December 2009 O&P Almanac

Almanac OP The American Orthotic & Prosthetic Association

DECEMBER 2009

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

FIT FOR THE

FUTURE

Retooled business models improve patient care, streamline processes, and boost profitability

New Forays into Patient Registry Data Collection 2009 Medicare POLICY CHANGES

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COLUMNS

COVER STORY 14

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Year-end review of policies

Fit for the Future

By Kim Fernandez Continued success in O&P means overcoming managed care difficulties, administrative burdens, and Medicare issues to work smarter and increase profit margins. Hear from practitioners who are embracing change and how it’s affecting their patients and bottom lines.

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Ask the Expert Questions about undeliverables, generic prescriptions, and more

DEPARTMENTS

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AOPA Contact Page How to reach staff

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FEATURES

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Reimbursement Page

In the News Updates and company announcements

Outcomes Research Captures Results

By Erin Thomson, Neil Goldfarb, and Anita Mohandas A new O&P patient registry pilot study will develop a framework for data collection and prioritize the O&P community’s comparative research effectiveness. Hear from the team behind the initiative and learn how you can get involved.

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

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AOPA Membership

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Marketplace

Applications

Products and services for O&P

5 Questions… Tomas Dowell, LPO Tomas Dowell, LPO, began his career in O&P in the US Army in 1968 and currently serves as the chief of the orthotic-prosthetic lab at the Bruce W. Carter VA Medical Center in Miami.

NEW!

Visit O&P Almanac online at www.AOPAnet.org.

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Jobs Opportunities for O&P professionals

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Calendar

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Ad Index

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/431-0899; e-mail: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, e-mail: dmather@mrvica.com.

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O&P AlmAnAc DECEMBER 2009

table of contents

Volume 58 Number 12

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inside

DECEMBER 2009

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AOPA contact information

AmericAn OrThOTic & PrOsTheTic AssOciATiOn (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES

MEMBERSHIP AND MEETINGS

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org

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

O&P ALMANAC

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

Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Angela Brady, editorial director, abrady@strattonpublishing.com

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

Josephine Rossi, managing editor, 703/914-9200 ext. 26, jrossi@strattonpublishing.com

Erin Kennedy, office, meetings administrator, and associate editor, AOPA in Advance, 571/431-0834, ekennedy@AOPAnet.org

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

AOPA Bookstore: 571/431-0804 GOVERNMENT AFFAIRS

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

Kathy Dodson, senior director of government affairs, 571/431-0810, kdodson@AOPAnet.org

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

Devon Bernard, reimbursement services coordinator, 571/431-0854, dbernard@AOPAnet.org

Erin Kennedy, staff writer, 571/431-0834, ekennedy@AOPAnet.org

OP Almanac &

DECEMBER 2009

Vol. 58, No. 12

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

bOArd OF direcTOrs OFFicers President James A. Kaiser, CP, Scheck & Siress, Chicago, IL President-Elect Thomas V. DiBello, CO, FAAOP, Dynamic O&P, LLC, Houston, TX Vice President Bert Harman, Otto Bock Health Care, Minneapolis, MN Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President Brian L. Gustin, CP, BridgePoint Medical Inc., Suamico, WI Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA direcTOrs

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

Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA

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

Russell J. Hornfisher, Becker Orthopedic Appliance Co., Troy, MI

Rick Fleetwood, MPA, Snell Prosthetic & Orthotic Laboratory, Little Rock, AR

Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA

Dynamic Online Version NEW! Now Available

O&P Almanac

Reading the O&P Almanac has never been easier!

Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Mahesh Mansukhani, MBA Ossur Americas, Aliso Viejo, CA John H. Reynolds, CPO, FAAOP, Reynolds Prosthetics & Orthotics Inc., Maryville, TN

Access advertiser Web sites by simply clicking on the hotlinks

Lisa Schoonmaker, CPO, FAAOP, Tandem Orthotics & Prosthetics Inc., Sartell, MN

Access content with the click of a mouse or the touch of a smart phone

Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL

Easily e-mail to colleagues

Copyright 2009 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

your favorite articles

Save articles as PDFs! Go to www.AOPAnet.org, click on ‘O&P Almanac Online’ today!

For more information, contact Steven Rybicki at 571/431-0835 or srybicki@AOPAnet.org.

For advertising information, contact Dean Mather at 856/768-9360 or dmather@mrvica.com.

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O&P AlmAnAc DECEMBER 2009

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in the news

University of Michigan ADVANCES TISSUE ENGINEERING By studying the interface of nerves and muscles, researchers at the University of Michigan (UM) are identifying ways to eventually give artificial limbs the sense of touch.

When a hand is amputated, the nerve endings in the arm continue to sprout branches, growing a mass of nerve fibers that send flawed signals back to the brain. To examine the nerve endings, the researchers created an “artificial neuromuscular junction,” composed of muscle cells and a nano-sized polymer placed on a biological scaffold (made from the patient’s own muscle tissue). Neuromuscular junctions are the body’s own nerve-muscle connections that enable the brain to control muscle movement.

Using lab rats, the scaffold was placed over the severed nerve endings like a sleeve. The muscle cells in the scaffold and in the body bonded, and the body’s native nerve sprouts fed electrical impulses into the tissue. The bioengineered interface revealed both motor and sensory electrical impulses, and created a target for the nerve endings to grow properly. Researchers believe the interface will improve fine motor control of prostheses, and may relay sensory perceptions such as touch and temperature back to the brain.

“The polymer has the ability to pick up signals coming out of the nerve, and the nerve does not grow an abnormal mass of nerve fibers,” explains Dr. Paul S. Cederna, a plastic and reconstructive surgeon at the University of Michigan, and associate professor of surgery at UM’s medical school.

For more information, visit www2.med.umich.edu.

TRANSITIONS

Scientists Fashion Artificial Nerve Cells Scientists at the Lawrence Livermore National Laboratory in Livermore, California, have developed a method for encasing nanowire transistors in a fatty membrane, allowing them to function like human nerve cells. This technique may lead to improved performance of prostheses with microelectronic and/ or robotic components, according to the Web site Medical Device Link.

The fatty membrane protects the transistor the same way it would the contents of a cell. This means that membrane-encased transistors don’t change their electrical properties when dipped in a solution that is basic or acidic. This enables the scientists to obtain the signals from specific nanowires. Left unprotected, nanowires are very sensitive to pH. Chemist Aleksandr Noy and graduate students Nipun Misra and Julio Martinez developed the technique. The technique is in its infancy, so prototypes will take some time to emerge.

For more information, visit www.devicelink.com.

PEOPLE IN THE NEWS

DEAN KAMEN received the Leadership Award as part of Popular Mechanics’ 2009 Breakthrough Awards. Kamen, who holds 440 patents, has created such widely know inventions as the Segway, the DEKA or “Luke” arm, and the iBOT, a wheelchair that can climb stairs. One of his more recent inventions is a water purifier that can make almost any water potable. In 1989, Kamen founded FIRST (For Inspiration and Recognition of Science and Technology), a robotics competition for teenagers. FIRST drew about 42,000 competitors in 2009. Kamen believes that among all his inventions, FIRST will have the greatest lasting impact.

JORDAN THOMAS, a 20-year-old bilateral lower limb amputee, is among the finalists for CNN’s “Hero of the Year.” The college student lost both legs in a 2005 boating accident and was fit with legs that cost about $24,000.

Realizing many families cannot afford such devices, Thomas was inspired to start the Jordan Thomas Foundation, which provides prosthetics to children in need. From such activities as selling bracelets and holding golf tournaments and cookouts, the Foundation has raised more than $400,000 to pay for prosthetics for three children until they reach the age of 18. Thomas hopes to become a voice for the amputee community and plans a career in orthotics and prosthetics. Learn more about—and vote for— Jordan Thomas at www.cnn.com.

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O&P AlmAnAc DECEMBER 2009

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in the news

Third Annual Kick-a-Thon The fundraising organization Kicking for Kids Who Can’t (KFKWC) held its third Kick-a-thon on the National Mall in Washington, DC, in October. KFKWC raises money on behalf of the Limbs for Life Foundation, a global nonprofit organization dedicated to raising amputee awareness and to providing full prosthetic care for individuals who cannot otherwise afford it. The kick-a-thon event is an annual highlight, but the organization also raises money at various events throughout the year and welcomes donations.

The event featured the DC Fire Department Pipes and Drums and the Walter Reed Color Guard, martial arts demonstrations, and dancers, including a break dancer who is also a lower-limb amputee. The event’s main activity is getting all participants to engage in kicking in all ways—martial arts kicks, kickball, kicking a soccer ball, a ballerina’s grand battements, and more.

KFKWC raised $38,000 at the event toward this year’s goal of $50,000. Fundraising continues through December 31. Find out more at www.kickingforkidswhocant.org.

TRANSITIONS

OttoBock Improves Liner Performance OttoBock Health Care will now use parylene to coat prosthetic liners to better protect residual limbs from pressure points and friction. Other liner materials, such as a polyurethane gel, proved to be too sticky. OttoBock consulted with U.S. division engineers and the University of Utah, and determined that coating liners with a polymer called parylene eliminated the stickiness, according to Medical Device Link.

The company will use Para Tech Coating Inc.’s parylene surface treatment process. Parylene is applied in a gas phase process under vacuum, which helps to ensure that the film will be free of imperfections, such as pinholes.

During tests, coated samples showed that parylene film can stretch up to 15 times its size at creation without loss of adhesion.

OttoBock will coat its liners with parylene in-house.

The coating should both shorten production time and improve performance.

More information can be found at www.devicelink.com.

BUSINESSES IN THE NEWS

Artifi cial Limb Specialists, Inc., of Phoenix, recently celebrated 10 years in business. Founded in 1999 by Michael Pack, CP, and Kevin Kohler, CP, the company serves a wide array of clients from children and returning soldiers to Paralympics athletes and patients with diabetes. With the company’s growth, Randy Whiteside, CP, and Owen Larson, CP, have joined Pack and Kohler.

Ohio Willow Wood has agreed to let Wilhelm Julius Teufel GmbH be the exclusive distributor of its products in Germany. Ohio Willow Wood has transferred its German sales office to Wilhelm Julius Teufel GmbH, a company that has served the worldwide O&P industry for more than 100 years. Ohio Willow Wood maintains distributor partners in various countries including Canada, the United Kingdom, South Africa, Australia, Japan, Israel, Spain, and Switzerland.

Hanger Orthopedic Group, Inc. recently acquired Creative Orthotics & Prosthetics, Inc., Custom Orthopedics of Wyoming, and certain orthotics and prosthetics assets from the Hospital of the University of Pennsylvania. These acquisitions add patient-care centers to existing markets in New York, Wyoming, and Pennsylvania.

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O&P AlmAnAc DECEMBER 2009

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reimbursement page

I

t is fitting that we end the year in the same way we began. In the January 2009 O&P Almanac, we provided you with an overview of each of the Medicare medical policies, with the message that they had not changed much. That’s not been the case as the year continued. So, this month’s Reimbursement Page will close out the year by taking a look at some of the changes to medical policies that have occurred during 2009.

By Devon Bernard, AOPA government affairs department

Medicare Annual Checkup Time for a year-end review of code changes and other revisions

Policy Changes Twice during this past year, changes were made to the policy for ankle-foot orthoses (AFO) and kneeankle-foot orthoses (KAFO). The first update took place at the beginning of June. Any claim with a date of service of June 1, 2009, and forward must now attach the KX modifier to the base code and addition codes, if coverage criteria has been met and documented. Also, as of June 1, any material code, L2770, became invalid for AFO/KAFO claims.

The next change was published in the December revision, but was already in place since the end of July, with the release of a Pricing, Data Analysis and Coding (PDAC) contractor coding decision. This revision refers to the use of code A9283 to describe AFOs used solely for the treatment of ulcers or edema. When providing such an AFO, you must submit the claim with an A9283, foot pressure offloading/supportive device, instead of using an L4398 or L4360 with a GY modifier. When submitting a claim for an A9283, a GY modifier is not needed.

The other change made in the December revision was a clarification on the use of concentric adjustable torsion joints. These types of joints are still not to be used with prefabricated AFO/KAFOs, and if they are, the device must be coded as an E1810 or E1820. In the past you were able to use the concentric adjustable torsion joints in a custom device to add an assist function to the knee or ankle joint during ambulation, and you were able to use the miscellaneous code

L2999 to describe the joints. This is no longer the case: If you use an L code to describe these joints, that claim line will be rejected as incorrect coding.

• LSO/TLSO Policy: In April the policy changed to reflect the PDAC decision that elastic braces were no longer a covered benefit, because they are not rigid or semirigid in construction; and therefore don’t meet the definition of a brace. This announcement means that braces described by codes L0450, L0454, L0621, L0625, and L0628 would no longer be covered and must be submitted with the GY modifier. However, if these braces are constructed of nonelastic material (cotton or nylon), or have a rigid posterior panel, they would be covered and should be submitted with the CG modifier.

• KO Policy: As As with the LSO/ TSLO policy in April, the KO policy was changed to indicate that elastic braces (L1800, L1815, and L1825) are non-covered services. The April update also clarified that the KX modifier must be used on both the base code and any approved addition codes.

The next change went into effect at the beginning of this month. Each claim line, on a KO claim, must now be submitted with the KX, GA, or GZ modifier. If a claim line doesn’t include one of those modifiers, it will be rejected.

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O&P AlmAnAc DECEMBER 2009

Diabetic Shoe Revisions This policy was updated twice during the year. The first update took place in August and affected the LCD portion of the policy, and dealt with the requirements of the “certifying statement.” The certifying statement now must be filled out by the certifying physician (the physician treating the patient for their diabetes); you may no longer fill out the form and have the treating/certifying physician sign and date it. The certifying statement also is not enough by itself to qualify for the use of the KX modifier. There must be documentation in the treating physician’s records

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reimbursement page

that the criteria on the certifying statement have been met.

The next change became active at the beginning of September, and affected the PA portion of the policy: • First, when billing for a pair of diabetic shoes, you must now use the modifier LTRT and indicate 2 units of service. If the claim doesn’t include the LTRT modifier, it will be rejected.

• Second, the revision now says that custom inserts fabricated in-house, described by code A5513, do not to have to be listed on the PDAC Web site. However, a list of the materials you used and a description of your fabrication process must be made available upon request. Custom inserts, A5513, which are fabricated by someone else, i.e., from a manufacturer/ central fabrication site before you provide them to the patient, must still be listed on the PDAC site in order to bill for them.

The September revision also provided additional clarification on what type of documentation must be in the certifying physician’s record to satisfy criteria number two of the certifying statement. Criterion two indicates that the patient has a secondary foot condition (for instance, poor circulation, deformity, previous amputation, etc.). In order for this criterion to be met, the certifying physician must personally document the condition in the patient’s chart, or obtain the medical records from another physician, nurse practitioner, physician assistant, osteopathic doctor, or podiatrist who is treating the patient. The certifying physician must then date and initial the charts, indicating that he or she agrees with what the other physicians have noted in their charts.

Finally, each claim line must include the GY, non-covered service, modifier or the KX modifier along with the appropriate directional modifier. If a claim line doesn’t include a combination of these modifiers, the claim line will be rejected.

If rejected, you will not be able to

perform a reopening, and you must resubmit the claim line with the appropriate modifiers.

• Orthopedic Shoe Policy: Beginning with claims submitted on October 1, each claim line must include the KX or the GY modifier. If the items you are providing meet the coverage criteria, each claim line would include a KX modifier. If an item does not meet the coverage criteria, it is a noncovered item, and the claim line must include the GY modifier. If a claim line doesn’t include the KX or GY modifier, then that line will be rejected, and you will have to resubmit that claim line with the appropriate modifier.

• Lower-Limb Policy: The published policy hasn’t changed, as of yet, but there is a change that took effect in early January that you may already know. The code L5940, ultralight material, will only be reimbursed when it is billed with definitive endoskeletal prosthesis base codes L5301, L5311, L5321, L5331, and L5341.

The L5940 code also may be used with replacement socket codes described by codes L5700, L5701, L5702, and L5703. The ultralight material code may no longer be used with preparatory base codes.

• Surgical Dressing Policy: This policy still addresses the usage criteria for compression stockings, described by codes A6531 and A6532. Compression stockings are covered when they are used in the treatment of open venous stasis ulcers. However, A6531 and A6532 will not be covered if they are used for venous insufficiency without stasis ulcers, prevention of stasis ulcers, prevention of the reoccurrence of stasis ulcers that have healed, and treatment of lymphedema in the absence of ulcers. The policy has added the compression wrap, A6545, to the list of codes that is covered when treating open venous stasis ulcers.

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O&P Almanac DECEMBER 2009

Medicare will cover one A6545 per limb per six months.

The Year’s Exception No changes were made to the breast prostheses policy during 2009.

Here is a quick recap of the policy.

An external breast prosthesis garment, L8015, is only covered when the patient is in postoperative care. A mastectomy sleeve, L8010, is not covered because it doesn’t meet the Medicare definition of a brace.

The L8035, a custom-fabricated prosthesis, will not be denied but will be reimbursed at the same rate as a prefabricated prosthesis, L8030. The reason is that Medicare does not see the custom prosthesis as medically necessary.

A patient is entitled to receive a silicone breast prosthesis every two years. A patient who has a fabric/ foam/fiber breast prosthesis may receive one every six months.

These are only a few highlights of the changes made to the medical policies during 2009. Please review the policies to be sure that you have all the updated information. The complete polices may be found on your local DME MAC Web site: • Jurisdiction A: www.medicarenhic.com • Jurisdiction B: www.ngsmedicare.com • Jurisdiction C: www.cignagovernmentservices.com • Jurisdiction D: www.noridianmedicare.com If you are not sure what items have been changed, refer to the Revision History heading at the end of both the Local Coverage Determination and Policy Article portions of the policies. a Devon Bernard is reimbursement services coordinator for AOPA. Reach him at dbernard @AOPANet.org.

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With technology and outsourcing, O&P adopts smarter business models for better patient care

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O&P AlmAnAc DECEMBER 2009

BY KIM FERNANDEZ

T

he future keeps coming. Faced with health-care reform, likely changes in the insurance industry, and nationally mandated electronic record-keeping requirements, along with an uncertain economic recovery, the orthotics and prosthetics industry will be seeing a new landscape in the next few years.

Many say that to survive and thrive, O&P practices must embrace change, including moving to streamlined computer systems to manage every aspect of a practice, or relying on outsourced fabrication. So far, these changes have taken hold slowly and are not widespread. In fact, some long-time practitioners and owners of smaller practices say the change is just too costly and the way they’ve been operating for years will continue to work well.

Not surprisingly, O&P pioneers on the leading edge of new business strategies disagree.

“We’re just now starting to come around,” says Jonathan Naft, CPO, G.R.E. Prosthetics & Orthotics in Chardon, Ohio. “Most of the leading physician groups have been much more digitally savvy than O&P. That’s ironic when you consider the nature of the high-tech devices we fit.”

Others who are embracing change say that outsourcing as many functions as possible, while far from the traditional model of a small O&P facility, can help not only improve patient care, but also boost the overall image of this industry.

“Our industry needs to start looking at how we continue down the path of being professionals and

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O&P AlmAnAc DECEMBER 2009

being viewed as professionals,” says Jeffrey Brandt, CEO and CPO, Ability Prosthetics & Orthotics in Gettysburg, Pennsylvania. “We need to free up our practitioners from modifying molds to spending more time in political action committee meetings, and clarifying positions about what we do. That way, people will start to know us as prosthetists and orthotists, not suppliers and vendors, not Johnny-on-the-spot with a shoe.”

While embracing new business models can be daunting, if not overwhelming, to some practitioners, those who’ve successfully retooled say the process is often as simple as taking one step at a time. Plus, they advise, there’s plenty of available help to manage transitions both smoothly and cost effectively.

And a key benefit of a more streamlined business model is a positive and almost immediate impact on the bottom line.

n Paradigm Shift “A good starting point is to remember that this isn’t that expensive,” says Brandt, whose practice has always outsourced all of its fabrication.

“Fabrication is a lot different than it was 10 years ago,” he says. “By outsourcing, we can offer our patients so many more device options than we could if we were making everything here. We don’t have to feel like we have to make it in the back; we’re on the front end of a lot of advances, and a lot of these new products are made by the manufacturer more efficiently than I could make them.”

Others agree, and say that newly trained prosthetists and orthotists aren’t spending nearly as much classroom time on learning fabrication techniques as once required.

Mike Brncick, who helped develop the O&P program at Northwestern University, Chicago, and is currently O&P coordinator at Joliet Junior College, Joliet, Illinois, says classroom training has changed to reflect the streamlined business models that students may enter after graduation.

“Many of the students in our clinical programs are learning more about the formulation of treatment plans, and not getting as much technical work as they had in the past,” he says. “The field is changing that way, and the role of the technician is changing. They will play a much more important role and a much more active role in overall patient care.”

Brncick sees this trend emerging already with technical staff assuming much more hands-on work with patients, instead of doing fabrication in the back room.

matching the physical parameters of the patient with the appropriate materials and production techniques. All of this allows the practitioner to focus more on the clinical and administrative needs of the patient.”

In Ohio, Naft’s practice has embraced more outsourcing, linking it with a high-tech computerized system that tracks every aspect of patient care. Together, he says, the two result in greater efficiency and a higher level of patient care.

“By outsourcing, we can offer our patients so many more device options than we could if we were making everything here.”

––Jeffrey Brandt, CPO

“Clinicians will continue to rely more and more on technical expertise from technicians who have been taught to manage some of the issues and problems that might show up,” he says.

“They work more with the clinicians.

That’s going to be a paradigm shift in this profession as we go forward.”

“The role of the technician at the clinical site will transition to that of a clinical assistant, providing much of the hands-on skills, Brian Gustin, CP and AOPA immediate past president adds. “Technicians at the central fabrication facility will become more of a professional in their own right by

“We use a computer-aided design system here, so we try not to take hand molds,” he says. Instead, shapes are molded using computer scanners, and then e-mailed to a remote fabricator. As a result, returning an item to the patient is “very fast,” he says.

“It’s instantly digitally captured and e-mailed off to a central fabricator.

Then, it’s returned right back to us.”

Beyond speedy turnarounds, the new system is much better at keeping everyone updated on the status of the process, eliminating waiting for days while packages make their way through the postal system.

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O&P Almanac DECEMBER 2009

“The practice is much more trackable because it’s automated,” he says. “We used to have a clipboard with a log where we’d hand-write when something got sent out and when it got through the mail. Boxes got lost or got crushed.

This is much better.”

“When you’re outsourcing 100 percent—and this has been said a million times in the last 10 years—it allows you to focus more on being a practitioner,” says Brandt. “As attrition in our field continues, and prosthetists and orthotists who have been in the field continue to retire, we’re seeing young practitioners come in who really have been trained and taught to manage patients’ care.”

This also applies when practices begin using care extenders—those who may not be certified O&P professionals, but who’ve been trained to take care of aspects of patient care that don’t require advanced training.

“The care extender model really has a place in our industry,” says Brandt.

“We’re seeing care extenders start to perform diagnostics before [practitioners] come into the room. The analogy is that a dental hygienist does an entire exam, and then the dentist comes in and checks everything in five minutes.

As we go forward in O&P, we’re going to see more and more people who provide a lot of the data-recording and diagnostics on a device before a practitioner comes in and greets the patient.

We’ll be used more for the expertise we all have.”

n Technology Trends Hand-in-hand with new business models, say practitioners, is a new reliance on automated offices, where paper records are obsolete, and everything is done on a centralized computer system that’s shared by everyone in the practice. Naft says his office started scanning documents several years ago. Patients are now directed to the practice’s Web site to pre-register online before their first appointments. And, from any computer in the office, a patient’s entire record can be accessed. The manila folder has no place in his office, he says, and it’s on its way out throughout the industry.

“A savvy practice can take on more responsibility during a day and streamline operations in staffing this way,” he says. “As soon as you need information, it’s right there.

If a physician or a therapist or a case manager wants information, he or she just goes to the nearest computer and e-mails away. There’s no copying, no faxing, and no questions about it.”

Using software to help manage every aspect of a practice is not only a good idea but also critical to facing the future, says Paul Prusakowski, CPO, Gainesville Prosthetics in Florida.

“We’re seeing the use of sophisticated software for workflow management, practice management, and billing and collections,” he says.

“By using a system that collects every aspect of the practice, you’re collecting data along the continuum of patient care.”

“This is sweeping across every aspect of medicine,” he says. “We need to be moving toward an operating system to run our practices.

If you go into a dentist’s office or a veterinarian’s office, you’re seeing computers in every patient room.”

This streamlines operations, especially for practices with more than one office. With a centralized, linked computer system, there’s no waiting for information to travel from office to office, from office to fabricator, or from office to off-site support.

“We have these paper charts that are typically the starting point,” he says, noting that when one file is kept in a file cabinet, it can hold up patient care. “You can’t move forward unless the next person in line has that piece of paper. It creates a bottleneck. With a computer system, everybody’s connected, and there are no bottlenecks.”

Naft says that while some practitioners balk at the initial investment for a computerized system, software, and training, his practice has actually saved a lot of money since automating.

Beyond streamlining, practitioners say automation will be necessary for stricter compliance regulations that may be coming in the future. The best solution, they say, is to get started now by bringing in a consultant to identify the needs of the practice and how to meet them in a budget-friendly way. While there is a learning curve, offices that have already automated are more efficient and, importantly, have more time to focus on patient care.

“A savvy practice can take on more responsibility during a day and streamline operations in staffing this way.”

––Jonathan Naft, CPO

“I can’t tell you how many times we couldn’t read the information on a registration sheet,” he says of the days before his patients pre-registered online. “If the receptionist inputs the information incorrectly, it causes a chain reaction of administrative burdens. Ultimately, that can result in claims not being paid because information wasn’t transcribed correctly.”

“It’s not a significant investment for most average small, independent practices,” notes Prusakowski.

As computer prices drop, he says it’s not cost-prohibitive to set up a few computers throughout an office, install software to track everything from patient care to billing and receivables, and train staff.

“I call it administrative scrapbooking,” he says of paper files.

“You’re making paper sandwiches–– you have administrative staff and practitioners busy stacking paper into a chain when absolutely none of that is important to a practice. It’s the information that’s important, but the paper becomes a bottleneck. And it’s hard to monitor. You don’t know what’s in each chart.”

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O&P AlmAnAc DECEMBER 2009

“We’ve never looked back,” says Brandt of his office’s computer system. “Our practitioners love it, and it’s highly compliant. Anybody going forward has to make sure to have a platform in place to keep leveraging against the compliance issues that are being stacked against us.”

“Many practices resist change— even positive change—because it invalidates previous behaviors” says Gustin. “In other words, if I could lose weight now after years of being overweight why did I become overweight in the first place?”

O&P needs to overcome this fear by creating a written process flow chart of their current operations so it becomes visible, only then can changes be made and incorporated into an electronic system, he adds.

Without this visibility, the process becomes invisible within the electronic system, further complicating the process flow. a

Kim Fernandez is a contributing writer to O&P Almanac. Reach her at kim@ kimfernandez.com.

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Outcomes Research Captures

RESULTS New O&P patient registry pilot study tests ways to collect clinical data

BY ERIN THOMSON, NEIL GOLDFARB, AND ANITA MOHANDAS

I

In July 2007, Susan Bailey, a wife and mother of two, became infected with E. coli bacteria. The infection ultimately spread to her legs and doctors were forced to perform a bilateral above-knee amputation. C-Legs were recommended for her condition, but Bailey’s insurance company denied her coverage. Instead she was given prostheses that made walking and keeping up with her two children difficult. The Virginia Bureau of Insurance ultimately reviewed her case and ordered her insurance company to pay for the C-Legs.

Susan’s story is not unique: There are nearly 2 million amputees in the United States, and most health insurance policies do a poor job of covering prosthetics for them.

Patients with bilateral above-knee amputations face a complex process of physical and emotional recovery, which is only made worse when also having to face the ordeal of denied insurance claims.

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O&P AlmAnAc DECEMBER 2009

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O&P AlmAnAc DECEMBER 2009

O&P Providers Join JSPH Pilot Study Over the course of the pilot study, AOPA leadership has provided expert consultation and continued support for this initiative. They have played a crucial role in recruiting and establishing a network of orthotic and prosthetic clinics to take part in this pilot test. Below are some of the sites currently participating in data collection: Geauga Rehabilitation Engineering Chardon, Ohio OrPro Prosthetics & Orthotics Irvine, California Dynamic Orthotics and Prosthetics Houston, Texas Benchmark Orthotics and Prosthetics Exton, Pennsylvania BridgePoint Medical Inc. Lexington, Kentucky Scheck & Siress O&P Inc. Hickory Hills, Illinois These sites have been instrumental in this initiative and continue to be engaged as we discuss the expansion of the project.

If you would be interested in participating in this initiative, please contact Erin Thomson at erin.thomson@jefferson.edu or 215/955-3888.

Limited information is currently available regarding outcomes related to orthotics and prosthetics. As a result, there is little evidence available to health insurance companies when deciding what devices and procedures to cover. With the advent of reliable self-reporting instruments and the availability of advanced technology, the O&P industry is well-positioned to engage in the evaluation of the quality and effectiveness of their services, and benefit tremendously from the results.

An important step toward increasing the availability of outcomes research in the O&P field is a new collaboration between AOPA and the Jefferson School of Population Health (JSPH). JSPH is part of Thomas Jefferson University, an academic health center founded in 1824 and located in Center City Philadelphia. JSPH has launched a pilot study with nine orthotic and prosthetic clinics across the country to develop a patient registry and to test the feasibility of collecting outcomes data in a clinical setting. Here’s a look at this new initiative, including opportunities for future participation by the O&P industry.

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O&P AlmAnAc DECEMBER 2009

What is Outcomes Research?

The field of outcomes research emerged from a growing concern about which medical treatments work best and for whom. Outcomes research seeks to understand the end results of particular health-care practices and interventions, and evaluates the effect of the health-care process on the health and well-being of patients and populations.

A variety of outcomes can be examined, ranging from clinical events such as pain or gait symmetry to a patient’s quality of life in relation to a particular device. By bridging the care patients receive to the outcomes they experience, outcomes research has become fundamental to developing improved methods to monitor and improve the quality of health care.

Patients, providers, payers, politicians, and the public are interested in evaluating the value of diverse health-care interventions. For clinicians and patients, outcomes research provides evidence about benefits, risks, and results of treatments so they can make informed decisions. For health-care managers and purchasers, it can identify potentially effective strategies they can implement to improve the quality and

value of care. Public programs, such as Medicaid and Medicare, can use outcomes research to provide policymakers with the tools to monitor and improve quality both in traditional settings and under managed care. In the O&P field, however, the urgent need for outcomes research becomes apparent when examining the lack of information about the functional ability for patients who receive a particular device, and the lack of comparative studies demonstrating device effectiveness and patients’ health-related quality of life.

Measurement Tools Patient input is an essential component in the delivery of optimal health care, particularly in evaluating functional disability and health-related quality of life. Evaluating patients with amputations is now more practical due to the development of various self-report instruments that have been validated over the past decade, including these two examples: • The Prosthetic Evaluation Questionnaire (PEQ) is a relatively simple-to-use instrument that answers a wide variety of questions pertaining to the functional outcomes of lower limb prostheses.

• The Orthotics and Prosthetics User Survey (OPUS) is considered a promising instrument to measure changes in lower limb functional status, health-related quality of life, and consumer satisfaction.

Incorporating these instruments and others into outcomes measurement would provide several benefits, including promotion of evidencebased practice, enhancing program outcomes, and serving as the basis for establishing a patient registry that would help practices measure performance on key health outcomes.

What is a Patient Registry?

In its simplest form, a registry is a database of patients who share some characteristic, for instance, a certain medical condition or course of medication therapy. The data may

originate from multiple sources, including hospitals, pharmacy systems, physician practices, and insurance companies. An analysis of patient registry data can offer valuable insights for physicians, payers, and patients about the safety and effectiveness of devices in diverse populations and in situations that represent real-world conditions.

For example, doctors may use a registry database to monitor disease patterns in specific populations.

Physician groups may analyze treatments to identify opportunities for quality improvement. Health insurers may review treatment trends before making coverage decisions. Unlike randomized clinical trials, which study patients under strict eligibility and treatment protocols, patient registries document the experiences of patients in everyday clinical practice. Observing patients’ responses to treatment can provide important insights into which health-care strategies work best in actual practice.

In an industry of limited resources and patients faced with myriad devices to choose from, it is essential for the O&P industry to determine which products and services are safer and more effective in the populations they serve.

Registry Project Pilot Test Rapidly emerging innovative and often expensive technologies in the O&P field have increased the need for clinical, humanistic, and economic evaluation studies to provide sound guidance to decision makers.

As part of the patient registry pilot, we developed two electronic surveys—a Consumer Survey and a

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O&P AlmAnAc DECEMBER 2009

Provider Survey. At the participating clinics, patients who have had their device for at least six weeks will be asked to complete the Consumer Survey. If computer terminals are available at the provider sites, patients can complete the online survey in the office at the time of their visit. Otherwise, patients are asked to complete the survey on their computers at home. For those patients who complete the survey, their providers also will complete a brief survey regarding the patient’s care. The Provider Survey includes questions regarding patients’ demographic information as well as the type of orthotic or prosthetic device they are currently wearing.

In addition, the providers are asked to rate the patient’s overall level of compliance in learning how to use the device as well as their functional status and overall improvement since receiving the device. Conversely, the Consumer Survey asks patients to rate their functional abilities both before and after receiving the device. They also are asked about their level of satisfaction with the device, current pain levels while wearing the device, and their quality of life since obtaining the device. Finally, the patients are asked a series of questions pertaining to their out-of-pocket expenses to purchase and maintain their devices. In conducting this study, we are seeking to not only collect data from a small patient population but also to demonstrate the feasibility of point-in-time data collection in a clinical setting.

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The need to measure and evaluate the O&P practice has received increasing attention over the past several years. Currently, there are more than 12 million people in the United States with lower limb loss, and estimates indicate that this number is likely to grow as a direct result of diabetes and vascular diseases, and the overall aging of the population. To ensure that patients receive the proper treatment, rehabilitation, and devices, the insurance industry needs to improve upon current coverage. Information from outcomes measurement could

be used to change or modify the device or a component of the device, provide objective measures to thirdparty payers, and most important, improve the health and quality of life of the consumer of orthotics or limb prosthetics.

Project Expansion Data collection for the pilot study is concluding, but JSPH is looking to continue these efforts and further expand the project by increasing the number of participating O&P sites.

JSPH also would like to expand the registry into a longitudinal nation-

wide outcomes database. This data would provide better information to support treatment decisions, and serve as the basis for quality improvement in the O&P industry.

“Databases that depict outcomes in patient populations over time carry great potential for advancing the quality, safety, and effectiveness of health care,” says Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality.

Although the field of orthotics and prosthetics is fairly small, the study of outcomes research in O&P is a complex process requiring interplay between various disciplines. The scale and complexity of outcomes research in O&P suggests that the contributions of researchers and clinicians from a variety of invested disciplines should work together to move toward evidence-based practice. a Erin Thomson, Neil Goldfarb, and Anita Mohandas are colleagues at JSPH who are working on the pilot study. Reach them at erin.thomson@jefferson.edu.

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5

QUESTIONS FOR…

Tomas Dowell, LPO

1)

Describe a typical day at the Center.

A typical day involves patients that are referred to the prosthetics department from a variety of VA primary-care providers and specialty clinics. We also are responsible for treating hospital in-patients recuperating in the wards, in-patient units, and the ICUs (intensive care units) who need our services. Because we see walk-in and scheduled patients as well, my daily routine has to be flexible.

Our patients suffer from both common and serious chronic conditions, from carpal tunnel syndrome and venous insufficiency to diabetes.

Other patients suffer the effect of acute injuries they have sustained in war or in civilian life. So we have to be ready for just about any contingency.

We are supported by a medical staff that truly understands the challenges we face. It helps to work with a multi-disciplinary approach with medical specialists, when necessary, to achieve the most optimum outcomes.

2)

What is the biggest challenge facing the veterans you work with?

The scope and depth of the services that we provide the veterans in our region varies greatly. We treat those who served in the armed forces during World War II up to the current conflicts in Iraq and Afghanistan— and all those in between.

Some have transitioned to civilian life unscathed, but others have had to bare the brunt of the physical

Tomas Dowell, LPO, began his career in O&P in the US Army in 1968 and currently serves as the chief of the orthotic-prosthetic lab at the Bruce W. Carter VA Medical Center in Miami. He often is consulted on a variety of challenging cases throughout the hospital.

and mental injuries and scars they received. Most have been healed and rehabilitated of that experience; however others still carry the wounds they’ve received and the accompanying pain for years, if not decades. The biggest challenge we face is reaching that segment of the population that is ignorant of the services they may receive, neglectful of themselves, or too proud to receive help. Some are just in denial, too.

3)

How has the reimbursement process for treating veterans changed over the past fi ve years?

The biggest change I’ve seen in the past five years is that the VA is now using a credit card to pay for orthotic and prosthetic services performed outside of the VA medical centers or clinics. Vendors are paid within three days of the delivery of orthotic and prosthetic items.

4)

Which prosthetic technologies excite you the most? Why? Technologies have improved the comfort, function, and lifestyle of patients in ways that I couldn’t have imagined when my Army military occupational specialty changed from an infantryman in Vietnam to orthotist and prosthetist at Fort Hood, Texas, in 1968.

The technologies at our disposal are not a panacea or a cure-all. Yet, we use them for specific indications, on a case-by-case basis, and to compliment the craftsmanship and fundamental practices in our

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O&P AlmAnAc DECEMBER 2009

profession. That motivates me to research and consider better innovations myself.

For example, the medical center administration here supports our efforts to use negative-pressure prosthetic suspension systems for the patients who would benefit from them, and to develop innovations and techniques to improve its function and effectiveness. We also are researching to develop a dynamic response, pin-suspension foot for patients with Symes amputations.

5)

If you could outsource one aspect of your job, what would it be? Why? Our responsibilities are wide, varied, and sometimes deep in scope. Likewise, our practitioners have to balance and manage their immediate, walk-in and in-patient workload—from the hospital’s wards, units, and primary-care providers—with those needing more involved orthotic and prosthetic services on an out-patient basis.

Consequently, our department must maintain a balance between what is done in-house as opposed to what is outsourced. Typically, we outsource the casting, fitting, and fabrication of custom-molded shoes.

We also outsource the fabrication of orthoses and prosthetic limbs, but the casting, modifying work, alignment, and component selection of the prostheses are done by our staff.

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n Ask The Expert

DECODING

medicAre

By Joseph McTernan, AOPA’s government affairs department

AOPA hears many of the same questions from members, especially about Medicare coding, billing, and reimbursement.

So, this month, we’ll focus on many of those issues. As always, if you have specific questions, the AOPA reimbursement staff is ready to help you. And, we continue to work on new programs to meet your needs.

Q. I completed a prosthesis for a Medicare patient but have not been able to reach him to schedule delivery. What are my options?

A. Medicare policy allows you to

bill for custom-made items that are completed but cannot be delivered due to a patient’s death, a change in the patient’s condition that causes the item to no longer be needed, or if the beneficiary cancels the order. In the scenario described above, the prosthesis cannot be delivered because the patient cannot be located. There is no formal guidance regarding how many times you need to attempt to contact a patient before you may consider the item “cancelled” by the beneficiary.

AOPA recommends several contacts via telephone and at least one written attempt via a tracking-capable system (FedEx, UPS, certified mail, etc.) before considering an item to be cancelled by the beneficiary. You should have a well-documented record of your contact

30

O&P AlmAnAc DECEMBER 2009

attempts and of any correspondence that you may have with the patient or anyone affiliated with the patient.

Once you determine that the order has been cancelled, you may bill the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for the completed device minus the salvage value of any reusable components. The date of service is equal to the date that you documented the cancellation of the custom item.

Q. If a patient comes into the

offi ce with a generic prescription for an item that is in stock, can we provide it to them and still bill Medicare?

A. Yes. Medicare allows suppli-

ers to dispense Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items based on a verbal or non-detailed written prescription. However, the supplier must have a fully detailed prescription, signed and dated by the physician, in its records before the claim is submitted to Medicare.

Although it is acceptable to dispense the item based on a preliminary order, the physician may not sign a detailed order if he or she does not believe that all of the components provided were necessary. This is part of the inherent risk of dispensing an item based on a non-detailed or verbal order.

Q. A patient arrived at my office

in a power wheelchair and had a prescription for a prosthesis. Will Medicare pay for a prosthesis and a power wheelchair at the same time?

A. Medical policy governing

ORLANDO

Medicare coverage of lower-limb prostheses and power wheelchairs is no longer in conflict. Years ago, the main coverage criteria for a power wheelchair was that the patient was non-ambulatory. This was in direct conflict with the ambulatory criterion that was required for Medicare coverage of a prosthesis. Medicare revised the power wheelchair policy and based the medical necessity of power wheelchairs on a patient’s activities of daily living. Medicare patients who have received power wheelchairs should be evaluated for prosthetic services the same as those patients who do not have power wheelchairs.

If a Medicare patient meets the medical necessity criteria for a prosthesis, it should be covered by Medicare.

Q. With all of the recent changes A. Medicare will most likely deem

the second pair of shoes as not medically necessary. While the therapeutic shoe benefit allows for one pair of shoes and up to three pairs of inserts Medicare requires the use of the per calendar year, this is a maximum benefit and not an entitlement. While KX modifier on claims for therapeutic the benefit may be available, if there (diabetic) shoes, orthopedic shoes that is no medical need for the shoes and/ are an integral part of a brace, knee or inserts, Medicare may deny the orthoses, and ankle-foot orthoses/ claim. If a patient is insistent that you knee-ankle-foot orthoses. It is imporprovide new shoes and/or inserts, tant to remember that by adding the KX modifier to a claim, you are indicat- you are within your rights to ask the ing that the patient has met all required patient to sign an Advance Beneficiary Notice based on the fact that you medical necessity criteria and that do not believe the materials are medidocumentation exists in the patient’s cally necessary. a medical records supporting the medical need for the device or service.

Joe McTernan is AOPA’s director of reimbursement We provided a patient with services. Reach him at diabetic shoes and inserts in Novemjmcternan@AOPAnet.org. ber 2008. The patient returned in January 2009 and requested a new pair of shoes. The pair provided in November show little sign of wear and remain functional. Will Medicare pay for the new pair of shoes and inserts? to Medicare’s medical policies, when exactly is it appropriate to use the KX modifier?

A.

Q.

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O&P Almanac DECEMBER 2009

AOPA

AOPA WORKING FOR YOU

HEADLINES

newsletter and the weekly AOPA Insider are two communication tools used by AOPA to reach members. We continue to look for additional information delivery systems that will inform even more members.

The late Speaker of the House Tip O’Neill said “all politics is local.” We could say, “all communications are local.” And this is where the Communications Strategic Initiative, led by AOPA Board member Lisa Schoonmaker CPO, FAAOP, will have an impact. The initiative’s work New “communicator champions” will group also includes Bill Barringer, CO; Bill Teague, CP; help to more fully and quickly inform Brad Ruhl; Karen Lundquist; Richard Gingras, CPO; and Tim Lacy, CP. members nationwide The initiative’s primary objective is to take all that AOPA is doing and get the word out to members by recruiting local AOPA members to relay messages. wo strategic initiatives resulting from the December This means expanding communications about the latest 2007 member survey address the public relations AOPA legislative activities, updates on public relations and communications challenges faced by AOPA efforts, reporting on new ways to interpret or influence and the orthotics and prosthetics industry. The Public CMS rules, or any other AOPA activity on behalf of the Relations Initiative fast-tracked both advocacy public O&P community. service and paid advertising to reach public policy The initiative’s first major task is to decision makers over the summer as identify AOPA members who attend health-care reform measures were The American Orthotic & and are known at the 40 or 50 regional taking shape.

Prosthetic Association (AOPA) and state meetings, and who will agree AOPA and the Amputee Coalicongratulates all of the athletes participating in the 2008 to become “communicator champions.” tion of America (ACA) joined forces Paralympic Games in Beijing.

These ambassadors will be equipped with in bringing 40 amputees to WashYour energy, dedication and positive spirit a PowerPoint presentation highlighting ington, D.C., on September 16, which excite all of us and empower others who will emulate your accomplishments. the latest legislative and regulatory issues coincidentally was the day Sen. Max AOPA’s 2,000 members, committed to affecting our business, progress reports on Baucus (D-Montana) introduced his restoring mobility and fullness of life, salute your powerful example. other initiatives, information about AOPA long-awaited reform measure. The activities, educational tools that improve congressional visits by the amputees clinical and management knowledge, and, were covered extensively by CNN and when appropriate, specific calls to action. featured ACA Spokesperson Jordan Richard Gingras, CPO, of Level 4 Thomas. The Washington Post ran a American Orthotic & Prosthetics and Orthotics, based in three-column photo of the group, Prosthetic Association Winston-Salem, North Carolina, piloted shown outside the Senate Finance the PowerPoint at a recent meeting in Committee offices. www.AOPAnet.org Georgia, and fielded a series of quesThree days later, Sen. Ron Wyden tions about AOPA programs and made an (D-Oregon) filed an amendment to the Oncefrom again the O&P story… appeal for O&P Political Action Committee support.

Baucus bill that included the provisions H.R. telling 2479, The next step the O&P Medicare ImprovementInAct authored by Rep. addition to the USA Today June 18th ad in 3 major will be to develop an annual or bi-annual this ad appeared during the video Beijingthat Paralympics the newinteam of communicators also can use to Shelley Berkley (D-Nevada) thatmarkets, links service, complexity USA Today and in Roll Call, a must read for Washington bring the AOPA story to members. The video also would be of patient needs, and provider qualifi cations.

The Wyden politicos and policy makers. posted on the AOPA Web site and offered free to members. amendment did not get a vote in the Senate Finance …Telling the O&P story…

Recognizing that information is most credible when Committee because the dollar savings had not been scored it comes from people who are known to you, AOPA by the Congressional Budget Office. However, through will provide communicators with content for their own this amendment, O&P did see action and received customized newsletters, which can be e-mailed monthly or visibility on the battlefield of health-care reform. bi-monthly to AOPA members in their areas.

And, it’s not over yet.

O&P faces myriad challenges, regardless of whatever The November issue of O&P Almanac gave AOPA direction health-care reform takes over the next few years. members the full story on how all this happened. The How best to communicate these challenges and offer solid ongoing challenge is how AOPA can make sure members solutions are some of the reasons why the new communiare fully informed about these kinds of activities on a cations initiative is so vital to your future. a timely basis. The AOPA In Advance bi-weekly electronic

Telling the

AOPA sTOry

T

32

O&P AlmAnAc DECEMBER 2009

Dennis Amtower, CPO

�

Now, my partial foot patients are able to return to activities they enjoy.�

BlueRocker gives them a functional solution TM

Incorporating a socket with a filler prosthesis onto the BlueRocker provides the best of both limb preservation and gait restoration.

Contact Allard USA for a Voice Over Power Point program detailing the step-by-step protocols for accomplishing your goals for all levels of partial foot amputations.

www.allardusa.com

ALLARD USA, INC. 21 Pine Street, Suite 120 Rockaway, NJ 07866-3130

info@allardusa.com Toll Free 888-678-6548 Fax 800-289-0809

AOPA HEADLINES

AOPA’s Web Site Gets New Look

AOPA Offers

2010 MEDICARE

Members who visit the AOPA Web site will find that this important resource has been revamped to be more userfriendly. Members can now login directly from the home page using the boxes in the top righthand corner. The “Member Directory Search” and “O&P Product Finder” functions have been given a more prominent location that’s easier to spot on the home page. The lefthand navigation features a convenient menu, sorted by topic, where members can find just about everything they need to know.

Visit www.AOPAnet.org to see more; and contact AOPA with any questions.

Audio Conferences

AOPA will again offer its series of Medicare audio conferences in 2010. Seminar prices have not increased; members pay just $99 per audio conference ($199 for non-members).

Members also can buy the complete series of 12—and get two free—for $990; the non-member cost is $1,990.

These convenient one-hour telephone seminars are designed to fit easily into your busy schedule. Get information that you and your staff can put to work immediately. Practitioners also can earn 1.5 credits per audio conference by returning the provided quiz within 30 days and scoring at least 80 percent. All conferences will be taped and available as CDs for purchase at the same member/non-member price ($99/$199). For more information, contact Erin Kennedy at ekennedy@AOPAnet.org or 571/431-0876.

2010 Medicare Audio Conferences

Audio Conference Focuses on

MARKETING

YOUR PRACTICE Russell J. Hornfisher, vice president of sales for Becker Orthopedic and an AOPA Board member, is the special guest speaker for the December 16 audio conference on the theme of improving your bottom line. Topics will include: • What is marketing?

• Is marketing important in O&P? • Who is your customer?

• How do you build relationships with that customer?

• Who is your most effective sales person?

For members, the cost to participate is just $99 ($199 for non-members). Any number of employees can participate at a registered site. For continuing education, participants can earn 1.5 credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register today by contacting Erin Kennedy at ekennedy@aopanet.org or 571/431-0876. Join us on Wednesday, December 16, from 1-2 p.m. EST, for this informative session.

January 13*

Red Flag Rules: Are You In Compliance?

February 10

Hints on Passing Your Supplier Standards Inspection

March 10

Billing for Refused/Returned Devices and Deluxe Features

April 14

Documenting for Success: Chart Notes, Prescriptions and Physicians’ Records

May 12

New Rules for HIPAA: Are You Still Compliant?

June 9

When Disaster Strikes: Implementing a Contingency Plan

July 14

Medicare Appeals Strategies

August 11

Medicare’s Knocking: How Good Is Your Compliance Plan?

September 8

Missed Billing Opportunities: Are You Billing Everything You Can?

October 13

You’re Going To Pay Me WHAT? Hints on Managed Care Contracting

November 10

The Ins and Outs of Billing in a Part A Setting: Hospital, SNF and Hospice

December 8

2011 New Codes and Medical Policies

* All dates are the second Wednesday of the month.

34

O&P AlmAnAc DECEMBER 2009

DEMAND THE BEST Your patients do!

Why shouldn’t you?

ABC facility accreditation is the BEST. We offer the: :: Best value :: Highest standards :: Longest track record for excellence in the orthotic, prosthetic and pedorthic professions

We Can Help The American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc. 330 John Carlyle St., Ste. 210 Alexandria, VA 22314 703-836-7114

ABC facility accreditation isn’t just about meeting the minimum standards—it’s about you and the quality of care you provide.

Accreditation from ABC tells your patients that the highest standards in the profession have been met.

Contact us today at 703-836-7114 and join the best in the profession. Download the accreditation guidelines and an application at www.abcop.org.

www.abcop.org

ST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST DEMAND THE BEST D THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND THE BEST :: DEMAND T

AOPA HEADLINES

AOPA Announces 2010 CODING & BILLING SEMINARS The 2010 Mastering Medicare: Advanced Coding & Billing Techniques seminar schedule will include the following sessions: Atlanta (February 18-19); Pittsburgh (May 24-25); and Las Vegas (October 14-15). Watch for more details in future issues of this column, on AOPA’s Web site, and in the AOPA in Advance newsletter.

ATLANTA

PITTSBURGH

AOPA MEMBERSHIP APPLICATIONS

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

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

At the end of each new supplier member listing is the supplier level associated with that company.

Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million

LAS VEGAS

Coming to a Location Near You!

Center for Orthotic & Prosthetic Care 3400 Executive Dr., Ste. 102 Raleigh, NC 27609 919/821-5221 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

Center for Orthotic & Prosthetic Care

Independence Prosthetics-Orthotics Inc.

171 N. Eagle Creek Dr., Ste. 102 Lexington, KY 40509 859/268-5708 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

2711 Edgemont Ave. Brookhaven, PA 19015 Category: Affiliate Parent Company: Independence Prosthetics-Orthotics Inc., Newark, DE

Farmington Prosthetics & Orthotics

Innovative Prosthetics & Orthotics

728 Sunset Dr. Farmington, MO 63640 573/747-1144 Category: Affiliate Parent Company: Benchmark Medical Inc., Exton, PA

223 E. 14th St. Hastings, NE 68901 402/461-4931 Fax: 402/461-4932 Category: Patient Care Facility Rakesh Srivastava, MS, CPO

Freedom Prosthetics LLC

Northeast Orthotics & Prosthetics

303 Marion East Ave. Crystal Springs, MS 39059 601/892-7745 Fax: 601/892-7746 Category: Affiliate Parent Company: Freedom Prosthetics LLC, Denham Springs, LA

36

O&P AlmAnAc DECEMBER 2009

765 Allens Ave. Providence, RI 02905 401/444-5477 Category: Affiliate Parent Company: Northeast Orthotics & Prosthetics, Providence, RI A

Extreme Cushion

Liner & Sleeve

Providing more of what you want and need!

Extreme Advantage-Indicated for Transfemoral OR ACTIVE Transtibial amputees; Reduce on-hand inventory cost and space requirements through application on either TT or TF amputees.

Extreme Contact-- 80% Less Vertical Stretch As compared to other Alps gel liners, resulting in demonstratively increased contact while stabilizing movement of redundant tissue.

Extreme Suspension-New GripGEL™ is more tactile than EZGel to gently but firmly support the residual limb and sensitive tissues.

Extreme Versatility-Alps New Extreme Cushion Liner has limited vertical stretch to reduce movement of redundant tissue. Use appropriate for TT or TF applications.

Cushion liner available in 3 mm or 6mm Uniform profile to fit circumferences ranging from 1653 cm. Sleeve available in 3mm or 6mm in sizes 20 - 70 cm.

Alps New Extreme Sleeve seals against the skin without restricting circulation or causing shear forces. ALPS GripGel helps prevent the sleeve from rolling down the patient’s limb.

800.574.5426 www.easyliner.com info@easyliner.com

NOW IN STOCK: © 2009 ALPS. All Rights Reserved.

Experience Our Commitment

the eDuCAtion You need

from the experts You require

Webcast Online learning Courses designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. Education does not get any more convenient than this. Learn at your own pace—where and when it is convenient for you.

Earn up to

1.5 CE

Credits per Conference

Modules Currently Available AOPAversity Module 1

What is Medicare

AOPAversity Module 2

Filing Claims

AOPAversity Module 3

Medicare as Secondary Payer

AOPAversity Module 4

Administrative Documentation

AOPAversity Module 5

Hospital SNF Billing

AOPAversity Module 6

ABNs and EOBs

AOPAversity Module 7

O&P Coding Basics

AOPAversity Module 8

Orthopedic and Diabetic Shoes

AOPAversity Module 9

When Bad Things Happen

Earn up to

14 CE Credits

Mastering Medicare Advanced Coding & Billing Techniques Seminar ClassrOOm learning 3 Two full days of in-depth, advanced training Available three different dates at three different locations to serve you better.

Feb. 18-19, 2010 Atlanta

May 24-25, 2010 Pittsburgh

Oct. 14-15, 2010 Las Vegas

At this seminar, AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff: • Learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts and your colleagues; • Join in-depth discussion on compliance with Medicare billing rules and documentation expectations; • Learn how to assess compliance risk areas and deal with them; • Learn successful appeal strategies and hints on avoiding claim denials; • Break-out sessions for practitioners and office staff; • Detailed information on “Hot Topic” issues in O&P; and • Earn 14 continuing education credits in two days.

2010 Telephone Audio Conferencing

Earn up to

1.5 CE During these one-hour sessions, AOPA experts Credits per Conference provide the most up-to-date information on the following topics. Perfect for the entire staff—one fee per conference, for all staff at your company location ($99 Member/$199 Non-Member). A great team-building, money-saving, educational experience! Sign up for the entire series and get two conferences FREE. Entire Series ($990 Member/$1,990 Non-Member) DAte January 13 February 10

telephone ConferenCe Red Flag Rules: Are You In Compliance?

Hints on Passing Your Supplier Standards Inspection March 10 Billing for Refused/Returned Devices and Deluxe Features April 14 Documenting for Success: Chart Notes, Prescriptions and Physicians’ Records May 12 New Rules for HIPAA: Are You Still Compliant?

June 9 When Disaster Strikes: Implementing a Contingency Plan July 14 Medicare Appeals Strategies August 11 Medicare’s Knocking: How Good Is Your Compliance Plan?

September 8 Missed Billing Opportunities: Are You Billing Everything You Can? October 13 You’re Going To Pay Me WHAT?...

Hints on Managed Care Contracting November 10 The Ins and Outs of Billing in a Part A Setting: Hospital, SNF and Hospice December 8 2011 New Codes and Medical Policies Previous telephone conferences are available on CD. Please visit the AOPA Bookstore for details.

Register Today!

Visit us online at

www.AopAnet.org or call 571/431-0876 for more information.

“I Get Around”

The C-Leg® Redefines “Getting Around” There is no better word than “Go!” to describe Massimo and his approach to life. As a new C-Leg® microprocessor knee user, Massimo has quickly returned to his busy routine. And that suits him just fine.

Worldwide, the C-Leg microprocessor knee has helped more than 30,000 others just like Massimo get back to the business of living. It’s a commitment to mobility that Otto Bock has been making for over 90 years.

To discover more about what Massimo and others are saying about “The Standard”, please visit www.clegstories.com. Or find us on Facebook, at www.facebook.com/ottobockus.

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cOllege PArk’s lATesT innOVATiOn – The sOleus™

The Soleus offers a dynamic heel that allows for a seamless, smooth transition between heel strike and toe-off.

Involving the entire foot in absorbing and returning energy, the Soleus four-spring system accommodates a moderate to the most active lifestyle.

The multi-composite design and wide platform heel affords stability, durability, and comfort on various terrain.

Key features include: • Synchronized control throughout the stance phase • Superior terrain compliance • Precision gait matched for out-ofthe-box performance • Available in Gold and Silver For more information, call 800/ 728-7950 or visit www.college-park.com.

sFx

A cOmPleTe cAd sOluTiOn FOr cliniciAns

The all new Sfx from Hosmer adds adjustable stance flexion to most endoskeletal knee-shin systems.

This compact and light weight stance flexion device provides added stability, increased balance, and moderate shock absorption in a modular configuration. Sfx offers 10 degrees of adjustable stance flexion resistance and three different load levels. The Sfx comes with a proximal pyramid receiver and distal tube clamp making it easy to add to most prostheses.

• Improved stability and balance • Absorbs shock for smoother gait • Adjustable up to 10° • 3 stiffness options • Rated for 275 lbs / 125 kg • Available with Weight Activated Locking Knee (W.A.L.K.).

Contact Fillauer at 800/251-6398 or www.fillauercompanies.com.

TrAns-FemOrAl rOTATOr

inTrOducing kiss suPerslider™ The Superslider™ simplifies test socket dynamic alignment. It allows linear alignment changes, in the transverse plane, and slides one inch in all directions. It is durable and reusable. Combine with KISS Superhero™ damage-free test socket plate, with pyramid or receiver, and achieve superior test socket slide and angular adjustment.

• KISS Superslider™ Part #: CMP28/A • KISS Superslider™ KIT (includes KISS Superhero™) Part #: CMP29/A. Contact KISS Technologies at 410/663-KISS (5477) or visit www.kiss-suspension.com.

Every day clinicians are challenged to help patients regain functionality with prosthetic and orthotic solutions. A critical key to success starts with securing patient shapes and then crafting personalized solutions.

The OMEGA Tracer system, with the hand-held OMEGA Scanner, equips clinicians with a versatile system for shape capture, shape modification, and fabrication. This system may be used for lower and upper extremity prosthetics including sockets, custom liners and even custom breast prostheses. Orthotic solutions with OMEGA Tracer include insoles, cranials, AFOs, and spinals. For more information about the OMEGA Tracer system, please contact Ohio Willow Wood at 800/848-4930 or visit www.owwco.com.

brighTen uP 2009 wiTh OPTec’s sTeAlTh And VerTAmAx The Trans-Femoral Rotator 300 (TFR) from Hosmer is a welcome addition to any above-knee prosthesis. It allows the amputee to rotate the shin section of the prosthesis relative to the socket, making entry and exit of tight spaces, such as automobiles, much easier.

• Allows cross-legged sitting • Facilitates entering and exiting cars • Smooth, one-handed, push-button operation • Robust spring-loaded lock • Automatic relock • Low profile and lightweight.

Contact Fillauer at 800/251-6398 or www.fillauercompanies.com.

40

O&P AlmAnAc DECEMBER 2009

Now you can have a choice. OPTEC is offering the revolutionary Stealth and Vertamax orthoses in new appealing colors. The Stealth and Vertamax will be offered in white and beige respectively. Both spinal systems will continue to be available in black.

The Stealth and the VertaMax continue to offer superior support and comfort, which your patients deserve. Call 888/982-8181 for a free 30-day trial sample of the Stealth and Vertamax.

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^^^ KYJVTMVY[ZOVLZ JVT Â&#x2039; 'U &RPIRUW 6KRHV $OO 5LJKWV 5HVHUYHG

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The New Vari-Flex® with EVO™ Technology by Ossur (*Please note: Product shown without its accompanying foot cover.)

The Flex-Foot® Vari-Flex now features EVO (Energy Vector Optimization) technology for improved dynamic response, better comfort, and excellent stability throughout the gait cycle. Patients can now experience a smoother rollover and more energetic toe-off, allowing for a smooth transition even in hard-soled shoes.

Patients report that Vari-Flex with EVO gives them greater stability and reduces fatigue even after increasing their overall activity level. For more information contact us at 800/2336263 or www.ossur.com.

Redesigned StepLock Handle from OTS Corp.

OTS Corp. has redesigned the StepLock handle to allow the use of a special bail kit. In the past, a stiff connecRedesigned StepLock tion between Handle the two joints risked one side locking, while the other was not completely locked, causing the last ratchet tooth to be worn away.

The new bail kit has rubber grommets inside the connection, allowing some play between the two sides.

The kit attaches through two spaces in the redesigned handle, which also allows for a better lever release kit connection. The new handle also is less obtrusive and less likely to catch on clothing. It is now standard on all StepLocks ordered.

For more information, call 800/221-4769 or visit www.ots-corp.com.

Less Is More––Introducing the new Harmony® P3

by Otto Bock Elegant design with maximum functionality! The P3 is lighter with a smaller overall height and width than its predecessors. Appropriate for amputees who are moderate to high activity level and want to ensure optimized fit. Like previous generations of the mechanical Harmony devices, the P3 is waterproof to support your patients in a number of environments. The P3’s Functional Ring provides vacuum generation, vertical shock absorption, and torsion, all in one simple component. To find out how to get your patients into Harmony P3 today, call 800/328-4058 or visit www.ottobockus.com.

Save 10% on Otto Bock’s 4R57 Rotation Adapter from now through the end of 2009!

DYCOR's New CFS Partial Foot

Dycor's new CFS Partial Foot incorporates an integrated custom silicone liner with an advanced carbon fiber/epoxy composite socket and urethane nylon composite upper. This combination enhances pressure dissipation and reduces bulk. The custom silicone liner is available in 4, 5 and 6 millimeter with optional zone padding, soft, medium and firm. The cosmetic cover is either a silicone or urethane/nylon composite. Function is facilitated with either passive or flexible keel feet and optional Velcro closure, depending on ADLs and ablation level. Modified model, tracing of contralateral foot and shoe are required. Allow 10 working days for fabrication. Samples available upon request.

Weight including 5mm liner and flexible keel foot is 8 oz.

(26med.). Prior to casting, please call our Technical Services dept. at 800-794-6099.

Visit our website at www.dycormfg.com. .

42

O&P Almanac DECEMBER 2009

This low-profile adapter is an excellent addition to virtually any above-knee prostheses. It simplifies activities of daily living such as getting into and out of a car, donning/doffing shoes, and driving by allowing the user to quickly and easily reposition his or her leg. The adapter is available with either a pyramid or threaded connection. Call Otto Bock at 800/328-4058 to find out more!

The iPecs* (Intelligent Prosthetic Endoskeletal Component System) research goals. It is destined to change the type of prosthetics research possible and allow for measuring things in a “real world” environment like never before.

The iPecs accurately measures all the forces & moments experienced by an amputee while performing nearly any activity in a variety of settings. The precision data is collected and transmitted wirelessly to your PC or onboard memory. iPecs is considered a vital tool for developing evidenced based endoskeletal prosthetic with the use of an industry standard 4-hole adapter. Once again, College Park continues to lead the way with innovative ideas and products. * The project described was supported by Award Number R43HD059285 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.

17505 Helro Drive • Fraser, MI 48026 800.728.7950 | FAX: 800.294.0067 586.294.7950 | FAX: 586.294.0067

www.college-park.com

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Pel suPPly OFFers new FillAuer gerimAc knee The GeriMac knee is a new single-axis knee from Fillauer that incorporates a novel, automatic mechanical lock to provide maximum stability during the stance phase of gait. This new knee is perfect for geriatric needs and requires very little maintenance.

Features of the GeriMac knee include: • Automatic knee locks at full extension • Rated for up to 175 lb.

• Adjustable stance flexion • Low-profile proximal adapter • Free-swing design • Friction swing-control adjustment.

PEL Supply is the authorized distributor for more than 45,000 products from hundreds of the world’s leading manufacturers. For more information on the new GeriMac

or any pediatric products from the Fillauer Companies, call your friendly PEL customer service rep at 800/321-1264, fax your order to 800/222-6176, e-mail customerservice@ pelsupply.com, or order online at www.pelsupply.com.

ThermOTecc FrOm POlygel: The hOTTesT PrOFiT cenTer FOr yOur PrAcTice!

ThermoTecc is the new low temperature, heat moldable, orthotic system that saves you time and money for your practice. With a thin, full length, anatomically designed shell, ThermoTecc orthotics provide maximum

performance, stability, mid-stance, and lateral control.

Three heat moldable styles to choose from (in seven sizes): • Standard Uncovered shell • Uncovered Bi-Laminate shell with PTecLT Memory foam Layer • Fully Finished Tri-Laminate orthotic with PTecLT and BambooTecc Top Cover (antifungal, anti-odor, anti-microbial) • Heat and modify quickly! Easily modified using several techniques like oven, spot modifications, or dynamic to patients.

Do not miss this opportunity to increase your profit with ThermoTecc: the orthotic system that is: • Customizable • Time Efficient • No Name, No Marks • Minimal Inventory.

To order or for more information call 973/884-8995 ext. 29 or visit www.thermotecc.com. a

OP Almanac

Dynamic Online Version NEW! Now Available

&

Reading the O&P Almanac has never been easier!

Access advertiser Web sites

by simply clicking on the hotlinks

Access content with the click of a mouse or the touch of a smart phone Easily e-mail

your favorite articles to colleagues

Save articles as PDFs! Go to www.AOPAnet.org, click on ‘O&P Almanac Online’ today!

For more information, contact Steven Rybicki at 571/431-0835 or srybicki@AOPAnet.org. For advertising information, contact Dean Mather at 856/768-9360 or dmather@mrvica.com.

www.AOPAnet.org 44

O&P AlmAnAc DECEMBER 2009

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jobs

run your ad in the O&P Almanac and on jobs.AOPAnet.org.

Northeast

cO/Practitioner Assistant Manchester, New Hampshire New England Brace Co. is firmly committed to its motto: “The Patient First – Continuing a Tradition Since 1946.”

We are a progressive, family-owned company with five ABC-accredited facilities in New Hampshire and Maine.

We are looking for a highly motivated professional who enjoys working within a team atmosphere. The candidate should be comfortable in all facets of orthotics, and a strong pediatric background would be a plus. We offer a salary commensurate with experience, and an attractive benefits package. Send your resume to:

karen Acton, PT, cO new england brace co.

15 nelson street, unit 1 manchester, nh 03103 Phone: 603/668-8360 Fax: 603/668-0031 e-mail: Karen@nebrace.com

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

cPO cO board-eligible Orthotist or Prosthetist bOcO or bOcPO c.Ped cFO

Use our map to find which region you fit into!

Maine • Are you looking for something more?

• Do you want to be more than a number?

• Do you want a great life and a great job?

• We are a terrific practice looking for some nice people.

Is this you?

We are a well-established, patient-oriented, ABC-accredited facility seeking to strengthen our staff. Competitive salary offered, with bonuses commensurate with productivity, and renumeration for required educational credits. Offices located in picturesque Maine, just a short distance from our coast and mountain regions. Learn more about joining our team of dedicated specialists by contacting:

classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, e-mail and Web addresses are counted as single words.) AOPA member companies receive the member rate. member rate non-member rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color $482 $678 1/2 page, color $634 $830

O&P Ad 25356, O&P Almanac 330 John carlyle st., ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone.

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

cPO/bOcPO Northeast United States Are you in a rut? Want to use your skills, knowledge, and competitive spirit to improve your life? We are looking for a highly motivated practitioner to become involved with the management of a medium-sized accredited facility with a strong potential to grow. We need a person with clinical and fabrication skills, interpersonal tact and ability. We offer: an attractive benefits package, profit sharing, bonuses, and pleasant work conditions. You will find our area offers excellent schools, affordable housing, outstanding outdoor cultural opportunities, and is a great place to live.

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

Company logos are placed free of charge.

Job board rates Visit the only online job board in the industry at jobs.AOPAnet.org! member rate $80

non-member rate $140

Save 5 percent on O&P Almanac classified rates by running your ad both in the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

contact radcliff33@yahoo.com and we can discuss your future with us.

46

O&P AlmAnAc DECEMBER 2009

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ABC – BOC Orthotist/Prosthetist For Multiple Facility Locations Yankee Medical has immediate openings available in one of our six locations. We are a “family friendly,” privately owned company with a 58-year history of providing high-quality patient care throughout Vermont and its border communities.

While we concentrate the majority of our focus on increasing the health and wellness of our patients, we never forget the source of the highquality care that we provide is the hearts and minds of our staff. That’s why we do everything we can to help them develop and improve the knowledge and skills they need to move forward in their career.

We are looking for an experienced practitioner who desires a long-term relationship with our progressive company. We would also consider a motivated resident with prior O&P work experience.

CO or CPO

Opportunity in Marshfield, WI

Yankee Medical offers a generous benefit package, including fully paid health insurance, 401K matching, profit sharing, bonuses, life insurance, short- and long-term disability insurance, as well as remuneration for your required education credits and help with relocation expenses.

The candidate we are seeking must be a graduate of an Orthotic Practitioner program and/or a Prosthetic and Orthotic Practitioner program, and certified by the American Board of Certification (ABC) in Prosthetics and Orthotics. An undergraduate degree and a minimum of 3 years of experience as an Orthotist and Prosthetist desired.

Experience in Child Orthotics desired.

Come join the family of lifelong Yankee Medical people.

For a more detailed job description and to apply online, please visit our website at www.marshfieldclinic.jobs and refer to job number MC090202.

Call, fax, or e-mail inquiries to:

Linda Wells, Operations Manager Yankee Medical Inc. 276 North Avenue Burlington, VT 05401 Phone: 802.863.4591  Fax: 802.658.3101 E-mail: ljw@yankeemedical.com

Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

1000 N.Oak Ave., Marshfield, WI 54449

AVAILABLE POSITIONS

Why do I work at Hanger?

Orthotist

Chad Simpson, BOCP, LP, Practice Manager

Phoenix, AZ Folsom, CA Pasadena, CA Rancho Mirage, CA Lafayette, CO Waterbury, CT Tampa, FL Tallahassee, FL Springfield, IL

In a word, access. At Hanger, I have access to the very latest technologies and that keeps me on the leading edge in my clinical practice. I Inc. also have access depth of knowledge 550 Heritage Driveto the Suite 200, Jupiter, FL 33485 that Recourse Communications Date Phone: Fax:network 561.687.2180 www.rci-together.com 07/29/09 comes with being part561.687.3737 of a national of skilled practitioners.

Ad Number Publication Section

AOPA

Sept. issue

Run Date(s)

MRC113214

In today’s uncertain economy, I have job security. I benefit from Run Folder Size

Orthotist/Prosthetist

09/01/09 3x5 (3.5x4.5) the strength of an established company, and at the same09/06/09 time,

Est. Cost

Artist

enjoy the freedom I find in my work mc as a local practice manager.

Evansville, IN Jackson, MI Fairfield, OH Tahlequah, OK Harrisburg, PA NW PA/NE OH Milwaukee, WI Wheeling, WV

Thomasville, GA Cincinnati, OH

Proof

Havertown, PA El Paso, TX

Prosthetist

For more information visit www.hanger.com/careers

Modesto, CA Salina/Hays, KS

Bowling Green, KY Jackson, MS

Prosthetist/Orthotist Beverly Hills, CA Cameron Park, CA Denver, CO Washington, DC W. Monroe, LA Columbia, MO Meridian, MS Roswell, NM

Contact, in confidence:

Sharon King, Director, Recruitment 5400 Laurel Springs Pkwy., Suite 901 Suwanee, GA 30024 Tel: 678-455-8865, Fax: 678-455-8885 sking@hanger.com www.hanger.com Hanger Orthopedic Group, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any

Boardman, OH Bend, OR Clackamas, OR Memphis, TN Fort Worth, TX Alexandria, VA Bremerton, WA

Certified Pedorthist Lafayette, CO Waterbury, CT

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

47

O&P Almanac DECEMBER 2009

Columbia, MO Wheeling, WV

jobs

A Healthy Career Is A Growing Career

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jobs

Northeast

CPO & Technician

CPO

Birmingham, Alamaba UAHSF Orthotics & Prosthetics has an immediate opening for a highly motivated, ABC-certified orthotist/ prosthetist as well as an orthotic & prosthetic technician located on the University of Alabama at Birmingham campus. We offer competitive compensation, moving expenses, medical/dental/life insurance, short- and long-term disability, 403(b) retirement, incentive plan, paid vacation/sick/personal holidays, and an educational allowance. Come join our team today! Send your resume to:

Long Island, New York Do you feel like you are not appreciated for your talents?

Do you feel like you are building a practice that you can enjoy the benefits of? We are offering a unique opportunity for an ABC CPO with at least three years of certified clinical experience. A person who has the motivation and team-building philosophy to help grow the practice will have the potential for equity interest and profit sharing. Compensation package including competitive salary, health, and vacation benefits, 401(k), and paid continuing education. We are a 23-year-old, established, innovative, ABC-accredited facility with an excellent reputation on Long Island (Port Jefferson, New York).

Send resume in confidence to:

Tracy Brewer, Director Fax: 205/975-6065 E-mail: tbrewer@uabmc.edu

Mid-Atlantic

E-mail: marty@mhmoandp.com

Certified Prosthetist w/Orthotic Experience

Southeast

Certified Prosthetists and Orthotists Florida Come to Sunny Florida: Due to recent growth and expansion, we are adding to our Florida team! If you have excellent clinical, organizational and communication skills and possess or are eligible for Florida licensure, we would love to speak with you. Management experience a plus!

These positions are accompanied by top compensation and benefits, relocation assistance, paid certification dues, state-of-the-art education, sign-on bonus, and much more!

If you have what it takes, the sky is the limit! Send resume, in confidence, to:

Bowling Green, Kentucky Head for the National Corvette Homecoming event and assembly plant; Western Kentucky University, the third largest city in Kentucky; four seasons that support all types of outdoor sports! We are searching for a well-rounded prosthetist…someone with great organizational and communication skills along with excellent patient-care experience. We offer a very attractive salary and benefit package, which includes relocation assistance and a sign-on bonus. Ready to make a change?

Join the Hanger Team! If interested, please contact, in confidence:

Sharon King Director, Recruitment Hanger Prosthetics & Orthotics, Inc. 678/455-8865 Fax: 678/455-8885 E-mail: sking@hanger.com www.hanger.com/careers

Sharon King Director, Recruitment Hanger Prosthetics & Orthotics, Inc. 678/455-8865 Fax: 678/455-8885 E-mail: sking@hanger.com www.hanger.com/careers

Prothetist/Prosthetic Technician

CO/CPO

Louisiana Louisiana-based company seeking certified prosthetist and prosthetic technician. Prosthetist must have the clinical experience, rehabs and hospital settings. Marketing skills would be appreciated. Prosthetic technician requires good fabrication skills. Salary commensurate with experience.

Employee benefits, paid continuing education, and other opportunities. Send resumes to:

El Paso, Texas Locally owned and operated family O&P business, we offer a competitive salary and exceptional benefits package and retirement plan. Please send or fax resume to:

Susan M. Guerra, RN Total Orthotic & Prosthetic Solutions Inc. 900 E. Yandell Dr. El Paso, TX 79902 915/541-8677 Fax: 915/541-8678

Bias Orthotics & Prosthetics P.O. Box 4571 Lake Charles, LA 70606 E-mail: lapobias@suddenlink.net

48

O&P Almanac DECEMBER 2009

Introducing OC-2000

Orthotic Carver

The ultra compact and affordable solution for positive and negative carving needs

Portable Scanner (optional equip. $2,295/set):

only need 0.3 second to take 3D image of foot or impression box

Cost: Lease for $300/month.

Carving machine with software support Cost for making 1 pair of foot orthotics: Using positive carving:

$10.25/pr.(Material include Firm PU foam Block to carve positive,& PE/PP sheet, or Tri-lam EVA/PPT/Thermozote cover)

Using negative carving: $8.25/pr.(Material include 55 Durometer EVA Block to carve nagative, dual-lam PPT/Thermozote cover)

Time savings: 2 min. scanning + 2 min. on comp. screen cast modifications/finish + 4 min. carving,

Labor savings: 1-2 full time labors

2239 Tyler Ave S. El Monte, CA 91733 1-888-937-2747 fax 1-626-448-8783

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calendar

New calendar additions appear in color AOPA-sponsored activities appear in a color box

2009 december 2: Ultrafl ex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO. Register at www.ultraflexsystems.com, 800/220-6670.

december 3-4:

december 10-12:

ALLARD USA: T.O.T.E. (Tomorrow’s Orthotic Technology Education).

Denville, NJ. Three courses: Gait Biomechanics and Orthotic Applications; Management of Hip and Foot/Ankle Complex for Tone-Involved Pediatrics; Mold-To-Patient Custom Orthotics. Approved for 18 CEUs. Call 888/678-6548, e-mail info@allardusa.com.

Rehabilitation Institute of Chicago: Pediatric Gait Analysis and Orthotic featuring Elaine Owen.

Chicago. 23 ABC Credits.

For more information visit www.ric.org/education or contact Melissa Kolski at 312/238-7731. december 15: Ultrafl ex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, Noon – 1:00 pm ET course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO. Register at www.ultraflexsystems.com, 800/220-6670.

lisT eVenTs in The O&P ALMANAC Telephone and fax numbers, e-mail addresses and Websites are counted as single words.

Refer to www.AOPAnet.org for content deadlines.

Words

Member rate

25 or less $40 26-50 $50 51+ $2.25 per word Specials: 1/4 page, color 1/2 page, color

$482 $634

2010 JAnuAry 7: Ultrafl ex: Pediatric Spasticity Continuing Education Course, via WebEx, 2:00 – 3:00 pm ET course covers lengthening and strengthening muscles and improving range with postural support and therapeutic/stretching assist. Instructor: Taffy Bowman, CPO. Register at www.ultraflexsystems.com, 800/220-6670.

JAnuAry 12-17: OPGA/POINT Premier Conference, Dreams Resort, Cancun, Mexico. Premier Members and Suppliers will meet with leading speakers from the orthotic and prosthetic community for a week of education, networking, and relaxation.

For more information, go to www.opga.com or contact OPGA at info@opga.com or 800/214-6742.

Non-member rate

JAnuAry 13:

$50 $60 $3.00 per word

Ultrafl ex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 2:00 – 3:00 pm ET course covers clinical assessment and compensating for pediatric gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO. Register at www.ultraflexsystems.com, 800/220-6670.

$678 $830

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

Make checks payable in U.S. currency to:

American Orthotic & Prosthetic Association Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or E-mail srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date.

For information on continuing education credits, contact the sponsor. Questions? E-mail srybicki@AOPAnet.org.

50

O&P AlmAnAc DECEMBER 2009

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MAY 12-15:

June 4-5:

Ultraflex: Adult UltraSafeStep™ Continuing Education Course, via WebEx, 2:00 – 3:00 pm ET course covers clinical assessment and compensating for adult gait deficits with the new Adjustable Dynamic Response (ADR) technology. Instructor: Taffy Bowman, CPO. Register at www.ultraflexsystems.com, 800/220-6670.

International Trade Show for Prosthetics, Orthotics and Rehabilitation Technology: “Orthopadie + Reha-Technik 2010” Leipzig, Germany. www.ispo-2010-leipzig.de.

PrimeFare East Regional Scientific Symposium 2010, Nashville Convention Center, Nashville.

Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

MAY 13-15:

June 10-11:

February 19-20: PrimeFare West Regional Scientific Symposium 2010, Salt Lake City.

Salt Palace Convention Center. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

WAMOPA/COPA Combined Meeting Sparks/Reno, Nevada, Nugget Hotel. Combined meeting of Western and Midwestern Orthotic and Prosthetic Association and California Orthotic and Prosthetic Association.

For information contact Steve Colwell at 206/4401811 or Sharon Gomez at 503/521-4541 or visit www.wamopa.com.

February 24-27:

MAY 20-22:

36th Academy Annual Meeting & Scientific Symposium. Hyatt Regency Chicago. Visit www. academyannualmeeting. org for the latest information.

Contact Diane Ragusa at 202/380-3663, ext. 208 or dragusa@oandp.org.

Louisiana Assocation of Othotist & Prosthetist Meeting. Lafayette Hilton.

O, P & C.Ped Credits.

Come take in Louisiana’s creole culture and culinary delights! Contact Sharon Layman, 504/464-5577 or visit www.LAOP.org.

Michigan Orthotics & Prosthetics Association (MOPA) Continuing Education Seminar. Mt. Pleasant, Michigan. Soaring Eagle Casino & Resort. For details visit www.mopa. info or contact Mary Ellen Kitzman at 248/615-0600 or MOPA_meeting@MOPA.info.

SEPTEMBER 29OCTOBER 2

AOPA National Assembly. Rosen Shingle Creek Resort. Orlando, FL. Exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/431-0852 or koneill@AOPAnet.org.

JUNE 2-5: Association of Children’s Prosthetic-Orthotic Clinics 2010 Annual Meeting.

Clearwater, Florida.

Sheraton Sand Key Resort.

For more information call 847/698-1637, e-mail acpoc@aaos.org or visit www.acpoc.org.

51

O&P Almanac DECEMBER 2009

2011 MARCH 28 - APriL 2: Association of Children’s Prosthetic-Orthotic Clinics 2011 Annual Meeting. Park City, Utah. The Canyons.

For more information call 847/698-1637, e-mail acpoc@aaos.org or visit www.acpoc.org. a

calendar

January 19:

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ad index

For free product information from these advertisers, enter the advertiser name online at www.opalmanac.org/shop.

Company

Page

Phone

Web site or E-mail

Allard USA Inc.

33

888/678-6548

www.allardusa.com

ALPS

37

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics and Pedorthics

35

703/836-7114

www.abcop.org

Apis Footwear

23, 49

888/937-2747

www.bigwideshoes.com

College Park Industries Inc.

13, 43

800/728-7950

www.college-park.com

Daw Industries

1, 45

800/252-2828

www.daw-usa.com

Dr. Comfort

11, 41

800/556-5572

www.drcomfortdpm.com

Fillauer Companies Inc.

25

800/251-6398

www.fillauercompanies.com

KISS Technologies LLC

17, C3

410/663-5477

www.kiss-suspension.com

Ohio Willow Wood

2

800/848-4930

www.owwco.com

OPTEC

27

888/982-8181

www.optecusa.com

Ossur Americas Inc.

C4

800/233-6263

www.ossur.com

OTS Corp.

7

800/221-4769

www.ots-corp.com

Otto Bock HealthCare

C2, 39

800/328-4058

www.ottobockus.com

PEL Supply Company

29

800/321-1264

www.pelsupply.com

Poly-Gel LLC

19

866/438-2297

www.ThermoTecc.com

Spinal Technology Inc.

5

800/253-7868

www.spinaltech.com

SPS

9

800/767-7776 Ext. 3

www.spsco.com

ÂŽ

2009 AOPA

OPerATing PerFOrmAnce & cOmPensATiOn rePOrT (BASED ON 2008 DATA)

A

re you curious about how your business compares to others?

This survey will help you see the big picture. The OPC report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement, compensation information, employee benefit analysis, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 118 patient-care companies representing nearly 964 O&P facilities nationwide.

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52

O&P AlmAnAc DECEMBER 2009

FLEX-FOOT® ASSURE BY OSSUR

Allow your patients to reach their potential with the unprecedented soft and smooth rollover of Flex-Foot® Assure.

But more than just a comfortable foot, the easy-to-fit Assure, is a stable, dynamic addition to the Flex-Foot line. Its lightweight, low-profile design, reduces impact, optimizes walking symmetry and helps restore mobility. Perfect for patients who need the benefits of performance in an easy to walk design.

Your patients have the will.

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PLEASE VISIT OSSUR.COM/ASSURE TO LEARN HOW THE FLEX-FOOT ASSURE PROVIDES TRUE POTENTIAL.