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The American Orthotic & Prosthetic Association

&

WWW.AOPANET.ORG

JANUARY 2013

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

Learning from

LEAN

Although a well-established concept, lean manufacturing principles are breathing new life into fabrication processes

Taking a Team Approach to Diabetes Care Reimbursement Rules for Medicare as a Secondary Payer


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Fillauer Modular Dynamic AFO

Hosmer 5XA - Standard Canted Hook • Extra lightweight aluminum body • Canted “fingers” allow visual feedback • Available 1/2-20 in. or M12x1.5 mm thread • Variety of anodized colors* available: Black, Blue (pictured), Gold, or Red

• Prevents distal migration of knee orthosis • PEEK rods available in straight or dorsi-assist. • Allows active motion at the ankle joint for excellent terrain accommodation • Adjustable height • Easy attachment to orthosis

*Additional charge for anodized colors. Standard Color: Aluminum

Knit-Rite Hugger Top Soft-Sock® with 3-D Toe Shape

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• Provides a more tailored fit • Reduces rolling and bunching • Helps maintain sock placement • Features patented hemispherically knit three-dimensional distal shape that provides improved fitting qualities • Moisture wicking • Available in white, pink, and black

PEL Supply Co. Orthotic & Prosthetic Components 4666 Manufacturing Avenue Cleveland, OH 44135-2638 USA

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

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O&P JANUARY 2013, VOLUME 62, No. 1

CONTENTS Cover Story

18 Learning from Lean

By Adam Stone A “lean” approach to manufacturing has resulted in more efficient processes, reduced turnaround time, and even cost savings for several O&P business owners. Applying a lean philosophy can take many forms—from a complete process overhaul to incorporating bits and pieces into overall best practices.

Feature

24 Teaming Up Against Diabetes

By Deborah Conn Orthotists and prosthetists are playing critical roles in the nation’s fight against diabetes, adding their expertise to a team approach to diabetic foot care. Physicians, surgeons, endocrinologists, and other specialists are including O&P professionals in a collaborative effort to prevent amputations and provide a continuity of care.

departments

4

AOPA Contact Page How to reach staff

6

At a Glance Statistics and O&P data

42 Jobs

In the News Research, updates, and company announcements

45 Calendar

AOPA Headlines News about AOPA initiatives, meetings, and more

47

Ad Index

48

AOPA Answers Expert answers to your FAQs

08 28 COLUMN

14

Reimbursement Page Medicare as a secondary vs. primary payer

37 AOPA Membership 00 Applications

39 Marketplace

Products and services for O&P Opportunities for O&P professionals

Upcoming meetings and events

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

JANUARY 2013 O&P Almanac

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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 www.AOPAnet.org EXECUTIVE OFFICES

MEMBERSHIP & Meetings

BOARD oF DIRECTORS

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

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

Officers

directors

President Tom Kirk, PhD, Hanger Inc., Austin, TX

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

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

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

Scott Schneider, Ottobock, Minneapolis, MN

O&p Almanac

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

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

Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com Stephen Custer, production manager, 571/431-0876, scuster@AOPAnet.org Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org AOPA Bookstore: 571/431-0865 Communications Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org

Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

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

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 Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA

Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org

Mike Hamontree, Hamontree Associates, Newport Beach, CA

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.

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O&P Almanac JANUARY 2013


Our Comfort Is Preferred By Your Patients!

Beautiful Design, Details and Construction Lead To Increased Patient Compliance.

Men’s Athletic Comfort Collection

From A Family of Comfort. ©2012 Dr. Comfort All Rights Reserved


AT IN THE A GLANCE NEWS

Diabetes, State By State The highest prevalence of diagnosed diabetes among adults in 2010 was found in Mississippi, Alabama, Tennessee, West Virginia, Texas, and Puerto Rico

Age-adjusted prevalence of diagnosed diabetes among adults in 2010 n ≥10.0 % n 9.0-9.9 n 8.0-8.9 n 7.0-7.9 n 6.0-6.9

Source: Centers for Disease Control and Prevention (CDC): “Increasing Prevalence of Diagnosed Diabetes—United States and Puerto Rico, 1995-2010,” Morbidity and Mortality Weekly Report, Nov. 16, 2012.

8.2%

Median age-adjusted prevalence of diagnosed diabetes in the United States in 2010, up from 4.5% in 1995.

18.8 million

Number of Americans with diagnosed diabetes mellitus in 2010.

60%

Annual percentage of all nontraumatic lower-limb amputations performed on diabetic patients.

42

Number of states in which diabetes prevalence increased by at least 50% between 1995 and 2010; 18 states had at least 100% increases.

7 million

Estimated number of Americans with undiagnosed diabetes in 2010.

$174 billion

Total medical and productivity costs associated with diagnosed diabetes in the United States in 2007.

Sources: American Diabetes Association; CDC: National Diabetes Fact Sheet, 2011; CDC: “Increasing Prevalence of Diagnosed Diabetes—United States and Puerto Rico, 1995-2010,” Morbidity and Mortality Weekly Report, Nov. 16, 2012. 6

O&P Almanac JANUARY 2013


THE MOST CLINICALLY PROVEN OA BRACE WITH A NEW TWIST. The Unloader line of braces by Össur are clinically proven to reduce pain and improve function for patients who wear them. Recent clinical research* demonstrates that the Unloader One® provides decreased pain, improved function and reduction in pain medications for patients. * Briggs KK, Matheny LM, Steadman JR. Improvement in quality of life with use of an Unloader knee brace in active patients with OA: A prospective cohort study. J Knee Surg 2012; Advance online publication. Retrieved 23rd August 2012. DOI:10.1055/S-0032-1313748

SmartDosing™ now available. SmartDosing, powered by Boa® Technology, provides patients with a simplif ied, single-hand dosing dial for on-the-f ly adjustability of the dual Dynamic Force Straps (DFS), helping them better manage their unicompartmental OA knee pain.

Lightweight, low-profile and easy. Unloader One‘s lightweight, low-profile design is barely noticeable to the user and fits comfortably under clothing. And, by utilizing the new SmartDosing dial, users can easily adjust the dual DFS tension right through their clothes.

Prescribe the Unloader One for any OA patient. If they are not happy with it for whatever reason, they can return it within 30 days for a full refund.

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IN THE NEWS

Diabetes-Related Foot Complications More Prevalent in Men According to a study published in Endocrine, diabetesrelated foot complications are more prevalent in men, and this at-risk group should be provided with additional attention and aggressive treatment. In a retrospective study, a team of Brazilian researchers evaluated medical records of 496 patients with an established foot at risk or diabetes-related foot complications, based on age, gender, type and duration of diabetes, foot-at-risk classification, and the presence of deformities, ulceration, and amputation. Researchers found that diabetes-related deformities were associated with an increased prevalence in patients with neuroeschemic disease and neuropathy when compared to the ischemic-only group, regardless of age, gender, and diabetes duration or type. Men more than women (33 percent versus 18 percent) and those with Type 1 rather than Type 2 diabetes (41 percent versus 24 percent) were more likely to experience ulceration. However, male gender only remained a significant predictor for ulceration in the multivariate analysis.

Amputation also was more significant in men than women (20 percent and 7 percent, respectively) as well as in patients with neuroischemic disease as compared to patients with neuropathy or ischemic disease alone (21 percent versus 9 percent and 6 percent, respectively). The researchers attribute part of the gender discrepancy to better wound care in women, as men are more commonly involved in heavy physical work activities and dealing with social pressure to not miss work.

z

z y

y

1 mm

Examples of polymeric (PU) foam and microporous polymer (ex-PTFE) piezomorphic materials are presented.

8

O&P Almanac JANUARY 2013

A new shape-changing “smart” material that has potential in the medical textiles industries and in making better-fit prosthetic limbs has been developed by a team of research scientists. According to the researchers, who are from the University of Bolton, England; the University of Manchester, England; and Harbin Institute of Technology, China, the new “piezomorphic material” reacts to force; it undergoes dramatic changes in shape on simple stretching or compression. Potential applications for the material are diverse. The researchers have identified how a piezomorphic lining could respond to pressure applied when, for example, walking, to improve prosthetic fit and comfort. The team also has identified smart bandages as a potential application. A bandage layered with medication, which could be released depending on wound swelling, would allow controlled, condition-dependent treatment without the need for constant wound checking. The material also could be used in the manufacture of advanced composite components for cars and aircraft.

Photo: http://onlinelibrary.wiley.com/doi/10.1002/mame.201200028/abstract

New Material May Improve Prosthetic Fit


Simple As :

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2. Visit www.kiss-suspension.com or Call 410-663-KISS (5477) Š 2011, U.S. Patent, Patent Pending Worldwide KISS is a registered trademark


IN THE NEWS

CMS Releases 2013 HCPCS Codes The Centers for Medicare and Medicaid Services (CMS) has released the new Healthcare Common Procedure Coding System (HCPCS) codes, which take effect Jan. 1, 2013. The full list is available on the CMS website at www.cms.gov/ Medicare/Coding/HCPCSReleaseCodeSets/Alpha-NumericHCPCS.html. The addition of one new L-Code and description changes to four L-Codes are specific to orthotics and prosthetics:

New Code L5859 • Addition to lower-extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/ extension assist control, includes any type motors.

Code Description Changes L5972

L8000 • New description: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type. • Old description: Breast prosthesis, mastectomy bra.

L8001 • New description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type. • Old description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral.

L8002 • New description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type. • Old description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral.

• New description: All lower-extremity prostheses, foot, flexible keel. • Old description: All lower-extremity prostheses, flexible keel foot (safe, sten, bock dynamic, or equal).

TRANSITIONS

people in the news

Chris Baughman, CP, BOCO, is the managing practitioner at Ability Prosthetics & Orthotics’ newest patientcare facility in Raleigh, North Carolina. Sue Borondy, Endolite’s marketing and communication manager, has been elected to the OPAF Board of Directors. James Button has been named to the Review Board of the Dralla Foundation, a nonprofit organization founded by Allard USA. Hanger Clinic/Dynamic Orthotics and Prosthetics has named AOPA Immediate Past President Thomas DiBello, CO, FAAOP, as regional director of Texas Gulf Coast and Jason M. Jennings, CPO, LPO, FAAOP, as area clinic manager. Traci Dralle has joined Fillauer as director of marketing.

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O&P Almanac JANUARY 2013

Tammy Duckworth (D-Illinois) has been elected to the U.S. House of Representatives. Duckworth is an Iraq war veteran who underwent bilateral lower-limb amputations in 2004, and a former assistant secretary for the Department of Veterans Affairs. The orthotics and prosthetics program at Eastern Michigan University has announced its incoming class of 2014. In addition, two O&P students, Theresa Field and Angela Kanavel, have been recognized as recipients of the school’s Wyle G. Bonine Scholarship. R. Scott Hosie, CPO, has been named clinical educator for Motion Control, headquartered in Salt Lake City. Scheck & Siress, headquartered in Chicago, has hired Jim Kingsley as chief operating officer.

Blake Manufacturing Inc. has hired Nelson LeMarquand MS, CO, LO, FAAOP, as director of sales and education. Timothy Miller, CPO, has been named president of the board of directors of the American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. Ottobock has hired Gerald Stark, MSEM, CPO/L, FAAOP, as senior upper-limb specialist and as clinical leader of the company’s upper-limb professional and clinical services team. Claudia Zacharias, MBA, CAE, president and CEO of the Board of Certification/Accreditation, International, has been elected to the Institute for Credentialing Excellence Board of Directors.


IN THE NEWS

A team of students from Purdue University, West Lafayette, Indiana, has designed a new type of prosthetic leg for Lucas Resch, a 5-year-old boy who was born with proximal femoral focal deficiency (PFFD). The leg uses a gearbox design that enables the prosthesis to move like a real leg. Resch was born with only a fraction of his left femur, making his left leg far shorter than his right. Conventional prostheses do not give Resch the ability to run and ride a bicycle or play like his friends do, and his parents have been searching for ways to allow him to attain that level of activity as he grows without the need for to rotationplasty surgery. The new prosthesis, created by a team of Purdue mechanical and biomedical engineering students, uses a gearbox to produce a knee’s range of motion; whereas an ankle joint swivels about 40 degrees, a knee joint moves about 90 degrees. The new design hinges on the innovative gearbox that converts the ankle’s limited movement to the motion of a knee, providing greater mobility. The Purdue students created a mold of Resch’s shin to make a better fit, and he and his family will return later this year to receive the form-fitted leg. The leg will be adjusted as Resch grows.

Photo: Resch family

University Students Design Prosthesis for Child With PFFD

A team of Purdue students has designed a new type of prosthetic leg for 5-year-old Lucas Resch, who has a rare birth defect that makes his left leg far shorter than his right. At left are conventional prosthetics, which do not give Lucas the ability to run and ride a bicycle or play like his friends. The new prosthetic leg, not shown, uses an innovative gearbox design that enables the prosthetic to move more like a real leg.

Researchers at the Wake Forest Institute for Regenerative Medicine (WFIRM) are developing an oxygen gel that can be injected into wounded muscles to sustain tissue and limbs. The research is part of the federally funded Armed Forces Institute for Regenerative Medicine. Wake Forest is a co-leader of the $300 million program, which involves 34 universities and is tasked with changing the way wounded soldiers are treated on the battlefield. The gel would be injected into the muscle, providing a water-based source of oxygen. The idea is to apply the gel to open wounds on the battlefield and save limbs, and maybe even lives, because it buys the soldier crucial time keeping tissue alive until surgery.

Photo: www.wakehealth.edu/WFIRM/

Muscle Regeneration Therapy May Prevent Amputations One of the overarching goals of the federal program is to identify ways to repair massive muscle loss injuries, according to Dr. George Christ, lead researcher on the project. “The same way you exercise in a gym, we exercise these [muscles] in a laboratory,” he explains.  In addition to battlefield protocols, some of the WFIRM research will have far-reaching applications. Christ hopes to use the muscle implant therapy in a clinical trial on young patients with cleft lips. Several years down the road, the ultimate goal is to regenerate human limbs.

JANUARY 2013 O&P Almanac

11


IN THE NEWS

Visual Feedback Helps Upper-Limb Amputees Gauge Grip Force Erik Engeberg, PhD, University of Akron, Ohio, and Sanford Meek, PhD, University of Utah, Salt Lake City, have concluded through recent research that providing visual feedback about grip force can improve the manipulation of brittle or rigid objects for those using a prosthetic hand. Engeberg and Meek used and rated visual feedback supplied to the user through a bicolor LED mounted to the thumb to communicate grip force requirements. A hybrid force-velocity sliding mode controller was used with and without additional visual force feedback as part of the research methodology. The results provided a statistically significant improvement in handling brittle objects with the prosthesis when using the visual force feedback. The results of the research could lead to the implementation of a noninvasive, functional, and cost-effective technique to visually indicate to upper-limb amputees the grip force applied by a prosthetic hand. More information about the study and its methods can be found in Prosthetics and Orthotics International.

Photo: Touch Bionics

TRANSITIONS

BUSINESSES in the news

Researchers from Marquette University and the Medical College of Wisconsin, both in Milwaukee, received a one-year, $50,000 grant from the Clinical and Translational Science Institute of Southeast Wisconsin to evaluate how patient perception affects the success of prosthetic and orthotic lower-limb devices. The Clement Zablocki Veterans Affairs Medical Center, Milwaukee, will be one of the research sites.

OPAF and The First Clinics partnered with the Mutual Amputee Aid Foundation to introduce the First Target Archery Clinic on October 28 in Encino, California.

College Park Industries has moved its corporate headquarters to a renovated facility in Warren, Michigan, resulting in a 30 percent increase in manufacturing space.

A prosthetics and orthotics school building recently was inaugurated at the Orthopedic Training Centre in Nsawam, Ghana. The project was funded by Australia’s Direct Aid Program, and the new facility features classrooms for training of O&P technical assistants and a fully equipped technology building.

Hi-Tech Prosthetic in Aguadilla, Puerto Rico, has announced the launch of a Spanish-language O&P website, www.miprotesis.com, where individuals in Puerto Rico and Latin America can download news and interact in a socialnetwork forum.

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O&P Almanac JANUARY 2013

Two new supplier partners have joined OPGA: The vanHalem Group, LLC, an audit and consulting firm; and O&P Solutions, which brings a professional management model to O&P practices.

Össur’s Symbionic Leg has received the 2012 Best of What’s New Award from Popular Science magazine.

Proteor announces the following clarification to the “Businesses in the News” item from Ergoresearch that appeared in the October O&P Almanac: A distribution agreement between Proteor, France, and Ergoresearch, Canada, was signed for the distribution on the Canadian market of an orthotic patented worldwide joint, called ODRA, manufactured by Proteor and used for the fabrication of custom-made OA braces.

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.


You’re going to love this!

ABC is making all certification exams more readily available. Beginning January 2013 all Written and Written Simulation exams will be given every other month, and the Clinical Patient Management exams will be given three times a year. In addition, candidates for the Practitioner Certification exams will have 30 days after the application deadline to complete their residency requirements.  For more information on exam dates and application deadlines go to abcop.org.

SCAN THE CODE TO learn more about ABC certification

Setting the standard for O&P certification for over 64 years.

American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc.

abcop.org (703) 836-7114


n

Reimbursement Page By Devon Bernard, AOPA government affairs department

Get How to determine a patient’s primary payer—and what to bill Medicare

W

hen the only insurance a patient has is Medicare, determining who to bill is easy; most of the time, you bill Medicare solely and directly, and you know how much Medicare will pay. When a patient has Medicare and other insurance coverage, where to send the bill first and how much Medicare will pay becomes a little more complex. The patient’s other insurance will either be billed first (making Medicare a secondary payer), or Medicare is billed first and the patient’s other insurance is billed second. When Medicare is the primary payer, the rules are fairly straightforward and don’t change: Medicare will always be the primary payer. The rules for when Medicare is a secondary payer are not always that simple; sometimes certain conditions have to be met in order for Medicare to become the secondary payer. Because the rules and scenarios for Medicare as a secondary payer are a little more fluid, the following provides a brief synopsis of the programs that are primary to Medicare, how you can identify if your patient is eligible for one of the

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O&P Almanac JANUARY 2013

programs, and a quick tutorial on calculating Medicare’s liability—an easy way to do those calculations. Before discussing the programs that make Medicare a secondary payer, here is a list of the programs that will always be considered secondary to Medicare: • Medigap or Medicare Supplemental Insurance. These insurances, provided by private insurance companies, help beneficiaries fill the gaps in their original Medicare plan. If you are a participating provider, Medicare automatically forwards your claim to the Medigap provider after it made its payment. • Medicaid. This program helps cover the costs for people with limited resources and is a joint federal and state insurance program. Because of the joint effort, each state’s Medicaid program varies, but most health costs are covered if a beneficiary qualifies for both Medicare and Medicaid. • TRICARE. This health-care insurance is for active duty members of the armed services, retirees, and their families.


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Programs Primary to Medicare Currently, the following six programs always render Medicare to secondary payer status. In other words, if your patient is participating in one of these programs, the patient’s other insurance must be billed first before you may bill Medicare. • Working Aged. By far the most common scenario, working aged means a person has become entitled to Medicare benefits based on age, but he or she has not yet retired. For patients to be considered working aged, they must be at least 65 and enrolled in their employer’s group health plan (EGHP); the employer must have at least 20 employees. The EGHP also may cover the patient’s spouse, and the spouse would be considered working aged, even if he or she is currently retired. If a patient chooses not to be covered by the EGHP and wants Medicare as a primary insurer, he or she cannot receive any benefits from the EGHP. However, if the patient has a retirement plan provided by his or her employer and is 65 or older, the retirement plan will always be secondary to Medicare. • Workers’ Compensation. For a workers’ compensation (WC) claim, or a claim that is the result of an injury occurring on the job, Medicare normally will not make payments. But there are times when you may send a WC claim to Medicare. If you don’t agree to accept the WC payment as your payment in full, and your state allows you to collect your full charge, you may submit the WC claim to Medicare for secondary payment. In some cases, a WC claim may involve an arrangement to set aside money to cover the patient’s

current and future medical care related to an injury sustained on the job. When a set aside arrangement has been made, you may not have the ability to bill Medicare, even if the WC claim was long before the patient became eligible for Medicare. Medicare may not be billed or make a payment when a set aside agreement is in place, until you can provide evidence that the money in the set aside agreement has been exhausted, and the money was spent on appropriate medical expenses. • No-Fault and Liability Insurance Programs. These programs involve coverage by an insurance company, typically involving some type of accident that doesn’t occur at work. No-fault insurance, personnel protection, or medical expense coverage covers expenses due to injuries that occurred on the insured’s property or in the use of the insured’s vehicle, regardless of who is responsible for the accident. Liability insurance applies when someone is found to be at fault for causing an injury and payment is based on the policyholder’s legal liability for injury. The two most common types of liability insurance are auto and malpractice insurance. With liability insurance claims, you can seek a conditional payment too, but you may also seek conditional coverage.

Reimbursement Page

With liability insurance, no-fault insurance, and WC insurance claims, you can seek a conditional payment from Medicare for any covered benefits if you don’t believe the primary insurer will pay your claim in a prompt manner, essentially making Medicare the primary payer. Typically, if after 120 days you haven’t received payment from the primary payer, you may submit the claim to Medicare, and Medicare will make a conditional payment. However, if it is determined that someone else should have paid first or you eventually receive payment from the primary insurer, you must refund Medicare. Keep in mind, you may not seek primary payment from two insurers. So, if you choose to seek a conditional payment from Medicare, you must withdraw any claims you have with the primary insurer and/or drop any liens you may have placed on the beneficiary. • End-Stage Renal Disease. If a patient is diagnosed with end-stage renal disease (ESRD), he or she is entitled to receive Medicare benefits, even if the patient is under the age of 65. If ESRD is the only reason a patient has Medicare, and he or she is covered by an EGHP, then Medicare will be secondary to the EGHP. The patient also is entitled to all Medicare benefit categories, not just those related to the treatment of the ESRD. ESRD is somewhat complicated. Because it will not always be primary to Medicare, certain situations exist when Medicare will become primary. Medicare will be secondary for ESRD patients for a total of 30 months, which is called the ESRD coordination period. The coordination period begins when the patient first becomes eligible for Medicare benefits. After the coordination period ends, Medicare will become the primary payer.

JANUARY 2013 O&P Almanac

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Reimbursement Page

If the patient is under 65 and has Medicare benefits solely because of ESRD, his or her entitlement to Medicare benefits will expire 12 months after the last dialysis treatment or 36 months after a successful kidney treatment. So, if you have a patient who has Medicare coverage due to ESRD, you should routinely check his or her coverage or status because primary and secondary insurers can shift, and the patient may no longer have Medicare coverage.

• Disability Insurance. Medicare offers benefits to anyone who has a permanent disability, other than ESRD, regardless of age. If someone is receiving Medicare benefits because of a disability, Medicare will usually be primary. Certain criteria must be met for Medicare to become the secondary payer for someone with a disability. First, the patient must be under 65, receiving Medicare benefits solely because of a disability; the patient must also

have other health-care coverage under a Large Group Health Plan (LGHP). The coverage from the LGHP may be through the patient’s current employment or the current employment of a family member— mother, father, spouse, and so on. In order for a group health plan to be considered an LGHP, the offering employer must have 100 or more employees or be part of a multi-employer association where at least one member has more than a 100 employees.

Medicare Second Payer Cheat Sheet If the patient...

And…

The primary payer is…

And the secondary payer is…

Is age 65 or older and is covered by a Group Health Plan through current employment or spouse’s current employment…

The employer has less than 20 employees.

Medicare

Group Health Plan

Is age 65 or older and is covered by a Group Health Plan through current employment or spouse’s current employment…

The employer has 20 or more employees, or at least one employer is part of a multiemployer group that employs 20 or more individuals.

Group Health Plan

Medicare

Has an employer retirement plan and is age 65 or older…

The patient is entitled to Medicare.

Medicare

Retiree coverage

Is disabled and covered by a Group Health Plan through his or her own current employment or through a family member’s current employment…

The employer has less than 100 employees.

Medicare

Group Health Plan

Is disabled and covered by a Group Health Plan through his or her own current employment or through a family member’s current employment…

The employer has 100 or more employees, or at least one employer is a multi-employer group that employs 100 or more individuals.

Group Health Plan

Medicare

Has end-stage renal disease and Group Health Plan Coverage…

Is in the first 30 months of eligibility or entitlement to Medicare.

Group Health Plan

Medicare

Has end-stage renal disease and Group Health Plan Coverage…

After 30 months.

Medicare

Group Health Plan

Is covered under Workers’ Compensation because of a job-related illness or injury…

The patient is entitled to Medicare.

Workers’ Compensation (for health-care items or services related to jobrelated illness or injury claims)

Medicare

Has been in an accident or other situation where no-fault or liability insurance is involved…

The patient is entitled to Medicare.

No-fault or liability insurance for accident or other situation related health-care services

Medicare

16

O&P Almanac JANUARY 2013


n

Medicare as a Secondary Payer Now that you know and understand which programs may render Medicare a secondary payer, the next step is to figure out if a patient has insurance primary to Medicare. The following three tools can help you determine who is the primary payer: • the Coordination of Benefits (COB) contractor • a patient intake questionnaire • a Medicare secondary payer (MSP) cheat sheet. Patient intake is the best time to ascertain if the patient may have a payer primary to Medicare. To assist in that endeavor, the Center for Medicare and Medicaid Services (CMS) has created a questionnaire your office can use. The CMS questionnaire was designed to be answered in sequence, and it will prompt the patient to answer questions that apply to his/her situation. The form will not only help you determine if patients have insurance primary to Medicare but also which program they have. This questionnaire takes all the guesswork out of the process, and it is simple and easy to follow; however, it is rather long. You can find the questionnaire in Chapter 3, section 20.2., of the Medicare Secondary Payer Manual: www.cms.gov/Regulationsand-Guidance/Guidance/Manuals/ Internet-Only-Manuals-IOMs.html. If you don’t want to have each and every patient fill out a long questionnaire, you can create a shorter version, using an MSP cheat sheet, like the one found on page 16. You also may review any insurance information provided to you by the patient and match it against the scenarios on the cheat sheet to determine if Medicare will be the primary or secondary payer. Lastly, you may enlist the help of the COB. The COB is responsible for handling all aspects/activities of the Medicare secondary payer program, excluding making payments. Those activities include creating and maintaining an insurance coverage

profile on Medicare beneficiaries, which means it collects, manages, and reports all events that can result in a patient having insurance coverage primary to Medicare to ensure Medicare doesn’t make a mistaken payment when multiple insurers are involved. Besides being able to help you determine if a patient has insurance primary to Medicare, the COB also can answer any of your questions about the Medicare as secondary payer program. The COB customer service line (800/999-1118) is available MondayFriday, 8 am – 8 pm, ET. If you call the COB about a specific patient, be sure to have the following information ready: your supplier number, patient’s name, patient’s date of birth, and the patient’s Medicare number. The patient also is able to call the COB to verify if he or she has insurance primary to Medicare. Keep in mind, however, if your supplier number doesn’t match what the COB has on file, your questions must be submitted via mail. The COB address is: MEDICARE Coordination of Benefits P.O. Box 33847 Detroit, MI 48232

How to Determine Medicare’s Liability If you determine a patient has insurance primary to Medicare, the next step is to determine how much Medicare will pay you. Because Medicare will never pay more than its allowable, be aware that the most Medicare will pay in a MSP claim is its allowable amount. However, to determine the exact amount Medicare will pay, use the following three calculations—and know that Medicare will pay the lesser of the amounts derived from these calculations: • First, determine the amount Medicare would pay if it were primary, or if it were the only payer. • Second, calculate Medicare’s liability with regard to the primary

Reimbursement Page

insurer’s payment. That calculation is done by subtracting the primary insurer’s payment (what it actually pays) from either the Medicare allowable or insurer’s allowable (how much it could pay). • Finally, subtract your submitted charge minus the payment made by the primary insurer. Rather than doing the calculations yourself—and if you want to determine Medicare’s payment in a MSP claim— AOPA recommends visiting your DME MACs website. Each website has aides or calculators to determine Medicare’s liability in an MSP situation. For example, the Jurisdiction B DME MAC, National Government Services, has an excellent MSP calculator on its website. All you have to do is enter the amounts, and it does the rest. Here’s the link: www.ngsmedicare.com/wps/ portal/ngsmedicare/medicaresppandsc. One insurance program not covered above was Department of Veterans Affairs (VA) benefits. So, are VA benefits primary to Medicare or is Medicare a secondary payer if the patient has VA benefits? If veterans have Medicare and VA coverage, they must choose one of the agencies to handle their orthotic and prosthetic services. A claim can’t be submitted to both agencies for the same date of service and for the same items. a

Editor’s Note: If you want to learn more about MSP and other coding, billing, and reimbursement issues, consider attending an AOPA Coding & Billing Seminar or one of AOPA’s AOPAversity Audioconferences. See page 32 for calendar of events.

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

JANUARY 2013 O&P Almanac

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Photos: Arizona AFO

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O&P Almanac JANUARY 2013


COVER STORY

Learning from

LEAN

By Adam Stone

A “lean” approach to manufacturing offers processes, reduced turnaround time, and cost savings for O&P fabricators

F

for some time, it is increasingly taking hold or a while, it looked as if there was no way for custom fabricator among O&P businesses and central fabrication companies. Arizona AFO, headquartered in Mesa, to grow. The firm had moved into a larger space in 2005, but there still seemed Clear the Decks no way to keep up with a growing volume of Arizona AFO implemented lean with the orders from O&P practitioners. help of Arizona State University Professor “There was a time when I didn’t want any Andrew Feller. He consulted with the more business. We couldn’t handle one more firm for a month, observing activities and order coming in,” says Vice President Don diagramming processes. Then he recomPierson, CO, C.Ped. The business seemed to mended a few simple steps. have reached maximum capacity, and O&P “The first thing you find out is that you clients found themselves waiting longer and have a lot of ‘stuff’ you don’t need, stuff longer for their orders to come through. that is just in the way. Machinery, boxes— Then something happened. Within a anything that was just in the way—we got month the firm cut its production time from rid of all that,” Pierson says. Then a few 18 days to seven, even while taking on a pieces of the assembly process got shifted. higher order volume. “We saw that if we could adjust the sewing What happened is a “lean” philosophical machine to where it should actually be, as approach to manufacturing that emphasizes the next step in the line, we saved all sorts efficiency by addressing everything from of time.” work flow to production tools to the physical These kinds of basics represent simple space where workers stand. While lean has examples of lean thinking in action, but the been around in the business community philosophy of lean runs deeper.

JANUARY 2013 O&P Almanac

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At Cascade Dafo, “motion waste” was dramatically reduced after the work area was redesigned into a U-shaped cell, placing materials within easy reach of the operator.

“Lean is an operational excellence strategy. It basically enables you to change for the better. More than just a predefined method, it gets you together as a company and teaches you a communication style to actually achieve change,” says Scott Wimberley, operations director at Fabtech Systems, a central fabrication company in Everett, Washington. A lean enterprise will scrutinize every aspect of its operations. How does purchasing work, and how does it synch with inventory? What are the steps in the manufacturing process and how are they achieved? Are the right tools being kept in the right places? Does a piece pass through multiple hands as it is built, or is a single individual responsible from start to finish? The net result of all this analysis: “You are able to deliver a higher quality product in less time with less rework and fewer surprises,” says Wimberley. Business books point to successful lean implementations among very large manufacturers—Toyota is most often cited—but in fact these ideas can yield significant improvements even at much smaller O&P C-Fabs. “O&P has a stigma that everything is personal, everything is customized—and it is. But from a manufacturing and production point of view, it’s all pretty standard,” Wimberley explains. Generic parts can be readily streamlined, while custom elements can be folded into a tight system. It’s like making a pizza: The

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O&P Almanac JANUARY 2013

basic dough-cheese-sauce assembly is standardized, while the addition of toppings—although customized for each order—still is achieved with great efficiency. The point is, even a small, mainly custom shop has as much to gain from lean as any bigger manufacturer.

Streamlining the Process It can be easy to view lean more as an idea than an action, a loose affiliation of production concepts rather than a concrete set of practices. To understand how it works in the day-today, it helps to take a close look at a single example. Fillauer Companies of Chattanooga, Tennessee, turns out anywhere from 50 to 10,000 parts at a time, with a typical run producing 100 to 1,000 parts. The 78-year-old company has had plenty of time to get good at

this, but present day management is looking to get even better and has implemented a range of lean practices to help speed production and enhance overall efficiency. “The first thing with lean is cleaning out the clutter,” says Paul Pelletier, machine shop production supervisor. To that end, cutters, drillers, and other machinery have been consolidated in a single warehousing area. This tight organization feeds a streamlined process in which materials are pre-cut and ready to be dropped into place once manufacturing begins. This process has helped Pelletier deal with challenging situations, for example the notoriously inaccurate casting of knee joints. To address this recurring issue, he has revamped the process to include different machinery, paired with more efficient practices, especially the addition of

“More than just a predefined method, [lean] gets you together as a company and teaches you a communication style to actually achieve change.” —Scott Wimberley

Photo: Cascade Dafo

all needed tools and


computer-aided controls. With these changes in place, a product that previously had to be handled seven times now can be handled just once. “It’s more efficient, and it is a great deal more precise, since the more you handle things the less accurate they are,” says Pelletier. Improved technologies have driven productivity in other areas, including the cutting of knee lock pieces. In addition to computer-guided milling, Fillauer has upgraded its cutting tools, investing in machines that work 10 to 15 times faster than older models. The entire project cost about $8,000 but it has shaved off production time dramatically. Where it used to take three months to produce 12,000 parts, today the firm can do that in a week and a half. The lean aspect at Fillauer involves more than just buying new machinery. The infrastructure investments are part of a bigger process in which operations are reviewed globally, in an effort to understand how all the pieces fit together. It isn’t always easy to generate that kind of thinking. “The challenge is more about personnel than anything,” Pelletier explains. When a task has always been done a certain way, it can be difficult to change course. Lean requires buy-in at all levels. “Machinists and operators— they have to have the mindset of wanting to do this,” Pelletier says. To get that kind of team spirit going, management has to take a participatory approach. “I have to keep my mind open to everyone else’s suggestions. I don’t always see things the way they do, so we need to have pretty good communications. It can’t just be one person’s way or the highway. If they are active in the decision-making process, they are more likely to jump on board.” Despite the many advantages of lean, Pelletier says there are some areas of production where close analysis and the reinvention of systems are simply not justified. “There are parts that we have been making for 50 years. They are small sellers, but they are still

“It can’t just be one person’s way or the highway. If [machinists and operators] are active in the decisionmaking process, they are more likely to jump on board.” —Paul Pelletier

necessary. People still want them. But to put a lot of effort and money into re-thinking those, it just isn’t worth it.”

Start with Purchasing Fillauer’s lean emphasis has been on the integration of new technologies, but others taken an even more basic approach, tackling lean not as a product question but rather as a matter of business processes. Headquartered in Troy, Michigan, Becker Orthopedic employs more than 100 people in the manufacture of

knee, ankle, and hip joints. President Rudy Becker Sr. views lean as a means to a very specific end. “It’s our ability to try and keep the costs down, so we can pass those savings onto customers,” he says. While others may tackle lean first as a matter of cleaning up the shop floor or organizing to production process, Becker begins with an emphasis on inventory. “Lean manufacturing starts with purchasing. If you have twice as much raw material in here as you need, then you are carrying too much cost,” he

 

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“The point of lean manufacturing is to control as many costs as you possibly can.” —Rudy Becker Sr.

says. “We try to be very intelligent in working with our suppliers to make sure we get the parts that we need and we get them on time.” This focus on smart purchasing is bolstered by Becker Metal Works, a sister company producing knee and ankle joints through a lost wax process. “That helps a lot in our ability to get stuff right when we need it, so if we have a big influx of orders we can respond to that,” Becker adds. This tight integration in the supply chain has helped cut lead time from 24 to 30 weeks down to eight weeks for a typical order. Becker can do it in three weeks if necessary. Purchasing, supplies, inventory: These are not first topics that typically come up in discussions of lean business practices. But that is exactly the point that Becker makes, and experts in the field back him up. Lean is all about processes, and these do not begin or end on the shop floor. A business is a holistic entity and needs to be considered as the sum of all its parts to gain maximum efficiencies. “There are all sorts of costs in manufacturing. There is the cost of the building you are in, the cost of the electricity, the cost of the inventory you carry, the cost of the labor, and the costs of the materials. The point of lean manufacturing is to control as many of those costs as you possibly can,” Becker says.

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O&P Almanac JANUARY 2013

A New View With so many variables to consider, one still has to start somewhere. Cascade Dafo in Ferndale, Washington, starts with cardboard boxes. Practitioners send the manufacturer of pediatric bracing systems hundreds of boxes every day. In the past it took five people to open them all, and sometimes rush orders would not be discovered until halfway through the day, according to Loretta Sheldon, director of business development and education. By streamlining the types of equipment needed, reducing the number of steps, and reorganizing the space to cut down on walking-around time, management was able to pare down the process by 20 percent. The project succeeded in large measure because changes were driven by those who were most hands-on. “We gathered the people who were actually doing the work. That is the most important thing, because they know from doing it every day exactly where the waste is,” Sheldon says. Sometimes, lean can be little more than a mental shift, a way of viewing the work that allows people to adjust their behaviors. At Arizona AFO, workers had been putting out 35 custom braces per day. As part of its lean review, management asked employees to boost that number substantially, up to eight

pieces an hour—enough to nearly double production. The challenge came with improved tools and systems, but ultimately it proved to be a mental shift that carried the day. “People are overwhelmed by having this huge 35 number. It feels like that is all you can do,” Pierson says. “But if you organize it, breaking the big chunks into small chunks, it somehow just becomes a lot easier.” It keeps coming back to the people: Their understanding, their interest, their buy-in. Lean cannot come from the top down. It has to grow organically. “We do education and meetings daily to talk about what we do and how we do it. It’s a sizable expense but that expense is well-rewarded,” Wimberley explains. Some meetings focus on a particular aspect of lean theory. At others, employees talk about operations in their areas to identify potentials for streamlining. Often the daily meeting will look at some shortfall, a run of plastic for example that turned out thinner than expected. While all aspects of the system will be scrutinized, Wimberley says, the solution 80 percent of the time is more training. Lean has made some inroads among O&P manufacturers, some formally embracing the philosophy, others taking bits and pieces and incorporating them into overall best practices. Wimberley predicts it will become even more deeply entrenched in the near future. While generally associated with large-scale production, lean has much to offer even smaller-scale C-Fabs. “With any company, improving what you do and how you do it, becoming more efficient, that is what leads to success,” he says. a Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.


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By Deborah Conn

Teaming Up Against

Diabetes

Photo: Nascott O&P

A continuity of care offers patients promising results

Charles Crone, CP, conducts an initial fitting of a below-knee prosthesis.

M

ore than 60 percent of nontraumatic amputations in the United States result from diabetes, according to the Centers for Disease Control. The CDC estimates that 8.3 percent of the population— almost 26 million Americans—now has diabetes, which is associated with $116 billion in annual direct medical costs alone. Further, more than 30 percent of those costs are the result of peripheral

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O&P Almanac JANUARY 2013

vascular disease and related neuropathic complications. The good news is that the rate of lower-extremity amputations among patients with diabetes fell significantly between 1996 and 2008; the bad news is that far too many people still risk losing a limb to the disease. Many diabetes patients suffer from peripheral neuropathy. Their inability to sense the discomfort of an ill-fitting shoe or


a small cut or blister, combined with compromised vascular systems, can allow such injuries to develop into full-blown ulcers, with devastating consequences. Almost 100,000 limbs are amputated each year in the United States due to complications from diabetes, according to Christopher E. Attinger, co-director of the Center for Wound Healing at Medstar Georgetown University Hospital in Washington, D.C. A recent study in the United Kingdom found that people with diabetes are 210 percent more likely to have a leg amputated above or below the knee and 331 percent more likely to need part of a foot removed than is the general population. Taking a collaborative approach to diabetic foot care isn’t new. New England Deaconess Hospital in Boston established the nation’s first foot hospital in the 1920s, and by the 1950s had established itself as a world leader in foot care and treating ischemic foot ulcerations. What is new, however, is the sophistication and pace of the team-based approach to saving limbs from diabetic-related amputations. “A team approach to diabetic limb salvage such as that developed at Georgetown University Hospital over the past 20 years can result in a much greater number of limbs being saved,” says Attinger. At the Madigan Army Medical Center in Tacoma, Washington, the number of diabetes patients increased 48 percent from 1999 to 2003. At the same time, however, the number of lower-extremity amputations dropped 82 percent, from 33 in 1999 to 9 in 2003, according to a recent study published by the journal Diabetes Care. The chief reason? “The value of a focused multidisciplinary foot care program for patients with diabetes,” the study concluded. After Broadlawns Medical Center in Des Moines established an amputation prevention program with the team approach, the number of limb losses decreased by 72 percent.

“The greatest advancement is availability—that we can actually talk with all the different disciplines in the hospital and blend all the professionals together and determine the best course of action.”

While at Broadlawns, Lee C. Rogers, DPM, now co-medical director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles, developed a six-step protocol for diabetic limb salvage that incorporates a wide range of medical specialties. The program, which Rogers teaches at medical facilities nationwide, begins with an acronym, VIP—vascular, infection, and pressure—although not in that order. The first step is to address the infection, which is the most common reason for losing a leg. After that comes vascular management, and then off-loading of plantar pressure. Wound management follows, with debridement, promotion of granulation tissue, and wound closure.

Becoming a Team Player The big difference in treating the diabetic foot, as opposed to, say, a heart attack, is the need to combine multiple disciplines, says Rogers. “If you go to the emergency room with a heart attack, you see a cardiologist who can do everything you need. When you are at risk of losing your leg, there is no single doctor who can intervene and do everything.” Diabetic ulcers are a complex problem and therefore require an array of specialties, including infectious disease specialists; podiatrists and foot surgeons, who debride wounds; and vascular surgeons, who address blood flow issues that can contribute to ulcers and slow their healing. Endocrinologists and nutritionists attend to patients’ glycemic levels,

—Charles Crone, CP

and teams also can include internists, orthopedic surgeons, nephrologists, and plastic surgeons. O&P practitioners fit ankle foot orthoses and full and partial prostheses when needed, and pedorthists supply therapeutic footwear. All of those specialties need to be organized, and at the Georgetown Center for Wound Healing, chief residents and nurse managers are the quarterbacks of communicating, says co-director John Steinberg, DPM, ensuring the flow of information and coordination of services. In addition to the availability of so many relevant specialties at the Georgetown center, what sets the team apart is its egalitarian approach. “Everyone is empowered,” says Steinberg. “The hierarchy and egos are removed. The patient is the center of the puzzle, not the medical team.” That spirit of collaboration is one of the challenges to establishing a team approach, according to Rogers. “Doctors, especially surgeons, don’t have the best reputation for working well together,” he says. “When implementing programs, we have to do a lot of team building and philosophy sharing.” The Georgetown center provides both inpatient and outpatient limb salvage and wound care. If a patient needs to be admitted, there is a seamless transition and continuity of care. Caregivers meet weekly to review cases and participate in a group learning activity. “Team members attend different conferences and come back with new knowledge,” says Steinberg. JANUARY 2013 O&P Almanac

25


”The patient is the center of the puzzle, not the medical team.” —John Steinberg, DPM

Nascott Orthotics and Prosthetics, with offices in Virginia, Maryland, and Washington, D.C., is part of the center’s team and sends practitioners each day to the clinic to work with Georgetown staff members and their patients. Charles Crone, CP, clinical director of prosthetics for Nascott, values the easy access to physicians and other health-care providers at the center. “We are able to give our input and unique insight directly to the team and patient while we’re there in the clinic,” he says. “We’re not dictating prescription criteria but offering education on the most appropriate modality. This has been a protocol that has worked well with other providers also.” In addition to seeing patients in the Georgetown clinic, Crone does inpatient pre-surgical consultations. “One of the best services we can provide is to explain the entire process to prospective amputees and their families,” he says. “When patients understand their options and can coordinate with peer counselors such as from the Amputee Coalition, monthly amputee support group participants, and fellow clinic patients, they feel much better about the upcoming major life-altering surgeries and short- and long-term rehab process.” Crone says this approach helps him catch potential problems in the clinic and resolve fitting, alignment, or suspension issues. He has prevented needless testing and additional medical procedures by correctly identifying the source of a problem. “We can look at the surface of the skin and see that the problem is friction from the device rather than impaired vascular circulation,” he says.

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Even in cases where amputation is the proper course, the team approach offers substantial benefits, according to Crone. He cites the example of a patient who wanted a higher-level amputation than physicians initially recommended. The patient received psychiatric counseling at Georgetown, and after weighing all the factors, including the psychological, doctors performed the amputation procedure she desired. Crone notes that patients are highly satisfied with the seamless nature of the team approach. “They have this continuity of care with all of the paraprofessionals in the same clinic, brainstorming and creating and troubleshooting issues.” “From the clinical standpoint, this is the future of how wound care is going to be managed throughout the country,” says Joe Jones, C.Ped, CFo, also with Nascott and part of the team at the Center for Wound Healing. “It allows me as a practitioner to have more contact with the physician, and I am able to fine tune devices as we go. And we are privy to a great deal of information that we wouldn’t necessarily have without the team approach.”

“[The team approach] allows me as a practitioner to have more contact with the physician, and I am able to fine tune devices as we go.” —Joe Jones, C.Ped, CFo

Georgetown is unusual in having orthotists and prosthetists on clinic staff, according to Lee Rogers, and most limb salvage centers refer patients to outside practitioners. “For some of our more complicated cases, orthotists will come on site to scan or cast the leg and return to the clinic to fit the device.” But whether O&P practitioners are part of a physical, on-site team or a “virtual” team, Rogers regards them as invaluable to the long-term goal, which is to prevent the risk of limb loss from ever happening again. “Finding an appropriate orthotic or shoe is one of the most difficult parts in long-term prevention,” says Rogers. And, he notes, it requires a real commitment by the practitioner to offer continued follow-up care.

Building Your Own Team

Although the Georgetown Center and Valley Presbyterian Hospital offer exemplary models of the team approach, practitioners can use other means to provide comprehensive and collaborative care to diabetes patients. Crone, for example, has developed a network of other resources that he uses in his practice at Nascott. “I’ve researched who are the best surgeons, therapy departments, skilled nursing facilities,” he explains. “I go out and interview them. That way, when I refer patients, we can work out a wellrounded rehab plan with everyone on the same page.”


”If you go to the emergency room with a heart attack, you see a cardiologist, who can do everything you need. When you are at risk of losing your leg, there is no single doctor who can intervene and do everything.” —Lee Rogers, DPM

As an independent practitioner, Cathie Norsen, RN, CFo, based in Orlando, Florida, has to work a little harder to be part of a team, but she finds it well worth the effort. Norsen works with home health agencies and nursing homes to help identify appropriate patients for her therapeutic shoe-fitting services. For example, the fact that a patient uses a wheelchair doesn’t mean diabetic shoes are unnecessary. “There are shear forces from the foot rests, feet can slip between the rests or get bumped,” she says. Norsen is quite clear on the relationship between shoes and diabetic foot complications: “The whole point of the 1992 Therapeutic Shoe Bill [providing reimbursement for diabetic shoes] was to reduce Medicare’s amputation budget by paying for better shoes,” she says. “Poor shoes and poor foot care led to too many amputations. Not only that, but statistics show that once you have a diabetic amputation, you are far more likely to die from the illness within five years.” According to Norsen, the bill has succeeded in both reducing

Limb-Saving Techniques Both the Center for Wound Healing at Medstar Georgetown University Hospital and Valley Presbyterian Hospital use the latest procedures to treat diabetic ulcers and save limbs, including the following: •

Stages of treatment. At Georgetown, the medical team does not try to complete debridement of the wound in one fell swoop, says John Steinberg, DPM and co-director of the center. Instead, it works in stages to preserve as much healthy tissue as possible and remove all infection.

Vascular surgery. Surgeons use both open and closed endovascular procedures to restore blood flow to the limb.

Hyperbaric oxygen. Patients lie in a hyperbaric chamber breathing in 100 percent oxygen while the atmospheric pressure is raised, allowing the oxygen to super saturate their blood. Results include new vessel growth, new tissue growth, and an environment hostile to bacteria. “We can heal a wound with less absolute blood flow than would be required,” says Steinberg.

Negative pressure wound therapy. This technique uses a vacuum dressing, and new designs also bathe the wound frequently in an antibiotic solution.

New type of culturing. Polymerase chain reaction culture testing is more sophisticated and faster than traditional methods. “It’s much more sensitive and can pick up a true reading of what’s happening at the wound surface,” says Steinberg.

New topical treatments. Among them is ultrasound technology, which uses low-frequency sound waves to reduce bacteria and stimulate healthy cells.

Stem cell therapy. Valley Presbyterian podiatric surgeons are engaged in clinical trials using marrow-derived stem cell therapy and regenerative medicine to heal chronic ulcers

Bioengineered skin tissue grafts. Surgeons at Valley Presbyterian apply engineered grafts from neonatal foreskins to promote faster healing.

Medicare’s budget as well as the number of amputations. Norsen works with orthotists, prosthetists, podiatrists, and primary care physicians to serve her patients. Education is a huge component of her work, and she brings in nursing home administrators, home healthcare workers, and family members in addition to other health-care providers and the patients themselves. She teaches diabetes patients how to examine their feet for injuries, cautions them to have podiatrists trim their toenails, and explains what to do and whom to call if a problem surfaces.

“Sometimes people don’t like to refer patients to others. I don’t have that problem,” she says. “I feel the more I work as part of a group, the better the outcomes and the more referrals I get.” Charlie Crone of Nascott Othotics and Prosthetics agrees. “The greatest advancement is availability—that we can actually talk with all the different disciplines in the hospital and blend all the professionals together and determine the best course of action.” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@ cox.net.

JANUARY 2013 O&P Almanac

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AOPA HEADLINES

AOPA WORKING FOR YOU

O&P Wins Big on 2.3% Excise Tax Exemption Ruling

AOPA estimates $100 million to be saved annually

A

lthough success was a long shot, AOPA couldn’t pass up the opportunity to press for exempting O&P devices from the 2.3 percent excise tax on medical devices imposed by the Affordable Care Act (ACA). The exemption AOPA secured from the tax, which went into effect Jan. 1, 2013, saves O&P patients, their providers, and suppliers a whopping $100 million a year, based on AOPA’s estimate of what the government would have collected if O&P medical devices were not exempt. It’s important for members of the O&P community to know how the exemption came about, what it means to the industry, and why it is so important to be unified, have adequate resources, and pursue the right strategy.

The Affordable Care Act and O&P The ACA was signed into law in March of 2010. During an initial reading of the law, AOPA Executive Director Tom Fise, JD, spotted the provision known as “the retail exemption.” Eyeglasses, hearing aids, and contact lenses are all

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O&P Almanac JANUARY 2013

medical devices that qualify for the retail exemption and escape the 2.3 percent excise tax. These are all customized products purchased at retail for individual use. Further examination of the law disclosed other parallels between those customized devices and O&P, such as they are prescribed for each individual patient by a physician but don’t require a medical professional to implant the device. It became clear that AOPA could make a strong case to persuade the U.S. Department of Treasury and the Internal Revenue Service (IRS), the agencies charged with writing regulations to implement the tax, to also include O&P devices in the retail exemption. AOPA first met with Treasury and IRS officials Feb. 10, 2011. Fise and AOPA representatives Charles Dankmeyer and Scott Schneider were joined by AOPA legislative counsel Stephanie Kennan and Carolyn Smith. This meeting laid the groundwork for the extensive effort that followed, which included submitting comments to Treasury and IRS by a March 4, 2011 deadline.


AOPA HEADLINES

The initial success of this first meeting, follow-up written comments, and subsequent contacts and conversations was reflected in the proposed regulations issued Feb. 7, 2012. They included much of AOPA’s input and clearly applied the same “retail exemption” to O&P devices that eyeglasses, hearing aids, and contact lenses enjoy. This was a good first step for O&P, but questions remained as to whether componentry manufacturers also would enjoy the exemption. Kennan, an AOPA lobbyist with McGuireWoods, testified at Treasury Department/IRS hearings on May 16, 2012, reinforcing support for exempting O&P devices but also asking for further clarification on exempting component parts supplied by manufacturers that are used in the exempt devices provided to patients by patient-care facilities. Another clarification was requested on the phrasing “administered by a medical professional” to ensure this criterion did not adversely affect the O&P device exemption. Kennan reminded Treasury and IRS officials that orthotics and prosthetics require ongoing fitting and adjustment. As a result, the final regulations clarify that the exemption applies to O&P devices that require initial or periodic fitting or adjustment. A new example, Example 8 in the final regulations, relates to prosthetics, clarifying that component parts of an exempt device qualify for the exemption. (See sidebar for more details.)

Dedication and Commitment Pay Off In the final analysis, the long, hard slog to success vividly demonstrates that securing a regulatory victory is much like building a house: There has to be an overriding plan with a clear view defining what the end result should look like. Many tools must be deployed to make sure the pieces fit together and operate in a harmonious way to achieve the finished product.

What the Tax Exemption Means to You While the celebration over O&P medical device exemption took place December 5, the payoff of almost $100 million a year in tax savings for O&P patients, providers, and suppliers will continue for years to come provided that industry professionals recognize and understand the specifics of the ruling. Here’s a deeper look. The technical jargon in the final rule confirmed “prosthetic and orthotic” devices, as defined in 42 CFR 414.202 that do not require implementation or insertion by a medical professional, and “(T)herapeutic shoes,” as described in 42 CFR 414.228(c), qualify for the safe harbor provision “considered to be of a type generally purchased by the general public at retail for individual use” (and thus qualify for retail exemption). AOPA had several meetings and consultations with the Internal Revenue Service and Treasury, beginning nearly two years ago, explaining why O&P devices should be eligible for this retail exemption. Additionally, the Treasury responded favorably to the specific argument AOPA presented that this retail exemption required that the manufacturers of components (and potentially complete devices) also should be exempt from the 2.3 percent tax because otherwise the patient would be required to “… pay the excise tax as the tax would just be shifted higher up the distribution chain.” This is a dramatically important and favorable outcome for O&P in this final rule. It is clear that companies that manufacture components that are used by a patient-care facility provider to fabricate an exempt O&P device (i. e., one that qualifies under the safe harbor rule above) also are exempt, as to those components, from the medical device excise tax. The key statement from the final regulations on the component policy is the following example: “Example 8. X manufactures single-axis endoskeletal knee shin systems, which are used in the manufacture of prosthetic legs. X sells the knee shin systems to Y, a business that makes prosthetic legs. The FDA requires manufacturers of knee shin systems and prosthetic legs to list the items as devices with the FDA. The FDA classifies prosthetic leg components, including knee shin systems, as external limb prosthetic components under Subpart D of 21 CFR part 890.3420 and product code ISH. The FDA classifies prosthetic legs as an external assembled lower-limb prosthesis under 21 CFR part 890.3500 and product code ISW/KFX. In addition, the Centers for Medicare and Medicaid Services have assigned the knee shin systems Healthcare Procedure Coding System code L5810. “Prosthetic legs and certain prosthetic leg components, including single-axis endoskeletal knee shin systems, fall within the safe harbor for prosthetic and orthotic devices that do not require implantation or insertion by a medical profession(al) that is set forth in paragraph (b)(2)(iii) (D)(1) of this section. Accordingly, both the single-axis endoskeletal knee shin systems manufactured by X and the prosthetic legs made by Y are devices that are of a type generally purchased by the general public at retail for individual use.”

JANUARY 2013 O&P Almanac

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AOPA HEADLINES

AOPA WORKING FOR YOU

Similarly, this effort required an initial strategy that clearly outlined the objective—an exemption for O&P medical devices—and then assembled all of the tools and firepower to make it happen. At the request of AOPA members and lobbyists, members of Congress generated letters raising questions about imposing the medical device excise tax. Meetings with Treasury and IRS officials humanized AOPA’s position, particularly when AOPA members were part of the conversation, and lent credibility to the argument. Testimony at hearings became part of the record to help support and justify a position the final regulations might adopt; AOPA wanted to make sure the record was clear on how and why this exemption

should apply to O&P medical devices. In short, no stone was left unturned in this ongoing, nearly three-year effort to save O&P patients, their providers, and suppliers an estimated $100 million in excise taxes each year. When you contemplate the modest investment the O&P community makes in AOPA and the allied organizations, a payday like this exemption represents a whopping return. That’s why AOPA plans to include a reminder in upcoming communications encouraging current members—who have carried this ball, provided the funding, and written the letters to members of Congress—to take one more significant step: To make sure colleagues

and competitors also are contributing to the O&P community’s ability to achieve these kinds of successes. To check on whether your colleagues or competitors are stepping up to the plate, just go to www.AOPAnet. org. In the upper right-hand part of the screen, search by state or city for a list of AOPA members. If your colleagues or competitors are missing from that list, it’s time to take action to protect your future interests by urging them to get on board and join AOPA. It may only take a phone call or a casual conversation the next time you meet. But, by all means, make an effort to ensure that every single patient-care provider and all of your suppliers are helping make good things happen for O&P and your business. a

Is the Device Exempt? It is important to note that the December 5 ruling is not a universal exemption of any manufacturer’s entire product line; it depends on whether the component goes into a finished O&P device that qualifies for exemption. If every component a company makes is used in an exempt device, then all of its products would be exempt from the tax. Other manufacturers may sell some components that meet the criteria for the retail exemption and other products (e.g., non-O&P devices) that do not qualify for the exemption. They will have to pay tax on the latter products, but not on the former ones. The example provided above is the “safe harbor” eligibility for the retail exemption, and it appears virtually all O&P devices will qualify under this preferred pathway. A second pathway to exemption—the facts and circumstances test—is open to any type of manufacturer (not limited to O&P) that wishes to argue that the retail exemption should apply to its product(s). This route would take a longer time and have less immediate certainty.

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AOPA HEADLINES

Master Medicare: Advanced Coding & Billing Techniques Join your colleagues March 4-5, 2013, at the DoubleTree by Hilton Hotel Atlanta Airport for AOPA’s “Mastering Medicare: Advanced 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: Advanced Coding & Billing Techniques” seminar in Atlanta at https:// aopa.wufoo.com/forms/2013-mastering-medicare-atlanta/, or contact Devon Bernard at dbernard@aopanet.org or 571/431-0854.

AOPAversity Secrets to a Successful Audit— Join the Audio Conference January 9 Join AOPA January 9 for the first AOPAversity Mastering Medicare Audio Conference that will focus on the tips and tricks of handling an audit.

How do audits work? Who is auditing your claims? To learn the answers to these and related questions, including how to successfully handle an RAC audit, attend the audio conference. An AOPA expert will address the following issues: • What is an audit and how does it work? • Who is auditing your claims and why? • What documentation should you use? • What is a timely response? • How do you identify potential problems? 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 dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at https://aopa.wufoo.com/forms/2013telephone-audio-conferences/. Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0876 with registration questions.

JANUARY 2013 O&P Almanac

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AOPA HEADLINES

AOPAversity Understanding the LSO/TLSO Medicare Policy—Join the Audio Conference February 13 Ever wonder what items require a PDAC coding verification? Ever have trouble determining who is responsible for payment? If you have ever faced these challenges, join AOPA February 13 for an AOPAversity Mastering Medicare Audio Conference. This conference will provide you with the tools to help answer most of your LSO/TLSO Medicare Policy questions. The following topics will be covered: • Learn when an LSO/TLSO is covered. • Learn the proper use of the CG modifier. • Learn who is responsible for payment. 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 dbernard@AOPAnet.

org or 571/431-0854 with content questions. Register online at https://aopa.wufoo.com/forms/2013telephone-audio-conferences/. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

2013 AOPA Audio Conferences: Mark Your Calendar AOPA has confirmed the dates and topics for its 2013 series of audio conferences. Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1 p.m. EDT. This series provides an outstanding opportunity for you and your staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions.

Buy the Series and Get Two FREE! Visit the AOPA Bookstore, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions ($1,990 for nonmembers). If you purchase the entire year’s worth of conferences, all conferences from months prior to your purchase of the set will be sent to you as CDs. Seminars are priced at just $99 per line for members ($199 for nonmembers).

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2013 Topics January 9:

Secrets to a Successful Audit

February 13: Understanding the LSO/TLSO Medicare Policy March 13:

Contracting With the VA: Hints for Landing the Contract

April 10:

Handling Adversity: Coping With Difficult Patients

May 8:

Navigate the Maze: Get to Know the Appeals Process

June 12:

Clinical Documentation: Dos & Don’ts

July 10:

Networking for the Future: Building Relationships With Referrals

August 14:

Don’t Get Stuck With the Bill: Medicare Inpatient Billing

September 11: Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy October 9:

What’s the Word: A Health-Care Reform Update and What You Can Expect

November 13: Advocacy: A Potent Weapon for Change December 11: What’s on the Horizon: New Codes for 2014


AOPA HEADLINES

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 shousman@ AOPAnet.org 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.

Take This BOAT for a Ride

Create your own secure and confidential web pages on the BOAT—a tool specifically tailored to help O&P business owners manage their businesses for greater profit and quality patient care. By using this tool, you not only will examine the financial fitness of your business, you also will be pushed to identify and better understand your competition, market conditions, referral sources, and internal effectiveness. Use the BOAT to create budgets, track your finances, and participate in the annual Operating Performance and Compensation surveys. The new AOPA Patient Satisfaction Survey (required by certifying bodies) will be accessed through the BOAT site, which will be free to those firms using electronic data capture devices. All information is confidential and secure. Members can sign up for the BOAT website by going to www.AOPA-BOAT.com and clicking on the orange “Register for BOAT” button on the bottom right-hand section of the screen. The direct link for the registration page is www.iisecure.com/ BOAT/Register.asp. Once you have registered and logged in, visit the tutorial video on the landing page.

AOPA 2012 Operating Performance Report Available Now 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 130 patient-care companies, representing 1,050 full-time facilities and 68 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. Purchase the 2012 Operating Performance Report at the AOPA Bookstore, www.aopanetonline.org/store.

JANUARY 2013 O&P Almanac

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AOPA HEADLINES

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: www.AOPAnetonline.org/education. 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 http://bit.ly/AOPAwebcasts.

Coming Soon 2013 AOPA Products & Services Catalog

If You’re Paying More Than 1.9%, You’re Paying Too Much

AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2013 Products & Services Catalog is coming soon— check the AOPA website at www. aopanet.org.

AOPA has partnered with Bank of America Merchant Services to offer credit card processing rates as low as 1.9 percent to AOPA members. Many members are paying more than 2.5 percent, and if you’re handling $500,000 a year in credit card transactions, the 0.6 percent savings is like getting a 200 percent return on your membership dues investment. To enroll, contact 888/317-5402 or email tellmemore@bankofamericamerchant.com. AOPA encourages members to request an audit of a recent processing statement to identify the savings they would enjoy.

Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCode-Search.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

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AOPA HEADLINES

Special Thanks to the 2012 O&P PAC Contributors AOPA would like to thank the following individuals for their contributions in 2012 to the O&P PAC:

President’s Circle  ($1,000-$5,000) Michael Allen, CPO, FAAOP  Robert Arbogast Kel Bergmann, CPO Maynard Carkhuff Ronald Cheney, CPO Thomas DiBello, CO, FAAOP Mike Fenner, CPO, BOCPO, LPO Thomas F. Fise, JD Rick Fleetwood, MPA Michael Gozola, CP Russell Hornfisher, MBA Harry Layton, CPO, LPO Jon Leimkuehler, CPO Robert Leimkuehler, CPO Mark Maguire, CPO Gary Mahler Patty Petersen Walt Racette, CPO John Roberts Jr., CPO Scott Schneider Gordon Stevens, CPO, LPO Paulette Vaughn Bernie Veldman, CO Frank Vero, CPO James Weber, MBA James Young Jr., CP, LP, FAAOP

Senator’s Table  ($500-$999) J. Martin Carlson, CPO Glenn Crumpton, CPO, C.Ped Edward DeLatorre Ed Gildehaus III, CPO, C.Ped, FAAOP Michael Hamontree, MBA Al Kritter, CPO, FAAOP Ellen Leimkuehler William Leimkuehler, CPO Marlon Moore, CO Ted Muilenburg, CP Rodney Pang, CPO Gerri Price, CFom, C.Ped Ashlie White Jeffrey Yakovich, CO

Chairman’s Table ($100-$499) Rudy Becker Sr. Robert Biaggi, CPO Jeffrey Brandt, CPO George Breece Terri Bukacheski, CP, LP Alan Burke, BOCO Erin Cammarata, RTO Ken Cornell, CP Charles Dankmeyer, CPO Don DeBolt William DeToro Jr., CPO Mark Devens, CPO Martin Diaz, BOCO, C.Ped Ted Drygas, CPO David Falk, CPO Jim Fenton, CPO Michael Hall, CPO Joe Huntsman, MBA, MA Fran Jenkins Marc Karn, CP John Kenney, CPO, FAAOP Tom Kirk, PhD Eileen Levis Pam Lupo, CO Ann Mantelmacher Lee Mantelmacher, CPO Clyde Massey, CPO

Brad Mattear, CPA Steve McNamee, CP, BOCO, FAAOP Steven Mirones, CO, C.Ped Michael Oros, CPO James Price, CPO, C.Ped Jon Ruzich, CP, LP  Mark Smith, CP Chris Snell Peter Thomas, Esq. Joan Weintrob, CPO Steven Whiteside, CO, FAAOP Jon Wilson, CPO Claudia Zacharias, MBA, CAE

1917 Club (Up to $99)  J. Laurence Allen, CPO David Bow, CPO Jim Campbell, CO, FAAOP, PhD Maureen Canter Frank Caruso, CO Melvin Cunningham Joe Davant Jason Eddy Jeff Erenstone, CPO Troy Fink John Galonek, CO Carey Glass, CPO, FAAOP Eddy Gosschalk, CPO Garrett Griffith April Groves, CO Rita Hammer David Johnson, CO Rahul Kaliki, PhD Paul Macy Salvatore Martella, CPO Kathy Mascola, BOCPO, CO, LPO Kevin Matthews, CO Sean McKale, CO Nina Miller George Newton, CPO Daryl Reuter Eric Schopmeyer, CO Anthony Squiccuarini, CPO, C.Ped Jeff Wensman, CPO (Continued) JANUARY 2013 O&P Almanac

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AOPA HEADLINES (Continued)

2012 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an O&P PAC sponsored event. Rudy Becker Sr.  Kel Bergmann, CPO Frank Bostock, CO Brightree, LLC Kendra Calhoun Jim Campbell, CO, FAAOP, PhD Luis Carbajal Maynard Carkhuff Thomas J. Costin Megan Damewood Don DeBolt Tom V. DiBello, CO, LO, FAAOP Tom Fise, Esq. Rick Fleetwood, MPA Nancy Gagne Richard and Marbee Gingras Eddy Gosschalk Catherine Graf, Esq. Paul Gudonis Darlene Hall, C.Ped Michael Hamontree, MBA Hanger PAC Russell Hornfisher, MBA Joe Huntsman, MBA, MA James Kaiser, CP, LP Marc Karn Patricia Kaviani

Steve Kelly Mark Kenney, CPO Tonya Kettering Tom Kirk, PhD Anthony Korjagin, CP Alfred E. Kritter, CPO, FAAOP Terri Kuffel, Esq. Scott Langston Jon P. Leimkuehler, CPO, FAAOP Robert V. Leimkuehler, CPO Eileen Levis Anita Liberman-Lampear, MA Pedro Llanes, CPO Ronald Longo, CP Pam Lupo, CO Alexander Lyons, CPO Catriona Macdonald Ron Manganiello Ann Mantelmacher Mollie Matthews Doug McCormack Joe McTernan Steve Mirones, CO, C.Ped Tina Moran Dominique Mungo Michael Oros, CPO, LPO Ed Peguero, BOCO

Patty Petersen Anthony Potter Proteor Walter Racette, CPO Rick Ramos, CP, LP, C.Ped John Roberts Jr., CPO Luke Rogers, CO, BOCP Rick Riley Bradley N. Ruhl Joyce Schlemmer Scott Schneider Brian Smith, BOCO Chris Snell William C. Snell, CPO Jan Stokosa, CP, FAAOP Peter Thomas Randall Valverde Frank Vero, CPO Ben Walker, LPO, BOCPO James Weber, MBA Ashlie White Daryl Williams Connie Withers James O. Young Jr., CP, LP, FAAOP Claudia Zacharias, MBA, CAE

! s k n a h Special T

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and help elect those individuals who support the O&P community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@aopanet.org.

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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.

Atlanta Prosthetics & Orthotics Inc.

Center for Orthotic & Prosthetic Care

1100 Sherwood Park Drive, Ste. 220 Atlanta, GA 30501 770/287-2395 Fax: 770/287-2398 Category: Affiliate Parent Company: Atlanta Prosthetics & Orthotics Inc., Executive Park South, Atlanta, GA

156 Main Street Binghamton, NY 13905 607/235-3066 Fax: 607/235-3068 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

Atlanta Prosthetics & Orthotics Inc.

21 Railroad Avenue, Ste. 2-5 Cooperstown, NY 13326 607/547-4066 Fax: 607/547-5011 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

869 Walnut Street Macon, GA 31201 478/238-6464 Fax: 478/254-2019 Category: Affiliate Parent Company: Atlanta Prosthetics & Orthotics Inc., Executive Park South, Atlanta, GA

Bledsoe Brace Systems

Membership in AOPA is one you can make in the future of your company.

Central Ohio Orthotic & Prosthetic Center Inc.

2601 Pinewood Drive Grand Prairie, TX 75051 972/647-0884 Fax: 972/660-0946 Category: Supplier Affiliate Parent Company: Hope Orthopedic, Arlington, TX

248 Badenton Avenue Dublin, OH 43017 614/231-4256 Fax: 614/231-0127 Category: Affiliate Parent Company: Central Ohio Orthotic & Prosthetic Center Inc., Columbus, OH

Center for Orthotic & Prosthetic Care

Cranial Technologies Inc.

1141 Broadway, Ste. 6 Elmira, NY 14904 607/215-0847 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

11620 Wilshire Blvd., Ste. 200 Los Angeles, CA 90025 310/231-3406 Fax: 310/231-3529 Category: Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ

Center for Orthotic & Prosthetic Care 4702 Creekstone Drive Durham, NC 27703 919/797-1230 Fax: 919/797-1240 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

Center for Orthotic & Prosthetic Care

of the best investments that

Center for Orthotic & Prosthetic Care

166 Springbrook Avenue, Ste. 203 Clayton, NC 27520 919/585-4173 Fax: 919/879-8248 Category: Affiliate Parent Company: Center for Orthotic & Prosthetic Care, Louisville, KY

CyberKinetics LLC 9435 Provost Road NW, Ste. 202 Silverdale, WA 98383 360/692-2500 Fax: 360/962-1322 Category: Supplier Affiliate Parent Company: Cybertech Medical, La Verne, CA

Dafonte Medical Services LLC 1101 Hwy. 6 S. Houston, TX 77077 281/498-3566 Fax: 281/498-5388 Category: Patient-Care Facility Brandee Wiseman (Continued) JANUARY 2013 O&P Almanac

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AOPA Applications (Continued)

Frank Javier Lopez/dba Next Step Orthotics & Prosthetics 11731 Sterling Avenue, Ste. H Riverside, CA 92503 951/352-9203 Fax: 951/352-9205 Category: Patient-Care Facility Sandra Lopez

Independence ProstheticsOrthotics Inc. 1500 S. Columbus Blvd., 2nd Floor Philadelphia, PA 19147 215/271-9476 Category: Affiliate Parent Company: Independence Prosthetics-Orthotics Inc., Newark, DE

KMC Pedorthics Inc. 86-20 Jamaica Avenue Woodhaven, NY 11421 718/441-5621 Fax: 718/441-5622 Category: Patient-Care Facility Kim Castelli, C.Ped, CFo, CMO

www.savewithups.com/aopa

3333 N. Calvert Street, Ste. 400 Baltimore, MD 21218 410/554-4411 Category: Affiliate Parent Company: Nascott Rehabilitation Services Inc., Elkridge, MD

2915 Dave Ward Drive, Ste. 11 Conway, AR 72034 501/664-2624 Category: Affiliate Parent Company: Snell Prosthetic & Orthotic Laboratory, Little Rock, AR

Nascott Rehabilitation Services Inc.

Tindal Orthotics & Prosthetics

5445 Loch Raven Blvd., Ste. 107 Baltimore, MD 21239 413/444-3280 Category: Affiliate Parent Company: Nascott Rehabilitation Services Inc., Elkridge, MD

3244 Kimball Avenue Manhatten, KS 66503 785/537-8897 Fax: 785/537-8893 Category: Patient-Care Facility Lisa Tindal

Orthocare America, Inc.

Tropical Brace and Limb, LLC

199 S. Chillicother Road, Ste. 100 Aurora, OH 44202 330/562-2455 Fax: 330/562-2514 Category: Patient-Care Facility Natalie Prasky

2909 N. Orange Avenue, Ste. 111 Orlando, FL 32804 407/897-2112 Fax: 407/897-2133 Category: Patient-Care Facility Christina Stewart a

2425 W. 28th Avenue Pine Bluff, AR 71603 870/534-1900 Fax: 870/534-3187 Category: Affiliate Parent Company: Snell Prosthetic & Orthotic Laboratory, Little Rock, AR

17530 Dugdale Drive South Bend, IL 46635 574/233-3352 Category: Affiliate Parent Company: Midwest Orthotic Services, South Bend, IN

O&P Almanac JANUARY 2013

Snell Prosthetic & Orthotic Laboratory

Snell Prosthetic & Orthotic Laboratory

Midwest Technology

38

Nascott Rehabilitation Services Inc.

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All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy!


Marketplace

Modular Dynamic AFO from PEL Supply The Modular Dynamic AFO is an extension device that adds all of the features and benefits of the Centri Dynamic Walk, from Fillauer LLC, to any knee orthosis. Available from PEL Supply, the Modular Dynamic AFO prevents distal migration of the knee orthosis while also providing some “toe pick up” to allow for better ground clearance. The PEEK Rods of the Modular Dynamic AFO allow for virtually unlimited active motion at the ankle joint, thereby providing excellent terrain accommodation. Product features include: • Thermoformable foot plate • Adjustable height • PEEK Rod available in straight or dorsi-assist • Easily attaches to the knee orthosis • Prevents distal migration of the orthosis. For more information on this and all products from the Fillauer LLC companies, contact PEL Supply at 800/3211264, fax 800/222-6176, email customerservice@pelsupply.com, or order online at www.pelsuppy.com.

Prepreg from Ottobock Give your patients the most advanced KAFO technology combined with the most advanced fabrication! Ottobock’s line of KAFOs is now available in prepreg, creating KAFOs up to 40 percent lighter than laminated alternatives. Prepreg also creates more consistent fabrication outcomes that avoid unwanted buildups. Ottobock Fabrication Services offers decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want. Visit www.ottobockus.com or call 800/795-8846.

The NEW Triton Low Profile (LP) Foot from Ottobock We’ve added a new low-profile carbon fiber foot to the popular Triton family! Now patients with lower clearance (2.5 in) can take advantage of the same smooth rollover and robust function as the original Triton. The multiaxial Triton LP provides excellent dynamics and flexibility for above- or below-knee individuals. A titanium adapter makes the foot waterproof and especially robust (maximum weight 330 lbs, up to K4). With a split toe design for safety, stability, and control, the Triton LP is ideal for all your active patients. Contact your sales representative at 800/328-4058.

Total Knee® by Össur®. Totally versatile. With K2, K3, and K4 models to choose from, Total Knee enables a broad range of amputees to walk with a smooth, more natural, energy-efficient gait, enhancing their confidence and stability. Key features include geometric locking for stability, plus mid-swing shortening designed to prevent hip-hiking and reduce the chances of tripping. Each model fits a wide range of amputees and is lightweight and easy to cosmetically finish. To learn more about Total Knee by Össur, call 800/2336263 or visit www.ossur.com today.

JANUARY 2013 O&P Almanac

39


Marketplace

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 www.kiss-suspension. com or call 410/663-KISS for more information.

Wrist Rotator From Motion Control, A Fillauer Company • New MC Wrist Rotator • Two new versions–– both mount in forearm • Standard: use with ProControl 2; Utah Arm 3 and 3+; Utah Hybrid Arm • ProWrist: use with microprocessor-controlled TDs • 2x speed and torque of previous versions • In-hand version also available––built into MC Hand or ETD. For more information, call 888/696-2767, email info@ UtahArm.com, or visit www.UtahArm.com. a

40

O&P Almanac JANUARY 2013


JOBS

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

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

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

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140

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

42

O&P Almanac JANUARY 2013

Inter-Mountain CPO/LPO Beaumont, Texas Great opportunities await you in Texas. A Houston-based established practice is looking for a practitioner to run an affiliate office in Beaumont with an opportunity of ownership. If you like small communities with fabulous outdoor activities and a relaxed environment to operate out of, then this is your place. The ideal candidate is an energetic, self-starting, motivated practitioner who processes excellent patient care and communication skills to conduct comprehensive patient evaluations to deliver the best in O&P services and follow-up patient care. If you have a great personality who can conduct in-services and marketing whilst practicing your craft then this is your amazing opportunity. We offer a competitive salary and benefits including health-care coverage, continuing education, paid vacation, and more. Send resume to:

Email: LegFixr@aol.com

Pacific CO/CPO Central Valley, California Competitive Western United States O&P business seeking a certified orthotist or certified prothetist/orthotist in the Central Valley of California (Fresno area). We are seeking a seasoned practitioner with experience in practice management, clinical expertise in outpatient and inpatient settings, and a willingness to work within a dynamic team. Unlimited business opportunities available in an expanding local market. Competitive salary, benefits, and bonus plan. Interested parties should email inquiries/resume to:

Email: jwiley@pacmedical.com Fax: 888/853-0002

www.AOPAnet.org YOUR resource for the O&P Community


JOBS

Southeast

North Central

CO/CPO, C.Ped

CO

Easley, South Carolina Immediate openings for two practitioners in a rapidlygrowing, multilocation practice. We need practitioners who are self-motivated with strong clinical skills—five years’ experience preferred. Must share our passion for providing exceptional patient care. We are centrally located in upstate South Carolina, offering convenient access to mountains, lakes, and coastal regions. Very competitive salary and benefits package offered. Come join our team and make a real difference in the prosthetic/orthotic community! Submit resumes by fax to:

Novi, Michigan Wolverine Orthotics Inc. is seeking a motivated certified orthotist to work in a smaller but busy facility. See patients in our office, hospitals, schools, therapy clinics, etc. Applicant must be willing to learn and manage time. Excellent benefit package with health care and retirement, not bound to pay scale. Performance-based incentive program for marketing and building practice. Pediatric to geriatric patient population. Novi, Michigan, is a metropolitan city. Send resumes to:

864/855-9331 Email: scot@advancedpro.biz

Email: ebastianco@aol.com

& Prosthetic

Association

(AOPA)

DISCOVER more AOPA advertising opportunities.

2013

American Orthotic

mediakit Rates effective

Promoting

O&P Since

Jan. 1, 2013

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

1917

et.org

www.AOPAn

“ Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Tina Mann Tina Mann

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 us.

Clinic Manager

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all are part of Hanger Clinic career offerings. • 1,000,000+ patients treated annually • 270,000+ orthotic and prosthetic products • 4,500+ employees 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.

View our current positions and apply online at: www.hanger.com/careers or scan the QR code.

150 YEARS

700 CLINICS

Available Positions:

Clinic Manager Annapolis, MD Bartlesville, OK Burnsville, MN Tacoma, WA

Waterville, ME Longview, WA Seattle, WA

Jackson, MS Lancaster, PA Philadelphia, PA Glendale, AZ Springfield, IL Camp Hill, PA Roswell, NM Beaufort, SC Columbia, MO

Mesa, AZ Methuen, MA Parker, CO Urbana, IL Fairfield, OH Hammond, IN Cary, NC Aurora, IL Folsom, CA

Orthotist

Prosthetist / Orthotist Longview, WA Buffalo, NY Mayfield Heights, OH Wilkes Barre, PA San Antonio, TX Portland, OR Amherst, NY Johnson City, NY Grand Junction, CO

Springfield, IL Holland, MI New London, CT Novato, CA Oklahoma City, OK Kissimmee, FL San Antonio, TX Jacksonville, FL Pensacola, FL Tallahassee, FL

Waterbury, CT Brunswick, GA

Easton, MA

Morgantown, WV Prosthetist

1 VISION

JANUARY 2013 O&P Almanac

43


JOBS

Eastern Michigan University

Eastern Michigan University

Tenure-Track Assistant Professor

Tenure-Track Assistant Professor Posting # FA1305E - Prosthetics

Posting # FA1304E - Orthotics

Candidates should have theshould following required qualifications: Candidates have the following required qualifications: Candidates should have the following required qualifications: • Master’s Degree in Orthotics Prosthetics or in a • Master’s Degree in Orthotics and Prosthetics or in a • Master’s Degree in Orthotics and Prosthetics or in a and related field • Master’s Degree in Orthotics related field related field and Prosthetics or in a related field • Minimum of 2 years O&P Clinical experience post certification, five years post certification • Minimum • of 2Minimum years O&PofClinical post certification, post certification experience is• preferred Minimum of 2 years O&P Clinical experience post certifi2 yearsexperience O&P Clinical experiencefive postyears certifiexperience is preferred five years post certification experience is preferred cation, five years post certification experience is preferred • Certification by cation, the American Board for Certification (ABC) in Prosthetics • Certification the Americanby Board for Certification (ABC) in Orthotics (ABC) • Certification • by Certification the American Board for Certification • Active membership in AAOP by the American Board for Certification (ABC) in Prosthetics in Orthotics • Active membership in AAOP • Two years teaching experience • Active membership in AAOP Activeexperience membership in AAOP • Two years• teaching Responsibilities of Faculty Appointee: • Two years teaching experience • Two years teaching experience Responsibilities of Faculty Appointee:

Candidates should have the following required qualifications:

• Teach graduate-level courses in Upper Extremity and Lower Extremity Prosthetics • Teach graduate-level courses in andAppointee: Lower Extremity, and Spinal Orthotics Responsibilities of Faculty Responsibilities ofUpper Faculty • Provide primary and secondary supervision of Appointee: prosthetic technical assignments

Teach graduate-level courses in Upper Lower • Teach graduate-level courses in Upper and Lower Extremity, • Provide primary and secondary supervision of orthotic technical assignments • Continually • review curriculum to ensure content reflects currentExtremity practice andand technology Extremity Prosthetics and Spinal Orthotics • Continually review curriculum to ensure content reflects current practice and technology • Advise graduate students

• Provide primary and secondary supervision of prosthetic • Provide primary and secondary supervision of orthotic • Oversee student research projects and independent study projects technical assignments technical assignments • Serve on academic and professional committees • Oversee student research projects andcurriculum independent study projects • Continually review curriculum to ensure content reflects • Continually review to ensure content reflects • Actively participate in professional service • Serve on academic andpractice professional current practice community and technology current andcommittees technology • Demonstrate• a commitment to teaching excellence Advise graduate students • Advise • Actively participate in graduate professionalstudents community service • Maintain an • ongoing agenda for research including grants and and publications Oversee student research projects independent • aOversee student research projects and independent • Demonstrate commitment to teaching excellence study projects study projects • Maintain an ongoing agenda for research including grants and publications A competitive salary will be based on qualifications and experience. Starting date is no later than August 28, must professional be made online at https://www.emujobs.com. • 2013. ServeAll onapplications academic and committees • Serve on academic and professional committees A competitive salary will be based on qualifications and experience. Starting Applicants date is no later should submit a letter of interest, a detailed curriculum vitae, and academic • least Actively in professional service Actively participate in must professional service transcripts. At than August• 28, 2013. All applications be made community online at https://www.emujobs.com. three participate letters of reference should becommunity mailed directly to the Search • Demonstrate a commitment teaching excellence Demonstrate a commitment excellence vitae,Committee Chair, Mr. Frank Fedel, 318F Porter to Building, Ypsilanti, MI 48197. Review of Applicants • should submit a letter of interest,toa teaching detailed curriculum and academic applicants will• begin on November 15, 2012agenda and continue until the including position is filled. For more transcripts.• AtMaintain least three of reference should be mailed directly to the Search Maintain an ongoing for research grants anletters ongoing agenda for research including grants information contact Committee Chair, Mr. Frank Fedel, 318F Porter Building, Ypsilanti, MI 48197. Review of Mr. Frank Fedel, Search Committee Chair at ffedel@emich.edu. applicants will and beginpublications on November 15, 2012 and continue until the position is filled. For more and publications • Advise graduate students

Eastern Michigan University, a public, comprehensive university, enrolls nearly 24,000 students information contact Mr. Frank Fedel, Search Committee Chair at ffedel@emich.edu. who are served by over 2,000 faculty and staff, both on campus, off campus, and electronically. A competitive salary will be based on qualifications A competitive will be based on qualifications and students in culturally and environmentally diverse southeastern Michigan,and characterized by Eastern Michigan University, asalary public, comprehensive university, enrolls nearlyLocated 24,000 metropolitan growth and economic thethan University is an experience. Startingtransformation, date is no later August 28,environment 2013. All rich in experience. Starting is noboth later August 28, 2013. All who are served by over 2,000 facultydate and staff, onthan campus, off campus, and electronically. academic, research, resources. The School of Health Promotion Located in applications culturally andmust environmentally diverseatsoutheastern Michigan, characterized by technological applications mustand be recreational made online at https://www.emujobs.com. be made online https://www.emujobs.com. and Human Performance offers undergraduate programs in Athletic Training, Health Education, metropolitan growth and economic transformation, the University is ancurriculum environment rich in Applicants should submit a letter of interest, a detailed Applicants should submit a letter of interest, a detailed Physical Education, Sport Management, and Exercise Science. At the graduate level the School academic, research, technological and recreational resources. The School of Health Promotion offers degrees in Healthvitae, Education, Physical transcripts. Education, Exercise Physiology, curriculum and academic At least three letters Sport vitae, and academic transcripts. At least three letters of reference and Human Performance offers undergraduate programs in Athletic Training, Health Education, Management, Orthotics and should Prosthetics Physician Assistant Studies. of reference be and mailed directly to the Search Committee should be mailed directlyand toExercise the Search Committee Chair, Mr. Physical Education, Sport Management, Science. At the graduate level the School EMU is an equal opportunity employer, and Building, the institution is regularly Chair, Mr. Frank Fedel, 318F Porter Ypsilanti, MI FrankinFedel, Porter Building, Ypsilanti, Exercise MI 48197. Review Sport offers degrees Health318F Education, Physical Education, Physiology, recognized News & World Reporton forNovember its diversity.15, 2012 and Management, Orthotics andwill Prosthetics andNovember Physician Assistant 48197. Review by ofU.S. applicants will begin of applicants begin on 15, 2012Studies. and continue until

the position is filled. For more information Mr.isFrank Fedel, EMU is an equal opportunity employer, and thecontact institution regularly by U.S. News & World Report for its diversity. Searchrecognized Committee Chair at ffedel@emich.edu.

continue until the position is filled. For more information contact Mr. Frank Fedel, Search Committee Chair at ffedel@emich.edu.

O&P Almanac

Eastern a public, comprehensive university, Eastern Michigan University, a public, comprehensive university, Size: 1/2 Page VMichigan (4.5” x University, 7”) enrolls nearly 24,000 students who are served by over 2,000 enrolls nearly 24,000 students who are served by over 2,000 O&P Almanac Issue: Janfaculty and staff, both on campus, off campus, and electronically. faculty and staff, both on campus, off campus, and electronically. Size: 1/2Located Page V (4.5” x 7”) Deadline:Located 11/15 in culturally and environmentally diverse southeastern in culturally and environmentally diverse southeastern Michigan, characterized by metropolitan growth and economic Michigan, characterized by metropolitan growth and economic Issue: Jan Cost: $1,310.00 transformation, the University is an environment rich in transformation, the University is an environment rich inacaDeadline: 11/15 academic, research, technological and recreational resources. demic, research, technological and recreational resources. The Cost: $1,310.00 The School of Health Promotion and Human Performance offers School of Health Promotion and Human Performance offers undergraduate programs in Athletic Training, Health Education, undergraduate programs in Athletic Training, Health Education, Physical Education, Sport Management, and Exercise Science. At Physical Education, Sport Management, and Exercise Science. At the graduate level the School offers degrees in Health Education, the graduate level the School offers degrees in Health Education, Physical Education, Exercise Physiology, Sport Management, Physical Education, Exercise Physiology, Sport Management, Orthotics and Prosthetics and Physician Assistant Studies. Orthotics and Prosthetics and Physician Assistant Studies. EMU is an equal opportunity employer, and the institution is regularly recognized by U.S. News & World Report for its diversity.

44

O&P Almanac JANUARY 2013

EMU is an equal opportunity employer, and the institution is regularly recognized by U.S. News & World Report for its diversity.


CALENDAR

2013 ■ January 9 AOPAversity Audio Conference–Secrets to a Successful Audit. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.

■ January 14-19 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 Nov. 1, 2012. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification.

■■

■ JANUARY 27 Raleigh, NC. Study gait analysis and evidence-based treatments with orthotic fabrication and taping–– while supporting a good cause. Register at www. footcentriconline.com/ for eight credits. ■ JANUARY 29-31 WillowWood: OMEGA® Training. Mt. Sterling, OH. Course covers basic and advanced software tool use and shape capture with OMEGA Scanner. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: TBD. Visit www.willowwoodco.com.

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. 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 www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org.

■ February 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email info@abcop.org, visit www. abcop.org/certification. ■ February 13 AOPAversity Audio Conference–Understanding the LSO/TLSO Medicare Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.

■ February 20 WillowWood 2013 Academy Technical Workshop. Orlando. Caribe Royale Orlando. 1 PM. Fitting and Operating the New LimbLogic System: Learn about new system features which build upon field-proven technology, making the LimbLogic more vigorous and easier to use. Includes new socket design techniques that can decrease fabrication time while increasing system’s longevity. Visit www.willowwoodco.com. ■ February 20-23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org. ■ February 28 WillowWood: LimbLogic® for Practitioners. Mt. Sterling, OH. Course focuses on 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: TBD. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco. com.

■ March 1 ABC: Application Deadline for Certification Exams. Applications must be received by March 1, 2013, for individuals seeking to take the May 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification. ■ MARCH 1 WillowWood: LimbLogic® for Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Includes basic operation and hands-on fabrication of LimbLogic adapters. Work with patient models and fabricate a LimbLogic socket. Credits: TBD. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco.com. ■ MARCH 1-2 Oklahoma Association for O&P Annual Meeting. Tulsa, OK. Marriott Southern Hills. For more information, visit www.okaop.org or contact Jane Edwards at 888/388-5243 or email jledwards88@att.net.

MARCH 4-5 AOPA: Essential Coding & Billing Seminar. Atlanta. DoubleTree by Hilton Hotel, Atlanta Airport. To register, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.

■ March 9-10 ABC: Orthotic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/ certification.

JANUARY 2013 O&P Almanac

45


CALENDAR

■ March 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 was Jan. 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www. abcop.org/certification.

MARCH 13 AOPAversity Audio Conference–Contracting With the VA: Hints for Landing the Contract. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org. ■

■ MARCH 15-16 PrimeFare West Regional Scientific Symposium 2013. New Location: Denver. Denver Marriott City Center. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

■ MARCH 21-23 2013 Annual Meeting of the International AfricanAmerican Prosthetic Orthotic Coalition. Atlanta. Georgia Tech Hotel and Conference Center. Contact Tony Thaxton Jr. at 404/8750066 or email thaxton.jr@ comcast.net. Visit www.iaapoc. org for more information.

April 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification. ■

APRIL 4-6 Rehabilitation Institute of Chicago: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.25 ABC Credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education. ■

APRIL 10 AOPAversity Audio Conference–Handling Adversity: Coping with Difficult Patients. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■

■ March 15-16 ABC: Prosthetic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

March 18 WillowWood: Alpha DESIGN® Liners. Mt. Sterling, OH. Half-day course teaches how to use OMEGA software files to create custom liners. Attendees can practice with all aspects of the software, including file import, liner creation, liner fabrication and Design liner options. Credits: TBD. Visit www.willowwoodco.com. ■

46

O&P Almanac JANUARY 2013

the July 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or July/August CPM exams for orthotists and prosthetists. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/ certification.

■ APRIL 13-15 National Pedorthic Services, Milwaukee WI. Handson Custom Foot Orthosis Fabrication Course. Credits: 18.25 ABC. Contact Nora Holborow at 414/438-6662, email nholborow@npsfoot.com, or visit www.npsfoot.com. ■ May 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by May 1, 2013 for individuals seeking to take

■ MAY 8 AOPAversity Audio Conference–Navigate the Maze: Get to Know the Appeals Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.

May 13-18 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 March 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■

■ MAY 16 -18 PA Chapter AAOP Spring Conference. Sheraton Station Square Hotel. Pittsburgh. Contact Beth Cornelius at 814/455-5383 or Joseph Carter Jr. at 814/4555383. ■ June 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

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

■ 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 scuster@AOPAnet.org.

■ 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 scuster@AOPAnet.org.

■ 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@ AOPAnet.org.

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


CALENDAR

■ 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@ AOPAnet.org.

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

2014

2015

2016

■ FEBRUARY 26 - MARCH 1 40th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■ FEBRUARY 18-21 41st Academy Annual Meeting & Scientific Symposium. New Orleans. Hyatt Regency New Orleans. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■ MARCH 9-12 42nd Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■ 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@ AOPAnet.org.

■ 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 info@ AOPAnet.org.

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

■ 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@ AOPAnet.org.

AD INDEX Company

Page

Phone

Website

ALPS

C4

(800) 574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics

13

(703) 836-7114

www.abcop.org

DAW Industries

41

(800) 252-2828

www.daw-usa.com

Dr. Comfort

5, C3

(800) 556-5572

www.drcomfortdpm.com

Ferrier Coupler Inc.

40

(800) 437-8597

www.ferrier.coupler.com

Hersco Ortho Labs

1

(800) 301-8275

www.hersco.com

KISS Technologies LLC

9

(410) 663-5477

www.kiss-suspension.com

Motion Control

23

(888) 696-2767

www.utaharm.com

Orthotic and Prosthetic Study and Review Guide

21

ww.oandpstudyguide.com

Össur® Americas Inc.

7

(800) 233-6263

www.ossur.com

Otto Bock HealthCare

C2

(800) 328-4058

www.ottobockus.com

PEL Supply

2

(800) 321-1264

www.pelsupply.com JANUARY 2013 O&P Almanac

47


AOPA Answers

New Year, New L Code Answers to your questions regarding 2013 coding changes

AOPA

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

Q. A.

Were there any changes to the 2013 codes?

Q. A.

What were the changes to the 2013 HCPCS codes?

Yes, the Centers for Medicare and Medicaid Services (CMS) has released the new Healthcare Common Procedure Coding System (HCPCS) codes. There were a few minor changes for 2013, which will be effective for all claims with a date of service on or after Jan. 1, 2013.

One new code was introduced, and four codes had their official descriptors changed. No codes were deleted. The new code is L5859, and it is an addition code to a lower-extremity prosthesis. The full descriptor for L5859 reads: Addition to lowerextremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/ extension assist control, includes any type motor(s). The L8000, L8001, and L8002 code descriptors were changed to reflect a revision that was made in the External Breast Prosthesis Policy in June of 2012. The revision in the policy provided updated

48

O&P Almanac JANUARY 2013

coding guidelines and stated that L8000 describes a bra, without an integrated breast prosthesis, which has pockets designed to hold mastectomy form/breast prosthesis adjacent to the chest wall, and codes L8001 and L8002 describe mastectomy bras with integrated breast prosthesis. The L8000, L8001, and L8002 codes also include the following characteristics: may be constructed of any material including but not limited to cotton and polyester, may include any type of closure and the closure may be located anywhere on the bra, may be of any size, and may be constructed with or without integrated structural support, e.g., an underwire. So, in 2013, these three codes now include the phrase “any size, any type,” to reflect the change in policy. The last code descriptor change was for the code L5972. The new code descriptor eliminated any reference to a particular brand or model. The new descriptor reads: All lower-extremity prostheses, foot, flexible keel. The full list of HCPCS code changes is available on the CMS website at https://www.cms. gov/Medicare/Coding/HCPCSReleaseCodeSets/AlphaNumeric-HCPCS.html.

Q. A.

Did the Medicare Part B deductible change for 2013?

Yes. The Medicare Part B deductible for 2013 has increased from $140 to $147, and the Medicare Part B coinsurance remains at 20 percent of the Medicare allowed charge. Medicare beneficiaries are required to pay their annual Part B deductible before Medicare will make any claim payments. This is important to keep in mind at the beginning of the year, when a beneficiary may have not met his or her $147 deductible. a


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January 2013 Almanac