June July 2022 O&P Almanac

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The Magazine for the Orthotics & Prosthetics Profession

J UNE /JULY 2 0 2 2

Update Your Facility’s Social Media Consent Form P.16

Leadership Series: O&P Technology Trends P.32

Sneak Peek: Dynamic Educational Sessions at the AOPA National Assembly




Quiz Me!




Check out the 2022 AOPA National Assembly Preliminary Program

View at www.AOPAnet.org.









Members save up to $300 on Assembly Registration

Earn up to 40+ CE Credits

Registration Is Open! NEW! Stellar partnership with the Texas Society of Orthotic and Prosthetic Professionals (TXSOPP) NEW! Innovative two-day education track on O&P Digital Care and Post Mastectomy Care. NEW! The O&P Experience Zone—A fun interactive event in the Exhibit Hall featuring patient success stories and their clinician caregiver. NEW! Digital O&P Care Showcase A Who’s Who line up of experts presenting the most relevant education. Customizable meeting experience to fit your needs Earn over 100 CE Credits.

San Antonio

Join us September 28-October 1, 2022, for an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.

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For more info and to register, visit:




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JUNE/JULY 2022 | VOL. 71, NO. 6




DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4 Midyear update

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

22 | Everyday Advocates When O&P professionals embrace advocacy roles to speak out on behalf of the profession and patients, everyone benefits. Find out how several O&P stakeholders—from across the age and experience spectrum— have made a significant impact by supporting their patients’ interests, vocalizing the need for policy change, and engaging lawmakers. By Christine Umbrell

32 | O&P Almanac Leadership Series Tech Transitions

New technologies are propelling the O&P profession forward— but some advancements are making a bigger impact than others. Four leaders share their thoughts on how microprocessor technology, neuroprosthetics, additive manufacturing, and other innovations are changing the future of O&P. Interviews Conducted By Josephine Rossi


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

Staying Social—and Compliant

Adhere to HIPAA when leveraging social media Opportunity to earn up to two CE credits by taking the online quiz.

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

38 | Pro Tips and Hot Topics Take a sneak peek at the buzzworthy education planned for this year’s AOPA National Assembly. New tracks, high-level speakers, unique programming—including an orthotic case study on NFL quarterback Alex Smith—and more are on the docket for the premier O&P event in San Antonio.



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AOPA News................................................. 51

AOPA advocacy, announcements, member benefits, and more

Welcome New Members................... 52 O&P PAC Update.................................... 52 Marketplace.............................................. 54 Careers..........................................................57

J. Chad Duncan, PhD, CRC, CPO............... 44

Professional opportunities

Meet the chair and director of the new O&P master’s program at Salus University. Learn how his extensive background in O&P education has uniquely prepared him to lead the new program, which is focused on “well-being.”

Upcoming meetings and events


Calendar...................................................... 58

Ad Index....................................................... 59 State By State.......................................... 60

Illinois, Kentucky, Maine, Pennsylvania, and Virginia


Midyear Update


OPA HAS BEEN HARD AT WORK FOR YOU. With half of 2022 already in the

books, I wanted to take a few moments to recap what we have accomplished for you, our members. I’d like to start with our most recent event, the 2022 Policy Forum. We intentionally narrowed our focus this year to the Medicare Orthotics and Prosthetics Patient-Centered Care Act, legislation that would clarify the distinction between O&P and durable medical equipment (DME) and help prevent fraud and abuse. More than 100 O&P professionals and patients came to Washington, DC, for this event. Thanks to their efforts, we had more than 100 meetings with members of Congress and added five new cosponsors to the bill. For details, check out the article “Everyday Advocates” on page 22. During Limb Loss and Limb Difference Awareness Month in April, we raised awareness about this profession and the patients we serve on social media, using the WeAreOandP hashtag. This initiative supports one of our core strategic priorities for 2022: to communicate the importance of orthotic and prosthetic care. We saw record growth across all of our platforms with this campaign: Instagram accounts grew by 5,150%, reaching more than 20K; LinkedIn post impressions grew by 339.1%, with more than 57K impressions; and we reached more than 23K people on Facebook. Moving forward, we will look to build on this effort in a variety of ways to achieve our strategic objective. We also have made progress on another strategic priority: helping members succeed in the changing healthcare environment. In my last Views From AOPA Leadership column, I wrote about the investment AOPA has made to help members address state legislative and regulatory issues. I had the opportunity to sit in on the State Representatives Meeting at the Policy Forum, and it was both exciting and impressive to see what’s happening in the states we’re collaborating with. California and New York are both on the verge of increasing their Medicaid program fee schedules after decades of stasis. Maine passed a law giving children under 18 the right to a recreational prosthesis in addition to their primary limb. And AOPA is supporting legislative and regulatory activity in several other states to positively influence policy for our members where they are every day. If you want to learn more about those efforts, visit the AOPA Co-OP, the State by State column in every issue of O&P Almanac, and AOPA’s Legislative & Regulatory Meteorologist (trust me on this one), featured in our State Policy Forecast video series. We also have experienced important success at the federal level. After communicating to Medicare the problems associated with prior authorization of certain off-the-shelf orthoses required by patients on an urgent basis, the final rule included a pathway for orthotists to deliver these orthoses to patients without having to wait two days for authorization. The final regulation permits immediate delivery of orthoses needed on an emergent basis if the authorization process would delay care and risk the health or life of the beneficiary. The rule also addresses Medicare’s concern about fraud and abuse by making these claims subject to prepayment review. Let me end by looking forward: Registration for the 2022 AOPA National Assembly in San Antonio is now open! From September 28 to October 1 we will be providing you the high-quality education you’ve come to expect, plus two new tracks: Postmastectomy Care and O&P Digital Care. Exhibitors will have a chance to tell their stories in an innovative, new way at the O&P Experience Zone. And, as always, this meeting gives you the opportunity to share your views on the challenges and opportunities in O&P with AOPA staff and members of the Board of Directors. I encourage every member to consider attending the National Assembly in person. For more information on the upcoming Assembly, check out “Pro Tips and Hot Topics” on page 36 and visit www.AOPAassembly.org. Dave McGill is president of AOPA. 4


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

Board of Directors OFFICERS President Dave McGill Össur Americas, Foothill Ranch, CA President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Vice President Mitchell Dobson, CPO Hanger, Austin, TX Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ottobock, Exton, PA Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL Linda Wise WillowWood, Mount Sterling, OH Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA






Our Mission Statement A trusted partner, advocating for and serving the orthotic and prosthetic community by: • Fostering relationships with decision makers to ensure equitable access • Providing education that promotes professional excellence • Supporting research that informs innovative care • Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

A world where orthotic and prosthetic care transforms lives.

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 Nicole Ver Kuilen, manager of public engagement, 571/431-0836, nverkuilen@AOPAnet.org

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

Timishia Bannister, membership coordinator, 571/431-0835, tbannisterAOPAnet.org

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org



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

Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org

Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571/431-0852, kelly.oneill@AOPAnet.org Kristen Bean, digital meetings specialist, 571/431-0876, kbean@AOPAnet.org




Susannah Engdahl, PhD, manager, health policy and research, 571/431-0843, sengdahl@AOPAnet.org


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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

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O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/520-9632 , bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email 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 © 2022 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options!

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The Digital Transformation of Healthcare New report demonstrates how global healthcare delivery is evolving for providers and patients


The recently released “2022 State of Healthcare Report” discusses the transformation of healthcare and the integration of digital tools. Published by HIMSS: Healthcare Information and Management Systems Society, the report shares opinions from a range of stakeholders in the United States, United Kingdom, Germany, Australia, and New Zealand about the shifts, advancements, and priorities that are shaping the way healthcare is delivered.



Percentage of clinicians globally who say their digital skills have improved over the past year

Percentage of clinicians globally who say their organizations require them to use digital health tools




Percentage of patients globally who have used at least one digital healthcare tool, such as a smartwatch or fitness tracker, in the past year

Ratio of Gen Z and millennial patients in the United States who have used alternative models of care, such as retail clinics in Walgreens or CVS





Ratio of global health systems in 2021 that said they had some plans for hospital at home in the next five years



“According to U.S.-based clinicians, tools that do not fit into clinical workflows, lack of proper training, and lack of clear communication within the health organization are impeding efforts.”

Ratio of global health systems in 2022 that said they had some plans for hospital at home in the next five years



—2022 State of Healthcare Report

United States






58% 40%



Lifestyle (diet, exercise, smoking status)

Physical Health



36% 19%

Mental and Behavioral Health


Genomic Profile


13% Religion

SOURCE: “2022 State of Healthcare Report,” HIMSS, April 27, 2022, www.himss.org/resources/state-healthcare-report-infographic


Percentage of patients globally who agree their providers personalize care based on their current health, lifestyle, and unique health goals


Percentage of U.S. clinicians who say their organization has completed its digital transformation


Researchers Study Costs, Complications of Osseointegrated Prostheses Patients who received unilateral lowerlimb osseointegrated prostheses at New YorkPresbyterian Hospital were the subject of a retrospective chart review conducted by physician-researchers at that institution and Cornell Medical College. The research team conducted the first cost-benefit analysis of osseointegrated prostheses compared to traditional socket-suspended prostheses. Patients who are fit with osseointegrated devices generally exhibit poor tolerance for traditional devices, but implants can be costly. The researchers compared the lifetime costs, considering that patients with implants require customized components and additional surgeries. They calculated costs among 25 patients, with a mean follow-up of 17 months postamputation. Among those patients, 20% required preimplantation soft tissue revision surgery. Complications experienced by patients included soft tissue infections (29%), bone/implant infections (11%),

neuromas (14%), and mechanical failures (17%). The researchers identified an incremental cost-effectiveness ratio of osseointegrated prostheses compared to traditional prostheses of $44,660. A cost-effectiveness acceptability curve demonstrated that osseointegration was favored over traditional prostheses in 78% of cases at a willingness-to-pay of $100,000 per quality-adjusted life year, according to the researchers. “The model shows that osseointegrated prostheses provide a higher quality of life at affordable costs when compared to poorly tolerated socket-suspended prostheses in patients with lower-limb amputations in the United States,” the researchers noted. “The cost-effectiveness is largely determined by the patient’s socket-suspended prosthesis costs and is limited by the frequency and costs of osseointegration mechanical failure.” The study was published in May in Annals of Plastic Surgery.

OASIS II Study Supports Coding of Prosthetic Feet Based on Patient Outcomes Hanger Inc.’s “Outcomes ASsessment and DISsemination (OASIS) II” study evaluates the effectiveness of 10 common prosthetic feet models across L5981 and L5987 procedure codes, as assigned by CMS’s Pricing, Data, Analysis, and Coding contractor. The second study in the OASIS series by the Hanger Institute for Clinical Research and Education reports L5987coded feet are associated with improved mobility compared to the L5981 category, a confirmation of results reported previously in a purely dysvascular/diabetic population of 738 individuals with amputation in the Institute’s Mobility Analysis of Amputees (MAAT) 5 study. OASIS II also questions whether prosthetic feet and componentry should be categorized based on functional outcomes instead of mechanical features. The researchers investigated real-world evidence on highly utilized prosthetic feet that were re-coded from L5987 to L5981 due to a lack of visual distinct vertical loading mechanism. The analysis compared functional outcomes of 526 users across different etiologies who utilized prosthetic feet that retained an L5987 coding, prosthetic feet that were newly assigned an 10


L5981 coding, and those that sustained an L5981 coding. Results showed no significant difference in functional mobility for individuals with prosthetic feet that had its coding modified to L5981, compared to those that retained the L5987 designation. “At Hanger, we believe our clinical care should be measured by the outcomes we achieve, not the devices we deliver,” said James Campbell, PhD, Hanger chief clinical officer. “This second OASIS study uses real-world clinical outcomes data to demonstrate that emphasizing functional performance over visible characteristics may be a pathway toward higher performance for the end user.” The OASIS series is part of a collection of research studies already published, or in various stages of publication, by the Hanger Institute for Clinical Research and Education, in collaboration with leading researchers, clinical, and academic institutions. The study was published in the Journal of Rehabilitation and Assistive Technologies Engineering. Additional information on OASIS II and summary of the research is available at https://hangerclinic.com/blog/published-research/oasis2/.



PHOTO: T. Betler/UPMC/Pitt Health Sciences

Electrical Stimulation Spurs Sense of Touch in Prostheses Researchers at the University of Pittsburgh’s Rehab Neural Engineering Labs are making advancements in their work to add sensation of touch to prostheses. Their goal is to equip artificial hands and feet with sensors that are linked to an individual’s nervous system. The team has tested the ability to generate sensations in the Lee Fisher, PhD, works with a study participant who reports missing limb with four people with upper-limb that a prototype has partially restored her sense of touch. amputation, and three control during standing, according to the people with lower-limb amputation, researchers. Participants also reported according to Lee Fisher, PhD, assistant reduction in phantom limb pain. professor in the university’s Department The current study may have signifiof Physical Medicine & Rehabilitation. cant implications for prosthesis users. “If “We’ve shown that electrical stimulation we can use spinal cord stimulation to of the spinal cord can produce sensaproduce sensations that feel like they tions that feel like they come from the come from the missing limb, the next missing hand or foot, and that those step is to use sensors on the prosthesis sensations can help to improve the to control stimulation,” Fisher said. “That control of a prosthetic limb,” he said. way, if we detect pressure under the Fisher’s team is using commercially fingertips of the hand, or under the sole available devices to stimulate the spinal of the prosthetic foot, we stimulate in a cord. “These devices are currently way that produces a sensation in the implanted in over 50,000 people every same location on the missing limb. Our year to treat pain. We use them in a hope is that this restored sensory slightly different way, and our goal is to feedback will help to improve control of restore sensory feedback to improve the prosthetic limb.” prosthetic limb performance,” he said. Fisher hopes to use his lab’s techThe team is hoping to leverage “all of the niques outside the research setting soon. knowledge and infrastructure built “This will involve development of around spinal cord stimulation to next-generation prosthetic limbs that accelerate our translation from the have sensors in the hand or foot,” he research lab to the clinic.” predicts. “Alternatively, it may be easier to Several study participants reported attach external sensors to the prosthesis, “feeling” their limbs during electrical stim- or use a sensorized insole in the shoe. If ulation. One upper-limb subject reported we are successful, this approach will feeling her hand, even though her right improve control of upper-limb prosarm was amputated to stop an infecthetics, reduce the fall risk for people with tion. A lower-limb subject experienced lower-limb amputation, and help to improvements in stability and balance reduce phantom limb pain.”


Scoliosis Prevalent Among PWS Patients Among patients with PraderWilli syndrome, more than 80% are likely to develop an abnormally curved spine, with 33% experiencing a severe degree of scoliosis. —“High Prevalence of Scoliosis in a Large Cohort of Patients With Prader-Willi Syndrome,” Journal of Clinical Medicine, March 2022


Physical Activity Linked to Longer Lifespan In a study of U.S. adults ages 40 to 85, increasing moderate to vigorous physical activities by 10, 20, or 30 minutes per day was associated with a 7%, 13%, and 17% decrease in the number of deaths per year, respectively. Adding 10 minutes per day of physical activity results in an estimated 111,174 preventable deaths per year. —“Estimated Number of Deaths Prevented Through Increased Physical Activity Among U.S. Adults,” JAMA Internal Medicine, January 2022





Wellness Checks Reduce Amputation Risk People with diabetes who attend an annual wellness check may be 36% less likely to require an amputation, according to research based on Medicare beneficiaries. —American Diabetes Association Scientific Sessions, June 2022


Diabetes Patient Outcomes Improved After ACA Expansion African American, Hispanic, and other individuals of minority status experienced relatively improved outcomes in states that adopted Medicaid expansion after Affordable Care Act implementation. The major amputation rates for racial and ethnic minority adults with diabetic foot ulcers decreased in earlyadopter states compared with nonadopter states after expansion. —“Rates of Diabetes-Related Major Amputations Among Racial and Ethnic Minority Adults Following Medicaid Expansion Under the Patient Protection and Affordable Care Act,” JAMA Network Open, March 2022




Robotic Arm System Leverages Implanted Chip for Control University of Minnesota researchers developed a new technology to enable individuals with upper-limb loss to move a robotic arm using brain signals. The technology is designed for accuracy and is reported to be less invasive than other approaches. The researchers created a small, implantable device that attaches to the peripheral nerve in an individual’s arm. By integrating a robotic arm and artificial intelligence (AI), the device can be leveraged to read and interpret brain signals. This system allows individuals with upper-limb loss to control the arm using their thoughts. The technology records the human nerve data, and the AI system “fills in the gaps and determines what’s going on,” said Jules Anh Tuan Nguyen, PhD, a postdoctoral researcher in the university’s Department of Biomedical Engineering. The system is designed to be intuitive, according to Nguyen. “With other commercial prosthetic systems, when amputees want to move a finger, they don’t actually think about moving a finger.

They’re trying to activate the muscles in their arm, since that’s what the system reads. Because of that, these systems require a lot of learning and practice,” he said. “For our technology, because we interpret the nerve signal directly, it knows the patient’s intention. If they want to move a finger, all they have to do is think about moving that finger.” The system currently requires wires that come through the skin to connect to the exterior AI interface and robotic arm, but in the future the chip may be able to connect remotely to a computer, according to the research team. The study was published in Journal of Neural Engineering.

Wear Time and Functionality Varies Among Transradial Prosthesis Users Researchers at the Medical University of Vienna in Austria recorded the number of grasping motions of individuals with below-elbow amputation to evaluate daily use of prosthetic devices in this population. The research team leveraged a variety of objective and timed assessments in five unilateral patients with transradial amputations. They also studied the number of performed prosthetic movements over a period of three months and analyzed patient-reported data regarding daily wear time. Patients

reported a wearing time of nearly 13 hours per day and were found to have performed approximately 257 prosthetic motions each day. The researchers concluded that “neither high functionality nor long wearing times necessitated frequent use of a prosthesis in daily life. However, frequent daily motions did translate into good functional scores, indicating that regular device use in different real-life settings related to functionality.” The study was published in May in Prosthetics and Orthotics International.


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Adapttech has hired two team members to boost its U.S. presence and to provide support to prosthetic patient-care practices and university research partners. John Braddock has joined the Adapttech team as the U.S. director of sales. Braddock has extensive experience in various leadership roles within the O&P field. His knowledge of new technologies within the prosthetic profession comes from his time spent with Blatchford, iWalk, and Össur. Braddock will provide face-to-face sales and support to U.S. Adapttech technology users. Derek Inserra, CPO, has been named Adapttech’s U.S. clinical specialist. Inserra attended the University of Texas Southwestern for his orthotic and prosthetic education and has spent the past seven years directly in O&P patient care. He has extensive experience of working with new technologies and a strong focus on utilizing patient outcome measures to improve the results of patient-care efforts. Inserra will conduct training and provide support to practitioners utilizing INSIGHT systems. “Expanding our sales and clinical teams in the U.S. is a key step toward making Adapttech technologies integral to caring for amputees and improving patient outcomes,” said Frederico Carpinteiro, CEO. “We were extremely excited to find two experienced O&P professionals who fit so neatly with Adapttech’s company culture.” Claudia Zacharias, MBA, CAE, has announced she plans to retire from the Board of Certification/Accreditation (BOC) at the end of 2022. “It is an honor to conclude my professional career as BOC’s CEO,” said Claudia Zacharias, Zacharias. “I’m electing to retire in December, MBA, CAE which aligns with my personal retirement goal timeline and enables a deliberate, thoughtful, and disciplined transition for BOC. I am confident of the organization’s continued success as I embark on my next life chapter.” During Zacharias’s tenure, BOC’s revenue grew consistently and sustainably. Facility accreditations increased by an average of 30 percent each year, and BOC’s certification program successfully transitioned from a cost center to a profit center. “Claudia announced her retirement decision to the Board of Directors earlier this year, giving us plenty of time to prepare for her departure,” said BOC Board Chair Wayne Rosen, BOCP, BOCO, LPO, CDME, FAAOP. BOC plans to announce Zacharias’s successor later this year.




Todd Eagen, president of the Orthotics & Prosthetics Group of America (OPGA), passed away June 4 at the age of 54. Eagen worked in pharmaceutical sales before joining VGM & Associates in 2011. Todd Eagen In 2017, he was chosen to lead OPGA, becoming its president in 2018. “Todd was a fierce advocate for the profession, a beloved colleague, loving father, and a loyal friend,” said Mike “Ike” Isaacson, SVP of operations at OPGA. “His impact on those around him will be greatly missed. VGM and those in the industry that loved him will ensure that his legacy lives on in the work he loved and the people he cared for.” He served on several national boards during his time with VGM, including the National Association for Advancement of Orthotics and Prosthetics and Tate’s Army Foundation. Eagen also was known for his love of football. He was a standout defensive lineman at the University of Northern Iowa, then served as an assistant and defensive line coach for the team for 12 years postgraduation, before moving into pharmaceuticals. “Todd was not only a coach, but a mentor and lifelong friend to many,” said VGM CEO Mike Mallaro. “He had a gift for finding points of connection and using those to bring people together. And he was a fierce advocate for those whose rely on O&P care.”


Hanger Clinic has selected more than 300 board-certified pediatric O&P clinicians to be part of an esteemed group of pediatric specialists. Hanger Clinic pediatric specialists are experienced in the O&P management of more than 50 pediatric conditions, applying their knowledge of pediatric anatomy and clinical expertise to help achieve the best possible outcome for each child. These specialists participate in focused training related to pediatric growth patterns, developmental milestones, and treatment timelines and strategies. The team follows a set of validated, research-based clinical practice guidelines in treating cerebral palsy, scoliosis, plagiocephaly, and hypotonia. They also prioritize the collection of outcomes data, which allows them to track and monitor patient progress over time. “Between Hanger Clinic’s collective expertise, commitment to education and outcomes, and high standard of care, our pediatric specialists are able to meet growing children wherever they are in their care pathway and empower them to succeed,” said James Campbell, PhD, Hanger’s chief clinical officer.

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Staying Social—and Compliant Tips for crafting a social media consent form for patients—and retaining HIPAA compliance

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 20 to take the Reimbursement Page quiz. Receive a score of at least 80%, and AOPA will transmit the information to the certifying boards.



provisions within the Health Insurance Portability and Accountability Act (HIPAA) were written and enacted long before social media sites like Facebook, Twitter, Instagram, and TikTok became popular. These social media venues have become valuable tools for reaching out to and educating patients, and for marketing your business. However, the HIPAA security and privacy rules remain relevant and must be followed; there are multiple potential areas of risk for violating the HIPAA rules and breaching a patient’s privacy on social media platforms. How can your facility use social media without running the risk of violating HIPAA rules? This month’s Reimbursement Page examines some of the common mistakes associated with social media and HIPAA and offers tips for ensuring compliance.



Personal Health Information

When using social media platforms, or when dealing with HIPAA in general, it is never acceptable to disclose or share protected health information (PHI) outside of your normal business operations for treatment or payment. PHI is any information about a patient or the patient’s care, and any details that could expose or identify the patient’s identity. This goes beyond photographs, birthdates, health ID numbers, or telephone numbers; it also includes things like the patient’s email address or their Instagram account name. PHI may only be included in your company’s social media posts if a patient has given their permission, in writing, to allow their PHI to be used—and then only for the purpose specifically referred to on the consent form.

Common HIPAA Violations on Social Media

Some of the more common mistakes, violations, breaches, or issues that can arise with social media and HIPAA are listed below. Remember that a breach or violation is any impermissible use or disclosure of information that compromises the security or privacy of the PHI and, ultimately, the patient. • Sharing pictures and videos of patients without their express written consent or authorization. It is never acceptable to directly share information about your

patients outside of normal business operations, unless you have the patient’s permission. • Referring to unconfirmed news about patients, or sharing gossip about patients. • Inadvertently or accidently showing patients’ pictures or patients’ PHI. This would include posting a picture of your office where, in the background, you can see a patient or a patient chart. • Posting or sharing information to sites or groups that you thought were private. Just because a group is marked as “private” doesn’t mean that the information will not be shared with others. If you would not share it or post it in an open forum or on a public platform, then you should not share it in private. In addition, on some sites, even if they are “private,” the messages may not be encrypted and secured. Along the same lines, don’t assume that just because a post or photo has been deleted, it is no longer visible to the public.

Social Media Policy

To facilitate compliance with HIPAA and avoid potential fines, there are a few steps you can take when using social media. Most importantly, create or review your social media policy. While your policy should be tailored to fit your company’s needs, following some general rules will help protect your employees and your facility.

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Your social media policy should clearly define your company’s penalties for violating HIPAA on social media platforms. These could mirror your penalties or punishments for other HIPAA violations, or you may create penalties tailored specifically for social media usage. You may choose to set your policies to be strict and severe—for example, one offense is enough to fire someone. Alternatively, you may decide to give one or two warnings to an employee. Having a clear discipline policy in place will help reinforce the importance of HIPAA compliance and discourage employees from posting inappropriate information or materials. Make sure you, your employees, and your company keep all social media accounts separate. For example, avoid using one Instagram or Facebook account for both your personal life and your facility; and try not to post work-related material on your personal account. Monitor your work accounts regularly to ensure no improper material or information has been posted. If something inappropriate does post, have protocols in place to quickly remove it. Keep in mind that improper posts may originate from people outside your company—for an example, a patient accidentally sharing some of their PHI. Also consider including guidance on communicating with current or future patients via social media platforms. For example, if a new patient contacts you on your facility’s Facebook page asking about an appointment or treatment, you may respond to them and let them know of your office hours or how to schedule an appointment. However, you should not have the patient discuss their medical history; instead, ensure they send that information to your email or other secured means of communication.

Social Media Consent Form

The only time you or your facility may share any PHI on a social media platform is when a patient has given you express written permission. The best way to prevent most HIPAA breaches, violations, or issues with social media campaigns and posts is to have a valid authorization or consent form on file. 18


If you have an old photo consent or authorization form on file as part of your HIPAA intake forms, you should consider reviewing and updating the form—especially if you have not done so in a long time. Make sure new forms include information about social media usage. Whether you are reviewing, updating, or creating a social media consent form, consider taking the following actions when preparing the document: Explain the type of content you wish to use and share. For example, are you only asking for a photo, or are you asking the patient to share a story and provide a testimonial? This is important because each patient is different and will have varying comfort levels regarding what they may be willing to share. Specifying the type of content you will be sharing gives the patient control to choose what they are comfortable with. Explain how the content will be used, or the purpose of the content. Do you intend to use the patient’s photo and/or story for marketing purposes or for educational purposes? Be clear on the purpose. Also consider explaining the type of information you intend to include in your posts. If possible, specify the type of social media platforms you will be using, or where the patient’s information will end up. Perhaps allow the patient to choose which platforms they are comfortable with—and only post

to those approved sites and platforms. Explain when the information will be used and shared, and for how long you intend to share or post the information. The form should clearly identify who the patient is authorizing, so make sure your facility’s or company’s name is prominently listed. If you may authorize use by one of your agents, contractors, or businesses associates, let the patient know that—especially if you are using a third party to help with your social media campaigns and postings. Include an age acknowledgement, or an indication that the patient is eligible to make decisions about consent and authorizations on their own. If the patient cannot make these decisions—for example, if they are a minor—then include a way to identify the legal guardian. Include contact information. This is not always required to be directly on the consent form since contact information is usually already known. However, it is useful to include your facility’s contact information, and request the patient’s contact information, within the social media consent form. Be clear that the patient may revoke the authorization at any time. In addition, explain what will happen if information was used or posted prior to them revoking their consent. Will you remove all previous postings, or does the revocation only apply to future postings?

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Explain the patient’s rights to, or lack of, compensation if you plan to use the patient’s information and/or likeness for marketing or anything that can lead to a financial gain for you and your facility/company.


Be sure your form has a space for the patient and/or their guardian to sign and date the form. Below is a sample consent form. Your form doesn’t have to be this long, or


I, (Patient or Patient Guardian Name), hereby authorize (Facility Name) and its authorized employees, agents, or contractors to publish the following personal health information (PHI) and/or story that contains my name or likeness: (Include all information that may be used). This information, photo, and/or story may contain information relating to the diagnosis, treatment, and healthcare services provided or to be provided to me by (Facility Name) and identifies my name and other personally identifiable information. This information may be used in print media, on the radio, TV, the (Facility Name) website, blog, podcast, and on the following social media platforms: Facebook, Twitter, Instagram, and YouTube. (If you have or use other social media platforms, be sure to include them.) The following information about me will not be disclosed if specifically stated: I understand that I have a right to revoke this authorization by providing written notice to (Facility Name). However, this authorization may not be revoked if (Facility Name), or its employees, agents, or contractors, have taken action on this authorization prior to receiving my written notice. I further understand that this authorization is voluntary and that I may refuse to sign this authorization. My refusal to sign will not affect my ability to seek treatment with (Facility Name), eligibility for benefits or enrollment, or payment for or coverage of services. This authorization is valid from the date of (Date of Patient’s or Guardian’s Signature Below) and shall expire on ______________. Lastly, I understand I will not be compensated for the use of any images or my likeness that are used in any social media platforms. I also understand that (Facility Name), and its authorized employees, agents, or contractors, are not liable to notify photographers/agencies of the use of these photos, and it is between myself and the photographer to discuss the distribution rights of any images. Name of Patient: __________________________________________________ Signature of Patient/Guardian: ______________________________________ Guardian Relation to Patient: _______________________________________ Date: ____________

even look like this—this is just one example of how a social media consent/ authorization form could appear. The purpose of the final form is to ensure the patient has a clear understanding of exactly how their information and/or likeness will be used, and the purpose of sharing their information. If you have any concerns about your consent forms or what should or should not be included, consider speaking with your attorney.

Protecting Your Facility

By providing a complete and thorough consent or authorization form, you will assist your patients in feeling more comfortable sharing their information, likeness, or story—especially if they can have a say and control over where it ends up and what information you use. When you are dealing with social media, PHI, and HIPAA, caution is key. The criminal penalties for HIPAA violations could be severe, ranging from $100 to $50,000 per violation, with a maximum penalty of $1.5 million per year for each violation. A good rule of thumb is that if you would not share it or talk about in real life, then you should not share it or post it on any social media, without proper authorization and consent. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. This material is not intended, and should not be relied on, as legal advice. AOPA members should consult with their own legal counsel about the legal matters presented. 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




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Everyday Advocates

Several O&P professionals stepped up their advocacy roles to improve the lives of individual patients—and O&P patients as a whole By CHRISTINE UMBRELL

PHOTOS: Nicole Ver Kuilen




NEED TO KNOW • O&P professionals of all ages and experience levels can embrace advocacy roles in support of patients and the profession. • Alex Gates, CPO, was spurred to advocate in Washington to support a patient seeking a policy change so she can join the military. • Chris Baschuk, MPO, CPO, FAAOP(D), attended his first AOPA Policy Forum and has since become a vocal advocate in Utah, educating lawmakers about the profession and needed changes. • O&P student Evan Smith came to the Policy Forum without much experience—and was instrumental in convincing Rep. Pete Aguilar (D-California) to sign on to the O&P Patient-Centered Care Act. • Every voice matters—all O&P professionals can stretch out of their comfort zone and find ways to support O&P and their patients. AOPA has resources to help get started.


PHOTOS: Nicole Ver Kuilen

CTIVISM COMES IN many forms.

That was the message shared at AOPA’s Policy Forum in May, and that is the philosophy embraced by several committed O&P professionals who have found that advocating for patients on the individual level is equally important as advocating on local, state, and national levels. The big “asks”—such as asking legislators to sign on to the Medicare O&P Patient-Centered Care Act (see sidebar on page 28)—are critical for the future of the O&P profession and the individuals requiring O&P care. But many O&P professionals also spend time and effort advocating for individual patients, and for groups of patients impacted by specific payor rules or state regulations. These individual acts of advocacy are just as important as systemic advocacy—and the two can overlap. Here’s how.

Bringing a Patient Problem to the National Spotlight

Alex Gates, CPO, a clinician and manager at Evergreen Prosthetics &

Orthotics in Spokane, Washington, ramped up her involvement in national O&P advocacy this year in her quest to improve quality of life for one of her patients. Hannah Cvancara was born with fibular hemimelia that resulted in the amputation of her left foot when she was just 1. Today, the 26-year-old is a nurse and an avid athlete, using a prosthesis to surf and rock climb. She wants to serve the United States as a military nurse—but military regulations prevent individuals missing a body part, including pre-service amputations, from joining the services. Cvancara, whose father was an Air Force flight surgeon, will not be deterred from her goal. Early this year, she approached Gates to assist her with finding a way to pursue military service. Gates began by writing a “strongly worded letter” on Cvancara’s behalf, she says—then the pair worked with AOPA to bring the issue into the national spotlight.

Hannah Cvancara and Alex Gates, CPO O&P ALMANAC | JUNE/JULY 2022



Cvancara hopes to one day serve in the U.S. military as a nurse. “Hannah is a very dynamic person, so I found myself on an airplane coming to DC,” Gates says. “There are a lot of CPs and COs who don’t deal with politics”—they deal with patients. But

she soon realized that advocating for policy change is an important way to improve life for individuals with limb loss and impairment. The pair traveled to AOPA Headquarters in April, where they strategized with staff members Nicole Ver Kuilen, Ashlie White, MA, Sam Miller, and others, before visiting Capitol Hill. AOPA recently invested in enhanced legislative tracking software and used it to determine which legislators to contact for visits—those who would be most open to hearing Cvancara’s story. AOPA staff “guided us on who should speak about what at each meeting,” Gates recalls. As a prosthetist, her role at the meetings was to testify to Cvancara’s physical abilities and explain the capabilities of an individual with a prosthesis. She also spoke to the durability and stability of Cvancara’s device. They had several successful meetings, including one “magical” visit with Rep. Cathy McMorris Rodgers (R-Washington), a representative with whom Cvancara had already established a relationship. “We discussed the barriers the disabled community faces,” says Cvancara, including her exclusion from military service as well as the need to pass the Medicare O&P Patient-Centered Care Act. Cvancara and McMorris Rodgers “share a passion for supporting disabled military,” she

says. “I am so thankful for that experience and to discuss some of the changes needed in the O&P world.” As a result of the meetings, more individuals with authority are aware of Cvancara’s situation and are working to change the rules so she— and others like her—may one day have the opportunity to join the military, according to Gates. Before visiting Washington, Gates had focused most of her energy on her patients—but she has learned that she can expand her viewpoint. “I didn’t realize I have such a powerful tool in my toolbox to advocate on each patient’s behalf,” Gates says. “It was a profound experience for me in realizing we could make our voice heard.” The experience “opened up more pathways I could take on behalf of my patients—to work with patients to push these things up higher, and to advocate.”

Keeping Patients’ Interests in Mind

Like Gates, Chris Baschuk, MPO, CPO, FAAOP(D), was recently motivated by his patients to advocate on their behalf, and for the whole profession. Formerly a regional clinical manager at Handspring, and now as the clinical director at Point Designs, Baschuk was moved to participate in his first in-person Policy Forum this year.



PHOTOS: Hannah Cvancara, Nicole Ver Kuilen

Cvancara, Gates (far right), and others meet with staffers from Sen. Thom Tillis’ office.



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Capitol Hill Club, where AOPA convened on Day Tw0 at the AOPA 2022 Policy Forum



Baschuk (right) at the office of Sen. Mike Lee, with Chris Medrano, legislative correspondent for Sen. Lee

Recognizing That No Experience Is Necessary Advocacy is not solely for seasoned professionals—just ask Evan Smith. He recently learned that even O&P students like himself can make an impact. During the May Policy Forum, Smith’s participation was instrumental in convincing Rep. Pete Aguilar (D-California) to sign on to the Medicare O&P Patient-Centered Care Act. Smith, who will graduate from the MSOP program at Loma Linda University (LLU) in 2023, traveled to the AOPA Policy Forum as the university’s student representative, sponsored by NCOPE. Smith grew up in a medical family; his father is an occupational therapist and several relatives are nurses. He originally

PHOTOS: Chris Baschuk, MPO, CPO, FAAOP(D)

manufacturing companies call Utah their home—the state is an “epicenter of O&P,” according to Baschuk. He has sent emails and follow-up letters to Levin Sliker, PhD, CEO of Point Utah’s senators and representatives to Designs, with Chris Baschuk, MPO, “raise awareness of issues that are a big CPO, FAAOP(D), in front of U.S. deal” to the profession. Capitol at the AOPA 2022 Policy Forum Baschuk encourages other O&P professionals to get involved in In addition to wanting to push advocacy at whatever level they the Medicare O&P Patient-Centered are comfortable with. “Advocacy is Care Act forward, Baschuk wants thinking beyond yourself; it’s about to influence policy and regulatory the patients,” he explains. “We need decisions—particularly since the to advocate for others, but also for durable medical equipment Medicare the profession. We all need to come administrative contractors published together and have a common goal. “Upper-Limb Correct Coding “Fundamentally, you have to find Guidance” this year. The guidelines your ‘why’”—why you advocate, in the document, which “did not go Baschuk says. “Then, what can you do? through a proper public comment Inaction is action—so just try someperiod and circumvented the approthing. Send a letter to legislators. Go to priate Local Coverage Determination the local offices of your legislators and process,” according to Baschuk, limit talk to staffers. Educate yourself on the the codes that will be covered by current issues and policies, and talk to Medicare for upper-limb prostheses. AOPA staff. Be consistent—and keep During the Policy Forum, Baschuk going back, so they know they can’t get met with aides from the offices of Sens. rid of you.” Mitt Romney (R-Utah) and Mike Lee When you are presented an oppor(R-Utah). He found Lee’s aide, Chris tunity to meet with a legislator—at any Medrano, to be particularly receptive level—Baschuk says that it’s important to the O&P issues they discussed, to look up that individual’s voting including the proposed legislation. record and identify the causes that are In the weeks since the Policy important to that legislator. Then find Forum, Baschuk has expanded his areas of overlap between the legisadvocacy to state legislators and is lator’s causes and your own. “Draw hoping that Utah lawmakers will parallels” to motivate legislators to champion the O&P cause. Several O&P sign on to your own bills, he says.

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In-Person Advocacy Makes a Comeback O&P student Evan Smith met with legislators during the AOPA Policy Forum in May. planned to become a physician—but then he “stumbled across the field of O&P” during his second year of medical school at LLU, “and it immediately piqued my interest,” he says. “It seemed like a beautiful intersection between medicine and hands-on engineering.” Now halfway through the master’s program, he “jumped at the chance” to represent LLU at the Policy Forum. “I didn’t know a lot about it, or what to expect, but I enjoy traveling and meeting interesting, caring people in our field.” Smith says politics has never been an area of interest, but he

Maggie Baumer, JD, president of NAAOP, notes that the energy at this year’s Policy Forum was high. “It was exciting to be able to go in person and visit the Hill,” says Baumer, who also is area clinic business manager for Hanger Clinic in Massachusetts. O&P advocacy is a multilevel commitment, says Baumer, and there are many ways to get involved. When geography and expense prevent would-be advocates from traveling to the national Policy Forum, these individuals could get involved locally and at the state level, says Baumer. She encourages O&P business owners to identify employees who may be enthusiastic about advocacy, and task them with that work—perhaps allocating some of their clinical time to advocacy each month. With the success of the event fresh on their minds, O&P professionals are looking forward to the next opportunity to network in person with colleagues on a national scale—at the AOPA National Assembly in San Antonio, September 28-October 1.

Smith (far right) with Policy Forum participants Debbie Hatch, Katie Devlin, and Rick Riley 28


PHOTOS: Evan Smith

More than 110 AOPA members and O&P students reunited in Washington, DC, May 17-18 for the annual Policy Forum—the first time the event was held face-to-face since 2019. Attendees from across the nation convened on the Hill to take part in more than 70 congressional visits with representatives of 30-plus states. This year, participants pushed for legislators to sign on to the Medicare O&P Patient-Centered Care Act—HR 1990 and S 2556. The congressional visits by Policy Forum attendees led to five additional co-sponsors of the legislation: Reps. Pete Aguilar (D-California), Randy Feenstra (R-Iowa), Terri Sewell (D-Alabama), and Dan Meuser (R-Pennsylvania), and Del. Eleanor Holmes Norton (D-District of Columbia). The legislation aims to accomplish four patient-centered goals: • Distinguish O&P clinical care from the provision of durable medical equipment. • Protect patient access to necessary clinical care associated with O&P intervention, by returning the definition of “minimal self-adjustment” to its original meaning. • Protect patient access to a continuum of care by exempting appropriately credentialed clinicians from competitive bidding. • Prevent fraudulent acts targeting Medicare patients in need of O&P care by prohibiting drop shipping of custom-fit and customfabricated O&P devices.

PHOTO: Evan Smith


“couldn’t help getting caught up in the passion that everyone had about advocacy” on Day One of the Policy Forum. “I learned that we as clinicians can make a difference for our patients in a national way, when we join together and make O&P needs known,” he says. “I also realized both how big and how small our field is. We are a relatively small group, yet we have a national presence.” On Day Two of the Forum, he participated in congressional visits to Aguilar, Rep. Doug LaMalfa (R-California), and Sen. Dianne Feinstein (D-California). Smith and Ver Kuilen met with Aguilar himself “for about 20 seconds” before he had to rush to another meeting, then they met with one of his staffers, Elise Sugarman. “Nicole and I took turns telling Elise about the bill and how that directly impacts patients and clinicians,” Smith says. Apparently, the pairing of a young, energetic O&P student-advocate with an O&P consumer/AOPA representative—Ver Kuilen—made quite the impression. “Two days later, on Friday, Elise emailed Nicole and I letting us know that Rep. Aguilar had agreed to co-sponsor the bill!” says Smith. “We were thrilled and quickly wrote back expressing our appreciation. We are now one step closer to getting this bill enacted.” Since then, Smith and Ver Kuilen have coordinated to send a signed thank you letter to Aguilar, along with a photo of Smith’s fellow LLU O&P students. While Smith’s other Capitol Hill meetings have not yet yielded additional co-sponsors, Smith is still holding out hope that LaMalfa or Feinstein will sign on. Reflecting on his experience the Policy Forum, he appreciates both learning about some issues for the first time and realizing “that we are actively working to fix said issues and … that our field is just filled with amazing, caring, and intelligent people.” As Smith discovered, anyone can make a difference, regardless of age or experience. “We need to educate

our legislators about the needs and issues in our profession, and we need to educate our patients that their voice matters. Patients have the unique opportunity to tell their own stories.” He also encourages O&P professionals at all levels to “to let our legislators, patients, family, and friends know that we are invested in advocating for—and with—those who have limb loss and/ or limb impairment.”

Integrating Advocacy Into Everyday Practice

In some cases, advocating for patients can be as simple as working with patients’ insurance Nicole Van Kuilen, AOPA manager of public to ensure coverage, or helping patients without engagement; Elise Sugarman, a staffer from Rep. means to find ways to get Pete Aguilar’s office; and Smith devices. Erik Schaffer, CP, founder and CEO of A Step Ahead the microprocessor units critical Prosthetics in New York, integrates to restoring function, causing the advocacy into each patient interaction. patient restrictions, limitations, and After each patient’s needs and goals risk of injury. Not only do they deny are established, his staff evaluates the prosthetic, but they also refuse their insurance policy for limitations to update their fee schedule, or have or exclusions that would prevent the lowered their fees, forcing the patient patient from reaching their desired or to go in-network. A prosthetic device potential functional levels. “A prosis essential to a person’s health, and thesis is an artificial device designed our entire facility has always been to replace a missing part of the body, dedicated to advocating for our and more and more, insurance compapatients’ needs.” nies are denying the patients their Jim Druwe, CPO, who spent eight restoration of life. So, every day, we years at Bio-Tech Prosthetics and fight against payors who deny claims Orthotics and is now with Hanger or do not want to provide the most Clinic, also believes it’s important appropriate device for their member,” to go above and beyond to help Schaffer says. “Sometimes the fight patients. In the past, he has worked lasts years—only to be denied at the with Challenged Athletes Foundation claims level.” to solicit running leg donations for Schaffer says that some insurers are active patients. He also contacts “not following policy guidelines or the local distributors and manufacturers’ accepted standards of care outlined representatives to ask for donated by Medicare” and the Department of parts—such as liners or feet—for Veterans Affairs. Some payors “deny patients who don’t have insurance. O&P ALMANAC | JUNE/JULY 2022



“From a more local standpoint, it’s all about growing relationships,” he says. “When you show some compassion, patients will be loyal and refer others back to you.” He believes individual acts of kindness are not only good for clinicians, but good for the O&P profession—demonstrating that the profession is dedicated to its patients and their outcomes.

Calling All Advocates

Ashlie White, MA, AOPA director of health policy and strategic alliances; Alex Gates, CPO; Sam Miller, AOPA manager, state and federal advocacy; Hannah Cvancara; and Kate Cvancara on their visit to Capitol Hill in April

Become an O&P Advocate No contribution to O&P advocacy is too small. To learn how you can get involved, try the following: Visit the AOPA Co-OP to view up-to-date information about what is happening in your state: www.AOPAnet.org/resources/co-op.

Read the State By State column in each issue of O&P Almanac for important updates.

Read up on the Medicare O&P Patient-Centered Care Act, and ask your members of Congress to cosponsor the bill—visit AOPAvotes.org for details.

Clear your calendar for next spring and plan to attend the 2023 AOPA Policy Forum in Washington, DC.

If you’re encountering a policy challenge in your state, contact Sam Miller, AOPA’s state and federal advocacy manager, at smiller@AOPAnet.org.

Join forces with local clinicians to share the O&P message in the community and at regional and state legislative sessions.

Attend the 2022 AOPA National Assembly in San Antonio, September 28-October 1, to unite with other O&P champions and discuss top-of-mind policy issues during networking events.


Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

PHOTO: Nicole Ver Kuilen


As more O&P professionals recognize they, too, can play a role in advocating on behalf of the profession, O&P’s voice will get louder. “Don’t wait to be asked to advocate. Do it yourself—help your patient beyond the exam room,” says AOPA President-Elect Teri Kuffel, JD. Even patients are beginning to recognize the power of clinician participation in advocacy initiatives. Cvancara encourages prosthetists to stretch out of their comfort zone to advocate on patients’ behalf. “Prosthetists have more power than they think in the healthcare world,” she says. “If they get to know their patients—and their hopes and dreams—they have a voice as part of their ‘continued care” for patients,” she says. “Don’t stop once the limb is done—use your voice in Congress or in the healthcare world.” Gates, for her part, encourages other clinicians to continue advocating on behalf of patients—even if it doesn’t seem to be yielding results. “Enough people chipping away at these barriers will help break them down. It won’t happen overnight—but eventually.” “We’re a very small profession,” adds Gates. “To make change, and to protect our field, we need to be more vocal than most—to speak out louder.” O&P professionals will have another opportunity to make in-person visits to legislators when the Policy Forum returns in 2023. In the meantime, there are plenty of opportunities for clinicians, business owners, and students to engage in everyday activisim.

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Tech Transitions

New materials, designs, and integration increase possibilities for O&P professionals—and patients Interviews conducted by JOSEPHINE ROSSI

EDITOR’S NOTE: For 2022, O&P Almanac has revived the popular Leadership Series, which originally appeared in the magazine in 2015, to once again feature revealing insights and opinions from senior-level leaders on topics of critical importance to the future of the profession. To complement AOPA’s launch of a new mission and vision and emphasis on “reimagining the profession,” subsequent installments of this feature will include interviews with O&P stakeholders on topics of key importance to O&P clinicians, manufacturers, researchers, and educators.


ERSONALIZED 3D PRINTING, advanced microprocessor

control, neural-machine interfaces, pressure sensor application—the world of prosthetics and orthotics has radically improved in recent years. Yet despite these and other breakthroughs, barriers exist in terms of access, affordability, functionality, and clinician know-how. With technology already so ingrained in our society, the future of balancing scientific gains with the daily needs of patients seems certain. But how do we get there as a profession? In this third installment of the revamped Leadership Series, O&P Almanac convened four industry leaders to reflect on the significance of technology on patient care and new device development, and offer some insights for what’s next.

What technology has had the most significant impact on patients? Russell Cannon: Thinking about it in terms of the entire length of my time in O&P, I would say the most significant technological advancement would be the advent of carbon fiber in prosthetic 32


feet. Prior to carbon fiber being used, we were using more standard, passive materials. In fact, when I first broke into the [field], wooden feet were still being used on some patients. And certainly, plastic or nylon were rather common. Those materials don’t really provide any energy return. All of the energy, through the full gait cycle, needed to be provided by the amputee.

Once carbon fiber was introduced, it had an energy-storing rebound effect. So basically, you take a stride, you load the toe, and that puts energy into the material that springs back. The patient moves faster, more naturally. Initially, when that material was introduced, it was considered a niche product, but before too long, just about all patients were given access to carbon fiber feet, because of the energy return property. Even lower-level, what we would think of K3 or even K2, patients were getting carbon fiber feet. Now, carbon fiber is used a lot in orthotics as well, [such as] carbon fiber AFOs. …So, both orthotics and prosthetics are benefiting from that material. Jeff Erenstone, CPO: CAD software in combination with 3D printing. CAD technology has been slowly growing in importance, but in the past 10 years, it has really been able to jumpstart forward. ... [Meanwhile, the 3D printer has] closed the loop to go from a digital design to a physical object. That object may have some shortcomings in different ways, but it is very easy to have something in your head and, within a day or so, have that physical object in your hand. Andreas Kannenberg, MD (GER), PhD: The development of microprocessor knees with full stance and swing control including stumble recovery has probably made the biggest impact on patients. What’s really fascinating is that [approximately] 90 to 95% of patients with knee disarticulation or above-knee amputation would benefit from the technology. There are only a few patients who are physically very fit, who prefer a non-microprocessor knee. But for most of the patients, in their daily lives, this is probably the technology that has made the biggest impact in the past 25 years. Shane Wurdeman, PhD, CP, FAAOP(D): As a profession, we have historically interlaced our patients’ success with the advancement of technology. For example, the introduction of silicone

Meet Our Contributors: Russell Cannon is the director of sales, North America, for Lindhe Xtend, a prosthetics manufacturer based in Sweden. He has more than 30 years of experience in the O&P profession working for patient-care providers, manufacturers, and distributors. He has served as a technician and customer service representative, and held roles in sales, production, and management. Jeff Erenstone, CPO, is founder of the nonprofit Operation Namaste and head clinician for Mountain Orthotic and Prosthetic Services. He has provided prosthetic care around the world, and has significant experience with digital technologies, especially 3D printing. He is a member of the AOPA Digital O&P Committee and Socket Guidance Workgroup. Andreas Kannenberg, MD (GER), PhD, graduated from Charité Medical School at Humboldt University in Berlin and worked as a physician in Germany for more than 10 years. He joined Ottobock in 2003 and has been serving as executive medical director of North America since 2013. He coordinates Ottobock’s clinical research in the Americas. Shane Wurdeman, PhD, CP, FAAOP(D), is the director of clinical research at the Hanger Institute for Clinical Research and Education. He holds a degree in physics, a master’s degree in prosthetics and orthotics, and a doctorate in biomechanics. He also serves on the AOPA Board of Directors as the research director.

and gel liners allowed many patients who were previously limited by pain and discomfort to be able to achieve their goals with a prosthesis. The advent of the microprocessor knee in prosthetics, and now in orthotics, enhanced patient safety to the extent that patients began to recapture their lives. But, while there continues to be advances in the devices and the components that we use when caring for our patients, the advances that are dramatically impacting our patients’

lives now are related to care delivery models. We now have a process to remotely capture outcomes for our patients through their smartphone, which are then instantly fed back into the patient’s electronic health records. I then, as a clinician, can see how the patient is doing without them necessarily needing to come into the clinic. If there is a problem, it becomes easier to identify and I can bring the patient in ASAP to troubleshoot and help them get back to where they should be. O&P ALMANAC | JUNE/JULY 2022


To go a step further, when the patient arrives at the clinic, the outcomes that we captured remotely through their smartphone are populated into a report that enables the patient to understand historically what their journey looks like in terms of progress—and setbacks. This has been very impactful; patients want to know how well they are doing.

What are some of the recent advances in microprocessor technology, and how are those advancements benefitting patients? Erenstone: I think the biggest is prosthetic knee stability: The ability for the knee to sense what’s going on and prevent a fall or improve function, so that a person is able to walk around more intuitively. That’s huge because if your knee gives out, you fall to the ground. Some of the most highly active people don’t actually need the microprocessor knees. … [O]n the other hand, someone in their 70s who is moving a little bit slower, and their coordination is not as good as it used to be, could be greatly helped by a microprocessor knee. Kannenberg: The first patients who benefited from microprocessor technology were lower-limb amputees, with the development of microprocessor knees and then later microprocessor feet. But in the past 10 years, we’ve seen some major advancements in upperlimb prosthetics, with the development of more multiarticulating hands. What’s even more important is the development of new control mechanisms like pattern recognition and targeted muscle reinnervation. In addition, microprocessor technology is now available to patients who are dependent on an orthosis to walk, like knee-ankle-foot orthosis (KAFO) users. As a result, patients with neurological conditions who need an orthosis to be ambulatory again have the passive devices like Ottobock 34


C-Brace, and patients with complete paralysis have the powered exoskeletons. These developments started much earlier, but the devices have improved over time. They have become more practical to use and more viable for O&P clinicians to fit. Wurdeman: It’s definitely an exciting time to be an O&P clinician with the integration of microprocessors making it possible to put together rehabilitation plans for patients who may not have otherwise had options for success moving forward, or perhaps their success would have been defined within a much narrower scope.

The technology is fantastic when it works properly and perfectly. But it’s not where it needs to be quite yet. Hopefully, in the next five to 10 years, some significant advancements will take place. …With our founder being our driving force, we are open to exploring anything that would help him, as an amputee of both upper and lower extremity. So, we would certainly see developing or partnering to develop a technology or a process that would help upper extremities, particularly with neuroprosthetic advancements, as a growth opportunity and emerging market for us down the road.

"In the past 10 years, we’ve seen some major advancements in upper-limb prosthetics, with the development of more multiarticulating hands. What’s even more important is the development of new control mechanisms like pattern recognition and targeted muscle reinnervation." —ANDREAS KANNENBERG, MD (GER), PHD

The emerging evidence on microprocessor ankle-feet is demonstrating strong clinical benefits for patients. Patients with reliance on a KAFO are starting to see new care plans that allow them to increase their activity and improve their quality of life by integrating microprocessor knees into the KAFO.

How do you envision emerging neuroprosthetic technologies to affect your organization? Cannon: Lindhe Xtend was founded by Christoffer Lindhe. He’s a triple amputee; he lost his left arm and both legs above the knee when he was 17. I’m close to him, and I’ve had the opportunity to see how some of the neuropathic and neuroprosthetic technologies work, both good and bad. This is a guy who’s as motivated as any amputee, and he's obviously in the industry, and he still has some issues with myo connectivity. …

Erenstone: I foresee a lot going on in the near future with myoelectric devices and device feedback, giving patients better spatial understanding. In 2016, I attended the Cybathlon competition in Switzerland. They had electric wheelchairs, exoskeletal suits, high-tech prosthetics [perform] in different categories. It’s not like the Paralympics where it’s all about the athlete; this was all about the technology. They called the users “pilots.” In the transradial arm category, the pilots had to do a number of tasks, like button some shirts, screw in a light bulb, do dishes—things like that. Bob Radocy of TRS won using the Grip 5 Prehensor. It was very much a John Henry moment to watch him outperform all the greatest and most expensive devices out there. The reason that story is relevant is the feedback, not what the hands can actually do. That’s where the neural integration is huge: to be able to get that

greater input to the device and receive that feedback back from the device. There have been some interesting steps in that direction, but we need to get directly to those nerves somehow. I think that’s what’s necessary before Bob gets beat in competition. Kannenberg: Improvements of the control for upper-limb prosthetics will have a significant impact. Many of these multi-articulating hands already offer much more function than a patient can realistically and intuitively control. The standard two-channel myoelectric control is very cumbersome to switch between the functions of the hand and the different grip types. That is not very practical. These new control mechanisms [such as pattern recognition and targeted muscle reinnervation] offer more intuitive control and more function, which is very important, but we still have a long way to go there. Regarding orthotics, the C-Brace is a passive hydraulic microprocessor-

"I foresee a lot going on in the near future with myoelectric devices and device feedback, giving patients better spatial understanding." —JEFF ERENSTONE, CPO

controlled orthosis, and the goal is to make the device ever lighter and more functional, and to improve the programming and software. Another issue [that will need to be addressed] is that the software enhancements are not considered a reason for improved reimbursement. Medicare considers all of that covered by the microprocessor codes. The [R&D work] is all included—along with all future improvements—regardless of how many man-hours or man-years you invest.

For the future, I anticipate the addition of power for prosthetic and maybe also orthotic devices. But with all of these technologies come challenges [in terms of approvals for reimbursement by payors]. Several years ago, we acquired BionX, with the only commercially available powered ankle-foot component; it is still not covered by most insurance companies. The VA covers it, but Medicare doesn’t cover it, and most private insurances don’t cover it either. Wurdeman: Consistent with all new care options, as these new neuroprosthetic technologies become commercially available, our teams of clinical experts and scientists at Hanger Clinic will evaluate when and how leveraging such devices as part of patient-care plans can yield better outcomes. When caring for patients that need either orthotic or prosthetic care, it’s important that the approach is to find the solution for my patient’s problem, not to try to find the problem for a device to solve.

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What are some of the advances in additive manufacturing that are making an impact on the design of orthoses and prostheses? Cannon: The 3D printing revolution is here. It used to be, people were doing 3D check sockets, and that was the extent. I don’t know that there was a lot of confidence in their reliability, their durability. But with improvements in materials and the 3D printing process, [the industry has] crossed the threshold of reliability for at least check sockets going toward permanent sockets. So, I think you will see the progression on this. One of the problems with trying to 3D print a foot—which has happened—[is] wear and tear. Three million cycles is the standard testing, and that’s a lot of steps. To have a 3D-printed foot withstand that kind of testing, and then actual realworld existence, is really difficult. I don’t think really much of anything, certainly nothing at a K3 or more level, could live up to that at this point in time. But I do think we’ll see it come within the next few years, even. If you were to tell me five years from now, there are 3D-printed feet on the market that are legitimately and commonly used, I wouldn’t be at all surprised. Erenstone: I would say it’s definitely the Hewlett Packard MJF, multi jet fusion printer. That’s a game changer, and part of the reason is that it’s Hewlett Packard. They have 50, 60, 70 years’ worth of patents in printing technology. When 3D came around, they were able to dip into their existing pool of patents and onboard technology rather quickly—something no one else was able to do. To go a little technical here, they’re very good at isotropic bonding, which means bonding the material evenly and without creating stress. Other technologies use lasers to bond together. As you can imagine, that heats up the material and creates some stress. Because of the chemical process that 36


HP has, they were able to make something isotropic without creating that stress and still get consistent results. Wurdeman: There are many potential applications for additive manufacturing in orthotics and prosthetics. However, I do see many people falling into the classic trap of trying to force a process to fix something that is not broken. The benefits of additive manufacturing, in my opinion, will ultimately be realized in areas that currently have no solution or solutions that don’t work well. One recent example was a 3D-printed partial hand for a pediatric patient. The vast array of presentations with partial hand amputation has made general solutions challenging, and those challenges expand when working with the pediatric patient. However, in this particular case, a custom 3D-printed partial hand, designed for the patient’s desired uses and encompassing the unique residual anatomy, resulted in a happy patient with improved function reflected in the patient’s outcomes report.

How does research on technologies inform your decisions for patient care, business implementation, or otherwise? Kannenberg: Currently, we only have Class I devices. We don’t need to do regulatory research to satisfy the FDA. The research that we do is to support reimbursements of new devices by Medicare and private insurers. For some devices, there are product categories, like microprocessor knees for above-knee amputees or knee disarticulation patients, that benefit approximately 90 to 95% of the patients [in that category of amputation]. But when we look at some other devices—for instance, the Empower powered foot—it appears that only certain patient groups really benefit from that technology. The purpose of the research is either to better define the patient

groups that are most likely to benefit from certain technologies, that is to help the clinicians match patient needs and technologies … or to improve the product or develop a training program to make more patients eligible to become responders to the technology.

"When caring for patients that need either orthotic or prosthetic care, it’s important that the approach is to find the solution for my patient’s problem, not to try to find the problem for a device to solve." —SHANE WURDEMAN, PHD, CP, FAAOP(D)

…It looks like the integration of external power into neuromuscular control is not intuitive for many patients. Some patients find a way to effectively use the power, but many patients struggle with it. [We can use the research] to develop training programs to help patients better utilize the technology and broaden the indication or the patient groups that could benefit from the technology. When you look [at] studies that published the individual results of the patients, … between 40 and 50% of the patients benefited individually. … How can we help the other 50 to 60% of the patients also benefit from the technology? Maybe [we can’t], but it’s important to ask that question and look for solutions. Wurdeman: I think the pressures of modern healthcare have made it critical that all decisions rely on research, but also recognize there is an element of experience and instinct to inform the decision. In clinical-decision making, these two

components, research and clinical experience, combine with the patient’s personal situation to form the elements of evidence-based practice.

What one app/device/software do you rely on professionally to do your job better? Cannon: Google Maps or whatever map feature you use on your phone. I’m a director of sales … and I’ve been on the road as far back as the late ’80s. …I look back and think, “I can’t believe how we used to do this.” I used to carry around maps and atlases, trying to figure out roads. I realize that answer is myopic and specific to an on-the-road salesperson, but I bet some clinicians would agree with me, too. Those who have to go to various hospitals, or clinics, or patient homes. They probably feel the same way, which is, it takes a burden off your shoulders that you don’t have to worry about prepping all of that

"If you were to tell me five years from now, there are 3D-printed feet on the market that are legitimately and commonly used, I wouldn’t be at all surprised." —RUSSELL CANNON

in advance—or reading a map while you’re driving. Erenstone: I do a lot of work with nonprofits and, specifically, Operation Namaste. There, we’ve developed a software called collaborative CAD. We’re still in beta testing, but we’re providing it free to anyone in the field. We have been using it at George Brown University during the pandemic when they couldn’t have all of the students in the fabrication laboratory together. We

geared our software toward helping them teach their class: Half the class would work in-person, and the other half would do it virtually in our software. They alternated weekly. Over the past two years, we have been able to improve the software and build in tools so they can somewhat compare classroom models to the digital models to ensure consistency. This is profound because we now can teach a prosthetist how to do modern prosthetic care without physically being with them. These virtual labs allow us to improve and break down education barriers in low-income countries. Even if someone goes to school, after they finish, they’re probably not going to have the support network back at home to help them. We have the ability to go to conferences, continuing education, and so on. There, they’re isolated and on their own. Now we can continue to work with them, keep them up to speed, and easily disseminate new, modern care.



Pro Tips and

s c i p o T t o H What’s new at the 2022 AOPA National Assembly? Almost everything



annual AOPA National Assembly is on—and with good reason. This year, more O&P professionals will be gathering in one spot than at any time in the past two-and-a-half years. AOPA is rising to the occasion, planning a dynamic educational experience featuring plenty of new content and cutting-edge presentations. “I don’t think we have ever had such a high-level faculty or such interesting programming—such as an orthotic case study based on the treatment of former NFL quarterback Alex Smith,” says Joanna Kenton, MHA, CPO, LPO, FAAOP, co-chair of the



AOPA Assembly Planning Committee. “There are so many new items this year that it is hard to cover them all!” “I’m particularly excited about this year’s theme: The Intersection of Technology & Humanity,” says Rick Riley, co-chair of the Assembly Planning Committee. The 2022 educational content is relevant and timely, according to Riley, with many sessions focused on emerging technology, 3D printing, and new research. “Each track has a diverse range of topics, and we are excited there are more than 150 speakers scheduled to present at this year’s National Assembly.”

The Clinical Education Workgroup of the Assembly Planning Committee “has worked diligently to communicate and solidify the best speakers in the industry,” agrees Charles Kuffel MSM, CPO, LPO, FAAOP, co-chair of the workgroup. Assembly participants “will be afforded an exciting in-person opportunity to meet with peers, obtain educational and business credits, and participate in hands-on workshops,” he says. This year’s Assembly education will bring to light new studies, concepts, and ideas that “were left virtually unknown for the past two years,” due to the COVID-19 pandemic, Kuffel adds. “Researchers, clinicians, and others have spent two years working behind doors and in lockdown on their research and clinically impactful designs.” The San Antonio conference “will allow those presenters the in-person opportunity to discuss their research and evidence-based practice models.” These new sessions will be offered in seven distinct categories; in addition to the traditional sessions in Orthotic, Prosthetic, Pedorthic, Technical, and Business Tracks, a new Digital O&P Care Track and a new Postmastectomy Care Track will debut this year. Here’s a sneak peek at some of the buzz-worthy sessions attendees will experience this year in San Antonio.

Can’t-Miss Clinical Sessions

Professional athlete Alex Smith became one of the highest profile orthosis users two years ago when he returned to quarterback for the Washington Football Team after a gruesome 2018 on-the-field leg injury that necessitated 17 surgeries. Assembly attendees will hear firsthand from Smith’s orthotist, Michael Muratore, CPO, in one of the most exciting sessions planned for San Antonio: “Orthotic Case Study Based on the Treatment of Former NFL Quarterback Alex Smith.” “The presentation is unique to this show. I do not recall a presentation like it in any of the shows I have attended in the past 10 years,” says Tyler Klenow, MSOP, CPO, LPO, CPT, co-chair of the Clinical Education Workgroup. Presenters—including Muratore and other members of Smith’s rehab team—will describe “the clinical details of a high-activity, highprofile user who relied on orthotic care to return him to the highest level of professional competition,” he says. Smith’s rehabilitation journey, from injury to return-to-play, will be outlined. “Rumor has it that Alex is going to record a video for attendees as well, to share his experience as a high-level end user,” Klenow adds. This session is scheduled for Thursday, September 29, at 2 p.m.


PHOTO: Heidi Muratore

g n i o G #WeAreOandP

Alex Smith The high-profile case study is just one of many new orthotic and prosthetic clinical sessions for 2022. Another session, led by representatives from the Department of Defense (DoD), including Lee Childers, PhD, CP, and several other renowned researchers, will highlight current and future studies that are ongoing at the Center for the Intrepid, Walter Reed Military Medical Center, and Naval Medical Center San Diego. “O&P Research Developments Across the DoD/VA Extremity Trauma and Amputation Center of Excellence,” held Thursday, September 29, at 10:30 a.m., offers “a glimpse into the care our service members are receiving and the innovations being accomplished by the military program,” Klenow says. “The innovative mindset has always driven our profession,” he says, “and this session will reignite the imagination of attendees to create innovations in their own patient-care practices.” Osseointegration is another hot topic and the subject of “Osseointegration in the United States—Prosthetic Implications for Today and Tomorrow.” This session, O&P ALMANAC | JUNE/JULY 2022


scheduled for Thursday, September 29, at 10:30 a.m., will have a clear focus on the prosthetic approach to care. “For the right patient, osseointegration is transformative,” says Jeffrey Cain, MD, a professor at the University of Colorado School of Medicine, and one of the speakers for this session. This discussion will cover surgical considerations and procedures, rehab, potential complications, costs, and payment challenges. “We will talk about the critically important role of the prosthetist in the success of the patient after osseointegration,” adds Cain.

Two New Tracks

Looking to expand your facilities’ capabilities? Be sure to check out two new educational tracks—O&P Digital Care and Postmastectomy Care. The O&P Digital Care Track will feature several sessions focused on digital O&P, including “Applications and Innovations of 3D Printing in Orthotics: A Digital and Clinical Joint Program,” set for Saturday, October 1, at 10:30 a.m. This panel discussion will be presented by experts armed with data demonstrating the durability of 3D-printed orthotic 40


devices. Several “old school” practitioners will share their experience in taking a leap of faith into the digital manufacturing space—and will detail the results of their initial capital investment. The new digital sessions will be capped off by an inaugural interactive experience, the Digital Care Showcase, which will take place at noon on Saturday, October 1. Participants in this hands-on event will learn about computer-based 3D design software tools utilizing a provided prosthetic or orthotic patient case, to include the patient file, a 3D scan, and positive model. Exhibitors will present a fabricated model, device, or 3D print. AOPA expects the Digital Care Showcase to be extremely popular. “The membership has been asking for ‘hands-on’ sessions for years,” says J. Chad Duncan, PhD, CRC, CPO, who co-chairs the O&P Digital Care Committee with Jeff Erenstone, CPO. “The fact is, we are a hands-on profession—and what better way to engage membership? Additive manufacturing [is] unknown to some and very new to others. Being hands-on will allow membership to engage in a way that we hope is beneficial to their learning and allow for richer conversation about digital care.” In one of several sessions in the all-new Postmastectomy Care Track, experts will discuss the growing need for certified mastectomy fitters. The session, “Keeping Pace With Surgical Advancements—Partial Forms Play a Key Role,” will take place Thursday, September 29, at 10:30 a.m. Moderated by Tanya Baer, CFom, a panel of industry experts will discuss the growing need for nontraditional breast forms, given a rise in lumpectomies in place of mastectomies. Attendees will “learn about an avenue of the postmastectomy care that is growing and not being as utilized as it could be,” says Baer, and “come away from the presentation with a better understanding on the use of partial breast prostheses and more options in the provision of care for their patients.”

“Breast cancer is a complicated disease and a complicated recovery,” adds Rebecca Weldon-Martin, CMF, CFm, who will also speak at the partial forms session. “Once the cancer is removed, there is usually a lifetime necessity for products that can improve the quality of life for the breast cancer patient. Most of these women have no idea what products are available and how they can help. … In particular, women who have had partial mastectomies or restorative surgeries are especially in need of assistance and guidance toward products that will help them.” O&P professionals “can increase your patient base and have a wider outreach in your community” by embracing postmastectomy care, Weldon-Martin says.

Fabrication Tips and Tricks

Within the Technical Education Track, a new “Fabrication Tricks & Tips” session is sure to be of interest to attendees who create orthotic and prosthetic devices. This session will showcase tips from members throughout the country, who submitted three- to five-minute videos explaining their O&P “trick or tip” to be considered for inclusion. During the Assembly, session attendees will vote for their favorite tip—and winners will be awarded cash prizes. “The video submissions we have received focus on improving outcomes,” says Joanna Kenton, MHA, CPO, LPO, FAAOP, co-chair of the AOPA Assembly Planning Committee. “This includes materials used in fabrication, equipment, and tools for efficiency.” Attendees can expect to learn about various cosmetic finishing techniques, tips for working with black polypropylene, 3D imaging lamination, partial foot lamination using a carbon footplate, and patching holes in suspension sleeves, according to Kenton.

Extend your range. Introducing the Motion Foot SLX. Lightweight. Short. Waterproof. No special maintenance. Finally, a hydraulic ankle foot developed for the patient and their prosthetist.


© 2022 Fillauer LLC

Better Business Practices

The Business Education Track at AOPA’s National Assembly is renowned for top-notch and futurefocused information that empowers O&P professionals to revamp and revise their business practices. This year, attendees will have several

sessions with brand-new content to choose from, beginning at 2 p.m. on Thursday, September 29, when three industry experts will present Hamontree speeches on topics of critical importance to O&P businesses, and attendees will vote for their favorite presentation.

Profit-minded business owners will want to be in attendance for the first Hamontree lecture, “The Three Things You Have Control Over To Speed Up Your Cash Flow.” Stacy Toner, CBCS, will share her expertise as chief operating officer at CBS Medical & Building Consulting LLC.

Excitement Beyond Education The 2022 AOPA National Assembly has much to offer in terms of location, exhibit hall, and networking events. Situated in downtown San Antonio, the conference center “is an impressive facility, right on the city’s River Walk—with hotels conveniently located beside the show site,” says Rick Riley, co-chair of the AOPA Assembly Planning Committee. This year’s exhibit hall will feature hundreds of cutting-edge products and technologies from worldwide manufacturers and O&P innovators. Attendees will have additional opportunities to convene and network in the exhibit hall this year. AOPA will launch the “O&P Experience Zone” on Thursday, September 29—a fun, interactive event showcasing patient success stories and their caregivers. The Experience Zone will be held in conjunction with a traditional happy hour on the exhibit hall floor. O&P professionals will meet and greet colleagues and contacts during a new “networking icebreaker” during exhibit hall breaks, according to Joanna Kenton, MHA, CPO, LPO, FAAOP, co-chair of the Assembly Planning Committee. Friday’s lunch in the exhibit hall will have a traditional Texas barbecue theme, complete with cornhole and other games. Assembly-goers may spy dozens of “next-generation” recruits on Thursday, September 29. “We have invited two local, health career and STEM-focused 42


high schools to join the Assembly,” says Kenton. AOPA expects approximately 80 high school students to visit the convention center for a short presentation to learn about the O&P profession and glean insights from keynote speaker Mona Patel, who is local to San Antonio. “Then the students will break up into smaller groups” to visit the exhibit hall with tour guides, Kenton explains. They will learn about O&P products and how they assist patients, then have lunch and hear about experiences from those with limb loss. “We believe that this is a valuable opportunity to share about our amazing profession,” Kenton adds. “To hear from us and our stakeholders will be a powerful introduction to explore a career in O&P.” Perhaps the most highly anticipated aspect of the conference is the in-person interactions. “While an online option is available and a great way to earn continuing education credits, it cannot compare to physically being at the convention center,” says Kenton. “The exhibit hall experience has an energy and a pulse that’s all its own. It allows us as professionals to network—to learn what is new and available so we can ultimately benefit the people we serve.” AOPA members and O&P stakeholders “are ready to see each other’s faces and smiles,” says Riley. “There is pent-up demand for a big meeting that feels normal.” Riley anticipates a “great turnout” for the 2022 event. “The National Assembly is an ideal forum for gaining knowledge and building relationships,” he says. “Supporting our industry, supporting each other—that’s how we improve care and quality of life for O&P patients.”

She will inform participants of the three common causes for revenue cycles “to become disrupted and even screech to a halt.” Toner will share insights and analysis into these trends and how to identify, correct, and avoid them. “Attendees will leave with an understanding of the importance of every step of the revenue cycle,” she says, “and tools and tips on how to make their practice’s revenue cycle management strong and efficient.” The second Hamontree presentation, headlined by Gerald Stark, MSEM, PhD, CPO, LPO, FAAOP(D), will explain the findings of a “Survey of Emotional Burnout and Its Effects on Innovation in O&P.” Stark will examine the definitions of “emotional intelligence” and “emotional burnout” as they relate to O&P. He will discuss findings on the levels of burnout among demographic groups, looking specifically at certification levels, experience, work context, and job function in O&P, especially during the pandemic. O&P professionals who understand the value of outcome measures will want to stay for the final Hamontree presentation, “Using Outcome Measures To Justify Medical Necessity, Reimbursement, and Business Development in RealLife Settings,” presented by Jason Kahle, MSMS, CPO, LPO, FAAOP.

This presentation will discuss a novel approach to using available outcome measures to assist the clinician who is accountable for justifying medical necessity—recognizing that clinicians’ time and accountability must be considered. Kahle will “discuss outcome measures that have the best ecological validity,” he says. “These ecological outcome measures are not commonly discussed, have internal validity, are sanctioned by Health and Human Services (HHS), CMS, and Office of the National Coordinator (ONC), used every day by treating physicians, and consider medical necessity and reimbursement.” Justifying medical necessity and being accountable for patients’ needs “starts with understanding the healthcare climate for treating physicians,” says Kahle. HHS’s and ONC’s directive for quality incentive programs now dictates that physicians are paid incentives based on four considerations—quality, cost, improvement, and interoperability—so “the O&P profession must become attentive to the expectations that have been forced on physicians … and should consider these same outcome measures for our population of patients.” Aside from the Hamontree presentations, additional business sessions touch on hot topics to help O&P businesses increase revenues and avoid claim denials. Attendees won’t want to miss the “Medicare Updates

and Comprehensive Error Rate Testing (CERT)” session on Thursday, September 29, at 10:30 a.m. Experts on this topic—the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Outreach Team—will present an overview of recent changes and updates to the Medicare program. The DME MACs also will address the most common CERT denials for O&P claims and provide resources to help avoid and resolve common errors.

Something for Everyone

From Alex Smith, to osseointegration, to additive manufacturing and more, this year’s Assembly will feature innovative education with a great deal of never-seen-before content. The sessions highlighted above are just a small sample of the education being prepared for this year’s event. [For the full schedule of sessions planned for the conference see the Preliminary Program included with this issue, or visit www.AOPAassembly.org.] Of course, for those who cannot attend, and for those attendees who want to see sessions they may have missed, AOPA is recording all sessions. “If an attendee would like to review or watch another session of interest, they will be able to do so through December 19,” explains Kenton. “This is especially helpful to our attendees and is unique to the Assembly since the onset of the pandemic.” O&P ALMANAC | JUNE/JULY 2022



Prioritizing Student Well-Being J. Chad Duncan, PhD, CRC, CPO, brings years of experience to his latest task: launching a master’s program

O&P Almanac’s new O&P Educator column focuses on experienced educators within the O&P profession. Here, you will get to know inspiring individuals who educate the next generation of O&P professionals.



Made for the Moment

J. Chad Duncan, PhD, CRC, CPO, worked closely with a team in designing the space for the new O&P master’s program at Salus University. 44


Duncan’s own educational experience perfectly prepared him for designing the new master’s program. He first discovered O&P as an undergraduate at Auburn University in the early ‘90s. “I did a job shadow in pediatric orthotics, and I fell in love with it,” he recalls. He worked as a prosthetic technician while earning his bachelor’s degree in rehabilitation sciences, and continued to work as a

technician after moving to Chicago to pursue certificates in orthotics and prosthetics from Northwestern University. After receiving ABC certification, Duncan moved back to his hometown of Auburn to work in O&P clinical practice. There, he was introduced to teaching: He was invited to give a two-hour lecture to undergraduates on O&P. “The professor who invited me to speak asked me to consider teaching,” which spurred his decision to pursue master’s and doctoral degrees at Auburn and transition to full-time teaching. Duncan’s influence within the field of O&P education is unmistakable. The O&P program at ASU won accreditation by NCOPE in 2012. He moved back to Chicago to work on faculty at Northwestern University’s Prosthetics-Orthotics Center (NUPOC), eventually becoming director—fulfilling a professional dream. In addition to his teaching roles, Duncan has contributed to the O&P community as a member of AOPA National Assembly Planning Committee, a licensure board member, a speaker at dozens of conferences and industry events, a content developer for NCOPE materials and ABC item writer, an author of journal articles and book chapters,

PHOTOS: J. Chad Duncan, PhD, CRC, CP; Hope Daluisio

prepares to open the doors to a new O&P master’s program at Salus University, he is pulling from his extensive background in education to create a unique learning environment for the next generation of O&P clinicians. “‘Salus’ means well-being,” Duncan says, “so we’ll be focused on student well-being” in the program set to launch in August on campus in Elkins Park, Pennsylvania. Before taking on the role of chair and program director of orthotics and prosthetics at Salus last year, Duncan served as director of Northwestern University’s Prosthetics-Orthotics Center (NUPOC). Prior to that, he was chair and program director at Alabama State University (ASU)—a program he helped build from the ground up 10 years ago.


and a mentor to several master’s students completing their capstone projects. He also is an inaugural member of AOPA’s Diversity, Equity, and Inclusion Committee. Duncan has won several teaching awards, including the 2021 Best Teachers of Feinberg Award at NUPOC. The decision to move from Chicago to Pennsylvania two years ago was a difficult one for Duncan—but he knows he made the right choice. “I was in my pinnacle job at NUPOC” when he and his wife decided to move closer to family on the East Coast. The move led Duncan to his current position at Salus. “Since I had already gone through the process of building a program from the ground up [at ASU], I decided to build this program a bit differently,” incorporating some new concepts. He is leveraging the lessons learned at both ASU and NUPOC as a foundation in creating the new program—and integrating new concepts as well.

Setting a New Tone

The Salus program will complement several existing healthcare-related programs at the university. Duncan is working to establish curricula that align with standards put forth by NCOPE within the interdisciplinary model already established at the university. Salus expects an initial class of 12 O&P master’s students, overseen by four faculty. The small cohort will enable faculty to be flexible, taking a “nimble” approach the first year to allow for adaptation to improve the program as necessary. So far, Duncan has hired a lab manager, an administrative assistant, and two faculty; he expects one more faculty member will be on board by August 1. The newly constructed space features plenty of room for lab work. “The lab is on the fourth floor, with lots of windows, lots of light, and open space,” Duncan says. The lab promotes interactive, rather than

passive learning, and it has room for growth as new technologies advance and become integrated into the NCOPE curriculum. “I’m a lab rat and believe in hand skills,” says Duncan. “I want our students to practice, and to become comfortable with different materials, so that when they’re working with patients they can focus.” NCOPE representatives recently conducted a site visit and subsequently granted Candidacy, which will now allow the university to accept the inaugural class. Orientation is set to begin August 15. Duncan believes in a flipped classroom model, which is more interactive than traditional learning. A flipped classroom is structured around the idea that lecture or direct instruction is not the best use of class time; students come to class having already encountered the information, then spend class time engaging in activities that involve higher order thinking.




Rendering of O&P area within Salus University’s Elkins Park, Pennsylvania, campus

















(12) 5'-0" X 2'-6" WORK BENCHES OVEN




This approach encourages “focused learning” among students, Duncan says. “They learn from home and then focus on active learning while in class.” For the most part, Salus O&P N program content will be similar to content at the other O&P schools, which must all adhere to the NCOPE standards. “The introductory courses will remain the same” as at the other schools, says Duncan. But in some of the more advanced classes, “we will take a slightly different spin,” he says. “Since I have a background in rehabilitation, I’ve worked with a wide range of disabilities. In the rehab world, we’re always looking at the assets of an individual person, and we’ll be incorporating rehab principles into O&P.” Salus’s program is unique in that “its whole curriculum is based on cultural humility,” says Duncan. “The goal of this approach is to push the next generation of clinicians into being more holistically focused on patient care.




PHOTOS: Hope Daluisio

IMAGE: J. Chad Duncan, PhD, CRC, CPO 11X17


I hope this approach draws diverse interest to Salus’s O&P program.” Salus faculty will emphasize listening to students and will encourage diverse andPROPOSED inclusive studies. “We’re trying to ORTHOTICS & PROSTHETICS LAB bring the profession together,” Duncan explains. Professors will ask students to become “listeners who make things” to improve quality of life for patients, while being open to differences and diversity, he says. An independent study portion of the program will be based on heutagogy, or self-determined learning, under the guidance of a mentor. “Learners will drive their own experience and learning through others, and take ownership of their education.” This approach is designed to inspire lifelong learning and an openness to others, according to Duncan. Scale: 1/8" = 1'-0" Date: SEPTEMBER 29, 2021 ELKINS PARK CAMPUS - WEST WING

Readying Adult Learners

Recognizing that students are preparing for important clinical roles while completing their master’s work, the

Salus program embraces the concept of andragogy—the method and practices of teaching and giving the students an understanding of the why, to be independent, hands-on, and adult learners; this approach will help prepare students for residency, according to Duncan. The Salus program will be only the second O&P master’s program to feature an integrated residency. Students will complete their didactic work in 16 months, then take part in an 18-month residency while continuing to follow independent study. With only 12 students in the first cohort, Duncan hopes that all students will be able to complete their residencies locally, so he and his colleagues can fully support them. To ensure optimal instruction, Duncan plans to train faculty in educational best practices. “Most O&P professors don’t have backgrounds in education,” he says. He has consulted an expert on principles of teaching to help the instructors perfect their teaching strategies as the program develops. Today’s O&P students are more than ready for the educational strategies that


will be employed at Salus, according to Duncan. O&P master’s candidates in 2022 are highly motivated, highly educated students who are intentionally choosing the profession, he says. Duncan hopes the Salus program will help give students an identity within the profession, and that they will feel as though they already play integral roles within O&P—even as students. Current students also are at an advantage when it comes to understanding new technologies, according to Duncan. Many enter master’s programs already familiar with additive manufacturing and the digital workspace—concepts the O&P profession is gradually adopting. “These things are the next big phase,” even as hand skills continue to be needed, he says. “Scanning can be used as a tool to modify and collect data, even if we’re not using it for all patients. “We’re becoming more data-driven and more outcomes-driven. That’s where the profession is going, and that’s where education needs to be.”

Educating Current Professionals on Cutting-Edge Technologies In addition to his many roles in educating O&P students over the years, J. Chad Duncan, PhD, CRC, CPO, has been involved in education for professional clinicians at venues such as the AOPA National Assembly. For the past several years, Duncan has helped plan the clinical content at the annual event, working closely with Charles Kuffel, CPO, LPO, FAAOP. He has been involved in determining and selecting session topics and poster presentations, as well as identifying Thranhardt lecture candidates. This year, Duncan, along with Jeff Erenstone, CPO, co-chairs the O&P Digital Care Committee, which will launch a new educational track at the Assembly in San Antonio. According to Duncan, this track will help alleviate the concerns of clinicians who are nervous about new technologies and wary of moving “out of

their lane.” The education on digital topics will expose AOPA members to newer technologies and increase their comfort level, says Duncan. “We’re trying new things” in this track, he says. For example, the O&P Digital Care Track will include a new interactive experience during a breakout session, where companies can consider two case studies—one in prosthetics or one in orthotics—and share with participants how they would handle the cases leveraging their technologies, according to Duncan. “This will be a more immersive experience and informative for Assembly-goers,” he says. Duncan also encourages attendees to consider the content on additive manufacturing within the Digital Care track, which will touch on the many ways 3D-printing technologies can be integrated into O&P facilities.

Deliver stability and smiles Solutions head-to-toe Surestep offers a full range of custom fabricated orthotic solutions for your pediatric patients. For over 20 years, we have been providing superior quality and innovative products.

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Catdaddy Consulting


O&P Partner Consulting firm assists both patient-care facilities and technology firms in optimizing operations





A clinician fits a confidence socket from Adapttech, one of Catdaddy’s consulting clients.

Mark Ford

COMPANY: Catdaddy CONSULTING OWNER: Mark Ford LOCATION: Jamestown, Ohio HISTORY: Three years

A wearable pressure monitoring system and app from Amparo, another client of Catdaddy

than 100 years of experience among them. “We have CPOs, MBAs, and CPAs on our team.” On the patient-care side, Ford and his team offer business analytics, training programs, marketing support, and contract assistance with insurance companies. Catdaddy recently added fractional management staffing to its services. “Most small companies can’t afford and don’t need a full-time chief operating or chief financial officer,” he notes. “We offer these smaller businesses access to highly experienced people on an as-needed basis to help them determine strategy, and then work with them to set up ongoing systems and processes to run more efficiently.” Catdaddy’s work with technology companies focuses primarily on firms outside the United States. “Many of these companies were founded by engineers so they know their products extremely well. But creating a commercial success takes more than a good product,” says Ford. “Commercializing a new healthcare technology requires an understanding of reimbursement, how to work with distributors,

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

PHOTOS: Catdaddy Consulting

O&P career in 1998, after working in agriculture. He knew that he wanted to get into the healthcare industry and took a marketing position at what was then Ohio Willow Wood (today WillowWood) to gain some experience. “I planned to be there for a year or so,” and then ended up staying close to 10 years, Ford says. He worked in marketing, sales, customer service, and training, as well as in the CAD/CAM department. He moved on to Touch Bionics, as the Scottish company’s third U.S. employee, helping to build its infrastructure in this country. “It was so exciting to build a company from nothing with an entirely new technology,” remembers Ford. He followed that position with almost five years at OPIE Software, helping to build OPIE Business Builders and to introduce the OPIE Choice Network. Ford then used that experience to help lead a patient-care practice, Prosthetic and Orthotic Associates, located in New York. Ford never planned to create a consulting business, but his varied background and connections in the industry led past customers and associates to ask for his help in the patient-care space. In addition, his former boss at Touch Bionics asked if Ford was interested in helping young, early-stage British and European companies that were developing new O&P technologies to bring them to market in the United States and elsewhere. Today, Ford has a team of seven consultants under the Catdaddy umbrella, with more

and even how best to package the product efficiently.” His team helps young companies with these activities. so they can enter the U.S. market in “a more positive, effective way.” Among Catdaddy’s clients is Portuguese-based Adapttech, which has developed a socketpressure measurement system, leveraging customized sensors connected to an iPad through Bluetooth to give the clinician real-time information. Another firm, Amparo Prosthetics, started in Germany and has developed a new way to create prosthetic sockets by utilizing innovative material science. “When working with either patient-care practices or with technology clients, our goals remain the same: to be the brutally honest voice of the customer,” says Ford. Ford believes the O&P industry is undergoing another significant evolution. “We’re seeing a lot more vertical integration, as large manufacturers are setting up patient-care divisions,” he says. “What’s really interesting, though, is that we are seeing more new, creative product development happening outside of the major players in the O&P field. We strongly believe that there’s a greater opportunity for O&P practices to access new tech from young companies” that are seeking U.S. partners. “This time of change presents so many opportunities for independent practices to be successful by taking advantage of new technology and running more efficient practices,” Ford says. “We are excited about how young technology companies can partner with open-minded practices to help patients even more in the future.”

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Let us support you. For more information on membership, or to join, call 571/431-0810 or email bleppin@AOPAnet.org.

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Cranial Kids


Penchant for Pediatrics Clinician in Colorado specializes in cranial remolding orthoses





Kristen Thessing, CPO, scans a patient for a cranial remolding orthosis. adjustments has been my biggest success story,” Thessing says. Today, Thessing has her own facility in Colorado Springs, OWNER: Colorado, where she partners Kristen Thessing, CPO with Mosaic Orthotics and Prosthetics, a pediatric-focused LOCATION: practice. Her four daughters are Colorado Springs, 7, 9, 11, and 12, and Thessing works Colorado a flexible four days a week so she can continue to “be a mom.” HISTORY: Thessing uses the Orthomerica Four years SmartSoc scanning system, which allows her to create photo scans on her smartphone and upload them to Orthomerica to fabricate the helmets. She plans to get the Orthomerica STARscanner for the office while continuing to use portable technology for home visits. Outcome measures are integral to her treatment, as the software takes measurements at the first evaluation and again when the patient “graduates,” Thessing awards allowing Thessing to see the patients “certificates of results of the cranial remolding completion” once their treatment is finished. therapy. “We send that information to physical therapists and pediatricians,” she says. “It is a

FACILITY: Cranial Kids

fantastic measure of success.” Thessing is passionate about her patients, and she says that fair reimbursement from Medicaid is essential to treating patients. “Medicaid reimbursements are being cut in Colorado, and we have to fight for it,” she says. “AOPA has been a huge help in fighting for fair reimbursement. They also have resources for a clinician starting a business—like me—who doesn’t necessarily have a background in business. They were a great help when I got started.” Another passion for Thessing is helping orphans in Africa. Each year, she travels to Uganda and Kenya to work with young people through Faith, Hope, and Love Missions. Looking ahead, Thessing hopes to hire another orthotist “with a heart for cranial orthoses” and increase her practice’s presence in the Pueblo area. She wants to educate the public and medical professionals about the benefits of cranial remolding helmets. “My mission is to give families the choice to treat infants. Many times, they aren’t even given the option, and when I see them at age 1, it’s too late,” she says. “Helmets are completely successful if we can start early and they are worn 23 hours a day.” Meanwhile, Thessing revels in her job. “I love the interaction of moms and newborns. It’s a hard treatment, but I walk the journey with them.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Cranial Kids

Kristen Thessing, CPO, entered the O&P field as the result of a personal experience. In Thessing’s case, she lost her leg below the knee after a car accident while she was serving in the Peace Corps in South Africa in 1999. Four months later, she ran a four-mile race. A year later, she enrolled in the prosthetics and orthotics program at the University of Texas Southwestern. After completing two residencies and obtaining her certification, Thessing worked for Hanger Clinic for 14 years in both prosthetics and orthotics. During her fourth year, she began to have children and decided to reduce her work hours. She focused on pediatrics as a part-time orthotist and grew the cranial remolding business for several years, then “took a leap of faith” and started her own company in 2018. Thessing launched Cranial Kids with a flexible schedule that allows her to do the work she loves. Early on, she maintained a small office space at her husband’s physical therapy clinic, but worked mostly out of her car, visiting patients at their homes with portable scanning technology. “Success stories come from home visits,” she says. “Some families don’t have a car and can’t get to appointments,” and home visits enable her to get to know the family better, see the patient’s home environment, and help them with a treatment they may not have received if they had to drive to weekly appointments. “My ability to go to homes and make


AOPAversity Webinars

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for the most up-todate information on specific topics during these one-hour 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.


August 10 Roadmap to Appeals Hear the latest information about the O&P appeals process—mark your calendar now for the August 10 webinar.

October 12 Clinicians’ Corner— Prosthetics Join AOPA for the final Clinicians’ Corner of 2022. Learn tips, tricks, and insights while earning scientific credits.

September 14 An Operations Presentation

Learn how your daily operations can impact your business: Discover strategies to improve your operations by preventing denials, improving practices for patient intakes, and more.

Register for the AOPA National Assembly


HE 2022 AOPA National Assembly,

September 28 through October 1 in San Antonio, is your intersection of education and connection. It represents the intersection of humanity and technology, of the patient and clinician. It will generate synergy and passion for all that we have accomplished and motivate us to further the profession. Whether learning about the latest in clinical education, talking to a colleague about how they have evolved, getting your hands on new products, or celebrating with friends—there is something for everyone at the 2022 AOPA National Assembly. And whether you are in-person or virtual, unique content will inspire motivation and expand your knowledge. You won’t want to miss: • The best of the best in education including two new tracks, O&P Digital Care and Postmastectomy

• The ability to earn more than 100 CE Credits • Learnings from top researchers, practitioners, and business experts • Special guest speakers, including representatives from Medicare, VA, and DOD • Highlights from AOPA-funded research • All the fabulous exhibitors • The opportunity to catch up with old friends and colleagues while meeting new ones

• Special events such as the Welcome Reception, Women in O&P event, the O&P PAC Reception, and new this year—the O&P Experience Zone.






In addition to the in-person Assembly, AOPA will be offering all of the education virtually. This content will be available for 60 days starting October 17. Registration is now open. There are two registration options, in-person with virtual access or virtual only. Both will have access to the online content for 60 days post-Assembly. Register at https:// aopa.omnievent.com/2022/step-1-prelim. O&P ALMANAC | JUNE/JULY 2022



Welcome New AOPA Members


HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic

Association (AOPA) are pleased to present these applicants for membership. Each company will become an 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. MOZN Solutions 3811 Pebble Creek Road Midlothian, VA 23112 757/535-5477 www.moznsolutions.com Jessica Norrell, MBA, CPO Supplier/Consultant

Unlimited Tomorrow Inc. 6579 Spring Brook Avenue Rhinebeck, NY 12572-3711 518/429-1334 www.unlimitedtomorrow.com Sean Jones Supplier


O&P PAC Update


HE O&P PAC UPDATE provides information on the activ-

ities 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 recently received donations from the following AOPA members*: George Breece Elizabeth Ginzel, MHA, CPO, LPO Matthew Nelson, CPO Lesleigh Sisson, CFm Susan Vicino 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 22, 2022. Any donations or contributions made or received on or after June 22, 2022, will be published in a future issue of O&P Almanac.

AOPA Member Benefit

AOPA’s Co-OP is

THE Compendium of O&P A confluence of coding, billing, and policy information, the AOPA Co-OP provides a cooperative space for collaboration among O&P colleagues. This easily accessible, online resource enables your organization to be successful in today’s everchanging healthcare environment.

Resources include: State-specific insurance policy updates L Code search capability Data and evidence resources, and so much more!




After creating your Co-OP account, Download to your mobile device at aopanet.atlassian.net.

FOLLOW US @AmericanOandP

Learn more and sign up at www.AOPAnet.org/co-op. www.AOPAnet.org


Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email bob.rhmedia@comcast.net. Visit bit.ly/AOPAMedia2022 for advertising options.

KiddieFLOW™ In response to clinician requests for an orthosis with more foot plate flexibility, Allard USA has extended its pediatric AFO line with KiddieFLOW™. KiddieFLOW™ allows for better control of foot positioning in late swing, which aids in stability during stance. FLOW models offer increased ROM in the sagittal plane and a smoother transition (flow) throughout the gait cycle. For more information, contact customer service at 888/678-6548 or info@allardusa.com and request your free Product Selection Guide!

VIP by ALPS The VIP is ALPS’ air expulsion integrated pump for creating elevated vacuum in prosthetic sockets. The VIP stabilizes the residual limb, minimizing volume fluctuation throughout the day, thereby reducing pistoning and increasing comfort. Top features and benefits include: • Two interchangeable vacuum levels: high (red) and low (green) • Simple and durable: no battery or hoses • Easy installation • Low maintenance • Lightweight and quiet • Improves and preserves residual limb skin • Provides better proprioception and socket stability. To learn more about ALPS’ VIP, visit www.easyliner.com or call 727/528-8566 or 800/574-5426.



FITEC by Apis Apis’s all new lowcost diabetic shoe program FITEC offers a competitive selection and aims to add more cash to your bottom line. These shoes come with one pair of heat moldable tri-lam diabetic inserts (billable under A5512). Fly-knitted styles are breathable, water-repellent, and slip-resistant, and are offered in a variety of widths and sizes. Call us for free display samples at 888/937-2747.

The Original Preflexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

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.

MARKETPLACE More Torsion in a Lower Profile It’s the AllPro performance you have come to expect with an even smoother rollover and forgiveness on rough terrain or around town. The IP67 waterproof XTS unit provides adjustable torsion and vertical shock reduction without sacrificing build height. This field-serviceable unit is built with an active lifestyle in mind. For more information, visit https://fillauer.com/allpro.

C-Brace®: Step Into Your Future

Naked Prosthetics

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com.

The Xtern, a Life-Changing Solution for Foot Drop Patients by Turbomed Orthotics

C-Brace is the world’s first swing and stance phase control orthosis (SSCO®) with microprocessor sensor technology. Compared to the functionality of traditional KAFOs, C-Brace supports the user during the entire gait cycle and adapts to everyday situations in real-time. C-Brace defines a new level of mobility, whether it’s navigating slopes or going down stairs step-over-step. Your patients can take on new terrain and get back to doing what they love with safety, stability, and confidence in C-Brace. Learn more at shop.ottobock.us or scan the QR code.

Say goodbye to your painful and stiff in-shoe orthosis! This revolutionary brace, specifically designed for people suffering from foot drop, has one thing in mind: movement. The Xtern sits entirely outside the shoe (and, to add to that, to any shoe!), and is so flexible that it allows maximal range of motion and calf muscle strength. No more rubbing injuries or skin breakdowns: You’ll barely notice it’s there. Walking, running, mountain climbing, skiing? Not a problem! The Xtern will follow you as far and as long as you want. Turbomed’s innovative products are designed in Quebec, Canada, sold in more than 30 countries around the world, and distributed by Cascade in the United States. Visit turbomedusa.com, and think outside the shoe!



MARKETPLACE Hersco 3D Printing

Expert-Selected Lower-Limb Solutions

Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800/301-8275, for a free sample.

Ottobock iFab EasyScan 3D Scanning Solution

Ottobock’s product experts examined our full range of lower-limb products and designed winning combinations with ideal patient outcomes in mind. With six recommended combinations, there’s something for everyone. Winning combinations are driven by the priorities of your patient, such as activity level, foot preferences, hygiene needs, optimal volume management, and so much more. One of the winning combos even features the most preferred MPK, Ottobock’s trusted C-Leg. With these expert-curated options at a 25% discount, providing your patients with the best components for their desired outcomes is easier than ever. Learn more at shop.ottobock.us or scan the QR code.

Quattro by PROTEOR

Equipped with an ergonomic and easy-to-use camera, enhanced tracking behavior, and texture detection, the EasyScan provides an accurate 3D image of the residual limb, even for the most complicated fittings. As you scan the residual limb, you can follow your results in real-time and make adjustments with Ottobock’s iFab platform solution. Contactless detection of the patient’s residual limb and shortened process times during scanning provides an improved experience for both you and your patient. Embrace the digital future and learn more about EasyScan at shop.ottobock.us/EasyScan or contact us at 800/328-4058. 56


Freedom QUATTRO microprocessor knee (MPK) by PROTEOR is designed to give users the freedom to live their lives without interruption. With PROTEOR’s innovative H.A.R.T. Control Technology, Quattro is the first MPK to provide a unique customized experience that captures users’ distinctive gait patterns. Boasting 20 user modes, remote data capture, outcome measure reporting, and independent resistance for stairs/ramps and sitting, it challenges and drives the status quo for MPKs to the next level. For more information, visit www.FreedomQuattro.com.



Opportunities for O&P Professionals

Northeast, Mid-Atlantic, Southeast Boston Orthotics & Prosthetics Launches New Hiring Program for Experienced Clinicians

Job Location Key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. 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

Boston O&P is searching for experienced O&P professionals who want to work in a new clinic in the geographical area of their choice, but may be limited by noncompete agreements with their existing company. We understand that experienced clinicians may have noncompete contracts that limit their ability to practice in a certain area for a specified period of time. Our new program ensures that your contract is honored by relocating you to one of our established clinics outside the restricted area, where you will learn our culture and service programs. We offer flexible schedules to limit the amount of time you are away from your family. Once your noncompete requirements have been honored and your training is complete, you will move to the new clinic near your home, where your role will involve building the internal team to improve the quality of pediatric care in that market and actively building the practice. To be considered, candidates can simply follow this link https://www.bostonoandp.com/for-providers/ experienced-clinicians-new-clinics/. For more information, confidentially contact Boston O&P President and CEO Tom Morrissey.

Contact: Tom Morrissey Email: tmorrissey@bostonoandp.com

FOR SALE: Orthotic Equipment For more opportunities, visit: http://jobs.AOPAnet.org.

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.

Recently retired business owner of a small orthotic fabrication lab is selling orthotic machinery, equipment, and inventory valued at $20,000 retail. Seller is willing to accept 50% of value. This is a great opportunity for a practitioner seeking to work for himself or a company wanting to open a satellite facility to build their business. Take advantage of this valuable offer. For more information: Contact: Bob Genaze, CPO Email: rgenaze@gmail.com Cell: 708/807-3876

Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com O&P ALMANAC | JUNE/JULY 2022




September 14

An Operations Presentation. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

September 28–October 1

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

October 12

Clinicians’ Corner—Prosthetics. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar


October 15

POMAC’s One-Day Pedorthic, Orthotic, and Prosthetic Program. The Marriott New York LaGuardia Airport Hotel (across from LaGuardia Airport), East Elmhurst, NY. Contact Drew Shreter at 800/946-9170, ext. 101, or dshreter@pomac.com for more details.

July 1–31

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit ABCop.org/contact-us.

November 9

The Do’s & Don’ts of Gift Giving. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

July 13

Clinicians’ Corner—Orthotics: How To Get Started Into Digital Workflow. From Scanning, to Carving, to 3D Printing, the Next Step for O&P. 1 PM ET. Register at www.AOPAnet.org. Monthly Webinar

November 9–11

New Jersey Chapter of American Academy of Orthotists and Prosthetists (NJAAOP) Meeting. Atlantic City, NJ. For more information, visit www.njaaop.org/annual-meeting.

August 1–31

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at ABCop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit ABCop.org/contact-us.

2023 May 19–20

Orthotic & Prosthetic Innovative Technologies Conference. Minneapolis, MN. For updates, check our website at optech.ucsf.edu. Email cme@gilletteSave Lorem Ipsum childrens.com tothe beDate! added to conference mailing list.

August 10

Roadmap to Appeals. 1 PM ET. Register at Monthly Webinar www.AOPAnet.org.

May 19 & 20, 2023

August 18–19

September 6–8

Shirley Ryan Ability Lab—Growing Up With CP: The Teenage Years. Chicago. Held virtually, 11 ABC credits. Contact Leslie Marriott at 312/238-6839 or visit www.sralab.org/CP22.

Calendar Rates

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.



AOPA National Assembly. Indianapolis, IN. For more information, visit www.AOPAnet.org.

Words/Rate 25 or less 26-50 51+

Member $40 $50 $2.25/word

Nonmember $50 $60 $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.


Advertisers Index Company




Aether Biomedical




Allard USA












Apis Footwear Company




Becker Orthopedic




Cailor Fleming Insurance




College Park Industries




Dr. Comfort








Ferrier Coupler Inc.












Naked Prosthetics




27, C4











TurboMed Orthotics





Finding your next job or hire just got easier with the AOPA Career Center. For Job Seekers: Job searching is easy with the pane-view job search page. Set up job alerts, upload your resume or create an anonymous career profile that leads employers to you. For Employers: Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email.

For more information on recruitment options, contact Customer Service at clientserv@communitybrands.com or (727) 497-6565.

AOPA_PrintAd.indd 1

Log in at jobs.aopanet.org to get started!

O&P ALMANAC | JUNE/JULY 8/19/21 8:022022 PM


STATE BY STATE Become an AOPA State Rep.

Expanding Coverage

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

Updates from Illinois, Kentucky, Maine, Pennsylvania, and Virginia


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.

After several meetings with state lawmakers in early 2022, a proposal by the Illinois Society of Orthotists and Prosthetists (ISOP) to add 58 L codes to the Medicaid fee schedule has obtained budget approval. Reimbursement for these new codes, which include myoelectric and other high-tech components, will be set at 2022 prevailing Medicare rates minus 6%. ISOP and the Illinois Department of Healthcare and Family Services will work together to implement these fee schedule changes. For a detailed rundown of the approved proposal, visit the Illinois page of the AOPA Co-OP.


The Kentucky legislature has introduced coverage mandate legislation, HB 713, which requires that state insurance plans provide coverage at least equivalent to Medicare. In addition, state insurance plans issued to public employees are required to provide access to providers that practice O&P, as well as at least two distinct O&P practitioners. For more information, visit the Kentucky page of the AOPA Co-OP.


Maine has passed HP 741 into law. The law mandates that, for enrollees under age 18, 60


state insurance plans must cover an additional prosthetic device that is intended for recreational purposes, such as running, swimming, or biking. In April of 2021, AOPA took part in a Health Coverage, Insurance, and Financial Services Committee hearing in support of the bill. To read the enacted version of the bill, visit the Maine page of the AOPA Co-OP.


HB 2605, a bill mandating coverage for prosthetic devices, repair, and replacement in state insurance plans, has been introduced in the Pennsylvania legislature. Several legislators have indicated support for the bill, which garnered 15 cosponsors just days after its introduction May 20. This success may be attributed to the bill’s predecessor, SB 289, which was introduced in early 2021 but failed to pass out of committee despite considerable support. To learn more, visit the Pennsylvania page of the AOPA Co-OP.


HB 925 and SB 405, identical companion bills mandating prosthetic coverage in state insurance plans, have been passed into law, effective July 1, 2022. For details, see the Virginia page of the AOPA Co-OP page.

Are you ready to take your career and your business expertise to new heights? The all new Certificate in O&P Business Management can help you do just that!

A comprehensive certificate program for business owners, managers, and practitioners of O&P patient care facilities, O&P manufacturers and AREAS OF LEARNING distributors to explore crucial business challenges as they relate to O&P.

This joint certificate program will provide you with: • Basic business acumen • Practical knowledge to apply immediately to your work • Techniques for developing better business practices • How to think about improving your company’s returns

Areas of Learning include:

HEALTHCARE OPERATIONS Learn techniques for planning, design, operation, control, and improvement of the processes needed to operate your business efficiently.

To complete the certificate program, you must register and complete one core course and one elective course from each of the four areas of learning within a four-year period.

Certificate in O&P Business Management AREA OF LEARNING



Healthcare Operations

Healthcare Operations for O&P Professionals

Mastering Medicare

Healthcare Management

Healthcare Management for O&P Professionals



Financial Management for O&P Professionals


Sales and Marketing

Sales and Marketing for O&P Professionals


HEALTHCARE MANAGEMENT Increase your knowledge and skills to better manage multiple, individual, and team priorities.



Learn business financial management concepts and perspectives for Healthcare Today, Business Models, Accounting & Finance Pillars, and Strategic Decisions

Learn the functions of marketing along with a variety of tools and approaches to personal selling along with the many digital marketing tools available.



Sign up with AOPA for the program


Select and complete within 4 years


• 4 core courses from UHart’s Barney 1. Sign up with AOPA for the program School of Business - Online • 4 elective courses through AOPA

3. Graduation ceremony at the National 2. Select and complete within 4 years Assembly • 4 core courses from UHart’s Barney School of Business - Online • 4 elective courses through AOPA

3. Graduation ceremony at the National Assembly

Visit bit.ly/AOPACP to sign up for the certificate program. Questions? Contact info@AOPAnet.org.


Trust, Move, Live. Since the introduction of C-Leg and its groundbreaking control technology, Ottobock has never stopped inventing new ways to take your patients as far as they want to go. With a portfolio including the Kenevo, Genium, X3, and now the latest iteration of C-Leg 4, every microprocessor knee supports a journey toward a limitless future.

Kenevo IP 22

The Kenevo is designed specifically for users with mobility limitations who need a high level of stability. State-of-the-art technology allows users to feel safer and more independent in their everyday life. An IP 22 rating protects from dripping water or dust.

C-Leg 4 IP 67

The C-Leg 4 provides exceptional reliability and dynamically adapts to a wide variety of everyday situations. The legacy lives on with the new C-Leg 4 Update with over 10 new features including supported descent on ramps and stairs. The C-Leg 4 is easier and more intuitive than ever before.

Genium IP 67

The Genium provides the highest degree of intuitive function to individuals who need to adapt to changing environments, move quickly over short distances, or require more than 2 days of battery life.

X3 IP 68

The Genium X3 is the most durable, intuitive and technologically advanced microprocessor knee available. With features that support activities like running, swimming and ascending stairs step-overstep, X3 supports individuals who push the boundaries of mobility.

An IP 67 rating provides protection from damage due to casual contact With an IP 68 rating, Genium An IP 67 rating provides protection or temporary submersion in fresh from damage due to casual contact water up to 1 meter for 30 minutes. also offers the highest level of water protection offered in a or temporary submersion in fresh microprocessor knee. water up to 1 meter for 30 minutes.