The Magazine for the Orthotics & Prosthetics Profession
N OV E M B E R 2016
Do’s and Don’ts for Holiday Gift Giving P. 16
Year-End Performance Reviews Reimagined P. 30
Tips for Billing Lower-Limb Protective Coverings
O&P
Culture CHANGE
HAVE REIMBURSEMENT CHALLENGES AFFECTED CLINICAL EFFORTS AND BUSINESS OUTCOMES? P.22
P.48
E! QU IZ M EARN
2
BUSINESS CE
CREDITS
WWW.AOPANET.ORG
P.18
Exclusive: New Advocacy Opportunities in the Post-Election Push P.20
YOUR CONNECTION TO
EVERYTHING O&P
THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.
SE PTE M B E R
6-9,
2017
LAS VEGAS EXCELLENCE in EDUCATION
Mark your calendars September 6-9, 2017, for an ideal combination of top-notch education and entertainment at the combined 100th AOPA National Assembly and World Congress Meeting in Las Vegas. We look forward to seeing you in 2017!
#AOPA2017
AOPAnet.org
NOVE M B E R 2016 | VOL. 65, NO. 11
contents
FEATURES COVER STORY
DEPARTMENTS | COLUMNS Views From AOPA Leadership......... 4
AOPA President James Campbell, PhD, CO, FAAOP
AOPA Contacts............................................6 How to reach staff
Numbers........................................................ 8
At-a-glance statistics and data
Happenings............................................... 10
Research, updates, and industry news
People & Places........................................ 14
Transitions in the profession
22 | O&P Culture Change During the five years since the publication of the “Dear Physician” letter, O&P facilities have adjusted their business and clinical practices to meet documentation requirements and navigate a challenging audit process to claim reimbursements. O&P business owners explain how they have adapted to this audit-heavy environment, and discuss whether new findings on net profits from AOPA’s 2016 Operating Performance Report point to a brighter future for the profession. By Christine Umbrell
Reimbursement Page.......................... 16
November To-Do List
Medicare participation and gift-giving guidelines
CE Opportunity to earn up to two CE credits by taking the online quiz.
CREDITS
Member Spotlight................................. 34 n
20 | This Just In
n
New Options Sports Prosthetic & Orthotic Care
Post-Election Push With a new president and new legislators preparing to take office in January, it’s time for O&P stakeholders to focus on several initiatives that may impact the profession. Learn details regarding proposed legislation, research initiatives, an O&P Patient Registry, and the 2017 Policy Forum.
30 | Appraising the Appraisal
AOPA News................................................ 38
AOPA meetings, announcements, member benefits, and more
PAC Update.............................................. 40
P. 20
Marketplace..............................................42
Careers........................................................ 44
Professional opportunities
Calendar...................................................... 45
Best practices for conducting employee performance reviews have evolved, with many HR departments forgoing the once-a-year sit-down approach—and embracing an ongoing feedback process that allows for more frequent evaluation of accomplishments. Measurable goals remain an important aspect of O&P employee assessment.
Upcoming meetings and events
Ad Index.......................................................46 Ask AOPA.................................................. 48 Reimbursement for limb-lower covers, skins, and materials
By Lia K. Dangelico
P. 30 O&P ALMANAC | NOVEMBER 2016
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VIEWS FROM AOPA LEADERSHIP
Thank You for the Opportunity To Serve
T
HERE HAVE BEEN SO many challenges for all of us in the past 12 months, but we also have enjoyed a high level of collaboration and collegiality. The issues are and will remain complex, but I am confident that our due diligence will be adequate and our efforts coordinated. Under the very capable leadership of incoming President Michael Oros, CPO, FAAOP, I believe that AOPA will continue to work with our colleagues across the orthotic and prosthetic community to build consensus around the key points and toward a common theme that is patient centered. The idea that change is a period of transition between two periods of stability is rapidly disappearing as we realize that periods of stability within our field of orthotics and prosthetics, and within the health-care environment in general, are getting shorter. Our key initiatives, or survival imperatives, are in place to help you, our members, navigate this changing health-care environment, and they are intended to keep AOPA relevant. The development of our Scientific and Evidence Base has been one of AOPA’s highest priorities for the last five years, and we can claim significant progress in supporting and advancing research that demonstrates the true value and positive patient outcomes resulting from the care we provide. In the last 12 months we have maintained momentum with the development of our patient registry, or “longitudinal database,” project; under the very capable leadership of Kenton Kaufman, PhD, we are making significant progress in this area. If we are successful, this registry of prosthetic patients will house, in a central database, a clearly defined set of health and demographic data that will be of benefit to our profession, our patients, and our industry. As part of our Prosthetics 2020 initiative we have engaged the RAND Corporation to help us define, develop, and disseminate cost-effective analysis data, the data that measures and demonstrates the true value of prosthetic care and prosthetic technology. In closing, I would extend my sincere thanks to my colleagues on the AOPA Board of Directors and to Thomas F. Fise, JD, Tina Carlson, and the rest of the AOPA staff for their support and guidance, and to all of you, who year after year have demonstrated your commitment through your membership in AOPA. Please accept my heartfelt thanks for the opportunity to serve.
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
Board of Directors OFFICERS
President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Ottobock, Austin, TX
James Campbell, PhD, CO, FAAOP, is president of AOPA and chief clinical officer at Hanger Clinic in Austin, Texas. Beginning in December, he will serve as AOPA’s immediate past president. 4
NOVEMBER 2016 | O&P ALMANAC
Bradley N. Ruhl Ottobock, Austin, TX
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AOPA CONTACTS
American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org
Editorial Management Content Communicators LLC
Our Mission Statement The mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation, and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.
EXECUTIVE OFFICES
REIMBURSEMENT SERVICES
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@ AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org
Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org
Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org
Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com
Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org
Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com
AOPA Bookstore: 571/431-0865
Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com
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NOVEMBER 2016 | O&P ALMANAC
Publisher Thomas F. Fise, JD
Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. COVER PHOTO: iStock.com/Filograph
Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamediakit for advertising options!
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NUMBERS
How ‘Standard’ Are Your SOPs? Standard operating procedures related
OUTSOURCED BILLING
to central fabrication usage, hours of
5.8 Percent
operation, and billing practices varied among the O&P companies included
ACCRUAL VS. CASH BASIS ACCOUNTING
54.7 Percent
Percentage of all reporting companies that outsource billing procedures.
in the recently released AOPA 2016
Percentage of all reporting companies that use accrual basis accounting.
Operating Performance Report. How “Profit Leaders” are those firms whose returnon-assets performance was in the upper 25 percent of all respondents.
SATURDAY BUSINESS HOURS
Percentage of “Profit Leaders” that outsource billing procedures.
85 % 79.1 %
11.5 Percent
Percentage of all reporting companies that offer Saturday appointments.
Percentage of all reporting companies that offer evening appointments.
5 Percent
15 Percent
Percentage of “Profit Leaders” that offer Saturday appointments.
Percentage of “Profit Leaders” that offer evening appointments.
USE OF C-FABS BY COMPANY NET SALES
Percentage of all reporting companies that use central fabrication (c-fab). Percentage of “Profit Leader” companies that use c-fab.
AMOUNT OF WORK SENT TO C-FABS BY COMPANY NET SALES
Sales Up to $1 Million
69.2%
$1 to $2 Million
92%
$2 to $5 Million
60%
27.4%
$1 to $2 Million
26.9% 20.7%
More Than $5 Million
71.4% 40%
Sales Up to $1 Million $2 to $5 Million
83.3%
More Than $5 Million
20%
Percentage of “Profit Leaders” that use accrual basis accounting.
CENTRAL FABRICATION
EVENING BUSINESS HOURS
3.5 Percent
0%
60 Percent
10 Percent
does your facility compare?
80%
100%
43.5% 0%
10%
20%
30% 40%
50%
EDITOR’S NOTE: The 2016 Operating Performance Report is now available through the AOPA bookstore. Visit www.aopanet.org. 8
NOVEMBER 2016 | O&P ALMANAC
Happenings
O&P ATHLETICS
First Cybathlon Draws Teams From Across the Globe Sixty-six teams from various countries travelled to Switzerland in October to take part in the inaugural Cybathlon. The international event, organized by ETH Zurich, showcased competitions among athletes with disabilities who use bionic assistive technology, such as robotic prostheses, brain-computer interfaces, and powered exoskeletons. Participants tested their skills in six disciplines and demonstrated how novel technologies can assist people with disabilities in their daily life. Each team was made up of a “pilot” and supporting team members; approximately 400 contestants took part in the competition. Winners were announced in each of six events: a powered leg prosthesis race, a powered wheelchair race, a functional electrical stimulation bike race, a brain-computer interface race, a powered arm prosthesis race, and a powered exoskeleton race. The Cybathlon was designed with a goal of encouraging researchers and developers to make progress on assistive technologies. The competition was initiated by Robert Riener, professor of sensory-motor systems at ETH Zurich. “People with a physical disability that restricts daily life—these are the real winners of the Cybathlon,” said Riener. Spectators at the event were provided the opportunity to learn more about modern assistive technology, by travelling over uneven terrain in wheelchairs and controlling computer games by thought at PluSport stands. They also browsed an exhibition covering the history of assistive technical appliances.
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NOVEMBER 2016 | O&P ALMANAC
First-place winners in each competition include the following: • • • • • •
Robert Radocy, Team DIPO Power – Powered Arm Prosthesis Race Mark Muhn, Team Cleveland – Functional Electrical Stimulation Bike Race Florian Hauser, Team HSR Enhanced – Powered Wheelchair Race Andre Van Rueschen, Team ReWalk – Powered Exoskeleton Race Numa Poujouly, Team Brain Tweakers – Brain-Computer Interface Race Helgi Sveinsson, Team ÖssurRheoKnee – Powered Leg Prosthesis Race
PHOTOS: Courtesy of Össur/Nicola Pitaro
Cybathlon pilots Billy Costello, Silver medalist; Helgi Sveinsson, Gold medalist, and David Jonsson, Bronze medalist
HAPPENINGS
RESEARCH ROUNDUP
Brain Implant Restores Sense of Touch Via Robotic Arm
PHOTO: University of Pittsburgh Medical Center
Technology has been developed enabling an individual to experience the sensation of touch directly in the brain, via a neural interface system connected to a robotic arm. Research funded by the government’s Defense Advanced Research Projects Agency (DARPA) led to a volunteer subject, quadriplegic Nathan Copeland, using a brain-machine interface to “feel” sensations in robotic fingertips. As part of DARPA’s Revolutionizing Prosthetics Program, a Modular Prosthetic Limb (MPL) was developed by a team at Johns Hopkins Applied Physics Laboratory. The latest system enables two-way communication between the brain and the machine, with outgoing signals for movement and inbound signals for sensation. Researchers at the University of Pittsburgh and University of Pittsburgh Medical Center worked with volunteer patient Nathan Copeland to introduce him to the mind-controlled robotic arm, which features pressure sensors in each fingertip to send signals directly to the user’s brain. Copeland, who became paralyzed in his hands after a car accident 12 years ago, underwent surgery to have four microelectrode arrays placed in his brain—two in the motor cortex and two in the sensory
Nathan Copeland, right, during testing
cortex regions that correspond to feeling in his fingers and palm. The researchers ran wires from those arrays to the MPL. When Copeland touches an object with the robotic hand, he can tell which finger the sensation is coming from and whether the object is soft or hard, said Robert Gaunt, bioengineer and assistant professor in the department of physical medicine and rehabilitation at the University of Pittsburgh. “DARPA has previously demonstrated direct neural control of a robotic arm, and now we’ve completed the circuit, sending information from a robotic arm back to the brain,” said Justin Sanchez, director of DARPA’s Biological Technologies Office and the program manager for Revolutionizing Prosthetics. “This new capability fundamentally changes the relationship between humans and machines.” Details of the work were published in October in the online version of Science Translational Medicine.
Quadruple Amputee Undergoes Double Arm Transplant
PHOTO: Brigham and Women's Hospital
Retired Marine Corps Sgt. John Peck in August became the second quadruple amputee from the conflicts in Iraq and Afghanistan to undergo a double arm transplant. Peck, who lives outside Fredericksburg, Virginia, travelled to Brigham and Women’s Hospital in Boston for the 13-hour transplant surgery. The arms were donated by the family of a young man who chose not to be identified, via the New England Organ Bank. Peck lost his limbs in 2010 after stepping on an improvised explosive device in Afghanistan. After learning of the transplant option in 2014, he underwent rigorous physical and psychological testing prior to being put on the donor wait list. Peck continued to undergo physical therapy while he waited to hear about a donor. The surgery was performed by a team of 12 surgeons, led by Simon Talbot, MD, director of the upper-extremity program at Brigham and Women’s Hospital, and David Crandall, MD, medical director of the amputee program at Spaulding Rehabilitation Network. The donor’s right arm was attached to Peck’s right arm above the elbow, and the donor’s left arm was attached below Peck’s left elbow.
The procedure involved trimming the ends of the bones in Peck’s residual limbs and equipping them with plates, which were connected to the bones in the donor arms. The surgeons John Peck and connected the arteries and veins Spaulding Rehabilitation in Peck’s arms to those in the Network occupational donor’s. As Peck’s blood flowed therapist Tiffany Pritchett, into the donor arms, the donor OTR/L, after bilateral arm hands turned pink. The surgeons transplant then connected Peck’s nerves to those in the donor arms and sewed the connecting skin closed. Peck made his first public appearance following the procedure in early October. At that time, he already was experiencing faint sensation in his new arms, but it will take nine to 12 months for Peck to feel stronger sensations, said Talbot. Significant results may take months or years, according to his doctors, but the goal is for Peck to be able to open heavy doors, shake hands, and grasp and hold objects to perform tasks of everyday living. O&P ALMANAC | NOVEMBER 2016
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HAPPENINGS
CERT SUBMISSIONS
CMS Announces Address Change for Audit Requests Effective Oct. 7, 2016, documentation submitted in response to a Comprehensive Error Rate Testing (CERT) audit request should be sent to the following address: CERT Documentation Center 1510 E. Parham Road Henrico, VA 23228 Fax: 804/261-8100 Customer Service: 443/663-2699 Toll-Free: 888/779-7477 Email: certmail@admedcorp.com The address change is a result of the recent transition in CERT contractor duties that combined the medical review and documentation collection activities of the existing CERT contractor, Advamed. This change applies only to documentation requests involving CERT audits. Documentation submitted in response to prepayment reviews conducted by the durable medical equipment Medicare administrative contractors (DME MACs) should continue to be submitted to the DME MAC address provided in the request.
RESEARCH ROUNDUP
First Drug for Duchenne Muscular Dystrophy Granted Accelerated FDA Approval The U.S. Food and Drug Administration (FDA) in September approved Exondys 51 (eteplirsen) injection, the first drug approved to treat patients with Duchenne muscular dystrophy (DMD). Exondys 51 is specifically indicated for patients who have a confirmed mutation of the dystrophin gene amenable to exon 51 skipping, which affects about 13 percent of the population with DMD. DMD is a rare genetic disorder that occurs in about one out of every 3,600 male infants worldwide. The most common type of muscular dystrophy, DMD is characterized by progressive muscle deterioration and weakness. It is caused by an absence of dystrophin, which starts a chain reaction that eventually leads to muscle cell degeneration, as well as loss of ambulation and breathing. DMD patients typically require orthotic intervention as well as wheelchairs as the disease progresses. “Patients with a particular type of Duchenne muscular dystrophy will now have access to an approved treatment for this rare and devastating disease,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research. “In rare diseases, new drug development
LITIGATION LOWDOWN
Court Rejects HHS Request to Delay Hearing on OMHA The lawsuit filed by the American Hospital Association (AHA), regarding the Office of Medicare Hearings and Appeals’ (OMHA’s ) “exceeding statutory provisions on administrative law judge (ALJ) hearings,” will proceed. In 2014, AHA filed suit in the federal District Court seeking
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NOVEMBER 2016 | O&P ALMANAC
is especially challenging due to the small numbers of people affected by each disease and the lack of medical understanding of many disorders. Accelerated approval makes this drug available to patients based on initial data, but we eagerly await learning more about the efficacy of this drug through a confirmatory clinical trial that the company must conduct after approval.” Exondys 51, manufactured by Sarepta Therapeutics, was approved under the accelerated approval pathway for drugs that treat serious or life-threatening diseases and generally provide a meaningful advantage over existing treatments. The accelerated approval of the drug was based on the surrogate endpoint of dystrophin increase in skeletal muscle observed in some Exondys 51-treated patients. The FDA concluded that the data submitted demonstrated an increase in dystrophin production that is reasonably likely to predict clinical benefit in some patients with DMD who have a confirmed mutation of the dystrophin gene amenable to exon 51 skipping. Sarepta Therapeutics is conducting a clinical trial to confirm the drug’s clinical benefit.
relief because the U.S. Department of Health & Human Services (HHS) and OMHA have, for many years, exceeded the statutory provision, which assures a final ALJ decision within 90 days after filing a request for ALJ appeal. Originally, the District Court dismissed the case, but early this year the D.C. Circuit Court of Appeals reversed that decision and ordered that the case should go forward in the District Court. HHS/OMHA asked for a delay of more than a year, but the court ruled not to approve HHS’s request for such a delay, and the case will go forward with a hearing. The outcome of this hearing will have ramifications for all providers subject to recovery audit contractor audits.
HAPPENINGS
MEDIA MADNESS
R
WINNE
10-Year-Old Wins Mobility Photo/Video Contest
IMAGE: Össur
Joel “Diego” Mercado has been named the winner of Össur’s second #MyWinningMoment online contest celebrating amputees’ mobility. Mercado was born with a congenital condition that resulted in the loss of his left leg and most of the fingers on his left hand. In his winning video, the 10-year-old is shown working out with Marine Corps Sgt. Jose Luis Sanchez, flipping a tractor tire that’s taller and much heavier than he is. He and his father will enjoy a four-day, three-night, all-expense-paid trip to attend Össur’s Running & Mobility Clinic presented by the Challenged Athletes Foundation, and the 2016 Aspen Medical San Diego Triathlon Challenge in Southern California.
“In his entry, Diego reminded us that size is no indicator of ability or heart, and showed how he truly enjoys a life without limitations,” said Össur President and Chief Executive Officer Jon Sigurdsson. View the video at http://bit.ly/2dv6rba.
THE LIGHTER SIDE
RESEARCH REVIEW
AHRQ Announces Systematic Review of Clinical Literature The Agency for Healthcare Research and Quality (AHRQ), the “government agency tasked with producing evidence to improve the quality of health care while working with partners to ensure that the evidence is understood and used,” is initiating a systematic review for lower-limb prostheses. The systematic review will be performed through the EvidenceBased Practice Center Program of the AHRQ. The stated purpose of the review is “to examine the available clinical evidence that defines practices in the care of beneficiaries who require lower-limb prostheses.” The announcement is likely tied to the work of the interagency taskforce assigned to review the 2015 draft Local Coverage Determination for lower-limb prosthetics. AOPA will request a meeting to share similar research conducted by independent researchers with AOPA funding. O&P AWARENESS
White House Hosts Design Showcase The White House in September hosted a fashion show that featured inclusive design, assistive technology, and prostheses. The event celebrated innovation as well as the assistive technology and adaptive equipment that helps people live more independent lives. The showcase “recognized people creating and using innovative technology and design to break down barriers, reduce stigma, and improve the quality of life for Americans with disabilities,” according to a press release. O&P ALMANAC | NOVEMBER 2016
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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS
Teresa Alpert, CO, CPed, has joined Foot Solutions in Aurora, Colorado. Before moving to Colorado, she practiced in the Baltimore metropolitan area, where she also owned a pharmacy. Alpert completed her initial orthotics Teresa Alpert, CO, and prosthetics studies at Northwestern CPed University, and is past chair of the Board for Certification/Accreditation. She also has been a member of the Board of Directors of the Board for Certification in Pedorthics, which merged with the American Board for Certification in Orthotics and Prosthetics, and a speaker and educator in programs sponsored by the Pedorthic Footcare Association. Bob Arbogast has sold his shares in WillowWood to his four children. The transfer of company ownership was shared publicly on Aug. 31, 2016. Through an outright purchase of Bob Arbogast’s company shares, and Bob Arbogast those from the estate of his brother Joseph, company ownership was transferred to his children, Michelle, Lisa, Leslie, and Ryan Arbogast. Majority shares are now owned by Ryan Arbogast, who has served as WillowWood’s president since 2011 and oversees all company operations and sales. The remaining company shares are divided among Bob Arbogast’s three daughters. “This is an exciting time at WillowWood,” says Ryan Arbogast. “We’re remaining a privately held family business, and we’re exploring new opportunities for investment and new technologies to utilize in the development of prosthetics.” Brad Mattear, LO, CPA, CFo, has been named managing director in the United States for Nabtesco & Proteor in USA. Mattear will be responsible for sales team leadership and driving revenue, and will contribute in product selection, Brad Mattear, LO, distributor, and out-channel relationships, CPA, CFo in addition to overall general management responsibilities. He previously worked at Cascade Orthopedic Supply, where he served as central U.S. and national strategic account manager. Mattear holds a B.S. in sports medicine (athletic training) from Upper Iowa University in Fayette, Iowa. Chris Nolan has been appointed vice president of the orthotics business unit at Ottobock North America. Nolan, who also is a member of the Ottobock North America Regional Management Team, will help Chris Nolan lead Ottobock’s strategic effort in the O&P industry and provide guidance into growing new markets. 14
NOVEMBER 2016 | O&P ALMANAC
Nolan has extensive industry experience, most recently as vice president and general manager for Endolite US. Prior to that, he held the positions of regional sales director for DJO and regional sales manager for Össur. He currently serves on AOPA’s Board of Directors and chairs AOPA’s National Assembly Committee. “We are extremely happy to be able to welcome Chris Nolan to our company,” said Andreas Schultz, regional president and chief financial officer for Ottobock North America. “His wealth of experience in the industry will open up new avenues for business development in North America.”
BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
Curbell Plastics Inc., a supplier of plastic sheets, rods, tubes, film, adhesives, sealants, and prototyping materials headquartered in Orchard Park, New York, has named Airlite Plastics Co. as its 2015 Vendor of the Year. Omaha, Nebraska-based Airlite Plastics specializes in the manufacturing of a variety of extruded plastic sheet materials for the O&P industry. Curbell Plastics honors an industry partner with its Vendor of the Year Award in recognition of quality products, exemplary work, and service. Airlite Plastics Co. was noted for its responsiveness, its focus on providing technical assistance, its top-quality products, and its ability to work with Curbell to develop new products as key company attributes. The Hanger Charitable Foundation has awarded $17,500 to four grant recipients, concluding its third round of 2016 grants. The Foundation has awarded more than $199,000 to 20 organizations in 2016 thus far. The most recent grant recipients include organizations that serve a variety of communities, including children with spina bifida and young adults with limb loss: • Spina Bifida Association of Arizona, Children's Rehab Support: $2,500 to help fund weekly clinics to provide support to children living with spina bifida and their families. • Project H.O.P.E. of Cleveland, Foot Care Health Education and Clinical Care: $2,500 to support a free foot care clinic once a month for members of the community. • Wisconsin Amateur Hockey Association, Coulee Region Sled Hockey: $5,000 to purchase adaptive sleds and protective equipment to support the sled hockey program. • Children’s Healthcare of Atlanta, No Limb-itations Leadership Academy: $7,500 to support a program that helps teens with limb loss develop life skills and build community. The application deadline for the next round of funding is Jan. 31, 2017. Visit the Hanger Charitable Foundation page on Hanger. com for more information.
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REIMBURSEMENT PAGE
By DEVON BERNARD
November To-Do List It’s time to evaluate your Medicare participation status and review gift-giving guidelines
Editor’s Note—Readers of CREDITS 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.
CE
E! QU IZ M EARN
2
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CREDITS P.18
A
S THE YEAR COMES to a close, we
begin to think about the possibility of new Healthcare Common Procedure Coding System (HCPCS) codes, fee schedule increases or decreases, closing out outstanding accounts, and other housekeeping matters to prepare for the new year. It also is the time of year to consider two important facility initiatives: changing your Medicare participation status, and holiday gift giving. This month’s Reimbursement Page offers a quick primer on Medicare participation status and the rules for providing acceptable and compliant gifts to Medicare beneficiaries and referral sources.
Participation Status
Participation status with Medicare is valid for one year and can only be changed during the open enrollment period. At the start of each open enrollment period, typically around mid-November, the National
National Supplier Clearinghouse P.O. Box 100142 Columbia, SC 29202-3142 16
NOVEMBER 2016 | O&P ALMANAC
ILLUSTRATION: iStock.com/Jesadaphorn
Supplier Clearinghouse (NSC) sends all Medicare-enrolled suppliers a letter reminding them of their current participation status. The letter also informs suppliers that if they wish to update or change their status, they must do so before December 31, the closing of the open enrollment period. If your organization has a current participation agreement in effect for 2016 and you wish to change your status for 2017, you must submit written notice to the NSC that you no longer wish to be a participating provider. There is no standard form to be used; you must write a letter informing NSC of your desire to change your participation status. The letter must be submitted on your official letterhead and signed by one of your company’s authorized representatives. The authorized representative must be the same person who is on file with NSC as an authorized individual—usually a chief executive officer, chief financial officer, president, or board director. If you are unsure who is on file as the authorized individual for your company, review your most recent Medicare enrollment application, the CMS 855S form, and refer to Section 15. The letter must be received by NSC by December 31. The letter may not be postmarked by December 31 and arrive at a later date; it must arrive on or by December 31. Be sure to factor in mailing time, and consider setting an artificial deadline a week in advance to allow for mailing issues. The letter should be sent to the following address:
REIMBURSEMENT PAGE
If your company is currently enrolled as a nonparticipating provider and you wish to change your company’s status to participating, the process is slightly more formal than simply mailing a request letter to NSC. Your company must complete an official Medicare participation agreement for 2017, or the CMS 460 form, which can be found at cms.gov/Medicare/CMS-Forms/CMSForms/downloads/cms460.pdf. You should have received a copy of the form with the letter you received from NSC at the start of the open enrollment period. The one-page CMS 460 form is pretty straightforward and simple to fill out. Anyone at your facility may fill out the form; however, it must be signed by an authorized individual. If the completed form is not received by Dec. 31, 2016, your participation status will remain nonparticipating for 2017. If you are happy with your current Medicare participation status and do not wish to make any changes for 2017, simply do nothing and your status will remain the same. When selecting your participation status for 2017, remember that your status is tied to your tax identification (ID) number and not to the physical location of your facility. Any changes you make will not take effect until the start of the next calendar year. If you have several locations operating under the same tax ID, all locations must be either participating or nonparticipating. Since your participation status choice has far-reaching effects on all locations, be sure you understand the differences between a participating provider and a nonparticipating provider, and what it means to be each one. The term “participating provider” does not relate to the fact of whether or not you wish to be enrolled in the Medicare program. By the act of completing a Medicare enrollment application and obtaining a Medicare supplier number, you are part of the Medicare program. Instead, your participation status relates to your agreement with Medicare to automatically accept assignment for all Medicare claims; or to not accept assignment on claims. In short, your decision to be a participating
or a nonparticipating provider in the Medicare program hinges primarily on how you wish to handle the assignment of Medicare claims; the choice to accept assignment only relates to the amount of money you may collect from the patient and where Medicare will send its check. When you elect to be a participating provider with Medicare, you are agreeing to accept assignment on all Medicare claims. By accepting assignment, you agree to accept the Medicare allowable for any given item or service as payment in full, and you don’t have the ability to balance bill a patient. This means that Medicare will forward its payment, 80 percent of the approved allowed amount, directly to you, and you may then collect the remaining 20 percent coinsurance directly from the patient.
TING ICIPA T R A P IDER PROV
NON-
accept assignment, however, must be made on a claim-by-claim basis; you cannot accept assignment on one claim line and then not accept assignment on another claim line. When a nonparticipating provider elects not to accept assignment, that provider has the ability to collect its usual and customary charge from the patient, or balance bill the patient, and is not required to accept Medicare’s allowable as payment in full at the time of service. You should be aware of some risks associated with not accepting assignment for a claim. First, you must still submit the claim on the patient’s behalf and Medicare will make payment directly to the patient; the patient is not obligated to use the Medicare
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1
As a participating provider, you receive a couple of benefits beyond direct payment from Medicare: Your company’s name and contact information will be listed in the Medicare provider directory, and any claims involving a Medigap supplement policy will be automatically crossed over by the durable medical equipment Medicare administrative contractors. A nonparticipating provider, on the other hand, is not automatically tied to accepting assignment. A nonparticipating provider will have the option to make a claim-by-claim decision on whether to accept assignment. The decision to accept or not
payment to pay you. Most importantly, not accepting assignment does not relieve you from meeting Medicare policy criteria or eliminate your financial liability should the claim be denied. There may be some additional considerations when it comes to making your final decision regarding participation status. For example, you should review your existing and future contracts with outside private payors; some of your contracts may require you to be a participating member with Medicare, so if you choose to become a nonparticipating member of Medicare, the contract may be voided or will have to be renegotiated. O&P ALMANAC | NOVEMBER 2016
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REIMBURSEMENT PAGE
Remember there is no wrong or right decision regarding your Medicare participation status. You must review all of the options and possible ramifications, and make the choice that is best for you and your company. But keep in mind that you will not have another chance to change your status again until the next open enrollment period, a year from now.
Rules for Gift Giving
Giving gifts to Medicare patients and referral sources is acceptable and allowed, but there are some restrictions and provisions that must be followed. These provisions mainly relate to providing a gift as an inducement to encourage patients to choose you; or to encourage referral sources to provide you with business. If these provisions are not followed, your gifts could land you in some serious trouble. So how do you know what to keep in mind when shopping for and providing gifts to your patients and your referral sources? In August 2002, the Office of Inspector General (OIG) for the Department of Health and Human Services published a special fraud alert creating three guidelines that remain in effect. Follow these guidelines when providing gifts to Medicare beneficiaries:
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NOVEMBER 2016 | O&P ALMANAC
$392. It is important to note that the annual $392 aggregate is a limit, not an entitlement. It can be easy to slip over the line from an acceptable gift to an unacceptable gift, or from compliant to noncompliant gift-giving behavior. If you have any questions or doubts when considering gift-giving at your facility, consult with an attorney or the OIG. As you count down the days to the start of 2017, keep these tips in mind. Re-evaluate your participation status before the deadline has passed, and follow the guidelines when gifting your patients and referral sources. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:
www.bocusa.org
ILLUSTRATION: iStock.com/Jesadaphorn
• Gifts of cash or cash equivalents of any type (gift certificates, gift cards, or even free samples of products) are strictly prohibited. • The use of nonmonetary gifts is acceptable as long as the gifts are of nominal value. OIG has stated that the value of gifts should not exceed $10 per gift, with a $50 aggregate per calendar year. This means that you may offer your Medicare patients a maximum of five gifts valued at $10 in any calendar year. • There may not be terms or strings associated with gifts. For example, you cannot require that a patient come in for an evaluation to receive his or her gift, or that the patient may only receive a gift if he or she chooses to receive a particular service or item.
Gift-giving rules for referral sources are similar to guidelines for beneficiaries: Gifts of cash or cash equivalents are prohibited, but nonmonetary gifts are allowed, under very limited circumstances. First, the value of the gift may not be tied to the volume of referrals received from a physician’s office. For example, you cannot provide a gift of higher value to your regular referral sources than you do to practices that only refer patients periodically. While you are not required to offer the same gift to all of your referral sources, you cannot base your decision on the number of referrals you receive. Second, gifts may not be directly solicited by referral sources. If a referral requests a specific gift and you provide it, this could be construed as an inducement and a violation of federal antikickback statutes. Finally, there is a limit to the amount of money that may be spent on gifts for referral sources. This gift limit is not a fixed sum, and it may fluctuate from year to year as the limit is set and adjusted according to the increase in the Consumer Pricing Index. For 2016, there is an aggregate limit of $392, so any gift or gifts provided to a referral source in 2016 may not exceed
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Curt A. Bertram, CPO, FAAOP Director, National Residency Program National Orthotics Specialist
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This Just In
Post-Election Push With a new president and new legislators come new opportunities to make an impact
T
HE VOTES ARE IN, and come
Jan. 20, 2017, there will be a new president in the White House and a new Congress in the Capitol. Though this article was written before the November 8 election, there are some significant developments that can be shared as of this writing that will make for a productive and interesting year to come, regardless of the political outcomes. Looking toward the next few months, O&P stakeholders can make their voices heard via a number of initiatives that are currently being planned or are already underway.
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AOPA Policy Forum policy forum
AOPA
It will take weeks—maybe even months—for the new Congress to organize itself, make committee appointments, and begin setting an agenda. That’s why the 2017 Policy Forum is being planned to take place in late May. As in prior years, Policy Forum attendees will arrive for a day of briefings and updates, plus a second day spent on Capitol Hill visiting with legislators and their staffs. Though the Policy Forum has traditionally been held in April, these later dates for 2017 allow time for the
legislative process to begin to unfold so member congressional visits can have some substance. Participants will be able to take advantage of whatever political winds may be blowing in the wake of a contentious presidential election.
Lame Duck Session
Advocacy experts, in conjunction with former Sen. Bob Kerrey (D-Nebraska), have developed a strategy whereby provisions of the O&P Medicare Improvements Act—S. 829 or H.R. 1530—could be attached to two possible vehicles: the continuing resolution needed to keep the government open for business, or a needed part B premium increase fix provision.
Sen. Chuck Grassley (R-Iowa)
Former Sen. Bob Kerrey (D-Nebraska)
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NOVEMBER 2016 | O&P ALMANAC
PHOTO: iStock.com/YinYang
Sen. Chuck Grassley (R-Iowa) has spoken with Majority Leader Sen. Mitch McConnell (R-Kentucky), and Kerrey has spoken with Minority Leader Sen. Harry Reid (D-Nevada), about these possibilities. Both McConnell and Reid seem amenable to action on S. 829 during the lame duck session.
This Just In
AOPA’s next push with its Washington-based lobbying team will begin immediately after the election. Kerrey and AOPA Executive Director Tom Fise, JD, will lead the effort to re-engage many of the members of the House and Senate who were previously committed to this initiative to help with enactment. O&P professionals should continue to take advantage of the quick and easy www.aopavotes.org website to send emails to their legislators urging support for inclusion of S. 829 in an appropriate year-end legislative vehicle. Less than five minutes of your time can have a huge impact on the future of O&P patients’ ability to receive proper care.
Local Coverage of Determination
The recently announced literature review on lower-limb prostheses by the Agency for Healthcare Research and Quality (AHRQ) “to examine the available clinical evidence that defines practices in the care of beneficiaries who require lower-limb prostheses” suggests finalization of the Local Coverage of Determination (LCD) proposal will likely be delayed even further. The original proposal was so lacking in any evidence-based information that the interagency workgroup tasked with developing a revised proposal may have concluded that this additional research is a “must.” While CMS officials say they did not request the AHRQ review as part of the interagency taskforce work, the likelihood of some relationship to the flawed July 2015 LCD proposal seems undeniable. This announcement serves to both underscore and validate AOPA’s decision to undertake the literature-driven valuation project with RAND Corp. (see below), and highlights the urgency of bringing this work to completion as an important contributor to/counterbalance for the ongoing work of the interagency taskforce as well as the newly announced AHRQ-supported systematic literature review. AOPA and the O&P Alliance, in collaboration with the Amputee
Coalition, are exploring how the research that has been conducted by AOPA and other O&P researchers can be brought to the attention of AHRQ—which could be a very positive development. Meanwhile, the work of the House Oversight and Government Reform Committee investigating how such an ill-conceived LCD saw the light of day, and the rules and mechanisms CMS uses in managing its own contractors, continues. AOPA recently delivered suggestions on how future document/information requests by the House Oversight & Government Reform Committee to Secretary of Health and Human Services Sylvia Mathews Burwell might be fashioned. The response from Burwell to the initial request by the committee was considered inadequate by the committee.
RAND Corporation Project
AOPA has engaged RAND Corporation to establish the value proposition for prosthetic services to amputees, which includes a focus on cost-benefit for advanced prostheses and K2/ K3 comparisons. The AOPA Board of Directors approved an expanded economic analysis spanning microprocessor knee versus nonmicroprocessor knee transfemoral prostheses, as well as three types of transtibial prostheses, including the dynamic response (energy storing) foot, the microprocessor-controlled ankle-foot system, and the powered ankle-foot system. The RAND analysis will, among its many components, examine the economic impact of osteoarthritis, falls, obesity, and likelihood of amputee patients receiving a prescription for a prosthesis based on published evidence as part of the expanded effort. A briefing is expected in January.
New Dobson-DaVanzo Study
Work is underway on the “Medicare Database Relating to CostEffectiveness of O&P Care” study for Dobson-DaVanzo 2 (DD2). The analysts are already working on 200710 Part D drug cost data as well as the new 2011-14 (Parts A, B, and D) custom cohort data. The 2011-14 (Parts A, B,
and D) custom cohort data should be received by early November. The Dobson-DaVanzo team is re-examining the conclusions of work covering the 2007-2010 data and a potential revalidation of the earlier cost-effectiveness findings, and is taking a deep dive into the relationship between prosthetic and orthotic care and Medicare drug benefit costs per patient. It is hoped that the preliminary data runs and information from DD2 will be available for coordination with the RAND study.
O&P Patient Registry
The ambitious O&P Patient Registry project is continuing to bear fruit; a pilot effort demonstrating the ability of patient-care facilities to collect the necessary data proved very successful. Project leaders recently met with Alison Cernich, PhD, director of the National Institutes of Health’s National Center for Medical Rehabilitation Research; this meeting added further encouragement to the project. In addition, the Mayo Clinic’s Kenton Kaufman, PhD, has been invited to submit a proposal to the Department of Defense (DoD) Outcomes Kenton Grant Project for Kaufman, PhD potential funding for the initial implementation period of the registry project. It should be noted that outcomes DoD funding for O&P research was the direct result of multiyear efforts by AOPA, Policy Forum attendees, and AOPA consultants, who encouraged the inclusion of $10 million per year of O&P research funding in each of the last three DoD budgets.
Looking Ahead
The initiatives mentioned above all have the potential to make a significant impact on the O&P community and the patients served by the O&P profession. As we recover from one of the most intense elections in our lifetime, O&P stakeholders can take note of these activities and do our part to help shape the future of the profession. O&P ALMANAC | NOVEMBER 2016
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COVER STORY
Culture O&PCHANGE Business leaders explain changes facilities have made to drive profitability in a challenging reimbursement climate
NEED TO KNOW
By CHRISTINE UMBRELL
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n After adapting business and clinical processes and procedures to better navigate the audit-heavy O&P reimbursement environment, some facilities are starting to see a return to more normal profitability than during the previous five years, according to AOPA’s 2016 Operating Performance Report and anecdotal evidence.
n While the number of prepayment audits continues to rise, the number of audits by the Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing program has decreased recently. This may be a temporary reprieve as the RAC audit activities have been placed on hiatus to allow for the award of new RAC contracts.
NOVEMBER 2016 | O&P ALMANAC
n Since 2011, many O&P facilities made strategic operational changes, such as adjusting internal procedures to reduce claim denials, upgrading business software, improving workflow processes, and developing more comprehensive patient evaluations.
n Some O&P business owners have focused on improving relationships with physicians, implementing creative solutions to help ensure referral sources provide proper clinical documentation for their patients.
n An encouraging byproduct of the challenging reimbursement climate has been the unification of the O&P industry: Competing business owners, practitioners, patient advocates, and the amputee community have created partnerships to combat some of the most difficult issues, and to advocate for the best outcomes for O&P consumers.
COVER STORY
M
ANY OF TODAY’S SUCCESSFUL O&P facilities can look back to a very
specific point in time—August 2011—when the reimbursement climate for O&P became more challenging. Five years ago, the infamous “Dear Physician” letter was sent to physicians participating in the Medicare program, instructing those physicians that only their medical records—and not the prosthetists’ records—are relevant in determining medical necessity of prosthetic care.
What followed was a dramatic change in terms of the expected documentation required to pay for O&P services. O&P professionals faced increased scrutiny from the durable medical equipment Medicare administrative contractors (DME MACs), recovery audit contractors (RACs), and zone program integrity contactors (ZPICs). The number of audits and withheld payments soared, as claims with insufficient physician notes were deemed to be “overpayments.” Many O&P facilities struggled to keep their businesses profitable while navigating
a lengthy appeals process to recover their payments. “As noted in several O&P articles over the past several years, the challenging reimbursement climate affected sales and profitability for most O&P facilities in a negative way,” says Teri Kuffel, Esq., vice president of Arise Orthotics & Prosthetics Inc. “For some, it was a mere inconvenience because reimbursements were delayed, but, for others, it was catastrophic, forcing business owners to make reductions across the board and even close doors.” O&P ALMANAC | NOVEMBER 2016
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Net Profit Margins Reported
1
in AOPA’s Operating Performance Reports
10% 8%
PERCENTAGE
Fast forward to 2016. The reimbursement climate remains challenging, but many practitioners have adapted, tightening their internal documentation processes and adjusting their standard operating procedures to contain their budgets and increase profitability. These difficult but necessary changes are starting to make an impact and, according to some O&P business owners, may indicate that the O&P profession is in a healthier position today than during the previous five years.
TA B L E
COVER STORY
6%
7.3%
6.4% 5.0%
5.5%
4% 2% 0
Frank Snell, CPO, FAAOP
2013 OPR
2014 OPR
2015 OPR
2016 OPR
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NOVEMBER 2016 | O&P ALMANAC
Percentage Increase in Net Sales/Billing Versus Previous Year
2 10% PERCENTAGE
Net profit margins for O&P facilities in 2015 were up to 7.3 percent, according to AOPA’s recently released 2016 Operating Performance Report (OPR). The report also found that companies experienced a 7.3 percent increase in net sales/billing in 2015 over the previous year. While the report is not inclusive of all O&P facilities, it features the financial facts from 88 companies representing 1,164 full-time facilities and 71 part-time facilities, a large portion of U.S. O&P company revenues. The numbers in the 2016 OPR indicate a more positive outlook than has been seen in recent years. By contrast, net profit margins in the 2015 OPR were reported at 5.5 percent, while the overall percent increase in net sales/ billing was reported at 3.9 percent (see Tables 1 and 2). The more positive numbers for 2016 are supported by anecdotal evidence from some business owners. “This year is the first one in awhile where I have not felt as if the sky were falling,” says Jim Young, CP, FAAOP, owner of Amputee Prosthetic Clinic in Georgia. Frank Snell, CPO, FAAOP, also notes that the future has become a little brighter for the profession. “We, like the rest of the O&P world,
TA B L E
Turning a Corner?
8%
7.3%
6.7%
6% 3.9%
4% 2.0%
2% 0
2013 OPR
2014 OPR
suffered with the oppressive audits and still have some appeals unsettled,” says Snell, who is president of Snell Prosthetic & Orthotic Laboratory in Arkansas. “As a result of this new normal, we made certain corrections to our business plan, regrouped, deleted unprofitable services, and in 2015 had our very best year ever.”
2015 OPR
2016 OPR
Snell acknowledges that making changes at his facility was “a painful process—because of the not knowing what tomorrow may bring.” He recalls many months when “you were literally scared to open the mail.” While some of the facility’s problems stemmed from self-inflicted issues, others did not: “In a few cases, we were guilty of
R
www.easyliner.com info@easyliner.com
TA B L E
making mistakes in coding and other documentation requirements—stupid mistakes that we no longer make. Experience is a great teacher,” says Snell. “In other cases, I feel we were unfairly treated in that our clinical notes were ignored, and some doctors would not cooperate in a timely manner.” Jeff Lutz, CPO, vice president, Central Zone, Hanger Clinic, notes that many O&P clinicians and referral sources have adapted to the new policies, adjusting their business practices to some extent. “Hopefully, this has resulted in decreased denial of reimbursement for many AOPA member companies.” Yet, it’s important to note that some facilities remain in recovery mode.
3
Percentage That Reported Having Been Audited by Medicare During Previous Year
2013 OPR
77.4%
2014 OPR
82.8%
2015 OPR
79.2% 85.5%
2016 OPR
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
TA B L E
PERCENTAGE
Jeff Lutz, CPO
“While many of the larger players have found ways to maintain and even improve their margins, I believe that smaller providers are suffering from a decrease in cash flow resulting from lower reimbursements, denials, and increased DSOs [days sales outstanding],” says Alex Meyers, director of operations and innovation at Eschen Prosthetic and Orthotic Labs. To counteract those issues, facilities both large and small are implementing significant changes in their standard operating procedures.
Beyond ‘Business as Usual’
Recently, some companies have felt a bit of a reprieve in recoupment activity, as the RAC audit activities have been placed on hiatus to allow for the award of new RAC contracts. Lutz says he believes some O&P facilities are feeling slightly less pressure because there has been a “slowdown in audit activity related to the changing of audit contractors and internal CMS pressures of the administrative law judge backlog.” Data from the 2016 OPR shows that 85.5 percent of participants reported 26
NOVEMBER 2016 | O&P ALMANAC
4
Type of Audits in Previous Year, Among Those Respondents Who Were Audited 2013 OPR
2014 OPR
2015 OPR
2016 OPR
RAC
78.3%
78.9%
64.4%
48.6%
CERT
56.5%
49.3%
52.5%
40.0%
79.7%
88.6%
Prepayment 63.8% 64.8% ZPIC
NA
4.2%
5.1%
7.1%
OIG
NA
1.4%
0.0%
1.4%
having been audited by Medicare in 2015. Of those who were audited, 48.6 percent had undergone a RAC audit (down from 64.4 percent in the 2015 OPR and 78.9 percent in the 2014 OPR); 40.0 percent had undergone a CERT audit (down from 52.5 percent in the 2015 OPR and 49.3 percent in the 2014 OPR); and 88.6 percent had undergone a prepayment audit (up from 79.7 percent in the 2015 OPR and 64.8 percent in the 2014 OPR). (See Tables 3 and 4.)
In response to the increased documentation requirements, many O&P facilities have “created internal procedures in order to better protect current claims from being denied or recouped,” says Teri Kuffel. “These include changes in both clinical and administrative procedures.” For example, some facilities have revised their documentation procedures, instituted education programs for staff and referring physicians about the importance of notes, and implemented procedures to
Teri Kuffel, Esq.
prepare for claim reviews and audits. For many facilities, adapting business practices has led to some success in terms of improved profits. “The process was a learning experience,” says Snell. “We certainly got a crash course in compliance, and hope we are prepared for the future.” In particular, he explains that his facility’s business software (OPIE) has improved, and his management has intensified internal education efforts. “We are very strong in our position for now and trust to stay there,” he says. Meyers says that his company’s defense against shrinking margins has been “a more effective cost management program. To that end, we have developed a multipronged approach centered around a proprietary, internal software application and improved workflow processes.” In addition, Eschen created an ongoing marketing campaign to drive business from new and existing referral sources, and is working with vendors to optimize margins, says Meyers.
Charles Kuffel, MSM, CPO, FAAOP
At Arise O&P, management has developed “a more comprehensive patient evaluation, one that follows a more narrow line of questions tailored to provide us with more specific verbiage in our clinical documentation,” says Charles Kuffel, MSM, CPO, FAAOP, the company’s president and clinical director and chair of the National Commission on Orthotic and Prosthetic Education.
In addition, Arise employees are now expected to complete an “internal audit” for claims, says Teri Kuffel. “I created a documentation checklist that all employees have become familiar with, and I audit every high-dollar claim prior to billing. What seemed an arduous and somewhat painful process at the beginning has now become standard practice in our offices.” At Amputee Prosthetic Clinic, staff have similarly re-evaluated their processes and “practice more defensively now,” says Young. “The RAC audits changed the way most of us practice, [and] behavior modification has happened on a grand scale. We are more mindful regarding following the letter of the LCD [Local Coverage Determination], and specific policy stipulations. Between RAC and LCD scares, we know that every claim must be scrutinized, start to finish.” As facilities adjust to a more documentation-driven care model, some companies have invested in staff with expertise in health-care reimbursement. “There is heightened respect for the administrative side of our businesses,” says Charles Kuffel. “Paying administrators like practitioners is something that has been challenging for some business owners to digest; however, the reality is the O&P administrators are an essential part of not only getting paid, but staying paid.”
Building Relationships With Physicians and Payors
Part of the process of ensuring proper documentation in an audit-driven environment is relying on physicians to do their part. “Physician education activities have become very important,” says Lutz. “While we do not want to overburden physicians, we do need to educate them in the need for compliant medical notes.” One downside to the increased documentation requirements is, according to Charles Kuffel, that “there is often an inherent delay in waiting for documentation from the physician.” He states, however, “As a result, we have had to work closely with several physician offices in an effort to help them more readily accept and return our documentation requirements. The benefit is that we have created stronger relationships with some of our referring physicians.” Charles Kuffel explains that Arise utilizes an “amputee clinic” to offer physicians an alternative pathway to referring patients: “In some situations, we have been able to provide the prescribing physician with a choice to either evaluate the patient and provide us with specific information, or refer the patient to an amputee clinic to be evaluated by a physician who specializes in physical medicine and rehabilitation.” He explains, O&P ALMANAC | NOVEMBER 2016
27
COVER STORY
“Many choose the clinic. There the patient, physician, and prosthetist meet together for a full prosthetic evaluation.” All parties seem to benefit from the clinic evaluation, says Charles Kuffel: The patient gets the benefit of a full, comprehensive prosthetic evaluation performed by a specialist (rather than a general practitioner or a busy surgeon), and, if the patient needs further rehabilitative services, he or she can continue care with the clinic. Some physicians “seem more than cooperative to work with and refer to one another,” says Kuffel. “And the prosthetists often find themselves advantaged in many ways, with the most important result being the receipt of the requisite documentation in the patient’s medical record.”
Alex Meyers
Meyers also emphasizes the importance of working with physicians “to build solutions that work for them.” Eschen’s dedication to educating referral sources has led to “several opportunities to collaborate with physicians on building tools that allow them to quickly and easily provide us with clinical documentation that is comprehensive and patient-specific.” While partnering more collaboratively with physicians is a “must” in today’s reimbursement climate,
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NOVEMBER 2016 | O&P ALMANAC
working more closely with payors also may be advantageous, says Lutz. He advises O&P professionals to “learn each payor’s policy and follow it.” He also suggests contacting payors and challenging them “when you know that the policy will negatively affect your patient; often the payor will consider a properly substantiated request.”
United Focus on Patient Care
Throughout the reimbursement evolution, practitioners have at times struggled to ensure patients are being fit with appropriate componentry. “As an industry, we have seen not only negative business effects of misguided payor policy but also negative effects on our patient communities,” says Lutz. “Utilization of K3/K4 componentry dropped as audits ramped up. This decrease was not driven by any change in the functional potential of patient population, but rather by payor pressure and policy that effectively limited patients’ access to technology. This effect was felt in both the public and private payor sectors.” Lutz notes that the challenges brought about by the audit activity may have caused decreased utilization of advanced technology. “While companies may not be experiencing the denial of payments equal to the past few years, we need to be very mindful that we are still providing the best possible medically necessary device for our patients,” he says. “The best practice has been to increase the quality of clinical documentation and rehabilitation team alignment, so the
patient is given the best possible care and the care properly reimbursed. “We cannot allow payor pressure to unduly limit patients’ access to medically necessary care,” says Lutz. “We must continue to advocate for our patients both in Washington and in the exam room. Now, more than ever, proper documentation of medical necessity and being well versed in specific payor policy has a profound impact on the quality of care and optimum outcome for the O&P patient.” One encouraging byproduct of the reimbursement climate has been the unification of the O&P industry: competing business owners, practitioners, patient advocates, and the amputee community are creating partnerships to combat some of the most difficult issues. “These challenging reimbursement times have brought the profession together in ways like never before,” says Teri Kuffel. This O&P stakeholder unity was crystallized in the wake of the release of the proposed LCD for lower-limb prosthetics in the summer of 2015. “The rally around the defeat of the LCD marked a time when the industry and the entire amputee rehabilitation team locked arms with our patients, led by organizations like AOPA and the Amputee Coalition, and effectively defeated a recommended bad payor policy,” says Lutz. “In my 32 years in the profession, I have never seen such coordination of leadership, inside the industry and externally with all stakeholders…. I also see that coordination has continued beyond the immediate crisis that the LCD presented and believe it will continue to help shape sound policy.” Lutz hopes that the O&P community will continue to work together to combat the “increasing misapplication of commercial policy to payors’ managed Medicare lines of business.” Says Lutz, “There are several examples of technology that our patients need that are not statutorily excluded from payment for Medicare, yet are routinely denied by commercial managed Medicare.” He cites two examples: prosthetic volume management and
COVER STORY
microprocessor-controlled feet. “Often the payor will correct their mistake when it is highlighted in appeal; however, the appeal process increases provider costs and, more importantly, slows the patient’s care.” In addition, many O&P stakeholders are currently working to support legislation recognizing O&P’s role in patient documentation. “Critical to any successful facility is the support of AOPA’s legislative efforts to gain recognition of prosthetists’ and orthotists’ notes as part of the patient’s medical record, affirming our role as the experts in the care team,” says Lutz.
Hoping for a Brighter Future
Those O&P facilities with increasingly positive profit margins remain committed to clinical practices that will result in fewer claims denials. “Going through the audit process really makes you stronger if you survive it,” says Young. But he says some of the changes have come at a price, noting there is now “more paperwork, from
Jim Young, CP, FAAOP
every provider, and slowing access to care for our patients, and more patient visits to more providers to get the same care that once was done by a single provider.” He questions whether this is an effective way to provide care: “This whole system revolves around the third-party payors’ desires, not the patients’ needs.” Meyers believes that the future of O&P may depend on prosthetists and orthotists “solidifying their professional networks, especially their relationships with local hospitals and other large institutions.” He advises providers to look closely at their service lines to identify which products have the strongest and weakest margins and opportunities
for growth. “I believe that as payors and providers become increasingly outcomes-centric, they will be looking to partner locally with others who are best-in-class, which means we should all start to take some time to figure out what we are the best at,” says Meyers. For the time being, O&P leaders at facilities that have adapted their practices are hopeful that their new business and clinical processes and procedures will continue to result in fewer claims denials. “We would like to think that the O&P industry has started to recover from the challenges brought about by the ‘heavy-handed audit practices,’ but we will remain cautiously optimistic,” says Teri Kuffel. “We know all too well that the best indicators of future events stem from the activities of the past.” Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.
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O&P ALMANAC | NOVEMBER 2016
29
By LIA K. DANGELICO
Appraising the Appraisal
Revamp your employee review process with more regular performance checks and measurable goals
NEED TO KNOW • Some forward-thinking HR departments are eschewing the traditional approach to conducting annual employee performance reviews and embracing an ongoing feedback process that allows for more frequent evaluation of goals and accomplishments. • Quarterly, or even monthly, sit-downs with individual employees to discuss performance can yield more timely feedback and allow for ongoing adjustments of goals as conditions within a facility evolve. • Some HR managers suggest measuring employee performance by incorporating specific responsibilities featured in accreditation standards into employee goals, or by developing productivity scores for clinicians and care extenders. • Companies can leverage new technologies, such as software-based platforms and apps, to aid in employee communications and evaluations.
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NOVEMBER 2016 | O&P ALMANAC
I
S IT THAT TIME of the year again? At many O&P facilities,
evaluating employee performance is a once-a-year task. Some companies continue to take the traditional approach of conducting an annual review, with supervisors checking boxes on an evaluation form and holding a brief discussion with each employee about his or her long-term goals. Reviews for clinicians and other staff members get completed and filed away, without much thought until 12 months later when the next review is “due.” While an annual review methodology certainly gets the job done, it does not necessarily inspire employees to continuously review their goals and ensure they are meeting expectations on a regular basis. According to a study released in April by Accenture Strategy, the traditional review model is no longer effective. While 94 percent of global workforce leaders believe that performance management improves business performance, just 39 percent say their current practices help to achieve their organization’s business objectives. (Accenture itself did away with annual performance appraisals in 2015.) And this news isn’t new: Back in 2008, The Wall Street Journal published “Get Rid of the Performance Review,”
an exposé written by Samuel A. Culbert, researcher and professor at the University of California—Los Angeles. Culbert shared his findings that traditional employee reviews may destroy morale, kill teamwork, and hurt a company’s bottom line. In 2014, The Washington Post reported on work by psychologists at three universities who wanted to assess how people respond to negative feedback in a performance review. The aptly written headline, “Study finds that basically every single person hates performance reviews,” describes their research, which “is a reminder not only of how much people dislike criticism, but of how dangerous performance review tools like rankings and ratings can be,” says the article. Given such findings, other modern corporations, such as Netflix, GE, and Adobe, have parted ways with the annual performance review. Some have embraced a more efficient and effective model for performance management, where manager and employee frequently sit down to review goals and progress, and communication is more freely flowing between supervisors and their direct reports. O&P facilities that are seeking to improve internal evaluation processes and motivate staff to continuously analyze their contributions should consider restructuring their employee review process and building a more a successful performance management program.
Instant Feedback for an Instant World
With the traditional annual review process, even the best of employees can be caught off guard. A staff member who comes in early, stays late, and receives great feedback from customers may be surprised by a bombshell at review time—some unnamed, intangible task or area where he or she missed the mark, maybe even in Quarter 1. This too-little-too-late approach to employee management can be dangerously ineffective, with employees reprimanded for long-forgotten actions. Such a scenario can be avoided with more regular employee evaluations:
Some companies are finding that addressing performance and goals with staff more frequently actually boosts performance. While monthly sit-downs are an option, Bettina Deynes, vice president of human resources for the Society for Human Resource Management (SHRM), says that managers should be reviewing performance and providing employees with feedback quarterly, at a minimum. That way, “the feedback is more timely and can be utilized by the employee during the remainder of the year, rather than having to wait until the end of the year to discuss progress or lack thereof.” Some forward-thinking executives within the O&P community are adopting this practice, too. Sharon Myatt, executive director of treasury and administration for Wright & Filippis, sits down with each of her employees once a week for 30 minutes. She meets with members of her accounts payable, accounting, and HR teams in order of seniority; once she completes the cycle—typically quarterly, depending on how many employees are on her team at a given time—she starts again. The topic of discussion is up to the employee, and he or she has an opportunity to talk about work issues or whatever may be top of mind at that time. This less structured approach promotes a more comfortable atmosphere and creates an ease during conversations that leaves a positive impact on the performance review process. But it’s difficult to generate that valuable feedback if you’re not objectively measuring employee development and progress. Regularly assessing performance is not just about knowing who to promote and who to fire. It’s about investing in your employees, sustaining your business, and identifying opportunities, says Pam Lupo, CO, a consultant and member of the boards of directors of Wright & Filippis and Carolina Orthotics & Prosthetics, as well as a member of AOPA’s Board of Directors and Coding and Reimbursement Committee. Lupo served as director
of orthotics for 20 years at Wright & Filippis, where she maintained hiring, education, and clinical care for more than 150 certified orthotists, certified pedorthists, orthotic assistants, and certified fitters. “The performance improvement plan—or whatever you call it—is a written plan of action and a guide to correct action,” she says. When it comes down to it, employees are human capital value. The knowledge and skill sets they bring to a company are essential. Developing employees’ skills and motivating them to perform at a higher level is “an art, a talent, and it’s something you should be passionate about if you’re in a leadership role,” Lupo says. Of course, not all employees and skill sets are created equal. So as managers assess their teams as part of the performance review, they should be considering what each individual’s specific contributions are and how to measure them. Not every staff member is going to be your biggest, best rainmaker, says Lupo, but you have to dig a little deeper: Perhaps he or she is a mentor, always working to better others; or that team member you can always count on to show up; or that bubbly cheerleader, who motivates the team and keeps morale high. He or she might bring a unique specialty area, or niche, such as pediatrics, that drives business to your clinic. O&P ALMANAC | NOVEMBER 2016
31
“Sometimes, employee value is about more than dollars and cents,” says Lupo, who led a class on performance appraisal essentials for the O&P Business Management Certificate at the 2016 AOPA National Assembly. “Developing and mentoring are vital and don’t always translate into dollars. So we have to find other ways to motivate staff” because managers and owners have to understand that human capital value is a depreciable asset. “If we don’t value it, if we don’t train it, and if we don’t create an environment in mentoring staff, then that value will depreciate.” As they work to build a functional performance management process, managers also should look closely at their training and mentoring programs and ensure they are providing ample opportunities for growth and development for all employees.
Compliance Is a Team Sport
For the O&P world, one of the most important aspects of training is building a staff that understands and takes compliance seriously. CMS requires that providers have a compliance program that includes employee education on fraud, waste, and abuse. Providers also must take appropriate steps to inform and educate their employees on areas of noncompliance and encourage future compliance. There’s no need to recreate the wheel when sharing these requirement with employees, says Lupo. Plenty of compliance information and education materials are available on the Office of the Inspector General’s website (oig.hhs.gov/compliance/101/), she says.
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The American Board of Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has a set of standards as part of its accreditation program outlining not only human resources’ detailed requirements, but also “best business practices” in employee management. The business must have HR policies and procedures, verification of certificates and qualification, and documented performance appraisals. Privileging also is a credentialing component. (For a complete list of the ABC standards on human resources, visit abcop.org and download the “Patient Care Accreditation Guide.”) The Board of Certification/ Accreditation (BOC) accreditation program also has standards requiring that suppliers monitor the performance of their employees and their contractors. These measures of performance must be documented in the employee’s or contractor’s file, noting corrective actions for any tasks performed below expectations. As part of the performance review process, businesses should work with employees to identify specific goals, such as new certifications to support current and planned product category offerings. In addition to annual performance reviews, BOC recommends implementing quarterly customer satisfaction surveys, with survey results tied back to individual performance measures and goals. BOC’s customer service team is available
to answer specific compliance questions and provide detailed guidance. Additionally, several resources are available on the BOC website (bocusa. org), including an “Accreditation Standards Guide,” which encompasses CMS Supplier and Quality Standards, and a list of facility accreditation consultants. Employee performance reviews provide an opportunity to document your facility’s compliance with these standards. They also offer an opportunity to identify noncompliance, and to specify a corrective action plan for an employee. When improvement is needed, managers should document a timeline for a change in behavior, and be sure to follow up with the employee on his or her progress or lack of progress in the corrective action, says Lupo.
Tools of the Trade
If talk of more feedback, more training, and more compliance has your head spinning—take heart. There are plenty of tools and techniques available today that can help facilities streamline the historically paperwork- and man-hourheavy project of performance reviews. First, every manager needs an up-to-date employee handbook, an orientation form, and accurate job descriptions, says Lupo. These resources help educate and direct employees on company policy, culture, and processes—such as defining sick leave and appropriate work attire—and also highlight employer expectations and unacceptable behavior. These documents help establish your company as a fair, nondiscriminatory,
and consistent work environment. To ensure reviews and feedback are fair and consistent, facility managers should be gathering and tracking data on employee and company performance throughout the year. From there, you can create an easy-to-read and shareable dashboard or scorecard that, for example, showcases the company’s financial goals, provides recognition, and highlights key areas of improvement; this information can be distributed to staff on a regular basis, says Lupo. Managers can use this tool to educate employees and hold them accountable. In turn, employees may feel motivated and empowered by this more transparent approach to assessment.
Lupo also suggests developing a productivity score based on time, to measure clinical productivity. For example, O&P facilities could assign an expected amount of time to complete specific clinical tasks tied to Healthcare Common Procedure Coding System products and services. By studying each clinician’s delivered devices for a particular timeframe, a percentage of productivity could be measured. This information could be shared with clinicians to help them understand where their time is being spent, and help identify opportunities for improving patient interactions and increasing revenue. In addition to generating data, some companies are turning to technology
to manage employee performance. For example, GE launched its cuttingedge app PD@GE (which stands for performance development at GE) in 2015. The app enables constant and consistent communication about goals, performance, etc., between supervisors and employees. In GE’s new process, employees are given quarterly “priorities,” and managers conduct regular “touchpoints” with their direct reports—brief, informal conversations where, together, they discuss and commit to priorities and resolve conflicts. Employees can use the app’s “insights” feature to request or give feedback from or about anyone within the company. Finally, each employee receives an annual summary conversation, which touches on points addressed throughout the year and summarizes progress. The process was developed to focus on outcomes and constant improvement, rather than process. While your O&P facility may not be able to afford a custom app, some off-the-shelf options are available for a variety of budgets. For example, The Pulse Program’s 360° Software System conducts automated, anonymous, web-based surveys for physicians, practitioners, nurses, and other health-care management and staff, and offers educational modules and coaching programs. Cloud-based performance management platform Trakstar offers real-time feedback, customized review forms and documents, and strategic project and goal tracking for teams as small as 10 and into the thousands. Regardless of whether you choose to use an app to aid in employee performance management, that technology presents an opportunity for companies to improve processes and reengage employees. A recent study by web-based performance management platform Reviewsnap found that 85 percent of employees felt their companies’ current review processes were ineffective, but just 21 percent of those same employees said their companies use software-based platforms to conduct reviews.
Consistent Communication
Inevitably, managers will have to address poor performance with an employee. This is never easy, but, says Deynes, it circles back to frequency of conversations with employees. “The more frequent the opportunities to candidly discuss performance results and the more thorough the prior agreement between supervisor and employee, the less probability that the conversations will be difficult.” This has been shown to be the case at Wright & Filippis, where Myatt’s regular, employee-driven conversations lead to a more positive work environment and fewer instances of catching an employee with a bad review at the end of the year. (More information on how to address difficult topics with an employee is available on SHRM’s website, shrm.org.) Regardless of whether a review or performance conversation goes well or poorly, Deynes isn’t seeing any significant changes or trends in the way compensation and bonuses are delivered at this time. “That said, they should be tied directly to the performance management system— if implemented properly—so that compensation and bonuses are a direct reflection of performance results achieved,” she says. As with most things, when it comes down to it, companies can try every new approach, technology, and technique—but it won’t be successful unless it rings true for the organization and its employees. “The most effective performance management system is one directly tied at every level to the organization’s strategic plan,” says Deynes. “One that provides ample opportunity for employees and supervisors to agree in advance on the key standards of performance that reviews will be based upon; and one that requires very frequent—but not long and drawn-out— review conferences throughout the year that focus on those agreed-upon desired results.” Lia K. Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@contentcommunicators.com. O&P ALMANAC | NOVEMBER 2016
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MEMBER SPOTLIGHT
New Options Sports
By DEBORAH CONN
Made in the USA Texas manufacturer offers orthopedic and sports medicine braces as well as liners and covers
J
OHN SCOTT REALIZED
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NOVEMBER 2016 | O&P ALMANAC
New Options occupies a 3,200-square-foot facility, including a fabrication room.
COMPANY: New Options Sports OWNER: John Scott LOCATION: Dallas, Texas HISTORY: 23 years
John Scott
products, says Scott. “We recently built a custom product for a veteran with severe loss of buttocks tissue due to a roadside bomb,” says Scott. “Scar tissue covered the area, and he was unable to sit down without a special pad. We customized a pair of lycraspandex pants and padded all the areas of pain and pressure points, along with additional padding so he looks normal in pants. “The veteran called me later, crying, saying he could sit normally, he could drive, and he looked normal in clothes. He told me no one was able to do that for him in the eight years since his injury. I think that was the most important thing we ever did.” The JAFO Freedom cover, just one of a number of products for which New Options holds patents, is a new product that covers and protects prosthetic legs. The cover not only protects the prosthesis from the elements; it also fills out and replicates the calf muscle of the patient’s healthy limb. “Under long pants, both legs look the same,” he says. Freedom covers are available in a number of colors, including digital camo.
PHOTOS: New Options Sports
the potential of neoprene in 1977, when his longtime friend Jim Pelletier, a certified orthotic fitter, showed him a basic knee sleeve made of neoprene, which was then more commonly used to make wetsuits. Scott founded a company, Sport Supports Inc., building it from the ground up. Before long, he was providing braces to the Dallas Cowboys, the U.S. Olympic team, the Association of Tennis Professionals, and a number of orthopedic and physical therapy clinics in the Dallas area. Scott sold Sport Supports in 1990 and launched New Options Sports in 1993. Soon after, the facility, with its made-in-America products, landed a contract with the U.S. Department of Veterans Affairs (VA). A veteran himself, Scott is particularly proud of the VA contract, which is in its 16th year. Today New Options occupies a 3,200-square-foot facility in Farmers Branch, Texas, a suburb of Dallas. The company has 80 employees, including manufacturing, sales, and administrative staff. It sells its products through distributors, sales reps, and original equipment manufacturer accounts in the United States, Canada, and Mexico. The company manufactures knee, lumbar/spine, ankle, wrist, elbow, and shoulder braces, prosthetic suspension liners, and the recently introduced JAFO Freedom covers for prosthetic limbs. New Options is one of the few manufacturing companies to fabricate custom
The company also offers a full line of pediatric soft bracing. Scott created his first pediatric brace 18 years ago when his young son sprained his ankle playing soccer. When the rehabilitation doctor saw the device, he said, “This brace doesn’t exist. Where did you get it?” Scott explained, and the doctor immediately placed an order. Today, the Kids’ Stuff Line offers the same products available in New Options’ adult line, but tailored to children and available in multiple colors. Scott believes his company has two attributes that set it apart from others. The first is its commitment to providing completely American-made products. “Since the beginning, we have never wavered as far as going to another country to manufacture our products,” he says. The second is New Options Sports’ two-day turnaround time for custom braces. “No one else offers this,” says Scott. Many people don’t fit in a standard size, so Scott hand-cuts the devices for adults or children who need specialized treatment. “We probably lose money on this, because we have to do it by hand, but we take pride in meeting our customers’ needs, whatever they are,” he says. Scott, an art major in college, enjoys doing the custom work, as well as creating his own drawings for the patent process. The company consults with orthotists and prosthetists in developing and refining its products. “We never set up our own patient-care division, because we have no interest in competing with O&P providers,” he says. “We make it, and they fit it.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
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MEMBER SPOTLIGHT
Prosthetic & Orthotic Care
By DEBORAH CONN
Shared Vision Facility leverages three locations and six minivans to serve wide-ranging patient population
J
ON WILSON, CPO, LPO,
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NOVEMBER 2016 | O&P ALMANAC
Dylan Borrenpohl, MPO, works with a patient in one of the expansive walk rooms at P&O Care.
FACILITY: Prosthetic & Orthotic Care OWNERS: Jim Weber and Jon Wilson, CPO, LPO LOCATIONS: St. Louis and Festus, Missouri, and Fairview Heights, Illinois HISTORY: 14 years
James Weber, MBA, and Jon Wilson, CPO, LPO, in 2002, the night they started P&O Care
only sewing and oven capabilities. A generator powers tools, such as a heat gun and a grinder, which enables clinicians to make nearly any adjustment needed. Practitioners who are the busiest have access to their own vans, and Weber says the vehicles are on the road every day. Weber, who is vice president of AOPA, and becomes president elect December 1, recently instituted some new technology into P&O Care offices: software that enables remote face-to-face meetings. It helps the practice nurture its common purpose and culture, Weber says, and has become integral to communications within the company. About 75 percent of O&P Care’s patients are prosthetic cases, including a significant number of upper-extremity fittings as well as such rare amputations as hemipelvectomies and even hemicorporectomies, where the body is amputated at the midsection. Wilson won the Thranhardt Award at the 2004 AOPA National Assembly for designing
PHOTOS: Prosthetic & Orthotic Care
and James Weber, MBA, launched Prosthetic & Orthotic (P&O) Care Inc. in the St. Louis suburb of Fairview Heights, Illinois, in 2002. Weber, with a background in business and finance, had worked in the O&P industry some years earlier, and the two decided the only way to focus on their vision of quality patient care was to start their own facility from scratch. Their first office had four employees: Wilson as the sole practitioner, Weber as chief executive officer, Mark Woodson as director of fabrication, and Wanda Stevens as director of accounting and compliance. Today, P&O Care continues to serve the patient community in Fairview Heights but also has offices in St. Louis and Festus, Missouri. The staff has grown to 23, including eight practitioners, two residents, and five technicians. The Fairview Heights and St. Louis facilities feature about 4,100 square feet each and house a fabrication lab, two full walk rooms, and two additional patient rooms. The Festus office is slightly smaller, at 2,700 square feet, but also includes fabrication capabilities. From day one, Weber and Wilson knew they wanted to integrate mobile services into their practice. “Not only is it convenient for patients,” explains Weber, “it benefits practitioners, who save time, and the business, which saves money.” The facility has six Chrysler minivans, each equipped with a comprehensive lab, and lacking
an innovative “body bucket” that uses ROHO cushioning to support a corporectomy amputee comfortably in an upright position. That work has informed his care of hemipelvectomy patients as well, and he receives referrals from across the country for these services. P&O Care’s marketing efforts are led by Lauren Rehme, CP, whose experience as a prosthetist is a big plus, says Weber. She sees patients in the hospital and focuses on educating and building relationships with physicians, physical and occupational therapists, nurses, case managers, and vascular and orthopedic surgeons. “I also get involved in the documentation process,” says Rehme, which is especially important in light of today’s auditing environment. “With inaccurate records, you’re hurting patients, who don’t get the devices they need,” says Weber. “It’s arduous, but we stay ahead on documentation. Jon Wilson is very detail-oriented, and our team of practitioners shares the same interest and focus. The patient coordinators work closely with practitioners and the referring physician’s staff to get the appropriate physician notes in the medical record.” In thinking about the future of P&O Care, Weber looks to the past. “We started as two partners with a single vision of patient care, and we found quality people who shared that vision and applied it to the marketplace,” he says. “We didn’t decide to be the largest facility; we just wanted to take care of one patient at a time and provide the best quality service in our region. Our growth will be a natural outcome of adding practitioners as we attract more patients.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
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AOPA NEWS
DECEMBER 14
New Codes and What Lies Ahead for 2017 As 2016 comes to an end, it’s time to start thinking about what comes next. Prepare for the new year by taking part in the “New Codes and What Lies Ahead for 2017” webinar on December 14: • Examine the code changes for 2017. • Take a look at the fee schedule for durable medical equipment, prosthetics, orthotics, and supplies. • Learn about the new deductibles and co-pays. • Review all of the important changes in 2016. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/ 2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions. Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.
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NOVEMBER 2016 | O&P ALMANAC
NOW AVAILABLE:
2016 Operating Performance Report AOPA Releases Results From Member Benchmarking Survey
Are you curious about how your O&P business is performing compared to others? Have you been asking questions like these: • How does our spending on materials, advertising, or other expenses compare with other companies similar to ours? • Is our gross margin better or worse than other facilities of the same size? • Are our employees generating enough sales? Copies of the 2016 Operating Performance Report are now available. The annual report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payor information organized by total revenue size, community size, and profitability. This year’s data was submitted by more than 88 patient-care companies representing 1,164 full-time facilities and 71 part-time facilities. Copies of the 2016 Operating Performance Report are available electronically or print in AOPA’s bookstore: • 2016 Operating Performance Report (Electronic)— Member/Nonmember: $185/$325 • 2016 Operating Performance Report (Print)— Member/Nonmember: $285/$425.
AOPA NEWS
RECOGNITION
O&P Almanac Honored With Design Awards O&P Almanac has been honored with two Graphic Design Awards of Excellence in Graphic Design USA’s 53rd Annual Design Competition. The December 2015 and June 2016 issues of the magazine were submitted for consideration for the awards. The December 2015 design will be featured in the Graphic Design USA Award issue. The Magazine for the Orthotics & Prosthetics Profession
The Magazine for the Orthotics & Prosthetics Profession
J U N E 2016
Understanding the VA RFP Process
DECE M B E R 2015
! QU IZ ME EARN
Code and Fee Schedule Changes for 2016
P.16
2
BUSINESS CE
CREDITS P.20
P.18
Participants' Take on Co-Creating Legislation
Highlights from the 2015 AOPA National Assembly
P.32
P.34
Exclusive: Preview the 2016 Thranhardt Lecture Series
Update on Medicare DMEPOS Supplier Application Fee
P.40
P.56
! QU IZ ME EARN
2
BUSINESS CE
CREDITS P.19
O&P
How virtual reality could be the next powerful tool for the profession P.24
Reaching
for
Virtual
Function
UPPER-LIMB SPECIALISTS DISCUSS EVOLVING TECHNOLOGIES AND ENSURING THE BEST FIT AND COMPONENTRY LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON
Preliminary Program and Registration Materials
Exhibits. Education. Networking. 32+ CE Credits. There is a reason why more orthotic, prosthetic, and pedorthic professionals
This Just In: Driving Positive Change— An Update on Recent Advocacy Efforts P.20
choose the AOPA National Assembly. If you are going to attend a National Convention, choose the one that has it all. Get access to the best in
REGISTRATION IS
business education, advanced clinical programming from physicians,
OPEN
high-level researchers and top practitioners, the largest exhibit hall in the United States and of course, fun networking events.
For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.
AOPAnet.org
SAVE $300
Membership Has its Benefits: Build a Better Business with AOPA Members save over $300 on their Assembly registration. Learn more at www.AOPAnet.org/join.
Watch Your Mailbox for the AOPA 2016 National Assembly Preliminary Program
YOUR CONNECTION TO
EVERYTHING O&P
WWW.AOPANET.ORG
P.24
#AOPA2016
American Orthotic & Prosthetic Association
THE PREMIER MEETING for orthotic, prosthetic, and pedorthic professionals.
This Just In: Analyses of Policymakers’ Statements Regarding the Draft LCD for Lower-Limb Prostheses P.22
YOUR CONNECTION TO
2017 Webinar Topics Released Mark your calendars for AOPA’s 2017 monthly webinars. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits—so you can still take advantage of the series discount and the valuable learning opportunities. Register for the complete 2017 series and get two free webinars! Members pay $990 and nonmembers pay $1,990, for the series. Register at bit.ly/2017webinars.
EVERYTHING O&P
2017 Webinars • January 11: O&P Clinical Documentation: Who Needs To Document and What You Need To Document • February 8: LSO/TLSO Policy • March 8: Marketing Your Business • April 12: Grassroots Advocacy • May 10: Modifiers: What Do They Mean and When To Use Them
Join the AOPA Google+ Community AOPA has launched a members-only Google+ Community to establish a forum for discussion about issues facing the O&P profession, and to develop advocacy strategies to address those issues. This forum serves to empower the O&P community to make more informed decisions when new challenges arise. To join, visit AOPAnet.org, clicking the Google+ icon on the homepage, and request to join.
• June 14: Internal Audits: The Why and the How of Conducting Self-Audits • July 12: Know Your Resources: Where To Look To Find the Answers • August 9: What the Medicare Audit Data Tells Us and How To Avoid Common Errors • September 13: ABC Inspections and Accreditation • October 11: AFO/KAFO Policy • November 8: Gift Giving: Show Your Thanks and Remain Compliant • December 13: New Codes and Other Updates for 2018
O&P ALMANAC | NOVEMBER 2016
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AOPA O&P PAC
O&P PAC Update
T
HE O&P PAC IS AOPA’s federally regis-
tered political action committee (PAC), AOPA’s lobbying branch, representing the O&P profession on Capitol Hill to ensure that your voice is heard during pertinent discussions and /or debates on legislation that may have an effect on the future of O&P. The O&P PAC is bipartisan and does not support one political party over the other, but instead focuses on seeking out key legislators on key committees, who have demonstrated an interest and concern for the issues facing the O&P community. The O&P PAC then supports these legislators and their election efforts with a donation to their campaign funds and/or will help sponsor a fundraising event for these candidates. Since the O&P PAC is federally registered, it must comply with all of the rules and regulations of the Federal Election Committee (FEC). The FEC has very specific rules on who may contribute to a trade association’s political action committee. All O&P PAC contributions must be voluntary and come from eligible employees of AOPA member companies, including O&P practitioners, executive and administrative personnel, board of directors, stockholders, and their family members. All contributions from these eligible individuals must be made with personal funds. The O&P PAC may not accept contributions from corporate accounts. Also, monies collected by the O&P PAC cannot be used for government relations administrative functions, those things funded by Capitol Connection; they may only be used for direct or indirect support of federal candidates. To participate in and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo.com/forms/op-pac-authorization. 40
NOVEMBER 2016 | O&P ALMANAC
The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to the O&P PAC*: • Michael Allen, CPO, FAAOP • Ryan Arbogast • Vinit Asar • Rudy Becker • Dale Berry, CP • Bret Bostock, CO • Frank Bostock, CO • Erin Cammaratta • James Campbell, PhD, CO, FAAOP • Doyle Collier, CP • Kenneth Cornell, CO • Charles H. Dankmeyer Jr., CPO • Thomas DiBello, CO, FAAOP • Mark Edwards, CP • A.J. Filippis, CPO • Arlene Gillis, CP, FAAOP • Paul Gudonis • Alfred Kritter, CPO , FAAOP • Teri Kuffel, Esq.
• Eileen Levis • Anita LibermanLampear, MA • Pam Lupo, CO • Jeff Lutz, CPO • Chris Nolan • Michael Oros, CPO, FAAOP • Anthony Potter • Paul Prusakowski, CPO • Rick Riley • Bradley Ruhl • Scott Schneider • Andreas Schultz • Frank Snell, CPO, FAAOP • Chris Snell • Clint Snell, CP • Mike Sotak • Gordon Stevens, CPO • Thomas Watson, CP • James Weber, MBA • Eddie White, CP • Pam Young
AOPA O&P PAC
The O&P PAC would like to acknowledge and thank the following AOPA members for their recent support of O&P PAC sponsored events: • • • • • • • • • • • • • • • • •
Thierry Arduin Vinit Asar Rudy Becker David Boone, PhD Frank Bostock, CO James Campbell, PhD, CO, FAAOP J. Martin Carlson Tina Carlson Jeff Collins Thomas Costin Charles H. Dankmeyer Jr., CPO Don DeBolt Thomas DiBello, CO, FAAOP David Edwards, CPO, FAAOP A.J. Filippis, CPO Thomas Fise, JD Rick Fleetwood
• • • • • • • • • • • • • • • • • •
Elizabeth Ginzel, CPO Alfred Kritter, CPO, FAAOP Robert Leimkuehler, CPO Eileen Levis Anita Liberman-Lampear, MA Jeff Lutz, CPO Dave McGill Hans Georg Näder Michael Oros, CPO, FAAOP Pam Lupo, CO Rick Riley Anne Rowell, CPO Bradley Ruhl Steven Rybicki Scott Schneider Mike Sotak Gordon Stevens, CPO James Weber, MBA
Left to right: Rick Fleetwood, Anita LibermanLampear, MA, and Scott Schneider at the 2016 AOPA Wine Tasting and Auction.
*Due to publishing deadlines, this list was created on Oct. 12, 2016, and includes only donations received between Aug. 31, 2016, and Oct. 12, 2016. Any donations made/received on/or after Oct. 12, 2016, will be published in the next issue of the O&P Almanac.
The Source for Orthotic & Prosthetic Coding
Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.
T
HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.
Log on to LCodeSearch.com and start today. Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.
Manufacturers: AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.
SPECIA16L! for 20
www.AOPAnet.org
O&P ALMANAC | NOVEMBER 2016
41
MARKETPLACE
Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.
New AFO Gauntlets, Part of ACOR PRIME! A custom AFO Gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2016 Acor is now offering our refined-design AFO Gauntlets hand-made in our Cleveland, Ohio, facility as part of our new ACOR PRIME services. ACOR PRIME is designed to eliminate pricing and shipping hassles, with free shipping both ways and standard orthotics mods included at no additional charge! See our ad this issue for information regarding our new ACOR PRIME services or just call Acor at 800/237-2267.
ALPS Superior Performance Liner The Superior Performance Liner (SP) features a black fabric that allows for comfort and stability for active patients. This liner features ALPS GripGel or HD Gel to help facilitate donning as well as reduce pistoning and bunching behind the knee. The SP Liner provides superior comfort and is offered in 3-mm and 6-mm uniform thickness to accommodate most users. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.
Custom Stealth Foot Orthotics Custom carbon fiber foot orthotics—and boy, are they pretty. And strong. And lightweight. Trusted to protect the feet of our service members, this beauty goes more than skin deep. Fabrication available from foam boxes or Amfit digital files in two rigidities (firm or flex). Corrections and adjustments are molded into the carbon fiber to eliminate movement of pads and edges during wear. EVA heel counter maintains stability in the shoe or boot. Contact our customer service team to learn more today. orders@amfit.com or 800/356-FOOT(3668), x250.
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NOVEMBER 2016 | O&P ALMANAC
FootPrinter Impression Box Program Need a way to order custom foot orthotics without adding technology to your office? Keep it simple with impression foam for your custom foot orthotic orders. FootPrinter Program available for standard EVA, diabetic, carbon fiber, and polypropylene orthotics. No equipment or software necessary, just a quick and easy order form to get you on your way. A5513 PDAC-approved diabetic insert program includes return shipping to the lab and the finished inserts back to your door. Fabrication time from three to five business days. Contact our customer service team to learn more today. orders@amfit.com or 800/356-FOOT(3668), x250.
Cool Liner 2.0 Vertical Stretch Control (VSC) by DAW Industries Cool Liner 2.0 VSC DAW, the world’s leading manufacturer in prosthetic socket interface (DAW Sheath/ Sock), has improved upon our unbelievably advanced Cool Liner™ technology to create a thermoformable gel socket liner that provides a level of socket comfort beyond what is thought possible. You will never go back after using our new and improved Cool Liner with patented Vertical Stretch Control (VSC)—no other liner provides total elimination of vertical stretch with this level of comfort. For more information, call DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.
Sure Stance K3 Knee by DAW Industries HK-4PSC This ultralight, true variable cadence, multiaxis knee is the world’s first nonmicroprocessor, four-bar stance-control knee. The positive lock of the stance control activates up to 35 degrees of flexion! The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients not qualifying for a microprocessor knee. For more information, call DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.
MARKETPLACE Child Variable Cadence Multiaxis Knee Never heard of before: This ultralight miniaturized knee provides the ultimate in function and dependability for the active above-knee child amputee or smaller petite adults. Designed as a four-bar Pneumatic Polycentric, the knee’s instantaneous center of rotation is projected proximally to the patient's residual limb. The specially engineered alloy construction accommodates the most active child amputee or lightweight adult with uncompromising strength and durability. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.
Innovative OA solution Agilium™ Freestep gives you an entirely new approach to relieve your patients’ knee pain due to osteoarthritis. It provides targeted support to alleviate knee pain while minimizing traditional compliance issues. The unique design allows it to fit a wide variety of patient sizes, and the low-profile figure means it can fit conveniently underneath your patient’s pant leg. Talk with your local sales representative to learn more or go to professionals.otto bockus.com.
design. dexterity. intelligent motion.
LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit www.hersco.com.
DVS—Dynamic Vacuum Integrating innovative design with simplicity, the DVS reduces the movement between the limb and socket associated with limb volume fluctuations. By generating a vacuum during walking within the socket, it maintains a level of elevation in both swing and stance phase. This sets it apart from passive systems, such as valves, where a vacuum is only generated in the swing phase. Developed for easy fabrication, fittings are simplified for both the patient and prosthetist when integrating the system into the socket. Learn more by visiting professionals.ottobockus.com.
•
Smarter: uses simple gestures to change grips
•
Faster: boost digit speed by up to 30 percent
•
Smaller: new form-fitting anatomical design reduces profile in every dimension For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.
O&P ALMANAC | NOVEMBER 2016
43
AOPA NEWS
CAREERS
Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.
Mid-Atlantic
CPO/BOCPO
Elizabethtown, Kentucky At Center for Orthotic & Prosthetic Care (COPC), our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, New York, and Pennsylvania. Due to the opening of the office manager position at our patient-care facility in Elizabethtown, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years of clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits, including medical, dental, disability, 401K, certification, and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, submit your resume, in confidence, to: Fax: 502/451-5354 Email copchr@centeropcare.com
O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad
Member $482 $634
Nonmember $678 $830
Listing Word Count 50 or less 51-75 76-120 121+
Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word
Membership has its benefits:
BUILD A
Better BUSINESS
ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board
For more opportunities, visit: http://jobs.aopanet.org.
SUBSCRIBE
A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.
44
WITH AOPA
Member Nonmember $85 $150
NOVEMBER 2016 | O&P ALMANAC
Visit www.AOPAnet.org/join today! Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing and Audit Resources Education, Networking, and CE Opportunities Advocacy Research and Publications Business Discounts
CALENDAR
2016
2017 November 9
Don’t Miss Out: Are You Billing Webinar Conference for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
November 14-15
AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar. The Tropicana, Las Vegas. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Seminar
December 1
ABC: Practitioner Residency Completion Deadline for January Written & Written Simulation Certification Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
December 9-10
ABC: Prosthetic Clinical Patient Management (CPM) Exam, Caruth Health Education Center. St. Petersburg College, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
January 1
ABC: Application Deadline for all March Exams. Applications must be received by January 1 for individuals seeking to take the March ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.
January 11
O&P Clinical Documentation: Who Needs To Document and What You Need To Document. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
February 8
LSO/TLSO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
March 8
Marketing Your Business. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
April 12
December 14
New Codes and What Lies Ahead for Webinar Conference 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
Grassroots Advocacy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
Apply Anytime! Apply anytime for COF, CMF, CDME; test when ready; receive results instantly. Current BOCO, BOCP, and BOCPD candidates have three years from application date to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit www.bocusa.org.
www.bocusa.org
Calendar Rates Let us
SHARE
your next event!
Online Training Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.
CE For information on continuing education credits, contact the sponsor. Questions? Email landerson@AOPAnet.org.
CREDITS
Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.
Words/Rate
Member
Nonmember
25 or less
$40
$50
26-50
$50 $60
51+
$2.25/word $5.00/word
Color Ad Special 1/4 page Ad
$482
$678
1/2 page Ad
$634
$830
O&P ALMANAC | NOVEMBER 2016
45
CALENDAR
May 10
Modifiers: What Do They Mean and Webinar Conference When To Use Them. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
September 13
ABC Inspections and Accreditation. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
October 11
June 14
Internal Audits: The Why and the How Webinar Conference of Conducting Self-Audits. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.
AFO/KAFO Policy. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
November 8
Gift Giving: Show Your Thanks and Remain Compliant. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
June 21-23
New York State Chapter of AAOP Educational Program. Albany Marriott Hotel, Albany, NY. Visit www.NYSAAOP.org or contact Joann Marx, CPO, FAAOP, at Marx4nysaaop@aol.com.
December 13
New Codes and Other Updates for 2018. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
July 12
Know Your Resources: Where To Look To Find the Answers. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
August 9
What the Medicare Audit Data Tells Us and How To Avoid Common Errors. Register online at bit.ly/2017webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference
BUILD A
Better BUSINESS
September 6-9
100th AOPA National Assembly and Second World Congress. Las Vegas. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.
WITH AOPA
AOPA membership has its benefits. Visit www.AOPAnet.org/join today!
ADVERTISERS INDEX
46
Company
Page Phone
Website
ACOR Orthopedics Inc. ALPS South LLC Amfit Amputee Coalition DAW Hanger Inc. Hersco Medex International Inc. OPTEC USA Ottobock Touch Bionics
15 25 7 37 1, 35 19 2 9 29 C4 5
www.acor.com www.easyliner.com www.amfit.com www.amputee-coalition.org www.daw-usa.com www.EmpoweredCareers.com www.hersco.com www.medexinternational.com www.optecua.com www.professionals.ottobockus.com www.touchbionics.com
NOVEMBER 2016 | O&P ALMANAC
800-237-2276 800-574-5426 800-356-3668 800-267-5669 800-252-2828 512-777-3800 800-301-8275 888-886-2420 888-982-8181 / 770-513-7380 800-328-4058 855-694-5462
EXTRAORDINARILY SIGNIFICANT FINDINGS: Medicare data proves the economic value of an O&P intervention.
O&P CARE is COST EFFECTIVE The Study that Started MobilitySaves.org
5
A major study, commissioned by the Amputee Coalition with support from the American Orthotic & Prosthetic Association, shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. Mobility Saves Lives And Money!
Reasons to visit MobilitySaves.org
Learn about the study proving orthotic and prosthetic care saves money
1.
Find ads and videos on Medicare’ costcutting to share on your website or social media
See healthy lives affected by O&P care
2.
Follow us on social media!
Find resources to share with your patients
3.
4.
Learn how much Medicare has saved this year by providing O&P care
5.
Visit MobilitySaves.org.
“Search Mobility Saves” on Facebook, Twitter, and LinkedIn
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: 9/29/16 4. Issue Frequency: Monthly 5. No. of Issues Published Annually: 12 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: Thomas F. Fise, 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: September 2016 Avg. No. Copies Each Issue During Preceding 12 Months 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, Streeet 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 e. Free Distribution Outside the Mail f. Total Free Distribution g. Total Distribution h. Copies Not Distributed i. Total (Sum of 15g and h) Percent Paid and/or Requested Circulation
Actual No. Copies of Single Issue Published Nearest to Filing Date
13,495
15,634
12,615 0 0
12,410 0 0
0 12,615
0 12,410
0 0 0 546 546 13,161 496 13,657 92%
0 0 0 2,950 2,950 15,360 545 15,905 78%
O&P ALMANAC | NOVEMBER 2016
47
ASK AOPA CALENDAR
Lower-Limb Lessons Medicare coverage of covers, skins, and materials for lower-limb prostheses
AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.
Q
Does Medicare provide coverage and pay for both the protective foam covers and covering skins on a lower-limb prosthesis?
Q/
The answer is yes and no. Medicare will cover and pay for both the protective foam covers and skin coverings on the same prostheses, but only under certain documented conditions or scenarios.
A/
The durable medial equipment Medicare administrative contractors (DME MACs) have stated that medical neccessity for both prosthetic covers (L5704-L5707) and protective covering systems or skins (L5962, L5964, and L5966) on a single prostheses is rare. They have stated that custom-shaped protective covers provide sufficient protection and waterproofing for normal daily usage of a prosthesis, and that the addition of an outer surface covering/skin is only medically necessary when there are unusually harsh environmental situations that warrant additional protection. To ensure payment when billing for skins (L5962, L5964, or L5966), you must include information on your claim regarding the type of protective cover provided (i.e., manufacturer name, make, model or type). What are the rules for billing ultralight materials with a lower-limb prosthesis?
Q/
To answer this question, look to two different sources: the lower-limb prosthesis policy and the coding/billing reminder announcements from the DME MACs. First, the lower-limb prosthesis policy states that the ultralight material codes (L5940, L5950, and L5960) may only be used to describe the materials used in the fabrication of the socket, and not the componentry. It also states that the unit of service is “per limb.” Second, the coding/billing reminder announcements released by the DME MACs state that the ultralight codes (L5940-L5960) may only be billed when using or providing certain endoskeletal prosthesis and socket replacement codes. These base codes are L5301, L5312, L5321, L5331, L5341, L5700, L5701, L5702, and L5703.
A/
What information is needed on a claim in order for Medicare to process a claim for a miscellaneous code, such as L1499, L2999, or L3999, etc.?
Q/
When submitting a claim for a miscellaneous code, you must provide the following information with the claim: • Description of the item • Manufacturer name • Product name and number • Supplier price list amount • Health Care Common Procedure Coding System code of related item (if applicable)
A/
Claims submitted without this information will be denied, and you will be required to resubmit the claim with all of the appropriate information. 48
NOVEMBER 2016 | O&P ALMANAC
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