OP
The American Orthotic & Prosthetic Association
APRIL 2013
&
WWW.AOPAnet.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
To Brace or not to BracE?
Experts say orthotic treatment for muscular dystrophy can prolong ambulation without a wheelchair
Strategies for Staff Recruitment HIPAA Omnibus Rule Explained
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O&P APRIL 2013, VOLUME 62, No. 4
CONTENTS Cover Story
18 To Brace or Not to Brace?
By Christine Umbrell Treating muscular dystrophy patients can be a complicated undertaking for orthotists. As treatment protocols have advanced, the strategies for bracing patients have changed—but orthotic intervention remains an important consideration.
Feature
24 Help Wanted
By Adam Stone O&P business owners and HR managers offer proven strategies for identifying potential employees to fill clinical and administrative positions. These hiring experts share creative best practices—including seeking candidates both within and outside of the O&P industry.
departments
4
AOPA Contact Page How to reach staff
6
At a Glance Statistics and O&P data
42 Jobs
In the News Research, updates, and company announcements
44 Calendar
08 COLUMNS
14
Reimbursement Page Complying with the new HIPAA Omnibus Rule
28
Facility Spotlight Hogan Prosthetics & Orthotics
30
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
40 Marketplace
Products and services for O&P Opportunities for O&P professionals
Upcoming meetings and events
47
Ad Index
48
AOPA Answers Expert answers to your FAQs
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.
APRIL 2013 O&P Almanac
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AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD oF DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
directors Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX
O&p Almanac
Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org
Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com Stephen Custer, production manager, 571/431-0876, scuster@AOPAnet.org Steffanie Housman, staff writer, 571/431-0835, shousman@AOPAnet.org Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com
Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org
President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD
Scott Schneider, Ottobock, Minneapolis, MN Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT
Communications
Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX
Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org
Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO
Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL
Government affairs
Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA
AOPA Bookstore: 571/431-0865
Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org
Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA
Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Eileen Levis, Orthologix, LLC, Trevose, PA
James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 2013 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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O&P Almanac APRIL 2013
Do You Have Knee Pain?
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AT IN THE A GLANCE NEWS
Muscular Dystrophy By the Numbers Muscular dystrophy is a genetically inherited group of diseases that weaken the musculoskeletal system and inhibit locomotion. Duchenne is the most common childhood form of MD, generally affecting only boys. Percentage of males with Duchenne or Becker MD who use a wheelchair
Ages 5-9:
Ages 10-14:
Ages 15-24:
29% 82%
90%
Source: Centers for Disease Control and Prevention.
50%
Chance that the son of a “carrier” mother will inherit the disease.
67
Number of new clinical trials for drugs or therapies for muscular dystrophy treatment that have been conducted since the MD Care Act of 2001 went into effect.
95%
Accuracy with which Duchenne MD can be detected by genetic studies performed during pregnancy.
1:3,500 Incidence of Duchenne MD among males.
20,000
Number of new cases of Duchenne MD worldwide each year.
1987 Year that the protein “dystrophin” was identified as missing in muscle cells of Duchenne MD patients.
Sources: Centers for Disease Control and Prevention, MMWR Morb Mortal Weekly Report; Encyclopedia of Children’s Health; www.kidshealth.org; National Institutes of Health Medline Plus; Parent Project Muscular Dystrophy. 6
O&P Almanac APRIL 2013
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IN THE NEWS
‘Artificial Muscles’ Under Development Researchers at Duke University’s Pratt School of Engineering are working on coupling graphene (atom-thick lattices of carbon) with acrylic elastomer in an arrangement that reacts similarly to muscle tissue when an electric current is used. The idea is to create artificial muscles that could be used in a range of technologies including robotics and artificial limbs. “In particular, they promise to greatly improve the quality of life for millions of disabled people by providing affordable Crumpled graphene devices such as lightweight prostheses,” says Xuanhe Zhao, assistant professor. When graphene, a pure carbon material, is layered with acrylic elastomer film, it can act like muscle tissues because of its ability to contract and expand when electricity is applied. Varying voltage levels control the degree of contraction and relaxation, giving actuation strains above 100 percent. The crumpling and unfolding of graphene allows large deformation of the artificial A molecular model of graphite: graphene sheets of one-atom thick muscle, according to Zhao. carbon atoms in a stong hexagonal “New artificial muscles are enabling diverse technologies ranging from robotics and arrangement. drug delivery to energy harvesting and storage,” Zhao says. “The broad impact of new artificial muscles is potentially analogous to the impact of piezoelectric materials on the global society.” Results of the Duke research were published online in the journal Nature Materials.
CDC Asks Health-Care Providers to Help Stop Spread of ‘Superbug’ Government officials are asking the nation’s health-care providers to step up efforts to halt the spread of a drugresistant bacteria that attacks the bloodstream and kills up to half of patients who become infected. O&P practitioners are asked to do their part, especially when treating seniors and patients in hospitals. In the first half of 2012, nearly 200 hospitals and acutecare facilities treated at least one patient for the lethal “superbug” known as CRE—which stands for Carbapenemresistant Enterobacteriaceae, part of a family of more than 70 bacteria that live in the digestive system—according to new data from the U.S. Centers for Disease Control and Prevention (CDC). Director Tom Frieden, MD, MPH, called CRE a “nightmare bacteria” because of its high mortality rate, its resistance to nearly all antibiotics, and its ability to spread its drug resistance to other bacteria. Patients receiving long-term or complex medical care in hospitals and nursing homes are at the greatest risk for CRE infection. The bug is spread mainly by unclean hands, but medical devices like ventilators and catheters increase
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O&P Almanac APRIL 2013
the risk of infection because they allow the bacteria to get deep into a patient’s body. The health-care community needs to do its part to help contain the bacteria, according to Frieden, to ensure it doesn’t advance beyond hospitals and nursing homes, where it has been concentrated. The fear is it could follow the pattern of another bacterial superbug, known as MRSA, which has turned up in schools, gyms, and other public facilities. “Compliance with hand-washing, with using gowns and gloves properly, remains a challenge, and it’s something that we call on health-care facilities to work with their providers” to do a better job of, says Arjun Srinivasan, the CDC’s associate director for hospital-associated programs to prevent infections. “We have the weapons at our disposal right now to stop this from becoming a bigger problem.”
THE MOST CLINICALLY PROVEN OA BRACE WITH A NEW TWIST. The Unloader line of braces by Össur are clinically proven to reduce pain and improve function for patients who wear them. Recent clinical research* demonstrates that the Unloader One® provides decreased pain, improved function and reduction in pain medications for patients. * Briggs KK, Matheny LM, Steadman JR. Improvement in quality of life with use of an Unloader knee brace in active patients with OA: A prospective cohort study. J Knee Surg 2012; Advance online publication. Retrieved 23rd August 2012. DOI:10.1055/S-0032-1313748
SmartDosing™ now available. SmartDosing, powered by Boa® Technology, provides patients with a simplif ied, single-hand dosing dial for on-the-f ly adjustability of the dual Dynamic Force Straps (DFS), helping them better manage their unicompartmental OA knee pain.
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IN THE NEWS
Prosthetic Flippers Fitted to Loggerhead Turtle
Loggerhead turtle
Yu Chan, a female loggerhead turtle, made her public debut with prosthetic flippers—her 27th pair—in front of an enthusiastic crowd at the Suma Aqualife Park in western Japan. The prosthetic flippers are attached to a soft vest that slips over the turtle’s head. The new design was developed to prevent the turtle from accidently taking the prostheses off. Yu was pulled from the sea in 2008 after she became tangled in fishing nets in the Kii Channel, with half of one forelimb and a third of another gone. Teeth marks could be observed across her body. Concerned citizens set up a fund to aid her recovery, as well as assist in paying for the development of her prosthetic limbs. National Geographic writes that research and development of the turtle’s limbs was aided by the Sea Turtle Association of Japan and prosthetic limb manufacturer Kawamura Gishi.
In MEMORIAM
TRANSITIONS
Hugh Panton, CPO, FAAOP, an upper-extremity specialist with Hanger and an amputee himself, recently passed away. Panton graduated from New York University in June 1965 with the world’s first bachelor of science degree in prosthetics and orthotics. He joined Hanger Clinic soon after graduation. During his 40-plus years of full-time tenure with the company, Panton made an indelible mark and a profound impact on the profession that will endure for generations to come. Panton was a founder of the Project First Step program, and was granted the Lifetime Achievement Award by Hanger Inc.
Hanger Clinic has announced a number of practitioner hirings at its patient-care clinics across the country: Nathan Aleksiewicz, CPO, in Salt Lake City, Utah; Stephen Garcia, BOCOPO, in San Antonio; Randy Johnson, C.Ped, in Belleville, Illinois; Harold Johnson, CO, in Lake Oswego, Oregon; Stacey McDonough, CO, in Waukesha, Wisconsin; Preetam Singh Panwar, BOCOP, in American Canyon, California; Carlos Saucedo, BOCO, in Fort Smith, Arkansas; and William Trock, CP, in Orangeburg, South Carolina.
people in the news
Todd Eagen has been promoted to vice president of the Orthotic and Prosthetic Group of America in Waterloo, Iowa. San Diego Navy veteran and U.S. Paralympic hopeful Michael Johnston stars in a new commercial that encourages military veterans with physical disabilities to “get back in the game.” The public service announcement, co-sponsored by
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O&P Almanac APRIL 2013
the U.S. Paralympics and the U.S. Department of Veterans Affairs, is titled “Mission ReDefined” and features Johnston running on a prosthetic leg. AOPA will welcome three individuals to the 2013 World Congress in September after awarding them complimentary full registrations during the AAOP Trade Show. The winners of the free registrations are Jane Marlor, CO, FAAOP, from Lakeland, Florida; Teresa Masters, CPO, LPO, from TMC Orthopedic in Houston; and Nick Marro, a graduate student from the University of Pittsburgh. Donald D. Virostek, CPO, has been awarded the William D. Beiswenger Volunteer Award by The American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. (ABC). Virostek was recognized for his extraordinary volunteer work supporting ABC’s mission and for embodying the spirit of the award.
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IN THE NEWS
Special Consideration Needed in Treating Amputee Youth Fitting children for prosthetic sockets can present many challenges, according to a recent presentation by Kevin Carroll, CP, FAAOP, vice president of prosthetics for Hanger Clinic, and John Dieli, CPO, clinical manager of Hanger’s Methuen, Massachusetts, clinic. “Children grow very quickly, and we as clinicians are trying to determine the best way to manage these kids and be successful with their rehabilitation,” Carroll said. According to Dieli, it is important to remember that a child’s socket design may need to be redesigned as the child grows. “Children grow so quickly, so when you first fit them, you may think, ‘This is the perfect socket for this child,’” he said. “But as the child grows and gets heavier, you may have to redesign how you are going to fit that prosthesis.”
TRANSITIONS
BUSINESSES in the news
Alliance Orthotics and Prosthetics LLC has a new location in Denton, Texas. The American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. has released its 2012 Annual Report, available now at www.abcop.org. The Amputee Coalition has announced its 2013 officers and board of directors. The officers are Marshall J. Cohen, chairman; Dennis Strickland, vice chair; Dan Berschinski, vice chair, Jeffrey Lutz, treasurer; and Charles Steele, secretary. Board members include Annie Berdy, Pat Chelf, Michael Estrada, Mahesh Mansukhani, Leslie Pitt Schneider, and Terrence P. Sheehan, MD. The Amputee Coalition also is launching “Show Your Mettle Day.” On April 27, amputees are asked to show their prostheses in public and post pictures on the Coalition’s Facebook page, facebook.com/AmputeeUSA.
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O&P Almanac APRIL 2013
The child’s parents should be involved throughout the entire fitting process. Carroll recommends using positive reinforcement to encourage children to get involved with physical activity as soon as they are able.
Led by Billy Costello, a Green Beret staff sergeant who lost his right leg above the knee to an improvised explosive device in Afghanistan, the Combat Wounded Veteran Challenge Team climbed and celebrated its ascent of Mount Kilimanjaro at Gilman’s Point, one of the highest spots on the Tanzanian mountain. As part of a Department of Veterans Affairs Innovation Initiative competition, WillowWood, in partnership with The Ohio State University and The University of Akron, has secured a new contract to develop a prosthetic system to help transfemoral amputee patients at VA medical centers. The International Society for Prosthetics and Orthotics (ISPO) and Leipziger Messe have signed a cooperation agreement to continue to work together to organize the exhibition that accompanies the ISPO World Congress.
Kingetics LLC announced it has received a patent for its spring orthotic device for use by the Army, other Department of Defense entities, and key markets in the government and civilian sectors. In the Phase I project, the primary goal is to demonstrate the feasibility of the orthosis to reduce injury and enhance ambulatory performance using advanced composite materials. OPAF and The First Clinics has announced that the American Board for Certification in Orthotics, Prosthetics, and Pedorthics is a silverlevel sponsor for 2013. A group of experienced clinicians and prosthetists at RSLSteeper has developed a set of guidelines designed to help prosthetists and clinicians make appropriate treatment choices for their patients. The guidelines, which are built around evidencebased medicine and clinical opinion and aim to provide practitioners with consistent information, are available at www.rslsteeper.com.
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Reimbursement Page By Devon Bernard
Implementing the HIPAA Omnibus Rule The brand new rule may affect your agreements with business associates and breach notification policies
T KEY TERMS AND DEFINITIONS FROM HIPAA • Covered Entity: An organization that must comply with all HIPAA rules and regulations when using/creating PHI. As a health-care provider, you are considered a covered entity. • Disclosure: The means by which a covered entity communicates PHI to an outside entity, and is normally allowed under HIPAA. • Protected Health Information (PHI): Information created by a health-care provider that is used to identify an individual for the purpose of treatment and billing. PHI also is referred to as individually identifiable health information, and could be such information as Medicare ID or Social Security numbers. • Secured: Any PHI that has been rendered unusable, unreadable, or indecipherable by accepted methods. These methods include encryption for electronic records or shredding for paper information. • Unsecured: Any PHI that has not been destroyed, made unreadable, or made unusable by acceptable methods. • Use: Refers to acceptable, under HIPAA, disclosures of PHI in the daily operations of a business; for example, PHI used for treatment or billing.
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O&P Almanac APRIL 2013
he final Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule was published by the Office of Civil Rights (OCR) and the Department of Health and Human Services (HHS) on Jan. 25, 2013. The intention of the rule is to implement new privacy, security, and enforcement provisions to provide greater protection to a patient’s privacy and strengthen the ability of the government to enforce HIPAA. With an effective date of March 26, 2013, and a mandatory compliance date of Sept., 23, 2013, this new rule is based on and modifies provisions or statutory changes that were first introduced and enacted under the Health Information Technology for Economic and Clinical Health (HITECH) Act.
off guard. However, there are some changes that will alter your business practices, including updating your Notice of Privacy Practices, creating new business associate agreements, and updating your breach notification protocols. Several changes from the HITECH Act to the final Omnibus Rule may have an impact on your current business practices and HIPAA policies and procedures. The changes have been divided into four categories: business associates and business associate agreements, breaches and breach notifications, patients’ rights, and compliance and enforcement.
What You Need To Know
A business associate (BA) is a person or entity that provides services on behalf of or to covered entities, and requires the use and disclosure of PHI. Examples of BAs include but are not limited to third-party billers, accounts, or clearinghouses. With the new rule, the role of the BA hasn’t changed, but its definition has changed: A BA is any entity that creates, receives, maintains, or transmits PHI on behalf of a covered entity. This expanded definition includes any subcontractors that a BA may use to carry out the duties assigned to it by a covered entity.
The HITECH Act was enacted as part of the stimulus bill and signed into law on Feb. 17, 2009. The purpose of HITECH was to further advance the use of electronic communications in the health-care arena; but it also expanded the reach of HIPAA’s privacy and security provisions. In late 2009, HHS released its interim rules for the new privacy and security provisions of the HITECH Act and they became effective; active enforcement began in 2010. Thus, a lot of the changes brought about by the Omnibus Rule are not new and should not catch you completely
Businesses Associates and Business Associate Agreements
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This expansion provides greater protection to a patient’s PHI. Why? Because under the HITECH Act, BAs were required to directly comply with the HIPAA standards, which include both the privacy and security statutes. This requirement is now finalized with the publication of the Omnibus Rule. In essence, your BAs must comply with the same rules as you, including breach notification guidelines, instead of just informally following the rules as a business practice, and they also are directly liable for any HIPAA rules violations.
If a breach involves more than 500 people, you must notify HHS immediately, and the breach notification information will be posted on the HHS website. The Omnibus Rule also made some changes in how the BA is to interact with the covered entity through the creation of contracts or business associate agreements (BAAs). BAs are required to provide you with breach notifications, and provide you with access to PHI in an electronic format. BAs also must disclose PHI to HHS to demonstrate compliance with HIPAA and be able to provide an accounting of all disclosures of PHI. The final rule also modified the required content for a BAA. Since there is a grandfathering period, you have until Sept. 23, 2014, or when the current agreement expires (whichever is first), to review and amend your BAAs. Any BAA created on or after Jan. 25, 2013, must meet the new requirements or be amended to meet the new requirements by Sept. 23, 2013.
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O&P Almanac APRIL 2013
Building Your BAAs If you don’t have agreements with your BAs, now is the time to create them. A sample business associate agreement is available on the OCR website, www.hhs.gov/ocr. Consider including the following items in your amended or new agreements: • First, include a section that allows you to verify that the BA is in compliance with the HIPAA security and privacy regulations. This means they should have administrative, physical, and technical safeguards in place. • Second, ensure the BA will report all breaches to you in a timely manner, and that these notifications will be done in a standard format. Some of the information you should request when breaches are reported include contact information for those affected; a detailed account of the breach, including what was breached; and any steps the BA is taking to ensure the breach doesn’t recur. Include a request for any information you may require when you have to report the breach because it is your responsibility, not the BA’s, to make the notifications. • Third, if a BA uses any subcontractors, ensure the subcontractors agree to the same restrictions and conditions you apply to the BA. These are some sample items to consider addressing within your BAAs; be sure you create agreements that are specific to your needs. Most importantly, make sure the BAA doesn’t impose any unnecessary burdens or liabilities on you or your BA.
Breaches of PHI and Breach Notifications The final Omnibus Rule did not change the breach notification requirements established by HITECH. A covered entity is still required to notify the patient, in a timely manner, when an unsecured breach of PHI has been discovered.
A breach is considered “discovered” on the date the covered entity learns of the breach, and not on the date the breach occurred. A “timely manner” is considered to be no later than 60 days after the discovery. The notification must be in writing. If a breach involves more than 500 people, you must notify HHS immediately, and the breach notification information will be posted on the HHS website. You also must notify the media, and notify patients in writing. Finally, you must keep a record/log of all breaches that occur during the year and submit a copy to HHS, no later than 60 days after the end of the year. What the final Omnibus Rule did change was the definition of a breach, and subsequently when a breach must be reported and the patient notified. Under HITECH, a breach occurred when it was demonstrated that unsecured PHI was accessed, used, or disclosed by an unauthorized individual and that the unsecured PHI had the potential to harm the patient in any way—the “risk of harm” standard. Now, the “risk of harm” standard has been removed. There is the presumption that any unauthorized use, disclosure, or access of a patient’s PHI is a breach, unless a covered entity or a covered entity’s business associate can demonstrate that that there is a low probability that the PHI has been compromised. To determine if a breach occurred, or that there is a low probability that the PHI has been comprised, and notification is required, you must conduct a risk analysis. The Omnibus Rule provides you with four factors, or questions, that must be part of your risk analysis, but you may include more if you choose; these could include questions you created as part of your risk of harm analysis under HITECH. Whether you use additional factors or stick with the four provided by the final rule, the key is to appoint an individual who will be responsible for conducting the investigation of breaches and the risk analysis, and to ensure the results are thorough, fact-based, and well-documented.
n
4 Factors in Risk Analysis
The 3 Exemptions to a Breach
The first required step in your risk analysis is to examine the unauthorized person who used the PHI or to whom the disclosure of PHI was made. If the PHI is accessed by an individual in your organization who is not authorized to view this information, this could be viewed as compromising the PHI and require a notification. However, if the PHI was impermissibly disclosed to an entity that is governed by HIPAA, the likelihood of PHI being compromised is lower, and may not require notification. Second, determine whether the PHI was actually acquired or viewed. Consider this example: A laptop containing patient information is stolen and later recovered. If you can determine—and prove—that the information was not accessed, then the risk of the PHI being compromised may be low and notification may not be required. If you can’t prove the information wasn’t accessed, then the likelihood that the PHI has been compromised is high and a notification would be required. Third, determine the type and amount of information that was impermissibly accessed, used, or disclosed and the nature and the extent of the PHI involved, including the types of identifiers and the likelihood of re-identification. If the information potentially breached was a list of names and Social Security numbers, the information is identifiable and the PHI has been compromised. Fourth, document the steps you took to limit the possible chances of the PHI being compromised or the extent to which any risk to the PHI has been mitigated. Consider another example: You faxed information to the wrong facility, and you were able to get assurance from that facility that staff received the material and shredded the document. In this case, there is a low chance that the PHI was compromised. However, if you contact the facility to which the information was erroneously faxed and the staff reports the document was not received, there is a chance the PHI is compromised.
The three exemptions to a breach established by the HITECH Act, designed to allow for good-faith company disclosures, are still in play under the final rule and are as follows: • The acquisition, access, or use of PHI by any workforce member or person acting under the authority of a covered entity or business associate, if such acquisition, access, or use was made in good faith and within the scope of authority, and does not result in further use or disclosure in a manner not permitted by the privacy rule. An example: In the daily course of business, your biller needs the file for Jane Smith, but instead pulls the file for Jane Smyth. Once the biller realizes the mistake, she places the file back and doesn’t discuss Jane Smyth’s file. There was no breach because the file was accessed during routine work under the biller’s authority, and it didn’t result in any further uses or disclosures. • The disclosure of PHI by an individual otherwise authorized to access PHI at a facility operated by a covered entity or business associate to another person at the same covered entity or business associate, or at an organized healthcare arrangement in which the covered entity participates, and information received as a result of such disclosure is not further used or disclosed under the privacy rule. An example: Your billing company, with whom you have a BA agreement, sent you an explanation of benefits for a patient who is not yours, or you fax a detailed prescription to the wrong physician. Once you realize what has occurred, you correct the action, and the PHI is not disclosed or used any further. In both cases, there is not a breach because all parties involved were authorized to view the PHI, and are bound by HIPAA not to disclose or use the PHI. • A disclosure where a covered entity or business associate has a good
Reimbursement Page
faith belief that an unauthorized person to whom PHI is disclosed would not reasonably have been able to retain the information. An example: During a patient visit, your staff places a different patient’s chart in the examining room with the patient. They immediately recognize the mistake and retrieve the wrong chart. This wouldn’t constitute a breach because there is a good-faith belief that the patient didn’t have enough time to review the chart and retain any information. The burden of proof is on you to demonstrate that a breach occurred or didn’t occur and that a notification is or is not required. The individual who conducts the breach investigation must thoroughly document findings and ensure that all results are fact-based. When in doubt as to whether a breach has occurred, or if the PHI has been comprised, or if one of the exemptions applies, contact your attorney. Remember the risk analysis should be done as soon as you learn of a breach, or believe that a breach may have occurred. You must notify patients of a breach in a timely manner (within 60 days). You may choose not to conduct a risk analysis to determine the probability that the PHI has been compromised; however, if you choose not to conduct the risk assessment, it is assumed a breach occurred and you must notify the patient or patients. a
Editor’s Note: Look for more information concerning how the Omnibus Rule affects patients’ rights to privacy and how the rule will be enforced in next month’s Reimbursement Page article; see the May issue of the O&P Almanac.
Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.
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To Brace or Not to Brace
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COVER STORY By CHRISTINE UMBRELL
Orthotic treatment for muscular dystrophy remains an important factor in the patient-care equation
O
rthotists who treat muscular dystrophy patients are special practitioners. Those who understand the disease and who advocate on behalf of their patients to ensure the proper orthotic treatment plan can help their patients stay ambulatory for as long as possible—which can mean a longer lifespan and greater quality of life. However, as treatments have become more advanced in recent years, the role of the orthotist has become less clear. Muscular dystrophy patients suffer from a degenerative muscle disease affecting primarily boys. Those with Duchenne muscular dystrophy (DMD), the most common form of the disease, lack a protein called dystrophin, which helps keep muscle cells intact. In the United States, DMD affects approximately 1 in 3,500 live male births each year. Boys with DMD may notice symptoms as young as age 2 or 3 and experience muscle weakness progressively in the hips, pelvic area, thighs, and shoulders, and later the skeletal muscles in the arms, legs, and trunk. Until recently, these boys did not survive much beyond their teen years. However, recent advances in cardiac and respiratory care, in addition to steroid treatments, have led to a rising life expectancy; survival into the late 20s and beyond is becoming more common. Most DMD patients are treated at muscular dystrophy clinics throughout the country. These clinics host teams of specialists, which can include neurologists, cardiologists, dieticians, social workers, physical therapists, and others. Some of these teams include orthotists on staff; others refer out when the team recommends orthotic intervention. Orthotists provide critical services to DMD patients as braces help to keep tendons and muscles stretched, avoiding painful contractures, in addition to assisting patients in ambulation. But it’s a tough job: Not only does the orthotist need to help determine the bracing regimen best-suited for the patient; he or she must do so in conjunction with the treatment plan devised by the entire team and the patient’s parents.
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The Orthotic Variable Over the past 10 to 15 years, steroids such as prednisone and other drugs in the corticosteroid family have become standard treatment for DMD. These drugs slow the decline of muscle function and prolong walking ability for an additional two to five years. As a result, more young people are living longer and making the transition to adulthood, surviving into their late 20s or early 30s. “Treatment for Duchenne has changed quite a bit,” says Gene Bernardoni, CO, president of Ballert Orthopedic and part of several muscle dystrophy Gene Bernardoni, clinical teams in CO the Chicago area. Before steroid treatment became widely accepted, Bernardoni helped develop several orthotic treatment protocols for Duchenne patients. Ten or 15 years ago, a typical DMD protocol might have involved a supra-malleolar orthosis, followed by a floor-reaction AFO (such as a tone-balancing orthosis), followed by a KAFO, followed by wheelchair use, according to Bernardoni. “It was felt that keeping the patients up and walking would be of benefit, and prevent scoliosis and early deterioration,” explains Bernardoni. Because steroids have significantly improved the lives of DMD patients by delaying onset of some symptoms, allowing more ambulatory years and even longer life spans, orthotic intervention has become less necessary during certain stages of treatment, and daytime bracing has become much less common. Still, orthotists remain a necessary part of the medical team, says Bernardoni. “Even a DMD child on a steroid will eventually get weaker and go through the same progression of weakness of gluts and toe-walking, and could benefit from orthoses,” he explains.
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A variety of ankle-foot orthoses.
Night-Time AFOs These days, the first braces many Duchenne patients use are AFOs intended for use while they’re sleeping. According to the official website of Parent Project Muscular Dystrophy, one of the largest nonprofit U.S. organizations dedicated to DMD, “the use of night splints (AFOs) is highly recommended. A research study from Sweden has indicated that regular stretching in conjunction with the use of orthotics is one of the best ways to reduce the development of contractures.” Karl Barner, CPO, LPO, site leader and residency director at Children’s Healthcare of Atlanta, is an advocate as well: “Night-time is Karl Barner, CPO, a great time to LPO improve range of motion.” He believes night-time splinting is important from the earliest diagnosis. In addition to providing “more of a stretch” in patients who are not moving, the devices “help kids learn to tolerate wearing braces,” says Barner. “Our main goal is to keep up range of motion in the ankles.”
Finding the right AFO solution requires working closely with the patient. “You can kind of feel in a patient what kind of Mike Traub, CP, contractures they BOCO, LP have, and what kind of brace is best,” says Mike Traub, CP, BOCO, LP, a practitioner with Preferred Orthotic & Prosthetic Services in Tacoma, Washington, who also works in the Children’s Therapy Unit at Good Samaritan Hospital in Puyallup, Washington. “There can be, right at the joint, a muscle hardening— a contracture,” says Traub. “You look at how their weight line goes through their foot, you feel the contractures, and measure ranges.” Bernardoni also fits Duchenne patients with night-time AFOs, and has even developed leather-lined braces designed for comfort that have a sole in case patients need to walk to the bathroom in the middle of the night. But he believes night-time bracing only has value if it is coupled with daytime stretching. “Without physical therapy, there’s no chance of gaining muscle strength,” agrees Traub.
Loss of Ambulation DMD patients who can still walk typically rely strictly on night-time orthoses until ambulation becomes impossible. “Because their weakness is proximal more than distal, if you brace them [during the day], walking potential decreases,” says Barner. “Once they are braced, they [tend to] stop walking.” Though ambulation lasts longer with steroids—boys who previously required a wheelchair by age 11 typically walk for three or more additional years—DMD patients still eventually experience a precipitous loss of strength, which propels some patients straight to a wheelchair in their mid-teens. While there is a point at which KAFOs could be introduced, most treatment plans today bypass a bracing-for-walking stage altogether, according to Bernardoni. For a variety of reasons, KAFOs are no longer considered an option in most protocols for DMD patients before they shift to wheelchairs. For one, the patients have grown older and bigger by the time they can no longer walk unassisted, and it can be difficult to walk in KAFOs. Complicating this, weight gain can be a side effect of steroids. “As kids get bigger—and weaker—they become more chairdependent,” explains Barner. In addition, insurance companies may not cover KAFOs—and the physical therapy that goes along with productive KAFO use—as an intermediary step. “A lot of insurance companies may not pay for a [KAFO] device for a child who is worsening,” explains Barner. “A motorized wheelchair can cost as much as a car—$25,000 or $30,000,” adds Bernardoni. If a Duchenne patient requires a wheelchair for at least part of the day, then insurance often won’t pay for a KAFO in addition to a wheelchair. Despite current trends, some advocate rethinking the treatment progression and delaying wheelchair dependency when possible. Once a
Treating Muscular Dystrophy Patients While working with young patients who have a degenerative disease can be challenging, it also can be rewarding. Traub and Raborn offer these suggestions for connecting with patients: Take it slow. Explain everything you’re doing, and why. Tell your patients what they can expect as well as how orthoses will help them. Get down to their level. You can remove some of the “fear factor” of your treatment plan by appearing less intimidating. “I get down on the floor with my patients,” says Traub. Include the entire team in your treatment discussions. Work closely with the patient’s physical therapist and parents to ensure everyone understands how and why orthoses are an integral part of the process.
patient relies on a wheelchair full-time, the onset of scoliosis becomes imminent and severe contractures of hip and knee flexors, as well as foot and ankle deformities, increase. In addition, patients requiring a wheelchair can experience rapid decline in bowel, kidney, and bladder function. A KAFO stage also might be advantageous because a medical breakthrough for muscular dystrophy can happen at any time, says Bernardoni. “A person who is up and walking and who has the most function is going to be at a greater benefit [should a cure be discovered] than someone who is immediately wheelchair-bound.” For all of these reasons, Bernardoni insists keeping patients upright and walking for as long as possible should
be a goal. “Instead of going directly to the wheelchair, why not use KAFOs for one year before the wheelchair?” Barner agrees that encouraging use of KAFOs before wheelchairs could be beneficial, especially since remaining upright and active can keep a patient’s lungs and intestines functioning better. But Barner says such a treatment protocol can only work if a patient’s entire “team” is on board with the idea. The patient’s parents, physician, physical therapist, social worker—and insurance company—all need to work together to make KAFO treatment successful in prolonging ambulation and delaying muscle deterioration. And, perhaps most importantly, the patient has to do the work necessary to walk in KAFOs, which can be a challenge for Duchenne patients.
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Advanced Treatments for DMD on the Horizon While there is no cure for Duchenne muscular dystrophy (DMD), the future holds much promise for decreasing and delaying some of the symptoms associated with the disease. Some of the more promising approaches in clinical studies include these: Exon skipping. Dystrophin, the protein absent in DMD patients, contains 79 exons, but only one or two exons are typically faulty. Exon skipping is a strategy in which antisense oligonucleotides are used to mask the faulty exon(s) so they are ignored during protein production, allowing the creation of partially functional dystrophin. Exon skipping could restore the genetic code for DMD patients, allowing the production of dystrophin commonly seen in Becker muscular dystrophy, a much milder form of the disease. While not a cure, exon skipping could lessen the severe muscle weakness and atrophy of DMD. Clinical trials are ongoing. Microdystrophin gene therapy. Scientists are working on fitting the large dystrophin gene into an abbreviated “microdystrophin gene” to make it possible to deliver to the body. The first successful microdystrophin study with dystrophic dogs was published in the January 15 issue of Molecular Therapy. Led by Dongsheng Duan, a team at the University of Missouri School of Medicine engineered a new microdystrophin gene, placed it into a virus, then injected the virus into dystrophic dogs’ muscles. The new version of microdystrophin was found to reduce inflammation and fibrosis and effectively improve muscle strength. “This is the first time that we have seen positive gene therapy results in large mammals of DMD,” says Duan. “Our next step is to test our strategy in a large group of muscles in the dogs, and then, eventually, see if ‘whole-body therapy’ will work in the dogs. We are still a long way off before we will have a human treatment, but with this finding, I do see a light at the end of this tunnel.” Utrophin modification. Duan and his colleague Yi Lai, PhD, identified a sequence in the dystrophin gene that is essential in helping muscle tissues function, a breakthrough discovery that could lead to treatments for DMD. Duan and Lai have found a way to modify utrophin—a protein all people, including DMD patients, have that is similar to dystrophin—so that it contains the repeaters missing in DMD patients. Duan and Lai have experimented with mice but are planning to test larger animals in the next phase.
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One way to encourage patients to use KAFOs when ambulation becomes difficult is to make sure the orthoses are designed specifically for this patient population, adds Barry Raborn, CO, BOCO, president of Raborn Orthotics in Bellaire, Texas, who works with patients at an MD clinic affiliated with the Baylor College of Medicine. KAFOs for DMD patients “don’t need a lot of bells and whistles,” he says. “They need to be light and easy to use. The devices need to be simple so the patients can trust that they won’t fall.”
Keeping Orthotists in the Equation Even a patient using a wheelchair can benefit from orthotic intervention, says Bernardoni. “Once a child is in a wheelchair, his contractures advance more rapidly—and he can no longer wear regular shoes,” he explains. “He may need an AFO to maintain foot position and for transfers.” Many wheelchair users also require spinal orthoses. Going forward, orthotists should continue to play an important role in the treatment of muscular dystrophy patients. “The orthotist is important because we are experts in biomechanics,” says Bernardoni. Ensuring other clinical team members understand the value of orthotic intervention can enhance the quality of life for these patients, he says. “The orthotist has to take more of an active, leadership role in the clinic.” In addition, more research into the value of orthotic intervention is warranted. “We need to make sure what we’re doing is being done properly,” says Bernardoni. a Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@strattonpublishing.com.
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Experience the Power of One.
By Adam Stone
Help Wanted O&P businesses share tactics for hiring the right staff
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T
odd Stone, CPO, has no problem finding applicants to fill out his front office staff. If anything, he suffers an embarrassment of riches. “We may get 100 resumes in two days from a little ad in the local paper,” he says. But most of them are not people he can hire. “You see that they switch jobs every two years. I really try to find people who will stay for a lifetime. If they’ve had four jobs in six years, I won’t interview them,” says Stone, CEO and owner of Teter Orthotics & Prosthetics, which employs about 55 people in 19 Michigan offices. Stone has had similar experiences in the clinical and fabrication realms. It isn’t hard to find people, but it’s hard to find the right people. For a variety of reasons, making a match in O&P can prove especially challenging. But practitioners nationwide have found a range of ways to get their staffing needs met.
Rewards of Residencies At Scheck & Siress of Chicago, Residency Director Jason Wening, CPO, LPO, FAAOP, looks to graduate trainees to keep 45 clinical staff positions filled. The American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) requires aspiring clinicians to put in a year’s residency in orthotics and another in prosthetics. This gives Wening a chance both to train up-and-coming O&P professionals, and to assess their potential as future employees. Scheck & Siress typically takes on half a dozen residents at a time, and ends up hiring two thirds of those, depending on the number of vacancies. The residency landscape has changed in recent years, with a broader applicant pool emerging. In the past, bachelor’s degree and certification candidates tended to come from Wening’s local area, largely from Northwestern University. With the rise of the master’s degree, applicants have been coming from further afield.
Tips for Successful Searching The costs to recruit and onboard one new employee range between $4,000 and $40,000, according to the Human Capital Institute (HCI), a global talent management association. That puts a premium on getting new hires right the first time. To do so, HCI recommends the following: • Look beyond skills. Focus a job description on specific job tasks and personality characteristics. • Use current high performers as a guide. What skills and traits do they bring? They may be a template for new hires. • Quantify the process. Look for objective assessment tools to take some of the guesswork out of hiring.
Having moved once to attend grad school, students seem more ready to move again for a residency. Residents have proved a valuable pipeline for Marty Ryan, CP, FAAOP, general manager of clinical operations for Actra, which along with sister company Wisconsin Prosthetics and Orthotics operates 10 locations. “It’s a wonderful way to develop somebody when they have just been introduced to the field. They learn your team, they learn your systems, and they know the way your organization operates,” he says. “It’s a great way to bring somebody in and have them advance to leadership positions.” If residencies are a powerful means of recruiting on the clinical side, there’s no better place to look for fabricators than in … an auto body shop.
Manual Skills When it comes to O&P fabrication, “it can be a real challenge to find somebody with this specific experience,” says Tom Johnson, human resource manager for Fillauer in Chattanooga, Tennessee. Rather than seek out those who have worked in the field before—since these are few and far between—“we look for people with experience working with their hands, working with tools. We like people
from the automotive industry who have done auto body work.” In fact, manual dexterity rates high among traits O&P operators seek in fabrication hires, especially in regions where sparse population tends to make for slim pickings among a potential workforce. “It’s not like you can find somebody local who just knows how to do this. So we look for people who were carpenters, electricians, and we train from there,” says John Ficociello, CPO, president of Yankee Medical, a 40-person enterprise in Burlington, Vermont, whose ranks include 15 fabricators. “We start them off on the basics, simple mold filling, and then train them further as they progress.” Past experience with tools may not guarantee a win: Some trainees never get the knack. On the other hand, formal training is no assurance either, says David Sisson, CP, of Sisson Mobility in Madison, Wisconsin. “I’ve worked with folks who couldn’t make a rivet work. Straps routinely fall off, or the trim lines defy the laws of physics. And these have been people who were board certified,” he says. “It’s like saying someone with a college degree automatically has a certain level of intelligence. It’s just not necessarily true.” APRIL 2013 O&P Almanac
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Questions Worth Asking The American Medical Association suggests posing these probing questions to help hiring managers decide whether a candidate is a good fit: • What are examples of times you have shown compassion? • What has been your role in team projects? • How have you handled a challenging patient? • For what kind of practice do you want to work? • How do you manage your time?
Economic Impact On the administrative side, most O&P leaders agree that the basic skills can be taught. And while the economic crunch has helped put more job-seekers into the pipeline, it also has created new complications. “The bigger candidate pool definitely helps,” says Johnson, who has seen no shortage of potential employees when he has advertised a position. “Sometimes it becomes unmanageable. We’ve advertised for an office position and I’ve gotten 185 resumes. But I will read through each and every resume and try to pick out 10 or 20 that seem to have the qualifications. Then I’ll bring them in for the managers to interview.” Having gotten that far, some find that the economic realities of the day can derail what would otherwise be a promising hire, among either administrative or clinical staff. Stone, for instance, typically draws experienced clinicians either from ads in the trade journals, or from among his residents. That’s all well and good, and he’s had success finding people who seem to fit—and who are willing to re-locate to join the team. The problem comes when he makes the offer. “I’ve had several really good prospects, we’ve gotten far enough to discuss salaries, and then they go to
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sell their houses and they find they are so far upside-down on their mortgage, they can’t move. That’s happened three times in the past year,” he says. “They can’t move, and I can’t write a check for $150,000 to get somebody out of a mortgage.”
Successful Strategies So there are some sticking points to recruiting these days: Too many resumes to read, too few people with specific manual skills, a housing market that takes strong players out of the game. All this begs the question, what works? On the clinical side, Ryan has his best success when he taps the pool of O&P veterans. “We see people who may have owned their own business for a number of years and have decided they would like to spend the balance of their careers treating patients [rather] than running operations,” he says. “Sometimes with all
of the administrative burden, it just starts to make more sense to them to be involved with an organization that can handle all the billing and regulatory issues, so they can go home and have a family, have a life.” For his admin team, Ryan draws from temp agencies, bringing them on as contract workers and developing the best into full-timers. “You do have to look at the cost,” he says. “On the one hand with a temp agency you see the initial invoice for the buy-out and you just think about that. But on the other hand, there is a cost to hiring blind, investing, and then not having it work out.” Stone knows just where to look for capable front-office staff: the food service industry. “I’ve gone into local restaurants, found the one waiter or waitress doing 60 percent of the work with a smile on [his or her] face, and offered [that individual] a job. It’s hard to teach somebody to have a good work ethic and be able to multitask.” Sometimes it helps, too, to take a cue from others in specialized medical fields. Take, for instance, NovaSom in Glen Burnie, Maryland, a firm devoted to treating sleep disorders. Much like O&P, the firm is challenged to hire for a niche market. HR Director Shawn S. Talley says one solution is to hire all the time. “Your specialty jobs should always be posted, whether you have a current opening or not,” Talley says. “Think pipeline, here. When your opening does occur, you will have a pool to source from as opposed to starting from scratch.”
Thanks to a variety of factors (take your pick), medical front-liners across the board are faced with the challenge of paperwork, be it Medicare forms or insurance company filings. For O&P offices looking to fill in their front lines, this can raise a substantial hurdle. “We can hire office people, but the intricacies of billing for the different insurance agencies—no one comes in knowing that,” Ficociello says. “For Medicare alone, the manual is gigantic. So we can’t really hire someone who knows medical billing or even the kind of information gathering that we need.” The answer, obviously, lies in training. But even before training, Ficociello says, his best success comes from hiring for personality. He needs people who can take rejection. “When you are in medical billing, you are almost destined for failure. Every time you send a bill out, the insurance companies want to reject it. You have to have resilience,” he says. Personality likewise becomes an issue in dealing with the clientele. O&P patients may be distressed about their present position, and that can generate heat in the waiting room. “We need employees who can accept that these people aren’t angry at them. They are angry at their disability,” Ficociello says. Empathy rates high on Ryan’s wish list, too. “We are a very unique profession and if you do not have an understanding of that client coming through the front door, then you probably are not a good fit for us,” he says. “That’s the first thing we talk about with anyone who we are interviewing: ‘This is what we do. Are you comfortable with it?’” On the clinical side, meanwhile, a hands-on test can make or break a candidate. Ryan still remembers his first job interview coming out of school, being asked to build a prosthesis in a day. “They wanted to be sure I could do what I said I was able to do,” he says. Today he takes a similar approach, asking a candidate to work by his
side for a day as part of the interview. “That can tell you a lot. You’ll see the body language. You can assess where they are at, at a clinical level. That makes a difference, especially if all you know about them up to that point is what’s on their resume,” he says. At the end of the day, there’s no sure bet. Trade-journal ads can deliver a degree of clinical experience. Face-to-face interviews can put personalities on display. Ultimately, though,
you sometimes just have to go with your gut. “They can look great on paper and you can bring them in, and in six months you realize it’s never going to work out,” Johnson says. “It’s an art to hire somebody.” a
Adam Stone is a contributing writer for O&P Almanac. Reach him at adam. stone@newsroom42.com.
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Facility Spotlight By Deborah Conn
Mike Hogan, CPO, LPO, assists an above-knee patient in walking with his prosthesis outside a rehab center.
The Comforts of Home A mobile O&P business in Florida serves patients for whom traveling is a challenge
M
Facility:
Hogan Prosthetics & Orthotics
Location: Orlando, FL
Owner:
Mike Hogan, CPO, LPO
HISTORY:
2 years in business
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ike Hogan, CPO, LPO, realized he had a winning formula in 1989 when, a few years out of the military, he started his first mobile business repairing furniture. The income from that venture helped support his return to school to learn prosthetics and orthotics. In 1994, Hogan and his wife, Barbara, launched their first O&P business, Mobile Prosthetics & Orthotics Inc. Since then, he has established and sold two other mobile O&P ventures, and in 2011, he and his wife created Hogan Prosthetics and Orthotics in Orlando. Although Hogan P&O maintains a fully equipped facility in Orlando, Hogan sees only two or three patients a year there. The rest of the time, he travels throughout a roughly 100-mile radius of the city, fitting patients in their homes, in nursing homes, and in long-term-care facilities. He sees roughly two-thirds orthotics patients and a third prosthetics. Although the vast majority of his patients are elderly, he also works with a growing number of pediatric patients with cerebral palsy through a clinic in Lake Mary, Florida. “I decided long ago not to compete head to head with the wellestablished companies who sit in their offices and wait for the patients to come to them. I knew that there was a vast underserved niche of folks who found traveling to a fixed facility difficult, if not impossible,� says Hogan.
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Hogan’s vehicle is equipped with supplies to make simple modifications and do casting when visiting patients.
He charges nothing additional for house calls. “We survive by keeping the business lean and mean,” he says. With the exception of Barbara Hogan, who runs the office, Hogan outsources every other aspect of his operation to fellow entrepreneurs, including prosthetic/orthotic central fabrication and a bookkeeper. “The relationship is very different from that of employer and employee,” he notes. “I’m not a boss, I’m a customer. They know I can go somewhere else if I’m not satisfied.”
Facility Spotlight
thing to walk up a set of parallel bars in the clinic, but quite another when the patient lives in a double-wide trailer in the middle of a horse pasture!” he says. Hogan markets himself to home health agencies, nursing homes, and physical and occupational therapists. He will meet with a prospective patient and then write a letter to the doctor citing his credentials and making recommendations. Hogan says he succeeds in obtaining a prescription 99 percent of the time. After launching four O&P businesses, Hogan is well versed in the process and consults with budding mobile business owners. The requirements have become more onerous with each startup, though, and Hogan is content to have Hogan P&O as his final company. He is convinced that mobile O&P is a growth area and, as more practitioners take to the road, he’d like to see the development of accreditation requirements for in-home services. “It involves a whole other skill set than office accreditation,” he says. “I’d like to propose this at a national meeting and see if we can’t come up with some standards.” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@cox.net.
Hogan scans a patient for a new below-knee prosthesis at the patient’s home.
In 2010, he studied with Alan Finnieston, CPO, LPO, who developed the BioSculptor CAD/CAM digital scanning system, which Hogan incorporated into his new practice. “I learned that you don’t want to fabricate on the road,” he says. “As long as I do my job in getting scans and measurements, when I get a device back from my tech, there are few or no modifications required.” Hogan carries with him some basic tools—a drill, heat gun, hand tools, casting materials—just enough to allow him to make modifications or do some casting, when required. Hogan finds that he gets to know his patients much better by treating them at home. He is able to meet and get information from family members, observe the patient’s environment, and suggest appropriate modifications. “It’s one
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AOPA HEADLINES
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AOPA WORKING FOR YOU
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O&P Goes Global
Behind the scenes at the first-ever O&P World Congress
F
ive years ago, AOPA first tested the waters on whether support existed in other countries for an O&P World Congress to be held in the western hemisphere that could offer some of the same global impact and excitement enjoyed by the annual Leipzig, Germany, event. That event is jointly sponsored by the German Association of Orthopaedic Technology and its subsidiaries con.fair.med and Leipziger Messe. Those initial feelers not only confirmed a need but also drew enough enthusiastic support that AOPA is expanding its annual National Assembly into an O&P World Congress this year, which is scheduled for Sept. 18-21, 2013, at the spectacular Gaylord Palms Resort and Convention Center in Orlando, Florida. Further evidence of global enthusiasm for this event emerged as the initial planning committee met this past October, assembling representatives from 10 countries around the globe. Leading the effort as chair of the World Congress Planning Committee is David A. Boone, CP, PhD, MPH, Orthocare Innovations LLC. Since October, five planning committee conference calls have further shaped the event
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O&P Almanac APRIL 2013
and high-level speakers for plenary sessions already have been confirmed. They include these esteemed O&P professionals: • Professor Yoshiyuki Sankai—currently serves as professor of the Graduate School of Systems & Information Engineering at the University of Tsukuba, and president and CEO of CYBERDYNE Inc. He is the inventor, creator, and driving force behind the advanced robotics Robot Suit HAL® (Hybrid Assistive Limb®), various cybernetics, medical, care and welfare technologies. • Heinz Trebbin, CPO, MSc—has been working in developing countries since his first experience in Tanzania in 1985. His area of expertise is the education of ortho-prosthetists and the clinical rehabilitation of people with disabilities. He gained experience with emergency aid projects through a three-year assignment with the ICRC. He has developed extensive experience in the planning, implementation, and evaluation of sustainable rehabilitation and education projects. He is currently working as an independent consultant and as a manger for DOI ortho-innovativ.
AOPA WORKING FOR YOU
• Jan Geertzen, MD— immediate past president of International Society of Prosthetics and Orthotics. Geertzen will speak on skin problems with prosthetics and orthotics and latest treatments, a key topic identified by the organizing committee. • Roy D. Bloebaum, PhD—research scientist and co-director of the VA Bone and Joint Research Lab at the Department of Veterans Affairs Salt Lake City Health Care System. Bloebaum’s publications include 113 peer reviewed manuscripts on bone and total joint replacement related topics, and he has been a guest lecturer on those topics all over the world. • Andrew Hansen, PhD—director of the Minneapolis VA Rehab Engineering Research Program and associate professor at the University of Minnesota. Hansen is an internationally recognized expert in ankle-foot prosthetics. His team is actively developing rehabilitation technologies and performing research studies to evaluate effects of medical devices on user performance. • Dan Berschinski—combat-wounded double amputee and retired Army captain. He recently founded and serves as president of Two-Six Industries LLC, a service-disabled veteran-owned small business. He also serves on the Board of Directors for the Amputee Coalition. That roster of exceptional speakers is only the beginning. With the deep roots of the planning committee’s global knowledge and contacts, the line up of clinical and O&P management expertise promises to be unprecedented. Supplementary education content planned by the event’s co-sponsors will assure attendees of 30 percent more education options. As of late December, co-sponsors include the United States Member Society of the International Society of Prosthetics and Orthotics (USISPO), the Amputee Coalition (AC), Canadian Association of Prosthetics &
Orthotics (CAPO), Uniendo Fronteras, Mexico Member Society of the International Society of Prosthetics & Orthotics, and con.fair.med (sponsors of the Leipzig Education Congress). The supplier community has already grasped that the O&P World Congress will provide an excellent opportunity to promote their brands and products to a global audience in Orlando. Several exhibitors have significantly expanded their presence on the trade show floor: one firm has doubled its booth space reservation and exhibit space reservations are running more than 25 percent ahead of last year at this time. You can see from the floor plan the vast expanse of exhibit space already reserved in the largest hall AOPA has ever staged an exhibition. Supplier members also are being called upon to help build our global audience attendance by sponsoring travel costs for prominent O&P practitioners and promising young professionals from developing countries. Pavilions are already designated for Latin America, Germany, Spain, the Netherlands, Italy, France, Turkey, and the United Kingdom—new exhibitors who have never before been part of the AOPA meeting. AOPA has engaged a world-class trade show marketer to sign up the individual pavilion exhibitors. Getting the word out about the O&P World Congress will be an ongoing challenge, but AOPA is gearing up a massive communications program that involves all the social network opportunities; traditional tools like the AOPA SmartBrief, quarterly staff reports, and the O&P Almanac also
AOPA HEADLINES
will be used, along with arrangements with a network of global agencies specializing in moving their citizens to global trade show venues. One of the most important communications components is the building of relationships with all of the national O&P organizations around the world who will help AOPA spread the word about this unique western hemisphere O&P spectacular. AOPA members are noted for their philanthropic attitude in providing needed O&P services around the world. The outpouring of U.S. practitioner time and energy in the wake of the 2010 earthquake in Haiti is a recent example. Such good works have developed many friendships around the world. Please encourage your colleagues all across the globe to attend the 2013 World Congress. It can be a wonderful professional growing and enriching experience for all. Your help is most appreciated. All of the progress to date is due to AOPA’s Board having the foresight to launch the 2013 World Congress in place of what would have been the National Assembly over the September 18-21 dates in Orlando, and the exceptional contributions of the World Congress Planning Committee. Hats off to Chair David A. Boone, CP, PhD, MPH, Orthocare Innovations LLC, and the planning committee consisting of the following: • Lisa Arbogast, WillowWood, USA • Jon Batzdorff, CPO, USISPO Vice Chairman and Latin American Consultant, Prosthetika, USA • Frank H. Bostock, CO, FAAOP, Hanger Clinic, USA APRIL 2013 O&P Almanac
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AOPA HEADLINES
AOPA WORKING FOR YOU
Exhibit Hall Floor Plan
• Bernhard Budaker, Dr.-ING, Representative for German Association/Confair and Deputy Head of Department and Group Manager Fraunhofer Institute for Manufacturing Engineering and Automation, Stuttgart, Germany • James H. Campbell, PhD, CO, Becker Orthopedic, USA • Andrea Giovanni Cutti, Meng, PhD, INAIL Prostheses Centre, Italy • Thomas V. DiBello, CO, LO, FAAOP, AOPA Immediate Past President, Member of Hanger Inc. Board,/ Dynamic Orthotics & Prosthetics, USA • Dianne Farabi, Staff USISPO, USISPO, USA • Mark Geil, PhD, Associate Professor, Department of Kinesiology and Health, Georgia State University, USA • Ritu Ghosh, BPO, Deputy Director –Training, Mobility India, Bangalore, India • Jose Miguel Gomez, MD, LO, Gomez Orthotic Systems, Bogota, Columbia • Thomas Kirk, PhD, AOPA President, Member of Hanger Inc. Board, USA • Robert S. Kistenberg, MPH, CP, LP, FAAOP, Chair USISPO, Co-Director 32
O&P Almanac APRIL 2013
•
• •
• • •
• •
•
and Coordinator of Prosthetics MSPO Program, Georgia Institute of Technology, USA Geza Kogler, CO, LO, PhD, L.Ped, MSPO, LOcularist, Coordinator of Research, Instructor of Orthotics MSPO Program, Georgia Institute of Technology, USA Kathy Kostycz, CAPO Association Manager, Winnipeg, MB Aaron Leung, PhD, MD, Associate Professor, Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong Karen Lundquist, MBC, Ottobock, USA/Germany Brad Mattear, CPA, CFo, Cascade Orthopedic Supply, Inc., USA Masse Niang, CPO, President, African Federation of Orthopaedic Technicians, Burkina Faso, Africa Stephanie Olivo, Euro International, USA Michael Orendurff, PhD, Senior Scientist, Director, Biomechanics Laboratory, Orthocare Innovations LLC, USA Marlo Ortiz Vazquez del Mercado, P.O, Ortiz International S.A., Guadalajara, Jalisco México
• Karen Peters, Ottobock, USA/ Germany • Klaas Postema, MD, PhD, Professor, University Medical Center Groningen, Netherlands • Anthony Potter, Director, Product Marketing, Hanger Clinic, USA • Nerrolyn Ramstrand, PhD, Associate Professor in Prosthetics and Orthotics, School of Health Sciences, Jonkoping University, Jonkoping, Sweden • Urs Schneider, MD, PhD, Representative for German Association/Confair, Head of Department Orthopaedics & Systems in Motion, Fraunhofer Institute for Manufacturing Engineering and Automation, Stuttgart, Germany • Jack E. Uellendahl, CPO, Hanger Clinic, USA • Jason Douglas Wening, MS, CPO, FAAOP, Scheck & Siress Orthotics and Prosthetics, USA • Linda Wise, WillowWood, USA. Watch this space for more updates on this historic O&P World Congress event coming soon!
AOPA HEADLINES
Handling Adversity: Coping With Difficult Patients– Join the Audio Conference April 10 Ever have difficulty communicating with a patient’s dispute or disapproval? Join AOPA on April 10 for an AOPAversity Mastering Medicare Audio Conference that will focus on learning how to handle patient complaints, and why it’s an important part of your business operation. The following topics will be covered: • How to handle patient complaints. • How to communicate with difficult patients. • What makes a patient difficult. • How to discharge a patient from your care.
AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.
Navigate the Maze: Get to Know the Appeals Process—Join the Audio Conference May 8 What type of information should and should not be included in an appeal? Join AOPA on May 8 for an AOPAversity Mastering Medicare Audio Conference that will focus on navigating the curves of the appeals process, and explain why it’s an important part of your business operation. An AOPA expert will address the following issues during the audio conference: • The five levels of appeals • Helpful hints on filing appeals • Strategies to achieve a successful appeal • Evaluating the necessary information to include in an appeal. AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing
education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.
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AOPA HEADLINES
Social Media and Your O&P Practice Getting started in social media can be a scary adventure for O&P business owners who aren’t sure where to start. AOPA Content Strategist Steffanie Housman offers these simple steps to ease your practice into this newer form of communication and marketing: 1.
2.
Talk to your patients. Find out where they spend their time when they’re using social media. Do you notice them playing on their phones before their appointments? Do you have a mayor in foursquare? Conducting a little research before you jump in will save you time and frustration. Pick one social media venue—just one—and join in. It may be Facebook, Twitter, Pinterest, foursquare, Google+, or something new. It’s best to do one thing well, rather than do 10 things poorly. Once you’re up and running, connect with your patients—and ask your patients to connect with you.
www.savewithups.com/aopa
3. Connect with other O&P practices that use the social media venue you have chosen. You never know if a patient in Arkansas will stumble upon your practice in Indiana—you may be able to help that individual connect with your social media colleagues in Indiana.
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O&P Almanac APRIL 2013
Connecting online with other practices can be mutually beneficial. 4.
Remember social media is just another way of communicating. Make friends in different areas, and share ideas. You don’t necessarily have to discuss O&P all of the time, but make sure you decide on your “voice.” It’s okay to share about the awesome achievements and milestones your patients are accomplishing, product advancements, and healthy recipes you just tried out. Have an office pet? Post pictures; everyone loves animals.
5. Once you master one platform and feel comfortable with it, start expanding to other social media venues. People want to see the personality of your facility and your staff. Ultimately, a human connection is what they are after—and you can share that online.
UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air®
al i c e Sp s! ng savi
All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy!
Mastering Medicare: AOPA’s Essential Coding & Billing Techniques Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. AOPA will be offering the seminar twice this spring. The first will take place April 8-9, 2013, at the Hyatt Regency Columbus in Columbus, Ohio. Register online at www.bit.ly/AOPAcol, or contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854. The second takes place June 13-14 at the Renaissance Phoenix Downtown Hotel in Phoenix. Register online at www.bit.ly/AOPApho, or contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854.
ARIZONA
OHIO
Join your colleagues at the “Mastering Medicare: AOPA’s Essential Coding & Billing Techniques” seminar this spring. AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group.
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steffanie Housman at shousman@ AOPAnet.org or 571/431-0835 with social media and content questions.
Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •
Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.
• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways.
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AOPA HEADLINES
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis. AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management.
Discover Employment Opportunities at AOPA’s Online Career Center As an O&P professional, you can make a difference every day. Job opportunities abound throughout the country, and the need for O&P professionals is increasing rapidly. Currently, 100 percent of O&P program graduates find employment, and most choose to make it a lifelong profession. If you’re seeking employment, access the most recent jobs available. If you’re recruiting, reach the most qualified candidates by posting your job on AOPA’s Online Career Center. Visit http://jobs.AOPAnet.org, or email Stephen Custer at scuster@ AOPAnet.org with questions.
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• Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCode-Search.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.
24/7
Now Available: 2013 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of O&P business in laws, regulation, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the online 2013 AOPA Products & Services Catalogue, available at www.bit.ly/ AOPA2013productcatalog.
IN G
SHAPE STRAPS PADDING SOFTSHELL PRODUCT SIZE
Visit www.allardusa.com for brochure about all the NEW products!
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AOPA HEADLINES
O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • • •
Maynard Carkhuff William Leimkuehler, CPO Brad Mattear, MA, CFo Ronald Pawlowski, CPO
The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org. *Due to publishing deadlines this list was created on Feb. 27, 2013, and includes only donations received between Feb. 4, 2013, and Feb. 27, 2013. Any donations received or made after Feb. 27, 2013, will be published in the next issue of O&P Almanac.
SEPTEMBER 18-21, 2013
Why you should plan to attend:
ORLANDO, FLORIDA, USA
•
Research and development expenditures in the United States are more than $95 billion, making the United States the leader in medical innovation and creating the ideal location for a unique gathering of high visibility and importance.
Don’t miss the opportunity to participate in an expanded National Assembly in 2013 as AOPA and partners from around the world work to create an O&P World Congress experience for practitioners in the Western Hemisphere and around the world.
•
Superior Clinical Education featuring the best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners.
•
Practical learning and live demonstrations.
•
Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy.
•
Networking with an elite and influential group of professionals.
•
Ideal U.S. location chosen for travel ease and popularity.
Gaylord Palms Resort & Convention Center
Expand your knowledge, grow your market presence and advance your career at this unique, global gathering of high visibility and importance. For more information, contact us at worldcongress@AOPAnet.org or visit www.opworldcongressusa.org.
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Marketplace
WillowWood Custom Liners
The new Triton family of feet from Ottobock
Clinicians may provide patients who have unique or hard-to-fit residual limbs with a comfortable option with the Alpha DESIGN® Liner. A DESIGN Liner is a custom Alpha Liner featuring a tailored gel pattern created by a clinician. WillowWood’s Alpha DESIGN Liners offer extensive customization options: choice of gel type, control of gel placement and thickness, choice of fabric, and choice of upper-extremity, transtibial, or transfemoral application. In addition, clinicians may create these custom liners via OMEGA® software or by cast with order form. Have questions or want more information? Call 800/8484930 or visit www.willowwoodco.com.
Comfort, security, reliability! Now your patients have more options to meet the demands of their active lifestyle. The Triton Low Profile (LP) and the Triton Heavy Duty (HD) are especially robust and waterproof, ready for the most challenging conditions. Or, choose the lightweight Triton carbon fiber foot; the Triton Vertical Shock (VS); or the Triton Harmony® with integrated vacuum technology for outstanding flexibility and support. Contact your sales representative at 800/328-4058 or visit www.ottobockus.com.
Orthomerica A-Flex™ Protective Headgear from PEL Supply
Try it! The NEW 3S80 Fitness Knee from Ottobock
New A-Flex™ Protective Headgear from Orthomerica is constructed of flexible plastic that readily conforms to a variety of head shapes, allowing the user an easy fit and making it a more readily adjustable alternative to other head protection devices. Equipped with easy-to-adjust straps, A-Flex™ Headgear performs like a shock absorber when confronted with low impact forces, by preventing cracks and penetration across the surface, thus eliminating the need for chin straps, which are available. Lateral straps and side slits are also optional features. A posterior strap “locks” the device below the mastoids accommodating various sizes, while lateral straps provide easy donning and doffing. Ventilation holes reduce trapped heat for added comfort. A-Flex™ Protective Headgear is available in pediatric small to adult 2XL sizes and can be easily trimmed without special tools. For more information on A-Flex™ or any Orthomerica high-quality products, call PEL Supply at 800/321-1264, or email customerservice@pelsupply.com.
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O&P Almanac APRIL 2013
Have your patients experience the 3S80 Fitness Prosthesis—ask for a trial kit, which includes the 3S80 knee, a variety of adapters, and a series of 1E90 feet. The 3S80 Fitness Prosthesis makes it possible for your above-knee patients to get up and moving again, increasing strength and mobility and enhancing overall health. Contact your sales representative to schedule a trial fitting. If you know which products your patients need, simply call our customer service at 800/328-4058, or visit www.ottobockus. com/FitnessKnee.
Marketplace
Total Knee® by Össur®. Totally versatile.
New From College Park— Endo Components
With K2, K3, and K4 models to choose from, Total Knee enables a broad range of amputees to walk with a smooth, more natural, energy-efficient gait, enhancing their confidence and stability. Key features include geometric locking for stability, plus mid-swing shortening designed to prevent hip-hiking and reduce the chances of tripping. Each model fits a wide range of amputees and is lightweight and easy to cosmetically finish. To learn more about Total Knee by Össur, call 800/2336263 or visit www.ossur.com today.
College Park Industries has increased its offerings to include a line of commonly used endoskeletal components. Utilizing knowledge from 25 years of material research and product design, these endo components are carefully engineered for structural integrity and noise abatement. Tested to the highest of quality standards, the components perfectly complement the performance and outcomes College Park prosthetic feet are known for. For more information, call 800/728-7950, or visit www. college-park.com/. a
Patented KISS® Superhero™ Reusable Test Socket Plate The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit www.kiss-suspension. com or call 410/663-KISS for more information.
O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2013 test standards.
Introducing our NEWEST Study Guide in PEDORTHICS
The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics
Now Offering Customizable Orthotic and Prosthetic Patient Device Instruction Sheets in English AND Spanish
Our Products NOW available for IMMEDIATE DOWNLOAD! No need to wait, BEGIN your STUDIES NOW!
www.oandpstudyguide.com APRIL 2013 O&P Almanac
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JOBS
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
& Prosthetic
Association
(AOPA)
DISCOVER more AOPA advertising opportunities.
2013
American Orthotic
mediakit Rates effective
Promoting
O&P Since
Jan. 1, 2013
Call Dean Mather, advertising sales representative, at 856/768-9360 or email dmather@mrvica.com.
1917
et.org
www.AOPAn
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O&P Almanac APRIL 2013
Southeast CO/BOCO or CPO/BOCOP Meridian, Mississippi Methodist Orthotics and Prosthetics, a division of Methodist Rehabilitation Center, is looking for a certified orthotist or certified prosthetist/orthotist for our facility in Meridian, Miss. Located only minutes from the Alabama line, Meridian is a growing town with three major hospitals within ½ mile of our office. Meridian offers many outdoor activities and is only three hours from the Gulf Coast. Ideal candidate should be a self starter with solid fabrication skills who wants professional growth with an exciting orthotics and prosthetics company. Clinical skills in office and hospital environment as well as the ability to function as a team player are vital. Methodist Rehabilitation Center is a progressive orthotics and prosthetics facility with five locations throughout Mississippi and Louisiana. Competitive salary and benefits including 403b retirement with employer matching, continuing education, paid vacation, and more. Please forward resumes in confidence to:
Chris Wallace, CPO, FAAOP Director Department of Orthotics and Prosthetics 1 Layfair Drive, Ste. 300 Jackson, MS 39232 Fax: 601/936-8896 Email: cwallace@mmrcrehab.org
North Central CPO Fort Wayne, Indiana Prevail Prosthetics & Orthotics is looking for a CPO for Northern Indiana. We are a well-established company that has been servicing Northern Indiana for 28 years. We have an opening for a CPO who has experience working with both adult and pediatric populations. If you are looking for a long-term relationship with your patients and work environment and want to work with professionals that desire to make a difference in the lives of people, we would like to talk with you. Please forward your resume to:
Linda Trzynka, Business Manager Prevail Prosthetics & Orthotics 7735 West Jefferson Blvd. Fort Wayne, IN 46804 Email: ltrzynka@prevailpando.com Website: http://prevail1.com
JOBS
Tina Mann
Clinic Manager
“Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic. She was so inspired by her experience that she became an orthotic resident with Hanger Clinic. Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.
View our current positions and apply online at: www.hanger.com/careers or scan the QR code.
Hanger was recently named one of Forbes Best Small Companies in America.
Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.
Available Positions: Clinic Manager San Jose, CA Walnut Creek, CA
Valdosta, GA Morgantown, WV
Orthotist Hammond, IN Cary, NC Sacramento, CA Wichita, KS Richland, WA Grand Rapids, MI Richmond, VA Camp Hill, PA
Fairfield, OH Urbana, IL Jacksonville, FL Beaufort, SC Longview, WA Pensacola, FL Tucson, AZ
Prosthetist / Orthotist Chambersburg, PA Redding, CA Willoughby, OH Holland, MI Johnson City, NY Springfield, IL Amherst, NY
Tamarac, FL Vancouver, WA Williamsport, PA Mayfield Heights, OH Buffalo, NY Wilkes Barre, PA
Prosthetist Waterbury, CT Waterville, ME
Hazel Crest, IL
www.LCodeSearch.com
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Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org.
Log on to LCodeSearch.com and start today. Not an AOPA member? GET CONNECTED
Visit AOPA at www.AOPAnet.org.
Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811. APRIL 2013 O&P Almanac
43
CALENDAR
YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http:// my.bocusa.org. For more information, visit www. bocusa.org or email cert@ bocusa.org. ■
■ On-site Training Motion Control Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fitted immediately. For more information, call 801/326-3434, email info@ UtahArm.com, or visit www. UtahArm.com.
2013 ■ APRIL 8-9 AOPA: Essential Coding & Billing Seminar. Hyatt Regency Columbus. Columbus, OH. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.
■ APRIL 10 AOPAversity Audio Conference–Handling Adversity: Coping With Difficult Patients. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ APRIL 13-15 National Pedorthic Services. Milwaukee. Hands-on Custom Foot Orthosis Fabrication Course. 18.25
ABC CEUs. Contact Nora Holborow at 414/438-6662, email at nholborow@npsfoot. com, or visit www.npsfoot.com. ■ APRIL 16 WillowWood: Intro to OMEGA®, via WebEx, 1:30 PM ET. Potential CAD users have opportunity to investigate OMEGA and find out how the system benefits a growing O&P practice. Credits: TBD. Visit www.willowwoodco.com. ■ APRIL 18 WillowWood: Alpha DESIGN® Liners, via WebEx, 1:30 PM ET. This webinar is the customization of Alpha Liners when off-the-shelf options do not suffice. Session educates attendees on how to use OMEGA software individually or in conjunction with WillowWood staff for creating a custom Alpha® Liner. Credits: 2.5 ABC/ TBD BOC. Visit www. willowwoodco.com.
APRIL 18-19 New York State AAOP: Chapter Meeting. Albany, NY. Albany Marriott. For more information, visit www.nysaaop.org/. ■
■■
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
Member Rate
Nonmember Rate
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 44
O&P Almanac APRIL 2013
■ APRIL 18-20 Texas Association of Orthotists & Prosthetists. Hyatt Regency North Dallas. Richardson, TX. To register, contact TAOP at taopstaff@ gmail.com or visit www.taop.org. ■ APRIL 23-25 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture with OMEGA Scanner. ‘By Measurement’ shape creation and custom liners discussed. Extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/TBD BOC. www.willowwoodco.com.
■ May 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by May 1, 2013, for individuals seeking to take the July 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or July/August CPM exams for orthotists and prosthetists. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/certification. ■ MAY 2 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: 7.0 ABC/TBD BOC. Registration deadline is April 11, 2013. Contact 877/665-5443 or visit www.willowwoodco.com. ■ MAY 3 WillowWood: LimbLogic® Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Course includes basic operation and hands-on fabrication of vacuum sockets. Credits: 8.5 ABC/TBD BOC. Registration deadline is April 11, 2013. Contact 877/665-5443 or visit www.willowwoodco.com. ■ MAY 3-4 2013 Northwest Continuing Education Conference. Bellevue, WA. Hilton Hotel. Visit www.nwaaop.org for more information or contact Julie at 206/948-6239. ■ MAY 5 Asheville, NC. Study gait analysis and evidence, pathology based treatments with orthotic fabrication and taping—while supporting a good cause. Register at footcentriconline.com to earn 8 credits.
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www.orthomerica.com/spectrum • 877-737-8444
CALENDAR
MAY 8 AOPAversity Audio Conference–Navigate the Maze: Get to Know the Appeals Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■
May 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was March 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www. abcop.org/certification. ■
■ MAY 16-18 PA Chapter AAOP Spring Conference. Pittsburgh. Sheraton Station Square Hotel. Contact Beth Cornelius at 814/455-5383 or Joseph Carter Jr. at 814/455-5383.
MAY 16-18 Western Mid-Western Orthotics and Prosthetic Association. WAMOPA Annual Meeting. Reno, NV. Peppermill Resort & Casino. 24 CEU credits with the best value in our industry. Visit www. wamopa.com for program and golf tournament updates, or call Steve Colwell at 206/4401811. ■
■ June 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification.
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O&P Almanac APRIL 2013
■ JUNE 7 National Pedorthic Services. Milwaukee. Contact Nora Holborow at 414/438-6662 or email nholborow@npsfoot.com. Visit www.npsfoot.com for more information. ■ JUNE 12 AOPAversity Audio Conference–Clinical Documentation: The Dos & Don’ts. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
■ JUNE 13-14 AOPA: Essential Coding & Billing Seminar. Phoenix. Renaissance Phoenix Downtown Hotel. To register, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
■ JULY 1 ABC: Application Deadline for Certification Exams. Applications must be received by July 1, 2013, for individuals seeking to take the September 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.
JULY 8-13 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■
■ JULY 10 AOPAversity Audio Conference–Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
JULY 26-27 ABC: Orthotic Clinical Patient Management (CPM) Exam, Georgia Institute of Technology, Atlanta. The application deadline for this exam is May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■
AUGUST 1 ABC: Practitioner Residency Completion Deadline for September Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703-836/7114, email info@abcop.org, or visit www. abcop.org/certification. ■
■ AUGUST 2-3 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. San Antonio. Grand Hyatt on the Riverwalk. Contact Katie Brinkley at 940/243-4198, email secretarytreasurer@txaaop.org, or visit www.txaaop.org. ■ AUGUST 2-3 ABC: Prosthetic Clinical Patient Management (CPM) Exam, Georgia Institute of Technology, Atlanta. The application deadline for this exam is May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.
■ August 14 AOPAversity Audio Conference–Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ SEPTEMBER 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by Sept. 1, 2013, for individuals seeking to take the November 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or December/January CPM exams for orthotists and prosthetists. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification. ■ SEPTEMBER 11 AOPAversity Audio Conference–Read Between the Lines: The Medicare Lower Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■ SEPTEMBER 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is July 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.
CALENDAR
September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org. ■
■ OCTOBER 9 AOPAversity Audio Conference–What’s the Word: A Health-Care Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ November 13 AOPAversity Audio Conference– Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.
■ DECember 11 AOPAversity Audio Conference–What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
2014
2015
■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Halifax, Nova Scotia. Marriott Halifax Harbourfront. Visit www.prostheticsandorthotics.ca/ for more information.
■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.
■ SEPTEMBER 3-6 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.
2016 ■ SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org. a
AD INDEX
Company
Page
Phone
Website
Allard USA Inc.
37
888/678-6548
www.allardusa.com
ALPS
13
800/574-5426
www.easyliner.com
American Board for Certification in Orthotics, Prosthetics & Pedorthics
15
703/836-7114
www.abcop.org
Cailor Fleming Insurance
11
800/796-8495
www.cailorfleming.com
Cascade Dafo
2
800/848-7332
www.cascadedafo.com
College Park Industries Inc.
C4
800/728-7950
www.college-park.com
DAW Industries
1
800/252-2828
www.daw-usa.com
Delcam Healthcare Solutions
27
877/335-2261
www.orthotics-cadcam.com/
Dr. Comfort
5, C3
800/556-5572
www.drcomfortdpm.com
FLO-TECH® O&P Systems Inc.
29
800/356-8324(FLO-TECH)
www.1800flo-tech.com/
Hersco Ortho Labs
7
800/301-8275
www.hersco.com
KISS Technologies LLC
39
410/663-5477
www.kiss-suspension.com
Orthomerica Products
45
800/446-6770
www.orthomerica.com
Orthotic and Prosthetic Study and Review Guide
41
www.oandpstudyguide.com
Össur Americas Inc.
9
800/233-6263
www.ossur.com
Otto Bock HealthCare
C2
800/328-4058
www.ottobockus.com
PEL Supply
23
800/321-1264
www.pelsupply.com
®
APRIL 2013 O&P Almanac
47
AOPA Answers
h t i m S n Joh
Signing on the Dotted Line
Answers to your questions regarding physician documentation signatures
AOPA
receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q.
If the ordering physician signs our notes indicating agreement with our findings and then places these notes in his or her records, would this meet the physician documentation requirements Medicare is currently using to justify payment?
A.
No. The current language in the Medicare medical policies in regard to medical records clearly states that this is not a valid option. The policies read: “Supplierproduced records, even if signed by the ordering physician, and attestation letters (e.g., letters of medical necessity) are deemed not to be part of a medical record for Medicare payment purposes.” Medicare is looking for information that is contained in the patient’s contemporaneous medical record and in the own words/writing of the person entering the information. Despite the fact that the physician’s
48
O&P Almanac APRIL 2013
signature on your notes does not fulfill the physician documentation requirement, you may still continue to request that the ordering physician sign off on your records indicating agreement. Doing so can help you establish the medical necessity of an item or service further in the appeals process.
Q. A.
Are new orders/prescriptions required for repairs?
If a repair requires the replacement of a major component or part, then you should obtain a new order. However, a new prescription is not required for repairs or adjustments as these types of services are covered under the original order for the lifetime of the device. As always, you should document the need for the repair or the adjustment in your records.
Q.
I keep seeing announcements for competitive bidding for DMEPOS items. Are O&P items still exempt from competitive bidding?
A.
At this time, no O&P items are part of the competitive bidding process, either Round I or Round II. In the future rounds of competitive bidding, O&P items could be included; the only O&P items that are legislatively eligible to be included in the competitive bidding program are off-the-shelf orthoses. a
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