October 2023 O&P Almanac

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Seven tips to boost profits and position your facility for long-term viability 18


The Magazine for the Orthotics & Prosthetics Profession




Join us September 12–15, 2024, for an ideal combination of top-notch education and entertainment at the 107th AOPA National Assembly in Charlotte, NC.

Exhibits. Education. Networking. FOLLOW US @AmericanOandP


AOPA National Assembly


Not just a 3.0 Redefining the Ankle Experience

It actually feels like you have a leg. Feels a

lot lighter, very comfortable. When I stand still, I balance very easily.

It’s like a part of you and you’re not scared.”

Francisco M.

Retired Car Salesman



For the first time in all the different prostheses and feet I have tried, and I have tried so many, it felt like I

had my leg back again. The Kinterra is life changing. It has inspired me.”

Tarsha N.


Behavioral Therapist


October 2023 | Vol. 72, No. 9 FEATURES



26 TRAILBLAZERS AND TRENDSETTERS Meet the talented O&P professionals who were honored during this year’s AOPA National Assembly. From pioneers in the profession to innovators in digital education, research, business strategies, and more, this year’s award winners represent a spectrum of O&P aptitude that drives the advancement of the profession.

Independent O&P patient-care facilities can survive, and even thrive, in a competitive market amid heightened merger and acquisition activity—but they must be strategic, embrace change, and foster positive relationships with patients and referral sources. Try these seven practical tips for long-term success.







The latest on prior authorization and coding changes

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


30 Transformations

Views From AOPA Leadership

36 Welcome New Members

Why you should join the Limb Loss & Preservation Registry

36 O&P PAC

AOPA Contacts How to reach staff


Despite more limited componentry options for pediatric patients, Taylor Sisson, CPO, designed a helpful solution for a 6-year-old patient with congenital bilateral transfemoral amputation.


Happenings Research, statistics, and industry news

12 People & Places Transitions in the profession


O&P Almanac October 2023

AOPA announcements, member benefits, and more

37 Marketplace 39 Calendar Upcoming meetings and events

39 Ad Index 40 State By State So Every BODY Can Move scores legislative victories

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Views From AOPA Leadership

An Update on the LLPR: Are You Involved in This Transformational Resource?


know you understand that the lack of current and reliable data for those living with limb loss and limb difference has impacted the ability of the O&P community to provide standardized comprehensive care, thereby affecting the quality of life for patients. You may not be aware that there is a solution. The Limb Loss and Preservation Registry (LLPR) was created to collect data nationally for the acquired and congenital limb difference and limb preservation populations—for both upper and lower extremities. The LLPR is a collaborative data hub and accumulates valuable data, integrating hospital, prosthetist, orthotist, and patient-reported outcomes data to produce a comprehensive view of patient care. As a collaborative data hub, the LLPR provides hospitals and O&P providers the opportunity to work together and revolutionizes management of patient care for healthcare professionals, insurance companies, and patients. It was developed and supported by the U.S. Department of Defense and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Since its impetus, AOPA has been a supporter of it and encourages its membership to participate. As data in the registry increases, healthcare professionals, manufacturers, researchers, and patients will enter a new era of personalized care, fueled by comprehensive aggregated data transformed into information to improve quality, safety, and treatment protocols in the O&P industry. The registry has partnered with OPIE, OPSolutions, and Nymbl to make exporting the uniform data elements convenient. It is designated a Federal Risk and Authorization Management Program (FedRAMP) moderate impact level secure database. Providers push their data to the registry—the LLPR does NOT and cannot access a provider’s electronic medical records system. At this time, there is no cost to join, send data, and receive basic dashboard reports from the registry. Beginning in 2024, subscription plans offering varying levels of benchmarking, progress, and performance will be available for purchase. You may ask what participating means for you. Using the data from the LLPR, practitioners, clinical leaders, and operators can: Evaluate treatment options and care plans to improve and maximize patient function Set meaningful, realistic, and consistent goals and objectives with patients and the care team Access insights that can lead to earlier care interventions and predictive indices Critically assess the care provided compared to regional and national benchmarks Use patient population and social disparities to risk-adjust outcomes. For smaller practices, participating in clinical registries allows facilities to effectively leverage larger volumes of data and requires no additional practitioner time to collect information. AOPA Executive Director Eve Lee, MBA, CAE, recently said it best in a video: “When you restore mobility for even one patient, you actually get them up and mobile and fully participating in their lives, in their communities, in their families, and in their work life, so that you have full members of society able to reach their full potential.” Currently there are seven hospital providers and 16 O&P providers, totaling more than 185 patient-care locations. To learn more and to join these providers, visit llpregistry.org.

• • • • •

Very truly yours,

Teri Kuffel, JD Teri Kuffel, JD, is president of AOPA.


O&P Almanac October 2023

A world where orthotic and prosthetic care transforms lives.

Board of Directors OFFICERS President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN President-Elect Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX Vice President Jeffrey M. Brandt, CPO Brandt Ventures, Exton, PA Immediate Past President Dave McGill Össur Americas, Foothill Ranch, CA Treasurer Rick Riley Bakersfield, CA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY James Kingsley Hanger Clinic, Oakbrook Terrace, IL Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV Linda Wise Fillauer Companies, Chattanooga, TN Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

AOPA Contacts Our Mission AOPA staff and volunteers are committed to our mission of being a trusted partner, advocating for and serving the orthotic and prosthetic community by: Fostering relationships with decision makers to ensure equitable access. Providing education that promotes professional excellence. Supporting research that informs innovative care. Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

• • • •

Our Vision


A world where orthotic and prosthetic care transforms lives.

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 | AOPAnet.org

EXECUTIVE OFFICES Eve Lee, MBA, CAE, executive director, 571-431-0807, elee@AOPAnet.org Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

HEALTH POLICY AND ADVOCACY Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571-431-0854, dbernard@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571-431-0814, smiller@AOPAnet.org Susannah Engdahl, PhD, manager, health policy and research, 571-431-0843, sengdahl@AOPAnet.org

MEETINGS & EDUCATION Tina Carlson, CMP, senior director, education and meetings, 571-431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571-431-0852, kelly.oneill@AOPAnet.org Kristen Bean, digital meetings specialist, 571-431-0876, kbean@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571-431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571-431-0810, bleppin@AOPAnet.org Nicole Ver Kuilen, manager of public engagement, 571-431-0836, nverkuilen@AOPAnet.org Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org AOPA Bookstore: 571-431-0876 Reimbursement/Coding: 571-431-0833, LCodeSearch.com

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

ADDRESS CHANGES Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2023 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.

O&P ALMANAC Eve Lee, MBA, CAE, executive director/publisher, 571-431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703-662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786-252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856-520-9632, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703-662-5828, cumbrell@contentcommunicators.com


O&P Almanac October 2023

ADVERTISE WITH US Engage the profession today. Reach AOPA’s membership with more than 10,694 subscribers. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net. Learn more at bit.ly/23AlmanacMediaKit.

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Happenings BUSINE SS B OOS T

Graduates of O&P Business Certificate Program Celebrate at Assembly New graduates of the Certificate in O&P Business Management Program were honored at a graduation ceremony Sept. 9 during the 2023 AOPA National Assembly in Indianapolis. Bridget Augustine; Amy Bauman, CPO; Curt Bertram, CPO; Jenny Chen; Linda Calabria; Yuri Escoto; Dana Glover; Fernando Ortiz; Caciel Ruvalcaba; and Karla Spero were recognized during the ceremony. These individuals join Sarah Marich and Jennifer Porter, who graduated during a previous iteration of the program. The Certificate in O&P Business Management is offered at University of Hartford’s Barney School of Business through a partnership with AOPA. The comprehensive program offers a series of business and management courses to provide business owners, managers, clinicians, and representatives from manufacturers and distributors an opportunity to explore O&P business challenges. The curriculum covers finance, sales, marketing, business operations, reimbursement policies, and management. “The Barney School of Business heartily congratulates the 2023 AOPA graduates at the National Assembly,” said Lillian Kamal, MIBA, PhD, associate dean of Barney. “We offer a comprehensive certificate program that provides O&P business owners, managers,


UKRAINE LIMB LOSS NUMBERS CLIMB Between 20,000 and 50,000 Ukrainians have been seriously hurt and forced to amputate one or more limbs since the Russian full-scale invasion began in February 2022. SOURCE: PBS NEWSHOUR, AUGUST 2023.


O&P Almanac October 2023

and practitioners with the acumen and skills needed to grow and succeed in business. We continue to enjoy a strong partnership with AOPA, and we look forward to welcoming many more AOPA students to our certificate program.” “We were pleased to celebrate the accomplishments of the graduates during the 2023 National Assembly,” said Eve Lee, MBA, CAE, executive director of AOPA. “The Certificate in O&P Business Management is a unique leadership experience that provides an opportunity to learn fresh insights, new tools, and proven techniques for developing better business practices, all with the goal to help improve the individual’s place of business.” To learn more about the business certificate, visit AOPA’s website.



Survey Finds 11% of Veterans Discontinue Prosthesis Use

ABC Provides Precertification Course Approval

Nearly 4,000 veterans with upper-limb or lower-limb amputation completed an online survey investigating the rate, reasons for, and factors associated with never using or discontinuing use of a prosthesis. The survey was conducted by researchers from the U.S. Department of Veterans Affairs (VA) and Virginia Commonwealth University and published in the June issue of Prosthetics and Orthotics International. Survey respondents were 96% male with a mean age of 67 years old and a mean of 18 years since amputation. Approximately 8% had never used a prosthesis, and 11% had discontinued using a prosthesis. The most common reasons for discontinuing use were functionality (62%), undesirable prosthesis characteristics (57%), and comfort (53%). Individuals with upper-limb loss, female respondents, individuals with above-knee amputation, and individuals with diabetes were more likely to discontinue prosthesis use. Current prosthesis users reported the highest prosthesis satisfaction and quality of life.

The Board of Directors of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) recently took action to create a pathway for future pedorthists to receive approved education in preparation for pursuing a career in pedorthics. The ABC Board convened a task force of pedorthic subject matter experts, then approved new standards for pedorthic precertification education. The application for course approval is available for pedorthic course providers. A listing of approved courses is available on ABC’s Pedorthic Precertificaion Course page on ABC’s website. CREDITS: AOPA, ADOBE STOCK, AOPA


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Quick Connect Device May Aid Limited Community Ambulators As an alternative to the traditional fastening devices for tether lanyards, University of Washington researchers designed a simple “quick connect” to facilitate easy attachment and detachment of the tether from the liner for cleaning or replacement purposes. The new design features a slide-and-lock mechanism. Users can turn open the lock, slide it onto a short pin extending from the liner, and release the mechanism, which results in it springing back to the locked position. The research team conducted mechanical tests, which demonstrated the system well-tolerated tensile loads of 25,000 cycles

Childhood Orthotic Use Improves Mobility for Adults With MMC Researchers in Sweden investigated ambulation regarding orthosis use and satisfaction with orthoses after intense orthotic management during childhood for individuals with myelomeningocele (MMC), a defect of the backbone and spinal cord. The research team, from Karolinska Institute and University Hospital, conducted a retrospective follow-up with a cross-sectional study of 59 individuals at adult age who had received orthoses from the same local O&P clinic from childhood into adulthood. The researchers studied orthosis use by study subjects at three points in time: 100% of subjects had used orthoses at age 5, 98% had used orthoses at age 12, and 78% used orthoses at their current adult age. Participants had used an array of orthosis types, including ankle-foot orthoses, kneeankle-foot orthoses, and others, depending on their individual support needs. The study subjects, who had participated in the O&P clinic and adhered to orthotic use in childhood, reported higher ambulatory function (63%) than the general population of individuals with MMC (42%) who may or may not have adhered to a strict bracing protocol. “The high frequency of orthosis use and similar satisfaction in all ambulation groups emphasize that early planning and follow-up of orthosis treatment during growth are important for mobility in adulthood,” reported the authors. The study was published in September in Prosthetics and Orthotics International.


O&P Almanac October 2023

at 100 N and single cycles at 350 N. Five individuals with transtibial amputation trialed the system and were able to fasten and unfasten the quick connect, taking between 2 and 30 seconds to do so. However, the subjects voiced a preference for the traditional pin-lock system, which they deemed less complex. “In its current form, the quick connect is likely to be used by limited community ambulators who struggle with the pin-lock donning procedure,” concluded the authors. “It also has potential use with powered tethers that use a motor to adjust tether length.” The study was published in September in Prosthetics and Orthotics International.

Psychological and Social Factors Influence Amputation Rehabilitation Postamputation, quality of life is significantly lower in individuals with lower-limb loss when compared to individuals without limb loss, but that perception starts to improve six months to one year later, according to researchers from Italy’s Scientific Institute of Pavia Maugeri. The research team conducted a systematic review to investigate quality of life and psychological adjustment among nontraumatic lower-limb amputees. The researchers reviewed 52 studies that included more than 5,500 limb loss patients and found that depression with or without anxiety symptoms is a key factor in quality of life among the limb loss population. Other factors include physical aspects of limb loss, cause and level of amputation, prosthesis use, relational aspects, social support, and relationships with healthcare providers. Transtibial amputations correspond to a higher level of health than transfemoral amputations, according to the researchers. The team also noted that prosthesis use corresponded with improved quality of life, noting that the ability to walk influenced participation in social activities and the ability to live independently. In addition, pain plays a crucial role in quality of life: Individuals who report pain postamputation were found to have lower disease acceptance, while subjects who received more benefits from amputation—such as less pain and reduced risk of death—reported greater satisfaction and acceptance. “In lower-limb amputee patients, psychological adjustment is a complex and multifaceted process, and quality of life/healthrelated quality of life may be influenced by various factors,” the researchers concluded. “Shedding light on these issues may provide useful suggestions for promoting clinical and rehabilitative interventions that may be tailored and effective in this clinical population.” The study was published in June in Healthcare (Basel). CREDITS: ADOBE STOCK




Public Policy Researchers Advocate for Expanding Prosthetic Coverage A new article published in IEEE: Technology and Society Magazine in September posits that the safety and care of individuals with limb loss should be a high priority for the U.S. government. Researchers from George Mason University’s Schar School of Policy and Government wrote the article, which recaps the public policy landscape surrounding prosthetic limbs in the United States and proposes ways to increase access and adoption of prosthetic limbs. After outlining some of the advances in the O&P industry and the roles played by the Food and Drug Administration, the Department of Veterans Affairs, and the Defense Advanced Research Projects Agency (DARPA), the authors pointed to 2022 legislation in Maine as a model for ensuring greater access to prosthetic devices. Maine’s law, An Act To Improve Outcomes for Persons With Limb Loss, LD 1003, requires all health insurance policies regulated by the state of Maine to consider the recreational needs of children when deciding which prostheses

to cover. This legislation is in alignment with AOPA’s So Every BODY Can Move initiative. “Other states need to follow Maine’s lead,” concluded the authors, Carolena Stephanie Larson and Muhammad Salar Khan. “With developments like [DARPA’s hand proprioception and touch interfaces] and [agonist-antagonist myoneural interface], the future looks bright for the people who will benefit from these advancements the most, and insurance companies nationwide need to adapt their policies to cover and support bionic technologies. “We urge that there be a federal mandate to include bionics in federal insurance programs and insurance companies regulated by Obamacare. As prostheses advance in sensory capabilities, insurance companies also need to recognize prosthetic limbs as a part of the body susceptible to personal injury, not just as equipment, since they have haptic capabilities … and can feel distress. This recognition would ensure better coverage and support for those with prosthetic limbs.”

DISEASE SHORTENS LIFESPANS “Estimates suggest that people with diabetes die, on average, six years earlier than people without diabetes. … Every decade of earlier diagnosis of diabetes was associated with about three to four years of lower life expectancy.” SOURCE: “LIFE EXPECTANCY ASSOCIATED WITH DIFFERENT AGES AT DIAGNOSIS OF TYPE 1 DIABETES IN HIGH-INCOME COUNTRIES,” THE LANCET, OCTOBER 2023.

O&P By the Numbers Where To Find O&P Clinicians According to the U.S. Bureau of Labor Statistics, certain states and areas house significantly higher concentrations of orthotists and prosthetists (numbers are from May 2022).




Employment of orthotists and prosthetists, by state, May 2022

Employment Per 1,000 Jobs

Ohio Pennsylvania Florida Texas California

0.09 0.08 0.06 0.05 0.05

ME T ROP OL ITA N A RE A WIT H HIGHE S T C ONCEN T R ATIONS OF JOB S Area Duluth, Minnesota/Wisconsin Gainesville, Florida Portland, South Portland, Maine Reno, Nevada Little Rock, North Little Rock, Conway, Arkansas

Employment Per 1,000 Jobs 0.31 0.23 0.19 0.18 0.16


Employment 80 - 120 130-230


Blank areas indicate data not available.


October 2023 O&P Almanac




3D PRINTING GAINS GROUND Nearly half (49%) of O&P facilities use some type of additive manufacturing technologies/3D printing in fabrication. SOURCE: “2022 AOPA OPERATING PERFORMANCE REPORT.”



Elon Musk Launches Neurotech Startup

AI Expert To Headline OTWorld

Several companies are experimenting with brain-computer interface (BCI) technologies, which are already playing a role in aiding individuals with limb loss, Parkinson’s disease, depression, and other medical conditions. Elon Musk has entered the BCI space, launching a neurotechnology startup called Neuralink. Neuralink and several other high-profile companies, including Synchron and Blackrock Neurotech, are currently developing neuroprosthetics. Musk’s company has received approval from an independent review board to begin the first human trial of the Neuralink brain implant for human subjects with paralysis. The company is seeking participants who have quadriplegia or ALS for human trials in which a wireless implant will be inserted into subjects’ brains via a surgical robot. The trials are expected to last six years.

Thousands of professionals in the orthopedic field will travel to OTWorld 2024, an international trade show and Congress, in Leipzig, Germany, next year. Scheduled for May 14-17, the biannual Claudio Castellini event will feature a keynote address by Claudio Castellini on “Co-Adaptation: The Key to a New Generation of Assistive Robots.” Castellini, who heads the Assistive Intelligent Robotics Lab at the Friedrich-Alexander-Universitat Erlangen-Nurnberg, will discuss the challenges and opportunities that assistive robotics present to patients with motor disorders and will explain “co-adaptation”: the process by which users and robots adapt to each other. Castellini’s research focuses on improving arm prostheses and developing interfaces that give limb loss patients more precise control over their prostheses. Visit ot-world.com for details.

People & Places BUSINE SSE S IN T HE NE WS of Cole Orthotic Pediatric Center in Toledo. The facility has been renamed Cole Leimkuehler Orthotic-Prosthetic Center. “We are pleased to expand our services to the Toledo area,” said Paul Leimkuehler, CPO, LPO. “We will continue the pediatric orthotic practice the previous owner, Daniel Cole, CO, LO, provided, but we will be expanding to include pediatric prosthetics as well as adult orthotics and prosthetics. Daniel will also continue to see patients.”

Paul Leimkuehler, CPO, LPO, and Daniel Cole, CO, LO

Össur Custom Solutions has announced it will expand into a new state-of-the-art facility in Orlando, Florida. The new facility, which will open in 2024, will include the Össur Training Center as well as the Össur Mobility Lab, which will supply education around Össur’s technology.

Leimkuehler Orthotic-Prosthetic Center, with offices in Amherst, Sandusky, and North Olmsted, Ohio, has completed the acquisition 12

O&P Almanac October 2023




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Reimbursement Page


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Stay in Step With Medicare Modifications How prior authorization and recent coding additions impact your business


wo of the hottest topics in reimbursement today are prior authorization and new codes. This month’s Reimbursement Page features important and timely information on both topics: quick tidbits, reminders, and tips about the prior authorization program for orthoses, as well as need-to-know code changes effective this month and in 2024.

Prior Authorization Tips

CMS announced in January 2022 the expansion of the Medicare prior authorization program to include five orthotic Healthcare Common Procedure Coding System (HCPCS) codes (see sidebar). Implementation took place in three phases beginning April 13, 2022, launching in one state in each of the four durable medical equipment Medicare administrative contractor (DME MAC) jurisdictions; full 14

O&P Almanac October 2023

Five Orthotic Codes Added To Prior Authorization 1. L0648: Lumbosacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf 2. L0650: Lumbosacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf 3. L1832: Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise 4. L1833: Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the-shelf 5. L1851: Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf


Reimbursement Page

implementation in all states and territories took place Oct. 10, 2022. With prior authorization of these select orthoses in full effect for about a year, it’s a good time to review what have we seen so far, and reinforce lessons learned. First, let’s look at the prior authorization approval rate. The rate is much lower than the initial rates we saw with the implementation of prior authorization for lower-limb prostheses in 2020. Approximately 80% of prior authorization requests for lower-limb prosthetic codes were approved on their initial submission, and almost all requests are being approved after the first resubmission. With prior authorization for knee and spinal orthoses, however, we are seeing approximately 65% of the prior authorization requests being approved on the first submission. According to Noridian, the DME MAC for jurisdictions A and D, there are a handful of top denial reasons. The primary denial reason relates to the knee orthosis codes

(L1832, L1833, and L1851): The medical record didn’t contain any documentation or didn’t demonstrate an objective description of joint laxity (i.e., varus/valgus testing, drawer test), and/or there was no documentation that the patient had a recent injury or surgery to the knee. Remember that with the knee orthoses, the documentation of joint laxity is not always required if the patient has had a recent injury or surgery. Other primary reasons for nonaffirmative prior authorization decisions include that the submitted documentation showed the orthosis had already been delivered, or that the documentation indicated the orthosis was needed in a postoperative setting but the surgery had yet to take place—meaning there is not medically necessity for the item. When submitting a prior authorization request, remember the medical necessity for the orthosis must be established. So, if the surgery has not yet taken place, then there would not be a need for the orthosis; and if you are

providing the brace for the patient to wear immediately following surgery, then you would be billing the hospital—not Medicare—so you would not need a prior authorization. Also, there are no retroactive or after-the-fact authorizations for orthoses you have already delivered. Now, there may be situations where there is an immediate need for an orthosis to treat an emergent injury or instability, and requiring a wait time of two days or more for a prior authorization decision may not be realistic for patients who require immediate stabilization to prevent further injury. AOPA discussed this concern with CMS and the DME MACs, and on April 12, 2022, CMS released guidance consistent with AOPA’s recommendations. The CMS guidance stated that if the two-day expedited review process would delay care and risk the health or life of the beneficiary, the Medicare prior authorization requirement would be suspended. Claims for emergent-need orthoses that

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October 2023 O&P Almanac


Reimbursement Page

would otherwise require Medicare prior authorization must be submitted with an ST modifier. The ST modifier will allow claims to be processed and paid; however, all claims submitted with the ST modifier will then be subject to prepayment review. We have learned that the ST modifier is routinely being used improperly. Remember that if the ST modifier is to be used, there must be documentation to explain or show that a delay in care would risk the health or life of the patient. Simply applying the ST modifier to bypass prior authorization or using it before the orthosis is needed, such as delivery prior to surgery, would not be appropriate. The DME MACs have stated that they will continue to process the claim, conduct the prepayment review, and pay the claim if all other medical necessity has been met, even if the ST modifier was used improperly; however, this practice could change in the future. It is vital that you only use the ST modifier when appropriate and that you have documentation to support its use. Finally, don’t forget that these five codes require Pricing Data Analysis and Coding (PDAC) approval, so make sure the orthoses you are providing have been reviewed and approved by the PDAC.

October 2023: Two New Codes

Twice a year, CMS’s HCPCS Workgroup holds public meetings to review HCPCS code applications and make determinations on coding, benefit categories, and payment determinations. The workgroup met in May/ June 2023 and released its final findings in late August. Their findings and recommendations resulted in two new codes being created, effective with dates of service on or after Oct. 1, 2023. The first of the new codes is rather unique; it is the first Level II HCPCS code to be created for osseointegration: L5991 (Addition to lower-extremity prostheses, osseointegrated external prosthetic connector) to describe the Axor II from Integrum S.E. The HCPCS Workgroup assigned the L5991 to the Artificial Leg (Prosthetic) benefit category and determined the average 2023 fee schedule amount to be approximately $10,969.24. 16

O&P Almanac October 2023

L Codes To Take Effect January 2024 Current Temporary Code

New Permanent Code as of 1/1/2024

Code Descriptor



Addition, endoskeletal kneeshin system, 4-bar linkage or multiaxial, fluid swing and stance phase control



Foot, adductus positioning device, adjustable



Addition to lower-extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type

The second code with an effective date this month, L1681, is designed to describe a custom-fitted bilateral hip orthosis. Its official descriptor is: Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. The PDAC, Palmetto GBA, submitted the code application for the L1681, as it determined a need for a code to describe a hip orthosis designed for bilateral postoperative range-of-motion control. The HCPCS Workgroup assigned L1681 to the Leg Brace (Orthotic) benefit category and determined the average 2023 fee schedule amount to be approximately $2,249.62.

January 2024: Three Permanent L Codes

In addition to creating two new codes, the CMS HCPCS Workgroup also began the process of establishing long-term and permanent L codes for items and services that may have received a temporary K code between Jan. 1, 2020, and the end of 2022. As you may know, CMS may establish or create temporary K codes for items and services for which a national code has not yet been created, and those K codes are considered valid for all claims submissions and payment.

The new, permanent L codes for three items will become effective for claims with a date of service on or after Jan. 1, 2024, and until then you may continue to use the active K codes (see sidebar).

Next Year: More Changes To Come

As a result of the Consolidated Appropriations Act of 2023 and the Lymphedema Treatment Act, Medicare will be required to provide coverage of lymphedema compression treatment items under a new Part B benefit category starting in 2024. With the creation of the new benefit category, CMS needed to revise the current codes for lymphedema sleeves and garments. At this time, the final updates and changes are uncertain, but expect changes to be announced in the near future—especially as a new Medicare Local Coverage Determination (LCD) and Policy Article are created. Stay tuned to news from AOPA and future Reimbursement Page articles in O&P Almanac to learn about the new codes and code changes related to the new lymphedema compression treatment LCD. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org.

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O&P Almanac October 2023



Seven practical tips for boosting profits and building long-term viability


&P patient-care business owners are maneuvering an increasingly challenging market, facing rising inflation, decreasing reimbursement, employee staffing shortages, and, of course, an uptick in mergers and acquisitions (M&A). Facility owners who hope to boost revenues and remain viable into the future must be willing to adapt to new technologies and processes and to scrutinize their referral source and billing practices. Smaller O&P practices that operate strategically will continue to have a place in the O&P market, despite continuing M&A activity, according to several O&P business experts. “I feel confident there will continue to be space for independent facilities,” says Mark Ford, founder of NuTech Synergies, “but you need to ask yourself how you will compete.”

“There will always be a place for small practices— particularly specialty practices and companies in rural areas,” agrees Lesleigh Sisson, CFo, CFm, founder of O&P Insight and an AOPA board member. Her consulting firm assisted seven individuals in launching new O&P practices this past year. “There are a lot of acquisitions—but there will be long-term successful [smaller] businesses that do the right thing for their patients and are highly regarded in their community,” adds Rick Riley, owner of O&P Boost and an AOPA board member. “Smaller facilities can remain viable, but they have to be purposeful.” So how can today’s O&P facilities become “purposeful” and tactical to boost profits and position their facilities for growth amid the realities of today’s market? O&P consultants offer seven strategies for long-term success.


f In a competitive O&P market with heightened

merger and acquisition activity, smaller O&P patient-care facilities must be strategic in their operations to succeed and thrive into the future.


Facilities must be willing to analyze their current business practices and make changes to modernize, improve efficiencies, and boost the bottom line.

f Smaller facilities can leverage their competitive advantage of being “nimble” to become early adopters of new technologies.

f Experts recommend prioritizing “patient experience”

by providing a welcoming facility space and branding your facility in a positive and memorable way.

f O&P facilities should “monitor” their referral activity

to determine how business from specific surgeons and physicians compares to previous years, and foster relationships by providing feedback of patient progress.

f Business owners should examine their contracts with insurers and try to renegotiate terms regarding fee schedule percentages, payments, and renewals.

October 2023 O&P Almanac


Cover Story


Adopt a Change Mindset

Some O&P facilities “mistakenly believe that just because they’re still in business today, they can continue with their old business practices. On the contrary, companies seeking to remain profitable in an increasingly competitive market must get better at adapting to change,” says Ford. “It’s very easy to just keep doing what you’ve been doing—but the healthcare system will no longer allow that to be a profitable approach,” he says. “There’s so much change going on within the U.S. healthcare system that you have to keep up with new technologies and strategies.” Leaders must embrace “a willingness to get uncomfortable, and to look at how you can change your business to compete with a new wave” of competitors. Companies that remain committed to aging business practices may be reluctant to adopt a “change mindset” because they have so far remained sustainable, says Ford. “But they must start to make changes—consistently and regularly. Leaders should issue a call to arms to get better at what you’re doing in every aspect of your business.” Ford suggests that facilities examine each key facet of their business—such as administrative, clinical care, fabrication, billing, and reporting—“and determine, ‘What’s my single biggest problem in each of those areas?’ Then, ask, ‘What can I do in the next 30 days to make a change’ in each area?” “Take smaller steps to start,” Ford advises. “You don’t have to switch from plaster casting to scanning all at once—but you could try one aspect of it on some segment of your patients. And that will make an impact on growing your team’s willingness to change things while also likely saving some money.” Then repeat this process each month—identifying one more small change in each facet of your business—and you will see steady progress in modernizing, improving efficiencies, and boosting your bottom line, according to Ford. “This is a good way to get comfortable with change.”


Be Nimble To Compete With Larger Facilities

Mastering a willingness to live with ongoing change is critical for smaller practices when competing with extremely large companies that have big marketing budgets and buying power, says Ford. Independent practices with just a few locations must be quick to offer new products, and quick to talk to referral sources about new patient procedures or pilot programs. Ford says. “The speed at which you can adapt can become your competitive advantage.” “We have a growing number of larger patient-care companies as vertical integration grows” in the in U.S. O&P market, Ford explains. These organizations have many extra layers of support available—”but they are not nimble, they are slower to change, and so they adopt new technologies less quickly.” Practices with fewer layers of management and oversight involved in decision-making can usually move in new directions more rapidly. “If you can learn [a new technology or process] quickly and figure out if you can make it work for your office or your patients, then you can be the first in your area to implement an innovation.” 20

O&P Almanac October 2023

Seeking Acquisition? If your longer-term plan includes some form of a merger or acquisition, take the time to prepare properly, says Mark Ford, founder of NuTech Synergies. “Try to create a two-year plan to position your business for an exit in 24 months,” he says. “As part of that effort, take an honest look at your company Mark Ford and dig around to find ways that you can become more efficient. What new technologies can allow you to use less time to create a successful patient outcome? “The reality is that any company who looks to merge or acquire your practice will focus on the trends that you are showing with your revenues or profits. You need growth in both of these areas to be attractive,” says Ford, “The more value that you can show in your markets, the more options you will have for different types of exits.”

For example, “how fast can you figure out firsthand if the latest new vacuum suspension system is a good product, at a favorable reimbursement, that you can integrate into your practice this month?” Your ability to be an “early adopter” on new technologies can position your team as the innovator in your market—and that positioning of your practice can boost profits, according to Ford. He suggests getting creative on the fabrication or operations side as well. Consider one O&P company that is leasing 3D printers instead of purchasing them: “There’s a low cost of entry to lease and learn how to use this equipment, plus you also get maintenance and software support. It’s a great way to reduce your learning curve on a new technology before making a large investment in purchasing a printer.” The idea of bringing new things to market is “an underestimated way to drive revenue,” Ford adds. “When you are the O&P practice in your market that is proactively trying new ideas to improve your patients’ lives, that message resonates really well with referral sources.” Outcome measures play a key role here: “If you can demonstrate that your newer technologies or services are improving mobility via patient outcome testing, activity monitoring data, and device utilization information, your team becomes a true information source for referral sources,” he says. “This change in mindset reinforces that your O&P practice is not just about selling a device. You are a legitimate patient-care provider.”


Prioritize the Patient Experience

Most O&P professionals understand that excellent patient care is important—but the greater “patient experience” is what brings patients back and builds the company’s brand among referral sources, says Riley.

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Cover Story

Ready To Open Your Own Facility? Despite the challenging business climate, some O&P clinicians are opening their own businesses. In fact, Lesleigh Sisson, CFo, CFm, founder of O&P Insight, says her company assisted seven individuals in launching new patient-care practices over the course of the past year. Before you open the doors on a new business, Sisson has several suggestions: Understand how to start a clinical Lesleigh Sisson, CFo, CFm entity and how to enroll in Medicare. Familiarize yourself with the fee schedule and cost of goods. Hire a good accountant and attorney, or hire an O&P consulting firm that specializes in those areas. Think ahead to succession planning—will a family member eventually take over your business, or would you want to merge with or be acquired by another facility?

• • • •

Patient experience extends beyond the exam room. “Consider, with fresh eyes, what you want the patient’s first impression of your facility to be,” Riley advises. For example, how welcoming is the facility? Is it neat and organized, rather than cluttered? What art or messaging is on the walls greeting patients? How are patients treated by receptionists and the staff who bring patients to their exam rooms? “View every patient who comes in as a consumer who has choices,” he says. Treating patients well—by providing a welcoming facility space, remembering patients’ names and background stories at subsequent visits, and branding your facility in a positive and memorable way—will keep patients coming back. In turn, says Riley, those patients will share their positive experiences when talking with their physicians, physical therapists, and surgeons—the very individuals who are your referral sources. For orthotics, in particular, landing and retaining referral sources is critical: “The orthotics side of the business is so much more complex because of the many other [non-O&P] companies distributing bracing,” says Riley. He recommends making follow-up calls for patients who receive orthoses to ensure they are satisfied with the device and wearing it on a regular basis. “Call two weeks later and ask how often they’re wearing it,” Riley says, to ensure you check in with that patient before they see their physician again—and address any problems before the physician hears about them. Riley suggests adding patient feedback mechanisms into your daily business operations. “Consumers have become much more 22

O&P Almanac October 2023

astute, so find ways to reach out to them and monitor how they feel about their patient-care experiences.” For example, follow the lead of other consumer-centric businesses: After each appointment, contact patients using an automated voice call or text to ask patients to rate their patient experience on a scale of 1 to 5, Riley says. “If they rate you a ‘1’ or a ‘2,’ that warrants an immediate follow-up call.” Clinicians also can try calling patients for a quick follow-up to see how they’re doing after their appointment earlier in the day—to ask if the device is still fitting well, if it’s causing any irritation, and if they’re wearing the device. “These quick calls to check in could result in leaving a 30-second voice mail, or in a three- to Rick Riley five-minute conversation,” he says. “That personal touch will resonate—and will differentiate your business.”


Monitor Referral Source Relationships

More personalized relationships with referral sources also are vital. Riley suggests fostering more personal interactions with both current and potential referrers. When sending patient chart notes to update physicians, “don’t just send the notes—send a Hallmark card signed by your whole staff to thank them” for referring a patient, Riley says. “Or send a photo of the clinician with the satisfied patient, explaining the patient is doing well and appreciates the device and care you provided.” To take it a step further: “Take a 15-second video of the patient walking, and share it with the referral source” to demonstrate how your care has improved the patient’s quality of life. “Monitoring” referral activity is essential, says Riley. “Can you name your top 10 referral sources, and do you know how their business is trending this year, versus last year?” he asks. “Analyze where your business is coming from, and where there are opportunities.” Riley also suggests contacting new surgeons as they begin practicing in your area. “Any time a new orthopedic or vascular surgeon comes to town, do your research on their backgrounds, and see if you can find a common bond,” he says. “It is hard to get face time with them—but you have to try.” Joining charitable organizations that physicians and surgeons belong to, or purchasing tickets to hospital fundraisers, can be a way to more organically interact with potential referrers.


Renegotiate Insurance Contracts

One often-overlooked way to increase profit margins is to renegotiate contracts with insurers. Sisson notes that “it’s very difficult to move the needle with the bigger payors,” but there are ways to increase payments for certain devices. “Concentrate on specific codes that are very important to you,” and reach out to payors to see if you can renegotiate pricing on the top 10 or 20 codes you typically bill, she suggests.

Cover Story

Jessica Norrell, MBA, CPO, owner of MOZN Solutions, also encourages O&P facilities to take a hard look at insurance contracts because that’s an area where change is possible. When considering the various costs associated with running an O&P business—salaries for administrative and clinical teams, overhead, supplies, and devices—“we can’t control most of those,” says Norrell, “but we can try to improve our insurance contracts.” The first step is locating and reviewing each contract already in place, says Norrell, noting that many facilities skip this practice. “You really need to go through each contract and find out what it says” regarding fee schedule percentages, payments, and renewals. Next, identify the “top three” contracts that could be beneficial to renegotiate in 2024—contracts that may be outdated or that have a big impact on your bottom line. Even though the renewal period could be several months out, O&P business owners and managers should start building relationships with those companies’ representatives now, says Norrell. Then, determine which aspects of each contract could be adjusted to provide more reasonable reimbursement, such as updating to the most current Medicare fee schedule, and boosting the percentage of Medicare fee paid. One of Norrell’s clients discovered their contract was still operating on the 2009 Medicare fee sched- Jessica Norrell, MBA, CPO ule—which is 24% lower than the most current version. She also recommends evaluating the percentage of Medicare that the insurer pays, as stated in the contract: “Many pay 65% to 80% below Medicare rates,” which leads to “nonexistent margins.” O&P business owners and managers must adopt a “relentless” approach to contacting insurance representatives who may try to avoid renegotiation conversations, says Norrell. “Continue to knock on doors, and don’t give up after the first ‘No.’ Be prepared to show them seven years of operating expenses” to back up your request, and share “patient timing data” to demonstrate that O&P intervention is not a one-and-done appointment—and can in fact require 15 to 20 hours of clinical time to ensure an appropriate and well-fitting device. Such persistence can be challenging, and “it may be a yearlong process,” says Norrell, “but it just might lead to a 24% boost” in reimbursement.


Implement Well-Defined Patient Collection Practices

Collecting the patient’s portion of payment during patient visits prevents costly follow-up calls and invoicing—and prevents write-offs when some patients ignore bills. After the Affordable Care Act took effect, many out-of-pocket maximums increased for consumers—so today’s patients are expected to contribute greater percentages of total payments when insurance is involved, says Sisson. Facilities should ensure their policies for collecting the patients’ portion of payments—both deductibles and co-pays—are well-defined, and that office staff adhere to these policies during every patient visit.

Build Your Brand Advice from an O&P business owner In today’s competitive environment, independent O&P facilities should focus on differentiating themselves, says Paul Sugg, MA, CPO, CPed, FAAOP, owner of EastPoint Prosthetics & Orthotics, with locations in North Carolina, Ohio, and Pennsylvania. Building a brand that is unique to Paul Sugg, MA, CPO, your O&P facility can set you apart CPed, FAAOP from other O&P businesses, according to Sugg. EastPoint’s differentiator is its mobile care model: Its brick-and-mortar locations are supplemented by 14 fully equipped O&P mobile vans that travel to patients on a regular basis, making it easy for homebound or mobility-challenged patients to receive comprehensive care. Having a strong and easily recognizable brand can attract referral sources, too; for Sugg, physicians and surgeons in surrounding areas understand that EastPoint’s prosthetists and orthotists will travel to see patients, which can be a determining factor in choosing a clinician. Building a strong pool of referral sources can increase revenue and ensure patient satisfaction, according to Sugg. He suggests that both marketing personnel and clinicians prioritize referral-building while continuing to emphasize the facility brand.

“Typically, if you let a patient leave the facility without paying [their portion] for a device, you have only a 20% chance of collecting any of that money,” Sisson says. Facilities that are proactive in establishing financial payment plans and collecting fees before patients exit the office will be much more successful in their collections.


Evaluate Your Patient Base and the Surrounding Market

To succeed, facility leaders must truly understand their patient base. Delve into your electronic health record system to determine which HCPCS codes figure most predominantly. This can help you decide whether you should expand some of the services you offer—or narrow your business down, suggests Sisson. You may decide to ramp up efforts to pull in patients with certain etiologies that seem to be missing in your database. Conversely, you may decide to narrow your offerings to specialize in what “you’re really good at” to decrease costs of goods and make better use of staff time, Sisson says. Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com

October 2023 O&P Almanac


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AOPA National Assembly



Influential O&P professionals were recognized for their contributions, innovations, and research during the AOPA National Assembly


ongtime visionaries, leading innovators, and talented up-and-comers from the O&P community were honored with prestigious awards at the 2023 AOPA National Assembly in September. Among a crowd of 1,800 O&P stakeholders gathered for education, networking, and exhibit hall opportunities in Indianapolis, AOPA bestowed several awards to recognize high-achieving individuals and presentations: the AOPA Lifetime Achievement Award, the Hans Georg Näder Digital Education Award, the Thranhardt Awards, the Sam E. Hamontree Business Education Award, and the Student Poster Awards.

Össur Kristinsson, CPO

Marty Carlson, MS, CPO, FAAOP(D)

Lifetime Achievement Award: Two O&P Game Changers At a time of unprecedented change in the O&P profession, the award winners remind us that hard work, innovation, and a deep commitment to patient care will ensure success for O&P businesses and patients today and well into the future. Two recipients of AOPA’s 2023 Lifetime Achievement Award—Össur Kristinsson, CPO, and Marty Carlson, MS, CPO, FAAOP(D)—have exemplified these traits over the course of their long careers. The Lifetime Achievement Award honors outstanding leaders who made significant contributions to the advancement of patient care in the O&P profession over their lifetimes. This award—the highest honor bestowed upon any individual by AOPA—recognizes the brightest and most influential minds in the field. In a moving tribute delivered at the Assembly, Carlson’s son, Cole, explained how his father, who was born in 1941 to first-generation 26

O&P Almanac October 2023

AOPA National Assembly

Swedish and Norwegian immigrant parents, dedicated his career to the orthotics, prosthetics, and the complex rehabilitation industry. Carlson joined Gillette Children’s Hospital in 1972 and remained at the hospital for 16 years, resigning as director of habilitation technologies in 1988. Two years later, he and his wife, Cole Carlson spoke about his Peggy, founded Tamarack Habilitation father’s accomplishments Technologies Inc. At Tamarack, Carlson developed 15 U.S. and international patents—of which the most famous and well-recognized are the Tamarack Flexure Joint, ShearBan, GlideWear, and FlexForm wheelchair seating system. That drive to excel on behalf of helping people was a defining feature of Carlson’s career. “He has always demanded excellence from himself and those around him, and as a result of that uncompromising commitment to quality, proved that excellence can be a cost-effective business model in this industry,” Cole said of his father. “He has improved the lives of countless people around the world through his educational efforts, the services he provided, products he designed, and his leadership and compassionate work throughout the industry.” Dave McGill, past president of AOPA and vice president of market access and business alignment at Össur, accepted the Lifetime Achievement Award on behalf of Kristinsson, who was unable to attend the National Assembly. McGill explained that Kristinsson was born a congenital belowknee amputee and was frustrated Dave McGill, who accepted the by the limited prosthetic solutions award from Teri Kuffel, JD, on available to him. He moved to Sweden behalf of Kristinsson to study O&P as a young man and became a certified clinician. In 1971, he returned to Iceland and established his own O&P clinic. His driving mission was to create a better solution to protect amputees’ limbs. Through trial and error, he eventually identified silicone as a skin-friendly material and added a locking mechanism, leading to the invention of the Iceross liner. The technology received its first global patent in 1986 and quickly became the new standard of care for limb comfort and socket suspension. Innovations to the original Iceross design, such as the Seal-In liner, are still advancing the cause of patient comfort and safety today. Kristinsson later created the early version of the Össur Direct Socket, then helped deliver it to people around the world. After the devastating 2010 earthquake in Haiti, Kristinsson rushed to the island and dove into relief work, providing care and training local healthcare providers on the Direct Socket, ensuring adequate follow-up care would be possible for Haitian amputees. Some U.S. prosthetists later acknowledged that working with Össur in Haiti changed their approach to prosthetic care back home.

“While he is no longer a part of daily operations, his legacy remains at the center of all we do,” McGill said. “His vision and entrepreneurial spirit captured the hearts and minds of his colleagues back in the 1970s. That vision and spirit remain in our company’s DNA to this day, propelling our growth into a global organization focused not only on prosthetics, but on noninvasive orthopedics and patient care as well.”

Digital Education Award: Sensor Technology for OA Bracing The second annual Hans Georg Näder Digital Education Award went to Andrew McDaid, BEng(Hons), PhD, and Freeborn Mondello, PT, DPT, for their presentation, “The Impact of Sensor Technology on Bracing Outcomes for Knee Osteoarthritis (OA): A Randomized Clinical Trial.” McDaid is chief executive officer and Mondello is chief operating officer at OPUM, a New Zealand-based company specializing in wearable robotics, medical devices, sensors, clinAndrew McDaid, BEng(Hons), PhD ical research, machine learning, and artificial intelligence. The Näder award was established in 2022 by a gift from Ottobock Healthcare in honor of Professor Hans Georg Näder and his many contributions to the field of O&P. “We have partnered with AOPA to create this award to recognize the importance of advancing the digitaliFreeborn Mondello, PT, DPT zation of the O&P industry through research, education, technology, and treatment solutions,” Nader said upon creation of the award last year. “Technology that serves people is one of our highest ambitions. We are proud to be able to honor those who also believe in the importance of digital O&P care.” McDaid and Mondello embarked on their award-winning clinical trial to further explore digital technology’s ability to mitigate chronic pain. “I was excited by the potential of digital technologies to address a huge need with the growing osteoarthritis population who are suffering from chronic pain and reduced functional ability,” McDaid said. “The award is such an honor given all the top-quality research work that is being done around the world in this space. I hope that this will be a catalyst for more R&D and improved October 2023 O&P Almanac


Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)

translation to patient impact in the O&P field as it has demonstrated what can be done by adding digital tech to traditional devices.” McDaid also noted that he and Mondello appreciated their partners on the study, including Shirley Ryan AbilityLab, Thuasne, and Thuasne USA.

Thranhardt Awards: Myoelectric and Microprocessor Advances Two pioneering presentations were honored with Thranhardt Awards, established in 1996 by a gift from J.E. Hanger in memory of the late Howard R. Thranhardt. Thranhardt, a visionary prosthetist and O&P business executive, was one of only two people to serve as president of three O&P organizations: AOPA; the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; and the American Academy of Orthotists and Prosthetists. This year, two presentations were honored with Thranhardt Awards. Matthew Wernke, PhD, director of research and development at WillowWood Global LLC, presented “Upper-Extremity Myoelectric Interface and Control Methodologies.” Wernke, who also received a Thranhardt Award in 2015, compared user performance Matthew Wernke, PhD and satisfaction while using different myoelectric interfaces and control methodologies. The second 2023 Thranhardt presentation, “Microprocessor Stance and Swing Control Orthosis for Patients Dependent on a KAFO for Walking,” was delivered by Shane Wurdeman, MSPO, PhD, CP, FAAOP(D), vice president of scientific affairs at Hanger Clinic, and Andreas Kannenberg, MD(GER), PhD, executive medical director at Ottobock Healthcare LP. Wurdeman is a six-time Thranhardt Award winner. 28

O&P Almanac October 2023

Andreas Kannenberg, MD(GER), PhD

Their presentation explored the results of an international, multicenter, randomized controlled cross-over trial with 102 subjects comparing the benefits of the C-Brace to those of conventional knee-ankle-foot orthoses. This important research found that C-Brace use resulted in significant improvements in balance, reduction in actual reported falls, and improvements in risk of falling, mobility, function, and quality of life. “Their work will help improve and further the clinical care provided to the patients our profession is privileged to serve,” AOPA President Teri Kuffel, JD, said of the three 2023 Thranhardt Award winners.

Business Education Award: Clinical Quality Measures The Sam. E. Hamontree Business Education Award recognizes the best business papers submitted for presentation at the annual AOPA National Assembly. The 2023 nominations included “Clinical Quality Improvement as a Foundational Business Strategy,” by Gerald Stark, PhD, MSEM, CPO, LPO, FAAOP(D), and “Nine Nuances of ‘99’ Codes … a Payor’s Perspective,” by Dale Berry, CP, FAAOP, LP. Stark’s presentation, which ultimately won the 2023 award, focused on the growing economic pressures facing practitioners, and how clinical quality measures are often at odds with revenue goals. By learning to interpret and compare data at a more refined level, Stark said cliniGerald Stark, PhD, MSEM, cal leaders can develop CPO, LPO, FAAOP(D) robust data models that anticipate and transform their business strategy to predict possible clinical gaps and opportunities before they happen. He offered examples of how these data activation models will form the foundation of future intelligent services, impact workflow, and drive greater transformation.

“When you look at how you’re evolving as a practitioner, there’s the business relational pathway, and there’s the clinical technical pathway,” Stark explained during his presentation. “It’s really difficult to manage … and we have to take a tactical approach. Are we personally prepared, is our team Dale Berry, CP, FAAOP, LP prepared? Do we have the right response? Do we have context preparation? Do we have the right tools to portray that sense of value? Do we have the right equipment, the right system, and the right tools for success?” Berry’s presentation featured a clever adoption of the Indy 500 theme. He reviewed the nine flags used to communicate with drivers and announce track conditions. He then applied their meanings, such as track hazards or taking a pit stop to consult with race officials, to the O&P realm.

Student Poster Awards: AFO Abandonment and ENS for Hand Amputation Two talented students were honored for their poster work during the Assembly: Yasir Aljahani of the University of Pittsburgh was awarded the Otto and Lucille Becker Student Poster Award for “Reasons for AFO AbanYasir Aljahani donment by Children in Saudi Arabia,” and Abigail Citterman of Northwestern University was awarded the Edwin and Kathryn Arbogast Student Poster Award for “Transcutaneous Electrical Nerve Stimulation (ENS) at the Wrist as a Method to Restore Sensory Feedback for Individuals With Partial Hand Amputation.” Citterman, a research fellow at the Utah NeuroRobotics Lab, said her work seeks to recreate the sensory experience of an intact hand for individuals using partial hand prostheses. It’s a

patient population that is historically underserved, and with the profound impact of missing digits, innovation is required to provide functional solutions. “I am incredibly grateful for this honor,” Citterman said. “The award is especially meaningful to me as it signifies my commitment to the interAbigail Citterman section of research and clinical care. With my background in biomedical engineering, I have performed, presented, and published research. I have also been honored with numerous research awards recognizing the impact of my work within the broader field of engineering. Now an MPO student, this is my first O&P-specific recognition, demonstrating the value of this work on the patient populations I strive to serve. This award marks my transition into the field, and I am more eager than ever to continue my work as a researcher and future clinician.” Aljahani, who said his award “holds great significance for me,” selected the topic of AFO abandonment in Saudi Arabia because of his profound interest in pediatric orthotics. “I have a firm belief in the necessity of shedding light on the challenges faced by caregivers and orthotists,” he said. “Given the scarcity of literature addressing this issue in Saudi Arabia, my hope is that this poster provides valuable insights into the reasons behind AFO abandonment, thereby encouraging policymakers to consider and implement effective solutions. This research allowed me to fill a significant gap in the field, contributing to the enhancement of children’s mobility and overall well-being.”

Revisit the Award-Winning Presentations

If you missed the Thranhardt, Hamontree, or Digital Education Award presentations during the 2023 AOPA National Assembly, there’s still time to review the sessions. Content from the conference is available virtually until Nov. 20 for registered participants. Earn CE credits by reviewing the sessions. Log in at AOPAassembly.org, or contact assembly@aopanet.org with questions. Michael Coleman is a contributing writer to O&P Almanac. Reach him at mcoleman@contentcommunicators.com.

October 2023 O&P Almanac



Pediatric Troubleshooting Nevada prosthetist creates personalized solution for 6-year-old with bilateral limb absencee

Taylor Sisson, CPO, and 6-year-old Allison

In each issue of O&P Almanac, the Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Taylor Sisson, CPO, who worked with a 6-year-old patient with congenital bilateral transfemoral limb difference and her family to create an effective prosthetic solution.


or Taylor Sisson, CPO, treating 6-yearold Allison has meant a great deal of brainstorming and innovating. When treating pediatric patients, one of the most challenging aspects of clinical care is the more limited componentry options for children. Sisson drew on both his clinical experience and his creative side to design a prosthetic solution aimed at boosting Allison’s mobility and comfort.

Getting Resourceful

Allison and her mother


O&P Almanac October 2023

Allison became a patient at Prosthetic Center of Excellence (PCE), where Sisson works, in 2022. “Allison had congenital limb differences when she was born,” and

underwent bilateral amputation above the knee in infancy to prepare her to wear prostheses, says Sisson. At the time she became Sisson’s patient, “her current set of prostheses were in need of replacement due to growth changes and normal wear and tear, so she required an entirely new set of bilateral transfemoral prostheses,” including new sockets, prosthetic knees, and prosthetic feet. Sisson was up for the challenge. Acclimated to the O&P field from an early age, Sisson worked as a lab technician at a facility where his parents were employed during high school, learning important aspects of fabrication as a teenager. “I discovered I had PHOTO CREDITS: SARAH SISSON


To alleviate discomfort and donning challenges with Allison’s previous prosthetic system, Sisson created a suspension strategy utilizing a removable sealing ring and a cushion liner, along with a proximal Velcro lanyard strap.

a passion for the profession,” he says, so he earned an undergraduate degree in kinesiology at the University of Nevada—Las Vegas, followed by a graduate certificate in O&P at the California State University, Dominguez Hills. He eventually came to work at PCE in 2016. Allison’s previous prostheses were a traditional solution: “Her prostheses utilized a lanyard strapping system, with the distal strap attaching to the umbrella and the proximal strap attaching to the liner with Velcro,” says Sisson. He soon learned that the old system achieved its goal in helping Allison walk—but it was not ideal. “She and her parents always had some challenges with that system,” Sisson explains, “but they had settled and accepted that those challenges would exist.” One problem was discomfort. “She would experience a lot of distal-lateral pressure,” which would “come and go” as she used the old system, says Sisson. The family also had problems helping Allison with donning: Her father expressed frustration when feeding the strap down into the distal region of the socket due to the size of his hands while helping her put her prostheses on. There was also a challenge with achieving a low-profile build height with her previous design and having the prosthetic knee joint centers as close to the end of her residual limbs as possible. “In the old system, the distal umbrella of the liner and the distal base to feed the distal strap increased the PHOTO CREDITS: SARAH SISSON

distance between the end of her residual limbs and the socket attachments,” he says. “If this could be eliminated altogether, the build height would be reduced greatly.” “That’s when I started brainstorming some different methods of suspension for her, in the pediatric realm, in order to try to solve some of the problems,” recalls Sisson. Given the reduced inventory of pediatric solutions compared to adult componentry options, “I really couldn’t find anything” that resolved all of the challenges. Sisson created a suspension strategy utilizing a removable sealing ring and a cushion liner, along with a proximal Velcro lanyard strap, so that if the suction suspension failed, Allison would have an auxiliary suspension method keeping her going. “It’s a unique solution for a transfemoral pediatric patient of her size” to have a seal-in suction socket and a proximal strap to aid with suspension, says Sisson. Because some other types of liners had caused skin problems for Allison in the past, “we were not able to utilize liners designed for seal-in suction suspension,” and instead worked with liners made of a material that did not irritate Allison’s skin. “We were able to adapt that liner to accept a seal-in ring and provide a suction suspension solution, enhancing the overall fit and mitigating micromovement within the socket, causing rubbing of her distal femur.” “We were also able to mold the distal end of the socket really well to the shape of her

residual limb,” which is a positive change from the previous lanyard suspension, “where you not only had to contend with the umbrella of the socket, but you also had to contend with the transition from the umbrella to the distal puck attachment,” which doesn’t always provide a total contact fit. Another important feature of the new system is a reduced build height, which is important because Allison has long residual limbs. “We brought her knee centers up closer to her residual limb, by eliminating not only the umbrella but also the distal base used to feed the strap outside of the socket,” says Sisson. “By eliminating both of those, we were able to decrease the length of her knee center to the socket attachment. That was a bonus, in that it helped reduce her overall height. Getting the knee centers closer to bottom of her residual limb helped achieve a more anatomical knee center, and helped actuate the 3R67 prosthetic knee joints when she was walking.”

Fitting Right In

Allison is now in school full-time, and the new suspension system has been working as hoped. At her most recent appointment in September, she and her family reported their satisfaction with the new prostheses, and “her distal-lateral pressure is gone,” says Sisson. “We eliminated the umbrella but also the pulling you would get from a distal-suspended suspension system.” October 2023 O&P Almanac



Allison’s new devices facilitate stair and ramp mobility and help her participate in school activities.

Her new devices help Allison participate in school activities. “She likes to play, just like all the other kids, at recess,” Sisson says. Interestingly, on the school playground she prefers to wear her stubbies, so that she has a lower center of gravity and doesn’t have to focus on the knees. “This gives her the freedom to just be a kid and play with her peers,” he says. Sisson and the PCE administrative team attempted to help secure insurance coverage of Allison’s stubbies, but the payor denied the claim as a duplicate service— “even though I explained how these are different, compared to her primary prostheses,” says Sisson. The payor “said it wasn’t medically necessary—they essentially said ‘playing’ was not a medical condition that required different prosthetic intervention.” (Sisson used donated components and contributed his time so that Allison was able to get stubbies.) Allison would also like to do gymnastics, “but we’ve been running into some difficulty with getting her the type of prostheses that’s going to be able to support that,” says Sisson. “We’re in the works with some organizations to see if we can get funding for these different types of devices.” Difficulty in funding prostheses for activities is exactly why AOPA has launched the So Every BODY Can Move initiative. Nevada has yet to pass a bill that would require coverage of activity-specific devices for children, but Sisson is hopeful that the advocacy efforts from AOPA and allied 32

O&P Almanac October 2023

associations will result in Allison—and other patients—getting coverage for the equipment they are seeking.

Preparing for Growth

Because Allison is a young pediatric patient, Sisson schedules frequent appointments— every one to three months—to monitor her growth, take height and weight measurements, and look for changes. “We also measure residual limb lengths and sizes to get an understanding of how the sockets may or may not be fitting any longer.” Sisson also ensures Allison attends regular appointments with her physician “to get standing X-rays done to see if there’s any length changes or spinal misalignment,” as well as residual limb X-rays to observe how her femurs are growing, “and to see if there’s anything we need to change with the socket to make sure that the femur is growing healthy and straight, and not having any influence and malformation from the socket.” In addition, “we also have frequent follow-ups with her physicians as well, just making sure they’re monitoring other aspects of her health, such as spinal alignment and skin conditions.” Sisson will be following Allison closely as she ages and as componentry options expand. “As she grows and gets larger, she’ll have access to different components that are out there, such as different knees, and different types of feet. Build height, particularly from the connection point of the knee to the floor,

remains challenging, says Sisson. Eventually he will be able to switch Allison into higher-profile feet that have more dynamic capabilities, and into different knees “that provide more control and function in being able to go down ramps and stairs and enhancing stability where needed.” “As a kid, she has functioned very well and has been able to figure it out using less advanced devices,” says Sisson. “But having access to some of these higher-end mechanical or microprocessor knee joints will help support the type of ambulation she sees in her peers—especially as a bilateral transfemoral amputee.” More advanced components will allow her to descend stairs facing forward instead of sideways, and to have normal ramp descent as well as increased support on uneven terrain. For now, Allison and her family are happy with the solution Sisson created—and the care he provided, above and beyond their initial expectations. For now, Allison and her family are happy with the solution Sisson created—and the care he provided, above and beyond their initial expectations. DO YOU HAVE A TRANSFORMATIVE PATIENT-CARE EXPERIENCE YOU’D LIKE TO SHARE WITH O&P ALMANAC READERS? Contact Editor Josephine Rossi, jrossi@contentcommunicators.com, with your story to be considered for an upcoming profile.


Member Spotlight






Prosthetic Solutions Inc.

Wade Skardoutos, CP

Santa Clara and Hollister, California

21 years

Facilitating Fitness California prosthetist hosts clinics to aid mobility and boost activity

W Wade Skardoutos, CP

The Santa Clara location of Prosthetic Solutions features an open gym area.

Skardoutos designed a new socket that features raised dots inside to help prevent slippage.


ade Skardoutos, CP, knew that when he opened his own facility, he wanted it to be “patient forward,” a place that focused on the goals his patients wanted to achieve, rather than on his bottom line. As part of that philosophy, he started Fitness for Life clinics with Paralympic athletes Todd Schaffauser and Dennis Oehler. The program brings together individuals with limb loss from throughout the area, whether or not they are his patients, to practice skills and meet others with limb difference. And the clinics are completely free. “Some patients do well with their prostheses, while others struggle,” Skardoutos says. “We mix them up together and use games to motivate them.” Participants start with simple activities, like soccer, frisbee, and cornhole, and then move on to golf, baseball, basketball, and other sports. These activities allow participants to focus on the game, rather than their prosthesis, he says. Before the COVID-19 pandemic, Skardoutos hosted a monthly amputee walking school; once a quarter, he hosted a fitness day, with basketball, volleyball, pickleball, and horseback riding. Today, amputees can attend weekly clinics where they can practice drills, stretching, heel target and heel strike, and weight shifting, for muscle memory. “For above-knee amputees, we work on how to control the yield [stance flexion],” he says. “If the knee twitches, patients pull back and stiffen up. But if we repeat that movement, they get more relaxed and confident. Patients know they can come in and practice any time.” Skardoutos has found the clinics so successful that he invites his competitors and teaches them training drills for their patients. He didn’t start the clinics to make money, although he has found that they are indirectly profitable, as patients become more active and need more advanced devices. Skardoutos and his brother, Jim, grew up in the industry. Their grandfather, Wade Hampton, CP, was a prosthetist in San Jose, California, and the boys worked at his facility during school vacations, and then full time after they graduated. Hampton divided the work, assigning lower-limb prosthetics to Skardoutos and upper-extremity work to his brother.

When his grandfather retired, Skardoutos went to work for Wright & Filippis in Michigan for more than nine years, where he was impressed by the facility’s patient-first approach. Next, he worked at a facility in California. In 2002, Skardoutos launched Prosthetic Solutions in Hollister, California. One year later, he opened the Santa Clara office. The Santa Clara facility features an open gym area, complete with a ceiling harness, stairs, and ramps. Patients can use the space to practice on their prostheses without fear of falling. Because of its exercise clinics, Prosthetic Solutions attracts a high proportion of active limb loss patients in addition to veterans, some teens, and vascular amputees. Skardoutos finds the younger patients can inspire older ones. “They have no fear; they just want to get out and do things,” he says. “We try to give our older patients the same mindset, because fear causes them to stop and hesitate.” Skardoutos has developed a new socket he calls the OSC—Offset Surface Contact, which minimizes slippage. Patients call it the “Gripper,” he says. “I was wearing Crocs during a wind and rainstorm, trying to put things away outside, and I noticed that the small bumps on the insole kept my feet from sliding around,” he says. Skardoutos added raised dot patterns in small sections of a socket. Patients liked how it held the residual limb in place, so he added them throughout the socket. “These offset dots control sweat, rotation, and pistoning; they don’t irritate the skin; and they stay on,” Skardoutos says. “One of my above-knee patients wore the Gripper socket to a river and fell in … water got into the socket, but the prosthesis stayed on.” Prosthetic Solutions contributes to nonprofit organizations, both by sponsoring adaptive sporting events and by providing free sockets to the Challenged Athlete Foundation, which partners with Össur. Skardoutos has another civic project in mind: building a fitness center next to the facility, where individuals with limb loss can come and work out anytime. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

October 2023 O&P Almanac


Member Spotlight






Amparo Prosthetics

Wesley Teerlink and Stuart Mead

Headquarters in Salt Lake City, Utah; Aylesbury, United Kingdom; and Berlin, Germany

Seven years

Quick Fitting


Amparo Prosthetics offers the Confidence Socket, which is built directly on the patient. The system comes with a mobile clinic so patients can be fit in their homes or other locations.


O&P Almanac October 2023

Socket system that launched in Europe expands to the United States

esley Teerlink discovered the field of prosthetics in graduate school, where he and two other mechanical engineering and design students were assigned prosthetic socket technology as a research subject. Their work led to an innovative design and process, and in 2016, they founded Amparo GmbH to manufacture and commercialize the Confidence Socket. “We discovered in our research that the socket component is difficult and time-consuming to create and can be the bottleneck of the whole experience,” Teerlink says. “We wanted to change this for users. And because of our varied backgrounds, we approached this problem in a different way.” Their solution was to build the socket directly on the patient. The project took first place in the Innovation Showcase of the American Society of Mechanical Engineers in 2016 and has garnered top prizes in other competitions since then. In 2021, the company moved its European administrative headquarters to the United Kingdom, while retaining its warehouse and logistics platform in Germany. Most of Amparo’s customers were in Europe, South America, and Asia, but Teerlink also knew the U.S. market would benefit. A native of Utah, Teerlink had connections there and saw opportunities for medical device manufacturers, so in 2022 the company founded Amparo Prosthetics Inc. in the United States, and added a four-person team in charge of manufacturing. Teerlink’s fellow founders moved on to other projects, and he brought in a new partner, Stuart Mead, the former chief executive officer of Touch Bionics. The Confidence Socket is made with a prefabricated cone composed of Amparo’s proprietary thermoplastic composite. It has a low melting temperature but is strong enough to function as a prosthetic device for years, Teerlink says. The socket comes with a preassembled and offset mounting plate and either a pin or valve suspension model. The clinician heats the cone in a mobile oven and uses a heat gun to form the socket. The material becomes malleable, but it retains its cone shape, which the clinician stretches on to the patient, drawing a vacuum and creating a functional socket in about an hour.

The Amparo system comes with a mobile clinic, which includes a portable oven, vacuum pump, sockets, suspension units, and accessories. As a result, clinicians can fit patients in their homes or other locations in just one visit. “We make the cones in two sizes, so they accommodate most below-knee amputees,” says Teerlink. “The best part is that, as the residual limb loses volume, we can reheat the socket and completely remold it to fit.” This makes the system especially useful for new limb loss patients, who go through volume changes very quickly, he explains. “With our system, they don’t have to sit around in a wheelchair waiting for a new socket because we can remold it in about an hour.” As an added benefit for O&P facilities, same-day delivery eliminates the delay between paying for the device and being reimbursed. Amparo offers training to facilities in the United States through a seven-member team of clinicians and sales representatives. “We offer a half- or one-day course where practitioners can bring in a friendly patient and do the whole process multiple times, with guidance from our technical staff,” says Teerlink. “We also offer group classes, and we have an online training portion that can speed up the process.” The company is committed to corporate citizenship, working with nonprofits and selling products at a large discount in places that have the need. Amparo has had grants to do outreach projects in Kenya. Because Amparo’s system enables fitting patients with a fully functioning device in one visit, Teerlink is hopeful the technology may one day be used to provide fast fittings for amputees in war-torn areas, such as Ukraine. “We are always looking for opportunities and partners to help get our technology to those who need it most,” he says. Teerlink is excited about the expansion to the United States. “We are a young, small company, but our product has been well proven clinically in Europe. We have more than 3,000 patients in 200-plus locations with resounding user satisfaction,” he says. “We’re looking forward to reaching out to those who need us in North America.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.




COMPREHENSIVE GUIDE The Most Popular Orthotic and Prosthetic Illustrated Reference

2023 Illustrated Guide Updated Medicare Codes for

Access the 2023 Assembly Sessions Before It’s Too Late— Closing Nov. 20

Orthotics and Prosthetics

Purchase the Updated AOPA Illustrated Guide The 2023 Illustrated Guide is now available! Purchase this easy-to-use digital guide, featuring the Healthcare Common Procedure Coding System codes for orthotics, prosthetics, and shoes. The 2023 Illustrated Guide is a digital product; you will receive a PDF file to view digitally or print on your own. Prices are for $135 for members and $425 for nonmembers. Contact info@ aopanet.org or visit My AOPA Connection for details.

Earn CEs and review sessions from Indianapolis

Don’t Miss AOPA’s Next Coding & Billing Seminar Take part in the virtual event Nov. 13-14 Sign up for the next AOPA Virtual Coding and Billing Seminar, which will take place Nov. 13-14, from 12 to 4 p.m. ET both days. You’ll learn how to get claims paid, survive audits, collect interest from Medicare, and file successful appeals. Earn CEs! What’s new? AOPA experts have updated the Policies and Procedures section and will be presenting the new rules for standard written orders, which replace the need for an initial/dispensing order and a separate detailed written order. Visit AOPAversity online at bitly.aopaversity for details and to register. For questions regarding seminar content, email Devon Bernard at dbernard@aopanet.org.

Content from the 2023 AOPA National Assembly is available virtually until Nov. 20. View cutting-edge clinical and business sessions, download handouts, and earn CE credits! Login at AOPAassembly. org, or contact assembly@ aopanet.org with questions.

Help AOPA Conduct a New Survey O&P professionals: Please share this information with your patients and their families!

Calling All People With Limb Loss, Limb Difference, or Limb Impairment: You’re invited to complete a 10-minute survey about your participation in physical activity.

SURVEY LINK: aopa.questionpro.com/ physical-activity

Participants may enter a raffle to win a $10 Amazon gift card. Help AOPA create groundbreaking research on physical activity. Research will be used to support the So Every BODY Can Move initiative. Questions? Contact Susannah Engdahl, PhD, at sengdahl@aopanet.org, or call 571-431-0843. October 2023 O&P Almanac


O&P PAC Update and New AOPA Members

Welcome New AOPA Members


he O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA member*: Erin Cammarata The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

Goal Pediatric Orthotics LLC 471 E. 1000 Street, Ste. D Pleasant Grove, UT 84062 385-215-9985 goalpediatrics.com David Patterson, CO, LO Patient-Care Facility

Wandercraft 1411 Broadway FL 16 New York, NY 10018 609-855-9079 en.wandercraft.eu Laurent Metz, MD, MBA Supplier Startup

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

To participate in, support, 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: bit.ly/aopapac.


• Explore new career opportunities for FREE! • Click on any websites, emails, and videos to learn more. • Download the guide to look back on organizations and opportunities that appeal to you.

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O&P Almanac October 2023

8/7/23 9:49 PM


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KiddieFLOW™ KiddieFLOW™, Allard USA’s extension to our pediatric AFO line, was introduced in response to clinician requests for an orthosis with more foot plate flexibility. KiddieFLOW™ allows for better control of foot positioning in late swing, which aids in stability during stance. FLOW models offer increased range of motion in the sagittal plane and a smoother transition (flow) throughout the gait cycle. For more information, contact Customer Service at 888-678-6548 or info@allardusa. com and request your free teddy bear tape measure!


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

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

October 2023 O&P Almanac




Naked Prosthetics offers four finger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger. ™


The Xtern Line: A Step Up for Foot Drop By Turbomed Orthotics

Introducing the Taleo Adjust.

Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function. The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

The Taleo Adjust was designed for active users who navigate a variety of indoor and outdoor environments and value flexibility when choosing their footwear. With a simple push of a button, patients can easily set the appropriate heel height from 0 up to 2 3/4 inches. It’s more than a foot, it’s a foundation. Scan here to learn more!

Dynion. A dynamic companion for every step.

Designed for motivated patients with higher mobility, the Dynion mechanical knee is an ideal companion for independent, self-determined users who are ready to push their goals to the next level. Scan here to learn more!


O&P Almanac October 2023

The RUSH ROGUE 2 provides an optimal vertical shock experience, axial rotation for improved comfort, predictable performance, ultimate fiberglass strength, and flexibility for daily life and high impact activities. And NOW, patients will no longer have to choose performance over SANDAL TOE availability. With the RUSH ROGUE2 & EVAQ8 models, patients can choose optimal performance with the freedom to express themselves in their preferred daily footwear. Walk YOUR Way with RUSH Sandal Toe by PROTEOR. Visit proteorusa.com.

Virtual education now available! September 20 – November 20. Earn CE Credits at your own pace.

Visit AOPAnet.org for more information.


SHARE YOUR UPCOMING EVENT WITH O&P PROFESSIONALS Contact Bob Heiman at bob.rhmedia@comcast.net.

2023 September 20–November 20

AOPA National Assembly. Virtual education available online. For more information, visit aopanet.org.

October 1–31

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

Live and Online/On Demand CEs

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

November 8–10

New Jersey AAOP Annual Meeting. Harran’s Resort, Atlantic City, NJ. Visit njaaop.org.

November 13–14

Virtual Coding & BIlling Seminar. 12-4 PM ET. Register at aopanet.org.

AOPA Monthly Webinar Series— Now On Demand! Full-year series: AOPA member $790; Nonmember $1,999 Individual webinar: AOPA member $79: Nonmember $199 Register for the series at My AOPA Connection.


Share Your Calendar Event

September 12–15

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

Advertise O&P events for maximum exposure with O&P Almanac. Contact Bob Heiman at bob@rhmedia.comcast.net or learn more at bit. ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Advertisers Index A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P. Scan the QR to start advertising in the O&P Almanac or visit bit.ly/23AlmanacMediaKit.





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October 2023 O&P Almanac


BECOME AN AOPA STATE REPRESENTATIVE If you are interested in participating in the AOPA State Reps network, email smiller@AOPAnet.org.

State By State

Join the Movement So Every BODY Can Move initiative notches several victories in its inaugural year


he So Every BODY Can Move (formerly known as So Kids Can Move) initiative began a little more than a year ago. Over the past 12-plus months, states across the country have taken great strides to gain increased access to activity-specific O&P care. The So Every BODY Can Move initiative advocates for a policy solution rooted in dignity and justice by empowering state-by-state legislative action, ensures activity-specific O&P care is considered medically necessary. The initiative is led by AOPA, along with partner organizations the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), the Amputee Coalition, and the American Academy of Orthotists and Prosthetists. Now that the majority of state legislatures have adjourned for the 2023 session, it’s important to look back at what we’ve accomplished, and look forward to the years ahead.

State-Level Success

In 2022 and 2023, activity-specific O&P coverage legislation was enacted in five states (in orange): Maine (LD 1003), New Mexico (HB 131), Arkansas (HB 1252), Colorado (HB 1136), and Illinois (SB 2195). Five additional states introduced legislation in 2023 (in blue): New Hampshire (SB 177), Indiana (HB 1433), New Jersey (S 3919), Massachusetts (HD 4491), and Minnesota (HF 3339 and SF 3351). For the majority of states, bills “carry over” from one year to the next, depending on whether a state’s two-year legislative session begins in an even- or odd-numbered 40

O&P Almanac October 2023

Enacted Legislation 2022-2023 Introduced Legislation 2023 Interested 2024+

year. Indiana (one-year session), New Hampshire (limited carryover), and New Jersey (session ending in 2023) may need to reintroduce bills in 2024; however, Minnesota and Massachusetts advocates have the chance to enact their bills during 2024 since bills carry over from odd- to even-numbered years in those states. On top of enacted and in-progress legislation, advocates in approximately 20 states have expressed interest in bringing the So Every BODY Can Move initiative to their statehouse in 2024 and beyond (in yellow): Washington, Oregon, California, Idaho, Utah, Arizona, Iowa, Missouri, Wisconsin,

Kentucky, Tennessee, Ohio, Florida, Georgia, North Carolina, Virginia, Maryland, Pennsylvania, and Connecticut.

Advocate in Your State

So Every BODY Can Move is quickly taking hold nationwide, and AOPA, along with our national partners NAAOP, the Amputee Coalition, and the Academy, are excited to work with state advocates and push for activity-specific O&P coverage. Interested in getting involved? Email advocacy@aopanet.org to learn more.

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A comprehensive certificate program for business owners, managers, and practitioners of O&P patient care facilities, O&P manufacturers and AREAS OF LEARNING distributors to explore crucial business challenges as they relate to O&P.

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O&P Marketing Strategies



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3. Graduation ceremony at the National Assembly

Visit bit.ly/AOPACP to sign up for the certificate program. Questions? Contact info@AOPAnet.org.

C-Brace. Mastering spinal cord injury together.

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Introducing Sina, our ambassador for SCI, who refuses to let a spinal cord injury hinder her dedication to her students, her work, and the life she desires. With the help of people like Sina and Ottobock's C-Brace, we aim to empower other patients, to achieve freedom of movement and unwavering confidence.

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