July 2014 Almanac

WATERGet your patients in on the action this summer

ots or custom-Fit: Know the DifferenceP.16

state issues affecting your Business—nowP.30

new tool for mobility outcomes assessmentP.34

SportS

This Just In: Prior Authorization No Cure-All for Reimbursement P.18

ww

w.A

OPA

ne

t.O

rg

julY 2014

The Magazine for the Orthotics & Prosthetics Profession

Earn 4 BusinEss CE

CrEdits

QuiZ ME!

P.16 & P.38

Your ConneCtion to everythinG o&p

Life in action

Fillauer LLC • 800.251.6398 • 423.624.0946 • www.fillauer.com

The DuraShock has quickly become the industry standard for dynamic torque and shock absorption because of its high performance and durability. The DuraShock uses a titanium core in combination with a durable, yet pliable, geometric urethane coupling to provide a high degree of active performance for golfing, hiking, gardening, or simple everyday use.

AD341/10-08-12/04-28-14

DURASHOCK from Fillauer LLC

Shorty now available in heavy duty version rated to 300 pounds

AD341 - DuraShock.indd 1 5/30/14 3:44 PM

COOL LINERCool Liner +

UpgradeTo

Heat Customizable

® www.daw-usa.com Tech Hotline (877) 242-2423

All Sizes: 3, 6, and 9mm

Cushion Liners

Distal Attachment Liners

TRI-GEL™

YOURSILICONELINERS

TURBO CHARGE !

Original Stretch Control

™

All New Technology

Copyright © 2014, DAW Industries, San Diego, CA. All rights reserved.

22

CO

VE

R S

TO

RY

O&P AlmAnAc / July 2014 3

contentsFeatures

22 | No Waves, No Glory Get your patients into the water this summer with these practitioners’ tips for fitting, minimizing component corrosion, and more. By Lia Dangelico

Departments | COLUmns

President’s View ...................................... 4Insights from AOPA President Anita Liberman-Lampear, MA

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

Numbers........................................................ 8At-a-glance statistics and data

Happenings .............................................. 10Research, updates, and industry news

People & Places .......................................14Transitions in the profession

Reimbursement Page .........................16OTS or Custom-Fit?Proper billing procedures for orthoses

CE Credits

Opportunity to earn up to 2 CE credits by taking the online quiz.

Compliance Corner ..............................38Pay Attention to the PDACWhat this coding verification process means to you

CE Credits

Opportunity to earn up to 2 CE credits by taking the online quiz.

Member Spotlight ............................... 40n The Ohio Willow Wood Co.n Prosthetic Care Facility of

Virginia

AOPA News ...............................................46AOPA meetings, announcements, member benefits, and more

Welcome New Members ..................51Marketplace .............................................52Careers ........................................................53Professional opportunities

Calendar .....................................................54Upcoming meetings and events

Ad Index ...................................................... 55Ask AOPA ..................................................56Expert answers to your questions about Medicare and mailings

P. 16

P. 34

P. 30

18 | This Just InPrior Authorization No Cure-All for ReimbursementExperts say a poorly constructed prior authorization system could further slow review requests and complicate patient care.By Adam Stone

30 | The State of O&PUnderstanding regulators, legislator, and private insurers’ moves at the state level offers valuable insights for protecting your business and career. By Christine Umbrell

34| Prosthetic Limb Users Survey of MobilityResearchers review the development and validation of a patient-reported outcome measurement tool.By Susan Spaulding, CPO; Sara Morgan, CPO; and Brian Hafner, PhD

julY 2014 | VOL. 63, NO. 7


Advertise with Us! For advertising information, contact Bob Heiman at 856/673-4000 or email [email protected].

EVeRyTHING HAS TO START somewhere, with something and someone. In 2008, the something was a dream for AOPA

to sponsor an O&P World Congress in the western hemisphere. The somewhere was the then Orthopaedie + Reaha- Technik show for orthotics and prosthetics held in Leipzig, Germany, every two years. That someone was one of my predecessors, Brad Ruhl, then president of AOPA. Brad, along with Tom Fise, executive director, and Tina Moran, senior director of meetings and membership, traveled to Leipzig that year to share the idea

with the global O&P players of AOPA’s dream in hosting the World Congress. Brad had arranged in advance a series of meetings with the German Association of Orthopaedic Technology, sponsors of the Leipzig event, exhibitors, ISPO, and other groups to begin seeking indications of interest about participation in the event.

Another of my predecessors, Tom DiBello, CO, FAAOP, journeyed to the Leipzig show in 2010 to further cement relationships with individual practitioners from around the world and to gauge and encourage their interest. More and more the reality of a World Congress on U. S. soil took shape. Tom and AOPA staff went back in 2012 and continued an intensive effort to enlist specific high-profile, internationally recognized speakers and to recruit the leading lights of global O&P to serve on the World Congress Planning Committee.

Of course the smashing result of all of this effort by these two former presidents was the now historic AOPA World Congress held Sept. 18-21, 2013, in Orlando, Florida.

Just a few weeks ago, it was my pleasure to attend the OTWorld, as it is now known, to advance our plans for the 2nd AOPA World Congress, Sept. 6-9, 2017, at the Mandalay Bay Hotel and Resort in Las Vegas. Not only will it be a World Congress but it will be AOPA’s Centennial Celebration, and you can bet it will be a big deal! The response from everyone we met in Leipzig this year was enthusiastic and confirms my personal belief that the 2013 World Congress paved the way for bringing the far-flung world of O&P just closer and closer together.

From a more personal perspective, it was a tremendous honor to attend OTWorld and talk to our colleagues from other countries—Holland, France, Belgium, Spain, Germany, to mention a few—and, of course, see our American colleagues in action showing their products to folks from around the world. The exhibit space was four times (or more) the size of our shows, however, it was different than what we were used to as well. Products were showcased in enclosed cases or better yet, on the many patients walking around. And of course, I’d be remiss if I didn’t tell you about the great German beer (and wine) served along with local bratwurst and other yummy treats! Leipzig was definitely the epitome of Old World meets New World!

In the meantime, don’t forget to mark your calendar to join us in Las Vegas, Sept. 4-7, 2014, for the 98th annual National Assembly, also at the Mandalay Bay. And as long as you’re marking your calendar, 6:30 p.m., Friday, September 5 is the Sixth Annual Wine Auction—you will not want to miss it. Contact Devon Bernard for details on how to donate wine or other treasures to help us raise money for the AOPA Political Action Committee and the continuous advocacy it supports on behalf of O&P.

Sincerely,

Anita Liberman-Lampear, MA, AOPA President

Building the Global O&P Presence

Board of DirectorsOffICeRS

President Anita Liberman-Lampear, MAUniversity of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD

Vice President James Campbell, PhD, COBecker Orthopedic Appliance Co., Troy, MI

Immediate Past President Tom Kirk, PhDMember of Hanger Inc. Board, Austin, TX

Treasurer James Weber, MBAProsthetic & Orthotic Care Inc., St. Louis, MO

Executive Director/Secretary Thomas F. Fise, JDAOPA, Alexandria, VA

DIReCTORS

Maynard CarkhuffFreedom Innovations, LLC, Irvine, CA

Jeff Collins, CPACascade Orthopedic Supply Inc., Chico, CA

Alfred E. Kritter Jr., CPO FAAOPHanger, Inc., Savannah, GA

Eileen LevisOrthologix LLC, Trevose, PA

Ronald ManganielloNew England Orthotics & Prosthetics Systems LLC, Branford, CT

Dave McGillÖssur Americas, Foothill Ranch, CA

Michael Oros, CPOScheck and Siress O&P Inc., Oakbrook Terrace, IL

Scott SchneiderOttobock, Minneapolis, MN

Don Shurr, CPO, PTAmerican Prosthetics & Orthotics Inc., Iowa City, IA

4 July 2014 | O&P AlmAnAc

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

PReSIDeNT’S VIeW

sUBsCriBeO&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 [email protected]. 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 ChAngesPOSTMASTER: send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2014 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Cover Photo: Arthur Finnieston

Publisher Thomas F. Fise, JD

editorial Management Content Communicators LLC

Advertising salesRH Media LLC

design & Production Marinoff Design LLC

Printing Dartmouth Printing Company

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

eXeCUTIVe OffICeS

Thomas F. Fise, JD, executive director, 571/431-0802, [email protected]

Don DeBolt, chief operating officer, 571/431-0814, [email protected]

MeMBeRSHIP & MeeTINGS

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, [email protected]

Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, [email protected]

Stephen Custer, communications manager, 571/431-0810, [email protected]

Lauren Anderson, manager of membership services, 571/431-0843, [email protected]

Betty Leppin, project manager, 571/431-0876, [email protected]

AOPA Bookstore: 571/431-0865

GOVeRNMeNT AffAIRS

Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, [email protected]

Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, [email protected]


O&P ALMANAC

Thomas F. Fise, JD, publisher, 571/431-0802, [email protected]

Josephine Rossi, editor, 703/662-5828, [email protected]

Catherine Marinoff, art director, 786/293-1577, [email protected]

Bob Heiman, director of sales, 856/673-4000, [email protected]

Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, [email protected]

Stephen Custer, production manager, 571/431-0810, [email protected]

Lia K. Dangelico, contributing writer, [email protected]

Our Mission StatementThe mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.

Our Core ObjectivesAOPA 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.

Advertise with Us!Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email [email protected]. Visit http://bit.ly/aopa14media for advertising options!

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

AOPA CONTACTS


mailto:[email protected]








PELL- APPROVALS

Job No:Ad Title:Prepared by:Media Type:Printed At:Bleed:Trim:Live:Pubs:

PELL-6298JulyCoOpAdDenise LingenfelserPrintNone8.5” x 11.125”8.25” x 10.875”7.75” x 10.375”O&P Almanac_July

Digital Artist:Proofreader:Copywriter:Art Director:Creative Director:Production:Account:Project Manager:

DeniseNoneClientNoneBillyNoneAnastasiaStephanie

Document Path: Working:Users:dlingenfelser:Do...:PELL-6298_O&PalmanacJulyMECH.indd Created: 5-8-2014 1:59 PM Current Date: 5-19-2014 9:37 AMFonts: Minion Pro (Regular), Aller (Regular, Italic, Bold)Images: letterheadGraph.psd (CMYK; 300 ppi; 100%), PELHorizLogo2Spot.ai (120.9%), PEL_PuzzlePeople_YoungGirl_c_FLATcmyk.psd (CMYK; 714 ppi; 42%), WW_SmartTemp_Family 0001sm.tif (CMYK; 643 ppi; 46.63%), Ease_r1.tif (CMYK; 560 ppi; 53.52%)Inks: Cyan, Magenta, Yellow, Black

5-19-2014 9:37 AM

There are bigger O&P supply companies out there, sure. But you won’t fi nd one that cares more about its customers than PEL. Just ask the people who know us. Or better yet, get to know us yourself. Learn more at pelsupply.com

The products you need. The service you deserve.

©2014 PEL, LLC

Together, we’ll solve it.

Knit-RiteEase by Therafi rm® Gradient Compression Hosiery

• Made with ultra stretchy yarns for ease in pulling on • Very innovative, yet aff ordable, premium line • Super soft, breathable material off ers superior comfort for all-day wear• Moisture wicking CoolMax® fi bers provide dry comfortable coolness• Delivers lab-tested true gradient compression to promote better blood fl ow, prevent mild to moderate swelling, and relieve tired, achy legs and feet

Willow WoodAlpha® SmartTemp™ Liner featuring Outlast®

• Revolutionary level of comfort and temperature control to prosthetic liners.• Silicone liner absorbs and stores heat to delay the onset of sweating• As the liner absorbs heat, the silicone softens to feel more like gel • Retrofi ts with Alpha Liners of the same profi les

NEW

T:8.25”T:10.875”

PELL-6298_O&PalmanacJulyMECH.indd 1 5/19/14 9:38 AM


Mobility Saves Lives and MoneyUsing Medicare’s own data, report proves what the O&P community has known all along

“this study finds that patients who received o&P services experience greater independence than patients who do not, with better comparable outcomes and Medicare payments.”

—Dobson DaVanzo final report

O&P users were found to have fewer ER admissions:

0.13 fewer for lower-extremity orthosis users, and 0.55 fewer for lower-extremity prosthesis users.

12 months

18 months

Amount saved by lower-extremity orthosis users in total average Medicare episode payments

compared to non-orthosis users.

Amount saved by spinal orthosis users in total average Medicare episode payments

compared to non-orthosis users.

Average age range of patients

in the study

$2,920$93

70-72

Time period during which lower-extremity prostheses users

were found to have increased independence compared to non-prosthesis users.

Time period during which lower-extremity orthosis users were found to have

better outcomes compared to non-orthosis users.

Commissioned by AOPA and the Amputee Coalition, the recent Dobson DaVanzo study

“Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries” explains how orthotic and prosthetic care is a cost-saver in the long term. Here, we examine exactly what this means for payers, patients, and the more than 3,000 facilities that provide O&P services.

LOWER COSTS

FEWER ER ADMISSIONS BETTER OUTCOMES

NUMBeRS

Average Medicare Per-Month-Per-Member Costs Non-O&P o&P study Comparison Group group

Lower-Extremity Orthosis Patients $1,663 $1,500

Spinal Orthosis Patients $1,816 $1,811

Lower-Extremity Prosthesis Patients $6,015 $6,099

0.13

0.55

2895 42nd Ave. North St. Petersburg, FL. 33714 Tel: 1-727-528-8566 Fax: 1-727-528-8862 www.easyliner.com [email protected]

ALPSTM new Guardian Suction Liner features raised Grip GelTM bands that grip against the socket wall to

form a secure interface. The low modulus bands stretch against the socket wall, while the inner wall conforms easily

to the residual limb. This ensures there is no restriction of blood �ow or sti�ening to inhibit donning.

R

Grip GelTM bands are strategically placed for both transtibial and transfemoral

applications.

JUST SAy NO

Lawmakers Decry Audit PauseLegislators have put pen to paper to support the O&P profession’s opposition to the Office of Medicare Hearing and Appeal’s (OMHA’s) decision to suspend for two years referrals of non-beneficiary-initiated appeals to Administrative Law Judges (ALJs).

More than 30 lawmakers responded to the request of AOPA Policy Forum attendees to support the industry’s position. Written by Reps. Tammy Duckworth (D-Illinois) and Todd Rokita (R-Iowa), with signatures from dozens of additional legislators, the letter opposes the egregious violation of the

law, which requires that a provider receive a final decision from an ALJ within 90 days of filing an appeal.

“OMHA’s decision to suspend ALJ referrals constitutes an explicit interruption of due

process that is devastating to providers who are the backbone of delivering Medicare services to over 40 million beneficiaries,” wrote the lawmakers.

To read the letter in its entirety, or to watch a video clip of Duckworth questioning CMS Deputy Director Shantanu Agrawal, MD, on this point, visit www.aopanet.org.


PH

OT

O: A

OP

A

PATIeNT DATA

Diabetic Denial One in four Americans who have diabetes do not know it, according to the recently released National Diabetes Statistics Report 2014, published by U.S. Centers for Disease Control and Prevention. Other key findings:

• More than 29 million people in the United States have diabetes.

• Another 86 million adults have prediabetes.

Learn more at www.cdc.gov/diabetes/pubs/statsreport14.htm.

Medicaid Influx?You may see an uptick in Medicaid patients now that the Affordable Care Act is in play: An additional 6 mil-lion Americans enrolled in Medicaid and related health programs during the six-month period ending April 30, compared to before the six-month ACA signup period began last October.

The likelihood of increased Medicaid patients is especially high if you live in a state that adopted the Medicaid expansion.

Number of Medicare Patients

3.3% increase in states that did not adopt Medicaid expansion

15.3% increase in states that did adopt Medicaid expansion

Learn more at www.hhs.gov.

PA PURVIeW

POPS Stays On Top of CR8730 ChangesCMS recently notified the Pennsylvania Orthotic and Prosthetic Society (POPS) on the updated status of Medicare requirements for orthotic, prosthetic, and pedor-thic providers in licensing states (CR8730). CMS has advised that when the state directs the National Supplier Clearinghouse Medicare administrative contractor (NSC MAC) that the licensure rules are final for suppliers of prosthetics, orthotics, and pedorthics, the NSC MAC will then require the license for any new enrollment, change

of enrollment, or revalidation that includes products requiring the license.

The new rules have not yet been introduced for public comment. There will be a 30-day comment period before the rules can be finalized.

The NSC MAC is aware of the status of licensure in Pennsylvania and will not require the licensure until confirmed by the state that the license rules are finalized. “We will continue to keep practitioners in Pennsylvania informed as the process continues,” says Eileen Levis, POPS president and AOPA board member.

Happenings

Tammy Duckworth (D-Illinois)

HAPPeNINGS


PH

OT

OS

: Otto

bo

ck, w

ww

.da

rpa

.mil, w

ww

.3d

system

s.co

m

Scoliosis Brace Goes 3-DTesting of a new 3-D printed scoliosis brace designed by 3D Systems has shown positive results. Twenty-two patients at the Children’s Hospital of Oakland tested the device, under the direction of James Policy, MD, of Stanford University, and Robert Jensen, CPO. The brace was shown to have a good ability to correct the scoliosis, and the patients provided positive feedback on its comfort.

The process used by 3D Systems to create the device involves a check-socket brace, which is digi-tized, creating a reference underlay. It is then adjusted for optimal fit. That data is used to 3-D print the brace on a special printer. The final product is flexible and thin, making it easy to hide under a child’s shirt.

TeCH UPDATe

Patient Fitness? There’s an App for That

Lower-limb amputees can now find rehab and ongo-ing health support on their iPhones with Ottobock’s Fitness for Amputees app. The free app is designed to assist lower-limb prosthesis users with a self-managed workout regimen. The app was developed by physical and occupational therapists to help leg amputees achieve more mobility and to provide professional support during rehabilitation.

The app offers exercises in two areas:

strength and endurance and coordination and balance. Workouts are designed for amputees to use both with and without their prostheses in easy, normal, and difficult intensities.

Users can configure the app to match a personal training or therapy plan. Enhanced features include

user statistics to track progress and optional alarm reminders, and no special equipment is required. The app is available at the iTunes store.

DEKA Arm Gets the Green LightThe Food and Drug Administration (FDA) has approved the 510(K) premarket notification for the DEKA Arm System, a myoelectric prosthetic arm developed by DEKA Integrated Solutions Company and funded primarily through a grant from the Defense Advanced Research Projects Agency. The FDA reviewed the DEKA arm through its de novo classification process, a regulatory pathway for low- to moderate-risk medical devices that are considered to be innovative. This process does not rely on information previously submitted for “predicate” devices as a means to evaluate new products but rather reviews the submit-ted product as a one-of-a-kind device.

The FDA studied data from a Department of Veterans Affairs study of 36 patients who used the DEKA arm to perform several activities of daily living. Ninety percent of the participants reported they were able to perform activities using the DEKA arm system that they were unable to perform with their existing prosthesis.

FDA approval of the 510(K) premarket notification clears the way for DEKA to manufacture and market its prosthetic arm to health-care professionals and consumers.

HAPPeNINGS

#ICyMI

O&P Exempted From Proposed Bundling LegislationIn an initial victory for O&P professionals across the United States, orthotics and prosthetics has been exempted from the proposed bundle in the final version of H.R. 4673, the Bundling and Coordinating Post-Acute-Care Act of 2014.

The exemption comes after AOPA and key industry professionals participated in several meetings with key lawmakers and submitted a position paper to other congressional staff. AOPA outlined the reasoning and need for orthotics and prosthetics to be included in the list of exceptions to post-acute-care bundling. These same sentiments were echoed by the O&P Alliance in sepa-rate meetings and testimonies before Congress as well.

While this is an early victory for AOPA, the O&P Alliance, and the O&P community, it is important to remember that the bill was just introduced and has not been passed by either the Senate or the House. Nothing is finalized until the bill is signed into law.

Ph

oto

: ww

w.sp

co

lleg

e.e

du

/op

/,

Jurisdiction B will no longer require providers to reference a manufacturer catalog page number (including MSRP) for established Healthcare Common Procedure Coding System codes with its additional documentation requests (ADRs) as part of its

prepayment review program for lower- and upper-limb prosthetic claims. While the request will remain part of the ADR letter, verbiage has been added to indicate that this information is only required when a miscellaneous code is reported by the provider of service.


Big Holdup for ICD-10Each of the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) has released a statement acknowledging the delay in implementa-tion of ICD-10 diagnosis codes as a result of the April

1 passage of the Protecting Access to Medicare Act of 2014. This law delayed implementation of ICD-10 codes from Oct. 1, 2014, until no sooner than Oct. 1, 2015. The DME MACs also announced that an interim final rule establishing the new compliance date of Oct. 1, 2015, will be issued by CMS in the near future.

New Facility Accreditation Guide Published

The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) has published its Patient Care Facility Accreditation Guide for facility owners seeking accreditation. The publication is available electronically at www.abcop.org and in print by emailing [email protected].

Policy Change for Jurisdiction B

eDUCATION & ACCReDITATION

O&P Associate Degree DebutsSt. Petersburg College in Florida has begun accepting applications for its new two-year associate in science degree in orthotics and prosthetics technology, a first-of-its-kind degree for orthotic and prosthetic O&P technicians in the Sunshine State.

The coursework will be offered at the institution’s J.E. Hanger College of Orthotics and Prosthetics at the Health Education Center. The associate degree expands options for students at the college, which has had a bachelor’s degree program in O&P since 2005. The degree will help prepare graduates to become certified technicians who can fabricate, repair, and maintain quality O&P devices under the direction of certified practitioners.

With the addition of the associate degree, St. Petersburg College has become the only U.S. educational institution offer O&P education of all levels and scopes.

HAPPeNINGS

PH

OT

OS

: Le

ipzig

er M

esse

Gm

bH

/ Uw

e F

rau

en

do

rf, Th

inksto

ck/iS

toc

k/ La

tsalo

ma

o,

MeeTING MASHUP

Auf Wiedersehen, OTWorld!If you weren’t able to hop on a plane and participate in this year’s OTWorld—the renamed International Trade Show and World Congress at the Leipzig Fair and Exhibition Centre—you missed a record-breaking event where profes-sionals from O&P and related industries networked and shared their experiences.

OTWorld drew more than 20,400 visitors from 80 countries. “Innovation” was the focus at the trade show, where attendees were met with interdisciplin-ary approaches and global networks.

This year’s event was the largest in its history, with orthopedic tech-nicians, orthopedic shoemakers, engineers, medical practitioners, and therapists congregating for high-level discussions and profes-sional development sessions.

Your absence this year can be corrected in two years—you can start planning now to attend the next OTWorld. Mark your calendar and research fares to Leipzig, Germany, May 3-6, 2016.

Bonjour, ISPO!

Europe will set the stage for another important O&P event in 2015—the International Society for Prosthetics and Orthotics (ISPO) World Congress, scheduled for June 22-25, 2015 in the French city of Lyon.

The ISPO World Congress offers a unique platform for the international exchange of ideas and experiences between technicians, doctors,

therapists, and engineers involved in treating orthotic and prosthetic patients. Participants benefit from the unique international discussions and the concentration on the individual markets.

Interested in contributing to the agenda? The deadline for submitting proposals for symposia and instructional courses is September 15. Download the online form on www.ispo2015.org and email it to [email protected] to submit your proposal.


Prof. Fritz Uwe Niethard

Stay Stateside for 3-D Printing WorkshopWant to learn more about how 3-D printing will impact O&P facilities? Attend a free public workshop hosted by the Food and Drug Administration (FDA) on “Additive Manufacturing of Medical Devices: An Interactive Discussion on the Technical Considerations of 3-D Printing.”

Scheduled for October 8-9 in Silver Spring, Maryland, the workshop will provide a forum for the FDA, medical device manufacturers, additive manufacturing companies, and academia to discuss technical challenges and solutions of 3-D printing. FDA is seeking input regarding technical assessments that should be considered for additively manufactured devices to provide a transparent evaluation process for future submissions.

To register, visit www.fda.gov, or contact Matthew Di Prima at 301/796-2507, [email protected].

PROFESSIONALS

Richard Browne Jr., a below-knee amputee and Team Össur sprinter, has been named the first parathlete to simultaneously hold four world records in sprinting: 60 meters (6.99), 100 meters (10.75), 200 meters (21.91), and 4- by 100-meter relay (40.73).

Sylvia Mathews Burwell has been confirmed as secretary of the Department of Health and Human Services.

Gerry Helbig has been named president of Curbell Plastics Inc.

Matthew Okon, CPO, has been named laboratory manager of Scheck & Siress’ Hickory Hills, Illinois, patient-care facility.

Kate Ross, a blogger for Ottobock Momentum, has been awarded a Give Life Hero Award by

a Minnesota branch of the American Red Cross. Ross, who lost her right leg above the knee in 2009, is being recognized for her commitment to blood and platelet donation.

John Ruzich, CP, has transferred his interest in Scheck & Siress to the remaining seven shareholders at the company. He will continue providing patient care on a part-time basis at Scheck & Siress’s Hickory Hills, Illinois, location.

Kate ross, give Life hero Award Winner

Gerry Helbig

Kate Ross

TRANSITIONS TRANSITIONS

IN MEMORIAM

Melvin J. Glimcher, MD, a pioneer in the orthopedic and O&P fields, passed away on May 12. Glimcher is credited with creating the Boston Arm, an upper-extremity prosthesis activated by electrical impulses generated in muscles of the residual limb. The engineering principles in the device have been adapted in more modern prostheses.


BUSINESSES

CFI Prosthetics-Orthotics, headquar-tered in Memphis, hosted a First Swing Learn to Golf Clinic on April 26 at Vantage Point Golf Center in Cordova, Tennessee, with OPAF & The First Clinics. Area therapists, practitioners, and golf teaching professionals were

schooled in both equipment and techniques for golf instruc-tion for those with physical challenges.

Euro International Inc. operating as Streifeneder USA in Tampa, Florida, has become the exclusive U.S. office of Streifeneder ortho.production, head-

quartered in Emmering, Germany. The company is a supplier to the prosthetics, orthotics, and sports medicine fields.

Hanger Clinic has teamed up with the nonprofit group The Buried Life to provide a bionic

hand to Torri Biddle, a 19-year-old woman born with-out part of her right arm. Hanger Clinic practitioner Craig Jackman, CPO, provided the prosthetic clinical care. See more at http://youtu.be/QV0bdzQRBD8.

Orthotic Holdings Inc., a lower-extremity orthot-ics manufacturer, has announced the acquisition of PedAlign, a foot orthotics company in San Diego.

Touch Bionics has announced enhancements to its i-limb ultra revolution. Visit www.touchbion-ics.com for more information.

PeOPLe & PLACeS

Boston Arm

MobilitySaves.org

You Know Mobility Saves—But How Do You Spread The News? Simple! Visit MobilitySaves.org.

Find All the Tools You’ll Need at MoblitySaves.org:

O&P CARE IS COST EFFECTIVE—It is a SAVER, not an expense to insurers! O&P professionals have learned the positive outcomes from the Dobson DaVanzo study, which proves that timely O&P intervention results in fewer co-morbidities and lower healthcare costs for both patients and payers. Share this signifi cant news by using the educational tools provided at MobilitySaves.org. Dobson DaVanzo’s study commissioned by the Amputee Coalition, funded by AOPA and publicly released August 27, 2013, makes the cost effective case for O&P intervention and proves that “Mobility Saves.” O&P professionals knew that intuitively and now Medicare’s own costs and fi gures prove it irrefutably:

Mobility Saves Lives And Money!

Access the Full Study

Educate others with informative slide shows

Watch the News Release

Review the White Paper

Share this information with clinicians, practitioners, and

insurance providers

Extraordinarily signifi cant fi ndings show Medicare data proves the value of an O&P intervention based on economic criteria.

Get Involved and Spread the Word About The Valuable Benefi ts of O&P Care

Get Involved, Spread the Good Word

Follow Mobility Saves on Facebook and Twitter

Watch Katy Sullivan’s story and more experiences.

Healthy Lives


REIMBURSEMENT PAGE

represented “split” codes that could be billed either OTS or custom-fitted, depending on the specific clinical needs of the patient. The list was memorialized in the 2014 HCPCS update with the issu-ance of new/changed codes effective for dates of service on or after Jan. 1, 2014.

While the 2014 HCPCS update iden-tified the descriptive difference between OTS and custom-fitted orthoses, signifi-cant questions remain regarding what level of clinical care is required to justify the coding of an orthosis as custom-fitted rather than OTS. In addition, the Medicare fee schedule for the OTS versions of the 23 split codes was left unchanged from the previous fee sched-ule, creating a situation where, in the current environment, providers receive identical reimbursement whether they provide clinical care in fitting the device or simply hand the device to the patient without any clinical care.

This has caused a dilemma for providers who, under increasing demands for documentation, may choose to take the “easy way” and bill all split-code orthoses they deliver using OTS codes, regardless of whether they provided clinical care. While this may seem like a logical choice, it may have long-term conse-quences if providers are misreport-ing the services they are providing due to a perceived lesser burden of documentation for OTS orthoses.

Evolution of OTS Orthosis CodesThe Medicare Modernization Act of 2003 (MMA) established the legislative authority for Medicare competitive bidding of certain Medicare Durable

OTS or Custom-Fit? Orthoses billing advice in an uncertain environment

by JOSePH McTeRNAN

CE Credits

Editor’s Note—Readers of Reimbursement Page are

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

PH

OT

OS

: AO

PA

, Th

inksto

ck/M

ich

ae

ljun

g

WITH THe JAN. 1, 2014, implemen-tation of 55 Healthcare Common

Procedure Coding System (HCPCS) codes dedicated to off-the-shelf (OTS) orthoses, CMS created a new and uncertain future for providers of orthotic devices regarding proper coding of prefabricated orthoses.

A total of 32 codes were either issued as new or had their descriptors changed to describe orthoses that are always considered OTS. Another 23 pairs of existing codes were split into custom-fitted and OTS versions.

With these changes comes a whole series of questions regarding how to bill for prefabricated orthoses, and what specifically categorizes an ortho-sis as being delivered off-the-shelf versus custom-fitted. This month’s Reimbursement Page provides guidance on how to properly bill for these items while remaining compliant with Medicare regulations and policy requirements.

History of OTS CodesTo understand where we are today, we must look back at a brief history of OTS orthoses. The discussion began in February 2012 when CMS published a list of 62 codes that it believed could be considered OTS for purposes of competitive bidding. AOPA thoroughly reviewed the list and provided CMS with almost 500 pages of formal comments—including references to clinical literature—that discussed each of the 62 codes and why AOPA agreed or disagreed with CMS’ proposal that they could be classified as OTS.

When CMS released its final list of OTS codes in August 2013, the list had been reduced to 55 codes, 23 of which

Earn 2 BusinEss CE

CrEdits

QuiZ ME!

P.18

ReIMBURSeMeNT PAGe


Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items. While all prosthetics and custom-fabricated and -fitted ortho-ses were legislatively exempted from competitive bidding, the exemption did not extend to OTS orthoses. OTS orthoses were not included as product categories subject to competitive bidding in the first and second round of Medicare competitive bidding, but CMS created the list of OTS orthosis codes in anticipation of their inclusion in future rounds of competitive bidding.

The MMA originally created the definition of OTS orthoses as those that require “minimal self-adjustment” to achieve a proper fit. This definition was significantly expanded through regulation, when the term minimal “self-adjustment” was further defined as that which can be performed by the patient, caregiver, or supplier of the device.

After the implementation of the OTS orthosis codes in January 2014, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) further expanded the definition of OTS orthoses when they created policy that included the need for “substantial modification” to bill a device using the custom-fitted version of one of the split codes.

While AOPA believes the progres-sive expansion of the definition of OTS orthoses exceeds the intent of the statutory definition of minimal self-adjustment and continues to challenge CMS’ authority to further expand the definition of minimal self-adjustment, the policy containing the expanded definition is currently in effect and therefore cannot be disregarded.

Proper Coding DecisionsFor the 32 codes that CMS classified as always OTS, the decision on how to properly code products described by these codes has already been made. The only way to code these items is by using a code that is defined as OTS.

This does not mean that there is no need for documentation to justify the medical need of the device, as this is required for everything you do. It simply means that there is no choice whether to code the same item using an OTS or custom-fitted HCPCS code.

For the 23 split codes, however, a decision must be made regarding the correct way to code a specific device, using either the custom-fitted code or the OTS code. By definition, these code pairs describe identi-cal devices. The decision regarding which code to use is not determined by the device itself, but rather by the level of clinical care required to meet the medical needs of the patient.

To use the code that describes the custom-fitted version of the code pair, there must be documentation of the specific modification(s) that were made to the device and why they were medically necessary in order for the device to function properly, according to the recent DME MAC policy announcement. In addition, documentation must indicate that the modifications were performed by an individual with the expertise neces-sary to perform the modification (e.g., certified orthotist). Failure to maintain this documentation will result in a claim denial for incorrect coding.

In addition to making the decision regarding the proper code to describe the service you provide based on the level of clinical service required to

Under increasing demands

for documentation,

[providers] may choose…

to bill all split-code

orthoses they deliver using

OTS codes. While this may

seem like a logical choice,

it may have long-term

consequences if providers

are misreporting the

services they are providing.

PH

OT

O: A

OP

A

properly fit the patient, you also must consider the role of the Pricing, Data Analysis, and Coding (PDAC) contrac-tor in this process. The PDAC recently announced that it will be contacting manufacturers who have previously submitted products to the PDAC for code verification in an effort to determine if any of those products are designed to always be provided as OTS items. If a manufacturer indicates that this is the case, the PDAC will reclassify that product using the OTS code only.

As with all PDAC coding verifications, once a coding verification is issued, it is binding on the supplier community. This means that claims submitted for products that contain codes that are not verified as correct by the PDAC will be denied as incorrect coding.

As with all coding decisions, the final responsibility of how you code for your services is yours alone. As the provider of record, you are held liable for proper coding by Medicare and its auditors. While many questions remain, as long as your documentation supports the medical need for clini-cally based modifications to ensure the proper fit of an orthosis, you should be confident in your claim submis-sion for custom-fitted codes.

Jospeh McTernan is AOPA’s director of coding and reim-bursement services. Reach him

at [email protected].

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

www.bocusa.org

Earn CE credits accepted by certifying boards:


THe USe Of PRIOR authoriza-tion has proven successful in a

number of medical practice areas. So if Medicare were to implement the practice in the O&P field, the reim-bursement landscape might change for the better?

Not likely, say AOPA and its allies. Here’s why.

Advocates say prior authorization could finally ease the burden of time-consuming, expensive, and generally unfair audits. By identifying a proce-dure in advance as being acceptable under Medicare criteria, prior autho-rization would, in theory, ensure there would be no doubt down the road as to the appropriateness of either the procedure or the cost.

So far, there is little indication that a prior authorization initiative would

This Just In

Prior Authorization No Cure-All for ReimbursementPotential CMS initiative could add layers of bureaucracy, compromise patient care

By ADAM STONe

achieve any of these hoped-for ends for O&P, says Joe McTernan, AOPA director of coding and reimbursement, programming and education. There are simply too many unknown—and perhaps unknowable—factors in the equation. First and foremost, nothing in the CMS proposed rule indicates an affirmative prior authorization decision is a guarantee of Medicare payment. For AOPA to consider any support of a prior authorization initiative, there must be assurance that claims that receive a positive prior authorization decision will be paid, assuming technical requirements (e.g. proper proof of delivery documenta-tion) are met. Equally as important is AOPA’s concern about the impact prior authorization will have on timely access to quality clinical care for Medicare beneficiaries. Patients who require prosthetic care cannot be made to wait for weeks or even months for Medicare to decide whether a par-ticular prosthesis is covered for their clinical needs. Delaying patient care due to administrative issues may have a significant negative impact on the patient’s ability to begin the rehabilita-tion process. Early rehabilitation is a crucial part of the recovery process and must not be delayed as the result of another step in the Medicare claim processing system.

CMs takes First stepsCMS initiated an educational session about new prior authorization initia-tives in mid-June, when it hosted an open forum call on the topic. Suppliers, physicians, practitioners, ambulance suppliers, and other interested parties participated in the call. The forum was intended as a step toward establishing a prior authorization process for cer-tain O&P activities that are “frequently subject to unnecessary utilization,” according to CMS.

Such a statement may give an indication of CMS’ intent in writing these new rules: Rather than seeking to ease the burden on practitioners, the statement suggests, prior authorization would be yet another means to limit practitioners’ autonomy.

Some positive news came out of the call, McTernan notes. In particular, two different CMS representatives indicated that in cases where prior authorization is granted to a prosthetic claim, that claim would not be sub-ject to future audit. While no official changes have been made, the public comment now gives AOPA some lever-age in pressing for such a rule.

“This now opens the door for AOPA, as part of our comments, to point out that this was said by CMS representa-tives, and now we need this in writing,” McTernan says. It’s not a win, but it

BONUS! fRee WeBINAR: Participate in the free AOPA Prior Authorization Webinar offered July 8 and July 22 at 1:00 pm. Learn the pros and cons under the pending CMS proposed rule, how the pro-posal w0uld affect O&P, what prior authorization means for prosthetic patients, and more. Register now at http://bit.ly/PriorAuthAOPA.

O&P AlmAnAc | July 2014 19

Prior Authorization: Be A Player in Shaping Your Future AND Be Careful What You Ask For

CMS threw us a curve when they published their proposal on May 28, 2014 seeking to institute prior authorization for Medicare prosthetics. Some O&P folks have said, in essence, ‘any alternative to these god-awful audits has to be an improvement,’ or “involving the patient as his/her own advocate for Medicare approval must be good.” But are we really sure what Medicare prior authorization will require or how it will really affect you or your patients? There is an old saying: “the devil you know is better than the devil you don’t know.”

AOPA is urging EVERYONE in O&P to be a player—YOU NEED TO SEND YOUR COMMENTS TO CMS in advance of the July 28 deadline! If you don’t, they’ll do whatever they like and say—“see, very few people bothered to comment, so clearly these folks aren’t concerned about prior authorization and how we do it.” And before you can speak up, you NEED TO STUDY AND UNDERSTAND THE PROPOSAL. What does it really say, what does it NOT say, and what issues are left unclear in Medicare’s proposal?

AOPA’s action plan and recommendations to all O&P stakeholders (patient care facilities, manufacturers/suppliers, licensed and/or credentialed O&P practitioners, and your patients) includes:• Offering two FREE educational webinars on July 8 and July 22 at 1 pm ET. O&P

insiders—people who you know and trust—will examine Medicare’s proposal and explain its pros and cons for you. Sign-up and reserving your spot at http://bit.ly/PriorAuthAOPA.

• Providing a pre-written letter for you to quickly submit comments to CMS via AOPAvotes listing ways that prior authorization needs to be changed to be acceptable to your business (including a guarantee of payment and elimination of RAC audits). All letters through AOPAvotes.org will be hand-delivered to CMS prior to the comment submission deadline. Or submit personalized comments directly using this suggested text.

• AOPA is communicating regularly with the Amputee Coalition to trade perspectives on this new process so impor-tant to practitioners and patients alike;

• The truth is that Medicare cares a lot more about what patients/Medicare beneficiaries think than they care about what providers think. AOPA will be distributing information that practitioners can share with your patients to get them involved.

• Informational tools, like “Prior Authorization—What it is & What it isn’t”• AOPA will be submitting its own comments on behalf of you, its members. This is not a substitute for you,

assuring that Medicare hears your views, so send CMS your comments in addition to those from AOPA.• AOPA is working with the O&P Alliance and all organizations in the profession to educate and encourage folks to

participate.

Participate in one of the upcoming FREE AOPA webinars—July 8 or July 22. Learn the facts and hear the pros and cons of the Medicare proposal.

Get more info on how to participate, to be heard, and to send in your comments.

Visit http://bit.ly/PriorAuthAOPA.

• For today, recognize that, as CMS has written its proposal on Prior Authorization• A Medicare approved prior authorization would NOT be a guarantee of payment, AND• Medicare Prior Authorization would be in addition to, not in place of RAC and pre-payment audits. The

proposal makes no promise to stop or reduce audits, rather it lays another regulatory level on top of audits!

This Medicare Prior Authorization proposal, if implemented as written, will dramatically change

how you do business. Be a player... Learn about Medicare’s proposal and make sure your voice is heard! For more information, contact 571/431-0876 or [email protected].

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION, 330 JOHN CARLYLE STREET, SUITE 200, ALExANDRIA, VA 22314

(571)-431-0876, [email protected], WWW.AOPANET.ORg


This Just In

is a small step forward. These state-ments may only be considered as what they are—individual statements made during a telephone conversation. CMS must be willing to memorialize these statements by adding a section to the final rule that confirms, in writing, that claims that are affirmed through prior authorization will not be subject to future audit.

Process Could Compromise CareWhile AOPA is concerned that prior authorization would not ease the audit burden, the O&P community is equally apprehensive that prior authorization could, in practice, significantly slow the process of patient care.

As the situation stands in mid June, a new rule would require that contactors make “a reasonable effort” to decide on authorization requests within 10 days. That is a vast and frightening loophole, leaving open the possibility of prolonged decisions that could have a seriously deleterious effect on care.

What is a “reasonable effort,” and

who is to determine the yardstick for such an effort? What system will be put in place to deal with cases that exceed the 10-day target? “How in the world can they assure anybody that is going to happen? And what happens if it doesn’t?” McTernan asks.

As practitioners know, any delay in the delivery of O&P care can sig-nificantly erode a patient’s short- and long-term quality of life. “There are patients who require ambulation as part of their rehab process, who will be exposed to further injury, who will be exposed to higher rates of co-morbidity, if decisions are not made in a timely way,” McTernan says.

The promise of a “reasonable effort” gives little reassurance to practitioners seeking to halt the domino effort of symptoms that can arise when the delivery of care is stalled by government bureaucracy. “There are many patients who already may be compromised, and if they don’t have the ability to get up and move, the potential for further damage can be huge,” McTernan says. “The last thing you want for a patient

who has circulation impairment is for them to be lying in bed.”

For providers, patient care is the foremost concern. At the same time, providers should be wary of any prior authorization rule that cannot offer a promise of timely review. “It obvi-ously has an immediate impact on cash flow,” McTernan says. “If you receive a component from a manufacturer, you typically don’t have the luxury of pay-ing for the component six months from now. Just like in any other business relationship, there are terms, and that manufacturer is expecting payment.”

The issue of cash flow is especially sensitive given the current environ-ment surrounding delayed due process through the Medicare appeals process, especially when requesting hearings before an Administrative Law Judge (ALJ). Many O&P practitioners have found themselves virtually pushed out of business simply by having a tremen-dous portion of their operating monies tied up in the audit process. Any new imposition on cash flow will only exac-erbate an already challenging situation.

An AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.

How to get started:1. Complete the online sign up form: https://aopa.wufoo.com/forms/earn-a- certifi cate-in-op-business-management/

2. Select and complete four required core modules and four elective modules within three years.

3. Complete a Module specifi c quiz for each program.

4. Participants that successfully complete the program will be awarded a certifi cate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.

For more information on the program, please visit bit.ly/BizCertProgram.For more information on the program,

Earn Your Certifi cate in O&P Business Management

O&P BUSINESS MANAGEMENT: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company.

■ REFRESH YOUR KNOWLEDGE

■ DEVELOP BETTER BUSINESS PRACTICES

■ ADVANCE YOUR CAREER

■ CREATE ONGOING RETURNS FOR YOUR COMPANY


This Just In

Cause for Alarm?While the recent CMS public call helped to clarify some of the nuances of the proposed rule, it did little to alter the fundamentals of prior autho-rization. In general, the basic premise of prior authorization may prove dis-advantageous to the O&P community. Consider just a few of the downsides that could result from a poorly con-structed prior authorization scheme:• Unacceptably slow review of

requests. A track record for this already exists. For example, a demonstration project for power mobility devices showed significant delays in the processing of prior authorization requests for Medicare beneficiaries with needed services. Prior authorization could result in further delays.

• Too many layers in the process. Medicare itself operates on a vast and sometimes unwieldy scale. Under the proposed rule, contrac-tors may add another layer of complexity to the equation, and the contractors who process requests

may not be the same individuals who eventually process claims. The hazards are clear: not just miscom-munication, but the real possibility of claims being denied after the fact, even if authorization has been granted in advance.

o&P Community remains AlertEven as the debate over prior authori-zation unfolds, AOPA has been active on the legislative front. AOPA has sub-mitted statements to the House Energy and Commerce Health Subcommittee; the Oversight and Government Reform Subcommittee on Energy Policy, Health Care, and Entitlements; and the Health Subcommittee of the House Ways and Means Committee.

In all of these meetings, “AOPA proposed constructive ways to address fraud, waste, and abuse of the Medicare system as alternatives to the current RAC program, which harms honest providers and has cre-ated a massive backlog of appeals at the administrative law judge level,” McTernan says.

AOPA pointed to a potentially powerful antifraud measure that has never been implemented: Section 427 of the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act of 2000 (BIPA). This requires CMS to make payments only to “qualified providers.” AOPA drove home the points that Medicare should only pay licensed providers (in licensure states), or providers accredited by the major O&P accred-iting bodies.

On behalf of providers struggling with a challenging audit climate, AOPA once again proposed reason-able reforms of the RAC and prepay-ment audit systems. By speaking out in public forums at the highest levels of government, AOPA is working to ensure the best possible care for patients, as well as the commercial well-being of O&P providers.

Adam Stone is a contributing writer to O&P Almanac. Reach him at [email protected].

• The O&P coding expertise you’ve come to rely on is now available whenever you need it.

• Match products to L codes and manufacturers—anywhere you connect to the Internet.

• This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843or [email protected].

Log on to LCodeSearch.com and start today.

Not an AOPA member? GeT CONNeCTeD

www.LCodeSearch.com

eXPeRT CODING ADVICe 24/7

MAnufAcTurers: Get your products in front of AOPA members! Contact Joe McTernan at [email protected] or 571/431-0811.

Visit AOPA at www.AOPAnet.org.

24/7

Need to Know

Body image, removing the prosthesis, and getting in and out of the water tend to be big concerns for patients. encourage them with practical solutions, such as using the corner of the pool as a leverage point to get in and out of the water.

Assess the feasibility of waterproofing patients’ current devices. second devices can be expensive and are not covered by insurance, so be sure to discuss this upfront to help manage expectations.

strike a balance between rust-resistance and function. Carbon fiber, titanium, or stainless steel are commonly used materials and tend to be waterproof.

Fitting problems can be amplified during water sports, so focus on the basics of socket fit, alignment, and the system to prevent the patient from losing his or her limb in the water.

With a suction sockets, use an extended suspension sleeve proximally and for the distal aspect of the sleeve, and employ a strap or tape to seal it to the socket.

No

WavesNO GLORY


PH

OT

OS

: Ad

am

Fin

nie

ston

, CP

O, L

PO

/Se

an

Re

yng

ou

dt

by LIA DANGeLICO

Water sports help patients build confidence and enjoy the outdoors. Are you up to the challenge of fitting them this summer?

WHeN THe BeACH BOyS sang, “Catch a wave and you’re sittin’ on top of the world,” anyone who has ever surfed fully under-

stands what they meant.But it’s not just surfing. There’s just something about being out

on the water. Whether it’s floating on a raft in a neighborhood pool or twisting this way and that on a wake board, water brings a mix of calm and power and weightlessness that has mesmerized humans for ages. Those who engage in water sports know everyone should experience them at least once, but for prosthetic users, the idea and all that comes with it can seem daunting—if not impossible. And for practitioners, extra consideration is needed for fitting and working with these amputees.

In search of solutions, O&P Almanac spoke to several prosthe-tists from around the United States who prove every day that it’s not only possible to get patients in the water, it also can be a great tool of empowerment, self-confidence, and fulfillment for every-one involved.

COVER STORY

No

Waves

Waves



COVER STORY

(Continued on page 26)

scopin’ the swellA California resident and lifelong water sports enthusiast, Amy Ginsburg, CP, CFom, of Hanger Prosthetics, understands the lure of the sea and has helped a number of lower- and upper-extremity pros-thetic patients get back in the water. She attributes much of her success to partnering with her colleagues Dave Coe, CPO, and Dan Selleck, CPO, who have guided her and shared what works for them along the way.

Ginsburg emphasized that the work is dictated by her patients’ desires, rather than her chasing water sports in particular. “My patients drive me to make things that help them get back to what they want to do,” she says. With the ocean nearby, water sports are typically something her patients did before their amputations and want to get back to, or [it’s] something new they want to try.

Coming up with the right solution for individual patients also means a reality check. “It’s a matter of knowing your patient,” says Ginsburg, “what they’re going to do in the water and what their goals are, in order to talk about componentry and what it takes to get there.”

Prosthetists who are new to water sports should consider where their patient will be using the device—in chlorinated pools, fresh water, or ocean salt water. A device that makes sense for standing in the surf may not work for someone looking to catch a wave or two with the device on, con-sidering the current, salt water, and the waves. Similarly, many patients who want to swim in a pool simply remove their everyday devices before getting in the water—they don’t bother with a second device for water activities.

While some individuals don’t use their prosthesis in the water for a vari-ety of reasons—notably because they can become a hindrance—others work with prosthetists to create a dedicated “water leg,” that they can use for a variety of high-intensity water sports.

…the rest is detailsStaying focused on the patient in

front of you is important, say experts. Their fears, unique physical abilities and disabilities, and even personal preferences all play into the challenges you, as a practitioner, will face in help-ing them get back into the water.

For some, even though they want to do the activity, the thought of doing it can invoke anxiety, says Robin Burton, executive director of the Orthotics and Prosthetics Activities Foundation (OPAF). Taking off the prosthesis and getting in and out of the water are big concerns, as is body image. After all, “there isn’t a soul alive who likes putting a bathing suit on and walking out to a pool, and if you’re dealing with mobility issues, that is typically a big ‘to do,’” she says, noting that “once we get them in the water, we’ve got them sold. But it’s a major hurdle to get there.”

How can you encourage a reluctant patient? Burton says take a step back and try to swim a lap in their shoes, so to speak. “For many of these individu-als, one of their great fears is that they are ‘different,’ and everything they

PH

OT

OS

: Am

y Gin

sbu

rg, C

P, CF

om


COVER STORY

PH

OT

OS

: OP

AF

Turning Dreams into Reality OPAF and other nonprofits help O&P patients and others with mobility issues get back into the water

Now in its 10th year, First Clinics, provided by the Orthotics and Prosthetics Activities Foundation (OPAF), offer introductory-level adaptive activities to O&P patients, stroke and brain injury victims, and others. With three aquatic programs available, including swimming, kayak-ing, and scuba diving, each clinic is led by certi-fied instructors who assist patients with getting

in and out of the water and learning the basics of the given sport. “We try to give them a taste of adaptive scuba [and other sports],” says

Robin Burton, OPAF’s executive director. “We show them what they can expect, but we want them to continue, for this to become a lifelong activity.”

Participation is open to ages five and older and is “inclusive,” says Burton. All participants are encouraged to bring a friend, spouse, or family member so that the activities can be experienced by individuals of all ages and abil-ity levels. Being surrounded by others with mobility issues is “not the way life works,” she says, “so we like to have able bodied people there, too. And we want younger participants to see adults involved… We want them to see that life as an adult goes on, and that a full, quality life can be had by all.”

OPAF, which will host 30-35 clinics this year, welcomes patient-care facilities to sponsor First Clinics in their area, as a way to bring providers and patients together to learn from one another and build community, not to mention as a great marketing tool for the facility. For more information, go to www.opafonline.org.

In addition, several other non-profit organizations are making an impact as well:

• AmpSurf works to “help all people with disabilities and their families through adaptive surfing and other outdoor activities.” Its Learn to Surf clinics have helped disabled veterans and others get in the water for more than 11 years. www.ampsurf.org

• Disabled Sports USA’s Summerfest programs provide “low-cost adaptive sports opportunities to youth, adults, and wounded warriors with disabilities in more than 30 different sports,” including waterskiing, kayaking, and swimming. www.disabledsportsusa.org/programs/summer

• first Descents offers young adult cancer fighters and survi-vors (including amputees) a free outdoor adventure to “climb, paddle and surf beyond their diagnosis,” reconnect with others, and reclaim their lives. www.firstdescents.org.

Participants in OPAF’s First Dive and First Swim clinics.


COVER STORY

(Continued from page 24)

A patient at Arthur Finnieston Prosthetics and Orthotics, Sean Reyngoudt is a competitive kiteboader and wakeboarder and water sports enthusiast. Here, he’s wearing an all-terrain foot with a custom titanium thermoplastic adaptor.

COVER STORY

do is going to be different,” she says. In reality, practitioners know from experience there’s very little these amputees can’t do, so Burton advises practical solutions for some of the most common challenges. For example, she suggests swimmers use the corner of the pool as a leverage point to get in and out of the water.

Prosthetists also need to assess the componentry that is currently being used. Can the device—or should it —be made “waterproof,” or is a second device is needed? Fabrication costs, prosthetic parts, whether the amputee is an upper- or lower-extremity ampu-tee, and the suspension system all fac-tor into the total cost, which typically is comparable to that of a high-end sports leg, according to Ginsburg and several other prosthetists. Given that and the fact that insurance won’t cover it, a second device isn’t a reality for all patients. So be sure to share your recommendations and any costs involved in fabrication up front. This will help manage expectations from the start.

But if patients decide to pursue a water-specific device, practitioners

must strike a balance between function and anti-corrosion, says Adam Finnieston, CPO, LPO, of Arthur Finnieston Prosthetics & Orthotics. Finnieston helps 10 to 15 patients pursue both recre-ational and competitive water sports each year.

In the past, waterproof prostheses required a compromise—they could get wet but they couldn’t do much else. The challenge, says Finnieston, has been to come up with a highly functional prosthesis that also hap-pens to be waterproof. “Prosthetists have everything available to us everyday to make devices suitable for water sports, including carbon fiber, titanium, or stainless steel—all of which tend to be waterproof.”

For many, this is where the passion of the job comes in. With the right resources, prosthetists must get cre-ative to mold a device to each patient’s unique needs. For example, for a below-elbow amputee who wanted to get back to surfing, Ginsburg used the smallest seal-in liner she could find. “With below-elbow, you’re not so much worried about rust; instead,

you’re thinking about extension,” she says. But for below-knee surfers, Ginsburg does have to worry about corrosion and water’s effects on all of the metal parts. For a patient who used a seal-in liner, Ginsburg laminated the entire prosthesis to the foot, carrying the lamination all the way down so no components were exposed. That allowed the patient to wave ski—sitting on top surfboard and maneuvering with a paddle.

Faced with such challenges, Finnieston champions the K.I.S.S method—keeping it simple. He uses the Active Socket system—an elevated vacuum socket that inherently is neg-ative pressure without any batteries, parts, and pieces—with competitive athlete and patient Sean Reyngoudt, as well as stand-up paddle boarders, surfers, scuba divers, and others.

With water sports, fitting problems

PH

OT

OS

: Ad

am

Fin

nie

ston

, CP

O, L

PO

/Se

an

Re

yng

ou

dt


COVER STORY

can be amplified because “a lot of the forces required for surfing, wake boarding, and kite surfing are in multiple planes,” he says. So focus-ing on the basics of socket fit, align-ment, and the system being used are key to avoiding disasters—such as a patient losing his or her limb in the water. Though he hates to admit it, Finnieston says this has happened numerous times. When using a suc-tion socket, water sprays are a big concern, where water can shoot up underneath the suspension sleeve and create a loss of suction. Embarrassing or not, it’s a reality for anyone work-ing with this population and to combat it Finnieston’s patients use an extended suspension sleeve proxi-mally and for the distal aspect of the sleeve, they employ a strap or tape to seal it to the socket. This helps keep any water out of the sleeve and keeps the device on securely.

First in, Last outWhen facing any number of chal-lenges, there’s strength in numbers, and many patients, practitioners, and the greater community have benefited from coming together, united with a shared goal. For amputee athletes across the country these clinics, part-nerships, and community groups have helped them get back in the water and establish life-long friendships.

Ginsburg saw this first hand when she started an amputee surf group that brought together surfers in Orange County, California, each month for several years. Developing that sense of community helped everyone involved, as did being able to get in the water with her patients

PH

OT

OS

: Ad

am

Fin

nie

ston

, CP

O, L

PO

/Se

an

Re

yng

ou

dt; A

my G

insb

urg

, CP, C

Fo

m

with their devices and see what was working and what wasn’t. For practi-tioners, these gatherings provide an experience that can’t be had during an office visit.

She also saw how much patients learned from one another and helped each other face their fears. “It helped them, especially first timers, to see other amputees and able bodied people doing what they wanted to do and to have someone to help them get into the water and feel safe,” she says.

Similarly, OPAF’s First Clinics introduce O&P patients, stroke and brain and spinal injury victims, and others with developmental chal-lenges to a variety of activities. At a recent golf clinic, referral sources offered training for practitioners on how to advise and work with patients to pursue their golf hobbies in the morning and, in the afternoon, patients showed up to work with practitioners, who were able to apply what they had just learned.

For Ginsburg, the value of

community connection is framed in a distinct, feel-good memory: when a hip-disarticulation patient was able to get back to surfing by paddling in on her stomach. The woman made her way to the shoreline and then had two others help her get onto her board. “For her, that was just amazing,” say says. “She never thought would be able to do it, and getting to ride a wave on her stomach is something she will never forget.”

There’s so much fulfillment in seeing patients succeed, but “knowing that with a prosthesis, there’s a way to challenge yourself or get into things that you wouldn’t think you’d be able to get into,” is incredible says Ginsburg. “There’s always a way to make some-thing to help that person get back on his board or bike… it just comes down to working together to find a solution.”

Lia Dangelico is a contributing writer to O&P Almanac. Reach her at [email protected].

AOPA’s

national assembly ’14

There is a reason why more people attend

the AOPA National Assembly than any other

O&P convention in the United States. Maybe

it is simply because the National Assembly

has it all: a massive exhibit hall, luxurious

accommodations, top-notch speakers, fun

networking events, and, of course, extreme

education. This year’s show offers fi ve distinct

education tracks for orthotists, prosthetists,

pedorthists, technicians, and

business managers.

Featured Speakers

Hugh Herr, PhD, heads the biomechatronics research group at the MIT Media Lab.

Andrew Hansen, PhD, is the director of the Minneapolis VA Rehabilitation Engineering Research Program and associate professor at the University of Minnesota.

Adrianne Haslet-Davis tells her compelling story of how her life changed after the Boston Marathon Bombing.

Janos Ertl, MD, specializes in adult orthopedic trauma and sports medicine/arthroscopy.

Jason Highsmith, PhD, DPT, CP, FAAOP, is a dual-licensed prosthetist and physical therapist with a PhD in medical science.

Urs Schneider, MD, PhD, oversees the Fraunhofer Orthopedics Research Department in Stuttgart.

Troy Watson, MD, is a board-certi� ed orthopedic surgeon specializing in treatment of the foot and ankle.

Cordell Atkins, PT, DPT, CWS, CDE, C.Ped, currently serves as the director of the Diabetic Foot Clinic at the TOSH Campus in Salt Lake City.

Lori A. Dolan, PhD, is well known for her research in the area of adolescent idiopathic scoliosis.

Steven King, PTM, C.Ped, is a podiatrist, pedorthist, and researcher.

Please see the preliminary program for all programming and esteemed speakers.

What’s new this year? 36–38 CE credits.

21 pedorthic scienti� c credits.

New Exhibit Hall Schedule provides more time in the exhibit hall without sacri� cing CE credits. The exhibit hall will not be open the traditional last half-day.

Five dedicated education tracks for orthotists, prosthetists, technicians, pedorthists, and business managers.

13 organized symposia on topics such as scoliosis, impact of research and outcomes, the diabetic foot, generational factors, elevated vacuum, modern technologies, emerging trends in pediatric orthotic management, clinical use of direct measurement, growing an O&P practice in a no-growth environment, cranial remolding treatment, evaluating evidence, and more.

Coordinated four-day Pedorthic Education Program focusing on diabetic treatment and wound care from a multidisciplinary faculty of physicians, wound care experts, and diabetes educators.

More receptions and networking events, plus a new and improved Thranhardt Golf Classic scheduled the day before Manufacturers’ Workshops.

Alumni Networking Opportunities.

New Las Vegas Location—The Assembly meeting space at the Mandalay Bay has the exhibit hall and meeting space in very close proximity, which will keep attendees engaged. The venue features 29 dining outlets, ranging from Charlie Palmers Steakhouse to a Food Court and everything in between. Many entertainment options are available at the Mandalay Bay and within close proximity—it’s Vegas.

So much more!

Register today for the 2014 AOPA National Assembly, to be held September 4-7 at the Mandalay Bay Resort in Las Vegas. Don’t gamble with your valuable time, fi nancial resources, or continuing education—attend the show that provides the biggest return on your investment: the AOPA National Assembly.

EDUCATIONCLINICAL | BUSINESS | TECHNICAL

EXPERIENCEEXPERIENCETHE

Make the Alumni ConnectionWhen completing your Assembly registration, be sure to include your graduating school and year so you can be invited to connect with other alumni from your school. (Even if it is the school of hard knocks, connect with your classmates.)

• Connect with your classmates through the mobile app—your school will be set up as a networking group.

• Proudly wear your school button, which will be provided at registration.

• Join your friends at the Welcome Reception, where you will fi nd a table and message board for your school.

• Share pictures, messages, and more through the Facebook event page.

• Meet your friends at informal social gatherings on Saturday night.

Preview the Preliminary Program: http://www.aopanet.org/wp-content/uploads/2014/05/Natl-Assembly-2014-Prelim-Program.pdf

Register Online: https://www.expotracshows.com/aopa/2014/

General Information: http://www.aopanet.org/education/2014-assembly/

Hotel Reservations: http://www.aopanet.org/education/2014-assembly/attend/#hotel

Questions: Visit www.AOPAnet.org or contact AOPA at 571/431-0876 or [email protected]

OF THE AOPA NATIONAL ASSEMBLY

“The poster session and the quality of the speakers is what really sets AOPA apart.”

WHAT PARTICIPANTS SAID about the last meeting

Registration is now open.Visit www.AOPAnet.org for updates and more information. Be sure to follow AOPA on Face-book, Twitter and Linked In for all the latest news about the Assembly and of special interest to the profession.


The State of O&P

AS AN O&P PRACTITIONeR, it’s a good bet you are all too aware of

the countless federal regulations cur-rently affecting the industry. But when was the last time you took a hard look at the changes facing O&P at the state level?

“Any O&P group that hasn’t plugged into the state decision-making pro-cess is really behind the eight ball,” says Peter Thomas, JD, general counsel for National Association for the Advancement of Orthotics and Prosthetics and counsel for the O&P Alliance.

Unprecedented activity is occur-ring at the state level as the Affordable Care Act (ACA) takes effect. Many states are aggressively reviewing their Medicaid policies. “In some ways, the ACA federalizes the rules of private insurance, but it also pushes a lot of the insurance and Medicaid decisions down to the states,” says Thomas. In many cases, an increased number of Medicaid enrollees means that states are looking for ways to stem the bleed-ing caused by higher enrollment costs. Unfortunately, O&P is an easy target.

And it’s not just state programs that are rethinking O&P coverage—many private insurers in each state are looking closely at their fee sched-ules and making cuts that could affect the industry.

Need To Know Regulators and legislators pay close attention to how other states are cutting back, and borrow those ideas for their own state’s budget cuts.

In several states where capitated benefits, or “per-member-per-month” rates, are on the table, O&P patients might not have enough coverage—even for one device.

In Tennessee, private insurer fee cuts take effect this month. The new maximum allowable for O&P items is 75 percent of the Medicare Jurisdiction C fee schedule—essentially a 30 percent cut in reimbursement.

Some states view licensure as a tool for amplifying their voice, protecting the public, and defining O&P as a profession and not a trade by separating it out from DME.

Is your neighbor the bellwether for what’s to come?By CHRISTINe UMBReLL


Even if the regulatory activity is relatively quiet in your backyard, keep-ing an eye on other states is imperative for industry professionals. Regulators and legislators pay close attention to how other states are cutting back, and look to borrow those ideas to imple-ment their own state budget cuts. What’s happening in a neighboring state today could determine your fate tomorrow.

overcoming Capitation in Alabama

In Alabama, a state that has not opted into the Affordable Care Act, the health-care model has changed to feature five Medicaid regional care organizations (RCOs). Once the RCO model was announced last fall, repre-sentatives of the Alabama Prosthetic and Orthotic Association began meet-ing with Medicaid representatives to determine how O&P would be viewed in the new system.

“We were told in March 2014 that O&P would be handled within the RCO system, which means it would be in a capitated system,” says Glenn Crumpton, CPO, of Alabama Artificial Limb & Orthopedic Services Inc., and an active member of the state associa-tion. The state hired Scott Williamson, MBA, president of Quality Outcomes, to help maneuver the red tape to ensure O&P did not become a capi-tated benefit. If it did, that would mean a contracted rate for each individual, or “per-member-per-month” rate, regardless of the number or nature of services provided. In this system, O&P patients might not have enough cover-age—even for one device.

“Capitated arrangements typically have not fared well for people who need O&P care,” says Thomas. “They may exclude many newer technolo-gies and components that are actually pretty standard.”

Alabama successfully argued that the proposed capitated system would catastrophically endanger and poten-tially disable beneficiaries who have traditionally benefited from appro-priate O&P intervention. They also

Licensure: The Industry Debate Continues

SO fAR, ABOUT 20 states have enacted licensure laws. Several others are pushing initiatives to do so. But practitioners in some states remain uncon-

vinced that licensure is the best way to ensure quality O&P care.Licensure can be positive when it’s used as a tool to help recognize quali-

fied providers, and when it has teeth to ensure any unlicensed professionals do not treat patients. But if it’s viewed as just another credential and regulators are not given enforcement powers, then it’s simply not worth it, some argue.

In Georgia, James Young Jr., LP, CP, FAAOP, of Amputee Prosthetic Clinic headquartered in Macon, can see both sides of the argument. “As someone in a licensure state, I have mixed emotions about licensure,” says Young. The added costs associated with licensure fees and the associ-ated regulatory burdens can be challenging for business owners. “But I’m an amputee and an O&P patient, too, so I like to know that only individuals who have met a mini-mum benchmark will be treating patients.”

Young also adds that licensure can be a challenge for practitioners who want to move across state lines: Established practitioners who were licensed in their home states because of grandfather clauses may not meet licensure requirements in other states because their education level does not meet new requirements. And sometimes this doesn’t seem fair: “A prosthetist who started as an apprentice and worked his way up may be much more competent than a new master’s level practitioner—but he may not be able to get licensed,” explains Young.

Practitioners in North Carolina have conflicting opinions about licensure. “We don’t have licensure here, and there’s a 50/50 split about whether we should pursue it,” says Ashlie White, an employee at Beacon P&O in Raleigh and a board member for NAAOP. Some fear the additional regulations would add financial and administrative burdens. Others worry that their current staffing structures would be scrutinized. “You need to have a lot of money

for a licensure fight, and you need more than 50 percent of the state to be onboard.”

But White notes the many advantages of licensure as well: It increases profes-sionalism, provides a forum for patient complaints, and legitimizes the profession.

“Licensure is something states should do, but it should be more uniform,” says Carey Glass, CPO, of Allied O&P in New Jersey, a licensure state. “If we all have the same rules, then we could have reciproc-ity, and one high standard level of care.”

James Young, LP, CP, FAAOP

Ashlie White

FEATURE: THe STATe Of O&P


pointed out that since O&P accounts for less than 0.1 percent of Alabama’s Medicaid appropriation, moving to a capitated payment system for O&P would not save the state much money.

Initially, O&P advocates wanted O&P services to fall outside the RCO system. But when they realized that being within the system would be a more secure option, they worked to change the contract language between the RCO and the state agency to require O&P care be covered as if it were fee for service. By collaborating with Medicaid represen-tatives to explain the importance of non-capped cover-age, they were able to achieve their goal.

“RCO contract language will be modified to require the provision of medically necessary O&P services in the amount, duration, and scope that is equivalent to the previous Medicaid fee-for-service population,” explains Crumpton. “By working within the system and being proactive, we were able to get a good outcome.”

“This was an incredibly suc-cessful grassroots campaign,” says Williamson. “We were able to have conversations with influential people who provided invaluable guidance. We’re hoping the changes we have made in Alabama can be modeled in other states.”

Alabama practitioners are now working on the next step: meeting with Medicaid representatives to discuss developing metrics to mea-sure quality care and define outcome measures. They will be holding an Alabama Medicaid Workshop in mid-July to explain the recent changes and elicit support for future state-centered endeavors.

They also are keeping a watchful eye on Tennessee, where trouble is brewing with private insurers.

Facing Fee Cuts in tennesseeO&P providers in the

Volunteer State were blindsided when Blue Cross Blue Shield (BCBS) subtly announced it would imple-ment a rate change effective July 1, 2014. The new maximum allowable for O&P items is 75 percent of the Medicare Jurisdiction C fee sched-ule—essentially a 30 percent cut in

reimbursement.Tennessee provid-

ers hope to engage in a dialogue to discuss the reduction rather than engage in a full-fledged fight with the insur-ance company, says Michael Fillauer, CPO/L, president of Fillauer LLC in Chattanooga. “Hopefully we can have a conversation without being confrontational,”

he explains. “We want to define who we are and have an honest discussion to share with them the work of O&P providers, to work with them and not against them.”

Quality Outcomes is engaging in this effort to help open doors and start conversations on the state level. “The real story of O&P needs to be commu-nicated to officials so they understand what these fee reductions mean to beneficiaries,” says Williamson.

Fillauer says that Tennessee’s status as a licensure state should help get practitioners a seat at the table for such discussions. “We enacted licen-sure to protect the public and to define ourselves as a profession and not a trade.” He cites the findings in AOPA’s Dobson DaVanzo study as supporting documentation for the discussion. “The study demonstrates that O&P keeps patients mobile and saves money over the long term.”

Practitioners from all 50 states should be paying attention to the reduction in Tennessee: “If it can happen here, it can happen anywhere,” says Fillauer.

Michael Fillauer, CPO/L

Impact of the ACA on Your State The rollout of the Affordable Care Act (ACA) means changes to health-care regulations in every state. Here are three ways it might be affecting your home state, according to Peter Thomas, JD, general counsel for NAAOP and counsel for the O&P Alliance:

• Private insurance plans are adapting. Changes to private plans and provider networks—including who is qualified to be included in a network—could affect O&P coverage.

• Half of the states are expand-ing Medicaid programs. In states where Medicaid is expanding, the benefits packages are changing—and O&P coverage could shift. For those states adopting alternative benefit plans, the states may design specific plans for certain popula-tions or beneficiary groups.

• Some patients could lose coverage. “We need to monitor and make sure that as the ACA is rolled out, amputees and others with physical disabilities have access to the O&P care they need,” says Thomas.



Getting Proactive in north CarolinaO&P practitioners in

the Tar Heel State are watching their neighbors closely, and following how Alabamans have prevented O&P from falling into a capitated system. Like Alabama, North Carolina did not accept Medicaid expansion as part of the ACA, but is contemplating changes to the state health-care system—changes that may include a capitated system.

“It’s a big concern for us,” explains Ashlie White, an employee at Beacon P&O in Raleigh and a board member for NAAOP. “The law doesn’t see us as separated from DME and we do not have our own line item in the state Medicaid budget. This is something we’d like to change in the future.”

Promoting O&P as patient care that helps patients return to mobility is an important way to distinguish O&P, White says: If the state doesn’t pay for care that helps individuals return to mobility, then it will fall on the state to take care of them.

Another problem in the state—and across the country—is repeated denial of coverage by private insurers of devices they deem experimental—even components that are regularly covered by Medicare. “Sometimes it’s common practice to deny cover-age until a third appeal,” White explains. “This makes patients wait longer than they need to for care.”

The state has a trade association with a busi-ness and legislative focus, which helps keep practitioners apprised of changes. White is help-ing to write an Insurance Fairness Bill for the state, and has also designed an online portal dedicated to insurance fairness for people with limb loss and limb difference. “One of the goals of the site is to get our legislation introduced,” she says. “This central-ized website is a starting point and works as a call to action,” she says.

Matters of taxes and LicensureSouth Carolina practi-

tioners face a challenge that’s unique to their state: O&P providers must pay a 6 percent sales and use tax on all orthoses they deliver for patients with private insurance. “From what I understand, we are the only state with such a tax,” says Maurice Johnson, CO, of Floyd Brace in Charleston.

Though practitioners in the state joined forces to fight the tax several years ago, their efforts fell on deaf ears. Now, they are “going to the poli-ticians to see if we can have discus-sions about this,” says Johnson.

The next step may be to pursue licensure within the state: “Licensure could rectify the issue by separating us out from DME,” Johnson says.

Licensure also is being considered in Minnesota, where prac-

titioners involved in the Minnesota Society of Orthotists, Prosthetists, and Pedorthists (MSOPP) put forth a licensure bill that has yet to be passed. Practitioners are hopeful it could pass in the next cycle—not only because they want to protect their patients, but also because they want to ensure they have input into how they are regulated.

Teri Kuffel, Esq., vice president of Arise Orthotics & Prosthetics in Blaine, is also on the board of directors for MSOPP and serves as the Minnesota state representative for AOPA.

Minnesota O&P business owners also share in a spirit of cooperation: “We have

fewer amputees in Minnesota” than in most other states, says Kuffel. “And there are fewer O&P providers—so less competition. A highly regulated state health-care system exists to keep all players in check.”

That willingness to work together has been a lifeline when regulators

have put O&P in the hot seat. Three years ago, a bill was introduced that would have removed O&P care for adults in the Medicare system. MSOPP reached out to the com-munity, and used letter-writing, in-person meetings, phone calls, and assistance from AOPA and the Amputee Coalition to kill the bill.

More recently, O&P providers worked within the system to help determine their own fate when changes were imminent to the state health-care system. “We met as a group with our Medicaid administra-tor to help redefine the prior authori-zation process. We were a part of the continuing feedback and input” in the process, says Kuffel.

What state Are You in?You never know what changes may be heading your way—so keep an eye on your state capital, but also be aware of the challenges facing practitioners across the country.

Get involved before a chal-lenge arises in your state, advises Williamson. “When we only meet with Medicaid and legislators in a crisis, our message falls on less willing ears.”

“If we don’t take the time to do research on what’s happening in our own states, then we won’t see what’s coming,” adds White. “We need to work together, instead of compete with each other, to advocate for the profession. The practitioners who are not owners also need to pay attention because it’s their careers at stake,” says White.

Christine Umbrell is a contributing writer for O&P Almanac. Reach her at [email protected].

Scott Williamson , MBA




Prosthetic Limb users survey of mobilityResearchers develop self-report instrument for measuring mobility of adults with lower-limb amputation

By SUSAN SPAULDING, CPO; SARA MORGAN, CPO; and BRIAN HAfNeR, PHD

Why develop a Patient-reported Measure of Mobility?Patient-reported outcomes (PROs) are instruments intended to measure aspects of health from the patient’s perspective, without interpretation from physicians or other health-care providers.1 PROs are especially useful for measuring patients’ percep-tion of their health outside of the clinic, such as their mobility in their home and community. PROs provide information that is distinct from, and complementary to, physical perfor-mance measures (which are designed to assess a patient’s ability to perform activities under direct observation of a clinician or researcher). In addi-tion, outcome measures take valuable clinical time to administer, score, and interpret.

With these considerations in mind, the PLUS-M was envisioned to have the following characteristics:• Quick and easy to administer• Simple to score and interpret• Able to be administered by paper,

computer, tablet, or phone • Suitable for use in both research

and clinical care.

Enhancing mobility in individuals with lower-limb amputation is a primary goal for prosthetists and other health-care providers. Many important clinical decisions, such as the selection of prosthetic components, are based on predictions and evaluations of a patient’s mobility. Determination of a patient’s mobility status (or potential) often is based on observations made by a managing physician or prosthetist. However, these subjective clinical assessments may limit clinicians’ ability to accurately assess changes in mobility over time, compare mobility across individuals, or clearly communicate mobility outcomes to other providers.

Standardized outcome measures (like timed walk tests) can be used to measure and document patient outcomes, but they may be time-consuming to administer and may be limited to tasks or activities that can be completed in a clinic environment. Thus, there is a need for efficient and meaningful outcome measures that can be used to quantify patients’ broad experiences with mobility.

Researchers at the University of Washington Center on Outcomes Research in Rehabilitation (UWCORR) have devel-oped the Prosthetic Limb Users Survey of Mobility (PLUS-M) to meet this need. PLUS-M is a patient-reported outcome measure intended to efficiently and effectively measure prosthetic mobility in people with lower-limb amputation. PLUS-M has been rigor-ously developed to fulfill the needs of a variety of stakeholders, including clinicians, researchers, patients, and payers. This article reviews motivations for developing PLUS-M and provides an over-view of efforts undertaken to develop and validate this instrument.

IntroductIon


Work to create and test the PLUS-M item bank began in 2010 under a five-year research grant from the National Institutes of Health (NIH). The devel-opment efforts described in this article have been guided by existing standards for creating high-quality PROs.2 These standards encourage use of rigorous qualitative and quantitative research techniques to produce measures that are both psychometrically sound and clinically meaningful.

Advisory PanelAn advisory panel of key stakeholders was assembled to guide PLUS-M’s development and validation efforts. Panel members included consumers, researchers, clinical providers, and representatives from prosthetic indus-try partners and government agencies. These stakeholders met regularly to review the project’s progress and guide future research and dissemination efforts. The first step in developing the PLUS-M was to gather this group to define and discuss mobility while using a prosthesis. This group also reviewed and prioritized items for potential inclusion in the PLUS-M item bank.

Literature review Development of the initial PLUS-M item bank, or a collection of survey questions, began with a thorough literature review to find questions that could be used or adapted to measure prosthetic mobility. In total, more than 1,000 questions from 45 different PROs were identified. These questions were analyzed and used to identify general mobility activities (like “walking over uneven terrain”) that could be included in the new survey.

PLUS-M questions were then developed around each of the activities identified in the review. In cases where

existing questions could be included, PLUS-M developers requested permis-sion from the original item authors to include them in the list of candidate questions. The developers also cre-ated novel questions based on unique or complex mobility activities (like “walking up steep gravel driveway”). Ultimately, more than 120 questions were developed or included from existing surveys.

Focus GroupsFocus groups were assembled to discuss mobility from the perspective of prosthetic limb users. Four focus groups, with a total of 37 adults with lower-limb amputation (between six and 12 participants per group), were conducted across the United States to solicit perspectives of people from dif-ferent geographic areas and climates. These groups consisted of individu-als who had diverse perspectives on mobility with a prosthesis, including people with various amputation levels, etiologies, and prosthetic experience.

The focus group sessions were semi-structured, and allowed for informal interviews to be conducted in

FEATURE: PROSTHeTIC LIMB USeRS SURVey Of MOBILITy

PLUS-M Protocol


an interactive, supportive group envi-ronment. These group sessions were moderated by clinicians and research-ers trained in qualitative methods.

Example of a focus group discussion about a mobility challenge:• Moderator: “Are there things that

you encounter in your environment that makes walking tough?”

• Participant A: “Sidewalks.”• Participant B: “One difficult thing is

walking on sidewalks that are angled toward the street at different levels.”

Later, transcripts of the groups’ conversations were qualitatively analyzed to identify common themes related to the amputees’ experiences with mobility. Items identified in the existing item review were then reas-sessed to ensure that they addressed aspects of mobility that were identified as important to prosthetic limb users. Focus group discussions informed development of seven new items that were subsequently evaluated in cogni-tive interviews.

Cognitive interviews Cognitive interviews are one-on-one sessions with respondents that explore the cognitive processes used when answering survey questions.3,4 These interviews were used to elicit the perspective of prosthetic limb users in regard to the quality of items selected and written by the develop-ment team.

This qualitative process was criti-cal in determining whether items were meaningful to patients with lower-limb amputation and if they were under-stood as intended. Cognitive inter-views were conducted by members of the research team who had experience working with people with lower-limb amputations. A total of 156 items (130 items from existing item review and focus groups and 26 new items cre-ated through the cognitive interview process) were assessed in 36 cognitive interviews. Following the interviews, items were revised or deleted based on participant feedback.

Example of question revised through cognitive interviews:

• Initial item: “Are you able to walk on a sideways incline (e.g., a sidewalk that slopes toward the street)?”

• Revised item: “Are you able to walk on a surface that slants sideways where one side is higher than the other?”

Of the 156 items assessed, 80 were accepted as is, 22 were substantially revised, and 54 were removed. In addi-tion, three items were split, resulting in three additional items. The remaining 105 items were then administered to more than 1,000 prosthetic limb users.

Large-scale Administration Following the cognitive interviews, the remaining items were co-adminis-tered with legacy measures of mobil-ity to more than 1,000 prosthetic limb users in an 18-month national survey. This group of prosthetic limb users will be referred to as the development sample because their responses were used to assess each of the 105 items using quantitative modern measure development methods. In addition, normative data for the PLUS-M is established from the development samples’ responses.

The initial development sample consisted of adults with unilateral transtibial or transfemoral amputation as the result of traumatic or dysvas-cular causes. The responses from the PLUS-M and existing measures of mobility were used to establish evidence of reliability and validity. Psychometric analyses of the remain-ing 105 survey questions informed fur-ther removal of items, resulting in the inclusion of the 44 survey questions in the final PLUS-M item bank.

Current and Future directionsLongitudinal Testing: Currently, more than 200 patients with lower-limb amputation are involved in a national, longitudinal validation study to investigate the psychometric proper-ties (reliability, validity, sensitivity, and responsiveness) of the PLUS-M outcome measure. Patients are assessed during five time points over a one-year period. Thirty-nine clinics

and 79 prosthetists are administering the PLUS-M, other existing PROs, and two performance measures (AMP and TUG) to patients before and after delivery of a new prosthesis or replace-ment socket. Similar outcome data will be compared to evaluate PLUS-M’s validity or its effectiveness in measur-ing mobility.

The fitting of a new prosthesis or replacement socket event was selected, as this is a point when a change in mobility may be observed. Prosthetists and patients are asked to rate the change in mobility after delivery of the new socket. This perception of change in mobility will be correlated with the change in the PLUS-M score to identify the degree of responsive-ness. In other words, how many points must the PLUS-M score change to be considered clinically relevant?

Secondary Analyses: Development and validation of PLUS-M has included collection of data from more than 1,300 prosthetic limb users. This represents one of the largest prospec-tive studies of health outcomes in persons with lower-limb amputation to-date.

To maximize the usefulness of this data, PLUS-M developers asked each study participant to complete multiple standardized outcome measures, including those designed to measure outcomes such as pain, fatigue, and concerns with cognitive function. This rich data set is now being studied by the PLUS-M developers to provide additional insight to clinicians and researchers regarding the health and quality of life of people with lower-limb amputation.

Future Research: Although originally developed for people with unilateral lower-limb amputa-tion, efforts are underway to expand application of PLUS-M to other limb loss populations. PLUS-M is cur-rently undergoing testing among bilateral, lower-limb prosthetic users. Developers are assessing performance of PLUS-M with these participants and plan to release a bilateral version of the PLUS-M instrument later this year.

PLUS-M researchers also have



received funding from the Orthotics and Prosthetics Research and Education Foundation to compare paper and computerized versions of PLUS-M (and other PROs). This research will allow the developers to determine if PLUS-M can be admin-istered equally well using both paper and computer forms. Results of this research are expected to facilitate integration of PLUS-M into practice management software and electronic medical record systems.

Lastly, developers are pursuing funding to translate PLUS-M into Spanish. These efforts collectively aim to improve PLUS-M’s clinical usability and convenience.

Conclusion PLUS-M is a new patient-report out-come measure of prosthetic mobility that has been developed for clinicians and researchers using contemporary instrument development standards. PLUS-M instruments and user’s guides are freely available from the PLUS-M website, www.plus-m.org. The short forms are easy to use, take little clinical time to administer and score, and are easy to interpret.

Our ongoing development efforts are intended to enhance the clinical usefulness of this measure and may provide additional insight to clini-cians and researchers about outcomes affecting the health and quality of life in people with lower-limb amputa-tion. It is our hope that the routine use of PLUS-M will provide clinicians and researchers with the means to accurately assess mobility, aid clinical decision-making, justify prosthetic care decisions, and document the effectiveness of provided services.

Susan Spaulding, CPO, is a teaching associate in the Division of Prosthetics and Orthotics at the University of Washington. Sara Morgan, CPO, is a prosthetist/orthotist and a doctoral candidate in Rehabilitation Science at the University of Washington. Brian Hafner, PhD, is an associate profes-sor in the Division of Prosthetics and Orthotics at the University of Washington.

PLUS-M: Getting Started

What does the PLUS-M measure? PLUS-M instruments measure prosthesis users’ mobility, defined as the ability to move intentionally and independently from one place to another. Individual PLUS-M questions assess respondents’ perceived ability to carry out specific activities that require use of both lower limbs. PLUS-M ques-tions cover movements that range from basic ambulation, like walking a short distance indoors, to complex activities, like hiking for long distances over uneven ground. PLUS-M response options reflect the degree of dif-ficulty with which respondents report they can carry out these activities.

Who can take the PLUS-M? The PLUS-M is optimized for adult, English-speaking, unilateral, lower-limb prosthesis users who have acquired amputations. Work is underway to assess PLUS-M for use in people with bilateral amputation. Additionally, future efforts will involve translations into languages other than English.

Can I use the PLUS-M in my clinic? Yes, PLUS-M short forms are free for non-commercial use. Examples of non-commercial use include administration of paper surveys in clinical practices for the purposes of monitoring patients or administra-tion in research for the purposes of assessing study participants.

How do I administer the PLUS-M? PLUS-M is a self-report measure, which means that the patient answers the survey items directly. The PLUS-M instrument can be administered electronically, on paper, or verbally.

How do I interpret my patient’s PLUS-M score? The PLUS-M score is a T-score. T-scores tell you how much your patient’s mobility deviates from the average mobility score of prosthetic limb users. The average mobility score for prosthetic limb users falls around the average T-score of 50, the mean mobility score of the development sample. In addition, T-scores may be compared to those reported by subgroups defined by level of amputation, etiology of amputation, gender, and age.

For more information, visit www.plus-m.org.

References1. U.S. Food and Drug Administration. “Guidance for industry: Patient-reported outcome measures:

Use in medical product development to support labeling claims: Draft guidance.” Health Qual Life Outcomes. 2006. 4(79).

2. “Patient-Reported Outcome Measurement Information System (PROMIS).” Instrument Develop-ment and Psychometric Evaluation Scientific Standards. 2012.

3. PROMIS Validity Standards Committee on behalf of the PROMIS Network of Investigators. (2012). PROMIS Instrument Development and Psychometric Evaluation Scientific Standards. [Internet] (un-published document). Available at http://www.nihpromis.org/Documents/PROMIS_Standards_050212.pdf

4. Collins D. “Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research: An International.” J Qual Life Asp. 2003. 12:229-238.



COMPLIANCE CORNER

What Is the PDAC? The PDAC is one of many contrac-tors used by CMS to administer the Medicare program. While contractors such as the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) process Medicare claims for payment purposes, the PDAC has a specific role that is unrelated to the payment of actual claims.

The PDAC provides three primary functions: the pricing of Healthcare Common Procedure Coding System (HCPCS) codes without Medicare allowables; data analysis, used to identify utilization patterns of HCPCS codes; and coding verification, used to establish coding guidance for specific products.

This last function is performed either on a voluntary basis (when a manufac-turer or other interested party requests the review of a specific product by the PDAC) or as a policy requirement for payment of certain categories of durable medical equipment, prosthetics, orthot-ics, and supplies (DMEPOS) items. Whether the code verification is submit-ted on a voluntary basis or as a require-ment of policy, once a product has been reviewed by the PDAC and assigned a coding verification, the PDAC deci-sion is binding for Medicare purposes.

Any claims submitted to Medicare for that product must be coded accord-ing to the PDAC coding verification.

Why Is the PDAC Important?Compliance with PDAC coding veri-fications is extremely important to your business, as failure to do so may place Medicare claim payment at risk. Medicare claims for devices that are coded in conflict with a PDAC coding verification will be denied as incorrect coding. If they are inadvertently paid, they are exposed to post-payment audit and overpayment determinations. It is important to be familiar with the process of checking the PDAC website for coding verification to prevent incorrect coding of devices for which a coding verification has been published.

Pay Attention to the PDACAccess the PDAC website often to check for coding verification

by JOSePH McTeRNANP

HO

TO

: TH

INK

ST

OC

K.C

OM

The Pricing, Data Analysis, and Coding contractor, or PDAC, is a specialized Medicare contractor that does not process claims but plays a very important role in correct coding of O&P services delivered to Medicare patients. Properly understanding the role of the PDAC is crucial to maintaining full compliance with Medicare rules and regulations. This month’s Compliance Corner will focus on the PDAC, what its coding verification process means to providers, and how to remain compliant when coding devices that have been reviewed by the PDAC.

CE Credits

Editor’s Note: Readers of Compliance Corner are now

eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 39 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the infor-mation to the certifying boards.

Compliance with PDAC coding

verifications is extremely important

to your business, as failure to do so may

place Medicare claim payment at risk.

Earn 2 BusinEss CE

CrEdits

QuiZ ME!

P.39

COMPLIANCe CORNeR


Using the PDAC WebsiteTo access the PDAC website, visit www.dmepdac.com. Once on the site, click on the term, “Search DMECS for codes and fees.” This will take you to a series of searchable fields.

To determine if a coding verifica-tion exists for a specific product, use the section labeled, “Search DMEPOS product classification list.” This section allows you to search by manufacturer/distributor, HCPCS code, product name, or product model number. You may enter information in any or all of these fields to narrow your search, but be careful not to miss a coding verification by being overly specific. If you know the name of the product you are looking to verify, this is usually a good starting point.

If you do not get any results this way, try searching by manufacturer. This will typically lead to a larger list of returns but may capture a product that was missed due to misspelled or incorrect product names. If a product has had its coding verified by PDAC, Medicare providers are bound by that verification. Regardless of whether you agree with the verification, Medicare rules require that you code the device according to the PDAC verification.

What Products Require PDAC Coding Verification?Several categories of O&P devices require PDAC coding verification as part of the Medicare medical policy govern-ing coverage. These include virtually all spinal orthoses, ankle-foot orthoses

described by L1906, knee orthoses described by L1845, power assist features of prosthetic feet described by L5969, prefabricated diabetic inserts described by A5512, and custom-fabricated diabetic inserts (A5513) that are fabri-cated anywhere other than the labora-tory of the supplier that delivers them.

If you provide a product described by one of these codes and the PDAC has not published a coding verifica-tion for the product, your claim will be denied as incorrect coding.

In addition to policy-mandated coding verification, manufacturers may voluntarily request a coding verification for a product. This is accomplished through an application process that requires significant information regarding the product and its use.

Once a voluntary request for coding verification has been received and the PDAC publishes its decision, the coding verification becomes bind-ing on the provider community for Medicare claims. It is important to maintain efficient communication with manufacturer partners to deter-mine if specific products have been reviewed and verified by the PDAC.

PDAC Advisory ArticlesThe PDAC occasionally issues advi-sory articles that provide specific clarification regarding coding in certain scenarios. Like coding verification, these advisories, once published, become binding for purposes of Medicare claim submission and could lead to future denials for incorrect coding.

PDAC advisory articles are located in the “Articles/Publications” section of the PDAC website. Click on the subtitle, “Advisory articles.” This will take you to a chronological listing of advisory articles.

While not all of these advisory articles relate to O&P services, it is important to review the articles on a regular basis to maintain full compliance with Medicare rules. Recent advisory article subjects include the correct coding of powered L-coded items, guidance regarding proper coding of microprocessor knee components, proper coding of articulat-ing digits and prosthetic hands, and proper coding of ankle-foot orthoses.

PDAC advisory articles carry the same weight as published coding verifications, and providers are expected to be aware of and compliant with anything published by the PDAC.

Respecting the PDACThe PDAC plays an important role in the Medicare program. While it plays no active role in the adjudica-tion and payment of Medicare claims, compliance with published information from the PDAC is crucial to the success of your business.

Your company’s compliance team should monitor the PDAC website on a regular basis, and communicate to your clinical and administrative staff any new information generated through advisory articles as well as the coding verification process. Failure to do so may result in serious compli-ance issues now and down the road.

As O&P providers continue to address the compliance challenges of the current Medicare environment, maintaining compliance with PDAC decisions remains an important part of an effective compliance program.

Joseph McTernan is AOPA’s director of coding and reim-bursement services. Reach him

at [email protected].

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

www.bocusa.org



WHeN JOHN HATTINGH, CP, LP, CPO(SA), sold his

Seattle facility to Hanger in 2009, he and his wife, Michele, thought they were finished with running an O&P business. Hattingh had worked at the Northwest Pros-thetic and Orthotic Clinic for 25 years, seeing thousands of patients, and he was ready for a change.

“It was our intention to retire,” explains Michele. “But the economy had different ideas.”

The two headed to South Africa, where they maintained a second home, and John did pro bono work there and some humanitarian projects in North Africa. When they heard a grandchild was on the way back in the United States, they decided to return stateside and explore setting up a new O&P facility.

John Hattingh had an idea that he’d like to work small and selectively, concentrating only on prosthetics and seeking out the most difficult cases. The two settled in Leesburg, Virginia, near Dulles Airport.

“I decided to try one case, to see if my heart was still in it,” says Hattingh. He and Michele set up Prosthetic Care Facility of Virginia one year ago, just after his noncompete expired, and they started looking for the first patient, preferably an uninsured unilateral amputee. Their Facebook notice came to the attention of Lacey Phipps, a young woman born with club feet who chose to undergo a bilateral amputation because she wanted so badly to be physically active. Hattingh worked with her intensively, and today Phipps competes in triathlons, goes

white-water kayaking, dances, and sets out on a new adventure nearly every week.

After working with Phipps, John “realized he still had it,” says Michele, and the two decided to establish a different sort of facility. Prosthetic Care Facility of Virginia sees one patient per week. About 65 percent of patients are from out of state, and the company promotes “destination prosthetics” for those who are unable to find the care they want closer to home. The majority of their patients heard of the facility through word of mouth.

“Many of these patients have not had success working with other prosthetists,” says Hattingh. “They think that life as an ampu-tee has to be uncomfortable. I don’t believe that. And it doesn’t really matter what device you put on the patient—if the socket doesn’t fit, it doesn’t work.”

A recent patient, a 71-year-old woman with an above-knee amputation, had never been able to walk on her prosthetic leg. Hattingh realized a traditional

Destination: ProstheticsProsthetic Care Facility of Virginia offers intensive one-on-one treatment for patients miles from home

PH

OT

OS

: Pro

sthe

tic C

are

Fac

ility of V

irgin

ia

MEMBER SPOTLIGHT Prosthetic Care Facility of Virginia by DeBORAH CONN

socket would not work. “He used a socket so old-fashioned that most prosthetists today wouldn’t even recognize it,” recounts Michele. “But it did the trick, and she is walking farther and farther every day.”

The company is housed in a medical building, and because Hattingh did his own office renovation, their overhead is quite low. The facility includes a 2,000-square-foot gait lab, and Hattingh does all fabrication in-house. Michele serves as chief financial officer and handles coordination and administra-tion. The only additional staff member is a receptionist. A physical therapist is on call.

Because patients stay for a full week, Hattingh can assess them on a daily basis. He allows them to try a number of different devices, although he finds that when the socket fit is comfort-able, patients frequently prefer lower-cost feet and knees over highly complex components.

The unusual, personal nature of their business is appealing to both Hattinghs, who develop close relationships with their patients—many of whom stay in their guest room. The facility has treated 49 patients in the last year, a far cry from the 1,000 patients Hattingh would have seen during a typical year in Seattle.

Still, they are planning to expand. But just enough to accom-modate hiring a technician—who happens to be their son.

Deborah Conn is a contributing writer to the O&P Almanac. Reach her at [email protected].

FACILITY: Prosthetic Care Facility of Virginia

LoCATIon: Leesburg, Virginia

owner: John Hattingh, CP, LP, CPO(SA)

HIsTorY: 1 year

John Hattingh, , CP, LP, CPO(SA)


WILLOWWOOD WAS fOUNDeD MORe than a

century ago by William E. Arbo-gast, a bilateral amputee who got his start by carving prostheses out of willow wood. Today, William’s great-grandson Ryan Arbogast runs the company, which manufactures a range of lower-extremity pros-theses, components, and liners. Arbogast assumed his role in 2010 when his father, Robert Arbogast, retired at 65.

“We manufacture 95 percent of everything we sell in-house,” Ryan says. The company has 180 employees, with about 170 on site in Mount Sterling, Ohio. Its inter-national network of distributors, first established about 20 years ago, has brought the company’s products to a worldwide audience.

Perhaps the company’s best-known product is the Alpha Liner, the first fabric-covered gel interface system in the industry, introduced in 1996. Appropriately enough, it echoes one of the com-pany’s first products, the Sterling Stump Sock, a woolen socket liner that was released in 1921.

Other products include the high-performance Pathfinder Foot, which was originally designed for military use. Its design connects a toe spring, footplate, and pneumatic heel spring in a triangular configuration that, says Ryan, “offers optimal flexibility, stability, and comfort.”

The company’s 1984 Carbon Copy II Foot was the first energy-storing foot with a lifelike cosmetic cover, and WillowWood was the first to introduce a remote-controlled vacuum suspension

system, called LimbLogic, in 2007. WillowWood also offers a

CAD/CAM software system called OMEGA that enables prosthe-tists to capture digital patient measurements for prosthetic and orthotic devices. Users can send the data to a central fabrication facility or, with additional OMEGA hardware, fabricate lower-limb prostheses and orthoses in-house.

In early 2000, Robert Arbogast added two prosthetic clinicians to his staff. “He wanted to get better feedback for the engineers who were developing products,” explains Ryan. “It was hard to tap our customer base since they were busy serving patients, so we opened our own clinical facility for product testing and evaluation.”

Through its clinic, WillowWood works with a patient base of about 100 amputees to test new devices. “We are able to develop products more quickly and be more confi-dent when we come to market that they will solve the intended problem and that users will have the best possible experience,” says Ryan. An onsite fabrication facility primarily serves clinic patients but takes in outside business as well.

While WillowWood’s sole focus today is the O&P industry, the company owes its longevity in part to a willingness to branch out during challenging times. During the Great Depression,

Carved From a Strong FoundationAfter 107 years in business, WillowWood continues to be an innovative product developer

PH

OT

O: T

he

Oh

io W

illow

Wo

od

Co

.

WillowWood manufactured polo mallets and balls. During World War II, it made parts for PT Boats and B-17 bombers. And Ryan doesn’t rule out future forays outside of the industry.

The company recently part-nered with Outlast to develop a new liner that can absorb and store body heat. The SmartTemp Liner helps delay the onset of sweat in the residual limb and releases stored heat as the body cools, creating more stable skin temperatures throughout the day.

The technology has great applications within the O&P industry, says Ryan, but it also is being used in clothing and bedding. “We even had a request to use it for a horse saddle pad,” he says.

These ventures into other fields are interesting, but the ultimate goal is to stay focused on advancing care for orthotics and prosthetic s patients. “I want to direct any gains we make in other fields back to research and development in O&P,” says Ryan.

Innovation is a priority for WillowWood. “Our size allows us to move very quickly and be fast to market relative to some large companies,” says Ryan. “Our goal is to continue to try to level the playing field for ampu-tees. We try to look for the big problems and solve them. I have my whole career ahead of me, and we’re going to be aggressive in attacking those issues.”

Deborah Conn is a contributing writer to the O&P Almanac. Reach her at [email protected].

FACILITY: The Ohio Willow Wood Co.

LoCATIon: Mount Sterling, Ohio

owner: Ryan Arbogast

HIsTorY: 107 years

Ohio Willow Wood Facility in 2007.

MEMBER SPOTLIGHT The Ohio Willow Wood Co. by DeBORAH CONN

The AOPA National Assembly is already the most

talked about event for 2014—It is the premier

destination for the world-wide orthotic, prosthetic

and pedorthic community. Register today to

participate in the National Assembly.

Sept. 4–7, 2014Mandalay Bay, Las Vegas

REGISTRATION IS NOW OPEN. Visit www.AOPAnet.org for updates and additional information.

Exhibits. Education. Networking. CE Credits.

AOPA’s

national assembly ’14The premier meeting for orthotic, prosthetic, and pedorthic professionals

For information about the show, scan

the QR code with a code reader on your

smartphone or visit www.AOPAnet.org.

OF THE AOPA NATIONAL ASSEMBLY

AOPAversity Webinar SeriesDuring these monthly one-hour sessions, AOPA experts provide the most up-to-date

information. Perfect for the entire staff—one fee per conference, for all staff at your company location. Complete the accompanying quiz to earn 1.5 CE credit for each conference.

The brand new and improved team-building & money-saving, educational experience!

Mastering Medicare: Webinar Education

AUG

13AFO/KAFO Policy: Understanding the Rules*

Obtaining Medicare reimbursement for AFOs and KAFOs can sometimes be a challenging and often frustrating experi-ence. Join AOPA for an AOPAversity Mastering Medicare Audio Conference that will focus on the nuances of AFO/KAFO LCD and Policy Article and help you to better understand the rules. Attendees will learn:

; What documentation must exist in order to use the KX modifier on your claim

; What are the coverage rules for AFOs with ambulatory vs. non-ambulatory patient

; How to bill for repairs to AFOs and KAFOs

; When is it okay to use a custom fabri-cated AFO/KAFO

; Basic review of the major component of a Medicare medical policy

SEPT

10Urban Legends in O&P: What to Believe*

Rumors run as rampant in O&P as any other industry. Just because you hear the same things from different people does not always mean they are true. AOPA will attempt to dispel some of the bigger myths surrounding O&P billing. Some of the topics discussed will include:

; Billing for diabetic shoes involv-ing amputees;

; Financial liability on non-assigned claims;

; Proper use of the KX modifier; ; Prostheses and Power

Wheelchairs; ; Billing for unlisted procedure

codes

OCT

08Medicare Enroll-ment, Revalidation, and Participation*

Will focus and cover the basics of Medicare Enrollment Procedures and topics for discussion will include:

; Reviewing new Medicare Enrollment Standards

; Reviewing the Medicare Enrollment Application

; PECOS vs. the 855S Form ; Difference between a participating

Medicare provider and a non-participating Medicare provider

; When you must revalidate and reenroll your Medicare number

; When/How you may change your participation status

NOV

12Gifts: Showing Appreciation without Violating the Law*Medicare has very specific rules about what

you can and cannot do .What is and is not considered a kickback and how to acknowledge referral sources without getting into trouble. Also a general discussion of other types of activity that can be interpreted as a kickback.

; When gifts to referral sources are acceptable ; When gifts to patience are acceptable ; Federal Anti-Kickback regulation prohibitions ; Doing something nice vs. doing something illegal

2nd Wednesday of each month!

LIVEEVERY

MONTH

DEC

10 New Codes and Changes for 2015*A discussion of any new codes and modifiers for 2015, including information on how the codes are

created and how the DMEPOS fees are established. The call will also cover any new changes in medical policies.

; Learn about new HCPCS codes effective January 1, 2015.

; Discuss verbiage changes to existing codes and how they may affect your business.

; Find out which codes will no longer be used as of January 1, 2015.

; Discover other changes to the HCPCS system. ; Find out AOPA’s interpretation of why the changes

took place.

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. For content questions, contact Devon Bernard at [email protected] or 571/431-0854.

Register online at http://bit.ly/aopa2014audio. For registration questions, contact Betty Leppin at [email protected] or 571/431-0876.

Register online at http://bit.ly/aopa2014audio. EARN CREDITs

1.5 CEPER CONFERENCE

AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER

NO fAST-fORWARD IN LITIGATION. AOPA

members continue to patiently await a ruling on the govern-ment’s motion to dismiss the AOPA lawsuit against CMS due to CMS failure to follow the rules in making policy changes that ultimately led to the rise of devastating recovery audit contractor (RAC) audits. This is a classic example of the wheels of justice moving slowly. The lone bright spot was a recent ruling by the U.S. District Court in Allina Health Services vs. Kathleen Sebelius where a government motion to dismiss was overruled and the case proceeded. The Allina case similarly attacked the absence of proper notice and comment when the Department of Health and Human Services published a proposed rule and provided notice and comment opportuni-ties, but then issued a final rule that bore scant resemblance to the original proposal. The court held that agency promulga-tion of “a rule by another name evading altogether the notice and comment requirements” constitutes the “most egre-gious” type of violation of the Administrative Procedure Act. AOPA’s law firm, Winston and Strawn, promptly filed a notice of supplemental authority with the presiding judge in AOPA’s lawsuit, calling attention to the higher court’s decision. In short, all is not lost just yet.

TeSTIMONy, fAST AND fURIOUS. There was hardly a break between the April 30 hearings held by the House Ways and Means Health Subcommittee on Combating Waste, Fraud and Abuse in the Medicare system and two hearings, both on May 20. At the first hearing, held by the Health Subcommittee, AOPA submitted a statement on short stays and unintended consequences of RAC audits and the massive backlog of Medicare appeals. The second hearing was held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements. Both events were followed by a May 21 House Energy and Commerce Health Subcommittee hearing, which again focused on RAC audits and other issues. AOPA

statements in all four forums carried a common thread of criticism of the overly aggres-sive RAC audits, their conse-quents on small businesses, and disruptions in timely patient care.

In the statements submitted, AOPA proposed constructive ways to address fraud, waste, and abuse of the Medicare system, as alternatives to the current RAC program, which harms honest providers and has created a massive backlog of appeals at the administrative law judge (ALJ) level. AOPA pointed out that a potentially powerful anti-fraud measure has never been implemented: section 427 of the Medicare, Medicaid and SCHIP Benefit Improvement and Protection Act of 2000 (BIPA), which requires CMS to only make pay-ments to “qualified providers.”

In our quest to deliver maximum return on investment to you the reader and AOPA member, each issue O&P Almanac will summarize recent actions AOPA has undertaken in making a difference in solving problems or meeting challenges faced by the O&P community and deliver a greater ROI on the AOPA investment for all of O&P.

Never a Dull Moment Round up of the latest legislative and regulatory activity reveals some encouraging news in the fight for O&P

PH

OT

O: C

om

mitte

e o

n E

ne

rgy a

nd

Co

mm

erc

e


AOPA NeWS THE AOPA BULLETIN

To fight fraud on the front end, AOPA advocated for HR 3112, the Medicare Orthotic and Prosthetic Improvement Act, which, among other provisions, would ensure that Medicare only pays licensed providers (in licensure states) or providers accredited by the major O&P accrediting bodies. AOPA emphasized that imposing surety bond requirements, eliminating the exception to Stark self-referral rules, and implementing prior authoriza-tion would not penalize fraudulent providers and ease the burden on legitimate providers. AOPA proposed reasonable reforms of the RAC and prepayment audit systems: establish the prosthetist/orthotist’s notes as part of the medical record; establish the prosthetist/orthotist as a provider of care to distinguish from durable medical equipment (DME) suppliers; and establish financial penalties for RAC audits that are overturned on appeal. AOPA also included four other specific sugges-tions to mitigate the appeals backlog and protect honest O&P providers.

CMS ACTIONS ALSO DeMANDING. Following the rules—at least so far—CMS proposed on May 28 a regulation on prior authorization and invited public comment until July 28. The proposal identified 89 lower-limb prosthetic codes that would be subject to submitting a “request for prior authorization.” The CMS proposal carefully avoids using the word “approval,” and instead uses the term “affirmation,” which only confirms the services are covered but is not a

promise or a guarantee of payment. The actual payment decision will be based on the claim submitted after delivery of the device. Even with an “affirma-tion” from CMS on the request for prior authorization, a claim could still be denied for other specific reasons. AOPA’s comments were initially pre-pared by a subcommittee of the Board of Directors and then reviewed at the June 23 board meeting before final submission. AOPA is urging all mem-bers to also comment individually on the proposal. AOPA’s comments were made available to all members in late

June, offering ample time for members to draw upon AOPA comments in submitting their individual comments. The official AOPA position is opposi-tion to the prior authorization pro-posal as an unnecessary step that offers no sure pathway for avoiding claim denials or receiving final payment or a lessened threat of a RAC audit.

Perhaps the only plus might be that a non-affirmation of a prior authoriza-tion request would enable the provider to offer the patient an informed choice on whether to receive the device and accept financial responsibility for payment by signing an Advanced Beneficiary Notice (ABN). Medicare

only allows providers to request an ABN from a patient when there is reason to believe that the claim will be denied as not medically necessary.

MORe OTS CHALLeNGeS. New wrinkles continue to appear in the long-running saga over what is and what isn’t an off-the-shelf (OTS) orthotic. The latest development is a query of suppliers of those devices or components that CMS deems are OTS because they can be supplied with or without clinical care. For now, the two separate codes for the same device

yield the same reimbursement. That, of course, will certainly change with OTS devices at a lower reimburse-ment than custom-fit. AOPA has disputed the list of exploded codes that CMS claims can be supplied with or without clinical care. AOPA believes the statutory definition is clear: Only those devices that can be utilized with “minimal self adjustment” by the

patient are OTS. CMS has expanded that definition to include adjustment by a patient’s caregiver to the more recent iteration of “substantial modi-fication.” If a device can be delivered without substantial modification, then it qualifies as OTS according to CMS—but not according to the view AOPA and the O&P Alliance have advanced in letters and personal visits with CMS officials. The looming issue is if CMS’ definition is expanded beyond “minimal self adjustment” and devices are then included in the next or future rounds of competitive bidding, patient care will suffer.

As they say, stay tuned!


AOPA NeWSTHE AOPA BULLETIN

AOPA NeWS

Let’s Make a Movie!Submit Your Videos for AOPA’s Public Relations Campaign

LAST yeAR, MANy Of AOPA’s supplier members and exhibitors generously shared video footage to help create

the World Congress Opening Ceremony. This year, AOPA is creating a public relations campaign to promote the cost-effectiveness study funded by AOPA and commissioned by The Amputee Coalition (www.aopanet.org/wp-content/uploads/2014/04/January-2014-ED-Letter.pdf). The study proves that orthotics and prosthetics saves lives and money.

Specifically, AOPA is seeking examples of patient care in action; how orthotics and prosthetics help people achieve indepen-dence; and/or video clips showing people doing things that they would not be able to do without an O&P device.

If you have a video clip for AOPA to include in the campaign, please send the video or video link to Tina Moran at [email protected].


AOPA’s 2014 Coding Products Are Available in the Bookstore

2014 Illustrated GuideThis easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.

2014 Coding ProThe Coding Pro is O&P’s compre-hensive guide to Medicare codes, reimbursement, and medical policies. This is the single-source refer-ence for all of your coding needs! The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Network Version for use on multiple office terminals.

2014 Quick CoderStop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, long-lasting, and convenient to store.

2014 Coding SuiteSave $50 when you purchase the newly updated Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (Single-User CD Software), and the 2014 Quick Coder.

Go to the AOPA Bookstore and order your Coding Products today, visit http://bit.ly/BookStoreAOPA.

O&P


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

www.bocusa.org


Earn 4 BusinEss CE

CrEdits

QuiZ ME!

P.17 & 39

BuY 3 GEt OnEFrEE

BOnus

Earn CE Credits by Reading the O&P Almanac!

Because of the highly educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free.

Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appear-ing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis.

Find the digital edition of O&P Almanac at: • http://www.aopanet.org/publications/digital-edition/Find the archive at: • http://issuu.com/americanoandpAccess previous monthly quizzes at:• http://bit.ly/OPalmanacQuizThe June 2014 quiz is located at: • https://aopa.wufoo.com/forms/

op-almanac-june-2014-reimbursement-page/

Be sure to read the Reimbursement Page and Compliance Corner article in this issue and take the July 2014 quiz.

Education Programs for 21st Century Entrepreneurs—

Survive and Thrive: Bottom-Line, Profit-Oriented O&P Business Programs

If yOU MISSeD THe 2013 O&P World Congress, don’t let this opportunity to participate in these important

programs pass you by:

• Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment

• Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm?

• Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors

• Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?

You and your staff can now have a private viewing of business saving strategies and earn continuing education credits at the same time. Learn more about each session by visiting http://bit.ly/CreditCEpromo.

AOPA members just $59 per session ($99 per session for nonmembers), and the price covers your entire staff. Take advantage of a special offer to buy three, get one free. Review the videos as many times as you like.

Register at http://bit.ly/aopabusiness. For more infor-mation, contact Betty Leppin at [email protected] or 571/431-0876.

AOPA NeWS


AOPA NeWS

Coding Questions Answered 24/7AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropri-ate products three ways—by L code, by manufac-turer, or by category. It’s the 21st century way to get quick answers to many of your coding questions.

Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions.

Contact Devon Bernard at [email protected] or 571/431-0854 with content questions.

Welcome to AOPA JobsAOPA’S ONLINe CAReeR CeNTeR gives you access to a very specialized niche. The Online Career Center is an easy-to-use,

targeted resource that connects O&P companies and industry affiliates with highly qualified profession-als. The online job board is designed to help connect our members with new employment opportunities.

JOB SeekeRS: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers.

eMPLOyeRS: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you.

ReCRUITeRS: Create and manage your online recruiting account. Post jobs to our site and browse candidates interested in your positions.

The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org.

In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations!

Regardless of your staffing needs or budget, we have an option that is right for you. For advertising, call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email [email protected].

Log On for Free at the AOPAversity Online Meeting Place

eDUCATION DOeS NOT GeT ANy MORe CONVeNIeNT THAN THIS. Busy professionals need options—and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you.

For a limited time, AOPA members can learn and earn for free at the AOPAversity Online Meeting Place: www.AOPAnetonline.org/education.

Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management.

Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on cod-ing and billing Medicare.

Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice.

Register online by visiting http://bit.ly/WebcastsAOPA.

WeLCOMe NeW MeMBeRS

AOPA O&P PAC


Choice O&P314 Erin Drive Knoxville, TN 37919865/588-4256Fax: 865/246-0080Category: Patient-Care MemberWilliam Kitchens, CO, LO

Martin Bionics InnovationsP.O. Box 2391 Oklahoma City, OK 73101405/850-2391Category: Educational Research MemberJay Martin, CP, LP, FAAOP

Mobility Solutions Prosthetics and Orthotics4474 Cummings Place N. Keizer, OR 97303971/340-8485Category: Patient-Care MemberShannon Levin, CPO

North Texas Regional Orthotics & Prosthetics105 S. Grand AvenueWaxahachie, TX 75165972/923-2285Fax: 972/923-1994Category: Patient-Care MemberAmy Jones

THe OffICeRS AND DIReCTORS of the American Orthotic & Prosthetic Association

(AOPA) are pleased to present these applicants for membership. Each company will become an

official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

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 state-licensed 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:

Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999Level 3: $2 million to $4,999,999Level 4: more than $5 million.

www.AOPAnet.org

The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*:

THe O&P PAC ADVOCATeS for legislative or political interests at the federal level that have

an impact on the orthotic and prosthetic com-munity. To achieve this goal, committee members

work closely with members of the House and Senate to educate them about the issues, and help elect those individu-als who support the orthotic and prosthetic community.

To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authori-zation form contact Devon Bernard at [email protected].

We would also like to thank those individuals who have donated directly to a candidate’s fundraiser or to an O&P PAC-sponsored event, as they, too, are valuable supporters in achieving the legislative goals of AOPA and the O&P PAC*.• Jim Cahill, CPO• Glenn Crumpton, CPO• Eileen Levis• Gordon Stevens, CPO

*Due to publishing deadlines, this list was created on June 1, 2014, and includes only donations and contributions made or received between April 21, 2014, and June 1, 2014. Any dona-tions or contributions made or received after June 1, 2014, will be published in an upcoming issue of O&P Almanac.

Rick Fleetwood, MPA

Frank Snell, CPO, FAAOP

Claudia Zacharias, MBA, CAE

Is Your Facility Celebrating a Special Milestone This Year?O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email [email protected].


DAW Industries Inc.

San Diego, CA800/[email protected]

ePAD: The electronic Precision Alignment DeviceThe ePAD shows precisely where the point of origin of the ground reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable

representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information.

New Sure Stance knee by DAWThis ultra-light, true variable cadence, multi-axis knee is the world’s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients.

Trautman expansion Arbors from fillauer

Fillauer’s new Trautman Expansion Arbors are designed to prevent the sanding cone from flying away. When the expansion arbor spins, it expands and applies pressure to the inside of the sanding sleeve—holding the sleeve on

the arbor. If you have ever had to pick up your sanding cone off the floor mid-use because it flew off or had to keep readjusting the cone because it was migrating, then you will find the Trautman Expansion Arbor a must for your lab.

Features and benefits:• Provides a smoother grinding surface for

straighter lines and higher quality finish• Eliminates grinding chatter that hard grinding surfaces gives• Available in three sizes and as a kit of three• Available in 1/2-13, 5/8-11, and M16 threads

to fit most O&P machineryFor more information, contact Fillauer at

800/251-6398 or visit www.fillauer.com.

Compact Double Action Ankle Joint from PeL

Intended for both small adults and pediatric patients, the Compact Double Action Ankle Joint from Becker Orthopedic is comprised of a precontoured stainless steel upright and stirrup, which reduce fabrication time and provide a lightweight and low-profile enhance-ment to the clinical application.

Designed specifically for use with thermoplastics, the Compact Double Action Ankle Joint includes pins in the anterior panels and springs in the posterior panels, which afford the patient a normal gait while providing control in the sagittal plane and increased mediolateral stability of the knee and hip.

Contact PEL at 800/321-1264 or www.pelsupply.com.

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email [email protected]. Visit http://bit.ly/aopa14media for advertising options.

MARKETPLACE

www.savewithups.com/aopa

UPS Savings ProgramAOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa!

Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs,

putting your products to market faster. AOPA members enjoy discounts for all shipping needs

and a host of shipping technologies. Members save:

•Upto30%offUPSNextDayAir®

•Upto30%offInternationalExport/Import

•Upto23%offUPS2ndDayAir®

All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy!

Special

SavingS!


The most gratifying piece of what I do every day is to get up early in the morning, get to the office and know that we are going to make a difference.”

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.

“

To view available positions and apply online visit: www.hanger.com/careers or scan the QR code.

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.

Join Hanger Clinic and make a difference today.

- Kevin Carroll, MS, CP, FAAOP

AVAILABLE POSITIONS

Ardmore, OK Lynchburg, VA Auburn, CA Evansville, IN Havertown, PA Johnston, IA Kansas City, KSLa Mesa, CA Olivette, MO

Overland Park, KS

Albuquerque, NM Brunswick, GA Carson City, NV Columbus, OH Dayton, OH Denver, CO Englewood, CO Lansing, MI Las Vegas, NV

Corvallis, OR Zanesville, OH

Orange, CA Salisbury, MD Valdosta, GA Wethersfield, CT Cincinnati, OH Somersworth, NH Wichita, KS

Riverside, CA

Macon, GA Montrose, CO Oklahoma City, OK San Jose, CA Santa Rosa, CA Tallmadge, OH Thomasville, GATulsa, OK Springfield, IL

CLINIC MANAGER

PROSTHETIST

ORTHOTIST

PROSTHETIST/ORTHOTIST

CAREERS

Opportunities for O&P Professionals Job location key:

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

- North Central

- Northeast- Mid-Atlantic- Southeast

- Inter-Mountain- Pacific

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email [email protected]. Visit http://bit.ly/aopa14media for advertising options.

O&P Almanac Careers rates

Color Ad Special Member Nonmember1/4 Page ad $482 $6781/2 Page ad $634 $830

Listing Word Count Member Nonmember50 or less $140 $28051-75 $190 $38076-120 $260 $520121+ $2.25 per word $5 per word

onLine: o&P Job Board ratesVisit the only online job board in the industry at jobs.AOPAnet.org.

Job Board Member Nonmember $80 $140

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


2014

July 7-12 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be adminis-

tered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic techni-cians in 250 locations nationwide. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

Audio Conference

July 9AOPA: The OIG—Who Are They and Why Are They Important? Register

online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email [email protected].

July 25-26 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health

Education Center, St. Petersburg, FL.Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

August 1 ABC: Practitioner Residency Completion Deadline for the September 2014 Exams. Contact 703/836-7114,

email [email protected], or visit www.abcop.org/certification.

August 1-2 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health

Education Center, St. Petersburg, FL.Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

Audio Conference

August 13AOPA: AFO/KAFO Policy—Understanding the Rules. Register


August 14-15Spinal Technology Scoliosis Orthotic Symposium—Scoliosis Management, Spinal Trauma Management,

and Lower-Limb Orthotics Management. Spinal Technology Inc. hosts our annual Scoliosis Symposium in Boston. Course will cover full-time scoliosis bracing protocol for adolescent idiopathic scoliosis; the Providence Nocturnal Scoliosis System; measure-ment techniques and brace options for lower-limb orthotics; with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABC-certified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. Contact Nancy Francis at [email protected] or call 508/775-0990 x8374.

September 4-797th AOPA National Assembly. Las Vegas. Mandalay Bay

Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or [email protected].

www.bocusa.org

Year-Round TestingBOC Examinations. BOC has year-round testing for all of its examinations. Candidates

can apply and test when ready, receiving their results instantly for the multiple-choice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email [email protected].

Let us share your upcoming event!Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember

25 or less $40 $50 1/4 page Ad $482 $678

26-50 $50 $60 1/2 page Ad $634 $830

51+ $2.25/word $5.00/word

BonUs! Listings will be placed free of charge on the “Attend o&P events” section of www.AOPAnet.org.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email [email protected] 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.

For information on continuing education credits, contact the sponsor. Questions? Email [email protected].

Online TrainingCascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free

ABC-approved online courses, designed for pediatric practi-tioners. Visit www.cascadedafo.com or call 800/848-7332.

CE Credits

CALENDAR

Calendar rates

Audio Conference

September 10AOPA: Urban Legends in O&P: What To Believe. Register online

at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email [email protected].

September 13-14The Foot and Ankle: From Athletic to Decrepit. Durham, NC. Study pathology-based treatments,

orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

September 27-28 The Foot and Ankle: From Athletic to Decrepit. Asheville, NC. Study pathology based treatments,

orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

Audio Conference

October 8AOPA: Medicare Enrollment, Revalidation, and Participation. Register


Bio-Mechanical Composites, Inc.

October 10Fall 2014: Learning and Leisure—“Dynamic Response

Orthotic System” Certification Course. Join us at the LaGuardia Airport Marriott in New York the day prior to the POMAC meeting. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www.phatbraces.com. For more information, call 515/554-6132.

October 16-18Virginia Orthotic & Prosthetic Association. Glen Allen, VA. Wyndham

Virginia Crossings Resort & Conference Center. For more infor-mation, visit www.vopaweb.com or email [email protected].

November 5-7New Jersey Chapter AAOP Educational Seminar. NEW LOCATION: Revel Atlantic City Resort Casino, NJ. For more information, visit www.njaaop.com or email [email protected].

November 6-7COPA 2014 Northern California Educational Event. Hilton Garden Inn. Emeryville, CA. For more information, visit www.regonline.com/builder/site/?eventid=1567170.

November 8-9 The Foot and Ankle: From Athletic to Decrepit. Durham, NC. Study pathology-based treatments,

orthotics, shoe modifications and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

Audio Conference

November 12AOPA: Gifts—Showing Appreciation Without Violating the Law. Register


November 15Midwest Chapter AAOP—One-Day Fall Symposium. Hickory Hills, IL. For more information, visit www.mwcaaop.org/meetings-events.html or email [email protected].

Audio Conference

December 10AOPA: New Codes and Changes for 2015. Register online at http://

bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email [email protected].

2015

OCTOBER 7-1098th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information,

contact AOPA Headquarters at 571/431-0876 or [email protected].


Company Page Phone Website

ALPS South LLC 9 800-574-5426 www.easyliner.comAmfit, Inc. 41 800-356-3668 www.amfit.comCailor Fleming Insurance C3 800-796-8495 www.cailorfleming.comDAW Industries 1 800-252-2828 www.daw-usa.comDr. Comfort 5 877-713-5175 www.drcomfort.comFillauer C2 800-251-6398 www.fillauer.comHersco 2 800-301-8275 www.hersco.comOttobock C4 800-328-4058 www.professionals.ottobockus.comPEL 7 800-321-1264 www.pelsupply.com

CALENDAR

Advertisers indeX


AOPA receives hundreds of queries from readers and members who have questions about

some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at [email protected].

Constant ContactAnswers to your questions regarding mailings and address information

Q/ Given the Medicare guidelines for contacting patients, can

I ever call or mail postcards to my patients?

A/ Most of Medicare’s prohibi-tions on contacting your

patients are outlined in Supplier Standard 11. Prohibited contact applies only to contact via telephone, meaning any other form of contact—including mailing postcards—is permitted at any time.

This standard does not eliminate your ability to contact patients via telephone. You may still contact patients by phone if one of the following criteria has been met:• The patient has given you writ-

ten permission to contact him or her concerning the furnishing of a Medicare-covered item.

• You are contacting the patient to coordinate delivery of a Medicare-covered item.

• You provided a Medicare-covered item to the patient within the past 15 months.

The intent of this standard is to eliminate unsolicited calls to the patient in order to drum up potential sales; it is not designed to block your ability to treat your patient.

Q/ What address should I use on my delivery slip or proof of

delivery: my office address or the patient’s home address?

A/ The address you should use depends on where you actually

delivered the item. The delivery address that appears on the delivery slip must match the physical address of where the items/services were provided. For example, if the items were delivered in your office, the delivery address should be your office address. If you delivered the items at the patient’s home, the delivery address should be the patient’s home. If you delivered the items in a physician’s office, the delivery address should be the physician’s office.

Q/ When filling out the advanced beneficiary notice (ABN) form,

what information must be included in Section A or the Notifier section?

A/ The intent of Section A is to indicate who provided the

ABN to the patient and to provide the patient with a means of following up with any questions he or she may have about the ABN form. At a minimum, you must include your company’s name (to show who provided the ABN) and your company’s address and telephone number (so the patient may contact you, either in writing or by phone, if he or she has any questions). You may also include a fax number or email, but these are not required.

Q

3

ASk AOPA

Call Cailor Fleming today and we’ll gladly customize a specifi c plan for you.We’ve been a trusted insurance company for years, let

our experience and lasting service speak for itself.

PROFESSIONAL LIABILITY | GENERAL LIABILITY | PROPERTY | AUTO | UMBRELLA | WORKERS COMP & MORE

800-796-8495http://cailorfl eming.com/OandP.asp

AOPA’S INSURANCE PROGRAM— Practitioners trust us most because we know your business and we know insurance unlike any other program.

An Endorsed Member of AOPA

Support You Can Count On!

The incredibly responsive DynamicArm elbow gives your patients the power and speed to get things done! The powerful electric motor and VarioDrive clutch go from zero to full � exion in half a second, and provide quick, precise positioning.

Now with a high li� ing force of up to 13 lbs and a more natural appearance, the DynamicArm is a great way to li� your patient to the next level.

Attend the workshop quali� cation course at Academy. If you’d like more information—or to have your patient trial the DynamicArm—please contact your sales rep at 800 328 4058.

Responsive. Powerful. Dynamic. The DynamicArm elbow prosthesis

www.professionals.ottobockus.com

12822_DynamicArm_Ad.indd 2 11/21/13 8:35 AM

July 2014 Almanac

Documents

Transcript of July 2014 Almanac