Clinical staff retention will be crucial in 2023. Experts advise taking an empathetic look at your company’s culture and offerings to find common ground with employees.
FABRICATED WITH ACCURACY & PRECISION
At Hersco, we pride ourselves on being on the leading edge of technology. We have mastered the art of accepting scans and 3D printing to bring you precise orthotics every time. Our team works to deliver custom orthotics tailored to each individual’s needs and specifications. We also keep an exact digital record of each patient’s foot orthotics for ease of reproduction.
IfBy CHRISTINE UMBRELL
AGAINST THE ODDS
New for 2023, O&P Almanac debuts the Transformations column. Each month, we will interview an O&P clinician and share a truly unique or challenging patient-care experience. We begin this month with Mike Muratore, CPO, who assisted quarterback Alex Smith in his return to the NFL after a devastating injury.
Bringing AOPA’s Vision and Mission to Life in 2023
A world where orthotic and prosthetic care transforms lives. This, AOPA’s vision, guides our mission—a mission that revolves around core elements of advocacy, research, education, and equality in our profession. The AOPA Board of Directors is committed to working hard to continue on this path into 2023. As I assume the role of president, I’d like to take a moment to tell you a little bit about myself and how these tenets resonate with me.
I am an attorney, a 20-year O&P business owner, and the proud wife of one of the hardest working CPOs in our profession, Charles Kuffel, MSM, CPO, LPO, FAAOP. Together, we founded our small business, Arise Orthotics & Prosthetics, in Minnesota. Our four amazing children provide the basis of support for our personal and professional worlds. Literally, VZNG appear as the four roots of the tree in our Arise logo. I cherish time spent with family, simple joys, and feeling connected to those around me.
I am an instructor for our O&P graduate students at Concordia St. Paul University, and I am an active advocate for those in need of O&P care. I have spent much of the past 20 years bringing my two worlds together—using my legal background to educate others and engaging in nonprofit legislative advocacy work at the state and federal levels with AOPA, Minnesota’s Society of O&P, and Wiggle Your Toes, an amputee nonprofit organization.
As the fourth female in more than 100 years to take the gavel at AOPA, I am motivated by the opportunity to serve all of our members. I plan to build on the accomplishments of the board and staff, to continue to dig into our strategic plan, and to execute the priorities that have been set. A big part of doing this successfully is making new connections as well as maintaining traditional ones. We will continue to foster relationships with government agencies and contractors—specifically, CMS; the durable medical equipment Medicare administrative contractors; the Pricing, Data Analysis, and Coding contractor; and state Medicaid agencies. We will develop and strengthen relationships with private payors to increase advocacy in the private sector, to show the value of O&P care, and to ensure that AOPA members become trusted partners of payors. We will continue to support and build on the research work we have begun with the American Academy of Orthotists and Prosthetists in the creation of The Foundation. And we will continue to strengthen relationships with all our industry partner organizations; patient advocacy groups like the Amputee Coalition; and allied health partners, including physical therapists and occupational therapists.
Along with AOPA’s state representatives and volunteers, I will continue our work at the state level. With great momentum from several notable accomplishments in 2022, we know a lot more progress can be made within each of our own state boundaries. I have worked on legislative advocacy issues firsthand in Minnesota and will use my experience there to help move the needle forward in other states.
As a small O&P business owner, I also am committed to making improvements for other small O&P business owners. I know AOPA can do more. To this end, I have an open-door policy and ask that you please communicate with me directly so that I can learn more about how we can better serve you in the future. With our strategic priorities and our connections, we can strive to do all of this and more for all our members.
Thank you for honoring me with the opportunity to serve as your president. I am grateful. I am humbled. And I very much look forward to the simple joys that will come from connecting and working together in 2023.
Very truly yours,
Teri Kuffel, JD
Teri Kuffel, JD, is president of AOPA.
Board of Directors
President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN
Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX
Jeffrey M. Brandt, CPO Brandt Consulting, Exton, PA
Immediate Past President Dave McGill Össur Americas, Foothill Ranch, CA
Rick Riley Bakersfield, CA
Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA
Arlene Gillis, MEd, CP, LPO
International Institute of Orthotics and Prosthetics, Tampa, FL
Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX
Kimberly Hanson, CPRH Ottobock, Austin, TX
John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY
Hanger Clinic, Oakbrook Terrace, IL
Lesleigh Sisson, CFo, CFm
Prosthetic Center of Excellence, Las Vegas, NV
Fillauer Companies, Chattanooga, TN
Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)
Research Chair Hanger Clinic, Houston Medical Center, Houston, TX
A world where orthotic and prosthetic care transforms lives.
AOPA staff and volunteers are committed to our mission of being a trusted partner, advocating for and serving the orthotic and prosthetic community by:
• Fostering relationships with decision makers to ensure equitable access.
• Providing education that promotes professional excellence.
• Supporting research that informs innovative care.
• Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.
A world where orthotic and prosthetic care transforms lives.
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
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HEALTH POLICY AND ADVOCACY
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O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/ December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571-431-0876, fax 571-431-0899, or email firstname.lastname@example.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.
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Copyright © 2023 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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VR Training Aids in Prosthetic Rehab
Virtual reality (VR) may be leveraged to improve motor function outcomes and assist in clinical decision making among individuals with amputation, according to a team of U.S. and Chinese researchers. The researchers, led by Jie Hao, DPT, from the University of Nebraska Medical Center, examined 10 clinical studies involving VR: seven lower-extremity amputation and three upper-extremity amputation studies.
“Results reveal the positive effects of VR on improving motor function in prosthesis training, including balance, gait, and upper-extremity outcomes,” the authors reported. Participants also reported enjoying the VR interventions.
The authors noted that more properly designed randomized controlled trials with larger sample sizes are needed to determine whether VR induces better therapeutic outcomes than conventional rehabilitation. The study was published in November in the American Journal of Physical Medicine & Rehabilitation
Limb Loss Patients Report Low-Back Pain
Researchers from the University of Genoa in Italy conducted a cross-sectional study based on an online questionnaire to investigate the prevalence and intensity of low-back pain among individuals with lower-limb amputation. The questionnaire, completed by 239 participants, included questions regarding demographic information, comorbid conditions, amputation history, low-back pain history, and acceptance of amputation.
Results indicated a prevalence of low-back pain among 82% of participants, with 70% reporting pain in the past year. “This study shows that the prevalence of low-back pain in lower-limb amputees appears to be higher than in the general population, with similar levels of pain and frequency,” reported the authors. “The highest percentage of people with a sedentary lifestyle not practicing any kind of sports emphasizes the importance of educating this patient population on the importance of physical activity.” The study was published in November in Spine.
Researchers Study CostEffectiveness of Implants
Researchers conducted an initial cost-effectiveness analysis of above-knee limb loss patients in the United States using the OPRATM Implant System and concluded that for active individuals with transfemoral amputation, the implant is a cost-effective alternative to a socket prosthesis when evaluated with a disease-specific health instrument. The research team presented its findings in November via poster presentation at the annual meeting of the American Congress of Rehabilitation Medicine.
Jeff Voight, MBA, MPH, lead author of the study, participated in conducting Markov health state transition models as well as probabilistic sensitivity analyses to perform the cost-effectiveness analyses in an array of health states that could arise over a typical 42-year life span, wearing a socket prosthesis or having an implant. The researchers found values of $228/QALY (Quality Adjusted Life Years) for treatment refractory (for those patients who had problems with a socket prosthesis and then switched to an implant) and $84/QALY for those patients who have not had a socket prosthesis. Researchers are developing a more comprehensive manuscript on this study.
The number of individuals who signed up for new health insurance coverage via the Affordable Care Act on healthcare.gov increased by 40% in 2022 compared to 2021. Total plan selections, including those continuing from previous plans, increased 17% over the previous year.SOURCE: HHS.GOV
Athletes Prepare for 2024 Paralympics
More than 4,400 athletes from 184 nations are expected to compete at the 2024 Summer Paralympic Games, slated for Aug. 28 through Sept. 8, 2024, in Paris, France. Competitors will take part in 22 sports at 549 events, with more than 3 million spectators watching the competition.
The Paris 2024 Committee recently unveiled the mascots for the event: the Paralympic Phryge and the Olympic Phryge, who will be the primary ambassadors of the Games. A Phyrgian cap is a symbol of liberty and is present at the heart of major historical events in France. “The Olympic Phryge and the Paralympic Phryge are the leaders of a tribe who always have their trainers on. The Paris 2024 mascots aim to lead a revolution through sport,” noted the Paris 2024 Committee.
The Paralympic Phryge wears a running blade. “By choosing to have a mascot with a visible disability, Paris 2024 aims to give maximum representation to people who are living with disabilities and to promote the inclusivity of the Paralympic Games and of sport as a whole,” noted the committee.
As in past years, Ottobock is expected to be present with a technical repair service in the Paralympic Village and in several competition venues.
COVID-19 Increases Diabetes Risk
Several recent studies have found evidence of an increased risk of diabetes among individuals who had contracted COVID-19, according to an article published in The Lancet Diabetes & Endocrinology in December.
In one study, a CDC analysis of a large electronic healthcare database of 353,000 adults who had had COVID-19 and 1.6 million controls with no evidence of infection suggested that people with COVID-19 had an increased risk of new onset Type 1 diabetes and Type 2 diabetes.
In a German investigation, a cohort study of 36,000 people with COVID-19 indicated higher risk of newly diagnosed Type 2 diabetes than an equal number of matched controls with acute upper respiratory tract infections.
In a third study, investigators reviewed data from the U.S. Department of Veterans Affairs and discovered that people with COVID-19 had increased risk of incident diabetes and incident use of antihyperglycemic therapy in the postacute phase. The increased risk of diabetes “was evident even in people who had very low baseline risk of diabetes, according to traditional risk factors,” according to the authors.
“Before the pandemic, the global burden of diabetes was high and rising; the possible increased incidence of diabetes due to the pandemic could further compound the already staggering prepandemic burden,” noted author Ziyad Al-Aly, MD. “In turn, this could lead to substantial ramifications on health systems, healthcare costs, life expectancy, and economic indicators such as employment and labor participation.”
TYPE 1 DIABETES ON THE RISE
Between 13.5 million and 17.4 million cases of Type 1 diabetes are expected by the year 2040, according to an international team of experts—an increase of 60% to 107% over 2021 numbers, with the largest increases expected in low-income and lower-middleincome countries.
The American Academy of Orthotists and Prosthetists (AAOP) has announced its 2023 AAOP Thranhardt Lecture Series winners. During the AAOP Annual Meeting in March, Geoffrey Balkman, PhD, CPO, LPO, will speak on “Initial Construct Validity of the Orthotic Patient-Reported Outcomes—Mobility (OPRO-MTM) Item Bank for Assessing Mobility of Lower-Limb Orthosis Users.” Shane R. Wurdeman, PhD, CP, FAAOP(D), a member of the AOPA Board of Directors, will speak on “PROMIS-UE Physical Function Demonstrates Good Clinical Utility for Patients Following Upper-Limb Amputation.” The meeting is planned for March 1-4 in Nashville.
BUSINESSESR. Wurdeman, PhD, CP, FAAOP(D)
Theresa “Terri” McLeod, CMF, COF, has been named the 2022 recipient of the Jim Newberry Award for Extraordinary Service, according to the Board of Accreditation/ Certification (BOC).
McLeod’s volunteerism with BOC spans many years. Beginning in 2005, she served as a test development volunteer for BOC Certified Mastectomy Fitter exams and, in 2007, she joined the board of directors, lending her expertise to BOC’s board for nine years, where she served on the Finance & Investment and Audit committees.
The Hanger Foundation awarded its second round of 2022 Empowerment Grants, awarding a total of $120,000 to several nonprofit organizations. Grant recipients include the following local and national organizations: Adaptive Sports New England, American Amputee Soccer Association, Association of Amputee Surfers, Break the Barriers, Central Maine Adaptive Sports, CPATH, Kinetic Kids Inc., Less Leg More Heart, Lone Star Paralysis Foundation, Orthotic and Prosthetic Activities Foundation, Palms to Pines Parasports, Raleigh Youth Hockey Association—Carolina Hurricanes, Rehab and Beyond Inc., the Institute for Rehabilitation and Research, Variety—the Children’s Charity of Wisconsin, and Wisconsin Adaptive Sports Association.
In addition to the 16 community grants, Hanger Foundation has awarded an Empowerment Signature Grant to Camp No Limits. To date, the Foundation has been able to send more than 5,000 families to Camp No Limits. In addition to the financial contribution, Hanger employees volunteer their time to help staff the camps and provide encouragement and support to the campers.“Terri” McLeod, CMF, COF
As a board member, McLeod managed the prestigious Memorial Sloan-Kettering Cancer Center Evelyn H. Lauder Boutique and was well known and respected in the postmastectomy community. Through her personal contacts, representation of BOC at trade shows, and participation in BOC certificant outreach, she promoted BOC’s mastectomy fitter certification.
“Terri has shown the same kind of passion for and commitment to BOC that defined our good friend Jim Newberry,” said Claudia Zacharias, MBA, CAE, former president and CEO of BOC. “Our board is proud to award her with this honor.”
Bob Radocy, who served as executive vice president of Fillauer TRS and founder of TRS, retired from full-time employment Dec. 31. He will continue as a consultant for Fillauer, providing research and development, customer support, and public relations services.
Radocy incorporated TRS in 1979 and began manufacturing the Prehensile Hand in 1980. He developed many devices for recreational use, including the Criterium Plus, Black Iron Trainer, Downhill Racer Ski, and JAWS. He sold the company to Fillauer in 2019.
“On behalf of our entire team, I would like to thank Bob for the tremendous impact he has made at Fillauer and, most importantly, for the upper-limb loss and limb difference community,” said Traci Dralle, CFm, Fillauer president. “His passion, determination, and ingenuity have made the everyday possible and inspired dreams to become reality for over 40 years. While we will miss Bob’s daily presence in the office, we are grateful for the opportunity to continue our partnership with him in new and creative ways.”
The Orthotic and Prosthetic Group of America (OPGA) and Össur have announced the application period is now open for two grants available for individuals in O&P.
The Russell Walker, CP, LP, Emerging Leader Grant is designed to pay tribute to Russell (Rusty) Walker, a practitioner who was passionate about mentoring the next generation of O&P leaders.
In addition, OPGA and Össur Americas are co-sponsoring and co-supporting the inaugural Todd Eagen Advocacy in Action Memorial Grant. Eagen, former president of OPGA, unexpectedly passed June 4, 2022, and was an important leader in the O&P profession.
Both grants are designed to provide annual funding to a current O&P resident and certified orthotist or prosthetist (or both), respectively, that will allow them to attend and participate in two nonclinical events that are highly important to the O&P profession and the patients it serves. These events include the AOPA Policy Forum and the Challenged Athletes Foundation Triathlon Challenge. The application period closes Feb. 10. Visit OPGA’s website for details.
We have big ambitions for the word FIT.
It’s given that the AFO should fit and follow the shape of the leg and fit and adapt well to the shoe, for a comfortable wear for each individual. But fit should also mean a good dynamic function for the individual, and
that’s where the similarity between a one-size version and an Allard AFO STOPS!
We offer different models for different needs of support and stability. Our 25 years experience and development of composite AFO confirms the necessity of variety to meet and fulfill the need from patients in the best possible way, not only one way!
Responding footplate is a key
function for control, safety and comfort. Within each model we offer 4-5 different sizes (XS-XL) to match different foot sizes and heights of users. All sizes have individual composite lay-up to optimize dynamic response, especially of the important footplate. (Both build height and footplate length can also be adjusted, 1-1.5 cm).
How Type 1 identifiers can play a role in recognizing O&P professionals as allied healthcare providers
If you attend any meeting of the orthotic and prosthetic profession—whether a small local meeting, a midsized state or regional meeting, or a large national meeting—you will undoubtedly hear or participate in discussions regarding how O&P practitioners can gain recognition as the true allied healthcare providers they are.
For years, our profession has fought to be seen as more than just another supplier of medical equipment. O&P professionals often have as much as or more direct interaction with patients than other healthcare practitioners that have long been classified as allied health providers, and it is increasingly frustrating to continue to be pigeonholed into the durable medical equipment (DME)/supplier category.
One of the challenges the O&P profession faces when trying to achieve recognition as allied health practitioners is the fact that most payors only reimburse for completed prostheses or orthoses. Payment is based solely on the device and not on the time, knowledge, and expertise that contributes to the successful delivery of a well-fitting,
properly functioning orthosis or prosthesis.
This is a challenge for which there is no easy solution. Discussions on the subject have prompted several suggestions, including completely separating the professional service of the orthotist or prosthetist; creating an entirely new reimbursement system for O&P services; or developing a hybrid solution that would provide partial reimbursement for the actual orthosis or prosthesis and additional reimbursement based on the time spent by the orthotist or prosthetist providing direct patient care.
The road to recognition as true allied health professionals is long, and the challenges are many, but one action that O&P practitioners can take now to prepare for
the future is to obtain and utilize an individual National Provider Identifier (NPI).
The NPI was implemented in 2007 and 2008 as a result of the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act. It was adopted as a single and unique number to identify an individual or healthcare entity in all healthcare transactions.
The NPI eliminated the need for separate provider numbers for each insurer with which a provider has an agreement. NPIs may be obtained, at no charge, through a simple online application process established by CMS via the National Plan and Provider Numeration System, available at nppes.cms.hhs.gov
Two kinds of NPIs are available: Type 1, Individual Provider NPIs; and Type 2, Organization NPIs. Type 1 NPIs are used to identify individual physicians, practitioners, or sole proprietor-based business owners and are unique to a single person. Type 2 NPIs are used to identify healthcare entities such
One action that O&P practitioners can take now to prepare for the future is to obtain and utilize an individual NPI.
as hospitals, nursing facilities, physician group practices, and suppliers of DME, prosthetics, orthotics, and supplies (DMEPOS).
under the Type 2 NPI of the company for which they work. This task force has met several times and is in the process of creating resources to educate our respective memberships about the value of the individual NPI and how to obtain it.
IN THEIR WORDS: Reimbursement Page
Obtaining an individual NPI has no impact on the use of a Type 2, entity-based NPI number to bill claims to Medicare or other payors.
Limitations of Type 2 NPIs
The reliance on the use of Type 2 NPIs is an inherent barrier for prosthetists and orthotists to gain recognition as allied health providers. While physicians, physician assistants, nurse practitioners, and therapists all utilize their individual NPIs in addition to any Type 2 NPIs associated with their facility or practice, there has never been an established need for Type 1 NPI numbers to be reported on O&P claims.
AOPA and the American Academy of Orthotists and Prosthetists (AAOP) have established a task force to explore and promote the positive impact of orthotists and prosthetists obtaining an individual NPI and reporting it on claims submitted
PHOTO CREDIT: GETTY IMAGES
There are currently no restrictions in place that prevent an individual orthotist or prosthetist from applying for and obtaining an individual NPI. Because the individual NPI is only associated with a single practitioner, it can be used to identify the practitioner even if they change employers. Obtaining an individual NPI has no impact on the use of a Type 2, entity-based NPI number to bill claims to Medicare or other payors.
An Important Step Forward
The pathway to recognition of orthotists and prosthetists as allied health providers is long and will require significant regulatory, administrative, and strategic work. The use of the individual NPI is just one step in this process, but it is one that can be done immediately with no disruption to current reimbursement models for O&P services.
AOPA and AAOP will continue to work together to promote the adoption of the individual NPI. As additional resources are developed, we will make sure that they are readily available for our members, and that appropriate support is available as we move forward toward this common goal.
Joe McTernan is director of health policy and advocacy at AOPA. Reach him at jmcternan@AOPAnet.org
With the help of Charl Stenger, Orthomena (Spinal Technology’s partner in Dubai) the fitting I did of 2 braces remotely was excellent and showed good correction. I am so pleased with the easiness of fitting and hope this is the beginning of our business together.
LEADING THE GREAT RENEGOTIATION
The years 2021 and 2022 saw record numbers of workers resigning, with an average of 4 million Americans quitting their jobs each month—a startling 96 million employees leaving their jobs over the past two years.
These trends are particularly troubling for the O&P profession, where the need for clinicians is rising. With an aging baby boomer population and expected clinician retirements on a collision course, the
NEED TO KNOW:
f Employment trends have shifted dramatically over the past few years, with millions of Americans quitting their jobs each month, and record numbers of employees “quiet quitting” or experiencing emotional burnout.
possibility of a future O&P clinician shortage looms large. Employment for orthotists and prosthetists is projected to grow 17% from 2021 to 2031, according to the Bureau of Labor Statistics (BLS), with 1,000 job openings projected each year, on average, over the decade. “Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire,” according to BLS.
f In this tight and rapidly shifting climate, O&P businesses should take a hard look at their employee retainment practices and ensure their workplace culture meets the needs of current staff and prospective employees.
f Companies that foster community and offer flexible options—for example, self-determined hours and remote work— are more attractive to workers, so O&P facilities should consider adopting some of these perks.
f It’s also important to demonstrate empathy to young workers, to maximize new employees’ strengths when considering workflow, and to offer training and growth opportunities.
Improve workplace culture to counteract trends in resignations, employee burnout, quiet quitting, and more
In recent years, some facilities have noted more students graduating from O&P master’s programs—but exiting clinical practice within the first few years, says Mark Ford, president of Catdaddy Consulting Services.
When the profession evolved to a master’s requirement for O&P certification—necessitating a graduate degree that can cost up to $170,000, according to the International Institute of Orthotics and Prosthetics—salaries remained stagnant. (The most recent data from the BLS reports a median annual salary of $75,440.) New clinicians are expecting their wages to cover comfortable living conditions and student loan repayments—but most facilities are not prepared to offer salaries commensurate with new hires’ expectations, says Ford. As a result, he has witnessed many young clinicians leaving positions at patient-care facilities for jobs on the manufacturing side of O&P, where salaries are typically higher.
On the other end of the clinician age spectrum, some older clinicians “aren’t having as much fun” practicing O&P now that documentation requirements are so encompassing, says Ford. Those who, years ago, chose the profession to combine patient care with hand skills now are spending more time using CAD and completing documentation—and less time fabricating and seeing patients. This trend, combined with rising mergers and acquisitions, has triggered “a growing number of experienced clinicians” to sell or leave their O&P practices, according to Ford.
In addition to the clinicians who actually exit the profession, recent data shows many of those who remain in their jobs are experiencing emotional burnout or engaging in “quiet quitting,” both of which significantly hurt productivity—and could lead to future resignations. While burnout is defined as a state of physical or emotional exhaustion that involves a sense of reduced accomplishment and loss of personal identity, quiet quitting is an intentional choice: The employee chooses to stay in their job but puts in no more effort than absolutely necessary.
Young clinicians are particularly vulnerable to both emotional burnout and quiet quitting behaviors, according to Gerald Stark, PhD, MSEM, CPO, LPO, who has conducted several surveys of more than 400 O&P professionals concerning both issues. Stark, who is director of clinical affairs at Ottobock Patient Care and adjunct instructor at the University of Tennessee at Chattanooga, found that almost one-third (29%) of respondents are at “severe risk or higher of burnout,” and 8% are at “levels of burnout that are affecting mental and physical health.” These rates are higher than burnout scores captured among physical and occupational therapists, according to Stark. He is particularly concerned
about clinicians with five or fewer years of experience, who reported the second highest rates of burnout and anxiety. “If clinicians are burned out at a young age, what happens when they reach the typical time of career burnout in 10 to 15 years? This could definitely lead to more attrition in O&P later, when we need them most,” he says.
In fact, Stark’s data points to specific factors that influence the risk for burnout: the dramatically higher volume of documentation needed per patient to support reimbursement; pressure from management to meet monthly income goals; the personal cost of entry to the profession; and the large amount of knowledge needed to practice orthotics and prosthetics immediately. “Previously, we started with one discipline, then added the other,” explains Stark. “New students are expected to practice it all.”
Stark’s December 2022 survey shows reasons to be concerned about quiet quitting as well. Between 15% and 20% of respondents reported they had reduced their work “to the point that others had noticed, but they didn’t care that it was obvious to co-workers,” he says. “Work/life balance is one thing, but when you can’t function at the level of work that is expected, that’s a problem for the entire organization. Quiet quitting causes communication—and, subsequently, innovation—to slow, and can cause downturn in patient care.”
Quiet quitting may be a tough challenge for the profession, Stark adds, “because O&P professionals are usually not rewarded for their quality of work. Instead, employers may only measure productivity by the revenue they produce” because businesses are paid by device. “In a sense, clinicians value themselves based on how effective and inventive they are in patient care, but the organization tends to value them in another way,” with insurers reimbursing by device delivery and not quality of care. That dichotomy can make it hard for clinicians to go above-and-beyond to deliver differentiated, high-quality patient care.
Considering recent trends in employee shortages and decreased productivity, it’s more important than ever that O&P companies focus on retention, recognize signs of employee dissatisfaction, and remain mindful of how company culture impacts prospects and employees.
How can O&P companies accomplish these goals? This is a complicated problem with no clear answer, but O&P consultants, educators, and experts suggest these strategies:
Set expectations and define job responsibilities early. No two O&P facilities are alike, so O&P managers should clearly communicate what will be required of new hires, says Lesleigh Sisson, CFo, CFm, president of Prosthetic Center of Excellence in Las Vegas and founding partner of consulting firm O&P Insight. “Not all CPO roles are created equal.
Prevent Workplace Harassment to Retain Employees
Thomas Karolewski, CP, LP, FAAOP, past chair of NCOPE and owner of Legmaker Pro, an O&P consulting service, is currently studying harassment trends in O&P education and the O&P workforce while pursuing his doctoral degree.
Two years ago, he conducted a “negative acts survey” and discovered anecdotal evidence of many O&P professionals experiencing discriminatory behavior, with some choosing to leave the profession altogether after experiencing harassment. Identifying this “disturbing trend” prompted Karolewski to follow up with a dissertation on how people respond
to harassment in O&P. “I’m interviewing individuals who are in the field on how they responded to bullying.”
Karolewski says he recently interviewed three young clinicians who left the field soon after residency due to both “bullying” and low wages. “One person told me that out of [an O&P master’s program] graduating class of 20, five had left the field,” he says. Another young clinician reported that about one-eighth of their graduating class had already left the profession.
The attrition rates among recent O&P master’s program graduates warrant more consideration. Karolewski believes
Some clinicians in urban environments must go from hospital, to nursing home, to clinic, working long hours. In rural areas, clinicians may need to drive significant distances to see patients,” while others may be expected to have more traditional 8-to-5 jobs, she says. “So, employers will need to set expectations appropriately.”
Match young clinicians with appropriate tasks. Set up young clinicians for success, rather than failure, by empowering them to excel in work they are familiar with. J. Chad Duncan, PhD, CRC, CPO, department chair of orthotics-prosthetics at the new Salus University O&P master’s program, suggests reevaluating workflow to maximize new employees’ strengths, create an efficient work environment, and avoid new clinicians feeling underutilized.
“The quality of students today is very high,” and new graduates have a lot to offer, says Duncan. However, some companies may have unrealistic expectations about young clinicians’ abilities. Current students may not have as much fabrication experience as previous generations, but many young clinicians enter the profession with engineering backgrounds, programming skills, and experience in scanning, CAD, and 3D printing.
retainment of O&P clinicians will require more attention to harassment challenges and more transparent conversations about salaries.
“Older people don’t realize that millennials have plenty of time to make corrections with their careers,” he says. “The average millennial only stays at a job five to seven years, so we have to focus on ensuring young clinicians stay engaged.” O&P facilities should recognize the “generational cavern” between older clinicians who earned O&P certificates and recent O&P graduates, he says. Facilities should be sure to foster a workplace with respect for each other’s strengths and a willingness to collaborate. “It’s important to provide a good working environment” so people want to do their jobs.
Companies that “slow down” the process of integrating new employees into the facility can benefit, according to Duncan. “Students today may not be as strong in fabrication, but they can see patients, scan, and develop their clinical skills slowly,” while leveraging their programming and CAD skills to contribute to their companies’ success.
Ford encourages facilities to “give availability and time for new clinicians to learn as much as they can as fast as they can.” Many facilities allocate easier, lower-end work, such as fitting AFOs, to new hires—which can be “boring,” says Ford. He suggests that facilities intersperse this necessary work with more high-tech cases “to keep their interest level high” and demonstrate that they will have opportunities to learn advanced O&P.
Value the contributions of care extenders and other staff members. Ford suggests that O&P facilities “get serious about care extenders” as an integral part of the office. Care extenders can be used to handle some aspects of patient care, capture and record outcome measures, and more—all at lower salaries than certified clinicians.
Hiring technicians, assistants, and fitters is “a great way to expand clinical staff” and provide support to orthotists and prosthetists, as long as appropriate in-house training and oversight is available, agrees Sisson. “Look at alternative ways for O&P practitioners to have extended staff—and to become more of the ‘overseers’ rather than always the ‘doers.’”
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Sisson also recommends hiring and training well-qualified administrative staff to help manage the intricacies of proper O&P documentation and billing—thus freeing up time for clinicians to focus on patient care.
Offer flexibility. Gen Z and millennials have a different mindset that is not bound by the traditional 9-to-5 schedule, says Duncan. Young professionals “do not connect with punching clocks,” he says. They also recognize that other professions offer remote work and would welcome opportunities to work from home on occasion—for example, for meetings, when completing documentation (in accordance with HIPAA guidelines), or for virtual consultations.
Another way to offer flexibility is to consider a four-day workweek—a movement that is gaining some momentum. A recent trial of the four-day workweek in the United States and Ireland had positive results. Thirty-three companies with more than 900 employees collectively took part in a six-month pilot program rolled out by 4-Day Week Global, in which workers were given
100% pay for logging 80% of their normal hours. Despite the reduced hours worked, average revenue increased by 38%, absentee days decreased, and resignations fell. Nearly all employees wanted to keep the four-day workweek; they reported stronger work performance, a decrease in burnout levels, and improved work-life balance.
Experiments like this could be adopted within the O&P workplace, perhaps by offering four-day workweeks with extended hours— something companies should consider to remain competitive.
Empathize with young workers. “We have to think about the context of our workers,” and recognize that Gen Z and millennial employees may have different expectations about work/life balance than their older counterpoints, says Stark. “We need to have greater empathy for their holistic career expectations, and recognize they may be carrying a large debt load,” he says. “They also want to know how you are going to help them grow as professionals. If we don’t, they are simply more prone to go somewhere else” to find that growth opportunity.
Tailoring O&P Education for Future Patient Care
At the new Midwestern University O&P master’s program, Director Christopher Hovorka, PhD, CPO, FAAOP, has been studying O&P industry trends and is designing curricula to prepare future clinicians for client-patient care in 2030 and beyond. The new courses will help the program, which is currently pursuing NCOPE accreditation and plans to accept its first cohort in the fall, prepare students for the realities of working in the profession.
Hovorka examined trends in O&P, technology, and healthcare in general, and he considered what skills and competencies will be needed five to 10 years from now. In a “sobering and enlightening” undertaking, he spoke with managers at bigger O&P facilities as well as general healthcare innovators and engineers, wearable tech manufacturers, educators, reimbursement professionals, and policymakers.
demanding more holistically informed and personalized care from their healthcare providers. Hovorka believes O&P providers in the future “can offer a value-added difference compared to disruptors entering the market by being a client-patient centered care provider, within a devicecentric reimbursement model.”
geographic boundaries when digital options are appropriate.Christopher Hovorka, PhD, CPO, FAAOP
One potential complementary option is the boutique care model, an alternative approach to pricing. Clientpatients forgo insurance and pay a set fee per year for “concierge service, and unfettered access” to clinical care, suggests Hovorka. If this model is found to be a legally acceptable practice within O&P, some O&P companies that are willing to offer both traditional and boutique pricing options could find success in geographic areas with wealthier populations, Hovorka notes.
He noted a conundrum: Although the O&P profession is “device-anchored for reimbursement,” client-patients are
The Midwestern program also will prepare clinicians-to-be to compete in an increasingly digital world, and to serve client-patients outside of regular
Considerations such as these are guiding Hovorka and his team in informing new care delivery models in coursework—to focus on the value added by strategic personal interactions and client-patientcentered care. “We are evolving from a device provider to a clinical care provider,” but are still limited by a device-centric reimbursement model, Hovorka says. O&P master’s curricula will have to evolve as well. “If we can consider new complementary models of care, such as boutique practice to supplement” traditional reimbursement models and consider branching out to new markets that might seek boutique care, then O&P facilities can expand their target market with client-patient-centric care. This will require greater efficiencies in the O&P device design and manufacturing processes by leveraging the use of digital technologies that improve the reliability of manufacturing, when appropriate, to reduce the cost of doing business, according to Hovorka.
Sisson notes that empathy goes both ways. Young clinicians should be encouraged to be self-reflective and self-aware, and to “not discount the older clinicians who don’t have master’s degrees,” she says. “I cannot express enough the need to value what each staff member brings to the team.”
Foster community. Stark advises business owners to “work more on individual communication,” and create community within the workplace—doing so can be particularly effective at mitigating burnout and boosting a sense of connectedness that can prevent quiet quitting. “This doesn’t mean we don’t challenge people—quite the opposite: People want to do great things but just need help managing the anxiety that innovation naturally presents.
“Relationships and career development are the main ways we can achieve personal and professional transformation,” so O&P leaders should encourage staff members to work collaboratively, adds Stark. “When employees become isolated, they’re in danger of falling into a pit of uncontrolled anxiety. If COVID taught us something, [it’s that] we need each other to distribute and endure the anxiety of a quickly changing world.”
Consider wage adjustments or other incentives. O&P companies should be aware that U.S. employers are planning to increase their salary budgets by 4.6% for 2023, the highest annual jump in 23 years, according to a survey from consulting firm Willis Towers Watson. Most companies attribute the expected increase to inflation and a tight labor market. In addition, some U.S. companies recently offered, or are planning to offer, “inflation bonuses” to assist their employees with the rising cost of living.
It’s time for O&P facilities to examine their financials to see if salary bumps or bonuses are a possibility. Alternatively, “some facilities are finding creative ways to incentivize clinicians,” says
Ford. Some employers are measuring individual performance and empowering clinicians to earn additional income if they meet certain benchmarks—for example, seeing more patients, boosting patient satisfaction scores, or successfully fitting patients in fewer visits, Ford explains.
Support O&P master’s programs. One of the bright spots when predicting future employment in O&P is the recent addition of O&P master’s programs, which will enable more prospective clinicians to earn their degrees. Two new O&P master’s programs have opened—one at Salus University, which accepted its first cohort last fall, and one at Midwestern University, which will accept its first students for fall 2023. These programs should boost the numbers of students who will be eligible to be certified after they complete their residencies.
Expand efforts to create a diverse and inclusive workplace. O&P is primed to become a more diverse profession, given the current population at O&P schools, says Ford. Hiring and retaining female clinicians and clinicians of color will be a critical next step. “We need to think about how we support [the current diversity of students] so that we can keep diverse folks in the field, and we can improve how we relate to patients,” he says.
“Know your workplace culture, and develop safe spaces for people to learn about each other in an open and humble environment,” agrees Duncan. “Owners and managers have to be open to diversity, and create environments where people feel they can belong. It makes us a stronger profession to be more diverse professionally; it brings diverse thought and diverse solutions.”
Christine Umbrell is a contributing writer to O&P Almanac Reach her at email@example.com
Against the Odds
New for 2023, O&P Almanac debuts the Transformations column. Each month, you will meet an O&P clinician who will share the success story of one inspiring or challenging patient. We start off this month with the story of Mike Muratore, CPO, who treated NFL quarterback Alex Smith when he required a unique orthotic solution.
It was Oct. 11, 2020, and Hanger Clinic prosthetist/orthotist Mike Muratore, CPO, was anxiously focused on his TV. This was no ordinary Sunday of relaxing and watching professional football. It was the second quarter, and the thenWashington Redskins were playing the Los Angeles Rams when starting quarterback Kyle Allen went down with an injury. The Redskins would have to put in their backup.
When the backup QB took the field, “I wondered: What if I didn’t find the right device, and that kept him from being able to play in the NFL?” Muratore says, recalling the stress he felt that day. After all, treating a patient in the national spotlight, “your success and failure will be presented before the world,” he explains.
When Muratore got the call from the Redskins training staff in 2019, he was
already familiar with the background of his new patient. Quarterback Alex Smith had made national headlines when he was injured in a game against the Houston Texans in 2018, suffering a compound fracture that broke both the tibia and fibula in his right leg. His rehabilitation was complicated when he developed a flesh-eating bacterial infection following his initial surgery; Smith endured 17 operations before he could fully start the recovery process and, in his own words, was “very much lucky to be alive.”
Once Smith had recovered to the point that he was ready to begin walking, the Redskins (now Commanders) contacted Muratore for his assistance in finding an
orthotic solution. During their initial meeting, Muratore recalls that Smith was using crutches and wearing a Sarmiento orthosis. Muratore could see his wounds were still deep and his skin graft very recent.
“I did what all of us would do,” says Muratore. “I started manual muscle testing. I knew that he had an injury; I knew the nerve was compromised. I knew that he had lost some muscle.” Then, Muratore discovered the entire anterior lateral compartment of Smith’s leg was debrided down to the bone. “Basically, what I was feeling on his leg was his vastus lateralis from his contralateral thigh. That’s where we started.”
Moving the Goalposts
Because his leg was so badly damaged by the infections and surgeries—comparable to service members who suffer blast injuries—Smith had sustained footdrop. “We started with simple goals,” he recalls. “When I met him, he had no tibial nail, and was non-weight-bearing. So, his goals were to return to weight bearing, return to walking, return to playing with kids, and perhaps return to being athletic”—but Muratore was not sure if Smith would play football again.
Smith had not “put foot to ground” in months, and “I wasn’t sure how much support he would need,” says Muratore. Because “the volume of his leg was in a state of flux, given an impending [medical procedure], and time was of the essence,” he began by fitting Smith with an off-the-shelf SpryStep and a Fillauer Dynamic Walk, “which allowed me to quickly supply options that would offer Alex immediate aid.”
Smith had his tibial nail implanted and tested the initial braces. “He came back three weeks later into my office and said, ‘When I do loaded sled pulls, this brace pulls a little bit.’” Muratore was shocked to learn Smith was already pulling 200 pounds; the athlete had defied expectations and was progressing much faster than most individuals in similar circumstances. “That showed me that our goal-setting process would have to go deeper,” to meet Smith’s elevated definition of
“returning to being athletic.” Muratore and Smith set new, targeted goals of returning to high-impact activity, returning to football conditioning, and returning to professional-level athletics.
To reach those goals, Smith would need a brace that could handle punishing athletic movement. Muratore and Smith worked together and tested out a Richie-style ankle-foot orthosis (AFO) with dorsi-assist joints. Their progress was interrupted when the COVID-19 pandemic began. “Alex went to Hawaii and quarantined there. He sent me a video of him running in the Richie-style brace.” The treadmill was turned off—Smith was powering it with his legs alone, so weight bearing was no longer an issue. At that point, “his only pain was tibial plateau pain, where the tibial nail was driven in. Distally, he was fine,” although he still wanted to protect his skin graft.
“As he progressed through his goals, we needed a more dynamic functional solution,” says Muratore. Once Smith returned to the practice field and began to test his athletic abilities, it was clear he needed a different orthotic solution. Smith saw a televised NBA game showing the Denver Nuggets’ Michael Porter Jr., who had footdrop and was competing wearing a SpryStep Flex AFO from Thuasne; the brace is made of a
Muratore says Smith learned medical terminology to communicate exactly how his ankle and foot were functioning.
flexible material blend, fits into shoes, and offers posterior-lateral strut.
Muratore contacted Fraser Allen, product manager at Thuasne. They discussed composition and materials, and recognized that Porter’s brace was too short for Smith. They considered Smith’s functional goals and brainstormed on how to custom-build an orthosis similar to Porter’s that would meet the quarterback’s unique needs. “He needed a more dynamic solution that would allow him to put his foot on the ground and drive off of it,” Muratore explains. “It had to rotate, it had to have torsion, and he had to be able to plantarflex off of it. But it had to give him enough upward motion of his toe that he cleared the ground.”
Muratore with the orthosis he designed for Smith
They decided to adapt a SpryStep Flex. “We took a cast” to customize a brace that could fit into a football cleat. “Of that mold, we made three models.” Smith tried all three options and chose the most flexible option. Once Smith tested it at practice, he called Muratore and said, “This is the one!”
“That was surprising for us,” says Muratore, who expected Smith to prefer a stiffer brace. The orthosis offered plantarflexion but also allowed him to cut and twist, and move laterally on the field. Using this solution, Smith was able to fully rehab, and was cleared by the team for football activities. Muratore and Allen helped adjust and tweak the design, particularly in the footplate. “The first feedback he gave was that when he started to run, he was still scraping the grass. So, we increased the dorsiflexion angle 5 degrees. And to give him less third-rocker back pressure, we angled the toeplate up slightly more, and we feathered the carbon out so it was more flexible,” Muratore says. “We wanted the brace to ‘get out of his way,’ so he could pull his foot up— and literally nothing else.” Once they finalized the design, they built him two backups.
Returning to the Field
Smith earned a spot on the roster of the Washington Football Team on Sept. 5, 2020, as a backup quarterback. He altered the
way he played compared to pre-injury: “His first step was not as quick,” but he was able to adapt in other ways. He quickly determined the best way to wear the orthosis during play: one sock, then the brace, then a game sock, then a shoe, then tape on the shoe.
Wearing his newly designed orthosis, Smith returned to field 693 days after his initial injury, and during that Oct. 11 game against the Texans, he completed his first pass.
A few minutes later, Aaron Donald, defensive end for the Texans, jumped on Smith’s back and brought him to the ground in the first of six sacks Smith endured. Muratore was watching closely on his television. “I was rocking back and forth worrying from home,” Muratore recalls. He wasn’t sure how durable the orthosis would be under such intense and unique circumstances. “We thought it might de-laminate [and crumble, like folded-up paper], but it actually worked more like a rubber band,” says Muratore.
Smith went on to play in several more games that season, including a memorable performance in December in leading his team to beat the undefeated Pittsburgh Steelers. In an almost-unanimous vote, he earned NFL Comeback Player of the Year honors.
Smith ultimately retired from professional football after that season, but he “ended his career on his own terms,” thanks to orthotic intervention. Today, he works as an NFL analyst for ESPN and spends his spare time with his wife and three children, playing golf, and engaging in other activities. He continues to wear the adapted SpryStep Flex, which he says gives him confidence to participate in rigorous and demanding activities. He also has an off-the-shelf out-of-shoe AFO that just provides enough dorsiflexion to enable a normal walking gait, for everyday activities.
Carrying the Ball
Muratore is grateful for both the benefits and challenges he experienced when treating a high-profile athlete. He worked collaboratively with Smith, who taught himself medical terminology to communicate exactly how his ankle and foot were functioning.
“Professional athletes are so in tune with their body and know what they’re feeling, and they’re very good at describing it,” says Muratore. “He knew his muscles, his nerves, internal rotation, external rotation— he could explain how he felt and what he needed from his device in words I understand,” says Muratore, which allowed him to tune the brace quickly.
Treating Smith required extra time and expertise to ensure the right solution to a complicated presentation. He spent many hours traveling to and from the training facility. Other challenges included ensuring his patient’s privacy. “I kept Hanger Clinic’s involvement under wraps—for HIPAA purposes, plus it’s his story to tell.” At one point—after word got out that Smith was being treated at Hanger Clinic—news crews showed up at the facility, but Muratore asked them to leave. “We wanted to protect him and not let him feel ambushed.”
Overall, working with Smith—who is “a genuine individual—kind and courteous, with no celebrity aura”—was an overwhelmingly positive experience. And Muratore learned to take a slightly different approach with dropfoot patients—and some other orthosis users: “Now I don’t take away motion unless I have to,” Muratore says. “The more flexibility you can leave, the more comfortable the user feels.”
He attributes the success of the patientcare experience to a team approach. “The success that we had was based on good communication, being clear and openminded about goals and solutions, and employing all the resources available to us,” he says. In addition to collaborating with Smith and Allen, he also worked with Smith’s physical therapists, trainers, and orthopedic surgeon throughout the process.
“I’m humbled to have been a part of it,” says Muratore. “It was the perfect outcome for a great guy.”
YOU HAVE A TRANSFORMATIVE PATIENT-CARE EXPERIENCE YOU’D LIKE TO SHARE WITH O&P ALMANAC READERS?
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One Patient at a Time
Texas facility prioritizes individualized care
Sheri Hatt, MHI, LPO, has been a practicing O&P clinician for more than 20 years. After working for two different practices in her early years as a clinician, “I decided to go ‘rogue’ and open my own business,” Hatt says. She launched Rogue Prosthetics in 2011.
Since then, Hatt has enjoyed providing patient care by her own standards, which sometimes involves extra unreimbursed hours of work. Her diligence has paid off with company growth: She opened the facility as a solo practitioner, but Rogue has grown to two locations and five employees, including another clinician. Throughout the expansion, Hatt has stayed true to her company’s stated mission: to help one amputee at a time meet their mobility goals.
One key differentiator at Hatt’s facility is that she and her colleagues look at the whole person, not just their disability. “We actually sit down and listen to the patient,” she says. “Our initial interview may take a whole day. We also visit each patient’s home to analyze conditions and come up with a plan that allows them to be successful using a prosthesis at home.”
Hatt is open to new technology and has used 3D scanning and printing—but admits she usually comes back to hand skills, where she feels she has more control. The facility uses an O&P practice management system, which streamlines the work and has eliminated the need for additional administrative staff, according to Hatt.
Rogue regularly employs outcome measures. “We use AMPPro [the Amputee Mobility Predictor assessment tool] to evaluate patients’ progress every three to six months. Our practice management software also includes a tracker that allows us to enter information and monitor when patients reach their goals.”
Hatt has treated several patients who have overcome great obstacles to successfully use their prostheses. “I have one patient I work with every week,” she says. “He is 6 feet, 5 inches tall and weighs 364 pounds. He couldn’t afford a prosthesis after his amputation, so he spent a year in a wheelchair before we even saw him.” Hatt was able to get donated components and fit him for a leg, “but we were concerned that because of
his size and inactivity, he wouldn’t be able to use it.” Hatt met with the patient regularly, and he is now walking with a walker and about to graduate to a cane. “I honestly don’t think he would be as successful if he’d gone anywhere else,” she says.
That sentiment also applies to another patient, who lost his leg at 73. “He was almost not able to move ahead with a prosthesis because he was so upset,” she recalls. Hatt worked closely with him—and he is now so adept with his prosthesis that he participated in Rogue’s annual limb loss skydiving event.
In addition to sponsoring skydiving, Rogue works with a local organization that helps underfunded patients gain access to prosthetic care. The company also works with the Texas Ramp Project to identify homes that need a ramp in case of a fire.
In another effort to support families, Rogue made room on its website for a group called Careopolis, an online “caring community” for families to coordinate care for their loved ones. “We had more than 700 people sign up, so even though we are not affiliated with the group, we want to make it available to our patients and their families,” she says.
Hatt has big plans for the future, both in growth that stalled during COVID and in a greater emphasis on education, including a partnership with Texas A&M Agrilife to provide a diabetic education program.
However quickly the company grows, Hatt’s love for her work will remain consistent. “I’ve been in this field for 33 years,” she says, “and I don’t feel I’ve worked a day in my life.”
Deborah Conn is a contributing writer to O&P Almanac. Reach her at email@example.comFACILITY: Rogue Prosthetics
Virginia company leverages 3D printing to design braces
Dave Johnson’s first invention, the Ascender Brace, was born of desperation. Johnson had blown out his knee playing football as a high school student. The damage was significant and later contributed to a patellofemoral cartilage defect that turned into knee osteoarthritis. Normally this would be cause for a knee replacement, but Johnson was in his 20s at that point, so a replacement might need to be redone after seven to 10 years, particularly given his higher level of activity.
Johnson, who eventually became an engineer, decided to explore creating a brace that would help the knee spring back up after bending down.
“I wanted to stay active, especially because your body weight is multiplied in the joint and causes more pain, so I needed a device to assist the knee and unload weight,” he says. “I bought some knee braces, cut out the hinge, and 3D printed my own hinge. I designed torsion springs out of heavy piano wire to make them the right size with enough power and range of motion.” Johnson tested his brace and found he could snowboard without pain.
“I realized I was on to something, but I had to make it lighter and allow the user to adjust the tension level,” he recalls. Using his free time, Johnson spent the next five years turning his idea into a viable product, and in 2019 he launched Icarus Medical Innovations. “At first, this was just to solve my problem, but other people saw it and wanted one.”
Icarus is based in Charlottesville, Virginia, and Johnson’s first intern was a University of Virginia student, whom he hired in 2020. Later that year, Icarus launched the Ascender Brace as its first product. Today, the company has 40 employees, many from the university. Starting a business just before the COVID-19 pandemic was challenging, but Johnson benefited by securing an office and manufacturing space right on the busy Downtown Mall.
The Ascender Brace unloads up to 40 pounds from the knee. Icarus developed a smartphone app that captures a 3D scan of the leg, so the brace is 3D printed to exactly conform to the patient. The device is extremely lightweight, and the user can adjust the tension to improve stability and support a variety of
activities, according to Johnson.
Icarus also developed a knee-ankle-foot-orthosis (KAFO) that enables users to gain stance control by adjusting the tension level of the device. “The KAFO is only 26 ounces and conforms perfectly to the leg,” he notes.
Icarus’s products are available to orthopedic physicians and orthotists, as well as directly to the public. Many physicians and orthotists carry the devices, using the app to send precise measurements to the company.
As 3D printing and scanning technologies evolve, Johnson believes costs will come down and products will be increasingly tailored to each user. “As orthopedic bracing improves, insurance companies will recognize that savings can be had by delaying surgery,” he predicts.
Icarus gives back to its community in several ways. The company holds a ball each year to raise money for veterans’ groups, and it supports the clean-water initiative of the Chris Long Foundation, a nonprofit founded by two professional athletes who met at the University of Virginia.
In addition, Icarus has an “every patient” policy, where it tries to get every patient braced, regardless of their financial situation.
It would have surprised the high school Dave Johnson to see how his sports injury engendered a career and a mission. “We have a cool culture at Icarus,” he says. “We like to try new things. If you have an idea, you can have it in your hands in 12 hours. Everyone is so excited and motivated to invent useful stuff [and] to solve problems that have been ignored for a long time. It’s a blast!”
Don’t Miss Monthly Video Updates From AOPA
Catch Joe McTernan’s monthly “quick takes” on key reimbursementrelated concerns. Hear insightful analysis from AOPA’s director of health policy and advocacy on hot topics such as the DME MACs, National Provider Identifiers, advanced beneficiary notices, Medicare rules, and so much more! Look for AOPA’s Take on YouTube and in AOPA members-only communications.
State Policy Forecast
Take a few minutes to watch Sam “The Weatherman” Miller share up-to-the-minute advocacy updates from across the country! Each month, AOPA’s manager of state and federal advocacy shares highlights of important regulatory and legislative movements in states with heightened activity. Look for Miller’s State Policy Forecast each month on Facebook, YouTube, and LinkedIn.
AOPA Unveils Electives for Certificate in O&P Business Management
Certificate in O&P Business Management
SAVE THE DATE
Mark your 2023 calendar now and start making plans to travel to Indianapolis September 6-9 for the 106th AOPA National Assembly! Visit AOPAassembly.org
AOPA will offer several elective courses in 2023 for credit in the Certificate in O&P Business Management, brought to you by AOPA and the University of Hartford.
Clinical Documentation and Evaluation
March 22, Noon – 2 p.m. ET
Join Chris Doerger, PT, CP, March 22 for a new online elective in AOPA’s Certificate in O&P Business Management Program. Doerger, who is senior manager, education strategy and development, at Ottobock’s Professional and Clinical Services, will offer an in-depth discussion on proper clinical documentation and evaluation.
Brought to you by AOPA and the University of Hartford, the Certificate
in O&P Business Management is a comprehensive certificate program that offers a series of business and management courses to provide business owners, managers, and practitioners of O&P patient-care facilities, O&P manufacturers, and distributors an opportunity to explore crucial business challenges—from finance, sales, and marketing to business operations, reimbursement policies, and management. Visit the AOPA website for details and register for courses on My AOPA Connection
Welcome New AOPA Members
BioAdvance Prosthetic Solutions PLLC 1111 Raintree Circle, Ste. 150 Allen, TX 75013 972-521-6101 bioadvanceoandp.com Scott Williams, CPO, LPO Patient-Care Facility
Home Orthopedics Corp. 202 Calle Federico Costa San Juan, Puerto Rico 00918 787-763-1002 Idolkis Diaz, CFO, CFTs International Patient-Care Facility
O&P Insight LLC 12236 Sea Voyage Avenue Las Vegas, NV 89138 702-400-1661 oandpinsight.com Curt Bertram, CPO Supplier Level 1
Orthofit Inc. 3581 Centre Circle, Ste. 104 Fort Mill, SC 29715 980-585-3571 orthofitinc.com Alex Ford, CPO Patient-Care Facility
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.
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For more information on recruitment options, contact Customer Service at firstname.lastname@example.org or 727-497-6565
2 ½ and BlueROCKER® 2 ½
Now offering more Allard AFOs with ½ the heel height. All 2 ½ models include choice of wrap-around or D-Ring straps, shorter wings, and a Starter SoftKIT ™ included. It is easier to adapt ToeOFF® 2 ½ and BlueROCKER® 2 ½ to shoes with lower heel heights because there is a lower forefoot curvature and more space in the shoe toe box. ToeOFF® 2 ½ Addition models available in camouflage, birch, and black. Call 888-678-6548 or email email@example.com to receive your free Product Selection Guide.
The Original Preflexed Suspension Sleeve
ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement.
For more information, call ESP LLC at 888-932-7377 or visit wearesp.com
ALPS BioStep™, available in five different styles, is a breakthrough innovation among dynamic response feet. ALPS BioStep™, powered with patented NRG Technology™, is based on a biomimetic design that enables dynamic patients to perform a wide range of activities with just one single foot. Active users can experience a high dynamic response combined with a fluid step and stability on all terrains.
To learn more about ALPS BioStep™ Dynamic Feet, scan the QR code or call your sales representative at 800-574-5426.
Hersco 3D Printing
Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry.
Call today, 800-301-8275, for a free sample.
Cyclone™ Bike Foot
The Cyclone™ Bike Foot was designed without compromising durability and to minimize foot weight. While pedaling, the Cyclone™ gives unmatched energy transfer. The short foot length design increases pedal stroke efficiency. The innovative design eliminates energy lost to weight caused by a foot shell and shoe. It also eliminates energy loss to deflection caused by the flex in a shoe and foot shell. The adjustable pyramid allows the foot to be either a right or a left. The cleat bracket can be used with two or three hole cleats.
Contact Coyote at 208-429-0026 or coyote.us
It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All are available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit npdevices.com
Skeo Unique Custom Liner: The Right Solution Is Unique
Unique Liners from Ottobock are highly customized, so you can achieve innovative fitting results. The silicone Skeo Unique custom liner is recommended when high stability and durability are required. This liner:
• Is appropriate for very conical or scarred residual limbs
• Stabilizes residual limbs, even those with significant soft tissue
• Skin-friendly silicone enables a superior connection with the residual limb
• Easy handling, easy cleaning.
Utilize the new Ottobock EasyScanner or the free Custom4U iPad app with a Structure scanner to digitally capture the limb. STL files from any scanner can be uploaded into our iFab Customer Center (iCC) for easy digital ordering without shipping casts.
Learn more at shop.ottobock.us
Uneo Unique Liner: There’s No One-Size-Fits-All When It Comes to Liners
Unique Liners from Ottobock are highly customized, so you can achieve innovative fitting results. The urethane Uneo Unique custom liner achieves an exact and comfortable fit thanks to the extraordinary flow characteristics. Other qualities include:
• Polyurethane gel to cushion highly sensitive or scarred residual limbs
• Good pressure distribution within the socket
• Comfortable impact absorption
• Skinguard antibacterial or fresh scent options available.
Utilize the new Ottobock EasyScanner or the free Custom4U iPad app with a Structure scanner to digitally capture the limb. STL files from any scanner can be uploaded into our iFab Customer Center (iCC) for easy digital ordering without shipping casts.
Learn more at shop.ottobock.us
RUSH ROGUE 2
The RUSH ROGUE 2 provides an optimal vertical shock experience, axial rotation for improved comfort, predictable performance, ultimate fiberglass strength, and flexibility for daily life and high impact activities.
And now, patients will no longer have to choose performance over sandal toe availability. With the RUSH ROGUE2 & EVAQ8 models, patients can choose optimal performance with the freedom to express themselves in their preferred daily footwear. Walk Your Way with RUSH Sandal Toe by PROTEOR. Visit Proteor.com
Having a component inventory available in your facility, does not make our product OTS. A VertAlign® Spinal Support System is custom fit, requiring the clinical and biomechanical expertise of an orthotist to select the correct front and back shells from the 550 different size, shape, lordosis- and kyphosis-possible configurations. The orthotist’s professional skills are needed to select, adjust, and apply the components that meet the patient’s unique anatomical and spinal support needs. We provide components and product training. You provide clinical judgement and professional skills.
Contact The Bremer Group at 800-4282304 or visit bremergroup.com
The Xtern Summit, A Step Up for Foot Drop By Turbomed Orthotics
Are you making countless adjustments to braces? Seeing the same unhappy patients over and over?
Casting legs? Losing money? You may be ready for the Xtern. Your patients are ready.
This revolutionary brace, specifically designed for people suffering from foot drop, is entering its sixth generation: the Xtern Summit. The Xtern line sits entirely outside the shoe, and is so flexible that it allows maximal range of motion and calf muscle strength. It combines extraordinary lightness with proven comfort. You’ll barely notice it’s there.
Turbomed’s Xtern Classic, Xtern Summit, and Xtern Frontier are designed in Quebec, Canada, sold in more than 30 countries around the world, and distributed by Cascade in the United States.
Visit turbomedusa.com, and think outside the shoe! The Xtern Summit launches October 15, and will replace the Xtern Classic in the U.S.
. ProComp® is produced in a high-pressure laminating process that infuses discontinuous carbon fiber into homopolymer propylene. The patented prepreg composite sheeting is compatible with standard drape-encapsulation or bubble vacuum thermoforming. Finishing techniques are standard. Four standard gauges are available for both orthotic and prosthetic applications. Eligible for double L2755 application in thermoplastic AFOs and appropriate prosthetic addition codes. For more information, visit fabwithprocomp.com. Contact Gary G. Bedard, CO, FAAOP(D), managing principal, Rhode 401 LLC, at 650-773-3730 or email firstname.lastname@example.org
“I designed this composite to allow you to transition from plastic to composite thermoforming.”
GARY G. BEDARD, CO, FAAOP(D)
ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at email@example.com or visit ABCop.org/contact-us
Certificate in O&P Business Management—Clinical Documentation and Evaluation. Virtual, Noon – 2 p.m. ET. Register on My AOPA Connection
Orthotic & Prosthetic Innovative Technologies
Minneapolis. For updates, check . Email cme@gillettechilto be added to conference mailing list.
Nashville Renaissance Hotel and Conference Center. In-Person Meeting. Contact pruittprimecare@gmail. ; or Jane Edwards at 901-487-6770, jledwards88@ primecareop.com
Indianapolis. For more
AOPA is centered onYOU.
Let us support you.
For more information on membership, or to join, call 571/431-0810 or email bleppin@AOPAnet.org
Share Your Calendar Event
Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at firstname.lastname@example.org or learn more at bit.ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 223340711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.
A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.
Scan the QR to start advertising in the O&P Almanac or visit bit.ly/23AlmanacMediaKit
PAGE PHONE WEBSITE
Allard USA 11 866-678-6548 allardusa.com
ALPS South LLC 35 800-574-5426 easyliner.com
Coyote Prosthetics & Orthotics 27 800-819-5980 coyote.us ESP LLC 5 888-WEAR-ESP wearesp.com
Flo-Tech O&P Systems Inc. 25 800-356-8324 1800flo-tech.com Hersco 1 800-301-8275 hersco.com
Naked Prosthetics 17 888-977-6693 npdevices.com
Ottobock C4 800-328-4058 professionals.ottobockus.com
Proteor USA 3 855-450-7300 proteorusa.com
Spinal Technology Inc. 13 508-957-8281 spinal.tech/almanac
The Bremer Group Company 19 800-428-2304 bremergroup.com TurboMed Orthotics 7 888-778-8726 turbomedorthotics.com Xtremity 29 970-429-4203 xtremity.com
BECOME AN AOPA STATE
If you are interested in participating in the AOPA State Reps network, email smiller@AOPAnet.org
Updates from Colorado, Pennsylvania, South Dakota, and Texas
Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at AOPAnet.org/resources/co-op
In December, a team of advocates led by Angela Montgomery, CPO, and the Rocky Mountain Orthotic & Prosthetic Coalition presented the So Kids Can Move initiative at the Colorado State Capitol in Denver as part of the Disability Rights Conference hosted by Rep. David Ortiz (D-38). So Kids Can Move is working to expand access to prostheses and orthoses utilized for physical activity as medically necessary healthcare for children and youth.
experienced denials stemming from a section of the Medical Practice Act requiring accreditation from the National Commission for Certifying Agencies, a voluntary status that both the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the Board of Certification/Accreditation (BOC) have chosen not to maintain.
With the help of the Pennsylvania Orthotic and Prosthetic Society, ABC, and BOC, HB 2800, the bill removing this requirement, quickly moved through the legislature and was signed into law Nov. 3 by Gov. Tom Wolf. Applicants who experienced denials previously due to this issue will now be reconsidered.
During the Nov. 8 midterm elections, South Dakotans voted to expand their Medicaid program to thousands of additional low-income residents, becoming
the seventh state to do so via the ballot box. With 56% approval from voters, South Dakota brings the total number of Medicaid expansion states up to 39. Under the expansion, it’s estimated that more than 50,000 new enrollees will join the program once it is implemented, starting in 2024.
HB 134, which was pre-filed Nov. 14 for the 2023 legislative session, mandates coverage of cranial remolding orthoses (CROs), code S1040, in certain individual and group health insurance plans, as well as Texas’s Medicaid and child health plan programs. AOPA has engaged its CRO Intervention Workgroup and CRO providers in the state to assess the bill’s coverage language and develop an evidence-based advocacy approach.
HB 134 has been previously introduced during the 2013, 2015, and 2021 sessions. If passed, HB 134 would take effect starting September 2023. To stay updated regarding this bill, check the Texas page of the AOPA Co-OP.
For more information on these and other state developments, visit the AOPA Co-OP or contact Sam Miller at smiller@AOPAnet.org
Colorado was the first state to enact a fair coverage law for prosthetics in 2000, thanks in part to the assistance of long-time Coloradan and limb loss advocate Jeffrey Cain, MD. Since then, 20 additional states have followed Colorado’s example over the past 22 years.
In September, many O&P licensure applicants in Pennsylvania
So Kids Can Move
So Kids Can Move is a new policy and advocacy initiative working to expand access to prostheses and orthoses utilized for physical activity as medically necessary healthcare for children and youth on a state-by-state basis. It is the result of a collaboration between AOPA, the National Association for the Advancement of Orthotics and Prosthetics, the Amputee Coalition, and the American Academy of Orthotists and Prosthetists.
Trust, Move, Live.
Since the introduction of C-Leg and its groundbreaking control technology, Ottobock has never stopped inventing new ways to take your patients as far as they want to go. With a portfolio including the Kenevo, Genium, X3, and now the latest iteration of C-Leg 4, every microprocessor knee supports a journey toward a limitless future.
Scan the QR code to learn more!
Kenevo C-Leg 4 Genium X3
IP 22 IP 67 IP 67 IP 68
The Kenevo is designed specifically for users with mobility limitations who need a high level of stability. State-of-the-art technology allows users to feel safer and more independent in their everyday life.
An IP 22 rating protects from dripping water or dust.
The C-Leg 4 provides exceptional reliability and dynamically adapts to a wide variety of everyday situations. The legacy lives on with the new C-Leg 4 Update with over 10 new features including supported descent on ramps and stairs. The C-Leg 4 is easier and more intuitive than ever before.
An IP 67 rating provides protection from damage due to casual contact or temporary submersion in fresh water up to 1 meter for 30 minutes.
The Genium provides the highest degree of intuitive function to individuals who need to adapt to changing environments, move quickly over short distances, or require more than 2 days of battery life.
An IP 67 rating provides protection from damage due to casual contact or temporary submersion in fresh water up to 1 meter for 30 minutes.
The Genium X3 is the most durable, intuitive and technologically advanced microprocessor knee available. With features that support activities like running, swimming and ascending stairs step-overstep, X3 supports individuals who push the boundaries of mobility.
With an IP 68 rating, Genium also offers the highest level of water protection offered in a microprocessor knee.