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BreakING News: AOPA FILES LAWSUIT AGAINST MEDICARE The American Orthotic & Prosthetic Association

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JUNE 2013






Innovative research solving complex challenges and improving patient quality of life

Page 52

New Heights for Lifelong Learning Medicare Reimbursement During Sequestration

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O&P JUNE 2013, VOLUME 62, No. 6

CONTENTS Cover Story

18 Groundbreaking Research

By Jill Culora Innovative research has led to a number of groundbreaking components and protocols, from bone-anchored prostheses with implanted electrodes, to a new understanding of residual limb volume fluctuation, to studies on the efficacy of spinal orthoses, and much more.


SPecial Feature

28 New Heights for

52 O&P Buyers’ Guide 2013

Lifelong Learning By Christine Umbrell Today’s O&P professionals must stay current on clinical innovations as well as practice management strategies. Fortunately, a number of continuing education options are available, from webinars and short courses to post-professional master’s degree programs.

The 2013 Buyers’ Guide features all of the products and services you need to meet your patients’ diverse needs. This musthave resource includes a comprehensive index to manufacturers and AOPA member suppliers.




AOPA Contact Page How to reach staff


At a Glance Statistics and O&P data


Reimbursement Page Communication bolsters physician documentation



Facility Spotlight Syracuse Prosthetic Center

In the News Research, updates, and company announcements



Ask the Expert Medicare reimbursement during sequestration

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

50 AOPA Membership 00 Applications

74 Jobs

Opportunities for O&P professionals

76 Calendar

Upcoming meetings and events


Ad Index


AOPA Answers Expert answers to your FAQs

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

JUNE 2013 O&P Almanac


AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 EXECUTIVE OFFICES



Thomas F. Fise, JD, executive director, 571/431-0802,

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808,


directors Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA

Don DeBolt, chief operating officer, 571/431-0814,

Kelly O’Neill, manager of membership and meetings, 571/431-0852,

President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX

O&p Almanac

Stephen Custer, coordinator, membership communications and meetings, 571/431-0876,

Thomas F. Fise, JD, publisher, 571/431-0802, Josephine Rossi, editor, 703/914-9200 x26, Catherine Marinoff, art director, 786/293-1577, Dean Mather, advertising sales representative, 856/768-9360,

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, Betty Leppin, Project Manager, 571/431-0876,

Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX

Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA


Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL

Steffanie Housman, content strategist, 571/431-0835,

Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

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

Government affairs

Steffanie Housman, staff writer, 571/431-0835,

Devon Bernard, manager of reimbursement services, 571/431-0854,

Christine Umbrell, editorial/production associate, 703/914-9200 x33,

Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD

Scott Schneider, Ottobock, Minneapolis, MN

Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO

AOPA Bookstore: 571/431-0865

Stephen Custer, production manager, 571/431-0876,

Lia K. Dangelico, contributing writer, 703/914-9200 x24,

President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

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

Catherine Graf, JD, director of regulatory affairs, 571/431-0807,

Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, Reimbursement/Coding: 571/431-0833,

James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI

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

Copyright 2013 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.


O&P Almanac JUNE 2013

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O&P Education Programs and Residencies A number of O&P educational programs have been accredited by CAAHEP/NCOPE: United States Map of Accredited Programs

Seattle Spokane


White Bear Lake White Bear Lake

West Hartford Newington





Chicago Joliet

Loma Linda Long Beach


Okmulgee Oklahoma City Atlanta

Orthotic and Prosthetic Practitioner Programs


Orthotic and Prosthetic Practitioner Programs “Candidacy Status�



Orthotic and Prosthetic Technician Programs

St. Petersburg

Source: NCOPE.

NCOPE Residency Program Fast Facts:

12 Months

Length of orthotic or prosthetic residency at accredited residency sites (18 months for dual O&P residency).

66 320

Number of patient-care facilities accredited by NCOPE for residency programs in 2012.

Average number of students who graduate from O&P schools each year.

Sources: NCOPE Annual Report 2012, 6

O&P Almanac JUNE 2013


Number of O&P graduates who completed NCOPE residencies in 2012.




Application fee for NCOPE residency sites.

Year NCOPE became an incorporated accreditation agency.

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Low-Cost Bamboo Prosthesis Prototype Developed Individuals from several countries are working together to develop a prosthesis with a $50 price tag. The goal of the Low-Cost Prosthesis Project is to design a transtibial prosthetic leg using a three-dimensional printer to create the joints and bamboo for the supports. Different parts of the low-cost prosthesis. The project aims to keep production costs for each Low-cost prosthesis at device below $50 because of the ease of access to the Fablab Amsterdam. low-cost and relatively low-tech materials. The joints will be made with three-dimensional plastic molds and finished using a computer numerical control milling machine. The section for the tibia and fibula will be made of bamboo, which is flexible and lightweight, and can be repaired and replaced without requiring technical expertise. The project is being funded by the Dutch Institute of Sustainable Technology through the Smart Prevention, Rehabilitation, and Intervention Technologies initiative; the Waag Society, an institute for art, science, and technology based in Amsterdam; and the House of Natural Fiber, Jakarta, Indonesia, which focuses on cultural development and innovation. The first prototype is under construction in Amsterdam; the development team includes orthopedic surgeons, biomedical engineers, and staff from the fabrication lab in Jakarta.

MIT Focuses on Affordable Custom-Fit Socket Design Researchers at MIT’s media lab have begun designing a variable-resistance socket to increase comfort for amputees. David Sengeh, a doctorate student in the biomechanics group, is leading the project. Sengeh’s methodology involves using Computer-Aided Design and Computer-Aided Manufacturing, or CAD/CAM, to produce a David Sengeh multilayer printed socket made of materials with different degrees of stiffness, customized using MRI scans of a patient’s residual limb. Using this process, he can design a comfortable prosthetic socket using a minimum set of data (including data that quantifies the body’s impedance, stiffness, and degree of stiffness at each point). Sengeh hopes this technology will have a positive impact on the industry. Originally from Sierra Leone, Sengeh lived through the country’s civil war, during which time many people became amputees. He noticed many amputees chose not to use prostheses due to discomfort, thus prompting his desire to create a better fit for prostheses.


O&P Almanac JUNE 2013

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IPC General Assembly To Be Held in Athens The Greek capital of Athens, the host city of the 2004 Paralympic Games, will stage this year’s International Paralympic Committee (IPC) General Assembly and Conference. The conference will take place at the Athenaeum Intercontinental Hotel on November 22, while the General Assembly will be held over the weekend of November 23-24. The Paralympic Sport and Media Awards, in conjunction with Allianz, also will take place in Athens, coinciding with the IPC General Assembly and Conference. This year’s awards will recognize and honor the performances of athletes, teams, officials, and the media from the London 2012 Paralympic Games.


O&P Almanac JUNE 2013

Photo: Touch Bionics Inc.

Touch Bionics’ new i-limb ultra revolution has been designed to be controlled by a new biosim app. The application, which is compatible with the latest Apple products, is designed to give wearers quick access to up to 24 different grip patterns. The product offers powered thumb rotation to enhance dexterity, which can be controlled either directly by the wearer’s muscle signals, or automatically as part of a pre-set grip pattern or gesture. The new “quick grips” option from the biosim mobile control app allows the user to automatically activate 24 different grip patterns and gestures with a tap of the screen.

people in the news

Hanger Clinic has announced several practitioner hirings at its patient-care clinics across the country: Matthew Dame, CO, in Longview, Washington; Michael Daniels, CPO, in Kissimmee, Florida; Matthew DeLay, C.Ped, in Jackson, Mississippi; Clark Driver, CO, in Boulder, Colorado; Daniel Drowne, CP, in Wheeling, West Virginia; Ted Friedmann, CO, in Des Moines; David Giurlanda, CO, in Phoenix; Brian Hayes, CP, in Kissimmee, Florida; Jonathan Jetton, CO, in Springfield, Illinois; Garth Pfeifer, C.Ped, in Portland, Oregon; Bobby Roe, CP, in Brunswick, Georgia; Keith Sardo, CPO, in Salinas, California; Robyn Skogman, CP, in Portland and Lake Oswego, Oregon; Michael Varro, CP, in St. Paul, Minnesota; and Ross Workman, CPO, in Chula Vista, California. Eythor Bender has been appointed CEO of FitBionic, formerly Tensegrity Prosthetics, in Boulder, Colorado. Freedom Innovations, Irvine, California, has named Rob Cripe as its senior vice president of global marketing.

Carrie Davis, a Hanger Clinic upper-extremity patient advocate and the national coordinator of Amputee Empowerment Partners, a peer-topeer amputee support group, has been presented with the International Margarette Golding Award for her dedication to the foundation. Jack Richmond, CPOA, CFo, director of sales for Fillauer Companies, was featured on National Public Radio’s Morning Edition show on April 19 as a StoryCorps interview. Richmond shared the story of the 1987 accident that led to his transtibial amputation. Mike “Monster” Schultz, an adaptive snocross and motocross racer, was honored with a 2013 Popular Science Invention Award for his Versa Foot sports prosthesis, which uses a custom-tuned FOX mountain bike shock to provide fine-tuning adjustability. Sveinn Sölvason has been appointed chief financial officer of Össur, Reykjavik, Iceland, and will become a member of the executive management team.



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Boy Receives Lightweight Artificial Limb Implant In Chennai, India, 12-year-old Naveen Kumar received an ultralight, above-the-knee prosthesis. The ultralight artificial limb was implanted at India’s Government General Hospital, as part of a public/private partnership. Kumar is receiving training on use of the prosthesis at the Ottobock training center in Anna Nagar. Kumar, who was in an accident last year that resulted in an aboveknee amputation to his left leg, was fit with the prosthesis thanks to the Ungalukagha Charitable Trust, which also will cover Kumar’s medical and education expenses. The ultralight prosthesis weighs only 1 kilogram, considerably lighter than comparable prostheses that weigh up to 15 kilograms. The Government General Hospital is considering using more of the lightweight devices in the future.

Naveen Kumar, an above-knee amputee, stands with his new prosthetic leg at the Rajiv Gandhi Government General Hospital.


BUSINESSES in the news

The Amputee Coalition has announced that Hanger Inc. has pledged a $100,000 educational grant to support the Coalition’s “Improving the Well-Being of People With Limb Loss–Phase II” program. The Amputee Coalition also has announced a peer support affiliation agreement with TIRR Memorial Hermann Hospital in Houston, which will allow the hospital to officially embed the Coalition’s peer support program into its facilities. The CMS has provided several questions and answers on Medicare and sequestration that address, among other things, the use of claim adjustment reason code 223 (CARC 223) to report the sequestration reduction. CMS also confirms that sequestration modifies final FFS payments to providers, not fee schedules, and pricers, and it provides examples of how claims are calculated after application of patient cost-sharing.


O&P Almanac JUNE 2013

Tensegrity Prosthetics, Boulder, Colorado, has changed its name to FitBionic. The Orthotic & Prosthetic Activities Foundation has announced that Hanger Inc., headquartered in Austin, is a 2013 bronze-level sponsor. Össur has announced locations for six mobility clinics to take place in 2013. The clinics will be led by Bob Gailey, PhD, PT, and Peter Harsch, CP. For information, visit mobilityclinics.

Ottobock, Duderstadt, Germany, has won three 2013 Red Dot Product Design Awards in the life sciences and medicine category for its Patella Pro knee orthosis, 3S80 Fitness Prosthesis for amateur athletes, and the 1C63 Triton Low-Profile prosthetic foot. Prosthetic-Orthotic Service in Reading, Pennsylvania, is celebrating its 40th year of business. RSLSteeper, Leeds, England, has won a 2013 da Vinci Award for the bebionic3 multi-articulating myoelectric prosthetic hand.










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Reimbursement Page By Joseph McTernan, AOPA government affairs department

Physician Documentation:

Problem or Opportunity? Improve communications with physicians and elevate the role of the O&P practitioner


he last few years have seen a dramatic change in Medicare payment for prosthetic and orthotic devices. For many years, O&P providers flew comfortably under the radar while other provider groups faced reimbursement challenges through increased audits and scrutiny of their services. That all changed with the August 2011 release of a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) titled, “Questionable Billing by Suppliers of Lower-Limb Prostheses.” 14

O&P Almanac JUNE 2013

The publication of this report, which is available at oei/reports/oei-02-10-00170.pdf, placed O&P providers in the crosshairs of the OIG and Medicare auditors. The days of a reasonable expectation to be paid for providing an obviously needed service were wiped away by 35 pages of criticism of Medicare’s payment process for artificial limbs. While much of the information in the report was based on incorrect assumptions regarding how O&P services are prescribed and delivered, the damage was done and the response was swift and comprehensive. Within a week of the report, the medical directors from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released the now infamous “Dear Physician” letter, and the reimbursement landscape for O&P services was forever and irreversibly changed.

A Shift in Perspective AOPA continues to view the Dear Physician letter and the subsequent reaction of the DME MACs and Medicare auditors to essentially disregard the value of O&P practitioners’ documentation when determining medical necessity for

an O&P device as inappropriate, egregious, and inherently unfair. This is especially true in that the rule change has been applied retroactively when Recovery Audit Contractor (RAC) auditors are reviewing claims for services as much as three years in the past. Rest assured that AOPA views this issue as its top priority and continues to make every effort to effect a reasonable solution through continued negotiation with the Centers for Medicare and Medicaid Services (CMS) and its contractors. In addition to the ongoing negotiation with CMS, on May 13, 2013, AOPA filed suit against the Department of Health and Human Services, claiming that the actions of CMS and its audit contractors are egregious and illegal as they represent a substantive change in the rules that govern Medicare payment without following the requirements of the Administrative Procedures Act. Additional information regarding this suit may be found on page 44. While AOPA hopes that common sense and reasonableness will ultimately prevail, the fact remains that O&P providers can no longer rely on the “we didn’t know” argument when dealing with reimbursement issues.

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Reimbursement Page

This situation represents an ideal opportunity to take a big step away from the shadow of being “just another device dealer” and into the realm of health-care providers. The Dear Physician letter is almost two years old and the DME MACs and various Medicare auditors are, at the very least, fairly consistent in their opinion that in order for an O&P claim to be paid, documentation relative to the specific medical need of the device for the individual patient must exist within the records of the physician who is prescribing the service. There are two ways to approach this situation: as either a problem or an opportunity. Those who view this issue as a problem will say, “I cannot be held responsible for how a physician documents,” or, “Physicians will not do this because they have no incentive to do it.” Those who see this issue as an opportunity will approach it from a different angle and say, “How can I work with physicians to make sure this documentation exists?” or, “How can I increase my role in the overall rehabilitation of my patient?” During my 15 years of experience working with orthotists and prosthetists, one of the concerns I continuously have heard is that O&P providers need to stop being viewed as just equipment dealers and start being viewed as educated and trained health-care providers. This situation represents


O&P Almanac JUNE 2013

an ideal opportunity to take a big step away from the shadow of being “just another device dealer” and into the realm of health-care providers. The question becomes how to use this opportunity to turn proverbial lemons into lemonade.

Communication Is Key Turning a problem into an opportunity begins and ends with proper communication. The delivery of O&P services must no longer be a multistep process where interaction between those involved in the patient’s rehabilitation is limited, but must become an integrated process—from the time the patient is first evaluated by the physician, through delivery of the completed device, and during therapy where the patient uses the device to achieve a positive rehab outcome. For this process to be successful, all of those involved in the patient’s rehab, including the patient, must continually communicate with each other using the technology and resources available to them. One piece of the puzzle is no less or no more important than any other. Instead of falling back on the phrase, “I cannot be held responsible for how a physician documents,” an

opportunist will work with referral sources to ensure the physician documents exactly what needs to be in the patient’s medical record. The orthotist or prosthetist in this scenario often has more subject knowledge and expertise than the physician and may find that the physician is willing to take the time to document the specific medical need for the device. Physicians often view their patients from a 30,000-foot vantage point and may not understand the importance of documenting the specific medical conditions that warrant the need for a prosthesis or orthosis. Communicating that specific need is a challenge—but also an opportunity to not only improve your professional relationship with the physician but also to gain his or her trust when making future referral decisions. There will always be those physicians who are set in their ways and reluctant to change the way they document, but with proper communication, these should be the exception rather than the rule.

No Easy Solution Those who view physician documentation as a problem focus on one thing: a solution. If this issue had an easy solution, it would have been shared long ago and we would not be facing the challenges we are today. There truly is no single form, document, or template that will be sufficient to meet the current expectations of Medicare contractors and auditors. CMS recently proposed a draft document that claims to provide assistance to physicians regarding the medical information that must be documented when prescribing lower limb prostheses. AOPA has reviewed this document and believes that it represents an overly burdensome expectation of what physicians are willing to document when prescribing a lower limb prosthesis. CMS recently hosted the first of several scheduled Open Door Forum conference calls to discuss this document. AOPA is


currently working on an alternative document that will be presented to CMS and will be significantly less burdensome to physicians. Rather than looking for a solution, a better approach is to look for opportunities to change the way you deliver care, to interact more closely with other providers on the rehab team, and to take control of the situation rather than react to it. Instead of scrambling for documentation after you have delivered a device, take the steps to ensure the documentation exists from the beginning. This comes back to making sure you are effectively communicating with your referral sources and other members of the rehab team. Your unique training and expertise provide you with a point of view that may provide significant value to the rest of the team in achieving a successful outcome for the patient. Make sure you share that perspective from the beginning of the process, establishing your role among your peers.

Think Outside the Box Ensuring that the medical necessity of the services you provide is clearly documented offers an opportunity to break with traditional thinking regarding the provision of O&P devices. As providers, it is too easy to fall into the concept of “the way it is” as opposed to “the way it should be.” Traditionally, O&P services start with a basic prescription from the physician, followed by an evaluation by the O&P practitioner and subsequent creation of a detailed prescription that is returned to the physician for review and signature. This model often contributes to a lack of documentation in the physician’s records because he or she is relying on you as the subject matter expert. Alternate models involving physician specialists may be an option in ensuring the patient’s medical record contains the necessary documentation to support your claim. Physical medicine and rehabilitation (PM&R)

physicians are trained to document differently than other physicians and may play an important role in the rehabilitation of the patient. Referring the patient through a specialist, like a PM&R physician, who understands the need to document in a way that better supports your claim may not only help your situation but also achieve a better outcome for the patient. Other specialty physicians also may be consulted depending on the specific needs of your patient. Regardless of how you choose to use alternate delivery models, it is important to consider them. The status quo is no longer an option. As health care evolves through the creation of accountable care organizations, healthcare exchanges, and other systems designed to lower the cost but increase the quality of health care, those who are not willing to change will unfortunately be left behind.

Reimbursement Page

lead to uncomfortable conversations with your referral sources and others, but sitting back and waiting for a solution rarely results in success. At the end of the day, you must make your own decision regarding whether the reimbursement challenges the O&P industry is facing are a problem or an opportunity. While AOPA will continue to fight for fair treatment of its members, the organization cannot achieve success alone. You must be willing to recognize the opportunities to control your own destiny and respond in a way that is most appropriate for your business. a Joseph McTernan is AOPA’s director of coding and reimbursement services. Reach him at

Take the Lead A very simple definition of the term opportunity is “the chance for advancement or progress.” The operative term in this definition is “chance.” Opportunity is available for those who are willing to take it. There is very little chance that a referral source will approach you with ideas on how he or she can provide you with better documentation. If you want to create change, you must be willing to take the initiative to make it happen. This will inevitably

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O&P Almanac JUNE 2013



Research Innovative research solving complex challenges and improving patient quality of life

Advances in osseointegrated implants are paving the

way forward to a new era of prosthetics, as researchers in Sweden are using permanently implanted electrodes in nerves and muscles with a human-machine interface to give an amputee prosthetic control that is much more similar to controlling a natural limb. The research, unveiled by Sahlgrenska University Hospital and Chalmers University of Technology earlier this year, addresses the two biggest challenges with the advancement of robotic prostheses: how to firmly attach the artificial limb to the human body and how to intuitively and efficiently control the prosthesis to regain lost functionality. “This technology solves both these problems by combining a bone-anchored prosthesis with implanted electrodes,” says Rickard Brånemark, MD, MSC, PhD, who along with his team has developed a pioneering Rickard Brånemark, implant system called Osseointegrated Prostheses for the MD, MSC, PhD Rehabilitation of Amputees (OPRA).

JUNE 2013 O&P Almanac



The OPRA implant uses a titanium screw—an osseointegrated implant—to anchor the prosthesis directly to the stump, providing advantages over a traditionally used socket prosthesis. According to Brånemark, “It allows complete degree of motion for the patient, fewer skin related problems, and a more natural feeling that the prosthesis is part of the body. Overall, it brings better quality of life to people who are amputees.” In earlier experiments, researchers used electrodes on the surface of an amputee’s skin, which did not create a signal that was stable enough because body movement caused skin stretching. Also, over-the-skin electrodes would normally only pick up about two functions out of the tens of different movements an able-body is capable of.

Schematic drawing of the principles of osseointegration. 20

O&P Almanac JUNE 2013

Scanning electron micrograph showing a bone cell attaching to titanium.

Advancing the Industry Exciting novel research—such as this work by the Sahlgrenska University Hospital and Chalmers University of Technology—is happening throughout the O&P industry. Here is just a taste of those studies, several of which were submitted to be part of AOPA’s O&P World Congress 2013, taking place in Orlando, Florida, September 18-21:

Limb-socket Interface.


OPRA implant system.

“We believe that implanted electrodes, together with a long-term stable human-machine interface provided by the osseointegrated implant, is a breakthrough that will pave the way for a new era in limb replacement,” says Brånemark. This research success was possible due to the development of advanced technology by Chalmers doctoral student Max Ortiz Catalan and Professor Bo Håkansson, and was funded by Vinnova, a number of Swedish government agencies, and the Promobilia Foundation.

Residual limb volume loss creates complex issues for the limb-socket interface. Arjan Buis, PhD, a biomedical engineering senior research fellow at the University of Strathclyde in Glasgow, Scotland, together with Jia Lizhang, PhD, and Luder Mosler, PhD, is researching how to improve the understanding of biomechanical mechanisms that contribute to the generation and control of load transfer forces dealing with an amputee where “man meets machine,” and especially volume management, which is believed to be a considerable influencing factor. In his study, “Understanding Residual Limb Volume Loss; Utilizing a Physical Model (manikin),” Buis concludes that volume loss cannot be avoided. He made that determination by investigating whether it was physically possible to manage volume changes in a controlled environment.

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O&P Almanac JUNE 2013

Photo: Ottobock

“It is notoriously difficult to quantify residual limb volume fluctuations in a user population due to the immense biological variability, such as pathology, activity levels, co-morbidities, socket design, and lifestyle to name a few,” says Buis. “Therefore, it was decided to investigate if it is possible to manage volume in a controlled environment.” Buis used a physical model, complete with bone structure and validated silicon soft tissue simulant that was capable of reducing and gaining volume by controlled fluid in and out using bladder-like structures, and placed it in a programmable testing machine, exposing it to a variety of static and dynamic loading conditions that simulate stance and swing phase. In addition, sub-atmospheric pressure conditions were introduced to mimic normal clinical practice. The results showed volume loss irrespective of subatmospheric pressure and significant reduced pistoning with vacuumassisted conditions. Those findings are relevant, according to Buis, because it is highly unlikely that, on a physiological level, active vacuum is able to manage volume within a prosthetic socket due to the high interface loading conditions. “When fluid is migrating out of the residual limb due to external loading conditions during gait, the tibia bone sinks a little deeper in the socket. However, the volume relative to the prosthetic socket remains the same. Beside the likely discomfort, this normally manifests itself by pistoning during swing and weight acceptance. The latter can be counteracted by the application of active vacuum, which acts as an automatic compensation system, by drawing the soft tissues inside the rigid prosthetic socket when volume is lost. This is important because it is a kind of automatic volume compensation system although not on a residual limb level.”

One of Ottobock’s athlete ambassadors, Heinrich PoPow is a sprinter and Paralympic gold medalist from Germany.

Vacuum-Assisted Socket Suspension Systems. While numerous studies have examined the amount of pistoning that occurs in a transtibial amputee during static activities—and recently research has been conducted on pistoning during transtibial gait— few investigations have looked at pistoning in transfemoral amputees, says Eric Lamberg, EdD, PT, C.Ped, clinical associate professor, Department of Physical Therapy, School of Health Technology and Management, Stony Brook University. His research, “Dynamic Assessment of Transfemoral Prosthetic Suspension: Does Vacuum Hold Better?” uses motion analysis to measure pistoning in the transfemoral amputee during gait. He carried out this work by examining five individuals wearing their existing prosthesis and while wearing a new subatmospheric technology (SAT) socket at the ischial containment (IC) and subischial (SI) levels while undergoing instrumented gait analysis using Vicon motion analysis. “To determine the amount of pistoning that occurred during gait, we calculated the distance between the ASIS [anterior superior iliac spine]

and thigh/socket marker along the long axis of the femur throughout stance. The range of vertical thigh/ socket displacement [pistoning] was represented as the difference between the maximum and minimum values derived. Larger values indicated greater vertical displacement,” says Lamberg. The results showed the amount of pistoning differed significantly depending on the suspension method used. On average, pistoning was reduced by 4.1 millimeters and 6.7 millimeters when using SAT with the brim at the IC and SI levels, Lamberg’s results showed. “This is part of a larger study that is investigating how superior brim height affects balance and gait. Since vacuum allows us to get a more secure suspension, we are able to lower the brim to levels previously not thought possible,” he says. Lamberg’s study, which includes researchers Raymond McKenna, PhD, PT, associate professor of physical therapy at Stony Brook University; Marc Werner, CPO, of Long Island Orthotics and Prosthetics; and Ian Kremenic, MEng, of the Nicholas Institute of Sports Medicine and Athletic Training, is funded by Ottobock Healthcare.

$ Kick-Start Funding Research like the studies described in this article is not possible without the drive to solve complex challenges that face the O&P community, and vital funds to carry out such research. The AOPA Board of Directors recently identified the most difficult challenges the O&P professional community faces, and, together with AOPA research grants and other funding, researchers and practitioners are well poised to take on emerging issues. The board categorized issues into the following six streams: • patient intakes, outcomes, and data collection • outcomes/evidence-based practice • cost and comparative effectiveness • education and communications • alliances • risks/reimbursements. For details about each of these streams, see “Marshalling Change” on page 40.

Spinal Orthoses. Osteoporotic compression fractures cause enormous personal and societal burdens with few treatment options other than ones that can have adverse side effects. Researcher Sigridur Lara Gudmundsdottir, PhD, at Össur’s department of development in Reykjavik, Iceland, and who also is with the University of Iceland, together with Össur’s Asa Gudlaugsdottir, Micah Nicholls, and Thorvaldur Ingvarsson, MD (Nicholls and Ingvarsson also are with the University of Iceland), has examined the benefits of using a newly designed spinal orthosis on chronic back pain in patients with vertebral compression fractures. Her research paper “Effects of Bracing on Chronic Pain Due to Vertebral Compression Fractures—A Randomized Controlled Pilot Study” has preliminary findings that indicate the use of orthoses decreases pain and may improve daily function. The study involved 30 patients wearing either a new Össur product called the Össur Miami Posteo or


O&P Almanac JUNE 2013

AOPA, working with the Center for Orthotic and Prosthetic Learning and Outcomes/Evidence-Based Practice, is currently reviewing funding request submissions for original pilot research in eight specific areas, plus an open topic area. AOPA’s goal is to fund research projects (one-time grants in amounts up to $15,000) that could lead to larger trials that would qualify for government and other research funding support. In addition, AOPA is funding two $50,000 research projects for developing an evidence-based statement relating to prosthetic management following transtibial amputation, and orthotic management after stroke. Key tasks are to include a systematic review of literature and establishing assessment and treatment pathways that relate to defined episodes of care. For more information, visit

the Spinomed Medi and patients not wearing a brace at all. Through self-reporting pain levels and functional limitations at one, three, and six weeks, the study found back pain was significantly reduced in subjects wearing either brace, and functionality limitations also were significantly reduced in those wearing either brace. “The results indicate that the use of orthoses decreases back pain and improves daily function. In addition, the subjects reported reduced use of pain medication. Therefore, orthotic treatment may be an option for treating chronic back pain due to vertebral compression fractures, and at the same time reduce the use of NSAIDs [nonsteroidal anti-inflammatory drugs],” says Gudmundsdottir. “Previous studies on the effect of bracing on pain due to vertebral compression fractures have yielded inconclusive results. We were therefore surprised by the

immediate pain relief observed in some of the participants. Also, we were very pleased to observe the high level of compliance and to experience the thankfulness expressed by the participants.”

Cost and Comparative Effectiveness. Selecting an appropriate device is a patient-specific, multi-faceted decision that involves not only many considerations for restoring lost function but also acknowledges the varying costs of different types of prostheses. INAIL researcher Andrea Giovanni Cutti, PhD, PT; along with INAIL’s Martina Del Maestro, MSc; and Gennaro Verni; and researchers from the Politecnico di Milano’s Department of Management, Economics, and Industrial Engineering—Emanuele Lettieri, Giovanni Radaelli, and Cristina Masella—performed a “stratified cost-utility analysis” regarding the impact of the C-leg (Ottobock) and polycentric mechanical knees on different amputees.

Photo: Ottobock

Ottobock C-leg.

The study, “Stratified Cost-Utility Analysis of C-leg vs. Mechanical Knee Prostheses: Findings from a Retrospective Study on 127 TransFemoral Amputees,” found that while the C-leg provided better outcomes compared to mechanical knee users in all sub-groups of patients, it was most cost-useful among amputees aged 35 to 53, with first prosthesis at 26 to 40 years of age. Older amputees with first prosthesis at more than 40 years of age revealed the lowest quality of life, meaning the C-leg had limited differential impact. The findings are based on self-administered questionnaires from 127 transfemoral amputees who walked without external aids, were amputated for work-related injuries, were 35 years of age or older, and were fit with a C-leg electronic knee (70 patients) or a mechanical knee (57 patients). The questionnaire measured mobility, self-care, activities, pain/ discomfort, anxiety/depression, and it also measured “costs” by including cost of prosthesis and its maintenance, and any transportation and overnight stays. “This result is moving INAIL to design a specific strategy of provision to over-40 patients that could exert stronger impacts on the quality of care through interventions such as psychological support, after-sale assistance, [and] special rehabilitative aids,” writes Cutti in the study.

Orthoses for Stroke Victims. Ankle-foot orthoses (AFOs) are often prescribed to poststroke patients to normalize or improve joint position and increase stability, yet there are conflicting ideas and views about the real benefits of AFOs to stroke patients. For that reason, Marcus Besser, PhD, director of the Human 26

O&P Almanac JUNE 2013

Performance Lab and Professor of Physical Therapy at Thomas Jefferson University, undertook a systematic review of literature to assess the effectiveness of AFOs in improving balance in adults with post-stroke hemiparesis. For his study, “Effectiveness of Ankle-Foot Orthosis on Balance in Adults with Post-Stroke Hemiparesis: A Systematic Literature Review,” Besser examined 10 substantive studies that included 302 subjects ranging in age from 17 to 58 and concluded that there is moderate evidence to support the use of AFOs to improve balance in subjects with post-stroke hemiparesis. He reports there is no evidence that AFO use has a detrimental effect on balance. This study was funded by AOPA and is part of the Survival Imperatives project.

A Look to the Future The studies above describe just a few of the recent industry advances O&P professionals have made to help improve the quality of life for our patients. But the good news doesn’t stop here. In fact, two studies in the works are sure to offer more insight into how we can better serve our clients by ensuring we have the best data available to help them make treatment decisions: • Northwestern University Prosthetics-Orthotics Center Research Associate Professor Steven Gard, PhD, and Research Fellow Matthew Major, PhD, are conducting an AOPA-funded research project “Validation and Critical Evaluation of the AOPA Prosthetic Foot Project Report,” which is aimed at achieving two goals: validating and evaluating the 10 standardized mechanical tests as detailed in the Prosthetic

Foot Project Report, and critically reviewing the context-based code descriptors, content impartiality, and the overall Prosthetic Foot Project Report to serve as a means to classify prosthetic feet for the Healthcare Common Procedure Coding System L-Coding scheme. • University of South Florida’s M. Jason Highsmith, PhD, DPT, CP, FAAOP, is researching “Prosthetic Management Following Transtibial Amputation: A Systematic Review to Establish Assessment and Treatment Pathways.” The purpose of Highsmith’s project, also funded by AOPA, is to conduct a systematic literature review that will produce treatment algorithms and evidence statements supporting clinical decision making for patients following transtibial amputation. Each day in the clinical setting, O&P practitioners face many challenges in providing the best patient care—from technology issues, to funding and patient compliance. Only through effective communications can clinicians and researchers bridge gaps and work toward addressing these challenges and improving the quality of care for all patients. a Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@ Editor’s Note: Learn more about the progressive studies taking place in the O&P field by attending AOPA’s O&P World Congress 2013, September 18-21, at the Gaylord Palms Resort and Convention Center in Orlando, Florida.

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New Heights for

Lifelong Learning Seasoned practitioners can choose from a wide array of continuing education options to advance their careers


O&P Almanac JUNE 2013

By Christine Umbrell


hile the O&P profession has always been one in which practitioners must stay abreast of the newest techniques and devices to remain relevant, it has become increasingly important for O&P professionals to embrace lifelong learning. Not only must today’s O&P professionals be aware of the latest clinical developments, but they also must participate in ongoing educational opportunities that focus on the business side of practice management. Knowing about the reimbursements process and how to keep a business profitable is just as important as staying up-to-date on components and treatment plans.

Those who choose to conduct “business as usual” without participating in continuing education are finding that their businesses become irrelevant—and some are closing their doors for good.

JUNE 2013 O&P Almanac


O&P Business nagement tificate Program resses skills that fundamental to success of an P business.

New—and More—Skills Needed


“Twenty years ago, we were ‘make a device’ practitioners. Your ability to make a well-fitting prosthesis made you a good practitioner,” says Brian Gustin, CP, president of Forensic Prosthetic & Orthotic Consulting and an AOPA coding and billing course instructor. But the modern practitioner successfully combines clinical craft with business acumen.

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Your AOPA’s CertifiBusiness cate in Management

“You won’t have a clinical side if you don’t keep up with the business side of O&P.” —Brian Gustin, CP


O&P professionals seeking to hone their business skills are finding a new oint partnership between AOPA and the University of venue to do so: AOPA’s O&P Business Management Certificate Program. The ool of Continuing and Professional Studies program has been developed as a joint partnership between AOPA and the University of Virginia (UVA) School of Continuing and Professional Studies. Participants register to take classes to ultimately earn a certificate in O&P get started: business management. 3.itsComplete a Module153 specifi c quizprofessionals for plete the online signThough up form: the program is in initial phases, O&P have each program. // registered for and begun taking courses in the program, with a targeted cate-in-op-business-management/ that successfully complete the 2014. graduation date for some of4.theParticipants first certificate recipients of early program will be awarded a certificate of and complete four required core modules certificate areas learning, according to Tina completion, four in addition to of being recognized at our elective modulesThe within three years.program encompasses the AOPA Assemblyoperations and the Moran, CMP, AOPA’s senior director ofNational membership and meetings: O&P Almanac. sales and marketing, operations, finance, and management. Within each area, participants must complete two courses—a “core” course plus an elective— and complete a quiz. Some of the programming overlaps with AOPA’s other educational offerings—for example, the core course for the operations module versity OPPORTUNITY! to the valuable education, products and is AOPA’s Mastering Medicare Advanced Coding and Billing seminar. Some AOPA that you need to succeed. travel is required for completion of the certificate because some courses require in-person sessions. “When you graduate, you’ll receive a certificate from AOPA and UVA to hang in your office,” says Moran. There is no initial registration fee; participants pay for each course as they go. This program is unique in that it offers business classes specifically targeted to O&P professionals, taught by both O&P professionals and UVA professors, says Moran. Those owners, managers, and practitioners who complete the program “will learn better business practices and create ongoing returns for their companies.” Editor’s Note: The program’s finance module can be completed at this year’s O&P World Congress. For more information, visit


O&P Almanac JUNE 2013

“Today, the emphasis is on practitioners knowing more aspects of both a facility business and clinical applications,” explains Andy Marsland, CP, LPO, BOCPO, a clinical support prosthetist with WillowWood. “Coupled with advanced technology knowledge, traditional clinical application, and the hand skills to implement these, the clinician today has to have a much broader skill set.” The credentialing bodies clearly recognize the need for continuing education, requiring certified practitioners to maintain their certification through appropriate learning activities. Some O&P professionals agree that the current economy demands more focus on business administration. “You won’t have a clinical side if you don’t keep up with the business side of O&P,” says Gustin.

Practitioners nowadays are “much more involved in Medicare guidelines, payer sources, and which devices are financially viable,” adds Frank Vero, CPO. “The clinical and business sides go hand-in-hand. You need to control costs and overhead, and adjust your business practices. If you’re the world’s greatest clinician, but a poor businessman, you won’t succeed.” Contributing to the blurred line between clinical and business responsibilities are necessary patient-care tasks, such as documentation and reimbursement. “If a practitioner cannot convince a payer that a treatment is medically necessary via their documentation, then treatment may be delayed or denied—that’s bad patient care,” explains Gustin. “Patient care involves knowing and understanding how to gain medically necessary approvals from various payers. Given the standardization of clinical components, the differentiating factor from one clinician to another is not the type of device, but their ability to gain approvals to provide care.” Fortunately, with the need for increased education has come a multitude of offerings and formats for both clinical and business education options. No longer do practitioners have to spend time and money traveling to in-person courses for all of


O&P Almanac JUNE 2013

their professional development needs. More economical options—such as videos, webinars, audio conferences, and other e-learning opportunities— enhance traditional learning formats. An abundance of options provide a perfect fit for busy O&P professionals.

Master’s Level Education— for Novice and Veteran Practitioners As the O&P profession has evolved, so too have the O&P schools. In fact, all of the National Commission on Orthotic and Prosthetic Education (NCOPE)-accredited schools were required to be elevated to master’s level by the end of 2012. Considering that O&P graduates have a residency requirement, today’s newest

practitioners are completing a much longer and more thorough education than some previous generations. And the residency program is an extension of that initial education experience: “There is a greater emphasis to put people in real-world settings, so they see the business side and reimbursement side” of becoming a prosthetist or orthotist, says Robin Seabrook, director of NCOPE. “Because of technology and the learning that is needed in [master’s level O&P programs], you have people coming out of school who have more of a research focus and more of a technology focus. They have a higher level of learning,” says Mark Edwards, director of professional and clinical services at Ottobock. Experienced professionals are appreciative of the industry’s movement to provide more continuing education opportunities. When seeking to upgrade their education to match the new entry-level requirements, seasoned professionals will notice some O&P schools are planning to offer post-professional master’s degrees, according to Seabrook. Such programs, which may be offered via distance-learning options, are designed for O&P professionals who are already in the profession and are certified/ licensed in at least one discipline.

Post-Professional Options for Certified Practitioners One such post-professional master’s degree program will debut next year, with applications being accepted this fall. The University of Hartford has developed a Modified Master’s Program, according to Matthew Parente, CPO, PT, clinical director of the university’s prosthetics and orthotics program. The program has been accepted and approved in the state of Connecticut and is in the last stages of approval by the university. Current practitioners may apply to participate in the program and earn master’s degrees, with most of the coursework being completed via distance learning. To fit the needs of each type of practitioner, Hartford’s Modified Master’s Program has been designed with three pathways: Certified orthotists can take a pathway with a

“Because of technology and the learning that is needed in [master’s level O&P programs], you have people coming out of school who have... a higher level of learning.” —MARK EDWARDS combined prosthetic focus/master’s coursework; certified prosthetists can take a pathway with a combined orthotic focus/master’s coursework; and certified CPOs can take a pathway geared toward master’s coursework with extra electives. Participants in the University of Hartford program will be required to earn 30 credits to receive their master’s degrees, 24 of which must come through the University of

Ferrier Coupler Options!

Hartford. Those individuals who are already CPOs and attained baccalaureates through a Commission on Accreditation of Allied Health Education Programs (CAAHEP)accredited program will be eligible to take more electives. “We’re looking to partner with the university’s business school,” says Parente. He recognizes that many master’s students would benefit from MBA-type courses geared specifically toward the O&P profession.

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. JUNE 2013 O&P Almanac


Durbin Legislation Would Increase O&P Master’s Programs Sen. Dick Durbin (D-Illinois) has introduced two bills designed to help wounded veterans returning from combat. S. 522, the Wounded Warrior Workforce Enhancement Act of 2013, would fund grants for universities to develop (or expand upon) master’s programs in O&P. As written, the bill requires those institutions receiving a grant to rotate students through facilities run by the U.S. Department of Veterans Affairs (VA) or that hold VA contracts. Another provision of S. 522 is the establishment of a Center of Excellence in Prosthetic and Orthotic Education to provide evidence-based research on the skills and training necessary for O&P professionals who treat veterans. U.S. Sen. Dick Durbin (D-Illinois) introduced a pair of bills to ensure service members and Despite the demand veterans in need of orthotics and prosthetics for trained clinicians who receive high-quality care at a news conference can provide high-quality at the Rehabilitation Institute of Chicago on services to wounded Monday, March 11, 2013. warriors, veterans, seniors, and an aging population of seniors and civilian amputees, O&P with increasing health needs,” AOPA programs are not high-profile said in a statement. This bill would enough and don’t generate enough authorize $15 million over three money for universities to underwrite years in competitive grants to help sufficient numbers of programs. ensure that American universities “With a significant percentage of our can deliver sufficient numbers of nation’s trained and experienced O&P professionals. orthotic and prosthetic clinicians Sen. Dick Durbin’s (D-Illinois) eligible to retire in the next 10 second bill, S. 521, the Wounded years, existing O&P master’s degree Warrior Research Enhancement Act programs cannot graduate enough of 2013, supports prosthetic research providers with master’s degrees to better match patients with the even to maintain the current O&P appropriate devices. workforce, much less the number of Both bills have been referred to clinicians that will be needed to care committee for further discussion. for young veterans of current wars


O&P Almanac JUNE 2013

“The vast majority of the coursework could be completed from home,” says Parente, making this option an attractive one for practitioners across the country. “Attendance would be required for a twoto three-day period for practical exams.” But students may also be expected to incorporate some of their practice into their coursework for evidence-based applications, says Parente. Of course, those COs or CPs who participate will be expected to complete a residency in the discipline they are not currently certified in before they can receive their Master of Science in Prosthetics and Orthotics (MSPO), says Parente. If their current facility is already an official NCOPE residency site, that requirement should be an easy one. Parente believes this approach will be well-received: “We’ve been doing distance learning for the Newington Certificate Program for 10 years, and we understand how distance learning can work.” Another O&P school considering offering a post-professional MSPO degree via distance learning is the University of California, San Francisco. “We’re in the very early inception of this effort,” explains Matthew Garibaldi, CPO, director of the university’s orthotic and prosthetic centers and assistant clinical professor in the department of orthopaedic surgery. “The process has started, and we have developed a Curriculum Design Committee.” Garibaldi hopes to formulate a business plan and possibly start marketing the program in the spring or summer of 2014, pending university approval. Loma Linda University already offers a postprofessional MSPO in orthotics; however, its program is targeted toward local practitioners who can attend classes twice a week. The 11-month, Tuesday- and Thursdayevening format of the Loma Linda MSPO program allows working clinicians to enhance their professional experience and earn a master’s degree via in-person coursework.

Continuing Ed Options Abound For those O&P professionals seeking professional development—but not at the master’s level—there is a wide selection of offerings and formats. “Continuing education has been very important and very positive recently,” says Vero. “It helps everyone stay current, and it helps quality people stay up-to-date.” AOPA offers education in all different mediums: online video learning, audio conferences, seminars, workshops, and sessions at the annual National Assembly and the upcoming World Congress. For professionals who want to enhance their business acumen, AOPA is offering a new Business Management Certificate Program (see sidebar on page 30). Outside of the AOPA umbrella are a number of other educational opportunities: supplier in-services, manufacturer seminars, online classes offered by the Academy, the Academy’s Certificate Program for Professional Development, articles and quizzes in the Journal of Prosthetics and Orthotics (JPO), licensure courses offered in conjunction with state meetings, etc. Course organizers have noticed growing interest in business-themed classes. “Over the course of the past year, I’ve seen a significant increase in terms of people wanting education to figure out how to move forward in this challenging legislative and regulatory environment,” says Steve Custer, AOPA’s membership, meetings, and communications coordinator. He cites recent increases in participation rates for AOPA’s 2013 audio conference series as an example. “Audio conference sales from January to April of 2013 have been higher than for all of 2012. But they are also higher than 2011 and 2010 individually as well.” In particular, the January audio conference on Recovery Audit Contractor (RAC) audits had the “highest call volume we’ve ever had,” says Custer. That’s not surprising given the fact that RAC audits are a particularly challenging facet of the business these days. Other topics receiving heightened interest include contracting

with government agencies including CMS, and coding and billing, according to Custer. While e-learning is proving popular, not all subject matters lend themselves to online learning. “Some methods of education will not work as efficiently online as they do by attending a workshop and getting hands-on knowledge,” explains Marsland. “For a subject matter that is, say, administrative, then online is a great method of learning.” But for classes designed to teach practitioners how to fit and use specific products, the initial training is more effective in-person, he says. O&P professionals also may benefit from attending educational sessions at national meetings, such as AOPA’s National Assembly and the upcoming World Congress. “You really find out what’s going on—politically, clinically, and business-wise—when you attend a meeting,” says Vero. This year, the continuing education offered at AOPA’s annual meeting

promises to be bigger and better: “We’re bringing people from all over the world together in Orlando for an international O&P World Congress. There will be opportunities to learn about new products and techniques from all over the world,” says Tina Moran, CMP, AOPA’s senior director of membership operations and meetings. Whether an O&P professional chooses to participate in continuing education at an annual meeting, at an on-site CEU course, via distance learning, or even as part of a postprofessional master’s course, there is one underlying truth: Ongoing continuing education in both business and clinical aspects of O&P has become a requirement for providing optimal patient care. a

Christine Umbrell is editorial/production associate for O&P Almanac. Reach her at

JUNE 2013 O&P Almanac



Facility Spotlight By Deborah Conn

A Legacy of Care

Syracuse facility has a personal touch with patients and politics

Mike Mahar, CP, assists an above-knee amputee patient.


Syracuse Prosthetic Center


Syracuse, New York


John Tyo, CP, BOCP


16 years in business


O&P Almanac JUNE 2013


yracuse Prosthetic Center may be 16 years old, but the legacy that its founder, John Tyo, CP, BOCP, brought to the business stretches back 147 years. After losing his leg in World War II, John’s father, Howard, apprenticed with artificial limb maker Chauncy W. Frees, the grandson of Chauncy A. Frees, who began his career in 1866 making artificial limbs for Civil War veterans. Howard took over the business from Chauncy W. in 1952 and was succeeded by his son John, who eventually built the practice into the 10th largest O&P provider in the country. With size, however, came a new role for John, who says, “I became a business manager, not a prosthetist. I don’t like managing, but I love prosthetics.” So, he sold the business, and in 1997, opened Syracuse Prosthetic Center, a single-office facility that allows him to focus on his profession.


demanding refunds of reimbursements or holding up payments. As a result, smaller facilities are struggling, many laying off employees and, like John, abandoning any plans to grow. “People are not providing prosthetics to Medicare patients because they are afraid to,” he says. “This will affect patients immensely. Hundreds of facilities will go out of business if things stay as they are. “When I first heard about this, I’m ashamed to say I hid my head in the sand,” John acknowledges. “It was so insane and impossible, I thought it couldn’t go forward. But it did.” John has been working with AOPA on this issue and trying to organize a more coordinated effort among fellow O&P providers. “My business traces its roots back to the 19th century,” he says. “We are in the midst of a turmoil that may determine whether we survive at all.” a

Owner and director John Tyo, CP, BOCP, works to fit a patient with a Genium C-leg.

Syracuse Prosthetic Center has four practitioners and one technician, Tim Harrington, who does most of the fabrication in-house. Both John’s son, Jeff Tyo, CP, and his son-in-law, Mike Mahar, CP, decided to pursue prosthetics after exploring other professions. (Jeff formerly worked in hotel, restaurant, and institutional management and Mike in molecular biology.) The two completed their residencies at Syracuse Prosthetic Center and are now full-time clinicians. Gary Rivers, CP, BOCP, brings a background in management and prosthetic fabrication to his role as chief prosthetist. The staff is rounded out by John’s partner and administrative manager, Sheila Harrington. John, Gary, and Sheila have worked together for more than 25 years. The majority of the facility’s practice centers on trauma-related amputations, although it does include work with vascular amputees and veterans. John had plans to expand, but he’s keeping them on hold while he faces what he regards as the most significant challenge facing Syracuse Prosthetic Center, and indeed, he says, the profession as a whole: Recovery Audit Contractor audits. John explains: Medicare has instituted new requirements for physician documentation and is retroactively auditing files and

Facility Spotlight

Deborah Conn is a contributing writer to O&P Almanac. Reach her at

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JUNE 2013 O&P Almanac



Ask the Expert By Joseph McTernan, AOPA government affairs department

Sequestration and Medicare Payments How does the 2 percent reduction in Medicare reimbursement affect your facility?


s a result of the Budget Control Act of 2011, sequestration became a reality for Medicare providers for claims with a date of service on or after April 1, 2013. This month’s Ask the Expert column addresses many of the questions AOPA has received regarding the impact of sequestration on Medicare payments.


How are sequestration cuts being applied to Medicare claims?


For Medicare claims with a date of service on or after April 1, 2013, reimbursement is being reduced by 2 percent. This reimbursement reduction applies to almost all Medicare services, with very limited exemptions for Medicare beneficiaries receiving low-income subsidies for Part D (prescription drug) services. There are no exemptions available for O&P services.

Q: A:

Is sequestration affecting only O&P providers?

No. Except for the very limited circumstances discussed above, sequestration affects all Medicare payments, including those to O&P providers, physicians, hospitals, etc.


O&P Almanac JUNE 2013

Q: A:

Is the Medicare fee schedule being reduced?

No. The Medicare fee schedule for durable medical equipment, prosthetics, orthotics, and supplies remains the same and will continue to be adjusted by the consumer price index for urban consumers-based annual adjustment as well as the productivity adjustment that was implemented in 2011. The 2 percent reduction is applied after the Medicare allowable amount, based on the fee schedule, is determined.


Does sequestration affect the amount of coinsurance or deductible that may be collected from Medicare beneficiaries?


No. Because the 2 percent reduction is applied after the determination of the allowed

amount, Medicare beneficiaries remain responsible for any unmet deductible as well as the full 20 percent coinsurance on assigned claims. For example, if the Medicare allowable for a service is $100, and the patient has met his or her annual deductible, you may collect $20 from the patient at the time of delivery. Medicare will then reimburse you 98 percent of $80, or $78.40. The total reimbursement for the service in this scenario would be $98.40.


Are other insurers allowed to reduce their reimbursement by 2 percent as a result of sequestration?


No. Assuming the terms of your contract with an insurance company involve reimbursement based on a percentage of the current Medicare fee schedule, insurance companies may not reduce their reimbursement due to sequestration. Since the fee schedule remains the same as prior to sequestration, any discounts negotiated off of the current Medicare fee schedule also should remain unchanged.

reduction will be applied each year after the annual update to the Medicare fee schedule. If Congress and the White House reach agreement on a new federal budget, sequestration will end as an immediate result of the passage of the law establishing a new budget.

Q: A:

How much money will sequestration “save?�

The Congressional Budget Office has estimated that in 2013, sequestration-related reductions to Medicare reimbursement will

result in $10 billion in savings to the Medicare program. These questions represent a small sample of the questions AOPA has received regarding sequestration and its impact on reimbursement for O&P services. If you have additional questions, please contact AOPA. a Joseph McTernan is AOPA’s director of coding and reimbursement services. Reach him at


Are non-assigned claims subject to the 2 percent sequestration reduction?


Yes. Medicare reimbursement sent directly to the patient for non-assigned claims will be reduced by 2 percent as a result of sequestration. You are not obligated to address this reduction when determining what you charge the patient on a non-assigned basis and may continue to charge the same amount for services that were delivered prior to the implementation of sequestration cuts.

Q: A:

When will sequestration end?

If the federal government cannot agree on a federal budget, sequestration is scheduled to last until 2022. The effects of sequestration are not cumulative, however, meaning that the 2 percent JUNE 2013 O&P Almanac





Change Facing challenges head-on, AOPA sets a strategy for success


dedicated group of AOPA members is leading the charge to help our industry prepare for a challenging future as new business models, payment systems (such as bundled care), and accountable care organizations (ACOs) begin wielding a strong influence in the delivery of patient care. In early April, members received a letter from AOPA President Tom Kirk, PhD, detailing how that work is progressing. He prefaced his letter with the following observation: “Our profession has been under siege from outside regulatory, reimbursement and competition forces. We have seen new regulations with onerous conditions requiring excessive documentation, draconian processes and new forms of local coverage determinations. Changes in reimbursements are rampant in the form of fee schedule reductions, productivity adjustments, sequestration cuts, and the threat of commoditization through competitive bidding. Finally, new delivery models are being proposed that are bringing new business models and competitors. Our ability to proactively employ actions to mitigate these forces will determine whether we prosper, stay the course in the status quo or become obsolete.” Kirk went on to describe the six Survival Imperatives that are designed to help meet those


O&P Almanac JUNE 2013

AOPA President Tom Kirk, PhD

challenges. The term “stream” was selected to describe each of the Survival Imperatives because, in reality, each of the separate endeavors has an end point or confluence that leads to a more stable and powerful flow, like a strong river, capable of delivering, in this case, higher quality patient care. You can see how those streams come together with this brief overview of each. Stream 1, headed by Paul Prusakowski, CPO, has staked out a necessary underpinning of the entire project by developing a longitudinal patient database via uniform intake data tools that track treatments and outcomes. Some preliminary work laid the foundation for this effort based on a patient registry survey commissioned by AOPA and developed by the Thomas Jefferson University Medical School, which was then refined by representatives from within the profession, as the first leg of this project. Ongoing in nature, it will be a data repository that can continually be referenced as new questions arise. Existing software providers in the O&P field, along with the U.S. Department of Veterans Affairs and others, are expected to join in expanding the scope of the data collection.


Programme now available! The preliminary programme for this year’s Annual Conference is included with this issue. The programme features a fantastic line up of speakers including renowned industry speakers and some new names that will inspire, excite and motivate delegates. Keynote speakers include: • Dr Noel Fitzpatrick, The “Bionic Vet”, Director and Clinical Chair, Fitzpatrick Referrals Ltd, UK • Professor John McGrath, Professor of Molecular Biology, Kings College London • Nicola Munro, Advanced Specialist Orthotist, NHS Greater Glasgow and Clyde • Debbie Wilson, Diabetes Specialist Podiatrist, Wishaw General Hospital, Lanarkshire • Hannah Yirrell, Clinical Lead Podiatrist, Help for Heroes Rehabilitation Complex, Headley Court • Glen Foley, Biomechanical Podiatrist, Help for Heroes Rehabilitation Complex, Headley Court • Professor Alon Wolf, Professor of Mechanical Engineering and Director, Biorobotics and Biomechanics Lab (BRML) Technion University & Institute of Technology, Haifa, Israel • Dr Simon Bartold, Specialist Sports Podiatrist and ASICS International Research Consultant • Joanna McCardle, Diabetes Specialist Podiatrist, Edinburgh Royal Infirmary • Ben Yates, Consultant Podiatric Surgeon, Great Western Hospital, Swindon • Stella Vigs, Consultant Vascular and General Surgeon, Mayday University Hospital A wide range of concurrent sessions will provide delegates with the latest developments and updates in specialist areas including diabetes, dermatology, rheumatology, private practice, research, forensics, surgery, MSK, footwear, podopaediatrics and complementary medicine. In addition, the programme offers a number of specially designed workshops to offer a hands on, interactive learning experience that will provide valuable skills and tips to take back to the workplace.

Social programme

This year’s social programme promises delegates a unique experience, sampling some of the best venues and entertainment Liverpool has to offer to provide a truly memorable time! Comedy night, Thursday 14 November, The Supper Club The comedy night will be held at The Supper Club on Blundell Street, a short walk from the ACC. The venue holds many live music and comedy evenings. Delegates will enjoy a hilarious line-up of comedians, a complimentary drink on arrival and simple basket meal. Tickets are £20. Places are limited so early booking is advised. Pods in a pod, Rides on Liverpool Wheel, Thursday 14 November We are offering delegates the opportunity to ‘party in a pod’ on the Liverpool Wheel adjacent to the ACC. Enjoy a glass of champagne with friends and colleagues whilst taking in the fantastic views of the city. Tickets are £10 CPSA annual student conference party, Thursday 14 November The CPSA will be hosting an evening party which will offer an excellent opportunity for networking and fun with students and colleagues. Further details to follow. Conference dinner and party, Friday 15 November, St Georges Hall The conference dinner and party will take place at St Georges Hall, a magnificent venue featuring a beautiful main banqueting hall with stunning chandeliers and stain glass windows. The venue offers a fantastic setting for the event. The evening will incorporate a drinks reception, three course dinner with wine, live Beatles music and dancing. Dress code: Lounge suits. Tickets are £55 for members and £75 for non members.

For further information and the latest programme updates please visit, call +44(0)20 8832 7311 or email



Stream 2, headed by Jim Campbell, PhD, CO, and Tom DiBello, CO, FAAOP, is creating a process for studying outcomes for specific diagnoses to develop a series of best practices/practice guidelines. The initial studies target two important areas: the orthotic management of post-stroke patients and prosthetic management following transtibial amputation. Chief scientists have been awarded grants of approximately $50,000 each to conduct literature searches. Jason Highsmith, PhD, DPT, CP, FAAOP, University of South Florida, was selected for the transtibial amputation project to conduct a systematic literature review that will produce treatment algorithms and evidence statements supporting

Stream 3, headed by Anita Liberman-Lampear, MA, seeks to identify and prioritize a range of important but unanswered research questions and determine how to achieve valid, verifiable evidence on each. As a first phase, the Medicare database originally procured for a research project commissioned by the Amputee Coalition and funded by AOPA to demonstrate the cost-effectiveness of timely O&P intervention is being mined for further comparative effectiveness information to validate the efficacy and economics of various O&P treatment programs. This effort should provide the basis for identifying other sources, seeking new clinical studies, or commissioning additional comparative effectiveness studies.

clinical decision making for patients following transtibial amputation. Marucus P. Besser, PhD, of Thomas Jefferson University, was selected to conduct the study on the orthotic management of patients post-stroke, which will similarly conduct a search of all literature published in the last 15 years and prepare a framework for an assessment and treatment pathway, a potential algorithm that would encompass all key decision points and episodes of care following a stroke. In both projects, the findings will be aligned with episodes of care to identify measurable outcomes and, by doing so, determine best practices that will become the basis for an in-depth review by a larger reference group of experts. (Note: For more information on Besser’s study, see page 26.)

Stream 4, headed by Scott Schneider, is all about education and communications, and taking the information gained from comparative effectiveness, cost-effectiveness, and various treatment research projects and playing it back to policy, payer, and patient decision makers. Initial efforts in cooperation with streams 3 and 4 have been focused on creating a survey instrument that can be used in face-to-face interviews with the target audience decision makers to measure current perceptions and expectations. Volunteers associated with stream 3 will be deeply involved in identifying and arranging appointments with decision makers reinforced by a market research firm that has been retained to conduct the interviews, so there is data consistency.


O&P Almanac JUNE 2013

Stream 5, headed by Michael Oros, CPO, broadens the opportunities for O&P’s success in the new world of health care by identifying similarly situated allies in other specialty medical areas that may share some of the same challenges and then determining whether alliances with ACOs, insurance companies, and other provider groups play a role in the future of O&P. Data gained from the survey instrument and interviews by the marketing firm will help shape the direction of those potential alliances. Leveraging as a group could muster more benefits for all as opposed to going it alone. Stream 6, headed by Mike Hamontree, also is relying initially on the data gained from the survey instrument and marketing firm interviews of policy and payer decision makers to guide efforts in determining what alternative delivery methods for O&P best work in the new environment. What risk-sharing models currently in use or under consideration appear most beneficial for O&P providers and patients? This effort will include looking at care bundling diagnosesrelated group approaches for specific episodes of care and how quality of care can be measured more reliably to predict the most patient/provider friendly models.

A special session at the O&P World Congress, September 18-21, 2013, at the Gaylord Palms Resort in Orlando, Florida, will be devoted to presenting progress reports on each of the streams on Thursday, September 19, from 11 a.m. to noon. This work in progress could be one of the landmark undertakings of your association—so stay tuned. a


Social Media and Your O&P Practice: Useful Twitter Tools and Tips for O&P Social Networking New to Twitter? Follow these examples to send tweets or retweets to your patients or community:

@username + message Send a tweet to another person that can be in the “replies” tab and/or in their main stream if they follow you. This tweet is public to everyone if you have a public account. Example: @americanoandp Did you see the new article on social?

D username + message Sends a person a private message that goes specifically to that user. Example: D americanoandp Sending you a private message

Retweets or RT Users can resend tweets to their followers from people they follow. Example: I follow @AARP but you don’t. I like their last tweet and want to send it out to you. So I retweet it by hitting the “retweet” button. The retweet looks like this in my followers’ stream: RT @AARP AARP/AARP Foundation launch major hunger effort—text ‘hunger’ to 50555 now to donate $10 to fight hunger among older Americans! #orlando50.

Hashtag Hashtags are great tools used to aggregate accounts that use the hashtag. To create a hashtag, think of a short collection of letters and/or numbers you would like and put the # symbol in front of it—the shorter, the better. Example: I really hope the #Colts win tonight! #GoColts In the above tweet, Colts and GoColts were used as hashtags. You can integrate the tag into the tweet and/or put it at the end of a tweet. Be careful not to use too many hashtags; one to two in a tweet should be sufficient, if you need one at all. Most users use hastags when attending events—they are great for conferences!

Common Twitter Terms DM or Direct Message A direct message; see above for example. RT or Retweet

Repeating a tweet from someone else; see above for example.

Tweeps / Tweeple

People on Twitter—used only colloquially.


The act of posting to Twitter.


An in-person meetup of Twitter members.


Twitter—everyone and everything that make up Twitter.

JUNE 2013 O&P Almanac




AOPA Files Lawsuit Against Medicare


OPA has filed suit against the U.S. Department of Health and Human Services (HHS), Medicare, in the Federal District Court for the District of Columbia. AOPA said the suit is seeking relief from the unfair and unauthorized actions of the Centers for Medicare & Medicaid Services (CMS), primarily via actions of its Recovery Audit Contractor (RAC) auditors and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) relating to physician documentation requirements.

AOPA’s suit arises with respect to Medicare actions that began in August 2011 when the HHS Office of Inspector General released a report alleging fraud in the O&P industry. When the lawsuit was filed on May 13, AOPA President Thomas F. Kirk said, “Today, AOPA has stated emphatically that we will not stand by when government acts inappropriately to threaten either the quality of care we provide to our patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession.” AOPA’s suit arises with respect to Medicare actions that began in August 2011 when the HHS Office of Inspector General (OIG) released a report alleging fraud in the O&P industry. According to a written statement from AOPA, the report misunderstood that patients don’t go to their physicians when their prostheses are not working properly; misunderstood that it is not unusual that most Medicare amputees may not see the referring physician who first prescribed their prosthetic care because that


O&P Almanac JUNE 2013

physician is commonly the surgeon who amputated their limb; created extensive confusion about whether individuals with bilateral amputations should have both prostheses on a single claim or two separate claims; leapt to conclusions of fraud because claims costs had increased with a fixed number of Medicare amputee beneficiaries while failing to recognize that the Iraq and Afghanistan wars had prompted a “quantum leap in technology,” and a related incremental increase in unit cost, which together with CMS-approved O&P fee schedule increases, “after years of ‘freeze,’” had driven per capita increases; and failed to track, as required by BIPA 427, whether or not care providers were, or were not, qualified providers under federal law. AOPA alleges that CMS was in violation of the federal Administrative Procedure Act and the Medicare Act, when, in August 2011, it revised the standards by which a prosthetic claim would be judged for reimbursement approval by circulating a “Dear Physician” letter. AOPA has met with virtually every ranking official at CMS, including three meetings with the CMS Administrator. Thirty-five members of the U.S. House recently signed a letter to the Secretary of HHS seeking relief for O&P and our Medicare patients. But, despite knocking on every door, little if anything substantive has been done by Medicare to remedy this unworkable situation. Under these dire circumstances, AOPA, having exhausted all other prospects for relief, had little choice but to place this matter, and the future of the O&P profession as well as the quality of care delivered to Medicare amputee beneficiaries, in the hands of the courts. To read the full complaint, visit CMS/AOPAcomplaint.pdf.



About the Congress

Participate in the Second Annual AOPA OPTA Technical Fabrication Contest Don’t miss out on a fun and exciting opportunity to compete with your colleagues in the 2nd Annual AOPA OPTA Technical Fabrication Contest. Enter the contest to fabricate a partial foot prosthesis. Your device may be selected as a cash prize winner in one of three categories: Student, Technician, and Practitioner. Contestants may determine the final shape and cosmetic finishing, and may choose amputation level; contestants must include a short description specifying the issues addressed in the design of the device. A $25 entry fee with online registration is required. There will be a winner and runner-up in each category; these individuals will be awarded cash

prizes and certificate/trophy recognition. Additionally, special recognition in the form of a trophy and press release announcement will be awarded to the school representing the winning students. In addition, one entry will be recognized as the Attendees’ Choice Award. Register today at techfab2013. Contact Steve Custer for registration/administrative questions at or 571/4310810. Contact Scott Wimberley for device/technical assistance questions at or 425/349-9557. The contest is sponsored by ABC, OPTA, OttoBock, Cascade-USA, and AOPA.

O&P Almanac Magazine— Don’t Miss an Issue! If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization. As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. Your print issue features all of the latest

The 2013 O&P World Congress already is the most talked about event for 2013—the premier destination for the worldwide O&P community. Register today to participate in an expanded National Assembly as AOPA and partners from around the world work to create an O&P World Congress experience for orthotic, prosthetic, and pedorthic professionals in the Western Hemisphere and around the world. Learn more or register for the congress at

Gain com from



a co devi

Regis http:

Learn more or register for the or Steve Custer at scuster@AOPA or 571/431-0810.

O&P news, regular departments, and special features on hot topics. A digital version of each issue also is available on AOPA’s website at under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase a year subscription of the O&P Almanac at AOPA’s Online Bookstore,

JUNE 2013 O&P Almanac



AOPA Leading ‘Coalition for Compassionate Care’ for Boston Marathon Amputee Victims

As announced in last month’s O&P Almanac, AOPA is leading a coalition to provide access to care for uninsured/ underinsured individuals who sustained an amputation or mobility impairment due to the Boston Marathon bombing to assure the victims that they “will walk and run again.” Manufacturer and patient-care facility members of AOPA and coalition partners have pledged to connect these individuals with the needed specialized care or the means

to ensure access to the needed care as well as free prosthetic limbs, customized bracing, and mobility assistive devices. According to AOPA, the coalition partners, which include the American Academy of Orthotists and Prosthetists, the National Association for the Advancement of Orthotics and Prosthetics, and the Amputee Coalition, have mobilized their national membership networks to provide care access and support. Visit for more information.

Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easy-to-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. • Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. • Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. • Recruiters: Create and manage your online recruiting account. Post jobs to our site and browse candidates interested in your positions.


O&P Almanac JUNE 2013

The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For more advertising opportunities, please contact Dean Mather, advertising sales representative at 856/768-9360 or


Clinical Documentation: The Dos and Don’ts— Join the Audio Conference June 12 What are the most vital pieces of documentation necessary to support your claim? Find out by joining AOPA on June 12 for an AOPAversity Mastering Medicare Audio Conference that will take the helm on what is expected in clinical documentation. An AOPA expert will address these expectations during a role-play scenario of practitioner and medical reviewer, and will explain why this is a critical force in your business operation. The following topics will be covered: • Methods for taking notes and understanding when you should document • Use of SOAP and the timing of chart notes • Words to avoid and words to emphasize in progress notes • Working with referral sources to make sure they are documenting properly.

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ or 571/431-0854 with content questions. Register online at Contact Steve Custer at or 571/431-0876 with registration questions.

Mastering Medicare: AOPA’s Essential Coding & Billing Techniques Renaissance Phoenix Downtown Hotel • June 13-14, 2013 • Phoenix Join your colleagues June 13-14 at the Renaissance Downtown Hotel in Phoenix for AOPA’s “Mastering Medicare: Essential Coding & Billing Techniques” seminar. AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for

both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the “Mastering Medicare: Essential Coding & Billing Techniques” seminar in Phoenix at www. Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.

JUNE 2013 O&P Almanac



Networking for the Future: Building Relationships With Your Referrals— Join the Audio Conference July 10 The value of the relationship should never be underestimated. Networking and marketing your business are vital to its success. Join AOPA on July 10 at 1 p.m. EST for an AOPAversity Mastering Medicare Audio Conference that will focus on maintaining referral source relationships for your O&P practice. Learn strategies and techniques to attain that all-important edge in the competitive world of O&P. An AOPA expert will address the following topics: • • • •

Networking and marketing your O&P practice Reaching out to the right people Techniques that result in out-of-the-box thinking Building and maintaining relationships with referral sources • The importance of brand recognition in O&P. AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon

Bernard at or 571/431-0854 with content questions. Register online at Contact Steve Custer at or 571/431-0876 with registration questions.

Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steffanie Housman at or 571/431-0835 with social media and content questions.

Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •

Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.

• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways.


O&P Almanac JUNE 2013


Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. • Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting


Business Optimization Analysis Tool (BOAT) AOPA’s largest and most successful members use the BOAT. The BOAT will help you:



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

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

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

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

This Amazing Profit Booster is FREE for AOPA Members.


understand your competi-

Examine the

financial fitness of your business

business owners manage their business for greater profit and quality patient care. If you do not already have a BOAT account, contact AOPA’s BOAT partner, Michael Becher, Industry Insights, (614)389-2100 x 114 or mbecher@, to enroll today.

Help you identify and

your finances

tion, market conditions and referral sources

And much more!

JUNE 2013 O&P Almanac


AOPA Applications

Welcome new 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. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.



Member Benefits

Bowman Enterprise Services Inc.

ProtoKinetics LLC

16430 Ventura Blvd., Ste. 304 Encino, CA 91436 818/279-2440 Category: Supplier Member Vanessa Rebolledo

60 Garlor Drive Havertown, PA 19083 610/449-4879 Fax: 610/853-2925 Category: Supplier Member Michael Rowling

Bryan College Station Prosthetics

Rehabilitation Institute of Indianapolis

1602 Rock Prairie Drive, Ste. 150 College Station, TX 77845 979/696-8300 Fax: 979/696-8328 Category: Patient-Care Member Keri McDuffie

2437 N. Meridian Street Indianapolis, IN 46208 317/924-4505 Fax: 317/924-5223 Category: Patient-Care Member James Goff Jr., CPA, BOCP a

Hattingh Incorporated dba Prosthetic Care Facility 44115 Woodridge Parkway, Ste. 180 Leesburg, VA 20176 703/723-2803 Fax: 703/723-2804 Category: Patient-Care Member Michele Hattingh

Medex International Limited Unit D, 13/F Block 2 Tai Ping Industrial Centre 55 Ting Kok Rd Tai Po, Hong Kong (Inc. Kowloon) +1 85226623556 Fax: +1 85235444047 Category: International Member Julia Tang

Experience the Benefits of AOPA Membership Membership in AOPA is one of the best investments that you can make

Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority. All options are on the table to eliminate these burdensome and patient harming practices. Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care. Making Your Voice Stronger. The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives and hope.



Experience the Benefits of AOPA Membership

in the future of your company.

The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.

Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to deliver the O&P story personally to their members of Congress.

Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.

O&P Almanac JUNE 2013

Cost Effectiveness Research. The changing climate of health care is moving to a patient driven process and is demanding more and more evidence of cost effectiveness to measure outcomes. AOPA has funded the first in a series of research projects that will measure the cost effectiveness of timely O&P treatment of patients with the same diagnoses as patients who did not receive treatment. More cost effectiveness research projects will be necessary and are simply too expensive for individual O&P businesses to undertake. AOPA can aggregate the resources of the field to conduct this vital research.

2013 AOPA Annual Membership enrollment is now open. Call 571/431-0876 to request an application form, or visit

Join today!

Value What defines

For over 50 years, PEL has offered the O&P industry outstanding value on the most popular and best performing products from leading manufacturers. We combine a commitment to the independent practitioner with dependable, personal service, a competitive price and our customer-friendly return policy, so it all adds up to great value.

WillowWood LimbLogic® System WillowWood has made its popular LimbLogic elevated vacuum system even better!

• Improved 4-hole controller • Works seamlessly design with fieldwith LimbLogic Sleeve serviceable exhaust filter for an airtight, secure system • Utilizes a small, convenient, ® Bluetooth Low Energy • LimbLogic Sleeve’s remote repositionable inner cuff allows wearer to fix • Inductive charging for easy leaks immediately patient use

New! d! Improve

Becker Orthopedic Camber Axis Hinge®

• Adjustable range-of-motion ankle joint • Anatomical axis alignment for thermoplastic orthoses • Seven color coded range-of-motion keys • Eliminates need for posterior stop mechanisms • Permits solid ankle design changes to articulated motion with variable stop settings • Three sizes • Optional black non-corrosive finish • US Patent 5,542,774

Bev Barnhardt

Director of Customer Service/ Collections Manager • Started with PEL in 2000 • Trains and coaches Customer Service staff to expedite order processing, minimize errors • Husband just returned from overseas duty in Afghanistan • Sports-mom of two girls and one boy • Loves to exercise and enjoy family activities • “What spare time?”

New for dos! the Kid

Allard USA KiddieROCKER™ AFO

• Allard’s BlueRocker™ version of KiddieGAIT™ AFO • Extra rigidity offers enhanced stance, balance and posture control – especially for kiddos with weak quadriceps • Lateral strut serves as solid base to affix T-Strap to control excessive eversion at ankle • Designed to allow integration of custom foot orthotic to help control ground-up forces

PEL Supply Co. Orthotic & Prosthetic Components


4666 Manufacturing Avenue Cleveland, OH 44135-2638 USA

Ph 800-321-1264 Fx 800-222-6176


Experience the Power of One.


2013 Buyers’ GUIDE The annual

one-stop resource



for O&P products and services


Orthoses and Components

53 Orthotics—All


Ankle/Foot Orthoses-AFO


Hip Orthoses


Knee Orthoses


Orthoses: Lower-Limb


Pediatric Orthoses


Soft Goods/Orthotic


Spinal Orthoses


Upper-Extremity: O&P

56 Prostheses and Components 56 Prosthetics—All


Prosthetic Components


Soft Goods/Prosthetics

60 Feet


Foot Care: Custom Footwear


Lower-Limb Prosthetics

62 Mastectomy/Post-Mastectomy


Prosthetic Liners

64 Miscellaneous


CAD/CAM Systems


Central Fabrication


Specialty O&P Distributors


Business Services


Reference Materials



O&P Almanac JUNE 2013

Comprehensive Index


Orthoses and Components Orthotics—All Becker Orthopedic 635 Executive Dr Troy, MI 48083 800/521-2192 Becker Orthopedic was founded in 1933 by Otto K. Becker to provide high quality, innovative, orthotic components and central fabrication services. His vision continues today with new product offerings like the Stride Stance Control Family and SpineCor®.  When it comes to orthotics, Becker has the options you are looking for. • Largest orthotic component selection available • Custom central fabrication services • Dedicated technical support • Knowledgeable customer service staff • Educational in-services • Online support via WebEx. For more information, or assistance with component selection, fabrication, or problem solving, contact Becker Orthopedic at 800/521-2192 or visit

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058

Established in 1946, Soletech has a full line of fabrication materials for the O&P industry including the largest selection of EVA sheets, multi-durometer laminated sheets and blockers, Poron, Plastazote, Neoprene sheets, diabetic insoles, rubber and crepe outsoles, and many other foam materials. Soletech introduced its registered brand of Cloud EVA to the O&P industry in the early 1980s and is recognized as the industry leader for fabrication materials for custom foot orthotics and AFOs as well as for build-ups and shoe modifications.

Ankle/Foot OrthoSES–AFO Allard USA Inc. Rockaway, NJ 888/678-6548

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Hip Orthoses Allard USA Inc. Rockaway, NJ 888/678-6548

Knee Orthoses

2013 Buyers’ Guide

Differentiating yourself and your clinic. Staying on the cutting edge. Offering patients innovative solutions. All these goals are within your reach—and Ottobock is here to help you grow your orthotic business. As stance‑control products become more sophisticated, we’ve led the way, offering the FreeWalk, E-MAG Active, and Sensor Walk KAFOs to provide users with a secure, efficient gait. Now Ottobock opens a whole new world of mobility with the remarkable C-Brace orthotronic mobility system: fluid, natural, efficient movement with support on uneven terrain, on inclines, and going down stairs. Turn to Ottobock for all your orthotic needs.

Soletech Inc. 425 Washington St, Ste 4 Claremont, NH 03743 877/625-9494

Allard USA Inc. Rockaway, NJ 888/678-6548

JUNE 2013 O&P Almanac


2013 Buyers’ Guide

ORTHOSES: Lower-limb

Soft Goods/Orthotic

Allard USA Inc.

Allard USA Inc.

Rockaway, NJ 888/678-6548

Rockaway, NJ 888/678-6548

Orthomerica 6333 N Orange Blossom Trail Orlando, FL 32810 800/466-6770 Lower Extremity Fracture Bracing System from Orthomerica Orthomerica’s Orlando KAFO/HKAFOs are modular, lightweight and can be ordered and stocked as components, making them immediately available, or custom assembled to your measurements. Orthotists choose from a wide selection of pelvic, femoral and tibial components, hip joints, knee joints and shoe inserts to meet individual patient needs. Anatomically designed pelvic components offer a variety of shapes and sizes to accommodate even the most difficult to fit patient. Unique, patented hip joints control flexion/extension and abduction/adduction. Available in individual prefabricated components, pre-assembled, customto-measurements or custom-to-cast. For more information, call 800/446-6770 or visit

Pediatric Orthoses Allard USA Inc. Rockaway, NJ 888/678-6548

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398


O&P Almanac JUNE 2013

Spinal Orthoses Allard USA Inc. Rockaway, NJ 888/678-6548

Euro International Inc. 5906 Breckenridge Pkwy, Ste G Tampa, FL 33610 813/246-5995 LumboVario.tec Euro International presents the “LumboVario.tec” by Streifeneder ortho.production, a multifunctional spinal orthosis with mobilization functionality. This orthosis thoroughly stabilizes and steadies the entire lumbar spine, including the lumbo-sacral passage, throughout the course of the rehabilitation process. The “LumboVario.tec” allows targeted training of the spine by removing stabilizing elements of the orthosis (back shell and boning bars) and is suggested for the following indications: • Post-surgical after intervertebral disc-surgery of the lumbar spine • Post-surgical after stabilizing surgery or fusion (spondylodesis) • Vertebral slipping (lumbal spondylolisthesis) • Narrowing of the vertebral canal (lumbal spinal canal stenosis) • Nerve root irritations due to narrowing at the foramen intervertebrale • Degenerative instability (lumbal spondylarthrosis) • Bone cancer (osteosarcoma) of the lumbar spine • Inflammatory diseases of the lumbar spine (spondylitis). For more information call us at 800/378-2480 or visit


Natural Motion. Mechanical Stability. The SafetyStride is a mechanical stance control orthotic knee joint that utilizes a low-profile cabling system to automatically unlock itself at the end of stance phase. The key feature of the SafetyStride is its ability to resist knee flexion at any angle. The SafetyStride does not require full 180° knee extension to resist knee flexion in stance phase.

The SafetyStride works in conjunction with the FullStride and can be easily installed on a FullStride equipped KAFO. For individuals with significant weakness of hip musculature, the SafetyStride may also be ordered with a GX-Assist option that incorporates a pneumatic spring on the medial joint unit to assist in knee extension during the swing phase of gait.

Designed to unlock at terminal stance, an internal lever re-engages during swing phase to ensure knee joint stability prior to heel contact. Individuals who intermittently fail to reach full extension will now have the added security and stability they require while ambulating.

US Patent 7,462,159 B1 Suggested Base L-Code: L2005

The responsibility for accurate coding lies with the patient care facility that is billing for the product and service.


Rev 4/13 ©2013 Becker Orthopedic Appliance Co., All rights reserved

(800) 521-2192 (248) 588–7480

Stride Family of Stance Control

2013 Buyers’ Guide

Spinal Orthoses, Continued Spinal Technology Inc. 191 Mid Tech Dr West Yarmouth, MA 02673 800/253-7868 Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper and lower-limb orthotics and prosthetics. Our ABC Certified staff orthotists / prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products, fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, call 800/253-7868, fax 888/775-0588, or email Visit our website at

UPPER EXTREMITY: O&P Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Texas Assistive Devices LLC Brazoria, TX 800/532-6840

Prostheses and Components Prosthetics—All ARTech Laboratory, Inc. 309 West Avenue F Midlothian, TX 888/775-5501 The loss of a limb causes deep emotional trauma. Apart from the obvious difficulties with mobility and self-care, the disturbance in body image requires significant emotional readjustment. Our objective is to eliminate the stigma associated with the disfigurement. As opposed to the robotic or mannequin look of a traditional prosthesis, our restorations have a natural appearance since they are sculpted and painted to match the opposite limb. Without close examination, ARTech’s prostheses are virtually undetectable. It is our privilege to work in an industry that gives self-sufficiency, mobility, and self confidence back to those with amputations and birth defects. For more information, call 800/775-5501 or visit

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

KISS Technologies LLC 8517 Loch Raven Blvd Baltimore, MD 21286 410/663-5477 Patented KISS® Superhero Reusable Test Socket Plate The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit or call 410/663-KISS for more information.


O&P Almanac JUNE 2013

Quality fabrication you can depend on Experts in lower limb orthotic & prosthetic fabrication Lower Limb Orthotics AFO FO KAFO HKAFO

Prosthetics Modifications Elevated Vacuum Systems Check Sockets Definitive Sockets Powered Ankles

191 Mid Tech Drive West Yarmouth, MA 02673

800 253 7868

2013 Buyers’ Guide

Prosthetics—All, Continued


Motion Control—A Fillauer Company

Fillauer Companies Inc.

115 N Wright Brothers Dr Salt Lake City, UT 84116 801/326-3434

P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 Your goal is success for your patients and your business. You’ve always counted on Ottobock’s high-quality prosthetic products to provide increased mobility, confidence, and independence for your patients. Now turn to us for help to grow your business, too. Your patients get the benefits of Ottobock’s solutions, suitable for even for the most demanding situations, for every level of function and amputation. And you get the advantages of a dedicated support team of clinicians, reimbursement experts, and product specialists to put you and your patients on the road to success.

WillowWood Company 15441 Scioto Darby Rd. Mount Sterling, OH 43143-9036 800/848.4930 WillowWood is dedicated to partnering with clinicians by providing quality prosthetic products like the Alpha® Family of Liners, LimbLogic® VS, OMEGA® and the Fusion™ Foot. We work closely with clinicians to create strong relationships and solutions for their patients. WillowWood has the leading technology in CAD software and active vacuum suspension as well as one of the most robust product lines of prosthetic liners within the industry. We are here to help you craft prostheses that deliver mobility, comfort, and range of motion so your patients see satisfying, active futures. Call us at 800/848-4930 or view our complete product line at


O&P Almanac JUNE 2013

Össur Americas Inc. 27051 Towne Centre Foothill Ranch, CA 92610 800/233-6263 The Unity™ Vacuum System by Össur®. Go Sleeveless! Despite the reality that most volume fluctuations occur at the distal end of the residuum, traditional vacuum systems apply vacuum throughout the entire socket, thereby requiring a sleeve to maintain vacuum. However, sleeves can fail to maintain vacuum if punctured or stretched. They are also uncomfortable to wear and cumbersome, restricting normal range-of-motion of the knee joint. In contrast, the new Unity Vacuum System by Össur uses proven Iceross® Seal-In technology to create a revolutionary vacuum socket. In doing so, Unity provides effective volume management where it is needed most, while generating a highly effective and sleeveless vacuum suspension. To learn more about the Unity Vacuum System by Össur, call 800/233-6263 today, or visit

Syncor Ltd. 2463 W Frontier Road Abrams, WI 54101 920/435-1199 Designed to meet client’s needs by prosthetists who understand, Syncor Ltd. originated the TES Belt for trans-femoral suspension and developed the Durasleeve for trans-tibial suspension. Our products feature the highest quality materials. They are available in sizes from Infant to XXL with custom orders welcome. • Durasleeve standard • Durasleeve EZ for those with limited dexterity/low activity • Durasleeve HD for the more active. TES Belt features Silesian design with a low profile and an anti-bunch, anti-roll panel. Sold world-wide; new distributors welcome. Ask your distributor for the Original TES Belt and Durasleeve or contact us for a distributor near you.

Soft Goods/Prosthetics ALPS 2895 42nd Ave N Saint Petersburg, FL 33714 800/574-5426 ALPS Prosthetic Socks Flatbed manufacturing allows Alps to precisely control the shape and thickness, without adjusting yarn volume or tension— which can create non-uniform wear and constriction in unwanted areas. Because Alps does not remove fibers to create it soft feel, the sock does not loose volume and will not mat down. Performance based moisture management system of Coolmax moves perspiration away from the body and through the fabric, where it can evaporate quickly, allows wearer to feel cooler and more comfortable. The plastic reinforced hole prevents fraying of the seam around the distal hole.

Comfort Products Inc. 931 River Road Croydon, PA 19021 800/822-7500

PEL Supply Co. A/K Brim Sheath from PEL Supply 4666 Manufacturing Avenue Cleveland, OH 44135-2638 800/321-1264 Now available from PEL Supply, the Knit-Rite A/K Brim Sheath is for above-knee patients and all socket styles. It is designed to separate and protect the soft tissue in the top brim of the socket by bridging the gap between the top edge of any roll-on liner and the groin. The A/K Brim Sheath will work on pin suspension and seal-in liners. It uses a stretchy, slick nylon material constructed in two angled sections to allow the fabric to appropriately fit the high lateral and lower medial shape, and includes gripper elastic to secure to the outer socket. Suggested billing, L8410, Prosthetic Sheath, AK each. Patent pending. For more information about the A/K Brim Sheath—or any other products from Knit-Rite, call your friendly PEL Supply customer service rep at 800/321-1264, fax 800/222-6176, or email Registered customers may order online at

2013 Buyers’ Guide

Complete Line of Prosthetic Socks The Comfort Products tradition lives on in the latest advancements in fiber technology with the finest knitting equipment available. Throughout the years we have become the Innovation Leader in Knitted Orthotic and Prosthetic Products. Our innovations include: • First to incorporate X-Static® silver yarn into products for Orthotics & Prosthetics • First to offer a Seamless Diabetic Sock • First to marry X-Static® silver yarn with CoolMax® fabric • Developed and introduced SpectraCarb™, a unique lamination stockinette that combines Spectra Fibers and Carbon. We are committed to providing the best knitted products with the latest innovations and highest quality for wearers of orthotic and prosthetic devices. We believe that this commitment is unparalleled in the world of orthotic and prosthetic knitted goods today. With our full line of Prosthetic Socks we have something for everyone! For more information, contact Comfort Products at 800/8227500 or

JUNE 2013 O&P Almanac


2013 Buyers’ Guide

Feet College Park Industries Inc. 27955 College Park Dr Warren, MI 48088 800/728-7950 New from College Park—Endo Components College Park Industries has increased their offerings to include a line of commonly used endoskeletal components. Utilizing knowledge from 25 years of material research and product design, these endo components are carefully engineered for structural integrity and noise abatement. Tested to the highest of quality standards, the components perfectly compliment the performance and outcomes College Park prosthetic feet are known for. For more information, call 800/728-7950, or visit

Ferrier Coupler Inc. North Branch, MI 800/437-8597

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398


O&P Almanac JUNE 2013

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 The Triton Family of Feet from OttoBock The search is over! Now your high-mobility patients can choose from a variety of superb options to fit their active lifestyles. The Triton Low Profile (LP) and the Triton Heavy Duty (HD) are especially robust and waterproof, ready for the most challenging conditions. Or, choose the lightweight Triton carbon fiber foot; the Triton Vertical Shock (VS); or the Triton Harmony® with integrated vacuum technology for outstanding flexibility and support. Each foot features a split carbon toe, multi-axial terrain conformance, heel stiffness adjustment, and a weight limit up to 330 lbs. Call 800/328-4058 or visit

PEL Supply Co. 4666 Manufacturing Avenue Cleveland, OH 44135-2638 800/321-1264 Trulife Seattle Kinetic Light Foot from PEL Supply Now available from PEL Supply is the Trulife Seattle Kinetic Light Foot. Offering a full length composite keel, this K2 foot offers an integrated multi-axial ankle, with five interchangeable bumper options, as well as a non-removable split toe foot shell. The Kinetic Light Foot utilizes Z-Shock Technology™ to provide better shock absorption and greater comfort to the user. The new proximal male pyramid adaptor provides easier access to the receiver, while maintaining lightweight construction, low build height and good durability. Available in three colors and five keel categories, the Kinetic Light Foot is recommended for patients at low to medium activity levels (K2) with a weight limit of 366 lbs. (166 kg). For more information on the Trulife Seattle Kinetic Light Foot or any of Trulife other high quality products, contact PEL Supply 800/321-1264, or email Registered customers may order online at

FOOT CARE: CUStOM FOOTWEAR Soletech Inc. 425 Washington St, Ste 4 Claremont, NH 03743 877/625-9494 Established in 1946, Soletech has a full line of fabrication materials for the O&P industry including the largest selection of EVA sheets, multi-durometer laminated sheets and blockers, Poron, Plastazote, Neoprene sheets, diabetic insoles, rubber and crepe outsoles and many other foam materials. Soletech introduced its registered brand of Cloud EVA to the O&P industry in the early 1980’s and is recognized as the industry leader for fabrication materials for custom foot orthotics and AFO’s as well as for build-ups and shoe modifications.

Lower-limb prosthetics Ferrier Coupler Inc. North Branch, MI 800/437-8597

Fillauer Companies Inc. P.O. Box 5189, 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Össur Americas Inc. 27051 Towne Centre Foothill Ranch, CA 92610 800/233-6263 

2 Carlson Parkway N, Suite 100 Minneapolis, MN 800/328-4058 Microprocessor Knees Fit with confidence! The first fully microprocessorcontrolled knee, today’s third-generation C-Leg®, is the most clinically evaluated prosthetic knee in history and PDAC-verified, too. The intuitive Genium® knee opens up a whole new realm of mobility—it’s the closest technology has come to a natural, physiological gait. Together with the Compact (for lower mobility patients), Ottobock’s family of microprocessor knees brings its proven advantages to all your patients. Your business gets the advantage of Ottobock’s unmatched reimbursement support. Call 800/328-4058 or visit to learn more about the benefits of Ottobock’s advanced microprocessor knees.

PEL Supply Co. 4666 Manufacturing Avenue Cleveland, OH 44135-2638 800/321-1264 PEL Supply Offers New LimbLogic® System WillowWood’s LimbLogic® VS has been a popular choice to provide patients with elevated vacuum. Now WillowWood is making it even better. PEL Supply offers the new LimbLogic featuring an improved 4-hole controller design with a field-serviceable exhaust filter. The new design offers a smaller, convenient, Bluetooth® Low Energy remote fob and inductive charging for easy patient use. This simplified fob is more intuitive to use, yet maintains the same functionality. Also new to the product line is the LimbLogic Sleeve. The controller and sleeve work together seamlessly to make an airtight, secure system. This new silicone sleeve has a repositionable inner cuff that allows the wearer to fix any leaks immediately for greater sleeve longevity. For more information about the LimbLogic system, or any other popular products from WillowWood, contact your friendly PEL customer service representative at 800/321-1264 or email . Registered customers may order online at

JUNE 2013 O&P Almanac

2013 Buyers’ Guide

SYMBIONIC LEG® by Össur: Move naturally with the world’s first complete bionic leg. A winner of Popular Science Magazine’s coveted “Best of What’s New” Award, SYMBIONIC LEG is the first commercially available, complete bionic leg that combines a MPK and a powered, microprocessor ankle. SYMBIONIC LEG provides unmatched toe clearance for enhanced safety and enables transfemoral amputees to confidently traverse terrain they might otherwise avoid, without the gait deviations commonly seen in MPK users. SYMBIONIC LEG is insurance billable using existing, approved L-Codes and, when used with RHEOLOGIC Workbench software, offers the ability to document actual user cadence variation to reduce insurance reimbursement risk. To learn more about the SYMBIONIC LEG by Össur, call 800/233-6263 today, or visit



2013 Buyers’ Guide

Lower-limb prosthetics, Continued


Spinal Technology Inc.

Anita International Corporation 

191 Mid Tech Dr West Yarmouth, MA 02673 800/253-7868

Fort Lauderdale, FL 954/730-8189  Email: 

Lower-limb Technology is a division of Spinal Technology, Inc. We are a leading central fabricator of upper and Lower-limb orthotics and prosthetics. Our ABC Certified staff Orthotists/Prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality custom products and prosthetic devices, fast delivery time, as well as unparalleled customer support to our customers. For information, call 800/253-7868, fax 888/775-0588, or email Visit our website at

WillowWood Company 15441 Scioto Darby Rd. Mount Sterling, OH 43143-9036 800/848.4930 LimbLogic® & LimbLogic Sleeve LimbLogic® provides secure, reliable vaccum. LimbLogic features a small, Bluetooth® Low Energy fob, inductive charging, and an improved 4-hole controller design with fieldserviceable exhaust filter. The small, simplified fob is intuitive to use for setting, adjusting, and monitoring vacuum levels. Other features include inline mounting in a prosthesis, adjustable vacuum from 0 to 20 in-Hg, ‘set & forget’ vacuum monitoring, waterproof in fresh water, and suitable for use in laminated and thermoplastic sockets. Use the system with the LimbLogic Sleeve and silicone cuff to ensure an airtight, secure system. For information, call 800/848-4930 or visit


O&P Almanac JUNE 2013

Prosthetic LINERS WillowWood Company 15441 Scioto Darby Rd. Mount Sterling, OH 43143-9036 800/848.4930 The Alpha Family of Liners Alpha® Liners are designed to protect residual limbs from abrasion and breakdown. Within the Alpha Liner Family numerous options exist for optimum fit and comfort for patients. Alpha Classic and Hybrid Liners contain mineral oil and vitamin E making them skin-friendly and extremely comfortable to wear. Each Alpha DESIGN® Liner, with either classic or hybrid gel, has a custom-tailored gel pattern to meet patient needs. Alpha Silicone Liners use a proprietary blend of silicone, vitamin E, and skin conditioners, yielding a pleasing surface that is non-greasy, non-tacky, and comfortable against the skin. Contact WillowWood at 800/848-4930 or visit

EEZZFFlex lex L Liner iner

Practical PracticalMagic Magic Hardly Hardlyjust justa apretty pretty face,the face,theEZEZFlex FlexLiner Liner delivers deliversunequaled unequaledfunction function without withoutsacrificing sacrificinganything. anything. Unified Flexible Front Unified Flexible Front

The unique fabricfabric on the The unique on the anterior surface provides anterior surface provides unlimited stretch over over the the unlimited stretch patella for greater elasticity patella for greater elasticity whilewhile reducing pressure on the reducing pressure on the knee knee and the of energy andamount the amount of energy required to flex required to the flexknee the knee

80% Less Vertical Stretch 80% Less Vertical Stretch Posteriorly Posteriorly

AsAs compared toto other Alps gelgel compared other Alps liners, virtually eliminating liners, virtually eliminating pistoning while minimizing pistoning while minimizing bunching behind the knee bunching behind the knee during flexion during flexion

Medial viewview of theofknee in flexion Medial the knee in flexion demonstrates the greater elasticity demonstrates the greater elasticity of theofanterior fabric to extend over over the anterior fabric to extend the front of theofknee. Paring it with the front the knee. Paring it with the limited vertical stretch posterior the limited vertical stretch posterior fabric reduces the overall efforteffort fabric reduces the overall expended by the to bend the the expended byamputee the amputee to bend kneeknee and increases comfort. and increases comfort.

AlpsAlps NewNew EZ EZ FlexFlex Liner Liner (anterior viewview shown (anterior shown above) is available in in above) is available 3mm or 6mm Uniform 3mm or 6mm Uniform thicknesses. Eight sizes thicknesses. Eight sizes fit circumferences of 16 fit circumferences of 16 cm cm to 44 to cm. 44 cm.

NOW NOW ININ STOCK: STOCK: Experience Our Commitment

ŠŠ 2010 ALPS. Rights Reserved. 2009 ALPS.AllAll Rights Reserved.

Antioxidants & EZ GelGel Antioxidants & EZ Protect Skin-Protect Skin--

Antioxidants in EZin Gel Antioxidants EZhelp Gel help protect the skin damage protect the from skin from damage caused by free caused by radicals. free radicals. ALPS ALPS EZGelEZGel is perfect for those is perfect for those with with poor poor skin characteristics skin characteristics or sensitive tissues. or sensitive tissues.

Budget Friendly-Budget Friendly-No other liner liner on the No other onmarket the market provides this quality, durability provides this quality, durability and functionality at this and functionality at price... this price... absolutely no other! absolutely no other!

800.574.5426 800.574.5426

2013 Buyers’ Guide

Miscellaneous CAD/CAm Systems Amfit Inc. 5408 NE 88th St, Ste D406 Vancouver, WA 98665 360/573-9100 Foot Orthotic Technology— That is out of this World Amfit is the world leader of equipment and software for manufacturing custom foot orthotics quickly, accurately, and at a low cost. Choose either of our 3D scanners—the Contact Digitizer™ or the Impress Scanner—and combine with the Amfit CAD/CAM Mill to fabricate superior custom foot orthotics in your own facility. Our Correct & Confirm™ software is highly accurate and easy to use. Amfit combines cutting edge technology and over 25 years of global experience, making us the best choice for any foot care professional.

Vorum 6-8765 Ash St Vancouver, BC V6P6T3 604/321-7277 Toll Free: 800/461-4353

Central Fabrication Becker Orthopedic 635 Executive Dr Troy, MI 48083 800/521-2192 Becker Orthopedic was founded in 1933 by Otto K. Becker to provide high quality, innovative, orthotic components and central fabrication services. His vision continues today with new product offerings like the Stride Stance Control Family and SpineCor®.  When it comes to orthotics, Becker has the options you are looking for. • Largest orthotic component selection available • Custom central fabrication services • Dedicated technical support • Knowledgeable customer service staff • Educational in-services • Online support via WebEx. For more information, or assistance with component selection, fabrication, or problem solving, contact Becker Orthopedic at 800/521-2192 or visit

Fillauer Companies Inc. P.O. Box 5189 2710 Amnicola Hwy Chattanooga, TN 800/251-6398

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 Whether your fabrication job is simple or complex, you want specialty facilities with the broadest range of services available, staffed by knowledgeable, caring people. That’s why Ottobock Fabrication Services is a perfect partner for your business: we offer decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Try our prepreg services for the most consistent fabrication outcomes. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want. Visit or call 800/795-8846.


O&P Almanac JUNE 2013

Specialty O&P Distributors Texas Assistive Devices LLC Brazoria, TX 800/532-6840 Texas Assistive Devices (TAD) distributes UE prosthetic and orthotic components for individuals with hand dysfunction or amputation. TAD’s products include an interchangeable tool system featuring the N-Abler II to which a variety of adapted tools and utensils can be attached. The N-Abler II offers 360° radial deviation and 60° flexion on any plane, so that tools and implements can be held at a natural angle allowing the user to independently perform activities which might otherwise be impossible (eating, cooking, grooming, carpentry, fishing, etc.). TAD’s products co-ordinate with body-powered or myo-electric prostheses, as well as with wrist-hand-othoses (WHO) braces. All have L Codes.

Business Services Aon O&P Insurance Program 159 East County Line Road Hatboro, PA 19040 801/559-9670

4610 Market Street Youngstown, OH 44513 800/796-8495 Since 1918 Cailor Fleming has carrier a wide range of insurance products to meet all your needs, from Life & Health, to Professional Liability, Property & Liability, Surety Bonds, Work Comp, Business Auto, Home & Personal Auto, EPLI and Disability Insurance. We have been insuring the O&P marketplace for over 20 years, and have the exclusive endorsements from three of the four main governing bodies in the O&P industry. We are a leader with Paramount Service and distinct competence. Experience the benefits of a rich history and a solid future by calling Cailor Fleming today!

Ottobock 2 Carlson Parkway N, Suite 100 Minneapolis, MN 55447 800/328-4058 Reimbursement Services Get the support you need for success for your patients and your business. Find our Audit Survival Kit, coding help, and documentation guides at reimbursement. If you have questions about Ottobock products, call 800/328-4058 and ask for reimbursement staff. Cooperative Care Fitting and Clinical Support At Ottobock OR in your own facility—work with patients you may not see frequently, such as hip disarticulation or upper limb amputees. Learn how Cooperative Care can help you build your business. Call or email to get detailed estimates for components, fabrication and clinical services 763/489-5165 or

2013 Buyers’ Guide

Whether you’re a patient care facility, manufacturer, distributor, or supplier, the Aon O&P Insurance Program was designed to meet your unique needs. Aon can help you protect your entire business from your vehicles to your equipment and employees. When you package together your commercial insurance program you can gain additional savings. Commercial insurance products include: • Commercial Property • General Liability (Premises/Products) • Professional Liability • Commercial Auto • Commercial Umbrella • Crime • Workers’ Compensation • Employment Practices Liability • CMS-Required DMEPOS • Surety Bond • Corporate Identity Protection. For more information, call Jeremy Hahn at 801/559-9670 or email at

Cailor Fleming Insurance

JUNE 2013 O&P Almanac


2013 Buyers’ Guide

Reference Materials 2013 AOPA Coding Products Coding Suite New L codes? No problem! Order the 2013 AOPA Coding Suite today! Get your facility up to speed, fast, on all the O&P HCPCS code changes with an array of 2012 AOPA coding products. Get illustrations of each HCPCS code and the AOPA interpretations with the 2013 CodingPro software and 2013 Illustrated Guide. The CodingPro also contains Medicare fee schedules and medical policy information. Ensure each of your staff has a 2013 Quick Coder, a durable, easy-to-store desk reference of all the O&P HCPCS codes and descriptors. Now being offered at a lower price! (Coding Suite includes CodingPro single user, Illustrated Guide and Quick Coder): $350 AOPA members, $895 non-members. • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 non-members. • CodingPro CD-ROM (network version): $435 AOPA members, $695 non-members. • Illustrated Guide: $185 AOPA members, $425 non-members. • Quick Coder: $30 AOPA members, $80 non-members.

AOPA Operating Performance Report Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 112 patient care companies representing 1,036 full time facilities and 64 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2011 operations. Electronic Version • AOPA Member: $85.00 • Non-Members: $185.00 Note: The 2013 version will be available in September 2013 and will be automatically substituted for 2012 version. A new Benefits & Compensation Report also will be available.

2013 AOPA Coding Suite

Order at or by calling AOPA at 571/431-0876.


O&P Almanac JUNE 2013

The O&P Almanac’s Buyers’ Guide is paid advertising. Entries were submitted and paid for by product manufacturers and distributors. AOPA and the O&P Almanac do not endorse, support, or recommend the use of any specific products included in the Buyers’ Guide. In addition, AOPA and the O&P Almanac neither sanction nor approve manufacturers’ claims about the function or reliability of their products. These listings can also be found on AOPA’s website: When you contact manufacturers about these products, be sure to tell them you saw them in the O&P Almanac Buyers’ Guide. a


INDEX Ability Dynamics LLC Tempe, AZ 480/361-1714 ACOR Orthopaedic Inc. Cleveland, OH 216/662-4500 Acsys Orthopedic Vista, CA 760/598-8191 Advanced O&P Solutions LLC Hickory Hills, IL 708/237-4088 Aetrex Worldwide Inc. Teaneck, NJ 201/833-2700 AliMed Inc. Dedham, MA 800/225-2610


O&P Almanac JUNE 2013

+Allard USA Inc. Rockaway, NJ 888/678-6548


Saint Petersburg, FL 800/574-5426

Alternative Prosthetic Services Inc. Bridgeport, CT 203/367-1212 American Central Fabrication Shreveport, LA 318/636-3751 American Prosthetic Components LLC Green Bay, WI 800/772-7508

+AMFIT Inc. Vancouver, WA 360/573-9100

Companies with

+ are Supplier Plus Partners.

Anatomical Concepts Inc. Poland, OH 800/837-3888 Apis Footwear Co. El Monte, CA 626/448-8905 Arizona AFO Inc. Mesa, AZ 480/222-1580 ARTech Laboratory Inc. Midlothian, TX 972/775-2000 Aspen Medical Products Irvine, CA 800/295-2776 Atlantic Rim Brace Mfg. Corp. Nashua, NH 800/233-0356

Bader Prosthetics & Orthotics/Kinetic Research Inc. Tampa, FL 800/919-3668 Becker Oregon Inc. Albany, OR 541/967-1821 Becker Orthopedic Appliance Co. Troy, MI 248/588-7480 BioSculptor Corp. Hialeah, FL 305/556-5815 Bledsoe Brace Systems Grand Prairie, TX 972/647-0884

Bort-Swiss Orthopedic Supply Anderson, SC 864/760-0364

Boston Brace International Inc./dba NOPCO East Brunswick, NJ 732/651-1223

Boston Brace International Inc./dba NOPCO Weymouth, MA 781/849-0247

Boston Brace International Inc./dba NOPCO Mountainside, NJ 908/233-3720

Boston Brace International Inc./dba NOPCO Lawrence, MA 978/688-7900 Boston Brace International Inc./dba NOPCO Waltham, MA 781/216-1390 Boston Brace International Inc./dba NOPCO Philadelphia, PA 215/590-7702 Boston Brace International Inc./dba NOPCO Voorhees, NJ 856/258-6712

Boston Brace International Inc./dba NOPCO Burlington, MA 781/270-3650 Boston Brace International Inc./dba NOPCO Avon, MA 508/588-6060 Bowman Enterprise Services Inc. Encino, CA 818/279-2440 Brightree LLC Lawrenceville, GA 888/598-7797 Cadence Biomedical Seattle, WA 206/659-0614

+Cascade Dafo Inc. Ferndale, WA 800/848-7332

+Cascade Orthopedic Supply Inc. Chico, CA 530/879-1500

CyberKinetics LLC Silverdale, WA 360/692-2500 Cybertech Medical La Verne, CA 909/447-7050 DAW Industries Inc. San Diego, CA 800/252-2828


Salt Lake City, UT 877/335-2261 Center for Orthotic Design— A Fillauer Co. Campbell, CA 408/364-7209 www.centerfororthoticdesign. DJO com Vista, CA 800/321-9549 Centri—A Fillauer Co. Sollentuna, Sweden Dr. Comfort 46-8-505-332-00 Mequon, WI 262/236-8469 College Park Industries Inc. EMR Stat Warren, MI Waterloo, IA 800/728-7950 800/214-6742 Endolite Comfort Products Inc. Miamisburg, OH 800/548-3534 Croydon, PA 800/822-7500 Euro International Inc. Tampa, FL Complete Business 813/246-5995 Solutions Amesbury, MA 888/510-4416




JUNE 2013 O&P Almanac

2013 Buyers’ Guide

Boston Brace International Inc./dba NOPCO Boston, MA 617/975-3854

Boston Brace International Inc./dba NOPCO Boston, MA 617/355-6887

Cailor Fleming Insurance Youngstown, OH 330/782-8068


2013 Buyers’ Guide

Fabtech Systems LLC Everett, WA 425/349-9557

Friddle’s Orthopedic Appliances Inc. Honea Path, SC 864/369-2328

Ferrier Coupler Inc. North Branch, MI 810/688-4292

Futura International Inc. Anahiem, CA 727/791-3332

+Fillauer Companies Chattanooga, TN 423/624-0946

+Fillauer LLC—A

Fillauer Co. Chattanooga, TN 423/624-0946 Florida Brace Corp. Winter Park, FL 407/644-2650

FLO-TECH® Orthotic & Prosthetic Systems Inc. Trumansburg, NY 800/356-8324 Forbin Waterloo, IA 866/999-9469 Freedom Innovations LLC Irvine, CA 888/818-6777


O&P Almanac JUNE 2013

Gaitrite-CIR Systems Sparta, NJ 973/862-6151 Grace Prosthetic Fabrication Inc. New Port Richey, FL 800/940-5347 Guard Industries Inc. Saint Louis, MO 800/535-3508 Hope Orthopedic Grand Prairie, TX 972/647-0884

+Hosmer Dorrance

Corp.—A Fillauer Co. Campbell, CA 408/379-5151

+iWalk Inc.

Bedford, MA 781/761-1560

JMS Plastics Supply Neptune, NJ 732/918-8115

MD Orthopaedics Inc. Wayland, IA 877/766-7384

Kingsley Mfg. Co. Costa Mesa, CA 949/645-4401

Med Spec (ASO) Charlotte, NC 704/573-4040

KISS Technologies LLC Baltimore, MD 410/663-5477

Medex International Inc. Burtonsville, MD 301/657-2681

Knit-Rite Inc. Kansas City, KS 913/281-4600

Medi USA Whitsett, NC 336/449-4440

Lawson Medical LLC Virginia Beach, VA 866/631-6311

Mike’s Medical Clinton, OK 888/419-5666

Levy & Rappel Saddle Brook, NJ 973/478-6511

MJ Markell Shoe Co. Inc. Yonkers, NY 914/963-2258

Life-Like Laboratory LLC Carrollton, TX 972/620-0203 siliconerestorations@lifelikelab. com Maramed Orthopedic Systems Hialeah, FL 305/823-8300

+Motion Control

Inc.—A Fillauer Co. Salt Lake City, UT 801/326-3434

Motion Medical Inc. Pelham, AL 205/982-1511

Mueller Sports Medicine Inc. Prairie du Sac, WI 608/643-8530 brett.mueller@muellersprotsmed. com Nabtesco Proteor— USA Muskego, WI 504/319-1954 lroberts@nabtescoproteor-usa. com Nearly Me Technologies LLC Waco, TX 254/662-1752 New Options Sports Dallas, TX 800/872-5488 nora systems, Inc. Salem, NH 496/201-8077 Northwood Inc. Center Line, MI 586/755-3830

O&P Billing Solutions Inc. Murfreesboro, TN 615/217-9821

O&P EDGE/Western Media LLC Northglenn, CO 303/255-0843 Gainesville, FL 352/331-3741 OPTEC USA, INC. Lawrenceville, GA 888/982-8181 Orfit Industries America Jericho, NY 516/935-8500

Orthotic & Prosthetic Group of America (OPGA) Waterloo, IA 800/214-6742 Össur Americas Inc. Foothill Ranch, CA 949/382-3883

+OTS Corp.—A Fillauer Co. Weaverville, NC 828/658-8330

Ottobock Minneapolis, MN 800/328-4058 usa.customerservice@ottobockus. com

Professional Technologies International Inc. (Pro-Tech) Raynham, MA 866/819-1157 Prosthetic Design Inc. Clayton, OH 800/459-0177 bcarpenter@prostheticdesign. com Prosthetic Orthotic Center of New England Portland, ME 207/838-4945 PROTEOR Dijon Cedex, FRANCE 011 33 380784285

Parker Hannifin Corporation Cleveland, OH 216/896-2044

ProtoKinetics LLC Havertown, PA 610/449-4879

PEL Supply Co. Cleveland, OH 800/321-1264

Provel Inc. Cle Elum, WA 509/857-2009

Orthofeet Northvale, NJ 201/767-6224

PFS Med Inc Springfield, OR 541/349-9646

PSL Fabrication Fulton, MO 573/642-5554

Orthomerica Products Inc. Orlando, FL 800/446-6770

POINT Health Centers of America Waterloo, IA 866/283-2872

Quality Outcomes Fredericksburg, VA 540/412-1429

Orthocare Innovations LLC Oklahoma City, OK 405/239-5310 dadams@orthocareinnovations. com

JUNE 2013 O&P Almanac

2013 Buyers’ Guide

O&P 1 Central Fabrication Waterloo, IA 800/408-3598

O&P Business News/ SLACK Inc. Thorofare, NJ 856/848-1000


2013 Buyers’ Guide

Renia GmbH Cologne, Germany 011+49-221-630799-0

SPS Port Orange, FL 800/653-0826

Tamarack Habilitation Technologies Inc. Blaine, MN 763/795-0057

Restorative Care of America Inc. Saint Petersburg, FL 800/627-1595

SPS Alpharetta, GA 800/767-7776

VGM Financial The Bremer Group Co. Waterloo, IA 319/274-6661 Jacksonville, FL 904/645-0004 VGM Insurance Waterloo, IA Top Shelf 866/497-0836 Orthopedics Tracy, CA 209/834-1158 Vorum Research Corporation Vancouver, BC Touch Bionics 800/461-4353 Mansfield, MA 614/388-8071 WBC Industries Inc. Westfield, NJ Townsend Design 908/789-1234 Bakersfield, CA 661/837-1795 WillowWood TRS Inc. (Therapeutic Mount Sterling, OH 740/869-3377 Recreation Systems Inc.) Boulder, CO 303/444-4720 Yale Surgical Co./Yale Comfort Shoe Center Stratford, CT 203/372-7112 Truform Orthotics and Prosthetics Cincinnati, OH 513/271-4594 Yale Surgical-Yale Comfort Shoe New Haven, CT 203/777-2396 Trulife Jackson, MI a 800/492-1088

Roden Leather Co. Inc. Royal Oak, MI 800/521-4833 Royal Knit Inc. Lees Summit, MO 800/664-5648 RX Textiles Inc. Monroe, NC 704/283-9787 Silipos Inc. Niagara Falls, NY 800/229-7105 Soletech Inc. Claremont, NH 877/625-9494

+Spinal Technology Inc. West Yarmouth, MA 800/253-7868


O&P Almanac JUNE 2013

SPS National Labs Alpharetta, GA 800/767-7776 Spyder Technologies Waterloo, IA 319/234-7942 ST&G USA Corp. Placentia, CA 714/524-0663 SteeperUSA San Antonio, TX 210/481-4126 richard.shapcott@steeperusa. com SureFit Coral Springs, FL 800/298-6050 SureStep South Bend, IN 877/462-0711 Syncor Ltd. Abrams, WI 920/435-1199

VGM Education Waterloo, IA 800/214-6742


Find your region on the map to locate jobs in your area.

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Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate! $80 $140 American Orthotic

& Prosthetic



DISCOVER more AOPA advertising opportunities.


- Northeast

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

mediakit Rates effective

Specials: 1/4 page, color 1/2 page, color

$482 $678 $634 $830


O&P Since

Jan. 1, 2013

Call Dean Mather, advertising sales representative, at 856/768-9360 or email



24/7 Expert Coding Advice 24/7 •

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

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

This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or

Log on to and start today. Not an AOPA member? GET CONNECTED

Visit AOPA at

Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at or 571/431-0811.


O&P Almanac JUNE 2013


Live and work, where you can play.

Southeast CPO/BOCPO Morristown, Tennessee Southern Orthocare, in beautiful East Tennessee near the Smoky Mountains, is seeking prosthetist/orthotist (CPO or BOCPO) with either 1) dual (O&P) graduate certification, residency, and two years’ post-residency experience, OR 2) current Tennessee license (LPO) and 10 years’ clinical experience. We are an ABC accredited facility, and are seeking a practitioner who loves to serve O&P patients, has genuine integrity, and wants to work with a first-class team dedicated to optimum patient care.  If this is you, we would be honored to meet you!  We have two locations.  Salary negotiable, based on experience.  OPIE proficiency a plus.  Check us out at  If interested, please email resume to:


Orthotist/Prosthetist-Certified Evaluate, design, fabricate and fit devices for patients that have a limb or segment of a limb missing due to congenital or traumatic reasons, or with disabling conditions of the extremities and spine. Must be a graduate of Orthotic or Orthotic/Prosthetic Practitioner Program. BA/BS preferred. Formal training must include basic design principles and fitting skills in lower and upper extremity prosthesis and orthoses. Thorough knowledge of anatomy, kinesiology, developmental philosophy, mechanics and biomechanics. ABC Certification in Orthotics or Orthotics/ Prosthetics. A minimum 3 years of experience as a CO or CPO preferred. Experience in Pediatric Orthotics would be helpful.

Apply online at: Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

Tina Mann

Clinic Manager

“Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic. She was so inspired by her experience that she became an orthotic resident with Hanger Clinic. Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.

View our current positions and apply online at: or scan the QR code.

Hanger was recently named one of Forbes Best Small Companies in America.

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.

Available Positions: Clinic Manager Morgantown, WV

Seattle, WA

Herndon, VA

Sacramento, CA

Valdosta, GA

Prosthetist / Orthotist

Chambersburg, PA

Seattle, WA

Annapolis, MD

Burbank, CA

Buffalo, NY

Dayton, OH

Johnson City, NY

Thomasville, GA

Redding, CA

Tamarac, FL

Orthotist Wichita, KS

Jacksonville, FL

Louisville, KY

Auburn, CA

Hammond, IN

Richland, WA

Grand Junction, CO

Cary, NC

Beaufort, SC

Phoenix, AZ

Pensacola, FL

Prosthetist Williamsport, PA

Hattiesburg, MS

Hazel Crest, IL

Bullhead City, AZ

Jackson, MS JUNE 2013 O&P Almanac



■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http:// For more information, visit www. or email cert@

2013 ■ JUNE 12 AOPAversity Audio Conference–Clinical Documentation: The Dos & Don’ts. For more information, contact Stephen Custer at 571/431-0876 or scuster@


■ JUNE 13-14 AOPA: Essential Coding & Billing Seminar. Phoenix. Renaissance Phoenix Downtown Hotel. To register, contact Stephen Custer at 571/431-0876 or scuster@

■ JUNE 21 Prime Fair East. Nashville. Our two hour workshop focusing on LimbLogic. Learn unit operation features and diagnostics that keep the system optimal for patient use. Includes overview of socket fitting, evaluation, and fabrication basics. For more information, visit ■ JUNE 27-29 Amputee Coalition National Conference 2013. Orlando. Renaissance Orlando at SeaWorld. For more information, call 888/2675669 or visit

PROMOTE Events in the O&P Almanac

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

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email 76

O&P Almanac JUNE 2013

■ JULY 1 ABC: Application Deadline for Certification Exams. Applications must be received by July 1, 2013 for individuals seeking to take the September 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email, or visit certification.

JULY 1 WillowWood: Intro to OMEGA®, via WebEx, 1:30 PM ET. Potential CAD users have an opportunity to investigate OMEGA and find out how the system benefits a growing O&P practice. Credits: 2.5 ABC/2.5 BOC. Visit ■

■ JULY 8-13 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was May 1, 2013. Contact 703/8367114, email, or visit certification. ■ JULY 10 AOPAversity Audio Conference–Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or

■ JULY 12 WillowWood: LimbLogic® Technicians, via WebEx, 1:30 PM ET. Learn the essential elements for elevated vacuum socket fabrication. Learn unit operation features and diagnostics that keep the LimbLogic system optimal for patient use. Credits: 2.5 ABC/2.5 BOC. Visit ■ JULY 16-18 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture by scanning. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive handson practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit ■ JULY 18-20 The Florida AAOP Chapter Annual Meeting. Orlando. Hyatt Regency Grand Cypress For more information, visit chapters/florida. ■ JULY 24-25 Using Closed Cell Foams: Understanding, Techniques, Hands-on. nora systems inc., Salem, NH. Approved CEUs: 4 ABC/ 4 BOC continuing education credit. The course, hotel, airport transportation, and meals are provided. Contact Jon Fogg at 770/8809786 or email Jonathan.Fogg@ ■ JULY 26-27 ABC: Orthotic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email, or visit www.


■ AUGUST 1 ABC: Practitioner Residency Completion Deadline for September Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703-836/7114, email, or visit ■ AUGUST 2 Interprofessional Engagement for the LE Amputee Conference. (PreConference Reception and Community Amputee Event on August 1, 2013). Mountain Area Health Education Center, Asheville, NC. For more information, visit or email ■ AUGUST 2-3 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Grand Hyatt on the Riverwalk, San Antonio. Contact Katie Brinkley at

940/243-4198, email, or visit ■ AUGUST 2-3 ABC: Prosthetic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email info@, or visit www.abcop. org/certification. ■ AUGUST 5-9 Applied Technology Institute (ATi) Orthotic Fitter School. Philadelphia. Homewood Suites University City. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE, ABC, and BOC, and for continuing education by BOC. Course descriptions and registration available on line at For more information, contact Lois Meier at 888/265-6077 or email

SEPTEMBER 18-21, 2013

■ AUGUST 8 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses on all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: 7.0 ABC/7.0 BOC. Registration deadline is July 18, 2013. Contact 877/665-5443 or visit ■ August 14 AOPAversity Audio Conference–Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or

■ AUGUST 15-17 Spinal Technology Inc. Hosts the Annual Scoliosis Symposium, with the addition of Lower-Limb Orthotics Management. Boston. Course will cover measurement techniques and brace options for lower-limb orthotics, fulltime scoliosis bracing protocol for adolescent idiopathic scoliosis, and the Providence Nocturnal Scoliosis System, with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABCcertified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. For more information, contact Nancy Francis at 508/775-0990 x8374, or email

Why you should plan to attend:


Research and development expenditures in the United States are more than $95 billion, making the United States the leader in medical innovation and creating the ideal location for a unique gathering of high visibility and importance.

Don’t miss the opportunity to participate in an expanded National Assembly in 2013 as AOPA and partners from around the world work to create an O&P World Congress experience for practitioners in the Western Hemisphere and around the world.

Superior Clinical Education featuring the best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners.

Practical learning and live demonstrations.

Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy.

Networking with an elite and influential group of professionals.

Ideal U.S. location chosen for travel ease and popularity.

Gaylord Palms Resort & Convention Center

Expand your knowledge, grow your market presence and advance your career at this unique, global gathering of high visibility and importance. For more information, contact us at or visit

JUNE 2013 O&P Almanac



AUGUST 16-18 Foot Orthosis Course. National Pedorthic Services, Milwaukee. Contact Brian Dalton at 414/438-6662 or email Visit ■

■ SEPTEMBER 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by Sept. 1, 2013 for individuals seeking to take the November 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or December/ January CPM exams for orthotists and prosthetists. Contact 703/836-7114, email, or visit www.

SEPTEMBER 11 AOPAversity Audio Conference–Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@ ■

■ SEPTEMBER 13-15 Shoe Modification Course. National Pedorthic Services, Milwaukee. Contact Brian Dalton at 414/438-6662 or email Visit ■ SEPTEMBER 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is July 1, 2013. Contact 703/8367114, email info@abcop. org, or visit certification.


O&P Almanac JUNE 2013

September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or ■

■ OCTOBER 1 ABC: Practitioner Residency Completion Deadline for November Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email, or visit www. ■ OCTOBER 3-5 The Virginia Orthotic & Prosthetic Association, 2013 Annual Meeting and Scientific Sessions. Hyatt Fairfax at Fair Lakes, Fairfax, VA. Online registration and hotel reservations will be available beginning Friday, May 18. Calling for papers for the orthotics, prosthetics, and technical tracks as well as for the Compliance Clinic. Abstract submission deadline is June 15. Send abstracts by email to

OCTOBER 9 AOPAversity Audio Conference–What’s the Word: A Health-Care Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or scuster@ ■

■ OCTOBER 18-20 Pedorthic Extremes: Managing Difficult and Challenging Feet. National Pedorthic Services, Milwaukee. Contact Brian Dalton at 414/438-6662 or email Visit

OCTOBER 22-23 AOPA: Essential Coding & Billing Seminar. Mirage Hotel & Casino. Las Vegas. To register, contact Stephen Custer at 571/431-0876 or ■

■ NOVEMBER 1 ABC: Application Deadline for Certification Exams. Applications must be received by Nov. 1, 2013 for individuals seeking to take the January 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email info@abcop. org, or visit certification. ■ NOVEMBER 11-16 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is Sept. 1, 2013. Contact 703/836-7114, email info@, or visit www.abcop. org/certification.

November 13 AOPAversity Audio Conference– Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or ■

■ DECember 11 AOPAversity Audio Conference–What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@

2014 ■ JANUARY 26-29 U.S. Member Society of ISPO: Pac Rim 2014: Learning Beyond Our Horizons—A Biennial Symposium on Prosthetics, Orthotics & Rehabilitation. Wiakoloa Beach Marriott Resort and Spa on the Big Island of Hawaii. Learn about progressive treatment options and innovations and hear from recognized physical rehabilitation professionals while enjoying attractions on the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at ■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Halifax, Nova Scotia. Marriott Halifax Harbourfront. Visit

www.prostheticsandorthotics. ca/ for more information.

■ SEPTEMBER 3-6 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@

2015 ■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or

2016 ■ SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or a







9, 63

(800) 574-5426

American Board for Certification in Orthotics, Prosthetics & Pedorthics


(703) 836-7114



(800) 356-3668

Becker Orthopedic


(800) 521-2192

Cailor Fleming Insurance


(800) 796-8495

Cascade Dafo


(800) 848-7332

The College of Podiatry Annual Conference and Exhibition


College Park Industries Inc.


(800) 728-7950

DAW Industries

1, 73

(800) 252-2828

Dr. Comfort

5, C3

(800) 556-5572

Ferrier Coupler Inc.


(800) 437-8597



(800) 251-6398

FLO-TECH® O & P Systems, Inc.



Hersco Ortho Labs


(800) 301-8275

KISS Technologies LLC


(410) 663-5477

Motion Control


(888) 696-2767


(503) 428-1851

Orthomerica Products


(800) 446-6770


Orthotic and Prosthetic Study and Review Guide Össur Americas Inc.


(800) 233-6263



(800) 328-4058



(800) 321-1264

7, 57

(800) 253-7868

Willow Wood


(800) 848-4930

PEL Supply Spinal Technology Inc.

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JUNE 2013 O&P Almanac


AOPA Answers

O&P By the


Answers to your questions regarding PTAN, NPI, and supplier numbers


receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at


We have multiple offices but our billing is done from a central location. Is each office required to have a separate Provider Transaction Access Number (PTAN) and National Provider Identification (NPI) number?


Yes. The PTAN and NPI numbers are not attached to a specific billing location, but rather attached to each physical location where Medicare services are rendered. You are not required to bill from each location, but each claim should indicate where the service was rendered. That is why the CMS-1500 form has separate boxes for billing location and services rendered location.


We operate a “stock and bill” or “consignment closet” in a physician’s office. Do we need a separate PTAN and NPI number for this facility?


This is a grey area. There has not been any direct information from Medicare on how to govern stock and bills.


O&P Almanac JUNE 2013

If you are paying rent and the location is staffed by one of your employees, even on a part-time basis, it would be wise to obtain an NPI and PTAN. There can only be one billing number per location, Supplier Standard 18. If the physician bills for any durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) products, your “closet” must have a separate viable post office address. If the location is not staffed by one of your employees, but rather the physician provides the device and you do the billing, you have a business decision to make. Do you want to continue to assume responsibility for collecting all of the required documentation: delivery slip, progress notes, prescription, proper training, etc? If you are willing to continue operating this type of arrangement, no NPI or PTAN is needed at this time. This requirement may change in the future, but for now Medicare has not set forth guidelines on these types of scenarios.


I’m buying an existing O&P company. Do I need to get a new supplier number, or can I use the business’s original number?


It depends on the kind of purchase you have made. If you have made an assets-only purchase, you will need a new number. This is because you will be obtaining a new tax identification number (TIN) for that new business and will need a new supplier number to go with it. Supplier numbers are tied to TINs. However, if you have made a stock purchase of the assets and liabilities, where you will be operating the business under the original tax identification number, you do not need to obtain a new supplier number. a

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June 2013 Almanac  
June 2013 Almanac  

American Orthotic & Prosthetic Association (AOPA) - June 2013 Issue - O&P Almanac