June 2015 O&P Almanac by AOPA

LATE-BREAKING NEWS: CONGRESS WRITES HHS SEEKING O&P POLICY CHANGES P.24 The Magazine for the Orthotics & Prosthetics Profession

J U N E 2015

E! QU IZ M EARN

BUSINESS CE

CREDITS

Prepare Now for the ICD-10 Transition P.18

This Just In: Congressional Briefing Hits CNN P.22

Leadership Series: Partnering with Hospitals P.34

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TRENDS Central in

Fabrication

CHALLENGES AND OPPORTUNITIES IN MEETING THE NEEDS OF TODAY’S CLINICIAN P.26

SPECIAL FEATURE: 2015 O&P BUYERS’ GUIDE

WWW.AOPANET.ORG

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The 98th Annual AOPA National Assembly in conjunction with the Texas Academy Chapter Meeting October 7-10, 2015 The Henry B. Gonzalez Convention Center On the Riverwalk in San Antonio, TX

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J U N E 2015 | VOL. 64, NO. 6

FEATURES

DEPARTMENTS | COLUMNS President’s View....................................... 4

Photo: Courtesy of Advanced Orthopedic Designs

COVER STORY

Insights from AOPA President Charles Dankmeyer, Jr., CPO

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

Numbers........................................................ 8

At-a-glance statistics and data

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

Research, updates, and industry news

26 | Trends in Central Fabrication Whether outsourcing just one type of device, or sending all fabrication to an outside facility, O&P practitioners understand that central fabrication plays a key role in the O&P industry. Today’s c-fabs are challenged by competition from startups and lag times in collections, but are embracing opportunities in terms of new technologies and quality control measures. By Christine Umbrell

22 | This Just In—AOPA’s

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n n

P. 34

Partnering with hospitals may appear a daunting task, but those clinicians with experience in this area say it’s important to build relationships now so those institutions will know where to look as more services become bundled and the health-care landscape evolves. Here, three experienced clinicians share their tips for initiating partnerships and contracting with hospitals.

CE Opportunity to earn up to 2 CE credits by taking the online quiz.

CREDITS

Member Spotlight................................. 54

AOPA and the Amputee Coalition hosted a congressional briefing in May to educate legislators about O&P policies. Several O&P advocates shared hard data and personal experiences, and speaker Adrianne Haslet-Davis followed up by sharing her story on CNN.

Hospitals—What’s the Hype?

Reimbursement Page..........................18 ICD-10: What Does It Mean for O&P?

Prep your facility for the October 1 transition

Congressional Briefing Hits CNN

34 | O&P Almanac Leadership Series

People & Places.........................................17

Transitions in the profession

PLUS: Exclusive Interview with Francis McGuigan, MD, on Building Relationships With Surgeons

40 | SPECIAL FEATURE

2015 O&P Buyers’ Guide The 2015 Buyers’ Guide features all of the products and services you need to meet your patients’ diverse needs.

Lee’s Comfort Shoes Orthomerica

AOPA News.................................................57

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 62 Careers.........................................................64

Professional opportunities

Ad Index....................................................... 65 Calendar......................................................66

Upcoming meetings and events

Ask AOPA...................................................68 Expert answers to your questions about secondary payors

Advertise with Us! For

advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

O&P ALMANAC | JUNE 2015

PRESIDENT’S VIEW

Time To Prove Our Worth

XPERTS IN HEALTH-CARE POLICY at AOPA’s Futures

Leadership Conference in January drove home the point that the essential survival tools of O&P are data, data, data; outcomes, outcomes, outcomes; and value, value, value. To get the data to identify the outcomes that prove the value of O&P care, we need to complete research, research, research. Without data and good outcomes, it’s clear we will have a tough, if not impossible, road to survival. The goal is professional recognition with appropriate reimbursement for services provided, not simply hardware delivered. That’s why it was so encouraging for AOPA and the Center for Learning and Evidenced-Based Practice to receive 16 submissions to the small pilots grant request for proposals (RFPs)—$15,000 each, for up to four grants—issued in February of this year, and another dozen plus submissions in response to the higher dollar-level funding for the literature review RFPs that will be partially funded by AOPA in collaboration with other interested parties. The AOPA board allocated a total of $240,000 to partially fund four literature reviews in response to what we learned at the Futures Leadership Conference about the importance of research to our survival, and another $40,000 toward developing a patient registry project. The same collaborative funding approach was used last year when awarding the Mayo Clinic a $249,999 grant to measure the comparative effectiveness of microprocessor-controlled knees versus nonmicroprocessorcontrolled knees, a study now underway. About 75 percent of that award is underwritten by a consortium of Freedom Innovations, Ottobock, and Össur, with the balance provided by AOPA. Why are these research projects so important? They identify patient outcomes that, combined with cost effectiveness data, prove that when these devices are utilized in an O&P treatment plan, overall medical costs are reduced. That is the value proposition. Memories are short, but the impetus for these foot and knee studies was triggered in part by a report by the U.S. Department of Health and Human Services Office of Inspector General (OIG) that took issue with the growing costs of prostheses to Medicare while there was no increase in the number of amputees. That OIG report accused prosthetists of inappropriately providing more costly devices beyond patient needs. The flawed report did not account for the increase in the fee schedule, nor the higher technology level that did, in fact, legitimately improve patient outcomes. It is encouraging to see the growing interest in research efforts that demonstrate the outcomes and value of O&P care. We all see positive patient results every day. The media is flooded with amputees and persons using prostheses and orthoses to climb mountains, run marathons, and participate in all manner of competitions— these are all very powerful and positive. No one can deny the work we do provides amputees and those with functional loss the ability to live full and active lives. But those patient stories have never been enough to convince Medicare and other payors that O&P is a professional service with real benefits. I say it’s about damn time we started proving our professional value with solid research so we are not simply depending on anecdotal patient stories. What do you think? Email info@AOPAnet.org.

Charles H. Dankmeyer Jr., CPO AOPA President

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

JUNE 2015 | O&P ALMANAC

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Austin, TX Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Thomas F. Fise, JD 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.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

MEMBERSHIP & MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

JUNE 2015 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company 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 almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2015 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 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

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NUMBERS

Orthotists Essential for Scoliosis Care June is Scoliosis Awareness Month, and the Scoliosis Research Society (SRS) is bringing national attention to spine curvatures. Scoliosis, a musculoskeletal disorder in which there is an abnormal curvature of the spine, affects 2 to 3 percent of the U.S. population. For patients with adolescent idiopathic scoliosis, orthoses have been shown to prevent curve progression and the need for surgery.

PREVALENCE

1 in 40

93 Percent

Approximately 7 million Americans, or one in 40, are affected by scoliosis.

More than nine out of 10 Americans with spinal deformity problems are diagnosed with scoliosis.

PATIENT CHARACTERISTICS

Females > Males

Primary age of onset is between 10 and 15 years, though it can impact all ages.

Females are eight times more likely to have a curve progress to a stage that requires treatment.

One quarter of children with spinal curves require medical attention.

Rate of Treatment Success of Bracing By Hours of Daily Brace Wear

Source: “Effects of Bracing in Adolescents With Idiopathic Scoliosis,” New England Journal of Medicine, October 2013

JUNE 2015 | O&P ALMANAC

30,000

Thirty-thousand children are fitted for a brace each year, typically for curves between 25 and 45 degrees.

85 Percent Idiopathic More than eight out of 10 scoliosis cases have “unknown” causes.

100,000

More than 100,000 children and adults undergo surgery each year, generally when curves are greater than 45 degrees and progressive.

“Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. Longer hours of brace wear were associated with greater benefit.” —Stuart Weinstein, MD; Lori Dolan, PhD; James Wright, MD, MPH; and Matthew Dobbs, MD, “Effects of Bracing in Adolescents With Idiopathic Scoliosis,” New England Journal of Medicine

SOURCES: Scoliosis Research Society, National Scoliosis Foundation, American Chiropractic Association

10-15 Years Old

25 Percent

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Happenings Peripheral Nerve Interface May Foster ‘Feeling’ in Prosthetic Hands

RESEARCH ROUNDUP

Researchers Design Two-Armed Rehab Exoskeleton

JUNE 2015 | O&P ALMANAC

ILLUSTRATION: Washington University in St. Louis

PHOTO: University of Texas at Austin

A team at the Cockrell School of Engineering at the University of Texas at Austin has developed a two-armed robotic exoskeleton, called “Harmony,” that uses mechanical feedback and sensory data to provide therapy to patients with spinal and neurological injuries. Although exoskeletons are typically designed with one arm, Harmony was designed with two arms to provide full upper-body therapy with natural motion. Clinical trial participants are using Harmony to learn to perform activities of daily living. The lightweight device, which fits the entire upper body, has 14 axes of movement and a shoulder joint that helps with scapulohumeral rhythm to aid in rotation of the upper arm, shoulder, and back and enhance long-term joint stability. It also features a suite of sensors designed to record data at a rate of 2,000 times per second, which assists clinicians in providing more precise therapy. Harmony was “specially designed to offer customized therapy for optimal efficacy,” says mechanical engineering researcher Ashish Deshpande. “Not only does the exoskeleton adjust to patient size, it can also be programmed to be gentle or firm based on the individual’s therapy needs.”

Washington University in St. Louis researchers have developed a macrosieve peripheral nerve interface to stimulate the nerves in the upper arm and forearm. The device is intended to be used in conjunction with motorized upper-limb prostheses to allow users to “feel” various sensations through the prosthesis, which would send sensory signals to the brain. The goal is for users to receive hot and cold sensations, as well as a sense of touch to enable them to adjust the pressure when handling different items with their prostheses. Daniel Moran, PhD, professor of biomedical engineering and neurobiolulnar and median nerves so it feels as if someone is touching them. ogy and lead on the project, has received “We want to determine what they a three-year, $1.9 million grant from the can perceive through artificial stimulaDefense Advanced Research Projects Agency (DARPA) to test the device. tion of the nerves,” says Moran. The Made of an ultrathin, flexible material researchers will use low levels of stimusimilar to a soft contact lens and onelation to determine how many different eighth the size of a dime, the device has nerve sectors they can independently the appearance of a mini wagon wheel. encode within a unique target locaDuring the test tion. They also will analyze phase, the researchers how the brain processes will implant the device the feedback from nerve into the forearms of stimulation. The goal is to anesthetized nonhuman stimulate sensory neurons, primates, and then which has not been done determine the amount of before. The researchers will sensory information that work with DARPA to deteris encoded by providing mine how many sensors to Daniel Moran, PhD, and low levels of stimulation put on prosthetic hands. to a small group of nerves. his team have developed DARPA also funds a novel device that The researchers will the “Luke arm” prosthesis, would stimulate the a high-tech bionic limb train the nonhuman nerves in the upper arm created by DEKA Research. primates to play a and forearm, possibly The prosthesis allows users joystick-controlled video giving amputees to perform six different game, using cues to teach with prosthetics the grips but does not have the them how to move the ability to feel. senses of touch or orientajoystick by stimulating specific sectors in the tion of a natural hand.

HAPPENINGS

MILITARY MATTERS

U.S. Service Members Undergo Fewer Amputations As fewer U.S. service members are called to engage in overseas conflicts, there has been a downward trend in military amputations during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), according to data published in “U.S. Military Statistics: OND, OIF, and OEF.” While the number of battle-injury major limb amputations during those operations peaked in 2011 at 253 (251 OEF and two OIF/OND), there were 33 such amputations in 2013 and only four during the first eight months of 2014. The total number of amputations for the duration of the three operations combined, as of Sept. 1, 2014, was 1,573. From 2003 until the first quarter of 2009, the majority of major limb amputations due to battle injuries occurred in OIF. The trend changed in the second quarter of 2009, when the majority of major limb amputations shifted to OEF participants.

Major Limb Amputations Due to Battle Injuries in OIF, OND, and OEF, 2001-2014 (as of Sept. 1, 2014) Injury Date

OEF

OIF/OND

Total (OEF, OIF, OND)

2001

2002

2003

2004

149

155

2005

145

161

2006

148

157

2007

196

209

2008

2009

2010

204

205

2011

251

253

2012

141

2013

2014

Source: U.S. Military Statistics; OND, OIF, and OEF

0 77

MEETING MASHUP

DoD, VA Host Amputee Care Innovation Symposium Health-care providers from the Department of Defense (DoD) and Department of Veterans Affairs (VA) gathered at Center for the Intrepid, Brooke Army Medical Center, in Texas, May 19-21 for a joint training symposium focused on innovations in amputee care. More than 100 DoD and VA physicians, therapists, prosthetists, and other clinicians attended the second annual Federal Advanced Amputation Skills Training Symposium (FAAST) to learn skills to improve amputee care. The three-day symposium featured morning sessions presented by subject matter experts followed by hands-on training in adaptive sports equipment, the use of 3D printing in rehabilitation, and blood-flow restricted strength training. Patients also attended the event, sharing their experiences and challenges with patient-care providers. “We’ve learned that an optimal model for amputee care places the patient at the center of the process and addresses their care needs with an integrated, multidisciplinary team,” says John Shero, director of the DoD-VA Extremity Trauma and Amputation Center of the Excellence. “FAAST is a great opportunity to learn from each other and to establish contacts.” One of the goals of the symposium was to equip clinicians with skills that can be immediately applied to short- and long-term patient care.

O&P ALMANAC | JUNE 2015

HAPPENINGS

O&P ATHLETICS

Amputees ‘Get Active’ in DC

Össur presents 13-year-old Amanda Merrell with a running leg.

Dozens of people with limb loss participated in the inaugural “Get Active DC” event on the campus of George Washington University on May 2, in conjunction with the Amputee Coalition’s Limb Loss Education Day. The event, sponsored by the Amputee Coalition, the Challenged Athletes Foundation (CAF), and Össur, hosted community-building endeavors, education, and running and mobility

Merrell takes her first step with the new running leg.

PHOTOS: Courtesy of Össur

Merrell practices drills.

activities. Helping run the events were Terrance Sheehan, MD, medical director of the Amputee Coalition and chief medical officer at Adventist Rehabilitation Hospital in Maryland, and amputee rehabilitation experts Bob Gailey, PhD, PT, and Peter Harsch, CP. Amanda Merrell, a 13-year-old cancer survivor from Gaithersburg, Maryland, was among the participants. She was one of the first individuals in the United States to try out the Össur Flex-Run Junior running leg, which was specifically designed for kids’ high-impact physical activities. In addition to the hands-on running and mobility sessions, attendees took part in education sessions on “The Team Approach to Amputee Care,” “How To Get the Most Out of the Rehabilitation Process,” and “Health and Emotional Benefits of Remaining Active.” “Our Limb Loss Education Day program is an important resource for the amputee community, and we are very pleased to be partnering with the Challenged Athletes Foundation and Össur in Washington, D.C., to make this unique event possible,” says Susan Stout, president and chief executive officer of the Amputee Coalition.

Amputees ‘Horse Around’ at McKeever’s First Ride

JUNE 2015 | O&P ALMANAC

Purple Heart Homes, and Reggie Showers, who is known as the “World’s Fastest Amputee” for his drag motorcycling championships. More than 90 volunteers were on hand to assist 50-plus participants. The American Board for Certification in Orthotics, Prosthetics, and Pedorthics; Endolite; SPS; Hanger Clinic; College Park Industries; SureStep; and Children’s Hospital of Atlanta served as sponsors of the event.

PHOTO: Courtesy of OPAF/McKeever’s First Ride

Reggie Showers, Deenie McKeever, and Dale Beatty

The Orthotic and Prosthetic Activities Foundation (OPAF) sponsored a McKeever’s First Ride event in April in Atlanta, where participants were taught how to interact with gentle horses. McKeever’s First Ride was designed to promote companionship and self-esteem as participants learned new skills in riding, roping, grooming, and groundwork. The Atlanta event was led by Dale Beatty, a military amputee who co-founded

HAPPENINGS

#ICYMI

New York Eliminates ‘One Limb’ Restriction The director of New York’s health insurance exchange has ordered the elimination of the “one limb per lifetime” restriction in private insurance coverage under the essential benefits package under the Affordable Care Act in that state, effective for the 2016 plan year. The policy violated several provisions in the ACA, including the nondiscrimination requirements based on age and disability status, according to staff at the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). In addition, “capping coverage at one limb per life prevents individuals with limb loss from returning to work or school, raising their families, participating in community activities, and obtaining

the health care they need to be healthy and independent,” say NAAOP officials. New York legislators drafted letters to the Health Marketplace requesting a rescission of the restriction in 2016, and more than 15,000 supporters signed an online petition posted by NAAOP asking for the restriction to be lifted. The New York provision was

The Source for Orthotic & Prosthetic Coding

struck down because the director of the insurance exchange found that a recent federal regulation requires coverage for rehabilitative and habilitative devices.

Correction

A photo in the cover story on page 30 of the April O&P Almanac was labelled incorrectly. The photo, shown on left, depicts the lab at AmPro Orthotics & Prosthetics Inc., located in Las Vegas. The O&P Almanac regrets the error.

Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.

HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.

Log on to LCodeSearch.com and start today. Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. www.AOPAnet.org

JUNE 2015 | O&P ALMANAC

NEW

Manufacturers: for 2015! AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

HAPPENINGS

CODING CORNER

Protests Concerning National RAC Contractor Dismissed Two formal protests lodged pertaining to the national contract for the recovery audit contractor (RAC) program have been dismissed. In December 2014, Connolly LLC was awarded the contract to serve as the national RAC contractor for durable medical equipment, prosthetics, orthotics, and supplies; home health; and hospice. The implementation was put on hold after Performant Recovery, the current Jurisdiction A RAC contractor, filed two protests. The dismissal of the protests, announced on the Government Accountability Office website, clears the way for CMS to finalize the award of the contract and authorize Connolly LLC to begin work. While an official start date for Connolly to begin actively auditing national claims has not been announced, the transition is expected to take place in June or July of 2015.

CMS Decreases Interest Rates CMS has announced that the interest rates for both Medicare overpayments and underpayments has been adjusted to 9.875 percent, effective for claims with a date of service on or after April 17, 2015. This represents a significant decrease from the last quarterly update of 10.5 percent that was effective for claims with a date of service on or after Jan. 1, 2015. The Medicare interest rate is updated quarterly and is based on the higher of the private consumer rate or the current value of funds rate prevailing on the date of final determination of a claim.

JUNE 2015 | O&P ALMANAC

DME MACs Revise Policy for Custom-Fitted Orthoses The four durable medical equipment Medicare administrative contractors have revised a joint coding bulletin regarding the proper coding of custom-fitted prefabricated orthoses versus off-the-shelf (OTS) orthoses. The revised bulletin reiterates the need for “substantial modification by a qualified individual” when billing for a custom-fitted orthosis as opposed to an OTS orthosis. Most of the information in the bulletin is a re-statement of existing policy. However, the revised bulletin states that if a Health-Care Common Procedure Coding System code is identified as prefabricated but does not have a corresponding code that describes the same product delivered as an OTS orthosis, it can only be used to bill orthoses that are supported by documentation of substantial modification to the orthosis performed by an individual with expertise in fitting. If this documentation does not

exist, or the substantial modification was performed by a person without expertise in fitting, the orthosis must be billed with the appropriate miscellaneous code (L1499, L2999, L3999), and the supplier must indicate that the orthosis was delivered as an OTS item in the narrative field on the claim form. The Medicare local coverage determinations for spinal orthoses, ankle-foot orthoses, knee-ankle-foot orthoses, and knee orthoses have been updated, effective May 1, 2015, to incorporate the language of the revised coding bulletin. When providing a custom-fitted orthosis, practitioners should ensure that documentation supports the need for whatever modifications were required to obtain a proper fit of the device and that the modifications were performed by a certified orthotist or other medical professional who is deemed qualified to perform the modifications.

Jurisdiction A DME MAC Announces Prepayment Probe Reviews The Jurisdiction A durable medical equipment Medicare administrative contractor has announced it will be initiating widespread prepayment probe reviews for claims for two codes: • L1940—AFO, plastic or other material, custom fabricated • L4360—walking boot, pneumatic, and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.

These reviews are being initiated as a result of a high volume of claim denials identified by the Comprehensive Error Rate Testing contractor. AOPA members are reminded that probe reviews often are a preliminary step that may lead to more comprehensive widespread prepayment reviews. If you receive a probe review request, your response should be as complete as possible and include all documentation necessary to support your claim.

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics at Hanger Clinic, was honored in April with the National Meningitis Association’s (NMA’s) Nancy Ford Springer Inspiration Award. The award, which was presented Kevin Carroll, MS, at the 2015 NMA “Give Kids a Shot!” Gala CP, FAAOP in New York City, was given in recognition of Carroll’s long-term work treating meningitis survivors, many of whom lose limbs as a result of the disease.

Brenda Adelson is the first person in the United States to be fit with Ottobock’s C-Leg 4.

David Motycka, CPO, recently fit above-knee amputee Brenda Adelson with the first C-Leg 4 fit in the United States. David Motycka, CPO Motycka is a managing partner at New England Orthotic and Prosthetic Systems in Hamden, Connecticut. The prosthesis incorporates new technology for reporting that is designed to help clinicians more easily document the benefits of the knee, says Andreas Kannenberg, executive medical director for Ottobock North America. The device also features enhanced stumble recovery and improvements in stance and swing phase control.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Ability Prosthetics and Orthotics and Paceline hosted an OPAF First Swim Clinic on Saturday, March 28, at Queens University of Charlotte in Charlotte, North Carolina. First Swim was led by three-time Paralympic swim champion Jason Wening, CPO, FAAOP, and the Queens University swim team.

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. (ABC) has updated its Model State Licensure Practice Act, administrative rules, and handbook for individuals considering orthotic, prosthetic, and pedorthic licensure in their state. ABC provides these tools as a resource to the profession to assist with implementing a contemporary licensure act. The newly revised “Model Licensure Handbook” contains information on the common rationale used to initiate licensure in a nonlicensure state; instructions on how to get started with writing a bill, generating support, and lobbying your legislator; and navigating the regulatory process.

Rep. Doug LaMalfa (R-California)

Cascade Orthopedic Supply Inc. hosted a visit from Rep. Doug LaMalfa (R-California) and District Director Lisa Buescher in May to discuss the challenges facing the changing O&P landscape. LaMalfa and Buescher toured Cacade’s facility, learned about the company’s impact on the local economy, and reviewed key legislation affecting the O&P industry. Representatives from Elite Biomechanical Design also participated in the visit to express the effects of the changing health-care policies on their referral sources, company, and patients.

Orthologix LLC has launched a patient navigation program focused on O&P patients. The two-year pilot program will begin June 1, 2015, with phase one devoted to prosthetic patients. The program is structured “to assist patients on eliminating barriers across the rehabilitation continuum,” says President Eileen Levis. “Those barriers can be communication related, lack of understanding of the rehabilitation process, physical barriers such as mobility or transportation, or missed appointments.” The navigators are designed to help coordinate patient care, connect patients with resources, and help them reach optimum outcomes. Össur has entered into a licensing agreement with SpringActive Inc., a privately held engineering firm that specializes in human-compliant robotics and powered prosthetic devices. The multiyear agreement calls for Össur to be involved in final design, manufacturing, and commercialization activities for SpringActive’s Odyssey, a motorized prosthetic ankle replacement system that has completed several months of field testing.

O&P ALMANAC | JUNE 2015

REIMBURSEMENT PAGE

By JOE MCTERNAN

ICD-10: What Does It Mean for O&P? Prepare now for the October 1 transition to ICD-10 diagnosis codes

Editor’s Note—Readers of Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

E! QU IZ M EARN

BUSINESS CE

CREDITS

HERE HAS BEEN A tremendous

amount of buzz surrounding the upcoming conversion from the use of ICD-9 diagnosis codes to the latest version, ICD-10. Orthotists and prosthetists are asking, “Do we have to memorize thousands of new diagnosis codes?” “How can we make sure we are reporting the ICD-10 codes correctly?” “Where can we look to find more information on the transition?” This month’s Reimbursement Page will take a look at the basics surrounding the ICD-10 conversion, currently scheduled for implementation on Oct. 1, 2015. This column will dispel some of the myths surrounding ICD-10 and provide a general understanding of the impact the transition will have on O&P providers.

P.20

How Is ICD-10 Different?

ICD-10 is yet another acronym in the universe of acronyms in the medical community. It stands for International Classification of Diseases, 10th Edition, and is created and maintained by the World Health Organization. Although work on the ICD project was essentially completed in 1992, many countries, including the United States, have continued to use the previous version (ICD-9) as its primary resource for defining and classifying various diseases 18

JUNE 2015 | O&P ALMANAC

and health-care-related conditions. ICD-10 greatly expands on the ICD-9 system by adding an alphabetical character at the beginning of the ICD-10 code, and additional digits to the five-place coding system used in the ICD-9 system. ICD-9 codes, which have been in use for more than 30 years, use a five-place numbering system with three digits before the decimal, followed by up to two digits after. The principle in place is that the three digits prior to the decimal provide basic information regarding the disease or condition, and the two digits after the decimal provide more specific information regarding the specific nature of the condition or disease. For example, the ICD-9 code for a fracture of the tibia is 823.00, but the ICD-9 code for a fracture of the tibial shaft is 823.30. The additional numbers after the decimal provide specific information regarding the section of the tibia where the fracture is located. Under ICD-10, physicians will be able to more accurately describe the nature of the fracture through the use of additional places after the decimal. ICD-10 codes will include information such as the degree of the fracture, whether it is displaced, etc.

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O&P facilities must make

ICD-10 format. Since the transition to ICD-10 has already been announced and subsequently delayed several times, this should not be an issue. Software vendors have had plenty of time to ensure that their products are up to date and include the multitude of diagnosis codes that make up the ICD-10 system. It remains prudent, however, for O&P facilities to confirm with their software vendors that their systems are up to date and ready for the switch on October 1. Second, while O&P facilities will only be reporting the ICD-10 code(s) assigned by the physician, it is in their best interest to make sure their staff is at least familiar with the expanded format under which ICD-10 operates. Medicare regulations have always required diagnosis codes to be reported to the highest level of specificity. Claims with incomplete ICD-10 codes may be subject to unnecessary rejection or denial. Finally, O&P facilities must be prepared to review the revised Medicare local coverage determinations and policy articles that will be released to reflect the updated ICD-10 system. This is especially important for policies where coverage is tied to a specific diagnosis, such as the Medicare knee orthosis policy. O&P providers must make sure that the ICD-10 codes assigned by physicians remain eligible for coverage of certain types of O&P devices.

sure that their software

What Happens Next?

The addition of up to two additional digits after the decimal creates a larger universe of potential ICD-10 codes compared to ICD-9 codes. While there are approximately 15,000 ICD-9 codes, the current list of ICD-10 codes includes more than 64,000 unique ICD-10 codes, an increase of more than 300 percent. The sheer number of ICD-10 codes under the new system has created tremendous apprehension among physicians, who have grown accustomed to operating within a fairly limited set of common diagnosis codes. This apprehension has led to several delays in the implementation of the ICD-10 system, and may lead to additional delays in the future.

What Is the Impact on O&P Facilities?

At the risk of downplaying the importance of the transition from ICD-9 to ICD-10, the direct impact the transition will have on O&P facilities is significantly less than it is for physicians. The responsibility for assigning a diagnosis to a patient lies solely with the physician. O&P facilities have responsibility only for reporting the diagnosis code on claims to Medicare and other payors.

systems have been updated to properly record and report diagnosis codes under the ICD-10 format.

However, there are many things that O&P facilities must prepare for in anticipation of the October 1 transition from ICD-9 to ICD-10. First and foremost, O&P facilities must make sure that their software systems have been updated to properly record and report diagnosis codes under the 20

JUNE 2015 | O&P ALMANAC

While the current implementation date for the transition to ICD-10 is set for October 1, it is possible that implementation will once again be delayed. The more than 300 percent expansion of diagnosis codes from ICD-9 to ICD-10 has led to significant pushback from the physician community and their representative trade organizations. The American Medical Association, the largest and most powerful physician trade association, has been very vocal regarding its opposition to the current implementation date for the ICD-10 transition. It believes the increased administrative burden and increased costs to update physiciansâ&#x20AC;&#x2122; systems to incorporate ICD-10 codes are extremely high and has continually

lobbied for additional delays in the final implementation of the ICD-10 system. While each day closer to October 1 represents a slightly lower chance that implementation will be delayed, it is not out of the realm of possibility that another delay will occur.

While the direct impact of the ICD-10 transition to O&P facilities is relatively minimal, failure to ensure that you are prepared for the transition may negatively impact your ability to have claims processed properly after October 1. Assuming that implementation of ICD-10 is not delayed any further, O&P facilities must be ready to report ICD-10 based diagnosis codes for claims with a date of service on or after Oct. 1, 2015. Any claims submitted with ICD-9 codes on or after this date will be rejected as not having a valid diagnosis code. This can lead to significant cash flow issues, which will most certainly have a direct impact on your business. It is better to prepare now than to react later. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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This Just In

AOPA’s Congressional Briefing Hits CNN O&P advocates present policy positions during event that receives media attention

HE RECOGNITION THAT BOSTON

Marathon survivor Adrianne Haslet-Davis gave AOPA and the Mobility Saves program during her May 18 CNN op-ed piece is just one of the positive aftereffects of the congressional briefing hosted by AOPA and the Amputee Coalition, which was held in the Rayburn House Office building on Friday, May 1. The briefing offered the O&P community and their patients a moment in the political spotlight. AOPA members who attended the March 23-24 Policy Forum had hand-delivered invitations to the briefing during their appointments with members of Congress and their staff. Several members of Congress, including Reps. Tammy Duckworth (D-Illinois) and Dutch Ruppersberger (D-Maryland), also assisted in encouraging participation. Congressional briefings are a highly regarded tool to help put a face on policy positions, such as the message communicated by AOPA and the Amputee Coalition during the May 1 event. The briefing was highlighted by presentations from a diverse group of experts and O&P patients, ranging from Haslet-Davis to prosthetic technology experts, clinicians, and patient advocates.

JUNE 2015 | O&P ALMANAC

Data Supported by Testimonies

AOPA President Charles H. Dankmeyer Jr., CPO, welcomed the group and explained how care for limb loss and the limb impaired in today’s health environment actually saves payors money in the long term. Audrey El Gamil, senior manager at DobsonDaVanzo & Associates, started connecting the dots with the impressive results from Medicare’s own database and demonstrated how timely O&P intervention saves Medicare big dollars over the long run compared with Medicare’s expense for the costly co-morbid conditions that develop in those not receiving timely care. The numbers resonated when Haslet-Davis told her story of how life changed forever in three seconds. She shared her personal survival story, which had an obvious emotional impact on participants. Haslet-Davis praised her prosthetist and explained that the abilities she has regained serve as inspiration to many others. More importantly, she gave visual credibility to the day-in and day-out efforts of the O&P community to leave their patients better than they found them. Peggy Chenoweth of the Amputee Coalition, herself an amputee, also provided a poignant voice of experience

This Just In

Positive Press in the Aftermath

Ian Fothergill, CPO, of Medical Center O&P, and Adrianne Haslet-Davis

in the patient community. Chenoweth emphasized the importance of returning people’s mobility, the quality-of-life improvements that result from O&P care, and the struggles in a health-care system that often seems to focus solely on reducing payments. Those presentations set the stage for a glimpse of the technology available today and tomorrow for amputees. Aaron Holm of Ottobock USA and Ian Fothergill, CPO, of the Medical Center O&P—which serves Walter Reed patients as special clinical providers— both delivered eye-opening presentations that underscored how advances in orthotic and prosthetic technology are delivering a mobility and qualityof-life value unthinkable just a few years ago. Lauren Anderson, AOPA’s manager of communications, policy, and strategic initiatives, offered a tour of the Mobility Saves website, demonstrating the resources available to provide patients, providers, and payors with facts and information that enable more informed decisions about O&P’s role in health care’s continuing quest for quality care based on value. AOPA Executive Director Thomas F. Fise, JD, presented the legislative goals portion of the event, explaining

After speaking at the briefing, HasletDavis penned an op-ed piece for CNN, titled “Boston Survivor: Our 25 Months.” Haslet-Davis described how her life has evolved over the past 25 months—from the day of the bombing and her amputation to the day the verdict and death sentence for Dzhokhar Tsarnaev were revealed. Haslet-Davis also wrote, “Recently, I spoke to members of Congress on behalf of the American Orthotic and Prosthetic Association with the Amputee Coalition for Mobility Saves. Mobility Saves has proven to Medicare that providing coverage for prosthetics saves lives and money. It was an honor and privilege to speak to members of Congress and their aides.” To view the full CNN op-ed article, visit bit.ly/aopacnn. The congressional briefing was videotaped and is available on the Mobility Saves website at www. mobilitysaves.org. Click on the “News” pulldown menu to access videos of each presentation. AOPA members are free to add these videos to their own websites for even greater impact.

how it is unfair to O&P patients when their practitioners must face over-thetop recovery audit contractor (RAC) audits and the current nearly-threeyear delay in administrative law judge appeals—obstacles that have driven many O&P providers out of business. He followed up with how critical it is for payors to acknowledge the notes of the orthotist and prosthetist in the patient’s medical record and as part of the medical necessity determination. Fise also plugged the legislative corrective opportunities embraced by the Medicare O&P Improvement Act, H.R. 1530 in the House of AOPA President Representatives and S. Charles H. Dankmeyer Jr., CPO 829 in the Senate. There was also discussion of H.R. 1526, the Mobility Saves, a collaborative effort Medicare Audit Improvement Act of by the Amputee Coalition and AOPA, 2015, as a much needed solution; this can be used by AOPA members to legislation provides some RAC audit help educate legislators and staff, who relief and recognition of the O&P also can be encouraged to visit AOPA provider’s notes in the medical record. member O&P facilities. The video preThe briefing provided the platform to sentations are a great training tool for summarize the entire O&P legislative members to further familiarize their and policy agenda in one of the most own employees with some of the chalsignificant settings advocacy organizalenges faced by the O&P community in their effort to deliver quality care. tion can hope to obtain. O&P ALMANAC | JUNE 2015

LATE-BREAKING NEWS

O&P Advocates Win Support From U.S. Representatives Members of Congress pen letter to HHS seeking O&P policy changes

HE O&P COMMUNITY SCORED

Rep. Ryan Costello Rep. Tammy Duckworth (R-Pennsylvania) (D-Illinois)

JUNE 2015 | O&P ALMANAC

a major victory on May 19 when 26 members of Congress sent a letter to Sylvia Mathews Burwell, secretary of the Department of Health and Human Services (HHS), expressing their concerns regarding Medicare’s O&P-related policies. Led by Reps. Ryan Costello (R-Pennsylvania) and Tammy Duckworth (D-Illinois), this initiative demonstrates the strong congressional support the O&P community is receiving from legislators. In the introduction of the letter, the legislators wrote: “Specifically, we’re concerned that examples of deviation from clear statutory instructions from Congress to the administration may jeopardize patient access to proper treatments and access to appropriately trained providers for Medicare’s limb loss and limb-impaired beneficiaries. Given the drastic positive impact these devices can have on a beneficiary’s ability to conduct activities of everyday life, and the associated contribution potential for this at-risk population, it is our hope that appropriate remedies can be found.” The letter goes on to address specific issues relating to the definition of “minimal self-adjustment” and the need for enforcement of the Beneficiary Improvement Protection Act to ensure only qualified practitioners provide O&P care. The full text of the letter to Burwell can be accessed at bit.ly/costelloduckworth. In response to the letter, AOPA Executive Director Tom Fise, JD, sent the following message to the AOPA Board of Directors and allied organizations, announcing the success

of the sign-on letter that obtained the wide support of members of Congress responding to the fullcourt press from AOPA members and the other O&P organizations: I am pleased to enclose a copy of the final letter to HHS Secretary Sylvia Burwell, led by Reps. Ryan Costello (R-Pennsylvania) and Tammy Duckworth (D-Illinois) and signed by a total of 26 members of the House of Representatives. As you can see, the letter: (1) presses HHS/ CMS to revise the regulatory definition of off-the-shelf (OTS) orthotics in 42 C.F.R. § 414.402 to conform with the statutory definition, recognizing the clear meaning and limitation of “minimal self adjustment” [as previously stated in the prior letter from Sens. Chuck Grassley (R-Iowa) and Tom Harkin (D-Iowa), October 2014]; (2) modify the OTS list and codes to eliminate from that list any device which does not meet fully and unambiguously the statutory definition of OTS orthotics, including “minimal self-adjustment”; and (3) reverse the durable medical equipment Medicare administrative contractor action of Aug. 15, 2014, as inconsistent with the APA and an open rule-making process, and excise the resulting Feb. 18, 2014 FAQ. AOPA launched the efforts targeted at this letter, but we need to say “thank you’” to a large number of people for helping to carry the effort forward. These include: (a) attendees at the 2015 AOPA Policy Forum who personally requested their legislators to send this message [and those who used AOPAVotes (roughly 700 letters) and other vehicles to write this request to their legislators]; (b) our partner organizations in the O&P Alliance and its counsel, Peter

LATE-BREAKING NEWS

Did Your Representative Sign On?

The following representatives signed the letter to HHS Secretary Sylvia Mathews Burwell:

View the full text of the letter sent by Reps. Costello and Duckworth and 24 other representatives to HHS Secretary Sylvia Mathews Burwell at bit.ly/costelloduckworth.

Thomas, who fostered similar strong efforts advocating for the letter; (c) AOPA’s lobbying teams from Alston & Bird and McGuireWoods, and others for relentlessly pushing this message over the past seven weeks; and (d) members of Congress and their staffs, and most importantly the staffers of Reps. Costello and Duckworth, who were steadfast in advancing the letter. IF HHS/CMS takes this message seriously, it would mark both the conclusion

to a 15-year struggle to get Medicare to implement and enforce the provisions on licensure and accreditation for O&P that Congress enacted in Section 427 of BIPA 2000, and reverse Medicare’s misguided effort to expand the relatively narrow category of OTS orthotics beyond the strict terms of the definition Congress wisely established with the “minimal self-adjustment” criteria, remedying both errant, overly expansive rules CMS

Ryan Costello (R-Pennsylvania) Tammy Duckworth (D-Illinois) Glenn “GT” Thompson (R-Pennsylvania) Erik Paulsen (R-Minnesota) Mike Thompson (D-California) Mark Pocan (D-Wisconsin) Peter T. King (R-New York) Phil Roe, MD (R-Tennessee) Earl L. Carter (R-Georgia) Patrick Meehan (R-Pennsylvania) Mark Meadows (R-North Carolina) Sam Farr (D-California) Renee Ellmers (R-North Carolina) Brenda L. Lawrence (D-Michigan) Dave Loebsack (D-Iowa) J. Randy Forbes (R-Virginia) Chellie Pingree (D-Maine) Steve Chabot (R-Ohio) Dutch Ruppersberger (D-Maryland) Brett Guthrie (R-Kentucky) John Garamendi (D-California) Mike Quigley (D-Illinois) Ted S. Yoho (R-Florida) James R. Langevin (D-Rhode Island) Dan Benishek, MD (R-Michigan) Ann McLane Kuster (D-New Hampshire)

promulgated in 2007, as well as CMS’s failure to finish the proposed rule on OTS orthotics that it initiated in July 2014 and seemingly abandoned in October 2014. So, thanks to all, and we will keep everyone posted on feedback as we receive it from CMS and key members of Congress on this issue. —Tom Fise, JD, AOPA Executive Director O&P ALMANAC | JUNE 2015

COVER STORY

Trends in

Central

Fabrication TODAY’S C-FABS FACE AN ARRAY OF CHALLENGES AND OPPORTUNITIES IN MEETING THE NEEDS OF O&P CLINICIANS

By CHRISTINE UMBRELL

JUNE 2015 | O&P ALMANAC

COVER STORY

Need to Know: • As they increasingly focus on patient care, practitioners have become more comfortable with the idea of letting skilled technicians take over fabrication tasks. • C-fabs service a wide array of clients and must be knowledgeable about the latest technological innovations. • Local startups can be a challenge to larger c-fabs, and they may find it hard to compete on pricing and turnaround time. Quality, certifications, and device extended warranties can be differentiators. • To mitigate fabrication consistency issues, some c-fabs have initiated communication and collaboration tools to ensure clinicians’ satisfaction with final products. • Monitoring collections and finding ways to work with past-due customers will be important strategies for long-term success in a tight market.

ENTRAL FABRICATION HAS BECOME an integral part of O&P

patient care over the past several decades. As the O&P industry has evolved, the job of the O&P clinician has shifted, requiring more focus on patient evaluation and fitting and less of a need to be the individual who makes the orthotic or prosthetic device. Though some O&P facilities choose to keep fabrication in house, research has shown that up to 90 percent use central fabrication facilities (c-fabs) for some portion of their fabrication needs, according to a report by Fillauer President and COO Dennis Williams, CO, BOCO. When central fabrication facilities first opened, it took some time for many orthotists and prosthetists to buy into the idea of outsourcing fabrication. “People were used to doing their work in the back of their facilities—they were used to a close connection with and control over the

fabrication process,” says Loretta Sheldon, director of business development and education for Cascade Dafo Inc. “It was a challenge for people to learn how to hand it off.” But practitioners Loretta Sheldon today have become more comfortable with the idea of letting skilled technicians—in house or at c-fabs— take over many of the fabrication tasks. Sheldon believes more O&P clinicians will embrace central fabrication now that new practitioners have master’s level education, and clinicians are being pressured to see more patients to increase profit margins. “For clinicians, the best use of their time to grow their businesses is not doing their own fabrication—it’s seeing patients,” she says. “So there’s been more acceptance of c-fabs to achieve this goal.” O&P ALMANAC | JUNE 2015

COVER STORY

JUNE 2015 | O&P ALMANAC

PHOTOS: Courtesy of WillowWood

WillowWood technicians

TREND 1

At WillowWood, Custom Solutions Manager Jon Shell has noted an increase in practitioners using the company’s central fabrication serJon Shell vices, particularly among clinicians from outside the immediate area. “C-fabs are usually regional, with practitioners using facilities where they can get quick turnaround,” he explains. “But we’ve recently seen more people from outside our region using our services.” Today’s practitioners face a barrage of audits and reimbursement challenges, which leads to ongoing decisions about whether to keep fabrication Ed Grace in house or take advantage of c-fabs. “Everyone has their own ideas,” says Ed Grace, president of Grace Prosthetic Fabrication. “But I think people will start to use c-fabs more, rather than in-house techs, because it is more cost effective. Why? With a c-fab, you only have to pay for fabrication when there’s work—you don’t have to pay salaries and employee expenses during down times,” says Grace. In addition, practitioners can contain costs by housing smaller facilities without expansive fabrication labs. As orthotists and prosthetists embrace central fabrication to a greater extent, it’s important to understand the opportunities and challenges facing c-fabs today. Following are some of the latest and most impactful trends sweeping the c-fab environment.

New Technologies and Materials

C-fabs service a wide array of clients and must be knowledgeable about the latest technological innovations. Most c-fabs are well-equipped with the newest, most flexible plastics, and have the capability to fabricate the latest high-tech components. “We work with 75 or 80 practitioners, and we have to be able to fabricate what each of them wants made,” explains Mike Verhoff, co-owner of PSL Fabrication. In addition, as portable scanning systems have come down in price, more practitioners are using them. But to make the most of these innovations, “c-fabs have to be in a position to accept these files to carve positive models,” says Bill Gustavson, vice president—business development for Orthomerica Products Inc. “In Bill Gustavson the near future, casts will become the exception, not the norm, so we have to be able to adapt at the c-fabs.”

Just as it’s important to stay educated on the latest innovations, it’s equally important to avoid jumping the gun. “New technologies are moving at warp speed—but we need to make sure they’re viable before jumping on the bandwagon,” says Gustavson. “What today is high-tech, tomorrow could be obsolete, so we have to be careful.” One area where many c-fabs are taking a wait-and-see attitude is digital printing. “3D printing is nowhere near ready for our industry,” says Shell. While WillowWood has a 3D printer on premises for prototyping and machine parts, it is not being used for fabrication yet; the same goes for Orthomerica. There are a number of unknowns when it comes to 3D printing and its applications for orthotics and prosthetics. At the moment, both time and materials are barriers to consideration: It can take hours or days to make a device using a 3D printer, and the machines are not yet designed to manufacture using the plastics needed for durable components. Verhoff believes that, with proper materials and reduced printing time, 3D printing may one day allow O&P manufacturers to fabricate custom braces for less money, which would ultimately be better for orthotics patients.

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Kevin Matthews, CO/LO, owner of Advanced Orthopedic Designs, also believes the technology could be a boon to his orthotics business Kevin Matthews, if a 3D printer CO/LO becomes available that can work with polypropylene or equivalent materials. He suggests it may be less expensive to use 3D printing than current CAD/ CAM or hand fabrication techniques for orthoses. But Matthews is concerned that 3D printing could lead to nonqualified persons adapting standardized programs to print devices.

JUNE 2015 | O&P ALMANAC

Competition From Startups

Executives at several c-fabs have noticed increased competition from startups—smaller companies offering fabrication services with only one or two staff members. In fact, Shell says there has been an uptick in the number of people who are purchasing WillowWood’s carvers and software so they can do their own fabrication. While competition can be good for business, many caution against using c-fabs that are not properly equipped for high-quality fabrication. “Since the O&P profession is not growing as it used to, facilities are looking for new revenue streams, and some are opening up smaller c-fabs,” says Gustavson. “There are minimal barriers to entry to get into the c-fab business,” which can be seen as an opportunity to service a local market. “After an FDA inspection at our manufacturing facility, one of the FDA inspectors told us that some of these new, small local c-fab operators literally are operating out of a garage,” he says. Established c-fabs can find it hard to compete with a small startup on pricing and turnaround time. “These

startups can charge less because they don’t have as much overhead,” says Grace, “but are they using the proper materials and techniques? Are the devices being built correctly?” Most fabricators believe quality should be the focus: “I don’t sacrifice quality, so my c-fab products are 10 to 20 percent higher in costs. But I believe my quality is significantly higher,” says Matthews. Some well-established c-fabs are differentiating themselves by offering clinical education programs and extended warranties, becoming ISO certified from a manufacturing standpoint, and seeking accreditation by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, which recently unveiled a program targeted specifically for c-fabs. Doing these things “shows you’re following very stringent manufacturing and quality guidelines,” says Gustavson. Competing with local startups can be a challenge for c-fabs—but only startups that are truly viable will stand the test of time. Because some of these smaller c-fabs may not fully understand the cost structure and overhead involved in running a fabrication business long term, they often price their devices lower than they should, says

Orthomerica technicians

PHOTOS: Courtesy of Orthomerica

In addition, questions remain concerning whether the Food and Drug Administration (FDA) will get involved in 3D-printed O&P devices (see “AOPA Responds to Liability and FDA Compliance Issues” in the November 2014 O&P Almanac). So for now, the technology remains a future question for O&P fabricators. In the meantime, c-fabs continue to fabricate a wide array of devices to meet practitioners’ diverse needs— which at times means reverting back to old-style devices. “We fabricate to the specifications of the practitioner who sends it to us,” says Grace, who has seen a recent comeback in some old-fashioned devices. Perhaps due to reimbursement challenges, Grace has been asked to make a cowhide liner and three above-knee exoskeletons within the past 12 months—devices he had not made in years.

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Gustavson. This may cut into business for more established c-fabs in the short term, “but it will not sustain profitability in the long term,” he says.

Product Consistency and Improved Communications

Consistency can be one of the greatest challenges for central fabrication facilities. If you get a product made by one of the c-fab’s “best” technicians, and notice a difference when another technician makes the same product, the inconsistency can trigger dissatisfaction in clinician customers. But many c-fabs have implemented programs and processes delineating standard operating procedures and have established clear lines of communication between c-fabs and

JUNE 2015 | O&P ALMANAC

practitioners. Some, such as Cascade Dafo and WillowWood, offer both online and in-person educational sessions and have created extensive customer service and support teams. “We’ve developed tools to make sure that practitioners can communicate the design they see in their heads, and to make sure that vision is what the final product looks like,” says Sheldon. Cascade Dafo has instituted lean manufacturing methods and standard training to facilitate consistency. “We have a team of trainers, strong quality assurance teams, and a standard for each device,” she says. “It’s important that c-fabs are mindful to keep consistent as we grow.” Sheldon also notes that many c-fabs are open to suggestions from clinicians. “Practitioners should share their thoughts and ideas on what they want to get out of their experience at a c-fab—we’ll listen. These are all custom orders made one at a time.”

Containing costs and showing profits are constant challenges for c-fabs today, particularly given rising shipping costs. “You have to be able to produce a product that still shows profit for the ordering company,” says Matthews. “You have to be able to do more with less. Margins are eroding, and costs have been steadily rising while reimbursements really haven’t,” he says. The challenging reimbursement climate for O&P clinicians has made an impact on central fabrication facilities as well. “The RAC audits have created cash flow problems for our customers, which creates accounts receivable problems for us,” says Gustavson. He notes that Orthomerica works with its customers that have cash flow problems due to regulatory challenges associated with today’s marketplace. “More and more companies are getting further behind on their payments,” agrees Grace. By the time a clinician receives a device from a c-fab, that c-fab has already paid for supplies and staff time, so it can be difficult to wait for overdue payments. “In the past, we never had to make collection calls. But now, even companies that used to always pay on time are paying late,” says Grace. Worse, three facilities for which Grace had made components closed their doors over the past year, leaving unpaid bills that had to be written off.

Staying on top of collections and finding ways to work with customers to get the bills paid will be important strategies for long-term success. “You need to know how to deal with multiple offices and companies at the same

PHOTOS: Courtesy of Cascade Dafo

Cascade Dafo technicians

Greater Emphasis on Collections

COVER STORY

time. You have to be able to manage effectively and get along with a lot of different personalities,” says Verhoff.

Predicting the Future

PHOTOS: Courtesy of Advanced Orthopedic Designs

It’s clear that central fabrication plays an important role in ensuring optimal outcomes for many orthotic and prosthetic patients. But most experts predict a continued mix of in-house and outsourced fabrication solutions. “Central fab services will continue to grow, but there will always be specific products that some will continue to do in house,” says Gustavson. For example, many clinicians have specific expertise in one sector of O&P care and prefer to keep fabrication of related devices on their premises. And a facility may choose to keep fabrication in house for items related to a particular hospital contract that requires a 24-hour turnaround. Those c-fabs that stay on top of the latest trends by preparing for new technologies, being aware of the

Advanced Orthopedic Designs technicians

competition, and keeping open lines of communication with customers will be best prepared to continue fabricating orthotic and prosthetic devices for years to come.

Ferrier Coupler Options!

Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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

O&P ALMANAC | JUNE 2015

LEADERSHIP SERIES

Hospitals—

What’s the Hype? As alternative payment systems become the norm, experienced O&P professionals offer tips for partnering with hospitals and institutional networks

The O&P Almanac’s Leadership Series shares insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of hospitals and institutional networks.

Meet Our Contributors

ANDREW MEYERS, CPO, is managing partner of AHM Healthcare Strategies. He also is president of Eschen Prosthetic and Orthotic Labs in New York City. When he acquired Eschen in January 2011, one of the attractive qualities about the company was its standing contract with the Hospital for Special Surgery (HSS) in Manhattan: “What drew me to Eschen was the fact that they already had an exclusive inpatient contract for O&P services with HSS, and they also served as one of three outpatient vendors.” 34

JUNE 2015 | O&P ALMANAC

T IS BECOMING MORE important than ever that O&P business owners and managers recognize the powerful role hospitals play within in the U.S. health-care arena. As payors continue to seek ways to reduce costs, hospitals will be a central part of the pathway of care. Many forward-thinking O&P practitioners are looking to the future and finding ways to partner with hospitals to ensure orthotists and prosthetists are part of the health-care solution in alternative payment systems. Some have entered into contracts with hospitals to provide either inpatient or outpatient care—or both. This month, the O&P Almanac speaks with three O&P professionals who have expertise in contracts with hospitals and institutional networks.

JIM KINGSLEY is chief operating officer at Scheck & Siress, where he focuses on business development, manufacturing, process improvement, finance, and marketing. When it comes to Scheck & Siress’s relationships with hospitals, the company’s practitioners typically have the primary relationship with the hospital staff from a clinical perspective, and Kingsley often gets involved when the company is looking at renewing a contract or looking to provide new or enhanced services to the hospital network.

REBECCA HAST is president of Linkia, a Hanger Co. that offers O&P network management and administration offerings. In her current position, she has responsibility for the business units within Hanger that have negotiated with hospitals for stock-and-bill items. In previous positions, Hast worked in a hospital setting and has spent a large part of her career in large payor organizations.

LEADERSHIP SERIES

O&P ALMANAC: Why should O&P practices consider developing relationships with hospitals and institutional networks? MEYERS: I don’t look at hospitals as threats, but as more of an opportunity. Hospitals want someone else to manage O&P because it’s such a small component of what they provide. The ones that have their own department have recognized it is not a profit center. It is a service they need to offer patients and, therefore, they seek strategic relationships with organizations that can provide services. Health care is moving toward a bundled system of payments. O&P will not be a major cost in a bundle package or to an accountable care organization (ACO). But you need to create the relationships with hospitals and institutional networks so they will look to you to satisfy their O&P needs when required. O&P is never going to be a lead; it will have to come from another discipline. As hospitals are acquiring physician services, they will be controlling the chain. O&P cannot just wait for business to come to us; we have to think about how business will be done in the future. You have to look at your own individual environment to determine how partnering with a hospital will benefit you. In New York, there are three or four large systems that are buying up practices and integrating with each other, so developing relationships with them is important. JIM KINGSLEY: Scheck & Siress’s focus is always about the patients and doing whatever we can to manage any pain and get them back moving again and enjoying their lives. This requires a partnership among health-care providers. Many of our patients begin their service episode by receiving care in a hospital setting for something that may or may not be directly related to their need for orthotic or prosthetic care. It is important that we forge strong relationships with hospitals and the medical professionals that work

there to ensure that those patients who need our services receive them in a timely basis. We participate in many clinic environments where we are evaluating patients along with the doctors to determine the most appropriate course of treatment. It is this partnership that allows us to be certain that the patients are receiving the services that they need and not receiving those that they do not—all in one, convenient care environment. This results in the best outcomes while helping the hospital manage its costs and driving patient convenience and satisfaction—all critical metrics for health-care providers. REBECCA HAST: Right now, the whole landscape around health care— who’s a payor and who’s a provider—is shifting. Many hospitals are forming ACOs, and they are here to stay. This can be very game changing. ACOs are local entities. They want to partner with organizations in their communities that are in alignment with their mission of providing better care at a lower cost. Now is the time for O&P to start building these relationships.

O&P ALMANAC: What are some of the benefits for O&P facilities that align with hospitals? MEYERS: I see several benefits to hav-

ing contracts in place with the Hospital for Special Surgery (HSS), where I currently have contracts. First, HSS is a teaching hospital, so my facility is exposed to many new and innovative techniques. Second, we gain exposure to several high-quality physicians. And third, when HSS is responsible for managing costs of a procedure, like a total knee or hip procedure, we are there to provide immediate services to expedite patients moving through the rehabilitation process. Medicare has pilot programs offering financial incentives to reduce costs for a total knee and hip procedure. If my services help get patients to their homes quicker, then I provide value and I am an important part of the process. KINGSLEY: Forging a strong rela-

tionship with the hospital can be a big advantage. Essentially, the O&P provider becomes the resident expert O&P ALMANAC | JUNE 2015

LEADERSHIP SERIES

for those patients at the hospital that require O&P services. You have the advantage of working closely with the hospital medical staff, which gives you a deeper understanding of the patient’s broader medical condition; this is important when determining the appropriate course of action. Over time, there is a trust that develops between the hospital

team and the O&P provider—you understand how they think and you know all of their procedures, which results in an efficient patient-care model. You get to understand the hospital’s goals and you can work together to achieve them, delivering the best quality care at an appropriate cost.

HAST: We’ll be seeing more and

more of the ACO and network type of health-care delivery, where the lines are blurred between payors and providers. As this whole delivery system proves itself, hospitals will migrate. O&P professionals need to understand this migration and get in on the ground floor by developing key relationships with their community hospitals.

Achieving the ‘Gold Standard’:

H A physician’s perspective

S THE MOMENTUM FOR alternative payment systems

builds, the movement toward multidisciplinary patient care becomes not only a step toward better outcomes but also a business imperative for O&P facilities. “In an ideal world, you want the orthotists and prosthetists working with the orthopedic surgeons and working with the physical therapists to develop treatment plans that are geared toward the individual,” says Francis McGuigan, MD, an orthopedic surgeon at MedStar Georgetown University Hospital who specializes in foot and ankle care. Practicing since 1994, he has been working with the O&P community for nearly 20 years to create a “gold standard of care,” as he calls it, and he partnered closely with O&P practitioners to treat wounded soldiers during the Iraq War. Although federal agencies believe that the physician or surgeon should be directing the care, McGuigan disagrees with that approach: “I believe it is a team of equals,” he says. “We are all professionals unless proven otherwise.” The most effective way to achieve this high level of care is for providers to be “co-located and evaluate the patient simultaneously,” says McGuigan. Otherwise, “too much is lost in translation, and the ability to learn from both providers is limited.” Working together to create a treatment plan, in concert with the physical therapist, also helps determine which conditions can be retrained to correct and which need surgical intervention, he adds, noting that he usually inspects orthoses and prostheses personally but does allow clinicians to modify as desired. Although Georgetown has an exclusive agreement with its O&P partner, McGuigan says his ideal practitioner must be fully trained and certified. He also is looking for someone who stays up-to-date on continuing education because “the amount of exposure that orthopods and other medical professionals have to O&P is decreasing,” he explains. Even if a physician had a very vigorous residency program, it’s a point in time and is fairly antiquated. “I know what I want the orthotic to do, but I don’t always know the latest materials or dynamics for trying to restore function.” The best partners also intervene when they know a

JUNE 2015 | O&P ALMANAC

treatment or course of action has had previous adverse outcomes, and they go the extra mile to provide innovative, custom solutions. “Even though you have the credentials and you look good on paper, if you don’t have that desire to produce excellence, I don’t like you. I don’t want someone who just goes through the motions.” McGuigan urges facility owners and practitioners to think of the physician—not just the patient—as their “customer,” especially when it comes to documentation. He says it is “magical thinking” to expect orthopedic surgeons or prescribing physicians to keep abreast of exhaustive documentation requirements and to curtail their practice— regardless of the time involved—to meet those standards. “I think it is up to the individual provider to manipulate the system to work for you. For orthotists and prosthetists, that doesn’t mean going to the orthopod and saying, ‘I need you to do this, this, and this,’” he says. For example, he cites one orthotic provider that places the letters of medical necessity on the same carbon copy form as the orthotic prescription along with the diagnostic codes most likely used by his practice. “If you provide me a quality product, I could write all of this out for orthotist A, or I could send this to orthotist B who just made my life easier and whose products are just as good,” he says. “I think with documentation and meeting the criteria—if you want the business, you have to be willing to put the time in to ask yourself, ‘How could I make this easier for my customer?’” The bottom line, says McGuigan, is that facilities need to stop thinking like an individual provider and start thinking like they are part of a health-care provider team. He encourages facility owners to form alliances with active, innovative orthopods to build the “center of excellence” concept he describes and to gain a local reputation as a one-stop-shop to be seen by the physician/ surgeon, O&P practitioner, and physical therapist. “As an individual provider, you could stay as a mom-and-pop shop, but if you want to increase, you need to partner.”

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LEADERSHIP SERIES

O&P ALMANAC: What are some areas of caution for O&P facilities that enter into these relationships? MEYERS: One thing to be careful about

is the financial aspect of contracts. You have to make sure you don’t underprice yourself or put yourself in a position that will not be profitable for your facility. You need to sell your services and the value of your services—timely response to orders, your professional staff, and quality of the products provided. Reinforce your part as a component of the rehabilitation team. KINGSLEY: There are some areas that

require caution. It is no secret that we need to better manage our healthcare costs, and hospitals are front and center on this. The rules for who has responsibility to pay for services provided can become a little complicated and can create some confusion, and in some cases, can create issues between the hospital and the O&P provider. As with most issues, communication is the key. We always offer to have a training session with the hospital staff so they can understand the various rules that are in play based on the specific patient circumstances—it is not a one-size-fits-all game. The good part is that by communicating frequently and sharing information, together you can help manage the hospital’s costs while always delivering the care the patients need. Another situation can arise when the hospital has a desire to lower its costs, and inevitably you end up in front of someone from the procurement department who often views O&P services like purchasing gloves or syringes. It is important for the O&P provider to not get commoditized and to proactively define the wealth of clinical knowledge that they bring to the table. Furthermore, you need to note that the fee 38

JUNE 2015 | O&P ALMANAC

paid by the hospital not only includes the cost of any device delivered, but also and most importantly, the clinical expertise that can be an important factor in avoiding hidden future costs to the hospital such as readmissions or patient complaints. HAST: Right now, in the fee-for-service

world, you have to be smart about what services you are providing and who is paying for those services. Those terms need to be clear. If you are treating an inpatient, you will likely get paid through the hospital. At the emergency room or stockand-bill area, the opportunity to bill the patient, or a third-party insurer, is much greater. O&P ALMANAC: Who are the key individuals within the hospitals that O&P facilities should contact to develop appropriate partnerships? MEYERS: You need to find the “right” person to talk with in the hospital. If you go to the purchasing department, it’s all about dollars—they don’t take into consideration the difference in quality and value between O&P providers. So instead, develop relationships with other people—for example, the discharge planning manager or the director of rehabilitation. Establish these relationships first. Once you get a relationship with a hospital, then you have a “license to hunt”—to talk to physicians, rehab

departments, and anyone that utilizes your services; let them know you have a contract in place and are available to help them. KINGSLEY: We believe that it is always

best to forge your relationships as close to the patient as possible. This means the doctors, nurses, therapists, etc., who best understand the importance of O&P care to the overall health of their patients. Doctors often work across multiple hospitals and have partners if they are in private practice, and those relationships that you have with them can be leveraged into the hospital setting where they work. Inevitably at some point, you will end up in the office of a department administrator or a procurement team member, so it is best to seek them out before they come to you. Establish a relationship with them that focuses on the added value you are providing to the patients and their clinical staff. Be sure to note your focus on cost management and how your work closely with the hospital team to meet that shared goal.

HAST: Most people have to start with

the director of procurement or purchasing because O&P is considered a vendor. But if you can go into a hospital with a program that demonstrates how you can save money for the hospital, then you may capture the interest of higher-level hospital staff members. Of course, developing relationships with physicians is an age-old but still valid way to find a connection to a hospital. O&P ALMANAC: How are

contracts with hospitals/ institutional networks typically structured? MEYERS: Most hospital contracts are for inpatient services. So if the hospital is responsible for payment, the hospital pays the O&P vendor directly. But we also have some arrangements where a hospital will pay me directly if I can’t

LEADERSHIP SERIES

get approval for an inpatient quickly enough. For example, if I have to wait three days to get approval for a device, but otherwise the patient could go home, the hospital will pay me so the patient can get the device and leave the hospital. It saves the hospital money on inpatient charges. There are also contracts specifically designed for outpatient services. KINGSLEY: They can vary

across different networks, but in general, they set out the ground rules for how the hospital network and the O&P provider will interact to provide patient care. Sometimes they are exclusive contracts and other times there are contracts with multiple O&P providers, so you have to prove your value in order to gain share at the hospital. The agreement lays out the types of services to be provided and a related fee schedule for these services. The contract will often describe when the hospital expects to pay for the services by issuing a purchase order and those circumstances where they expect the O&P provider to bill an appropriate thirdparty payor for the services rendered. There is typically a requirement that services be provided on a 24/7 basis with stated response times. More recently, we have seen requirements for O&P providers to deliver reports detailing services delivered, which are then reviewed and discussed with the administrative staff to determine if appropriate O&P care is being provided to hospital patients—for example, was a custom device required? HAST: Contracts will depend on what

services you are providing. If you’re providing services as a provider in a network, then that network will have a contract, or a hospital may have a purchase order. You’ll need to think about who the end payor is, and that will govern how you contract with entities.

O&P ALMANAC: What are some strategies for positioning O&P facilities as beneficial partners to hospitals? MEYERS: Let them know you can pro-

vide a full spectrum of services, and that you are there as a partner. You are available to provide in-services to staff and residents and participate in community-based outreach programs. Have them understand how you are different than other providers— maybe you have a larger certified staff or an individual who specializes in a certain area. Promote yourself. And sell hospitals on the expedience of your services. With hospitals, it’s all about getting the patient out the door—and O&P can play a part in that. KINGSLEY: The key word is partner-

ship. No partnership lasts very long if it is not delivering value to both parties. O&P providers bring a level of clinical expertise that is not usually available at hospitals. By partnering with an O&P provider, a hospital can be sure that its patients are receiving excellent care. Furthermore, the hospital is paying on an episodic basis versus investing in salary and benefits to have this expertise on their staff. Many hospitals have satellite locations, but often they have areas where they do not have convenient coverage. An O&P provider can position its locations as extensions of the hospital

network to provide followup or ongoing O&P care for hospital patients at a location closer to the patients’ homes and hence increasing their satisfaction. Positioning yourself as a partner in managing hospital costs can be very appealing. Hospitals can experience a high level of turnover, so it can be compelling to pitch yourself as the steady hand that understands the rules and can work with the changing hospital staff to make sure the hospital is compliant with payors’ procedural requirements, while at the same time, making sure the hospital never pays more than its fair share. Be sure to talk about your ability to track patient satisfaction. This is an important part of the “triple aim” that often takes a back seat to lowering costs and generating good clinical outcomes. However, the forward-thinking hospitals know that they need to be able to provide these types of statistics as part of the justification of the overall efficacy of their services. HAST: I think hospitals like the “easy”

button. The model of the future may require O&P to team up with durable medical equipment or other partners in the community, such as physical therapists, occupational therapists, or physiatrists, to create a continuum of services. O&P may need to build alliances; there’s lots of opportunities for innovators. Also, O&P facilities may need to establish broad services that hospitals can tap into—such as stock-and-bill services. Some O&P providers don’t want to provide stock and bill, but stock-and-bill arrangements are typically what get conversations started with hospitals. That connection— although some might not consider it to be true O&P—can open a door. Remember that hospitals are looking to fill the full spectrum of O&P, from the simplest off-the-shelf brace to the most complicated services. It’s a need that needs to be met, and can serve as an entry point for O&P facilities. O&P ALMANAC | JUNE 2015

15 2015 2015 201 Buyers’ Guide THE ANNUAL

ONE-STOP RESOURCE

FOR O&P PRODUCTS AND SERVICES

Contents 41 Othoses & Components 41 42

Lower-Limb Orthoses Spinal Orthoses

43 Prostheses & Components 44 44 46

Upper-Extremity Prosthetics Lower-Limb Prosthetics Soft Goods Prosthetics

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

JUNE 2015 | O&P ALMANAC

46 46 47 47

CAD/CAM Systems Fabrication Materials Central Fabrication Reference Materials

48 Comprehensive Index

2015 Buyers’ Guide

Orthoses & Components Acor Orthopaedic, Inc. 800/237-2267, ext. 1 www.acor.com

Poron XRD is now available from Acor! XRD stands for Extreme Impact Protection. It is lightweight material that is engineered to absorb up to 90% of energy when impacted under high strain rates. This product is infused with an anti-microbial protectant which will help prevent the growth of bacteria that can cause stains and odors. Under the foot, the foam’s memory-like properties provide a contoured fit for each user. XRD raises the bar when it comes to comfort, control, and protection. Call today for your free sample!

Lower-Limb Orthoses Hersco

800/301-8275 www.hersco.com Dynamic Chopart Gait Stabilizer This unique ankle-foot orthosis (AFO) has been designed for Chopart amputees who wish to remain active. Often a traditional full-length AFO for this patient will be stiff, feeling unnatural. Using a hinged ankle and flexible foot plate with a segmented dynamic filler allows flexion before providing a “stop” that protects the residuum and prevents shoe vamp collapse. The PTB design and the anterior shell redistribute groundreaction forces up the lower extremity. For more information, contact at 800/301-8275 or visit www.hersco.com.

Hersco

800/301-8275 www.hersco.com 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 AFO 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, contact at 800/301-8275 or visit www.hersco.com.

Orthomerica

877/737-8444 www.orthomerica.com Salvage (OWLS) Program Orthomerica Introduces the Wise Choice for Diabetic Wound Care. Orthomerica Wound Limb & Salvage (OWLS) Program is a culmination of 10-plus years of clinical orthotic development—treating diabetic ulcers classified Wagner 1-4 with custom orthoses to better enhance diabetic wound unloading and mobility and promote healing. These orthoses will complement the ongoing wound therapies and postoperative care being offered at Wound Centers worldwide. OWL products include: • Wound Healing Orthosis: Heel Relief • Wound Healing Orthosis: Forefoot Relief • Wound Healing Orthosis: Midfoot/Walking AFO • Advanced Diabetic Orthosis. For more information, contact Orthomerica at 877/737-8444 or visit www.orthomerica.com.

O&P ALMANAC | JUNE 2015

2015 Buyers’ Guide

Lower-Limb Orthoses

Spinal Orthoses

Cascade Dafo Inc.

Aspen Medical Products

DAFO® 4 TURNS 30 The original DAFO® (Dynamic Ankle Foot Orthosis), the SMO-style DAFO 4, is turning 30 years old this year! One of our most popular brace styles, the lightweight and comfortable DAFO 4 was developed to meet the needs of children who exhibit strong low tone pronation, and led to the creation of numerous other dynamic brace styles for pediatric patients. Since its introduction in 1985, thousands of practitioners have trusted us to custom-build this effective solution for their low-tone patients.

Introducing the New Peak Scoliosis Bracing System™ This revolutionary new bracing system from Aspen was specifically designed for Adult Scoliosis patients and has been shown to: • Significantly Reduce Pain • Improve Quality of Life • Increase Mobility • Promote Better Posture • Increase Patient Compliance.

1360 Sunset Ave. Ferndale, WA 98248 800/848-7332 www.cascadedafo.com

Happy Birthday DAFO! Like all Cascade Dafo orthoses, the DAFO 4 is backed by a Full (90-Day) Warranty. For more information, visit www.cascadedafo.com or call 800/848-7332.

6481 Oak Canyon Irvine, CA 92618 800/295-2776 www.aspenmp.com

Code L1005 Approved.

Spinal Technology Inc. 191 Mid Tech Dr West Yarmouth, MA 02673 800/253-7868 info@spinaltech.com

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

JUNE 2015 | O&P ALMANAC

2015 Buyers’ Guide

Prostheses & Components DAW Industries Inc. 800/252-2828 www.daw-usa.com

Dawskin New MegaStretch is the most durable Tear-free Skin in the world. It is the ideal Skin for your patient to shower on both legs (definitely the safer way). DawSkin MegaStretch provides the vertical ankle stretch required for multi-axis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear. DawSkin New EZ-Access dons on and off just like a sock yet provides all the benefits of the DawSkin New MegaStretch. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

PEL

800/321-1264 www.pelsupply.com Coyote Design’s Proximal Lock From PEL PEL now offers the new Proximal Lock by Coyote Design. The Proximal Lock is a zero-clearance, proximally mounted lock that works for suspension and rotational control. Using the distal adaptor of your choice, the new lock design allows for easy donning while the silicone liner attachment is more flexible and larger for increased pull. Benefits and features include: • Zero-clearance lock • Suspension and rotation control • Ideal for long limbs with minimal clearance • Silicone adhesive remains flexible after it sets • Flexible attachment rolls on easier • Water-resistant. For more information, contact PEL at www.pelsupply.com.

DAW Industries Inc. 800/252-2828 www.daw-usa.com

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the groundreaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

O&P ALMANAC | JUNE 2015

2015 Buyers’ Guide

Prostheses & Components

Lower-Limb Prosthetics

Ottobock

Aqualeg Inc.

EMS Socket Exclusively from Ottobock The EMS flexible inner socket provides up to 100% more surface area for better force distribution and 400% more coefficient of friction for better linkage to the socket. All of that translates into an advanced socket with superb connection for your patients who use Harmony vacuum suspension. In addition to the enhanced connection, EMS includes lower definitive socket trim lines for greater range of motion and reduced wear on sleeves. The EMS is available exclusively from Ottobock by calling your locals sales rep at 800/328-4058 or logging into www.professionals.ottobockus.com.

Aqualeg With New Soft Shell Technology The Aqualeg soft shell cover has an exact fit and is self-supporting without the need for foam underneath. This allows the cover to be used in and around water. It has flexibility modeled after real limbs and is available in a precise 3D custom fabrication. Every cover is produced to fit perfectly on the socket. The covers are intended to be used everyday and provide a solution for active people who have lifestyles that include getting into water or harsh environments. They offer the perfect solution for prosthetic devices that are traditionally difficult to cover, including those with electronic components or vacuum assistance. For more information, contact Aqualeg Inc. at 855/955AQUA (855/955-2782) or visit www.aqualeg.com.

800/328-4058 www.professionals.ottobockus.com

Upper-Extremity Prosthetics Ottobock

800/328-4058 www.professionals.ottobockus.com New AxonHook from Ottobock For maximum versatility, precision, and power, look for this latest addition to the AxonBus Family – the AxonHook. The AxonHook is the perfect complement to the Michelangelo Hand. It includes titanium with polyurethane coated fingers so the AxonHook can provide superb precision and power, making it the perfect companion to the Michelangelo Hand. For more information, contact your local sales reps at 800/328-4058 or logging onto www.professionals.ottobockus.com.

JUNE 2015 | O&P ALMANAC

855/955-AQUA (855/955-2782) www.aqualeg.com

Freedom Innovations, LLC 3 Morgan, Irvine, CA 92618 888/818-6777 www.freedom-innovations.com

Maximum Shock Valuewith the New Freedom Agilix™ The Freedom Agilix is a multiaxial, shock-absorbing, flexible foot system designed to manage loading impacts, reduce socket shear forces, and improve comfort while walking on nearly any terrain. The ultra-lightweight design offers low-impact K3 ambulators shockingly comfortable performance at a value like no other. Learn more about the Agilix on our website.

2015 Buyers’ Guide

Lower-Limb Prosthetics Freedom Innovations, LLC 3 Morgan Irvine, CA 92618 888/818-6777 www.freedom-innovations.com

Fit, Finish, and Roll ... with the New Freedom DynAdapt™ The Freedom DynAdapt Foot is a slim-profile, carbon-fiber foot system with a slender, anatomic design for easy fit and finish. Its multiaxial function provides maximum comfort, and the uninterrupted strands of carbon fiber in the full-length heel provide patients with effortless rollover and a more natural gait. The new EnduraCore™ Technology composite laminate delivers up to three times the fatigue life of a standard laminate in a design that also returns more energy. The result is a highly durable product that preserves users’ energy so they can do more with confidence.

College Park Industries Inc. 27955 College Park Drive Warren, MI 48088 800/728-7950 www.college-park.com

A New Element from College Park The Horizon foot brings College Park composite expertise to a carbon fiber foot design. The Horizon is constructed with aircraft-grade titanium components, allowing for additional durability and a high weight limit. Even with an ultra-low profile and ultra-light weight design, the dynamics of the foot provide superior energy return for high-impact K3 users. The rollover Enviroshell design, combined with the specially engineered carbon composites, provide the perfect blend of comfort and ability for all activities. See the Horizon in action at www.youtube.com/CollegeParkInd.

DAW Industries Inc. 800/252-2828 www.daw-usa.com

New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

Ottobock

800/328-4058 www.professionals.ottobockus.com New K2 knee from Ottobock The 3R62 Pheon packs a lot into a small package for your K2 patients. The stability of a polycentric design with added safety features like an optional manual lock and extension assist means it gives your patients the security they need. As patients progress, they’ll appreciate the smooth extension stop and up to 10° of stance flexion the knee provides. You’ll appreciate that this little knee packs so much function into such a small package. To find out more, ask your sales representative or call us at 800/328-4058.

O&P ALMANAC | JUNE 2015

2015 Buyers’ Guide

Soft Goods/Prosthetics CAD/CAM Systems Össur

www.ossur.com

Össur Iceroross® Seal-In® X. Make Your Move! With a moveable seal ring to ensure optimal seal positioning, Seal-In X offers both maximum comfort for users with uniquely shaped or sensitive limbs and easier donning and doffing for users with compromised hand dexterity. Seal-In X also features seamless Anatomy Conforming Fabric, a durable yet flexible weave that comfortably controls soft tissue and elongates over the knee without bunching in the popliteal region. Plus, Seal-In X is Unity® compatible, so your patients can experience all the benefits of sleeveless vacuum, as well. For more information, visit www.ossur.com or contact your Össur® representative today.

Amfit Inc.

3611 NE 68th Street Vancouver, WA 98661 800/356-FOOT(3668) sales@amfit.com www.amfit.com The best advertising? Happy patients. Send patient satisfaction soaring without sacrificing control over the orthotic design or the outcomes. 3D Digital Contact Casting (Contact Digi tizer) and Amfit design software (Correct and Confirm) are powerful patient treatment tools. Save time and money with Amfit Lab Services, a Full Fabrication System or the combination that fits your business best. • 30 years specializing in custom foot orthotics • 3D Digital Casting and Fabrication Systems • Laser scanning and Fabrication Systems • Casting and orthotic “design only” options • Financing available. Talk with us today about the best options for your business now and into the future.

Fabrication Materials Soletech Inc.

425 Washington St., Suite 4 Claremont, NH 03743 877/625-9494 www.soletech.com Established in 1946, Soletech has a full line of fabrication materials for the O&P industry including the largest selection of EVA sheets, multi-durometer laminated sheets and blockers, PORON, Plastazote, neoprene sheets, diabetic insoles, rubber and crepe outsoles and many other foam materials. Soletech introduced its registered brand of Cloud EVA to the O&P industry in the early 1980’s and is recognized as the industry leather for fabrication materials for custom foot orthotics and AFO’s as well as for build-ups and shoe modifications. Now available is our NEW Soletech Cloud Comfort Gel Sleeve and Liner as well as our Carbon Fiber AFO(The Feather Walker) in Pediatric and Adult sizes. 46

JUNE 2015 | O&P ALMANAC

2015 Buyers’ Guide

Central Fabrication/ Lab Services

Reference Materials

Amfit Inc.

2015 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2015 AOPA coding products. Ensure each member of your staff has a 2015 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers. • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers. • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers. • Illustrated Guide: $185 AOPA members, $425 nonmembers. • Quick Coder: $30 AOPA members, $80 nonmembers. Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

3611 NE 68th Street Vancouver, WA 98661 800/356-FOOT(3668) sales@amfit.com www.amfit.com It’s your patient; shouldn’t it be your orthotic design too? Take complete control for the ultimate in patient satisfaction with Amfit Lab Services. • Carbon fiber (flex and firm) • Polypropylene (flex, semi-flex, rigid) • 5 EVA styles and densities • 1-4 day turn-around • Diabetic specific program: 3 pair for $60 includes shipping • Foam box processing • Contact Digitizer 3D Digital Casting system • Equipment rental and lease programs available. 30 years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact us today.

Spinal Technology Inc. 191 Mid Tech Dr West Yarmouth, MA 02673 800/253-7868 info@spinaltech.com

2014 Operating Performance Report Are you curious about how your business compares to others? This updated survey will help you see the big picture. The OperatAOPA Operating Performance Report ing Performance Report provides a comprehensive financial profile of the 2014 O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 98 patient care companies representing 1,011 full time facilities and 62 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. (Reporting on 2013 Results)

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

Electronic Version AOPA Member: $85.00 Non-Members: $185.00 Note: The 2015 version will be available in September 2015 and will be automatically substituted for 2014 version. A new Benefits & Compensation Report also will be available.

O&P ALMANAC | JUNE 2015

15 2015 2015 Buyersâ&#x20AC;&#x2122; Guide

Comprehensive Index Companies with

+ are Supplier Plus Partners.

Ability Dynamics LLC Tempe, AZ 480/361-1714 www.abilitydynamics.com rsainz@abilitydynamics.com Abletech Orthopedics Corp. Taichung, Taiwan +886/2-2926-1765 www.wellcare-supports.com sales@wellcare-supports.com ACOR Orthopaedic Inc. Cleveland, OH 216/662-4500 www.acor.com requestinfo@acor.com Advanced O&P Solutions LLC Hickory Hills, IL 708/237-4088 www.aopsolutions.com mangelico@aopsolutions.com Aetrex Worldwide Inc. Teaneck, NJ 201/833-2700 www.aetrex.com asabbach@aetrex.com AliMed Inc. Dedham, MA 800/225-2610 www.alimed.com wdegiacomo@alimed.com Allard USA Inc. + Rockaway, NJ 888/678-6548 www.allardusa.com info@allardusa.com

JUNE 2015 | O&P ALMANAC

ALPS + Saint Petersburg, FL 800/574-5426 www.easyliner.com cathie@easyliner.com

Alternative Prosthetic Services Inc. Bridgeport, CT 203/367-1212 www.alternativeprosthetics.com info@alternativeprosthetics.com American Central Fabrication Shreveport, LA 318/636-3751 www.oandp.com/edge/advertisers/ americanfab/ americancenfab@aol.com American Prosthetic Components LLC Green Bay, WI 800/772-7508 www.apcomponents.com comments@apcomponents.com AMFIT INC. + Vancouver, WA 360/573-9100 www.amfit.com sales@amfit.com

Anatomical Concepts Inc. Poland, OH 800/837-3888 www.anatomicalconceptsinc.com info@anatomicalconceptsinc.com

Apis Footwear Co. El Monte, CA 626/448-8905 www.bignwideshoes.com apisfootwear@earthlink.net

BiOM + Bedford, MA

781/761-1560 www.biom.com contact@biom.com

Arizona AFO Inc. Mesa, AZ 480/222-1580 www.arizonaafo.com don.pierson@arizonaafo.com

BioSculptor Corp. Hialeah, FL 305/823-8300 www.biosculptor.com bio_info@biosculptor.com

ARTech Laboratory Inc. Midlothian, TX 972/775-2000 www.artechlab-prosthetics.com mholt36107@aol.com

Bort-Swiss Orthopedic Supply Anderson, SC 864/231-9144 www.bort-swissortho.com beth.swiss@bort-swissortho.com

Aspen Medical Products Irvine, CA 800/295-2776 www.aspenmp.com jketchersid@aspenmp.com Becker Oregon Inc. Albany, OR 541/967-1821 www.beckeroregeoncatalog.com born@beckerorthopedic.net Becker Orthopedic Appliance Co. Troy, MI 248/588-7480 www.beckerorthopedic.com mail@beckerorthopedic.net

Boston Brace International Inc./dba NOPCO Weymouth, MA 781/849-0247 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Boston, MA 617/975-3854 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Boston, MA 617/355-6887 www.nopcoclinics.com info@bostonbrace.com

2015 Buyers’ Guide

Boston Brace International Inc./dba NOPCO Burlington, MA 781/270-3650 www.nopcoclinics.com info@bostonbrace.com

Boston Brace International Inc./dba NOPCO Avon, MA 508/588-6060 www.nopcoclinics.com info@bostonbrace.com

Boston Brace International Inc./dba NOPCO East Brunswick, NJ 732/651-1223 www.nopcoclinics.com dfornuff@yahoo.com

Bracemasters International LLC New Berlin, WI 262/797-9771 www.bracemasters.com info@bracemasters.com

Boston Brace International Inc./dba NOPCO Mountainside, NJ 908/233-3720 www.nopcoclinics.com dfornuff@yahoo.com

Breg Carlsbad, CA 877/250-7951 www.breg.com todd.eagen@vgm.com

Boston Brace International Inc./dba NOPCO Philadelphia, PA 215/590-7702 www.nopcoclinics.com jwalker@bostonbrace.com Boston Brace International Inc./dba NOPCO Waltham, MA 781/216-1390 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Lawrence, MA 978/688-7900 www.nopcoclinics.com emerson@bostonbrace.com Boston Brace International Inc./dba NOPCO Voorhees, NJ 856/258-6712 www.nopcoclinics.com info@bostonbrace.com Boston Brace International Inc./dba NOPCO Neptune, NJ 732/481-4500 www.nopcoclinics.com jshimkus@bostonbrace.com

Brightree LLC Lawrenceville, GA 888/598-7797 www.brightree.com m_blount@brightree.com Bulldog Tools Inc. Lewisburg, OH 877/962-0205 www.bulldogtools.com rmeyer@bulldogtools.com Cailor Fleming Insurance Youngstown, OH 330/782-8068 www.cailorfleming.com dfoley@cailorfleming.com

Comfort Products Inc. Croydo, PA 800/822-7500 www.comfortoandp.com info@comfortoandp.com

Fabtech Systems LLC Everett, WA 425/349-9557 www.fabtechsystems.com greg@fabtechsystems.com

Coyote Design & Mfg Inc. Boise, ID 800/819-5980 www.coyotedesign.com mailbox@coyotedesign.com

Ferrier Coupler Inc. North Branch, MI 810/688-4292 ferrier.coupler.com sales@coupler.com

CyberKinetics LLC Silverdale, WA 360/692-2500 cyberkinetics.us.com dsaucier@cyberkinetics.us.com DavMar Waterloo, IA 800/214-6742 www.davmarshoes.com amanda.hewitt@vgm.com DAW Industries Inc. San Diego, CA 800/252-2828 www.daw-usa.com info@daw-usa.com Delcam + Salt Lake City, UT

877/335-2261 www.delcam-healthcare.com northamerica@delcam.com

Cascade Dafo Inc. + Ferndal, WA

DJO Vista, CA 800/321-9549 www.djoglobal.com dale.hammer@djoglobal.com

+Cascade Orthopedic

Dr. Comfort Mequon, WI 800/556-5572 www.DrComfort.com info@drcomfort.com

800/848-7332 www.cascadedafo.com dafo@dafo.com

Supply Inc. Chico, CA 530/879-1500 www.cascade-usa.com info@cascade-usa.com

College Park Industries Warren, MI 800/728-7950 www.college-park.com rspielman@college-park.com

EMR Stat Waterloo, IA 800/214-6742 amanda.hewitt@vgm.com Endolite + Miamisburg, OH 800/548-3534 www.endolite.com info@endolite.com

Fillauer Companies + Chattanooga, TN 423/624-0946 www.fillauer.com customerservice@fillauer.com

Fillauer Europe Sollentuna, Sweden +46/8 505 332 00 www.fillauer.com kevin.moore@centri.se Fillauer LLC - A Fillauer Co. Chattanooga, TN 423/624-0946 www.fillauer.com customerservice@fillauer.com Fillauer North Carolina Weaverville, NC 828/658-8330 www.ots-corp.com info@ots-corp.com FLO-TECH® Orthotic & Prosthetic Systems Inc. Trumansburg, NY 800/356-8324 www.1800flo-tech.com kathy@1800flo-tech.com Forbin Waterloo, IA 866/999-9469 www.forbin.com jeremyk@forbin.com Freedom Innovations LLC Irvine, CA 888/818-6777 www.freedom-innovations.com info@freedom-innovations.com

O&P ALMANAC | JUNE 2015

2015 Buyers’ Guide

Friddle’s Orthopedic Appliances Inc. Honea Path, SC 864/369-2328 www.friddles.com info@friddles.com Grace Prosthetic Fabrication Inc. New Port Richey, FL 800/940-5347 www.gpfinc.com grace@gpfinc.com Hope Orthopedic Grand Prairie, TX 972/647-0884 www.hopeortho.com sales@bledsoebrace.com

Knit-Rite Inc. Kansas City, KS 913/281-4600 www.knitrite.com info@knitrite.com

Motion Medical Inc. Pelham, AL 205/982-1511 www.motionmedical.com sales@motionmedical.com

O&P Billing Solutions Inc. Murfreesboro, TN 615/217-9821 www.oandpbilling.com chantelle@oandpbilling.com

LegWorks Inc. Toronto, Canada 570/994-8525 www.legworks.org brandon@legworks.org

Mueller Sports Medicine Inc. Prairie du Sac, WI 608/643-8530 www.muellerrx.com brett.mueller@muellersportsmed.com

O&P Business News/SLACK Inc. Thorofare, NJ 856/848-1000 oandpbiznews.com drosenstock@slackinc.com

Myomo Cambridge, MA 617/401-2623 www.myomo.com paul@myomo.com

O&P EDGE/Western Media LLC Northglenn, CO 303/255-0843 www.oandp.com/edge tonja@opedge.com

Liberating Technologies Inc. Holliston, MA 508/893-6363 www.liberatingtechnologies.com info@liberatingtech.com

Hosmer, Division of Fillauer Campbell, CA 408/379-5151 www.fillauer.com customerservice@hosmer.com

Maramed Orthopedic Systems Hialeah, FL 305/823-8300 www.maramed.com custsupport@maramed.com

Human Motion & Control Macedonia, OH 216/896-2044 www.parker.com adorotheou@parker.com

MD Orthopaedics Inc. Wayland, IA 877/766-7384 www.mdorthopaedics.com mdortho@farmtel.net

JMS Plastics Supply Neptune, NJ 732/918-8115 www.jmsplastics.com steves@jmsplastics.com

Med Spec (ASO EVO) Charlotte, NC 704/573-4040 www.medspec.com request@medspec.com

Kinetic Research Inc. Tampa, FL 800/919-3668 www.kineticresearch.com email@kineticr.com

Medex International Inc. Burtonsville, MD 301/657-2681 medexinternational.com info@medexinternational.com

Kingsley Mfg. Co. Costa Mesa, CA 949/645-4401 www.kingsleymfg.com info@kingsleymfg.com

Medi USA Whitsett, NC 336/449-4440 www.mediusa.com events@mediusa.com

KISS Technologies LLC Baltimore, MD 410/663-5477 www.kiss-suspension.com ann@kiss-suspension.com

Motion Control, Division of Fillauer Salt Lake City, UT 801/326-3434 www.UtahArm.com info@utaharm.com

JUNE 2015 | O&P ALMANAC

Nabtesco Proteor - USA Muskego, WI 504/319-1954 www.proteor.com lroberts@nabtescoproteor-usa.com Naked Prosthetics Tumwater, WA 360/269-7115 www.nakedprosthetics.com dulcey@nakedprosthetics.com New Options Sports Farmer’s Branch, TX 800/872-5488 www.newoptionssports.com iheather@newoptionssports.com nora systems Inc. Salem, NH 496/201-8077 www.nora-shoe.com info-shoe@nora.com Northwood Inc. Center Line, MI 586/755-3830 www.northwoodinc.com debbiec@northwoodinc.com O&P 1 Central Fabrication Waterloo, IA 800/408-3598 www.oandp1.com sclark@oandp1.com

OPIE Software Gainesville, FL 352/331-3741 www.oandp.com info@oandp.com OPTEC USA, Inc. Lawrenceville, GA 888/982-8181 www.optecusa.com optecusa@aol.com Orfit Industries America Jericho, NY 516/ 935-8500 www.orfit.com ales-us@orfit.com Orthocare Innovations LLC Mountlake Terrace, WA 800/672-1710 www.orthocareinnovations.com cferrendelli@orthocareinnovations. com Orthomerica Products Inc. Orlando, FL 800/446-6770 www.orthomerica.com vthomas@orthomerica.com Orthotic & Prosthetic Group of America (OPGA) Waterlo, IA 800/214-6742 www.opga.com info@opga.com

2015 Buyers’ Guide

Össur Americas Inc. Foothill Ranch, CA 949/382-3883 www.ossur.com ogylfason@ossur.com Ottobock Austin, TX 800/328-4058 www.ottobockus.com usa.customerservice@ottobockus. com Paceline Monroe, NC 704/283-9787 www.paceline.com joe.davant@paceline.com Parker Hannifin Corporation Macedonia, OH 216/225-5759 www.parker.com stefan.bircher@parker.com

PEL + Cleveland, OH

800/321-1264 www.pelsupply.com management@pelsupply.com

PROTEOR Dijon Cedex, France +33/ 380 7842 42 www.proteor.com ht.orthopedie@proteor.com

Renewal Technologies Scottsdale, AZ 480/588-7887 www.renewaltechnologies.com mike.sperduti@emergesales.com

PFS Med Inc. Springfield, OR 541/349-9646 www.pfsmed.com rirish@pfsmed.com

ProtoKinetics LLC Havertown, PA 610/449-4879 www.protokinetics.com info@protokinetics.com

Renia GmbH Cologne, Germany +49/221 6307990 www.renia.com info@renia.com

POINT Health Centers of America Waterloo, IA 866/283-2872 www.pointhca.com info@pointhca.com

Provel Inc. Cle Elum, WA 509/857-2009 www.provel.us info@provel.us

Roden Leather Co. Inc. Royal Oak, MI 800/521-4833 www.rodenleathercompany.com rodenleather@gmail.com

PSL Fabrication Fulton, MO 573/642-5554 www.pslab.com pslab1@sbcglobal.net

Royal Knit Inc. Lees Summit, MO 800/664-5648 www.royalknit.com royalknitinc@yahoo.com

Pro-Tech Orthopedics Raynham, MA 866/819-1157 www.protech-intl.com mandersson@protech-intl.com

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O&P ALMANAC | JUNE 2015

2015 Buyersâ&#x20AC;&#x2122; Guide

Silipos Inc. Niagara Falls, NY 800/229-7105 www.silipos.com brij@silipos.com

SteeperUSA San Antonio, TX 210/481-4126 www.steeperusa.com cheryl.wagner@steeperusa.com

The Bremer Group Co. Jacksonville, FL 904/645-0004 www.bremergroup.com bremergroup@bremer.net

VGM Financial Waterloo, IA 319/274-6661 www.vgmfs.com chamann@vgmfs.com

Simona America Inc. Archibald, PA 570/876-8199 www.simona-america.com jeff.hester@simona-america.com

Streifeneder USA Tampa, FL 813/246-5995 www.streifeneder-usa.com sales@streifenederusa.com

ThyssenKrupp AIN Plastics Madison Heights, MI 877/246-7700 www.ainplastics.com lisa.anderson@thyssenkrupp.com

VGM Insurance Waterloo, IA 866/497-0836 www.vgminsurance.com service@oanpinsurance.com

Soletech Inc. Claremont, NH 877/625-9494 www.soletech.com tom@soletech.com

SureFit Coral Springs, FL 800/298-6050 www.surefitlab.com jmeador@surefitlab.com

Top Shelf Orthopedics Tracy, CA 209/834-1158 www.pacmedical.com csindel@pacmedical.com

Viscent LLC Plano, TX 214/501-0360 www.viscent.com bnorquist@viscent.com

SOLS New York, NY 855/932-7765 www.sols.com kristi@sols.com

SureStep South Bend, IN 877/462-0711 www.surestep.net bernie@surestep.net

Touch Bionics Mansfield, MA 855/694-5462 www.touchbionics.com info@touchbionics.com

Vorum Vancouver, Canada 800/461-4353 www.vorum.com info@vorum.com

Spinal Technology Inc. West Yarmouth, MA 800/253-7868 www.spinaltech.com info@spinaltech.com

Swiftwick Brentwood, TN 615/370-8611 www.swiftwick.com grant@swiftwick.com

SPS Port Orange, FL 800/653-0826 www.spsco.com dpresnell@spsco.com

Syncor Ltd. Abrams, WI 920/373-4300 syncorltd@gmail.com

SPS + Alpharetta, GA

TaiLor Made Orlando, FL 407/245-7770 tlmprosthetics.com info@tlmprosthetics.com

800/767-7776 www.spsco.com kwilson@spsco.com

SPS National Labs Alpharetta, GA 800/767-7776 www.spsco.com belliott@spsco.com Spyder Technologies Waterloo, IA 319/234-7942 sclark@oandp1.com ST&G USA Corp. Placentia, CA 714/524-0663 www.stngco.com info@stngco.com 52

JUNE 2015 | O&P ALMANAC

Tamarack Habilitation Technologies Inc. Blaine, MN 763/795-0057 www.tamarackhti.com info@tamarackhti.com TechMed 3D Inc. Quebec, Canada 418/836-8100 www.techmed3d.com mike@techmed3d.com

Townsend Design + Bakersfield, CA

661/837-1795 www.townsenddesign.com townsend@townsenddesign.com

WillowWood Mount Sterling, OH 740/869-3377 www.willowwoodco.com info@owwco.com

TRS Inc. (Therapeutic Recreation Systems Inc.) Boulder, CO 303/444-4720 www.oandp.com/trs bob@trsprosthetics.com

Yale Surgical Co./Yale Comfort Shoe Center Stratford, CT 203/372-7112 www.yalesurgical.com EJKaufman@yalesurgical.com

Trufit Biomechanics Labs Orlando, FL 321/202-2800 www.trufitusa.com info@trufitusa.com

Yale Surgical-Yale Comfort Shoe New Haven, CT 203/777-2396 www.yalesurgical.com kauf740@aol.com

Trulife Poulsbo, WA 360/697-5656 www.trulife.com info@trulife.com VGM Education Waterloo, IA 800/214-6742 www.vgmeducation.com amanda.hewitt@vgm.com

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MEMBER SPOTLIGHT

Lee’s Comfort Shoes

By DEBORAH CONN

If the Shoe Fits Ohio pedorthists offer clinical services and retail shoe sales

HE SHOE BUSINESS GOES

JUNE 2015 | O&P ALMANAC

FACILITY: Lee’s Comfort Shoes OWNERS: Jeff Reser, CO, CPed, and John (Jack) Reser, CPed LOCATIONS: Bucyrus, Columbus, Sandusky, Fremont, and Bellefontaine, Ohio HISTORY: 67 years

The difficult part of retail shoe fitting is gaining enough experience to do the job well, Reser notes. “I’ve been fitting shoes for 40 years and I’ve never seen the same thing twice,” he says. “There’s no schooling for shoe fitting; you have to learn on the job. No two feet are exactly the same, and there’s no match between left and right feet on the same person.” By contrast, says Reser, the most difficult part of pedorthics is the bureaucracy. “What makes it tough is not vendors or manufacturers, it’s the insurance companies,” he says. “There are more barriers than ever: the cost of accreditation, cost of licensing, low reimbursements, audits. This puts providers out of business and will discourage new people from coming in.” Because of their long history and good reputation—and a lack of experienced competition—the Resers have not found it necessary to market their services.

“We are the last full-service shoe store in our area, and there aren’t any other pedorthists around,” Reser says. “Some competition comes from foot doctors, nurses, and pharmacists, who can bill for pedorthic services, but they don’t have the training.” Reser and his brother receive many referrals from local physicians, and they are usually booked a month ahead. Many of Lee’s Comfort Shoes customers are in a generation accustomed to mall shopping and big box stores, he says, who have never had their feet measured. Reser is wistful about the future of shoe fitting. His own children, and Jack’s, are pursuing different career paths, and manufacturers’ online presence makes it less likely that people will visit a store. “I’m concerned about the level of service people will get after we retire,” he says. “When I was young, we had a lot of people who could measure and fit shoes, but not many podiatrists. Now nobody knows how to fit shoes properly and we have loads of podiatrists! I believe that 90 percent of all foot problems can be relieved with a well-fitted pair of shoes, having both the correct last and the correct size. Finding pain relief through professional shoe fitting is inexpensive and practical, and there are no side effects!” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Courtesy of Lee’s Comfort Shoes

back a long way in the Reser family; Jeff and Jack Reser’s grandparents began working in a shoe store in 1928, buying their own shop in Freemont, Ohio, 20 years later. Today, the Reser brothers own the company Lee’s Comfort Shoes, headquartered in Bucyrus, with outlets in four other Ohio communities. “When my brother and I bought the stores from our parents in 1990, we could see the handwriting on the wall for retail shoe stores, which had been declining for some time, along with the small towns they served,” explains Jeff Reser, CO, CPed. “But we also realized the need for people with more expertise in fitting shoes. By offering those services, we could draw customers from a much wider area.” Both Jack and Jeff became certified in pedorthics in 1995, and Jeff earned his certification as an orthotist shortly after. The Resers’ pedorthic patients include those with diabetes, partial foot amputations, and posterior tibialis tendon/flat feet issues, among other conditions. “People come from all over the area to see us,” says Reser. “These small towns are full of people with diabetes and amputations.” Three of the company’s locations—in Bucyrus, Fremont, and Bellefontaine—offer pedorthic services in addition to retail shoe sales, including high-end athletic shoes and hard-to-find sizes. The Resers see only pedorthic patients, by appointment, in Columbus and Sandusky.

Jeff Reser, CO, CPed

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MEMBER SPOTLIGHT

Orthomerica

By DEBORAH CONN

From Head to Toe Company manufactures cranial and lower-extremity orthoses—and everything in between

RTHOMERICA HAS COME

JUNE 2015 | O&P ALMANAC

PHOTOS: Courtesy of Orthomerica Products Inc.

a long way since its launch in 1989, when it produced only prefabricated orthoses. The introduction of the Newport hip abduction system in 1990 was key to the company’s growth, according to Bill Gustavson, vice president— business development, who says the device became the most popular hip orthosis in the world. Soon after, Orthomerica moved into making semi-customto-measure, lower-extremity hip-knee-ankle-foot orthosis (HKAFO) and knee-ankle-foot orthosis (KAFO) fracture braces, providing same-day shipping when customers faxed in patient measurements. “That led us to expand our breadth of line to custom orthoses in the early 1990s,” says Gustavson. Orthomerica now produces a head-to-toe line of custom orthotic devices, including cranial remolding orthoses, spinal orthoses, hip orthoses, and a complete range of lower-extremity orthoses. Orthomerica became one of the first manufacturers to gain clearance from the Food and Drug Administration for a cranial remolding orthosis to treat head deformities in infants. “We were the first O&P company to manufacture class II medical devices for cranial remolding orthoses marketed and sold to the O&P profession,” says Gustavson. “These must meet stringent safety and quality protocols.” To maintain FDA clearance, the company undergoes an audit every two to three years. Today, Orthomerica is the largest maker of cranial

remolding orthoses in the world, Gustavson notes, with sales of more than 200,000 devices since 2001. A companion product is the STARscanner, a laser data acquisition system that can measure a baby’s head in less than two seconds, eliminating the need for plaster casting. Orthomerica technician In addition, the scanner has a comparison utility program that allows the orthotist to overlay images before, during, and after treatment, demonCOMPANY: strating quantifiable outcomes Orthomerica for clinical and reimbursement purposes. “This technology OWNERS: is used by over 160 leading David Kerr and pediatric hospitals throughout Shannon Schwenn the world,” says Gustavson. Orthomerica has 200 LOCATION: employees and occupies more Orlando, Florida than 100,000 square feet of manufacturing space in Orlando. HISTORY: Most operations are handled in house, including research and 26 years development staffed by mechanical and industrial engineers. “A comprehensive lab for ‘destructive testing’ examines devices’ durability and response to stress so we can make sure our new products meet rigorous testing and safety standards,” Gustavson says. The company’s clinical education department has three clinical orthotists who offer educational seminars in Orlando and throughout the country, as well as online. Orthomerica’s marketing department produces nearly everything

in house, including graphics, the company website, and customized collateral materials. One of the company’s latest products is the Orthomerica Would Limb Salvage (OWLS) program, a new line of offloading orthoses designed for patients with diabetes. This product is the result of more than 10 years of development and includes designs to address forefoot, heel, and midfoot deformations. Recently, Orthomerica introduced SmartSoc, another scanning system that can convert two-dimensional images into 3D models. Using a camera equipped with special software, practitioners take photographs of their patients wearing a soft head sock printed with hundreds of individual markers. The software transmits the photos to Orthomerica’s eBrace website, where practitioners enter key demographic and clinical information, and the images are converted into a 3D model. “Handheld scanners can cost $10,000 to $20,000,” says Gustavson. “At $2,500, this is a much less expensive solution. While we are using it only for cranial devices right now, our goal is to make it a scanning solution for prosthetics starting in May 2015.” Future modules will include lower-extremity orthoses as well as a clinical documentation module for the system that will provide clinical notes needed for medical justification with insurers. As Orthomerica looks to the future, according to Gustavson, it will expand its focus on new technologies and clinical education, increase submissions for research grants, “and help our customers identify new referral sources and incremental revenue streams.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

AOPA NEWS

Stay Out of Trouble: Building a Medicare-Approved Compliance Plan

Mastering Medicare Webinar, June 10

8th Annual AOPA

WINE TASTING

& AUCTION

Donate to AOPA’s Wine Tasting & Auction AOPA’s 8th Annual Wine Tasting & Auction will take place this October during the 2015 AOPA National Assembly in San Antonio. This exciting event provides attendees with a unique opportunity to mingle, network, and learn about and taste a variety of wines—but most importantly, it raises awareness of and funds for AOPA’s government relations outreach programs. Let’s keep the tradition of success alive and make this year’s event the best ever. Please join this great cause and add to the continued success of the Wine Tasting & Auction by donating today. Your special donations are what make this event unique and successful. Your attendance is what makes it fun! Your donation may be one of the gems from your cellar, jewelry, artwork, wine glasses, a bottle of your favorite spirit, cigars, craft beer, etc. We also have a team of personal shoppers who can locate that perfect item for you if you would prefer to make a monetary donation. Contact AOPA’s Devon Bernard at dbernard@ AOPAnet.org or 571/431-085 with questions, or access the donation form at bit.ly/aopawine.

In today’s environment of increased provider scrutiny, a well-designed, effective compliance plan is a necessity. The ability to make sure your own billing practices are sound may prevent unnecessary audits down the road. Join AOPA for its June webinar, “Stay Out of Trouble: Building a Medicare-Approved Compliance Plan” on Wednesday, June 10. The following topics will be discussed: • Establishing and managing an efficient compliance plan • Assigning a dedicated company compliance officer • Interpreting guidance from the Office of Inspector General on the seven fundamental elements of an effective compliance plan • Taking action when compliance deficiencies are discovered • Knowing how and when to perform self-audits • Providing appropriate compliance training to your staff. 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 online at bit.ly/aopawebinars. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.

O&P ALMANAC | JUNE 2015

AOPA NEWS

PROSTHETICS 2020:

An Invitation to AOPA Members

The O&P profession has endured a veritable sea of change in the past five years, impacting which prostheses and orthoses are available to our patients, as well as how and at what rate our services are paid for by payors. What do the next five years hold in store? What will prosthetics be like five years from now, and what can be done to permit us to help participate and shape that future? It is clear that evidence, outcomes, and research are keystones. All three were front and center at the January AOPA Futures Leadership Conference. A new program, initiated under the title “Prosthetics 2020,” is a collaborative effort to operate as an adjunct to AOPA’s ongoing Survival Imperatives. Prosthetics 2020 is a partnership open to interested companies that want to take a strong, proactive role in shaping the drivers of prosthetic patient care five years down the road. If you share a commitment to protect, fortify, and enhance the recognized, scientifically substantiated value of prosthetic care in the minds of payors, patients, and the general public, consider making an investment to be part of Prosthetics 2020. AOPA will be managing this effort with the assistance of a small expert steering committee to be appointed by AOPA’s president. We are inviting interested AOPA member companies to join in the effort. The program will include establishing an AOPA Medical Advisory Board to help identify the essential endpoints of measuring value in prosthetic care, and in conveying our scientific messages to payors, both in government and in the private commercial insurance community. AOPA envisions that new prospective clinical research studies will need to be developed and funded, to be conducted by the best and the brightest in the prosthetic research world. New rock-solid science may well portend new payment models and better reimbursement. Companies considering participation should recognize that the mission of Prosthetics 2020 goes well beyond AOPA’s annual dues. Each participating company will be required to commit to an initial financial commitment of $35,000, and it would be anticipated that participating companies would need to provide in the range of $35,000 per annum for the next three years largely to sustain the Medical Advisory Board. In the event that the project results in also funding one or more new prospective research studies in prosthetics, additional financial outlays would be needed. Any AOPA member company, and especially those companies with strong engagement in prosthetics, can join in Prosthetics 2020 provided they are willing to contribute their fair share of the costs. This will entitle participants to receive regular detailed reports and invitations to provide advisory input on the progress of the effort. While it is 58

JUNE 2015 | O&P ALMANAC

likely that representatives from a few of the participating companies may be among the members of the steering committee that AOPA’s president appoints to guide the project, that group needs to be organized as a small, flexible, hard-working group. A small steering committee will be formed and will include a physician, researcher, representatives from one or two of the participating companies, and an AOPA leadership representative. All supporting companies will have input in an advisory role. The steering committee will meet, advance research proposals, coordinate with the Medical Advisory Board and make other recommendations/decisions, subject to the overall AOPA governance framework via the AOPA Board of Directors. General reports on the group’s progress will be shared in the form of updates to all AOPA members. The new framework is being undertaken first in the prosthetics profession. Based on the success of the prosthetics initiative, AOPA will consider the prospects for a subsequent parallel effort in the orthotics profession. The success of Prosthetics 2020 will depend on consistently gathering a cohesive working group and substantial resources on a relatively long-term basis, with the doors open to both large and small patient-care facilities and manufacturers. In principle, key premises will include the following: 1. Maintaining equal contributions from each participant 2. Recognizing that accomplishing the purpose of the Prosthetics 2020 initiative will require substantial financial support 3. Abiding by a participation agreement that addresses the long-term nature of the endeavor, termination, etc. For example, funding the Medical Advisory Board alone will likely require more than $100,000 per year. The likelihood is that there will be one or more prospective research studies that evolve, with costs likely to run into the mid six figures for each study. While we need to balance all of these factors, we also need to retain flexibility. One way we can do that is to suggest that as to patient-care facilities and companies that are not engaged at all in the manufacture or prosthetic knees or feet (all manufacturer participants who have any products in either or both of these product lines need to have the same financial stake), we would be open to “pooled” participation—for example, up to three companies may want to join together over multiple years to meet the annual participation fee. AOPA will share details as the committees form and the Prosthetics 2020 initiative advances.

AOPA NEWS

Encourage Your Patients To Enter the Mobility Saves Testimonial Contest Become part of an important public relations campaign that proves cost effectiveness for orthotics and prosthetics. Create a video testimony and become eligible to win $500!

Why Participate?

• • • •

Help patients obtain medically necessary devices. Support the O&P profession. Become part of a major public relations campaign. Help spread the word that orthotic and prosthetic devices not only restore lives but are cost effective, too. • Receive a T-shirt. • One grand prize winner ($500), one second-place winner ($250), and one third-place winner ($100) will be awarded. • All entries must be received by 11:59 p.m. EST on Sept. 30, 2015.

It’s as easy as

1•2•3!

O CE T

WIN0

H AC

$50

1. Create your video testimony by using your smartphone or video camera. 2. Complete the online entry form at bit.ly/MobilitySavesContest.

The AOPA Coding Experts Are Coming to Philadelphia July 13-14 The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of both O&P practitioners and O&P billing staff. The seminar will feature hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff.

Top 10 Reasons To Go to Philadelpha

1. Get your claims paid. 2. Increase your company’s bottom line. 3. Stay up to date on billing Medicare. 4. Code complex devices. 5. Earn 14 CE credits. 6. Learn about audit updates. 7. Overturn denials. 8. Submit your specific questions ahead of time. 9. Advance your career. 10. Benefit from more than 70 years of combined experience from AOPA coding and billing experts.

3. Upload your video testimony or email video from your smartphone. EARN CREDITS

Questions?

Contact AOPA at 571/431-0876 or ymazur@AOPAnet.org.

JUNE 2015 | O&P ALMANAC

14 CE

PER SEMINAR

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. In this audit-heavy climate, can you afford not to attend? Register at bit.ly/2015billing.

AOPA NEWS

Annual Operating Performance and Compensation Survey:

Submit Your Survey By June 19

Better Business Performance Starts Here AOPA offers its members the opportunity to participate in an operating Personalized Company performance and compensation survey Performance Report each year. Data from these surveys with Survey Submission provides benchmarks that enable the comparison of your O&P business with those of similar size and location. This information can assist you in identifying strengths and weaknesses and formulating strategies for meeting business goals. Participation is free, and there are some incentives to thank you for investing 60 minutes of your time to complete the survey. Surveys were mailed to members May 1. Participants can complete the hard copy, enter the data online at www.aopa-survey.com, or send data to Industry Insights to have it entered for you. All data is confidential. The deadline for submission is June 19. Participants in the survey receive a free personalized company performance report, comparing their business with others of similar size and location. (This would cost hundreds of dollars from a private consultant.) The published 2015 Operating Performance Report and 2015 Compensation Report are also available free to participants—a $370 value. As an added incentive for participating this year, AOPA is offering the online Mastering Medicare Webcast series free of charge, a $693 value, with 13.5 CE credits available. For more information about the survey, contact Betty Leppin, bleppin@aopanet.org, or 571/431-0876.

n FREE

Stay in the Know— Subscribe to AOPA’s Take! AOPA has designed AOPA’s Take, a new blog to keep you informed with important issues and real-time news that arise within the O&P world. This is a more immediate avenue to find the latest updates. AOPA’s Take is available at no charge to all members of the O&P community, and subscribing is simple. Go to www.aopastake.org and click on the subscribe button. Fill out a few fields, and you’re in! Welcome to AOPA’s Take…..Where you go when you need to know!

AOPA’s monthly webinar series is the regulatory and business education that you can count on. No one in the O&P profession knows the ins and outs of Medicare, coding, billing, or Veterans Administration contracting like AOPA. Sign up for all 2015 webinars for only $990 for members, which includes two free webinars. If you missed one, we will send you the recording. The monthly webinars are a great way to bring your staff together for lunchtime learning by AOPA experts. Don’t miss any of the important topics in the webinars planned for the rest of the year: June 10

Building a Medicare-Approved Compliance Plan

July 8

Who’s on First? Medicare as a Secondary Payor

August 12

Off the Shelf Versus Custom Fit: The True Story

September 9

Prior Authorization, How Does It Work?

October 14

Understanding the LSO/TLSO Policy

November 11

Make a Good Impression: Marketing Yourself to Referrals

December 9

Bringing in the New Year: New Codes and Changes for 2016

O&P ALMANAC | JUNE 2015

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an www.AOPAnet.org official member of AOPA if, within 30 days of publication, no objections are made regarding the companyâ&#x20AC;&#x2122;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 AOPAâ&#x20AC;&#x2122;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.

Hanger Clinic 315 Percy Street Talladega, AL 35160-2158 256/315-0660 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 1480 S. Harbor Blvd., Ste. 1 La Habra, CA 90631-7534 714/871-1480 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 2275 Myers Street, Ste. C Oroville, CA 95966-5319 530/533-7344 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 802 Pinebrook Road Venice, FL 34292-7103 941/485-1430 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 1359 Milstead Road, Ste. 102 Conyers, GA 30012-3865 770/785-6792 62

JUNE 2015 | O&P ALMANAC

Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 101B 13th Avenue Cordele, GA 31015-5043 229/273-2269 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 109 Parker Drive LaGrange, GA 30240-6436 706/884-2864 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 215 N. Convent Street, Ste. 3 Bouronnais, IL 60914-5601 815/937-0241 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 1602 N. Second Street, Ste. 101 Clinton, MO 64735-1192 660/885-5512 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 1828 E. 9th Street Trenton, MO 64683-2644 660/339-7094 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 8000 Highway 242, Ste. 100 Conroe, TX 77385-4360 936/271-2022 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 510 Foster Lane, Ste. 203 Warrensburg, MO 64093-3239 660/429-1080 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 7320 Highway 90, Ste. 150 Sugarland, TX 77478-3391 281/242-2118 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 2888 Rob Shepard Drive Alamance, NC 27201-9998 336/222-9765 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 556 Merrick Road, Ste. LL2 Rockville Centre, NY 11570-5487 516/678-3650 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 4401 W. Memorial Road, Ste. 137 Oklahoma City, OK 73134-1787 405/752-4298 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 124 N. Henderson Avenue, Ste. A, Bldg. 1 Sevierville, TN 37862-5948 865/453-1476 Category: Affiliate Parent Company: Hanger Clinic

Hanger Clinic 17490 Highway 3, Ste. 100-A Webster, TX 77598-4160 281/332-4888 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 887 E. Vine Street Salt Lake City, UT 84107-6515 801/293-8777 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 1655 South Market Street, Ste. B Chehalis, WA 98532-3826 360/748-3412 Category: Affiliate Parent Company: Hanger Clinic Hanger Clinic 826 E. 8th Street Port Angeles, WA 98362-6419 360/417-3022 Category: Affiliate Parent Company: Hanger Clinic SOLS 601 W. 26th Street, Ste. 815 New York, NY 10001 855/932-7765 www.sols.com Category: Supplier Level 1

949/645-4401 ● 800/854-3479 ● (CA) 800/824-9704 ● (FAX) 949/646-0805

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast

Job location key:

Certified Prosthetist-Orthotist

Johnson City, Tennessee Well-established multioffice ABC-certified O&P company is looking for certified individual with excellent orthotic and prosthetic skills to provide comprehensive treatment of patients. Excel offers competitive salary and bonus opportunity with full benefits package. Salary to be determined on experience. Send resume to:

- 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 jobs.AOPAnet.org. 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

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

Pacific Certified Prosthetist-Orthotist, Certified Prosthetist, and Certified Orthotist

Orange County, Riverside County, San Bernardino County, California Here we grow again: A reputable, well-established, multioffice, Southern California O&P company is looking for energetic and motivated individuals who possess strong clinical skills and experience to provide comprehensive patient assessments to determine patient needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits. Salary is commensurate with experience. Local candidate preferred. Send resumé to:

Member Nonmember $80 $140

For more opportunities, visit: http://jobs.aopanet.org.

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Email: sethwalters@excel-prosthetics.com

JUNE 2015 | O&P ALMANAC

Attention: Human Resources Inland Artificial Limb & Brace, Inc. Fax: 951/734-1538 SUBSCRIBE

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

MEMBER VALUE GUIDE www.AOPAnet.org/join

CAREERS AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Beneﬁts Northeast Certified Prosthetist-Orthotist, Certified Orthotist

Central New Jersey and Southern New Jersey

Experience the Benefits of AOPA Membership

Experience the Beneﬁts of AOPA Membership

O&P Technician Southern New Jersey AlliedOP is a well-established and growing full-service prosthetic and orthotic company with multiple offices in New Jersey and Pennsylvania. We are looking for hardworking and self-motivated individuals with strong clinical and technical skills to help continue our growth. We offer a very competitive compensation/benefits package. Contact:

•

Challenging RAC and CERT audit policies implemented by overly aggressive CMS contractors is AOPA’s number one priority. We have ﬁled litigation against CMS seeking relief from the unfair and unauthorized actions of CMS, its RAC auditors, and DME MACs relating to physician documentation requirements, and the change in policy resulting from the “Dear Physician” letter.

MISSION

•

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.

Expert Reimbursement and

•

Cost-Effectiveness Research. The

changing climate of health care is Coding Guidance. AOPA’s Membership inreim-AOPA is one of the moving to a patient driven process bursement specialists provide

Your Survival Advocacy in Washington. AOPA’s staff and the lobbying team bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain ﬁnancial times to ensure quality patient care.

coding advice and keep you up-to-date on the latest Medicare quality standards, RAC and other audits, billing rules and regulations. Answers to all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.

and is demanding more and more

of cost-effectiveness to best investments that evidence yououtcomes. canAOPAmake measure has

Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level brieﬁngs and to E E GUIDdeliver the O&P story personally to VALU BER MEM rg/join their members of Congress. www.AOPAnet.o

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LCodeSearch.com, AOPA’s online coding resource, provides members with a one-stop, up-to-the minute coding reference available 24/7, from anywhere you connect to the Internet.

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n Orthotic services; audit of the America regulation and RAC and CERT The mission Challenging business in laws, ented by overly of the O&P to e treatment policies implem contractors is g skills; and for favorabl and marketin CMS aggressive management one priority. ion. s improve their the associat AOPA’s number to help member industry and litigation against unfair nding of the We have filed relief from the CMS, ss and understa of CMS seeking raise awarene rized actions MACs and unautho The , and DME ss Research. is ectivene its RAC auditors n documenta• Cost-Eff of health care t and relating to physiciaand the change changing climate driven process ents, Reimbursemen reimto a patient tion requirem • Expert the “Dear more AOPA’s moving e. and from more ing Coding Guidanc ts provide in policy resulting s to and is demand cost-effectivenes bursement specialis Physician” letter. evidence of and keep you s. AOPA has coding advice the latest Medicare measure outcome Advocacy in study by health up-to-date on s, RAC and other • Your Survival funded a major -DaVanzo proving ons. team Dobson Washington. quality standard regulati rm fi lobbying and O&P the care rules and s of timely AOPA’s staff healthcare knowlaudits, billing of your questions the same cost-effectivenes of all sepatients with bring years Answers to ce to the issues did treatment of coding, reimbur patients who can assure edge and experien related to O&P nce—via telephone diagnoses as efforts help t. AOPA of O&P. AOPA’s sement policies ment and complia s have unlimited not receive treatmen s of the field to resource equitable reimbur or email. Member aggregate the vital research that n financial times staff experts. in these uncertai access to AOPA to conduct this cannot conduct. patient care. rms ensure quality AOPA’s online s individual fi earch.com, • LCodeS Connect. , provides member Your Voice coding resource, up-to-the minute • Making Policy Forum ton one-stop a 24/7, AOPA’s Annual with e e availabl leaders to Washing (Continued) and to brings O&P coding referenc you connect to the level briefings re to receive high story personally to from anywhe deliver the O&Pof Congress. Internet. s their member

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diagnoses as patients who did not receive treatment. AOPA can aggregate the resources of the ﬁeld to conduct this vital research that individual ﬁrms cannot conduct.

2015 AOPA Annual Membership enrollment(Continued) is now open. Call 571/431-0876 or visit www.AOPAnet.org/join.

eﬁts Member Ben ORTHO TIC

funded a major study by health care ﬁrm Dobson-DaVanzo proving

cost-effectiveness of timely O&P in the future of your company. treatment of patients with the same

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AMER ICAN

Howard Brand Phone: 856/273-6400 Fax: 856/273-0506

The mission of the American Orthotic and Prosthetic Association is to work

Join today!

ADVERTISERS INDEX

Company ACOR Orthopedics Inc.

Page Phone

Website

800/237-2276

www.acor.com

Aqualeg Inc.

855/955-2785

www.aqualeg.com

Arizona AFO Inc.

877/780-8382

www.arizonaafo.com

Board of Certification/Accreditation

877/776-2200

www.bocusa.org

Cascade Dafo

800/848-7332

www.cascadedafo.com

College Park Industries

800/728-7950

www.college-park.com

ComfortFit Labs Inc.

888/523-1600

www.comfortfitlabs.com

Custom Composite

866/273-2230

www.cc-mfg.com

1, C3

800/252-2828

www.daw-usa.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

Freedom Innovations

888/818-6777

www.freedom-innovations.com

Hersco

800/301-8275 www.hersco.com

Kingsley Manufacturing

800/854-3479

www.kingsleymfg.com

Orthomerica

800/446-6770

www.orthomerica.com

Össur Americas Inc.

800/233-6263

www.ossur.com

Ottobock

800/328-4058 www.professionals.ottobockus.com

DAW Industries

PEL Spinal Technology Inc. WillowWood

800/321-1264 www.pelsupply.com

800/253-7868

www.spinaltech.com

Insert 800/848-4930 www.willowwoodco.com O&P ALMANAC | JUNE 2015

CALENDAR

2015

fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/836-7114; email certification@abcop.org; or visit www.abcop.org/certification.

June 10

Stay Out of Trouble: Building a Webinar Conference Medicare-Approved Compliance Plan. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

June 11-12

MOPA: Michigan Continuing Education Meeting. DoubleTree by Hilton Bay City-Riverfront. Now offering pedorthic continuing education credits. Contact 517/784-1142 or visit www.mopa.info.

June 17-19

New York State Chapter Annual Meeting. Pediatrics and more. Albany Marriott, Albany, NY. For information, visit www.NYSAAOP.org.

June 19-20

PrimeFare East Regional Scientific Symposium 2015. National Convention Center, Nashville, TN. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

July 6-11

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 certification@abcop.org; or visit www.abcop.org/certification.

July 8

Who’s on First? Medicare as a Secondary Payor. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

July 13-14

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Philadelphia. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

August 12

Off the Shelf vs. Custom Fit: The True Story. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

July 1

ABC: Application Deadline for Certification Exams. Applications must be received by July 1, 2015, for individuals seeking to take the September ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy

Year-Round Testing

Online Training

BOC BOC Examinations. Examinations. BOC BOC has has year-round year-round testing testing for for all all of of its its exams exams and and no no applicaapplication tion deadlines. deadlines. Candidates Candidates can can apply apply and and test test when when ready ready and and receive receive their their results results instantly instantly for for the the multiple-choice multiple-choice and and clinical-simulation clinical-simulation exams. exams. Apply Apply now now at at my.bocusa.org. my.bocusa.org. For For more more information, information, visit visit www.bocusa.org www.bocusa.org or or email email cert@bocusa.org. cert@bocusa.org.

Cascade Cascade Dafo Dafo Inc. Inc. Cascade Cascade Dafo Dafo Institute. Institute. Now Now offering offering aa series series of of six six free free ABC-approved ABC-approved online online courses, courses, designed designed for for pediatric pediatric practipractitioners. tioners. Visit Visit www.cascadedafo.com www.cascadedafo.com or or call call 800/848-7332. 800/848-7332.

www.bocusa.org www.bocusa.org

Calendar Rates Let us share your upcoming event! Telephone Telephone and and fax fax numbers, numbers, email email addresses, addresses, and and websites websites are are counted counted as as single single words. words. Refer Refer to to www. www. AOPAnet.org AOPAnet.org for for content content deadlines. deadlines.

JUNE 2015 | O&P ALMANAC

For information information on on continuing continuing education education credits, credits, contact contact the the sponsor. sponsor. CE CE For Questions? Questions? Email Email landerson@AOPAnet.org. landerson@AOPAnet.org.

CREDITS CREDITS

BONUS! BONUS! Listings Listings will will be be placed placed free free of of charge charge on on the the “Attend “Attend O&P O&P Events” Events” section section of of www.AOPAnet.org. www.AOPAnet.org.

Words/Rate: Words/Rate: Member Nonmember Member Nonmember Color Color Ad Ad Special: Special: M Member ember Nonmember Nonmember 25 25 or or less less 26-50 26-50 51+ 51+

$40 $40

$50 $50

1/4 1/4 page page Ad Ad

$482 $482

$678 $678

$50 $50

$60 $60

1/2 1/2 page page Ad Ad

$634 $634

$830 $830

$2.25/word $5.00/word $2.25/word $5.00/word

Send Send announcement announcement and and payment payment to: to: O&P O&P Almanac, Almanac, Calendar, Calendar, P.O. P.O. Box Box 34711, 34711, Alexandria, Alexandria, VA VA 22334-0711, 22334-0711, fax fax 571/431-0899, 571/431-0899, or or email email landerson@AOPAnet.org landerson@AOPAnet.org along along with with VISA VISA or or MasterCard MasterCard number, number, the the name name on on the the card, card, and and expiration expiration date. date. Make Make checks checks payable payable in in U.S. U.S. currency currency to to AOPA. AOPA. Note: Note: AOPA AOPA reserves reserves the the right right to to edit edit Calendar Calendar listings listings for for space space and and style style considerations. considerations.

CALENDAR

Motion Control Motion Control SUPERCOURSE FALL 2015

September 9

Prior Authorization, How Does Webinar Conference It Work? Register online at bit. ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

SUPERCOURSE FALL 2015 AUGUST 19-22, 2015

AUGUST 19-22, 2015 TN Fillauer Headquarters, Chattanooga, Fillauer Headquarters, Chattanooga, TN

• In-depth training of Utah • In-depth of Utah Arm 3+ /training Hybrid Arm / Arm 3+ TDs / Hybrid Arm / ProPlus and Wrist ProPlus TDs and Wrist • Hands-on training with • Hands-on UI softwaretraining with UI software

September 25-26

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Jon Shreter at 800/946-9170, ext. 108, or email jshreter@pomac.com.

October 1-3

2015 NC-SC Annual Meeting. The Ballantyne, Charlotte, NC. More information online at www. ncaaop.com/joinrenew-membership. For exhibitors and sponsorship opportunities, contact Jennifer Ingraham, jingraham@spsco.com or 800/767-7776, x1173, or contact Skyland Prosthetics at 828/684-1644.

October 7-10

98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org. Understanding the LSO/TLSO Policy. Register online at bit.ly/ aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Plus training in the NEW

• Casting/fitting/socket design F.L.A.G. Plus training the NEW (ForceinLimiting Auto • Casting/fitting/socket design F.L.A.G. (Force Limiting Auto for SD/FQ, T-H, T-R levels; Grasp) feature for ETD & Hand for SD/FQ, T-H, provided T-R levels; patient subjects Grasp) feature for ETD & Hand patient subjects provided

The 4-day SuperCourse fee is $1,350.00 The 4-day SuperCourse fee is $1,350.00 CEUs: 28 (estimated) ABC/BOC CEUs: 28 (estimated) ABC/BOC For more information or to register for more information or to register for the For SuperCourse, email: info@UtahArm.com the SuperCourse, email: info@UtahArm.com

115 N. Wright Brothers Dr. • Salt Lake City, UT 84116 115 N. Wright Brothers Dr. •• Fax: Salt 801.978.0848 Lake City, UT 84116 Phone: 801.326.3434 Phone: 801.326.3434 • Fax: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com Toll Free: 888.MYO.ARMS • www.UtahArm.com

October 14

Webinar Conference

• Latest MC components, • Latest MC components, integrating with i-limb, integrating with i-limb, bebionic, and others bebionic, and others • Convenient Wednesday • Saturday Convenient Wednesday schedule Saturday schedule

O&P Almanac Calendar Ad SuperCourse Fall 2015.indd 1 O&P Almanac Calendar Ad SuperCourse Fall 2015.indd 1

December 9

5/13/15 1:27 PM 5/13/15 1:27 PM

Bringing in the New Year: New Codes and Changes for 2016. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

November 4-6

NJAAOP. The New Jersey Chapter of AAOP presents the 21st Annual Continuing Education Seminar. Harrah’s Atlantic City, NJ. For more information contact Lisa Lindenberg at 973/6092263, or email director@njaaop.org, or visit www.njaaop.com.

November 9-10

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. The Flamingo, Las Vegas. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

November 11

2016 September 8-11

99th AOPA National Assembly. Hynes Convention Center, Boston. For general inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

How To Make a Good Impression: Marketing Yourself to Your Referrals. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

O&P ALMANAC | JUNE 2015

ASK AOPA

Secondary Benefits Know the rules when secondary payors are involved in Medicare claims

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

How does Medicare calculate its payment when it is considered the secondary payor?

Medicare calculates its secondary payor amount by using the following four-step formula:

1. Medicare determines what it would pay if it were the primary payor (what it normally would pay). 2. Medicare reviews the primary payor’s allowable to determine if it is higher than its allowable (the amount from step 1). 3. The amount that is paid by the primary payor is subtracted from the amount determined in Step 2. 4. Medicare’s secondary payment will be the lower amount of Step 1 or Step 3. Are there any insurance programs that are always secondary payors to Medicare?

Yes, there are three programs, or payors, that are always secondary to Medicare: • Medigap/Medicare supplemental insurance, or insurance that is provided by private companies to help fill in the gaps or offset the coverage a patient may have with Medicare • A state’s Medicaid program • TRICARE, the health insurance plan for active-duty members of the armed forces and their families.

JUNE 2015 | O&P ALMANAC

Are Department of Veterans Affairs (VA) benefits primary or secondary to Medicare benefits, if a patient is eligible for both programs?

If veterans have Medicare and VA coverage, they must choose one of the agencies to handle their orthotic and prosthetic services. A claim cannot be submitted to both agencies for the same date of service and for the same items.

If the primary payor does not pay or process a claim in a timely manner, is it possible to submit the claim to Medicare without receiving an explanation of benefits from the primary payor?

Yes; you may submit a claim to Medicare and seek a “conditional payment.” However, if it is determined that someone else should have paid first or you eventually receive payment from the primary insurer, you must refund Medicare. If you choose to seek a conditional payment from Medicare, you must withdraw any claims you have with the primary insurer and/or drop any liens you may have placed on the beneficiary.

MPK with pinpoint programmable gait accuracy Advanced Pneumatics with extremely high exion resistance 5-bar stability, fully adjustable stance exion Full range adjustable geometric stance control

Trouble free low maintenance. Proven durability and dependability Fully programmable centrode (PC) Record-able gait data for seamless Bluetooth transfer to another Stealth MP Knee Patient weight: up to 275 lb

This latest New technology detects instantly any change in knee 3-D positioning. The programmable Stealth microprocessor translates the data and provides the optimum extension--exion resistance. Its advanced Pneumatics with unheard of high compression ratio never requires adding air. It can easily be set to provide the desirable resistance while walking down an incline or stairs.

Michelangelo is the natural choice Natural design and incredible freedom of movement Give your patients the intuitive, responsive functionality of Michelangelo that brings them closer to a natural hand than any other myoelectric. The Michelangelo difference is more than cosmetic. It offers seven different hand positions and a powerful grip function. Along with its flexible wrist, unique fingertips, and electronically movable thumb, Michelangelo can open up a whole new world of possibilities for your upper limb patients. Ask your local sales rep to trial a Michelangelo today and see how it has become the natural choice.