March 2024 O&P Almanac

GUIDANCE FOR POWERED

EXOSKELETON DEVICES P.10

VALUE-BASED CARE AND CHALLENGING THE STATUS QUO P.22

FRESH FACES: MEET A DYNAMIC O&P ADVOCATE P.26

Learning Curves

Current

A step up for foot drop

Turbomed’s premium foot drop or thosis sits on the outside of the shoe to facilitate maximized ankle movement while reducing the risk of injury .

PDAC validated (L1951)

Simplified assembly

18% more dorsi-flexion power

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the shoe

14

To ensure optimal treatment for scoliosis patients—who may resist or voice frustration at having to wear TLSOs—experts recommend following nationally established guidelines and best practices while individualizing treatment for each patient. Plus, access tips for encouraging adherence to wear times, view trends in infantile bracing, and read about scoliosisspecific exercises.

By CHRISTINE UMBRELL

Maggie

22

Is it time for the O&P profession to move from its longstanding fee-for-device reimbursement model to a fee-for-value model? There are both advantages and disadvantages to such a transition, says Jason Highsmith, PT, DPT, CP, FAAOP, and the O&P community should understand the challenges and potential benefits when advocating for change.

fit

function for control, safety and comfort. Within each model we offer 4-5 different sizes (XS-XL) to match different foot sizes and heights of users. All sizes have individual composite lay-up to optimize dynamic response, especially of the important footplate. (Both build height and footplate length can also be adjusted, 1-1.5 cm). SOME SAY ONE-SIZE FITS ALL WE SAY one-size fits almost no-one!

We have big ambitions for the word FIT.

It’s given that the AFO should fit and follow the shape of the leg and fit and adapt well to the shoe, for a comfortable wear for each individual. But fit should also mean a good dynamic function for the individual, and that’s where the similarity between a one-size version

and an Allard AFO STOPS!

We offer different models for different needs of support and stability. Our 25 years experience and development of composite AFO confirms the necessity of variety to meet and fulfill the need from patients in the best possible way, not only one way!

Responding footplate is a key

AOPA Contacts

A world where orthotic and prosthetic care transforms lives.

Board of Directors

OFFICERS

President

Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

President-Elect

Rick Riley

O&P Boost, Bakersfield, CA

Vice President

Kimberly Hanson, CPRH Ottobock, Austin, TX

Treasurer

Chris Nolan

Össur, Foothills Ranch, CA

Immediate Past President

Teri Kuffel, JD

Arise Orthotics & Prosthetics, Spring Lake Park, MN

Executive Director/Secretary

Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS

Arlene Gillis, MEd, CP, LPO

International Institute of Orthotics and Prosthetics, Tampa, FL

Adrienne Hill, MHA, CPO(L), FAAOP Kennesaw State University, Kennesaw, GA

John “Mo” Kenney, CPO, LPO, FAAOP

Kenney Orthopedics, Lexington, KY

James Kingsley

Hanger Clinic, Oakbrook Terrace, IL

Lesleigh Sisson, CFo, CFm

Prosthetic Center of Excellence, Las Vegas, NV

Matt Swiggum

Proteor, Tempe, AZ

Linda Wise

Fillauer Companies, Chattanooga, TN

Shane Wurdeman, PhD, CP, FAAOP(D) Research Chair

Hanger Clinic, Houston Medical Center, Houston, TX

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

330 John Carlyle St., Ste. 200 Alexandria, VA 22314

Office: 571-431-0876

Fax: 571-431-0899

AOPAnet.org

AOPA Staff

EXECUTIVE OFFICES

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

Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

HEALTH POLICY AND ADVOCACY

Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@AOPAnet.org

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

Sam Miller, manager, state and federal advocacy, 571-431-0814, smiller@AOPAnet.org

MEETINGS & EDUCATION

Tina Carlson, CMP, senior director, education and meetings, 571-431-0808, tcarlson@AOPAnet.org

Kelly O’Neill, CEM, assistant director, meetings and exhibitions, 571-431-0852, kelly.oneill@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS

Joy Burwell, director of communications and membership, 571-431-0817, jburwell@AOPAnet.org

Betty Leppin, senior manager of member services, 571-431-0810, bleppin@AOPAnet.org

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

Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org

AOPA Bookstore: 571-431-0876

Reimbursement/Coding: 571-431-0833, LCodeSearch.com

O&P ALMANAC

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

Josephine Rossi, editor, 703-662-5828, jrossi@contentcommunicators.com

Catherine Marinoff, art director, 786-252-1667, catherine@marinoffdesign.com

Bob Heiman, director of sales, 856-520-9632, bob.rhmedia@comcast.net

Christine Umbrell, editorial/production associate and contributing writer, 703-662-5828, cumbrell@contentcommunicators.com

PUBLISHER EVE LEE, MBA, CAE

EDITORIAL MANAGEMENT CONTENT COMMUNICATORS LLC

ADVERTISING SALES RH MEDIA LLC

DESIGN & PRODUCTION MARINOFF DESIGN LLC

PRINTING SHERIDAN

SUBSCRIBE

O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/ December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571-431-0876, fax 571-431-0899, or email info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES

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

Copyright © 2024 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.

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Share your message with AOPA membership— approximately 9,000 orthotic and prosthetic professionals, facility owners, and industry personnel. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net. Learn more at bit.ly/24AlmanacMediaKit

PUTTING YOUR BEST FOOT FORWARD

One size does not fit all. At Hersco, our team of professionals works to fabricate orthotics from your scans and casts to match your patients’ specific needs. Customer service is at the heart of everything we do and we work endlessly to help you be as effective and efficient as possible. When you want the job done quickly and accurately, Hersco is here to help.

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

O&P OUTREACH

IS YOUR FACILITY READY FOR LLLDAM?

Next month is Limb Loss and Limb Difference Awareness Month. Prepare now to celebrate your patients in April.

INSURANCE INSIGHTS

RESEARCH ROUNDUP

TMR Reduces Pain for Majority of Patients

Some individuals who have undergone targeted muscle reinnervation (TMR) to improve control of their myoelectric prostheses have reported the procedure also served to alleviate chronic pain, so researchers from the University of WisconsinMadison’s School of Medicine and Public Health conducted a study to investigate postoperative expectations of pain outcomes and the recovery process.

The research team collected data by analyzing posts and comments between Jan. 1, 2020, and March 24, 2023, from a closed Facebook group: the Osseointegration Peer Support Group. The group comprises 3,258

members who have undergone TMR or are potential patients. In analyzing posts reporting on TMR outcomes, the researchers found that 72% reported reduction in pain following TMR, 16% reported persistent or worsened pain, and 12% reported no difference in pain. They also noted wide variation in the time needed to note improvement in chronic pain after undergoing TMR.

“As a result of this social media review, we determine that TMR is an effective and reasonable option for treating chronic pain conditions, given the patient-reported data gathered within the Facebook group,” noted the researchers. The study was published in February in Journal of Plastic, Reconstructive, & Aesthetic Surgery

Design Team Builds EEG-Controlled Robotic Arm

FAST FACT COVERAGE DENIALS PREVALENT

Among “high utilizers” of healthcare—more than 10 visits to a healthcare provider per year—27% say they’ve received a claim denial for care they thought was covered.

HEALTH COSTS EXPECTED TO RISE IN 2024

U.S. employers expect total health benefit cost-peremployee to rise 5.4% on average in 2024, even after they make changes to slow growth.

Researchers and students at Northern Kentucky University (NKU) are building a 3D-printed robotic prosthetic arm, comprised of 80 small parts, that will be paired with technology to enable brain-computer interface (BCI). Mahdi Yazdanpour, PhD, assistant professor in NKU’s Engineering Department, leads the team, which is leveraging a noninvasive electroencephalogram (EEG)-based hybrid BCI. “While many bionic arms rely solely on electromyography-based control methods, our system combines BCI technology with traditional control mechanisms, allowing users to control the prosthetic arm through brain neural signals,” explains Yazdanpour, with a goal of developing a customizable, affordable, and noninvasive braincontrolled prosthetic arm.

The design includes a headset device that captures brain signals, then classifies and processes them before converting them into commands for the prosthesis. Five actuators allow each finger to move

independently. The team plans to optimize signal processing algorithms to improve the accuracy and responsiveness of neural signal decoding, as well as conduct user studies to evaluate the system’s effectiveness in realworld scenarios. “The next steps will focus on integrating sensory feedback to the fingers, creating a more natural interaction between the user and the prosthetic by simulating the sense of touch, pressure, and temperature,” Yazdanpour says.

“By integrating BCI technology with traditional prosthetic control methods, we seek to provide individuals with upper-limb loss greater autonomy and functionality in their daily lives,” says Yazdanpour. His research also highlights “the importance of interdisciplinary collaboration between engineering, neuroscience, and healthcare professionals to develop innovative solutions that address the diverse needs of prosthetic users.” Read more in Spectrum News

SOURCE:

SOURCE: “KFF SURVEY OF CONSUMER EXPERIENCES WITH HEALTH INSURANCE.”

PATIENT PERSPECTIVES

Actress With Bilateral Limb Loss Takes the Stage

Katy Sullivan, who was born without the lower half of both legs, is being touted by Chicago Shakespeare as the first woman with a disability to play the title character in a major U.S. production of “Richard III.” She led the production from Feb. 2 through March 3.

Sullivan wore her own advanced black-and-silver prosthetic legs for much of the production and navigated the stage in other ways as well. “I like the idea of the different ways I can use my body to inform the story and manipulate the people who are around” the title character, Sullivan told Chicago Magazine

Sullivan was nominated for a 2023 Tony Award for her role in “Cost of Living.” She also is a Paralympic athlete, having competed in the London Games in 2012.

CERTIFICATION CENTRAL ABC and NCOPE Plan New CPO Residency Standards and Exams

Representatives from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the National Commission on Orthotic and Prosthetic Education (NCOPE) announced they are working to advance the process of becoming a CPO by transitioning to new residency standards and certification exams that require both disciplines. The goal is to lower current barriers for entry into the profession and meet the present and future workforce demands.

Because current educational standards require a master’s degree including both prosthetics and orthotics studies, ABC and NCOPE believe “it is consistent to also transition the residency standards and practitioner exams to include both disciplines,” according to an ABC announcement. They tentatively plan to administer a new dual-discipline simulation exam in April 2027 and a new dual-discipline CPM exam in May 2027.

With

People & Places

PEOPLE IN THE NEWS

OPGA and Össur Americas have announced the recipients of two O&P grants that are co-sponsored and co-supported by the two companies. The grants are designed to provide funding to a current O&P resident and certified orthotist or prosthetist (or both), respectively, that will allow them to attend and participate in two nonclinical events that are highly important to the O&P profession and the patients it serves: the AOPA Policy Forum and the Challenged Athletes Foundation (CAF) Triathlon Challenge.

Matthew Jones, a combined prosthetic/ orthotic resident with Alabama Artificial Limb & Orthopedic Service Inc., has been selected as the 2024 recipient of the Russell Walker, CP, LP, Emerging Leader Grant, which pays tribute to Russell (Rusty) Walker, a practitioner who was passionate about mentoring the next generation of O&P leaders.

Kelley Berk, CPO, with Shamrock Prosthetics Inc., has been selected as the 2024 recipient of the Todd Eagen Advocacy in Action Memorial Grant, which honors Todd Eagen, former president of OPGA, who unexpectedly passed away in 2022 and was an important leader in the O&P profession.

Jason R. Morin has joined the Board of Certification (BOC) Board of Directors as a public member. Morin is an executive leader with experience in optimizing reimbursement operations and third-party payor relationships in the home medical equipment sector.

Currently, Morin is senior manager, payor relations, for Coloplast, a global medical device company. “We are pleased to welcome Jason to the Board,” said BOC Board Chair Cameron Stewart, BOCO, BOCP.

BUSINESSES IN THE NEWS

Curbell Plastics Inc. donated polypropylene sheet materials to support the Range of Motion Project (ROMP), enabling the organization to deliver definitive prosthetic sockets to access-limited individuals through its U.S. Assistance Program at a clinic held in San Antonio, Texas.

“We were happy to supply the 14 sheets of half-inch-thick copoly polypropylene that were needed to help the patients participating in the San Antonio clinic,” said Jeff Wilson, senior business development manager–O&P for Curell Plastics. “We fully support ROMP’s mission to ensure access to high-quality prosthetic care for underserved people, improving their mobility and independence.”

This clinical volunteer program in San Antonio was supported by several organizations and businesses. Patients were identified

by ROMP’s partners Connect+Ability and Center for Refugee Services. The clinic was held in partnership with Bionic Prosthetics & Orthotics Group LLC, which provided the clinical facility and oversight, and Baylor College of Medicine’s O&P program, which provided volunteer prosthetics residents and professors.

Hanger Inc. announced the completion of its previously announced transaction to acquire Fillauer. “Adding Fillauer’s strong U.S.-based fabrication and manufacturing capability, coupled with their European operation, represents an exciting step in our journey to build an unmatched O&P ecosystem and to become the most valued O&P organization in the world,” said Pete Stoy, Hanger chief executive officer. “We are thrilled to welcome the team into the Hanger family.”

Fillauer will be part of Hanger’s Products & Services business segment and will maintain its brand, leadership, and team, led by Michael Fillauer. “Our priority is designing and fabricating quality products that will provide optimal, life-changing outcomes, and our unwavering dedication to the entirety of the O&P field will only grow stronger as we continue providing the same level of excellence on which we built our reputation,” said Fillauer. “We’re looking forward to now combining our industry-leading manufacturing, research, and development with Hanger’s outcomes-based research and clinical data to benefit the entire profession.”

Hanger Inc. also announced the launch of Hanger Ventures, a subsidiary that will focus on accelerating innovation, developing technology, and improving patient outcomes worldwide. Hanger Ventures will invest in entrepreneurs and small businesses, helping to bring innovative O&P healthcare solutions to the market.

“Hanger Ventures will enable us to provide resources typically not accessible to entrepreneurs and small businesses, collaborating from incubation to commercialization,” said Stoy.

Hanger Chief Clinical Officer James Campbell, PhD, who leads the Hanger Institute and Clinical and Scientific Affairs Division, will serve as president of Hanger Ventures. Campbell has 40 years of experience in the O&P profession and is a named inventor on five issued U.S. Patents. “Dr. Campbell is uniquely qualified to lead Hanger Ventures, leveraging his expertise, the work of the Hanger Institute, and our nationwide outcomes data to move the entire practice of O&P forward,” said Stoy. For more information, visit hanger.com/ventures

Jason R. Morin

Kelley Berk, CPO

Matthew Jones

James Campbell, PhD

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BY DEVON BERNARD

Rules for Exoskeletons, 3D-Printed Orthoses, and More

Review changes that may affect your coding and documentation practices

Recent Reimbursement Page articles covered the new codes and fees for 2024 as well as possible changes to Medicare’s Lower-Limb Prosthesis Local Coverage Determination (LCD). This month, we examine some of the updates and changes to the Medicare Policy Articles for orthotics and prosthetics and review additional updates and announcements.

Correct Coding Advisory Articles

CMS in November released a final rule that included powered orthoses and exoskeletons in the brace benefit category for Medicare coverage and payment purposes—in other terms, expanded the

definition of orthoses to include powered exoskeleton devices.

At this time, CMS and the durable medical equipment Medicare administrator contractors (DME MACs) have not created LCDs or Policy Articles for these new items, but they have provided some guidance. The DME MACs and the Pricing Data Analysis and Coding (PDAC) contractor released two correct coding advisory articles, or bulletins, Jan. 3 and 4 for powered exoskeletal orthoses: one for lower-extremity and one for upper-extremity devices.

The lower-extremity article addresses code K1007: bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any

type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors. The article states that this device must support “the weak legs for a patient that can perform ambulatory functions with the device. Ambulation may include the assistance of a cane, crutches, or a walker to return to mobility activities of daily living.”

The article also states that K1007 is to be considered a custom-fitted item and must adhere to the rules of custom fitting: Adjustments must be made at the time of fitting; the adjustments must go beyond minimal self-adjustment; and the adjustments must be made by someone with specialized training. Regarding fabrication, the coding article

states that K1007 is a complete item, and no other codes may be used.

The upper-extremity article states that “upper-extremity powered exoskeleton devices are used for chronic upper-limb weakness; these custom-fabricated orthotic devices are used to support and assist movement, thereby promoting functional activities of daily living,” and this currently includes codes L8701 and L8702.

In addition to being custom fabricated, L8701 (powered upper-extremity rangeof-motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) and L8702 (powered upper-extremity rangeof-motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) are all inclusive, and no other add-on codes may be used. They also must include an adjustable microprocessor control feature that utilizes electromyography signals. These signals are derived from intact muscle tissue, which controls the motors and results in support and movement of the limb through functional motion.

Lastly, the coding bulletin requires that, effective for claims with a date of service on or after June 1, 2024, all items billed with the K1007, L8701, or L8702 code must be reviewed and verified by PDAC and placed on the PDAC Product Classification List. At the time this article was written, only the following products have been placed on the PDAC Product Classification List: Rewalk (K1007), Ekso Indego (K1007), MyoPro 2 Motion E &W (L8701), and MyoPro 2 Motion G (L8702).

Reminder for 3D-Printed Orthoses

The DME MACs and PDAC also released a correct coding reminder for the use of 3D printing and digital scanning as it relates to custom-fabricated orthoses, stating that 3D printing and any other additive manufacturing technique could be considered a form of custom fabrication. However, just because

an orthosis is 3D printed doesn’t mean it is custom fabricated.

The DME MACs and PDAC stressed that if an additive manufacturing or 3D-printing method is used for fabrication, it must meet and adhere to the definition of custom fabricated found in the Quality Standards for Durable Medical Equipment, Prosthetics,

The coding reminder is consistent with AOPA’s longstanding position that 3D printing/additive manufacturing should be considered a valid custom fabrication method.

Orthotics, and Supplies, Appendix C: “A custom-fabricated item is one that is individually made for a specific patient. No other patient would be able to use this item. A custom-fabricated item is a device [that] is fabricated based on clinically derived and rectified castings, tracings, measurements, and/or other images (such as X-rays) of the body part. The fabrication may involve using calculations, templates, and components. This process requires the use of basic materials including, but not limited to, plastic, metal, leather, or cloth in the form of uncut or unshaped sheets, bars, or other basic forms and involves substantial work such as vacuum forming, cutting, bending, molding, sewing, drilling, and finishing prior to fitting on the patient.”

If an orthosis is 3D printed in small, medium, and large sizes without any specific patient in mind, then it would not be considered a custom-fabricated orthosis. In

addition, there is a separate definition within the Quality Standards for those customfabricated items that require being molded to a patient model: Per the definitions, you must create a positive model, and the fabrication must be done over this positive model. So, unless you have created a positive model and you are printing over that model, then the item would not meet the definition of custom fabricated.

This coding reminder is consistent with AOPA’s longstanding position that 3D printing/additive manufacturing should be considered a valid custom fabrication method. This coding reminder is another positive step taken by CMS, the DME MACs, and PDAC in accepting and identifying technological advancements in O&P.

Policy Article Revisions and Updates

All of the orthotic and prosthetic Policy Articles have been revised to address three main topics.

First is the inclusion of information previously released in a DME MAC/PDAC correct coding reminder from March 2021. Remember that once the DME MACs or PDAC releases a correct reminder or similar bulletin, it is to be considered part of policy and must be followed—even if the information is not currently found in the LCDs or Policy Articles. The information will most likely be incorporated into future versions of the policy, which is what has happened in the case of these recent revisions.

The information added to the policies clearly states that if the Healthcare Common Procedure Coding System (HCPCS) code describing the item being delivered only includes the phrase “prefabricated, includes fitting and adjustment,” but does not indicate if it is off the shelf or custom fitted, such as the L1831 (knee orthosis, locking knee joint(s), positional orthoses, prefabricated, includes fitting and adjustment), it is to be considered a custom-fitted item. If no custom fitting was provided at the time of delivery, then you should look for the appropriate crosswalked off-the-shelf HCPCS code.

If there is no corresponding off-theshelf code, use the most appropriate not-otherwise-classified or miscellaneous code: L1499, L2999, or L3999.

Second, as pointed out in the new 3D-printing coding reminder, the DME MACs stress the need for all customfabricated items—both base codes and addition codes—to meet the definition of custom fabricated in the Quality Standards, Appendix C. To ensure that suppliers are aware of these definitions, they have been reintroduced into the Policy Articles.

It is not a direct requirement under the policy, but it may be wise to put together a description of your fabrication methods and the type of materials you use—just in case the DME MACs request this information or there is a question as to whether the item you delivered was custom fabricated. You may already being doing this for your in-house custom-fabricated items that require PDAC verification, such as spinal braces.

In addition to stressing the importance for the custom fabrication method to meet the approved definition of custom fabrication, the Policy Articles also stress the importance of the proper use of addition codes. Specifically, the use of customfabricated additions are only appropriate for use with custom-fabricated base codes and should not be used with prefabricated (off-the-shelf or custom-fitted) base codes. The only exemption is if an item has previously been reviewed and approved by the PDAC prior to Jan. 1, 2023, and that verification included the mixing of codes.

The Policy Articles also stress that addition codes should not include, or partially include, features or functions described by other codes billed for a specific item. For example, if the base code descriptor includes padding or any type of joint, then you may not use addition codes to bill for padding or any other type of joint.

The third and final update is clarification to the definition of “specialized training” when it comes to the delivery of customfitted orthoses. When providing customfitted items, there must be some sort of custom fitting, beyond minimal selfadjustment, that occurs at the time of fitting, and this fitting must be done by a certified orthotist or individual with specialized training. In the past, the term “specialized training” was a little vague and left open to interpretation.

The policies now clearly define “specialized training” as training that provides knowledge, skills, and experience in the provision of orthoses in compliance with all applicable federal and state licensure and regulatory requirements. This slight change puts the definition more in line with current interpretations by the DME MACs that individuals such as certified fitters could provide custom-fitted items, as long as it is within their scope (knowledge/skills) and not prohibited by any state licensure laws.

The Policy Articles on Lower-Limb Prostheses and Ankle-Foot Orthoses/ Knee-Ankle-Foot Orthoses (AFOs/KAFOs) also added some new coding guidelines for specific addition codes. The AFO/KAFO

Policy Article now includes coding guidelines for six addition codes: L2200, L2210, L2220, L2280, L2330, and L2820. The Lower-Limb Prostheses Policy Article has new coding guidelines for L5991, L5845, and L5848, and updated coding guidelines for L5982, L5984, and L5926. Take time to review the Policy Articles and review these new guidelines.

Standard Documentation

Policy Article Revisions and Updates

The Standard Documentation Requirements (SDR) Article has been updated regarding what is considered to be part of the medical record for medical documentation to support medical necessity. The SDR now states, “Supplier-prepared statements and physician attestations by themselves do not provide sufficient documentation of medical necessity, even if signed by the ordering physician.” The previous SDR stated, “Supplier-produced records, even if signed by the treating practitioner, and attestation letters (e.g., letters of medical necessity) are deemed not to be part of a medical record for Medicare payment purposes.”

This slight change is to emphasize that the ordering/referring physician must make some sort of documentation in the contemporaneous medical records. The physician may not simply provide you a statement attesting to the patient’s condition. You may have the physician provide this type of statement to help clarify and provide a summary of their notes, but this statement by itself would not be sufficient; you would still have to provide copies of the physician’s notes and records.

Take the time to review all of the LCDs and Policy Articles to make sure you are current. Reviewing the documents now saves time later if you receive a denial and must appeal a claim.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org

BY CHRISTINE UMBRELL

LEARNING CURVES

Even with guidelines and best practices, scoliosis treatment requires individualized physical and emotional care

Orthotists who regularly treat scoliosis patients often encounter some resistance and frustration from their patients. Whereas other orthotists and prosthetists return children to mobility and provide patients with the ability to walk, play, and interact with friends, orthotists who treat scoliosis patients fit children with confining braces that limit their movement and set them apart from their peers.

Given those challenges, experts say it’s critical that orthotists consider each individual patient when determining which thoracolumbosacral orthosis (TLSO) is most appropriate; work collaboratively with other members of the healthcare team; and take an empathetic approach when educating patients to ensure they understand how bracing improves their long-term health and mobility.

Judgment Calls

Scoliosis experts typically refer to nationally established guidelines and best practices to determine when to start bracing, type of brace, and length of treatment—but they also say it’s important to consider each patient on a case-by-case basis.

At Hanger Clinic, for example, orthotists consult Clinical Practice Guidelines for treating idiopathic scoliosis that were developed by a team of Hanger experts, based upon the consensus findings from the 2016 SOSORT—International Society on Scoliosis

NEED TO KNOW:

f Orthotists who treat scoliosis patients typically refer to nationally established guidelines and best practices to determine the most appropriate thoracolumbosacral orthosis (TLSO) as well as recommended wear schedules and duration of treatment.

f It’s also important to consider the individual patient and adopt a flexible mindset when determining when and how to brace as there is no “definitive answer” in scoliosis care, and certain extenuating circumstances may influence treatment decisions.

Orthopedic and Rehab Treatment. The guidelines include seven different biomechanical design considerations to ensure all braces provided through Hanger Clinic are fabricated to a specific, high-quality standard, according to Hanger’s website.

Treatment decisions are affected by how much more growth the patient is predicted to experience. Scoliosis expert and Hanger Clinic Pediatric Specialist Megan Chamis, MSPO, CO, who works at Hanger Clinic located within Connecticut Children’s Medical Center, was part of the team that developed Hanger’s Clinical Practice Guidelines for scoliosis. She references Risser sign and Sanders scores to determine bone age of a patient compared to chronological age. Risser sign is an indirect measure of skeletal maturity, ranging from 0 to 5, that considers the ossification stage of the iliac apophysis; Sanders scores assess a child’s maturity based on bone age, usually via a single X-ray of the left hand, fingers, and wrist.

At Texas Scottish Rite Hospital (TSRH) in Dallas, “we’ve developed a complex chart, or algorithm,” to determine when and with which type of brace to treat a patient, says Kara Davis, MS, CPO, LPO, FAAOP, who manages one of TSRH’s scoliosis teams. The algorithm takes several factors into account, including Cobb angle, Sanders score, skeletal maturity, gender, family history, family preference, and willingness to wear a brace.

f Orthotists can play an impactful role by getting to know their patients and encouraging them to wear their brace as prescribed; empathy goes a long way when caring for children and communicating with families.

f Thermal sensors embedded within braces that provide objective wear time data assist healthcare professionals—and families—in monitoring adherence; this data can be leveraged to celebrate victories or discuss strategies if children fall short of their goals.

f Successful intervention for scoliosis patients requires orthotists to work collaboratively with other members of the healthcare team, including pediatricians, pediatric orthopedic surgeons, physical therapists, psychiatrists, and nurses.

f Scientific investigations focusing on the underlying causes of idiopathic scoliosis and TLSO adherence patterns will likely impact future scoliosis care.

Megan Chamis, MSPO, CO

Kara Davis, MS, CPO, LPO, FAAOP

Scoliosis Fast Facts

Get to know the scoliosis patient population with these facts from the National Scoliosis Foundation and the American Association of Neurological Surgeons:

• Scoliosis affects 2%-3% of the population, or an estimated 6 to 9 million people in the United States.

• Every year, scoliosis patients make more than 600,000 trips to private physician offices, an estimated 30,000 children are fitted with braces, and 38,000 patients undergo surgery.

• The most common age for onset of scoliosis is 10-15 years, although it may develop in infancy or early childhood.

• Infantile scoliosis occurs among children 0 to 3 years old; juvenile scoliosis occurs among children 3 to 10; and adolescent scoliosis occurs among children 11 and older.

• Scoliosis occurs equally among boys and girls, but females are eight times more likely to progress to a curve magnitude that requires treatment.

• Scoliosis is often defined as spinal curvature in the coronal (frontal) plane, but it is actually a more complex, three-dimensional problem involving the coronal, sagittal, and axial planes.

• Scoliosis may be classified as idiopathic, congenital, or neuromuscular.

In most cases, “it’s standard practice that a curvature between the 25- and 50-degree threshold is the best time to brace,” Chamis says. But you must take into consideration “juvenile age, Risser, curve magnitude, and stage of menses for female patients,” she says. That means the 25- to 50-degree rule doesn’t always apply. For example, “if a patient is female and pre-menses, and thus has a lot of growth remaining,” then she will likely benefit from bracing to prevent further curvature, Chamis explains.

In another example, Chamis notes, “If a 10-year-old girl is at significant risk but only has a 20-degree curve,” and there is likely much more growth to come, then it might be appropriate to start nocturnal bracing early.

A more recent trend is to begin pediatric treatment at a slightly younger age. “We’re catching curves sooner,” says Davis, which may lead to less curve progression or shorter treatment time. Plus, “with a smaller curve, the patient might be able to use a nighttime brace” rather than wearing a brace all day.

Still, “there’s no definitive answer” to determine appropriate candidates for nighttime versus daily TLSOs, says James Wynne, CPO, FAAOP, president of SOSORT and director of education and resident director at Boston Orthotics & Prosthetics, which was recently purchased by OrthoPediatrics Corp.

Daytime and nighttime braces each correlate with different amounts of correction during wear. “We can expect 50%-60% correction with a daytime brace, and 80% correction with nighttime braces,” explains Chamis. “With the brace off, the spine bounces back to its original magnitude. But by getting the correction from the bracing, the goal is to prevent further curve progression over time.”

Some studies have shown that nighttime bracing is appropriate for smaller curves: “Nocturnal treatment is most effective for curves of 35 degrees or less,” says Chamis. But that rule doesn’t necessarily apply for every child: “What does the individual patient look like? For a patient at Risser 0 with a lot of growth yet, nighttime might not be enough,” she says. “But for a patient at Risser 2 with a 38-degree curve whose growth has slowed, a nighttime brace might be appropriate.”

Orthotists also must engage the patient and family to understand where they are at, and combine that information with the evidence base, to help the family make as informed a decision as possible. “If a patient knows it’s going to be a problem to wear a brace all day, we may try to be accommodating with a nighttime brace,” says Wynne. Some reasons why a patient may add nighttime bracing, or switch to nighttime only, include higher apexes; as a supplement to full-time bracing if the in-brace correction is not ideal on a stiffer curve; or if they’ve outgrown their full-time brace, but there is growth remaining and the hours per day can be reduced, according to Wynne.

James Wynne, CPO, FAAOP

Davis works with a patient at Texas Scottish Rite Hospital in Dallas.

SOURCES: “INFORMATION AND SUPPORT,” NATIONAL SCOLIOSIS FOUNDATION; “SCOLIOSIS,” AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS.

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Managing Expectations

Because some patients and families can be confused about the goal of the brace, it’s important for orthotists to explain clearly. “Our treatment for scoliosis is to prevent the curve from progressing—it will never be completely corrected,” Chamis explains. “Sometimes that can be misunderstood in conversations.”

Chamis finds it useful to describe a brace as “medicine,” for which it’s important to determine the correct “dosage.” “We look at recommended wear time at 16-20 hours per daytime brace or 8-10 hours for a nighttime brace. But we want these kids to stay active,” so it’s important to consider their lifestyle when discussing wear time, she says. “If we have a dancer, we may ask her to wear the brace at school, then take it off for her dancing activities, and put it back on again in the evening. This is just one example of how to communicate with patients and families to combine the

recommended treatment plan with a lifestyle that encourages socialization and activity,” Chamis explains.

A flexible approach also may be warranted when discussing surgery and is always best addressed with the pediatric orthopedic surgeon, according to Chamis. “We usually recommend surgery for curves higher than 50 degrees. But more and more, if we see a patient with a 55- to 60-degree curve, and it’s been stable for a couple of years post-bracing, that patient might choose not to undergo surgery,” whereas a patient with a 50-degree curve that is more noticeable might elect to go the surgical route.

Chamis tries to be realistic about patients’ need to take time off from wearing the brace for special events, sleepovers, or short vacations. “I might explain their curve probably won’t change if they take a five-day break on occasion,” she says. “Having them out of the brace may be a necessary reward system.”

Tips for Families To Encourage Brace Wear Compliance

Psychologist Catherine McClellan, PhD, regularly works with scoliosis patients and other members of scoliosis treatment teams in her role as chief of behavioral health at Shriners Children’s–Portland.

To reinforce the importance of compliance when working with new patients, McClellan advises that families review the following journal article: “Early Adherence to Prescribed Brace Wear for Adolescent Idiopathic Scoliosis Is Associated With Future Brace Wear.” The article “points to the increased adherence to bracing prescription for patients who are able to get up to 80% of wear time within the first month,” says McClellan. “We often talk about orthodontics, and how kids get used to mouth braces really fast because they can’t take them off. I like to emphasize that the hardest part of brace wear is getting your body used to the brace without giving up too quickly.”

McClellan may suggest that parents grant extra privileges to their youth as they adjust to wearing the brace: “If incentives are recommended, we speak about how we can use external motivators to help a patient establish a new behavior.”

Each patient and family is unique, so “we tend to tailor our approach to the specific concerns for the particular youth,” McClellan says. Some of the steps she may encourage families to take include the following:

Identify clothing that patients will feel comfortable wearing with their brace.

Examine sleep concerns, particularly among patients wearing nocturnal or Providence braces. “So many youths have sleep concerns, and these can really make it hard to wear the brace,” McClellan says. “Knowing this in advance can make introducing the brace more successful. For example, many youths inadvertently engage in activities before sleep— video games, using their phone in bed, overconsumption of caffeinated beverages—that can make sleep harder. Additionally, given some of the shifts in adolescent sleep patterns, it can be hard for them to get enough sleep. For youths who are prescribed [nocturnal braces] who are already only sleeping 6-7 hours nightly, their sleep limitations can translate into brace wear limitations as well.”

Work closely with the orthotist. “Many patients and families do not feel comfortable speaking up in medical settings, especially for many of our families who are not native English speakers and those from other cultures,” explains McClellan. “From our first meeting, I let patients know that it is normal for a brace to need some tweaks, and if it is very uncomfortable, they should tell their provider to see what else can be done.”

Give patients the tools they need to tell their friends about the brace. “I like to talk about how, statistically, they are highly likely to have peers who also have scoliosis, and I sometimes encourage scoliosis support groups, such as the Scoliosis-us Mentor Program.”

Wynne agrees with adopting a flexible mindset: “We may compromise, based on what’s going on in their life,” he says. He suggests setting a “weekly” wear goal in combination with recommended hours per day, with the understanding that the patient may choose to wear the brace for fewer hours during a day with a special event, then make up the hours on the other days of the week.

Empathy and Education

Getting to know patients and encouraging them to wear their braces as prescribed is not always an easy task. “I see some patients who are dragging—they don’t want to be at their [orthotic] appointments,” says Chamis. “They feel it’s not fair that they’ve been singled out from their peers in having scoliosis,” and they may be frustrated at having to sit in patient appointments to be fit for constraining TLSOs.

For these patients, empathy goes a long way: “I’ll start by asking, ‘How are things going? I realize this is really hard, and it doesn’t seem fair.’ That can start a conversation,” says Chamis. “Sometimes we get so busy seeing patients and recording notes, that it’s easy to forget these patients feel alone in their journey. Making them feel seen and heard can go a long way.”

fits correctly, explain wear recommendations, and allow for follow-up questions. But it’s also helpful to provide take-home information, as verbal instructions can be overwhelming. Two years ago, Chamis helped develop Hanger Clinic’s “Scoliosis Brace Wear & Care Guide,” featuring guidelines, clothing suggestions, wear schedule recommendations, and more. Hanger Clinic orthotists regularly share the printed booklet or URL with patients.

At TSRH, patients can access follow-up information by scanning a QR code that is now included on every brace. The code brings users to the TSRH webpage for bracing. “It links to videos, advice, peer mentoring options,” and other aspects of brace wear, says Davis.

Catherine McClellan, PhD

Delivery day can be particularly emotional. These appointments should be long enough for the orthotist to ensure the brace

Behavioral health specialists on the care team who are involved in conversations about brace wear can help boost the number of in-brace hours, says Catherine McClellan, PhD, chief of behavioral health at Shriners Children’s–Portland. “Minimizing barriers to brace wear is quite important, especially if you can identify these even before brace wear starts,” she says. “These barriers can be psychological, such as being worried about peer rejection for wearing a brace, as well as logistical— being too hot on summer nights.

Chamis works with a scoliosis patient at Hanger Clinic.

“Wearing a brace is a healthcare behavior, and we know that there are factors that can promote brace wear—such as living in a household with a high degree of structure,” adds McClellan, “and things that can make it harder to wear the brace—such as concerns about appearance and social acceptance.”

Ongoing Orthotist Visits

Once patients have received their braces and have begun wearing them at home, orthotist appointments continue to be important. The first in-brace X-ray, typically taken three to four weeks after delivery, is a key milestone. “The in-brace X-ray can illustrate whether the brace is achieving the 50% day or 80% nighttime goal for correction,” explains Chamis, “and if the X-ray shows those targets aren’t being reached,” the brace likely needs adjustments. “I’ve had to remake braces when it wasn’t accomplishing what we needed it to.”

Seeing the initial progress after just one month of brace wear “can be a big motivator,” says Davis. After that, “it’s important to see kids regularly and frequently.” At TSRH, scoliosis patients have appointments every three months. “Kids are growing fast, but their brace is not, so you almost always need to make adjustments.”

“These patients are changing very dramatically,” adds Chamis. “They may be getting taller but not wider—in which case the forces are not being applied in the same place after a few months.”

In addition to making adjustments, orthotists can take advantage of these appointments to download data tracking wear time

via clinical sensors embedded within the brace, says Davis. “This gives us a starting point” to prompt conversations on compliance and offer suggestions if patients are falling short of wear time goals.

Oftentimes, orthotists at TSRH will be accompanied by psychologists or child life specialists during appointments; these individuals can help develop strategies to encourage children to wear their scoliosis braces appropriately, on a patient-specific basis, says Davis. (See sidebar on page 18 for additional tips on encouraging compliance for TLSO wear.)

It’s not just patients who orthotists must consider during these appointments: “Educating the family is of utmost importance so they understand the goals,” says Davis. “Parents can positively or negatively impact brace wear. And sometimes they complain more than the child,” in which case the team will have to “re-educate parents to get them on board” with the treatment plan.

Leveraging New Technologies

Bracing design and thought processes have evolved in recent years as new technologies and techniques have been introduced. Most facilities have moved to scanning for designing TLSOs: “We’re scanning 98% of patients, then custom-fabricating using CAD to design,” says Wynne. This process allows for precise orientation of the corrective pushes, shifts, and relief areas, and applies corrective pushes/reliefs where it will make the most impact, resulting in “improved in-brace correction,” as well as better adherence because braces fit appropriately and comfortably.

Scoliosis-Specific Exercises Complement TLSOs

Many O&P facilities work collaboratively with local physical therapists (PTs) to ensure their scoliosis patients also engage in some form of physiotherapeutic scoliosis-specific exercises (PSSE). “It’s important for the orthotist to understand the scoliosis-specific exercises,” says James Wynne, CPO, FAAOP, director of education and resident director at Boston Orthotics & Prosthetics, “and important for the therapist to understand the biomechanics of bracing.”

“In correlation with scoliosis bracing, the goal of PSSE is to create a ‘muscle brace’ to support the posture and mechanics whether the patient is wearing the scoliosis brace or not,” according to the Boston O&P website. “PSSE works toward creating a new muscle and mind scaffolding to support your bones and posture. The benefit of this is that when you are not thinking about your posture, like while you are at school, work, playing your instrument, sleeping, watching a movie, or on your phone, you can rely on the learned corrections that the exercise, training, and brace provide so that you remain compliant with your treatment goals. Over time, PSSE posture and mechanics

become automatic, and the PSSE physical therapist helps you accomplish this outcome.”

Schroth therapy is another example of scoliosis-specific exercise that is gaining ground in the United States. Developed in Germany in the late 1800s, Schroth exercises combine strength building and breathing exercises with posture awareness to balance the muscles and tissues of the back.

“The main goal of Schroth exercises is to prevent scoliosis from advancing,” according to Johns Hopkins Medicine’s website, and some patients try Schroth even before bracing is needed. “Schroth-specific breathing complements the bracing as children are taught to breathe within their custom braces.” Advocates caution that participants must make a long-term commitment to the Schroth guidelines to ensure successful treatment.

“For a certain population, Schroth exercises can be helpful not to replace bracing, but to complement it,” says Megan Chamis, MSPO, CO, of Hanger Clinic. “They can teach patients how to elongate.” In addition, “some families have said it’s helpful to have PTs reinforcing the messaging of the orthotist.”

Thermal sensors that provide objective wear time data are embedded within braces to assist in monitoring adherence. While some orthotists download reports from the sensors at each appointment, other facilities ask patients and parents whether they would like to leverage Bluetooth technology to monitor adherence at home. “This empowers patients and parents to see reports on a regular basis, without waiting between visits,” Wynne says. He also asks that parents submit the reports to their orthotist, physical therapist, referring physician, and other members of their medical team as part of the protocol.

Sensors offer objective data regarding wear time, says McClellan: “It is so easy for parents and youth to enter a battle over whether their child is wearing their brace or not, and this can become a huge issue,” she says. “Using temperature-monitoring sensors, it is possible for parents and orthotists to have really helpful details, without having to rely on patient report.”

Compliance reports generated from sensor data can be provided at follow-up appointments throughout treatment. This allows the opportunity to celebrate victories—like hitting the goal of 16-20 hours of wear per day—or to discuss strategies if children are falling short of their goals, Chamis says.

Care Team Collaborations

Successful orthotic intervention for scoliosis patients requires orthotists to work collaboratively with other members of the healthcare team, including pediatricians, pediatric orthopedic surgeons, physical therapists trained in scoliosis-specific exercises (see sidebar on page 20), psychiatrists, and nurses.

At Shriners Children’s–Portland, for example, the O&P department is on site, and orthotists work with orthopedic surgeons, behavioral health staff, and other team members. “This has resulted in a great feedback loop whereby the [orthotist] can speak more to the concerns raised by the youth and family, and they can refer back to behavioral health if there are additional concerns about starting brace wear,” says McClellan.

Beyond collaborating with healthcare professionals, orthotists also may communicate with school officials, with parents’ permission—particularly for elementary-aged children. Chamis suggests that orthotists touch base with school nurses to discuss proper donning and doffing for children who take off their brace during gym class.

For even younger children in pre-K and kindergarten, “talk to teachers to suggest giving patients a stool to sit on during ‘circle time,’” because it’s hard to sit on the floor while wearing a brace, says Chamis.

Future-Focused Care

More technological advances are underway, and several current investigations will likely have a significant impact on future scoliosis care.

Researchers at TSRH and the University of Texas Southwestern Medical Center were recently awarded a five-year, $6.6 million grant from the National Institutes of Health to continue research

Trends in Infantile Scoliosis

Among new developments in the treatment of scoliosis is a bracing protocol for children with infantile idiopathic scoliosis, which affects infants and toddlers younger than 3. Traditionally, many patients have been treated via serial Mehta casting, which uses slight traction and derotation techniques to reduce the curve and a large abdominal opening to facilitate breathing. Mehta casts must be replaced every 4 to 8 weeks, depending on the child’s age, as young children grow rapidly.

Today, some orthotists are seeing success with using a Boston Brace Baby orthosis instead of casts. This method relies on specially designed thoracolumbosacral orthoses (TLSOs) with large abdominal cutouts, similar to the shape of Mehta casts. The orthoses are custom fabricated using scanning and CAD/CAM technology, which eliminates the need to subject young patients to anesthesia—typically required for Mehta casting each time a new cast is created. In addition, “we’re finding that with a good bracing response and adherence to wearing, the curves may actually reduce similar to Mehta cast ing,” says James Wynne, CPO, FAAOP, director of education and resident direc tor at Boston Orthotics & Prosthetics. “We’re actually correcting the curve” in some cases.

A large multicenter study is in progress in several locations across the United States to determine the effectiveness of the protocol.

into the underlying causes of idiopathic scoliosis. “We can already predict risk based on the Cobb angle and skeletal maturity,” explains Davis, “but we still need to fine-tune who needs to be braced, and who doesn’t.” Studying genetic factors should assist in making those determinations.

Additional ongoing studies are targeting adherence to brace wear recommendations. “As we learn more in these areas, we’ll be able to identify the kiddos that are at risk of being non-adherent and the reason why,” says Wynne, so that “we’ll be able to do an intervention early on and improve adherence rates.”

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

FEAR OF CHANGE, RISKS OF STANDING STILL

Challenging the status quo of O&P coding and reimbursement

Complacency cannot steer O&P toward a purposeful future. Instead, open dialog, grounded in facts, can help the field determine whether fundamental changes may be needed in how O&P care is valued and compensated. If the status quo goes unexamined, confidence in O&P clinical excellence may gradually decline.

So said Jason Highsmith, PT, DPT, PhD, CP, FAAOP, during a session at the AOPA Leadership Conference in January. He raised critical questions about the profession’s coding and reimbursement model and challenged fellow orthotists and prosthetists to seriously examine issues central to the field’s identity and perceived value. The O&P community must decide if the current model is optimal to best serve public interest, its professional members, and most importantly, the patients who rely on services provided by O&P professionals, in a fiscally responsible manner.

Jason Highsmith, PT, DPT, PhD, CP, FAAOP

Highsmith presented a balanced case so professionals can judge the merits of transitioning to value-based care for themselves.

Soul of the Profession

To frame the conversation, Highsmith asserted that though most O&P professionals aim to provide ethical patient care, questionable cases—such as recommending high-tech devices for elderly low K-level patients—threaten to undermine the field. Such breaches of sound practice endanger patients and erode external confidence in O&P competence and integrity.

The anecdote was “not only an over prescription, but I would say it was some level of abuse, waste, fraud, et cetera,” Highsmith said.

To address such issues, O&P must decide if it is truly a healthcare profession. Citing widely accepted standards to evaluate if an occupational group is a true “profession”—having a code of ethics, a sanctioning body, unique body of knowledge, standards of entry, service, and autonomy—Highsmith contended that O&P clearly meets the criteria of an established healthcare profession. Further, the profession “has had a major role in shaping our own body of knowledge, our own body of literature,” he said. “… We’ve participated in multidisciplinary and professional groups to develop clinical practice guidelines.”

Current O&P definitions from various industry groups all point to specifically educated healthcare professionals who manage comprehensive patient care. “It’s scope of practice, not a scope of provision,” Highsmith noted. Consequently, if it is accepted that O&P is a healthcare profession, logic dictates that the profession also takes a role in determining if it stays with the HCPCS fee-for-device or pursues a fee-for-value model—especially when considering that most healthcare professions “at least partly self-identify based on their codes and how they bill, reimburse,” he explained.

Tied to CMS’s Durable Medical Equipment (DME) benefit, payment correlates with devices furnished rather than comprehensive

clinical services rendered. That shift of focus from O&P’s professional scope, education, and capabilities toward device-centric coding skews perceptions and confuses the understanding of what orthotists and prosthetists actually do, according to Highsmith.

“It leads to O&P practitioners being improperly viewed, not as clinical service providers, but instead as suppliers of DME benefits,” he said.

Inevitable Change

Evaluating the current O&P reimbursement issues within the larger context of ongoing changes in how all healthcare is paid for and valued is a necessary starting point in the value-based care conversation, said Highsmith.

The “healthcare reimbursement industry has introduced fee for value, and it’s here now,” he explained. “It’s what’s been colloquially described as a shift from volume-based care to value-based care. It relates to CPT service provision, not fee for device, and, in coding terms, that’s HCPCS versus CPT, or device versus professional clinical service.”

“This profession, the folks in this room, others as a group have to decide what’s next. It’s not going to be one person, it’s not going to be some group in a dark, back room after hours figuring this out.”

The value-based paradigm ties payment levels to the outcomes achieved from an intervention rather than merely paying for quantity of services. This rewards providers for the quality and efficacy of care delivered. Value-based care also considers the total arc of treatment, from initial assessment to judging whether goals were met at discharge. In that context, migrating O&P reimbursement from a narrow DME “device benefit” to a value-based clinical service model would better capture the full scope of care clinicians provide, but it also would involve seriously examining and validating expected patient outcomes and establishing objective, industry-wide standards for treatment efficacy.

Do We Stay…

Maintaining the linkage with DME could allow for potentially generous reimbursements for some higher-cost devices, Highsmith explained. “If you think about O&P reimbursement on some kind of a continuum, and you look at the lowest end, some of you can probably think of devices [for which] the codes that have been assigned are completely inadequate from a reimbursement perspective, and they wouldn’t sustain any sort of profitability; you couldn’t build your practice around it.”

On the other end of that continuum, however, are some microprocessor knees “in the neighborhood of the low $20,000 range,” but their reimbursements could be nearly double. “It can be fairly profitable on some ends, but you’ve got to balance that with the other end of the continuum, as well.”

Moreover, looking at trends from other healthcare specialties, such as cardiology and radiology, inflation-adjusted reimbursements have fallen significantly in the value-based care model. In cardiology, reimbursement decreased from 2016 to 2022 by roughly 34%. “If you average that out over time, the compounded annual growth rate is -2% growth in their reimbursement,” Highsmith explained. Radiology experienced a similar decline in a similar timeframe with a mean adjusted change of -3%.

“In contrast, last year when the Medicare fee schedule came out, O&P—as part of DME—saw a fee schedule increase of 8.7%,” he noted.

…Or Go?

The existing fee-for-device coding model has certain benefits, including bundled services and a somewhat more relaxed documentation process. Professionals have taken advantage of this system, but Highsmith acknowledged potential drawbacks, such as a possible impact on the profession’s reputation and the ability to implement change effectively, according to Highsmith.

Larger discussions will be needed to shape the optimal path forward; hard questions with no easy answers remain. For example, “how would incentives need to change” in a value-based care model?” he asked participants. After all, incentives drive behavior. The current model incentivizes providers to maximize the number of patients served, use the most advanced technology for better profits, and complete the episode of care efficiently.

To fully consider the incentives, episodes of care need to be defined. Typically, the starting point is the prescription, and the ending point, which triggers payment, occurs when the patient signs the device delivery slip.

“But you do have to provide some ongoing care, right?” Highsmith pointed out. “How do you fit that into the episode of care? … We have to put some bookends on somewhere.”

Highsmith also noted that migrating toward a value-based model would require extensive work to document and validate O&P interventions—similar to the processes physical therapy and other rehabilitative professions have worked through with payors.

“We’re struggling to get on the same page with this, it seems,” he said in reference to debates within the profession about who should be collecting patient data and which outcomes should be documented. “I’m just asking rhetorically here, are we ready to document at that level as a profession? There’s a lot of groundwork that has to be done before we get to that.”

Reflecting on the entire chronology of the reimbursement journey of other medical professions, Highsmith reminded attendees that the path to the value-based concept happened over many decades and involved “enormous contributions” from volunteers and consultants to measure, validate, and define their work. The process went through extensive revision and reiteration over years.

Something To Talk About

Properly valuing clinical expertise could benefit patients and perceptions of the field. But the path to coding and payment policy reform could be obstacle laden. These pros and cons for O&P potentially transitioning to a value-based care model are discussion-worthy:

Potential Pros:

• Better conveys clinical, patient-centered nature of O&P care

• Addresses misperception of orthotists/prosthetists as just “equipment suppliers”

• Could incentivize tracking outcomes and quality of care

• May improve professional stature/standing of field over long run.

Potential Cons:

• Documentation not robust enough yet to justify each intervention

• Huge effort needed to validate every O&P task and decision

• Less bundled payment could reduce efficiency incentives

• No guarantee of increased revenue

• Need to carefully align incentives to quality care, not overproduction

• Could meet resistance from entrenched bureaucracies and statutes equating O&P with DME.

“When all the work was done, if you read their publications, it actually worked out very favorably for some professions in medicine to expand their profit. Some it was a wash, and some lost money when this first came out,” he said.

Ultimately, Highsmith urged the profession to decide its own future. “This profession, the folks in this room, others as a group have to decide what’s next,” he said to the leaders in attendance. “It’s not going to be one person, it’s not going to be some group in a dark, back room after hours figuring this out. … Everybody in this room, for example, is on the hook to make a decision.”

O&P stands at a pivotal moment. By confronting difficult questions and clearly communicating its identity and value, the profession has an opportunity to chart a new course forward. But first, it must decide what it truly wants to be.

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Professional Purpose

Advocate Maggie Baumer, JD, seeks to improve access to care for individuals with limb loss and limb difference

Maggie Baumer, JD

New this year, O&P Almanac features Fresh Faces, where we introduce readers to prominent O&P professionals who are making an impact with their contributions to the orthotics and prosthetics profession. This month, we speak with Maggie Baumer, JD.

Maggie Baumer, JD, has worn many hats. Baumer, who leads patient advocacy efforts at Hanger, has spent time as a clinical manager, advocate, and support group leader for those with limb loss and limb difference in Massachusetts. She also enjoys the outdoors, writing, acting, and “connecting” people, ideas, and patterns.

An attorney licensed to practice law in both New York and Massachusetts, Baumer earned an undergraduate

O&P Almanac: What brought you to a career in O&P?

Maggie Baumer, JD: I love O&P! My own experience of traumatic injury and recovery introduced me to the field. In 2012, my left (nondominant) arm was crushed at the elbow by a trash compactor in my apartment building and barely made it through intact. After about a month of limb salvage efforts, my healthcare team at Massachusetts General let me know that they had

degree in clinical psychology. She has served on the board of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), played an instrumental role as a Certified Peer Visitor for Hanger Clinic’s AMPOWER peer mentoring program, advocated for individuals with limb loss via the So Every BODY Can Move initiative, and served as a legal intern for the Long-Term Care Community Coalition and the New York State Attorney General in New York City.

done all they could to save my forearm and hand, but at that point it was necrotic and needed to be amputated.

I’m so grateful to that team for connecting me with a peer visitor from Hanger Clinic’s AMPOWER program, Mike Benning, who also is missing his left forearm and hand from cancer when he was a teenager. By the time I met Mike, he’d lived for decades wearing a prosthesis and was able to show me what it was like to wear one and perform everyday tasks. Meeting him

Baumer (right) and Shelby Luce, MPH, during a trip to the Capitol to advocate on behalf of O&P

was a pivotal moment for me, as I had been avoiding an identity as an “amputee” up until that point. I soon became a peer visitor myself with AMPOWER.

Eventually, an opportunity at Hanger Clinic opened up in my area for a business development manager, and I jumped at the chance to join the team. It seemed like such a positive and purpose-driven field and everyone I’d met had been so kind, so I saw it as an exciting opportunity to redirect my career path.

O&P Almanac: How do you combine your legal background with your healthcare expertise to benefit the O&P community?

Baumer: Joining the O&P field provided me with a sense of professional purpose that I had not previously experienced. I’ve always been motivated to help people and worked in both the psychology and legal fields before starting in O&P. I found that my experiences in both of those fields hugely aided me in my personal recovery from injury, learning to navigate life with a disability, and with helping others.

My legal education and training helped my understanding of how to organize my “case,” negotiate medical bills, draft documentation for my Social Security disability application, obtain Medicaid insurance benefits, and keep appropriate records of

5

my interactions. It was almost a full-time job managing all of these things after my amputation, and I often thought about how difficult it would be without some of the skills I’d picked up as a lawyer—especially when you’re going through emotional and physical strain. When I was provid ing peer support to those with limb loss, I also understood how to approach people from a place of empathy and understand ing through my experience as a mental health counselor.

Today, I use all of those skills, as well as the knowledge I’ve gained through 10 years of working in the O&P space, to advocate for appropriate insurance policies, coverage, and reimbursement at the state and federal levels. I’m also working to educate people with limb loss and limb difference about the resources available to them in their communities and how to advocate for their healthcare.

O&P Almanac: What are your priorities as you take on a new role leading patient advocacy efforts at Hanger?

Baumer: My key priorities are to improve access to care for people with limb loss and limb difference and enhance the value-based care model we are embracing at Hanger. One of my areas of focus is supporting the So Every BODY Can Move (SEBCM) initiative.

Baumer (second from left) with her team at Hanger Clinic

Early on in my career in the O&P field, I noticed that certain elements of my care were deemed “not medically necessary.” For example, the best upper-limb prosthesis for me is a silicone restoration prosthesis. But insurance plans will often deny silicone restoration as “cosmetic” and therefore not medically necessary. Similarly, there are many times when insurance policies will not cover prostheses and orthoses for physical activity—the classic example being a running blade—deeming them not medically necessary.

I admire Nicole Ver Kuilen, founder of Forrest Stump, inaugural fellow of NAAOP, and current manager of public engagement at AOPA, because she didn’t accept this definition of medical necessity. Instead, she decided to challenge it and through the collective efforts of AOPA, the Amputee Coalition (AC), American Academy of Orthotists & Prosthetists (AAOP), and NAAOP, as well as the advocacy of Jordan Simpson in the state of Maine, the first activity-specific prosthesis law was passed [in Maine]. She helped to form the SEBCM initiative, and we have been pushing to pass legislation in multiple states that will change what is considered “medically necessary.” We believe that movement is medicine and that access to physical activity is a right, not a privilege.

I plan to adopt the same spirit, backed by clinical reasoning and research, to increase coverage and access through Medicaid plans across the country. In addition, I want

to ensure that our team is well versed on the myriad resources available to our patients within each state, so we can best support them in accessing those resources.

O&P Almanac: You are on the board of NAAOP, including recently serving as president. What have your accomplishments been in that capacity?

Baumer: I first joined the NAAOP board in 2016 and have learned so much about the wider field through my participation on that board and the O&P Alliance. One of the efforts I spearheaded was leading a subcommittee of O&P leaders to put forth

education on sexual harassment prevention and creating positive workplaces for all. I think it is incumbent on leaders in our field to adopt a culture of curiosity, learning, and safety so that all of us can thrive in our careers in the O&P space.

I also served on the NAAOP Fellowship Committee, interviewing candidates and identifying fellows, along with accompanying them on tours of Hanger Clinic facilities and the National Rehabilitation Hospital in Washington, DC, during their fellowships. My leadership style is collaborative, and I hope that during my time as president, I created more collaboration and engagement within the NAAOP board and with its external partners.

O&P Almanac: Tell us about your role as a Certified Peer Visitor for the AMPOWER Program.

Baumer: I became a Certified Peer Visitor early on in my O&P journey and find it to be a foundational element of advocacy. Sitting down with another person who is just beginning their recovery from limb loss, looking them in the eye, showing them what’s possible while also acknowledging the grief, loss, and difficulty they are facing is one of the most valuable experiences I’ve had.

I started running an AMPOWER support group in 2015, which I have since handed off to my very capable colleague, Laura Grady. The group serves as a place where people

Baumer (far left) and a group of advocates meet with Rep. Jim McGovern (far right).

Baumer (second from left) participated in a trip to the Massachusetts State House to advocate for So Every BODY Can Move.

can be open and honest about the highs and lows of dealing with amputation and disability. It’s also a place for shared experiences like Christmas parties, sessions in the park, and trips to favorite local restaurants. I think finding and providing peer support and community can be one of the cornerstones of healthy living with limb loss and limb difference.

O&P Almanac: How have you been involved in the So Every BODY Can Move initiative and other volunteer opportunities not yet mentioned?

Baumer: SEBCM is one of the key initiatives I am supporting in my new role at Hanger. I’m currently acting as a state coach for Massachusetts, New Hampshire, and New Jersey. I’m also supporting groups in different states that are looking to build coalitions and/or form state O&P associations.

O&P Almanac: What are the biggest challenges and opportunities for the future?

Baumer: I see a lot of opportunity for both people with limb loss and limb difference, as well as those working in the O&P field, to engage in advocacy. Some of the ways that can happen is through:

• Providing education and opportunities for people with limb loss and limb difference to advocate for themselves and their care at the state and federal level

• Providing additional support and resources to those with limb loss and limb difference

• Joining or starting a state O&P association

• Building a coalition around SEBCM

• Building relationships with allied health organizations with shared policy agendas

• Building relationships with state and federal legislators.

I also see increased opportunity for all of the O&P organizations to continue working collaboratively to align on policy agendas, support and bring up new leaders in the advocacy space, and continue publishing research that supports value-based care models.

Challenges include adapting to ever-changing technology while accommodating frameworks that were created decades ago. For example, upper-limb prosthetic coding needs serious updating. The good news is, we are fortunate to have strong experts in our field who are up for the challenge and are already working on solutions.

I hope we can all keep the values of service to others, flexibility and curiosity, and innovation at the forefront of our policy agendas as we continue to push the profession forward.

OWNER:

OWhy Am I an AOPA Member?

“AOPA has proven to be a valuable asset time and again to my small business—helping us to navigate the rough seas often associated with our profession.”

—Eric Otto Oertel, CPO, LPO

LOCATION: Union, New Jersey

HISTORY: 41 years

Third-Gen O&P

New Jersey facility owner grew up in the profession and prioritizes in-house fabrication

ertel Orthopedics opened its doors in 1983, but its legacy stretches back to 1918, when Otto Oertel began his O&P career in Eisleben, Germany. Otto’s son, Horst, followed his father into the field with an apprenticeship in 1954, becoming certified three years later, at age 17.

Germany was a divided country at the time, and Horst disagreed with the politics of the East German government. In December 1957, he crossed the border to West Berlin and then to Hamburg, where he was placed in a youth camp. Horst found work as an orthotist/prosthetist in southern Germany, and in 1958, he started a new job in Lörrach.

“I was young, with no one to take care of, and I wanted to see the world,” Horst says. Over the next five years, he found work in Paris; Basel and Zurich, Switzerland; Genoa, Italy; and Rio de Janiero, Brazil. Looking for his next job in 1962, he placed an ad in a German O&P trade paper and was offered positions in Egypt, Australia, and the United States, ultimately choosing to take the position at Ernst Orthopedics in Elizabeth, New Jersey. He obtained a green card nine months later and found passage on a German freighter, working his way from Rio to New Jersey.

His next job was in Allentown, Pennsylvania, with Ernie Boas. After 18 months, Horst opened his own facility in 1968: Modern Limb and Brace Co., now in Watchung, New Jersey, where he finally stayed put. Horst, a certified and licensed prosthetist, added a second venture in 1983, purchasing Ernst Orthopedics, which he renamed Oertel Orthopedics.

Meanwhile, Horst’s eldest son, Eric, grew up in the profession. “As the third generation in O&P, it was in my blood,” Eric says. He studied at the University of Washington and completed residencies in Manhattan and with his father at Modern Limb and Brace. Eric worked for many years at a large, national O&P company, but in 2017, he returned to New Jersey and soon assumed ownership of Oertel Orthopedics. Horst, 83, is winding down his professional career, with Eric poised to take over Modern Limb and Brace as well.

Both facilities focus on custom work and feature in-house fabrication labs. “We use all the

cutting-edge new technology for components and design, but we do focus on hand work and managing the process from evaluation to hand-casting models to overseeing production on site,” says Eric. “I know the profession is pivoting to 3D scanning and printing and central fabrication, but … I want to see things through, right here, from beginning to end.”

Oertel Orthopedics and Modern Limb and Brace serve patients of all ages and offer a full range of O&P services, although Eric specializes in upper-extremity prosthetics. Both facilities leverage practice management software that integrates outcome protocols.

Eric is a sole practitioner at Oertel Orthopedics, with support from a technician and office administrator. Modern Limb and Brace has a second practitioner, Gregory Hovsepyan, LPO, a practicing physiatrist in Armenia, who moved to the United States and trained as a prosthetist-orthotist.

Horst and Eric both believe in community outreach, providing free evaluations and services to patients without sufficient healthcare coverage. “We often have outreach from local churches and communities, especially related to the influx of migrants,” says Eric. “We regularly respond to those in need with care at little or no cost.”

Success stories are integral to Eric’s pleasure in his work. When he returned to New Jersey, he met a bilateral below-knee amputee in his 60s who had suffered a crushing injury at work years before. “There was tri-limb involvement, and he was in great pain and looking at life in a wheelchair,” says Eric. “Today, he is one of the most active individuals I know. Aside from his prostheses, he doesn’t use any assistive devices and is very active, splitting firewood and taking on house projects with his son.”

Patients such as this “are the shining stars that keep you going through all the frustrations with insurance and other issues,” Eric says. “It feeds the soul.”

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

FACILITY: Oertel Orthopedics

Eric Otto Oertel, CPO, LPO, and his father, Horst Oertel, CP

Photo of the family’s original facility

Eric Otto Oertel, CPO, LPO

Martin Bionics

OWNER: Privately Held LOCATION: Oklahoma City, Oklahoma

JHISTORY: Six years

Fluctuation Focus

Oklahoma City manufacturer offers alternative to traditional sockets

ay Martin, CP, FAAOP, created the Socket-less Socket after working with NASA to develop exoskeletons for space and military applications. Martin Bionics, the company he founded, began purely as a manufacturer, but the company opened a clinic in 2018 to provide proof of concept and work closely with limb loss patients.

That business model took hold, and the company began acquiring patient-care facilities where patients interested in the technology could be fitted. Martin Bionics acquired a practice in Austin, Texas, in 2019, and in 2020 acquired a location in Tampa, Florida. That same year, Time magazine named the Socketless Socket one of the year’s best inventions.

Why Am I an AOPA Member?

“We initially joined AOPA for educational reasons. We did a lot based on trial-anderror, and AOPA helped us understand how the industry handles things. We also appreciate the opportunities AOPA gives us to participate in conferences and to get our name out there.”

—Seth Reiter

“The open design means the socket doesn’t dig into the body or the back of the knee, so it is a lot more comfortable for sitting or driving. Many patients report it feels lighter, because it moves with the limb and there’s no sense of dragging it around.”

Today, Martin Bionics has 57 employees in its Oklahoma City facility, where the sockets are manufactured. The company makes sockets for individuals with above- and below-knee amputation; above- and below-elbow amputation; and hip and shoulder disarticulation.

The device is designed to address a common issue in prosthetics: the fluctuation in volume of the residual limb. “Many patients have to deal with this, and they often manage it with socks, but this means they have to remove the socket several times in a day,” explains Seth Reiter, chief operating officer. “If you’re wearing pants, it’s even more of a struggle. That’s the pain point we were seeking to alleviate.”

The Socket-less Socket has an open design that dissipates heat and reduces sweating. Ratchet straps, like those used on snowboarding boots, allow users to loosen or tighten the fit as needed throughout the day. The company’s software, Socket-Soft, streamlines the clinical fitting process, allowing the practitioner to “micro-adjust the socket on the user,” according to Reiter.

“Our goal is to make it really comfortable because the more comfortable it is, the more people will use it, which means they will be more active,” says Reiter.

Because fitting the device and training patients to use it can involve a learning curve, the company makes the device available only to the facilities it owns or to those that would like to join its clinical network of practitioners. Martin Bionics launched its clinical network in 2021 and refers patients to clinical network practitioners, or CNPs. Any practitioner may receive training to become a CNP. The company also launched a Facebook group for patients where they can ask questions, talk about their experience with the socket, and share ideas.

Last year, Medicare introduced a new L code for volume management, which is a game changer, according to Reiter. “The credit goes to Click Medical, which also makes an adjustable prosthetic socket,” he says. “They also asked us to participate in the effort to get the code.”

One challenge for Martin Bionics is the cost of the socket, which is more than a traditional socket. “We do extend discounts to our clinical network, but now, with the L code, it will change the dynamic. Practitioners will know that they will get reimbursed for taking the time to fit patients, and it will make access more widespread.”

As prosthetic technology evolves, Reiter believes that newer entrants to the O&P field will be more inclined to use new technology. “I think it will be a shift in the industry, as younger practitioners embrace innovative materials, designs, and procedures,” he says. “Adjustable tech is on the cusp of becoming more accessible and widespread as practitioners become more aware of it and as it becomes easier to learn.”

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

A clinician fits a patient with above-knee amputation.

A sample below-knee Socket-less Socket

The Martin Bionics team

AOPA Policy Forum

Join AOPA in Washington, DC, to advocate for the profession

April 15 and 16

Washington Marriott Capitol Hill

Washington, DC

Join forces with other O&P professionals to advocate on behalf of the profession— and your patients! The Policy Forum is your opportunity to learn about the latest legislative and regulatory issues and how they will affect you, your business, and your patients. Don’t miss this chance to educate members of Congress about the importance of O&P care for patients living with limb loss/difference and limb impairment. Visit the AOPA website for details.

Don’t Miss AOPA’s 2024 Webinars

Mark your calendar for the April 17 “Ask the Expert” webinar

AOPA will offer six webinars throughout 2024—in February, April, June, August, October, and December.

February’s webinar has been released and is available now as a recording. “Changes & Updates to Medicare Policies: Do You Still Know the Rules?” provides a brief update on the proposed changes to the Lower-Limb Prostheses Local Coverage of Determination and reviews what it means for you; discusses the new coding guidelines for prosthetics and lowerlimb orthoses; and much more.

Save the date—April 17—for the next webinar. You won’t want to miss this “AOPA Ask the Expert” event!

Webinars are $99 for members and $199 for nonmembers. All webinars are live, but all those who register will receive access to the recordings.

To purchase the February webinar or register for future sessions, access your AOPA Connection account or visit aopanet.org. Questions? Contact Devon Bernard at dbernard@aopanet.org

Don’t Miss AOPA’s Next Coding & Billing Seminar

Take part in the virtual event

May 13-14

Sign up for the next AOPA Virtual Coding & Billing Seminar, slated for May 13-14. You’ll learn how to get claims paid, survive audits, collect interest from Medicare, and file successful appeals. Earn CEs!

Visit AOPAversity online at bitly.aopaversity for details and to register. For questions regarding seminar content, email Devon Bernard at dbernard@aopanet.org

SEPTEMBER 12-15, 2024 | CHARLOTTE, NC

Save the Date Mark your calendar for the AOPA National Assembly in September

The 2024 AOPA National Assembly, with a theme of “Ignite 24,” takes place Sept. 12-15 in Charlotte, North Carolina. Plan now to attend this year’s Assembly.

Why attend?

• Earn continuing education credits

• Hear from physicians, researchers and top-notch practitioners

• Participate in hands-on learning and demonstrations

• Network with an elite and influential group of professionals

• Explore the largest O&P exhibit hall in the western hemisphere, featuring devices, products, services, tools, and the latest technology from exhibitors around the world.

Call for Papers

Submit your proposal by March 30! For details, visit www.AOPAassembly.org

Questions? Contact AOPA at 571-431-0876 or email assembly@aopanet.org

FUN FACT

Charlotte is known for its rich NASCAR history and is home to the NASCAR Hall of Fame, an interactive museum celebrating the history of stock car racing and the sport’s legendary drivers.

AOPA Members

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

Euroinsoles Inc.

4824 SW 75th Avenue

Miami, FL 33155

305-815-7442

edserlabs.com

Jamison Goldberg, DPT Supplier Startup

Kavella Prosthetics & Orthotics

99 Cheek Sparger Road, Ste. 104A

Colleyville, TX 76034

682-390-4499

Batool Summer

Siddiqui, CPO Patient-Care Facility

Synergy Healthcare LLC

664 E. Grand Ave

Hot Springs, AR 71913

501-623-4000

dmenearme.com

Robert Bukowski Supplier Startup

INTRODUCING THE NEW

MICROPROCESSOR FULL LEG SYSTEM

AN ENTIRELY NEW ANGLE

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See how SYNSYS is transforming lower limb prosthetics

Ypsilon® FLOW ½ & ToeOFF® FLOW 2 ½

FLOW AFOs are Allard’s newest generation of AFOs, fabricated with a new proprietary formula that offers increased range of motion in the sagittal plane and smoother transition (flow) throughout the gait cycle. The footplate is shaped to allow more clearance for the forefoot in the shoe toe box. Plus, both Ypsilon® FLOW ½ and ToeOFF® FLOW 2 ½ are designed to accommodate lower shoe heel heights, fitting more shoe styles.

For more information, call 888-678-6548 or email info@allardusa.com. Request your free magnetic level!

Step Into Your Comfort Zone with the Terrain iW from College Park

With a focus on low-impact K2 users, College Park combines some of its most popular and trusted technology in the new Terrain iW. This lightweight foot offers triaxial movement on an Intelliweave® composite base. Featuring anatomical ankle motion, flexible springs, and a durable heel wedge, the Terrain iW was designed for ultimate comfort and stability.

To learn more or request a demo, please visit college-park.com/ terrain-iw

Air-Lock Push Button Valve

Increase suction suspension even more with the new air expulsion valve release button for all Coyote Air-Locks.

Sold Separately

Coyote’s Air-Lock Push Button Valve

Increases suction suspension even more with the new air expulsion valve release button for all Coyote Air-Locks. Sold separately.

• Air expulsion built into the release button

• Retrofittable to all Air-Locks

• Quiet expulsion

• Increases negative pressure in the socket.

Contact Coyote at 208-429-0026 or coyote.us www.coyote.us/airlocka

Hersco 3D Printing

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

Elevate your mobility and expect more from every step with our revolutionary features. With QUATTRO Control Technology’s patented valve, enjoy seamless transitions between activities with infinite resistance levels. Our hyper-responsive sensors adapt to your body’s natural gait, ensuring smooth and effortless movement. Plus, our stumble recovery feature intelligently adjusts resistance for a more natural recovery in any situation. Discover a new standard in knee prosthetics. Take the next step toward enhanced mobility and confidence. Try PROTEOR QUATTRO today! Visit our website at shop.proteorusa.com or contact us for more information.

Turbomed Foot Drop AFOs

Turbomed’s leading line of foot drop AFOs sit completely outside the shoe for an invisible, painless support that will follow you as long and as far as you want. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function. Each model takes minutes to assemble and is easily transferrable to most shoes, boots, and sandals through an innovative lace clip design.

The Xtern Summit is the lightest model, has the most dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the

Calendar

September 12–15

AOPA National Assembly. Charlotte, NC. For more information, visit aopanet.org

March 1–31

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

March 30

Deadline to Submit Proposal for AOPA National Assembly. Visit aopanet.org/2024-national-assembly.

April 15–16

AOPA Policy Forum. Washington Marriott Capitol Hill, Washington, DC. Visit aopanet.org

April 17

AOPA Ask the Expert Webinar. To register, visit aopanet.org

April 23 and April 25

Certificate in O&P Business Management— Healthcare Operations. Virtual, 9 a.m. – 1 p.m. ET. Register on My AOPA Connection

May 13–14

AOPA Virtual Coding & Billing Seminar. To register, visit aopanet.org

June 28–29

PrimeFare East. Sheraton Grand Hotel Downtown Nashville. In-person meeting. For information, contact Cathie Pruitt at 901-359-3936, primecarepruitt@ gmail.com, or visit primecareop.com

August 19–20

AOPA Virtual Coding & Billing Seminar. To register, visit aopanet.org

Live and Online/On Demand CEs

The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/.Diabetic_Series_LMS_List

September 3–6, 2025

AOPA National Assembly. Orlando, FL. For more information, visit aopanet.org

Share Your Calendar Event

Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at bob.rhmedia@comcast.net or learn more at bit.ly/24AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

A

From care packages to pallets – or anything in between – count on UPS for convenient, dependable services and tools that make sending and receiving packages easy. Members can now take advantage of:

•

•

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State By State

Revisiting Reimbursement

Proposed legislation in Mississippi, Nebraska, and Ohio

Mississippi

House Bill 477, introduced in late January, would set Mississippi Medicaid reimbursement at the lesser of a provider’s usual and customary charge, or a fee from the statewide uniform fee schedule, which will be calculated using 100% of the prevailing Medicare rural fee schedule for durable medical equipment, prosthetics, orthotics, and supplies for the state.

Nebraska

As part of the foundation-building efforts of the So Every BODY Can Move initiative, Vincent Lau, CPO, of Limb Lab has worked with Nebraska State Sen. John Cavanaugh to introduce Legislative Bill 1274, which implements insurance fairness by ensuring that state-regulated commercial plans cover and reimburse O&P care at a level equivalent to Medicare. The bill will begin to move through Nebraska’s unique unicameral (one-chambered) legislature.

Ohio

Through the advocacy of the Ohio Orthotic and Prosthetic Association, Ohio Medicaid has increased its reimbursement rates for 48 L codes and added 18 previously missing L codes to the fee schedule. Reimbursement for increased codes went from 12% to 54% of 2024 Medicare to 69% of 2024 Medicare, while newly priced codes are now set at 18% to 140% of 2024 Medicare. This update went into effect Jan. 1, 2024.

Interested in getting involved?

Email advocacy@aopanet.org to learn more.

The Latest From So Every BODY Can Move

Indiana

During the 2023 session, Indiana’s SEBCM bill, House Bill (HB) 1433, did not make it through the legislative process in time. However, the Indiana Association of Orthotics and Prosthetics has worked to reintroduce the bill, numbered HB 1428, for the new session. The bills are virtually identical in ensuring Indiana Medicaid covers activity-specific O&P for enrollees under 18, with the major difference being that HB 1428 specifies activity-specific devices are limited to one per enrollee.

Maryland

As a result of advocacy work from Sheryl Sachs, CPO, a clinician at Dankmeyer Prosthetics and Orthotics and treasurer of the National Commission on Orthotic and Prosthetic Education Board of Directors, Maryland’s SEBCM companion bills—Senate Bill (SB) 614 and HB 865—were introduced in early February. The bills ensure that stateregulated commercial health plans and Maryland Medicaid cover activity-specific O&P care. The bills also expand insurance fairness provisions to include orthotics; exempt O&P from reasonable useful lifetime restrictions; consider O&P as an essential health benefit under the Affordable Care Act; implement nondiscrimination standards as they relate to O&P care; and specify provider network requirements.

New Hampshire

SB 177, which ensures coverage of activityspecific prostheses for enrollees under 18 in state-regulated commercial health plans, successfully passed a full Senate vote after being “carried over” into the 2024 session by its sponsor, Sen. Sue Prentiss.

New Jersey

S 3919, which ensures coverage of activityspecific orthoses and prostheses for enrollees of all ages in state commercial and public employee plans, successfully passed a full Senate floor vote right before the conclusion of the 2022-2023 session. The bill has been reintroduced on the Senate side by SEBCM New Jersey’s legislative champion and renumbered S 1439. Although S 1439 will have to “start over” in the legislative process, S 3919 passing successfully through the Senate once before will likely allow the new version to move more quickly in the 2024-2025 session.

Tennessee

With the help of the Tennessee Society of Orthotists and Prosthetists, companion SEBCM bills HB 1992 and SB 2010 were introduced in late January. If enacted, the bills would implement insurance fairness, activity-specific coverage, nondiscrimination standards, and unfair trade practice prohibitions as they relate to O&P care in state-regulated commercial plans.

Visit the New Website!

The So Every BODY Can Move initiative has launched a new website. Visit soeverybodycanmove.org , where you’ll find a dynamic platform designed to tell real stories and bring increased awareness to the need for activity-based orthoses and prostheses. The website features a user-friendly interface, engaging content, an interactive state map, and more. For the most up-to-date information on the initiative, including state activity, log on today!

www.AOPAnetonline.org/aopaversity

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

100+

Set

Choose

Take

EARN SCIENTIFIC, BUSINESS, AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Ready to start?

Log in at www.AOPAnet.org/education. Your username is the email used to create your profile. If you do not currently have an AOPAversity account, visit www.AOPAnet.org/education to create a profile.

Use your AOPA member ID and the zip code a liated with your membership when you create your profile to access the free o ering.

Kenevo. Choose everyday confidence.

Kenevo is the first microprocessor knee designed specifically for the activities and challenges of K2 patients.

• Stumble Recovery Plus – active in complete swing phase and is proven to reduce falls

• Adaptive stance release in Mode B/B+

• Low Mobility Functions including supported sitting down/up

Scan the code to register for our upcoming Experts on Demand webinar "Proposed MPK Medicare LCD Expansion" where we'll discuss changes to the Medicare LCD that could expand coverage of MPKs to K2 patients.