March 2016 Almanac

The Magazine for the Orthotics & Prosthetics Profession

M AR C H 2016

In This Issue: Documenting O&P Efficacy P.22

When Date of Service and Date of Delivery Do Not Match P.18

2016 AOPA Policy Forum Preview P.34

Using Trendline Data to Chart Performance

A Co-Created

FUTURE HOW ONE MANUFACTURER IS TAKING AN OPEN APPROACH TO R&D P.26

WWW.AOPANET.ORG

P.40

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.18

YOUR CONNECTION TO

EVERYTHING O&P

NEW!

AOPA 2016

POLICY

FORUM

You can make a difference!

AOPA O&P Legislation Writing Congress and Policy Forum

APRIL 26-27, 2016

Join us for a new Policy Forum experience!

Former Senator Bob Kerrey will preside over a special session to write a simple one-to-two page piece of legislation to take to the Hill to educate your lawmakers. This is your opportunity to make your voice heard and participate in a landmark event.

Why should you attend?

Educate lawmakers on the issues that are important to YOU: • Participate in the 2016 O&P Legislation Writing Congress • Ensure O&P has fair representation in any O&P LCDs • Make sure Prior Authorization is administered fairly • Help curb RAC audit practices that harm honest providers and don’t prevent fraud • Prevent the expansion of off-the-shelf orthoses and competitive bidding

The 2016 AOPA O&P Legislation Writing Congress and Policy Forum will be held April 26-27 in Washington, DC. Visit bit.ly/aopapolicyforum for more information. Your appointments with your legislators will be arranged by AOPA staff and lobbying team.

Meet your member of Congress and tell them how, through orthotics and prosthetics:

Support your profession!

Make your plans now to attend the 2016 AOPA O&P Legislation Writing Congress and Policy Forum.

American Orthotic & Prosthetic Association

www.AOPAnet.org

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contents

MARCH 2016 | VOL. 64, NO. 3

FEATURES

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

COVER STORY

Dave McGill asks the O&P community to keep the momentum going

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

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

Transitions in the profession

26 | A Co-Created Future Forward-thinking O&P companies should be aware of more interactive and inclusive approaches to product research and development in an increasingly digital world. Ottobock is trying its hand in this arena and has debuted the Open Innovation Space in Bötzow Berlin, where engineers, designers, artists, and inventors are invited to use the space’s high-tech equipment to test their ideas.

Reimbursement Page..........................18

Conflicting Dates

When date of service does not match date of delivery

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

CREDITS

By Christine Umbrell

22 | This Just In

Documenting O&P Efficacy

Decem

ber 7, 2012

Serious Adve Communica rse Impa ct Competitiv tions from on Amputee Care the Cente e Biddi Would Devices r in DMEP ng Were Adop for American Ensue If Rece Progress ted for OS. nt Acquisitio Were Adop Custom-Fa n of All bricated Medicare ted, and Orthotic Prost Medical BeneficiarBracing Typic hetics, As Well ally Refer As of Patie y which inclu s to a comb Custom-Fa nt des Amputee Care and Clinic both the produ ination of bricated and Custo servi ct and needed or Limb-Impa al Visits/Inter a Long ces for the Medim-Fitted ired Patie actions by the Medicare Between -Standing Clinic care nt Beneficiar and His/Her the al Relat Dear Memb Caregiver Medicare Bene ionship y Ampu er of Congr Wher tee ficiary or e the ess: Limb-Impa We are ired Patieclinical services writing nt. inform becau

se we have ed America communications been which have very conce expansionProgress. CAP rned with recently overly Medicare to encompassessentially has appeared simplistic program, every medic argued billion. and under for unive in the name and al This of the rsal comp cliff/seques is a very offers the prom device made Center etitive tanta available for biddin extensive tration delibe lizing idea ise that doing to put forwa so would beneficiarie g rations potential bidding s rd in a could trigge savings. would delicate save the gover in the Unfor r quick result Medicare nment attention time when beneficiary in devastating tunately, such $38 impairment to a prom fiscal interruption universal amputees, ise of relian bifida and from chron ic condi and of simila s and disorientat ce on comp such rly situat ongoing others—patients tions like etitiv ed benef ion of the care e multiple whose not underprosthetic and iciarie sclerosis, of mobility orthotic is sever cerebral s with limb as a walkestand that prost care to palsy, scolio maintain ely threatened r or a hetics of the for an sis, spina their indep and who prostheticcane, it is a ampu medic tee endence. rely intervention device involves al device that is more than CAP clearlon by be lost a simple is attac y does by treati a provider they a great deal ng prost of fitting hed to a perso commodity trust and such hetics n’s as well Care of and custo who understand as health body and use these Medic m ortho device—th tics like s their needs care are . This a cane dramaticallyis is a critica patients is not is what or a walke accomplishe will different lly important r.

Confusion d by the distinction from typica mere delive payment may be engen because l items in the prosthetics ry of than on for orthotics dered by the and prost fact that, durable medic and orthoa medical the associated basis of the al hetics tics are has been for whatever equipment categ with fitting number use the historical made on ory. the patien or intensity device. reaso the basis of patien custom-fab ns, Medic That said, t for the of the t visits are ricated the device and custo complexity and teach and encou device, rathe nters which r of custo m-fitted ing the m-fab patient orthotics, to prope are coupled ricated prosthetics rly with the as well typical as

Amid the threat of proposed regulations mandating competitive bidding for all orthoses and prostheses, O&P advocates are documenting the efficacy of O&P intervention. Two articles were featured in a recent issue of Military Medicine journal, including the findings of a multidisciplinary Orthotics Workgroup and the DobsonDaVanzo study on the cost-effectiveness of O&P care.

34 | A New Twist at the AOPA Policy Forum With a number of critical issues facing the O&P profession this year, personal meetings with lawmakers take on greater significance. AOPA staff is scheduling hundreds of congressional appointments for participants during the April 26-27 Policy Forum in Washington, D.C., where attendees will take part in a Legislation-Writing Congress and several Issues Briefings Panels to prepare for their meetings with legislators.

40 | Putting Trendline Data To Work In the second of a three-part series on the financial aspects of running an O&P facility, the O&P Almanac covers trendline data. Learn to plot historical data points to analyze your company’s financial performance.

By Michael Oros, CPO, FAAOP

Member Spotlight.................................42 n n

Kenney Orthopedics Anodyne Shoes

AOPA News................................................46

AOPA meetings, announcements, member benefits, and more

Welcome New Members ................. 48

AOPA PAC.................................................. 48

Marketplace............................................. 50

Careers......................................................... 58

Professional opportunities

Ad Index....................................................... 59 Calendar..................................................... 60

Upcoming meetings and events

Ask AOPA...................................................64 Proof of delivery and detailed written orders

O&P ALMANAC | MARCH 2016

3

VIEWS FROM AOPA LEADERSHIP

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

Every Person Matters

By DAVE MCGILL

D

ESPITE THE FACT THAT I have spent my entire career dealing with insurance

and reimbursement issues, I am an optimist. I have never deeply analyzed why that is the case, but I suspect it may be because I have so frequently seen ordinary people do extraordinary things. And my guess is that you have, too. Indeed, if you work in the orthotic and prosthetic profession, finding solutions to unique clinical challenges and watching people transcend adversity are just a normal day at the office. And happily, those characteristics prove useful in other areas as well.

In 2015, we united to prevent implementation of proposed changes to Medicare’s Local Coverage Determination (LCD) for lower-limb prosthetic claims and coverage policy. In only 17 days, 100,000 people signed a petition that obligated the White House to respond—the first disability-related petition to crack the 100,000-signature barrier. AOPA and O&P Alliance partners helped bring more than 100 amputees to a rally in front of the Department of Health and Humans Services headquarters to protest the CMS proposed limits on the access to prosthetic care, culminating in a post-rally meeting with top CMS officials who ultimately declined to implement the proposal. National media picked up the story, generating widespread television, radio, and newspaper coverage.

We also saw a grassroots movement in New York State overturn a “one prosthesis per limb per lifetime” limitation that every insurance plan on that state’s health exchange had adopted. As of January 2016, amputees in New York can now receive medically necessary repairs and replacements to their prostheses.

What both of these examples make clear is just how powerful we can be when we work together toward a common cause. The O&P profession’s story is a powerful one: We help people walk; we allow them to use their arms and hands; because of our work, people can function independently. But this narrative is worthless if no one hears it. And that’s why you should attend AOPA’s Policy Forum in Washington, D.C., on April 26 and 27.

We face significant challenges as we look to 2016 and beyond: the potential for competitive bidding of some orthotic devices; the pending prior authorization program for lower-limb prosthetics; and the continued fallout from last year’s LCD controversy. We need you to help educate legislators about these issues and how they will affect your ability to help the patients you treat.

A common theme I heard at the end of last year was that the entire O&P world had united in a way that everyone previously thought impossible. Another common theme I heard was, “I’m worried that we’ll lose all of that momentum.” The way you keep that ball rolling is by coming to the 2016 AOPA Policy Forum and, most importantly, bring a patient. On behalf of the entire AOPA Board of Directors and AOPA’s staff, I hope to see you there.

Read “A New Twist on the AOPA Policy Forum” on page 34 for details on the events planned during the AOPA Policy Forum.

Dave McGill is vice president, legal affairs and reimbursement, at Össur Americas and is a member of AOPA’s Board of Directors.

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MARCH 2016 | O&P ALMANAC

Board of Directors OFFICERS

President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, PhD, MPH Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Bradley N. Ruhl Ottobock, Austin, TX

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AOPA CONTACTS

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

Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

6

MARCH 2016 | O&P ALMANAC

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

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org.

Yearly subscription rates: $59 domestic, $99 foreign.

All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamediakit for advertising options!

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NUMBERS

The Rising Cost of U.S. Health Care National health expenditures have become a much higher percentage of gross domestic product

U.S. HEALTH-CARE EXPENDITURES

As the O&P community knows all too well, regulatory agencies, legislators, and politicians are demanding

U.S. HEALTH CARE AS A PERCENTAGE OF GDP

$1.5 Trillion

cost-cutting measures in relation to U.S. health care. To get a better idea of how the costs associated with health care in general have risen over the years, the O&P Almanac offers a look at recent national

Amount spent on U.S. health care in 2001

Percentage of gross domestic product (GDP) in 2001

$3.0 Trillion

17.5 Percent

health expenditures (NHE).

Amount spent on U.S. health care in 2014

2014 SPENDING

BY CATEGORY

COSTS OF HEALTH SERVICES IN 2014

$618.7

BILLION

Medicare spending, accounting for 20 percent of NHE

Medicaid spending, accounting for 16 percent of NHE

WHO PAID FOR HEALTH SERVICES IN 2014?

Hospital costs, an increase of 4.1 percent from 2013

7%

$603.7 Billion Physician and clinical services costs, an increase of 4.6 percent from 2013

$329.8

Private health insurance spending, accounting for 33 percent of NHE

Out-of-pocket spending, accounting for 11 percent of NHE

BILLION

Prescription drug costs, an increase of 12.2 percent from 2013

20%

$3.08 T

18% 16% 12%

$1.71 T $1.37 T

10% 8% 6% 4% 2%

8

MARCH 2016 | O&P ALMANAC

1980

1990

2000

2010

28%

28%

Households Federal government

TOTAL

Private businesses

PUBLIC PRIVATE

14%

1970

20%

$297.7 Billion

U.S. Health-Care Expenditures, Percent of GDP

1960

17%

State and local governments Other private revenues

SOURCES: www.cms.gov; “CMS National Health Expenditure Report 2014.”

$991

BILLION

Percentage of GDP in 2014

$971.8 Billion

$485.8

BILLION

13.9 Percent

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Happenings RESEARCH ROUNDUP

Mind-Controlled Prosthesis Moves Individual ‘Fingers’ move corresponding fingers based on the data. The prosthesis was wired to the patient via the brain electrodes.

As the subject thought about individually moving each finger, the electrical activity generated in the brain moved the prosthetic fingers. Initially, the mind-controlled prosthesis was accurate 76 percent of the time, but that accuracy improved to 88 percent after adjustments were made. There was no pretraining of the subject prior to this trial, and the experiment took less than two hours.

“We believe this is the first time a person using a mind-controlled prosthesis has immediately performed individual digit movements without

An illustration showing the electrode array on the subject’s brain, including a representation of what part of the brain controls each finger.

extensive training,” says Nathan Crone, MD, professor of neurology and leader of the research team, which comprised physicians and biomedical engineers.

Crone says application of this technology to amputees is still several years away.

The study was published in the February issue of Journal of Neural Engineering.

ILLUSTRATION: Courtesy of Guy Hotson

A subject using a mind-controlled arm prosthesis was able to perform individual digit movements without extensive training during a recent experiment at Johns Hopkins School of Medicine. The subject, a young man with epilepsy, is not an amputee, but was outfitted with a device that essentially took advantage of a brain-mapping procedure to bypass control of his own arm and hand.

Prior to the trial, researchers made brain recordings of the subject using more than 100 electrodes surgically implanted, and the signals were used to control a modular prosthesis developed at Johns Hopkins. The researchers mapped and tracked the specific parts of the subject’s brain responsible for moving each finger. The researchers then programmed the prosthesis to

Researchers Study EMFs as Pathway to Neuroma Prevention

10

MARCH 2016 | O&P ALMANAC

to a radiofrequency electromagnetic antenna for 10 minutes, once a week for eight weeks. The antenna delivered a power density equivalent to that measured at 39 meters from a local cellphone tower—a power density common in occupational settings.

By week 4 of the study, 88 percent of the nerve-injured subjects demonstrated a behavioral pain response, while only one subject in the control group exhibited pain at a single point in time. The pain responses persisted after growth of a neuroma and resection (which is the typical treatment in humans with neuromas).

“Our study provides evidence, for the first time, that subjects exposed

to cellphone towers at low, regular levels can actually perceive pain,” says Romero-Ortega. “Our model found that electromagnetic fields evoked pain that is perceived before neuroma formation; subjects felt pain almost immediately. My hope is that this study will highlight the importance of developing clinical options to prevent neuromas, instead of the current partially effective surgery alternatives for neuroma resection to treat pain.”

The next step is to develop devices that block neuropathic pain from radiofrequency electromagnetic energy, according to the researchers. Details of the study were published in January in PLOS ONE.

IMAGE: iStock.com/Bjoern Meyer

Scientists at the University of Texas at Dallas recently studied the effects of electromagnetic fields (EMFs), such as those found in cellphone towers, on nerve-injured rats to test their hypothesis that the formation of neuromas creates an environment that may be sensitive to EMF-tissue interactions.

The research team, which was led by Mario Romero-Ortega, an associate professor of bioengineering in the university’s Erik Jonsson School of Engineering and Computer Science, tested its hypothesis by assigning rats to two groups: one group with a nerve injury simulating amputation, and one control group.

Researchers exposed the subjects

HAPPENINGS

CODING CORNER

Sensation-Sensing Prosthetic System Shows Long-Term Results

Jurisdiction B Prepares for DME MAC Transition

Igor Spetic holding a cherry tomato.

PHOTO: Russell Lee

The prosthetic system that helps users perceive sensation, developed by researchers at Case Western Reserve University (CWRU) and the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, continues to help initial clinical trial participants in “feeling” the items they touch.

The system uses electrical stimulation to give the sense of feeling. The nerves used to relay the sense of touch to the brain are stimulated by contact points on cuffs that encircle major nerve bundles in the arm, rather than via electrodes inserted through protective nerve membranes. The different signal patterns, passed through the cuffs, are read as different stimuli by the brain.

Igor Spetic, who lost his right hand in an industrial accident four years ago, underwent a procedure two-and-a-half years ago during which three electrode cuffs were implanted in his forearm.

The prosthetic system allowed patterns of electric signals to be sent from a computer into nerves in Spetic’s arm and brain, giving him feelings of sensation.

Spetic has been able to “feel” 19 distinct points while blindfolded, and reported that his phantom limb had subsided.

A second patient, Keith Vonderhuevel, who lost his right hand and much of his forearm in an accident, also was implanted with two cuffs in his upper arm.

Vonderhuevel has been able to feel 16 distinct locations and a reduction in phantom limb.

After several months of wearing the prosthetic system, both patients began feeling sensations that were familiar, such as sandpaper and cotton, and were able to control their prosthetic hands with more dexterity, according to the researchers. The system has worked for more than two years for Spetic and 18 months for Vonderhueval, which is significant because amputees using other experimental sensing prosthetic systems have reported the sense of touch fading over time.

“The work reactivates areas of the brain that produce the sense of touch,” says Dustin Tyler, an associate professor of biomedical engineering at CWRU and associate director of the Advanced Platform Technology Center at the Cleveland VA. “When the hand is lost, the inputs that switched on these areas were lost.

“Our goal is not just to restore function, but to build a reconnection to the world. This is long-lasting, chronic restoration of sensation over multiple points across the hand.”

In addition to hand prosthetics, Tyler believes the technology can be used to help those using prosthetic legs receive input from the ground and adjust to gravel or uneven surfaces.

Beyond that, the neural interfacing and new stimulation techniques may be useful in controlling tremors, deep brain stimulation, and more.

The stage is set for CGS to take over as the durable medical equipment Medicare administrative contractor (DME MAC) for Jurisdiction B in June. Although NGS had protested the award of the contract to CGS, that protest has been denied, clearing the way for CGS to begin transition work in preparation for the June 27, 2016, start date.

CGS has announced that Jurisdiction B claims will be processed out of the company’s existing operations center in Nashville, and that it intends to hire at least 150 staff members to ensure that it has adequate capability to begin processing claims as of June 27. Doran Edwards, MD, will serve as the Jurisdiction B DME MAC medical director. Edwards currently serves as an associate medical director for the Jurisdiction C DME MAC. CGS has established a website where providers may learn more about the transition process: www.cgsmedicare.com/jb.

O&P ALMANAC | MARCH 2016

11

HAPPENINGS

MEETING MASHUP

BRACING BENEFITS

Joint Statement on Scoliosis Underscores Orthosis Efficacy

PFA Announces Stand-Alone Symposium in November The Pedorthic Footcare Association (PFA) will hold its 57th Annual Symposium and Exhibition as a standalone event this year, rather than in conjunction with the American Podiatric Medical Association’s annual meeting. The symposium will feature three educational tracks where practitioners will have the opportunity to earn up to 23 CEUs. The association is calling for abstracts for those interested in presenting at the symposium, which will be held in Atlanta, Nov. 4-6, 2016, at the Renaissance Waverly Hotel.

Details on submitting abstracts are available at www.pedorthics.org.

For more information, contact Jeremy Long at j.long@pedorthics.org or 229/389-3440.

Clinicians Travel to Vegas for Hanger Education Fair PHOTO: iStock.com/Sean Pavone

12

MARCH 2016 | O&P ALMANAC

More than 850 clinicians and therapists attended Hanger Inc.’s 2016 Education Fair & National Meeting, held February 1-5 at the Rio Hotel in Las Vegas. Also in attendance were members of the amputee community. With a theme of “Reimagine,” the Education Fair offered continuing education on orthotic, prosthetic, and therapeutic solutions. Employees took part in many opportunities to learn and network, and many took part in the third annual “Women in Leadership” course. The event featured more than 125 exhibits and 375 exhibitor representatives. Awards were distributed throughout the week to celebrate the success of employees who excelled at delivering exceptional care and service in 2015.

PHOTO: iStock.com/luckyracoon

Four associations have joined forces to issue a statement focusing on scoliosis.

The “Screening for the Early Detection of Idiopathic Scoliosis in Adolescent” document is a joint statement from the American Academy of Orthopaedic Surgeons, the American Academy of Pediatrics, the Pediatric Orthopaedic Society of North America, and the Scoliosis Research Society. The statement highlights recent research and calls for early scoliosis detection and appropriate treatments to minimize further curvature of the spine.

The study cites the findings in the “Bracing in Adolescent Idiopathic Scoliosis Trial” (BrAIST) study, which was undertaken by Stuart Weinstein, MD, professor of orthopaedics and rehabilitation at the University of Iowa,

and funded by the National Institutes of Health. The research showed that bracing of adolescents with moderate scoliosis was an effective treatment in the reduction of the number of patients who advance to the need for surgery.

The research also indicated a correlation between the number of hours of orthosis wear and the success rate of bracing.

“The BrAIST study provided high-quality evidence that bracing for adolescent idiopathic scoliosis can decrease the rate of progression of spinal curve to the surgical level,” said M. Timothy Hresko, MD, co-author of the joint statement. “Early detection of scoliosis is essential to identifying patients who may benefit from the use of a spinal brace.”

In particular, the statement recommends that screening for spine deformity be part of preventive care visits for girls (at age 10 and age 12) and boys (at age 13 or 14), and that screening programs should be staffed by well-trained personnel who can appropriately administer forward bending tests, and the use of a scoliometer, to correctly measure and identify abnormal spine curvature. The statement also emphasizes that bracing is an effective nonoperative intervention to reduce the risk of progression to surgical treatment.

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Mike Mallaro has been named chief executive officer of VGM Group Inc. Mallaro will fill the role that was vacated with the sudden passing of VGM’s founder, Van G. Miller, in October.

Jim Walsh, VGM’s interim chief executive Mike Mallaro officer, will transition to chairman of the board and continue to serve as general counsel.

For the past 15 years, Mallaro has been VGM’s chief financial officer where he was responsible for the company’s financials, business development strategies, and executive oversight. During that time, he also served as the lead on development of the employee stock ownership plan, which included transition to a 100 percent employee ownership. “I’m looking forward to expanding my role within the company and our industry,” says Mallaro. “Despite its challenges, our industry has an exciting future ahead. VGM will continue to lead, advocate, innovate, and connect, helping our members propel their business forward.”

In addition, Jim Phillips has been named president of VGM Group Inc. Phillips will continue to serve as the company’s chief operating officer along with his new duties as president.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Liberating Technologies, a College Park Company, was recently awarded five government grants totaling approximately $3.3 million. The grant projects include developing a device to improve blood flow in residual limbs at risk of additional amputations; a powered hand orthosis; new technologies to train upper-limb myoelectric prosthesis users; and a system to obtain quantitative outcome measures related to optimizing lower-limb prosthesis balance and dynamic function.

The grants are funded through the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Center for Medical Rehabilitation Research; National Institute on Disability, Independent Living, and Rehabilitation Research; Defense Health Program Small Business Innovative Research through the Congressionally Directed Medical Research Program; and Congressionally Directed Medical Research Program’s Orthotics and Prosthetics Outcomes Research Program.

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MARCH 2016 | O&P ALMANAC

IN MEMORIAM: Junior Odom, CP(e) Junior Odom, CP(e), died on Jan. 22, 2016, at the age of 85. He was the founder of Bluegrass Artificial Limb Company in Lexington, Kentucky. He served as president of the American Junior Odom, Board for Certification in Orthotics, CP(e) Prosthetics, and Pedorthics (ABC) in 1979. While on ABC’s Board of Directors, he established a formal orientation program and grievance policy for candidates taking the certification exam. He served as an active member in AOPA and was past president of AOPA Region IV. Odom continued to serve on multiple committees for both AOPA and ABC throughout his career.

Odom was well known for travelling the country and visiting with prosthetists everywhere. He and Bob Arbogast went to every major league baseball stadium during the 1996 season without ever purchasing a ticket themselves, thus earning the designation as the officials of the IBOF— International Brotherhood of Freeloaders.

Following the 1985 earthquake in Mexico City, Odom traveled with a group of volunteers to aid victims. He connected with local prosthetist Arturo Vasquez Vela and surgeon Eduardo Vasquez Vela, and together they founded Centro Rehabilitacion Integra Para Minusvalidos del Aparato Locomotor (CRIMAL) in Queretaro, Mexico, where more than 2,500 amputees have been provided prostheses.

The laboratory at CRIMAL is dedicated in honor of Odom, who was affectionately known as “El Patron.”

CRIMAL continues to operate today with volunteers and supporters from both the United States and Mexico providing direct patient care as well as education and training for prosthetists, physicians, and therapists. Odom is survived by his wife, Pam Odom.

The Amputee Coalition has announced its national sponsors for 2016. National sponsors support the mission and all of the programs that the Amputee Coalition provides to the limb loss community, including education, advocacy, and support.

Gold Sponsors for 2016 are College Park, Freedom Innovations, Hanger Clinic, and Össur. Silver Sponsors are Ability Dynamics, BionX, Fillauer, Lim Innovations, Ottobock, and WillowWood. Bronze Sponsors are the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; the Board of Certification/ Accreditation; Kenney Orthopedics; and Scheck & Siress.

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PM several individuals with upper-limb The interchangeable components of the ETD2 will allow for personalized prosthetics based on injury and individual lifestyle needs.

OHI and the American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) have announced a joint educational partnership to support the podiatric profession at large and to advise on the impact of the rapidly shifting health-care industry. The partnership is built around a $120,000 education and advocacy grant from OHI for programs that will support biomechanics and the podiatric profession over a four-year period. The alliance will enable the development of educational programs and resources for ACFAOM members, and all doctors of podiatric medicine. Össur and Ottobock have announced a joint philanthropic effort to further development in the field of mindcontrolled prosthetics. The Össur and Ottobock Research Trust Fund has been established at the University of Iceland and will award international grants for scientific research and innovative projects in the field of advanced neural control of prosthetic limbs.

“Neural-controlled prosthetics is one of the greatest clinical challenges in our field, and its potential to impact lives is so significant that both companies embraced the opportunity to marshal resources and help accelerate this critical technological development,” said Thorvaldur Ingvarsson, MD, PhD, executive vice president of research and development of Össur.

“Neural-controlled prosthetics could transform the lives of thousands of people with limb loss throughout the world, and we look forward to supporting the ongoing exploration of the field through the creation of this new fund,” said Hans Dietl, PhD, chief technology officer of Ottobock.

The first grants from the fund will be awarded within one year. The fund will be governed by a four-person committee, comprising two University of Iceland representatives and one representative from each company. Details regarding the fund’s grant application process will be announced in the near future.

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MARCH 2016 | O&P ALMANAC

Ottobock has announced the formation of a new U.S. Orthotics Business Unit, which is supported by the North American Orthotics Sales Organization and focuses solely on orthotic product sales in O&P. Ottobock’s existing activity and sports medicine representatives have been renamed Ottobock orthotics sales representatives and will support the full line of Ottobock orthotics products and services.

The previous Technical Orthopedics Business Unit has been renamed the Ottobock Prosthetics Business Unit and will be supported by the North American Prosthetics Sales Organization.

Ottobock customers will now have one dedicated sales representative for orthotics and one dedicated sales representative for prosthetics.

The Pedorthic Foundation accepted a $100,000 donation from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics in November to help further the foundation’s mission of providing research demonstrating the efficacy of pedorthic treatment. “The timing of this gift is excellent as it allows the foundation to aggressively move forward with additional research for the profession,” says Dennis Janisse, CPed, president of the Pedorthic Foundation.

Information for grants is posted on the foundation’s website, pedorthicfoundation.org. Grants will be considered for clinical or laboratory research in prescription footwear, orthotics, and pedorthic modifications. Questions can be directed to the Pedorthic Foundation office at 920/356-1200 or info@pedorthicfoundation.org.

Rehab Systems, an O&P patient care located in Boise and Twin Falls, Idaho, and its sister company Coyote Design, located in Boise, Idaho, are changing their hours. The patientcare facilities will now be open until 5:30 p.m. Monday through Thursday, and until 4 p.m. on Fridays. To supplement for the longer workday, each staff member will get every other Friday off, resulting in 75 work hours instead of 80 over a two-week period.

Coyote Design’s manufacturing and central fabrication site will see a similar reduction in work hours as it switches to a four-day work week. The changes in hours will not affect employee pay.

“While this is a hit in terms of workable hours, we feel that with extra time off for family, friends, hobbies, and enjoying the great area we live in, our staff will more than make up for those hours in enthusiasm, engagement, and general happiness, all of which leads to better customer service and performance,” says President and Chief Executive Officer Matt Perkins.

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REIMBURSEMENT PAGE

By DEVON BERNARD

Conflicting Dates Know the rules for the instances when date of service does not match date of delivery

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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ILLING FOR ORTHOTIC AND pros-

thetic items and services can be very complex. Fortunately, no matter how complex it gets, you can almost always count on three steadfast rules to assist you in the process: • The location where an orthosis or prosthesis will be used is usually what determines who is responsible for paying the claim.

• Bilateral items/services are billed with the LTRT modifier and two units of service.

• The place of service code selected should correspond with where the item will be used, and not where the item is delivered.

The Two-Day Rule

The most common exemption to the date-of-service rule is the Predischarge Delivery of DMEPOS [durable medical equipment, prosthetics, orthotics, and services] for Fitting and Training 18

MARCH 2016 | O&P ALMANAC

IMAGE: iStock.com/eskamilho; ILLUSTRATION: iStock.com/Bannosuke

What about the rule that says your date of service should equate to your date of delivery? The date the patient takes delivery of the item should always be the date of service—right?

Typically, that statement is accurate; however, there are exceptions to prove the rule. This month’s Reimbursement Page focuses on the few instances where your date of service will not match your date of delivery.

Rule, more commonly referred to the “two-day rule” or the “48-hour rule.”

Hospitals and skilled nursing facilities (SNFs) are paid for Medicare Part A services through a prospective payment system (PPS). This system pays the facility a daily rate to cover the costs of all medically necessary services for a patient. Hospitals or SNFs use outside suppliers when they are unable to provide a particular service directly. They then must pay the outside supplier for its services, since they have already received payment in full for the patient’s care under the PPS. However, the two-day rule states that you may deliver an item to a Medicare patient in a Part A hospital (such as an acute-care, rehab, or long-term care facility) or SNF within 48 hours (two days) of the patient’s anticipated discharge, and bill Medicare instead of the facility where the item was delivered. This is permitted as long as the following criteria have been met: • The device is not medically necessary during the remainder of the patient’s stay (the patient does not need or does not use the item).

• The patient is being discharged to his or her home (not to a different hospital or to an SNF).

• You are delivering the item in order to provide basic instruction on how to use and care for the device.

REIMBURSEMENT PAGE

If all of these criteria are met and you bill under the two-day rule, date of service is the patient’s discharge date from the hospital or SNF, and not the date of actual delivery. While the two-day rule allows you to use the date of discharge as your date of service, the actual date of delivery should be documented in the patient’s chart in case questions arise in the future. You also may want to get a verification in writing from the hospital or SNF of the patient’s anticipated discharge date; this will become handy, especially if the patient’s discharge date changes.

The purpose of the two-day rule is not to alleviate or shift the responsibility of the hospital or SNF to provide its patients with appropriate care and medically necessary services. If an orthosis or prosthesis, or any other type of O&P device or service, is needed as part of the patient’s recovery or rehabilitation in the facility, it must be paid for by the facility regardless of when it was delivered. To learn more about this rule, including the responsibilities of the hospitals or SNFs, review Chapter 20, Section 110.3, of the Medicare Claims Processing Manual.

Items Ordered Prior to an SNF Stay

IMAGE: iStock.com/sturti

The next exemption regarding when your date of delivery will not equal your date of service also is fairly common, but its scope is much narrower than that of the two-day rule.

There may be instances when an item is ordered when a patient is in a Part A hospital stay, but you are unable to deliver the item until the patient is discharged to a Part A SNF stay. Alternatively, an item is ordered while the patient is at home but is delivered while the patient is in an SNF Part A stay. We will focus on the latter, as it is the instance where your date of service or date of delivery on your claims will be altered.

If a custom orthosis or prosthesis is ordered while a patient is at home, the medical need for the item has been established before the patient was admitted to the SNF. So, if the custom

orthosis or prosthesis (or even an item or service not exempt from SNF billing) was ordered while the patient was at home but it was delivered to the patient in an SNF, you may bill Medicare.

However, you must alter your date of service; if you use the date of delivery as your date of service, Medicare will deny the claim, indicating that it is not the payor of record because the SNF has already been paid for the item/service under its prospective payment system bundled payment.

So, what is your date of service?

Your date of service would be the start date of the order, or the date you began treating the patient.

All of the scenarios in this article apply only to custom orthotic items and prosthetic items, and do not apply to prefabricated items or diabetic shoes. This is because of the extra time required to fabricate and provide a custom item. The basis of this narrow exemption was established by the MLN Matters article SE0507, “Prosthetics and Orthotics Ordered in a Hospital or Home Prior to a Skilled Nursing Facility Admission,” which was revised in March 2013 and can be found on the CMS website, www.cms.gov.

Refused Items

There is another common scenario when date of service may differ from actual date of delivery: when an item is not delivered at all because it has been refused. An orthosis or prosthesis is traditionally considered to be refused if the patient no longer requires the item because the item is no longer medically necessary.

The change in medical necessity, or refusal, may be the result of a change in a patient’s condition. This may occur, for example, if you are going to provide a patient with a thoracic lumbarsacral orthosis (TLSO), but before you are able to deliver the TLSO, the patient and physician decide on a different course of treatment. Since the patient chose a different means of treatment, the TLSO may no longer be needed, or medically necessary. The device has now been refused. Similarly, if a patient dies before you are able to deliver the device, it is no longer medically necessary, and the device is refused.

Once you are aware that a patient has refused a device, or the device is no longer medically necessary, document the date you learned of the refusal. The date you learned about the refusal, or O&P ALMANAC | MARCH 2016

19

REIMBURSEMENT PAGE

POD Signature and Date Requirements

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MARCH 2016 | O&P ALMANAC

the item is prefabricated or custom fabricated. For more information, review Chapter 15, Section 20.3, of the Medicare Benefit Policy Manual. Copies of the Medicare manuals may be found on the CMS website, www.cms.gov.

Items Delivered Via Shipping Service

The last scenario when the date of delivery will be different than the actual date of service is when you use a shipping service to deliver an item to a patient.

This is a rarity for orthotic and prosthetic items, as most O&P devices are delivered directly to the patient, but you may use a shipping service for consumables, such as socks, shrinkers, etc. If you utilize a shipping service, your date of delivery/ date of service becomes the date you mailed the item, and not the date or the anticipated date of delivery or when the patient actually receives the shipment.

If you are using a shipping service, remember that your proof of delivery form or documentation will have some additional features or components beyond those found on a traditional proof of delivery slip. Both types of delivery slips will require the presence of the patient’s name, the delivery address, a detailed description of the item(s) being delivered, and the delivery date; but the proof of delivery documentation

for the shipping service must have two additional components. First, you must have something that links your delivery records to the records of the shipping/ delivery company, such as a package identification number or a tracking number. Second, you must include documentation indicating evidence of delivery, such as a confirmation from the delivery company.

To learn more about the proof of delivery requirements, review Chapter 4, Section 4.26, of the Medicare Program Integrity Manual, or contact AOPA. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@aopanet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

Earn CE credits accepted by certifying boards:

www.bocusa.org

IMAGE: iStock.com/kzenon

the date you learned the device is no longer medically necessary, will become your date of service when billing. If the patient has died, your date of service is the date of the patient’s death, and not the date you learned of the patient’s passing. If you use a date of service that is after the date of the patient’s death, your claim will be denied.

If the patient’s condition has not changed or he or she has not passed away, but he or she simply refuses delivery of the item or will not pick it up, your date of service would be the last day you attempted to make a delivery. There is no minimum or maximum number of attempts required to declare a device refused, but AOPA recommends at least three attempts, all of which should be included in your documentation. If a patient still refuses to pick up the item, you may wish to notify him or her of your intent to bill for the item. It is not necessary, but using a certified letter to inform the patient of your intent to bill will provide documentation, such as a signed receipt of the letter, which confirms that you communicated with the patient about opportunities to pick up the item in question and that you are billing for the item.

Be aware there are certain rules regarding refused items, outlining how much you may bill and what to do if

It’s important to understand the signature and date requirements on a proof of delivery form. The delivery date entered on the proof of delivery form must be the date the patient received the item or service. This date may be entered or included on the proof of delivery by you, be printed on a preprinted delivery form, or be written by the patient when he or she signs the proof of delivery form. However, if the proof of delivery form has two dates—the one entered by you and the one written by the patient—the date written by the patient will be considered your date of service.

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This Just In

Documenting O&P Efficacy Publications highlight the value of O&P intervention amid ongoing competitive bidding concerns

T

UCKED AWAY IN THE president’s

December 7, 2012

Ensue If Recent on Amputee Care Would d, and Serious Adverse Impact an Progress Were Adopte the Center for Americ Medical Communications from ition of All Medicare Were Adopted for Acquis Competitive Bidding Devices in DMEPOS. and Custom-Fitted As Custom-Fabricated the Medicare Prosthetics, As Well Custom-Fabricated ation of services for l Relationship ly Refers to a combin a Long-Standing Clinica Orthotic Bracing Typical s both the product and re Beneficiary Beneficiary which include Visits/Interactions Between the Medica Clinical the clinical services Where er Caregiv of Patient Care and paired Patient and His/Her Limb-Impaired Patient.

Amputee or Limb-Im or e re Beneficiary Ampute needed by the Medica s: Dear Member of Congres

ic and undered with overly simplist we have been very concern of the Center for appeared in the name We are writing because which have recently itive bidding for universal compet informed communications aries in the essentially has argued made available to benefici America Progress. CAP ass every medical device doing so would save the government $38 encomp to on expansi offers the promise that time when fiscal Medicare program, and forward in a delicate of such tantalizing idea put attention to a promise billion. This is a very tions could trigger quick on competitive cliff/sequestration delibera . Unfortunately, such universal reliance of the care of savings extensive potential tions and disorientation with limb in devastating interrup aries benefici situated bidding would result amputees, and of similarly sclerosis, cerebral palsy, scoliosis, spina Medicare beneficiary multiple like ns rely on conditio threatened and who impairment from chronic whose mobility is severely independence. CAP clearly does bifida and others—patients maintain their commodity such and orthotic care to e is more than a simple ongoing prosthetic prosthetics for an ampute is attached to a person’s body and use not understand that that it is a medical device health care of fitting as well as as a walker or a cane, This is what will involves a great deal of the prosthetic device they trust and who understands their needs. r or a walker. intervention by a provide tics and custom orthotics like a cane be lost by treating prosthe of a medical lished by the mere deliveryorthotics are accomp not is and e patients because prosthetics Care of these Medicar nt category. important distinction device—this is a critically typical items in the durable medical equipme al reasons, Medicare t from for whatever historic dramatically differen red by the fact that, of the device, rather Confusion may be engende prosthetics has been made on the basis s and encounters which are payment for orthotic y of patient visits and to properly the number or intensit and teaching the patient as well as than on the basis of the patient for the device prosthetics associated with fitting of custom-fabricated said, the complexity the typical with coupled s, use the device. That custom-fitted orthotic custom-fabricated and

(over please) refinement ent, modification and ongoing training, adjustm that would be patient’s need for regular, and detriment to existing patient care risk underscores the huge g and mobility-restorin perpetrated if the these custom medical and followed as a walker or were such CAP dity recommendations of an off the shelf commo in the same way as devices were treated a wheel chair. c could exercise dramati ended that Medicare aries, economists recomm vouchers to benefici Suppose that health issuing patient visit ns who, while the program started the offices of physicia cost containment if their medical visits at to the lowest ‘per directing them to secure a program committing as aries, had enrolled in y reject such a concept certainl unknown to the benefici almost ers with their e? Congress would visit’ cost to Medicar es health care encount average citizen conceiv inimical to what the of, and we would agree. physician to consist tics and custom n of adding prosthe iate conclusion considered the questio and has drawn the appropr ion.

Medicare has already program bidding itive conclus orthotics to the compet . We agree with this good fit for the program that they are not a adopted as to as touted by CAP were l competitive bidding appropriate custom If the concept of universa they would receive the product without device useful to because needed to make the prosthetic patients a program and other clinical services can be re-directed into fitting, gait training expect that these patients coming to them in box, directed via bracing them. We cannot blithely not diabetic customized limbs and n. Artificial limbs are operatio which would have their se distribution warehou tailored, fitted, and a Medicare-sanctioned custom made devices instead ditization are they Commo chairs; features. test strips or wheel anatomical and skin ing their longthe patient’s unique patients from maintain modified regularly to s would divorce those health care of prosthetics and orthotic relationship and visits with their trusted and have earned care ts who understand standing clinical patient orthotis and tists prosthe professionals—the specific ed treatment and care. decades of specializ the patients’ trust over all medical devices h to competitively bid the blanket approac relationships. But we We cannot be sure how beneficiary-provider e orthotic and might impact other idea if applied to Medicar support the espoused by the CAP tive destruc terribly be a s of Congress to know that this would re strongly urge member of commoditizing orthotic and therefo we and concept prosthetic care, e and reject any such protect their current position of Medicar the CAP, and in doing so, continue to d by aired patients. limb-imp prosthetic care propose and es Medicare ampute constituents who are with limb loss and limb for Medicare patients information. interest and concern Thank you for your provide any further let us know if we can impairment, and please Very truly yours,

Kendra Calhoun President/CEO Amputee Coalition Suite 100 9303 Center Street, Manassas, Virginia 20110 865/524-8772

22

Thomas F. Fise Executive Director Prosthetic Association American Orthotic & Suite 200 330 John Carlyle Street, Alexandria, VA 22312 571/431-0876

MARCH 2016 | O&P ALMANAC

budget message was a troubling provision proposing that competitive bidding in durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) be expanded “to additional categories, including: inhalation drugs, all prosthetics and orthotics, and ostomy, tracheotomy, and urological supplies. ($3.8 billion in savings over 10 years.)”

The 2017 presidential budget proposals were labeled “dead on arrival” with little or no chance of serious consideration by this Congress.

Nevertheless, the O&P community has once again been put on notice that there is strong intent on the part of some CMS officials who participated in the budget preparation to put all of O&P in the gun sights of competitive bidding. This idea started several years ago with the proposal by the Center for American Progress that Medicare competitively bid every medical device (visit bit.ly/otsletter to see that proposal and the joint reply by AOPA and the Amputee Coalition), not just certain off-the-shelf (OTS) orthoses that the law now specifies as the only subset of O&P that CMS is authorized

by Congress to competitively bid.

This new proposal would embrace all orthotic and prosthetic devices.

Unrealistic, for sure, but it appears to be part of the pattern to lower the level of O&P patient care in the name of Medicare saving dollars, such as the proposals in the now delayed Local Coverage Determination for lowerextremity prosthetics—which would have reverted prosthetic patients to a 1970s standard of care level.

AOPA’s vigilance on competitive bidding in recent years goes back to the Sept. 15, 2010, Health Subcommittee of the House Energy and Commerce Committee hearings when AOPA reminded Congress that “the custom nature of orthotics and prosthetics is why they were excluded from competitive bidding in the first place.”

CMS has continually pushed to expand the definition of those orthotic devices eligible for competitive bidding, stretching the definition well beyond the law with the view that “minimal self-adjustment means an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and does not require the services of a certified orthotist (that is, an individual certified by either the American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc., or the Board of Certification/Accreditation) or an individual who has special training.”

This Just In

The current statutory language defines OTS orthoses as those “which require minimal self-adjustment for appropriate use and do not require expertise in trimming, bending, molding, assembling, or customizing to fit the individual.” Letters from key senators and House members have pressed CMS to stick to only what the law permits, i.e., OTS orthoses limited solely to those that the patient can use with “minimal self-adjustment.”

Visit bit.ly/congressletters to see copies of a letter sent by Sen. Chuck Grassley (R-Iowa) and Sen. Tom Harkin (D-Iowa) in October 2014 and a letter sent by Rep. Ryan Costello (R-Pennsylvania) and Rep. Tammy Duckworth (D-Illinois) and signed by several other members of Congress in May 2015.

This ambiguity has given rise to CMS expanding the definition, and AOPA has sought further statutory clarification language that would define “minimal self-adjustment” as “solely provided by the patient.” This language is present in several pieces of pending legislation in Congress, and AOPA will continue pursuing the legislative path as one strategy.

To further the understanding of orthotic devices and, among other things, what are and what are not eligible orthotic devices for competitive bidding, AOPA assisted in the work of a multidisciplinary Orthotic Workgroup in 2014 to develop guidelines for determining orthotic prescriber authority, documenting medical necessity, and ensuring continuity of care for patients needing orthoses. The workgroup also identified OTS devices that can safely and appropriately be delivered to patients without professional adjustment, as well as those that cannot. John R. Fisk, MD, served as chair of the workgroup, and members included Sharon DeMuth, PT, DPT; James Campbell, PhD, CO, FAAOP; Thomas DiBello, CO, FAAOP; Alberto Esquenazi, MD; Robert S. Lin, MEd, CPO, FAAOP; Bryan Malas, MHPE, CO; Francis X. McGuigan, MD; and Thomas F. Fise, JD. The guidelines developed by the Orthotic Workgroup were published in February Supplement issue of the 24

MARCH 2016 | O&P ALMANAC

This Just In

peer-reviewed Military Medicine journal. The conclusion, as stated in the abstract, “provides expert guidance for patient safety, minimizing wasted expenditures, maximizing clinical outcomes, and providing efficient delivery of care for Medicare and other patients. CMS guidelines should be directed toward recognizing the level of expertise of the orthotists, the value of their patient encounters, and their role in facilitating the timely, safe, and effective use of orthotic devices.”

The workgroup identified more than 80 paired codes from the HealthCare Common Procedure Coding System (HCPCS), with specific expert consensus on the ones where between 60 and 85 percent of usages “will require at least custom-fitting services.” It then identified from the list of 23 CMS designated split codes those codes that could be either custom fit or OTS, specifying those codes that will typically be OTS and those codes usually requiring custom-fitting/clinical services. The guidelines contain a warning: “Expanding the categories of

OTS devices in a Medicare population with potential physical and cognitive limitations can be detrimental and lead to more costly intervention.”

That warning becomes even more potent should there be any future effort to expand competitive bidding to all orthotics and prosthetics.

All AOPA member companies have received a copy of the February 2016 Supplement of Military Medicine that contains the guidelines, including the list of “Paired Codes Where Custom Fitting Is Necessary” and the list of the 23 “HCPCS Codes Split by CMS.” This issue of Military Medicine also features an article on the Dobson-DaVanzo study on cost-effectiveness, which demonstrates, using four years of Medicare data, that timely O&P intervention saves payors money; this study has been a central feature of the www.mobilitysaves. org website. Both journal articles may be identified through their respective citations: Orthotics, Military Medicine, Volume 181, February Supp 2016, p. 11; Dobson-DaVanzo, Military Medicine, Vol. 181, February Supp 2016, p. 18.

The President’s budget proposal sends a clear message that AOPA must remain vigilant to prevent the expansion of competitive bidding. AOPA will continue to be your advocate on Capitol Hill, educating lawmakers about the realities of providing highquality O&P care in an increasingly hostile regulatory climate, and will continue working behind the scenes fighting harmful recovery audit contractor audit practices and attempts at expanded competitive bidding. AOPA will share the message that orthotists and prosthetists are health-care providers and not durable medical equipment providers. Member dues make this advocacy possible, and this year is no exception. If you have not renewed your 2016 membership, now is the time. And share with your colleagues that all O&P practices need to join in to strengthen our efforts.

If this is what the federal government has in mind for the future of your business, can you really afford not to be a member of AOPA?

O&P ALMANAC | MARCH 2016

25

COVER STORY

A Co-Created

Future

Ottobock’s Open Innovation Space in Berlin offers a collaborative environment for research and development

By CHRISTINE UMBRELL

26

MARCH 2016 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Rather than rely on a traditional in-house product development model, some businesses are experimenting with open innovation—a more collaborative and decentralized approach to research and development.

• Ottobock is taking an open innovation approach via its recently opened Makea, or Open Innovation Space (OIS), in Berlin. Developers, designers, artists, and inventors are invited to use the space, which houses 3D printers, laser cutters, CNC routers, design software, and electronics. Ottobock engineers also try out concepts at the OIS. • The cooperative environment allows for creativity and prototype creation without the constraints of regulations mandated in traditional manufacturing facilities. It also fosters partnerships and collaboration among inventors.

• Building an open innovation center for development that is not necessarily O&P-related promotes new ways of thinking. People of all backgrounds visit the space to try new ideas—which may ultimately benefit O&P innovation.

• Several products have come to market after being developed at OIS, including a medical device, electronic fabric, and a vibrating metronome. Some ideas also are being explored that may lead to development of new solutions for O&P patients.

• As open innovation takes hold across industries, more O&P businesses may be willing to test collaborative approaches to product development.

T

O ENSURE PATIENTS ARE receiving optimal care, O&P professionals must be aware of the latest devices, evaluate whether new technologies may work for specific patients, and advocate for appropriate reimbursement. Part of anticipating the future involves understanding when and how the next generation of orthoses and prostheses will develop. Enter “open innovation.”

In years past, businesses generated product ideas internally then developed and manufactured those products. Competitive advantage was based on investment in internal research and development and hiring staff to bring products to market before the competition. Company profits were generally reinvested back into R&D to build more products and generate increased profits, all within the confines of company walls.

Many companies still work this way. But a few businesses— including one O&P manufacturer—are exploring new ways to develop products. Open innovation is a more distributed, more participatory, and more decentralized approach to innovation, O&P ALMANAC | MARCH 2016

27

COVER STORY

according to Hans Chesbrough, a professor at the Haas Business School at University of California—Berkeley, and the author of Open Innovation: The New Imperative for Creating and Profiting From Technology. Unlike the traditional vertical integration approach, open innovation is “the use of purposive inflows and outflows of knowledge to accelerate internal innovation, and expand the markets for external use of innovation, respectively,” says Chesbrough. “For business, open innovation is a more

Ottobock Office

Makea Industries Office

profitable way to innovate, because it can reduce costs, accelerate time to market, increase differentiation in the market, and create new revenue streams for the company. So there’s a lot of opportunity for business to profit from open innovation.”

Of course, open innovation is not just about profits—it’s also about preparing for the next generation of industry, or Industry 5.0, says Scott Schneider, Ottobock’s chief future development officer for North America. “The assets of the future

Workshop & Meeting Rooms

Machine Shops

Copyright © Otto Bock HealthCare

28

MARCH 2016 | O&P ALMANAC

Why Open Innovation?

While most O&P companies continue to develop new devices using traditional business models, Ottobock recently split from the status quo.

Last spring, the company opened the Makea, or Open Innovation Space (OIS), at Bötzow Berlin.

The OIS can be simply defined as an “incubator,” says Schneider: a large, accessible digital fabrication studio where hardware and software developers, as well as designers, artists, and inventors, can learn how to use the space’s 3D printers, laser cutters, CNC routers, design software, and electronics to make almost anything they want.

The OIS is owned by Ottobock and run

by Makea as a service provider, which works on independent projects, one of which is the Fab Lab Berlin. The OIS comprises workshops; meeting rooms; areas for working with electrical, mechanical, metal, wood, and textile materials; and areas with 3D printers of all sizes. The space also

PHOTO: Copyright © Fab Lab Berlin

R&D Center Co-working

are not necessarily going to be manufacturing facilities and the factories; they’re going to be the ideas that people generate” in an increasingly digital world.

Ottobock has begun to adapt to this new environment by investing in its own open innovation facility.

COVER STORY

Moving From Idea to Market

S

ince Makea’s doors first opened in May of 2015, thousands of ideas have been generated, a few of which have made it to market. The following products, developed at Makea, are currently available:

includes a research and development workshop, Ottobock offices, and Makea offices. The Fab Lab Berlin section is part of a network of open digital fabrication studios that originated at the Massachusetts Institute of Technology and has grown to an international system of Fab Lab centers.

Space at the OIS can be rented by individuals or smaller companies, and certain days of the week are open access for all, with modest fees for Massachusetts Institute of Technology

30

MARCH 2016 | O&P ALMANAC

ELEKTROCOUTURE: This innovation marries electronics with fabrics via conductive threads, enabling glowing or other electronically enhanced clothing.

SOUNDBRENNER PULSE: This smart vibrating metronome, which was designed in watch-format for musicians, keeps a beat through the vibration of light.

classes and rental of the machines.

Private individuals and startups, as well as other businesses and institutions, are invited to learn how to use digital fabrication machines and apply this knowledge under supervision to implement their ideas.

The cooperative environment allows for innovation and prototypes, which can immediately be tested and realized by developers, students, and researchers from academic institutions, such as the Technical University of Berlin and the

Elektrocouture

Design Research Lab. “The economy, the education sector, and the inventor community can all be interconnected through the OIS,” says Schneider.

Ottobock’s development engineers and product designers also make use of the space to test new ideas. “This exciting interdisciplinary mixture makes the OIS a breeding ground for new, creative ideas that lead to inventions,” says Hans Georg Näder, president and CEO of Ottobock.

The decision to initiate the OIS stemmed from the desire on behalf of Ottobock’s senior management to foster development in a more creative environment, without the regulatory constraints of a typical manufacturing facility.

Hans Dietl, PhD, global chief technology officer for Ottobock, who resides in Vienna and has offices in both Austria and Germany, researched the open innovation concept—Fab Labs in particular—before spearheading the effort to open the digital fabrication studio at Ottobock.

“The idea was to have a place that serves a couple of needs for our

PHOTO: ElektroCouture

ANGIOTRAINER: This medical device is designed to assist physicians and interventional radiologists during their training and works as a model of the human body; the device can be used to conduct simulated medical examinations and develop treatments for patients at risk of vascular disease.

COVER STORY

PHOTO: Copyright © Fab Lab Berlin

company,” says Dietl. “We wanted to invite people with great ideas to have the possibility of trying things out.

Also, we wanted to be able to work in an open, regulation-free environment.

Regulations are good, because they guarantee patient safety, but they do not allow you to try out crazy ideas. In an open innovation space, away from all of the regulations, you can try new things.

“The idea behind it is to create a co-working environment, which brings together creative people and innovators from inside and outside the company. There are various possibilities for almost anybody to run a productive project there. Since there is no limitation regarding the field of the project, this brings fresh ideas to the field of O&P," says Dietl. Once an idea takes hold, “we may have the opportunity to further develop ideas that may ultimately be helpful to patients and the company.”

Hosting the OIS for development that is not necessarily O&P-related clears the way for new thinking.

People of all backgrounds visit the space—from engineers, to architects, to entrepreneurs—“all kinds of people, with all kinds of ideas,” says Dietl. This inclusive environment fosters creative thinking and collaboration—which may ultimately benefit O&P innovation. “We need these kinds of concepts because we have to shake up old routines,” says Dietl.

Many visitors at the OIS are “making things that have nothing to do with any of the businesses that we’re in,” says Schneider. “But that’s the whole idea. It’s a brain trust. It’s getting ideas.” He offers an example of how seemingly unrelated conversations can lead to a great idea: “How many times do you sit down and talk with a friend you have nothing in common with in your careers, and all of a sudden you start to learn from them?” asks Schneider. “That’s what an incubator’s all about.”

Another benefit for Ottobock is the potential for partnerships with individuals and companies that use the space. Though the OIS in Berlin has been open for less than a year,

it has received much positive feedback as well as attention from big-name companies. BMW, Audi, Mercedes, and Siemens have all been in contact with Ottobock in conjunction with the facility, and hundreds of entrepreneurs with big ideas have frequented the space. (See sidebar for a list of new products that have been developed.)

An Environment Well-Suited to O&P

Open innovation can be considered a modern twist on the way O&P practitioners developed new devices at their facilities many years ago.

“Most O&P innovations come from the workbenches of orthotists and prosthetists,” says Dietl. “This goes back to the roots of letting people try things out and come up with good solutions for patients.” The future of O&P innovation will come from “scientific ingredients mixed with workbench ideas,” he says. “This is a far more effective way to innovate” than having one company put millions of dollars into one idea.

Currently, a small area within OIS is set aside for Ottobock engineers, but they often work in the larger spaces within the facility, alongside innovators visiting the lab. “Ottobock engineers come to try out concepts,” says Dietl.

As for progress thus far in developing devices geared specifically toward the O&P patient base, Dietl notes that there has been nothing finalized yet—but only because the space is in its infancy. “We are in the initial stages

of developing new products,” he says.

“I am confident that there are a couple of ideas there now that will end up as solutions for O&P patients.” It’s important to remember that any products initially developed at OIS will have “to move into the regulated environment” to finalize prototypes, says Dietl.

Any company, O&P or otherwise, that chooses to take an open innovation approach will need to overcome traditional mindsets that confine development to within company walls.

Collaboration and partnerships form the basis for working in an open innovation environment—so leaders have to get past concerns about competitors gaining access to ideas, and be willing to partner with outsiders, to truly innovate and develop in the best interests of the company—and its customers.

“The idea is to be open to fresh ideas—and to do so, you have to take the risk of working in this new way,” says Dietl. “If you want access to new ideas, and you want to motivate inventors who have good ideas, you have to offer them space to try out their ideas.

Then you can discuss the ideas and form partnerships.” Dietl says businesses never completely mitigate the risk associated with working in an open space, but “it’s a risk that you take to get new ideas.”

O&P ALMANAC | MARCH 2016

31

COVER STORY

O&P School Embraces Collaborative Approach

O

pen innovation can take many forms—and educational institutions have been known to lead the way in more collaborative undertakings. Last fall, the Department

of Orthopaedic Surgery at the University of California—San Francisco (UCSF) hosted the inaugural O&P Innovation and Technology Symposium. The symposium convened O&P stakeholders from across the country—including practitioners, engineers, designers, physicians, ergonomic specialists, researchers, physical therapists, venture capitalists, and inventors—for a day of discovery and networking. The goal in bringing everyone As a result of the symposium, several partnerships were formed. For example, UCSF and the University of Michigan (UM) are currently partnering on a 3D-printing project, says Matthew Garibaldi, MS, CPO, assistant clinical professor and one of the event’s organizers. UM will present the results of this partnership at the second O&P Innovation & Technology Symposium in October, which will be expanded to a two-day event, given the interest from the O&P community.

Dietl and other advocates of open innovation believe the concept will continue to gain steam, and more businesses will participate to develop cutting-edge products. Dietl compares this movement to the innovation revolution that took place in Silicon Valley 20 years ago: “Everyone talks about how great it was with Silicon Valley and the garage businesses” during the initial growth of the tech firms, says Dietl.

“We’ve lost momentum there. But the open innovation concept brings back of lot of momentum in that direction.”

The open innovation movement also goes hand-in-hand with recent crowdfunding and crowdsourcing trends: People with big dreams but little capital can use open innovation labs such as OIS to develop and prototype their

MARCH 2016 | O&P ALMANAC

Investing in Tomorrow

One often-overlooked sector of the population that plays an important role in innovation for the future is children, and Ottobock has made sure that children are included in the OIS. The space hosts a series of Junior Lab Days, where children are invited to visit the facility, test some of the equipment, and even try out some ideas of their own.

“The investment in people and our next generation” is an integral part of OIS and the future of technology, says Schneider. “I’m not sure we will see where this is all going to go and what’s going to happen in Industry 5.0,” he says, referring to the concept’s

infancy, “but it’s phenomenal, and it’s fun to see these kids working at it. It’s so cool to get these kids involved at an early age and make this investment.”

Schneider predicts there will be a supply chain revolution using the open innovation concept: “This is a way to bridge technology with industry, and to develop new ideas with less equipment.”

Open innovation is all about “being on a continuous quest to understand and learn and embrace technology. We need to create environments to foster technology and embrace change. We need to invest in people and our next generation,” Schneider says.

As O&P businesses begin to understand the profits and partnerships to be made from a more collaborative approach to idea generation in a digital world, expect to see many more O&P companies testing open innovation concepts in the coming years.

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

PHOTO: Copyright © Fab Lab Berlin

32

ideas, then raise funds via Kickstartertype campaigns to bring the products to market. In fact, one product has already been developed this way at OIS: the Soundbrenner Pulse, a smart vibrating metronome that keeps a beat through vibration of light. Its inventors sought $75,000 in crowdsourcing, but received more than $200,000. The product is now available on Amazon, selling for $99 apiece.

PHOTO: Matthew Garibaldi, MS, CPO

together was to initiate discussions on new areas of clinical innovation and technology.

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A New Twist at the

AOPA Policy Forum PARTICIPANTS IN THIS YEAR’S EVENT CAN EXPECT CLEAR GUIDANCE FROM HIGH-PROFILE SPEAKERS ON O&P IMPERATIVES IN PREPARATION FOR CONGRESSIONAL VISITS

NEED TO KNOW

• O&P professionals who travel to Washington, D.C., in April to take part in the 2016 AOPA Policy Forum will engage in two days packed with targeted education, expert advice, and meetings with members of Congress.

• Tuesday morning’s events will feature a brand-new O&P LegislationWriting Congress, where participants will write a brief piece of legislation to share during the next day’s meetings with legislators.

• A series of Issues Briefings Panels will take place Tuesday afternoon, where O&P experts will share information on hot topics such as proposed and pending legislation, audit activities, veterans’ issues, outcomes data, and more.

• Wednesday will kick off with a review of the talking points and a mock congressional visit to ensure participants are ready to share the most relevant O&P information during their meetings.

• More than 400 congressional appointments will be scheduled between 8:30 a.m. and 3 p.m. Wednesday, where Policy Forum participants will meet with their senators and representatives and ask for their support.

Participants will reconvene during a debriefing session to share their experiences and close out the Policy Forum.

34

MARCH 2016 | O&P ALMANAC

AOPA 2016

POLICY

FORUM L

ASER FOCUS IS THE new format for the 2016 AOPA Policy Forum, which will take place April 26-27 at the

Marriott at Metro Center in Washington, D.C. Each year, hundreds of AOPA members become frontline O&P advocates during the annual Policy Forum, assembling in the nation’s capital to share the message of O&P with members of Congress during personal meetings in legislators’ offices. With a host of critical issues impacting O&P this year, it’s more important than ever for members of the profession to speak out during this important event.

The 2016 AOPA Policy Forum is the perfect opportunity to muster the forces of O&P to deliver the information and education that will influence lawmakers to stand up for O&P practitioners and patients. This year’s event has been redesigned to be more targeted: Attendees will take part in an O&P Legislation-Writing Congress at the start of the event, Sen. Bob Kerrey led by former Sen. Bob Kerrey (D-Nebraska), where they (D-Nebraska) will learn to write a simple piece of legislation. Participants also will attend a series of four AOPA Issues Briefings led by industry experts to ensure all participants understand the issues facing O&P, as well as current and proposed legislation and regulations that impact the profession. Armed with the latest information, participants will be well-prepared to lead discussions during individual visits with lawmakers on the second day of the event.

O&P ALMANAC | MARCH 2016

35

NEW! AOPA 2016 POLICY

FORUM

Crafting the O&P Message

This year’s Policy Forum will kick off with an O&P Legislation-Writing Congress beginning at 8:30 a.m. on Tuesday morning, April 26. Kerrey will lead this session, where participants will collaborate to write a one- or two-page bill to be named the O&P Modernization Act; this document will be a lead issue for the next day’s congressional visits. The goal is a short, simple solution in legislative language form that all AOPA members can put before their legislators in asking for their support. Kerrey will proceed to personal visits with several key senators Tuesday afternoon to begin beating the drums for the legislation’s consideration by Congress.

Advocates who take part in the Policy Forum will be armed with talking points on several key issues.

Participants will educate legislators on the need for the Medicare O&P Improvement Act (H.R. 1530/S. 829) and ask for their support and cosponsorship to incorporate the O&P Improvement Act’s language into the House Ways & Means Committee’s and the Senate Finance Committee’s Audit & Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) bill (S. 2368). Participants also will advocate for O&P research/education funding issues—the Wounded Warrior Workforce Enhancement Act (S. 1021) and the Wounded Warrior Research Enhancement Act (S. 1022)— which will provide needed funding for expanded O&P education and research, respectively, to meet growing needs for trained clinicians and research data to achieve better patient outcomes.

Hot Topics at Issues Briefings

Three regulatory hot buttons will be covered in the first Issues Briefing Panel: prior authorization, the Local Coverage Determination (LCD) for lower-extremity prosthetics, and the resumption of recovery audit contractor (RAC) audits. Panelists will include AOPA President James Campbell, PhD, CO, FAAOP; Immediate Past President Charles H. Dankmeyer Jr., CPO; 36

MARCH 2016 | O&P ALMANAC

Honoring O&P’s Supporters on the Hill There will be several opportunities during the Policy Forum for AOPA members to show appreciation for those legislators who have been especially perceptive and supportive of O&P issues.

• On Tuesday, AOPA will host a luncheon for Rep. Renee Ellmers (R-North Carolina), who introduced the Medicare DMEPOS Audit Improvement and Reform Act.

Rep. Renee Ellmers (R-North Carolina)

• Tuesday evening, participants will attend an evening reception for the co-lead sponsor of S. 829, Sen. Mark Warner (D-Virginia).

• The Wednesday morning breakfast will honor Rep. Tammy Duckworth (D-Illinois).

Duckworth, a co-sponsor of H.R. 1530 and a candidate for Senate in 2016, has authored several letters to CMS and the Department of Health and Human Services on recovery audit contractor concerns, administrative law judge delays, the expanding CMS definition of orthotic devices eligible for competitive bidding, and the recent Local Coverage Determination on lower-extremity prosthetics.

Sen. Mark Warner (D-Virginia)

Rep. Tammy Duckworth (D-Illinois)

Board Member Dave McGill; and Joe McTernan, AOPA’s director of coding and reimbursement services, education, and programming. The briefing will be followed by the “CMS Medicare Perspective on O&P,” delivered by a top CMS official.

The second Issues Briefing Panel will cover the continued research and education appropriations that have

been included in three successive Department of Defense budget bills, creating O&P research and education funding in excess of $75 million.

AOPA Consultant Catriona Macdonald of Linchpin Strategies will discuss the Department of Veterans Affairs (VA) Template and how the new VA law affects O&P patients and providers; Macdonald also will cover the

For us, it’s personal.

There’s a reason PEL was voted “Most Trusted O&P Distributor.” And it’s an honor we work hard to earn every day. Learn more at pelservice.com ©2015 PEL, LLC

NEW! AOPA 2016 POLICY

FORUM

Dan Ignaszewski

At the conclusion of the afternoon session, Sen. Mark Warner (D-Virginia) will share his perspective on what Congress is thinking about Medicare and amputees in this election year.

Final Prep for Congressional Visits

appropriations briefing. Michael Oros, CPO, FAAOP, will detail the emerging Prosthetics 2020 project and discuss the need for a more data-driven O&P profession to empower the O&P community to demonstrate cost-effective patient outcomes. Audrey El-Gamil of Dobson-DaVanzo will explain what the 2010-2014 Medicare utilization data for O&P really shows in terms of cost-effective outcomes.

Thomas F. Fise, JD

Attendees will learn of four pressing issues that have risen to the “acute” stage in terms of adverse impact on O&P during the third Issues Briefing Panel. McTernan will consult his crystal ball in an effort to answer the question: Where are we headed on RACs and prepayment audits? Mark Rayder, JD, of Alston & Bird LLC will share his expertise and discuss 38

MARCH 2016 | O&P ALMANAC

whether he believes Congress is hearing the O&P outcry on making the prosthetists’ notes part of the medical record; he also will discuss the current status of the delayed LCD. Campbell will describe the orthotic threats of 2016: the Office of the Inspector General, split codes, new cost-setting authority, and competitive bidding. Peter Thomas, JD, will wrap up this session by commenting on the Benefits Improvement and Protection Act (BIPA) 2000, Section 427, and the issue of qualified providers not being implemented by CMS for the 16 years since congressional passage of BIPA. Thomas also will discuss whether O&P can really be separated from durable medical equipment.

During the fourth and final Issues Briefing Panel, those attending will receive clear marching orders, talking points, and guidance on distilling the essence of the O&P message. Thomas F. Fise, JD, AOPA’s executive director, and Dan Ignaszewski of the Amputee Coalition will join together in discussing how to present clear and concise messages on the Medicare O&P Improvement Act; the AFIRM bill; the O&P Modernization Act written that morning; and the patient perspective on supporting the Wounded Warrior Workforce Enhancement Act and the Wounded Warrior Research Enhancement Act. Fise also will touch on the sustainable growth rate fix and why it’s important to O&P.

AOPA will ensure Policy Forum attendees are well-prepared for their congressional visits on Wednesday with several morning activities. During breakfast, participants will review the talking points, take part in strategic discussions centering on O&P legislative aims, and hear a presentation from Rep. Tammy Duckworth (D-Illinois) on “2016 and Beyond: A Look Back and a Look Ahead.” Next, a session titled “Your Mock Congressional Visit” will provide the final patina to prepare O&P advocates for the more than 400 congressional appointments that will be scheduled by AOPA staff and legislative consultants for Policy Forum participants to meet with their respective legislators and staff.

Congressional visits will take place throughout the day on Wednesday, with participants reconvening for a final debriefing session before the day’s end.

This year, it’s more important than ever for O&P advocates to join forces and share the O&P message with the inhabitants of Capitol Hill.

Faced with a challenging regulatory environment and looming changes to the health-care landscape, those O&P professionals who take part in the 2016 AOPA Policy Forum will have a chance to help shape their own destinies in a positive manner.

EDITOR’S NOTE: It’s not too late to register for the 2016 AOPA Policy Forum. Be part of this important event—visit bit.ly/aopapolicyforum for details.

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By MICHAEL OROS, CPO, FAAOP

Putting Trendline Data To Work Learn to plot historical data points to analyze your company’s financial performance This article is the second in a three-part series written by members of AOPA’s Operating Performance Committee focusing on the financial aspects of running an O&P facility. This month, we discuss how and why O&P facilities can use trendline data to understand the historical performance of a company across financial measures, and use that information to make business decisions.

T

HERE IS TREMENDOUS VALUE in looking at trendline data as a means to help guide your company’s short- and long-term financial decision-making.

For example, what if you are considering signing a contract that is a bit lower than most of your current contracts: Can you afford to sign it while maintaining your current cost structure?

Trendline data (data points plotted over time) can be particularly useful to help you understand your company’s historical performance across a variety of financial measures. Caution: Like

most things in life, there is some labor involved before the reward is revealed.

You or someone in your organization should have moderate skills in Microsoft Excel to compile the appropriate data points and lay them out in an organized manner in a worksheet.

While it is not complicated, it does take a bit of time. However, with experience, each successive period recorded (month, quarter, or year) can be plotted faster and will add more significance to your analysis. By participating in the annual AOPA Operating Performance Report, you will be able to access most of the information you need.

Table 1 illustrates historical data points over a seven-year period. The information in the first column represents the financial metric on which you want to perform your trend analysis.

The time periods represented in the top row are annual, but they could be

TABLE 1

2009

2010

2011

2012

2013

2014

2015

COGS %

50.0%

47.2%

45.3%

45.7%

48.0%

52.8%

51.0%

Gross Profit

50.0%

52.8%

54.7%

54.3%

52.0%

47.2%

49.0%

G&A

41.6%

42.5%

45.8%

48.2%

45.6%

42.2%

43.5%

Net Profit

8.4%

10.3%

8.9%

6.1%

6.4%

5.0%

5.5%

$65.9

$63.7

$68.6

$66.4

$67.2

$74.4

$68.1

$160

$166

$157

$155

$150

$163

$165

$400

$447

$467

$440

$440

$464

$404

“Cost” Per Employee in Thousands Revenue Per Employee in Thousands Revenue Per Practitioner in Thousands 40

MARCH 2016 | O&P ALMANAC

quarterly or monthly as well, depending on which lens you choose to select— near-term versus longer-term trends.

To add additional insight to your analysis, you can look at the information in graphical form with the help of Excel and use trendline analysis.

Table 2 shows how a different visual approach provides clarity to the information. The solid line graph represents a seven-year history of Cost of Goods Sold as a Percentage of Net Sales (COGS %). The dotted line represents the trendline for this same period.

For the seven-year period considered, we can now clearly see an upward trend in the COGS %.

TABLE 2 Cost of Goods Sold as a Percentage of Net Sales, 2009-2015 54% 52% 50% 48% 46% 44% 42% 40%

2009

2010

2011

2012

2013

2014

2015

TABLE 3 Cost of Goods Sold as a Percentage of Net Sales, 2012-2015 54% 52% 50% 48% 46% 44% 42%

2012

2013

Additionally, if we shorten the data set to consider only the previous four years—which may be a better representation of the future—we see a much steeper acceleration of COGS % (see Table 3).

As you analyze the hypothetical contract, you now realize that your COGS % has been on the rise for the last several years, and committing to a lower contract reimbursement will be additive to this effect unless you are able to change your cost structure to offset the decreased reimbursement.

2014

2015

What if you’re simply curious as to the impact a more regulated health-care environment is having on your practice efficiency? A review of trendline information on revenue per employee and/or revenue per practitioner will give you data to support your thought process.

Michael Oros, CPO, FAAOP, is president and chief executive officer of Scheck & Siress, and is president-elect of AOPA.

EDITOR’S NOTE: Contact bleppin@aopanet.org to participate in the 2016 Operating Performance Survey. Participation is free for AOPA members, and participants receive a copy of the final published report ($325 value) and a personalized company report ($1,000-plus value) free of charge comparing their business to other O&P facilities of similar size and location.

If you missed the first article in this series, be sure to access the February 2016 issue of O&P Almanac to read “Leveraging Data for O&P Business Management,” by Mark Ford. Visit bit.ly/markford for the article.

O&P ALMANAC | MARCH 2016

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MEMBER SPOTLIGHT

Kenney Orthopedics

By DEBORAH CONN

Serving the Underserved Kentucky facility opens rural offices and facilitates humanitarian efforts in Mexico

J

OHN “MO” KENNEY, a

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MARCH 2016 | O&P ALMANAC

Kenney Orthopedics hosts a quarterly amputee walking school, where retired Paralympians Dennis Oehler and Todd Schaffhauser work with patients.

FACILITY: Kenney Orthopedics OWNERS: John M. “Mo” Kenney, CPO, FAAOP, and six minority partners LOCATION: Lexington, Kentucky, with 10 other offices in Kentucky and Indiana HISTORY: 15 years

information about above- and below-knee amputations to better prepare them for recovery and prosthetic fitting. The site includes links to amputee groups and other resources, as well as positive news articles about amputees.

Physicians and therapists can use the website to view presentations, receive help in composing a letter of medical necessity, access outcome measures, and schedule continuing education programs.

Kenney Orthopedics is a research partner with Jason Kahle, CPO, FAAOP, of the University of South Florida at Tampa. The collaboration allows Kenney’s patients to participate in clinical trials of advanced sockets and prosthetic knees and feet. Kahle also presents continuing education sessions to local therapists.

The facility offers an amputee walking school four times a year, a practice started 13 years ago.

Two retired Paralympians, Dennis Oehler and Todd Schaffhauser,

PHOTOS: Kenney Orthopedics

below-knee amputee since a childhood car accident, says he lives by the mantra, “If you care about people, success will follow.” It seems to be working for Kenney, whose O&P practice has expanded over the last five years from four facilities to 11, each headed by an ABC-certified practitioner.

Kenney Orthopedics is based in Lexington, Kentucky, where Kenney launched his business in 2001 after working with Hanger Orthopedics for 12 years. Other offices serve Louisville, Mt. Sterling, Morehead, London, Danville, and Paducah in Kentucky, and Greenwood, Carmel, Seymour, and Columbus in Indiana. The business operates as a holding company, with a separate LLC number for each independently operated office. Many facilities are located in smaller, more rural areas that had no previous local access to O&P services.

Kenney Orthopedics has more than 60 employees, says Kenney, including 25 O&P clinicians. Each office has the capacity for limited fabrication, but most items are produced at the Lexington office’s central fabrication facility. Other centrally operated functions include purchasing and billing.

The practice offers complete orthotic and prosthetic services, including transradial/transhumeral prostheses, hemipelvectomy prostheses, and advanced bionic hands. The company’s website not only markets its services, but provides patients with thorough

teach amputees the dynamics of artificial limbs and how to use their muscles properly to control the devices. Participants practice walking, running, climbing stairs, bending down, jumping, and moving from side to side. Amputees, rehabilitative therapists, and case workers attend the sessions, which offer continuing education credits to professionals.

A former president of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), Kenney currently serves as a prosthetics examiner for ABC and is vice chair of the board of the Amputee Coalition. The two positions draw on his expertise as both a practitioner and an amputee.

Humanitarian efforts are central to Kenney’s work ethic.

He has regularly volunteered at the Total Rehabilitation Center for the Mobility Impaired, known as CRIMAL for its Spanish name, located in Queretaro, Mexico. Each year, three groups comprising six volunteer practitioners make a visit to the clinic, where they fit 20 to 40 patients a day with artificial limbs.

Kenney organizes and accompanies one crew each year. For these mission visits, Kenney asks O&P manufacturers to donate supplies, which can be usable returned items or brand-new components. His charitable work earned him the title of 2015 Hero of the Year by the local chapter of the American Red Cross.

When looking ahead, Kenney doesn’t rule out further expansion, but “we want to maintain our mission of keeping patients first before we make any business decisions,” he says. Whatever happens, he knows that his humanitarian efforts will continue to be a major component of his practice, and certainly a defining element to his life.

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

MEMBER SPOTLIGHT

Why I Choose Plié 3...

“

...it gives me the freedom to choose how I live my life unrestricted. I can wear the Plié 3 for everyday life, as well as, competing in marathons.

Because of the superior quality, reliability, and customer service I receive from Freedom Innovations, I put my confidence in their products every time I land on my prosthesis.”

Warren Castleberry ~ Tulare, CA

Both weatherproof and FULLY SUBMERSIBLE. The fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. n The most responsive stumble and fall protection. n Users can instinctively move at their own pace in any direction...even if it’s taking small short steps or pivoting in confined spaces. n Streamlined, intuitive set up makes the Plié 3 MPC knee even easier for prosthetists. n n

To learn more, call your Freedom representative at 888-818-6777 or visit www.freedom-innovations.com/ Plie-3

© 2015 Freedom Innovations, LLC. All rights reserved. Made in the USA.

#freedominnovations #plieknee

Connect with us

MEMBER SPOTLIGHT

Anodyne Shoes

By DEBORAH CONN

Fashion Footwear New company takes a stylish approach to diabetic shoes

S

ELLING FOOTWEAR FOR DIABETIC patients is quite

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MARCH 2016 | O&P ALMANAC

Brian O’Reilly, CPed, (standing) reviews the corrections process with an Anodyne technician.

COMPANY: Anodyne Shoes OWNERS: Bobby Kanter and Brian O’Reilly, CPed LOCATIONS: Milwaukee, Wisconsin HISTORY: One year

Bobby Kanter (left) and Brian O’Reilly, CPed, have plans to build out their custom laboratory.

sense of soothing and comfort,” says O’Reilly. The pair officially introduced their new business to the market at the AOPA Assembly in San Antonio in October.

Both owners have extensive backgrounds in the diabetic footwear industry. Kanter’s father, Rick, was the original founder of Dr. Comfort. O’Reilly also worked at Dr. Comfort, and served as the original vice president of the company, before leaving in early 2014.

Starting this new diabetic footwear brand together, with a completely blank slate, O’Reilly and Kanter had a chance to meticulously design all aspects of the business—everything from the product to how the shoes are packed and shipped.

The company currently has 18 employees, four of whom are CPeds (in addition to O’Reilly), including Director of Laboratory Operations Frank Ledezma, and Billy Kanter, a co-founder and senior account executive.

Although consumers can order directly from the company, Anodyne encourages them to consult a practitioner, particularly if they are eligible for Medicare.

“When it comes to the design and manufacturing process, we don’t take any shortcuts,” says

PHOTOS: Anodyne Shoes

a bit different from selling other kinds of shoes, explains Bobby Kanter, chief executive officer of Anodyne, a new diabetic footwear brand based in Milwaukee.

Unlike fashion-based shoe companies, which supply retailers with cartons of seasonal footwear four times a year, Anodyne ships only one or two pairs of shoes at a time to orthotists, prosthetists, podiatrists, and other clinicians, requiring the business to maintain a substantial inventory.

“To compete, we needed a full line of shoes, right away—51 styles and colors, in 36 individual sizes. [Medicare] A5500-coded shoes are required to be available in a minimum of three different widths: medium, wide, and extrawide,” says Kanter. “We probably have 150,000 pairs of shoes in our warehouse at this very moment, and we’ve only been shipping product for around four months.”

In deciding to launch their diabetic footwear business, Kanter and his partner, Chief Operating Officer Brian O’Reilly, CPed, sensed a need for a more contemporary, stylish take on diabetic shoes. “We looked at the state of the market and saw a place for a new player,” Kanter says.

“The product was outdated. The marketing and branding were stale.

“The whole point of diabetic shoes and inserts is to prevent potential foot problems. That’s not a possibility when patients don’t want to wear the shoes in the first place.”

Kanter and O’Reilly launched their company in fall 2015, naming it Anodyne, which means “something that brings you a

O’Reilly. Anodyne’s shoes are lined with soft microfiber, which helps prevent slippage. The company keeps inside seams to an absolute minimum, and nearly all shoes weigh less than 8 ounces, making it easier for diabetic patients to lift their feet.

“It’s unusual to have a stray needle or staple left in a shoe, but it does happen,” says O’Reilly. That could wreak havoc on diabetic feet. To avoid that possibility, Anodyne runs every shoe through a metal detector before shipping.

In addition, the inside of each shoe is sprayed with a proprietary, medical-grade, antimicrobial spray.

The company also offers Medicare-reviewed custom inserts and toe fillers, and will modify any shoe upon request.

Anodyne brings its contemporary focus to the supplier side as well, with an iPad application that allows clinicians to scan a foot and transmit the data to Anodyne, which can then craft A5513-coded inserts within a day. Casts and impressions can be a headache to ship, says Kanter, so the scanning app provides a real efficiency benefit.

With less than a year under its belt, Anodyne has an eye to the future. The company will focus on establishing national distribution this year and expects to expand to the international market by 2017.

Kanter and his colleagues also want to increase their shoe offerings to include dress shoes, work boots, and slippers. “We started with shoe styles that people would wear five to seven days a week, but will move into more specialized products in the near future,” he says.

Through it all, everyone at Anodyne seeks to maintain the friendly and helpful tone of a family business. “We want to build an awesome company, but we want to have a blast doing it,” Kanter says.

“And we want to extend that same feeling to our customers.”

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

ROBUST adjective; strongly or stoutly built.

INTUITIVE adjective; readily learned or understood.

TRUSTED verb; a belief that something is reliable, good, honest, effective.

FREE Scanner - Ask How Custom Diabetic A5513, EVA and Rigid Foot Orthotics in Days, not Weeks Use of Scanner with lab services agreement, terms and conditions apply. sales@amfit.com . +1-800-356-3668 . AMFIT.COM .

@Amfitinc

AOPA NEWS

AOPA Coding Experts Are Coming to Portland

April 11-12

Doubletree Hotel Portland

Shift the Liability: The Proper Use of the ABN Form The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The April 11-12 Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff.

The seminar features hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Take part in this seminar to better your business, your staff, and your patients!

Top 10 reasons to attend:

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2016billing.

In this audit-heavy climate, can you afford not to attend?

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MARCH 2016 | O&P ALMANAC

Advanced beneficiary notices (ABNs)—when, why, and how should you use them? Get the answers and earn 1.5 credits during the hour-long webinar on March 9. AOPA experts will be on hand to share their expertise on ABNs. • Learn when an ABN is appropriate.

• Examine common scenarios regarding when an ABN should be used.

• Learn how to use an ABN when billing for upgraded features, and ensure at least a partial payment for services rendered.

• Avoid the common mistakes that can make your ABN invalid.

• Understand all of the modifiers associated with an ABN. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

IMAGE: iStock.com/GarysFRP

1. Get your claims paid.

2. Increase your company’s bottom line.

3. Stay up-to-date on billing Medicare.

4. Code complex devices 5. Earn 14 CE credits.

6. Learn about audit updates.

7. Overturn denials.

8. Submit your specific questions ahead of time.

9. Advance your career.

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

Register for the March 9 Webinar

AOPA NEWS

Understanding Shoes, Mastectomy, & Other Policies Register for the April 13 Webinar

Don’t miss the April webinar on “Understanding Shoes, Mastectomy, & Other Policies.” Participants in this webinar will complete the following: • Review the nuances of the Therapeutic Shoes for Persons With Diabetes Policy.

• Review the Orthopedic Shoe Policy and when the L3000 series of codes is covered.

• Review the External Breast Prostheses Policy.

• Learn when and how compression garments are covered.

• And much more.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by

returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2016webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars!

The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

What are we doing?

Where are we going?

How do we survive?

2016 OPERATING PERFORMANCE REPORT FREE for AOPA members

Find the best practices to help you manage your business.

Participate in the annual O&P Operating Performance Survey to chart your course.

Contact Bleppin@aopanet.org to participate in the 2016 survey coming this spring.

www.AOPAnet.org

O&P ALMANAC | MARCH 2016

47

WELCOME NEW MEMBERS

T

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

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Compass Limb & Brace LLC 1140 36th Street, Ste. 165 Ogden, UT 84403 801/392-0075 Category: Patient-Care Facility Thad Neilson Florida O&P Services Inc. 3636 University Blvd. S. Jacksonville, FL 32216 904/737-7755 Category: Patient-Care Facility Gail Rood

Prosthetic Orthotic Specialists of Monroe 1420 Ellen Street Monroe, NC 28112 704/635-7029 Category: Patient-Care Facility

Is Your Facility Celebrating a Special Milestone in 2016?

O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

AOPA O&P PAC

The O&P PAC recently made contributions to the following members of Congress:

O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to the O&P PAC*: • George Breece • Rick Fleetwood, MPA The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form contact Devon Bernard at dbernard@AOPAnet.org.

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MARCH 2016 | O&P ALMANAC

• Rep. Tammy Duckworth (D-Illinois), who is currently running for Senate and has been a key O&P ally and supporter.

• Rep. Renee Ellmers (R-North Carolina), who is a supporter of recognizing the documentation of orthotists and prosthetists as part of the medical record, and separating O&P from durable medical equipment.

• Rep. Dutch Ruppersberger (D-Maryland), who is a member of the Appropriations Committee and was a co-sponsor on key pieces of O&P legislation in the 114th Congress.

• Rep. Gus Bilirakis (R-Florida), who is a member of the Energy & Commerce Committee and the Veterans Affairs Committee. *Due to publishing deadlines this list was created on Feb. 12, 2016, and includes only donations/contributions made or received between Jan. 1, 2016, and Feb. 12, 2016. Any donations/contributions made or received on or after Feb. 12, 2016, will be published in the next issue of the O&P Almanac.

A donor-supported nonprofit

2016

national ConferenCe

Greensboro

north Carolina June 9-11, 2016

Sheraton Greensboro at Four Seasons 3121 Gate City Boulevard Greensboro, NC 27407

Visit us at amputee-coalition.org/conference

Celebrating 30 Years of the Amputee Coalition and You.

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamedia for advertising options.

The Unstoppable RUSH™ Foot Collection Virtually indestructible even in the most extreme conditions.

Maintain a natural gait even in the most rugged or uneven terrain. One foot for all adventures. Water? Mud? Sand? No problem. Carbon feet can’t say the same.

To learn what RUSH™ Foot is right for your patient, visit www.rushfoot.com.

Online ordering is now available.

New AFO Gauntlets From Acor!

A custom ankle-foot orthosis (AFO) gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2016, Acor is offering our refined-design AFO gauntlets hand-made in our Cleveland, Ohio, facility.

Also known as a “Leather Lacer” and our most popular AFO gauntlet, the G9110 offers a choice of color, polypro reinforcement, and a leather or optional X-Static®-covered NeoSponge™ lining.

See our ads in this issue for information regarding our new Custom Products catalog, or just call Acor at 800/237-2267 to get a copy.

ALPS Thinner Seamless Suspension Sleeve Formulated with the ALPS GripGel, the new SFB seamless suspension sleeve provides superior comfort with a singlepiece construction. The SFB sleeve features a new black knitted fabric that allows the user excellent freedom of knee flexion. This new sleeve seals with the skin without restricting circulation, while the GripGel sticks to the patient’s skin without causing shear forces. With a thinner profile of 2 mm, the SFB is an ideal choice for those concerned about bulk.

Fo r more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

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MARCH 2016 | O&P ALMANAC

ALPS Extreme AK/BK Gel Liner Designed with the end user in mind, the Extreme liner is the perfect fit for transfemoral and active transtibial patients.

Offered in 3-mm and 6-mm uniform thickness, the Extreme offers 80 percent less vertical stretch than our other gel liners, and allows for more control and stability during increased activity. This liner also is formulated with both our ALPS GripGel and our all new HD Gel; these gels contain properties that help facilitate donning as well as reduce pistoning and bunching behind the knee.

Fo r more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Introducing Precise Insoles by Amfit Amfit is proud to announce a prefabricated, functional insole in 24 sizes. Confidently offer a noncustom orthosis with biomechanically engineered arch support built right in. Millions of unique foot shapes formed the basis for designing a ready-towear insole with true functional support and the widest size range on the market. Most high-quality premade insoles offer less than 10 shell sizes. Precise insoles were designed to bridge that gap so you can offer a high-quality, functional orthosis when full custom isn’t an option.

• 24 sizes • Integrated length, width, and arch height • Anatomically correct design • Functional shell with no crack guarantee • Forefoot comfort insert • Stabilizing deep heel cup • Tablet-style digital sizing guide Opt for the Starter Kit (36 pairs, digital sizer, mount, and display materials) or order by the pair.

Ask about introductory specials at sales@amfit.com or 800-356-FOOT (3668), x264.

MARKETPLACE It’s Your Patient; Shouldn’t It Be Your Orthotic Design Too? Take complete control for the ultimate in patient satisfaction with Amfit Lab Services.

• Carbon fiber (flex and firm) • Polypropylene (flex, semiflex, rigid) • Five EVA styles and densities • One- to four-day turnaround • Diabetic-specific program: three pair for $60, includes shipping • Foam box processing • Contact Digitizer 3D digital casting system • Equipment rental and lease programs available.

Thirty years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact Amfit Inc. today at 800/356-FOOT(3668), email sales@amfit.com, or visit www.amfit.com.

Aspen Medical Products: Introducing the New Peak Scoliosis Bracing System The revolutionary Peak Scoliosis Bracing System is an unloader brace designed to relieve pain and enhance the quality of life for adult scoliosis patients. This patented, highly adjustable brace from Aspen has been shown to improve posture, enhance mobility, increase vital capacity, and ultimately increase a patient’s ability to perform activities of daily living.

For more information, contact Aspen Medical Products at 800/295-2776 or visit www.aspenmp.com.

NEW KS SURE STANCE KNEE BY DAW BOOTH #204

This ultralight, multiaxis knee is the world’s first four-bar stance control and stance flexion knee. The positive lock of the stance control activates up to 35 degrees of flexion. Unlike single-axis knees, there is no need to shorten the pylon, which produces undue strain on the lower spine. All of the above, combined with the reliability of toe clearance at swing phase, makes this

knee the choice prescription for K2 patients.

For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

EZ ACCESS DAWSKIN BOOTH #204

The New MegaStretch DawSkin is the most durable tear-free skin in the world.

The New MegaStretch DawSkin provides the vertical ankle stretch required for multiaxis feet and energy restitution feet. “Heat-shrink” skins limit the ankle movement and will tear; not so with the New MegaStretch DawSkin.

DawSkin New EZ-Access dons on and off just like a sock yet provides all the benefits of the New MegaStretch DawSkin.

For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

DAW’S DGEL RESIN II BOOTH #204 Tubular Braid: • 38 million Modules Fiber means way stronger than the market best!

• Two layers lay-up is all you need for 75 percent of your patients.

• Double its strength when used in conjunction with DGEL Fiber Beam.

• Available in 4-, 5-, 6-, 7-, and 8-inch diameters to fill all your lay-up needs.

Epoxy Resin: • Half the resin—double the strength.

• So safe it can ship overnight.

• The “no smell” resin.

• Ultralight, ultrastrong, and ultrathin.

• Twice as strong as acrylic resin, “You can • stand on it.”

For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

O&P ALMANAC | MARCH 2016

51

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamedia for advertising options.

Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee Stronger construction makes the new Plié 3 MicroprocessorControlled (MPC) Knee both submersible and more rugged than ever.

Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees.

With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small, short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom.

To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.

Freedom Foot Products Just Got Better

Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied.

Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted.

Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark).

For additional information, contact customer service at 888/818-6777 or email us at info@freedom-innovations.com.

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MARCH 2016 | O&P ALMANAC

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

For more information, call at 800/301-8275 or visit www.hersco.com.

Socket-less Socket Transfemoral We’ve reinvented sockets from the ground up. No more static socket shape.

No more hard ischial seat. No more loss of suction. Using our NASA-based hammock-fit technology, the Socketless Socket truly conforms to the user, providing a custom-fit socket every time you put it on. Fitting a socket is now microadjustable in real time, eliminating the need for the antiquated casting, modification, and iterative test socket fitting methods from the past.

View the free Socket-less Socket training at MartinBionics.com.

Contact Martin Bionics at 844-MBIONIC.

Bikini Socket—One Third the Size, One Third the Weight, Three Times the Comfort Instead of encapsulating the pelvis with a bucket, our patented, lightweight Bikini Socket and Iliac Crest Stabilizers provide a direct biomechanical link between the device and its user, resulting in superior control, comfort, and functional outcomes.

Fitting a hip or hemipelvectomy level has never been so simple. The Bikini Socket Hammock Casting Stand allows you to microadjust the socket shape using our NASA-based mesh fabric hammock—eliminating point-specific ischial loading and providing an ultra-comfortable hammock fit. The casting shape becomes the final socket shape. It’s that simple.

View the free Bikini Socket Hammock Casting Stand training at MartinBionics.com. Contact Martin Bionics at 844-MBIONIC.

DAW’s MPK FAMILY

The Demanding Professional’s Choice Cost effective

✓ No other MPK provides this level of pinpoint accuracy in gait and cadence ✓ Full range adjustable geometric stance control ✓ Fully adjustable stance flexion

✓ Trouble free low-cost maintenance.

Proven durability and dependability

© Copyright 2016, Daw Industries. San Diego CA. All rights reserved.

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamedia for advertising options.

Introducing the Fuzion™ Family of Orthoses Patients experience greater fit, function, and freedom with Orthomerica’s new Fuzion line of custom orthoses. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Available for both select adult and pediatric patients.

Key benefits: • Proprietary heat-adjustable plastic makes patient management much easier vs. traditional orthoses • New treatment options for patients historically not candidates for orthotic intervention & management • Fuzion’s compression design holds the patient in a secure comfortable position while assisting with spasticity management • Accommodates volume changes.

Call 877/737-8444 or visit www.orthomerica.com.

Silicone, Urethane, and Copolymer Liners The Skeo family of silicone liners includes an internal matrix to reduce pistoning plus a slick outer surface to aid in donning and doffing.

Choose from a variety of options that include preflexed for enhanced fit, and SkinGuard protection to reduce odor. Our copolymer liners are ideal for lower-activity patients, and our Anatomic 3D Urethane liner is preferred for Harmony vacuum or valve systems. Whether your patients need a silicone, urethane, or copolymer solution, Ottobock can help you find the right fit.

Call your local sales rep to find out more.

For more information, call Ottobock at 800/328-4058 or visit www.professionals.ottobockus.com.

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MARCH 2016 | O&P ALMANAC

Ottobock: 28U90 Ankle-Foot Orthosis The 28U90 ankle-foot orthosis from Ottobock blocks foot drop during swing phase. Its thin-walled polypropylene construction has been optimized for increased resilience, providing effective support in an incredibly lightweight orthosis. The long sole provides precise foot guidance and good pressure distribution. New calf pads and closure straps are included and ensure a high level of wearer comfort. These can be adapted without additional tools.

Ask your sales rep at 800/328-4058 about how the 28U90 can help your patients.

Independent Practitioners Rank PEL as the Top O&P Distributor. Again.

A recent distributor study revealed practitioners prefer PEL over competitors for many reasons. The study asked O&P practitioners to rate the major O&P distributors on service, greatest overall value, website, and other business areas.

O&P practitioners rated PEL as the distributor who provides the greatest overall value of service and price. They also rated PEL significantly higher in service, products, and website dimensions. Based on these results, we can say with confidence that O&P practitioners view PEL as the leading O&P distributor.

For more information, visit pelservice.com or call 800/321-1264.

Custom AFO Gauntlets from ____________ ____________ ____________ ____________ ____________ ____________ ____________

                                                 

Made in the USA

Standard Features

 Soft PORON®-padded collar  Molded polypropylene inner shell with PORON® padding throughout  Lined with leather or optional X-Static®-lined NeoSponge™  PORON® + Multicork™ orthotic  In-house turnaround time of 7-10 business days  *PDAC Letters available at: www.acor.com/PDAC-Sadmerc.php

L1940 L2330 L2820 L5000 (G9118) G9115*

G9110*

Acor AFO Gauntlets are available with your choice of three polypropylene reinforcements.

Full Heel

G9110*

G9430

Standard

G9431

Flexure Joint Articulating

Lace

G9110*

G9110*

Boot Hooks

Speed Lacer

www.acor.com orderentry@acor.com

Leaf Heel

G9118*

Dorsi-Assist Articulating

Chopart Toe Filler

18 Color Options!

Multiple Closure Options

G9110*

Open Heel

G9111*

Velcro

G9110*

Lace/Velcro

(natural leather - colors may vary)

G9115*

black

brown

bone

white

taupe

navy blue

oak

sand

pink

red

orange

yellow

purple

royal blue

kelly green

light grey

medium grey

sky blue

Navicular Strap

800-237-2267 (option 2)

Scan this barcode with your smartphone QR reader or visit: www.acor.com/downloads.php to download our new catalogs

Look for us:

You

Tube

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/aopamedia for advertising options.

design. dexterity. intelligent motion.

Webinar: The Foolproof CAD/CAM Plan

“It’s all about where your mind’s at.”

•

Why are hundreds of P&O clinics succeeding spectacularly with CAD/CAM technology while others stumble?

—Quote by Kelly Slater Drawing on lessons learned from 650 installations, this free webinar will lead you through an easy, pragmatic approach that guarantees a successful transition from plaster to CAD/CAM. To learn more or register, please contact Andrew Smyth at Vorum: 800/461-4353, ext. 2301, asmyth@vorum.com Smarter: uses simple gestures to change grips

•

Faster: boost digit speed by up to 30 percent

•

Smaller: new form-fitting anatomical design reduces profile in every dimension For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

Visit us at AAOP in booths 1120 and 1122.

Switch Liners Without Switching Socket WillowWood is the only manufacturer to offer liners with a range of interface materials and profiles that retrofit with each other, allowing an amputee to use the same socket with different liners.

The key to retrofitting is the liner profile. The transtibial Uniform profile is offered in hybrid gel and our Alpha silicone blended with Outlast® heat management technology.

The transtibial Progressive and transfemoral Symmetrical profiles are both offered in hybrid gel, Alpha silicone, and Alpha silicone with Outlast®. The benefit of retrofitting liners is that clinicians and amputees can avoid the timeconsuming and costly process of creating multiple sockets.

For information, visit willowwoodco.com/retrofit.

Online Link: http://www.willowwoodco.com/ products-and-services/liners/retrofit.

56

MARCH 2016 | O&P ALMANAC

2016 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HCPCS code changes with an array of 2016 AOPA coding products. Ensure each member of your staff has a 2016 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

RIDE THE WAVE WITH

THE TRUSTED SOURCE FOR THE O&P PROFESSION

Cailor Fleming Insurance has been a trusted insurance agency for years—let our experience and lasting service speak for itself. Because of the unique exposures the O&P industry faces, we designed an insurance program specifically for these risks and offer comprehensive protection that helps your business succeed, whether it’s a patient care facility, central fab, manufacturer or distributor.

800-796-8495

Gain your peace of mind with a customized insurance plan specific to YOUR business by calling Cailor Fleming at 800/796-8495.

http://cailorfleming.com/OandP.asp

AOPA’S INSURANCE PROGRAM— Practitioners trust us most because we know your business and we know insurance unlike any other program.

EXCLUSIVELY ENDORSED by the American Orthotic and Prosthetic Association

PROFESSIONAL LIABILITY

|

GENERAL LIABILITY

|

PROPERTY

|

AUTO

|

UMBRELLA

|

WORKERS COMP & MORE

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

Job location key:

Prosthetic and Orthotic Technician

Southern California Inland Artificial Limb and Brace Inc. is currently seeking a prosthetic and orthotic technician for our Southern California central fabrication facility.

We offer competitive pay (commensurate with experience), medical, and retirement benefits. We look forward to speaking with you. Please forward your résumé to:

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Job Board

Member Nonmember $85 $150

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

Inland Artificial Limb and Brace Inc. Email: careers@inlandlimbandbrace.com

Mid-Atlantic CPO/BOCPO

Louisville, Kentucky At Center for Orthotic & Prosthetic Care (COPC), our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, New York, and Pennsylvania. Due to an opening at one of our patient-care facilities in Louisville, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest-quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your résumé, in confidence, to:

SUBSCRIBE

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

58

MARCH 2016 | O&P ALMANAC

Center for Orthotic & Prosthetic Care (COPC) Fax: 502/451-5354 Email: dkoch@centeropcare.com

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

The Source for Orthotic & Prosthetic Coding

T

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

Log on to LCodeSearch.com and start today.

Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

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

SPECIA16L! for 20

www.AOPAnet.org

ADVERTISERS INDEX

Company Ability Dynamics

Page Phone

Website

23

855/450-7300

www.abilitydynamics.com

ACOR Orthopedics Inc.

5, 55

800/237-2276

www.acor.com

ALPS South LLC

7, 61

800/574-5426

www.easyliner.com

Amfit

45

800/356-3668 www.amfit.com

Amputee Coalition

49

888/267-5669

www.amputee-coalition.org

Aspen Medical

33

800/295-2776

www.aspenmp.com

BCP Group

39

615/550-8774

www.bcpgroup.com

Cailor Fleming Insurance

57

800/796-8495

www.cailorfleming.com

ComfortFit Orthotic Labs Inc.

25

888/523-1600

www.comfortfitlabs.com

Custom Composite

29

866/273-2230

www.cc-mfg.com

1, 53

800/252-2828

www.daw-usa.com

Freedom Innovations LLC

43

888/818-6777

www.freedom-innovations.com

Hersco

2

800/301-8275 www.hersco.com

Martin Bionics

15

844/BIONICS

Orthomerica

17

800/446-6770 www.orthomerica.com

Ottobock

C4

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

PEL

37 800/321-1264 www.pelsupply.com

DAW

www.martinbionics.com

Touch Bionics

13

855/694-5462

Vorum

21

800/461-4353 www.vorum.com

www.touchbionics.com

WillowWood

9

800/848-4930 www.willowwoodco.com O&P ALMANAC | MARCH 2016

59

CALENDAR April 1

2016 March 9

Shift the Liability: The Proper Use of the ABN Form. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

March 14-19

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

March 18-19

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

March 18-19

PrimeFare West Regional Scientific Symposium 2016.

Denver Marriott City Center, Denver. Contact Jane Edwards at 888/388-5243, jledwards88@att.net or visit www.primecareop.com.

March 25 & 31 Webinar Conference

Prior Authorization Preparation. Register online at bit.ly/priorauthorization.

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

April 4-5

Orthomerica Whole Limb Solutions Seminar. Las Vegas. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Las Vegas. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

April 7-9

Texas Association of Orthotists & Prosthetists.

Dallas/Addison Marriott Quorum by the Galleria, Dallas.

For more information, visit www.TAOP.org.

April 11-12

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar.

Doubletree Hotel, Portland, OR. Register online at bit.ly/2016billing.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Seminar

April 13

Understanding Shoes, Mastectomy, & Other Policies. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

No Application Deadlines BOC offers year-round testing for all of its exams and has no deadlines. Candidates can apply, test when ready, and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at http://my.bocusa.org. To learn more about our nationally recognized, in-demand credentials, visit www.bocusa.org or emailcert@bocusa.org.

www.bocusa.org

SHARE

your next event!

60

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

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates Let us

Online Training

CREDITS

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

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@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.

MARCH 2016 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR April 22-23

PrimeFare Central Regional Scientific Symposium 2016.

Southern Hills Marriott, Tulsa, OK. Contact Jane Edwards at 888/388-5243, jledwards88@att.net, or visit www.primecareop.com.

April 26-27 AOPA Policy Forum. Washington Marriott at Metro Center, Washington, DC. For more information, visit bit.ly/policyforum2016 or contact Ryan Gleeson at rgleeson@AOPAnet.org.

May 11

When Things Go Wrong: Making Lemonade Out of Lemons. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

May 11- 13

New York State Chapter Annual Meeting. Albany Marriott, Albany, NY. For information, email Marx4NYSAAOP@aol.com, or visit www.NYSAAOP.org

May 19-20

Orthomerica Whole Limb Solutions Seminar. Dallas. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Dallas. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

June 23-24

Orthomerica Whole Limb Solutions Seminar. Newark, NJ. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Newark, NJ. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

June 24-25

PrimeFare East Regional Scientific Symposium 2016. Renaissance Hotel & Convention Center, Nashville. Contact Jane Edwards at 888/388-5243, jledwards88@att.net, or visit www.primecareop.com.

July 13

Strategies and Levels: How To Play the Appeals Game. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 10

The Supplier Standards: Are You Compliant? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

BUILD A

Better

May 19-21

International African-American Prosthetic & Orthotic Coalition.

Memphis, TN. For more information, visit www.iaapoc.org.

BUSINESS

June 8

Physician Documentation: How To Get Webinar Conference It & How To Use It. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

June 9-10

MOPA: Michigan Continuing Education Meeting.

DoubleTree by Hilton Bay City—Riverfront, Bay City, MI. Now offering pedorthic continuing education credits. Contact 517/784-1142 or visit www.mopa.info.

June 13-14

AOPA Mastering Medicare: Essential Seminar Coding & Billing Techniques Seminar.

Grand Hyatt, San Antonio. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

62

MARCH 2016 | O&P ALMANAC

WITH AOPA

Visit www.AOPAnet.org/join today!

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

CALENDAR August 11-12

October 12

Orthomerica Whole Limb Solutions Seminar. Milwaukee. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Milwaukee. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

KO Policy: The ABCs of the LCD and Policy Article. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

August 18-20

Webinar Conference

Virginia Orthotic & Prosthetic Association. Hyatt Regency Reston, Reston, VA. For more information, visit www.vopainfo.com.

September 8-11

99th AOPA National Assembly. Boston.

For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@ AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

Webinar Conference

November 9

Don’t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

December 14

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

September 14

Fill in the Blanks: Know Your Forms.

Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

Motion Control

SUPERCOURSE SPRING 2016 APRIL 6 - 9, 2016 Motion Control Headquarters, Salt Lake City, UT • In-depth training of Utah

• Latest MC components,

• Hands-on training with

• Convenient Wednesday -

• Casting/fitting/socket design

Plus training in the NEW F.L.A.G. (Force Limiting Auto Grasp) feature for ETD & Hand

Arm 3+ / Hybrid Arm / ProPlus TDs and Wrist

UI software - bring your Windows laptop & iOS device (iPhone®, iPad®, iPod touch®) for SD/FQ, T-H, T-R levels; patient subjects provided

Ottobock 360˚ Education and Events

Select from a range of upper and lower limb prosthetic courses as well as orthotic training. Courses are offered around the country and at our North American Headquarters in Austin, TX. Go to our site, find the Education menu, and select Classroom Training to see the full list of options. www.professionals.ottobockus.com www.professionals.ottobock.ca

integrating with i-limb, bebionic, and others

Saturday schedule

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

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

| MARCH 2016 63 O&P EDGE Calendar Ad SuperCourse Spring 2016.indd O&P 1 ALMANAC 1/26/16 12:51 PM

ASK AOPA CALENDAR

Delivery Dilemmas Know the rules for proof of delivery forms, detailed written orders, and more

AOPA receives hundreds of queries from readers Q and members who have questions about some aspect of the O&P industry.

Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

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

On a proof of delivery (POD) form or slip, what should be entered as the delivery address?

Q/

The delivery address on the POD should match the physical address of the building where you delivered the items and/or services. If you delivered a device in your office, then your office address should be entered on the POD; if you delivered a device in the hospital, then the hospital’s address should be entered on the delivery slip.

A/

I thought the delivery address was always entered as the patient’s home address?

Q/

No; the patient’s home address should not be entered as the delivery address unless you deliver an item to a patient in his or her home.

However, the place of service (POS) will most likely be recorded/entered as home, and the POS code for home is 12. Remember that for durable medical equipment, prosthetics, orthotics, and supplies, the POS is equal to where the patient will use the item and not the place where the item or service is provided.

A/

I understand that with POD, the sole use of health-care common procedure coding system (HCPCS) codes, or L codes, for the descriptions of the items being delivered is no longer valid and accepted, but may we still use the L codes on our detailed written orders (DWOs)?

Q/

Just as with the POD, the DWO requires that you provide a detailed description of the items being ordered. The Medicare manual states: “The written order must be sufficiently detailed, including all options or additional features that will be separately billed….” However, with a DWO it is still acceptable to use the L codes and their descriptors as your detailed description.

A/

Is a POD required for everything I provide and bill for, including simple repairs and adjustments?

Q/

The short and easy answer is yes. You must have a POD on file for every item and service you provide and intend to bill. The Medicare Program Integrity Manual is very clear on this issue. The manual states: “For any services, which do not have proof of delivery from the supplier, such claimed items and services shall be denied and overpayments recovered.”

A/

Editor's Note: For more detailed information on proof of delivery forms and date of delivery rules, see the Reimbursement Page article on page 18.

64

MARCH 2016 | O&P ALMANAC

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

#AOPA2016

AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Earn more than

32 CE

SAVE THE DATE

CREDITS

Join us September 8-11, 2016, for the 2016 AOPA National Assembly at the Hynes Convention Center in Boston, MA.  PLOT A COURSE FOR FUTURE SUCCESS with 5 concurrent sessions for Orthotists, Prosthetists, Pedorthists, Technicians, Business Owners and Managers

The O&P community has experienced stormy seas for the past several years with legislative challenges, rising costs, and reimbursement pressures. If you are looking for a lighthouse in the storm—join us at the 2016 Assembly.

Our goal is to bring our profession together to build a strong future through clinical and business education, networking and the support of a strong supplier community.

 Cruise through the stormy seas of REGULATORY RULES with answers you can only get from AOPA  Navigate the country’s LARGEST O&P EXHIBIT HALL  Sail through spectacular general sessions with inspiring KEYNOTE PRESENTERS

 Partake in FUN NETWORKING EVENTS  Enjoy exciting and HISTORIC BOSTON BACK BAY  Catch up with the ALUMNI CONNECTION  Maneuver your way with CASE STUDIES AND SYMPOSIA  GET ONBOARD with MDs, PhDs, Wound Care Specialists, Research Scientists, Attorneys, Business Experts and Top-Notch Practitioners.

Questions?

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

For information about the show, scan the QR code with a code reader on your smartphone

Visit www.AOPAnet.org to learn more, submit a paper, or to exhibit.

Pheon and Terion K2 Solutions for you and your patient

Up to 10Ëš stance flexion plus aggressive extension assist for great stability

Split toe for ground conformance and sandal-toe design for flexible footwear choices

www.ottobockus.com