The Magazine for the Orthotics & Prosthetics Profession
D E C E M B E R 2015
E! QU IZ M EARN
Code and Fee Schedule Changes for 2016
Highlights from the 2015 AOPA National Assembly P.34
Update on Medicare DMEPOS Supplier Application Fee P.56
How virtual reality could be the next powerful tool for the profession P.24
This Just In: Analyses of Policymakersâ€™ Statements Regarding the Draft LCD for Lower-Limb Prostheses P.22
YOUR CONNECTION TO
BOSTON 2016 AOPANET.ORG
Mark your calendars September 8-11, 2016, for an ideal combination of top-notch education and entertainment at the combined 99th AOPA National Assembly and New England Chapter Meeting in Boston, MA. We look forward to seeing you in 2016!
EXCELLENCE in EDUCATION Prosthetic
For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.
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DECE M B E R 2015 | VOL. 64, NO. 12
DEPARTMENTS | COLUMNS
Presidentâ€™s View....................................... 4
Insights from AOPA President James H. Campbell, PhD, CO, FAAOP
AOPA Contacts............................................6 How to reach staff
At-a-glance statistics and data Photo: ASU/Lee Childers
24 | Virtual O&P Inside military and academic settings, O&P professionals have been leveraging virtual reality technology for years. Both current and future patients stand to benefit from the technology as participants rehab in virtual reality lab environments where real-time feedback and extensive data collection open up research opportunities that could impact payorsâ€™ reimbursement decisions. By Christine Umbrell
Research, updates, and industry news
People & Places........................................ 16
Transitions in the profession
Looking Ahead to 2016
Tips for closing out 2015 and preparing for the new HCPCS codes and fee schedule
CE Opportunity to earn up to two CE credits by taking the online quiz.
Member Spotlight.................................42 n
22 | This Just In
A Temporary Reprieve October statements from CMS and the White House indicating the DME MACS will not finalize the draft Local Coverage Determination governing coverage of lower-limb prosthetics were encouraging. However, the proposed LCD has not yet been rescinded and remains posted on the websites of CMS and the DME MACs, so O&P stakeholders are encouraged to monitor the actions of payors and legislators.
34 | Creating Opportunity from Uncertainty
While the O&P profession faces uncertainty as it continues to evolve, new opportunities borne from technological advancements and increased research are emerging. At the 2015 AOPA National Assembly, more than 2,200 professionals gathered to network, learn, and share their expertise on how to deliver quality patient care in the future.
Orthotics & Prosthetics Associates Pinnacle Prosthetic Labs
AOPA meetings, announcements, member benefits, and more
Welcome New Members ................. 48
Upcoming meetings and events
Ad Index....................................................... 55 Ask AOPA................................................... 56 Expert answers to your questions about application fees
+PLUS: AOPA Board Members Begin 2015-2016 Term
O&P ALMANAC | DECEMBER 2015
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
A Question for CMS
HE RAPID DRIVE TOWARD cost-efficient, evidence-based, and outcome-driven orthotic and prosthetic care is not slowing down. I believe if we are to stand any chance of defending our industry, our profession, and our patients from those who attack and undermine the value of what we do, the ongoing development, establishment, and dissemination of our evidence base is of critical importance. There is clearly increasing pressure on all of us to show results about treatment protocols and practices that work. I hear people continually say that orthotics and prosthetics has a low, or at best an immature, scientific base; however, this is neither unique nor entirely negative, but rather an exciting opportunity. The development of a scientific or evidence base within orthotics and prosthetics is a process, not an event, and we are making progress. The most recent red alert for all of us was the CMS draft Local Coverage Determination (LCD) for the provision of lower-limb prostheses, a proposal that would have diminished both the quality and access to prosthetic care across our nation. The orthotic and prosthetic community came together in unprecedented fashion to advocate for the patients we serve. I was privileged to testify at the public hearing, where I specifically addressed the absence of any scientific base and evidence to support the changes in the draft LCD. The articles referenced by CMS that it claimed to support the changes actually had no bearing on any of the policy changes described within the proposal. In fact, I was able to point out that the evidence that does exist could be used to refute the changes. By now you know that we have received a temporary reprieve as Medicare contractors will not implement the ill-conceived and non-evidenced-based policy. CMS has announced that it will convene a Multidisciplinary Interagency Workgroup that will develop a consensus statement that informs Medicare policy by reviewing the best available clinical evidence that defines best policy. Medical consensus is a public statement on a particular aspect of knowledge at the time the statement is made that a representative group of experts agree to be evidence-based and state-of-the-art/science knowledge. The acknowledgement by CMS that a review of the best available evidence is required is a positive step; it is, however, equally important that the workgroup is comprised of a representative group of subject matter experts. The question for CMS is, how will the voices of subject matter experts (the independent patient advocates, prosthetists, physicians, therapists, and researchers) be heard during the development of the consensus statement?
Board of Directors OFFICERS
President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA
James H. Campbell, PhD, CO, FAAOP AOPA President
Dave McGill Ă–ssur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Bradley N. Ruhl Ottobock, Austin, TX
DECEMBER 2015 | O&P ALMANAC
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American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC
Our Mission Statement The mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation, and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@ AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
MEMBERSHIP & MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865
DECEMBER 2015 | O&P ALMANAC
Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, email@example.com Catherine Marinoff, art director, 786/293-1577, firstname.lastname@example.org Bob Heiman, director of sales, 856/673-4000, email@example.com Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, firstname.lastname@example.org
Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email 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. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. COVER PHOTO: ASU/Lee Childers
Advertise With Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email email@example.com. Visit bit.ly/aopamedia for advertising options!
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O&P Productivity Levels on the Rise Latest data indicates productivity at O&P facilities is returning to levels not seen since 2010 AOPAâ€™s 2015 Operating Performance Report, based on 2014 data, captured the financial facts from 93 companies representing 1,148 full-time facilities and 75 part-time facilities.
Current assets/current liabilities ratio, compared to 2:6 in FY2013.
NET SALES FOR FY2014
$2,669,715 Median sales, compared to $2,667,461 for FY2013.
$5,623,551 Average sales, compared to $5,055,730 for FY2013.
USE OF CENTRAL FABRICATION
Percentage of all respondents who use central fabrication.
Percentage of profit leaders who use central fabrication. 8
DECEMBER 2015 | O&P ALMANAC
REVENUES FOR FY2014
$476,000 $165,000 Median revenue per nonowner practitioner, compared to $464,000 in FY2013.
PERCENT OF SALES BY CATEGORY Durable medical equipment 3% Pedorthics 3%
Median revenue per employee, compared to $163,000 in FY2013.
4% 37% 13%
O&P FACILITY NET PROFIT MARGINS Up to $1 Million $1 to $2 Million $2 to $5 Million
Office administration/ marketing staff
5.8% 7.1% 5.3%
3.0% 5.7% 6.0% 5.7% 1% 2% 3% 4%
Technicians Nonclinical owner/managers
Over $5 Million
5% 6% 7% 8%
Other job titles Editorâ€™s Note: The 2015 Operating Performance Report is now available through the AOPA bookstore. Visit www.aopanetonline.com/store.
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Happenings RESEARCH ROUNDUP
Researchers Develop Dynamic Scoliosis Orthoses specific directions. Agrawal’s team is seeking to combine the merits of both designs in the new dynamic orthosis. The research team was recently awarded a $1 million grant from the National Science Foundation’s National Robotics Initiative toward this project. The goal is to build orthoses that overcome some of the challenges associated with rigid braces currently in use, such as limited upper-body movement. The researchers have developed prototype wearable spine braces and plan to test the orthoses on children with scoliosis at the Columbia University Medical Centre. “We expect our work will transform treatment
Prototype wearable spine brace: Sensors record the force and motion data and transmit the information to a computer for monitoring and treatment.
due to the ability of the brace to modulate force or position at specific locations of the spine and will greatly improve the quality of life” for children with scoliosis, Agrawal says.
Study Reveals Link Between Severe Combat Injuries and Chronic Disease A new study finds that the more severely a service member is injured, the more likely he or she is to develop a wide variety of chronic medical conditions, including high blood pressure, diabetes, chronic kidney disease, and hardening of the arteries. More than 3,800 soldiers who were injured in Afghanistan or Iraq
DECEMBER 2015 | O&P ALMANAC
were included in the study. Each soldier received a score ranging from 1 to 75 based on the severity or his or her wounds. The higher the score, the worse the injuries. The researchers found that for every five-point increase in injury score, the risk of high blood pressure rose 6 percent; coronary artery disease and diabetes jumped 13 percent; and chronic kidney disease increased 15 percent. Led by Major Ian Stewart at the David Grant Medical Center at Travis Air Force Base in California, the research team also found that veterans who developed chronic diseases tended to be older, had higher injury scores, and experienced more serious kidney damage. When
wounds were complicated by kidney damage, the risk of high blood pressure rose 66 percent and the risk of chronic kidney disease was nearly five times higher, the study revealed. Among the most severely injured veterans, rates of high blood pressure, coronary artery disease, and diabetes were significantly higher than overall in the U.S. military. Inflammation may be the reason why combat injuries increase the risk of chronic disease, the study authors suggested. “Our study lays important groundwork to better understand the longer-term effects of combat-related injury on the risk of chronic disease,” says Stewart. Details of the study were published in the November 2 issue of the journal Circulation.
PHOTO: Jane Nisselson
Columbia University’s Sunil Agrawal is spearheading an effort to develop dynamic spine braces for scoliosis patients. Agrawal, professor of mechanical engineering, is working with David P. Roye, professor of pediatric orthopedic surgery at Columbia, and Charles Kim, professor of mechanical engineering at Bucknell University, in designing a hybrid semi-active spine orthosis that incorporates elements of two braces: one that consists of rings that are dynamically actuated by servomotors placed on adjacent rings to control the force and position applied to the human body, and a second passive brace made of compliant components that are able to adjust stiffness in
Gene Therapy Shows Promise in Muscular Dystrophy Treatment A team of University of Missouri researchers has developed a strategy to send microdystrophin to all of the muscles in a dog’s body to prevent the progression of Duchenne muscular dystrophy (DMD), and is planning to begin clinical trials in humans. Patients with DMD, which primarily affects boys, experience damaged muscle tissue that is replaced with fibrous, fatty, or bony tissue and eventually lose function. DMD patients have a gene mutation that disrupts the production of the protein dystrophin. Absence of dystrophin starts a chain reaction that eventually leads to muscle cell degeneration, as well as loss of ambulation and breathing. Many DMD patients require orthotic intervention as well as wheelchairs. Because dystrophin is one of the largest genes in the human body, it has not been possible to deliver the entire gene with a gene therapy vector. However, the University of Missouri researchers have developed a miniature version of dystrophin, called a microgene. “This minimized dystrophin protected all
muscles in the body of diseased mice,” says lead researcher Dongsheng Duan, PhD. The research team recently experienced a breakthrough when it demonstrated that a common virus can deliver the microgene to all of the muscles in the body of a diseased dog. Research dogs were injected with the virus when they were two to three months old; they are now seven months old and continue to develop normally. “The virus we are using is one of the most common viruses; it is also a virus that produces Dongsheng no symptoms in the Duan, PhD human body, making this a safe way to spread the dystrophin gene throughout the body,” Duan says. “These dogs develop DMD naturally in a similar manner as humans. It’s important to treat DMD early before the disease does a lot of damage, as this therapy has the greatest impact at the early stages in life.” Clinical stages in humans will begin in the next few years.
y, Chene ; Gary vid P L D , P n a a man, C Congressm r e k c T P ; Nick A LPO, AAOP CPO, LPO, F Shurr, n CPO, o D ; and Young
Iowa Congressman Tours Local Facility
Practitioners at American Prosthetics & Orthotics, headquartered in Clive, Iowa, recently hosted Congressman David Young (R-Iowa-03). Young toured the facility to learn how amputees learn to walk and run again through available technology, then had discussions with staff on recovery audit contractor audits, delays in appeals to the administrative law judge, and the changing levels of local coverage determination for lower-limb prosthetics as proposed by the durable medical equipment Medicare administrative contractors. The facility’s practitioners also asked for and received Young’s support on HR 1526, the Medicare Audit Improvement Act of 2015, and HR 1530, the Medicare Orthotics and Prosthetics Improvement Act of 2015.
O&P ALMANAC | DECEMBER 2015
Leadership Conference O&P
A N E XC L U S I V E , BY I N V I TAT I O N O N LY E V E N T
JAN. 8-10, 2016 • PALM BEACH, FL EAU PALM BEACH RESORT & SPA
Charlie Cook, renowned political analyst and publisher of the “Cook Political Report”
Michael Lovdal, PhD
O&P Executives To Convene at O&P Leadership Conference AOPA will host the O&P Leadership Conference January 8-10 in Palm Beach, Florida. Building on the success of the inaugural event in January 2015, AOPA has invited the top O&P executives from each AOPA member company to participate in a program intended to bring together the best minds in the O&P community. Attendees will hear speakers and take part in panel discussions on a number of critical topics, including the U.S. health landscape, 2016 election implications for O&P, key trends in clinical care, advocacy at the state level, CMS, research priorities, and more. A number of prominent speakers will share their expertise, including former Senator and Governor Bob Kerrey, an amputee, Medal of Honor recipient, and O&P advocate whose powerful story helped bring attention
to the LCD proposal. He will present “Perspectives on LCD and Prosthetic Payments.” Charlie Cook, a renowned political analyst and publisher of the “Cook Political Report.” Cook is considered by many to be a trusted and accurate voice on all things political, and has been featured on the ABC, CBS, and NBC evening news programs as well as Nightline, Meet the Press, This Week, and other news shows. During the January conference, Cook is expected to offer his analysis of the political scene in America as it pertains to the world of health care. Michael Lovdal, PhD, also will share his knowledge in Florida. A health-care expert and emeritus partner at Oliver Wyman, Lovdal spoke at the 2015 Leadership Conference and will lead a dynamic session in January on “The Top 10 U.S. Health-Care Projections for 2020.”
O&P Stakeholders Take Part in California Innovation Symposium Hundreds of O&P practitioners, engineers, designers, physicians, ergonomic specialists, researchers, physical therapists, physicists, venture capitalists, and inventors participated in the inaugural O&P Innovation & Technology symposium on November 6. The event,
Top: Jon Schull discusses 3D printing; on left, Rickard Branemark, MD, PhD; on right, Neil McCaffrey 12
DECEMBER 2015 | O&P ALMANAC
a day of discovery and networking.” While many of the sessions pertained specifically to O&P, others discussed topics on a broader level, with applications for O&P in the future. In addition to educating participants, the organizers sought to partner dynamic thinkers and innovators with investors and entrepreneurs as a means of more rapidly advancing the technological developments in O&P. Some of the topics included osseointegration, spinal tethering for scoliosis, digital health for O&P, advanced sports prosthetics, 3D printing, and other emerging trends. The organizers plan to host the event annually, so it can serve as a platform for new and marketable technologies in O&P, as well as for those in the early stages of development.
PHOTOS: Matthew Garibaldi, MS, CPO
which was designed to connect O&P innovators with investors, was hosted by the Department of Orthopaedic Surgery at the University of California— San Francisco and the California Orthotic & Prosthetic Association. The symposium was initiated “out of an increasing desire to discover new areas of clinical innovation and technology, in an attempt to address the increasing demands of our patients and to improve care we provide them,” says Matthew Girabaldi, MS, CPO, assistant clinical professor and one of the event’s organizers. “The best way of accomplishing this goal was to gather all interested parties in one room for
Amputee Basketball Players Compete in Phoenix The AMP1 basketball team, comprised of stand-up (nonwheelchair) amputee basketball players, successfully defended its championship title in October in Phoenix. The team went undefeated to win the tournament. Though the AMP1 team frequently plays against nonamputee competitors, the Phoenix event consisted of a series of games against other amputee athletes as part of the Duel in the Desert 3-on-3 Tournament. The competition took place at Ability360, with a showcase of adapted sports featuring amputee basketball, wheelchair basketball,
power soccer, and wheelchair rugby. AMP1 team members utilize Freedom Innovations’ Renegade Foot, and transfemoral amputee players utilize the Plié MPC Knee.
PHOTOS: Freedom Innovations
First Female Bilateral Amputee Completes Marathon and the Challenged Athletes Foundation throughout my journey as an athlete. The race was everything I imagined and more.” Marseilles, 46, became an amputee in 1988 as a result of gangrene resulting from severe frostbite after she and a friend were trapped in a car in a snowbank for 11 days. While Marseilles says she wasn’t very physically active in her younger years, she embraced physical fitness following her amputation, setting records first as a sprinter and now as a distance runner.
During a recent episode of the television show The Doctors, Jesse Crumpton West of Montgomery, Alabama, was surprised by prosthetist Erik Schaffer, CP, with an offer of state-of-the-art prostheses. West, a mother of three, lost both of her legs and her right arm in 2011 in amputations to save her life after being burned by a pot of boiling water. West has undergone more than 200 surgeries and skin grafts. Though she first was fit with prosthetic legs in 2012, West stopped using them after bone spurs began growing at the end of her legs, breaking through the muscle and rendering her unable to walk. But the staff of The Doctors had several surprises during West’s appearance on the show, including a Skype session with Schaffer, where he promised to fit West with customized prostheses that will work around her bone spurs. West will travel to Schaffer’s facility, A Step Ahead Prosthetics in Hicksville, New York, to be treated. West says the new prosthetic legs “will change my life.”
O&P ALMANAC | DECEMBER 2015
PHOTO: Montgomery Advertiser
Össur Ambassador Jami Marseilles became the first bilateral amputee woman to complete a full marathon. Wearing custom Össur Flex-Run prostheses, Marseilles ran the 26.2-mile Bank of America Chicago Marathon on October 11 with a time of 6 hours, 27 minutes. “Setting this goal was intense, mentally and physically, but finishing the marathon wasn’t a choice, it was a necessity,” Marseilles says. “I appreciate everyone who cheered me on, from close and afar, and am grateful for all of the support I’ve received from Össur
Trilateral Amputee Receives State-of-the Art Prostheses
2016 HCPCS Codes Released CMS has released the new Health-Care Common Procedure Coding System (HCPCS) codes for 2016. There were no L codes added or deleted for 2016. However, there were two minor verbiage changes for codes L1902 and L1904, which describe prefabricated and custom-fabricated ankle gauntlet style
devices, respectively. Below is a breakdown of the code descriptor changes that will be effective for claims with a date of service on or after Jan. 1, 2016. EDITOR’S NOTE: For more detailed information, see our Reimbursement Page column on page 18.
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
AFO, ankle gauntlet, prefabricated, off-the-shelf
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
Ankle orthosis, ankle gauntlet, custom fabricated
Jurisdiction A Publishes Prepayment Reviews of Spinal Orthoses and K3 Prostheses NHIC Corporation, which serves as the Jurisdiction A durable medical equipment Medicare administrative contractor (DME MAC), has released the results of its ongoing prepayment review for spinal orthoses described by L0631 and L0637. From June 2015 through August 2015, 1,068 claims for L0631 and L0637 were submitted and 568 were reviewed; 500 claims could not be reviewed because the DME MAC did not receive any additional information from the suppliers. Of the 568 claims reviewed, 551 were denied— representing a claim denial rate of 97 percent. The charge denial rate (CDR), the dollar amount of services determined to be billed in error divided by dollar amount of services medically 14
DECEMBER 2015 | O&P ALMANAC
reviewed, was 95.5 percent, which is an increase over the last reported CDR of 81.8 percent. The top reasons for denial were missing/incomplete detailed written orders, missing/incomplete proof of delivery, and missing or unsubstantiated clinical documentation. Based on the denial rates, NHIC will continue its prepayment review for these codes. NHIC also recently released the results of its ongoing prepayment review of lower-limb prostheses billed with a K3 modifier. From May 29, 2015, until Sept. 3, 2015, 118 claims were submitted, 28 of which could not be reviewed because the DME MAC did not receive any additional information from the suppliers. Out of the remaining 90 claims, 37 were denied—representing a claim denial rate of 41
percent. The CDR was 42.1 percent, which is a decrease from the last reported CDR of 50.6 percent. The top reasons for denial were no documentation submitted, documentation did not support the functional level, invalid/missing proof of delivery, and no documentation supporting the need for replacement. Based on these results, NHIC will continue its prepayment review for lower-limb prostheses. O&P practitioners should pay special attention to the changes to the proof of delivery requirements currently being enforced by the DME MACs. It is no longer acceptable to solely use HCPCS codes and descriptors on a proof of delivery. For a proof of delivery to be considered valid, it must include either a brand name and/or model number, or a detailed narrative description, for each component that is billed separately and provided to the patient.
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PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
Orthotic Holdings Inc. (OHI) and Sensoria Fitness have partnered in developing the new Smart Moore Balance Brace, an orthosis designed to help prevent falls by improving the wearers’ balance and stability. The device is an Internet-connected version of the Moore Balance Brace; the new design allows clinicians to monitor their patients’ adherence, activity levels, and gait parameters. “We are so excited to bring an IoT-enabled orthotic to the market, and we hope this will be the first of many successful product developments with Sensoria,” says Jason Krauss, president and chief executive officer of OHI. The Prosthetic Care Facility of Virginia has announced that the U.S. Patent and Trademark Office has issued a trademark to the company for the name Destination Prosthetics®. The Destination Prosthetics program is designed for amputees who want to achieve mobility, but are unable to receive the rehabilitation care needed in their own community or from their own prosthetist. Patients accepted for the program receive intensive one-on-one treatment with no interruptions at the Prosthetic Care Facility of Virginia. John Hattingh, CP, LPO, CPO(SA), works directly with patients, reviewing limb-loss history, and then fitting them with the correct socket and components. Patients receive gait training and education in the care and use of their components. Adjustments are offered as needed.
PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS
Hanger Clinic announced that James Campbell, PhD, CO, FAAOP, has joined the company as chief clinical officer, effective Nov. 16, 2015. A primary focus for Campbell will be the development of Clinical Practice Guidelines James Campbell, for major medical conditions, as well as PhD, CO, FAAOP capturing the medical outcomes of Hanger Clinic’s patients, and translating it into value for payors. Campbell joins Hanger Clinic with a high level of distinction for his work, leadership, and research in the field of orthotics and prosthetics. He worked for the past 17 years at Becker Orthopedic in Troy, Michigan, where he served most recently as the executive vice president responsible for clinical services, as well as research and product development, manufacturing engineering, quality, regulatory affairs, and central fabrication. 16
DECEMBER 2015 | O&P ALMANAC
Campbell has served on AOPA’s board of directors since 2012 and is the president for 2015-2106. He chairs AOPA’s survival imperative on outcomes and evidencebased practice. He also is a past member of the board of directors for the American Academy of Orthotists & Prosthetists (AAOP) and served as chair of its Educational Development Council. In addition, Campbell serves as a member of the Advisory Board for the doctorial department of applied physiology at Georgia Tech University, on the Biomedical Engineering Industrial Advisory Board at Lawrence Technological University, and on the Advisory Board for the O&P Program at Eastern Michigan University. A named inventor on five U.S. patents, Campbell has authored several book chapters and journal articles, and served as the editor-in-chief for the Journal of Prosthetics and Orthotics from 2000 to 2003. He received the Thranhardt Award in 2000, and in 2005, he was the Orthotic Education & Training Trust Invited Lecturer at the UK National Member Society of International Society for Prosthetics & Orthotics. In February 2013, he received the Distinguished Practitioner Award from AAOP in recognition of his significant contribution to the field.
Charlie Huizinga has been promoted to sales and marketing manager at WillowWood. He will continue to be responsible for international sales, concentrating on the European market, while taking on the management of the company’s product specialist team for domestic customer education and product awareness. Linda Wise has been promoted to chief marketing officer of WillowWood. She has assumed full leadership of the company’s marketing team and has joined the company’s executive leadership team. Wise also spearheads domestic and international sales within the Americas.
The Board of Certification/Accreditation’s President and Chief Executive Officer Claudia Zacharias, MBA, CAE, assumed leadership as board chair of the Institute for Credentialing Excellence (ICE) Board of Directors. ICE is Claudia Zacharias, a professional membership association that MBA, CAE advances credentialing through education, standards, research, and advocacy to ensure proficiency across professions and occupations. The announcement was made at the ICE Annual Meeting in Portland, Oregon. Earlier this year, Zacharias was re-elected to the ICE Board of Directors for a second three-year term. She has served as secretary/treasurer for the past two years and will serve as board chair for the first year of the current term. On continuing her commitment to the ICE Board of Directors, Zacharias says, “I am pleased and proud to take on the role of ICE board chair. I have enjoyed my experience on the ICE Board of Directors and I look forward to what ICE will accomplish in 2016.”
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By DEVON BERNARD
Looking Ahead to 2016 December is the month to reflect on milestones in 2015 and prep for billing and coding changes in the new year
Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
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DECEMBER 2015 | O&P ALMANAC
HE END OF 2015 is in sight, and
everyone is looking forward to the new year. As we approach the last weeks of 2015, it’s time to take a sneak peek at 2016; to wrap up a few things before the end of the year; and to take a look back at some important changes that occurred in 2015.
2016 HCPCS Codes
CMS has released its annual update to the Healthcare Common Procedure Coding System (HCPCS) code set. Compared to years past, this year’s updates were relatively minor. So what are the changes? Two codes had their official descriptors changed. The two codes affected are both on the orthotic side of the code set, and both are used to describe ankle gauntlet style ankle foot orthoses (AFOs). For 2016, the phrase “or similar, with or without joints” has been added to the descriptors for L1902 and L1904. The full descriptor for each code now reads: • L1902 - Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf • L1904 - Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
What we did not see happen this year was the deletion of certain prosthetic codes and the creation of new codes, based on the information that was published in the proposed Local Coverage Determination (LCD) and Policy Article governing Medicare coverage of lower-limb prosthetics. There was a slight concern that the HCPCS Coding Panel, the CMS group in charge of updating the code set, might latch onto the changes suggested in the draft LCD and make the changes even if the LCD was not active or ratified. As you may remember, the draft LCD suggested the deletion and cross-walking of 10 codes and the creation of two new codes. We also were surprised to see that no new L codes were created for the K codes that have been active since late 2014. As you remember, the K0901 and K0902 were introduced and cemented in the code set in 2015, to describe off-the-shelf versions of single- and double-upright knee braces, usually used to treat osteoarthritis. Since K codes are designed to be temporary codes, or a place holder until an L code can be created or assigned, we thought the HCPCS coding panel would have created new L codes for these K codes in 2016.
2016 Fee Schedule
The 2016 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule has been released, and as expected next year’s fee schedule will be slightly lower than the 2015 rates, with an overall reduction of -0.4 percent. The increases or decreases in the DMEPOS fee schedule are legislatively tied to the increases and decreases in the Consumer Pricing Index for All Urban Consumers (CPI-U). The CPI-U is the average change over time in the prices paid by urban consumers for certain goods and services (e.g., food, housing, clothes, transportation, medical care) and is calculated by the Bureau of Labor & Statistics (BLS). This year’s CPI-U was calculated using data collected between June 2014 and June 2015. The CPI-U adjustment will be 0.1 percent; and, the second component of the equation: the annual legislatively mandated reduction to the DMEPOS fee schedule or the productivity adjustment is -0.5%. The productivity adjustment also is calculated by BLS, but is based on a 10-year rolling average of changes in annual economy-wide private nonfarm business, or a multifactor productivity. When you combine the 0.1 percent CPI-U increase with the -0.5% productivity adjustment, you will see an overall reduction in the 2016 fee schedule of -0.4 percent.
Medicare Participation Status
The end of the year is the only time you may make a change in your Medicare participation status from participating to nonparticipating provider, or vice versa. This change must be completed by Dec. 31, 2015, and any change you make will become active and effective Jan. 1, 2016. The decision to be a participating provider, meaning you agree to accept assignment on all Medicare claims, or a nonparticipating provider, meaning you may choose to accept Medicare assignment on a claim-by-claim basis and have the ability to balance bill your patient, is an important business decision. The decision is binding for all
of 2016 and is tied to your company’s tax ID and not to each location’s supplier number or Provider Transaction Access Number (PTAN). This means that if you have multiple locations and PTAN numbers under one tax ID, the decision you make will affect all locations; you may not choose to have some locations be participating and other locations be nonparticipating, unless they are under different tax IDs. If you are currently a participating provider, and you want to switch to nonparticipating status, you must notify the National Supplier Clearinghouse (NSC) in writing. If you choose to switch and become a participating provider, you must complete and sign a participation agreement form, which may be found on the Medicare website at cms. gov/cmsfrms/downloads/cms460.pdf. If you don’t wish to make any changes to your company’s participation status, simply do nothing and your current status will remain the same in 2016.
at which you see and treat patients, be sure to do so before the end of 2015. As a Medicare supplier, you are required to submit claims at least once within four consecutive quarters, or at least one claim a year, to maintain your billing privileges. Since each location where you are seeing Medicare beneficiaries is required to be enrolled separately and have its own National Provider Identifier and PTAN, be sure each office is submitting at least one claim a year. If you do not submit at least one claim form each of your locations, your Medicare billing privileges could be suspended or deactivated by the NSC. To reinstate or reactivate your billing number, you will have to reapply with the Medicare program (i.e., complete a Medicare application, pay the application fee, etc.), which could take several months; during this time you will not be able to see or treat Medicare patients. To review how and why your supplier number and Medicare billing privileges could be deactivated or suspended and what you must do to reactivate them, read the October 2015 Reimbursement Page article in the O&P Almanac. If you have already submitted a claim from each of your company’s offices, be sure to start off the new year right and submit a claim from each of your offices, immediately in 2016. This way, you will not have to worry about one of your offices having its PTAN number deactivated for inactive billing at some point during the year.
2015 Medicare Claims
If you have not already submitted a claim from each of your office locations O&P ALMANAC | DECEMBER 2015
What Changed in 2015
The two biggest coding and billing changes in 2015 were the new/revised/ clarified proof of delivery requirements and the new/revised/clarified directions for off-the-shelf (OTS) orthoses. The durable medical equipment Medicare administrative contractors (DME MACs), along with the pricing, coding analysis, and coding (PDAC) contractor, released a joint publication on April 30, 2015, which revised a previously published announcement released in 2014: “Correct Coding— Definitions Used for OTS Versus Custom-Fitted Prefabricated Orthotics (Braces).” The announcement provided additional guidance on how to code for orthoses that may have a split code and can be provided as an OTS item or as a custom-fitted item, and also clarified some existing information. The revised announcement clarified that an OTS orthosis is an orthosis that requires only minimal self-adjustment (an adjustment the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and does not require the services of an orthotist certified by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) or the Board of Certification/Accreditation (BOC) or an individual who has specialized training) at the time of delivery. It also clarified that custom-fitted orthoses are those orthoses that require substantial modification (changes made to an orthosis to achieve an individualized fit through the expertise of an orthotist certified by ABC or BOC, or an individual who has equivalent specialized training) for fitting at the time of delivery in order to provide an individualized fit. The revised announcement also included some new information: If you are delivering an orthosis described by a custom-fitted code and the item doesn’t have a corresponding OTS split code, and you did not substantially modify the orthosis or if it was not provided or modified by a certified orthotist or other individual with specialized training, then it must be billed with the appropriate miscellaneous code: L2999. For example, if you are providing 20
DECEMBER 2015 | O&P ALMANAC
an L1620, a custom-fitted hip orthosis, and you didn’t substantially modify the item, you would have to bill it as an L2999, because the L1620 doesn’t have an OTS corresponding code. The DME MACs in February released a joint publication that discussed the proper format for proof of delivery documentation. The joint publication indicated that medical reviewers have routinely seen a list of HCPCS codes and their descriptors used on proof of delivery forms, especially for orthotic and prosthetic claims. According to the DME MACs, the sole use of HCPCS codes and their descriptors is not acceptable for proof of delivery purposes because it does not allow the medical reviewer to make a determination of what was billed and if it was coded correctly. The joint DME MAC publication provided the following recommendation to ensure all proof of delivery forms remain compliant: “The preferred method is use of a brand name and model number, brand name and serial number, or manufacturer name and part number to identify the product. If this type of information is not available for the product, suppliers may use a detailed narrative description of the item; however, it must contain sufficient descriptive information to allow a proper coding determination. This ‘narrative description’ of the item is not the HCPCS code narrative.” This announcement has led to an increased amount of claim denials, so be sure to include brand names and model numbers on your proof of delivery forms whenever possible. If the items you are providing are custom fabricated, include
a phrase along the lines of, “Customfabricated (insert item) made in house.” AOPA still contends that this abrupt change appears to be inconsistent with existing policy found in the Medicare Program Integrity Manual and other CMS policy documents, and is continuing to seek a reversal in this policy shift. In 2015 CMS published the MLN Matters article, “Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims,” and this article limited the type of information the CMS contractors conducting the first two levels of appeals (redetermination and reconsideration) could review. Prior to this article, it was possible for a provider/supplier to receive a denial on a claim and proceed through the appeals process based on this original denial reason. The provider/supplier may have been able to prove the original denial reason was incorrect and then have the contractor issue an unfavorable appeal decision for a completely different reason; and this would be repeated at the next level of appeal. For all redetermination and reconsideration requests received on or after Aug. 1, 2015, the contractors may only review and issue decisions based on the original denial reason. However, this limitation of review only applies to claims that were subject to postpayment reviews/audits and does not apply to prepayment reviews. To see what 2016 has in store, be sure to stay tuned via the AOPA website and future Reimbursement Page articles. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at email@example.com. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
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This Just In
A Temporary Reprieve The absence of a full rescission to the proposed LCD means the O&P community must carefully monitor payors’ actions to ensure they comply with existing policy
As of this writing, AOPA’s policy is to continue seeking full rescission of the proposed LCD as the next step will be for CMS to convene a multidisciplinary Lower-Limb Prostheses Interagency Workgroup in 2016.
DECEMBER 2015 | O&P ALMANAC
N NOVEMBER 2, CMS released a statement, and the White House offered an updated response, regarding the “We the People” petition seeking a rescission of the proposed Local Coverage Determination (LCD) and Policy Article governing Medicare coverage of lower-limb prosthetics. These actions certainly indicated that the administration did hear the multiple voices of amputees, providers, and its own agency, the Department of Veterans Affairs—all of which saw the proposal as harmful to amputees and urged rescission of the draft LCD. The petition, in combination with efforts by AOPA, the Amputee Coalition, and the O&P Alliance partners to stop the LCD from implementation through media outreach, congressional involvement, and a successful patient rally in front of the Department of Health and Human Services (HHS), provided powerful persuasion that the proposed LCD was simply a very bad idea. CMS took to heart the outpouring of concern from the many stakeholders and deserves applause for the announcement that the durable medical equipment Medicare administrative contractors (DME MACs) “will not finalize the draft LCD at this time.” This welcome news was only tempered by unanswered questions and concerns that failure to secure prompt rescission
of the LCD invites private-sector payors to continue to view the draft LCD as a work in progress, and could encourage them to make their own policy changes mimicking provisions of the draft LCD. The first example of such an action came from major health-care payor United Healthcare within weeks of the July 16 publication of the draft LCD. United Healthcare issued its own policy directive declaring, “The use of vacuum pumps for residuallimb volume management and moisture evacuation systems among amputees is unproven and not medically necessary due to insufficient clinical evidence of safety and/or efficacy in published peer-reviewed medical literature.” Coincidentally, the language in the draft LCD regarding vacuum pumps said, “There is insufficient published clinical evidence to support these claims. Claims for L5781 and L5782 will be denied as not reasonable and necessary.” In a letter responding to the Amputee Coalition’s complaint about the policy, United Healthcare promised to “reassess our position based upon the evolution of published clinical evidence or any future finalized guidance from the Centers for Medicare & Medicaid Services.”
This Just In
So there are big concerns remaining, even after the “will not finalize the draft LCD” announcement. Left on the websites of CMS and the DME MACs instead of being rescinded, the proposed LCD policy article could wreak havoc by appearing to be a work in progress and delivering harmful unintended consequences to amputees. That’s a big reason why the White House and CMS announcements did not elicit overwhelming praise from amputees and other stakeholders for CMS. To some extent, the hands of CMS may be tied when it comes to outright overruling an action by the DME MACs. CMS contractors enjoy a somewhat hands-off relationship, in part because of the way the HHS general counsel and inspector general have chosen to interpret statutory requirements that seek to avoid political influence over the policies implemented. That’s why there was cautious optimism conveyed to AOPA before the White House announcement by signaling that, indeed, the July 16 LCD would not be implemented in anything close to its original form. Clearly, navigating the shoals of government regulations is not always predictable or smooth, even when you’re part of the government supposedly in control. As of this writing, AOPA’s policy is to continue seeking full rescission of the proposed LCD as the next step will be for CMS to convene a multidisciplinary Lower-Limb Prostheses Interagency Workgroup in 2016. The charge, according to the official CMS statement that was released simultaneously with the White House email, will be to “develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower-limb prostheses. The working group will be comprised of clinicians, researchers, and policy specialists from different federal agencies.” It’s a disappointment that stakeholders such as amputees and patients don’t have positions set aside at this
ETERMIN D E G A R E OV
federal agency table, although the White House email states, “CMS will ensure there is opportunity for public comment and engagement on the workgroup consensus statement and any related activity.” Bottom line, it could be a slow slog before any definitive policy is released by the CMS workgroup and even longer before it can be validated through the public comment and engagement process that CMS said would occur when the workgroup’s draft policy is completed. It will not happen overnight; in the meantime, amputees may face some remaining uncertainties relating to care and payment. Because of this uncertainty, AOPA will urge other stakeholders to encourage continual congressional and public monitoring, awareness, and vigilance on the existing lower-limb prosthetic policy, even though the near-term uncertainty for Medicare amputees has diminished markedly. It remains essential to ensure in the longer view that CMS and the DME MACs be reminded
of their obligation to observe the existing policy—a policy that is supported by ample scientific and medical evidence—unlike the proposed LCD, which would have reverted amputees to a 1970s standard of care. Vigilance will be required to respond to any further indications that private payors are revising their own payment policies, on the errant view of the draft LCD proposals, now put on hold. The draft still needs to be formally rescinded and removed from the websites of CMS and the DME MACs. Members are urged to make AOPA aware of any situations that appear to be penalizing amputee care based on the draft LCD provisions being inspiration for any payor policy changes. It’s now clear that the complicated web of regulations and the relationships between the DME MACs and CMS needs continued and constant scrutiny to ensure that the most advanced care and devices appropriate to an amputee’s needs are carefully protected in this interim period. O&P ALMANAC | DECEMBER 2015
VIRTUAL How virtual reality could be the next powerful tool for the profession By CHRISTINE UMBRELL
DECEMBER 2015 | O&P ALMANAC
Need to Know: As the consumer virtual reality market goes mainstream, the O&P community has been quietly using it in military and academic settings for the past several years. Access to a VR environment during treatment can help speed the rehabilitation process both physically and psychologically. The technology can be used to improve gait function, stability, and motor control; boost research and treatment protocols; conduct evaluations; and more. Because VR environments create conditions where patients can be tested and data collected to support the efficacy of O&P intervention, the technology may play a role in reimbursement as studies and trials are brought to the attention of payors. While the majority of the patients benefitting from VR-assisted rehabilitation are military patients, it is possible that practitioners at small facilities may help their civilian patients participate in clinical trials at facilities with VR systems. Future VR applications could include more realistic rehab scenarios and real-time feedback on gait parameters that allow online tuning and adjustment of orthoses and prostheses.
Photos: Courtesy of Motekforce Link
HE VIRTUAL REALITY (VR) market is heating up. Nearly every industry is beginning to harness its power to transcend physical and economic barriers. The immersive multimedia platform has become useful for storytelling in education, research, tourism, marketing, and more. In the gaming world, VR headsets and VR-capable hardware and software debuted for sale this holiday season, and movie studios and news organizations are expected to bring VR content to the masses later in 2016. In the medical arena, VR has a number of important usages. In clinical settings and experimental studies, the technology is being used for pain management: Participants who are immersed in VR experience reduced levels of pain, distress, and unpleasantness. The technology also has been used as “exposure therapy” to treat
patients with phobias, post-traumatic stress disorder, and other anxiety disorders. In addition, high-fidelity VR and augmented reality—video and digital images superimposed over users’ view of their actual environment—are being used in physician training exercises as well as for surgical simulation purposes. Experts predict that augmented reality will be increasingly streamlined into health care. But the idea of VR is not new to the O&P community. Beginning in the 1990s, rudimentary virtual environments were created to treat phantom limb pain: Researchers developed “mirror boxes” and similar mirror therapy environments to help amputees view a mirror image from the limb they still have and find relief as their brains synced with the movements of real and phantom limbs. O&P ALMANAC | DECEMBER 2015
Photo: ASU/Lee Childers
Virtual reality, combined with data collected on limb forces and joint angles, can be used to optimize the design of a running-specific prosthesis.
More recently, researchers have begun leveraging VR to facilitate motor retraining for O&P patients to help them refine motor pathways and improve movement and function. Across the United States, a few institutions have purchased VR “labs” to create conditions where O&P patients can walk and maneuver in simulated environments, with the goal of improving gait. These labs are being used for both rehabilitation and research purposes. Because the VR technologies being used at O&P facilities are extremely expensive, the majority of current VR-related research and rehabilitation is being conducted at military O&P facilities and a handful of educational institutions. As these early adopters
publish their findings and demonstrate the efficacy of VR training, it is hoped that the technology will become less costly—and more O&P patients will benefit from it.
Photo:David Campbell/Alabama State University
Lee Childers, PhD, MSPO, CP 26
DECEMBER 2015 | O&P ALMANAC
O&P-specific advanced VR systems have the ability to revolutionize the rehabilitation process, say those who are familiar with them. Lee Childers, PhD, MSPO, CP, has seen this firsthand at the Biomechanics and Motor Control Laboratory at Alabama State University (ASU), where a VR system was recently installed. The ASU lab was awarded a $480,000 grant by the Army Research Laboratory to purchase a Gait Real-Time Analysis Interactive Lab (GRAIL) system built by Amsterdam-based Motekforce Link to study human locomotor control. The GRAIL is designed as a gait analysis and gait training system that employs an instrumented dual-belt treadmill, a motion capture system, and VR environments, as well as three video cameras. “GRAIL empowers user-friendly assessments and exercises, in challenging conditions, to improve pathological gait patterns,” says Els Wessels, vice president of marketing and sales for Motekforce Link. “Real-time feedback in GRAIL enables analysis and training during the same
session.” The company also manufactures a second VR system designed for O&P, called the Computer-Assisted Rehabilitation Environment (CAREN); the CAREN system incorporates a sixdegrees-of-freedom moving platform, allowing a patient to be perturbed in all directions. Designed with the goal of decreasing rehabilitation time and increasing effectiveness of treatment, these VR systems allow patients to explore interactive scenarios as practitioners and researchers monitor their motor and postural tasks, says Wessels. These systems are extremely advanced, so prices vary from $300,000 to $750,000, rendering them cost-prohibitive for most O&P facilities. But Wessels says there are currently 16 GRAIL or CAREN systems in use in the United States; worldwide, 60 such systems are being used. The “cool part” of the GRAIL system is that “the virtual reality of what you’re seeing can be altered to you, to help train you to do something correctly that you may be doing wrong,” says Childers. For patients, learning to walk with a prosthesis becomes much more interesting in a virtual environment. “It makes people forget that they’re in rehab,” says Childers. “You think you’re just playing video games, but in reality, you’re being trained to be
Study Demonstrates Gait Improvements After VR Training
TTENDEES AT THE 2015 AOPA NATIONAL ASSEMBLY learned about
Photo: Riley Sheehan/CFI
During the final training session trial, the participant was walking at 1.27 m/s and the pitch and roll went up to a maximum of 9.3 degrees.
To assess the success of the program, Sheehan and Wilken collected a functional stepping test, which measures balance and agility and selfselected walking speed and is related to walking function. “We also calculated step width and step width variability as a measure of stability during unperturbed walking, side-to-side visual oscillations, and side-toside walking surface oscillations. These measures were collected before, during, and after the intervention to track the participant’s improvements,” says Sheehan. Over the course of the study, researchers saw improvements in the functional measures and the stability measures following the intervention. “We are most excited by the finding that these benefits were retained even five weeks after the end of the intervention,” says Sheehan. “This suggests that this type of intervention has promise since the goal of rehabilitation is not to just get someone functioning well when they leave the facility, but continue to be high functioning for the rest of their lives.”
DECEMBER 2015 | O&P ALMANAC
Photo: ASU/Lee Childers
virtual reality research during a session presented by Riley Sheehan, PhD, and Jason Wilken, PhD, MPT, of the Brooke Army Medical Center’s Military Performance Lab/Center for the Intrepid (CFI), where a CAREN is installed. “Our goal was to improve walking function and stability in an individual with transfemoral amputation through the use of a perturbation-based gait training program in a virtual reality environment,” says Sheehan. To improve lateral walking stability, the participant walked in a progressively destabilizing virtual environment. “We utilized continuous, random walking surface oscillations of both pitch and roll to destabilize the participant and promote the development of strategies that maintained stability,” says Sheehan. “We systematically increased the walking speed and maximum pitch and roll over time. By the end of the intervention, the participant was walking at a typical walking speed with up to 9.3 degrees of pitch and roll.”
out in the real world—but within a safe and controlled environment.” It helps amputees explore new ways of walking, ultimately achieving improved gait, says Childers. Different virtual environments, or “games,” can be programmed into VR systems to help patients learn to maneuver different settings. For example, in a retraining game called “Microbes,” patients use their position on the treadmill to walk on different parts, biasing their feet. “It looks at how you step to help improve gait—for example, if you’re stepping too long, it gives you targets to help you shorten your step,” says Childers.
Another popular game used in VR settings depicts an environment where the patient feels as if he is operating a jet ski. “The platform you’re on is also moving. To get a high score, you have to weight-bear on your prosthetic leg(s) and shift your weight—which is teaching you balance,” says Childers. Military amputees who use this game during rehab often compete with each other to try to get high scores.
Patients at the Walter Reed National Military Medical Center benefit from having a virtual environment lab on premises that is accesBarri Schnall, MPT sible to all members of a patient’s health-care team, including orthotists, prosthetists, and physical and occupational therapists. “Patient needs, wants, and goals are conveyed through the clinicians who work together with the engineers who develop and run the applications to identify the content for desired virtual scene development or modification,”
Photo:David Campbell/Alabama State University
says Barri Schnall, MPT, the facility’s clinical research gait specialist. Schnall serves as a subject matter expert to assist the health-care providers with identifying deficits and establishing changes in the plan of care using data collected in the gait and virtual environment labs. “I work closely with the engineers who operate
the system to tailor the applications to each specific patient population to meet goals of the patients and clinical staff.” Walter Reed staff leverage the virtual lab environment as a clinical tool: The patients they serve are working on problems that present as a disturbance of gait that may be associated with limb loss, traumatic brain injury, and/
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or injury resulting in visual, vestibular, neuromuscular, or other orthopedic compromise. “A virtual environment allows us to test different prosthetic components in controlled, occupationally relevant scenarios. This control is advantageous in that the rehabilitation team can optimize the prosthetic components under similar conditions
Interchange or Disconnect
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The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.
The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.
NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.
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NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.
The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.
O&P ALMANAC | DECEMBER 2015
Photos: Walter Reed National Military Medical Center
The virtual environment lab at Walter Reed National Military Medical Center
in which they will be utilized that perhaps aren’t traditionally accessible at a medical facility,” says Schnall. For example, Schnall recently worked with an engineer to develop an alpine ski application for the facility’s ski/snowboard training program, which allowed a patient to test skiing components in a virtual environment; this minimized slope-side adjustments. Access to a VR environment during treatment can help speed the rehabilitation process both physically and psychologically. “The use of these tools takes the focus off the routine of rehab,
DECEMBER 2015 | O&P ALMANAC
Seeking Positive Outcomes
Photo: Courtesy of Motekforce Link
The CAREN combines a fully instrumented dual-belt treadmill mounted on a motion base, with a motion capture system and an immersive VR environment.
serves the same purpose: training and evaluating injured service members before returning to their desired occupational and/or recreational activity,” she says. “This training can be especially beneficial to individuals who must now complete these activities utilizing a prosthetic or orthotic device, as it provides them an environment where they can again become comfortable completing these functions.”
and incorporates treatment in a video game-like scenario,” explains Schnall. From a neuro-rehabilitative perspective, “a virtual environment enables providers to manipulate the scene to achieve the desired physical response. Practice can occur in a safe and controlled setting, which may facilitate retention and carryover into daily function.” Schnall notes that simulated environments and scenarios are common in the civilian sector for job training in many professions. “Utilizing this technology in the military population
Military patients at Brooke Army Medical Center’s Military Performance Lab/ Riley Sheehan, Center for the Intrepid PhD (CFI) also benefit from the use of a virtual environment lab. CFI was one of the first U.S. institutions to begin incorporating VR into O&P research and rehabilitation, in the form of a CAREN system: “Our CAREN was the second ever—the first in the United States, and the first with a full dome screen,” says Riley Sheehan, PhD, a research biomechanist and program manager at CFI. Staff at CFI leverage the CAREN’s features for both research and clinical treatments. “Our research studies focus on developing novel rehabilitation
Photo: Courtesy of Motekforce Link
Real-time gait analysis using the 3D motion capture system and the instrumented dual-belt treadmill of the GRAIL system aids in prosthetic and orthotic fitting.
assessments to identify deficits and interventions to improve function,” says Sheehan. “Many of our study scenarios have been adapted to a clinical version, which allows therapists to bring their patients in to supplement their conventional therapy.” Sheehan says the main advantages of using a VR system are the flexibility, control, and safety the system offers. “We are able to design a wide variety of scenarios with the ability to tightly control the terrain, speed, and difficulty, all while in a safe environment thanks to the safety harness. These capabilities are especially important when working with a military population that is young and highly motivated, and committed to not having their injury limit their activity,” he says. Many of CFI’s patients intend to return to duty—and even the front lines. “This requires us to develop militaryspecific rehabilitation and assessment scenarios that include variable terrain, wearing body armor and helmets and carrying a simulated weapon, and engaging targets. The CAREN allows us to expose our patients to the challenges that they would face in a safe, controlled environment.” The VR system at CFI also aids in prosthetic and orthotic fitting: By having patients walk through variable
terrain for extended periods, prosthetists can identify issues with socket fit as patients develop “hot spots”’ where their socket rubs. “These socket issues likely would not have been identified during the typical level walking in the clinic,” says Sheehan. While the majority of the patients benefitting from rehabilitation via VR systems are military patients, civilian O&P patients also stand to gain from the research currently being conducted. In the meantime, Childers suggests that practitioners without access to VR systems try to locate the nearest system and ask whether that facility is seeking patients for their studies—it is possible that practitioners at small facilities may be able to help their patients participate in clinical trials that could improve their gait and quality of life.
Because VR environments create conditions where patients can be tested and data collected to support the efficacy of O&P intervention simulating real-life scenarios, the technology may play a role in reimbursement as studies and trials are brought to the attention of payors. The instrumentation and software in advanced VR systems offer expanded data collection
and reduction capabilities. These efficiencies allow researchers to conduct pre- and post-trials with a patient—and remove the expense of having a technician process that data over the next several days. “VR environments do a better job of getting the research participant to relax and forget they are walking on a treadmill with a bunch of sensors strapped to them,” says Childers. “This means that the data we collect is of a more natural gait and more similar to what they would do in the real world.” Childers cites studies conducted at the VU Medical Center in Amsterdam that compare data collected with traditional over-ground walking and walking on the treadmill with different parts of the VR turned on. “When the full VR was turned on—and this included projection of the pathway from the screen and onto the treadmill—there were no differences in any variable measured, meaning virtual reality enables more natural gait on a treadmill,” Childers says. Childers predicts that VR systems— and their ability to control all aspects of the environment—have the potential to affect reimbursement. “VR will provide payors with better data because the whole VR system provides better data,” he says. Using a virtual reality O&P ALMANAC | DECEMBER 2015
DECEMBER 2015 | O&P ALMANAC
Into the Future
As virtual reality systems of all shapes and sizes become more commonplace, it is hoped that more O&P patients will reap the benefits of VR technology. “As the technologies improve, we will be able to provide more realistic, more immersive scenarios that expose patients to the challenging situations that they will encounter in their lives—from walking down the aisle of a crowded grocery store to going on a patrol in the mountains of Afghanistan—and develop strategies to complete the tasks and maintain stability,” says Sheehan. He notes that one advancement that shows promise is augmented reality, which will take
Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.
Photos: Courtesy of Motekforce Link
environment, researchers can continue to provide the visual information that subjects are walking normally—but then rapidly change something with the treadmill, such as speed, to replicate a trip or slip, or pitch, or to replicate an unexpected drop in a pothole. “The VR ensures that the perturbation we provide will be unexpected. The ability to unexpectedly perturbate someone during gait will enable us, for example, to prove that the stumble recovery features in microprocessor knees do indeed benefit the prosthesis user.” Payors will likely be interested in the results of devices worn by patients within realistic VR environments. For example, Childers says he can conduct pre- and post-testing for a new prosthetic leg specific to one patient, with results in about an hour. “We can also do larger research studies that would be useful to payors, such as, ‘Is this foot better than that foot across 20 people?’” he says.
Photo: ASU/Lee Childers
Virtual reality labs like the GRAIL and CAREN allow patients to ambulate in a variety of virtual outdoor settings.
the virtual environment “beyond the projection screen and display objects and obstacles directly in the patient’s path that they need to step over or around.” Schnall anticipates great advancements over the next few years, as more complex, realistic scenarios and applications that incorporate multisensory inputs are developed. “By aligning or choosing prosthetic or orthotic components or devices based on practical, simulated experience, decisions can be made founded on objective measures versus anticipated responses,” she says. In the near future, Wessels believes VR systems will incorporate features for real-time feedback on gait parameters that allow online tuning and adjustment of orthoses and prostheses; as well as features that conduct evaluations during more functional tasks, such as side step and obstacle avoidance, and higherdemand walking tasks. For the far future, “we see automatic alignment of orthoses and prostheses based upon gait data,” predicts Wessels. “But this will take a while longer—that would be the killer application.” Sheehan notes that the most impactful advancement may be the creation of small, low-cost systems, “which would increase their accessibility and allow smaller clinics to take advantage of the benefits that virtual reality can provide to their O&P patients.” Though limited in number, today’s virtual reality systems allow O&P patients to rehab on new devices, and researchers to record performance measures, in controlled environments that simulate real-world experiences. As more patients benefit from the technology, a broader world of opportunities will emerge for research as well as for treatment options.
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The 2015 AOPA National Assembly tackles technology, regulation, and the ability to deliver quality patient care in the future
HE “BEST OF THE BEST” of the global orthotic and prosthetic pro-
fession gathered in San Antonio October 7 to 10 for a Texas-sized 98th annual AOPA National Assembly. Held in conjunction with the Texas Chapter of the American Academy of Orthotics and Prosthetics, this year’s conference offered the more than 2,200 attendees and 170 exhibitors unparalleled access to renowned experts, clinical and business thought leaders, networking events with colleagues, and the technological advancements that will shape patient care in the years to come. In his first address as incoming AOPA president, James Campbell, PhD, CO, FAAOP, touched on the uncertainty in the profession, new opportunities, and the continued need to develop an ongoing evidence base.
DECEMBER 2015 | O&P ALMANAC
AOPA President James Campbell, PhD, CO, FAAOP
“It is no secret that governmentfunded health-care programs face deficits, within the midst of this unprecedented revolution in health care, payors—health insurers and government agencies—are in the driving seat,” Campbell said during the annual business meeting. “The changes they are unleashing are disrupting the business and clinical service delivery models that have been the norm.” The most recent “red alert” demonstrating this need was “the absence of any scientific base and evidence” to support the changes in the CMS draft LCD for the provision of lower-limb prostheses—a fact that Campbell and the O&P community pointed out to policymakers.
AOPA Past President Charles H. Dankmeyer Jr., CPO
“Guess what? It worked,” said AOPA Past President Charles H. Dankmeyer Jr., CPO, in his parting address to attendees. “The executives at HHS invited a small group of AOPA, Amputee Coalition, and O&P Alliance representatives … to sit with them to discuss our issues with the DME MACs.” (O&P Almanac has since reported on more favorable news regarding the draft LCD as a result of these and other efforts.) “Stand up for your beliefs,” said Dankmeyer, who talked at length about the need to challenge regulators that are threatening to make unwelcomed changes to the profession. “Be strong when you face adversity and never cower.”
Technology at Heart
Despite these challenges, technological innovations continue to advance how O&P practitioners care for their patients. Exhibitors in San Antonio showed off a wide variety of new products and services, ranging from prosthetic devices that help patients push the boundaries of action sports to exoskeletons that allow the paralyzed to walk—and everything in between. “I’ve been in practice since the ‘70s, and it’s always nice to come out to the shows and talk to the vendors and meet them face to face and see the new products,” said Mark Eland, CO. “A lot of times you see the products in the books, but you can’t tell what they’re like until you feel them and touch them.”
O&P ALMANAC | DECEMBER 2015
Attendees for 2015 may have noticed a change with some of the products this year, as a number of manufacturers chose the Assembly to debut their latest devices. Touch Bionics, for example, launched its new i-Digits Quantum myoelectric partial hand prosthesis at the conference. This “smarter, faster, stronger, and smaller” version uses new gesture control to automatically adjust hand grip. Similarly, Becker Orthopedic unveiled its new Triple Action ankle joint, which adds a third rocker control to its Double Action joint that has been on the market since 1964. The new feature allows clinicians to “optimize biomechanical control of lower-extremity joint segments through all phases of the gait cycle,” according to product information. Prosthetic cover manufacturer UNYQ also unveiled a mobile app for streamlining the process of making personalized covers and “brings prosthetists closer to the 3D printing
and digital manufacturing workflow for prosthetics.” The app helps them to measure patients and track production. Outside of the exhibit hall, attendees also were given a firsthand look at 3D printing and how it’s changing the field from two of the leaders in its application to prostheses devices. Jon Schull, founder of e-NABLE, and Jeff Erenstone, CPO, CEO, of Create Prosthetics, teamed up to pull back the curtain and explain how 3D-printed prosthetics are helping patients all over the world. “3D-printing technology has been around for years and is primarily used to prototype new products and manufacture products on the O&P side,” Dankmeyer explained in their introduction. “Once it became widespread it was only a matter of time before this technology found its way into the patient-care level of O&P.” e-NABLE, a nonprofit foundation, creates and designs 3D-assisted hands for those in need. Many of e-NABLE’s clients are children in third-world
Jeff Erenstone, CPO, CEO of Create Prosthetics 36
DECEMBER 2015 | O&P ALMANAC
countries who do not have access to custom prosthetics and ongoing patient care. “The devices and the community are important in part because of something that is usually not visible, which is the psychological and social aspects,” Schull said, as he recounted stories of children who say they feel like a superhero when they get their 3D-printed prosthesis. He also pointed out that these products do not replace custom-fitted prostheses, but rather serve as a cosmetic upgrade and a boost of confidence for patients. Like Schull, Erenstone also acknowledged his company could be considered a disruptive force within an industry experiencing rapid change. “It may be disruptive, but I disagree with that,” Erenstone said. “I think it’s evolutionary. We are masters of 10 different technologies. This is not necessarily something we need to fear. It’s something we need to embrace and evolve with.”
Jon Schull, founder of e-NABLE
Clinical and Research Advancements
This year’s keynote address came from Ret. Lt. Col. Donald Gajewski, MD, an orthopedic surgeon and former director of the Center for the Intrepid (CFI), who discussed the critical role O&P professionals play in the Center’s mission to restore mobility to wounded soldiers. “Not much good comes from war, except for the advancement of medicine, and that’s what we need to focus on as providers,” said Gajewski, who talked at length about the Center’s interaction with returning soldiers and their families. He praised the O&P practitioners at Walter Reed National Military Medical Center and the CFI for teaching him important lessons in patient care, which he explained to the audience.
Ret. Lt. Col. Donald Gajewski, MD
First, Gajewski discussed the trend of consumerism in health care, noting that patients often Google information and try and direct the level of the care being given. “Use of the best technology is not always the best use of technology,” he said, stressing that practitioners must carefully work with patients to manage their expectations. “Just because it’s out there doesn’t mean it is the best [option for that patient].” “It’s not what you put on the patient, it’s what you put in the prosthesis,” he reminded the audience. He advised practitioners to focus less on the prosthesis itself and more on patient-specific care—especially rehab—to physically and mentally prepare patients for a successful life with a prosthetic device. “If you get out of shape, if you get fat, you are not going
O&P Almanac EXCLUSIVE:
VIDEOS From the 2015 AOPA National Assembly Missed the conference or want to relive your experience in San Antonio? Get caught up with these O&P Almanac videos: • KEYNOTE SPEAKER: Highlights from the opening address given by Ret. Lt. Col. Donald Gajewski, an orthopedic surgeon and former director of the Center for the Intrepid. bit.ly/1PSHgyn • EXHIBIT HALL: Interviews with exhibitors and attendees, and find out more about the hundreds of novel products and services showcased in San Antonio. bit.ly/1XlWP5U • 2015 AWARDS: AOPA Past President Charles Dankmeyer Jr., CPO, presents the Lifetime Achievement Award, Legislative Awards, Arbogast & Becker Student Poster Awards, and more during the October 9 General Session. bit.ly/1IeYfYZ • 3D-PRINTING UPDATE: O&P Almanac interviews Jon Schull and Jeff Erenstone, CPO, about their much-anticipated presentation on 3D printing at the Assembly. bit.ly/1MJ5K9h to walk,” he said. “I could take all of walkers and all of our nonwalkers from this war, and you would immediately know the difference.” Finally, Gajewski noted that “nothing beats a stable soft tissue envelope; length comes in second.” From a surgical perspective, length of the residual limb does matter, but through his work with O&P practitioners, he learned that comfort is paramount, and he emphasizes this to surgical residents as well. Gajewski also expressed shock and disapproval of the government for trying to limit civilian amputees’ access to the high-tech devices, citing the draft LCD for lower-limb prosthetics as an example. He offered his
full support to the O&P community to oppose such policymaking. Gajewski concluded his address by acknowledging the efforts of O&P professionals who provide a lifetime of ongoing care for amputees—a fitting message for the National Assembly audience who could earn up to 35 continuing education credits for attending. As the centerpiece of the Assembly’s clinical education program, the 2015 Thranhardt Award lecturers all offered insights into recent research advancements. Previously, the lectures were limited to two presenters, but thanks to the efforts of the AOPA Planning Committee, attendees heard from two additional presenters in San Antonio. O&P ALMANAC | DECEMBER 2015
Sponsors AOPA extends special thanks to our title sponsors:
BEST of SHOW
DECEMBER 2015 | O&P ALMANAC
BEST of SHOW
Elizabeth Russell Esposito, PhD
J. Megan Sions, PhD, DPT, PT, OCS
This year, Elizabeth Russell Esposito, PhD, a biomechanics researcher at the CFI, and J. Megan Sions, PhD, DPT, PT, OCS, a researcher and faculty member at the University of Delaware, received the distinguished honor. Esposito presented “Can Individuals With Transtibial Amputation Reduce the Metabolic Demand of Walking Using Real-Time Visual Feedback?” She explained that the purpose of her work was to investigate and disrupt the trend toward a sedentary lifestyle and “progressive disablement” among patients with transtibial amputations. Her work focused on studying the center of mass sway and thigh activity during gait retraining on a treadmill where participants wearing passive prostheses received real-time feedback on a monitor. As a result, participants were able to decrease center of mass sway by 12.5 percent and elicit a “12 percent change in thigh activation and early stance,” but Esposito and her colleagues concluded that walking economy did not improve despite previous research that indicates otherwise. “We did not get a reduction in metabolic demand in this population,
potentially because there was very little room for improvement,” she said. Sions presented her findings from “Balance-Confidence May Help Explain Physical Function and Community Integration Among Individuals with Unilateral Transfemoral and Transtibial Amputations.” The objective was to explore the relationships between balance confidence and physical function and social integration. The researchers hypothesized that lower confidence led to less mobility and social interaction, and to measure that assumption, participants completed self-reporting assessments as well as a performancebased six-minute walking evaluation. “It’s really important as clinicians that we take into account both of these measures because they seem to tap into different constructs,” she said. The study revealed that individuals with low balance confidence, as compared to their peers with high balance confidence, have worse self-reported and performancebased function and tend to be less integrated in their community, she reported. “That’s really important because balance confidence does
not seem to improve despite further improvements in walking ability,” she said, citing other existing research. “Balance confidence is actually a better predictor of how an individual is going to do than their actual walking ability.” Scores lower than 80 percent suggest the patient needs further rehabilitation, she noted. Assembly attendees also had the opportunity to listen to the Sam E. Hamontree, CP, Business Education Award Business Lecture Series. The Hamontree family created this forum in an effort to identify and recognize innovation on the business management side of O&P. The 2015 participants provided thought-provoking approaches to building and maintaining a successful patient-care practice.
Tom McGovern, the 2015 honoree, presented “Control Your Marketing Message by Controlling the Medium.” McGovern is a managing partner and vice president of sales for Clinical Education Concepts, a company that specializes in marketing platforms for O&P patient-care facilities and manufacturers. Like the Thrandhardt lecturers, his message to attendees on how to effectively market and sell services to prospective clients centered on the underlying focus on patient care and improving lives. “Barriers shoot up the moment you begin to deliver a sales pitch,” McGovern said. “In contrast, people sit up and listen when you start telling them how you’re going to help them start taking better care of their patients.”
2015 Technical Fabrication Contest
Tests Speed and Precision
OR THE PAST FOUR YEARS, AOPA and the Orthotic & Prosthetic Technological Association (OPTA) have hosted the Technical Fabrication Contest at the National Assembly. This year’s event challenged participants to assemble an articulating ankle-foot (AFO) orthosis as quickly as possible. “Each year, we try to bring something new to the table, and this year we created a fun and challenging atmosphere,” said Brad Mattear, LO, CPA, who heads the event. This was the first year for the “hands-on skill component. [We] wanted to try something that we felt would be fun, competitive, and repeatable year over year.” Contestants were judged on their time and their ability to completely and accurately assemble the AFO device. First place winners received a $500 prize, and second place winners received a $200 prize. Three of the six winners—Tommy Coronado, CPOA; Brian DeMain, CPO; and Dan Lopez, ROPT—successfully completed their AFOs in less than one minute. The contest was open to O&P professionals, technicians, and students and promoted friendly competition among participants. Several of the students tweeted their successes and challenged other schools to beat their times. Mattear said the planning committee wants to expand the contest for other disciplines next year. “We look forward to growing the contest into a mature annual event that the contestants will look back well into their careers and remember ‘the good old days!’”
O&P ALMANAC | DECEMBER 2015
Experienced O&P Professionals Lead AOPA’s 2015-2016
BOARD OF DIRECTORS
MOOTH AND SEAMLESS” CHARACTERIZES the transi-
tion to the 2015-2016 leadership team elected October 9 at the San Antonio AOPA National Assembly Annual Meeting. On December 1, James Campbell, PhD, CO, FAAOP, succeeded Charles H. Dankmeyer Jr., CPO, as AOPA president, and David Boone, PhD, MPH, was elected to the clinical at-large director post for a two-year term, succeeding Don Shurr, CPO, PT, whose term expired. Returning to the board after having served previously, including as president in 2007-2008, was Brad Ruhl, replacing Scott Schneider as a supplier director. Dave McGill was re-elected to a three-year term as at-large director.
“The threats we face are real—but so are the opportunities—and it will be crucial that we respond collectively during this next year and into the future.” – JAMES CAMPBELL, PHD, CO, FAAOP
DECEMBER 2015 | O&P ALMANAC
Michael Oros, CPO, FAAOP, transitioned from vice president to president-elect. Anita LibermanLampear ended her service on the board, retiring from the immediate past president post after nine years of service and leadership. LibermanLampear and her husband, Alan Lampear, spearheaded the successful Wine Tasting and Auction event—a lead fundraiser for the O&P Political Action Committee and the Capital Connection advocacy education fund. Jim Weber, MBA, returned to the board as the new vice president, having served five years as AOPA treasurer. AOPA’s bylaws provide the framework for the annual transition by providing for the automatic elevation of vice president to presidentelect, president, and immediate past president positions. The wisdom of the bylaws’ structure is reflected in the continuity and depth of experience, which has been a major factor in the ability of AOPA’s Board of Directors to balance the pressure of change with a deep knowledge base of the past. The bylaws provide three-year terms for directors, with eligibility to be elected to a second three-year term. People typically rotate off the board after six years and must be off of the board for at least one year before being eligible for additional board service. The formal announcement of the newly elected leadership team was made during AOPA’s Annual Meeting, where results of the electronic voting simplified the changing-of-the-guard
Jim Weber, MBA, Vice President
Jeff Collins, CPA, Treasurer
Pam Lupo, CO
David A. Boone, PhD, MPH
Jeffrey Lutz, CPO
experience by eliminating the cumbersome manual voting and need for gathering a quorum. Quorums happen more naturally in the electronic voting scheme. In addition to election results, AOPA members got a bird’s eye view of AOPA’s finances, presented by Treasurer Jeff Collins, CPA. Fortunately, the news was positive: Even with the troublesome decline
Anita Liberman-Lampear, MA
in membership revenues, largely due to consolidation and retirements plus financial strains imposed by the recovery audit contractor clawbacks, AOPA completed the year with an operating surplus on the $5.5 million budget that increased “rainy day” reserves to $6.5 million. An increase of $605,000 in investment portfolio earnings and values enhanced the 2014 reserve picture.
Charles H. Dankmeyer Jr., CPO, Immediate Past President
Michael Oros, CPO, FAAOP, President-Elect
2016 AOPA Board Members
2016 AOPA Officers
James Campbell, PhD, CO, FAAOP, President
Don Shurr, CPO, PT
During his acceptance remarks, Campbell said, “The threats we face are real—but so are the opportunities—and it will be crucial that we respond collectively during this next year and into the future. You have my assurance that we will continue to work to build consensus across the O&P community around the key points, and toward a common theme that is patient centered.” O&P ALMANAC | DECEMBER 2015
Orthotics & Prosthetics Associates
O&P By the Book Wisconsin prosthetist focuses on optimal patient care and complete documentation
AKE WOOD, CP, FAAOP,
DECEMBER 2015 | O&P ALMANAC
Jake Wood, CP, FAAOP, fits an above-knee amputee.
FACILITY: Orthotics & Prosthetics Associates LOCATION: Milwaukee and Waushara, Wisconsin OWNER: Jake Wood, CP, FAAOP HISTORY: 15 years
Orthotics & Prosthetics Associates’ reception area
operate that way anymore—even though I believe we are still the experts.” For example, patients must get their functional level from physical therapists now. “We used to do that.” Wood notes that practitioners are interacting more with patients’ doctors and therapists. “We can assist the clinical team with our recommendations, but the fact is that our colleagues need to provide documentation for our records before we can even start.” The importance of that documentation means that prosthetic care can get delayed. “We will not provide services until all documentation has been reviewed in our office. Whether it’s from doctors, physical or occupational therapists, a skilled nursing facility—whoever is involved, I have to have that documentation before I will go forward. As a result, we are doing very well passing our audits,” he says. The launch of version 10 of the International Statistical Classification of Diseases and
Related Health Problems (ICD10) codes in October has made that process even more complicated. According to Wood, physicians have a one-year grace period to make mistakes in using the new system, as long as the mistaken ICD code is in the same family as the correct one. “But O&P was not given that grace period,” he says. “We have to bill with the most specific ICD-10 code, which could be more than what physicians initially provide. And that means more delays before we can even get started in helping the patient obtain a prosthesis.” While today’s regulatory issues may be onerous, Wood is quick to point out the benefits of improved prosthetic technology. “I actually made wooden legs early in my career,” he says, “and I never in my wildest dreams thought we would have the componentry suppliers have dreamed up for us.” Wood has devoted part of his career to charitable groups. He has traveled to Zacapa, Guatemala, to provide prosthetic care with an orthopedic team sponsored by Hearts in Motion. His office continues to collect O&P components, hospital supplies, clothing, and footwear to donate to Hearts in Motion and the Range of Motion Project to benefit those in third-world countries. Looking forward, Wood says he worries for the next generation of practitioners. “I know of a young CPO who quit the business because of the intolerable burdens being presented to us,” he says. But at the same time, Wood loves what he does. “I’m not making a lot of money, but I am doing the best work this field can provide, and I love it.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at firstname.lastname@example.org. AOPA members can visit www.AOPAnet.org to use the free ICD-10 conversion bridge.
PHOTOS: Orthotics & Prosthetics Associates
first thought about a career in prosthetics when he met his sister’s boyfriend, who “made arms and legs for people.” Wood was in the military at the time, and he followed up by spending four days with a certified prosthetist. “When I walked out, I said, ‘I will have my own facility one day,’” he recalls. Wood left the military in 1975, and for the next 25 years worked as a certified prosthetist in a number of facilities. In 2000, he teamed with an orthotist to open an O&P facility. His partner soon decided he didn’t want to be on the management end of the industry, so Wood has been a solo practitioner since 2010. Wood’s facility, Orthotics & Prosthetics Associates, is based in a 5,000-square-foot space in Milwaukee, with a satellite office in Waukesha, Wisconsin. Wood sees patients of all ages, providing both upper- and lower-extremity prostheses. His employees include an office manager, two administrative workers who handle billing and infrastructure, and two part-time information technology specialists. Wood outsources nearly all fabrication, particularly specialty items, although he modifies his own casts and has an oven to create diagnostic sockets. With 40 years in the O&P industry under his belt, Wood has a broad view of the changes— both good and bad—that have taken place. “There is a feeling that our profession is being dummied down,” he says. “We were considered the experts, but the system doesn’t
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Pinnacle Prosthetic Labs
By DEBORAH CONN
Shouldering Fabrication Maryland c-fab specializes in a wide range of upper-extremity prosthetics
INNACLE PROSTHETIC LABS, BASED in Damascus,
DECEMBER 2015 | O&P ALMANAC
From left, Bruce Thomas, COF; Jacqueline Thomas; and Jack Stephens, CTPO
COMPANY: Pinnacle Prosthetic Labs OWNER: Jacqueline Thomas LOCATION: Damascus, Maryland HISTORY: 11 months
Technician Jack Stephens, CTPO, works in the fabrication lab.
facilities because shoulder, arm, and hand prostheses are relatively uncommon. “Most O&P offices will see one or two upperextremity cases a year,” says Thomas. “That’s all we do, and we have a combined track record of 23 years in the industry, so we have the experience and expertise to make it cost-effective.” Stephens has fabricated the full gamut of upper-extremity prostheses, from body-powered devices with cables to advanced myoelectric prostheses, as well as partial-hand devices. He makes hybrid arm prostheses as well, which combine a body-powered elbow with a myoelectric hand. “Users can shrug their shoulders to lift the elbow and manually lock and unlock the position,” he explains. A hybrid device is lighter than an electrically powered arm, which would require another motor and additional batteries. Stephens also fabricates prosthetic devices that use pattern recognition. “I’m making a COAPT arm right now for a
PHOTOS: Pinnacle Prosthetic Labs
Maryland, specializes in central fabrication of upper-extremity prostheses. Its vice president for sales, Bruce Thomas, COF, also is the owner of Pinnacle Orthopedic Services in nearby Germantown, an O&P distributor and services provider since 2010. Thomas and his wife, Jacqueline, founded Pinnacle Prosthetic Labs to provide upper-extremity devices for local hospital facilities. The company’s patient population primarily consists of military personnel who have served in the most recent conflicts in the Middle East, although Thomas plans to grow within the region. “There are not a lot of labs local to the Maryland, Virginia, and [Washington] D.C. area,” he says, “and we’d like to expand in that market.” Pinnacle does not use computer-aided design and manufacturing at this point, although Thomas hopes to add it eventually. The company is owned by Jacqueline Thomas, who is responsible for all operational functions at both Pinnacle Orthopedics and Pinnacle Prosthetic Labs. The c-fab employs Jack Stephens, CTPO, as a full-time technician, and fills in with part-time techs as needed. For Bruce Thomas, staffing has been a running challenge for the growing company as it seeks to balance new business with the appropriate number of employees. Both Thomas and Stephens stress that central fabrication of upper-extremity prostheses makes sense for most O&P
patient,” he says. “To use the arm, he had to start with surgery to relocate nerves to the surface of his triceps and bicep muscles.” In training sessions for patternrecognition devices, patients try to flex their “phantom” elbow, which triggers the relocated nerves to send signals to eight electrodes placed on the muscles. Clinicians assign the pattern of those signals to the elbowflexing motion, and ultimately users can flex the prosthetic elbow just by thinking about it. “There is a lot of research going in this field, and we get to see it at local hospital facilities,” says Stephens. “We are currently working with the Alfred Mann Foundation on a research pattern-recognition arm.” Stephens often creates prostheses that enable an amputee to perform specific tasks. “I’ve made arms for driving, riding a bike, golfing, playing baseball, bow hunting, and playing a guitar,” he says. “Some of the soldiers like to shoot, and they need to be able to hold the gun and rack the slide on a pistol.” So far, Pinnacle Prosthetic Labs has focused its marketing efforts on industry expositions such as the AOPA National Assembly, but it is in the process of launching a website and expanding its marketing efforts throughout the metropolitan Washington, D.C., region. Ultimately, says Thomas, “We want to provide quality service in a timely way.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at email@example.com.
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AOPA 365 Wherever You Go You used the AOPA app during the 2015 National Assembly—now you can use an AOPA app all year long! Download AOPA 365, AOPA’s new app that connects you with the important O&P-related information you need to help your business succeed.
2016 Bringing in the New Year: New Codes and Changes for 2016 Register for the December 9 Webinar
As we finish out 2015, it’s time to examine changes that will affect O&P businesses going forward. Plan to participate in the December 9 webinar and gain new knowledge on a number of critical topics. • Learn about the new codes for 2016. • Hear about the 2016 DMEPOS fee schedule changes. • Get an update on the status of the proposed Local Coverage Determination and Policy Article governing Medicare coverage of lower-limb prosthetics. • Find out how to close out 2015. • And see what other changes Medicare has in store for 2016. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit. ly/aopawebinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions.
DECEMBER 2015 | O&P ALMANAC
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Learn about AOPA. Read the O&P Almanac. See how membership with AOPA has its benefits. Get current with “Hot Issues.” Find out how Mobility Saves. Visit the AOPA Bookstore. Access the AOPA Membership Directory. Connect with AOPA through social media.
Download the app by scanning the QR code or by visiting www.tripbuildermedia.com/apps/aopa365.
Have You Read the O&P Almanac’s Leadership Series? Find out what senior-level O&P professionals have to say about the most critical issues facing the O&P profession. Several 2015 issues of the O&P Almanac have featured a new Leadership Series, showcasing Q&As with O&P experts on targeted topics of importance to the profession. Visit www.aopanet.org/publications/op-almanac-magazine to access past issues of the magazine and read what executives have shared, in their own words, on these important topics: HOSPITALS—WHAT’S THE HYPE? Andrew Meyers, CPO; Jim Kingsley; and Rebecca Hast detail their success strategies. June 2015 O&P Almanac, page 34
AOPAversity Online Learning Center
TECHNOLOGY SMARTS David Boone, PhD, MPH; Jan Saunders, CPO; and Stephen Blatchford share their insights. July 2015 O&P Almanac, page 36
O&P ALMANAC: What is the difference between consolidation and vertical integration?
A Place in the
Experts weigh in on the future of independent O&P facilities amid evolving economics
The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of consolidation and vertical integration.
S O&P PROFESSIONALS GRAPPLE with reimbursement challenges and dwindling profit margins, it’s impossible to ignore the industry consolidation trends taking place within the greater health-care arena. The number of “independent” health-care providers across medical specialties is falling. In fact, the number of U.S. physicians in independent practice has dropped significantly, from 57 percent in 2000 down to 37 percent in 2013, with a predicted decline to 33 percent by the end of 2016, according to data published by Accenture. The same report finds that those independent physicians who have sold their practices or sought employment directly with health systems have done so largely due to disruptive market conditions, such as reimbursement pressures. Some of the independent physicians who have kept their practices are coping by experimenting with other models to remain competitive—for example, 17 percent of U.S. independent physicians are participating in accountable care organizations (ACOs). Today’s O&P practitioners are facing similar reimbursement challenges and increasing costs. Several independent O&P facilities have recently consolidated with larger O&P practices, or have aligned themselves with suppliers or distributors on the O&P production pathway. What do these consolidation and vertical integration trends mean for today’s typical O&P provider and the outlook for the O&P profession? O&P Almanac recently spoke with three O&P experts, who shared their insights on the current business climate and the pros and cons of industry consolidation.
Meet Our Contributors
Mike Sotak is president and chief executive officer of PEL in Cleveland, Ohio. Sotak acquired PEL two years ago, after a diverse business career managing distribution and manufacturing businesses in pharmaceuticals, wound care, durable medical equipment, and related health fields.
Pam Filippis Lupo, CO/LO, is a member of the board of directors at Wright & Filippis and at Carolina O&P. She also is a surveyor for the facility accreditation program of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, and an industry consultant.
Rick Riley is chief executive officer of Townsend Design in Bakersfield, California, a company with more than 150 employees. He worked in hospital administration before joining Townsend in 1995 as vice president of marketing, then took on duties as the company’s vice president of sales and marketing in 1997. He assumed the role of CEO in 2003.
PAM FILIPPIS LUPO, CO/LO:
Consolidation is a merger or acquisition of smaller companies into a larger company. Vertical integration is when the supply chain or manufacturer owns the company to which it supplies products. MIKE SOTAK: Consolidation is gener-
ally driven by the need or objective to realize economies of scale; it’s fewer companies getting bigger to leverage costs and gain efficiencies. With vertical integration, the goal is usually different—diversification, to spread risk, or to gain control upstream or downstream across the continuum of care. Examples of vertical integration include aligning with referral sources and partnering with physical therapists or other service providers, such as ACOs. Many O&P facilities right now are vertically integrated with c-fabs, which are technically custom manufacturing operations.
O&P ALMANAC: What types of
consolidation and/or vertical integration are occurring in O&P right now?
LUPO: There are a number of differ-
ent ways O&P facilities are consolidating and being integrated into larger companies. For example, O&P companies are buying other O&P companies. Several O&P companies have made acquisitions, including Hanger, Wright & Filippis, Level Four O&P, and New England Orthotics and Prosthetics. Some O&P companies are combining with physical therapy. Some hospitals are buying O&P and durable medical equipment (DME) facilities. Some physician groups are acquiring prosthetists. On the manufacturing side, some manufacturers are working together,
or are working together with O&P as a provider, potentially under competitive bidding. There are numerous configurations. SOTAK: We’re seeing some consolidation on the patient-care side. Some larger regional players are looking to acquire other practices—facilities that are looking to get bigger for efficiencies of scale. For example, many organizations are feeling a need to hire compliance officers—but how can you afford to hire someone on staff as a compliance officer if you’re a two-person staff? So they’re looking to consolidate to justify hiring professionals necessary to consistently meet regulatory requirements. We’re also seeing consolidation at the manufacturer level, and I think we will see a lot more as manufacturers face new challenges in meeting expected financial performance. RICK RILEY: There is an emerging
model, especially in larger markets, where hospitals, physician clinics, and ancillary services—including
38 SEPTEMBER 2015 | O&P ALMANAC
O&P—are vertically integrated to create increased synergy and efficiency. In some cases, a local O&P facility is purchased by a large medical provider, and in other cases the network is hiring in-house orthotists and prosthetists. Among suppliers and manufacturers, there is also increasing consolidation. The companies that have the financial capital to make acquisitions can amass a vast range of products. This creates a strategic advantage in terms of offering one-stop-shopping to group purchasing organizations and integrated provider networks. O&P ALMANAC: What types of opportunities do these mergers present for the O&P profession and its patients? LUPO: Mergers and acquisitions can
lead to decreased costs due to the consolidation of redundancies. They may also allow O&P companies to expand into different scopes of practice—for example, foot care or DME. O&P ALMANAC | SEPTEMBER 2015
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Meet Our Contributors
Providing ancillary services may offer benefits for both O&P facilities and patients
The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of ancillary services.
Meet Our Contributors
Ivan Sabel, CPO, is chief executive officer of Orthotic Holdings Inc. in Hauppage, New York, a company that specializes in technologies and treatment options for health-care providers who treat conditions associated with the lower extremities. He previously served as chairman and CEO of Hanger.
30 NOVEMBER 2015 | O&P ALMANAC
O EXPAND OR NOT TO EXPAND into the world of ancillary services? That was the question posed to four senior-level O&P executives for this month’s Leadership Series article. While some practitioners may believe it’s important to adhere to the core competency inherent in O&P—strictly defined orthotic and prosthetic services—others trust that tremendous opportunities are available to O&P business owners who broaden their scope of practice. Disciplines such as durable medical equipment, physical therapy, foot care, mastectomy services, and home remodeling are all possible areas of growth. Here, our experts share their personal thoughts and experiences related to offering additional services at traditional O&P practices, emphasizing that the only expansions that will succeed are those that are well researched, properly staffed, and reimbursable.
Anthony Filippis, CPO, is chief executive officer of Wright & Filippis, a patientcare company focused on prosthetics, orthotics, and custom mobility products and accessibility solutions headquartered in Rochester Hills, Michigan.
Michael Tillges, CPO, is co-vice president at Tillges Certified Orthotic Prosthetic Inc., where he has worked since 2004. The company has facilities throughout Minnesota and western Wisconsin.
Jeff Lutz, CPO, is zone vice president of Hanger Clinic and currently serves on the AOPA and Amputee Coalition boards of directors. He has been a practicing CPO for the past 30 years.
O&P ALMANAC: Why should O&P professionals consider including ancillary services as part of their practice? IVAN SABEL, CPO: As the landscape
for O&P continues to evolve and change, it’s becoming more and more difficult to look at it as a pure orthotic or pure prosthetic business. Some people are navigating well around the headwinds that are affecting the profession; others are not faring as well. A pure O&P practice, which I define as a facility that solely offers custom orthotics and/or prosthetics, will continue to face reimbursement challenges as well as challenges with the orthotic and prosthetic codes. In this environment, ancillary services can be leveraged as bottom-line contributions to offset these challenges and the changes in the headwinds. ANTHONY FILIPPIS, CPO: There are a lot of synergies of products that patients need. O&P patients are coming into our facilities anyway, so we need to consider the items they may need as rehabilitative—when they can’t use an orthosis or prosthesis, or to use as additional support. For example, items such as canes, grab bars, bathroom aids, and raised toilet seats are examples of things that can make our patients’ lives better and easier. We need to be thinking: “What are the things that are going to help improve our patients’ lives?” MICHAEL TILLGES, CPO: Ancillary services provide the patients and referral sources a full-service facility—in essence, a “one-stop shop.” They also allow a facility to become better diversified, and to tap into different revenue streams and markets to increase profitability. JEFF LUTZ, CPO: Consider is the key word in this question. The possibility of adding services or product lines to an existing O&P practice is intriguing to many. However, owners will need to carefully consider the impacts the addition may have on their core business.
To assist, AOPA has recently formed an Ancillary Service Committee to identify services and products that are related to O&P but not typically provided in an O&P practice. The concept is to be able to provide practices with alternative income and identify what is required to participate, as well as the potential profit. It should be noted that we are also looking at potential value-adds that may not be a traditional revenue stream, but add to the practice’s value proposition to the patient and referral communities, driving our current core competency, O&P. O&P ALMANAC: How can the O&P profession leverage our core competency and core asset to broaden our scope? SABEL: O&P’s greatest asset is our
ability to identify and provide services to our patient population in a way that traditional business models outside of O&P don’t necessarily provide. Our referral sources come to us with one specific request—an orthotic or prosthetic device. But we need to look at patients in a much more holistic way; our patients need other services and products to continue to live their lives to the fullest. They come into our
facilities requesting just an orthosis or prosthesis, but they have a number of other needs in their treatment modality. By offering ancillary services, you’re contributing to a better quality of life for your patients, and you may make a profit to help offset some of the reimbursement and other recent challenges impacting O&P. FILIPPIS: I think it all ties to patient management. Sometimes we get tunnel vision and focus only on orthotics or only on prosthetics. But we have to look at the activities of the patient before and after they arrive at our facilities. We can meet some of their needs—either with ancillary services, or by serving as a resource. TILLGES: O&P’s core competency includes crafting and fitting of orthotic and prosthetic devices, as well as assessing the needs of the patient to provide appropriate products and services to better their life. O&P’s core asset includes the patients we take care of, our referral sources, third-party payors, and employees and staff members. By focusing holistically on the patients’ needs and providing them with the highest quality products and services, we enhance the quality of life for the patients we serve. O&P ALMANAC | NOVEMBER 2015
S THE O&P PROFESSION begins to collect patient data to demonstrate the effectiveness of orthotic and prosthetic intervention in restoring function— data that is increasingly important to payors—it’s a good time for O&P practitioners to take a look at those disease trends that are emerging from data generated by other health-care sectors. Many medical disciplines already have a vast array of patient information—data that could prove useful to orthotists and prosthetists as they consider patient demographics and set business plans. With reimbursement challenges on the rise and profit margins on the decline, it has become more important than ever for O&P businesses to understand which types of patients may be in greatest need of services in the near- and long-term future. Those O&P business managers and clinicians who follow disease trends will be best positioned to treat the patients most likely to visit their offices in the coming years. Here, O&P experts share their thoughts on the importance of following disease trends, such as diabetes and cerebral palsy, and offer suggestions for staying current on relevant medical advances.
Thomas DiBello, CO, FAAOP, is clinic regional director at Hanger Clinic; honorary adjunct faculty at Texas Women’s University; and chairman of the Advisory Committee of the Baylor College of Medicine Masters Program on Orthotics and Prosthetics. He is past president of both AOPA and the Academy of Orthotists and Prosthetists.
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Understanding disease prevalence and forecasts can help O&P professionals adapt their practices
The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of disease trends.
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O&P ALMANAC: Why should O&P professionals pay attention to disease trends?
48 OCTOBER 2015 | O&P ALMANAC
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A PLACE IN THE CONSOLIDATION CONTINUUM. Pam Filippis Lupo, CO/LO; Mike Sotak; and Rick Riley weigh in. September 2015 O&P Almanac, page 36
DISSECTING DISEASE TRENDS Thomas DiBello, CO, FAAOP; Phil Stevens, MEd, CPO, FAAOP; and Rudolf B. Becker offer their thoughts. October 2015 O&P Almanac, page 48
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Phil Stevens, Med, CPO, FAAOP, is immediate past president of the American Academy of Orthotists and Prosthetists and is in clinical practice with Hanger Clinic in Salt Lake City, Utah.
Rudolf B. Becker is chairman and president of Becker Orthopedic, a supplier of orthopedic component parts and central fabrication services located in Troy, Michigan.
THOMAS DIBELLO, CO, FAAOP:
As we evolve as a profession, it’s important that we be very involved in understanding and appreciating the changes occurring in the diseases that we treat. For instance, if there were an effective way to completely cure diabetes, then there may be a diminished number of amputations for diabetes patients, and that would reduce the need for prosthetic devices for diabetic amputees. On the orthotics side, if physicians begin performing more prenatal intra-uterine surgeries to repair spinal insults that occur in unborn infants with spina bifida, and research shows that these patients are then more cognitively alert but still have neuromuscular limitations that require bracing, that may have an impact on orthotics treatments—and we would need to be aware that further advances could ultimately eliminate the need for those types of orthoses. One example of the importance of following disease trends can be seen in the case of a well-known rehabilitation hospital. During the course of a decade during the 1980s and ‘90s, the hospital transitioned from being primarily a spinal cord injury center to a hospital that primarily treats stroke patients. They were watching trends and recognized that the number of spinal cord patients was diminishing—mainly because the majority of spinal cord injuries occurred secondary to motor vehicle injuries. As cars became safer, there were fewer spinal cord injuries. A change in focus to stroke patients helped ensure the hospital’s longevity. We, as a profession, need to be equally aware of trends that may affect the work we do. PHIL STEVENS, MED, CPO, FAAOP:
Every industry has to forecast its future. Are the demands for their
services going to increase or decrease? For orthotics and prosthetics, disease trends constitute a big part of that forecasting. RUDOLF B. BECKER: It’s important to follow disease trends so the profession and the companies that supply practitioners can prepare for the future needs of patients and offer viable treatments to referral sources.
O&P ALMANAC: What do individual practitioners, or the O&P profession as a whole, need to do to ensure we follow disease trends? DIBELLO: I know there is a lot of uncertainty in the profession these days related to possible Local Coverage Determination (LCD) changes and downward pressures on reimbursement, but we need to devote human and financial resources within the O&P profession to look at these trends, as so many other professions do. In the past, we have not studied the changes occurring in general medicine related to our patients whose diagnoses
we encounter the most. At times, we have been caught by surprise. We have to face this as a profession. We know very little about these areas of medicine we are most affected by, and we are at risk of being caught in a situation for which we are unprepared. STEVENS: I think individual practitioners will continue to be dependent on larger entities within the profession to follow disease trends. Individual practitioners don’t have the time or means to access the kinds of data that tell those stories. However, organizations like AOPA and the Academy do. Journalists within the profession can also do so. Once these entities create secondary knowledge sources that summarize these trends, then it’s up to individual practitioners to consume them and include those findings in their decision making.
Visit www.AOPAnetonline.org/aopaversity for more information.
BECKER: AOPA does a fine job of publishing data and the appropriate links in its biweekly AOPA in Advance Smart Brief and monthly O&P Almanac. They couldn’t be easier to access, and if you want more data, just use one of the search engines available online. O&P ALMANAC | OCTOBER 2015
BROADENING OUR SCOPE Ivan Sabel, CPO; Anthony Filippis, CPO; Michael Tillges, CPO; and Jeff Lutz, CPO, share their experiences. November 2015, O&P Almanac, page 30.
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Along with some of the best educators in the world! O&P ALMANAC | DECEMBER 2015
WELCOME NEW MEMBERS
HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publiwww.AOPAnet.org cation, 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 state-licensed 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.
Bremer Prosthetics LLC 5310 Hampton Place Saginaw, MI 48604 989/249-9400 Category: Patient-Care Facility Scott Baranek
Arnold O&P Lab Inc. 619 Jordan Street Shreveport, LA 71101 318/428-2400 Category: Affiliate Parent Company: Premier Hope Orthotic & Prosthetic Enterprises LLC, Monroe, LA
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Bremer Prosthetics Design G3487 S. Linden Road, Ste. U Flint, MI 48507 810/733-3375 Category: Affiliate Parent Company: Bremer Prosthetics LLC, Saginaw, MI Fountain Orthotics & Prosthetics 2151 N. Harbor Blvd., Ste. 1200 Fullerton, CA 92835 714/871-9960 Category: Affiliate Parent Company: Fountain Orthotics & Prosthetics Inc. Loren Rojek, CPO Fourroux Prosthetics Inc. 6630 McGinnis Ferry Road, Ste. A Duluth, GA 30097 678/584-1706 Category: Affiliate Parent Company: Fourroux Prosthetics Inc., Huntsville, AL McKesson Patient Care Solutions 4630 Richmond Road, Ste. 270 Cleveland, OH 44128-5954 800/451-6510 Category: Affiliate Parent Company: McKesson Patient Care Solutions, Moon Township, PA Methodist Orthotics & Prosthetics 1207 Office Park Drive, Ste. A Oxford, MS 38655 662/234-8193 Category: Affiliate Parent Company: Methodist Rehab Orthotics & Prosthetics, Flowood, MS
Northville Health Center University of Michigan Orthotics & Prosthetics Center 39901 Traditions Drive Northville, MI 48168 248/305-4620 Category: Affiliate Parent Company: University of Michigan Orthotics & Prosthetics Center, Ann Arbor, MI Optimus Prosthetics 3132 Olentangy River Road Columbus, OH 43202 614/263-5462 Category: Affiliate Parent Company: Optimus Prosthetics, Dayton, OH UH Acute Care 1500 E. Medical Center Drive, I220, Reception 2 Ann Arbor, MI 48109 734/936-7043 Category: Affiliate Parent Company: University of Michigan Orthotics & Prosthetics Center, Ann Arbor, MI Welso Medical LLC 6401 S. 33rd Street, Bldg. H, Ste. 18 McAllen, TX 78503 631/871-4388 Category: Supplier Level 1 Archana Vasudevan
Is Your Facility Celebrating a Special Milestone in 2016? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email firstname.lastname@example.org.
MARKETPLACE New AFO Gauntlets From Acor! A custom AFO gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2015-1016, Acor is offering a selection of our refined-design AFO gauntlets handmade in our Cleveland, Ohio, facility. Also known as a “Leather Lacer” and our most popular AFO gauntlet, the G9110 offers a choice of color, polypro reinforcement, and a leather or optional X-Static®-covered NeoSponge™ lining. See our ad in this issue for information regarding our new Custom Products catalog or just call Acor at 800/237-2267 to get a copy. For more information, visit www.acor.com
ALPS Thinner Seamless Suspension Sleeve Formulated with the ALPS GripGel, the new SFB seamless suspension sleeve provides superior comfort with a single piece construction. The SFB sleeve features a new black knitted fabric that allows the user excellent freedom of knee flexion. This new sleeve seals with the skin without restricting circulation, while the GripGel sticks to the patient’s skin without causing shear forces. With a thinner profile of 2 mm, the SFB is an ideal choice for those concerned about bulk. Fo r more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.
Introducing Precise Insoles by Amfit Amfit is proud to announce a prefabricated, functional insole in 24 sizes. Confidently offer a noncustom orthosis with biomechanically engineered arch support built right in. Millions of unique foot shapes formed the basis for designing a ready-towear insole with true functional support and the widest size range on the market. Most high-quality premade insoles offer less than 10 shell sizes. Precise insoles were designed to bridge that gap so you can offer a high-quality, functional orthosis when full custom isn’t an option. • 24 sizes • Integrated length, width, and arch height • Anatomically correct design • Functional shell with no crack guarantee • Forefoot comfort insert • Stabilizing deep heel cup • Tablet style digital sizing guide Opt for the Starter Kit (36 pairs, digital sizer, mount, and display materials) or order by the pair. Ask about introductory specials at email@example.com or 800-356-FOOT (3668) x264.
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Coyote Design’s Zero-Clearance Lock The Proximal Lock is a zero-clearance lock mechanism that also controls rotation. Mounted on the side of the liner and socket proximally instead of distally allows for the use of any distal adaptor. Use on its own, or with a distal pin system for extra suspension and controlled rotation. The Proximal Lock was designed to work with and can be primary suspension for long limbs that may not have room distally for other lock options. It can be used with short limbs but should be used with a distal pin and will act only as rotational control. For more information, call your distributor or Coyote Design at 208/429-0026 or go to coyotedesign.com.
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Coyote Composite Now Available in 10 Foot Lengths It’s now more affordable than ever to have multiple sizes of Coyote Composite on hand. No more guessing what sizes of composite you might need, get them all! Available sizes include 3 inch, 4 inch, 5 inch, 6 inch, 7 inch, 8 inch, and 10 inch. On sale until Dec. 31, 2015. Coyote Composite is the alternative to itchy, expensive carbon fiber braid! Since it’s made from basalt filament it’s a safe, tough material for composite sockets and AFOs. Also easy to cut and finish compared to other materials. Get more information at www.coyotedesign.com/coyotecomposite.html. 50
DECEMBER 2015 | O&P ALMANAC
New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first four-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients. For more information, call DAW Industries Inc. at 800/252-2828, email email@example.com, or visit www.daw-usa.com.
DawSkin New Mega Stretch
DawSkin New MegaStretch is the most durable tear-free skin in the world. It is the ideal skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multiaxis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear. DawSkin New EZ-Access dons on and off just like a sock yet provides all of the benefits of the DawSkin New MegaStretch. For more information, contact DAW Industries Inc. at 800/252-2828, email firstname.lastname@example.org, or visit www.daw-usa.com.
ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground-reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email email@example.com, or visit www.daw-usa.com.
MARKETPLACE Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee Stronger construction makes the new Plié 3 Microprocessor Controlled (MPC) Knee both submersible and more rugged than ever. Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small, short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom. To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.
Freedom Foot Products Just Got Better
Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied. Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted. Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark). For additional information, contact customer service at 888/818-6777 or email us at firstname.lastname@example.org.
LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit www.hersco.com.
Polycentric Pneumatic Knee The key element of the new 3R106 Pro is the servo-pneumatic control unit. Its powerful dual-chamber pneumatic unit with progressive damping has a flexion valve set for the patient’s normal walking speed. At faster walking speeds, the flexion resistance increases, which prevents too much knee flexion. This helps provide more consistent swing phase even during fast walking. With three options for the proximal connection (pyramid, threaded connector, and lamination anchor) and a 275-lb weight limit, the 3R106 Pro offers you great fitting options. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.
New Aluminum Components Our new line of aluminum pylons, adapters, and tube clamps are designed and tested to support up to a 300-lb weight limit while providing you with a costeffective, high-quality solution. The line includes double adapters at various lengths, a 30-mm pylon, a 30-mm tube clamp, and a pyramid adapter. For more information, contact your sales representative at 800/328-4058 or visit ottobockus.com.
O&P ALMANAC | DECEMBER 2015
Opportunities for O&P Professionals
Job location key:
Prosthetic Technician, Orthotic Technician, and/or Orthotic and Prosthetic Technician
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad
Member $482 $634
Nonmember $678 $830
Listing Word Count 50 or less 51-75 76-120 121+
Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word
ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board
Member Nonmember $85 $150
For more opportunities, visit: http://jobs.aopanet.org.
A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.
DECEMBER 2015 | O&P ALMANAC
Tampa, Florida Pediatric Orthotics and Prosthetics Services LLC, located in Shriners Hospitals for Children in Tampa, has full-time openings for experienced O&P technicians. The position requires a high school diploma or equivalency, technical certificate or degree a plus. The candidate ideally should have a minimum three years of experience fabricating a variety of upper- and lower-limb orthoses and/or prostheses, as well as experience in completing orthotic cast modifications. Additionally, the ideal candidate has pediatric experience, good to excellent orthotic cast modification skills, and central fabrication experience. With minimal supervision, he/she should be able to efficiently fabricate structurally sound and cosmetic orthoses and or prostheses in a busy laboratory setting. The candidate also must be able to build and maintain supportive relationships with staff co-workers and practitioners. Shriners Hospital, an Equal Opportunity Employer, is located on the campus of the University of South Florida campus and housed in a state-of-the-art 10,000-square-foot facility. The O&P facility was thoughtfully and carefully built with employee safety and a professional setting as a high priority. We offer excellent benefits, salary commensurate with experience. If you are a technician with good to excellent skills, give us a call at 813/975-7116. Send résumé to:
Attention: Human Resources Department Shriners Hospitals for Children 12502 USF Pine Drive, Suite 100 Tampa FL 33612 Email: email@example.com Phone: 813/975-7116 Fax: 813/631-7169
CPOs, COs, Board-Eligible Orthotist, Manager/CPO
Certified Prosthetist or Certified Prosthetist-Orthotist
Various areas in California and Nevada Are you worried about your future? Come join the industry leader! Hanger Clinic offers a dynamic, well-established and financially stable team where education and growth are paramount. Hanger Clinic has numerous opportunities in the Southern California and Las Vegas areas. Candidates must be motivated individuals who possess a strong clinical presence and want to help empower human potential. We offer competitive salaries, medical, dental, vision, and 401k. Encino, CA
CPO or CO
Apple Valley, CA
CPO or CO
El Centro, CA
Manager/CPO Spanish speaking with some pediatric experience
La Mesa, CA
CO with pediatric experience for a large clinic
Reno, Nevada ABILITY Prosthetics & Orthotics of Nevada LLC is looking for a seasoned practitioner with clinical expertise in both outpatient and inpatient settings. Candidates must have excellent communication, patient-care, and interpersonal interaction skills. We offer a competitive salary, based on experience, health insurance, and 401k options. If you are interested in joining our AMAZING team, please submit your résumé to:
Attention: Human Resources ABILITY Prosthetics & Orthotics of Nevada LLC Email: firstname.lastname@example.org Fax: 775/333-9202 Website: www.abilityofnv.com
Rancho Mirage, CA Manager/CPO with hospital experience Ontario, CA
CO or CPO
CO or CPO to be hospital specialist
Contact Phil Conley, RVP, at email@example.com to learn more or apply online at www.hangerclinic.com/careers. Hanger Inc. is an Equal Opportunity Employer. All candidates are considered regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability, or veteran status.
Attention: Phil Conley, RVP Hanger Inc. Email: firstname.lastname@example.org Website: www.hangerclinic.com/careers
Northeast Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist
Watertown, New York A well-established, multioffice practice has immediate openings for residents and ABC-certified CPOs/ CPs/ COs. Candidates must be motivated individuals who possess a strong clinical presence, technical experience, the ability to document all aspects of patient contact, and the desire to improve the quality of life for those who require our services. Northern Orthopedic Laboratory is based in Watertown, New York, located on the outskirts of scenic Lake Ontario and St. Lawrence River. We offer a competitive salary (commensurate with experience), medical, dental, vision, 401K, and profit sharing. Send résumé to:
Northern Orthopedic Laboratory Inc. 1012 Washington Street Watertown, NY 13601 Office: 315/782-9098 Email: email@example.com www.northernorthopediclaboratory.com O&P ALMANAC | DECEMBER 2015
R.I.C: Elaine Owen. Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. 22.0 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.
ABC: Prosthetic Clinical Patient Management (CPM) Exam. Caruth Health Education Center, St. Petersburg College, FL. Contact 703/836-7114, email firstname.lastname@example.org, or visit www.abcop.org/certification.
Bringing in the New Year: New Codes and Changes for 2016. Register online at bit.ly/aopawebinars. For more information, contact Ryan Gleeson at 571/431-0876 or email rgleeson@AOPAnet.org. Webinar Conference
ABC: Orthotic Clinical Patient Management (CPM) Exam. Caruth Health Education Center, St. Petersburg College, FL. Contact 703/836-7114, email email@example.com, or visit www.abcop.org/certification.
ABC: Application Deadline for all March Exams. Applications must be received by January 1 for individuals seeking to take the March ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians. Contact 703/836-7114, email firstname.lastname@example.org, or visit www.abcop.org/certification.
O&P Leadership Conference. Palm Beach, Florida. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. Contact 703/836-7114, email email@example.com, or visit www.abcop.org/certification.
Prepayment Reviews: What You Need To Know To Pass. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email firstname.lastname@example.org.
Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.
Calendar Rates Let us share your upcoming event! Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www. AOPAnet.org for content deadlines.
DECEMBER 2015 | O&P ALMANAC
CE For information on continuing education credits, contact the sponsor. Questions? Email landerson@AOPAnet.org.
BONUS! Listings will be placed free of charge on the â€œAttend O&P Eventsâ€? section of www.AOPAnet.org.
Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less 26-50 51+
1/4 page Ad
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Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations.
CALENDAR February 10
SNF Billing: Beyond the Basics Webinar Conference (The Ins and Outs). Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
PrimeFare Central Regional Scientific Symposium 2016. Southern Hills Marriott, Tulsa, OK. Contact Jane Edwards at 888/388-5243, email@example.com, or visit www.primecareop.com.
When Things Go Wrong: Making Lemonade out of Lemons. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
Taping it to the Next Level. Raleigh, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 8 credits. Register at Footcentriconline.com.
Children and Their Feet. Sanford, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at Footcentriconline.com.
Physician Documentation: How To Get It & How To Use It. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
March 5-6, March 19-20
The Foot and the Ankle: To Mobilize or To Stabilize. Greenville and Greensboro, NC. Focus on balance and gait, orthotics, shoes, and taping while supporting a good cause. 16 credits. Register at Footcentriconline.com.
Shift the Liability: The Proper Use Webinar Conference of the ABN Form. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org..
PrimeFare West Regional Scientific Symposium 2016. Denver Marriott City Center, Denver. Contact Jane Edwards at 888/3885243, firstname.lastname@example.org or visit www.primecareop.com.
Understanding Shoes, Mastectomy, & Other Policies. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
PrimeFare East Regional Scientific Symposium 2016. Renaissance Hotel & Convention Center, Nashville. Contact Jane Edwards at 888/388-5243, email@example.com, or visit www.primecareop.com.
Strategies and Levels: How To Play the Appeals Game. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
The Supplier Standards: Are You Compliant? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
99th AOPA National Assembly and New England Chapter Meeting. Boston. For exhibitors and sponsorship opportunities, contact Kelly Oâ€™Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
ADVERTISERS INDEX Company
ACOR Orthopedics Inc. ALPS South LLC Amfit Cailor Fleming Insurance Coyote Design DAW Industries Delcam Healthcare Solutions Ferrier Coupler Inc. Flo-Tech O&P Systems Inc. Freedom Innovations Hersco Ottobock
9 15 17 5 7, 33 1 27 29 48 21 2 C4
800/237-2276 www.acor.com 800/574-5426 www.easyliner.com 800/356-3668 www.amfit.com 800/796-8495 www.cailorfleming.com 800/819-5980 www.coyotedesign.com 800/252-2828 www.daw-usa.com 877/335-2261 www.orthotics-cadcam.com 810/688-4292 www.ferrier.coupler.com 800/356-8324 www.1800flo-tech.com 888/818-6777 www.freedom-innovations.com 800/301-8275 www.hersco.com 800/328-4058 www.professionals.ottobockus.com O&P ALMANAC | DECEMBER 2015
Anticipating Application Fees
Answers to your questions regarding DMEPOS application fees and more
AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at firstname.lastname@example.org.
What will the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Medicare application fee be set at for 2016?
The 2016 Medicare DMEPOS supplier application fee will be $608. The 2015 application fee is currently set at $553, and the fee will vary from year to year based on adjustments found in the Consumer Price Index for Urban Areas (CPI-U). Thus year’s CPI-U has been established as 0.1 percent, resulting in a $55 increase in the DMEPOS supplier application fee.
new tax identification number (TIN) for that new business and will need a new supplier number to go with it. (Supplier numbers are tied to TINs.) With this type of purchase, you would have to pay the application fee because you are applying for a new supplier number. However, if you have made a stock purchase of the assets and liabilities, where you will be operating the business under the original TIN, you do not need a new supplier number. You would not have to pay the application fee because you are simply making a change in the ownership.
you were informed by the patient that he or she no longer wants the item; or the date you last made an attempt to deliver the item/service. If you are billing the claim as refused because the patient has passed away, then your date of service would be the date the patient passed away. I am set to deliver an orthosis/ prosthesis to a patient in a hospital prior to his discharge, but he is being discharged to a rehab hospital; can I still bill Medicare using the two-day rule?
No, you may not bill Medicare using the two-day rule, and you would have to seek payment from the hospital where the orthosis/ prosthesis was delivered. Certain criteria have to be met in order to bill using the two-day rule exemption, and one of those criteria is that the patient must be discharged to his or her home. In the scenario you described, the patient is not being discharged home, but rather is being discharged to a different facility or hospital.
I’m buying an existing O&P company. Do I need to get a new supplier number, or can I use the business’s original number? Do I need to pay the supplier application fee?
The answers depend on the kind of purchase you have made. If you have made an assets-only purchase, you will need a new number. This is because you will be obtaining a
DECEMBER 2015 | O&P ALMANAC
If a patient refuses delivery of an item/service, what should I use as my date of service for billing purposes?
When billing for a refused item or service, your date of service will be the date you learned of the refusal. This could be the date you learned that the item/service was no longer medically necessary; or the date
THE ONLY THING BETWEEN AMPUTEES AND A HIGHER QUALITY OF LIFE IS MEDICARE’S GLASS CEILING. MICROPROCESSOR KNEE
BIONIC PROPULSION ANKLE
As seen in The Washington Post and The Hill
HIGH ENERGY FOOT
Medicare’s glass ceiling moves today’s prosthetic devices out of reach for most amputees. Decades of technological advancements mean that new levels of mobility, health and
Amputees Who Receive Better Prostheses Save Medicare Money*
Though new, higher quality custom prostheses are widely available, Medicare
independence are possible for amputees. The only problem? Medicare. The federal
K3 Prostheses (Higher Quality) $79,967
restrictions are a glass ceiling
government makes it highly unlikely that a
that keeps them out of reach
patient will qualify for these devices, and
of most amputees. Even
new regulations will make the situation
K2 Prostheses (Lesser Quality) $81,513
though it’s been shown these devices provide a better
worse, not better. FIRST 12 MONTHS, ALL HEALTH COSTS.
quality of life.
If Medicare is trying to save money, denying
amputees prosthetic devices isn’t the
Who has fewer incidents that require
way to do it. A new study shows patients
expensive care? In most cases, it is the
who receive timely prosthetic and orthotic
amputees who have been given the
devices can actually save Medicare money
prosthetics that kept them active and
over patients who are not treated — more
healthy. And now Medicare and its
than $231 million was saved for Medicare in
contractors are planning to further restrict
who can get these better prosthetic limbs.
fewer skilled nursing claims for people with high-quality prostheses
It’s an outrage that Medicare would deny amputees the life-changing mobility that comes with prosthetics. To learn more about the Medicare study
Who Had Fewer Medical Incidents?
Received Higher Quality Prosthetics
Received Lower Quality Prosthetics
and what you can do to stop these policies, visit mobilitysaves.org.
Fewer E.R. Admissions? Fewer Skilled Nursing Needs? Fewer Doctor Visits? Fewer Hospice Admissions?
* Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007‐2010) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 (and matched comparisons), according to custom cohort database definition.
Reclaim your choice Introducing Triton® smart ankle
The numbers don’t lie. Triton smart ankle is unmatched with 34⁰ range of motion, 2 inches heel height adjustment, up to 72 hours of battery life, and packed with more features and function. Setting up and programming Triton smart ankle are completely wireless due to the integrated Bluetooth, and your patients will love the app that puts simple daily adjustments in the palm of their hand. Talk with your Sales Rep to see what makes Triton smart ankle so different from the rest.
www.professionals.ottobockus.com | www.professionals.ottobock.ca Ottobock Lower Limb Prosthetics
American Orthotic & Prosthetic Association (AOPA) - December 2015 Issue - O&P Almanac