November December 2021 O&P Almanac

Page 1

The Magazine for the Orthotics & Prosthetics Profession

N OV E M B E R / D E C E M B E R 2021

Meet the 2022 AOPA Board of Directors P.13

The Latest in Coding and Fee Schedule Changes P.16

Supply Chain Disruptions in O&P P.28

COVID-19 Vaccination Rules P.34



Quiz Me!



P.18 & 39




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FOLLOW US @AmericanOandP

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













NOV./ DEC. 2021 | VOL. 70, NO. 10


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


20 |

Mature Mobility

Senior patients with comorbidities often face long rehabilitation journeys postamputation. Prosthetists play important roles in supporting this population by helping patients identify achievable goals, encouraging progressive exercise under the supervision of physical therapists, and providing well-fitting prostheses. By Christine Umbrell

Strategic planning

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 13

Transitions in the profession

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

The Ever-Evolving Reimbursement Scene

Fee schedule changes, competitive bidding, and more Opportunity to earn up to two CE credits by taking the online quiz.

Compliance Corner............................... 34

28 | O&P, Interrupted O&P manufacturing companies, fabrication facilities, and patient-care clinics are all experiencing delays in receiving materials and products due to global supply chain disruptions. Find out what these companies are doing to ameliorate the delays and reduce their impact on patient care. By Michael Coleman

O&P and the Vaccine Requirements

Complying with the new CMS and OSHA rules

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

Member Spotlight................................ 44 n n

HiTek Fabrication J&J Artificial Limb and Brace

AOPA News............................................... 48

AOPA advocacy, announcements, member benefits, and more

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

PRINCIPAL INVESTIGATOR Mark Geil, PhD..........................................................................40 Meet a biomedical engineer and associate dean at Kennesaw State University who is studying the role of cognitive bias in gait, particularly with respect to O&P devices.



Marketplace............................................. 50 Careers......................................................... 54

Professional opportunities

Ad Index........................................................57 Calendar...................................................... 58

Upcoming meetings and events

State By State.......................................... 60

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Board of Directors

AOPA’s Future Is Bright


S 2021 COMES TO a close, we want to thank you for your continued support of

AOPA during these trying times. We know that the challenges you’re facing today are profound, and on behalf of AOPA’s entire Board of Directors, we want to let you know just how much we appreciate all you do for AOPA and, more important, the patients you serve. With this issue of O&P Almanac spanning both our terms as AOPA president, we wanted to write this column jointly and provide you an update about AOPA’s strategic planning process, which will guide us through the next several years. Hopefully you have heard about this process already—from a previous Views From AOPA Leadership column, via a video from AOPA Executive Director Eve Lee, MBA, CAE, or through the strategic planning survey our consultant sent to all members recently. And that’s where we want to focus this message: on the strategic planning process. The first thing we want to do is thank every one of you who responded to the survey sent by our consultant. The AOPA Board of Directors met in September and reviewed every single comment submitted by members. We learned a lot from your feedback—about what AOPA does well, but even more important, what we can do better. Your responses mattered. A lot. Your insights, your criticisms, your compliments were the foundation AOPA staff and the Board started from as we contemplated our strategy for the next three to five years. We emphasize this so strongly because it can’t be overstated: This strategic plan will, we hope, feel to all of you like it’s yours when we unveil it, because it’s built on what you’ve shared with us. One of the most important things the strategic planning process has revealed is that we can do a better job of providing value to all our members. The diversity of AOPA’s membership is unique. It is what makes us strong, but it also presents unique challenges. Thanks to your feedback and input, we now have a clearer understanding of where key fault lines are. We believe the information you’ve provided and the resulting discussions it has provoked will lead to an AOPA that better meets the needs of every member moving forward. Finally, one of the most exciting aspects of this process has been revisiting AOPA’s vision and mission. These statements are the North Star for any organization. Changing them is not something we considered lightly, but we believe the insights you’ve given us as part of this process compel the conclusion that we must reexamine both. We can tell you that the Board discussions about vision and mission were spirited and energizing for everyone involved—reams of large, easel-sized Post-It sheets hung around the walls of a large meeting room in Boston can attest to that. We can’t wait to share the results with all of you in the new year. In closing, we thank you again for all you’ve done to support AOPA in 2021. We look forward to unveiling our new strategic plan in January, and to working with you and for you in 2022 and beyond. Traci Dralle, CFm, ends her term as AOPA president Nov. 30, 2021.



Dave McGill, begins his term as AOPA president Dec. 1, 2021.

OFFICERS President Dave McGill Össur Americas, Foothill Ranch, CA President-Elect Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Vice President Mitchell Dobson, CPO Hanger, Austin, TX Immediate Past President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS Jeffrey M. Brandt, CPO Ottobock, Exton, PA Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY Jim Kingsley Hanger Clinic, Oakbrook Terrace, IL Linda Wise WillowWood, Mount Sterling, OH Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair, Hanger Clinic, Houston Medical Center, Houston, TX James O. Young Jr., CP, LP, FAAOP Amputee Prosthetic Clinic, Tifton, GA





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

Publisher Eve Lee, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met. EXECUTIVE OFFICES


Eve Lee, MBA, CAE, executive director, 571/431-0807,

Tina Carlson, CMP, senior director, education and meetings, 571/431-0808,

Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571/431-0817, Betty Leppin, senior manager of member services, 571/431-0810, Kristen Bean, membership and meetings coordinator, 571/431-0876, AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, Reimbursement/Coding: 571/431-0833,



Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, Susannah Engdahl, PhD, manager, health policy and research, 571/431-0843, Sam Miller, manager, state and federal advocacy, 571/431-0814, O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, Josephine Rossi, editor, 703/662-5828, Catherine Marinoff, art director, 786/252-1667, Bob Heiman, director of sales, 856/520-9632 , Christine Umbrell, editorial/production associate and contributing writer, 703/6625828,

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2021 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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


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Senior Stats Treating the growing senior population means understanding comorbidities

Many O&P facilities see a large percentage of senior patients—those ages 65 and older. With this population only expected to grow, it’s important for clinicians to understand their physical challenges as well as their comorbidities.


54.1 Million

Have some type of disability


1 in 4


Ages 65-74

Number of seniors with diagnosed or undiagnosed diabetes


Percentage of seniors who have peripheral artery disease

22.3% assess their health as fair or poor

Ages 75 and Older 29.3% assess their health as fair or poor

Physical Functioning Among People Ages 65 and Older, 2019

Percentage of seniors reporting any level of difficulty


Difficulty with mobility Difficulty hearing

31% 27%

Difficulty with cognition 22%

Difficulty seeing Difficulty with self-care


Difficulty with communication


SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey



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“The number of people ages 65 and older in the United States has increased steadily during the past century, and growth has accelerated since 2011, when baby boomers first started to turn 65. Between 2020 and 2060, the number of older adults is projected to increase by 69%, from 56.0 million to 94.7 million. The number of people ages 85 and older is projected to nearly triple, from 6.7 million in 2020 to 19.0 million by 2060.” —Population Reference Bureau,

SOURCES: U.S. Census Bureau, CDC, Population Reference Bureau; “Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults,” and “National Diabetes Statistics Report, 2020,” CDC; American Diabetes Association;;

14.3 Million

2 in 5

Number of U.S. residents ages 65 and older

Percentage of the U.S. population comprised of seniors



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Happenings FAST FACT

Pandemic Spurs Innovation

SOURCE: “The Era of Hyper-Innovation,” Fieldwork by Citrix, October 2021

Optimizing Prostheses’ Shock-Absorption Capabilities Kota Takahashi, PhD, an assistant professor of biomechanics at University of Nebraska Omaha, has been awarded a $2 million grant to optimize shock absorption for service members with lower-limb amputation. Takahashi will create objective guidelines from which to design prostheses that more effectively soften the impact and absorb the shock of walking and running. The goal is to better protect individuals from injuries by improving artificial limbs’ shock-absorbing functions. Takahashi and his team will study the effects of various shock-absorbing prosthetic components—including feet, ankles, and pylons—on user performance during high-demand activities, such as walking on slopes and stairs and completing pivot maneuvers. Service members and veterans will serve as study participants and will trial various combinations of shock-absorbing prostheses. The research team will use advanced tools to obtain estimates of musculoskeletal health-related

outcomes—including forces, motion, and energy of the legs—as well as qualitative surveys on mobility and comfort. The researchers will generate new evidence to inform clinical prescription of shock-absorbing prostheses, and enable active-duty service members and veterans to perform at their highest level without compromising their health years decades later, according to Takahashi. He has assembled a team of scientists from Northwestern University, the Naval Medical Center San Diego, Humotech, University of Nebraska Medical Center, and the Omaha VA to carry out the investigations.

PHOTO: Getty Images

The U.S. healthcare industry experienced a rapid acceleration of innovation during the first 18 months of the COVID-19 pandemic, according to a new survey by Citrix Systems. Among the healthcare leaders surveyed, 92 percent said their businesses adopted new ways of working and processes during the 92% pandemic, and 82 percent said they’re using new tech tools and infrastructure. In addition, 58 percent of healthcare leaders reported that collaboration within their businesses increased during the pandemic, and 72 percent reported that innovation increased during the pandemic.



Visit the Smithsonian’s Prosthesis Exhibit



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The Smithsonian Institution in Washington, D.C., unveiled a FUTURES exhibit November 20, which will remain open until July 6, 2022. The exhibit encompasses nearly 32,000 square feet of new immersive site-specific art installations, interactives, working experiments, inventions, speculative designs, and “artifacts of the future.” The FUTURES exhibit features a prosthetics section, with several objects that document the history of O&P. Visitors will be able to view the first complex prosthesis—the 1911 Carnes arm—as well as soft robotics created from highly flexible materials, a grip glove for rehabilitating stroke victims, and an exoskeleton that can improve spinal injury recovery and combat degenerative disease. Visit the display at the Arts and Industries Building in Washington, D.C., or learn more at



ROMP Elite Team Travels to Cotopaxi Participants in the Range of Motion Project (ROMP) recently completed an in-person climb of Cotopaxi, a heavily glaciated stratovolcano and Ecuador’s second highest mountain at over 19,300 feet. The climb was designed to increase awareness of communities marginalized by lack of access to quality rehabilitative technology. By summiting one of the world’s most challenging peaks on October 8, the ROMP Elite Team promoted its vision of independence through mobility by demonstrating that amputees are not disabled by a missing limb, but by a missing prosthesis. Twenty-seven adaptive and ablebodied athletes participated in the climb, raising more than $100,000 to provide assistive technology, including prosthetic and orthotic services, for marginalized disability communities. “It’s exciting to be part of this team, to challenge myself physically and make the most of the opportunities available

to me,” said Eric Neufeld, CPO, FAAOP, co-founder of ROMP and chief prosthetist and medical director at Agile Orthopedics. “It’s meaningful to raise awareness around the lack of resources that are preventing amputees from living up to their potential and being able to climb their own mountains.” The climb was particularly meaningful to participants who were unable to complete a ROMP trip to Ecuador in 2020, due to the COVID-19 pandemic.


Nobel Awarded for Sense of Touch Research

PHOTOS: Getty Images

Ardem Patapoutian shared the 2021 Nobel Prize in Physiology or Medicine for his work on mechanisms sensing touch or pressure. Patapoutian and his team at Scripps Research in La Jolla, California, identified pressure-sensitive ion channels called Piezo1 and Piezo2. These specialized molecules, which are embedded in the membranes of some cells, enable signals to be transmitted in response to touch or pressure. Patapoutian’s team has demonstrated that these ion channels are the principal sensors for touch sensation, and that they play an important role in both proprioception—awareness of the position and movement of the body—and interoception—the sense of the internal state of the body. In addition to having applications that will aid in developing prostheses for limb loss patients, the research may eventually become relevant for people who suffer from neuropathic pain, according to Patapoutian.


Employment Numbers Low Among Individuals With Disabilities

In 2020, only 18 percent of persons with a disability were employed, compared with 62 percent of individuals without a disability. Twenty-nine percent of workers with a disability were employed part-time, compared with 16 percent without a disability. Among working-aged individuals—those ages 16 to 64—approximately 29 percent of persons with a disability and 70 percent without a disability were employed. SOURCE: “Persons With a Disability: Labor Force Characteristics,” Bureau of Labor Statistics, U.S. Department of Labor





Researchers Awarded AOPA/COPL Grants for Innovative Studies The AOPA Board of Directors and the Center for Orthotic and Prosthetic Learning and Outcomes/EvidenceBased Practice (COPL) have selected several research projects to be awarded as 2021 COPL pilot grant recipients. “AOPA is thrilled to be able to improve the current level of original orthotics and prosthetics evidence-based or outcomes research by providing funding through COPL,” said Eve Lee, MBA, CAE, AOPA executive director. “This year showed incredible growth in COPL Pilot Grant Program submissions. The number of submissions grew by 75 percent and, in turn, the number of proposals recommended for funding by the COPL Board and reviewers tripled. In the end, 18 proposals were recommended by at least one reviewer, but of those, 12 clearly stood out.” In order to fund the 2021 COPL Pilot Grant projects, the COPL Board asked AOPA to pursue additional funding, equaling $239,537.50. AOPA allocated $95,000 for the 2021 COPL cycle and received key sponsorship dollars from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), the Brown Foundation, and the Board of Certification (BOC).

“ABC is pleased to support the Center in its mission to promote research and education in O&P,” said Anthony C. Ward, CPO, president of ABC. “We are especially hopeful that the evidence-based and patient-oriented research will lead to improved patient outcomes. The alignment of ABC’s and the Center’s missions and goals for the profession couldn’t be clearer.” “BOC is proud to be a key funder for the 2021 COPL Pilot Grant Program Cycle,” said Bradley “Brad” Watson, BOCO, BOCP, LPO, BOC board chair. The following studies received awards: • Joshua Burns, PhD, “Feasibility of Smart Ankle-Foot Orthoses With Embedded Wearable Sensors To Measure Real-World Function and Compliance in Childhood” • Cole Cheney, MD, “Sciatic Block in Contralateral Limb for Treatment of Refractory Phantom and Residual Limb Pain; a Triple-Blind Randomized Crossover Controlled Trial” • John Chomack, MS, “Advanced Wearable Fitness Tracker for Individuals With Transtibial Amputation: A Feasibility Study Using the Oura Ring” • Michael Dillon, PhD, “Closing an Evidence-Practice Gap:

• •



Exploration of the Barriers and Facilitators Influencing Use of Telehealth for Orthotic/Prosthetic Services in the United States” Graci Finco, CPO, LPO, “Wearable Sensors in Prosthetic Practice: Can Walking Symmetry Supplement Clinical Measures To Assess Fall Risk?” Szu-Ping Lee, PhD, “Socioeconomical Disparities on Postamputation Outcomes in Individuals With Lower-Limb Amputation” H. Edward Garrett Jr., MD, “Investigating Mobility and Prosthetic Utilization Outcomes in Patients With Lower-Limb Amputation and Vascular Comorbidities Under Physician-Led Collaborative Care Model” Cody McDonald, PhD, “Racial Bias in Orthotics and Prosthetics” Taavy Miller, PhD, “Do Corrective Scoliosis TLSOs Fabricated Using 3D Scanning Show a Greater Percentage of In-Brace Curve Correction Compared to TLSOs Fabricated From a Traditional Casting Method of Image Capture?” Andrew Sawers, PhD, “Improving Documentation of Falls in People Living With Lower-Limb Amputation: Reconstructing Fall Events With the Lower-Limb Prosthesis User Fall Survey” Fanny Schultea, CPO, LPO, “Controlled Intervention Study of Community-Based Rehabilitation for People With Amputation in the Houston, Texas, Area” Shane Wurdeman, MSPO, PhD, CP, FAAOP(D), “Care Patterns and Total Cost of Care Associated With Diabetic Foot Ulcer and Lower-Limb Amputation Among Medicare Beneficiaries: A Five-Year Cohort Analysis”




AOPA Board of Directors Takes the Reins for 2022 AOPA leadership is looking forward to the opportunities that the coming year will bring. New and returning board members are planning to launch both innovative and revamped programs and projects to assist member companies in providing quality patient care and services while supporting one another by sharing best practices. Dave McGill, begins his term as AOPA president December 1 after being elected during the AOPA National Assembly in September. McGill will be supported by Teri Kuffel, JD, president-elect; Mitchell Dobson, CPO, vice president; Rick Riley, treasurer; Eve Lee, MBA, CAE, secretary; and several additional board members. Traci Dralle, CFm, who served as president for the 2020-2021 term, will continue serving the association as immediate past president. Jim Kingsley is the newest member of the profession to join the AOPA board. Kingsley has spent the past nine years in the O&P industry working as chief operating officer for Scheck & Siress and regional vice president at Hanger Inc. During his 37-year career, he has served in accounting, sales and marketing, business development, mergers and acquisitions, operations, and general management roles. Jeffrey Lutz, CPO, who served as immediate past president last year, concludes his board service at this time. To the right is the full list of 20212022 AOPA Board of Directors members, who take office Dec. 1, 2021, and will serve through Nov. 30, 2022.


2022 AOPA Officers

Dave McGill President

Teri Kuffel, JD President-Elect

Mitchell Dobson, CPO Vice President

Traci Dralle, CFm Immediate Past President

Rick Riley Treasurer

Eve Lee, MBA, CAE Secretary (Nonvoting)

2022 AOPA Board Members

Jeffrey M. Brandt, CPO

Elizabeth Ginzel, MHA, CPO

Kimberly Hanson, CPRH

Linda Wise

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

James O. Young Jr., CP, LP, FAAOP

New Board Member

John “Mo” Kenney, CPO, FAAOP

Special Thanks, Retiring Jim Kingsley

Jeffrey Lutz, CPO




Hanger Inc. announced an external advisory board, along with academic and industry partners who will join the Hanger Institute for Clinical Research & Education (Hanger Institute) in its efforts to advance the clinical practice of O&P and improve patient outcomes. The Hanger Institute launched in March 2021 to explore, expand, and facilitate opportunities that help advance leading-edge research, evidence-based care, and quality education in O&P. To provide guidance around this mission, the Hanger Institute formed an external Advisory Board composed of experienced members of the healthcare community, including Biykem Bozkurt, MD, PhD; Judith M. Burnfield, PhD, PT; Catrine TudorLocke, PhD, FACSM, FNAK; and Douglas Smith, MD. The Hanger Institute also is partnering with academic and institutional research organizations, along with several industry collaborators: Infinite Biomedical Technologies, Össur, Ottobock, Parker Hannifin, Point Designs, WillowWood, and Zimmer Biomet. “By establishing these strategic partnerships, we’re poised to drive scientific advancements and leading-edge research in the orthotics and prosthetics field,” said James Campbell, PhD, Hanger’s chief clinical officer. Forty-four O&P providers have been honored with a 2021 Freedom Award from Orthotic and Prosthetic Group of America (OPGA) in recognition of their attention to military personnel. “We’re excited to recognize these O&P providers for the exceptional care they provide to the men and women who have sacrificed for our freedoms,” said Todd Eagen, president of OPGA. “These dedicated professionals blend patient care with precision design to ensure our military heroes can have increased mobility and independence.” Recipients of the 2021 Freedom Award received a framed award to showcase in their patient-care facility, which “highlights their dedication to the distinguished veterans they treat, and to the stars and stripes,” Eagen said. The following AOPA members are among the 2021 Freedom Award recipients: • Allegheny Orthotics and Prosthetics, Altoona, Pennsylvania • Central Brace and Limb Co., Indianapolis, Indiana • Clark & Associates Prosthetics and Orthotics, Waterloo, Iowa • Clark and Associates, Cedar Rapids, Iowa • Decker Integrated O&P, Overland Park, Kansas 14


• Great Lakes Prosthetics & Orthotics, Ypsilanti, Michigan • Holmes Prosthetic Center, Houston, Texas • LeTourneau Lifelike Orthotics and Prosthetics Inc., Beaumont, Texas • Limb Lab, La Crosse, Wisconsin • Limb Lab, Mankato, Minnesota • Limb Lab, Rochester, Minnesota • NovaCare Prosthetics & Orthotics, Fond du Lac, Wisconsin • NovaCare Prosthetics & Orthotics, Oshkosh, Wisconsin • O&P1, Waterloo, Iowa • OrthoPro Services LLC, Dublin (Laurens), Georgia • Rehability, Spring Hill, Florida • Sampsons Prosthetic and Orthotic Lab, Schenectady, New York • Sierra Prosthetics-Orthotics, Grass Valley, California • Snell’s Orthotics and Prosthetics, Shreveport, Louisiana • Tillges Certified Orthotic Prosthetic Inc., Maplewood, Minnesota • Total Rehab Orthotics and Prosthetics, Fayetteville, North Carolina • Valley Institute of Prosthetics & Orthotics, Bakersfield, California.


Wishing you a healthy, relaxing, and joyous holiday season. The American Orthotic and Prosthetic Association Staff




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The Ever-Evolving Reimbursement Scene Developments in prior authorization, competitive bidding, audit programs, and more

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.





been as disruptive as 2020, but 2021 was still a busy year. We saw the full implementation of prior authorization take effect. We saw the implementation of Round 2021 of the competitive bidding program (CBP), which for the first time included off-the-shelf orthoses. We saw the reintroduction of the Target, Probe, and Educate (TPE) audit program. And we experienced many other smaller, but just as significant, changes. This month’s Reimbursement Page offers a recap of some of the 2021 changes that you may have missed, overlooked, or forgotten—and takes a sneak peek at some updates in store for 2022.





Fee Schedule Updates

The best place to start is at the beginning—and in this case, that’s the 2021 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule. The annual Medicare fee schedule increase for DMEPOS services and items is based on a combination of two factors: 1) the change in the Consumer Pricing Index for All Urban Consumers (CPI-U) from June to June of the previous year, and 2) the annual multifactor productivity adjustment (MFP). The CPI-U for June 2019 through June 2020 was 0.6 percent, and the annual MFP adjustment was -0.4 percent. This resulted

in roughly a 0.2 percent increase in the 2021 DMEPOS fee schedule. Looking to next year, the CPI-U from June 2020 to June 2021 was 5.4 percent. The official MFP has not been released; however, it is expected to be between 0.2 and 0.4 percent. Given these numbers, it is possible that the 2022 DMEPOS fee schedule could see an increase between 5.0 and 5.2 percent. What about the mandatory 2 percent sequestration-based reduction to all Medicare payments? At the start of the COVID-19 public health emergency (PHE), the 2 percent sequestration-based reduction was suspended until Dec. 31, 2020, but was later extended to March 3, 2021. Then, the March suspension was extended to the end of this year. Currently, there is no indication that the suspension will continue past Dec. 31, 2021. The fee schedule also was impacted by the implementation of Round 2021 of the CBP—and not just for suppliers who won contracts in one or more of the 130 competitive bid areas (CBAs). The Social Security Act requires “that the payment determined under the competitive bidding program be used to adjust the fee schedule amounts that would otherwise be used in making payment for DMEPOS furnished outside of the competitive bidding areas for these items.” This means there is a statutory


requirement to adjust the Medicare fee schedule for the 23 off-the-shelf spinal and knee orthoses subject to Round 2021 of the CBP, including non-CBAs, and this adjustment became effective for dates of service on or after Jan. 1, 2021. The adjusted rates for non-CBAs are calculated using a rather complex formula that takes into account an average of the single pricing amounts established within multiple CBAs and whether the service was provided in a rural or nonrural area or ZIP code. Additional adjustments resulting from the PHE included a “blended rate” calculation methodology, resulting in a temporary increase in adjusted fee schedule amounts for nonrural areas. The blended rate calculation has been extended until April 20, 2021, or the end of the PHE, whichever comes later. As a result of the CBP, the fees for the 23 off-the-shelf spinal and knee orthoses saw a reduction, on average, between 35 and 40 percent in the CBAs.

New Codes in 2021

PHOTO: Getty Images

CMS in 2020 made a change in how it processes applications and requests for new or revised Healthcare Common Procedure Coding System (HCPCS) Level II codes. The agency implemented shorter and more frequent coding cycles. Previously, all code applications were required to be submitted by the end of the calendar year, and then the applications would be reviewed the following midyear, and any new codes or revisions would be implemented at the start of a new calendar year. This meant that if a code application was submitted in 2021, the review would take place in 2022 and a new code would be implemented in 2023. Under the updated process, code applications are submitted on a biannual basis for DMEPOS, and CMS publishes coding decisions more frequently. Code applications can now be submitted in January, for example, with a review in July and the codes becoming active in October; applications submitted in April will have a meeting and review in December and the codes may become effective in April of the following year.

In 2021, we saw the introduction of two new codes in April, instead of January; they were the result of the Second Biannual 2020 nondrug and nonbiological items and services review cycle (which includes orthotics and prosthetics), held in December 2020. These two new codes became active for dates of service on or after April 1, 2021: • K1014—Addition, endoskeletal knee-shin system, four-bar linkage or multiaxial, fluid swing and stance phase control • K1015—Foot, adductus positioning device, adjustable. In July 2021, CMS held the First Biannual 2021 nondrug and nonbiological items and services review cycle. This resulted in one new prosthetic code: K1022—Addition to lower-extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. The K1022 became effective for claims with a date of service on or after Oct. 1, 2021. Since these three new codes were all introduced midyear, they were assigned K codes, or temporary codes, and in due time they should be transitioned over to the more traditional L codes. At the time this article was written, none of these codes had been assigned a fee—they are paid under an individual consideration by each DME MAC. The Second Biannual 2021 nondrug

and nonbiological items and services review cycle should take place in early December, and it is possible that new O&P codes could be introduced with an implementation date of early 2022. At the time this article was written, there was no information available on the code applications for the Second Biannual 2021 nondrug and nonbiological items and services review cycle.

LCD, PA, and Coding Reminder Updates

The local coverage of determinations (LCDs) and policy articles (PAs) did not undergo significant change in 2021; however, the durable medical equipment Medicare administrative contractors (DME MACs) and the Pricing Data Analysis and Coding (PDAC) contractor did release new coding reminders and updates. First, on March 11, the DME MACs and the PDAC published a joint correct coding bulletin regarding HCPCS code descriptors that include only the term “prefabricated, includes fitting and adjustment,” and do not mention “offthe-shelf” or “customized to fit a specific patient by an individual with expertise” (or custom fitted). The bulletin indicates that HCPCS codes that only include the term “prefabricated, includes fitting and adjustment,” such as L0472, L1005, L1686, L1831, and L1910, are to be classified and categorized as O&P ALMANAC | NOVEMBER/DECEMBER 2021



custom-fitted orthoses. This means they may only be used to describe orthoses that require customization and/ or modification by a certified orthotist or other properly trained individual. This announcement also made it clear that orthoses described by these codes that are delivered as off-theshelf, without customization and/or modification, must be billed using the appropriate not otherwise specified code (L1499, L2999, or L3999). In addition, if a custom-fitted orthosis does not have a corresponding off-theshelf code, and the brace is provided as off-the-shelf (no custom fitting or adjustments), then you also must use the appropriate miscellaneous code. For example, the thoracolumbosacral orthosis, L0460, does not have an equivalent off-the-shelf code—so if the L0460 is provided without custom fitting, you must bill it as L1499. Next, the DME MACs and PDAC released guidance requiring the mandatory coding verification of products described by HCPCS codes L6715— Terminal device, multiple articulating digits, includes motor(s), initial issue or replacement, and L6880—Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s). So, for claims with a date of service on or after Jan. 1, 2022, only the products that have been verified and listed on the PDAC Product Classification List (PCL) as L6715 and L6880 may be billed to Medicare. Lastly, the DME MACs and the PDAC updated their correct coding guidance for the bilateral lumbosacral hip orthosis, L1690—Combination, bilateral, lumbosacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment. The guidance states that, at a minimum, an L1690 must have the following characteristics: • Contains left and right hip joints specialized for combined planar motion • Each hip joint uses rigid connectors for attachment to a rigid lumbosacral component to 18


maintain therapeutic alignment • Rigid lumbosacral component wraps around the posterior pelvis, includes anterior closures • Lumbosacral component extends from the distal sacrum to L2/L3 • Hip joints align the femurs in abducted posture, set by supplier • Each thigh cuff attaches to the rigid distal upright of each hip joint, includes closures • Each hip joint provides internal rotation control of the hip joint during ambulation • May be worn when seated and during ambulation.

In 2021, site inspection duties were transitioned to two new contractors: Deloitte Consulting and Palmetto GBA. Since the L1690 states “includes fitting and adjustment,” it would be considered a custom-fitted orthosis and require more than minimal self-adjustment at the time of delivery. In addition, there is no off-the-shelf equivalent for the L1690 so if it is provided without being custom fitted, it must be billed as L1499.

DMEPOS Supplier Enrollment Activities

CMS directed the National Supplier Clearinghouse (NSC) to suspend certain activities related to enrollment in response to the PHE. These suspended activities included the charging of the enrollment application fee, fingerprinting and background checks (for select suppliers), and the revalidation process for currently enrolled suppliers. These activities were resumed starting in October. Suppliers who missed their original revalidation date because of the PHE will be notified of their new revalidation due date in two ways: A letter will be sent to the most recent correspondence address on file with NSC and listed in the Provider Enrollment Chain and

Ownership System, and the Medicare Revalidation List ( tools/medicare-revalidation-list) will be updated to reflect the new dates. The letters and revalidation site will be sent and updated at least three months prior to the new revalidation due date. If you were originally scheduled to revalidate your locations and supplier numbers during the PHE, keep an eye out for your revalidation letter and begin checking the revalidation website. Failure to respond to the revalidation request by the revalidation due date will result in the deactivation of your Medicare billing privileges. The application fee will only apply to new locations that are being enrolled for the first time and any current locations being revalidated. The application fee for 2021 is $599; the fee for 2022 has not yet been released. Finally, as part of enrollment and revalidation, your locations are subject to site visits and inspections to determine compliance with the DMEPOS Supplier Standards. These site visits were previously conducted by NSC; however, in 2021, site inspection duties were transitioned to two new contractors: Deloitte Consulting and Palmetto GBA. Deloitte will handle site inspections west of the Mississippi River and Palmetto will handle site inspections east of the Mississippi River. This article reviewed some of the updates that took place in 2021—get ready for more change as we head into 2022. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit Earn CE credits accepted by certifying boards:

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NEED TO KNOW Ø O&P clinicians can make a big difference in the recoveries of their senior limb loss patients by ensuring they have optimal rehabilitation plans. Ø Rehabilitation programs that emphasize balance, gait symmetry, and reintegrating into the community are particularly important for patients with comorbidities. Ø Appropriate therapy and a healthy lifestyle can help senior patients improve motor function, neural function, and reaction times. Ø Prosthetists should be aware of older patients with decreased muscle density and reduced skin protection characteristics, which may impact volume changes and affect proprioception and socket fit. Ø Leveraging technologies such as telehealth and step-monitoring devices can enhance the rehabilitation process for older patients.


HE COMBINATION of amputation

PHOTO: Getty Images

and aging can be discouraging to older O&P patients. Many senior patients undergo amputation due to diabetes, peripheral artery disease (PAD), or other ailments, which can complicate the postamputation rehabilitation journey. Clinicians and rehabilitation professionals who work closely with these patients, help them commit to appropriate rehabilitation protocols, and offer encouragement can help them regain mobility—and hope.

Cory Christiansen, PhD, PT “Aging happens with us all,” says Cory Christiansen, PhD, PT, professor in the Department of Physical Medicine and Rehabilitation at the University of Colorado (CU) and co-director of the Interdisciplinary Movement Science Lab at CU’s School of Medicine. He works with postamputation seniors for his research, much of

which is focused on improving quality of life for people with major lowerlimb amputations due to complications of severe diabetes mellitus and severe PAD. When he asks older patients about their problems, “many of them will jokingly say, ‘Well, I’m just getting old,’” he reports. “But we don’t take that as an excuse.” Christiansen and his team focus on debunking the myth that aging inevitably leads to disability, and that older adults can’t get stronger or more active—“that hopeless kind of mindset,” he explains. When we look at aging, Christiansen suggests we must separate out “primary” aging, which is directed by genetics, from “secondary” aging, which is influenced by the environment and life experience—for example, health behaviors and physical activity. “We can address a lot of the causes of secondary aging that are reversible— things that you might not even think can be altered,” such as motor function, neural function and reaction times, and cognitive function. “It’s important for clinicians that work with older adults to identify those modifiable changes that happen with aging, and target those with intervention.” O&P ALMANAC | NOVEMBER/DECEMBER 2021



Strengthening, muscle extensibility, joint mobility, and neuromuscular coordination are alterable, according to Christiansen, so clinicians and physical therapists should work with seniors to identify their personal goals, then work on improving their physical function to achieve those goals.

exercise.” He emphasizes that exercise and training to regain balance and gait symmetry are particularly important. “Encouraging and creating a plan for senior patients to practice exercising and walking in their own living environments instills confidence that they can return to activities that they enjoy.”

Recognizing Seniors’ Unique Perspectives

Working with seniors who have comorbidities can be daunting, says Chelsey Anderson, CPO, FAAOP, a clinician and rehabilitation science research student in the Department of Physical Medicine and Rehabilitation at CU’s School of Medicine. Anderson, who collaborates with Christiansen to facilitate research studies geared toward improving health for seniors, points to a particularly alarming statistic: “There is an approximately 50 percent survival rate over five years after amputation in the older dysvascular population,” she says, citing a popular article in the Physical Medicine and Rehabilitation Clinics of North America. A focus on rehabilitation and mobility can help seniors in this population defy the odds to live longer and more productive lives.

Chelsey Anderson, CPO, FAAOP

“Maintaining a healthy lifestyle, including physical activities like walking, can help support the aging minds and bodies of seniors,” agrees Jesse Mitrani, CP, LP, a clinician at Hanger Clinic in South Florida who also provides mobile prosthetic services. “Staying active is critical for seniors with lower-extremity limb loss, to reduce illness, maintain flexibility, improve balance, and reduce chances of falling. Rehabilitation programs are important for them to learn proper techniques for safe ambulation and 22


Jesse Mitrani, CP, LP

Mitrani believes in the importance of community, which is supported by Christiansen’s and Anderson’s research: Their studies demonstrate a link between lack of community reintegration and poor physical outcomes following postamputation rehabilitation. “Being involved in the community socially is linked to improved health” for patients with lower limb loss, Christiansen explains. “With decreased social support, there’s decreased participation.” On the flip side, finding ways to help seniors show self-efficacy—to self-manage their healthcare or physical activity—may help them become more physically active and engaged in their community. The success of a patient’s rehabilitation journey also is dependent on the patient’s understanding of the process. “It’s important to detail the added health benefits of increased mobility when providing encouragement,” says Mitrani. When working with older patients and setting rehabilitation goals, he tries to identify important factors that will affect patients’ immediate and future outcomes, such as their ambulatory/mobility goals, home environment, ability to independently fulfill activities of daily living and self-care, and skin and hygiene considerations. In her work with dysvascular seniors, Anderson has embraced “motivational interviewing” techniques to help patients set realistic and attainable

goals. This is a collaborative style of communication wherein the healthcare professional listens to the patient’s concerns and priorities, then guides the patient to identify their own meaningful goals, in a patient-led approach. “We don’t make goals for them; we talk about what’s important to them,” by asking probing questions such as, “What brings you joy? What activities keep you on track for achieving that happiness?” explains Anderson. Patients’ motivations may be related to their family, specific activities, or continued independence, she says. “Especially as older adults, it’s emotional to accept the limitations of their bodies. As practitioners, we want to energize them to continue to want to achieve or accomplish some form of activity,” she says. “I lean on their values, and revisit their goals, and talk through the rationale behind their goals a little bit more frequently than with younger patients. “We help them set smaller, more realistic goals that they can accomplish over time,” she explains. This approach helps keep patients motivated and enthusiastic during their rehab, according to Anderson. Successfully achieving smaller goals will help them eventually return to the activities that matter most to them.

Promoting Progressive Exercise

Exercise during rehabilitation is important for senior patients, so prosthetists, PTs, and other rehab professionals should be careful not to treat older adults as if they’re fragile. “PTs sometimes worry they’re going to hurt patients if they push them too hard,” Christiansen says, explaining that the perceived fragility is related more to comorbidities than aging. “Being able to push people to test their boundaries and limits is really critical, especially with the older adult population, because many people aren’t getting ‘dosed’ the right amount of exercise and physical activity,” Christiansen says. Sometimes, clinicians think that they’re going to cause harm—“but the research would suggest not.”

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Mental Health Matters



lose a limb, you have to go through the stages of loss, no matter how expected or unexpected the loss may be.” Depression affects motivation for addressing health problems, and it limits people’s desire to participate in the community, which can result in reduced physical activity, Christiansen says. “Like other issues, it’s not inevitable, and it’s definitely treatable. “If depression is an issue, we have to address that head-on before we can make any headway with prosthetic rehabilitation,” adds Christiansen. He suggests engaging in direct conversations and asking patients if they are feeling depressed, and even employing some basic depression screening tools. “It’s not always comfortable, especially with new clinicians, to discuss this issue with patients” since prosthetists and PTs are not experts in this area. “But we don’t have to be mental health experts to be sure the patient has appropriate resources.” Christiansen’s team at CU includes a staff psychologist, but all clinicians can refer patients to local mental health experts.

IMAGE: Getty Images

Patients’ ability to participate in their rehabilitation can be affected by their mental health. Anxiety, diminished cognitive function, or mood disorders are all possibilities among the senior population, says Jesse Mitrani, CP, LP, a clinician at Hanger Clinic. “This can reduce their motivation to do their exercises. Memory function can cause problems for consistent, proper prosthetic use and care. There can also be effects to their balance, making them worried about falls,” he says. Finding the right prosthetic design to reinforce patients’ confidence is important, as is their continued practice through home training and rehabilitation, he says. “Support from immediate family, caregivers, friends, and community is very beneficial.” Cory Christiansen, PhD, PT, professor in the Department of Physical Medicine and Rehabilitation at the University of Colorado (CU), encourages practitioners to refer patients to mental health professionals, when appropriate. “Depression is common in older adults, and among older adults with amputation,” he says. “You

Older adults must build on the gains they make during rehabilitation appointments—developing their strength and joint motion—by continuing to exercise on their own, in their homes and their communities, according to Christiansen. “Just because we’re older, doesn’t mean we can’t have progressive exercise prescribed to us,” he says. He notes that best results occur when both the patient and clinician embrace the concept that progressive exercise will improve mobility. Of course, for patients with diabetes and PAD specifically, healing can be delayed, “so we have to be very intentional about how we move forward,” cautions Christiansen. “We want to be progressive in terms of increasing the amount of exercise and activity that people do, but we need to do it in a way that is tailored for the individual.” Some eager older patients may try to do too much immediately postamputation, “but they don’t have the capacity to heal as quickly as they did when they were younger,” Christiansen notes. If they ramp up the wear of their prosthesis too quickly, they risk developing a wound, which can delay rehabilitation for several months. For rehabilitation to be successful, patients require a well-fitting prosthesis— a more challenging proposition when working with senior patients. “Older patients commonly have other comorbidities that need attention,” says Mitrani. “It’s also important to take note of any medications they may be taking, as these will often play a role in limb presentation and limb maintenance as they progress through the different phases of rehab and mobility.” For patients who have diabetes or PAD, these pathologies affect the circulatory system and often are accompanied by nerve complications and reduced sensations, says Mitrani. “Senior patients also often have decreased muscle density and reduced skin protection characteristics, and can demonstrate limb volume fluctuations,” he says. “This can affect their proprioception, balance, and socket fit.”


He incorporates limb interfaces that can provide increased protection into the socket design and utilizes “knee and feet options to maximize safety, stability, comfort, and energy efficiency. “Volume changes and fluctuations need to be anticipated so that their activity and rehabilitation can be optimized,” Mitrani continues. When volume changes are identified, “we can plan for the ideal time of day for a casting appointment and diagnostic fittings. We can plan for use of volume socks in many cases, or, if applicable for the patient, incorporate an adjustable socket system.” It is critical to educate seniors and their caregivers on how to manage, adjust, and understand proper socket fit, using visual, tactical, and auditory feedback to reinforce the learning process, says Mitrani. It’s also important for O&P and rehabilitation professionals to explain to patients how their prosthesis may

PDAC Verified

“Volume changes and fluctuations need to be anticipated so that [senior patients’] activity and rehabilitation can be optimized.” —JESSE MITRANI, CP, LP

impact other aspects of their health— particularly because many patients with diabetes or PAD may also have kidney disease, high blood pressure, or peripheral neuropathy. “The rehabilitation specialists that work with older adults have to have a good

handle on the pathophysiology of all these conditions,” because they may cause limitations in the limbs, says Christiansen. For example, if a limb loss patient has diabetes, complicated by high blood pressure and neuropathy, “we have to talk about how they manage their blood glucose,” he says. Exercise may influence the patient’s blood sugar and blood pressure, as well as how their residual limb heals. “We have to do a lot of problem-solving as clinicians, but we also should engage the patient in the problem-solving” to prevent sores and episodes of low blood sugar, he says. Rehabilitation is likely to be most successful when prosthetists work closely with other members of the healthcare team—physical and occupational therapists, physicians, and even dietitians, says Christiansen. “It has to be a team effort with older adults, addressing their complex health conditions.”

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Leveraging Technology While some may view senior patients as technophobes, that’s been proven untrue for the majority of baby boomers. In fact, many seniors have embraced telehealth—which can enhance the rehabilitation process. “Telehealth really improves healthcare access” and increases the chances that seniors without social support or access to transportation will participate in appointments, says Christiansen. Telehealth also enables clinicians to work with patients in their homes, rather than the controlled clinic setting. “I see exercise as a health behavior, and for people to change health behaviors, they need to practice it in their own environment,” he explains. Seniors also benefit from adopting new self-monitoring resources, according to Anderson. Many of her older patients use Fitbits and other step-count monitoring devices to calculate steps each day as a frame of reference for their progress. “This has been huge—they’re getting information on how much they’re walking” more effectively than in the past, which helps to validate some of their feelings. “If they come in and they’re

“I see exercise as a health behavior, and for people to change health behaviors, they need to practice it in their own environment.” —CORY CHRISTIANSEN, PhD, PT

feeling really exhausted, we can talk through what it felt like, and what led to that exhaustion,” says Anderson. For example, if a patient with a recent amputation is adjusting to using their prosthesis, and they develop an ulcer on their residual limb, “we can look back to see what their Fitbit looked like that week,” Anderson explains. “They may realize they did a lot of shopping—which involved much more walking than they realized—maybe 2,000 steps more than they normally take.”

Prosthetists and rehab professionals can use that information to set safer ranges for activities. In addition, this feedback “allows for setting smaller goals that empower an individual to work up to larger tasks safely.” Of course, technology also is integral to the prostheses themselves. Many patients who meet the criteria for microprocessor knees are learning to walk with these more advanced components. “We rely on our thorough clinical evaluations and specialized treatment plans to support our patients’ mobility needs and goals. We will use specialized technology when applicable to ensure positive treatment outcomes,” says Mitrani. “Detailed research studies have demonstrated microprocessor knee technology is able to provide patients with superior clinical and economic results compared to mechanical systems.” For patients who are benefiting from microprocessor feet or knees, they can allow clinicians to view and analyze their activity from stored data on the device, according to Mitrani.

Offering Hope

Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at 26


PHOTO: Getty Images

Prosthetists who treat senior patients should recognize their position in the rehabilitation process. “Our field has always acted as patient champions,” explains Anderson. “We’re the ones that are driving the ship in a lot of ways, and there is a lot of uncertainty that people experience.” Because O&P professionals are typically more accessible than other members of the healthcare team, “it falls on prosthetists many times to clarify the whole process and elucidate what needs to happen in order to actively and effectively use a prosthesis,” she says. “It’s really challenging for a lot of patients, and prosthetists can serve as a pillar in the process.”


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NEED TO KNOW • O&P companies at all levels are facing backlogs in their orders for materials and products, triggered by plant closures, labor shortages, and shipping and port delays. • In response, some manufacturers and distributors are stocking up on available supplies, offering substitute materials, and advising patient-care facilities to order early and anticipate patients’ needs.

• Supply chain disruption is causing delays in delivering devices to O&P patients—some of whom are sympathetic, but their expectations remain high.



PHOTOS: Getty Images

• Some clinics are increasing their use of 3D printing, when appropriate; printer supplies are delayed, too, but they are not as difficult or expensive to come by as casting materials.



triggered by the COVID-19 pandemic and exacerbated by pent-up demand for goods is affecting nearly every segment of the U.S. economy, and the O&P industry is no exception. Major snarls in the supply chain— that is, the path on which goods get from where they are manufactured or harvested to those who want to buy them—is not only disrupting the flow of goods and services, but also fueling worries about inflation. Rising costs for supplies and materials are creating concerns that patient-care providers whose payor contracts do not adjust for inflation will not be compensated for their increased expenses to care

for patients. For instance, The Chicago Sun-Times recently reported the price of ethylene, a component of modified polyethylene often used in socket liners, is up more than 40 percent. Meanwhile, the supply of plastic resins took a hit not only from the pandemic, but also due to a winter storm that dramatically reduced domestic production capacity and increased prices 30 to 50 percent, according to an industry report. Not surprisingly, hospitals and healthcare providers across the spectrum are reporting universal problems procuring medical supplies, according to a survey by the healthcare consulting firm Kaufman Hall. Roughly eight in

10 respondents said pandemic supply shortages have forced them to seek out new vendors and even stockpile supplies when possible. The overall supply chain crisis is so acute, and so pervasive, that President Joe Biden has asked the European Union and 14 “like-minded” countries to cooperate on near-term supply chain disruptions. At the same time, the White House points out that more goods than ever are moving across American ports, warehouses, and stores. Between January and September of this year, more than 7 million loaded containers were imported, 18 percent more than the same period in 2018, which had been the previous record. O&P ALMANAC | NOVEMBER/DECEMBER 2021


O&P device manufacturers and distributors are experiencing difficulties obtaining raw materials, especially plastics and resins that are produced in Asia, because they are in short supply. And when materials are available, significant shipping delays are adding to the lag time. O&P product distributors and fabricators report that when they can obtain hard-to-get materials or components, they’re stocking up. But that can be difficult for labs with constrained space, and may require them to seek out storage, which adds to operational costs. Some also report staffing shortages in-house, which reflects an extremely tight labor market nationwide. Many O&P businesses have been forced to innovate workarounds to meet customer needs.

Materials Shortages



PHOTOS: Getty Images

“Our biggest issue is managing the inconsistency of imported goods from overseas,” says Jeff Collins, president of Cascade Orthopedic Supply, which is headquartered in Chico, California. “Unfortunately, these same issues impact our domestic suppliers, many of whom rely on raw materials coming from overseas.” About 20 percent of the industry’s

products come from overseas, according to Pete Stoy, chief operating officer at Hanger Inc. “Plant closures, labor availability, and shipping and port delays have increased product lead times and caused product backorders of 30 to 90 days,” he says. In addition, domestically skilled manufacturing labor shortages, coupled with wage increase pressures, have increased manufacturing lead times. “Raw material price increases— especially oil-based products—and manufacturing interruptions from weather events have also added to supply interruptions,” Stoy says. To minimize the impact, Hanger has been proactive in partnering with its suppliers on long-term usage forecasts, has increased its warehouse safety stock inventory levels, and is redirecting customers to clinically equivalent alternate items, according to Stoy. At Cleveland-based PEL, shipping delays are problematic, but an increasing lack of clarity about order statuses is making a bad situation worse, says Michael A. Sotak, president and CEO. “One of our biggest challenges is obtaining accurate and reliable information from our vendor partners when purchase orders are

delayed,” he explains. “Our goal is to provide our customers the best possible service, which includes providing accurate availability information.” The company is offering alternative brands and product solutions for scenarios “where first-choice products are unavailable or delayed.” Sotak reports that petroleum-based products, resins, and products originating in Asia seem to be the most affected by the supply chain breakdown. General supplies have only been a problem intermittently. He also says it’s been a challenge to get “consistent vendor partner performance filling purchase orders” completely and on time. “Carriers no longer guarantee delivery times, and they are warning that their service levels will get worse as we approach the holidays,” Sotak says. “The volume of packages is simply more than their capacity, which is resulting in longer delivery times to customers.” Most everyone in the O&P industry is in a similar situation, and everyone in the supply chain—even most customers—are sympathetic, but that doesn’t solve the real problem. “Customers understand what is happening, but their expectations remain high,” Sotak explains. To help mitigate the supply chain issues affecting his customers’ practices, he is advising facilities to “order sooner, order more.” He explains, “We suggest they revisit their ordering processes, specifically reviewing the timing of when items are ordered relative to when patients are scheduled. Adding two to three days may avoid having to reschedule patients who show up and the ordered items have not arrived.” Long Island City, New York-based Hersco Ortho Labs, a lower-extremity central fabricator that specializes in custom foot orthotics, ankle gauntlets, and ankle-foot orthoses, has encountered particular difficulty acquiring an adequate supply of cork and ethylenevinyl acetate (EVA). Hersco technicians typically use the materials in large, thick sheets placed on CAD/CAM router tables to carve custom foot orthotics.

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How To Manage Supply Shortages • Identify historically challenging supplies. Develop acceptable substitutes, if possible, and diversify and partner with several alternative suppliers to ensure that critical needs are met. • Focus on inventory management. While supply chain staff must collaborate with clinical staff to ensure their inventory needs will be met, supply chain staff should have full responsibility for inventory management so clinical staff can focus their energy on delivering patient care. Utilize technology as economically feasible to gain early insight into issues and enhance maintenance, efficiency, and accuracy. • Gather supply chain data and build supply demand models per category or supply item. Share this data with vendors, request the same supply chain visibility from them, and work together to evaluate and verify the accuracy of the data. Be conscious of variations in product demand from historical usage patterns, which may be attributable to short-term disruptions in patient census or the supply chain. • Manage vendors. Thoroughly vet all vendors to understand past performance, initiate vendor business reviews with targeted vendors, and institute bilateral information and data sharing regarding supply availability. SOURCE: Kaufman Hall’s 2021 Fall Report



the company has had to improvise to meet other supply shortages: “We have paid higher prices to alternate vendors to get what we want,” while waiting longer for deliveries, Kennedy notes. “In certain cases, we have accepted close substitutes. For example, the plaster bandage we use for cast pouring was changed. It did not affect the final product, but it altered the process.” Hersco also is planning further ahead to meet its ongoing supply challenges, according to Kennedy. “In order to secure supply, ensure seamless production, and insulate our customers from the [supply chain] issues, we have invested in larger inventories and triggered reorders sooner.”

It’s not just the manufacturers that are coping with supply chain delays. O&P facilities also are finding ways to shorten the lag times in delivery of devices. Eric Shoemaker, CPO, executive director of clinical operations at Ability Prosthetics & Orthotics, headquartered in Exton, Pennsylvania, says his company has been challenged by delays due to supply chain issues, as well as COVID-19-induced staff shortages. “One fabricator sent everyone’s jobs back when he was forced to quarantine for 14 days,” he says. “They’re all having difficulty hiring, too. “It’s delaying care, and we are having to find creative solutions” in some cases, says Shoemaker. For example, Ability P&O has a contract with prisons to fit patients with diabetic shoes. When “we learned our supplier was back-ordered until February or March,” the team found comparable shoes to provide the prisoners to ensure they receive timely care. Some clinics are pursuing high-tech solutions to their problems. Comb O&P, an Ohio-based 3D-scanning company designed by and for O&P practitioners, is seeing interest in its services spike. Stefan Purington, Comb O&P’s accounts manager, says he’s had at least a dozen conversations with potential new clients since mid-October stemming from their frustrations with supply chain challenges. “Because of COVID-19 and supply shortages, there are a lot of materials that are more expensive and sparse,” Purington says, citing plastic and plaster casting materials in particular. Before the supply chain issues spiked, practitioners generally sent casts to fabrication facilities and would expect to get devices back “in a few days.” Those days—at least for the moment— are a thing of the past. That’s not only because supplies are tight, but because a glut of orders and cutbacks in the U.S. Postal Service have slowed shipping times. “It’s taking four

PHOTOS: Getty Images

Seamus Kennedy, CPed, BEng(Mech), and owner/operator at Hersco Ortho Labs, says he learned from his supplier in late summer that inventory of cork and EVA was running low. “Their raw material was bottlenecked in California, so as an alternative we accepted delivery of half sheets,” Kennedy explains. “Using smaller sheets is less efficient, but maintaining delivery to our customers is more important than internal efficiency.” Hersco also made preparations to use a similar substitute material if supplies became completely depleted, says Kennedy. “So far, we have not had to deploy this contingency,” he says, and he is hopeful that the supply chain pressures are easing. However,

Patient-Care Solutions

or five-plus days to get it there, and an equal amount of time to get it back,” Purington says. The supply shortages also affect 3D printing, but not as much as traditional fabrication. “The 3D-printing components are going to be a little bit more difficult to get, but at the same time they are still readily available. You can purchase them in bulk, and you can have them shipped, so I don’t think the actual filaments for 3D printers will be as difficult or as expensive to come by as something like casting materials.” Collins also points to employee shortages as a problem in solving supply chain disruptions. “Staffing has been a challenge” for Cascade, “but fortunately, we have been able to manage the operational needs with reduced staffing levels,” he says. “Overtime and temporary labor have also helped augment our traditional staff levels, but these temporary measures are not longterm solutions.”

Cascade has plans in place to return to pre-pandemic employment levels, except in its distribution centers, where they’re moving toward automation to alleviate labor shortages in entry-level jobs, according to Collins. “In our distribution centers, we have invested heavily in technology and the inVia Robotic Automation System to help mitigate the impact of labor shortages,” Collins says, adding that it is not just a temporary solution. “Automation will be deployed at all of our sites and will reduce labor in entry-level positions that historically have had the highest turnover,” he explains. “We had been in the planning stages for this technology years before the pandemic.” SPS, a distributor of O&P devices and components, is advising customers to order items that are already in-stock when possible, according to Regina Weger, president of SPS. “With our new ‘typically in-stock’ filter on our website, we have made it easier than

ever for customers to find the products they need and determine their availability,” she says. “Customers should also be flexible when possible by ordering alternative, comparable product choices if their regular items aren’t available.” It’s hard to tell how long the O&P industry—and the U.S. economy at-large—will have to contend with supply chain disruptions. But Weger says planning ahead and devising alternatives is the smart play. “While there is no way to really know when these issues will be resolved, we do expect to see some of the same challenges through 2022, including shipping delays, inflation, and labor shortages,” she says. “Until then, SPS will concentrate on our safety stock and finding alternative options for our customers, so they can focus on their patients.” Michael Coleman is a contributing writer to O&P Almanac.

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O&P and the Vaccine Requirements Who must be vaccinated against COVID-19 to remain in compliance with CMS and OSHA rules?

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 39 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.









COVID-19 were clarified in the November 5 Federal Register, which featured CMS’s Interim Final Rule and the Occupational Safety and Health Administration’s (OSHA’s) Emergency Temporary Standards (ETS). These two separate but complementary regulations established COVID-19 vaccination requirements for a large swath of healthcare workers and other privately employed individuals. With these two new rules, four types of workers fall under some type of vaccine mandate, directly or indirectly, and are required to be fully vaccinated by Jan. 4, 2022: federal workers, federal contractors, healthcare workers, and anyone employed by a company with 100 or more employees. The two rules share many similarities: They both require a plan to have all covered and eligible employees to be fully vaccinated by Jan. 4, 2022, and they require a plan to track the vaccination progress and allow for religious and medical exemptions. However, there are some differences—the biggest difference being that the CMS rule does not allow for a weekly testing option in lieu of getting vaccinated, whereas the OSHA ETS does offer this option.

Here, we examine the two rules to more clearly explain the similarities and differences, and provide tips and ideas to help you prepare for and comply with the provisions that may apply to you and your facility.

CMS Interim Final Rule

The CMS rule only applies to certain Medicare and Medicaid providers and suppliers that are regulated under specific health and safety standards known as Conditions of Participation (CoPs). The following facilities are subject to CoPs, so their eligible employees are subject to the CMS rule: • Ambulatory surgical centers • Hospices • Psychiatric residential treatment facilities • Programs of all-inclusive care for the elderly • Hospitals (acute care hospitals, psychiatric hospitals, hospital swing beds, long-term care hospitals, children’s hospitals, transplant centers, cancer hospitals, and rehabilitation hospitals/inpatient rehabilitation facilities) • Long-term-care facilities, including skilled nursing facilities and nursing facilities, generally referred to as nursing homes

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• Intermediate care facilities for individuals with intellectual disabilities • Home health agencies • Comprehensive outpatient rehabilitation facilities • Critical access hospitals • Clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services • Community mental health centers • Home infusion therapy suppliers • Rural health clinics/federally qualified health centers • End-stage renal disease facilities.

has a contract with a facility, or your practitioners have privileging rights at one of the named facilities, those staff members must be fully vaccinated. “Fully vaccinated” is defined to mean that you have received the single-dose vaccine (Johnson & Johnson) or both doses of a multidose vaccine (Moderna, Pfizer, etc.) by Jan. 4, 2022. “Fully vaccinated” does not require you to obtain a booster shot. To ensure compliance with the CMS rule, the above-listed facilities and suppliers must complete some basic requirements: institute a plan or process to vaccinate all eligible employees and staff, institute a process for providing exemptions (religious or medical), provide accommodations for those who are exempt (masks, social distancing, etc.), and create a plan for tracking employee vaccinations.


The vaccination requirement in the CMS rule applies to all individuals working at the facilities listed above— whether or not they have direct contact with patients. This includes facility employees, licensed practitioners, students, trainees, volunteers, and those who provide care or treatment to patients or any other services under a contract or other arrangements. It does not include teleworkers, but it does include employees who may work remotely or off site and have interactions with patients. O&P facilities and professionals are not included in the list of facilities subject to the CMS rule and CoPs, and are therefore not directly subject to mandatory vaccination as a requirement for continued Medicare enrollment. However, they may be indirectly affected. For the above facilities to be compliant with the rule, anyone entering the facility to provide care must be fully vaccinated. So, if your O&P facility 36


The ETS released by OSHA is much broader in scope and applies to all U.S. employers that employ 100 or more employees. The OSHA ETS is focused on promoting safety in the workplace and is not limited to any industry or profession. Unlike the CMS rule, the OSHA regulation provides an alternative to vaccination that would allow employees to undergo weekly COVID-19 testing; however, the employer is not required to pay for the testing and the unvaccinated individual must wear appropriate face coverings while at work. The OSHA ETS requires all eligible employees and those not exempted for religious or medical reasons to be fully vaccinated by Jan. 4, 2022, and the definition of fully vaccinated is the same as discussed previously. The eligible employees, or those that make up the 100 total, are slightly different than described in the CMS rule. The OSHA 100-employee count is conducted at the company level as a whole and not by an individual location level. So, if you have satellite offices or locations for a single corporate entity, all employees at all locations are to be counted. This includes all part-time employees as well as employees who

are teleworking/working from home. However, the OSHA ETS does not apply to employees and workers who do not directly report to a workplace where other individuals such as co-workers, customers, or patients are present; this means that staff who are working from home are still counted in the employee totals, but they are not required to be fully vaccinated by the deadline. To ensure compliance with the OSHA ETS, those companies that have 100 or more employees must meet the following requirements: develop and implement a policy on vaccination; determine the vaccination status of all employees; support employee vaccinations (via paid time off); implement testing for employees who are not fully vaccinated; require employees to provide notice of a positive COVID test; require face coverings for nonfully-vaccinated employees; provide information to employees about the ETS and vaccines; report work-related COVID fatalities and hospitalizations; and make your records available.

Compliance Tips

The CMS and OSHA rules are currently being challenged in court and could possibly be altered—but that does not mean you should wait to comply. These rules are effective immediately, so you must accomplish several steps now if your facility falls into the categories described within the rules. Determine your coverage. Are you required to follow the CMS rule or OHSA’s ETS—or are you not included in either? Also, determine which employees are required to be fully vaccinated.


Determine the vaccination status of employees. You must determine and maintain the vaccination status of all employees and staff. Create a log indicating the vaccination status of each employee (fully vaccinated, partially vaccinated, weekly testing results, etc.). This log does not need to track and record those who have received additional booster shots.


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Compliance/Implementation Date

CMS Rule


Establish written policy on vaccination

On or before Dec. 6, 2021



Determine vaccine status of employees

On or before Dec. 6, 2021



Ensure non-fully-vaccinated employees wear face coverings

On or before Dec. 6, 2021

Not an option, except for exempted employees


Provide employees with information about the rules and company policies/procedures

On or before Dec. 6, 2021



Ensure all employees are fully vaccinated

On or before Jan. 4, 2022



Ensure non-fully-vaccinated employees are tested weekly

On or before Jan. 4, 2022

Not an option, except for exempted employees


Employees receive the single-dose Johnson & Johnson vaccine

On or before Jan. 4, 2022



Employees receive the first dose of the Pfizer-BioNTech vaccine (two doses required)

On or before Dec. 14, 2021 (second dose will be 21 days later)



Employees receive the first dose of the Moderna vaccine (two doses required)

On or before Dec. 7, 2021 (second dose will be 28 days later)



Review and update your paid-time-off (PTO) requirements/policy. Under the OSHA rule, employers are required to provide employees with up to four hours of PTO to schedule a vaccine appointment, complete the paperwork, receive the vaccine, and travel to and from the vaccination site, but only if the vaccination takes place during normal business hours. You also must provide a fair amount of paid sick leave for an employee to recover from any side effects following vaccination.


Create a policy. Develop a policy to address the new rules. The policy should include information regarding implementation date, to whom the policy applies (covered and eligible employees), deadlines (e.g., deadline for getting vaccinated), and procedures for compliance and enforcement. The main body of your policy should address these elements of the CMS and OSHA rules: • Requirements for COVID-19 vaccination • Applicable exclusions from the written policy (e.g., medical




• • • • • • •

contraindications, medical necessity requiring delay in vaccination, or reasonable accommodations for workers with disabilities or sincerely held religious beliefs) Information on telework, if this is provided as an option (teleworkers under the OSHA ETS do not need to be vaccinated) Information on determining an employee’s vaccination status Information on PTO for obtaining the vaccine Notification of positive COVID-19 tests Information on testing options (OSHA ETS only) Removal of COVID-19-positive employees from the workplace, and guidance on when it is safe to return Information on how you will share CMS and OSHA rule requirements with employees Information on masking requirements for unvaccinated employees, if applicable.

It’s not necessary to develop this policy from scratch—OSHA has created a policy template you may

use to create a policy tailored to your company. Visit the OSHA website, Start communicating with employees. The rules do not specify the frequency by which you must provide information to your employees, or the manner in which you must communicate (memos, letters, emails, meetings, etc.). However, they do specify that you must provide employees with information about the rules, employees’ rights and protections, and the benefits of vaccination. So, you must inform each employee in plain everyday language about the requirements and the policy you’ve developed to address the requirements (employee vaccination status, PTO for vaccines, notices of negative COVID-19 testing, etc.). You also are required to share information on the safety and benefits of being vaccinated by providing access to CDC’s “Key Things To Know About COVID-19 Vaccines.” Examine the size and geography of your location and determine the best method of relaying vaccination information to your employees.



Create record-keeping and reporting procedures. This involves a three-step process. First, the OSHA rule states that employers must create steps or procedures for employees to report, without delay, a positive COVID-19 test or positive COVID-19 diagnosis to their employer; and positive employees must be removed from the workplace until they meet the CDC’s return-to-work criteria. Ensure your employees understand how and when to notify you if they test positive for COVID-19. Second, in alignment with Tip 2, a log of employees’ vaccination status must be kept among confidential medical records and must be retained, at a minimum, the length of the ETS. Acceptable proof of vaccination status includes the following: • A record of immunization from a healthcare provider or pharmacy • A copy of the COVID-19 vaccination record card • A copy of medical records documenting the vaccination


• A signed and dated employee attestation. Keep in mind that you are required to make available to an employee, or an employee representative, the aggregate number of fully vaccinated employees at a workplace, along with the total number of employees at that workplace, if requested. Finally, as with already standing OSHA requirements, you must report to OSHA any work-related COVID-19 fatalities within eight hours of learning about them, and work-related COVID-19 in-patient hospitalizations within 24 hours.

Mandate for Federal Contractors

The mandate for federal contractors does not apply directly to O&P facilities; however, it may impact facilities or practitioners indirectly. For example, if you are applying for a future contract with the Department of Veterans Affairs (VA),

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there may be a stipulation in the contract requiring you to be vaccinated. In addition, just like the CMS rule, if you enter a federal facility to conduct business, you would be required to be vaccinated. So, if you visit a VA hospital to provide care, you must be vaccinated. Contact AOPA if you have any other questions about the new vaccination rules. Don’t wait to the last minute; begin your compliance now. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at Editor’s Note: Multiple federal lawsuits have resulted in temporary injunctions preventing enforcement of the CMS, OSHA, and Federal Contractor vaccine requirements. AOPA will continue to provide updates as these lawsuits are pursued.

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Solving Pediatric Problems Biomedical engineer focuses studies on pediatric O&P patients

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.




concluded a long line of research in collaboration with Children’s Healthcare of Atlanta (CHOA) on prosthetic prescription protocols for children with limb loss requiring a knee component. The project started in the late 1990s when Geil, who is currently professor and interim associate dean for research

and operations at Wellstar College of Health and Human Services, Kennesaw State University (KSU), first learned that CHOA was achieving positive results when providing children with a working prosthetic knee much earlier than standardly advised. “Since then, we’ve collected 3D-instrumented motion analysis on children walking with and without locked knees, on younger children crawling with and without a knee, and most recently in a multisite study on children in what we call the ‘early knee’ protocol compared to children in the traditional prescription protocol,” says Geil. The results have consistently shown that children who receive a knee earlier develop more normal gait patterns at an earlier age and also are afforded opportunities to meet other developmental milestones at more normative ages. “We’re seeing this research start to find its way into medical textbooks, and we believe it’s actually changing the accepted protocols at multiple facilities,” Geil says. “It’s a distinct pleasure to see the research we conduct in our labs not only make it into the world in scientific publications, but also have a direct and meaningful impact on the development of children around the country.”

PHOTO: Mark Geil, PhD




Diving Into O&P

Geil decided to pursue a career in biomedical engineering back when he was in high school, during a career day. “I was already drawn to engineering because I enjoyed building things and taking them apart, and did well in science and mathematics,” he says. “But when I learned there was a discipline within engineering so focused on directly helping people, I was all in.” He went on to earn his bachelor’s degree in mechanical engineering from North Carolina State University in 1993. While pursuing his doctorate in biomedical engineering at Ohio State University, he took an O&P class designed for the medical students. In the hospital where the course was taught, “I learned about energy-storing prosthetic feet, which at the time were relatively new, and learned that gait lab-based research was giving unclear messages about their effectiveness. I set to find out why and have been working in O&P ever since—over 25 years now.”

OPAlmanac_Nov2021.indd 2

During those two and a half decades, Geil participated in many studies designed to benefit O&P patients, including a plethora of pediatric studies. One of his often cited plagiocephaly studies investigates results in infants who use cranial remolding orthoses designed with a noninvasive laser shape digitizer. Today, as associate dean at KSU, Geil is responsible for facilitation and oversight of faculty and student research. He assists with grant proposals, collaboration development, and public awareness of the work being carried out at Wellstar College of Health and Human Services. He also is responsible for the college’s facilities and operations. Geil and his research team are currently focusing on the role of cognitive bias in gait, particularly with respect to O&P devices. “We have one line of research on confirmation bias, studying the possibility that people who are given an advanced, computerized device, or maybe just an expensive device, might alter their feedback—or

even their motion—just because they expect the device to perform better, regardless of the device’s actual function. We have some fascinating results already,” he says. Subjects given a standard knee orthosis who were led to believe it had dynamic microprocessor control very highly favored the device’s stability and function, according to Geil, even though they did not actually walk any differently with it. Geil’s team also is studying children with idiopathic toe walking. “We’ve developed a strong team of international collaborators and, with each study, are closing in on finally identifying the etiologies of the condition.” Looking to the future, Geil plans to expand his work on cognitive biases, “because I think it undergirds all the research we do on advanced devices, and the future will undoubtedly hold more and more technological advancements,” he says. “I’m also invested in continuing our work with idiopathic toe walking until we find a cause and can

9/7/2021 9:23:15 AM O&P ALMANAC | NOVEMBER/DECEMBER 2021



develop tailored treatments, instead of just trying to treat the symptoms.” Geil also plans to continue collaborating with orthotists and prosthetists in the years to come. “As an engineer, I recognize the importance of the clinician in the research process, which is why I’ve worked so closely with clinicians on all of my research projects,” he says. “I’ve had lots of ideas for research projects that don’t resonate with clinicians, so I don’t pursue them. I believe research that involves clinicians will always be more clinically applicable.”

Facilitating O&P Education



Notable Works

Mark Geil, PhD, has been involved in dozens of important published studies, including the following: • Geil, M.D., Safaeepour, Z., Giavedoni, B., Coulter, C.P. “Walking Kinematics in Young Children With Limb Loss Using Early Versus Traditional Prosthetic Knee Prescription Protocols.” PLoS ONE, 2020; 15(4): e0231401. PMID: 32275734 PMCID: PMC7147787. https://doi. org/10.1371/journal.pone.0231401 • Balsamo, B., Geil, M.D., Ellis, R., Wu, J. “Confirmation Bias Affects User Perception of Knee Braces.” Journal of Biomechanics, 2018; 75: 164-170. PMID: 29724537. https://doi. org/10.1016/j.jbiomech.2018.04.028

• Fanchiang, H., Geil, M.D., Wu, J., Ajisafe, T., Chen, Y. “The Effects of Walking Surface on the Gait Pattern of Children With Idiopathic Toe Walking.” Journal of Child Neurology, 2016; 31(7): 858-863. • Plank, L.H., Giavedoni, B., Lombardo, J.R., Geil, M.D, Reisner, A. “Comparison of Infant Head Shape Changes in Deformational Plagiocephaly Following Treatment With a Cranial Remolding Orthosis Using a Noninvasive Laser Shape Digitizer.” Journal of Craniofacial Surgery, 2006; 17(6), 1084-1091.

PHOTO: Mark Geil, PhD

In addition to his research responsibilities, Geil is proud of his work in O&P education—in particular, helping to launch the O&P master’s program at Georgia Tech two decades ago. “In the summer of 1999, I first learned of discussions among the engineering faculty at Georgia Tech regarding the future need for advanced degrees in O&P,” he recalls. Because he was conducting research in the area, Geil became involved and wrote the proposal to the Georgia Board of Regents for what became the world’s first entry-level master of science degree program in O&P. “We started the program in 2002, and it quickly became a leading model in how to elevate education to the master’s level, how to infuse research into O&P curricula, and how to balance clinical skills with advanced engineering

concepts,” he says. Eventually, the accreditation model used nationwide moved to the master’s level. Most recently, after administrative changes, the Georgia Tech program found a new home at Kennesaw State University. (See “Education Upgrades” in the September issue of O&P Almanac.) “I’m teaching a clinical gait analysis class to the first class of 24 students this semester, and it feels just like old times.”

Outside of his day job, Geil has a unique part-time gig: He works in Atlanta’s booming movie and TV industry. “I’m a blur in the background of movies like ‘Avengers: Endgame’ and the ‘Hunger Games’ series,” he says. “I should be making an appearance on the upcoming season of ‘Stranger Things,’ and I even played a cadaver on a show called ‘The Resident.’” In his spare time, Geil spends time with his wife and three daughters. “This year, we welcomed our first grandchild, who is just delightful,” he says. During the pandemic, Geil and his wife purchased an RV, and they have spent time traveling to state and national parks. But the travel will have to fit within his current work responsibilities, as Geil plans to spend many more professional years studying pediatric outcomes. “It’s a challenging population with which to conduct research, which might be why it’s understudied in O&P, but that just motivates me more,” he says. “I consistently find that we don’t give kids enough credit for what they’re naturally capable of when we plan for components and rehabilitation.”



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Filling Their Needs Clinicians launched fabrication firm to access components quickly and cost-effectively




Lower-limb orthoses are among the products manufactured at HiTek Fabrication.

work best with repetitive tasks. We developed an algorithm so these robots can handle unique items,” he explains. The result is OWNERS: that clinicians receive something Shawn Bright, CO, consistent. “They can specify and Tracy Ell, CP trim lines and they will be exactly that, every time. You don’t have to rely on a tech knowing that a LOCATION: St. Peters, Missouri clinician likes it a certain way,” he says. “The machines do it the same way, every time.” HISTORY: According to Bright, other Three years companies have dabbled in similar technologies, but none have implemented a process that is faster than a human doing it. “That’s been the sticking point,” he says. “But we have been able to develop robots that can do it more quickly than a human.” HiTek also has its own CNC milling machines, which carve metal and other materials to produce items for prosthetic components. “If we use it in the O&P field, these machines can produce it,” says Bright. The company manufactures industry-standard and proprietary devices, including Prosthetic liner cover lower-extremity orthoses, spinal bracing, pediatric pronation/ supination braces, pediatric

COMPANY: HiTek Fabrication


Deborah Conn is a contributing writer to O&P Almanac. Reach her at

PHOTOS: HiTek Fabrication

Tracy Ell, CP, founded HiTek Limb and Brace, an O&P patientcare facility in Columbia, Missouri, in 2000. Several years ago, the clinicians sought out a company to manufacture a part they needed, but the companies were all too busy, recalls Bright. “One of my friends was a machinist, and we started talking about making our own parts, which led us to create a central fabrication lab,” he says. “At first, we only made parts for our own clinics, but word spread and other practitioners started sending us work.” Bright and Ell launched HiTek Fabrication in 2018 in St. Peters, Missouri, and they continue to serve both their own clinics and those of O&P professionals worldwide. The company, which has grown to 25 employees, has never formally marketed its services, relying The HiTek HOPS System solely on word is used to make custom of mouth, prosthetic liners. says Bright. The owners are committed to finding the most cost-effective methods of producing highquality products, and for HiTek, automation is key. “We’re creating devices that are custom molded and not scaled, using robots to make the process more efficient by carving the foam, trimming the brace, buffing it, and drilling holes for straps,” says Bright. “Robots don’t like it when the process is unique for each item—they

subtalar-control foot orthoses, and a full range of upper- and lowerextremity prosthetic devices. The company developed a system, patent-pending, that allows practitioners to produce foam blanks in house, a process that can save up to 80 percent on foam, says Bright. “HiTek Limb and Brace was paying $220,000 a year for foam, and now we are paying $33,000,” he notes. The patent-pending HiTek HOPS system allows practitioners to create just-in-time foam blanks, saving on inventory and storage space and avoiding steep shipping costs from foam blank manufacturers. The system is modular, allowing facilities to start small and add new molds as needed. “The tech uses a computerized gun, which fills the metal mold with the exact amount of foam required,” he explains. “After the foam expands and hardens, the tech removes it from the mold and it’s ready for carving.” HiTek’s prosthetic liner system is another cost-saving innovation; it allows clinicians to pour liner molds in the office. “So a liner you might buy for up to $250, you can pour in the office for $50 or less,” Bright says. “This is a modular system, too, so customers can choose the appropriate-size mold.” Bright’s overarching goal is to help O&P return its focus to service rather than products. “When we bill for a device, it includes both the product and the service. The issue is that the products are starting to exceed the reimbursement, so we are not getting paid for any of our service,” he says. “Our intention is to reduce the product cost so that we can focus on the excellent service our patients need.”

At Renewal, Remember


Contact Us Today • 800-796-8495 Orthotics and Prosthetics Program Application 4610 Market Street, PO Box 3989 Youngstown, Ohio 44513

1. Download the O&P Program Application at:

Policy Effective Date:

I. ACCOUNT INFORMATION 1. Business Name: 2. Mailing Address: 3. City: 5. Contact Name and Phone Number:

The Exclusively Endorsed AOPA Insurance Agency

7. Coastal State: Yes




4. Phone: 6. Fax: 8. Number of locations:

(If yes, distance to body of water):

9. Do you have a website? Yes 10. Email address:


(If yes, URL):

II. DESCRIPTION OF OPERATIONS 1. FEDERAL TAX ID #: 2.Corporation:Yes 3. Provide a brief description of operations including years in business:


Individual: Yes


4. If new venture, please explain your prior experience, how many years, and what position and field this experience is in: 5. Practitioner for Patient Care Certified by ABC or BOC? Yes 6. Any business conducted other than Orthotics & Prosthetics? Yes 7. Current Insurance Carrier:





Pedorthic Footwear Association

Is the facility accredited? Yes


(If yes, please describe):

Years with carrier:



III. CLAIMS HISTORY 1. Have you had any losses in the past 3 years? Yes


(If yes, please describe below):

Description of Loss

Practitioners trust us most because we know your O&P business and we know insurance unlike any other program.


No No


8. Prior Insurance Carriers and policy dates: 9. Check off if you are a member of any of the following:

Date of Loss

Amount Paid


$ $ $

Retail Sales: Sales/ Revenue includes pre-fab items that you rent/sell to others. Off-the-shelf items that you do not repackage. Includes ‘prefab’ custom fit braces.



Medical Equipment Repair: Sales/ Revenue of Medical Equipment that is repaired, installed (no retail sales)



No direct sales to patients.


Est. updated sales for current term

$ Manufacturing: Items manufactured by you and sold to others to distribute. There is no patient care for this class $ $ Wholesale Distribution: Includes all items purchased from others that you resell to other facilities. Practitioner Patient Care: Includes all items fabricated for patients. Custom Products.



2. Fill out the form. 3. Email the form to Cailor Fleming Insurance will quickly provide your individual program quote.







J&J Artificial Limb and Brace

Accessibility in the Golden State Facility prioritizes personalized care to a majority-pediatric patient base



been good to Jason Friedman, CPO, and Esperanza Friedman, CO. The couple first met in 1991 while working for the same company in Los Angeles. Ten years later, they launched their own facility in the San Diego area, J&J Artificial Limb and Brace—named for their two sons at the time, Justin and Joshua, now 22 and 23, who were later joined by brother Jaden, 15. J&J specializes in pediatric orthotics and prosthetics but treats adult patients as well. “About 90 percent of my patients are pediatric,” says Jason Friedman. “Overall, we see about 75 to 80 percent pediatric patients, and about 80 percent of our practice involves orthotics.”


FACILITY: J&J Artificial Limb and Brace OWNERS: Jason Friedman, CPO, and Esperanza Friedman, CO LOCATIONS: Rancho Bernardo, Oceanside, and Mission Viejo, California HISTORY: 20 years

Esperanza Friedman, CO, and Jason Friedman, CPO


that office to accommodate them,” says Jason. “Now families who live in that area are coming to our Mission Viejo office as well.” The impetus to establish their own practice stemmed from the Friedmans’ desire to treat patients differently. At some of their previous workplaces, “we both noticed that patients were more of a quantity,” explains Jason. “We weren’t comfortable with that. We wanted to spend more time and offer better care, to treat patients more as family.” At J&J, clinicians share their personal emails and cell phone numbers with patients. “They know they can get in touch with us whenever they need to.” One of the most important aspects of the Friedmans’ work is taking the time to listen to their patients. “During a 20- to 30-minute appointment, some patients—especially parents who are dealing with serious issues with their children—just have to vent. We let them talk, and if it takes more time, we make it work,” says

Jason. “I appreciate that my staff is compassionate and understanding with every patient.” J&J does most of its fabrication in house and uses 3D scanning and 3D printing when appropriate. The facility offers a wide range of patterns, graphics, and colors that are custom made by Jason and some of his staff for children’s devices, all of which can be seen on the J&J website. Before the pandemic, the Friedmans and some staff members visited a clinic in Tijuana, Mexico, every four months to treat children without access to O&P services. “We would bring braces or refurbish them, modifying them to make them work for each child,” Jason says. “We hope we can go back soon.” As a successful Latina businesswoman, Esperanza has received significant media attention. She was the subject of a “Good Morning America” segment on October 14 this year and was featured in 2019 in both Forbes magazine and in an article and video by Wells Fargo, “The State of LatinoOwned Businesses in the U.S.” She also was a finalist for the 2019 Woman of the Year Award presented by the Orthotic and Prosthetic Group of America. The company relies heavily on word of mouth to market its services. “Our workmanship— which is guaranteed for a full year—has done the marketing for us,” Jason says. “If a physician calls for an articulating brace, for example, and the therapist sees it’s not working, we will remake that device. No one makes a perfect decision the first time. By offering a good quality product and a good warranty, we have kept our business growing.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at

PHOTOS: J&J Artificial Limb and Brace

The facility’s staff comprises 14 employees, including four practitioners and four technicians. J&J spans three offices, each about 30 minutes apart, which makes it easy for patients to reach them. The Friedmans opened their newest office, in Mission Viejo, in response to patients travelling from out of state and from northern California—often combining trips to Disneyland with visits to J&J. “We felt bad they had to drive so far, so we opened

Jason Friedman, CPO, works with a pediatric limb loss patient.


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

WHAT IS IT? • A comprehensive certificate program that offers a series of business and management courses that provide an opportunity to explore crucial business challenges. • Administered by AOPA and the University of Hartford • Topics addressed include finance, sales and marketing, business operations, reimbursement policies, and management. • Similar to non-degree continuing education programs that universities offer in conjunction with their MBA programs. • Courses will be offered online, at the AOPA National Assembly, and at targeted seminars throughout the country.

Participating is easy… 1. Enroll in the program. 2. Select and complete four required Core Courses and four Elective Courses within four years and pass a Course specific quiz for each program. 3. Be awarded a frameable certificate from both the University of Hartford and AOPA.

Sound good? Enroll today at Need more information? Visit

FOLLOW US @AmericanOandP


AOPAversity Webinars

Sign up now for expert guidance on hot topics—and start earning CE credits


OIN AOPA EXPERTS FOR the most up-to-date informa-

tion on specific topics during these one-hour webinars, held the second Wednesday of each month at 1 p.m. ET. One registration is all it takes to provide the most reliable business information and CE credits for your staff at a single office location. Visit for details and registration information.


DEC. 10


Year-End Review and What Is Ahead

Did you miss any updates, coding guidelines, or announcements? Are there any new codes or fee increases for 2022? This webinar will provide a recap of the important Medicare announcements, updates, and changes that took place in 2021, and will preview some updates and changes that may take effrect in 2022 and beyond.

Don’t Miss the Virtual Programming From the 2021 AOPA National Assembly Available for Viewing Until December 18 Most of the in-person education from the AOPA National Assembly in Boston will be available until December 18 for paid registrants. And don’t miss the bonus education only available on the Virtual Assembly Platform. Visit AOPA’s website and access the AOPA National Assembly Program for a full list of bonus online education.

COMING SOON: 2022 AOPAversity webinars—visit the AOPA website. NEW MEMBERS

Welcome New AOPA Members



the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. 48


Gouterman Orthopedic Appliances 11900 Parklawn Drive, Ste. 207 Rockville, MD 20852-2658 301/984-3342 Richard M. Gouterman, CO, CPed

AOPA Member Benefit

AOPA’s Co-OP is

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

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


After creating your Co-OP account, Download to your mobile device at

FOLLOW US @AmericanOandP



Learn more and sign up at


Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email Visit for advertising options.

CROSS™ Knee Hyperextension CROSS™ Knee Hyperextension is intended for mild to moderate knee hyperextension due to neuromuscular diseases or other injuries. The orthosis can be used alone or together with any Allard anklefoot orthosis (AFO) when knee hyperextension is present with foot drop. The CROSS™ Knee Orthosis has a preflexed anatomical shape to fit leg contours and be comfortably worn with any Allard AFO. • Hyperextension resistance is easily adjusted • Easy to grasp wide cuff for single-handed donning • ‘Donning Aid’ included for users with limited hand dexterity • YouTube video fitting: https://www. Available in sizes S/M/L/XL. For more information, contact customer service at 888/678-6548 or email

ALPS Liberty™ Liner The ALPS Liberty™ Liner allows the expulsion of sweat and air through a built-in valve either through the pin or reducer. The one-way evacuation valve is strategically placed distally to evacuate air and sweat between the user’s skin and the liner. The best part—ALPS has recently introduced a new pin that can be used with most shuttle locks! To learn more about the Liberty™ Liner and the new pin, call your ALPS sales representative today at 800/574-5426.


Vacuum Integrated Pump (VIP) The features that CPOs like best about the Vacuum Integrated Pump (VIP) are how easy it is to install and its lightness. Compared to other elevated vacuum systems available on the market, the VIP provides a more comfortably elevated level of vacuum. The low vacuum version offers a gentle elevated vacuum, bringing the benefits of this innovative suspension system even to less active amputees. The high vacuum version is ideal for more dynamic prosthetic users and users already accustomed to other elevated vacuum systems. The two versions are entirely interchangeable, making it easy to modify the level of vacuum by simply switching from one unit to the other, according to the needs and desires of the patient. Plus, it is perfect both for laminated and thermoplastic sockets, allowing complete freedom to choose the socket adapter, prosthetic foot, and prosthetic liner most suitable for the needs and lifestyle of the amputee. To learn more, call your ALPS sales representative today. Visit or call 727/528-8566 or 800/574-5426.



Apis custom programs offer practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.

Becker GEO™ (Gait Evaluation Orthosis) The Becker GEO™ is a prefabricated, carbon composite evaluation orthosis used to assess the benefit of an ankle-foot orthosis on ankle and knee stability. Please contact our customer service department today for more information. Visit

MARKETPLACE Coyote’s New Dynamic Strut AFO

Naked Prosthetics

Designed to flex and move with the patient and create a more natural gait, the Dynamic Strut AFO is strong enough to climb stairs and offloads the foot and ankle. • Natural gait • Works great with thermoformed braces • Provides energy response. Our unique varying thickness creates a comfortable natural gait. Contact Coyote at 208/429-0026 or visit

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

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

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

Fid-Lock V-Buckle by O&P Solutions Have a TLSO, LSO, or CTLSO patient with dexterity issues? Now there is a solution! Introducing the “Fid-Lock V-Buckle” now available on your custom or prefab spinal system. These “magnetic” buckles require little effort to secure and release. In fact, the magnetic feature securely fastens when the patient brings the two components into close proximity to each other. Dual hook-and-loop closure allows the practitioner to preset the closure to the exact location and tension. Contact us for more information at O&P Solutions at 1625 Rock Mountain Blvd., Ste. H-J, Stone Mountain, GA 30083; call 800/922-5155; or visit



MARKETPLACE New Pediatric AFO: Ottobock’s WalkOn Flex Junior Introducing the WalkOn Flex Junior, an ankle-foot orthosis designed for children with mild to moderate drop foot. • Dynamic, spiral-shaped strut provides greater flexibility at heel strike, and carbon fiber construction provides excellent energy storage and return during gait cycle. • Medial guidance of the longitudinal arch prevents supination in solid footwear. • Trimmable footplates are easily shaped with scissors, often requiring only one office visit. • New, improved padding for universal use on left or right side.

PDI 3D Central Fabrication

The 4th Gen Squirt Shape 3D Printer is now available for purchase! Test sockets, definitive sockets, custom liners, and more! Deliver quicker, with a 24-hour socket turnaround. Have a difficult fit or extreme size? Don’t struggle with fabrication, let us print a check or definitive socket for you. For more information, email or call 800/459-0177 for a quote today!

Visit to learn more. 800/459-0177 | WWW.PROSTHETICDESIGN.COM

C-Brace®: Step Into Your Future Freedom ShockWave™ by PROTEOR

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



The Freedom ShockWave™ utilizes the industry-leading classic Freedom foot design with its proprietary EnduraCore® hybrid composite technology and incorporates a Spherical Shock Unit (SSU). The SSU provides both vertical shock absorption and axial rotation, giving K3 / K4 patients a shockingly natural and comfortable experience during both everyday and high-impact activities. For more, visit

MARKETPLACE Spinal Technology Inc.

Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis. For information, contact 800/253-7868 or visit

Myo Kinisi The Myo Kinisi is a myoelectric prosthetic hand, externally controlled by the electric signals naturally generated by a user’s muscles. Designed for everyday use, the Myo Kinisi offers a secure grip, highspeed open and close, and a natural appearance. It is suitable for patients at levels equivalent to transradial and more proximally, in both unilateral and bilateral applications. The hand is available in three sizes and four wrist and thread variations, to suit a broad range of clinical presentations. Visit us at to learn more or email for more information.

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

Start earning your credits today!


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





Opportunities for O&P Professionals


Job Location Key:

Prosthetist, Orthotist, CPed, Resident Prosthetist

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at Job Board 50 or less

Member $85

Nonmember $280

For more opportunities, visit: SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit to view your trusted source of everything O&P.

Columbia, Missouri HiTek Limb & Brace has opportunities in our teaching and research facility, providing trauma and patient-care services at the university hospital and clinics in Columbia, Missouri. We are seeking innovative clinicians who possess a curiosity to explore new possibilities in design and techniques and the will to make them a reality. Learn more at, then select Career Opportunities. We have the following openings available: • ABC-/BOC-certified prosthetist • Resident prosthetist • ABC-/BOC-certified orthotist • CPed. Salary and/or commission is best in the industry. We offer moving expense assistance, and our complete benefits package includes PTO, health, dental, vision, accident insurance, 401k, and many other optional programs. Contact: Email:

Mid-Atlantic CP/CPO

Euclid, Ohio Orthotic and Prosthetic Specialties Inc., located in Euclid, Ohio, is looking to add a dynamic experienced practitioner to our team. This position has potential to grow into a management position for the right candidate. If you are compassionate about providing the best care for your patients and have a strong work ethic, come join our team! We have developed a positive culture that results in long-term employee retention and consistent growth. We offer on-site fabrication with a blend of pediatrics, sports medicine, geriatrics, postsurgical, and traumatic event exposure in both orthotics and prosthetics. The practitioner must be eligible for Ohio state licensure. This is a full-time position Monday–Friday 8:00 a.m. – 5:00 p.m. with rotating on call. Full-time benefits include individual/family health insurance, company pays 80 percent of premium for employee and dependents. Benefits also include generous holiday, sick, and vacation pay. See how you can contribute to our team’s success. Contact with résumé: Jeffery M. Gerl, CO Email:



CL MB The path to the top isn’t always easy. But at Hanger, no one has to do it alone. And there’s no limit to how high any of our team members can climb. Hanger is the clinical leader in orthotic and prosthetic care because we hire the best and the brightest. We provide vast resources, opportunities for career advancement, and the most innovative technology in our field to help them do what they do best: care for our patients. We’re passionate about the life-changing, fulfilling work we do to empower our patients to take on life’s challenges with increased mobility, independence and self-confidence. We know this important work starts by supporting our employees. Empower your career. Apply today and climb higher at Hanger.

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.




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Job searching is easy with thejust got Finding your next job orpage. hire pane-view job search Set up Job searching is easy with the easier with the AOPA Career Center. job alerts, upload your resume or pane-view job search page. Set up If you want to sell your business or Seekers: just need to For Job

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pane-view job search page. Set up job alerts, upload your resume or Barry Smith Job searching is easy with thean anonymous career profile create Telephone: (O) 323/722-4880 • (C) 213/379-2397 pane-view job search page. Set upemployers to you. that leads

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Reach 4,500+ O&P professionals through the Job Flash™ email. For Employers: Ensure high visibility for your open positions through this highly Reach 4,500+ O&P professionals engaging email.

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Reach 4,500+ O&P professionals For Employers: through the Job Flash™ email. Ensure high visibility for your open Reach 4,500+ O&P professionals positions through this highly through the Job Flash™ email. engaging email.

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Career Opportunities... California

CPO-Modesto CPO- Salinas Oregon CPO –Portland CPO –Bend Washington CPO-Richland CO Resident-Richland CPO-Tacoma CPO-Yakima Cped-Yakima To apply, submit resume to:

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services. The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others. A competitive salary, benefits and profit sharing are offered based on position/experience.

Our Culture & Commitment “We will serve and help others grow personally, professionally, and strive to put others needs first and foremost as demonstrated by our positive attitude, teamwork and professionalism.” 56



Welcome to AOPA Connection, the one-stop-shop for all things AOPA. Logging into AOPA Connection you will instantly have access to all your AOPA benefits, including: • AOPAversity • Your Membership Record • Your Individual Profile • Event Calendar • Bookstore • Co-OP But, it doesn’t stop there! We are pleased to introduce a new benefit accessible through AOPA Connection, My O&P Community. In this online community of your O&P colleagues you can get guidance, share advice, have one-on-one and group conversations, and access resources.

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Advertisers Index Company

Page Phone


Allard USA Inc.




15, 43



31 800/356-3668

Apis Footwear Company



Becker Orthopedic Appliance Co.



Cailor Fleming Insurance



Cascade Dafo Inc.



Coyote Prosthetics & Orthotics






Ferrier Coupler Inc.




55 877/442-6437


1 800/301-8275

Naked Prosthetics



O&P Solutions (formerly Spinal Solutions)




C4 800/328-4058




Spinal Technology Inc.




25 877/462-0711

TurboMed Orthotics Inc.







January 9–11

U.S. ISPO Pacific Rim Conference. Waikoloa, Hawaii (Big Island). For more information, visit

January 12

AOPA Webinar. 1 PM ET. For more information, visit


January 12–15

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email, or visit individual-certification.


January 19–22

December 1

ABC: Application Deadline for January/February Written & Simulation Exams. Applications must be received by December 1 for individuals seeking to take the January/February Written and Simulation certification exams. Contact 703/836-7114, email certification@, or visit

December 1

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

December 6–11

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email, or visit

December 8 WEBINAR

Year-End Review and What Is Ahead. 1 PM ET. To register, visit

2022 January 1

ABC: Practitioner Residency Completion Deadline for February Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email, or visit 58


ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email, or visit individual-certification.

January 30–February 3

Hanger Live. Dallas, TX.

January 31–February 5

ABC: Written and Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email, or visit

February 1

ABC: Application Deadline for Spring Certification Exams. Applications must be received by February 1 for individuals seeking to take the April Written and Simulation certification exams and Spring CPM exams. Contact 703/836-7114, email, or visit

February 9 WEBINAR

AOPA Webinar. 1 PM ET. For more information, visit

March 2–5

AAOP. Atlanta. For more information, visit


AOPA Webinar. 1 PM ET. For more information, visit

March 18–19

Ohio O&P Meeting. Columbus Hilton at Easton. Visit and


May 10–13


June 24–25

OT World. Leipzig, Germany. For more information, visit

Nashville Renaissance Hotel and Conference Center In-Person Meeting. For more information, contact Cathie Pruitt at 901/359-3936, email, or Jane Edwards at 888/388-5243, email jledwards@attnet. Visit

May 18–20

New York State Chapter of American Academy of Orthotists and Prosthetists (NYSAAOP) Meeting. Rivers Casino & Resort. Schenectady, NY. For more information, visit

September 28–October 1

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

May 20–21

Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis. For more information, go to

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Statement of Ownership, Management and Circulation (required by U.S.P.S. Form 3526) 1. Publication Title: O&P Almanac 2. Publication No.: 1061-4621 3. Filing Date: 9/28/20 4. Issue Frequency: Monthly, except for combined issues printed June/ July and November/December 5. No. of Issues Published Annually: 10 6. Annual Subscription Price: $59 domestic/$99 foreign 7. Complete Mailing Address of Known Office of Publication (Not Printer): American Orthotic & Prosthetic Association, 330 John Carlyle St., Suite 200, Alexandria, VA 22314 8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not Printer): Same as #7 9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor: Publisher: Eve Lee, address same as #7. Editor: Josephine Rossi, Content Communicators LLC, PO Box 938, Purcellville, VA 20132. 10. Owner (Full Name and Complete Mailing Address): American Orthotic & Prosthetic Association, same as #7 11. Known Bondholders, Mortgagees, and Other Security Holders Owning 1 Percent or More of Total Amount of Bonds, Mortgages, or Other Securities: None. 12. The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During the Preceding 12 Months. 13. Publication Name: O&P Almanac 14. Issue Date for Circulation Data Below: August 2021

15. Extent and Nature of Circulation: a. Total number of Copies (Net Press Run) b. Paid and/or Requested Circulation (1) Paid or Requested Outside-County Mail Subscriptions (2) Paid In-County Subscriptions (3) Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and other non-USPS Paid Distribution (4) Other Classes Mailed through the USPS c. Total Paid and/or Requested Circulation d. Free Distribution by Mail (1) Outside-County as Stated on Form 3541 (2) In-County as Stated on Form 3541 (3) Other Classes Mailed through the USPS (4) Free or Nominal Rate Distribution Outside the Mail e. Total Free or Nominal Rate Distribution f. Total Distribution g. Copies not Distributed h. Total i. Percent Paid and/or Requested Circulation

Avg. No. Copies Each Issue During Preceding 12 Months

No. Copies of Single Issue Published Nearest to Filing Date



10,791 0 0

10,728 0 0

3 10,794

3 10,731

0 0 0 233 233 11,027 129 11,156 98%

0 0 0 1,141 1,141 11,872 191 12,063 90%




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Rules and Regulations

If you are interested in participating in the AOPA State Reps network, email

Updates from Colorado, Indiana, Nevada, Texas, and Wisconsin

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at resources/co-op.


In response to the advocacy of providers in the state, the Colorado Department of Health Care Policy and Financing issued a statement September 8 announcing that the rate would be reverted to the original rate prior to the July 1, 2021, reduction. The department also announced that a rate-setting project is being completed to determine the appropriate rate for cranial remolding orthoses. View a copy of the statement on the Colorado page of the AOPA Co-OP.


The newly formed Indiana Association of Orthotics and Prosthetics (IAOP) has elected new leadership. Eric Schopmeyer, CO, of 60


Transcend Orthotics and Prosthetics, will serve as president, and Tim Ruth, CPO, of Kenney Orthopedics, will serve as vice president. IAOP is focusing its efforts in the coming year on educating O&P professionals in Indiana about the goals of the organization, increasing membership, and building awareness of the organization. IAOP has a group on LinkedIn and has started conducting outreach to Indiana’s O&P community. Contact erics@ for more information.


The Nevada State Board of Pharmacy released a proposed regulation on October 14 requiring regular inspections of licensed pharmacies and removing the requirement of licensed pharmacies to conduct self-assessments of their operations. AOPA seeks to raise awareness of this rule among members in Nevada and is seeking feedback on its possible effects on the state’s O&P community. Visit the Nevada page of the AOPA Co-OP for the full text of the order.


The Texas Department of Licensing and Regulation (TDLR) is seeking subject matter experts (SMEs) to assist its Enforcement Division with complaint case reviews. SMEs will be tasked with reviewing complaint cases, generally involving standard of care issues, during the investigation stage of the

enforcement process. Responsibilities may include examining documents and statements, writing reports, answering prosecutors’ questions, and testifying as a witness for TDLR at hearings. If you are interested in becoming an SME, visit the Texas page of the AOPA Co-OP for a link to the application. Once you submit the application, you will receive an additional questionnaire to complete and return.


The Wisconsin Department of Health Services has proposed an order to adopt permanent rules relating to the use of complex rehabilitative technology, effective Nov. 1, 2021. The intent of the proposed rules is to establish rules defining complex rehabilitation technology and certification requirements for complex rehabilitation technology suppliers, as well as identify circumstances under which complex rehabilitation technology may be covered or reimbursed by Medicaid fee-for-service and managed care organizations. AOPA is seeking feedback from Wisconsin members on this topic. Visit the Wisconsin page of the AOPA Co-OP for the full text of the order.

Submit Your State News To submit an update for publication in the State by State department of O&P Almanac, email


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