AOPA 2017 Annual Report

2017

ANNUAL REPORT

WWW. A OPA NE T. O R G

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AOPA’S MISSION

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

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2017 Annual Report

Table of Contents

AOPA’s Mission

Leadership Report

2

AOPA Board of Directors

3

Overview of Accomplishments in 2017/AOPA’s Centennial

4

Advocacy

5

Research

6

Inside Cover

Education 7

New Benefits for Members

8

Membership

9

AOPA’s Volunteer Leadership

10

Financial Highlights

12

How are my membership dues invested?

12

Statement of Activities and Financial Position 2017 year end

13

Special Acknowledgment of Our Sponsors

14

AOPA National Assembly 2017

14

AOPA Policy Forum 2017

15

O&P Almanac 2017

15

Prosthetics 2020, Orthotics 2020

15

2017 Award Recipients

16

WALK THROUGH TIME

17

AOPA Resource Guide for 2018

Calendar of Events for 2018

Inside Back Cover Back Cover

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LEADERSHIP REPORT

A Message from Michael Oros No one could possibly say 2017 was an ordinary year—let us count the ways it wasn’t.

This was a very special year for O&P and AOPA as we celebrated 100 years of steady progress and growth in serving our patients. The Centennial Directory, our special website www.AOPA100.org, the Walk Through Time at the World Congress in Las Vegas, and a record breaking O&P PAC event—were all a proper tribute to a legacy left by those who came before.

A new U.S. president was inaugurated after an election that revealed how sharply divided the politics of our country can be. In these circumstances advocacy organizations like AOPA are really put to the test.

The O&P community was optimistic that CMS would implement BIPA 427 regulations after nearly eighteen years of inaction. The proposed regulation would have clarified the role of the prosthetist and orthotist by making their notes part of the patient’s medical record, among many other important requirements.

Our efforts then refocused on the passage of the O&P Medicare Improvement Act (S. 1191 and HR 2599) or inclusion of its provisions embedded in a larger piece of healthcare legislation.

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2017 saw the completion and publication of the very significant RAND Corporation study on the cost effectiveness of O&P transfemoral prosthetic care which clearly articulated the economic benefits of advanced technology for the K3 amputee. Soon to come is a similar report on transtibial amputations. These unassailable research findings will help communicate our value proposition to payers and support our efforts to make sure policy makers take these findings into account when making decisions that affect our patients.

Additional research findings unfolded in the Dobson DaVanzo project updating the 2007-2010 Medicare Data with additional 2011-2014 Medicare services data – and Part D prescription data which helps capture further cost information that can compare patients receiving O&P intervention with a cohort of patients not receiving O&P care.

A new member benefit was released in 2017 as AOPA rolled out its Co-OP which is an online resource that brings members the latest information that will inform their billing practices leading to more favorable reimbursement.

LEADERSHIP REPORT

2017 AOPA Board of Directors

From left to right: Pam Lupo, CO; Jeff Collins, CPA; Chris Nolan; Michael Oros, CPO, FAAOP; Traci Dralle, CFM; David Boone, BSPO, MPH, PhD; Jim Weber, MBA; Jeffrey Lutz, CPO; Teri Kuffel, JD; Rick Riley; Dave McGill, James Campbell, PhD, CO.

AOPA collaborated with the Health Care Compliance Association (HCCA) to observe “Healthcare Compliance and Ethics Week” which energized more than 500 members of our community to participate in seminars, educate staff, and share their focus on ethical behavior with their patients and community. The effort was a reminder that O&P professionals are committed to delivering quality service with integrity.

PROSTHETICS

ORTHOTICS

2020 2020

Further progress was made in our Prosthetics 2020 initiative when our Medical Advisory Board met with all four DME MAC Medical Directors at AOPA headquarters on November 15th. This meeting elevated our interaction with these important decision makers which resulted in a new level of understanding.

A special thanks goes to the MAB members, the Prosthetics 2020 steering committee members, and others for making this such a worthwhile event.

Progress with Prosthetics 2020 stimulated interest and identified the need to launch a parallel project—Orthotics 2020. Work has already begun and

efforts are underway to address five distinct areas including osteoarthritis; stroke, scoliosis, traumatic spinal injuries, and plagiocephaly. You’ll hear much more about this effort in 2018 from my successor, Jim Weber, MBA. Closing off this centennial year reminded me what a privilege it is to serve a profession that makes such a huge difference in the lives of our patients.

We’re usually in an enviable position of being bearers of good news and progress in the lives of patients. But I am similarly reminded that what we do and the patients we serve is still a work in progress with much more to achieve.

With your continued support, AOPA will do its best to make those achievements ones of which we can all be proud.

Michael Oros, CPO, LPO, FAAOP 2017 AOPA President

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OVERVIEW OF ACCOMPLISHMENTS IN 2017/AOPA’S CENTENNIAL

2017

AOPA’s Centennial: Celebrating the Past— Envisioning the Future AOPA

celebrated its 100th anniversary in a variety of ways last year. A keepsake member directory listed all AOPA member locations and included special sections for O&P history, technology timeline and photographs that showcased our member’s proud heritage.

As an added bonus, AOPA used the directory to advertise AOPA members in the Commission for Case Manager Certification (CCMC) newsletter for seven weeks. CCMC has 40,000+ members and is the largest membership organization for case managers.

AOPA100.ORG

6,000 Number of visits

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The Walk through Time exhibit at the World Congress in Las Vegas showcased O&P technology in the context of AOPA’s history and world events through the last century.

The commemorative website, www.

AOPA100.org was launched to revisit the past with photographs and member stories and to encourage visitors to dream about what is next for O&P. Throughout the year, a special monthly column in the O&P Almanac and weekly social media posts spotlighted how the O&P profession has evolved over the years.

Lisa Arbogast and Rep. Steve Stivers (R-OH)

Advocacy LEGISLATIVE During the healthcare debate in Washington and across America, AOPA sponsored its annual Policy Forum where more than 100 AOPA members traveled to DC to discuss the issues most important to them and their patients with their lawmakers. AOPA scheduled more than 350 appointments with lawmakers.

AOPA members thanked Senators Grassley (R-IA) and Warner (D-VA) as well as Reps. Glenn Thompson (R-PA) and Mike Thompson (D-CA) for their work in introducing the 2017 Medicare O&P Improvement Act (S. 1191 and H.R. 2599).

AOPA members also heard from and had a chance to interact personally with Sen. Bill Cassidy (R-LA) and Reps. Brian Mast (R-FL), Brad Wenstrup (R-OH) and Richard Neal (D-MA) who spoke at the 2017 AOPA Policy Forum.

AOPA’s efforts resulted in the U.S. House of Representatives passing H.R. 3178, which included the long-awaited provision to recognize the orthotist-prosthetist’s notes as part of the medical record in Medicare Medical Necessity Determinations. Our attention refocused on the passage of the O&P Medicare Improvement Act (S. 1191 and HR 2599) or inclusion of its provisions embedded in a larger piece of healthcare legislation.

Sen. Bill Cassidy (R-LA) speaks at the 2017 Policy Forum

Rep. Brad Wenstrup (R-OH) and Jeffrey Brandt, CPO

Rep. Brian Mast (R-FL)

Jeffrey Brandt, CPO, an AOPA member and newly elected board member, presented AOPA’s testimony before the Veteran’s Affairs Subcommittee on Health informing representatives of the need to expand the number of highly qualified prosthetists and orthotists who can meet the needs of Veterans with limb loss and limb impairment, and to reduce the barriers to timely, appropriate lower extremity care.

POLICY FORUM ATTENDEES

112

CAPITOL HILL APPOINTMENTS Michigan O&P professionals organized a Prosthetic Forum at their Congressional Representative’s request, to educate Rep. Bishop on all aspects of challenges facing the O&P community. The O&P attendees and AOPA leadership expressed appreciation for his support in helping advance H.R. 3178—the provision legitimatizing the orthotist/prosthetist notes as part of the Medicare record for purposes of medical necessity determinations*, and opened discussions on other topics in the Medicare O&P Improvement Act (HR. 2599/S. 1191) with which Rep Bishop can assist.

at Policy Forum

395 O&P PAC DONATIONS

$63,540 Representing 94 Donors

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OVERVIEW OF ACCOMPLISHMENTS IN 2017/AOPA’S CENTENNIAL

REGULATORY

Research will continue as a priority with capabilities greatly expanded to capture data that even more convincingly tells the story that mobility saves.

RAND Study By the Numbers

RAND’s simulation, published in “Economic Value of Advanced Transfemoral Prosthetics,” shows the following results when comparing microprocessor knees (MPKs) with nonmicroprocessor knees (NMPKs): ■■ For every 1,000 people, MPKs result in 82 fewer major injurious falls

and 62 fewer minor injurious falls, and save 11 lives over a one-year period.

■■ Similarly, MPKs result in significantly fewer instances of osteoarthritis.

■■ On a per-person-per-year basis, MPKs reduce direct health-care costs by $3,676 and indirect costs by $909, but increase device acquisition and repair costs by $6,287 and total costs by $1,702.

■■ On a per-person basis, MPKs increase the number of life years by 0.11 and quality-adjusted life years by 0.91.

■■ MPKs have an incremental cost-effectiveness ratio of $11,606 per qualityadjusted life year.

■■ The economic benefits of MPKs are robust in various sensitivity analyses.

■■ On a per-person basis, MPKs are associated with an incremental total cost

of $10,604.

Throughout the year, AOPA coding and billing experts participated in the DME MAC Advisory Councils so that the perspective of O&P businesses is represented in their policy related discussions.

AOPA met with several key members of the HHS Leadership team as a first step in communicating the positions of AOPA members to the new administration.

The agenda focused on activities and solutions that AOPA believes can help achieve better outcomes for patients and deliver economic benefits for Medicare. A top concern expressed was the status of the flawed Local Coverage Determination that would have imposed a 1970s standard of care on amputees.

Citing “cost and time burdens” CMS withdrew the BIPA 427 Proposed rule that would implement the qualified provider provisions for prostheses and custom fabricated orthoses. AOPA believed that the issues of concern to certain provider groups should have been addressed through changes to the final rule, rather than its complete withdrawal. This action leaves the Medicare population with no regulations regarding the qualifications required to provide custom orthotic and prosthetic services.

CMS Auditor Performant Recovery announced an automated review of L5845. AOPA’s review determined this action was not in compliance with their statement of work. The audit was canceled after AOPA’s protest. This reversal represents $30 million or more in reimbursements that were potentially at risk over 3 years.

AOPA represented O&P interests by submitting official comments on several important topics including: CMS regulations that would reduce reimbursement for direct milled diabetic inserts by 14%, defining essential health benefits to include access to O&P, and veterans’ continued choice in private care providers. AOPA also continued to inform policy makers about how research clearly shows how timely O&P care saves lives and money. * The President subsequently signed into law the Continuing Resolution to fund the government on February 9, 2018, that included the recognition of orthotists and prosthetists notes as part of the patient’s medical record.

Research Two important AOPA funded socio-economic research studies were concluded in 2017 as part of the Prosthetics 2020 initiative: the RAND study and the updated Dobson/DaVanzo study— the former used a comprehensive literature search in building a ten year simulation model on transfemoral prosthesis; and the latter used Medicare data to examine how timely and appropriate O&P care improves lives and saves money over the long term.

This data is invaluable in communicating to public and private payers that short-term costs of providing care are outweighed by long-term savings and improved patient outcomes with appropriate treatment. Such evidence will be needed to substantiate reimbursements in the future,

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as health care moves towards value-based care. The RAND ten year value simulation represents a lasting resource in making the value case for O&P. A national O&P patient registry is being pursued in conjunction with the Mayo Clinic and the American Joint Replacement Registry which would provide the first comprehensive patient outcomes measurement for O&P services.

The groundwork has been laid for Orthotics 2020, intended to build on experience learned from Prosthetics 2020 to develop value measures for orthotic services.

AOPA has initiated a process to secure critical appraisals of the available scientific literature on five topics: osteoarthritis; stroke, scoliosis, traumatic spinal injuries, and plagiocephaly.

AOPA 2017 2ND WORLD CONGRESS SPEAKERS

ATTENDEES

EXHIBITORS

234 183

2,579

PRESENTATIONS Prosthetic & Orthotic

127

Pedorthic

13

Technical

10

Business

23

Education The 2017 World Congress in Las Vegas gathered over 2,500 orthotic, prosthetic and pedorthic professionals from 41 countries for networking, education and exhibits. Over 40 CE credits were available to attendees.

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2017 MOST POPULAR WEBINARS

1

Implem enting Written Policies and

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JANUARY

2017 | O&P ALMANAC

Proced The first step in creating ures ance plan your compliis developi ng of your pany’s written comstandard the broad values set s of conduct, or in place for organization your to follow. standard For example s should , your include comply with all state and your desire to tions and federal regulaYour policies a statemen t that your will conduct address specifi and procedures facility should and proper business in a professio that are prone c areas of risk or manner. The areas nal to potentia conduct abuse. This standard will then s of would include l fraud or help frame the you create areas as the such general specific written and claims developm procedur submission policies and es that process (establis ent and your company are tailored to ical necessity meet needs—t , orders, proof hing medshow your selection he steps that of delivery, commitm of codes, ent to complian will self-refe etc.), kickback rrals, s/ ce. tion of records,marketing, and retenamong other things.

AOPA continued to offer CE credits in other ways: online through AOPAversity, Coding & Billing Seminars, webinars and free for those reading the Reimbursement Page and Compliance Corner in the O&P Almanac.

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O&P Clinical Documentation: Who Needs to Document and What You Need to Document

What the Medicare Audit Data Tells Us & How to Avoid Common Errors

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AFO/KAFO Policy

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OVERVIEW OF ACCOMPLISHMENTS IN 2017/AOPA’S CENTENNIAL

OPERATING PERFORMANCE & COMPENSATION SURVEY

PARTICIPANTS

88 COMPANIES Representing 1,164 Full-Time facilities and 71 Part-Time facilities

Operating Performance & Compensation Survey

New Benefits for Members Co-OP

2017 Publication Awards

2 Award of Excellence for O&P Almanac Health & Medical Writing from Communications Concepts 2017 All Media Trends Commemoration/Tribute Bronze Award for AOPA 100th Year Commemorative Directory from Association Trends

@AOPA

The Co-OP, AOPA’s Compendium of O&P, an important members-only service, was launched in 2017 as an online reimbursement, coding and policy resource. This tool has assisted hundreds of members by providing information for new hires, administrative managers, billing coordinators and practitioners on state-specific insurance policy updates, L-code search capability, and data and evidence resources to assist in receiving fair reimbursement.

Healthcare Compliance and Ethics Week For the first time, AOPA sponsored Healthcare Compliance and Ethics Week, Nov 5-11th, and made available resources for its members to use in company-wide compliance and ethics education.

Webinars, white papers, compliance tips and promotional items were available for members to reinforce their compliance and ethical obligations in O&P.

Healthcare Apparel FOLLOWERS

FOLLOWERS

11,000+ 4,100+ 8

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PARTICIPANTS

Eighty-eight patient care facilities participated in the 2017 AOPA-sponsored financial benchmarking surveys on operating performance and compensation. The survey is free for AOPA members and participants receive a customized company report comparing their performance with others of similar size and geographic location.

AOPA partnered with Encompass Group, a leading provider of healthcare apparel, to offer members special prices on polos, scrub tops and lab coats that can be customized to help O&P staff make a great first impression.

500+

CO-OP USERS

252

companies signed up with 408 unique users

Research Findings to Support Your Reimbursements AOPA and Prosthetics 2020 partners sponsored research by RAND on the Economic Value of Advanced Transfemoral Prosthetics.

This independent research proves that microprocessor knees (MPKs) provide economic benefits and quality of life over non-MPKs. Specifically, risks of death and serious fall injuries among transfemoral amputees are 4.5 times higher if the patient has a non-microprocessor knee, than if patient has a K-3 microprocessor knee.

AOPA’s research initiatives fill a huge gap in quality research demonstrating the value of O&P services needed to justify reimbursement. Findings from these studies completed this year are available to help members convince payers of the value of O&P care. Visit bit.ly/randstudy.

OVERVIEW OF ACCOMPLISHMENTS IN 2017/AOPA’S CENTENNIAL

Membership

2,086

TOTAL AOPA MEMBER LOCATIONS IN 2017

593

1,362

Patient Care Facility

12

7

18

Affiliate

Other

International

Research/Education

112

Supplier

Canada

Sweden United Kingdom Germany

Russian Federation

USA Mexico

9

Puerto Rico

COUNTRIES REPRESENTED IN MEMBERSHIP

Taiwan

Australia

(Australia, Canada, Germany, Mexico, Russian Federation, Sweden, Taiwan, United Kingdom, and USA including Puerto Rico)

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AOPA’S 2017 LEADERSHIP

AOPA’s Volunteer Leadership AS WE REFLECT ON THE ACCOMPLISHMENTS OF 2017, we acknowledge and thank a diverse group of members and experts who volunteer their time and energy to serve on committees that are the backbone of AOPA’s activities throughout the year.

AOPA Board of Directors

Michael Oros, CPO, LPO, FAAOP (right) and Rep. Brian Mast (R-FL)

Michael Oros, CPO, LPO, FAAOP, President James Campbell, PhD, CO, FAAOP, Immediate Past President Jim Weber, MBA, President Elect Chris Nolan, Vice President Jeff Collins, CPA, Treasurer Jeffrey Lutz, CPO (Director 31+ Facilities) Traci Dralle, CFm (At-Large Director) Teri Kuffel, JD, (Director 1-5 Facilities) Dave McGill, (At-Large Director 2) Rick Riley, (Director Supplier Level 2) Bradley N. Ruhl, (Supplier Director 1) David A. Boone, BSPO, MPH, PhD, (Clinical Director) Pam Lupo, CO, (Director, 6-30 Facilities)

Stream Leaders

Debbie Hatch and Jeff Collins ready for the Party with a Purpose celebration.

Stream 1 (Patient Registry) Kenton Kaufman, PhD Stream 2 (Outcomes) David A. Boone, BSPO, MPH, PhD Stream 3 (Comparative Effectiveness) Jeffrey Lutz, CPO Stream 4 (Communications) Traci Dralle, CFm Stream 5 (Co-OP) Michael Oros, CPO, LPO, FAAOP Dave McGill Stream 6 (Membership) Jeff Collins, CPA Jim Weber, MBA

Mobility Saves Marketing Committee Traci Dralle, CFm, Chair Jeffrey Erenstone, CPO Karen Lundquist, MBC

Veterans Affairs Committee Dennis Clark, CPO Don Hardin Jeffrey Lutz, CPO Frank Snell, CPO, FAAOP, Chair Tom Watson, CP, LP Jim Weber, MBA

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Coding & Reimbursement Committee Mark Porth, CPO, FAAOP, Chair Bill Beiswenger, CPO, FAAOP Mitchell D. Dobson, CPO, FAAOP Dennis E. Ebbing, CPO Brian L. Gustin Pam Lupo, CO Jonathan M. Naft, CPO

Operating Performance Survey Committee Jim Weber, MBA, Chair Jeffrey Brandt, CPO Michael Becher Mark Ford Elizabeth Ginzel, CPO, LPO Scott Hackworth, CPA Michael Oros, CPO, FAAOP

O&P Political Action Committee Rick Fleetwood, MPA, Chair

Prosthetics 2020 Medical Advisory Board Michael Jaff, DO Kenton R. Kaufman, PhD Paul F. Pasquina, MD Douglas G. Smith, MD

Prosthetics 2020 Steering Committee

James Campbell, PhD, CO, FAAOP Maynard Carkhuff Jim Colvin Kim DeRoy, MSc, RPT Sam Liang, MBA Michael Oros, CPO, LPO, FAAOP Andreas Kannenberg, MD, PhD David Moser, PhD, BEng, BSc, MIET Thomas Fise, JD James Weber, MBA Saeed Zahedi, PhD

2017 World Congress Chris Nolan, Chair James Campbell, PhD, CO, FAAOP Andrea Giovanni Cutti, Meng, PhD Thomas V. DiBello, CO, LO, FAAOP, Clinical Chair Michael Dillon, PhD Traci Dralle, CFm Elizabeth Ginzel, CPO, LPO Michal-Lynn Jakala Dennis Janisse, CPed Rosie Jovane, CPO Aaron Leung, PhD Eileen Levis Karen Lundquist, MBC Pam Lupo, CO Mike Magill Brad Mattear, LO, CPA, CFo Michael Oros, CPO, LPO, FAAOP Marlo Ortiz Vazquez, CPO(M) Kristen Pierson Klaas Postema, MD, PhD Silvia Raschke, PhD Rick Riley Michael Schaefer, CPO, Dipl.

Urs Schneider, MD, PhD Don Shurr, PT, CPO Gulapar Srisawasdi, MD, CPed Brian Stroup Jim Weber, MBA

Centennial Celebration AOPA 1917-2017

AOPA’s Centennial Celebration at the World Congress in Las Vegas on Sept. 9, 2017.

Centennial Committee

Traci Dralle, CFm, Chair James Campbell, PhD, CO, FAAOP Karen Lundquist, MBC Chris Nolan Michael Oros, CPO, LPO, FAAOP Rick Riley

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2017 Financial Highlights How are my membership dues invested?

The financial decisions AOPA makes are rooted in how best to put dues and all other revenue sources to work in ways that will continue to deliver value for AOPA members. Your dues dollar in 2017 was allocated as follows:

SOURCES OF REVENUE, 2017 Seminars Insurance Other Advertising, Publications, Merchandise

5%

3%

2%

7%

Investment

35%

Assembly

14%

FOR EVERY $1 IN DUES: $.45 provided member services, such as education, assembly, and publications.

34% Dues

$.25 was put towards government relations/reimbursement services/advocacy. $.26 provided for organizational governance and research.

EXPENSE BY FUNCTION, 2017 Administration

$.04 provided for general administration.

4%

Governance

26% 45%

25% Government Relations

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Membership Services

FINANCIAL HIGHLIGHTS

STATEMENT OF FINANCIAL POSITION

STATEMENT OF ACTIVITIES

Year ending 11/30/2017

Year ending 11/30/2017

ASSETS

REVENUE

2017

Membership Dues

$2,259,681

World Congress

2,270,988

Cash and cash equivalents Accounts receivable

Advertising

418,744

Investments

Insurance Admin fees

137,500

Due from affiliate organizations

Seminars

219,469

Prepaid expenses and other assets

Publications

66,735

Sponsorships

30,000

Other Income

94,084

Contributions

62,820

Investment Earnings Net assets released from restriction Total Revenue (100%)

EXPENSES

902,598 63,269 $6,525,888

2017

Membership Services

$2,570,634

Gov’t Relations/Reimb. Services

1,385,478

Governance/Research

1,492,361

Support Services General & Administrative Total Expenses (100%)

218,254 $5,654,812

Furniture, equipment and leasehold improvements Less Accumulated depreciation Property and Equipment, Net Total Assets

Change in temporarily restricted net assets Change in permanently restricted net assets Total Change in net assets

Net Assets, end of year

46,257 248,646

784,044 (677,862) 106,182 $10,815,863

2017 $783,013

Accrued payroll and related liabilities

202,049

Deferred dues revenue

924,380

Deferred meeting revenues and other

615,555 $2,524,997

$859,161 162,751

Long-term Liabilities Deferred rent liability

$55,260

0 $1,033,827

Total Liabilities Unrestricted net assets

Net Assets, beginning of year

361,811 8,836,607

Accounts payable and accrued expenses

Total Current Liabilities Change in unrestricted net assets

$1,216,359

Property and Equipment at Cost

LIABILITIES AND NET ASSETS

Program Services

2017

$7,213,694 $8,235,606

$2,580,257 7,705,650

Temporarily restricted net assets

439,014

Permanently restricted net assets

90,942

Total net assets Total Liabilities and Net Assets

8,235,606 $10,815,863

 

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Special Acknowledgments THANK YOU TO OUR SPONSORS AND STRATEGIC PARTNERS We especially thank the following companies who provided financial support for AOPA meetings, programs, and the O&P Almanac throughout the year.

2017 WORLD CONGRESS SPONSORS AND PARTNERS DIAMOND SPONSORS

PLATINUM SPONSORS

GOLD SPONSORS

www.bocusa.org

SILVER SPONSORS

WORLD CONGRESS PARTNERS

SUPPORTING SPONSORS Amfit Aspen Medical Products Becker Orthopedic Appliance Co. Cailor Fleming Insurance Cascade Dafo Cascade Orthopedic Supply Inc. College Park Industries Comfort Products Inc.

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Fillauer FLO-TECH® Orthotic & Prosthetic Systems Inc. KISS Technologies LLC Knit-Rite Inc. LegWorks MD Orthopaedics Inc. Naked Prosthetics OPGA PEL

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Pine Tree Orthopedic Lab Protokinetics Gait Analysis Walkways Protosthetics Surestep Tamarack Habilitation Technologies Townsend Design \ Thuasne USA Charcot-Marie-Tooth Association

2017 SUPPLIER PLUS MEMBERS

2017 POLICY FORUM SPONSORS

2017 O&P ALMANAC ADVERTISERS Advertisers in more than 3 issues in 2017 American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. (ABC) Allard USA Inc. ALPS Amfit Anatomical Concepts Board of Certification/ Accreditation (BOC) Cailor Fleming Insurance Cascade Dafo Inc. COAPT LLC College Park Industries ComfortFit Orthotic Laboratories Coyote Designs Custom Composite Ferrier Coupler

PROSTHETICS

2020 PROSTHETICS 2020 SPONSORS

FLO-TECH® Orthotic & Prosthetic Systems Inc. Fillauer Hersco LIM Innovations Orthomerica Ottobock Spinal Technology Touch Bionics

Scheck & Siress

VQ Orthocare

Prosthetics. Orthotics.

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2017 Award Recipients Ralph R. “Ronney” Snell, CPO, FAAOP Legislative Advocacy Awards

Lifetime Achievement Award Saeed Zahedi, PhD

Adrianne Haslet Aaron Holm

The Sam E. Hamontree, CP(E), Business Education Award

Ryan Ball, “Competitive Differentiator: Executing a Data-Drive Growth Strategy in O&P”

Edwin and Kathryn Arbogast Award

A Mixed-Methods Examination of Limitations to Physical Activity as Reported by Individuals with Lower Extremity Amputations Elizabeth Bell, University of Maryland-College Park

Thranhardt Awards

Shenan Hoppe-Ludwig, CPO, “The Micro-Processor Controlled Orthosis: What is the Impact to the User Versus the Stance control Orthosis and Conventional Locked KAFO”

Otto and Lucille Becker Award Characteristics of Delphi Processes in Orthotics and Prosthetics Research Kierra Falbo, Northwestern University

Andrea Giovanni Cutti, PhD, “Reference Values for Temporal Gait and Loading Symmetry of Lower-Limb Amputees Can Help in Refocusing Rehabilitation Targets” Adrianne Haslet

Aaron Holm

AOPA Staff Thomas F. Fise, JD Executive Director 571-431-0802 tfise@AOPAnet.org Tina Carlson, CMP Chief Operating Officer 571-431-0808 tcarlson@AOPAnet.org Don DeBolt Chief Financial Officer 571-431-0814 ddebolt@AOPAnet.org

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Lauren Anderson Manager of Communications, Policy, and Strategic Initiatives 571-431-0843 landerson@AOPAnet.org

Betty Leppin Manager Member Services & Operations 571-431-0810 bleppin@AOPAnet.org

Kelly O’Neill, CEM Manager of Membership and Meetings 571-431-0852 koneill@AOPAnet.org

Devon Bernard Assistant Director of Coding and Reimbursement Services, Education and Programming 571-431-0854 dbernard@AOPAnet.org

Yelena Mazur Membership and Meetings Coordinator 571-431-0876 ymazur@AOPAnet.org

Ashlie White Manager of Projects 571-431-0812 awhite@AOPAnet.org

Ryan Gleeson Assistant Manager Meetings 571-431-0876 rgleeson@AOPAnet.org

Joe McTernan Director of Coding and Reimbursement Services, Education and Programming 571-431-0811 jmcternan@AOPAnet.org

WALK THROUGH TIME

Walk Through Time

AOPA celebrated its 100th anniversary with a Walk Through Time exhibit at the World Congress in Las Vegas.

The exhibit showcased O&P technological advancements in the context of AOPA’s history and world events during the last century. We wish to thank the many volunteers who loaned devices and materials and those who contributed time and expertise in making this historic exhibit possible.

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WALK THROUGH TIME

AOPA

The Early Years

AOPA emerged in 1917, just as the United States entered World War I—a conflict that would leave 2,300 American soldiers as amputees.

The story of the founding of AOPA—originally established as the Association of Limb Makers of America (ALMA)—was documented in ALMA’s 1922 “Open Letter to Each Physician and Surgeon of the Land,” which read as follows:

1920s

1917

On April 15, 1917, 12 representative artificial limb manufacturers of the United States were called to Washington by the Council of National Defense. A conference was held with the surgical staff of the U.S. Army and Navy. The purpose was to impress on the limbmakers the importance of immediate preparation for efficient and skillful service for the amputated soldiers as soon as they returned from Europe. As a result of the conference and under advisement of the government officials, the Association of Limb Makers of

America came into existence.

DURING ALMA’S EARLIEST YEARS, the association did not have a central office or staff. “The major value of ALMA was that it permitted the free exchange of ideas between limb manufacturers. At its meetings, some attempts were made to present technical papers and, from time to time, the organization published a newsletter or magazine called the ALMAnac,” reports the History of Prosthetic-Orthotic Education.

One of the earliest gatherings of association members occurred when 33 members assembled at the 1918 Annual Convention in Indianapolis.

Between the years of 1917 and 1922, ALMA held eight meetings in different states, had regional offices throughout the country, and developed a code of ethics.

November 1918 marked the end of

18

AOPA 20 17 ANNUAL REPO RT

World War I and also denoted the evolution from simple one- and twoperson shops to larger facilities. O&P research initiatives became more prevalent, thanks in part a research program instituted by ALMA. ALMA members also were kept busy during the 1920s due to the rise of industrial accidents. A 1924 article in Surgical Appliance and Instrument Review stated, “Competent investigators have found that industrial accidents alone in the United States injure over a million and a half. Of this number, about 30,000 are amputation cases.”

ALMA soon began its focus on elevating the profession. In 1924, ALMA President Chester B. Winn gave a rousing speech during the association’s Seventh Annual Meeting, which was documented in an issue of Surgical Appliance and Instrument Review. Winn spoke of the association’s emphasis on the use of “clean competition” to avoid

price fixing and noted that ALMA members should conduct their business “with a firm resolve to make their product better and in keeping with the standard advanced by our association, which has brought forth a gradual increase in the benefits to be derived from correctly manufactured prostheses.”

WALK THROUGH TIME

The Early Years

The World The World circa 1917

Over the last 100 years, the world has changed tremendously. In 1918, about 4,400 amputees lived in the United States compared with two million today.

WORLD POPULATION 8

Population in Billions

7 6 5 4 3 2

1910s

2000

1980

1960

1940

1920

1900

1880

1860

PHOTO: F.G.O. Stuart (1843-1923)

1840

1 0

Titanic strikes an iceberg on April 14, 1912

1820

In 1917, it took 5 days to get from London to New York; 3.5 months to travel from London to Australia.

The historic sinking of the Titanic causes the deaths of nearly 1,500 people and attracts global attention.

The US population broke 100 million, and the global population reached 1.9 billion.

1917

Congress declares war on Germany, marking America’s entry into World War I.

July 11, 1914

Babe Ruth makes his major league debut

1910

Boy Scouts of America founded

1920s

1930s

The decade following World War I brought sweeping changes. The economy entered a period of spectacular— though uneven—growth. The booming economy and fast-paced life of the decade gave it the nickname of the Roaring Twenties. But the good times ended abruptly.

In 1929, a stock market crash triggered the worst and longest depression in America’s history.

1928

Emelia Earhart becomes the first female aviator to successfully fly solo across the Atlantic Ocean.

Shriners In 1922, Polio was reaching epidemic proportions and only families of means had ready Shriners Shreveport access to doctors, leaving Hospital 1922-1923 thousands of children at risk without health care.

Shriners Hospitals for Children opened as a place where children coping with the after effects of polio, as well as clubfoot and other orthopaedic conditions, could receive life-changing medical care.

1920s

“First to Fight.” A group of U.S. Marines. US Marine Corps Recruiting Publicity Bureau, 1918.

1930’s After the Wall Street Crash of 1929, the largest stock market crash in American history, most of the decade was consumed by an economic downfall called the Great Depression that had a traumatic effect worldwide, leading to widespread unemployment and poverty. In response, authoritarian regimes emerged in several countries in Europe and South America, in particular the Third Reich in Germany. Weaker states such as Ethiopia, China, and Poland were invaded by expansionist world powers, the last of these attacks leading to the outbreak of the Second World War a few months before the end of the decade. The 1930s also saw a proliferation of new technologies, especially in the fields of intercontinental aviation, radio, and film.

1934

Labor: Strikes: New York City, New York: union men picketing Macy’s FSA Photo by Dorothea Lange

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1935

The Boulder (Hoover) Dam is completed.

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WALK THROUGH TIME

The Early Years

Products

Profession

and the

While 1917 marks the year AOPA was established, the association’s past is tied to the history of O&P in the United States, predating the association itself.

The Civil War and its 60,000 amputation surgeries spurred the growth of the O&P industry in the United States. Some of AOPA’s oldest member companies have histories dating back to that time period and its aftermath, as veteran amputees sought improved devices.

J.E. HANGER

After the war, Albert Winkley patented the “slip socket” to reduce friction between the socket and the stump by wrapping a piece of leather around the residual limb, and, in 1888, established the Winkley Artificial Limb Co.

A full Day and Full Pay on a Pair of Double Slip Socket Legs.

Photo courtesy of Winkley Company

Winkley Shop

William Arbogast, a railroad brakeman who became a bilateral amputee in a train accident in 1905, established Ohio Willow Wood, a prosthetic manufacturing company in 1907.

In 1911, R.W. Snell bought the prosthetics and orthotics end of a surgical supply business in Memphis.

1900s

Photo courtesy of Fillauer

J.E. Hanger, one of the first amputees of the Civil War, designed the “Hanger Limb” from whittled barrel staves and was granted two patents from the Confederate government.

The J.E. Hanger facility, 1907, in Washington, DC. Photo courtesy of Wade Barghausen, Columbus, OH

Photo courtesy of Winkley Company

The D.W. Dorrance Co. was founded in 1912, manufacturing a popular arm prosthesis; the company later underwent a merger to become the Hosmer Dorrance Co., now a subsidiary of the Fillauer Cos. Fillauer got its start in 1914, when George Fillauer, a German immigrant, opened a pharmacy that offered orthoses.

1930s

The way things used to be: this image from the Winkley Company’s 1906 informational catalog is called “Limbs Set up in the Rough.” According to the caption, legs were Winkley Shop Photo courtesy of Winkley Company assembled at this station before a preliminary trial.

Each piece of English willow used on the legs came from a tree whose wood had been cut down and left to dry for two years before use.

Circa 1920

Circa 1920

Photo courtesy of Shriners Hospital For Children

Photo courtesy of Shriners Hospital For Children

Orthopedic Brace

1936 Eugene Jewett, MD, designed the Jewett brace, a hyperextension spinal brace that revolutionized fracture treatment in the 1930s and 1940s. The devices replaced the heavy casts and prolonged bed rest that were standard treatment at the time. Because patients were able to get up sooner they suffered fewer complications such as pneumonia caused by prolonged inactivity.

Orthopedic Brace

1918

Artificial Limb Company, Minneapolis

WALK THROUGH TIME

1940s – 1950s

AOPA

After the bombing of Pearl Harbor on December 7, 1941, the United States entered World War II, and ALMA took on a larger role, ensuring prosthetic professionals were prepared for the deluge of amputee and limb-impaired patients. Such support was essential as the brutality and length of U.S. involvement led to 18,000 amputees.

In 1946, ALMA leaders invited orthopedic brace fabricators to join the association, resulting in a name change to the Orthopedic Appliance and Limb Manufacturers Association (OALMA). OALMA established a national office in Washington, DC, and hired an executive director.

1940s

OALMA continued to hold meetings and grow its membership. The organization began publishing a journal, initially called The Journal of OALMA from 1946 to 1951, which became the Orthopedic & Prosthetic Appliance Journal from 1952 to 1967, and Orthotics and Prosthetics from 1967 to 1988.

AOPA co-published the Journal of Prosthetics and Orthotics from 1988 until the dissolution of the O&P National Office. AOPA also published an early version of the O&P Almanac, initially called the ALMAnac, and later the OALMA Almanac.

In 1948, OALMA members recommended the formation of an organization with the responsibility to establish minimum requirements for the operation of a limb or brace facility to ensure that patients would receive adequate service. The American Board for Certification of the Prosthetic and Orthopedic Appliance Industry Inc. was formed, which later became the American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. (ABC). At the recommendation of an ABC advisory committee, OALMA’s Education Committee developed on-the-job training schedules and course materials for related training to meet the adopted standards for apprenticeship training.

As reported in October 6, 1941 Annual Business Meeting Minutes, …membership committee chairman, Mr. Korrady, reported that ALMA had 126 members; this is a twenty percent drop in membership from 1940. Considering that dues increased from $10 to $25 the renewal rate is not bad.

October 1940

1950s

Association of Limb Manufacturers of America Annual Meeting

February 1950 letter to membership discussing government encroachment

In the middle of the 20th century, when the United States became involved in the Korean War, OALMA members helped tend to wounded warriors once again, with more than 1,500 amputations to U.S. soldiers recorded during this conflict.

1957

The 1950s marked the establishment of O&P schools at some universities. The University of California–Los Angeles

In 1957 the Association celebrated it’s 40th Anniversary with flair.

(UCLA) began to offer its Prosthetic Education Program in 1952. New York University and Northwestern University soon followed suit, offering short courses in various aspects of O&P. In 1958, an 18-month program in upper-extremity orthotics was begun at Rancho Los Amigos Hospital in Downey, California, which expanded to a 24-month program to include lower-extremity orthotics.

Chester C. Haddon accepts ATAE Award of Merit

January 1958

Members of the Executive Committee of OALMA and eight OALMA past presidents met for four days in Augusta, Georgia, at a “Planning Our Future” event. The event’s minutes noted that OALMA had made remarkable progress during the past decade, and that the profession was undergoing a remarkable transition: “Are we a business or a profession? Hopefully we have to be both. And, are we mechanics, with engineering skills, or are we in the medical field where the structure of anatomy is all important? Again, we have to be both. Therein lies our complicated future.”

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WALK THROUGH TIME

1940s – 1950s

The World 1955: The First Polio Vaccine is Discovered In the early 20th century, polio was one of the most feared diseases in industrialized countries, paralysing hundreds of thousands of children every year. Soon after the introduction of effective vaccines in the late 50s/early 60s, polio was brought under control and practically eliminated as a public health problem.

Worldwide Immunizations It took somewhat longer for polio to be recognized as a major problem in developing countries. Lameness surveys during the 1970s revealed that the disease was also prevalent in developing countries. As a result, during the 1970s routine immunization was introduced worldwide as part of national immunization programs, helping to control the disease in many developing countries.

The vast majority of polio victims are children, but it can also strike adults.

Franklin D. Roosevelt contracted polio in 1921 at age 39. Here, two men lift a little girl in a wheelchair so that Roosevelt can greet her from his vehicle during his first presidential campaign.

Disability Rights Movement As thousands of polio survivors with varying degrees of paralysis left the rehabilitation hospitals and went home, to school and to work, many were frustrated by a lack of accessibility and discrimination they experienced in their

1940s

communities. In the early 20th century the use of a wheelchair at home or out in public was a daunting prospect as no public transportation system accommodated wheelchairs and most public buildings including schools, were inaccessible to those with disabilities. Many children left disabled by polio were forced to attend separate institutions for “crippled children” or had to be carried up and down stairs.

1940

Eloy, Pinal County, AZ

1950s

Many people infected with polio don’t show any symptoms. Some become temporarily paralyzed; for others, it’s permanent. In 1952, the polio epidemic reached a peak in the U.S.: almost 58,000 reported cases and more than 3,000 deaths.

22

AO PA 2017 AN N UAL REPO RT

As people who had been paralyzed by polio matured, they began to demand the right to participate in the mainstream of society. Polio survivors were often in the forefront of the disability rights movement that emerged in the United States during the 1970s, and pushed legislation such as the Rehabilitation Act of 1973 which protected qualified individuals from discrimination based on their disability, and the Americans with Disabilities Act of 1990. Other political movements led by polio survivors include the Independent Living and Universal design movements of the 1960s and 1970s.

F6F taking off from flight deck of the USS Lexington (CV-16)., 11/1943

WALK THROUGH TIME

1940s – 1950s

Products

Profession

and the

During the 1940s and 1950s,

1940s

the most common type of socket for the above-knee amputee in the United States was an ischial containment socket (ischial tuberosity within the walls of the socket) called a “plug fit” or “anatomical” socket. The suspension method used for these prostheses was suspenders, pelvic belt and band, or air chamber suction.

Developments

Congress Passed Legislation Congressional Legislation resulted in the Department of Veterans Affairs (VA) Prosthetics and Sensory Aids Service in 1948.

1945: The National Academy of Sciences established the Artificial Limb Program as a way to improve the quality of life of World War II veterans who were suffered the lost of limbs in combat.

Private companies contributed to O&P development. Ohio Willow Wood introduced the first semi-finished, above-knee prosthesis, which used interchangeable parts. In 1948, Jim Snell developed a revolutionary process for making lightweight leg braces, using aluminum that was heat-treated after shaping, with steel bushings at the knee and ankle joints.

67

1945

Review Article

After World War II, prosthetic limbs were mostly made of wood and leather. They were heavy and hard to clean.

Upper Extremity Prosthesis – What Is New in It?

S. Abdul Gafoor1, Mohan Raj M2

Abstract

Over the past 40 years, technology has dramatically affected the field of upper limb prosthesis. With improvement in the electronics industry, along with advances in the miniaturisation and mass production of electronic components, myoelectrically controlled prosthesis has become reliable and widespread in their use. Compared to lower extremity amputees, the acceptance of prosthetic replacement is less in upper extremity amputees. This may be due to different factors like functional needs, cosmetic factors, motivation of the patient, inadequate training following conventional prosthetic fitment, etc. More and more developments are going on in upper limb extremity prosthesis which will fulfill the need of the upper limb amputees. Such developments ensure better rehabilitation though cost is a limiting factor.

This article is an earnest attempt to review the recent trends in upper limb prosthetics.

Key words: Upper limb amputees, myoelectric prosthesis.

Introduction:

T

who lost their hand, as it is heavy and do not provide any information regarding the texture, shape, temperature and proprioception. However each has advantages within their intended use. eg, body powered hooks are well suited to the demands of manual labour. They are simple and tough in design. Prosthetic hand obviously provides a more natural appearance than hooks and can provide adequate function. Electric hand provides the user with a wide range of gripping force, all with minimal effort by user.

he human hand is a very sophisticated and beautiful tool. It provides plenty of information and means by which one interact with environment. The hand is also a powerful tool of communication. The hand can be used to augment the meaning and feeling behind the spoken word, or it can sometimes take the place of the word. Hence the loss of hand results, not only in functional ability of that individual, but also ends in profound psychological trauma and apprehension.

Clinically the most physiologically natural method of controlling an electric hand is through myoelectric control. Myoelectric control is also a dynamically natural appearing system because the act of controlling the prosthesis is invisible in contrast to other control methods that require body motion of more proximal body segments.

The ideal prosthesis has to replace the lost body parts, both in appearance and function. The sensibility, power and grace of the lost body parts should be replaced.

Though the idea appears simple, it is very difficult to accomplish. Present technology is far from ideal.

The search for ideal upper extremity prosthesis is continuing. The conventional prosthesis is functionally inferior, cosmetically unacceptable to any individual,

History: The concept of using myoelectric signals to control prosthesis dates back to the 1940’s. Reinhold Reiter, a physics student at Munich University created the first known myoelectric prosthesis between 1944 and 19481. This prosthesis was mounted on a bench top, had vacuum tubes in the electronic system and used one muscle for opening and closing the hand (single site control) (Fig1).

Authors’ affiliation: MBBS, D.P.M.R, M.D, Professor MBBS, D.P.M.R, M.D, Associate Professor Department of PM&R, Govt. Medical College, Kozhikode Cite as: S. Abdul Gafoor, Mohan Raj M , Upper extremity prosthesis – What is new in it? IJPMR, September 2016; Vol 27 (3) : 67-72 1 2

Correspondence: Dr. S. Abdul Gafoor, Professor, Department of PM&R, Govt.

Medical College, Thiruvananthapuram, Email: drsagafoor@gmail. com.

Myoelectric systems are commercially available during 1960’s. Kobrinski, a Russian became the first person to make a myoelectric hand, which found place in clinical use2. This prosthesis was made fully portable by the

Received on 28/03/2015, Accepted on, 29/06/2016

67

1946

1945

An important progress was made in the attachment of lower limbs. A suction sock for the preceding-knee prosthesis was created by researchers at University of California (UC) at Berkeley.

The first myoelectric prosthesis was created by Reinhold Reiter, a physics student at Munich University.

Becker Orthopedic 1945

1948 Patient-care company Wright & Filippis debuted in 1944, and Leimkuehler Limb Co. opened its doors.

“Swing and Stance” This customized artificial leg incorporates the Mauch S-N-S “Swing and Stance” hydraulic automatic movement. Designed in the late 1950s, the S-N-S design remains in widespread use.

First Hydraulic Knee for the Transfemoral Amputee Hans Mauch and another German scientist, Ulrich Henschke, came to post-World War II America and developed a prototype for the first hydraulic knee (Mauch Laboratories; Dayton, Ohio) in the late forties.

In just a few months, they designed the swing and stance control but took more than a decade to refine all the engineering and incorporate important patient feedback from the amputees.

1950s

Paul E. Leimkuehler. Circa 1950

1958 High School Diploma Required The minimum requirement of a high school diploma was established to sit for the certification examination.

1959 Stubbies were introduced.

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WALK THROUGH TIME

1960s – 1970s

AOPA

OALMA Becomes AOPA The 1960s were a decade of change for the nation, and for AOPA. In particular, 1960 was a notable year because of the election of John F. Kennedy to the presidency, the development of the first pacemaker, and the first U.S. troops being sent to Vietnam. More than 5,300 U.S. service members became amputees.

1960s

This was also a period of transition for OALMA, beginning with a name change to the American Orthotic and Prosthetic Association in 1966.

AOPA 1960 National Assembly Exhibit Hall Ribbon Cutting

AOPA VIPs cut the ribbon opening the 1975 exposition in New Orleans, LA. Pictured from left is Junior Odom, Gene Lambert, Don Hardin, and 1975 President Ronney Snell.

1970s

AOPA 1960 National Assembly Exhibit Hall Ribbon Cutting

AOPA Celebrates its 50th Anniversary

AOPA partnered with ABC in 1970, calling for the development of an organization focused on continuing education for O&P professionals. As a result, the American Academy of Orthotists and Prosthetists was founded in November 1970.

Because of the increased need for advanced O&P education, the Association and the University Council of Orthotic and Prosthetic Education formed the National Association of Prosthetic and Orthotic Educators (NAPOE) in 1972. Known today as the National Commission on Orthotic and Prosthetic Education (NCOPE), NCOPE now formally oversees O&P educational programs.

Ponte Vedra Meeting In 1976, AOPA joined forces with ABC and the Academy at a seminal meeting in Ponte Vedra, Florida, to evaluate the O&P profession’s education and occupational status.

This meeting led to the requirement of a four-year baccalaureate degree for O&P practitioners going forward.

HCFA 24

1973-1983: Explosive Growth in AOPA Membership AOPA more than doubled its membership roster between 1973 and 1983

AOPA’s Past Presidents sit for their annual picture.

Seated–McCarthy Hanger (left), Paul Leimkuehler, Ralph Storrs, Alvin Muilenburg (left), William Bartels, Roy Snelson, Howard R. Thranhardt, Romney Snell, Mary Dorsch, Gene Lambert, and Bob Bush.

Healthcare Financing Administration—currently known as Centers for Medicare & Medicaid Services In the 1970s, AOPA worked with Blue Cross Blue Shield of South Carolina to develop the first template for the L-Code system. Blue Cross Blue Shield of South Carolina applied the pilot system in 1979; other insurance companies followed.

The Health Care Financing Administration ,which is now CMS, established the Healthcare Common Procedure Coding System (HCPCS) in 1978.

AOPA 20 17 ANNUAL REPO RT

Year 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983

Number of Members

390

431 451 482

575

671 702

756 771

832 850

SOURCE: 1983 AOPA Annual Report

With a slew of new member benefits in place, AOPA membership numbers soared, almost doubling between 1973 and 1980. AOPA was well-prepared to lead the O&P profession into the final two decades of the 20th century.

WALK THROUGH TIME

1960s – 1970s

The World

A game changer in the U.S. health-care system arrived with the enactment of Medicare in July 1965.

1960s

With 19 million individuals signing up during the program’s first year, Medicare opened access to O&P care to many Americans who had previously gone without due to cost—leading to more growth for the O&P profession.

19 Million

July 30, 1965 With former President Harry S. Truman at his side, President Lyndon B. Johnson signs the Medicare bill into law. President Johnson became the first Medicare beneficiary.

Number of individuals who signed up for Medicare during its first year, in 1965.

VIETNAM WAR

1962

1960

The Beatles release their first single “Love Me Do”

JFK is President.

1963 1961

The Peace Corp is created.

The US Post office begins using Zip Codes

1962

The first manned Apollo mission, Apollo 7, is launched by NASA.

WOODSTOCK August 15, 1969

The popular children’s television show “Sesame Street” debuts.

1970s

By Frank Wolfe - Lyndon B. Johnson Library, Public Domain

1973 Insulin Pump An inventor and entrepreneur, Dean L. Kamen, patented the first insulin pump. He became perhaps even better known for a later invention, the Segway transporter, but for O&P Professionals, Dean Kamen is known for his “DEKA Arm.”

1969

The United States reached the moon in 1969.

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WALK THROUGH TIME

1960s – 1970s

Products

Profession

and the

1960s

O&P Technology O&P technology continued its rapid advance, with innovations such as Ohio Willow Wood’s first solidankle-cushion-heel (SACH) foot and Durr-Fillauer’s introduction of nonporous, thermomoldable foam called PeLite.

1960s Otto Bock introduces the first Myoelectric Arm At Becker—a manufacturing company originally founded in 1933

by Otto K. Becker—a new doubleaction joint and modified drop-lock knee joint were being developed.

The first reciprocating gait orthosis also was introduced.

By the 1960s, the schools of prosthetics at New York University, Northwestern University, and the University of California were teaching the quadrilateral socket shape. During the 1980s, Ivan Long, CP, introduced us to Long’s Line, and not long after that, John Sabolich, CPO, described the Contoured Anterior Trochanteric Controlled Alignment (CAT/CAM) Method. During these years the “ischial containment” socket went through a number of changes.

The Becker Booth at the AOPA 1960 National Assembly

Hall of Fame Knee Brace

1970s

During the 1967 season and Super Bowl III, Hall of Fame New York Jets’ Quarterback Joe Namath played with a now-famous knee brace. Jack Castiglia of the Lenox Hill Brace Shop with along with noted sports physician Dr. James Nicholas designed the brace. This allowed Namath to keep playing despite being plagued by knee problems.

Namath’s knee brace was so iconic that it is now on display at the Pro Football Hall of Fame.

1965

Per-Ingvar Brånemark began his first successful experiments on humans using osseointegration.

1967

The first reciprocal gait orthosis was introduced

by Wally Motlock, CO, at the Toronto Children’s Hospital.

1975 In 1975, amputee and Mexican American inventor Ysidro Martinez had an idea to improve the design for below-the-knee devices that were used at the time. Rather than replicate the current designs, which themselves tried to replicate the natural movement of organic limbs, Martinez revolutionized the prosthetic field by creating a prosthesis that was better at giving the wearer control of acceleration and deceleration, while simultaneously reducing pressure and friction for the wearer. This concept is still used in prosthetic devices today.

1969

A modular lower-limb prosthesis was developed by OttoBock, allowing components to be exchanged.

1970

1970

Mark Mosley and Eric Barron incorporate metal into prosthetic limbs to distribute force better.

Gel lined socket liners, developed by Dr. George Koepke, dramatically improved fit and comfort for insensate transtibial amputees.

Boston Brace for Scoliosis

Developed in 1972 by M.E. “Bill” Miller, CO and John Hall, MD at Boston Children’s Hospital in Boston, Massachusetts. Lacking the metal superstructure of the Milwaukee brace, which was the most commonly worn brace at that time, the Boston Brace’s lower profile allowed it to be less noticeable under patient’s clothing making it more acceptable to the patient. The Boston Brace was originally prescribed for correcting curves in the lumbar or thoracolumbar spine and later proven to be effective in the thoracic spine as well.

1978

Philadelphia Eagles football player Mark Nordquist teamed up with two of his friends to explore the possibilities of neoprene. There in his garage in Carlsbad, CA, DJO Incorporated was formed.

WALK THROUGH TIME

1980s – 1990s

AOPA

1980s

In the 1980s, AOPA extended its interests to such areas as business education and members’ marketing needs.

One of AOPA’s most widely regarded publications was released in October 1986: the first edition of the Pictorial Reference Manual of Orthotics and Prosthetics, now known as the Illustrated Guide.

Tony Fillipis, CPO, Bonnie Stump, and Bob Leimkuehler, CPO, tour of the new Willow Wood facility.

In 1990, AOPA and the O&P profession claimed a major victory when O&P won the right to be considered a separate field from durable medical equipment for reimbursement purposes. Other efforts on Capitol Hill resulted in the signing of H.R. 3839, which increased funding for O&P schools.

First AOPA Legislative Conference

The first AOPA Legislative Conference took place in 1992, as AOPA celebrated its 75th anniversary. At that conference—which was later renamed the AOPA Policy Forum—several O&P professionals convened on Capitol Hill to meet individually with lawmakers and share the O&P message. This marked the beginning of AOPA’s annual trek to Washington, DC.

1990s

1992 ISPO 7th World Congress

The National Easter Seal Society presented the O&P Almanac with an EDI (Equality, Dignity, Independence) Award for the article “Disability in America: A Transition in Awareness,” which appeared in the May 1992 issue. Other winners included Newsweek, The Washington Post, People Magazine, ABC’s World News Tonight, NBC’s Today Show, AT&T and McDonalds Corp.

1995

Harkin Dinner

1997

Legislative Advocacy Award Winners

The O&P Athletic Fund

The O&P Athletic Fund was established in 1995 by the O&P National Office to provide financial support for the 1996 Paralympic Games. Its goal was to raise money so athletes would be cared for by orthotic and prosthetic certificants. After the games, the fund changed its name to the O&P Activities Fund and changed its mission to promoting health and fitness for disabled individuals. In August 2005, the fund developed First Volley, a tennis program for players with prosthetic limbs. It fills the gap between able-bodied tennis and wheelchair tennis.

AOPA demonstrated its influence in 1996 in several ways. In a legislative win, AOPA persuaded the Senate Judiciary Committee to shelve the Prosthetic Limb Access Act of 1996, which would have increased manufacturers’ liability and provided “used” prosthetic devices to the poor. AOPA also worked with the Academy to develop and disseminate educational materials related to the new ABC Facility Accreditation Program and Standards.

In addition, AOPA debuted its first website:

www.theaopa.org

1999 AOPA Board Meeting

Compliance

In 1999, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) created and released a document, OIG’s Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply Industry.

This document would become the framework for most O&P office compliance plans. Although this document is almost 20 years old, the guidance found in it is still relevant—and may be even more important today than when it was written.

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WALK THROUGH TIME

1980s – 1990s

The World

The decade saw great socioeconomic change due to advances in technology and a worldwide move away from planned economies and towards laisse-faire capitalism.

November 9, 1989

As the Cold War began to thaw across Eastern Europe, the spokesman for East Berlin’s Communist Party announced a change in his city’s relations with the West. Starting at midnight that day, he said, citizens of the GDR were free to cross the country’s borders.

In the early 1980s, the United States’ average spending on health per capita as a percent of Gross Domestic Product (GDP) were on par with the spending patterns of its peer countries. In the decades that followed, these 11 countries all experienced increases in healthcare spending, but the U.S. was an outlier in terms of how quickly its healthrelated spending increased. From 1980 to 2011, the United States’ total expenditures on health as a percent of GDP doubled; in the same time frame, its average spending on health per capita grew by a factor of eight.

International Comparison on Spending on Health, 1980-2011

1980s

Many economists at the very least agree that the changing global economic trends of the 1980s can be somewhat attributed to the “Reagan Boom”, which, in the 1980s was a record setting era that produced more jobs and more economic expansion than any other time in U.S. history.

1984

First CD is pressed

1986

Space Shuttle

Challenger explodes

1990s

The 1990s saw extreme advances in technology, with the World Wide Web, the first gene therapy trial, and the first designer babies all emerging in 1990 and being improved and built upon throughout the decade.

28

AOPA 20 17 ANNUAL REPO RT

WALK THROUGH TIME

1980s – 1990s

Products

Profession

1980s

and the

With the 1980s and the advent of personal computers, the dawn of the digital age arrived.

In O&P, there was extraordinary innovation with the development of Van Phillips’ “spring-like” Flex-Foot Inc. In 1984, and the subsequent debut of Ernest Burgess’s energy-storing Seattle Foot. Endoskeletal prostheses also gained ground, featuring modular components.

Fiber Technology Advances in fiber technology enabled companies such as Knit-Rite to incorporate high-stretch yarns and wicking yarns, as well as silver fiber, into their O&P products.

1980

Endolite developed the world’s first carbon fiber prosthetic system using materials developed for the aircraft industry.

Computer-Aided Design and Manufacture (CAD/CAM) Technologies

1984

Ohio WillowWood introduced the first conventional, lightweight, energy-storing prosthetic foot to incorporate carbon composites.

1990s

The 1980s also saw the introduction of computer-aided design and manufacture (CAD/ CAM) technologies, which would revolutionize prosthetic practice with increased shape management options, production capabilities, and access to outsourced fabrication as well as greater ease in transmitting digital files.

1993

Endolite introduced the first artificial knee to incorporate microprocessor technology to automatically adjust to amputee’s walking speeds.

The concept of using CAD/CAM technology for prosthetics and was introduced in technical journals.

1984

Van Phillips, a biomedical design engineer at the University of Utah, created an innovative workable artificial foot made from carbon graphite; the first “spring-like” prosthesis stored kinetic energy from the wearer’s steps as potential energy, and allowed users to run and jump.

The 1990s saw more technological innovation, marked by the introduction of Endolite’s swingcontrol microprocessor knee in the early 1990s and the 1997 release of Ottobock’s C-leg, the first fully microprocessor-controlled leg prosthesis system.

These technologies changed not only the ability of people to walk but also the reimbursement climate, with greater scrutiny of O&P devices due to the higher costs associated with advanced technology.

In the field of socket designs, Marlo Ortiz, CPO(M) developed the ischial containment concept. Like many innovations in prosthetics, this new development began with an amputee requesting something better. It started in 1999 with Ortiz trimming down the posterior wall of an ischial containment socket to make it more cosmetic in the gluteal area. What evolved is a socket configuration now called the MASdesign (Marlo Anatomical Socket). Más is also Spanish for more.

1985

1996

Ohio Willow Wood introduced the first fabric-covered, gel interface system.

1990

The International African-American Prosthetic-Orthotic Coalition was founded in 1990. The IAAPOC fosters information exchange, networking, and camaraderie among practitioner and technicians of African descent.

1997

The first fully microprocessorcontrolled leg prosthesis—the C-leg—was introduced

by Otto Bock.

July 1999

Hanger conducts the largest acquisition in O&P history by purchasing NovaCare Orthotics & Prosthetics, adding nearly 400 centers to its existing 256.

WALK THROUGH TIME

21st Century

AOPA The New Millennium

AOPA Membership 1917-2017

AOPA began the new millennium as a more inclusive association, changing its bylaws in 2001 to include more O&P businesses and thus be more representative of the entire O&P industry. The broader membership led to AOPA having an even stronger, more effective voice on Capitol Hill.

2,500

MEMBERSHIP

2,000

1,500

1,000

500

0

2000s

1917

1940

1946

1950

1955

1960

1975

1980

1985

1990

1995 2000 2005 2010

2016

2017

Under the umbrella of Provide, Promote and Protect, priorities were established by the AOPA Board of Directors—A sampling of those priorities include: • Tying quality to financial outcomes (develop more data along lines of cost effectiveness) which resulted in the Dobson-Davanzo Study.

• Outcomes/Evidence-based Research, which resulted in AOPA dedicating over 2 million dollars to AOPA funded grants in the last 7 years.

• Elimination of Medical Device Excise Tax, for O&P at both the patient level and manufacturer level, which was accomplished by AOPA making an appeal directly to the IRS. • Public Relations which was achieved through public service announcements and print.

• Ensuring O&P is included as an Essential Health Benefit in the Affordable Care Act, which was accomplished.

AOPA Policy Forum

AOPA Print Ad Campaign

Jan. 30-Feb. 1, 2000

As seen in the following publications:

2000

Left to right: T. Watson, V. Sabel and M. Schuch at 2000 World Rehab Dinner honoring Van Sabel.

Standing for Change in Washington is Easier for Some Than for Others.

It’s hard enough having to maneuver around Congress when you’re seeking support for your cause. But when you’re trying to do it on one leg, it’s even harder.

That’s why the American Orthotic and Prosthetic Association is urging Congress to pass bills S. 3223 and H.R. 2575, giving amputees comparable benefits for prosthetic arms and legs to those they would receive for any other medical or surgical treatment.

AOPA has continued to lead research efforts, securing grants for outcomesbased research, and commissioning a study by Dobson-DaVanzo that ultimately proved the efficacy of custom orthoses versus off-the-shelf devices. The most recent research includes a powerful literature-based analysis and model measuring the comprehensive economic value of transfemoral prostheses that will be released during this meeting.

Currently, insurance companies are using arbitrary caps and lifetime limits, which may not be enough to reimburse amputees for even the most rudimentary prosthetic and orthotic devices. And it’s certainly not enough to cover today’s prosthetics that can greatly improve an amputee’s mobility.

Please urge Congress to pass S. 3223 and H.R. 2575, the bills that will enable amputees to get the medically necessary devices they need to lead full, productive lives.

Because in America, arms and legs are not a luxury. For more information go to any of the following sites: AOPAnet.org, amputee-coalition.org, or armsandlegsarenotaluxury.com.

$2 Million IN RESEARCH SINCE 2013

LCD Rally

As the result of a 2015 ill-conceived LCD policy, AOPA arranged for five speakers at the DME MAC public meeting in Linthicum, Maryland, then organized a patient rally at the headquarters for the U.S. Department of Health and Human Services. At the rally’s conclusion, AOPA representatives met with high-ranking CMS officials, who said they would work with the regional contractors’ medical directors to reach a solution.

2010s

Research

Gary Horton with Bill Clinton

2016

AOPA Past Presidents Meeting

2016 AOPA Board of Directors

Front row (l to r): David A. Boone, MPH, PhD; Maynard Carkhuff; Jim Weber, MBA; Eileen Levis; Chris Nolan; Pam Lupo, CO; Charles H. Dankmeyer, Jr., CPO; James Campbell, PhD, CO, FAAOP; Back row (l to r): Dave McGill; Brad Ruhl; Michael Oros, CPO, FAAOP; Jeffrey Lutz, CPO; Jeff Collins, CPA.

WALK THROUGH TIME

21st Century

The World

In 2001, the 9/11 attacks shocked the world, causing the deaths of nearly 3,000 people and injuring 6,000 more.

In response, the United States engaged in war in Afghanistan, known as Operation Enduring Freedom, which continued from 2001 through 2014. Beginning in March 2003, the United States also engaged in Operation Iraqi Freedom.

The growth of the Internet contributed to globalization during the decade, which allowed faster communication among people around the world.

2001

First version of the iPod released

Tammy Duckworth, an Iraq War veteran, served as a U.S. Army helicopter pilot and suffered severe combat wounds, losing both of her legs and damaging her right arm.

Diabetes Diabetes continues as a global healthcare epidemic.

One in four individuals in the U.S. are not aware they have the disease. The aging population has an increased risk of complications from diabetes, a leading cause of amputations.

DIABETES AMPUTATION RISKS

73,000

29.1 Million Individuals in the United States who have diabetes.

Number of nontraumatic lower-limb amputations performed in adults with diagnosed diabetes in 2010.

Earthquake January 12, 2010 A catastrophic 7.0 magnitude earthquake stuck Haiti with an epicenter just 25 kilometres west of Portau-Prince, Haiti’s capital.

An estimated three million people were affected by the quake. Death toll estimates range from 100,000 to about 160,000 to Haitian government figures from 220,000.

Ice Bucket Challenge

ZUMBA

According to the World Health Organization, diabetes is on the rise:

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION

AMERICAN ACADEMY OF ORTHOTISTS AND PROSTHETISTS

AOPA and AAOP HAITIAN AMPUTEE RELIEF

AOPA and the Academy joined forces to create a database of resources where members could sign up to donate cash, time, supplies or devices.

93

individuals signed up to participate in the program.

2010s

2000s

These U.S. engagements resulted in more than 1,600 major limb amputations as of June 2015, according to U.S. Military Casualty Statistics. Many O&P facilities and manufacturers rose to the challenge of creating innovative prosthetic solutions for the generally young and active military amputee population.

A O PA NE T.ORG

31

WALK THROUGH TIME

21st Century

Products

Profession

and the

2000s

IN THE 21ST CENTURY, advanced myoelectric devices have increased in popularity, particularly as more amputees undergo advanced surgeries such as osseointegration and targeted muscle reinnervation. Innovations such as powered orthoses, virtual reality, brain-controlled prostheses, alternative materials, and 3-D printing are leading O&P professionals to explore new solutions.

The DEKA Arm system

2000

The DEKA Arm system developed by DARPA and Dean Kamen, inventor of the Segway, was awarded approval by the U.S. Food and Drug Administration. This prosthetic system utilizes a series of electrodes capable of reading muscle movement so that a wearer feels as though the appendage is being naturally operated by the brain. This system can handle fine motor operations like picking one grape from a bunch and bringing it to a person’s mouth. Vibrations generated by the prosthetic device can tell a person if they are gripping fruit, keys or some other item too hard. DARPA has invested more than $100 million into the technology and more than 300 scientists have contributed to the project.

​Stance Control Orthoses (SCOs)

2010s

The 21st century provided new innovations in lower limb orthotics with the popularity of Stance Control Orthoses (SCOs)—a type of KAFO that uses advanced technology to lock the knee while standing and allows the knee to be in free motion during the swing phase of normal walking.

The Infinite TT

A custom-molded, modular, and dynamic socket system for below-the-knee patients.

A modular frame and advanced pressure distribution system enables clinicians and patients to adjust the socket in response to activity, pressure areas, and the body’s shape change.

Össur—an O&P manufacturing company founded in Iceland in 1971—acquired Flex-Foot Inc. Össur’s presence in the United States grew throughout the decade, as the company applied for hundreds of U.S. patents and established Össur Americas.

2002

Horton Technology’s Stance Control Orthotic Knee Joint hits the market.

C-Brace® combines real time gait analysis, the energy redistributing properties of carbon fiber, and software capabilities to customize to joint response. C-Brace helps normalize gait, freeing patients to ambulate to his or her full potential.

The Basko SCO uses a simple internal pendulum mechanism to lock and unlock the knee depending on the angle of the joint in the sagittal plane--because the mechanism is position dependent, it does not rely on heel loading or cabling as in other designs.

Globalization

Former Hanger Clinic lead prosthetist Jay Tew, CP, and Hanger Prosthetics & Orthotics practitioner Randy Roberson, CP, walk with a patient who was recently fit with a prosthetic leg at the Hanger Clinic in Haiti.

Business Solutions for O&P

Standardizing processes and workflow through Computer software specifically for O&P practices provides seamless connection of front office administrative staff, practitioners, fab technicians, billing staff, and the management team, using integrated workflow processes that create complete electronic medical records.

The inability to access a quality prosthesis is a reality for most low-income patients around the world, either because products are unaffordable or care is unavailable. O&P providers in the U.S. will continue their care of the global community by donating devices and volunteering their clinical expertise in underdeveloped countries or regions where natural disasters have struck.

While most O&P practitioners cite a sense of gratification from providing care for O&P patients, those who are involved in humanitarian efforts say that being able to impact people in great need makes their work more fulfilling.

Flex Cell by Infinite Biomedical Technologies

A boy in ARSOBO's Nogales, Mexico, clinic shows off his new leg

The first flexible battery for myoelectric prostheses. For size, shape and function, Flex Cells are engineered specifically to meet the needs of Upper Limb amputees. It is less that 4mm thick and can be placed anywhere within the socket to craft better looking and long lasting prostheses.

WALK THROUGH TIME

AOPA

Today and Tomorrow

This year, as AOPA celebrates its 100th anniversary, there are several key AOPA imperatives that will likely have a favorable impact on the profession: • National Prosthetic Patient Registry • Comparative effectiveness research

DARPA

• Updated research by Dobson-DaVanzo & RAND quantifying how mobility saves lives & money

MICROPROCESSOR KNEE

BIONIC PROPULSION ANKLE

POWER KNEE

MYOELECTRIC

HIGH ENERGY FOOT

• Prosthetics 2020 continuing initiative • The prospective launch of Orthotics 2020 No

• Topic-centered systematic reviews of scientific literature

No

No

No

Medicare, please don’t disable us!

Prosthetics 2020

Recognizing CMS’ commitment to moving in the direction of value-based purchasing, AOPA introduced Prosthetics 2020 as a forward-looking commitment to meet the challenges ahead.

Prosthetics 2020 has these core objectives: • Improve the future • Define new patient reimbursement landscape segments that can benefit for lower extremity from lower extremity prosthetics prosthetic technology • Define and provide the • Separate the O&P profession appropriate technology to from Durable Medical the appropriate patients to Equipment (DME) in the mind reduce the current trend of of the payers. providing the lowest cost technology to all patients

AOPA commissioned RAND Corporation to perform a comprehensive, independent validated study quantifying the value of prosthetic services. The study, the report on which will be presented on Friday at the 7:15 AM General Session to World Congress attendees, goes beyond the typical health care expenditures to include costs and savings associated with employment, taxpayer status and state and federal social assistance programs.

Prosthetics 2020 Medical Advisory Board Members Michael Jaff, DO Medical Director Mass General Vascular Center Boston, MA

Paul F. Pasquina, MD Washington, DC

Kenton R. Kaufman, PhD Mayo Clinic Rochester, MN

Douglas G. Smith, MD University of Washington Medical Center Seattle, WA

The RAND Corporation Value Simulation Study

O&P Alliance AOPA looks forward to future successes with the Alliance. AOPA joined forces with ABC, the Academy, BOC and the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) to form the O&P Alliance.

The Alliance’s accomplishments have included convincing the Centers for Medicare & Medicaid Services (CMS) to make the new Medicare standards more reasonable for O&P, lobbying for removal of O&P from competitive bidding, and pushing CMS to enforce qualified provider regulations.

2013 Dobson-DaVanzo Research Study

AOPA funded the 2013 DobsonDaVanzo research study, commissioned by the Amputee Coalition that proved O&P care saves money and improves quality of life for patients. AOPA has commissioned an update of this study using more recent Medicare health care data and newly obtained prescription drug data. The updated findings are being released at the 2017 World Congress and will further quantify the message: Mobility Saves.

Research will continue as a priority with capabilities greatly expanded to capture data that even more convincingly tells the story that mobility saves.

Co-OP

NEW!

As AOPA celebrates Co-OP it’s 100th Anniversary new member benefits and programs are being released, including the Co-op--an online reimbursement tool that includes a collection of detailed information and supporting links—like a Wikipedia of sorts geared toward everything O&P. Co-OP

An AOPA Member Benefit As an online reimbursement, coding, and policy resource, this site includes a collection of

detailed information with links to supporting documen-

tation for the topics most important to AOPA Members.

Like a Wikipedia of all things O&P, the Co-OP incorporates a crowdsourcing component, which is vetted by AOPA

staff, to garner the vast knowledge and experience of our membership body.

Resources include: •

State-specific insurance policy updates,

•

L code search capability,

•

Data and evidence resources,

and so much more!

Learn more and sign up at

www.AOPAnet.org/co-op.

www.AOPAnet.org

Healthcare Compliance and Ethics Week

The membership will celebrate its first annual Healthcare Compliance and Ethics Week in 2017 with new products, tools, resources and white papers for AOPA members.

AOPA Celebrates

Health-Care Compliance & Ethics Week November 5-11, 2017

Why Should you Participate?

• Demonstrate your company’s commitment to ethic business practices.

• Create awareness of the Code of Conduct, relevan laws, and regulations.

• Provide your staff with recognition for training completion, compliance, and ethics successes.

• Reinforcement—of the culture of compliance for which your organization strives.

AOPA has developed tools and resources to assist you.

Learn more about our products, special webinars, compliance tip of the day, how to win prizes and more at bit.ly/aopaethics.

www.AOPAn

WALK THROUGH TIME

The World

Today and Tomorrow

Future Developments in O&P Future developments will be in the area of globalization and communications as we experience no barriers in gathering a shared world of O&P treatment with teams consisting of medical expertise in multiple disciplines readily available for collaboration regardless of patient or provider locations. A patient in England may have a team consisting of experts from India, Singapore and other parts of the world with selection based solely on the expertise possessed and the patient needs.

Mobile Health and Wearables Remote health monitoring and diagnostics by Mobile Health and Wearables are projected to reach $59 Billion by 2020

Changes in Health Insurance in U.S. Millions more people are insured since the Affordable Care Act’s inception in 2010 and access to health care has increased. As the heated debate about the potential shift in U.S. health care continues, AOPA has meticulously looked at “repeal and replace” through the lens of three key issues - higher premiums linked to pre-existing conditions, essential health benefits, and Medicaid cuts - as these three have a profound impact on O&P patients, and therefore on the professionals who serve those patients.

34

AOPA 20 17 ANNUAL REPO RT

DECREASE IN UNINSURED RATE

18.2

PERCENT

16.6

PERCENT

10.5

PERCENT

Uninsured rate in 2010.

Uninsured rate in 2013 (the year the insurance exchanges opened, in October).

Uninsured rate in 2015.

Transition to Value-Based Care $2 trillion of all health care spending will migrate to value-based care. This transition to a fee-forvalue world, is where a payer is responsible for deciding how much each entity on the treatment team gets paid. O&P business owners will need to communicate the value of their services and dedicate more resources to building relationships with payers to ensure a share of the business under this new health care payment model.

LOWER COSTS

VALUEBASED CARE

HIGHER VALUE

WALK THROUGH TIME

Today and Tomorrow

Products

Profession

and the

Osseointegration Osseointegration involves implanting titanium rods in the bones of residual limbs to attach a prostheses directly to the body. The goal is to provide amputees with greater mobility and increased comfort. Implants eliminate the need for a socket, and may allow prosthesis users to experience osseoperception—sensory awareness of the patient’s surroundings.

PHOTOS: Top: Hanger Clinic, bottom two: Salt Lake City VA

X-ray of a patient who underwent osseointegration implant surgery at the Institute of Musculoskeletal Reconstruction and Osseointegration

In 2015 The U.S. Food and Drug Administration authorized use of the first Osseointegration prosthesis marketed in the U.S. for adults who have amputations above the knee and who have rehabilitation problems with, or cannot use, a conventional socket prosthesis.

Current research trials are combining electrode implants with targeted muscle reinnervation (TMR) surgeries, and a more advanced prosthesis system to provide even better functional achievement for upper extremity amputees as well as in lower extremity amputees.

How Does 3D Printing Work?

3-D Printing

PHOTO:Thinkstock

The O&P profession will continue to learn more about 3D-printed devices, to get a greater understanding of their advantages and limitations.

3D printers make use of a process called “additive manufacturing.” The process starts with a blueprint created in a 3D digital-modeling program, which is programmed into the printer.

The printer then builds the desired object by laying down super-thin layers of the materials—which can range from metal to plastic and more.

3D printers range widely in price, with simple models retailing at $2,000 and industrial models costing $100,000 or more.

Modern materials like carbon fiber are making prosthetics both lighter and stronger.

Advancements like 3D printing and biometrics have enhanced the lives of amputees and will continue to do so.

PHOTOS: Jen Owen

O&P Services in Demand An aging population and an increase in diabetes and cardiovascular disease result in increased demand for O&P services. The Bureau of Labor Statistics projects growth in the O&P industry through 2024.

W W W. A O PA NE T.ORG

35

WALK THROUGH TIME

36

AOPA 20 17 ANNUAL REPO RT

EDUCATION & CE OPPORTUNITIES

COMMUNICATIONS

ADVOCACY

AOPA Resources Topic (alpha)

Description

How to Access

AOPA Co-OP

An online reimbursement, coding and policy resource tool

www.aopanet.org/resources/co-op

AOPAversity Online

Earn CE credits, watch online videos and take quizzes for ABC and BOC pre-approved credits.

www.AOPAnetonline.org/aopaversity

AOPAvotes.org

Advocacy resource for legislative contacts, model letters and information on O&P legislative proposals

www.AOPAVotes.org

Policy Forum

Held in DC each spring to inform, educate, and build relationships with Congress on key O&P legislation; March 7-8, 2018

bit.ly/policyforum2018

O&P PAC and Capital Connection

Financial support for AOPA’s government relations program

For information, visit bit.ly/oandppac.

Apparel Program

Save on customizable polos, scrub tops and lab coats

www.iconscrubs.com ACCESS CODE: icon-aopa

8

201

AOPA

policy forum

Bookstore Publications Products to help you with coding & billing e.g. annual Illustrated Guide, Coding Pro & Quick coder

www.AOPAnetonline.org/store enter your user name and password for member discounts

Coding, Billing & Audit Guidance

Get one on one assistance & answers to your regulatory, coding, billing & audit questions

Phone: 571-431-0876 Email: dbernard@AOPAnet.org or jmcternan@AOPAnet.org

O&P Almanac

Monthly magazine

Available at bit.ly/opalmanac AOPA’s

Take

AOPA’s Take Blog

Where to go for late breaking news and info

AOPA 365 APP

Mobile APP for smartphones and tablets FREE AOPA 365

Search keyword AOPA365 in Apple or Google Stores

AOPA in Advance SmartBrief

Bi-weekly online newsletter

Sign up your member profile at www.AOPAnetonline.org/profile.

Access previous issues “archives” under the publications tab

Google +

Connect with AOPA members about issues facing the O&P profession, like ways others deal with payer reimbursement trends and policies.

Join the conversation at www.aopanet.org and click on the G+ symbol. Click “Ask to Join”.

Social Media

Connect with AOPA on social media to learn about special news and events

YouTube: www.youtube.com/user/AOPAnet LinkedIn: www.linkedin.com/company/1065340?trk=tyah Facebook: www.facebook.com/AmericanOandP Twitter: twitter.com/AmericanOandP Instagram: Instagram/American.OandP

Business Certificate Program

Continuing education program in areas of finance, marketing, business operations, reimbursement policies and management for O&P businesses.

www.AOPAnet.org/education, under the education tab

Coding & Billing Seminars

Mastering Medicare: Coding & Billing course offered four times per year across the country for O&P practitioners and office staff, 14 CEs awarded at completion of 2-day course.

www.AOPAnet.org/education/coding-billing-seminar

National Assembly

O&P Industry’s largest meeting with education and exhibits. Get continuous updates on speakers, online registration, and events.

Typically more than 30 CEs in multiple disciplines are available for attending the annual National Assembly meeting.

www.AOPAnet.org

O&P Almanac Quizzes

1.5 CEs awarded for Reimbursement Page & Compliance Corner articles

www.AOPAnet.org/publications/op-almanac-magazine/quiz-archive

Online Learning Videos

CEs available for online videos for multiple disciplines

www.AOPAnet.org/education

Webinars

One hour webinars on the 2nd Wednesday of each month on a business related topic. Members $99, Nonmembers $199; 1.5 CEs. Buy 10 get 2 free.

www.AOPAnet.org/education Enter “member” in promo code box and click APPLY to change price to $99.

Webcasts

2 webcast series on Practice Management and Mastering Medicare: Coding & Billing Basics and Principles; 1.5 CEs available for each module

www.AOPAnet.org/education

Job Board

Job and resume postings for employers and employees

jobs.AOPAnet.org, create account

Insurance

Member savings of 10% or more for professional & general liability, worker’s comp, property, umbrella and auto with Cailor Fleming Insurance

Call 800-796-8495 or visit: www.cailorfleming.com/specialty/orthotics-prosthetics-insurance/

LCodeSearch.com

Members-only resource for matching LCodes with O&P products

Register for an account at www.LCodeSearch.com; activation for members follows in 24-48 hours

Register free online to get email notification of updates at AOPAStake.org app

The Source for Orthotic & Prosthetic Coding

Membership Renewal & Profile Update

Pay your membership dues online, update contact information, edit employee names and preferences

www.AOPAnetonline.org/profile Input user name and password to submit payment or to update contact info, employees listed, emails, etc.

Mobility Saves

Communications tool for patients, providers and insurance companies and policy makers showing how O&P provides cost-saving care

www.mobilitysaves.org

Operating Performance & Compensation Benchmarking Survey

Operating performance survey conducted annually; compensation & benefits survey conducted biannually. Survey participation FREE for members who receive final report and detailed company report comparing their results to all participants. Final published reports available for sale in AOPA bookstore.

Prosthetics 2020 Orthotics 2020

Industry funded project to shape the future of the prosthetics profession through evidence, outcomes and research

www.AOPAnet.org/prosthetics-2020

UPS Discounts

Save on select shipping options. Sign up for new account or add onto existing account.

Savewithups.com/aopa

www.AOPAnetonline.org/store, to purchase published reports. Contact bleppin@AOPAnet.org for more information.

American Orthotic & Prosthetic Association 330 John Carlyle St., #200 Alexandria, VA 22314 Phone: 571-431-0876 Fax: 571-431-0899 www.AOPAnet.org info@AOPAnet.org

CALENDAR OF EVENTS FOR 2018 2018 Events JANUARY 5-7 | Leadership Conference, Palm Beach, FL

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars

MARCH 7-8 | Policy Forum Washington, DC

JANUARY 10: Lower-Limb Prosthesis Policy: A Comprehensive Review FEBRUARY 14: Inpatient Billing

NOVEMBER 4-10 | Healthcare Compliance & Ethics Week

AOPA Celebrates Healthcare Compliance & Ethics Week

2018 Webinars

MARCH 14: Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More FEBRUARY 26-27: Atlanta, GA

November 4-10, 2018

JUNE 13: Audits: Know the Types, Know the Players, and Know the Rules JULY 11: Administrative Documentation AUGUST 8: Outcomes & Patient Satisfaction Surveys

JULY 23-24: St. Louis, MO

Vancouver, BC, Canada Convention Center

For more information, visit www.AOPAnet.org

SEPT 25-28, 2019 | AOPA National Assembly.

San Diego, CA, Convention Center SEPT 9-12, 2020 | AOPA National Assembly Las Vegas, NV Mandalay Bay

OCTOBER 10: Year-End Review: How To Wrap Up and Get Ready for the New Year

SEPT 9-12, 2021 | AOPA National Assembly Boston, MA

DECEMBER 12: New Codes, Medicare Changes, and Updates

W WW.AO PANET. O RG

SEPT 26-29, 2018

SEPTEMBER 12: Medicare as Secondary Payor: Knowing the Rules

NOVEMBER 14: Evaluating Your Compliance Plan and Procedures: How To Audit Your Practice

NOVEMBER 12-13: Las Vegas

AOPA NATIONAL ASSEMBLY

APRIL 11: Enhancing Cash Flow and Increasing Your Accounts Receivable MAY 9: Coding: Understanding the Basics

APRIL 30-MAY 1: San Antonio, TX

AOPA National Assembly