June 2019 O&P Almanac by AOPA

CHECK OUT THE AOPA 2019 NATIONAL ASSEMBLY PRELIMINARY PROGRAM. View at www.AOPAnet.org. The Magazine for the Orthotics & Prosthetics Profession

PRELIMINARY

PROGRAM

Updates to the Medicare Medical Policies

take place September 25-28 in San Diego,

ed meeting for Prosthetic, Orthotic and

Hemisphere. Hear the best in business

mming from physicians, high-level researchers

ur premierP.16 Exhibit Hall offering more exhibitors,

chnologies and services than any other show

ss your chance to be part of it.

AOPAnet.org

Advocates Spread the O&P Message in Meetings With Lawmakers P.30

Hot Spots in San Diego: AOPA National Assembly Preview

J U N E 2019

Negotiating

Tactics

BOOSTING BUSINESS BY CONTRACTING WITH HOSPITALS, U.S. DEPARTMENT OF VETERANS AFFAIRS, AND MORE

P.22

P.36

Advances in Fall Prevention Research P.42

E! QU IZ M EARN

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.19

This Just In: The Countdown Begins: Competitive Bidding 2021 P.20

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contents

J U N E 2019 | VOL. 68, NO. 6

COLUMNS

COVER STORY

FEATURES

Reimbursement Page.......................... 16

Keeping Current With the Policies

Recent revisions to the Medicare medical policies CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Principal Investigator.........................42 Andrew Sawers, PhD, CPO

22 | Negotiating Tactics Successful O&P companies are getting strategic in partnering with hospitals, the U.S. Department of Veterans Affairs, and other entities to provide orthotic and prosthetic services. These partnerships can be profitable if O&P professionals are careful in their contract negotiations, build relationships with key contacts, offer education on device fitting, and provide high-quality clinical care. By Christine Umbrell

20 | This Just In

Investigations into fall prevention are yielding useful findings for lower-limb amputees, according to a researcher who heads the Locomotor Rehabilitation Lab at the University of Illinois at Chicago. Member Spotlight................................ 44 n

Adaptive Technologies

SPS

DEPARTMENTS

Gearing Up To Compete CMS has revised the timeline for Competitive Bidding 2021, which will include 23 off-the-shelf knee and spinal orthosis codes in the competitive bidding process. While June 10 marks the opening of the registration window, the opening of the bid window has been delayed until July 16. See all of the key dates in the timeline.

Views From AOPA Leadership......... 4 Is your facility ready for competitive bidding?

AOPA Contacts............................................6

P. 20

How to reach staff

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

At-a-glance statistics and data

30 |

P. 30

Meetings With a Message

More than 100 O&P advocates were inspired by the words of keynote speaker John Register, CSP, before meeting with members of Congress during the 2019 AOPA Policy Forum. O&P advocates from across the country sat with their legislators and staff members to explain the O&P profession and generate support for two key pieces of legislation.

36 |

Head for the Coast

It’s time to make your travel plans for the 2019 AOPA National Assembly in San Diego. Plan now to network with O&P colleagues and attend educational sessions—and schedule some extra time to visit historical destinations, explore the coast, and stop in at “hot pick” locations shared by AOPA insiders. By Meghan Holohan

P. 36

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

Research, updates, and industry news

People & Places........................................ 14

Transitions in the profession

AOPA News............................................... 48

AOPA In the News, webinars, meetings, and more

PAC Update ............................................. 50 AOPA New Members............................ 51 Careers......................................................... 52

Professional opportunities

Marketplace.............................................. 54 Ad Index...................................................... 5 6 Calendar...................................................... 58

Upcoming meetings and events

Ask AOPA.................................................. 60 Q&A on competitive bidding

JUNE 2019 | O&P ALMANAC

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VIEWS FROM AOPA LEADERSHIP

To Bid, Or Not To Bid?

(DMEPOS) competitive bidding program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The intent of the program is for Medicare to set more reasonable payment rates for DMEPOS items, save money for beneficiaries and taxpayers, and limit fraud and abuse while ensuring access to quality items. Round 2021 is scheduled to begin on Jan. 1, 2021. However, you must be ready in the next two months to successfully submit a bid. There are 130 competitive bidding areas (CBAs). Even though your location may not be in the ZIP code of the CBA, the patientâ€™s ZIP code is what drives whether you can provide the braces without being a qualified competitive bidding supplier. I recommend reviewing your patient demographics to evaluate if you should submit a bid proposal, and determine how much business will be impacted if you choose not to. After Jan. 1, 2021, Medicare beneficiaries needing the off-the-shelf (OTS) knee or spine braces that are listed in the program will need to get those braces from a qualified competitive bidding supplier. If you choose not to submit a bid, you will need to refer those patients to an authorized supplier. You will not be allowed to use an Advance Beneficiary Notice. Accreditation: In order to submit a bid, you must be accredited. Even though CMS allows for exemption from accreditation for O&P practitioners, you must be accredited in order to participate in the competitive bidding program. Licensure: If you practice in a licensure state, you will want to make sure your information is up to date. You can review all your information to ensure compliance with Medicare requirements for competitive bidding using the National Supplier Licensure Data Base. You will not be allowed to submit a bid unless the information is complete and current. Bid Surety Bonds: Your organization will need to obtain a bid surety bond in the amount of $50,000 for each CBA for which you plan to submit. The bid surety bond is different from your standard surety bond that is required to participate in the Medicare program. Get familiar with your financial statements and the software tool. There are very specific financial requirements for submission in order to be considered a qualified bidder, including tax returns, 2017 or 2018 financial statements, and a credit report. Bidder registration begins June 10, and Connexion is the software tool used for competitive bidding. This will be the tool to house the bid amounts, financials, and communication with the competitive bidding program. Bidding: The competitive bidding program has changed in the way you bid for a category. Instead of submitting a bid for each Healthcare Common Procedure Coding System code, you will submit a bid on the lead item, and the program will calculate the reduction to the remaining codes automatically in the DBidS system. The lead item in the category (L1833 for the knee category and L0650 for the spine category) is the item with the highest total allowed charges nationwide. I recommend conducting an analysis of each code to be certain you can provide all of the items profitably before you submit your bid. There are several factors to consider when participating with the competitive bidding program. Historically, the winning bids were as low as 30 percent off of the current allowable. I certainly do not suggest submitting a bid at that rate. You will want to do an in-depth analysis of your practice, the OTS products you dispense, and the payors that you bill, and compare that analysis to the administrative time required to manage the program and the expenses. There are many training webinars to help educate you on the requirements, but only you and your team know your business and can determine if the program is a good fit for your practice. Kimberly Hanson, CRPH, is a member of AOPAâ€™s Board of Directors.

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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 6

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

JUNE 2019 | O&P ALMANAC

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

Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published 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.

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

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

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NUMBERS

Government Spending on Healthcare Federal subsidies for health insurance coverage of individuals younger than 65 cost $737 billion in 2019

2019 ENROLLMENT IN EMPLOYMENT-BASED INSURANCE (EBI) BY INCOME

21 Percent

Percentage with income below 150 percent of the federal poverty level (FPL) enrolled in EBI.

68 Percent 88 Percent Percentage with income between 150 percent and 400 percent of the FPL estimated to be enrolled in EBI.

Percentage with income greater than 400 percent of the FPL estimated to be enrolled in EBI.

PROJECTIONS FOR 2029

35 Million

The number of people projected to be without health insurance, up from 30 million in 2019.

COMPOSITION OF THE UNINSURED POPULATION UNDER 65, IN 2019

$1.3 Trillion

Expected net federal subsidies for insured people, up from $737 billion in 2019.

FEDERAL HEALTH INSURANCE SUBSIDIES FOR THE UNDER-65 POPULATION, 2019 In billions of dollars

Eligible for Subsidized Coverage Through a Marketplace Other

30 Million People

With Income Less Than 100 Percent of the FPL and Living in a State That Has Not Expanded Medicaid

n 2019 n 2029

$549

23%

30%

12%

$567

15% Eligible for Medicaid or CHIP

JUNE 2019 | O&P ALMANAC

$287

$314

20% Not Lawfully Present

$62 Support for Work-Related Coverage

Medicaid and Children’s Health Insurance Program

$79

Nongroup Coverage and Basic Health Program

$86

$131

Medicare

“In each year during the 2019-2029 period, Medicaid and the Children’s Health Insurance Program account for between 40 percent and 45 percent of the federal subsidies, as do subsidies in the form of tax benefits for work-related insurance. Medicare accounts for 10 percent, and subsidies for coverage obtained through the marketplaces established by the Affordable Care Act or thorough the Basic Health Program account for less than 10 percent.” —“Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029”

SOURCE: “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029,” Congressional Budget Office, May 2019

A new report from the Congressional Budget Office (CBO) provides estimates for the 2019-2029 period regarding the number of noninstitutionalized people under age 65 with health insurance and the federal costs associated with each kind of subsidy. “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029” includes estimates of the federal cost of subsidizing health insurance purchased through the Affordable Care Act’s marketplaces, of spending to subsidize insurance provided through the Basic Health Program, and of net spending and revenues associated with stabilizing insurance premiums, as well as of enrollment in the marketplaces and of the number of uninsured people.

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Happenings RESEARCH ROUNDUP

International Literature Review Examines Scoliosis Bracing Outcomes Researchers in Amsterdam have completed a systematic review of the literature to evaluate predictive factors for brace treatment outcomes in adolescent idiopathic scoliosis (AIS). Led by Barend J. Van Royen, MD, PhD, an orthopedic surgeon and professor at the Amsterdam University Medical Center, the research team identified 26 studies from across the globe that included subjects diagnosed with AIS who had been treated with a thoracolumbosacral orthosis. The researchers found that there is moderate evidence that brace wear time—but not initial curve and magnitude—is associated with treatment success or failure. The researchers assessed 19 radiographic and eight clinical predictive factors as possible predictors of brace treatment outcome. In studying average brace wear time and brace treatment success in analyzing the various published studies, the researchers concluded that “insufficient brace wearing seems to be an important driver for treatment failure, and AIS patients should be counseled accordingly.”

Engineers Integrate Sensors Into 3D-Printed Hands

Yuxin Tong, an industrial and systems engineering graduate student, adjusts a 3D-printed prosthesis. Tong was first author of a newly published research study about integrating electronic sensors in personalized 3D-printed prostheses.

JUNE 2019 | O&P ALMANAC

functionalities of wearable system interfaces using 3D scanning and 3D printing opens the door to the design and manufacture of new technologies for human assistance and healthcare,” said Johnson, “as well as examining fundamental questions associated with the function and comfort of wearable systems.” Details of the research were published in the March in PLoS One.

PHOTO: Linda Hazelwood

A team of engineers from Virginia Tech have made advances in integrating electronic sensors with personalized 3D-printed prostheses. Led by Blake Johnson, PhD, an assistant professor in industrial systems and engineering, the team has integrated electronic sensors at the intersection between a prosthesis and the wearer’s tissue. To develop the prototype, the researchers used 3D scanning data referencing a mold of a teenager’s limb. They used the 3D scanning data to guide the integration of sensors into the form-fitting cavity of the prosthesis, using a conformal 3D printing technique. Using the sensor, the researchers have gathered information related to prosthetic function and comfort, which will inform further iterations of 3D-printed prostheses. The technology also will lend itself to further applications in personalized medicine and design of wearable systems. “Personalizing and modifying the properties and

Van Royen and his team also found strong evidence suggesting that lack of initial in-brace correction is associated with brace treatment failure. The researchers noted that “AIS patients with a higher degree of initial in-brace corrections are less prone to treatment failure,” but they were unable to establish the exact minimal threshold of immediate in-brace correction needed to minimize the risk of failure. In addition, initial curve magnitude does not predict outcomes, according to the literature review. In the case of AIS patients “fulfilling the appropriate criteria to undergo brace treatment (Cobb angle less than 45 degrees), initial curve magnitude is not associated with treatment failure or success,” the researchers reported. Details of the study are available in the article “Predictive Factors for Brace Treatment Outcome in Adolescent Idiopathic Scoliosis: A Best-Evidence Synthesis,” published in January in European Spine Journal.

HAPPENINGS

AOPA Thranhardt Lecture Published in Journal of Craniofacial Surgery A study conducted by Tiffany Graham, CPO, LPO, MSPO, “Significant Factors Influencing the Effectiveness of Cranial Remolding Orthoses in Infants With Deformational Plagiocephaly,” was honored as a Thranhardt lecture at AOPA’s 2018 National Assembly—and that work has now been published in the Journal of Craniofacial Surgery. The study was inspired by the lack of reimbursement for cranial remolding orthoses by Texas Medicaid and is “part of an effort to improve what’s

out there and potentially have outcomes evidence for insurers,” said Graham, a clinician and instructor at the University of Texas Southwestern Medical Center in Dallas. “In addition, by understanding how different factors influence treatment outcomes, practitioners can make more informed decisions about who would benefit from cranial remolding orthosis treatment.” See the April 10 online edition of Journal of Craniofacial Surgery to read the published article.

O&P CYBERSECURITY

Hacking/IT Incidents Spur Record Numbers of Healthcare Data Breach Incidents

Forty-four data breaches were reported to the federal government by healthcare providers, health plans, and their business associates during the month of April—the highest number of healthcare breaches reported in a single month. The overall number of people who had data exposed in these types of breaches decreased, however, from 963,794 in March to 686,953 in April, according to the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR).

Nearly two thirds of the compromised healthcare entities attributed the breaches reported in April to hacking or IT incidents. The remaining breaches resulted from theft, loss, improper disposal, or unauthorized access or disclosure of patient records. A pediatric orthopedic group was among the facilities with the highest number of records affected by a breach in April. Fraudsters engaged in a “hacking/IT incident” targeting network servers that resulted in a compromise of more than 20,000 records. The largest breach in April involved a ransomware attack at a company that provides medical billing services to hospitals and physician practices. The patient data of more than 200,000 people seen at 38 client locations may have been compromised, according to HHS OCR.

INSURANCE INSIGHTS

Private Insurers See Rising Profits

Companies in the individual insurance market expect to pay record-high rebates to consumers for failing to meet the medical loss ratio requirement, according to a new report from the Kaiser Family Foundation (KFF), “Individual Insurance Market Performance in 2018.” This finding indicates that insurers overcorrected when setting 2018 premiums, according to KFF. Insurance companies raised benchmark premiums an average of 34 percent going into 2018, as a result of policy changes and legislative uncertainty, KFF reported. But individual market insurers saw better financial performance in 2018 than in any previous year since implementation of the Affordable Care Act (ACA). Insurers are expecting to pay $800 million in rebates to individual market consumers for not meeting the ACA medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues on healthcare claims or quality improvement activities. Premiums fell slightly for 2019 as insurers realized they had raised 2018 rates more than necessary, according to KFF.

O&P ALMANAC | JUNE 2019

HAPPENINGS

AUDIT ANSWERS

FAST FACT

Record Number of Amputations Reported in United Kingdom

Medicare Announces Proposed RAC Audit for Reasonable Useful Lifetime for Upper-Extremity Orthoses

Statistics from Public

CMS posts a list of topics monthly that have been proposed, but not yet approved, for RACs to review. The RAC contractors may not audit any items or services unless they have been reviewed and approved by CMS and they place the audit on their website under “Approved Issues.” The listing of a proposed topic by CMS is one of the first steps in identifying an approved issue for the RAC contractors. For April, CMS announced the proposed topic of an automated review for reasonable useful lifetimes and upperextremity orthoses described by the following codes: L3650, L3660, L3670,

Health England reveal 27,465 amputations between 2015 and 2018, compared with 24,181 cases between 2012 and 2015—a rise of 14 percent. Britain’s obesity levels are the highest

AMPUTEE ATHLETICS

Marathon Runner Sets Record

in Western Europe, and rising faster than those of the United States. SOURCE: Public Health England

JUNE 2019 | O&P ALMANAC

Bilateral amputee athlete Marko Cheseto Lemtukei set a new marathon world record for bilateral amputees, completing the 2019 Boston Marathon in 2:42:24. Cheseto Lemtukei was born and raised in Kapenguria, Kenya, then came to the United States on an athletic scholarship at the University of Alaska. There, he set several collegiate track and field records before losing his legs below-the-knee in 2011, due to an accident that resulted in severe frostbite. Now in his mid-30s, Cheseto Lemtukei serves as an Össur ambassador and is focused on continuing to improve his times, with a goal of completing a marathon in under two hours. In 2020, the Boston Marathon will become the first major marathon to launch a new Parathletic Division to recognize competitors beyond those in the wheelchair and handcycle division.

PHOTO: Courtesy of ÖSSUR

Marko Cheseto Lemtukei

L3671, L3674, L3675, L3677, L3678, L3702, L3710, L3720, L3730, L3740, L3760, L3761, L3762, L3763, L3764, L3765, L3766, L3806, L3807, L3808, L3809, L3900, L3901, L3904, L3905, L3906, L3908, L3912, L3913, L3915, L3916, L3917, L3918, L3919, L3921, L3923, L3924, L3929, L3930, L3931, L3956, L3960, L3961, L3962, L3967, L3971, L3973, L3975, L3976, L3977, L3978, L3980, L3981, L3982, L3984, and L3995. At this time the proposed automated review has not been approved by CMS, and Performant, the RAC contractor for Region 5 (which includes all O&P claims), has not listed the topic as an approved issue for review on its website.

HAPPENINGS

AMPUTEE ATHLETICS

Eastern Michigan Hosts Three OPAF Clinics

PHOTOS: OPAF

The MSOP students of Eastern Michigan University (EMU) hosted three OPAF First Clinics on the campus of EMU in March. More than 60 participants tried adaptive scuba, swimming, and kayaking during the event, which was sponsored by University of Michigan O&P Center. Many of the participants were first-timers. Instruction for each was provided by leaders in their area of expertise in adaptive instruction and included Capital City Scuba, the EMU Down River Paddlers, and Rob Hendry and Stephanie Miner, CPO, both OPAF First Swim instructors. Event sponsors, including Ropp Orthopedics, Anew Life, and College Park Industries, assisted by providing volunteers, refreshments, and swim goggles.

April Is Limb Loss Awareness Month

Paralympians Celebrate Limb Loss Awareness Month

Dozens of elementary school children met with four Paralympians to commemorate April as National Limb Loss Awareness Month. The athletes, who are part of the #ÖssurFamily, included 2016 Rio Paratriathlon Bronze Medalist Mohamed Lahna; Team USA Sprinter Femita Ayanbeku and Long Jumper Trenten Merrill; and Team Canada Sprinter Marissa Papaconstantinou. They took part in an educational event at Woodbury Elementary School in Irvine, California, where they spoke to children about life with limb loss and limb difference. In telling his story, Lahna said, “I was born with a birth defect that made me different from other kids, but I learned to not let those differences keep me down. As a result, I gained their respect and learned to respect myself. Everyone is unique—we may all be different in some way—but we are also all equal and valuable as human beings.” Merrill, who became an amputee at age 14, said “One year after my amputation, I was strong enough to play sports again, and I was excited about that, but I also felt compassion for other people—for the first time, I appreciated how hard it could be for other amputees who are in situations like mine.” Following the presentations, the athletes led the students through a series of exercise drills and a relay race. #AmplifyYourself

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PHOTO: Courtesy of ÖSSUR

USA Long Jumper Trenten Merrill was among four Paralympians who led elementary school students through a series of exercise drills to commemorate Limb Loss Awareness Month.

O&P ALMANAC | JUNE 2019

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Cathy Carter, executive director of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), has been elected to the Board of Directors for the Commission on Accreditation of Allied Health Cathy Carter Education Programs (CAAHEP). CAAHEP is a programmatic accreditor of the health sciences professions. In collaboration with its Committees on Accreditation, CAAHEP reviews and accredits more than 2,100 individual education programs in 30 health science occupations. ABC is a sponsor of orthotics and prosthetics within the CAAHEP system. “I am honored to represent the O&P profession on the CAAHEP Board,” said Carter, “and excited to work with its members to oversee the execution of the new CAAHEP strategic plan.”

Eve Lee, MBA, CAE

AOPA Executive Director Eve Lee, MBA, CAE, has been recognized by the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) for her leadership, service, and commitment to the O&P profession. NAAOP Executive Director George Breece presented Lee with a plaque in recognition of the award during the AOPA Policy Forum in May.

Matthew Swiggum has been appointed president and chief executive officer of the U.S. division of PROTEOR USA. Swiggum’s appointment marks a “significant step in PROTEOR’s path to build a strong presence in North America,” said Edouard Matthew Swiggum Archambeaud, chief operating officer of PROTEOR Group. Swiggum’s previous experience includes more than 21 years with Ottobock Healthcare, most recently as regional president and chief executive officer, as well as a member of Amputee Coalition’s Board of Directors.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Scheck & Siress

Scheck & Siress has acquired Reichert Prosthetics & Orthotics (RPO) located in Kenosha, Wisconsin. RPO has locations both in Kenosha and Racine, Wisconsin, and in Gurnee, Illinois. Scheck’s partnership with Reichert and his team expands its presence into Wisconsin. Doug Reichert, CP, LP, owner of Reichert Prosthetics & Orthotics, said, “We are excited to be partnering with the Scheck & Siress family. Prosthetics. Orthotics.

JUNE 2019 | O&P ALMANAC

Having Scheck & Siress take the lead of RPO ensures the continuation of best personalized and individualized care for our patients going forward, a philosophy that has allowed RPO to be successful over the years.” Scheck & Siress President and Chief Executive Officer Michael Oros, CPO, LPO, FAAOP, added, “This is a wonderful opportunity to grow our presence into Wisconsin with the right partner and aligns with our strategic belief that healthcare is a regionally delivered service.” Scheck & Siress also announced the acquisition of Ballert Orthopedic in April. Ballert has seven patientcare facilities in the greater Chicago O&P market. WillowWood has announced plans to accelerate the company’s growth with the sale of a majority stake to DW Healthcare Partners (DWHP), a private equity investment firm based in Toronto and Utah. DWHP has managed four funds with over $800 million under management, focusing exclusively on healthcare businesses. WillowWood’s partnership with DWHP will enable the addition of new products to its portfolio through a combination of internal innovation and external acquisitions in an effort to bring together the complete prosthetic solution. “This is a very exciting partnership that will ensure we serve our O&P clinic customers and their patients even better by optimizing and expanding our suite of products and services,” said Mahesh Mansukhani, WillowWood’s chief executive officer. “WillowWood is truly woven into the fabric of the prosthetic industry. Our values and mission in support of the amputee community remain unchanged and will continue to guide the company and the work we do.” Ryan Arbogast, board member and WillowWood’s president, will continue to be a significant stakeholder in the company. The Arbogast family has owned and operated WillowWood since its founding 112 years ago. “WillowWood will always be rooted in its core values: serving the needs of the amputee community through innovative product design and service,” said Arbogast. “This is a prime time for growth in the O&P industry, and we plan to do it the right way—serving our patient-care facility customers even better, rather than competing with them.”

THE LIGHTER SIDE

REIMBURSEMENT PAGE

By DEVON BERNARD

Keeping Current With the Policies

E! QU IZ M EARN

BUSINESS CE

CREDITS P.19

Reviewing the 2019 revisions to the Medicare medical policies

Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 19 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

HE MIDPOINT of the year is a good

time to examine some of the changes and updates that have been made to the Medicare medical policies so far, and to share some additional reimbursementrelated announcements. This month’s Reimbursement Page examines some of the vital information found in the policies and reviews recent updates. Some of the changes are policy specific, but most were made across all of the appropriate policies.

Therapeutic Shoes Update

On April 4, 2019, the Therapeutic Shoes for Persons With Diabetes Policy was updated to include the new code A5514 (for diabetics only, multiple-density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of

JUNE 2019 | O&P ALMANAC

PHOTO: Getty Images

the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16-inch material of shore a 35 durometer or higher; includes arch filler and other shaping material, custom fabricated, each). A5514 replaced the temporary code K0903 as of Jan. 1, 2019. All custom diabetic inserts billed to Medicare using the A5514 must be listed on the Pricing, Data Analysis, and Coding (PDAC) product classification list. Inserts that are not included on the PDAC list must be coded as A9270 and will be considered noncovered by Medicare. With this update, it’s important that you verify the proper coding of any inserts you are providing using the product classification list from the PDAC contractor at www.dmepdac.com. If the insert is not listed, use the A9270. Typically, if custom inserts are fabricated in house and provided directly to your patients, you don’t need to have the inserts reviewed and placed on the PDAC product classification list. However, you must be able to provide information regarding your fabrication methods and materials used, if requested. This exemption does not seem to apply to inserts described by the A5514, as the current policy doesn’t make a distinction between direct-milled inserted fabricated in house or by an outside fabricator. In addition, the policy was updated to indicate the verbiage change made to the A5513, which also was part of the 2019 Healthcare Common Procedure Coding System (HCPCS) code changes.

REIMBURSEMENT PAGE

Bilateral Billing Update

The policy update related to bilateral billing affects the following policies: • Ankle-Foot Orthosis/Knee-AnkleFoot Orthosis (AFO/KAFO) Policy • Knee Orthosis (KO) Policy • Lower-Limb Prostheses Policy • Diabetic Shoes Policy • External Breast Prostheses Policy • Orthopedic Policy. The announcement was originally communicated as a durable medical equipment Medicare administrative contractor (DME MAC) correct coding announcement in early December 2018 and became effective for all claims with a date of service on or after March 1, 2019; it is now enshrined in the Policy Article portions of policy. When providing and billing for bilateral items, you now must bill each item on separate claim lines using the

RT and LT modifiers, and report one unit of service on each claim line. You may no longer use the RTLT/LTRT modifier combination on the same claim line and two units of service. If you continue to use the RTLT/LTRT modifiers, your claim will be rejected as incorrect coding.

Prefabricated: Custom-Fitted Update

This update affects those policies that include items that may be categorized as prefabricated off-the-shelf (OTS) and prefabricated custom-fitted. This category would include the AFO/ KAFO, KO, and LSO/TLSO policies. The update provides guidance on the proper coding of prefabricated items that do not require substantial modification or minimal self-adjustment. The revision indicates that when an HCPCS code descriptor only states prefabricated and does not define a brace as OTS or custom-fitted, the

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code should be used whether the device requires custom fitting or is delivered OTS. Here is the full passage from the LSO/TLSO Policy Article: “In most cases for prefabricated orthoses, the correct coding of the orthosis is dictated by actions that take place at the time of fitting to the beneficiary, either custom-fit (requiring expertise) or OTS (requiring minimal beneficiary self-adjustment). However, for certain types of orthoses, the HCPCS code narrative that best describes the product does not make a distinction between prefabricated orthoses that are provided as custom-fit or OTS. These code narratives are correct and must be used for Medicare billing, without regard to how the product is provided to the beneficiary at the final delivery.”

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REIMBURSEMENT PAGE

Previous interpretations by CMS indicated that if the HCPCS code only stated prefabricated, it was to be considered custom-fitted by default. This interpretation was later reversed and is now clearly stated in the Policy Article. The updated policies also have removed a key word from the definition of custom-fitted. The policies no longer make a reference to having to make “substantial modifications” and replaced it with the phrase “more than minimal self-adjustment.” This is defined as “changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has specialized training in the provision of orthotics in compliance with all applicable federal and state licensure and regulatory requirements.” This change in definition was reinforced with the release of a DME MAC correct coding reminder released on March 28, 2019. The correct coding reminder also included some old directions on how to code for a brace classified as custom-fitted, but custom fitting was not provided at the time of delivery. This is not new information, or information in the policies, but it is important to review. Your first choice would be to use the appropriate split code for the custom-fitted item, the established OTS code. However, if there is no corresponding OTS code that can be used, and there is not a code that simply states prefabricated, then you must use a not-otherwise-classified code.

orthotics, and supplies when it is necessary to introduce fee schedule amounts for newly established codes, or to adjust already established codes and fees. In a Med Learn Matters article (article number MM11179), CMS announced it would be adding or updating fees for four HCPCS codes, and the new fees took effect April 1, 2019.

The most likely rationale for adding a fee for the L0623 is that it is one of the non-lead items in the Competitive Bidding 2021 program of off-theshelf back braces. To be able to calculate a single pricing amount for a competitively bid item, it must have an established and current Medicare fee.

Placing ICD-10 Codes in the Policy Article

The DME MACs are in the process of moving all of the International Classification of Diseases, 10th Edition, commonly known as ICD-10, that indicate coverage from the Local Coverage Determination (LCD) portion of the policy to the Policy Article (PA) portion of the policy. This does not alter or change coverage rules but is more of an administrative change.

Fee Schedule Updates

On a quarterly basis, Medicare will update the fee schedule for durable medical equipment, prosthetics, 18

JUNE 2019 | O&P ALMANAC

Three of the codes are related to wheelchair accessories, and one is for a sacroiliac orthosis, L0623 (sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf). The L0623 is not

a new code—it was introduced in 2006 and revised in 2014—but it has not had a dedicated fee associated it with it. The most likely rationale for adding a fee for the L0623 is that it is one of the non-lead items in the Competitive Bidding 2021 program of off-the-shelf back braces. To be able to calculate a single pricing amount (SPA) for a competitively bid item, it must have an established and current Medicare fee. It also is important to point out that the April 2019 quarterly update did not assign a fee to two of the new HCPCS codes introduced for this year: L8701 (powered upper-extremity rangeof-motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated) and L8702 (powered upper-extremity range-of-motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated). We may have to wait until the next quarterly update to verify if these new codes will be assigned a fee.

Standard Documentation Requirements: Proof of Delivery Updates

This is a quick recap of the Local Coverage Article called the Standard Documentation Requirements (SDR) Article, in case you are still not familiar with this document. In the past, each Medicare medical policy contained an individual general documentation requirements section and specific policy-related documentation requirements, but this changed slightly in late 2017 when all of the standard documentation language was removed. This standard documentation information was then placed into a single SDR Article, and this allows the DME MACs to update and correct information quicker and more efficiently instead of having to update multiple Local Coverage Determinations anytime there are changes in policy to standard documentation requirements (for example, orders, record retention, continued need/use, proof of delivery, etc.).

REIMBURSEMENT PAGE

The SDR recently made a revision to its proof of delivery requirements, and this revision is a reversal of a recent change. The update relates to the proper date of service (DOS) on your proof of delivery when you use a shipping service when delivering an item to your patients. The SDR has stated that you have two options as to what may be considered your DOS. First, you may use the shipping date as the DOS. The shipping date is the actual date the shipping service label is created, or the date the item is picked up by the shipping/delivery company. Just keep in mind that the two dates should not show too much difference. The second option is that you may use the actual date that the shipment is delivered as your DOS. In previous SDRs, it was stated that you also may use a return postage-paid delivery invoice from the patient as proof of delivery, if it contains all of the elements of a compliant proof of delivery. This option was removed from the SDR; however, in the April 4, 2019, update, it was added back as an option.

Ongoing Updates

As the policies are updated on a rolling quarterly basis, you should routinely review the policies and stay up to date on all revisions, whether they are small updates or drastic changes. To check and see if any changes have been made—and what those changes are—review the Revisions History portion of the policies found at the end of both the Local Coverage Determination and the Policy Article. 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:

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2021

This Just In

Gearing Up To Compete CMS revises timeline for Competitive Bidding 2021

• • •

&P PROFESSIONALS ACROSS

the nation are being proactive in preparing for the next round of competitive bidding, now known as Competitive Bidding 2021. CMS recently announced that a total of 23 off-the-shelf (OTS) knee and spinal orthosis codes would be included Competitive Bidding 2021— and that even though contracts would not be effective until January 2021, the bidding process would begin in June 2019. On May 7, CMS updated the timeline for Competitive Bidding 2021 and announced that the new program will now open on July 16, 2019. CMS provided the following target dates for participation in the bidding process: • June 10, 2019: Registration window opens for the Durable

JUNE 2019 | O&P ALMANAC

• • • •

Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Bidding System, DBidS, and Connexion, the program’s secure portal. July 16, 2019: Bid window opens. Aug. 16, 2019: DBidS registration closes (Connexion registration always remains open). Aug. 19, 2019: Covered document review date for bidders to upload financial documents in Connexion. Sept. 18, 2019: Bid window closes. Fall 2019: Preliminary bid evaluation notifications released. Summer 2020: Single payment amounts announced by CMS; contracting process begins. Fall 2020: Contract suppliers announced by CMS.

While this timeline is tentative and subject to change, it offers bidders a basic understanding of how the competitive bidding process will work and explains the deadlines for various steps in the process. In addition to the updated timeline, the Competitive Bidding Implementation Contractor (CBIC) website has been updated with

additional information regarding implementation of Competitive Bidding 2021. Access the CBIC website at www.dmecompetitivebid.com/cbic/ cbic.nsf/DocsCat/Home.

Do Your Homework

The updated Competitive Bidding 2021 timeline provides answers to questions that AOPA members have had since the March 7, 2019, announcement that certain OTS orthotic codes would be included. The bid window will be open for approximately two months, closing in mid-September 2019, and potential bidders will be able to register to participate in competitive bidding on or after June 10, 2019. As more information regarding Competitive Bidding 2021 becomes available, AOPA will continue to update its dedicated competitive bidding page on the AOPA website, found at www. aopanet.org/coding-reimbursement/ round-2021-competitive-bidding-announced/. Access to these resources is an AOPA member benefit; members must log in using their AOPA username and password to view the information. Bidders must submit separate bids for each of the 130 competitive bidding areas (CBAs) in which they wish to

This Just In

be considered for a contract award and must meet all CMS enrollment, credentialing, and licensure requirements in order to participate in the competitive bidding process. Below are some suggested steps to prepare for the program rollout: 1) Make sure you are licensed and accredited. 2) Obtain your competitive bidding surety bond(s). 3) Create a user ID and password with the CMS Enterprise Portal at https://portal.cms.gov. 4) Make sure your Medicare enrollment is up to date and accurate. 5) Compile your financial information. This is not an all-inclusive list, but it is a starting point. For more information, read the Ask AOPA column on page 60, featuring answers to some of the most common questions surrounding Competitive Bidding 2021.

CODING UPDATE

L0650 Now Subject to Medicare Prior Authorization CMS published an announcement in the April Federal Register that added four Healthcare Common Procedure Coding System (HCPCS) codes to the master list of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are subject to inclusion in the Medicare prior authorization program. One of the codes—L0650— describes an off-the-shelf lumbosacral orthosis. L0650 was added because it meets the criteria necessary for inclusion on the prior authorization master list. Specifically, the average Medicare allowable for L0650 exceeds $1,041, and L0650 was listed in the “2018 Medicare Fee for Service Supplemental Improper Payment Report.” The inclusion of L0650 on the Medicare prior authorization master list does not mean that claims for L0650 are subject to prior authorization currently; it just means that Medicare may choose to require prior authorization for L0650 in the future. The inclusion of L0650 is a significant development as it represents the first orthotic code to be identified and included in the Medicare prior authorization master list. Previously, all of the codes on the master list described prosthetic devices.

O&P ALMANAC | JUNE 2019

COVER STORY

Negotiating

Tactics

O&P professionals share best practices for contracting with hospitals, the U.S. Department of Veterans Affairs, private insurers, and more By CHRISTINE UMBRELL

JUNE 2019 | O&P ALMANAC

COVER STORY

NEED TO KNOW • Successful O&P companies seek out opportunities to partner with hospitals, the U.S. Department of Veterans Affairs (VA), prisons, and other entities to provide O&P care in today’s competitive healthcare environment. • Pursuing contracts with these types of organizations can be challenging, so it’s important to read contracts carefully, with an understanding of the fee schedule and your own costs, before signing on the dotted line. • Most hospitals do not sign “exclusive” contracts, so several O&P companies may have contracts with the same hospital. In these environments, it’s important to make yourself known to hospital staff, secure privileges quickly, and be responsive to requests for O&P clinical care. • O&P businesses can ask that hospitals input patient data ahead of visits and prepare prescriptions in advance to reduce the O&P documentation burden, which can help offset discounts in hospital pricing.

ARTNERSHIPS ARE KEY IN today’s

competitive healthcare environment. Gone are the days when traditional word of mouth ensured enough business for an O&P facility to be profitable. Instead, most O&P companies stay successful by surveying their immediate surroundings, identifying opportunities, and pursuing contracts with entities such as hospitals, the U.S. Department of Veterans Affairs (VA), and prisons, in addition to standard contracts with private insurers. One of the most important steps an

• To work with the VA, registering in FedBizOppz will help keep O&P companies informed when a contract with one of the 23 Veterans Integrated Services Networks becomes available. In some areas, providers can work with veterans without a contract if they are vendor-authorized, or by exception based on discretion of a VA clinic or VA physician. • Federal, state, and county prisons may offer contracts for O&P work. But facilities should research how much work a specific prison may have available before signing a contract. • When negotiating with commercial insurers, O&P facilities should pay close attention to the main terms of the document, including the parties, the services to be provided, the terms of the agreement and renewal, and the fee schedules. And O&P professionals should build positive relationships with representatives from the insurance companies.

O&P facility can take when pursuing a contract of any type is to “set yourself apart,” says Joyce Perrone, director of business development at De La Torre Orthotics & Prosthetics in Pittsburgh. Startups and newcomers can draw attention to their companies by “doing something different” than competitors, and by being more responsive when an opportunity presents itself. New companies “may have to jump through hoops to make an inroad”—but doing so can pay off in terms of long-term contracts later on, explains Perrone. O&P ALMANAC | JUNE 2019

COVER STORY

When contracting with a hospital, While many O&P facilities will be several O&P facilities, it will be VA, commercial insurer, or other able to sign a contract with a hospital critical to “put yourself out there entity, “make sure you know what as long as they are willing to accept and network,” and introduce youryou are getting into—especially if you the fee schedule—often at a depressed self to different individuals within are a new business owner,” says Elliot rate—there is not much “exclusivity.” the hospital as soon as you land a Weintrob, CPO, president Most hospitals have contract, explains Eric Shoemaker, of Orthotic Prosthetic contracts with so many MS, CPO, regional director for Ability Center in Fairfax, Virginia. providers that it’s hard to Prosthetics & Orthotics. “You have Before signing any know how much business to change the habits of staff who are contract, “be diligent in to expect. That’s why it’s used to working with other” O&P reading it because if you are important to stand out, companies, says Shoemaker, who contracted, you are bound build relationships, and manages Ability P&O’s contract to those prices,” which may add value to the partnerwith WellSpan Health in York, be lower than your normal Elliot Weintrob, CPO ship, explains Perrone. It’s Pennsylvania. “It can be a slow and pricing, cautions Weintrob. also critical to learn and tedious process.” It’s important to know your “true cost follow each individual hospital’s poli Another important first step once per item” when deciding whether a cies and procedures. you have signed a contract is to get contract will be profitable. Dennis Clark, CPO, chief leadership privileging at the hospital, according In addition, Weintrob suggests officer at VGM Group and president to Jeff Quelet, CPO, regional director asking detailed questions before of Clark and Associates Prosthetics and clinical management officer at signing on the dotted line. “Find out if and Orthotics, notes that Ability P&O. His Ability there’s any guarantee of the volume of even though you’ll have to location in Hagerstown, work—especially if the pricing is low,” accept discounted rates, it is Maryland, has a contract he says. possible to benefit from the with Meritus Medical Tips such as these become espepartnership if you include Center, a level 2 trauma cially important when a facility’s certain provisions in a center, that covers both survival is dependent upon partcontract. “Make sure the orthotics—such as neck, nerships and contracts with outside hospital can do some things hip, and back braces— entities. Before signing or renewing to make your job easier,” and postoperative Dennis Clark, CPO a legal agreement, it’s important to suggests Clark. O&P facilprosthetic care. consider the type of contract, the pros ities can ask that hospitals Securing hospital privand cons of entering into a business agree to input all patient demographic ileges usually allows O&P clinicians relationship, and how an O&P facility data ahead of a hospital visit and to access the hospital’s electronic can provide value in the to have prescriptions medical records (EMR) system. long term. prepared in advance. “If “Then, you can tell your referral the hospital staff is helping bases that you have that contracWorking With Hospitals out with all of the papertual relationship” and possibly gain After a period of significant work and reducing our more business, Quelet says. He also consolidation in the hosdocumentation burden,” recommends reaching out to the pital space, it has become that can help offset doctors within the hospital—including more challenging to secure discounts, Clark explains. vascular surgeons, orthopedic trauma contracts and garner a spot In addition, O&P facilsurgeons, and neurological surgeons— Joyce Perrone as a preferred provider ities can optimize their to tell them that your company has a at many hospitals, says time spent at hospitals contract and ask that they think of you Perrone. De La Torre O&P does a lot by setting up specific, predetermined if any of their patients could benefit of work in Pittsburgh, where there are hours when an O&P clinician will from your services. many hospitals—but recent consolidabe on site, says Clark. Once such an Building and fostering relation has brought the majority of those arrangement is in place, it’s OK to be tionships is an important step in hospitals under just two umbrellas. flexible and to make exceptions for maintaining and renewing contracts, “Previously, there was an ability and emergencies—but setting a schedule according to Shoemaker. It’s opportunity to be ‘relational’” and will let the hospital staff know when important for credentialed clinicians figure out the right people to talk to patients should expect to see an to work well with surgeons, residents, when seeking to become a preferred orthotist or prosthetist, and will make and nurses on staff. “We have to be provider, she says. “But with the big optimal use of O&P clinicians’ time. responsive,” he says. That may include conglomerates, it can be trickier to find Of course, because any given “dropping everything” to respond to your way through.” hospital will have contracts with an emergency. 24

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COVER STORY

More importantly, having the right staff available to meet the demands of the contract can be a difference-maker: “Be picky about who you send to hospitals,” suggests Perrone. She recommends that O&P companies conduct additional internal training on “interpersonal skills, how to deal with difficult patients, and how to have difficult conversations with patients,” so that clinicians present themselves in a professional

manner when on the premises—and so hospital staff are impressed with your clinicians and request that they return. “Get the nurses to comment that your clinicians give good service,” she says. To boost brand awareness, Perrone suggests that team members wear scrubs embroidered with the O&P company logo as well as a name tag when they visit hospitals, so staff make the connection with your facility.

Tips for Negotiating More Profitable Commercial Insurance Contracts

OST O&P FACILITIES HAVE plenty of experience in

contracting with private insurers, but there are a few strategies that can improve these relationships. For example, it’s important to start with a checklist when finalizing a contract, says Teri Kuffel, JD, vice president at Arise Orthotics & Prosthetics in Minnesota. She reviews the main terms of the document, including the parties, the services to be provided, the terms of the agreement and renewal, and—most importantly—the fee schedules. Ensuring all of these areas are spelled out, and negotiating when possible for better terms, will lead to a better contract, says Kuffel. Elliot Weintrob, CPO, president of Orthotic Prosthetic Center, recommends against signing a contract for too long of a time period: “We have found that locking yourself into a long-term contract generally does not work in your favor because things change.” A two- or three-year contract allows for more flexibility for all parties. Jeff Quelet, CPO, regional director and clinical management officer at Ability P&O, cautions against signing an initial contract with extremely low reimbursement rates because that sets a low baseline and makes it hard to bring the numbers up in better alignment when it’s time for renewal.

JUNE 2019 | O&P ALMANAC

Occasionally, it may be possible to negotiate better rates from a commercial carrier—if you can get the chance to explain O&P and the care provided by certified clinicians, in addition to device provision. Kuffel has worked with commercial carriers and has secured improved fee schedules for certain codes. “I explain how we’re small, and describe the specialized and unique care we provide, and the value we provide,” she says. “We provide so much more than just the device.” In some instances, her explanations have resulted in higher reimbursement—“just because I asked,” she says. “You’ll never know if you don’t try.” And Joyce Perrone, director of business development at De La Torre Orthotics & Prosthetics, recommends a strategy of establishing positive relationships with representatives from commercial carriers. Write down the names and numbers of individuals you can speak with at insurance companies, then “remember it’s a human being on the other end” of the phone when you call with a concern. “We always ask who our rep is and invite them to visit our company” because they may not know much about the work of orthotists and prosthetists, Perrone adds. During these visits, “we show them how our company operates, and we make sure all of our employees treat that rep with kindness and respect. You want them to want to work with you” to resolve problems.

COVER STORY

Offering education to hospital staff hospital staff may blame the is another important task for O&P orthosis or prosthesis, rather facilities with hospital contracts. than look closely at the patient’s “Don’t just be an expense to the overall care and how the device is hospital—be a resource and an asset,” being applied. “It’s easy to blame says Clark. His facility, for example, the ‘widget’—the orthosis—if offers in-services on appropriate there’s a problem with care, donning and doffing for nurses, instead of the many hands who physical therapists, and other staff are touching it,” says Quelet. members. Perrone cautions Ability P&O also offers that, because these training, in the form of contracts can be so resident education, various complicated and courses for CEU credit, and require so much other high-touch interwork, partnering actions. “We try to keep with hospitals may ourselves relevant and bring not be the right fit more value to the relationfor all O&P facilities. Eric Shoemaker, ship,” says Shoemaker. She recommends MS, CPO Quelet adds that it’s surveying the local important to make sure everyone surroundings and determining understands why an O&P device where your business is coming is needed and how it should fit to from, then pursuing hospital ensure optimal outcomes. If there’s contracts that makes the most a problem with a patient, sometimes sense to your business model.

O&P ALMANAC | JUNE 2019

COVER STORY

Contracting With the VA

In some areas, it’s hard to know when a VA contract with one of the 23 Veterans Integrated Services Networks (VISNs) becomes available unless you are registered in FedBizOppz, the online system that posts federal procurement opportunities (www.fbo.gov). In order to receive purchase orders to provide service and receive payment from the VA, O&P providers must be authorized through the online System for Award Management Registration, Renewal, and Migration, or SAM. It’s helpful to know that, in some areas, providers can work with veterans without a contract if they are vendor-authorized, or by exception based on discretion of a VA clinic and/ or VA physician. Teri Kuffel, JD, vice president at Arise Orthotics & Prosthetics in Minnesota, recently took part in a phone-in Q&A session for facilities that were interested in submitting proposals to an upcoming RFP, and she learned some tips that may be useful to other facilities. For example, Kuffel was reminded that the VA gives preference to businesses that are certified as disabled-veteran owned, veteran owned, or woman owned. She encourages facilities that fit any of those parameters to share that information with the VA when writing proposals. Kuffel also suggests getting to know the individuals asso- Teri Kuffel, JD ciated with the area VA clinics. “You have to work with the contracting manager or purchasing director for each individual VISN” that you want to do business with, she says. In addition, she encourages O&P facilities to avoid getting frustrated when working with the VA—and to pursue one-on-one meetings with VA personnel if possible. Kuffel suggests accompanying patients to their VA office visits to get to know the staff there. “The face-to-face visit will help foster a relationship,” she says. 28

JUNE 2019 | O&P ALMANAC

Pursuing Prison Contracts

Community Outreach

For O&P facilities looking Prison contracts can be to establish relationships especially hard to come by. within their communi“There are a few compaties, management should nies out there that do a lot think locally and seek of prisons,” and there are out contracts that may be different types of prisons: available with city councils federal, state, and county, or school boards, suggests Jeff Quelet, CPO explains Perrone. “Each Perrone. While these may prison has its own rules not entail a huge amount of and regulations—you need to find work, they could lead to other opportuout what those are and follow them.” nities down the road—especially if your Perrone is experienced in this area facility is proactive and responsive. because De La Torre has signed some Ultimately, the most important state contracts with prisons, and she thing to do when partnering with has reached out to O&P facilities any type of entity is to be consistent across the nation as subcontractors in and provide high-quality O&P care. some areas. “Take the extra step when needed Working with prisons poses some to help patients,” says Clark. Then challenges for O&P facilities. “Some anyone who witnesses your patient prisons are way out in rural areas,” care—including other healthcare and there may not be a lot of O&P professionals and your patients— work available at some locations, says “will believe you are going to have Perrone. “It might just be shoes and a positive impact.” inserts, or maybe just one [prosthesis],” “At the end of the day, you have to she says. provide the best device for the patient,” To ensure a profitable relationship, adds Quelet. “Then, you’ll get [posiO&P facilities should research how tive] outcomes and rise to the top.” much work a specific prison may have available before signing a contract, Christine Umbrell is a contributing Perrone says. “Check them out, and be writer and editorial/production associate willing to travel to locations” to fulfill for O&P Almanac. Reach her at a contract. cumbrell@contentcommunicators.com.

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By CHRISTINE UMBRELL

Meetings With

a Message

More than 100 O&P advocates joined forces at the AOPA Policy Forum to present patient-centric policies to legislators

“Y

OU TELL A STORY. You make

NEED TO KNOW • O&P professionals from across the country travelled to Washington, DC, May 7-8, for the 2019 AOPA Policy Forum. Participants spent the first day in motivational and educational sessions in preparation for one-on-one meetings with members of Congress. • Paralympic Silver medalist John Register, CSP, provided one of the highlights—a presentation encouraging attendees to fight for the rights of O&P patients when speaking with legislators. • O&P experts shared “Lobbying 101” tips as well as updates on O&P-themed legislation—the Medicare O&P Patient-Centered Care Act and the Wounded Warrior Workforce Enhancement Act. Many participants took part in an AOPA-sponsored reception with Sen. Mark Warner (D-Virginia), a strong supporter of the profession.

JUNE 2019 | O&P ALMANAC

• First-time participants, seasoned professionals, students, and O&P consumers visited with legislators and staff members from their congressional districts on Day 2 of the event. These advocates shared their own stories, explained why members of Congress should support new O&P legislation, and made plans for follow-up visits. • Members of the O&P community who missed this year’s event are encouraged to advocate for the O&P profession and their patients by emailing or calling their own representatives and learning more about proposed legislation.

a point from that story. And you make a personal connection with the people you’re speaking to.” Those words of wisdom were shared by John Register, CSP, a Paralympic athlete and keynote speaker at the 2019 AOPA Policy Forum last month, during a presentation preparing attendees for meetings on Capitol Hill with their senators and representatives the following day. Register spoke to a packed room of O&P professionals who had travelled from across the country in advance of one-on-one meetings with members of Congress to educate legislators on the profession and O&P-related legislation. Register, a Gulf War Army veteran and former member of the Army Olympic Program in track-and-field who lost his left leg due to an injury he suffered while practicing hurdles, spoke of overcoming negative selfstigma and the stigmas of others while recovering from his amputation. He eventually joined the U.S. Paralympic team, winning the Silver medal in the long jump at the Sydney 2000 Games. (Continued on page 32)

Gearing Up

for Productive Meetings

PHOTOS: AOPA

The keynote presentation in which O&P devices are from John Register, CSP, provided, according to the was just one session in a day speakers. packed with education and Three other provisions in information preceding the the Medicare O&P Patientnext day’s trip to Capitol Centered Care Act address Hill. AOPA President Jim patient access to orthotic Weber, MBA, and AOPA care. During the General Executive Director Eve Session, McGuireWoods’ Stephanie Kennan Lee, MBA, CAE, presided Stephanie Kennan, AOPA’s over the Day 1 events, Joe McTernan, and AOPA's which included a morning Ashlie White spoke on these provisions, which seek to Lobbying 101 session for restore Congress’s intended meaning of the term “minimal newcomers and an afterself-adjustment” when speaking of off-the-shelf orthoses; noon General Session to prohibit the drop shipment of custom orthoses and educate all attendees about prostheses and off-the-shelf orthoses, except in special recently drafted legislation, circumstances; and preserve so they could share talking patient access to off-thepoints for their congressioshelf orthoses from licensed John Register, CSP nal visits. or certified orthotists or Participants in Lobbying 101 learned tips and strateprosthetists. gies for sharing an impactful message. For meetings with Attendees also heard from members of Congress to be successful, you have to “educate Catriona Macdonald, presiand advocate, with the purpose of improving access” for dent of Linchpin Strategies, O&P patients, explained AOPA Board Member Teri Kuffel, on the Wounded Warrior JD, who led the session, along with AOPA Director of Workforce Enhancement Act, Catriona Macdonald Government Affairs Justin Beland. which would create grants to During the General Session, policy experts explained help universities establish master’s degree programs in O&P, the talking points from the recently drafted Medicare or to expand upon existing institutions’ master’s programs— O&P Patient-Centered Care Act. The with the goal of ensuring enough first provision in this new bill, which properly educated and trained orthowas awaiting a sponsor and bill number tists and prosthetists in the future to during the Policy Forum, centers on the care for U.S. veterans and the aging separation of O&P from durable medical civilian population. equipment (DME). Speakers on this topic Breakout sessions at the concluincluded Peter W. Thomas, JD, general sion of the General Session allowed counsel for the National Association attendees to take part in mock visits for the Advancement of Orthotics & and Q&A sessions to “practice” for Prosthetics (NAAOP) and counsel to the their congressional visits. O&P Alliance; Dan Elling and Laurence To cap off the first day, particiWilson from the Lincoln Policy Group; pants visited with Sen. Mark Warner Sen. Mark Warner (D-Virginia) and Justin Beland, director of government and Eve Lee, MBA, CAE (D-Virginia), who is considered a affairs at AOPA. While Congress and strong supporter of the profession and CMS already treat O&P differently from who has sponsored O&P legislation in DME, further separation is needed, and the new legislation the past. Marco Calcagno, a first-time attendee at the Forum, seeks to ensure safe and effective patient care by distinsaid he enjoyed meeting Warner, “who was pivotal in past guishing orthotists and prosthetists from suppliers of DME successes achieved in the O&P field, and we very much and by differentiating the clinical, service-oriented manner appreciated his help.”

O&P ALMANAC | JUNE 2019

During his presentation, Register shared with attendees the “lessons learned” from his personal journey and challenged them to share the O&P message by advocating during this year’s Policy Forum. “You are fighting for the rights of those who are ‘tolerated,’” Register told attendees. “You are educating others not to accept the status quo.” He encouraged the clinicians-turned-advocates to “find the stories that will elevate your message.” Energized by Register’s motivational speech, and bolstered by the Lobbying 101 and General Session presentations given on the first day of the May 7-8 Policy Forum (see sidebar, “Gearing Up for Productive Meetings”), participants headed to the Capitol on Wednesday morning fully prepared to share the O&P message. O&P advocates appreciated that they had many opportunities to explain the profession and its value, and to ask for the support of lawmakers for two important pieces of legislation: the Medicare O&P Patient-Centered Care Act and the Wounded Warrior Workforce Enhancement Act.

Sara Peterson, PhD, CPO, LPO, FAAOP, and John Register, CSP

Representing O&P Patients

Jim Weber, MBA, Diane Weber, and Denise Hoffmann

JUNE 2019 | O&P ALMANAC

Following Up on DOJ Indictments

Denise Hoffmann, a nurse and mother of three who lost her leg in college, made her third AOPA Policy Forum appearance this year. She has travelled on several occasions to share her story and support the O&P message by accompanying the chief executive officer of her O&P facility in St. Louis— AOPA President Jim Weber, MBA. Hoffmann enjoyed learning about the new proposed legislation—the Medicare O&P Patient-Centered Care Act—and how it can further the care that practitioners are giving to their patients. The legislation is patient-focused and aims to ensure only qualified clinicians offer O&P care, which fits nicely with the April announcement of the U.S. Department of Justice indictments against 24 individuals responsible for more than $1.2 billion in losses to the Medicare

PHOTOS: AOPA

PHOTO:Dara Ross, CPO

Meghan Holland, legislative counsel for Rep. Ralph Norman (R-South Carolina); Dara Ross, CPO; and Rachel FriddleJohnson, CPO

Register’s message resonated with Dara Ross, CPO, one of the more than 100 advocates who took part in one-on-one meetings on Day 2 of the Policy Forum. Ross’s main goal in travelling to Capitol Hill with AOPA was “to represent the people with limb loss or impairment that can’t go to Washington.” Ross, a clinician at Prosthetic Orthotic Associates in Rock Hill, South Carolina, works in a rural area. “My patients don’t try out for the Paralympics or want to run 5Ks. They are happy to get in and out of a car for dialysis and to stand up to sing at church or to go to the bathroom instead of a bedside commode,” she says. “It sounds naive in our current political climate, but if those of us from South Carolina did not go talk in person to our elected representatives, they might never hear that story. Our story is that care for people in need

of quality O&P services is at risk, both due to policy and to a shortage of clinicians who can serve people with limb loss and limb impairment.” Ross made the rounds with Maurice Johnson, CO, CPed, and Rachel Friddle-Johnson, CPO, meeting with representatives from three district offices, as well as both South Carolina Senate offices. “The staffers were receptive, and—unusually—all of the staffers that I met had some personal experience or knowledge of O&P,” Ross recalls. “One had even done a short internship at Sabolich Prosthetics & Research in Oklahoma during college. The discussions were positive and friendly. It may be the Southern hospitality, but I always love visiting DC because our South Carolina state officials are so welcoming. We talked about the need for quality patient care.” To capitalize on the momentum from the May meetings, Ross plans to invite the South Carolina legislators and their staffs to visit her facility, so they can “come see what we do on a day-to-day basis.” She will also share her experience with fellow members of the O&P state society she belongs to and begin recruiting volunteers for next year’s Policy Forum.

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program through fraudulent schemes involving the use of lead generation marketing to deliver orthoses that were not medically necessary or not wanted by the beneficiary. “By separating custom orthotics and prosthetics from the durable medical equipment category, [the Medicare O&P Patient-Centered Care Act] would further ensure that patients are getting their devices from qualified providers,” Hoffmann says. “This will hopefully be one more step to ensure that patients are getting the appropriate care and the appropriate device for them.” Hoffmann and Weber, along with Manuel Rivera, CP, from Premier Prosthetics, and his current prosthetics resident, met with two Missouri representatives as well as the staff of two additional Missouri representatives, and the staffs of their senators. “The staff and legislators all seemed to be very interested in our proposed legislation,” says Hoffmann. “Especially since the recent multibillion dollar Medicare

A First-Timer’s Perspective

Marco Calcagno, CPO, from Limbionics in North Carolina, was one of the newcomers at the Policy Forum. He was able to meet with several legislators from his home state during Day 2 of the Forum, after having completed the Lobbying 101 session the previous day. Calcagno, accompanied by Stella Seiber; Rebecca Cook, MSPO; and OPAF’s Robin Burton, met with several North Carolina legislative assistants, including staffers for Rep. David Price (D), Sen. Tom Tillis (R), and Sen. Richard Burr (R), and stopped into the offices of Rep. G.K. Butterfield (D). “We all took turns introducing ourselves as well as presenting the information regarding the Medicare O&P Patient-Centered Care Act and

Anthony "Trey" Cimorelli, Vincent Benenati, CO, and Rep. Peter King (R-New York)

JUNE 2019 | O&P ALMANAC

A Student Making the Rounds

Anthony “Trey” Cimorelli, a University of Washington MPO student, was one of several O&P master’s students who attended this year’s Policy Forum. “One of my priorities during the first few years of my career is to expose myself to many different aspects of the profession to determine what I am most passionate about and what I want to focus my attention on throughout my career,” says Cimorelli. He considered the Policy Forum “a perfect opportunity for me to pursue another educational experience.” As a student, Cimorelli appreciated the Lobbying 101 event. “Coming into the Policy Forum, I had very little experience with policy and advocating in our nation’s capital. So, it was really helpful for me to get a better understanding of the entire process of how things get done in our government system,” he says. “Learning about how an act becomes a law and how the advocating/lobbying groups work … allowed me to feel more confident in the entire process and helped me focus more of my attention on understanding the details of each policy we were

PHOTOS: AOPA

Several O&P students attended this year’s Policy Forum and advocated for the new legislation. 34

the Wounded Warrior Workforce Enhancement Act,” says Calcagno. “All were very interested in what we had to say and gave positive support indications.” The best part of the event for Calcagno was “being on Capitol Hill and seeing our government at work—and actually getting to speak with someone from my representatives’ offices,” he says. “At times, I feel that [our legislators] forget where they came from and may not always be listening; however, this helped to change my mind.” Calcagno, who is president of the North Carolina Chapter of the American Academy of Orthotists and Prosthetists, plans to stay in close contact with AOPA and use his leadership position in his home state to “inform the practitioners of my state about the work being done on their behalf, and to encourage them to get more involved.”

PHOTO: Courtesy of Anthony "Trey" Cimorelli

Policy Forum attendees at the General Session

abuse findings in orthotics. Not only would this legislation help protect against future potential Medicare fraud, but it would help protect the patients from being deceived as well.”

PHOTOS: AOPA

going to be advocating for.” On Day 2, Cimorelli visited with legislators representing both Washington State and New York. “I am originally from New York, and that is where I am a registered voter, so I thought it was important to meet with those representatives. However, with one of the main topics being the Wounded Warrior Workforce Enhancement Act [which would expand O&P master’s programs], and the fact that I am currently pursuing my master’s degree in O&P, I thought my voice would mean more coming from one of the states that currently has one of the 13 OP master’s programs,” he explains. For his Washington visits, Cimorelli was accompanied by Kate Allyn, CPO, LPO, FAAOP, a researcher at the University of Washington and the current president-elect of the American Academy of Orthotists and Prosthetists. They met with staffers from the offices of Sen. Patty Murray (D), Rep. Pramila Jayapal (D), and Rep. Maria Cantwell (D). Cimorelli teamed up with Vincent Benenati, CO, chief executive officer of East Coast Prosthetics and Orthotics, for his New York meetings. They met briefly with Rep. Peter King (R) and with staffers from the offices of Sen. Chuck Schumer (D) and Rep. Tom Suozzi (D). “During all of the visits, we were educating the representatives about our field and what it consists of,” he says. “The response from almost all of the representatives was very positive. They seemed to be on board with the information we were explaining and understood the importance of what we were asking for. Our biggest response from them was to follow up with more information when we had bill numbers.” Back home, Cimorelli contacted the offices of all of the members of Congress he met with, updated them with new bill numbers for the Wounded Warrior Workforce Enhancement Act, and offered to host a visit to the University of Washington MPO program next time they are in the area.

Patient Stella Seiber from North Carolina

Justin Beland; Peter W. Thomas, JD; Dan Elling; and Laurence Wilson spoke to participants about the Medicare O&P Patient-Centered Care Act.

James Young Jr., CP, LP, FAAOP, and his son James Young meet with Rep. Austin Scott (R-Georgia).

Experienced Advocates

Of course, there were many dedicated O&P advocates who make it their mission to take part in the AOPA Policy Forum every year. From Minnesota, a team of five advocates—which included AOPA Board Member Teri Kuffel, Esq., along with her husband, Charles Kuffel, MSM, CPO, LPO, FAAOP, and a patient advocate—took part in several visits with members of Congress. The team explained the nature of the small community that is O&P and asked for legislators’ support of the Medicare O&P Patient-Centered Care Act and the Wounded Warrior Workforce Enhancement Act. Kuffel says the staff members she met with were very receptive to their talking points. A team of advocates also met with staff for the congressional committees that oversee policy related to veterans’ access to prosthetics and orthotics. Among the advocates at that meeting were Register; Charles Kuffel; Chris Dunn, a former Marine who lost his leg as the result of a service-related injury; and Catriona Macdonald, president of Linchpin Strategies and an AOPA lobbyist. Register, Kuffel, and Dunn “are articulate, thoughtful, and

compelling advocates for veterans’ access to prosthetic and orthotic care in the setting that best meets their needs, whether it be a VA facility or a community-based practice more convenient to their home or work,” says Macdonald. “Their personal insights added immeasurably to the discussions with congressional staff on these issues.”

Continuing the Message

Participants at the 2019 AOPA Policy Forum viewed their meetings in May as a starting point rather than a onetime event. Going forward, O&P stakeholders will continue to advocate for the profession by following up with legislators, supporting the new legislation, educating other O&P professionals, and ensuring an ongoing focus on the care provided to O&P patients by certified clinicians. As Weber told participants at the Policy Forum, “We are small, but we need to be mighty.” Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P ALMANAC | JUNE 2019

Head for the

COAST By MEGHAN HOLOHAN

NEED TO KNOW • In September, O&P professionals will experience the latest O&P technologies, educational sessions, and networking opportunities at this year’s AOPA National Assembly in San Diego—a destination marked by miles of beaches, parks, and historical sites. • The San Diego Convention Center sits at the entrance of the Gaslamp District, a 16½-block historic neighborhood that is home to beautifully restored Victorian buildings. The area features hundreds of options for urban entertainment, dining, craft breweries, and shopping. • San Diego conference-goers will want to bring their families and extend their stays to explore “America’s Finest City.” The San Diego Zoo, Balboa Park, Hotel del Coronado, and the La Jolla beaches are just of few of the popular attractions in the area. • AOPA has planned several special events for this year’s conference, including AOPA Night at the Ballpark for a Padres/Dodgers game, a benefit concert featuring Montgomery Gentry, receptions, happy hours, and more.

JUNE 2019 | O&P ALMANAC

Make plans to visit area attractions and take part in special events before, during, and after the AOPA National Assembly in San Diego

HIS SEPTEMBER, O&P STAKEHOLDERS will descend upon

San Diego for the AOPA National Assembly, themed “Driving the Waves of Change” for 2019, and presented in partnership with the California Orthotic & Prosthetic Association. Clinicians, physicians, technicians, fitters, students, business owners, and other O&P-related personnel will convene at the San Diego Convention Center September 25-28 for four days of immersion in the latest O&P products, education, legislation, business management, and more. AOPA has already planned several special events that will keep attendees entertained for hours. From a Padres game at “AOPA Night at the Ballpark,” to the Veterans Stride Foundation’s Benefit Program, to Friday Night Happy Hour in the Exhibit Hall, travelers will have many opportunities to relax and engage in the San Diego culture (see sidebar, “Can’t Miss” Special Events). But the city has even more to offer visitors who plan to bring their families or extend their stays. For those looking to explore the surrounding areas in their downtime, San Diego

features the perfect blend of outdoor activities, fine dining, and history to interest attendees and their families.

Know Your History

San Diego—perched on the Pacific Ocean and adjacent to the Mexican border—provides a beautiful backdrop for learning about the latest innovations in the O&P field and pursuing professional education. The eighth largest city in the United States, San Diego is known as “the birthplace of California.” The area was inhabited by the San Dieguito, La Jolla, and Kumeyaay people until 1542, when European explorer Juan Rodriguez Cabrillo landed and claimed the land for Spain. Hundreds of years later, this region became the foundation for Alta California, a Mexican settlement that flourished after Mexico won its independence from Spain in 1821. At the conclusion of the Mexican-American War, Mexico ceded San Diego—and all of Alta California—to the United States. In 1850, California became a state, and San Diego became the seat

of newly established San Diego County. San Diego is home to a deep water port, which provided a natural location for a naval base. By 1901, the U.S. Navy started opening new stations, and today the city is home to the largest naval presence in the world with 53 ships; 120 tenant commands; and more than 35,000 sailors, soldiers, and U.S. Department of Defense employees and contractors. Nearly 5 percent of the city’s jobs are military related, and 15,000 businesses benefit from defense contracts. History buffs seeking more information about San Diego’s place in military history can visit the Maritime Museum of San Diego or the USS Midway Museum, located on the aircraft carrier Midway. The Midway was in commission from 1945 to 1992, making it the longest serving carrier in the 20th century.

Explore the Outdoors

Beyond San Diego’s military associations, residents and tourists enjoy the area for its pristine beauty and ample outdoor activities. O&P ALMANAC | JUNE 2019

“Hot Picks” From the Locals

Balboa Park

AOPA members from San Diego and nearby communities offer their “insider tips” for making the most of your visit during the National Assembly. Take note of the following suggestions for restaurants and activities—and make room for your favorites in your San Diego itinerary. Blue Points in the Gaslamp District is great—awesome seafood and great atmosphere. My two favorite places are Georges at the Cove and Karl Strauss, which are both in La Jolla. The best place to view the bay and see all of the Navy ships while eating some great food is the Fish Market, which you can walk to from the [conference center] hotel. House of Blues is always good. “And to see ‘iconic San Diego,’ get over to Ocean Beach Pier. Walk the tide pools, check out the beach, hit the restaurants and bars (too many to name), and then hit Belmont Park for a roller coaster.” —MARK MULLER, CPO, FAAOP, MS, department chair, orthotics and prosthetics, California State University, Dominguez Hills

The Sunny Jim Sea Cave in La Jolla and the USS Midway Museum are two “hot picks” I would recommend.” —MATTHEW GARIBALDI, MS, CPO, director at University of California—San Francisco O&P Centers

I would recommend visiting the San Diego Zoo. It has a ton of exhibits, special experiences, and a diverse group of animals and plants to discover.” —KRISTEN PIERSON, marketing manager, Cascade Orthopedic Supply Inc.

“There are so many attractions to choose from. Cabrillo National Monument is located at the southern tip of Point Loma Peninsula in San Diego and has a great view of downtown San Diego. Wild Animal Park is an 1,800-acre zoo in the San Pasqual Valley area near Escondido—you are in the cage and the animals are in the wild! Take the Caravan Safari and feed the giraffes! At La Jolla Cove, you can see the sea lions by the cliffs and the seals at the Children’s Pool. Torrey Pines Golf Course is a public golf course with a beautiful setting on the coastal cliffs overlooking the Pacific Ocean. “For restaurants, try Kansas City Barbeque, best known for being the filming location for scenes used in the movie Top Gun. Or go to The Marine Room, which is fine dining in a romantic setting with waves crashing against the windows at high tide.” —KENTON KAUFMAN, PhD, PE, director, Motion Analysis Laboratory, Mayo Clinic, and former San Diego resident

JUNE 2019 | O&P ALMANAC

Since its creation in 1868, Balboa Park, then known as “City Park,” has been a centerpiece of the community. Overlooking downtown San Diego, the park underwent little development in its first 20 years until a local citizen, Kate Sessions, offered to plant 100 trees annually in the park, starting in 1892. That sparked a series of upgrades over the next several decades. From 1903 to 1910 the city installed water systems, built roads, and continued planting. When San Diego was preparing to host the 1915 Panama California Exposition, the city was renamed Balboa Park to remember the Spanish-born explorer, Vasco Nunez de Balboa—the first European to see the Pacific Ocean while exploring the New World. In preparation for the 1915 exposition, the city installed walkways and constructed Spanish-Renaissance style buildings, including the California Tower, now home to the San Diego Museum of Man, the Cabrillo Bridge, and Spreckels Organ Pavilion, which houses one of the largest outdoor pipe organs in the world. When the city hosted the 1935-1936 California Pacific Exposition, it added more buildings, plants, and art. Today, Balboa Park spans 1,200 acres and is home to 17 museums; the Botanical Building, with more than 2,000 plants; restaurants; shopping; and the world-famous San Diego Zoo.

The San Diego Zoo covers 100 acres with natural habitats for its more than 3,700 rare and endangered animals. Even more impressive, its botanical collection features more than 700,000 plants. Visitors can wander through the zoo or embark on a 35-minute guided bus tour that provides an overview of the zooâ€™s wonders. National Assembly participants who enjoy water sports have several options at their disposal. Businesses such as Aqua Adventures Kayak and Paddleboards rent kayaks, paddleboards, hydro bikes, surf skis, and canoes and offer lessons for novices. For O&P professionals who prefer a more passive sightseeing experience, companies such as San Diego Whale Watch, Hornblower Cruises and Events, and Adventure Rib Rides offer whale-watching tours. Beach lovers have several options to choose from. Coronado Beach is conveniently located close to the city and the Hotel del Coronado, which played a prominent role in the

Hotel del Coronado

Marilyn Monroe movie Some Like It Hot. The hotel, a stunning example of a wooden Victorian beach resort, is the second largest wooden building in the United States. While the hotel itself offers beautiful architecture and history, the nearby beaches literally sparkle.

Ferrier Coupler Options!

The sand shimmers, thanks to the mineral mica sprinkled throughout. While people enjoy swimming at the Coronado Beach, they also enjoy driving over the 200-foot-tall Coronado Bridge, which offers magnificent views of the city and of the artsy Coronado ocean enclave nearby.

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 | JUNE 2019

Petco Park Tours

“Can't Miss” Special Events

Preview the following activities planned by AOPA when setting your calendar for your San Diego trip. For details, visit the AOPA website, www.AOPAnet.org.

Welcome to San Diego Reception Wednesday, September 25, 5:30 – 7:30 p.m. Join AOPA during a San Diego-style kickoff event. Following the AOPA National Assembly Opening General Session at 4:30 p.m. featuring Captain Lanny Boswell, U.S. Navy (Ret.), AOPA will host a reception in the adjoining Exhibit Hall. Enjoy refreshments, door prizes, and a first look at the exhibits. The Opening General Session and reception are included with your full conference registration. Guest tickets can be purchased for $45.

Tuesday, September 24 – Saturday, September 28 at various times Experience the ballpark as only players and staff do. Go behind-the-scenes and discover “Writer’s Row” in the press box, sit in a major league dugout, peek inside the Visitors’ Clubhouse, and learn more about baseball in San Diego at the Padres Hall of Fame.

AOPA Night at the Ballpark— Padres Vs. Dodgers

Tuesday, September 24, 7:10 p.m. Enjoy an evening of baseball with O&P colleagues at Petco Park—a field that combines the best sightlines in baseball with breathtaking views of San Diego. Sit in the stands at the stadium—located across the street from the San Diego Convention Center—for a showdown between the San Diego Padres and their rivals, the Los Angeles Dodgers. Reserve discount tickets at https://groupmatics.events/event/AOPA2019.

Benefit Concert Featuring Montgomery Gentry Thursday, September 26, 7:15 – 9:30 p.m. The Veterans Stride Foundation will host a benefit concert on the upper level of the convention center. Enjoy a fun evening while supporting a worthy cause. Tickets can be obtained when completing your registration form. Contact AOPA for details.

Professional Women of O&P—Celebrating Success and Driving the Waves of Change PAC Appreciation Reception Thursday, September 26, 5:15 – 6:15 p.m. O&P PAC donors are invited to a private reception as a “thank you” for their support. Enjoy prize drawings, refreshments, and networking.

JUNE 2019 | O&P ALMANAC

Friday, September 27, 11:15 a.m. – 12:30 p.m. Women registering for the 2019 Assembly are invited to join AOPA for a special event acknowledging the contributions and advancements of women in O&P. The program offers women a casual opportunity to network and learn from other successful female professionals. Join us for lunch as we celebrate landmark achievements and discuss the future of women in the industry. RSVP required.

Exhibitor-Sponsored Happy Hour in the Exhibit Hall

Friday, September 27, 5:00 – 6:00 p.m. Spend an hour celebrating and networking with O&P colleagues. Exhibitors will host refreshments throughout the Exhibit Hall. Enjoy door prizes and pick up your complimentary show shirt—while supplies last. The Happy Hour reception is included in your full conference registration.

The La Jolla beaches feature dramatic and diverse scenery, including everything from 300-foot sea cliffs, to reefs, to sandy beaches, to covers. The La Jolla Shores, a mile-long sandy beach, is a popular swimming destination. At the northmost point, visitors can see the 300-foot sea cliffs. Hikers will appreciate a walk along the bluffs to view native flora and fauna. While visitors often have to access La Jolla Cove via kayak, at the right tides adventurous hikers can access it. Visitors enjoy snorkeling at this location and seeing brightly colored sea life. The area also boasts a “Children’s Pool,” a cove enclosed with a concrete breakwater wall to be a safe swimming area for children. But the name is a misnomer— it’s now closed to swimming as seals and sea lions have overtaken it.

Eat, Drink, and Be Merry

San Diego is home to hundreds of options for urban entertainment, dining, craft breweries, and shopping. The San Diego Convention Center sits near the Gaslamp District, a 16½block historic neighborhood that is home to beautifully restored Victorian buildings. It was once desolate—until Alonzo Horton purchased the land for less than $300 in the late 1860s to build a new city center close to the

water. Building began in 1867, and residents soon called the area “New Town” as it quickly became a bustling center. After falling into disrepair, developers in the 1980s and 1990s revitalized the area, creating a walkable entertainment center. The Gaslamp District, near the San Diego Convention Center, is home to a diverse group of restaurants. Visitors craving all types of cuisines—from quick bites to breakfast to sushi to Mexican—can find a restaurant that meets their needs. And it should come as no surprise that seafood is plentiful, with all sorts of menus featuring fresh fish. Popular options include Osetra Seafood & Steaks, Gaslamp Fish House, Tin Fish Gaslamp, and The Poke Co. Sushi is a “can’t miss” at Full Moon and Nara Sushi. Traditional Mexican food is plentiful because of the city’s proximity to the border—La Puerta, The Blind Burro, Senor Taquero, and El Chingon are just of a few of the choices in the Gaslamp District. O&P professionals seeking a nightcap can relax at one of the Gaslamp District’s numerous pubs— Henry’s Pub, Dublin Square Irish Pub and Grill, and Patrick’s Gaslamp Pub are a few hometown favorites. There also are plenty of club options for dancing and late-night adventures. For craft beer fans, San Diego has been named the “Top Beer Town” in America by Men’s Journal and is home to more than 150 breweries, brew pubs, and tasting rooms. Assembly attendees may choose to visit establishments known as craft brewing pioneers, such as Stone Brewing Company,

Ballast Point, and Coronado Brewing. While not an original craft brewery, Tiger Tiger! offers some of the best in local brewing, paired with great food. Several local companies advertise beer-themed tours, including Brewery Tours of San Diego, San Diego Brew Tours, and Brew Hops. Japanese cuisine flourishes in the San Diego area, and many of the city’s most popular restaurants feature ramen, sushi, and grilled skewers. Yakitori Hino, Menya Ultra, Sushi Ota, and Sushi Tadokoro rank among the region’s best restaurants. San Diegans love taquerias, and there are plenty of options for those looking for quick, flavorful tacos. Tacos Mimi, Carnitas Las Michoacanas, Taqueria Zapata, Coal Bros, La Playa Taco Shop, and City Tacos are just a few options.

Mark Your Calendar

With so many activities and outings possible in San Diego, AOPA National Assembly participants should plan their visits now—and include extra time at the front or back ends of their trips to sightsee, take part in water adventures, and enjoy the restaurant and nightlife scenes in “America’s Finest City.” Meghan Holohan is a contributing writer to O&P Almanac. O&P ALMANAC | JUNE 2019

PRINCIPAL INVESTIGATOR

A Steady Stream of Studies Andrew Sawers, PhD, CPO, focuses on the who, why, and how of fall prevention among lower-limb amputees

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.

NDERSTANDING WHY FALLS

JUNE 2019 | O&P ALMANAC

Sawers has been at UIC since 2015 and has spent the past several years overseeing students and leading research in the lab that revolves around the who, why, and how of fall incidences. He is pursuing several interrelated research goals to help answer these questions and has published dozens of papers on various aspects of his research—with plans to publish many more as the investigations progress. First, Sawers is interested in the “who” of falls among amputees—who is at risk for a fall? Sawers and his team have looked at fall risk/balance assessment tools that are currently being used and have developed a tool of their own for predictive purposes: a narrowing beamwalking test. The team has designed a protocol that consists of four beams that are approximately ¾-inch off the ground, each six feet long, and of progressively narrowing widths. Subjects are asked to navigate the beams, and the researchers record how far along the beams subjects get during multiple trials. After conducting several studies, Sawers concluded that narrowing beamwalking presents as a clinically feasible approach for evaluating balance ability across a range of ambulatory lower-limb prosthesis users. He presented these findings during a presentation at the

American Academy of Orthotists and Prosthetists in 2018, which earned him an Academy Thranhardt Award. He is currently finishing up a prospective study that will help indicate which amputees may be at greatest risk of a fall.

“Our long-term goal is to develop an electronic clinical outcomes dashboard to help clinicians determine the best test to select given what they want to measure [to assess the likeliness of a fall].” Second, Sawers’ team is investigating the “why” of falls—why are lower-limb prosthesis users at risk for falls? When they fall, what goes wrong? His team members are studying the gait and biomechanics associated with falls, and implementing electromyography tests, to explore this aspect. “We want to translate this information into usable information for clinicians,” Sawers explains, “so they can say to their patients, ‘Here’s why you might fall, and here are some strategies to prevent that.’”

PHOTO: Andrew Sawers, PhD, CPO

happen and determining optimal methods for reducing the incidence of falls among lower-limb amputees is the central focus of the research currently being conducted by Andrew Sawers, PhD, CPO. Sawers, an assistant professor in the Department of Kinesiology at the University of Illinois at Chicago (UIC), directs the department’s Locomotor Rehabilitation Lab. The lab’s mission is to determine why people fall—and why they don’t—with the goal of remediating balance impairment. “We pursue this objective by developing novel tools to assess balance proficiency and fall risk, identifying neuromechanical mechanisms of ‘better’ balance, and optimizing rehabilitation interventions that improve walking balance,” explains Sawers.

Pursuing Comprehensive Solutions

PRINCIPAL INVESTIGATOR

And third, Sawers is studying the “how” of falls, using epidemiological studies and leveraging new technologies, such as wearable sensors. “We are studying the circumstances of falls—are they slips? Trips? Do they happen during the day or at night? Inside or outside?” In addition, he is examining what types of falls are consequential, resulting in discomfort, injury, loss of work, etc. The goal is to understand and quantify the most common types of falls to determine where to focus clinical interventions. The team has been concentrating on the health of the amputee—strength and cardiovascular health as well as physical therapy interventions—rather than specific types of devices. So far, Sawers’ team has conducted studies of groups of 60 or 70 amputees to answer the “how,” and now they’re expanding that effort. “We want to provide clinicians with tools they can use, such as a probability of distribution, so they know what types of falls” their patients are most susceptible to.

Planning for Deliverables

Given his many investigations into fall circumstances and prevention for amputees, Sawers hopes to build on his research to develop useful resources for O&P clinicians and other healthcare professionals. “Our long-term goal is to develop an electronic clinical outcomes dashboard to help clinicians determine the best test to select given what they want to measure [to assess the likeliness of a fall],” he explains. The dashboard would provide an explanation of how to administer the recommended test, allow clinicians to input results, and then provide guidance on fall likelihood and preventive measures. Sawers also plans to conduct additional statistical modeling as well as qualitative research to develop an open access tool—a survey asking amputees who have fallen about the circumstances surrounding the fall event. This will enable data surrounding amputee fall events to be aggregated in an organized manner for comparative and educational purposes. The comprehensive studies being carried out by Sawers’ team will benefit not only lower-limb prosthesis users, but also clinicians, physical therapists, and related

healthcare professionals. The information “will aid in one-on-one clinical decision making to help prosthetists make evidence-based decisions,” Sawers says. In addition, Sawers believes his data will aid manufacturers seeking scientific guidance on prosthetic device development.

Research-Driven Career Path

Given Sawers’ expansive research background, it’s no surprise that he is strategizing on how best to aid the O&P profession with evidence-based outcomes and related tools. He grew up in Calgary, Canada, and became involved in initial research studies during his undergraduate years at the University of Calgary, where he earned a bachelor’s degree in kinesiology in 2002. Soon after, he moved to Atlanta, where he continued to take part in research studies while earning his MSPO from Georgia Tech. Sawers next practiced O&P in New York, completing residencies in orthotics and prosthetics and achieving his certification while working in the O&P

Department at University of Rochester’s Medical Center. He moved across the country in 2008 to pursue his PhD in rehabilitation medicine, then returned to Atlanta to work as a postdoctoral fellow in biomedical engineering at Emory University. In 2015, he settled in Chicago, taking on his current role at UIC. Sawers encourages O&P professionals to contribute to research initiatives in whatever way they can. For some, that may mean simply understanding how to interpret and make use of professional resources. For others, it may mean recruiting patients to participate in clinical studies or providing clinical input to a nearby scientific team. “We’re always looking for clinicians to contribute in some way,” he says. Looking to the future, Sawers will be relying on the help of students at the Locomotor Rehabilitation Lab, as well as assistance from local clinicians and research partners, to help him finish up his work on fall prevention to improve the quality of life for lower-limb prosthesis users.

Notable Works Andrew Sawers, PhD, CPO, has been involved in the publication and presentation of dozens of important articles and papers over the course of his education and career. Some of his most impactful works include the following: • Sawers, A., Ting, L.H. “Beam Walking Can Detect Differences in Walking Balance Proficiency Across a Range or Sensorimotor Abilities.” Gait & Posture 2015; 41: 619-623. • Sawers, A., Hafner, B. “Narrowing Beam-Walking Is a Clinically Feasible Approach for Assessing Balance Ability in Lower-Limb Prosthesis Users.” Journal of Rehabilitation Medicine 2018; 50: 457-464. • Sawers, A., Hafner, B. “Validation of the Narrowing Beam-Walking Test in Lower-Limb Prosthesis Users.” Archives of Physical Medicine and Rehabilitation 2018; 99: 1491-1498. • Sawers, A., Bhatt, T. “Neuromuscular Determinants of Slip-Induced Falls and Recoveries in Older Adults.” Journal of Neurophysiology 2018; 120: 1534-1546. • Kim, J., Major, M.J., Hafner, B., Sawers, A. “Frequency and Circumstances of Falls Reported by Ambulatory Unilateral Lower-Limb Prosthesis Users: A Secondary Analysis.” Physical Medicine & Rehabilitation Journal 2019; 11: 344-353

O&P ALMANAC | JUNE 2019

MEMBER SPOTLIGHT

Adaptive Technologies

By DEBORAH CONN

Where Choice Is Chief Canadian facility offers a wide selection and in-depth customer education

HE FOUR OWNERS OF

Adaptive Technologies— Ryan Cochrane, CPO(c); Koji Duncan, CO(c); Emilie Soper, CPed; and Rianna Wilson, who serves as business manager—had been working at a different facility when they decided to join forces. They envisioned a practice that offered both custom and off-theshelf orthotic, prosthetic, and pedorthic devices. “We wanted to bring a marriage of the two, so that people would have wider choice with more options,” says Cochrane. “Not everyone needs a customized device.”

Ryan Cochrane, CPO(c)

FACILITY: Adaptive Technologies

Adaptive Technologies facility

JUNE 2019 | O&P ALMANAC

LOCATION: Lethbridge, Alberta, Canada HISTORY: One year

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

PHOTOS: Adaptive Technologies

Adaptive Technologies occupies a 2,700-square-foot building in Lethbridge, Alberta, Canada. It features a small retail area in front with such items as knee sleeves, ankle braces, maternity braces, hernia trusses, compression stockings, and orthotic inserts. The facility offers four dedicated patient assessment rooms: one for prosthetics, with parallel bars, stairs, and a ramp; one geared to fitting custom knee devices; one devoted to pedorthics; and one for providing custom ankle-foot orthoses and all other devices. Clinicians fabricate most devices on site, although they outsource some knee braces and custom ankle-foot orthoses.

OWNERS: Ryan Cochrane, CPO(c); Koji Duncan, CO(c); Emilie Soper, CPed; and Rianna Wilson

Adaptive Technologies developed two acronyms that form the basis of the practice. The first is CHIEF. “The C is for choice, from simple to customized devices,” explains Cochrane. “H stands for humility, as we always want to listen to patients and understand that we may have to keep searching for a solution. I is for integrity. Our goal is never to overprescribe to make more money, but to always provide the most appropriate device for patients’ needs. E stands for expertise, and F is for family. We want to treat everyone who comes in the door like a member of our family.” The second acronym is CARE: C for create, A for adapt, R for results, and E for education. “We want people to understand why we are prescribing things to them,” Cochrane explains. Another important goal for the group is to maintain a work-life balance. “All of us have children younger than 10,” Cochrane says, “and we want to be able to spend time with our families and cover each other’s backs when our kids have things we have to attend.”

Clinicians place importance on spending enough time with patients, rather than rushing them through as quickly as possible. “We’ve had patients who said they felt like cattle going down a chute at other facilities,” Cochrane says. “It’s important to take the time to do a thorough assessment.” Administration of the facility is without hierarchy. No one person is at the top; Cochrane likens the structure to a table, where each owner holds up a corner. He, Soper, Duncan, and Wilson have a formal meeting every two weeks, but in such a small practice, communication is ongoing. Adaptive Technologies markets its services by calling on physical therapy and physician clinics. The facility is active on social media, including Facebook and Instagram, and recently began a radio ad campaign. The company opened its doors on July 3, 2018, and is still in its initial growing phase. “We’re getting close to where we want to be,” says Cochrane, “which includes paying ourselves. Every month is getting better, and we’re getting many more calls from hospitals.” The road hasn’t always been smooth, but Cochrane and his colleagues have experienced great generosity in unexpected places. “Former patients and people we’ve worked with helped spread the word about our new facility,” he says. “It was humbling and surprising.” At its one-year mark, Adaptive Technologies’ goals are straightforward: to grow enough to earn a living for its owners, and then to hire more staff. In the meantime, Cochrane, Duncan, Soper, and Wilson continue to do what they love: provide quality care to patients.

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MEMBER SPOTLIGHT

SPS

By DEBORAH CONN

Catering to Clinicians’ Needs Distributor offers popular clinical services and rewards programs

PS WAS FOUNDED by Daniel

JUNE 2019 | O&P ALMANAC

SPS offers many ways to access its website

Steve Peterson, sales manager; Chris Erbacher, regional sales manager; Tina Scurry, inside sales rep; and Jamie Seabold, regional sales manager

COMPANY: SPS OWNER: Hanger Inc. LOCATION: Alpharetta, Georgia, with five regional U.S. distribution centers HISTORY: 67 years

Coleson Chase, director of marketing

Robin Hester, inside sales specialist

and explain how to use them. For example, a practitioner who needed a quick review on a complex process could quickly brush up on how to program a microprocessor knee to adjust gait and get right back to work.” More than 20 videos on four devices are available on YouTube and the SPS website, with additional videos in the works. The company’s online rewards program offers a 5 percent discount on “rewards” products and a 2 percent discount on any product outside the program. SPS has a strong focus on sharing relevant industry content—one vehicle it uses to accomplish this goal is an online blog covering business tips on saving time and money, product features, and how-to articles. The company also produces a quarterly magazine in print and digital formats called the SPS Xpress, which updates customers on industry news, new product offerings, company happenings, and more. SPS has transitioned from

traditional print advertising to a more digital approach, says Chase. “By and large, customers are becoming more digitally savvy,” he notes. “We do more than 60 percent of our business through our website, and that’s growing every year.” The company also leverages a popular email program with SPS’s customer base and is active on social media as well. Company representatives attend all regional O&P trade shows and AOPA’s National Assembly. SPS prides itself on its attention to customers. “Right now, we’re serving four generations of clinicians,” says Chase. “We find the right approach for each one. Any way you want to order from us, there’s a way to do it. Our 12 sales reps in the field make regular visits, our nine internal sales specialists dedicate themselves to customer territories for every need, our 25 customer service reps are always available for calls, and, overall, SPS will answer any question, at any time,” he says. “Using SPS allows independent facilities to do one-stop shopping for O&P products at competitive prices,” adds Chase. “You get your items more quickly than trying to manage multiple suppliers—you just have to place one order.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: SPS

McKeever, CP, in 1952, as both a patient-care facility and a distributor of prosthetic components. Today, the company carries more than 400,000 orthotic and prosthetic products and operates five distribution centers located across the United States, serving independent O&P facilities throughout the nation. The company’s distribution centers are located at its headquarters in Alpharetta, Georgia, as well as in Woodridge, Illinois; Middletown, Pennsylvania; Garland, Texas; and Reno, Nevada. Within the past five to 10 years, SPS has invested in and put an emphasis on technology, with a website that Director of Marketing Coleson Chase calls “the destination platform for the industry.” According to Chase, the site has a comprehensive selection of O&P products and a popular rewards program, “and it’s easy to access on a laptop, phone, or tablet.” SPS has an active clinical services program, with two clinicians on staff and many ways to support practitioner training. Customers can view webinars, receive assistance via telephone and video chat, and attend regional clinical education sessions. The company also offers on-site clinical support tailored to meet each facility’s needs. “We launched a new YouTube series last year called ‘The Clinical Minute,’” says Chase. “Our clinicians present the features and benefits of specific products

CALL FOR VOLUNTEERS

AOPA Wants YOU!

Build your network. Advance your career. Give back to the profession. Volunteer for a Workgroup and/or Committee.

Together we will drive the waves of change. The American Orthotic & Prosthetic Association

AOPA VOLUNTEER COMMITTEES | WORKGROUPS

(AOPA) has opened its annual call for volunteers

•

Assembly Planning Committee

•

Coding and Reimbursement Committee

•

Government Relations Committee

and we need your talent. Employees of all AOPA member companies are invited to serve on one of AOPA’s Committees and/or Workgroups. From

•

Government Relations Contributions/Fundraising

planning the National Assembly to driving the O&P

•

Member Services Committee

research agenda to developing our legislative

•

Mobility Saves Committee

strategy, there is something for everyone. Find a

•

Operating Performance and Compensation Workgroup

Committee and/or Workgroup that interests you,

•

Research Committee

•

State Representatives

•

Veterans Affairs Committee

and submit an online application on the Call for Volunteers webpage today!

Don’t miss this exciting opportunity to become

involved in the O&P profession by supporting AOPA and your fellow colleagues! Terms of service are two-years and will begin December 1, 2019. Most workgroups or committees meet face-to-face at least once per year with monthly conference calls lasting approximately one-hour. Additional time commitments include reviewing materials and work to accomplish the goals of each workgroup or committee. For details about the goals and responsibilities of each workgroup or committee and information on the nomination process, refer to the Nominations Policy.

APPLICATION DEADLINE: JUNE 30, 2019

Submit your application at www.AOPAnet.org/volunteer.

QUESTIONS? Contact Betty Leppin at bleppin@AOPAnet.org or 571-431-0810.

AOPA NEWS

By CHRISTINE UMBRELL

AOPA IN THE NEWS data now outcome measures How and why collecting the future your patients—in your facility—and

the T MANY O&P COMPANIES, comprehendecision to implement processes to outcome measures formal policies and sive procedures for facilities are implementing particularly for lower-limb amputees. gradually, Many O&P patient-care data collection happens data from their patients, the benefits of capture outcome measures after reading about several hearing about data are responsible for conducting such endeavors or or other staff members test, and more, at nearby facilities. At some facilities, clinicians Amp Pro/NoPro, the timed up-and-go collection activities databases and as the CP, owner of recognized tests, such be input into HIPAA-compliant But for Scott Sabolich, This information can & Research, the during patient visits. comparison data. Sabolich Prosthetics reports and provide an evidence-based leveraged to generate decision to become with prove useful when working made almost overnight, may was data practice that outcome measures two months for Some clinicians predict Having well-documented and it took less than the documentation process. data as part of processes to payors and in streamlining require outcome measures the facility to implement lower-limb and Medicare will soon for all insurance companies measure outcomes fee-for-value care. the movement toward prosthetic patients. support O&P into outcome availability of data to This sudden jump chart data collection is the was driven by a Another benefit of enhanced be leveraged for retrospective appropriately. measures collection a measures data can de-identified 2014, we suffered research efforts. Outcome as long as the data is seminal event. “In r knees,” other types of studies, review research and minor audit of microprocesso practice approach “we shut down an evidence-based says Sabolich. Then that have embraced their appointment out” what needed are reluctant to alter Some patient-care companies until we figured such as clinicians who audits and have encountered obstacles, come to see the benefits of such an approach. to be done to prevent from payors, reimbursement routines. But most clinicians promote data collection. with great value of outcomes measure and others are he says. “We partnered scenario to already recognize the clinics in these efforts, Many manufacturers minds to seek a best-case partnering with patient-care to Medicare and Some companies are show due diligence the data collection process. developing tools to facilitate to show outcomes.”

NEED TO KNOW

AOPA’s monthly magazine, O&P Almanac, has been honored with two awards for publication excellence in the 25th Annual Communicator Awards Program. “Diving Into O&P Research,” a feature published in the October 2018 issue of O&P Almanac, won an Award of Excellence in the Writing—Feature Article category. This award is the highest honor and is “given to those entrants Prosthetics & Orthotics PHOTO: Ability

O&P Almanac Wins Communicator Awards

can benefit

| O&P ALMANAC MARCH 2018

whose ability to communicate positions them as the best in the field,” according to the Academy of Interactive & Visual Arts (AIVA), which administers the Communicator Awards. “Measure for Measure,” the cover story in the March 2018 O&P Almanac, won an Award of Distinction in the Writing—Feature Article category. This distinction “is presented for projects that exceed industry standards in quality and achievement,” according to AIVA.

AOPAversity: Webinar Half-Year Series 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.

AOPA Members Nonmembers

Price Per Seminar

$99.00* $199.00*

Price for Half-Year

$495.00 $995.00

* 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.

JULY 10

AUGUST 14

Target, Probe, & Educate—Get To Know the Program & What the Results Are Telling You

Are You Ready for the Worst? Contingency Planning

AOPA experts will offer a TARGET review of the most recent Target, Probe, & Educate (TPE) audit results released TPE Program by the durable medical equipment Medicare adminEDUCATION PROBE istrative contractors. Hear answers to some of your most pressing questions: • What claims are being denied? • What are the common denial reasons in the TPE program? • What steps you can take to avoid future denials?

JUNE 2019 | O&P ALMANAC

Is your facility prepared for the next natural disaster? Take steps now to minimize disruptions in the event of fire, flood, hurricanes, and other unexpected events. Experts will share tips and recommendations for creating a contingency plan, testing that plan, and carrying out that plan should a disaster occur. Plus, make sure you have all of the necessary insurance coverages in place.

AOPA NEWS

AOPA ANNOUNCES CALL FOR VOLUNTEERS

Volunteer Before the June 30 Deadline AOPA has opened its annual call for volunteers—we need your talent. Employees of all AOPA member companies are invited to apply to serve on one of AOPA’s committees or workgroups. From planning the AOPA National Assembly to driving the O&P research agenda to developing the association’s legislative strategy, there is something for everyone.

To find what interests you, review the full list of the committees and workgroups on the Call for Volunteers webpage, www.AOPAnet.org/volunteer/ . Terms of service are two years and will begin Dec. 1, 2019. Most committees or workgroups meet face-toface at least once per year, with monthly conference calls lasting approximately one hour. Additional time commitments include reviewing materials and work to accomplish the goals of each committee or workgroup. To apply, please complete an online application. Applications are due by Sunday, June 30. Don't miss this opportunity to become involved in the O&P profession by supporting AOPA and your fellow colleagues. Questions? Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0810.

Apply at www.AOPAnet.org/volunteer.

Thank You

to AOPA’s Policy Forum Sponsors

O&P ALMANAC | JUNE 2019

O&P PAC

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 would like to thank the following AOPA members for their contributions to the O&P PAC*:

• • • • • • • • • • • • • • • • • • • •

Leslie Allen, CFo Kate Allyn, CPO, FAAOP Christopher Berdahl, CP Curt Bertram, CPO Kevin Bidwell, CP Chellie Blondes Jeffrey Brandt, CPO George Breece Robin Burton Joy Burwell Marco Calcagno, CPO J. Douglas Call, CP Tina Carlson Christina Cox Joseph Cozza Glenn Crumpton, CPO Mitchell Dobson, CPO, FAAOP Traci Dralle, CFm John Chad Duncan, PhD, CPO Daryl Farler, CPA

• • • • • • • • • • • • • • • • • • • •

Mike Fenner, CP, BOCPO, LPO Rick Fleetwood, MPA Elizabeth Ginzel, MHA, CPO, LPO John Hays, CP, LP Denise Hoffmann Michele Hogan Dan Ignaszewski Dennis Janisse, CPed Maurice Johnson, CO Charles Kuffel, CPO, FAAOP Teri Kuffel, Esq. Eve Lee, MBA, CAE Robert Leimkuehler, CPO William Leimkuehler, CPO, LPO Jeffrey Lutz, CPO Sourabh Nagale, CPO Matthew Nelson, CPO, FAAOP Michael Oros, CPO, LPO, FAAOP Paul Prusakowski, CPO Patrick Reichel

• • • • • • • • • • • • • • • • • • •

Rick Riley Dara Ross, CPO Michael Schlesinger Ryan Schuetzle, CPO Robin Seabrook Lesleigh Sisson, CFo, CFm Chris Snell, BOCP Frank Snell, CPO, LPO, FAAOP William Snell, CPO Jason Tanner, CPO Bernie Veldman, CO Suzi Vicino Jim Weber, MBA Ashlie White Dennis Williams, CO, BOC(O) Scott Williamson, CAE, MBA Linda Wise James Young Jr., CP, LP, FAAOP Claudia Zacharias, MBA, CAE

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 U.S. House of Representatives 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: bit.ly/pacauth. *Due to publishing deadlines, this list was created on May 14, 2019, and includes only donations/contributions made or received between April 19, 2019, and May 14, 2019. Any donations/contributions made/ received on or after May 14, 2019, will be published in a future issue of O&P Almanac. 50

JUNE 2019 | O&P ALMANAC

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.

Liston Prosthetics 5292 S. College Drive, Ste. 103 Murray, UT 84123 385/425-3960 Member Type: Patient-Care Facility PSYONIC 60 Hazelwood Drive Champaign, IL 61820 773/888-3252 Member Type: Supplier

Rimrock Prosthetics 1139 N 27th Street Billings, MT 59101 406/252-6100 Member Type: Patient-Care Facility Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

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 | JUNE 2019

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

Certified Orthotic Fitter

Job location key: - Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned

Long Beach, California VA Long Beach Healthcare System The Long Beach VA Medical Center is looking to hire an orthotic fitter. The job will entail working alongside two other certified fitters in a progressive orthotic clinic that provides off-the-shelf orthopedic braces and therapeutic shoes. Individuals should be self-motivated, provide good customer service, and possess good management skills of daily work load. Excellent federal employee health benefits and retirement package is included. Work with supportive co-workers in a hospital setting in sunny southern California. Certification is a plus but may be obtained on the job. The job will be posted on usajobs.gov, search “orthotic fitter” in Long Beach, CA.

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,

Visit: Website: https://www.usajobs.gov Search “Orthotic Fitter” in Long Beach, CA Email: Christopher.dang@va.gov

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

DOTHAN, ALABAMA

Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

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

Nonmember $678 $830

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

OWNERS WANTED!

Member Nonmember $85 $150

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

LUBBOCK, TEXAS LONG ISLAND, NY

INCREDIBLE BUSINESS OPPORTUNITY! NATIONAL BRACE is looking to put clinicians into practice with three offices that are BOC accredited along with many private insurances. Please, only licensed and highly motivated individuals apply. So if you have ever dreamed of owning a practice will little or no money down, Brightree, back office support, vertically integrated purchasing, and completely turnkey: NATIONAL BRACE™ Email in confidence to nationalbraceinc@gmail.com.

JUNE 2019 | O&P ALMANAC

CAREERS

WANTED!

2019 AOPA Coding Products

A few good businesses for sale. Lloyds Capital Inc. has sold over 150 practices in the last 26 years. If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323/722-4880 • (C) 213/379-2397 Email: loyds@ix.netcom.com SUBSCRIBE

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

Get your facility up to speed, fast, on all of the O&P Health-Care 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.

O&P ALMANAC | JUNE 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.

ALPS Antioxidant Cream ALPS Antioxidant Cream contains antioxidants that are an effective scavenger against free radicals and hydroxyls. Used for moisturizing, the Antioxidant Cream can also be used to protect irritated skin and aid in reducing friction. Used throughout the day, the cream is just what you need to soothe pain and itchiness! Call us or visit www.easyliner.com for more details.

The Original Pre-Flexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Pre-flexed 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.

Fabtech Epoxy Meter Mixer Making your fabrication life easier! Our Epoxy Meter Mixer offers a faster, cleaner, and accurate way for you to meter your RESTECH+ Epoxy resin ratio every time! • Our resin pump meter mixing system has onegallon resin reservoirs for the A & B sides for a total of two gallons. • Keeps your mixing station clean and organized! • Accurately dispenses up to three quarts of unmixed two-part RESTECH+ epoxy resin per minute. • All you have to do is mix the resin. • No more gram scale! For more information, call 800/322-8324 or visit www.fabtechsystems.com.

JUNE 2019 | O&P ALMANAC

Sutti Bounders Store and Return Energy —Mimicking Normal Muscle Function New “Sutti Bounders” modular pediatric dynamic elastomers are a patent-pending elastomer technology that offer two progressive solutions. Sutti No tools for on the fly adjustments Bounders store and return by healthcare providers 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.

Adjustable Post-Operative Preparatory Prosthetic System—Transfemoral This two-part post-operative preparatory prosthetic system that consists of the FLO-TECH-TOR™–TF and UFOS™–TF (waist belt and components available as separate line items) allows the prosthetist to provide a continuum of care, from the time of amputation, through early weight bearing, until the patient is ambulating independently. Both sockets work together to enable prosthetists to fit virtually any shape or size amputation. Custom sockets can also be fabricated from your measurements, making the benefits of the APOPPS®–TF available to almost all transfemoral amputees. Call 800/FLO-TECH (800/356-8324) for information.

Rheo Knee® The perfect combination of stability and dynamics—combining both stability and a dynamic walking experience, Rheo Knee utilizes magnetorheological fluid and a state-of-the-art microprocessor to automatically adapt with every step. Now featuring: upgraded Össur Logic App, enhanced stability control, and weatherproofing. Visit ossur.com/rheo-knee to learn more.

MARKETPLACE 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.

Arizona AFO’s Moore Balance Brace Check out the latest peer-reviewed, published study substantiating the efficacy of Arizona AFO’s Moore Balance Brace. This randomized controlled trial investigated the long-term impact of a balance ankle-foot orthosis, the Moore Balance Brace, on balance, fear of falling, and physical activity in older adults. Researchers reported not only a decrease in fall risk, but a meaningful reduction in fear of falling, leading to an increase in physical activity. Check out the full study at arizonaafo.com/baylor.

From Land to Water With Ottobock’s Aqualine Orthosis System The Aqualine AFO/KAFO is a waterproof orthosis system for the shower, pool, beach, and more. • Durable, waterproof, and corrosion-resistant to chlorine, salt, and soapy water • Lightweight knee and ankle joints suitable for both thermoplastic and prepreg orthoses • Easy to clean, easy to dry, and fully serviceable components • Ask about our current Aqualine promotion. For more information, call 800-328-4058 or visit professionals.ottobockus.com.

Introducing 1C50 Taleo® From Ottobock Ready for everyday life. The carbon fiber Taleo foot is the newest foot in our portfolio. 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. • 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 representative.

O&P ALMANAC | JUNE 2019

MARKETPLACE Discover PROTEOR USA

Spinal Technology Inc.

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.

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.

AD INDEX

Advertisers Index Company

45 703/886-7114

www.abcop.org

Amfit

7 800/356-3668

www.amfit.com

Anatomical Concepts

800/837-3888 or 330/757-3569

www.anatomicalconceptsinc.com

ComfortFit Orthotic Labs Inc.

888/523-1600

www.comfortlabs.com

888-WEAR-ESP

www.wearesp.com

17, 33

800-FABTECH

www.fabtechsystems.com

Fabtech Systems LLC

800/574-5426

Website

ALPS South LLC American Board for Certification in Orthotics, Prosthetics, and Pedorthics

ESP LLC

www.easyliner.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

Flo-Tech O&P Systems Inc.

800/356-8324

www.1800flo-tech.com

Hersco

1 800/301-8275 888/977-6693

www.hersco.com

Naked Prosthetics

OHI

15 877/780-8382

www.ohi.net

Össur Americas Inc.

www.ossur.com

800/233-6263

www.npdevices.com

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

PROTEOR USA

855/450-7300

www.proteorusa.com

800/253-7868

www.spinaltech.com

Spinal Technology Inc. 56

Page Phone

JUNE 2019 | O&P ALMANAC

www.bocusa.org

EARN CE CREDITS AT YOUR OWN PACE www.AOPAnetonline.org/aopaversity

100+ TOP-QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION COURSES.

EARN SCIENTIFIC, BUSINESS, AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Learn & Earn TOP QUALITY

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

Itâ€™s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

Start earning your credits today!

Visit www.aopanetonline.org/aopaversity.

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.

July 11–13

State Association Meeting: Alabama Prosthetic & Orthotic Association. Embassy Suites Birmingham/Hoover, Birmingham, AL. For more information, email info@ alabamapoa.org or visit www.alabamapoa.org.

August 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.

August 1

ABC: Application Deadline for ABC/OPERF Resident Travel Award. Four residents will be selected to present their Directed Study Research project at the 2020 Academy Annual Meeting and receive $2,500 plus complimentary meeting registration. For more info or to apply, go to operf.org.

2019 June 12

Documentation—Understanding Your Role. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

July 1

ABC: Practitioner Residency Completion Deadline for August Written & Written Simulation and Fall CPM 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.

July 10

Target, Probe, Educate—Get To Know the Program & What the Results Are Telling You. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

July 12–13

Primefare East Regional Scientific Symposium. Renaissance Hotel and Convention Center, Downtown Nashville. For more information, visit www.primecareop. com, call 888/388-5243, or email Cathie Pruitt at primecarepruitt@ gmail.com or Jane Edwards at jledwards88@att.net.

June 14

State Association Meeting: Kentucky O&P Association. Hyatt Regency Lexington, Lexington, KY. For more information, email kopa.editor@gmail.com or visit www.kyopa.net.

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

JUNE 2019 | O&P ALMANAC

August 5–10

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.

August 14

Are You Ready for the Worst? Contingency Planning. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

August 23–24

ABC: Orthotic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/836-7114, email certification@abcop.org, or visit ABCop.org/ certification.

August 23–24

Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Baylor College of Medicine McNair Campus in Houston. Contact Ben Guenther at 903/884-6681 or visit www.txaaop.org.

September 1

ABC: Practitioner Residency Completion Deadline for October 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

November 13

September 6–7

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

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

September 11

Veterans Affairs Updates: Contracting, Special Reports, and Other News. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

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

September 12–14

State Association Meeting: Midwest Chapter AAOP. Grand Geneva Resort & Spa, Lake Geneva, WI. For more information, email mwcaaop@gmail.com or visit www.mwcaaop.org.

September 25–28

AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

2020 September 9–12

AOPA National Assembly. Mandalay Bay, Las Vegas. For general inquiries, contact Ryan Gleeson at 571/4310836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

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

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

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.

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.

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

COMPLETE CONTROL

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 | JUNE 2019

ASK AOPA CALENDAR

Bidding Q&A Answers to your questions regarding Competitive Bidding 2021

This month’s Ask AOPA column provides Q answers to questions that have arisen regarding Competitive Bidding 2021, the recently announced competitive bidding program for off-the-shelf orthoses that will include 23 offthe-shelf spinal and knee orthosis codes. Although the program will not take effect until January 2021, the bidding process begins this month. For details about the program, read Views From AOPA Leadership and This Just In on pages 4 and 20.

If we are submitting a bid for Competitive Bidding 2021, do we submit the bid as a dollar amount, or is it submitted as percentage off the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule amounts?

The bids for the lead items in each product category—L1833 for off-the-shelf (OTS) knee braces and L0650 for OTS spinal braces—will be submitted as a dollar amount. The actual dollar amount must be at or below the 2019 DMEPOS fee schedule.

JUNE 2019 | O&P ALMANAC

What is the recourse for a bidder that breaches its contract? Is there any recourse if a supplier goes out of business and ceases operation?

A contract supplier that is found in violation of the contract articles will be found in breach of contract (BOC). However, the supplier may submit a corrective action plan to resolve the breach, which must be approved by CMS, or request a hearing. However, if no action is taken, the supplier will be found in breach, the contract will be terminated, and the supplier will be precluded from the next round of bidding. A supplier that goes out of business is found in BOC and subject to the same adverse actions for failing to fulfill its obligation to the terms of the contract.

Is it true that physicians and therapists are exempt from Competitive Bidding 2021?

The answer is yes and no. The Medicare Claims Processing Manual states that there is an exemption, but it is limited to crutches, canes, walkers, folding manual wheelchairs, blood glucose monitors, and infusion pumps that are durable medical equipment. Physicians and nonphysician practitioners are exempt from bidding for OTS orthoses. Hospitals and physical therapists are exempt, as well. Exemptions for physicians/ nonphysician practitioners and hospitals were expanded in the Medicare Improvements for Patients and Providers Act of 2008 to include certain OTS orthoses. Physical therapists were granted the exemption to provide competitively bid OTS orthoses to their own patients as part of the physical or occupational therapy service in the 2017 Final Rule. However, the payments they will receive will be based on the established rates for each competitive bidding area (CBA). (Note that Competitive Bidding 2021 will be implemented in 130 CBAs across the United States.)

If I already have a surety bond as part of my Medicare enrollment, am I required to get a new surety bond if I want to place a bid? How many bonds do I need?

Yes, you would be required to get a new surety bond, which is separate from the bond you obtained when you enrolled in Medicare. How many bonds you require will depend on the number of CBAs in which you intend to place a bid. In other words, one bond is required per CBA, regardless of how many products you are bidding on in that CBA. So, you may have one bond, or you could have up to 130 bonds; there are currently 130 CBAs.

THE PREMIER MEETING FOR ORTHOTIC, PROSTHETIC, AND PEDORTHIC PROFESSIONALS

Experience all the AOPA National Assembly has to offer while visiting San Diego.

SEPTEMBER 25-28 / 2019 SAN DIEGO CONVENTION CENTER

Driving the Waves of Change Join AOPA this fall in San Diego, known for incredible panoramic views. Located in the downtown Marina district, the San Diego Convention Center has many top attractions within walking distance.

ION

T STRA I G E R

ENation, OP rm e info

#AOPA2019

1 or For m e pp.36-4 se

SOUTHERN CALIFORNIA San Diegoâ€™s unbeatable location makes it the perfect gateway providing you with outstanding opportunities for pre- and post-conference travel.

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Introducing ÂŽ Taleo The 1C50 Taleo carbon fiber foot is the newest addition to the Ottobock foot portfolio. The Taleo is designed for active individuals who want a smooth foot and place a high value on effortless walking and the ability to go wherever life takes them.

Smooth rollover Energy efficient walking Terrain conformance

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Ready for everyday life.