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The Magazine for the Orthotics & Prosthetics Profession

J U N E / J U LY 2021

Review PDAC Advisory Articles

Check out the 2021 AOPA National Assembly Preliminary Program


View at www.AOPAnet.org.

Trends in Vertical Integration P.32

Studying Socket Suspension, Prosthetic Feet, and More P.36


Quiz Me!








The premier meeting for orthotic, prosthetic, and pedorthic professionals.


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Join your colleagues for the 2021 National Assembly as we come together safely, in celebration of unity and recovery. who are unable to joinfor us an in ideal JoinThose us September 9-11, 2021,


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Members save over $300 on Assembly Registration. Learn more at www.AOPAnet.org/join. FOLLOW US @AmericanOandP


Boston September 9-11 can still be

combination top-notch education in and part of theofreunion by participating the virtual option 16-18. entertainment at the September 104th AOPA

National Assembly in Boston, MA.



J U N E /J U LY 2021 | VOL. 70, NO. 6





20 | The Road to Tokyo

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

As the world prepares for the Summer Paralympic Games in Tokyo, several clinicians who see Paralympic hopefuls share their experiences and explain how they help ensure their patients are fit with the most appropriate componentry for both training and competing. Plus, hear form a prosthetic technician who plans to repair devices at the technical services repair station in Tokyo. By Christine Umbrell

AOPA Contacts............................................6

Summer reading

How to reach staff

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

At-a-glance statistics and data

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

Research, updates, and industry news


PHOTO: UPMC/The University of Pittsburgh Schools of the Health Sciences

People & Places........................................ 13

Transitions in the profession

Reimbursement Page.......................... 14

Be Advised

Examining the PDAC’s advisory articles Opportunity to earn up to two CE credits by taking the online quiz.

32 | O&P Integration O&P manufacturers, large O&P patient-care companies, and other entities are acquiring smaller patientcare facilities. Stakeholders from various sectors of the profession weigh in on this growing trend, sharing benefits and challenges—and some small facility owners explain why they maintain their independence. By Michael Coleman

Member Spotlight................................ 40 n n

New Horizons Orthotics and Prosthetics VQ OrthoCare

AOPA News............................................... 44

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 45

PRINCIPAL INVESTIGATOR Sarah R. Chang, PhD....................................................... 36 Meet the director of research and development at Orthocare Innovations—who also is an AOPA/COPL grant recipient— and read about her investigations into vacuum-assisted socket suspension systems, prosthetic knees for geriatric populations, “smart” ankle-foot orthoses, and patient outcomes and outcomes measurements.



O&P PAC...................................................... 45 Marketplace..............................................46 Careers........................................................ 50

Professional opportunities

Ad Index....................................................... 53 Calendar...................................................... 54

Upcoming meetings and events

State By State........................................... 56

California, New York, Texas, and Washington

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Summer Reading


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

ODAY, THERE ARE so many mediums in which to keep learning. Two of my

favorites are books and podcasts. With summer vacations heating up, here are a few suggestions to pack in your beach bag or backpack, or download to your iPad®, Kindle, or phone. BOOKS

• “Radical Candor: Be a Kick-Ass Boss Without Losing Your Humanity,” by Kim Scott: This book was recommended to me by an interviewee, and I read it in one sitting. While the title suggests this is for bosses only, I recommend it for everyone because being radically candid requires communication and trust from both the employee and the boss. • “Momentum: Creating Effective, Engaging, and Enjoyable Meetings,” by Mamie Kanfer Stewart and Tai Tsao: This book offers a way to make meetings more engaging, fruitful, and enjoyable for everyone on your team. We have enough meetings—this book helps ensure you do not meet just to meet and explains how to get the most from your meetings. This book is not just for those putting on the meetings. If you are going to create change within your organization, you need buy-in from everyone; so, share your “why” by having them read this. • “Reframing Healthcare: A Roadmap for Creating Disruptive Change,” by Zeev Neuwirth, MD: Dave McGill introduced this book to me. It’s is a step-by-step guide that shares tools used in marketing to improve healthcare at an accelerated pace. It’s written for healthcare organizations that wish to thrive in a customercentric, community-oriented, value-based healthcare system. PODCASTS

• “Dare To Lead With Brené Brown”: This podcast features conversations with change-catalysts, culture-shifters, and more than a few troublemakers who are innovating, creating, and daring to lead. • “Coaching for Leaders With Dave Stachowiak, PhD”: He brings his perspective from a thriving, global leadership academy and interviews bestselling authors and expert researchers, while also regularly dialoging with listeners. AUDIOBOOKS

(Because sometimes the story is even better in the authors’ voices)

Board of Directors OFFICERS President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN President-Elect Dave McGill Össur Americas, Foothill Ranch, CA Vice President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Immediate Past President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary (Nonvoting) Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Baker O&P, Fort Worth, TX

• “Born a Crime: Stories From a South African Childhood,” by Trevor Noah: This autobiography from the award-winning comedian explores his life growing up in South Africa. • “Greenlights,” by Matthew McConaughey: From the Academy Award-winning actor, this memoir shares the stories of his life beyond his infamous “Alright, alright, alright.”

Kimberly Hanson, CPRH Ottobock, Austin, TX

I hope you have a great summer—and if you have your own book or podcast recommendations, access your My OP Community account and share in the Hot Topics Community.

James O. Young Jr., LP, CP, FAAOP Amputee Prosthetic Clinic, Tifton, GA

Traci Dralle, CFm, is president of AOPA.




John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY Linda Wise WillowWood, Mount Sterling, OH

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX






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

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

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


Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org

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

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 MEETINGS & EDUCATION Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

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

HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org


Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email info@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 © 2021 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.

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com


Design & Production Marinoff Design LLC

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options!

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2021 Paralympic Games Thousands of competitors—including hundreds of amputee and limb-impaired athletes—will convene in Tokyo

Athletes from across the world will finally unite to compete in the originally scheduled 2020 Paralympic Games, now slated to take place August 24-September 5. This is the second time the Paralympic Games are being held in Tokyo; they also were hosted there in 1964.





Medals to be awarded in badminton


Medals to be awarded in taekwondo



Athletes expected to compete


Individuals expected to serve on the technical service team

Athletes expected to represent Team USA


Metric tons of equipment and machinery needed for the stations

17,300 Spare parts expected to be available


Medals to be awarded

2,000 Expected number of repairs

22 SPORTS Here’s the full list of the sporting events to be held at the Summer Games: Goalball Judo Powerlifting Rowing Shooting para sport Sitting volleyball Swimming Table tennis

Taekwondo Triathlon Wheelchair basketball Wheelchair fencing Wheelchair rugby Wheelchair tennis












MEET THE MASCOT Someity is the mascot of the Tokyo Paralympic Games. “Someity” is derived from “Someiyoshino,” which is a popular type of cherry blossom, and the word “mighty.” Someity can fly using its cape, has telepathic powers, loves being outdoors, and can communicate with natural elements such as trees and plants. The mascot was chosen by children from more than 16,000 Japanese elementary schools. —World Para Athletics

SOURCES: Paralympic.org; teamusa.org; ottobock.com/en/engagement/paralympics/

Archery Athletics Badminton Boccia Canoe Cycling Equestrian Football 5-a-side

Think outside the shoe® Are you over bracing your patients? For the last 50 years, patients suffering for foot drop have been fitted and braced with 90 degrees carbon or plastic AFOs. This resulted in many patients stopping to wear their AFO, simply because it was not working properly and giving them daily limitations or discomfort. I am an orthotist with over 31 years of experience, and I have a confession to make: I have overbraced patients in the past. Why, may you ask? Because for a long time, it was the only option. But not anymore! The Xtern was designed with movement in mind. Its lightweight thermoplastic design fully sits outside the shoe to maximize comfort, movement and energy return. Please reach out! We offer professional training as well as demo kits to help you offer the best options to your patients.

Stéphane Savard, Orthotist President and co-founder of Turbomed Orthotics

PDAC Validated (L1951) USA turbomedusa.com


Brain Stimulation Speeds Robotic Arm Control



PHOTOS: UPMC/The University of Pittsburgh Schools of the Health Sciences

Bioengineers from the University of Pittsburgh Rehab Neural Engineering Labs are studying how adding brain stimulation that evokes tactile sensations makes it easier for a prosthetic user to manipulate a brain-controlled robotic arm. The research team experimented with supplementing vision with artificial tactile perception and found that it could reduce time spent grasping and transferring objects by half. “The primary goal of this study was to evaluate whether restored sensory feedback improved the ability to use a brain-computer interface-controlled robot for functional tasks involving picking up and transporting objects,” explained Jennifer Collinger, PhD, an associate professor at University of Pittsburgh’s Department of Physical Medicine Robert Gaunt, University of Pittsburgh associate professor, touches and Rehabilitation and a study author. the fingers of the robotic hand, which Copeland can “feel.” In the experiment, Nathan Copeland, who has tetraplegia, used an implanted bidirectional since there was little to no learning required to use the brain-computer interface that recorded signals from system,” said Collinger. “The performance improvement with the motor cortex to enable control of the robotic arm and sensory feedback was immediate. We saw that completion provided sensory feedback about grasp force by stimulating times on a clinical assessment of upper-limb function, the electrodes implanted in the somatosensory cortex, the Action Research Arm Test, improved significantly from a area of the brain that typically processes signals related to median time of approximately 20 seconds to 10 seconds.” touch. After the arrays, which enable him to receive tactile The researchers noted that the performance improvefeedback, were implanted, Copeland was able to pick up ments came from a reduction in the amount of time spent and transfer various objects from a table to a raised plattrying to grasp the object, “which is when we would expect form twice as fast compared to tests without stimulation. tactile information to have the largest impact,” she said. “The bidirectional brain-computer interface seemed to “Intracortical brain-computer interfaces can enable tap into natural sensorimotor control networks in the brain sophisticated control of a robotic arm that allows a person with upper-limb impairments to pick up and manipulate objects, and this ability is significantly improved when we provide sensory feedback about the forces experienced in the robotic hand,” added Collinger. The study, published in May in Science, supports further development of bidirectional brain-computer interfaces such that they can be translated into clinical use, she says. “Our work so far has been conducted with people with tetraplegia due to spinal cord injury. For people with limb loss, a brain-computer interface would have to deliver a significant improvement in function over nonimplanted methods such as myoelectric conCopeland uses the brain-computer interface to control the trol,” Collinger said. “For individuals with very high-level robotic arm to perform reaching and grasping tasks. arm amputations, current control options are limited.”


AFOs Have Positive Impact on Older Adults With Balance Issues

and standing, there have been concerns about AFOs possibly restricting natural movements or interrupting sensory feedback from the lower leg and foot. The research team identified 11 articles that met their inclusion criteria, and found that AFOs have a generally positive impact in four ways: They improve lateral stability, improve balance under static conditions, provide a reduction in postural sway, and increase walking speed in communitydwelling older adults. “These findings suggest that AFOs have a largely positive impact on the balance of older adults,” reported Laidler, “and can be considered to help improve balance in certain patient populations.”

Study Finds Limited Community Ambulators Benefit From Microprocessor Technology Individuals who were assessed at the K2 functional level were found to experience improvements in gait performance, safety, and reported measures when using a microprocessorcontrolled knee, according to a study published in May in the Journal of Neuroengineering and Rehabilitation. Researchers from the Shirley Ryan AbilityLab and Northwestern Feinberg School of Medicine, led by Chandrasekaran Jayaraman and Chaithanya K. Mummidisetty, conducted a 13-month longitudinal clinical trial to determine the benefits of using a C-Leg and 1M10 foot in 10 individuals at K2 level with transfemoral amputation due to vascular disease. Participants spent six months using a microprocessorcontrolled knee with a standardized 1M10 foot, and six months with their predicate nonmicroprocessor-controlled knee and a standardized 1M10 foot. The researchers assessed both clinical outcomes and self-reported outcomes,

and found that “statistically significant and clinically meaningful improvements were observed,” and that “most participants were able to achieve higher clinical scores in gait speed, balance, self-reported mobility, and fall safety,” while using the microprocessorcontrolled knee with the 1M10 foot, according to the journal article. Potential contributing factors for the observed improvements, according to the authors, include the sensors at the knee that provide feedback on dynamic ambulation conditions to the microprocessor, which provide a more stable and modulated gait, as well as the advanced functionality of stumble recovery to reduce fall risk. “We hope our study will further strengthen the evidence base and potentially impact policy-level decisions to improve healthcare access in K2-level transfemoral amputees” who are currently using a nonmicroprocessor-controlled knee, said the authors.

HERL Researchers Develop Prosthetic Hook Mouse PHOTO: Rory Cooper, PhD

A new study published in Canadian Prosthetics & Orthotics Journal demonstrates the usefulness of ankle-foot orthoses (AFOs) on older adults with balance impairment. Researchers from the Department of Rehabilitation Therapy at Queen’s University in Kingston, Canada, conducted a scoping review of the literature related to adults over age 65 with dropfoot or sensory deficits in the lower-extremity who were treated with AFOs. The researchers, led by Jenna Laidler, undertook the study with the recognition that falls are a serious cause of injury and death in the senior population. While many older individuals are fit with AFOs to aid in balance during walking


A computer mouse that is compatible with prosthetic hooks has been unveiled by scientists at the Human Engineering Research Laboratories (HERL), a collaborative effort between the VA Pittsburgh Healthcare System and the University of Pittsburgh. HERL Director Rory Cooper, PhD, worked closely with Army and Coast Guard veteran Dave Riley, a past national commander of Disabled American Veterans and a quadruple amputee, and several other team members in designing the mouse. The cost-efficient mouse is shaped like a pyramid and elevated a few inches in the back; it provides a space for a user to rest the wrist area of a prosthesis. In the front, the hook can drag a cursor and click right and left. The design team developed both right-handed and left-handed versions. Users have provided positive feedback, stating that the mouse gives them more control on the computer, according to the researchers. HERL has 3D-printed more than 100 of the prosthetic mice. The devices are currently in use by patients with limb loss at the James A. Haley Veterans’ Hospital; the Center for the Intrepid; and Walter Reed National Military Medical Center. HERL is working with VA’s Technology Transfer Program to license the specialized mouse. O&P ALMANAC | JUNE/JULY 2021




Diabetes-Related Amputations Rise After Brief Decline

Record Number of Americans Covered Via Affordable Care Act O&P facilities will likely be seeing more patients who have health insurance coverage through the Affordable Care Act (ACA). The Health and Human Services Department released a report in June noting that a record 31 million Americans were covered via the ACA as of February 2021. That number comes from four sectors: 11.3 million who are enrolled in Marketplace plans and 14.8 million who are newly enrolled in Medicaid through the ACA’s expansion of eligibility. In addition, 1 million individuals were enrolled in the ACA’s Basic Health Program option, and an additional 3.9 million “previouslyeligible” Americans gained Medicaid coverage “due to enhanced outreach,

31 million Americans were covered through the ACA as of February 2021 streamlined applications, and increased federal funding” under the law. “All 50 states and the District of Columbia have experienced substantial reductions in the uninsured rate since 2013, the last year before full implementation of the ACA,” states the report.

“Estimates based on the National


Inpatient Sample showed that

OPGA To Name 2021 O&P Woman of the Year

diabetes-related nontraumatic lower-extremity amputation (NLEA) rates declined among hospitalized patients between 2000 and 2009, followed by an increasing NLEA rate between 2009 and 2015. … The recent increase in NLEA rates among privately insured adults with diabetes was driven by minor amputations and men aged 45–64 years old.” —“Trends in Nontraumatic Lower-Extremity Amputation Among Privately Insured Adults With Diabetes in the U.S., 2004-2018,” Diabetes Care, May 2021.




The Orthotic and Prosthetic Group of America (OPGA) issued a call for nominations by July 9 for its 2021 O&P Woman of the Year Award. The annual award, organized by OPGA, is open to all women who work in the profession. Nominators were encouraged to provide examples of how the nominee has made significant contributions throughout her career to serve her patients, community, business, and the O&P profession. “We’re excited to continue recognizing the women in O&P who create impactful and positive experiences for the patients and communities they serve. We hope to not only highlight existing leaders, but also inspire action and mentorship to grow the O&P architects of tomorrow,” said Todd

Eagen, president of OPGA, a division of VGM & Associates. “There are so many deserving candidates out there.” In 2020, Kathleen DeLawrence, chief operating officer of Ability Prosthetics and Orthotics, was selected from a group of outstanding women as the fourth O&P Woman of the Year. The 2021 O&P Woman of the Year Award winner will be selected by a committee of O&P professionals and announced during the AOPA National Assembly in September.





Tamra Averill, PT, has been named the Great Lakes district manager at Allard USA. Averill, who worked the last 14 years with Accelerated Care Plus, a Hanger Company, resides in Fort Wayne, Indiana, and has Tamra Averill, PT more than 25 years of experience building relationships with patients, therapists, and client-partners as a physical therapist, clinical consultant, and educator. Chellie Hollis Blondes, CAE, has announced she is leaving her position as executive director of the American Academy of Orthotists and Prosthetists, effective July 2, 2021. The Academy has announced that any questions regarding the transition should be directed to Sarah Thomas, CPO, FAAOP, president-elect of the Academy.

Dralla Foundation, an organization founded by Allard USA President Peter Allard that awards grants to nonprofits to improve life for individuals with physical challenges, has announced its 2021 grant recipients: Catalyst Sports, Friends of Greensboro Parks and Recreation Foundation, Great Lakes Adaptive Sports Association, and STRIDE Adaptive Sports. The grant awards will help fund two adaptive mountain bike experiences (in Knoxville, Tennessee, and Greensboro, North Carolina); a Paralympic track and field experience; and an outdoor sled hockey event in Crooked Lake, New York. The next grant cycle begins in January when Dralla Foundation will begin accepting applications, with a submission deadline of Feb. 1, 2022. For more information, visit www.dralla.org.


to our 2021 AOPA Supplier Plus Members for their continued support of the association.




For more information, contact Kelly O’Neill at 571/431-0852 or kelly.oneill@AOPAnet.org. FOLLOW US @AmericanOandP






Be Advised


Examine the PDAC’s advisory articles for the most comprehensive coding guidance



Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

and Coding (PDAC) contractor plays an important role in creating and publishing clarifying information related to correct coding of O&P services delivered to Medicare patients. This information sometimes goes beyond what is found in the Local Coverage Determinations (LCDs) and Policy Articles (PAs). In some cases, the PDAC provides information when no LCD or PA exists, such as with upper-extremity orthoses and prostheses. Because this information can be more extensive than information provided by the LCDs and PAs, it is important to be aware of and review the PDAC advisory articles. Since 2018, Palmetto GBA LLC has served as the PDAC contractor; Palmetto also has the contract for the National Supplier Clearinghouse. As the PDAC contractor, Palmetto performs three main functions: establishing and distributing pricing files for items and services that fall under the durable medical equipment, prosthetics, orthotics, and supplies category; conducting data analysis to identify utilization patterns of Healthcare Common Procedure Coding System (HCPCS) codes, and reporting; and performing HCPCS coding verification, used to establish coding guidance for specific products. This month’s Reimbursement Page reviews the key functions of the PDAC’s role in providing correct coding guidance and examines some recent advisory articles.

PDAC Coding Verification

Coding verification may be a voluntary process where manufacturers can request a Medicare-approved






coding decision for their product or service; however, a coding verification also may be mandated by a policy as a requirement for payment. It is the duty of the PDAC to review these products to provide the appropriate HCPCS code for Medicare billing. There are currently eight categories/ policies of O&P devices that may be provided by an O&P facility and that require PDAC coding verification as part of the LCD, PA, or other guidance as a condition of payment. These categories/policies include the following (note that spinal orthoses are split into prefabricated and custom-fabricated): • Therapeutic Shoes for Person With Diabetes: A5512, A5513, and A5514 • Spinal Orthoses—Cervical, Thoracolumbosacral (TLSO), Lumbosacral (LSO)—Prefabricated: L0174, L0450, L0454, L0455, L0456, L0457, L0458, L0460, L0462, L0464, L0466, L0467, L0468, L0469, L0470, L0472, L0488, L0490, L0491, L0492, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0635, L0637, L0639, L0641, L0642, L0643, L0648, L0649, L0650, and L0651 • Spinal Orthoses—Cervical, TLSO, LSO—Custom-Fabricated: L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, and L0640 • Knee Orthoses—L1845 and L1852 • Ankle-Foot Orthoses/Knee-AnkleFoot Orthoses: L1906 and L2006 • Upper-Limb Orthoses: L3906 • Lower-Limb Prostheses: L5856, L5857, L5858, L5969, L5973, L5980, and L5987 • Surgical Dressings: A6545 • Functional Electrical Stimulator: E0770

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The advisory articles will inform you if they are still active or if they have been retired, and will provide revision history and dates. This can be helpful when you need to research when an advisory article was introduced and when it may have been revised. PDAC advisory articles may be found on the PDAC website at www.dmepdac.com/ palmetto/PDACv2.nsf/DID/B7CL2557. To better understand the type of information found in and addressed by the advisory articles and the scope of what they may cover, here is a quick sample of some PDAC advisory articles:

Effective for claims with a date of service on or after Jan. 1, 2022, products described by codes L6715 and L6880 will also require PDAC coding verification. If you provide a product or item described by one of the above codes and the PDAC has not made and published a coding verification, your claim will be denied as incorrect coding. To check whether a product or item has received a published PDAC coding verification, visit the Durable Medical Equipment Coding System maintained by Palmetto at www4.palmettogba.com/pdac_dmecs and view the Product Classification List (PCL). The PCL is your official source and record for all O&P items with current and past PDAC coding verifications. Keep in mind that, for customfabricated spinal orthoses (cervical, TLSO, LSO) and custom-fabricated therapeutic shoe inserts that are fabricated in-house and delivered directly to your patients, PDAC verification is not mandated. However, you must be able to provide a list of the materials used in the fabrication and a description of your fabrication process, if requested. Once a request for coding verification—voluntary or mandated—has been received and the PDAC publishes its decision, the coding verification then becomes binding for Medicare purposes. Any claims submitted to Medicare must be coded according to the PDAC coding verification, and claims for items that are coded in conflict with a PDAC 16


coding verification will be denied as incorrect coding. PDAC coding verifications are normally product- and model-specific, so when checking the PCL, be sure you are checking the product and model information as well.

PDAC Advisory Articles

In addition to coding verification for specific products, the PDAC also occasionally publishes, in corroboration with your local durable medical equipment Medicare administrative contractor (DME MAC), advisory articles that provide specific clarification regarding coding in certain scenarios, for specific products, or for a specific group of HCPCS codes. Just as with the coding verifications, these articles and coding reminders, once published, become binding for the purpose of Medicare claim submission and must be followed, in addition to the information and directions found in the LCDs and PAs. The advisory articles also may provide guidance on items not currently covered by an LCD and PA, such as upper-extremity orthoses. In some instances, the information published in the PDAC advisory articles will make its way into future revisions and updates of LCDs and PAs, but a majority of the time the advisory articles stand on their own. Thus, it is important that you review these articles on a regular basis to maintain full compliance with Medicare rules.

“Custom-Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code—Correct Coding,” published March 12, 2021. At the time this article was written, this was the most recent advisory article related to orthotics and prosthetics. The article focuses on HCPCS code descriptors for prefabricated items that only include the term “includes fitting and adjustment” and do not mention “off-the-shelf” (OTS) or “customized to fit.” It also addresses other orthotic HCPCS codes that don’t have a corresponding OTS code. In 2014, CMS introduced a series of HCPCS code pairs that included both an OTS version and a version that requires custom fitting by an individual with appropriate expertise or training—a customized-to-fit or custom-fitted orthosis. Fifty-one orthotic HCPCS codes did not have their descriptors changed and continued to simply state, “Prefabricated, includes fitting and adjustment,” or did not mention the type of fitting at all, or did not have a corresponding OTS HCPCS code. The advisory article indicates that these 51 HCPCS codes are to be appropriately classified as custom-fitted orthoses; therefore, they may only be used to describe orthoses that require customization and/or modification by a certified orthotist or other properly trained individual at the time of fitting.



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The article then explains that if you deliver an orthosis described by one of these 51 codes, and it is delivered as OTS without customization and/or modification, it must be billed using the appropriate not-otherwise-specified code: L1499, L2999, or L3999. “L1005—Tension-Based Scoliosis Orthosis and Accessory Pads, Includes Fitting and Adjustment—Correct Coding,” published Nov. 19, 2020. One of the functions of the PDAC is to conduct data analysis to identify utilization patterns of HCPCS codes, and this advisory article was a direct result of this function. According to the article, the DME MACs had noticed an increase in the use of L1005 (tension-based scoliosis orthosis and accessory pads, includes fitting and adjustment); as a result, the DME MACs and the PDAC released this article to provide education and to help suppliers properly code possible braces described by the L1005. To do this, the PDAC created some coding guidelines for the L1005, such as the brace contains



multiple tension features that would be connected to a semirigid pelvic section/structure, and these components must create tension forces in order to exert a force on the torso for resisting the scoliosis curve. The article also states that the L1005 is an all-inclusive item and no additional codes may be used when billing; this is a reiteration from a previous DME MAC/PDAC advisory article on the correct coding of scoliosis bracing (published July 28, 2020, and includes information on the five HCPCS codes used to describe scoliosis braces: L1000, L1005, L1200, L1300, and L1310). “L3960—Coding Verification Review Requirement,” published March 24, 2020. This advisory article is a good example of guidance being provided when there is no existing LCD or PA. The PDAC and the DME MACs had noticed an increase in the billing of claims for L3960 (shoulder-elbow-wrist-hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment). To help combat this increase, in case the items were being billed incorrectly, the PDAC created some coding guidelines for the L3960, such as the brace should have adjustable rigid cuffs and joints/components to optimize the shoulder, elbow, wrist, and hand angles, and that the brace includes all soft interfaces and closure or straps. The advisory article also announces that any product to be billed with L3960 must be verified by the PDAC and placed on the PCL. This PDAC verification requirement went into effect with claims of dates of service on and after Aug. 1, 2020. Also, according to the March 12, 2021, article “Custom-Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code— Correct Coding,” the L3960 would be considered a custom-fitted orthosis. This means that you have two coding/ billing options based on the type of fitting done at the time of delivery.

If the brace was custom-fitted, requires modifications beyond minimal self-adjustment, then the L3960 should be used. If the brace was provided without any modifications at the time of delivery, and is considered OTS, then the L3999 should be used. PDAC advisory articles, even if they are not incorporated into Medicare medical policies, carry the same weight as published coding verifications. Suppliers are expected to be aware of them and follow them as soon as they are published. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@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: www.bocusa.org

BALDWIN BELT (shown on model)


With the Paralympic Games set to start in August, prosthetists discuss how they are helping elite athletes optimize their performance and achieve their goals in Japan By CHRISTINE UMBRELL






NEED TO KNOW • Several prosthetists have dedicated part of their careers to treating elite-level athletes, whose unique needs require close attention to ensure optimal fit and function during both training and competition. • Working with athletes involves extremely personalized prosthetic care, with particular attention to type of amputation, length of residual limb, amount of tissue, and ability level. • Prosthetists who treat elite athletes typically work at high-tech facilities that are equipped to help them analyze patients’ movements while practicing their sports and then optimize prosthetic fit and alignment. • Most athletes look to their clinicians to help them understand the mechanical aspects of their devices— and some go a step further, becoming intimately involved in the design and mechanics of their devices. • Once competitors arrive at the Games, they can turn to technicians who staff technical repair stations, hosted by Ottobock, for last-minute repairs and adjustments.

started treating Scout Bassett 21 years ago, she was just 11 years old. After having spent the first seven years of her life in a government-run orphanage in China, Bassett, who lost her right leg to a chemical fire as an infant, was adopted by an American couple from Michigan. Her parents eventually brought her to Patterson’s facility, Prosthetic and Orthotic Associates (POA) in Orlando, Florida, and she began participating in sports. Patterson built Bassett her first running leg when she was 14 and introduced her to the World Para Athletic Championships, which were being held in Orlando. That sparked her love of running. After competing as a triathlete in her teens and early 20s, Bassett transitioned to shorter distances. She worked her way up to qualify for the 2016 U.S. Paralympic team and competed in the 100-meter run and the long jump. Now Bassett, who stands 4 feet 9 inches tall and weighs 86 pounds, plans to compete in Tokyo. Patterson, who has worked with dozens of Paralympic athletes over the course of his almost 30-year career, is extremely proud of Bassett’s accomplishments. “Her whole life has been overcoming obstacles—whether it was being given up at birth and staying at an orphanage in China, or trying to make different sports teams—she just never gave up. It all started from going out and watching the trials here in Orlando,” he says. “And right now, she’s [ranked] No. 1 in the U.S.” in the 100-meter event at her classification. O&P ALMANAC | JUNE/JULY 2021



Customizing Care

PHOTOS: Prosthetic and Orthotic Associates

2016 Paralympic athlete Scout Bassett, who hopes to compete again in Tokyo, has been a patient of Stan Patterson, CP, LP, since she was 11 years old.



PHOTOS: Stephanie Sevilla

Patterson also treats Desmond Jackson, a congenital knee disarticulation patient who competed in Rio at age 16 and hopes to both run and jump in Tokyo.

Patterson has devoted much of his career to working with competitive athletes and has even invented some high-performance prosthetic devices. Several of his current patients hope to compete in Tokyo, including several track and field athletes. In addition to Bassett, he treats Desmond Jackson, a congenital knee disarticulation patient who competed at age 16 in the 2016 Paralympic Games in the long jump and hopes to both run and jump in Tokyo. Patterson’s work with Bassett and Jackson provides a perfect example of the need for extremely personalized prosthetic patient care. As he explains, they “are two completely different athletes.” Jackson, who is 21 years old and 5 feet 9 inches, is “tall enough that he can utilize a knee and a blade,” says Patterson. Bassett, on the other hand, “has just a whole different running style.” Although she has above-knee limb loss, Bassett is “closer to a knee disarticulation” patient due to the length of her residual limb. Because of her short stature and the length of her running blade, she sprints without a prosthetic knee. “They function completely differently—one runs with a knee; one runs without a knee. They’ve both found, for them, the ‘best way’ to do it,” says Patterson. It takes a lot of clinical time and effort to “dial it in to optimize the performance of the individual,” he says. “With every case, it’s completely different—different length of residual limb, different amount of tissue, different ability levels.” Luis Puertas, a bilateral knee disarticulation patient and the only combat-wounded veteran on the U.S. Paralympic track team, also benefits from Patterson’s customized strategy. Puertas, who finished first in the Desert Challenge competition 200-meter event with a personal record of 25.9 seconds, trains regularly at POA, where he has been a patient since 2009, and is expected to compete in Tokyo.


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PHOTO: Prosthetic and Orthotic Associates

Patterson has worked with Paralympic hopeful Luis Puertas for 12 years; Puertas lost his legs in combat in 2006 while serving with the U.S. Army in Baghdad. He recently competed in the Desert Challenge and earned a personal record of 25.9 seconds in the 200-meter event.

Francois Van Der Watt, CPO, LPO, works closely with 22-year-old Hunter Woodhall, a former Division I athlete and bilateral amputee who hopes to compete in the 400-meter event.

In addition to personalizing the prosthesis to the individual, prosthetists also must take into consideration the specific events in which athletes will be competing, says Francois J. Van Der Watt, CPO, LPO, owner of Van Der Watt Prosthetics & Orthotics in Greenwood, Arkansas. Van Der Watt, who was born and raised in South Africa then moved to the United States in 2002, first started working with competitive athletes when he treated Oscar Pistorius, a Paralympic athlete and the first amputee sprinter to compete at the Olympics. Van Der Watt has continued his involvement with the Paralympics as the U.S. team prosthetist, working with dozens of athletes—many of whom travel long distances to see him. Van Der Watt is currently preparing track and field athletes Hunter Woodhall, a bilateral amputee and former Division I runner for the University of Arkansas, and Trenten Merrill, a long jumper and sprinter from California, for the Tokyo Games. Woodhall and Merrill both receive product support from Team Össur, says Van Der Watt, but they use different components. Merrill uses the Cheetah Xpanse, a long jump-specific foot for jumping, as well as a Cheetah Xcel for sprinting in the 200-meter running event, says Van Der Watt. “With Hunter, who’s concentrating more on the 400-meter, we use the Cheetah Xtend.”



PHOTOS: Van Der Watt Prosthetics & Orthotics

Van Der Watt also works with Trenten Merrill, a long jumper and sprinter from California, in preparation for the 2021 Games.


PHOTOS: Van Der Watt Prosthetics & Orthotics

Van Der Watt helps 30-year-old Jason Macom prepare to compete in para-cycling in Tokyo. Macom has helped design and 3D-print some of his components.

No matter the event, or the athlete, fostering positive working relationships with competitive patients is critical, says Kyle Wagner, CP, LP, a clinician at Scott Sabolich Prosthetics and Research. “When you take on Olympic or Paralympic hopefuls, you take to spending even more time with them than you would a typical patient, just because the amount of impact on the patient’s limb is so much more extreme,” explains Wagner. “Every little possible imperfection in that socket is magnified.” When an athlete starts training for competition on a prosthesis, “you start to notice the imperfections … a lot more things show up that don’t show up on a typical everyday prosthesis.”

Relying on Top-Notch Facility Space and Equipment

Prosthetists who treat elite athletes typically work at high-tech facilities that are equipped to closely analyze patients’ movements and optimize prosthetic fit. POA—Patterson’s facility—is a 23,000-square-foot building that features a full gym, a 40-meter indoor track area, and plenty of outdoor space. Special equipment at the track allows for athletes to don vests that vary the resistance during runs. To ensure proper alignment, “we use a lot of slow-motion videos, via drones 26


that fly beside the person,” Patterson says. Cameras are clipped directly to athletes, “or you can just follow along and the camera steadies itself. We can get footage from overhead or from the side; we can get whatever angle that we need.” Patterson’s team can slow the footage down to analyze each frame and study “where you’re landing at on the blade, the angle of your body, is your core tight enough while you’re running, are you getting the proper knee drive,” and many other considerations, he says. “There are so many things that you can do to fine-tune what you’re trying to achieve with the prosthesis.” Wagner agrees that it’s critical to make refinements that assist athletes—particularly runners—in achieving better times. Doing your job as a prosthetist “takes a lot of time at the track [because] the alignment is completely different for a set of running legs than it is for someone’s everyday legs,” he says. “We’re looking at cutting milliseconds off times,” and it’s important to harness as much energy into propelling the athlete forward as possible, he says.

“You’re talking about millimeters of movement that can make a difference” in ensuring the prosthesis is as efficient as possible—and that the athlete is quick as they can be. Van Der Watt notes that working outside of the facility is key; he spends about 50 percent of his time outdoors when working with competitive athletes. “We try to do initial setup and initial fittings in the office, then go outside to the track,” he says. This is helpful not just for track and field athletes but for cyclists as well. He works closely with Jason Macom, a below-knee patient and Team USA para-cyclist who hopes to compete in Tokyo. “We have a stand so he can cycle in the office,” but Macom also spends time outdoors testing his prosthetic equipment on his bike, says Van Der Watt. Involving patients in their prosthetic care is another critical task. At POA, “almost everyone knows how to make minor adjustments and finetuning on their prosthesis themselves because you want them to be able to understand the mechanical aspects of their devices,” explains Patterson. “We make sure we tell them what we’re doing and why we’re doing it—then they’re even more in tune with the prosthesis,” he says. Some athletes go a step further and become intimately involved in the design and mechanics of their devices. Van Der Watt points to Macom, who “is very hands-on” and also skilled in 3D-printing technology. About two years ago, Van Der Watt worked with Macom to study the para-cyclist’s position on his bike—how he sits—then together they drafted a CAD-design and 3D-printed the components, including the attachment between Macom’s prosthesis and his bike/cleat. Macom also came up with a design to make a new, more aerodynamically fluid prosthetic leg. Van Der Watt respects that Macom is “very mechanically inclined, so he does a lot of things on the fly,” noting that he “can replace any component on his prosthesis if he needs to.”

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Assisting Athletes Without Prostheses



PHOTO: Prosthetic and Orthotic Associates

Patterson facilitated a symposium on fabricating and aligning prostheses for elite athletes at the 2019 AOPA National Assembly in San Diego.

PHOTO: Scott Sabolich Prosthetics and Research

Kyle Wagner, CP, has worked closely with Oksana Masters, who competes in Nordic skiing/biathlon and road cycling.

In addition to fitting athletes with prostheses for use in elite competition, prosthetists also fit athletes who compete without their devices—but still need prostheses for everyday use and training. Wagner has worked closely with Oksana Masters, who has won medals in both the Winter and Summer Paralympic Games. She started her competitive career in rowing, but injuries spurred her transition to Nordic skiing/biathlon in the winter and road cycling in the summer. Wagner’s expertise aids Masters during training for those events. “Last summer, we built Oksana new everyday prostheses due to hers being more than 8 years old, and simply worn-out and unsafe,” he says, as she was having problems weightlifting and even walking safely on the legs. Wagner’s team also fit Masters with her very first pair of running legs that were built just for running and cross training, with the correct category blades. “Her previous ‘running legs’ were simply old sockets with someone’s old donated running feet,” built for someone heavier, and too stiff for Masters. “Most Paralympic athletes train year-round for one sport, whereas Oksana trains six months in one sport and six months in another but tries to keep her conditioning up for her offseason sport,” Wagner says. “I’m not sure how she does it, but it’s downright amazing.” Members of both the men’s and women’s sitting volleyball teams are patients of Wagner. Although these Paralympians do not wear prostheses while competing, Wagner notes that his team works “with them for their everyday prostheses, for their normal everyday activities.” He explains: “They’re doing lots of weightlifting and high-activity cardio that has a tendency to wear down the prosthesis a lot sooner, so we are constantly working with them to repair parts, fix sockets—things like that. They fall in the top echelon of your K4 active patients, and they test those limits.

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A Prosthetic Technician’s Role at the Games



Snethen notes that a large proportion of the athletes who visit the repair stations are from third-world countries, “because they don’t have the resources other countries have for their athletes.” Working at the repair station, “you have to widen your technical abilities,” he says. In addition to repairing prosthetic devices, Snethen has been pulled in to work on orthoses and wheelchairs. “In wheelchair rugby and wheelchair basketball, wheelchairs just get mangled and beat up,” he says—and some wheelchairs are even damaged on the flights over. Snethen notes that helping elite athletes achieve their goals is extremely rewarding—even if it means just helping them get to their competition venue. “In Lima, I helped a gentleman get a prosthesis to fit” so he could travel from Athletes’ Village to his event. “He was competing in sit volleyball, but his prosthesis was in such bad shape that he couldn’t even ambulate to the area he needed to be in. I helped him get a prosthesis—it wasn’t laminated, but it helped him get by” during the Parapan Games. He also got an education about how prosthetists and technicians meet athletes’ needs in different ways. “It was interesting to see how other countries set up their running prostheses,” Snethen says. “We have

Certified prosthetic assistant/ technician John Snethen, far right, has volunteered at Ottobock’s technical repair stations at the Rio Paralympic Games and the Parapan Games in Lima, Peru, and plans to repair components in Tokyo. a set way that we set ours up here, at Sabolich, so it was interesting to see all these different ways. And all of these different ways enabled athletes from all over the world to compete—and run strong—on the different setups.” Being part of the Paralympic Games is “beyond an honor,” says Snethen. “It’s one thing to make somebody walk again—it’s a great feeling to know that something I built helped somebody walk. So, it’s a step above when you not only bring some normality back to someone’s life, but you help them go beyond normality, to push harder than anything I could do. It’s such a great feeling to know that they didn’t let anything stop them, and I had a hand in helping them achieve their goals.”

PHOTOS: John Snethen, Scott Sabolich Prosthetics and Research

John Snethen, a certified prosthetic assistant/technician at Scott Sabolich Prosthetics and Research, will soon be heading to Tokyo to provide technical services to athletes in need of repairs as part of Ottobock’s role as the Official Technical Service Partner of the Paralympic Games. Ottobock contributes to the Paralympic Games with an on-site, international team of technicians, providing technical repair service centers close to Athletes’ Village as well as in selected training and competition venues. Experienced O&P professionals, wheelchair specialists, and welders John Snethen work together to ensure that equipment is repaired and maintained, regardless of athletes’ nationalities or the brands of their devices. This will be Snethen’s second time at the Paralympics; he also worked in the repair station in Rio de Janeiro five years ago. In 2019, he traveled to Lima, Peru, to work in the Ottobock repair station at the Parapan Games. A marathon runner himself, Snethen is looking forward to the challenges of assisting athletes in Tokyo. In Rio, “there were about 100 of us” working as technicians, he says. Because the games include Paralympians from all over the world—and not everyone speaks a common language—organizers “bring in a variety of people to assist,” explains Snethen. He recalls working alongside a gentleman that only spoke Spanish, “but we both understood what needed to be done for the patient, and we could communicate through work. It’s phenomenal to see a working group of people who all have one thing in common—and that’s to help these athletes.”


“Unfortunately, there’s no prosthesis out there that will do everything that the human body will do,” so prosthetists have to be creative to determine how best to accommodate the different sport and make a prosthesis that works well for the activity, adds Wagner. “You’re constantly figuring out how you can get patients to do what they want to do—and a lot of times, it takes multiple prostheses to do that.”

Preparing for Tokyo

For both the athletes themselves and the prosthetists who treat them, the Tokyo Games have been a long time coming. Many of the competitors ramped up their efforts 18 months ago in preparation for the 2020 Summer Games—only to find the games delayed for a year due to the COVID-19 pandemic. These athletes were left scrambling to find gyms and training areas that were open last year. Bassett, who normally trains

five hours a day at the Elite Athlete Training Center in Chula Vista, California, resorted to running “on an old dirt track” during the pandemic, says Patterson. Now that the games are finally within sight, most of the Paralympians have finalized their componentry and are taking stock of what they will need to bring to Tokyo. Several months prior to any competition, Van Der Watt checks to see if athletes need to update to new components due to wear-andtear. “Running blades delaminate and get soft over time. When you’re preparing for competition, you want to make sure there are no blades that need to be replaced, or new feet or sockets that need to be exchanged,” he says. “We make sure everything is ready at least four months before competition, so they can get used to any changes. “When they leave to get on the plane, we’ll make sure they have

backup of everything they need—an extra foot, extra socks, sleeves, or liners, just in case they run into any issues,” says Van Der Watt. Once the athletes arrive in Tokyo, they will have access to a technical services repair station, hosted by Ottobock (see sidebar on page 30). For the prosthetists back home, watching their patients compete on TV will offer rewards beyond comparison. “You do this because you love to do it, not because of financial gain,” says Patterson. “It’s the love for the sport,” agrees Van Der Watt, “but also having the satisfaction of seeing something you helped create being used, and watching the athletes use the opportunity to excel,” he says. “Seeing your handiwork in motion is a pretty good feeling.” Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.





Acquisitions of patient-care companies—by manufacturers, larger facilities, and others—are on the rise



healthcare—the acquisition of one company by another at a different part of the supply chain—has been gaining steam across the traditional segments of the industry for a decade, and O&P is a growing part of the trend. Spurred in part by the Patient Protection and Affordable Care Act of 2010, hospitals and health systems are increasingly buying out smaller, independent medical practices across the treatment spectrum. Other major U.S. healthcare organizations, including insurers, drug companies, and retail pharmacies, also are beginning to integrate to reduce competition and cut costs through efficiencies and economies of scale. CVS Health’s announcement in 2018 that it would acquire Aetna for $69 billion is one of the largest examples of a trend that shows no sign of abating. 32


Between July 2016 and January 2018, hospitals acquired 8,000 medical practices, and an additional 14,000 physicians left private practice to become employed by hospitals, according to a report by Avalere Health and the Physicians Advocacy Institute. The O&P industry has been slower to vertically integrate than the U.S. healthcare industry at-large. But mergers, buyouts, and both vertical and horizontal integration are beginning to occur with increasing frequency. “Right now, you’ve got sharp elbows at the table for most deals,” says Barry Smith, principal at California-based Lloyds Capital and a longtime broker of O&P business sales. “They’re all going after the same companies. It’s brutally competitive, and it’s going to dramatically change, over time, the face of the O&P industry.” But Smith

notes that, so far, large health systems and hospitals appear to have little interest in acquiring O&P businesses. Assimilating an O&P practice into a traditional physician environment is more complicated than bringing on an independent team of heart surgeons or orthopedists, he says. Opinions among O&P practitioners and executives regarding the consolidation and vertical integration trends are mixed. Last year, a clinic owner took to a popular O&P community forum to solicit her colleagues’ feedback after news broke that Ottobock had invested in patient-care companies and purchased Cascade Orthopedic Supply. There was no shortage of opinion, with about 20 practitioners or executives weighing in on the subject. “I see no issue here at all,” one commenter responded. “It’s positive change that increases patient choice, drives quality, and will progress us further down the line of a patientcentric model where quality care and outcome measures will remain the means of staying in business and thriving. There will always be room for smaller providers to remain competitive. Please remember, with any change comes great opportunity.” But another commenter, who identified as an independent clinic owner, wasn’t so optimistic. “I’m not a fan of manufacturers moving into patient care or the consolidation within our industry as a whole,” the respondent wrote. “Independent clinic owners like us are getting rarer, but I’m a firm believer that it’s better for patients. I don’t blame folks selling when it comes time to retire, but I’d like to see more folks selling to other clinicians and not the big-name groups. Competing against large corporations is hard enough with their manpower, purchasing power, and marketing budgets. Competing against the manufacturers is a whole new level.”

International Influence

Brad Ruhl, managing director of Ottobock North America, says his company’s steady march toward

vertical integration is rooted in the global company’s history. “For many, many years, Ottobock, outside of the United States or North America, needed to be directly involved in patient care, because in a lot of parts of the world, there were no technicians, there were no CPOs,” Ruhl explains. “And so, the company really had no choice but to bring the products directly to end users. And based on that experience, over time, [Ottobock] has been involved in patient care pretty much everywhere outside of North America until just the last 18 to 24 months. “The idea is that we will participate at basically all levels—from manufacturing, through distribution, to actual patient care,” Ruhl says. “While some may view that as a threat, I think others view it as an investment in the future. That will probably continue as time goes on, as the healthcare industry continues to evolve and transform.” In addition to acquiring several patient-care clinics, Ottobock in 2020 also made a significant investment in California-based distributor Cascade Orthopedic Supply, which has distribution facilities located in California, Texas, Illinois, and Pennsylvania. “What’s important to know is that we’re investing; we continue to invest in the development of new technology. We’re also investing in the supply chain, and we’re investing in the delivery of high-quality, outcomebased patient care,” Ruhl says.

Private equity investors are looking at O&P as well, according to Ruhl. “There has been some engagement by certain investment groups, whether on the manufacturing side, distribution, or indirect patient care,” he notes. And while investors can have the reputation of trying to “wring profits out of the business and then move on,” he says, “that’s not what we are interested in.”

Beyond Vertical

Given the recent difficulties faced by smaller healthcare companies that struggled financially during the COVID-19 pandemic, it’s not surprising that some O&P facilities have chosen to participate in consolidation activities. A July 2020 survey of 230 independent medical practices by the Journal of the American Medical Association found that 26 percent were considering partnering with a larger health system because of the pandemic. A survey of 3,500 doctors found that 59 percent believed COVID-19 would result in fewer independent practices in their communities. Meanwhile, O&P clinic owners across the country—many of whom experienced an incredibly challenging pandemic year—likely are also weighing the pros and cons of being acquired. Michael Oros, CPO, LPO, FAAOP, zone vice president at Hanger Clinic, says horizontal integration—adding more clinics to a large patient-care company’s roster—may benefit both parties. O&P ALMANAC | JUNE/JULY 2021


“There are numerous advantages for the O&P care clinics that join Hanger through mergers and acquisitions,” Oros says. “Our team at [Chicago-based] Scheck & Siress Prosthetics & Orthotics, which joined Hanger Clinic in 2020, has retained our long-standing focus on quality patient care, while having access to better tools to deliver that care, due to Hanger’s investments in clinical infrastructure.” Oros cites electronic medical records, IT security, research and clinical outcomes, and human resources development as examples. “The significant increase in resources also allows our leadership team to focus more time on patient care and less on administration,” he says.

Barriers to Change

Despite the recent acquisitions of O&P companies by both manufacturers and larger patient-care companies, several factors make for slow-going in consolidation efforts in general. For example, vertical integration of the O&P industry is much more established in Europe than in the United States, in large part because most European countries have some form of universal healthcare. “We have a different medical system, which basically is Medicare, Medicaid, and insurance companies that pay a substantial part of the treatment,” Smith says, explaining that the complicated U.S. system will be a barrier to rapid vertical integration in O&P. “I don’t think it’s going to change

under which a vertical merger would not require an extensive investigation. In January of this year, the FTC ordered six health insurance companies to provide information that will allow the agency to study the effects of physician group and healthcare facility consolidation that occurred from 2015 through 2020. Ottobock and others in the O&P industry’s vertical integration mix are paying attention to the feds’ concerns. “We are really sensitive to making sure that we’re in full compliance with all applicable laws and regulations,” Ruhl says. “Manufacturers are getting into patient care, but we’re doing it in a way that’s very intelligent, very cautious, and very deliberate. We take every precaution that we can to stay in compliance with FTC guidelines and regulations. To the extent that they’re going to directly impact us, we will be prepared.”

The Benefits of Independence

While some small medical facilities have seen increased acquisitions by large healthcare systems, Smith does not believe healthcare systems and hospitals will begin flocking to purchase O&P clinics anytime soon. Durable medical equipment companies such as Stryker, Medtronic, or Johnson & Johnson aren’t biting on O&P manufacturers, either—at least not yet, according to Smith. “These are all huge companies; they do a lot of medical equipment and devices that go into the body,” as opposed to prosthetic devices that replace missing limbs, Smith says. “Maybe the O&P industry is just too small for them to go after.” 34


quickly because I don’t think health insurance—the health markets—are going to change quickly.” In addition to structural barriers to vertical integration, the consolidation trend in the U.S. healthcare industry has caught the attention of federal regulators concerned about monopolies and a lack of competition. In June 2020, the Department of Justice and the Federal Trade Commission (FTC) published vertical merger guidelines to update the Justice Department’s previous guidance issued 35 years ago, in 1984. The intent was to help agencies recognize potential anticompetitive behavior, including conditions

Profitable, well-run O&P clinics are increasingly in the acquisition sights of industry giants and investors. But not everyone wants to sell. Just ask Jim Weber, MBA, president and CEO of Prosthetic & Orthotic Care Inc. in St. Louis, or Clint Snell, CPO, president of Louisiana-based Snell’s OrthoticsProsthetics. Snell and Weber run two highly successful patient-care facilities, but they’ve maintained independence despite the trend toward takeovers and vertical integration. “It would be very simple to sell to one of the large, rapidly growing concerns, but I guess we take special pride in patient care, and maybe even have a little independent streak,” says Snell, whose family-owned business was founded more than a century ago in 1911, and now has clinics in Louisiana, as well as clinics owned by his cousins Arkansas and Tennessee. “I’m in the category of die-hard independent now, and I always have been,” says Weber, noting that he and his business partner and clinical

director, John Wilson, CPO, LPO, launched the company more than 30 years ago. “We wanted to create a company that was based on our vision, and our vision alone, of taking care of patients. We didn’t start the company to grow and sell it.” Both Snell and Weber acknowledge that the industry has undergone immense change since they started decades ago. Snell says he’s not sure he could launch a new, independent O&P business with today’s barriers to success. “It is definitely getting harder,” Snell concedes. “The foremost reason is regulation through Medicare, Medicaid, and private insurance.” Weber notes that when he came into the business 30 years ago, he was an anomaly—a former banker and businessman who had no experience in O&P aside from handling a clinic’s money. But that business acumen has served Weber and his three clinics very well, especially as

the bureaucratic side of running an O&P practice has gotten more complex. He says independent clinics today need a business professional in the mix. “John and I have been great partners because he knows technology, and I know business, and we’ve worked very well in our respective responsibilities,” Weber says. “I think if you don’t have that, you’re setting yourself up for disaster. It doesn’t matter what business you’re in, you need business acumen to do it.” Snell says his business benefits from a cooperative agreement he has with two cousins in Arkansas and Tennessee, who also run independent Snell clinics. “One of the things that has made a big difference in our remaining independent is the cooperation,” he says. “We have cooperative purchasing agreements and cooperative sharing of knowledge. There’s really not any overlap

in our geographic areas so direct competition is not an issue.” For other O&P business owners who hope to remain independent, Snell says it’s important to focus on your goals and be open to change. “Part of the reason I’m still independent is that I enjoy what I do, and looking for the next challenge, the next change—because change is constant,” he says. “It’s not anything to be afraid of. If you face it, you can continually progress.” Weber also encourages independent practitioners to keep up with trends and embrace innovation. “Challenges provide opportunities for growth, or retraction in your growth,” Weber says. “You have to either improve or you go the other direction; you’re not standing still.” Michael Coleman is a contributing writer to O&P Almanac.




••••••• • ••


••••••••••• •••

Offering Evidence to Support Clinical Decision-Making



AOPA/COPL grant recipient shares her research into socket suspension and other O&P technologies

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.


ARAH R. CHANG, PhD, embraced a

career in O&P research with the goal of making a positive impact on people’s lives. “Learning about the international O&P needs in low- and middle-income countries when I was younger was one of the initial starting points for my interest in this field,” says Chang, director of research and development (R&D) at Orthocare Innovations. That interest developed over time throughout college and graduate school as she became more exposed to the opportunities and needs in O&P. Chang—one of the recipients of a 2020-2021 grant from AOPA and the Center for Orthotic and Prosthetic Learning (COPL)—was awarded funds to develop evidence-based clinical practice guidelines for vacuum-assisted socket suspension systems (VASS) based on the best available evidence evaluated in a systematic review. “We’ve completed a systematic review to gather all of the available published evidence on VASS,” she explains, “drawn from more than 60 peer-reviewed articles.” Chang and her team at Orthocare are currently evaluating the data, evidence, and clinical applications to provide guidelines for clinicians who may be

deciding whether elevated vacuum is the appropriate technology for a patient. The work will support prosthetists in their clinical care, says Chang, as well as offer the necessary evidence to support decisions on the best possible technology for each prosthesis user’s needs.

Overseeing R&D

Chang earned a bachelor’s degree in biomedical engineering from California Polytechnic State University in 2011, followed by a doctorate in biomedical engineering from Case Western Reserve University in 2017. She served as a postdoctoral fellow at Northwestern University Prosthetics-Orthotics Center in 2017, then took a job with Orthocare—an R&D company. “We develop prosthetic, orthotic, assistive, and rehabilitation devices as well as tools and approaches to assist O&P clinicians,” Chang explains. In her current position at Orthocare, Chang is responsible for leading and collaborating with the multidisciplinary R&D team, which includes a mix of engineers and clinicians. She also initiates and oversees areas of R&D— both new and ongoing projects—which can include acquiring grant funding

PHOTO: Sarah Chang, PhD




or developing external collaborations. In addition, she performs engineering as needed; conducts experiments and clinical trials to evaluate the technologies; and collaborates with researchers and other professionals in the O&P and rehabilitation fields. “My focuses are helping people lead healthy lives by being or staying mobile and positively impacting the lives of individuals with disabilities,” Chang adds. “Advancing medical technology and care through engineering and research is one way to provide the means for individuals to have improved or higher quality of life.” In addition to their current work related to prosthetic socket suspension, Chang and the Orthocare team are involved in a project related to the “Assist-Knee” that is partially funded by the National Institutes of Health, National Center for Medical Rehabilitation Research. “We are developing a prosthetic knee to help geriatric or new transfemoral

Sarah Chang, PhD, was assisted by Natalie Harold, MSPO, CPO, in taking physical measurements that are used in motion analysis calculations.

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PHOTO: Sarah Chang, PhD

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Chang presented a poster describing the multidomain approach to outcomes at the 2019 Military Health System Research Symposium.



Chang also recently studied evidence related to the effects of hydraulic ankle-foot prostheses on transtibial prosthesis users’ gait biomechanics and patient-reported outcomes. “Improved walking speed was consistently reported when using a hydraulic ankle-foot prosthesis as compared to a nonhydraulic ankle-foot prosthesis in transtibial prosthesis users,” she explains.

Measuring Outcomes

Some of Chang’s research is directly related to patient outcomes and outcome measurements. “We are working on implementing digital mobile app versions of validated outcome measures, such as the Prosthesis Evaluation Questionnaire (PEQ),” she says. The PEQ was originally designed in paper format and can be labor-intensive for clinicians to score and calculate the results, so Chang and her colleagues have converted the PEQ to a mobile app that automates scoring. The digital version should help clinicians save time and allow them to focus on explaining to patients their results “and what it means for their clinical care,” she explains. “PEQ Mobile also gives clinicians the ability to export the patient’s results in a report to include in the medical record.”

Eyeing the Future

As she plans for new investigations and considers what will be important to future O&P patients, Chang believes O&P projects will need to support clinicians in their clinical care and provide evidence or tools that the clinicians

PHOTO: Sarah Chang, PhD

prosthesis users retain independence and mobility for high quality of life and better health,” she says. The prosthesis will assist with stand-to-sit and sitto-stand transitions by using energy storage and release technology. She also is developing a smart ankle-foot orthosis (AFO), with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research. “Our team previously conducted research that established relationships between gait characteristics of post-stroke AFO users and sagittal AFO stiffness and range of motion, and established how to improve the gait of persons after stroke,” she explains. “These scientific findings provide the foundation upon which we are developing an integrated system design that evaluates AFO user gait data to provide orthotists with AFO adjustment guidance.” Other recent studies include an investigation into technology to assist with remote prosthetic alignment by providing a system of sensors and software to diagnose and guide the correction of very subtle and difficult-to-see imbalances in prosthesis user dynamic gait. “The system enables controlled alignment changes by the prosthetist,” she says.

Chang says she emphasizes a “multidomain approach” to outcomes. As more O&P facilities collect outcome measures and implement evidence-based practice, “it is important that we combine multiple domains of information to create a holistic view of patient performance and well-being, rather than looking at a single domain, which can be limited in scope and not necessarily be a complete picture of a patient,” she says. For example, Chang points to a patient who performs the two-minute walk test well but is dissatisfied with the function of their O&P device. “If we only evaluated the walk test, we would only be looking at one dimension or one outcome, but not truly understanding the patient’s outcomes as a whole,” she explains. “This multidomain approach to outcomes that I’ve been working on provides a clinically useful scientific methodology that integrates a wide range of outcome measures and automates data processing to inform clinicians about patients’ function to support clinical decisions, evidence, and reimbursement.” Different domains could include patient-reported outcomes, clinical tests, biomechanics, real-world activity, and clinician expertise, according to Chang. Data for those domains can come from a variety of sources, such as validated questionnaires, wireless wearable sensors, validated clinical tests, and clinician input. “We are currently developing and validating this approach, and working to automate it so it aligns with workflows in the clinic,” she says, to support clinical decision-making, comprehensively measure patient performance, engage patients in their rehabilitation, and provide the evidence that may be needed to adequately justify prescription in the eyes of the payors.

need to serve their patients. “We need to continue including stakeholders, such as patients and providers, as active participants in the device research and development,” she says. “Future O&P projects will continue to provide individuals with the technology they need to maintain independence and the needed functionality to remain mobile.” Chang has been “doing a lot of thinking lately” about the importance of real-world data—not just information collected in a study setting. “We need to collect more real-world evidence in O&P, in outcomes areas that are important to the users,” she says. “The means to collect, analyze, synthesize, report, and share the real-world evidence may need further development and exploration.” Of course, researchers should continue to discuss what equates to “appropriate outcomes” for O&P patients. “There are several outcomes areas and outcome measurements that we can look at for our patients. Which

ones should we be evaluating, and are there easy ways to implement the data collection and analyses within the patients’ lives and clinicians’ work?” she asks. “How do cultural, societal, or economic environments factor into

these outcomes areas and outcome measurements?” Chang plans to stay focused on these questions as she continues her studies and plays a pivotal role in improving the quality of life for people with disabilities.

Notable Works Sarah R. Chang, PhD, has been involved in dozens of important published studies, including the following: • Boone, D.A., Chang, S.R. “Enabling Technology for Remote Prosthetic Alignment Tuning.” Military Medicine. 2021; 186(Suppl 1): 659-664. • Chang, S.R., Miller, C.H., Kaluf, B. “Effects of Hydraulic Ankle-Foot Prostheses on Gait in Individuals With Transtibial Limb Loss: A Scoping Review.” Journal of Prosthetics and Orthotics, 2021; 33(2): 101-109. • Chang, S.R., Boone, D.A. “A Conceptual Framework for MultiDomain Clinical Decision Support in Orthotics and Prosthetics.” Submitted in 2021.

Ferrier Coupler Options!

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.




New Horizons Orthotics and Prosthetics

Community Services

New facility caters to patients in a small Nebraska town and surrounding areas


F HE HAD KNOWN what was



New Horizons Orthotics and Prosthetics an office manager, Jo Cook, and a business manager, Sandi Olson, as well as a part-time technician. Jo Cook Much had changed since LOCATION: Quick last ran his Kearny, Nebraska own facility in the early 2000s, mainly OWNER: with insurance. One Brandon Quick, CP, Sandi Olson change in particular BOCO has made care more difficult: “If a patient has had anything, from an ankle support orthosis to a full custom ankle-foot orthosis, in the past five years, they’re not eligible for another brace,” he says. “It’s a big hurdle, and we’ve had to Brandon Quick, CP, BOCO appeal just about everything.” New Horizons uses computer-aided design (CAD) for HISTORY: all above-knee prostheses, but 18 months Quick and his technician still hand-craft below-knee devices. “I can’t get the results I want with CAD,” he says. “We’re pretty old school around here. I’m a fan of hand craftsmanship. You get that personal touch and the ability

FACILITY: New Horizons Orthotics and Prosthetics

to put your spin on it. Even with CAD/CAM, subtle differences appear that shouldn’t be there.” Working in a small town— Kearny has a population of about 30,000—allows Quick to develop personal relationships with patients. “We see them on the street; we know their families; we’ve been in their homes.” The practice also draws from nearby Nebraska communities, such as Grand Island and North Platte, serving much of the western half of the state. While many of his patients have diabetes, Quick says he has seen an increase in trauma cases. He suspects it may have something to do with pandemic. “People are getting cabin fever and doing [foolish] things,” he suggests. Quick has a history of O&P missionary work, particularly in St. Lucia, and hopes to resume these activities when the pandemic subsides and international travel ramps back up. While he does not advertise that he is an amputee, Quick finds that patients respond well and that it gives him an underlying connection to and empathy with his patients. He hopes to expand his facility, both by adding another practitioner to the office and by opening an additional location. The snag, Quick says, is finding qualified clinicians in central Nebraska. “I think our compensation and benefits package is great,” he notes, “but it’s difficult to attract practitioners who want to live in a small town.” In the meantime, Quick will continue to serve his community, offering the quality patient care and neighborly attention he is known for. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: New Horizons Orthotics and Prosthetics

coming, Brandon Quick, CP, BOCO, would not have chosen to open his new facility in January 2020. Nevertheless, New Horizons Orthotics and Prosthetics managed to thrive during the pandemic. “It was pretty hairraising,” says Quick. “But it forced us to become inventive in marketing our services.” Because of COVID-19, Quick was not able to meet directly with referral sources, so he assembled marketing materials and sent them along with patients to share with their physicians and therapists. “We’d invite doctors to Zoom meetings,” he says. “They would sit with their patients and get me on the line, and we were able to accomplish the goal.” His marketing efforts were successful, and the facility began to pay for itself within only four months. Quick was originally drawn to O&P by his personal experiences with the profession. He lost his leg below the knee in 1986 as the result of a hunting accident, and was so impressed with the two prosthetists who worked with him that he decided to become a practitioner himself—and later became business partners with his former clinicians. Certified in 2001, Quick and his prosthetic partners opened a small facility, Nebraska Orthotic and Prosthetic Services. When the business sold to Hanger, Quick continued to work there for 10 years, and then decided to set out on his own again. He soon opened New Horizons in Kearny, Nebraska, where he is a sole practitioner. He is assisted by




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VQ OrthoCare


Bracing and Beyond California company continues to innovate in designing orthoses and related devices





VQ OrthoCare headquarters

COMPANY: VQ OrthoCare OWNERS: Jim and Dorian Knape LOCATION: Irvine, California HISTORY: 33 years

eCast app

TRUlign OA

crash into the frame,” Macchia explains. The product “allows the brace to move with the anatomy, have a little spring to it, a little more flexibility, so patients are more comfortably corrected.” This year, the company released an osteoarthritis wrap brace called TRUlign. “It’s a comfortable wrap that changes angle for improved three-point leveraged pressure relief,” Macchia says. “Patients love the look and feel of wrap braces, and we put the lessons we learned with OActive into it. A rigid brace looks like a medical device, but a wrap brace looks more like something that’s treating an athletic injury.” The new product comes in three sizes, so O&P facilities need to keep only three rights and three lefts in stock at a time, reducing inventory costs. Another offering, the Eclipse Cervical Collar, features a universal design that is more rigid and open than other leading collars, according to Macchia. It also eliminates Velcro closures, so when patients don the device, they replicate the initial fit as determined by their orthotist. The clinician sets it and then patients can just snap it on, he notes.

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: VQ OrthoCare

in 1988 by Jim and Dorian Knape as a manufacturer and supplier of electrotherapy products. In 2006, the company added a knee bracing line, and today the company manufactures and distributes a wide variety of proprietary medical devices and braces as well as recovery and rehabilitation products. Headquartered in Irvine, California, the company has manufacturing facilities in Vista, California, and a national system of representatives. The company’s flagship bracing product is the OActive Osteoarthritis Knee Brace, introduced in 2009 and now entering its third iteration. “It was the first universally sized osteoarthritis knee brace that could push or pull to relieve either lateral or medial compartment,” explains Carl Macchia, BBA, CO, director of product marketing, bracing. Its universal sizing eliminated the need for sized inventory in the form of a highly effective and ultralow-profile brace that patients and clinicians prefer, Macchia says. “We really led the way with that brace.” Another innovation, the Active Thigh Cuff, is a patented uppercuff system that moves with the thigh musculature, reduces slipping and resulting malalignment, and improves suspension, total contact, and control, Macchia says. The company uses the cuff on double-upright ligament and double-upright osteoarthritis braces. “When you have an arthritic knee with laxity in a rigid brace with metal uprights on either side, the knee can move inside the brace during gait and

VQ OrthoCare also has been furthering a technology called BioniCare, an electrotherapy device for osteoarthritis that can be used in bracing products or on its own. Unlike transcutaneous electrical nerve stimulation (TENS) units, which only mask pain, BioniCare treats the underlying cause of the disease by stimulating joint tissue and improving the overall health of the osteoarthritic knee, says Macchia. “It was the only device of its kind to be granted this indication by the Food and Drug Administration, based on its numerous clinical studies,” he notes. “We have found it improves patients’ lives dramatically.” The company developed its eCast custom brace measurement system more than 15 years ago and has been refining it ever since. Today it takes the form of an iPhone app that allows a clinician to take digital images of a patient and submit an order on the phone. “This system allows you to capture more anatomical information than tape-based systems, and it requires no physical contact with the patient, unlike traditional casting or measurement systems,” Macchia says. The company offers in-person and online, on-demand educational courses through its Pathways to Education program, some of which provide practitioners with continuing education credits. “We are committed to continually improving our designs in response to clinical needs and to adapting to changing reimbursement conditions,” Macchia says. “In addition to our clinical expertise, we’re able to give our customers access to extensive resources related to reimbursement, coding, and billing. All of that leads to better outcomes for patients.”

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information on specific topics during these onehour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to



provide the most reliable business information and CE credits for your staff at a single office location. Visit www.AOPAnet.org/education/monthly-webinars for details and registration information.

Prior Authorizations: What We Have Learned, and What You Need To Know


AUG. 11

Prosthetics Clinicians Corner

Join us for our second Clinicians Corner of 2021. The focus will be on documentation and support for upper-extremity prostheses.

Why are prior authorization requests being denied? Learn the steps you can take to avoid common errors. Access the latest details released by CMS and the durable medical equipment Medicare administrative contractors about the prior authorization process.




Don’t Sleep on the Latest AOPA Member Resource



Attend the upcoming live tutorial to learn about one of the best resources available for O&P practices, the AOPA Co-OP. A Wikipedia for all things O&P, the Co-OP is a onestop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, state-specific legislation, private-payor



updates, and more. Members can access detailed information on everything from modifiers to productspecific L codes and associated policies. Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcome to join this free tutorial. Learn more at www.AOPAnet.org/resources/co-op.


Welcome New AOPA Members



the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

Comb O&P 13376 Ravenna Road Chardon, OH 44024-9007 Aaron Naft Supplier Level 1 http://combscan.com

Mecuris GmbH Lindwurmstrasse 11 Munich, Germany 80337 Phone: 01149892000573000 Tara Nicoll International Company www.Mecuris.com

O&P PAC Update


HE O&P PAC UPDATE provides infor-

mation on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC has received donations from the following AOPA members*:

• • • • • • • • • •

Curt Bertram, CPO George Breece Tina Carlson, CMP Steven Hoover, CP Teri Kuffel, JD Brad Mattear, CFo, CPA Joe McTernan Wendy Miller, BOCO James Weber, MBA James Young Jr., CP, LP, FAAOP


The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac. * Due to publishing deadlines this list was created on June 11, 2021. Any donations or contributions made or received on or after June 11, 2021, will be published in a future issue of O&P Almanac.



orthotic, prosthetic and pedorthic education and CE credits from the organization that knows O&P.

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Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2021 for advertising options.

Allard AFOs

Allard AFOs are not just for foot drop; they are an excellent option for your patients with chronic plantar fasciitis, Achilles tendonitis, posterior tibial tendon dysfunction, or any metatarsal stress fracture. By not locking up the ankle, Allard AFOs assist with better balance, thereby preventing falls. The slim design allows the AFO to fit in most standard shoes with a heel height difference. ToeOFF® 2 ½ Addition models offer three attractive anterior shell surface options: camouflage, birch, and black. Email info@allardusa.com and ask for your free Product Selection Guide.

ALPS Prosthetic Sock (KC) The ALPS prosthetic sock (KC) is lightweight and soft, providing cushioning and comfort for a superior fit. Available in one-, three-, and five-ply, the socks are manufactured with Coolmax® fibers to create a moisture management system that moves perspiration away from the body and through the fabric, where it can evaporate quickly. They accommodate volume fluctuation and can be worn alone or with a prosthesis. Now available in hole, no hole, and reinforced hole. Visit www.easyliner.com for more information.


Apis custom programs offer practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

Becker GEO™ (Gait Evaluation Orthosis) The Becker GEO™ is a prefabricated, carbon composite evaluation orthosis used to assess the benefit of an ankle-foot orthosis on ankle and knee stability. Please contact our customer service department today for more information. Visit BeckerOrthopedic.com.


50 cc or 220 cc Now available in 30-, 60-, and 90-second set times. • Great for attaching componentry • Multiple repair uses • Very quick set with no sag. They ship nonhazardous and are safe with no odor. For more information, contact Coyote at 208/429-0026 or visit www.coyote.us.



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Black Iron Trainer Pivot The TRS Black Iron Trainer is the world’s most popular weight training prosthetic accessory. The Black Iron Trainer Pivot provides 32 degrees of friction-adjustable freedom for added versatility, safety and control over barbells, dumbbells, and other weight training apparatus. For more information, visit www.fillauer.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 ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses. Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device. For more information, visit www.npdevices.com.

24-7-365 TLSO/LSO Central Fabrication Services We fabricate all styles in all materials. More than 25 years of custom spinal fabrication experience (formerly Spinal Solutions). Hundreds of clients call us “Their Best Value.” Why? Because we have a “Best Value Guarantee!” Totally verifiable! How? Take 20 percent off the current price you’re paying and that’s your new price from O&P Solutions! O&P solidarity is our mission! Contact Mark Dentler, president/owner of Spinal Solutions Inc., O&P Solutions, at 800/922-5155 or visit www.spinal.solutions, http://oandpsolidarity.com, or www.oandp.solutions.



MARKETPLACE Stepping Up With Ottobock Sports Feet

For over 100 years, Ottobock has been building products that help anyone and everyone meet their goals—every step of the way. If you have patients who are looking for a foot to keep them moving to new heights, to make them faster, or even for those highly active kiddos, we’ve got you covered. • The Ottobock Runner and Sprinter blades have high energy return for high-performance running. • The Challenger foot offers excellent vertical shock absorption for running and jumping on the court or power walking. • For little ones, the Runner Jr. is suitable for a variety of sports, playtime, and active recreation. For more information, call 800/328-4058 or visit ottobockus.com.

PDAC, Meet Plié® 3

PROTEOR USA is pleased to announce that the Freedom Plié® 3 microprocessor knee is now PDAC verified L5828, L5848, L5845, L5856, and L5850! For more information visit www.proteorusa.com/plie3.



Ottobock Service Center To Assist All Athletes in Tokyo

Since 1988, Ottobock has attended the Paralympic Games with an on-site, international team of technicians. We’re thrilled to again host Technical Repair Service Centers close to the Athletes’ Village as well as in selected training and competition venues in Tokyo. The best part? We’re there to support all athletes and their needs—not just Ottobock users. Experienced O&P professionals, wheelchair specialists, and welders ensure that equipment is professionally repaired and maintained—regardless of nationalities or the brands of their prostheses, orthoses, and wheelchairs. We’re there to help— even if athletes just need support with their everyday devices. Learn more at: https://www.ottobock.com/en/engagement/paralympics/

The Xtern Foot Drop AFO by Turbomed Orthotics Think outside the shoe! This oneof-a-kind orthosis (AFO) is a game changer for foot drop patients: The Xtern is totally affixed outside the shoe to maximize comfort, and prevent skin breakdown and rubbing injuries. Its flexibility promotes maximal ankle range of motion and calf muscle strength. The Xtern allows running, walking, and even mountain hiking as long and as far as you want without any restrictions, and moves from sandals to boots flawlessly. Turbomed’s innovative products are designed in Quebec, Canada, sold in over 26 countries, and distributed by Cascade in the United States. Visit turbomedusa.com to get your life back!

CL MB The path to the top isn’t always easy. But at Hanger, no one has to do it alone. And there’s no limit to how high any of our team members can climb. Hanger is the clinical leader in orthotic and prosthetic care because we hire the best and the brightest. We provide vast resources, opportunities for career advancement, and the most innovative technology in our field to help them do what they do best: care for our patients. We’re passionate about the life-changing, fulfilling work we do to empower our patients to take on life’s challenges with increased mobility, independence and self-confidence. We know this important work starts by supporting our employees. Empower your career. Apply today and climb higher at Hanger.


Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.



Opportunities for O&P Professionals

Certified Prosthetist Orthotist (CPO) and Certified Orthotist (CO)

Job Location Key:

Texas Baker Orthotics & Prosthetics and CARE Orthotics & Prosthetics—BCP Group companies, are hiring for certified prosthetist orthotist (CPO) and certified orthotist (CO) in the following locations: Texas • CPO—Austin • CPO—Houston • CO—Houston

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to www.AOPAnet.org for content deadlines. 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. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations. 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 $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less

Member $85

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.




Baker O&P and CARE O&P are innovative clinics in noninvasive, high-quality prosthetics and orthotics, with a passionate focus on patient care and patient mobility! We are a team to build a long-term career with, providing career growth, positive company culture, and a purpose in patient care. We are excited for talented people to join our purpose and our O&P family! To apply, submit your résumé to maureen.lee@bcpgroup.net. To review the job description, go to: https://employers. indeed.com/j#jobs/view?id=ec0dfe48e4b2. Email: maureen.lee@bcpgroup.net Website: www.baker-oandp.com

WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com

EMPOWERING HUMAN POTENTIAL Their lives are our purpose. Each year we help more than one million people regain their confidence, independence and quality of life. And we’ve been doing it for more than 155 years. All across the country, our team of unsurpassed clinical talent is growing. We’re looking for experienced clinicians who want to make a difference and help lead the future of orthotic and prosthetic care. Experts in our field determined to mentor the next generation of O&P caregivers. Leaders committed to changing lives. Empower your career. Apply today and make a difference.


Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.



Pacific Assistant Professor, Division of Prosthetics and Orthotics, Department of Rehabilitation Medicine

Seattle, Washington The University of Washington’s Department of Rehabilitation Medicine, Division of Prosthetics and Orthotics, invites faculty candidates to apply for a full-time faculty position at the level of assistant professor (without tenure due to funding). This position has a 12-month service period (July 1 – June 30), with an anticipated start date of Sept. 1, 2021. This position will collaborate with research faculty at the University of Washington Center on Outcomes Research in Rehabilitation (uwcorr.washington.edu), a department-based research center focused on improving measurement of health outcomes through the development, testing, and application of novel performance-based and self-report instruments. All UW faculty are expected to engage in research, teaching, and service. Responsibilities will include directing and supporting research efforts for federally funded instrument-development projects focused on improving measurement of mobility and fall-related health outcomes in people who use lower-limb orthoses and prostheses. Representative relevant research activities include developing outcome measures for orthosis or prosthesis users, conducting comparative effectiveness studies of prosthetic and orthotic interventions, etc. Responsibilities also will include developing grant applications, authoring or co-authoring manuscripts, and presenting research findings at scientific conferences, as well as developing an externally funded research program, collaborating with other faculty on existing research projects, supporting teaching activities in our Master of Prosthetics & Orthotics Program, and mentoring graduate students in our PhD Program in Rehabilitation Science. Opportunities for mentorship and career growth are available. The Department of Rehabilitation Medicine is committed to an inclusive environment and to reducing inequities in patient care through education, research, leadership, and excellence in clinical care. We strongly believe that diversity enriches training and scientific discovery and promotes the best healthcare. The greater Seattle area is a great place to live, offering a treasure-trove of natural beauty, quaint neighborhoods in which to reside, year-round outdoor activities, and varied cultural and artistic activities.


The candidate must: • At the time of application, possess a PhD in prosthetics and orthotics (from a program accredited by the Commission on Accreditation of Allied Health Education Programs) or related field (or foreign equivalent degree) • At the time of application, be certified to practice prosthetics and orthotics through the American Board 52


for Certification in Orthotics, Prosthetics, and Pedorthics • Hold or be eligible for a professional prosthetist and orthotist license in the state of Washington • Have at least three years of clinical experience in prosthetics and orthotics, a record of relevant research, and experience teaching and/or mentoring prosthetics and orthotics students. Applications will be accepted until the position is filled. We will start reviewing applications immediately and on an ongoing basis until the position is filled. Interested candidates should submit a curriculum vitae, responsive cover letter, research statement, teaching statement, and contact information for three professional references. In addition, all candidates must provide an additional written description of their personal commitment to diversity, equity, and inclusion in prosthetics and orthotics. Apply at http://apply.interfolio.com/86362. For questions about the position, contact Brian Hafner, PhD, Search Committee chair, by email at ahrrehab@uw.edu. Website: http://apply.interfolio.com/86362 Email: ahrrehab@uw.edu

AOPA’s O&P Career Center Connecting highly qualified O&P talent with career opportunities EMPLOYEE

• Research who is hiring • Apply online for job openings • Free résumé review.


• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.

LOG ON TODAY! https://jobs.AOPAnet.org


Career Opportunities... California

CPO-Salinas Oregon CPO –Portland CPO –Bend

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

Washington CPO-Richland CO Resident-Richland

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

To apply, submit resume to: careers@pacmedical.com

A competitive salary, benefits and profit sharing are offered based on position/experience.

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


Advertisers Index Company Allard USA

Page Phone










15 800/356-3668


Apis Footwear Company




Becker Orthopedic




Cailor Fleming Insurance




College Park Industries




ComfortFit Orthotic Labs Inc.




Coyote Prosthetics & Orthotics








Ferrier Coupler Inc.





25 800/251-6398


49, 51


www.fillauer.com www.hangerclinic.com


1 800/301-8275


Naked Prosthetics




O&P Solutions (formerly Spinal Solutions)





C4 800/328-4058



17 855/450-7300


TurboMed Orthotics







July 12–13 SEMINAR

AOPA Virtual Coding and Billing Seminar. For more information, visit www.AOPAnet.org.

July 14

Prior Authorizations: What Have We Learned and What You Need To Know. 1 PM ET. For more information, visit www.AOPAnet.org. WEBINAR

August 1

ABC: Application Deadline for October Written & Simulation Exams. Applications must be received by August 1 for individuals seeking to take the October Written and Simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

August 1

2021 July 1

ABC: Practitioner Residency Completion Deadline for August Written & Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

July 1

ABC: Application Deadline for Fall CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

ABC: Practitioner Residency Completion Deadline for Fall CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

August 2–7

ABC: Written and 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 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

August 11 WEBINAR

Prosthetics Clinicians Corner. 1 PM ET. For more information, visit www.AOPAnet.org.



AOPA Members are Shaping the Future of O&P Centered on YOUR success, AOPA provides the tools to build strong O&P businesses that provide excellent patient care.

Running an O&P business is no easy feat, but you don’t have to do it alone. AOPA is here to help you.






Built exclusively for members, ACCESS AOPA’s Affinity Health Plan launching in September.

Plus, as a member you’ll SAVE UP TO $300 per attendee on a basic registration for 2021 National Assembly.

For more information on membership, call 571/431-0810 or email bleppin@AOPAnet.org.

www.AOPAnet.org/join 54


For more

this offe


November 10

August 13–14

PrimeFare Central. Tulsa Renaissance Hotel and Convention Center. In-person meeting. For information, contact Cathie Pruitt at 901/359-3936 or email pruittprimecare@gmail.com, or Jane Edwards at 888/388-5243 or email jledwards88@att.net. Visit www.primecareop.com.

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.


December 8

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.


August 26–27

A Comprehensive Approach to the Management of Cerebral Palsy: 3-12 Years, featuring Peter Rosenbaum and Can Child. Shirley Ryan AbilityLab, Chicago, held virtually. 14.75 ABC credits. Contact Leslie Marriott at 312/238-6839 or visit www.sralab.org/CP21.

2022 January 9–11

September TBD

U.S. ISPO Pacific Rim Conference. Waikoloa, Hawaii (Big Island). For more information, visit www.usispo.org.

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.


January 30–February 3

September 9–11, 16–18

AOPA National Assembly. The 2021 National Assembly will be held in Boston, September 9-11. In addition to the in-person Assembly, we will be offering all the education virtually. This content will be available a week after the Assembly, September 16-18. For more information, visit www.AOPAnet.org.

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

October 16

One-Day Pedorthic, Orthotic, and Prosthetic Program. POMAC is pleased to announce a one-day pedorthic, orthotic, and prosthetic program to take place at The Marriott New York LaGuardia Airport Hotel (across from LaGuardia airport in East Elmhurst, New York). Contact Drew Shreter at 800/

946-9170, ext. 101, or dshreter@pomac.com for more details.

March 2–5

AAOP. Atlanta. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.

May 18–20

October 13 WEBINAR

Hanger Live. Dallas, TX.

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort. Schenectady, NY. For more information, visit nysaaop.org/meeting.

Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis, MN. For more information, go to http://cecpo.com/documents/OrthoAndProstheticTech_2022_1up.pdf.

September 29–October 1

November 1–4

AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.

ISPO 18th World Congress. Now virtual. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

Calendar Rates

May 20–21

Let us share your next event!

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

Words/Rate 25 or less 26-50 51+

Member Nonmember $40 $50 $50 $60 $2.25/word $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

$678 $830

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



STATE BY STATE Become an AOPA State Rep.

Seeking More Appropriate Reimbursement

If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.

Updates from California, New York, Texas, and Washington

California Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/ resources/co-op.


AOPA has invested in a new resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.



The California Orthotic and Prosthetic Association (COPA) has been working on a budget proposal to address low MediCal reimbursement rates in the state. While the proposal did not make it in this cycle, COPA plans to continue advocating for a Medicaid fee schedule increase and is working with AOPA to develop another advocacy campaign for launch in the coming months. For details, visit the California page on the AOPA Co-OP.

New York

AOPA has been working with the New York State Chapter of the American Academy of Orthotists and Prosthetists to secure a Medicaid fee schedule increase for O&P providers in the state. After two very successful letter-writing campaigns, the groups decided to pursue legislation that would direct the commissioner of health to conduct a study on rate adequacy of orthotics and prosthetics. The bill, S 7023, was introduced May 24 by New York State Sen. John W. Mannion (D). See details on the bill at nysenate.gov/ legislation/bills/2021/S7023. By taking this multipronged approach, advocates in New York can continue to push the budget proposal forward while simultaneously advocating for an analysis of the existing rates, which will likely produce data that underscores the need

for the Medicaid fee schedule increase. Call to action: If you live or work in New York, please visit the New York page of the AOPA Co-OP to see how you can help.


Texas HB 2134, Relating to Coverage for Childhood Cranial Remolding Orthosis Under Certain Health Benefit Plans, passed in the Texas House of Representatives, with 113 in favor and 29 opposed. It was referred to the Senate Committee on Business and Commerce, prior to Senate adjournment, but did not receive a vote. In Texas, the legislature is biennial, and no regular session is held during the second year of a biennium.


HB 1427, a bill to increase insurance coverage of prosthetics and orthotics, gained significant bipartisan support, but unfortunately did not receive a vote during regular session. However, in Washington state, bills introduced in odd-numbered years may carry over to even-numbered years, and this bill is expected to move during next year’s regular session. Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email awhite@AOPAnet.org.

Passion for Paralympics

Supporting athletes for more than 30 years Ottobock on-site Technical Repair Service Centers have been supporting athletes at the summer and winter Paralympic Games since 1988. Thousands of world-class athletes trust our team of experts to tune-up and repair their equipment for competition and we can’t wait to do it again in 2021. We look forward to the 16th Summer Paralympic Games where 4,400 athletes will participate in 22 disciplines. Are you ready?

Lacey Henderson 6-time USA National Champion, Long Jump Training for Tokyo

Passion for Paralympics

Profile for AOPA

June July 2021 O&P Almanac  

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