July 2011 O&P Almanac

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The American Orthotic & Prosthetic Association

JULY 2011

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WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

Today’s lower-limb technology meets tomorrow’s vision

GREAT STRIDES IN PROGRESS

Get Involved in O&P ADVOCACY 2011 Medicare Codes: WHAT’S NEXT?

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O&P Almanac JULY 2011, VOLUME 60, NO. 7

COVER STORY

COLUMNS

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20 Great Strides in Progress

By Jill Culora From devices featuring artificial intelligence to sophisticated microprocessor knees, advances in lower-limb prosthetic technology are making the future a reality. Discover some of the latest innovations and how they are restoring more natural mobility to patients.

CONTENTS

Reimbursement Page A review of 2011 Medicare updates and a look at what’s ahead

DEPARTMENTS

4

AOPA Contact Page How to reach staff

6

At a Glance Statistics and O&P data

10

In the News Research, updates, and company announcements

34

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

40

FEATURE

26 Taking a Stand for O&P

By Deborah Conn In today’s budget-slashing environment, it’s more important than ever for O&P practitioners to speak out on behalf of the profession. Hear from O&P professionals who participated in the AOPA Policy Forum, and get ideas for involvement from lobbying experts.

AOPA Membership Applications

42 Marketplace

Products and services for O&P

46 Jobs

Opportunities for O&P professionals

52 Calendar

Upcoming meetings and events

55

Ad Index

56

AOPA Answers

Expert answers to your FAQs

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

JULY 2011 O&P ALMANAC

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OP Almanac

AOPA CONTACT INFORMATION

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

EXECUTIVE OFFICES

MEMBERSHIP AND MEETINGS

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

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

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

Tom Wessel, director of business development, 651/724-8753, twessel@AOPAnet.org Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org

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

BOARD OF DIRECTORS OFFICERS President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthotic and Prosthetics Inc., LLC, Houston, TX

Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

President-Elect Bert Harman, Otto Bock Health Care, Minneapolis, MN

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

Ann Davis, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0876, adavis@AOPAnet.org

Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org

AOPA Bookstore: 571/431-0865

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

Ann Davis, staff writer, 571/431-0876, adavis@AOPAnet.org Teresa Tobat, editorial/production assistant, 703/914-9200 x33, ttobat@strattonpublishing.com

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

Vice President Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX

Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

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

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

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

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O&P ALMANAC JULY 2011

Mahesh Mansukhani, MBA Össur Americas, Aliso Viejo, CA

EASY! UPDATE MEMBERSHIP DIRECTORY INFORMATION ONLINE

Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2011 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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At a Glance

Snapshot of Lower-Limb Conditions, Amputations Ankle Pain Most Common During Middle Age…

Dysvascular Disease Causes Most Lower-Limb Losses…

Major Lower-Limb Loss Cases (2005)

Ankle-Related Physician Visits (2006)

CAUSES

NUMBER OF VISITS

AGE 0-18

NUMBER OF CASES All etiologies

441,000

623,000

All dysvascular disease

750,000

19-42

837,000

43-61 62 and older

Dysvascular disease with diabetes

626,000

Source: American Academy of Orthopaedic Surgeons

504,000 359,000

Trauma

106,000

Cancer

13,000

Note: Dysvascular disease with diabetes is a subset of the all dysvascular disease category.

Source: “Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050,” Archives of Physical Medicine and Rehabilitation 2008

140,000–150,000 Average number of lower-extremity amputations performed each year in the United States from 2000 through 2008.

36%

Percentage of all cancerrelated amputations that are below the knee.

1.2 million Number of visits to emergency rooms for ankle sprains in the United States in 2006.

581,000

Approximate number of knee replacements performed annually in the United States.

90%

Percentage of lower-limb amputees who regularly wear a prosthetic device.

1.6 million Number of hip fractures that occur worldwide each year.

Sources: American Academy of Orthopaedic Surgeons; American Orthopedic Foot & Ankle Society; Amputee Coalition 2011; “Limb Amputation and Limb Deficiency,” Southern Medical Journal 2002; Healthcare Cost and Utilization Project’s (HCUP National Inpatient Sample (NIS); National Limb Loss Information Center 2008 6

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In the News

Photos: Courtesy of Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

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Groundbreaking Surgery Restores Patient’s Mobility In an extraordinary operation, a team of surgeons have successfully used living bone to reconstruct a cancer patient’s pelvis to support a prosthetic leg—the first time this procedure has been performed in the United States.

The surgeons, from the Ohio State University (OSU) Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, removed the patient’s left leg, hip, and pelvis and used healthy bones from his amputated leg to rebuild the connection between

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O&P ALMANAC JULY 2011

his spine and right pelvis to support a prosthetic leg.

Surgeries for pelvis bone tumors typically use artificial parts or cadaver bones to rebuild the pelvis, and many patients are confined to wheelchairs afterward because their pelvises do not heal well enough to support their body weight, which is required to use a prosthetic leg.

The OSU surgical team, however, removed the tumor and worked together to design a method to rebuild the patient’s pelvis using titanium

supports along with parts of the patient’s amputated leg. This allowed the bones to fuse together to create an intact pelvic ring strong enough to enable the patient to walk on a prosthetic leg, says Joel Mayerson, MD, an orthopedic oncologist who was part of the team of surgeons.

The patient’s prosthetic device features two large rods and several smaller rods fixed to the pelvis and spine with 14 screws to help provide support while the leg bones fused together.

TRANSITIONS

Lower-Limb Neural Control Possible, says RIC

PEOPLE IN THE NEWS

Photo: The Rehabilitation Institute of Chicago (RIC)

The Rehabilitation Institute of Chicago (RIC) announced preliminary research results demonstrating real-time neural control of knee and ankle motions for lower-limb amputees.

Researchers studied real-time neural control in four lower-limb amputees and four non-amputee control participants, measuring the neural, or electromyographic (EMG), signals in nine lower-limb muscle sites during lower-limb movement. During the tests, all participants were instructed to move a virtual lower limb Hailey Daniswicz, one of the patients undergoing testing at the RIC’s Center for Bionic Medicine, through a variety of motion demonstrates real-time neural control of a virtual leg. patterns on a computer screen.

Metrics were created based on Although RIC’s findings also accuracy of movement, the time it complement success in providing its took to complete the motion, and the upper-limb amputees with neural percentage of successfully completed control of prostheses through Targeted motions.

Muscle Reinnervation (TMR)—a Results showed all participants were surgical procedure that re-routes able to control their knee and ankle brain signals from nerves severed from neural information measured in during amputation to intact muscles, the thigh. These preliminary findings allowing patients to control their robotic were published in the April issue of prosthetic devices by merely thinking the Journal of the American Medical about the action they want to perform.

Association (JAMA).

But, study author Levi Hargrove, MD, of Because lower-limb amputees RIC’s Center for Bionic Medicine, now form a large portion of the amputee questions the necessity of TMR surgery. population—more than 130,000 “These findings in JAMA also lower-limb amputations occur each showed that real-time ankle control year—there is an unmet need for the was attainable by only using EMG development of a neural-controlled signals from the thigh muscles, leading prosthetic leg. However, challenges me and my colleagues to believe that in transitioning the current bionic TMR surgery may not be necessary for technology used for upper limbs to amputees to regain control of knee and lower limbs exist because of inconankle movements with prostheses,” sistencies in recording EMG signals. says Hargrove. “We look forward Research has provided some insight to applying these findings to our into overcoming these challenges, continued research investigating neural but additional studies are needed to control in lower-limb amputees and evaluate and develop a new lower-limb the future development of advanced physical knee and ankle prostheses.” neural interface.

Ability Prosthetics & Orthotics has hired Dan Brinkmann, CPO, as the managing practitioner of its Lexington, Kentucky, patient-care facility.

Eastern Michigan University congratulates the Orthotics and Prosthetics class of 2011.

Graduation was on April 16 at the Convocation Center on the university’s campus. Sixteen graduates received master’s degrees in orthotics and prosthetics and will begin residency in the coming months. The class of 2011 includes: • Liz Devries • Shawn Ginebaugh • Tom Gore • Lindsey Griffin • Kevin Hickey • Mike Huhn • Brian Karl • Kurt Leindecker • Meghan Mckenna • Sarah Newkirk • Adrienne Oday • Jeff Sampson • Sean Saunders • Eric Steinmetz • Kyle Watson • Megan Zachar.

Randy DeSha, CPA, joined Fillauer Companies as chief financial officer.

WillowWood hired Jennifer Dowell, CPO, as its OMEGA development clinician.

JULY 2011 O&P ALMANAC

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In the News TRANSITIONS

PEOPLE IN THE NEWS

Hanger Orthopedic Group hired the following employees: • Adam Archibee, CP, joined its patient-care facility in Buffalo, New York.

• Daniel Ballarin, CO, joined its patient-care facility in Omaha.

• William (Bill) Barringer, CO, joined its patient-care facility in Oklahoma City.

• Andre Bellicini joined its patient-care facility in Tallahassee, Florida.

• Ross Bosetti, CPO, joined its patient-care facility in Manitowoc, Wisconsin.

• Alicia Boniecka, CO, joined its patient-care facility in Tamarac, Florida.

• Jared Butler, CO, joined its patient-care facility in Salt Lake City.

• Kelly Davis, BOCOP, joined its patient-care facility in El Dorado, Arkansas.

• Lee Engel, CO, joined its patientcare facility in Geneva, New York • Patrick Flaherty, CP, joined its patient-care facility in Cincinnati.

• Spencer Gordon, C.Ped, joined its Stratford and North Haven, Connecticut, patient-care facilities.

• Brian Greer, CP, joined its patient-care facility in Lynchburg, Virginia, as practice manager.

• Wm. David Horrell, CPO, joined its Springfield, Missouri, patientcare facility.

• Cameron Kay, CPO, joined its Merced, California, patient-care facility.

• Leslie King, CPO, joined its patient-care facility in Oak Ridge, Tennessee, as practice manager.

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O&P ALMANAC JULY 2011

• Kurt-Christian Konrad, CPO, joined its Lancaster, Pennsylvania, patient-care facility.

• Daryl Lea joined its patient-care facilities in Thomasville and Moultrie, Georgia.

• Jennifer Marchel, CP, joined its patient-care facility in Austin.

• Gregory Pummer, CO, joined its patient-care facility in Pittsburgh.

• James Richter, C.Ped, joined its Laguna Hills, California, patientcare facility.

• Carlos Garcia Rodriguez, CPO, C.Ped, joined its patient-care facility in Louisville, Kentucky.

• Brock Sande, CPO, joined its patient-care facility in Richland, Washington.

• Jay Sciortino, CPO, joined its patient-care facilities in Vancouver and Longview, Washington.

• Anthony Ung, CO, joined its patient-care facility in Orange, California.

• Rodney Wilkinson joined its patient-care facility in St. Louis.

Jessica Smith-Armstrong is the latest recipient of The International African American Prosthetic & Orthotic Coalition’s Sam D. Benson Scholarship. Smith-Armstrong has just completed her first year in Georgia Tech’s Master of Science in Prosthetics and Orthotics program.

Touch Bionics has appointed Ian Stevens as its CEO.

Photo: James Kachan

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Ryerson University, located in Toronto, Canada, undergraduate biomedical engineering students Thiago Caires and Michal Prywata have built a brain-controlled prosthetic arm that uses compressed air as its main power source.

Canadian Students Create Brain-Controlled Prosthetic Arm Two Ryerson University undergraduate biomedical engineering students have created a brain-controlled prosthetic arm that uses compressed air as its main power source.

Users wear a headset that senses a thought signal and sends it to a miniature computer in the arm. The computer then compares the signal to others in a database, and the resulting information is sent to the pneumatic system that activates the arm to create the correct movement. Simulating the expansion and contraction of real muscles, the system makes use of compressed air from a small, refillable tank in the user’s pocket.

The students are attempting to design the arm to sense different materials and adjust the force used proportionately depending on the object’s weight.

O&P Assistants

BE RECOGNIZED FOR YOUR TRAINING AND EXPERIENCE –

Become an ABC Certified Assistant!

If you are currently working as an orthotic or prosthetic assistant, here’s your chance to gain recognition for your training and experience.

The future of the profession depends on your skills. Many O&P practices are looking for ways to deliver services more cost effectively, ways that allows them to meet the challenges of today’s health care regulations while effectively meeting the needs of an increasing patient population. Your unique position may be the answer for many practices as they look to the future.

ABC’s Certified Assistant credential will be phasing in over the next three years — for 2011, the eligibility requirement is your experience in the profession. Take advantage of this window to become certified as an orthotic or prosthetic professional.

The American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc. 330 John Carlyle St., Suite 210 Alexandria, VA 22314 703-836-7114 :: 703-836-0838 (fax)

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In the News TRANSITIONS

BUSINESSES IN THE NEWS

The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) is conducting a Practice Analysis Survey of the Mastectomy Fitter and is searching for ABC-certified mastectomy fitters to participate.

The survey results will help define the certification, education, and training of future fitters; aid in the development of valid and reliable examinations; and convey to others outside the O&P disciplines the scope of services provided by certified mastectomy fitters.

The survey will be emailed in mid-July 2011. If you would like to participate, please send your email address to info@abcop.org.

The ABC 2010 Annual Report is now available on the ABC website, www.abcop.org. The report summarizes the organization’s successes and provides data on the total number of certified individuals and accredited facilities.

The ABC also congratulates the National Commission on Orthotic and Prosthetic Education on its 20th anniversary in developing and assuring O&P education and residency accreditation standards.

The Amputee Coalition launched its public awareness program for its lawnmower safety guidelines.

Hanger Orthopedic Group and Sikorsky Aircraft Corporation have teamed up to provide Colombian students with scholarships to study O&P in the United States so that they can return to Colombia to assist in caring for landmine victims.

The first two beneficiaries of the scholarship, Miguel Angel Gutierrez, 34, and Sebastian Ramirez, 24, both of Bogota, returned to work at Columbia’s Central Military Prosthetics Laboratory in May. Hanger also announced the release of a trailer for the upcoming film Dolphin Tale. Inspired by the volunteer work of Hanger’s Vice President of Prosthetics Kevin Carroll, MS, CP, FAAOP, and Practice Manager Dan Strzempka, LPO, CPO, the movie details how the men provided prosthetic tails to a dolphin in Florida’s Clearwater Marine Aquarium that lost its tail in a crab trap. The trailer can be viewed on Hanger’s YouTube page, www.youtube.com/HangerOrthopedic.

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Next Step Orthotics & Prosthetics from Manchester, New Hampshire, is one of seven finalists in the Dream Big Award presented through the U.S. Chamber of Commerce. The awards program honors companies that create jobs and recognizes their significant contributions as drivers of economic growth. The award is open to all industries.

The Orthotic & Prosthetic Assistance Fund and the First Clinics welcome 2011 sponsors for their support of adaptive recreational pursuit. Sponsors include • Becker Orthopedic of Troy, Michigan (Bronze Level Sponsor) • Cardinal Prosthetics and Orthotics of Winchester, Virginia (Signature Level Sponsor) • O&P Business News (Patron Level Sponsor).

The Orthotic & Prosthetic Group of America announced its premier partnership with SoleTech.

An intensive two-day workshop for O&P practitioners and office billing staff

Master coding and billing for the most difficult devices without the panic that may have plagued you in the past!

The International African American Prosthetic & Orthotic Coalition held its 21st Annual Meeting on May 8 in Charlotte.

Southern Prosthetic Supply (SPS) and oandp.com have announced the integration of SPS’ product inventory and ordering capabilities with OPIE software tools.

Correction: The email address listed for the Orthotic and Prosthetic Group of America (OPGA) in the buyers’ guide on page 65 of the June issue of O&P Almanac was incorrect. The correct email address is info@opga.com. a

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Reimbursement Page

By Devon Bernard, AOPA government affairs department

Medicare’s Changing Rule Book Here’s a look at some of the changes CMS has already made this year, plus some changes to come

A

s we pass the half-way mark of 2011, it’s a good time to look back and review the changes implemented in the Medicare reimbursement program and take a look at some changes that are on the horizon.

The New Year started out, as it always does for Medicare, with the introduction of new codes and an update to the DMEPOS fee schedule and deductibles. This year was no exception, but two changes are worth further review.

First, Medicare introduced a list of deleted codes that included L3660, L3670, and L3675. Almost immediately, however, these three codes were reinstated. This led to confusion among providers and some payers because the codes didn’t appear on the 2011 Medicare fee schedule.

Medicare issued a statement saying these codes would be added to the 2011 fee schedule during one of its quarterly updates and provided an addendum to the fee schedule, which contained the 2011 fees for the three codes.

The second item of interest was the 2011 DMEPOS fee schedule, which included a 0.1 percent decrease in Medicare allowables from 2010 levels.

This was the first year the DMEPOS fee schedule was subject to a productivity adjustment—that is, an adjustment

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O&P ALMANAC JULY 2011

So far in 2011, we have seen changes or updates to five of the eight Medicare medical policies associated with O&P products and services, the AFO/KAFO, KO, Therapeutic Shoes, Lower-Limb Prostheses, and External Breast Prostheses. In this column, we will focus on the most recent changes and those that seem to be causing the most confusion.

Lower Limb Prostheses

to account for increased productivity due to technological advancements, as mandated by the Patient Protection and Affordable Care Act (PPACA).

In the past, increases and decreases in the DMEPOS fee schedule were tied to the Consumer Price Index for Urban Areas (CPI-U). For 2011, the CPI-U was 1.1 percent. CMS determined the productivity adjustment for 2011 was to be set at 1.2 percent, and, because the CPI-U for 2011 was 1.1 percent, the DMEPOS Fee Schedule was reduced by 0.1 percent for 2011.

The main change to the Lower Limb Prostheses Policy relates to the new code L5961—addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control.

The policy has been revised to include hips in the list of codes that require the use of a K-Level or functional modifier. The L5961 has been assigned a functional level of K3, and no other hip codes have been assigned a functional level. The policy also includes some housekeeping updates. In previous editions of the Lower Limb Prostheses Policy, code L5978—all lower extremity prostheses, foot, multiaxial ankle/foot—was listed as being both a K2 and K3. The policy has now been updated to reflect the L5978 as solely a K2 functional level.

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Lastly, the policy was updated to be consistent with the Skilled Nursing Facility (SNF) Consolidated Billing regulations. As you know, most prosthetic codes are excluded from SNF consolidated billing and may be billed directly to Medicare, but some are not excluded and must be billed to the SNF. Previous policies did not list all the excluded codes, which led to providers incorrectly submitting claims to Medicare, instead of seeking payment from the SNF. The updated policy now has a more complete list of codes that must be billed to the SNF. The most important thing to notice is that the list now contains code L5987—all lower extremity prosthesis, shank foot system with vertical loading pylon.

Therapeutic Shoes The changes to the Therapeutic Shoe Policy and the requirements for the certifying physician have probably led to the most confusion this year. Here is a quick recap of the changes. Now the certifying physician must do the following: • Have a documented in-person visit with the patient in which diabetes management is discussed.

This visit must take place within six months before the patient receives shoes and/or inserts.

• Sign the certification statement on or after the date of the visit and within three months before the patient receives shoes and/or inserts.

• Document the nature of the qualifying criteria in the patient’s medical record within six months before delivery of the shoes and/or inserts.

If certifying physicians do not have documentation of the qualifying criteria that support the need for therapeutic shoes in their own notes, they may obtain the documentation from the medical records of an in-person visit with a podiatrist, another MD, physician assistant, nurse practitioner, or clinical nurse specialist. The certifying physicians must then initial, sign, and date these

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O&P ALMANAC JULY 2011

records on or before the day they sign the certification statement and indicate agreement with this information. If the certifying physician is not the one writing the prescription, there must also be documentation of an in-person visit with the person prescribing the shoes and/or inserts within six months of their delivery.

New enrollment procedures were introduced this year aimed at combating fraud and abuse within the Medicare program.

Alternative Payment As of February, the least-costly alternative payment method was eliminated in the AFO/KAFO, KO, Therapeutic Shoes and External Breast Prostheses policies. In the past if you provided a custom device to a patient and Medicare deemed the device not reasonable or necessary, CMS would down-code the device and reimburse you based on the cost of the most appropriate prefabricated item—the least-costly alternative.

Medicare will now no longer down-code your claim if the device is deemed not medically necessary.

Instead, the claim will be denied.

However, you can protect yourself and ensure that you obtain a partial payment for the device by billing for an upgrade using the GK modifier and the GA or GZ modifiers. To review how to bill for an upgrade, read the Medicare Claims Processing Manual, Chapter 20 Section 120 (www.cms.gov/Manuals/IOM/list.asp), or review your Jurisdictions Supplier Manual.

Also, if you had a claim denied due to the elimination of the least costly alternative, you may appeal the claim and prove the medical necessity

of the item or you may resubmit the claim and bill for an upgrade using the GZ modifier.

Enrollment Procedures New enrollment procedures were introduced this year aimed at combating fraud and abuse within the Medicare program.

Risk categories. The new procedures place O&P providers into two of three possible categories: moderate risk or high risk. All existing O&P providers are considered to be moderate risk. This means O&P providers currently enrolled as Medicare providers are subject to unannounced site visits and verification by CMS of certain items, including licenses, Tax IDs, and NPIs. Any O&P provider enrolling with Medicare for the first time or adding a new business location will be considered high risk. Not only are high-risk providers subject to unannounced visits and verification of licenses, but any owner having more than a 5 percent ownership in the company will be subject to fingerprinting and background check procedures, which are not yet in place. The new fingerprinting and background checks requirements will become active 60 days after CMS issues guidance on how they are to be carried out.

Enrollment fees. Anyone enrolling or reenrolling in the Medicare program must now include a fee with the application. This fee will not be required if you are submitting an application to change or update your information (change of address or ownership, for example). For applications submitted after March 25, 2011, this fee is $505. It must be paid using the Department of the Treasury’s web-based payment system and must be received by the National Supplier Clearinghouse (NSC) before your application can be processed.

To pay the application fee, visit www.pay.gov and follow these steps: 1. On the left-hand side of the page, you will see a search box called

“Find Public Forms.” Type “CMS” into the search field and click “GO.” 2. Select the form for Medicare application fee.

3. Fill out the form and submit payment as directed. (Note: Use MAC ID 99001-NSC.) 4. Print a copy of the confirmation screen for your records. This is your receipt for payment.

Medicare will forward the payment information to the NSC, but it’s recommended that you send a copy of your payment receipt to the NSC. Provider Enrollment Chain Ownership System (PECOS) enrollment. Phase II of PECOS, which was scheduled to take effect on Jan. 3, 2011, requires that referring physicians or non-physician practitioners be enrolled in PECOS in order for services they order to be valid for Medicare claim submission. As of May, however, Medicare has suspended the implementation of Phase II until further notice. Medicare has promised to provide advanced warning of when Phase II will be implemented.

As a reminder, PECOS is an Internet-based Medicare enrollment system and is an alternative to the traditional paper-based enrollment application. It has been available to O&P providers since October 2010. You aren’t mandated to use PECOS, but it does have some benefits, including quicker processing time and the ability to quickly and easily correct any errors on the application form.

On the Horizon That takes care of the changes that have already occurred in 2011, but what changes are forthcoming?

The biggest change that lies ahead is the transition to the new HIPAA 5010 format for electronic transactions (claims, remittance advances, claim status inquiries, and so on); the transition will not affect paper transactions. The transition to the new format must be completed by Jan. 1, 2012; after that date, claims using the current 4010 format will not be accepted.

To get ready for the transition, ask your clearinghouses, software vendors, and payers (the transition is not solely related to Medicare claims) when they plan to make the transition, what you must do on your end to get ready, and when you may begin testing the new HIPAA 5010 format.

The biggest change that lies ahead is the transition to the new HIPAA 5010 format for electronic transactions.

proposed rule that would revise some of the standards but did not specify when these new revisions would take effect. The proposed rule would formally clarify Standard 1 to allow the use of contracted employees as long as it is not prohibited by the state. The proposed rule would also revise Standard 11 to prohibit only direct solicitation of beneficiaries via telephone. In 2011, CMS also clarified Standard 29, stating that an O&P practice may share space with a physician’s office, as long as the physician is not also billing for DMEPOS items or services.

To stay atop of changes in the Medicare program, sign up to receive the AOPA in Advance email newsletter, visit your DME MAC website regularly, and sign up for your DME MAC’s list serve. a

You may also want to download a side-by-side comparison of the two formats to see exactly what is changing and determine how these Devon Bernard is AOPA’s changes may affect your business. manager of reimbursement (For example the billing provider’s services. Reach him at address can no longer be reported dbernard@AOPAnet.org. as a P.O. Box or lockbox.) This sideby-side comparison

may be found on the O&P Board Study Resources Common Electronic We can help you PASS your BOARDS Data Interchange (CEDI) website, All products updated to 2011 test standards. www.ngscedi.

com/5010/5010.htm.

If you are using the free Medicare

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You will also want to The ONLY Comprehensive Study Guides contact the CEDI to Specifically for Orthotics and Prosthetics see when you may (Many of our products are available in DVD Format also!) begin submitting test 5010 transactions.

JUST ADDED: Also on the The MASTECTOMY FITTER’s Review and Study Guide horizon are revisions We also have Board Study Value Packages to the new Supplier in Orthotics and Prosthetics Standards that Check out your readiness to sit for your boards went into effect in with our Clinical Practice Exams.

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JULY 2011 O&P ALMANAC

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Great

BY JILL CULORA

S trides in Progress Advances in lower-limb prostheses are paying off in greater, more natural functionality

D

esigners and developers of lower-limb prostheses have tried for decades to produce artificial limbs and components that replicate the human body’s natural movement. Today, advances in technology are finally catching up with their visions.

Over the years, research on kinetics has unearthed many promising ideas for solving dilemmas in prosthetic design, yet a dearth of suitable materials and technologies has always held these innovations back. A lot of ground remains to be covered, but designers and developers are excited about a new generation of lower-limb prostheses available now and coming to market in the next 12 to 18 months.

“The human body is very complex, with all the bones and muscles working in unison, and the technologies are allowing us to get closer and closer to that symphony of movement,” says Dale Berry, CP, FAAOP, vice president of clinical operations for Hanger Orthopedic Group.

These advances are “allowing the patient to be able to functionally get from point A to point B in as natural a gait as possible,” he says. “This reduces stress to the body, to the joints, reduces energy consumption, and makes the patient walk more naturally.”

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O&P ALMANAC JULY 2011

The list of design requirements for lower-limb prostheses has always been long, but with the advent of pinhead-sized computers, ultra-light-weight materials, and compact rechargeable batteries, designers are now more able to produce sophisticated prostheses that aren’t encumbered by inappropriate size or weight or lack of energy supply.

Ankles and Feet By far, some of the most exciting advances are occurring in ankle and feet prostheses, as developers make breakthroughs in shifting from passive to active technologies in building artificial ankles and feet. Two new prostheses are especially notable.

One is Powerfoot BiOM, by iWalk, the first power-actuated bionic lower-leg system that stores and returns power much like an anatomical lower leg. Developed by Hugh Herr, PhD, and his interdisciplinary team at the Massachusetts Institute of Technology’s Media Lab, the BiOM dramatically lowers the metabolic costs of walking. It enhances stability, which increases patient confidence, and reduces back, hip, and socket pain because the heel strike of the leading leg is much gentler than with conventional prostheses.

JULY 2011 O&P ALMANAC

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Photo: Courtesy of iWalk Photo: Webb Chappell

Hugh Herr, PhD

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O&P ALMANAC JULY 2011

Powerfoot BiOM

Herr, who lost both his legs at 17 from severe frostbite, says having the ability to integrate research groups from various scientific fields was key to the BiOM’s development. “You can have teams of extraordinary roboticists that know very little about the biomechanics and physiology of human movement,” he says. “In distinction, you can have research teams schooled in the nuances of biological movement, but with little engineering knowledge.

What is absolutely critical is an interdisciplinary approach where both biological and engineering sciences are represented.”

The way a human leg works is not at all obvious, Herr continues.

“Nature has come up with extraordinarily beautiful functionality that an engineer might never be able to create. Applying principles of nature and applying such knowledge to prosthetic design I call ‘stealing from nature.’ We’re just not smart enough to think of these things,” he says.

“The human ankle is very, very powerful and strong, and it’s exceedingly difficult to get that amount of strength and power in a small and lightweight package. That’s an enormous challenge, and we’ve been able to succeed at that challenge by extracting principles of how the biological limb works,” he explains.

“Designed within the prosthesis are structures that emulate the calf muscle, Achilles tendon, and control structures that emulate how such muscle and tendon structures are being controlled in walking,” Herr says. “It turns out that there are principles of biological movement that allow us to build something so powerful and strong in a lightweight and small package.”

The Powerfoot BiOM is commercially available and is currently being fitted on wounded service members at Walter Reed Army Medical Center.

Also of note is the Proprio Foot with Evo, by Össur, a completely redesigned foot that effectively addresses the durability and performance issues of its predecessor. Based on Flex-Foot technology, the new Proprio Foot has sensors that enable it to make

appropriate and immediate adjustments for the slightest variations in activity and terrain.

The device uses artificial intelligence, called Terrain Logic, to help reduce the compensating movements that amputees are usually forced to make. “Terrain Logic is the ‘brain’ of the device and helps to replace the function that the body’s central nervous system would normally play in processing information about changes occurring inside and outside the limb as if it was still intact,” according to Össur.

Active vacuum technology has the potential to significantly improve fit, comfort, and stability for the prosthetic wearer because it allows for an extremely intimately fitted socket, minimizing changes in the size and shape of the residual limb. Vacuum technology has come a long way since debuting with Carl Casper’s Vass system, which struggled in the 1990s due to ineffective materials. Today’s systems are equipped with electronic vacuum pumps that can make minor adjustments either automatically or with a remote control key fob.

“We can set the amount of vacuum that is being applied to the socket to optimize suspension,” says Berry.

“Patients report that the prosthesis becomes part of them for a more intimate fit, like comparing a wellfitted pair of shoes to wearing a pair of shoes that are two sizes too big with the shoe laces untied.”

Electronic vacuum systems include the following: • Harmony ePulse, by Otto Bock.

Small and lightweight, this system has no restrictions on patient weight, height, or activity level.

• Limb Logic VS, by WillowWood.

Equipped with a remote control, this system monitors the vacuum level; except for the fob, it is waterproof .

• V-Hold, by Hanger. This system has Bluetooth technology and is fully automated to make real-time adjustments to suspension to

Photo: Courtesy of Hanger Prosthetics & Orthotics

Vacuum Suspension

Hanger V-Hold

accommodate for changes in activity, terrain, and barometric pressure.

A nonelectronic vacuum system is Harmony P3, by Otto Bock. Redesigned to improve complexity and component weight, this mechanical vacuum system is suitable for patients weighing between 100 and 220 pounds.

Berry predicts that use of vacuum products by below-knee amputees will go from 5 percent in 2010 to 15 or 20 percent this year. The limit to growth is not due to the technology, he adds, but to how long it takes practitioners to adapt to making new sockets correctly.

“Practitioners have all those years of experience of making a socket in a particular way, and active vacuum sockets require a shift to understand that the new technology requires a new, updated socket design,” says Berry. But making the new sockets is not difficult, he adds: “If you follow the instructions as opposed to trying to reinvent the instructions, it’s actually pretty simple.”

New Knees Although microprocessor knees (MPK) have been around more than a decade, today’s MPKs are unrecognizable compared to their predecessors.

Functions have been re-engineered to offer higher levels of stability and durability. The improvements result in a higher confidence for patients and reduced fear of tripping or falling.

“The prosthesis, through the sensors, is reading everything around you,” says Berry. “It’s assessing everything from the stresses being applied to the prosthesis, so it’s making minute adjustments to make sure the prosthesis is always in the appropriate adjustment for the patient at that time.”

Here’s how the manufacturers describe their newest knees: • Rheo Knee, by Össur. Microprocessors, sensors, and magnet technology combine to enable this artificial knee to sense, “think,” and act. An onboard

JULY 2011 O&P ALMANAC

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Photo: Courtesy of Otto Bock

C-Leg

by Otto Bock

Genium

by Otto Bock

Rheo Knee by Össur

Genium Knee by Otto Bock

•

•

•

•

24

computer tracks gait patterns and instructs an actuator to work as a brake when it senses a downward incline or a stumble.

C-Leg, by Otto Bock. The latest version of this knee and leg has an additional mode called “static stance” that allows the wearer to lock the leg for standing. Controlled using either a remote control, or with the tap of the toe, this leg allows patients to use less energy.

Smart Adaptive, by Endolite.

Designed for amputees with a moderate to high level of voluntary muscle control, this microprocessor knee senses and adapts to the most complex of terrains. Onboard batteries last up to 14 days on a single charge.

Plié 2.0, by Freedom Innovations.

Perhaps the lowest profile MPK on the market, this knee has sealed electronic components for water resistance. A high-performance processor and hydraulic system enable patients to stay in stance longer, take smaller steps, and change walking speed more fluidly.

Genium Knee, by Otto Bock. This

O&P ALMANAC JULY 2011

new knee technology combines four advanced microprocessors with a gyroscope and an accelerometer, creating a system that can intuitively respond to different situations in multiple dimensions. The highly adaptive knee enables enhanced stability, allowing the wearer to walk up ramps and stairs, step over step, and walk backwards. The new battery technology provides up to five days between charges.

• Integrated Bionic Prosthetic Leg, by Össur. Just on the horizon, this prosthesis combines the technology of the Rheo Knee and the Proprio Foot into a single, fully integrated unit. Össur expects the field-tested leg will be available in a limited capacity in late 2011.

Advances are being made in liner materials as well. One example is electro-elastomer— a muscular-like silicone membrane material that is capable of sensing and activating through electric charges.

The Patients Perhaps the most notable trend in technologically advanced lower-limb prosthetics is that they are no longer solely aimed at young, active amputees.

Instead, these new hi-tech devices are rapidly becoming mainstream as insurance companies realize their benefits to older amputees as well.

“When an older person falls, there’s a great potential that they’ll end up breaking a hip. But because of these new advanced technologies, we’re seeing fewer falls and more active older adults,” says Kevin Carroll, MS, CP, FAAOP, Hanger’s vice president of lower-extremity prosthetics. “They work incredibly well for young people, but especially for the older population, they really make sense.”

But there is no unanimity that the latest and greatest is always the most appropriate for everyone. Matching lifestyle and needs to technology is vital, and some patients will prefer to stick with what they know.

“I know some people that are very high functioning that would get a C-Leg, and they would end up switching to a mechanical knee.

The C-Leg is much more expensive,

it’s more advanced, but, for that individual, they liked the C-Leg but once they got into some more demanding conditions, perhaps, it wasn’t working for them the best,” says Justin Laferrier, MSPT, OCS, SCS, CSCS, a physical therapist with the Pittsburgh VA and Human Engineering Research Laboratories.

“An experienced clinician who knows about the prosthetic technology because they’ve gone to the courses and they’ve made inquires with manufacturers, they’re going to say: ‘With these attributes, I think this is going to work for you because you have [certain] functional deficits, so we’re going to give it a shot,’” says Laferrier.

Hanger uses a Patient Assessment Validation Evaluation Tool (PAVET) to help match the right technology to the right patient, says Berry. “What’s great about this application is you identify the right technology and apply it with the right patient and clinically document and justify it,” he explains. “You could have a functionally level-three individual who is a mailman, delivers mail for a living, and you can have a functionally level-three individual who is an accountant and sits at a desk all day.

Do they both need the same type of prosthesis? They are both functionally level three, but their needs are different. And so documenting and clearly delineating why this patient will benefit from this technology will make a huge difference.”

But, Berry notes there’s another important reason practitioners must exercise caution in making their assessments. “The one concern I have is not only putting the patient with the wrong technology, but what I think is more damaging to our industry is when we take a patient and we put excessive technology on them and get the insurance company to pay these large volume prices for technology that is not being used,” says Berry.

“I think that’s damaging to the industry. The insurance company will become hesitant to approve appropriate technology unless we can clearly

AOPA Funds Research Research that demonstrates successful outcomes of new technology is vital for the O&P industry. For that reason, the American Orthotic & Prosthetic Association, in collaboration with partners, is making funding available for research projects.

AOPA recently funded six small pilot projects and in May 2011 accepted proposals for two large research projects. The majority of these projects focus on outcomes with lower-limb prosthetic technologies.

Now available for review online are the results from the following three pilot studies: “Center of Rotation Position in Non-Articulated Prosthetic Feet: Implications for Prosthetic Foot Kinetics”

by Andrew Sawers, CPO, MSPO University of Washington “Functional Outcomes of a Custom, Energy Harvesting ‘Bullfrog’ AFO”

by Géza F. Kogler, PhD, CO Georgia Institute of Technology, Georgia Tech University “Comparison of Liner Assisted Suspension in Transtibial Prosthetics”

by Robert Kistenberg, MPH, CP, LP, FAAOP Georgia Tech University “It is virtually certain that future health-care reimbursements will be closely tied to the available research demonstrating successful outcomes of new technology,” says Tom Fise, JD, AOPA’s executive director. “That’s why it is so vital for O&P, which severely lacks a very robust body of rigorous, competitive, effective research to regain the initiative and push for the most sophisticated and useful outcomes research that our resources permit.” justify and validate the appropriate and medically necessary application to each individual patient,” he says.

As technology is advancing at lightening speed, so is access to information, and patients are now doing research themselves to find new products for their needs. “Patients are coming in equipped with questions,” says Carroll. “Grandma comes in with her iPad and says, ‘This is the foot I found that I would really like to use. What do you think?’”

Carroll believes that patients’ lack of fear about new technology and their access to information represent a major shift in patient care. “We can no longer come in the door and say to a patient: ‘This is what you are getting,’” he says.

“We really have to be educators—really.

We’re a resource for them. And there are technologies that definitely would not be appropriate. That’s when we come in, to educate and say that a particular product will be too heavy, too light for you, wouldn’t be strong enough to hold your weight.

“It’s a team approach, and the leader of the team has to be the patient.” a Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@gmail.com.

Editor’s Note: Hugh Herr, PhD, will be presenting a session “Advanced Technology and the Biomechatronics Group at MIT” on September 20 at the 2011 AOPA National Assembly, Las Vegas. For more information, visit www.

AOPAnet.org.

JULY 2011 O&P ALMANAC

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O&P ALMANAC JULY 2011

BY DEBORAH CONN

Taking A Stand for O&P If practitioners don’t speak up for the profession, who will?

G

etting involved in the legislative and policy issues that affect their businesses has always been important for O&P practitioners and facility owners. But in today’s budget-cutting environment, involvement is imperative. Legislators at both the state and national levels are searching for ways to decrease costs, and, unless they understand what O&P is and how it affects the lives of their constituents, the industry faces serious cuts in reimbursement.

Even so, too many practitioners and business owners are reluctant to participate. The very word “lobbying” conjures up an uncomfortable sales pitch. Many feel awkward about writing to or speaking with a member of Congress or even a state representative. They may believe that they are not sufficiently savvy about the legislative process, that they don’t have connections with the right people, or that their input would make no difference because legislators don’t really care about O&P issues.

Not true, says Mary Andrus, assistant vice president of government relations for Easter Seals in Washington, DC. “Those of us who do this for a living believe that legislators do care about these issues,” says Andrus, who spoke at the 2011 AOPA

Policy Forum. “They may have much to learn, but they care.”

Both Andrus and fellow speaker Kevin Brennan, senior health policy specialist with Washington, DC-based Foley Hoag LLP, prefer to use the word “educating” instead of “lobbying.”

“Legislators have to make decisions on hundreds of issues, from health care to defense to transportation to cybersecurity,” says Brennan. “The world has become so complicated that folks in health care need to educate members of Congress and their state legislatures as to what’s going on.”

“Remember that you, as an O&P professional, are the expert,” says Andrus. “You bring specific details about what it is your business does, what your products are, and how you change the lives of your patients.”

And legislators—many of whom don’t know the difference between an orthosis and a prosthesis—are grateful for the education.

Getting Started Once you decide to get involved, how do you proceed? Andrus suggests calling the legislator’s office and identifying yourself as a constituent. Tell your legislator what you do, explain why the O&P industry is important, and voice your concerns.

“You don’t need a voting issue to make that call,” she says. “It can be a way just to introduce yourself. Get to know the staffers who handle your issues. Over time, try to establish a relationship so you can become their resource on O&P, the person they think of when those issues arise.”

Personal meetings are not necessary, Andrus says, particularly with your national representatives. But if you travel to Washington, use the opportunity to make an appointment. Or find out when your representative will be back in the local district and schedule a meeting.

You also can make yourself heard at a local town meeting or even, as Brennan suggests, invite the member to visit your practice. It may take repeated calls to set up an appointment, but persistence pays off. And once you manage to meet your representative face-to-face, be prepared.

“Go in with a sense of what you want to say,” recommends Andrus.

“What are the topics, why are they important, who is affected? If you have a specific ask—such as a vote for or against a particular bill—make it as clean a request as possible. For example, instead of saying, ‘We’re opposed to legislation that would limit access to O&P care,’ say ‘Please vote

JULY 2011 O&P ALMANAC

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Frank Bostock, CO, FAAOP, (left) and Melinda Lisle (middle center) speaking about their experiences combating state Medicaid cuts.

against HR 1234.’ Make your reasons as clear as possible.”

Whenever possible, provide a human side to the issues you present. Explain what might happen to a specific patient without health insurance fairness for amputees (S. 773) or Medicaid coverage, or show how appropriate care made a dramatic difference in another patient’s life.

last October that Nevada was on the verge of discontinuing all Medicaid coverage for O&P patients over 21, she called AOPA for assistance. She also sent letters to every ABC- or BOC-accredited facility in the state, asking them to join the fight against the budgetary line item.

AOPA contributed a highly visible billboard ad in the state capital of

“We’ve discovered our representatives don’t care about the [bill] number—they want to know about your business and your patients and your employees who are taxpaying citizens.”

—Melinda Lisle To help staff members follow up, it’s a good idea to leave behind a one-page fact sheet that summarizes who you are, why you are there, and what requests you made.

Grassroots Efforts In educating legislators, as in most endeavors, joining a coalition of like-minded participants can have a greater impact than working alone.

When Melinda Lisle, facility manager of OrthoPro of Reno Inc., realized

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O&P ALMANAC JULY 2011

Carson City and ran ads against the proposal in local newspapers. The association also provided a conference call line that enabled Lisle to connect the state’s approximately 16 accredited O&P practices. This sparked the creation of an informal group that met in Las Vegas in February to discuss the issue and consider how to respond.

The group hired a professional lobbyist to meet with state representatives, attend legislative hearings and committee meetings, and keep

practitioners informed through the group’s monthly conference calls.

“I think we’re succeeding,” says Lisle. “The line item has been removed from the budget for the next two fiscal years.”

Lisle expects the group to carry on beyond this fiscal crisis and perhaps continue to retain the lobbyist. “We were surprised to find more O&P issues than just Medicaid, including an autism bill and a child protection act calling for early childhood intervention services,” she says.

“The process has been very time consuming, but, in return, we’ve seen our efforts rewarded,” Lisle adds. “We have personal relationships with representatives at the state and national level that didn’t exist before.

We have access to people who can help us understand legislative matters and know what’s out there.

“I’ve talked to a lot of O&P people who are nervous about saying the right thing or getting the bill number wrong. But we’ve discovered our representatives don’t care about the number—they want to know about your business and your patients and your employees who are taxpaying citizens. They just want to hear from you about the reality of patient care.”

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Major Issues AOPA has compiled a list of important national legislative issues affecting O&P, along with the main messages to communicate to policymakers about each issue. Additional information is available on the O&P website, www.AOPAnet.org, under 2011 AOPA Policy Forum.

1. O&P Medicare Improvement Act (HR 1958).

This bill would limit reimbursement for O&P services to licensed providers in states with licensure. In non-licensure states, reimbursement would be limited to providers with credentials from a recognized body that meets ABC or BOC standards. It limits deemed accrediting bodies to those experienced in O&P that meet Benefits Improvement and Protection Act’s 427 criteria. The act also links reimbursement to the qualifications of the provider and the complexity of the device.

If implemented, this would save taxpayers a minimum of $250 million over five years by curbing fraud and abuse, and it would protect patients and improve quality of care.

4. Exclusion of O&P medical devices from the 2.3 percent excise tax. Because they are customized, finished devices, orthoses, and prostheses should qualify for an exemption from this tax, as do eyeglasses and hearing aids. AOPA believes that manufacturers and patient care facilities alike qualify for the exemption.

2. Insurance Fairness for Amputees Act (S 773).

Formerly called O&P Parity, this bill would require private insurers who choose to offer O&P coverage to provide benefits equal to other surgical and medical benefits in their policy, with no caps or lifetime limits. It does not require insurers to cover O&P care.

Providing appropriate O&P care can avoid costly co-morbidities (diseases or disorders that are caused by the primary condition or exist independently) and return patients to productive, tax-paying lives. Studies have shown that the incremental costs of improving coverage would raise premiums less than 60 cents per year for each person covered by the insurance.

6. Funds for outcomes-based research and evidence-based practice. Results of such research would help ensure that patients receive appropriate, necessary care, reducing future health-care costs.

3. Inclusion of O&P in the definition of “essential benefits.” Although the House version of the Affordable Care Act clearly included O&P as an essential benefit, the Senate’s version, which was signed into law, left the definition of essential benefits to the Secretary of Health & Human Services.

If O&P care is not considered an essential benefit, lack of reimbursement by insurers would have a serious negative impact on the quality of patient care.

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O&P ALMANAC JULY 2011

5. Veteran’s Bill of Rights (HR 850). Among other things, this gives veterans the right to receive care from the practitioner and in the venue of their choice and to obtain a second opinion. Every Veterans Administration O&P clinic would be required to post these rights where patients can see them.

7. Short-term grants to train future practitioners.

An aging population and the rise of diabetes and other cardiovascular diseases heighten the need for O&P care. In addition, entry-level qualifications for the field have become more rigorous, and many current practitioners are retiring.

Competitive short-term grants to universities would help provide a new stream of qualified practitioners.

“As soon as you get your foot in the door, you are the expert. You can talk very simply because the stories and the patients are so compelling.”

—Teri Kuffel

Since she returned from the AOPA Policy Forum in Washington, DC, Lisle and others in the fledgling association have reviewed national as well as state concerns. They plan to set up in-state meetings with their congressional representatives to discuss the Medicare Improvements Act and the Veterans’ Bill of Rights (HR 805) among other issues.

At the National Level Teri Kuffel has had lobbying experience at the state level as a director of the Minnesota Society of Orthotists, Prosthetists, and Pedorthists (MSOPP), but this year’s visit to the Policy Forum was her first effort at the national level. Kuffel, who is an O&P business administrator and an attorney, and her husband, Charles Kuffel, CPO, FAAOP, own Arise O&P Inc., in Blaine, Minnesota, just north of the Twin Cities. After contemplating the trip to Washington for several years, they finally put schedules aside and made the effort.

“For anyone with experience at the local level, this was much easier,” she says. “AOPA took care of just about everything, from scheduling appointments to preparing fact sheets and talking points for each meeting. We met with both our senators and six representatives.”

The Kuffels were part of a 10-member delegation from Minnesota that included suppliers, representatives of the Amputee Coalition and AOPA, and a 12-year-old bilateral amputee. Teri Kuffel echoes the theme of educating legislators, and, she says, bringing along a patient really gets their attention.

“As soon as you get your foot in the door, you are the expert,” she says.

“You can talk very simply because the stories and the patients are so compelling. And people are happy to see you in their office because they know you had to travel to be there.”

Kuffel found the trip eye-opening.

She learned that O&P may not be considered an essential benefit under

health-care reform and says “that would be simply devastating for our industry and the patients we help.”

Back in Minnesota, as a director of MSOPP, Kuffel has worked with several professional lobbyists to promote insurance fairness and educate state legislators about the needs of O&P patients. While the lobbyists help guide Kuffel through the political maze, she is reminded constantly that she and her associates are the true experts on these O&P matters.

Kuffel believes that although each state has its own issues, all of them need to work on establishing or maintaining licensure and ensuring parity, or insurance fairness (see sidebar on page 30). “Hopefully, your state won’t need to be concerned with Medicaid cuts to O&P, but that seems to be a recent trend that must be eliminated quickly,” she says.

Kuffel believes investing in a professional lobbyist is worthwhile.

“The state association in Illinois has had a lobbyist for 14 years,” she notes, pointing out that “they have O&P licensure and parity in that state and, most important, a relationship with their legislators.”

Common Cause Joining forces with other facilities and practitioners in your area to lobby legislators can seem daunting, especially if you don’t have a state association to turn to for help.

OrthoPro’s Lisle recognizes that many people are reluctant to call their professional competitors. “But for the purposes of saving our industry and protecting our patients, we are not competitors, we are on the same side,” she says.

“And don’t be afraid of rejection. I can’t tell you how many practitioners rejected me before I persuaded them to join. They will get involved, as soon as they know what’s going on. But you have to pick up the phone.” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@ cox.net.

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AOPA Headlines AOPA WORKING FOR YOU

State of the States O&P services have been under attack in legislatures from coast to coast—what’s happening in your state?

M

ost state legislatures have adjourned for the year, but, before heading home, many legislators considered serious budget cuts that threatened the availability of O&P services to Medicaid recipients.

California, Nevada, Arizona, and Minnesota all made headlines. Most notable was Arizona, which enacted hard-line restrictions into law rather than impose them through a budgetary process. Efforts to repeal limitations on providing orthotic services to those over 21 were not successful, but there will be another bite at the apple in 2012.

In addition to threatened or real Medicaid cuts, other important issues arose in state legislatures as well. Here’s what AOPA has learned about them from contacts in the various states.

Success in Texas Mike Allen, CPO, FAAOP, reports success obtaining a rule change by the Texas Department of Insurance,

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O&P ALMANAC JULY 2011

Division of Workers’ Compensation.

The new rule adds “OP for Othotists/ Prosthetist” as a new data element when submitting Workers’ Compensation claims that require the provider’s license number. The change creates a clear separation of O&P from DME and lets payers ensure that care comes from qualified providers.

Separating O&P from DME in the Texas Medical Assistance Program, a long-desired objective, was achieved in this legislative session with the passage of SB874. This bill requires the Health and Human Services Commission (HHSC) to establish a unique Medicaid provider type for O&P providers, instead of classifying them as providers of in-home hyperalimentation supplies.

Another important legislative initiative involved changing the state’s licensure act so that physicians’ assistants and nurse practitioners could issue orders for O&P. HB2703 passed both chambers, and the governor is expected to sign it.

A real threat now looms from the passage of the 2012-13 General Appropriations Act, which directed the HHSC to reduce Medicaid payments.

Concerned practitioners gathered on July 12 to rally for a hearing on the legislation. AOPA has provided supporting materials to prepare for testimony in the hearings.

Lobbying in Nevada Melinda Lisle reports success so far in stopping a proposed budget recommendation that would have limited O&P services to Medicaid recipients over the age of 21. The Nevada O&P community funded a lobbyist, who provided continued updates on other legislative and regulatory threats and opportunities. AOPA supported opposition to the proposed Medicaid cuts by providing a billboard and print ad templates, along with talking points and a recommended letter to legislators. AOPA also facilitated regular conference calls connecting state practitioners.

care treatments for patients who are not able to receive orthotic treatment options. This data is needed to make the case that lack of timely orthotic care can lead to more costly treatments arising from complications that could have been avoided had care been provided.

Progress in Pennsylvania AOPA Board Member Eileen Levis reports progress on enacting a state licensing law. House of Representatives Bill 48, which passed on May 2 by a vote of 174-20, would establish state licensure requirements for prosthetists, orthotists, pedorthists, and orthotic fitters. Efforts now turn to the Pennsylvania State Senate, where passage would position the licensure act for the governor’s signature.

Advocacy in Minnesota Teri Kuffel reports success in blocking recommendations to cut prosthetic Medicaid reimbursements for those over age 21. The prosthetic cuts had been included in a Senate bill, but the House refused to incorporate the benefit reductions during the House-Senate conference on the bill, and Gov. Mark Dayton (D) seemed poised to veto it had it reached his desk.

Advocacy efforts included a visit from Sue Stout (Amputee Coalition) and Leslie Pitt-Schneider (Otto Bock) with the commissioner of Minnesota’s Department of Human Services, prompting Commissioner Lucinda Jesson to write a letter urging the Minnesota House and Senate to reject the cuts. Jesson pointed out the difficulty in ending coverage “especially for people with disabilities who depend on medical assistance for much of their lives.” She continued, “If optional services that help people to be more independent are eliminated, some people will substitute more expensive

long-term care services (such as home care assistance) to meet their needs.”

The Amputee Coalition played a major advocacy role, providing more evidence of the powerful force providers and patients can wield when working in unison.

The Minnesota Society of Orthotists, Prosthetists, and Pedorthists (MSOPP) retained a lobbying firm. Initially, the firm was to help push parity efforts, but it ended up being of great assistance when the Medicaid issue arose. Just before the cuts were nixed, MSOPP had been working with AOPA’s Executive Director Tom Fise, JD, pulling together an ad campaign (billboard, print ad, editorial placement, and letters) to build public support for keeping prosthetic services available to Medicaid recipients.

Also effective was an immediate grassroots initiative that inundated members of the House and Senate with emails, phone calls, and letters requesting deletion of the word “prosthetics” in the language proposed by the Senate. A key legislative advocate for the cause was Minnesota Rep. John Kriesel (R), a bilateral amputee war hero and author of the Minnesota O&P parity bill, now known at the federal level as the Insurance Fairness for Amputees Act (S. 773).

Cooperation in Arizona Frank Bostock, CO, FAAOP, reports the state medical director for the Arizona Health Care Cost Containment System is cooperating in helping assemble utilization data on alternative

Victory in California Bryce Docherty reports the ongoing COPA advocacy campaign to spare Medi-Cal O&P benefit cuts scored another victory with the “May Revise” budget submitted by Gov. Jerry Brown (D). The revised budget took into account unexpected tax receipts, eliminating the need for draconian Medi-Cal cuts that would have affected O&P.

What About Your State?

Let us know about activities in your state that could benefit from AOPA resources. AOPA has invited scores of members to be “state reps,” serving as an early warning system for the O&P community to make sure regulatory and legislative threats and challenges at the state level receive proper support.

These state reps also have been asked to serve as communicators to provide updates on AOPA’s national and state activities at local meetings or through email communications to colleagues.

Our commitment to supporting state regulatory and legislative challenges to the O&P field has expanded through the addition of Catherine Graf, JD, as AOPA’s new director of regulatory affairs. Graf comes to AOPA from the Department of Health and Human Services, where she provided legal advice to the CMS. Catherine Graf, JD She previously served as a law clerk for the chief special master at the United States Court of Federal Claims, Office of Special Masters, in Washington, DC. a

JULY 2011 O&P ALMANAC

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AOPA Headlines

Breaking News: Rumors of Competitive Bidding for OTS Could Bring Confusing ‘Business Opportunities’

C

MS is giving solid signs that it is considering including off-the-shelf (OTS) orthotics in future competitive bidding, which has spurred some confusing opportunities for O&P patient-care facilities.

Here’s a blinded excerpt of an offer that several AOPA members have reported to us: “I have recently been contacted by a web based DME company that wants me to check out the braces that they have already sold to people over the internet.

This feels as though they are trying to borrow my certification.

The company writes: “(Company Name) would like to retain your services as a Licensed Orthotist on an as-needed, independent contractor basis, to ensure that our customers, who have already been prescribed, sold, and received the necessary LSO, are able to correctly fit and adjust it for proper use in compliance with the requirements mandated by the CMS regarding supplying L0631 LSO. As an independent contractor your obligations would be to see the customer and simply fit and adjust the LSO on him or her within seven (7) business days of being contacted by (our company), as well as complete and return a form (via fax or email to orthotist@company email address.com), that you would compose, evidencing that you saw the customer and that the LSO was fit and adjusted by you. If, for some reason, the customer requires a different size LSO, please inform me have the customer return the LSO, and a new LSO will be shipped out immediately, at no cost to you or the customer. Within twenty-four (24) to forty-eight (48) hours after the receipt of the form evidencing that you have fit the LSO to our customer, (Company Name) will send you a check in the amount of $25.00 as compensation for services rendered.”

Many of the members who received mail, faxes, emails, and phone calls from this company have contacted AOPA with the impression that this company had already secured a successful bid agreement with CMS for O&P products.

FACT: At press time, no Round Two competitive-bidding announcement or product list relating to orthotics and prosthetics has been issued by CMS. So, no company has secured a successful bid agreement with CMS for O&P products.

When orthotists consider such proposals, they should to be aware of the statutory definition of OTS devices, because this term applies to any competitive-bidding program CMS chooses to pursue for orthotics and prosthetics. Several years ago, Congress granted CMS authority to competitively bid OTS orthotics, provided these “off-the-shelf” orthotics fall within this definition: 34

O&P ALMANAC JULY 2011

Social Security Act section 1847(a)(2)(C) states: “(C) OFF-THE-SHELF ORTHOTICS.—Orthotics described in section 1861(s)(9) for which payment would otherwise be made under section 1834(h) which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit to the individual.”

The circumstances described in the above narrative appear significantly different from traditional O&P patient-care relationships. Bidding companies, such as the one that generated the communication above, may think they are bolstering their competitive-bidding position if they assemble and can point to a network of independent contractors that can address patient-care needs. It should be noted that CMS rules do not limit the use of subcontractors other than they must meet the supplier and quality standards.

However, one must wonder how consistent such a “patient relationship” is with the limitations in the above definition of OTS orthotics. In short, isn’t the need for “an independent contractor…to see the customer and simply fit and adjust the LSO on him or her…” a strong indication that this device actually falls outside the “minimal self-adjustment” criteria stipulated in the above statutory definition of “off-the-shelf orthotics,” and therefore that the device falls outside those authorized for competitive bidding because it requires “trimming, bending, molding, assembling, or customizing to fit the individual”?

AOPA believes that the need for a patient relationship is the differentiating criteria. For a device to qualify as an OTS device, there cannot be the need for any patient encounter related to fitting the device. Conversely, the need for an encounter between an orthotist and the patient demonstrates unequivocally that the device requires more than “minimal self-adjustment.” Therefore, it does not meet the definition of an off-the-shelf orthotic device and cannot be legally included by CMS within competitive bidding.

Further, AOPA believes that outreaches such as the communication from the potential bidding firm outlined above amount to “brokering” patient relationships. They are excellent examples of how far afield an overly aggressive CMS view of what constitutes “off-the-shelf” orthotics could take the traditional, long-term patient relationship, which is customary for patients with lifelong conditions such as multiple sclerosis, cerebral palsy, and spina bifida.

In the weeks and months ahead, we expect all of our patient-care facility members will see—and need to evaluate the merits of—many more similar business opportunities.

AOPA Debuts Hard-Hitting PSA AOPA is committed to educating politicians on how legislation affects O&P practitioners and patients with limb loss or chronic limb impairment. Most recently, the organization funded a public service announcement (PSA) that conveys the devastating effects on Medicaid beneficiaries over the age of 21 if states were to eliminate their orthotic or prosthetic coverage. Several states are considering such bills to compensate for budget deficits.

The 30-second message, which was released in partnership with the Amputee Coalition, is AOPA’s first TV PSA. Shot in black and white from the perspective of surveillance camera inside a government agency, the ad features a voice-over describing how state Medicaid budgets for O&P devices are being cut. Actor and amputee John Siciliano stars in the ad as a man removing his prosthetic leg and surrendering it—and his mobility—to government officials. The PSA will hopefully be picked up by major cable channels across the country.

Tom Fise, executive director of AOPA, explains the intent

Scenes from AOPA’s first TV PSA

of the ad was to provoke a strong response from audiences.

“We hope that this hammers home to ordinary citizens the message, ‘I knew the economy is bad, and that our states have been in serious budgetary crisis...I just didn’t know that things have gotten so bad that states are talking about taking artificial limbs away from amputees!’”

President and CEO of the Amputee Coalition Kendra Calhoun agrees. She says the PSA expresses a very strong message and addresses a key problem in many states.

“Prosthetic devices are critical to helping amputees, and coverage should not be cut,” Calhoun says. “I hope we raise awareness of the critically important role that Medicaid coverage plays in providing prosthetics for amputees.”

The ad also will run on the Amputee Coalition’s billboard in Times Square, located at 47th and Broadway, through July 3 and is expected to make 150 million impressions, according to Calhoun.

Visit www.LimbsAreEssential.org or www.AOPAnet.org to view the PSA.

AOPA Challenges ‘Essential Health Benefit’ Definition O&P services should be considered an essential health benefit, AOPA argued in a letter to Kathleen Sebelius, secretary of Health and Human Services (HHS), and Hilda Solis, secretary of labor. The letter and accompanying materials were in response to a Department of Labor report Secretary Kathleen Sebelius issued to HHS as part of the HHS effort to define “essential health benefit” under the new health-care reform law.

The Department of Labor report speculated that approximately 50 percent of employer-health insurance plans provided coverage for orthotics and prosthetics. AOPA argued that the number of plans that offer such coverage is much higher.

AOPA’s response cited two major problems in the report.

First, the report detailed search results for the coverage of orthotics and prosthetics by using a superficial and limited set of search terms. AOPA argued that a more robust and accurate set of search parameters would have made it more apparent that a high number of private employer health

plans cover O&P. Second, AOPA noted that the Department of Labor did not conduct a current survey of employer health plans.

Instead, it relied on historical data that was collected only from employers (and not from insurers) on a voluntary basis.

As a result, AOPA said, there is no way to know if the information is a complete or accurate representation of employer health insurance plans.

The materials AOPA submitted contained a background study by the Society for Human Resource Management (SHRM) on this same question. The SHRM study found that approximately 75 percent of employer plans offer O&P coverage. Also included were a letter from Rep. Rob Andrews (D-New Jersey), who supports including O&P as an essential health benefit, and similar supportive statements in the Congressional Record by Reps. George Miller (D-California) and Bill Pascrell Jr. (D-New Jersey).

The entire AOPA packet can be found at www.AOPAnet. org/AOPA_Sebelius_Package_042811.pdf.

AOPA will keep members abreast of continued interaction with HHS and the Department of Labor.

Questions? Contact Steven Rybicki at srybicki@AOPAnet. org or 571/431-0835.

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AOPA Headlines

Minnesota Commissioner Rallies Against Medicaid Cut

Completing the 2011 Survey Benefits the Field—and You

As state legislatures nationwide consider cuts to Medicaid programs, AOPA was notified of a Minnesota budget proposal that would “eliminate ‘optional’ services, including therapies, eyeglasses, and prosthetics.”

Members from various organiLucinda Jesson, commiszations have spoken out for O&P in sioner of Minnesota’s the state, and AOPA received news Department of Human that Lucinda Jesson, commissioner Services of Minnesota’s Department of Human Services, sent a letter to the Minnesota House and Senate expressing concerns over some budget proposals, including the one that would cut O&P. Commissioner Jesson wrote:

Proposal to eliminate “optional” services, including therapies, eyeglasses and prosthetics. Ending coverage for these services creates significant holes in coverage, especially for people with disabilities who often depend on Medical Assistance for much of their lives.

If optional services that help people to be more independent are eliminated, some people will substitute more expensive long-term care services such as home care assistance to meet their needs. Additionally, this proposal creates an incentive for people to go into a facility to receive therapy. Nursing homes and intermediate care facilities (that are obligated to meet people’s care needs) would have to provide therapies within their current rates.

Watch for the 2011 Operating Performance, Compensation and Benefits Report survey. By completing the questionnaire, you contribute to knowledge of the O&P field. And in return, you receive a free copy of the survey report, a customized report on your company, and an opportunity for a one-to-one consultation with Industry Insights, AOPA’s consulting experts.

Industry Insights has conducted this survey for almost a decade and has a wealth of experience in analyzing the data and providing “top performer” comparisons with your own performance. The lessons learned can be invaluable to your management decision-making process and represent useful benchmarking information for the O&P field.

Remember—all data are confidential and will be viewed only by Industry Insight consultants, who are bound by a confidentiality agreement.

The complete report is $295 for members and $425 for nonmembers. But why pay for this must-have information when you can get your own free copy, along with a company report that analyzes your business and qualifies you for a personal consultation?

View her letter to the Minnesota Legislature at www. mnprogressiveproject.com/upload/4.27.11%20HHS%20to%20 Conference%20Committee.pdf.

AOPA will continue to monitor the ongoing Minnesota budget process and keep members updated.

Questions? Contact Steven Rybicki at srybicki@AOPAnet. org or 571/431-0835.

In odd-number years such as 2011, the annual report is expanded to include not only operating data, but also the all-important compensation and benefits information.

This is the year for reporting the entire package to get the full benefit of your free report, analysis, and personal consultation.

Leading this project are AOPA members Mike Hamontree (chair), and Candy Carlson, Bob Leimkuehler, Jim Weber, and Craig Wright. They are joined by Industry Insight experts Michael Becher and Scott Hackworth.

Questions? Contact Steven Rybicki at srybicki@AOPAnet. org or 571/431-0835.

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O&P ALMANAC JULY 2011

3 Ways

to participate

1. Complete the hard-copy questionnaire and return it to Industry Insights.

2. Go to www.AOPA-Survey.com for the convenient save-and-return way to provide your data.

3. Send your financial statements for data entry to Industry Insights.

Record Number of Visits For 2011 Policy Forum Telling the O&P story got a big boost at the 2011 AOPA Policy Forum, April 11-12, when members attended a record number of visits on Capitol Hill. More than 100 AOPA members attended two to eight meetings each, for a total of 413 meetings with Congressional members and staff. These annual visits make huge contributions toward deepening understanding and appreciation for the difference O&P services can make in the lives of patients.

Last year’s Policy Forum entailed 232 separate meetings with legislative decision makers.

During the 2011 visits, AOPA members were given a set of talking points to use, and recounted anecdotal experiences as patient-care providers and asked for support on specific issues. They drove home the message that their work often helps patients achieve a quality of life that allows them to reach their maximum potential.

For a copy of the talking points and participant materials and to see videos of the sessions during the first day of the Policy Forum, please visit www.AOPAnet.org and click on the “Policy Forum ” button.

JULY 2011 O&P ALMANAC

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AOPA Headlines • educating your staff on OSHA compliance • properly reporting workplace injuries or incidents.

Maintain Your Compliance With OSHA Regulations The federal Occupational Safety and Health Administration (OSHA) ensures workplace health and safety in the United States. Compliance with OSHA regulations is mandatory, and failure to comply may lead to unnecessary and dangerous working conditions.

Join AOPA on July 13, 2011, for an hour-long telephone audio conference, “Don’t Rile the OSHA Police.” The conference will address OSHA requirements for O&P facilities and why compliance is such an important part of your business operations.

An AOPA expert will discuss the following issues: • understanding OSHA and how it affects your facility’s operations • complying with OSHA regulations • correcting issues of noncompliance • responding to an OSHA inspection at your facility

The audio conference, which will include an interactive question-and-answer period, has been approved for 1.5 continuing education credits through the ABC and BOC. Cost for members is just $99 ($199 nonmembers) per line, and as many people as you like can listen on that line.

Listeners can earn 1.5 continuing education credits each by returning the provided quiz within 30 days and scoring at least 80 percent. All audio conferences begin at 1 p.m. EST. Questions? Contact Ann Davis at adavis@AOPAnet.org or 571/431-0876. a

Brandon Barth

IN MEMORIAM

Brandon Barth, a resident working at Hanger Prosthetics and Orthotics Phoenix office, died April 9. He was 26. Barth was training to become a certified orthotist.

The family has requested donations be made to the Brandon Barth Memorial Fund, a Wells Fargo account the family will use to collect donations and distribute to charitable causes. Donations can be made directly at any Wells Fargo bank or by checks payable to the Brandon Barth Memorial Fund.

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AOPA Applications

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

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

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million

Dallas Prosthetics Inc. 7700 San Jacinto Place, Ste. 200 Plano, TX 75024 469/241-1477 Fax: 469/241-1433 Category: Patient Care Facility Ronald Nelson, CP

Eastern Shore Orthotics & Prosthetics Inc. 761-A Middle Street Fairhope, AL 36532 251/990-4040 Fax: 251/990-0594 Category: Patient Care Facility Chad Myers, CO, LO

AOPA PRESENTS

Horvath Medical Supply Inc.

The Surgical Clinic PLLC

9930 Johnny Cake Ridge Road, Unit 1C Concord, OH 44060 440/423-1921 Fax: 440/423-1522 Category: Patient Care Facility Frank Horvath, BOCP, CP, RFO, CFO

356 24th Avenue N., Ste. 300 Nashville, TN 37203 615/301-5264 Fax: 615/320-3662 Category: Patient Care Facility Joshua Fann, CP

Lighthouse Orthotics & Prosthetics 1786 Baker Drive San Angelo, TX 76905 325/223-6380 Category: Patient Care Facility David Light, CPO

Pine Tree Orthopedic Lab Inc. 175 Park Street Livermore Falls, ME 04254 207/897-5558 Fax: 207/897-1117 Category: Supplier Level 1 Maghan Wells, C.Ped.

Quorum Orthopedics Inc. 561 Garden Drive, Ste. H Windsor, CO 80550 970/686-2266 Fax: 970/686-8823 Category: Patient Care Facility Joe Johnson, CP

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O&P ALMANAC JULY 2011

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Total Care Orthotics & Prosthetics LLC 6565 S. Yale, Ste. 901 Tulsa, OK 74136 918/502-5975 Fax: 918/502-5980 Category: Patient Care Facility John Brest, CO, C.Ped.

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Marketplace

APIS FOOTWEAR COMPANY Apis is devoted to offering our customers high-quality, genuine leather Diabetic/ Therapeutic footwear off the shelf or custom-made, comfortable accommodative orthotics custom made for your patient using top-quality materials, value added services include: guaranteed fit for custom-made shoes, shoe modification services, free foam boxes, free samples and a no-hassle return policy, large inventory, and quick turnaround. Together with your support and our continuous efforts, Apis Footwear Company is striving to become the one-stop shop for all your therapeutic footwear needs.

Please call our friendly customer service at 888/937-2747, or visit www. bignwideshoes.com.

THE TRIBUTE® FOOT FROM COLLEGE PARK The Tribute® delivers dependable performance in an economical package. The true multi-axial design and precision Gait Match provides the user better control and stability. The full-length toe lever and a low-frequency response are ideal for people that require firm footing on varied terrain. The Tribute® is an ideal solution for initial fittings and low to moderate impact users. Key features include: • True multi-axial function with transverse rotation for natural feeling performance • Adjustable Stride Control™ offers fine adjustment to match any individual’s gait

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O&P ALMANAC JULY 2011

• Full-length toe lever with low frequency dynamic response • Scaled design allows for more natural proportions for improved cosmetic appearance • Same-day, custom built-to-order.

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

EURO INTERNATIONAL’S PLUTO Euro International’s brand new and very attractive wound care shoe PLUTO, a forefoot relief shoe from Streifeneder ortho.production, is not even on the market yet, but already a hit. PLUTO was specifically designed for individuals lacking the capacity to stand properly and walk stable (e.g., vertigo, blindness, etc.) amongst a variety of other indications it can be used for. PLUTO is available in shoe sizes 35 – 50 and a 49/50 in double sizes. The forefoot protection cap is enhanced, and gets approximately 20 mm more volume in the toe area than other shoe of its kind.

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

ElementDS FOOT SYSTEM, AN EMOTIS DESIGN The ElementDS adds the DuraShock function to the Element’s performance to create the lowest profile shank-foot system available.

• Smooth rollover and superior stability • Vertical shock and 60 degrees of axial rotation • Innovative Micro-Slice technology for multi-axial performance • Durable, passed the ISO-22675 test standard • Rated for patients up to 275 lbs (125 kg) • Low-profile design–– 6.5 in. build height.

For more information and ordering, please contact Fillauer LLC at 800/251-6398 or visit our website at www.fillauer.com.

KISS TRAINERS––DYNAMIC FLEXIBLE KEEL STUBBIE FEET

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

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

STEALTH PRO™––PDAC APPROVED L0631

OPTEC is proud to present our new Stealth PRO, which is ideal for patients requiring firm support. The Stealth’s revolutionary intercrossing strapping system, along with the anterior opening design, combines with a rigid back panel to provide spinal stabilization from the sacrococcygeal junction to T9 vertebra. The Stealth PRO back panel attaches to the Stealth brace with our secure elastic suspender, which ensures the same fit every time with no rotation of either component when donning. PDAC recently approved both the Stealth PRO2 and Stealth PRO4 for HCPCS code L0631.

Find out more about this and our many other products online at www.optecusa.com or call us today at 888/982-8181! Don’t forget to visit us at AOPA, Las Vegas Booth 311!

OPTEC USA––EZ STEP ™ LEATHER ANKLE GAUNTLET OPTEC EZ Step Leather Ankle Gauntlet continues the pattern of innovation and excellence catered to your needs. The EZ Step’s custom fabrication combines incomparable comfort with unparalleled control, helping to make each step easier than the last.

Key features include: • Unsurpassed craftsmanship and professionalism • Premium leather outer shell with soft, comfortable, padded leather lining

• Thin, durable, polymer ankle and foot stabilizer • Less bulky and rigid than traditional gauntlets • Multiple closure systems for easy donning and doffing.

For more information on OPTEC EZ-Step ™ Leather Ankle Gauntlet or our other products, please call customer service at 888/982-8181 or visit us at www.optecusa.com. Don’t forget to visit us at AOPA, Las Vegas Booth 311!

FOR UNMATCHED VERTICAL SHOCK AND ROTATION TRY ÖSSUR’S NEW RE-FLEX ROTATE™ TODAY! Re-Flex Rotate with EVO boasts the most vertical travel of any vertical

shock and rotation foot on the market today. A titanium spring provides over 1/2 in. of vertical travel and gives the foot a lightweight, responsive feel. Torsion cell technology provides smooth, progressive rotation with no abrupt stops. The EVO feature promotes a smoother, more comfortable rollover while increasing stability in stance.

This unmatched combination makes Re-Flex Rotate the ideal solution for low to high impact patients who can benefit from vertical shock and rotation.

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

DYCOR Renewing Independent Lifestyles HD‐FDS Foot

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

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

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

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

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ATTEND THE PREMIER O&P EVENT OF THE YEAR: THE 2011 AOPA NATIONAL ASSEMBLY We look forward to seeing you at the AOPA 2011 National Assembly September 19-22, 2011, at The Mirage Resort & Casino in Las Vegas!

THE MIRAGE—THE PLACE TO BE FOR THE PREMIER O&P EDUCATION EVENT OF THE YEAR! •

Exceptional $135 room rate at The Mirage Resort & Casino— AAA-Four Diamond Resort

•

Unprecedented business education featuring experts in health-care reform, documentation, O&P business management, ethics, different business models, new round table discussions and more.

•

Experience the country’s largest and oldest trade show for the orthotics, prosthetics, and pedorthics profession.

[ THE E C E PLTA OB

•

34 Continuing Education (CE) Credits available.

•

Scientific programs featuring an extensive symposium on treating spinal trauma with live demonstrations and futuristic topics such as osseo integration, robotics, stroke management, wound care, and material science.

•

Fabulous shopping, entertainment, championship golf, and unparalleled people watching—all of this right in the heart of the Las Vegas Strip!

SAVE THE DATE SEPTEMBER 19-22, 2011

]

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

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Marketplace

NEW! RE-DESIGNED E-MAG ACTIVE KAFO: TAKE A STEP IN THE RIGHT DIRECTION! New feature allows patients to temporarily deactivate the locking function— great for biking or physical therapy!

The integrated, low-profile joint provides the best in electronic stance control and helps patients achieve a more active lifestyle.

Simple onboard programming helps the E-MAG Active calibrate itself to the user’s unique gait pattern, adding a whole new dimension of functionality for people who previously have had limited bracing options, such as a locked knee or manual device. Help your patients get back into the swing of things with the E-MAG Active!

Contact your sales representative at 800/328-4058 or visit www.ottobockus.com.

THE LATEST INNOVATION IN FLEXIBLE SOCKET MATERIAL POLYTOL®—BACKED BY EXPERT FABRICATION A flexible socket made with Otto Bock’s breakthrough PolyTol® material contours to the body with exceptional, long-lasting elasticity.

PolyTol is easy on your patient’s skin, with no irritating or allergenic components. The material offers good moisture absorption and skin adhesion for an intimate and comfortable fit.

As the clinician, you also have the advantage of Otto Bock’s fabrication staff, experts who work with PolyTol every day and can give you just what you ordered, right when you need it, and at a cost with no surprises.

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

FLEXION CONTROL ANKLE JOINT FROM PEL SUPPLY Made in the USA of highquality, stainless steel, the FC2 Flexion Control Ankle Joint is manufactured by Lower Extremity Technology, Inc. It is heat treated for strength and has a 185 lb. weight limit. According to the manufacturer, a key feature is the joint’s spherical axis that allows the ball and socket to work with the ankle joint for 26 degrees of adjustability. In addition, anterior-posterior set screws offer infinite positioning of up to 70 degrees. The orthosis can be adjusted while the patient is wearing it.

Available from PEL Supply, the FC2 is pre-contoured so that fabrication time is substantially reduced. It also offers a self-squaring molding dummy to further save fabrication time.

For information on the FC2 or any quality fabrication products, contact PEL at 800/321-1264, by fax 800/2226176, or email customerservice@ pelsupply.com. Visit www.pelsupply.com.

MICROPROCESSOR KNEE SYSTEM FROM PEL SUPPLY The REL-K™ (Rizzoli Electronic Knee) is the latest generation of microprocessor knees which promises amputees the ability to navigate their environment simply and easily. With six modes of control, the patient can walk, run, negotiate slopes, climb stairs, or ride a bicycle. An innovative position and load-sensor system samples angular position, velocity, and knee loads at 1,000 times per second. The REL-K® instantly works in concert with the

patient and adjusts itself for optimum performance. Because the load sensor is located proximally, most foot and pylon combinations can be used.

Unlike other microprocessor knees that restrict ankle and foot combinations, the REL-K—a Fillauer LLC exclusive in the US market—is adaptable to a variety of foot and ankle components.

For more information on the REL-K and other innovative new products from the Fillauer Companies, call your friendly PEL Customer Service Rep at 800/321-1264, fax 800/222-6176, email customerservice@pelsupply.com or order online at www.pelsupply.com.

LOCKING LANYARD BY WILLOWWOOD The Alpha® Lanyard includes suction with a one-way air expulsion valve, plus a locking mechanism. The product’s design features an easy release mechanism, and is available with or without a titanium pyramid.

The lanyard is part of the Alpha Interlock™ Suspension System that permits clinicians to interchange suspension methods without remaking a socket. The Lanyard may be used in laminated or thermoplastic sockets and has a simple fabrication process.

The weight limit is 250 lbs. The lanyard comes with a one-year warranty.

For more information, please contact WillowWood at 800/848-4930 or visit willowwoodco.com. a

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Jobs

INCREASE EXPOSURE AND SAVE!

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

North Central Certified Prosthetist/Orthotist, Certified Orthotist, Board Certified Prosthetist Privately owned practice with a 50-year track record has an immediate opening in our large, Midwest facility. We’re looking for an orthotist or prosthetist who is good with patients, familiar with the latest technology, aggressive with patient care, and motivated to help us market our facility.

We offer a competitive salary and health benefits. Send resume to:

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

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

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

1/2 page, color

$482 $678 $634 $830

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

No orders or cancellations are taken by phone.

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

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

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

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

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O&P ALMANAC JULY 2011

Fax: 317/858-3146 Email: mhcbl@aol.com

Staff Orthotics/Prosthetics Practitioner Minneapolis/St. Paul, Minnesota Full-time opening for a staff orthotics/prosthetics practitioner in the Rehabilitation Services Department of Fairview Orthotics & Prosthetics. The CPO will provide orthotic/ prosthetic services mainly in our St. Paul location, but may work in other metro area locations as needed. Duties include evaluation, fitting, and modification of orthotic/ prosthetic devices. Qualifications: bachelor’s degree and an orthotics/prosthetics practitioner degree required. Must be board eligible for certification from the American Board of Certification (ABC). Must be certified by the ABC in orthotics and prosthetics within one year of hire date. We offer competitive compensation with the flexibility to select benefits that best fit you and your family’s needs. Apply online at fairview.org/careers and search by Job # 11-35304.

EEO/AA.

fairview.org/careers

ABC Certified Prosthetist/Orthotist St. Louis Privately owned, rapidly growing practice located in St. Louis has an opening for a certified prosthetist/orthotist.

This is a great opportunity for someone looking to become part of a motivated, successful team. We offer a competitive compensation package including health care, 401(k), and profit sharing. Send resume to:

Premier Prosthetics and Orthotics Richard Doerr 633 Emerson Road St. Louis, MO 63141 Fax: 314/743-3575 Email: Richard.Doerr@premierpando.com

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Northeast Orthotic Technician Mid-Hudson Valley, New York Established and independently owned O&P company has an immediate opening for a motivated and skilled technician.

Must be able to learn new fabrication techniques quickly and keep pace with a busy workload. Three or more years experience preferred. Great work environment, wages, and benefits, please fax resume to:

Jobs

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

Send resume to:

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

ATTN: Job Board Fax: 571/431-0899

JULY 2011 O&P ALMANAC

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Jobs

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Certified Prosthetist/Orthotist

Mid-Atlantic Certified Orthotist Philadelphia Full-time certified orthotist wanted for a hospital-based practice in the Philadelphia suburbs. Competitive salary and benefits package. Reply in confidence to:

Phone: 215/576-1888 Email: sbrennan@alliedoandp.com

Certified Orthotist (or Eligible) and/or Credentialed Orthotic Fitter Southwest Ohio Immediate opening in Cincinnati area, with an accredited, privately owned facility. Offering competitive salary, bonus, and education/license reimbursement. Candidate shall be expected to be involved in daily office activities and clinical interactions. Send resume to:

Kempf Surgical Appliances Email: Stephenrkempf@aol.com

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

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

AVAILABLE POSITIONS Orthotist

Why do I work for Hanger?

“

I like working for a company that cares for its employees as much as they care for their patients. That’s why I’ve been with Hanger for the past 28 years.

When Hurricane Katrina hit my hometown of New Orleans, Hanger was there for me. They gave me as much time as I needed—with pay—and helped me relocate to Atlanta.

By working at the largest prosthetic and orthotic company in the nation, I have more than just career opportunities.

I have an employer that treats me like family.

”

Tony Thaxton Jr., CPO, LPO, Certified Practitioner, Orthotist-Prosthetist

Frisco, CO Pensacola, FL Griffin, GA Belleville, IL Joliet, IL Mt. Vernon, IL Urbana, IL

Prosthetist American Canyon / Fairfield, CA Port St. Lucie / Melbourne, FL Hazel Crest, IL Jackson, MS St. Louis, MO

Hanger Orthopedic Group, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any

other basis prohibited by federal, state or local law. Residency Program or Certificate Primary Education Program Info, contact: Robert S. Lin, CPO/Dir. of Academic Programs. Hanger P&O/ Newington O&P Systems, Ph. 860.667.5304; Fax 860.667.1719

Albany, NY Elmira, NY Oneonta, NY Enid, OK Pittsburgh, PA Austin, TX

Prosthetist/Orthotist Springdale, AR American Canyon / Fairfield, CA Long Beach, CA Pensacola, FL Dubuque, IA Indianapolis, IN Bangor, ME

Denver, CO Belleville, IL Mt. Vernon, IL St. Louis, MO

To apply for any of these positions, visit www.hanger.com/careers

Evansville, IN Indianapolis, IN Paducah, KY Tahlequah, OK York, PA Spartanburg / Union, SC Houston, TX

Baltimore, MD Brooklyn, NY Bend, OR Salem, OR Philadelphia, PA Memphis, TN Houston, TX

Certified Pedorthist

Tahlequah, OK Olympia / Vancouver, WA Tacoma / Renton, WA

Orthotic Fitter Olympia/ Vancouver, WA

Orthotist/Certified Pedorthist

Mt. Vernon, IL St. Louis, MO

Tahlequah, OK

Area Practice Manager Hollywood, FL

Naples, FL JULY 2011 O&P ALMANAC

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Jobs Inter-Mountain Certified Orthotist, Certified Prosthetist (licensed or eligible)

Come Join Our Team!

Shriners Hospitals for Children® is a one-of-a-kind international system of 22 hospitals dedicated to improving the lives of children by providing specialty pediatric care, innovative research, and outstanding teaching programs. Children up to age 18 with orthpaedic conditions, spinal cord injuries, and limb deficiencies are eligible for admission, care, and treatment regardless of financial need or relationship to a Shriner.

With recent program development and an expanding operative schedule, we are anticipating a need to expand our O&P service to meet the need of our patients and hospital.

O&P Practitioner Works with a multi-disciplinary care team to determine, design, fabricate, fit, and evaluate the effectiveness of orthoses and prostheses for children with orthopedic impairments, spinal cord injuries, and limb deficiencies. Engages in evidence-based practice related to the field of orthotics, prosthetics, neuroprosthetics, and rehabilitation. Supports and actively engages in performance improvement initiatives and research.

Undergraduate degree in O&P, allied health field, engineering, kinesiology, biology, or biomechanics preferred. Experience in prosthetics and/or orthotics as evidenced by successful completion of an accredited prosthetic and/or orthotic program with certification by the American Board for Certification in Orthotics and Prosthetics. At least three years of experience preferred. Strong interest in working with children and families is a must.

Call, fax, or email inquires to:

Megan Hauser Shriners Hospitals for Children®-Philadelphia 3551 North Broad Street Philadelphia, PA 19140 Phone: 215/430-4061 Fax: 215/430-4180 Email: hr_phila@shrinenet.org

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O&P ALMANAC JULY 2011

Houston Energy capital of the world; voted first in Texas and third in the U.S. for “Best Places for Business and Careers”; known for the youngest population in the nation; the Houston Livestock Show and Rodeo; ZZ Top, Lyle Lovett, Clint Black, Hilary Duff, Blue October; NASA’s Lyndon B. Johnson Space Center; many parks and outdoor venues! Considered by many to be one of the premier practices in the country, this position will challenge the successful applicant with a broad exposure to a diverse patient population. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign on bonus potential…plus much more! To apply for this position, please contact, in confidence:

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

Certified Prosthetist, Certified Prosthetist/ Orthotist, Orthotic/Prosthetic Technician Nevada ABC accredited, privately owned O&P firm with three offices seeking experienced practitioner, skilled technician.

Competitive salary and benefits. Send resume to:

Tony Gorgun 2650 N. Tenaya Way, Suite 210 Las Vegas, NV 89128 Phone: 702/256-5265 Fax: 702/256-5205 Email: aponv@aol.com

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Pacific Operations Manager Honolulu Established and privately owned DME/O&P company has an immediate opening for an operations manager with a business administration/finance degree, minimum 5 years medical/management experience, and billing knowledge in DME/O&P. Responsible for the daily operations, managing/ training staff, sales and marketing, working with clinicians, developing policies/procedures, and compliance for continued national accreditation. Salary to commensurate with experience. Email or fax resume to:

Fax: 808/791-1025 Email: leslie@crnewton.com

Jobs

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

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

Contact, in confidence:

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

TERRITORY MANAGERS Arizona (Phoenix) Colorado/Utah Florida (Orlando) Ohio (Columbus/Cincinnati) New York (Albany) Northern California (Sacramento) Trulife, a global manufacturer of post mastectomy, orthopedic, prosthetic, and physical-rehab products, is seeking experienced Territory Managers responsible for sales, servicing, and promotion of new and existing product lines to all direct and distributor accounts in a multi-state territory. Must also perform administrative duties and provide special field data to inside personnel.

The ideal candidate must have Bachelor’s degree in business, medical science or related field or comparable work experience, and 3+ years as a successful external sales manager. Must be competent in the use of Microsoft Office products. Must be able to travel up to 80 percent.

Trulife offers a competitive salary plus commission; health, dental and vision insurance; and 401(k).

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

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

Discover Marshfield, Wisconsin & enjoy:

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

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

Experience in Pediatrics would be helpful.

Join us and see how your career can shine.

To apply, please visit:

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

Please submit resume to: employment@trulife.us Or fax 360/697-1952 JULY 2011 O&P ALMANAC

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Calendar

2011 ■■ JULY 13 AOPA Audio Conference: “Don’t Rile the OSHA Police.” To register, contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

■■

PROMOTE EVENTS IN THE O&P ALMANAC

JULY 13 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5:00 – 6:00 pm ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■

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

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

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

$678 $830

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

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

For information on continuing education credits, contact the sponsor.

Questions?

Email srybicki@AOPAnet.org.

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O&P ALMANAC JULY 2011

■■ JULY 14-15 Two Day RCR Workshop: A comfortable hands on format of the RCR Transtibial socket design. Boise, ID. The RCR socket increases patient comfort, rotational control, and range of motion.

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

■■ JULY 14-16 The Florida Chapter AAOP Annual Scientific Symposium.

Orlando. Hyatt Regency Grand Cypress. For more information, visit www.oandp. org/membership/chapters/florida/.

■■ JULY 15 Bio-Mechanical Composites, Inc: Florida Chapter of AAOP Educational Program Presentation. Orlando.

Custom Engineering of Energy Storing AFO’s and Partial Foot Prostheses utilizing Pre-Preg Carbon Fiber.

■■ JULY 16 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9:00 – 10:00 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™ technology. Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ JULY 18-19 Reciprocal Gait Orthosis Advanced Seminar.

Chattanooga, TN. Fillauer LLC and Center for Orthotics Design hosts a seminar on the Reciprocal Gait Orthosis.

Be a part of the team that enables a spinal cord injury or congenital birth defect patients to leave their wheelchair and walk with a natural gait, regain independence, and make a difference in their lives. Contact Nicki Cantrell at 800/251-6398 or ncantrell@ fillauer.com.

■■ JULY 20 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

Credits: 2.5 ABC/2.5 BOC. Visit www.willowwoodco.com.

■■ JULY 21-22 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Springfield, MA. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs. Contact 888/678-6548 or email: info@allardusa.com.

■■ JULY 26 Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ JULY 28 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ JULY 28-29 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

San Antonio. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. 18 CEUs. Contact 888/678-6548 or email: info@allardusa.com.

■■ JULY 28-29 WillowWood: Existing OMEGA® Tracer® Users Orthotics and Prosthetics Course. Mt. Sterling, OH. Advanced course covers OMEGA Scanner use, modifying orthotic and prosthetic shapes, and review of custom liner, cranial, and spinal software. Must be current OMEGA Tracer facility to attend. Credits: 14.25 ABC/15.5 BOC. Visit www.willowwoodco.com.

■■ AUGUST 3 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8:00 – 9:00 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Register at www.ultraflexsystems. com or call 800/220-6670.

AUGUST 5 Bio-Mechanical Composites, Inc. Texas Chapter of AAOP Educational Program Qualifying Workshop.

Austin. Custom Engineering of Energy Storing AFO’s and Partial Foot Prostheses utilizing Pre-Preg Carbon Fiber.

■■

■■ AUGUST 3 One Day RCR workshop.

Flint, MI. A condensed version of the RCR socket design workshop. Features a live casting, fabricating, and a fitting of an amputee.

Multiple suspension options are covered. Contact Miranda Johnson, Coyote Design & Mfg., at 208/429-0026.

■■ AUGUST 3 Advanced Lower Extremity Prosthetic Design Seminar.

Baltimore. The seminar will examine the development of current composite dynamic foot and microprocessor knee systems with respect to biomechanics, physiologic function, and functional design classification. Attendees will receive hands-on demonstrations that allow them to experience the new feet and knee designs firsthand. Please contact Nicki Cantrell at 800/251-6398 or ncantrell@fillauer.com.

■■ AUGUST 5-6 The Texas Chapter AAOP Annual Meeting. Austin.

Sheraton Austin Hotel at the Capitol. For more information, visit www.oandp.org/ membership/chapters/texas/.

■■ AUGUST 10 AOPA Audio Conference: “How to Get Paid for Miscellaneous and Repair Codes.” To register, contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

■■ AUGUST 11 Bio-Mechanical Composites, Inc. Custom Engineering of Energy Storing AFO’s and Partial Foot Prostheses Utilizing Pre-Preg Carbon Fiber Qualifying Workshop.

Orlando. 7.25 ABC credits.

Contact Agnes Curran, CP, at 515/554-6132 or agnes@ phatbraces.com.

■■ AUGUST 11-12 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Ft. Lauderdale, FL. Two

courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. Approved for 18 CEUs. Contact 888/678-6548; email: info@allardusa.com.

■■ AUGUST 13 Arizona AFO Inc.: The Custom AFO Workshop.

Atlanta. Learn L-Coding, AFO selection, hands-on casting, footwear/modification tips, and ideas for marketing to referral sources. The $150 fee includes lectures, handouts, and lunch. Approved for 6.5 ABC/7 BOC CEUs. To register, call 877/780-8382, ask for the “Workshop” or email education@arizonaafo.com.

■■ AUGUST 16 WillowWood: Discover LimbLogic® VS via WebEx, 10:30 am ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/ 2.5 BOC. To register online, visit www.willowwoodco.com.

■■ AUGUST 18 WillowWood: LimbLogic® VS Applications Practitioner Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline: 7/28/2011. Contact 877/665-5443 or visit www. willowwoodco.com.

■■ AUGUST 19 Advanced Lower Extremity Prosthetic Design Seminar.

St. Louis. The seminar will examine the development of current composite dynamic foot and microprocessor knee systems with respect to

biomechanics, physiologic function, and functional design classification.

Attendees will receive handson demonstrations that allow them to experience the new feet and knee designs first hand. Please contact Nicki Cantrell at 800/251-6398 or ncantrell@fillauer.com.

■■ AUGUST 19 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting.

Fabricate sockets following recommended techniques for airtight socket designs.

Credits: 9.75 ABC/9.75 BOC. Registration deadline: 7/28/2011. Contact: 877/665-5443 or visit www. willowwoodco.com.

■■ AUGUST 25-26 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Madison, WI. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. Approved for 18 CEUs. Contact 888/678-6548 or email info@allardusa.com.

AUGUST 25 – 26 Two Day RCR Workshop.

Boise, ID. A comfortable hands on format of the RCR Transtibial socket design. The RCR socket increases patient comfort, rotational control and range of motion. Workshop features the fitting of suction pin suspension as well as vacuum pin suspension.

Contact Miranda Johnson, Coyote Design & Mfg., at 208/429-0026.

■■

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Calendar

■■ AUGUST 25-26 WillowWood: Existing OMEGA® Tracer® Users Prosthetics and Orthotics Course. Mt. Sterling, OH. Advanced course covers OMEGA Scanner use, modifying orthotic and prosthetic shapes, and review of custom liner, cranial, and spinal software. Must be current OMEGA Tracer facility to attend. Credits: 14.25 ABC/15.5 BOC. Visit www.willowwoodco.com.

AUGUST 30 One Day RCR workshop.

Tampa, FL. A condensed version of the RCR socket design workshop. Features a live casting, fabricating, and a fitting of an amputee.

Multiple suspension options are covered. Contact Miranda Johnson, Coyote Design & Mfg., at 208/429-0026.

■■

■■ SEPTEMBER 8-9 The Northern Plains Chapter AAOP Annual Meeting.

Vadnais Heights, MN. Jimmy’s Conference & Catering Center.

For more information, visit www.oandp.org/membership/ chapters/northern_plains/.

■■ SEPTEMBER 12-13 Allard USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Norfolk, VA. Two courses: Concepts in Applied Biomechanics; Transferring CAB Principles into Customized Orthotic Solutions. Approved for 18 CEUs. Contact 888/678-6548 or email info@allardusa.com.

■■ SEPTEMBER 14 AOPA Audio Conference: “Don’t Run Afoul of the KO Rules.” To register, contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

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O&P ALMANAC JULY 2011

■■ SEPTEMBER 19 Bio-Mechanical Composites, Inc. AOPA National Assembly Technical Workshop. Las Vegas. Mirage Hotel. Custom Engineering of Energy Storing AFO’s and Partial Foot Prostheses Utilizing Pre-Preg Carbon Fiber.

■■ SEPTEMBER 19–22 AOPA National Assembly.

Las Vegas. Mirage Hotel.

Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852, or koneill@AOPAnet.org.

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

■■

■■ OCTOBER 12 AOPA Audio Conference: “Developing Your Medicare Billing Compliance Plan.” To register, contact Ann Davis at 571/431-0876 or adavis@ AOPAnet.org.

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

Denver Renaissance Hotel.

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

For more information, visit www.usispo.org/skills_ for_life.asp.

■■ OCTOBER 15 Arizona AFO Inc.: The Custom AFO Workshop. San Jose, CA. Learn L-Coding, AFO selection, hands-on casting, footwear/modification and ideas for marketing to referral sources. The $150 fee includes lectures, handouts, and lunch.

Approved for 6.5 ABC/7 BOC CEUs. To register, call 877/7808382, ask for the “Workshop” or email education@arizonaafo. com.

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

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

■■ OCTOBER 20-21 Two Day RCR Workshop.

Boise, ID. A comfortable hands-on format of the RCR Transtibial socket design. The RCR socket increases patient comfort, rotational control, and range of motion. Workshop features the fitting of suction pin suspension as well as vacuum pin suspension.

Contact Miranda Johnson, Coyote Design & Mfg., at 208/429-0026.

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

Phoenix. Learn L-Coding, AFO selection, hands-on casting, footwear/modification tips, and ideas for marketing to referral sources. The $150 fee includes lectures, handouts, and lunch. Approved for 6.5 ABC/7 BOC CEUs. To register, call 877/780-8382, ask for the “Workshop” or email education@arizonaafo.com.

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

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

■■ DECEMBER 14 AOPA Audio Conference: “Are You Ready for the New Year? 2012 New Codes and Policies.” To register, contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org.

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

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

■■ NOVEMBER 9 AOPA Audio Conference: “Happy Holidays: Kickbacks and Gifts in O&P.” To register, contact Ann Davis at 571/4310876 or adavis@AOPAnet.org.

■■ NOVEMBER 12 The Academy’s 6th Annual Golf Invitational. Scottsdale, AZ. Contact Manisha Bhaskar at 202/380-3663, x 210, or mbhaskar@oandp.org.

2012 MARCH 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x 208 or dragusa@oandp.org.

■■

n

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

Hynes Convention Center.

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

Exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. To register, contact Ann Davis at 571/431-0876 or adavis@ AOPAnet.org.

2013 ■■ FEBRUARY 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x 208 or dragusa@oandp.org.

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

Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Ann Davis at 571/431-0876 or adavis@AOPAnet.org. a

Ad Index

COMPANY

PAGE

PHONE

WEBSITE

ALPS

39

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics

13

703/836-7114

www.abcop.org

Apis Footwear

48

888/937-2747

www.bigwideshoes.com

College Park Industries Inc.

17

800/728-7950

www.college-park.com

Complete Professional Office Services

38

810/629-6424

www.oandpoffice.com

DAW Industries

1

800/252-2828

www.daw-usa.com

Dr. Comfort

5, C3

800/556-5572

www.drcomfortdpm.com

Dycor

43

800/794-6099

www.dycormfg.com

Euro International

7

800/378-2480

www.eurointl.com

Ferrier Coupler Inc.

37

800/437-8597

www.ferrier.coupler.com

Fillauer Companies Inc.

15

800/251-6398

www.fillauercompanies.com

KISS Technologies LLC

41

410/663-5477

www.kiss-suspension.com

KNIT-RITE

2

800/821-3094

www.knitrite.com

OPTEC

8, 9

888/982-8181

www.optecusa.com

Össur Americas Inc.

C4

800/233-6263

www.ossur.com

Otto Bock HealthCare

C2

800/328-4058

www.ottobockus.com

PEL Supply Company

29

800/321-1264

www.pelsupply.com

®

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AOPA Answers

Dealing With Denials Answers to your questions regarding SNF and PECOS

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

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

Q:

I just received a denial for a vertical loading foot (L5987) for a patient who was in a Medicare Part A skilled nursing facility (SNF) stay. I thought prosthetic codes were exempt from SNF Prospective Payment System (PPS) and were billable directly to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC).

Should I file a redetermination request?

A:

While most prosthetic Healthcare Common Procedure Coding System (HCPCS) codes are exempt from the SNF PPS rules, there are several exceptions, one of which is L5987. Reimbursement for L5987 is included in the PPS payment that Medicare makes to the SNF. Therefore, payment for L5987 must be negotiated with the SNF directly. In the scenario described above, L5987 was properly denied as not separately payable, and further appeals will most likely be unsuccessful. You may be able to negotiate payment terms with the SNF because it has technically been paid to provide the service, but you may find it difficult to negotiate because the prosthesis has already been provided.

A complete list of HCPCS codes that are exempt from SNF PPS and can be billed directly to the DME MAC may be found at the following link: www.cms.gov/SNFConsolidatedBilling/02h_2011Update. asp#TopOfPage.

Once you reach this page, click on “File 1” to download the list of SNF PPS exempt codes.

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O&P ALMANAC JULY 2011

Q:

What is the status of Medicare denials involving referral sources that are not registered in the PECOS system?

A:

CMS has no immediate plans to implement claim denials when a referring physician or practitioner does not have an active registration in the PECOS system. While CMS continues to encourage physicians and non-physician practitioners to establish and maintain active records in the PECOS system, it has indicated that for the immediate future, claims will not be denied solely based on the presence of an active PECOS record for the referral source. a

A screen shot of the complete list of HCPCS codes exempt from SNF PPS available online (link information on left.)

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