April 2019 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

A P R I L 2019

Four Steps To Ensure a Valid ABN Form P.16

Protecting Your Facility When Disaster Strikes P.28

Prioritizing

Patients O&P ADVOCATES PUSH FOR LEGISLATION TO PROMOTE THE SAFE PROVISION OF O&P SERVICES BY QUALIFIED PROVIDERS P.22

E! QU IZ M

Common Mistakes in Developing Performance Management Plans

EARN

BUSINESS CE

CREDITS P.18 & 38

P.36

AFO Research for Poststroke Patients WWW.AOPANET.ORG

P.40

This Just In: The Perils of Lead Generation Marketing of Orthoses P.20

YOUR CONNECTION TO

EVERYTHING O&P

contents

APR I L 2019 | VOL. 68, NO. 4

FEATURES COLUMNS

COVER STORY

22 | Prioritizing Patients

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

ABN Advice

Steps for proper completion of the Advanced Beneficiary Notice

O&P advocates across the nation are getting behind two important pieces of legislation that are designed to protect and benefit O&P patients. The proposed Medicare Orthotics and Prosthetics Patient-Centered Care Act would distinguish O&P from durable medical equipment and clarify the meaning of “minimal self-adjustment.” The Wounded Warrior Workforce Enhancement Act would create grants to help universities establish or expand O&P master’s degree programs.

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

CREDITS

Compliance Corner............................... 36

The Bottom Line in Performance Management

Tips on collecting data, measuring outcomes, and more

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

CREDITS

Member Spotlight................................ 44 n

20 | This Just In

Speaking Out Against Lead Generation Marketing AOPA has released a position statement opposing lead generation marketing of orthoses. This model of delivery does not offer patient evaluation or fitting by certified orthotists and does not include patient education or follow-up care—falling short of the standard of care required to provide high-quality orthotic intervention.

28 | Weathering the Storm

P. 20

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

AOPA Board member Teri Kuffel, JD, shares strategies for O&P advocacy

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

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

P. 28

Stefania Fatone, PhD, BPO (Hons).................40 Meet the lead investigator on a new study that examines use of ankle-foot orthoses (AFOs) by individuals with poststroke hemiplegia who use an AFO to facilitate ambulation.

At-a-glance statistics and data

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

PHOTO: American Red Cross

PRINCIPAL INVESTIGATOR | SPECIAL EDITION

APRIL 2019 | O&P ALMANAC

SoleTech

DEPARTMENTS

Does your facility’s contingency plan adequately address all of the needed steps to protect patients and employees and minimize physical and financial damages should a natural disaster strike? Read tips and takeaways from experts and O&P professionals who have successfully navigated hurricanes, fires, and winter storms. By Christine Umbrell

Alliance Orthotics and Prosthetics

Research, updates, and industry news

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

Transitions in the profession

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

AOPA meetings, announcements, member benefits, and more

AOPA New Members........................... 49 Careers........................................................ 50

Professional opportunities

Ad Index........................................................5 1 Marketplace.............................................. 52 Calendar...................................................... 54

Upcoming meetings and events

Ask AOPA................................................... 56

Bilateral modifiers, salvage claims, and more

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% of amputees

have fallen in the last year1

% of falls result in injury

with half needing medical attention2

% reduction in falls

while using Proprio Foot3

1. Miller, William C., Mark Speechley, and Barry Deathe. “The prevalence and risk factors of falling and fear of falling among lower extremity amputees.” Archives of physical medicine and rehabilitation 82.8 (2001): 1031-1037. 2. Kaufman, K. Risk factors and costs associated with accidental falls among adults with above-knee amputations: a population-based study. American Orthotic and Prosthetic Association 2016.(Mayo Clinic). http://www.aopanet.org/resources/research/ 3. Ludviksdottir A, Gruben K, Gunnsteinsson K, Ingvarsson Th, Nicholls M. Effects on user mobility and safety when changing from a carbon fiber prosthetic foot to a bionic prosthetic foot. Presented at Orthopadie&Reha-Technik Congress, Leipzig, May 2012.

VIEWS FROM AOPA LEADERSHIP

Time To Plant Some Seeds

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

T’S THAT TIME OF YEAR. The snow is melting

in Minnesota, and the April showers bring May flowers. It’s quite invigorating to watch our black-and-white world blossom with all kinds of beautiful color. Most of the seeds were planted years ago, but they return with bigger and bolder blossoms each year. It’s also that time of the year when a group of us from Minnesota make the concerted effort to attend the AOPA Policy Forum in Washington, DC. About 10 years ago, I started to “hobby lobby” at our nation’s capital. No one asked me to do it; I was drawn to it—drawn to help a certain group of people who needed it. It’s that simple. I had no idea the seeds we would plant, the mountains we would climb, nor the invigoration we would feel, together. That first year our Minnesota group included an 11-year-old bilateral amputee and his mother, who sat on the board of a local nonprofit for amputees. Her passion to make a difference in her son’s life was like none I had ever seen. As O&P business owners, my husband, Charles Kuffel, MSM, CPO, LPO, FAAOP, and I felt compelled to do more than tell legislators they should better our systems. We felt compelled to show them, through the eyes of a passionate mother and her child, who had his whole abled-life ahead of him. That child is now an adult who attends an O&P school in Minnesota, and who is planning a career to help other amputees. Over the years, his mother was instrumental in testifying at committee hearings at the Minnesota State Capitol, which ultimately led to the passage of licensure for orthotists, prosthetists, and pedorthists in Minnesota. Amazing how planted seeds can blossom! Whether you are an O&P business owner, a practitioner, or an administrator, determined to do more for your patients, or just someone who has thought, “Wow, I’d really like to go to DC to see how I can make a difference,” the AOPA Policy Forum is for you! Please join us to learn about the things that matter most in our O&P world and how we can work together to make a difference in the lives of our patients, colleagues, friends, and family members. The appointments will be made for you, but if you call ahead to your congressperson’s office and let them know you’re coming (with or without someone who has experienced limb loss or limb impairment), you just might get some face time. Minnesota always does. My anticipation is, your experience will be invigorating and you will feel compelled to return. My hope is, you will plant a few seeds in your garden, in your legislator’s garden, or in the lives of that certain group of people who make us realize that our world is not so black and white after all, but filled with all kinds of beautiful color. Please, join us in DC for the AOPA Policy Forum May 7-8. For more information, please visit www.aopanet.org. Teri Kuffel, JD, is a member of AOPA’s Board of Directors.

APRIL 2019 | O&P ALMANAC

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

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AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Joy Burwell, director of communications and marketing, 571/431-0817, jburwell@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

APRIL 2019 | O&P ALMANAC

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

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

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

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

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NUMBERS

Health-Care Costs on the Rise for Americans With Private Insurance Report examines total health-care spending for Americans covered by employer-sponsored plans and their dependents

Total annual per-person spending on individuals under age 65 covered by employer-sponsored health insurance (ESI) increased 16.7 percent over the fiveyear period between 2013 and 2017, climbing from an average of $4,834 in 2013 to $5,641 in 2017, according to the “2017 Health-Care Cost and Utilization Report,” published in February 2019 by the Health Care Cost Institute. The report relies on claims data from four of the country’s largest private insurers: Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. The report drew on the health-care claims of more than 40 million Americans to provide a view into healthcare spending, use, and prices for this population.

CHRONIC CONDITIONS’ IMPACT ON ANNUAL COSTS IN 2017

$8,921

Per-person health-care spending for those with one chronic condition.

$20,257

Per-person health-care spending for those with two or more chronic conditions.

34 Percent

Professional services spending, including office visits (e.g., O&P services).

28 Percent

Outpatient visits and procedures.

OUT-OF-POCKET SPENDING

15.4 Percent

Ages 19-25 $ 3,254

Ages 26-44 $ 4,871

Ages 45-54 $ 7,282

Ages 55-64 $ 10,476

APRIL 2019 | O&P ALMANAC

18 Percent

Prescription drugs.

OUT-OF-POCKET COSTS ON THE RISE

RISING COSTS OF PREMIUMS

14 Percent

Rise in premium costs for ESI plans between 2013 and 2017 for single coverage.

15 Percent

Rise in premium costs for ESI plans between 2013 and 2017 for family coverage.

2017 Spending Per Person By Age

Inpatient admissions.

Share of spending paid out of pocket in 2017 for deductibles, co-payments, and co-insurance.

HEALTH-CARE COSTS INCREASE WITH AGE Ages 18 and Under $ 3,170

20 Percent

“Total out-of-pocket spending per person rose each year between 2013 and 2017, rising a cumulative 12.2 percent ($94) over the five-year period. These estimates do not include premiums paid for insurance coverage, and so do not reflect the full financial costs for individuals with ESI.” —“2017 Health-Care Cost and Utilization Report,” Health Care Cost Institute

SOURCE: “2017 Health-Care Cost and Utilization Report” from the Health Care Cost Institute, February 2019

$3,603

Per-person health-care spending for those with no chronic conditions.

AVERAGE PORTION OF TOTAL PER-PERSON SPENDING BY COST TYPE IN 2017

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Happenings O&P ADVOCACY

Patient Resources Translated to Spanish For clinicians treating significant Spanish-speaking populations, new resources are available from the Amputee Coalition. The organization has launched a new Spanish microsite and Facebook page to serve the Spanish-speaking community. Amputees and their caretakers can turn to these new resources for information about their unique medical and psychological needs. Both the microsite and the Facebook page address common amputation topics, family issues, difficulties for older amputees, and needs of caregivers. The Spanish microsite can be found at www.amputee-coalition.org/ coaliciondeamputados and coaliciondeamputados.org.

APRIL 2019 | O&P ALMANAC

European Team Builds Prosthesis With Proprioceptive Properties

Swiss, Italian, and German neurologists and engineers have teamed in building a next-generation prosthetic hand that offers users proprioception, or the ability to feel position and movement. The prosthesis has been designed to send touch information to the brain through electrodes patched into the nerves of the arm— information that is used to provide real-time proprioceptive feedback. “Our study shows that sensory substitution based on intraneural stimulation can deliver both position feedback and tactile feedback simultaneously and in real time,” said Silvestro Micera, PhD, a professor in the School of Engineering at the École Polytechnique Federale de Lausanne (EPFL), in a press release. “The brain has no problem combining this information, and patients can process both types in real time with excellent results.” The research team tested its approach with two transradial amputee subjects,

who were able to regain “high and close-to-natural remapped proprioceptive acuity,” according to the researchers. The subjects were asked to use the new technology, which works by stimulating nerves in the amputees’ residual limbs, to reach out for objects on a table and to ascertain each object’s consistency, shape, position, and size without looking at it. Both subjects could discriminate the size and compliance of four objects with high levels of performance. The results demonstrate that “tactile information delivered via somatotopic neural simulation and position information delivered via sensory substation can be exploited simultaneously and efficiently by transradial amputees,” according to the researchers. The research was published in a technical article titled, “A Closed-Loop Hand Prosthesis With Simultaneous Intraneural Tactile and Position Feedback,” in the February 20 issue of Science Robotics.

PHOTO: ©Luca Rossini

RESEARCH ROUNDUP

HAPPENINGS

Researchers Pave Way for Solar-Powered Prostheses Engineers from the University of Glasgow have made a breakthrough in energy storage technology that could lead to the development of flexible electronic devices, including solarpowered prostheses. A research team from the university’s Bendable Electronics and Sensing Technologies unit has used layers of graphene—a thin, strong, “supermaterial” just one atom thick—and polyurethane to create a flexible supercapacitor that can generate power from the sun and store excess energy. The technology harnesses sunlight as it passes through the top layer of graphene to generate power via a layer of flexible photovoltaic cells. Surplus power is stored in a supercapacitor for later use. The technology is designed to be used as “energy autonomous e-skin,” with the potential for use in prostheses, according to the researchers. The engineers worked to develop a ratio of

graphite to polyurethane that “provides a relatively large, electroactive surface area where power-generating chemical reactions can take place, creating an energy-dense flexible supercapacitor [that] can be charged and discharged very quickly,” according to a press release. “This is the latest development in a string of successes we’ve had in creating flexible graphene-based devices [that] are capable of powering themselves from sunlight,” said Ravinder Dahiya, PhD, professor of electronics and nanoengineering at the University of Glasgow’s School of Engineering. “There’s huge potential for devices such as prosthetics, wearable health monitors, and electric vehicles which incorporate this technology, and we’re keen to continue refining and improving the breakthroughs we’ve made already in this field.” Details of the research were published in the February 13 issue of Advanced Science.

DIABETES DOWNLOAD

Study Links Diabetes To Cardiovascular Deaths Diabetes is associated with a 16 percent increase in dying from any cause and an 18 percent increase in dying from cardiovascular disease, according to new research published in the February 19 Journal of the American Heart Association. Researchers from several hospitals in the U.S. Department of Veterans Affairs (VA) system examined data from nearly one million individuals treated in the VA health-care system between 2002 and 2014, including 330,000 with diabetes, and concluded that while diabetes-related deaths were lower than during the 1980s and 1990s, the disease still had a major impact on higher death rates. The study also found

that individuals with diabetes who had an A1C level—a measure of average blood glucose control for the past two to three months—of between 6.0 and 6.9 percent had the lowest incidence of death, regardless of their age. The researchers called for health-care providers to educate patients about the relationship between diabetes and cardiovascular disease, and to promote nutrition and exercise to decrease heart disease risk. “You can actually mitigate a lot of the mortality risk related to diabetes by controlling cardiovascular risk factors like smoking and cholesterol levels and blood pressure levels,” said Sridharan Raghavan, MD, the study’s lead author.

MEDIA MADNESS

New Stock Photo Collection Boosts Representation of Individuals With Disabilities

Verizon, Getty Images, and the National Disability Leadership Alliance have partnered to create “The Disability Collection,” a growing collection of stock images that are designed to “break stereotypes and authentically portray people with disabilities,” according to Verizon Media. “We are empowering our industry to get real about disability representation with stock photos that can be licensed and used by anyone in the world.” The collection features hundreds of images, including photos of people wearing prostheses. It can be viewed by searching “The Disability Collection” at gettyimages.com. In addition, browsers are invited to submit their own images to the collection, apply to be a model in a photo shoot, or host a photo shoot at their own location. Individuals who have disabilities are asked to share their stories on social media using #thedisabilitycollection.

O&P ALMANAC | APRIL 2019

HAPPENINGS

NATIONAL ASSEMBLY NEWS

Save the Date

Mark your calendar for Sept. 25-28, 2019, and make your travel plans now to attend the 2019 AOPA National Assembly. Participants at this year’s conference will travel to the San Diego Convention Center, just a short walk from award-winning dining venues, shopping, and nightlife in the historic Gaslamp Quarter. The convention center itself features three Starbucks, a FedEx office, and free Wifi. AOPA has reserved room blocks at four nearby hotels. Attendees are responsible for making their own hotel reservations. Visit the AOPA website for details on four hotel options: Hotel Solamar San Diego, Hard Rock Hotel San Diego, Hilton San Diego Bayfront, and Omni San Diego Hotel.

APRIL 2019 | O&P ALMANAC

AOPA Invites O&P Advocates to 2019 Policy Forum Registration is open for the 2019 AOPA Policy Forum, scheduled for May 7-8 in Washington, D.C. The Policy Forum offers an opportunity to learn the latest legislative and regulatory proposals and find out how they will affect you, your business, and your patients. During the Forum, participants will receive education and training before heading to Capitol Hill to educate members of Congress and their staff on common-sense solutions and share how the O&P profession restores lives and puts people back to work. New attendees are invited to take AOPA’s Lobbying 101 course, which provides

simple and effective measures to familiarize participants with laws, procedures, and tips for communicating with Congress. Visit the AOPA website for scheduling details or to register.

Hanger Hosts 2019 Education Fair and National Meeting presented a full day of clinical keynote sessions, including talks on clinical outcomes measurement and utilization, telemedicine applications in amputation care, and neurally integrated assistive technology. Leaders from Hanger Clinic’s Department of Clinical and Scientific Affairs presented on Hanger-led initiatives, including a lower-limb prosthetic activity tracker developed in partnership More than 1,100 Hanger employees, with AT&T and the next phases of including 850 clinicians and therapists, Hanger Clinic’s Mobility Analysis took part in Hanger Inc.’s 2019 of Amputees (MAAT) studies. Education Fair & National Business The Vegas event featured more Meeting, held February 18-22 in than 115 exhibits. During the awards Las Vegas. The annual conference ceremony, Hanger recognized provided continuing education, several supplier partners for their offered a venue for patients to role in manufacturing products used share personal challenges and to deliver exceptional O&P care, accomplishments, and paid tribute to including PLS for being a “Rising Star,” employees during an awards ceremony. Fillauer for “Collaboration,” Townsend Instructors taught approximately Thuasne USA for “Innovation,” 100 courses throughout the week. and College Park Industries for Physicians, scientists, and therapists “Operational Performance.”

PHOTO: Hanger Clinic

MEETING MASHUP

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PEOPLE & PLACES

PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Traci Dralle, CFM, has been named president of Fillauer Companies Inc. and has responsibility for the company’s business units. She reports to Chief Executive Officer Michael Fillauer. Dralle joined Fillauer in November 2012 as Traci Dralle, CFM director of marketing and was promoted to vice president in 2017. During her tenure, she helped unite all Fillauer subsidiaries together with a shared mission and common direction. “As vice president, Traci has helped to lead Fillauer through two years of growth and innovation. She has been instrumental in defining and implementing our new business strategy and forming and strengthening strategic partnerships as we embark on our second century as a leader in the orthotics and prosthetics industry,” said Michael Fillauer. “Traci’s outstanding performance and commitment to Fillauer have brought many achievements for our organization, and I am confident that her new role will lead to many more in the years to come.” Courtesy of Össur

Hugh Gill, BSc (Hons), HonFIES, developer of the world’s first bionic multiarticulating prosthetic hand, has been named an honorary member of the American Academy of Orthotists and Prosthetists (AAOP). Hugh Gill, BSc Gill, who is vice president of research and (Hons), HonFIES development for upper-limb prosthetics at Össur, was lauded by AAOP’s Board of Directors for his contributions to the O&P profession, which include developing the i-limb® and i-digits™ prosthetic limbs. “Hugh’s work and dedication to the field of orthotics and prosthetics—and those served by our organization—is nothing short of inspirational,” said Alicia J. Davis, MPA, CPO, FAAOP(D), senior orthotist and prosthetist at the University of Michigan and immediate past president of AAOP. “Our committee was moved by his desire to make people’s lives better, not merely by building a more well-engineered hand, but by really listening to the needs of patients, and how his work could make their everyday lives better.”

APRIL 2019 | O&P ALMANAC

Erin Hayes has been named to the Dralla Foundation Review Board as interim member. The Dralla Foundation was founded by Peter Allard, president of Allard USA, and awards grants each year to select Erin Hayes nonprofits that are aligned with its mission. Hayes has more than 13 years of fundraising experience in both nonprofit and for-profit organizations. She will team with other board members to determine distribution of funds for this year’s grantees to determine where the Dralla Foundation can make the most meaningful impact for children and adults with physical challenges. The next round of awards will be announced in May. Regina Weger has been promoted to vice president and general manager of Hanger Inc.’s SPS subsidiary. Weger has been with SPS for more than 20 years, most recently serving as vice president of SPS sales and marketing. Regina Weger “This is a well-deserved promotion for Regina, as she has been functioning in a general manager capacity for us, taking on several additional leadership responsibilities on top of her role as vice president of sales and marketing,” said Jay Wendt, president of Hanger’s products and services business segment. “Regina has been integral in leading our SPS team to consistent, sustainable growth with strategic partnerships and streamlined operations, strengthening our products and services organization as a whole.”

THE LIGHTER SIDE

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REIMBURSEMENT PAGE

By DEVON BERNARD

ABN Advice Follow four steps to ensure proper documentation if Medicare may deny payment for services

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

APRIL 2019 | O&P ALMANAC

ITH THE INCREASE IN denials

for “reasonable useful lifetime” and “same or similar devices,” more questions have been arising regarding the use of the Advanced Beneficiary Notice of Noncoverage (ABN) form. This month’s Reimbursement Page examines four things you should pay attention to when completing the ABN. This is important because a mistake in filling out the ABN can result in the form being considered invalid and not accepted by Medicare. The ABN is used to notify Medicare beneficiaries that you believe that Medicare will deny a claim as not medically necessary—and if Medicare denies the claim for medical necessity reasons, the beneficiary will be financially responsible to pay for the services provided. Using the ABN also allows you to collect your full usual and customary charge for an item or service at the time of delivery. While you still remain obligated to submit a claim at the request of the beneficiary, if Medicare denies that claim due to the reason stated on the ABN, you are not required to refund the patient any payment collected (unless Medicare considers the ABN invalid), and you are permitted to bill the patient directly for the service if no payment was collected at the time of delivery.

STEP 1 Use the Proper Form

The first step when asking your patients to sign an ABN form is to make sure you are using the correct and most recent version of the form. As with all Medicare forms, the ABN is routinely examined—approximately every three years—and updated if needed. The last time the ABN was examined was in 2017, and at that time the form was updated. The revised ABN went into effect for all claims with a date of service on or after June 21, 2017. There are two ways to determine whether you are using the most recent and correct version of the form. First, you can look for this statement at the bottom of the form, which was added when the form was updated in 2017: “CMS does not discriminate in its programs and activities. To request this publication in an alternative format, please call: 1-800-MEDICARE or email: AltFormatRequest@cms.hhs.gov.” Second, look at the bottom left corner of the form, where the form number is located. If your version of the ABN reads “Form CMS-R-131 (03/11),” then you are using the incorrect form, or the previous version of the

REIMBURSEMENT PAGE

ABN. The current ABN form should read “Form CMS-R-131 (03/20).” When reviewing the bottom portion of the ABN, you also may see the disclaimer statement about the form being subject to the Paperwork Reduction Act of 1995. It may seem very innocuous, but you must make sure this statement is present on your ABN form; if this statement or the form numbers are missing, Medicare could consider the ABN invalid.

STEP 2 Provide Accurate Information in the Notifier Section

After ensuring the copy at the bottom of the ABN signifies the form is the most recent version, pay attention to the information you place in the notifier section of the form. This is where you must place information about your facility, or

the group issuing the ABN to the patient. The ABN is not like a proof of delivery form, where you must list the exact location or address of where the ABN was issued. However, you must provide information so that the beneficiary or the beneficiary’s representative knows whom to contact with questions about the ABN. At a very minimum, you must include your facility’s name, address, and telephone number. You may choose to add more information, such as a fax number or email address, but doing so is optional. It doesn’t matter how the required information is presented—it can be part of your logo, it could be a sticker, or it could be handwritten—but it must appear on the top of the form. If any of the minimum information is missing, the ABN could and will be considered invalid. If, for some reason, the notifier is not the billing entity, you must let

the beneficiary know how and where to direct any billing questions. To do this, you must provide alternate contact information in the additional information section of the ABN— Section H on the current form.

STEP 3 Follow CMS Guidance on Supplier Alterations

Next, it’s important to follow updated instructions when completing the form. CMS routinely provides updated guidance on how the ABN form is to be filled out. This is the case with new directions on what to do if you are having the patient sign an ABN and you have elected not to accept assignment on the claim. When this scenario occurs, Medicare requires the supplier/notifier to make two alterations to the ABN form.

O&P ALMANAC | APRIL 2019

REIMBURSEMENT PAGE

The first alteration is in Section G— the section where the beneficiary makes a choice about whether he or she wishes to proceed with care and sign the ABN. On the current form, Option 1 in Section G reads: “I want the (blank) listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles.” If you are not accepting assignment, the new directions require you to cross out the last sentence in Option 1: If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles. When crossing out the last sentence, the approved method is to use a single strikethrough line. You may do this on preprinted ABNs, or you may do it by hand. However, you should not completely black out or delete the sentence, and you are not required to include your initials or date as you would when making alterations to other documents in the patient’s record. That is provided the alteration took place before the patient signed the ABN. In addition, you must make a second alteration to the form—in Section H, the additional information section—if the patient signs an ABN and you have elected not to accept assignment. You must include the following 18

APRIL 2019 | O&P ALMANAC

CMS-approved statement: “This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.” If this statement is missing on an unassigned claim, then the ABN is considered invalid.

STEP 4 Secure the Proper Signatures

We started in Step 1 with the bottom of the ABN form, so we shall end with the bottom of the ABN form—the signature requirements for an ABN to be considered valid. This section and requirement is straightforward: The patient must sign and date the ABN form after he or she has read the form and made an informed decision about proceeding or not proceeding with care—receiving or not receiving the orthosis/prosthesis. Things may get more confusing if the patient is unable or unwilling to sign the ABN. If the beneficiary is unable to sign the ABN, you may look to an authorized representative to sign. An authorized representative is “a person who is acting on the beneficiary’s behalf and in the beneficiary’s best interests, and who does not have a conflict of interests with the beneficiary.” Just as with proof of delivery slips, neither you nor your employees may sign the ABN as an authorized representative because you have a conflict

of interest, a financial stake in the claim. Typically, an authorized representative would be, unless otherwise indicated by the patient via a power of attorney or similar statement, a current spouse, an adult child, a parent, or an adult sibling. In extreme cases, a close friend could be considered an authorized representative. When a representative signs on behalf of the beneficiary, he or she should write out “representative” in parentheses after his or her signature, and you should document in your records who signed and why. Also, you should ensure the representative’s name is clear and legible, so you may ask that individual to print his or her name on the ABN form. If the patient simply has difficulty with writing and requires assistance, you may have him or her sign the ABN form, and you as the supplier/notifier can fill in the date portion of the form. If the patient refuses to sign and date the completed ABN form, you would want to annotate the form to indicate this decision, and possibly list any witnesses who were present when the patient refused to sign. Remember that if the patient refuses to sign the ABN, you are not under any obligation to provide care.

Proper Paperwork

The ABN form is an important document, one that is useful to O&P clinicians when they believe Medicare will deny a claim as not medically necessary. Following the four tips outlined above should help ensure you provide a compliant and valid ABN to your patients. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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This Just In

Speaking Out Against Lead Generation Marketing AOPA opposes broad-stroke advertising and advocates for appropriate orthotic care for Medicare beneficiaries

OPA HAS ANNOUNCED THAT it

is strongly opposed to the model for delivery of orthoses that relies on what is known as lead generation marketing to identify and recruit potential patients for treatment with orthoses. Lead generation marketing uses broad-stroke advertising such as television ads, websites, and social media to encourage potential patients to contact a call center, which then provides the

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â&#x20AC;&#x153;leadsâ&#x20AC;? to a select group of physician referral sources and medical equipment suppliers. These individuals then facilitate the delivery of one or more orthoses to the patient, often without the patient ever seeing the referring physician or the supplier of the device. This model of delivery is of great concern to AOPA as it does not include any fitting of the orthoses by healthcare professionals, such as certified and/or licensed orthotists. This model does not include patient education on the proper care and use of the orthosis or follow-up care to ensure that the orthosis is providing its intended benefit. It also lacks any kind of patient evaluation to determine the clinical appropriateness of the prescribed orthosis. This model of delivery is not one that is interested in the provision of clinically appropriate orthoses by properly trained, educated, and certified or licensed orthotic professionals. It is simply an opportunity for unscrupulous providers to take advantage of loopholes in the Medicare claims processing system to generate as much revenue as possible without regard to the medical need of the orthoses they are marketing.

This Just In

In addition, lead generation marketing of orthoses typically relies on a limited number of physician referral sources who often have no relationship with the patient prior to their brief consultation, usually over the telephone, upon referral from the lead generation company. These physicians are often fully aware of their role in this process and are often compensated by the lead marketing company on a per prescription basis. This practice is clearly not in the best interest of Medicare beneficiaries. Recent reports published by the U.S. Department of Health and Human Services Office of Inspector General (OIG) have confirmed that there have been increased instances of fraud and abuse involving knee and spinal orthoses. AOPA believes that lead generation marketing strategies may be a significant contributor to this increase in fraud and abuse investigations. The orthoses that have

This model of delivery is not one that is interested in the provision of clinically appropriate orthoses by properly trained, educated, and certified or licensed orthotic professionals. been highlighted in the OIG reports have shown significant increases in utilization since the first appearance of the online and televised advertisements produced by lead generating marketing companies. It is not a coincidence that the largest increases in Medicare spending for orthoses represent the high-cost orthoses that are being marketed to unsuspecting Medicare beneficiaries. AOPA firmly believes that Medicare beneficiaries deserve to receive the highest quality, most clinically appropriate orthotic care available and that it is in the best

interest of the Medicare program to ensure that the delivery of all orthoses be coordinated through the physician or practitioner who is treating the patient’s orthopedic condition and a properly trained and educated orthotic provider, such as a certified or licensed orthotist. Alternative models, such as those that use lead generation marketing, will continue to facilitate increased fraud and abuse, unnecessary costs and utilization, and the delivery of ill-fitting orthoses that may not be medically necessary without any clinical care, patient follow up, or patient education.

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O&P ALMANAC | APRIL 2019

COVER STORY

Prioritizing

Patients

O&P STAKEHOLDERS ARE RALLYING BEHIND TWO IMPORTANT PIECES OF LEGISLATION THAT ARE MEANT TO IMPROVE PATIENT CARE FOR O&P CONSUMERS

APRIL 2019 | O&P ALMANAC

COVER STORY

NEED TO KNOW ★★ Two proposed pieces of legislation are garnering buzz within the O&P community. Participants in next month’s AOPA Policy Forum will champion these proposals during one-on-one meetings with members of Congress in Washington, D.C. ★★ The Medicare Orthotics and Prosthetics Patient-Centered Care Act is a new proposal for 2019. It is expected that this proposed legislation will include provisions to ensure safe and effective patient care by qualified O&P clinicians. ★★ The Wounded Warrior Workforce Enhancement Act would create grants to help universities establish master’s degree programs in O&P or to expand upon existing institutions’ master’s programs. ★★ O&P professionals of all ages and in all areas of the country can become advocates for O&P by reaching out to legislators at town halls, during legislators’ visits back to their districts, or via letters, emails, and phone calls.

HERE IS OPTIMISM IN the air

surrounding two proposed pieces of legislation that are designed to prioritize O&P patient needs and protections. O&P professionals will be advocating for the patient-focused provisions within both the Medicare Orthotics and Prosthetics Patient-Centered Care Act and the Wounded Warrior Workforce Enhancement Act at next month’s AOPA Policy Forum. During the May 7-8 event, AOPA members and O&P stakeholders, many of whom will be accompanied by patient advocates, will gather in Washington, DC, to meet with members of Congress, share the O&P story, and ask for legislators’ support of these two important initiatives. While advocates work year-round to advance the O&P legislative agenda via in-person meetings, facility visits, phone calls, and written communications, the Policy Forum provides a unique and timely opportunity to convene O&P stakeholders from across the country to unite their voices in spreading the O&P message. “It’s critically important that we stay on the radar screen before Congress

and take a proactive position” on issues that have an impact on O&P patients, says Peter W. Thomas, JD, general counsel for the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) and counsel to the O&P Alliance, whose members include AOPA; NAAOP; the American Academy of Orthotists and Prosthetists; the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; and the Board for Certification/Accreditation. This year’s Policy Forum will provide the venue to advance patient interests by advocating for new legislation. With fresh faces in many seats in Congress this year, it will be especially important that O&P advocates share their message and explain how proposed legislation has an impact on O&P patients, according to AOPA Executive Director Eve Lee, MBA, CAE. “Advocacy efforts on behalf of our profession and the patients we serve have never been more important as these new members of Congress must be educated on the value of O&P,” she says. O&P ALMANAC | APRIL 2019

COVER STORY

Protecting patient access to clinical services associated with the provision of orthoses by restoring the original meaning of the term “off-the-shelf orthotics.” This provision would restore Congress’s intended meaning of the term “minimal self-adjustment,” which defines off-the-shelf (OTS) orthoses that may be subject to competitive acquisition. This provision seeks to protect beneficiaries by preserving access to the clinical assessment, fitting, and instruction necessary to achieve the therapeutic value of non-OTS orthoses, as well as to prevent potential patient harm.

MEDICARE ORTHOTICS AND PROSTHETICS PATIENT-CENTERED CARE ACT

Prioritizing Patient Needs

O&P advocates are heading into the legislative season fresh off a huge legislative victory. Last year, the provision from the Medicare O&P Improvement Act recognizing the orthotist’s and prosthetist’s notes as part of the medical record was signed into law as part of the Bipartisan Budget Act of 2018. Section 50402 of the Act amended the Social Security Act to say that “documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals.” That change constituted a clear legislative victory for the O&P profession, signaling recognition of O&P professionals as well-educated and trained health-care professionals whose notes are an integral part of patients’ medical records. Prior to the Bipartisan Budget Act of 2018, O&P advocates had spent a significant amount of time and effort pushing for the recognition of O&P notes via one provision in previously proposed O&P legislation, the Medicare O&P Improvement Act. And while recognition of O&P notes constituted a true “win” for O&P, other provisions in that bill were unfortunately not passed. This year, rather than pushing for the other provisions in the Medicare O&P Improvement Act, O&P stakeholders have drafted new proposed legislation, which streamlines some of the suggestions from the older bill, simplifies some of the more complex elements, and 24

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includes some new provisions as well. This new proposed legislation—which will be a primary focus at the AOPA Policy Forum—is called the Medicare Orthotics and Prosthetics PatientCentered Care Act. The provisions in the Medicare Orthotics and Prosthetics PatientCentered Care Act had not been finalized by the O&P Alliance as of press time, but the overarching goal of the proposed legislation is to advance patient care, according to Thomas. It was expected that three important provisions, or variations thereof, would likely be included: Ensuring safe and effective patient care by distinguishing orthotists and prosthetists from suppliers of durable medical equipment (DME) and supplies. This provision would elucidate the clear distinction between the level of care and service associated with the provision of orthotics and prosthetics and the provision of DME for Medicare beneficiaries. “We’re asking that they regulate O&P separately from DME,” explains Thomas. This provision would help protect patients’ access to services provided by orthotists and prosthetists, thereby improving patient outcomes in terms of improved mobility and compliance with these devices, according to AOPA.

Preserving patient access to OTS orthoses from licensed or certified orthotists or prosthetists. This new provision would ensure that patients have access to the full range of orthotic care, effectively and efficiently, from one O&P practitioner, rather than from multiple providers. It would allow a Medicare patient with a custom orthosis or prosthesis on one side to be fit with an OTS knee brace on the other side, or back brace, and to be reimbursed for that device without being subjected to competitive bidding, explains Thomas. This provision helps ensure efficient and convenient patient care and is similar to the treatment afforded physicians, physical therapists, and occupational therapists, according to Thomas.

The proposed legislation is “very focused on ‘patient-centered care,’ to put the focus on the true beneficiaries of the legislation,” says Tom Andrews, a member of AOPA’s lobbying team. Andrews knows all sides of these issues, as he is both a former member

COVER STORY

of Congress and an amputee; he in the United States, according to National Commission on Orthotic and lost his leg above the knee to cancer Macdonald. Estimates from the VA Prosthetic Education commissioned while in his early 20s. The proposed indicate that more than 80 percent of an update to its 2006 workforce study, language “ensures the patient gets which concluded that demand for O&P care provided to veterans comes from the care he or she needs, and the O&P community-based practices. care will outstrip supply professional gets recognition for the “It’s important that they get by qualified providers over skill and training he or she is equipped their care from well-trained the next 10 years. The with,” says Andrews. and highly qualified providers researchers estimated that, “The next step is to go to Capitol who are familiar with the by 2025, demand for O&P Hill and get our sponsors to introduce unique needs of veterans,” professionals will be about the bill,” says Thomas. It is expected Macdonald says. 60 percent higher than the that, prior to the Policy Forum, the Over the past few years, the available supply of certiCatriona Macdonald O&P Alliance will have achieved legislation has passed the VA fied providers. consensus regarding the final Committee in the Senate three Since then, several language of the bill, and Policy times, but each time failed to make versions of the Wounded Warrior Forum attendees will be educated it out of the full Senate. Until last Workforce Enhancement Act have about each of the provisions as part year, the legislation had not passed been introduced, with the emphasis of their advocacy training. out of committee in the House of on the need for O&P care to “We have heard there Representatives. But there was a breakmeet the needs of the counis strong support among through last year, says Macdonald, with try’s veterans, many of whom our existing champions” the legislation finally passing through will require the services of and are hopeful that some the House Veterans Committee. While O&P professionals over the new legislators will become it didn’t advance in the full House next couple of decades. The strong advocates of O&P, in 2018, there is optimism for 2019 Department of Veterans Affairs says Thomas. He anticinow that the bill has made it out of Sen. Mark Warner (VA) is the largest single pates that Sen. Mark Warner (D-Virginia) committee in both chambers. purchaser of O&P services (D-Virginia) may serve as one of the sponsors of the bill.

Boosting the Number of Qualified Providers

The Medicare Orthotics and Prosthetics Patient-Centered Care Act is not the only piece of legislation that AOPA Policy Forum attendees will be advocating next month. They also will be asking for congressional approval of the Wounded Warrior Workforce Enhancement Act, which would create grants to help universities establish master’s degree programs in O&P or to expand upon existing institutions’ master’s programs. The goal is to ensure enough properly educated and trained orthotists and prosthetists in the future to care for U.S. veterans and the aging civilian population. AOPA and the O&P Alliance first began working on this legislation about six years ago, to help address the “bottleneck” in graduates with master’s degrees in O&P, according to Catriona Macdonald, president of Linchpin Strategies and a consultant working with AOPA to advance the legislation. In 2015, the O&P ALMANAC | APRIL 2019

COVER STORY

WOUNDED WARRIOR WORKFORCE ENHANCEMENT ACT

This is good news, according to Macdonald, as need for the legislation has grown. Georgia Tech—one of the 13 schools offering O&P master’s programs—recently announced the O&P program will graduate its last students in June. Although there seems to be increasing interest in the O&P profession among undergraduates, many applicants to master’s programs are turned away, according to reports. “Many schools average at least three qualified applicants for each position available—and some have as many as 10 qualified applicants for every slot,” she says. Some O&P companies have reported difficulties in finding qualified candidates to fill positions. Macdonald is hopeful that the Wounded Warrior Workforce Enhancement Act will be introduced into Congress once again in late April— right before the AOPA Policy Forum. Rep. Matt Cartwright (D-Pennsylvania) and Sen. Richard Durbin (D-Illinois) are expected to introduce the legislation to their respective chambers. As written now, the legislation would allocate $15 million toward investing in O&P master’s programs: $5 million per year for three years 26

APRIL 2019 | O&P ALMANAC

for competitive one-time grants to be awarded to schools that can demonstrate the ability to expand an existing program or create a new one, according to Macdonald. The maximum grant per school would be $1.5 million, with the funds to be used for equipment, staffing, updating curriculum, and related expenses. AOPA Policy Forum members are expected to discuss the proposed legislation when they take part in one-on-one meetings in the Capitol. “We are very encouraged by the progress in the House in the past year,” says Macdonald. She also is encouraged by the number of O&P master’s students who are expected to attend the 2019 Policy Forum. Participation from “nextgeneration” O&P professionals is an important part of spreading the O&P message, according to Macdonald. “During the last couple of Policy Forums, we found the students were excellent advocates,” she says, and anticipates a similar result at the event this May.

All Hands on Deck

For those individuals who are unable to make it to this year’s Policy Forum—be they students, clinicians, business owners, patient advocates, or other O&P stakeholders—there is

still plenty to be done to raise awareness of these pieces of legislation specifically—and to advance the O&P agenda more broadly. Reaching out to legislators in any way possible can be beneficial, says Andrews. “There is no substitute for communication with members of Congress and their staffs,” says Andrews. During his four years in office, “the most important people [whose opinions mattered the most] were those individuals who lived in my district.” Advocates can “personalize” abstract policy issues by explaining why they matter, and turn them into a “concrete reality” that is easier to understand, Andrews explains. And they can do so at the AOPA Policy Forum, at town halls, during legislators’ visits back to their districts, or via letters and emails, he suggests. With this in mind, AOPA will be updating its AOPA Votes page to allow O&P stakeholders to reach out to their legislators, even if they can’t travel to Washington. “It’s important for legislators to know that legislation [like the O&P-themed bills] really protects the health and well-being of patients— their constituents,” Andrews says. “Members of Congress need to see the real-life stories of these individuals who are providing services to their patients. The chances of success will be enhanced by the engagement of those in the community.”

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By CHRISTINE UMBRELL

Planning for natural disasters—such as wildfires and hurricanes—has become an important component of strategic planning at O&P facilities

NEED TO KNOW

The best way to ensure your O&P After disasters, O&P facilities facility stays in business after an unexpected event, such as a fire, hurricane, or winter storm, is to prepare a disaster plan that is focused on ensuring the safety of employees and patients and to budget for recovery efforts.

Business owners or managers

should ensure they will be able to access emergency contact information for all employees in the event of power outages or loss of Internet access. They also should explore options for transferring funds to employees during a disaster.

Facilities should stock essentials

that might be needed during an emergency—for example, water, food, blankets, and a generator.

APRIL 2019 | O&P ALMANAC

should consider reaching out to patients who live in the neighborhood to see if they need any help or supplies, and investigate whether any patients are missing O&P componentry.

It’s helpful to be flexible

with appointments and even walk-in patients in the days following a disaster, and to be sensitive to patients who may be suffering from PTSD.

Having the proper insurance

coverage can help minimize the economic impacts of disasters, so O&P companies should review their policies to ensure coverage is adequate and appropriate for the types of disasters most common in their area.

ECKY TEGERSTRAND, CPO, CFm,

had just opened up a new satellite facility of Tegerstrand Orthotics and Prosthetics in Chico, California, the day the Camp Fire started. It raged through the nearby city of Paradise and eventually became the deadliest wildfire in California history, causing 85 fatalities and destroying nearly 19,000 structures. Tegerstrand had a disaster plan in place. She removed her laptop and employee files out of the office. She also reminded employees of the facility evacuation plan, should the fire reach their locale. Fortunately, the fire did not hit Chico directly. Her building remained standing, but some of her patients’ residences didn’t fare so well. “We had a lot of prosthetic patients calling us,” many of whom ended up in shelters, Tegerstrand says. About a dozen “lost everything.” In the aftermath, many prosthetic patients who

PHOTO: American Red Cross

had worn their devices during evacuations called to replace extra parts, such as sleeves and mastectomy components, that had been left behind. Some patients with frail immune systems could not make their appointments for several weeks due to lingering smoke in the area.

Becky Tegerstrand, CPO, CFm Tegerstrand adapted by accommodating patients who missed appointments and fitting in those who needed to be seen immediately. She adjusted to seeing patients who have been traumatized by the fire and harrowing escapes. “Many of them are suffering from PTSD,” she says. “I listen a lot and try to do whatever I can” to ensure their O&P care is not a source of concern. As Tegerstrand has learned, disaster planning has become a more important function at O&P facilities as floods, hurricanes, and fires dominate the news cycle. When these disruptive

The Camp Fire that burned in California last November resulted in 85 fatalities and destroyed nearly 19,000 structures. weather events cause damage, they can be disastrous for small businesses such as O&P. According to the Federal Emergency Management Agency, between 40 and 60 percent of small businesses close permanently after a disaster. Among businesses that are closed for at least five days, 90 percent fail within a year. Disaster planning is primarily about the safety of employees and patients, and secondarily about having the revenue sources you need to get up and running again after a disaster, says Bill Wilson, vice president of sales and marketing for VGM Insurance Services. “Every facility should have a disaster recovery plan” that details, for example, where staff will evacuate to, which staff members will contact emergency personnel and insurance companies, how management will communicate with employees, and even who will handle talking with

the media, says Wilson. An unplanned disaster—natural or manmade—will be stressful and chaotic when it happens, “but hopefully the disaster plan will guide you through it,” he says. A well-thought-out disaster plan— one that stands on its own but also may be incorporated into your policies and procedures manual—can lead to fewer days out of business, better communication with employees and patients, and a better settlement from your insurance company.

Stepping Up

The massive Camp Fire that impacted many of Tegerstrand’s patients also took its toll on the Chico location of Spectrum O&P, where Sanjay Gupta, BOCPO, is clinical manager. The fire took Gupta by surprise, as it burned so quickly and forced thousands of residents of the nearby town of Paradise to evacuate at a moment’s notice. O&P ALMANAC | APRIL 2019

The Camp Fire did a great deal of damage in the densely populated town of Paradise. Most of the damage occurred within the first four hours.

APRIL 2019 | O&P ALMANAC

diabetic shoes. “We were able to document that patients had lost items in a calamity and provided replacements” quickly, he says. Fortunately, the insurance companies and the U.S. Department of Veterans Affairs were very accommodating to the wildfire victims. Sanjay Gupta, BOCPO After seeing the fires escalate so quickly, Gupta offers the following advice to O&P professionals when developing their contingency plans: “Everybody should have emergency packs, with blankets, food, and water, ready to go—including at O&P facilities,” he says. After the disaster has abated, “reach out to patients who live in the neighborhood to see if they need any help or supplies.”

Assisting Employees

It’s especially important for companies to have disaster plans in place to ensure assistance is available for employees in the event of an emergency. Such was the case at Cascade Orthopedic Supply, whose corporate offices are in Chico. “The Camp Fire erupted in our backyard,” says President Jeff Collins. “Many of our employees lost homes or were displaced.” While the Cascade facility itself did not incur damage other than minimal smoke, contacting employees who were displaced became a challenge. “The need for assistance during and after a disaster is overwhelming. We had a significant number of displaced staff with immediate and long-term needs that go beyond what we as an organization could respond to,” Collins says. To best assist employees—approximately 12 lost their homes, and about 20 more had to adapt their lives to care for relatives—Collins delivered cash to

PHOTO: American Red Cross

“It was very sad,” Gupta recalls. He headed into his facility on the Friday morning of the fire, but he immediately realized the extent of the emergency in nearby Paradise and noted a massive influx of evacuees into Chico looking for aid. “So we shut down the office for the day, and all of the employees volunteered” instead. Gupta and his team went to Caring Choices, a local volunteer organization, and were put to work at make-shift shelters, organizing donations and handing out food and water. Gupta continued volunteering all weekend, then reopened his facility on Monday. Gupta’s first point of business was to reach out to patients located in Paradise who may have been affected by the fire. For the most part, prosthetic patients had been able to escape with their prostheses but needed liners and socks, and orthotic patients had left behind custom orthoses and

Photos of Cascade's facility in Chico on Day One of the Camp Fire (left and middle), and a photo taken by Becky Tegerstrand, CPO, CFm (right)

displaced employees to help them fill their immediate needs, and he set up a GoFundMe account to raise money for those impacted. “We are so thankful our friends in the industry responded with their offers and direct assistance,” Collins recalls. “Our suppliers, customers, competitors, and service providers all responded in significant ways. This has been one of the brightest outcomes from the devastation in our community.” Jeff Collins

PHOTOS: Cascade/Becky Tegerstrand, CPO, CFm

Collins now recommends that business owners and managers gather a list of emergency contact information for all employees before disaster strikes. “We had this information in our HR systems, but it wasn’t easily accessible. Nor did we have a tool to leverage personal contact information for quick and efficient communications via SMS,” he recalls. “We quickly set up a Remind account, invited all employees to join and authorize use of their personal numbers, and were able to push out communications in real time via SMS once this was set up.” He also suggests talking with a bank representative to determine the best way to transfer funds to employees during a disaster. Gathering employee bank information and transferring nonpayroll funds was a challenge during the Camp Fire. “Many services like Zelle, Venmo, and PayPal aren’t compatible with corporate bank accounts or commercial banking services. I had to take cash out of our accounts and drive it to affected employees as the only quick way to

take care of our employees over the weekend of the Camp Fire.” Collins also recommends re-evaluating your company’s facility preparedness plan. “We learned a lot about our building and building systems during the Camp Fire. Our area was

inundated with smoke from the fire for over two weeks, and our HVAC and air filtration systems were not adequate,” he says. “We ultimately acquired commercial air filtration equipment but took days after the disaster to acquire the necessary equipment.”

U.S. Agencies Offer Tips for

DISASTER PLANNING The Federal Emergency Management Agency (FEMA) issued new guidance in October to assist businesses in developing plans to protect employees and safeguard assets to minimize the disruption to the business. FEMA offers the following general business preparedness tips: Create a communications plan to keep in touch with customers, suppliers, and employees. Provide employees with information on when, if, and how to report to work after a disaster. Check insurance policies to ensure you have enough damage coverage.

Develop a plan to help identify ways to protect facilities, physical assets, and electronic information.

Have an information technology recovery plan. Compile an inventory of computer hardware and back-up data.

Develop professional relationships with more than one company in case your primary contractor cannot service your needs.

Keep copies of important records such as building plans, insurance policies, bank account and employee contact information, and other priority documents in a waterproof container. Store a set of records at an off-site location.

Identify and prepare for any support your employees, clients, and communities may need. Connect with local officials on social media like Facebook and Twitter.

In addition, the U.S. Small Business Administration offers disaster-specific checklists and safety tips to prepare for wildfires, hurricanes, earthquakes, tornadoes, floods, winter weather, and cybersecurity. Visit www.sba.gov.

O&P ALMANAC | APRIL 2019

Powering Through Outages

Advice From

INSURANCE EXPERTS Having the proper insurance coverage can help minimize the economic impacts of disasters, according to Don Foley, principal/program specialist at Cailor Fleming Insurance, and Bill Wilson, vice president of sales and marketing for VGM Insurance Services. “Natural disasters are increasing at an alarming rate,” says Foley. “When disasters happen, many companies don’t have the insurance to cover them properly.” Below are a few tips from Foley and Wilson to consider when reviewing your current insurance coverages: Read through your policies on a regular basis to ensure coverage is adequate to meet your needs, says Wilson. “If not, there may be coinsurance penalties,” he says. Ensure your policy includes coverage for “loss of income and extra expenses,” says Wilson. You will need coverage to finance an alternate site, temporary staffing, and related expenses. Consider purchasing flood and earthquake insurance, even if it’s not mandated by law. “Less than 10 percent of O&P companies have flood insurance, and less than 2 percent have earthquake insurance,” says Foley. But many areas outside of traditional flood plains have experienced flooding recently, leaving those without insurance without coverage.

APRIL 2019 | O&P ALMANAC

Check to see if wind coverage is excluded from your policy, which is often the case, says Foley. Consider adding this type of coverage as wind-induced damages can be costly. “Every O&P facility should have wind coverage, if possible, though it’s not always possible if you’re in a coastal county.” Of course, workers’ compensation coverage and general liability insurance are key in the event of employee injury or patients injured if they are on premises during a disaster, says Wilson. Consider purchasing cyber insurance. “Hackers can get through anything these days, including the best defenses of the CIA, FBI, and NSA,” says Foley, “and insurance coverage may be the only way to recover damages caused by a breach.”

While fires dominated the news cycle last fall, other recent weather events have had dire consequences as well. In February, Tegerstrand found out the hard way that disasters really can strike twice. She had just gotten over the nearmiss of the wildfire in Chico when a rare California snowstorm paralyzed parts of the area in February. On the day of snowfall, Tegerstrand was scheduled to be at her Redding location for surveys from both CMS and the American Board for Certification in Orthotics and Prosthetics (ABC). With no power and no Internet at her home—powerlines were down throughout the city—she was cut off from communicating with others in a way she had never expected. While two of her locations suffered no damage, her Redding facility— and her home—had no electricity. Tegerstrand set out to contact her employees but soon realized that while her phone still functioned to make calls, cellular data was not available. She was unable to search for contact information of individuals whose numbers were not already programmed in her contacts or stored in her recent call history. She also was unable to access her EMR system to contact patients. Tegerstrand eventually worked through all of the challenges, contacted employees, and reopened for patients once power was restored. Since then, she has made changes to her contingency plan and recently updated her policies and procedures manual to better prepare for future disasters. For others who may face similar challenges, Tegerstrand says it’s important to plan for the possibility of not having Internet access for several days—including no access to cellular data. “Now I have all of my employees’ numbers in my phone, plus the numbers of my insurance carriers, landlords, and contacts at ABC and OPIE,” she says. She also suggests limiting cell phone use and storing portable chargers to ensure smartphones can charge even if all power is gone.

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Puerto Rico suffered catastrophic damage during Hurricane Maria in September of 2017. Hi-Tech Prosthetics in Aguadilla ran on a generator for months after the hurricane. She urges O&P facilities to have both online and hard copy versions of their policy and procedures manual easily accessible at all facility locations in case of emergency. “You have to prepare for extreme cases,” she says. “You really need to think outside the box, and consider how you will be able to keep going if you don’t have Internet and power.”

Adapting to Long-Lasting Impacts

APRIL 2019 | O&P ALMANAC

Frank Ucros, CP

After the hurricane was over, Ucros held a staff meeting with available employees to assess the damage and closed the facility’s doors for about two weeks. During that

time, Ucros jumped into community response efforts. Because Hi-Tech is in such a central location, “people came looking for water, and we were handing out supplies” to neighbors. “I did not expect to have to take care of so many in the community.” The facility even hosted a cookout to help feed the community, and Ucros pitched in pumping fuel at the local service station. A couple of weeks later, despite an ongoing power outage, no Internet access, and no cell phone service, except from one local provider Claro, Ucros opened his doors to provide much needed O&P services to his patients. “We started back up with limited hours” to conserve fuel for his generator, he says. He posted signs on

PHOTOS: Frank Ucros, CP

Like Tegerstrand, Gupta, and Collins, Frank Ucros, CP, thought he was prepared for disaster. But when Hurricane Maria hit Puerto Rico in September 2017, he did not expect the damage to be so devastating. Situated on a busy intersection in Aguadilla, his concrete-built Hi-Tech Prosthetics facility ended up serving as an “oasis” for much of the community in the wake of the hurricane. “Puerto Rico had not been hit with something like that in more than 60 years,” says Ucros, recalling the fear that set in when the Category 5

hurricane swept in with winds topping 200 MPH. In the days leading up to the event, “you tried to prepare for the worst—but next time we’ll prepare much better.” Prior to the hurricane he boarded the building’s windows and doors with plywood and stocked up on supplies, including cash. While his facility remained intact, with some minor water damage to the interior of the building, the ensuing power outages and lack of communication with the outside world lasted months— much longer than he had anticipated.

his facility doors and ran announcements with a local radio station to communicate his new hours and a new phone number—that could be accessed via Claro—to patients. In those first weeks post-hurricane, Ucros accommodated patients who showed up at all hours. He recalls his biggest challenge in treating patients in substandard conditions was the “loss of technology.” He typically relies heavily on technologies such as CAD, electronic carvers, and OPIE software. He got creative in meeting all of his patients’ needs and relied on his generator, he says, and even reverted to manual billing since the Internet was down—although many bills went unpaid for months because shipping services slowed significantly. It took almost six months to get back to a fully functioning facility, Ucros says. Now, he is working on creating a revised disaster plan for hurricane season, so that he is ready should another event occur. For other O&P facilities that are creating

disaster plans, Ucros says his most important pieces of advice include buying “tons of water,” working with maintenance people to prepare the physical building for impact, taking out cash, stocking up on componentry, bringing in patients ahead of time who may be having issues, and stockpiling fuel for generators.

Planning for Interruptions— Both Big and Small

Developing a disaster plan is not only a good idea—it’s also a requirement from the American Board for Orthotics, Prosthetics, and Pedorthics (ABC) for those O&P facilities that are ABC accredited. The plan does not have to be complex, but facilities should have a plan in place that is appropriate given the geographical location of the facility, says Ted Markgren, CP(E), FAAOP, senior surveyor at ABC. Your disaster plan should anticipate natural disasters, manmade disasters, and even cyber attacks, says Markgren. There should be plans in

place whether there is a major disaster, or just a small event that impacts business operations. “You should have a plan to store records off-site, be able to move operations off-site, and even see patients at an off-site clinic” if your facility must shut its doors, he says. Markgren recommends reviewing disaster plans at least annually. It’s important to talk with staff on a regular basis, and to look for any changes or “holes” in the plan, he says. And every time there’s a new hire, “they need to be educated that there’s a disaster plan,” says Markgren. While it’s impossible to anticipate when the next disaster will strike, putting a plan in place so you can ensure the safety of your employees and patients, and minimize the ensuing damages and costs to your facility, can help soften the blow. Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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O&P ALMANAC | APRIL 2019

COMPLIANCE CORNER

By WENDY MILLER, BOCO, LO, CDME

The Bottom Line in Performance Management Ensure quality standards compliance by properly implementing performance management procedures Editor’s Note: Readers of CREDITS Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 38 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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APRIL 2019 | O&P ALMANAC

ERFORMANCE MANAGEMENT

is one of the key quality standards mandated for compliance with accreditation requirements and to obtain or maintain billing privileges through CMS. An O&P practice must implement a performance management plan that measures consumer services, billing practices, and adverse events. But how can you optimize performance management? In addition to the requirements outlined in CMS’s quality standards, the CMS Program Integrity Manual contains a policy on performance management, and a practice will not meet accreditation standards if it fails to include and implement the policy. However, effective performance management goes far beyond simply having a policy. The Board of Certification/ Accreditation (BOC) routinely receives feedback from our accredited practices regarding performance management plan implementation. A key lesson learned and reported by these practices is that by successfully creating and implementing a performance management plan and related procedures, you will set up your business for long-term, sustainable success. What does successful performance management entail? An effective performance management process

is a continuous cycle of collecting data, measuring outcomes, developing a plan, implementing that plan, making midcourse adjustments, and continually evaluating efforts.

Collecting Data

Data collection is a critical element of performance management, and regularly documenting data via tools such as recording logs and spreadsheets is evidence your business is tracking and monitoring quality standards indicators. There are a variety of types of data collection required to meet minimum compliance standards, including the following: • Regulatory agency reports, as applicable (e.g., CMS site visits, state health-care administration agencies, accrediting organization site surveys, etc.) • Complaint logs (including client satisfaction surveys, incident reports, adverse/sentinel events) • Client follow-up records, including timeliness of response • Billing/coding error logs • Employee policies and orientation guidelines • Proof of annual employee in-services.

COMPLIANCE CORNER

After collecting it, what do you do with the data? At the end of each quarter, each type of record should be summarized and interpreted in a report. These reports must then be presented to and acted upon by a Performance Management Committee. (For steps in creating the committee, see the “Evaluating Efforts” section below.) To comply with the requirement for data collection, you do not need special software, nor do you need to be an expert in creating spreadsheets and graphs. Reports can consist of simple tables showing your data and comparing your results by quarter.

Measuring Outcomes

In addition to collecting and recording data, you must measure your practice’s outcomes. Outcomes tracked must include the following: • Beneficiary satisfaction with and complaints about product(s) and service(s) • Timeliness of response to beneficiary questions, problems, and concerns • Frequency of billing and coding errors (e.g., billing or coding errors found after a claim denial) • Adverse events to beneficiaries (e.g., injuries, accidents, signs and symptoms of infection, hospitalizations) due to inadequate services or malfunctioning equipment and/or other items. These adverse events may be identified through follow-up with the prescribing physician, other health-care team members, or the beneficiary or caregivers.

A practice should continually seek and document input from employees, customers, and referral sources to assess the quality of its operations and services. As a best practice, it also is important to provide timely responses to these stakeholders upon receipt of this valuable feedback.

Developing a Plan

Developing a performance management (PM) plan should not be a perfunctory exercise to simply meet quality standards; the plan must be fully integrated into practice operations to drive short-term, mid-term, and long-term business goals. Your PM plan must concentrate on two key components: patients and practice management. The patient component includes creating and utilizing up-to-date policies relating to patient care and evaluating customer service. For example, when assessing patient satisfaction, do you have a plan to address negative feedback? An effective PM plan will list procedures for immediate patient follow-up, steps to address the cause for the negative feedback, and ongoing evaluation to determine if the issue was corrected. The PM plan’s practice management focus includes a variety of elements related to your physical working space, employees, and human resources procedures. For example, does your practice have infection control procedures? Are they documented? This portion of the plan also should set expectations for your employees, including job performance and a commitment to helping team members improve.

Implementing a Plan

After developing your business’s PM plan, identify all resources required for implementation. The most important resource for effective PM plan implementation is staff training. Staff must understand how measuring and evaluating outcomes will not only ensure compliance

with accreditation, but also obtain crucial knowledge on how to improve your overall patient satisfaction.

Evaluating Efforts

To thoroughly evaluate PM efforts, businesses should form a PM Committee. The committee’s size is often related to the practice size, but typically includes the practice owner, manager, compliance officer, and key team members. The committee should meet quarterly to review the reports from each quarter’s data collection. Committee members can then compare quarters, develop action plans where results fell below expectations, and investigate areas that exceeded the minimum requirements to extract “best practices” moving forward. In addition to establishing a PM Committee, your business can self-assess its performance management by ensuring the following: • Satisfaction surveys are completed and logged. • Policies are up to date. • Staff members are educated on their PM roles. • Data collection logs are completed. • Results are recorded and reviewed. • Action plans are completed. Again, educating and training staff on performance management is critical; each team member must understand his or her role in data collection (e.g., tracking an incident, complaint, billing or coding error, and rejected claims). O&P ALMANAC | APRIL 2019

COMPLIANCE CORNER

comply with the CMS Supplier and Quality Standards. These standards are the foundation for achieving accredited status. • Ceasing your PM efforts postaccreditation. It is not enough to pass your initial survey, as your practice is subject to unannounced surveys at any time. You will be expected to produce all elements required by the quality standards from the date of your initial accreditation.

Avoiding Common Mistakes

It’s easy to allow complacency to set in after establishing a performance management policy; however, to meet standards, diligence and accountability are key. Stay prepared for your next site visit and remain compliant by avoiding these common mistakes: • Falsifying data. While it may be tempting to populate your own customer surveys and neglect creating a comprehensive reporting log during busy moments, falsifying data is unethical at best. It leads to a major loss in integrity. • Failing to create a true PM plan. Simply having blank data collection spreadsheets and forms in a binder is not an adequate substitution for an active PM plan. • Not holding billing accountable. Whether your practice utilizes a third-party billing company or an in-house team member, this role is an important aspect of performance management tracking. Financial discipline is critical. • Lack of improvement. If your PM Committee continually 38

APRIL 2019 | O&P ALMANAC

reports the same outcomes, re-evaluate your strategies. True performance management constantly examines best practices and adjusts accordingly. • Not asking for feedback. Your business should never assume customers are satisfied due to lack of complaints filed. It is important to ask customers for their level of satisfaction; they are your most important business ambassadors. And you can never know your customers too well! • Assuming your business is too small to worry about performance management. Whether you manage a one-person practice or a 1,000person operation, CMS Supplier and Quality Standards remain the same. To comply, you must have a performance management policy to develop a PM plan that fits your business and meets standards. • Assuming your business does not need a PM plan because it does not bill Medicare. Whether or not you bill Medicare, to maintain your accreditation, your business must

The bottom line? Simply having a performance management policy is not enough to meet accreditation standards; a business must create and implement a full performance management plan. There are many excellent online resources available, as well as experienced consultants who can assist you in getting started. If you are uncertain where to begin, start with your accrediting organization. BOC team members are available by phone and email to answer questions, and you can find a list of consultants on the BOC website. Always remember, effective performance management is up to you. While an experienced consultant can set up a PM plan and provide data collection tools, a consultant cannot produce data. With ongoing PM commitment, your practice will not only remain compliant, it will improve its practices, customer retention, and profitability. Wendy Miller, BOCO, LO, CDME, is chief credentialing officer of the Board of Certification/Accreditation (BOC) and leads the direction, strategy, policies, and day-to-day operations of BOC's credentialing programs. Contact her at wendy. miller@bocusa.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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PRINCIPAL INVESTIGATOR

Improving Poststroke Mobility

Special Edition

Stefania Fatone, PhD, BPO (Hons), is leading a study on ankle-foot orthoses for poststroke hemiplegia patients

Fulfilling AOPA’s mission to advance research in the profession, O&P Almanac introduces individuals who have undertaken O&P-focused research projects. In this “Special Edition” series of Principal Investigator, we profile participants in the Orthotics 2020 initiative established by AOPA and the Center for O&P Learning/ Evidence-Based Practice. Here, you will learn about some of the research being conducted as part of the Orthotics 2020 initiative, which is a vital enterprise created to evaluate the orthotic services upon which O&P patients depend and to begin populating a stronger research base around issues on the benefit of orthotic services.

APRIL 2019 | O&P ALMANAC

Stefania Fatone, PhD, BPO (Hons), is juggling many balls. A professor at Northwestern University Prosthetics-Orthotics Center (NUPOC) in Chicago, Fatone has responsibilities as a researcher, educator, and mentor. With more than 80 publications under her belt, she has been involved in dozens of significant O&P research endeavors, focusing, she says, on “the effects of prostheses and orthoses on human motion in order to increase understanding, establish efficacy, and improve effectiveness of prosthetic and orthotic interventions for people with physical impairments.” Amidst all of her current responsibilities, Fatone has taken on the role of lead investigator of a study titled “Effect of Ankle-Foot Orthoses (AFOs) on Continuous Walking in Persons With Post-Stroke Hemiplegia.” The investigation will take the form of a “prospective, randomized, crossover, comparative assessment trial” and is part of AOPA’s Orthotics 2020 initiative—supported by an AOPA research award administered by the Center for Orthotics and Prosthetics Learning and Outcomes/Evidence-Based Practice.

PHOTO: Stefania Fatone, PhD, BPO (Hons)

PHOTO: Getty Images

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PRINCIPAL INVESTIGATOR

Fatone is currently working with co-investigators Kristin Carnahan, MS, CPO; Rebecca Stine, MS; and Kurian Thomas, MD, on the project, with the intention of improving rehabilitation for individuals after experiencing a stroke. “This study focuses on persons with poststroke hemiplegia who use an ankle-foot orthosis to facilitate ambulation,” she explains. “Despite some indication that AFOs may have a more demonstrable effect on gait during continuous walking, to our knowledge no studies have evaluated gait biomechanics and/or energy expenditure data during continuous walking in persons with hemiplegia following stroke.” Fatone and her team are in the beginning stages of conducting the study, with the following goals: • Investigate how continuous walking affects the gait of persons with hemiplegia following stroke when walking without AFOs. • Evaluate how well a clinically prescribed AFO addresses impairments that occur during continuous walking. • Evaluate if a “tuned” AFO-footwear combination (AFO-FC) is more effective than the clinically prescribed AFO at diminishing walking impairments during continuous walking.

“Despite some indication that AFOs may have a more demonstrable effect on gait during continuous walking, to our knowledge no studies have evaluated gait biomechanics and/or energy expenditure data during continuous walking in persons with hemiplegia following stroke.” —STEFANIA FATONE, PhD, BPO (HONS)

Study Design

To carry out the research, Fatone and her team are recruiting 21 subjects with poststroke hemiplegia who regularly use an AFO from both the Jesse Brown VA Medical Center and Northwestern University. Subjects must have abnormal shank (i.e., tibial) kinematics during barefoot walking to meet the published requirements for an AFO-FC, according to Fatone. The study requires five visits over approximately five weeks. “At the first visit, an impression and measurements will be taken of the subject’s limb so that an AFO-FC may be fabricated,” Fatone explains. Subjects will return for a second visit for fitting and “tuning” of the AFO-FC, which will take place with guidance from the Motion Analysis

Laboratory to ensure that the desired sagittal plane moments are created at the knee and hip, according to Fatone. Following the second visit, subjects will be allowed three weeks of accommodation time, during which time the AFO-FC will be worn “as much as possible” for the first two weeks. During the last week of the accommodation period, subjects will be asked to alternate wear of the AFO-FC and their clinically prescribed AFO on a daily basis. “During the third, fourth, and fifth visits, gait and energy data will be recorded in random order for each condition—no AFO, clinically prescribed AFO, and AFO-FC—during continuous walking,” Fatone says. These three visits will take place within a week and at the same time of day for each visit.

Related Research

Stefania Fatone, PhD, BPO (Hons), has a longstanding interest in the effect of ankle-foot orthoses on the gait of persons poststroke, as illustrated by the following publications from prior studies: • Fatone S., Hansen A. “Effect of an Ankle-Foot Orthosis on Rollover Shape in Adults With Hemiplegia.” Journal of Rehabilitation Research and Development 2007, 44(1): 11-20. • Fatone S., Gard S., Malas B. “Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on Knee Kinematics and Kinetics in People With Hemiplegia.” Archives of Physical Medicine and Rehabilitation 2009, 90(5): 810-818. • Fatone S., Sorci E., Hansen A. “Effects of Clinically Prescribed Ankle-Foot Orthoses on Ankle-Foot Rollover Shapes: A Case Series.” Journal of Prosthetics and Orthotics 2009, 21(4): 196-203. • Zissimopoulos A., Fatone S., Gard S.A. “The Effect of Ankle-Foot Orthoses on Self-Reported Balance Confidence in Persons With Chronic Poststroke Hemiplegia.” Prosthetics and Orthotics International 2014, 38(2): 148-154. • Zissimopoulos A., Stine R., Fatone S., Gard S.A. “Mediolateral Foot Placement Accuracy During Ambulation in Individuals With Chronic Poststroke Hemiplegia.” Gait and Posture 2014, 39(4): 1097–1102. • Zissimopoulos A., Fatone S., Gard S.A. “Effects of an Ankle-Foot Orthosis on Mediolateral Foot Placement Ability During Poststroke Gait.” Prosthetics and Orthotics International 2015, 39(5): 372-379. • Choi H., Bjornson K., Fatone S., Steele K. “Using Musculoskeletal Modeling To Evaluate the Impact of Ankle-Foot Orthosis Footwear Combination on Musculotendon Dynamics.” Disability and Rehabilitation Assistive Technology 2016, 11(7): 613-618.

APRIL 2019 | O&P ALMANAC

PRINCIPAL INVESTIGATOR

Fatone hopes to complete the study in the next six to eight months, and she is hopeful that the results of the study will provide clinicians with outcomes regarding AFO use for this patient population. This project merges two ideas, according to Fatone: testing of both continuous walking and the AFO-FC approach. “It has been proposed that the gait of persons poststroke should be assessed over longer distances if a truly representative assessment is to be made of ambulation in the community,” she explains. “This idea was echoed by subjects who participated in previous studies who commented that they rely on their orthoses more at the end of the day when they are tired than the beginning when they are fresh. “Furthermore, it is possible that an AFO-FC that has been tuned for level walking may be more effective at diminishing gait impairments and improving metabolic efficiency during continuous walking than a clinically prescribed AFO.”

Adding to the Research Well

This new AFO/poststroke hemiplegia study will be an important addition to the current research related to AFOs, and it marks a significant addition to Fatone’s expansive research undertakings. Fatone, who appreciates the “blend” of art and science inherent in O&P, is particularly interested in trying to better understand and quantify the effect of specific aspects of O&P design on function and synthesizing the evidence available to support O&P practice. Over the course of her career, Fatone has spent most of her research time concentrating on two areas: the lower-limb orthotic management of persons with upper motor neuron lesions, such as stroke and cerebral palsy, and prosthetic sockets for persons with lower-limb amputation. “My lower-limb prosthetics research explores ways to improve prosthetic sockets for persons with lower-limb amputation by developing more comfortable sockets, developing

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sensor-based tools for monitoring inside prosthetic sockets, and exploring features of socket design that might enhance function,” says Fatone. “Additionally, I am interested in how we improve decision making regarding dysvascular partial foot amputation using shared decision making.” In terms of orthotic research, Fatone’s upper-limb work has focused on how novel orthotic devices might improve upper-limb function in persons with brain injury. In the lower-limb orthotics realm, her studies have centered on assessing how AFOs can improve function in persons with upper motor neuron lesions and how to assess quality of care when providing ankle-foot orthoses. Her current Orthotics 2020 study fits right in with her body of work. Looking to the future, Fatone—who also enjoys travelling to visit family and friends around the world—hopes to do her part to improve rehabilitation for individuals with poststroke hemiplegia, while keeping busy at NUPOC in her roles as both researcher and educator.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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

O&P ALMANAC | APRIL 2019

MEMBER SPOTLIGHT

Alliance Orthotics and Prosthetics

From Classmates to Co-Owners UT—Southwestern grads join forces to offer O&P care, with a pediatric focus

LAN SHEPPARD, CPO,

APRIL 2019 | O&P ALMANAC

Alliance Orthotics and Prosthetics opened its second, and busiest, location in Denton, Texas, seven years ago.

FACILITY: Alliance Orthotics and Prosthetics OWNERS: Phyllis McNiel, CPO; Alan Sheppard, CPO; Mike McNiel; and Jammy Sheppard LOCATION: Denton and Gainesville, Texas HISTORY: 11 years

Phyllis McNiel, CPO

Alan Sheppard, CPO

and occupational therapists and assistants. The facility is an “early adopter” of new techniques and technologies, and houses a full fabrication area—outsourcing to central fab when needed. Alliance treats a significant percentage of pediatric patients. “We consider it a calling,” says Sheppard. He credits much of their success in this area to a team approach and good relationships with physical therapists. “We work with a lot of therapists who have our cell phone numbers,” he says. “We maintain our connections. Our professions complement each other. When we work together, the outcomes are better for the patients.” The facility’s clinicians meet patients at therapy or rehab appointments as part of their team approach. In addition, Alliance provides mobile service to patients who are homebound or reside in assisted living or nursing facilities. Alliance maintains strong connections with patients. “We like to emphasize patient follow-up and being involved in their lives,” says McNiel. “Instead of being so clinical, we want to be a part of their ongoing care. We follow up

so they know we can help them be successful in whatever they want to do. That’s one reason we do so well in pediatrics—we see kids over and over again.” McNiel and Sheppard believe they are best at marketing themselves, rather than hiring someone. “We take advantage of social media and try to have a strong online presence, but building relationships is really where it happens,” says Sheppard. “Phyllis and I do in-services, meet oneon-one with therapists, and host educational opportunities. … The nice thing is that therapists move around, and as we build relationships, they help us connect with their new colleagues,” he adds. Alliance extends its relationship building to the community. The company actively supports a local amputee support group, which has been meeting monthly for years at a nearby rehabilitation facility. Alliance prosthetists attend meetings and plan activities for the group. One of Alliance’s practitioners, Katie Brinkley, CPO, engages in mission work with the nonprofit organization Prosthetic Promises in His Name, traveling to Africa twice a year. Her work there has the full support of the company, which also provides recycled prosthetic feet and knees. Looking ahead, Sheppard and McNiel are not averse to expansion, but they are not in a hurry, either. “So far our growth has been organic: We saw a need and responded to it. We will continue to evaluate where we can best serve our patients.” Meanwhile, the longstanding friendship between the two continues to flourish. “Our strengths and weaknesses complement each other,” says Sheppard. “We are still friends, and our families really enjoy spending time together.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Alliance Orthotics and Prosthetics

xand Phyllis McNiel, CPO, first met at the University of Texas in Arlington, where they were fulfilling prerequisites for a physical therapy track. They each discovered orthotics and prosthetics, which seemed a more natural fit, and quickly changed course, eventually graduating from University of Texas—Southwestern in Dallas. They embarked on separate careers in O&P but continued to stay in touch, and in 2008, the two decided to open their own practice. Today, McNiel and Sheppard and their spouses own Alliance Orthotics and Prosthetics, with five certified clinicians on staff and offices in Denton and Gainesville, Texas. Jammy Sheppard is the company controller, and Mike McNiel is director of finance. Alliance’s original location was in Gainesville—a 2,000-squarefoot facility in a rural area along the Red River. “When we started, we saw a lot of legs just sitting in the closet. It broke our hearts,” recalls Sheppard. “Often, all that was needed was sock management or a pad. We refit a lot of amputees.” In 2012, Alliance opened its office in Denton, just north of the Dallas-Fort Worth metroplex, an area that is still growing. “It keeps all of us busy,” says Sheppard. Alliance is a residency site, and McNiel and Sheppard share a philosophy of O&P that emphasizes education. They often serve as guest lecturers for physical therapy classes and offer continuing education courses to physical

By DEBORAH CONN

www.bocusa.org

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MEMBER SPOTLIGHT

SoleTech

By DEBORAH CONN

Sole Searching Northeast company supplies materials for footwear, inserts, and lower-limb orthoses

OLETECH, WHICH HAS A

APRIL 2019 | O&P ALMANAC

Neil Dotzenrod, vice president of key accounts (left), and Kevin McNamara, vice president of sales, at a recent conference

COMPANY: SoleTech OWNER: Tom Costin LOCATION: Claremont, New Hampshire HISTORY: 73 years

A pallet of SoleTech’s bright red Cloud EVA being readied for delivery

for retail shoe stores and the shoe repair industry. SoleTech produces a full line of cushioning and fabrication materials. Its original EVA product is trademarked Cloud EVA, a medium-density material, and Soleflex, which has a firmer density. “What we found, working with the industry, was that EVA was used for orthotic inserts but also as a midsole in footwear modifications to build up leg length differentials,” says Costin. “And when working with diabetic patients, we realized that different patients needed different levels of firmness, so we now offer seven degrees of hardness—from a very soft, accommodative EVA to a rigid supportive material.” SoleTech’s line of EVA ranges from the softest, Ultra Cloud, to the hardest, Soleflex 80. Most EVA products are available in a range of colors, including multicolored patterns. Another product line offers dual and three-layer laminated sheets containing EVA and other materials, such as poron and plastazote, to create the

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

PHOTO: SoleTech

long history of providing bottom components to the U.S. shoe industry, was founded as the M. Jaffee Co. in 1946. Tom Costin acquired the company in 1979, and soon after, it became a specialty manufacturer of compression-molded ethylene-vinyl acetate (EVA) soles for athletic shoes. In the early 1980s, much of the shoe industry was moving to Korea and Taiwan, says Costin. “I had been buying from domestic sources, but I ended up going to Korea,” says Costin. “I was one of the first to import EVA sheets and unit soles, and we started supplying bottom components to running-shoe companies, using EVA as the midsole.” Costin had no idea of EVA’s O&P applications until he was approached by a colleague at Langer Biomechanics, which makes orthotic inserts, footwear, and ankle-foot orthoses. “He asked if SoleTech’s EVA was thermomoldable” and shared a story about how technicians at Langer had adapted it. EVA was soon adopted by the O&P community because of its light weight and thermomolding properties, becoming the most widely used material for lower-extremity orthoses and opening up a whole new market for Costin’s business. Today the company, which changed its name to SoleTech in the late 1980s, supplies the pedorthic and O&P industry as well as other medical markets. It also manufactures components for large shoe companies and distributes shoe care products

strength and density suitable for individual patients. SoleTech makes off-the-shelf diabetic insoles, rigid-flex and semiflex plastic shells, and neoprene sheets. The company also offers an environmentally friendly adhesive. SoleTech’s administrative offices are located in Nahant, Massachusetts, with a distribution center in Claremont, New Hampshire, of about 40,000 square feet and a 30-foot ceiling for maximum inventory use. The company employs 14 people full time in the United States, as well as an overseas representative. It sources its products from Europe, Mexico, and China and sells directly to O&P labs as well as through distributors. While SoleTech has no certified practitioners on staff, it maintains a working relationship with Jon Fogg, CPed, who runs the consulting and educational firm Pedorthic Services. “If people have technical questions, Jon will help support our customers to find the best applications for their patients,” says Costin. What makes SoleTech stand apart from competitors, says Costin, is that it works closely with customers and its research and development team to find the best solutions for each patient. “Not all EVAs are created equally,” he says. “This is especially true in the O&P industry, where techs are very particular about the feel of the product—the hardness, the density, the rebound, even the smell.” The company will develop proprietary products for customers who request them. In the end, says Costin, “We want to help our customers succeed by offering the best quality materials at a competitive price—delivered with outstanding service.”

AOPA Coding Experts ARE COMING TO

Indianopolis

June 3-4, 2019

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA June 3-4 2019, in Indianapolis to advance your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN 14 CEs

AOPA experts provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group.

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2019billing.

The Indianapolis Marriott Downtown 350 West Maryland Street Indianapolis, Indiana 46225 Book your hotel by May 10 for the $189/night rate by calling (877) 640-7666 and asking for the AOPA room rate.

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices.

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience. Find the best practices to help you manage your business.

Participate in the 2019 Coding & Billing Seminar!

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

www.AOPAnet.org

AOPA NEWS

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

MAY 8

AOPA Members Nonmembers

Price Per Seminar

$99.00* $199.00*

Price for Full Year

$990.00 $1,990.00

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

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

JUNE 12

Are You Compliant? Know the Supplier Standards Take part in this webinar and gain a deeper understanding of the Medicare Supplier Standards. Hear from experts on how to determine your level of compliance, and learn what you can do to remain compliant. Topics of discussion will include the following: • Do you have a proper contract with your vendors on file? • Are you required to have a surety bond? • Can you use contracted employees? • What happens if you’re noncompliant with the Medicare Supplier Standards? • What are some tips for preparing for a Supplier Standards site inspection?

APRIL 2019 | O&P ALMANAC

Documentation— Understanding Your Role The rules have changed regarding orthotists’ and prosthetists’ documentation. This webinar will explore the O&P clinician’s role in documenting medical necessity. Reimbursement experts answer these questions: • • • •

What needs to be documented? What must the physician document? Are there any special rules for O&P notes? What has changed with the new “Dear Physician” letter?

AOPA NEWS

NOW AVAILABLE:

‘2018 Operating Performance Report’ AOPA Releases Results From Member Benchmarking Survey

Are you curious about how your O&P business is performing compared to others? Have you been asking questions like these: • How does our spending on materials, advertising, or other expenses compare with other companies similar to ours? • Is our gross margin better or worse than other facilities of the same size? • Are our employees generating enough sales? Copies of the “2018 Operating Performance Report” are now available. The annual report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payor information organized by total revenue size, community size, and profitability. This year’s data was submitted by more than 90 patient-care companies representing 1,022 full-time facilities and 191 part-time facilities. Copies of the “2018 Operating Performance Report” are available electronically in AOPA’s bookstore: • “2018 Operating Performance Report” (Electronic)—Member/Nonmember: $185/$325

NEW MEMBERS

HE OFFICERS AND DIRECTORS of

the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or 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.

Invent Medical USA LLC 1800 Mearns Road, Ste. Y Warminster, PA 18974 267/368-8165 Member Type: Supplier Orthotic Prosthetic Solutions LLC 1446 Hover Road Longmont, CO 80501 720/652-0100 Member Type: Affiliate

O&P ALMANAC | APRIL 2019

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

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

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

Member $482 $634

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

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

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150

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

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

APRIL 2019 | O&P ALMANAC

Southern California A well-established, privately owned, multioffice, ABCaccredited corporation is seeking experienced CPOs who will support the company’s vision, mission, and values and provide premier prosthetic and orthotic patient care to join our team. Candidates must be energetic, self-driven, motivated, and knowledgeable individuals who possess strong clinical, technical, and interpersonal interaction skills. They must be patient oriented and innovative, and desire a long-term career with a growing company. We offer competitive salaries, benefits, and a rewarding place to take the next step in establishing a great career and make a difference. Salaries are commensurate with experience. Local ABC-accredited practitioners are preferred. Apply by email to: Email: Box100@AOPAnet.org Reference Job ID: 45402723

Southeast

CO, CPO, CPOA

O&P Almanac Careers Rates

CPO

Job location key:

Job Board

Pacific

Charlotte, North Carolina, and Columbia, South Carolina, Areas Looking for compassionate professionals who are dedicated to quality patient care. Come live and work in a thriving community, conveniently located near beautiful mountains, lakes, and beaches. Candidates must possess strong clinical skills. Advanced Prosthetics has an in-house marketing team, which allows practitioners to focus on patient care. Consider joining our team and making a difference in patients’ lives. We are Amputees Serving Amputees. Competitive salary, benefits package, and sign-on bonus. Send réumés to: Human Resources Email: carol@advancedpro.biz Fax: 864/622-0592

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

CAREERS

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities

EMPLOYEE

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AD INDEX

Advertisers Index Company

Page Phone 800/574-5426

Website

ALPS South LLC

Amfit

9 800/356-3668

www.easyliner.com

ComfortFit Orthotic Labs Inc.

888/523-1600

www.comfortfitlabs.com

ESP LLC

888/WEAR-ESP

www.wearesp.com

Fabtech Systems LLC

800/FABTECH

www.fabtechsystems.com

Ferrier Coupler Inc.

810/688-4292

www.ferrier.coupler.com

www.amfit.com

Hersco

1 800/301-8275

www.hersco.com

Naked Prosthetics

www.npdevices.com

OHI

27 877/780-8382

www.ohi.net

Össur Americas Inc.

www.ossur.com

888/977-6693 800/233-6263

Ottobock

C4 800/328-4058

www.professionals.ottobockus.com

Proteor USA

855/450-7300

www.proteorusa.com

Spinal Technology Inc.

800/253-7868

Surestep

21 877/462-0711

www.spinaltech.com www.surestep.net O&P ALMANAC | APRIL 2019

MARKETPLACE

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

LEAP Balance Brace

ALPS Smart Seal Liner Our Smart Seal Liner features raised bands that grip to the socket wall to form a secure interface. The bands are coated to ensure longer life and extra security for a smarter seal. The Smart Seal Liner has a new seamless knitted construction with a modern look and is available in locking and cushion suspension. The locking version features a new distal construction to control distal distraction with no matrix. The Smart Seal Liner is just what you need to achieve great suspension! Call us or visit www.easyliner.com for more details.

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

Naked Prosthetics The Original Pre-Flexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Pre-flexed at 43 degrees for maximum comfort and natural unrestricted movement. For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

Sutti Bounders Store and Return Energy— Mimicking Normal Muscle Function New “Sutti Bounders” modular pediatric dynamic elastomers are a patent-pending elastomer technology that offer two progressive solutions. Sutti No tools for on the fly adjustments Bounders store and return by healthcare providers energy—mimicking normal muscle function to produce both eccentric and concentric contractions and, if needed, a ground-reaction force. Smart and simple modular design, standardized sizes, and three levels of performance to choose from add up to an easy-to-use expandable dynamic system to treat your pediatric and young adult patient base. For more information, visit www.fabtechsystems.com/ bounders or call 1-800/322-8234.

APRIL 2019 | O&P ALMANAC

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

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

MARKETPLACE Discover PROTEOR USA

Proprio Foot® Proprio Foot® debuted in 2006 with a simple goal: to reduce trips and falls. This latest-generation microprocessor ankle, built upon a Pro-Flex® LP foot module, provides 44 percent more toe-off power—taking us one step closer to our goal. Visit ossur.com/proprio-foot to learn more.

Enhance Mobility With Ottobock’s E-MAG Active The E-MAG Active electronically controlled joint system is activated independently of the ankle and the foot, allowing patients to take advantage of the joint’s functionality even if they have no ankle function. • Intelligent sensor system measures position of the leg while walking and controls the joint accordingly • Prelock function securely locks the user’s knee joint even before full extension is achieved. For more information, call 800-328-4058 or visit professionals.ottobockus.com.

New Caleo 3D 6Y95 Liner TPE comfort for your more active patients. The Caleo range has now been expanded to include a further version, the Caleo 3D 6Y95 liner. This liner with new gel formula is particularly suited to more active users due to its high level of durability and resistance to wear. • The 3D design features a thicker wall (6 mm) in the front for better protection, and a thinner wall (3 mm) at the rear for more flexibility • New, improved gel formula combines durability and comfort, and can also be thermoformed • Special knee flexion zone and monoelastic textile elsewhere for reduced pistoning.

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

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

For more information, call 800-328-4058 or visit professionals.ottobockus.com. O&P ALMANAC | APRIL 2019

CALENDAR

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

Cascade Dafo Institute

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

2019

May 7–8

AOPA 2019 Policy Forum. Register online at bit.ly/policyforum2019. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

May 8

Are You Compliant? Know the Supplier Standards. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. WEBINAR

May 17–18

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

June 1

April 8–13

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

April 10

Shoes, External Breast Prostheses, Surgical Dressings, and Other Policies. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

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

June 1

ABC: Application Deadline for Fall CPM Exams. Applications must be received by June 1 for individuals seeking to take the August and September CPM exams. Contact 703/836-7114, email certification@ abcop.org, or visit www.abcop.org/certification.

WEBINAR

April 18–20

International African-American Prosthetic Orthotic Coalition Annual Meeting. Texas Scottish Rite Hospital for Children, Dallas. Contact Tony Thaxton Jr. at 404/875-0066, email thaxton.ir@comcast.net, or visit www.iaapoc.org.

May 1

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

May 3–4

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

APRIL 2019 | O&P ALMANAC

June 3–4

Coding & Billing Seminar. Indianapolis. Book your hotel by May 10 for the $189/ night rate. For more information, email Ryan Gleeson at rgleeson@ AOPAnet.org. SEMINAR

June 3–8

June 12

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

CALENDAR July 1

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

November 3–9

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

November 13

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

July 10

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

December 11

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

July 12–13

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

August 14

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

September 11

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

2020 September 9–12

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

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

September 25–28

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

COMPLETE CONTROL

October 9

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

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

Let us share your next event! Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

O&P ALMANAC | APRIL 2019

ASK AOPA CALENDAR

Modifier Meanings Answers to your questions on bilateral modifiers, salvage claims, and more

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 jrossi@contentcommunicators.com.

As of March 1, 2019, you must report bilateral items using two separate claim lines. The RT modifier x1 unit of service is placed on one line, and the LT modifier x1 unit of service is placed on the second line. You may no longer use the LTRT modifier x2 units of service on one claim line. If you use the RTLT modifier combination after March 1, 2019, your claim will not be processed.

Is there a modifier to indicate a claim is being billed as a salvage claim?

No, there is no modifier available to indicate you are billing a claim as a salvage claim or a refused or returned item. You may include a narrative on your claim indicating that you are billing the item as refused, but the key is to make sure you have documented the reason for the refusal in your records.

RT 56

What is the correct way to report bilateral items on a claim for Medicare patients?

APRIL 2019 | O&P ALMANAC

What happens if I bill my claim with a GZ modifier?

The GZ modifier indicates that you are aware that the claim is not reasonable and necessary and you are expecting the denial, but you did not have the patient sign an Advanced Beneficiary Notice (ABN). Because you have indicated that the claim should be denied, if your claim has the GZ modifier, it will automatically be denied. It will not be adjudicated or reviewed, and you will be held financially liable for the claim. The GZ does not eliminate your ability to appeal the denial, so you may still appeal your claim.

If I don’t have a proper order on file and I bill with the EY modifier, and then my claim is denied, may I appeal the denial?

Yes. The use of an EY modifier should result in a not medically necessary denial. All not medically necessary denials may be appealed.

Help Show Elected Officials

Mobility Saves Members of Congress are working on legislation that can have a very real impact on you, your business, your employees, and most importantly your patients. The Policy Forum is the best opportunity to advocate for your business and bring you face-to-face with your policymakers. The conference gives you the opportunity to explain your business, share how policies will directly affect your business and our profession, and clarify the critical impact O&P intervention has on saving lives.

Educate lawmakers on key issues important to YOU and your PATIENTS: Veterans right to choose their own O&P provider

O&P be excluded from competitive bidding

Patients ability to receive prompt and effective care

O&P care only be provided by qualified individuals

Questions regarding registration, travel or the agenda should be directed to Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0836. Questions regarding programming, congressional visits or key issues should be directed to Devon Bernard dbernard@AOPAnet.org or 571/431-0854.

New for 2019 •

New schedule with an opening Keynote luncheon

•

New Lobbying 101, pre-event course. Great for first-timers or anyone who just wants a civics refresher course.

•

New breakout discussion sessions

The 116th Congress, with it it’s wave of activism and fresh faces, is an opportunity for O&P to both educate and reinforce the critical reality that O&P intervention saves lives and money.

HOST HOTEL: Ritz Carlton, 1250 South Hayes Street, Arlington, VA 22202 AOPA has a special rate of $284/night until April 16, 2019.

bit.ly/policyforum2019

The new C-Brace® Step into the future.™

Meet the world’s first mechatronic stance and swing phase control orthosis system (SSCO®), which controls both the stance and swing phase with microprocessor sensor technology. For patients with neurological conditions of the legs, C-Brace supports during the entire gait cycle and adapts to everyday situations in real-time. It is time to step into the future.

• Request a C-Brace Trial at

professionals.ottobockus.com/c-brace