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SPECIAL SECTION: 2021 AOPA NATIONAL ASSEMBLY EXHIBITOR PREVIEW P.44 The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2021

Optimizing Business Practices To Increase Profits P.16

Why Cybersecurity Isn’t Optional P.32

Honoring Past and Present O&P Research Pioneers

MEANINGFUL

MEASURES

O&P FACILITIES PRIORITIZE THE COLLECTION OF PATIENT OUTCOMES DATA TO MOVE TOWARD EVIDENCE-BASED PRACTICE P.20

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Join your colleagues for the 2021 National Assembly as we come together safely, in celebration of unity and recovery. who are unable to joinfor us an in ideal JoinThose us September 9-11, 2021,

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Members save over $300 on Assembly Registration. Learn more at www.AOPAnet.org/join. FOLLOW US @AmericanOandP

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combination top-notch education in and part of theofreunion by participating the virtual option 16-18. entertainment at the September 104th AOPA

National Assembly in Boston, MA.

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ADVOCACY | RESEARCH | EDUCATION www.AOPAassembly.org


PUTTING YOUR BEST FOOT FORWARD

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contents

AUG UST 2021 | VOL. 70, NO. 7

COVER STORY

FEATURES

20 | Meaningful Measures The O&P community has reached a tipping point on outcomes measurements, with several facilities formalizing their policies and procedures to ensure they are collecting specific performance-based and patientreported outcomes. Find out how facilities are ramping up their data-gathering efforts, beginning with lower-limb prosthetic patients, to become evidence-based practices, and learn how smaller facilities can participate in this growing trend. By Christine Umbrell

32 |

Managing Cyberthreats

As healthcare companies across the country experience a significant increase in ransomware attempts and other data breaches, O&P facilities must bolster their efforts to both prevent and minimize damage from cyberattacks. Experts discuss the need for protecting personal health information, educating employees, conducting risk assessments, and more. By Michael Coleman

40 |

Celebrating 25 Years of Thranhardt Awards

AOPA will recognize pioneers in O&P research during the Howard R. Thranhardt Award 25th Anniversary Celebration and Luncheon at the AOPA National Assembly in Boston. Past recipients of the Thranhardt Award describe how the lecture series has helped advance research and education within the O&P profession, following in the footsteps of the O&P icon who inspired the award.

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AUGUST 2021 | O&P ALMANAC

PRINCIPAL INVESTIGATOR W. Lee Childers, PhD, CP........................................60 Meet a senior scientist for the Department of Defense/Veterans Affairs’ Extremity Trauma and Amputation Center of Excellence at the Center for the Intrepid, and find out about current research to aid soldiers immediately after injury and during rehabilitation.


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contents

SPECIAL SECTION

DEPARTMENTS Views From AOPA Leadership......... 6

2021 AOPA National Assembly

Reconnect at the National Assembly

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

44 | Rebuild, Reconnect, and Reunite

Numbers...................................................... 10

As O&P stakeholders convene in person for the first time in two years, find out what’s in store for participants and what’s new on the trade show floor.

Research, updates, and industry news

at the Assembly Exhibit Hall

At-a-glance statistics and data

Happenings................................................12

People & Places........................................14 Transitions in the profession

46 | 2021 Title Sponsors Meet the title sponsors of this year’s event, and find out what they expect to experience and share in Boston.

52 | Exhibitor Directory See the full list of international companies exhibiting at the 2021 AOPA National Assembly.

COLUMNS

AOPA News.............................................. 68 Reimbursement Page.......................... 16

Better Business Practices

Expanding revenue opportunities

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

AOPA advocacy, announcements, member benefits, and more

Welcome New Members.................. 69 Professional opportunities

Marketplace............................................. 70 Ad Index...................................................... 78 Careers........................................................ 80

Member Spotlight.................................64 n n

Ortho Pro Associates Inc. Orfit

Calendar..................................................... 82 Upcoming meetings and events

State By State.......................................... 84 Colorado, New York, Tennessee, and Texas

P.64

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VIEWS FROM AOPA LEADERSHIP

Let’s Connect at the 2021 National Assembly

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

B

EING TOGETHER IN PERSON in Boston for the 2021 AOPA National Assembly is going to be energizing as we spend time rebuilding, reconnecting, and reuniting in the hopes of returning to our businesses recharged. Reconnecting is something I am particularly looking forward to at the Assembly. In a normal year, I would have seen many of you at various O&P events and would have had the chance to talk about AOPA and how it is serving you, your patients, and the profession. But this year has been anything but normal. As I have written in several of these Views From AOPA Leadership columns, connection and belonging are critical to the success of AOPA. We have all done our best to connect virtually, but now that we have the opportunity to connect in person, I plan to take full advantage of it—and hope you will, too. The AOPA Board of Directors, Assembly Planning Committee, and staff recognize how important this opportunity to connect is, given the profession hasn’t been together in almost two years. To this end, we’ve planned an Assembly that provides numerous safe opportunities to connect with one another. Here are some of the special events on my agenda: • Women in O&P Luncheon: All women in the profession are invited to join AOPA on Thursday, September 9, from 12:30 to 1:30 p.m. I would love for all females at the Assembly to join me to honor our contributions and advancements to the profession. The program offers women a casual opportunity to network and learn from other successful female professionals, celebrate landmark achievements and leadership, and discuss the future of women in the industry. • Welcome Celebration: The Assembly officially starts with the Welcome to Boston Celebration from 5:30 to 7:30 p.m. on Thursday, September 9, in the Exhibit Hall. You won’t want to miss the fun opening reception, during which you can enjoy refreshments, peruse the Exhibit Hall, and connect with friends and colleagues. • PAC Reception: As a thank you, O&P PAC donors are invited to a private reception to celebrate their advocacy efforts on Friday, September 10, from 6 to 7 p.m. Donors will hear from Washington insider Jane Lucas, who will share her insights into how policy is made based on her previous roles in the administration and Congress and her current role as a lobbyist. • AOPA’s Annual Business Meeting: On Saturday, September 11, join AOPA leadership to hear how AOPA continues to serve its members and the profession as well as to learn about plans for the coming year. This also is an opportunity to celebrate your colleagues as several awards will be given.

I look forward to seeing you during at least one of these events, and throughout the week. And, for those unable to be in Boston, I invite you to join the Assembly virtually. Stay well. Stay safe. Stay kind. Stay strong. Traci Dralle, CFm, is president of AOPA.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION 6

AUGUST 2021 | O&P ALMANAC

Board of Directors OFFICERS President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN President-Elect Dave McGill Össur Americas, Foothill Ranch, CA Vice President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Immediate Past President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary (Nonvoting) Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Baker O&P, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY Linda Wise WillowWood, Mount Sterling, OH James O. Young Jr., LP, CP, FAAOP Amputee Prosthetic Clinic, Tifton, GA Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX


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AOPA CONTACTS

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

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

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

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

REIMBURSEMENT SERVICES

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

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

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 MEETINGS & EDUCATION Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

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AUGUST 2021 | O&P ALMANAC

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2021 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options!


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NUMBERS

Healthcare Facilities Face Ransomware Threats Studies shows independent health or medical clinics, like O&P facilities, are more likely than other types of healthcare entities to be targeted in attacks

59 Percent Percentage of global ransomware incidents in healthcare and public health sector that occurred in United States, January-May 2021

RANSOMWARE PAYMENTS ON THE RISE

Percentage of healthcare organizations whose data was encrypted that paid the ransom to get their data back

10 Incidents California

$131,304

Four incidents

Average ransomware payment for healthcare sector

Texas

$1.27 Million

Average total costs for rectifying a healthcare sector ransomware attack, considering downtime, employee time, device cost, etc.

Three incidents Georgia, Illinois, and Louisiana

Top Five Types of U.S. Healthcare Entities Impacted by Ransomware, January-May 2021

Health or medical clinic Healthcare industry services Hospice or elderly care Hospital Pharmaceutical

Number of incidents 19

3

4

15

2

SOURCE: “Ransomware Trends 2021,” HHS Cybersecurity Program, Office of Information Security, June 3, 2021.

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AUGUST 2021 | O&P ALMANAC

Percentage of U.S. ransomware incidents that resulted in patient data being leaked

U.S. STATES WITH HIGHEST INCIDENTS, JANUARY-MAY 2021

34 Percent

Type of healthcare sector

72 Percent

“Healthcare is more likely to pay the ransom and less likely to backup [systems compared to other U.S. sectors]. Among the healthcare organizations whose data was encrypted, 34 percent paid the ransom compared with a cross-sector average of 32 percent. This may be because healthcare was less able to restore data from backups than almost all other sectors.” —“The State of Ransomware in Healthcare 2021,” Sophos Ltd., May 2021.

SOURCE: Source: “Ransomware Trends 2021,” HHS Cybersecurity Program, Office of Information Security, June 3, 2021; “The State of Ransomware in Healthcare 2021,” Sophos Ltd., May 2021.

U.S. HEALTHCARE ENTITIES AT HIGH RISK


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Happenings RESEARCH ROUNDUP

Researchers Identify Need for Continued O&P Telehealth, Postpandemic A team of Department of Defense researchers conducted a comprehensive literature review of existing evidence for virtual care delivery across the phases of amputation rehabilitation to study telehealth trends. After noting a “dramatic uptake of virtual care” utilization due to COVID-19 restrictions, a team from the Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, studied the literature to identify ways that telehealth has improved healthcare accessibility and efficiency among individuals with limb loss. Emphasizing the mobility challenges among the O&P patient population, the research team, which included Melissa A. Hewitt, Douglas G. Smith, MD, Jeffrey T. Heckman, DO, and Paul F. Pasquina, MD, conducted a literature search using PubMed between August and December 2020 encompassing available publications related to the topic of telehealth and limb loss. They found 73 articles, 15 of which had been published in the past two years. Some of the studies related to virtual care of patients preamputation—for

example, while monitoring patients with diabetes—while others related to surgical decision making, inpatient care, postoperative and preprosthetic training, various phases of prosthetic and gait training, and follow-up care. The researchers concluded that recent advancements in platforms available for telehealth and telerehabilitation have great potential for improving care for limb loss patients, but that it also is important to consider the need for continued in-person care. They noted that “telehealth interventions should ideally be incorporated as a complementary tool within a comprehensive holistic approach to caring for individuals with limb loss. … We believe that telehealth has the capacity to greatly improve access to care, patient participation, and overall outcomes.” Full research findings were published in the article “COVID-19: A Catalyst for Change in Virtual Healthcare Utilization for Persons With Limb Loss” in April in PM&R, published by the American Academy of Physical Medicine and Rehabilitation.

Powered Prosthetic Ankles May Restore Wide Range of Abilities

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AUGUST 2021 | O&P ALMANAC

PHOTOS: Aaron Fleming

Neural control of a powered prosthetic and had to bend his back to lift ankle leads to a wider range of abilities heavy objects from the ground. among users, according to researchers When using the powered ankle, from North Carolina State University and he could voluntarily control his the University of North Carolina at Chapel prosthesis ankle joint force and Hill. The research team conducted a case angle and maintained a healthy study in advance of a larger group study. posture while lifting objects, The researchers, led by He (Helen) according to the researchers. Huang, PhD, asked a study participant Huang and her team also to perform various activities using noted a significant improveA study participant performs a squatting activity with different prosthetic devices. When the participant used his daily prosthesis (left), he had a limited his daily prosthesis and again using ment in the subject’s stability, range of motion and had to bend his back significantly to lift objects off the a neural-controlled prosthetic whether standing or moving. ground. When using a neural-controlled prosthetic ankle (right), he was able to voluntarily control his prosthesis ankle joint force and angle and keep a healthy ankle. The powered prosthesis reads “This case study shows that posture while lifting weight from the ground. electrical signals from two residual it is possible to use these neural calf muscles, which are responsible for controlling ankle control technologies, in which devices respond to electrical motion, according to the researchers. The technology signals from a patient’s muscles, to help patients using robotic leverages a control paradigm developed by the researchers prosthetic ankles move more naturally and intuitively,” said to convert electrical signals from those muscles into Huang. She and her team are working with additional subjects commands that control movement of the prosthesis. to expand their testing. “As with any prosthetic device for lower After training, the study participant was asked to complete limbs, you have to make sure the device is consistent and relitasks that had been difficult with his daily device. For example, able, so that it doesn’t fail when people are using it,” she said. using his daily prosthesis, he had a limited range of motion The case study was published in Wearable Technologies in April.


HAPPENINGS

Pandemic Brought Higher Rate of Diabetes-Related Amputations in South India

The COVID-19 pandemic spurred an increase in diabetes-related amputations at one hospital in South India. Researchers from M.V. Hospital for Diabetes the M. Viswanathan Diabetic Research Centre, Chennai, India, conducted a retrospective singlecentered study on major amputations during the prepandemic period (March to December 2019) compared to the pandemic period (March to December 2020). They found that 24 major amputations were performed during the prepandemic time period, and 37

were performed one year later—a 54 percent increase in major amputations, according to the study authors. More below-knee amputations were performed during both time periods. The researchers cited the increased severity of diabetic foot infection, as well as pandemic-related delayed care, improper diet, nonadherence to medications, and physical inactivity, as possible reasons for the spike in amputations. “We observed there was a delay in seeking healthcare during the pandemic period when compared to the prepandemic period. … This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased prevalence of lowerextremity amputations, which might cause a drastic impact on their quality of life,” noted the researchers. The study was published in May in The International Journal of Lower-Extremity Wounds.

ADDITIVE O&P

Academy Issues Position Statement Regarding 3D-Printed Devices

The American Academy of Orthotists and Prosthetists has published a position statement noting that the provision of 3D-printed orthoses and prostheses should be administered by a certified/ licensed orthotist or prosthetist. The position statement clarifies the distinction between a manufacturing process and the minimum education essentials and credentialing for

providers of custom-fabricated and custom-fit orthoses and prostheses. “Individually designed orthoses and prostheses are the culmination of provider and patient face-to-face interactions involving assessment, evaluation, goal-setting, design criteria, material and component selection, fabrication, fittings, training, providing proper use instructions, and follow-up appointments as necessary,” according to the Academy. “An orthotic/prosthetic patient’s maximum rehabilitation potential is reached when appropriately educated and credentialed professionals provide the comprehensive level of care needed.” The full statement is available on the Academy’s website, oandp.org.

FAST FACT

Reamputation Rates Remain High Among Patients With Diabetes

Nearly four in 10 patients

who have undergone initial amputations secondary to diabetes will have a reamputation within five years. Rates of reamputation have not changed over the past two decades. —“Lower-Extremity Reamputation in People With Diabetes: A Systematic Review and Meta-Analysis,” BMJ Open Diabetes Research and Care, January 2021

MEETING MASHUP

Amputee Coalition National Conference To Be Hosted Virtually Next Month The Amputee Coalition has announced it will bring a “spirit of innovation” to planning, outreach, and execution of the 2021 National Conference, which will be held virtually September 29-October 2. The conference will offer informational sessions and resources around health and wellness, community living, work and career, youth, and family, as well as ways to navigate the current COVID-19 environment, according to the conference planners. They plan to develop and execute an “innovative, inclusive experience” that will feature a virtual exhibit hall and expansive peer support and educational sessions. Visit amputee-coalition.org for details.

O&P ALMANAC | AUGUST 2021

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Tamra Averill, PT, is the new Great Lakes district manager at Allard USA. She joins the company with over 25 years’ experience working with patients, therapists, and client-partners as a physical therapist, clinical consultant, Tamra Averill, PT and educator. She has worked the last 14 years with Accelerated Care Plus, a Hanger Company. Hannah Clark, an O&P resident at the Baylor College of Medicine, has been named the winner of the 2021 Larry Lange Travel Fellowship Award by the National Commission on Orthotic & Prosthetic Education. She served as the interim warehouse manager for Limbs for Life, helping provide prostheses free of charge to patients without insurance, and she also completed a field study on O&P care disparities in Native American communities. Clark will use the award to go with Operation Namaste to teach Nepalese prosthetists to make inexpensive gel liners without electricity or clean water. She has spent the last two years partnering with Operation Namaste and the University of Washington conducting materials tests that correspond to stresses liners undergo throughout the gait cycle. Kathrin Dahnke will take over as head of finance at Ottobock on September 1. She succeeds Jörg Wahlers as chief financial officer (CFO); Wahlers will continue to support the company and its committees in an advisory capacity. Kathrin Dahnke Dahnke is an experienced CFO with broad responsibility for finance, controlling, mergers and acquisitions, and IT. She is a supervisory board member of B.Braun and Knorr-Bremse. Until the end of June 2021, she acted as CFO of the photonics company Osram. She previously was on the executive board of the family-owned company Werhahn and served as CFO of the machine tool manufacturer DMG Mori Seiki. “At an early stage, Kathrin Dahnke took on responsibility for finance departments and proved to be an outstanding CFO in both family businesses and listed companies,” said Philipp Schulte-Noelle, CEO of Ottobock SE & Co. KGaA. “She is thus an ideal appointment.”

Ashlie White, MA, AOPA’s director of health policy and strategic alliances, is one of four finalists nominated for the 2021 O&P Woman of the Year Award, sponsored by the Orthotic and Prosthetic Group of America (OPGA). Ashlie White, MA Kelly Gies, CFO/COO and general manager with Cornerstone Prosthetics & Orthotics, founder of KG Simple Solutions; Megan Smith, director of education and research with Surestep (Dienen LLC); and Heidi McGlade, director of administration with NovaCare Prosthetics & Orthotics also have been nominated for the award. Nominees were selected based on their contributions to serving O&P patients, the O&P community, business, and the O&P industry. “We’re excited to continue recognizing the women in O&P who are creating impactful and positive experiences to the patients and community they serve,” said Todd Eagen, president of OPGA, a division of VGM & Associates. “There are so many deserving candidates out there, and we are ready to highlight the woman who exemplifies everything that is exceptional about the O&P community.” The winner of the 2021 O&P Woman of the Year award will be announced online September 21 at 1 p.m. ET. Visit www. vgm.com/oandpwomanoftheyear to tune into the ceremony.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Hanger Foundation completed its first round of 2021 Empowerment Grants, awarding $120,000 to 14 different nonprofit organizations. Grant recipients include local and national organizations serving a variety of communities, including the following: • Adaptive Sports Ohio • ARC Active Resolute Connected • Austin Speech Labs • BlazeSports America • CPATH–Cerebral Palsy Awareness Transition Hope • Move United • No Barriers USA • NubAbility Athletics Foundation • Servants at Work • Spaulding Rehabilitation Hospital • Sportable Richmond Adaptive Sports and Recreation • Triumph Foundation • Variety—the Children’s Charity of Wisconsin. In addition to the 13 community grants, Hanger Foundation has awarded an Empowerment Signature Grant to Camp No Limits, a U.S. camp for young people with limb loss or limb difference in the United States.

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AUGUST 2021 | O&P ALMANAC


PEOPLE & PLACES

Össur has congratulated the U.S.-based members of Team Össur and Össur Ambassadors for qualifying as members of Team USA. Team Össur track and field athletes Femita Ayanbeku, Noelle Lambert, Trenten Merrill, and Hunter Woodhall all took first place in at least one of their qualifying events, and three new U.S. records were set: by Femita Ayanbeku in the 100-meter, Hunter Woodhall in the 400-meter, and Trenten Merrill in the long jump. Named to Team USA’s triathlon team were Össur Ambassadors Jamie Brown and Grace Norman, as well as Eric McElvenny, who frequently participates as a product champion for the company. “On behalf of Össur, we applaud these individuals for their continued excellence,” said Jon Sigurdsson, president and CEO of Össur, “and look forward to seeing them and all of the other Team Össur athletes compete on the world’s stage later this summer.” The Paralympic Games will be held August 24 through September 5 in Tokyo.

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O&P ALMANAC | AUGUST 2021

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REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Better Business Practices Boost your revenue through improvements in practice management

T

HE LAST 18 MONTHS have proven

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

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that no matter how prepared you think you may be, sometimes life is simply unpredictable. While it appears that the COVID-19 global pandemic may finally be managed through the development of effective vaccines, nobody really knows what the new reality will look like. What is clear is that no one was prepared for the public health crisis that COVID-19 created. Running a successful O&P practice has always been demanding, with challenges constantly evolving, but the basic principles of creating a profitable business have remained steady. The COVID-19 public health emergency forced many companies to consider alternative business models to generate revenue, but the delivery of healthcare services has remained a vital public service. Healthcare companies have continued to find new and innovative ways to care for patients both safely and effectively.

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This month’s Reimbursement Page reviews some basic strategies for maintaining and improving revenue opportunities at O&P facilities. Since the Medicare annual fee schedule increase is even with or slightly below the annual rise in the cost of living, O&P businesses have had to find creative ways to increase profits through the use of efficient business practices.

Manage AR Effectively

Revenue recorded on the books is only as good as your ability to collect it. While it is not uncommon to book revenue at the time of delivery of a device, it must be collected to have real meaning. Consider these three suggestions for managing your accounts receivable (AR) efficiently and turning revenue into assets. First, be organized. Businesses that manage their AR successfully have implemented defined, repeatable processes to collect AR in a manner that best meets their needs. Simple steps, such as classifying AR according to amount, collectability, and age, aid in creating efficient collection processes. The old saying that “time is money” is extremely relevant when dealing with AR, especially as it ages. The goal is to convert AR into real revenue as quickly as possible; successful managers are usually skilled in quickly deciding what AR is collectable and what is not. If AR is determined to be noncollectable, there is no reason to leave it on the books— write-offs can be hard to swallow, but there is really no point in leaving uncollectable AR within your system.


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Second, understand how to quickly turn AR into income. It’s no secret that the older the AR is, the harder it is to collect. Strategies to collecting AR efficiently include electronic payment arrangements with payors, collection of coinsurance and deductibles at the time of delivery, the use of third-party credit issuers when appropriate, and maintaining contact with patients when they have a balance due. Finally, know how to reach the correct people to facilitate claim payment. Whether you are dealing with a small individual plan or a large group plan, knowing to whom to talk can be the difference between getting paid and not getting paid. Creating relationships with the key contacts at insurance companies will help to ensure fair and proper treatment when dealing with reimbursement issues.

changes only for the sake of change, updating your company policies and procedures regularly is an important strategy for a successful O&P business.

Establish Goals

Review Contracts

Your success as a business is not always directly related to the number of patients you can treat in a day. A successful business is one that operates in an environment that is as financially favorable as possible. Access to patients is a good thing but can sometimes come at a price that may not be worth the cost of admission. Bad contracts can cost your business money, especially if they include terms that are unfair or overly one-sided in favor of the insurance company. Volume-based discounts are a fact of life in today’s healthcare environment, but it is important to consider if it is worth signing a contract if there is little chance of it being a profitable relationship. Federal antitrust regulations prohibit AOPA from providing guidance to members on specific contractual terms, but it is not hard to spot an unfavorable contract. Just remember that contracts are negotiable—but only before you sign on the dotted line. You should review your contractual relationships on a regular basis. Consider designating the start of each new year to examining existing contracts to determine if their terms are in the best interest of your business. If not,

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there may be an opportunity to renegotiate terms that are more favorable. If you find that you have contracts that are no longer palatable, look for exit clauses that allow you to cancel the contract with appropriate notice.

Reread Policies and Procedures The business of O&P is not static. If the past 18 months have taught us anything, it’s that change is inevitable—and what made sense last year may no longer be realistic or in the best interest of your company. Policies and procedures are more than just books on a shelf; they are the outline that should be used to run your business on a daily basis. The beginning of the year is the ideal time to review your policies and procedures and initiate any changes that will lead to greater efficiencies and, potentially, higher profits. If you find that a policy or procedure is no longer relevant to your business, do not be afraid to make changes. Once you make changes, communicate to employees what the changes are, why they were made, and what the expectations are going forward. While you should never make

A strategy for success for any business— including O&P—is the establishment of reasonable goals that the business can strive to achieve. Whether they are financially based, clinically based, or based on another factor entirely, goals provide a direction and a focus for the business that can be extremely healthy. When considering establishing goals, be careful that they can be reasonably attained but not assured. Goals are something to strive for, not an expectation of the status quo, and should be established accordingly. In addition to establishing specific goals, consider designing incentives for obtaining those goals. Small rewards can go a long way when motivating employees to take that extra step for the benefit of the company. Motivated employees will likely work hard to achieve the goals that can move your company forward. While all of these strategies provide examples of how you can maximize profits, there are endless things you can do to grow your business and ensure your success. The best strategies are developed by those who know the business best: business owners and employees. Understanding the need to change and implementing necessary changes may help your business grow and thrive. Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org


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COVER STORY

Meaningful

MEASURES O&P FACILITIES STEP UP THEIR

DATA COLLECTION EFFORTS TO

IMPROVE PATIENT CARE AND DEMONSTRATE VALUE By CHRISTINE UMBRELL

NEED TO KNOW • In a movement toward evidence-based practice, several O&P facilities have formalized their policies and procedures regarding the collection and use of outcomes measurements. • Facilities are capturing both performance-based and patient-reported measurements and storing data in patients’ charts, involving both clinicians and patients in the process. • Some patient-care facilities are leveraging data to inform clinical decision making, share progress with patients, and provide evidence of the value of O&P intervention to payors. • Lower-limb prosthetic patients remain the current focus of outcome measures at most facilities, but some clinicians have developed upper-limb measures, and others are planning to capture lower-limb orthotic outcomes in the near future.

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COVER STORY

O

&P FACILITIES HAVE taken

disparate approaches to collecting outcome measures during the past few years, with varying degrees of commitment and a broad array of approaches to leveraging the data. As the O&P profession prioritizes this important activity and moves toward evidence-based care, those same facilities are expanding their effort, and several are formalizing their policies and procedures. Leaders in the O&P field believe that formalized data collection and aggregation efforts will enhance patient care, demonstrate the value of O&P intervention, and aid in O&P research and development initiatives.

Maggie Baumer, JD

At Hanger Clinic, for example, capturing outcome measures has become a strategic process and “part of our culture,” explains Maggie Baumer, JD, clinic manager at Hanger Clinic in Springfield, Massachusetts. Hanger Clinic clinicians regularly conduct outcome assessments on their patients. “Collecting this data helps the entire field recognize and promote best practices,” she says. “This awareness can inform access to optimal care and coverage for those with limb amputation.” At Ability P&O, August marks the official debut of a new tool: an outcome measures database and digital solution, according to Brian Kaluf, BSE, CP, FAAOP, clinical outcome and research director. The tool will assist in real-time clinical decision making while aggregating data for future clinical assessments. O&P ALMANAC | AUGUST 2021

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COVER STORY

Christie watches the patient maneuver the Four-Square Step Test.

Standardizing Data Collection

Hannah Christie, CPO, oversees a patient taking the TUG test at Scott Sabolich Prosthetics & Research.

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PHOTOS: Courtesy of Scott Sabolich Prosthetics and Research

Christie assists the patient in a 10-Meter Walk Test.

The solution was developed by Ability P&O and Scott Sabolich Prosthetics & Research, with support from the Ottobock North America clinical research and services team, led by Andreas Kannenberg, MD (GER), PhD, executive medical director for Otto Christie evaluates the Bock Healthcare LP. For now, the patient via the AMPRO. solution focuses on lower-limb prosthetic measures but will expand later to include other measures, such as lower-limb orthotic and upper-limb The Timed Up-and-Go (TUG), the prosthetic outcomes, says Kaluf. Four-Square Step Test (FSST), the In determining which measures Activity-Specific Balance Confidence to include for lower-limb prosthetics, (ABC) Scale, the AMPPRO mobility “we relied on our experiences and how predictor, the 10-Meter Walk Test, the Six-Minute Walk Test, the Prosthetic Limb Users Survey of Mobility (PLUS-M), Socket Comfort Score, and Scott Sabolich, CP the EuroQol Five-Dimension FiveLevel test all factor into the solution, says Scott Sabolich, CP, an owner of Scott Sabolich Prosthetics & Research. we have utilized outcome measures in The patient-reported measurements the past,” explains Kaluf. “We selected require less time of clinicians because measures in consideration of the patients can complete those forms unique needs of patients in the United on their own; however, the perforStates.” The team also referred to guid- mance-based tools must be conducted ance from the American Academy of in the clinic, by certified prosthetists Orthotists and Prosthetists, as well as or properly trained assistants or recommendations from Ottobock and technicians, Kannenberg says. The Scott Sabolich Prosthetics & Research, Ottobock team developed software according to Kaluf. and a database in Europe to collect Both performance-based and and analyze the measures as part of patient-reported measurements the company´s outcomes initiative, related to lower-limb loss are included. according to Kannenberg.


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COVER STORY

For the new tool to function properly, a clinician or employee inputs demographic data, amputation details, and comorbidities information. Once the relevant outcome measurements are collected and stored in the database in a HIPAA-compliant fashion, the software creates reports for clinicians to consider in their clinical decision making, says Kannenberg. It also provides reports that can be shared with physicians or insurance companies. For now, each facility that uses the solution can access only its own patient data.

Informing Clinical Care

Formalized outcome measurement protocols enable O&P professionals to embrace “outcomes- or data-informed clinical care,” says Kannenberg.

Brian Kaluf, BSE, CP, FAAOP

The primary purpose of the tool is “to assist clinicians in gathering and interpreting results for individual

Digitizing Patient-Reported Outcomes Capturing meaningful data directly from patients is an important part of a sustainable outcome measurements protocol. At Hanger Clinic, practitioners have implemented updated protocols to ensure the process is both easy for patients and informative for clinicians. “Over recent years, our process has evolved to digital direct input, moving away from paper processes,” explains Erin O’Brien, CPO, FAAOP, clinical education specialist for Clinical and Scientific Affairs at Hanger Clinic. Patients provide results to standardized assessments via their smartphone Erin O’Brien, prior to their appointments. “This has improved the CPO, FAAOP consistency and efficiency of collecting outcomes, with clinicians able to see the results of the patient’s self-report questionnaires in real-time and within our electronic health records system,” she explains. During the ongoing COVID-19 pandemic, this digital transition has reduced the amount of time spent in the clinic and “reduces the risk of exposure to our patients and staff,” she adds. “Our outcomes program allows the assessments to be collected remotely, and our clinicians can act proactively on the results of those assessments.” The facility’s scheduling system generates reminders to ensure patients complete their assessments at appropriate points during their care, adds O’Brien, which helps both office administrators and clinical staff remember which patients need to have an outcome measure completed at various appointments.

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patients, and to provide actionable data immediately,” says Kaluf. The solution generates real-time reports that aid clinicians—and patients with whom they share information—in understanding how a patient’s status compares to that of other people in similar situations. The solution, notes Kaluf, is designed to evaluate the important lower-limb domains, including mobility, fall risk, socket comfort, and health-related quality of life. He explains how the solution can aid in clinical decision making, for example, by assessing fall risk. “For fall risk, the solution is designed to capture four measures [TUG time, FSST time, ABC score, and walking speed] and automatically note if a patient may be at greater risk of falling,” he says. Then the clinician can take action— for example, by recommending that a more stable prosthesis be fit, and/ or by referring the patient to an allied healthcare professional, such as a physical therapist. “This saves clinicians time and increases the utility of outcome measures.”

Andreas Kannenberg, MD (GER), PhD

Similarly, for socket domain, the measures help determine “if the patient’s socket comfort has decreased over time, and the tool helps tell you when the socket might need to be replaced,” says Kaluf. Clinicians use information from the tool to help them determine what type of device would be most useful for a particular patient. Component selection becomes less arbitrary and is more dialed into patient-specific needs. As Sabolich points out, the tool is not product-specific.


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COVER STORY

O&P Outcome Measures Become More Advanced, Fine-Tuned The more formalized efforts to collect outcome measures are the culmination of many years of effort by forward-thinking O&P professionals working to advance and elevate the O&P profession. “The science behind outcome measures has advanced greatly over the past 10 or 15 years,” says Brian Hafner, PhD, a professor at the University of Washington (UW) and a principal investigator at UW’s Center on Outcomes Research in Rehabilitation. Hafner was involved in developing the Prosthetic Limb Users Survey of Mobility (PLUS-M), used to measure mobility of adults with lower-limb amputation. Brian Hafner, By working with measurement PhD experts at UW during development of the PLUS-M, Hafner says his team learned contemporary techniques to develop better outcome measures. Now the team is creating a similar measure for lowerlimb orthosis users, with funding from DoD and AOPA. In addition, Hafner is collaborating with other O&P professionals around the country to develop new performance-based and self-report measures for lower-limb prosthesis users.

Sharing patient-specific data with patients so they are involved in their care decisions is another key use of data collected via outcome measurements. At Hanger Clinic, Baumer says they explain “how the data is used to assess their mobility and quality of life. We also place this in context of others who are similar based on certain demographics. This helps patients understand how their recovery process is going in a comprehensive way and can also help them set goals for themselves and their healthcare team.” Each patient type has different measures that are pertinent to those specific patients, “which is why our outcomes measures vary depending on why the patient is being seen,” says Erin O’Brien, CPO, FAAOP, clinical education specialist for Clinical and Scientific Affairs at Hanger Clinic. For lower-extremity prosthetics patients, Hanger uses the PLUS-M and the Well-Being subsection of the Prosthesis Evaluation Questionnaire 26

AUGUST 2021 | O&P ALMANAC

“The recommended approach to developing outcome measures has really evolved” and become more rigorous since some of the early O&P-specific measures were introduced, says Hafner. “For example, we now engage target respondents and other stakeholders early in the development process so that we know we’re measuring the right concepts and using the right language to design questions.” Hafner explains that involvement of target respondents in this manner has allowed them to ensure questions are well understood by respondents, thereby providing clinicians and researchers with better information. Newer instruments are more often being designed with the input of hundreds or thousands of patients, instead of dozens of individuals, as was sometimes the precedent for early O&P outcome measures, according to Hafner. “So now, when you create the instrument, you have reference or normative data, which can help clinicians or researchers apply this outcome measure with the knowledge of where their patient is, and benchmark themselves along the continuum of people in the United States,” Hafner says. “Being able to provide that context has been very helpful to our field.”

Taavy Miller, PhD, CPO

(PEQ-WB) to assess patients’ mobility, quality of life, and satisfaction. “On the other hand, for scoliosis we are using radiographic information and adherence monitoring to track the patient’s progress over time,” she explains. Each patient’s outcome measure information is stored in their chart to be used to inform clinical decisions. “A big hurdle to the utilization of outcomes measures to inform patient care has been the translation of scores and results into a consumable product for patients and clinicians,” O’Brien explains. “This was the springboard for Hanger Clinic’s trademarked Mobility Empowerment Scorecard, or ME Scorecard. This individualized patient report provides information

in a way that is easily consumed by clinicians, patients, and caregivers.” In addition, the information is always available, so clinicians can reference it during future appointments to track progress and set goals. “We hear of numerous cases where patients see their scores and … are motivated to improve their condition,” explains Taavy Miller, PhD, CPO, research scientist for Clinical and Scientific Affairs at Hanger Clinic. She cites the example of an individual with an above-knee amputation who reported falling every day. “Unfortunately, while a microprocessor knee would have benefited her, she did not qualify as a K2 ambulator,” Miller recalls. However, utilizing her outcomes measures, Hanger Clinic clinicians put a plan in place that included increased activity and physical therapy, which subsequently elevated her to K3 status—and qualified her for the microprocessor knee. She no longer experiences falls, according to Miller.


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COVER STORY

Advances in Upper-Limb Outcome Measures

M

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PHOTO: Arm Dynamics

OST O&P FACILITIES are prioritizing lowerlimb prosthetic outcome measures for now— but at Arm Dynamics, where upper-limb prosthetic patients are the key demographic, prosthetists and therapists have developed their own novel outcome measures. “Upper-limb is a very unique population,” comprising less than 10 percent of Americans with limb loss, says John Miguelez, CP, FAAOP(D), president and senior clinical director. “But in the John Miguelez, industry in general, there’s a very CP, FAAOP(D) high abandonment rate,” so his company developed outcome measures to boost prosthesis acceptance rates and improve patient care. “We want to optimize the rehabilitation potential of each patient; to motivate Staff at Arm Dynamics, including Kerstin Baun, MPH, OTR/L, rely on extensive outcome measures them throughout the rehabilitation process via data-driven specifics, so they can understand where to optimize each patient’s function. they’re improving, even if it’s subtle, and where they • The Wellness Inventory is a patient screening tool that need additional attention; and to look at aggregate helps identify psychosocial changes that could have a outcome measures to create benchmarks,” he explains. negative impact on rehabilitation or success with the Those goals led the company to convene its cliniprosthesis, and screens for issues such as pain, PTSD, cians several years ago to identify what was missing depression, and other quality-of-life issues. in the current measures. They also recruited a psychometrician to help refine questions before validating Miguelez and Baun believe using measures. “Then, we partnered with the U.S. Food and these tools has improved clinical deciDrug Administration and tested these measures with our sion-making over the past several years. patient population,” Miguelez says. “The moment-to-moment ability to impact “The beauty of these measures is we can use them patient care” has been the most significant with any level of [upper-limb] amputation,” says Kerstin benefit, says Miguelez. In addition, the Baun, MPH, OTR/L, national director of therapeutic Kerstin Baun, Arm Dynamics team has uncovered some services. And the measures are “manufacturer-agnostic.” MPH, OTR/L interesting statistics. Through the Wellness Clinicians at Arm Dynamics now regularly impleInventory, the team learned that individment the three outcome measures developed in-house, uals with partial hand loss have a higher according to Baun: feeling of disability than those with higher levels of amputa• The Capacity Assessment of Prosthetic Performance tion—at least according to their patient base. “That helps us for Upper Limb (CAPPFUL), an assessment tool approach each case and be mindful of the unique populadesigned to measure upper-limb prosthetic perfortion,” Miguelez says. mance during common activities, enables therapists Arm Dynamics is sharing de-identified data from its to identify a patient’s functional challenges and then outcome measures with referral sources and payors. modify treatment plans to improve outcomes. “My aspirational hope is that others will have access to • The Comprehensive Arm Prosthesis and Rehabilitation [these types of] measures to create a standard of care, then Outcomes Questionnaire (CARPROQ) is a enhance that care,” says Miguelez. “It really involves buy-in patient-reported outcome measure presented in by all the clinicians and the patients.” question-and-answer format.


COVER STORY

Providing Evidence for Payors In addition to elevating patient care, standardized outcome measurement processes and the information they provide to show improvement in patient outcomes have become critical to claims submissions. O&P facilities are increasingly receiving pushback about documentation, Kannenberg says, “so we need to collect data to demonstrate that the prostheses and orthoses we fit on patients really work.” Sabolich agrees that O&P must prepare for payors to begin requiring test results to ensure reimbursement. “We need to set an industry standard, then we can justify product selection to payors with satisfaction rates, test scores, and fall risk calculations,” says Sabolich. “The O&P field should do this on their own and bring it to the payors.” By being proactive with outcome measurements and sharing positive outcomes, O&P facilities can help lead the transition to evidence-based care. “We need to try to ‘shape the change,’ so

“We need to set an industry standard, then we can justify product selection to payors with satisfaction rates, test scores, and fall risk calculations.” —SCOTT SABOLICH, CP

others who aren’t qualified don’t make decisions for us,” says Kannenberg. “We need to set the stage and say, ‘We have a set of outcome measures that can be assessed in everyday practice and deliver usable results.’”

Aggregating Data for R&D

Hanger Clinic has already begun leveraging its outcome measurement protocols to aggregate data to conduct research and improve standards of care. The company “has demonstrated a continued commitment to the O&P field through clinical research and education efforts that span beyond our

organization through partnerships with leading researchers, professionals, and manufacturers,” Miller explains. “Dissemination of results from our outcomes program is a key component of research to ensure data is translated into evidence that supports clinical care and health policy.” She points to published research articles written by Hanger Clinic clinicians, including studies in the Mobility Analysis of Amputees (MAAT) series as well as the recent Outcomes Assessment and Dissemination (OASIS) publication.

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COVER STORY

Those studies have helped clinicians make more informed decisions. “For example, there were previously numerous times where clinicians were assessing and noting various comorbidities,” explains Miller. “As some of these comorbidities were not pertinent to prosthetic rehabilitation, it created confusion in developing a plan of care.” In the second analysis from Hanger’s MAAT 2 series, it was “clearly determined” which comorbidities should be accounted for when developing an effective plan of care, according to Miller. “Now our evaluations are subsequently more targeted and promote more effective care planning.”

“If your clinic doesn’t use outcome measures, then I believe you are going to start to fall behind.” —BRIAN HAFNER, PhD

At Kaluf’s facility, “we can look at all of the patients at Ability, or at just one location, over the course of a year, and conduct a data analysis” that can lead to improved care, he explains. In addition, the Ottobock research team leverages the de-identified data collected at its patient-care facilities to both conduct research and inform device development. Kannenberg explains that researchers “can analyze the data and see if there are any weak spots or need for improvement, or to identify unmet patient needs.” 30

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Expanding the Data Pool

O&P stakeholders that are formalizing outcome measures protocols call on others in the industry—large and small—to implement their own approaches, to ensure all O&P facilities are preparing for evidence-based care and looming reimbursement requirements. Brian Hafner, PhD, a professor at the University of Washington (UW) and a principal investigator at the UW’s Center on Outcomes Research in Rehabilitation, has been involved in several efforts to educate the clinical field about the importance of using outcome measures. Hafner, who helped develop PLUS-M, one of the most widely accepted O&P patient self-report instruments, says his team is working on identifying barriers to measurement so that the O&P profession can find ways to address them. “For example, we are learning about situations where prosthetists-orthotists may want or need help from other rehab professionals to administer outcome measures.” Hafner’s team also is undertaking outreach efforts to communicate that this process doesn’t have to be difficult. “It [measurement] does take a little time, but there’s also value to it.” His team focuses on developing tools that integrate well into normal clinical practice. For smaller facilities, “it can be more of a challenge to use these measures,” concedes Hafner. But the UW team and many others are working to ease the transition. “All the tools we develop [at UW, including the PLUS-M] are free, they’re available on our website; I make myself available to answer questions; and I help with translations into other languages in my spare time,” Hafner says. “My hope is that even small clinics will find ways to integrate them into clinical practice.” He also is pushing for electronic health record companies to integrate outcome measures into their systems to increase access for smaller facilities. “If your clinic doesn’t use outcome measures, then I believe you are going

to start to fall behind,” says Hafner. He encourages small facilities to start “using at least one self-report measure and one performance-based test related to the construct that you think is most relevant to that individual patient.” He recommends resources from groups like the Academy; its website features lists of recommended outcome measures and a “how-to” video series designed “to properly administer outcome measures and correctly report results.” “Collecting outcome measures in O&P clinical work allows clinicians to utilize quantifiable data to monitor the individual patient-specific effect of a treatment plan, improves the clinician-patient shared decision-making communication, and provides objective justification to payors for a certain treatment plan,” says Miller. “It is important for each clinic to consider their workflow and how they can incorporate outcomes collection into their practice because it takes a team approach to support the integration of an outcomes program.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.


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By MICHAEL COLEMAN

MANAGING CYBERTHREATS PROTECTING COMPANY AND PATIENT DATA IS NO LONGER OPTIONAL FOR O&P BUSINESSES

NEED TO KNOW • Data breaches and ransomware attacks are a growing problem for U.S. healthcare companies, including O&P facilities, causing financial and reputational damage to facilities that are targeted. • Protecting patient data also is critical because O&P facilities must comply with the HIPAA Security Rule mandating that covered entities evaluate risks and vulnerabilities in their environments and implement appropriate security measures. • Healthcare facilities are experiencing phishing attacks that target employees and trick them into sharing sensitive business information, as well as ransomware attacks that aim to extract a ransom by locking a company’s stored data and demanding payment for a key to regain access. • Many O&P facilities choose to contract with security firms to assess vulnerabilities and handle IT security, and some also choose to purchase cyber insurance to minimize damages should a breach occur.

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B

Y THE END of 2021, U.S. businesses

will be targeted by a ransomware attack every 11 seconds, according to research firm Cybersecurity Ventures. Healthcare companies—including O&P facilities—are especially vulnerable because of the extensive and valuable patient data they maintain. About 15 percent of all data breaches in 2019—ransomware, phishing attacks, and more—involved the healthcare system, with losses to the industry reaching $25 billion, according to the “2021 Data Breach Investigations Report.” And there’s more bad news: According to global cybersecurity giant Sophos, the cost of remediating ransomware attacks—in which cybercriminals seize records or entire computer networks and demand a ransom for their return—has doubled in the past year. A growing number of organizations are paying ransom demands ranging from an average of $10,000 to more than $1 million,


but only 8 percent of those who pay manage to get all of their data back. The O&P industry, like other healthcare sectors, is a target because facilities store patient information that could potentially be leveraged on the dark web: Medicare ID numbers, Social Security numbers, insurance information, and even payment data. “If those could potentially be tapped into, they can be used for very unpleasant purposes—not just trying to steal someone’s ID but exposing people to public knowledge about their personal health trials and tribulations,” says Rebecca Snell, information technology and marketing director at Dankmeyer Inc. The financial and reputational harm to an O&P company if patient data is made public can be devastating. “We’re talking about the goodwill of your patients and clinical partners,” Snell explains. “How many O&P companies could survive the loss of 50 percent of their patients who bail, because you are required by law to notify patients of a potential breach? Who’s going to stick around if they think you did a horrible job of protecting their data?” Faced with increasing cyber threats, O&P facilities are expanding their efforts to understand the potential costs and dangers and ramping up initiatives to prevent and minimize damage from breaches.

Understanding the Latest Threats

Cyber breaches typically emanate from one of two threats: phishing or ransomware. A phishing attack typically involves a malicious person using social engineering techniques to trick an individual into supplying sensitive personal or business information. A ransomware attack, which can be delivered through a phishing communication such as an email, aims to extract a ransom from a victim by locking their files and demanding payment for a key to regain access. The vulnerabilities don’t necessarily end at a clinic’s front door. A study released in July by cybersecurity firm

CynergisTek found that 76 percent of healthcare providers are not adequately validating that their outside vendors are meeting contractual security obligations. The Privacy Rule in the Health Insurance Portability and Accountability Act (HIPAA) allows covered providers and health plans to disclose protected health information (PHI) to business associates if they obtain satisfactory assurances that the associates—typically paid contractors—will use the information only for the purposes for which it was engaged and protect the information. Some examples of business associates are a third-party administrator that assists a health plan with claims processing, a CPA firm, attorneys, consultants, and more. According to Security Intelligence, a website devoted to informing organizations about cybersecurity issues, supply-side attacks could arise in various ways. Digital attackers could prey upon openings within a supplier’s network, possibly from a mobile healthcare app or a product’s outdated firmware to make their way through the supply chain. From there, criminals can get access to a healthcare entity and steal its stored PHI. Healthcare providers not only have to worry about the typical—and sometimes staggering—costs of ransomware attacks, they also risk running afoul of federal law. HIPAA requires that any entity covered under the law that experiences a ransomware attack or other

cyber-related security incident “must take immediate steps to prevent or mitigate any impermissible release” of PHI. Failure to comply can potentially be fatal for small businesses. Under HIPAA’s Enforcement Rule, the Office of Civil Rights (OCR) in the U.S. Health and Human Services Department (HHS) may assess civil money penalties of up to $1,677,299 per violation, per year, against a covered entity that fails to properly protect PHI.

Boosting Preventative Measures

The good news is that the HHS website (www.hhs.gov/hipaa/for-professionals) offers plenty of guidance on compliance designed to help healthcare providers implement appropriate protections and processes to help protect against cyberattacks. The guidelines include recommendations on how to comply with security awareness and training requirements, ensuring outside contractors meet HIPAA security standards, understanding facility access controls, securing individual workstations, understanding electronic transmission of data, and much more. Jeffrey Schultz, partner and cybersecurity expert at Armstrong Teasdale, a full-service national law firm, helps healthcare firms navigate the stressful and bewildering aftermath of an attack, especially counseling them on their regulatory and other legal requirements, as well as their incident response. O&P ALMANAC | AUGUST 2021

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10 TIPS 1. Establish a security culture. Ongoing cybersecurity training and education emphasize that every member of the organization is responsible for protecting patient data, creating a culture of security. 2. Protect mobile devices. An increasing number of healthcare providers are using mobile devices at work. Encryption and other protective measures are critical to ensure that any information on these devices is secure. 3. Maintain good computer habits. New employee onboarding should include training on best practices for computer use, including software and operating system maintenance.

FOR PREVENTING A CYBER ATTACK

5. Install and maintain antivirus software. Simply installing antivirus software is not enough. Continuous updates are essential for ensuring healthcare systems receive the best possible protection at any given time. 6. Plan for the unexpected. Files should be backed up regularly—automatically, if possible, or at least weekly—for quick and easy data restoration. Organizations should store this backed-up information away from the main system if possible. 7. Control access to protected health information. Access to protected information should be granted to only those who need to view or use the data.

4. Use a firewall. Anything connected to the internet should have a firewall.

8. Use strong passwords and change them regularly. A Verizon report found that 63 percent of confirmed data breaches involved taking advantage of passwords that were the default, weak, or stolen. Healthcare employees should not only use strong passwords, but ensure they are changed regularly. 9. Limit network access. Any software, applications, and other additions to existing systems should not be installed by staff without prior consent from the proper organizational authorities. 10. Control physical access. Data also can be breached when physical devices are stolen. Computers and other electronics that contain protected information should be kept in locked rooms in secure areas.

SOURCE: “Cybersecurity: How Can It Be Improved in Health Care?” University of Illinois—Chicago, https://bit.ly/3s8NQYq

Healthcare providers that are HIPAA regulated and involved in a cybersecurity breach will typically be contacted by OCR at HHS, according to Schultz. If OCR accepts a complaint for investigation, it will notify the person who filed the complaint and the covered entity named in it. Then the complainant and the covered entity will be asked to present information about the incident or problem described in the complaint. OCR may request specific information from each to get an understanding of the facts, Schultz notes. Covered entities are required by law to cooperate with complaint investigations. If a complaint describes an action that could be a violation of the criminal provision of HIPAA, OCR may refer the complaint to the Department of Justice for investigation. If the evidence indicates that the covered entity was not in compliance, OCR 34

AUGUST 2021 | O&P ALMANAC

will attempt to resolve the case with the covered entity by obtaining voluntary compliance, corrective action, and/or resolution agreement.

Raising Awareness of the Dangers

It is critical that healthcare companies, especially smaller organizations like O&P facilities, realize that they are not immune to cyberattacks, according to Schultz. “There needs to be some sort of recognition that you’re not just going to fly beneath the radar,” he says. “You might be thinking, ‘Nobody will come after me, they’ll go after the big outfits.’ Really, it doesn’t have to do with size, and it doesn’t have to do with the industry in which you’re operating. It’s opportunistic. And if you can be hurt, from a business or reputational perspective, by having an incident, you’re a target.”

Schultz and Snell agree that the top cyber vulnerability at most health organizations is the staff. “The experts tell us that the No. 1 cause of incursions is employee error, people who click on things they should not be clicking on and who don’t recognize it,” Snell says. “It’s the folks who say, ‘Hey, it’s really difficult to go through the two-factor authentication to access all this data on our network,’” Schultz adds. “They create their own sort of shadow IT, and they put unencrypted information on a flash drive so they can access the data more easily. And with the pandemic, there are more people working remotely. That in and of itself has created more vulnerabilities,” he says. “Making sure that you get your employees trained and that they’re complying, and that they understand the importance of compliance, is a big, big first step.”


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RISK ANALYSIS REQUIREMENTS UNDER THE HIPAA SECURITY RULE The Health Insurance Portability and Accountability Act (HIPAA) Security Rule mandates that covered entities “evaluate risks and vulnerabilities in their environments” and “implement reasonable and appropriate security measures” to guard against possible security threats to protected health information (PHI). While the security rule does not state a specific assessment methodology, it does establish “several objectives that any methodology” must accomplish. The security management process standard in the security rule states the following for risk analysis: Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the [organization]. The following questions adapted from NIST Special Publication (SP) 800-665 are examples organizations could consider as part of a risk analysis. These sample questions are not prescriptive and merely identify issues an organization may wish to consider in implementing the Security Rule: a Have you identified the e-PHI within your organization? This includes e-PHI that you create, receive, maintain, or transmit. a What are the external sources of e-PHI? For example, do vendors or consultants create, receive, maintain or transmit e-PHI? a What are the human, natural, and environmental threats to information systems that contain e-PHI? In addition to an express requirement to conduct a risk analysis, the Rule indicates that risk analysis is a necessary tool in reaching substantial compliance with many other standards and implementation specifications. For example, the Rule contains several implementation specifications that are labeled “addressable” rather than “required.” An addressable implementation specification is not optional; rather, if an organization determines that the implementation specification is not reasonable and appropriate, the organization must document why it is not reasonable and appropriate and adopt an equivalent measure if it is reasonable and appropriate to do so. The outcome of the risk analysis process is a critical factor in assessing whether an implementation specification or an equivalent measure is reasonable and appropriate. Organizations should use the information gleaned from their risk analysis as they, for example: a Design appropriate personnel screening processes. a Identify what data to backup and how. a Decide whether and how to use encryption. a Address what data must be authenticated in particular situations to protect data integrity. a Determine the appropriate manner of protecting health information transmissions. SOURCE: “Guidance on Risk Analysis,” U.S. Department of Health & Human Services, https://bit.ly/2VHeJab

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To help keep data at Dankmeyer safe, the facility has contracted with a security firm to handle its email security for the past eight years, according to Snell. “They have very, very strenuous controls to trap malware and quarantine it,” she says. “They’re an incredible company, and they help me with sleeping at night” because of their security expertise and diligence.” A midsize company (35 employees) could spend anywhere from $4,000$6,000 annually for such a service, depending upon how many different platforms can be used to access the email and how much storage is provided per email user, according to Snell. The firm Dankmeyer uses is priced on a per user basis, per month. This increased security has become even more important with the rise of more sophisticated data breaches carried out via “spear phishing,” which occurs when a malicious actor acquires specific information about a target and then tailors a phishing email with that information, so an employee may mistakenly believe the email is legitimate. Snell points to an incident where a supplier of O&P materials was hacked, with malicious actors using the supplier’s logo and other information in an email asking that the recipient “click on this invoice,” she says. “I have made phone calls before to suppliers to say, ‘Hey, one of our employees got an email that purports to be you.’” Schultz recounts a story of a human resources manager who got an email that appeared to be from the firm’s CEO asking for all employees’ W-2 tax forms. “It was right around tax time, so what do you think was going to happen?” Schultz says. “The bad guy who was impersonating the CEO was going to take those and use them to file a whole bunch of fraudulent tax returns and try and get the refunds.”


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Readying for Ransomware

In light of the increase in sophistication in ransomware attempts at healthcare facilities, O&P facilities should be boosting their efforts to ward off attacks. Until recently, if an O&P business had a ransomware plan that included computer data backup— or copies of their files and data in a separate location—they could avoid paying the ransomware fee and not lose much time in resuming business as usual. But that is no longer the case. “Now one of the things that we’re seeing is exfiltration” when malware and/or a malicious actor carries out an unauthorized data transfer from a computer, Schultz says. “The bad guys can now have a backup and can say, ‘OK, well, not only is your data encrypted, but also if you don’t pay, we’re going to dump all your data out on the dark web and put it for sale.’ Essentially, they’re trying to give you additional motivation to pay” to avoid having patient data made public. O&P facilities should be aware of the threat ransomware attacks can cause and engage in appropriate preventive measures. Snell contends that the O&P field isn’t as well protected against cyberattacks as other healthcare segments because of a lack of resources. “It’s not just a lack of equipment or hardware, but not having knowledge of the potential threat,” she says. “If you know about the threat, what resources do you have to defend yourself against it? Do you have someone on staff that can put a firewall in place? Someone who can install antivirus software? And if you don’t have that, do you have the financial resources to find a good consultant who can help you with those things? A lack of education and resources are the most difficult problems that we face in our industry, in order to be able to protect ourselves digitally.” And if you have no—or very few— resources to protect yourself? At a minimum, you need antivirus protection, and you must understand where all of your data resides, says Snell. “Determine what data you have— where is it and what is the exposure. 38

AUGUST 2021 | O&P ALMANAC

If you have any resources at all, focus it on the things where you have the greatest exposure. … Take it offline, or at least make sure you have backups … so you don’t lose everything” if a breach occurs. “Ideally, you want to have a firewall,” but it’s just as important that a staff member understands how the firewall works, she adds. Snell says it may take an expert consultant to determine exactly where and how an O&P practice is most vulnerable to ransomware or phishing schemes. But the question isn’t “if” you are vulnerable. “Everyone is vulnerable,” she says, adding that HHS’s HIPAA guidelines offer toolkits to help small providers assess their data. “Hospitals get hacked, individual O&P practices have been hacked. No one is immune. The question is: Are you easy pickings, or are you going to require a lot of effort?”

Exploring Insurance Options

While no amount of preemptive spending can ensure 100 percent protection against cyberattacks, cyber insurance offers significant peace of mind if a successful incursion does occur. Don Foley, a longtime healthcare industry insurance specialist at Cailor Fleming Insurance, says the averagesized O&P company—with seven or eight employees and approximately $1 million in annual sales—typically spends less than $5,000 annually for liability and property insurance, unless the real estate holdings are

extensive. A cyber policy with a $1 million limit for a company this size costs around $1,500 a year, Foley says. He estimates that only 25 percent of U.S. O&P companies hold cyber insurance. Cailor Fleming, as a matter of course, now adds $100,000 to every liability policy it issues. Other insurers also offer similar baseline coverage. “It’s an automatic addition, but it is not the best,” Foley concedes. “The average claim is about $250,000. So, that’s not going to cover it. And most of these policies don’t cover social engineering. This is an important point, and this is why companies ought to have a standalone cyber policy, because it is much more comprehensive. And it has a much higher limit of insurance.” In addition to covering social engineering breaches, a good cyber policy will pay for legal representation, the cost of hiring a public relations firm to restore donor confidence or mitigate negative publicity, computer forensics specialists, required legal notices, credit monitoring and a call center for victims to seek recourse, and more. “And last but not least, is business interruption,” Foley says. “If you’re shut down for a week, and you lose all the profits for that week ... the carrier will reimburse you all the profits that you lost.” A lot of O&P owners believe they have adequate cyber insurance, but the fact is most don’t. “That may be part of the reason why they’re not buying it,” Foley says. “They just don’t think it’s that important just yet.” Being adequately prepared for a data breach and possible ransom demands is part of the new normal of doing business, so O&P facilities must be prepared—with insurance as well as other preventive measures. “I obsess over this,” Snell says. “It’s seriously important. We must be concerned about our patients, and the trust our patients place in us to protect their information.” Michael Coleman is a contributing writer to O&P Almanac.


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Celebrating 25 Years of

Thranhardt Awards

PAST THRANHARDT HONOREES WILL CONVENE IN BOSTON TO MARK A QUARTER-CENTURY OF CUTTING-EDGE PRESENTATIONS

A

ONE-OF-A-KIND MEETING OF

elite O&P researchers will take place when AOPA celebrates the 25th anniversary of the Thranhardt Awards during the National Assembly in Boston. Dozens of O&P professionals who have been winners of the Thranhardt Lecture Series—an award established by J.E. Hanger Inc. in 1995 in memory of Howard R. Thranhardt recognizing individuals committed to advancing orthotic and prosthetic research and education—will be honored during the Howard R. Thranhardt Award 25th Anniversary Celebration and Luncheon Friday, September 10. H.E. “Ted” Thranhardt, CPO(E) Often described as a man ahead of his time, Howard R. Thranhardt spent his career advocating for O&P education and research before most other stakeholders understood the value of investing in those areas. “Education of the field, not only at home but also abroad, was very important to my father,” says H.E. “Ted” Thranhardt, CPO(E), Howard’s son, and a past president of AOPA, the American Academy

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of Orthotists and Prosthetists, and American Board for Certification in Orthotics, Prosthetics, & Pedorthics. Given Howard’s background (see sidebar on page 41), it’s no surprise that the presentations shared by winners over the past 25 years at AOPA and Academy meetings have been of the highest caliber, and in many cases have provided evidence for the value of specific orthotic and prosthetic components and interventions. “The Thranhardt Awards are associated with the best, most interesting presentations in the field,” says Jason Kahle, MSMS, CPO, FAAOP, a past award winner (1998, 2002, and 2012). Each year, the Thranhardt sessions boast “a room full of the best O&P scientific minds.”

An Evolution in O&P Research

A look back at the presentations honored with Thranhardt Awards over the past quarter-century demonstrates a steady progression in O&P research. “It has been exciting to see the evolution of research in O&P, as in many ways, [the award] has reflected the changes of O&P from a device-oriented industry to a patient-care industry that is heavily embedded within the rehabilitation team,” explains Shane Wurdeman, MSPO, PhD,


CP, FAAOP(D), director of clinical research at Hanger Clinic and AOPA research chair, and a Thranhardt Award winner in 2014, 2019, and 2021. Some of the first presentations were simple case studies, but more recent presentations are based on randomized clinical trials or systematic reviews. “We’ve raised the bar as a profession and as a scientific community,” adds Kahle.

Jason Kahle, MSMS, CPO, FAAOP “The quality of research has increased significantly over the past decade,” agrees Andreas Hahn, MSc, PhD, corporate vice president of clinical research and services at Otto Bock Healthcare Products GmbH, and a Thranhardt Award winner in 2014 and 2019. Hahn also is a nominee this year. “The cohorts become larger, the study designs and the analysis more sophisticated. All research topics are well-selected, providing a great oversight over the field. It is also fantastic to see how new talents get and use their chance to present their work.”

Andreas Hahn, MSc, PhD

The inaugural Thranhardt Awards were presented to Donald Shurr, CPO, during the 1996 AOPA National Assembly in Cincinnati and the 1996 Academy Meeting in Orlando. His presentations on “Physiological Measurements of Gait During Walking and Running in Transtibial Amputees” and “Flex-Foot Vs. SACH Foot” marked a turning point in the emphasis put on O&P research. Shurr, who had expertise in both physical therapy and O&P, was affiliated with the University of Iowa Department of Orthopaedics

Honoring a Pioneer in O&P Education The annual Thranhardt Lecture Series was created in 1995 in memory of Howard R. Thranhardt, CP, recognizing individuals committed to advancing orthotic and prosthetic research and education. The first awards were bestowed in 1996 at the AOPA National Assembly in Cincinnati and the Academy Annual Meeting in Orlando. They are presented annually in the spirit of providing education and information to the O&P field—a priority for the man for whom the awards were named. As a young man, Howard never intended to pursue the O&P profession, and instead he studied general education and physical education in college—eventually earning a master’s degree in education, according to his son, H.E. “Ted” Thranhardt, CPO. However, when Howard’s brother-in-law, Daniel A. McKeever, CP, was called to active duty as a first lieutenant during World War II, Howard’s mother-in-law asked him to run the family O&P business in downtown Atlanta. Howard heeded the call and stepped in to manage J.E. Hanger (Hanger Southeast). He became a national leader in O&P during the post World War II period, emphasizing research and expanded learning to elevate the field. “He championed, early on, education in the field,” says Ted, who will be in Boston for the celebration. “My dad came into this business not knowing the craftsmanship, but he had studied anatomy, kinesiology, and biomechanics” as part of his physical education training. The elder Thranhardt pushed for education and for policies and procedures to be documented and shared among the profession. “He felt strongly that we needed a written base of knowledge,” explains Ted. He applauded any attempt to write down and teach an O&P curriculum, and he offered free education to employees at his own company. Howard got involved with the Committee on Prosthetics Research and Development and helped secure funding for prosthetics research and education, then pushed for the first O&P short-course programs at New York University and University of California—Los Angeles to develop written documentation for clinical training. He also was among the early supporters who contributed to the success of Northwestern University’s Prosthetics-Orthotics Center. Howard served the industry associations, including tenures as president of AOPA (1975-1976) and American Board for Certification in Orthotics, Prosthetics, & Pedorthics (1960-1961). He also spent time “traveling the world” in his quest to elevate the profession. “He helped establish rehab programs” in Egypt, Pakistan, Cuba, Venezuela, and Argentina, according to Ted. He also sought to “bring ideas and technologies back” from other countries to improve patient care in the United States. Ted points to this quote from A. Bennett Wilson Jr. about his father, published in his obituary in Prosthetics and Orthotics International: Howard “perhaps more than anyone else in the United States has contributed to the transition of prosthetics and orthotics from a craft to a profession.” Given his influence, it was only natural to create a legacy of advancing O&P research and education by establishing the Thranhardt Award.

O&P ALMANAC | AUGUST 2021

41


and sought to grow and elevate O&P educational offerings. By the time he was recognized with the awards, “I had published a lot of papers with PTs and doctors,” and had come to recognize that more O&P clinicians should delve into research, he says. Shurr believes the Thranhardt Award was instrumental in motivating prosthetists and orthotists to try their hand at clinical research—starting with answering clinical questions at a low level. “The award provided a push to convince CPOs they could do research, and influenced O&P schools to incorporate research into their curricula,” he says. “I was very honored to be nominated as a Thranhardt lecturer, and I was glad to show other people that CPOs could do this. And that’s made an impact on the care we provide patients.”

Donald Shurr, CPO

on the “hot topic” of microprocessor knees (MPKs). By providing evidence that MPK technology helped reduce falls by 64 percent and stumbles by 59 percent, Kahle contributed to the decision by payors to reimburse for the more effective devices.

Brian Hafner, PhD

Being honored with Thranhardt Awards has been fulfilling to Kahle. “I’m proud of my research—you put a lot of time, effort, and money into these studies, so having the forum [at the AOPA and Academy meetings] and recognition from peers is great,” he says. He makes it a point to attend the Thranhardt sessions, even when he’s not a nominee. “You always learn something.”

A Unique Forum Kahle, a five-time nominee and three-time winner, agrees that the transformation of the types of presentations selected over the years demonstrates how far the O&P field has advanced. He spent the early part of his career as a clinician, engaging in research on the side; he also spent time in academia and now serves as CEO of OP Solutions in Tampa, Florida, a company that offers clinical resources for the O&P community. His Thranhardt presentations were designed “to put some evidence behind” untested hypotheses about the efficacy of new O&P interventions. Kahle’s 1998 presentation studied the value of pin systems and silicone in sockets compared to more traditional sockets; and in 2002, he studied the benefits of newer ischial containment sockets compared to conventional quad sockets. In 2005, his presentation (which was nominated but did not win that year’s award) was the first of several important studies focusing 42

AUGUST 2021 | O&P ALMANAC

Past Thranhardt recipients are grateful for the opportunity to present their research at the AOPA and Academy venues, surrounded by their colleagues. “The Thranhardt Award is an incredible recognition of one’s work,” says Hahn. “The Thranhardt lecture offers a very special platform to stimulate insight and discussion.” “There aren’t a lot of ways where [O&P] investigators can be singled out for exceptional work, so it means a lot” to be recognized with a Thranhardt nomination or award, says Brian Hafner, PhD, a professor at the University of Washington (UW) and UW’s Center on Outcomes Research and Rehabilitation. Hafner was nominated four times and received the Thranhardt Award in 2006 and 2013. Because the awards are presented during general sessions, “you have the whole audience there” when presenting your study to AOPA National Assembly or Academy meeting attendees. The annual award presentations also serve to motivate attendees to

strive for excellence, says Wurdeman. “I recall attending my first Thranhardt lecture,” as an O&P student, he says. “In that environment, eager to learn as much as I could about the profession I was undertaking, I was enamored by the standard of excellence that was set by the Thranhardt lecture. For the lecture to have all audience attendance without competition made it very obvious that this was the research that was viewed by the profession as the work that would continue to advance O&P.” As young researchers make their mark on the O&P profession, earning the honor of Thranhardt nominee becomes an important goal. “One of my favorite things about O&P is the community, and within that community is an even smaller community of researchers,” says Wurdeman. “Being a part of that community, I have had the opportunity to interact with many previous Thranhardt recipients. The common thread I find across all of the O&P researchers is passion for their work, and a deep desire to help patients that require O&P care.”

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) As O&P stakeholders gather in Boston, many new memories will be made. The Thranhardt presentations will be part of the 25th Anniversary Celebration and Luncheon, attended in-person by many past honorees— with an introductory speech by Ted Thranhardt. He believes his father “would be delighted that we have the educational and research opportunities” available today. “He truly believed that education of the field—not only at home but also abroad—was the best way to improve patient care.” EDITOR’S NOTE: For a complete list of Thranhardt winners over the years, visit www.AOPAnet.org.


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REBUILD, RECONNECT, AND

REUNITE

AT THE ASSEMBLY EXHIBIT HALL

Meet the exhibitors, sponsors, and special events planned for the trade show floor during the 2021 AOPA National Assembly 2021 Title Sponsors...................... 46 Meet the exhibitors that have signed on as title sponsors for the 2021 AOPA National Assembly

Exhibitor Directory....................... 52 Access a complete, alphabetical listing of the exhibitors and their booth numbers

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AUGUST 2021 | O&P ALMANAC


I

F YOU ARE associated with the O&P

field in any way, the Exhibit Hall at the 2021 AOPA National Assembly is “the place to be” as stakeholders from the O&P community reunite in person. O&P professionals will appreciate the opportunity to navigate the trade show floor at the Hynes Convention Center as they mingle and catch up with colleagues—all while learning about latest and greatest products and visiting with representatives of manufacturing companies. The Exhibit Hall at the AOPA National Assembly in Boston serves as the headquarters for O&P professionals seeking to become “stronger together” as the O&P community gathers as one. Plan to spend plenty of time on the trade show floor September 9-11, browsing hundreds of exhibits and demonstrations. Meet up with old friends and forge new partnerships during the special events scheduled to take place on the Exhibit Hall floor throughout the Assembly—including lunch Saturday.

Don’t miss the Welcome to Boston Celebration, scheduled for 5:30 p.m. Thursday, September 9, where attendees will enjoy refreshments, door prizes, and more, while supplies last. In between visits to the trade show floor, you’ll be able to participate in top-notch education and learn about cutting-edge research in O&P. Attend the prosthetic, orthotic, pedorthic, technical, and business sessions to hear the latest clinical breakthroughs and to soak in practical tips to run your business in a more efficient, safe, and patientfriendly manner. With so many special events scheduled for this year’s truly meaningful AOPA National Assembly, plan to set aside several hours to browse the Exhibit Hall aisles, meet with representatives from exhibiting companies, and interact with like-minded O&P professionals from across the world. Keep these O&P Almanac pages handy as you navigate the conference.

EXHIBIT HALL HOURS THURSDAY

September 9 5:30 – 7:30 p.m.

FRIDAY

September 10 1:30 – 6 p.m.

SATURDAY

September 11 11 – 5 p.m.

DON’T MISS THESE SPECIAL EVENTS IN THE EXHIBIT HALL Welcome to Boston Celebration Thursday, September 9 5:30 – 7:30 p.m.

Lunch in Exhibit Hall Saturday, September 11 12:15 – 1:30 p.m.

CAN’T MAKE IT TO BOSTON? No problem! For those who cannot travel to Boston for the 2021 AOPA National Assembly, AOPA will bring the education to you—virtually— starting September 16 and available for 90 days. Plus, full conference attendees can access the education for up to 90 days post Assembly to earn and learn on their own schedule. SE TO-U EASYtal

r

o web p

O&P ALMANAC | AUGUST 2021

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2021 TITLE SPONSORS

Sponsors preview their exhibits and share their visions for the future of O&P

ALPS South LLC   BOOTH 205

www.easyliner.com Area of Specialty: Advanced gel-based prosthetic liners What are you most looking forward to at this year’s National Assembly? We are incredibly excited to be back at AOPA’s National Assembly in Boston this year. Although this past year has brought many challenges, we never stopped developing new solutions for the complex problems amputees face. Therefore, we are looking forward to connecting with the O&P community to share these new solutions, uncover and inspire new product solutions, and break the wide misconception that a low price point reflects low-quality products and value. Most importantly, we look forward to speaking with all attendees and becoming stronger together. 46

AUGUST 2021 | O&P ALMANAC

What will you be showcasing at your exhibit? We will be showcasing the significant value ALPS brings to the O&P community. Through research and innovation, cost-effective manufacturing strategies, and extreme production efficiency, we can design and deliver superior products for the least possible cost, providing maximum value to amputees, prosthetists, and orthotists worldwide. What changes do you expect to see in 2022 and beyond?   At ALPS, we aspire to be a leader of positive change within the O&P community. Our strong relationships with medical professionals and continuous dedication to research and development allow us to uncover needs that others may not be able to. With infinite production capabilities and top-grade staff focused on making lives better, we are confident that, as we move into 2022 and beyond, we will invent and deliver a wider variety of product solutions meant to solve the needs of even the most challenging cases.  


TITLE SPONSORS 2021

What are you most looking forward to at this year’s National Assembly? The BOC team is looking forward to seeing and reconnecting with colleagues, associates, and friends in the AOPA community.

Allard USA BOOTH 521

www.allardusa.com Area of Specialty: Ankle-foot orthoses (AFOs)

American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

What are you most looking forward to at this year’s National Assembly? Connecting with friends and business associates again not seen since before the COVID-19 pandemic. The opportunity to touch, feel, and learn about new products.

www.abcop.org Area of Specialty: O&P certification and accreditation

What will you be showcasing at your exhibit? We’ll share a live demo on customizing an Allard AFO. We will be showcasing Allard AFOs; Flow and 2½, short versions, the iFIT transtibial and new transfemoral, the new and improved SWASH, new central fabrication materials, and our expanding Smart Orthotic Treatment line. What changes do you expect to see in 2022 and beyond? We expect to see the ability to see and care for patients in person again. Another positive change would be that patients won’t continue to delay receiving medical care only to have their conditions worsen. We also expect to see the continuation of telemedicine in our industry. Hopefully, we will also see the continued use of technology for better outcomes, more research that supports the use of O&P devices, and better collaboration with reimbursement agencies so we can better care for our patients.

TABLETOP C1

What are you most looking forward to at this year’s National Assembly? We are looking forward to being able to reconnect in person with our credential holders and colleagues. What will you be showcasing at your exhibit? We’ll share certification and facility accreditation info and resources as well as a few friendly and familiar faces. What changes do you expect to see in 2022 and beyond? We expect to see continued advances in technology and accessibility.

What will you be showcasing at your exhibit? BOC will showcase our CMS-deemed accreditation for O&P providers and fitter certifications for professionals. What changes do you expect to see in 2022 and beyond? The public health emergency increased recognition for the important role of orthotists and prosthetists in the medical care ecosystem. It also confirmed that access to clinicians, care, and service is critical to positive patient outcomes. We expect to see a continued focus on patient outcomes and the need for the O&P communities to work together to define success and deliver for our patients.

Cailor Fleming Insurance    BOOTH 233

www.cailorfleming.com/specialty/ orthotics-prosthetics-insurance Area of Specialty: Insurance www.bocusa.org

Board of Certification/ Accreditation TABLETOP C5

www.bocusa.org Area of Specialty: Accreditation and certification

What are you most looking forward to at this year’s National Assembly? Cailor Fleming is bringing five people to the Assembly this year because we are very much looking forward to gathering with the industry in person, and we want to be prepared for presenting our newest and maybe biggest product O&P ALMANAC | AUGUST 2021

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TITLE SPONSORS 2021

yet, the AOPA Affinity Health Plan. Our brand-new Affinity Health Plan (AHP) will be more comprehensive (especially with O&P coverage) and more cost-effective than most group benefits plans. What will you be showcasing at your exhibit? We will showcase this new Affinity Health Plan, along with new cyber insurance products as well as new management liability (employment practices liability, or EPL) products. EPL covers sexual harassment, discrimination, and wrongful termination, among other things—it basically covers employers for any violations of employees’ civil rights. Good stuff, to say the least! What changes do you expect to see in 2022 and beyond? From an insurance standpoint, we anticipate better risk management, which will result in fewer claims and lower insurance premiums.

O&P Almanac TABLETOP C9

www.aopanet.org/publications/ op-almanac-magazine Area of Specialty: O&P news and information What are you most looking forward to at this year’s National Assembly? AOPA and O&P Almanac staff look forward to connecting with Assembly attendees and learning what’s top-ofmind for today’s O&P professionals. What will you be showcasing at your exhibit? The O&P Almanac booth will feature current and past issues of AOPA’s O&P Almanac magazine. Stop by to pick up a copy, learn about earning continuing education credits by reading, and sign up for our digital edition. 48

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What changes do you expect to see in 2022 and beyond? The O&P profession is changing quickly. As changes to the broader healthcare environment filter into O&P healthcare, O&P Almanac will share updates, interview key players, and disseminate the latest information to help you run your businesses successfully.

Össur Americas

     

BOOTH 219

www.ossur.com What are you most looking forward to at this year’s National Assembly? Community is the perfect word. Össur is looking forward to reconnecting, to looking to the future with the added wisdom and resilience gained through the past months. There is so much that has been accelerated and explored in technology and finding new ways to continue serving people safely, and sharing those lessons is an exciting opportunity. What will you be showcasing at your exhibit? We are celebrating the 50-year anniversary of our founding and look forward to toasting the future with friends new and far! We also are highlighting several new products and expanded services and look forward to sharing some transformational products in particular. What changes do you expect to see in 2022 and beyond?       The O&P industry has long been shaped by disruption, from the battles individuals wage for mobility to the broader pushes for access to care, closing the mobility gap with creative products, and finding new ways to maximize outcomes. We expect more of the same, with new ways to deliver care leading the way.

Ottobock        BOOTH 415

www.professionals.ottobockus.com Area of Specialty: Prosthetics, orthotics, fabrication What are you most looking forward to at this year’s National Assembly? Reuniting with colleagues from across the industry and showcasing how Ottobock continues to support our profession with new, innovative solutions for patients. What will you be showcasing at your exhibit? We are excited to unveil new products at this year’s show. We continued development efforts last year and will highlight these latest innovations in multiple categories, including feet, at our exhibit. What changes do you expect to see in 2022 and beyond? There’s a clear opportunity for the O&P profession to embrace the digitalization that has transformed other areas of healthcare. The products, services, and technologies of the future that allow seamless connectivity with patients and providers to achieve better outcomes and experiences are at our fingertips.


M E ET TH E

CONDUCTIVE TIP. Naked Prosthetics’ human touchscreen interface. Utilizing an innovative multi-material process, our new Conductive Tip couples with the body, allowing the end-user to interface with smartphones, tablets, and other touch-related systems with relative ease. This feature is now available as an option for all of our devices.

npdevices.com Natasha wears two MCPDrivers.

Naked Prosthetics: (888) 977-6693 | (360) 915-9724 | fax (360) 918-8619 | info@npdevices.com | npdevices.com © 2021 Naked Prosthetics. All rights reserved.


TITLE SPONSORS 2021

PROTEOR USA                   BOOTH 531

www.proteorusa.com Area of Specialty: Lower-limb prosthetics What are you most looking forward to at this year’s National Assembly? First and foremost, the team at PROTEOR USA is looking forward to seeing and touching base with all of our good friends throughout the O&P community live and in person. Aside from that, we’ve also been working hard developing several new lifechanging products and eagerly look forward to the National Assembly as a great opportunity to introduce these products to our friends and colleagues.

What will you be showcasing at your exhibit? July 1 saw the launch of the RUSH ROGUE® 2, our newest fiberglass foot. With its redesigned VSR, the RUSH ROGUE 2 offers increased vertical shock and rotation with a decreased overall product weight. We’ve also got Shockwave, our newest carbon-fiber foot from the Freedom Innovations collection. We’re most excited to showcase QUATTRO, our newest MPK. This knee has been causing quite a buzz, and we’re excited to showcase this at the National Assembly. What changes do you expect to see in 2022 and beyond? To see positive change in these times, products and services must adapt and evolve to meet the ever-changing needs of amputees worldwide. To best serve our community, PROTOER USA is committed to providing an expansive

product portfolio, offering the best options in O&P. A great product portfolio is essential but must also be backed up by the best clinical and technical support in order to reach the best possible outcomes.

Spinal Technology Inc. BOOTH 305

www.spinaltech.com Area of Specialty: Spinal orthotics What are you most looking forward to at this year’s National Assembly? I think the thing we are most looking forward to at this year’s National Assembly is being back in the company of all of our colleagues and offering our customers the education and technical support they expect from us. We also are looking forward to having our loyal customers help us celebrate our 30th year in business and as the leader in custom spinal orthotics. What will you be showcasing at your exhibit? Our knowledge! With our corporate headquarters only 60 miles south of Boston, we will have some of our best technicians in attendance to help answer all technical questions. And, with the Assembly located in Boston, we also can offer up our knowledge on all things Boston. What changes do you expect to see in 2022 and beyond? I think as a whole the O&P community has grown quite a bit throughout the closures and lack of face-to-face meetings. With everyone becoming more comfortable with platforms like Zoom, GoToMeeting, and Skype, we are able to offer our technical support and training in a minute’s notice.

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KINGSLEY MFG. CO. COSTA MESA, CALIFORNIA, USA 949/645-4401 • 800/854-3479 (CA) 800/824-9704 • (FAX) 949/646-0805 E-MAIL: info@kingsleymfg.com


2021 EXHIBITOR DIRECTORY O

N THE FOLLOWING PAGES

is a look at the companies exhibiting at the 2021 AOPA National Assembly. You’ll find website information and booth numbers for each exhibitor. Use this guide to organize your visit to the Exhibit Hall.

Bold listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA). indicates the exhibitor is a Supplier Plus Partner with AOPA. indicates new exhibitor for 2021. Exhibitors as of July 28, 2021.

3D O&P Booth: 536 www.fikesbraceandlimb.com ACOR Orthopaedic Inc. Booth: 630 www.acor.com AliMed Inc. Tabletop: T90 www.alimed.com

Alps South LLC Booth: 205 www.easyliner.com Alternative Prosthetic Services Inc. Tabletop: T3 www.alternativeprosthetics.com

Allard USA Inc. Booth: 521 www.allardusa.com AllClaim by Ottobock Tabletop: T92 www.shop.ottobock.us 52

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American Academy of Orthotists & Prosthetists Tabletop: C3 www.oandp.org


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As an AOPA member, some of the benefits you’ll enjoy include: Strong, strategic advocacy for your O&P profession and patients Free Ask the Expert consultation for your coding, billing and audit questions Convenient access to earn CEs online, on-demand in AOPAversity

Built exclusively for members, ACCESS AOPA’s Affinity Health Plan launching in September.

Coding and billing tools and resources needed to support reimbursements, like the Co-OP Savings on professional liability insurance, educational events, and publications.

Running an O&P business is no easy feat, but you don’t have to do it alone. AOPA is here to help you.

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Plus, as a member you’ll SAVE UP TO $300 per attendee on a basic registration for 2021 National Assembly.

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EXHIBITOR DIRECTORY 2021

Comfort Products Inc. Booth: 299 www.comfortoandp.com Corflex Global Tabletop: T11 www.corflexglobal.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) Tabletop: C1 www.ABCop.org American Central Fabrication Booth: 614 https://certifiedlimbandbrace.com/ american-central-fabrication American Prosthetic Components LLC Booth: 616 www.americanprostheticcomponents. com

Board of Certification/Accreditation (BOC) Tabletop: C5 www.bocusa.org

C-Pro Direct Booth: 194 www.c-prodirect.com

Bremer Group Company, The Booth: 711 www.bremergroup.com

Curbell Plastics Inc. Tabletop: T8 www.curbellplastics.com

Bulldog Tools Inc. Tabletop: T1 www.bulldogtools.com

Cypress Adaptive LLC Booth: 400 www.cypressadaptive.com DAW Industries Inc. Booth: 312 www.daw-usa.com DJO Global/Dr. Comfort Booth: 200 www.DrComfort.com

Anodyne Booth: 632 www.anodyneshoes.com

Aspen Medical Products Booth: 627 www.aspenmp.com Becker Orthopedic Appliance Co. Booth: 315 www.beckerorthopedic.com Bionic Prosthetics & Orthotics Group LLC Booth: 624 www.bionicpo.com Blatchford Inc. Booth: 421 www.blatchfordus.com

Cailor Fleming Insurance Booth: 233 www.cailorfleming.com Cascade Orthopedic Supply LP Booth: 617 www.cascade-usa.com CBS Medical Billing & Consulting LLC Booth: 197 www.cbsmedicalbilling.com Coapt LLC Booth: 500 www.coaptengineering.com College Park Industries Booth: 227 www.college-park.com Comb O&P Booth: 192 www.combscan.com

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Coyote Prosthetics & Orthotics Booth: 435 www.coyote.us

Boston Orthotics & Prosthetics Booth: 641 www.bostonoandp.com

Amoena USA Corp. Booth: 725 www.amoena.com

Apis Footwear Company Booth: 542 www.emeys.com

Covvi USA Inc. Tabletop: T94 www.covvi.com

Drew Shoe Corp Booth: 715 www.drewshoe.com Epoch Medical Tabletop: T72 www.epochmedical.com Fillauer Booth: 427 www.fillauer.com FLO-TECH® Orthotic & Prosthetic Systems Inc. Booth: 188 www.1800flo-tech.com Friddle’s Orthopedic Appliances Inc. Tabletop: T71 www.friddles.com Glaze USA Inc. Tabletop: T95 www.glazeprosthetics.com Grace Prosthetic Fabrication Inc. Booth: 199 www.gpfinc.com


EXHIBITOR DIRECTORY 2021

Hitek Fab Booth: 727 www.hitekfab.com HYMED Technology Co. Booth: 719 www.hymedtech.com

Adjustable Post-Op Preparatory Prosthetic System ® APOPPS

From Post-Op to Preparatory

Impulse Technology LLC Tabletop: T18 www.impulse-technology.com Integrum Booth: 334 www.Integrum.se International Institute of Orthotics and Prosthetics Tabletop: C7 www.iiofoandp.org

Trans-Tibial

FLO-TECH-TOR™ 2020 Patent Pending

Anatomically Engineered Side Specific

When your Patient is ready

Invent Medical USA Booth: 240 www.inventmedical.com

for Early Ambulation

Kinetic Research Inc. Tabletop: T66 www.KineticResearch.com KISS Technologies LLC Booth: 622 www.kiss-suspension.com

Most Effective

KLM Laboratories Booth: 187 www.klmlabstore.com

for Convalescing Patients

Knit-Rite Inc. Booth: 613 www.knitrite.com LaunchPad O&P Tabletop: T89 www.launchpad-op.com

Comprehensive

LegWorks, Inc. Tabletop: T96 www.legworks.com

Rehabilitation

Limbs for Life Foundation Tabletop: C6 www.limbsforlife.org Lindhe Xtend Inc Booth: 717 www.lindhextend.com Livinguard Inc. Tabletop: T93 www.livinguard.com MD Orthopaedics Booth: 610 www.mdorthopaedics.com

Management Trans-Tibial Preparatory

Trans-Femoral Preparatory

VCSPS™ & UFOS™

FLO-TECH-TOR™ & UFOS™ O & P Systems, Inc.

www.1800flo-tech.com

1-800-FLO-TECH (356-8324) O&P ALMANAC | AUGUST 2021

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EXHIBITOR DIRECTORY 2021

Mecuris GmbH Booth: 191 www.mecuris.com Mile High Orthotics Labs Booth: 713 www.mholabs.com Monetek LLC Booth: 522 www.monetek.com Naked Prosthetics Booth: 195 www.npdevices.com

Orthotic & Prosthetic Group of America (OPGA) Booth: 327 www.opga.com Orthotic Holdings OHI Booth/Tabletop: 520 www.ohi.net Osseointegration International Inc. Booth: 241 www.osseointegration.org

PROTEOR USA Booth: 531 www.proteorusa.com

NCOPE Tabletop: C2 www.ncope.org

PSYONIC Booth: 242 www.psyonic.io

New Step Orthotic Lab Inc. Tabletop: T88 www.newsteporthotics.com Nymbl Systems Booth: 433 www.nymbl.healthcare.com

Pro-Tech Orthopedics Booth: 196 www.protech-intl.com

Ossur Americas Inc. Booth: 219 www.ossur.com/en-us

PVA Med Booth: 189 rapidplaster.pva.net rcai Booth: 185 www.rcai.com Roam Robotics Tabletop: T14 www.ascend.health Rodin 4D Booth: 342 www.rodin4d.com

O&P Almanac Tabletop: C9 www.AOPAnet.org

Ottobock Booth: 415 shop.ottobock.us

OPAF and The First Clinics Tabletop: C8 www.opaffirstclinics.org

Paceline Inc. Tabletop: T73 www.paceline.com

OPIE Software Booth: 519 www.opiesoftware.com

PEL Booth: 311 www.pelsupply.com

Orfit Industries America Tabletop: T69 www.orfit.com

Phoenix Molded Shoes, Inserts, and Braces Tabletop: T12 www.phoenixmolded.com

Orthobroker BV Booth: 707 www.orthobroker.com www.orthosolid.com Orthomerica Products Inc. Booth: 525 www.orthomerica.com

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Pine Tree Orthopedic Lab Tabletop: T68 www.pinetreeorthopedic.com Point Designs Booth: 612 www.pointdesignsllc.com

Royal Knit Inc. Tabletop: T10 www.royalknit.com

Spinal Technology Inc. Booth: 305 www.spinaltech.com SPS Booth: 405 www.spsco.com ST&G USA Corp. Booth: 721 www.stngco.com


Think she’s worrying about wearing a Scoliosis brace at school? Dream On. The Providence Nocturnal Scoliosis® Orthosis is worn while the patient sleeps, which maximizes compliance. It lets kids... be kids.

Visit us at AOPA 2021 booth #305

Out of Brace (Standing)

A past study has shown that the Providence brace, a spinal orthosis worn only at night, is just as effective in the treatment of adolescent idiopathic scoliosis as full-time braces. That's important for two reasons; the human growth hormone (HGH) in Send your orders to: orders@spinaltech.com Call us for more information: 800 253 7868

children has been shown to peak at night, and compliance increases when spinal braces don't interfere with a child’s daytime activities. Spinal Technology is proud to be the exclusive manufacturer of the Providence Nocturnal Scoliosis® System. Follow us @spinaltechnologyinc

In Brace (Supine)


EXHIBITOR DIRECTORY 2021

SteeperUSA Booth: 621 www.steeperusa.com

Thermo-Ply Inc. Booth: 442 www.thermoplygel.com

Vorum Booth: 333 www.vorum.com

Steps of Faith Foundation Tabletop: T7 www.stepsoffaithfoundation.org

Tillges Technologies Booth: 731 www.tillgestechnologies.com

VQ OrthoCare Tabletop: T6 www.vqorthocare.com

SureStep Booth: 319 www.surestep.net

Top Shelf Orthopedics Booth: 183 www.topshelforthopedics.com

Waystar Booth: 615 www.waystar.com

Tamarack Habilitation Technologies Inc. Tabletop: T9 www.tamarackhti.com

Townsend Design (Thuasne USA) Booth: 609 www.thuasneusa.com

WillowWood Booth: 423 www.willowwood.com

Techmed 3D Inc. Booth: 625 www.techmed3d.com The ALLELES Design Studio Ltd. Booth: 235 www.alleles.ca The O&P Edge / Amplitude Tabletop: T4 www.opedge.com

Turbomed Orthotics Inc. Booth: 626 www.turbomedorthotics.com Ultraflex Booth: 193 www.ultraflexsystems.com US ISPO Tabletop: C4 www.usispo.org VitalFitSR Booth: 499 www.vitalfitsr.com

Welcome to AOPA Connection, the one-stop-shop for all things AOPA. Logging into AOPA Connection you will instantly have access to all your AOPA benefits, including: • AOPAversity • Your Membership Record • Your Individual Profile • Event Calendar • Bookstore • Co-OP But, it doesn’t stop there! We are pleased to introduce a new benefit accessible through AOPA Connection, My O&P Community. In this online community of your O&P colleagues you can get guidance, share advice, have one-on-one and group conversations, and access resources.

FOLLOW US @AmericanOandP

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MyAOPAConnection.org


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PRINCIPAL INVESTIGATOR

Enhancing Solutions for Wounded Service Members DoD researcher seeks to improve care for wounded soldiers— immediately after injury and throughout rehabilitation

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

AUGUST 2021 | O&P ALMANAC

. LEE CHILDERS, PhD, CP, has

combined his interest in O&P with his respect for the U.S. military in his career as a senior scientist for the Department of Defense/Veterans Affairs’ Extremity Trauma and Amputation Center of Excellence (EACE) at the Center for the Intrepid (CFI), Brooke Army Medical Center, in San Antonio. He recalls being drawn to both pursuits when he was just a fifth grader. “I was originally introduced to O&P through reading the book ‘Reach for the Sky’ by Paul Brickhill about a World War II flying ace named Douglas Bader with bilateral amputations,” he says. “Seeing that someone could return to duty as a pilot after amputation inspired me to learn more.” After studying engineering and all things “mechanical and fast,” including airplanes, bicycles, and race cars, as an undergrad, he came to a crossroads. “After graduating from Southern Polytechnic State University, my best friend and I rode our bicycles across Europe,” Childers explains. Traversing Belgium and northern France—and seeing graveyard after graveyard of World War I and World War II soldiers—he felt a calling to

help those service members who made it back home. “At the time, I just didn’t know how,” he recalls. When he returned to the United States, he started a career in National Hot Rod Association top fuel drag racing. While working on the pit crew, Childers was introduced to Reggie Showers, a pro-stock motorcycle rider, and his sponsor, Tracy Slemker, at Prosthetic Design Inc. “Through my interactions with them—combined with what I had seen in Europe—I decided to change my career path and go back to school to study prosthetics and orthotics.” He followed a master’s in O&P with a doctorate in applied physiology from Georgia Tech, then completed a prosthetic residency at the Hanger Clinic in Atlanta. “I enjoyed clinical practice,” Childers recalls. “Watching someone walk again for the first time is incredibly rewarding. Yet, I was still unfulfilled.” Through clinical practice, Childers saw how policy decisions impact clinical care and how research can influence policy. “I wanted to have broader impact, and this led me to research— and I haven’t looked back since.”

PHOTO: W. Lee Childers, PhD, CP

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PRINCIPAL INVESTIGATOR

Reassessing Research Goals

While Childers believes his most significant research work is yet to come, he has played a role in both small and large projects that have had impact. “My work as a student laid the groundwork for how to best design the prosthesis or adapt the bicycle for people with amputation,” he says. “With some fantastic collaborators, I have been able to demonstrate that the relationship between prosthetic foot push-off and sound limb impact is not as straightforward as it may seem.” Before joining the DoD, Childers worked on a team with Alabama State University researchers studying the relationship between prosthetic foot multiaxial stiffness and dynamic stability to help better justify the use of those components for uneven terrain. He partnered with Aaron Young, PhD, at Georgia Tech, developing advanced control systems for powered knee/ankle systems. He also served as the prosthetist on an osseointegration animal study, “where we made the prosthetic

OPAlmanac_Aug2021.indd 2

feet for a powered system that was directly tied into the animal’s nervous system,” a project Childers describes as both interesting and influential. At the DoD, Childers is currently involved in several projects that promise to significantly affect the O&P profession. He is working with David Morgenroth, MD, at the Seattle VA, and Andrew Hansen, PhD, at the Minneapolis VA, studying a prosthetic foot emulator that “continues to demonstrate the successful ability to ‘test drive’ different prosthetic feet.” He also is conducting exoskeleton work, developing new ways to manage fractures and enable mobility, and studying residual limb health to enable more people to use their prostheses for longer periods of time. In addition, Childers assisted Chad Duncan, MD, in building the MSPO program at Alabama State University. “That program is still going strong,” he says, “and I know graduates of that program will continue to make significant

impact through our profession.” Childers says he recently changed his outlook on how the DoD’s research program could best serve service members after seeing a landmark DoD briefing. “There is an expectation that our country will not have the air superiority in future conflicts with a peer or near-peer adversary,” he explains. “This drastically changes the paradigm for how we will care for our wounded. Lack of air superiority means we will not be able to evacuate our wounded within the ‘golden hour’ as we have done in the past while requiring our units to remain mobile so they may evade adversarial airstrikes. “The need to keep people mobile so that they may come home has been a major driver of the development of our new research initiative to develop exoskeletal systems that can be applied in the battlefield to stabilize a lower-limb fracture and enable mobility until the service member may be evacuated,” he explains. Childers is working on two

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PRINCIPAL INVESTIGATOR

major efforts in this space: “One is to develop field-improvised exoskeleton solutions that a combat medic can build out of materials currently available to them in the field,” he says. “The second is a ground-up development that will advance fracture orthoses to whole new levels as we rise to meet this challenge.” Childers also emphasizes the importance of ensuring injured service members have access to superior care once they return from conflict and are treated at CFI: “Our research focus to advance care for people with an amputation will be centered around keeping the residual limb as healthy as possible within the prosthetic socket.”

He sees a similar opportunity for growth regarding outcome measures. “There are multiple outcome measures based on patient report and functional testing. There is a lot of ongoing research now on which ones best predict which patient outcomes,” he explains. “Once that information is aggregated and published, what can be done to take this and develop clinical decision tools?” Other topics that have received less attention also should be explored, suggests Childers. He cites residual limb pain management and residual limb health within the prosthetic socket as two critical areas in need of further investigation. He also emphasizes the larger need to optimize the interface between the human and the device—whether that is a prosthetic socket, an open tibia fracture stabilized in an exoskeleton, or the skin/ bone and skin/implant interface for osseointegration. “These interfaces are extremely complex, very hard to understand, and when things go badly,

the patient loses their mobility,” he says. In addition, Childers believes that the psychology of disability and helping the patient through monumental change in their life—amputation—is another area worth investigating. “How do we design better treatments to help our patient overcome residual limb and/or phantom limb pain?” he says. “All of these areas have large impact into whether or not someone will even use their device, regardless of the latest and greatest technology that is being used.” EDITOR’S NOTE: The views expressed herein are those of the author and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, the Department of Defense, or the U.S. Government.

Notable Works Looking Forward

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• Bhakta, K., Camargo, J., Kunapuli, P., Childers, W.L., Young, A. “Impedance Control Strategies for Enhancing Sloped and Level Walking Capabilities for Individuals with Transfemoral Amputation Using a Powered Multijoint Prosthesis.” Military Medicine, 2020; 185 (Supplement 1), 490-499. • Childers, W.L., Takahashi, K.Z. “Increasing Prosthetic Foot Energy Return Affects Whole-Body Mechanics During Walking on Level Ground and Slopes.” Scientific Reports, 2018; (1), 5354. • Childers, W.L., Prilutsky, B., Gregor, R.J. “Motor Adaptation in People With Unilateral Transtibial Amputation During Cycling.” Journal of Biomechanics, 2014; 47, 2306-2313. DOI: http://dx.doi.org/10.1016/j.jbiomech.2014.04.037. PMCID: PMC4076118. • Childers, W.L., Kistenberg, R., Gregor R.J. (2009) “Biomechanics of Cyclists With Transtibial Amputation: Recommendations for Prosthetic Design and Direction for Future Research.” Prosthetics and Orthotics International, 2009; 33(3) 256-271. EDITOR’S NOTE: The views expressed herein are those of the author(s) and do not reflect the official policy or positon of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, or the Department of Defense, or the U.S. Government.

PHOTO: W. Lee Childers, PhD, CP

Childers continues to work for better solutions in all aspects of O&P patient care. “I am a nerd, and I love what I do,” he says. At home, he may be passing his love of science down to the next generation—Childers enjoys watching his daughter, Sara, learn new things while she develops and tests her own scientific hypotheses. “I also enjoy camping, astrophotography, working on a race car being set up for the 24 Hours of Lemons [an endurance race for $500 cars], and my 1970 Plymouth ’Cuda,” he says. As he considers the current state of O&P research and future goals, Childers says that substantial work has been done regarding how people with amputation perform with different types of prosthetic feet. “I see enormous opportunity for research to start consolidating that information toward developing clinical decision tools,” he says.

W. Lee Childers, PhD, CP, has been involved in many important published studies, including the following:


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MEMBER SPOTLIGHT

Ortho Pro Associates Inc.

By DEBORAH CONN

Embracing the Culture in the Magic City Miami facility celebrates 30 years and a new building

T

ERRI SPARBER BUKACHESKI, CP, LP, became a prosthetist

in part because her father was an above-knee amputee. “He was very athletic,” she says, “and he inspired me to pursue a degree in therapeutic recreation.” Eventually, she went back to school and became a certified prosthetist. After a few years in the field, she launched Ortho Pro Associates in 1991. “When I was getting my degree at Northwestern, I was one of only two women in the [O&P] program,” Bukacheski says. She is one of the few women O&P business owners in South Florida, and she feels this is especially helpful when treating female patients with limb loss.

Alvarez works in the fabrication area of the 4,000-square-foot facility.

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University’s O&P program, completed his residency at Ortho Pro, and has been there ever since. Ortho Pro provides the full range of orthotic and prosthetic FACILITY: services, including pediatrics. The Ortho Pro facility has 12 employees, including Associates Inc. a third clinician, Nicholas Mata, MPO, CPO. The business recently OWNERS: moved into a 4,000-squareTerri Sparber foot facility in Miami, after the Bukacheski, CP, LP, neighboring hospital bought the and Aldo Alvarez, building they had been in for 28 years. Bukacheski and Alvarez MS, CPO, LPO worked closely with architects to design the new space. Their five LOCATION: patient rooms enjoy natural light Miami and hold 10-foot parallel bars, and the facility has a fully functional HISTORY: laboratory. The spacious waiting 30 years room can accommodate wheelchairs, walkers, and strollers. “That extra space in the waiting room was especially useful during the pandemic,” says Alvarez. Like other facilities, Ortho Pro shut down for two months at the beginning of the pandemic Bukacheski works with a lower-limb patient on but continued to the parallel bars.

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

PHOTOS: Ortho Pro Associates Inc.

Bukacheski’s co-owner, Aldo Alvarez, MS, CPO, LPO, answered an employment ad at Ortho Pro for a receptionist in 1996. “I was applying to medical school and wanted to beef up my résumé,” he says. Bukacheski gave him the opportunity to help out in the lab and observe the clinical practice, and Alvarez was hooked. Instead of medical school, he attended Northwestern

Aldo Alvarez, MS, CPO, LPO, and Terri Sparber Bukacheski, CP, LP, are the owners of Ortho Pro in Miami.

respond to emergencies. The facility reopened in May 2020, with half the staff working from home and only one practitioner at a time in the office. “Little by little, we all came back to work, following CDC guidelines and taking precautions,” says Alvarez. Ortho Pro’s patient base is “extremely family oriented, so that’s how we run our clinic,” adds Alvarez. “We get involved with our families, and when you do that, they will put their entire trust in you.” Some long-term patients first visited the facility as children 30 years ago, a testament to the community’s trust in the business. For its 25th anniversary, Ortho Pro held a huge outdoor barbecue in conjunction with Shake a Leg, a sailing and aquatics program for those with disabilities, with around 350 attendees. “We hope to do it again this year, if we can, to celebrate our 30th anniversary,” says Alvarez. In addition to local residents, Ortho Pro frequently sees patients from the Caribbean and Central and South America who visit the United States for services that may not be accessible in their own countries. Prepandemic, Ortho Pro conducted in-house prosthetic workshops for patients and occupational and physical therapists, as well as in-services in physical therapy (PT) and occupational therapy (OT) schools. The facility’s practitioners lecture at several local universities and host OT and PT students for their clinical rotations. Integrating into the community has been the mission for Ortho Pro. As the pandemic abates, both Bukacheski and Alvarez look forward to getting back out there, growing their relationships and their business.


AOPA Member Benefit

AOPA’s Co-OP is

THE Compendium of O&P A confluence of coding, billing, and policy information, the AOPA Co-OP provides a cooperative space for collaboration among O&P colleagues. This easily accessible, online resource enables your organization to be successful in today’s everchanging healthcare environment.

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

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MEMBER SPOTLIGHT

Orfit

By DEBORAH CONN

A Source for Thermoplastics

Manufacturer with multinational presence supplies advanced O&P materials

O

RFIT INDUSTRIES, WHICH MANUFACTURES thermo-

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processes, Orfit’s thermoplastic products are preferred by many O&P professionals, Hebert says. The company’s Orfitrans product line includes thermoplastic sheets for orthotic device COMPANY: and prosthetic socket fabrication. Orfit The products offer a range of flexibility, rigidity, and colors, as OWNERS: well as transparency; this enables The Cuypers Family prosthetists to observe pressure points or hollow areas caused by LOCATION: excess space between the socket Headquartered in and limb during test fittings. Wijnegem, Belgium Clinicians can make small local adjustments with a heat gun or HISTORY: easily adhere pads inside the socket 30 years to fill open spaces. In addition, the durability of the thermoplastics allows patients to benefit from longer evaluation periods, including in-home and community use. Several products come with Protect, a nanoparticle technology that offers advanced odor control and better wearing comfort by inhibiting the growth of bacteria, according to Hebert. The technology is embedded throughout the entire material, she says, so cutting, grinding, buffing, or drilling will not lessen its effect. Orfit has facilities throughout the world, including in Norfolk, Virginia, where a warehouse, situated near the docks,

Orfit offers a broad range of flexibility, rigidity, and colors in its thermoplastic products.

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

PHOTOS: Orfit

plastic materials, traces its origins to the development of low-melt thermoplastic back in 1958, which led to the introduction of high-temperature melting thermoplastic in 1987. Steven Cuypers, president and CEO, and his family launched Orfit in 1991 in Wijnegem, Belgium, just outside of Antwerp. This year marks a milestone as the Cuypers family and Orfit Industries celebrate the company’s 30th anniversary. “One thing that makes us unique as a thermoplastics company is that we have everything under one roof,” notes Amanda Hebert, CPO, product and educational specialist for orthotics and prosthetics. “Manufacturing, marketing, sales, and research and development are all based in Belgium, which allows us to maintain tight quality control.” Orfit serves three different industries: orthotics and prosthetics, physical rehabilitation, and radiation oncology. The company’s technology employs an extrusion process, rather than a press method, to create reliable medical-grade thermoplastics, according to Hebert. “Raw materials are used in our proprietary formulas that are mixed, heated, and pressed in the extruder under vacuum,” she explains. “Eventually, the material emerges as a long sheet that is later trimmed, which is specific for use in O&P.” Due to the inherent properties of the proprietary mix and the extrusion manufacturing

supplies North America with thermoplastics. The company sells its products in more than 100 different countries through several distribution channels. Orfit has beefed up its marketing and educational offerings to the O&P community, adding its own efforts to those of its distributors—including nine distributors that sell its products in North America. During the pandemic, the company launched an online educational channel called Orfit Academy, which offers continuing education credits to practitioners, technicians, and assistants in the United States and Canada. Orfit also initiated O&P-specific social media channels during the pandemic to help market products and educate those in the industry. “We are trying to do a much better job of educating and marketing to our middle users, the practitioners and technicians,” says Hebert. “Our direct customers are distributors, and the end users, of course, are patients.” Orfit launched several new products during the pandemic, including Orfitrans PETG, Orfitrans Stiff Protect, and Orfitrans Medium Soft Protect, and Hebert notes that education is key to their promotion and proper use. Eventually, Hebert says, Orfit will offer in-person trainings at national and regional meetings. The company also plans to have representatives accompany distributors to O&P facilities, with the potential to offer educational workshops. While the company is currently focused on education and marketing, Orfit may eventually refine and add to its existing products, says Hebert. “The next thermoplastic advancement may be just around the corner.”


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AOPA NEWS

Webinars

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information on specific topics during these onehour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to

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SEPT. 1

provide the most reliable business information and CE credits for your staff at a single office location. Visit www.AOPAnet.org/education/monthly-webinars for details and registration information.

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KO Policy: A Review

Log on for this in-depth review of the Knee Orthosis Local Coverage Determination and Policy Article. Review the documentation required for coverage, which addition codes may be used with each base code, when you must use the KX modifier, which braces require approval by the Pricing, Data Analysis, and Coding contractor, and more.

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NEW MEMBERS

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

Impulse Technology LLC 200 Innovation Blvd. State College, PA 16803 814/321-3710 Kamrun Nahar, PhD Education & Research Member www.impulse-technology.com

Comb O&P 13376 Ravenna Road Chardon, OH 44024 440/285-5785 Jonathan M. Naft, CPO Supplier Member http://combscan.com

J.L. Artificial Limb & Brace 1774 Highway 95 Bullhead, AZ 86442 928/234-7114 Jason Leal, CPO Patient-Care Facility Member

T

HE OFFICERS AND DIRECTORS of

HiTek LLC 222 Turner Blvd. St. Peters, MO 63376 636/387-7900 Jeremy Shaver Supplier Member www.hitekfab.com

Ferrier Coupler Options!

Mecuris GmbH Lindwurmstrasse 11 Munich, 80337 Germany 0114989200057300 Tara Nicoll International Member http://mecuris.com Professional Orthotic & Prosthetic Services LLC 919 Westport Place Manhattan, KS 66502 785/320-2320 Brandon Lee Smith, CP Patient-Care Facility Member http://www.popsks.com

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.

O&P ALMANAC | AUGUST 2021

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MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options.

THANK YOU

to our 2021 AOPA Supplier Plus Members for their continued support of the association.

AOPA 2021 SUPPLIER PLUS MEMBERS

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MARKETPLACE Immediate Fitting Lower Extremity Post-Op Care

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To learn more visit surestep.net or call 877.462.0711

www.vqorthocare.com O&P ALMANAC | AUGUST 2021

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MARKETPLACE ToeOFF® 2 ½ & BlueROCKER® 2 ½ Available

Now offering more Allard AFOs with half the heel height. All 2 ½ models include the 2.0 features you love: choice of wrap around or D-ring straps, shorter wings, and a Starter SoftKIT™ included. It is easier to adapt ToeOFF 2 ½ and BlueROCKER 2 ½ to shoes with lower heel heights because there is a lower forefoot curvature, and there is more space in the shoe toe box. ToeOFF 2 ½ addition models are available in camouflage, birch, and black for your fashion-conscious patients. Call 888/678-6548 or email info@allardusa.com to receive your free Product Selection Guide.

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Apis custom programs offer practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

Arizona Balance Brace (ABB) The Arizona Balance Brace (ABB) is the original balance brace and the only one clinically proven to reduce postural sway and increase postural stability. The ABB is a custom-made AFO designed to reduce the risk and incidence of falls in the elderly and high-risk populations. The ABB is best utilized in conjunction with a comprehensive fall prevention protocol which may include strength training, certain environmental changes in the home, physical therapy, and other related specialties. For more info, please visit www.ArizonaAFO.com.

Small Adult Triple Action® The ALPS VIP is an air expulsion integrated pump for elevated vacuum for prosthetic socket. The use of VIP provides patients continuous total contact when donning the prosthesis. This is essential for an even weight distribution and to distribute the suspension of the prosthesis over the whole surface of the residual limb. Elevated vacuum created by the VIP stabilizes the residual limb, overcoming all issues connected with the residual limb changing volume during the day. To learn more, visit our website, www.easyliner.com, or call us today at 800/574-5426.

The new Small Adult Triple Action offers true independent adjustment of alignment, range of motion, and stiffness to promote natural, dynamic motion control throughout the gait cycle. Indications: • Stroke • Multiple sclerosis • Cerebral palsy. For additional information, please contact our customer service department at 800/521-2192 or visit BeckerOrthopedic.com.

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MARKETPLACE Boston Orthotics & Prosthetics eLearning Center

Boston Orthotics & Prosthetics eLearning Center is pleased to offer seven online courses. You can take advantage of this new training option from anywhere, including your home. With our new eLearning Center, you can stay connected with the most up-to-date technology and techniques with Boston O&P. Students, residents, certified orthotists, physical therapists, and other allied health professionals are welcome to register for our courses. CEUs are provided upon completion of the course. Questions? Contact Jim Wynne, CPO, FAAOP, at jwynne@bostonoandp.com. To gain access to our eLearning courses, simply use the following link: https://www.bostonoandp.com/ for-providers/education-and-training/online-training.

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

Coyote Has a New Robust Easy-Off Lock Design

Coyote’s Easy-Off Lock is a lever-action airtight pin system giving dual-suspension pin security with the comfort of suction, it also works with elevated vacuum mechanisms. Coyote has improved the Easy-Off Lock with a new robust lock plate and lever design. Its patented lever mechanism makes doffing easy for amputees with hand strength issues. The airtight seal of the Easy-Off Lock prevents air from entering the bottom of the socket by creating negative pressure inside the socket (suction), which reduces pistoning even without a sleeve. This lock is also water-resistant. For more information, contact Coyote at 208/429-0026 or visit www.coyote.us.

Vista Ankle The Vista Ankle is a universal single-axis prosthetic ankle joint designed for elevated vacuum applications. The vacuum is generated from the ankle movements of plantarflexion and dorsiflexion during the gait cycle. The barb fitting for the vacuum hose connection is located inside the proximal tube clamp of the ankle, protecting it from damage. The distal female pyramid adapter is compatible with a wide range of prosthetic feet. The Vista Ankle is cost effective, low maintenance, and lightweight (13 oz/385 g) and has a weight limit of 275 lbs/125 kg. For more information, contact us at www.cypressadaptive.com, 888/715-8003.

The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com. O&P ALMANAC | AUGUST 2021

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MARKETPLACE AllPro DS

New and Improved EZ Stride APO for 2021! Built on the AllPro distal mount platform, the AllPro DS combines the shock absorption, energy return, and ground compliance of the AllPro with the added shock and 60-degree rotation of the DuraShock. This foot is ideal for the K3 and low K4 portion of the AllPro population with the exception of those that run long distances on a regular basis. Visit www.fillauer.com for more information.

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

New and improved EZ Stride APO for 2021! • Optional five-year warranty • Trimmable footplate • High-gloss finish • Washable liner-strap combo • Tibia tuberosity relief. Contact O&P Solutions (formerly Spinal Solutions) at spinalsolution@mindspring.com , call 800/922-5155, or fax 800/813-8139. For more information, visit http://spinal.solutions or http://oandpsolidarity.com.

Introducing the New Taleo Side Flex

Naked Prosthetics

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to preforming activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com. 76

AUGUST 2021 | O&P ALMANAC

More than a foot, a foundation. The new Taleo Side Flex was designed for active individuals who navigate varied indoor and outdoor environments and place a high value on effortless walking and a high degree of socket comfort on uneven services. The Terrain Adaptation Unit provides mediolateral adaptability of 20 degress (10 degrees medial and 10 degrees lateral) for immediate and full-surface ground contact while walking and standing, including on uneven surfaces and slopes. The Taleo family allows your patient to be ready for everyday life. For more information, visit www.professionals.ottobockus.com or talk to your sales rep.


MARKETPLACE Put Patients First with Kenevo®

PDI 3D Central Fabrication

The 4th Gen Squirt Shape 3D Printer is now available for purchase! Meet your lower mobility patients’ unique needs with the Kenevo® microprocessor knee. Since its launch in 2015, the Kenevo® has fundamentally changed prosthetics for those who need a high level of stability due to mobility limitations. With key features such as Stumble Recovery Plus, supported sit-to-stand and stand-to-sit functions, consistent swing release with irregular gait and use of walking aids, Kenevo provides unmatched security and support to those who need it most. For more information, visit www.professionals.ottobockus.com or talk to your sales rep.

RUSH ROGUE® 2 The newly redesigned, PDAC-verified RUSH ROGUE® 2 provides the most realistic and dynamic foot and ankle motion available. The Vertical Shock & Rotation (VSR) vertical shock relief up to 4.24 mm while offering +/- 15 degrees torsion, allowing the user to push the foot and themselves to the limits. The RUSH ROGUE® 2 is made of our advanced fiberglass composite which is three times more flexible than conventional prosthetic feet. The roll-through characteristics of the foot provide exceptional energy return with no “dead spot.” The RUSH ROGUE® 2 is also available in the PDACverified EVAQ8 elevated vacuum and H2O models. For more information, visit www.proteorusa.com.

Test sockets, definitive socket, custom liners, and more! Deliver quicker, with a 24-hour socket turnaround. Have a difficult fit or extreme size? Don’t struggle with fabrication, let us print a check or definitive socket for you. Email: fab@prostheticdesign.com Call for a quote today! 1-800/459-0177

800/459-0177 | WWW.PROSTHETICDESIGN.COM

Spinal Technology Inc.

Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit www.spinaltech.com. O&P ALMANAC | AUGUST 2021

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MARKETPLACE The Xtern Foot Drop AFO by Turbomed Orthotics

Introducing WillowWood META Arc and META Shock

Think outside the shoe! This one-of-a-kind orthosis (AFO) is a game changer for foot drop patients: The Xtern is totally affixed outside the shoe to maximize comfort, and prevent skin breakdown and rubbing injuries. Its flexibility promotes maximal ankle range of motion and calf muscle strength. The Xtern allows running, walking, and even mountain hiking as long and as far as you want without any restrictions, and moves from sandals to boots flawlessly. Turbomed’s innovative products are designed in Quebec, Canada, sold in over 26 countries, and distributed by Cascade in the United States. Visit turbomedusa.com to get your life back!

Discover the amazing, and expanding, META family of products from WillowWood. The groundbreaking META Arc combines the first-ever unibody foot design with the first-ever polycentric ankle. It’s the ultimate in performance, adaptation, and stability. Learn more about META Arc at meta-arc.com. The META Shock brings the same breakthrough unibody design together with maximum deflection, minimum build height, and responsive absorption for one dynamic shock absorbing foot. Learn more about META Shock at meta-shock.com. Go Beyond. Go META.

AD INDEX

Advertisers Index Company Allard USA Inc. ALPS South LLC Amfit Apis Footwear Company Arizona AFO Becker Orthopedic Appliance Co. Boston Orthotics & Prosthetics Cascade Dafo Inc. Coapt LLC ComfortFit Orthotic Labs Inc. Coyote Prosthetics & Orthotics Cypress Adaptive LLC ESP LLC Ferrier Coupler Inc. Fillauer Flo-Tech O&P Systems Inc. Hanger Hersco Kingsley Naked Prosthetics O&P Solutions (formerly Spinal Solutions) Ottobock PROTEOR USA Spinal Technology Inc. Surestep The Bremer Group Company Turbomed Orthotics Inc. WillowWood 78

AUGUST 2021 | O&P ALMANAC

Page Phone 23 866/678-6548 9 800/574-5426 17 800/356-3668 63 888/937-2747 31 877/780-8382 27 800/521-2192 3 800/262-2235 61 800/848-7332 43 844/262-7800 15 888/523-1600 25 800/819-5980 37 888/715-8003 5 888/WEAR-ESP 69 810/688-4292 59 800/251-6398 55 800/356-8324 79 877/442-6437 1 800/301-8275 51 800/854-3749 49 888/977-6693 35 800/922-5155 C4 800/328-4058 7 855/450-7300 57 800/253-7868 29 877/462-0711 11 800/428-2304 39 888/778-8726 19 800/848-4930

Website www.allardusa.com www.easyliner.com www.amfit.com www.apisfootwear.com www.arizonaafo.com www.beckerorthopedic.com www.bostonoandp.com www.cascadedafo.com www.coaptengineering.com www.comfortfitlabs.com www.coyote.us www.cypressadaptive.com www.wearesp.com www.ferrier.coupler.com www.fillauer.com www.1800flo-tech.com www.hangerclinic.com www.hersco.com www.kingsleymfg.com www.npdevices.com www.spinal.solutions www.professionals.ottobockus.com www.proteorusa.com www.spinaltech.com www.surestep.net www.bremergroup.com www.turbomedorthotics.com www.willowwood.com


EMPOWERING HUMAN POTENTIAL Their lives are our purpose. Each year we help more than one million people regain their confidence, independence and quality of life. And we’ve been doing it for more than 155 years. All across the country, our team of unsurpassed clinical talent is growing. We’re looking for people who want to make a difference and help lead the future of orthotic and prosthetic care. Experienced clinicians who understand the power of combining clinical practice with scientific research. Experts in our field determined to mentor the next generation of O&P caregivers. Leaders committed to changing lives. Empower your career. Apply today and make a difference.

Hanger.com/Empower

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.


AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Northeast

Job Location Key:

ABC or BOC Certified Practitioner Immediate Opening

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, 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. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

New Hampshire/Massachusetts FDR Center for Prosthetics & Orthotics is seeking a fulltime practitioner, CPO, CP or CO, to join us in our Southern NH and MA offices. We have a supportive team with on-site fabrication, cooperative support and mentoring, competitive salary and benefits with no weekend calls! We are looking for a Certified Practitioner who’s self-driven, energetic, has strong clinical, technical and communication skills with a willingness to travel locally. If you enjoy working as an integral part of a team, are passionate about providing the best quality care to patients, this is the position for you. Come join our amazing team! For further inquiries or to submit résumé for consideration, direct email to cindy.minich@fdrcenter.com. All inquiries will be kept confidential.

Email: cindy.minich@fdrcenter.com FDR Center for Prosthetics & Orthotics is an Equal Opportunity/ Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or veteran status.

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

Nonmember $280

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

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

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AUGUST 2021 | O&P ALMANAC

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


CAREERS

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities

EMPLOYEE

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

EMPLOYER

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

LOG ON TODAY!

https://jobs.aopanet.org

Career Opportunities... California

CPO-Salinas CPO-Modesto CPOA-Walnut Creek Oregon CPO –Portland CPO –Bend

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

Washington CPO-Richland CO Resident-Richland CPO-Tacoma

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

To apply, submit resume to: www.pacmedical.com/careers

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

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.” O&P ALMANAC | AUGUST 2021

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CALENDAR September 1

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

September 9–11, 16–18

AOPA National Assembly. The 2021 National Assembly will be held in Boston, September 9-11. In addition to the in-person Assembly, we will be offering all the education virtually. This content will be available a week after the Assembly, September 16-18. For more information, visit www.AOPAnet.org.

2021

October 1

August 13–14

PrimeFare Central. Tulsa Renaissance Hotel and Convention Center. In-person meeting. For information, contact Cathie Pruitt at 901/359-3936 or email pruittprimecare@gmail.com, or Jane Edwards at 888/388-5243 or email jledwards88@att.net. Visit www.primecareop.com.

August 26–27

A Comprehensive Approach to the Management of Cerebral Palsy: 3-12 Years, Featuring Peter Rosenbaum and Can Child. Shirley Ryan AbilityLab, Chicago, held virtually. 14.75 ABC credits. Contact Leslie Marriott at 312/238-6839 or visit www.sralab.org/CP21.

September 1

Missed Revenue Opportunities. 1 PM ET. For more information, visit www.AOPAnet.org. WEBINAR

ADVOCACY | RESEARCH | EDUCATION

October 1–9

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

JOIN US

!

Running an O&P business is no easy feat, but you don’t have to do it alone. AOPA is here to help you.

Join Now: ADVOCACY

RESEARCH

We ARE AOPA

October 1

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

www.AOPAnet.org/join

AOPA Members are Shaping the Future of O&P Centered on YOUR success, AOPA provides the tools to build strong O&P businesses that provide excellent patient care.

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

EDUCATION

Built exclusively for members, ACCESS AOPA’s Affinity Health Plan launching in September.

Plus, as a member you’ll SAVE UP TO $300 per attendee on a basic registration for 2021 National Assembly.

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

www.AOPAnet.org/join 82

AUGUST 2021 | O&P ALMANAC

For more

this offer


CALENDAR December 8

October 6–9

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

October 13

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

WEBINAR

2022 January 9–11

October 16

U.S. ISPO Pacific Rim Conference. Waikoloa, Hawaii (Big Island). For more information, visit www.usispo.org.

One-Day Pedorthic, Orthotic, and Prosthetic Program. POMAC is pleased to announce a one-day pedorthic, orthotic, and prosthetic program to take place at The Marriott New York LaGuardia Airport Hotel (across from LaGuardia airport in East Elmhurst, New York). Contact Drew Shreter at 800/ 946-9170, ext. 101, or dshreter@pomac.com for more details.

January 30–February 3

Hanger Live. Dallas, TX.

March 2–5

AAOP. Atlanta. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.

October 20–23

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

May 18–20

October 29–December 11

Pediatric Gait Analysis and Orthotic Management: An Optimal Segment Kinematics and Alignment Approach to Rehabilitation (OSKAR). Shirley Ryan AbilityLab, Elaine Owen. Online (on-demand and live), 31.5 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/ PedsGait.

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

May 20–21

Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis, MN. For more information, go to http://cecpo.com/documents/OrthoAndProstheticTech_2022_1up.pdf.

November 1–4

September 28–October 1

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

AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.

November 10 WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

Calendar Rates

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@ AOPAnet.org along with VISA or MasterCard number, cardholder name, 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.

Words/Rate 25 or less 26-50 51+

Member Nonmember $40 $50 $50 $60 $2.25/word $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

$678 $830

For information on continuing education credits, contact the sponsor. Questions? Email info@AOPAnet.org.

O&P ALMANAC | AUGUST 2021

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STATE BY STATE

Improving Access Updates from Colorado, New York, Tennessee, and Texas

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

NEW MEMBER RESOURCE ALERT

AOPA has invested in a new resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.

Colorado

Health First Colorado (Colorado Medicaid) has reportedly reduced reimbursement for cranial remolding orthoses (CROs) by 45 percent, down to $1,432.27, effective July 1, 2021. AOPA is actively investigating the rate decrease for CROs and checking to see if other O&P services have been impacted by Medicaid fee schedule reductions. 84

AUGUST 2021 | O&P ALMANAC

New York

AOPA has launched a call to action for members in New York to reach out to their state senators and General Assembly members in support of Senate Bill S7023 and Assembly Bill A7892, which would require the state to conduct an analysis of the ability of New Yorkers with NY Medicaid to access critical O&P clinical services. O&P stakeholders in New York are asked to make your voice heard to garner additional support of legislation that will improve access to critical and timely O&P services. This legislative effort will support the NYSAAOP coalition’s ultimate goals of: 1. Updating the more-than-30-year-old NY Medicaid O&P fee schedule to prevailing Medicare rates 2. Adding in missing O&P codes to NY Medicaid’s fee schedule 3. Regulating Medicaid HMO third-party benefit management companies to ensure they adhere to NY Medicaid fee schedules. Visit the New York page of the AOPA Co-OP to make your voice heard.

Tennessee

AOPA members have reported increased challenges receiving adequate reimbursement for services provided to dual Medicare/Medicaid patients due to state law that prevents Medicaid’s coverage of the remaining 20 percent coinsurance after Medicare reimbursement. According to AOPA members, managed-care organizations in the state have followed suit, but

Become an AOPA State Rep.

If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.

because they contract at lower than allowable rates, this process poses the potential for challenges to patient access. AOPA is seeking member feedback to better assess the impact of this practice on O&P patients.

Texas

AOPA has received reports that OPTUM has created an interview process in which patients in Texas are contacted after a claim has been submitted (before payment is issued) to confirm that the patient is being treated for a condition requiring the device and to confirm that they received the device. Reports indicate that in cases where the patient was not available or does not respond to the outreach from OPTUM, the claim may be denied, or delayed until outreach is made again. AOPA has reached out to OPTUM for additional information regarding this practice and requested the reference to this process in UHC policy.

Multiple States

AOPA continues outreach to BCBS in multiple states, including Illinois and Texas, in response to significant rate reductions for cranial remolding orthoses. Visit the AOPA Co-OP for additional information. Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.


C-Leg®

More than 55 published studies prove why C-Leg is the world’s leading microprocessor knee, selected more often than any other MPK. It’s no wonder why most prosthetists trust Ottobock and recommend C-Leg. •

C-Leg users experience up to an 80% reduction in stumbles and falls.

94% of users prefer C-Leg over their previous prosthetic knee joint.

As many as 70% of users have reported improved safety and comfort thanks to C-Leg’s Intuitive Stance feature.

professionals.ottobockus.com

7/21 ©2021 Ottobock HealthCare, LP, All rights reserved.

Trusted. For good reason.

Profile for AOPA

August 2021 O&P Almanac  

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