March 2012 Almanac

OP

The American Orthotic & Prosthetic Association

MARCH 2012

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

What’s the True Cost of Delivering Care?

Efforts to influence policy makers have yielded significant victories on behalf of O&P

How to Get the Documentation You Need

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O&P Almanac MARCH 2012, VOLUME 61, No. 3

CONTENTS

departments

Cover Story

22 A Win in Washington

Regulations are a fact of life in the O&P profession. But do you know what current issues have the potential to affect your business and patients? Here’s a look at six critical issues and AOPA’s efforts to influence policy makers and score victories on behalf of the industry.

4

AOPA Contact Page How to reach staff

6

At a Glance Statistics and O&P data

08

In the News Research, updates, and company announcements

40

AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

46 Marketplace

Products and services for O&P

Feature

30

O&P Costs in an ACO Age

By Brian L. Gustin, CP, BA In this second of a two-part AOPA exclusive, an industry veteran and AOPA past president explains recent industry performance, trends in Medicare, and how to systematically assess the true cost of delivering O&P care.

COLUMNS

51 Jobs

Opportunities for O&P professionals 56 Calendar

Upcoming meetings and events

59

Ad Index

60

AOPA Answers Expert answers to your FAQs

16 Reimbursement Page

Working with referrals for proper documentation

36 Ask the Expert

How the O&P PAC and Capitol Connection work for you

Want a Taste of O&P History?

Get your fill at www.oandplibrary.org/op— a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

MARCH 2012 O&P Almanac

3

AOPA Contact INFORMATION

OP Almanac &

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc.

EXECUTIVE OFFICES

MEMBERSHIP and Meetings

Advertising Sales M.J. Mrvica Associates Inc.

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

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

Design & Production Marinoff Design LLC

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org

Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com

AOPA Bookstore: 571/431-0865

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

Printing Dartmouth Printing Company

BOARD oF DIRECTORS Officers President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX President-Elect Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

directors Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, MBA, MSOD, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix LLC, Philadelphia, PA

AOPA Member-Get-A-Member Campaign GROWING FOR

THE FUTURE CLUB

Take 10% or More OFF Your 2012 Dues

Every major membership organization in the world has found their current members to be their most successful growth partners.

And there has to be something in it for the current member!

You, as an AOPA member, are invited to join our Growing for the Future Club. For each new member company you sign up who designates you as its recruiting member, AOPA will discount your current 2012 renewal by 10%. Get 10 new members and enjoy your 2012 AOPA benefits for free. The 10% discount per new member applies to company members signed up who pay the full 2012 dues of $1,745. For affiliates signed up at $305 each, AOPA will provide a credit of $30 against 2012 dues. You may also use the earned discount as a credit when you purchase any AOPA product, service, or seminar.

Discover MORE HUGE BENEFITS—To enroll in the club and receive your Growing for the Future membership marketing kit, email scuster@AOPAnet.org and we’ll take it from there. You can help make it happen!

4

O&P Almanac MARCH 2012

Ron Manganiello, New England Orthotic & Prosthetic Systems LLC, Branford, CT Mahesh Mansukhani, MBA Össur Americas, Aliso Viejo, CA Michael Oros, CPO, Scheck & Siress, Chicago, IL Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2012 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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AT A GLANCE

Health Insurance Coverage in the United States Majority of Employed Adults Covered by Private Insurance...

Health Insurance Status Among Employed Adults Ages 18-64 in 2009-2010

More Than Half of the Unemployed Are Uninsured‌

Health Insurance Status Among Unemployed Adults Ages 18-64 in 2009-2010

Uninsured 18.2% Private 29.3%

Public 6.6%

Private 75.2%

Public 19.7%

Uninsured 51.0% Source: CDC/NCHS, National Health Interview Survey

$15,073

Average cost of health insurance for a family of four in 2011 (for insured workers).

15.9%

Percentage of the U.S. population covered

by Medicaid in 2010 (another 14.5% were covered by Medicare).

2001

6.9% Percentage of the U.S. population who failed to obtain needed medical care due to cost in 2010.

49.9 million Number of Americans without health insurance in 2010.

The year the first prosthetic parity legislation was achieved in a U.S. state (in Colorado); 19 additional states have passed prosthetic parity laws since then.

17.3%

Sources: census.gov, cdc.gov/nchs, amputee-coalition.org, Kaiser Family Foundation report

6

O&P Almanac MARCH 2012

Percentage of Americans who have a disability who were uninsured in 2010.

from immobilization through support

PATENTED* SYSTEM ENABLES A FULL SPECTRUM OF CARE Not all back braces are alike!

For patients with a compromised spine, molded, rigid plastic, gender specific, custom or custom fitted TLSO back braces provide: •

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Greater protection against accidental re-injury

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Reduced risks of multi-part, fits all, TLSO-like braces

Ask your local ABC/BOC Certified Orthotist about “straps and strings” braces.

Research suggests1,2 that an inappropriate TLSO-like3 back brace is the same as no brace!

Embrace excellence for your patients, choose the VertAlign® Spinal Support System.

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For more information or to request a system, see your VertAlign representative or call 800-428-2304. *U.S. Patent No. 5,718,670.

1 Bailey C, Dvorak M, Nadeau M, et. al., No orthosis is equivalent to TLSO for the treatment of thoracolumbar burst fractures without neurologic injury: results from a multicenter RCT. Spine J 2011;11(suppl 10):1s-2s.

2 Bailey C, Dvorak M, Nadeau M, et. al., No orthosis is equivalent to TLSO for the treatment of thoracolumbar burst fractures without neurologic injury: results from a multicenter RCT. SpineLine 2011; Nov/Dec:18.

3 Study used a LSO with T-bar and straps. | VertAlign is a registered trademark of the Bremer Group Company. Copyright, The Bremer Group Company, 2012. All rights reserved. 12-1848-001

IN THE NEWS

Lower-Limb Amputations Among Diabetes Patients Declines The rate of leg and foot amputations among U.S. adults aged 40 years and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a new study by the Centers for Disease Control and Prevention (CDC). The decrease in the number of amputations was attributed to better blood glucose control, foot care, and diabetes management, along with a drop in heart disease, according to CDC researchers.

The age-adjusted rate of nontraumatic lower-limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996.

“It’s no coincidence that the decline in foot amputations coincides with the establishment of Medicare coverage for therapeutic shoes—that was precisely the intent of that legislation in 1993,” says Dennis Janisse, C.Ped, president and CEO of National Pedorthic Services and assistant clinical professor at the Medical College of Wisconsin. According to Janisse, clinical studies indicate a correlation between early preventive care and the use of therapeutic footwear in preventing foot ulcers and, consequently, more serious conditions including amputations.

PDAC Rescinds Product Labeling The Medicare Pricing, Data Analysis, and Coding (PDAC) contractor has rescinded the requirements for product labeling as outlined in the article, “Product Labeling and Product Sample Requirements for Coding Verification,” which has been removed from the PDAC website.

The Centers for Medicare & Medicaid Services said it will continue to look into this matter, and that it is possible that there may be a follow-up publication/guidance at a future date, according to Thomas Fise, JD, AOPA executive director.

8

O&P Almanac MARCH 2012

Orthotic Intervention Improves Balance in Older Adults Researchers found preliminary evidence indicating custom foot orthoses can effect improvement in balance measures for older adults, according to an article in the January issue of JOSPT Express, the online version of the Journal of Orthopaedic Sports and Physical Therapy.

Michael T. Gross, PT, PhD, professor of allied health science at the University of North Carolina College of Arts & Sciences, Chapel Hill, North Carolina, led a research team in a controlled laboratory study using a single cohort design. Study participants included 13 individuals aged 65 years and older who reported at least one unexplained fall during the

past year and who demonstrated poor balance.

Participants were tested for one-leg stance, tandem stance, tandem gait, and alternating step tests before and after orthotic intervention.

Researchers observed immediate improvements in static and dynamic measures of balance in older adults following the placement of custom foot orthoses. The improvements were maintained for at least two weeks following the intervention. The researchers concluded the results offer preliminary evidence that orthotic intervention may result in improved balance for older adults with balance impairments.

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IN THE NEWS

IN MEMORIAM

James Russ, CO James “Jim” Russ, CO, who spent more than 50 years contributing to the O&P profession, including more than 20 years as director of orthotics at Northwestern University, passed away February 25.

Born and raised in Toledo, Ohio, Russ attended Roosevelt Warm Springs Institute for Rehabilitation in Georgia and graduated in 1957. He took a job in New Orleans for the company now known as Hanger Prosthetics and Orthotics, assisting patients in the selection and use of orthotic equipment. In 1959, he joined the staff at the Institute of Physical Medicine and Rehabilitation in Peoria, Illinois, where he also opened a private practice. Three years later, he moved to Cincinnati to work for Surgical Appliance Industries.

Russ began his teaching career in 1968 at Northwestern University’s Feinberg Prosthetics-Orthotics Center, and he eventually became director. While at Northwestern, Russ helped establish a state-of-the-art orthotics department at Mary Free Bed Hospital & Rehabilitation Center in Grand Rapids,

TRANSITIONS

people in the news

Marc Bechler has been promoted to O&P district manager at Medi USA. He will manage territories covering Colorado, New Mexico, Utah, Arizona, Texas, Washington, Oregon, Idaho, Arkansas, Montana, and Wyoming.

Endolite North America, Miamisburg, Ohio, has appointed Chris Bottomley as national sales manager for U.S. sales. Endolite Vice President and General Manager Chris Nolan will continue his work with Endolite in a larger capacity. In addition, Endolite has hired two traveling clinical education coordinators: Amanda Hebert, CPO, and Mike Magee, CPO. Hanger’s Vice President of Prosthetics Kevin Carroll, MS, CP, FAAOP, was honored with the Roscrea People of the Year International Award by Roscrea People, a community publication of Roscrea Co., Tipperary, Ireland.

Pamela DeKouchay and John Gross received Wyle G. Bonine scholarships from the Eastern Michigan University

10

O&P Almanac MARCH 2012

Michigan, in 1976. There, he also helped create the first orthotics residency program in the United States.

Russ won the 1997 “Outstanding Educator” award from the American Academy of Orthotists and Prosthetists. He also won awards from Northwestern Feinberg School of Medicine for his commitment to the education of orthotists.

Russ retired in the mid-1990s but kept in touch with colleagues, former students, and others in the field on an almost daily basis. “Jim was a ‘warrior for professionalism’ for orthotics and prosthetics and never lost his passion for promoting O&P as a profession, lifting us beyond the standards that would be required for an industry,” says Michael Burton, O&P consultant and close family friend.

“No student who ever sat through one of his lectures will ever forget what he taught them about orthotics, and life. He challenged everyone to be their best.”

Russ is survived by his wife, Janice; three daughters, Kathy Biondi, Nancy Mier, and Leslie Russ; and several grandchildren.

O&P Program during its fall recognition reception for the College of Health and Human Services.

Tracy Ledford has been appointed mid-Atlantic area sales manager for Fillauer Companies Inc. She will be responsible for sales in Delaware, Maryland, North Carolina, South Carolina, Virginia, District of Columbia, and West Virginia.

Ottobock has hired Brian Long as a territory sales representative for technical orthopedics. Long is responsible for the territory that includes North Texas and Oklahoma.

Jeremy Murray, CO, was one of two recipients of the Distinguished Alumni Award for the School of Health Promotion and Human Performance at the Eastern Michigan University O&P Program. Murray graduated from the program in 2006.

Comprehensive Prosthetics & Orthotics, Peoria, Illinois, has named Eric Robinson as its chief marketing officer.

Advanced Arm Dynamics has hired Julian Wells, CPO. Wells will be a clinical specialist as part of the upperlimb clinical team at the company’s Midwest Center of Excellence, Waterloo, Iowa.

Several employees of Mt. Sterling, Ohio-based WillowWood were recently recognized for their dedication and years of service to the company and the O&P industry. The following individuals received service awards: • Regina Coy, product packer, 20 years • Rick Jones, DESIGN Liner lead technician, 20 years • Carol Schoonover, foot-assembly operator, 20 years • Tom Miller, engineering technician, 20 years • Sue Long, quality-control technician, 25 years • Jim Kern, foot-assembly operator, 20 years • Vivian Champer, assistant returns specialist, 30 years.

IN THE NEWS

CMS Acknowledges Declining Claims Related to Durable Medical Equipment In response to inquiries from HomeCare magazine, the Centers for Medicare & Medicaid Services (CMS) acknowledged that home medical equipment claims have declined in the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Round 1 biddings areas, as reported in a recent study by economist Peter Cramton, PhD, a University of Maryland, College Park, economics professor who is a critic of competitive bidding.

CMS confirmed that claims had declined since competitive bidding was implemented in January 2011, but disagreed with Cramton’s methodology and conclusions. CMS also said the declines are being driven by better controls for fraud and waste, and there is no evidence that beneficiaries are losing services.

Cramton said neither of CMS’ explanations make sense, as fraud of such a high magnitude is highly unlikely because CMS had previously implemented layers of audits

TRANSITIONS

BUSINESSES in the news

Ability Prosthetics & Orthotics, headquartered in Gettysburg, Pennsylvania, has opened a new patient-care facility in the PinnacleHealth Fredricksen Outpatient Center, Mechanicsburg, Pennsylvania.

The Amputee Coalition is partnering with the Minnesota Warriors Ice Hockey Program, a team for disabled veterans, to create the Minnesota Warriors Hockey Recruitment Initiative. Funded by a $20,000 grant from the U.S. Olympic Committee through Veterans Affairs, the initiative will work toward enhancing marketing, media, and fundraising efforts for the team.

Cascade Orthopedic Supply Inc. has announced it will begin carrying select Ottobock components, including knee and hip joints, cosmetic covers, and fabricating supplies.

12

O&P Almanac MARCH 2012

and oversight in Round 1 areas. He added that while his study was preliminary and there could be minor variations in how far rates of claim submissions are dropping, he used Medicare’s own data.

Handicap International issued a press release on the second anniversary of the 7.0-magnitude earthquake that devastated Haiti, stating the organization will continue to work in the country beyond the emergency phase to support Haiti as it moves into the reconstruction and development phase.

Hanger has unveiled a comprehensive new brand identity, which includes new company names, logos, and designs. Subject to shareholder approval at the company’s annual shareholder meeting in May, its parent group, Hanger Orthopedic Group, Inc., will be renamed Hanger. Its patient care business, Hanger Prosthetics & Orthotics, will be referred to as Hanger Clinic.

Hosmer is celebrating its 100-year anniversary in 2012. The company began in 1912 when D.W. Dorrance lost his arm in an industrial accident, which

led him to design the first split hook.

In the 1940s, Dr. A.J. Hosmer developed a line of wrist and elbow components that were later added to the Dorrance line when the two companies merged in 1952. The company now manufactures a wide range of components.

Medical Express PSI, a division of Texas-based MedEx, has announced that it has exited the prosthetics services. This decision will impact eight of the 10 Texas locations, including South Austin, San Antonio, Tyler, Paris, The Woodlands, Baytown, Dallas, and Lubbock. These locations will maintain operation of their orthotics service business.

Ottobock, Minneapolis, Minnesota, has returned as a 2012 gold-level sponsor for OPAF & The First Clinics, for the fifth year in a row.

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Make a Difference IN THE 2012 ELECTIONS AND THE

FUTURE OF O&P PAYMENTS APRIL 17-18, 2012 L’ENFANT PLAZA HOTEL WASHINGTON, DC

2012 TENTATIVE* SCHEDULE:

4/17 TUESDAY 11:00 a.m. – 3:00 p.m.

Registration Open 11:00 a.m. – 1:00 p.m.

AOPA State Representatives Meeting 1:00 p.m. – 5:00 p.m.

Policy Forum General Sessions 6:30 p.m.

Attendee Reception & Dinner

4/18 WEDNESDAY 7:30 a.m.

Attendee Breakfast and General Session 8:30 a.m. – 5:00 p.m.

Congressional Appointments

An election year offers special opportunities for building relationships with members of Congress. They need your support and the Congressional offices will be more interested in your issues. That’s just one more reason why you should attend the 2012 AOPA Policy Forum.

As Health Care Reform regulations continue to be developed, it is critical that the O&P field ensure its voice is heard during this process. The government is dealing with a budget deficit and is looking for ways to make cuts—so it is more important than ever to educate members of Congress on how orthotics and prosthetics restores lives and are an essential part of the healthcare system. Legislators need to understand how continuing coverage of these O&P benefits for your patients pays off in the long term.

Only you and your patients can carry that message.

As a participant in the Policy Forum, you will be provided with the necessary materials, background, and guidance to make your trip to Capitol Hill exciting and productive. In addition to on-the-spot training on AOPA’s federal policy objectives, there will be briefings and training on current issues and agenda items including the O & P Medicare Improvements Act (S. 2125, H.R. 1958), Health Care Reform, the Insurance Fairness for Amputees Act (S. 733), and the critical state O&P issues, such as licensure and Medicaid issues.

All this for a low registration fee of only $125! The Policy Forum is being held close to Capitol Hill, which is an ideal location for visiting the Nation’s Capital and visiting your legislators. Make a difference for the entire profession and enjoy our historic city, with easy access to all the attractions of our nation's capital from this ideal location. Walk to the Smithsonian and the National Mall, visit monuments and museums— all just minutes from the L' Enfant Plaza Hotel.

*This is a tentative schedule.

Times and events may change.

Register online at www.AOPAnet.org or call 571/431-0876 for details.

Hotel Information The AOPA Policy Forum host hotel is the L’Enfant Plaza Hotel, 480 L’Enfant Plaza, SW, Washington, DC 20024. (202) 484-1000.

Discover our historic city and enjoy easy access to all the attractions of our nation’s capital from this ideal location. Walk to Congressional Office buildings, the Smithsonian and the National Mall, visit monuments and museums—all just minutes from this Capitol Hill hotel. Additionally, you’ll find gracious service, deluxe amenities, extensive business facilities—among the largest in the city— plush Grand Beds and tempting dining.

Hotel Reservations AOPA has reserved accommodations at the L’Enfant Plaza Hotel for your convenience.

All hotel reservations must be made by attendees directly through the hotel by calling either (800) 635-5065 or (202) 484-1000. You must also indicate that you would like the AOPA room block to receive our preferred group rate of $255 per night.

RESERVE EARLY, AS THE HOTEL WILL LIKELY SELL OUT OVER THE DATES OF THE POLICY FORUM. Please be sure your hotel reservation request reaches the L’Enfant Plaza Hotel prior to Monday, March 26 when any remaining rooms will be released. Since rates quoted here are on a space-available basis only, once the Policy Forum block of rooms is sold out, which may be earlier than March 26, 2012, there is no guarantee that rooms will be available or that they will be available at the preferred rate.

Hotel Cancellations The L’Enfant Plaza Hotel has a 24-hour cancellation policy. Cancellations of your reservation within 24 hours prior to your scheduled arrival date will result in a penalty charge equivalent to one night’s room and tax charges.

Transportation The L’Enfant Plaza Hotel is about a twenty minute cab or Metro ride from Washington Reagan National Airport. If taking the Metro, board the yellow line at the National Airport Metro Station in the direction of Mt. Vernon Square, and exit the train at the L’Enfant Plaza Metro Station.

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Registration, travel and/or hotel accommodations questions, contact us at 571/431-0876 or scuster@AOPAnet.org.

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n

Reimbursement Page

By Joseph McTernan, AOPA government affairs department

The Documentation Dilemma When proper documentation is missing, what can you do?

A

key issue in Medicare reimbursement for O&P services involves the presence—or, more often than not, the lack—of documentation in the referring physician’s records supporting provision of the service for which the patient was referred to you.

Understandably, this issue has led to increased frustration among O&P providers. They ask, “How can Medicare hold me responsible for the documentation practices of someone else?” It seems unreasonable for Medicare to deny your claims on the basis of someone else’s documentation habits. But the fact remains that this is starting to happen more often, whether on a pre-payment basis, or through RAC auditors who are reviewing claims that were previously paid.

This month’s Reimbursement Page suggests some ways to work with your referral sources to make sure that the medical needs for the services you provide are properly documented.

First, however, you must understand what’s behind this apparent shift in Medicare reimbursement philosophy.

A Little History Every Medicare Local Coverage Determination (LCD) contains the following statement: “Section 1833(e) of the Social Security Act precludes payment to any provider of services unless there has been furnished such information as may be necessary in order to determine the amounts due such provider.”

In other words, it’s expected that the patient’s medical records will reflect the need for the care provided. That

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O&P Almanac MARCH 2012

includes records from the physician’s office, hospital, nursing home, home health agency, and other health-care professionals, as well as test reports.

This documentation must be available upon request. The LCD statement establishes the authority to require physicians to document the medical need for anything they prescribe.

For many years, however, documentation in the O&P provider’s progress notes was considered acceptable when Medicare made medical necessity determinations.

The first real shift in this philosophy was seen in the revised policy for Medicare coverage of therapeutic shoes that was effective for claims with a date of service on or after Aug. 1, 2009. The revised policy specifically indicates that the certifying physician’s documentation must include information regarding the management of the patient’s diabetes, as well as detailed documentation of the secondary foot condition that warranted the need for therapeutic shoes.

In a subsequent revision, effective for claims with a date of service on or after July 1, 2010, Medicare allowed the documentation of the secondary foot condition to be recorded by the referring physician as long as the certifying physician signed, indicated agreement with, and incorporated the notes of the referring physician into his or her own records. This revision also added the requirement of an in-person visit between the patient and both the certifying and referring physician.

Although these revisions in the therapeutic shoe policy represented a major change, only a small portion of the overall universe of O&P revenue was affected. However, when the Office of Inspector General released a negative report on Medicare reimbursement for lower-limb prostheses, the shift in philosophy became a much larger issue. This August 2011 document argued that a serious lack of proper documentation led to improper claim payments

by Medicare.

I want to provide my patients with the best care possible.

I want to have the reputation in my community of maintaining the highest standards.

I want my practice to be a success.

That’s why I care. That’s why I chose ABC for my facility accreditation.

ABC—The gold standard. I don’t want anything less, why should you?

n

Reimbursement Page

As a result of this report and several recommendations included in it, the DME MAC Medical Directors released a “Dear Physician” letter designed to educate physicians about their responsibility to properly document the medical need for any device they prescribe. The letter indicated that physician documentation would be used as the primary source to verify the medical necessity of a lower-limb prosthesis. It also indicated that the O&P provider’s documentation would not be used to justify medical necessity, as providers have a vested interest in the payment of the claim.

The immediate result of this letter and the change in reimbursement philosophy was a dramatic increase in both pre-and post-payment audits involving lower-limb prostheses.

In Jurisdiction A alone, results of pre-payment audits for K3 level-lower limb prosthetic components paint an ominous picture. Of the claims reviewed, 88 percent were disallowed; 96 percent of them due to a lack of physician documentation.

These staggering numbers clearly indicate a system problem as opposed to a provider problem, but Medicare continues to base both pre- and postpayment audits on the same set of criteria that resulted in these unusually high denial rates.

What You Can Do AOPA continues to speak to high-ranking CMS officials about how to better protect Medicare funds while allowing legitimate providers to provide legitimate services. What can you do in the meantime? Here are some suggestions: • Don’t give up the fight. First and foremost, you must be willing to fight for the reimbursement you deserve. It’s unlikely that you’ll see much success in overturning Medicare denials at the redetermination or reconsideration levels, but appeals that are carried through to the next level, an administrative law judge (ALJ), are much more likely

18

O&P Almanac MARCH 2012

to be successful. Unlike the two earlier levels in the appeal process, administrative law judges are not bound by medical policy. They must use the Social Security Act when making decisions regarding appeals, which gives them more decision-making leeway, as long as their decisions are consistent with the Social Security Act. It may take significant time and energy to carry your appeals through to the ALJ level, but that’s often your best chance to be reimbursed for services that were provided in good faith and were appropriate for the patient’s medical needs.

• Make the patient your advocate.

The consumer’s voice has power and often carries more weight than the voice of the provider, who is “just looking to get paid.” Educate your Medicare patients about the unrealistic documentation requirements Medicare is placing on you, and let them fight part of the battle for you. A well-educated consumer can often be an effective weapon.

Patients are often more than willing to help when a situation appears to be unfair. They can carry your message to their elected officials and express their concern that continued claim denials and reimbursement difficulties will lead to less access to care. CMS is a part of the federal government, which serves the citizens of the United States. There is often nothing as effective as a well-placed call to a representative or senator from a concerned constituent.

• Educate your referral sources.

Many physicians are reluctant to change the way they do things, and a one-page letter from the DME MAC Medical Directors probably has little impact on how they handle their medical records. There’s a thin line between educating your referral sources and telling them how to do their jobs, of course; but with the correct

approach, you may convince them to provide the documentation you need to support your claim.

Taking the time to schedule 15- to 30-minute in-service sessions for physicians and their staffs may be all it takes. Explain to them you are not trying to overburden them, but Medicare may not cover the items they prescribe without documentation support from them. If you give them the tools they need to document what Medicare is looking for, your referral sources will often be willing to work with you.

• Get involved. There is power in numbers, and getting some relief from these unreasonable documentation requirements will require many people speaking with the same message. The issue of physician documentation will be one of the primary subjects during the AOPA Policy Forum in Washington, D.C., on April 17 and 18. This is an opportunity to tell your story to your members of Congress. If you have never attended the AOPA Policy Forum in the past, you may want to consider it this time. If you can’t join us in Washington, try to schedule a time for your elected officials to tour your facility. It’s an excellent PR opportunity for them—and a great chance for you to show them that O&P is truly part of the allied health community, not just a group of medical-device dealers.

Unfortunately, when it comes to requirements for physician documentation, no single piece of advice will instantly change things. Resolving this situation favorably is a long-term goal for AOPA, but the association will need your help to achieve it. a Joe McTernan is AOPA’s director of coding and reimbursement services.

Reach him at jmcternan@ AOPAnet.org.

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A in Washington AOPA’s continuing efforts on important issues bear fruit— despite gridlock on Capitol Hill

22

O&P Almanac MARCH 2012

COVER STORY

I

t’s a fact of life: Regulations rule the O&P profession. And to make your life more difficult, the regulations are a moving target. Even when things seem to have come to a virtual standstill in Washington, there’s still plenty of action on the regulatory front that affects O&P. Just keeping up with changes and developments in relevant regulations can seem overwhelming—not to mention trying to educate legislators on the regulations’ implications for O&P practitioners.

That’s where AOPA comes in. For almost a century, AOPA has been working to raise awareness of the profession and influence legislation and policies that may affect practitioners, suppliers, and patients. And when it comes to regulations, there’s plenty of work to be done. Here is a rundown on AOPA’s continuing efforts on six important issues—starting with two where recently those efforts have paid off.

PDAC Labeling AOPA won a last-minute victory with a January 30 announcement rescinding a requirement that would duplicate the U.S. Food and Drug Administration’s (FDA) authority on medical device labeling. The announcement came just two days before the labeling requirement’s February 1 effective date. The requirement would have applied to all products submitted to PDAC

after that date by O&P device manufacturers for L Code advice.

The problem was a conflict with the FDA’s labeling requirements and the absence of any clear authority for CMS or its contractors to engage in labeling requirements for medical devices—an authority that has been granted by Congress to the FDA. The FDA is developing a single national system of unique device identifiers, and the PDAC effort would have been duplicative and unnecessary. AOPA secured two legal opinions, one authored by Richard Cooper of the Williams and Connolly law firm and former FDA chief counsel, and one authored

by Thomas Barker, former general counsel to the U.S. Department of Health and Human Services (HHS) for CMS/Medicare issues who now is associated with AOPA’s legislative counsel, Foley Hoag.

Both opinions concluded that the FDA has the sole authority to regulate medical device labeling. PDAC/CMS might find a system for device identification helpful by subsequently requiring that each component unit number be reported in claims. Some O&P patient-care facilities might see some value in the idea as well. Ultimately, such a system will almost certainly be put in place because Congress directed the FDA to develop a single Unique Device Identifier system to be applied to all medical devices.

MARCH 2012 O&P Almanac

23

…If government agencies can make new rules without any authority granted by Congress, nothing prevents other agencies from trying their hand at labeling rules for medical devices.

No good would have come from one government agency with no statutory authority—CMS—mandating identification information for some types of devices (including O&P), while another government agency— the FDA, which Congress explicitly authorized—is working on a comprehensive rule right now. Redundant or conflicting regulations would likely have resulted. And if government agencies can make new rules without any authority granted by Congress, nothing prevents other agencies from trying their hand at labeling rules for medical devices. Clearly, this was a case of “too many cooks.”

AOPA’s cover letter transmitting the legal opinions stated the following: “Based on these two analyses, it seems clear that CMS needs to withdraw the requirement articulated by its PDAC contractor on September 22 of any statements mandated to be affixed to the specific medical devices, in advance of the originally stated effective date of February 1, 2012.”

Medical Device Excise Tax This 2.3 percent tax, enacted as part of the 2010 Affordable Care Act, could have imposed severe paperwork and financial hardships on O&P manufacturers and patient-care facilities. AOPA and the O&P Alliance pushed for exempting both manufacturers and patient-care facilities from this tax and these efforts bore fruit. Meetings with the U.S. Department of the Treasury

24

O&P Almanac MARCH 2012

officials and representatives from the Internal Revenue Service (IRS) found a reasonably receptive audience. The case for exemption draws on the law’s language exempting makers and sellers of hearing aids, eyeglasses, and contact lenses that are purchased by the general public for individual use.

On February 3, the Treasury Department released a Proposed Rule that clearly exempts orthotic and prosthetic devices. The efforts of the O&P community to convince the Treasury Department and the IRS that O&P devices were indeed analogous to already exempt eyeglasses, hearings aids, and other devices purchased by the consumer for individual use paid off. AOPA will participate in the May 16 hearings and provide comments on the proposal. The exemption isn’t final until it’s adopted, but the initial indications are most favorable to O&P and their patients.

AOPA’s Jan. 4, 2011, letter to Treasury Secretary Timothy Geithner and IRS Chief Counsel William Wilkens used the similarities between O&P devices and exempt devices as the basis for extending the exemption to O&P.

Lower-Limb Fraud Compelling evidence that the HHS needs a better understanding of how prosthetic care is delivered surfaced Nov. 30, 2011, when DME MAC Jurisdiction A released the results of its prepayment probe

review. Some 88 percent of claims were denied—only 10 out of 86 of the claims reviewed were approved for payment. More disturbing was the report’s finding that “96 percent of the denied claims were missing the clinical documentation to corroborate the prosthetist’s records and support medical necessity.”

This entire mess started with an August report from the HHS Office of Inspector General (OIG) on lower-limb prosthetics that alleged fraud and coding deficiencies. AOPA responded on multiple fronts, but the major genesis of the report was OIG’s mistaken belief that physicians have a strong day-to-day role in prosthetic care.

On Nov. 10, 2011, AOPA met with CMS Deputy Administrator of Program Integrity Peter Budetti, MD, JD, to contest both the OIG report and the “Dear Physician” letter requiring physician documentation. Both are unreasonable. As a continued requirement, such documentation would surely delay or even prohibit timely care of patient needs.

In a follow-up letter to Dr. Budetti on Dec. 5, 2011, AOPA cited Jurisdiction A’s finding that 96 percent of claims were denied. The finding “only escalates AOPA’s concern about the unreasonable and unrealistic documentation requirements governing the Medicare payment of legitimate prosthetic claims to legitimate providers.”

O&P practitioners understand that, if O&P services are not included in the definition of “essential benefits,” payers—including Medicare and Medicaid—would be at liberty to exclude coverage for O&P services.

AOPA and most O&P providers believe the following: • The physician’s prescription for a brace or artificial limb is just as legitimate as the prescription for a medication in describing concisely, clearly, and accurately what the patient needs, without a long trail of additional physician paperwork.

• Prosthetists’ and orthotists’ own notes on patient encounters are a critical part of the claims documentation.

• Patients will be better off if physicians spend more of their time treating patients rather than preparing additional uncompensated paperwork—work that is often redundant with the original prescription that Medicare would like to have to assist in deciding to approve or deny claims payment.

AOPA believes patients should be spared the huge hassle factor of having to chase down their physicians to demand more and more paperwork just to ensure that the patients get the devices that will allow them to walk.

AOPA will continue efforts to convince CMS and their contractors of the unreasonableness of this requirement until it is rescinded.

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O&P Almanac MARCH 2012

Essential Benefits O&P practitioners understand that, if O&P services are not included in the definition of “essential benefits,” payers—including Medicare and Medicaid—would be at liberty to exclude coverage for O&P services.

That’s why AOPA and the O&P Alliance have so aggressively pursued this issue. AOPA and O&P Alliance members responded to the survey undertaken by the Institute of Medicine (IOM) to gather information that would provide guidance to HHS Secretary Kathleen Sebelius, who is charged with writing the definition.

IOM’s survey results specifically referenced prosthetics in a favorable light but did not offer any specifics on orthotics. Two follow-up meetings with HHS officials; testimony by AOPA Executive Director Tom Fise at the HHS national provider “listening session” on essential health benefits; and efforts to have O&P representatives at regional HHS listening sessions all furthered the argument for including O&P in the definition. AOPA members also have followed up by helping trigger letters to the secretary from members of Congress urging O&P’s inclusion as an essential benefit.

AOPA President Tom DiBello, CO, FAAOP, received a letter from Secretary

Sibelius on July 29, 2011, recognizing deficiencies in the U.S. Department of Labor’s data on the prevalence of O&P coverage in small private-employer plans. AOPA had commissioned an independent survey from the Society for Human Resource Management, which found that about 75 percent of such plans cover O&P. This also was acknowledged in the secretary’s letter, which promised further consultation with AOPA. HHS finally issued a “guidance” bulletin on Dec. 16, 2011, which contained good news and less good news. The good news is that orthotics and prosthetics were given as examples of essential benefits, along with physician office visits, emergency services, and mental health and substance abuse disorder services. In that respect, it doesn’t get much better.

The less good news is while these examples were provided, HHS left it up to the states to select from four benchmark-type plans to create their own version of essential benefits.

Benchmark plans that may be used for reference include the largest state employee health plan, the largest federal health plan operating in the state, the largest small business employer plan, and the largest HMO.

Learn More About the Issues Affecting Your Business Make plans now to attend the 2012 AOPA Policy Forum, April 17-18 at the L’Enfant Plaza Hotel in Washington, D.C. Get up-to-date briefings from key congressional lawmakers, the AOPA lobbying team, and other experts about critical issues confronting the O&P community, and visit with your elected representatives and their staff on Capitol Hill. For more information and to register, visit www.AOPAnet.org.

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O&P Almanac MARCH 2012

AOPA’s job going forward to is to identify the likely benchmark plans that will be considered in each state and make sure members are aware of any state plans that do not offer O&P coverage. State by state, the O&P community will need to discourage adoption of plans that exclude O&P coverage in favor of plans that offer it.

It’s a monumental task, and AOPA has retained one of the leading firms with state health-care expertise to help assemble the data. In the meanwhile, AOPA has submitted comments on the HHS approach, urging that more specific direction be given the states in determining essential benefits.

Competitive Bidding Everyone in O&P shared a sigh of relief when off-the-shelf (OTS) orthotics were not included in the details on Round 2 of competitive bidding that CMS announced on Aug. 19, 2011. AOPA was careful to make sure the entire community understood that nothing prevents CMS from including OTS in future bidding rounds, so this issue continues to be a potential threat. Perhaps it was a coincidence, but the CMS announcement came just four days after an AOPA/O&P Alliance meeting with CMS Deputy Administrator

Jonathan Blum. The meeting was a follow up to a conference call in late July with Laurence Wilson, the lead CMS individual with responsibility over competitive bidding.

The outcome was all the more gratifying because rumors had been circulating for weeks that CMS had identified more than $200 million worth of orthotic items that, in their opinion, merited inclusion. A dollar figure of that magnitude could only have been reached if CMS had gone beyond the statutory definition of OTS and included items that did not meet that definition.

AOPA President DiBello compiled an excellent list of 10 such prefabricated products and spelled out the possible detriment to patients if these products were provided without concurrent clinical care by an orthotics professional. In coordination with the O&P Alliance, these examples were used first in a telephone conference call in late July with Laurence Wilson of CMS, and then in a face-to-face meeting on August 15 with his boss, CMS Deputy Administrator Blum. In that meeting, AOPA addressed both the harm to Medicare patients as well as the prospect for a legal challenge if the CMS list did not meet the statutory definition.

Accountable Care Organizations Although few, if any, AOPA members will seek recognition from CMS as an accountable care organization (ACO), there is a strong prospect that hospitals and other large health-care providers will develop ACOs and that O&P providers will be invited to join or possibly recruited into employment.

AOPA is preparing a teaching tool that can be readily available to explain in simple terms how the ACOs may affect O&P and some options O&P providers may wish to explore.

A piece of the ACO structure includes a provision for shared savings programs, intended as an incentive for forming ACOs. The final rules, published Oct. 20, 2011, reflected significant suggestions offered by more than 1,300 stakeholders to make the program more appealing. The rules have no application unless an O&P organization is

or becomes part of an ACO. If your facility has any interest in pursuing this idea, contact AOPA for a copy of our summary of the CMS ACO regulations, as well as the ACO Shared Saving Program Final Rule.

AOPA has developed a 10-minute video presentation that can be part of the training arsenal needed to familiarize O&P professionals with the overall magnitude of ACOs and what options may be available for O&P patient-care facilities as more and more ACO’s are formed. For more on ACOs, see “The Case for Adaptation,” in the February issue, and “O&P Costs in an ACO Age” in this issue. a

Editor’s Note: If you have questions or comments about AOPA’s issue advocacy efforts, email them to info@AOPAnet. org, and they’ll be directed to the appropriate staff member.

www.AOPAnet.org

Coding & Reimbursment Legislative & Regulatory Education FInd it at www.AOPAnet.org

W NE IGN S E D

MARCH 2012 O&P Almanac

29

By Brian L. Gustin, CP, BA

O&P Costs in an

ACO Age

Today’s health-care world requires a new approach to assessing the true cost of delivering care

Part one of this article, “The Case for Adaptation,” was published in the O&P Almanac February 2012 issue. The online edition is available at www.AOPAnet.org.

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O&P Almanac MARCH 2012

I

n my February article on accountable care organizations (ACOs), I described the genesis of ACOs and their aim to control cost—or, more accurately, reimbursement or spending. I also addressed how O&P must transition from a traditional trade-style workplace to a professionally designed operational system in the new age of health care.

Regardless of whether ACOs become commonplace, the fact remains the United States spends far too much of its gross domestic product on health care. The figure is approximately 17 percent now and is expected to grow. With this emphasis on healthcare spending, all providers of care, including O&P care, will need to focus on their internal processes. Indeed, to remain viable, O&P providers must examine the costs of those processes to demonstrate not only the value of O&P care, but also how their facility, as an entity outside the ACO, can do a better job than other providers in terms of cost and quality.

To that end, this article will review recent industry performance, along with some recent trends in Medicare use, and then explore how to systematically assess the cost of delivering O&P care.

A Shrinking Market The O&P industry has been fortunate to have a robust financial survey with a response rate significantly higher than that in most industries. Analysis of the survey data from 2006 through 2009 reveals some interesting facts. As a whole, the industry has seen decreasing profitability (-7.12 percent). Although the overall reimbursement rate has increased each year since 2006 (see chart on next page), general profitability has declined.

A number of O&P professionals believe declining reimbursements are to blame. Why else would net income decline when revenues increase? Partly because a $100 reimbursement in 2006 translates into $115 in 2010 due to annual fee increases. That’s a 15 percent increase, or an average increase of 3.75 percent year-over-year for four years. At the same time, total general and administrative expenses (operational expenses) have increased 24.41 percent, adversely affecting the bottom line, or net income.

For example, the number of full-time employees has increased 33.2 percent, while median sales volumes are down 10.7 percent. Total company revenues per total number of

practitioners—the revenue generators of a practice—are up 15 percent.

Considering the overall fee increase over this same period, however, there is no real or net growth. Actually, this is an indicator of decreasing patient volume—thus, any real growth a company enjoys is market-share growth and not organic growth.

In other words, O&P is playing in a shrinking market. But is the market shrinking due to a lesser need for O&P services? Or is it because others outside of O&P are providing similar services?

The answer to both questions is yes.

Changing Players Despite popular belief, the amputation rate has been declining since 1997. Medicine has gotten better at limb salvage as a result of woundcare centers and other interventions.

A review of Medicare data from 2003 through 2008 reveals that the utilization rate has decreased for all lower-limb prosthetic base codes. Similarly, the use of custom lower-limb orthotic base codes has declined each year, while the use of noncustom lower-limb base codes has increased significantly.

What is revealing is the inverse relationship between the utilization rate and the provider type. Overwhelmingly, certified practitioners provide the custom devices, which are declining, while noncertified providers overwhelmingly provide the noncustom devices, which are increasing.

A search of active DMEPOS provider numbers reveals that in 2006, O&P owned 12 percent (18,591) of the active DMEPOS provider numbers, and physicians owned 19 percent (22,331).

By 2010, however, O&P ownership had declined by 8 percentage points, down to 4 percent (4,199) overall.

Physicians’ ownership had increased by 8 percentage points to 27 percent (25,713) overall.

The revelation here is that providers at the top of the referral food chain are finding ways to supplement their revenue streams horizontally as they get pressed on traditional fee-forservice revenues. The formation of the ACO delivery model will further affect

this shift of DMEPOS provider types, placing greater pressure on traditional O&P to figure its own value in the health-care stream and its own internal cost of providing that service.

What’s more, while an O&P provider can participate with more than one ACO, the ACO has little incentive to participate with an outside O&P provider. To do so would send defined dollars outside the ACO. And with the costs to administer an ACO estimated to be greater than the shared savings, at least in the early years, there is even less motivation to include outside entities.

Understanding Cost The stated goal of ACOs is to control or reduce cost and improve the quality of health-care outcomes. But the meaning of the term “cost” is different to different stakeholders. To politicians and policy wonks at CMS and private insurance companies, cost means provider reimbursements, which have absolutely nothing to do with the cost the provider incurs to provide a service.

To a provider, cost relates to the internal cost of delivering care. Many health-care providers relate internal costs to reimbursement, but that approach is flawed. O&P reimbursements are based on arbitrary amounts established in 1986; through a formula known as Gap Filling, a current fee is set for a given service, which is then increased or decreased each year based on the consumer price index and other factors mandated by Congress.

This is problematic because many contractual arrangements are based on a discount off an established reimbursement schedule. This arrangement serves the payer’s need but leads to the declining viability of O&P as an industry. To deal with this pressure, providers take simplistic measures such as staff reductions, across-the-board compensation freezes or reductions, use of lower-quality goods, and other actions that have a direct impact on profits. These steps create only marginal effects in the shortterm and can add up to long-term cost increases due to the loss of experienced

Reimbursement Growth Rate Year

Annual Reimbursement (Fee) Adjustment

2010

2.4%

2009

5.0%

2008

2.7%

2007

4.3%

2006

0.0%

Source: CMS

personnel and increasing problems in customer service.

In the age of the ACO, O&P will need to develop a system that can properly measure the cost of providing services and compare this cost to the quality of the outcome—comparative effectiveness analysis. In other words, O&P must first understand its costs, so it can begin to cut its costs based on knowledge, rather than beliefs and perceptions. Without such a system, providers destroy value. In our current technology fast track, these value losses may be masked with more highly reimbursed newer technologies to replace lost margins.

This problem has reared its ugly head recently as various agencies have alleged an overuse of the prosthetic functional level K3 category. The result has been an increase in the documentation required in order to prevail in a post-payment audit. Indeed, many have found the stipulated level of physician documentation to be simply an unattainable prospect, and, looking back, some firms are being required to return substantial sums.

MARCH 2012 O&P Almanac

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Resource cost rate = Expense of all resources/ Available capacity of the resource (time) Measuring Value If we accept the premise that value should be measured in terms of patient outcomes per dollar spent and that more expensive services do not necessarily create better outcomes, how can O&P frame its value within the overall cost of treating a patient? The answer is by considering the long-term relevant costs of all resources, such as clinical, technical, and administrative personnel and supplies, space, and capital equipment.

Key to understanding these costs is the assumption that O&P—as an industry in general and at the individual practice level—has some sort of defined processes for how care is delivered. But like all health care, O&P is fragmented in its delivery of care, even within the same organization. This fragmentation is not difficult to overcome at the practice level if management begins to operate like a designed system, rather than a workplace. (See part one of this article in the February issue.)

That means mapping the processes used to deliver service, from the time the phone rings or the door swings open to the conclusion of the warranty period. This involves serious rootcause analysis that looks at who is needed to perform a process, how long the process takes, how much space is required, and what supplies are necessary. It requires a hard, dispassionate, introspective look at how you do what you do and may call into question many long-held beliefs.

Keep in mind, O&P is losing market share in some product subcategories to our referral sources. If you do not want to fall victim to this fact, you must accept what was once thought to be unacceptable.

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O&P Almanac MARCH 2012

Calculating Cost Once you have mapped the processes, the rest is easy. Only two parameters must be estimated: human resource cost and the time of that human resource consumed by the patient. The other costs are hard costs obtained from the profit and loss statement.

Assume a patient consumes a certain amount of administrative process to check in, register, provide demographic documentation, and obtain clinical/technical services.

Assume an administrative person, a technician, and a practitioner are involved in the care. Say the administrative person spends 18 minutes (0.3 hrs.), the technician spends 24 minutes (0.4 hrs.), and the practitioner spends nine minutes (0.15 hrs.) to provide the service.

From here, you can calculate the cost of each resource available to the patient using the following formula: Resource cost rate = Expense of all resources/Available capacity of the resource (time) The expense of all personnel available for care includes the sum of all compensation (including taxes and fringe benefits), plus the cost of all other resources that allow personnel to be available for care, such as a pro-rata share of space cost, cost related to employee supervision, and any equipment or technology costs each person uses to perform the job. Space cost is a function of the square-foot cost of the space occupied, be it workspace or office. The supervision cost can be calculated based on how many people a manager supervises, then allocating a certain percentage of that manager’s salary to the cost of the caregiver.

Equipment and technology costs are based on the use of phones, computers, and janitorial and other services. Thus, the total costs for one of the people in the scenario may be as follows: • Annual compensation: $65,000 • Supervision cost (10 percent of the manager’s full-time cost): $9,000

• Space cost (100 sq. ft. @ $25/sq. ft./ year): $2,500 • Technology and support: $1,800 • Total annual cost: $78,300, or $6,535 per month To calculate the time this person is available to work with patients, the formula is as follows: • Total annual days: 365 • Less weekend days: 104 • Less vacation days: 20 • Less holidays: 12 • Less sick days: 5 • Total annual days available: 224, or 18.7 per month • Hours per workday: 8.0 • Less breaks: 0.5/day • Less lunch: 0.5/day • Less meetings, training, etc.: 1.0/day • Total available patient hours: 6.0/day In this scenario, the person is available for direct patient care for 112 hours a month (18.7 days x 6.0 hours).

So, using the formula, $6,535/112 hours gives us a cost for this person’s service of $58.35 per hour. Do this for each person in your practice who spends time with patients to arrive at that person’s costs. Then simply add all of the per-hour costs for all consumed resources and multiply by the total number of hours spent with the patient to arrive at the total cost of a visit.

Mapping Processes To repeat, the real key to this methodology is first developing process flow maps of a patient entering and leaving your facility.

This typically is done in engineering when developing an engineering process. In many ways, the delivery of O&P services—and indeed, all health-care services—is a manufacturing process. The cost-quality factor of the ACO model requires a more coordinated approach to the delivery of care, which means more standardization of treatment protocols between one clinician and another within the same organization.

To help develop these process flow maps, start with a common reason a patient comes into the practice, such as a new transtibial prosthesis. Then, break out the administrative, clinical, and technical services provided, when are they provided, and by whom.

Get input from the entire staff, then study this information and ask what can be done to reduce the cost and improve the quality. Consider the use of technology to create consistency when certain tasks are repeated for many different patients. Also consider lower-cost care extenders or assistants who can be taught to perform certain tasks, such as obtaining measurements or handling initial fittings.

In dentistry, practitioners—who are really oral orthotists and prosthetists—have used a system of assistants combined with technology successfully.

Traditional O&P can learn much from dentistry, as the processes and services

…Ask what can be done to reduce the cost and improve the quality.

are similar—straightening malformed teeth (orthotics) and replacing missing or diseased teeth (prosthetics). The next time you go to your dentist, think O&P. Which procedures are performed by the dentist and which by the hygienist? Do you remember a time when the dentist performed procedures now done by the hygienist?

Did technology allow the dentist to shift certain definable and repeatable procedures to competent lower-cost care extenders?

Shedding the old paradigms that are still current in O&P is necessary in order to move forward with the rest of health care in the new age of the ACO model. Remember, far too often far too many people place far too much value on what is and not enough value on what could be if they looked outside their comfort zone. Do not let the doctrines of the past become the dogma that prevents change from happening. I hope this two-part series will prompt you to re-examine your current business model and ask, “What if…?” a Brian L. Gustin, CP, BA, a past president of AOPA, clinical research and payer relations, at iWalk Inc., Green Bay, Wisconsin.

Reach him at bgustin@ iwalk.com.

MARCH 2012 O&P Almanac

33

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Ask the Expert

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By Devon Bernard, AOPA government affairs department

Your Voices on Capitol Hill How Capitol Connection and the O&P PAC help get the O&P message heard

With the presidential election just around the corner, 2012 is set to be a very important year politically. And that means it’s increasingly critical that the voice of O&P is heard. During the coming months, you may be asked to help AOPA spread the word in Washington about the importance of O&P. Our fight on Capitol Hill is carried out by two separate groups or funds: the O&P PAC and Capitol Connection. These two groups work together but are funded separately and work to achieve different goals.

This month’s Ask the Expert explains some of the differences between them.

Q. A.

What is Capitol Connection?

Capitol Connection is a fund AOPA established to supplement its government relations program and to cover costs or expenditures that are not covered by the general government relations budget. Typically, funds from Capitol Connection help finance studies that support AOPA’s legislative and regulatory positions. The funds are also used to create and distribute educational materials and to help cover the cost of the annual AOPA Policy Forum. However, Capitol Connection funds cannot be contributed to the federal campaigns of key legislators who support the O&P community.

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O&P Almanac MARCH 2012

Q. A.

Who can contribute to Capitol Connection?

Anyone can contribute to Capitol Connection. Because the funds are not used to directly support or endorse political candidates, corporate funds may be included in your contribution. However, although corporate funds contributed to Capitol Connection may be deductible as a business expense, they are not deductible as a charitable expense.

Introducing a new external mounting option for articulating AFOs! Tamarack Flexure Joint® Caps are a

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• Use for free motion or dorsiflexion assist Tamarack Flexure Joints (sold separately).

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n

Ask the Expert

Q. A.

What is the O&P PAC?

The O&P PAC is AOPA’s federally registered, bipartisan political action committee (PAC), representing the O&P profession on Capitol Hill. O&P PAC funds are used to ensure that your voice is heard during pertinent discussions and debates on legislation that may affect the profession. The O&P PAC actively seeks out key legislators on key committees who have demonstrated interest in and concern for issues facing the O&P community. The PAC then supports these legislators and their election efforts by donating to their campaign funds and helping sponsor fund-raising events.

Q. A.

Who can contribute to the O&P PAC?

Because the O&P PAC is federally registered, it must comply with all the rules and regulations of the Federal Election Committee, which has very specific guidelines for who may contribute to a trade association’s political action committee. All O&P PAC contributions must be voluntary, and all must come from eligible employees of AOPA member companies, including O&P practitioners, executive and administrative personnel, board of directors, stockholders, and their family members. All contributions from these eligible individuals must be made with personal funds. The O&P PAC may not accept contributions from corporate accounts.

Q.

How can I learn more about the difference between Capitol Connection and the O&P PAC?

A.

Visit the AOPA website, www.

AOPAnet.org, and click on the Legislative & Regulatory tab. Or call 571/431-0876 and ask for Catherine Graf or Devon Bernard.

Both the O&P PAC and Capitol Connection will continue to reach out to key members of Congress and educate them about the importance of O&P services. They will continue to keep you informed about current legislative issues and reach out for your help in achieving AOPA’s legislative goals. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

O&P PAC Authorization Card

3

YES! I want to spread the word about the O&P PAC! I authorize O&P PAC to share information with me and any other executive, administrative, and professional personnel associated with the company designated by me below.

To help O&P PAC contact these individuals,

here are their names: ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

Instead, I’ve attached a list of their names.

Return completed form to: 330 John Carlyle St., Suite 200, Alexandria, VA 22314 OR fax 571/431-0899 OR email dbernard@AOPAnet.org.

As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this “authorization” is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.

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O&P Almanac MARCH 2012

Authorized Signatures: AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC.

2012___________________________________________ 2013___________________________________________ 2014___________________________________________ 2015___________________________________________ 2016___________________________________________ Print Name_____________________________________________ Title___________________________________________________ Company_______________________________________________ Address________________________________________________ City/State/Zip__________________________________________ Signature______________________________________________ Date___________________________________________________

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AOPA HEADLINES

AOPA WORKING FOR YOU

A Bum Rap

on Prosthetic Feet

AOPA responds to skewed statistics and insinuations of fraud

M

ore than a few feathers were ruffled over a February 15 Associated Press story that raised questions about the increasing per-capita cost of prosthetic feet provided to Medicare beneficiaries in 2010. Costs were lower in 2005, despite a slight decline in the number of Medicare beneficiaries receiving the devices.

The story was triggered by an Aug. 28, 2011, report from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services. The report alleged questionable Medicare claims documentation that raised the suspicion of fraud.

The flawed OIG report was the seed that grew into the misleading AP story. Inspired by the smell of fraud, the AP reporter sought out specific data on prosthetic feet. The data showed that a declining number of Medicare amputee beneficiaries received prosthetic feet but Medicare payments for the services increased during a five-year period from 2005 to 2010.

By the time the reporter contacted AOPA, key flaws in the OIG report had already been identified, based on earlier meetings with CMS and OIG officials. AOPA President Tom DiBello, 40

O&P Almanac MARCH 2012

CO, FAAOP, and Executive Director Tom Fise, JD, personally shared this information with the reporter. AOPA’s counterpoints to the reporter’s allegations and conclusions have been incorporated into the OIG Talking Points paper that was shared with AOPA members on February 16.

conduct data analysis using the OIG flags as “indicators of questionable billing.”

Distorted Reporting

The number of amputations done each year is not even a good indicator because prosthetic feet are not designed to last a lifetime. They wear out and need to be replaced like any mechanical device. A better measure would be a comparison of the total number of living amputees and how that number has changed over time.

Don’t make such a broad reaching claim until you fully understand the situation.

AOPA members also weighed in, expressing their disgust at the distorted reporting and the suggestion that fraud played any significant part in explaining the modest drop in the number of Medicare amputee beneficiaries and an increase in Medicare prosthetic foot payments during the same period.

Here’s one comment on the AP story from AOPA member James B. Price Jr., PhD, CPO, C.Ped, FAAOP, of Faith Prosthetics and Orthotics in Concord, North Carolina: “We are under a mountain of paperwork because of the substandard mentality, generally uniformed opinions, and even negligent reporting that is evidenced in the Alonso-Zaldivar article. The naive nature of his comments are matched only by the laughable analysis of the OIG. After accepting the OIG report as gospel, third parties are now being hired by Medicare to

In a comment to USA Today, which ran the story, Jeff Erenstone, CPO, Mountain Orthotic and Prosthetic Services of Lake Placid, New York, wrote:

The truth is often lost in the noise when the smell of fraud is in the air.

As the dust settles AOPA, the O&P Alliance, and the AOPA lobbying team are sharing facts that put the skewed data collected by AP into perspective with policy makers, legislators, and the media.

Just the Facts Among the truths that need telling are the following facts: • The amputee’s original referring physician is typically the surgeon

AOPA HEADLINES

who performed the amputation, wrote the original prescription, and signed off on the prosthetist’s proposed treatment plan based on the prescription. Once discharged from surgical care, the patient is seldom seen again by that original referring physician. So the lack of contact during a five year period isn’t about fraud—it’s about the way amputees receive care and from whom.

• Diabetics are not the only amputees. Traumatic events and a bevy of other ailments in addition to diabetes play a significant role in the number of amputations. Basing the story on diabetic amputee statistics alone ignores the rest of the story and distorts the truth.

• Higher technology is not always provided to patients with “athletic” type needs. It can also be appropriate for people who are at risk for falling or other harmful

experiences that can be avoided with appropriate prostheses, often of higher technology.

• Overlooked was the fact that some 12 percent of the alleged Medicare payment increases during the five-year period represent the Medicare fee increases—that is, payments in 2010 were 12 percent higher than those in 2005 for identical services.

• Also overlooked was the fact that major improvements in technology have been generated in conjunction with injured and amputee wounded warriors from Iraq and Afghanistan, resulting in major improvements in care.

RAC audits, CERTs, and other sledge-hammer approaches to rooting out fraud are likely to do little more than bankrupt O&P providers and deprive amputees and other O&P patients of the quality care they deserve and have been receiving.

A much more sensible and patient-friendly approach to curbing possible fraud in O&P is to pass the AOPA-authored legislation endorsed by the O&P Alliance and the Amputee Coalition, H.R. 1958 and S. 2125. This legislation limits payments to licensed providers in licensure states and to those credentialed by recognized O&P certifying bodies in non-licensure states.

It also matches the qualifications of the provider with the complexity of patient needs. Savings are projected to be between $100 and $200 million a year.

This is just one more reason to join your colleagues at the AOPA Policy Forum at the L’Enfant Plaza Hotel in Washington, D.C., on April 17-18.

AOPA will schedule your appointments with congressional offices and provide talking points on these and other critical issues that threaten the field. Register today at www.AOPAnet. org by selecting Policy Forum on the pull-down Legislative and Regulatory menu. a

MARCH 2012 O&P Almanac

41

AOPA HEADLINES

AOPA Accepting Membership Sales Proposals AOPA is now accepting proposals for collaboration in expanding the membership and sale of AOPA products, including publications and seminars.

Every organization should continually search for ways to develop and expand its membership base. AOPA’s current membership is approximately 900 companies and suppliers that operate 2,037 affiliated locations. Of those members, 750 are patient-care companies, and AOPA seeks to expand its patient-care membership to a minimum of 1,500 companies operating 3,000 affiliated locations.

Proposals should include the following: • specific products or services the submitter would market (Products and Services Catalog available upon request) in addition to AOPA membership • proposed method(s) of marketing AOPA membership and products • expected commitment of submitter’s resources • expected commission rate on membership, products, and seminar sales • estimated time frame for activity, including sales goals for memberships, products, or seminars • expected support needed from AOPA, such as any AOPA staff responsibilities.

Submissions must comply with the following ground rules: • AOPA’s Board of Directors will consider proposals submitted at its regular meetings beginning in January 2012.

• Timing of submission is at the discretion of the submitter.

• Such arrangements will not be exclusive to any single party.

• AOPA’s Board will act on each proposal as soon as possible after submission.

• Action on any proposal will not preclude consideration of concurrent or subsequent proposals submitted.

• Action on any proposal is at the sole discretion of AOPA and not subject to external review. AOPA reserves the right to decline to accept any and all proposals or accept more than one proposal.

Submissions should be emailed to info@AOPAnet.org with a subject line “Growth Proposal.”

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O&P Almanac MARCH 2012

2012 National Assembly Call for Papers and Poster Presentations AOPA has issued a call for papers and poster presentations for the 95th annual AOPA National Assembly, September 6-9 in Boston.

Practitioners interested in presenting should submit an abstract of their proposed clinical or business paper.

Poster presentations should be graphical displays of research findings or a case study in a poster format using photographs, diagrams, flowcharts, graphs, and any sample educational materials.

Presentations will be selected by the AOPA Assembly Program Committee, and selected presenters will receive a complimentary full-conference registration for the 2012 AOPA National Assembly.

Applications will be accepted until July 1. For more information, contact Tina Moran at tmoran@AOPAnet.org or 571/431-0808.

Now Available 2012 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2012 Products & Services Catalog is available at www.AOPAnet.org/2012_ProductCatalogue.pdf.

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AOPA HEADLINES EARn

1.5 CE

Network and Market Your Way to Success— Join the Audio Conference April 11 Networking and marketing your business is vital to its success. Join AOPA April 11 at 1 p.m. ET for an AOPAversity Mastering Medicare Audio Conference that will focus on marketing techniques for your O&P practice. Learn strategies and techniques that may give you that all-important edge in

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the competitive world of O&P. An AOPA expert will address the following issues: • the value of both networking and marketing to your O&P practice • knowing how to reach out to the right people • techniques that result in “out of the box” thinking • building and maintaining relationships with referral sources • the importance of brand recognition in O&P. The cost of participating is $99 for AOPA members ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0876 with registration questions.

Don’t Miss the 2012 AOPA Policy Forum The 2012 AOPA Policy Forum will be held Tuesday and Wednesday, April 17-18, at the L’Enfant Plaza Hotel in Washington, D.C. This event will provide attendees with up-to-date briefings from key congressional lawmakers, the AOPA lobbying team, and other experts about critical issues confronting the O&P community.

Further guidance on how to use this information effectively in lobbying members of Congress will conclude the first day. The Tuesday evening reception and dinner will offer a terrific networking and further learning experience. The meeting will culminate on Wednesday with advocacy visits with your elected representatives and their staff on Capitol Hill. AOPA’s staff and lobbyists will schedule these meetings for you.

The attendance fee is $125. Register online here https://aopa.wufoo.com/forms/2012-policy-forum/. Contact AOPA’s director of regulatory affairs, Catherine Graf, with questions at cgraf@AOPAnet.org or 571/431-0807.

44

O&P Almanac MARCH 2012

Master Medicare in Chicago:

Essentials Coding & Billing Techniques Seminar Join your colleagues April 23-24 at the Westin O’Hare, Chicago, for AOPA’s Mastering Medicare: Essentials Coding & Billing Techniques seminar. AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature break-out sessions for these two groups to ensure concentration on material appropriate to each group.

Basic information that was covered in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

Register online for the Essentials Coding & Billing Techniques seminar in Chicago at https://aopa.wufoo.com/ forms/2012-mastering-medicare-chicago/ or contact Devon Bernard at dbernard@AOPAnet.org with questions. a

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Alps New Extreme Cushion Liner has limited vertical stretch to reduce movement of redundant tissue. Use appropriate for TT or TF Alps New EZ Flex Liner applications. (anterior view shown above) is available in 3mm or 6mm Uniform thicknesses. Eight sizes fit circumferences of 16 cm to 44 cm.

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For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com.

WalkOn Fit Kits from Ottobock: Assess Your WalkOn Patient Anywhere!

At hospital, clinic, home, or office— evaluate your drop-foot patients on the spot for a WalkOn AFO with either the 28T1N WalkOn Fit Kit or the 28T2 WalkOn Flex Fit Kit. Each kit comes in a handy carrying bag and contains four WalkOns (two small, L&R; two medium, L&R; plus four calf pads).

With the smaller footplates, there’s no need for grinding needed to get them into the shoe.

Get an instant check of the WalkOn function—and then take the order for a fit. Contact your local sales representative at 800/328-4058 to order your Fit Kits today.

46

O&P Almanac MARCH 2012

The Harmony® P3 Vacuum System from Ottobock: Now with a higher weight limit!

Patients up to 275 lbs can now benefit from the advanced science of Ottobock’s Harmony® P3 vacuum system. Harmony P3 creates an optimal limb environment, with volume management, excellent suspension, plus internal and external rotation for easier maneuvering and shock absorption. Ideal for your low- to high-mobility patients—they’ll feel the difference immediately in comfort, security, and proven reliability.

Contact your sales representative at 800/328-4058.

Fillauer II Standing Frame by Fillauer LLC The Fillauer II Standing Frame is an adjustable metal exoskeleton attached to a stable base of support that allows the child crutch-less, hands free standing. While supported in the Fillauer II Standing Frame, the child gains all the physiologic benefits of standing along with the ability to use his or her hands to explore their environment.

• Easy-to-assemble kit • Custom fit to child • Accommodates for growth • Allows for hands-free activities • Useful as training tool for progression to other assistive devices • Recommended for ages 1-3 years.

For more information, contact Fillauer LLC at 800/2516398 or visit www.fillauer.com.

ER2300 from Friddle’s ER2300 is the ideal component to use in conjunction with Friddle’s transfer paper. For an ideal transfer, all you need to do is apply a generous coating of ER2300 on the transfer side of the paper before rubbing the paper onto the plastic, place the plastic back into oven (with paper still applied) for 25 seconds, take plastic out of oven, and remove transfer paper.

ER2300 allows for a clean transfer without paper sticking.

Contact Friddle’s to order ER2300 for your c-fab today at 864/369-2328 or fax 864/369-1149, or visit www.friddles.com.

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FOR MORE INFORMAION CALL: (410)663- KISS (5477)

WWW.KISS-SUSPENSION.COM

© 2012 KISS Technologies, LLC. KISS is a registered trademark. U.S. Patent Pending. “All Rights Reserved” Made in U.S.A.

Marketplace New from Motion Control: MC Wrist Rotator • New MC Wrist Rotator (p/n 3010748) • Two new versions—both mount in forearm • Standard: use with ProControl2; U3; Utah Hybrid • ProWrist: use with microprocessor-controlled TDs • 2x speed and torque of previous versions • New lamination collar—available in three sizes • In-hand version also available—built into MC Hand or ETD. For more information, call 888/696-2767 or email info@ UtahArm.com or visit www.UtahArm.com.

Aluminum and Titanium Slide Adapters with optional rotation PEL Supply features these unique slide adapters from WillowWood, available with or without rotation.

They provide either medial/ lateral or anterior/posterior slide within a lower limb system. The 4-hole Pyramid Slide Adapter in Aluminum (shown here) provides up to 1/2 in (13 mm) of slide capability that can be left in a definitive prosthesis. Rotating versions of the adapter have 360 degrees of rotation. Also available from PEL are WillowWood Titanium Slide Adapters, intended for heavy or very active patients up to 350 lbs. Pyramids are stainless steel. Screws included.

For more information on structural core components such as adapters from WillowWood, call PEL 800/321-1264 or email customerservice@pelsupply.com.

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O&P Almanac MARCH 2012

PEL Supply Offers New Matrix Spiral The new Matrix Spiral, now available from PEL Supply, is the latest addition to the Matrix family of AFOs from Trulife. Suitable for bilateral use, the Matrix Spiral is indicated for drop foot, peroneal palsy, and CVA. Like other Matrix AFOs, it is height adjustable and features a slim, lightweight design and a composite footplate and strut. Other features include: • Smooth, dynamic transition from heel strike to toe off • Effective and consistent energy return • Flexible heel and toe plates • Lateral spiral design passes anterior to the lateral maleolus For more information on any of the Matrix Family of products from Trulife, contact PEL Supply at 800/321-1264, fax 800/222-6176, or email customerservice@pelsupply.com.

Do You Need Temporary Orthotic and Prosthetic Services?

Want to go on vacation? Need help in your practice? Need a CPO to teach your course?

As an ABC-certified, Florida-licensed, insured CPO with 30 years’ experience, I offer temporary O&P services to facilities and suppliers. For more information, contact Deb Sweeney, CPO, LPO, at 407/488-3887 or DSweeneyCPO@ me.com.

More Options in the Alpha Liner Family The hybrid gel, progressive profile, and Select fabric in WillowWood’s Alpha Hybrid Liners have proven popular with both clinicians and amputees. As a result, WillowWood is expanding its liner product line.

Clinicians may now order: • Locking or cushion Alpha Classic Liners with Classic gel, Select fabric, 6-mm uniform or progressive profiles • Locking or cushion Alpha Classic AK Liners with Classic gel, Select fabric, symmetrical profile, and • Cushion Alpha Hybrid AK Liners.

With these new liners, clinicians have a greater opportunity to retrofit liners.

Have questions or want more information? Call 800/8484930 or visit willowwoodco.com. a

HYNES CO NVENTI O N CENT ER , B O S T O N

Mark your calendar to attend the country’s largest, oldest, and essential meeting for orthotic, prosthetic, and pedorthic professionals.

S AV E T H E D AT E For information about the show, scan the QR code above with a code reader on your smartphone or simply visit www.AOPAnet.org.

The

e c a l P e!

To B

*

SEPTEMBER

6-9, 2012

Join us at the AOPA 2012 National Assembly and NE Chapter combined meeting at the Hynes Convention Center in Boston. The Place to Be for learning, networking, and exhibits.

• • • • • •

Superior Clinical Education featuring the best speakers from around the world

• • •

Largest Display of O&P exhibits in the United States

Advanced Business Programs to ensure your success during uncertain economic times Practical Learning and live demonstrations Networking with an elite and influential group of O&P professionals Preparation for the massive changes that health care reform is sure to bring Learn the latest rules, regulations, and Medicare billing changes needed to serve your patients Earn more than 34 CE Credits Ideal Location in the heart of one of America’s most historic cities.

Four miles from Logan Airport and blocks from the financial district, Charles River, trendy Newbury Street, and Fenway Park.

Earn more than 34 CE credits!

Visit www.AOPAnet.org for updates on events and education.

S P E A K E R S • E D U C AT I O N • E X H I B I T S • S P O N S O R S • N E T W O R K I N G

ate ★

e the D ★ Sav

JOBS

Find your region on the map to locate jobs in your area.

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

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140

Increase exposure and save!

Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

Mid-Atlantic Prosthetics and Orthotics Director, University of Pittsburgh Pittsburgh Tenure-stream prosthetics and orthotics director position now open at the University of Pittsburgh.

Qualifications: ABC certification and PhD related area of orthotics and/or prosthetics. Minimum of three years’ teaching, clinical, administrative experience of an educational program preferred. Evidence or potential for productivity in scholarly activity, as shown through publications, grants, and presentations. Involvement in professional O&P organizations preferred.

Responsibilities: Responsible for administration, education, and research in MS in O&P Program, including/ not limited to program/curriculum development, evaluation, accreditation, clinical education, recruitment, and O&P program policies and procedures. Develop/expand a research and development program. Participate in scholarly activity and secure independent research funding.

Participate in teaching within the O&P Educational Program and serve as a student mentor.

As part of the University of Pittsburgh, the School of Health and Rehabilitation Sciences, is an affirmative action institution and welcomes applications from minorities, handicapped, and other categories of under-represented persons.

Apply: Send CV to:

Rory A. Cooper, PhD Chair, Department of RST SHRS; University of Pittsburgh 5044 Forbes Tower Sennott and Atwood Streets Pittsburgh, PA 15260

Inter-Mountain Prosthetic/Orthotic Technician Arizona Established, independently owned company located in Central Arizona is looking to hire an experienced prosthetic/ orthotic technician. Applicant will be confident in skills and able to adjust techniques to client specifications. Growth and bonus opportunities are available. Please send resume with salary requirements to:

Northern Arizona Prosthetics Fax: 928/583-0505 Email: nap@nazprosthetics.com www.nazprosthetics.com

MARCH 2012 O&P Almanac

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JOBS

Inter-Mountain Certified Orthotist/Prosthetic-Orthotic Technician Denver-area, Colorado We are a small but growing company looking for a certified orthotist with experience in pediatrics, with ability to work with adults as well. Salary will be based off experience.

Please send resume to below fax number. We are looking for a prosthetic/orthotic technician with at least two years’ experience, primarily working on prosthetics but a willingness to work on orthotics. Please send resume and salary requirements to:

Ascent Orthotics and Prosthetics Fax: 303/331-9019

Certified Orthotist, Certified Prosthetist (licensed or eligible) San Antonio, Texas Seventh largest city in the U.S. and second-largest in Texas.

San Antonio is home to five Fortune 500 companies; regional headquarters to other large companies such as Kohl’s, Nationwide Mutual Insurance, Chase Bank, Toyota, AT&T, QVC, and Lockheed Martin; Brook Army Medical Center; the Center for the Intrepid; the South Texas Medical Center; home to one of the largest military concentrations in the U.S. employing over 89,000; San Antonio Spurs!

San Antonio is blessed with museums, Six Flags, Sea World, and Splashtown San Antonio. And we must mention the Tex-Mex cuisine at many fine restaurants.

If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more!

We also have positions available in Houston and Austin!

Northeast Prosthetist/Orthotist, Certified Prosthetist, Board-Eligible/Certified Orthotist Southern Maine Do you want to be more than a number? We are a terrific, patient-oriented company looking for some awesome practitioners. Is this you? Our well-established O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity.

Learn more about joining our team of dedicated specialists by contacting:

O&P Ad 1111 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing.

Send resume to:

O&P Ad 0611 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

NOW AVAIL ABLE

To apply for this position, please contact, in confidence:

Sharon King Email: Sking@hanger.com Phone: 512/777-3772 Or apply online: www.hanger.com/careers

The 2012 AOPA Products Catalog. Find it at www.AOPAnet.org/2012_ProductCatalogue.pdf.

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O&P Almanac MARCH 2012

JOBS

Northeast Part-Time Certified/Board-Certified Orthotist New York City Area O&P practice seeks a motivated ABC-certified or boardcertified orthotist, and an orthotic fitter with good people skills, for full-time and part-time position. Responsibilities include day and some evening and weekend hours in clinical, hospital, and home settings in the five boroughs of New York. We offer salary commensurate with experience.

Send resume to:

Email: orthoticandprosthetics@yahoo.com

Certified Prosthetist/Orthotist Vermont Yankee Medical, providing orthotic and prosthetic services for over 64 years, is looking for a certified prosthetist or orthotist ready to locate to Vermont. With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send your resume to:

Attn: President Yankee Medical 276 North Avenue Burlington, VT 05401 Email: jnf@yankeemedical.com

AVAILABLE POSITIONS Orthotist Denver, CO Frisco, CO Roswell, GA Belleville, IL Quincy, IL Springfield, IL Urbana, IL Indianpolis, IN Cape Girardeau, MO

West Orange, NJ Oneonta, NY Syracuse, NY Hermitage, PA Spartanburg, SC Galveston, TX San Antonio, TX Milwaukee, WI Waukesha, WI

Prosthetist Warner Robins, GA Hazel Crest, IL

Jackson, MS

Prosthetist / Orthotist San Francisco, CA Naples, FL Tamarac, FL Indianapolis, IN Louisville, KY Gulfport, MS West Orange, NJ Brooklyn, NY Oneonta, NY

Syracuse, NY Mayfield Heights, OH Tallmadge, OH Bartlesville, OK Portland, OR Salem, OR Austin, TX Houston, TX San Antonio, TX

Certified Pedorthist Springdale, AR Quincy, IL Bangor, ME Grand Rapids, MI

St. Louis, MO Portland, OR Roseburg, OR Huntington, WV

Orthotic Fitter Pittsburgh, PA

Portland, OR MARCH 2012 O&P Almanac

53

JOBS International Technical / Sales Manager Freedom Innovations, a leading manufacturer of high technology lower-limb prosthetic devices, is looking to expand our international team. Freedom Innovations is a rapidly growing company that is pushing the boundaries of prosthetic technology. We currently provide advanced technology carbon fiber foot products as well as the industry leading Plié 2.0 microprocessor controlled knee. We also have a robust R & D pipeline of high technology products for the future.

Freedom’s products are manufactured in the United States and sold worldwide in 41 countries. Candidates will have the opportunity to be part of an industry respected team of professionals. We are seeking a high achiever with a combination of clinical, technical and marketing/sales skills who has the ability to conduct technical training as well as effectively communicate and bring resolution to business issues in a timely manner. This position will provide marketing support and technical training for international distributors and their customers. Requirements include candidates that are a Certified Prosthetist with a minimum of 4 years experience in prosthetics and business or sales, candidates must have excellent verbal and written skills. The position will ideally be based at our corporate headquarters in Irvine California and will require up to 65% international travel. We offer an excellent compensation and benefits package. Please e-mail your resume to: Shawn Crane at scrane@freedominnovations.com.

Northeast Certified Orthotist, Certified Orthotist and Board-Eligible Prosthetist, or Certified Prosthetist/Orthotist New York Privately owned and growing multi-site ABC-accredited P&O practice in upstate New York is seeking a certified orthotist with a minimum of two years’ experience and/or a certified orthotist and board-eligible prosthetist, or certified prosthetist/orthotist. We are looking for individuals with strong orthotic backgrounds, and we may entertain an NCOPE prosthetic residency if needed. Our offices in the historic and scenic Hudson Valley and Catskill Mountains of New York are located from Saratoga to Poughkeepsie with immediate openings in Kingston and Poughkeepsie. The ideal candidate must be self-motivated, a team player, possess good communication and technical skills, and be willing to excel for performance-based objectives. Competitive salary and benefits package offered. Submit resume to:

David Misener, CPO Clinical Prosthetics & Orthotics, LLC Email: DBM@clinicalpando.com Fax: 518/432-0686

Orthotist Opportunity At University of New Mexico Hospitals, excellence is the basis of our every action. It’s evident in the accreditations, recognition, and honors that reflect our continued commitment to quality, and in our leadership as the only Level I Trauma Center in the state. More importantly, it’s visible in the care each member of our organization provides to our patients.

The only Academic Medical Center in New Mexico.

Think excellence.

Think UNM Hospitals.

Visit facebook.com/UNMHospitals EOE

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O&P Almanac MARCH 2012

O & P ALMANAC MAGAZINE

As a multidisciplinary member of our team, you will provide patient evaluation for chronic musculoskeletal conditions; delivery of orthoses that best meet medical needs/functions of individual patients; organization for outreach clinics; and orthotic services to outreach patients.

Exceptionally qualified candidates will possess a Bachelor’s degree in Orthotics/Bachelor’s with post graduate certification in Orthotics, 3 years of experience, and Orthotist certification.

Bring your expertise to UNMH and redefine your career with an organization committed to supporting your career quality and growth.

Learn more about UNMH and apply to our latest openings at http://hospitals.unm.edu/jobs

JOBS

O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2011 test standards.

Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations.

Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

Discover Marshfield, Wisconsin & enjoy:

The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics

CO or CPO

(Many of our products are available in DVD Format also!)

JUST ADDED: The MASTECTOMY FITTER’s Review and Study Guide We also have Board Study Value Packages in Orthotics and Prosthetics Check out your readiness to sit for your boards with our Clinical Practice Exams.

Our BEST SELLING products to save you money!

• Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

ABC Certified in Orthotics & Prosthetics and 3 years of experience required.

Experience in Pediatrics would be helpful.

Join us and see how your career can shine.

To apply, please visit:

www.marshfieldclinic.jobs Reference Job Number MC110156 Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

www.oandpstudyguide.com

Help Shape Babies’ Lives!

FULL-TIME & PART-TIME POSITIONS AVAILABLE Be part of a unique career opportunity treating babies up to 18 months of age.

If you are looking for a new challenge and want to specialize in a non-traditional, niche area, CranialTech may be the place for you. This is a unique opportunity to treat patients in a child-friendly, state-of-the-art clinic.

As a Clinician, you will treat infants from 3–18 months of age, using the DOC Band® to correct abnormal head shapes. Pediatricians and parents alike look to our Clinicians as the experts in the diagnosis and the treatment of plagiocephaly.

NOW HIRING ORTHOTISTS IN: Austin, TX | Charlotte, NC Los Angeles, CA | Miami, FL Orange, CA |Pasadena, CA San Diego, CA

Clinicians at CranialTech enjoy: • Direct patient care and visible patient progress within 2–3 weeks • No productivity/patient quotas, long days, weekends or holidays and minimal paperwork • Future opportunities available nationwide in training, mentoring and travel • Formal training program and one year of mentoring with a company that has specialized in plagiocephaly for more than 25 years • Competitive salary and generous benefits package, including 3.5 weeks paid time off and quarterly incentive bonuses

Learn more about this opportunity by visiting cranialtech.com/careers, or by calling (866) DOC-BAND!

Before

After

MARCH 2012 O&P Almanac

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CALENDAR

Orthopadie + Reha-Technik 2012: Leipzig, Germany Exhibit space. A few choice locations are still available in the U.S./Canadian Pavilion sponsored by the AOPA at O+R 2012 Leipzig this coming May 16-18. If you are interested in exhibiting, please contact Mark Alt at Kallman Associates, Inc., U.S. Representative. Call 201/ 652-7070 or email mark@ kallmanexpo.com.

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■■ YEAR-ROUND TESTING Multiple Choice Examinations. BOC has yearround testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November.

Applications are accepted any time, although seating is limited. For more information, visit www.bocusa.org or email cert@bocusa.org.

On-site Training Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately.

For more information, call 888/696-2767 or visit www.

UtahArm.com.

■■

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Words Member Rate Nonmember Rate 25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$3.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

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

For information on continuing education credits, contact the sponsor.

Questions? Email srybicki@AOPAnet.org.

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O&P Almanac MARCH 2012

2012 ■■ March 7 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

2012 Credits: TBD. Visit www.willowwoodco.com.

■■ March 8-9 2-Day RCR Workshop.

Boise, ID. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on casting, modifying, and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

■■ March 9-10 Oklahoma Association for O&P Annual Meeting.

Best Western Saddleback Inn and Conference Center, Oklahoma City, OK. For more information, contact Jane Edwards at 888/388-5243, email jledwards88@att.net, or visit www.okaop.org.

■■ March 10 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 9–10 am ET. Covers clinical assessment of the pediatric neuromuscular patient with

spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit at www. ultraflexsystems.com.

■■ March 13 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1:00 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function.

Presenter: Jim Rogers, CPO, FAAOP. To register, call 800/220-6670 or visit at www. ultraflexsystems.com.

■■ March 14 AOPAversity Audio Conference–AFO/KAFO Policy—What You Need to Know. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

■■ March 14 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5–6 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology.

Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ March 21 WillowWood Academy Workshop: The Latest in LimbLogic® VS, 8:30 am– 12:30 pm, Technical Workshop #7, Room 209.

Discusses principles of elevated vacuum, keys for creating airtight sockets, and all aspects of LimbLogic VS function. You’ll leave this seminar with the knowledge needed for everything from patient selection, fitting, and follow-up.

CALENDAR

■■ March 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ March 26-30 Applied Technology Institute (ATi) Orthotic Fitter School.

Dallas, TX. Hyatt Place Dallas, by the Galleria. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE (ABC) and BOC. For continuing education by ABC and BOC. For information, contact Lois Meier at 888/265-6077, lois@ kasseledu.com, or visit www. kasseledu.com.

March 27 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology.

Presenter: Mark DeHarde. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

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■■ April 4 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 8–9 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems.com.

■■ April 11 AOPAversity Audio Conference–Network and Market Your Way to Success.

For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■ April 17–18 AOPA Policy Forum.

Washington, DC. L’Enfant Plaza Hotel. To register, contact Stephen Custer at 571/432-0876 or scuster@ aopanet.org.

■■ April 19-20 WillowWood: Alpha Seminar.

Mt. Sterling, OH. Course breakdowns the Alpha family of products, identifies best clinical applications of liners, discussion of liners for vacuum suspension, and the latest in suspension systems. Includes brief review of TPE liner benefits and fitting assessment.

Credits: 12.75 ABC/12.25 BOC. Registration deadline is March 29. Contact 877/665-5443 or visit www.willowwoodco.com.

■■ April 23-24 AOPA: Essential Coding & Billing Seminar. Rosemont Hyatt, O’Hare Airport, Chicago. To register, contact Stephen Custer at 571/4320876 or scuster@aopanet.org.

■■ April 24-26 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, ‘by measurement’ shape creation, advanced tool usage, and creating custom liners.

Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: 18.5 ABC/18.5 BOC. www.willowwoodco.com.

■■ April 26-28 International AfricanAmerican Prosthetic Orthotic Coalition Annual Meeting. Hyatt Regency Jacksonville. Riverfront.

Jacksonville, FL. For more information, contact Reginald Mays at jax@unitedpando.com, call 904/444-3970, or visit www.iaapoc.org.

■■ May 2-5 Northwest Chapter of the American Academy of Orthotists & Prosthetists Meeting. Bellevue Courtyard

by Marriott Hotel. Seattle, WA. Meeting will host Elaine Owen for a three-day course in pediatric gait analysis and orthotic management and will include a fourth day of exciting prosthetic content.

For more information contact Tim Shride, CPO, LPO, at 612/203-0936, email nwaaop@ gmail.com, or visit www. regonline.com/nwaaop_2012.

casting, modifying and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

■■ May 3-5 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient With a Lower Extremity Amputation.

Chicago. Approved for 19.0 ABC credits. Contact Melissa Kolski. For more information, call 312/238-7731 or visit www.ric.org/education.

■■ May 14-19 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams is March 1. Phone 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

■■ May 9 AOPAversity Audio Conference–Contracting 101. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

May 10 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline is April 19. Contact 877/665-5443 or visit www. willowwoodco.com.

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■■ May 17-18 New York State Chapter Meeting. Marriott, Albany.

For more information visit www.NYSAAOP.org.

May 17-19 PA AAOP Chapter Annual Spring Conference.

Pittsburgh, Sheraton Station Square Hotel. For more information, contact Beth or Joe at 814/455-5383.

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■■ May 17-19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association.

Annual Meeting at Peppermill Hotel, Reno, NV. Best CEU credit value available! Contact Steve Colwell 206/440-1811 or Sharon Gomez 530/521-4541 or visit www.wamopa.com.

■■ May 10-11 2-Day RCR Workshop.

Boise, ID. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on

MARCH 2012 O&P Almanac

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CALENDAR

■■ June 1 ABC: Certification Exam Application Deadline.

Applications must be postmarked by June 1, 2012, for individuals seeking to take the summer 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/836-7114, info@abcop. org, or visit www.abcop.org/ certification.

June 1-2 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop. org, or visit www.abcop.org/ certification.

■■

June 4-6 LAOP: Annual Educational Conference. Hilton Riverside, New Orleans. Earn up to 13 credits in O, P, and Administrative tracts. Come enjoy summer family fun, unique city culture, cuisine, and all that jazz. Contact Sharon at 504/464-5577, laymansh@yahoo.com, or visit www.laop.org.

■■

■■ June 7-8 Michigan Orthotics & Prosthetics (MOPA) Continuing Education Meeting. Soaring Eagle Casino & Resort in Mt. Pleasant, MI. Contact Mary Ellen Kitzman at 248/615-0600 or email her at Kitzman@gmail.com.

■■ June 7-8 2-Day RCR Workshop.

Boise, ID. Credits: 11 CEUs. Day one: 1 pm-7 pm. Day two: 7 am-2 pm. This is a comprehensive workshop on the RCR™ Socket technique.

It includes instruction on casting, modifying and fitting. Multiple suspension options including suction locks, traditional suction, vacuum, and Easy Off Vacuum Compatible Locks

58

O&P Almanac MARCH 2012

are discussed. This two-day format allows for hands-on opportunities. We are offering special pricing for the first six that register. The normal cost is $395. First two—$100 each.

Second two—$200 each. Third two—$300 each. After that, it is full price, so don’t hesitate to sign up as soon as possible.

Contact 800/819-5980.

■■ June 8-9 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop.org, www.abcop.org/certification.

June 13 AOPAversity Audio Conference–Improving Your Bottom Line. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ September 6-9 AOPA National Assembly & NE Chapter Combined Meeting. Boston. Hynes Convention Center. The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting.

Please plan to join us for this significant event. Exhibitors and sponsorship opportunities available: contact Kelly O’Neill at 571/431-0852 or koneill@ AOPAnet.org. To register, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

■■ July 11 AOPAversity Audio Conference–Perfecting the Intake Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ August 6-7 AOPA: Essential Coding & Billing Seminar. Hyatt at Olive 8, Seattle. To register, contact Stephen Custer at 571/4320876 or scuster@aopanet.org.

■■ August 15 AOPAversity Audio Conference–The Ins and Outs of Advance Beneficiary Notices (ABNs). For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ December 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

2013

■■

■■ june 15-16 PrimeFare East Regional Scientific Symposium 2012.

Nashville Convention Center, Nashville, TN. For more information, contact Jane Edwards 888/388-5243 or visit www.primecareop.com.

■■ November 14 AOPAversity Audio Conference–Medicare Enrollment Procedures. For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.

■■ September 12 AOPAversity Audio Conference–How to Get Paid for Orthopedic and Diabetic Shoes. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org.

■■ October 10 AOPAversity Audio Conference–What Every O&P Facility Needs to Know about the FDA. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■■ October 18-19 University of Michigan Orthotics and Prosthetics Center: Centennial Celebration and Education Seminar. Making a difference for 100 years, providing service, education, and research in O&P. For details and information about registration, visit www.med. umich.edu/pmr/op/index.htm.

■■ February 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ September 18-21 O&P World Congress.

Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@aopanet.org. a

AD INDEX

Company

Page

Phone

Website

ALPS

9, 45

800/574-5426

www.easyliner.com

17

703/836-7114

www.abcop.org

American Board for Certification in Orthotics, Prosthetics & Pedorthics Arizona AFO

25

877/780-8382

www.arizonaafo.com

Aspen Medical Products

43

800/295-2776

www.aspenmp.com

Becker Orthopedic

37

800/521-2192

www.beckerorthopedic.com

Custom Composite

11

866/273-2230

www.cc-mfg.com

DAW Industries

1, 50

800/252-2828

www.daw-usa.com

Dr. Comfort

5, C3

800/556-5572

www.drcomfortdpm.com

Ferrier Coupler Inc.

33

800/437-8597

www.ferrier.coupler.com

Fillauer Companies Inc.

2

800/251-6398

www.fillauercompanies.com

Friddle’s Orthopedic Appliances

27

800/369-2328

www.friddles.com

Hersco Ortho Labs

19

800/301-8275

www.hersco.com

KISS Technologies LLC

47

410/663-5477

www.kiss-suspension.com

KNIT-RITE

C4

800/821-3094

www.knitrite.com

Med Spec

29

800/582-4040

www.medspec.com

Motion Control

39

888/696-2767

www.utaharm.com

OPTEC

20, 21, 34, 35

888/982-8181

www.optecusa.com

Orthotic and Prosthetic Study and Review Guide

55

www.oandpstudyguide.com

Otto Bock HealthCare

C2

800/328-4058

www.ottobockus.com

PEL Supply Company

13

800/321-1264

www.pelsupply.com

The Bremer Group Company

7

800/428-2304

www.bremergroup.com

Willow Wood

Insert

800/848-4930

www.willowwoodco.com

Expert Coding Advice 24/7

24/7

at www.LCodeSearch.com •

•

•

The O&P coding expertise you’ve come to rely on is now available whenver you need it.

Log on to LCodeSearch.com and get started today.

Match products to L codes and manufacturers—anywhere you connect to the Internet.

Contact Michael Chapman at 571/431-0843 or mchapman@AOPAnet.org.

This exclusive service is available only for AOPA members.

Not an AOPA member? GET CONNECTED

Manufacturers: Get your products in front of AOPA members!

Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.

Visit AOPA at www.AOPAnet.org MARCH 2012 O&P Almanac

59

AOPA Answers

Coding and Billing Solutions Answers to your questions regarding coding for articulating AFOs, split shoe sizes, and adjustments

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.

Q.

May we bill for repairs and/or adjustments within the first 90 days of delivering a prosthesis?

A.

A.

Yes. You may use more than one type of joint code when providing an articulating AFO; however, keep in mind that you may not bill for more than two joints. Here are some common combinations of joint codes and when they should be used: • Two units of the L2220 (addition to lower extremity, dorsiflexion and plantar flexion assist/ resist, each joint) may be billed as long as you are using a pair of “double-action” joints to control ankle motion.

• If you are only providing dorsi-assist joints, then use L2210 (addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint) x2 units.

• If you are providing a double-action effect through dorsi-assist joints and a posterior stop, use L2210 x1 unit and L2220 x1 unit. This allows you to bill for one dorsi-assist joint and one double-action provided by the combination of the dorsi-assist joint and the single stop.

60

Q.

May we use more than one joint code when providing an articulating ankle foot orthosis (AFO)?

O&P Almanac MARCH 2012

The answer is yes and no. Typically, you may not bill for repairs/adjustments during the first 90 days because your original reimbursement includes a payment to cover these repairs and adjustments. However, policy does allow you to bill for repairs/adjustments during the first 90 days under very specific guidelines or scenarios. If there is a documented change in the patient’s condition within the first 90 days, and this change necessitates the need for an adjustment, then you may bill for any adjustments made to the prosthesis.

Q.

Do I have the ability to charge for split shoe sizes when I am providing a pair of diabetic shoes?

A.

Yes, you may bill for a split shoe size with diabetic shoes; however, there is not a specific split shoe size code for diabetic shoes as there is for orthopedic shoes, the L3257. You must bill using the miscellaneous or not otherwise specified code for diabetic shoes, the A5507.

However, keep in mind that use of the A5507 for a split shoe size will count toward the allotment of inserts/modifications a patient is eligible to receive under the therapeutic shoe benefit category.

The A5507 may also be used to bill for repairs on diabetic shoes. a

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