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The Magazine for the Orthotics & Prosthetics Profession

O CTO B E R 2019

E! QU IZ M EARN

Appeal, Recoupment, and Interest Deadlines

BUSINESS CE

CREDITS PP. 20 & 49

P.18

Cost-Cutting and Profit-Boosting Business Strategies P.38

Preventing Sexual Harassment in the O&P Workplace

BALANCING ACT

TIPS FOR ASSISTING LOWER-LIMB PROSTHETIC PATIENTS P.30

P.46

Patient Self-Assessment and Self-Management Tools P.50

WWW.AOPANET.ORG

This Just In: Highlights and Photos From the 2019 AOPA National Assembly P.22

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contents

OCTOB E R 2019 | VOL. 68, NO. 10

30 | Balancing Act What strategies work well when assisting patients in achieving balance while standing and walking on a prosthesis? Rehabilitation experts discuss the latest assessment tools and outcome measures and share tips for working with fearful or overconfident patients to achieve optimal stability. By Christine Umbrell On the cover: A patient with a lower-limb prosthesis participates in an exercise session geared toward improving balance, via an aquatic walking protocol on an underwater treadmill at the Department of Kinesiology at the University of Alabama in Huntsville.

22 | This Just In

O&P Profession Rides a Perfect Wave Nearly 2,400 O&P stakeholders met last month to exchange ideas and best practices, attend "hot topic" educational sessions, and view the latest O&P products on the trade show floor in San Diego. See photos and read highlights from the 2019 AOPA National Assembly.

OCTOBER 2019 | O&P ALMANAC

38 | Attention to Detail Many O&P companies are keeping closer track of expenses and identifying areas to cut costs and boost profits in a challenging economic climate. Learn how some business owners are installing electronic dashboards, optimizing staff, examining outsourcing decisions, and focusing on patient retention and referrals. By Michael Coleman

44 | Proposals and Consequences Two of the provisions in CMS-1713-P, a proposed rule focusing on End-Stage Renal Disease and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), could have a significant impact on O&P facilities. Learn how potential changes to the DMEPOS fee schedule and a proposed master list of DMEPOS items may affect your business practices.

PHOTO: Michael Mercier, UAH Office of Marketing and Communications

COVER STORY

FEATURES

“I've been lucky to achieve some of my goals. But my ultimate goal is to support others, so they can achieve theirs.” Markus Rehm 3x Paralympian and CPO

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contents

PRINCIPAL INVESTIGATOR Daniel J. Lee, PT, DPT, GCS, COMT......................................................................50

Meet a technology-minded professor at Touro College School of Health Sciences who develops apps and tools for O&P clinicians and consumers.

DEPARTMENTS Views From AOPA Leadership......... 6 Traci Dralle, CFM, encourages members to join a committee

AOPA Contacts.......................................... 8 How to reach staff

Numbers...................................................... 10 At-a-glance statistics and data

Happenings................................................12

Research, updates, and industry news

People & Places........................................16 Transitions in the profession

COLUMNS Reimbursement Page.......................... 18

Check Your Schedule

Timelines and deadlines for appeals, audits, and more CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

P.18

Compliance Corner...............................46

Harassment Is Serious Business for Practice Owners

Preventing sexual harassment in the O&P workplace CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

P.46

P.12 AOPA News...............................................58 AOPA meetings, announcements, member benefits, and more

Member Spotlight................................. 54 n n

PSYONIC

O&P PAC Update ....................................61

Thompsonâ€™s Custom Orthotics & Prosthetics

Welcome New Members.................. 62 Careers........................................................ 64 Professional opportunities

Marketplace............................................. 66 Ad Index..................................................... 69 Calendar..................................................... 70 Upcoming meetings and events

Ask AOPA................................................... 72 P.54 4

OCTOBER 2019 | O&P ALMANAC

P.56

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VIEWS FROM AOPA LEADERSHIP

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

Find Your Niche Within AOPA

N CASE YOU ARE like me and only have five or 10 minutes to scan all of the articles in this latest O&P Almanac right now because that is all the time you have for lunch today, I am going to jump right to the point. We want you, the employee of an AOPA member company, to share your ideas, expertise, and insights by volunteering to serve on one of AOPA’s committees or workgroups. Each term is only two years, and the amazing AOPA staff does most of the heavy lifting based on the guidance and direction provided by each committee. By volunteering, you will ensure we continue AOPA’s mission to improve patient access to quality orthotic and prosthetic care through advocacy, research, and education. Below is the current list of AOPA committees and workgroups and a quick overview of their missions. • Assembly Planning Committee: Ensures the AOPA National Assembly provides the very best experience in O&P education, networking, and exhibitions for both attendees and exhibitors. • Coding and Reimbursement Committee: Analyzes and researches issues relating to the appropriate coding for O&P devices, and develops the association’s opinions and recommendations on appropriate coding. • Government Relations Committee: Provides an opportunity for broad member input in setting the association’s public policy positions, establishing annual policy objectives, and monitoring the progress of the government affairs program’s implementation. • Government Relations Contributions/Fundraising: Oversees fundraising campaigns and contributions for the O&P PAC and Capitol Connections in accordance with the organization’s advocacy initiatives. • Member Services Committee: Advises the AOPA Board of Directors on services and products required to meet members’ needs, such as appropriate dues structure, levels and prices, onboarding process for new AOPA members, reviewing the current products in the AOPA Bookstore, and reviewing Supplier Plus marketing. • Operating Performance and Compensation Workgroup: Encourages patient-care facility members to use valuable benchmarking data to measure and improve their business operations. • Research Committee: Advises the AOPA Board of Directors on which research initiatives to pursue and offers guidance on appropriate budgetary considerations, including the Prosthetics 2020 and Orthotics 2020 initiatives. • State Representatives: Serves the O&P community as the eyes and ears for reporting and advising AOPA on state payors’ (Medicaid, private, worker’s compensation, etc.) proposed and enacted legislation and regulations in each state. • Veterans Affairs Committee: Establishes efficient lines of communication between AOPA and representatives of the U.S. Department of Veterans Affairs at both the national and local levels, and communicates issues of importance to AOPA members and to the interested public.

As you can see, there’s something for everyone! Contact AOPA for details. Traci Dralle, CFM, is vice president of AOPA.

OCTOBER 2019 | O&P ALMANAC

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Vice President Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Immediate Past President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Executive Director/Secretary Eve Lee, MBA, CAE AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Edmonds, WA J. Douglas Call, CP Virginia Prosthetics & Orthotics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Elizabeth Ginzel, MHA, CPO NovaCare P&O, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN Rick Riley Thuasne USA, Bakersfield, CA Linda M. Wise WillowWood, Mount Sterling, OH

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AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org GOVERNMENT AFFAIRS Justin Beland, director of government affairs, 571/ 431-0814, jbeland@AOPAnet.org COMMUNICATIONS, MEMBERSHIP & MEETINGS

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

STRATEGIC ALLIANCES

Joy Burwell, director of communications and marketing, 571/431-0817, jburwell@AOPAnet.org

Ashlie White, MA, director of strategic alliances, 571/431-0812, awhite@AOPAnet.org

Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

O&P ALMANAC

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876 8

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org

OCTOBER 2019 | O&P ALMANAC

Eve Lee, MBA, CAE, executive director/publisher, 571/431-0807, elee@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2019 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. COVER PHOTO: Barbara Ries Photography/UCSF

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac19 for advertising options!

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NUMBERS

Do You Know Your Millennial Patients?

Younger adults are more likely to go online for healthcare answers—and less likely to have insurance Millennials—ages 22 to 38—are different than older nonsenior adults in several key ways—and it’s important that O&P professionals recognize these differences. A new report, “Millennials: Digital Natives Disrupting Healthcare Trends” from the Transamerica Center for Health Studies, provides details about the factors that influence millennials’ healthcare decisions, their access to healthcare, and their current state of health.

GENERATION MOST LIKELY TO BE UNINSURED • AGE 22-38 •

• AGE 39-53 •

• AGE 54-64 •

16 Percent

12 Percent

8 Percent

Percentage of millennials without healthcare insurance

WHY UNINSURED MILLENNIALS DO NOT OBTAIN COVERAGE

60 Percent

26 Percent

11 Percent

Say health insurance is too expensive

Say paying their own health expenses and the ACA tax penalty is less expensive than the available health insurance options

Say they did not have time to purchase health insurance before the deadline

GENERATION MOST LIKELY TO SEEK INFORMATION ONLINE

36 Percent

33 Percent

Percentage of millennials who rely on the Internet to gather information about their health, health insurance, and the healthcare system

Percentage of Gen X who rely on the Internet for this information

Percentage of baby boomers who rely on the Internet for this information

MILLENNIALS FREQUENTLY DIP INTO SAVINGS FOR SIGNIFICANT OUT-OF-POCKET HEALTHCARE EXPENSES 52%

46% 46%

44%

38%

33%

29%

38% 40%

16% 6% 3%

Pay using savings

Pay via credit card

MILLENNIALS | 10

OCTOBER 2019 | O&P ALMANAC

Pay via 401(k) withdrawal GEN X |

Pay using disposable income

BABY BOOMERS

Percentage of baby boomers without insurance

MANY MILLENNIALS CANNOT AFFORD HEALTHCARE

25 Percent

Percentage of millennial women who cannot afford routine healthcare expenses

15 Percent

Percentage of millennial men who cannot afford routine healthcare expenses

Eight in 10 millennials rate their health as “excellent” or “good.” … However, uninsured millennials (76 percent) and millennials who have Medicaid (58 percent) are less likely to rate their health as “good” or “excellent.”

—“Millennials: Digital Natives Disrupting Healthcare Trends,” Transamerica Center for Health Studies

SOURCE: “Millennials: Digital Natives Disrupting Healthcare Trends,” Transamerica Center for Health Studies

43 Percent

Percentage of Gen X without insurance

Happenings RESEARCH ROUNDUP

Lower-Limb Amputees Benefit From Sensory Feedback Restoration An international team of researchers studied the effects of surgical implantation of intraneural stimulation electrodes into the residual tibial nerves of two transfemoral amputees and found that the subjects experienced several benefits as a result of the surgery. The researchers, led by scientists at the University of Zurich, evaluated the participants while they were using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. The componentry comprised Iceross® liners, Direct TF Sockets, Pro-Flex® XC feet, and Össur’s bionic Rheo Knee® XC. Data from the knee and a sensorized insole was used to drive neural stimulation via the sensors, which reportedly enabled the users to experience real-time sensations of knee motion and the sole of their foot touching the ground. The researchers concluded that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural

A researcher adjusts the prosthesis on volunteer Savo Panic.

OCTOBER 2019 | O&P ALMANAC

study and more research is needed, the findings encourage the field to continue researching the technology and offer a glimpse into the possible future of lower-limb prosthetic solutions.” Although learning to use a prosthetic leg can be a long and strenuous process, with users experiencing variable outcomes, “one positive of this study was the presentation of a method that was found to require little training and yet was perceived to be very natural to the user,” added DeRoy. “Combining that improved learning experience with a potentially improved clinical outcome could prove important for future prosthetic care.” Results of the study were published in the September issue of Nature Medicine. The researchers plan to undertake expanded investigations into the clinical utility of neuroprostheses that restore sensory feedback.

PHOTOS: University of Zurich/ © Federica Barberi

sensory feedback compared to the no-stimulation trials. The participants also exhibited reduced phantom limb pain with neural sensory feedback. “This was the first time above-knee amputees have been reported as being able to ‘feel’ their prosthetic foot and knee in real time,” said Kim DeRoy, executive vice president, research and development, at Össur. “The findings are significant because they show that it is both possible and may have a considerable benefit for amputees in the future with regard to their ability to walk faster, with more confidence and while reducing their energy consumption. While this Metabolic preparation: researcher Giacomo was a proof-of-concept Valle and volunteer Savo Panic

HAPPENINGS

Prosthesis Use May Require More Cognitive Demand of Transfemoral Amputees Than Transtibial Amputees

IMAGE: Getty Images

While both transfemoral and transtibial amputees share some common neurocognitive features during dual-task walking with a prosthesis, there also are some important differences, according to a new study from the University of Maryland-College Park and Walter Reed National Military Medical Center. Most notably, walking with a prosthesis while concurrently performing a cognitive task imposes additional cognitive demand in individuals with more proximal levels of amputation, according to the researchers. This research, led by Rodolphe J. Gentili, PhD, an assistant professor in the Department of Kinesiology, and his PhD student Emma Shaw, in collaboration with Bradley D. Hatfield, PhD, a professor from the Department of Kinesiology and Brad D. Hendershot, PhD, facility research director with the DoD-VA Extremity Trauma and Amputation Center of Excellence, along with their co-authors, recorded 12 transtibial and eight transfemoral subjects’ electroencephalography (EEG) measurements as they performed tasks of varying cognitive demand while being seated and while walking. No significant difference in selfselected walking speeds between the two groups was detected. Accuracy in completing the cognitive tasks was similar between both groups. However, several between-group differences were apparent in the response time to perform the cognitive task as well as in the evaluation of EEG activity, suggesting there is an additional impact on neurocognitive processes to utilize a transfemoral prosthesis, compared to a transtibial prosthesis, while dual-task walking, according to the researchers. The work can be used to inform the development and assessment of

rehabilitative interventions for individuals with lower-limb prostheses, according to the authors. “It is important for prosthetists to be aware that this novel research effort is expanding traditional behavioral work by examining cognitive-motor processes underlying dual-task performance in individuals with lower limb loss via brain dynamics analyses,” explained Gentili. “Compared to purely behavioral evaluations, a more inclusive approach that combines behavior and brain dynamics has the potential to provide a more comprehensive assessment of these patients by estimating how much mental effort is deployed during their performance on a dual-task and can thus serve as an index of their degree of efficiency.” The research enables a deeper understanding of how individuals with different levels of lower limb loss recruit their cognitive-motor processes to dualtask walk under various task demands, according to Gentili. “Our work suggests that a greater neuromechanical loss results in increased engagement of cognitive-motor resources, resulting in greater mental effort to possibly ensure safe walking while executing a secondary

cognitive task; however, further examinations are needed to confirm these findings to a larger population and different situations,” he said. “Given that patients with lower limb loss often report fear of falling and cognitive burdens of ambulating with a prosthesis—for example, closely monitoring terrain and/or device control/actuation—it is important to objectively evaluate the cognitive-motor function in this patient population,” said Hendershot. “At the highest level, we aimed to first evaluate these outcomes across individuals with varying levels of limb loss, using a variety of methodologies, to better understand and characterize the population.” However, future extensions of this work, more specific to prosthetists and the rehab team, will include studies focused on near- and longer-term experience with acclimation to a particular prosthesis or design feature, according to Hendershot. “Such efforts may then assist with guiding optimal device prescription and/ or training practices that can facilitate rehab, recovery, and reintegration, both within the community and return to work or duty, following limb loss.” While the study was conducted in controlled laboratory conditions, “next steps” will involve examining cognitive-motor processes in the same patient population during dual-task walking by combining both behavioral and brain dynamics analyses in more realistic situations similar to those encountered in the real world, according to the authors. The results were published in “A Comparison of Mental Workload in Individuals With Transtibial and Transfemoral Lower Limb Loss During Dual-Task Walking Under Varying Demand” in the Journal of the International Neuropsychological Society.

The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

O&P ALMANAC | OCTOBER 2019

HAPPENINGS

PATIENT COMMUNICATIONS

Are Your Patients Keeping Secrets? Prosthetists and orthotists should be aware that some patients may not provide a complete picture of their physical and mental health. In fact, nearly half of U.S. patients don’t tell their physicians about life-threatening risks such as domestic violence, sexual assault, depression, or thoughts of suicide, according to a new study conducted by University of Utah Health. More than 40 percent of respondents to national online surveys reported failing to tell their healthcare provider about one of the four health threats. The main reason for withholding information was embarrassment or fear of being judged. Women and younger patients were more likely to withhold information. The findings add to evidence of discomfort and a lack of trust between some patients and their healthcare providers, according to study author Andrea Gurmankin Levy, PhD. “For physicians to achieve your best health, they need to know what you are struggling with,” said study author Angela Fagerlin, PhD. The results were published online in August in JAMA Network Open.

OCTOBER 2019 | O&P ALMANAC

INSURANCE INSIGHTS

Payors Draft Revisions to Medical Necessity Criteria for Microprocessor Knees Blue Cross Blue Shield (BCBS) Illinois, BCBS Montana, BCBS New Mexico, BCBS Texas, and Health Care Service Corp. have released revised draft policy with proposed changes to criteria for medical necessity criteria and supporting information. The following proposed revisions were released in August: • Revised medical necessity criteria for microprocessor-controlled and -powered knee (MPK); replaced K-PAVET score requirement with Medicare’s classification of functional levels K2, K3, or K4; revised criterion regarding physical ability to add strength and balance as examples. • Removed experimental, investigational, and/or unproven policy statement for the Genium Bionic Prosthetic System microprocessor-controlled knee.

• Revised not medically necessary policy statement for MPK to replace K-PAVET scores with MFL 0. • Revised medically necessary policy statement for a four-axis, hydraulic, or pneumatic hip joint (e.g., Helix 3D Hip [OttoBock]) to replace K-PAVET score requirement with MFL K3 or higher, and changed use in conjunction with the OttoBock C-leg from a requirement to an option. • Added table of Medicare’s classification of functional levels to the coverage section. • Removed all scoring information for the K-PAVET guide from the coverage section. • Updated notes in the coverage section. Updated description, rationale, and references sections.

ETHICS UPDATE

Join AOPA in Celebrating Corporate Compliance & Ethics Week O&P companies are encouraged to take part in “ethical activities” during the week of November 3-9, when AOPA will celebrate Healthcare Compliance & Ethics Week. The Health Care Compliance Association provides training, certification, networking, and other resources to members, which include compliance officers and staff from a wide range of organizations. Mark your calendar to participate in these webinars or audiorecordings: • Monday, November 4: Webinar: Cyber Top 10 Safety Rules, Presented by Rebecca Snell

• Tuesday, November 5: Audiorecording: Willful Neglect: Two Words That Can Cost You Your Business • Wednesday, November 6: Webinar: On Sexual Harassment in the Workplace, Presented by Joyce Perrone • Thursday, November 7: Webinar: Compliance in the Workplace, Presented by Teri Kuffel, JD • Friday, November 8: Audiorecording: Cybersecurity 101 Visit the AOPA website for more information or to register.

HAPPENINGS

MEETING MASHUP

Hanger Rebrands Annual Education Fair

Gaylord Opryland Hotel and Convention Center in Nashville Hanger’s annual education conference is moving to the Gaylord Opryland Hotel and Convention Center in Nashville in 2020 and 2021, followed by Dallas in 2022 and 2023. Formerly known as the Hanger Education Fair and National Business Meeting, the event has been reimagined and is now named Hanger LIVE, and features a new logo, look, and feel.

The Hanger LIVE event will continue to offer live collaboration between Hanger colleagues and live interaction with manufacturers and industry partners. The event also will provide clinical and business-focused educational offerings and discussions, visibility to new technology, and access to exhibitors, according to the company.

APPEALS UPDATE

Maximus Federal Services Assumes QIC Duties Maximus Federal Services Inc. replaced C2C Innovative Solutions as the Qualified Independent Contractor (QIC) on Sept. 1, 2019. Going forward, all reconsideration requests, or level two appeals, should be submitted to Maximus Federal Services. Requests can be submitted in writing to the following address: Maximus Federal Services Inc. Medicare DME 3750 Monroe Avenue, Ste. 777 Pittsford, NY 14534-1302 Reconsideration requests also may be submitted via the QIC Appeals Portal at https://qicappeals.cms.gov.

AMPUTEE ATHLETICS

Gearing Up for ‘Mighty’ Paralympic Games “Someity” has been announced as the mascot for 2020 Paralympic Games in Tokyo, scheduled to take place August 25-September 6. Someity, pronounced soh-may-tee, is “a cool character with cherry blossom tactile sensors and super power,” according to the Paralympics website. “It can send and receive messages telepathically using the cherry blossom antennae on both sides of its face. It can also fly using its ichimatsupattern cloak. It is usually quiet, but it can exhibit great power when necessary. It embodies Paralympic athletes that demonstrate superhuman power.” The mascot’s name comes from “someiyoshino,” a popular cherry

blossom variety, and additionally echoes the English phrase “so mighty.” The mascot was chosen to represent Paralympic athletes who overcome obstacles and redefine the boundaries of what is possible. Between December 2017 and February 2018, students at more than 75 percent of the elementary schools in Japan and at several overseas Japanese schools took part in a selection process and voted for their favorite set of mascot designs.

FAST FACT

Uninsured Rate on the Rise In 2018, 8.5 percent of people, or

27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent, or 25.6 million).

—“Health Insurance Coverage in the United States: 2018,” U.S. Census Bureau.

O&P ALMANAC | OCTOBER 2019

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Jeffrey Cain, MD, has been named chair of the Amputee Coalition Board of Directors. Cain is a family physician who has taught and practiced at the University of Colorado School of Medicine and is a champion for amputee advocacy. He Jeffrey Cain, MD has served the Amputee Coalition as a member of the Board of Directors and a past member of its Scientific & Medical Advisory Committee. He also is the founding chair of the Amputee Coalition’s Advocacy Committee, and he led the Coalition’s efforts to successfully pass the first state law to require coverage of prosthetic devices in Colorado in 2001. Cain, who is a bilateral below-knee amputee, also is a past president of the American Academy of Family Physicians and a co-founder of Tar Wars, the national youth tobacco-free education program. “We are excited that Dr. Cain has been selected as the next board chair for the Amputee Coalition. He will continue working with the limb loss and limb difference community to advance its crucial efforts around access to care and ensuring no one goes through their journey alone,” said Mary Richards, Amputee Coalition president and chief executive officer. “The Coalition is confident that Dr. Cain will bring critical experience and knowledge to this new role. We look forward to his leadership and interest in growing the organization’s support and services for a deserving community.” “When we combine the stories, passion, and commitment of people living with limb loss, we can accomplish anything, whether as individuals or as an advocacy organization,” said Cain. Jordan Carda, MOP, has joined Missouri-based Prosthetic and Orthotic Care Inc. (P&O Care) as a resident prosthetist and orthotist. Carda will work with practitioners in all three P&O Care clinics to gain additional experience in patient evaluation Jordan Carda, MOP and assessment, developing customized treatment plans and mastering the procedures and fabrication processes. Having earned both his bachelor of science and master of science in orthotics and prosthetics degrees from Concordia University in St. Paul, Minnesota, Carda will complete an 18-month, full-time residency program with the P&O Care team. At the completion of the program, he will be eligible to apply for certification through the American Board for Certification in Orthotics, Prosthetics, & Pedorthics. “I knew from an early age that I wanted to be in the medical field,” said Carda, a native of Belgrade, Minnesota. “Throughout high school, I found a passion for the orthotic and prosthetic profession.” When deciding on residency programs, Jordan says P&O Care caught his attention because he “noticed they had great reviews from patients, and I was impressed with the caliber and background of the practitioners. I also recalled professors using articles from P&O Care in my classes when we discussed prosthetics and componentry.” 16

OCTOBER 2019 | O&P ALMANAC

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Endolite is now Blatchford and has launched a new global brand. The new brand identity “forms a strong foundation for our ambitious mission: to overcome mobility limitations and improve the life of every person we meet,” according to the company. Fillauer Companies Inc. has signed an agreement to acquire Therapeutic Recreational Systems Inc. (TRS), an innovator in body-powered, upperlimb prosthetic devices. The transaction is scheduled to close by the end of October 2019. Following the closing, TRS will maintain its operations in Boulder, Colorado, and continue to service customers directly. Bob Radocy, TRS’s founder and chief executive officer, will remain with the organization to provide transitional leadership and to advance the research and development, education, and marketing support of the TRS product lines, as well as Fillauer’s Hosmer product offering. “By combining TRS’s expertise with our resources and technology, we will continue to build the future of upperlimb prosthetics for our customers in the United States and around the world,” said Fillauer Chief Executive Officer Michael Fillauer.

THE LIGHTER SIDE

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YEARS 19

07 - 2 01 9

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REIMBURSEMENT PAGE

By DEVON BERNARD

Check Your Schedule

E! QU IZ M

Know the timelines and deadlines to increase your chances of reimbursement and appeals success

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

HE MAJORITY OF THE Round

2021 Competitive Bidding Program’s deadlines have passed—most notably the Sept. 18, 2019, deadline to submit bids and upload all required documentation. To review the remaining timelines and timeframes for the Round 2021 Competitive Bidding Program, read the Reimbursement Page in the July 2019 O&P Almanac. This month, we will review some of the other deadlines and timeframes that will be meaningful to staff at your O&P facility.

New Medicare ID Cards

As of April 2019, all new and existing Medicare beneficiaries should have received their new Medicare identification (ID) card and Medicare Beneficiary Identifier (MBI) to replace the Health Insurance Claim Number (HICN).

OCTOBER 2019 | O&P ALMANAC

EARN

BUSINESS CE

CREDITS P.20

By now, everyone should have begun transitioning to using the new cards. The new cards with the MBI number are different in a couple of ways from the old Medicare ID cards. The HICN on the old cards was based on the beneficiary’s Social Security number, but the MBI is randomly generated, is 11 characters long, and includes both numbers and uppercase letters (excluding S, L, O, I, B, and Z). Each MBI is unique to the beneficiary—even spouses have separate MBIs—and since they are unique, they must be treated as personal health information and protected accordingly. The new cards include the beneficiary’s name but no longer have a signature line or list the beneficiary’s gender. However, the new cards still indicate the beneficiary’s eligibility and effective dates. Currently, the durable medical equipment Medicare administrative contractors (DME MACs) and CMS are in a transition period, and—for now—will respond to your Medicare-covered transactions (claim submissions, status inquiries, benefit inquiries, etc.) with the identifier of your choosing, either the HICN or MBI. For example, if you submitted a claim with a HICN, then the explanation of benefits/remittance advice will use the HICN. In addition, they will provide you with the patient’s MBI. Beginning on Jan. 1, 2020, however, you will be required to use MBIs for all Medicare-covered transactions—with a few exceptions. For example, there is an exception for any appeals you may file with dates of service prior to Jan. 1, 2020. In addition, for any claim status inquiries with a date of service prior to Jan. 1, 2020, you may use either the HICN or MBI.

REIMBURSEMENT PAGE

NSC Timeframes

For the most part, the National Supplier Clearinghouse (NSC) sticks to a 30-day timeframe—except for the processing of enrollment, re-enrollment, and revalidation applications, as these are processed in the order they are received. If you update or make any changes to your business—for example, adding or removing services, changing hours, or moving to a new location—you are required to notify NSC within 30 days of the change. This requirement is clearly stated in Supplier Standard 2. The ramifications of not updating this information in a timely manner will vary, but it may result in having your supplier number revoked; in essence, you can lose your billing privileges, and this revocation could last up to three years in extreme cases. NSC allows a 30-day timeframe to respond to any requests for additional information. Once you have paid your application fee and submitted your enrollment/revalidation form, NSC will review the form. If the form is missing information, NSC may request additional information from you to complete the revalidation/enrollment process. You must respond to all additional

information requests within 30 days because failure to submit a complete and valid revalidation application or respond in a timely manner to requests may result in the deactivation of your supplier number and billing privileges, or delay your enrollment process. In general, prior to any revocation or suspension of your Medicare billing privileges and supplier number, you will receive a certified letter outlining why your billing privileges are about to be revoked. The letter will state when the revocation will take effect, which is normally within 30 days of the postmarked date on the letter. The revocation is not a given; you may appeal the revocation and possibly even stop it before it happens. To do this, you must create and submit what is known as a corrective action plan (CAP). The CAP must be submitted within 30 days of the postmarked date on the letter of revocation. It is appropriate to submit a CAP if you can show that NSC made a factual mistake in its review, of if the noncompliance issued cited in the revocation letter has been addressed and corrected. You also should include assurances that you will comply in the future.

Appeal, Recoupment, and Interest Deadlines

Failure to submit a complete and valid revalidation application or respond in a timely manner to requests may result in the deactivation of your supplier number and billing privileges, or delay your enrollment process.

Even though it is not part of the official appeals process, the first unofficial step in fighting a denial is to request a reopening. The reopening allows you to fix minor clerical errors, such as wrong date of service, which may have caused the claim denial and allows the DME MAC to readjudicate your claim correctly. Your deadline to request a reopening is one year from the date on your remittance advice—the date your claim was adjudicated. Remember that you may not use the reopening process to fix all minor clerical errors. For example, you may not use a reopening to add or change the following modifiers: GA, GZ, KX, or GY. You also may not use the reopening process for claims that were rejected or returned

Your request for redetermination must be filed within 120 days after you receive the official notice of initial determination.

To Do:

File Request

3 as incomplete or unprocessable. The first official level of the appeals process is redetermination, and the clock for the redetermination timeline begins when you receive the official notice of denial or recoupment request. The official notice of initial determination is presumed to be received five days after the date provided on the notice. Your request for redetermination must be filed within 120 days after you receive the notice. If you don’t file a redetermination within the 120-day window, you may not proceed to the next level because your appeal will not be processed unless you can show “good cause.” Good cause would apply if you were provided incorrect or incomplete information about the claim or appeal by any official sources, or if you experienced a situation that was beyond your control, such as a natural disaster. The second level of appeal, the reconsideration, has a slightly longer timeline for completion. You have 180 days to file your reconsideration request. The 180 days begins with the receipt of your redetermination results notice. Once again, 180 days is a hard deadline, and nothing can be filed on day 181 or beyond unless you can show good cause. O&P ALMANAC | OCTOBER 2019

REIMBURSEMENT PAGE

The last three levels of the appeals— the administrative law judge (ALJ), the Departmental Appeals Board/Medicare Appeals Council review, and the federal court review—all have the same timeframe or deadline. All requests for each of these levels must be filed within 60 days of the official receipt of outcomes or your official letter from the previous level. If at any point you cannot meet the 60-day deadline, your appeal requests will be dismissed—unless you can document and demonstrate good cause. The one exception is taking your appeal to the final level, the federal court review; if you cannot make the deadline, your appeal rights have ended. If your appeal involves an overpayment demand letter, be aware of the timelines associated with recoupments and interest calculations. First is the timeline to make sure that you are not being charged any interest on the amount being recouped. If you repay Medicare within 30 days of receiving the overpayment request letter, you will not have to pay any interest to Medicare, as Medicare interest is calculated per 30-day periods. Second is the 40-day deadline; if, after 40 days of receiving your demand letter, no payment(s) are made against the overpayment amount, Medicare will begin to offset your future claims until the recoupment amount and any accrued interest has been paid in full, as interest is accrued on 30-day intervals. It is important to stress that if you wish to be able to collect interest from Medicare, you must not voluntarily refund the money or voluntarily allow Medicare to offset your claims. To delay the recoupment process or the offsetting of future claims, you have 30 days from when you first receive the overpayment demand letter to take action. You must file your redetermination request (the first level of appeal) within 30 days of receiving the overpayment demand letter, rather than the traditional 120-day timeframe to file a first-level appeal. If the request for a redetermination is filed after these 30 days, the recoupment process will resume as normal, but will be halted once the request has been submitted and received. 20

OCTOBER 2019 | O&P ALMANAC

As you proceed to the reconsideration level of appeal, you may continue to have the recoupment process postponed. To do this, you must file the reconsideration request within 60 days of receiving the redetermination decision letter. This is far shorter than the previously discussed 180 days. If you file your reconsideration request after this 60-day deadline has passed, the recoupment process will begin again, but as soon as you file your request the recoupment process will cease. Even though you may postpone the recoupment process, you may not postpone or extend the accrual of interest. Also, the ability to stop the recoupment process ends 30 days after your receive the reconsideration decision letter—this means that 30 days after the second level of appeals has concluded, Medicare will continue with the recoupment process, even if you continue to proceed through the appeals process to the ALJ level.

ADR Timeframes

Normally, when you have a claim that is being audited, you will receive an additional documentation request (ADR).

Each type of audit—for example, recovery audit contractor; comprehensive error rate testing; or target, probe, educate—will set the timeframe you have to respond to the ADR. However, most auditing bodies follow the 45-day timeline. This means that you must submit all of the pertinent documentation requested to the auditing entity within 45 days—or it is likely you will automatically fail the audit. These are just a few of the examples of timeframes imposed by CMS and their contractors. 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

This Just In

O&P Profession Rides a Perfect Wave in San Diego Clinicians, business owners, and stakeholders reveled in networking and educational opportunities at the AOPA National Assembly

EARLY 2,400 O&P STAKEHOLDERS convened in San

Diego for the 102nd National Assembly last month, bringing together clinicians and business owners, educators, manufacturers, innovators, and related healthcare professionals to focus on the changes occurring within the O&P arena. Speakers with clinical, business, and research expertise discussed hot topics and innovative approaches during the educational sessions, and hundreds of exhibitors shared the latest products and technologies.

OCTOBER 2019 | O&P ALMANAC

This Just In

gne Toa a p m a h C

The event kicked off Wednesday, September 25, with the Welcome to San Diego Grand Opening Reception and a keynote presentation from Lanny Boswell, CAPT, USN (Ret), PT, PhD, OCS, who was the Commanding Officer for the Military Hospital Ship USNS Comfort’s medical treatment facility. Boswell spoke about the importance of orthotics and prosthetics from a military perspective, and shared what he learned as the head of the Navy Health Research Center Warfighter Performance Lab and as chair of the Congressionally Directed Medical Research Programs O&P Outcomes Programmatic Panel. AOPA President Jim Weber, MBA, opened up the 2019 Exhibit Hall with a champagne toast sponsored by Blatchford (formerly Endolite). Attendees took the opportunity to begin counting their steps for the Step It Up Challenge! that was held throughout the event, sponsored by MD Orthopaedics. AOPA Executive Director Eve Lee, MBA, CAE, addressed attendees to start the day on Thursday, highlighting the importance of AOPA’s support of its members. A full day of clinical and business sessions—including the famous Thranhardt Lecture Series—was followed by a concert from Montgomery Gentry, with proceeds benefitting the Veterans Stride Foundation.

ess S l a r e n e ing G

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Right, Lanny Boswell, CAPT, USN (Ret), PT, PhD, OCS, gave the keynote presentation during the Welcome to San Diego Grand Opening Reception.

Left, AOPA President Jim Weber, MBA Right, AOPA Executive Director Eve Lee, MBA, CAE

rt for Benefit Conce ndation u o F e d i tr S s n a Veter Montgomery Gentry played at the benefit concert on Thursday evening.

O&P ALMANAC | OCTOBER 2019

This Just In

ment e v e i h c A e m ti Life

Award

Jim Kaiser, CP, LP, was honored with the 2019 AOPA Lifetime Achievement Award.

AOPA President-Elect Jeffrey Lutz, CPO Friday began with the AOPA Annual Membership Meeting. The results of the AOPA election were announced, and Weber offered reflections on his past two years as president. Jeffrey Lutz, CPO, AOPA president-elect, spoke about his plans for 2020. The meeting was followed by more clinical and business educational sessions, as well as multiple opportunities for networking during the lunch break and the Exhibitor-Sponsored Happy Hour in the Exhibit Hall.

AOPA Legislative Advocacy Awards Maynard Carkhuff, Stella Sieber (not pictured), and Glenn Crumpton, CPO, were the recipients of the 2019 Ralph R. “Ronney” Snell, CPO, FAAOP, AOPA Legislative Advocacy Awards.

tures

Thranhardt Lec

Tiffany Graham, MSPO, CPO, LPO (right), and Kelly Millay, MPO, presented a Thranhardt lecture that focused on a retrospective chart review of 500 infants treated for asymmetrical brachycephaly with a cranial remolding orthosis.

Maynard Carkhuff

Glenn Crumpton, CPO

Andreas Hahn, MSc, PhD, presented a Thranhardt lecture on the use of health economic instruments to evaluate prosthetic services.

res

Hamontree Lectu

During the Hamontree presentations, Mark Ford’s discussion of “The Hidden Drain on Practice Profitability” was named this year’s winner. Runner-up presentations were given by Andreas Kannenberg, MD (GER), PhD, on “The Concept of Medical Necessity” and Karyn Kessler, CHPC, CHC, on “Quality Management Program Development in O&P.”

OCTOBER 2019 | O&P ALMANAC

From left, Andreas Kannenberg, MD (GER), PhD; Karyn Kessler, CHPC, CHC; and Mark Ford

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Jeremy Campbell, a nine-time Paralympic gold medalist, gave the closing keynote presentation on Saturday, the final day of the event. Born with the rare deficiency fibular hemimelia, Campbell had his right leg amputated at the age of 1. He explained how his philosophy of treating obstacles as opportunities, tackling new challenges, and adopting a tireless work ethic has propelled him into a career of success and achievement. Members of the community were invited to the visit the Exhibit Hall in an “Expo Day.” Attendees took advantage of photo opportunities, a headshot photo lounge, a complimentary massage station, and door prizes and giveaways. Participants at the 2019 AOPA National Assembly reported learning a lot from the educational opportunities, appreciating the innovations shared, benefitting from the networking opportunities, and enjoying the Exhibit Hall. More than 150 exhibitors shared both traditional and technologically advanced devices, and many attendees chose to take part in manufacturers’ workshops. The O&P professionals who travelled to San Diego returned to their hometowns to share the ideas, knowledge, and products they learned about during the Assembly—and many are starting to make plans to meet back up with friends and colleagues for the 103rd National Assembly, which will take place in Las Vegas next year.

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Professional W in O&P

OCTOBER 2019 | O&P ALMANAC

wards

tion A Poster Presenta

Charles Noble (center) from the University of Pittsburgh was awarded the Edwin and Kathryn Arbogast Student Poster Award for his submission, “Is the Allied Health Field ‘Passing the Buck’ Regarding Fall Training?” Erin McGraw (right) of the University of Pittsburgh was awarded the Otto and Lucille Becker Student Poster Award for her presentation, “Comparing the Comfort of Ankle-Foot Orthosis Designs: Sleeve Cover Versus Traditional Cuff Strap.” Goeran Fiedler, PhD, (left) accepted on behalf of the University of Pittsburgh for both awards.

ession

lS Closing Genera

Jeremy Campbell, a nine-time Paralympic gold medalist , gave the final keynote presentation during the Breakfast and General Session on the final day of the Assembly.

This Just In

O&P Expo Day

Want To See More? Bonus Photos

AOPA members can access additional photos from the 2019 AOPA National Assembly via the “aopaevents” Flickr page.

Thank You Sponsors

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Supporting Sponsors ACRM/American Congress of Rehabilitation Medicine Adapttech ACOR Orthopaedic Inc. Bioskin/Cropper Medical Inc. Brightree Cascade Dafo Cascade Orthopedic Supply Click Medical College Park Industries

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O&P ALMANAC | OCTOBER 2019

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COVER STORY

B A L A N CIIN G BALANCING N C N A L ACT BA By CHRISTINE UMBRELL

A lower-limb amputee participates in an exercise session featuring an aquatic walking protocol on an underwater treadmill at the Department of Kinesiology at the University of Alabama in Huntsville. The self-contained unit has a submerged treadmill belt with a variable-speed motor and a water filtration system. Two large Plexiglas windows enable visual inspection of participants during walking.

OCTOBER 2019 | O&P ALMANAC

COVER STORY

Experts discuss recent developments and share tips for improving amputee balance and preventing falls NEED TO KNOW • O&P clinicians and therapists are leveraging new assessment tools to assist patients with their balance. Some of the outcome measures that may be useful include the single-leg balance test, the Four-Square Step Test, the Amputee Mobility Predictor, and the Component Timed Up and Go Test. • As patients work with physical therapists and advance through the rehabilitation process, their prostheses may need to be adjusted to ensure optimal balance and stability. • Clinicians should understand that fear can play a part in patients’ reluctance to stand and ambulate, and some patients may be subject to “pain catastrophizing,” which may lead to dis-use of the muscles and a disruption in balance.

PHOTO: Michael Mercier, UAH Office of Marketing and Communications

• Encouraging individuals to begin an exercise or therapy program immediately after amputation will help new patients strengthen their abdominal, back, and hip muscles, improve stability, and walk more efficiently with a prosthesis. • Patients who are overconfident may be subject to fall risks, so it’s important that clinicians help patients recognize their true ability level and understand how their prostheses work. • Increasing access to microprocessor technology beyond K3 and K4 level patients may lead to a reduction in injurious falls, according to studies, so O&P professionals should do their part to educate payors about the technology.

SSISTING PROSTHETIC PATIENTS IN improving their

balance and stability, when standing as well as while walking on their prosthetic limbs, has become more scientific as clinicians begin to integrate advanced evaluation tools and outcome measures into their decision-making processes. “It’s great to see how much the profession has moved forward with evidence-based practice,” says Jennifer Lucarevic, PT, PhD(c), DPT, a fulltime lecturer in the O&P master’s program at the California State University Dominguez Hills. “More and more, prosthetists are choosing devices based on what is best for the individual patient,” and taking into consideration the activities the patient will be engaged in, says Lucarevic, who has worked as a physical therapist specializing in amputee rehabilitation in outpatient, military, and adaptive sports settings.

Jennifer Lucarevic, PT, PhD(c), DPT

“You need to pick the right assessment tool and the right intervention,” particularly when addressing balance issues of a specific patient, says Lucarevic. In working with hundreds of limb-loss patients, she has learned that evidence-based practice is really “the intersection of clinical expertise, the information you collect from the patient, research evidence, and what’s feasible to do” in the clinical setting. “The ‘art’ is making sure that when you’re looking at balance, that your assessment begins with what’s important to the patient. We have to make sure everything we do is tied to improving function.” O&P ALMANAC | OCTOBER 2019

COVER STORY

During OPAF's First Things First clinics, instructors, including Chris Doerger, PT, CP, teach healthcare professionals targeted exercises and balance exercises that will be beneficial for prosthetic patients.

An array of outcome measures exists to help patients with their balance, says Lucarevic, beginning with patient-reported outcome measures. In addition, several industry tests to assess balance and stability are particularly useful in clinical practice. The Four-Square Step Test is “one of my favorites” because it assesses multidirectional mobility and postural control, which is very different than straight-ahead walking, and also considers foot clearance from the ground, Lucarevic says. She also conducts a single-leg balance test on almost every patient she sees, regardless of skill level, “because it’s a criterion that we need for single limb support phases of gait,” and if a patient can’t balance for at least three seconds, then that needs to be an area of focus. “And then we have measures like Amputee Mobility Predictor (AMP) and the Component Timed Up and Go Test (cTUG) that assess multiple functional tasks, so it is a great comprehensive assessment that can show you the functional limitations of your patient,” says Lucarevic.

Partnering With the Therapy Team

OCTOBER 2019 | O&P ALMANAC

Chris Doerger, PT, CP

OPAF advocates a three-pronged approach to improve walking ability: focusing on the individual and evaluating factors such as lower body strength, residual limb length, and range of motion; assessing the alignment of the prosthesis; and accounting for the prosthetic componentry, including whether it features microprocessor technology, says Doerger. As patients continue through the rehabilitation process, their prostheses may need to be adjusted to ensure optimal balance and stability. “The best thing for the patient is when the clinician and physical therapist can co-treat and be collaborative,” says Lucarevic. “I always tell my patients

PHOTOS: OPAF

When individuals are first learning to walk with a prosthesis, it is important to incorporate elements of static balance, dynamic balance, and gait training, says Chris Doerger, PT, CP, director of education at OPAF and the First Clinics and

an instructor for physical therapy students. The First Clinics, including First Stride, are designed to teach healthcare professionals targeted exercises and balance exercises that will be beneficial for O&P patients. They in turn teach the patients skills that will help improve ambulation and get out into the community, she says.

that, as a physical therapist, my job is to change the way you move.” The componentry that was initially selected and the patient’s alignment are based on how the patient used to move, before rehab. “So if I’m doing my job correctly, as the patient progresses and changes, they need to keep seeing their prosthetist to have adjustments made, to [adapt to] how the patient is able to move and stand after PT,” says Lucarevic. “It’s not that the alignment is incorrect—it’s that my job is to change how they move.” Lucarevic notes that as PTs work with patients to improve how they stand, to help them distribute their weight more evenly, and to position their pelvis so it’s in a neutral position, “that’s going to completely throw off the [prosthetic] alignment, so it’s really important that everyone on the healthcare team continue to collaborate—but especially PTs and prosthetists.” Re-examining alignment and componentry is necessary for both new amputees and more experienced prosthetic users, “because the goal is to change how someone is moving. What was comfortable and what worked before might not be as functional for that person when we change how they’re moving and how they’re standing. “Remember that the prosthesis is a static device for a dynamic person, so it has to change when there are changes in function. And we hope through the rehab process that that is fairly frequent,” adds Lucarevic. She tries to coordinate treatment with the prosthetist, either via a joint appointment, or by working together to specify regular intervals for follow-up based on when the patient hits major milestones.

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COVER STORY

Measurement Tool for Balance During Walking

OCTOBER 2019 | O&P ALMANAC

prosthetic feet to see if we could identify differences in their gait when walking on those feet, and if we could relate those differences to balance.” Through various trials, the team identified two feet to use for a study, and asked amputee subjects to walk in both feet. Then they used that data to develop an algorithm to look at dynamic balance. They looked at inclination angles in both the anterior-posterior direction and Jen Johansson, MS, and her team at Liberting the medial-lateral Technologies have developed a compact system direction, and plotted to identify when an individual may be more them against each off-balance, given a particular prosthetic foot. other. Initially the team looked at the single-support different prosthetic feet. We’re trying phase of gait, when you’re only on the to quantify and be able to detect the prosthetic foot—thinking that if you differences in balance” in continuing are able to see differences in balance, it the research, says Johansson. will be most apparent at that phase of “Balance is kind of a spectrum,” the gait cycle. concludes Johansson. “You can be very “As an initial result, we were able stable or more functional as you move to validate our system compared to across the spectrum. We’re trying to the motion-capture system as a gold find the sweet spot in that spectrum standard. Our measures of center of for each person.” Being able to have pressure and center of mass were some quantitative measure to justify functionally equivalent to theirs,” a particular foot for a patient can help says Johansson. “And we were able them to not only get the right foot, but to develop a model to our system that also get justification for reimbursewas amputee-specific. … We were able ment, she says. to find a threshold on which you can “It’s not clear right now whether see the difference between the better your standing balance and your walkers and the less balanced walkers. walking balance are at all related. Overall, the system was able to capture So while someone might be very the difference between good walkers comfortable standing in a foot, you and less balanced walkers.” also have to look at how they’re The next step is to “look at somewalking in it, and how balanced they thing that’s a little more subtle, and are there, and take all of that informawithin a single walker, to see if we are tion into consideration when you’re able to detect differences between choosing a foot for somebody.”

PHOTOS: Jen Johannson, MS, Liberating Technologies

Jen Johansson, MS, senior research engineer at Liberating Technologies, has been developing Jen Johansson, an in-clinic tool to assist prosthetists MS in determining the most appropriate prosthetic foot for a particular amputee, focusing on dynamic balance—or balance during walking. The initiative is being funding through the Congressionally Directed Medical Research Program at the U.S. Department of Defense. “A lot of research has been done looking at the relationship between the center of pressure and the center of mass when you’re standing,” says Johansson. “If the center of mass gets too far outside the center of pressure, where the force is going through your feet, you are likely to get off balance and fall.” Johansson and her team sought to examine this relationship in amputees to help clinicians identify “when somebody is more off balance, given a particular prosthetic foot,” she explains. They are developing a system “that is more clinic-friendly than the typical motion-capture systems” commonly seen in hospitals and research institutions, which require a great deal of space and financial investment. The new system is composed of an array of sensors, called inertial measurement units (IMUs), which are used to communicate the position of the limb (and give information similar to that which can be captured by motion capture systems), in conjunction with instrumented custom insoles, designed to extract information (similar to the force plates at a typical motion capture system), she says. Johansson and her team have leveraged the compact system to test amputees “on a couple of different

COVER STORY

Overcoming Fear

For patients struggling with balance and stability-related issues, fear can play a debilitating role. Shannon Mathis, PhD, a professor in the department of kinesiology at the University of Alabama in Huntsville, has conducted several studies with lower-limb amputees, during which she has noted a moderate level of “pain catastrophizing, but the pain catastrophizing was related to mobility apprehension, which is also considered a fear of movement.”

Shannon Mathis, PhD

PHOTO: Michael Mercier at the UAH Office of Marketing and Communications

Some people who suffer from musculoskeletal pain avoid any movement that might exacerbate it, or might lead to reinjury, according to Mathis. “So some individuals will avoid physical activity and social activities. And that leads to further disability due to dis-use of the muscles, or de-conditioning. With physical de-conditioning, the muscles are no longer strong enough to support one’s own body weight, and that will disrupt balance.” Mathis conducted a study using a questionnaire, given to 53 individuals with lower-limb amputation, and found that as fear of movement increases, then quality of life decreases. In a follow-up study—the results of which she shared during the AOPA National Assembly last month— Mathis spoke about her investigations into core strength, back strength, and hip strength, as well as measured balance. In a sample of 20 lower-limb amputees, her team found that greater hip strength was related to both better balance and a higher score on a balance test the subjects were asked to perform. Contrary to the instructions given to some new amputees, the literature supports the notion that patients should begin an exercise or therapy program immediately after amputation, according to Mathis. “Most people wait until they’re able to walk,

Shannon Mathis, PhD, works with a patient during an exercise session at the Department of Kinesiology at the University of Alabama in Huntsville. and then they go to therapy as part of rehabilitation or as gait training for learning to walk with a prosthesis.” But starting early to strengthen the abdominal, back, and hip muscles—as soon after surgery as possible—improves stability and therefore improves balance, and results in amputees learning to “walk more efficiently and economically with a prosthesis.” One of the most important “lessons learned” that Mathis shares with prosthetists is that increasing hip extensor strength will be helpful for gait patterns as well as for balance. “Hip flexor and hip extension strength will improve balance and be helpful for walking economy. Along with physical and occupational therapy, we need to identify exercise programs that will be beneficial to improve those areas.”

Fall Risks

Given the growing geriatric population and the associated fall risk, balance becomes an even greater focus, says Doerger. Reducing fall risk,

maintaining patient confidence, and reducing injuries can result in greater independence. But it’s not just senior patients who may be at risk—in the amputee patient population, frequent exposure to balance challenges can result in high rates of falls among younger amputees. “It’s people who are younger, more active, and very confident in their balance abilities who actually fall more often,” Lucarevic says. Individuals who have low balance ability and low balance confidence do not engage in any of the “risky balance behaviors,” says Lucarevic, who uses the Activity-Specific Balance Confidence scale to assess balance confidence. A recommended intervention for low-confidence patients “is to show them their ability, to give them more confidence—it’s really to primarily address confidence and give them a true benchmark of their abilities of what activities are safe to do at home, and when they should use a railing.” O&P ALMANAC | OCTOBER 2019

COVER STORY

Does Socket Affect Balance and Stability? During the 2019 AOPA National Assembly, Jason Kahle, MSMS, CPO, LPO, chief executive officer of OP Solutions, shared the findings of a randomized clinical trial comparing the effect Jason Kahle, of above-knee prosthetic MSMS, CPO, socket interface designs on LPO different outcomes—including balance and gait. The study, funded by the U.S. Department of Defense, examined differences among 15 above-knee amputees in three types of sockets: traditional ischial containment sockets, dynamic ischial containment sockets with large cutouts and a flexible interface, and subischial sockets with lowered trimlines. She worries more about patients who express great confidence despite having some balance issues, “because we know that it’s a mismatch in perception-versus-reality for balance,” she says. “They’re going to take high-risk challenges, but maybe not have the techniques and the skills to control their body positions in those situations.” For these patients, Lucarevic chooses an outcome measure that demonstrates what is difficult for them, “to help give a true perception of their current status, to make sure that their confidence has some reference points.” Doerger adds that amputees should really “know their prosthesis” to facilitate safer falls. “It’s important that an individual with limb loss knows how socket fit affects their control of the prosthesis, how to manage socket fit, and how to properly don the prosthesis,” she says. They also should fully understand how their foot and knee operate to improve their safety in unpredictable situations, she adds. Increasing access to microprocessor technology is another strategy advocated by O&P stakeholders for 36

OCTOBER 2019 | O&P ALMANAC

While Kahle and his team hypothesized that the subischial socket would be shown to best reduce perspiration, they found that the dynamic socket, by only a small margin, produced the best results. “The takeaway is that all the sockets are acceptable, and are basically equivalent” in areas such as promoting balance, skeletal kinematics, comfort, gait, perspiration, etc. Kahle’s findings lend credence to the recommendation that clinicians be willing to try different options for patients who have trouble with their sockets, and who choose not to wear their prosthesis because of the socket. Study subjects had no strong preferences, so it’s important “to listen to the patient” and be willing to adjust as necessary.

preventing falls. Microprocessor knees “have been demonstrated to reduce stumbles and falls,” according to Jason Kahle, MSMS, CPO, LPO, chief executive officer of OP Solutions and a researcher who conducted a systematic review on the devices a few years ago. “Any knee that helps an amputee walk at a normal speed leads to fewer falls,” says Kahle. The current reimbursement climate, where payors tend to cover microprocessor technology only for Level K3 and K4 ambulators, is “counter-intuitive,” says Kahle. In fact, individuals with greater degrees of disability are the ones who will benefit most from more advanced componentry, such as MPK knees and ankles, Kahle says. A 2017 study conducted by the RAND Corp. and funded by AOPA identified an 80 percent relative risk reduction in injurious falls—“not just falls where you trip and catch yourself, but falls where you really have an injury, either a minor injury or a major injury, that requires hospital admission,” says Soren Mattke, MD, who presented the findings of the report. “As a consequence, you also have about an

80 percent risk reduction in fall-related deaths that is basically a consequence of these major injuries of falling. These are pretty impressive effects.”

Leveraging All the Tools

Today’s clinicians and therapists have a wide variety of tools at their disposal to help ensure their patients achieve optimal balance and stability—when walking on their first prosthesis, during rehabilitation, and in increasing or decreasing activity levels. Participating in a team approach to healthcare, leveraging useful outcome measures, providing appropriate componentry, and encouraging patients to take part in related therapy and exercise regimens are all important strategies to promote balance and reduce falls. Ultimately, the body is a complex machine, says Lucarevic, “and trying to figure out how to make the body more efficient for patients is the goal.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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Small changes can make a big difference to cost-cutting and profit-boosting business strategies NEED TO KNOW • Today’s savvy O&P business owners and managers are ensuring the longevity of their facilities by containing costs and exploring opportunities to increase revenues and boost profits. • Some business leaders are being more thoughtful and calculating when making decisions regarding outsourcing fabrication and in determining which insurance plans to accept. • Many O&P companies are keeping closer track of each expense, invoice, and payment, and are comparing costs and profits to those of nearby facilities and O&P profit leaders via the annual AOPA Operating Performance Report. 38

OCTOBER 2019 | O&P ALMANAC

&P BUSINESS OWNERS AND

• O&P businesses can increase their reimbursement rates and prevent audits by understanding the payors’ processes and procedures, by being diligent in their paperwork, and by providing education when fitting patients with newer technologies. • Prioritizing patients and providing high-quality orthotic and prosthetic care is a great way to ensure repeat customers and boost referrals—and higher profits may follow.

clinicians understand that providing superior patient care is essential. But running a cost-conscious, profitable O&P business also is important to ensure a facility can thrive in a challenging reimbursement and economic climate. Today’s savvy O&P professionals are keeping a close eye on costs and exploring opportunities to increase revenues and grow their practices. Strategies such as rethinking purchasing and fabrication decisions, determining which insurance to accept, carefully tracking income and expenses, improving reimbursement processes, and revamping efforts to attract and retain patients can help reduce costs and boost profits.

Making Strategic Decisions

Many O&P facilities are more closely analyzing costs associated with each aspect of providing an O&P device. For example, some businesses are being more thoughtful when deciding

when to keep fabrication in-house versus outsourcing. “We try to consistently look at the cost/benefit of ‘make versus buy’ for certain custom products,” says Mike Boggs, chief operating officer for Reach Orthotic & Prosthetic Services in Newport News, Virginia, which features a fabrication lab. Reach’s team also keeps track of individual orders and inventory. “By doing so, we have identified opportunities to reduce costs without sacrificing quality or delivery time. This can be a time-consuming process—but it’s worth the effort.” Ensuring that staff is optimized to deliver appropriate care to patients who need it most is another focus at Reach. “We are always looking at our staffing model to ensure our CPs and CPOs are spending the majority of their time providing hands-on care to those patients with the most complex needs,” Boggs says. “By minimizing the time they spend on administrative and non-custom work, these practitioners can focus on optimizing outcomes for our [more] complex patients.” Being selective in which insurance to accept also can be good for business, says Jim Liston, CP, owner of Liston Prosthetics in Salt Lake City. Providing excellent patient care tends to result in steady revenues, he says, but “sometimes we don’t have as much control over costs as we’d like.” O&P facilities don’t have to accept every patient who comes calling, he says—and taking on fewer patients could result in a better bottom line. “Sometimes there is a mentality that we have to accept every insurance company, including Medicaid, because it makes everyone happy,” Liston says. “I want to take care of every patient, but I am limited in my hours and employees. Sometimes we have to draw a line in the sand and say, ‘I’m sorry, I just can’t take care of this or accept this reimbursement [rate], so I’m not going to be able to see patients with XYZ insurance. But we’re going to take great care of those with ABC insurance.” Liston advocates for quality over quantity, and notes high-quality

products and customer service can lead to repeat business and referrals. O&P facilities that cut corners on costs can end up losing both their reputations and their clients, he suggests. For example, choosing a more expensive liner for a device instead of an inferior one may result in increased patient satisfaction. Spending a little more time on ensuring a proper fit, for example, also will help bring customers back. “If you’re only getting the fit 80 percent correct, over time patients will talk, word of mouth will get around,” and referring physicians will send patients to other O&P facilities where patients are more satisfied, Liston says. “If you focus on enhancing your patient care and enhancing your result, it leads to more business.”

Boggs suggests that O&P business owners and managers implement an electronic dashboard that regularly monitors and benchmarks several targets and goals. Such a tool could include categories such as days sales outstanding, gross profit margin, visits per practitioner, labor expense as a percent of net revenue, and even patient satisfaction/likelihood to recommend. These are “good highlevel metrics to watch closely and strive to improve each year,” Boggs says. “Sharing results with the entire team promotes transparency and keeps everyone engaged in improving the company’s performance.”

Tracking Income and Expenses

Keeping track of each expense, invoice, and payment is more important than ever. And there are many ways to measure and improve on the factors contributing to a practice’s year-end financial report. O&P ALMANAC | OCTOBER 2019

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says. By sharing specific data with employees, managers can discuss how to implement change that will lead to improvements in those categories studied in the OPR—for example, “We’re going to improve our cost of goods sold. We’re going to improve our revenue per employee. We’re going to improve our total sales.” “You can track it and see it—and if that becomes your focus, then you [can] improve anything in your practice,” Ford says. “It’s about taking the data and really turning it into action.”

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Comparing a facility’s cost of goods and other line items via AOPA’s annual Operating Performance Report (OPR) is another helpful option, says Mark Ford, an Ohio-based O&P consultant who previously served as president of the OPIE Choice Network. Ford, who shared his expertise on this topic during his award-winning Hamontree presentation at the AOPA National Assembly, says studying the OPR can help businesses increase efficiencies. The report compiles data submitted from clinics across the country and analyzes it in ways that those in the industry can use to gauge their own business’s effectiveness. “One of the great things about the report is that the data is sliced and diced in lots of different ways,” Ford says. “You can look at it and determine what information is important to you—what's relevant to your practice.” Each participating facility receives a comparative report that indicates how the facility compares in several categories to other respondents and to the profit leaders. The cost of goods section within the OPR is especially useful for those 40

OCTOBER 2019 | O&P ALMANAC

trying to become more fiscally prudent, according to Ford. This is “one of those areas that you can control the fastest, that you can create change in your organization the fastest, and that you can get [employees’] attention about the fastest,” Ford says. “It’s also one of the places that very few people spend time. But cost of goods sold out of most practices runs about 30 percent, if you’re not including clinical labor as part of it.” The OPR features information about firms, profit leaders, size of company, geographical location, and similar detailed demographic information. “You can compare your business— where you fall in these categories—and really dig into cost of goods,” Ford explains. “If you can reduce your cost of goods and really focus your energy on that … your chance for profitability and cash flow will go up dramatically.” Ford also says that focusing on hard data, rather than targeting the performance of specific employees, can help managers avoid tense discussions with employees when talking about areas in need of improvement. “Every business can improve; look for how you want to get better,” Ford

Taking a closer look at all aspects of reimbursement—from private payors as well as Medicare and Medicaid— also may lead to more income. “Large national payors are reluctant to budge on rates, and independent providers have very little leverage,” Boggs says. But he has had some positive outcomes in communicating closely with some of the local payors. Understanding the myriad rules when it comes to reimbursement also can help increase approval rates. “There is a perception in the profession that correct clinical documentation just takes forever, and I don’t actually subscribe to that,” says Kevin Symms, CO, BOCPO, LPO, a Minnesota-based private O&P clinical documentation and appeal avoidance specialist who formerly worked as a clinician with a private practice. “Less is more if you can provide what an insurer requires. If you do your job, you won’t be subjected to a situation where money, or revenue, is sucked back from your company by Medicare or commercial insurers because of a postservice review.” Too many O&P practitioners take an oppositional approach to the notoriously laborious documentation and reimbursement process, according to Symms. “Folks are continually being hit with audits they don’t know how to defend,” he says. Convincing an insurer to pay for an expensive device isn’t as hard as it seems, if you take the right approach.

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It’s important that any supporting documentation “make sense to the person reviewing it,” Symms says. He has seen improvement in facilities’ clinical documentation since 2015, when recovery audit contractor audits were on the rise, but there is still room for improvement at many companies. O&P professionals also should do their part to navigate the payors’ processes and provide education when fitting patients with newer technologies. “For a higher-tech device, it’s more difficult now than it ever was to get through to your insurance,” Symms says. “But the reality is, the onus is on the profession to learn to play by the rules and better understand what it is the insurers provide. We have a duty of care to understand what their needs are, then reflect that in the documentation for qualifying patients; once we do that, we get a whole lot better. Getting clinicians to understand that their approach can be better is a difficult conversation.”

Providing optimal patient care can lead to satisfied patients who post positive reviews and encourage their other healthcare providers to send new patients your way. Symms encourages clinicians to “document to a patient,” rather than to a device. “If you’re documenting to a device, you’re saying, ‘Hey, this device over here does X, Y, and Z,’ but that’s a hollow point of view because now you’re fitting a patient to a device. But if you make an argument about your patient’s required activities of daily 42

OCTOBER 2019 | O&P ALMANAC

living and relate those to the features and benefits of an available device that you think will assist them, you are now documenting to the patient. “You’ve made it real,” Symms continues. “You’ve made it about the patient as opposed to the device or the possible perception that it’s all about the bottom line and you just chose the most expensive device.” Symms suggests including patients in this endeavor by asking them to document how an existing inadequate device is preventing them from completing routine and lifestyleenhancing activities, such as driving a car, going shopping, or even babysitting grandchildren. “What is the expected effect of the new device or component, and how is that going to help my patient? An insurance provider will read that and understand the story,” Symms says. “If you don’t provide the story, the first things they do is see the bottom-line expense and say, ‘That’s more expensive than my last car.’”

Prioritizing Patients’ Interests

Implementing cost-cutting and profit-boosting strategies will help any

facility prosper. But keeping patients top of mind will continue to be key— and providing optimal patient care can lead to satisfied patients who post positive reviews and encourage their other healthcare providers to send new patients your way. Higher profits at your business may follow naturally as you show your patients that you care, says Rick Riley, CEO of Townsend Design in Bakersfield, California, who also spoke at the AOPA National Assembly. He suggests following up with patients a few days after a fitting to ensure things are going well, and to remind patients of their next appointment. That’s the kind of effort that gets back to referring physicians. “All you have to do is reach out and say, ‘Hey, I care. I care about you, and I care about your outcome,’” Riley says. “And you can count on the fact that the patient is going to say to their doctor, ‘Wow, they even called to follow up.’ It differentiates you from your competitors.” Michael Coleman is a contributing writer to O&P Almanac.

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Proposals and Consequences Two of the provisions in a proposed rule regarding ESRD could have far-reaching implications for O&P businesses

N JULY 29, 2019, CMS issued the End-Stage

Renal Disease (ESRD) and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) CY 2020 Proposed Rule, CMS-1713-P. The primary purpose of the proposed rule was to update payment policies and rates under the ESRD Prospective Payment System for renal dialysis services furnished to beneficiaries on or after Jan. 1, 2020. CMS-1713-P features five total provisions, and two provisions may have a direct impact on orthotic and prosthetic suppliers and manufacturers.

Implications for the DMEPOS Fee Schedule First, the proposed rule includes a provision that would affect the DMEPOS fee schedule by creating a new methodology for calculating fee schedule amounts for new items and services. Currently, fee schedule amounts for new items and services are established using the gap-filling methodology and a base year of 1986-1987. Statute requires that CMS establish a Medicare fee schedule based on information from the base year of the Medicare DMEPOS fee schedule, and in most instances data from 1986-1987 is not available for CMS to use as a base. When this occurs, CMS must gap-fill, and it creates a reimbursement amount based on current pricing information (i.e., fees for comparable items, supplier prices, manufacturerâ€™s suggested retail prices, etc.), deflates that amount using the annual change in the Consumer Pricing Index for 44

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Urban Areas to 1986-1987 rates, and then reinflates the amount using the annual fee schedule increase associated with the DMEPOS fee schedule. Some have criticized the current gap-filling methodology as secretive and arbitrary, and have said it does not always allow for stakeholder input. To address some of these issues, the proposed rule attempts to improve the transparency of the methodology used in establishing fees for new DMEPOS itemsâ€”for example, determining if a new item is comparable to any current/ older items using five main categories (physical components, mechanical components, electrical components, function and intended use, and additional attributes and features); and if the new item is comparable, then the fee schedule amount for the older existing item will be used to determine the fee schedule amount for the new item. In addition, the proposed rule suggests using more appropriate

supplier/commercial prices to create the fee schedule amounts, such as Internet retail prices or information from supplier-produced invoices. CMS in the proposed rule recognizes that the new gap-filling method could result in higher-than-normal fee schedule amounts for the new items over a period of time, and that prices may go down once the market for the new items is more established; the proposed rule would provide an avenue for CMS to make a one-time adjustment to the newly created fee schedule amount after five years. So, if the supplier or commercial prices were used to establish the initial fee schedule amounts for a new item, and those prices decrease by no more than 15 percent within five years of establishing the initial fee schedule amounts, a one-time adjustment to the fee schedule amount using the new and lower prices would occur.

Proposed Master List of DMEPOS Items

The fifth provision in the proposed rule also would have repercussions for the O&P profession. The proposed rule suggests that CMS create one master list of DMEPOS items that could potentially be subject to faceto-face encounter and written order prior to delivery and/or prior authorization requirements.

Currently, there are three lists: a list of DMEPOS items that require a face-to-face examination with a physician or other qualified practitioner before they may be delivered; a list of DMEPOS items that require a written order prior to delivery; and a list of DMEPOS items that may be subject to prior authorization. CMS believes that implementation of these lists created differing or overlapping directions for the proper use of orders and prescriptions, which has led to confusion among DMEPOS suppliers. CMS-1713-P would create one standardized set of required elements for all DMEPOS orders; however, to do this the proposed rule would change the parameters for what DMEPOS items may be subject to prior authorization. Right now, the O&P items and services potentially subject to prior authorization must meet three distinct criteria. To be considered eligible for inclusion in Medicare prior authorization, the items must have Health-Care

CMS-1713-P would create one standardized set of required elements for all DMEPOS orders.

Common Procedure Coding System (HCPCS) codes that are included in the DMEPOS fee schedule, have an average purchase price of $1,000 or more or an average monthly rental rate of $100 or more, and have been identified as having a high rate of fraud or unnecessary utilization. Only 84 O&P codes meet all of the criteria, and these are predominantly for lower-limb prostheses.

The proposed rule would lower the monetary threshold to have an average purchase price of $500 or more or an average monthly rental rate of $50 or more; this would drastically increase the number of O&P items on the master list. However, the proposed rule does not address AOPAâ€™s previous concerns about the implementation of the prior authorization process for O&P, including but not limited to a positive prior authorization not being subject to future audits based on medical necessity.

Offering Feedback

The proposed rule included a 60-day comment period, and AOPA submitted a series of comments to address the possible expansion of the master list of DMEPOS items subject to prior authorization, and to discuss the new methodology for creating and updating DMEPOS fee schedule amounts. See AOPAâ€™s full comments at http://bit.ly/3118lqM.

O&P ALMANAC | OCTOBER 2019

COMPLIANCE CORNER

By MEGAN MATIJEVICH

Harassment Is Serious Business for Practice Owners Tips for reducing and preventing the incidence of sexual harassment in the O&P workplace

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 49 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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ARASSMENT OF ANY KIND,

especially sexual harassment, is certainly a sensitive subject—but one that benefits everyone to discuss. In recent years, the antiharassment conversation has ballooned, thanks in part to extensive mass media coverage. The stories in the media often highlight large company leaders and high-profile figures falling from grace in light of sexual harassment allegations. But that doesn’t happen in the O&P profession … does it? While we may believe, or want to believe, that the O&P profession is different, we should not be naive. There is a lot at stake, especially for business owners and those in leadership roles, but it will take a collective effort to help shift the culture.

Statistics and Stories Speak Volumes

According to “Sexual Harassment in the Workplace 2018,” a report from Edison Research, 21 percent of Americans say they have experienced sexual harassment in the workplace. To put that in perspective, let’s say there are 20 employees at one single facility. Roughly four of those 20 would have experienced workplace sexual 46

OCTOBER 2019 | O&P ALMANAC

harassment at some point. That doesn’t account for other forms of harassment, such as discriminatory, psychological, and third-party harassment. An even more startling statistic comes from “The 2019 Guide to Workplace Sexual Harassment” i-Sight infographic, which shows that 81 percent of individuals believe that sexual harassment occurs in most American workplaces, but 90 percent believe it’s not a problem in their own office. So, if we all think it’s happening, but we don’t think it’s happening to any of us, there is clearly a disconnect. The “Guide” also states that between 87 and 94 percent of individuals who are harassed do not file a complaint. Why not? There are several reasons, including fear of retaliation or embarrassment. In fact, 75 percent of employees who spoke out against workplace mistreatment reported that they had faced retaliation, according to the “Guide.” Despite the statistically low percentage of instances in which individuals do report harassment, even the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has received complaints over the years related to harassment issues and hostile work environments.

COMPLIANCE CORNER

One such example took place within an O&P practice. A female staff member alleged that a male co-worker had created a hostile work atmosphere by displaying inappropriate images in the office. These images were accompanied with coarse remarks that were sexual in nature. She also claimed that this person made remarks to her about her body that were personal and inappropriate. After encouragement from her human resource manager to handle the issue internally, she decided not to file an official complaint with ABC. Ultimately, the alleged harasser was terminated but continued to practice within the profession without any further repercussions or monitoring.

If the complainant had filed an official complaint with ABC, the Professional Discipline Committee would have opened a case and reviewed the situation. This information would have remained on record. If any additional complaints had been submitted against this individual, the documented history of complaints would aid in ABC’s decision to take disciplinary actions and to what severity.

Prevention Is the Best Defense Every O&P practice should have appropriate policies in place and provide adequate resources for training, prevention, and investigation of reports of harassment. This will not only ensure compliance with the law, but facilitate a safe and respectful work environment for everyone. In fact, leading organizations in the

Healthcare Compliance & Ethics Week November 3-9 will mark Healthcare Corporate Compliance & Ethics Week. AOPA is providing resources to help members celebrate. Visit bit.ly/aaopethics. In addition, visit the AOPA website at www.aopanet.org/about-aopa/privacy-policy/ to access the “Sexual Harassment Resource Guide” and “An Open Letter About Discrimination in O&P.”

O&P profession have recognized a need for such resources and a united effort to condemn sexual misconduct, harassment, and discrimination. Together as part of the O&P Alliance, several organizations—AOPA, ABC, the National Association for the Advancement of Orthotics and Prosthetics, the American Academy of Orthotists and Prosthetists, the Board of Certification/Accreditation, and the National Commission on Orthotic and Prosthetic Education—have developed a “Sexual Harassment Resource Guide” to assist O&P professionals and further support the O&P community and its patient population. In addition to “An Open Letter About Discrimination in O&P,” the resource guide includes relevant materials in various formats, such as articles, webinars, videos, and presentations, along with a list of resources available from other reputable organizations and outlets. The letter can be found on the AOPA website at www. aopanet.org/wp-content/uploads/2018/12/ An-Open-Letter.pdf as well as on each Alliance organization’s website. Accessing as many resources as possible is a great way to help prevent harassment. According to the Equal

HE SAVE T

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Employment Opportunity Commission (EEOC), prevention is the best defense against harassment in the workplace. EEOC suggests several best practices for preventing and responding to workplace harassment, including the following: • Implement a harassment policy that explicitly outlines what constitutes harassment, specifically sexual harassment, and states that harassment will not be tolerated. The policy should be clearly and regularly communicated to employees and effectively implemented. • Have a procedure for resolving harassment complaints that is accessible to all employees and includes multiple avenues for making a complaint so victims aren’t required to complain first to a supervisor, who may or may not be the offender. It also should ensure as much confidentiality as possible and provide protection against retaliation. • Regularly and effectively train all employees regarding the harassment policy and complaint system. • Regularly and effectively train supervisors and managers about how to prevent, recognize, and respond to harassing behavior. O&P ALMANAC | OCTOBER 2019

COMPLIANCE CORNER

Tips and Resources for Developing and Maintaining an Antiharassement Policy The “Small Business Requirements” section of the Equal Employment Opportunity Commission (EEOC) website offers information regarding federal antidiscrimination laws and the following antiharassmenet policy tips: • State that harassment based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, age (40 or older), or genetic information (including family medical history) is illegal and will not be tolerated. Provide definitions and examples of prohibited conduct, as needed. • Explain how employees can report harassment. o If possible, designate at least one person outside an employee’s chain of command who can receive harassment complaints. o Consider permitting employees to report harassment to any manager. • State that you will protect the confidentiality of employees who report harassment or participate in a harassment investigation, to the greatest possible extent.

• Investigate all complaints or alleged harassment in the workplace promptly and thoroughly. The employer should take immediate and appropriate corrective action by doing whatever is necessary to end the harassment and preventing the harassment from recurring. • Impose disciplinary actions against the offending supervisor or employee, ranging from reprimand to discharge. Generally, the corrective action should reflect the severity of the conduct. • Conduct evaluations of the effectiveness of the harassment policy and procedures through employee follow-up, periodic complaint system testing, and anonymous employee surveys.

• State that employees will not be punished for reporting harassment or participating in a harassment investigation or lawsuit. • Require managers and other employees with human resources responsibilities to respond appropriately to harassment or to report it to individuals who are authorized to respond. • Provide for a prompt, thorough, and impartial investigation of harassment complaints. • Provide for a prompt and effective corrective and preventative action when necessary. • Consider requiring that employees who file internal complaints be notified about the status of their complaint, the results of the investigation, and any corrective and preventative action taken. • Describe the consequences of violating the harassment policy. If you still feel unsure about creating your own policy, the Society for Human Resource Management (SHRM) has a sample “Antiharassment Policy and Complaint Procedure” available for download from its website to get you started. And be sure to check out EEOC’s Checklists and Chart of Risk Factor for Employers. Additional resources are available on the websites of both EEOC and SHRM as well as several other organizations. SHRM has a multitude of training tools and a list of vendors that can provide sexual harassment training and policy development. EEOC recently launched a “Harassment Prevention and Respectful Workplaces Training” initiative that allows you to schedule training sessions for both employees and supervisors. With the best practices and resources discussed above, your practice can provide a safe and respectful work environment for all. Whether you look at harassment from a legal or ethical viewpoint, having a clear antiharassment policy and environment in place protects everyone involved and makes good business sense. It is up to everyone—leaders and bystanders alike—to prevent harassment and help shift the culture.

OCTOBER 2019 | O&P ALMANAC

Carmen Feinberg, an experienced human resources (HR) executive-level consultant, takes these steps even further in her article, “Employers' Cliffs Notes for Creating Sexual Harassment Policies in a #MeToo World.” Feinberg provides specific suggestions for making the message clear, such as including training on your harassment policy and procedures during new employee onboarding and even asking employees to sign an official notification about the policy. Feinberg also recommends providing specific types of training, such as civility and bystander intervention training as well as separate employee and supervisor training, with more formal biannual training for supervisors. “If you see it, if you hear it, if someone told you about it, if it is known by others, and even if it is a rumor, speak up,” says

COMPLIANCE CORNER

Feinberg. She stresses the importance of training management to immediately inform HR if someone complains about perceived sexual harassment. If an employee informs a supervisor of harassment, it’s the same as telling “the company,” and the employer is liable.

Know the Law

Harassment falls under federal employment discrimination laws, which are interpreted and enforced by EEOC. The number of employees at a given company determines which laws apply. • One employee: Employers are required to provide equal pay for equal work to male and female employees. • 15-19 employees: The law prohibits discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, and genetic information (including family medical history). Employers also are required to provide equal pay for equal work. • 20+ employees: The law prohibits discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history). Employers also are required to provide equal pay for equal work. Keep in mind that state, city, and even county employment discrimination laws also may apply to your business. It’s important that you check state and local government websites to get information about these laws. You could face compensatory and punitive damages under these laws, so it’s best to have effective policies and procedures in place and to have them reviewed by an employment attorney. The EEOC website details what does and does not constitute unlawful harassment, who may qualify as “harassers” or “victims,” and under what conditions an employer is liable. Employer liability is contingent on proving whether the employer took actions to prevent and correct any

instances of harassment. However, employers are automatically liable when a supervisor is the harasser and his or her actions result in termination, failure to promote or hire, or loss of wages.

Accountability Begins With Leadership

While we generally think of harassment as being an issue between two people, there is more to it than that. According to Jackson Katz, PhD, a leading activist, scholar, and educator on issues of gender, race, and violence, harassment and abuse are not only about the victim and the harasser, but also about everyone else—the bystanders. He defines “bystanders” as individuals who are “not a perpetrator or a victim in a given situation […and] are not directly involved in a dyad of abuse, but are embedded in social, family, work, school, and other peer culture relationships with people who might be in that situation.” Bystanders are individuals potentially in the position to discourage, prevent, or interrupt an incident. Katz suggests that positive cultural changes will only begin to take hold when leaders among these bystander groups speak up, challenge, and create an environment where harassing behaviors are clearly seen as unacceptable. Unfortunately, business owners, managers, and practitioners may feel uncomfortable confronting partners

and peers, ultimately allowing harassing behavior to slide. But, turning a blind eye can pose great risks, both financially and professionally, for the whole practice or company. The best way to protect yourself, your practice, employees, and even patients is to stand up and say something—not only when you not only witness harassing behavior, but also when you become aware of such behavior. While a cultural shift won’t happen overnight, it’s important that victims of harassment be encouraged to come forward—not shamed, blamed, or retaliated against. All claims should be taken seriously with prompt and thorough investigations and appropriate corrective actions. Megan Matijevich is the manager of marketing and communications for the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. Reach her at mmatijevich@abcop.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

O&P ALMANAC | OCTOBER 2019

PRINCIPAL INVESTIGATOR

‘App’etite for Innovation Daniel J. Lee, PT, DPT, GCS, COMT, has built on his research endeavors to create an app for O&P consumers and clinicians

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.

F YOU’VE EVER DOWNLOADED

the O&P self-management and problem-solving app limbWISE, you can thank Daniel J. Lee, PT, DPT, GCS, COMT. Lee, who has developed and validated several self-managementrelated educational innovations, created the app after some initial forays into lower-tech decisionmaking tools designed for amputees.

OCTOBER 2019 | O&P ALMANAC

PHOTOS: Daniel J. Lee, PT, DPT, GCS, COMT

Daniel J. Lee, PT, DPT, GCS, COMT, demonstrates an O&P self-management and problem-solving app.

“My initial work involved the creation of paper-based decision-making trees that guided an individual through common issues faced by the prosthesis wearer,” explains Lee, who is an assistant professor in the Department of Physical Therapy and a geriatric specialist at Touro College School of Health Sciences in Bayshore, New York. “Things like getting a comfortable fit of the prosthetic socket on the residual limb may seem like a simple task, but because of the many complex variables that make up this equation, the task can be onerous.” After studying and testing the paper trees, Lee realized that a simpler user interface was needed. With the support of University of Hartford’s MSPO students, he created a beta version of the mobile app, which underwent usability and acceptability testing. “The results were resoundingly supportive of the content, interface, and promise of the mobile app,” Lee recalls. The limbWISE app, which is designed to solve a user’s problem through simple “yes” or “no” responses, has grown exponentially since its debut, and Lee’s team has added further layers of sophistication and problem solving. It was built in accordance with the National Institute on Aging’s standards so that older adults can benefit from

PRINCIPAL INVESTIGATOR

its offerings, but it can be used by all ages. And it’s designed not only for individuals with limb loss but also for their caretakers, prosthetists and other healthcare professionals, and O&P educators. Lee continues to develop related innovations, and he is currently in the final phase of validating a “first-ofits-kind knowledge assessment for individuals with limb loss,” he says, building on a concept first conceived and piloted by Adam Goodworth, PhD, while he was at the University of Hartford, with assistance from Robert Gailey, PhD, PT; Bini Litwin, PhD, PT; and Alicia Fernandez-Fernandez, PhD, PT. The measure is designed to detect gaps in a patient’s knowledge, then apply targeted educational interventions to remedy their deficits. Lee keeps both limb loss patients and their prosthetists in mind when developing new tools. “There are many self-management-related issues that result in the decreased efficiency and output of the clinicians,” he says. He

points to a prosthetist who may spend an hour or more visiting a patient at home “just to instruct them on proper sock-ply and donning procedures,” he says. With the right tool—for example, a “virtual guide”—the prosthetist could save that time. “The more we can empower the patient to help themselves, the greater our efficiency and productivity” as clinicians.

Driven by Technology

Lee says he is a “family man” and enjoys spending time with his wife and two young children in Southampton, New York, on the eastern end of Long Island. In his free time, he enjoys paddle boarding and fishing—and is “pretty good at pulling out Northern Pufferfish from the Peconic Bay,” he says. But he never wavers from a focus on advancing technologies. His introduction to O&P and his decision to study the profession was spurred by meeting an amputee with an early version of a microprocessor knee. “My first foray into O&P was when I

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was a student at SUNY Stony Brook in Long Island, New York,” he says. During an O&P course, he visited the home of a transfemoral amputee who had been provided a state-of-the-art microprocessor prosthesis—but who used the device “more as a piece of furniture than he did for ambulating,” Lee recalls. “It was evident he struggled to engage the prosthesis properly and thus ambulated with the prosthesis as if it was locked-out.” From the experience, Lee learned that appropriate rehabilitation is critical to the synergy between the human and the machine. “It was during that moment that the light turned on in my head,” steering him toward O&P rehabilitation. After earning his doctor of physical therapy degree, he worked at an inpatient facility. He honed his rehabilitation skills while observing trends regarding which individuals were successful with prosthetic devices. He then migrated to the skilled nursing setting, where “it became evident how difficult the rehabilitation process was

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O&P ALMANAC | OCTOBER 2019

PRINCIPAL INVESTIGATOR

for an older adult with limb loss, and I knew I would need further training.” Lee studied under a physical therapist who specializes in the rehabilitation of older adults with limb loss, and he earned a Board Certification in Geriatrics from the American Board of Physical Therapy Specialties. It was during Lee’s time in the skilled nursing setting that he learned the importance of the physical therapist/O&P clinician relationship. He found his way to the University of Hartford’s MSPO program, where he worked as an assistant professor and taught many of the foundational science courses, along with limb loss rehabilitation, to future O&P clinicians for five years.

Lee is an assistant professor at Touro College School of Health Sciences in Bayshore, New York.

OCTOBER 2019 | O&P ALMANAC

Continuing To Innovate

Looking to the coming year, Lee notes that his work with the app continues to be a focus: “While the app is always growing, it is not without its difficulties,” he says. “The issue with advancing the capabilities of the app is two-fold: Every time I want to expand the app it costs money, and every time the app changes I need to test it, thus restricting its release. Because of the inherent risks with medical-related mobile apps, great care needs to be demonstrated to reduce the risk of potential misuse by the target user. So before any release, it must be proven to work as expected.”

After efficacy and feasibility testing is completed, he plans to publish a new version of the app with updated problem-solving algorithms, general education, and knowledge assessment measures. “My hope is it can be used as a beneficial patient education tool, conduit for the communication of clinical issues from client to clinician, and a one-stop shop for solutions to the common issues faced by individuals with limb loss.” In addition, Lee hopes to investigate the economic impact of limbWISE on clinician productivity and the overall costs associated with life after losing a limb. “We conducted a study looking at the prevalence of unscheduled visits by patients during the first three months after receiving their initial prosthesis,” he says. The results demonstrated that several visits could have been prevented as they were related to selfmanagement complications. “While the economic impact is not yet understood, I hope to one day answer the question of the monetary value associated with these types of visits.”

Notable Works Daniel J. Lee, PT, DPT, GCS, COMT, has contributed to several publications for the scientific community. Some of his most impactful works include the following: • Lee, D.J., Veneri, D.A., Goodworth, A.G. “Self-Management ProblemSolving Tools for Lower-Limb Prosthesis Wearers: Mobile App Usability and Acceptability Study.” Journal of Prosthetics & Orthotics 2019; 31(1):33-42. • Lee, D.J., Veneri, D.A. “Development and Acceptability Testing of Decision Trees for Self-Management of Prosthetic Socket Fit in Adults With Lower-Limb Amputation.” Disability and Rehabilitation 2018; 40(9):1066-1071. • Lee, D.J., Wininger, M., Mahler, D., Parisi, M. “Taxonomy of Clinical Encounters During the First 90 Days Postdelivery of the Initial Definitive Lower-Limb Prosthesis.” Prosthetics and Orthotics International 2018; 42(5):490-97. • Goodworth, A.G., Veneri, D., Burger, J., Lee, D.J. “Development and Testing of an International Knowledge Assessment of Prosthetic Management for Patients Using Lower-Limb Prostheses.” Journal of Prosthetics & Orthotics 2017; 29(1): 28-34.

PHOTO: Daniel J. Lee, PT, DPT, GCS, COMT

Earlier this year, Lee joined the staff at Touro College School of Health Sciences, where he is responsible for teaching, service, and scholarship in the Department of Physical Therapy. “I primarily teach the evidenced-based practice course sequence, which takes students through a journey from the foundations of the scientific method to the presentation of a facultymentored research project,” he says. He collaborates with students and faculty on their research projects, helping take their projects “from the seed of an idea to full-out poster presentation or manuscript publication.” When teaching the research sequence, Lee says he strives to connect “the real-world issues we face with the evidence—or lack thereof— that can be used to solve it.” While

some students initially “brush off research as something secondary to their primary roles as a clinician … this couldn’t be farther from the truth,” Lee adds. “Evidence proves what works, disproves what doesn’t, and guides our clinical decision making. It is just as integral to our ability to meet the standard of care as our clinical skills. This is the message I hope to impart to future clinicians of all disciplines.”

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MEMBER SPOTLIGHT

PSYONIC

By DEBORAH CONN

Extending a Hand Upper-limb manufacturer works with nonprofits to improve access in developing countries

ADEEL AKHTAR, PhD,

was only 7 when he first encountered someone with limb loss. “I was visiting Pakistan, and I saw this little girl—just my age— missing her right leg and using a broken tree branch as a crutch,” he recalls. He knew then that he wanted to do something to help that child and others like her. The result, 25 years later, is PSYONIC, a company whose mission is to develop advanced bionic limbs that are accessible to everyone. Akhtar earned his doctorate degree in neuroscience at the University of Illinois at UrbanaChampaign, and he holds master’s degrees in electrical and computer engineering and in computer science. He launched PSYONIC in 2015 as he was completing his doctorate and has spent four years developing and perfecting the Ability Hand, which Akhtar introduced at the 2019 AOPA Assembly in San Diego last month.

Ret. U.S. Army Sgt. Garrett Anderson uses the Ability Hand to interact with his daughter.

COMPANY: PSYONIC OWNER: Aadeel Akhtar, PhD LOCATION: Champaign, Illinois HISTORY: Four years

Anderson has been testing the prosthesis in various activities.

OCTOBER 2019 | O&P ALMANAC

Aadeel Akhtar, PhD

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

PHOTOS: PSYONIC

The Ability Hand is a fully multiarticulated prosthetic hand. “All five fingers can flex and extend, and the thumb can rotate, both manually and electrically,” says Akhtar. The fingers, made of silicone and rubber, are flexible and impact-resistant. “You can take a hammer to the hand, and it will survive the blow,” he says.

Notably, the hand provides haptic feedback, using sensors in the index finger, pinky, and thumb that create a vibration in the socket. The vibration increases in intensity as additional pressure is applied, allowing users to use a grip strength appropriate to the object they are holding. “We are working with Garrett Anderson, a retired U.S. Army sergeant, who lost his arm below the elbow to a roadside explosive device in Iraq 14 years ago,” says Akhtar. “With the Ability Hand, Sgt. Anderson can tell how tightly he’s holding his young daughter’s hand.” Akhtar says he is hopeful that the prosthesis will be covered by Medicare using standard L codes. “The hand is made in the United States, and we leverage more cost-effective materials than traditional injection-molded plastics and custom-machined steel,” he notes. “Instead, we use two-part silicones and polyurethane, which are not only less expensive but have the added benefit of being impact-resistant.” PSYONIC is collaborating with the Range of Motion Project

(ROMP), a nonprofit dedicated to providing prosthetic and orthotic care to people around the world who can’t afford it. “According to the World Health Organization (WHO), 80 percent of amputees worldwide live in developing countries, and only 3 percent of them are able to access orthotic and prosthetic services,” says Akhtar. “Through ROMP, we were able to test an early prototype of the Ability Hand on a man who had lost his hand decades ago. Even though that early device was about three times the normal size and had wires everywhere, the patient said he felt as though a part of him had come back. He was able to make a pinching motion for the first time in 35 years.” Akhtar heads a staff of 12 employees, including a team of mechanical and electrical engineers, a research and development group, and a newly hired sales and support team. PSYONIC is based at the University of Illinois’s startup incubator in Champaign, which supported the company’s inception and has ceded all intellectual property rights to its products. Now that the Ability Hand is commercially available, Akhtar plans to work with nonprofits—such as ROMP, WHO, and the American Red Cross—to get the device to amputees in developing countries. PSYONIC’s immediate goals are to hold an initial launch in the Midwest and then expand nationally, but the company also is looking to the future. “We are already planning for osseointegration and implanting electrodes, and we expect to move to lower-extremity prostheses as well,” says Akhtar. “But for now, we are really excited to finally bring this to market, to make it accessible to everyone in the world who needs a hand.”

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MEMBER SPOTLIGHT

Thompson’s Custom Orthotics & Prosthetics

Positive Attitudes in the Upper Northwest Established Washington state facility meets the needs of a wide range of O&P patients

IM CAHILL, CPO, was only

OCTOBER 2019 | O&P ALMANAC

Owners Henry Bennett, CPO, and Cahill work together.

Jim Cahill, CPO, fits a C-leg prosthesis.

Vince Wilson prepares a dynamic leg socket.

designed for specific purposes and increased efficiency. A large segmented lab was designed to reduce waste and improve quality. Cahill says the facility’s “talented group of technicians,” who all graduated from the OWNERS: Spokane Falls technician program, Jim Cahill, CPO, and build approximately 70 percent Henry Bennett, CPO of the facility’s devices in the well-equipped fabrication lab. LOCATIONS: Thompson’s clientele ranges Spokane, Washington, from pediatrics to geriatrics, with with satellite a large veteran population and an even split between prosthetics offices in Spokane and orthotics. Each clinician has and Clarkston, his or her own focus; for example, Washington Cahill is a pediatric specialist and Bennett primarily does prosthetics, HISTORY: with an emphasis on veterans. The 19 years other clinicians are experienced in a full range of O&P services. Cahill doesn’t think his amputation has had an influence on the quality of his work, but he knows that patients respond positively, if the topic comes up. “It wasn’t intentional, but we Bennett fits a bilateral have a total of three practitioners below-knee amputee with with amputations, and there a dynamic check socket.

FACILITY: Thompson’s Custom Orthotics & Prosthetics

is a sense from some patients that they appreciate it and believe it makes a difference.” As the industry changed and audits have become commonplace, “we, like many facilities around the country, changed our clerical staff to ensure our survival,” says Cahill. “We’ve adjusted our workflow and processes to accommodate the changing environment of P&O.” Thompson’s marketing strategies are carried out via a broad network of professional acquaintances, word of mouth, and involvement in the Spokane community, “with, of course, our high-quality work,” says Cahill. Thompson’s clinicians regularly offer continuing education in-service programs, give lectures to the Eastern Washington University physical therapy program, and participate in local rehab facilities’ fundraisers and special events. Cahill and Bennett both serve on advisory committees for the Spokane Falls technician program and partner with the local ski venues in their adaptive skiing programs. Looking ahead, Thompson’s Custom O&P plans to continue its slow-growth trajectory. “Spokane is a booming town, and we will continue to meet the needs of its growing population,” says Cahill. “We have our motto painted above our check-in desk. At first it was meant to inspire our patients to achieve greater outcomes, but we’ve come to realize that it’s so much more than that. It reads ‘For success, attitude is equally important as ability.’” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Thompson’s Custom Orthotics & Prosthetics

18 when he lost his foot in an accident aboard a Coast Guard ship, an event that sparked his interest in prosthetics. The Coast Guard retired Cahill and paid for his education at the University of Washington, in Seattle, where he decided to study O&P. After graduating in 1994, Cahill moved to Spokane and began his career as a clinician. Coincidentally, Cahill’s prosthetist in Seattle, Henry Bennett, CPO, relocated to Spokane at about the same time, and in 2000, after competing with each other for six years, the two decided to join forces. They purchased an existing O&P facility called Thompson’s Custom Orthotics & Prosthetics and began with only six employees. Cahill is a fan of slow growth, and that’s the approach he and Bennett took. Today, Thompson’s Custom O&P has 21 on staff, including five certified clinicians and a practitioner who is completing her second residency, four technicians, three fitters, and a clerical staff member. In addition to its main office in Spokane, Thompson’s O&P has a satellite clinic in Clarkston, Washington, just across the river from Cahill’s hometown of Lewiston, Idaho. A third office in Spokane offers off-the-shelf as well as custom services. Thompson’s new central office was built in 2010 to the owners’ specifications. The design features seven patient rooms, each one

By DEBORAH CONN

Vegas Is About

Risk Taking Learn to mitigate your business risks, register for the Mastering Medicare: Essential Coding and Billing Techniques in Las Vegas, November 4-5. But don’t take our word for it. Attendees from the last seminar said:

Great takeaways and clarifications of topics that we are actively working on in the office. I wish all staff could attend!

This was my third time at this course.

Every time it gets better.

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.

Speakers did a great job. Thoroughly covered topics, were engaging and entertaining.

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Want even less risk? Register before October 4 to take advantage of the early bird rate.

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.

Attendees are responsible for making their own hotel reservations. Book by October 7 for the $135/ night rate by calling 800/374-9000 and asking for the AOPA Coding and Billing Seminar rate.

NOVEMBER 4-5, 2019

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS Co-OP

Don’t Sleep on the Latest AOPA Member Resource: AOPA Co-OP Are you utilizing your AOPA membership to its fullest? Be sure to visit the AOPA Co-OP at www.aopanet.org/ resources/co-op/. A Wikipedia for all things O&P, the Co-OP is a one-stop resource for information about reimbursement, coding, and policy. It is a searchable database that provides up-to-date information on developments in Medicare policy, state-specific legislation, private payor updates, and more. Members can access detailed information on everything from modifiers to product-specific L codes and associated policies. Additionally, members can share information and insights on developments impacting the entire O&P profession.

If you haven't signed up for the Co-OP yet, take part in a free live tutorial on one of the following dates: Friday, October 18 Friday, November 8 Friday, December 6 TUTORIAL

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All tutorials take place at noon EST. This is your opportunity to learn about O&P's most comprehensive resource for coding, billing, and reimbursement. Ashlie White, AOPA’s director of strategic initiatives, will demonstrate how to use the Co-OP and answer all of your questions. Contact Betty Leppin, bleppin@aopanet.org, for details.

NOVEMBER 13

AOPAversity Webinars During the one-hour monthly webinars, AOPA experts provide the most up-to-date information on a specific topic. Webinars are held the second Wednesday of each month at 1 p.m. EST. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities. Sign Up & Save! Registration Fee

Price Per Seminar

AOPA Members $99.00* Nonmembers $199.00*

* Includes an unlimited number of participants per telephone line. AOPA members may use code “member” when registering for the $99 price.

Earn 1.5 Business CEs each by returning the provided quiz within 30 days and scoring at least 80 percent. All webinars begin at 1 p.m. EST. Webinar registration fees are nonrefundable. AOPA can provide the webinar recording if registrants cannot make the scheduled webinar. 58

OCTOBER 2019 | O&P ALMANAC

UPCOMING WEBINAR

The Holiday Season—How To Provide Compliant Gifts ’Tis almost the season to be jolly! Learn the right way to demonstrate your appreciation to patients and referral sources while adhering to the guidelines surrounding gift giving. The November 13 webinar will explore the following topics: • When are gifts to referral sources acceptable? • When are gifts to patients acceptable? • What do you need to know about the federal antikickback regulations? • What are some tips for creating a compliant gift-giving policy?

DECEMBER 11

UPCOMING WEBINAR

New Codes for 2020, Other Updates, and Yearly Roundup Get ready for 2020 by learning about the new codes and fees to be implemented next year! AOPA experts also will review the important coding and billing reminders from 2019 and preview upcoming policy changes. All of your questions will be answered: • How are new codes created? • How are fees established? • When are policies updated? • And much more!

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AOPA NEWS

Attend the Las Vegas Coding & Billing Seminar November 4-5 The Mirage 3400 S. Las Vegas Blvd. | Las Vegas, Nevada

AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, colleagues, and more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. For more information and to register, visit www.aopanet.org/education/ coding-billing-seminar/. At this seminar, you will: • Receive up-to-date information on prior authorization and other hot topics. • Ensure your proof of delivery meets Medicare requirements. • Learn how to assess risk areas in your practice. • Learn successful appeal strategies and hints to avoid claim denials. • Practice coding complex devices, including repairs and adjustments. • Attend breakout sessions for practitioners and office staff. • Earn 14 continuing education credits.

IntROduCInG nEW REStECH

+ A d VA n C E d P O Ly m E R F O R m u L A E P Ox y R E S I n The strongest and easiest resin system available. Specifically formulated with an Advanced Polymer Formula designed to take the repetitive abuse laminated carbon orthotics and prosthetics receive. new REStECH+ Advanced Laminating Epoxy is the strongest and easiest resin system we have ever produced! Compliant with all common materials used in O&P. designed to deliver the highest flexural strength combined with superior toughness, REStECH+ can make more possible!

Positive new features: • Fastest Curing time • Easy 2:1 mixing By Volume • Superior toughened Resin matrix • Crystal Clear • High Luster Finish • thin High Flow Viscosity • Vacuum Socket Approved & tested • unperceivable Shrinkage • 3 year Shelf Life • non-Hazmat Shipping

Free Heat Sack* with your first order. need a cured socket fast? use our Rapid Cure technology Heat Sack.

Visit fabtechsystems.com for more information, or call: 800.FABTECH

Faster. Stronger. Better. © 2017 Fabtech Systems LLC. All Rights Reserved. *Free heat sack offer: 1 per customer with first purchase of Restech+ System, Hair dryer not included. Good while supplies last. Only available through participating distributors. Offer expires 12/31/ 2017.

Restech-OPNews-Halfpage-Ad-7.625x5.indd 1

OCTOBER 2019 | O&P ALMANAC

5/16/17 7:20 PM

O&P PAC UPDATE

HE O&P PAC UPDATE provides information

on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA members*: Gary Cheney, CPO Steven Hoover, CP, LP Clyde Massey

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. 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 at bit.ly/aopapac.

Aaron Moles, CP Wendy Miller, BOCO, LO Matthew Nelson, CPO, FAAOP

*This list was created on Sept. 13, 2019, and includes only donations and contributions made or received between Aug. 12, 2019, and Sept. 13, 2019. Any donations or contributions made or received on or after Sept. 13, 2019, will be published in a future issue of O&P Almanac.

Mark Porth, CPO Tyler Rowley, CPO Stephen Schulte, CP

Ferrier Coupler Options!

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.

O&P ALMANAC | OCTOBER 2019

NEW MEMBERS

Welcome New AOPA Members

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 made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or statelicensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

We ARE AOPA

ADVOCACY | RESEARCH | EDUCATION

Blue Ridge Prosthetics & Orthotics LLC 1951 Evelyn Byrd Avenue, Ste. E Harrisonburg, VA 22801 707/637-6190 Member Type: Patient-Care Facility Joint Active Systems 2600 S. Raney Street Effingham, IL 62401 217/342-3412 Member Type: Patient-Care Facility Mid State Artificial Limb Co. Inc. 4455 Medgar Evers Blvd. Jackson, MS 39213 601/981-2229 Member Type: Patient-Care Facility

WASHINGTON, DC YOUR CONNECTION TO EVERYTHING O&P 62

OCTOBER 2019 | O&P ALMANAC

New Life Brace and Limb LLC 250 Blossom Street, Ste. 200 Webster, TX 77598 280/316-5805 Member Type: Patient-Care Facility Orthocare Orthotics and Prosthetics Inc. 1501 N. U.S. Highway 441 Building 1100, Ste. 1108 The Villages, FL 32159 352/751-7265 Member Type: Patient-Care Facility Orthokinect 332 E. Lincoln Avenue, Ste. 150 Royal Oak, MI 48067 877/322-3876 Member Type: Patient-Care Facility

SAVE THE DATE

MAY 5–6

New Hope Prosthetics & Orthotics 424 N. University Avenue Little Rock, AR 72205 501/664-2345 Member Type: Affiliate

Total Contact Prosthetics and Orthotics 9900 Bell Ranch Drive, Ste. 107 & 108 Santa Fe, CA 90670 562/944-9001 Member Type: Patient-Care Facility

HOST HOTEL:

RENAISSANCE ARLINGTON CAPITAL VIEW HOTEL 2800 S POTOMAC AVE ARLINGTON, VA 22202

WWW.AOPANET.ORG

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

Hanger.com/Climb

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.

AOPA NEWS

CAREERS

WANTED!

Opportunities for O&P Professionals Job location key:

A few good businesses for sale.

- Northeast

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

- Mid-Atlantic - Southeast - North Central

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

- Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word

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

Member Nonmember $85 $150

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

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

Northeast

CO/CPO and/or Technician

Long Island and Queens, New York Wanted: CO/CPO and/or technician for busy Long Island and Queens practice. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable, and caring. Technician must have experience pouring and modifying casts. Apply by email to : Mark Goldberg Prosthetic & Orthotic Labs Email: careers@mgpolabs.com

Inter-Mountain Owner Wanted

Lubbock, Texas INCREDIBLE BUSINESS OPPORTUNITY! National Brace is looking to put a clinician into practice. Please only licensed and highly motivated individuals apply. If you have ever dreamed of owning a practice that is totally affordable with no money down, Medicare, Texas Medicaid, Brightree, vertically integrated purchasing, great lease, and completely turnkey in downtown Lubbock:

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

OCTOBER 2019 | O&P ALMANAC

National Brace™ Email in confidence to: Email: nationalbraceinc@gmail.com

CAREERS

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities

EMPLOYEE

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

EMPLOYER

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

LOG ON TODAY!

https://jobs.aopanet.org O&P ALMANAC | OCTOBER 2019

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/almanac19 for advertising options.

ToeOFF® 2 ½ and BlueROCKER® 2 ½ Available Now! 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 there is a lower forefoot curvature and there is more space in the shoe toe box. ToeOFF® 2 ½ Addition models available in camo, birch, and black for your fashion-conscious patients. Call 888/678-6548 or email info@allardusa.com to receive your FREE Product Selection Guide.

ALPS Valve Integrated Pump ALPS Valve Integrated Pump (VIP) is just what you need for elevated vacuum systems. Designed with the practitioner in mind, the VIP is easy to install and easy to use. Once the amputee dons the prosthesis and places a seal sleeve over the socket, the pump is activated from the user’s weight during heel strike, and draws elevated vacuum after toe-off during swing phase. Engineered out of a medical grade silicone and two valves to control the airflow, the VIP is available with two different levels of vacuum to accommodate most users’ activity levels and skin types. Call us or visit www.easyliner.com for more information.

Coyote Prosthetics and Orthotics

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.

Sutti Bounders Store & Return Energy— Mimicking Normal Muscle Function New “Sutti Bounders” modular pediatric dynamic elastomers are a patentpending elastomer technology that offer two progressive solutions. Sutti Bounders store and return energy— mimicking normal muscle function to produce both eccentric and concentric contractions and, if needed, a ground-reaction force. Smart and simple modular design, standardized sizes, and three levels of performance to choose from add up to an easy-to-use expandable dynamic system to treat your pediatric and young adult patient base. For more information, visit www.fabtechsystems.com/ bounders or call 800/322-8234.

AOPA Compliance Guide CD

Coyote’s locks are the all-terrain vehicles of prosthetic locks. Sand-, mud-, and water-resistant, all Coyote’s locks are tough enough for extreme activities, comfortable enough for everyday use. Coyote Prosthetics and Orthotics—call 208/429-0026 or visit www.coyotedesign.com. 66

OCTOBER 2019 | O&P ALMANAC

This Compliance Handbook helps patient care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General (OIG). This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective Audit/Quality Assurance program to monitor compliance and conduct introductory training sessions for employees. Order at www.AOPAnet.org or call AOPA at 571/431-0876.

MARKETPLACE Fillauer Obsidian Spring Blade Ready. Set. Go! Get ready for race day with the new Obsidian blade line. The Obsidian Running Blades are available in a posterior-mount option for kids and adults. The adult direct-mount option offers a pyramid slide for a variety of alignment locations and easy adjustments. The new Obsidian Sprint Blade, intended for elite athletes, provides a curve-hugging split toe along with a snap at toe-off that will push the elite to a new level. Check out Fillauer.com for more details.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call 800/301-8275 or visit www.hersco.com.

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

Proprio Foot® Because the world isn’t flat. Proprio Foot® debuted in 2006 with a simple goal: to reduce trips and falls. This latest-generation microprocessor ankle, built upon a Pro-Flex® LP foot module, provides 44 percent more toe-off power— taking us one step closer to our goal. Visit ossur.com/proprio-foot to learn more.

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

Discover PROTEOR USA

Delivering an extensive, progressive product line that includes everything today’s active amputees need to live the life they love. Offering an innovative portfolio that includes everything from the virtually indestructible RUSH Foot collection to the world’s first microprocessor-controlled hydraulic four-bar knee with both stance and swing functionality, the ALLUX. The EASY RIDE, multiuse extreme sports knee, to the KEASY, renowned prefabricated cones. The K2 GERY foot, to the flexible, all-terrain, DynaTrek foot. Discover the exciting PROTEOR USA product line today! A whole new look. A whole new vibe. A whole new world. #HumanFirst. Visit us at proteorUSA.com. O&P ALMANAC | OCTOBER 2019

MARKETPLACE Enhance Mobility With the E-MAG Active The E-MAG Active electronically controlled joint system is activated independently of the ankle and the foot, allowing patients to take advantage of the joint’s functionality even if they have no ankle function. For mobility with improved safety, the intelligent sensor system measures the position of the leg while walking and controls the orthosis joint accordingly. For even more security, the E-MAG Active features a pre-lock function, which securely locks the user’s knee joint even before full extension is achieved. For more information, call 800/328-4058 or visit professionals.ottobockus.com.

New: Ottobock’s Triton Side Flex Your will. Your way. The latest member of the Triton foot family helps your patients feel more confident with its unique degree of side-to-side flexibility and safe, full-ground contact— including on uneven surfaces. The M-L unit reduces the sideward tilting moments on the knee or in the socket. Simultaneously, compensatory movements can be minimized. • Comfortable adjustment for increased sense of security • Dynamic rollover supports vigorous walking • Delivers the performance suited to each step • Supports agile and high-impact movement across varying terrain conditions. Visit professionals.ottobockus.com to learn more.

OCTOBER 2019 | O&P ALMANAC

1C50 Taleo® From Ottobock Ready for everyday life. The carbon-fiber Taleo foot, one of the new additions to our portfolio, is designed for your active K3 patients who navigate varied indoor and outdoor environments and place a high value on effortless walking and the ability to go wherever life takes them. Properties of 1C50 Taleo: • Smooth rollover for effortless walking • Delivers performance suited to each step • Supports dynamic movement across varying terrain conditions. For more information visit www.professionals.ottobockus.com or talk to your sales rep.

The Xtern Foot Drop AFO From TurboMed Orthotics This unique AFO was designed for patients suffering from foot drop. It is worn 100 percent outside of the shoe. The Xtern is HCPCS code L1951 validated. Turbomed innovative products are now available through distributor partnerships in more than 26 countries. Its unique design and material composition give another meaning to walking and running. There is no limitation with the Xtern for the customers—not even a weight limit! For orthotists and professionals, a trial kit called AT (assessment tool) is available to quickly and easily assess patient compatibility with the Xtern in less than five minutes. Available in USA from Cascade Supply, SPS, Lakes Medical Innovations, Kevin Orthopedic, and Physio Tech. For more information, visit www.turbomedorthotics.com.

MARKETPLACE The Alpha Silicone Liner by WillowWood Want a silicone liner that’s easy to don and is skin-friendly? Consider the Alpha Silicone® Liner. WillowWood’s Alpha Silicone Liner blends a unique combination of Vitamin E and skin conditioners with medical grade silicone that is gentle on skin. The liner’s Select fabric stretches circumferentially for easy donning without requiring any lubricants. The liner’s one-way stretch Select fabric also controls pistoning without using a distal matrix. Available for transfemoral and transtibial applications. The transtibial version features a flexible knee panel for enhanced knee. For more information contact WillowWood at 800/848-4930 or visit willowwoodco.com.

2019 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P HealthCare Common Procedure Coding System (HCPCS) code changes with an array of 2019 AOPA coding products. Ensure each member of your staff has a 2019 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • 2019 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2019 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

AD INDEX

Advertisers Index Company

Page Phone

Website

Allard USA 5 866/678-6548 ALPS South LLC 11 800/574-5426 American Board for Certification in Orthotics, Prosthetics, and Pedorthics 55 703/886-7114 Amfit 25 800/356-3668 Anatomical Concepts 45 800/837-3888, 330/757-3569 Cascade Dafo Inc. 21 800/848-7332 Coyote Design 41 800/819-5980 ESP LLC 7 888/WEAR-ESP Fabtech Systems LLC 37, 60 800/FABTECH Ferrier Coupler Inc 61 810/688-4292 Fillauer Companies Inc. 33 800/251-6398 Hanger 63 512/777-3814 Hersco 1 800/301-8275 Naked Prosthetics 43 888/977-6693

www.allardusa.com www.easyliner.com

Össur Americas Inc. Ottobock PROTEOR USA Spinal Technology Inc. Surestep TurboMed Orthotics WillowWood

www.ossur.com www.professionals.ottobockus.com www.proteorusa.com www.spinaltech.com www.surestep.net www.turbomedorthotics.com www.willowwoodco.com

3 800/233-6263 28-29, C4 800/328-4058 C2 855/450-7300 53 800/253-7868 51 877/462-0711 9 888/778-8726 17 800/848-4930

www.abcop.org www.amfit.com www.anatomicalconceptsinc.com www.cascadedafo.com www.coyotedesign.com www.wearesp.com www.fabtechsystems.com www.ferrier.coupler.com www.fillauer.com www.hanger.com www.hersco.com www.npdevices.com

O&P ALMANAC | OCTOBER 2019

CALENDAR

APPLY ANYTIME! BOC Certification. Apply anytime and www.bocusa.org test when ready for the orthotic fitter, mastectomy fitter, and DME specialist certifications. To learn more about BOC’s nationally recognized, in-demand credentials and to apply today, visit www.bocusa.org.

November 1

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

November 1

Cascade Dafo Institute

Eight free ABC-approved online continuing education courses for pediatric practitioners. Take anytime, anywhere, and earn up to 11.75 CE credits. Visit cascadedafo.com or call 800/848-7332.

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

November 3–9

Healthcare Compliance & Ethics Week. AOPA is celebrating Healthcare Compliance & Ethics Week and is providing resources to help members celebrate. Learn more at bit.ly/aopaethics.

2019

November 4–5

October 7–12

ABC: Written and Written 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/certification.

Coding & Billing Seminar. Las Vegas. Book your hotel by October 7 for the $135/night rate. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org or register online at bit.ly/2019billing. SEMINAR

November 6–8

New Jersey AAOP. Harrah’s Resort Atlantic City. For general inquiries, contact Brooke Artesi , CPO, LPO, at 973/696-8100, or brooke@sunshinepando.com, or www.NJAAOP.com.

October 9

Performance Reviews: How Is Your Staff Doing? Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

October 10–12

NC Chapter of the AAOP Scientific Meeting. The Hotel Ballast, Wilmington, NC. For more information, visit www.ncaaop.com or email ncaaop@gmail.com.

October 19

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. Aloft Hotel New York LaGuardia Airport, 100-15 Ditmars Blvd., East Elmhurst, NY 11369. For more information, contact Drew Shreter at 800/946-9170, ext. 101, or email dshreter@pomac.com.

OCTOBER 2019 | O&P ALMANAC

November 13

The Holiday Season—How To Provide Compliant Gifts. Register online at bit.ly/ 2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

December 1

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

December 1

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

CALENDAR

December 9–14

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/certification.

December 11

New Codes for 2020, Other Updates, and Yearly Roundup. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

December 12–14

Pediatric Gait Analysis and Orthotic Management: An Optimal Segment Kinematics and Alignment Approach to Rehabilitation (OSKAR). Chicago. 25.5 ABC credits. For more information, contact Melissa Kolski at 312/238-7731 or visit www.sralab.org/academy/PedsGait19.

2020

January 17–23

US ISPO Pac Rim Meeting. Sheraton Maui Resort & Spa, Lahaina, Maui, HI. Visit www.usispo.org.

March 19–21

Georgia Society of O&P. Alpharetta, GA. Visit www.georgiasop.com.

May 5–6

AOPA Policy Forum. Washington, DC. Visit www.AOPAnet.org.

May 13–15 NYSAAOP Meeting. Schenectady, NY. Visit www.nysaaop.org/meeting. September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

AOPA Supplier Plus Partners

January 1

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

Thank you to our AOPA Supplier Plus Partners for their continued support of the association.

January 10–11

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

COMPLETE CONTROL

January 24–25

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@ABCop.org, or visit ABCop.org/certification.

Calendar Rates CE For information on continuing education credits, contact the sponsor. Questions? Email ymazur@AOPAnet.org. CREDITS

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, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

O&P ALMANAC | OCTOBER 2019

ASK AOPA CALENDAR

Orders and Delays Answers to your questions about initial and detailed written orders, appeal delays, and more

AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P profession. Each month, we’ll share several of these questions and answers from AOPA’s expert staﬀ with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

How long is a prescription or order valid?

The time period for which an order remains valid depends on the type of order, and what services or items are required. For example, an initial or dispensing order does not have an expiration date, as set by Medicare; however, it is a good idea to get a new order if the original order is more than 90 days old. Doing so will help ensure that the item you will be providing is still medically necessary, and that the patient’s condition has not changed. The detailed written order (DWO) is valid for the lifetime of the item delivered. This means that any repairs and adjustments are covered and would not need a new order, and the same goes for supplies. However, if you need to replace the whole item or a major component, then a new dispensing order and DWO would be required.

OCTOBER 2019 | O&P ALMANAC

Given the delays at the third level of appeal, the administrative law judge (ALJ) level, is there a way we can check the status of our appeal?

When we are billing for a miscellaneous code, what information must we include with the claim?

Yes, the Office of Medicare Hearings and Appeals (OMHA), the office in charge of the ALJs, created a portal where you may inquire about pending appeals. The portal is called the ALJ Appeal Status Information System, or AASIS. The portal may be accessed from the OMHA website: https://aasis.omha.hhs.gov/.

You should provide five pieces of information in the narrative field of your claim: • A brief description of the item or service • The manufacturer’s name, if available • The product name and number, if available • A supplier price list amount • A Health-Care Common Procedure Coding System code of a related or similar item, if applicable.

Q/ A/

Who is eligible to sign a proof of delivery (POD) form?

Ideally, the patient receiving the item or service should sign the POD. If the patient is unable to sign, then anyone may sign the POD—with the exception of you or anyone on your staff because you have a vested interest in the claim. When an individual other than the patient signs the POD, be sure to document why the patient was unable to sign and to indicate the relationship of the signatory to the patient on the POD. It also is recommended that the signatory print his or her name as well.

Q/ A/

If any of this information is missing, it is possible that your claim will be rejected and you will have to resubmit your claim. For Medicare, how long are we required to maintain our records?

Under Medicare, you are required to keep and maintain records for seven years from the date of service.

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NOV. 3-

2019 AOPA Celebrates Healthcare Compliance & Ethics Week NOVEMBER 3–9, 2019 Make plans to join your AOPA member colleagues in celebrating Healthcare Compliance and Ethics Week (HCEW), November 3-9. In its third year celebrating HCEW, AOPA energized more than 500 members of our community to participate in seminars, educate staff, and share their focus on ethical behavior with their patients and community.

KEY RESOURCES AT AOPA

AOPA is organizing resources, education, prizes, and more to help your organization participate. With a week-long celebration of compliance and ethics, you have a great opportunity to introduce and reinforce your chosen themes. Your plans will rely in part on your organization’s specific needs, but some basic goals may include:

AWARENESS of the Code of Conduct,

relevant laws/regulations, and other reporting methods, the organization’s compliance and ethics staff, etc.

RECOGNITION of training completion, compliance and ethics successes, etc.

REINFORCEMENT of a culture of compliance for which your organization strives. AOPA has developed several free tools and resources to assist you. Visit our dedicated web page for tools, resources and more:

bit.ly/AOPAEthics

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