January 2021 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2021

Prior Authorization Rollout P.14

Highlights of the New Coronavirus Relief Package P.26

Tips From the Competitive Bidding Implementation Contractor P.31

Improving Prosthetic Foot Prescription Through Research

NEW YEAR’S

RESOLVE O&P STAKEHOLDERS MAKE PLANS TO BOOST BUSINESS AND PRIORTIZE PATIENT CARE IN 2021 P.18

P.34

Quiz Me!

EARN 4 BU SI NE SS CE CREDITS

WWW.AOPANET.ORG

PP.17 & 33

YOUR CONNECTION TO

EVERYTHING O&P

AOPA Member Benefit

AOPA’s Co-OP is

THE Compendium of O&P A confluence of coding, billing, and policy information, the AOPA Co-OP provides a cooperative space for collaboration among O&P colleagues.

This easily accessible, online resource enables your organization to be successful in today’s everchanging healthcare environment.

Tutorial Webinars Co-OP Live on Friday at Noon ET February 5

April 2

June 4

March 5

May 14

July 2

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

DOWNLOAD THE APP!

After creating your Co-OP account, Download to your mobile device at aopanet.atlassian.net.

FOLLOW US @AmericanOandP

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Learn more and sign up at www.AOPAnet.org/co-op.

www.AOPAnet.org

JAN UARY 2021 | VOL. 70, NO. 1

contents

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

18 | New Year’s Resolve Many O&P business owners and managers are taking a proactive approach to the year ahead, preparing for a potential influx of patients and ongoing staffing challenges amid the continuing pandemic.

O&P facilities are looking to succeed in 2021 by optimizing their telehealth processes, taking a flexible approach to patient care, and fostering positive relationships with referral sources.

By Christine Umbrell

Views From AOPA Leadership......... 4

The importance of belonging

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 12

Transitions in the profession

Reimbursement Page.......................... 14

Adjusting to Medicare Changes Prior authorization and competitive bidding

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

26 |

O&P and the Coronavirus Relief Deal The omnibus spending and pandemic relief bill enacted December 27 offers some provisions that could provide cost savings to O&P facilities. The legislation extends the Paycheck Protection Program (PPP); clarifies the tax rules surrounding the PPP, the Economic Injury Disaster Loans, and net operating loss carrybacks; and offers a more generous application of the Employee Retention Tax Credit.

By Michael Coleman

Compliance Corner................................ 31

Entering Round 2021

Tips from the Competitive Bidding Implementation Contractor Opportunity to earn up to two CE credits by taking the online quiz.

Member Spotlight..................................37 n n

Walker Orthotics & Prosthetics Ă–ssur

AOPA News................................................ 39

AOPA announcements, member benefits, and more

Welcome New Members................... 39

PRINCIPAL INVESTIGATOR David C. Morgenroth, MD..................................... 34 Meet a physician-scientist affiliated with the University of Washington and the Department of Veterans Affairs who studies prosthetic foot prescription, the treatment of secondary disabling musculoskeletal conditions, and more.

2

JANUARY 2021 | O&P ALMANAC

Marketplace............................................. 40 Careers.........................................................42

Professional opportunities

Ad Index....................................................... 45 Calendar......................................................46

Upcoming meetings and events

State By State.......................................... 48

Kentucky, Massachusetts, New York, Ohio, and Texas

You Asked We Listened More Allard AFOs with ½ Heel Height AND Lower Toe Lift!

NEW! CAMO

BIRCH

BLACK

NOW More Options to Find the Best Functional Solution Call 888-678-6548 or email info@allardusa.com to receive your FREE Product Selection Guide!

VIEWS FROM AOPA LEADERSHIP

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

The Importance of Belonging

A

S I LOOK FORWARD to a new year, I can’t help but also reflect on my appreciation for you, our members; the O&P profession; and the patients we serve.

I’m proud to be part of AOPA. Belonging to this association enables members to speak with one voice, to have greater influence on decisionmakers, to garner respect from stakeholders, and to add value to one another and the work we are undertaking together.

As with any membership, an association is only as strong as its members are connected. That’s why this year, you will see a renewed focus on you, our members, and on solidifying a shared sense of belonging—at AOPA and across our profession. It’s your collective power we must harness to see progress and address needs.

Knowing to whom and what you’re connected is where belonging starts.

Practically speaking, that means being aware of the benefits available to you, including through our new online system, AOPA Connection, and to one another.

On the new site, you and your staff can stay informed on happenings across O&P as well as on critical topics that impact your day-to-day work. I encourage you to log in and reacquaint yourself with all AOPA has to offer.

Belonging also means being part of the “bigger picture” as we continue to reinforce our place as clinicians within the broader healthcare industry.

In a recent development that highlights the opportunity in front of us, the Biden transition team approached AOPA to provide input on its plans, and we did. As the new administration takes office, we will foster this relationship and others on the Hill, including dialogues with the regulators and durable medical equipment Medicare administrative contractors who regularly reach out for feedback on the impacts our members face because of regulations.

Under the leadership of our research chair, we will explore ways to fund research to assess care models and the time, resources, and intensity of O&P clinical care and outcomes. We also are looking to support more outlets for publication of O&P research.

We as a profession have gotten good at showcasing the patient and their device. Now, we will strive to better communicate the value you provide as professionals. In short, we want to meet your needs and, in turn, your patients’ needs, to make a positive impact on healthcare.

I look forward to working with you all. I know that by sticking together and speaking with one voice, we will continue to improve the profession and the lives of the patients we serve. We are all in this together, and together we will strengthen one another.

Traci Dralle, CFm, is president of AOPA.

4

JANUARY 2021 | O&P ALMANAC

Board of Directors OFFICERS President Traci Dralle, CFm Fillauer Companies, Chattanooga, TN President-Elect Dave McGill Össur Americas, Foothill Ranch, CA Vice President Teri Kuffel, JD Arise Orthotics & Prosthetics, Spring Lake Park, MN Immediate Past President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Treasurer Rick Riley O&P Boost, Bakersfield, CA Executive Director/Secretary (Nonvoting) Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger, Austin, TX Elizabeth Ginzel, MHA, CPO Baker O&P, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX John “Mo” Kenney, CPO, LPO, FAAOP Kenney Orthopedics, Lexington, KY Linda Wise WillowWood, Mount Sterling, OH James O. Young Jr., LP, CP, FAAOP Amputee Prosthetic Clinic, Tifton, GA Shane Wurdeman, MSPO, PhD, CP, FAAOP(D) Research Chair Hanger Clinic, Houston Medical Center, Houston, TX

ON

NIGHT MODE

OU R FU L L LINE O F VA LV ES .

N OW AVAILABLE IN MIDNIGHT BL ACK.

wearesp.com

AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

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

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org

Tina Carlson, CMP, senior director, membership, education, and meetings, 571/431-0808, tcarlson@AOPAnet.org Akilah Williams, MBA, SHRM-CP, senior manager for finance, operations, and HR, 571/431-0819, awilliams@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org COMMUNICATIONS, MEMBERSHIP & MEETINGS 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 Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

6

JANUARY 2021 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

STRATEGIC ALLIANCES Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/publisher, 571/431-0807, elee@AOPAnet.org

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published 10 times per year by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/4310876, 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 © 2021 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/AOPAMedia2021 for advertising options!

Emergency Rooms don’t just work from 9 to 5, and neither do we.

Accidents causing spinal trauma can happen anytime – overnight, weekends and holidays.

We understand your urgency. Spinal Technology offers a variety of custom spinal braces that address your patient’s most critical need for immobilization and spinal stabilization. Our custom TLSO and LSO orthoses are expertly crafted to your patients’ measurements for both comfort and fit, and are designed to provide the best outcome.

TLSO Bivalve

After 30 years and over a million custom braces fabricated, our customers depend on our quality, and our reliability in delivering what they need, when they need it. In most cases, we can turn around a custom fabricated orthosis and deliver it the next business day, depending on time of order placed, and carrier flight availability. We do everything within our control to make sure you have the brace when you need it.

See our family of Custom Spinal Braces for spinal trauma at spinaltech.com. All of these products can be ordered for delivery the next business day. At Spinal Technology, we’re here to support you, the practitioner, and meet your patients’ most urgent spinal bracing need for comfort and recovery.

TLSO Flex Foam® 1 Bivalve

Call us for more information: 800 253 7868 spinaltech.com

Send your orders to: orders@spinaltech.com

Follow us @spinaltechnologyinc

NUMBERS

Delay of Care Poses Risks Studies find increase in amputations, complications among those who postponed care during COVID-19 shutdowns

During the early months of the COVID-19 pandemic, localized lockdowns and patient fears prevented many individuals with amputations, vascular problems, and diabetic foot ulcers (DFUs) from seeking regular healthcare.

This resulted in health complications for many patients, according to three new studies from the United States, Italy, and the Netherlands.

O&P CLINICIANS REPORTED MORE COMPLICATIONS FOR THEIR PATIENTS

Respondents to a survey by ABC regarding patients who couldn’t be seen during the early shutdowns

Physical Problems, Such as Contractures or Skin Problems, Among O&P Patients Who Delayed Care Patients developed significant problems A few patients developed moderate problems A few patients developed mild problems

7% 16% 19%

No identified problems

57%

SOURCE: “COVID-19 Impact on the O&P Profession,” American Board for Certification in Orthotics, Prosthetics, and Pedorthics, September 2020.

MORE PATIENTS WITH DFUs EXPERIENCED COMPLICATIONS

Study of patients with DFUs admitted to the Teaching Hospital at the University of Campania, Italy 76%

More Emergency Patients

Gangrene More Likely

Amputation More Prevalent 60%

29%

26%

2019

64%

2020

2019

18% 2020

2019

2020

SOURCE: “Diabetic Foot Problems During the COVID-19 Pandemic in a Tertiary Care Center: The Emergency Among Emergencies,” Diabetes Care, July 2020.

MORE PATIENTS WHO UNDERWENT VASCULAR SURGERY REQUIRED AMPUTATION Study of vascular patients at Amphia Hospital, Breda, Netherlands

Amputation More Prevalent

2018 2019 2020

15% 18% 42%

SOURCE: “Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Amputations Than Usual,” Annals of Vascular Surgery, November 2020.

8

JANUARY 2021 | O&P ALMANAC

Before you renew, get a quick quote at bit.ly/cailorflemingOandP EXCLUSIVELY ENDORSED INSURANCE FOR AOPA

BE READY for any kind of WEATHER. WE’RE NOT HERE TO JUST PROTECT YOUR BUSINESS. We’re here to provide a

CO MPLE TE PLA N with our insurance program specifically designed for the orthotics and prosthetics industry. We understand the risks and offer comprehensive protection that allows your business to succeed, whether it’s a patient care facility, central fabrication, manufacturer, or distributor.

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

toll free 800-796-8495 | www.CAILORFLEMING.COM/OANDP.ASP PROFESSIONAL LIABILITY

|

GENERAL LIABILITY

|

PROPERTY

|

AUTO

|

UMBRELLA

|

WORKERS COMP & MORE

Happenings RESEARCH ROUNDUP

GAO Investigates Population of Female Veterans With Limb Loss

Examples of female veterans’ lower-limb prostheses Female veterans with amputations were younger than their male counterparts, averaging 61 years compared to 69 years for men. Among veterans with amputations who also had diabetes or cardiovascular conditions, the number and proportion of female veterans with amputations increased from 769 (1.5 percent) in fiscal year 2015 to 1,077 (1.9 percent) in fiscal year 2019.

The number and proportion of inpatient and outpatient visits increased

PHOTO: GAO (photos) | GAO-21-60

The U.S. Government Accounting Office (GAO) released a report in November detailing a study of women veterans who use prostheses. According to the Veterans Health Administration’s (VHA’s) Amputee Data Repository, the female veteran amputee population grew from 2,049 veterans (2.3 percent of the total veteran amputee population) to 2,622 veterans (2.7 percent) from fiscal year 2015 to 2019.

During this timeframe, VHA provided 47,939 artificial limbs to female veterans.

among female veteran amputees from fiscal year 2015 to 2019, rising from 973 female veterans (2.2 percent of all visits to an O&P clinic) to 1,587 (3.0 percent). In addition, the number of visits to an O&P clinic increased from 475 per 1,000 female veteran amputees to 605 visits per 1,000 female veteran amputees from fiscal year 2015 to 2019, representing a 27.4 percent change.

VHA has boosted initiatives to raise awareness of the prosthetic services provided to female veterans, according to the report. One VA medical facility created a prosthetics boutique in its women’s health clinic so that veterans could view gender-specific devices and ask contracted vendors questions about the items. The full report is available on the GAO website at www.gao.gov/assets/720/710600.pdf.

Study of Fingerprints Aids in Prosthetic Research

10

JANUARY 2021 | O&P ALMANAC

the resulting increase in the compliance of the ridges causes the sweat pores eventually to become blocked and prevents excessive moisture that reduces the ability to grip objects.

The research team leveraged laser-based imaging technology and discovered that moisture regulation could be explained by the combination of sweat pore blocking and the accelerated evaporation of excessive moisture from external wetting as a result of the specific cross-sectional shape of the epidermal furrows when in contact with an object. These two functions result in maintaining the optimum amount of moisture in the fingerprint ridges, which maximizes friction whether the finger pad is initially wet or dry.

“This dual-mechanism for managing moisture has provided primates with an evolutionary advantage in dry and wet conditions, giving them manipulative and locomotive abilities not available to other animals, such as bears and big cats,” said Adams. Future studies could help scientists develop better prosthetic limbs, robotic equipment, and virtual reality environments, according to Adams.

PHOTO: Getty Images

Researchers at the University of Birmingham in the United Kingdom are partnering with research institutions in South Korea in studying fingerprints to determine how to develop improved prostheses.

Fingerprints help increase friction when in contact with smooth surfaces, improve grips on rough surfaces, enhance tactile sensitivity, and employ moisture-regulating mechanisms—qualities that are important to understand when building artificial hands, according to the researchers.

“Understanding the influence of finger pad friction will help us to develop more realistic tactile sensors—for example, applications in robotics and prosthetics and haptic feedback systems for touch screens and virtual reality environments,” said Mike Adams, PhD, CEng, professor in product engineering and manufacturing at the University of Birmingham and co-author of the study.

The researchers have discovered that, when finger pads are in contact with impermeable surfaces, the sweat from pores in the ridges makes the skin softer, which increases friction. However,

HAPPENINGS

Research Team Studies High-Activity Prosthesis Users for Revised PLUS-M A team from the University of Washington (UW) convened focus groups of active, lower-limb prosthesis users to improve their understanding of mobility to inform the development of new items for the Prosthetic Limb Users Survey of Mobility (PLUS-M) self-report item bank.

A trained facilitator met in-person and online with four focus groups, which comprised athletes, service members, and other active amputees. The facilitator leveraged a semistructured guide to promote discussion. Researchers reviewed and coded the meeting transcripts, then conducted thematic analysis, to identify experiences across participants.

The research team, led by Sara Morgan, PhD, CPO, assistant professor

in UW’s Department of Rehabilitation Medicine, ultimately identified three themes: mobility after amputation, mobility characteristics, and healthcare providers and systems. Participants described engagement in high-level activities as a learning process that may involve equipment challenges, pain, and injury. They also noted that mobility characteristics, such as postural changes, terrain, and obstacles, sometimes influence their ability to perform high-level activities. These revelations can be integrated into a revised version of the PLUS-M to better assess mobility in active adults.

Details were published in December in Disability and Rehabilitation.

ICYMI

Postage Stamp Features Robotic Leg

COVID-19 CONCERNS

HHS Extends Public Health Emergency Into Spring The COVID-19 public health emergency has been extended until mid-April, according to the Department of Health and Human Services (HHS). The declaration was set to expire on January 20, but the 90-day renewal takes effect on January 21 and eliminates the risk of a lapse during the transition of administrations. “Our work to combat the virus will continue, as will our work to ensure a peaceful and orderly transition,” said HHS Secretary Alex Azar in a tweet announcing the renewal.

The extension means the continuation of several policies tied to the public health emergency, including the Medicare inpatient 20 percent add-on payment for COVID-19 patients, increased federal Medicaid matching rates and maintenance of effort requirements, waivers of telehealth restrictions, and continued requirements that insurers cover COVID-19 testing without cost sharing.

AMPUTEE ATHLETICS

Right, image (detail) of a bionic ankle-foot prosthesis, part of a series of stamps celebrating innovation

PHOTOS: U.S. Postal Service

A new series of U.S. Postal Service (USPS) Forever postage stamps celebrating innovation features a design showcasing a bionic prosthesis designed and built

by Matt Carney, PhD, and members of the biomechatronics team at the Massachusetts Institute of Technology’s Media Lab. Carney worked on the robotic leg as part of his PhD project in media arts and sciences at the Media Lab, which is overseen by Hugh Herr, PhD. The stamp is part of a USPS series on

innovation, representing computing, biomedicine, genome sequencing, solar technology, and robotics—the category for which the prosthesis was selected. The image used in the stamp was taken by photographer Andy Ryan, who suggested the bionic work of the biomechatronics group to USPS to represent the future of robotics. Ryan also created the images that became the computing and solar technology stamps in the series.

New Museum Showcases Paralympic Athletes The U.S. Olympic and Paralympic Museum has officially opened in Colorado Springs, Colorado. The museum features the history of Team USA in both the Olympic and Paralympic Games. Visitors can browse the 60,000-square-foot space to learn the compelling stories about the athletes who have competed and view the artifacts, media, and technology associated with the competitors.

The museum was designed to be accessible and interactive. Visit usopm.org for more information.

O&P ALMANAC | JANUARY 2021

11

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Two employees of The van Halem Group, a division of VGM & Associates, recently joined the boards of two different associations that serve the home medical equipment industry.

Kelly Grahovac, general manager, was named to the board of directors for the South Carolina Medical Equipment Services Association. Wayne van Halem, president, was named to the board of the Georgia Association of Medical Equipment Suppliers. VGM has sponsored events for both of these associations, and both Grahovac and van Halem have been regular speakers at their association meetings.

IN MEMORIAM Ronald F. Altman passed away Dec. 7, 2020, after a battle with Lewy body dementia. After losing his right leg at age 9, Altman chose to pursue the O&P profession. As a Peace Corps volunteer, he built the O&P facility at the Suva Crippled Children’s School in Suva, Fiji. Over the course of his long O&P career, Altman served as an examiner for the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), chair of the National Examination Committee, a member of the Board of Directors of ABC, president of ABC, and vice chair of the National Commission on Orthotic and Prosthetic Education. In addition, he conducted O&P facility evaluations in Mozambique, Uganda, and Vietnam as a consultant for US AID. In 2005, four years after retiring from clinical practice, Altman was recognized with the American Academy of Orthotists and Prosthetists’ Clinical Commitment Award.

Memorial gifts may be made to the Lewy Body Dementia Resource Center or the ISPO Global Development Fund.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Ability Prosthetics and Orthotics has announced it will open four new offices in Pennsylvania this year: one in Harrisburg in January, one in West York in March, and offices in Lancaster and King of Prussia later in the year.

The Board of Certification/Accreditation (BOC) was recognized as a Silver Winner of a www.bocusa.org 2020 Golden Bridge Award® in the “Company Rethinking of the Year” category. This category recognizes companies that have demonstrated resiliency and creativity 12

JANUARY 2021 | O&P ALMANAC

in adapting their business models and customer service offerings Contingency Planning During the COVID Pandemic during the COVID-19 pandemic.

BOC was acknowledged for introducing tools and technoloT gies to support customers during the pandemic with a focus on safety, efficiency, and customer service—including publishing an article in an issue of AOPA’s O&P Almanac magazine. BOC added COVID-19 resources to its website; offered live, online, remotely proctored exams for certification candidates; conducted virtual site surveys for facilities seeking BOC accreditation; and contributed the Compliance Corner article, “Contingency Planning During the COVID Pandemic” in the October O&P Almanac.

“COVID-19 continues to present a wide range of challenges for healthcare professionals and durable medical equipment, prosthetics, orthotics, and supplies facilities.

The BOC team is focusing on our customers’ needs and opportunities to be innovative to support them,” said Claudia Zacharias, MBA, CAE, BOC’s president and chief executive officer. “Like many organizations, BOC has embraced the opportunity to rethink and adapt. We are honored to be named a Silver Winner of this prestigious award.”

COMPLIANCE CORNER

By MATTHEW GRUSKIN, MBA, BOCO, BOCPD, CDME

COVID-19 teaches us that emergency preparedness goes beyond regulatory requirements

CE Editor’s Note: Readers of CREDITS Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 40 to take the Compliance Corner quiz.

Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

QUI Z ME! EARN

2

BUSINESS CE

CREDITS P.40

38

HE WORLD IS QUITE a different place now than it was a year ago.

COVID-19 has impacted lives and workplaces in ways that were once unimaginable and, without a doubt, has tested the preparedness plans we built and intended to rely on during times of crisis.

As we continue to navigate uncharted territory, the need to be flexible and innovative—while maintaining compliance to regulatory standards—has underscored the importance of contingency plans that allow us to continue caring for patients who rely on us every day, pandemic or not.

Like many other healthcare professionals, orthotists and prosthetists have made some critically important decisions and adjusted to “the new normal” since the onset of COVID-19.

Fortunately, every accredited O&P practice has a contingency plan on file, as required by Section 1 of the CMS Quality Standards. Ideally, the plan helped provide much needed guidance and direction as the COVID-19 virus rapidly spread. More likely, the plan lacked the level of detailed guidance needed during a global pandemic, and instead served as an outline for important discussions and decisions.

During the plan’s initial implementation phase, many O&P practitioners recognized the need to expand contingency plans, adding details and outlining new and revised procedures to guide operations during the pandemic.

Now is the time to reassess what we put (or didn’t put) on paper, as well as what we’ve learned from COVID-19.

Preparing now for future coronavirus surges, or any other crises, can help safeguard the health and safety of our employees, patients, and businesses.

Challenges Presented

by COVID-19

Without a doubt, COVID-19 changed the way we think about crisis management and the steps that healthcare providers must take to be prepared.

Prior to 2020, most contingency plans were designed in anticipation of things like tornados, hurricanes, workplace violence, or security breaches—specific events, each with an identifiable beginning and end, followed by a period of recovery.

Most practitioners never considered the possibility of a global health pandemic that would impact operations for weeks, months, or even years.

OCTOBER 2020 | O&P ALMANAC

Coapt has moved into a new space for its Chicago headquarters. The new address is 303 W. Institute Place, Ste. 200, Chicago, IL 60610.

THE LIGHTER SIDE

LOOKING FOR BETTER SILICONE?

LESS FRICTION • One fifth of the friction of regular silicone

INNOVATIVE • Lightweight liner with a cooling effect

COMFORTABLE • Skin-friendly material with a thin profile

REIMBURSEMENT PAGE

By JOSEPH MCTERNAN

Adjusting to Medicare Changes How will prior authorization and competitive bidding impact O&P facilities?

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

2020 E! QU IZ M EARN

2

Y

OU WILL BE HARD PRESSED to

find someone who is not happy to see 2020 in the rearview mirror. The COVID-19 public health emergency has impacted all aspects of our daily lives. Businesses have been forced to adjust their operations to be successful in an environment where personal interaction may no longer be an option.

Telehealth has taken on a new level of importance—for O&P providers as well as their physician partners and other members of the rehab team.

In addition to dealing with the continuing challenges associated with providing patient care during a global pandemic, O&P providers are faced with two new Medicare programs that will have a significant impact on their businesses in 2021: prior authorization and competitive bidding.

BUSINESS CE

CREDITS P.17

14

JANUARY 2021 | O&P ALMANAC

Prior Authorization

Prior authorization is not a new concept, as it has been utilized by private payors for years. Medicare has been slowly introducing prior authorization into its claim processing program, but O&P was not part of the program until recently.

Last year, Medicare implemented limited prior authorization for six lowerlimb prosthesis codes (L5856, L5857, L5858, L5973, L5980, and L5987) in four states (Pennsylvania, Michigan, Texas, and California) on September 1.

The program was implemented nationwide for claims with dates of service on or after Dec. 1, 2020.

Detailed information about Medicare prior authorization for lower-limb prosthesis codes can be found on the AOPA website at www. aopanet.org/legislative-regulatory/ prior-authorization. Highlights of the program include the following: • Claims that receive an affirmative prior authorization decision will generally not be subject to additional audit or medical review but may be denied for technical reasons (e.g., no proof of delivery, delivery of services not included in the prior authorization request, etc.).

• Effective for claims with dates of service on or after Jan. 1, 2021, products coded using one of the six codes subject to prior authorization must be code-verified by the pricing, data analysis, and coding contractor.

• In general, Medicare will provide a prior authorization decision within 10 business days of receipt of the request. Expedited prior authorization requests will be processed in two business days.

• There are no limits on prior authorization resubmissions, but each resubmission will result in additional processing time.

• Prior authorization requests will be assigned a unique tracking number (UTN) that must be submitted with the claim. UTNs will be assigned for both affirmative and nonaffirmative prior authorization decisions.

Think outside the shoe ÂŽ A game changer solution for people afflicted by foot drop The XTERN is the only dynamic AFO for foot drop totally affixed outside the shoe to maximize comfort, prevent skin breakdown and rubbing injuries to the foot. Its flexibility helps keep maximal ankle range of motion and calf muscle strength.

Virtual training sessions available during Winter 2021!

contact training.turbomed@gmail.com for Level 1 and Level 2 availabilities.

strength.

Amazing energy return Adaptable

No skin contact

Lightweight, sleak design

Versatile Symmetrical design

USA turbomedusa.com

REIMBURSEMENT PAGE

The AMPATT, a user-friendly resource, allows providers to easily organize and track their prior authorization requests.

The AMPATT can be used as an internal resource but also can be used to provide valuable feedback to AOPA regarding potential issues with the Medicare prior authorization program.

AOPA believes that Medicare prior authorization, if implemented properly, will be beneficial to Medicare providers and beneficiaries alike.

AOPA is hopeful that the program will continue to be successful as it is implemented on a national scale.

Competitive Bidding

During the four months since the initial, four-state pilot program began, we have learned a few important lessons. In general, Medicare prior authorization has been successful, with limited instances of delays in access to care and efficient, two-way communication between providers and the durable medical equipment Medicare administrative contractor (DME MAC) medical review staff.

Medicare prior authorization regulations require the DME MACs to process standard prior authorization requests (PARs) within 10 business days and expedited PARs within two business days. As part of the prior authorization pilot program, the average DME MAC PAR processing time was four business days, well below the 10-day threshold.

Jurisdiction B reported that two thirds of the PAR requests it received were approved upon initial submission.

Jurisdiction C reported that more than half of the PAR requests it received were approved upon initial submission, and both Jurisdictions B and C reported that almost all of the PAR resubmissions they received were approved on the first resubmission. The DME MACs reported that there has been excellent communication between providers and DME MAC staff throughout the 16

JANUARY 2021 | O&P ALMANAC

prior authorization process, and they will continue to provide important education to providers as the program moves to nationwide implementation.

The majority of nonaffirmative decisions during the pilot program were due to insufficient or missing clinical documentation that supports the medical necessity of the components provided.

It is important to remember that the six lower-limb prosthesis codes that require Medicare prior authorization are all K3 functional level components, and four of them incorporate microprocessor technology into their design. Documentation from both the prescribing physician and the prosthetist must support the medical need for the selected components.

AOPA’s coding and reimbursement team is following the progress of the Medicare prior authorization program closely and has developed multiple resources to help AOPA members have a positive prior authorization experience. A section on AOPA’s website dedicated to this topic, www.aopanet.org/legislative-regulatory/ prior-authorization, features resources such as a Medicare prior authorization video presentation, information about how the program works, and access to the AOPA Medicare Prior Authorization Tracking Tool (AMPATT).

Competitive bidding of select offthe-shelf (OTS) orthoses is another Medicare program that will impact O&P businesses in 2021. This program has been outlined in regulation for more than 10 years and was previously implemented for multiple categories of durable medical equipment.

While OTS orthoses have been eligible for inclusion as a product category subject to Medicare competitive bidding since the beginning of the program, Round 2021—implemented on Jan. 1, 2021—is the first time OTS orthoses have been included in the program.

Currently, Medicare competitive bidding of OTS orthoses is limited to 16 spinal orthosis codes (L0650, L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, and L0651) and seven knee orthosis codes (L1830, L1812, L1830, L1836, L1850, L1851, and L1852).

Round 2021 initially included all durable medical equipment, prosthetics, orthotics, and supplies product categories previously included in Medicare competitive bidding as well as the 23 OTS orthosis codes not previously included in competitive bidding.

However, after the bidding process was completed, CMS determined that additional savings would not be achieved by continuing competitive bidding for the previous product categories as Medicare fees had already been adjusted based on the single payment amounts (SPAs) established through previous rounds

REIMBURSEMENT PAGE

of Medicare competitive bidding. As a result, CMS elected to remove all of the previous product categories from future competitive bidding except for the selected OTS orthoses that had not had their Medicare fee schedules adjusted based on previous rounds of competitive bidding.

After an extensive bid submission process, CMS, on Oct. 27, 2020, announced the SPAs for the 23 OTS orthosis codes in each of the Medicare competitive bidding areas (CBAs). This was followed by the announcement of contracted suppliers for each CBA on Nov. 20, 2020. The Medicare competitive bidding program for the 23 OTS orthoses began on Jan. 1, 2021.

It is likely that the competitive bidding implementation has had an impact on your business. Effective for dates of service on or after Jan. 1, 2021, unless you were selected as a contracted supplier through the Medicare competitive bidding program, you will no longer be able to provide OTS orthoses described

by the 23 OTS orthosis codes included in Round 2021. Noncontracted suppliers who bill Medicare for one of the 23 OTS orthosis codes will have their claims denied. Medicare beneficiaries may only be held responsible for payment if they elect to sign an advanced beneficiary notice prior to receiving the orthosis.

In general, the SPAs for the 23 OTS orthoses represented an average reduction of 35 to 40 percent from the current Medicare fee schedule. Previous AOPA analysis of the competitively bid procedure codes indicated that only about 13 percent of the OTS orthoses paid for by Medicare were provided by traditional O&P companies so it was not surprising to see that the majority of competitive bidding contracts were awarded to medical equipment providers.

AOPA believes that O&P practitioners should be included in current exemptions from competitive bidding that are extended to other healthcare professionals such as physicians, nonphysician practitioners, and physical

and occupational therapists. The O&P Patient-Centered Care Act, currently under consideration by Congress, includes a provision that would extend this exemption to O&P practitioners.

While exempted practitioners must accept the SPA of competitively bid items, they are not restricted from providing services to Medicare beneficiaries. AOPA will continue to include this issue in its legislative priorities.

Joseph McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

Earn CE credits accepted by certifying boards: www.bocusa.org

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

FOLLOW US @AmericanOandP

MyAOPAConnection.org O&P ALMANAC | JANUARY 2021

17

COVER STORY

NEW YEAR’S

RESOLVE After a tumultuous 2020, O&P facilities commit to revamped business practices and fresh approaches to patient care

By CHRISTINE UMBRELL

NEED TO KNOW • Many O&P businesses are starting 2021 with renewed energy and reworked strategies to boost business and revenues, compared to 2020.

• Some facilities are anticipating a wave of patients as individuals who delayed patient care return to their regular appointments and seek out much-needed O&P intervention.

• Companies are optimizing their telehealth strategies by incorporating lessons learned from virtual patient care during the early months of the pandemic.

• Personal relationships will play a critical role in ensuring profitable partnerships between O&P facilities, allied healthcare companies, and payors.

18

JANUARY 2021 | O&P ALMANAC

COVER STORY

A

S WE BEGIN a new year, O&P stake

holders are seeking steadier business and increased revenue compared to what they experienced in 2020.

This year, “we are looking to pull ourselves out of the COVID bubble,” says Spencer Doty, MBA, CPO, president of Active Life Inc. in Glendale, California. “We have to start to move beyond” the reactionary response to the COVID-19 pandemic and take a more proactive approach, he says. The events of 2020 forced Active Life—and most facilities—to modify processes and procedures. Now, it’s time to evaluate the lessons learned, embrace the new technologies that O&P relied on during the pandemic, and jettison old systems, processes, and procedures that are no longer helpful.

Doty acknowledges that some facilities struggled to remain viable during the pandemic, but he believes O&P weathered the storm better than a lot of other professions. In many cases, the “strong got stronger, and the weak got weaker,” he says. Those facilities that took a flexible approach, embraced technology and telehealth, and fostered relationships with patients and referral sources in 2020 were the most successful.

Over the next 12 months, O&P owners and managers predict the profession may see an influx of patients, staffing challenges, innovative approaches to patient care, new relationships to foster, and ongoing reimbursement issues. They plan to embrace these challenges and opportunities with the goal of optimal patient care while keeping their businesses solvent. Here, O&P professionals share their advice for the new year.

O&P ALMANAC | JANUARY 2021

19

COVER STORY

months. At EastPoint Prosthetics and Orthotics in Raleigh, North Carolina, Brent Wright, CP, BOCO, anticipates an uptick in pediatric orthotic patients—a population that experienced a dip in new patients in 2020.

Brent Wright, CP, BOCO

Scott Sabolich, CP, and other stakeholders predict an influx in prosthetic patients in 2021, as recent studies indicated an increase in amputations last year.

Prepare for a Wave of Patients

Delayed patient care led to an increase in amputations in 2020, says Scott Sabolich, CP, owner of Sabolich Prosthetics & Research and chief executive officer of Ottobock Patient Care, so he expects to see a wave of patients with amputations this year.

Scott Sabolich, CP

20

JANUARY 2021 | O&P ALMANAC

Kevin Matthews, CO Some O&P professionals, however, caution that 2021 patient volumes may continue to be impacted by the COVID-19 crisis. Steve Filippis, president of Wright & Filippis, believes this year’s numbers will be much better than 2020 but may struggle to get back to 2019 volumes. “Some of the delays of care from 2020 might mean loss of revenue rather than delayed patient care,” he says, noting that patients who put off orthotic care during the pandemic may simply decide to forgo getting their prescribed orthotic device. In addition, prosthetic patients who delayed care and lost their ability to ambulate due to inactivity or using a wheelchair for the past nine months may no longer qualify for services.

PHOTO: Sabolich Prosthetics and Research

He points to international studies at the Amphia Hospital in the Netherlands and the University of Campania in Italy as evidence that a higher number of vascular and diabetic patients required amputations due to delay of care last year (see the Numbers section on page 8).

In addition, the CDC published a

study before the pandemic noting an upward trend in amputations in the United States, concluding that after a two-decade decline in lower-extremity amputations, the United States may now be experiencing a reversal in that progress.

“We’ll need to figure out how to handle potentially more patients,” while maintaining adherence to stricter safety protocols, such as longer time between appointments to allow for sanitation of patient-care rooms and reduced capacities in waiting rooms, says Sabolich. He suggests that O&P facilities facing an increased patient load may need to extend their patient-care hours of operation, add weekend appointments, or make other adjustments. “We’re going to have rush hour through 2021,” he says.

Beyond prosthetics, some O&P professionals expect to see a rise in orthotic appointments in the coming

Kevin Matthews, CO, owner of Advanced Orthopedic Designs in San Antonio, agrees. He explains that the parents of his orthopedic pediatric patients—many of whom have special needs—were afraid to visit when the virus was spreading quickly, so they delayed or skipped appointments.

Now, “I’m having parents come in with kids who should have had new AFOs made six months ago,” he says, noting that many of the prescriptions he is seeing are dated several months ago. “Parents are scared—but the kids are growing and need new orthoses.”

3D-Printed Custom Insoles have arrived!

Amfit has added 3D -Printing technology to our central fabrication services, using the highest quality of SLS printing materials!

These are the first custom printed F/O’s that meets Amfit’s expectations for function and durability.

Call today for information on how you can provide your customers with the finest 3D-printed functional orthotics on the market!

800-356-3668

Powerful Foot Orthotic Systems | Designed for Professionals orders@amfit.com · AMFIT.COM · @AmfitInc

COVER STORY

making. He recently surveyed all of his employees—from new hires to experienced clinicians—to ask what they would do to improve the practice in the years ahead. “Talk to your employees about their ideas, and include them” when planning for the future, he says.

Embrace Creativity and Technology in Patient Care

Clinicians at EastPoint P&O travel to see many of their patients at their homes or assisted living facilities, using mobile vans equipped with appropriate tools and supplies.

Take a Flexible Approach to Staffing

22

JANUARY 2021 | O&P ALMANAC

Jeff Arnette, CPO Some facilities will be reevaluating their staffing needs and deciding whether to hire or let go employees.

At Advanced Orthopedic, Matthews was able to retain his full staff in 2020—despite instituting some four-day workweeks while continuing to pay full-time salaries. In 2021, he is hoping to avoid asking staff to take occasional days off as leave without pay—but he is open to that approach if the facility’s financials don’t improve.

To keep up morale and effectively solve problems, Jeff Arnette, CPO, owner of Oklahoma-based Progressive Prosthetics & Orthotics, recommends involving staff in decision

PHOTO: EastPoint Prosthetics and Orthotics

O&P managers and owners may need to make creative—and sometimes difficult—decisions during 2021. “We’ll be busier, with more restrictions from Medicare, seeing more patients, with less staff” because some employees will need to take leave to quarantine due to coronavirus exposures or to care for family members, predicts Sabolich. “We as O&P facilities need to be on the defense, not just for COVID, but for the business interruption it will cause when clinicians have to take two-week breaks. So, we’ll need to be flexible. Even more than 2020, 2021 will be the year of the pivot.”

Last year, the pandemic affected Wright & Filippis’s ability to provide services because of stay-at-home mandates and some employees quarantining. Since March 2020, 120 of the company’s 320 employees have taken time off to isolate or quarantine.

“Over the course of the pandemic, in an abundance of caution, we closed six of our locations due to COVID-19 exposure concerns,” explains Filippis.

“While the number of clinical staff

has remained steady overall, there has been some turnover among office staff who are new to the field. Some new office staff did not anticipate the level of direct patient interactions and potential COVID risk and decided to pursue other employment.”

O&P facilities ramped up their use of telehealth dramatically last year. Now, they are analyzing what aspects of online care worked best to establish more defined rules and processes for virtual O&P patient care going forward.

Active Life clinicians will be more intentional about how they leverage the technology in 2021, says Doty.

“We’re modifying and scaling back” use of virtual patient care in 2021 to better match the hands-on requirements of O&P, he explains. “We’re optimizing how we approach telehealth,” including reevaluating all of the ways the facility connects with patients virtually—such as simple phone calls, joint appointments with allied rehab professionals, and more.

He likens this approach to learning to use food-ordering apps: “PreCOVID, we didn’t use apps as much to order food,” he explains. During the pandemic, many restaurants developed apps—some of which are more userfriendly than others, and consequently, more popular among consumers. O&P companies likewise should ensure their telehealth experiences add value to their facilities for 2021 and beyond, says Doty.

EastPoint clinicians also will focus on telehealth this year. Wright found that, in many cases, initial evaluations can be performed virtually, particularly for pediatric patients and patients in assisted living facilities. “It gives us an idea of what the patient needs so that when we go in to make a cast or device, we’re better prepared,” says Wright.

In addition, EastPoint will continue growing its mobile business—a key

COVER STORY

differentiator in the facility’s business model, and one that contributed to the facility’s resilience during the pandemic, says Wright. EastPoint has 17 mobile vans fully equipped to allow clinicians to travel to patients’ homes or assisted living settings.

Since the pandemic began, clinicians have been suiting up in personal protective equipment to visit housebound patients and those who were afraid to leave their homes. In many cases, clinicians are treating patients on their front lawns, decks, and porches—a safer choice than inside enclosed spaces.

Steve Filippis

Many O&P facilities plan to embrace new technologies when providing devices to their patients.

At Wright & Filippis, “we will focus on quality custom care, and high-tech solutions” when appropriate, says Filippis. “High-tech is not just for prosthetics and microprocessor knees and feet, but for pediatric cranial shaping helmets, orthoses like the C-Brace,” and scanning technology for all aspects of O&P care.

At EastPoint, clinicians will leverage new technologies during fabrication. The facility 3D prints some of its devices and found that during the pandemic, being able to offer devices that were 3D printed decreased lead times and prevented postponed appointments due to shipping delays.

“Having the ability to fabricate or partner with companies that did 3D printing” was a positive for patients— so EastPoint will build on these efforts this year.

Arnette believes in a back-to-basics approach in a patient-driven model of care, ensuring patient calls are returned immediately and paperwork is processed quickly. This approach will inspire patients to become advocates, he says.

Personal relationships also are the key to successful referral source and payor relations, says Arnette.

Progressive P&O is seeking out— and winning—new contracts, then following up by providing in-service programs so that employees at HMOs, PPOs, and other partners improve their understanding of O&P intervention. “Know your referral bases and maintain them,” Arnette says. “Make sure your referral sources know you and your company personally.”

Keeping referral sources informed of a facility’s status is very important, according to Filippis. “Part of marketing is reassuring referrals that you are open for business and following CDC policies” for safe and quality patient care, he says. Clinical staff, in particular, should foster positive relationships with physician and referral sources.

Of course, more of the one-on-one interactions needed to build relationships will be taking place virtually.

Given this trend, some facilities are rethinking their marketing approaches to reach more people while containing costs. One of Matthews’ priorities for 2021 is to leverage social media and website tools to reach current and potential patients, and referral sources—for example, by placing targeted ads on Facebook and similar platforms. “Then, when it’s safe— perhaps in the summer—we’ll market in person again.”

Focus on Lasting Revenues and Impactful Partnerships

In the new year, companies should be focusing not just on revenues, but on “lasting revenues”—opportunities that have long-term potential, says Doty.

“You see consolidation between health plans, physician groups—so you need to seek out revenue sources that tap into these larger pools.” For example, he suggests O&P facilities pursue partnerships with larger physician groups or medical networks, rather than individual physicians.

PHOTO: Getty Images

Foster Personal Relationships

To succeed in 2021, building and maintaining personal relationships with patients and referral sources will be critical, says Arnette. These relationships will inspire loyalty and retention.

O&P ALMANAC | JANUARY 2021

23

COVER STORY

Finding ways to boost lasting revenues will be particularly important given the increased scrutiny expected from payors. In the past year, the postaudit review process from Medicare has been particularly difficult to navigate, with audits increasing three- or fourfold in the past two years, according to Filippis.

As COVID-19 becomes less of a threat, he expects that Medicare oversight will become even more oppressive, because both Medicare and other payors will be looking for ways to save money lost to the pandemic. He emphasizes the importance of accurate and complete documentation because payors “will be looking for people who cut corners.”

Spencer Doty, MBA, CPO Developing new ways to increase new referrals and maintain revenue will be particularly important, as well as accounting for reduced reimbursements resulting from competitive bidding, says Filippis. “You have to do more now to make up for revenue that is being lost,” he says. “It does not

matter if you were awarded a bid, like Wright & Filippis, from Medicare for orthotics or you did not bid; physicians’ referrals will change for most providers in competitive bidding areas,” he says. He emphasizes that it’s difficult to forecast exactly how much additional business Wright & Filippis will receive because of competitive bidding, and how the increased audits will impact the company’s bottom line. “It’s challenging to make sure your costs meet your reimbursement,” Filippis says.

Doty recommends embracing— rather than fighting—the consolidation occurring in the greater healthcare world, given the growth of independent physician associations (business entities organized and owned by a network of independent physician practices) and other large medical groups. “We have to move beyond if they are ‘good’ or ‘bad’—they’re happening,” he explains. “There are a lot of new horizontal and vertical integrations, and new referral sources.

O&P needs to keep up with the consolidation and growth throughout regular healthcare,” says Doty, “and be positioned to support the demand and interests of our referral partners.”

Looking specifically at consolidation trends within O&P, Filippis

believes the profession will likely see increased mergers and acquisitions in 2021, as small facilities look to partner with larger facilities, manufacturing partners, or hospital systems in a challenging financial environment.

Promote the Value of O&P Intervention

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

24

JANUARY 2021 | O&P ALMANAC

PHOTO: Getty Images

During the early days of the pandemic, many O&P facilities worked hard to educate state and local regulators on their value as part of the healthcare team. AOPA clarified the point that O&P workers are essential personnel.

Expanding these advocacy efforts will be important in 2021.

As a new president and administration take the reins of U.S. government this month, O&P stakeholders will need to step up their efforts to inform legislators and regulators about the role of certified O&P clinicians within the healthcare team. Individual facilities should work to educate local regulators and lawmakers, suggests Arnette. “Know your market better than the next guy, and know your needs and wants,” he explains. “Become politically active, and get involved in advocacy efforts and educating CMS, local representatives, and national representatives.”

O&P stakeholders can look to the AOPA Co-OP for state-by-state advocacy-related information.

On the national level, AOPA and allied health organizations will be advocating to advance the O&P Patient-Centered Care Act this year, and pushing to ensure providers are recognized as essential healthcare workers. Details on these efforts are available on the AOPA website.

Working together to promote the profession will help position O&P in the spotlight—to the ultimate benefit of patients in 2021. “The O&P industry should remain open to looking at how others perceive us,” says Doty, “and respond accordingly.”

npdevices.com

Erik wears four MCPDrivers and a ThumbDriver.

IT ’S ALL ABOUT FUNCTION. Naked Prosthetics now offers four finger prostheses: PIPDriver, MCPDriver, ThumbDriver, and GripLock Finger.

PIPDriver

™

Custom device driven by an intact PIP joint with enough residuum to engage the ring.

ThumbDriver

™

Custom device driven by intact MCP and CMC joints in the thumb. However, patients with more proximal amputations may still benefit from the device as long as their residuum can engage the ring.

For more information:

(888) 977-6693 | (360) 915-9724 | fax (360) 918-8619

© 2020 Naked Prosthetics. All rights reserved.

MCPDriver

™

Custom device driven by an intact MCP joint with enough residuum to engage the ring.

GripLock Finger

™

Elegant solution for amputations proximal to the MCP joint. Positioned using a surface or their opposing hand, and then return to full extension by releasing the dorsal pawl or moving to the full flexion release point.

info@npdevices.com or visit npdevices.com

O&P and the Coronavirus Relief Deal

By MICHAEL COLEMAN

How O&P businesses may benefit during tax season and beyond from the newly enacted pandemic relief package

T

HE END OF 2020 delivered much

needed good news for O&P facilities and other small businesses across America, as Congress approved legislation to extend the Paycheck Protection Program (PPP) and relax federal tax requirements.

The changes are part of the larger Consolidated Appropriations Act, 2021, a 5,550-plus-page omnibus spending and coronavirus relief bill signed into law by President Donald Trump on December 27. The new legislation serves as a sequel to the Coronavirus Aid, Relief, and Economic Securities (CARES) Act passed in March 2020, when much was still unknown about the COVID-19 pandemic. Key provisions in the new legislation clarify tax rules and extend pandemic loan programs in ways that could be beneficial to O&P businesses.

26

JANUARY 2021 | O&P ALMANAC

NEED TO KNOW •

O&P business owners and managers should acquaint themselves with the December 27 coronavirus relief package that extends the Paycheck Protection Program (PPP) and relaxes federal tax requirements.

•

The legislation clarifies that PPP expenses are deductible and forgives the use of PPP loans to include costs for personal protective equipment and other adaptive investments.

•

The relief package also made advances from the Economic Injury Disaster Loan program deductible and included the right to deduct expenses paid with these types of loans.

•

O&P companies may also benefit from an announcement that the IRS is allowing for a five-year net operating loss carryback.

•

O&P stakeholders should consult with their tax and legal advisors to determine how the recent changes will impact their companies.

Clarifying the Rules Surrounding PPP Funds

The new relief package finally settled a longtime point of uncertainty about whether businesses would be able to deduct expenses paid with PPP money they received last year.

“PPP expenses are definitely not taxable—that’s one of the biggest things that happened” with the implementation of the new law, says Tricia Bush, CPA, an accountant and wealth manager at Baltimore-based Bestgate Wealth Advisors, which counts numerous healthcare industry businesses among its clients. Those expenses will, in fact, be deductible, and businesses will not have to include the money as part of their gross income declaration on their 2020 federal tax returns.

The new law also allows and forgives the use of PPP loans to include, among other eligible expenses, the costs for personal protective equipment and other adaptive investments made to comply

with “requirements established or guidance issued by the Department of Health and Human Services [HHS], the Centers for Disease Control, or the Occupational Safety and Health Administration, or any equivalent requirements established or guidance issued by a state or local government,” related to COVID-19 between March 1, 2020 and the end of the national emergency declaration, which HHS recently extended until the spring.

The law also mandates a simplified application for a next round of PPP-covered loans up to $150,000.

These loans will be forgiven if the eligible recipient signs and submits to their lender a certification, including: • A description of the number of employees the eligible recipient was able to retain because of the PPP • The estimated amount of the covered loan amount spent by the eligible recipient on payroll costs • The total value of the loan.

Those taking PPP loans of more than $150,000 will still need to submit documentation and verification required under the first round of PPP loans. The new law authorizes a second PPP loan for companies with fewer than 300 employees that saw at least a 25 percent drop in revenue during any quarter in 2019 and 2020. The maximum loan amount under the new round of PPP is $2 million, compared to $10 million in the first PPP round.

“The second set of PPP loans coming out are tougher to get,” Bush says, noting the political backlash that occurred when news surfaced that wealthy companies that could easily weather the pandemic’s storm were nonetheless grabbing up free government cash. “They really want to focus the newer loans on businesses that really need them.” The new round also offers another chance to businesses that missed out the first time.

“If you’re somebody who didn’t get the first round of money—let’s say you just missed the boat on it or you were distracted—you now have the opportunity to go back in and try to get your first PPP loan,” Bush says.

Updating Economic Injury Disaster Loan Deductions

The new law offers another benefit that may be helpful to O&P companies: It scraps a requirement that PPP borrowers deduct the amount of Economic Injury Disaster Loans (EIDLs)—which aren’t required to be paid back—from their PPP forgiveness amount. So, the total PPP forgiveness won’t be reduced due to the EIDL advance. The change is retroactive to the enactment of the CARES Act, the initial PPP-granting legislation signed into law on March 27, 2020.

“Previously, if you got the $10,000 grant for the Economic Injury Disaster Loan, which was the advance that you didn’t have to pay back, you had to take that out before your [PPP] money was forgiven,” Bush explains. “So, before, you would not have gotten that $10,000.

They undid that rule with the new bill.

O&P ALMANAC | JANUARY 2021

27

AOPA’s Behind-the-Scenes Efforts Pay Off for O&P Business Owners As Congress engaged in contentious negotiations over a second bill to help people and businesses stay financially afloat during the COVID-19 pandemic, AOPA was working behind the scenes on Capitol Hill to protect its members.

Justin Beland, AOPA’s director of government affairs, was in regular contact with key legislative staffers to convey the concerns of O&P business owners and press the need for streamlined loan application and tax filing options during an already incredibly difficult year. “We were trying to make it as little paperwork and number crunching as possible,” Beland says, to alleviate some of the burdens on O&P facilities. “The way we envisioned it was for our members to get this money and not have to jump through a whole lot of hoops to do so.”

The Coronavirus Aid, Relief, and Economic Securities Act and follow-on legislation appropriated $175 billion to the Department of Health and Human Services (HHS) to reimburse healthcare providers for healthcare expenses and revenue losses attributable to COVID-19. HHS began issuing payments under the COVID-19 Provider Relief Fund in April 2020.

“A lot of our members got Paycheck Protection Program (PPP) loans … and the physician fee funds that were available through HHS, so we fought hard to make sure our folks were included in that,” Beland says. “If folks were getting both of those things, it’s a pretty good chunk of change, to keep them afloat.” But as O&P companies started getting PPP and provider relief funds, they began questioning whether they would be required to pay taxes on those funds. So AOPA, and many other healthcare advocacy groups in Washington, asked Congress if they could remove tax burdens on that money, according to Beland. The second bill that finally cleared Congress in December did just that.

“It happened at the last minute, but that was a big one that we fought for— just to make sure that folks wouldn’t have to pay taxes on this on money that they won’t have to pay back in the first place,” Beland says.

The new round of PPP loans comes with an expanded eligibility for 501(C)(6) nonprofits, which benefits the AOPA organization itself. “We joined with a lot of other nonprofits and associations to make sure that, if necessary, we could have access to PPP money as well. So, we did some work behind the scenes and made sure that we were eligible as well.”

Beland also notes that the legislation approved in December was an appropriations bill for federal agencies. Included in that was $20 million for O&P research obtained through a Department of Defense program called the Congressionally Directed Medical Research Program. “There’s a stream in there for orthotics and prosthetics research,” Beland notes. “We were able to get the same amount of money we had in there last year. That was a big win for us— making sure, in the face of some other budget cuts, that we kept that money in there for our researchers.”

28

JANUARY 2021 | O&P ALMANAC

So now you don’t have to take that out, and you get your $10,000 back.”

Bush suggests that business owners make sure their accountants are aware of the change. “They need to be able to look out for how to adjust your application to get that money back,” she says.

The relief package also made EIDL advances deductible and included the right to deduct expenses paid with them. “The EIDL program has assisted millions of small businesses, including nonprofit organizations, sole proprietors, and independent contractors, from a wide array of industries and business sectors, to survive this very difficult economic environment,” said Jovita Carranza, administrator of the U.S. Small Business Administration (SBA), in a statement.

“EIDL loan applications will continue to be accepted through December 2021, pending the availability of funds,” the statement explains. “Loans are offered at very affordable terms, with a 3.75 percent interest rate for small businesses and 2.75 percent interest rate for nonprofit organizations, a 30-year maturity, and an automatic deferment of one year before monthly payments begin.” The SBA encourages “every eligible small business and nonprofit” to apply to “get the resources they need.”

Carrybacks for Net Operating Losses

For businesses that sustained large losses in 2020, the IRS is allowing for a five-year net operating loss (NOL) carryback. That means small-business owners can carry back their losses, if they had any in 2020, five years to recapture any tax dollars (with an amended return) that they previously paid in those years to offset what they lost this year.

“The idea is to get your money back faster,” Bush says. “However, the IRS is being very slow processing amended returns right now. If 2020 was a loss, and you can carry something back to 2019, they are allowing 2019 to be amended electronically. That could help people get something back quicker.”

STAND TALL. RUSH LIFE.

Also available in EVAQ8 and H2O Models!

VERTICAL LOADING SHOCK ABSORPTION AND +/- 8° OF TORSION! 1236 West Southern Avenue #101, Tempe, AZ 85282 • 855.450.7300

shop.proteorusa.com

! $ * '

#HumanFirst

Lower Extremity Post-Op Care Trans-Tibial Rehab System

Trans-Tibial Waist Belt

FLO-TECH-TOR™

UFOS™

Distal pad set

Trans-Femoral Prep System

Trans-Femoral Waist Belt

Distal pad set

FLO-TECH-TOR™

UFOS™

SOFTIE™

Trans-Tibial Trans-Femoral O & P Systems, Inc.

www.1800flo-tech.com 30

JANUARY 2021 | O&P ALMANAC

1-800-FLO-TECH (356-8324)

At Bush’s firm, “we are actively filing amended returns for people that have losses,” she explains. “We don’t know what the taxes are going to be in the future. But we can get them money back right now. This is probably the most significant kind of change that’s happened in tax rules and laws as a result of this crisis.”

New Rules for the Employee Retention Tax Credit

Yet another benefit of the recent relief package is a more generous application of the Employee Retention Tax Credit.

The credit in the CARES Act offered a 50 percent refundable tax credit (up to $10,000 total) for companies that kept employees on their payroll, whether they were open for business or not during COVID-19 lockdowns.

That percentage has now been raised to 70 percent of qualified wages. Also, the initial version applied to qualified wages paid after March 12, 2020, and before Jan. 1, 2021, but the law enacted in late December extends that time frame to July 1, 2021, or the first two quarters of 2021.

Another change: Employers who accepted PPP loans can now also take the employer retention credit if the same wages are not used for both.

“In 2021, they extended the credit to continue for the first half of the year, and you can get up to $7,000 per quarter, per employee,” Bush says.

“It’s a big credit.”

Overall, Bush characterizes the legislation Congress finally approved in late December as “more generous” to small and medium-sized businesses than what had been on the table during months of prior negotiation.

“They’re definitely doing some things to help the small-business person,” she says.

Michael Coleman is a contributing writer to O&P Almanac.

EDITOR’S NOTE: This material is not intended, and should not be relied on, as legal advice. AOPA members should consult with their own CPAs and counsel about tax questions.

COMPLIANCE CORNER

By ELAINE HENSLEY

Entering Round 2021 Tips from the Competitive Bidding Implementation Contractor for complying with key contract terms

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 33 to take the Compliance Corner quiz.

Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.33

A

S WE IMPLEMENT ROUND 2021 of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Competitive Bidding Program (CBP), we want to congratulate all of the contract suppliers. We all share a common goal, which is to ensure Medicare beneficiaries receive the off-the-shelf (OTS) back and knee braces prescribed by their physicians and other treating practitioners in a timely manner.

To achieve this goal, each contract supplier must comply with key contract terms under the competitive bidding contract to maintain good standing in the DMEPOS CBP.

Key Contract Terms and Compliance

By looking at each contract obligation closely, we will get a better understanding of the competitive bidding requirements.

Maintain an active Provider Transaction Access Number and state licensing and accreditation requirements. What does this mean?

As part of our monitoring program, we routinely review the Provider Enrollment, Chain, and Ownership System enrollment data to identify any contract suppliers that are not complying with program eligibility requirements, such as maintaining an active Medicare billing number, licensing, or accreditation. When an issue is identified, a competitive bidding liaison (CBL) will discuss the issue with the supplier to give them the opportunity to promptly correct the issue. Contract suppliers who are unable to resolve a Medicare supplier enrollment issue will be issued a notice of breach of contract.

Accept assignment on all items under the contract. Medicare payments are based on the single payment amounts (SPAs). Does this mean you must change your participating

status? No, you are not required to change your participating/nonparticipating status. However, you must accept assignment on all CBP items under your contract. If you file a nonassigned claim, it is processed on an assigned basis and payment is based on the SPA. You cannot collect more than the SPA for the item(s) from the beneficiary.

Complete the intake and assessment process, submit claims, coordinate care with the physician, deliver items and provide instruction to the beneficiary/caregiver(s), and ensure all services are performed in compliance with the physician’s order and Medicare rules and guidelines, including subcontracted services. Does this mean my subcontractor cannot work out arrangements with a doctor’s office or the beneficiary for a back brace? That is correct. A subcontractor cannot perform intake and assessment or coordinate care with the physician. Only the contract supplier can perform these tasks.

Provide all contracted items throughout the competitive bidding area (CBA), and do not discriminate against Medicare beneficiaries.

O&P ALMANAC | JANUARY 2021

31

COMPLIANCE CORNER

What does this mean? You must provide Medicare beneficiaries the same items that you furnish to other customers.

You also must furnish all competitively bid items included in your contract to any beneficiary who maintains a permanent residence in, or visits, a CBA, which includes skilled nursing facilities and nursing facilities.

if applicable, and be accredited for all of the services provided. A subcontractor that only delivers the item does not need to be accredited. However, if the subcontractor provides more than delivery by giving instructions on the use of the item, then the subcontractor needs to be accredited, unless a professional or pharmacy exemption applies.

on your behalf. If the subcontractor fails to provide services in compliance with Medicare requirements and the terms of your competitive bidding contract, your contract may be in breach. Therefore, be sure to trust who you are entering into business with before finalizing your subcontracting agreement.

Notify CMS within 10 business days of any subcontracting relationship(s) entered into to furnish competitively bid items. How do you notify CMS? You complete the subcontractor statement in Connexion, the DMEPOS CBP’s secure portal.

You must disclose the services the subcontractor is performing on your behalf and whether the subcontractor meets the accreditation requirements necessary to furnish these services.

If the subcontractor provides more than delivery by setting up or giving instructions on the use of the item, then the subcontractor needs to be accredited, unless a professional or pharmacy exemption applies.

Furnish all items listed on the contract, regardless of capacity. Does this mean you must provide items if you exceeded the estimated capacity you bid?

Yes, it does. While there is no guarantee of business under your competitive bidding contract, there are no limits or caps, either.

You cannot turn business away; otherwise, you may be in breach of your contract.

Furnish a specific brand of an item to avoid an adverse medical outcome for a Medicare beneficiary if ordered by a physician or other treating practitioner. What is the expectation?

You must either provide the item, work with the physician for a suitable alternative, or assist the beneficiary with finding a supplier that provides the prescribed brand. If you do not carry the brand and cannot resolve the issue with the physician or by locating another supplier, you must provide the prescribed item, regardless of cost.

Notify CMS of a change of ownership (CHOW). Can a contract be transferred? Yes, CMS may allow the full transfer or transfer of a portion of a competitive bidding contract when there is a CHOW in the company. CMS can approve a contract to be transferred to a new entity as a result of a CHOW, but competitive bidding contracts alone cannot be sold, and doing so would put the contract in breach.

Furnish competitively bid items directly or via subcontractors.

What does this mean? Consistent with the Medicare DMEPOS Supplier Standards, contract suppliers may use a subcontractor to perform the following services: purchase of inventory, delivery, and instruction of use of competitively bid items.

As a contract supplier, you may need a subcontractor to assist in providing OTS back and knee braces throughout a CBA. For example, if you are physically located in the southern portion of the CBA, you may choose to use a subcontractor to furnish the northern portion.

Even if you use a subcontractor, you must maintain applicable state licensure, 32

JANUARY 2021 | O&P ALMANAC

Oversee subcontractors’ performance. Failure for either the contract supplier or subcontractor to comply with the terms may result in breach of contract. Why are you responsible for your subcontractor?

You are the contract supplier, and the subcontractor provides services

Submit a semiannual report (Form C) indicating the manufacturer and model of specific items offered to all customers. Is this really required every six months? Yes, it is. However, there is the option in Connexion to indicate “no changes” if there are none for the items you provide. Also, if you add/change a product within the six-month window of the required submission dates of January 1 to January 15 and July 1 to July 15, this satisfies your Form C requirement for the applicable submission window. For example, if you submit an update in October 2021, then you will have satisfied your submission requirement for January 2022.

COMPLIANCE CORNER

Please note, you are only required to provide the manufacturer, make, and model for three Healthcare Common Procedure Coding System (HCPCS) codes for OTS back braces, which are L0457, L0621, and L0650; and for one OTS knee brace, which is L1833.

Failure to meet the Form C requirement is a breach of contract. Submissions are made via Connexion, and the information you provide is posted in the Medicare Supplier Directory on Medicare.gov for beneficiaries and referral agents to identify contract suppliers and the brands they carry.

Education and Monitoring

Now that we understand the contract obligations, let’s look more closely at the other tools we use to monitor compliance. To ensure we are meeting our shared goal to ensure Medicare beneficiaries have access to OTS back and knee braces, it is necessary for CMS and the Competitive Bidding Implementation Contractor (CBIC) to monitor contract suppliers to identify potential issues, address the issues, and resolve them through our partnerships, if possible.

CMS and CBIC utilize a variety of methods to ensure contract suppliers remain in compliance with the terms of the contract—complaints, claims data, and routine secret shopper calls.

The basis of our monitoring program is providing extensive education to ensure suppliers, beneficiaries, providers, and referral agents understand the DMEPOS CBP rules.

Our complaint monitoring process is one of the best ways to learn if contract suppliers are providing the competitively bid items in the CBAs on their contract.

It provides firsthand feedback from beneficiaries and their caregivers or advocates, referral agents, providers, and other suppliers. We investigate every complaint we receive, typically by contacting the complainant, who can be any of the persons listed, and the supplier(s) named; we want to learn all sides of the issue. We often learn there are issues with the documentation in the medical record where the coverage criteria are not met.

We also find that suppliers’ customer service representatives may mistakenly provide misinformation; it happens. Like you, our goal is to quickly and thoroughly resolve issues to ensure beneficiaries receive the items they need. Most issues are resolved in less than three or four days—and often in only one or two days.

As appropriate, we will work with the contract supplier to ensure any mistakes or misinformation is not repeated.

We also utilize claims data and make routine secret shopper calls to ensure contract suppliers are fulfilling their obligations. If an issue is identified—either through claims analysis and/or a routine secret shopper call—the regional CBL calls the contract supplier to review the issue and educate the supplier on its contractual obligations.

In addition, CMS has retained a contractor to administer surveys to learn more about key stakeholder and beneficiary experiences and satisfaction with the DMEPOS CBP. Specifically, surveys will be conducted among three key stakeholder groups: beneficiaries, suppliers, and referral

agents (e.g., discharge planners, physicians, social workers, case managers, nurses). The survey results will assist CMS in overseeing the DMEPOS CBP and determining if DMEPOS CBP changes are required. Future updates about the competitive bidding surveys can be found on CMS.gov.

Lastly, CMS performs health status monitoring with real-time claims analyses.

Health status reports for DMEPOS CBP contract periods are updated on a quarterly basis and published on CMS.gov. Each product category file includes a written summary of health status monitoring results and graphical displays of beneficiaries’ health status and their access to competitively bid items. The data is derived from claims for Medicare populations in each CBA and a corresponding “comparator” region that is similar to the CBA. We hope you find this information useful as you enter Round 2021. Please do not hesitate to contact the CBIC at 877/577-5331 or your regional CBL for assistance. We are here to help you navigate the next three years as a Round 2021 contract supplier.

Elaine Hensley is the chief competitive bidding liaison at the Competitive Bidding Implementation Contractor.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

Earn CE credits accepted by certifying boards: www.bocusa.org

O&P ALMANAC | JANUARY 2021

33

PRINCIPAL INVESTIGATOR

Stretching His Interests Physiatrist David C. Morgenroth, MD, is a physician-scientist and educator focused on improving the function and quality of life of people with limb loss

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

JANUARY 2021 | O&P ALMANAC

ROWING UP AS A 5-foot-7-inch

basketball player in New York City, David C. Morgenroth, MD, spent a lot of time training to jump higher—“a vital skill to earn respect in the New York City playgrounds,” he explains. So it came naturally that he decided to study gait biomechanics during his undergraduate years at University of California at Berkeley. While there, he worked for two years in a biomechanics lab studying the stiffness properties of the human ankle related to walking, running, and jumping.

After earning his bachelor’s degree in human biodynamics in 1996, Morgenroth moved back to New York City to teach middle school math and science at a public school. It was this experience as a teacher—coupled with his research studies as an undergraduate—that seeded his interest in academic medicine and led him to earn his doctor of medicine from the State University of New York at Brooklyn College of Medicine in 2003.

Fast forward 17 years, and Morgenroth now puts all of his interests to good use in academic, clinical, and research roles. “I am a physiatrist—a physical medicine and rehabilitation (PM&R) physician—with a background in gait biomechanics,” he explains. At the University of Washington (UW), he is

an associate professor and vice chair for research in the Department of Rehabilitation Medicine. He also serves in several positions at the Department of Veterans Affairs Puget Sound Health Care System’s Seattle campus: as a staff physician; an investigator for the VA’s Rehabilitation Research and Development Center for Limb Loss and Mobility (CLiMB); and an associate program director for the Amputee Rehabilitation Fellowship.

“As an academic physician, my professional roles include clinical care, research, teaching, administrative leadership, and service,” he explains.

“My goal as a physician-scientist is to ground my research in key questions most relevant to the patients I am caring for in the clinical setting, and subsequently to inform my clinical practice with high-quality research findings.”

Embracing O&P

Morgenroth discovered PM&R during medical school—a field he deemed “a great match for my interests in neuromusculoskeletal physiology and in helping restore function to individuals with disabling conditions.” During his residency training, he decided to focus on limb loss rehabilitation: “Not only did I enjoy working with this patient

PHOTO: David C. Morgenroth, MD

34

G

PRINCIPAL INVESTIGATOR

PHOTO: David C. Morgenroth, MD

population in the clinical setting, but I realized the opportunity to use my gait biomechanics background as a researcher focused on improving mobility in people with limb loss,” he says. He also enjoys the multidisciplinary nature of this field, “which affords me the rewarding opportunity to work closely with prosthetists and other rehabilitation professionals.”

Morgenroth seeks to elevate the lives of amputees through his many research endeavors. His most recent studies focus on improving the process and outcomes related to prosthetic foot prescription. “There is limited evidence to guide clinicians in the current prosthetic foot prescription process, which instead is based primarily on provider experience,” he explains. Although prescription success often is defined primarily by user satisfaction, “typically there aren’t opportunities for people with limb loss to try out different feet prior to prescription in order to provide experiential input to the process.”

In two concurrent projects, both funded by the Department of Defense Orthotics and Prosthetics Outcomes Research Program, Morgenroth’s research team is studying a patientcentered “test-drive” strategy to improve prosthetic foot prescription using either commercial prosthetic feet, or a customizable, robotic prosthetic foot that mimics the mechanical properties of commercially available prosthetic feet through software control. This prosthetic foot emulator (the Humotech Caplex system) can provide individuals with limb loss the opportunity to test several prosthetic foot designs within a single test session. By allowing patients a chance to offer experiential feedback during the prescription process, “this study has the potential to provide meaningful benefit to clinicians, as well as to the patients that they care for,” he explains. Although these studies are ongoing, the research team has noted a satisfying and unexpected preliminary result: Numerous study participants have, in an unsolicited manner, requested unblinding at the conclusion of the study because they greatly

favored one of the prosthetic feet trialed more than their prescribed prosthetic foot, says Morgenroth, and “they have subsequently asked their clinical team to prescribe that particular study foot.”

In other investigations, Morgenroth is studying the prevention and treatment of secondary disabling musculoskeletal conditions, such as intact limb knee osteoarthritis and low back pain, which are more prevalent in those with lowerlimb loss than in the general population and can cause further mobility limitations.

“My research has focused on understanding the underlying mechanical knee loading conditions of the intact limb in this population, as well as understanding the effect of prosthetic foot characteristics on intact limb knee loading during walking,” he explains. His team revealed in vivo evidence that knee joint loading rate may be as important as knee joint loading magnitude in association with degenerative tibiofemoral osteoarthritis, he says. “We also demonstrated that increased prosthetic ankle-foot push-off is associated with decreased intact limb knee loading in persons with transtibial amputations.” These findings have important implications for prosthetic ankle-foot design, according to Morgenroth.

In addition, Morgenroth is focused on developing a better understanding of the underlying etiology of low back pain and pain-related interference in persons with lower-limb amputation. He has been studying “whether commonly described clinical correlates were, in fact, associated with low back pain,” he says. “We demonstrated that low back pain was associated with increased transverse plane rotation during walking, and that excessive lumbar lordosis angle and relatively small leg-length discrepancies were not associated with low back pain in persons with transfemoral amputation.” He believes these findings have implications for the clinical care of veterans with transfemoral amputation. “For instance, we typically no longer attempt to correct relatively small leg-length discrepancies in the clinical setting,” minimizing the likelihood of falls due to catching the prosthetic foot on the ground during the swing phase of walking.

Morgenroth is involved in other projects that focus on novel strategies for reducing phantom limb pain, as well as novel prosthetic solutions for women with limb loss, and for people with partial foot amputations.

Patient-Focused

In his role as a clinician, Morgenroth cares for individuals with all types of amputations. “I find great satisfaction in caring for a spectrum of patients, ranging from high-functioning athletes with goals such as climbing mountains and running marathons, to older individuals with multiple comorbid conditions with more basic goals such as being able to transfer from a wheelchair to bed to allow independent living,” he says.

“The goal of my research program is to move projects along the continuum— from discovery and innovation through validation and, ultimately, implementation into clinical practice to help improve the lives of people with limb loss,” he says. His current prosthetic foot prescription research projects are in the innovation and validation phases, and he hopes “to continue this line of research with future projects moving into the O&P ALMANAC | JANUARY 2021

35

PRINCIPAL PRINCIPAL INVESTIGATOR INVESTIGATOR

translation phase.” This will include projects that continue to focus on a test-driven strategy for prosthetic foot prescription as well as parallel strategies, including developing predictive models that can aid clinicians in best-matching patient-level factors with characteristics of different prosthetic feet.

“I view prosthetic limbs as only one of multiple important aspects of improving the lives of people with limb loss,” says Morgenroth. “As a clinical community and as a research community, we need to focus as much on the biopsychosocial factors and interventions as we do on prosthetic factors and interventions in order to best serve our patients.”

Staying Active and Giving Back

While Morgenroth never pursued basketball professionally, he continues to enjoy sports and recreational activities in his free time. Married with two young boys, he says that “family and professional life fill most of each day,” but he seeks balance with sports and hobbies.

“After growing up as a basketball player, in my late 20s I was introduced to the sport of ultimate Frisbee and ended up playing competitively during my internal medicine Intern year at Brown University,” he says. He met his wife while playing on a coed team in Seattle, and the couple traveled to the Middle East two consecutive summers with the organization Ultimate Peace to help run ultimate Frisbee camps, bringing together youth from different backgrounds who have been divided by ongoing conflict in the area.

“These days, I play sports with my kids and love hiking in the beautiful Pacific Northwest,” Morgenroth says. He

also plays music and is an avid cyclist— having completed a 3,000-mile bike ride from his college apartment in Berkeley, California, to his parents’ apartment in New York City in 1996, following his graduation. “We carried everything we needed on our bikes, including camping equipment, clothes, bike tools, water, and food,” he recalls. “We rode almost every day for nine weeks, camping along our route, and receiving the generosity of strangers we met on the trip who occasionally housed us for the night and cooked us dinner. It was an incredible way to get to know the people and landscape throughout the United States, and a trip that I hope to take again when my kids are old enough.”

Given his wide variety of interests— both professional and personal—it’s clear that Morgenroth will be relentless in all of his pursuits, including his investigations into the O&P patient population to ultimately improve quality of life for lower-limb prosthesis users.

NOTABLE WORKS David C. Morgenroth, MD, a physiatrist affiliated with the University of Washington’s Department of Rehabilitation Medicine and the Department of Veterans Affairs Puget Sound Health Care System, is the author or co-author of dozens of peer-reviewed articles and conference presentations. Some of his most impactful contributions include the following:

Morgenroth hikes with his son, Louis.

He notes, for example, that the best possible prosthetic limb may not be helpful in cases where the person with limb loss has chronic residual limb pain, post-traumatic stress disorder, and poor social support.

“It is vital that we focus the lens of our research and clinical care on the patient who may be using a prosthesis, rather than overly focusing on the prosthesis itself,” he says. “Along these lines, while we have made great strides in prosthetic technologies, it is vital that technological advances are married to true clinical need.”

36

JANUARY 2021 | O&P ALMANAC

• Morgenroth, D.C., Medverd, J.R., Seyedali, M., Czerniecki, J.M. “The Relationship Between Knee Joint Loading Rate During Walking and Degenerative Changes on Magnetic Resonance Imaging.” Clinical Biomechanics, 2014 Jun; 29(6):664-70. PMID: 24820134; PMCID 4111971 • Morgenroth, D.C., Orendurff, M.S., Shakir, A., Segal, A., Shofer, J., Czerniecki, J.M. “The Relationship Between Lumbar Spine Kinematics During Gait and Low-Back Pain in Transfemoral Amputees.” American Journal of Physical Medicine and Rehabilitation, 2010 Aug; 89(8):635-43. PMID: 20647781 • Morgenroth, D.C., Roland, M., Pruziner, A.L., Czerniecki, J.M. “Transfemoral Amputee Intact Limb Loading and Compensatory Gait Mechanics During Down Slope Ambulation and the Effect of Microprocessor-Controlled and Power Knee Mechanisms.”

Clinical Biomechanics, 2018, Jun 12; 55:65-72. PMID 29698851 • Morgenroth, D.C., Segal, A.D., Zelik, K.E., Czerniecki, J.M., Klute, G.K., Adamczyk, P.G., Orendurff, M.S., Hahn, M.E., Collins, S.H., Kuo, A.D. “The Effect of Prosthetic Foot Push-Off on Mechanical Loading Associated With Knee Osteoarthritis in Lower Extremity Amputees.” Gait and Posture, 2011 Oct; 34(4):502-7. PMID: 21803584; PMCID: 3189331

MEMBER SPOTLIGHT

Walker Orthotics & Prosthetics

On-the-Job Training A new facility owner learned the ins and outs of his business during the early months of the pandemic

I

F GRANT ESPY HAD seen the

PHOTOS: Walker Orthotics & Prosthetics

future, he might not have bought an O&P practice 13 months ago.

But the pandemic in the United States was still a few months away, so Espy and his wife, Kelly Espy, and silent partner, Powell Fulton, took over the reins of Walker Orthotics & Prosthetics in Rome, Georgia, a facility founded in 2002.

Espy hailed from the banking arena, but as a resident of Rome, he was familiar with the facility’s owners. “I was ready for change and knew that the previous owner was interested in selling,” Espy says. “It was a good business, fully staffed, and I decided it was the thing to do.”

He plans to continue the Walker name for the time being.

The facility’s six employees include clinician David Baggett, CPO; two fitters, one of whom is certified in therapeutic shoes; one technician; and two administrative staffers. Espy also plans an important new hire: his wife, Kelly, who is a physical therapist.

Walker O&P has four exam rooms, a prosthetic room, and a fabrication lab. The location is ideal, according to Espy, since it is situated near major hospitals and the largest clinic in northwest Georgia.

Espy learned a lot about his new business when the coronavirus began spreading and fewer patients visited the office. “The pandemic set us back for six weeks in March and April,” says Espy. “We sent more than half our staff home, including both our admins. I got a lot of my

Walker Orthotics & Prosthetic staff

FACILITY: Walker Orthotics & Prosthetics OWNERS: Grant Espy, Kelly Espy, and Powell Fulton LOCATION: Rome, Georgia HISTORY: 18 years (one year under new ownership)

Grant and Kelly Espy

administrative training that way, sitting in the office by myself for six weeks! I didn’t enjoy it at first, but I got great on-the-job training.”

Today, everyone wears masks in the facility, which is regularly scrubbed and disinfected. Patients are screened for COVID-19, and only a limited number of patients are permitted in the lobby. Such precautions have been successful so far, says Espy.

Walker O&P’s business divides roughly evenly between orthotics and prosthetics. While clinicians see all types of patients, 90 percent of prosthetic cases are lower limb, often due to diabetes complications. About 70 percent of lower-limb prosthetic patients have below-knee amputations, and 30 percent have lost their limb through or just above the knee. Espy says the facility treated its first patient from a U.S. Department of Veterans Affairs (VA) hospital recently and hopes to expand that portion of its business.

By DEBORAH CONN

According to Espy, he has found many ways to increase his knowledge of successful O&P intervention over the past year.

He observes patient care in the facility’s prosthetic room and sits in on lab procedures. “It’s all valuable on-the-job training,” he explains. And his AOPA membership has been helpful: “We signed up to go to the virtual conference. It was very educational for me. Joining AOPA gives me access to classes, clinician webinars, and information on Medicare and Medicaid,” he says.

While business is slightly down from 2019 as a result of the pandemic, Espy looks forward to solid growth. Once Kelly Espy comes on board as a physical therapist, patients will be able to access services in one place.

Eventually, Espy would love to add another office or two in nearby counties because several current patients drive in from the surrounding community.

But for now, he says, “we have to continue to refine our services and make sure this single office is running the way it should.”

Espy is pleased with his transition from banking to O&P. “We do have competition in the area, but we are the only locally owned small clinic, and I take pride in that. Like other small businesses, we do focus on service, which means we will see you as many times as you need. We spend an extraordinary amount of time pre- and post-service. I give my cell number to people, and we do 24/7 service to hospitals.”

Espy’s favorite part of the business is watching someone move from a wheelchair to walking. “We get emails that we have changed someone’s life,” he says. “It’s so gratifying.”

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

O&P ALMANAC | JANUARY 2021

37

MEMBER SPOTLIGHT

Össur

By DEBORAH CONN

Manufacturing Milestones International orthopedics company celebrates 50-year anniversary in 2021

J

UST ONE YEAR AGO, Össur

38

JANUARY 2021 | O&P ALMANAC

upper-extremity prosthetics company, in 2016. More recently, Össur signed an agreement to acquire College Park Industries, in Warren, Michigan, and re-inked a collaboration with the Alfred Mann Foundation to explore mind-controlled prosthetic devices.

In 2019, Össur celebrated 20 years as a publicly traded company. Össur Americas is headquarJon Sigurdsson tered in Foothill Ranch, California, with a service network extending from Mexico to Canada and a COMPANY: manufacturing center in Tijuana, Össur Mexico. The company’s slogan, “Life Without Limitations,” underscores OWNERS: its commitment to patients. In Publicly held 2019, Össur began to feature on its website stories of those who pursue LOCATION: Worldwide presence, their dreams regardless of physical challenges. Athletes, teachers, with headquarters hikers, and dancers describe their in Reykjavík, journeys as people with limb loss.

Iceland The Össur Academy opened in 2014 in Orlando as a center for HISTORY: clinical education and research and development (R&D). The 50 years pandemic has halted in-person classes, but a wide range of online practitioner courses are available, many of which confer continuing education credits.

Other resources include reimbursement news and support, the Women’s Leadership Initiative for women O&P professionals, and Empower, an online platform for inventory management, reimbursement, and consulting services.

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

PHOTOS: Össur

was looking forward to its 50th anniversary in 2021, celebrating a half century of providing innovative technologies in orthotics and prosthetics. And then, of course, the pandemic appeared.

“I’ve been the chief executive officer of Össur for more than 20 years,” says Jon Sigurdsson, “and I never thought we’d be facing an existential threat to the company.

In the first few weeks of the pandemic, when everything was shut down, our sales dropped 50 percent, and at that rate, we couldn’t survive for long.”

Fortunately, essential businesses—like healthcare— reopened, and the situation improved. “The year 2020 was not a good one by any means,” says Sigurdsson, “but I think we can say that the O&P industry has fared well compared to a lot of others.” Össur adapted many of its operations to meet production needs safely.

Those who can, work from home.

Some employees, particularly in manufacturing and distribution, are unable to work remotely, so the company has severely limited the number of people who can be in the same room at one time and instituted double shifts to keep up with demand.

The company was founded in 1971 by Össur Kristinsson, a prosthetist who developed the Iceross, a silicon liner for prosthetic sockets. Since then, the company has become an international leader in noninvasive orthopedics, with approximately 4,000 employees operating in more than 25 countries. It acquired the German company Medi Prosthetics and the UK firm Touch Bionics, an

The company prides itself on its strong approach to corporate responsibility, including environmental and social measures. “We expect to be carbon neutral in 2021,” says Sigurdsson. In addition to taking advantage of Iceland’s country-wide geothermal energy, the company is focusing on reducing emissions from business travel and freight as well as choosing safe, recyclable materials whenever possible. The company has made a commitment to gender equality, achieving an even gender split among employees, and aims to increase the number of women in management positions.

Accompanying that is an effort to encourage greater diversity and inclusiveness in the industry. Össur sponsors elite athletes through Team Össur, providing advanced devices and support to an international roster of competitors, who in turn provide valuable feedback to the R&D team. The Össur Ambassadors program represents a diverse group who present a public face of the company at trade shows, amputee clinics, and other community events, demonstrating how Össur innovations help them achieve their goals.

According to Sigurdsson, Össur’s R&D efforts have been ongoing throughout the pandemic, although the testing phase of some products has had to be postponed. Nevertheless, he hints at the release of “exciting new developments” in 2021.

Through it all, Sigurdsson credits the success and longevity of Össur to its close contact with its customers.

“That is our backbone. Working together, we are always striving to help even more people live life without limitations.”

AOPA NEWS

Welcome New AOPA Members

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

T

HE OFFICERS AND DIRECTORS of the

J

OIN AOPA EXPERTS FOR the most up-to-date information on specific topics

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

WEDNESDAY

FEB. 10

Know Your Audit: Understanding the Difference

RAC, SMRC, ZPIC, TPE, postpayment, prepayment— there are several types of audits and contractors out there. Learn the differences between them all, find out how each audit operates, and hear what to expect from each contractor.

UPCOMING WEBINAR

WEDNESDAY

MAR. 10

Inpatient Billing: Working With Your Care Partners

Hospitals, skilled nursing facilities (SNFs), hospices, and emergency rooms are a few examples of care partners you may be working with. When your patient is an inpatient, it can be confusing to understand whom to bill, and when to bill, in these situations. Join AOPA experts to review the ins and outs of O&P inpatient billing, including discussion of the two-day rule and SNF exemptions.

Kelsey Prosthetics & Orthotics LLC 6790 W. Layton Avenue Greenfield, WI 53220 414/282-3100 Patient-Care Facility Brian S. Kelsey, CPO

O&P Boost

15821 Black Hawk Avenue Bakersfield, CA 93314 664/855-1248 Supplier Level 1 Rick Riley

UPCOMING WEBINAR

Co-OP

Don’t Sleep on the Latest AOPA Member Resource

A

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.

RE YOU UTILIZING YOUR AOPA MEMBERSHIP? Attend

the upcoming live tutorial to learn about one of the best resources available for O&P practices, the AOPA Co-OP. A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. This searchable database provides up-to-date information on developments in Medicare policy, statespecific legislation, private-payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies.

Register for the next Co-OP Live Tutorial hosted by AOPA Director of Strategic Initiatives Ashlie White, who

Tutorial Webinars

Co-OP Live on Friday at Noon ET • February 5

• April 2

• June 4

• March 5

• May 14

• July 2

will demonstrate how to use the Co-OP and answer all of your questions. Any employee of an AOPA member firm is welcome to join this free tutorial.

Learn more at www.AOPAnet.org/resources/co-op.

O&P ALMANAC | JANUARY 2021

39

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/AOPAMedia2021 for advertising options.

ToeOFF® 2 ½ & BlueROCKER® 2 ½ Available Now offering more Allard AFOs with ½ the heel height.

All 2 ½ models include the 2.0 features you love: Choice of wraparound or D-ring straps, shorter wings, and a Starter SoftKIT™ included.

It is easier to adapt ToeOFF 2 ½ & BlueROCKER 2 ½ to shoes with lower heel heights because there is a lower forefoot curvature, there is more space in the shoe toe box.

ToeOFF 2 ½ Addition models available in camouflage, birch, and black for your fashion-conscious patients.

Call 888/678-6548 or email info@allardusa.com to receive your free Product Selection Guide.

ALPS Liberty Liner II Our Liberty Liner allows the expulsion of sweat and air via a built-in valve either through the pin or reducer. The one-way evacuation valve has been strategically placed distally to evacuate any air between the user’s skin and the liner.

This liner features a superior fit and can be used for pin-lock and suction suspension systems.

Our Liberty Liner is available in 6-mm uniform thickness and is available in High Density Gel only.

Call us or visit www.easyliner.com for more information.

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 www.wearesp.com.

40

JANUARY 2021 | O&P ALMANAC

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue.

For more information, call 800/301-8275 or visit www.hersco.com.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses. Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device.

For more information, visit www.npdevices.com.

The Xtern Foot Drop AFO

by Turbomed Orthotics Think outside the shoe! This one-of-akind orthosis (AFO) is a game changer for foot drop patients: The Xtern is totally affixed outside the shoe to maximize comfort, and prevent skin breakdown and rubbing injuries. Its flexibility promotes maximal ankle range of motion and calf muscle strength. The Xtern allows running, walking, and even mountain hiking as long and as far as you want without any restrictions, and moves from sandals to boots flawlessly.

Turbomed’s innovative products are designed in Quebec, Canada, sold in over 26 countries, and distributed by Cascade in the United States. Visit turbomedusa.com to get your life back!

MARKETPLACE Amparo Confidence TT Socket From Ottobock

Are you ready for a revolution in interim socket technology?

The Amparo socket is formed over a liner directly onto the user’s residual limb, which means a new socket can be made in one go. Benefits include: • One-visit fittings • Easy alignment with offset distal adapter • No plaster casting required • Re-moldable material for fast socket (re)shaping and adjustments • Mobile oven and toolset for anywhere, anytime socket adjustments • Valve or pin suspension options

RUSH ROGUE® The PDAC-approved RUSH ROGUE provides the most realistic and dynamic foot and ankle motion available. The Vertical Loading Pylon (VLP) provides vertical shock relief while offering +/- 8 degree torsion, allowing the user to push the foot and themselves to the limits. The RUSH ROGUE is made of our advanced fiberglass composite which is 3X more flexible than conventional prosthetic feet. The roll-through characteristics of the foot provide exceptional energy return with no “dead spot.” The RUSH ROGUE is also available in the EVAQ8 elevated vacuum and H2O models. #goROGUE

Spinal Technology Inc.

For more information, contact your sales representative or visit professionals.ottobockus.com.

WalkOn® Carbon Fiber AFOs WalkOn AFOs are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low-profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return.

The WalkOn family of AFOs offer a full range of AFO designs and sizes, including the WalkOn Reaction junior.

Fast and easy to fit, the WalkOn Trimable footplate can be shaped with scissors, often requiring only one office visit.

Contact us at 800/328-4058 or professionals.ottobockus.com for details.

Spinal Technology Inc. is a leading central fabricator of custom spinal and scoliosis orthoses. Our ABC-certified staff orthotists collaborate with our highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

Spinal Technology is the exclusive manufacturer of the Providence Nocturnal Scoliosis® System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoamTM spinal orthosis.

For information, contact 800/253-7868 or visit www.spinaltech.com.

O&P ALMANAC | JANUARY 2021

41

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

WANTED! A few good businesses for sale.

Job Location Key: - Northeast

Lloyds Capital Inc. has sold over 150 practices in the last 26 years.

- Mid-Atlantic - Southeast - North Central

If you want to sell your business or just need to know its worth, please contact me in confidence.

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge.

Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com

Refer to www.AOPAnet.org for content deadlines. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org.

No orders or cancellations are taken by phone. Send classified ad and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email 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.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member $140 $190 $260 $2.25 per word

Nonmember $280 $380 $520 $5 per word

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org.

Job Board 50 or less

Member $85

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.

Connecting highly qualified O&P talent with career opportunities EMPLOYEE

• Research who is hiring • Apply online for job openings • Free résumé review

Nonmember $280

For more opportunities, visit: http://jobs.AOPAnet.org.

SUBSCRIBE

AOPA’s O&P Career Center

EMPLOYER

• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.

LOG ON TODAY! https://jobs.AOPAnet.org 42

JANUARY 2021 | O&P ALMANAC

Driven by Evidence, We Empower Human Potential.

Conducting meaningful clinical research is critical to providing effective patient care and informing clinical decisions. At Hanger Clinic, we recognize the power of outcomes-based data and the impact it can have on patient care.

Our commitment to the collection of outcomes data and the work conducted and published by our researchers and clinicians provides invaluable insight that empowers our broader clinical team to make informed, evidence-based decisions, and ultimately deliver effective patient care to each individual who requires O&P services.

J O I N O UR CLINICAL T EAM TODAY!

Hanger.com/Careers

AOPA NEWS

CAREERS

Pacific Assistant Teaching Professor (Division of Prosthetics and Orthotics)—Rehabilitation Medicine Seattle, WA

The University of Washington’s Department of Rehabilitation

of the instructional environment. We are committed to

Medicine, Division of Prosthetics and Orthotics (P&O),

facilitating the growth of our students into practitioners

invites faculty candidates to apply for a full-time faculty

with strong communication skills who will work to enhance

position at the level of Assistant Teaching Professor. This

participation in life activities for persons with limb absence

position is on a 12-month service period, with an anticipated

or neuromuscular and musculoskeletal conditions.

start date of Autumn, 2021. Successful candidates must

The ideal candidate will have a professionally rec-

have a commitment to quality practice in orthotics and

ognized degree at the Bachelors or Masters level (or

prosthetics. We encourage applicants with expertise and/or

foreign equivalent) from an accredited institution in

interest in one or more of these areas: lower-limb orthotics,

prosthetics and orthotics, education, or master of science,

pediatric prosthetics and orthotics, and spinal orthotics.

and clinical certification through the American Board

The candidate selected for this position will be expected to

for Certification in Orthotics and Prosthetics. Clinical

develop and teach clinical orthotic courses for students with

experience in orthotics and/or prosthetics of at least

diverse experiences and perspectives, collaborate with other

three years is a minimum requirement. Candidates must

Division faculty members to develop and grow our estab-

be eligible for licensure in Washington state as a pros-

lished P&O curriculum, participate in scholarly activities

thetist/orthotist (CPO). Dual certification in prosthetics

independently or in collaboration with our broad interdis-

and orthotics is a positive factor for consideration.

ciplinary Department and University faculty, and engage

Application review will begin immediately and

in service to the University of Washington and the P&O

continue until the position is filled. Interested can-

profession at large. In addition, they will assist with recruiting

didates should submit a responsive cover letter, a

students, selecting candidates for our program, advising

CV, and names and addresses of four references.

and mentoring students in our Masters of Prosthetics &

Apply at http://apply.interfolio.com/79952.

Orthotics (MPO) program, promoting diversity, equality and

If you have questions regarding the position, please feel

inclusion among our students and faculty, and preparing

free to contact Ellen McGough, PT, PhD, Search Committee

our students to provide quality and ethical patient care.

Chair, by email at emcg@uw.edu.

The University of Washington Prosthetics and Orthotics (P&O) Program is a well-established two-year MPO program dedicated to student diversity and success, and to fostering

Website: http://apply.interfolio.com/79952 Email: emcg@uw.edu

the interchange of ideas and different viewpoints in all areas

www.bocusa.org

2020 MONTHLY WEBINARS

TOP QUALITY

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

Start earning your credits today!

44

JANUARY 2021 | O&P ALMANAC

Visit www.MyAOPAConnection.org.

CAREERS

Career Opportunities...

California

CO-Modesto CPO-Salinas Oregon CPO –Portland

Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.

The positions we offer are created for candidates that are looking to create opportunity, self-driven, motivated, and enjoy serving and helping others.

To apply, submit resume to: careers@pacmedical.com

A competitive salary, benefits and profit sharing are offered based on position/experience.

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

AD INDEX

Advertisers Index Company

Page Phone

Website

Allard USA

3

866/678-6548

www.allardusa.com

ALPS South LLC

13

800/574-5426

www.easyliner.com

Amfit

21 800/356-3668

www.amfit.com

Cailor Fleming Insurance

9

800/796-8495

www.cailorfleming.com

ESP LLC

5

888/WEAR-ESP

www.wearesp.com

Flo-Tech O&P Systems Inc.

30

800/356-8324

www.1800flo-tech.com

Hanger Clinic

43

877/442-6437

www.hangerclinic.com

Hersco

1 800/301-8275 888/977-6693

www.hersco.com

Naked Prosthetics

25

Ottobock

C4 800/328-4058

www.npdevices.com www.professionals.ottobockus.com

PROTEOR USA

29 855/450-7300

www.proteorusa.com

Spinal Technology Inc.

7

800/253-7868

www.spinaltech.com

TurboMed Orthotics

15

888/778-8726

www.turbomedorthotics.com

O&P ALMANAC | JANUARY 2021

45

CALENDAR

2021

March 5 WEBINAR

February 1

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

February 1

ISPO 18th World Congress Deadline for Symposia and Instructional Courses. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

February 1–6

ABC: Written and Simulation Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 350 locations nationwide. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

February 5 WEBINAR

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

March 10

Inpatient Billing: Working With Your Care Partners. 1 PM ET. For more information, visit www.AOPAnet.org.

WEBINAR

March 29

ISPO 18th World Congress Deadline for Free Papers. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

April 2 WEBINAR

March 1

ABC: Application Deadline for Spring CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ ABCop.org, or visit ABCop.org/individual-certification.

WEBINAR

47th Academy Annual Meeting & Scientific Symposium. Hyatt Regency, New Orleans. For more information, visit www.oandp.org/page/annual_meeting.

May 12 WEBINAR

JANUARY 2021 | O&P ALMANAC

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

May 12–14

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

May 14 WEBINAR

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

June 4 WEBINAR

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

June 9 WEBINAR

46

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

May 4–7

March 1

ABC: Practitioner Residency Completion Deadline for April Written & Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

April 14

February 10

Know Your Audit: Understanding WEBINAR the Difference. 1 PM ET. For more information, visit www.AOPAnet.org.

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

CALENDAR

July 2 WEBINAR

December 8

Co-OP Tutorial. Noon ET. For more information, visit www.AOPAnet.org.

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

WEBINAR

July 14 WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

2022

August 11 WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

January 9–11

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

September TBD WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

January 30–February 3

Hanger Live. Dallas, TX.

September 9–12

March 2–5

AOPA National Assembly. Boston. For more information, visit www.AOPAnet.org.

AAOP. Atlanta, GA. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.

October 13 WEBINAR

May 12–14

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

NYSAAOP. Schenectady, NY.

May 20–21

November 1–4

Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis, MN. For more information, go to http://cecpo.com/documents/OrthoAndProstheticTech_2022_1up.pdf.

ISPO 18th World Congress. Expo Guadalajara Convention & Exhibition Centre in Guadalajara, Mexico. For more information, contact the ISPO World Congress team at info@ispo-congress.com or call +49/341-678-8237.

September 29–October 1

November 10 WEBINAR

AOPA Monthly Webinar. 1 PM ET. For more information, visit www.AOPAnet.org.

Calendar Rates

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

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or email 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.

Words/Rate 25 or less 26-50 51+

Member Nonmember $40 $50 $50 $60 $2.25/word $5.00/word

Color Ad Special 1/4 page Ad 1/2 page Ad

$482 $634

$678 $830

For information on continuing education credits, contact the sponsor.

Questions? Email info@AOPAnet.org.

O&P ALMANAC | JANUARY 2021

47

STATE BY STATE

New Year, New Advocacy Initiatives Updates from Kentucky, Massachusetts, New York, Ohio, and Texas

Kentucky

Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more.

O&P providers are working with Kentucky Medicaid to reevaluate the pricing model for cranial remolding orthoses. Currently, S1040 is manually priced. The “cost-plus” methodology used by Medicaid in the state does not adequately account for the time required from an orthotist to provide the appropriate and necessary care associated with orthotic intervention.

Massachusetts

Request for Information

AOPA is seeking information from its members on current efforts to address health disparities and inequities in O&P patient populations across the country.

If you are working to develop any initiatives or are aware of initiatives in your state, AOPA would like to hear about them. Please send information to AOPA’s Ashlie White, MA, at awhite@AOPAnet.org.

48

JANUARY 2021 | O&P ALMANAC

A bill that would establish a Durable Medical Equipment Board in Massachusetts, introduced previously in the 2020 legislative session, is expected to be reintroduced in the 2021 legislative session. The Massachusetts Society of Orthotists and Prosthetists is currently working to review options regarding this legislation and necessary actions to protect O&P providers in the state. For more information and a copy of the bill, visit the AOPA Co-OP.

New York

Providers in New York continue to push for a Medicaid fee schedule increase in the state. In addition to ongoing fundraising efforts, the New York State Chapter of AAOP is working with patient advocacy organizations to produce a sign-on letter that speaks to the importance of access to O&P devices for vulnerable patient populations in the state. To learn more about this effort, contact Ted Drygas, CPO, FAAOP, at ted@carecrafters.com.

Ohio

The Occupational Therapy, Physical Therapy, and Athletic Trainers Board is now accepting applications for the authority to conduct 3D printing of open-source prosthetic kits. According to Ohio law, those wishing to 3D print open-source prostheses must obtain authority from the board. Applicants may review final rule language and apply online at http://elicense.ohio.gov. An application checklist also is available on the site.

Texas

On Nov. 23, 2020, the Texas Commission of Licensing and Regulation passed an emergency rule related to the COVID-19 pandemic.

Under this rule, all Texas Department of Licensing and Regulation licensees with a renewable license that expired between Aug. 1 and Nov. 30, 2020, are considered to hold an emergency license valid for up to 120 days after their license expiration date.

These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/resources/co-op.

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

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.

COMING TO BOSTON 2021

2021 EXCELLENCE in EDUCATION Prosthetic

Orthotic

We ARE AOPA

Pedorthic

Technical

Business

Mark your calendars for September 9-12, 2021, for an ideal combination of top-notch education and entertainment

ADVOCACY | RESEARCH | EDUCATION

at the 104th AOPA National Assembly in Boston, MA.

#AOPA2021

We look forward to seeing you!

Leonard P. Zakim Bunker Hill Memorial Bridge in Boston

FOLLOW US @AmericanOandP

www.AOPAnet.org

C-Leg 4 ÂŽ

12/20 Š2020 Ottobock HealthCare, LP, All rights reserved.

Studied, proven, preferred.

Your patients trust you to deliver the best care.

You committed to their quality of life when you trusted C-Leg 4. As the original MPK, C-Leg redefined the standard of care for above knee amputees. Since its release in 1999, the microprocessor technology of the C-Leg has continuously raised the bar for an industry that demands innovation to achieve one primary goal: give amputees the mobility they deserve.

professionals.ottobockus.com