Issuu

The Magazine for the Orthotics & Prosthetics Profession

S E P T E M B E R 2020

New Coding Guidelines for Lower-Limb Prostheses P.16

Updates From the Extremity Trauma & Amputation Center of Excellence

LESSONS

LEARNED

O&P MASTERâ€™S PROGRAMS ADOPT INNOVATIVE STRATEGIES AMID THE COVID-19 PANDEMIC P.20

P.30

Investigations Into Biomechanics and Motor Control

WWW.AOPANET.ORG

P.42

AOPA National Assembly: 2020 Thranhardt and Hamontree Presentations P.36

Quiz Me! EARN 2 BUSINESS CE CREDITS P.18

YOUR CONNECTION TO

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SE PTE M B E R 2020 | VOL. 69, NO. 8

contents

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

20 | Lessons Learned Online classes, reorganized paths of instruction, and detailed safety precautions for in-person sessions are just a few of the changes impacting both faculty and students at the O&P master’s programs this fall. Find out how the schools are adapting their programming during the COVID-19 pandemic to ensure students receive appropriate instruction that will fully prepare them for careers as orthotists and prosthetists.

Views From AOPA Leadership......... 4

The Assembly has gone virtual

AOPA Contacts............................................6 How to reach staff

Numbers........................................................ 8

At-a-glance statistics and data

Happenings............................................... 10

Research, updates, and industry news

People & Places........................................ 14

Transitions in the profession

By Christine Umbrell

30 |

EACE Paves the Way for O&P Innovation

Some of the most important O&P research studies are being conducted by staff at the Extremity Trauma & Amputation Center of Excellence (EACE), affiliated with both the U.S. Department of Defense and Department of Veterans Affairs. EACE team members are heavily involved in developing strategies to return injured military personnel to duty, leveraging the latest technologies, and collaborating with outside entities in O&P research studies.

36 |

2020 AOPA Virtual National Assembly Award-Winning Ideas Find out what some of the brightest minds in O&P are sharing during the high-profile Thranhardt and Hamontree sessions at this month’s AOPA Virtual National Assembly. From innovative clinical procedures to best business practices regarding reimbursement, this year’s presenters offer can’t-miss O&P education. By Deborah Conn

AWARD WINNERS

2020

P.12 Reimbursement Page.......................... 16

Catching Up With Coding Changes

Updates to the Lower-Limb Prostheses Policy Article and additional changes from CMS

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

CREDITS

Member Spotlight.................................46 n

Progressive Prosthetics & Orthotics

AOPA News................................................ 47

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 49

PRINCIPAL INVESTIGATOR Christopher Hovorka, PhD, CPO, FAAOP ................................................................................ 42 Meet the director of the Orthotics and Prosthetics Program at East Tennessee State University, who studies biomechanics and motor control—with an emphasis on offering justification of O&P intervention. 2

SEPTEMBER 2020 | O&P ALMANAC

Careers........................................................ 50

Professional opportunities

Ad Index........................................................ 51 Marketplace.............................................. 52 Calendar...................................................... 54

Upcoming meetings and events

State By State........................................... 56

Florida, New Jersey, New York, and Texas

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VIEWS FROM AOPA LEADERSHIP

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

The Assembly Has Gone Virtual

AM SO PROUD of our ability to pivot to offer

the Assembly virtually this year. My sincere thanks to the Assembly Planning Committee, AOPA Board of Directors, and staff for all they did to make the 2020 Virtual National Assembly a reality. I also want to extend a special thank you to all of our 2020 presenters. COVID-19 has disrupted all of our lives, both professional and personal, but it is our hope that the Assembly will offer some sense of normalcy. Although not how we historically have come together, it is still your one-stop shop, providing you the best in clinical, business, and technical education as well as the latest technologies and services, brought to you by our exhibitor partners. This year it begins with our keynote speaker, leading healthcare analyst Michael Lovdal, PhD. You may have heard him speak before, but you haven’t heard this content. He will be talking about what has changed in healthcare since the pandemic began and the impacts COVID-19 will have on its future. As you have come to expect, the Assembly is full of premium education, best practices, and the latest regulatory developments that affect our profession, as well as strategies to support your business and take your career to the next level. This year’s itinerary features content on COVID-19, sessions that address policies, and resources that will help your business and aid in creating a positive work environment during this unprecedented time. The brightest minds in the profession will present on the latest advancements in clinical care. As always, the exhibit hall is the place to explore state-of-the-art technologies and see how to incorporate them into your practice. We’ve still got attendee favorites—the Thranhardt Award presentations recognizing clinical breakthroughs and the Hamontree Lecture Series recognizing the best business practices. (See the feature “Award-Winning Ideas” on page 36 to learn more about these presentations.) The Assembly still provides a great opportunity to network with the most influential O&P professionals; attendees will be able to reach out to individuals and connect with them. And we didn’t forget the “fun”—during the “Unvegas Vegas” Welcome Reception, we will have live entertainment from your fellow O&P colleagues as well as drawings for prizes. And yes, Elvis will be in building. A big benefit of the Assembly being virtual is the fact that the education will be available for 30 days post Assembly. This means you can take advantage of anything you missed or education you want to revisit. This also means you can earn up to 115 CE credits, which is enough to take care of your five-year certification requirements. Finally, I would be remiss not to thank our exhibitors and sponsors who, like everyone else, pivoted to a virtual environment. Thank you for being patient; we greatly appreciate all your support. I certainly hope to be together in-person in Boston for the 2021 National Assembly, but for this year, I know we will all make the most of the virtual experience. Thank you again to all who made it possible. Let’s all take a minute to celebrate this success. Jeffrey Lutz, CPO, is president of AOPA.

SEPTEMBER 2020 | O&P ALMANAC

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

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AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

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

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

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

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org

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

STRATEGIC ALLIANCES

COMMUNICATIONS, MEMBERSHIP & MEETINGS

Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org

Joy Burwell, director of communications and marketing, 571/431-0817, jburwell@AOPAnet.org

O&P ALMANAC

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

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

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org

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

Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

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

Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net

Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

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

SEPTEMBER 2020 | O&P ALMANAC

Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

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

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

IT ’S ALL ABOUT FUNCTION.

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NUMBERS

Missed Appointments Many Americans skipped or delayed healthcare due to coronavirus between March and June Has your facility noticed an uptick in calls to cancel or delay appointments since the pandemic began? In June, 42 percent of survey respondents in the United States reported that they had personally missed or postponed appointments for non-coronavirus-related healthcare, according to a Kaiser Family Foundation (KFF) Health Tracking Poll conducted among a nationally representative random sample of adults ages 18 and older. The good news is that many plan to reschedule missed appointments soon.

OLDER AND LESS HEALTHY AMERICANS MOST LIKELY TO HAVE SKIPPED CARE

50 percent

DELAYED OR POSTPONTED APPOINTMENTS

52%

52 Percent Reported that they or a family member skipped or postponed medical or dental care

REASONS FOR MISSED APPOINTMENTS*

82 Percent

Healthcare facility was closed or offered limited appointments

53 Percent

They or their family member felt unsafe visiting a medical facility

11 Percent

They or their family were unable to afford care or were concerned about cost

Of those 65 and older

RESCHEDULING MISSED CARE*

44 Percent Of those 50-64

Of those in “fair” or “poor” health

SERIOUS REPERCUSSIONS Percent who say they or their family member’s medical condition got worse as a result of missing appointments:

14%

36 Percent

13 Percent

7 Percent

Will get care in the next month

Will get care in the next two to three months

Will get care in four months to one year

Already got care that was skipped

* Among those who say they or a family member skipped or postponed care

MOST COMMON TYPES OF APPOINTMENTS MISSED DUE TO CORONAVIRUS Percent who say they or a family member skipped or delayed care:

Regular checkups or physical exams

SEPTEMBER 2020 | O&P ALMANAC

58%

Doctor visits for new symptoms

28%

Doctor visits for chronic conditions

25% 23%

Preventive screening Surgery

12%

Physical therapy or rehabilitation care

11%

Mental health care

11% 4%

Cancer treatments

71%

Dental checkups or procedures

SOURCE: “KFF Health Tracking Poll, June 2020,” Kaiser Family Foundation, June 26, 2020.

48 Percent

34 Percent

Happenings RESEARCH ROUNDUP

Utah Team Tests AI-Powered Prosthesis

SEPTEMBER 2020 | O&P ALMANAC

Tommaso Lenzi, PhD, works with a subject wearing a prosthesis powered by adaptive artificial intelligence. tested the AI limb in different scenarios, including walking continuously on a treadmill with obstacles of varying sized being tossed at them and walking through the lab while traversing obstacles. The study participants leveraging the AI technology were able to clear obstacles A trial subject navigates steps of increasing size easier than using the test prosthesis. participants wearing nonpowered prostheses—and traversed the into the robot controller. “We have obstacles with a similar success rate only done a few pilot tests using EMG to their nonamputee counterparts, sensors, but the response of the study albeit slower, according to Lenzi. participants has been overwhelmingly “We learned that people like to be in positive,” Lenzi said. “We also want to control of the prosthesis,” said Lenzi. “It see how people use our powered knee was exciting for us to see … the reaction and ankle prosthesis outside of the of the subject using the powered leg lab.” To make this possible, Lenzi’s team to do things that most people take for has built a new generation of powered granted but they haven’t been able to prosthesis and will begin testing it soon. do for years since their amputation.” “Powered prostheses are becoming Next steps will involve increasing the lighter, stronger, and more capable,” he connection between the human and the said. “Every day we are one step closer technology by integrating neural signals to clinically viable powered prostheses.”

PHOTOS: Freethink Media

Mechanical engineers from the University of Utah have designed a way to control the movement of prosthetic limbs using adaptive artificial intelligence (AI). The development team has leveraged this new approach, which allows for more natural interaction with new environments, in creating the Utah Lightweight Leg. The prosthesis consists of a powered knee module, a powered ankle module, and a control unit and battery. It weighs in at approximately 6 pounds. The prosthesis is unique in that both the ankle and knee joint can inject energy into the gait cycle “and actively control the movements of the prosthetic joint,” explained Tommaso Lenzi, PhD, assistant professor of mechanical engineering and director of the Bionic Engineering Lab at the University of Utah. Users can climb stairs “step over step,” and cross over obstacles without vaulting or hip circumduction, according to Lenzi. “It also provides energy when standing up, to relieve some stress from the intact leg and restore natural symmetry and balance.” The AI system, which has been funded by the National Institutes of Health and the National Science Foundation, is designed to imitate natural leg behavior. “It adjusts the movements of the powered prosthesis continuously,” explained Lenzi. “One thousand times each second, it looks at the user’s movements and defines a new trajectory for the robotic leg. So the controller continuously looks at the user movements and does what the biological leg would do in the same conditions.” In a study published in July in Science Robotics, Lenzi and his team shared their latest study of the technology. The study involved three nonamputee participants and three amputee participants, who

HAPPENINGS

DoD Awards Research Grant To Study Fall-Related Health Outcomes in Prosthesis Users A group of O&P entities, comprised of Hanger Clinic’s Department of Clinical and Scientific Affairs, the University of Washington (UW), the University of Illinois at Chicago (UIC), and the Minneapolis Veterans Administration Health Care System (MVAHCS), has been awarded a research grant of nearly $2 million from the Department of Defense (DoD) to study fall-related health outcomes in lower-limb prosthesis users. The study will include the largest clinical trial of microprocessor-controlled knees (MPKs) to date. The funds are part of the DoD’s Congressionally Directed Medical Research Programs’ Orthotics and Prosthetics Outcomes Research Program. The project, scheduled to begin Sept. 30, 2020, will be led by Brian Hafner, PhD, a professor at UW, and site leaders will include Shane Wurdeman, PhD, CP, FAAOP(D), Hanger Clinic’s director of clinical research; Andrew Sawers, PhD, CPO, a professor at UIC; and Sara KoehlerMcNicholas, PhD, from MVAHCS. In the first two aims of the project, the team is seeking to develop and validate new outcome measures to better assess the impact of

falls on individuals who use a lower-limb prosthesis. Once those instruments are designed and tested, they will be used in a clinical trial to be conducted at Hanger Clinic. “The randomized, controlled clinical trial is the gold standard for measuring effectiveness of medical devices including prosthetic technology,” said Wurdeman. “There is a growing body of evidence strongly suggesting patient benefits of MPKs for limited, community ambulators, or K2-level ambulators. The ability to study this technology in a controlled trial of this scale will significantly further our understanding of the potential benefits for these individuals.” The clinical trial will enroll 100 above-knee amputees of K2-level from Hanger Clinic. Half will be randomized into an MPK, while the other half will be randomized to a non-MPK, which is the current standard for this K-level. “This vital research will further enhance patient outcomes, and help ensure those living with limb loss and limb difference have coverage for the medically necessary and clinically appropriate technology that will help them live independent and fulfilling lives,” said James Campbell, PhD, Hanger chief clinical officer.

O&P Researchers Named as 2020-2021 COPL Grant Recipients

• • • PHOTOS: Getty Images

• •

The AOPA Board of Directors and the Center for Orthotic and Prosthetic Learning and Outcomes/ Evidence-Based Practice (COPL) have selected the 2020-2021 COPL grant recipients. The following individuals and studies have been awarded grants: Sarah R. Chang, PhD, “Develop EvidenceBased Clinical Practice Guidelines for Vacuum-Assisted Socket Suspension Systems” Jonathan D. Day, “Noninvasive Method for Quantifying Progress of Healing After Transtibial Amputation: A Pilot Study” Michael Dillon, PhD, “Describe the Population Receiving Orthotic/Prosthetic Services Using Telehealth, and Their Experience and Satisfaction With Those Services” Erik Hansen, MD, “The Effect of Osteoarthritis Bracing on Community Involvement: A Pilot Study” Natalie Harold, CPO, “Development of a Customizable Outcome Measures Electronic Toolkit (COMET)”

• Rebecca M. Miro, PhD, CP, MBA, CRA, “Prosthetic, Functional, and Clinical Outcomes Among Female Amputees: A Scoping Project To Include a Systematic Review and 10-Year Retrospective Record Review of Female Veterans With Limb Loss.” “There is a modest amount of original orthotics and prosthetics evidence-based or outcomes research. AOPA is thrilled to be able to address this gap and provide funding through COPL to original pilot research,” said Shane Wurdeman, PhD, CP, FAAOP(D), AOPA research chair. “This year, we received stellar requests and anticipate important results from the selected recipients.” Since its inception in 2009, COPL has awarded funds for 51 pilot studies totaling over $700,000. COPL was founded to support research objectives, which include advancement of knowledge and technologies in orthotics and prosthetics, enhancement of evidence-based medicine research capabilities, and patient-oriented outcomes designed to ensure that the needs of patients are best served. AOPA provides the funding to the grantees as well administrative support to the COPL Board. O&P ALMANAC | SEPTEMBER 2020

HAPPENINGS

CODING CORNER

COVID-19 COVERAGE

Amputation Rates Climb Among Diabetes Patients Who Delayed Care

CMS Releases New HCPCS Code, K1007 CMS and the Healthcare Common Procedural Coding System (HCPCS) workgroup has published the coding decisions from their inaugural biannual durable medical equipment and accessories, orthotics, prosthetics, and supplies HCPCS code application review cycle. As part of this first biannual code application review cycle, CMS has released the new code K1007—bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors. The K1007 will be effective for claims with a date of service on or after Oct. 1, 2020.

Researchers at the University of Campania in Italy identified troubling trends when they evaluated clinical features and amputation risk among individuals with diabetes and diabetic foot ulcers who had been admitted to a tertiary care center during the COVID-19 lockdown. The research team, led by Paola Caruso, MD, launched the study to determine how this patient population fared during the height of the pandemic in Italy. They compared the medical records of 25 patients who were admitted to the Teaching Hospital at the University of Campania between March 9 and May 18, 2020, to the medical records of 38 comparable patients admitted between January and May 2019. The results reveal high numbers of emergent and serious cases during the pandemic. The 2020 group experienced higher numbers of emergency

patients, fewer outpatients, and higher likelihood of gangrene. Amputation was more than three times more likely in the 2020 versus the 2019 groups. “The COVID-19 lockdown may have had a detrimental impact on amputation risk because of the sudden interruption of diabetic foot ulcer care and lowerlimb preservation pathways, resulting in delayed diagnosis and treatment,” the researchers wrote in their study, which was published in Diabetes Care in July. “Diabetic foot ulceration is often characterized by progressive clinical course, which can rapidly lead patients to critical worsening of their ulcers.” The increased likelihood of amputation among patients who delayed care confirms the need for proper and timely management of patients with diabetic foot ulcers “to prevent dramatic outcomes responsible for a reduction of quality of life and increased morbidity and mortality,” the authors reported.

PATIENT PERKS

AOPA Members Benefit From Partnership With Amputee Coalition AOPA has announced a new partnership with the Amputee Coalition with the goal of providing AOPA members with additional resources to better serve their patients. AOPA members will now be considered Amputee Coalition Partners and will have access to several benefits: • A listing on the Amputee Coalition website as an Amputee Coalition Partner • Complimentary copies of several Amputee Coalition resources to distribute to patients, including inMotion magazine, “First Step: A Guide to Adapting to Limb Loss,” 12

SEPTEMBER 2020 | O&P ALMANAC

“Intro to Pain Management” brochure, “Secrets of Success” brochure, “Phantom Limb Pain” brochure, “Working Together for a Successful Outcome” brochure, “Your New Journey” folder and related materials, and “Insurance Coverage & Reimbursement Guide: How To Be Your Own Advocate.” • An Amputee Coalition Partner window cling (similar to the AOPA Membership cling). Sample pieces of literature and window clings were mailed out to AOPA members in late August, along with a form to order additional resources.

HAPPENINGS

ORTHO

ASSO

C C

D PROS

WOMEN IN O&P

AOPA Celebrates Women’s Equality Day

The 2020 National Assembly Planning Committee hosted the fifth annual AOPA Professional Women in O&P event. AOPA celebrated the women of O&P on Women’s Equality Day, August 26, commemorating the 1920 certification of the 19th Amendment to the Constitution, granting women the right to vote.

Attendees participated in the event via Zoom. Special guest Martha Hamilton, author of Going Reptile: How Engaging Your Inner Lizard Leads to More Fulfilling Work & Personal Relationships, provided an interactive discovery and insights into ways of navigating challenges and tips for increasing awareness of how others respond to you.

OPGA Announces Nominees for Woman of the Year The Orthotic and Prosthetic Group of America (OPGA) has announced four finalists in its 2020 O&P Woman of the Year Award recognition program. The finalists are Kathleen DeLawrence, chief operating officer with Ability Prosthetics & Orthotics; Kassie Harnden, director of operations with OrthoMedics Omaha LLC; Mia Roberts, patient-care coordinator with Fourroux Prosthetics; and Amy Skuta, CPO, resident director with Martin Bionics. The winner will be announced online on Wednesday, September 9, via Facebook, LinkedIn, and Twitter. The annual award, organized by

OPGA, is open to all women who work in the O&P profession. Nominees are recognized for their significant contributions to serving patients, the community, their business, and the O&P profession. “We’re excited to continue recognizing the women in O&P who are creating impactful and positive experiences to the patients and community they serve,” said Todd Eagen, president of OPGA, a division of VGM & Associates. “There are so many deserving candidates out there, and we are ready to highlight the woman who exemplifies everything that is exceptional about the O&P community.”

FAST FACT

O&P Availability

Sixty-nine percent of O&P facilities offer a 24/7 on-call service.

MEDICARE MATTERS

CMS Reinstates Facility Site Visits and Accreditation Requirements CMS announced in its updated COVID-19 Medicare Provider Enrollment Relief Frequently Asked Questions document that it would resume all accreditation and reaccreditation activities, and provider enrollment site visits, as of July 6, 2020. These activities were previously suspended as part of the response to the declared public health emergency for COVID-19. Suppliers who initially enrolled after March 3, 2020, without obtaining the appropriate accreditation, must now submit a completed application to your accrediting organization within 30 days of notification from the National Supplier Clearinghouse (NSC). Those who received an extension for an expiring supplier accreditation due to the public health emergency will be contacted by NSC to begin the reaccreditation process. Certain accreditation and reaccreditation activities may be conducted onsite and in-person, virtually, or a combination of both, depending on each state’s reopening plan. All onsite survey activities will be conducted in accordance with the Centers for Disease Control and local guidelines. If CMS, NSC, or one of their agents conducts an in-person provider enrollment site visit, the inspector will follow all state and local requirements regarding the use of appropriate personal protective equipment when conducting the site visit. CMS continues its temporary stoppage of revalidation efforts for Medicare providers or suppliers until further notice.

SOURCE: “2019 AOPA Operating Performance Report”

O&P ALMANAC | SEPTEMBER 2020

PEOPLE & PLACES BUSINESSES

THE LIGHTER SIDE

ANNOUNCEMENTS AND TRANSITIONS

The American Academy of Orthotists and Prosthetists has delayed the date of its 2021 Annual Meeting & Scientific Symposium. The event will take place May 4-7. The new deadline for abstract submissions is September 22. Hanger continued its PowerUp webinar series designed specifically for women in O&P on August 13. The company hosted a webinar, led by Regina Weger, president of Southern Prosthetic Supply. Weger was joined by a panel of speakers who discussed “Recognizing Microaggressions and the Impact in the Workplace.”

“NEXT”

AOPA Supplier Plus Members Thank you to our 2020 AOPA Supplier Plus Members for their continued support of the association.

SEPTEMBER 2020 | O&P ALMANAC

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REIMBURSEMENT PAGE

By DEVON BERNARD

Catching Up With Coding Changes

Revisions to the Lower-Limb Prostheses Policy Article and additional guidance from CMS

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS

HE REIMBURSEMENT PAGE article

in the June/July O&P Almanac stressed the importance of keeping up to date and staying aware of changes to standard Medicare policies, even during these unique times. The article reviewed changes to the Lower-Limb Prostheses Policy Article (PA) and discussed the current status of the recently expired version of the Medicare Advanced Beneficiary Notice of Noncoverage (ABN) form. Since that article was published, there have been some additional changes to the Lower-Limb PA and the ABN, as well as some new guidance. This month, we offer a summary of the most recent updates.

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Lower-Limb Prostheses

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On June 25, the durable medical equipment Medicare administrative contractors (DME MACs) released a newly revised version of the LowerLimb Prostheses PA with new coding guidelines for codes L5856, L5857, L5858, L5980, L5981, and L5987; the new PA has an effective date of Aug. 1, 2020. The Pricing, Data Analysis, and Coding (PDAC) contractor released a joint announcement at the same time for a new coding verification requirement for six lower-limb prosthetic codes: L5856, L5857, L5858,

L5973, L5980, and L5987. The PDAC coding verification requirement also was included with the revisions of the Lower-Limb Prostheses PA with new coding guidelines, effective Aug. 1, 2020. Below is an explanation the new of coding guidelines: • The L5856 refers to a feature of an endoskeletal knee component that is incorporated into the entire kneeshin system. The microprocessor componentry with sensors, any type, provides automated adjustment for controlling the swing and stance phase of gait. This feature would be discernable from schematic drawings and user manual documentation. The documentation would provide details for all of the adjustments for the dynamic properties of this subsystem within the knee component. Adjustments could factor user characteristics such as the activity level, body weight, or gait preferences, among others. This adjustment feature is energized by an onboard rechargeable battery source. The code would include any external components needed to access the microprocessor for modification of the settings. • The L5857 refers to a feature of an endoskeletal knee component that is incorporated into the

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entire knee-shin system. The microprocessor componentry with sensors, any type, provides automated adjustment for controlling the swing phase of gait. The documentation would provide details for all of the adjustments for the dynamic properties of this subsystem within the knee component. Adjustments could factor user characteristics such as the activity level, body weight, or gait preferences, among others. This adjustment feature is energized by an onboard rechargeable battery source. The code would include any external components needed to access the microprocessor for modification of the settings. • The L5858 refers to a feature of an endoskeletal knee component that is incorporated into the entire kneeshin system. The microprocessor componentry with sensors, any type, provides automated adjustment for controlling the stance phase of gait. The documentation would provide details for all of the adjustments for the dynamic properties of this subsystem within the knee component. Adjustments could factor user characteristics such as the activity level, body weight, or gait preferences, among others. This adjustment feature is energized by an onboard rechargeable battery source. The code would include any external components needed to access the microprocessor for modification of the settings. • The L5980 describes a product that can be used for either endoskeletal or exoskeletal lower-limb construction. The Flex Foot has an energystoring J-shaped keel design. The heel component is attached onto the J-shaped keel section. The Flex Foot System’s J-shaped keel design extends proximally as a monolithic composite shank. Shank height is determined and modified by supplier to utilize the dynamics of the composite shank. • The L5981 describes a product that can be used for either endoskeletal or exoskeletal lower-limb construction.

The Flex Walk has an energystoring J-shaped keel design. The heel component is attached to the J-shaped keel section. The Flex Walk J-shaped keel design proximally terminates at a nonadjustable fixed height determined and modified by the prosthetic foot manufacturer. • The L5987 describes a product that can be used for either endoskeletal or exoskeletal lowerlimb construction. All components are integrated as a single product, i.e., not an assembly of separate products or components. The product has an energy-storing J-shaped keel design. The heel component is attached onto the J-shaped keel section. Verticalloading pylon allows controlled motion for shock absorption. This code does not describe vertical loading or shock absorption achieved from the inherent flexibility of the J-shaped keel section. Coding guidelines for L5973, published in a previous PA revision, state that the L5973 describes an endoskeletal device with an integrated energy-storage-and-release foot and a microprocessor ankle system. The PA also reads that the integrated microprocessor is programmable along with sensors to optimize plantar- and dorsiflexion

angles for stance and swing phase and includes a power source and charger. The PDAC coding verification requirement does not have the same effective date as the new coding guidelines; rather, for claims with dates of service on or after Jan. 1, 2021, the only products that may be billed using codes L5856, L5857, L5858, L5973, L5980, and L5987 are those for which a written coding verification review has been made by the PDAC and is listed on the PDAC Product Classification List, www.dmepdac.com. This brings the total number of prosthetic codes requiring PDAC verification to seven. The L5969 has required PDAC verification since 2014. These six codes are the codes that were included in the initial implementation of prior authorization for O&P. While implementation of Medicare prior authorization was temporarily postponed due to the COVID-19 public health emergency, the program is now back on track and being rolled out in two phases. CMS announced the reimplementation of prior authorization in early July when it updated its COVID-19 Reduction of Provider Burden Frequently Asked Questions (FAQ) document. Phase I will begin with claims with dates of service on or after Sept. 1, 2020, and will only take place in California, Michigan, Pennsylvania, and Texas. Phase II will start with claims with dates of service on or after Dec. 1, 2020, in all of the remaining U.S. states and territories. O&P ALMANAC | SEPTEMBER 2020

As the September 1 date has passed and the December 1 implementation is fast approaching, suppliers will want to review the prior authorization process to avoid any possible delays in claim processing and payment. Here is a quick recap of the prior authorization process: • Complete the prior authorization request (PAR) coversheet for lower-limb prostheses, available from your DME MAC. The coversheet collects basic information about you, your patient, and the Healthcare Common Procedure Coding System (HCPCS) codes. • Submit the coversheet and all supporting documentation (the standard written order, physician records, prosthetist’s notes, and any additional records to support medical necessity of the prosthesis) to the DME MAC for review. Submissions may be made by fax, mail, or DME MAC web portals. • Within 10 days, you will receive either an affirmative or nonaffirmative decision and a unique tracking number (UTN). The UTN is your proof that you completed the PAR process. • If you received an affirmative PAR, you may submit your complete claim for payment—but be sure to include your UTN on the claim. • The PAR and UTN will be valid for 120 days. • If you received a nonaffirmative PAR, you may attempt to fix any errors and resubmit the PAR. You also may elect to submit the claim with your UTN; however, the HCPCS code(s) in question will be denied. The DME MACs will begin to accept PARs on Nov. 17, 2020, for items furnished on or after Dec. 1, 2020.

Medicare Audits

The July FAQ from CMS included updated information on the status of prepayment and postpayment audits. CMS announced it had authorized its contractors—including the DME MACs, recovery audit contractors (RACs), and supplemental medical review contactors (SMRCs)—to resume audit activity, originally suspended due to the 18

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COVID-19 public health emergency, on August 3. CMS did clarify that it would not be restarting all audits on August 3, but instead would be implementing a phased approach to allow suppliers time to prepare and adjust. The audits were scheduled to begin with limited DME MAC-based postpayment reviews, involving claims with dates of service prior to the beginning of the declared public health emergency on March 1, 2020. CMS did not provide a timeframe for the next phase or for the renewal of audit activity through the Target, Probe, and Educate program, RACs, or SMRCs. CMS did stress that if individual providers or suppliers that are selected for medical review believe that responding to a request will create a hardship situation, they should discuss response options with the contractor; and the DME MACs may allow for flexibility with extensions and the cancellation of audits.

Scoliosis Brace Update

The DME MACs and PDAC released a correct coding reminder on July 23, 2020, for five base codes used to describe scoliosis braces: L1000, L1005, L1200, L1300, and L1310.The L1005 (tension-based scoliosis and accessory pads), L1300 (other scoliosis procedure, body jacket molded to patient model), and L1310 (other scoliosis procedure, postoperative body jacket) are considered to be complete devices and all inclusive. The use of any other addition codes will be considered unbundling and incorrect coding. The L1000 (cervical thoracolumbosacral orthosis, Milwaukee, inclusive of furnishing initial orthosis) is a custom-fabricated scoliosis brace. The following addition codes may be incorporated into the brace and are eligible for

separate payment: L1010, L1020, L1025, L1030, L1040, L1050, L1060, L1070, L1080, L1085, L1090, L1100, L1110, and L1120. The L1200 (thoracolumbosacral orthosis, inclusive of furnishing initial orthosis only) may have the following addition codes incorporated into the brace that are eligible for separate payment: L1210, L1220, L1230, L1240, L1250, L1260, L1270, L1280, and L1290.

ABN Update

The ABN, which is subject to reapproval every three years by the Executive Office of Management and Budget (OMB), expired in March 2020. The ABN, Form CMS-R-131, and instructions have been approved by the OMB for renewal. Due to COVID-19 concerns, CMS has expanded the deadline for use of the renewed ABN form. At this time, the renewed ABN will be mandatory for use on Jan. 1, 2021. The renewed form may be implemented prior to the mandatory deadline. When the ABN was last approved and updated in 2017, it included only a minor change by adding a nondiscrimination notice. This most recent approval did not make any changes to the content, outside of the new expiration date, or the purpose of the form. Ensure you are using the correct and most recent version of the form so the ABN is not considered invalid. The best way to do so is to look at the bottom left corner; the form number, CMS-R-131, and the Jun. 30, 2023, expiration date should be noted there. The revised ABN form may be downloaded from the CMS website. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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NEED TO KNOW M The 2020-2021 academic school year has just begun, bringing many changes in how instructors in O&P masterâ€™s programs are teaching in light of the ongoing COVID-19 pandemic. M University faculty are leveraging enhanced online instruction techniquesâ€”and taking advantage of the opportunity to invite guest speakers via Zoom calls.

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M Instructors have become more intentional regarding the content they are teaching in-person and in labs, and they are closely following federal, state, and local guidelines regarding social distancing and personal protective equipment. M The schools are taking a cautious approach to inviting patient models to work with students, keeping in mind that many patient volunteers may have comorbidities and fall into high-risk categories. M Some programs are revising their curricula to include more health and safety-related instruction and additional guidance on telehealth.

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Lessons ED

N R A E L

O&P MASTER’S PROGRAMS DRAW ON EFFORTS FROM THE EARLY MONTHS OF THE PANDEMIC TO CRAFT PLANS FOR THE FALL SEMESTER AND BEYOND By CHRISTINE UMBRELL

HE FIRST DAY of school for the

new class of O&P master’s students at California State University— Dominguez Hills (CSUDH) was anything but typical. On August 3, 17 first-year students were split into distinct morning and afternoon cohorts that will be kept separate throughout the semester to limit the number of students in the building and to maintain contact tracing. Upon entering the facility, “each student came in with a face mask on, disinfected hands with hand sanitizer, did temperature checks, used an ultraviolet light wand over any items they brought in, filled out a health questionnaire, and then washed hands for 20 seconds,” explains Mark Muller, MS, CPO, FAAOP, chair and clinical director of the MSOP program. This is just one example of how the O&P schools have adapted their programming for the fall. After being forced to close their physical doors last March due to statewide stayat-home mandates related to the coronavirus (COVID-19) pandemic, O&P master’s faculty quickly redesigned their curricula, turning to

online instruction, virtual office hours, and reorganized paths of instruction to ensure students continued to receive appropriate education. Fortunately for those students who were finishing up their master’s degrees, many of the O&P programs graduate after the spring academic term. The shift in education content delivery occurred for most programs in March, transitioning a relatively small amount of learning activities from the classroom/laboratory to other formats. The move away from traditional classroom/laboratory settings was not simple, but the creativity of the O&P school faculty enabled activities that were effective using online formats, such as problem-based learning and small group discussions. For nongraduating students, some schools were allowed to begin limited in-person clinical sessions in the summer—albeit in a completely different setting. Social distancing, masks and personal protective equipment (PPE), temperature checks, and health questionnaires have become the new reality.

O&P ALMANAC | SEPTEMBER 2020

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Today, the schools have university’s Prostheticsbegun their fall semesters and Orthotics Center last spring, have built upon the successes says John T. Brinkmann, and challenges from the early MA, CPO, LPO, FAAOP(D). months of the pandemic to While it was a challenge to provide safe, yet appropriate, move all classes online very educational experiences to quickly, the instructors ultiDarren Wiens, MS, prepare the next generation of mately improved their online At the University of Washington CP, BOCO O&P clinicians. “The O&P field delivery and created new O&P program, students are required has always done what we’ve interactive activities. “We’ve to follow safety protocols even had to do to overcome adversity,” says broken the content into smaller chunks, when working with each other. Darren Wiens, MS, CP, BOCO, MSOP and added some activities” for online program chair at Concordia University instruction, says Brinkmann. in St. Paul, Minnesota. “Now, we’re Faculty at the University sessions to keep students doing it with education. We’re looking of Hartford (UH) are building engaged, says Scott Bretl, at the NCOPE [National Commission upon the university’s library of MPO, CPO, O&P program on Orthotic and Prosthetic Education] past lectures to facilitate the director. Bretl notes that requirements and trying to adapt” to transition to majoritywhile some content, provide education in a new way, given online. In previous years, each including student presenthe ongoing health crisis. “Technology lecture was videorecorded tations and discussions, has Scott Bretl, changes the way the education is given, as part of business-as-usual, translated well to the online but they’ll still get the knowledge” they according to Matthew Parente, MPO, CPO format, the more complineed as the foundation for future resiMS, PT, CPO, FAAOP, MSPO cated subject matters—such dencies and clinical appointments. program director at UH. In as fabrication and fitting March, professors began skills—are challenging to teach Enhanced Online posting those videos, interemotely, especially because assessing Instruction grated with virtual Q&As, students’ comprehension of the mateThis fall, the O&P schools are in a combined synchrorial can be difficult. offering much more instrucnous/asynchronous format. ASU faculty members are considtion online, having revamped Parente also supplements ering more asynchronous learning in remote learning to be more online instruction with visual a “flipped classroom” setting in the dynamic than in years past—a Matthew Parente, aids, such as sockets, knees, future. In this model, students view MS, PT, CPO, development that may aid in and other components that prerecorded lessons ahead of planned FAAOP students’ learning long after can be viewed on-screen to sessions, and follow up with synchrothe pandemic is over. boost comprehension. nous online (or in-person) meetings At Northwestern University, where At Alabama State University (ASU), designed for Q&As and further blended learning has been part of the where all classes were in-person prior explanation. “You try to do as much as format since 2006, staff already had the to March, faculty have learned to possible get students to engage with infrastructure and personnel to deliver teach remotely and integrate breakout the material ahead of time,” explains content virtually when COVID-19 segments involving smaller numbers of Bretl, “then in person you can have shut down in-person activities at the participants into synchronous online more meaningful discussions.” 22

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PHOTOS: University of Washington

Students at the University of Washington O&P program work in the lab, complete with masks, face shields, and social distancing measures.

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Creating Options for O&P Residents It’s not just the O&P students who have been impacted by COVID-19-related shutdowns—O&P residents also have lost opportunities to complete some residency hours. At Baylor College of Medicine, where the master’s program incorporates the clinical residency into the degree program, residents faced clinic closings last spring. On March 16, the O&P master’s program moved Ashley Mullen, to virtual; at the same time, “we pulled our residents MSAT, CPO, LPO from their residency sites in order to stay in line with other programs here at Baylor,” says Ashley Mullen, MSAT, CPO, LPO, director of the O&P program. “To minimize the number of individuals in patient rooms, many patient-care companies stopped allowing residents.” The Baylor faculty sought to ensure the residents had access to some clinical education activities in the meantime. “Our clinical coordinator developed some webinars with our preceptor community,” Mullen says. Realizing that other O&P residents might be in similar situations, “we opened the webinars up to others outside our residency program.” Staff at the University of California—San Francisco (UCSF) also developed alternative clinical programming for residents. Residency Director Heidi Truman, CPO, reached out to other institution-based practices and established a set of one-hour Zoom presentations, given twice a week over an eight-week period in April and May. The sessions focused on clinical care rather than pathology/didactic knowledge. Heidi Truman, Topics ran the gamut from scoliosis to specialty CPO orthoses to bariatric prosthetics, and more, taught by instructors from UCSF and other institutions, including Shirley Ryan AbilityLab and the U.S. Department of Veterans Affairs. Up to 80 residents and students took part in each session, according to Truman, and the presentations were recorded for offline viewing. “One of the bright spots that emerged from the COVID response is the way the O&P hospital-based groups rallied to provide continued education for residents and students who missed clinical exposure time and opportunities,” Truman says. “There were some great talks and collaboration.” Building off the success of the programs, UCSF has begun hosting a monthly O&P forum for residents in hospital-based practices.

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Collaboration and willingness of outside experts to serve as visiting speakers has been a positive byproduct of the online formats. At the University of Washington, “a lot of former graduates did guest lectures or clinical presentations” via Zoom to supplement online learning and present virtual case studies, says Ann Yamane, CO, O&P program director. “And faculty from other schools shared their resources.” Many of the O&P program directors anticipate continued use of online formats for some instruction in the future, which will be helpful in continuing to include outside speakers without travel.

New Approaches to In-Person Instruction

Balancing the needs of students for face-to-face clinical instruction with the importance of physical safety, O&P faculty have become extremely intentional about what they choose to teach in-person. At CSUDH, the successful re-entry of students in August was the culmination of several months’ worth of preparaMark Muller, MS, tion, says Muller. CPO, FAAOP The university approved some onsite O&P coursework for the fall because the program meets in an off-campus facility, away from other university students. Faculty are teaching clinical subjects in a hybrid model with labs in face-to-face instruction, while most other subjects remain virtual. Faculty at Eastern Michigan University similarly are “thinking about how to keep everyone safe—to do some in-person instruction, but not

PHOTOS: Mark Muller, MS, CP, FAAOP, California State University—Dominguez Hills

Students in the O&P master's program at California State University— Dominguez Hills met in-person on August 3, the first day of the new semester.

COVER STORY

Students in Loma Linda University's O&P program work in the lab wearing personal protective equipment.

PHOTOS: Loma Linda University

as much” as in years past, says Rebecca Spragg, MSPO, CPO, O&P program coordinator. “We’ll be emphaRebecca Spragg, sizing time MSPO, CPO management.” Instructors have moved all of the “what” material online, while the “how” and “why” discussions are reserved for in-person instruction. For example, says Spragg, when focusing on prosthetic knees, students will be online to study “what” the options are, then participate in in-person labs for demonstrations of “how” you align those types of prostheses for a patient and “why” you make particular adjustments for specific patient issues. “We’ll jump right in during lab time” to hands-on work, having completed the related lecture online, she explains. Instructors at Loma Linda University, traditionally an in-person campus, are offering a mix of “emergency online education” and in-person clinical courses. “We’ve had to create courses online” for all of the content that can be delivered virtually, and will offer in-person lab and clinical education “in a safe way,” says Johannes

Schaepper, PhD, CPO, chair of the O&P department. While shorter quizzes and exams will be administered virtually through Canvas, Loma Linda plans to offer midterms and finals in-person. Some schools have added extra lab work this fall to make up for lost time in the spring and summer. Because they have already covered much of the material that could be consumed remotely, the ASU team is “front-loading” with multiple overlapping lab projects at the beginning of fall semester, says Bretl.

The goal is to get in as much in-person work as possible, while keeping students physically spaced throughout the lab—just in case the schools are forced to move to online-only again. While juggling multiple lab projects may challenge the students, “this is how it’s going to be” once they become practicing clinicians, Bretl says. “They’ll have lots of patients at once, with many different types of devices.” At Concordia, where online instruction is actually the norm, students are still expected to meet in-person for one week three times per year in “intensives,” according to Wiens. After an emergency “virtual” intensive last spring, students were finally allowed to meet for an in-person intensive in August—obeying social distancing mandates and precautions.

Strict Adherence to New Safety Protocols

All of the O&P master’s programs are closely following federal, state, and local health and safety guidelines as well as those put forth by their universities. Many of the schools used the summertime to ramp up safety policies and procedures. In Chicago, faculty set out to comply with rules mandated by Northwestern’s medical school and city regulations, which call for

Faculty and students at Loma Linda University were allowed back into the lab to complete coursework over the summer. O&P ALMANAC | SEPTEMBER 2020

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NCOPE Serves As a Resource to Schools In light of the COVID-19 pandemic, NCOPE has published “COVID-19 Guidance for Orthotic, Prosthetic, and Pedorthic Students and Educators.” The guidance begins by urging the O&P schools to follow guidance from local, state, and federal authorities, to review and refine infectious disease control and safety plans. Each program operates in a unique setting with factors that are best considered by the administration, faculty, and staff at each institution. The guidance also affirms that it is the responsibility of each program to ensure that all requirements within the core curriculum guide continue to be met as the CAAHEP educational standards have not been changed since the COVID-19 pandemic began. At the onset of the COVID-19 pandemic, educators were surveyed to determine what resources they would most value to assist with potential challenges faced by each program. The responses resulted in the creation of an online repository of O&P education community sources videos, lessons, assignments, and other learning activities. “The education community did a stellar job of stepping up and offering valuable input to be used across all levels of O&P education, including academic programs and residency,” says Robin Seabrook, executive director. Secure access to the education database is available through the NCOPE website. As an education accreditor, NCOPE worked collaboratively with O&P academic program faculty and residency program directors to create a “Graduate Preparedness” report that identifies how students graduating in 2020 potentially had their schooling impacted due to COVID-19. This tool enables an open dialogue between the O&P schools and the O&P professionals providing essential mentoring to the new graduate. NCOPE also recognizes that O&P residency programs have been agile in shifting some of their training from direct patient-care settings to focused activities such as courses housed on the American Academy of Orthotists and Prosthetists’ Online Learning Center due to changes in patient volume and population. These activities serve an important role in not only supplementing potential changes in patient-care settings, but in reinforcing concepts within the O&P practice framework including patient assessment, formulation of treatment plan, and other essential patient-care concepts. In some extenuating circumstances, residents were required to take a furlough or reduce their hours, which directly affects the duration of their residency program. To help address these challenges, “we created a tool that calculated what amount of time a resident’s residency completion may need to be extended if their schedules were changed due to circumstances beyond their control,” says Seabrook. Visit ncope.org for details.

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smaller groups for in-person meetings and stringent safety measures, says Brinkmann. During the summer, “we worked with our medical school and collaborated with the [nearby] ShirleyRyan Ability Lab to collaborate” and stock up on PPE. At the University of Washington, the O&P department requested permission to enter campus to work with patients this Ann Yamane, CO summer, explains Yamane. After being granted the exception, students returned to campus in July for patient sessions. “We had to create and implement a ‘COVID safety plan,’” which aligned with the recommendations of UW’s School of Medicine leadership for clinical settings, and included hand hygiene, safety protocols, and other precautions, says Yamane. “We’ve divided our cohort into smaller groups to manage physical distancing,” she says. “We have more enhanced cleaning procedures and lots of PPE.” Even when students are working on each other, they must follow the safety protocols and PPE requirements. At Loma Linda, the O&P program is expected to comply with strict rules put forth by a committee guided by medical doctors, administrators, and legal advisors. When interacting with patients, students must wear masks, goggles or face shields, gloves, and even gowns. “Gowns have been the

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biggest challenge,” says Schaepper, because they were never “standard procedure” in years past.

New Precautions With Patient Models

The hardest part of COVID-19, as far as educational training goes, is the loss of some interpersonal relationships—a key part of a student’s development in preparing to treat patients, says Wiens. As the early restrictions are lifted, schools are taking varying approaches to re-engaging with patients. Although CSUDH began in-person classes in August, the program is delaying patient interactions. “For the first 11 weeks of the program, we are having the students learn clinical evaluation techniques, work on fabrication skills, and make devices on each other. Then when we have a better control of the COVID-19 situation, we will bring in patient models,” says Muller. “Luckily, our program has contingency built in with extra time and more projects than are required by NCOPE’s accreditation standards, so we have the flexibility to alter the schedule to meet our current needs without jeopardizing the students’ education.”

PHOTOS: Loma Linda University

The O&P schools have found that many patient models continue to volunteer to work with O&P master’s students because they enjoy the social interaction— even in the pandemic.

At Loma Linda University, only one student is allowed near each patient model, with instructors supervising from more than 6 feet away. At Loma Linda, which of like a real O&P practice, continues instruction in the where you rely on assistants summer, the O&P program to help you.” was green-lighted for Eastern Michigan also in-person clinical instruchas reduced the number tion earlier than many other of individuals interacting programs. The program is with patient models; only housed in a large facility, with Johannes Schaepper, one faculty member and PhD, CPO room for social distancing, two students work with according to Schaepper. each volunteer. “Our clinical Upon entry and exit, each suite is set up into different individual—whether faculty, student, rooms,” Spragg explains. Each patient or patient model—must complete a room is equipped with a videosix-question health survey and have camera—used in the past to review their temperature taken. patient interactions, but now being Schaepper initially wondered leveraged for real-time viewing by whether patients would feel comfortfaculty and other students. able returning to the university setting, The schools are taking special but he was pleasantly surprised when care to protect their patient models. more than half of the program’s patient In some cases, this means relying models volunteered. “We told them the on younger, healthier volunteers. risks and explained students would be At Northwestern, says Brinkmann, in full PPE, taking universal precaustudent/patient interactions now tions,” says Schaepper. For social require clear communication of distancing, “three patients are straexpectations, pre-appointment tegically placed in classrooms where screenings, temperature checks, and we usually fit 27 students,” he says. increased use of PPE. O&P patients Students don full PPE, in the proper “are more likely to fall into high-risk order. “We only allow one student near categories—some due to age, some due each patient, with instructors superto comorbidities,” says Brinkmann. vising from more than 6 feet away. “Individuals who volunteer as patient A second student acts as a ‘gopher,’ models enjoy the interaction with running back and forth to the lab area students, so many are finding ways to with the devices,” he says. “It’s sort continue to participate as models.” O&P ALMANAC | SEPTEMBER 2020

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Wiens notes that patient models play a big role during Concordia’s intensives, “but now we’re more thoughtful” in choosing which patients to invite, considering the risk factors associated with the pandemic. Some situations benefit more from hands-on student/patient interaction than others, notes Wiens. Students can “treat” each other for certain orthotic interventions, but learning to treat spina bifida and amputee patients “really benefits from in-person, hands-on interaction with real patients,” he says.

Curriculum Additions

At many schools, the curriculum this fall has been updated, incorporating more health and safety-related instruction. At Eastern Michigan, “we’re adding COVID preparedness educational programming on how to manage COVID patients,” says Spragg. UH offers a Clinical Foundations class, where “we use the WHO model for handwashing, disease control, and donning of masks,” says Parente. “It’s a four-section module, so students can certify they have taken this training.” UH also is training students to educate patients on safety practices. 28

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In addition, “we’re Brinkmann says. “And the bringing some interviewing ‘not knowing’ what’s coming skills” into the curricnext is hard.” But in the end, ulum, says Parente. “We’ve “navigating these challenges revamped the section we and getting through them teach on telemedicine,” a successfully will contribute new focus in O&P. “We are to students’ long-term teaching students appropriate John T. Brinkmann, success—more than they MA, CPO, LPO, terminology, and how to talk realize,” he says. “They will FAAOP(D) to patients to ask them to come out of this stronger.” show on the screen not the Given the circumstances, ‘distal end of the residuum,’ but the many students are wondering how ‘bottom end of the limb,’ during a video they will be disadvantaged by the appointment,” explains Parente. turn of events in 2020. The students UH students also are engaging in are “nervous,” says Spragg. “We are practice telemedicine calls—working doing our best to make sure that these with patient models who may have students are ready for residencies. We compromised immune systems, to keep telling them that we don’t know minimize exposures and prepare exactly what O&P instruction is going students for virtual visits, says Parente. to look like, but that we’ll make sure they get the education that they need.” Managing Students’ Expectations Bretl agrees. “The students in the Of course, one of the most important O&P programs right now will come out goals this fall is ensuring students a lot more resilient and adaptable”— receive appropriate instruction— attributes that will serve them well and that they feel confident in their once they become certified clinicians. programs. “The students have had to be very flexible,” says Yamane, particularly in adjusting to online learning. Christine Umbrell is a contributing “Sometimes they have limited space writer and editorial/production associate to study or may be experiencing wifi for O&P Almanac. Reach her at problems” during remote learning, cumbrell@contentcommunicators.com.

PHOTO: University of Hartford

Matthew Parente, MS, PT, CPO, FAAOP, lectures to an empty room while being recorded at the University of Hartford.

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EACE

Paves the Way for O&P Innovation Cutting-edge investigations and collaborative research spur progress at the Extremity Trauma & Amputation Center of Excellence

M NEED TO KNOW • Researchers at the Extremity Trauma & Amputation Center of Excellence (EACE) are tasked with conducting investigations to optimize the function and quality of life of service members and veterans who have sustained traumatic injuries. • Osseointegration, additive manufacturing, and regenerative rehabilitation are among the latest developments under investigation. • New methodologies for return-to-duty assessments postamputation involve virtual reality systems and adapted functional capacity evaluations. • Scientists at EACE also are studying fall prevention, secondary health conditions, prosthetic foot comparisons, and a variety of other important O&P topics. • Many of the projects underway at EACE ultimately impact the greater O&P community. In addition, EACE conducts quarterly O&P educational webinars open to all and offers opportunities for civilian patient enrollment in numerous studies. 30

SEPTEMBER 2020 | O&P ALMANAC

ANY OF THE technological

advances in the O&P field have been borne of the need to provide optimal care and advanced solutions for U.S. service members and veterans. Today, one of the most important research entities in the U.S. military sector working on critical O&P-themed studies is the Extremity Trauma & Amputation Center of Excellence (EACE), the only congressionally mandated Center of Excellence that is jointly established between the U.S. Department of Defense (DoD) and Department of Veterans Affairs (VA). “The overarching goal of the EACE is to optimize the function and quality of life of service members and veterans who have sustained traumatic John Shero, MHA, FACHE extremity injuries, including amputation,” says John Shero, MHA, FACHE, director of EACE. “Accordingly, the EACE mission is primarily focused on the mitigation, treatment, and rehabilitation of traumatic extremity injuries and amputations sustained by service members and veterans.”

O&P clinicians in the private sector can look at the latest assessments, technologies, and protocols being researched and developed by EACE researchers and their partners for a sneak peek at what may be on the horizon for the civilian O&P population. From advanced prosthetic technologies to osseointegration to additive manufacturing to regenerative rehabilitation, EACE researchers are on the forefront of O&P innovation.

Latest Technologies, ‘Regenerative’ Rehab

Researchers at EACE are investigating many of the newest O&P-related technologies, as current and former military members receive advanced care options. For example, while many service members with limb loss have achieved desired outcomes using conventional Bradford Hendershot, PhD prosthetic sockets, there are some who are benefitting from osseointegration, says Bradford Hendershot, PhD, EACE facility research director at Walter Reed National Military Medical Center (WRNMMC). Prosthetic implants via direct skeletal attachment “have the potential to vastly improve functional outcomes and quality of life for those with challenging prosthesis fit or discomfort,” he says. In collaboration with the DoD Osseointegration Program, “we are supporting the longitudinal collection of a comprehensive suite of contemporary outcome assessments, to complement traditional surgical outcomes,” says Hendershot. These efforts are intended “to enhance our understanding of the feasibility and efficacy of osseointegration for service members with limb loss, facilitating the implementation and widespread adoption of osseointegration within the DoD.”

What Is EACE? The Extremity Trauma & Amputation Center of Excellence (EACE), the leading advocate for research and treatment of U.S. Department of Defense (DoD) and Department of Veterans Affairs (VA) patients with extremity trauma and amputation, was legislated by Congress through public law, via the Duncan Hunter National Defense Authorization Act for Fiscal Year 2009. It comprises 37 staff members from the DoD allocated across a Headquarters element (located at Joint Base San Antonio) and four divisions: Clinical Affairs, Clinical Informatics and Technology, Global Health Engagement, and Research and Surveillance (R&S). In addition, the VA currently has two staff members in the National Capital Region who coordinate with the VA Amputation System of Care. The EACE R&S Division is made up of a multidisciplinary team of clinicians and researchers embedded within several military treatment facilities, including Walter Reed National Military Medical Center, Womack Army Medical Center, Center for the Intrepid at Brooke Army Medical Center, and Naval Medical Center San Diego, as well as DoD research facilities (including Uniformed Services University of the Health Sciences and Naval Health Research Center) and a VA medical center—the Center for Limb Loss and Mobility at VA Puget Sound Healthcare System. The EACE R&S Division conducts a diverse portfolio of cutting-edge, mission-driven research projects that span the full spectrum of scientific inquiry—from contemporary basic science experiments to large, multisite, clinical trials. “The overarching goal of these research efforts is to generate the knowledge to support evidence-based improvements in clinical practice,” says Christopher Dearth, PhD, chief of the R&S Division at EACE, “such that the highest level of function and quality of life can be achieved by our nation’s service members and veterans.”

O&P ALMANAC | SEPTEMBER 2020

PHOTO: John Moore/Getty Images

The military population medicine/tissue engineering proficiency under stressed condialso is benefiting from and physical medicine tions,” says Childers. additive manufacturing, and rehabilitation,” says Data from both the virtual reality as 3D printing allows for Christopher Dearth, PhD, evaluations and the military-themed “the creation of customized chief of the R&S Division occupational therapy tasks have prosthetic componentry at EACE. Regenerative been used to successfully argue to to meet the unique needs rehabilitation “aims to the physical evaluation board that of highly active service capitalize on the synergy high-performing service members members and veterans,” between next-generation with amputation can return to Christopher Dearth, PhD explains Hendershot. regenerative medicine-based active duty and even redeployment, Multidisciplinary teams within technologies and state-of-the-art according to Childers. the Three-Dimensional Medical rehabilitation programs.” In addition, EACE encourages Applications Center at WRNMMC participation in lower-tech rehabil“have developed a variety of terminal New Return-to-Duty itation programs to aid individuals devices and attachments for activiAssessments with amputations in adapting to their ties such as fishing, weightlifting, and The EACE team has collaboratively new circumstances. EACE sponsored rock/ice climbing, among others,” developed—and successfully intea revival of the DoD peer visitor/ he says. These highly customizable grated with clinical practice at the mentoring program, working with devices have provided opportunities Center for the Intrepid (CFI) at the Amputee Coalition to modify the for service members and veterans Brooke Army Medical Center—two certified Peer Visitor training to be with extremity trauma to participate assessments for return-to-duty appropriate for military culture. in recreational activities, sports, decision-making after amputation. and hobbies. “One assessment Current Studies involves the virtual Research being conducted reality [Computer across the DoD and VA by EACE Assisted Rehabilitation researchers is generally intended Environment] CAREN to translate to the civilian sector, system at CFI,” says Lee according to Shawn Farrokhi, Childers, PhD, CP, an EACE PT, PhD, EACE facility research senior scientist at CFI. director at Naval Medical Center The multisensory CAREN Shawn Farrokhi, PT, PhD San Diego. Many of EACE’s system is equipped with an projects will have an impact on instrumented treadmill mounted on a future O&P care at private facilities. movable platform, as well as a motion For example, Childers and his capture system and immersive and colleagues partnered with the interactive environments. Shirley Ryan AbilityLab to develop During rehabilitation, service an upper-extremity myoelectric VR A U.S. Army soldier and leg amputee members with amputation leverage training system. “This will allow scales a two-story climbing wall at the Center for the Intrepid rehabilitation the system to navigate a simulated people with a new upper-extremity gym at Brooke Army Medical Center, dismounted patrol in Afghanistan and amputation to learn how to control a on Aug. 7, 2012 in San Antonio, Texas. must respond to simulated ambushes, myoelectric device before they are fit The EACE R&S Division also is Childers explains. The terrain is gradwith a definitive prosthesis.” getting in on the ground floor with ually made steeper, and the treadmill EACE also is involved in several investigations into regenerative belt speed gradually increases, until multisite clinical trials that feature rehabilitation; the team is engaged the participant cannot continue. “The collaborations with the VA to better in the development, evaluation, distance traveled compared to noninunderstand how features of prosthetic and implementation of regenerajured active-duty service members is feet influence a variety of outcomes, tive rehabilitation-based treatment indicative of their function,” he says. which will aid in device selection of paradigms for traumatic extremity The second assessment involves ankle-foot devices. “Each of these injuries, such as volumetric muscle combining the functional capacity studies employs different methodolloss and post-traumatic osteoarevaluation used in occupational therapy ogies, such as comparing classes of thritis. “Regenerative rehabilitation with military-specific tasks based on commercially available devices via is a newly established field that aims Army regulation, “like a buddy-drag in-lab and take-home evaluations, or to leverage and integrate technolto simulate moving an injured service using an emulation device to allow ogies and treatment approaches member off the battlefield, clearing a patients to ‘test drive’ devices in real from the fields of regenerative staircase, or demonstrating weapons time,” says Childers. 32

SEPTEMBER 2020 | O&P ALMANAC

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EACE and ARCs: A Winning Partnership While the Extremity Trauma & Amputation Center

orthotic and prosthetic componentry and patient

of Excellence (EACE) does not have a direct

functional status or outcomes through research

patient-care mission, “its role is the strategic

tools such as the biomechanics/human perfor-

planning for patient care, with the intent to

mance labs and the virtual reality system, the

Andrea Crunkhorn, DPT

continuously improve and

Computer Assisted Rehabilitation Environment

advance outcomes,” says

(CAREN). “This collaborative relationship bene-

Andrea Crunkhorn, DPT, chief

fits everyone, most particularly patients,” says

of the Clinical Affairs Division

Crunkhorn, “as these lab spaces serve as both

at EACE. “The DoD goal is full

research labs and a capability for advanced clin-

restoration of normal human

ical evaluation and treatment.”

function for both our limb

The symbiotic relationship between EACE

trauma and our limb loss

researchers and ARC clinical staff has resulted in

beneficiaries,” she says.

many important advances. For example, these

Clinicians on the administrative and research staffs at EACE often maintain clinical privileges

partnerships have helped evaluate advanced prosthetic knees through collaborations with the

and see patients in support of the Advanced

prosthetic industry, says Lee

Rehabilitation Centers (ARCs). “This support

Childers, PhD, CP, an EACE

creates trust and understanding between the

senior scientist at the Center

EACE and the full-time clinical staff, enhancing

for the Intrepid at Brooke

planning as well as the development of health-

Army Medical Center. They

care policy and regulation,” Crunkhorn explains.

also have helped assess

“The EACE has ensured that all military service

new developments on

members with any level of amputation have

Lee Childers, PhD, CP

access to care at an ARC.” The ARCs provide artificial limbs and other

Intrepid Dynamic Exoskeletal Orthosis (IDEO) that has enabled patients under-

devices to enable service members to return

going limb salvage to retain their limb while

as closely as possible to their preinjury level of

enabling them to run, and ultimately return to

function, according to Crunkhorn. The EACE

duty, in many cases,” says Childers.

recently sponsored a change in the TRICARE

“We have evaluated new prosthetic designs,

benefit that now allows active-duty service

such as powered prosthetic feet, for optimal

members with any level of amputation to receive

performance and decreased risk for downstream

more than one prosthesis through TRICARE.

secondary health effects,” adds Shawn Farrokhi,

“This was a true barrier to timely and efficient

PT, PhD, EACE facility research director at Naval

care for our service members, whether preparing

Medical Center San Diego. “We have also been

for a deployment, athletic competition, or an

involved in the development of new, low-trimline

annual physical training test.”

socket designs that accommodate the comfort

Working closely with the ARCs’ clinicians, EACE researchers provide support in assessing

the orthotic side, “like the

SEPTEMBER 2020 | O&P ALMANAC

needs of some individuals with transfemoral amputation.”

In another study, EACE staff are focusing on fall prevention for individuals with lower-limb trauma or loss, leveraging treadmill-based perturbations and virtual reality-based disturbances to challenge stability and improve balance recovery strategies, says Farrokhi. A previously developed fall-prevention program, led by the Mayo Clinic’s Kenton Kaufman, PhD, “established the ability to reduce falls in service members with unilateral transtibial limb loss,” explains Hendershot. In recent years, EACE has been participating in an ongoing, multisite effort to expand this program in preparation for broader clinical adoption, he says. “To date, we have demonstrated the utility of an effective and efficient training protocol to reduce falls in service members with lower-limb trauma, with improved functional capabilities and reduced fall risk for at least six months post training.” Expanding into whole-person health issues, EACE researchers are delving into the secondary health conditions faced by individuals with extremity trauma—conditions such as back or knee pain, joint degeneration, and cardiovascular disease. “These conditions, individually or collectively, impart a substantial physical and psychosocial burden after initial injury, and can reduce longer-term outcomes and quality of life,” explains Hendershot. One particular research thrust focuses on better understanding the onset, progression, and recurrence of these conditions “such that we can mitigate risk for, and hopefully one day altogether eliminate, secondary health conditions for persons with extremity trauma,” Hendershot says. This is especially important for individuals sustaining injuries at a relatively young age, such as service members with combat-related injuries “who are now living with a pronounced and progressively increasing risk for developing these conditions over the many remaining decades of life.” Hendershot hopes that outcomes of these studies will translate to other etiologies, such

as dysvascular problems, and may even facilitate a deeper understanding of musculoskeletal and cardiovascular conditions in the general civilian or military populations. Hendershot notes that there are “substantial gaps” in knowledge regarding how various prosthetic and orthotic technologies influence the risk for secondary health conditions. “We are therefore involved in a number of projects seeking to help establish more objective criteria for evaluating and prescribing prosthetic/orthotic devices, with an eye toward both nearterm performance but also longer-term outcomes,” he says. The investigations into secondary health conditions at EACE “span the full spectrum of the research continuum—from basic science, to preclinical animal models, to human clinical trials—and thereby include a comprehensive suite of outcomes,” says Hendershot. “From our perspective, such an approach is critical to providing a more complete understanding of a given phenomenon, which ultimately facilitates generation of broader knowledge and perhaps faster clinical adoption.”

Commitment to Information Sharing

Many of the staff members at EACE have contributed to important research studies with implications well beyond the military population. Team members were involved in developing the most recent “Clinical Practice Guidelines for the Rehabilitation of Individuals With Lower-Limb Amputation,” which offer guidance that is applicable to service members, veterans, and civilians. “We publish our work in field-relevant journals and present the results at conferences focused on O&P and rehabilitation such as [hosted by] AOPA and the American Academy of Orthotists and Prosthetists, for widespread dissemination of our research results,” says Farrokhi. “There are also opportunities for civilian patient enrollment in numerous studies across the EACE.”

EACE conducts monthly education webinars open to all, according to Joseph Miller, PhD, MS, CP, senior advisor, clinical orthotics and prosthetics, at EACE. “At least quarterly, these webinars focus on orthotic and prosthetic devices and are conducted with industry leaders and/or manufacturers presenting the newest technologies and techniques,” he says. Childers emphasizes the relevance of the work at EACE to civilian O&P professionals. “As one of EACE’s two certified prosthetists, I would like to reiterate to the larger P&O community that the EACE’s mission is parallel to the goals of clinicians across the country,” he says. “We are all looking for ways to optimize care for our patients with amputation.” He points to activities such as helping select the most appropriate prosthetic component, determining how someone can best learn to use their prosthesis, delving into what can be done now to mitigate secondary health effects later, and leveraging clinical outcome measures to demonstrate that care has been optimized as examples of EACE priorities that ultimately impact the greater O&P community. “We are always looking for ways that we can conduct research that benefits our service members while ensuring translation into civilian clinical practice,” says Childers. “The EACE is in a unique position to do that, as we are embedded at the three major military treatment facilities that fit people with amputation and have the resources to conduct research that will facilitate clinical translation with our Clinical Affairs team. It is an honor for me to be given the resources through the EACE that enable us to advance care for all patients with amputation.”

Editor's Note: A listing of all

research articles generated by the EACE R&S Division since 2012 is located on the EACE website at https:// www.health.mil/Military-HealthTopics/Conditions-and-Treatments/ Physical-Disability/Extremities-Loss/ Research-and-Surveillance/Publications.

O&P ALMANAC | SEPTEMBER 2020

By DEBORAH CONN

Award-Winning

IDEAS

O&P experts share trailblazing research and proven business practices during the Thranhardt and Hamontree Award sessions at AOPA’s Virtual National Assembly

OME OF THE BRIGHTEST MINDS

in O&P are being celebrated this month during the AOPA Virtual National Assembly. Award winners and nominees will share their clinical and business expertise during the first-of-its-kind remote O&P conference. These subject matter experts will proffer their knowledge as conference participants “learn, recharge, and connect,” through advanced programming and education, which is being offered in combination with the virtual exhibit hall and several virtual networking opportunities. In one of the highlights of the

SEPTEMBER 2020 | O&P ALMANAC

AWARD WINNERS

2020

2020 event, two research teams are being honored with Thranhardt Awards. The award, established by J.E. Hanger in 1995 to honor Howard R. Thranhardt, CP, recognizes individuals committed to advancing orthotic and prosthetic research and education. In addition, business-minded O&P professionals are sharing their best practices during the Hamontree Lecture Series, which showcases three important presentations competing for recognition as this year’s the Sam E. Hamontree, CP(E), Business Education Award winner.

THRANHARDT AWARDS

The 2020 Thranhardt presentations will feature the latest clinical information, with honorees presenting the results of their in-depth research endeavors. This year, Anton of Johannesson, PhD, CPO, is honored for his work in a unique approach to lower-limb amputation. And the team of Caitlin Deom, PT, DPT, and John Frederick, CPO, LPO, is being recognized for its work on a high-intensity gait training approach for the rehabilitation of stroke patients.

BEST

SHOW

Anton Johannesson, PhD, CPO

“Systematic Procedure in Lower-Limb Amputation—the Scandinavian Approach” Anton Johannesson, PhD, CPO Johannesson, clinical manager of prosthetics at Össur, has been concerned with methods of amputation since the early 1990s, when he was inspired by the work of Ernest Burgess, MD, in Seattle. “He had a vision of this total assessment, taking care of the amputee from the beginning: amputation, medication, postoperative treatment, and prosthesis,” says Johannesson. Today, surgeons in Sweden use the sagittal technique in transtibial amputations, whereby the residual limb is closed by equal side flaps. Unlike long posterior flap amputations that created a bulbous residual limb with a transverse scar over the end of the tibia, the sagittal method allows for a short time to first prosthetic fitting, says Johannesson. This is the most popular transtibial surgery in Sweden today, he says, but it is not as common in the United States or elsewhere. In addition, a postoperative liner is used for compression therapy. “When rolled on the residual leg with the sagittal incision line, it helps to compress the suture line together,” Johannesson notes. The liner also offers more consistency than traditional bandaging, according to Johannesson, avoiding variations in repeated applications or between

practitioners. “This results in excellent early outcomes regarding prevention of skin adhesions, scar formation, and shape of the residuum,” he says. The Swedish approach to vascular patients with transtibial amputations incorporates all stages of the process, from the amputation technique through applying a rigid dressing, mobilizing the limb, using a compression liner, training, and then moving to the definitive device, all within 41 days. Furthermore, in Sweden, physicians, prosthetic clinicians, and therapists work collaboratively throughout the process—an approach that leads to faster results and better outcomes.

“High-Intensity Gait Training for Stroke Patients: The Neuroplastic Principles Behind This EvidenceBased Treatment Modality, Comparison to Conventional Physical Therapy, and Effect on Orthotic Management”

Caitlin Deom, PT, DPT, and John Frederick, CPO, LPO The theme of collaboration continues in Deom and Frederick’s presentation. Both researchers work with stroke patients at the Shirley Ryan AbilityLab, where Frederick first learned about high-intensity gait training (HIGT) as a treatment modality. The approach, which is standard practice at the AbilityLab, leverages the principles of neuroplasticity to improve locomotor function and patient outcomes. “Physical therapists aim to achieve functional completion of gait at elevated intensity levels—typically defined as a cardiovascular intensity of 70 to 85 percent of the patient’s

maximum heart rate,” says Deom. This is in contrast to conventional rehabilitation, where the overarching goal is to incrementally challenge patients above their current ability, gradually building on skill level with nonlocomotor tasks to eventually progress to walking, she explains. As a result, patients work on various tasks, such as transfers, balance, and therapeutic exercises, without getting sufficient practice on any single task. With HIGT, weight-bearing, stepping, efficiency, and balance are retrained simultaneously during gait training.

Caitlin Deom, PT, DPT John Frederick, CPO, LPO

The use of HIGT calls for a different orthotic approach, notes Frederick. “Patients typically need an ankle-foot orthosis (AFO) as soon as therapy begins, and the design has to be flexible in terms of adjustability,” he says. “Some may need a solid or prearticulated design initially, but the orthotist is actively involved in adjusting the AFO to become more flexible as the patient progresses throughout the course of rehabilitation.” Deom and Frederick began a partnership that would benefit their patients, and both hope that their colleagues will follow suit. “By combining our knowledge and skill sets,” says Deom, “physical therapists and orthotists can more accurately prescribe AFOs to our patients, and thus facilitate excellent patient care.” O&P ALMANAC | SEPTEMBER 2020

AWARD WINNERS

SPECIAL RECOGNITION In addition to the Thranhardt and Hamontree Awards, several individuals will be recognized for their contributions to the O&P profession during the AOPA Virtual National Assembly. Join O&P professionals as AOPA presents the awards during the Opening Ceremony on Wednesday, September 9, from 6:00 to 6:30 p.m. ET.

Lifetime Achievement Award Each year, AOPA presents the prestigious Lifetime Achievement Award. This honor is bestowed on individuals who have made significant contributions to the field of orthotics and prosthetics. The AOPA Board of Directors is proud to name Arturo Vasquez-Vela (deceased) as the recipient of the 2020 Lifetime Achievement Award.

Ralph R. “Ronney” Snell, CPO, FAAOP, Legislative Advocacy Award This award recognizes individuals who have made valuable contributions toward advancing the legislative and regulatory goals of the O&P field by motivating members of Congress and other decision makers to take action on behalf of O&P. The 2020 award winner is George Breece, executive director of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). Breece helped grow NAAOP from a small group of prosthetists in 1987 to a well respected, national O&P advocacy organization today. “I am most proud of our enduring commitment to the O&P patient, the providers who serve them, and the current role NAAOP plays in working in collaboration with our O&P Alliance partners to advance the profession,” he says. He notes that there have been two key advocacy challenges during his career—first, that the world sees O&P care as device-based, “and that limits the profession in the goals we can accomplish,” Breece says. “We have been striving for separation from durable medical equipment (DME) for years and have been somewhat successful in doing that, but there is more to achieve to sufficiently separate DME from O&P clinical care.” A second challenge has been the size of the profession compared to other aspects of rehabilitation and the broader healthcare provider community. “Building and maintaining awareness of who we are and what we do has been a constant driving force behind NAAOP and is necessary to accomplish the goals of the profession.” Breece advises O&P stakeholders to stay vigilant and support AOPA and the organizations that speak on behalf of the profession. “The decisions in Washington will be made either with the profession’s input, or without it,” he says. “Advancement of the O&P profession is directly linked to the ongoing engagement of providers and consumers who advocate on its behalf.”

SEPTEMBER 2020 | O&P ALMANAC

Student Poster Awards The Edwin and Kathryn Arbogast Award and the Otto and Lucille Becker Award will honor two meritorious scientific papers submitted for presentation as a poster at the 2020 Virtual Assembly by a student or resident. The purpose of these awards is to encourage students and residents to share their research through outstanding poster presentations. This year’s winner of the Arbogast Award for best prosthetic abstract goes to Allison Gordon, University of Hartford, for her poster presentation, “Static and Dynamic Balance Comparison With the Transfemoral K2 Population Utilizing K3 Componentry.” The Becker Award for best orthotic abstract submitted for a poster presentation goes to William Eddy, University of Pittsburgh, for “Quality Standards in Custom Orthotics: Tracking Cause and Frequency of Failed Custom Orthoses by Warranty Cases.”

HAMONTREE PRESENTATIONS

A counterpart to the Thranhardt prize is the Hamontree Business Education Award. Three nominees are sharing BUSINESS presentations geared toward improving O&P business practices during the AOPA Virtual National Assembly: Andreas ABSTRACT Kannenberg, MD (GER), PhD, executive medical director North America for Ottobock Healthcare; Dale Berry, CP, LP, FAAOP, of Prosthetic Xpert Consultation; and Wayne van Halem, CFE, AHFI, of the van Halem Group.

BEST

Dale Berry, CP, LP, FAAOP

“Prior Authorization: How To PROVE Medical Necessity”

Dale Berry, CP, LP, FAAOP After a 27-year career at Hanger providing clinical care and serving as vice president of clinical operations, Berry thought he had plenty of experience dealing with the issue of medical necessity. But once he began consulting work with national workers’ compensation carriers and other payors, he realized there was another perspective. “It’s been a highly educational experience!” he says. “As an industry, we do suffer from the 80/20 rule: 80 percent of the industry does an adequate job of providing evidence of medical necessity, but 20 percent is creating a significant challenge and hardship for the entire industry,” he says. “It’s those egregious cases that get high visibility that lead paying agencies to believe something is wrong with the industry, rather than with individual claims. We, as an industry, need to improve our documentation standards and compliance.” Too often, practitioners focus on the device and not the patient when seeking reimbursement, says Berry. Rather than detailing the features of an advanced prosthesis, practitioners must detail why those features are medically necessary for a particular patient. “Why will this specific

component address the specific functional needs to benefit this individual patient?” he asks. “As prosthetists, we have a responsibility to our patients to ensure that they get the appropriate and optimum care—not only by providing a quality prosthesis, but by also providing quality documentation to get them through the administrative process.”

Andreas Kannenberg, MD (GER), PhD

“Case Studies of Medical Necessity: How To Convince Payors To Approve Advanced Devices”

Andreas Kannenberg, MD (GER), PhD Proving medical necessity is key to Kannenberg’s presentation, as well. He notes that most orthotists and prosthetists come from the technical side, so they tend to describe the advanced features of a device. But the doctors and nurses on the insurance side want to know exactly how those features will benefit the patient medically. Kannenberg spoke on medical necessity at the 2019 AOPA Annual Meeting, and this year he builds on that discussion, addressing how to prepare claims and deal with denials. He also applies those principles to stories of specific patients. “The patient must have unmet needs, and they need to be specified,” explains Kannenberg. For example, he

points to one patient whose activity level made him technically eligible for a microprocessor knee, but the claim was denied. Ottobock’s reimbursement department got involved and interviewed the patient at greater length. It turned out that the patient fell about twice a month, and his fear of falling prevented him from playing with his children because they had a sloped yard. Those details justified the use of the C-Leg, which has stumble recovery and aids walking on uneven surfaces and slopes. “When I am in touch with prosthetists, they often question policy criteria, saying they don’t make sense,” says Kannenberg. “I agree, but the important question is not, ‘Does the policy make sense?’ but, ‘Do you want to get paid?’ If yes, then you have to check all the boxes the policy requires.”

Wayne van Halem, CFE, AHFI

“Regulatory and Oversight Issues: What You Need To Know Now”

Wayne van Halem, CFE, AHFI With 10 years’ experience at CMS in the Program Integrity Department as a fraud investigator and national director of appeals, van Halem knows the ins and outs of regulatory issues. His presentation discusses issues of particular importance to the O&P profession.

O&P ALMANAC | SEPTEMBER 2020

Co-OP

AOPA’s Co-OP The O&P Compendium

Resources include: • State-specific insurance policy updates, • L code search capability, • Data and evidence resources, • And so much more!

An online reimbursement, coding and policy resource, the site includes a collection of detailed information with links to supporting documentation for the topics most important to AOPA Members. O&P’s best kept secret, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA staff, to garner the vast knowledge and experience of the membership.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Learn more and sign up at www.AOPAnet.org/co-op. The Co-OP is a FREE member benefit. FOLLOW US @AmericanOandP

SEPTEMBER 2020 | O&P ALMANAC

Perhaps the most timely topic is whether and how the government’s response to COVID-19, including certain waivers, will affect providers. For example, will waiving enrollment requirements for new providers, including background checks and accreditation requirements, mean more scrutiny for providers postpandemic? As the government reinstates audits, van Halem will outline the details and what this might mean for providers. “We’ll also discuss the future of audits,” he says. “There is a lot happening at the end of 2020 and into 2021.” Six-year lookback audits may be unfamiliar to some clinicians, he notes. “The government now requires that facilities identified with an overpayment, sometimes even just one claim, are required to conduct a self-audit of claims going back six years to see if other instances occurred,” he explains. “Providers will have to state they have personally reviewed every claim or use a statistically verified method to sample claims over that time period,” says van Halem. “This has been the case for all healthcare providers, but only recently have we seen it applied to the O&P industry. It may be rare, but it’s important that providers be aware of the rule—as not abiding by it could lead to False Claims Act implications.” van Halem will also discuss implementation of prior authorization for lower-limb prosthetics. “Once the system is up and running, it might be better than the current claim system,” he says. “People will know in advance whether Medicare will pay or deny, so providers will have less risk of an audit or unpaid claim.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

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PRINCIPAL INVESTIGATOR

Studying the Science Behind O&P Christopher Hovorka, PhD, CPO, FAAOP, studies biomechanics and motor control at East Tennessee State University, where he also is launching an O&P master’s program

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

SEPTEMBER 2020 | O&P ALMANAC

HRISTOPHER HOVORKA, PhD, CPO, FAAOP, director of the

Orthotics and Prosthetics Program at East Tennessee State University (ETSU), did not set out to become an O&P professional. He studied exercise physiology as an undergraduate at the University of New Mexico and started postgraduate work designing exercise programs for individuals who had recently suffered a heart attack or stroke. “To my astonishment, a fair number of clients lacked motivation to engage in an exercise program—despite their near-fatal medical event,” he recalls. “So, I began to look at other career options.” Realizing that O&P was a profession where he could make an impact, he switched careers and pursued a bachelor’s degree in O&P from the University of Washington. It was there that he discovered his passion for research. “As a student, I was surprised by the lack of research and evidence supporting device design and treatment planning,” he says. “I challenged my instructors to point me toward the evidence to support device design and patient-care decisions.” He realized that justification for O&P intervention was not available on the same scale as it is in the field of exercise science. “I decided that after graduation, I

would seek extended residencies combining clinical practice and research opportunities,” recalls Hovorka. He completed a residency in orthotics at Southern Illinois University School of Medicine and a residency in prosthetics at Newington Children’s Hospital in Connecticut—sites located adjacent to large medical centers and known for their solid training in orthopedics, rehabilitation, and movement science. “I figured if I worked in that type of environment where O&P residents were closely engaged with physician residents and movement scientists, that I would have more time to learn the science behind O&P, to engage in research and develop a more solid foundation as a clinical practitioner.” Over the years, he has worked as a research assistant and professor at several universities, including University of Texas Southwestern Medical Center, University of Connecticut, St. Ambrose University, Emory University, Georgia Institute of Technology (Georgia Tech), and the University of Pittsburgh. He earned his PhD from Georgia Tech five years ago. Today he serves as both assistant professor and director of the O&P program in the College of Clinical and Rehabilitative Health Sciences at ETSU.

PRINCIPAL INVESTIGATOR

Building a Research-Driven O&P Master’s Program

PHOTO: Johnson City Medical Center

ETSU has garnered a national reputation for excellence in interdisciplinary health professions education and research and is capitalizing on that strength by launching a new master’s degree program in O&P. “I recently came on board to build the new program, which is slated to start in the fall of 2022,” says Hovorka. The new program “will be intentionally located on the medical school campus in close proximity with clinical doctoral programs in physical and occupational therapy and with the medical school and associated medical centers.” While there is only a small number of faculty in the ETSU Department of Rehabilitative Sciences at this time, the department will be adding nine to 10 additional faculty and one or two more staff over the next couple of years, according to Hovorka. He is designing the O&P program to contribute to clinically relevant research via faculty-directed investigations involving multidisciplinary research in clinical therapeutic aspects of care. One of his specific goals is to continue studies on neuromotor adaptation to use motion-controlling technologies such as orthoses, prostheses, and footwear. Currently, there is little research in this area. “For example, we don’t know the optimal constraint of ankle motion by an ankle-foot orthosis (AFO)-footwear combination for stroke survivors and whether it can improve their movement coordination and minimize muscle atrophy,” he says. Improving motion and minimizing muscle loss is a typical rehabilitation goal, “yet there is little evidence to prove that orthotic treatment is appropriate. “Clinicians likely can cite many anecdotes and clinical cases, but the success stories have not been properly and systematically examined or reported,” he adds. “This has led some healthcare providers to avoid prescribing the use of motion-restricting orthoses for patients, citing a concern that orthotic treatment may lead to learned disuse and muscle atrophy. There is no clear evidence to support or refute orthotic treatment, and this is a concern.”

Aerial photograph of Johnson City Medical Center located on the Veteran’s Affairs (VA) Campus. The VA Campus is where the ETSU medical school is located and where the O&P program will be housed in a historic building (not shown) nearby this hospital. The ETSU O&P program will share the building with the clinical doctoral programs in physical therapy and occupational therapy.

Justifying O&P Intervention

Over the years, Hovorka has been involved in many research projects that align with his desire to offer justification of O&P intervention. His central area of focus is stroke survivors who use lower-extremity orthoses and footwear. “Stroke survivors represent the largest community of AFO-footwear users, and there is a lack of information on optimal treatments,” Hovorka says. He hopes that as understanding of this subject matter improves and grows, others will begin to take on related well-controlled research studies “so that practitioners will be armed with more rigorous information to better inform treatment decisions and improve patient-care outcomes.” In one key project, he led a clinical research study with collaborators at Boland Prosthetic and Orthotic Center in Macon, Georgia. “We examined gait and movement of persons with neuromuscular disorders that required use of an AFO,” he says. In the study, the team compared the use of custom-fit carbon composite AFOs (Toe Off AFOs) with

custom-molded passive-dynamic AFOs (PD-AFOs). “The term ‘PD-AFO’ refers to a device that contains molded shank and foot sections joined by a posterior strut,” he explains. “We hypothesized that persons using a PD-AFO and stiff configuration would engage the posterior strut, which acts as a spring, and by doing so, would exhibit improved propulsion and gait speed, compared to no AFO and compared to a Toe Off AFO.” In their preliminary results, Hovorka and his colleagues noticed that some patients using the PD-AFO walked faster and preferred it, whereas other patients who walked slower did not prefer it. “We think that the patients who walked faster in the PD-AFOs may have more effectively engaged the spring, which in turn may have improved their propulsion,” he says. “Interestingly, the patients that walked comparatively slower using the PD-AFOs commented that the AFO was too stiff and reported discomfort.” Hovorka and his team need further study with a larger sample size to confirm their preliminary findings. O&P ALMANAC | SEPTEMBER 2020

PRINCIPAL INVESTIGATOR

Aerial photograph of the VA Medical Center, which houses the building that the O&P program will share with the physical therapy and occupational therapy programs. The Johnson City Medical Center and Niswonger Children’s Hospital are located near the top of the photograph. The entire area within the photo is the VA Campus.

SEPTEMBER 2020 | O&P ALMANAC

of our rehabilitation research lacks a control group of healthy users and their response to orthoses and footwear,” he says, but this information is needed so that clinicians can make more informed decisions on the selection and use of orthoses and footwear for their patients and to see what the differences are between healthy response and pathological response. This is typical in medical research but is not typical in O&P-related research, according to Hovorka. “The rationale is that better informed clinical decisions will lead to improved clinical outcomes and greater reimbursement for services by payors, as there will be proof to support clinical decisions.” Hovorka concedes that it will take much time, effort, and support to get to this point. “Researchers like myself and others will need funding to support future endeavors in tandem with engagement by other clinicians to participate in clinical research studies,” he says. “It cannot happen in isolation and requires a community to engage and support it. It also will require a shift in thinking, that control groups—involving healthy subjects—should be included in clinical studies.” He notes that clinicians must be willing to take on the added effort of learning how to read and interpret this type of research. “The best way to start that is to reach out and collaborate with research teams.”

Learning From His Travels

Hovorka’s career path has brought him to many universities and institutions

across the United States, so it comes as no surprise that he enjoys visiting new places and exploring new areas. “I enjoy travel and adventure, which includes bicycling and trekking,” he says. “I have been fortunate to cycle and trek in many parts of the world. Those activities provided some profound experiences.” In addition, he is grateful for a career “that encourages collaboration with other disciplines within the United States and outside of it, on many continents,” he says. That, combined with his interest in learning and adventure, has allowed him to visit “nearly every state and a couple of dozen countries.” These travels have boosted his appreciation for how people adapt to their environments. “I am a bit in awe when I come across folks in difficult, impoverished environments and see that they lead generally happy lives,” he says. “It makes me reconsider my situation during tough times.” His travels also refresh him, and he returns from his trips re-energized to tackle new research endeavors and to continue his work in building a new O&P program. These efforts will hopefully contribute to establishing a shared vision in which research and translation of knowledge to the clinic is a high priority, says Hovorka. “The cost of not doing so is too great,” he says. “We jeopardize losing our relevance as members of the rehabilitation team and erode our chances of expanding our scope of practice and reimbursement for services to achieve our ultimate goal—to improve patient care.”

PHOTO: Johnson City Medical Center

His current investigations include a manuscript under review by the journal Clinical Biomechanics that is a summary of several years of his research at Georgia Tech regarding key design features and biomechanical principles that influence the motion control performance of AFOs and footwear when walking with maximum constraint of ankle motion. He also is working on two more manuscripts for future submission. “One involves research on the role of footwear and another on research regarding neuromuscular adaptation to use of orthotic ankle constraint of motion.” Considering future projects, Hovorka will launch a second clinical trial with an O&P clinic in Florida to extend the work from an earlier pilot study on the use of PD-AFOs in stroke survivors. He also hopes to work on developing a modular AFO-footwear combination to be used as a clinical diagnostic tool. “I wish to continue to expand the research on stroke survivors’ patterns of neuromotor response to various ‘doses’ of orthotic constraint of motion,” he says. He will continue his work with clinical partners so that the research can be employed across various clinics. “That way, we can take the study from the lab into the clinic, where it may be more relevant for the rehabilitation community.” Hovorka’s ultimate goal is to help build a baseline of normative data on the clinical efficacy of orthoses and footwear and their impact on gait and neuromuscular adaptation. “Much

MEMBER SPOTLIGHT

Progressive Prosthetics & Orthotics

Giving Care and Giving Back Oklahoma-based facility is active at home and in Nigeria

EFF ARNETTE, CPO, and his

wife, Kathy, are celebrating 25 years of providing O&P care through their company, Progressive Prosthetics & Orthotics, based in Tulsa, Oklahoma. The facility has grown over the years to comprise 16 employees in six offices in three states. Three of the couple’s five children also work in the business: Michael Arnette and Brandon Arnette are prosthetist/orthotists certified by the Board of Certification/Accreditation, and Daniel Arnette is an orthotic and prosthetic assistant certified by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics.

Michael Arnette, BOCPO; Ado Nicodemus Baggibawa; and Jeff Arnette, CPO

SEPTEMBER 2020 | O&P ALMANAC

FACILITY: Progressive Prosthetics & Orthotics

Medical O&P Advisory Board and directs Progressive’s residency program, while Brandon is president of the Oklahoma Association for Orthotics & Prosthetics. Early on, the Arnette family OWNERS: knew they wanted to bring their Jeff Arnette, CPO, skills to underserved parts of the and Kathy Arnette world. In 2016, Michael connected with Arise and Walk Ministries, LOCATION: founded by the Reformation Offices in Oklahoma, Baptist Church to provide low-cost, Missouri, and Kansas subsidized, or free prostheses to Nigerians who cannot afford them. HISTORY: As part of the plan for sustainability 25 years and employment of local staff, and to control the flow of supplies, Jeff, along with Dan Horn, established Dynamic Prosthetics Nigeria to provide patient prosthetic care. “According to the Plateau state disability commissioner in Nigeria, there are approximately 10,000 amputees in the area we serve, yet only a few hundred are estimated to have a prosthesis,” says Jeff. Arise and Walk employs two people in Jos, Nigeria. Through Dynamic Prosthetics Nigeria, the nonprofit has provided prosthetic devices for 82 people at no cost Ado Nicodemus Baggibawa works in the lab in Dynamics and 24 at a discounted rate. Prosthetics Nigeria. Overall, Dynamic Prosthetics Nigeria, with five employees, has

fit or repaired 149 prostheses. “Dynamic Prosthetics operates as a for-profit business, but it delivers 55 percent of its orthoses and prostheses for free and 16 percent at a discount,” Jeff explains. His goal is to establish an O&P testing and certification process in Nigeria. He is working with government officials to make this a reality. “I want to make this sustainable,” he says. “I’ll be visiting Nigeria for maybe four or five more years, but I’m working on an exit plan and a funding strategy so this work can carry on without the need for our involvement.” That’s a complicated effort, as Nigeria needs access to raw materials as well as donated limb components. “Little by little, we’re creating a supply chain through Arise and Walk, which can bring in materials and devices and make them available to local companies,” he says. Normally, members of the Arnette family visit Nigeria three times a year to work with the clinic, but the coronavirus pandemic has stymied any travel plans. “Fortunately,” Jeff says, “technology has made this a lot easier. We have been utilizing telemedicine, and I was on a videoconference yesterday with our practitioner and patients in Jos.” Whether in the United States or Nigeria, his mission is clear: “The heart of our company is to provide the best quality care we can, and to advance the industry in professionalism and political standing.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

Donating to the Cause Patients and practitioners can find information on donating products, components, or supplies at https:// progressivepo.com/charity.

PHOTOS: Progressive Prosthetics & Orthotics

Progressive offers the full range of orthotic and prosthetic services and fabricates all devices in-house, including 3D-printed prostheses. The facility has an active Facebook page featuring videos of patient success stories, as well as a robust website. Progressive sponsors several events for amputees and has a team of amputee peer visitors to help ease the process for new patients. The company also offers accredited in-services to referrers and other ancillary providers for continuing education credits. Volunteerism also runs in the family: Jeff serves on the Oklahoma

The combined staff of Arise and Walk and Dynamic Prosthetics Nigeria

By DEBORAH CONN

AOPA NEWS

Download Data From the CMS Data Portal DATA AT YOUR FINGERTIPS

FREE ACCESS

Looking to develop a new product? Want to see who is currently using what product? AOPA members can access the CMS Data Portal to access comprehensive, easy-to-use, easy-to-read, Medicare Part B orthotic and prosthetic claims data from the last five years; previous years are available with special request. You can download customized reports for use in your own reports and marketing material. The data is updated annually to ensure you have the most recent data at your fingertips. Just set your search parameters,

and in a matter of minutes you’ll get data to help you do the following: • Understand the current market in terms of size, geographic distribution, and provider specialty. • Predict growth and opportunities. • Compare historical and projected growth rates in Medicare. • Identify new product opportunities. This CMS Data Portal is free to AOPA members. To access it all you need is your AOPA member username and password. Visit the AOPA website, or contact Devon Bernard at dbernard@AOPAnet.org.

AOPA Offers Members Free Access to AOPAversity

AOPA knows you and your employees are being tremendously impacted by COVID-19. To help, we are offering you, our AOPA members, the ability to access our online learning management system, AOPAversity, for free for

the rest of 2020. It is our hope that this will make it easier to navigate the current unprecedented situation. What does this mean? You and your employees can now access all 72 online offerings, which are prerecorded videos available on demand. That’s 33 business offerings worth 34.5 Business Credits and 39 clinical offerings worth 60.5 Scientific Credits—all for free. If you do not currently have an AOPAversity account, visit www.AOPAnetonline.org/aopaversity/register to create a profile. You will need your AOPA member ID and the Zip code affiliated with your membership when you create your profile to access the free offering. Already have a profile? Log in at www.AOPAnetonline.org/aopaversity. Your username is the email used to create your profile. This offer is valid through Dec. 31, 2020, and excludes any refunds to purchases made prior to the start of this offer. We hope this benefit offers you additional support during this uncertain time. Contact Ryan Gleeson at rgleeson@AOPAnet.org with any questions. O&P ALMANAC | SEPTEMBER 2020

AOPA NEWS

Webinars UPCOMING WEBINAR WEDNESDAY

OCT. 14

During these one-hour sessions, AOPA experts provide up-to-date information on a specific topic. Webinars are perfect for the entire staff—they’re a great teambuilding, money-saving, and educational experience! Sign up for the entire series and get two conferences free. Entire Series ($990 Members/ $1,990 Nonmembers). Register at bit.ly/2020webinars.

Clinician’s Corner: Fitters and Techs

Join AOPA October 14 for the last installment of the new Clinician’s Corner of 2020. Learn about the newest tips and techniques for fitters and technicians, and access advice on optimal treatment of patients—all while earning some technical credits. This month’s Clinician’s Corner will be presented by one of AOPA’s many honored National Assembly presenters.

UPCOMING WEBINAR WEDNESDAY

NOV. 11

RAC Audits: What Are They Looking At?

The November 11 webinar will examine the rules governing the recovery audit contractor (RAC) program, the different types of audits conducted by the RAC, and what areas the RAC is currently auditing. Hear an expert discuss these issues and tips for avoiding potential RAC audits.

New Technical Credits

AOPA Offers COVID-19 Responses, Guidance, and Resources AOPA leadership has continued to closely follow the spread of the coronavirus disease (COVID-19) and its widespread impacts. We also have been taking your calls and emails and hearing firsthand how extremely difficult and uncertain things are for you, your businesses, and your patients. To that end, we are responding with support. We are responding with outreach to legislators about how they can best support the O&P profession. We are responding by providing guidance on regulations like documentation, telehealth, and stay-at-home orders. We are responding by pulling together resources. We are responding by creating a space on the Co-OP to share your experiences and strategies with one another. All of this information can be found on the newly developed COVID-19 Response and Resources webpage, 48

SEPTEMBER 2020 | O&P ALMANAC

www.AOPAnet.org/resources/covid-19/. We will be updating this webpage frequently with actions, guidance, and resources, and will be pushing out updates via email, Smartbrief, and AOPA’s social media channels. As the situation evolves daily, we encourage you to also follow the guidance being issued from the Centers for Disease Control and Prevention (CDC), the World Health Organization, and your local, state, and federal government. The CDC website features resources and guidance for healthcare facilities; visit www.cdc.gov/ coronavirus/2019-ncov/healthcare-facilities/. Thank you for all you continue to do for your patients and the O&P profession. The AOPA Board of Directors and staff are here to support you. If you have questions, concerns, or needs, do not hesitate to reach out to any of the staff at info@AOPAnet.org.

NEW MEMBERS

Welcome New AOPA Members

HE 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.

Now VIRTUAL SEPT. 9-12 | 2020

THE P R E M IE R M E E TING F O R O RTHOTIC, P R O ST H ET I C , A ND P E D O RTHIC P R O F E SSI O NA L S.

Special Thanks to Our Sponsors GOLD SPONSORS

SILVER SPONSORS

Freedom Prosthetics MS LLC 303 Marion Avenue Crystal Springs, MS 39059 601/892-7745 Morris Moncure Patient-Care Facility

Solutions Orthocare Group LLC 7001 St. Andrews Road, Ste. A-17 Columbia, SC 29212 803/781-1269 John Owen, BOCPD, BOCOF, CDME Patient-Care Facility

SUPPORTING SPONSORS

College Park Industries | Freedom Innovations LLC Orfit Industries America Spinal Technology Inc. | Surestep

SPECIAL

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Running an O&P business is no easy feat, but you don’t have to do it alone. AOPA is here to help you get back to business, to support you in the new normal.

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RESEARCH EDUCATION

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For more information on membership, call 571/431-0810 or email bleppin@AOPAnet.org.

ADVOCACY | RESEARCH | EDUCATION

www.AOPAnet.org/join O&P ALMANAC | SEPTEMBER 2020

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast Technician

Job location key:

East Tennessee Come join us in the great smoky mountains. Family owned and operated business for more than 30 years is looking for an experienced orthotic and prosthetic technician. Paid holidays, paid vacation, relocation assistance, and company paid insurance. Email résumé to:

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Email: hcprosthetics@gmail.com Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $85 $150

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

AOPA’s O&P Career Center Connecting highly qualified O&P talent with career opportunities EMPLOYEE

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

SEPTEMBER 2020 | O&P ALMANAC

• Apply online for job openings • Free résumé review

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.

• Research who is hiring

EMPLOYER

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• Manage your posted jobs and applicant activity easily on this user-friendly site.

CAREERS

Career Opportunities... California

CO-Sacramento CO-Modesto Oregon CPO –Corvallis & Salem

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services. The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

To apply, submit resume to: careers@pacmedical.com

A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.”

AD INDEX

Advertisers Index Company

Page Phone

Website

ALPS South LLC

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Amfit

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ComfortFit Orthotic Labs Inc.

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Coyote Design

800/819-5980

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Cypress Adaptive LLC

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ESP LLC

888-WEAR-ESP

www.wearesp.com

Hersco

1 800/301-8275

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Naked Prosthetics

www.npdevices.com

888/977-6693

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

Phoenix Molded Shoes, Inserts, & Braces

www.phoenixmolded.com

863/658-2616

PROTEOR USA

3 855/450-7300

www.proteorusa.com

The Bremer Group Company

800/428-2304

www.bremergroup.com

TurboMed Orthotics

888/778-8726

www.turbomedorthotics.com

O&P ALMANAC | SEPTEMBER 2020

MARKETPLACE

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

ALPS Silicone PRO (LSL / LSC) ALPS Silicone PRO is a liner with seamless knitted fabric for extra protection. Our Silicone PRO is a medical-grade silicone liner available in locking or cushion suspension in 3.0-mm uniform thickness. The fabric in the liner allows patients comfortable suspension in their prosthesis, and allows for freedom of movement. Other components of this liner include reduced pistoning, and it is one-fifth the friction of regular silicone. Call us or visit www.easyliner. com for more information.

ComfortFit Labs A Preferred Richie Brace Partner Lab We provide the most comprehensive Richie Brace® support in the industry. ComfortFit always offers free shipping on all Richie Brace products. Get a free STS casting sock, upon request, with each Richie order and 50 percent discount on all replacement straps and pads. Fast turnaround time is guaranteed. Our website provides you with advanced casting technique videos, coding and billing updates, and prescription forms for download. For more information, email contact@comfortfitlabs.com, visit www. comfortfitlabs.com, or call 888/523-1600. Reimbursement for the Richie Brace has increased for 2020. Call for details.

Aria Plate Valve by Cypress Adaptive The Aria Plate Valve by Cypress Adaptive is a simple and reliable solution for any suction suspension application that requires auto-expulsion function with push-button release. The Aria Plate Valve saves on fabrication time as it simply bolts to to any four-hole mounting plate. It is cost effective, durably constructed, and easily disassembled for cleaning and servicing. To learn more, visit us at www.cypressadaptive.com or call 888/715-8003. 52

SEPTEMBER 2020 | O&P ALMANAC

Coyote Design Kleenaire

An affordable alternative to purify the air. • Designed for easy installation—mount the Kleenaire on a wall and plug it in. • Pre-Filter—the medical grade filter will remove dust, viruses, bacteria, and allergens. • Charcoal Filter—the activated carbon absorbs odors and irritants. The Kleenaire Dual Filter System now has medical-grade filters. These are quality filters trusted by hospitals and healthcare facilities for higher efficiency air filtration for filtering dust, viruses, bacteria and allergens. Ask about our filter subscription. Call Coyote® for our new medical grade replacement filters for the Kleenaire. For more information, contact Coyote at 208/429-0026 or visit www.coyotedesign.com.

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

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

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

Proteor Rush Rogue® The PDAC approved RUSH ROGUE® provides the most realistic and dynamic foot and ankle motion available. The Vertical Loading Pylon (VLP) provides vertical shock relief while offering +/- 8 degrees of torsion, allowing the user to push the foot and themselves to the limits. The RUSH ROGUE is made of our advanced fiberglass composite, which is three times more flexible than conventional prosthetic feet. The rollthrough characteristics of the foot provide exceptional energy return with no “dead spot.” The RUSH ROGUE is also available in the EVAQ8 elevated vacuum and H2O models. #goROGUE

Quickchange—“Click, Twist, and Go” With the Quickchange adapter from Ottobock, your patients can switch between different prosthetic feet in just a few steps—just click, twist, and go. Changing to a secondary foot for specialty applications like swimming or sports is quick and easy. Help your patients be prepared with the Quickchange adapter. For more information, visit www.professionals.ottobockus.com or call 800/328-4058.

Ottobock iFab—Fabrication Services

Your busy practice is running at full capacity and you don’t want to turn custom orthotic and prosthetic fabrication away, but you want control—of your patient, the device, and the price. You need quality back-up you can trust—and you want to grow your business. We can help. Learn more about Fabrication Services for hip sockets, TT-TF test sockets, upper limb, custom silicone, orthotics, and SiOCX. For more information, visit www.professionals.ottobockus.com or call 800/328-4058.

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

O&P ALMANAC | SEPTEMBER 2020

CALENDAR October 3

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

October 8–10

South Carolina Society of Orthotists and Prosthetists (SCSOP) NC/SC Combined Meeting. SCSOP hosting. Greenville, SC. For more information, visit https://scsop.org.

APPLY ANYTIME. TEST ANYWHERE. Become a BOC-certified orthotic fitter, www.bocusa.org mastectomy fitter, or durable medical equipment specialist. Exams are offered year-round: in-person at test centers and select conferences and online from the location of your choice with a live, remote proctor! Visit www.bocusa.org/certification/apply.

Cascade Dafo Institute

Nine free ABC-approved online education courses to enhance your clinical practice. Take anytime, anywhere, and earn up to 14.5 CE credits. Visit cascadedafo.com or call 800/848-7332.

October 9–10

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

October 12–17

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

October 14

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

2020 September 9–12

AOPA Virtual National Assembly. For more information, visit www.AOPAnet.org.

September 24–26 (New rescheduled date)

Texas Society of Orthotic & Prosthetic Professionals (TXSOP) Meeting (formerly TAOP and TXAAOP). Rescheduled from June. Richardson, TX. For more information, visit www.txsop.org/annual-meeting.html.

October 1

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

October 1

ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.

SEPTEMBER 2020 | O&P ALMANAC

October 15–17 (New rescheduled date)

Tennessee Society of Orthotists and Prosthetists (TSOP) Annual Meeting. Rescheduled from April. Embassy Suites Nashville Airport, Nashville. For more information, visit www.tennsop.org.

October 27–29

OT World.connect 2020. A Virtual World Congress with more than 250 participants from more than 20 countries will be accompanied by digital presentations on industry innovations. For more information, visit www.ot-world.com/index-en.html.

November 1

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

November 1

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

CALENDAR November 4–6

New Jersey AAOP. Harrah’s Resort Atlantic City. For general inquiries, contact Brooke Artesi at 973/696-8100, brooke@sunshinepando.com, or www.NJAAOP.com.

November 11 WEBINAR

visit www.AOPAnet.org.

RAC Audits: What Are They Looking At? For more information,

May 12–14

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort, Schenectady, NY. For more information, visit nysaaop.org/meeting.

September 9–12

AOPA National Assembly. Boston. For more information, visit www.AOPAnet.org.

November 1–4

December 1

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

ISPO 18th World Congress. Expo Guadalajara Convention & Exhibition Centre in Guadalajara, Mexico. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

December 1

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

WEBINAR

www.AOPAnet.org.

December 9 New Year: New Codes, Fees, and Updates. For more information, visit

2021 February 1

ISPO 18th World Congress Deadline for Symposia and Instructional Courses. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

March 29

ISPO 18th World Congress Deadline for Free Papers. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

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

2020 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2020 AOPA coding products. Ensure each member of your staff has a 2020 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • 2020 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2020 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

Let us share your next event! Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

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O&P ALMANAC | SEPTEMBER 2020

STATE BY STATE

O&P Oversight Updates from Florida, New Jersey, New York, and Texas

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/resources/co-op.

Florida

AOPA members in Florida are reporting increased Medicaid audit activity. AOPA believes the uptick in audits may be in response to heightened scrutiny resulting from recent U.S. Department of Health and Human Services Office of Inspector General (OIG) activity, including the OIG report titled, “Freedom Orthotics Inc.: Audit of Medicare Payments for Orthotic Braces.” AOPA also is looking into reports that third-party administrators in Florida are not accepting electronic signatures on medical records.

New Jersey

COVID-19 Updates AOPA is maintaining statespecific updates related to the coronavirus disease (COVID-19) on all state pages of the Co-OP. Please visit your state’s page for additional information.

Horizon Blue Cross Blue Shield of New Jersey has updated its Myoelectric Prosthetic and Orthotic Components for the Upper-Limb Medical Policy with policy language stating that the myoelectric prosthetic and orthotic components for the upper limb are covered under mandate if obtained from a licensed orthotist or prosthetist or certified pedorthist, as determined to be medically necessary by the covered person’s physician.

New York

A call to action continues in New York. AOPA is working with the New York State Chapter of the American Academy of Orthotists and Prosthetists to help O&P practices fight for change to the Medicaid fee schedule, which is more than 33 years old. If you are in New York state, please consider taking action: 56

SEPTEMBER 2020 | O&P ALMANAC

• Send information about O&P practices that have closed in the state. • Send information regarding which L codes are poorly reimbursed (or not covered at all) under New York Medicaid impacting your O&P practice. • Share information about relationships or contacts you or your patients have with New York legislators. • Reach out to local state representatives. Please email @gmail.com with information, questions, or concerns.

Texas

Pursuant to House Bill 2059, orthotists, orthotic assistants, prosthetists, prosthetic assistants, and prosthetist/ orthotists are required to complete an approved human trafficking prevention training course in order to renew their license beginning Sept. 1, 2020. The training course must be approved by the Texas Health and Human Services Commission and is required for each license renewal submitted on or after the effective date.

Submit Your State News

To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.

COMING TO BOSTON 2021

2021 EXCELLENCE in EDUCATION Prosthetic

Orthotic

We ARE AOPA

Pedorthic

Technical

Business

Mark your calendars for September 9-12, 2021, for an ideal combination of top-notch education and entertainment

ADVOCACY | RESEARCH | EDUCATION

at the 104th AOPA National Assembly in Boston, MA.

#AOPA2021

We look forward to seeing you in 2021!

Leonard P. Zakim Bunker Hill Memorial Bridge in Boston

www.AOPAnet.org

Empower by Ottobock

It’s more than a foot, it’s a foundation.

Power, security, and real-time adaptation

The Empower microprocessor foot is the only prosthetic foot with powered propulsion. Give your patients an active ankle joint that provides power, even on ramps, stairs, and hills. The added security of real-time adjustments to terrain will help patients gain the confidence needed to return to daily life at home and work. Help your patients own their outcome. professionals.ottobockus.com/empower