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The Magazine for the Orthotics & Prosthetics Profession

JAN UA RY 2017


Changes to the HCPCS Code Set and Fee Schedules P.16

Opportunities in Telehealth P.28

Critical Elements of a Compliance Plan P.44



CREDITS P.17 and 47

The Start of Something



SPECIAL SECTION New columns for AOPA’s 100th Anniversary and World Congress Preview



This Just In: The Future of the Medicare O&P Improvement Act P.18








CALL FOR PAPERS NOW OPEN Clinical, Business, Technical and Symposia Presenters Wanted

Submit your best abstract to present at the World Congress to advance your career and gain international recognition. Learn more at The submission deadline for business abstracts is February 1, and the deadline for all other submissions is March 1.

EXCELLENCE in EDUCATION Mark your calendars September 6-9, 2017, for an ideal combination of top-notch education and entertainment at the combined 100th AOPA National Assembly and World Congress Meeting in Las Vegas. We look forward to seeing you in 2017!


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JAN UARY 2017 | VOL. 66, NO. 1





20 | The Start of Something Big 2017 marks the 100-year anniversary of the American Orthotic and Prosthetic Association. The O&P Almanac kicks off the year-long celebration with a look back at the past century, sharing the story of how AOPA was founded and paying tribute to the milestones of the orthotics and prosthetics industry that have shaped today’s O&P profession. By Christine Umbrell

18 | This Just In

O&P Legislation On Hold While the 114th Congress failed to pass the Medicare O&P Improvement Act in November, there is reason to believe the measure may pass once the 115th Congress is in session. Plus, learn what’s in store for O&P regarding the Office of the Inspector General’s 2017 Work Plan.

28 | The Future Is Virtual Health-care facilities are increasingly turning to telehealth—the use of medical information exchanged via electronic communications—as one tool in their treatment protocols. Find out how O&P professionals can leverage telehealth to communicate with remote patients as well as other members of the health-care team. By Lia K. Dangelico






36 | Then & Now Twenty-five years of AOPA’s Policy Forum


38 | Bridge to the Future


What does osseointegration mean for O&P?

DEPARTMENTS Views From AOPA Leadership......... 4

40 | The Global Professional

Insights from AOPA Board Member Dave McGill

Q&A with Andrea Giovanni Cutti, Meng, PhD, from Italy

AOPA Contacts.......................................... 6 How to reach staff

Numbers......................................................... 8 At-a-glance statistics and data

Happenings............................................... 10


Research, updates, and industry news

Reimbursement Page.......................... 16

People & Places........................................14

2017 changes to the code set and fee schedule

AOPA News...............................................52

Transitions in the profession

Jumping Into January

AOPA meetings, announcements, member benefits, and more

CE Opportunity to earn up to two CE credits by taking the online quiz.


Compliance Corner.............................. 44

Crafting Your Compliance Plan

PAC Update ..............................................54 Welcome New Members ..................56


Ad Index......................................................56 Marketplace.............................................. 57

The seven key elements of a compliance program

Careers........................................................ 60 Professional opportunities

Member Spotlight................................ 48 n n

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PHOTO: AtlanticProCare

CE Opportunity to earn up to two CE credits CREDITS by taking the online quiz.

Calendar..................................................... 62 Upcoming meetings and events

Ask AOPA.................................................. 64 Physician documentation, proof-of-delivery forms, and more





Get Ready for a Transformative Year


HE YEAR 2016 FEATURED the ongoing implementation of health-care reform, the looming specters of Medicare prior authorization and competitive bidding, pending health insurance mergers, and a federal workgroup developing a “consensus document” in the wake of 2015’s draft Local Coverage of Determination. Any one of these issues, standing alone, would have a potentially transformative effect on O&P. And then people went to the polls on November 8. We can now add to this list the likely repeal of the Affordable Care Act, the possible replacement of the individual mandate with the concept of “universal access” to health insurance, the potential re-emergence of pre-existing condition exclusions, an openness to the sale of insurance across state lines that could serve to end-run already-passed insurance fairness laws, Medicaid block grants, and new leadership at the U.S. Department of Health and Human Services and CMS. If you just read this and felt like you were clinging to a life raft on stormy seas in the middle of a hurricane, don’t worry—you’re like everyone else. If you don’t believe me, consider the comments of Aetna’s chief executive officer, Mark Bertolini, two days after the election: “If you were to look at our game board of all the possible outcomes of the election, this one wasn’t even on the sheet. We started with a fresh piece of paper yesterday. We had no idea how to approach it.” There’s an important lesson to be learned here: Running a business built on understanding health-care risks and predicting them well enough to generate revenue for shareholders does not translate into understanding risk and predicting it accurately outside of that domain. Fear and panic do little to help you navigate effectively and think coherently through complex problems. Pushing those emotions into the background and finding the right resources is the better way to help yourself and your business. From breaking news to weekly newsletters to educational webinars and in-person events, AOPA offers you the tools you need in 2017 to help separate signal from noise in this unprecedented time of change. And we also are working to develop new programs and services for our members that will provide more actionable information, more quickly than ever before. While the specifics of what will happen over the next 12 months are far from certain, AOPA will certainly be here to help make sense of the issues, plan appropriate responses, and champion your interests. We thank you for your support and look forward to working with and for you in 2017.

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

Board of Directors OFFICERS President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL President-Elect James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Vice President Chris Nolan Ottobock North America, Austin, TX Immediate Past President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Mountain Lake Terrace, WA Traci Dralle Fillauer Companies Inc., Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA

Dave McGill is a member of AOPA’s board of directors.

Rick Riley Townsend Design, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX




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

Editorial Management Content Communicators LLC

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.



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

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@

Don DeBolt, chief operating officer, 571/431-0814, MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, Betty Leppin, manager of member services and operations, 571/431-0810,

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, Reimbursement/Coding: 571/431-0833,

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802,

Yelena Mazur, membership and meetings coordinator, 571/431-0876,

Josephine Rossi, editor, 703/662-5828,

Ryan Gleeson, meetings coordinator, 571/431-0876,

Catherine Marinoff, art director, 786/293-1577,

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, Christine Umbrell, editorial/production associate and contributing writer, 703/6625828,



Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly 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 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. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2017 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email Visit for advertising options!


AOPA: A Century of Service and Advocacy The American Orthotic and Prosthetic Association kicks off a year-long centennial celebration

1973-1983: Explosive Growth in AOPA Membership AOPA more than doubled its membership roster between 1973 and 1983 Year 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983

AOPA, founded 100 years ago as the Association of Limb Makers of America (ALMA), will commemorate a century of serving as the voice of the industry this year. Here’s a look at some of the milestones of the past century.

Number of Members


431 451 482


671 702

756 771

832 850

SOURCE: 1983 AOPA Annual Report




Number of prosthetic company representatives who met in Washington, D.C., in 1917 to form the Association of Limb Makers of America (ALMA).




Estimated number of U.S. service members who suffered amputations during World War II, which the U.S. entered in 1941.


Attendance number of the first ALMA Annual Convention, held in 1918 in Indianapolis.

ALMA invites brace makers and fitters to join and becomes the Orthopedic Appliance and Limb Manufacturers Association (OALMA).



th 75 ANNIVERSARY The first AOPA Legislative Conference—an early iteration of the AOPA Policy Forum—is held in 1992, as AOPA celebrates three quarters of a century. 8

501(c)(3) AOPA joins ABC and the Academy in founding the Orthotic & Prosthetic Activities Fund in 1995, to provide financial support to the 1996 Paralympics.


AOPA persuades the Senate Judiciary Committee to shelve the Prosthetic Limb Access Act of 1996.


19 Million Number of individuals who signed up for Medicare during its first year, in 1965.

1966 OALMA officially changes its name to the American Orthotic and Prosthetic Association (AOPA).


43 Number of countries that took part in the first O&P World Congress, held in 2013 in conjunction with the AOPA National Assembly in Orlando.

Number of signatures collected on “We the People” White House petition during efforts to halt the proposed Local Coverage of Determination for lower-limb prostheses, published in July 2015.


AOPA celebrates its 100-year anniversary, culminating with a celebration at the AOPA World Congress and 100th National Assembly in Las Vegas.


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Researchers Develop Noninvasive Brain Cap To Control Robotic Arm

Research subjects at the University of Minnesota fitted with a specialized noninvasive brain cap were able to move the robotic arm just by imagining moving their own arms.

movement, according to the researchers. Neurons in the motor cortex produce small electric currents during the thought process. The UMN researchers leveraged advanced signal processing as the basis for their BCI technique. “This is exciting as all subjects accomplished the tasks using a completely noninvasive technique,” said He. “We see a big potential for this research to help people who are paralyzed or have neurodegenerative diseases to become more independent without a need for surgical implants.” He and the UMN team will continue their research and further develop the technology to include a brain-controlled robotic prosthetic limb attached to a person’s body.

Scientists Create Electronic Body Hair for Prosthetic Skin Chinese scientists have developed cobalt-based microwires that protrude up from electric skin, designed to replicate fine body hair on natural skin. The pressure-senstive, glass-coated microwires run through a layer of silicone rubber and connect with a circuit board underneath, with one end sticking out, much like an array of hair. The scientists conducted lab tests at the Harbin Institute of Technology. During the experiments, the sensors were 10


able to detect stimuli, such as light breezes and other slight sensations. When used with a two-finger robotic gripper that was grasping a plastic block, the sensors were able to detect slip and friction forces, according to the researchers. “The novel sensing mechanism and structure provide a new strategy for designing multifunctional tactile sensors and show great potential applications…sensing in harsh environments,” concluded the scientists. The findings were published in the American Chemical Society’s Applied Materials & Interfaces journal.

PHOTO: University of Minnesota

Researchers at the University of Minnesota (UMN) have developed a noninvasive technique, electroencephalography- (EEG-) based brain-computer interface (BCI), that records weak electrical activity of subjects’ brains via a high-tech EEG cap. The cap, which is fitted with 64 electrodes, converts “thoughts” into action by advanced signal processing and machine learning. “This is the first time in the world that people can operate a robotic arm to reach and grasp objects in a complex 3-D environment using only their thoughts without a brain implant,” said Bin He, lead researcher and a biomedical engineering professor at UMN. The researchers worked with eight nonamputee subjects, who wore EEG caps during experimental sessions. Over time, the subjects learned to control a robotic arm to reach and grasp objects—first in fixed locations on a table, and later in random locations. “Just by imagining moving their arms, they were able to move the robotic arm,” said He. By the end of the study, all eight subjects were able to control the robotic arm to pick up objects in fixed locations, with an average success rate of more than 80 percent. They also were able to move objects from the table onto a three-layer shelf, with an average success rate of more than 70 percent. The EEG-based BCI technology works due to the geography of the motor cortex, the part of the brain that governs



Incidence of Stroke Rising Among Generation X A new study has found that people born between 1965 and 1974 have a 43 percent higher rate of stroke than those born between 1945 and 1954, according to researchers at Rutgers University School of Public Health. While the incidence of stroke has decreased in individuals 55 and older, it has increased in Gen Xers. One of the most common disabilities resulting from stroke is paralysis, and many patients require short- or long-term orthotic intervention. Led by Joel Swerdel, a PhD candidate, the researchers compared stroke rates for people at the same ages between generations, based on more than 225,000 records of stroke data

between 1995 and 2014. They studied, for example how many people ages 35 to 39 suffered a stroke between 1995 and 1999, and compared those numbers to the number of stroke victims ages 35 to 39 between 2010 and 2014. During their analysis, the researchers discovered that stroke rates had more than doubled in people ages 35 to 39; doubled in people ages 40 to 44; and declined in age groups 55 and older. Reasons for the higher incidence of stroke in nonseniors may be tied to the addition of sugar to many foods beginning in the 1960s. Public programs to reduce added sugars in foods and deter consumption of sugary drinks, as well as

campaigns to emphasize a healthy diet and physical activity, could help reduce stroke rates in Gen Xers, said Swerdel. The study was published in the November 23 issue of the Journal of the American Heart Association.


Asian Americans Least Likely To Undergo Diabetes Screening


Asian American patients are nearly twice as likely as white patients to have type 2 diabetes, but are three times more likely to have the disease undiagnosed, according to a new study from the University of Chicago. Half or more of all diabetic Asian Americans are unaware of their condition, according to the research. Asian Americans “are not necessarily averse to screening tests,” said lead author Elizabeth Tung, MD, citing the study’s findings that even those who had completed breast and colon cancer screenings were less likely to be checked for diabetes. But even after accounting for education, access to health care, and other key factors, Asian Americans had 34 percent lower odds of being screened compared to non-Hispanic whites. Tung and the research team analyzed data from three years of an annual telephone study called the Behavioral Risk Factor Surveillance System. The

system featured self-reported data from more than 500,000 respondents who met criteria for diabetes screening, 9,310 of whom were Asian American. Approximately 60 percent of white, African American, and mixed race people reported diabetes screening, while 56 percent of American Indians and 50 percent of those of Pacific Island descent reported screening. Asian Americans, by contrast, reported getting the necessary screening only 47 percent of the time. “Doctors shouldn’t neglect to screen Asian Americans just because they appear to be thin,” Tung said. Even though proportionate to the general U.S. population, Asian Americans tend to be less overweight, they are still at a higher-than-average diabetes risk. The study was published the November issue of the Journal of General Internal Medicine. O&P ALMANAC | JANUARY 2017




Court Mandates HHS Remedial Action To Reduce ALJ Waiting Period In mid-2014, the American Hospital Association (AHA) filed suit against the U.S. Department of Health and Human Services (HHS) challenging the long delays—far in excess of the statutory limit of 90 days—before recovery audit contractor (RAC) audit appeal cases are heard by an administrative law judge (ALJ). Early on, the U.S. District Court ruled against AHA, but was overruled by the Court of Appeals. In a new ruling in favor of AHA, the court clearly demonstrated its impatience with the long delays, but also was careful not to try to force the hand of HHS with specific steps. “The agency is also bound by statutorily mandated deadlines, of which it is in flagrant violation as to hundreds of LABOR LAWS

New Overtime Threshold Rule Blocked A Texas federal judge has blocked the implementation of an Obama administration rule that would have extended overtime eligibility to workers earning up to $47,476. The U.S. Department of Labor’s (DOL's) overtime rule was scheduled to be implemented Dec. 1, 2016. The rule would have required employers to pay time-and-a-half to employees who worked more than 40 hours a week and earned less than $47,476 a year. The current law remains in effect, with the threshold at $23,660. The preliminary injunction was the first step in what likely will be continued litigation, including an already-filed notice of appeal by DOL to the Fifth Circuit Court of Appeals in New Orleans.



thousands of appeals,” noted the court. The court adopted a remedy with four threshold dates by which HHS is instructed to have reduced the backup in ALJ hearings by set percentages: • By Dec. 31, 2017—30 percent reduction in the backlog. • By Dec. 31, 2018—60 percent reduction in the backlog. • By Dec. 31, 2019—90 percent reduction in the backlog. • By Dec. 31, 2020—100 percent reduction in the backlog. AHA also had proposed the remedy that the court automatically issue rulings for defendants as January 2021 for any cases where there was a backlog of more than one year. The court

refused that request, at least for the present, though it left the door open to reconsider that option if HHS fails to meet the newly mandated target dates. This decision could have a significant impact on O&P RAC claims, which comprise a disproportionately high percentage of all Part B RAC claims. The lawsuit by AHA involved Part A hospital claims. Nonetheless, AHA is likely to institute some new mechanisms—for example, the opportunity for those appealing audit decisions to accept settlements based on the history of success in appeals. Such a mechanism was previously crafted by HHS and extended to hospitals, but it did not succeed in markedly reducing the ALJ backlog. AOPA will share more information as it becomes available.


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The American Academy of Orthotists and Prosthetists (the Academy) has announced the appointment of Chellie Hollis Blondes as its new executive director. Blondes has more than 25 years of management experiChellie Hollis ence in the nonprofit health-care industry. Blondes Blondes served as deputy executive director of the Academy for 15 years and as interim executive director for the past seven months. She championed innovative O&P continuing education offerings through the Academy’s Annual Meeting and through the creation, launch, and growth of the Academy's Paul E. Leimkuehler Online Learning Center. She has experience with legislative affairs and is known for fostering collaborative initiatives within the O&P profession. “I am honored to serve the O&P profession as executive director of the Academy, an organization to which I am devoted. O&P professionals work hard every day to enable individuals in need of care to lead full and more productive lives. It amazes me to see how far we have come as a profession, and I am excited about what the future holds,” says Blondes.

The Hanger Charitable Foundation completed its final round of 2016 grants, awarding $225,000 to five nonprofit organizations. These awards bring the Foundation’s total grants awarded for 2016 to more than $424,000, given to 25 organizations. The most recent grant recipients include local and national organizations that serve a variety of communities, including stroke survivors and children and adults living with limb loss or limb difference. Grants were awarded to the Amputee Coalition of America, Amplify Your Voice; No Limits Foundation, Camp No Limits; The Painted Turtle, a medical specialty camp program; Spaulding Adaptive Sports, ski program; and American Stroke Foundation, Next Step Program. The application deadline for the next round of funding is Feb. 24, 2017. Visit the Hanger Charitable Foundation page on for more information.

Rick Fleetwood

Rick Fleetwood of Snell Prosthetic and Orthotic Laboratory was named Outstanding Philanthropist during the 2016 National Philanthropy Day Luncheon sponsored by the Arkansas chapter of the Association of Fundraising Professionals.

Dave McGill and Peggy Chenoweth, advocates for O&P care and people with limb loss, have received Henry Viscardi Achievement Awards for their work in the limb-loss community. The awards, presented on December 1 in New Dave McGill York, recognize “exemplary leaders within the disability community and their extraordinary societal contributions.” McGill and Chenoweth, who each have a lower-limb amputation, cohost the Amp’d podcast and have vocal been advocates for O&P issues. McGill is vice president of reimbursement and compliance at Össur Americas, and also is an AOPA board member and president of the National Association for the Advancement of Orthotics and Prosthetics. Chenoweth writes a blog, The Amputee Mommy, discussing issues affecting people with limb loss, and has a monthly readership of nearly 500,000. She also is a consultant for the Amputee Coalition, where she manages the organization’s social media platforms.



Ottobock was recently featured on the BBC’s Click technology program focusing on technology that helps people who are living with a disability. Each segment is authored by someone who has a disability relating to the technology BBC is evaluating. The prosthetic segment featured BBC reporter Kathleen Hawkins, whose legs were amputated below the knee in 2008 after she contracted meningococcal septicaemia. Hawkins visited Ottobock’s North American headquarters in Austin, Texas, to film the segment on the latest advancements in prosthetic technology. Hawkins tried the new multipurpose Challenger foot and interviewed Mark Edwards, Ottobock’s North American director of professional and clinical services. She also saw how the X3 microprocessor knee works, and how jogging with fitness prostheses can help people live an active lifestyle. View the segment at Ottobock and Myomo Inc. have reached an agreement for Ottobock to exclusively distribute the Myomo® patented MyoPro® orthosis technology globally, starting with select markets in North America and Germany. The Pedorthic Foundation has awarded 10 scholarships to qualified applicants pursuing careers in pedorthics and for continuing education opportunities for the pedorthic footwear/ foot-care retailing communities. The Pedorthic Foundation’s scholarship programs support education and training for students who are seeking pedorthic certification, credentialed pedorthists, and retail footwear professionals and employees. Applications and detailed information for scholarship funds and requirements are available at

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Jumping Into


Breaking down coding and fee schedule changes for 2017 Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.








ment Page took a look at some changes that could be on the horizon for O&P businesses in 2017, this month’s column analyzes changes that are definitely in effect as of Jan. 1, 2017. Review these tips for updating your code lists, fee schedules, and more to make sure you start off 2017 on the right foot.

Code Changes

In early November 2016, CMS released its annual update to the Healthcare Common Procedure Coding System (HCPCS) code set. The 2017 update did not contain any massive upheavals or surprises, unlike those we saw in 2014. However, one code had its official descriptor corrected, three codes were deleted, and four new codes were added to the HCPCS code set. These changes are effective for all claims submitted on or after Jan. 1, 2017. 16


For code L1906, the 2017 change is simply the correction of a typo in the code descriptor. Previously, L1906 contained the word “multiligamentus,” which has been corrected for 2017 to read “multiligamentous.” The full descriptor for each code now reads: “ankle-foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf.” This correction in code verbiage does not alter or change the requirement that any brace described by code L1906 must obtain a Medicare Pricing, Data Analysis and Coding (PDAC) contractor coding verification. The deleted/discontinued codes for 2017 include the following: • A4466—Garment, belt, sleeve, or other covering, elastic or similar stretchable material, any type, each. • K0901—Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. • K0902—Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), mediallateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf. The A4466 code was cross-walked to the newly created code A4467 (belt, strap, sleeve, garment, or covering, any type), and it is assumed that it will remain a noncovered service because it does not meet the statutory definition of a brace; it is not rigid or semirigid in construction. Codes K0901 and K0902 were first introduced in late 2014 and then

reintroduced with the official release of the 2015 HCPCS codes, to describe off-the-shelf versions of single- and double-upright knee braces, usually used to treat osteoarthritis. Traditionally, K codes are designed to be temporary codes—a place holder until an L code can be created or assigned—so it is not a surprise that these two codes were deactivated and cross-walked to new, permanent L codes. The new L1851 will replace the K0901 and the code descriptor will remain the same, and the new L1852 will replace K0902 and the code descriptor will remain the same as well. It is important to stress that L1851 and L1852 are used to describe off-the-shelf braces, which means they require minimal self-adjustment (according to policy and CMS, this an adjustment the patient or his or her representative, or the supplier of the brace, can perform and that does not require the services of a certified orthotist) for fitting at the time of delivery. If you are providing a knee orthosis that does require substantial modifications, those beyond minimal self-adjustment, be sure to use the appropriate custom-fitted codes—in this case, the L1843 for the L1851, and L1845 for the L1852. A9285 (inversion/eversion correction device) is the other new code introduced with the 2017 HCPCS code set. This code is used to describe a device that controls the inversion and/or eversion of the foot, and is believed to be created in response to the code application for the Ottobock Agilium Freestep. At this time there is no guidance or coverage rules for the A9285, but based on the preliminary reviews of the CMS HCPCS Panel, it is believed that the A9285 will be a noncovered service/item.


New Fee Schedules

The 2017 durable medical equipment prosthetics, orthotics, and prosthetics (DMEPOS) fee schedule has been released, and will be increased by 0.7 percent over the 2016 fee schedule. All increases and decreases in the DMEPOS fee schedule are legislatively tied to the increases and decreases in the Consumer Pricing Index for All Urban Consumers (CPI-U). The CPI-U is the average change over time in the prices paid by urban consumers for certain goods and services (e.g., food, housing, clothes, transportation, medical care, etc.) and is calculated by the Bureau of Labor and Statistics (BLS). This year’s CPI-U was calculated using data collected between June 2015 and June 2016. This CPI-U also is the figure that is used to determine the increase or decrease in Medicare enrollment application fees.

you will see an overall increase in the 2017 fee schedule of 0.7 percent. Besides the 0.7 percent increase in the DMEPOS fee schedule, you may be wondering how sequestration—the mandatory 2 percent reduction, applied after the Medicare allowable amount, based on the fee schedule—is determined. As you may recall, sequestration was the result of the Budget Control Act of 2011 and became effective for claims with a date of service on or after April 1, 2013. For the foreseeable future, sequestration will remain in effect for 2017, and most likely will continue for the near future as it is scheduled to remain in effect until 2025. Remember, however, that other insurers may not automatically reduce their reimbursement by 2 percent as a result of sequestration. This is assuming that the terms of most of your contracts involve some sort of reimbursement based on a percentage of the current or future Medicare fee schedules. Since the fee schedule remains the same as prior to sequestration, any discounts negotiated off of the current Medicare fee schedule also should remain unchanged. This is especially true with any of your Medicare Advantage plan contracts because the Social Security Act directly prohibits CMS from getting involved in payment arrangements between providers/ suppliers and the plan providers.

Additional Considerations Since the CPI-U calculation period ended in June, we know with certainty that the CPI-U adjustment will be 1 percent, and the second component of the fee schedule equation is the annual legislatively mandated reduction to the DMEPOS fee schedule or the productivity adjustment. The productivity adjustment, also calculated by BLS, is based on a 10-year rolling average of changes in annual economy-wide private nonfarm business, or a multifactor productivity. The 2017 productivity adjustment for DMEPOS was recently set at -0.3 percent. When you combine the 1 percent CPI-U increase with the productivity adjustment of -0.3 percent,

The start of a new year is a good time to take a moment to review the previous year’s coding announcements and policy changes from Medicare, and make sure they have been incorporated into your policies and procedures, and that your policies and procedures are up to date. You also should be sure your staff is educated and made aware of all policy changes. This is also the perfect opportunity to review your previous year’s breach logs in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and determine if you have any breaches that be must reported by the March 1, 2017, deadline. Under the new HIPAA rules, you must notify CMS (more directly, HHS) of any

breaches within 60 days of the end of the calendar year in which the breach was discovered. This means that any 2016 breaches—specifically those involving less than 500 individuals that occurred and were discovered in 2016— must be reported by March 1, 2017. Finally, as a Medicare supplier, you are required to submit claims at least once within four consecutive quarters, or at least one claim per year, to keep your supplier number and associated billing privileges active. Since each location where you are seeing Medicare beneficiaries is required to be enrolled separately and have its own provider transaction access/supplier number, be sure each office submits at least one claim a year; the best time to take care of this is at the start of the year. If you do not submit at least one claim for each of your locations, your Medicare billing privileges will be deactivated. To reactivate your billing number, you will have to re-enroll with Medicare, including paying the application fee, or you will have to be able to demonstrate that you did submit a claim during the time period in question. During this time, you will not have the ability to submit claims or be paid for any claims associated with that supplier number and location. Now is the time to start fresh and make adjustments that will ensure appropriate reimbursement for 2017 claims. Be sure you understand the new codes and fee schedule, and make sure your business is properly prepared for optimal patient treatment in 2017. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit Earn CE credits accepted by certifying boards:



This Just In

O&P Legislation On Hold While there was no final action on the Medicare O&P Improvement Act during the 114th Congress, the legislation may be acted upon in 2017



its work in a “beat-the-clock” enactment around 11:30 p.m. on Friday, December 9, with the Senate passing a Continuing Resolution just 30 minutes before the government would have shut down. That Continuing Resolution will keep the U.S. government operating through April— without enacting the provisions of the Medicare O&P Improvement Act (H.R. 1530/S. 829). While Congress did come remarkably close to enacting the bill, it did not come to be. However, there is some promise that the bill will pass eventually, possibly early in the 115th Congress.

O&P Legislation Efforts Await New Session

If enacted, H.R. 1530/S. 829 would have accomplished four major steps: • Reiterate, expand, and underscore the mandate for CMS to implement the qualified provider/accreditation provisions first established in Section 427 of BIPA 2000. • Establish the orthotist/prosthetist notes as a legitimate part of the medical record for purposes of establishing Medicare medical necessity. • Complete statutory separation of O&P from durable medical equipment. 18


emerged as leaders in the fight, calling friends in Congress and calling in favors. For example, AOPA Past President Thomas H. Watson, CP, who was recently elected mayor of Owensboro, Kentucky, has been incredibly vigilant and supportive with his outreach within the powerful Kentucky delegation. AOPA President Michael Oros, CPO, O&P advocates had FAAOP, was one of some strong winds form several O&P profesbehind our legislation in the 114th Congress, an sionals who hosted uprising of AOPA/O&P events to advance enthusiasm. Interest the candidacy of now was ramped up with Sen. Tammy Duckworth the AOPA Policy (D-Illinois). The efforts Forum in April 2016, of AOPA’s capable and the preceding lobbying team were Sen. Tammy Duckworth and legislation-writing supplemented with AOPA President Michael Oros, coordination from Congress headed by former Sen. Bob Kerrey CPO, FAAOP lobbyists, such as (D-Nebraska), which gave all Policy former Rep. Scott Klug (R-Wisconsin), Forum participants the opportunity who represents Hanger, and the to write the essential bill components, legislative arms of Ottobock and other and include provisions to best meet manufacturing companies enlisted in the needs of O&P patients. There also the efforts. was remarkably strong advocacy on All of this activity resulted in a the part of all of the legislation sponmuch greater awareness in Congress of the concerns and needs of the O&P sors, and particularly relentless efforts community. The bill qualified as the by Sen. Chuck Grassley (R-Iowa) “triple crown” of what is needed to in the Senate and Rep. Glenn “GT” help pass health-care legislation: Thompson (R-Pennsylvania) in the • No one opposes what is requested House, as well as O&P professionals.   in the legislation. Members of the O&P community • Further clarify the already “bright line” defining off-the-shelf orthotics (and thereby limiting potential eligibility for competitive bidding) to devices that can be used by the patient with “minimal self-adjustment” by “the patient and no other person.” 

This Just In

• The Congressional Budget Office (CBO) confirmed the legislation will not cost the government any money. • Thanks to Kerrey’s efforts, CMS Administrator Andy Slavitt said he supports the bill. Given the swell of support, it may be difficult to understand why the legislation has not yet passed in Congress. But it’s important to remember that Medicare changes do not get enacted as standalone bills. Instead, they are usually grouped together, and are typically enacted in one or two major bills that move, usually at the end of the Congress. This year, there were two such pieces of year-end legislation. The 21st Century Cures Bill had a few Medicare items attached, but the “rules” were that only items that had already passed in either the House or Senate could be added, and the O&P legislation did not fit that criterion. Instead, it was hoped that the O&P provisions would be included in the final Continuing Resolution to fund the government. The O&P team pitched into a full-court press effort to get the legislation included in that resolution. Unfortunately, there was a roadblock in getting final sign-off from CBO confirming that there would be $0 cost, delaying the efforts. But in the end, on Tuesday, December 6, the bill received CBO clearance, and O&P advocates were told by Senate leadership that if any Medicare provisions got included in the Continuing Resolution, one or all of the S. 829 provisions would be among them. Later that day, the draft of the Continuing Resolution was released via the House Appropriations Committee, but a decision had been made in the House not to include any Medicare provisions. While the O&P community is disappointed that the legislation did not cross the finish line, all of the efforts by so many in, and on behalf of, the O&P profession in 2016 advanced our issues and prospects greatly, and that momentum will be carried forward into 2017.  

Administration Changes and the 2017 Work Plan

This month, Donald Trump takes office as U.S. President, and there are new incumbents in the offices as Secretary of Health and Human Services (HHS) and administrator of CMS. The new 115th Congress is ready to start work. As a formal matter, that means everything starts over—new bills will need to be introduced in both Houses, and new committees will be seated with responsibility over Medicare and other health matters. Many O&P stakeholders will continue their work to ensure the O&P legislation passes soon. Kerrey recently expressed his optimism for the O&P law: “We are in very good shape to get this done in 2017. Let’s keep pushing!”

prosthetics delivered to Medicare patients…the new emphasis on orthotics has the potential to trigger significant audits and to drive down both the cost of and quality of care received by Medicare beneficiaries,” says Fise. Fise also says O&P professionals should be aware of how the change in administration and new members of Congress being seated this month may impact health care. “In many senses, cost is king, so the pressures to deliver effective treatments at lower and lower costs will remain relentless,” says Fise. “The truth is that health economists—in government and the private sector—pay more attention to cost of care than they do to quality of care, though, obviously, the two must interact and everyone

How To Take Action What can AOPA members do to assist in advocacy efforts? • Visit to learn the status of key legislative and regulatory topics, and to download summaries and key talking points. • Make plans now to attend the 2017 AOPA Policy Forum on May 24-25. • Consider making a contribution to the O&P PAC. As the O&P community remains hopeful about the future of the Medicare O&P Improvement Act, the community also is keeping a close watch on the 2017 Work Plan released by the HHS Office of the Inspector General (OIG). “Over the past couple of years, the OIG work plans have focused on orthotics, including back braces, reflecting a misunderstanding on why Medicare payments are higher than the OIG fees advertised, for delivery of the device without any services, on the Internet,” says Thomas F. Fise, JD, executive director of AOPA. “It is important to note the priority areas identified by the HHS OIG, and also to try to educate and clarify so these misconceptions don’t end up transforming into errant, misguided policies.” Just as the development of advanced, more costly, prosthetic feet in 2005-2010 “spawned audits and intensive efforts by CMS contractors to trigger change or downgrade the

will embrace the importance of both,” says Fise. “Data, and outcomes…will continue to take center stage. Those who document and can support their treatments scientifically will survive and even prosper. Those who cannot will face a less certain path to viability.” Fise also emphasizes the need for O&P clinicians to code properly. O&P business owners and practitioners, and the rest of the O&P community, are encouraged to reach out to legislators to advocate for the Medicare O&P Improvement Act—and for O&P interests in general. “Lobbyists and AOPA staff can explain issues to legislators and their staffs, but we do not vote,” says Fise. “Clinicians, your fellow employees in your practices, and the patients you serve all vote, and—no surprise—politicians are most interested in folks who vote. So it is very important that you communicate with and visit your legislators.” O&P ALMANAC | JANUARY 2017



The Start of

Something Big

Gearing up for its centennial celebration, AOPA honors its rich history By CHRISTINE UMBRELL

Need to Know • With the association observing its 100th anniversary in 2017, AOPA has a full slate of commemorative activities planned—beginning with these pages, which tell the story of how the association was founded and how the O&P profession has evolved. • AOPA was originally established as the Association of Limb Makers of America in 1917 by 12 representatives of limb manufacturing companies, but the association’s past is tied to the history of O&P in the United States, with several companies tracing their roots to the Civil War. • The association has undergone two name changes, becoming the Orthopedic Appliance and Limb Manufacturers Association in 1946, and the American Orthotic and Prosthetic Association in 1966.



• As technological improvements spurred innovation, O&P companies made more complex devices using more durable materials, and O&P facilities offered increasingly sophisticated prostheses and orthoses to improve patients’ function. • Over time, the association has expanded its scope, offering more business education, government relations initiatives, and international relations activities. • The past 10 years have been especially productive for AOPA, with members increasingly accessing reimbursement education, and benefitting from targeted advocacy efforts and research initiatives. • Celebratory activities planned for the year include a commemorative membership directory, new columns in each month’s O&P Almanac, and special events at the AOPA World Congress and 100th National Assembly in September.


For the past 100 years, the American Orthotic and Prosthetic Association (AOPA) has led the way in advocating for O&P professionals, by ensuring favorable treatment for O&P businesses in legislation, regulation, and services; helping members improve their management and marketing skills; and raising awareness of the industry and the association.


OTH IN THE SPOTLIGHT and behind the scenes, AOPA’s

work has occasioned countless O&P victories—resulting in more knowledgeable practitioners, savvier O&P business practices, better-educated legislators, more O&P-friendly laws, and more favorable reimbursement. The association’s staff has continuously worked side-by-side with members to guide O&P facilities through challenging times, celebrating the many successes along the way. With the association observing its 100th anniversary in 2017, AOPA has a full slate of commemorative activities planned, which will culminate with a celebration at the AOPA World Congress and 100th National Assembly in Las Vegas this September. The O&P Almanac will take part in this year-long celebration, featuring new columns such as “Then & Now,” which will highlight AOPA’s historical accomplishments, and “Bridge to the Future,” which will forecast the future of the profession. We begin the celebration this month, with a special tribute to AOPA’s past 100 years. In these pages, we share the story of how the association was founded and how the O&P profession has evolved, paying particular attention to historical events that have shaped current achievements.






1918 ALMA Annual Meeting

AOPA’s Early Years

While 1917 marks the year AOPA was established, the association’s past is tied to the history of O&P in the United States, predating the association itself. The Civil War and its 60,000 amputation surgeries spurred the growth of the O&P industry in the United States. Some of AOPA’s oldest member companies have histories dating back to that time period and its aftermath, as veteran amputees sought improved devices. For example, J.E. Hanger, one of the first amputees of the Civil War, designed the “Hanger Limb” from whittled barrel staves and was granted two patents from



the Confederate government. He was later commissioned to develop prosthetic limbs for veteran soldiers. After the war, Albert Winkley patented the “slip socket” to reduce friction between the socket and the stump by wrapping a piece of leather around the residual limb, and, in 1888, established the Winkley Artificial Limb Co. William Arbogast, a railroad brakeman who became a bilateral amputee in a train accident in 1905, established Ohio Willow Wood, a prosthetic manufacturing company in 1907. In 1911, R.W. Snell bought the prosthetics and orthotics end of a surgical supply business in Memphis. The D.W. Dorrance Co. was founded in 1912, manufacturing a popular arm prosthesis. The company later underwent a merger to become the Hosmer Dorrance Co., now a subsidiary of the Fillauer Cos., which got its start in 1914, when George Fillauer, a German immigrant, opened a pharmacy that offered orthoses. Against this backdrop, AOPA emerged in 1917, just as the United States entered World War I—a conflict that would leave 2,300 American soldiers as amputees. The story of the founding of AOPA—originally called the Association of Limb Makers of America (ALMA)—was documented in ALMA’s 1922 “Open Letter to Each Physician and Surgeon of the Land,” which read as follows: On April 15, 1917, 12 representative artificial limb manufacturers of the United States were called to Washington by the Council of National Defense.


A conference was held with the surgical staff of the U.S. Army and Navy. The purpose was to impress on the limbmakers the importance of immediate preparation for efficient and skillful service for the amputated soldiers as soon as they returned from Europe. As a result of the conference and under advisement of the government officials, the Association of Limb Makers of America came into existence. During ALMA’s earliest years, the association did not have a central office or staff. “The major value of ALMA was that it permitted the free exchange of ideas between limb manufacturers. At its meetings, some attempts were made to present technical papers and, from time to time, the organization published a newsletter or magazine called the ALMAnac,” reports the History of Prosthetic-Orthotic Education. One of the earliest gatherings of association members occurred when 33 members assembled at the 1918 Annual Convention in Indianapolis. Between the years of 1917 and 1922, ALMA held eight meetings in different states, had regional offices throughout the country, and developed a code of ethics. November 1918 marked the end of World War I and also denoted the evolution from simple one- and two-person shops to larger facilities. O&P research initiatives became more prevalent, thanks in part a research program instituted by ALMA. ALMA members also were kept busy during the 1920s due to the rise of industrial accidents. A 1924 article in Surgical Appliance and Instrument Review stated, “Competent investigators have found that industrial accidents alone in the United States injure over a million and a half. Of this number, about 30,000 are amputation cases.” ALMA soon began its focus on elevating the profession. In 1924, ALMA President Chester B. Winn gave a rousing speech during the association’s Seventh Annual Meeting, which was documented in an issue of Surgical Appliance and Instrument Review. Winn spoke of the association’s emphasis on the use of “clean competition” to avoid price fixing and noted



1940 ALMA Annual Meeting

that ALMA members should conduct their business “with a firm resolve to make their product better and in keeping with the standard advanced by our association, which has brought forth a gradual increase in the benefits to be derived from correctly manufactured prostheses.”

Expanding Services

After the bombing of Pearl Harbor on December 7, 1941, the United States entered World War II, and ALMA took on a larger role, ensuring prosthetic professionals were prepared for the deluge of amputee and limb-impaired patients. Such support was essential as the brutality and length of U.S. involvement led to 18,000 amputees. This time period also saw many improvements to O&P devices. Some practitioners began to use plastic laminates instead of wood. Researchers at Northrop applied the same cable system used to control aircraft to power split hooks in upper-limb prostheses. In fact, the first patella tendon-bearing below-knee prosthesis was introduced, which became the basis for more modern prostheses.

Private companies also contributed to O&P development. Ohio Willow Wood introduced the first semi-finished, above-knee prosthesis, which used interchangeable parts. In 1948, Jim Snell developed a revolutionary process for making lightweight leg braces, using aluminum that was heat-treated after shaping, with steel bushings at the knee and ankle joints. Patient-care company Wright & Filippis debuted in 1944, and Leimkuehler Limb Co. opened its doors in 1948. In 1946, ALMA leaders invited orthopedic brace fabricators to join the association, resulting in a name change to the Orthopedic Appliance and Limb Manufacturers Association (OALMA). OALMA established a national office in Washington, DC, and hired an executive director. In 1948, OALMA members recommended the formation of an organization with the responsibility to establish minimum requirements for the operation of a limb or brace facility to ensure that patients would receive adequate service. The American Board for Certification of the Prosthetic O&P ALMANAC | JANUARY 2017



and Orthopedic Appliance Industry Inc. was formed, which later became the American Board for Certification in Orthotics and Prosthetics Inc. (ABC). At the recommendation of an ABC advisory committee, OALMA’s Education Committee developed on-the-job training schedules and course materials for related training to meet the adopted standards for apprenticeship training. Meanwhile, OALMA continued to hold meetings and grow its membership. The organization began publishing a journal, initially called The Journal of OALMA from 1946 to 1951, which became the Orthopedic & Prosthetic Appliance Journal from 1952 to 1967 and Orthotics and Prosthetics from 1967 to 1988. AOPA co-published the Journal of Prosthetics and Orthotics from 1988 until the dissolution of the O&P National Office. AOPA also published an early version of the O&P Almanac, initially called the ALMAnac, and later the OALMA Almanac. In the middle of the 20th century, when the United States became involved in the Korean War, OALMA members helped tend to wounded warriors once again, with more than 1,500 amputations to U.S. soldiers recorded during this conflict. The 1950s also marked the establishment of O&P schools at some universities. The University of California–Los Angeles (UCLA) began to offer its Prosthetic Education Program in 1952. New York University and Northwestern University soon followed suit, offering short courses in various aspects of O&P. In 1958, an 18-month program in upperextremity orthotics was begun at Rancho Los Amigos Hospital in Downey, California, which expanded to a 24-month program to include lower-extremity orthotics. In January 1958, members of the Executive Committee of OALMA and eight OALMA past presidents met for four days in Augusta, Georgia, at a “Planning Our Future” event. The event’s minutes noted that OALMA had made remarkable progress during the past decade, and that 24


1957 OALMA National Assembly

1957 OALMA National Assembly



1957 OALMA National Assembly

1960 OALMA National Assembly Becker exhibit booth

the profession was undergoing a remarkable transition: “Are we a business or a profession? Hopefully we have to be both. And, are we mechanics, with engineering skills, or are we in the medical field where the structure of anatomy is all important? Again, we have to be both. Therein lies our complicated future.”


The 1960s were a decade of change for the nation, and for AOPA. In particular, 1960 was a notable year because of the election of John F. Kennedy to the presidency, the development of the first pacemaker, and the first U.S. troops being sent to Vietnam. More than 5,300 U.S. service members became amputees. O&P technology continued its rapid advance, with innovations such as Ohio Willow Wood’s first solid-ankle-cushion-heel (SACH) foot and Durr-Fillauer’s introduction of nonporous, thermomoldable foam called PeLite. Over at Becker—a manufacturing company originally founded in 1933 by Otto K. Becker—a new double-action joint and modified drop-lock knee joint were being developed. The first reciprocating gait orthosis also was introduced.

1967 AOPA National Assembly and 50th Anniversary celebration

A game changer in the U.S. healthcare system arrived during this decade, with the enactment of Medicare in July 1965. With 19 million individuals signing up during the program’s first year, Medicare opened access to O&P care to many Americans who had previously gone without due to cost—leading to more growth for the O&P profession. This was also a period of transition for OALMA, beginning with a name change to the American Orthotic and Prosthetic Association in 1966. In the early 1970s, AOPA helped develop a guideline for the O&P education coursework essentials, universal orthotic-prosthetic terminology, and new occupational titles and job descriptions. Shortly thereafter, AOPA established the Business Procedures and Liaison Committee. Government and international relations activities also expanded during these years.

1992 ISPO 7th World Congress




1978 AOPA Past Presidents





1967 AOPA National Assembly ribbon cutting

AOPA partnered with ABC in 1970, calling for the development of an organization focused on continuing education for O&P professionals. As a result, the American Academy of Orthotists and Prosthetists was founded in November 1970. In 1976, AOPA joined forces with ABC and the Academy at a seminal meeting in Ponte Vedra, Florida, to evaluate the O&P profession’s education and occupational status. This meeting led to the requirement of a fouryear baccalaureate degree for O&P practitioners going forward. In the 1970s, the yearly AOPA National Assembly continued to be a popular event. Due to AOPA’s limited staff, most Assembly activities were organized by members, says Don Hardin, who volunteered for the National Assembly Committee in the 1970s and 1980s and served as AOPA president in 1991-1992. Then, as now,

members eagerly anticipated the meetings each year, but they were held in hotels rather than convention centers. AOPA was instrumental in helping to develop the L codes, which were created to provide a consistent, standardized method to describe the way O&P services were being provided. The Health Care Financing Administration (HCFA) adopted the system and established the Healthcare Common Procedure Coding System (HCPCS) in 1978. The L codes are included in HCPCS Level II codes. In 1979, another seminal AOPA program made its debut: AOPA’s Loss Control Program, which was designed to save members money by reducing overall rates for malpractice and product liability insurance. With a slew of new member benefits in place, AOPA membership numbers soared, almost doubling between 1973 and 1980. AOPA was well-prepared to lead the O&P profession into the final two decades of the 20th century.

Technology Takes Off

With the 1980s and the advent of personal computers, the dawn of the digital age arrived. In O&P, there was extraordinary innovation with the development of Van Phillips’

“spring-like” Flex-Foot Inc. in 1984, and the subsequent debut of Ernest Burgess’s energy-storing Seattle Foot. Endoskeletal prostheses also gained ground, featuring modular components. And advances in fiber technology enabled companies such as Knit-Rite to incorporate high-stretch yarns and wicking yarns, as well as silver fiber, into their O&P products. The 1980s also saw the introduction of computer-aided design and manufacture (CAD/CAM) technologies, which would revolutionize prosthetic practice with increased shape management options, production capabilities, and access to outsourced fabrication as well as greater ease in transmitting digital files. AOPA extended its interests to such areas as business education and members’ marketing needs. One of AOPA’s most widely regarded publications was released in October 1986: the first edition of the Pictorial Reference Manual of Orthotics and Prosthetics, now known as the Illustrated Guide. In 1990, AOPA and the O&P profession claimed a major victory when O&P won the right to be considered a separate field from durable medical equipment for reimbursement purposes. Other efforts on Capitol Hill resulted in the signing of H.R. 3839, which increased funding for O&P schools. The first AOPA Legislative Conference took place in 1992, as AOPA celebrated its 75th anniversary. At that conference—which was later renamed the AOPA Policy Forum— several O&P professionals convened on Capitol Hill to meet individually with lawmakers and share the O&P message. This marked the beginning of AOPA’s annual trek to DC. (See more on the history of the AOPA Policy Forum in Then & Now on page 36.) The 1990s saw more technological innovation, marked by the introduction of Endolite’s swing-control microprocessor knee in the early 1990s and the 1997 release of Ottobock’s C-leg, the first fully microprocessor-controlled leg prosthesis system. These technologies changed not only the ability of people O&P ALMANAC | JANUARY 2017







1999 AOPA Board Meeting

2015 AOPA led rally in front of HHS in response to the draft LCD limiting prosthetic care 2000 World Rehab Fund Dinner honoring Van Sabel, from left: Tom Watson, CP; Van Sabel; and C. Michael Schuch, CPO, FISPO, FAAOP

to walk but also the reimbursement climate, with greater scrutiny of O&P devices due to the higher costs associated with advanced technology. Improved componentry brought with it more widespread participation of O&P patients in athletic endeavors. In 1995, AOPA, in conjunction with ABC and the Academy, established and incorporated the Orthotic & Prosthetic Activities Fund. The fund was initially dedicated to providing financial and in-kind support to the 1996 Atlanta Paralympic Games. After the Games, the fund continued to provide support to adaptive sports programs, clinics, and activities. AOPA demonstrated its influence in 1996 in several ways. In a legislative win, AOPA persuaded the Senate Judiciary Committee to shelve the Prosthetic Limb Access Act of 1996, which would have increased manufacturers’ liability and provided “used” prosthetic devices to the poor. AOPA also worked with the Academy to develop and disseminate educational materials related to the new ABC Facility Accreditation Program and Standards. In addition, AOPA debuted its first website: 26


21st Century and Beyond

AOPA began the new millennium as a more inclusive association, changing its bylaws in 2001 to include more O&P businesses and thus be more representative of the entire O&P industry. The broader membership led to AOPA having an even stronger, more effective voice on Capitol Hill. In 2001, the 9/11 attacks shocked the world, causing the deaths of nearly 3,000 people and injuring 6,000 more. In response, the United States engaged in war in Afghanistan, known as Operation Enduring Freedom, which continued from 2001 through 2014. Beginning in March 2003, the United States also engaged in Operation Iraqi Freedom. These U.S. engagements resulted in more than 1,600 major limb amputations as of June 2015, according to U.S. Military Casualty Statistics. Many O&P facilities and manufacturers rose to the challenge of creating innovative prosthetic solutions for the generally young and active military amputee population. As the rate of technological innovation accelerated in the 2000s, AOPA member companies kept pace. In 2000, Össur—an O&P manufacturing company founded in Iceland in 1971—acquired Flex-Foot Inc. Össur’s presence in the United States grew throughout the decade, as the company

applied for hundreds of U.S. patents and established Össur Americas. In the 21st century, advanced myoelectric devices have increased in popularity, particularly as more amputees undergo advanced surgeries such as osseointegration and targeted muscle reinnervation. Innovations such as powered orthoses, virtual reality, brain-controlled prostheses, alternative materials, and 3-D printing are leading O&P professionals to explore new solutions. O&P stakeholders have begun collaborating in unprecedented ways, with AOPA leading the way. In 2005, AOPA joined forces with ABC, the Academy, and the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) to form the O&P Alliance. The Alliance’s accomplishments have included convincing the Centers for Medicare & Medicaid Services (CMS) to make the new Medicare standards more reasonable for O&P, lobbying for removal of O&P from competitive bidding, and pushing CMS to enforce qualified provider regulations. AOPA also has been the go-to resource for O&P professionals struggling with an increasingly challenging reimbursement climate. As more stringent documentation requirements were enforced, AOPA has provided guidance to help facilities understand the guidelines, navigate the audit and appeal processes, and improve overall documentation procedures. This instruction has come via monthly webinars and periodic coding and billing seminars, as well as via the AOPA website, O&P Almanac, AOPA In Advance, and other member benefits. AOPA has continued to lead research efforts, securing grants for outcomes-based research, and commissioning a study by DobsonDaVanzo that ultimately proved the efficacy of custom orthoses versus off-the-shelf devices. In July 2015, AOPA wielded its influence at a pivotal moment when the DME MACs published a draft Local Coverage Determination (LCD) governing Medicare coverage of


lower-limb prostheses. If enacted, this policy would have dramatically and adversely impacted care. AOPA immediately spearheaded an initiative that generated more than 5,000 comments, which were included in the official record for LCD rule-making. AOPA itself submitted 43 pages of comments, and conducted a data analysis demonstrating that the data used by CMS contractors to support their proposed policy was based on outdated information. On Aug. 26, 2015, AOPA arranged for five speakers at the DME MAC public meeting in Linthicum, Maryland, then organized a patient rally at the headquarters for the U.S. Department of Health and Human Services. At the rally’s conclusion, AOPA representatives met with high-ranking CMS officials, who said they would work with the regional contactors’ medical directors to reach a solution. These efforts were extremely successful; CMS soon announced that it would not finalize the draft LCD, and that the LCD would not be implemented in its original form. CMS has since convened a multidisciplinary Interagency Workgroup to “develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower-limb prostheses.” The decision to halt the progress of the proposed LCD was a clear win for AOPA and the profession, effectively defeating a bad payor policy.

Moving Forward

AOPA’s member offerings continue to expand. This year, as AOPA celebrates its 100th anniversary, there are several key imperatives that have been set in motion by AOPA that will likely have a favorable impact on the profession, including a national Prosthetic Patient Registry, comparative effective research, new projects with DobsonDaVanzo, and the Prosthetics 2020 initiative, says Michael Oros, CPO, FAAOP, AOPA president. “Our leadership believes the results and impact of each of these will bring long-term value to each of our AOPA members.”

AOPA Expands Offerings for 2017

As AOPA celebrates its 100-year anniversary, the association will offer a number of special member benefits: • AOPA’s 100th Anniversary Commemorative Who’s Who Membership Directory: This directory will be printed and distributed as a gift to all AOPA members. It will feature each member’s company name, address, and employee names. This publication will feature special sections for O&P history, technology timelines, and photographs that will showcase AOPA members’ proud heritage. AOPA members have the opportunity to add a special message to AOPA in the directory, in Who’s Who the form of congratulatory ads. Contact Bob Heiman at or 856/673-4000 with advertising questions. 100th Anniversary Commemorative Membership Directory

• O&P Almanac: Each monthly issue of the association’s flagship magazine will feature special anniversary-related content, including a “Then & Now” column highlighting historical accomplishments and a “Bridge to the Future” column designed to anticipate the next 100 years of the profession. • AOPA World Congress and 100th Centennial Celebration: Several events are scheduled for AOPA’s September 6-9 Assembly in Las Vegas. More information will be announced as the event nears. AOPA would like to include personal member stories in the year-long celebration. Please visit to share your photographs, memorabilia, and memories, which may be featured on AOPA’s commemorative website, on social media, and at the AOPA World Congress. Elvis greets exhibitors the 2016 AOPA National Assembly in Boston

As AOPA members ponder the association’s accomplishments of the past 100 years, it’s clear that AOPA is going strong, continuing to lead efforts to advocate on behalf of the O&P profession today—and into the next 100 years. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at

EDITOR’S NOTE: This article is a condensed version of a more detailed feature about the history of AOPA and the O&P profession that will appear in AOPA’s 100th Anniversary Commemorative Who’s Who Membership Directory, to be published this year.




The Future Is

Virtual A primer on telehealth: How is it shaping patient care and O&P of tomorrow?



NEED TO KNOW Telehealth—the use of medical information exchanged from one site to another via electronic communications—is becoming more commonplace, with some health-care facilities leveraging the technology to increase access to care and reduce costs.


Telehealth can take many forms, including patientphysician consultations via video conferencing, online patient portals, remote monitoring, nursing call centers, consumer-focused wireless applications, and much more.


to reduce costs is one of the ways health-care facilities can boost profits and ensure continued success. And figuring out how to make office visits easier and less expensive for patients is another key to attracting and retaining patients. Both of these goals can be achieved via telehealth. According to a 2014 report from The Commonwealth Fund, more than one third of adults who reported forgoing a recommended test, treatment, or follow-up care in the past year, did so because of cost. The issue of access is a familiar one for the O&P profession, with evermore regulations that pinch facility resources and a growing patient population in need of care and the latest devices. But technological advances in the way health care is provided could bring a much-needed boost for U.S. health care in general and, more specifically, the O&P profession. “Many believe that the answer to issues of cost and access in the U.S. health system lies in telehealth, which increases access to care, alleviates travel costs and

Some O&P professionals are experimenting with aspects of telehealth to consult with specialists for remote evaluations, get assistance from manufacturers in fitting new high-tech devices, and involve other health-care professionals in a team approach to patient care.

burdens, and allows more convenient treatment and chronic condition monitoring,” writes Tony Yang, associate research professor for the department of health administration and policy at George Mason University in a recent Health Affairs “Health Policy Brief.” As an increasing number of healthcare organizations, including O&P facilities and providers, incorporate telehealth into their practices, clinicians and patients are enjoying a more efficient, streamlined, and futuristic approach to care.

To Infinity and Beyond

So what actually is telehealth? The American Telemedicine Association (ATA) defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.” The related or alternative term “telehealth” often is used to encompass “a broader definition of remote health care that does not always involve clinical services.”

While the technology can offer many benefits, practitioners must ensure compliance with the Health Insurance Portability and Accountability Act, and investigate how reimbursement will be handled, before moving forward with telehealth.

Clearly, telehealth “is a broad term that encompasses many different services,” says ATA Chief Executive Officer Jonathan D. Linkous. For example, it may refer to patient-physician consultations via video conferencing, online patient portals, remote monitoring systems for intensive care units and chronic care patients, nursing call centers, consumer-focused wireless applications, and much more. It’s certainly not a new development. Nearly 50 years ago, the National Aeronautics and Space Administration developed medical telemetry and cardiac monitoring devices, which were used by astronauts during the first moon landing in 1969. It only continues to grow in application and implementation with the help of the Affordable Care Act (ACA), which takes steps to encourage and include telehealth services in health-care coverage. O&P ALMANAC | JANUARY 2017


But it’s important to note that “the ACA only implemented telehealth at the federal level through Medicare, in selected circumstances,” writes Yang. “The power to determine which, if any, telehealth services are covered by Medicaid still remains largely within the powers of individual states.” So there is still a long way to go before more widespread acceptance catches on—one of the many challenges telemedicine faces. Despite the hurdles, nearly 90 percent of health-care executives surveyed for a 2014 Foley study reported that their organizations had begun developing or had already implemented a telemedicine program. And the number of telemedicine patients is expected to increase in coming years, from 350,000 in 2013 to 7 million in 2018, according to a Cisco Customer Experience Report. The concept sounds simple enough, but implementing a successful telehealth program is anything but. “The components of success vary widely depending on the application,” Linkous says. In general, he says, it requires provider buy-in—there is still a lot of resistance to change in health care—as well as integration with in-person care and reimbursement. Another key to successful implementation is having the proper infrastructure in place, as slow




2018 (Predicted)

SOURCE: Cisco Customer Experience Report



Internet speeds or an exposed network could thwart success and detract from the patient experience. Of course, whenever patient data is being transmitted, compliance with the Health Insurance Portability and Accountability Act (HIPAA) and security concerns come into play. To ensure the safety of patient data, HIPAA guidelines encourage the following best practices for telehealth programs: • Only authorized users should have access to electronic protected health information (ePHI). • A system of secure communication should be implemented to protect the integrity of ePHI. • A system of monitoring communications containing ePHI should be implemented to prevent accidental or malicious breaches. • Only secure messaging solutions (including mobile devices and portals) should be used. • An established patient privacy policy as well as business associate agreements should be in place.

Fitting the O&P Mold

While aspects of telehealth implementation are universal, its application across subspecialties is less so. Can this remote, tech-driven movement actually work for such a hands-on profession as O&P? It can, and the evidence of its efficacy continues to grow. A March 2016 report by the President’s Council of Advisors on Science and Technology found that technologies, such as telehealth, prosthetics, and wearable sensors, can help more elderly Americans stay healthy and connected, as well as enable them to live independently, in their homes and communities, for as long as possible. The same can be said for patients with serious medical conditions and mobility issues. Linkous says that telehealth can be helpful in remotely monitoring and measuring gait, providing follow-up care post-hospitalization, and more. Telehealth has proven to be a useful tool for Matthew Mikosz, CP, LP, national clinical specialist, upper extremity, at Hanger Clinic.

As a traveling specialist who covers a large region, he uses telehealth for remote evaluations and follow-up appointments, and to assist with routine maintenance and servicing with local clinicians. “I also utilize it to walk a local clinician through the process of programming multi-articulating hands, elbows, and wrists, and many other tasks that may not require me to be there in person,” he says. Telehealth gives him the ability to demonstrate mold modification techniques, aspects of the casting process, harnessing and cabling troubleshooting or setup, and more, to clinicians from afar. In short, it allows his services and expertise to be accessed by a greater population of practitioners and patients. Clinicians at Ottobock have had a similar experience and applaud telehealth’s many benefits for O&P. “We use programs like LogMeIn and Webex to assist customers with programing of various high-tech devices,” says Mark Edwards, MHPE,

Key Telemedicine Terms Phrases to know, as defined by the American Telemedicine Association DISTANT SITE: Site at which the physician or other licensed practitioner

delivering the service is located at the time the service is provided via telecommunications system. (Other common names: hub site, specialty site, provider/physician site, referral site, or consulting site.)

ORIGINATING SITE: Location of the patient at the time the service being

furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service. (Other common names: spoke site, patient site, remote site, and rural site.)

PROTECTED HEALTH INFORMATION (PHI): Part of the HIPAA Privacy Rule that protects all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. REMOTE MONITORING SYSTEMS OR HOME HEALTH CARE:

CP, Ottobock’s director of professional and clinical services, North America. “We often will use Facetime or Skype to remotely assist in fittings where we cannot be there in person.” This presents a huge advantage for O&P businesses because the patient and O&P practitioner do not have to wait for the Ottobock clinician to be on site to assist with fittings for specialized high-tech devices. As a result, patients enjoy a more seamless experience; facility owners see efficiency, which boosts their bottom line; and O&P professionals can direct their time and energy to more challenging cases and situations. According to Edwards, any O&P facility can reap these benefits, but smaller clinics that have fewer resources and fewer clinicians, who may desire support and collaboration, may see the biggest returns. Telehealth also seems to integrate well with a team approach to care. According to Mikosz, it enables O&P clinicians to bring in specialists from across the country to consult

Care provided to individuals and families in their place of residence for promoting, maintaining, or restoring health, or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims and enrollment data, home health care refers to home visits by professionals including nurses, physicians, social workers, therapists, and home health aides. Use of remote monitoring and interactive devices allows the patient to send in vital signs on a regular basis to a provider without the need for travel. STORE-AND-FORWARD (ASYNCHRONOUS COMMUNICATION):

Type of telehealth encounter or consult that uses still digital images of patient data for rendering a medical opinion or diagnosis. Common services include radiology, pathology, dermatology, ophthalmology, and wound care. Store-and-forward includes the asynchronous transmission of clinical data from one site to another. SYNCHRONOUS COMMUNICATIONS: Interactive video connections that

transmit information in both directions during the same time period.

TELEMEDICINE AND TELEHEALTH: Telemedicine is the use of

medical information exchanged from one site to another via electronic communications to improve patients’ health status. Telehealth often is used to encompass a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, and nursing call centers are all considered part of telemedicine and telehealth.



These initial evaluations are free, so there would be no charge to the patient or insurance company, but other consultations throughout the process would be subject to reimbursement, which may not be covered for O&P.

Balancing Benefits With Hurdles

on specific cases or aspects, such as prosthetic design, where otherwise it would not be feasible. “We also use it quite frequently for conference calls and to discuss and share case presentations amongst my team of national specialists,” he says. “This is a great opportunity for a team approach and collaboration to achieve the optimal design for our patients.” In other cases, Mikosz has been involved in last-minute evaluations with surgeons, therapists, patients, and clinicians, where another clinician has reached out to him to be involved in a patient appointment, along with the rest of the team. “This allowed me to provide my feedback and avoid having the patient need to make a separate appointment to come to see me for another evaluation,” he says. That kind of efficiency is attractive to patients. “I believe patients accept remote consulting if it minimizes their need to come in for extra appointments and if it can expedite the process of providing them their device,” he says. “In cases where patients request me to be present, I make it a priority to be involved personally. Telemedicine allows me to decide when it makes sense to be involved remotely or if I am needed in person.” 32


Mikosz has used aspects of telehealth to perform Web-based video evaluations for patients who live or are traveling across the globe, from the British Virgin Islands to Dubai to Australia. And these remote evaluations very closely resemble an in-person consultation, with a few distinctions. One of the biggest differences is in the process of preparing for the evaluation; Mikosz must thoroughly check the Internet connection and equipment and troubleshoot any issues to ensure that the process runs smoothly. But very much like in-person visits, the appointment is prescheduled with the clinician(s) and patient, and Mikosz starts out by introducing himself and explaining his role throughout the process. He completes a formal evaluation form with all of the pertinent information for the patient file and insurance purposes. Then, he instructs the clinician to perform a myotest and manual muscle test to evaluate the patient’s range of motion. Finally, he discusses the available options, explaining the benefits of each, and he works with the on-site clinician and patient to put together a plan. All three (or more) parties are able to see, hear, and interact with each other throughout the evaluation—even if they are hundreds or thousands of miles apart.

A well-developed and well-implemented telehealth program offers value, both to patients and to practitioners. For Linkous, it provides three key benefits: First is improved access to health care, as millions of patients, who otherwise would not feasibly be seen by a physician due to provider shortages, mobility issues, etc., are given access to providers and even specialists across the country. It also allows physicians and facilities to expand their reach and impact with a broader patient base. For example, according to the Office of the National Coordinator for Health Information Technology (, “telehealth can help rural providers deliver better health care by connecting rural providers and their patients to services at distant sites and promoting patient-centered health care.” This increase in access and more regular monitoring and feedback from a provider may help empower more patients to take control of their health and better manage conditions and overall wellness. The second benefit is improved quality. “The service often is received more quickly than waiting for an appointment and sitting in a waiting room with other sick patients,” says Linkous. Patients are more likely to seek out care if it is a relatively painless experience. Telehealth also can help to connect patients with more qualified specialists.



The third key benefit is cost savings. According to the ATA, “telemedicine has been shown to reduce the cost of health care and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.” And for the broader health-care landscape, a study by Center for Information Technology Leadership found that telemedicine could save the United States $4.28 billion on health-care spending per year. But it’s not without its challenges. According to Linkous, some of the biggest hurdles that medical doctors face, which could extend to O&P, include “resistance from the status quo; integration in established health systems; over-regulation by state medical boards who don’t understand telemedicine and fear it will take away doctors’ jobs and are requiring a medical license from each state [both of which hinder implementation]; and payment from insurance payors, especially Medicare.” So, why do the states have so much say in where and how telemedicine is implemented? The ACA provided support for telemedicine but only implemented it at the federal level through Medicare, which only covers “synchronous communications,” such as real-time video. It does not cover “store-and-forward services”—a type of encounter or consult that uses still digital images of patient data

for rendering a medical opinion or diagnosis—or remote patient monitoring for chronic diseases, except in a few states. It’s important to note that Medicare offers coverage for these aforementioned services for patients who “live in some rural areas… under certain conditions,” and are receiving care in certain locations, including a doctor’s office, a hospital, a critical care facility, and others. At this time, Medicare does not cover telehealth services provided at O&P facilities. As recently as January 2016, the ATA was lobbying Medicare to reimburse physicians for a number of others services conducted via telehealth, including “adjustment and clinical support of prosthetic devices.” And there’s hope on the horizon: CMS recently introduced a model that would extend telemedicine coverage to 80 percent of Medicare beneficiaries in urban areas, and the Medicare Telehealth Parity Act of 2015 (H.R. 2948) was introduced as a bipartisan effort to “modernize” the way Medicare pays for telehealth coverage. According to Yang, “the act would expand the number of qualifying geographic locations and expand coverage of telehealth services, although its likelihood of enactment is unclear.” While it may not specifically provide more coverage for O&P

telehealth services, it does signify an expansion in coverage, and that could be good news for O&P and other industries. Outside of the federal system, we are beginning to see an improvement in private insurer reimbursement for telehealth services. “It is a complete change” from a few years ago, says Linkous. “Insurers are paying for telemedicine services and in some cases, even offering their own.” For example, Anthem recently launched its own telehealth joint venture with American Well called LiveHealth Online, which allows patients to have face-to-face conversations with doctors via computer or mobile device. Of course, implementing telehealth is not “so simple,” nor is it something that can be done in every O&P clinic today, say experts. But O&P businesses that investigate how some aspects of the technology could be integrated into their facilities stand to benefit in the long run. Ultimately, telehealth can offer “the ability to communicate remotely before and after the hands-on appointment to maximize the outcome for the patient and provide an optimal level of follow-up care,” says Mikosz. Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at



Join AOPA. 1917



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A strong voice today‌ and for the


Together we are AOPA. 100 years ago our O&P predecessors thought we needed a unified voice to secure the future of our profession. They were right. Our profession needs a strong voice today and for the next 100 years. Your membership matters!

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AOPA Policy Forum Annual convergence on Capitol Hill gives voice to O&P concerns New


Then & Now is a new monthly department for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will feature a different AOPA member benefit and discuss how it has evolved over the years. This month, we focus on the annual AOPA Policy Forum.


F YOU WANT TO have a say in public

policy to make sure laws and regulations don’t negatively impact your industry, you have to spend some time in Washington. That’s the rationale behind AOPA’s annual Policy Forum. As AOPA commemorates its 100-year anniversary during 2017, the association also celebrates the 25-year anniversary of its seminal advocacy event. The annual AOPA Policy Forum has become the most important gathering of the year for O&P professionals hoping to influence legislation. Each year, AOPA brings together Thomas H. hundreds of providers and Watson, CP patients in a unified voice on Capitol Hill to meet with their respective lawmakers and educate them on the most pressing issues affecting the profession and how to resolve them.

1999 Policy Forum. From left: Anthony J. Filippis, CPO; Aziz Naser, CPO; Tim Codd; and Dan Beardslee meeting with Rep. Dale Kildee (D-MI).




The first AOPA Legislative Conference took place in 1992, as AOPA celebrated its 75th anniversary. At that conference—which was later renamed the AOPA Policy Forum—several O&P professionals convened in Washington, D.C., to meet with lawmakers and share the O&P message. The first event was a small one, and participants had to be taught how to approach legislators to advocate on behalf of the O&P profession, says Thomas H. Watson, CP, who attended the event. “Congress had no idea what we did for a living and that we were the most qualified people to tell our story,” says Watson, who later served as 2000-2001 president of AOPA. He recalls reminding Policy Forum attendees that legislators are supposed to work for their constituents, and in-person meetings provide the proper forum for asking for support. As members began to understand the importance of selfadvocating, the yearly Policy Forum became a much more popular event, says Kathy Dodson, a former Kathy Dodson senior director of government affairs for AOPA. “In the first few years, the attendance was low. We were lucky to get 40 people, and one year we actually had to cancel because we only had 11 people sign up,” says Dodson. “But in later years it picked up as we had a track record and advertised it more.”


Left to right: Thomas H. Watson, CP; William De Toro, CO; and, Ralph (Ronney) R. Snell, CPO, FAAOP, at the 1999 AOPA Policy Forum

(Left) Scott Williamson, MBA, and Glenn Crumpton, LPO, CPed, during the 2016 AOPA Policy Forum

some members bring patients to share The event also attracted increasing numbers of participants as more serious the O&P message, which can have a great impact on the legislators during problems arose, “with Medicare, the in-person meetings. Department of Veterans Affairs, the U.S. Every year there seems to be a new Food and Drug Administration, and others,” says Dodson—issues that would “hot topic” to address during meetings with legislators. “Sometimes we would require congressional support for O&P. have only a couple of talking points, “Each year, as it is now, the goal was to while in other years we would have a determine how Congress could assist small list,” says Dodson. “Certainly if in resolving issues and then discuss our we were supporting any specific legissuggestions face-to-face with Congress and staff to sway them to supporting lation, that was always on top.” us.” AOPA invited members of Congress The Policy Forum continues to to address participants at sessions provide value to AOPA members seeking preceding the individual visits. a deeper connection with their repreThe Policy Forum continued to sentatives. Often, AOPA members are attract a growing number of AOPA introduced to legislators at the Forum, members, with attendance of more then follow up and “develop a working than 100 in the late 1990s/early 2000s— relationship over time,” says Dodson. similar to the numbers today, says Dodson. The format has usually included a session where AOPA leaders briefed attendees on the topics of legislative importance, followed by congressional visits where each participant engaged NOW in discussions with their members of Today, the AOPA Policy Forum is one Congress or their aides. of the association’s most important Each year, there are new faces, but offerings, with hundreds of particimany committed professionals return pants each year and high-profile memyear after year. “There seems to be bers of Congress addressing attendees. In 2016, a new feature was a committed core of people added: a pre-Forum legislathat understand the importion writing session where tance of in-person lobbying participants jointly authored and who enjoy these types a bill to address the various of meetings and continue challenges the O&P commuto support the effort—many nity faces. Led by former Sen. of the same ones that Former Sen. Bob Bob Kerrey (D-Nebraska), contribute to the O&P Kerrey (D-Nebraska) the event featured group PAC,” says Dodson. And

break-out sessions where smaller teams discussed the merits of a draft bill addressing seven key issues, including the separation of O&P from durable medical equipment, clear definitions for off-the-shelf orthoses and minimal self-adjustment, the connection between the qualifications of the provider and Medicare payments, and more.

The legislation writing session culminated in the creation of a one-page bill, the Prosthetic and Orthotic Care Modernization Act, consisting of five topics that Kerrey then personally presented on the Hill. The 150 Policy Forum attendees also split up to meet with their specific legislators and advocate for the legislation they had developed. AOPA has also started to focus on the future O&P practitioners, and invited O&P students to attend the 2013 Policy Forum. Since 2014, the O&P Alliance partners have supported an NCOPE initiative that provides annual scholarships to one O&P student from each school to attend. The 2017 AOPA Policy Forum promises to be an eventful meeting. All AOPA members are encouraged to “save the date” for the May 24-25 event in Washington, D.C., and play a part in sharing O&P’s message with our lawmakers. O&P ALMANAC | JANUARY 2017



A More Direct Connection Osseointegration will offer an alternative approach to traditional O&P care By CHRISTINE UMBRELL

! New

Bridge to the Future: The Interviews is a new monthly column for 2017. As part of AOPA’s Centennial Celebration, O&P Almanac will look to the next 100 years—by interviewing noted experts in the O&P field to learn their vision for the future of O&P. This month, we speak with Matthew Garibaldi, MS, CPO, on the topic of osseointegration.


several countries, improving the lives of many amputees across the globe,” says Garibaldi. “Rickard Brånemark later founded the Swedish company Integrum, responsible for creating the OPRA implant system.” Osseointegration is a revolutionary procedure, whereby a titanium rod is implanted in the bone of the residual limb; this rod is used to attach the prosthesis, eliminating the traditional socket. Over time, the existing bone grows into the titanium, creating an integrated structure.

Benefits of the Technology

The advantages of bone-anchored prostheses are fairly intuitive, says Garibaldi, because the technology bypasses the need for traditional sockets. “Clinicians and patients alike know that the ‘socket’ is the weakest link Trending in Europe to any prosthesis,” he says. Osseointegration was initially “The concept of anchoring introduced as a dental proan external prosthesis to the cedure in Europe: The first human body—via residual commercial use of the techlimb encapsulation—is the nology took place in the 1950s same clinical technique our when Sweden’s Per-Ingvar profession has used since its Brånemark, MD—Rickard inception, as evidenced by Brånemark’s father—discovRickard Brånemark, prosthetic artifacts dating ered that osseointegration back to 300 B.C. Although could be successfully used to MD, PhD this technique has served patients secure dental implants, says Garibaldi. well for some time, it’s fraught with The dental technology didn’t gain potential complications associated popularity in the United States until with skin issues, limb volume changes, the early 1980s. The procedure was first used for prosthetics in 1990, when Per-Ingvar Brånemark and Björn Rydevik, MD, performed the first osseointegration implant procedure for a transfemoral amputee in Sweden. “Since that time, bone-anchored external prostheses have been used successfully in Cairo toe



PHOTO: The University of Manchester

OPA’S FOUNDING 100 YEARS ago came at a time of intense innovation for the orthotics and prosthetics profession. In fact, almost every modern prosthetic device produced for today’s amputees “has its roots in the technological advances that emerged from World War I,” according to a 2014 CNN article written by Thomas Schlich, PhD, a history of medicine professor at McGill University. Innovation has continued to be a driving force in the O&P profession throughout AOPA’s history, and is more apparent than ever as we survey today’s O&P solutions. Osseointegration is one example of an advanced technology that could prove game-changing for many U.S. amputees in the years to come. “Osseointegration is the direct connection between bone and implant that occurs as a result of new bone formation in and around the implant surface,” says Matthew Garibaldi, MS, CPO, associate clinical professor and director of orthotics and prosthetics at the University of California–San Francisco (UCSF). UCSF is the first

U.S. center to proceed with a program focused on the Osseointegrated Prostheses for the Rehabilitation of Amputees Matthew Garibaldi, (OPRA) implant MS, CPO system, which was developed by Sweden’s Rickard Brånemark, MD, PhD. The OPRA system is “the only osseointegration implant approved by the U.S. Food and Drug Administration (FDA) for transfemoral amputees in the United States,” according to Garibaldi. UCSF also acts as the coordinating body for a multicenter FDA-approved clinical trial of the OPRA implant system.



pain, donning challenges, unwanted rotation, temperature, sitting comfort, and limited wear time.” Garibaldi notes that while the concept of a socketless prosthesis is foreign to most U.S. O&P professionals, positive outcomes from other regions of the globe “have shown that bone-anchored prosthetic technology has the ability to create a superior wearing experience for the user.” Because of the benefits osseointegration offers to patients, UCSF has embraced the technology and has hired Rickard Brånemark as a visiting member of the orthopedic surgery department faculty. It is UCSF’s intention to offer “the most viable clinical options for amputee patients and to provide the most current osseointegration surgical training techniques,” says Garibaldi. UCSF coordinated the first recorded OPRA patient in the United States in April 2016 when Brånemark; Richard O’Donnell, MD; and Rosanna L. Wustrack, MD, performed an osseointegration surgery on George Kocelj, who had lost most of his right leg due to a rare nerve tumor. UCSF also is collaborating closely with physicians at the Walter Reed National Military Medical Center on osseointegration opportunities. The Department of Defense Osseointegration Program, directed by Jonathan A. Forsberg, MD, PhD, is spearheading efforts at UCSF and nationwide to make the technology available to active duty military and veterans, as well as civilian patients. In addition to UCSF’s involvement with the OPRA system, other clinical trials involving alternative osseointegration procedures are being conducted in other parts of the country. Two military veterans became the first amputees in the United States to be surgically implanted with percutaneous osseointegrated prostheses in early 2016, when surgeons at the George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City performed procedures on them. The procedures were part of an FDA feasibility study to determine the safety and function of the new implant. The osseointegration procedure

used at Wahlen has been shown to prevent infection in preclinical studies, according to the researchers; the patients are being closely monitored for signs of infections.

Overcoming Challenges

There are two hurdles that need to be overcome for osseointegration to progress in the United States, says Garibaldi. The first is FDA approval for transhumeral amputees, since usage of the OPRA implant system for transfemoral amputees has aready received FDA approval, he says.

The second hurdle is acceptance of the technology from O&P clinicians. “Having the O&P community embrace osseointegration with open arms will be the greater challenge by far, so our primary focus now is aimed at the successful implementation of this technology to ensure positive outcomes,” says Garibaldi. “If we can prove that bone-anchored prostheses can, in fact, improve quality of life, O&P professionals will be more inclined to suggest this treatment modality for those suffering from chronic socket complications.”

Future Applications

While the earliest implementations of osseointegration in the United States have involved lower-limb amputees, the technology could vastly improve life for upper-limb patients as well, says Garibaldi. “The next step for osseointegration is to integrate neural control for upper-extremity prosthetic users,” he says. “The OPRA implant system has not yet received FDA approval

for upper-extremity applications, but Rickard Brånemark is working with Chalmers University of Technology and Sahlgrenska University Hospital in Sweden to develop a system that allows users of electric prostheses to operate their device via implanted neuromuscular interfaces.” Garibaldi predicts that, in 10 to 20 years, the technology will “greatly benefit” upper-extremity amputees— “a greatly disadvantaged patient population, given the disconnect between currently available prosthetic devices, control schemes, and interface systems,” he says. “The utilization of an osseointegration implant system that integrates neuromuscular control for direct activation of a device will greatly improve function for this patient population.” In the future, similar control strategies will be developed for powered lower-extremity prosthetics as well, says Garibaldi. Early work already is ongoing as a part of a collaboration between UCSF, Brigham and Womens Hospital, and Massachusetts Institute of Technology in Boston and Sweden. In the future, osseointegration will not drastically alter the provision of all O&P services, but it will instead offer an alternative to traditional prosthetic care and rehabilitation, says Garibaldi. “Despite the success of osseointegration in Europe and other parts of the world since 1990, traditional sockets remain a broadly utilized treatment method. I suspect the same outcome will hold true for the U.S. market.” O&P practitioners who hope to succeed in the future should, at a minimum, follow osseointegration developments in this country and understand which patients could benefit from the technology, says Garibaldi. Learn more at the 2017 AOPA World Congress as Dr. Branemark and other international experts share updates from around the world. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at O&P ALMANAC | JANUARY 2017



Andrea Giovanni Cutti, Meng, PhD Vigorso di Budrio, Italy O&P expert shares trends in treatments, new technologies, outcomes measures, and reimbursement in Italy New


O&P ALMANAC: Describe a typical

work day for you at the Prosthetic Center of the National Institute for Insurance Against Accidents at Work (Centro Protesi INAIL).


Andrea Giovanni Cutti, Meng, PhD Vigorso di Budrio, Italy



O&P ALMANAC: What are some of

the recent projects you have been working on?

CUTTI: Over the last year, I’ve mostly focused on developing procedures to fully exploit our new CAD/CAM system, which is based on a structured light and a laser scanner, advanced CAD software, and a seven-axis robot. Thanks to very motivated colleagues, the Transtibial Workshop has achieved top production results. Now we are moving on to fully exploit the system with our Transfemoral Workshop. The team there is equally great, and we managed to overcome some issues regarding undercuts of the brims and the thermoforming of elastic sockets, so we expect to reach very good results over the next year. The Production

PHOTO: Andrea Giovanni Cutti, PhD

As the O&P profession prepares for the Second O&P World Congress, to be held in conjunction with AOPA’s 100th Centennial Celebration Sept. 6-9, 2017, in Las Vegas, the O&P Almanac in 2017 will feature a question-and-answer section with international experts. Each month, we will spotlight an O&P professional from a different part of the world, to find out how each one practices the profession of orthotics and prosthetics, in anticipation of the global event coming in September.

At Centro Protesi INAIL, my primary role is applied research manager within the Production Directorate. This also includes responsibility over the Motion Analysis Laboratory, and supporting the production of sport, upper-limb, and custom silicone prostheses. Overall, I have the privilege to introduce and test new materials, production methods, and products in daily practice. This means that I frequently work with the “exceptions.”

Directorate firmly believes in the need to evolve production using digital processes and designing the socket within a virtual environment. This is a big shift and requires new skills by the technicians, but the potential benefits are enormous.

As part of production development, we also are considering the use of 3-D printing. This is a big topic and very controversial. Sometimes the general media does not publicize how sophisticated a lower- or upper-limb socket can be. At present, we can use multiple materials, carefully combined for the specific patient; we can ensure durability and safety, keeping time for production and costs within an acceptable range. 3-D printing will become a real industrial solution if it can keep the existing [quality] and speed up our work and boost our creativity. This is the way we want go: Tests are encouraging, but the final products are at least a few years away. I’ve also been quite active in the field of motion analysis, which is my primary background and “first love.” With SIAMOC, the Italian Society of


Motion Analysis in Clinics, we have run a National Consensus Conference on clinical gait analysis, which found that children with cerebral palsy and amputees are two groups of patients that can benefit, in different manners, from quantitative motion analysis. I expect this to have an impact within the field of prosthetics and orthotics, because the Italian community of gait experts has an excellent reputation around the globe. In addition, I’ve been working on two important technologies for our field: wearable technologies with our methods “ISEO” and “Outwalk” and 3-D thermographic imaging, which I consider to be ground-breaking technology. O&P ALMANAC: How do outcomes

measures fit in to your work?

CUTTI: I’m working on outcomes mea-

PHOTO: Andrea Giovanni Cutti, PhD

sures with the upper- and lower-limb workshops. I strongly believe that an orthopedic workshop that can quantify the quality of its outcomes in an honest and internationally accepted manner has a huge competitive advantage to spend. Moreover, as part of the Italian Workers’ Compensation Authority, we must provide to our patients the best solutions for their needs, using the most appropriate technology. Over the last years, several new, fascinating “bionic” components have become available on the market, which have the potential to improve patients’ lives. But these devices are expensive. Our goal is to provide solutions that really work, going beyond “what’s on the Internet.” For this purpose, we are running studies to prove the functional, biomechanical, psychosocial advantages of emerging technologies, and, ultimately, patients’ quality of life. Costs are also considered, and cost-effectiveness and cost-utility can be estimated. Most recently, we published a large study on a famous electronically controlled knee in Prosthetic & Orthotic International, and another study on a very sophisticated myoelectric hand in the Journal of Research Rehabilitation and Development.

O&P ALMANAC: Describe the

location where you provide your services.

CUTTI: Centro Protesi INAIL, which stands for “INAIL Prosthetic Center,” is a specialized division of the Italian Workers’ Compensation Authority. I work in the main production facility, which is in Vigorso di Budrio, near Bologna, in the north of Italy. Centro Protesi also has a production branch in Rome, and a third one is about to open in Lamezia Terme, in the south of Italy. Finally, Centro Protesi has customers’ points in Milan, Venice, Bari, and Naples. In 2017 it is planned to open new customers’ points in Torino, Catania e Palermo. Centro Protesi in Vigorso started its activities in 1961, under the Direction of Hannes Schmidl, who retired in 1992 and died two years later. At that time, the focus was on upper-limb myoelectric prostheses, which Centro Protesi routinely treated. Over the past 55 years, the Center has evolved to include workshops for the treatment of all levels of amputation, a silicone house, an assistive devices area, a hospital for inpatient and outpatient rehabilitation treatments, and a research directorate. The Center offers its services not only to injured workers, but to all Italian and foreign patients, of all ages. It is ISO 9001-2008 certified, houses 200,000 square feet, has about 280 staff members (including about 160 technicians, 70 CPOs, seven MDs, and 20 physical therapists), and sees more than 11,000 patients

every year, including 5,400 patients for prosthetic and orthotic treatments (4,200 with work-related injuries). It is considered a center of excellence at the international level. Most importantly, it is the Center’s approach that characterizes it best. We adopt a patient-centered, multidisciplinary approach. Prosthetic and orthotic treatment is tailored to the patient, and it is always combined with an equally tailored rehabilitation program. New patients are freely visited every Tuesday and Wednesday, together with consultant surgeons from two primary orthopedic hospitals around Bologna (Istituti Ortopedici Rizzoli and Policlinico di Modena). O&P ALMANAC: How are the devices

you provide paid for?

CUTTI: There are primarily three sources. INAIL covers the costs of the prosthetic/orthotic treatment of persons injured during their work, including injuries that occurred while travelling to and from the workplace and home. The INAIL Prosthetic Regulation dictates the rules, which are updated regularly. Patients falling in this category are eligible to receive the most modern technologies if medically appropriate, including electronically controlled/actuated components. Prosthetic/orthotic treatment is granted for life, and can consist of different prostheses at the same time, for instance, one for everyday use, a backup, a cosmetic solution, a bathing solution, and sport prostheses. O&P ALMANAC | JANUARY 2017



The second source of reimbursement is the National Healthcare System. National and regional laws govern the provision of prostheses/ orthoses. The National Regulation dates back to 1999, and it is expected to be updated at the beginning of 2017. At present, it codes for basic treatments, and remarkable restrictions exist compared to the INAIL Regulation. Therefore, when more modern solutions are recommended, patients might need to either pay out-of-pocket or through private insurance. However, private healthcare insurances are still relatively uncommon in Italy. On the contrary, private insurances play an important role in covering road accidents. Most commonly, insurances pay an overall compensation to the injured person, based on written expertise and after the decision of a court. O&P ALMANAC: Describe your

educational background and any certifications you have. How do you keep your skills sharp?

CUTTI: I received a master’s degree in electronic engineering at the University of Bologna. From the same university, I also received a PhD in biomedical engineering, working in the field of upper-limb biomechanics. Over the past 10 years, I had more than 35 full papers published in peer-reviewed international journals in the fields of prosthetics, shoulder biomechanics, and wearable technologies. I’m currently serving as chair of the International Shoulder Group (a technical group of the International Society of Biomechanics), as a member of the ISO TC 168 WG3 (Prosthetics and Orthotics—Testing), and as associate editor of Medical & Biological Engineering and Computing (Springer). Thanks to INAIL, I am able to participate in several conferences as a speaker or invited speaker, mostly in Europe and the United States. I started attending AOPA conferences in 2010. To further increase my competence in the field, I’m currently attending the bachelor’s course in prosthetics and orthotics at the University of Bologna.

The Source for Orthotic & Prosthetic Coding

O&P ALMANAC: What’s the biggest

challenge you face as a practitioner, and how do you deal with it?

CUTTI: I think that my role is to let our CPOs know new techniques, methods, and products available around the world, and to develop new solutions with their help. In this way, they will be able to deliver the best services to our patients and improve their quality of life. I think that the O&P field will see great changes in the future, and all our staff members must be prepared to face and manage those changes successfully. Building a strong, interdisciplinary team is essential. Due to the same changes, I think that improved best-practice guidelines are something our professional community should work on more intensively, possibly through international, multicenter studies.

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Your Compliance Plan


Understand the seven key elements of OIG’s Compliance Program

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 47 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.




AY BACK IN 1999, the U.S. Department of Health and Human Services’

Office of Inspector General (OIG) created and released a document, OIG’s Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics, and Supply Industry. This document would become the framework for most O&P office compliance plans. Although this document is almost 20 years old, the guidance found in it is still relevant—and may be even more important today than when it was written. Over the last few years, Medicare has increased its focus on finding and stopping fraud and abuse within the Medicare program through various methods (e.g., audits, new supplier enrollment standards, etc.). Medicare also has become more active and proactive in enforcing these and other regulations, like the Health Insurance Portability and Accountability Act (HIPAA). It is vital that you have a viable and useful compliance plan and program in place. The OIG stated that in order for any compliance plan to be effective it should include seven key elements or components: implementation of written policies; designation of a compliance officer; development of training/education programs; establishment of effective lines of communication; performance of internal audits; consistent enforcement of standards; and prompt response to issues. This month’s Compliance Corner offers an explanation of these seven elements.

Implementing Written Policies and Procedures

The first step in creating your compliance plan is developing of your company’s written standards of conduct, or the broad values set in place for your organization to follow. For example, your standards should include your desire to comply with all state and federal regulations and a statement that your facility will conduct business in a professional and proper manner. The standards of conduct will then help you create and frame the specific written policies and procedures that are tailored to meet your company needs—the steps that will show your commitment to compliance. 44


Your policies and procedures should address specific areas of risk or areas that are prone to potential fraud or abuse. This would include such general areas as the claims development and submission process (establishing medical necessity, orders, proof of delivery, selection of codes, etc.), kickbacks/ self-referrals, marketing, and retention of records, among other things.


To help you identify some of these compliance hotspots, OIG published a list of 47 potential risk areas specific to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in the 1999 report. However, not all of them would apply to O&P or to your specific business model; thus, not all of the 47 would be included in your policy and procedures. Finally, your standards and your subsequent policies and procedures should be readily available to all employees and well publicized in your company’s educational materials. For example, every employee should be required to sign a copy of the standards of conduct, and new hires should be educated on the policy and procedures. You might consider reviewing the policies and procedures on a yearly basis for existing employees.

Designating a Compliance Officer and Compliance Committee

You must designate one employee to be the compliance officer, and that individual must serve as the primary point person for all compliance activities and questions. If possible, create a compliance committee whose duties would be to advise and help the compliance officer in implementing, updating, interpreting, and enforcing (including disciplinary actions) the company’s compliance program/policies and procedures. There is no need to hire someone to act solely as a compliance officer; it is acceptable to have a compliance officer who has other duties and functions within the company. However, there are some keys things to think about when appointing your compliance officer. First, the individual should be a high-ranking staff member within your company, or should have direct access to high-ranking personnel or senior management. Second, he or she should have the ability and power to exercise independent judgment and implement policy changes, without fear of any reprisals. Third, if your compliance officer will be performing other duties, those duties should not be in

conflict with the goals of your standards of conduct and your compliance goals.

Implementing Training and Education Programs

The OIG Compliance Program Guidance for DMEPOS states: “The proper education and training of corporate officers, managers, and employees, and the continual retraining of current personnel at all levels, are significant elements of an effective compliance program.” Thus, you must implement education and training programs that are designed for existing employees as well as new hires, including the compliance officer and management staff; and these programs must be routinely revamped to account for current trends.

First, prep are training t hat is basic or g eneral that every one would be required to take, po ssibly on annua l basis. The type of education or training should be tailored to meet the needs of your employees and your company, but there are several general rules to follow. First, prepare training that is basic or general that everyone would be required to take, possibly on annual basis. This would be training on the fundamentals, such as state and federal regulations, audit policies, company standards, etc. This session also should include information that ensures that all employees are aware of the compliance program, understand their role in the program, and know the penalties for violating the policies and procedures of the program. Second, create plans or modules that are more specific and detailedorientated for specific audiences, such as billers and coders.

Finally, be sure you have an avenue to ensure that your education and training remains up-to-date on all changes; and that these changes are disseminated in a timely manner, via staff meetings, emails, memos, etc. Also make sure you are registered to receive all announcements from the durable medical equipment Medicare administrative contractors, read all of the trade magazines, belong to the appropriate associations, and attend yearly seminars when appropriate.

Developing Effective Lines of Communication

Your compliance program and company are expected to have effective, open lines of communication, both internally and externally, in place between the compliance officer/ committee and all people associated with the company; with the purpose of receiving clarification about the company’s policy and procedures; and to encourage the reporting of any potential areas or incidents of fraud and abuse. These lines of communication could include hotlines, emails, memos, newsletters, suggestion boxes, and posters. Whichever methods of communication you use, there are two areas to focus on. First, be sure that your employees are encouraged to use the established lines of communication, and communicate that they should not fear any retaliation or repercussions if they use the lines of communication to report fraud or abuse (these are whistleblower protections). Second, make sure that all questions and responses in regard to policies and procedures are documented, as they can be used in updating future versions of the policies and procedures.

Internal Auditing and Monitoring Systems

The goal of the audit program is to monitor ongoing operations to ensure that policies and procedures are being observed and that necessary corrective action can be taken to correct any deficiencies.



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When designing or reviewing the effectiveness of an audit program, the following issues should be considered: • Frequency (how often the audits are conducted: monthly, semimonthly, etc.) • Number of charts to be reviewed (what number provides you with a strong cross sample) • Particular issues to be monitored (be sure to audit for the right issues, using current guidelines) • Documentation of the results • Personnel involved (who is conducting the audits: staff, compliance officers, third parties, etc.) • Discussion of the results of the audits and the actions taken as a result with all those involved (this should be performed as often possible but, at a minimum, annually). Keep in mind that the extent of your auditing/monitoring program should be in line with your available resources and the identified risk areas that are pertinent to your company. The OIG report points out that if a “supplier failed to develop an adequate audit program, given its resources, the government will be less likely to afford the DMEPOS supplier favorable treatment under its various enforcement authorities.” What you do or don’t do may affect your liability.

Well-Publicized Disciplinary Directives

Your compliance plan must include written guidance regarding disciplinary action for anyone who has failed to follow the company’s standards of conduct and written policies and procedures for compliance, regardless of his or her position in the company. These well-publicized disciplinary directives should include information on who is in charge of handling disciplinary problems. For example, you should document whether minor issues may be handled by a manager or compliance officer, or if all issues will be handled by upper management (such as an owner, president, chief executive officer, etc.).

Review y our complia nce plan tod ay! The consequences of noncompliance and disciplinary action must be consistently applied and enforced, with all employees subject to the same types of disciplinary action for similar offenses. This must be done for the disciplinary actions to have any effect as a deterrent. For example, each employee could be subject to varying levels of discipline depending on the action, using disciplinary tactics such as additional education, verbal warnings/write-ups, demotion, and, in extreme cases, termination.

Responding Promptly/Taking Corrective Action

Once an individual has been identified as having violated your code of conduct or been otherwise noncompliant, regardless of the scope and size, you must have procedures in place that allow you to act rapidly to assess the issue and correct the action through the proper channels. Ensure your compliance plan includes a standardized process or format that can be used by your compliance officer/ committee, or any other management officials, for investigations. The scope and breadth of your investigation will depend on the size of your company, but consider including the following 10 steps in your investigations: 1. Put an immediate halt to the issues/actions/questionable actions that resulted in the investigation. 2. Determine the scope of the issue, i.e., is it an ongoing issue, or was it a one-time mistake? 3. If it is a large issue, consider involving others in the investigation. 4. If it is a large or complex issue, consider involving outside counsel (such as your company’s attorney). 5. Sort through all the information you gathered and determine the relevant facts.

6. Task the investigative team (compliance officer, compliance committee, etc.) with creating a report outlining the causes of the investigation, and what the investigation revealed. This leads into steps seven and eight, which also should be included in the report. 7. Review the findings to determine your exposure/liability. For example, are you required to self-report anything? Are there any overpayments involved? 8. Determine what you will do to correct the issue, and your corrective action plan. 9. Consider monitoring the issue and determine if your corrective action plan was effective, or if more action is required. 10. Keep and file copies of the information compiled as a result of the investigation in a secured location. The presence or absence of a compliance plan, and your adherence to that plan, can help you stay clear of certain Medicare trouble areas—and it can mean the difference between receiving a warning or receiving stiff fines or other dire consequences. Take time today to review your facility’s compliance plan, and update it if necessary. To learn more on this topic, view the full OIG report on the OIG website at authorities/docs/frdme.pdf. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit Earn CE credits accepted by certifying boards:






O&P in the Pine Tree State Southern Maine facility offers ‘rapid’ care platform for patients





John-Paul Donovan, CPO, works with a patient at his Maine facility.

FACILITY: AtlanticProCare LOCATION: Portland, Maine OWNER: John-Paul Donovan, CPO HISTORY: 23 years

John-Paul Donovan, CPO

Donovan says the RAM method is ideal for those for whom, for whatever reason, the long wait for a new prosthesis—which can take as long as eight weeks with other providers and involve multiple appointments—is just not practical. Clinicians work with patients to determine their goals, take outcome measurements, and obtain CAD data. While the orthosis or prosthesis is developed, patients can meet with peer volunteers or care coordinators. Clinicians fit the device and provide training. Follow-up visits are arranged, and after that, says, Donovan, “we take care of patients for the rest of their lives.” Contributing to the success of the RAM approach are AtlanticProCare’s coordinated care teams, which are assigned to each patient “pre-visit.” Care coordinators handle insurance coverage and documentation needs, set up appointments, and communicate with physicians. “They handle all of the patient’s needs outside of the clinical work,” explains Donovan. “Our

PHOTOS: AtlanticProCare

in 1993 with a clear mission: to provide personalized care, not simply devices, to his patients. “We don’t provide things, we help patients navigate through their rehabilitation and focus on their goals, and we base our care on that,” he says. “We listen to each patient” and provide care to help him or her achieve clearly defined goals. AtlanticProCare occupies a 6,000-square-foot turn-ofthe-century schoolhouse in Portland, Maine, which has been modified to contain a full CAD/CAM suite, patient rooms, and administrative offices. The practice has nine employees, including three clinicians. The facility specializes in upper- and lower-extremity prosthetics and spinal orthotic care. It draws most of its patients from an area of about 450,000 people in southern Maine, although some patients come from elsewhere in the United States and internationally. The local area has a rapidly aging demographic, says Donovan, but clinicians provide pediatric through geriatric care. AtlanticProCare prides itself on innovation in patient care: The facility uses the Rapid Ambulation Method, or RAM, which is designed to complete the entire prosthetic process—including evaluation, development of the device, fitting, and training—in one visit. According to Donovan, it’s an especially useful approach for patients who have to travel long distances to get a new prosthesis.

care coordinators interact with patients even more than the clinicians do, and it has led to an exceptional level of care.” Care coordinators also pair new amputees with peer volunteers, if desired. Meeting someone who has already gone through what they are facing is enormously helpful to new patients, says Donovan, who credits a focus on patient engagement to developing knowledgeable and helpful peer volunteers. AtlanticProCare has participated in a CMS-sponsored pilot clinic program in which practitioners team up with physiatrists to see patients and coordinate care and documentation. This approach eliminates the duplicative billing typical of an amputee clinic, says Donovan. The clinics are held once or twice a month, and, six years into the program, Donovan says they have resulted in 100 percent regulatory compliance and 100 percent patient satisfaction. Donovan expects AtlanticProCare’s steady growth over the past 10 years to continue, and he plans to add new prosthetistorthotists. “I do see quite a bit of expansion through additions to our clinical team,” he says. “We’re also adjusting our marketing approach to keep up with changing marketplace conditions, including working on ways to provide regional coverage for our payor partners.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at

Who is an innovator? Who is held to the highest O&P standards? Who is committed to life-long learning? I AM. I am a big part of great possibilities.

I AM ABC. Visit today to find out what ABC can do for you. 703.836-7114


Anatomi Metrix


A Handy Approach to Anatomical Data Capture Canadian niche company offers innovative hand-measuring system





COMPANY: Anatomi Metrix OWNER: JP Gibeault LOCATION: Montreal, Canada HISTORY: One year

The two-step process of scanning the hand and using Manu3 software to determine its dimensions takes three to five minutes to produce results. The Manu3 system occupies a small, highly specialized niche, and the only way to make it a viable business product is to expand its applications and market it worldwide, says Gibeault. In addition to its application in prosthetics, the Manu3 can be used to fabricate compression gloves as a treatment for burns, lymphedema, and some neurological conditions. The speed of measurement and the touch-free nature of the scan are especially useful for burn patients, says Gibeault, as it reduces the risk of infection and minimizes pain. “It’s a great application” for children, he says. “Imagine trying to get a child in pain to hold still while someone manually takes measurements of his or her burned hand.” Anatomi Metrix researchers are developing additional capabilities for the Manu3, such as detecting skin color and texture. Eventually, the technology will be

PHOTOS: Anatomi Metrix

had an entrepreneurial spirit. He started his first business when he was 10 years old. As an adult, he continued on that track with other ventures, one of which was acquired by GE in 1999; in 2003 he purchased OrtoPed, Canada’s largest O&P distributor. Gibeault’s first foray into the O&P industry yielded one surprise: He realized for the first time that his aunt had worn orthoses throughout his childhood. “She was paralyzed in both legs from polio, and I lived in the same house with her for eight years. As a child, I never really noticed she was wearing long-leg orthoses,” he says. “After I bought OrtoPed, I visited a number of clinics that used our products, and one of the largest was the facility that had made her braces.” When Cascade acquired OrtoPed in 2015, Gibeault launched Anatomi Metrix and its hand-measuring system, the Manu3 system. The Manu3 can determine the dimensions of the hand in 30 milliseconds, allowing clinicians to select or fabricate customized silicone prosthetic hand covers more accurately. Prosthetists can scan the existing hand to create a mirror image to cover the patient’s prosthetic hand. The software produces a report with a color photo of the hand and the corresponding anatomical dimensions of the fingers, thumb, palmar area, and wrist. Those who use computer-aided manufacturing can feed the data directly into CAD/CAM software; others may use the information to hand-fabricate a cosmetic glove.

able to track the dimensions of scars and monitor their changes over time. “We are talking with hand surgeons who see the benefit in this technology for monitoring postoperative results every few weeks,” Gibeault says. Team Anatomi Metrix includes 12 members. The company is based in Montreal, with manufacturing sites there and in New Hampshire and sales teams based in Toronto, Denver, and Germany. The company works with various research and development companies in the Boston area, and products intended for the United States and Latin America are manufactured in New Hampshire. Anatomi Metrix is engaged in an intensive marketing push, attending at least one trade show a month since its inception. “Because the device is portable, we can demonstrate how it works right on the showroom floor,” says Kellie-Ann Briand, who handles marketing for the firm. She also spearheaded construction of a comprehensive website, with information targeting clinicians and practitioners. “Our top priority for 2017 is to get distributors,” she says. “In addition, we have ongoing protocolled trials and are always looking for motivated early adopters to study our system.” Getting a new business up and running was not new to Gibeault, but he admitted that in spite of his experience, he was surprised that it took “twice as long and twice as much money” than expected to launch the company. He is delighted with the success of his new venture so far. “We have a phenomenal team of talented and enthusiastic people,” he says. “And our product is being used in Europe, Asia, and North America.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals





APRIL 10-11 | 2017

AOPA Coding Experts Are Coming to Denver, CO

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.


Increase your company’s bottom line.


Stay up-to-date on billing Medicare.


Code complex devices


Earn 14 CE credits.


Learn about audit updates.


Overturn denials.


Submit your specific questions ahead of time.


Advance your career.

Westin Denver Downtown, Denver, CO Join AOPA April 10-11 in Denver to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up¬-to¬-date on all the hot topics. AOPA experts 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 with AOPA experts, your colleagues, 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. Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at

10. AOPA coding and billing experts have more than 70 years of combined experience.

Mark your calendar for the next seminar:

JULY 17-18 Pittsburgh, PA

The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh, PA Find the best practices to help you manage your business.

Participate in the 2017 Coding & Billing Seminar! Register online at For more information, email Ryan Gleeson at .



Call for Papers for the World Congress O&P Clinical Documentation: Who Needs To Document and What You Need To Document Start the new year off on the right foot and make sure you are documenting correctly going forward—take part in the January 11 AOPA webinar on “O&P Clinical Documentation: Who Needs To Document and What You Need To Document.” • Learn who is responsible for documentation. • Learn the detailed requirements for your documentation. • Learn how to avoid common documentation mistakes. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz and scoring at least 80 percent. Register at Contact Ryan Gleeson at or 571/431-0876 with questions.



Clinical, Business, Technical, and Symposia Presenters Wanted




AOPA is seeking highquality educational and research content for the Second O&P World Congress to be held Sept. 6-9, 2017, at the Mandalay Bay Resort in Las Vegas. Your submissions will set the stage for a broad curriculum of high-value clinical and scientific offerings at the 2017 World Congress. All abstracts will be considered for both podium and poster presentations. Receive a complimentary one-day registration (or 50 percent credit toward a full conference registration) when your free paper is selected as a podium presentation. Those presenting more than one Podium Free Paper will receive a full complimentary registration. Poster presenters will receive a 40 percent discount off their full conference registration.The deadline for the Business Papers is February 1 and for all others is March 1. Learn more about presenting at




LSO/TLSO Policy Are you coding correctly for lumbosacral orthoses (LSOs) and thoracolumbosacral orthoses (TLSOs)? Take part in the AOPA webinar scheduled for February 8, where AOPA experts will review the following: • Which LSOs and TLSOs require approval by the Pricing, Coding Analysis, and Coding contractor. • When to use the CG modifier. • Hospital/skilled nursing facility billing for LSOs and TLSOs. • What type of documentation and ICD-10 codes are required for coverage. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at Contact Ryan Gleeson at or 571/431-0876 with questions. Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at

2017 Webinar Topics Released Mark your calendars for AOPA’s 2017 monthly webinars. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits—so you can still take advantage of the series discount and the valuable learning opportunities. Register for the complete 2017 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at

2017 Webinars • January 11: O&P Clinical Documentation: Who Needs To Document and What You Need To Document • February 8: LSO/TLSO Policy • March 8: Marketing Your Business • April 12: Grassroots Advocacy • May 10: Modifiers: What Do They Mean and When To Use Them • June 14: Internal Audits: The Why and the How of Conducting Self-Audits • July 12: Know Your Resources: Where To Look To Find the Answers • August 9: What the Medicare Audit Data Tells Us and How To Avoid Common Errors • September 13: ABC Inspections and Accreditation • October 11: AFO/KAFO Policy • November 8: Gift Giving: Show Your Thanks and Remain Compliant • December 13: New Codes and Other Updates for 2018




Special Thanks to the

2016 PAC Contributors

AOPA would like to thank the following individuals for their contributions in 2016 to the O&P PAC:

PRESIDENT’S CIRCLE ($1,000-$5,000)

SENATOR’S TABLE ($500-$999)

CHAIRMAN’S TABLE ($100-$499)

Michael Allen, CPO, FAAOP

Ryan Arbogast

Dale Berry, CP

Rudolf Becker III

Bret Bostock, CO

Jeffrey Brandt, CPO

George Breece

A.J. Filippis, CPO

Erin Cammaratta

J. Martin Carlson, CP

Arlene Gillis, CP, FAAOP

Kenneth Cornell, CO

Charles H. Dankmeyer Jr., CPO

Pam Young

Mark Edwards, CP

Vinit Asar James H. Campbell, PhD, CO, FAAOP Maynard Carkhuff

Thomas DiBello, CO, LO, FAAOP

Alfred Kritter, CPO, FAAOP

Rick Fleetwood, MPA

Teri Kuffel, Esq.

Pam Lupo, CO

Eileen Levis

Jeffrey Lutz, CPO

Anita Liberman-Lampear, MA

Michael Oros, CPO, FAAOP

Chris Nolan

Bradley Ruhl

Anthony Potter

Scott Schneider

Rick Riley

Andreas Schultz

Chris Snell

Frank Snell, CPO, LPO, FAAOP

William Snell, CPO

Gordon Stevens, CPO, LPO

Mike Sotak

Thomas Watson, CP

James Weber, MBA

Eddie White, CP Rob Yates, CPO

1917 Club (Up to $99) Frank Bostock, CO




2016 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an event sponsored by the O&P PAC.

Alston Bird PAC Ryan Arbogast Thierry Arduin Vinit Asar Gregory Bernhardt, CP Rudy Becker David Boone, PhD Frank Bostock, CO Doug Call, CP James Campbell, PhD, CO, FAAOP Maynard Carkhuff J. Martin Carlson Tina Carlson

Jeff Collins Thomas Costin Charles H. Dankmeyer Jr., CPO Don DeBolt Thomas DiBello, CO, FAAOP David Edwards, CPO, FAAOP A.J. Filippis, CPO Thomas Fise, JD Rick Fleetwood Elizabeth Ginzel, CPO Hans Georg Näder Hanger PAC Alfred Kritter, CPO, FAAOP Charles Kuffel, CPO, FAAOP Robert Leimkuehler, CPO Eileen Levis Anita Liberman-Lampear, MA Jeff Lutz, CPO Dave McGill McGuireWoods PAC Chris Nolan

Michael Oros, CPO, FAAOP Pam Lupo, CO Susan Paul Andrew Pedtke Tom Powers PPSV PAC Rick Riley Anne Rowell, CPO Bradley Ruhl Steven Rybicki Scott Schneider Keith Smith, BSME, MBA Chris Snell Clint Snell, CPO Mike Sotak Gordon Stevens, CPO Peter Thomas, JD Thomas Watson, CP James Weber, MBA Ashlie White James Young

In 2016 the O&P PAC made contributions to the following members of Congress: Rep. Gus Bilirakis (R-Florida) Sen. Tammy Duckworth (D-Illinois) Rep. Renee Ellmers (R-North Carolina) Sen. Charles Grassley (R-Iowa) Rep. French Hill (R-Arkansas)

Rep. Erik Paulsen (R-MN) Rep. Dutch Ruppersberger (D-Maryland) Sen. Brian Schatz (D-Hawaii) Rep. Glenn Thompson (R-Pennsylvania) Sen. Mark Warner (D-Virginia)

Special Thanks

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 to 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

* Due to publishing deadlines this list was created on Nov. 30, 2016, and includes only donations and contributions made/received between Jan. 1, 2016, and Nov. 30, 2016. Any donations or contributions made/ received on or made after Nov. 30, 2016, will be published in the next issue of the O&P Almanac.





HE 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 cation, 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.

Alpine Medical, LLC 720 Lindsay Lane Cody, MY 82414 Member Type: PatientCare Facility Bonnie Newton Kleiber Bionics LLC Skolkova Innovation Center Moscow, Russia Member Type: Supplier Level 1 Ivan Krechetov

Cranial Technologies Inc. 1000 Southhill Drive Cary, NC 27513 Member Type: Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 514/447-5894 Heather Frankena, CO

Cranial Technologies Inc. 14497 N. Dale Mabry Highway, Ste. 125N Tampa, FL 33618 Member Type: Affiliate Parent Company: Cranial Technologies Inc., Tempe, AZ 813/264-0082 Danielle Smith E&G Prosthetics & Orthotics LLC 23-05 Astoria Blvd. Astoria, NY 11102 917/780-5870 Member Type: Patient-Care Facility Vasilios Kehahias, CPO Minnesota Prosthetics & Orthoitcs 1715 Tower Drive W., Ste. 100 Stillwater, MN 55082 Member Type: Affiliate Parent Comapny: Minnesota P&O, Edina, MN

Orthotic Prosthetic Center 224 Cornwall Street, Ste. 200B Leesburg, VA 20176 Member Type: Affiliate Parent Company: Orthotic Prosthetic Center Inc., Fairfax, VA 571/291-3121 P&O Services 25775 W. 10 Mile Road, Ste. A Southfield, MI 48033 Member Type: Patient-Care Facility 248/809-3072 Cindy Winter Prosthetic & Orthotic Institute Inc. 10502 Park Road, Ste. 170 Charlotte, NC 28210 Member Type: Affiliate Parent Company: Prosthetic & Orthotic Institute Inc., Rock Hill, SC 803/980-5080




Page Phone


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






Amputee Coalition



Anatomical Concepts Inc.


800/837-3888 or 330/757-3569

Cailor Fleming Insurance




1 800/252-2828


5 800/301-8275

LIM Innovations



C4 800/328-4058

Touch Bionics



844/888-8LIM 855/694-5462

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email Visit for advertising options.

ALPS Skin Reliever ENCP The ALPS Skin Reliever eliminates shear forces and friction, and prevents abrasions on the skin of the stump. It offers both superior comfort and durability while also accommodating for volume fluctuations over the life of the prosthesis. The ALPS Skin Reliever provides superior elongation for very little compression against the skin, reducing shearing and abrasion. There is no need to make a new socket for this product, as the ALPS Skin Reliever can be worn under silicone and gel. For more information, contact ALPS at 800/574-5426 or visit ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Custom Fabrication Services Give us the opportunity to lessen the demands of your in-house fabrication team so your clinicians can devote more of their time to their patients and/or marketing new referral sources. Our highly trained technicians at Anatomical Concepts can provide a wide variety of custom-made lower-extremity orthoses, such as thermoplastic AFOs and KAFOs, as well as functional and accommodative foot orthotics. Any of our AFOs from our prefabricated PRAFO® family can be implemented to any custom-made KAFO system due to their unique modular designs for exceptional stability and patient comfort. For more information, call 800/837-3888 or visit


THK-5PS10MPK and THK-5PS0MPK-PYR by DAW Industries The technology for the THK-5PS10MPK and THK-5PS0MPK-PYR works like an ultrafast 3-D gyroscope that instantly detects the knee positioning in space and reacts by providing through its microprocessor the optimum extension flexion resistance while walking down an incline or stairs. Select on the DAW website a predetermined set of parameters from a menu according to patient weight, level of activity, muscle strength, and preferred activities. Then tweak the parameters to reach that perfect natural gait that everyone hopes for but cannot quite reach. For more information, contact DAW Industries Inc. at 800/252-2828, email info@, or visit

TGK-5PS0SLK and TGK-5PS10SLK by DAW Industries Welcome to the latest, most advanced world of True Variable Cadence Gait with the electronically controlled TGK-5PS0SLK and TGK-5PS10SLK. This knee unit utilizes the very advanced “Blank Slate Technology.” This means that the computer is preprogrammed with what gait is, but the parameters of that gait will self-program as the knee walks, constantly learning and changing to your individual patient’s gait pattern. This means that you are required to do very little adjustment and no programming. For more information, contact DAW Industries Inc. at 800/252-2828, email info@, or visit



AOPA membership has its benefits. Visit today!



MARKETPLACE Shower Seal by DAW Industries DAW Industries Inc. just introduced a below-knee prosthetic system allowing amputees to shower, bathe, and enjoy most aquatic activities standing up on both of their legs. It is so unique that a U.S. patent was filed. Its name is Shower Seal. No need any longer to navigate the dangerous floor of a bathroom (where most serious slip/fall accidents occur) with a walker or hopping around on one leg. Who can properly shower sitting on a chair? Many amputees tell us of the pure enjoyment of showering again standing up with no limitations. This add-on to their every day all-activities prosthesis is a far cry from putting up with a cumbersome and functionally limited “shower-leg.” Enjoy life again in all its aspects, not to mention the time saved every morning in getting ready. For more information, contact DAW Industries Inc. at 800/252-2828, email, or visit

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid anklefoot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit



New 10V41 Robo-Wrist Continuous locking positions provide precise, secure functions to support a wide range of ADLs. The 10V41 Robo-Wrist can rotate the terminal device by 360 degrees and simultaneously flex/extend it at any angle up to 43 degrees. Constructed of titanium, steel, and high-strength aluminum, the Robo-Wrist provides a durable solution without adding unwanted weight (5.8 oz / 165 g). The ball joint is suitable for highly functional body-powered fittings, for instance the Ottobock MovoHook 2Grip1. For more information on the Robo-Wrist, go to professionals. or call customer service at 800/328-4058.

Custom Silicone Leg Covers Ottobock’s Custom Silicone Services acts as your extended workbench, fabricating aesthetically pleasing and high-quality silicone covers for leg prostheses. Precise and custom made, each silicone leg cover is designed to your patients’ unique appearance. From skin pigmentation to freckles and hair, each silicone leg is as individual as your patient. For more information, go to professionals. or call customer service at 800/665-3327.

Introducing New Titanium Digits for All i-limb® Hands!

• New titanium material increases the maximum carry load at the proximal segment by 50 percent. • Titanium material improves the protection of the motor from impact forces. • Titanium digits add 1 oz of weight to the i-limb hand. • Available for i-limb™ quantum, revolution, ultra, and access hands in sizes—small, medium, or large. Contact us to learn more! For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit

Now taking Pre-Orders! Coding Products will be available for distribution Mid-February 2017.




Payment Information ______________________________ CONTACT NAME

______________________________ COMPANY

2017 CODING SUITE ALL these products in one discounted set! • CodingPro (Single User CD Software) • Illustrated Guide • QuickCoder

______________________________ CONTACT NAME

______________________________ ADDRESS

______________________________ ______________________________ CITY STATE



One easy to use manual with HCPCS code, official Medicare descriptor and an illustration for each code.




______________________________ EMAIL


q f y

______________________________ NAME ON CARD

Quickly find HCPCS Codes HCPCS orthotic, shoe and prosthetic codes and modifiers with these laminated cards.

______________________________ CREDIT CARD NUMBER

______________________________ EXPIRATION DATE


______________________________ SIGNATURE Enter your user name and password for member discounts

Products to help you with coding and billing, e.g. annual Illustrated Guide, Coding Pro, & Quick Coder




Comprehensive software for all your coding needs! This CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Choose single user for 1 computer or network version for use on multiple office terminals.

Bookstore Publications



Publication Title





No. 107

2017 Coding Suite (Coding Pro, Illustrated Guide, & Quick Coder)



No. 108

2017 Coding Pro Single User



No. 108

2017 Coding Pro Network Version



No. 109

2017 Illustrated Guide



No. 110

2017 Quick Coder



Please add $7.00 shipping to any Bookstore Publication order.

 Please send me special updates and information from AOPA including the AOPA In Advance newsletter.


Questions about your order? Contact Ryan Gleeson at 571-431-0836 or email American Orthotic & Prosthetic Association 330 John Carlyle St., #200 Alexandria, VA 22314 Phone: 571-431-0876 Fax: 571-431-0899



Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

Listing Word Count 50 or less 51-75 76-120 121+

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word


Certified Orthotist Boardman, Ohio Established in 1994, Ankle & Foot Care Centers is comprised of 18 podiatric foot and ankle surgeons with 20 locations in Northeast Ohio. We are seeking a full-time certified orthotist for our practice. This individual will be responsible for evaluation, recommendation, and fitting of custom AFOs, shoes, and foot orthoses. Candidates must be self-directed, possess strong clinical skills, have the ability to code for services rendered, and effectively communicate with physicians. Competitive salary, benefits, and profit sharing plan offered. Please send resume to: Email: Michael Vallas Practice Administrator Ankle & Foot Care Centers 8175 Market Street Boardman, OH 44512 Phone: 330/758-6226, ext. 207 Fax: 330/758-4914

Membership has its benefits:



ONLINE: O&P Job Board Rates Visit the only online job board in the industry at Job Board

Member Nonmember $85 $150

For more opportunities, visit:


A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at, or visit to view your trusted source of everything O&P.




Visit today! Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing and Audit Resources Education, Networking, and CE Opportunities Advocacy Research and Publications Business Discounts


A CAREER AS A PEDORTHIST Providing Quality Education and Training to the Changing PEDORTHICS AT BAKER COLLEGE OF FLINT Workplace Baker College’s Pedorthics program combines online education with hands-on training taught in a state-of-the-art facility in Flint, Michigan.

Tuition Cost:


(Price goes up April 1, 2017 to $2,190)

This noncredit course provides 150 hours of instruction (70 hours online and 80 hours on-campus). Participants will study human anatomy, pathology, biomechanics, and evaluation of medical conditions that originate at or below the ankle. Also included in the course are lower-limb orthotic design, materials used for orthotic and prosthetic modification, footwear fitting, and patient and practice management .

Now Enrolling, space is limited: Winter Session: Online education: Feb. 13—March 17, 2017 Campus classes: March 20—25 & 27-30.

MORE INFO: Email: Call: 810-766-4359 Baker College of Flint, Orthotic/Prosthetic Technology, Pedorthics

Also: Orthotic/Prosthetic Technology at Baker College of Flint, call for educational options! This ad was funded by a grant from the U.S. Department of Labor’s Employment and Training Administration (grant number TC-25103-13-60-A-26). This product was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The U.S. Department of Labor makes not guarantees, warranties or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued liability, or ownership.

Career Opportunities... Oregon

Bend, CPO Medford, CPO


Fresno, CP/CPO San Jose, CO Salinas, CO


Richland, CP/CPO To apply, submit resume to:

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services. The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others. A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremast as demonstrated by our positive attitude, teamwork and professionalism.”





February 8

LSO/TLSO Policy. Register online at For more information, email Ryan Gleeson at Webinar Conference

January 9-14

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. Contact 703/836-7114, email, or visit

January 11

O&P Clinical Documentation: Who Webinar Conference Needs To Document and What You Need To Document. Register online at For more information, email Ryan Gleeson at

January 23-24

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars. Nashville, TN. Holiday Inn Express Nashville Downtown, 920 Broadway, Nashville, TN 37203. Register online at For more information, email Ryan Gleeson at

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, or visit

March 1-4

43rd Academy Annual Meeting & Scientific Symposium. Chicago, Hyatt Regency Chicago. Visit or contact Diane Ragusa at 202/380-3663, or

March 8

Marketing Your Business. Register online at For more information, email Ryan Gleeson at Webinar Conference

March 10-11

ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College—Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email, or visit

Let us

your next event!

Free Online Training

Cascade Dafo Institute. Now offering a series of seven free ABC-approved online courses, designed for pediatric practitioners. Earn up to 10.25 CEUs. Visit or call 800-848-7332.

CE For information on continuing education credits, contact the sponsor. Questions? Email

Calendar Rates


ABC: Application Deadline for Certification Exams. Applications must be received by March 1 for individuals seeking to take the May Written and Written Simulation certification exams. Contact 703/836-7114, email, or visit

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when ready; receive results instantly. Current BOCO, BOCP, BOCPD candidates have three 3 yearsyears fromfrom application application datedate to pass to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit


March 1


Phone numbers, email addresses, and websites are counted as single words. Refer to for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.





25 or less




$50 $60


$2.25/word $5.00/word

Color Ad Special 1/4 page Ad



1/2 page Ad




March 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, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. Contact 703/836-7114, email, or visit

March 17-18

ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College—Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email, or visit

April 10-11

2017 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars. Denver. The Westin Denver Downtown, 1672 Lawrence Street, Denver, CO 80202. Register online at For more information, email Ryan Gleeson at

July 17-18

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Pittsburgh. The DoubleTree by Hilton Hotel and Suites Pittsburgh Downtown, One Bigelow Square, Pittsburgh, PA. Register online at For more information, email Ryan Gleeson at Coding & Billing Seminar

August 9

What the Medicare Audit Data Tells Us and How To Avoid Common Errors. Register online at For more information, email Ryan Gleeson at Webinar Conference

September 6-9

100th AOPA National Assembly and Second World Congress. Las Vegas. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or For general inquiries, contact Betty Leppin at 571/431-0876, or, or visit

April 12

Grassroots Advocacy. Register online at For more information, email Ryan Gleeson at Webinar Conference

September 13

ABC Inspections and Accreditation. Register online at For more information, email Ryan Gleeson at Webinar Conference

May 10

Modifiers: What Do They Mean and When To Use Them. Register online at For more information, email Ryan Gleeson at Webinar Conference

May 24-25

AOPA Policy Forum. Washington, DC. Come make a difference! Educate Congress on issues affecting your patients. For more information, contact Devon Bernard at or call 571/431-0876.

June 14

Internal Audits: The Why and the How of Conducting Self-Audits. Register online at For more information, email Ryan Gleeson at Webinar Conference

July 12

Know Your Resources: Where To Look To Find the Answers. Register online at For more information, email Ryan Gleeson at Webinar Conference

October 11

AFO/KAFO Policy. Register online at For more information, email Ryan Gleeson at Webinar Conference

November 6-7

2017 Mastering Medicare: Essential Coding & Billing Techniques Seminars. Phoenix. Sheraton Grand Phoenix, 340 N. 3rd Street, Phoenix. Book by October 13 for the $179 rate by calling 800/325-3535 or by calling the hotel directly at 602/262-2500. Register online at For more information, email Ryan Gleeson at Coding & Billing Seminar

November 8

Gift Giving: Show Your Thanks and Remain Compliant. Register online at For more information, email Ryan Gleeson at Webinar Conference

December 13

New Codes and Other Updates for 2018. Register online at For more information, email Ryan Gleeson at Webinar Conference




Paperwork Puzzles Answers to your questions regarding physician documentation, proof-of-delivery forms, and more

AOPA receives hundreds of queries from readers Q 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

If I am not accepting assignment on a claim, can I have a patient sign an advanced beneficiary notice and not collect any documentation from the ordering/referring physician?


No. Just because you are not accepting assignment on a claim doesn’t mean that you are free from your duties and obligations of obtaining the proper documentation needed to file a claim for payment. Not accepting assignment only relates to the amount of money you may collect from the patient and who pays you the money. If you are not accepting assignment on a claim, you may charge and collect your usual and customary amount for a service and you are not bound to Medicare’s allowable; you may collect your full amount directly from the patient. But you are still required to collect documentation as mandated.


If I mail an item to a patient, do I need a signed copy of the receipt or a returned, signed proof-ofdelivery form from the patient?


No. You are only required to have some form of proof that the item was delivered; this could be a notification from the shipping company or a similar document. Also, remember that if you use a shipping service, your date of service is not the date the patient receives the item; rather, it is the date you shipped the item to the patient.




Is a new prescription or order required when replacing supply items?


No. The replacement of supply items is covered under the original prescription or order for the lifetime of the item. However, be sure the final detailed written order includes information on the number of supplies originally provided and how often the supplies should be replaced.



Can I bill for repairs to diabetic shoes?

Yes, you may bill for repairs to diabetic shoes using code A5507. The diabetic shoe policy states, “Code A5507 is only to be used for not-otherwise-specified therapeutic modifications to the shoe or for repairs.” Keep in mind, however, that the A5507 code does count toward the total number of inserts/modifications a patient is eligible to receive in a year. So, if the patient has already received all of his or her eligible inserts/modifications, the repairs billed with A5507 will be denied as noncovered—which means that the cost of the repairs will be the patient’s responsibility.


Still #NotaLuxury Speak out. Advocate. Donate. Volunteer.

For 30 years, the Amputee Coalition has led the way in empowering people affected by limb loss and limb difference. With our focus on education, advocacy, and support, we work hard to make sure every time someone reaches out, they can feel someone reaching back. This work is possible through your support, whether it is adding your voice to the fight for appropriate coverage, making a donation, or sharing your time and talents. 888.267.5669

C-LegÂŽ 4

Clinically proven outcomes

C-Leg studies have shown improved quality of life* and satisfaction*, and up to 88% preference over non-microprocessor knees.*

The C-Leg has been shown to reduce falls by up to 80% in the K2 population when compared to mechanical knees.*

*Please reference


January 2017 O&P Almanac  
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