February 2012 Almanac

OP

The American Orthotic & Prosthetic Association

FEBRUARY 2012

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

HELP FOR the

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O&P Almanac CONTENTS

FEBRUARY 2012, VOLUME 61, No. 2

departments

Cover Story

4 AOPA Contact Page How to reach staff

20 Help for the Senior Spine

By Anya Martin Although dynamic orthoses can deliver powerful results for seniors suffering from posture and mobility problems, few physicians and practitioners have experience working with them.

6 At a Glance

08

Statistics and O&P data

In the News Research, updates, and company announcements

38 AOPA Headlines

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

45 AOPA Membership Applications 46 Marketplace

Feature

Products and services for O&P

30 The Case for Adaptation

By Brian L. Gustin, CP, BA In this first of a two-part AOPA exclusive, an industry veteran and AOPA past president explains the advent of accountable care organizations and how they signal much-needed change in the industry.

COLUMNS

48 Jobs

Opportunities for O&P professionals 52 Calendar

Upcoming meetings and events

55 Ad Index 56 AOPA Answers

Expert answers to your FAQs

16 Reimbursement Page

Common-sense tips for avoiding a lawsuit

30 Facility Spotlight

C.H. Martin Company

Want a Taste of O&P History?

Get your fill at www.oandplibrary.org/op— a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

FEBRUARY 2012 O&P Almanac

3

AOPA CONTACT INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

EXECUTIVE OFFICES

MEMBERSHIP and Meetings

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

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

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org

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

AOPA Bookstore: 571/431-0865

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

AOPA Member-Get-A-Member Campaign GROWING FOR

THE FUTURE CLUB

Take 10% or More OFF Your 2012 Dues

Every major membership organization in the world has found their current members to be their most successful growth partners.

And there has to be something in it for the current member!

You, as an AOPA member, are invited to join our Growing for the Future Club. For each new member company you sign up who designates you as its recruiting member, AOPA will discount your current 2012 renewal by 10%. Get 10 new members and enjoy your 2012 AOPA benefits for free. The 10% discount per new member applies to company members signed up who pay the full 2012 dues of $1,745. For affiliates signed up at $305 each, AOPA will provide a credit of $30 against 2012 dues. You may also use the earned discount as a credit when you purchase any AOPA product, service, or seminar.

Discover MORE HUGE BENEFITS—To enroll in the club and receive your Growing for the Future membership marketing kit, email scuster@AOPAnet.org and we’ll take it from there. You can help make it happen!

4

O&P Almanac FEBRUARY 2012

OP Almanac &

Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company

BOARD oF DIRECTORS Officers President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX President-Elect Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

directors Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, MBA, MSOD, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix LLC, Philadelphia, PA Ron Manganiello, New England Orthotic & Prosthetic Systems LLC, Branford, CT Mahesh Mansukhani, MBA Össur Americas, Aliso Viejo, CA Michael Oros, CPO, Scheck & Siress, Chicago, IL Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2012 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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At a Glance

Are You Prepared To Treat the Aging U.S. Population?

The Number of Seniors in America Continues To Grow‌

Several States Have Particularly High Senior Populations‌ Percentage of Population 65 and Older in 2010

U.S. Population Aged 65 and Older 1950

20.1 million

1970 1990

17.3%

Florida

12.3 million

West Virginia

16.0%

Maine

15.9%

31.2 million

2010

35.0 million

15.4%

Pennsylvania

14.9%

Iowa

Source: U.S. Census Bureau

Source: U.S. Census Bureau, 2010 Census Summary

80%

2025

Percentage of seniors who have at least one chronic health condition (50% have at least two).

13%

Increase in rate of physician office visits for patients aged 65 and older between 1998 and 2008.

2 in 3

Chance that a senior citizen will become physically or cognitively impaired in his or her lifetime.

2012

70%

The percentage by which the U.S. 75 and older population is projected to increase by the year 2025.

11 million

Approximate number of diabetes-related doctor visits made by patients aged 65 and older in 2008.

1 to 45

$

$

Ratio of Medicare and Medicaid dollars spent in 1971 compared to 2010.

Sources: U.S. Census Bureau, cdc.gov/nchs, payingforseniorcare.com, seniors.lovetoknow.com, seniorcaremarketer.com

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O&P Almanac FEBRUARY 2012

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In the News

The Sensors, Energy, and Automation Laboratory of the University of Washington (UW), Seattle, in collaboration with the U.S. Department of Veterans Affairs,

has completed the development of a prototype fringing field sensor array (FFSA). This collection of highresolution pressure sensors can be incorporated into the lining of artificial limbs to accurately and noninvasively measure sheer stress, pressure, and other characteristics at the limbprosthesis interface.

The FFSA is an improved version of the previously developed fringing field plantar array, according The Fringing Field Sensor Array fits seamlessly under the liner of prosthetic limbs, measuring all critical aspects of the prosthetic’s use.

to Kishore Sundara-Rahan, sensor engineer and doctoral candidate at the UW Department of Engineering.

The sensitivity and sheer range of data that the FFSA can provide will allow physicians and researchers to design prosthetic limbs specifically tailored for individual patients’ residual-limb surfaces. In addition, the FFSA can be used in diagnostic devices to measure contact patterns and reveal strain and stress information, enabling the design of prostheses that are “more comfortable and natural,” SundaraRahan says.

Several companies have expressed an interest in adopting the FFSA for both prosthesis fitting and diagnostic measurements.

Researchers Focus on Robotic Innovation for Next-Generation Prosthetics Researchers from Texas A&M University, Rice University, and Sweden’s Halmstad University are collaborating to develop software that can accurately predict the physical behavior of robots prior to prototyping, as well as expand a previously developed programming language.

The work has implications for the design of prosthetic and rehabilitative devices.

“One area that stands to significantly benefit from these innovations is the design of next-generation prosthetics,” says Aaron Ames, assistant professor of mechanical engineering and of electrical and computer engineering at Texas A&M. “The MAHI lab at Rice is already doing work on upper-body prosthetics, and

8

O&P Almanac FEBRUARY 2012

the AMBER lab (at Texas A&M) is working on prosthetics for the lower body. With improved modeling and simulation tools, we hope to dramatically accelerate innovation in this area.”

The team is working to find a way to conduct virtual testing so that key flaws can be found on a computer before a prototype is built. While robots can perform superhuman feats, they sometimes get tripped up by toddlerlevel tasks; though they are digitally programmable, the intricacies of their physical behavior go far beyond the reach of computer simulations.

“Part of the problem is that robots have a foot in both the digital and physical worlds,” says robotics researcher Marcia O’Malley, professor of mechanical engineering

and materials science at Rice and co-principal investigator on the new project. “Bridging these worlds is difficult. The physical world is a messy place with both smooth curves and discontinuities that are difficult for computers to deal with.”

The researchers are taking a new approach. They plan to develop a holistic system that robotics designers can use from start to finish. Specifically, the next generation of two-legged walking robots and robotic assistive devices will be developed by Ames and O’Malley through this new software infrastructure—ultimately aiding in the development of prosthetic devices.

Photo: Sensors, Energy, and Automation Laboratory image

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In the News

ORNL, BAMC Collaborate to Improve Prosthesis Design and Fitting Biomedical engineers at Oak Ridge National Laboratory (ORNL) and the Center for the Intrepid at Brooke Army Medical Center (BAMC) are collaborating in the development of a portable, wearable system to measure walking patterns that can be applied to realworld activities in a variety of settings, according to an article in Today’s Medical Developments. The technology is being targeted toward soldiers who have lost a limb, in particular soldiers returning from war.

ORNL’s Boyd Evans and John Mueller are collaborating with BAMC to improve prosthesis performance for young soldiers. Wounded soldiers tend to be between ages 18 and 25 and are generally active so they need a prosthesis that will last over time, with superior fit, alignment, and function.

trans i t i ons

People in the News

Kootenai Prosthetics & Orthotics of Coeur d’Alene, Idaho, has has hired the following practitioners: Sunye Tafoya, LCO; Alexandra Gates, CO, LP; and Patrick Sullivan, C.Ped. Mahesh Mansukhani, president of Össur Americas, has been elected to serve a three-year term on the Amputee Coalition’s board of directors.

10

O&P Almanac FEBRUARY 2012

Evans and Mueller plan to develop a gait analysis system that can be used in a large laboratory using controlled conditions and limited activities. The research team is making use of inertial measurement units (IMUs) and other sensors that can be strapped onto segments of a subject’s leg to monitor the motion and force of walking patterns. The data collected from the IMUs transfer to a computer, and algorithms calculate the motions and forces associated with specific joints.

To gauge the effectiveness of IMUs, Evans and Mueller plan to test their system on a human subject with a prosthetic and healthy leg at the Gait and Motion Analysis Laboratory at Center for the Intrepid. If the prosthesis is not fit or aligned correctly, it could affect a patient’s walking patterns, resulting in “asymmetric” gait.

Ottobock has announced the hiring of Robert Schmidt as a sales representative for technical orthopedics. Schmidt is responsible for calling on prosthetists and orthotists in Northern California and Northern Nevada.

Tensegrity Prosthetics has appointed Morgan Stanfield as its new director of marketing and communications.

DME-Related Medicare Fraud Uncovered Akinsunbo Akinbile, the owner of Hallco Medical Supply in Houston, Texas, pleaded guilty to eight counts of health-care fraud in connection with a Medicare fraud scheme involving durable medical equipment (DME). The plea was announced by the Department of Justice, the Federal Bureau of Investigations, and the Department of Health and Human Services. The case was brought as part of the Medicare Fraud Strike Force, supervised by the United States Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.

Akinbile admitted that he was the owner and operator of a company that purported to provide DME to Medicare beneficiaries. According to court documents, Hallco submitted claims to Medicare for DME, including orthotic devices, which were medically unnecessary and/ or never provided. Many of the orthotic devices were components of “arthritis kits” and purported to be for the treatment of arthritisrelated conditions. The arthritis kits generally contained a number of devices, including braces and related accessories.

From June 2007 through May 2009, Hallco submitted approximately $737,770 in fraudulent claims to Medicare. At sentencing, scheduled for Feb. 15, 2012, Akinbile faces a maximum sentence of 10 years in prison.

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In the News

Northwestern University Offers Master’s Program in P&O Northwestern University Prosthetics-Orthotics Center (NUPOC) in Chicago has announced the Feinberg School of Medicine approved the curriculum for a new master’s degree in prosthetics and orthotics (MPO). The NUPOC MPO is a 20-month postgraduate degree that offers clinically focused education in a research environment. It is slated to begin in 2012.

According to NUPOC, MPO students will complete their first two quarters online, and after demonstrating proficiency in fundamental concepts, students will attend an on-campus practicum for four quarters (11 months) of supervised clinical education. During the on-campus practicum, MPO students apply their knowledge and develop skills in assessment, design, fitting, and evaluation of trial prostheses and orthoses for educational models who have amputations and other physical disabilities. The final quarter offers students the opportunity to focus on a specialty area before beginning their residency.

trans i t i ons

BUSINESSES in the News

ABC Prosthetics & Orthotics has designed the first whale scoliosis brace for a rescued pilot whale who now resides at SeaWorld Orlando.

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. has announced its latest web tool for O&P professionals working in licensure states.

The new interactive licensure map can be accessed from ABC’s website and includes detailed information on licensure requirements for the 13 states currently requiring an individual to be licensed to practice in that state.

The California Orthotic & Prosthetic Association (COPA) has announced the 2nd Annual COPA Educational Event, to be held Friday, March 2, at CSUDH O&P Program in Long Beach, California. The one-day event will feature three concurrent

12

O&P Almanac FEBRUARY 2012

tracks: a hands-on prosthetic workshop, and hands-on orthotics workshop, and a clinical and business track.

Presentations will be led by representatives of SPS, Otto Bock HealthCare, Allard USA, Becker Orthopedic, Össur Americas, and several other companies.

During the 65th Annual Meeting of the American Academy of Cerebral Palsy Developmental Medicine, researchers from the National Institutes of Health presented a study finding that Hanger Orthopedic Group’s WalkAide System successfully improves mobility by significantly increasing ankle control during walking in children with lower-leg paralysis (“foot drop”) due to cerebral palsy.

Nabtesco, a Japanese company, and Proteor, a French company, have announced their partnership in the

United States, Nabtesco Proteor—USA. The company’s U.S. headquarters is located in Muskego, Wisconsin. The company plans to educate U.S. practitioners on how to use their products, which include microprocessor knees, prefabricated cones, and a number of related products.

PEL Supply Company has been identified as an exclusive distributor for OPGA, which represents more than 1,200 independent O&P facilities.

Atlanta’s Good Samaritan Health Center and Prosthetic Hope International, in cooperation with the Georgia Institute of Technology master of science in prosthetics and orthotics (MSPO) program, have opened the Prosthetic and Orthotic Community Clinic at Good Samaritan. Second-year MSPO students will primarily operate the new prosthetics and orthotics lab.

HHS Grants to Help Implement Affordable Insurance Exchanges The Department of Health and Human Services (HHS) recently awarded nearly $220 million in affordable insurance exchange grants to 13 states. According to a press release, this gives those states more flexibility and resources to implement the Affordable Care Act. Under the new health-care reform law, states may design affordable insurance exchanges by which families and small businesses can choose a health insurance plan that fits their needs. Beginning in 2014, the new exchanges will help consumers compare plans, find appropriate coverage, and receive answers to help them navigate the market. Insurers will provide new

information to consumers, such as a summary of benefits and costs, which is expected to increase competition among insurance providers and drive down costs.

“We are committed to giving states the flexibility to implement the Affordable Care Act in the way that works for them,” Kathleen Sebelius, HHS Secretary, said in the release.

“Exchanges will give consumers more choices and make it easy to compare and shop for insurance plans.”

In anticipation of state legislative sessions beginning in January, HHS also developed several frequently asked questions, with answers that states should know as they begin to set up new exchanges. For

example, states that run exchanges have more options than originally proposed in determining eligibility for tax credits and Medicaid. And state insurance rules and operations will continue even if the federal government is facilitating an exchange in the state.

Twelve states received Level 1 grants, which provide funding for one year to states that have already made progress using a previous exchange planning grant. Rhode Island received the first Level 2 grant, which provides multiyear funding to states that are further along in the planning process.

Including those states, 29 states are making significant progress in creating exchanges. a

FEBRUARY 2012 O&P Almanac

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Reimbursement Page

By Kathy Dodson

Nine Ways to

Avoid the Courtroom

Common-sense advice on winning a lawsuit— or avoiding one altogether

U

nfortunately, there is never a guarantee that someone, sometime, won’t sue you. But you can take some common-sense steps to help make a legal challenge much less likely. Take a look at the following nine recommendations, and consider how your practice compares to these guidelines. Then, make any changes you think are appropriate to help protect your livelihood.

Let’s start with patient interactions.

1.

Set reasonable expectations.

You want to keep your interaction with patients on as positive a note as possible, but it’s not wise to be so enthusiastic that patients hear only the upside of their treatment.

Unfulfilled expectations lead to unhappy patients, who are more likely to complain and file lawsuits. Try to portray their situation and potential for rehabilitation in realistic terms, and cover the potential problems as well as the hoped-for benefits.

16

O&P Almanac FEBRUARY 2012

2.

Don’t surprise your patients.

When you begin your care for a patient, discuss in some detail what you plan to do, why you are doing it, and what you expect the outcome to be. As time progresses, have this discussion again to ensure the patient understands where the treatment is headed and what to expect. Just as speakers often tell you what they will be covering before they actually start their presentation, outlining your thinking and planned course of action early on will make patients feel more organized and in control of their care.

3.

Make your patient a part of the team. As you probably know from experience, it is often easier to be mad at a stranger than a friend. Do everything you can to make patients feel that they are important to you and your staff and that you have their best interests at heart. Involve them as much as possible in decisions about their care, so they feel like part of a team.

Once you have established such a relationship, patients will be much more likely to discuss with you any problems or concerns they might have. However, if they feel shut out of the process, they will more often turn to their insurer or friends to voice complaints. And they will be much more likely to file a lawsuit.

4.

Present an appealing atmosphere to your patients.

You may want to enlist a friend to help you here, because it is often difficult to see with fresh eyes the place where you spend so much time. Have this person enter your facility as a patient and note any negatives. Are the waiting and treatment rooms clean and bright?

Are the hallways free of clutter? Is the carpet clean and securely fastened to the floor?

As mundane as these details might sound, deficiencies in these areas can really turn patients off and can be potential hazards that lead to lawsuits.

The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. Call 703-836-7114 or go online at www.abcop.org Find us on Facebook. www.facebook.com/abcopp

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Scan the code to find out more about ABC Certification.

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Reimbursement Page

A coat of paint, a bright poster on the wall, a batch of current magazines, and a green plant or two might be all you need to spruce things up and make your office a warm and friendly place that welcomes your patients.

Review your facility to make sure there are no lurking hazards to patients, or employees.

5.

Maintain a safe environment.

Review your facility to make sure there are no lurking hazards to your patients or employees. Is all of your equipment inspected periodically to ensure that it is operating as it should? Are your parallel bars secure?

Are the devices or DME items that you provide to your patients operating correctly and adjusted properly? Do you have adequate venting? Are your employees following safe procedures in your lab? Are your emergency exits clearly marked?

The simple fact is this: Without documentation in your files to support what you have done, it’s as if you hadn’t done it.

6.

Hire wisely. The majority of people you hire are honest, hard-working people, but it takes just one bad experience to show the value of taking certain precautions in the hiring process. Invest the time to verify professional credentials directly with the credentialing bodies.

Run background checks to ensure candidates have no prior or existing problems with the authorities. Check the Medicare Office of the Inspector General site, www.oig.hhs.gov/fraud/ exclusions/exclusions_list.asp, to ensure that the person you are considering has not been excluded from the Medicare program. Hiring such a person will put your ability to bill Medicare and Medicaid at serious risk.

Remember, successful conmen don’t look like crooks. (If they did, they wouldn’t be successful.)

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O&P Almanac FEBRUARY 2012

7.

Take the time to document.

The simple fact is this: Without documentation in your files to support what you have done, it’s as if you hadn’t done it. Although documentation has always been required, enforcement has been sketchy in the past. Often, Medicare paid without examining your files for supporting information. But that is becoming a thing of the past. Medicare is increasingly performing extensive audits, zeroing in on whether there is documentation of the care rendered.

Without documentation to support you in a court case, you’ve lost before you even start.

8.

Take adequate notes. Why take the time to document, if you’re not going to make sure the documentation is adequate for the job?

Go into enough detail that an outsider, such as an insurance company, could pick up your notes and know what you did and—what’s even more important—why you did it. Don’t simply copy from a manufacturer’s marketing brochure about the benefits of a device. Tell the reader why the device is important and medically useful for that specific patient, not just patients in general. Unless you tie it to the individual patient, Medicare will discount it.

9.

Work with physicians.

Increasingly, Medicare is looking to the records of the physician to support the medical necessity of the device you provide. Fair or not, that is the current situation, and it is resulting in some scary recoveries. A recent prepayment review of therapeutic shoes in Jurisdiction B found a denial

rate of 93.1 percent. The primary reason for denial was lack of adequate documentation from the certifying physician. Similar reviews are underway for lower-limb prosthetics, with similar results.

When it comes to legal challenges, unfortunately, there is no silver bullet.

AOPA continues to work with CMS, trying to make Medicare’s expectations and requirements more reasonable.

And you must try to work with your referring physicians to make them aware of the type of documentation Medicare expects. This is difficult even if you have a good relationship with your referring physician, and it’s almost impossible if you barely know the physician. So reach out and try to make personal contact with your referring physicians even before you need to ask them for help. Make use of the letter from the DME MAC medical directors that explains to physicians the need for such documentation. You can find a link to this document on your DME MAC website.

There’s no guarantee that these suggestions will make you bulletproof, but they will certainly improve your odds of staying out of a lawsuit or winning if you are involved in one.

Take the time to protect yourself, so you can continue to serve your patients. a Kathy Dodson, formerly senior director of government affairs, is a consultant for AOPA. For questions about this column, contact Joe McTernan at jmcternan@ AOPAnet.org.

Help for the

Senior

Spine

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O&P Almanac FEBRUARY 2012

COVER STORY

By ANYA MARTIN

Dynamic orthoses deliver dynamic results for older patients with scoliosis and osteoporosis

F

or five years, “Jane” had suffered from extreme back pain that no medical practitioner had been able to alleviate. Then last spring, the 77-year-old woman ended up at BioConcepts Inc., a Chicago-based O&P practice owned by Hanger Prosthetics and Orthotics. After describing her symptoms and sharing her story, Jane mentioned that when she tilted her torso to her left, she felt less pain, recalls Kevin P. Meade, PhD, professor of mechanical engineering at Illinois Institute of Technology. Meade was seeing her alongside Thomas M. Gavin, CO, who founded BioConcepts and continues to run the practice for Hanger.

“She actually tilted her torso toward the left,” Meade says. “It was a simple thing, but I realized what she was doing was opening up the foramen and relieving pressure on the nerve that comes out of her spine. That opened up a lot of things to ask her, and I could tell from her responses what was going on.”

Meade and Gavin recommended a posture-training support, which has no rigid parts but resembles a low-riding backpack.

Inside the support is a small weight, which was positioned to push Jane’s lower back

toward the left. Because she was driving a lot to check on her husband who was hospitalized, they also provided a support to place under her left buttock to position her spine upwards and to the left while seated in her car.

Two weeks later, Jane returned, dressed fashionably and smiling, with her chiropractor. “When a patient shows up with their doctor, that’s either really good or really bad news,” Meade says. “She came back and she looked completely different.

Actually it was her face. She didn’t have that look of pain on her face. I asked her how she was doing, and she said, ‘I’m getting my life back.’”

Dynamic spinal orthoses can deliver dynamic results by restoring upright posture, which can lead to greater mobility and improved quality of life. Unfortunately, most seniors who could benefit from this treatment don’t receive it because few referring doctors are familiar with these orthoses. As a result, few orthotists are experienced in fitting them, but a dedicated handful of pioneers on both sides of the Atlantic are determined to change that through education of peers and the medical community, as well as peer-reviewed, evidence-based comparative effectiveness research.

FEBRUARY 2012 O&P Almanac

21

Andrew Mills

A Growing Need More than 30 percent of adults over age 60 display scoliosis (Cobb angle ≥ 10°), with women affected more by adult-onset, degenerative scoliosis than men, according to a study published in 2010 in the Journal of Bone and Joint Surgery (British Volume). Significant research shows that the occurrence and progression of scoliosis increases with age and correlates with significant pain due to asymmetric loading, muscle fatigue, poor self image, and reduced social activity.

While osteoporosis rarely causes scoliotic curvatures of the spine, it can exist along with scoliosis in seniors, and it can cause hyperkyphosis, a skeletal deformity resulting in a humped or rounded back. About 10 million Americans suffer from osteoporosis, and 44 million more have low bone density, putting them at risk to

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O&P Almanac FEBRUARY 2012

develop the disease. Low bone density makes corrective spinal surgery very risky, leaving these seniors with medications, physical therapy, and chiropractic and orthotic solutions as the only ways to alleviate pain and restore mobility. If osteoporosis has caused a compression fracture, it can contribute to pain after the fracture heals, due to the resulting deformity.

As baby boomers age, these numbers can only be expected to rise, creating a huge pool of underserved patients, suggests Andrew J. Mills, managing director of the SpineCorporation Ltd. (SpineCor) in Chesterfield, Great Britain. “At a time when orthotists may be worrying where their next patient is coming from, it’s a huge opportunity,” he adds. “But it’s a huge opportunity also from a humanitarian point of view to help large groups of people have an opportunity for quality of life.”

For Gavin and Meade, helping seniors with scoliosis is more than just a job—it’s a passion. Both have treated their own mothers successfully with a brace they developed together called a posterior shell TLSO. Meade sees himself, at age 59, edging toward a time when he might need a brace, too.

“When I walk around a Wal-Mart or a Target,” Gavin says, “I feel relatively ashamed to see so many seniors hunched over a walker, walking slowly and painfully, and having trouble reaching because they have not been able to access this technology.”

A New Generation of Orthoses Traditional rigid spinal orthoses have little place in treating the geriatric spine. They tend to cause further atrophy to the already-compromised spinal muscles and can restrict movement, further reducing mobility.

“The worst thing you can possibly do is to immobilize these patients in any way,” says Mills. “That would weaken them and make them brace-dependent, and in the long term, that’s not good for their degenerative condition.”

The latest generation of spinal orthoses, however, use biomechanics to dynamically change spinal alignment and loading without those side effects. They also are significantly less cumbersome to wear and can bring immediate results. Seniors are easily sold on their benefits, Gavin says: “We all know that the best brace is none at all, so you want to be as close to it as possible in structure and usage.”

The orthosis that helped Jane—the posture-training support (also called a weighted kypho-orthosis)—is one of just two devices effective for osteoporosis, according to evidencebased research. It was developed by a research group led by Mehrsheed Sinaki, MD, in the physical therapy and rehabilitation department of the Mayo Clinic in Rochester, Minnesota.

The weight inside is adjustable up to 2.5 pounds, and the effect is to reduce anterior compression forces and increase back extensor muscle strength.

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AOPA Hosts Idiopathic Scoliosis Symposium at 2012 National Assembly

Jane’s experience is not unusual, Gavin says. He’s fitted thousands of seniors with a posture-training support or with a posterior shell TLSO, a dynamic brace with rigid components he and Meade have been testing and honing for almost two decades. With both, the results often are immediate and striking. “Patients carry their walker out, and they don’t return with it,” he says.

The posterior shell TLSO combines a plastic posterior shell, a soft corset front, and a series of straps for flexibility. For geriatric patients with 15 degrees or less of lordosis (inward curvature) of the lumbar and cervical spine, with decrepit erector spinae muscle origins, the posterior shell TLSO shortens the erector spinae and repositions the patient’s head and shoulders to be erect and behind the pelvis. “It’s designed [to] behave analogous to a posterior leaf spring [in an ankle-foot orthosis], guiding the patient upright into a lumbar fulcrum,” Gavin explains.

Despite using the term “brace,” the Adult SpineCor brace, developed by Mills and his team, does not work like

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O&P Almanac FEBRUARY 2012

The interactive session “Idiopathic Scoliosis: Current Global Management Strategies” will explore the latest evidence-based clinical practices of both conservative and surgical management on September 8 at the 2012 National Assembly in Boston.

The symposium will feature five international experts and include discussion of the biomechanics of correction for adolescent idiopathic scoliosis and how to optimize it using cutting-edge, 3D software and simulation, as well as current surgical techniques, says James H. Wynne, CPO, FAAOP, the sympoJames Wynne sium’s organizer and vice president and director of education for Boston Brace and National Orthotics & Prosthetics Company, its clinical division.

The speakers and topics include the following: • Dr. John Emans, MD, orthopedic surgery, Harvard Medical School and Children’s Hospital, Boston—surgical techniques and developments • Dr. Manual Rigo, MD, developer of the Rigo/Cheneau Orthosis, Instituto Èlena Salvá, Spain—evolution of brace principles and designs, using a better understanding of the 3D nature of idiopathic scoliosis • Dr. Carl-Eric Aubin, PhD, Department of Biomedical Engineering, École Polytechnique & CHU, Sainte Justine—the biomechanics of scoliosis correction and how to optimize it using advanced 3D software and simulation • Thomas McPartland, MD, Pediatric Orthopedic Associates, East Brunswick, New Jersey—developing a successful scoliosis clinic outside of the hospital.

“Boston Brace is excited to welcome AOPA and all attendees to our city,” Wynne says. “We thought it appropriate to organize a scoliosis symposium in the birthplace of the Boston System for scoliosis and to help celebrate our 40 years of service.”

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Managing Treatment It’s technically easy to construct orthoses for the geriatric spine, but clinical management remains challenging—you can’t just put braces on patients and send them on their way, says Tom Gavin, CO, a Chicago-based orthotist at Hanger Prosthetics and Orthotics and one of the field’s leading experts on geriatric spine management.

He estimates that 10 percent of fitting is technical, but 90 percent is clinical.

The new dynamic, flexible braces deliver dramatic results, but they also require significant customization for particular patients, Gavin says. Seniors, who must be convinced even to consider a cane or wheelchair, may be reluctant to wear what they see as rigid cages on their bodies. The patient or caregiver also needs to be taught how to put on the orthotic and to understand how it works, what goals might be achieved, and what activities and exercises can enhance its efficacy, adds Andrew J. Mills of Great Britain’s The SpineCorporation.

“The brace won’t necessarily magically retrain the posture,” Mills explains.

“Part of the job that an orthotist undertakes is to instruct the patient in exactly how they must use the orthosis and manage their patient’s treatment to gain the desired results.”

Often the solution may turn out to be a relatively simple one, but it takes time to get the information you need, says Kevin P. Meade, a professor of mechanical engineering at the Illinois Institute of Technology and frequent collaborator with Gavin. “If I just asked what kind of activity relieved [a patient’s] pain, she might not be able to tell me,” he adds. “It’s about developing a relationship with a patient and then at some point, they will tell you.”

Home situation and other health factors also come into play, Gavin says.

“If you have someone who has Alzheimer’s or is depressed or someone who has no help to put this device on and help wean them into it, it is going to fail,” he adds. When he was 22, despite being an avid runner and weightlifter, when he had a spinal injury himself, he needed help putting on his own brace.

In the case of the posterior shell TLSO, Gavin recommends the patient wear it full-time from getting out of bed in the morning to bedtime at night for four months. After that, the patient can wear it as needed, but because by that time the patient has seen the benefits, only a few take it off completely, he says. “It’s appealing to them to go part-time with the brace, but most folks know which activities cause them fatigue or pain,” Gavin says. “I recommend that they put the brace on before the activity.”

One piece of good news, he adds, is that lack of adequate Medicare/ insurance reimbursement is not prohibitive when it comes to taking the time to customize an orthosis for the patient.

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O&P Almanac FEBRUARY 2012

a traditional brace, Mills says. “It’s better described as a rehabilitation tool the patient is using to give themselves physical therapy while going through their normal activities of daily living,” he adds.

Originally developed to adjust loading to manipulate spinal growth in pediatric patients, the orthosis applies the same principles to reduce pain and relieve pathological spinal loading in adults. Studies have shown that the magnitude of the curve and its origin— whether idiopathic or adult-onset—is less important than sagittal and coronal balance. The flexible, lightweight structure resembles and is worn like a garment with four corrective bands that can be positioned in 12 different ways to adjust and balance loads.

“What the brace is trying to do is to move different segments of the body in different directions,” Mills explains.

After X-rays and assessment, a software program helps customize the fit to a particular patient’s needs.

However, the orthotist still requires significant training to fit the patient and optimize band tensions.

Educating Referral Sources Despite being available for years, the orthoses that Gavin, Meade, Mills, and Sinaki recommend are not well known throughout the orthotic profession—and even less so in other medical professions. Meade recalls a

Thomas M. Gavin, CO

recent conversation with a geriatrician who had never heard of treating senior back pain and scoliosis with a posture training support, although he had many patients with those conditions.

Part of the problem is that seniors may see a variety of specialists, general practitioners, geriatricians, or rheumatologists, but only orthopedists and podiatrists are likely to be familiar with orthotic solutions. And even they may not equate orthotics with spinal relief, Gavin says. If orthotists want to receive more geriatric spinal referrals, they need to educate their medical peers about what orthoses can do, he adds.

One of the best ways to prove that orthoses work is by example. In the case of Jane’s chiropractor, he came to her appointment because he was interested in finding out how a pair of orthotists had fixed a problem he had been treating for so many years and

open to alternatives, Meade says.

Gavin likewise cites a doctor who was convinced he could not help a heart-lung transplant patient who was sitting on the back of her sacrum in a wheelchair. “I turned to him and said that my last 600 patients had walked just fine,” Gavin says. After Gavin fitted the woman with a posterior TLSO, she left using a walker, with her daughter carrying the wheelchair.

In England, Mills has found that orthopedic surgeons who are familiar with bracing are positive about it because of the high risk of surgical failures in adults. “Ultimately, they feel a lot more comfortable in embarking on risky spinal surgery if all other treatment strategies have been tried first,” he says. “We’ve found that [bracing has] been well-received by spinal surgeons for this very reason.

The attitudes of surgeons to bracing in pediatrics is not such a positive one.

Many simply remained unconvinced of the benefits of bracing and prefer to go straight to surgery.”

Promising Future Research Gaining wide acceptance in the medical community, however, takes more than anecdotal results. The only solution is peer-reviewed, evidence-based research comparing patient outcomes between dynamic bracing and medication, surgery, physical therapy, and other alternatives, Gavin says. To that end, both Hanger and SpineCor are embarking on studies they hope will lead to greater awareness among medical professionals.

Starting this year, Gavin will be assessing various quality-of-life measures between senior patients at Hanger who wear a posterior shell TLSO and others with similar complaints who wear no orthosis. The plan is to identify study participants this year and begin results analysis in 2013. He’ll be speaking that year on the geriatric spine at the 14th World Congress of the International Society for Prosthetics and Orthotics in Hyderabad, India.

FEBRUARY 2012 O&P Almanac

27

SpineCor is in the final stages of launching its own two-year randomized control trial on the adult SpineCor brace. In 2012, it plans to enroll 150-160 scoliosis patients seen by two groups of spinal surgeons. The participants will be divided into two cohorts: One will receive the SpineCor brace and the other will not.

The main outcome metrics will be pain scores and quality-of-life questionnaires, but what will set this trial apart are detailed measurements taken of the coronal and sagittal planes using X-rays both before and after bracing to determine the relationship between those measurements and pain reductions, Mills says.

“The geriatric spine, despite significant degenerative changes, can still be mobile enough to make positive changes,” he says. “Something that nobody has attempted is to try to quantify this. Previously, only global coronal and sagittal balance changes have been measured. We intend to study also regional spinal balance, [of] the thoracic and lumbar segments independently, to 28

O&P Almanac FEBRUARY 2012

understand which of those is more important to reducing pain.”

Originally, Mills had hoped to complete a three-cohort study, including a group of patients who would receive physical therapy.

However, that piece was eliminated due to logistics and a lack of enthusiasm by the surgeon study partners, who generally are skeptical of physical therapy as an effective treatment for scoliosis pain.

Mills, however, firmly believes that physical therapy combined with bracing improves outcomes. Patients treated with the SpineCor brace are taught to make corrective movements as a routine part of the brace-fitting process. A complementary physical therapy program reinforces this corrective movement, possibly helping produce greater postural corrections sooner and consolidating corrections. Such a program can reduce the required time for wearing the brace, facilitate potentially better outcomes, and have a longer-lasting effect.

The benefits of strengthening back extensor muscles for seniors with

spinal problems and osteoporosis is also supported by numerous studies by the Mayo Clinic’s Sinaki. While her research does not necessarily explore physical therapy and exercise in conjunction with an orthosis, her findings consistently support their ability to improve or maintain lumbar lordosis or to reduce fracture risk.

“If mobility can be increased by improving balance, we can more successfully improve strength and general health,” Sinaki and her fellow researchers stated in a 2005 article in the Mayo Clinic Proceedings about the efficacy of posture training support. “Muscle strength and bone mass can increase with mobility and safe weight-bearing exercises.”

The new devices and treatment options have great potential for pain relief, but perhaps the most powerful benefit remains a return to physical activity, which has been shown to improve quality and length of life.

About two million osteoporosisrelated fractures occur in the United States each year, according to the National Osteoporosis Foundation, and vertebral fractures are the most common, averaging about 750,000 annually. Like hip fractures, vertebral fractures often lead to significant loss of quality of life and higher five-year mortality rates, including up to 15 percent in one often-cited 1993 study.

A sedentary lifestyle with little physical activity has been found to be one of the leading causes of preventable death, increasing mortality in male seniors by 28 percent and doubling the risk in female seniors, according to a sweeping 10-year study of nearly 10,000 seniors by Australian researchers published in Jan. 27, 2010, in the Journal of the American Geriatric Society.

But with dynamic bracing and physical therapy, seniors like Jane can go on to live pain-free, active lives. a Anya Martin is a contributing writer for O&P Almanac. Reach her at anya99@ mindspring.com.

HYNES CO NVENTI O N CENT ER , B O S T O N

Mark your calendar to attend the country’s largest, oldest, and essential meeting for orthotic, prosthetic, and pedorthic professionals.

S AV E T H E D AT E For information about the show, scan the QR code above with a code reader on your smartphone or simply visit www.AOPAnet.org.

The

e c a l P e!

To B

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SEPTEMBER

6-9, 2012

Join us at the AOPA 2012 National Assembly and NE Chapter combined meeting at the Hynes Convention Center in Boston. The Place to Be for learning, networking, and exhibits.

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Superior Clinical Education featuring the best speakers from around the world

• • •

Largest Display of O&P exhibits in the United States

Advanced Business Programs to ensure your success during uncertain economic times Practical Learning and live demonstrations Networking with an elite and influential group of O&P professionals Preparation for the massive changes that health care reform is sure to bring Learn the latest rules, regulations, and Medicare billing changes needed to serve your patients Earn more than 34 CE Credits Ideal Location in the heart of one of America’s most historic cities.

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ate ★

e the D ★ Sav

By Brian L. Gustin, CP, BA

The Case for

Adaptation In this first of a two-part series, AOPA past president discusses ACOs and what they mean for the O&P profession

L

et me set the stage. The year is 2008. The country is in the middle of a heated presidential campaign in which “hope” and “change” are the buzzwords. Then, in September, the global financial giants Lehman Brothers and AIG change the meaning of “hope” and “change” when they become insolvent and are considered too big to fail.

Suddenly, in a matter of weeks, the financial markets are turned upsidedown. The stock market plunges, businesses default on loans, and the unemployment rate soars to the double digits. Millions of homeowners find themselves underwater in homes they can no longer afford and cannot sell.

Fast forward to today. The financial markets here and across the globe have convulsed and, in some cases, collapsed (see Greece). Our government needs to do something to cut costs, and health care is a major cost center with no slow down in sight.

Many O&P facilities have experienced an audit from one agency or another during the past year, and increased regulations are making provision of our services more difficult and time consuming.

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O&P Almanac FEBRUARY 2012

If we take a dispassionate view of O&P, however, the provision of care has actually become much easier over time. From prefabricated component parts made from a variety of materials to CAD-CAM systems, much has been done to standardize the design and fabrication of O&P devices. No longer do we make feet, carve sockets, or pound out joints or sidebars. Instead we purchase feet, knees, and complete devices custom-made to specific measurements. Not so long ago, what differentiated one practitioner from another was the ability to “make” a device that fit a patient better. Now, however, with so many prefabricated component parts and sophisticated CAD systems, the skill of making a device takes on less importance because everyone has access to the same components and design systems.

Those who continue to believe in the status quo will argue that the making of a device is still what makes them special. Unfortunately, they will fade away, much like the independent physician practice. However, those who see opportunity and recognize the changing nature of health-care delivery will recognize the value of time spent building relationships of trust with key players, such as health-care administrators and payers, showing them the value of O&P in reducing the overall

cost to treat a patient. These O&P professionals will flourish and prosper in the age of the Accountable Care Organization (ACO) environment.

Understanding the ACO Model Several factors have caused the massive spending on health care in the United States and are driving adoption of the new ACO model of comprehensive health-care delivery.

One reason is that the entire healthcare marketplace—including O&P—is fragmented. Health care, despite the claim of being scientific, is artisanal in nature. Two different patients with the same diagnosis, who are seen by two different physicians or practitioners, will often travel two distinctly different treatment paths and have two distinctly different costs and outcomes even within the same office or system.

In response to this and other drivers, the Patient Protection and Affordable Care Act (PPACA) of 2010 allows for the formation of ACOs, which, essentially, are an effort to integrate local physicians, hospitals, and payers in the health-care system by rewarding them for controlling costs (that is, reimbursements) while improving outcomes.

Importantly, an ACO must be willing to be accountable for the quality, cost, and overall care of the Medicare fee-forservice beneficiaries assigned to it. The ACO concept is certainly not new, and many question whether it is simply another addition to the alphabet soup of health-care model acronyms, such as HMO, PPO, PHO, and IPA. What makes the ACO different, however, is the degree of flexibility afforded in its structure and payment methodology and the degree of risk assumed by the ACO. Presumably, this flexibility will garner a greater degree of buy-in from the physician groups. The question is, does O&P get brought in or is it left out?

The drafters of PPACA had proposed a threshold of payments—the strategy— to ACOs (and if you are thinking this sounds like capitation, you would be correct). However, the PPACA has said the ACO can determine how to achieve

With so many prefabricated component parts and sophisticated CAD systems, the skill of making a device takes on less importance because everyone has access to the same components and design systems. the cost and quality expectations—the tactics. The providers—hospitals and payers—can, within their local markets, design a system that works for them.

So, not all ACOs will look and act the same, but every ACO should contain a minimum of primary-care physicians, specialists, and a hospital and must have a minimum of 5,000 lives under care.

While PPACA allows for various types of organizations to form an ACO, the reality is that an, the ACO needs to be large enough to administer payments. It also must be able to agree on how to measure quality and distribute payments and penalties.

Successful ACOs, then, will need an infrastructure that provides leadership in organizational governance, along with a culture that promotes administrative and clinical effectiveness.

In considering the factors necessary for success, policymakers looked at what already existed within every local market. What they discovered was a system of informal virtual networks made up of disparate providers, sometimes referred to as an “extended hospital medical staff organization,” or HMSO. The ACO structure is an incentive to the local HMSO to control costs (reimbursements).

To help drive acceptance, the policy does not establish a national benchmark; instead, each ACO’s benchmark is determined by the level of expenditures during the previous three years for Part A and Part B services for the Medicare beneficiaries assigned to the ACO. The ACO must have a process by which it reviews its own work and outcomes. This allows for regional differences in treatment protocols, which begins to solve the fragmentation of care on a local or regional level, but it does not stipulate national practice standards. As the results of each ACO are compared to those of other ACOs, however, pressure will be applied for ACOs that rank behind the others to change their protocols.

But the real traction toward the ACO model took hold when the Medicare Payment Advisory Commission (MedPAC) recommended the ACO model as a viable means to rein in Medicare spending in its 2009 “Report to the Congress: Improving Incentives in the Medicare Program.” (The entire report is available online at www.medpac. gov/documents/ Jun09_EntireReport.pdf.)

CMS’ Pioneer ACO Model began in January 2012 as a Medicare demonstration project of 32 pioneer ACOs and will see widespread implementation in 2014 if successful (see side bar).

Providers such as O&P can participate along with an ACO as an outside entity if they conform to the standards of the ACO, primarily those that relate to the primary function of the ACO to control cost and improve quality.

Unfortunately O&P has little, if any, statistical evidence of its effect on the quality of outcomes in an integrated care system and has shown an inability to control internal costs as evidenced by the AOPA Operating and Performance Survey over recent years. The O&P industry has become less profitable despite the fact that reimbursements have increased on average 3.75 percent year-over-year since 2006.

From 2006-2009, net profits have declined 0.9 percent, and return on net worth—a measure of profitability from a shareholder’s perspective—has FEBRUARY 2012 O&P Almanac

31

The Beginning: 2012 The Pioneer ACO Model began in January as a Medicare demonstration project that will see widespread implementation if successful. While the Pioneer ACO Model initiative contains specific requirements for participation, there are some general ACO program considerations. According to the MedPAC report, an ACO should: • be composed of a minimum of 5,000 patients so that improvement can be measured reliably • be held to a fixed dollar-spending target in advance • have a formal organization and structure that allows ACOs to make joint decisions on capacity • have both private and public payers to ensure that physician incentives are uniform across the payer mix • either be voluntary, wherein high performance is rewarded with bonuses for quality and cost control, in which case Med PAC acknowledges that fee-for-service rates need to be constrained to reduce overall spending; or be mandatory, wherein overall spending is reduced with bonuses for quality or cost targets, or a mandatory organization where both bonuses and penalties are applied.

Additionally, the ACO must be capable of demonstrating these seven competencies: 1. define processes to promote care quality, report on costs, and coordinate care 2. develop a management and leadership structure for decision making 3. develop a formal legal structure that allows the organization to receive/ distribute bonuses to participating providers 4. include the primary-care providers of at least 5,000 Medicare beneficiaries 5. provide CMS with a list of participating providers and specialists 6. have contracts in place with a core group of specialist physicians 7. participate for a minimum of three years.

Although any group of providers can become an ACO that meets these criteria, four primary categories of providers have the potential to manage the ACO model successfully: 1. Integrated Health Systems, primarily made up of physicians, a hospital, and a payer organization 2. Multi-Specialty Groups, comprising various physician types 3. Independent Practice Associations, essentially a messenger model of independent physician groups that collaborate on administrative tasks common to all 4. Physician-Hospital Organizations

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declined 7.8 percent. This is telling because the net profits ratio is one of the most important measures of how well a company’s resources are being used. Similarly, return on assets, a measure of a how efficiently management uses its assets to generate earnings, increased only 1.9 percent over the same time period.

These basic business facts do not bode well for most in the O&P industry as we enter into a brave new world of health care. But only those who are willing to set aside their emotion and beliefs, cast off the doctrine that has become dogma, and base decisions on facts will be able to take advantage of the ACO opportunity during the next two years.

ACOs and O&P The ACO model will put the physician reimbursement methodology of fee-for-service at risk, but the physicians get to control their reimbursements, with some strings attached to quality and reporting. So to mitigate some of the perceived risk, physicians will look for other ways to generate revenue to offset the revenue that might be lost if they do not meet their quality targets.

An additional factor is the intense debate on how Congress will deal with the Sustainable Growth Rate (SGR), better known as the “Doc Fix.” At the time of this writing, Congress had not passed any permanent legislation to avert a 27.4 percent cut to the Medicare reimbursements of all physicians.

Also, if the ACO model proves to be successful in slowing or decreasing overall health-care spending, payment methodology may evolve to bundled payments, which could have a devastating impact on O&P. Notably, CMS introduced in August 2011 a Bundled Payments Initiative Demonstration project, which is separate from any of the ACO program initiatives. It is also possible the bundled payment concepts could be applied to ACOs. For example, for a given diagnosis, the ACO will be paid a set amount to provide all care, including ancillary services, for that patient. But the ACO has little incentive

to refer that patient outside of its direct quality and cost control; if the ACO is going to receive a bundled payment for a person who has spinal surgery and needs an orthosis, why would the ACO manager send those dollars to an outside O&P facility?

Technology is making our work more productive and effective, and O&P devices have become easier for others to attain. Consequently, we must show our value not through how well we “make” a device, but rather through our service and knowledge of treatment options that best serve the patient.

Creating Change To make this switch to a more patient-orientated delivery model, the adaptable O&P operation first needs to understand how a health-care system operates in the age of reimbursement compression and increased emphasis on comparative effectiveness. O&P is, and has been, a workplace where operations evolved over time, but we need to evolve into a designed system where they are planned. We have a lot of bright, talented, and hard-working people who do their best every day.

What we are trying to achieve is a system designed to allow those people to work at their maximum efficiency every day.

By comparing the characteristics of a workplace to those of an integrated, designed system, the need to create better, more efficient operations is revealed. Work done in the workplace often evolves over time and becomes tradition. These traditions change little but have not necessarily been designed.

To design a system, we must determine what we are trying to achieve and then design a system to accommodate those goals.

A workplace is often organized around tasks with accompanying obstacles. Even if we are adept at avoiding the obstacles and getting on with our work, we lack the constructive dissatisfaction that would allow us to design proper processes.

Constructive dissatisfaction with tasks not only allows us to dodge obstacles to get to our next task, it also says

that if there is an obstacle within our process, we have to fix the process.

In an O&P facility, work must be related to many disciplines to carry out the necessary functions—administrative, technical, clinical, purchasing, technical support, and customer relations. In a designed system, this work needs to be coordinated to interrelate in a particular manner. We need a designed way in which patient information is collected and disseminated to the practitioner staff; a designed way in which practitioners conduct patient evaluations and record data; and a designed way in which technical information is disseminated to in-house or outsourced fabrication centers. These processes must be defined and coordinated; the design must be written.

In a workplace, our tasks often evolve out of habits. In a designed system, our work comes out of standards that are well defined for efficiency. Rather than doing something simply because it is the way we have always done it, we do it because we have defined a standard and practice to this standard.

In a workplace, we understand work and outcomes in terms of perceptions (“I think the care we give is great.” or “We believe if only qualified providers are allowed to access the coding system, fraud would be reduced.”) But in a designed system, we grade our level of performance through measurement. (How do we know if we got better or worse this year over last year? How many visits does it take to deliver a particular service or device, practitioner by practitioner, team by team, and collectively as an organization, as an industry?) We have to measure these outcomes to improve our processes so we are functioning on fact rather than perception.

In a workplace, work changes over time by simply adapting to the next incentive or regulation. In a designed system that is working well, on the other hand, people are constantly learning—not based on perceptions and habits, but based on standards and measurements.

The last, and most important, part of changing our culture is recognizing the patient’s role— the patient’s voice— in how the system is ultimately designed.

To achieve the characteristics of a well-designed system, many changes will be needed, including a new workplace culture. Most O&P organizations have a strong culture in which they try to treat patients as if they were family members; we do not want to lose this. A designed system also has a culture, but how we arrive at is different, as is the language of the culture. We think we can achieve our goals in a designed system more efficiently than in a workplace.

Changing a culture is not an intervention, but the outcome of many interventions, which we are trying to introduce. A big part of the change is first learning to recognize how our processes can be better, then trying to create designed systems of care. This is how we think we can get better results for less cost, less suffering, and less dissatisfaction.

The last, and most important, part of changing our culture is recognizing the patient’s role—the patient’s voice—in how the system is ultimately designed. If we do not listen to our patients, we may design a system that falters because it does not have the right culture. a Brian L. Gustin, CP, BA, a past president of AOPA, is vice president, clinical research and payer relations at iWalk Inc. in Green Bay, Wisconsin. Reach him at bgustin@iwalk.com.

Editor’s Note: Watch for the March issue of O&P Almanac in which Gustin explains ACOs’ effect on O&P costs of delivering care.

FEBRUARY 2012 O&P Almanac

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Facility Spotlight

Reprinted with permission from the O&P Almanac published by the American Orthotic and Prosthetic Association

By Deborah Conn

Experience to Count On At C.H. Martin Co., four generations of one family have been providing O&P services for a full century

The downtown Atlanta location that is still in operation today

Facility: C.H Martin Co.

Location:

10 offices throughout Georgia

Owner:

George and Walter Counts

HISTORY:

100 years in business

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O&P Almanac FEBRUARY 2012

T

he C.H. Martin Company, which celebrates its centennial this year, can trace its beginnings back to Germany and a good deed.

George Martin was a German brace maker in Tuttlingen, Bavaria. One of his employees had immigrated to the United States around the turn of the 20th century, and in the early 1900s, that man’s widow wrote to Martin asking for help.

Her husband had designed an orthopedic instrument for his U.S. employer, but the company was refusing to pay the widow for his work.

The woman knew that her husband had sketched the device on a wooden pencil box still in Germany, and she asked Martin to testify on her behalf.

George’s son, Christian Hubert Martin, volunteered to bring the pencil

box to America. His testimony was so impressive that not only did the widow win her case, but the company she had sued offered Martin a job.

Martin declined, but he stayed in the United States and went to work for a rival. Eventually, at the instigation of an Atlanta physician, C.H. Martin started his own company. His first offices, located in his new home in Atlanta, opened in 1912, and in 1926 the business moved to the downtown building that still houses the company’s headquarters.

C. H. Martin had five children, three of whom survived into adulthood.

His daughter Irma married George B. Counts in 1934, and their two sons, George, 74, and Walter, 70, are now the president and vice president, respectively, of C.H. Martin Co.

Technicians fabricate custom metal bracing

George Counts Sr. with a polio patient

A fourth generation has entered the business as well: Walter’s son, Neal Counts, CO, and George’s sons, Martin Counts, CP, and Wesley Counts, an orthotic technician.

Today, C.H. Martin Co. has 10 offices throughout Georgia, with 62 employees, including 20 practitioners, three residents, 13 technicians, and 26 administrative staff members.

Reputation and Relationships Thanks to its long history, the company offers expertise that can be hard to find elsewhere, even though it may account for a small percentage of its overall business.

“When Wesley graduated from high school, a lot of the old guard were still working here,” explains Neal Counts.

“He acquired a deep knowledge of metal bracing, and people came to us because they could never find another company that knew how to work with metal braces.

“Even today, we have post-polio patients and others who would rather use original materials than the more advanced, lightweight braces now available,” he says. “They like the weight of the brace and the way it acts as a pendulum in advancing their leg. It makes them feel more stable.

Some are reluctant even to move from stainless steel to aluminum.”

The center of the original building once held huge drop hammers that

Leather work department

stamped out metal parts. Used mostly for storage today, the area also accommodates a room for pouring casts and two grinders for polishing and smoothing metal. The Counts added an extension to the building where more modern fabrication takes place.

The company’s patients come from all demographic groups, according to Neal Counts, and include many pediatric cases and patients with spinal cord injuries and neurological impairment. The business relies on its reputation and relationships with doctors and therapists to remain competitive.

Dedicated Staff

10, they are all so dedicated and work long hours to make sure we stay on top of things,” he says. “Treating patients, dealing with Medicare and insurance claims, doing what we need for accreditation—they all work so hard.

We have very little turnover, and I think that has helped us stay consistent throughout all these years.”

As for the future, Neal Counts is not anticipating any more expansion for the time being. “The way the economic climate has evolved,” he says, “we just try to be as efficient as we can and keep costs down.”

One cost that won’t be eliminated, however, is a big party this year to celebrate 100 years of O&P service. a

Counts credits the company’s employees for its success.

“Whether people have been with us for more than 20 years or for less than

Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@ cox.net.

FEBRUARY 2012 O&P Almanac

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AOPA Headlines AOPA WORKING FOR YOu

21 and Counting Important accomplishments AOPA has achieved in 2011

8. Published AOPA’s first FDA Compliance Manual to assist members facing increased FDA scrutiny.

9. Conducted a full-court press for an entire year that resulted in HHS/CMS including O&P as components that should be part of any health insurance plan recognized under the health-care reform law and its insurance exchanges.

10. Developed and released

T

he O&P industry continues to place a high value on AOPA membership, and the end of 2011 marked one of the most successful membership renewal periods in the organization’s history. But that’s only part of the story. The past year was filled with important accomplishments the organization made on behalf of its members and the O&P industry.

Here’s a look back at some of those top achievements.

1. Conducted a successful Policy Forum amidst government shutdown threats. As a result, more than 400 AOPA members visited their Congressional representatives to discuss O&P issues, which contributed to no O&P fee reductions and a 2.4 percent fee increase for 2012.

2. Concluded a new 11-year headquarters lease reducing AOPA’s rent and freeing up more than $1 million for member benefits over the lease term.

3. Awarded AOPA’s first grant for comparative effectiveness research—$150,000 (majority funded by five foot manufacturers)—to the British Columbia Institute of Technology to compare 38

O&P Almanac FEBRUARY 2012

performance of dynamic to non-dynamic prosthetic feet.

4. Awarded AOPA’s second grant for comparative effectiveness research—$250,000 (majority funded by four prosthetic knee manufacturers)—to the University of Pittsburgh to compare performance of microprocessor to non-microprocessor prosthetic knees.

5. Worked with AOPA lobbyist, Linchpin Strategies LLC, to secure language in the Department of Veteran Affairs’ appropriation bill underscoring the importance of funding O&P master’s degree programs and patient-oriented outcomes research.

6. Succeeded in assuring off-theshelf orthotics were not included in Round 2 of CMS competitive bidding.

7. Met with IRS and the Department of Treasury officials in February to set forth the legal justification for exclusion of both O&P patientcare facilities and manufacturers from the 2.3% Medical Device Excise Tax.

AOPA’s first-ever public service announcement, urging retention of full O&P benefits under Medicaid, which ultimately aired to an audience of 136 million viewers nationwide and had an ad buy value of $1.5 million.

11. Together with the O&P Alliance, the Amputee Coalition, and the American Medical Association, coordinated meetings with CMS officials and led efforts to discount the Office of Inspector General’s report on lower-limb prosthetics and its unfounded allegations of fraud and unrealistic demands relating to greater insurance physician documentation.

12. Conducted the first-ever Manufacturers’ Coding Seminar in July to assist AOPA members in preparing and filing coding applications.

13. Commissioned a study by the Society for Human Resource Management to determine the prevalence of the O&P benefits in major and small employer health plans. Results showed 75 percent prevalence, more than 25 percent higher than the Department of Labor had stated in its errant report.

14. In conjunction with the Amputee Coalition, initiated the first cost-effectiveness study of O&P care, working with research firm Dobson-Davanzo and securing authorization from CMS to draw on comprehensive Medicare patient data. Although the study is not completed, preliminary results indicate distinctive cost savings among patients who receive lower-limb orthotics, and perhaps other categories of care, compared to patients who do not receive such care.

and regulations and how they impact O&P manufacturers and patient-care facilities.

20. Continued advocacy across a full range of legislative issues, including Medicare fees, the Medicare O&P Improvements Act, the Insurance Fairness Act for Amputees, the Veterans O&P

Bill of Rights, and all regulations implementing the federal healthcare reform law.

21. Worked with the O&P Alliance to challenge CMS’ decisions on the addition and deletion of L-codes, citing the absence of fair procedures and due process in its decision-making process. a

15. Supported successful efforts in Nevada, Washington, Texas, and Minnesota to fight state efforts to deny Medicaid and other insurance coverage to certain subsets of O&P patients. Similar efforts are in progress in Arizona and Oregon.

16. Prepared timely, detailed, and accurate information explaining accountable care organizations’ (ACOs) regulations and the potential impact of ACOs on O&P providers.

17. Challenged new initiatives by the VA to undertake major changes in its reimbursement model and payment system for O&P.

18. Presented legal challenge, supported by two legal opinions, questioning the statutory authority for CMS and PDAC to issue labeling rules for O&P devices when only FDA has been authorized by Congress to write those rules. CMS and PDAC announced on Jan. 30, 2012, that the requirement was rescinded.

19. Set the stage for the first AOPA FDA Compliance Educational Workshop on Feb. 24, 2012. FDA experts will answer members’ questions about FDA inspections

FEBRUARY 2012 O&P Almanac

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AOPA Headlines

2012 National Assembly Call for Papers and Poster Presentations AOPA has issued a call for papers and poster presentations for the 95th annual AOPA National Assembly, September 6-9 in Boston.

Practitioners interested in presenting should submit an abstract of their proposed clinical or business paper.

Poster presentations should be graphical displays of research findings or a case study in a poster format using photographs, diagrams, flowcharts, graphs, and any sample educational materials.

Presentations will be selected by the AOPA Assembly Program Committee, and selected presenters will receive a complimentary full-conference registration for the 2012 AOPA National Assembly.

Applications will be accepted until July 1. For more information, contact Tina Moran at tmoran@AOPAnet.org or 571/431-0808.

Now Avail able 2012 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2012 Products & Services Catalog is available at www.AOPAnet.org/2012_ProductCatalogue.pdf.

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O&P Almanac FEBRUARY 2012

AOPA Accepting Membership Sales Proposals AOPA is now accepting proposals for collaboration in expanding the membership and sale of AOPA products, including publications and seminars.

Every organization should continually search for ways to develop and expand its membership base. AOPA’s current membership is approximately 900 companies and suppliers that operate 2,037 affiliated locations. Of those members, 750 are patient-care companies, and AOPA seeks to expand its patient-care membership to a minimum of 1,500 companies operating 3,000 affiliated locations.

Proposals should include the following: • specific products or services the submitter would market (Products and Services Catalogue available upon request) in addition to AOPA membership • proposed method(s) of marketing AOPA membership and products • expected commitment of submitter’s resources • expected commission rate on membership, products, and seminar sales • estimated time frame for activity, including sales goals for memberships, products, or seminars • expected support needed from AOPA, such as any AOPA staff responsibilities.

Submissions must comply with the following ground rules: • AOPA’s Board of Directors will consider proposals submitted at its regular meetings beginning in January 2012.

• Timing of submission is at the discretion of the submitter.

• Such arrangements will not be exclusive to any single party.

• AOPA’s Board will act on each proposal as soon as possible after submission.

• Action on any proposal will not preclude consideration of concurrent or subsequent proposals submitted.

• Action on any proposal is at the sole discretion of AOPA and not subject to external review. AOPA reserves the right to decline to accept any and all proposals or accept more than one proposal.

Submissions should be emailed to info@AOPAnet.org with a subject line “Growth Proposal.”

AFO/KAFO Policy— What You Need To Know Learn how to meet new Medicare supplier standards and why it’s an important part of your business operation. On March 14, an AOPA expert will discuss why obtaining Medicare reimbursement for AFOs and KAFOs can be a challenging and frustrating experience during an AOPAversity Mastering Medicare Audio Conference. The session will focus on the nuances of AFO/KAFO LCD and Policy Article and help you better understand the rules. Attendees will learn the following: • what documentation must exist in order to use the KX modifier on your claim • what the coverage rules are for AFOs with ambulatory versus nonambulatory patients • how to bill for repairs to AFOs and KAFOs. The cost of participating is $99 for AOPA members ($199 for nonmembers) and any number of employees may

Don’t Miss the 2012 AOPA Policy Forum The 2012 AOPA Policy Forum will be held Tuesday and Wednesday, April 17-18, at the L’Enfant Plaza Hotel in Washington, D.C. This event will provide attendees with up-to-date briefings from key congressional lawmakers, the AOPA lobbying team, and other experts about critical issues confronting the O&P community.

Further guidance on how to use this information effectively in lobbying members of Congress will conclude the first day. The Tuesday evening reception and dinner will offer a terrific networking and further learning experience. The meeting will culminate on Wednesday with advocacy visits with your elected representatives and their staff on Capitol Hill. AOPA’s staff and lobbyists will schedule these meetings for you.

The attendance fee is $125. Register online here https://aopa.wufoo.com/forms/2012-policy-forum/.

Contact AOPA’s director of regulatory affairs, Catherine Graf, with questions at cgraf@aopanet.org or 571/431-0807.

listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent.

Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0876 with registration questions.

2012 FDA Compliance Workshop Join AOPA on February 24 at the Sheraton Inner Harbor in Baltimore for an exclusive one-day seminar examining the compliance policies required of the O&P industry by the U.S. Food and Drug Administration (FDA).

Regulatory compliance awareness is important because regulatory agencies are legally entitled to conduct unannounced inspections if they believe there are suitable grounds for doing so. Regulatory compliance training is needed, so your organization can comply with FDA regulations that apply to manufacturing and distributing practices; medical devices and device classification; and forms, fees, and contacts. Penalties—ranging from fines to product recall—are severe if your company is in noncompliance.

AOPA is offering this compliance training in the wake of reports from members of increased FDA security. A major interest is whether FDA good manufacturing practices applies to O&P patient-care facilities, especially those with central fabrication companies.

Register online at https://aopa.wufoo.com/forms/2012-fdacompliance-workshop-baltimore/ or contact Steve Custer at scuster@AOPAnet.org with questions.

FEBRUARY 2012 O&P Almanac

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AOPA Headlines

Special Thanks to the 2011 O&P PAC Contributors AOPA would like to thank the following individuals for their contributions in 2011 to the O&P PAC:

PRESIDENT’S CIRCLE ($1,000-$5,000)

SENATOR’S TABLE ($500-$999)

CHAIRMAN’S TABLE ($100-$499)

Michael J. Allen, CPO, FAAOP Robert Arbogast Rudy B. Becker III Kel M. Bergmann, CPO Frank Bostock, CO Marty Carlson, CPO Ronald Cheney, CPO Lesley DiBello Thomas DiBello, CO, LO, FAAOP Mike Fenner, CPO, BOCPO, LPO Thomas J. Fise, JD Rick Fleetwood, MPA Steven Q. Foy, CPO Richard Gingras, CPO Russell J. Hornfisher James Hughes, CP, LP James A. Kaiser, CP Thomas F. Kirk, PhD Alfred E. Kritter, CPO, FAAOP Harry Layton, CPO, LP Jon Leimkuehler, CPO Mark Maguire, CPO Stephen Rinko, BS, CPO John A. Roberts, CPO Brad Ruhl William Sampson, CP Terry L. Shaw, CPO, BOCPO, FAAOP Frank Eugene Snell, CPO, LPO, FAAOP Ted Snell, CP William Clint Snell, CPO Rick Stapleton, CPO H.E. Thranhardt, CPO (E) Loretta Thranhardt Bernie Veldman, CO Pamela S. Veldman Thomas Watson, CP

Robert N. Brown Sr., CPO, FAAOP Maynard Carkhuff Doyle Collier, CP Glenn Crumpton, CPO, C.Ped Thomas E. Dalsey Edward DeLatorre Frank Friddle Jr., CO Ed Gildehaus III, CPO, C.Ped, FAAOP Michael E. Hamontree Sam E. Hamontree, CP Steve Hamontree, CPO Don Hardin Bert Harman Mo Kenney, CPO, FAAOP Ellen Leimkuehler Robert V. Leimkuehler, CPO William Leimkuehler, CPO Eileen Levis Ted Muilenburg, CP Lana Nassan Ralph Nobbe, CPO Tom Padilla, CPO Rodney M. Pang, CPO Ronald W. Pawlowski, CPO Frank M. Vero, CPO James Weber, MBA Ashlie White & Eddie White, CP Jeffrey Yakovich, CO Claudia Zacharias, MBA

John Allen, CPO Sherrie Anderson, CP Thomas Bain, BOCPO, LPO Lawrence J. Benenati, CFo Stephen A. Blackwell, CPO, LPO Jeffrey M. Brandt, CPO George Breece Michael Burton Erin Cammarata, CTO Brent A. Cheney, CO James Claiborne, CPO Ken Cornell, CO Fred Crawford Heather Davidson, CO Don DeBolt Kathy Dodson Kathy Easterbrooks Robert Easterbrooks, CPO Dave Edwards, CPO Chris Erbacher David Falk, CPO Norbert Fliess, CP Kevin Gilg, CP Susan M. Guerra, RN, CFo Daniel Hasso, CPO, LPO Carol J. Hentges, CO Donna C. Hinnant, CP Joseph T. Huntsman, MBA, MA Maurice A. Johnson, CO, BOCO, C.Ped Teri Kuffel, JD Randy S. Lacey Ronald G. Lanquist, CO Anthony Layton, CPO Alan Lett, CPO Anita Liberman-Lampear, MA Pam Lupo, CO Ann Mantelmacher Stuart Marquette, BOCP, CO Brad Mattear, CFo Clint McKinley

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O&P Almanac FEBRUARY 2012

John W. Michael, CPO Sander Nassan, CPO, FAAOP Michael H. Oros, CPO, FAAOP John J. O’Sullivan, LPO Curt Patton, CPO Sterling K. Phillips, CP, LP, FAAOP Mark A. Porth, CPO, FAAOP Laura Reidel, CPO Eduardo Reyes, LPO Rick Riley Ronald Sanders, CP Joshua Schenkman Scott Schneider David S. Sission, BOCO, CP Mark W. Smith Sean D. Snell Michael V. Tange, CPO

Cherylon Vinyard Donald Virostek, CPO, LPO John Wall, PT, CPO, FAAOP Jack Walker Tom Wessel Steven R. Whiteside, CO, FAAOP Connie Withers Ann Yamane, CO James Young, CP, LP, FAAOP

1917 CLUB (Up to $99) Rick Allen, CO Ann M. Anderson Michael F. Angelico Dale Baeten, CPA Gino Banco, PhD Johnny E. Baskin, CP Carey A. Bunch, CO Mary Chalfin, C.Ped Mary Charton Martin Diaz, BOCO Nicholas Diaz Noreen Diaz Marc Dufour, CO Jim Fitzpatrick

2011 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an O&P PAC sponsored event.

Ryan Arbogast Rudolf B. Becker III Kel Bergmann, CPO Stephen Blackwell, CPO, FAAOP Frank Bostock, CO, FAAOP Maynard Carkhuff Cascade Orthopedic Supply Dennis Clark, CPO Doyle Collier, CP Jeff Collins, CPA Fred Crawford

Jeff P. Fussner, CPO David Garcia Cary Glass, CPO, FAAOP Lou Goldstein Catherine Graf April Groves, CO Elizabeth A. Hammer, BOCO, CFO Natalia Hanavan Sprague Hanavan, CPO Robert Hartson, CPO Dennis Haun, CPO Elden Henry-Pottinger, BOCO M. Kale Hinnant, CP, FAAOP William Holzwrath, CPO Ross Huebner, C, CTO Joseph R. Hunter, CPO

Tami Jones Randy Kamin, CTP Ivan Letner, CP Michael A. Lewis, CPO, LPO Randall L. Ludolph, CP Dwayne M. Mara, CP, BOCP Clyde Newton Massey, CPO Kevin C. Matthews, CO, LO Mike Mattingly, CPO Mark Mazloff John S. McAtee, CP Tom McGovern Joe McTernan Tina Moran Brian C. Neep, CPO Eric Neufeld, CPO

Jason Pawelsky Tom Rankin Jerome Rifkin, MSME Daniel Rinella, CO Tim Riordan, CPO Richard Rocco Jr., CPO Jay Sleeth, CPO Alice Stride, CPO, LPO Kimberly Thomas, CFm. George Villarruel, CP Benjamin C. Walker, BOCP Joe Whiteside, CO Scott Williamson, CAE, MBA Bryan Wilson Darlene Wnek Jon Yanke, CPO

Glenn Crumpton, CPO, C.Ped Charles Dankmeyer Jr., CPO Don DeBolt Thomas V. DiBello, CO, FAAOP Kathy Dodson Deane Doty, CPO Robert Easterbrooks Jr., CPO Dave Edwards, CPO, FAAOP Kathy Edwards, CFm Thomas J. Fise, JD Rick Fleetwood, MPA Marbee Gingras Richard Gingras, CPO, BOCOP Catherine Graf, JD Michael Hamontree Hanger Orthopedic Group PAC Don Hardin Bert Harman

Russell Hornfisher James A. Kaiser, CP Marc Karn, CP Mark Kirchner, CPO Thomas Kirk, PhD Michelle Koehler, CO Al Kritter Jr., CPO, FAAOP Alan Lampear Jon Leimkuehler, CPO, FAAOP Eileen Levis Anita Liberman-Lampear, MA Mahesh Mansukhani Tina Moran Robert Morgan Ralph Nobbe, CPO Michael Oros, CPO, LPO Hanger Orthopedic Group PAC Jeff Parsons, LO, CO

Proteor Powers Pyles Sutter & Verville PAC Walter Racette, CPO John Reynolds, CPO Scott Schneider Lisa Schoonmaker, CPO, FAAOP Chris Snell Clint Snell, CPO Rick Stapleton, CPO Brian Steinberg, CO Frank Vero, CPO James Weber, MBA Tom Wessel Steve Whiteside, CO James O. Young, CP, FAAOP Claudia Zacharias, MBA, CAE

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community.

The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and help elect those individuals who support the O&P community.

In order to participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form contact Devon Bernard at dbernard@ AOPAnet.org.

FEBRUARY 2012 O&P Almanac

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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION

BUSINESS OPTIMIZATION ANALYSIS TOOL (BOAT) AOPA’s largest and most successful members use the BOAT and you should also.

The BOAT will help you:

THIS AMAZING PROFIT BOOSTER IS FREE FOR AOPA MEMBERS.

•

Create budgets

•

Track your finances

•

Participate in the annual Operating Performance and Compensation survey (OPC)—which provides you with a personal benchmark comparison study

•

OPC data you submit will automatically populate your BOAT site providing valuable historical information

•

Provide access to the new AOPA Patient Satisfaction Survey (required by certifying bodies)

•

Examine the financial fitness of your business

•

Help you identify and understand your competition, market conditions, and referral sources

•

Much more!

You will have access to your own secure and confidential account on the BOAT which will contain your company’s reported data and is specifically tailored to help O&P business owners manage their business for

✓

GREATER PROFIT AND QUALITY PATIENT CARE.

If you do not already have a BOAT account, enroll today by contacting AOPA’s BOAT partner, Michael Becher, Industry Insights, 614/389-2100 x 114 or mbecher@industryinsights.com.

Enroll Today!

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AOPA Applications

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

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s

bylaws. Affiliate members do not require a certified or statelicensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

Aroostook Orthotics & Prosthetics LLC

Leimkuehler Inc.

OrthoPro of Lewiston

P.O. Box 269 Presque Isle, ME 04769 207/760-3808 Fax: 207/762-3809 Category: Patient Care Facility Donna Gallant

5403 Mayfield Road Lyndhurst, OH 44124 440/442-0454 Fax: 440/442-0597 Category: Affiliate Parent Company: Leimkuehler Inc., Cleveland, OH

823 16th Avenue Lewiston, ID 83501 208/798-0200 Fax: 208/798-0201 Category: Affiliate Parent Company: OrthoPro of Twin Falls Inc., Twin Falls, ID

Leimkuehler Inc.

Prosthetic and Orthotic Care Inc. dba P & O Care

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28203 704/554-9933 Category: Supplier Level 3 Kate Dennstaedt

Capital Orthotics & Prosthetics Technologies 1500 Huguenot Road, Ste. 106 Midlothian, VA 23113 804/378-4902 Fax: 804/378-4904 Category: Patient Care Facility Preston Williams, CPO

Central Brace & Prosthetics Inc. 171 Hibbard Street, Ste. 3 Pikeville, KY 41501 606/509-0612 Fax: 606/509-0613 Category: Affiliate Parent Company: Central Brace & Prosthetics Inc., Lexington, KY

Comfort Prosthetics & Orthotics 140 S. Main Street Yale, MI 48097 810/387-4710 Fax: 810/387-4718 Category: Affiliate Parent Company: Comfort Prosthetics & Orthotics, Mount Clemens, MI

6478 Royalton Road North Royalton, OH 44133 440/582-8000 Fax: 440/582-0831 Category: Affiliate Parent Company: Leimkuehler Inc., Cleveland, OH

Liberty Prosthetics 6912-77 Street Edmonton, Alberta, Canada T6E 6U2 780/461-9925 Fax: 780/461-9215 Category: International Susan Kay

Mavlet Medical 241 Applewood Crescent, Ste. 7 Concord, Ontario, Canada L4K 4E6 905/660-5737 Fax: 905/660-5737 Category: International Eyal Leizgold

NabtescoProteor-USA 582 W18717 Gemini Drive Muskego, WI 53150 504/319-1954 Category: Supplier Affiliate Parent Company: PROTEOR, Dijon Cedex, FRANCE

1479 Highway 61, Ste. D Festus, MO 63028 636/232-2982 Fax: 636/232-2986 Category: Affiliate Parent Company: Prosthetic and Orthotic Care Inc., Fairview Heights, IL

Prosthetic Science San Antonio 4242 Medical Drive, Ste. 7275 San Antonio, TX 78229 210/949-0488 Fax: 210/949-0499 Category: Patient Care Facility Pia Bayly

SRT Prosthetics & Orthotics LTD 1607 W. High Street Bryan, OH 43506 419/633-3961 Fax: 419/633-3981 Category: Patient Care Facility Laura Wilison

Tyler Prosthetics Inc. 701 Turtle Creek Drive Tyler, TX 75701 903/595-2600 Fax: 903/595-2604 Category: Patient Care Facility Pia Bayly a FEBRUARY 2012 O&P Almanac

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Marketplace

Introducing the new Celsus K2 Foot from College Park Bringing College Park’s innovate composite technology into the K2 market, the Celsus combines proven durability with controlled stability. Its balanced design and natural motion provide smooth, stable transitions. The perfect lightweight design promotes confidence and security for lower impact patients.

Key features include: • Smooth proportional response with integrated spring technology (iST) • Low profile design • High weight limit of up to 136 kg (300 lbs) • Maintenance free design • Sandal toe feature • Same-day, custom built to order.

For more information, call 800/ 728-7950 or visit www.college-park.com.

Friddles Friddle’s LimbguardTM System (patent pending), once again shows our commitment to innovation. The Limbguard is a cost-effective postoperative residuum maintenance/knee R.O.M. preservation system that is completely customized by the practitioner—on site. Volume fluctuation is accommodated via the floating pretibial section and out proprietary distal GillsTM for the perfect fit!

• L5450 IPOP, rigid dressing • L5684 BK for strap • L5688 BK, waist belt, webbing.

Contact Friddle’s to order your pair today at 800/369-2328, fax 800/3691149, or visit www.friddles.com.

Introducing a new addition to the KISS® family!

WalkOn Fit Kits from Ottobock: Assess Your WalkOn Patient Anywhere!

At hospital, clinic, home, or office—evaluate your drop-foot patients on the spot for a WalkOn AFO with either the 28T1N WalkOn Fit Kit or the 28T2 WalkOn Flex Fit Kit. Each kit comes in a handy carrying bag and contains four WalkOns (two small, L&R; two medium, L&R; plus four calf pads).

With the smaller footplates, there’s no need for grinding needed to get them into the shoe.

Get an instant check of the WalkOn function—and then take the order for a fit. Contact your local sales representative at 800/328-4058 to order your Fit Kits today.

Water Transfer Printing – New from Ottobock!

OTS StepLock • Ten locking positions throughout knee flexion.

• Helps to increase the knee range of motion.

• Provides stability for standing before reaching full extension.

• Designed for knee flexion contracture management.

• Unlocks to enable sitting and reclining.

• Effectively blocks flexion while allowing free extension.

• Unparalleled strength plus a nickel plated finish for extra durability.

For more information, contact OTS Corp. at 800/221-4769 or www.ots-corp.com

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O&P Almanac FEBRUARY 2012

Angled Offset Base: Part # CMP44/A. Also Available as KISS® Kits: KS4/A and KS4/B. The base is constructed of aircraft-grade aluminum and can be laminated into a socket with a single lamination. It is angled 12˚ and has a four-hole pattern that is offset posteriorly .75 in for enhanced alignment for hip flexor tightness.

Lamination plate and spacer screws sold separately (CMP14/A).

For more information, call 410/663-KISS (5477) or visit www.kisssuspension.com.

Take advantage of this new fabrication service from Ottobock. Our unique coating technology makes it possible to print an almost seamless décor on complex shapes of prostheses, orthoses, and more! And with 30 different designs to choose from, your patients will be sure to find something they like.

Contact Ottobock Fabrication Services at 800/795-8846 for color specifics and to order.

Otto Bock® Products from PEL Supply

WillowWood Custom Liner Offerings Expanded

Effective immediately, the Power of One™ product lineup from PEL now includes items from Otto Bock.

Established in 1919 in Germany, Otto Bock HealthCare opened its doors in the U.S. in 1958 and in Canada in 1978.

The name Otto Bock has stood for innovation and entrepreneurial success.

Like Otto Bock, PEL Supply is in its third generation as a privately held company. Their partnership offers O&P practitioners maximized performance, outstanding service, and time-proven value. PEL will offer products from Otto Bock’s structure core items including adapters, knee and hip joints, cosmetic covers, foams, resins, and more. A new supplement to the PEL Prosthetic catalog is available now.

Contact PEL Supply at 800/3211264, fax 800/222-6176; email customerservice@pelsupply.com or order online at www.pelsupply.com.

Due to popular demand of the Alpha® Hybrid Liner and customer requests, WillowWood is pleased to announce that clinicians may now order Alpha DESIGN® Liners with Select fabric and Hybrid gel for transtibial and transfemoral applications. When placing an order, use the same DESIGN Liner part number you always have and complete the order form with your choice of fabric and gel type. Lead time for Alpha DESIGN Liners with Hybrid gel is five to seven business days. Ordering capability within OMEGA® will be available in Version 12.1.

Have questions or want more information? Please call 800/848-4930 or visit willowwoodco.com. a

www.AOPAnet.org

Coding & Reimbursment Legislative & Regulatory Education FInd it at www.AOPAnet.org

Expert Coding Advice 24/7

24/7

at www.LCodeSearch.com •

•

•

The O&P coding expertise you’ve come to rely on is now available whenver you need it.

Log on to LCodeSearch.com and get started today.

Match products to L codes and manufacturers—anywhere you connect to the Internet.

Contact Michael Chapman at 571/431-0843 or mchapman@AOPAnet.org.

This exclusive service is available only for AOPA members.

Not an AOPA member? GET CONNECTED

Manufacturers: Get your products in front of AOPA members!

Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.

Visit AOPA at www.AOPAnet.org

FEBRUARY 2012 O&P Almanac

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Jobs

Increase exposure and save!

Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific Use our map to find which region you fit into!

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

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

Note: AOPA reserves the right to edit Job listings for space and style considerations.

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

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

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O&P Almanac FEBRUARY 2012

Northeast Certified Prosthetist/Orthotist, Certified Prosthetist and Technician New Jersey Career opportunity for highly motivated certified prosthetist/orthotist or certified prosthetist/technician to work in our West Berlin, New Jersey location. Pro-Fit, LLC offers a comprehensive benefits package that includes a competitive salary commensurate with experience and an IRA plan, as well as health, prescription, and dental benefits.

Must be licensed in the state of New Jersey. Must be willing to travel with car allowance. Possible ownership opportunity for qualified practitioner. Email your confidential resume to:

Email: pro.fitllc@verizon.net Fax: 856/809-9954

Prosthetist/Orthotist, Certified Prosthetist, Board-Eligible/Certified Orthotist Southern Maine Do you want to be more than a number? We are a terrific, patient-oriented company looking for some awesome practitioners. Is this you? Our well-established, O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity.

Learn more about joining our team of dedicated specialists by contacting:

O&P Ad 1111 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Certified Prosthetist/Orthotist Nashua, New Hampshire We are expanding our business into the New Hampshire area and are looking for a dynamic individual with excellent communication and patient-care skills who can provide competent, comprehensive care to our patients.

We can offer a very competitive salary/benefit package along with relocation assistance and signing bonus potential. Management skills would be a plus! Send resume to:

O&P Ad 1011 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

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Northeast Certified Orthotist, Certified Orthotist and Board-Eligible Prosthetist, or Certified Prosthetist/Orthotist New York Privately owned and growing multi-site ABC accredited P&O practice in upstate New York is seeking a certified orthotist with a minimum of two years experience and/or a certified orthotist and board-eligible prosthetist, or certified prosthetist/orthotist. We are looking for individuals with strong orthotic backgrounds, and we may entertain an NCOPE prosthetic residency if needed. Our offices in the historic and scenic Hudson Valley and Catskill Mountains of New York are located from Saratoga to Poughkeepsie with immediate openings in Kingston and Poughkeepsie. The ideal candidate must be self-motivated, a team player, possess good communication and technical skills, and be willing to excel for performance-based objectives. Competitive salary and benefits package offered. Submit resume to:

David Misener, CPO Clinical Prosthetics & Orthotics, LLC Email: DBM@clinicalpando.com Fax: 518/432-0686

Jobs

Certified Prosthetist/Orthotist Vermont Yankee Medical, providing orthotic and prosthetic services for over 64 years, is looking for a certified prosthetist/orthotist ready to locate to Vermont. With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send your resume:

Attn: President, Yankee Medical 276 North Avenue Burlington, VT 05401 Email: jnf@yankeemedical.com

Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing.

Send resume to:

O&P Ad 0611 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-8099

AVAILABLE POSITIONS Orthotist Tucson, AZ Frisco, CO Macon, GA Roswell, GA Belleville, IL Quincy, IL Urbana, IL Indianapolis, IN W. Orange, NJ

Syracuse, NY Hermitage, PA Philadelphia, PA Spartanburg / Union, SC Houston, TX San Antonio, TX Parkersburg, WV Milwaukee, WI Waukesha, WI

Prosthetist Port St. Lucie / Melbourne, FL Macon, GA Hazel Crest, IL

Jackson, MS Oneonta, NY Bridgeport, WV

Prosthetist / Orthotist Springdale, AR American Canyon / Fairfield, CA Hollywood, FL Naples, FL Tamarac, FL West Palm Beach, FL Griffin, GA Macon, GA Brooklyn, NY

Long Island, NY Mayfield Heights, OH Tallmadge, OH Portland, OR Salem, OR Lancaster, PA Northeast PA Wilkes Barre, PA Austin, TX San Antonio, TX

Certified Pedorthist Denver, CO Bangor, ME Portland, OR Roseburg, OR

Pittsburgh, PA Nashville, TN Huntington, WV

FEBRUARY 2012 O&P Almanac

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Jobs Northeast

Inter-Mountain

Part-Time Certified/Board-Certified Orthotist

Certified Orthotist or Certified Prosthetist (licensed or eligible)

New York City Area O&P practice seeking a motivated ABC-certified or boardcertified orthotist with good people skills for a part-time position. Responsibilities may include providing care during day, evening, and weekend hours in clinical, hospital, and home settings in the five boroughs and Nassau and Suffolk Counties. We offer salary commensurate with experience.

Send resume to:

San Antonio, Texas Seventh largest city in the U.S. and second-largest in Texas. San Antonio is home to five Fortune 500 companies; regional headquarters to other large companies such as Kohl’s, Nationwide Mutual Insurance, Chase Bank, Toyota, AT&T, QVC, and Lockheed Martin; Brook Army Medical Center; the Center for the Intrepid; the South Texas Medical Center; home to one of the largest military concentrations in the U.S. employing over 89,000; San Antonio Spurs! San Antonio is blessed with museums, Six Flags, Sea World, and Splashtown San Antonio. And, we must mention the Tex-Mex cuisine at many fine restaurants. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential‌plus much more! We also have positions available in Houston and Austin! To apply for this position, please contact, in confidence:

Email: orthoticandprosthetics@yahoo.com

North Central ABC-Certified Prosthetist/Orthotist St. Louis Area Privately owned, rapidly growing practice located in St. Louis, Missouri, has an opening for certified prosthetist/ orthotist. This is a great opportunity for someone looking to become part of a motivated successful team. We offer a competitive compensation package, including health care, 401(k), and profit sharing.

Send resume to:

Premier Prosthetics and Orthotics Richard Doerr 633 Emerson Road St. Louis, MO 63141 Fax 314/743-3575 Email: Richard.Doerr@premierpando.com

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Prosthetic/Orthotic Technician Arizona Established, independently owned company located in Central Arizona is looking to hire an experienced prosthetic/ orthotic technician. Applicant will be confident in skills and able to adjust techniques to client specifications. Growth and bonus opportunities are available. Please send resume with salary requirements to:

Northern Arizona Prosthetics Fax: 928/583-0505 Email: nap@nazprosthetics.com www.nazprosthetics.com

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O&P Almanac FEBRUARY 2012

JOIN US and discover your potential!

Southeast Certified Pedorthist Georgia Amputee Associates is looking for a certified pedorthist to provide care in a stable and well-respected physician office in Southeastern Georgia. Competitive compensation and excellent benefits. Please contact:

• Patient-focused with clinical-based outcomes • Emerging technologies and in-house fabrication • Professional autonomy in a team environment • Free or low-cost internal and external CEU opportunities • Comprehensive benefits package Physiotherapy Associates has exciting opportunities for O&P Professionals in: Certified Orthotist • Cape Girardeau MO • Carbondale IL • Green Bay WI • Poplar Bluff MO

Chantelle Email: c.arabie@amputeeassociates.com

Certified Prosthetist/Orthotist • Green Bay WI • Milwaukee WI • Toledo OH Visit www.physiocorp.com and click on Careers to join us!

For more information, contact: Julie.Thomas@Physiocorp.com 972.547.6691

O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2011 test standards.

Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations.

Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

Discover Marshfield, Wisconsin & enjoy:

The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics

CO or CPO

(Many of our products are available in DVD Format also!)

JUST ADDED: The MASTECTOMY FITTER’s Review and Study Guide We also have Board Study Value Packages in Orthotics and Prosthetics Check out your readiness to sit for your boards with our Clinical Practice Exams.

Our BEST SELLING products to save you money!

• Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

ABC Certified in Orthotics & Prosthetics and 3 years of experience required.

Experience in Pediatrics would be helpful.

Join us and see how your career can shine.

To apply, please visit:

www.marshfieldclinic.jobs Reference Job Number MC110156 Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

www.oandpstudyguide.com FEBRUARY 2012 O&P Almanac

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Calendar Orthopadie + Reha-Technik 2012: Leipzig, Germany Exhibit space. A few choice locations are still available in the U.S./Canadian Pavilion sponsored by the AOPA at O+R 2012 Leipzig this coming May 16-18. If you are interested in exhibiting, please contact Mark Alt at Kallman Associates, Inc., U.S. Representative. Call 201/ 652-7070 or email mark@ kallmanexpo.com.

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PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Member Nonmember Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00

per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634

$678 $830

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

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations.

For information on continuing education credits, contact the sponsor.

Questions?

Email srybicki@AOPAnet.org.

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O&P Almanac FEBRUARY 2012

■■ YEAR-ROUND TESTING Multiple Choice Examinations. BOC has yearround testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November. Applications are accepted any time, although seating is limited. For more information, visit www. bocusa.org or email cert@ bocusa.org.

■■ On-site Training Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately.

For more information, call 888/696-2767 or visit www.

UtahArm.com.

2012 ■■ February 8 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5-6 pm ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www.ultraflexsystems.com.

February 9 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

Credits: 2.5 ABC/2.5 BOC. Contact 877/665-5443 or visit www.willowwoodco.com.

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■■ February 11 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9-10 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www. ultraflexsystems.com.

■■ February 11 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9-10 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www. ultraflexsystems.com.

■■ February 13-18 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams was December 1, 2011.

Phone 703/836-7114, email info@abcop.org or visit www. abcop.org/certification.

■■ February 16-18 PrimeFare West Regional Scientific Symposium 2012.

Salt Palace Convention Center, Salt Lake City, UT. For more information, contact Jane Edwards 888/388-5243 or visit www.primecareop.com.

■■ February 23 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Presenter: Jim Rogers, CPO, FAAOP. Register by calling 800/220-6670 or visit www. ultraflexsystems.com.

■■ FEBRUARY 24 AOPA: FDA Compliance Workshop. Sheraton Inner Harbor, Baltimore. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ March 2 2nd Annual COPA Educational Event. CSUDH O&P Program Campus.

Long Beach, CA. For more information or to register, visit www.californiaoandp.com/ education.

March 6 WillowWood: Discover LimbLogic® VS via WebEx, 1:30 pm ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/2.5 BOC. Contact 877/665-5443 or visit www.willowwoodco.com.

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■■ February 28 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Presenter: Mark DeHarde. Register by calling 800/220-6670 or visit www. ultraflexsystems.com.

■■ February 28-March 1 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, “by measurement” shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: TBD. Contact 877/665-5443 or visit www.willowwoodco.com.

March 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be postmarked by March 1, 2012 for individuals seeking to take the May 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians, or summer CPM ABC exams for orthotists and prosthetists.

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■■ March 7 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8–9 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www.ultraflexsystems.com.

March 8-9 2 Day RCR Workshop. Boise, Idaho. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on casting, modifying and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

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■■ March 9-10 Oklahoma Association for O&P Annual Meeting.

Best Western Saddleback Inn and Conference Center, Oklahoma City, OK. For more information, contact Jane Edwards at 888/388-5243 or jledwards88@att.net or visit www.okaop.org.

■■ March 14 AOPAversity Audio Conference–AFO/KAFO Policy—What You Need to Know. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

■■ March 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ March 26-30 Applied Technology Institute (ATi) Orthotic Fitter School.

Dallas, TX. Hyatt Place Dallas, by the Galleria. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE (ABC) and BOC. For continuing education by ABC and BOC. For information, contact Lois Meier at 888/265-6077 lois@ kasseledu.com or visit www. kasseledu.com.

Motion Control

SuperCourse SPRING 2012 February 27 – March 2, 2012

at Motion Control Headquarters, Salt Lake City, Utah • In-depth training of Utah Arm / U3+ / Hybrid / ProControl2.

• Hands-on experience with UI-software—bring your laptop.

• CEUs: 34 (estimated) awarded by ABC.

Overview of: NEW LI-Ion Battery for Utah Arm / U3+ / Hybrid NEW Electric Wrist Rotator NEW TRIAD Preamps Plus an overview of the NEW & EXCITING Motion Foot from Motion Control

The Spring 2012 SuperCourse is a 5-Day Course = $1,350.00 For more information or to register for the SuperCourse email: info@UtahArm.com

Motion Control, Inc. 115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801/326-3434 • FAX: 801/978-0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

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Calendar

April 11 AOPAversity Audio Conference–Network and Market Your Way to Success.

For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■

■■ April 17–18 AOPA Policy Forum.

Washington, DC. L’Enfant Plaza Hotel. To register, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

April 19-20 WillowWood: Alpha Seminar.

Mt. Sterling, OH. Course breakdowns the Alpha family of products, identifies best clinical applications of liners, discussion of liners for vacuum suspension, and the latest in suspension systems. Includes brief review of TPE liner benefits and fitting assessment.

Credits: 12.75 ABC/12.25 BOC. Registration deadline is March 29. Contact 877/665-5443 or visit www.willowwoodco.com.

■■

■■ April 23-24 AOPA: Essential Coding & Billing Seminar. Rosemont Hyatt, O’Hare Airport, Chicago. To register, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■ April 26-28 International AfricanAmerican Prosthetic Orthotic Coalition Annual Meeting.

Hyatt Regency Jacksonville.

Riverfront. Jacksonville, FL. For more information, contact Reginald Mays at jax@ unitedpando.com, call 904/4443970, or visit www.iaapoc.org.

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O&P Almanac FEBRUARY 2012

May 3-5 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient With a Lower Extremity Amputation. Chicago.

Approved for 19.0 ABC credits. Contact Melissa Kolski.

For more information, call 312/238-7731 or visit www.ric. org/education.

■■

■■ May 9 AOPAversity Audio Conference–Contracting 101.

For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■ May 10 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline is April 19. Contact 877/665-5443 or visit www. willowwoodco.com.

■■ May 10-11 2 Day RCR Workshop. Boise, Idaho. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on casting, modifying and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

May 14-19 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams is March 1. Phone 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

■■

May 17-19 PA AAOP Chapter Annual Spring Conference.

Pittsburgh, Sheraton Station Square Hotel. For more information, contact Beth or Joe at 814/455-5383.

■■

■■ May 17-19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association.

Annual Meeting at Peppermill Hotel, Reno, NV. Best CEU credit value available! Contact Steve Colwell 206/440-1811 or Sharon Gomez 530/521-4541 or visit www.wamopa.com.

■■ June 1 ABC: Certification Exam Application Deadline.

Applications must be postmarked by June 1, 2012 for individuals seeking to take the summer 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, info@abcop.org, or visit www.abcop.org/certification.

June 1-2 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop. org, or visit www.abcop.org/ certification.

■■

June 4-6 LAOP: Annual Educational Conference. Hilton Riverside, New Orleans. Earn up to 13 credits in O, P, and Administrative tracts. Come enjoy summer family fun, unique city culture, cuisine, and all that jazz. Contact Sharon at 504/464-5577, laymansh@yahoo.com, or visit www.laop.org.

■■

■■ June 7-8 Michigan Orthotics & Prosthetics (MOPA) Continuing Education Meeting. Soaring Eagle Casino & Resort in Mt. Pleasant, Michigan. Contact Mary Ellen Kitzman at 248/615-0600 or email her at Kitzman@gmail.com.

■■ June 7-8 2 Day RCR Workshop. Boise, Idaho. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on casting, modifying and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

June 8-9 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop.org, www.abcop.org/certification.

■■

■■ June 13 AOPAversity Audio Conference–Improving Your Bottom Line. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ june 15-16 PrimeFare East Regional Scientific Symposium 2012.

Nashville Convention Center, Nashville, TN. For more information, contact Jane Edwards 888/388-5243 or visit www.primecareop.com.

■■ July 11 AOPAversity Audio Conference–Perfecting the Intake Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ August 6-7 AOPA: Essential Coding & Billing Seminar. Hyatt at Olive 8, Seattle. To register, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

n

■■ August 8 AOPAversity Audio Conference–The Ins and Outs of Advance Beneficiary Notices (ABNs). For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ October 10 AOPAversity Audio Conference–What Every O&P Facility Needs to Know about the FDA. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ December 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ September 6-9 AOPA National Assembly & NE Chapter Combined Meeting. Boston. Hynes Convention Center. The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting. Please plan to join us for this significant event. Exhibitors and sponsorship opportunities available: contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. To register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ October 19-20 University of Michigan Orthotics and Prosthetics Center: Centennial Celebration and Education Seminar. Making a difference for 100 years, providing service, education, and research in O&P. For details and information about registration, visit www.med. umich.edu/pmr/op/index.htm.

2013

September 12 AOPAversity Audio Conference–How to Get Paid for Orthopedic and Diabetic Shoes. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

November 14 AOPAversity Audio Conference–Medicare Enrollment Procedures. For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■

■■

■■ February 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ September 18-21 O&P World Congress.

Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@aopanet.org. a

Ad Index

Company

Page

Phone

Website

Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics College Park Industries Inc. DAW Industries Dr. Comfort Fillauer Companies Inc. Friddle’s Orthopedic Appliances KISS Technologies LLC OPTEC Orthomerica Products Orthotic and Prosthetic Study and Review Guide Otto Bock HealthCare PEL Supply Company Vorum Research Corporation

23 9

(888) 678-6548 (800) 574-5426

www.allardusa.com www.easyliner.com

17 25 1 5, C3 2 19 C4 14, 15 7

(703) 836-7114 (800) 728-7950 (800) 252-2828 (800) 556-5572 (800) 251-6398 (800) 369-2328 (410) 663-5477 (888) 982-8181 (800) 446-6770

www.abcop.org www.college-park.com www.daw-usa.com www.drcomfortdpm.com www.fillauercompanies.com www.friddles.com www.kiss-suspension.com www.optecusa.com www.orthomerica.com

51 C2 11 39

(800) 328-4058 (800) 321-1264 (800) 461-4353

www.oanpstudyguide.com www.ottobockus.com www.pelsupply.com www.vorum.com

FEBRUARY 2012 O&P Almanac

55

n

AOPA Answers

FDA & O&P Answers to your questions regarding how the agency is affecting your work

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.

Q. A.

What is the FDA?

The U.S. Food and Drug Administration, or FDA, is an agency within the Department of Health and Human Services. Primarily, the FDA is tasked with protecting the public health as it relates to the safety of food, drugs, vaccines, other biological products, and medical devices, but it also regulates the labeling of these products, along with cosmetics and dietary supplements. The FDA’s regulation of medical devices is most important for the O&P field. In 1976, Congress passed extensive amendments to the Federal Food, Drug and Cosmetic Act, which expanded the power of the FDA to include the regulation of all medical devices.

Q.

I have heard a lot of reports about FDA activity. What does this mean for my business?

A.

We’ve received numerous reports of heightened FDA activity within the O&P field. Specifically, we’ve heard of increased FDA inspections taking place. This increased activity reinforces how important it is for business to be aware of what aspects of their business are subject to FDA regulations. In addition, businesses need to know what steps to take to comply with the law to avoid severe penalties, which range from fines to product recall.

56

O&P Almanac FEBRUARY 2012

As a result of this need, AOPA is bringing in outside experts for AOPA’s FDA Seminar on February 24 to cover these complex issuesto help ensure patient-care facilities, manufacturers, and distributors learn the skills they need to protect their businesses. (See page 41 for more information.) AOPA prepared the first-of-its-kind FDA Compliance Manual, which spells out what you should do when the investigator calls. It was sent to all members last year, and additional copies are available upon request. There is no charge for the manual for AOPA members.

Q. A.

What should I do if an FDA Investigator shows up at my business?

The best defense is a good offense. In the event your business is subject to an FDA inspection, you should have clear written instructions prepared in advance on how to work with the FDA investigator. Any ground rules you establish should be known to those persons in your operation likely to be in contact with the investigator. This groundwork is important to be prepared in advance to reduce the likelihood of problems or issues. Detailed guidelines on “what to do when the investigator calls” will be covered during AOPA’s FDA Seminar. a

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