February 2024 O&P Almanac by AOPA

PROPOSED CHANGES TO THE LOWER-LIMB PROSTHESIS LCD P.12 TRANSFORMATIONS: CHOOSING AMPUTATION AFTER LIMB SALVAGE SURGERY P.26

Bridging the Worker Gap Hiring care extenders, upskilling, and other strategies for alleviating staffing challenges P.18

FEBRUARY 2024

The Magazine for the Orthotics & Prosthetics Profession

AOPAnet.org

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ignite 24 THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.

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CONTENTS

February 2024 | Vol. 73, No. 2 COVER STORY

18 BRIDGING THE WORKER GAP O&P employers are facing hiring and retention challenges amid a growing demand for O&P care. Many companies are finding value in hiring more care extenders—and some are upskilling current employees to take on higher-level tasks within patient-care facilities. By CHRISTINE UMBRELL

COLUMNS

DEPARTMENTS

12 Reimbursement Page WATERSHED MOMENT

The Lower-Limb Prosthesis LCD will consider coverage of microprocessor technology for some K2 ambulators Opportunity to earn CE credits by taking the online quiz.

26 Transformations TRAUMA RECOVERY

Meet Phillip Call, CPO, and learn about his treatment of patient Ashley Holdren, who experienced a tragic car accident and chose amputation after limb salvage surgery proved too painful.

30 Member Spotlight y GOAL PEDIATRIC ORTHOTICS y NUTECH SYNERGIES

O&P Almanac February 2024

AOPA Contacts How to reach staff

Happenings Research, statistics, and industry news

10 People & Places Transitions in the profession

33 AOPA News AOPA announcements, member benefits, and more

34 AOPA New Members 35 Marketplace

39 Calendar Upcoming meetings and events

39 Ad Index 40 State By State Updates from Missouri, Nebraska, and New Hampshire

• For the active users with foot drop • When less support is needed during stance phase • More flexibility – greater ROM

AOPA Contacts

A world where orthotic and prosthetic care transforms lives.

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

Board of Directors

AOPA Staff

OFFICERS

EXECUTIVE OFFICES

President Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

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

President-Elect Rick Riley O&P Boost, Bakersfield, CA Vice President Kimberly Hanson, CPRH Ottobock, Austin, TX Treasurer Chris Nolan Össur, Foothills Ranch, CA Immediate Past President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL Adrienne Hill, MHA, CPO(L), FAAOP Kennesaw State University, Kennesaw, GA John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY James Kingsley Hanger Clinic, Oakbrook Terrace, IL Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV Matt Swiggum Proteor, Tempe, AZ Linda Wise Fillauer Companies, Chattanooga, TN Shane Wurdeman, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

O&P Almanac February 2024

PUBLISHER EVE LEE, MBA, CAE EDITORIAL MANAGEMENT CONTENT COMMUNICATORS LLC ADVERTISING SALES RH MEDIA LLC DESIGN & PRODUCTION MARINOFF DESIGN LLC PRINTING SHERIDAN

Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

HEALTH POLICY AND ADVOCACY

Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@AOPAnet.org

O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/ December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571-431-0876, fax 571-431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571-431-0854, dbernard@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571-431-0814, smiller@AOPAnet.org

MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571-431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, assistant director, meetings and exhibitions, 571-431-0852, kelly.oneill@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571-431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571-431-0810, bleppin@AOPAnet.org Nicole Ver Kuilen, manager of public engagement, 571-431-0836, nverkuilen@AOPAnet.org Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org AOPA Bookstore: 571-431-0876 Reimbursement/Coding: 571-431-0833, LCodeSearch.com

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

ADDRESS CHANGES Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2024 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

ADVERTISE WITH US Share your message with AOPA membership— approximately 9,000 orthotic and prosthetic professionals, facility owners, and industry personnel. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net. Learn more at bit.ly/24AlmanacMediaKit.

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Happenings RE SE A RCH ROUNDUP

Backward Walk Test Aids Lower-Limb Patient Evaluation The 3-meter backward walk test (3MBWT) is a valid, reliable, and easy-to-apply tool for measuring dynamic balance in high-functioning adults with lower-limb loss, according to researchers in Turkey. The researchers conducted a randomized cross-sectional study to investigate the test-retest validity and reliability of the 3MBWT. Thirty adults with lower-limb amputation and 29 adults without amputation were included in the investigation. The researchers asked study subjects to participate in three well-known lowerlimb assessments—the Modified Fall Efficacy Score, the Rivermead Mobility Index, and the Timed Up and Go test—in addition to completing the 3MBWT. One week after the initial tests, participants took part in the same tests again, conducted by the same

PEDI AT RIC O& P

physiotherapist. The research team assessed validity in two ways: by correlating the 3MBWT with the scores of the other measurement tools and by comparing the 3MBWT times of the subjects with amputation to those without amputation. Test-retest of the 3MBWT was “excellent,” according to the researchers, with an intraclass correlation coefficient of 0.950 for the 3MBWT. A moderate correlation also was found between the 3MBWT and the other three tests. “Significant differences in the 3MBWT times were found between adults with lower-limb amputation and healthy controls,” reported the authors. “The cutoff time of 3.11 seconds discriminates [non-amputee] adults from high-functional-level adults with lower-limb amputation.” The results were published in December in Prosthetics and Orthotics International.

Process Could Facilitate Personalized Breast Prostheses A patent-pending process for using a 3D bioprinter to “print” personalized breast prostheses for cancer survivors is under development by Liisa Kuhn, PhD, a professor of biomedical engineering at the University of Connecticut and director of the Beekley Lab for Biosymmetrix. A bioprinter is similar to a regular 3D printer but extrudes elastomer gel that results in a “lightweight, flexible, and porous product with an open cell foam design.” In developing the new process, Kuhn took 3D photos of women’s chests and worked with a CAD

AMPUTATIONS RISE IN GAZA Since Oct. 7, more than 1,000 children have had one or both legs amputated in Gaza, according to UNICEF. SOURCE: SAVE THE CHILDREN PRESS RELEASE.

O&P Almanac February 2024

designer to convert images to files that can be 3D-printed. Using the new technology, individuals with single mastectomies can have their remaining breast scanned while in a bra, which is then digitized and mirror-imaged in the software, resulting in a 3D model that fits against the patient’s chest. Kuhn’s process is currently being optimized to improve the robot arm capabilities of the bioprinter and thus overcome challenges associated with depositing thin elastomer in a multilayered lattice-like pattern. Details were published in December in UConn Today.

“Functionality” Top Reason for Prosthesis Discontinuation In a newly released survey of individuals with amputation, 8.2% of survey respondents said they had never used a prosthesis. The survey, conducted by Joseph Webster, MD, from Virginia Commonwealth University and his research team, sought to describe the rate, reasons for, and factors associated with never using or discontinuing prosthesis use. Nearly 4,000 individuals with limb loss participated in the survey. In addition to the 8.2% who had never used a prosthesis, another 10.5% had discontinued

use after initial acceptance. The top three reasons for stopping usage were functionality (62%), undesirable prosthesis characteristics (57%), and comfort (53%). Prosthesis discontinuation was more common among individuals with upper-limb loss, female respondents, individuals with diabetes, and individuals with above-knee limb loss. Satisfaction with prosthesis and quality of life were highest among current prosthesis users. Details were published in December in Prosthetics and Orthotics International.

Happenings

Social Determinants of Health Correspond to Amputation Rates in New Study Amputation rates in some of the most populous U.S. counties were the subject of a new study by researchers from Cambridge Health Alliance and other Massachusetts institutions. The research team, led by Daniel Kassavin, MD, conducted a cross-sectional study of the Healthcare Cost and Utilization Project State Inpatient Database, finding that counties with high amputation rates were associated with social determinants of health, such as African-American race, diabetes, smoking, and food insecurity. The researchers assessed data from 76 of the 100 most populous U.S. counties. Counties with high amputation rates were associated with higher rates of residents with physical distress, a higher incidence of racial segregation, and higher proportion of African-American inhabitants.

“Social determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level,” reported the authors. The study was published in November in JAMA Surgery.

O& P FA BRICATION

L IMB L OSS T RENDS

DME MACs and PDAC Release 3D Printing Guidance

The durable medical equipment Medicare administrative contractors (DME MACs) and the Pricing Data Analysis & Coding (PDAC) contractor released long-awaited guidance from CMS Feb. 1 on the use of 3D printing and digital scanning for custom-fabricated orthoses. The guidance states that 3D printing, or additive manufacturing, can be an acceptable alternative to traditional custom fabrication if the method used meets the definition of custom fabricated in the Quality Standards for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Appendix C. This new correct coding reminder is consistent with AOPA’s position that 3D printing/additive manufacturing should be considered a valid custom fabrication method. This is another step in the acceptance of new orthotic technologies by CMS, the DME MACs, and PDAC, according to AOPA.

O& P CY BERSECURIT Y

HEALTHCARE DATA BREACHES HIT ALL-TIME HIGH

Street Drug Spurs Growth in Amputations

A street drug known as xylazine, or “tranq,” is gaining traction in cities across the nation, reaching particularly high levels of usage in Philadelphia and other cities. Xylazine is a non-opioid sedative used by veterinarians and is not approved for use in humans. It is commonly—and illegally—mixed with other drugs and also can be used on its own, typically as an injection. The drug causes sedation, lowers blood pressure, slows the heart, and causes skin lesions that can cause the skin to decompose. Xylazine is associated with severe necrotic skin ulcerations. “People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis—the rotting of human tissue—that may lead to amputation,” according to the U.S. Drug Enforcement Administration. The percentage of fatal opioid overdoses in which xylazine was detected rose by 276%, from 2.9% in January 2019 to 10.9% in June 2022, according to data from the Centers for Disease Control and Prevention. Details about the threat of xylazine were published in the New England Journal of Medicine.

As many as 116 million individuals were affected by large breaches of personal health information in 2023. The majority of the breaches stemmed from cyberattacks. SOURCE: STATNEWS, DEC. 2023.

O& P INVE S TIGATIONS

FEMALE SUBJECTS LESS PROMINENT IN STUDIES In a study of 191 published O&P manuscripts, only 25% included female participants, although 35% of individuals living with amputation are female. SOURCE: “IDENTIFYING AND ACKNOWLEDGING A SEX GAP IN LOWER-LIMB PROSTHETICS RESEARCH,” JOURNAL OF PROSTHETICS AND ORTHOTICS, JAN. 2024.

February 2024 O&P Almanac

Happenings

GR A N T S & OPP OR T UNITIE S

O&P Foundation Offers First-Quarter Funding The Orthotics and Prosthetics Foundation for Education and Research (O&P Foundation) announced more than $85,000 in research grants and scholarship funding available in the first quarter of 2024. The available grants span the O&P Foundation’s three pillars of research, education, and scholarly achievement. Each award opportunity is rooted in the O&P Foundation’s mission and vision. Research funding opportunities include the following: Early Career Research Grant: Up to one, $30,000 grant awarded. Accepting letters of intent (LOIs) from Feb. 12 through March 4; application deadline April 8. Mentored Pilot Research Grant: Up to one, $5,000 grant awarded. Accepting LOIs from Feb. 12 through March 4; full application deadline April 8. Microgrant (details to be announced): Up to one, $2,000 grant awarded. Applications accepted March 18 through April 15.

• • •

Scholarship funding opportunities include the following: ABC O&P Technician Scholarship: Up to eight, $5,000 scholarships awarded. Applications accepted Feb. 12 through March 22. ABC O&P Technician Diversity Scholarship: Up to two, $5,000 scholarships awarded. Applications accepted Feb. 12 through March 22. Chester Haddon Scholarship: Up to one, $2,500 scholarship awarded. Applications accepted March 4 through April 12.

• • •

Visit oandpfoundation.org for details.

O&P By the Numbers Healthcare Costs a Top Financial Worry— Particularly for Younger Adults Almost half of U.S. adults find it difficult to afford health expenses, according to new KFF report “ Ver y/S omew ha t Dif ficult ” To Af for d He althc ar e C ost s

Skipp ed or Postponed He althc ar e Due to C ost

Repor ted Pr oblems P a ying for He althc ar e

Ages 18-29 Ages 30-49

47% “ Ver y/S omew ha t Dif ficult ” To Af for d Pr escr iption Dr ugs

Ages 18-29

30%

Ages 30-49

30% 24%

Ages 50-64

22% 7%

Ages 65 plus

Ages 18-49

30%

Ages 50-64

27%

Ages 65 plus

25%

SOURCE: “AMERICANS’ CHALLENGES WITH HEALTHCARE COSTS,” KAISER FAMILY FOUNDATION, DEC. 21, 2023.

O&P Almanac February 2024

32%

Ages 50-64 Ages 65 plus

36%

Happenings

MEE TING M A SHUP

Hanger LIVE Draws O&P Professionals to Nashville More than 1,500 Hanger employees, exhibitors, and speakers travelled to Nashville Jan. 22-25 to take part in Hanger LIVE, which offered educational and networking opportunities focused on the theme of “Next Level.” Attendees chose from 82 courses taught by 116 experts on topics including 3D scanning and printing; the use of outcomes in orthotics; and fitting and fabricating O&P devices. This year’s clinical keynote session featured Sonya Makhni, MD, MBA, MS, medical director of Mayo Clinic Platform, as well as several experts from the Hanger Institute for Clinical Research & Education: Shane Wurdeman, PhD, CP, FAAOP(D); Phil Stevens, MEd, CPO, FAAOP; Bretta Fylstra, PhD; and Molly McCoy, CPO. The group discussed how technologies such as machine learning and artificial intelligence are improving healthcare efficiencies and enhancing patient outcomes. Hanger’s annual Partner Awards recognized four partners for their roles in supplying products and services used to provide O&P

Hanger CEO Pete Stoy addressed the crowd at Hanger LIVE in Nashville.

Mayo Clinic Platform Medical Director Sonya Makhni, MD, MBA, MS, presented at the clinical keynote session.

care and improve patient outcomes: Aether Biomedical for “Rising Star,” Ottobock for “Collaboration,” Bio-Mechanical Composites for “Operational Performance,” and Cypress Adaptive for “Innovation.” The Hanger Foundation hosted a “Night to Inspire” event, presented by Access Healthcare, at the Country Music Hall of Fame. More than $500,000 was raised at the event; the funds will be used to provide grants to organizations that offer programs and services for people with physical challenges.

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February 2024 O&P Almanac

People & Places

PEOPL E IN T HE NE WS

BUSINE SSE S IN T HE NE WS

J. Chad Duncan, PhD, CRC, CPO, director of the O&P master’s program at Salus University, has been named to the Fulbright Specialist Roster for a tenure of three years. As a member of the roster, he is eligible to be matched with projects designed by host J. Chad Duncan, PhD, institutions in more than 150 countries globCRC, CPO ally during his tenure. Duncan anticipates his first assignment will be in Egypt in early 2024, where he will be a consultant at the New Cairo Technological University, working with the dean of industry and energy technology to help that program achieve the educational standards and curriculum development guidelines of the International Society of Prosthetics and Orthotics.

Allard USA has launched a central fabrication facility, SmartFAB, based in Chattanooga, Tennessee. “Expanding Allard USA’s portfolio and offering central fabrication services that will supplement our products ensures our customers receive the right solution to their custom fabrication needs,” said Diane Beesley, marketing manager at Allard. The 5,000-square-foot facility has been designed to assist clinicians in serving patients who have undergone partial foot amputations as well as patients using an Allard COMBO orthosis for genu recurvatum. “Our goal is to provide central fabrication services to assist facilities with their partial foot fabrication needs,” said Justina Appel, MD, director of education.

IN MEMORI A M Össur Kristinsson

Össur Kristinsson, founder of Össur, passed away Feb. 6. Kristinsson, who was born a congenital below-knee amputee, studied to become a certified O&P clinician in Sweden, then founded an O&P clinic in Reykjavik, Iceland, in 1971. Over the course of his long career, Kristinsson Össur Kristinsson had many accomplishments as a founder, inventor, and prosthetist within the O&P community. Kristinsson was honored with the AOPA Lifetime Achievement Award during the 2023 National Assembly. During the award presentation, Dave McGill, AOPA past president and vice president of market access and business alignment at Össur, spoke about Kristinsson’s accomplishments. Through trial and error, Kristinsson identified silicone as a skin-friendly material and added a locking mechanism, leading to the invention of the Iceross liner. Kristinsson later created the early version of the Össur Direct Socket, then helped deliver it to people around the world. After the devastating 2010 earthquake in Haiti, Kristinsson travelled to Haiti to provide care and train local healthcare providers on the technology, ensuring adequate follow-up care would be possible for Haitian amputees. “His legacy remains at the center of all we do,” McGill said during the Assembly. “His vision and entrepreneurial spirit captured the hearts and minds of his colleagues back in the 1970s. That vision and spirit remain in our company’s DNA to this day, propelling our growth into a global organization focused not only on prosthetics, but on noninvasive orthopedics and patient care as well.”

O&P Almanac February 2024

The Board of Certification/Accreditation (BOC) has added lymphedema/compression accreditation to its offerings. The new accreditation is being offered in response to CMS’s final rule regarding the Lymphedema Treatment Act and the news that Medicare Part B will now cover S04 lymphedema treatment items for certain patients. Fillauer Cos. has been working with UNBROKEN, Ukraine’s National Rehabilitation Center, to provide upper-limb prosthetic training. Michael Fillauer, CPO, LPO, president of Fillauer Cos., and Nathan Sprunger, MS, CP, clinical educator, travelled to Ukraine last summer to visit the rehab facility, meet with the mayor of Lviv, and determine how best to assist in Ukraine.

In December, Fillauer Cos. took part in a conference organized by the Government Office of Sweden and Swecare to focus on restoring Ukraine’s healthcare system. During the conference, Kevin Moore, president of Fillauer Europe, discussed the crucial role O&P companies can play in reintegrating Ukrainians with limb loss into society. Fillauer, Sprunger, and Christoffer Ramirez, CPO, travelled back to Ukraine in December to participate in a four-day workshop at UNBROKEN and share knowledge and skills with Ukrainian professionals, addressing the critical shortage of prosthetic specialists in the country.

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Reimbursement Page

BY JOE MCTERNAN

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Watershed Moment A new era dawns for microprocessor technology in prosthetics

n my almost 30 years of working for the O&P profession, there have only been a few occurrences that I would consider watershed moments. Some of these include the elimination of reasonable useful lifetime restrictions on prostheses and the recognition of O&P practitioners’ notes as part of the medical record. Jan. 18, 2024, represents another moment in O&P history that may permanently alter the delivery of O&P patient care, most definitely in a way that will positively impact the lives of the patients you serve. After many years of research on the benefits of microprocessor technology for patients classified as K2 ambulators, Medicare has published a proposed change to its Lower-Limb Prosthesis Local Coverage Determination (LCD) that, for the first time, will consider coverage of microprocessor 12

O&P Almanac February 2024

and hydraulic/pneumatic technology for both K2 and K3 ambulators. This is truly a seismic shift in coverage philosophy that will open this technology to a completely new population of Medicare beneficiaries who can benefit from the added stability and stumble recovery that microprocessorand hydraulic/pneumatic-based prosthetic components offer. This month’s Reimbursement Page takes an in-depth look at what the proposed policy does, which patient populations it will impact, and how O&P practitioners can work with their patients and referral sources to ensure that the technology is not only available, but also provided in a clinically responsible and ethical manner. To quote a memorable movie line, “With great power comes great responsibility.” This was meant for Peter Parker in “Spider-Man”

but very much applies to proposed policy changes that expand access to previously unavailable technology like microprocessor- and hydraulic/pneumatic-controlled prosthetic components. O&P practitioners and companies must be stewards of this increased accessibility and work with their physician partners to ensure that provision of this technology for K2 ambulators is well supported by clinical documentation in the patient’s medical record. Let’s start with a summary of the revisions in the proposed policy.

What Does the Proposed LCD Say?

The proposed LCD revision does not make any changes to the coverage criteria for K1, K3, or K4 functional-level ambulators. The proposed LCD revision includes updated

Reimbursement Page

language that expands Medicare coverage of Healthcare Common Procedure Coding System codes that describe microprocessor knees, pneumatic and hydraulic knees, and compatible prosthetic feet to include patients that are classified as K2 functionallevel ambulators when certain specific conditions are met. The specific conditions in the proposed LCD revision are as follows: 1. The beneficiary has had a clinical evaluation to determine their functional level (see Functional Levels section above); AND 2. Supporting documentation in the medical record outlines, in the context of the beneficiary’s overall medical health, the rationale for selection of a fluid, pneumatic, or electronic/microprocessorcontrolled knee, including (at minimum) how the selected knee will: a. Improve the beneficiary’s functional health outcomes (e.g., fall reduction, injury prevention, lower energy

expenditure); AND b. Help the beneficiary accomplish their activities of daily living; AND 3. All lower-level knee systems (e.g., knee systems [that] exclude use of fluid, pneumatic, or microprocessor) have been considered and ruled out based on the beneficiary’s specific functional and medical needs. In addition to the three criteria above, coverage for electronic/microprocessorcontrolled knees also requires that the following conditions be met: 1. The electronic/microprocessor knee is indicated for functional level 2; AND 2. The electronic/microprocessor knee has integrated technology that allows the knee to detect when the user trips or stumbles and can automatically adjust to stabilize the knee unit (e.g., stumble recovery); AND 3. The beneficiary is able to make use of a product that requires daily charging; AND

4. The beneficiary is able to understand and respond to error alerts and alarms indicating problems with the function of the unit. The proposed LCD also includes language that expands coverage for certain prosthetic feet to include K2 ambulators when the feet are integral to the proper function of the related hydraulic, pneumatic, or microprocessor-controlled prosthetic knee. The proposed LCD language is as follows: A microprocessor-controlled ankle foot system (L5973), energy-storing foot (L5976), dynamic response foot with multiaxial ankle (L5979), flex-foot system (L5980), flex-walk system or equal (L5981), or shank-foot system with vertical loading pylon (L5987) is covered when one of the following criteria is met: 1. The beneficiary’s functional level is 3 or above; OR

Ferrier Coupler Options! Interchange or Disconnect The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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

February 2024 O&P Almanac

Reimbursement Page

2. The beneficiary’s functional level is 2; AND a. Meets the functional level 2 coverage criteria for a fluid, pneumatic, or electronic/microprocessor-control addition for a prosthetic knee; AND b. A higher-level (i.e., functional level 3) foot is required for the safe and proper use of the prescribed knee system.

Which Patient Populations Will Be Impacted?

While it is obvious that K2 functional-level ambulators will benefit from the increased access the proposed policy revision creates, it is important to note that it does establish specific clinical conditions that must be met before K2 patients will be eligible for coverage of hydraulic, pneumatic, and/ or microprocessor-controlled knees and associated prosthetic feet. For years, O&P professionals have understood and promoted the increased stability and stumble control that higher technology prosthetic knees offer, especially for K2 patients, but research studies are now available that confirm this. The LCD reconsideration request that served as the conduit to the proposed policy revision included more than 30 clinical studies that showed the benefits of this technology for K2 patients who could benefit from additional stability and stumble recovery. It is important to understand, however, that the need for this additional stability must be well documented in the patient’s contemporaneous medical record. These records include not only those of the treating prosthetist but also the referring physician and any other members of the rehabilitation team. These records must corroborate each other and should not contain contradictory information. The proposed policy revision does not make any changes to the existing coverage criteria for K3 and K4 ambulators so there should not be significant impact on these populations. In general, hydraulic, pneumatic, and microprocessor-controlled knees and associated prosthetic feet will continue to be considered not medically necessary for K1 patients. While there is growing interest in exploring the benefits of this technology for all prosthesis users, current 14

O&P Almanac February 2024

clinical studies have primarily focused on the benefits to the K2 population.

documentation within the medical records of the patient.

Responsibility of the O&P Profession To Act as Proper Stewards of Technology

What Happens Next?

The proposed expansion of coverage to include certain K2 ambulators is an incredible opportunity to offer enhanced clinical care to some patients who may truly benefit from this technology. It would be inappropriate, however, to view the proposed policy revision as an opportunity to grow business through enhanced revenue opportunities. While higher-technology prostheses often cost more than more basic prostheses, potential profit should never be the driving force behind clinical treatment decisions.

The proposed expansion of coverage to include certain K2 ambulators is an incredible opportunity to offer enhanced clinical care to some patients who may truly benefit from this technology. Medicare prior authorization is required for all prostheses that incorporate microprocessor-controlled components so medical necessity will be required to be confirmed prior to provision of this technology regardless of whether it is for use by a K3 or K2 patient. Providers who view the proposed policy expansion as an opening of the proverbial floodgates of access will cause delays in the prior authorization process and unnecessary spikes in non-affirmation rates. This will only serve to fuel critics of the O&P profession and may lead to additional policy restrictions on coverage of current and future technology for all patients. While the proposed access to highertechnology prostheses is a welcome and necessary development, we must remember that as allied health professionals, there is a clinical and ethical responsibility to ensure the provision of the most appropriate prosthesis that best meets the clinical needs of the patient is properly supported by

As with any formal LCD revision, CMS and the durable medical equipment Medicare administrative contractors (DME MACS) must follow specific regulatory procedures prior to implementation of revised policies. These include publication of the proposed revisions, holding a public meeting to allow comments and input from the public, solicitation of written comments, publication of a formal response to all comments received, and implementation of the revised LCD. The proposed LCD revisions were published Jan. 18, and a public meeting was scheduled for Feb. 22, 2024. Depending on when you are reading this article, the public meeting may or may not have already occurred—but rest assured that AOPA will participate, or already has actively participated, in the meeting. Written comments on the proposed policy revisions must be submitted by March 2, 2024, and AOPA will submit official written comments. Once the public meeting is held and written comments submitted, it may take several months for formal responses to be published. It is expected that the final version of the revised LCD will be implemented sometime later in 2024. AOPA will follow this policy revision very closely and will work with the DME MACs and its O&P Alliance partners to ensure that the proposed policy revisions represent an expansion of coverage for technologies that will truly benefit the correct patient population. I opened this month’s Reimbursement Page with a message of hope and excitement, and I close it with the same. The proposed expansion of coverage for hydraulic, pneumatic, and microprocessor-controlled prosthetic knees and associated prosthetic feet truly represents a new era of clinical care for the patient population. Joe McTernan is director of health policy and advocacy at AOPA. Reach him at jmcternan@AOPAnet.org.

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Cover Story COVER STORY

BY CHRISTINE UMBRELL

BRIDGING THE WORKER GAP

How hiring care extenders and upskilling current employees can alleviate staffing challenges

O&P Almanac February 2024

Cover Story

he O&P profession received some good news Plus, not all O&P graduates become certified; not in January: The “orthotist/prosthetist” job was all certificants pursue full-time clinical roles; and ranked No. 16 in the U.S. News & World Report many are turning down positions that require on-call listing of “100 Best Jobs”—and No. 2 in “Best Healthor after-hours care. What’s more, some of the seats care Support Jobs.” Those rankings are encouragat the master’s programs are filled by international ing for stakeholders who want to see the profession students who may not practice in the United States. grow in visibility and attract potential students Within the current clinician population, attrition is to the career. But it doesn’t solve the immediate increasing as older clinicians retire and younger cliniproblem many facilities are experiencing of being cians leave positions in patient-care facilities, says stretched thin in terms of staffing—at all levels. Tamara Treanore, CO, director of the O&P Assistant O&P employers across the country are facing Program at Oakland University. During the AOPA employee hiring and retention challenges: The most Leadership Conference in January, several attendrecent data from the U.S. Bureau of Labor Statistics ees shared stories of high levels of burnout from indicates there were 9,500 orthotist/prosthetist jobs clinicians who are just entering the field, according to in 2022 and projects that the profession will grow Treanore. “This is a huge concern. We’re seeing many 15% by 2032, which is “much faster than average” people moving into academia [from patient-care posiemployment. Data from the National Commission on tions] because they are getting burned out. There’s a Orthotic and Prosthetic Education (NCOPE) confirms big departure on the clinical end.” a need for more O&P professionals (see Big-Picture Solutions sidebar on page 20). The O&P master’s programs have It’s not just certified clinicians who are been increasing the sizes of their annual in demand at patient-care facilities: cohorts, but other factors at play indicate “There’s a critical need at all staffing the clinician pool is insufficient to meet levels,” says Sisson. One solution may future demand. “Just because someone’s be to evaluate overall facility needs and in school right now doesn’t mean they’ll think creatively about employees who be a full-time clinician” immediately after Lesleigh Sisson, CFo, CFm can help fill the gaps. graduation, explains Lesleigh Sisson, Specifically, Sisson points to the need for CFo, CFm, president at OrthoPro Carson City, founder more care extenders—such as assistants, technicians, of consulting firm O&P Insight, and an AOPA board and fitters—to support clinicians with their workloads. member. “If they are starting their master’s program “Effective and appropriate use of care extenders or now, it will be five to seven years before they’re scribes [to assist with documentation] is very importready to be a full-time productive clinician.” ant,” she says.

NEED TO KNOW:

f Despite a growing need for

orthotic and prosthetic services, O&P businesses across the country are facing hiring and retention challenges for clinical positions as well as technical and administrative roles.

f The profession is seeing increased

attrition via both retirements of older clinicians and reports of younger clinicians choosing to leave positions in patient-care facilities.

f Some facilities are finding value in employing care extenders, such as assistants, technicians, and fitters, to support clinicians with their workloads.

f “Upskilling” staff via training

programs and development opportunities is another way to expand current employees’ capabilities and help minimize skills gaps within facilities.

f Providing support and training

opportunities for staff members to become certified pedorthists or mastectomy fitters can expand a facility’s offerings and boost the company’s value.

f O&P professionals can do their part

to raise awareness of the profession by reaching out to high school and college students about the many pathways to joining the profession.

February 2024 O&P Almanac

Cover Story

Trends in Student Enrollment and Residencies Offer Insight Into Clinician Shortage A study by Dobson & DaVanzo on demand for O&P schools and an increase in the capacity at existing professionals, commissioned by the National Commisprograms grants the ability to enroll an addision on Orthotic and Prosthetic Education (NCOPE) in tional 158 students today compared to 2014, 2015, projected that, by 2025, demand will increase to according to Robinson. “This is a 54.7% increase 20,504 O&P providers—while only 12,775 credentialled in master’s program enrollment capacity over professionals will be available. That equates, accordthe past decade,” he says. That increase could ing to Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), be helpful in addressing workforce demand, but clinical resource director of NCOPE, to a demand ratio “it is still less than the 60% increase in supply Chris Robinson, MS, MBA, of 1.6. required by 2025 to meet the anticipated demand CPO, ATC, FAAOP(D) Some recent developments in education and trainprojected by Dobson & DaVanzo.” Another caveat: ing are showing promise for boosting the numbers “The O&P education programs do not always of certified clinicians. For example, during the 2015 study, the fill 100% of the seats available, and the programs sometimes number of orthotic and/or prosthetic residents starting their have a small amount of attrition between the first day of class first residency was only 231 residents; by 2023, that number had and graduation.” grown to 304 residents. On a positive note, the percentage of master’s level graduates “Given that the residents of today are the future certified that achieved positive placement—landing a job as a resident or practitioners of tomorrow and the number of persons enterin the O&P profession or pursuing additional training in a related ing their first residency is trending upwards, these future CPOs field, such as a doctorate in rehabilitation science—“has been help address increasing demand hypothesized by the [Bureau of quite high, even with a steady increase in the number of seats at Labor Statistics] and the Dobson & DaVanzo workforce study,” the schools,” says Robinson. “More than 98% of master’s level says Robinson. graduates achieved positive placement since 2019-2020, and I’m And while the number of orthotist/prosthetist education optimistic the data being captured for 2022-2023 academic year programs has increased modestly, the combination of additional will be just as positive.”

“The on-ramp to become a certified prosthetist-orthotist is long. It requires formal secondary education with an extensive residency period. However, the field has created shorter on-ramps that open the door to interacting with patients in a meaningful way,” says Phil Stevens, MEd, CPO, FAAOP, vice president of clinPhil Stevens, MEd, CPO, ical affairs at Hanger. “Individuals that FAAOP are currently involved in the technical or administrative aspects of our field can pursue certifications as fitters and assistants. Those pathways are structured but much less onerous.” O&P assistants, in particular, can have a significant impact. Some facilities are taking note of the physical therapy (PT) practice model, in which PT assistants have become a critical component of many successful—and profitable—PT businesses. Individuals can become certified O&P assistants by the two O&P credentialing agencies, ABC and BOC. ABC defines an ABC-certified assistant as someone who, “under the guidance and indirect supervision of the ABC-certified practitioner … may perform orthotic and/or prosthetic procedures and related tasks in the management of patient care. This includes fabrication, repairs, and maintenance 20

O&P Almanac February 2024

of devices to provide maximum fit, function, and cosmesis that reflect the level of education and training received.” Treanore, who directs the only CAAHEP-accredited O&P assistant educational program in the U.S., notes that not enough O&P facilities hire assistants. “We are working to be integrated into this field but are meeting with some challenges,” she says. Hiring assistants “directly addresses the burnout our clinicians are experiencing. A burned-out clinician who is offered more money but who doesn’t want to or cannot work extended hours” might welcome the opportunity “to share the demands of patient care” with an assistant on staff. There are several pathways to becoming an assistant: One option for students is to attend the accredited program at Oakland University where Treanore works—this pathway also permits students to graduate with a bachelor’s degree in exercise science. In a less formal pathway, some established assisTamara Teanore, CO tants simply follow the steps outlined by the credentialing agencies and train at the facilities where they are employed, says Treanore. “Assistants have the potential of solving the problem of too many demands on a clinician at multiple levels,” says Treanore.

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“Incorporating well-trained assistants into busy O&P practices provides support for the clinical team’s needs and expands the patient-care scope, reducing stress and demand on clinicians and improving patient satisfaction.” Facility leaders also should consider ramping up hiring of technicians. Technicians were named the O&P professionals in shortest supply, relative to demand, in a Dobson & DaVanzo study commissioned by NCOPE a few years ago, says Chris Robinson, MS, MBA, CPO, ATC, FAAOP(D), clinical resource director of NCOPE. That same study projected the need for technicians would increase by six-fold, a demand O&P technician programs have been unable to provide, says Robinson. Another impediment is the fact that the number of accredited O&P technician programs has dropped from six to four over the past decade.

Upskilling

Regardless of whether employees are clinicians, care extenders, or even administrative staff, they may all benefit from upskilling— undergoing training programs and development opportunities to expand their abilities, a practice that could help minimize skills gaps within facilities. The concept of upskilling “resonates with the core values of the O&P profession, providing the current workforce additional knowledge and skills to meet the needs of the patients we serve,” says Robinson. Some facilities have had success at hiring from outside the profession and providing on-the-job training. At a patient-care facility Sisson previously owned, “we hired two PT technicians,” says

Sisson. After exposing them to the various aspects of the O&P profession, “one excelled at the technical part, and one is now an orthotic fitter” and is taking on assistant duties, she says. Hiring office staff and administrators who have the capacity to upskill and learn the intricacies of the O&P reimbursement process is another helpful strategy, says Sisson. “There’s a lot of turnover in office staff and admins who don’t understand the rules, or who make mistakes regarding compliance,” she says. “Make sure you offer the appropriate professional development to these staff members.” Some administrative staff may welcome opportunities to advance to more hands-on jobs, such as fitters or even assistants, says Sisson, so companies should ensure such individuals receive the training required by the credentialing agencies to become certified. At her former patient-care facility, Sisson explains they “hired an individual as a part-time inventory specialist [who] had a desire to help with clinical care. She became an assistant, then earned mastectomy and orthotic fitter certifications.” Sisson also suggests that facilities support staff members in taking pedorthic courses to become certified pedorthists. “Offering pedorthic services at your facility boosts your company’s value.” In addition, O&P facilities may offer upskilling opportunities to ensure staff members stay current on new technologies and to ensure the long-term business viability. Sisson recommends training employees in scanning, 3D printing, and even proper use of electronic health record systems to maximize their potential.

The Shifting Role of the O&P Technician Technical skills are in high demand, but the role Wright suggests facilities look both inside and of the O&P technician is changing. “The role of outside the O&P world to hire entry-level technicians, the technician fabricator is going to be needed fabricators, and 3D printing specialists, and then more than ever,” even though the numbers ensure they receive the appropriate O&P-specific of available technicians are decreasing, says training. In particular, many engineering students— Brent Wright, CP, BOCO, a clinician at Eastsuch as those pursuing industrial engineering and Point Prosthetics and Orthotics and co-owner mechanical design degrees—and even some students of Advanced 3D, a contract manufacturer of pursuing two-year associate degrees are learning Brent Wright, CP, BOCO 3D-printed devices. 3D printing skills. He suggests hiring such individWright believes many would-be techniuals and training them to serve as an extension of cians are choosing other professions to avoid the occupational your clinical team. “These upskilled technicians could help see hazards associated with a fabrication lab, such as the resins and patients as care extenders,” following the rules set forth by ABC, fumes associated with carbon fiber and other materials assoWright suggests. ciated with traditional fabrication methods. “We need to look at O&P facilities also may consider some non-engineering alternative ways to make devices,” Wright says. students for technical roles. In fact, at EastPoint and Advanced New fabrication methods that leverage additive manufactur3D, one of their best designers “has a degree in psychology and ing, ready-made components, and thermoplastics lead to less Hispanic studies—but he had extensive experience in 3D printing toxic fabrication labs, says Wright, so O&P professionals should for cosplay, which is also ‘designing for the body,’” says Wright. become familiar with those options—and hire and train employ“He has developed a passion for the field, and he enjoys leveragees accordingly. ing his skills” to aid in O&P patients’ mobility journeys.

O&P Almanac February 2024

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It’s a good time for O&P stakeholders to build on the recognition of the orthotist/prosthetist profession and potentially build a larger pipeline for the future. “ABC is doing a great job with the #WhatIsPOP? Program,” says Sisson. “We have to really start with the high schools and talk to guidance counselors” to ensure students know O&P professions are options. “There are so many pathways to joining the profession.” Robinson agrees that educating others about the many O&P-related job opportunities will be critical to the viability of the profession. “Increasing awareness to our communities about our profession—including entry-level positions that do not require enrollment in a formal education program—is often the first step an aspiring O&P professional takes. Gaining information and valuable real-world experience in the O&P profession will hopefully put that person on a path that results in a long-term career that benefits countless patients.” The onus will be on O&P owners and executives to ensure they are hiring appropriate candidates, providing advancement opportunities, and upskilling as new technologies require new competencies, says Sisson. “It all comes back to leadership: Is the leadership of our profession ensuring they’re caring for their teams? Are they giving their staff opportunities for advancement? “It’s important for O&P leaders to refine their leadership skills,” adds Sisson. “Refine job descriptions, offer advancement, and compensate competitively to reflect the skills your employees have developed.” Molly Null, left, patient liaison and director of marketing at Action Prosthetics, meets with a patient.

Sourcing From the Patient Base Sometimes, it makes sense to consider patients for the job. At Action Prosthetics in Ohio, for example, Molly Null was recruited by owner Karl Burk, CP, to become the patient liaison/director of marketing eight years ago. Null, a former first-grade teacher who lost both legs and two fingers in 2008 after strep throat turned septic, was unable to work as a teacher due to a compromised immune system. After Burk had been her clinician for seven years, he contacted Null to consider applying for the open position at Action; he had been impressed with her outgoing personality and her diligence in organizing an amputee support group. Null’s presence in the facility, along with her representation when conducting outreach to referral sources, have proven beneficial for Action. “When I meet patients and families, I can help change their outlook on their journey,” she says. “I explain that life will be different, and it can be harder. But they also see what I’m capable of,” and she explains how Burk’s prosthetic skills have restored her mobility—a particular challenge given her bilateral limb loss and short residual limbs. “There’s a credibility to talking to someone who wears a prosthesis,” she says. Null’s life experience also informs the social media initiatives she creates. And it’s possible Null will one day upskill to a more technical position at the facility: “Karl would love for me to get my technician certification,” she says. 24

O&P Almanac February 2024

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

Upskilling in O&P Business Management Pursuing a Certificate in O&P Business Management is one way for O&P professionals to build their business acumen. The certificate is offered at the University of Hartford’s Barney School of Business through a partnership with AOPA. The comprehensive program offers a series of business and management courses to provide business owners, managers, clinicians, and representatives from manufacturers and distributors an opportunity to explore O&P business challenges. The curriculum covers finance, sales, marketing, business operations, reimbursement policies, and management. “The Certificate in O&P Business Management is a unique leadership experience that provides an opportunity to learn fresh insights, new tools, and proven techniques for developing better business practices, all with the goal to help improve the individual’s place of business,” says Eve Lee, MBA, CAE, executive director of AOPA. To learn more about the business certificate, visit AOPA’s website. PHOTO: MOLLY NULL/ACTION PROSTHETICS

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Transformations

Trauma Recovery Virginia prosthetist helps a patient start over after a tragic car accident, limb salvage surgery, and decision to amputate

Phillip Call, CPO

The Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Phillip Call, CPO, about Ashley Holdren, who lost a child and ultimately lost a limb after a 2019 car accident.

Ashley Holdren, who was severely injured in a car crash, chose amputation of her right leg below the knee after limb salvage surgery failed to ameliorate her pain.

O&P Almanac February 2024

or 39-year-old Ashley Holdren, the decision to undergo amputation of her right leg below the knee in 2021 was one of the easier decisions she’s had to make over the past few years. The surgery was the culmination of two years of pain and distress in her foot—but just one of 20 surgeries she has endured since 2019, when she survived a horrific car accident. “It was a very tough situation,” says Phillip Call, CPO, who fit her with a prosthesis right after amputation. Call joined Virginia Prosthetics & Orthotics six years ago, after earning a bachelor’s degree in management at Virginia Tech and a master’s in O&P at the University of Pittsburgh School of Health and Rehabilitation Sciences. He currently serves as team lead and clinical manager at the Roanoke office. The sheer volume of surgeries and injuries Holdren was still recovering from made

fitting Holdren with a prosthesis an even more challenging task. “She had to endure several reconstructive surgeries,” says Call. But he worked closely with his patient and took both her physical and emotional state into consideration to provide Holdren with a critical step in returning to an active life.

Unimaginable Trauma

Four years ago, Holdren, a single mother, suffered a seizure while driving with her two children in Bedford County, Virginia. During the crash, her 6-year-old daughter, Grace, lost her life, and her then-8-yearold daughter, Hope, survived with injuries. Call was first introduced to the family when he fit Hope with orthoses for two broken femurs. The next 10 days post-accident were a blur for Holdren, as she was in and out of consciousness. Her own mother suffered a PHOTOS: PHILLIP CALL, CPO; SANDRA FIKE PHOTOGRAPHY

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Holdren, who lives with her daughter in a rural area in Virginia, plans to take dance lessons in the near future.

heart attack that day upon learning of the accident, and Holdren was unable to see Hope because she was being treated in a different area. “I woke up in the hospital but didn’t wake up to anyone in my family,” she recalls, although friends came to stay with her. “The doctor and chaplain came in” to explain what had happened. Holdren was utterly distraught. In addition, Holdren was in immense pain. Her injuries included an open pilon fracture, an open fracture in her right leg, a broken leg, ankle wounds, a heel fracture, spinal and neck injuries, and more. Her right leg was severely damaged, but “the doctors wanted to try and save it because I had already lost so much,” recalls Holdren. PHOTO: SANDRA FIKE PHOTOGRAPHY

“They tried to build my right foot back up” via reconstructive surgeries, Holdren recalls. Once she was discharged from the hospital, she tried to navigate life with her left leg slightly injured and her right leg causing her immense pain. “When my cast came off, I had two fracture blisters that had turned black. When I tried to walk, I felt like I was walking on a screw,” she recalls. “Then my foot started to turn in. The only shoes I could wear were Adidas slides.” After almost two years of trying to navigate life in such pain, “I made up my mind that I was ready for amputation,” she says. “I didn’t want to live like that for the rest of my life.”

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February 2024 O&P Almanac

Transformations

Living With Amputation

it works. “The kids call me a ‘robot’ and think the prosthesis After undergoing amputation is the coolest thing ever!” she surgery, Holdren felt a sense says. “I teach the kids we are all of loss, but she was excited for different in our own ways. I try a future with less pain. “I had to have a sense of humor” and prepared myself that [ampupositive attitude each day. tation] would happen at some Now that she is acclimated to point, so I already felt prepared,” her prosthesis, Holdren has set she recalls. “Then I met Philtwo new goals: First, she plans lip [Call], and remembered he to return to driving. “I haven’t had put braces on my daughter” driven since the accident, and after the car accident. “He has we live in a very rural area” been terrific,” she says. without access to Uber or public Holdren, shown here with her daughter, says prosthetic care from Virginia P&O Call initially fit Holdren with a has contributed to a “second chance at life.” transportation. Holdren has preparatory prosthesis consistrelied on family members to ing of a direct socket with the drive her to work and to obliÖssur Balance S foot. “That was to see (OT) to practice activities of daily living gations with her daughter. “At first I was where she would progress before getting with the new foot—relearning how to scared to drive, but I want to have my life a more active prosthesis,” says Call. “She balance, stand in the shower, and don her back.” She consulted with Call, as well as was physically fit enough” to learn to ambu- prosthesis quickly. her doctors, neurologist, and eye doctor, late with a new prosthesis quickly; Holdren Call has worked closely with Holdren to and was given the go-ahead to pursue her was up and walking by April 2021. fine-tune her alignment. “Her sound-side license. Wearing her prosthesis, she has Holdren eventually transitioned to a limb, postsurgery, is internally rotated,” completed a driver’s education course led definitive prosthesis: a suction prosthehe says, so he has adjusted to make sure by an OT specialist, and she is just waiting sis with the ProFlex Pivot, which offers her toe looks more natural while walkfor paperwork from the Virginia Depart“a lot of motion, is very durable, and ing. Holdren experiences some of the ment of Motor Vehicles. allows for extra dorsiflexion on uneven “expected” issues with her prosthesis, Her second goal is to dance. “I danced surfaces,” says Call. These attributes are such as shrinking of the socket and holes when I was younger,” she says. “This fall, critical for Holdren, who spends time on in her suspension sleeves, but overall has I will take ballet and lyrical dance at an a farm and has returned to her work as a had a good experience. “The psychologadult dance center,” she says. substitute teacher. ical aspect has gotten better,” says Call. “Virginia P&O has gone above and Ensuring coverage for this device “She’s still getting back to normal life with beyond, and Phillip has been a great was difficult, according to Call: “I took a her daughter.” prosthetist,” says Holdren. Call’s care chance—thankfully—based on her goals Holdren experiences occasional phanhas contributed to what Holdren calls her and functional level, to justify doing [this tom “sensation” after periods where she “second chance at life.” type of prosthesis] for her because she was has walked excessively, but she uses Call says he is grateful for the experihaving issues on uneven ground,” he says. legwarmer massagers and her own ence of working with Holdren: “I am a very In addition, Call says the direct socket “was version of mirror therapy to manage those family-oriented person, and I put myself in a great tool that I utilized to fabricate her feelings. With her intense pain in the past, Ashley’s shoes—I simply could not imagine socket.” Holdren’s patella was removed Holdren has just one regret about her how hard this has been and will continue to from the car accident “so I knew it was very amputation: “I wish I would have done it be for the rest of her life,” he says. “I really important to have a true total-surfaceway sooner,” she says. “I feel so strong feel for her and want nothing but the best bearing socket. with this [prosthetic] leg. It was the best for her and her family.” “This foot has allowed her to re-gain her decision I ever made.” DO YOU HAVE A TRANSFORMATIVE life,” says Call. “These are the patients that PATIENT-CARE EXPERIENCE YOU’D remind me of why I got into this profession.” New Life, New Goals LIKE TO SHARE WITH O&P ALMANAC “I’m the first in the area” to have this Equipped with her advanced foot, READERS? Contact Editor Josephine Rossi, type of foot, adds Holdren. “It moves up Holdren has returned to work as a jrossi@contentcommunicators.com, and down like a natural foot, and I can substitute teacher. She is patient with the with your story to be considered for an even wear a little bit of a heel with it.” She elementary-aged children, teaching them upcoming profile. worked with an occupational therapist about her prosthesis and explaining how 28

O&P Almanac February 2024

PHOTO: ASHLEY HOLDREN

Adjustable djustable Post-Operative A Post-Operative Preparatory reparatory P Prosthetic rostheticSSystems ystems P

APOPPS APOPPS

® ®

Home of the original flexible clamshell side-specific anatomic RRD Home of the original flexible clamshell side-specific anatomic RRD

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TransTibial Adjustable Post-Op Adjustable Post-Op Preparatory Prosthetic System Prosthetic System

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TheSOFTIE™ SOFTIE™isisconstructed constructedof of The firm but flexible Pelite, and firm but flexible Pelite, and comes with with an an anatomicallyanatomicallycomes correct posterior strut, Velcro® correct posterior strut, Velcro® compatible neoprene neoprene bands bands compatible anda aset setofofdistal distalpads. pads. and

This three-part three-part post-operative This post-operative preparatory prosthetic system preparatory system allows the Prosthetist to provide allows the provide continuum of of care, aa continuum care, from from the the time of amputation, through time of amputation, through early weight weight bearing, bearing, until early until the the patient is ambulating patient is ambulating indeindependently. pendently. All three three sockets sockets are All are part part of of aa system that that takes takes patients system patients from from post-op to definitive prosthesis. post-op to definitive prosthesis.

Minimizes Minimizesthe theeffects effectsofofpotenpotential tial injury injuryduring duringboth bothearly earlyand and preparatory stages of rehabilitapreparatory stages of rehabilitation. tion.Adjustable, Adjustable,accommodates accommodates for compression for compression and and swelling. swelling. Permits measured and Permits measured and concontrolled trolled weight weight bearing, bearing,through through early earlyambulation. ambulation. Bridges Bridges the thegap gapbetween betweenpostpostop and definitive prosthesis. op and definitive prosthesis.

Aneconomical economicalalternative alternative prepreAn fabricated prosthetic socket fabricated prosthetic socket Soft,non-constricting, non-constricting, easy easy to to Soft, removefor forwound woundconcerns. concerns. remove

Contact FLO-TECH FLO-TECH ® Contact

 info@1800flo-tech.com info@1800flo-tech.com  1-800-356-8324  1-800-356-8324  www.1800flo-tech.com www.1800flo-tech.com 

Member Spotlight

BY DEBORAH CONN

FACILITY:

OWNER:

LOCATIONS:

HISTORY:

Goal Pediatric Orthotics

David Patterson, CO, LO

Pleasant Grove, Utah; and Phoenix

Five years

Pediatric Niche Facility focuses on providing orthoses to young patients

The facility is designed to be attractive and safe for pediatric patients.

The team at Goal Pediatric Orthotics

Why I’m an AOPA Member “I am a member of AOPA so I can access all the benefits they provide, including continuing education, reimbursement/coding seminars, and updates on relevant legislation.” —David Patterson, CO, LO

O&P Almanac February 2024

avid Patterson, CO, LO, knew from an early age that he wanted to work with young people. “My first job was with a nonprofit that served youth and youth at risk,” he says. “I wanted to continue that.” He volunteered at a Shriners hospital while taking pre-med classes in college. “I walked out of the orthotics lab knowing exactly what I wanted to do,” he recalls. “I just fell in love.” Patterson became an orthotist and, after a few years of practice, decided he wanted to open his own facility. “My father told me that whatever I did, if I found a niche, I would become extremely successful, whatever that niche was. I decided to give it a real go.” He launched Goal Pediatric Orthotics in 2018, moving to his wife’s hometown in Utah, a location with a need for pediatric bracing. “When I first started, it was just me,” he says. “We now have two locations—one that covers most of Utah, and another that serves the greater Phoenix area—as well as five full-time and two part-time clinicians and about a dozen administrative staff members.” Goal offers a full range of pediatric orthoses, focusing on lower-extremity devices. About half the patients are special-needs children, including those with cognitive delays as a result of diagnoses like cerebral palsy, spina bifida, and Down syndrome. “We see children from infants to teens, but we don’t turn patients away,” Patterson says. “If we get a referral for a 21-year-old, or an existing patient ages out, we will treat them.” Patterson’s team works closely with pediatric rehabilitation professionals to achieve outcome goals. “Implementing outcome measures is at the top of our list, but we’ve been growing so rapidly—we’re doing all we can to keep up at this point,” he says. “We just opened our first clinic with a gym space and rehab room, where we are really excited to focus on outcomes.”

Patterson is a fan of new technology, leveraging digital scans and computer-aided design to produce devices. “We’re doing a lot more in the 3D printing space, and we work with all the major pediatric manufacturers,” he notes. “We have helped them design new products, including 3D-printed toe-walking supramalleolar orthoses and dynamic stretching ankle-foot orthoses (AFOs).” One of Patterson’s favorite stories about a patient involves a family who, with five children of their own, adopted 1-year-old twins. One of the twins has quadriplegic cerebral palsy and, at 2, had been unsuccessful at weight bearing. “She could sit up with assistance, but she wanted to do things,” Patterson says. “We were able to assess her, and when we fit her with dynamic AFOs and a compression thoracolumbosacral orthosis, she stood for the very first time to reach toys on a couch. Her mom and I just lost it! All the kids came in, and that baby was so excited to stand on her own to play with the toys.” Patterson has a long-standing interest in helping underserved children. He and his father worked with other board members to establish a nonprofit called Children’s Mobility Partners. The group contributes orthotic devices and physical therapy equipment to children whose families cannot pay, and Patterson donates his services. “One child came from Guatemala for intensive physical therapy services, and we were able to help pro bono,” he says. “Another family we helped had just moved here from Venezuela and had no insurance.” In all cases, Patterson says, “We are trying to provide the best pediatric care out there.” The company’s logo includes three stars in ascending size. These symbolize the past, present, and future and reflect the company’s slogan: “Learn from the past, live fully in the present, look brightly to the future.” “Whether parents or kids are dealt a hard hand, it’s easy to get stuck in the past,” explains Patterson. “In the time we have with them, we are here to help them pave a path to a brighter future.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTO CREDITS: GOAL PEDIATRIC ORTHOTICS

MAKING YOUR FOOTPRINT SMALLER

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

At Hersco, our first priority is to fabricate custom orthotics accurately and precisely. We have mastered the art of accepting scans and 3D printing to deliver better orthotics for your patients and the environment. 3D printing is not only environmentally friendly, but allows us to specify modifications that were not possible before.

BUILT ON TRUST.

Member Spotlight

BY DEBORAH CONN

COMPANY:

OWNER:

LOCATION:

HISTORY:

NuTech Synergies

Mark Ford

Indianapolis and Jamestown, Ohio

One year

Aiding the Innovators A socket fitting for Amparo Prosthetics, one of NuTech’s technology partners

NuTech Introduced its services at a booth during the 2023 AOPA National Assembly.

Why I’m an AOPA Member “We believe that AOPA provides helpful services to both patient-care practices and product manufacturers. AOPA’s ability to drive the lobbying efforts in Washington, DC, are critical for the future success of the O&P profession.” —Mark Ford

O&P Almanac February 2024

New company helps O&P product developers test and market devices

ark Ford, formerly head of the O&P company Catdaddy Consulting, has expanded his team, developed more services, and created a new firm: NuTech Synergies. NuTech focuses on helping innovators get their new ideas and technologies into the hands of O&P clinicians to improve patient care. Ford’s background includes years of working at WillowWood, Touch Bionics, and OPIE Software, as well as helping to lead a multilocation patient-care facility in New York. That varied experience helped him find a business niche and a path in his new career. “It became clear to me that early-stage product and technology development companies all need similar things and face similar pressures. They are doing a great job of solving very specific patient needs in orthotics or prosthetics, but they lack the resources to test and market their devices,” he says. “The NuTech team’s job is to help them take these innovative ideas and turn them into successful products that can help lots of patients.” Smaller innovators may have trouble affording a testing venue, marketing expertise, regulatory guidance, and a sales force—all critical elements in successfully launching a new product, notes Ford. NuTech offers a team of 11 experts, including clinicians, salespeople, practice managers, and reimbursement experts. NuTech recently opened a research facility in Indianapolis, along with a small patient-care facility, where innovators have access to a pool of patients and can share the costs of testing their new ideas. “We opened the clinic in September and already have more than 30 patients who are interested in trying new things,” says Ford. “We also conduct clinical research with academic institutions. We supply the clinicians and the patients, and we follow the university’s protocols. The universities analyze the data, and together we can present on these new technologies and patient-care concepts.” NuTech is working with several technology partners, including Amparo Prosthetics and a UK company called 2PD Ltd. It is also working with Nabtesco, an established Japanese firm that is

working to increase awareness of its unique prosthetic knees. The company’s strategy is based around working with technology partners who have noncompetitive products. Says Ford, “With our approach, our tech partners can cooperate and even collaborate with one another while sharing costs. In one situation, we have three of our tech partners all included in the same research study. They each bring a different element to our understanding of patients and gathering quantitative data.” NuTech seeks out O&P facilities to try new devices and integrate them into their practices. “We know a number of facilities who are serious about being innovative leaders in their markets and are willing to take the time and effort to master new technologies,” explains Ford. “A core group of early-adopter practices can learn about these new technologies, try them with an open mind, and provide consistent feedback.” As technology continues to advance, NuTech sees its larger role as finding ways to quantify the effects of orthotic and prosthetic solutions. “We need to go beyond a description of what we provide and show that our services and technologies improve the daily lives of the patients we serve,” Ford says. “The O&P community is treated like durable medical equipment providers because we don’t have enough data to prove how we are medical professionals. That’s where the field has to evolve.” Ford believes that O&P must create protocols for what it does, defining the steps and processes of patient care, and how new technologies fit into patient-care protocols. “Proving new ideas has historically been the space for the larger companies in our profession, but we need to find ways to allow a wider range of companies to be successful in developing new solutions for our patients,” he says. “Our goal at NuTech is to create a systematic approach to nurturing younger companies’ ideas, helping them to quantify the value of their technologies and to bring their innovations to market.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTO CREDITS: NUTECH SYNERGIES

AOPA News

SEPTEMBER 12-15, 2024 | CHARLOTTE, NC

Save the Date

AOPA Policy Forum Join AOPA in Washington, DC, to advocate for the profession April 15 and 16 | Washington Marriott Capitol Hill Washington, DC Join forces with other O&P professionals to advocate on behalf of the profession—and your patients! The Policy Forum is your opportunity to learn about the latest legislative and regulatory issues and how they will affect you, your business, and your patients. Don’t miss this chance to educate members of Congress about the importance of O&P care for patients living with limb loss/difference and limb impairment. Visit the AOPA website for details.

AOPA Quick Coder Available Now! Purchase the newly published 2024 AOPA Quick Coder to stay current on O&P coding. A speedy reference to the HCPCS codes for all orthotic, shoe, and prosthetic codes and modifiers, the Quick Coder also provides references for inpatient billing and off-the-shelf vs. custom-fit coding. Changes to the codes are now being made on a biannual basis. If a change is made during the year and you have purchased the Quick Coder, AOPA will notify you. This will ensure your Quick Coder remains up to date throughout the year. The cost is $30 for members and $80 for nonmembers. Visit My AOPA Connection or the AOPA website to purchase. Contact info@aopanet.org with any questions.

Mark your calendar for the AOPA National Assembly in September The 2024 AOPA National Assembly, with a theme of “Ignite 24,” takes place Sept. 12-15 in Charlotte, North Carolina. Plan now to attend this year’s Assembly.

• • • • •

Why attend? Earn continuing education credits Hear from physicians, researchers and top-notch practitioners Participate in hands-on learning and demonstrations Network with an elite and influential group of professionals Explore the largest O&P exhibit hall in the western hemisphere, featuring devices, products, services, tools, and the latest technology from exhibitors around the world. Call for Papers Submit your proposal by March 30! For details, visit aopanet.org/2024-national-assembly.

Questions? Contact AOPA at 571/431-0876 or email assembly@aopanet.org.

FUN FAC T Charlotte’s NBA team is called “The Hornets,” and area police vehicles feature a hornet’s nest logo. Why? In 1780, British General Charles Cornwallis marched his men through the city, where they encountered firm resistance. He’d go on to call Charlotte “a hornet’s nest of rebellion.”

February 2024 O&P Almanac

AOPA Members

Welcome New AOPA Members 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.

BrainRobotics 1826 Kramer Lane, Ste. A Austin, TX 78758 512-740-1597 brainrobotics.com Brian Long Supplier Startup

Phoenix Rising Prosthetic Orthotic Service 330 W. Colfax Street, Ste. 100 Palantine, IL 60067 847-865-1270 phoenixrisingpo.com Sandra Schechner, CPO Patient-Care Facility

Be Part of the

GET PAID, SAVE, STAY INFORMED, GROW YOUR BUSINESS…

Join AOPA

Visit AOPAnet.org/join for more information.

CHANGE

Superfeet Rx 1820 Scout Place Ferndale, WA 98248 superfeet.com/rx 844-274-7064 Chris Patton Supplier Startup

Join the AOPA Community

ProComp® – Make What You Want Bench Proven Thermoplastic Composite Technology • Reimbursements for prosthetic & orthotic L codes • 25% increased stiffness over standard polypropylene • Available in cut-to-size blanks

fabwithprocomp.com US Pat. # 8088320 Inventor: Gary G. Bedard

O&P Almanac February 2024

Marketplace

HAVE A PRODUCT OR SERVICE FOR MARKETPLACE? Contact Bob Heiman at bob.rhmedia@comcast.net.

ToeOFF® 2 ½ & BlueROCKER® 2 ½ Now offering more Allard AFOs with half the heel height. All 2 ½ models include choice of wraparound or D-Ring straps, shorter wings, and a Starter SoftKIT™ included. It is easier to adapt ToeOFF® 2 ½ & BlueROCKER® 2 ½ to shoes with lower heel heights because there is a lower forefoot curvature and more space in the shoe toe box. ToeOFF® 2 ½ Addition models available in camouflage, birch, and black. Call 888-678-6548 or email info@allardusa.com to receive your free Product Selection Guide.

It’s about comfort and natural gait. Can you kneel?

Can you walk backwards?

Can you stand up with both feet on the ground?

Can you walk on uneven ground?

www.coyote.us/dynamicstruta

Coyote’s Dynamic Strut Coyote’s Dynamic Strut was designed with varying thicknesses to flex and move, helping the patient navigate real world conditions. The strut excels at creating a comfortable natural gait for daily use, walking, working, hiking, biking, and golf. It works great with a thermoformed orthosis and provides the needed energy response. Comfortable natural gait Works great with thermoformed braces Provides energy response New smaller size available Contact Coyote at 208-429-0026 or coyote.us.

• • • •

Cypress 4-Hole Tie-In Plate With Aria Expulsion Valve Insert The Cypress 4-Hole Tie-In Plate with Aria Auto-Expulsion Valve insert is a versatile, simple, and reliable system for passive suction suspension for transtibial and transfemoral suction sockets. Its distal mount design offers a streamline, cosmetic option without the bulk of a standard socket-wall mount suction valve. The Aria Auto-Expulsion Valve insert is fully serviceable with replacement parts available if needed. For more information, contact us at 888-715-8003 or visit cypressadaptive.com.

Precision Fit With Mt Emey® Custom Shoes Embrace the comfort of custom-fit with Mt Emey ®’s Custom Shoe (Medical) Program. Our precise 3D scanning captures your unique foot contours, promising a perfect fit without the wait or waste. From stylish athletics to roomy comfort designs, our handcrafted shoes adapt to your needs. Satisfaction guaranteed before payment. Plus, qualified wholesale accounts receive a free 3D scanner. Step into the Mt Emey ® difference—where every shoe is made for you. For more information, call 1-888-937-2747 or visit emeys.com.

ContexGel Sleeves & Liners

ContexGel liners by Streifeneder, tailored for below-knee and above-knee amputations, feature a soft layer of ContexGel. Ideal for those with bony or pressure-sensitive residual limbs, they distribute pressure evenly, minimizing shear forces. Infused with medicinal white oils and antibacterial elements, the gel revitalizes stressed skin. The locking liner includes a stabilizing matrix to prevent excessive longitudinal stretching of soft tissues. ContexGel sleeves & liners provide specialized care, enhancing comfort and stability for amputees while promoting skin health. They ensure a secure fit for enhanced mobility and confidence. Visit fabtechsystems.com/streifeneder or call 800-FABTECH to learn more about our full range of Streifeneder liners.

February 2024 O&P Almanac

Marketplace

Naked Prosthetics oﬀers four finger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger. ™

™

IT’S ALL ABOUT FUNCTION.

™ SOFTIE™ and ™ SOFTIE and SOFTIE-TF

ng the effects ofSOFTIE-TF™ micro tears and/or injury to the incision ed rest holds a Minimizing high priority.the FLO-TECH designed the effects of® micro tears ™ and SOFTIE-TF to aid against distal end breakdown, and/or injury to the inclusion area ess for wound care, and daily hygiene. We incorporated at theextension bed restcontrol. holds aOur high priority. r struts to maximize SOFTIES aling and increase the qualitydesigned of rehabilitation for FLO-TECH® the SOFTIE™ gical amputees. The sockets are soft, non-constricting and SOFTIE-TF™ aidinventory againstof to remove for examinations. Havingtoan and SOFTIE-TF™distal sockets allows you to fit any patient at a end breakdown, easy access ’s notice. They easily fit most sizes including XL.

for wound care, and daily hygiene. We incorporated posterior struts to maximize extension control. Our SOFTIES assist healing and increase the quality of rehabilitation for postsurgical amputees. The sockets are soft, nonconstricting, and easy to remove for examinations. Having an inventory of SOFTIE™ and SOFTIE-TF™ sockets allows you to fit any patient at a moment’s notice. They easily fit most sizes including XL. Visit 1800flo-tech.com.

Hersco 3D Printing Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800-301-8275, for a free sample.

O&P Almanac February 2024

™

Marketplace

REDEFINING THE ANKLE EXPERIENCE

Tillges Technologies

Kinterra® Experience the highest level of satisfaction with the redesigned Kinterra® hydraulic ankle. Thoughtfully designed to meet more daily needs and to exceed all performance expectations with a 20% increase in industry-leading user weight rating of 330 lbs without an increase in product weight. PDAC verified for L5981 and L5968, the Kinterra also features a dorsiflexion assist spring, redesigned EnduraCore® footplate with split keel and heel for added mediolateral terrain adaptation. Trial what is redefining the ankle experience with Kinterra today. Visit shop. proteorusa.com.

We’re custom fabricators of industry-leading pre-preg braces, but we’re also clinical orthotic and prosthetic practitioners ourselves. That means Tillges Technologies is in a unique position to provide unrivaled care. Our Propulsion line of custom-fabricated, dynamic response orthotic and prosthetic devices are fit and proven on our own patients before we start building them for yours. We’re positive that our dynamic, ultra lightweight, adjustable, and modular designs using cutting-edge carbonfiber materials will provide your patients with the stability, balance, and energy they need in every step. To learn more, visit TeamTillges.com or call us at 1-855-4TILTEC.

Turbomed Foot Drop AFOs Turbomed’s leading line of foot drop AFOs sit completely outside the shoe for an invisible, painless support that will follow you as long and as far as you want. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees and provides the user with unparalleled levels of function. Each model takes minutes to assemble and is easily transferrable to most shoes, boots, and sandals through an innovative lace clip design. The Xtern Summit is the lightest model, has the most dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

For 30 years, The Bremer Group Company has established a reputation for supporting practitioners and patients with quality back braces, and exceptional customer service. For more information, call

800-428-2304

or visit www.bremergroup.com.

DISPLAY_Bremer-Almanac-Marketplace-1-6th.indd 1

1/5/2024 9:00:14 AM

Learn & Earn It’s as easy as 1-2-3:

1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate!

AOPAnet.org/education

February 2024 O&P Almanac

US JOIN 15-16 L

APRI

2024

AOPAnet.org

SCAN TO FIND YOUR NEXT JOB!

• Explore new career opportunities for FREE! • Click on any websites, emails, and videos to learn more. • Download the guide to look back on organizations and opportunities that appeal to you.

Ad.indd 38AOPAO&PProgram Almanac Book February 2024 1

8/7/23 9:49 PM

Calendar

SHARE YOUR UPCOMING EVENT WITH O&P PROFESSIONALS Contact Bob Heiman at bob.rhmedia@comcast.net.

2024

September 12–15

AOPA National Assembly. Charlotte, NC. For more information, visit aopanet.org.

February 1–29

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org; ABCop.org/contact-us.

Live and Online/On Demand CEs

The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/.Diabetic_Series_LMS_List.

March 30

Deadline to Submit Proposal for AOPA National Assembly. Visit aopanet.org/2024-national-assembly.

April 15–16

AOPA Policy Forum. Washington Marriott Capitol Hill, Washington, DC. Visit aopanet.org.

April 17

AOPA Ask the Expert Webinar. To register, visit aopanet.org.

May 13–14

AOPA Virtual Coding & Billing Seminar. To register, visit aopanet.org.

Share Your Calendar Event

June 28–29

PrimeFare East. Sheraton Grand Hotel Downtown Nashville. In-person meeting. For information, contact Cathie Pruitt at 901-359-3936, primecarepruitt@ gmail.com, or visit primecareop.com.

August 19–20

AOPA Virtual Coding & Billing Seminar. To register, visit aopanet.org.

Advertise O&P events for maximum exposure with O&P Almanac. Contact Bob Heiman at bob.rhmedia@comcast.net or learn more at bit.ly/24AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Advertisers Index

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

Scan the QR to start advertising in the O&P Almanac or visit bit.ly/24AlmanacMediaKit.

COMPANY

PAGE

PHONE

WEBSITE

Allard USA ALPS South LLC Apis Footwear Co. Coyote Prosthetics & Orthotics Cypress Adaptive Fabtech Systems Ferrier Coupler Inc. Flo-Tech O&P Systems Inc. Hersco Naked Prosthetics Ottobock ProComp PROTEOR USA Spinal Technology Inc. The Bremer Group Co. Tillges TurboMed Orthotics

3 1 9 25 C3 16-17 13 29 31 15 C4 34 11 27 5 21 23

866-678-6548 800-574-5426 888-937-2747 800-819-5980 888-715-8003 800-322-8324 810-688-4292 800-356-8324 800-301-8275 888-977-6693 800-328-4058

allardusa.com easyliner.com apisfootwear.com coyote.us cypressadaptive.com fabtechsystems.com ferrier.coupler.com 1800flo-tech.com hersco.com npdevices.com professionals.ottobockus.com fabwithprocomp.com proteorusa.com spinal.tech/almanac bremergroup.com tillgestechnologies.com turbomedorthotics.com

855-450-7300 508-957-8281 800-428-2304 855-484-5832 888-778-8726

February 2024 O&P Almanac

BECOME AN AOPA STATE REPRESENTATIVE If you are interested in participating in the AOPA State Reps network, email smiller@AOPAnet.org.

State By State

Making the Introductions Legislative updates from Missouri, Nebraska, and New Hampshire

Missouri Legislation amending Missouri’s 2009 Insurance Fairness Law has been introduced. House Bill 2115 includes several provisions: Allows O&P practitioners to evaluate and initiate treatment of patients without prescription/ referral from a physician, provided that they are certified by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) or the Board of Certification (BOC) Requires state commercial insurers to practice due diligence as it relates to prior authorization Ensures all ABC-/BOC-accredited facilities be deemed in-network by state commercial insurers Creates a reimbursement rate floor of 100% of Medicare for state commercial plans Clarifies documentation requirements for O&P providers without physician input.

•

The Latest From So Every BODY Can Move

• • • •

Nebraska

Legislative Bill 852, introduced in early January, requires that suppliers not participating in the Medicare program and that do not accept Medicare assignment not charge Nebraska Medicare beneficiaries an amount greater than 15% of the Medicare-approved reimbursement rate.

New Hampshire

Sen. Suzanne Prentiss, the legislative champion behind New Hampshire’s So Every BODY Can Move bill, introduced new legislation in February 2024. Senate Bill 455 would require that New Hampshire Medicaid reimburse for orthotic and prosthetic services at a level equal to Medicare rates. Interested in getting involved? Email advocacy@aopanet.org to learn more.

O&P Almanac February 2024

Here are the most recent developments in the So Every BODY Can Move initiative, developed by AOPA in conjunction with the National Association for the Advancement of Orthotics and Prosthetics, the American Academy of Orthotists and Prosthetists, and the Amputee Coalition. The movement advocates for a policy solution rooted in dignity and justice by empowering state-bystate legislative action, expanding access to medically necessary orthotic and prosthetic care for physical activity.

Florida

New So Every BODY Can Move legislation has officially been

introduced in Florida. Companion bills Senate Bill (SB) 828 and House Bill 1003 ensure that state commercial plans and Florida Medicaid cover activity-specific orthotic and prosthetic care, implement reasonable useful lifetime exemptions, and implement antidiscrimination provisions. The bills will now be assigned to committee to be debated at a future hearing.

New Jersey

SB 3919, which ensures coverage of activity-specific orthoses and prostheses for enrollees of all ages in state commercial and public employee plans, has officially passed both the Senate Commerce Committee and the Senate Budget and Appropriations Committee. Due to the ending of the 2022-2023 legislative session in early January, the bill will need to be reintroduced for 20242025. The So Every BODY Can Move New Jersey team is currently planning to work with their legislative champions to ensure the bill is reintroduced in the state.

NEW Symphonie Polaris System Create an instant socket in less than 15 minutes! • Full weight bearing shape capture • No plaster of any kind required • Saves time for more efﬁcient work ﬂow • Creates very little waste

“The Symphonie Aqua Polaris system is the smartest business decision I’ve made in 50 years.” - Frank Snell, CP, CO

The Symphonie Aqua Polaris System is now available. Contact Cypress Adaptive today!

An Extension of Yourself

C-Brace. Walk with confidence. The C-Brace is the world’s first microprocessor-controlled leg orthosis that responds to everyday movements and situations in real-time. Help your patients live the life they deserve with C-Brace.

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