of orthosis—a hands-free single crutch—to using standard axillary crutches, according to a study published in the October issue of Foot and Ankle International. Subjects in the randomized, controlled study, led by orthopedic foot and ankle surgeon Kevin D. Martin, DO, included 44 preoperative foot and ankle patients who were randomly assigned a device where a series of tests were carried out. The subjects subsequently tested the alternative device. The researchers found that 86 percent of subjects preferred the orthosis—an iWALK 2.0—to traditional crutches. While 68 percent of users reported axillary or hand pain using standard crutches, only 7 percent reported



VA Implements Tech for Early Detection of Diabetic Ulcers The U.S. Department of Veterans Affairs (VA) announced in November wide implementation of smart, connected foot mats that are designed for early detection of diabetic foot ulcers. In 2018, the VA reportedly treated more than 75,000 cases of diabetic foot ulcers across the country. Currently in use at 15 VA medical centers, the foot mats use thermographic monitoring, via a special camera that measures skin temperature, to identify the earliest stages of ulcers. This allows clinicians to develop plans for preventing added deterioration of a patient’s health, according to the VA, and could be instrumental in preventing limb loss among some veterans. VA’s use of the foot mat builds on a 2017 VA-led study at the Phoenix VA and the VA Greater Los Angeles Healthcare

Systems. Researchers found the in-home foot-temperature monitoring device was able to detect 97 percent of diabetic foot ulcers as early as five weeks before the onset of symptoms, with 86 percent of participants using the mat an average of three days per week. With more medical centers offering use of the mat, VA has continued to observe similar outcomes. “VA is uniquely positioned in its ability to test and quickly scale new solutions throughout its healthcare system, which can drastically change veteran lives,” said VA Secretary Robert Wilkie. VA announced that the mat will be available to veterans through their local Prevention of Amputations for Veterans Everywhere clinic providers. In addition, VA’s Veterans Health Administration Innovation Ecosystem is implementing a pilot program of the mats at VA facilities in the Southeast.


O&P Professionals Provide Care in Nepal

PHOTOS: Operation Namaste

Volunteers with O&P expertise travelled to Kathmandu, Nepal, in October 2019 to treat patients in need of orthotic and prosthetic intervention. Jeff Erenstone, CPO, founder of Operation Namaste, led a team that included prosthetists, a physical therapist, and an amputee peer counselor, in support of the organization’s mission of providing tools and support to O&P practitioners in low-income countries. During the trip, the team tested a new program to improve prosthetic care in developing countries by making low-cost prostheses more comfortable for amputees. They pioneered an economical method of locally fabricating silicone prosthetic liners using CAD-designed, 3D-printed molds, called the SILC Solutions method. The new liner solution seeks to make standard-sized silicone liners available to amputees in developing countries who previously did not have access, according to Erenstone. Operation Namaste partnered with the Range of Motion Project in this initiative. The organization has plans to finalize its prosthetic liners, then return to Nepal in spring 2020 to train practitioners on the process and Erenstone fits a deliver materials so they can continue to make liners new liner on an for their patients. “I’m really excited for this project to amputee in Nepal. take off in Nepal, and beyond,” said Erenstone. “Our goal here was to make liners affordable, accessible, Jeff Erenstone, CPO, mixes the silicone to make a and sustainable, and I think we are achieving that.” liner during an Operation Namaste trip to Nepal. O&P ALMANAC | JANUARY 2020




Record Demand for Tickets to Tokyo Games A record 3.1 million tickets were requested during the first 2020 Paralympic Games ticket lottery in December, according to the Tokyo Organizing Committee. The number is three times more than were requested during the same period for the London 2012 Paralympics, and it exceeds the 2.3 million tickets available for the Games. Approximately 600,000 tickets were purchased during the first Paralympic ticket lottery, with the next lottery scheduled for January 15-29. Tickets may only be purchased via authorized channels. “This is completely unprecedented and proves the huge interest there is for the Paralympics in Tokyo and Japan. It

shows we are on course for the best Paralympics yet,” said International Paralympic Committee President Andrew Parsons. “It will be hugely motivating for the Para athletes to compete in front of packed stadiums and to see how an entire country embraces the Paralympic Games in such a unique and fantastic way.” More than 4,200 athletes from 160 countries are expected to take part in the 2020 Paralympic Games, to be held August 25 to September 6 in Tokyo, according to Team USA. Information on the upcoming Games, including sport previews and news, is available on the Team USA microsite at TeamUSA.org/2020Paralympics.

Ronald Hertog

Daniel Wagner

PHOTO: Össur

PHOTO: Fillauer

PHOTO: Össur,Cecilie Graversen

Femita Ayanbeku


Athletes Travel to Dubai for 2019 World Para Athletics Championships



• Richard Whitehead (United Kingdom), Silver medal in 200-meter T61 • Femita Ayanbeku (United States), Bronze medal in the 200-meter T64 “We value our longstanding partnership with these athletes as their feedback helps our ongoing product development efforts for amputees of all activity levels,” said Jon Sigurdsson, president and chief executive officer of Össur. In addition, Ronald Hertog (Netherlands) won the Gold medal in the 200-meter T64 event at the 2019 World Para Athletics Championships wearing the Obsidian Sprint Blade from Fillauer. Hertog’s finish time was 22:20, which is a Dutch national record and personal record.

PHOTO: Össur, Bonzai Photography

Members of Team Össur travelled to Dubai in November to compete at the 2019 World Para Athletics Championships. Team Össur members earned four Gold medals, three Silver medals, and one bronze medal, in the following events: • Daniel Wagner (Denmark), Gold medal in 100-meter T63 and Silver medal in long jump T63 • Markus Rehm (Germany), Gold medal in long jump T64 • Ntando Mahlangu (Saudi Arabia), Gold medal in 200-meter T61 • Maya Nakanishi (Japan), Gold medal in long jump T64 • Marlene van Gansewinkel (Netherlands), Silver medal in long jump T64

Ntando Mahlangu



AOPA Coding and Billing Experts Head to Vegas Next Month O&P professionals will head to The Tropicana Las Vegas February 10-11 to take part in the first Coding & Billing Seminar of CODING & BILLING 2020. AOPA experts will provide timely information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group. Participants will earn 14 CEs while exploring the following subjects: • Prior authorization and other hot topics • Proof of delivery • Risk areas in an O&P practice • Successful appeal strategies and hints to avoid claim denials • How to code complex devices, including repairs and adjustments.


Attendees are responsible for making their own hotel reservations and should book by January 20 for the best rate. A daily resort fee of $18 plus tax will be charged. Visit www.aopanet.org for details.


Hanger LIVE To Feature Livestreamed Women in O&P Workshop The second installment in Hanger’s PowerUp series for women in O&P will be livestreamed from Hanger LIVE 2020 in Nashville on February 5. Personal branding expert and TEDx Lida Citroën speaker Lida Citroën will lead a workshop titled “Defining You: Building & Marketing Your Personal Brand,” geared toward both in-person attendees and women O&P professionals who join the livestream virtually. Citroën will discuss creating and driving a personal brand; discovering core values, voice, and purpose; and using LinkedIn, networking, and other tools to meaningfully impact their patients and peers. The workshop is open to all women in O&P and will be held 4:15 - 5:45 p.m. EST. A recording will be provided to those who register for playback, and CEUs will be available. Attendees can learn more and sign up to receive registration information at www.hanger.com/powerup. Hanger LIVE will be held at the Gaylord Opryland Hotel and Convention Center in Nashville, February 3-7. FAST FACT

More than 1,500 Certified Peer Visitors have been trained by the Amputee Coalition to meet with individuals living with limb loss and limb difference. More than 400 amputee support groups are registered with the Amputee Coalition. SOURCE: www.amputee-coalition.org




Joshua A. Bressler, COF, CDME, has been named survey process specialist for the Board of Certification/ Accreditation (BOC). A former member and officer of the BOC Board of Directors, Bressler’s background also includes sales experience at J&J Medical Inc. as well as work as a clinician for Ability Prosthetics & Orthotics Inc. and the Orthopedic Institute of Pennsylvania. In his new role at BOC, Bressler will manage the organization’s site surveys for businesses seeking BOC accreditation. He also will recruit, train, manage and evaluate BOC’s site surveyors, who are independently contracted. Wendy Garrett of Turner, Oregon, has been named to the Review Board of the Dralla Foundation, an organization founded by Allard USA President Peter Allard that awards grants to other nonprofits to improve life for individuals with physical challenges. Garrett, a gymnastics coach and marathon runner living with foot drop, will help assess applications from the perspective of someone with a mobility challenge. John Kenney, MURP, BOCO, is the 2019 recipient of the Jim Newberry Award for Extraordinary Service, awarded by the Board of Certification/Accreditation (BOC). James “Jim” L. Hewlett, BOCO, past Newberry John Kenney, Award winner and former chair of BOC’s MURP, BOCO Board of Directors, nominated Kenney. Kenney served on BOC’s Board of Directors for eight years, with roles including chair and vice chair, and was a member of BOC’s O&P Alliance team. He volunteered with the BOC test development cohort that crafted certification exam questions and helped write continuing education courses for orthotists, orthotic fitters, and therapists. He was former chair for Medicare’s Jurisdiction D Advisory Committee and volunteered on the board for the Center for Orthotics and Prosthetics Learning/Evidence-Based Practice. “John is a compassionate, intelligent leader who exemplifies the high level of dedication and support to BOC demonstrated by our dear friend Jim Newberry,” said Claudia Zacharias, MBA, CAE, BOC’s president and chief executive officer. “Our board was proud to select him for this honor.”

Kristleifur Kristjansson, MD, has been appointed executive vice president of research and development at Össur and will become a member of Össur's executive management team. Kristjansson joined Össur in 2012 and spent five years as medical officer before being named medical officer and vice president of clinical affairs two years ago. Kristjansson’s previous positions include co-founder and vice president of clinical affairs and collaborations at deCODE genetics ehf and co-founder and chief executive officer of Pediatric Services in Iceland.

In Memoriam David Alan Lewis, CO, an orthotist who practiced for many years in Minneapolis and St. Paul, Minnesota, passed away on Nov. 3, 2019, at the age of 53. Lewis was a graduate of the orthotic practitioner program at Century College in White Bear Lake, Minnesota, and spent most of his working years in the Twin Cities area. Lewis was a veteran of the U.S. Army Reserves, serving as a medic during Desert Storm. In 2006, he joined Minnesota Prosthetics and Orthotics, a division of Twin Cities Orthopedics, as a staff orthotist and was the clinical manager for the past several years. He is survived by his wife Patrice, and three children, Connor, Austin, and McKenna.


MAY 5–6









one unique product at a time SFX



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Off and Running Get ready for potential changes to reimbursement, healthcare delivery models, and educational opportunities in the new year Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 19 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.




T SEEMS LIKE JUST yesterday we

were discussing how the world would change when the calendar flipped to the year 2000. Would Y2K plunge the Earth into darkness and chaos? Would computers everywhere suddenly crash? What big changes would the new millennium bring? In hindsight, Jan. 1, 2000, turned out to be just another day. Technology continued to advance, and business carried on as usual. In the virtual blink of an eye, 20 years have passed, and it is now 2020. While the concerns may have evolved, 2020 is still a year of potential change as the O&P profession continues to advance. This month’s Reimbursement Page highlights some of the modifications and new programming that could impact your business, your patients, and your professional relationships in the coming year.

Medicare Prior Authorization

While there is no indication that Medicare prior authorization for orthotics and prosthetics is imminent, it may become a reality in 2020. The recently published 2020 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) final rule reduced the monetary threshold for potential inclusion in the Medicare prior authorization program from $1,000 to $500. This expanded the number of O&P procedure codes eligible for inclusion in competitive bidding from 82 codes to 226 codes and introduced the concept of prior authorization to 18


orthoses in addition to prostheses. To date, Medicare has chosen to implement prior authorization in a very calculated and limited fashion, implementing it only for power wheelchairs and pressure-reducing support surfaces. So far, Medicare prior authorization has proven relatively successful for both CMS and providers—so it is reasonable to assume that CMS will continue to explore product categories where prior authorization may be a viable option. Whether CMS chooses to implement Medicare prior authorization for orthotics and prosthetics in 2020 or later, it is a safe assumption that it will eventually become a reality. AOPA will continue to monitor CMS activity surrounding this issue and will work with CMS to ensure that prior authorization does not create unnecessary delays in the provision of clinically appropriate O&P services.

DMEPOS Competitive Bidding

Medicare competitive bidding for certain off-the-shelf spinal and knee orthoses will be implemented in 2021. While technically a year away, providers will experience significant developments in the competitive bidding process over the next 12 months. This summer, CMS will announce the single pricing amounts for the DMEPOS codes included in competitive bidding 2021. Winning bidders will be announced in the fall of 2020, and contracts will be implemented with an effective date of Jan. 1, 2021.


environment will require progressive thinking by all involved but is clearly the future of successful healthcare.

Getting Started in 2020

[ 2020 Essential Coding and Billing Seminars [ Medicare 101 Seminars [ AOPAversity Webinars

Educational Opportunities

AOPA is offering several new and improved educational opportunities this year. First, AOPA is updating its existing educational programs. The redesigned Essential Coding and Billing Seminar will be offered three times in 2020. The program provides two days of intense clinical and administrative education specific to orthotics and prosthetics. The curriculum is constantly evaluated and updated to ensure coverage of the issues of critical importance to seminar attendees. The 2020 Essential Coding and Billing Seminar programming will introduce new teaching concepts and reference materials that attendees will find extremely valuable—both during the seminar and as a resource once they return to their businesses. Second, AOPA is introducing an entirely new educational program in 2020. In response to member feedback regarding the need for a more basic course, AOPA has developed a Medicare 101-style seminar. This one-day program will be offered on March 30, 2020, in Chicago, convenient to O’Hare International Airport, and will provide a general overview of how the Medicare program works, the development and purpose of the L-code system, policy basics, documentation requirements, correct use of modifiers, and the appeals process. And third, AOPA will debut several clinical-based programs as part of

its monthly AOPAversity webinars. Once again, the new programming was designed in response to feedback from AOPA members requesting additional clinical education. Going forward, AOPA intends to provide at least three webinars in its monthly AOPAversity series that will contain content that is clinical in nature. AOPA is pursuing appropriate content and presenters for these sessions.

New Models for Patient Care

As healthcare evolves, the way it is delivered will continue to transform as well. O&P is not immune to the shifting dynamics, and 2020 will see significant changes to the way that O&P care is delivered. O&P care continues to become more vertically integrated as the lines between manufacturers, distributors, practitioners, and payors continue to blur. Healthcare in general has seen the development of accountable care organizations that use a shared risk model to achieve improved patient outcomes. Advancements in O&P research will help to improve patient outcomes, leading to better overall health and successful treatments. The best O&P care will be delivered by practitioners that are part of an integrated healthcare team that follows the patient through the entire treatment plan. This team extends beyond the clinical treatment team and includes insurers, manufacturers, and administrators. Working in this collaborative

Finally, it is important to look closely at some of the details regarding reimbursement that may have changed in the new year. For example, consider the Medicare deductibles for patients who remain covered under the traditional, feefor-service-based Medicare program. The 2020 Medicare Part B deductible of $198 must be met by the patient before Medicare will issue reimbursement to providers. While the Medicare deductible applies to all Medicarecovered treatment received by the patient, if it is early in the year the patient may not have met his or her annual deductible and may be responsible for all or part of your charges. Now also is a good time to review your contracts with private payors to evaluate any changes or coverage updates that may be tied to a new calendar year. In addition, you may want to review your usual and customary charges for the services you provide to make sure that they remain appropriate for your business. AOPA looks forward to continuing to serve its members efficiently and effectively in 2020. It is amazing how quickly 20 years have passed since the turn of the millennium. Keeping up with a rapidly changing healthcare environment is crucial to maintaining a successful business. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:




This Just In

A Second Look AOPA plans analysis and response to new OIG report on payments for orthoses



and Human Services’ Office of Inspector General (OIG) released a report on Oct. 30, 2019, that compared Medicare payments for orthoses to payments made by non-Medicare payors during the 2012-2015 time period. In the report, titled “Medicare Allowable Amounts for Certain Orthotic Devices Are Not Comparable,” OIG compared Medicare allowable amounts for certain back, knee, elbow, and wrist orthoses and recommended that CMS review the allowable amounts for 161 orthotic device codes for which Medicare and beneficiaries were found to have paid more than select non-Medicare payors, and that the allowable amounts be adjusted. AOPA was aware that the OIG was considering reviewing Medicare versus non-Medicare payments for orthoses, as the issue has been included in the OIG’s annual workplan since 2016. Upon first mention in the 2016 workplan, AOPA notified members of the potential report and commissioned a legal memo from McGuire Woods LLP that discussed the potential risks associated with charging Medicare more than a provider’s usual and customary charges. The potential impact of the OIG report will most likely take several years for CMS to implement through regulatory and legislative channels. AOPA understands the significant



ramifications that this report may have on its members, the O&P industry in general, and Medicare beneficiaries in particular—who may be forced to receive substandard orthotic care from unqualified, noncertified, or nonlicensed practitioners as a result of arbitrary and unreasonable reimbursement reductions. AOPA is performing a comprehensive analysis of the potential impact of the report, including individual analysis of each Healthcare Common Procedure Coding System code discussed in the report, the current and historic O&P provider market share of each code, and the potential impact a reimbursement reduction may have on each code. Based on this analysis, AOPA will aggressively pursue all strategies that will reduce the impact of the OIG report and ensure that AOPA members can continue to provide high-quality orthotic care to Medicare beneficiaries and receive equitable Medicare reimbursement. AOPA will continue to provide updates on this issue. The OIG report is available at https://oig.hhs.gov/oas/reports/ region5/51700033.pdf. Questions regarding this issue may be directed to Joseph McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.


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EW YEAR, NEW DECADE—and new business strategies. Over the

past 10 years, the O&P profession has seen the introduction of new technologies, increased collaboration with allied healthcare professionals, and the elevation of the profession as the MSPO degree has become a requirement. The industry also has experienced market upheaval, mergers and acquisitions, increasing documentation requirements, and a movement toward value-based care that has pushed O&P to incorporate outcome measures. It is against this backdrop that some O&P facilities are considering major shifts in their business processes and procedures in the coming year. But change management can be tricky—it can be difficult to determine just what changes need to be made, and challenging to convince employees of the need for change. Fortunately, there are many approaches to change management to choose from. One such strategy, pioneered by business management thought leader and Harvard Business School Professor John Kotter, recommends a multi-step approach to facilitate change. This award-winning methodology has been the subject of several books and articles and was adapted in his e-book, Eight Steps To Accelerate Change in Your Organization. Read on to learn the eight steps, along with advice from O&P leaders and consultants, on how to evolve your business in 2020 and beyond. O&P ALMANAC | JANUARY 2020



Create a Sense of Urgency.

reimbursement—and livelihood—was at stake if they did not revamp their processes to incorporate outcome measures.

staff plus Kannenberg and Russell Lundstrom, director of clinical research and services at Ottobock. They came up with a new “audit-resistant” process that requires staff members to administer seven standardized, validated, and internationally recognized tests at defined points in time: at the initial evaluation of the patient, one month postdelivery, and then every six months until the patient needs a new prosthesis. They also collaborated with several other patient-care facilities—all Ottobock clinical partners—to standardize data collections across all of those facilities. This new process became a requirement when treating all lower-limb patients, according to Sabolich.

The first step in implementing change in an organization, says Kotter, is to explain that a “big opportunity” is imminent. Building Build a Guiding Coalition. urgency is about concentrating on Kotter recommends assema window of opportunity that can bling a team that includes bring people together, “aligning them representatives of different levels and around a commonality, and clarifying functions—an “accountable, diverse where energy should be directed,” group bound by opportunity, strategy, according to Kotter. and action.” For example, many O&P profesIncluding several staff in the decisionals believe the need for thorough sion making and asking employees documentation, to prove to payors for their input can lead to successful the efficacy of O&P interchange management. When vention, is indeed urgent. selecting the change manage“The documentation ment team, don’t rely solely requirements that are on the current leadership being imposed upon or management, says Pam us, particularly for Lupo, an industry consulForm a Strategic Vision custom care,” have tant based in Michigan. and Initiatives. made it necessary to “Sometimes there are people A good strategic vision, revamp office procedures who are important to the according to Kotter, should be commuTeri Kuffel, JD to ensure that every step is success of the company” who nicable, desirable, flexible, feasible, documented and easily availcontribute a lot but do not have imaginable, and simple. able to submit to insurance companies, leadership titles. Lupo also suggests Start by meeting with your team says Teri Kuffel, JD, vice president including new staff members who and explaining the necessary change, at Arise Orthotics & Prosthetics in recently worked at other O&P compaand then solicit ideas for how to bring Minnesota. Facilities must implement nies, or even in other industries, who that change to life, suggests Perrone. changes to ensure they are organized can offer a different perspective. Be clear about what must change by and meticulous, with detailed guidIn O&P specifically, your guiding fully explaining the situation and by ance sheets and flowcharts to assist coalition may expand beyond your staff allowing staff to ask questions, she says. staff in their work, she says. members, says Joyce Perrone, director Information from dashboards and Scott Sabolich, CP, owner of of business development at De La key performance indicators should Sabolich Prosthetics & Research, Torre Orthotics & Prosthetics “lead the way” in forming noted a crucial need for change a few and an industry consultant. the vision and initiatives, years ago, when a massive audit in Just as hospitals and large suggests Lupo. “Some stakelate 2014 prompted him to shut down healthcare companies holders aren’t comfortable his operations for several weeks to are now run by business with trusting the data,” make institutional changes to become professionals and MBAs, she says, but it’s important an evidence-based practice. Sabolich some O&P facilities for the guiding coalition to sought to make his facility “more should employ or contract consider this information in Pam Lupo audit-proof, and to try to prove that with individuals with busiits planning. patients are at a particular activity ness expertise to oversee change Communication is key when level,” he explains. After working initiatives—and also to manage the sharing a strategic vision, advises closely with Ottobock—primarily with day-to-day operations going forward, Kuffel. “Explain the new process—but Andreas Kannenberg, PhD, executive suggests Perrone. It’s simply not also explain the ‘why,’” so that staff medical director, North America—“we possible for O&P owners or managers members understand that the changes decided to track, from the first visit on, to see a full schedule of patients and are being made, for example, to ensure seven different outcomes tests for each run all of the business aspects of a future reimbursement and to continue patient,” Sabolich explains. successful O&P facility, she says. to treat existing and future patients, Shutting down his facility During Sabolich’s change initiaKuffel says. “Explain that we have to created an extreme sense of urgency, tive, he relied heavily on a “coalition” amend the way we work to make sure convincing his staff that their made up of a few members of his own we get paid.” 24


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Having a clear-cut goal and plan Enable Action by can help jump-start the process and Removing Barriers. ensure employees comprehend what’s Discard inefficient manageexpected of them as they navigate ment practices and archaic norms so the transition. At Sabolich’s facility, employees are emboldened to “work he spent time communiacross boundaries and create real cating to staff members impact,” says Kotter. that collecting all seven In O&P specifically, there outcome measures may be barriers in the form when treating lowerof employees who fear limb patients is now switching processes from mandatory because “the way we’ve always it drives more favordone it.” Perrone explains able reimbursement. He that it’s easier to motivate Scott Sabolich, CP explained that doing so employees if O&P owners and leads to standardized information managers get to know the individual that can be used to support a patient’s staff members, and that they underneed for a specific device—and that stand each employee’s “triggers and data from all lower-limb patients coping mechanisms” during times of can be aggregated and analyzed on a change. “Some may become quiet and regular basis to provide evidence of the withdrawn, and others may become facility’s positive outcomes. belligerent,” Perrone says. “When you’re in a leadership role, you should Enlist a Volunteer Army. know what your employees are like,” Build excitement around the she says. Perrone advises listening “big opportunity” so that staff with empathy when speaking to these “want to” contribute, says Kotter. Give staff members. “There can be a lot employees “a choice to participate and going on. Sometimes you have to slow true permission to step up and act.” down and really understand where an Perrone suggests that O&P leaders individual is coming from,” she says. take a collaborative approach to “And recognize that the reason why enacting change at a facility, and one employee is resistant to change solicit their input in implementing may be a different reason than why change. “There will be another person is resistant to change.” resistance to change” if When transitioning his facility, staff is not part of the Sabolich encountered some solution at the outset, questions from both longshe says. Facility term clinicians and patients leaders should who were concerned about build excitement the extra time and effort so that employees required of capturing outcome want to be part of the measures. He was able to Joyce Perrone transformation. For “remove a barrier” by adding a example, says Perrone, if a staff member—a properly trained facility must change its procedures to medical assistant—tasked specifically comply with government or hospital with conducting the outcomes testing mandates, “everyone needs to underat each of his two facilities. “Because stand that change is happening and we have 12 prosthetists, it’s more work together to stay in alignment” efficient and more exact to have one so the facility moves in the right person do all the testing,” he explains. direction. The medical assistant ensures all tests O&P leaders also may look outside are administered in a standard way for the facility to build the “army.” It may be optimal data capture and comparison. helpful to share pending changes with Sabolich also upgraded data managereferral sources and patients who stand ment software for easier data input to benefit from the new procedures. and report generation. 26


Regarding patients who were reluctant to spend extra time at the facility, Sabolich says he explained that, just as primary-care physicians have nurses who take weight, height, blood pressure, and other intake data at their offices, O&P facilities now capture similar baseline data in the form of outcome measure testing. “This is normal medical care in 2020—why would our field be any different?”

Generate Short-Term Wins.

Identify big or small victories that help you move toward opportunity—these could include actions taken, a lesson learned, a process improved, or a new behavior demonstrated, according to Kotter. While communicating both the good and the bad along the pathway of change is important, it can be particularly motivating to commend staff members when they do something well, says Kuffel. These mini-victories can reinforce the steps being taken, and can remind staff members that the endgame is achievable. Depending on the change being undertaken at a particular facility, “wins” can be as simple as successfully fitting a patient with a new device, celebrating the collection of outcome measures from a specified number of patients, or even collecting reimbursement without delays. Each positive step can be shared with staff—and may even be shared outside the facility. Rewards for the wins don’t have to be expensive or monetary, says Lupo. Employees can be recognized for their contributions with a phone call from leadership or be given a longer lunch hour or comp day. She also encourages peer recognition programs, where employees look to point out their co-workers’ successful involvement.

“There were growing pains to get used to with this approach,” says Sabolich. “But you can either get on board now, or really struggle” when Medicare starts demanding some type of outcome studies and requiring preapproval—which he predicts will happen soon. “All other fields have to show documented track records” of their success, and O&P leaders “need to really push that what we do works for our patients,” Sabolich says. “If we can preach to payors that we can build a better widget, we can elevate ourselves to a higher level.”

Taking the First Step

Sustain Acceleration.

Build on the short-term wins as a foundation for larger challenges, and use them as momentum to further fuel the change. “Sometimes people move from task to task” and forget the larger goal in the busyness of their everyday professional lives, says Lupo. To ensure employees maintain their focus on the goal, leadership and management should maintain their focus and lead by example. Sabolich has built on the initial collection of lower-limb prosthetic outcomes by aggregating all of the outcome measures and publishing studies with the data collected at his facility since January of 2015. So far, data from more than 3,000 patients has been included in the studies, which confirm that the extra work is paying off in terms of positive patient outcomes. In addition, Sabolich brings in new residents from the Baylor College O&P program on a regular basis, which injects a fresh perspective and helps motivate staff in their data collection efforts. “All the Baylor residents love this; they love helping out with a progressive, growing research study,” says Sabolich. “They get it. They see the appreciable improvements that we can document. It’s quite exciting.” “You should absolutely take advantage of fresh minds by bringing in O&P

students and residents,” adds Kuffel, who says Arise regularly invites O&P students to work there. “They are smart and process-oriented. When fresh minds come in, it’s fascinating to see their views—doing so helps us avoid legacy mindsets.”

Institute Change.

Define and communicate the connections between new behaviors and the organization’s success. “Culture changes after you have successfully altered people’s actions, connecting the dots between new behaviors and better performance,” says Kotter. While there were challenges along the way at Sabolich’s facility, “I can now say I have retrospective studies showing positive outcomes” for particular patients using specific devices, he says. In the future, he and Ottobock, with the assistance of Kannenberg, plan to present this information to some of the large commercial payors and request to be reimbursed at rates equivalent to or above Medicare rates, hopefully resulting in “much more successful reimbursement.” His entire organization is proud that their work in implementing change has paid off in the form of a progressive facility that is well-prepared for 2020 and the future requirements of value-based healthcare.

Whether your facility needs to become a more evidence-based practice, or you are seeking other changes to bolster your business for the future, following these steps can help you start your journey and effect positive change. Of course, not every new idea is a good one, so analyze whether the time is right for change at your particular facility. “Don’t change just for the sake of change,” says Perrone. She suggests conducting a thorough analysis. “Get the smartest people in the room and study whether change is advantageous,” she says. “Sit down and have serious, logistical conversations— and include leaders, team leaders, representatives from the front lines, and people who aren’t just cheerleaders.” She also suggests posting anonymous surveys online to learn staff’s honest opinions and suggestions. “When you’re talking about major changes, have collaborative discussions to decide if change is necessary.” And if you do decide that the time is right, “be ready to fail as you’re facilitating change,” says Kuffel. It’s an inevitable and necessary part of the process. In the long run, your facility will be better for the learning experiences along the way. Most importantly, “be respectful of boundaries, and be kind,” says Kuffel. “Effective leaders are kind people, and they explain the ‘why,’— so that we can help patients walk and work. Never forget.” O&P ALMANAC | JANUARY 2020



Proving Our Worth As we enter a new decade, EBP is expected to be one of the most important changes in healthcare. Here’s why it matters to O&P.

y In the coming years, more facilities will be collecting outcome measures and getting involved in studies that demonstrate the value of specific O&P interventions— information that will be of interest as payors seek data to support their coverage decisions. y New clinicians, armed with MSPO degrees, are well-versed in O&P research, having learned about outcome measures and research techniques during school. Some of these practitioners bring their skills to O&P facilities and help facilitate research initiatives or forge collaborations with research institutions. y Organizations such as AOPA, in conjunction with the Center for Orthotic and Prosthetic Learning Outcomes/Evidenced-Based Practice, and the Orthotic and Prosthetic Education and Research Foundation are providing muchneeded funding for O&P research





NEED TO KNOW projects, such as pilot studies that help researchers win grants from larger federal funding institutions. y O&P professionals who have not traditionally been involved in O&P research will likely be pulled into it as outcome measures become an increasingly important part of practice. Newcomers can get acquainted with the world of O&P research by reading journal articles and assisting with recruiting potential subjects for studies. y The healthcare community will soon learn more about a national O&P research project, the recently launched Limb Loss and Preservation Registry (LLPR). The LLPR will provide a home for outcome measures data and other data points related to O&P—beginning with hospital-level data but expanding to include private practices within the next few years.

professionals have been gearing up to provide more proof of the efficacy of their interventions—by collecting outcome measures and by contributing to the O&P research well. “Since the turn of the century, there has been an increased emphasis on EBP [evidence-based practice] in healthcare. As healthcare service providers, orthotists and prosthetists are expected to be providing their care within the framework of EBP,” explains Shane Wurdeman, PhD, CP, FAAOP(D), director of clinical research, Hanger Clinic Department of Clinical & Scientific Affairs. Evidence-based practice, according to Wurdeman, comprises the intersection of three elements originally defined in 2000 in Evidence-Based Medicine: How To Practice and Teach EBM by David Sackett et al.: clinical expertise, patient values, and best research evidence. “Research removes a lot of the ‘trial-and-error’ from clinical care by providing guidelines and working toward more effective practice,” explains Wurdeman. “Trialand-error processes can be very

















Shane Wurdeman, PhD, CP, FAAOP(D)



stressful and anxiety-provoking for patients as they wonder if there is a solution out there that will work for them.” And trial-and-error methods may create greater practice variability. “This can also create anxiety for patients as they encounter other solutions that may have worked on a different patient, and wonder if their care plan was best for them.”






This movement away from trialand-error is attractive to O&P’s payor partners, adds Wurdeman, as their OPTION 2 OPTION 2 members/patients “end up more satisfied with better outcomes while to put good evidence out there that lot of patients, and we have proof that eliminating wasteful, ineffective informs what we do.” cranial remolding works,” she explains. attempts” to help patients. “We all know, clinically, that certain Some clinicians believe orthoses have things work—but if we don’t have superior outcomes compared to repoAggregating Evidence data to back it up,” then payors may sitioning techniques, but research is SHAPING reimbursement THE SHAPING THE needed to convinceSHAPING THE SHAPING THE In 2020, awareness of research in O&P, choose not to provide payors—research FUTURE OF O&P FUTURE OF O&P FUTURE OF O&P FUTURE OF O&P and the value that orthotists and prosfor devices they view as more costly she is currently conducting, thanks in thetists place in research, are at all-time than alternatives, says Tiffany Graham, part to a grant from AOPA’s Orthotics highs. Wurdeman, who was recently MSPO, CPO, LPO, FAAOP, a practicing 2020 funding initiative. “We have an named chair of AOPA’s Research Pillar, clinician and assistant professor at expensive device and expensive treatnotes that the “research question” in the University of Texas Southwestern ment [in the form of cranial remolding the profession has shifted from, “Is Medical Center. orthoses], but we don’t have proof that research valuable?” to, “How can we Graham points to the example this treatment is superior,” she says. do more research?” of cranial remolding orthoses as an She believes her research will demonarea where research will make an strate that cranial remolding orthoses impact for patients. “We have proof will result in better patient outcomes— that repositioning is successful in a thus, worth the investment by payors. Brian Hafner, PhD

prosthetics prosthetics

2020 2020

Brian Hafner, PhD, a professor at the University of Washington (UW) and a member of the External Collaborative Panel for the Limb Loss and Preservation Registry, agrees that O&P research is receiving increasingly more attention in recent years, as payors seek data to support their coverage decisions. “Payors look to our body of evidence as they set the rules regarding which devices to cover for which types of patients,” Hafner explains. “We, as a profession, will be in a much better position if we are able

orthotics orthotics

2020 2020



Finding Funding The growth of opportunities to conduct O&P research in recent years can be attributed in part to the support of the Orthotic and Prosthetic Education and Research Foundation (OPERF) and AOPA, working in conjunction with the Center for Orthotic and Prosthetic Learning Outcomes/Evidenced-Based Practice (COPL). Over the past 10 years, AOPA/ COPL and OPERF “have delivered many different sizes and types of grants, at different levels,” Hafner says. OPERF offers grants designed for O&P residents as well as fellowships of $5,000 per year for doctorial and master’s students, plus $25,000 small grant awards for junior investigators, according to Hafner.

Who’s Conducting the Research?

Twenty years ago, much of the O&P research was carried out by manufacturers, says Hafner. While that work was extremely important to the development of new devices and approaches to care, “there’s also been a recognition that we need independent research”— for example, studies that include not just one microprocessor-controlled knee developed by a single company, and studies that can investigate and compare different types of microprocessor-controlled knees, Hafner explains. He cites the U.S. Department of Defense’s Orthotics and Prosthetics Outcomes Research Program, which was established to support this type of research. Fortunately, research has become part of the education at most of the O&P schools. The 2012 requirement of the master’s degree for O&P clinicians has resulted in more young people completing research projects as part of the curriculum and becoming familiar with outcome measures and research techniques—skills they carry into their careers, says Graham. “And the overall quality of research is improving,” she says. 30


Tiffany Graham, MSPO, CPO, LPO, FAAOP

Hafner agrees. “We’re now training the next generation of researchers, educators, and program leaders.” He points to the increase of O&P-trained PhDs working in the field: “We’re not relying on individuals in other disciplines to conduct O&P research,” says Hafner. “Researchers that are trained as prosthetists/orthotists have direct experience working with patients,” and they may better understand the challenges faced by O&P patients. Individual facilities—both large and small—also are doing their part by collecting patient outcome measures that may be used in future studies. But corralling this data may require special skills, says Graham, such as statistical and analytical expertise. For her cranial remolding orthosis study, she has used part of her funding to engage the services of a biostatistician—a move that has been “instrumental” in her investigation.

COPL, in conjunction with AOPA, has awarded $15,000 and $30,000 grants, in specific areas of O&P. “These are great seed grants that can result in pilot data” that is generally required by the federal organizations like National Institutes of Health and DoD, which award much larger grants for much larger studies, explains Hafner. Awards from AOPA/COPL and OPERF “also help researchers develop new projects and build a track record, or history of funding—so it’s more likely that reviewers at the larger funding organizations” will have confidence that applicants will be capable of tackling higher-level projects. For these reasons, says Hafner, “awards provided by OPERF and COPL are critical to developing the ‘next gen’ of O&P professionals. “Both organizations have great success stories, where investigators have received pilot funding and used it to obtain subsequent research funding,” Hafner continues. AOPA/ COPL funding, for example, has been key to a project underway to develop a standardized outcome measure for lower-limb orthosis users. One of Hafner’s PhD students, Geoff Balkman, is using pilot funding from AOPA/


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The O&P Research Project


Kicking off the new decade is one of the most ambitious national O&P research projects ever undertaken: the Limb Loss and Preservation Registry (LLPR). The LLPR, in the initial stages of development, is a national program to improve the quality, safety, effectiveness, and cost of limb loss treatment and limb loss preservation. While the earliest stages of the LLPR were funded by seed money Kenton Kaufman, from AOPA’s Prosthetics 2020 PhD, PE program, says Ashlie White, AOPA’s director of strategic alliances, the project has grown to become a “multistakeholder model” and a national goal. Today, the prime contractor leading the registry initiative is the Mayo Clinic, with funding provided by DoD and National Institutes of Health, and in partnership with AOPA and the American Academy of Orthotists and Prosthetists. Kenton Kaufman, PhD, PE, the Mayo Clinic’s principal investigator, leads the project, along with a team of subject matter experts. The LLPR’s primary value is to enhance treatment and care for limb preservation and patients with limb loss, according to the project’s official statement of purpose. The registry has been designed to accomplish several additional goals: create a unified voice for all stakeholders, identify and support under-served populations, drive enhanced reimbursements, validate design concepts, generate real-time outcomes, and provide data points for evidence-based medicine and aftercare. Once the registry moves into advanced stages, it will provide a home for outcome measures data and other data points related to O&P. “We are excited to begin to see the Limb Loss Registry start to populate with data. Initially this will be hospital-level data,” explains Shane Wurdeman, PhD, CP, FAAOP(D), director of clinical research, Hanger Clinic Department of Clinical & Scientific Affairs, and chair of AOPA’s Research Pillar. “Hopefully through this next year, a clear workflow is established for O&P clinicians to be able to effectively begin contributing to its advancement.” Five years from now, the LLPR data set will ideally be available to help patients make decisions based on their specific circumstances, according to the LLPR statement of purpose. “The data analytics will forecast probabilities on what is possible given a patient’s functional status. [It] will provide education and generate knowledge and discovery.”



COPL to build a self-report survey instrument for lower-limb orthotics, similar to the PLUS-M developed by Hafner’s team at UW for prosthetics. In 2018, Balkman received a $15,000 grant from AOPA/COPL to develop candidate questions for the orthotics measure based on an extensive literature review, focus groups with orthosis users, and feedback from a multidisciplinary advisory panel. AOPA awarded him additional funds in 2019 to move the work forward and produce an instrument the orthotics field can use to advance measurement of important patient outcomes. “The extensive research that went into developing PLUS-M is one reason that it has been so readily adopted by clinicians, researchers, and manufacturers in our field,” says Hafner. He is confident that Balkman’s work can lead to a similar core outcome measure for orthotics. AOPA, for its part, has recently increased its contributions toward grants. “AOPA recognizes its position as a leader in advancing the O&P profession, which in this case means continuing to invest and build programs that advance EBP for O&P,” says Wurdeman. “The investment from AOPA in research these past few years has helped to further grow the evidence base in O&P directly and indirectly”—direct growth through studies that have subsequently advanced to publication and now provide useful information, as well as indirect growth by nurturing and fostering the growth of the next wave of researchers, “who may not have otherwise taken on a project in O&P due to difficulty with securing funds.”

Ashlie White

This year, the AOPA Board of Directors has allocated over $240,000 for FY 2020 for research and quality improvement, according to Ashlie White, AOPA’s director of strategic alliances. Part of that

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money will be distributed in COPL grants—with 2020 marking the most significant amount AOPA has allocated toward COPL grants, at $105,000, says White. AOPA also has lobbied for the past several years for money from the Congressionally Directed Medical Research Program (CDRMP) to be allocated to O&P, to improve clinical efficacy and quality-of-life for O&P patients. AOPA has helped secure $10 million over the past several cycles in CDRMP funding, with a 50 percent increase to $15 million in the budget for FY 2020.

This very characteristic, however, can quickly create an echo chamber where we all are marching to the beat of our own drum, but fail to realize others within healthcare are playing a different soundtrack,” he explains. The current structure of the MAB “helps us to be more aware of what our colleagues in healthcare outside of O&P are thinking.” Additionally, Wurdeman says it’s not uncommon for issues to impact larger groups within healthcare before they become an issue for O&P. “The MAB can help us be aware of these issues to position AOPA to be proactive.”

AOPA’s research efforts have recently evolved from a focus on the Orthotics 2020 and Prosthetics 2020 initiatives to a broader-scale “Research Pillar” that is guided by a Medical Advisory Board (MAB). “Orthotics 2020 and Prosthetics 2020 helped AOPA establish a modality for increasing research funding within O&P,” says White. “Those programs have matured and developed into the current research structure,” with a Research Committee as well as the MAB. Reaching outside the O&P arena to include allied healthcare professionals, such as surgeons and physicians, on the MAB is an important step, says Wurdeman. “I love the fact that O&P is such a small profession, which makes it very easy to network with others in this field.

Join the Movement



O&P professionals who have not traditionally been involved in O&P research will likely be pulled into it as outcome measures become an increasingly important part of practice. But clinicians without a research background can get involved in other ways—for the good of the profession and O&P patients. “Often clinicians wrongly interpret the message of ‘getting involved with research’ to mean they need to start formulating hypotheses and designing studies, which is just not the case,” says Wurdeman. Newcomers can dip their feet in the pool by reading journal articles and becoming more aware of the research that’s out there, says Wurdeman. “At first you may be overwhelmed when

you are reading about concepts or scientific terms that you are unfamiliar with,” he says. “This is likely a good exercise in understanding how patients feel when we start telling them about stance control and energy storage and return and other common vernacular. But just as patients slowly capture more and more of the terminology, you will start to understand more concepts and terms as well.” Wurdeman also notes that clinicians who are approached to help with a project should strongly consider offering their clinical expertise. “In many cases, the most helpful effort a clinician can provide is to assist with recruiting potential subjects. However, this requires more than just posting a flyer in your clinic,” he says. Patients will want to know details about potential studies they are asked to participate in, so clinicians should vet the projects before recruiting patients. “If you don’t understand all the elements of the study, push the researcher to explain,” he says. “It is the researcher’s responsibility to explain the study in a way that makes sense to clinicians and potential subjects. If they cannot do this, then that is not a study you want to support. If it is a study you want to support, then engage your patients to help them fully understand the study, so they can truly make an informed decision on participating.” Wurdeman encourages clinicians to support AOPA and other O&P organizations that are advancing research, and to attend national and regional meetings. “A key element of research is dissemination of findings,” he says, and it’s important “that we continue to provide strong platforms for our researchers to be able to disseminate their findings. This bodes very well for their continued advancement of studies and securing future funding.” Efforts such as this will help advance O&P research throughout the next decade. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.



Supplier Standard Compliance Tips Know the 30 Supplier Standards—and how to prevent errors when billing

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 39. to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.



The National Supplier Clearinghouse (NSC) is the single organizational entity responsible for issuing or revoking Medicare supplier billing privileges for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). NSC was recently asked to share with the O&P community some common errors and mistakes that we encounter on a regular basis. By sharing this information, we hope to help prevent some of these errors from happening in the future, in turn saving time for everyone. Please note that the information provided in this article is current as of November 2019.

Surety Bonds







Bonds are required to obtain and maintain Medicare billing privileges, per a CMS directive published on Dec. 29, 2008. So, what are DMEPOS surety bonds? A DMEPOS surety bond is a bond issued by an entity (the surety) guaranteeing that a DMEPOS supplier will fulfill an obligation or series of obligations to a third party (the Medicare program). If the obligation is not met, the third party will recover its losses via the bond. Surety bonds are required whether the DMEPOS supplier is a nonparticipating or participating provider. Note, however, that certain suppliers may qualify for exemption. The exemption requirement can be found in its entirety in 42 CFR 424.57(d)(15). Here are some applicable exemptions for suppliers that deal with orthotics and prosthetics: “State-licensed orthotic and prosthetic personnel in private practice making custom-made orthotics and

prosthetics are exempted from the surety bond requirement if: (1) the business is solely owned and operated by the orthotic and prosthetic personnel, and (2) the business is only billing for orthotics, prosthetics, and supplies.”


Supplier Standard 1 mandates that “if a state requires licensure to furnish certain items or services, a DMEPOS supplier must be licensed to provide the item or service.” NSC provides a Licensure Directory to assist suppliers with changes and updates (available at https://www.palmettogba.com/licensure/ licdirec.nsf/NSCLicensureMap_N). Note, however, that the directory is meant only as a guide. It is the responsibility of the supplier to ensure compliance with state licensure requirements. Additionally, suppliers can conveniently utilize the NSC Web Form submission option to submit licenses.


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NSC Supplier Standards Below is an abbreviated version of the Supplier Standards every Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier must meet in order to obtain and retain billing privileges. These standards, in their entirety, are listed in 42 CFR 424.57(c).


A supplier must be in compliance with all applicable federal and state licensure and regulatory requirements.


A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.






A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable state law and repair or replace free of charge Medicare-covered items that are under warranty.


A supplier must maintain a physical facility on an appropriate site and must maintain a visible sign with posted hours of operation. The location must be accessible to the public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.

An authorized individual (one whose signature is binding) must sign the enrollment application for billing privileges.

A supplier must fill orders from its own inventory or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, from any state healthcare programs, or from any other federal procurement or nonprocurement programs. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment and inform them of the purchase option for capped rental equipment.*



A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards.


A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll-free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service, or cell phone during posted business hours is prohibited.

10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance also must cover product liability and completed operations.


A supplier is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition, see 42 CFR 424.57(c)(11).


A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare-covered items and maintain proof of delivery and beneficiary instruction.

13. A supplier must answer questions and respond to complaints of beneficiaries and maintain documentation of such contacts.


A supplier must maintain and replace at no charge or repair directly or through a service contract with another company Medicare-covered items it has rented to beneficiaries.

15. A supplier must accept returns

of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.

16. A supplier must disclose these

standards to each beneficiary it supplies a Medicare-covered item.


A supplier must disclose any person having ownership, financial, or control interest in the supplier.


Web Tool

24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.

25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.

26. A supplier must meet the 18. A supplier must not convey

or reassign a supplier number (i.e., the supplier may not sell or allow another entity to use its Medicare billing number).

19. A supplier must have a complaint

resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.

20. Complaint records must include

the name, address, telephone number, and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.


A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.

22. All suppliers must be accredited

by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals).

23. All suppliers must notify their

accreditation organization when a new DMEPOS location is opened.

surety bond requirements specified in 42 CFR 424.57(c).

27. A supplier must obtain

oxygen from a state-licensed oxygen provider.

28. A supplier must maintain ordering and referring documentation consistent with provisions found in 42 CFR 424.516(f).

29. A supplier is prohibited

from sharing a practice location with other Medicare providers and suppliers.

30. A supplier must remain open

to the public for a minimum of 30 hours per week, except physicians (as defined in section 1848 (j)(3) of the Act) or physical and occupational therapists or a DMEPOS supplier working with custom-made orthotics and prosthetics.

* Although CMS has revised payment rules for capped rental items, Supplier Standard 5 still applies for inexpensive and routinely purchased items that do not fall into the capped rental category and applicable capped rental items (i.e., complex rehabilitative power wheelchairs and parental/enteral pumps, etc.).

NSC provides an NSC Web Form submission option on its website, available at www4.palmettogba. com/NSC_WebForm_Submission/. This tool allows suppliers to respond to requests from NSC by uploading required documents. Items that can be uploaded include appeals, certificates of insurance, licenses, National Provider Identifier letters, responses to Stabilization and Crisis Unit requests, and surety bonds. Providers also will be able to respond to the Competitive Bidding Implementation Contractor Preliminary Bid Evaluation directly from the web form tool. This option reduces mailing time as well as the paper burden for submitting required documents. This tool does not allow for CMS-855S applications or any change to information, and you may only submit documentation if you have a DMEPOS Provider Transaction Access Number (active or revoked). For additional information, check the NSC website at www. palmettogba.com/palmetto/providers. nsf/DocsCatHome/National%20 Supplier%20Clearinghouse . To access the most up-to-date information delivered straight to your inbox, sign up for NSC listservs at https:// www.palmettogba.com/registration.nsf/ Push%2BMail%2BArchive%2BHome? OpenForm. If you have additional questions regarding enrollment, NSC is happy to assist; email NSC directly at medicare.nsc@palmettogba.com. Malisa Rogan is senior provider relations representative at the National Supplier Clearinghouse. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:





Elevating the Human Condition Matthew “Matty” Major, PhD, strives to make a difference not only for O&P patients, but for all people experiencing inequalities

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.



research philosophy that drives Matthew “Matty” Major, PhD. As a research health scientist at the Jesse Brown VA Medical Center and assistant professor at the Northwestern University Feinberg School of Medicine, Major is responsible for many important studies designed to answer O&P-related clinical questions. Major adheres to a research framework that centers around optimizing interventions to maximize outcomes. This framework involves components

of shared decision making between patients and the rehabilitation team, assistive device design by rehabilitation engineers and clinicians, principles of clinical fitting of assistive technology, and therapeutic interventions performed by specialized therapists. “A foundation of this approach is establishing the link between assistive device design properties and user performance—for example, endurance, comfort, and stability,” says Major. Embracing this approach, Major points to his work on a study to optimize prosthesis mechanical function according to specific patient characteristics, such as stature, weight, and desired activity. “This type of approach embodies the concept of personalized intervention, which I believe will further improve our ability to fit the most appropriate technology to support longterm rehabilitation outcomes,” he says.

The Human Connection



PHOTO: Matthew "Matty" Major

Matthew "Matty" Major, PhD, gives many scientific presentations in his role as an assistant professor at Northwestern University's Feinberg School of Medicine.

Major traces his initial interest in O&P to his time as an engineering student at the University of Illinois at Urbana. While there, he attended a lecture from the founder of Engineers Without Borders, who discussed the organization’s guiding principle of practicing engineering “for the good and welfare of humankind.”


engineering design and human performance,” Major says. “In O&P, scientists can observe the direct impact of their work, either through the design of new assistive devices, developing better therapies, or informing clinical guidelines to elevate evidence-based practice.”

Ongoing Investigations

Major, center, travelled to Kobe, Japan, to take part in the 17th World Congress of the International Society for prosthetics and Orthotics last October. PHOTO: Matthew "Matty" Major

“This simple message struck a deep chord with me, and I concluded that I wanted to employ my engineering skills in a field that would have a direct impact on the human condition,” Major recalls. “I was quickly seduced by the field of biomechanics since … it was a discipline that applied engineering

principles to studying the human body.” Major focused his graduate studies on biomedical engineering, earning his PhD from the University of Salford Manchester in the United Kingdom. Along the way, he learned more about orthotics and prosthetics, which “represented the perfect marriage between

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Today, Major’s primary appointment is as a research scientist for the U.S. Department of Veterans Affairs at the Jesse Brown VA Medical Center, where he focuses his investigations into clinical biomechanics and rehabilitation engineering. His research program concentrates on designing improved assessment techniques, therapeutic interventions, and assistive devices to maximize clinical outcomes for individuals with musculoskeletal or neurological impairments. “My research takes a user-centered approach to intervention design and relies on contributions from a multidisciplinary team including bioengineers, prosthetists/orthotists, physicians, and therapists,” says Major.

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Major spoke on “Outcomes and Evidence-Based Practice in O&P” during the AOPA National Assembly last September.



unilateral upper limb-loss, Major’s team has found that this increased fall likelihood may be related to these individuals’ unique walking mechanics that is associated with their arm movement. Another project aims to better understand the effects of heel-height adjustable prostheses and different footwear on the mechanical function of the prosthesis system and walking biomechanics of women with lower-limb loss. “I am particularly excited by this project, as women with amputation are markedly underserved in prosthetics research, and there is a paucity of information available to guide prescription of prosthetic feet for women, despite their unique rehabilitation needs and challenges,” Major says. Other noteworthy investigations involve the design and evaluation of low-cost, tunable prosthetic feet and knees for developing countries, novel integrative therapies to enhance balance confidence in lower-limb prosthesis users, and development of new technology for vacuum-assisted suspension of prosthetic sockets.

Evidence-Based O&P

While Major has seen progress on the O&P research front in recent years, he believes there is still a lot of ground to be covered to identify those individual patient factors that are responsible for successful rehabilitation. “Investigators must not lose sight of the fact that one of

PHOTO: Matthew "Matty" Major

He also is affiliated with the Northwestern University ProstheticsOrthotics Center, where he is manager of the Prosthetics and Orthotics Rehabilitation Technology Assessment Laboratory and an instructor for the Master’s in Prosthetics and Orthotics clinical education program. He teaches courses on materials science, outcome measure assessment, clinical research, and biomechanics of movement. Major is involved in several ongoing projects. One of his studies explores the sensorimotor factors underlying postural control in older lower-limb prosthesis users. “We recognize that the likelihood of experiencing a fall increases with progressing age, and individuals who use leg prostheses already demonstrate a high prevalence of falls,” he explains. His recent findings suggest that factors such as limb sensitivity and muscle strength may be uniquely associated with fall likelihood, and he and his team are conducting experiments to observe responses of prosthesis users when recovering from a sudden trip during walking. A second line of investigation focuses on the falls and balance of individuals with upper-limb loss, where he has found that “individuals with arm amputation or upper-limb deficiency experience a fall prevalence that is near equivalent to those with lower-limb loss.” Through studies on persons with

the most critical components to determining the results of an intervention is the patient,” he says. “We can continue to design more advanced rehabilitation technology, but the intended beneficiary of these interventions will ultimately determine its success in practice.” Because there are countless physical and psychological factors that determine rehabilitation outcomes, “we need to consider the patient from a holistic approach and so must encourage research that integrates efforts from a multidisciplinary team,” he says. Major also notes that the findings of O&P research can be limited by small convenience samples of heterogeneous makeup. He would like to see the clinical and scientific communities address this issue and expand sample sizes—and hence the generalizability of O&P research. Ultimately, research will be able to inform clinical guidelines for personalized interventions according to individual patient factors. “Given that prostheses and orthoses are recommended according to medical necessity, it is important to report on the suggested health and function benefits of O&P interventions,” says Major. Toward this end, a primary track of Major’s research sets out to define the relationships between O&P device designs and clinical outcomes. “I am essentially asking the question: Which orthosis or prosthesis design features will maximize relevant outcomes such as endurance, comfort, and stability? Consequently, we can build a substantial body of literature to strongly suggest the advantages of this or that system on some functional impairment.” If research can help with this process, “clinicians are in a stronger position to justify their recommendations.” In addition, part of Major’s research is concerned with refining the means by which patient rehabilitation potential and functional capabilities are classified, as well as how prosthesis components are categorized according to their mechanical function. “This research directly addresses how we can improve the K-level and L-code systems, both driving influences in O&P practice,” he explains.


Major wants to provide clinicians with the tools to make clinical decisions that are as informed as possible , and he encourages clinicians as well as O&P students to engage with the scientific literature, which may lead to their becoming involved in research projects.

Community Outreach

While Major devotes his professional life to advancing the O&P profession and the interest of patients, he spends many of his off hours working to advance the standard of living for underserved populations in Chicago. He has been involved in social justice work and community service for over a decade, and currently chairs a social justice committee.

Looking ahead, Major hopes to help answer many of the unanswered questions in O&P. Future projects will address how new treatment modalities and rehabilitation technology can be implemented into clinical practice, he predicts. “I think we have made tremendous progress in improving O&P interventions, and will continue to do so with advancements in robotics and materials, but the means by which

to effectively translate these developments into practice is essential to their influence on clinical care. “It is not sufficient to simply generate new knowledge or develop new technology that has the potential to improve patients’ quality of life if these discoveries never translate from the lab to clinical practice,” Major says. “This translation is one of the biggest challenges of O&P research.”

Notable Works Matthew “Matty” Major, PhD, is the author or co-author of dozens of peer-reviewed articles. Some of his most impactful published contributions include the following: • Major, M.J., Fey, N.P. “Considering Passive Mechanical Properties and Patient User Motor Performance in Lower-Limb Prosthesis Design Optimization To Enhance Rehabilitation Outcomes.” Phys Ther Rev. 2017; July 17, 22(3-4):1-15. doi: 10.1080/10833196.2017.1346033. • Major, M.J. “Fall Prevalence and Contributors to the Likelihood of Falling in Persons With Upper Limb Loss.” Phys Ther. 2019; April 1, 99(4):377-387. doi: 10.1093/ptj/pzy156. • Major, M.J., McConn, S.M., Zavaleta, J.L., Stine, R., Gard, S.A. “Effects of Upper Limb Loss and Prosthesis Use on Proactive Mechanisms of Locomotor Stability.” J Electromyogr Kinesiol. 2019; Oct., 48:145-151. doi: 10.1016/j.jelekin.2019.07.012.

PHOTO: Matthew "Matty" Major

“My organization works to address racial, economic, criminal, and education inequalities in Chicago and Illinois more broadly,” he explains. “I would say that the passion I have for addressing injustice is also related to my desire to work in the field of O&P: pursuing efforts to elevate the human condition.” The organization operates weekly soup kitchens, clothing and food drives, and legislative advocacy efforts, and drives restorative justice criminal court volunteering and participation in rehabilitation/reconciliation training, among other projects. “Ultimately, my committee works to address social inequality through a series of diverse but cohesive initiatives that embody the concept of ‘proximity,’ where one must know and be near their neighbors who share the burden of injustice. This work forms an important part of my life and is equally fulfilling as my research.”

• Major, M.J., Stine, R., Shirvaikar, T., Gard, S.A. “Effects of Upper Limb Loss or Absence and Prosthesis Use on Postural Control of Standing Balance.” Am J Phys Med Rehabil. 2019, Oct. 25. doi: 10.1097/PHM.0000000000001339. • Borrenpohl, D., Kaluf, B., Major, M.J. “Survey of U.S. Practitioners on the Validity of the Medicare Functional Classification Level System and Utility of Clinical Outcome Measures for Aiding K-Level Assignment.” Arch Phys Med Rehabil. 2016; July, 97(7):1053-63. doi: 10.1016/j.apmr.2016.02.024. • Dillon, M.P., Major, M.J., Kaluf, B., Balasanov, Y., Fatone, S. “Predict the Medicare Functional Classification Level (K Level) Using the Amputee Mobility Predictor in People With Unilateral Transfemoral and Transtibial Amputation: A Pilot Study.” Prosthet Orthot Int. 2018; April, 42(2):191-197. doi: 10.1177/0309364617706748. • Major, M.J., Scham, J., Orendurff, M. “The Effects of Common Footwear on Stance-Phase Mechanical Properties of the Prosthetic Foot-Shoe System.” Prosthet Orthot Int. 2018; April, 42(2):198-207. doi: 10.1177/0309364617706749.




Friddle’s Orthopedic Appliances

Tradition and Innovation Manufacturing company builds on its past to fabricate for the future


ACHEL FRIDDLE-JOHNSON, CPO, is the fourth generation

in her family to own Friddle’s Orthopedic Appliances, an orthopedic manufacturing and distribution firm based in Honea Path, South Carolina. Friddle-Johnson’s great grandfather, William Dewey Friddle Sr., was the original owner. A mechanical engineer for the railroad, Friddle had friends who were launching a Shriners hospital in Greenville. “They asked if he would learn about O&P,” says Friddle-Johnson. “He went to school and helped them start an O&P department at the hospital in 1929.” Great-grandfather Friddle’s two sons, William Dewey Friddle Jr. and Franklin Eugene Friddle Sr., entered the field and worked as clinicians at Shriners and in private practice. The next generation—Friddle-Johnson’s father, Franklin Eugene Friddle Jr.—transitioned the family business from clinical work to manufacturing and distribution in 1985, where it has remained ever since.

Friddle’s Orthopedic Appliances office, in 2008

COMPANY: Friddle’s Orthopedic Appliances OWNERS: Rachel FriddleJohnson, CPO, and Rebecca Friddle-Evans LOCATION: Honea Path, South Carolina HISTORY: 42 years

Franklin Eugene Friddle Jr.

Rachel Friddle-Johnson began her O&P career as a practitioner for five years in Tennessee, then in 2010 joined her sister, Rebecca Friddle-Evans, in the family business. Rebecca, vice president of the company, oversees certain 44


A Friddle’s practitioner sees a Shriners patient in the early 1950s.

allows us opportunities to work with the designer on these products,” she says. “It adds to our ability to educate customers.” “We are a vertically integrated company,” says Friddle-Johnson. “We have a department that manufactures urethane that we use in carvers for central fabrication, as well as selling it in blocks to customers.” The company has about 30 employees, many of whom have been with the company for 20 to 30 years, leading to long-time working relationships and deep friendships. “We want a sense of family both for our employees and for our customers,” says Friddle-Johnson. “Many of our customers have been with us for a long time. They get the individualized attention they need, and it creates a great sense of loyalty.” The company leverages traditional marketing outlets— including magazine ads and appearances at national, state, and regional industry meetings— and is active on social media. Its website includes the option to receive an email newsletter with updates on new products and services, and customers may order online or by phone. Friddle-Johnson is active in O&P credentialing and accreditation, serving as an orthotics examiner for nine years and taking over in January as president of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. Looking to the future, the next generation of Friddles are only 9, 4, and 1, so it’s unclear if the family legacy will continue. Friddle-Johnson says the company plans to continue to grow, “to maintain that personal customer service connection and to keep doing what we do well as long as we can.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Friddle’s Orthopedic Appliances

William Dewey Friddle Sr.

operations, especially on the distribution side of the business, says her sister, who is company president. Friddle-Johnson’s husband, Mike Johnson, works for the company as an account executive. Friddle’s offers a wide range of orthotic, prosthetic, and pedorthic supplies and raw materials, as well as central fabrication services. “When I started, central fab accounted for less than 5 percent of our business, but today it’s nearly half,” says FriddleJohnson. She notes that Friddle’s central fab specializes in spinal orthotics and the full gamut of prosthetics, but does not work with lower-extremity orthotics. Facilities submit casts, scans, or measurements for digital production, with a same-day or 24-hour turn-around time for test sockets, and three to five days for everything else, she says. The company has a strong international presence, with distributors in Canada and South America. Friddle’s is the exclusive manufacturer for several brands, including the Charleston Bending Brace and the CJ Sails Socket. “Being the sole manufacturer


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New Life Brace and Limb


Fostering Friendship in the Lone Star State Texas company facilitates relationships among limb loss patients via support groups and patient advocates





New Life Brace and Limb supporting Limb Loss Awareness Month

FACILITY: New Life Brace and Limb OWNERS: Bob Draeger, CPO, LPO, CPed, and Russell Boone, BOCP LOCATIONS: Houston, Webster, Baytown, Conroe, and San Antonio, Texas HISTORY: 14 years

Brent White, MPT, CP, right, with a patient

Draeger is a pediatric orthotic and prosthetic specialist, with 30 years’ experience treating young patients, and New Life has a sizeable pediatric patient base. In addition, the facility offers diabetic foot care, fabricating and customizing orthotic inserts for patients. The company builds all devices in a central laboratory located in its 10,000-square-foot facility in the Texas Medical Center in Houston. Offices there feature several patient rooms and administrative services as well. As part of its commitment to patients, New Life employs several patient advocates, themselves amputees, who connect with patients to provide support even before surgery and throughout their journey. “They help patients realize that there is life after amputation,” says White. In addition, the facility offers support groups for its limb loss patients, with monthly meetings in two offices. Patient advocates

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

PHOTO: New Life Brace and Limb

in an O&P facility in Houston for several years, Bob Draeger, CPO, LPO, CPed, and Russell Boone, BOCP, decided they wanted to practice in a different way. The two launched New Life Brace and Limb at the University of Texas Medical Branch in Galveston in 2005. When the practice first opened, Draeger and Boone were the sole practitioners, along with an office administrator, Theresa Wells. But the practice grew rapidly. “We were on a roll until Hurricane Ike hit in 2008,” recalls Draeger. Much of the company’s patient base relocated after the storm, leaving New Life to pick itself up and start over. “We kept working hard and eventually built up a good-sized practice again,” says Draeger. Today, New Life Brace and Limb has 45 employees, including 13 clinicians, and offices in five Texas communities. A new office in San Antonio is a testament to the growing market for O&P services there, says Draeger. The company offers a full range of orthotic and prosthetic services. About two-thirds of its prosthetic patients are 60 or older, with amputations caused by diabetes, peripheral artery disease, and other medical conditions. “About a quarter of our patients are younger with trauma-related amputations,” says Brent White, MPT, CP, the company’s practice manager.

coordinate with speakers on such subjects as amputee care, diabetes, and health in general. “Not only do they get important information, they are able to come together for fellowship with other amputees,” White says. Draeger and Boone are firm believers in marketing, and they have a marketing director—who happens to be a registered nurse— who oversees a team of four sales reps and four patient advocates. Efforts include local sponsorships, social media, advertising, and building relationships with referrers as well as patients. The facility’s website features patient stories as well as educational videos on subjects such as donning and removing prosthetic legs. The site also features a “frequently asked questions” section with answers to typical questions. Another section of the website showcases a gallery of photos representative of specific devices as well as amputees in action. In addition to serving patients in Texas, Draeger and Boone have joined several orthopedic surgeons on a mission trip to Trinidad and Tobago. “We made arms and legs for some of the children, and we helped foster an O&P program there, which is now providing great service to people on the islands,” says Draeger. In all of their work, everyone at New Life focuses on forming close relationships with patients, physicians, and physical therapists. “I believe what sets us apart from other facilities is our constant communication and follow-up with patients,” says White. “Folks really do become like family. We all really enjoy building such long-term relationships.” Draeger sums it up: “We are not just building devices—we are building lives.”

embraceable For over 25-years, the Bremer Group Company has established a reputation for embracing practitioners and patients with high quality back braces and exceptional customer service. We provide comprehensive back brace solutions: • VertAlign® TLSO & LSO or Custom Back Braces. enveloping your patients with the support that fits their diagnosis; protects instability, helps to ease their pain • Application and use training in your office plus printed patient instructions, encircling a successful fit, enhancing compliance • Support for proper reimbursement encompassing products with verified payment histories and extraordinary customer service Embrace Bremer Group back bracing without delay! Visit www.bremergroup.com or call 904-645-0004.

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2020 AOPA National Assembly Call for Papers Submit Abstracts By March 20 Contribute to high-value clinical and scientific offerings and share your expertise with more than 2,000 orthotic, prosthetic, and pedorthic professionals. Submit your proposal for AOPA’s 2020 National Assembly, which will take place Sept. 9-12 in Las Vegas. AOPA is looking for: • Clinical Free Papers—The top-scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Symposia • Business Education Program—The top papers will be considered for the prestigious Sam E. Hamontree, CP(E), Business Education Award.

Abstracts will be considered for both podium and poster presentations and must be submitted electronically; email or fax submissions will not be accepted. Each submission will be graded by the Review Committee via a blind review process, based on the following criteria: • Relevance, level of interest in categories • Quality of scientific content • Quality of clinical content • Quality of technical content. What are you waiting for? Advance your career. Gain recognition. See your name in lights. Submit your abstract by March 20. Questions about the submission process or the AOPA National Assembly? Contact AOPA at 571/431-0876.




O&P Coding & Billing Myths: The Truth Is Out There

You’ve heard them before: “Medicare doesn’t pay for ’99 codes,” “Bilateral patients don’t require K levels,” “Payment rules don’t apply to unassigned claims.” How true are these statements? The February 12 webinar will explore some of the common O&P billing myths and provide you with accurate information. Take part in this session to separate fact from fiction and ensure you are billing correctly.

FEB. 12

U P C O M I N G W E B I N A R / / U P C O M I N G W E B I N A R / / N EUWP C O M I N G W E B I N A R


Clinician’s Corner: Orthotics




Join AOPA on March 11 for the first installment of the new Clinician’s Corner. Learn about the latest techniques in orthotics and take away practical tips for treating your patients for optimal results. And as a bonus, earn some scientific credits. Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters.

MAR. 11

During these one-hour sessions, AOPA experts provide up-to-date information on a specific topic. Webinars are perfect for the entire staff—they’re a great teambuilding, money-saving, and educational 48


experience! Sign up for the entire series and get two conferences free. Entire Series ($990 Members/ $1,990 Nonmembers). Register at bit.ly/2020webinars.


A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies. Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcomed to join this free tutorial. Co-OP Live Tutorial Webinar • January 17 • February 14 • March 13 Registration at bit.ly/Co-Op2020.




Mark Your Calendar With the

2020 Webinar Topics SEMINARS

| W E B I N A R S | E V E N T S | H O L I DAYS


Add the 2020 monthly webinar schedule to your calendar today! These informative sessions usually take place on the second Wednesday of each month at 1 p.m. Eastern time.

2020 Webinars January 8: Modifiers: Enhance Your Claims Two Letters at a Time

August 12: Contracting 101: Understanding the Basics

February 12: O&P Coding & Billing Myths: The Truth Is Out There

September 2: Outside the Norms: Outliers and Situations Where the Rules Are Different

March 11: New Technical Credits—Clinician’s Corner: Orthotics April 8: A Policy Review: LSO/TLSO May 13: Social Media Mayday: Increase Your Footprint June 10: New Technical Credits—Clinician’s Corner: Prosthetics July 8: The ABCs of Appeals: Know the Players and Get the Tips

October 14: New Technical Credits— Clinician’s Corner: Fitters and Techs November 11: RAC Audits: What Are They Looking At? December 9: New Year: New Codes, Fees, and Updates

Update Your Coding and Billing Procedures for 2020 Attend the Mastering Medicare: Essential Coding and Billing Techniques Seminar in Las Vegas, February 10-11.

But don’t take our word for it. Attendees from the last seminar said:

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

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

For more than 20 years, our faculty have helped thousands of attendees get claims paid, survive audits, collect interest from Medicare, file successful appeals and code miscellaneous items. Each Seminar is updated based on the latest developments, feedback from previous attendees, and needs of the profession. It is two days full of valuable instruction on topics O&P providers face

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

daily, like prior authorization, competitive bidding, Medicare documentation requirements, and new codes. Additionally, 14 CE credits can be earned. Attendees are responsible for making their own hotel reservations. Book at bit.ly/CB2020HOTEL by January 10 for the $105 plus $18 resort fee/night rate. Register online at bit.ly/AOPA2020CB. For more information, email info@AOPAnet.org. O&P ALMANAC | JANUARY 2020



Special Thanks to the 2019 PAC Contributors AOPA would like to thank the following individuals for their contributions in 2019 to the O&P PAC: PRESIDENT’S CIRCLE ($1,000-$5,000) Jeffrey Brandt, CPO Marco Calcagno, CPO J. Douglas Call, CP Traci Dralle, CFm Mike Fenner, CP, BOCPO Rick Fleetwood, MPA Eve Lee, MBA, CAE William Leimkuehler, CPO, LPO Jeffrey Lutz, CPO Lee Mantelmacher, CPO Michael Oros, CPO, FAAOP Rick Riley Bradley Ruhl Chris Snell, BOCP Frank Snell, CPO, LPO, FAAOP William Snell, CPO Bernie Veldman, CO Jim Weber, MBA Linda Wise James Young, Jr., CP, LP, FAAOP

SENATOR’S TABLE ($500-$999) Natalie Stewart, CPO



CHAIRMAN’S TABLE ($100-$499) John Allen, CPO Leslie Allen, CFo Kate Allyn, CPO John Angelico, CP, LP Christopher Berdahl, CP Curt Bertram, CPO David Boone, MPH, PhD George Breece Erin Cammarata Maynard Carkhuff Tina Carlson, CMP Kristin Carnahan, CPO, FAAOP Gary Cheney, CPO Christina Cox Joseph Cozza Glenn Crumpton, CPO Thomas DiBello, CO, FAAOP Mitchell Dobson, CPO, FAAOP John Chad Duncan, PhD, CPO Steven Filippis, CP Elizabeth Ginzel, CPO, LPO Kimberly Hanson, CPRH Bob Harmon John Hays, CP Denise Hoffman Michele Hogan Steven Hoover, CP, LP David Johnson, CO Maurice Johnson, CO James Kaiser, CP, LP Jim Kingsley Charles Kuffel, CPO, FAAOP

Teri Kuffel, JD Robert Leimkuehler, CPO Ron Longo, CP Pam Lupo, CO Stuart Marquette, CO Clyde Massey, CPO Brad Mattear, LO, CPA, CFo Brian Mayle Steve McNamee, CP, BOCO, FAAOP Wendy Miller, BOCO, CDME Aaron Moles, CPO Morris Moncure, BOCP, CPA Ted Muilenburg, CP, LP Jonathan Naft, CPO Sourabh Nagale, CPO Matthew Nelson, CPO, FAAOP Kathleen Pelz Dale Perkins Joyce Perrone Paul Prusakowski, CPO Ricardo Ramos, CP, CPed Patrick Reichel Eduardo Reyes, CPO Tyler Rowley, CPO Kurt Schlau Michael Schlesinger Stephen Schulte, CP, FAAOP Lesleigh Sisson, CFo, CFm Mike Sotak Jack Steele, CO Jason Tanner, CPO Robert Tillges, CPO, FAAOP Robert Tuck, CPO Jason Wening, CPO, FAAOP Larry Word, CPO Shane Wurdeman, PhD, MSPO, CP, FAAOP(D) Claudia Zacharias, MBA, CAE

1917 Club (Up to $99) Jacqueline Adolph, CO Maggie Baumer, JD Jenna Baxter Kevin Bidwell, CP Chellie Blondes Deborah Boone Mark Brady Robin Burton Joy Burwell Sarah Chang Kathleen DeLawrence Frank Erdeljac, CO Daryl Farler, CPA Kirk Ferris, CPO Jim Fitzpatrick Colton Graham Paul Gudonis David Henry Dan Ignaszewski Dennis Janisse, CPed Karyn Kessler Lindsey Kline Kyle Leister, CPO, LPO Thomas Metheney, CTO Joseph Pongratz, CPO, FAAOP Mark Porth, CPO Dara Ross, CPO Ryan Schuetzle, CPO Robin Seabrook Wanda Stephans Suzi Vicino Ashlie White Dennis Williams, CO, BOC(O) Scott Williamson, MBA, CAE Mark Woodsen, RTP Jessica Zistatsis, MSME


2019 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an O&P PAC-sponsored event. Rudy Becker Jeffrey Brandt, CPO David Boone, PhD, MPH, BSPO Marco Calcagno, CPO Thomas Costin Thomas DiBello, CO, FAAOP Mitchell Dobson, CPO, FAAOP Traci Dralle, CFm

Mark Ford Arlene Gillis, CP Christopher Koressel Teri Kuffel, JD Jeffrey Lutz, CPO Randall McFarland, CPO Jill Neuvirth Michael Oros, CPO, FAAOP Ron Lupo, CO Rick Riley

David Rotter, CPO Mike Schlesinger Chris Snell, BOCP Clint Snell, CPO Jack Steele, CO Jim Weber, MBA Paul Weber, CO Jason Wening, CPO, FAAOP Linda Wise

* Due to publishing deadlines, this list was created on Dec. 9, 2019, and includes only donations and contributions made or received between Jan. 1, 2019, and Dec. 9, 2019. Any donations or contributions made or received on or made after Dec. 9, 2019, will be published in the next issue of O&P Almanac.


Welcome New AOPA Members



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. Boston O&P of Stony Brook 207 Hallock Road, Ste. 211 Stony Brook, NY 11790 631/246-1717 Supplier

Clinical Prosthetics & Orthotics LLC 7 Wells Street, Ste. 207 Saratoga Springs, NY 12866 518/580-0267 Patient-Care Facility

Brighton Center for Specialty Care 7500 Challis Brighton, MI 48116 734/263-4000 Patient-Care Facility

Coyote Prosthetics & Orthotics 504 N. 10th Avenue, Ste. A Caldwell, ID 83605 208/453-6404 Supplier

Gillette Children’s Specialty Healthcare 1900 CentraCare Circle St. Cloud, MN 56306 651/290-8707 Patient-Care Facility

Virginia Prosthetics Inc. 10710 Midlothian Turnpike, Ste. 116 Richmond, VA 23235 804/823-7330 Patient-Care Facility

Mary Free Bed Orthotics & Prosthetics 2500 Niles Road, Ste. 9B St. Joseph, MI 49085 269/429-3292 Patient-Care Facility

Wolfchase Limb & Brace 367 Vamm Drive, Ste. B Jackson, TN 38305 731/660-5900 Patient-Care Facility

Orthotics & Prosthetics Laboratories Inc. 700 North Street, Unit 2 Springfield, MA 01201 413/442-0017 Patient-Care Facility





Opportunities for O&P Professionals

Certified Orthotist/Prosthetist

Job location key: ---

Northeast Northeast Mid-Atlantic Mid-Atlantic

-- Southeast Southeast -- North North Central Central -- Inter-Mountain Inter-Mountain -- Pacific Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Member $482 $634

Listing Word Count 50 or less 51-75 76-120 121+

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150

For more opportunities, visit: http://jobs.aopanet.org.


A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.



Marquette, Michigan Certified orthotist/prosthetist needed to join our team at a busy, full-time orthotics and prosthetics practice. Responsibilities are to supervise and participate in the design, fabrication, and fitting of orthotic devices for patients with congenital/acquired deformities of the body and disabling conditions of the limbs and spines. Eligibility for, or completion of, the certification examination by the American Board for Certification in Orthotics and Prosthetics is necessary. If you are looking for a long-term career with a company of dedicated professionals, come join our team in beautiful Marquette, Michigan. Job type: Full-time. Respond by email only to: Email: rfettig@teterop.com Visit our website at: www.teterop.com

Pacific Certified Orthotist/Prosthetist

Color Ad Special 1/4 Page ad 1/2 Page ad

Job Board

North Central


Work and Play in Alaska A wide variety of interesting patients, a great support staff, and upward growth opportunities await outgoing and energetic ABC-certified CPOs who are passionate about patient care. Come explore the Last Frontier in a family-friendly city where the great outdoors are just minutes away and you can make your mark with a well-established, Alaskan-owned company. CPOs with a minimum of two years’ experience post-second certification will receive a relocation allowance, sign-on bonus, salary starting at ~$85,000 (DOE), and extensive benefits as well as paid continuing education all while enjoying the ability to play in the beautiful state of Alaska. Email your résumé and inquiries to Marsha Foy at mfoy@northo.com.

Website: www.northo.com

CAREERS Pacific Certified Orthotic/Prosthetic Technicians Alaska

paid continuing education all while enjoying the ability to play in the beautiful state of Alaska. Salary DOE. Email your résumé and inquiries to Marsha Foy at mfoy@northo.com.

Website: www.northo.com

Work and Play in the Last Frontier Are you an accomplished ABC-certified CTPO looking for opportunities to showcase your skills in thermoforming, lamination, and leatherwork? Can you work well with others multi-tasking in a fast-paced lab that serves a large geographical area? Come explore Alaska in a family-friendly city where the great outdoors are just minutes away and you can make your mark with a well-established Alaskanowned company. CTPOs with a minimum of five years’ experience post-certification will receive a relocation allowance, sign-on bonus, and extensive benefits as well as

WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities


• Research who is hiring • Apply online for job openings • Free résumé review


• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.


https://jobs.aopanet.org O&P ALMANAC | JANUARY 2020



Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac20 for advertising options.

Kick Off the New Year With ALPS Silicone Pro Liner The ALPS Silicone Pro is a medical grade silicone liner that is one-fifth the friction of regular silicone liners. Protected by ALPS knitted fabric, the fabric allows for extended durability and helps to reduce pistoning. It is available in locking or cushion suspension and will comfortably suspend patients in their prosthesis and allow for freedom of movement. For more information please call us at 800/574-5426 or visit us at www.easyliner.com.

Boston Brace 3D® The Boston Brace 3D® is our next innovation in the nonoperative treatment of idiopathic scoliosis. Our clinical experts, working with pediatric orthopedic surgeons, have combined their knowledge of the three-dimensional scoliosis curvature with the latest in shape capture and CAD/CAM technologies to develop a brace that provides higher in-brace correction without reducing adherence. Outstanding Outcomes The combination of in-brace curve reduction and adherence to wear schedules has shown in multiple studies to reduce the curve progression, and in some cases, actually improve the curve. To get these results for your patients, contact Jamie Benelli at 508/638-1175 or visit BostonOandP.com

2ND Generation Coapt Control Gen2 is the all-new and reimagined myoelectric pattern recognition control system from Coapt. Compatible as an add-on system to virtually every powered upper limb prosthetic configuration, Gen2 unleashes an unprecedented level of personal, intuitive control for its wearers. Coapt’s Gen2 has enhanced the performance of the COMPLETE CONTROL pattern recognition core and introduces unrivaled new features, changing the field once again: • CONTROL COACHTM—An onboard A.I. companion guiding the wearer through accelerated learning and adoption of their prosthesis control • ADAPTIVE ADVANCETM—An extra machine learning layer capable of continuously improving Gen2’s harmony with its wearer. For more information, visit www.coaptengineering.com.

Coyote Prosthetics & Orthotics

Coyote Composites has HUGE price cuts again this year! • Costs less than carbon fiber • Little to no itch • Tougher than carbon fiber. Increased buying power has lowered our costs and your price. For more information, contact Coyote Prosthetics and Orthotics at 208/429-0026 or visit www.coyotedesign.com.



MARKETPLACE A Perfect Fit for You and Your Patients

Consistently capture true anatomy under weight-bearing conditions with the Symphonie® Aqua System, available through Cypress Adaptive. This innovative, hydrostatic technology replicates the exact forces one would experience while standing in a prosthetic socket. The accuracy of the weight-bearing impression eliminates the need for cast modifications and enables the practitioner to achieve consistent outcomes and efficiently provide the patient with a comfortable, well-fitting socket. For more information, contact Cypress Adaptive at 888/715-8003 or visit our website www.cypressadaptive.com

The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

Solvent Replacement Wipes +PLUSeries® Solvent Replacement Wipes are specifically designed to replace the use of acetone and other toxic solvents in your work environment, greatly reducing your exposure to harmful toxic chemicals. Learn more at 800/FABTECH or visit www.fabtechsystems.com.


NEXO provides two wrist options: the USMC-style quick disconnect wrist, previously only available for use in an exoskeletal system, and a lightweight friction wrist. For more information, contact Fillauer at 800/251-6398, 423/624-0946, or visit http://fillauer.com/Upper-ExtremityProsthetics/nexo.php.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses. Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device. For more information, visit www.npdevices.com.



MARKETPLACE Pro-Flex® LP Align Up to 2¾ inches of heel height adjustability allows users the freedom to choose their footwear, without compromising alignment, posture, or dynamics. Learn more on ossur.com or call your Össur representative to schedule a demo.


Delivering an extensive, progressive product line that includes everything today’s active amputees need to live the life they love. Offering an innovative portfolio that includes everything from the virtually indestructible RUSH Foot collection to the world’s first microprocessor-controlled hydraulic four-bar knee with both stance and swing functionality, the ALLUX. The EASY RIDE, multiuse extreme sports knee, to the KEASY, renowned prefabricated cones. The K2 GERY foot, to the flexible, all-terrain, DynaTrek foot. Discover the exciting PROTEOR USA product line today! A whole new look. A whole new vibe. A whole new world. #HumanFirst. Visit us at proteorUSA.com.

Introducing the Agilium® Vantage Knee OA Brace From Ottobock Meet the Agilium Vantage, a lowprofile, wraparound knee brace designed to provide lasting pain relief for patients with mild to moderate unicompartmental osteoarthritis. Key features: • Dynamic Y force strap system unloads the knee with a single pull • Adjustable, numbered closure straps for patient compliance • Trimmable sleeves reduce inventory to only three sizes. Give your patients less pain and more life with the Agilium Vantage. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

ThermoLyn Supra Flexible

Spinal Technology Inc. Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit www.spinaltech.com.



ThermoLyn Supra Flexible is an ideal material for fabrication of highly flexible definitive sockets for lower and upper limb prostheses. Available in 16 color options, give your patients a comfortable socket fit combined with customization to their personal style. Benefits of the material: • Permanently elastic • Shape retentive • Comfortable socket edge design • Can be self-bonding when heated • Washable • Multiple thickness options for various applications. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

MARKETPLACE The Xtern Foot Drop AFO From TurboMed Orthotics

AOPA Supplier Plus Partners

This unique ankle-foot orthosis (AFO) was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. The Xtern is HCPCS code L1951 validated. Turbomed innovative products are now available through distributor partnerships in more than 26 countries. Its unique design and material composition give another meaning to walking and running. There is no limitation with the Xtern for the customers—not even a weight limit! For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the Xtern in less than five minutes. Available in USA from Cascade Supply, SPS, Lakes Medical Innovations, Kevin Orthopedic, and Physio Tech. For more information, visit www.turbomedorthotics.com.

Thank you to our AOPA Supplier Plus Partners for their continued support of the association.



Advertisers Index Company

Page Phone 800/574-5426





C2 800/356-3668



Boston Orthotics & Prosthetics




The Bremer Group Company





7 844/262-7800


Coyote Design




Cypress Adaptive LLC








Fabtech Systems LLC




Fillauer Companies Inc.




Flo-Tech O&P Systems Inc.




1 800/301-8275


Naked Prosthetics




Ă–ssur Americas Inc.






C4 800/328-4058



21 855/450-7300


Spinal Technology Inc.




TurboMed Orthotics



www.turbomedorthotics.com O&P ALMANAC | JANUARY 2020



APPLY ANYTIME! BOC Certification. Apply anytime and www.bocusa.org test when ready for the orthotic fitter, mastectomy fitter, and DME specialist certifications. To learn more about BOC’s nationally recognized, in-demand credentials and to apply today, visit www.bocusa.org.

Cascade Dafo Institute

Nine free ABC-approved online continuing education courses for pediatric practitioners. Take anytime, anywhere, and earn up to 14.25 CE credits. Visit cascadedafo.com or call 800/848-7332.

2020 visit www.AOPAnet.org.

February 12 WEBINAR

visit www.AOPAnet.org.

Modifiers: Enhance Your Claims Two Letters at a Time. For more information,

February 14–15

PrimeFare Central Regional Scientific Symposium. Renaissance Hotel and Convention Center, Tulsa, OK. For more information, visit www.primecareop.com, call 888/388-5243, or email primecarepruitt@gmail.com.

ABC: Application Deadline for Spring CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

March 1

January 10–11

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

ABC: Practitioner Residency Completion Deadline for April Written & Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

March 10

January 17–23

U.S. ISPO Pac Rim Meeting. Sheraton Maui Resort & Spa, Lahaina, Maui, HI. Visit www.usispo.org.

January 24–25

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

ABC: Application Deadline for Certification Exams. Applications must be received by February 1 for individuals seeking to take the April Written and Simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

February 10–11



visit www.AOPAnet.org.

New Technical Credits—Clinician’s Corner: Orthotics. For more information,

March 19–21

Georgia Society of O&P. Alpharetta, GA. Visit www.georgiasop.com.

March 30

February 1


O&P Coding & Billing Myths: The Truth Out There. For more information,

March 1

January 8 WEBINAR

February 10–15

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

Coding & Billing Seminar. Las Vegas. For more information, visit www.AOPAnet.org.




April 1

Medicare 101: Get to Know the Basics. Rosemont, IL. For more information, visit

ABC: Practitioner Residency Completion Deadline for Spring CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.


ABC: Application Deadline for June Certification Exams. Applications must be received by April 1 for individuals seeking to take the June Written and Simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

New Technical Credits—Clinician’s Corner: Prosthetics. For more information, visit www.AOPAnet.org. WEBINAR



June 10

A Policy Review: LSO/TLSO. For more information, visit www.AOPAnet.org.

visit www.AOPAnet.org.

The ABCs of Appeals: Know the Players and Get the Tips. For more information,

July 31–August 1

April 8–13

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/certification.

PrimeFare East Regional Scientific Symposium. Renaissance Hotel and Convention Center, Downtown Nashville. For more information, visit www.primecareop. com, call 888/388-5243, or email primecarepruitt@gmail.com.

August 12

Contracting 101: Understanding the Basics. For more information, visit


April 23–25

International African–American Prosthetic Orthotic Coalition Annual Meeting. The Shriners Hospital for Children-Houston. Houston. For more information, contact Amandi Rhett at 404/754-4337, email arhett1@gmail.com, or visit www.iaapoc.org.


September 2

Outside the Norms: Outliers and Situations Where the Rules Are Different. For more information, visit www.AOPAnet.org. WEBINAR

April 27–28 SEMINAR

Coding & Billing Seminar. Charlotte, NC. For more information, visit www.AOPAnet.org.

May 5–6

AOPA Policy Forum. Washington, DC. For more information, visit www.AOPAnet.org.


visit www.AOPAnet.org.

Social Media Mayday: Increase Your Footprint. For more information,

May 13–15 NYSAAOP Meeting. Schenectady, NY. Visit www.nysaaop.org/meeting.

Calendar Rates CE For information on continuing education credits, contact the sponsor. Questions? Email ymazur@AOPAnet.org. CREDITS

September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For more information, visit www.AOPAnet.org.

October 3

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Plaza Hotel, New York LaGuardia Airport, 104-04 Ditmars Blvd., East Elmhurst, NY 11369. Contact Drew Shreter at 800/946-9170, ext. 101 or email dshreter@pomac.com.

October 14

New Technical Credits—Clinician’s Corner: Fitters and Techs. For more information, visit www.AOPAnet.org. WEBINAR

Let us share your next event! Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@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.




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2020! State by State Updates from Illinois, Indiana, and North Carolina

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.


The Illinois Department of Healthcare and Family Services has posted a new provider notice titled “Rate Increases for Custom Orthotic and Prosthetic Devices Effective Nov. 1, 2019.” The notice is available on the AOPA Co-OP and at https://www. illinois.gov/hfs/MedicalProviders/ notices/Pages/default.aspx. The Illinois Society of Orthotists and Prosthetists (ISOP) has reviewed and confirmed the custom L codes/ rates as those it had agreed to. The new rates represent a nearly 20 percent increase over the current rates. The new rates apply to items for participants covered under the department’s fee-for-service program as well as those covered under a managed care plan. 60


ISOP President Jim Kaiser, CP, LP, wrote the following in a message to ISOP members: “Many thanks go out to Sen. Tony Munoz (D-1st District), Reps. Greg Harris (D-13th Jim Kaiser, CP, LP District) and Dan Brady (R-105th District), and ISOP lobbyist Brian Duffy. HFS Exe's Doug Elwell and Lisa Barnes and staff worked with ISOP to define custom L codes based on the definitions in your OPP Practice Act. In March 2018, ISOP engaged in state budget hearings. “This big win for Illinois OPP helps ensure your patients will continue to be cared for by your company. This was achieved through the combined efforts of ISOP Corp members and their staffs of Kay Newton (Hanger), Tomi Lancaster (Scheck & Siress), Brock Berta, MBA, CPC-A (Transcend), and Dan Hasso, CPO, LPO (Scheck & Siress).”


The implementation of Medicaid work requirements in Indiana has been brought to a halt by the state Medicaid program amid pending litigation concerning

whether imposing the requirements and other proposed changes would violate the purpose of Medicaid. The state said it will not revoke coverage for Medicaid beneficiaries that fail to comply with the rules—an estimated 24,000 people—until a federal court has reached a decision.

North Carolina

The North Carolina Chapter of the American Academy of Orthotists and Prosthetists (NC AAOP) continues to work toward the introduction of a licensure bill and establishment of a licensure board. NC AAOP President Marco Calcagno, CPO, and Past President Brittany Stresing, Brittany Stresing, CPO, FAAOP CPO, FAAOP, also have been working closely with North Carolina Medicaid to ensure that adults continue to have adequate O&P coverage in the state.

Submit Your State News

To submit an update for publication in the State by State department of O&P Almanac, email awhite@aopanet.org. For up-to-date information about what’s happening in O&P in your state, visit the AOPA Co-OP.


Call for Papers Contribute to high-value clinical and scientific offerings and share your expertise with over 2,000 orthotic, prosthetic, and pedorthic professionals.

We are looking for:

Submit your proposal for the American Orthotic and

• Business Education Program The top papers will be considered for the prestigious Sam E. Hamontree, CP (E) Business Education Award.

Prosthetic Association’s 2020 National Assembly, September 9-12, 2020, in Las Vegas, NV.

Abstracts will be considered for both podium and poster presentations and must be submitted electronically; email or fax submissions will not be accepted. Each submission will be graded by the review committee via a blind review process, based on the following criteria.

• Clinical Free Papers The top scoring papers will compete for the prestigious Thranhardt Award. • Technician Program • Symposia

• Relevance, level of interest in categories • Quality of scientific content • Quality of clinical content • Quality of technical content

What are you waiting for? Advance your career. Gain recognition. See your name in the Vegas lights.

Submit your abstract by March 20, 2020, at bit.ly/AOPA20Paper.



FOLLOW US @AmericanOandP

Questions about the submission process or the National Assembly? Contact AOPA at 571/431-0876.


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January 2020 O&P Almanac  

The American Orthotic & Prosthetic Association (AOPA) - O&P Almanac - January 2020 Issue

January 2020 O&P Almanac  

The American Orthotic & Prosthetic Association (AOPA) - O&P Almanac - January 2020 Issue