The American Orthotic & Prosthetic Association
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
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O&P Almanac MAY 2012, VOLUME 61, No. 5
4 AOPA Contact Page
18 Exit Strategies
How to reach staff
By Deborah Conn O&P business owners contemplating retirement or closing their facility need to know their options for departing on a positive noteâ€” whether they choose to sell their business, keep it in the family, or liquidate it.
6 At a Glance
Statistics and O&P data
In the News Research, updates, and company announcements
32 AOPA Headlines
News about AOPA initiatives, meetings, member benefits, and more
Products and services for O&P
26 Healthy Back
By Tora Estep Spinal orthoses have come a long way in recent years, with new designs and treatments targeted toward treating traumatic injuries, scoliosis, and other degenerative disorders.
14 Reimbursement Page
New rules for Medicare revalidation
Opportunities for O&P professionals
Upcoming meetings and events
46 Ad Index 48 AOPA Answers
Expert answers to your FAQs
Want a Taste of O&P History?
Get your fill at www.oandplibrary.org/opâ€” a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: email@example.com. MAY 2012 O&P Almanac
AOPA IN THE Contact NEWS INFORMATION
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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
MEMBERSHIP and Meetings
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, firstname.lastname@example.org
Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org
Catherine Marinoff, art director, 786/293-1577, email@example.com
Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org
Dean Mather, advertising sales representative, 856/768-9360, firstname.lastname@example.org
AOPA Bookstore: 571/431-0865
Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Christine Umbrell, editorial/production associate, 703/914-9200 x33, email@example.com
Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a
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OP Almanac &
Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
BOARD oF DIRECTORS Officers President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX President-Elect Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
directors Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, MBA, MSOD, Becker Orthopedic Appliance Co., Troy, MI
H YN ES C ON VEN TIO N C EN TE R, BOST ON
Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen LLC, MARKLevis, YOUROrthologix CALENDAR! Philadelphia, PA
Attend the country’sNew largest, Ron Manganiello, England Orthotic & oldest, and Systems essentialLLC, meeting Prosthetic Branford, CT for orthotic, prosthetic and Mahesh Mansukhani, MBA pedorthic professionals.
Össur Americas, Aliso Viejo, CA
Michael Oros, CPO, Scheck & Siress, SUPERIOR EDUCATION Chicago, IL ADVANCED PROGRAMS
Frank Vero, Mid-Florida MYRIAD OF CPO, EXHIBITS Prosthetics & Orthotics, Ocala, FL EARN CE CREDITS
For information about the show, scan the QR code on the left with a code reader on your smartphone or simply visit www.AOPAnet.org.
O&P Almanac MAY 2012
QUALITY Copyright 2012 NETWORKING American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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AT IN THE A GLANCE NEWS
How Does Your O&P Business Compare? The average net sales/billing for an O&P business in 2011 was $4.1 million (median $2.2 million), with practitioners accounting for 40 percent of the employee makeup.
O&P Business Employee Makeup By Position
O&P Business Net Sales/Billing Up to$1 million
Over $5 million
Owner Practitioner Non-Owner Practitioner
19.9% $1 to $2 million
$2 to $5 million
Non-Clinical Owner/ Manager Other
Source: 2011 AOPA Compensation & Benefits Report
Average net profit margin (net profit before taxes as a percentage of sales) of O&P businesses in 2011.
Percentage of O&P businesses that offer full coverage of medical insurance for employees.
$91,384 Median compensation for an ABC-certified orthotist/prosthetist in 2011.
$3.45 billion Revenue from services provided by O&P businesses annually.
$48,144 Median compensation for an ABC-registered technician in 2011.
41% Percentage of O&P businesses that offer a fully paid life insurance policy for employees.
Sources: 2011 AOPA Compensation & Benefits Report, 2011 AOPA Operating Performance Report, AOPA Fact Sheet.
O&P Almanac MAY 2012
IN THE NEWS
Global Orthotics Market to Reach $5.2 Billion The global market for orthopedic orthotics is projected to reach $5.2 billion by the year 2017, according to a report released in April by Global Industry Analysts Inc. (GIA). Compelling growth drivers include a growing proportion of the elderly population, increasingly active lifestyles, and product innovations. The United States is the largest regional market for orthotic products, according to GIA. Asia Pacific is poised to register the fastest compounded annual growth rate over the analysis period. Segment-wise, orthopedic support devices constitute the largest segment in market, and orthotic braces represent the fastest-growing segment. Increasing numbers of injuries among an active aging population is one of the major factors spurring nonoperative use of orthopedic braces and supports. Growth in the braces segment also is spurred by repetitive stress injuries and increasing number of implant surgeries. The orthotics industry has emerged into a broad-based mainstream manufacturing sector, according to GIA, simultaneously offering an individualized approach toward the design of orthoses. Today’s orthotic products address a wide patient pool, including seniors suffering from debilitating diseases such as osteoarthritis, injured athletes, and patients with minor musculoskeletal deformities and dysfunctions. In addition, the advent of minimally invasive implant surgeries
is casting a cascading effect on the orthotics market, in terms of rising volumes of rehabilitative orthotics. Significant improvements in material and modeling technologies have eased the task of customizing and standardizing specifications of orthotic devices, extended the lifespan of products, enhanced the pliability of braces in accordance with the requirements of consumer, and upstaged product innovations that uniquely address the discomfort of users requiring extreme performance level, according to the report.
Diabetes Rate Growing in Australia The Australasian Podiatry Council (APC) estimates as many as 85 Australians—20 per 100,000 people— are undergoing diabetes-related lower-limb amputations each week, a rate it says is nearly the worst in the industrialized world. “In Australia, we don’t follow best practices as would be suggested by the scientific studies, and in countries where they do follow best practices, they get dramatically better outcomes than we do,” says APC President Andrew Schox. “Best practices would be better [than our current procedures] or increased access to podiatry services for people who either have diabetes ulcers [or] who are at risk of it. And integration with teams of multidisciplinary practitioners in the hospital setting for people who either have or are at very high risk [would be 8
O&P Almanac MAY 2012
beneficial]. Both of those things have been shown to improve outcomes and prevent ulcers.” In keeping with these best practices, Australian podiatrists are calling for urgent action from the country’s federal government to help reduce the number of diabetes-related amputations. Schox says the rate of lower-limb amputations in Australia in the 1990s was about 14 per 100,000 people, and in 2008 it was 18 per 100,000 people. “If we were to spend an extra $85 million a year on consultations and other things, our cost savings would be between $200 million and perhaps closer to $400 million a year,” he says. “We would save up to 3,500 amputations a year because about 80 percent of ulcers are preventable. We could save up to 160,000 bed days and about 600 deaths.”
The Australian Medical Association (AMA), however, is not convinced that a boost in funding for diabetesrelated podiatry services is warranted. AMA Federal President Steve Hambleton, MD, says large amounts of funding need to be spent in the best possible place, starting with the family physician. He also says the hospitalization rate for lower-limb amputations is declining, which would indicate that they are treating diabetes better. Schox disagrees: “I think the evidence that we’re using for this type of proposal was actually quite strong evidence, it’s high-quality evidence,” he says. “We’re not just trying to promote something that’s good for us or our profession, but we’re using strong scientific evidence to say this is where we should go.”
The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. Call 703-836-7114 or go online at www.abcop.org Find us on Facebook. www.facebook.com/abcopp
Smartphone User? Scan the code to find out more about ABC Certification.
IN THE NEWS
Researchers Build Bone From Cartilage
Researchers from San Francisco have found a way to regenerate bone through cartilage grafts, according to a study presented last February at the Orthopaedic Research Society Annual Meeting. “Cartilage graft induces bone that actually integrates with the host bone and vascularizes it,” study co-author Ralph S. Marcucio, PhD, stated in an Orthopaedic Research Society news release. For the study, the researchers chose a nonstabilized tibial fracture callus as a cartilage graft source. The cartilage grafts work through endochondral ossification, producing new tissue researchers
CMS Removes ‘Direct Solicitation’ Definition From Supplier Standards The CMS issued a final rule under which certain provisions in Section 424 of the Aug. 27, 2010, ruling on the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier standards have been changed. The final rule was published in the March 14, 2012, edition of the Federal Register. Most notably, this final rule removes the definition of “direct solicitation” and allows DMEPOS suppliers, including DMEPOS competitive bidding program contract suppliers, to contract with licensed agents to provide DMEPOS supplies, unless prohibited by state law. It also removes the requirement for compliance with local zoning laws and modifies certain state licensure requirement exceptions.
O&P Almanac MAY 2012
say is similar to the patient’s own bone. Without additional properties, the researchers found the graft integrated well and was fully vascularized. “The cartilage is naturally bioactive,” says study co-author Chelsea S. Bahney, PhD. “It makes factors that help induce vascularization and bone formation.” When people use a bone graft, it is often dead bone, which requires something exogenous to be added to it or some property of the matrix in the graft. “It is not the pathway that most people think about, but it made a lot more sense to follow the normal developmental mechanism,” she says.
people in the news
Human Technology, doing business as Hi-tech Prosthetics and Orthotics, headquartered in Jackson, Tennessee, has appointed Frank B. Caruso, CO, LO, to its clinical and management team as the director of orthotics and operations. The Amputee Coalition has hired Steve Cox as its director of finance and administration. Cox will oversee financial operations and management, human resources, business development, and the professional health-care provider membership program. The Amputee Coalition also elected Dan Berschinski, a decorated war veteran and amputee, to serve a three-year term on its board of directors. Orthofeet, Northvale, New Jersey, has announced two additions to its executive team: Mike DiSotto has joined as vice president, manufacturing, and Dennis Janisse, C.Ped, has joined as director of scientific affairs.
Ability Prosthetics & Orthotics has hired Jamie Hicks, CO, to join its Lexington, Kentucky, patient-care center and Jacob Townsend, CPO, to join its Asheville, North Carolina, patient-care facility. In addition, Ability hired Brian Kaluf, CP, to oversee its newest O&P patient-care facility in Greenville, South Carolina. Terry J. Supan, CPO, FAAOP, FISPO, president of Supan Prosthetic Orthotic Consultation, received the Titus-Ferguson Lifetime Award at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. The Titus-Ferguson Award is the highest level of recognition for an Academy member.
IN THE NEWS
Transplantations No Longer Considered ‘Experimental’ Hand transplantation is an established means of upper-limb reconstruction and should not be considered experimental, according to a presenter at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, March 21-24. Steven L. Moran, MD, professor of orthopedics and plastic surgery at the Mayo Clinic, told the audience that hand transplantation has been performed on more than 75 patients worldwide since 1998. A worldwide registry was established in 2002. “One of the more interesting things that we now know about injury to the limbs is
that the brain undergoes a component of atrophy when you lose a finger or limb,” he said. According to Moran, a component of a transplantation patient’s sensory and motor cortexes in the brain atrophies over time. It was thought to be impossible for patients who underwent an amputation several years earlier to recover that component in the brain. “We know now that it is possible,” Moran said. “MRI and CT scan studies have shown that after transplanting a limb, those areas of the sensory and motor cortex of the brain reactivates.”
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The O&P coding expertise you’ve come to rely on is now available whenever you need it.
Match products to L codes and manufacturers— anywhere you connect to the Internet.
This exclusive service is available only for AOPA members.
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Visit AOPA at www.AOPAnet.org.
Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811. 12
O&P Almanac MAY 2012
IN THE NEWS
HPHO SPORTS & RECREATION
High School Students Help Design Prosthesis
The H desig Hect mod versa ence
Eleven engineering technology students at the St. Vrain Valley School District Career Development Center (CDC) in Longmont, Colorado, have helped produce a new prosthetic device in cooperation with Bob Radocy of TRS in Boulder. Radocy, whose left hand was amputated in 1971, partnered with athlete and bilateral amputee Hector Picard to design the product—the HP Hoopster, a slightly flexible polyurethane ring attached to a wrist connector that allows individuals with upper-limb amputations to dribble, handle, and shoot a basketball. Picard’s prototype was constructed from the base of a galvanized steel bucket. Radocy worked with him to develop a device that would both flex and transfer energy to shoot the basketball. Radocy then turned to the CDC students, who are all in high school, to transfer the design into computer programs to create a 3D model and fabricate a prototype. TRS refined the CDC prototype and is manufacturing the product. a
Photo: TRS Inc.
BUSINESSES in the news
Baylor College of Medicine’s (BCM’s) Academic Council and Board of Trustees have approved a new master of science in orthotics and prosthetics degree program through the School of Allied Health Sciences. The two-and-a-half-year program will consist of one year of basic science education and will also include 18 months of pregraduate residency training through BCM’s affiliated institutions. The new program will enroll its first group of students in July 2013. Central Brace & Limb, headquartered in Indianapolis, hosted a First Dive introduction to scuba clinic at the Avon High School pool facilities. Central Brace & Limb sponsored the First Dive clinic for its patients and the community with the assistance of Midwest Scuba Center, Avon. The Challenged Athletes Foundation (CAF), San Diego, California, and Össur Americas, Foothill Ranch, California, have renewed their partnership. Össur will continue to serve as the exclusive provider of prosthetic components to CAF and will sponsor a series of mobility clinics for individuals with
amputations. Össur also will serve as a sponsor of all of CAF’s other sports clinics and the annual San Diego Triathlon Challenge. The Catholic Medical Mission Board awarded Hanger Orthopedic Group, Ivan R. Sabel, and the Hanger Ivan R. Sabel Foundation with its inaugural Global Health Care Leadership Award in honor of Hanger’s 150th anniversary and its humanitarian efforts in Haiti. The award was presented to Thomas F. Kirk, Hanger’s chief executive officer, and Ivan R. Sabel, the chairman of the Ivan R. Sabel Foundation The International Paralympic Committee (IPC) has announced the city of Glasgow, Scotland, will host the 2015 IPC Swimming European Championships. More than 500 swimmers from more than 40 countries are expected to compete. IPC also announced the publication of the first 2012 edition of its magazine, The Paralympian, which has been published online at www.paralympic.org. OPAF welcomes Cascade Orthopedic Supply, Chico, California, as a 2012 bronze-level sponsor.
A stiff captu fectly surfa Provi hand taneo
Leng Diam Thic Wei Mat Colo
Össur, Reykjavik, Iceland, has been named among the “most innovative companies in the world,” according to rosthetics the annual ranking by P Fast Company research ■ 3090 Sseventh terling CirCle, Studio a, Bou magazine. Össur was ranked Phone: 303.444.4720 toll Free: 80 among all health-care companies on the WeB: www.oandp.com/tr globally. The company was recognized for building the “smart” microprocessor knee. Ottobock, Duderstadt, Germany, has won a 2012 red dot Product Design Award, life sciences and medicine category, for its Genium leg prosthesis system. The award will be presented at a gala awards ceremony on July 2 in Essen, Germany. The Pedorthic Footcare Association has relocated to new offices in Northern Virginia: 8400 Westpark Drive, McLean, VA 22102; 703/610-9035. Water Street Healthcare Partners and Wind Point Partners, private equity firms based in Chicago, announced that they have signed a definitive agreement to sell Physiotherapy Associates, headquartered in Exton, Pennsylvania, to private equity firm Court Square Capital Partners, New York.
MAY 2012 O&P Almanac
Reimbursement Page By Kathy Dodson, AOPA government affairs department
New Rules for Revalidation You still have to confirm your status as a Medicare provider, but some details of the process have changed
very time you turn around, it seems some other organization or person has been exposed as a bogus provider even though enrolled in the Medicare payment system. To guard against this abuse, the CMS issued new regulations in February 2011 to ensure that existing Medicare providers would have to reenroll or, as it was termed in these regulations, “revalidate” their right to bill the Medicare program. The rules set up for revalidation affected all providers and suppliers, with the exception of physicians and nonphysician practitioners who were enrolled in Medicare as of March 25, 2011. (Generally, newly enrolled providers and suppliers that submitted enrollment applications to CMS on or after that date are not affected.)
O&P Almanac MAY 2012
Deadline Extended Originally, this revalidation process was to have been completed by March 2013. CMS has reevaluated this requirement, however, and changed the deadline to March 2015, allowing two additional years to complete the process. If you have not already received notification from the National Supplier Clearinghouse (NSC) that you must revalidate your billing privileges, you will receive such a notice by March 2015, sent to your primary practice address. (If you have already received your notice, proceed with your revalidation promptly.) Until you receive this notice, you should not proactively send in your revalidation. To avoid having to process a glut of applications, CMS has instructed all providers and suppliers
to hold off sending in revalidations until asked to do so. Once you receive the NSC notice, however, you have only 60 days from the date of the notice to submit your revalidation, so don’t delay. You still have two ways to submit your application: either through the Provider Enrollment, Chain and Ownership System (PECOS) at https:// pecos.cms.hhs.gov or by sending in a paper 855S form. If you choose the paper form, be sure to use the version with the July 2011 date on the bottom, as earlier versions are no longer valid. Using the automated PECOS system is still not mandatory, but it’s worth considering. It is the most efficient way to submit your application. With PECOS, you can check on the progress of your application and review the information you currently have on file.
Using the automated PECOS system is still not mandatory, but itâ€™s worth considering. It is the most efficient way to submit your application.
If you do use PECOS, once you submit your information electronically, you must print, sign, date, and mail the certification statement, along with any necessary additional documentation, to the NSC immediately. Without this, your application will not be reviewed.
Payment Changed When you submit your application (in whatever form), you also will be submitting your enrollment fee, instituted in 2011 for any entity submitting an application for new enrollment or for revalidating an existing Medicare number. Without receipt of this payment, the NSC will not process your application, so it is very important to know how to pay this charge. The amount of the fee is tied to the Consumer Price Index-Urban; for 2012, itâ€™s $523. How to pay is another change to the revalidation process. Rather than accessing the Pay.gov website, you will now pay the fee by registering with PECOS at https://pecos.cms.hhs. gov/pecos/feePaymentWelcome.do. This registration is mandatory, even if you submit your actual revalidation by paper form, rather than through PECOS. Remember that registering at
this website is just for payment and does not constitute completing your revalidation through PECOS. For that, you must complete the more extensive form, similar to the paper 855S, found at https://pecos.cms.hhs.gov. Once you pay through the PECOS welcome site, you will see a confirmation screen, which you should print for your records. CMS highly recommends sending a copy along with your certification statement or 855S (depending on how you chose to submit your revalidation), and any other necessary documentation, to the NSC. CMS will notify the NSC that you have paid the application fee, but sending a copy of your receipt will avoid any miscommunication that might hold up the application review.
such as balance sheets and income statements, cash flow statements, tax returns, or other pertinent documents. If you decide to apply for this exception, the request must accompany your revalidation application. Your application will not be processed until a decision is made on whether CMS will waive your fee. Remember that none of the above has any affect on the requirement that you notify the NSC within 30 days of any changes in the information that you have previously supplied to them on earlier applications. So if you change your address, telephone number, or types of services provided, you still must promptly notify NSC through an updated 855S or online via PECOS, if you have enrolled through that system. a
Hardship Exception There are provisions to allow a hardship waiver of the application fee, but the documentation required is quite extensive and the criteria are hard to meet. The applicant will be expected to make a strong argument to support the request, including providing comprehensive documentation that may include historical cost reports and recent financial reports,
Kathy Dodson, formerly senior director of government affairs, is a consultant for AOPA. For questions about this column, contact Joe McTernan at jmcternan@ AOPAnet.org.
MAY 2012 O&P Almanac
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Whether theyâ€™re retiring, handing the reins to a family member, or going out of business, O&P facility owners should know how to say good-bye
By Deborah Conn
O&P Almanac MAY 2012
ooner or later, every O&P facility owner must decide how to leave the business. Perhaps it’s time to retire, or perhaps circumstances lead to an earlier good-bye. Either way, disposing of your company is as inevitable as death and taxes. And even if that day seems far distant, it’s a good idea to think about available options and how to handle your departure.
“There are only three things a owner can do—keep the business in the family, sell it, or liquidate it,” says Barry Smith, an attorney and owner of Lloyds Capital, based in Monterey Park, California. Smith specializes in valuing and selling O&P businesses and has sold 120 companies with a combined value of more than $300 million during the past 20 years. The most common choice is to sell. Smith estimates that 90 percent of O&P business owners do so. “Liquidation is the last resort because it yields the least amount of dollars. So if there is no family that wants to or can handle running the business, a sale is the only option,” says Smith. Daryl Barth, CPO, FAAOP, sold his company, Orthotic and Prosthetic Associates of Central Illinois, in Springfield, in November 2011. He started the process about a year earlier. Nearing age 60 and having put in 38 years in O&P, he says, “I had an epiphany that I was not immortal and I would have to relinquish the business at some point. I wanted to try to control the process and plan it as much as I could.”
MAY 2012 O&P Almanac
How to Sell The first step in selling your business is to figure out how much it’s worth. This means assembling current and historical financial data, including tax returns, leases, employee information—every scrap of objective information about the company. It’s usually a good idea to have an expert analyze these financials. Attorneys, accountants, business brokers, and appraisers—especially those with experience in the O&P industry—are all good choices. Even so, the true value of your business emerges only when you sell it. “The definition of ‘fair market value’ is what a third party is willing to pay, not under duress, when all the relevant information is shared,” explains Smith. Many business owners have inflated ideas about the value of their company. “All sellers have a visceral number in mind,” he says. “But it’s important to have realistic expectations.” Once Barth decided to sell, he retained Smith to value his company. “I’m a clinician first and a business owner second,” says Barth. “I felt I needed the input from someone with current experience. The [valuation] number was no big surprise, although one always wants more, but I understood reality and had to be willing to accept what that was.”
O&P Almanac MAY 2012
The next step is to identify potential buyers. A big factor in finding buyers is geography, says Smith. Facilities in well-populated regions are far more likely to find buyers than those in remote areas. Wherever his clients are located, though, he advises them to consider nontraditional buyers as well as O&P providers. “The local hospital might be a buyer, or a local group of doctors,” he suggests. “Even the competitor with whom you’ve fought for market share for the last 10 years might
”Don’t expect that you can sell your O&P business and walk away.” —Barry Smith
be a buyer, just as a way to avoid having to compete with a new, wellfinanced player.” Smith advises clients not to overlook employees as possible buyers. But, he cautions: “Explore the availability of cash. Employees often have the desire to buy, but not the wherewithal.” He also notes the emergence in 2012 of private equity firms as
buyers, which could significantly expand the list of potential buyers in certain geographical areas. “Private equity seeks control, but not outright ownership, and prefers large deals rather than small ones, at least initially,” Smith says. Prospective buyers want to know how profitable you are, and this, says Smith, is the primary driving factor when it comes to the sales price. Profitability is hard to pinpoint, though, and may not be evident from your tax returns. “Most privately held businesses are run with an eye to minimizing taxes,” says Smith, “so you may need to go through a ‘financial physical’ and undress to convince a buyer that, notwithstanding your tax returns, you really are profitable.” Normally, the same person who values the company will conduct additional research to determine profitability. It’s important to remember that profitability—and thus sales price—is not necessarily related to a facility’s gross income. “I recently valued three companies, each of which was doing $1 million dollars a year in business,” says Smith. “But the sales prices ranged from $500,000 up to $2 million. The top line is only important in that it produces the bottom line, and that’s the one that matters.” Another significant component of a facility’s value is its employees. “They are crucial to the business, and without them, your company may not be salable,” he explains. “Key people, especially practitioners, can make or break your deal.” Once you’ve found a buyer, negotiations begin. “If you’re lucky, you’ll have more than one buyer, so you can play one against another to raise the bidding,” says Smith.
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Selling? Size Matters
What options are available to O&P facility owners to sell their business? According to Rich Gingras, CPO, owner of Level Four Orthotics and Prosthetics, in Winston-Salem, North Carolina, the answer has a lot to do with size. Here’s how Gingras sees it:
• Companies under $1 million in volume. In today’s health-care environment, the requirement is for size. Consider merging with a competitor to lower cost, increase volume, and become more attractive to the insurance industry. This is not an instant solution, however, Gingras cautions. Sometimes selling a business must be viewed as a journey, not a destination, so begin planning now. • Companies with $1million to $2 million in volume. Depending on location, this is a saleable size. Consider using an O&P business broker, Gingras advises. There are several who have industry contacts. He also advises looking at your local market. One sizeable provider in Greenville, South Carolina, recently sold his practice to the county hospital system. Such a sale might be a good move for an individual business, Gingras says, but there’s some question whether it’s good for the industry as a whole. Where does it leave the other providers in that particular market? • Companies over $2 million in volume. To compete successfully in the national health-care debate, the O&P industry needs more large providers to attract attention. And fortunately, Gingras says, the economy may provide a timely opportunity. A lot of financial resources are currently looking for a place to invest, he says, and health care is viewed as a growth industry. Private equity groups have been looking for a way to enter the O&P market for several years, but size is of importance to these groups. Gingras says it appears that the threshold they need to begin to build a new O&P company is $30 million dollars, with an opportunity to build to $75 to $100 million. The past year has seen several false starts and one notable failure, says Gingras, who notes that at least four private equity groups attended the AOPA Assembly in Las Vegas doing “due diligence.” He believes at least one major private equity group is ready to make its first large acquisition. When that happens, there will be a major push to acquire additional firms, especially those over $2 million in size. His recommendation? If you’re considering selling your practice within the next few years, contact a business broker now.
O&P Almanac MAY 2012
Normally, a broker represents the seller. The prospective buyer does his or her own analysis of the company’s financials and makes an offer. The seller typically counters, and offers bounce back and forth until the buyer and seller agree. In the following 60 to 90 days, the buyer conducts an on-site inspection, and attorneys prepare the documentation.
Life After the Sale You’ve signed the papers, packed up your stuff, and said good-bye. Now you’re ready to walk out the door. Not so fast. “Don’t expect that you can sell your O&P business and walk away,” says Smith. “Your presence is required. The buyer is scared that the business will tank without you, so you’ll have to commit to staying for at least one or two years. The only way they’d let you leave would be if they had grossly underpaid you for your business or they consider you to be incompetent. Consider it a testament to your selfworth that you’ll be required to stay.” The change of status from business owner to salaried employee can be difficult. One seller, who declined to be identified, said the sale of his practice has left him working the same hours but with none of the authority or autonomy he enjoyed as an owner. In his mind, the sale was not worth it. For others, like Barth, it is a fair tradeoff. A huge factor in deciding to sell in the first place was his stress level as the owner and decision maker. “The amount of stress on small business owners, especially in the state of Illinois, where government spending is being drastically curtailed, is tremendous. In some instances, we had to wait more than a year to be paid for state claims, and it created a terrible cash-flow problem,” he says. “I understood clearly from the start that I would be relinquishing my autonomy, and I was willing to do that to reduce my stress level. I knew it would be a long-term, multiyear transition that would slowly get me to where I could eventually slow down.”
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Barth enjoys patient care and envisions himself working at least part time for many years. “P&O owners may not like to give up autonomy, but they don’t want to sit in a rocking chair, either,” he says. To get a better idea of what life might be like after the new owner takes charge, Smith suggests asking the buyer for a list of the companies it has purchased. “Make some calls to see what transpired post-closing,” he says.
Family Planning In the past, O&P businesses tended to be small, family-owned enterprises that frequently turned to the next generation to take control. These days, with a few large players dominating the industry, passing the reins to one’s children is becoming less common. Nevertheless, it does happen, and as with a sale, expert guidance is a good idea. The main consideration in transferring your business to a relative is tax liability. “This changes from generation to generation, depending on the tax laws at the time,” says Rick Fleetwood, CEO of Snell Prosthetic & Orthotic Laboratory, based in Little Rock, Arkansas. Currently, business owners can transfer shares of the business to their children gradually over time, taking advantage of liberal gift tax laws to make yearly gifts of up to $13,000, with a lifetime maximum of $5 million.
O&P Almanac MAY 2012
Inheritance is another option, one that, according to Smith, can transfer a business in many situations with little or no tax liability. More complicated than the mechanics of passing down the family business are the judgments and emotions involved. Fleetwood witnessed firsthand the transfer of family ownership when Frank Snell took over the facility from his father, Ed Snell, in 1984. (Ed was the second generation of Snells to own the company; his father, R.W. “Pop” Snell, founded it in 1911.) The transfer of control to Frank Snell was successful, says Fleetwood, because Frank had developed a passion for the business. “He really wanted it. It wasn’t forced on him. He had been working for his father for years. It was very, very important that he exhibit the same work ethic he expected from others, and he did. He put in the extra hours and days, and as a result he earned the respect of his fellow workers, who eventually became his employees.” Unfortunately, not every child of a business owner is a good candidate to assume ownership. “Every family member wants the next generation to take the reins,” says Fleetwood. “But just because you were born into the job doesn’t mean you are the best one for it.” Fleetwood emphasizes that both generations must take into account family, patients, and fellow workers. “The decision must be one that reflects and respects everyone,” he says.
Cashing Out The least attractive exit strategy is liquidation. But when no one wants to buy the business and family members are either unable or unwilling to take it over, it may be the only choice. In this case, the owner simply walks away. “You can go into bankruptcy or just stop paying the bills and let your business go out of business,” says Smith. “Many business owners can’t afford bankruptcy, which costs $50 thousand, so they just sell off the equipment and furnishings and let their employees go. Most creditors will not sue you, but it’s not a pretty picture.” As in most endeavors, ensuring the best outcome means making careful preparations. “You need to consider all the options,” advises Barth. “It is not a decision you make based on emotion or a knee-jerk reaction. Your choices involve a long-term commitment, so carefully think through all of the issues before you pull the trigger. Take enough time.” But not too much time. Many people wait too long, says Smith. “Sometimes it’s because of inertia or thinking things will get better, the economic climate will improve, or health-care reform will disappear. “Don’t wait for things to get better. Just do it.” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.
By Tora Estep
Treatment and advances for spinal support and immobilization
he human spine is an elegant, balanced column of neatly interlocking vertebrae that protect the spinal cord and keep the human body upright. When it breaks, weakens, curves too much for proper balance, or becomes diseased, the whole body is affected and in some cases incapacitated. To treat spinal conditions such as breaks, idiopathic scoliosis, and degenerative disorders (such as osteoarthritis), a wide variety of spinal orthotic devices exists. One way to categorize those devices is by the region of the spine being treated: cervical, cervicothoracic, thoracolumbar, and lumbosacral. However, experts say a more useful way to organize the devices is by function: Are they used for immobilization or support? Hereâ€™s a look at devices and treatments that serve both.
The Ultimate in Immobilization Because the spine is housed deep inside soft tissue, treating breaks is difficult. Unlike an arm or a leg, the spine cannot be cast to achieve immobilization, which requires that the device contain and compress the soft tissue to restrict the patientâ€™s ability to move altogether. One external device that achieves immobilization of the cervical spine and allows unstable fractures to heal is the halo system, sometimes called a halo ring, halo vest, or halo crown.
O&P Almanac MAY 2012
The halo system accomplishes immobilization by placing a ring around the circumference of the head, which is then attached with four or more titanium, or sometimes carbon fiber, pins through the skin to the outer table of the skull. A superstructure—a series of bars or a framework attached to a vest on the torso—then connects to the ring. Fractures that require this level of immobilization can arise from a variety of means associated with trauma, explains Jeff Nemeth, CPO, FAAOP, of Hanger Prosthetics and Orthotics in Casa Grande, Arizona. Examples include a car accident, a fall down the stairs, a gunshot wound, or blunt or penetrating trauma to the neck. Fractures also result from degenerative disorders, such as ankylosing spondylitis, a long-term disease that causes inflammation between the spinal bones; congenital disorders, such as the hypoplastic dens or odontoid sometimes present in children with Down syndrome; and cancer. Halos also are used post-operatively. Most halos are put on in the emergency room or the operating room, and they are always installed by the attending physician—typically an expert in trauma such as a neurosurgeon, traumatologist, or ER surgeon—with assistance from the orthotist, explains leading halo authority Ross Bremer, CPO, CFO, and president of prosthetics at Bremer Brace in Jacksonville, Florida. “Orthotists do not apply halos. They can assist the physician with positioning; they can assist the physician in what system to use; they can assist the physician in the physical care of the patient—but all decisions made regarding the care of the patient are solely the job of the physician to determine. Orthotists are not licensed to do very much, frankly. They can’t break the skin, and they can’t be responsible for what is the proper position as far as the spine is concerned,” says Bremer. What they can do is make suggestions regarding the location or number
of pins used. Orthotists also look out for potential problems with positioning the patient. According to Bremer, “If you put yourself in military stance where you stand very erect with your chin tucked down to your throat and then try to swallow, you will find yourself unable to do so. We can assist physicians in getting the patient into the position that they need for their X-ray structures, but we also make sure that the patient can breathe, and eat, and swallow.” Once the device is set and X-rayed, the patient wears it for about three months, although Bremer notes he has known patients to wear them for as short a period as two months and as long as a year and a half for patients with metastasized cancer. During regular follow-ups, the orthotist cleans the device (which the patient cannot take off), adjusts the vest if necessary, ensures the halo is properly aligned, and inspects the pins and the pin sites. If the orthotist finds any problems or complications, he or she reports them to the attending physician immediately. Problems can include infections at the pin sites (which are open wounds), pressure sores on the torso, and loose pins. Pins loosen because “bone is a living material,” says Bremer. “At the tip of that pin, which screws through the outer flesh and into the outer table of the skull, is approximately 10,000 pounds of pressure. So the bone moves away, reducing the pressure at the tip. Also, if the patient is very active, the bone may erode a little, and sometimes it’s necessary to advance
the pin. Most manufacturers have a schedule indicating when the pin tightness should be checked.” Bremer also notes that “patients with soft or osteoporotic bone give us problems that are different from patients with normal bone.” As with most orthotic devices, one of the keys to success is compliance. Bremer says most complications with halos arise because of poor hygiene on the part of the patient. Patients with halos receive books and videos describing how to care for the open wounds at the pin site, how to keep their skin clean under the liners of the vest by ensuring they are kept free of debris and food particles, and how to take care of themselves. Another source of problems is too much activity. While the doctor must explain to the patient how active he or she can be, it is the patient’s responsibility to comply. Hanger’s Nemeth shares a surprising story of patients’ noncompliance with halos: “Sometimes patients go home and, for whatever reason, they decide to try to take their vest apart, actually take it off. I’ve actually had patients who have tried to take their halos off. Generally, they get about three quarters of the way into it and realize it was a really bad idea, and off they go to the emergency room.” Removing the halo typically occurs in the physician’s office. It involves stabilizing the patient with a cervical collar, removing the vest, establishing the integrity of the original wound or fracture through lateral X-rays, and removing the pins and finally the halo. MAY 2012 O&P Almanac
Custom Cad Modification 2 Months Post Fitting
13 Months Post Fitting
Photo: Gómez Orthotic Systems
–Ricardo Ramos, CP, LP
Photo: Gómez Orthotic Systems
José Miguel Gómez T., MD, LO, in Atlanta receiving the Clinical Creativity Award 2012
Gómez with the board members of AAOP
Bremer describes a successful outcome as “a patient who is fully mobile, who doesn’t have any pain,” and whose spinal fracture has healed. However, he continues, “if the patient has ligamentous injuries, those types of injuries don’t normally heal properly. Sometimes, we have a bony injury and a ligamentous injury, and a fusion is necessary. The business of doing surgery around a halo or through a halo system means that the physician and the orthotist should be trained to remove portions of the halo from the patient on the operating table without putting the patient at risk.”
A Creative Approach to Realignment Halos represent the most-extreme form of spinal orthotics designed to immobilize the spine. However, spinal orthoses also are used to support and realign the spine. They are less restrictive, providing compression that lifts and reduces pain, which is particularly useful in treating patients with spinal deformities such as scoliosis,
For more on the journal Scoliosis’ thematic series on scoliosis brace technology, visit http://www.scoliosisjournal.com/content/5/1/2.
O&P Almanac MAY 2012
Photos: Gómez Orthotic Systems
an abnormal curving of the spine that occurs most frequently among girls. Although there is no “state of the art” in scoliosis treatment, many schools of thought exist and various brace technologies and treatments are available (for example, the Milwaukee brace, the Charleston bending brace, the Boston brace, which are named after the cities where they were first used). To address the lack of research and consensus in the field of scoliosis bracing, the International Society on Scoliosis Orthopeadic and Rehabilitation Treatment (SOSORT) launched in 2010 a thematic series on scoliosis brace technology in its journal Scoliosis, noting, “The state of research in the field of conservative treatment is insufficient and while it can be stated that there is some evidence to support bracing, we must also acknowledge that today we do not have a common and generally accepted knowledge base, and that instead, individual expertise still prevails, giving rise to different schools of thought on brace construction and principles of correction.” One innovative, nonsurgical approach to scoliosis treatment was developed by José Miguel Gómez T., MD, LO, winner of the American Academy of Orthotics and Prosthetics “Clinical Creativity Award 2012.” His
initial interest in scoliosis began 26 years ago when he diagnosed an abnormally curved spine in his then one-year-old daughter. After a futile search for a good treatment protocol in his native Colombia and throughout Latin America, he came to the United States and eventually developed the Gomez Orthotic Spine (GOS) System. Although symptoms of pain, tiredness in the spine after sitting still for long periods of time, and uneven hips or shoulders are rarely present initially, untreated GOS system scoliosis can have some unpleasant consequences. “In general, many people in developing countries are not being treated properly for scoliosis. These people can develop severe pain because all the disks are damaged, thus creating a very unstable spine. Also, if the scoliosis is located on the thoracic region, there can be compression of the lungs and the heart, so many of them may need oxygen to breathe properly,” says Gómez. Although surgery is an option, Gómez prefers a more conservative, nonsurgical approach to correcting abnormal curves that are progressing. Some of the unique features of the GOS System include the use of computeraided design and manufacturing, a multiplanar treatment approach, and the use of moment instead of force to realign the spine. CAD-CAM increases precision and reproducibility of effective orthoses. One key to its successful use is multiple inputs. The GOS System protocol gathers multiple data points related to the patient’s spinal deformity, including digital photography of the frontal and anterior coronal planes, the left and right sagittal planes, and the transverse planes. An added benefit of those photographs, says Gómez, is cosmesis: “Because scoliosis doesn’t have pain related to the curve in the beginning, the kids who are wearing the braces don’t see that it’s important in the beginning. But if you show them initial pictures with and without the brace maybe two months later, it
Innovation in Support for Weakened Spine A somewhat recent innovation in brace technology that helps to support the spine and provide additional pain relief is the use of compound closure systems, explains Jeff Nemeth, CPO, FAAOP, of Hanger Prosthetics and Orthotics in Casa Grande, Arizona. Compound closure systems are somewhat similar to the levering system of cables and pulleys used in a compound bow. In spinal orthotic devices that use those systems, the braces close in the back, with drawstrings that come around the front. This allows the user, who may be an elderly person with little strength or someone who is in a great deal of pain, to exert little effort in pulling on the device to create a lot of compression around the soft tissue of the abdomen and low back and thus get some relief. Containing that soft tissue seems to help offload the pressure on the spine. “There’s this whole theory of how much intracavitary pressure really helps offload the spine; I can’t answer that definitively, but I will say if you have a patient who is in a great deal of pain and you put one of those devices on, regardless of the brand, they feel a lot of relief.So, it’s obvious that they are working well,” says Nemeth. Reducing pain and offloading pressure on the disks allows patients to be more active and able to participate in physical therapy. For example, a patient with a low back injury, whether it’s a disk issue or some degenerative conditions of the spine, might be able to get some physical therapy to strengthen core muscles, lose some weight, and so forth.
creates a good feeling that their bodies are changing to a normal shape.” The multiplanar approach evident in the thorough analysis and documentation of the spinal deformity carries through in treatment. Unlike many scoliosis treatments, which focus on correcting Cobb angles that measure deformity on the coronal plane, the GOS System aims to address deformities on three planes: the sagittal, coronal, and transverse. CAD-CAM makes that possible and makes another unique feature of the orthosis possible: the use of moment loading. Rather than applying force to the body in a few small areas—which can
cause patient discomfort and thus reduce compliance—the GOS System manipulates larger areas to not only correct curves but also to improve decompensation. Gómez’s recommended approach includes physical therapy. In the end, he suggests the best results may not be obtained from forcing one large curve back to a straighter position, but instead come from shifting the spine into several smaller curves that are well balanced. A Tora Estep is a contributing writer to O&P Almanac. Reach her at tora.thurisaz@ gmail.com. MAY 2012 O&P Almanac
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It Takes a Membership When it comes to standing up for what’s right, you can’t just “let George do it”
OPA’s recent response to a troublesome move by CMS is a case study in the importance of standing together. Here’s how the situation played out. On February 10, CMS published 62 proposed Healthcare Common Procedure Coding System (HCPCS) codes describing off-the-shelf (OTS) orthoses that had been rumored to be on a list of candidates for inclusion in any future competitive bidding round. Back in August 2011, the O&P community breathed a sigh of relief when OTS orthoses were excluded from the Round Two CMS list. At the time, AOPA applauded the CMS decision but warned members of the looming possibility that OTS orthoses could be included in a future round of competitive bidding. Concerns centered on a purported CMS list that was rumored to have a
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reimbursement value of $200 million. AOPA concluded that a list of that magnitude had to stray widely from the Congressional definition of eligible OTS orthoses requiring only “minimal self-adjustment” by the Medicare beneficiary.
The Medical Rationale Several months ago, the O&P Alliance petitioned CMS to make the list public so the O&P community could verify whether the 62 OTS products complied with the statutory definition. Any orthoses requiring third-party adjustment skills would clearly not meet the definition and must be excluded from competitive bidding consideration. The list of 62 items was exhaustively reviewed by the AOPA Coding and Reimbursement Committee. In the committee’s view, 48 codes did not
meet the statutory definition and could not legally be included if any future rounds of competitive bidding are mandated by Congress. The codes that were deemed unlawful were carefully documented, pictured, and described as part of the 457-page submission that AOPA made to CMS on March 13 in response to an invitation to comment. The original deadline of March 9 was extended by CMS at AOPA’s request to March 17 to provide sufficient time to research all the needed documentation. AOPA’s offices resembled a battle ground for several days. The Coding and Reimbursement Committee met on March 5, and then every member of the staff was commandeered to help gather medical rationale and supporting literature on the 62 devices—including information on possible risks to patients if devices not meeting the
“minimal self-adjustment” definition were included in any future rounds of competitive bidding. AOPA President Tom DiBello, CO, FAAOP, also enlisted a resident at his patient-care facility to assist in pulling together needed information.
AOPA’s Coding and Reimbursement Committee Michael S. O’Donnell, CPO, FAAOP, Chairman William Beiswenger, CPO, FAAOP Mitchell D. Dobson, CPO, FAAOP Dennis E. Ebbing, CPO Brian L. Gustin, CP Jason M. Jennings, CPO, LPO, FAAOP
The Team Effect It’s important for the entire O&P community to understand that it takes a concerted effort to pull together the kind of exhaustive information required to set the record straight on what should and should not be eligible for OTS orthoses competitive bidding. Only organizations with the member resources of AOPA and the O&P Alliance could have prepared such a comprehensive, welldocumented response in such a short time. Hundreds of staff and volunteer hours went into this effort. The O&P Alliance also submitted a separate statement of similar depth and relevance, which AOPA endorsed.
Often what needs to be done can only be done with the expertise and resources of organizations that enjoy the widespread support of the communities they represent. That’s a powerful example of how every member of these organizations should see to it that the financial and volunteer burden is shared by the entire O&P community. Make sure your colleagues and even your business competitors are supporting the appropriate organization. In the case of AOPA, you can check whether a colleague’s company is a member of AOPA by using the search
Pamala Filippis Lupo, CO Jonathan M. Naft, CPO Mark A. Porth CPO, FAAOP Joe McTernan, AOPA staff Devon Bernard, AOPA staff
tool on AOPA’s home page. You can pull up a list of AOPA members in a specific city or state as well as search for a specific company name. AOPA’s Member-Get-A-Member campaign encourages current AOPA members to join the Growing for the Future Club and to solicit nonmember companies. On payment of the new member’s dues, Growing for the Future Club members receive a 10 percent credit that can be applied to their own dues, publication purchases, or registrations for the National Assembly and other events.
The Legal Picture Critical to making the case that 48 items are, in our opinion, ineligible for competitive bidding was a legal brief prepared for the law firm of Winston and Strawn by its partner, Thomas Mills, who is considered one of the country’s top lawyers in challenging Medicare actions. The brief focused on the definition of “minimal selfadjustment” as written by Congress and makes a persuasive case that the CMS regulatory definition of these terms “departs materially—both as a legal matter and as a therapeutic matter.” Only OTS orthotics have been authorized by Congress to be considered for inclusion and to be competitively bid, for obvious reasons: If an orthotic is custom made, or needs to be fitted or adjusted by someone other than the Medicare beneficiary
patient, there can be no commonality to the items being competitively bid. For that reason, Congress defined OTS orthoses to include only those that can be used by the patient with “minimal self-adjustment.” To the extent that CMS’s proposed HCPCS list includes items for competitive bidding that may require adjustment by someone other than the person using the orthoses, the listing is inconsistent with statutory guidelines. Now that the public record includes the detailed information submitted by AOPA and a forceful legal brief challenging the CMS definition versus the Congressional definition of “minimal self-adjustment,” there will always be a basis for AOPA and the O&P community to challenge CMS if it steps outside the boundaries of the Congressional definition. The resources brought together by AOPA and its O&P Alliance partners and the AOPA Coding & Reimbursement Committee are a classic example: Often what needs to be done can only be done with the expertise and resources of organizations that enjoy the widespread support of the communities they represent. That was truly the case in this endeavor—and a good reason to encourage colleagues who don’t step up to help support their organizations to give up their “let George do it,” free-pass line of thinking. a
MAY 2012 O&P Almanac
Master ‘Contracting 101’— Join the Audio Conference May 9 Negotiating favorable contracts can make a huge difference in the success of your business. Join AOPA May 9 at 1 p.m. ET for an AOPAversity Mastering Medicare Audio Conference that will cover the basics of negotiating contracts with insurance companies, hospitals, skilled nursing facilities, and other payers. Learn strategies and techniques. An AOPA expert will address the following issues: • understanding the impact of competitors in the marketplace • emphasizing quality over quantity • negotiating from a position of power • separating yourself from your competition • addressing unfavorable contracting terms. Don’t miss this valuable opportunity to learn important strategies before you enter a contract negotiation. The cost of participating is $99 for AOPA members
Master Medicare in Seattle:
Essential Coding & Billing Techniques Seminar Join your colleagues August 6-7 at the Hyatt at Olive 8 in Seattle for AOPA’s “Mastering Medicare: Essential Coding & Billing Techniques” seminar. AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for practitioners and office staff, this advanced two-day event will feature break-out sessions for these two groups to ensure concentration on material appropriate to each. Basic material that was covered in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the “Essential Coding & Billing Techniques” seminar in Seattle at https://aopa.wufoo.com/ forms/2012-mastering-medicare-seattle or contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with questions.
O&P Almanac MAY 2012
($199 for nonmembers), and any number Credits of employees may listen on a given line. MINAR PER SE Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0876 with registration questions.
Now Available 2012 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2012 Products & Services Catalog is available at www.AOPAnet. org/2012_ProductCatalogue.pdf.
EEZZFFlex lex L Liner iner
Practical PracticalMagic Magic Hardly Hardlyjust justa apretty pretty face,the face,theEZEZFlex FlexLiner Liner delivers deliversunequaled unequaledfunction function without withoutsacrificing sacrificinganything. anything. Unified Flexible Front Unified Flexible Front
The unique fabricfabric on the The unique on the anterior surface provides anterior surface provides unlimited stretch over over the the unlimited stretch patella for greater elasticity patella for greater elasticity whilewhile reducing pressure on the reducing pressure on the knee knee and the of energy andamount the amount of energy required to flex required to the flexknee the knee
80% Less Vertical Stretch 80% Less Vertical Stretch Posteriorly Posteriorly
AsAs compared toto other Alps gelgel compared other Alps liners, virtually eliminating liners, virtually eliminating pistoning while minimizing pistoning while minimizing bunching behind the knee bunching behind the knee during flexion during flexion
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AlpsAlps NewNew EZ EZ FlexFlex Liner Liner (anterior viewview shown (anterior shown above) is available in in above) is available 3mm or 6mm Uniform 3mm or 6mm Uniform thicknesses. Eight sizes thicknesses. Eight sizes fit circumferences of 16 fit circumferences of 16 cm cm to 44 to cm. 44 cm.
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AOPA Applauds House Insurance Fairness for Amputees Act of 2012 AOPA has issued a press release supporting the introduction of the Insurance Fairness for Amputees Act of 2012 in the U.S. House of Representatives. This important legislation will ensure patient access to appropriate orthotic and prosthetic devices by providing fair insurance coverage. The House Insurance Fairness Bill, H.R. 4175, was introduced by the bipartisan team of Rep. Charles Dent (R-Pennsylvania) and Rep. Robert Andrews (D-New Jersey). A Senate version of the bill, S. 773, was introduced last year by Sens. Tom Harkin (D-Iowa) and Olympia Snowe (R-Maine). If passed, the Insurance Fairness for Amputees Act will reduce barriers to appropriate patient care such as restricted insurance coverage and payment caps on prosthetic and custom orthotic devices. Increasing insurance coverage and patient access to the appropriate O&P devices will enhance patient mobility and limit secondary health issues stemming from improper care, which eases the burden on Medicare and Medicaid. “One in every 200 Americans has decreased mobility due to injury, amputation, or a life event,” says AOPA President Tom DiBello, CO, FAAOP. “Those Americans face significant health insurance inequities, an issue that deserves Congress’ attention.
AOPA commends Reps. Dent and Andrews for leading this important legislative endeavor.” AOPA is partnering with the Amputee Coalition and nearly 25 other stakeholder groups in the disability field to champion passage of this critical piece of legislation. Thanks to the excellent advocacy efforts of the Amputee Coalition and other partners, the issue of O&P patient access to proper care also has gained importance across the country at the state level. At present, a total of 20 states have passed similar insurance fairness legislation. In most of the state laws similar to the federal Insurance Fairness for Amputees Act, there is no mandate for insurers to provide coverage. Rather, a truth-inadvertising measure requires an insurer that chooses to include coverage of custom orthotics and prosthetics in its policy to offer the same benefits as the plan’s other surgical and medical coverage without lifetime limits or other caps. Those states that have enacted comparable legislation have found minimal or no increases to insurance premiums, and they have reduced Medicaid and Medicare costs by avoiding the other health issues common when appropriate treatment is not made available to patients. Thirty other states are actively considering prosthetic and custom orthotic insurance legislation.
Registration Begins May 1 for AOPA’s 2012 National Assembly
Discover Employment Opportunities at AOPA’s Online Career Center
Online registration is open at www.AOPAnet.org for the AOPA 2012 National Assembly and Northeast Chapter combined meeting, September 6-9, at the Hynes Convention Center in historic downtown Boston. Experience the country’s largest, oldest, and most-essential meeting for orthotic, prosthetic, and pedorthic professionals. This year’s National Assembly will feature extensive scientific programs on topics such as scoliosis, microprocessor knees, balance, and wound care. Experts in the O&P industry will offer unprecedented business education covering health-care reform, documentation, business management, accountable care organizations, FDA, reimbursement challenges, and more. Dedicated education tracks are offered for pedorthists, post-mastectomy fitters, and technicians. Visit www.AOPAnet.org for program updates and detailed registration information, or call AOPA headquarters at 571/431-0876.
As an O&P professional, you can make a difference every day. Job opportunities abound throughout the country, and the need for O&P professionals is increasing rapidly. Currently, 100 percent of O&P program graduates find employment, and most choose to make it a lifelong profession. If you’re seeking employment, access the most-recent jobs available. If you’re recruiting, reach the mostqualified candidates by posting your job on AOPA’s Online Career Center. Visit http://jobs.AOPAnet.org, or email Steven Rybicki at srybicki@AOPAnet.org with questions.
O&P Almanac MAY 2012
Special Thanks to Our O&P PAC Contributors The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*:
Robert E. Arbogast
Robert Biaggi, CPO
Mike Fenner, CP, BOCPO, LPO
Jim Fenton, CPO
Rick Fleetwood, MPA
Ed Gildehaus III, CPO, C.Ped, FAAOP
Mark Maguire, CPO
Claudia Zacharias, MBA , CAE
The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and help elect those individuals who support the orthotic and prosthetic community. In order to participate in the O&P PAC, federal law mandates that you must first sign an authorization form.Â To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org. a Â *Due to publishing deadlines this list was created on April 10, 2012, and includes only donations received and contributions made between March 15, 2012, and April 10, 2012. Any donations received or contributions made after April 10, 2012, will be published in the next issue of the O&P Almanac.
MAY 2012 O&P Almanac
Marketplace FRIDDLE’S LIMBGUARD SYSTEM Friddle’s LimbguardTM System (patent pending) once again shows our commitment to innovation. The Limbguard is a cost-effective postoperative residuum maintenance/knee R.O.M. preservation system that is completely customized by the practitioner—on site. Volume fluctuation is accommodated via the floating pretibial section and out proprietary distal GillsTM for the perfect fit. • L5450 IPOP, rigid dressing • L5684 BK for strap • L5688 BK, waist belt, webbing. Contact Friddle’s to order your pair today at 800/3692328, fax 800/369-1149, or visit www.friddles.com.
Raize Microprocessor Foot by Hosmer, a Fillauer company Get ready to raise your expectation of what a foot can do. The new Raize ankle/foot system makes traversing uneven terrain and changing heel heights as easy as pressing a button. The Raize ankle/foot system is a hybrid system that utilizes dual microprocessors to control a hydraulic ankle that is coupled to a state-of-the-art composite foot platform. The Raize is a patented design that constantly monitors data from multiple sensors in the ankle to maintain stability in the everchanging environments amputees encounter. Changing heel heights on the go? Walking on hills? The Raize will know. It’s time to Raize your expectations. For more information, contact Hosmer at 800/827-0070 or visit www.hosmer.com
Reformulated KISS® Adhesive: Amazing adhesion The reformulated KISS adhesive features increased flexibility and less time needed for bonding. The adhesive bonds porous and nonporous surfaces, and bonds flexible as well as rigid materials. It is packaged in two separate bottles for increased shelf life. For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com.
O&P Almanac MAY 2012
WalkOn Fit Kits from Ottobock: Assess Your WalkOn Patient Anywhere At hospital, clinic, home, or office—evaluate your drop-foot patients on the spot for a WalkOn AFO with either the 28T1N WalkOn Fit Kit or the 28T2 WalkOn Flex Fit Kit. Each kit comes in a handy carrying bag and contains four WalkOns (two small, left and right; two medium, left and right; plus four calf pads). With the smaller footplates, there’s no need for grinding needed to get them into the shoe. Get an instant check of the WalkOn function—and then take the order for a fit. To order your Fit Kits today, contact your local sales representative at 800/328-4058.
NEW—ClickValve from Ottobock Patients will love the innovative features of the new ClickValve. The easy-to-grasp, threadless design offers simple opening and closing, with an audible “click” signaling that the connection is secure. Patients will also enjoy reduced skin irritation because the valve system is entirely flush on the inside of the socket. Finally, a safety “leash” keeps it connected to the socket, making it almost impossible to lose. Grab on to this valve—it’s just what your patients have been asking for! Call 800/328-4058 to order.
Detours No Longer Necessary— SYMBIONIC LEG SYMBIONIC LEG is the first commercially available, complete bionic leg that combines a microprocessor knee and a powered, microprocessor ankle. It provides unmatched toe clearance for enhanced safety and enables transfemoral amputees to stably and confidently traverse terrain they might otherwise avoid, without the gait deviations commonly seen in MPK users. SYMBIONIC LEG is insurance billable using existing, approved L codes and, when used with RHEOLOGIC Workbench software, offers the ability to document actual user cadence variation to reduce insurance reimbursement risk. SYMBIONIC LEG is the newest addition to the industry-leading Bionic Technology by Össur platform. For more information, contact Össur Americas at 800/233-6263 or visit www.ossur.com.
Marketplace Monodos® Joint from PEL Supply
More Options in the Alpha Liner Family
PEL Supply now offers the Monodos® Joint (Model 1900) from Becker Orthopedic. This joint incorporates a one-way clutch allowing rotation in one direction, while blocking rotation in the opposite direction until released. Now available in three sizes, the Monodos Joint is a cost-effective alternative to serial casting and offers a solution to a variety of clinical applications including: • Cerebral palsy • Spinal cord injury • Stroke. According to Becker Orthopedic, the Monodos Joint provides a powerful, but safe and easily controlled, mechanism for the orthotic treatment of spasticity and joint contracture often associated with cerebral palsy, stroke, and spinal cord injury. For more information on the Monodos Joint or any of Becker’s high-quality, innovative orthotic components, please call your friendly PEL Supply customer service representative at 800/321-1264, fax your order to 800/222-6176, email firstname.lastname@example.org, or place your order online at www.pelsupply.com.
A lightweight prosthetic foot that provides energy is a must for amputees focused on being active. WillowWood’s DuraLite Foot successfully meets these criteria. The DuraLite Foot, weighing 356 g, incorporates a urethane toe pad for enhanced medial and lateral motion. The split heel conforms to the floor, providing stability on uneven terrain. The foot has three proximal adapter options: a pyramid adapter, a pyramid receiver, or a torsion receiver that provides a total of 48 degrees rotation. A stair guard reduces the risk of the adapter catching on a step when descending stairs. For more information, call 800/848-4930 or visit willowwoodco.com. a
New PDAC-Approved L0631 PREMIER LSO WITH DUAL-PULLEY Closure The Premier LSO spinal back brace with a dualpulley closure system was designed so that a patient can easily don and doff as well as unload the intervertebral discs. The dual-pulley closure system enables the patient to apply a controlled amount of intra-abdominal pressure. The Premier LSO spinal back brace provides compression to the paravertebral soft tissues by featuring a rigid anterior panel. The breathable material allows for patient comfort and compliance. • Postsurgical stabilization • Spinal stenosis • Spondylosis • Spondylolisthesis • Degenerative disc disease • Bulging discs • Herniated discs. For more information, contact Premier Orthopedic Supply Inc. at 631/901-1300 or visit www.premierorthopedicsupply.com.
Jobs—Southeast Orthotist/Eligible for Florida Licensing Ocala/Gainesville, Florida Career opportunity for highly-motivated licensed or certified (Florida License eligible) orthotist to join our growing practice. Great opportunity to handle a diverse patient base while working with great co-workers. If you have strong communication skills and excellent patient care skills, contact us today. We offer a very competitive salary, bonus plan, health insurance, and IRA savings plan. Learn more about joining Mid Florida Prosthetics & Orthotics and the team of dedicated care providers by contacting:
Frank Vero or Rick Page Mid Florida Prosthetics & Orthotics 2300 SE 17th Street, Suite 401 Ocala, FL 34471 Fax resume: 352/351-3267 Email: email@example.com MAY 2012 O&P Almanac
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
Increase exposure and save! Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.
O&P Almanac MAY 2012
Pacific Certified Prosthetist/Orthotist for Management Position Sacramento, California Sacramento is home to a wide variety of higher education opportunities, including Sacramento State and the University of California and its UC Davis Graduate School of Management. They boast a wonderful history, visual arts, museums, and music, along with a growing food culture that has been publicized in many magazines and wellknown eateries. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more! For more information, contact, confidentially:
Sharon King Hanger Clinic Email: Sking@hanger.com
Inter-Mountain Certified Orthotist, Certified Prosthetist (Licensed or Eligible) Houston, Texas Energy capital of the world; voted first in Texas and third in the U.S. for “Best Places for Business and Careers”; known for the youngest population in the nation; the Houston Livestock Show and Rodeo; ZZ Top, Lyle Lovett, Clint Black, Hilary Duff, Blue October; NASA’s Lyndon B. Johnson Space Center; many parks and outdoor venues! Considered by many to be one of the premier clinics in the country. This position will challenge the successful applicant with a broad exposure to a diverse patient population. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential… plus much more! We also have openings in San Antonio and Austin! To apply for this position, please contact, in confidence:
Sharon King Hanger Clinic Email: Sking@hanger.com
Inter-Mountain Certified Prosthetist/Orthotist Corpus Christi, Texas Immediate opening for CPO with experience. Based in Corpus Christi, Texas, with minimal travel to satellite offices. Must be ABC-certified and licensed by the State of Texas. Competitive compensation package! Please send resume to Barbie Baker at:
Fax: 361/888-7424 Email: Barbie@ccprosthetics.com
Northeast Certified/New Jersey Licensed (or Eligible) Orthotist New Jersey Seeking a self-motivated, dedicated, patient-oriented orthotist who is certified/licensed or eligible for licensure in New Jersey. We are a fast-growing company in South Jersey with endless opportunities for the right person. We offer a competitive salary/benefits package. Responsibilities will include hospital calls, detailing physicians and therapists, providing in-services, and marketing. South Jersey offers an exciting array of activities from the beaches of the Jersey Shore to the nightlife of downtown Philadelphia and everything in between. Please contact Allison at:
CO or CPO Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations. Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.
Discover Marshfield, Wisconsin & enjoy: • Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package
ABC Certified in Orthotics & Prosthetics and 3 years of experience preferred. Experience in Pediatrics would be helpful.
Join us and see how your career can shine. To apply, please visit:
www.marshfieldclinic.jobs Reference Job Number MC110156 Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.
Phone: 267/433-1073 Email: firstname.lastname@example.org
MAY 2012 O&P Almanac
Northeast CPO, CP, CO, C.PED, & TECHNICIAN New Jersey Career opportunity for highly motivated New Jersey licensed CPO, CP, CO, C.Ped, and technician in our many locations throughout New Jersey. Pro-Fit offers a comprehensive benefits package that includes a competitive salary commensurate with experienc; an IRA plan; health, prescription, and dental; long-term and short-term disability; and life insurance. Possible ownership opportunity for qualified practitioner. Submit your confidential resume to:
Email: email@example.com Fax: 856/809-9954
Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing. Send resume to:
Certified Orthotist, Certified Orthotist and Board-Eligible Prosthetist, or Certified Prosthetist/Orthotist New York State Privately owned and growing multi-site ABC-accredited P&O practice in upstate New York is seeking a certified orthotist with a minimum of two years’ experience and/ or a certified orthotist and board-eligible prosthetist, or certified prosthetist/orthotist. We are looking for individuals with strong orthotic backgrounds and we may entertain an NCOPE prosthetic residency if needed. Our offices in the historic and scenic Hudson Valley and Catskill Mountains of New York are located from Saratoga to Poughkeepsie, with immediate openings in Kingston and Poughkeepsie. The ideal candidate must be self-motivated and a team player, possess good communication and technical skills, and be willing to excel for performance-based objectives. Competitive salary and benefits package offered. Submit resume to:
O&P Ad 0611 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899
David Misener, CPO Clinical Prosthetics & Orthotics, LLC Email: DBM@clinicalpando.com Fax: 518/432-0686
Help Shape Babies’ Lives! Full-Time & ParT-Time PosiTions available Be part of a unique career opportunity treating babies up to 18 months of age. If you are looking for a new challenge and want to specialize in a non-traditional, niche area, CranialTech may be the place for you. This is a unique opportunity to treat patients in a child-friendly, state-of-the-art clinic. As a Clinician, you will treat infants from 3–18 months of age, using the DOC Band® to correct abnormal head shapes. Pediatricians and parents alike look to our Clinicians as the experts in the diagnosis and the treatment of plagiocephaly.
noW HirinG orTHoTisTs in: austin, TX | Columbia, sC Charlotte, nC | los angeles, Ca orange, Ca |Pasadena, Ca san Diego, Ca
Clinicians at CranialTech enjoy: • Direct patient care and visible patient progress within 2–3 weeks • No productivity/patient quotas, long days, weekends or holidays and minimal paperwork • Future opportunities available nationwide in training, mentoring and travel • Formal training program and one year of mentoring with a company that has specialized in plagiocephaly for more than 25 years • Competitive salary and generous benefits package, including 3.5 weeks paid time off and quarterly incentive bonuses
Learn more about this opportunity by visiting cranialtech.com/careers, or by calling (866) DOC-BAND!
O&P Almanac MAY 2012
■■ YEAR-ROUND TESTING Multiple Choice Examinations. BOC has yearround testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November. Applications are accepted any time, although seating is limited. For more information, visit www.bocusa.org or email firstname.lastname@example.org.
On-site Training Motion Control Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately. For more information, call 888/696-2767 or visit www. UtahArm.com. ■■
2012 ■■ May 2-5 Northwest Chapter of the American Academy of Orthotists & Prosthetists Meeting. Bellevue Courtyard by Marriott Hotel. Seattle. Meeting will host Elaine Owen for a three-day course in pediatric gait analysis and orthotic management and will include a fourth day of exciting prosthetic content. For more information contact Tim Shride, CPO, LPO, at 612/203-0936, email nwaaop@ gmail.com, or visit www. regonline.com/nwaaop_2012.
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words Member Rate Nonmember Rate 25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$3.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email srybicki@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor.
■■ MAY 9 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5-6 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/ 220-6670 or visit www.ultraflexsystems.com. ■■ May 9 AOPAversity Audio Conference–Contracting 101. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org. ■■ MAY 12 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 9-10 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www.ultraflexsystems.com. ■■ MAY 15-17 WillowWood: OMEGA® Tracer® Training, Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, ‘by measurement’ shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: 18.5 ABC/18.5 BOC. www.willowwoodco.com. ■■ May 17-18 New York State Chapter Meeting. Marriott, Albany. For more information, visit www.NYSAAOP.org.
■■ May 17-19 PA AAOP Chapter Annual Spring Conference. Pittsburgh, Sheraton Station Square Hotel. For more information, contact Beth or Joe at 814/455-5383. ■■ May 17-19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association. Annual Meeting at Peppermill Hotel, Reno, NV. Best CEU credit value available! Contact Steve Colwell at 206/440-1811, or Sharon Gomez at 530/521-4541, or visit www.wamopa.com. ■■ MAY 21 WillowWood: Take the Guesswork Out of Elevated Vacuum Suspension, via WebEx, 1:30 pm ET. Course covers background information and theory on the concept of elevated vacuum. Appropriate clinical applications and components discussed. 2012 Credits: TBD. www.willowwoodco.com. ■■ MAY 22 WillowWood: Discover LimbLogic® VS via WebEx, 1:30 pm ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: TBD. To register online, visit www.willowwoodco.com. ■■ MAY 24 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon – 1 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Presenter: Jim Rogers, CPO, FAAOP. Register by calling 800/220-6670 or visit www.ultraflexsystems.com.
Questions? Email srybicki@AOPAnet.org.
MAY 2012 O&P Almanac
MAY 29 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon – 1 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Presenter: Marc Kaufman, CPO. Register by calling 800/220-6670 or visit www.ultraflexsystems.com. ■■
■■ June 1 ABC: Certification Exam Application Deadline. Applications must be postmarked by June 1, 2012, for individuals seeking to take the summer 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email@example.com, or visit www.abcop.org/certification.
June 1-2 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop. org, or visit www.abcop.org/ certification. ■■
■■ June 4-6 LAOP: Annual Educational Conference. Hilton Riverside, New Orleans. Earn up to 13 credits in O, P, and Administrative tracts. Come enjoy summer family fun, unique city culture, cuisine, and all that jazz. Contact Sharon at 504/464-5577, firstname.lastname@example.org, or visit www.laop.org. ■■ JUNE 6 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 8-9 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable
O&P Almanac MAY 2012
Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Register by calling 800/220-6670 or visit www.ultraflexsystems.com. ■■ June 7-8 Michigan Orthotics & Prosthetics (MOPA) Continuing Education Meeting. Soaring Eagle Casino & Resort in Mt. Pleasant, MI. Contact Mary Ellen Kitzman at 248/6150600 or email her at Kitzman@ gmail.com. ■■ June 8-9 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, email@example.com, www.abcop.org/certification. ■■ June 13 AOPAversity Audio Conference–Improving Your Bottom Line. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
june 15-16 PrimeFare East Regional Scientific Symposium 2012. Nashville Convention Center, Nashville. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com. ■■
■■ JUNE 21 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.0 ABC/6.75 BOC. Registration deadline June 1. Contact 877/665-5443 or visit www.willowwoodco.com.
■■ JUNE 21-22 OTS Corp: Two-Day Orthotics & Prosthetics Seminar. Asheville, NC. Course will cover the SPL2, RGO, TFC, OTS components, Trautman Fabrication Equipment, OTS Fabrication Equipment, the REL-K microprocessor knee system, eMotis feet, MotionFoot, Hosmer knee devices, and the all-new Raize microprocessor foot. Hosted by OTS Corp., presented by Fillauer & Center for Orthotics Design. Contact Tracy Ledford at 828/658-8330 or tracy@ ots-corp.com.
■■ JUNE 22 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting. Fabricate sockets following recommended techniques for airtight socket designs. 2012 Credits: 9.75 ABC/TBD BOC. Registration deadline June 1. Contact 877/665-5443 or visit www.willowwoodco.com.
independence. Contact Nicki Cantrell at ncantrell@fillauer. com or 423/624-0946.
■■ JULY 27 Fillauer Companies: Advanced Lower-Extremity Prosthetic Design Seminar. Chicago. Interactive workshop will explore the overall biomechanic effect of the latest in composite foot design and microprocessor control with respect to prosthetic lower-limb function. Attendees will come away with a more complete understanding of composite design and clinical integration of microprocessor design for the foot and ankle. Presented by Fillauer LLC, Motion Control, and Hosmer. Contact Nicki Cantrell at ncantrell@ fillauer.com or 423/624-0946.
■■ AUGUST 3-4 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Austin. Sheraton Austin Hotel at the Capitol. Contact Robb Walker at 325/793-3480, email
secretary-treasurer@txaaop. org, or visit www.txaaop.org.
■■ July 11 AOPAversity Audio Conference–Perfecting the Intake Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■■ August 6-7 AOPA: Essential Coding & Billing Seminar. Hyatt at Olive 8, Seattle. To register, contact Stephen Custer at 571/432-0876 or scuster@ AOPAnet.org.
■■ JULY 19-20 Fillauer LLC & Center for Orthotics Design: Reciprocal Gait Orthosis Seminar. Chattanooga, TN. This course is an interactive clinical seminar on the Reciprocal Gait Orthosis. Be a part of a team that makes a difference in people’s lives by enabling those with spinal cord injury or congenital involvement to stand up and walk with a natural gait to regain
■■ AUGUST13-18 ABC: Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams is June 1. Contact 703/836-7114, email firstname.lastname@example.org, or visit www.abcop.org/certification.
■■ August 15 AOPAversity Audio Conference–The Ins and Outs of Advance Beneficiary Notices (ABNs). For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■■ AUGUST 17 Fillauer Companies: Advanced Lower-Extremity Prosthetic Design Seminar. Phoenix. Interactive workshop will explore the overall biomechanic effect of the latest in composite foot design and microprocessor control with respect to prosthetic lowerlimb function. Attendees will come away with a more complete understanding of composite design and clinical integration of microprocessor design for the foot and ankle. Presented by Fillauer LLC, Motion Control, and Hosmer. Contact Nicki Cantrell at email@example.com or 423/624-0946.
■■ SEPTEMBER 1 ABC: Application Deadline for Certification Exams and Clinical Patient Management (CPM) Exams. Applications must be received by Sept. 1, 2012, for individuals seeking to take the November 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or winter CPM ABC exams for orthotists and prosthetists. Contact 703/836-7114, email firstname.lastname@example.org, or visit www.abcop.org/certification.
■■ September 6-9 AOPA National Assembly & NE Chapter Combined Meeting. Boston. Hynes Convention Center. The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting. Please plan to join us for this significant event. Exhibitors and sponsorship opportunities available: contact Kelly O’Neill at 571/431-0852 or koneill@ AOPAnet.org. To register, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
■■ SEPTEMBER 28 Fillauer Companies: Advanced Lower-Extremity Prosthetic Design Seminar. Dallas. Interactive workshop will explore the overall biomechanic effect of the latest in composite foot design and microprocessor control with respect to prosthetic lowerlimb function. Attendees will come away with a more complete understanding of composite design and clinical integration of microprocessor design for the foot and ankle. Presented by Fillauer LLC, Motion Control, and Hosmer. Contact Nicki Cantrell at email@example.com or 423/624-0946.
■■ September 12 AOPAversity Audio Conference–How to Get Paid for Orthopedic and Diabetic Shoes. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
■■ October 10 AOPAversity Audio Conference–What Every O&P Facility Needs to Know About the FDA. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
O&P Board Study Resources
O&P BUSINESS MANAGEMENT This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company. ■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER
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The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics
IN O&P BUSINESS MANAGEMENT Find more information at www.AOPAnet.org
(Many of our products are available in DVD Format also!)
Now Offering Customizable Orthotic and Prosthetic Patient Device Instruction Sheets in English AND Spanish
A NEW AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.
www.oandpstudyguide.com MAY 2012 O&P Almanac
■■ OCTOBER 12 Fillauer Companies: Advanced Lower-Extremity Prosthetic Design Seminar. Philadelphia. Interactive workshop will explore the overall biomechanic effect of the latest in composite foot design and microprocessor control with respect to prosthetic lower-limb function. Attendees will come away with a more complete understanding of composite design and clinical integration of microprocessor design for the foot and ankle. Presented by Fillauer LLC, Motion Control, and Hosmer. Contact Nicki Cantrell at ncantrell@ fillauer.com or 423/624-0946.
■■ October 19-20 University of Michigan Orthotics and Prosthetics Center: Centennial Celebration and Education Seminar. Making a difference for 100 years, providing service, education, and research in O&P. For details and information about registration, visit www.med. umich.edu/pmr/op/index.htm.
■■ NOVEMBER 1-2 Fillauer LLC: Advanced Technical Seminar. Chattanooga, TN. Course will cover Fillauer orthotic joints, shuttle locks, plastics and the Hosmer-Fillauer endoskeletal system, Hosmer knees and upper extremity, RGO, TFC, as well as Trautman equipment, PDQ ovens, and fabrication supplies. Contact
Nicki Cantrell at ncantrell@ fillauer.com or 423/624-0946.
■■ NOVEMBER 14 AOPAversity Audio Conference–Medicare Enrollment Procedures. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org. ■■ December 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■■ February 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663 x208 or firstname.lastname@example.org. ■■ September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet. org. a
AD INDEX Company
American Board for Certification in Orthotics, Prosthetics & Pedorthics
DeRoyal Industries Inc.
Ferrier Coupler Inc.
Fillauer Companies Inc.
Friddle’s Orthopedic Appliances
Hersco Ortho Labs
KISS Technologies LLC
16, 17, 30, 31
Orthotic and Prosthetic Study and Review Guide
Össur Americas Inc.
Otto Bock HealthCare
PEL Supply Company
O&P Almanac MAY 2012
I���������� � N�� A������� T� T�� KISS F�����!
A����� O����� B��� PART # CMP44/A
ALSO AVAILABLE AS KISS KITS KS4/A AND KS4/B
T�� ���� �� ����������� �� �������� ����� �������� ��� ��� �� ��������� ���� � ������ ���� � ������ ����������. I� �� ������ 12˚ ��� ��� � 4 ���� ������� ���� �� ������ ����������� .75 ������ ��� �������� ��������� ��� ��� ������ ���������. L��������� ����� ��� ������ ������ ���� ����������
FOR MORE INFORMAION CALL: (410)663- KISS (5477)
© 2012 KISS Technologies, LLC. KISS is a registered trademark. U.S. Patent Pending. “All Rights Reserved” Made in U.S.A.
X A65K 31
W G A653LT 2 AW A6545
Answers to your questions regarding GW, AW, and GL modifiers
AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at email@example.com.
O&P practitioners know how to use the common everyday modifier—such as the LT, RT, KX, and GA modifiers—but there are some modifiers that are a little less common. These modifiers are just as important as the common ones.
What is the purpose of the GW modifier?
Here’s the definition of the GW modifier: service not related to hospice patient’s terminal condition. This modifier is used when providing services to a patient who has elected to receive hospice care. When a patient elects hospice care, he or she is agreeing not to accept treatment for his or her illness, so the Medicare hospice benefit will only cover palliative treatment of the symptoms of the terminal disease for which the patient has elected hospice care. Treatments of conditions that are not directly related to the patient’s terminal disease will remain a covered Medicare benefit. In order for Medicare to properly process these claims, you must include a GW modifier indicating that the service is unrelated to the patient’s terminal disease or illness, and that the hospice is not responsible for payment.
O&P Almanac MAY 2012
When do you use the AW modifier?
When would I use the GL modifier?
The definition of the AW modifier reads as follows: item furnished in conjunction with a surgical dressing. While most surgical dressings are statutorily noncovered by Medicare, there is coverage for compression garments that are used in the treatment of open venous stasis ulcers, as stated in the Surgical Dressing Policy. The three codes that are covered in this scenario are A6531, A6532, and A6545. The AW modifier is used with these codes to indicate they are being provided in conjunction with a surgical dressing and are eligible for coverage.
The GL modifier is used when you are providing an upgraded item to a Medicare beneficiary, but you are choosing not to bill Medicare or the patient for the upgrade. When using the GL modifier, your claim must include only the charge and the code for the non-upgraded item along with the GL modifier. Then in the narrative field of your claim, you must provide a description of the item actually provided to the patient, the upgraded item, and why the item is an upgrade. a
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UNLOADER ONE PLUS. A NEW PLUS-SIZED OA BRACE FOR YOUR PLUS-SIZED PATIENTS. ®
Containing the situation. Obese suﬀerers of knee OA require soft tissue containment for eﬀective bracing. That’s why the Unloader One Plus has reinforced shells1, a wider thigh strap2 and a gastroc strap to help secure the brace in place.3
Extra large support. Bigger legs require bigger support. So, we outfitted the new Unloader One Plus with a sturdier upright and an Adjustable Dynamic Joint to give clinicians additional leverage for optimal pain management. OTS
Clinically proven. Multiple,, peer-reviewed clinical and biomechanical studies have proven the eﬃcacy of the 3 Points of Leverage philosophy on which the Unloader One Plus is based (research available at www.ossur.com/unloader).
Prescribe the Unloader One Plus for any patient. If they are not happy with it for whatever reason, they can return it within 30 days for a full refund.
TO LEARN MORE. USA (800) 233-6263 CANADA (800) 663-5982 WEB OSSUR.COM © 2012 Össur
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Published on May 1, 2012