The Magazine for the Orthotics & Prosthetics Profession
S E P T E M B E R 2021
Tips for Successful Prior Authorization P.16
Exclusive Interviews With the 2021 Thranhardt Award Winners P.32
NEW AND ENHANCED PROGRAMS FOR MSOP STUDENTS, CARE-EXTENDER TRAINING EVOLVES P.22
Studying Balance and Injuries Among Limb Loss Patients P.38
EARN 2 BU SI NE SS CE CREDITS
This Just In: 2021 AOPA National Assembly: Highlights From Boston P.20
YOUR CONNECTION TO
THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS.
o i n o t n San A SEPTEMBER 28-OCTOBER 1
rs a d n e l a Your C
Join us September 28-October 1, 2022, for
We ARE AOPA
ADVOCACY | RESEARCH | EDUCATION
FOLLOW US @AmericanOandP
an ideal combination of top-notch education and entertainment at the 105th AOPA National Assembly in San Antonio, TX.
MAKING YOUR FOOTPRINT SMALLER
CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES
At Hersco, our first priority is to fabricate custom orthotics accurately and precisely. We have mastered the art of accepting scans and 3D printing to deliver better orthotics for your patients and the environment. 3D printing is not only environmentally friendly, but allows us to specify modifications that were not possible before.
BUILT ON TRUST.
SEPTEMBER 2021 | VOL. 70, NO. 8
DEPARTMENTS | COLUMNS
As O&P facilities consider the next generation of O&P clinicians and care extenders, it’s important to know that several new and revamped educational programs may play key roles. From the debut of a master’s program at Kennesaw State University, to a new hybrid MSOP option at Loma Linda University, to new standards impacting pedorthic and O&P assistant training, O&P education is rapidly evolving. By Christine Umbrell
Views From AOPA Leadership......... 4 Supporting young professionals
AOPA Contacts............................................6 How to reach staff
At-a-glance statistics and data
Research, updates, and industry news
People & Places........................................ 14
Transitions in the profession
PHOTO: Courtesy of Researchers, MIT
22 | Education Upgrades
20 | THIS JUST IN Reunited in Boston
Reimbursement Page.......................... 16
Hundreds of O&P stakeholders traveled to Boston for the 2021 AOPA National Assembly. See highlights from the September 9-11 event, where participants immersed themselves in educational sessions, networking opportunities, and the exhibit hall—all in person.
Simply the Best
The 2021 Thranhardt presentations offer cutting-edge O&P research in two important areas: the benefits of microprocessor-controlled prosthetic knees for limited community ambulators, and treatment parameters for a pectus carinatum orthosis developed by UCSF researchers. Read a Q&A with the award recipients. By Josephine Rossi
Don’t Be Denied
Five common reasons for nonaffirmative responses from the DME MACs Opportunity to earn up to two CE credits by taking the online quiz.
Member Spotlight.................................42 n n
Allard USA Skyland Prosthetics & Orthotics
AOPA advocacy, announcements, member benefits, and more
Welcome New Members................... 47 O&P PAC...................................................... 47
PRINCIPAL INVESTIGATOR Christopher Kevin Wong, PhD, PT........ 38 Meet a physical therapist who has published several significant studies that impact the O&P patient population, including investigations into balance, phantom limb pain, and more.
Marketplace............................................. 48 Careers......................................................... 52
Upcoming meetings and events
Ad Index....................................................... 55 State By State........................................... 56
Colorado, New York, Oklahoma, and Utah 2
SEPTEMBER 2021 | O&P ALMANAC
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VIEWS FROM AOPA LEADERSHIP
Support the Next Generation of O&P
learn, passionate about outcomes, and curious about new technology. Professors are ensuring these students have the experience and tools they need to succeed. Yet, we all have a vested interest in the future of our profession—and one way we can ensure its continued success is to invest in the next generation of practitioners. So, how can you invest in the next generation of O&P professionals? Education: A lot of us provide education to our employees, referral sources, and the profession at large; why not open that up to students? If you have the bandwidth, reach out to the O&P schools to offer your assistance and support. Over the past eight years, I have supported clinical educational programs at each of the O&P master’s and technician programs through my work. Whether it is through in-person or virtual clinical training, sharing clinical content/outcomes, or loaning or donating product samples so that students are working with the latest technology, each of us can give back in our own way. Mentoring: A less formal but equally effective option is to mentor an O&P student or resident. Although this process typically starts when they are early in their career, it can span the duration of your and their career. The “how” and “what” of mentoring are up to you and the individual being mentored, so this option provides a great deal of flexibility. Providing insights and guidance in the one-on-one relationship is not only beneficial for the mentees, but for the mentors as well.
Residency Programs: Another way to train individuals to serve the needs of patients is to do it in a real-world setting. The opportunity to apply lessons taught in a classroom and collaborate as a member of the healthcare team is an extremely meaningful experience and helps set up young professionals—and the profession— for success. If you haven’t already, I encourage you to connect with the National Commission on Orthotic and Prosthetic Education (NCOPE) and see how your facility can become a residency site. AOPA’s Investment: At AOPA, we also are supporting the next generation of O&P practitioners. NCOPE O&P programs and schools are members of AOPA, making them eligible to access benefits like the Co-OP and My OP Community. We also provide students major discounts on the AOPA National Assembly. In partnership with NCOPE, we host O&P students from around the country at the AOPA Policy Forum to help them gain knowledge around the policymaking process and O&P legislative and regulatory issues. Our Career Center allows students and young professionals to post their résumés and peruse job openings. Finally, we run the Student-Resident Poster Award, which honors two scientific papers submitted for poster presentation at the AOPA National Assembly. As another school year gets under way, think about how you can give back to the profession; take action to support the next generation of practitioners through residency programs, mentoring, or education; or get involved with AOPA and help us build out our offerings to students. Traci Dralle, CFm, is president of AOPA.
We ARE AOPA
ADVOCACY | RESEARCH | EDUCATION 4
Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.
CHOOL IS BACK! O&P students are starting their first day of classes excited to
SEPTEMBER 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 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
OUR FULL LINE O F VA LV ES . NOW AVAILABLE IN MIDNIGHT BLACK.
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
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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
MEETINGS & EDUCATION
Eve Lee, MBA, CAE, executive director, 571/431-0807, elee@AOPAnet.org
Tina Carlson, CMP, senior director, 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 MEMBERSHIP & COMMUNICATIONS Joy Burwell, director of communications and membership, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, senior manager of member services, 571/431-0810, bleppin@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 REIMBURSEMENT SERVICES Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org 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
SEPTEMBER 2021 | O&P ALMANAC
Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org HEALTH POLICY & STRATEGIC ALLIANCES Ashlie White, MA, director of health policy and strategic alliances, 571/431-0812, awhite@AOPAnet.org Sam Miller, manager, state and federal advocacy, 571/431-0814, smiller@AOPAnet.org O&P ALMANAC Eve Lee, MBA, CAE, executive director/ publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, email@example.com Catherine Marinoff, art director, 786/252-1667, firstname.lastname@example.org Bob Heiman, director of sales, 856/520-9632 , email@example.com Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, firstname.lastname@example.org
Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/December, by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email email@example.com. 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.
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Stellar Performances From Team USA’s Women For the first time in Paralympic history, more women than men competed for Team USA.
TEAM USA ATHLETES WHO COMPETED IN TOKYO
TEAM USA RESULTS
Number of sports with Team USA representation
Medals won in para swimming, including 15 Gold
Medals won in para athletics, including 10 Gold
Of Team USA’s medals were won by women
Medals won by swimmer Jessica Long in Tokyo, for a total of 29 Paralympic medals
Gold medals won by Oksana Masters in Tokyo, for a total of 10 Paralympic medals as a multiseason athlete
Of Team USA’s Gold medals were won by women
TEAM USA DEMOGRAPHICS
Medals won in para cycling, including 3 Gold
MEDALS WON BY TEAM USA IN TOKYO Team USA came home with 104 total medals, finishing behind China and Great Britain.
States represented by Team USA, including 25 athletes from California
Athletes self-identified as military, including three active-duty
Athletes competed in track and field, the largest U.S. delegation
COMING UP NEXT:
2022 Winter Paralympic Games
37 Gold medals
SEPTEMBER 2021 | O&P ALMANAC
36 Silver medals
31 Bronze medals
SOURCES: teamusa.org, NBC Sports.
March 4-13, 2022 Beijing, China
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Happenings RESEARCH ROUNDUP
Researchers Develop Lightweight Inflatable Neuroprosthetic Hand
An MIT-developed inflatable robotic hand gives amputees real-time tactile control. The low-cost smart hand is soft and elastic, and weighs about half a pound.
mechanical engineering and of civil and environmental engineering at MIT. “There’s huge potential to make this soft prosthetic very low cost, for low-income families who have suffered from amputation.” Details were published in the August issue of Nature Biomedical Engineering.
PHOTO: Courtesy of Researchers, MIT
A research team from Massachusetts Institute of Technology (MIT) and China’s Shanghai Jiao Tong University has developed a soft, lightweight neuroprosthetic hand that features simultaneous myoelectric control and tactile feedback. The prosthesis offers six active degrees of freedom. It consists of five fingers and a palm, four electromyography sensors, and five hydrogel-elastomer capacitive sensors on the fingertips that measure touch pressure and elicit electrical stimulation on the skin of the residual limb. Study participants were able to complete tasks with speed and dexterity using the lightweight and low-cost prosthesis, according to researchers. Study subjects successfully performed a series of daily activities, including zipping a suitcase, pouring a carton of juice, and petting a cat, just as well as or better than those with more rigid neuroprosthetic devices. “This is not a product yet, but the performance is already similar or superior to existing neuroprosthetics, which we’re excited about,” said Xuanhe Zhao, professor of
New Upper-Limb Test Helps Predict Mobility Problems in Seniors
SEPTEMBER 2021 | O&P ALMANAC
did on all three mobility tests. Seniors with poorer performance on the upper-limb test also had poorer performance in tests involving the lower limbs. According to the researchers, the upper-extremity frailty index will make it easier to predict frailty in a wide variety of patients, including patients with pre-existing mobility impairments. The results also suggest an association between upper- and lower-limb functioning, according to the researchers. “The development and increasing use of technology in key aspects of our lives represents a creative opportunity to address unmet clinical needs,” said study corresponding author Bijan Najafi, PhD, a professor in the Department of Surgery and the Huffington Center on Aging at Baylor College of Medicine. The study was published in April in Gerontology.
PHOTO: Getty Images
Researchers at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine have found that a wrist-worn sensor can be used to test and assess frailty and mobility in surgery patients. The test may be used to predict the risk of surgery in patients with mobility limitations. Patients in the study were asked to wear an inertia sensor, such as a smartwatch, on their wrist. While seated, they were asked to flex and extend the elbow as quickly as possible in 20 seconds. The researchers measured how 100 patients, ages 65 and older, performed on the elbow test, then compared results to three common measures of functional mobility and frailty: gait speed, the Timed-Up-and-Go test, and the Five Times Sit-to-Stand Test. The test was used to assess weakness, slowness, range of motion, and exhaustion. The elbow test accurately predicted how well participants
O&P Companies Partner To Study MPK Use Among K2 Patients
PHOTO: Hanger Inc.
Hanger Inc. and Ottobock are collaborating to conduct a fiveyear clinical study to collect data around the potential health benefits of microprocessorcontrolled knee (MPK) technologies among individuals ages 65 and older. This collaboration seeks to establish evidence that could expand and support new coverage policies, offering greater access to seniors with aboveknee limb loss, according A Hanger clinician works with a study participant. to the companies. The Hanger Institute population of seniors with lower-limb for Clinical Research and Education amputations,” said James Campbell, and Ottobock are partnering with PhD, chief clinical officer of the Hanger Hanger Clinic prosthetists to conduct Institute for Clinical Research and the prospective randomized trial, called Education. “This important research ASCENT K2 (ASsessing outComes is designed to help ensure people with microprocEssor kNee uTilization living with limb loss have coverage in a K2 population). The research team for medically necessary and clinically will measure the short- and long-term appropriate technology, which will, effects of MPK use in K2-level commuin turn, enable them to participate nity ambulators, and will study specific more fully in their communities and data points, including health-related enjoy a higher quality of life.” quality of life, participation in society and “Ottobock has been working on the activities, fall rates, and fear of falling. generation of scientific evidence for the The study began enrolling test benefits of MPK in K2 patients for 15 subjects in July, with a goal of enrolling years now, with several clinical studies 100 Hanger Clinic patients by March conducted at academic research centers 2022. Half the patients will be ranwith only limited access to this patient domized into a group fit with an MPK, population,” said Andreas Hahn, MSc, and the other half will form a control PhD, VP clinical research and services, group using mechanical, non-MPK Otto Bock Healthcare Products GmbH, knees. Participants will be assessed Vienna (Austria). “We are very pleased periodically throughout their first 12 that our partnership with Hanger Clinic enables our two companies now to run months in the study, with initial analthe biggest interventional study yet in yses published at the one-year mark, the real-life environment of prosthetic and then annually for five years. clinics that should eventually compel “We are delighted to leverage the healthcare payor community our collaborative research capabilof the benefits that MPK deliver to ities and clinical expertise to gather limited community ambulators.” much-needed data about the growing
O&P Facilities Embrace Central Fabrication
Four out of five O&P facilities (80.5 percent) use outside central fabrication (c-fab) services. Of the total custom-fabricated work produced, 29 percent was outsourced to an outside c-fab in 2019.
—“2020 AOPA Operating Performance Report”
O&P ALMANAC | SEPTEMBER 2021
MIT Team Develops Magnetomicrometry To Increase Control of Prostheses Magnetomicrometry, a new method of controlling prosthetic limbs, may offer more precise control than current approaches, according to researchers at Massachusetts Institute of Technology’s (MIT’s) Media Lab. An alternative to electromyography (EMG), the system leverages small magnetic beads to rapidly measure the position of muscles and relay that information to a bionic prosthesis. Whereas EMG control offers an “intermediate signal”— meaning what you’re seeing is the brain telling the muscle what to do, but not what the muscle is actually doing—magnetomicrometry is based on the idea that magnets inserted
Study Identifies Racial and Rural Disparities in Minor Lower-Limb Amputation Rates The rates of minor lower-extremity amputations (at the level of the ankle joint or below) increased across all racial/ ethnic, rural/urban, and census region categories between 2009 and 2017, according to researchers at the Texas A&M University School of Public Health, who recently completed a study of racial, rural, and regional disparities in diabetes-related lower-extremity amputation rates. Using the National Inpatient Sample to identify trends among those primarily hospitalized for diabetes, the research team conducted multivariable logistic regressions to identify individuals at risk for lower-limb amputation based on race/ ethnicity, census region location, and rurality of residence. The increase in minor lower-extremity amputations 12
SEPTEMBER 2021 | O&P ALMANAC
was driven by Native Americans, with an annual percent change of 7.1 percent, and Asians/Pacific Islanders, with an annual percent change of 7.8 percent, according to the researchers. Regression findings showed that Native Americans and Hispanic individuals were more likely to have a minor or major lower-extremity amputation, compared with white individuals. The odds of a lower-extremity amputation increased with rurality, and was higher among residents of the South than among those of the Northeast. The researchers also noted a steep decline in majorto-minor amputation rates, especially among Native Americans. The full study was published in the August issue of Diabetes Care.
PHOTO: Courtesy of researchers, MIT
Researchers at MIT’s Media Lab have developed a new strategy that could offer more precise control of prosthetic limbs.
into muscles could measure how the magnets moved relative to one another, according to the researchers. That information can be leveraged to calculate how much the muscles are contracting and the speed of contraction. MIT researchers Hugh Herr, PhD, and Cameron Taylor, PhD, developed an algorithm that reduces the amount of time needed for sensors to determine the positions of the small magnets, reducing lag time. In a paper published in Science Robotics in August, the researchers tested the algorithm’s ability to track magnets inserted in the calf muscles of turkeys, placed a minimum of 3 centimeters apart. They were able to determine the position of the magnets with a precision of 37 microns within 3 milliseconds. The researchers believe these types of measurements could be leveraged to predict where a patient’s phantom limb would be, and use the information to direct a prosthesis to move the way a patient wants it to move. “With magnetomicrometry, we’re directly measuring the length and speed of the muscle,” Herr said. “Through mathematical modeling of the entire limb, we can compute target positions and speeds of the prosthetic joints to be controlled, and then a simple robotic controller can control those joints.” The MIT researchers plan to test the approach in individuals with lower-limb amputation within the next few years. “Our hope is that [magnetomicrometry] will replace electromyography as the dominant way to link the peripheral nervous system to bionic limbs,” said Herr. “And we have that hope because of the high signal quality that we get from [the approach], and the fact that it’s minimally invasive and has a low regulatory hurdle and cost.”
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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS
The Hanger Foundation has announced the 2021 recipients of the inaugural Hanger Foundation Diversity Scholarships. Six graduate students from three universities were each awarded a two-year scholarship to help supplement the cost of their Master of Science in Prosthetics and Orthotics (MSPO) programs. In addition to receiving the scholarship, all recipients will be offered a two-year mentorship, with the option of pursuing a residency at Hanger Clinic. The following individuals were awarded scholarships: • Taushima “Shima” Nixon, Alabama State University • Kayla Tillman, Alabama State University • Felicia Farrar, Northwestern University • Althea Fordyce, Northwestern University • Juan Argueta, University of Hartford • Isabella “Noelle” Medina, University of Hartford “It is an honor to align with the Hanger Foundation on the important work of increasing access to the MSPO degree, with the ultimate goal of ensuring O&P clinicians better represent the patient populations they serve,” said Hanger President and CEO Vinit Asar. “We are proud of these six outstanding individuals, who are the future of our profession, and look forward to having their unique perspective and talents within the O&P industry as we help build a more inclusive profession to better serve all.”
BUSINESSES ANNOUNCEMENTS AND TRANSITIONS
The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has awarded the Orthotic and Prosthetic Activities Foundation (OPAF & The First Clinics) a $40,000 grant for website modernization and content development projects. As part of this award, OPAF will modernize its website and web-based systems to increase functionality, presentation, donor management, and data tracking software. “We plan to completely overhaul our web-based systems to allow us to ease the financial burden of hosting a First Clinic. This award will allow us to develop a new donor management system that allows donors to create an integrated giving account, manage and track their donations, and produce itemized yearly giving statements on the OPAF First Clinics website,” said OPAF President Travis Young, CPO. “In addition, this funding will allow us to develop new educational content and exceptional professional video and photography for First Clinics that will be helpful to both patients and allied health professionals.” 14
SEPTEMBER 2021 | O&P ALMANAC
“ABC is pleased to be able to support OPAF in this important step to improve the experience of First Clinics, not only for attendees but those dedicated practitioners and practices that support this important work,” said ABC Executive Director Cathy Carter. Cailor Fleming Insurance and VGM Specialty Underwriters have announced the formation of an exclusive partnership aimed at meeting the needs of AOPA members and the orthotic, prosthetic, and pedorthic professions. “VGM Specialty Underwriters has extensive O&P risk management and underwriting expertise, along with decades of industry knowledge,” said Trent Cailor, president, Cailor Fleming Insurance. “I’m excited for these two organizations to come together to continue to build on the exceptional services we offer to the O&P profession.” “Creating this partnership allows us to serve O&P providers in an even greater capacity,” said Don Foley, owner/operator, Cailor Fleming Insurance. “We’ve developed tailored products and coverage options for the unique needs of O&P businesses to help them thrive now and into the future.” “Both of our organizations have positioned ourselves as industry leaders,” said Bill Wilson, senior vice president for VGM Insurance Services. “Together, we are the leading insurance program and the largest underwriter of O&P in the nation.”
THE LIGHTER SIDE ”Caption the Cartoon” Contest September 2021 Winner Congratulations to Tanya Baer, CFo, CFm, from Sierra Prosthetics-Orthotics for winning the second round of Caption the Cartoon. To learn more or to submit your caption entry, go to My OP Community.
“Bob began to wonder when the ‘paperless’ came into effect with the new paperless system…”
BALDWIN BELT (shown on model)
By DEVON BERNARD
Don’t Be Denied
E! QU IZ M EARN
Five reasons why providers receive nonaffirmative prior authorization responses
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 19 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
N DECEMBER 2020, the Durable
Medical Equipment Medicare Administrative Contractors (DME MACs) implemented Medicare prior authorization nationwide as a condition of claim payment for six lower-limb prosthesis Healthcare Common Procedure Coding System (HCPCS) codes: L5856, L5857, L5858, L5973, L5980, and L5987. So far, the Medicare prior authorization program has proven to be effective and efficient, with an average processing time of four business days for initial submissions, instead of the 10 days allowed under the regulations. While the program is mostly successful, some providers are still receiving denials on their prior authorization claims. This month’s Reimbursement Page examines five common reasons for a nonaffirmative response from the DME MACs.
1. The Order Was Missing or Incomplete
A “missing or incomplete” notification means that the submitted prior authorization request was missing a standard written order (SWO) or the SWO 16
SEPTEMBER 2021 | O&P ALMANAC
was not provided—or that the SWO submitted did not contain all of the required elements. Remember that as of Jan. 1, 2020, Medicare claims will only require a SWO; an initial or dispensing order is no longer required to be on file. Typically, an SWO must be received prior to claim submission; however, the prior authorization process now requires you to have one on file earlier in the process, when you submit the request. Be sure you obtain the SWO before you submit a prior authorization request, and include it with your required documents. The SWO contains essentially the same elements as the former detailed written order (DWO) that was part of the longstanding Medicare requirements for compliant claims prior to Jan. 1, 2020. According to the Local Coverage Article/Standard Documentation Requirements for All Claims Submitted to DME MACs, the following items
are required elements for the SWO: • Beneficiary name or Medicare Beneficiary Identifier • Order date • General description of the item (HCPCS code, HCPCS code descriptor, brand name, model number, etc.) • Quantity to be dispensed, if applicable • Treating/ordering practitioner’s name or National Provider Identifier • Treating/ordering practitioner’s signature. All separately billed supplies and features should be included and listed on your SWO. Review your SWO either prior to being signed by your referral sources or before you submit the SWO as your prior authorization request, and check that it includes all of the elements listed above.
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2. Medical Record Documentation Is Not Authenticated
When claims are denied due to medical records not being authenticated, it is likely because the documentation provided was not signed, the signature was illegible, or the entry was not dated. Medicare requires that anyone ordering or documenting the medical necessity for items/services is identifiable; each provider/supplier must sign each entry in the patient’s medical record. This applies not only to your referral sources but to your own documentation as well. When reviewing your records for a prior authorization request, if you realize a document is missing a signature or the signature has been deemed illegible or invalid, there are two common and acceptable ways you may authenticate the signature and/or the medical record entry. First, you may use a signature log. The signature log should include the printed name of the physician, provider, or supplier and the full signature and/ or the initials as they would appear on a signed document. Although it is not “required” to include the physician’s or provider’s credentials with your signature log, the DME MACs and Medicare do encourage this practice. Second, you may choose to use an attestation statement—a statement that allows an individual to attest to the authenticity of their signature and/ or the information in the record. For an attestation to be valid, it must be signed and dated by the person who made the original entry or who originally signed the document in question, and it must contain enough information to clearly identify the patient.
3. Item Billed Was Not Reviewed and Verified by the PDAC
Effective for claims with dates of service on or after Jan. 1, 2021, products described by the six codes subject to prior authorization must be verified for correct coding by the Pricing, Data Analysis, and Coding (PDAC) contractor. There was a brief time 18
SEPTEMBER 2021 | O&P ALMANAC
when the DME MACs were not issuing preliminary affirmation decisions without suppliers indicating the specific brand of prosthetic foot or knee they intended to deliver to the Medicare beneficiary. In other words, the DME MACS were requiring product selection information to be included with all prior authorization submissions, even if the supplier had not yet determined the exact knee and/or foot they planned to deliver and provide to the patient. After some reconsideration, the
Integrity Manual, apply to entries you have made to the medical record as well as those entries made by your referral sources and other providers. The same principles also apply to any entry that was not immediately entered into the medical record. First, all amendments, corrections, or delayed entries must be clearly identified so that individuals who review the record are able to easily identify anything that was amended and not part of the original medical record entry.
DME MACs are no longer requiring product information to be included with prior authorization requests. As a result of this change, you should not be receiving nonaffirmative responses as a result of PDAC verification or lack thereof. However, you are still required to provide a PDAC-verified item when it comes time to delivery and billing and to keep documentation that you provided a PDAC-verified item, if it is requested.
Second, all amendments, corrections, or delayed entries must indicate the date the correction or amendment was made, as well as who made it. This all goes back to ensuring that all medical record entries are authenticated. With the amendments, it may not be required to have a full signature (initials may be used); however, the initials must match the first and last name of someone already documented in the medical records; the initials must be tied to an existing person who has made an entry. Not including the signature/ initials and date is one of the most common reasons amendments are not accepted or considered valid. Finally, all original content must be identified; if changes are made, the original entry must not be deleted or removed from the record.
4. Amendments/Corrections Didn’t Comply With Accepted Recordkeeping Principles
Amendments and corrections to the medical record are acceptable, but you must follow certain guidelines. These guidelines and recordkeeping principles, which can be found in Chapter 3, Section 188.8.131.52, of the Medicare Program
5. Documentation Didn’t Demonstrate Current/ Expected Functional Levels
The last reason for a nonaffirmative prior authorization—while common—is probably the hardest to correct or address, and is one of the oldest denial reasons in audits: documentation. This issue is the hardest to control because it may have resulted from the actions of your referral sources. The bright side is that the documentation issue in question is rather specific: The documentation being provided for prior authorization does not demonstrate the beneficiary’s current functional levels, or their potential/ expected functional levels. The Lower-Limb Prostheses Policy is clear that functional ability is determined by, but not limited to, the following factors: the beneficiary’s past history (including prior prosthetic use if applicable); the beneficiary’s current condition, including the status of the residual limb and the nature of other medical problems; and the beneficiary’s
desire to ambulate. To avoid a nonaffirmative response, be sure these three items are addressed and documented in the medical record; this may be accomplished by you and the treating physician. Since the six lower-limb prosthesis HCPCS codes are associated with a K3 functional level, make sure your documentation supports this level. The medical record should demonstrate that the beneficiary “has the ability to traverse most environmental barriers” and “has a vocational/therapeutic/exercise activity that demands prosthetic utilization beyond simple locomotion.” Finally, if you are documenting the beneficiary’s current functional level and providing prostheses based on the beneficiary’s expected functional level, be sure you include an explanation for the difference. If you don’t provide this information, your request will likely be nonaffirmed.
Hopefully, this information will help you avoid some of the common reasons
people receive nonaffirmative prior authorization requests. However, if you do receive a nonaffirmative response, remember that you have the ability to address the reasons it was nonaffirmed and resubmit your request. The good news is there has been preliminary information indicating an affirmation rate of 90 percent and higher for resubmissions. So, fix the common mistakes listed above—and make sure they don’t happen again. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards: www.bocusa.org
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O&P ALMANAC | SEPTEMBER 2021
This Just In
Reunited in Boston The 2021 AOPA National Assembly convened stakeholders from across the country to learn, view the latest products, and finally reconnect in person
UNDREDS OF O&P stakeholders—
clinicians, business owners and managers, educators, researchers, manufacturers, and more—reunited in Boston for the 2021 AOPA National Assembly. The first large gathering of O&P professionals since the COVID-19
Welcome to Boston Celebration
AOPA President Traci Dralle, CFm
SEPTEMBER 2021 | O&P ALMANAC
pandemic began, the Assembly provided a much-needed opportunity for the industry to catch up on the latest advances, innovations, and technologies. The event kicked off Thursday, September 9, with a Welcome to Boston Celebration in the exhibit hall as well as a “Professional Women in O&P” session. Attendees were excited to connect in person with friends, colleagues, and other O&P stakeholders, and to celebrate achievements and discuss the future of women in the industry. Friday, September 10, began with opening remarks and a keynote presentation from former Rep. Erik Paulsen (R-Minnesota) and O&P advocate Nicole Ver Kuilen on “Defining the Equation for Success: Stronger Together.” Throughout the day, attendees chose from educational sessions in orthotic, prosthetic, pedorthic, technical, and business tracks, and were treated to a one-of-a-kind event during the 25th Anniversary Thranhardt Celebration at lunch time. Dozens of former Thranhardt award recipients united to honor the occasion, which concluded with 2021 Thranhardt presentations from Andreas Hahn, MSc, PhD; and Chrysta Irolla, MS, MSPO, CPO, and Emily Nelson, MSE, MSOP, CP (see page 32 for more on the Thranhardt presentations). Later in the day, participants learned about three timely business
This Just In
25th Anniversary Thranhardt Celebration and Luncheon
Professional Women in O&P—Celebrating Success Keynote Presentation: Defining the Equation for Success: Stronger Together
Former Thranhardt Award winners
O&P advocate Nicole Ver Kuilen and former Rep. Erik Paulsen (R-Minnesota) Sam E. Hamontree Award: Adverse Outcomes Audit: Using Simplified Six Sigma as a Loss Control Measure
Rebecca Snell topics during the annual Sam E. Hamontree Business Education presentations; Rebecca Snell’s “Adverse Outcomes Audit” presentation was voted the award winner. O&P PAC contributors finished the day with a special reception in their honor. The final day of the Assembly— Saturday, September 11—brought dozens more educational sessions, including the General Session and AOPA Membership Meeting and Awards Ceremony. During the ceremony, Brad Ruhl was presented the AOPA Lifetime Achievement Award, and two students were recognized with poster awards: Gila Baer from Shirley
Ryan AbilityLab won the Edwin and Kathryn Arbogast Award (prosthetics), and Jessica Sider from the University of Pittsburgh won the Otto and Lucille Becker Award (orthotics). Throughout the event, participants perused the latest O&P devices, technologies, and services in the exhibit hall. O&P stakeholders from all sectors reported appreciating the innovations shared, learning a lot from the educational sessions, and benefitting from the in-person networking opportunities afforded all three days. The O&P professionals who travelled to Boston returned to their hometowns to share the ideas, knowledge, and products they learned about during the Assembly—grateful for the opportunity to reunite with purpose in 2021. For those who missed the in-person event, a virtual Assembly option September 16-18 enabled registrants to engage in the Assembly education virtually, with content available for 90 days. O&P stakeholders are now gearing up for next year’s AOPA National Assembly, which will take place September 28 through October 1, 2022, in San Antonio, Texas.
Andreas Hahn, MSc, PhD, one of the 2021 Thranhardt Award winners AOPA Lifetime Achievement Award
Traci Dralle, CFm, and 2021 award winner Brad Ruhl
O&P ALMANAC | SEPTEMBER 2021
New and enhanced O&P programs are preparing students for O&P clinician and extender positions By CHRISTINE UMBRELL
SEPTEMBER 2021 | O&P ALMANAC
T’S BACK-TO-SCHOOL TIME, and
changes are happening for several O&P educational programs. As O&P facilities look to hire new clinicians, or to send current staff members for training in O&P care extender positions, faculty at many O&P schools have a lot to share about new programs and enhanced learning opportunities. A deeper look at some of the latest program launches offers insights into how the newest cohorts of students are being educated, and the wide array of opportunities for individuals to train for positions at O&P patient-care companies.
KSU Debuts Master’s Program NEED TO KNOW •
The O&P education space is evolving, with new opportunities for prospective MSPO students and updated training for pedorthists and O&P assistants.
At the O&P master’s level, Kennesaw State University welcomed its first class of students in August, and Loma Linda University launched a hybrid MSOP option in June.
The pedorthics program at Francis Tuttle Technology Center is reshaping its curriculum to comply with more robust standards from CAAHEP.
Oakland University is preparing a program to train O&P assistants in accordance with new CAAHEP standards.
These new educational offerings exemplify the wide array of opportunities for individuals to train for highly skilled positions at O&P patient-care companies.
In August, Kennesaw State University (KSU) officially welcomed its first class of first-year students to its new master’s program with a white-coat ceremony. The KSU master’s program was developed after the Georgia Tech O&P program was disbanded, with the last class graduating from that institution in May 2019. When former Georgia Tech Program Director Geza Kogler, PhD, CO, initially learned that master’s program would be cut, he set out to find another home for the program via “transfer of sponsorship”—a process that allows a currently accredited program to move to a new university if it maintains the same director and same curriculum. “I visited in-person several universities,” he says, and found KSU to be a mutually beneficial location—keeping the program within the state of Georgia.
O&P ALMANAC | SEPTEMBER 2021
Students in Kennesaw State University’s MSPO Class of 2023 took part in a white coat ceremony before their classes began in August.
SEPTEMBER 2021 | O&P ALMANAC
program and its labs. O&P master’s programs are smaller in size than other programs within health sciences departments at universities, which sometimes results in universities undervaluing their worth. Within O&P, “we don’t have as large a voice as other departments,” he says. Kogler hopes that O&P stakeholders outside of academia recognize the value in the current programs. He believes educational offerings should be expanded and better funded to support the ongoing need for more certified clinicians. “We need to invest in the future of the profession—or there will be encroachment from other professions,” he says.
LLU Expands Master’s Program Options
Individuals seeking O&P master’s degrees also can choose from new learning opportunities. Loma Linda University (LLU) in Loma Linda, California, launched a hybrid MSOP option in June.
PHOTO: Geza Kogler, PhD, CO, Kennesaw State University
Kogler joined KSU in January 2020 for a transfer of sponsorship—the as director of the new MSPO program, classes at KSU were designed to preparing for the first cohort to join encourage students to embrace digital in fall 2021. Final approval to accept technologies. “The field has to change” students was granted in December to adapt to the evolving healthcare 2020—cutting it close for climate, says Kogler. “At accepting students for the KSU, we will integrate August 2021 start date. The new things—we are first-year cohort at KSU training our clinicians comprises 24 students—a to be successful 20 larger group than was years from now,” when typical at Georgia Tech. practitioners will likely For now, the faculty engage in less fabricaconsists of Kogler and one tion. “We are aiming other instructor. “We’re to increase student Geza Kogler, PhD, CO up and running, and skills at 3D modeling things are looking posiand CAD/CAM tive,” he says. The two-person faculty manufacturing, increase students’ team teaches the required classes to problem-solving skills, and prepare the first-years, supplemented by a students for evidence-based practice.” vast array of guest lecturers, such as Kogler is proud of the launch. “The medical doctors and physical therKSU program is very well funded; we apists. Next summer, the program have beautiful labs; the investment will hire additional staff to support a is there,” he says. But he remains second cohort of students. concerned that other universities While the overall curriculum is the could cut their O&P programs, due to same as at Georgia Tech—as required the expense involved in hosting the
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Traditionally offered as an in-person and Schaepper thoughtfully develmaster’s program, LLU’s new pathway oped. During the early months of is a two-year, eight-quarter, blended the pandemic, Kingsley had to teach learning program, according to remotely material that had previously Johannes Schaepper, PhD, CPO, chair been hands-on, and she found innoof the O&P department. vative ways to effectively The format is one year and efficiently instruct in online, augmented by a the virtual environment. “I one-day-per-week clinrealized we could do this ical rotation at an O&P on a larger scale and give facility of the student’s more students another choice, followed by one option for learning” in a year in person. While streamlined, economical it is not the only O&P manner. Although the first master’s program with cohort of hybrid students Johannes Schaepper, an online component, are only in their first PhD, CPO the structure of the quarter, the roll-out has LLU program, with an gone smoothly, and the entire year online, is unique. program is drawing applications for The hybrid program focuses on next year, says Kingsley. providing a “spiral learning approach,” “We feel encouraged that online where students who have already education for O&P in a blended approach earned bachelor’s degrees learn and can be successful,” adds Schaepper. absorb all essential content online in LLU also continues to offer its a mix of synchronous and asynchrocombined BS/MSOP program, which is nous coursework. Then, when they the only simultaneous undergraduate/ arrive on campus for their second year, graduate MSOP program in the United students focus on the O&P core projStates, according to Schaepper. The ects around actual patients appropriate undergraduate program attracts high to their projects. “The hybrid MSOP school students who already know students repeat, in person, what they they want to be clinicians, as well as conceptually learned online,” explains undergrads in their first two years of Schaepper. “In their second year they clinically, technically, and from a patient-management and documentation perspective learn everything again in person.” In addition, instead of a traditional “mock” exam offered to the students at the end of a program, “this track requires each student to take a clinical-practical, summative O&P review in Quarter 7, and a theoretical summative O&P review in Quarter 8,” he explains. Both summative review courses are part of the students’ grades and required for successful completion of the MSOP degree. Aileen Kingsley, MSOP, CPO, director of the hybrid MSPO/blended learning program, says that the COVID-19 pandemic that forced some O&P education to temporarily move online “was somewhat of an inspiration” for the new format, which she 26
SEPTEMBER 2021 | O&P ALMANAC
general education (GE) coursework and junior college transfer students. The undergraduate applicants finish simultaneously with a BS in health science and an MSOP—in as little as four-and-a-half years of college. Graduate applicants finish with an MSOP. The nature of this track is a seated program, following the more traditional O&P curriculum, according to Michael Moor, MS, CPO, the BS/ MSOP in-person program director. “The psychosocial aspects of O&P care and history of disability classes give the undergraduate students some necessary GE requirements while learning O&P content,” he explains. Another benefit of this track is a full series of courses in biomechatronics, and each student is involved in a start-to-finish research project—from design, IRB approval, data collection, and analysis to write-up and presentation. Undergraduate students transfer 96 quarter GE credits, or 64 semester GE credits, into the program. Students with BS/BA degrees also are welcomed in this track. The program has a rolling admissions process, so students can apply throughout the year, according to Moor.
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Pedorthic Program Adopts New Standards
The O&P master’s programs are not the only O&P education tracks that are undergoing renovation. Pedorthic program content is being 28
SEPTEMBER 2021 | O&P ALMANAC
PHOTO: Joe Young, CPO, Francis Tuttle Technology Center
With both the hybrid and traditional options available to prospective students, “our goal is to piggyback on each other” and grow the O&P program at LLU, says Schaepper. Because many students are spending one year online, fewer students are working within the program’s expansive lab space at once—“so we have the space to grow” both programs, he says. Moor encourages O&P clinicians and managers to educate prospective prosthetists and orthotists about the many educational options available—at LLU and other universities. “A lot of our students have told us they wished they knew about our programs earlier,” he says.
at Francis Tuttle Technology Center,” says Joe Young, CPO, program director. To meet the updated requirements, the program is transitioning from a 350-hour program to a 960-hour program, or two semesters, says Young, and features three weeks of on-site work, compared to two weeks under the old curriculum. “This change is not a small one; it has increased the tuition of our program” significantly, and has nearly tripled the seat time. In a typical year under the old standards, Francis Tuttle would graduate 24 to 28 students, the majority of whom were already working in the industry and financially supported by their employer for tuition, travel, and the 1,000-hour work experience requirement to become certified. “We also enrolled students who had no previous experience in the field and needed to break into the field,” Young adds. By comparison, the updated pedorthics program focuses on the perspectives of students that are Students in the pedorthics program currently employed by the industry at Francis Tuttle Technology Center and need a convenient way to obtain their education to become certified. overhauled following new standards “We are working to make a program from CAAHEP adopted in the fourth that can help transition the field from quarter of 2019. Established NCOPEa short-term course to the goal of accredited programs are required to having an associate of applied science comply with the new, more robust degree in pedorthics,” Young says. standards at the time of renewal. “We hope that this will still allow The pedorthics employers to have a program at Francis supply of new pedorthists, Tuttle Technology while we transition to Center is the first to the elevated educational reshape its curricrequirements.” ulum to comply with The new program the new standards, “dives deeper into patient with the program set evaluations and the ability to switch over to the to digest current research new requirements in than we were able to Joe Young, CPO early 2022. The new with the previous shorter standards require the program,” says Young. “We program to be two are also planning to have semesters in length and tied to either live patient models to evaluate and an associate degree in pedorthics or fit during the added week of on-site any other subject and a two-semester training.” Francis Tuttle is adding projcertificate course in pedorthics. “We ects that will allow students to practice have chosen the two-semester certifexchanging ideas and information icate course option for the program between professionals and peers.
The online content has been significantly overhauled and offers a mix of instructional models, with both synchronous and asynchronous components. “We have learned that interactive case studies, videos, accessible curriculum, and open communication lines are important for student success,” explains Young. The synchronous interaction is designed to encourage student engagement “and also keep student retention high, as working through two semesters of online education could be a daunting task with no collaboration.” Young is excited to debut the new program and help train the next generation of pedorthists, who are in demand. “Pedorthists are very valuable—they treat a large percentage of diabetic patients,” so he hopes that more O&P facilities will consider sending staff members to accredited programs for pedorthic training.
“Our school is trying to accommodate students so their education will still fit into their work schedules,” he explains.
launch as part of the exercise science program at Oakland. Students will prepare to perform O&P procedures and related tasks associated with Accredited O&P Assistant patient care, with the evaluation and Program Prepares for Launch formulation of the treatment plan In addition to updating pedorremaining the responsibility of the thic program standards, CAAHEP orthotist or prosthetist. approved the initial set With CAAHEP of orthotic/prosthetic accreditation expected assistant standards in to be granted soon, late 2019. At present, no according to Daniel J. assistant program has Goble, PhD, director undergone the CAAHEP and associate professor accreditation process— in Oakland’s exercise but a new program at science program, the Oakland University is first group of students preparing to do so. that can participate in Daniel J. Goble, PhD The new program, the new program just which will train O&P started their second year assistants—individof college. “Exercise uals who participate in directed O&P science students will take their first set care while under the supervision of a of O&P classes in the winter of their certified orthotist or prosthetist—will sophomore year,” he says.
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O&P ALMANAC | SEPTEMBER 2021
Among the three different pathways to completing the O&P assistant program at Oakland, earning a bachelor’s in exercise science, with a specialization in O&P, is the most popular, according to Tamara Treanore, CO, director of O&P assistant studies. Students who follow this path will earn a four-year bachelor’s degree through the program, Treanore says. Other pathways allow more
mature students to complete assistant requirements after having earned other associate degrees, or to minor in an O&P specialization and major in a different area. Students who finish the program will still need to meet ABC
requirements to become certified as an O&P assistant. The new program elevates the role of the O&P assistant as a care extender at O&P facilities, and it also exposes students to working as fitters. Before the Tamara Treanore, CO accredited requirements were introduced, assistants completed hands-on training and sought attestations from O&P employers, explains Treanore, “but that education was not meeting the standards the field as a whole is being held to,” she says, pointing to the master’s requirement for clinicians. While there have been tremendous strides in O&P education in recent “O&P is becoming more complicated. Treatments are becoming more years, educating individuals outside the O&P profession about the proscomplex. And clinicians are now thetist/orthotist education track remains a challenge, says Ann Yamane, working with assistants.” CO, O&P program director in the University of Washington Department Including assistant positions at a of Rehabilitation Medicine. “Our profession facility can be an economical business model, so well-trained assistants is still not well known to enough people— will grow in demand, says Goble. not enough people know how to go about “Plus, there’s a lack of clinicians out becoming an orthotist or prosthetist,” she there, so this can help fill the gap” by says. “So, we need to make people aware of allowing clinicians to share appropriate tasks with other staff members. the O&P master’s programs.” “The field has now identified a Yamane notes that many of the schools better approach to train assistants are doing their part to increase awareness by appropriately,” says Treanore. “Those Ann Yamane, CO teaching students to work as part of interdiscompanies that bring [assistants] on staff can help clinicians get relief on ciplinary healthcare teams. “There’s a push in the programs to move from their heavy workloads, and it also educating students in siloes and embracing an interprofessional educaexpands the number of patients tion approach,” she says. they see.” Yamane also advocates for increasing diversity of the O&P applicant Treanore notes that elevating the O&P assistant position through new pool, and for adopting a holistic approach to reviewing applications. standards also will advance the O&P “We need to look at the whole person, versus just their grades,” when profession as a whole. “If you look selecting students for admission. She hopes that schools strive to include at the success of the PT assistant curriculum that raises awareness of systemic racism and disparities in position—that’s really changed the physical therapy field,” Treanore says. healthcare, and “how we can be agents of change.” Growing the O&P assistant program One thing that has not changed at the O&P schools over the years is has the potential to similarly elevate the passion and innovation of both faculty and students, and their dediO&P within the greater healthcare cation to improving lives of O&P patients, Yamane says. “The students we field. have are really bright, caring, compassionate people,” she says—which Christine Umbrell is a contributing bodes well for the future of the profession. writer and editorial/production associate for O&P Almanac. Reach her at firstname.lastname@example.org.
Elevating the Profession to Outside Stakeholders
SEPTEMBER 2021 | O&P ALMANAC
By JOSEPHINE ROSSI
Simply the Best THREE OUTSTANDING RESEARCHERS SHARE DETAILS OF THE WORK THAT EARNED THEM ONE OF THE MOST DISTINGUISHED HONORS IN THE O&P PROFESSION
MEET THE 2021 WINNERS
ORIGINALLY PRESENTED IN 1996,
in memory of O&P education pioneer Howard R. Thranhardt, the annual Thranhardt Awards have become synonymous with exceptional educational information and the highest caliber research advancing the O&P field. This year also marked a milestone for the award and lecture series—25 years of honoring the best and brightest minds in the profession. During the celebratory event, held during the AOPA National Assembly in Boston, the three 2021 winners presented their work to attendees in person and virtually. Andreas Hahn, MSc, PhD, discussed his project, “The Effect of Microprocessor-Controlled Exo-Prosthetic Knees on Limited Community Ambulators: Systemic Review and Meta-Analysis,” and Chrysta Irolla, MS, MSPO, CPO, and Emily Nelson, MSE, MSOP, CP, expounded on their study, “Treatment Parameters for the UCSF Pectus Carinatum Orthosis: A Pilot Study.” O&P Almanac recently spoke to all three honorees about their research and what it means for the future of O&P patient care.
SEPTEMBER 2021 | O&P ALMANAC
Andreas Hahn, MSc, PhD, holds the global corporate responsibility for Otto Bock’s clinical research activities. He was trained as a physicist at Oxford University, and he currently co-chairs the ISPO Industry Advisory Group’s outcome measurements working group. He previously received the Thranhardt Award in 2014 and 2019. Chrysta Irolla, MS, MSPO, CPO, explored her interest in patient rehabilitation while obtaining her Master of Science in engineering design from Northwestern University, and she subsequently decided to focus on patient care and earn her MSPO from The Georgia Institute of Technology. Irolla is now the clinical manager and residency mentor at the University of California, San Francisco (UCSF). Emily Nelson, MSE, MSOP, CP, pursued a master’s degree in biomedical engineering from the University of Michigan with hopes to design prosthetic components. After a career stint in process engineering in the consumer healthcare manufacturing industry, the desire to work with patients led her back to the MSOP program at Eastern Michigan University. Nelson is now a certified prosthetist and completed her orthotics residency at UCSF.
Dr. Hahn, what compelled you to investigate the benefit of MPKs for limited ambulators? Andreas Hahn: This topic had been in my focus for a long time. People with disabilities are treated very differently in different social security systems. In Germany, people with limb loss are entitled to receive state-of-the-art technology to compensate their disability. It was recognized very early on that, specifically, amputees with limited
community ambulation capabilities over-proportionally benefit from advanced safety features. In 2014, I was able to present—also at the Thranhardt lecture series—that mobility grade rating has very little predictive value when it comes to the utilization of the benefits of microprocessor-controlled prosthetic knee components. Still, it was argued that the scientific evidence was not sufficient to mirror what could so clearly be experienced in clinical practice.
Briefly explain your study design/methods used. Hahn: We updated a systematic review (published by my colleague Andreas Kannenberg et al. in 2014), and as an innovative element, I included a meta-analysis to reduce ambiguities found earlier. We chose to use the AAOP State-of-the-Science Conference’s validity assessment system as it allowed us to assess a wide range of study designs and validity indicators relevant to our field. Our aim was to make the meta-analysis as robust as possible. We understand that research in our field is characterized by heterogeneous study designs and not all aspects may be controlled as well as those in pharmaceutical trials, for example. Therefore, we chose Hedges’ g as an effect size estimator and drew conclusions from a random effects model only.
What were the main findings of your research?
Hahn: First of all, we were most delighted to see how active this field of research had become. The number of high-quality studies increased significantly since 2014. Fifteen documents relating to 13 research projects could be identified. It is also quite telling that, in all those studies, not a single outcome was identified that favored the use of non-microprocessor-controlled knee components in this population. The meta-analysis revealed a clear reduction of the number of falls, the fear of falling, the risk of falling, but also an increase of the mobility grade rating itself. Furthermore, the self-selected walking speed increased. For the first time, we could now detect the effects related to subjects’ perception as measured by the prosthetics evaluation questionnaire (PEQ) ambulation and utility subscales.
Which outcomes were most profoundly affected by use of MPKs?
Hahn: The results on the reduction number of falls were investigated
Andreas Hahn, MSc, PhD in seven research projects. Fear of falling, the change of mobility grade, and self-selected walking speed were reported in six studies, respectively. The ambulation and utility PEQ subscales were investigated in a smaller number of studies but still showed relevant and significant effects.
Did you encounter any limitations?
Hahn: In research projects with exo-prosthetic components, the blinding of studies is a huge challenge. However, many researchers address the underlying problem by applying a multiple crossover design. I think this is an elegant and appropriate way to also account for learning effects. It may be worthwhile to remember that the Oxford Centre of Evidence Based Medicine Classification ranks multiple crossover designs within evidence class 1. We were also overwhelmed by the number of different outcomes being used in the studies and, in some cases, by the variety of reporting standards. We commend any effort in providing a larger harmonization of outcomes and reporting standards. Unfortunately, the difference in presenting some of the investigated items did not allow for full utilization of all data provided. This is regrettable, as we can see from the publications that those data would have helped to further reduce ambiguity.
Did your work reveal anything you did not anticipate?
Hahn: Next to the number of highquality studies currently published and given the heterogeneity of the trial designs, we were astonished by the homogeneity of the results. A lot of the ambiguity we may have had earlier was resolved, and we feel the argument that a lack of scientific evidence may justify withholding this therapeutic option from an entire class of amputees is no longer sustainable.
How will your findings be used?
Hahn: We hope we’ve made a recognizable contribution to the scientific community and helped reduce the ambiguity related to the clinical effectiveness of microprocessor-controlled prosthetic knees in limited community ambulators. We believe this work can help inform healthcare providers and supports the choice of the most appropriate prosthetic fitting. The Ascent K2 study, a landmark trial initiated by the Hanger Institute for Clinical Research and Education and Ottobock, will in addition assess the long-term effects in the real-life environment of prosthetic clinics. This important research is designed to help ensure people living with limb loss and limb difference have coverage for medically necessary and clinically appropriate technology, which will, in turn, enable them to participate more fully in their communities and enjoy a higher quality of life. O&P ALMANAC | SEPTEMBER 2021
Chrysta Irolla, MS, MSPO, CPO
Chrysta and Emily, what is pectus carinatum and how has it been treated in the past? Emily Nelson: Pectus carinatum is a chest wall deformity that presents as a protrusion of the sternum due to overgrowth of the costal cartilages. It is most commonly diagnosed in adolescent males during a longitudinal growth spurt. Chrysta Irolla: Historically, pectus carinatum was treated with surgical intervention involving placement of a metal bar along the sternum. Following this procedure, there was an uncomfortable recovery period and a permanent scar. Starting in the 1990s, we saw an increase in use of orthotic interventions to correct pectus carinatum while the chest wall was still flexible, prior to skeletal maturity. There are a wide range of both off-the-shelf and custom orthotic designs that have emerged.
What was the impetus for your study, and how is the UCSF orthosis different from prefabricated orthoses?
Nelson: There has been research regarding orthotic treatment of pectus carinatum over the last 20-30 years; however, there is not consensus regarding the treatment parameters with these different devices. The purpose of our study is to create a detailed protocol by determining which variables have the greatest impact on successful correction of the chest wall deformity. 34
SEPTEMBER 2021 | O&P ALMANAC
Emily Nelson, MSE, MSOP, CP
Irolla: From the literature and clinical experience, we found that patients often abandon use of a pectus carinatum orthosis because it is uncomfortable and excessively bulky, does not correct the chest wall deformity at a reasonable pace, does not address prominent inferior costal cartilage, and/or is hard to breathe when using. We developed the UCSF Pectus Carinatum Orthosis (UCSF-PCO) to address these specific concerns. We made a custom design that is contoured as close to the patient's anatomy as possible while allowing appropriate space for ML chest expansion for breathing; includes the ability to add extensions to address the inferior costal cartilage; has a comfortable gel interface against the pectus carinatum; includes shoulder straps for appropriate suspension; and is designed to produce enough force that patients start to see correction in the first month of use.
How was your research conducted? What materials were used in the orthosis?
Nelson: This is a longitudinal prospective clinical research study which collects both qualitative and quantitative metrics to assess success of the UCSF-PCO. We recruited a convenience sample of patients referred mostly through the UCSF chest wall deformity clinic. Inclusion criteria is 7- to 17-years-old, skeletally immature, diagnosed with flexible pectus carinatum,
and recommended for conservative treatment with an orthosis. Irolla: Each subject is provided with a custom UCSF-PCO made from 3/16" polypropylene anterior and posterior shells with 1" wide polypropylene reinforcement struts. A PediFix Visco-gel sheet pad is added to the anterior shell to provide a soft interface against the pectus carinatum. Adjustable 1" Dacron backed lateral straps are used to allow for adjustability of the AP pressure and 1" C-fold shoulder straps are added to help with suspension. A Maxim Integrated Products Thermochron I-Button temperature monitor is installed in the posterior panel to track wear time. The recommended orthotic wear time is at least 18 hours per day, during the corrective phase of treatment. At routine follow-ups, we take new measurements of the pectus carinatum size, download the data from the I-Button sensor, and use TekScan FlexiForce force sensitive resistors to measure the in-orthosis corrective pressure. Once the prominence remains reduced for a 24-hour period outside of the orthosis, the patient can transition to the maintenance phase where they only wear it at night for eight hours per day. Nelson: Throughout treatment, we administer surveys to better understand the patient’s overall quality of life and feelings about their chest wall shape.
What were the main findings of your research?
Irolla: We hypothesized that subjects who were older and/or had a stiffer pectus carinatum deformity would spend more time in the corrective phase of treatment. Thus far, it does not appear there is a clear predictive relationship between age and pectus carinatum stiffness. We also discovered that in younger subjects (7- to 13-year-olds), the pectus carinatum corrected at a meaningfully faster rate compared to the older subjects (14- to 17-year-olds). Nelson: Younger subjects also had a reduction in pressure of treatment from delivery to final follow-up, but this was not true in older subjects. Overall, all patients were happy with the appearance of their chest at the end of treatment, and there was no negative impact on their quality of life over the course of treatment.
How much did social and psychological factors affect patient wear time?
Irolla: We found that subjects in the older age group (14- to 17-year-olds) pushed to transition to maintenance phase of the treatment (eight hours per day of wear) sooner than was clinically recommended and sooner than their younger counterparts. Subjective feedback from subjects is that they did not want to wear the orthosis during high school given the increased social pressures of that environment. This earlier transition results in an increase in the length of the overall treatment time for these subjects.
Did you encounter any limitations to your work?
Nelson: The biggest limitation is that this treatment is conducted over a one- to two-year time frame. A number of subjects were lost to follow-up or self-discontinued their treatment outside of the clinical setting, leading to an incomplete data set. We surveyed
those subjects who self-discontinued, and they mostly reported doing so because they were satisfied with the appearance of their chest wall.
Did you discover anything surprising?
Nelson: We expected a clear correlation between age and time to correct the pectus carinatum, and it was surprising that there was no clear trend.
Irolla: This is an ongoing study, so we are still actively recruiting patients. Our end goal is to develop a predictive model that allows clinicians to input specific physical metrics collected at an initial evaluation and outputs the transition points in pectus carinatum treatment for that specific patient. This will be a clinical tool that can better guide treatment in the future. Josephine Rossi is editor of O&P Almanac. Reach her at email@example.com.
Welcome to AOPA Connection, the one-stop-shop for all things AOPA. Logging into AOPA Connection you will instantly have access to all your AOPA benefits, including: • AOPAversity • Your Membership Record • Your Individual Profile • Event Calendar • Bookstore • Co-OP But, it doesn’t stop there! We are pleased to introduce a new benefit accessible through AOPA Connection, My O&P Community. In this online community of your O&P colleagues you can get guidance, share advice, have one-on-one and group conversations, and access resources.
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SEPTEMBER 2021 | O&P ALMANAC
With more than 600,000 infants successfully treated with the STARband, Orthomerica remains the global leader in cranial remolding orthoses. We have worked with the most experienced cranial clinicians from around the world for more than 20 years. Our success is built on the latest technologies, communication, and collaboration. Our commitment is reinforced with the production and shipment of each and every cranial orthosis. Orthomerica continues to set the benchmark for cranial remolding treatment. Key benefits of using the STARband include: One Headband Guarantee — Analysis of treatment data shows that over 99% of infants with deformational head shapes complete treatment with a single STARband. Orthomerica is the only manufacturer that offers the “One Headband Guarantee” through qualified cranial clinicians — One and Done for Everyone! AllSTAR™ Team — Membership in the first network of international cranial clinicians dedicated to best practices and clinical research. STAR Family Designs — Orthomerica offers five different FDA-cleared cranial remolding orthoses to allow you to offer the best treatment plan for each patient. Empowered Clinicians — The most effective treatment plans are created after a thorough evaluation of each patient. Every STARband is fabricated to the treating clinician’s design specifications. Advanced Pediatric Scanning Technologies — The STARscanner® and SmartSoc® are the most accurate FDA-cleared scanners available for cranial applications. Clinical Documentation and Reports — Both the STARscanner and SmartSoc offer detailed anthropometric reports that establish baseline and comparative measurements to accurately document efficacy of treatment programs. Clinical Outcomes — Publications on the STARband, STARscanner, and SmartSoc continue to be published by independent researchers in peer-reviewed medical journals. Clinical Education — Ongoing clinical education is critical to your success and is available through online and onsite courses, the STAR Summit, webinars, emails, heads up! memos, and clinical consultations.
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Improving Rehab Outcomes Physical therapist studies balance, phantom limb pain, injury risk, and more among individuals with amputation
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.
HRISTOPHER KEVIN WONG, PhD, PT, who has published several signif-
SEPTEMBER 2021 | O&P ALMANAC
Wong’s work on the balance instrument is just one of his many contributions to the O&P field. An OCS-boardcertified orthopedic clinical specialist,
Resisted side steps away from the prosthetic limb develop glute medius muscle strength that supports prosthetic weight bearing. he currently serves several roles at Columbia University Irving Medical Center, including associate director of faculty development for the program in physical therapy; curriculum director of the clinical residency in orthopedic physical therapy; and associate professor of rehabilitation and regenerative medicine.
PHOTO: Christopher Kevin Wong, PhD, PT
icant studies regarding physical therapy and the O&P patient population, believes his most important contribution to the O&P field is verifying the Berg Balance Scale as a valid and reliable assessment of balance for people with limb loss across performance ability levels. “Surprisingly, this was the first paper to establish a standard balance assessment for people with limb loss, as none had been established with rigorous psychometric testing prior to 2013,” he explains. Although standing on one leg was used as a balance measure, people with unilateral limb loss get “lots of practice” standing on one leg—“and this activity did not rate in the top three most difficult activities of the Berg Balance Scale,” says Wong.
The assessment of the Berg Balance Scale incorporated the use of Rasch rating scale analysis to validate the instrument, “which allowed robust analysis of the full range of balance task difficulty and subject performance ability—from K1 to K4—to be used in determining outcome measure validity and reliability,” Wong says. The Rasch approach provides more clinically useful information than concurrent validity via comparison to other measures, he says, “especially when subjects of only a narrow range of performance ability are used—a common issue in prosthetics research.” For instance, the Rasch analysis identified the most difficult Berg Balance Scale tasks for people with limb loss to perform, which can then be used as goals for rehabilitation as ability improves. The Berg Balance Scale evaluations were found to be reliable for use by physical therapists of various levels of clinical experience, according to Wong.
Gait resisted through the arms demands forceful gluteal and abdominal muscle activation and facilitates prosthetic weight bearing.
PHOTO: Christopher Kevin Wong, PhD, PT
For the past few years, Wong has been investigating injuries in people with limb loss. “While falls have been frequently reported, injury had been rarely mentioned prior to our first paper [in 2016],” he says. The prospective study with up to 41-month follow-up found that while falls occur regardless of individual characteristics, women were more than six times more likely to be injured. However, the most important takeaway for the O&P community from this study, according to Wong, is that people with limb loss suffered fall-related injury at rates higher than other at-risk populations such as elderly hospitalized people. He conducted a larger retrospective study that confirmed the danger for women and also highlighted the high risk for people with vascular disease. “These studies help to raise awareness of the risk of injury for people with limb loss, both for researchers and the public,” he says. He and his team built an open-access web-app—based on their study findings and other research—that features a free injury risk profile screening for people with limb loss, with evidence-based suggestions (visit https://pump.ctl.columbia.edu). “My team recently completed a grant exploring injury of all causes, regardless of falls, in people with limb loss” and plans to publish the results soon.
Phantom limb pain is another area of concentration for Wong. Developing treatments to alleviate phantom limb pain without an associated clinical measure can be difficult because that type of pain is episodic and hard to quantify, so his team identified a reliable clinical measure that correlated with phantom limb pain. “Our paper, published in Pain Medicine in 2017, found that the ability to recognize pictures of feet as left or right—known as limb laterality recognition—was strongly associated with the frequency of phantom limb pain,” he says. While limb laterality recognition scored for either accuracy or speed had been unrelated to phantom limb pain in past research, “we found that simply dividing accuracy by speed produced a reliable measure of cognition linked to phantom limb pain,” he says. His team followed up with a second study, currently in press, that suggests a link between cognition and phantom limb pain that may lead to a better understanding of the phenomenon. In another key investigation, Wong’s discrete understanding of balance abilities led him to develop an early clinical prediction rule for community-dwelling people with limb loss. “Applying a rigorous prospective longitudinal methodology, we found
Gait resisted from the prosthetic side front of the hip demands gluteus maximus muscle activation at the critical moment that the sound limb begins to swing forward.
Christopher Kevin Wong, PhD, PT, demonstrates a useful patient position for mobilizing the hip and pelvic joints to help reduce hip flexor contractions. that two simple balance tasks [reachto-floor and look-over-shoulder] and two self-report scales [ActivitiesSpecific Balance Confidence Scale and Houghton Scale] could accurately predict whether a person post-initial prosthetic rehabilitation would achieve independent community walking ability as defined by scores ≥9 on the Houghton Scale,” Wong explains. “The primary lesson learned from this research was that most people who had not already achieved the independent community walking ability, would not advance without intervention.” Wong also investigated methodologies to advance ambulation among individuals with limb loss and designed an efficient program accordingly. “Exercise, which can be thought of as practiced movement under various conditions, can only utilize motion that is available at the relevant joints,” he explains. Since people with limb loss are known to have limited range of motion, specifically at the hip, “it stood to reason that this joint motion should be optimized to be fully utilized during exercise,” Wong notes. “The most essential joint motions could be obtained using manual therapy for the lumbar spine, pelvis, and hip joints in a four-session program described briefly in an early pilot study,” though further therapy is beneficial. The whole approach is described fully in a narrative review addressing elements of complete care, called PANACEA: Passive limitations, Active muscles, Neuromotor planning, Activities O&P ALMANAC | SEPTEMBER 2021
Wong presented research findings at the Columbia University Irving Medical Center Precision Medicine Scholars Day in October 2019. essential for function, Capacity to perform both cardiac and cognitive, Environmental requirements, and Attitude, he says. “The take-home message, however, is that people with limb loss, beyond their prosthetic concerns, have the same needs of all of us, and addressing them can improve their health status and quality of life.”
Wong believes strongly in the importance of education—beginning with his own. He earned a master’s degree in physical therapy from Columbia University, followed by a doctorate in health education and research from Touro University International in Los Angeles, California. He gravitated
toward O&P while in physical therapy school, under the direction of Joan Edelstein, MA, PT, CPed. “Joan had been the director of New York University’s prosthetics program, taught O&P around the country and world, and published multiple O&P books and papers,” he recalls. “Her vast experience and patient stories fascinated me.” He has been a New York statelicensed physical therapist since 1993 and an American Board of Physical Therapy Specialists board-certified orthopedic clinical specialist since 2000. Today, Wong makes the most of his roles at Columbia University to influence students in healthcare fields. “In the DPT program, I teach prosthetics and orthotics, soft tissue mobilization, and advanced orthopedics,” he says. Wong integrates advanced physical therapy treatment concepts typically applied to patients with orthopedic conditions such as knee and back pain to the care of people with limb difference. “After all, people with limb difference have essentially the same musculoskeletal impairments, but with the additional challenges of limb loss,” he notes.
Notable Works Christopher Kevin Wong, PhD, PT, has been involved in dozens of important published studies, including the following: • Wong, C.K., Chen, C., Welsh, J. “Preliminary Assessment of Balance With the Berg Balance Scale in Adults Who Have a Leg Amputation and Dwell in the Community: Rasch Rating Scale Analysis.” Phys Ther, 2013; 93(11): 1520-1529. Epub June 6, 2013. doi: 10.2522/ptj.20130009. PMID: 23744457
• Wong, C.K., Varca, M.J., Stevenson, C.E., Maroldi, N.J., Ersing, J.C., Ehrlich, J.E. “The Impact of a FourSession Physical Therapy Program Emphasizing Manual Therapy and Exercise on the Balance and
SEPTEMBER 2021 | O&P ALMANAC
• Wong, C.K., Sheppard, J.K., Williams, K.L. “Balance and Gait Training to Community-Dwelling People With Lower-Limb Loss: A Narrative Review With Clinical Suggestions.” Phys Ther Rvw, 2018; 23(2): 124-132. Epub April 4, 2018. https://doi.org/10.1080/10833196.2018.1451291 • Wong, C.K., Gibbs, W., Chen, E. “Use of the Houghton Scale to Classify Community and Household Walking Ability in People With LowerLimb Amputation: Criterion-Related Validity.” Arch Phys Med Rehabil, 2016; 97(7): 1130-1136. Epub Feb 10, 2016. pii: S0003-9993(16)00090-3. doi: 10.1016/j.apmr.2016.01.022. PMID: 26874230
PHOTO: Christopher Kevin Wong, PhD, PT
• Wong C.K., Young, R.S., Ow-Wing, C., Karimi, P. “Determining One-Year Prosthetic Use for Mobility Prognoses (PUMP) for Community-Dwelling Adults With Lower-Limb Amputation: Development of a Clinical Prediction Rule.” Am J Phys Med Rehabil, 2016; 95(5): 339-347. Epub Sept 18, 2015. doi: 10.1097/ PHM.0000000000000383. PMID: 26390393
Prosthetic Walking Ability of People With Lower-Limb Amputation: A Pilot Study.” J Prosthet Orthot, 2016; 28(3): 95-100. doi: 10.1097/JPO.0000000000000099
PRINCIPAL PRINCIPAL INVESTIGATOR INVESTIGATOR
Wong also teaches O&P courses, positioning them as advanced applied biomechanics courses. Beyond teaching amputation rehabilitation and the components and biomechanics of prosthetics and orthotics, he focuses on biomechanical and rehabilitation implications for gait as well as other movement such as sit-to-stand, stairs, and slopes, as well as sport, dance, and work activities. “Learning to use prostheses is adapting movement after subtraction of an anatomic segment,” he says, “while learning to use orthoses is adapting movement after addition to an anatomic segment.” Wong says that the concepts and techniques he teaches have direct applications to all people—including those without limb impairments. “Inactivity and prolonged time spent sitting leads to stiff spines, tight hip muscles, and weakness of the core and hips,” he says. “Through effective joint manipulations, soft tissue releases, and
strategic exercises, efficient and durable changes can be achieved for people with and without limb difference.”
Spreading the Manual Therapy Message
Looking to the future, Wong hopes to educate more rehabilitation and O&P professionals about the benefits of soft tissue mobilization. “Manual therapy and soft tissue mobilization in particular are difficult to standardize and therefore research,” he says. “Many physical therapists have the manual therapy skills to achieve rapid improvements in musculoskeletal function, balance, and walking ability for people with limb loss,” pointing to certain “essential” skills: muscle energy technique for the lumbopelvic region, joint mobilization/manipulation for the hip and lumbar spine, and myofascial manipulation for the hip flexor muscles, including the tensor fascia lata. “Some modifications are required
for people without a lower limb, of course, but the biggest barrier may be recognizing that the same skills required for addressing back pain apply to people with limb loss,” he says. To ensure more healthcare workers are aware of the benefits of these manual therapy skills, Wong recently held an in-service with physical therapists at Walter Reed Hospital, and he hopes to provide additional trainings for clinicians working with the limb loss community. “While manual therapy is more often provided to younger and healthier people, I say: Who is most likely to be stiff and in need of manual therapy— the older or less active person, or the younger or more active person?” he asks. “In my opinion, people with other disadvantages can benefit the most from the manual skills that physical therapists can offer. It can be the difference between being able to get up from a chair independently and needing assistance.”
O&P ALMANAC | SEPTEMBER 2021
By DEBORAH CONN
Demonstrating Support International manufacturer focuses on orthoses, soft goods, and education for its products
HE ALLARD CO. GROUP
SEPTEMBER 2021 | O&P ALMANAC
COMPANY: Allard USA OWNER: Peter Allard LOCATION: International headquarters in Helsingborg, Sweden; U.S. subsidiary in Rockaway, New Jersey HISTORY: 67 years
Wendy in Montana
practitioners can feel sure of the way they fit the AFO to give the best outcome to the patient.” Clinicians can make adjustments to the bottom or the top of the footplate and grind down certain areas on the footplate and anterior shell. Allard also offers a line of soft goods, such as the Vission Clavicle splint, and thermoplastic materials for making custom splints and casts. “We have some that are precut, preshaped for the final front and back panels, so clinicians can mold them to each patient,” Beesley adds. In addition to manufacturing, the company launched a new central fabrication service in 2020, which offers straps, chafes, buckles, and other materials needed to build an orthosis. “Education before sales” is Allard’s mantra. The company offers a full range of continuing education programs, product training, and marketing support. Initially, all courses were held at Allard USA headquarters in New Jersey. “But people had to take two
Deborah Conn is a contributing writer to O&P Almanac. Reach her at email@example.com.
PHOTO: Allard USA
Peter Allard created the Dralla Foundation to support activities, such as the Adaptive Sports Foundation’s Race4ALL.
PHOTO: Samuel Vickrey Photography
dates back to the 1950s, when Camp Scandinavia was founded in Stockholm as a spinoff from another company to manufacture orthopedic corsets. In 1996, Bertil Allard purchased Camp Scandinavia and began to develop products that could be sold outside of Scandinavia. Its first product was the ToeOFF®, a foot drop ankle-foot orthosis (AFO) made of composite materials. AFOs continue to be the company’s flagship product. Peter Allard, Bertil’s son, took over the company in 2005 and founded Allard International. The company began producing its own materials, including composites, low-temperature plastics, textiles, and plastic corsets. Today, Allard has warehouses and sales offices in Sweden, Norway, Finland, Ireland, and the United States. Allard’s AFOs comprise three different product lines. “We have been innovating these devices for 20 years, so we offer a variety of AFOs. The rigidity differs among the product lines and also among sizes,” says Diane Beesley, the company’s marketing manager. BlueROCKER® offers more rigid orthotic control, ToeOFF is intended for moderate stability, and Ypsilon® is designed for mild stability. “While these are considered off-the-shelf AFOs, you have much more success with the lifespan when they are properly customized to your patient,” explains Beesley. “We offer a number of CEU courses, so
full days off to attend, and that was difficult, so we started offering them in the evenings and on weekends,” explains Beesley. “We have eight district managers around the country, and when they can get a group of people together, they will do a live course.” Even before the pandemic, Allard offered online courses, and they continue as a convenient way for participants to gain training and earn CEUs. Seeking to support the patients he serves, Peter Allard created the Dralla Foundation (Allard spelled backward) in 2011. The foundation awards grants to organizations that hold events for those with disabilities. “The foundation is dear to Peter’s heart,” says Beesley. “Its tagline is, ‘Giving individuals with physical challenges a day to remember.’” Dralla has funded such events as adaptive skiing, biplane adventures, a 100-mile European trek on Camino de Santiago that ended in Spain, adaptive skating, and an outdoor adventure camp. Get Back Up Today is another important segment of Allard. Beth Deloria, a marathon runner whose medical issues left her with foot drop, was able to compete again with the help of the ToeOFF® orthosis. She founded Get Back Up Today to connect and inspire patients with foot drop, and the organization has become a global movement. Other outreach efforts include advertisements in trade publications and co-promotions with distributors. The company is active on social media, including Facebook, Twitter, Instagram, and LinkedIn. “It’s all part of our goal to educate patients and practitioners,” says Beesley, “so they can achieve the best possible outcomes.”
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Skyland Prosthetics & Orthotics
Integrating Nature North Carolina facility features an outdoor gait lab
N 1979, BRUCE DOLEN, CP, and
SEPTEMBER 2021 | O&P ALMANAC
Skyland Prosthetics & Orthotics’ main office features an inspirational wall. are much needed, and the facility holds weekly clinics at the hospital and provides services in the office. The Asheville office has been a dream of Dolen’s for years, but it was nearly derailed Shaun Dolen, CP by the COVID-19 pandemic. Dolen’s idea was to sublease half FACILITY: Skyland Prosthetics the office’s 6,000 square feet to a therapy group that would & Orthotics focus on advanced prosthetic rehabilitation. “Technology has OWNERS: advanced so much in recent years, Pippa Dolen and we felt our patients might not be Shaun Dolen, CP maximizing their potential with the prostheses,” he says. Dolen LOCATIONS: formed a separate entity with the Headquarters in therapy group and was ready to Fletcher, North open the office when everything Carolina, plus shut down in March of 2020. The satellite offices O&P office and the therapeutic division were finally able to open HISTORY: eight months later. Today, says 42 years Dolen, “it’s producing really great outcomes for our patients.” Another advantage of the Asheville office is its location within walking distance of a hospital associated with the U.S. Department of Veterans Affairs The ribbon-cutting cere- (VA). “We’ve had a VA contract mony at the Asheville, since 1979, and now we literally North Carolina, office, just walk across the street to which opened last year
see our patients,” he says. “This is helpful for veterans when coordinating their appointments, reducing travel issues.” While Skyland has leveraged a wide range of marketing strategies, including billboard advertising, radio spots, television promos, and even advertising in movie theaters, Dolen has found social media to be enormously effective. One staff member regularly updates Skyland’s website and Facebook page, where the practice can share news, patient stories, and education directly with the community. The facility also focuses on increasing Google reviews. “Our own surveys show we have an exceptional 98 percent satisfaction rate, and we want the public to know it, so we want to increase the number of online reviews,” Dolen says. Among the facility’s community activities, Dolen is particularly proud of its Amputee Appreciation Day, an annual event that brings together Skyland patients and individuals with limb loss from across the region for a day of music, food, and special stations where patients can try specific athletic activities and different components. Skyland’s entire team is on hand for adjustments and questions in what results in a morale booster for both patients and employees. Dolen attributes the success of his practice to the dedication and teamwork of everyone employed at Skyland. “I’m blessed as an owner because every team member takes their role in this business seriously,” he says. “It’s the clinicians, the techs, the billing and admin staff—every person at Skyland is a cog in the wheel, and they keep us rolling in the right direction.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at email@example.com.
PHOTOS: Skyland Prosthetics & Orthotics
his wife, Pippa Dolen, launched Skyland Prosthetics & Orthotics in Fletcher, North Carolina. Nine years later, their son, Shaun, joined the practice, becoming a certified prosthetist in 1996. Bruce died unexpectedly in 1995, but Pippa and Shaun were determined not to sell the business. Their resolve paid off, and Skyland is thriving. Today, the 6,000-squarefoot company headquarters is still in Fletcher, but the facility has expanded to include satellite locations in Sylva and Asheville—growing the practice’s reach from western North Carolina to upstate South Carolina, east Tennessee, and northeastern Georgia. Eighteen employees work at the Fletcher office. The site includes a fabrication lab, where devices are made for all three locations. The facility also features a unique outdoor gait lab. “The purpose is to put amputees in real-world dynamic trials,” explains Shaun Dolen. “The lab has grassy and rocky terrains and features a 70-foot ramp with 12 steps on one end and four on the other. Patients can train on stairs and inclines and traverse uneven surfaces, and clinicians are able to identify patients’ prosthetic needs on these terrains. Everyone loves it!” The satellite office in Sylva, which opened six years ago, is close to the local hospital and staffs three employees onsite. This office serves the nearby Cherokee Indian Reservation. “We’ve had a relationship with the hospital and this unique population for all of our 42 years,” says Dolen. Because Native Americans have high rates of diabetes, Skyland’s services
By DEBORAH CONN
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AOPA’S INSURANCE PROGRAM— Practitioners trust us most because we know your business and we know insurance unlike any other program.
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OIN AOPA EXPERTS FOR the most up-to-date
information on specific topics during these onehour 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.
COMING SOON: WEDNESDAY
KO Policy: A Review
Log on for this in-depth review of the Knee Orthosis Local Coverage Determination and Policy Article. Review the documentation required for coverage, which addition codes may be used with each base code, when you must use the KX modifier, which braces require approval by the Pricing, Data Analysis, and Coding contractor, and more.
Orthotics Clinician’s Corner
Year-End Review and What Is Ahead
Don’t Miss the Virtual Programming From the 2021 AOPA National Assembly
HE IN-PERSON EDUCATION from the AOPA
National Assembly in Boston becomes available on the virtual platform for viewing starting September 16 and will be available for 90 days for paid registrants. In addition, don’t miss the bonus education only available on the Virtual Assembly Platform. Visit AOPA’s website and access the AOPA National Assembly Program for a full list of bonus online education.
SEPTEMBER 2021 | O&P ALMANAC
Welcome New AOPA Members Davidson Prosthetics & Orthotics / dba Renew Prosthetics & Orthotics 146 Medical Park Road, Ste. 102 Mooresville, NC 28117 704/765-9837 Martha Matthews, CPO www.renewpo.com Patient-Care Facility
HE OFFICERS AND DIRECTORS of
the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are EARN made regarding the company’s ability to meet the qualifications and requirements of membership.
100+ CE Credits
Integrity Orthotics & Prosthetics 221 State Hwy. 165, Ste. F Placitas, NM 87043 505/437-3900 Jacque Newman, CO http://integrityoandp.com Patient-Care Facility
Special Thanks to the 2021 PAC Contributors AOPA would like to thank the following individuals for their contributions in 2021 to the O&P PAC:
C AT I
S T I B HI
N O I T A C U
* Due to publishing deadlines this list was created on Sept. 8, 2021. Any donations or contributions made or received on or after Sept. 8, 2021, will be published in a future issue of O&P Almanac.
To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac.
The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and helping elect those individuals who support the orthotic and prosthetic community.
Mike Sotak Frank Snell, CPO, FAAOP Jack Steele, CO, FAAOP Jason Tanner, CP Bernie Veldman, CO Greg Wahl James Weber, MBA Paul Werner, LPO Ashlie White James Young, CP, FAAOP
Joe McTernan Wendy Miller, BOCO, LO, CDME Michael Oros, CPO Sara Peterson, PhD, CPO, FAAOP Jeff Quelet, CPO Rick Riley John Roberts, CPO Peter Rogerson, COA Lesleigh Sisson, CFm
Steven Hoover Teri Kuffel, JD Eve Lee, MBA, CAE William Leimkuehler, CPO James Lewallen, CO James Liston, CP Melanie Liston Mahesh Mansukhani Brad Mattear, CPA, LO, CFo David McGill Martin McNab, CPO
Gerald Bernar, CP Curt Bertram, CPO George Breece Joy Burwell Maynard Carkhuff Tina Carlson, CMP Thomas Costin Michael Fenner, CP, LPO Scott Hebert, CPO Denise Hoffmann Shelly Hogan
O&P ALMANAC | SEPTEMBER 2021
Feature your product or service in Marketplace. Contact Bob Heiman at 856/520-9632 or email firstname.lastname@example.org. 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 wrap-around or D-ring straps, shorter wings, and a Starter SoftKIT™ included. It is easier to adapt ToeOFF® 2 ½ and BlueROCKER® 2 ½ to shoes with lower heel heights because if 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 email@example.com to receive your FREE Product Selection Guide.
ALPS Flex Sleeve (SFX) ALPS Flex Sleeve (SFX) is a prosthetic suspension sleeve made with seamless knitted construction in high-density gel to provide maximum comfort and control for active amputees. With 30-degree preflexion, the SFX effectively allows for ease of bending and reduces bunching behind the knee. The SFX is available in one length and thickness that accommodates most users. Plus, you can choose from two sleek color options—black or beige. For more information, visit www.easyliner.com or call us today at 800/574-5426.
SEPTEMBER 2021 | O&P ALMANAC
Apis custom programs offer practitioners best options and services for patient compliance. All products are covered under risk-free guaranteed-fit promise. We stand firmly behind our words. Call us at 1-888/937-2747.
Small Adult Triple Action® The new Small Adult Triple Action offers true independent adjustment of alignment, range of motion, and stiffness to promote natural, dynamic motion control throughout the gait cycle. Indications: • Stroke • Multiple sclerosis • Cerebral palsy. For additional information, please contact our customer service department at 800/521-2192 or visit BeckerOrthopedic.com.
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.
MARKETPLACE Your Everyday Ambulator Coyote’s new Dynamic Strut AFO is designed to flex and move with the patient, creating a more natural gait and providing energy response while offloading the foot and ankle with a custom thermoformed orthosis. • Designed to flex • Moves with patient • Natural gait • Works great with thermoformed braces • Provides energy response. Our unique varying thickness creates a comfortable natural gait. For more information, call Coyote at 208/429-0026 or visit www.coyote.us.
TASKA HandGen2 After bringing the first waterproof myoelectric hand to its users, TASKA is once more leading the way in innovation, introducing the new industry-compatible dual-button release Quick Disconnect Wrist System—a game-changer in the industry and a life-changer for users. The latest model of the TASKA HandGen2 featuring the new Quick Disconnect Wrist System can be paired with the MC Seal Ring from TASKA and the Fillauer Motion Control End Cap to create a totally waterproof wrist connection. Interested in a demo? Contact us at 801/326-3434 for information. Learn more: www.fillauer.com/taska-hand/.
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.
It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit www.npdevices.com.
Orthomerica EZ-ON™ The EZ-ON™ is specifically designed for easy donning and doffing. This custom ankle gauntlet features a single Dacron® strap to simplify the opening and closing process. The posterior plastic trim is designed to allow a semi-living hinge with greater flexibility. This allows the gauntlet to easily pass over the ankle bones and relax securely into place. The single strap can then be secured with one hand and allows tighter closure for effective ankle stabilization and support. For more information, please visit www.orthomerica.com.
O&P ALMANAC | SEPTEMBER 2021
MARKETPLACE RUSH ROGUE® 2 The newly redesigned, PDAC-verified RUSH ROGUE® 2 provides the most realistic and dynamic foot and ankle motion available. The Vertical Shock & Rotation (VSR) vertical shock offers relief up to 4.24 mm while offering +/- 15 degree torsion, allowing the user to push the foot and themselves to the limits. The RUSH ROGUE 2 is made of our advanced fiberglass composite, which is three times more flexible than conventional prosthetic feet. The roll-through characteristics of the foot provide exceptional energy return with no “dead spot.” The RUSH ROGUE 2 is also available in the PDACverified EVAQ8 elevated vacuum and H2O models. For more information, visit shop.proteorusa.com.
Ottobock C-Leg 4 Your patients trust you to deliver the best care. You commit to their quality of life every time you trust the C-Leg 4. As the original MPK, C-Leg redefined the standard of care for above-knee amputees. Featuring technology to keep your patients safe with real-time adaptation across terrains and speed, this knee has an unmatched, industry-leading track record. After 21 years of innovation, the microprocessor technology of the C-Leg continues to raise the bar for an industry that demands innovation to achieve one primary goal: give amputees the mobility they deserve. For more information, call 800/328-4058 or visit professionals.ottobockus.com.
SEPTEMBER 2021 | O&P ALMANAC
Give your lower-mobility patients the comfort and control they need with the K2 hydraulic Kintrol prosthetic foot. Kintrol is the only K2 hydraulic foot with above-the-footshell, independent DF/PF adjustability, allowing for easy and precise adjustments. Additionally, the active dorsi-assist spring aids in toe clearance during swing phase to help prevent toe stubbing and tripping. The full-length, unbolted fiberglass keel provides optimal flexibility and comfort, resulting in a smooth rollover. Kintrol provides your K2 patients the flexibility, stability, and confidence to be more mobile and independent. For more information, call 800/328-4058 or visit professionals.ottobockus.com.
The Xtern Foot Drop AFO by Turbomed Orthotics Think outside the shoe! This one-of-a-kind 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!
EMPOWERING HUMAN POTENTIAL Their lives are our purpose. Each year we help more than one million people regain their confidence, independence and quality of life. And we’ve been doing it for more than 155 years. All across the country, our team of unsurpassed clinical talent is growing. We’re looking for people who want to make a difference and help lead the future of orthotic and prosthetic care. Experienced clinicians who understand the power of combining clinical practice with scientific research. Experts in our field determined to mentor the next generation of O&P caregivers. Leaders committed to changing lives. Empower your career. Apply today and make a difference.
Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state, or local law.
Opportunities for O&P Professionals
Job Location Key:
ABC or BOC Certified Practitioner Immediate Opening
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Hire employees and promote services by placing your classified ad in the O&P Almanac. Include your company logo with your listing free of charge. Refer to 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.
New Hampshire/Massachusetts FDR Center for Prosthetics & Orthotics is seeking a full-time practitioner, CPO, CP, or CO, to join us in our Southern New Hampshire and Massachusetts offices. We have a supportive team with on-site fabrication, cooperative support and mentoring, competitive salary and benefits, with no weekend calls! We are looking for a certified practitioner who’s selfdriven and energetic and has strong clinical, technical, and communication skills with a willingness to travel locally. If you enjoy working as an integral part of a team and are passionate about providing the best quality care to patients, this is the position for you. Come join our amazing team! For further inquiries or to submit a résumé for consideration, direct email to firstname.lastname@example.org. All inquiries will be kept confidential.
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
Email: email@example.com FDR Center for Prosthetics & Orthotics is an Equal Opportunity/ Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, or veteran status.
ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Job Board 50 or less
For more opportunities, visit: http://jobs.AOPAnet.org. SUBSCRIBE
A large number of O&P Almanac readers view the digital issue— If you’re missing out, visit issuu.com/americanoandp to view your trusted source of everything O&P.
SEPTEMBER 2021 | O&P ALMANAC
WANTED! A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: firstname.lastname@example.org
Ca reer Opportunities... California
CPO-Salinas CPO-Modesto CPOA-Walnut Creek Oregon CPO –Portland CPO –Bend
Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for superior patient care, products and services.
Washington CPO-Richland CO Resident-Richland CPO-Tacoma
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: www.pacmedical.com/careers
A competitive salary, benefits and profit sharing are offered based on position/experience.
Ou r C u l t u re & C om m i t m e n t “ We w i l l s e rve a n d h e l p oth e rs g row p e rs on a l l y , p rofe s s i on a l l y , a n d s tri ve to p u t oth e rs n e e d s fi rs t a n d fore m os t a s d e m on s tra te d b y ou r p os i ti ve a tti tu d e , te a m w ork a n d p rofe s s i on a l i s m . ”
Finding your next job or hire just got easier with the AOPA Career Center. For Job Seekers: Job searching is easy with the pane-view job search page. Set up job alerts, upload your resume or create an anonymous career proﬁle that leads employers to you. For Employers: Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email.
For more information on recruitment options, contact Customer Service at email@example.com or (727) 497-6565.
Log in at jobs.aopanet.org to get started!
8/19/21 8:02 PM
O&P ALMANAC | SEPTEMBER 2021
CALENDAR October 13
KO Policy—A Review. 1 PM ET. For more information, visit www.AOPAnet.org.
One-Day Pedorthic, Orthotic, and Prosthetic Program. POMAC is pleased to announce a one-day pedorthic, orthotic, and prosthetic program to take place at The Marriott New York LaGuardia Airport Hotel (across from LaGuardia airport in East Elmhurst, New York). Contact Drew Shreter at 800/ 946-9170, ext. 101, or firstname.lastname@example.org for more details.
2021 October 1
ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.
Pediatric Gait Analysis and Orthotic Management: An Optimal Segment Kinematics and Alignment Approach to Rehabilitation (OSKAR). Shirley Ryan AbilityLab, Elaine Owen. Online (on-demand and live), 31.5 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/PedsGait.
ABC: Application Deadline for December Certification Exams. Applications must be received by October 1 for individuals seeking to take the December Written and Simulation certification exams. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.
ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.
October 29–December 11
ISPO 18th World Congress. Now virtual. For more information, contact the ISPO World Congress team at email@example.com or call +49/341-678-8237.
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.
November 10 WEBINAR
December 8 WEBINAR
Orthotics Clinician’s Corner. 1 PM ET. For more information, visit www.AOPAnet.org.
Year-End Review and What Is Ahead. 1 PM ET. For more information, visit
ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@ABCop.org, or visit ABCop.org/individual-certification.
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.
SEPTEMBER 2021 | O&P ALMANAC
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
For information on continuing education credits, contact the sponsor. Questions? Email info@AOPAnet.org.
U.S. ISPO Pacific Rim Conference. Waikoloa, Hawaii (Big Island). For more information, visit www.usispo.org.
Orthotic & Prosthetic Innovate Technologies Conference. Minneapolis. For more information, go to http://cecpo.com/documents/OrthoAndProstheticTech_2022_1up.pdf.
September 28–October 1
AOPA National Assembly. San Antonio, TX. For more information, visit www.AOPAnet.org.
January 30–February 3
Hanger Live. Dallas, TX.
AAOP. Atlanta. For more information, visit www.oandp.org/events/event_list.asp?DGPCrSrt=&DGPCrPg=2.
OT World. Leipzig, Germany. For more information, visit www.ot-world.com/index-en.html
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.
Advertisers Index Company Allard USA Inc. ALPS South LLC Amfit Apis Footwear Company Becker Orthopedic Appliance Co. Board of Certification/Accreditation Cailor Fleming Insurance College Park Industries ComfortFit Orthotic Labs Inc. Coyote Prosthetics & Orthotics ESP LLC Ferrier Coupler Inc. Fillauer Hanger Hersco Naked Prosthetics Orthomerica Ottobock PROTEOR USA TurboMed Orthotics Inc.
Page Phone 35 866/678-6548 3 800/574-5426 43 800/356-3668 19 888/937-2747 15 800/521-2192 41 877/776-2200 45 800/796-8495 17 800/728-7950 31 888/523-1600 27 800/819-5980 5 888/WEAR-ESP 29 810/688-4292 9 800/251-6398 51 877/442-6437 1 800/301-8275 25 888/977-6693 37 800/446-6770 C4 800/328-4058 13 855/450-7300 7 888/778-8726
Website www.allardusa.com www.easyliner.com www.amfit.com www.apisfootwear.com www.beckerorthopedic.com www.bocusa.org www.cailorfleming.com www.college-park.com www.comfortfitlabs.com www.coyote.us www.wearesp.com www.ferrier.coupler.com www.fillauer.com www.hangerclinic.com www.hersco.com www.npdevices.com www.orthmerica.com www.professionals.ottobockus.com www.proteorusa.com www.turbomedorthotics.com
O&P ALMANAC | SEPTEMBER 2021
STATE BY STATE Become an AOPA State Rep.
If you are interested in participating in the AOPA State Reps network, email awhite@AOPAnet.org.
Questioning Cuts Updates from Colorado, New York, Oklahoma, and Utah
Each month, State by State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at www.AOPAnet.org/ resources/co-op.
NEW MEMBER RESOURCE ALERT
AOPA has invested in a new resource that allows us to track legislative and regulatory activity related to O&P in every state. We will be updating the state pages on the AOPA Co-OP with alerts as they arise.
SEPTEMBER 2021 | O&P ALMANAC
In response to the advocacy of providers in the state, the Colorado Department of Health Care Policy and Financing issued a statement on September 8 announcing that the rate would be reverted to the original rate prior to the July 1, 2021, reduction. The department also announced that a rate-setting project is being completed to determine the appropriate rate for cranial remolding orthoses. To view the statement and the latest updates, please visit the Colorado page of the AOPA Co-OP.
A coalition of O&P providers in New York continues to push for a budget resolution to increase the Medicaid fee schedule and protect patient access to O&P care in the state. The efforts of the group have gained momentum, supported by the introduction of bicameral legislation (S 7023/A 7892) that, if passed, would direct the New York commissioner of health to conduct a study on rate adequacy for orthotics and prosthetics.
The governor of Oklahoma signed into law a sunset extension, through July 2024, for the Advisory Committee on Orthotics and Prosthetics, which consists of members appointed by the Board of Medical Licensure and Supervision.
AOPA members have reported the removal of more than 50 A and L codes from the Utah Medicaid fee schedule. These codes include cervical, spinal, and upper-limb orthoses, as well as external power for upper-limb and terminal devices. AOPA is looking into this member-reported issue. For additional information, visit the Utah page on the AOPA 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.
Coding and Billing Got You Confused? Attend the Mastering Medicare: Essential Coding and Billing Techniques Seminar in Las Vegas, on November 8-9, 2021. But don’t take our word for it. Attendees have said:
I’ve learned more in the past few days than I’ve learned in the past year.
All practitioners should attend this conference so they can learn to document the correct way and ensure compliance.
For more than 20 years, our faculty have helped thousands of attendees get claims paid, survive audits, collect interest from Medicare, file successful appeals and code miscellaneous items.
The speakers are very knowledgeable and helpful. This is my second time at a seminar and I’m still learning so much.
Tropicana Las Vegas—a DoubleTree by Hilton Hotel & Resort Las Vegas, NV HOTEL: Attendees are responsible for making their own hotel reservations at the Tropicana Las Vegas—a DoubleTree by Hilton Hotel & Resort. Hotel rooms are $59/ night plus a daily resort fee of $25 and tax. Book your room online to receive the group rate. Reserve by October 18.
Each Seminar is updated based on the latest developments, feedback from previous attendees, and needs of the profession. It is two days full of valuable instruction on topics O&P providers face daily, like prior authorization, competitive bidding, Medicare documentation requirements, and new codes. Additionally, 14 CE credits can be earned.
November 8-9, 2021 Register online at www.AOPAnet.org.
For more information, email info@AOPAnet.org.
8/21 ©2021 Ottobock HealthCare, LP, All rights reserved.
The future of O&P care is here
With digital solutions from Ottobock Designed with the iFab EasyScan software solution, the *MyFit TT 3D printed socket* eliminates the use of plaster for a traditional cast, saving your clinic time and money. Affordable and easy to use, the high-perfomance handheld scanner allows you to capture intricate details of your patient’s limb for a precise, customized fit. Ottobock is on the forefront of the digital revolution in O&P care – and the future is now. professionals.ottobockus.com