january 2013 almanac

OP&THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRYWWW.AOPANET.ORG

The American Orthotic & Prosthetic Association JANUARY 2013

Taking a Team Approach to Diabetes Care

reimbursement rules for Medicare as a Secondary Payer

What the 2.3% Excise Tax Exemption Means to You | Page 28AOPA

Exclusive!

although a well-established concept, lean manufacturing principles are breathing new life into fabrication processes

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O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/431-0899; email: [email protected]. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: [email protected].

JANUARY 2013 O&P AlmAnAc 3

departments

4 AOPA Contact PageHow to reach staff

6 At a GlanceStatistics and O&P data

08 In the NewsResearch, updates, and company announcements

28 AOPA HeadlinesNews about AOPA initiatives, meetings, and more

37 AOPA Membership 00 Applications

39 MarketplaceProducts and services for O&P

42 JobsOpportunities for O&P professionals

45 CalendarUpcoming meetings and events

47 Ad Index

48 AOPA AnswersExpert answers to your FAQs

CONTENTSJANUARY 2013, VOLUME 62, NO. 1

OP&

Cover story

Feature

18 Learning from LeanBy Adam StoneA “lean” approach to manufacturing has resulted in more efficient processes, reduced turnaround time, and even cost savings for several O&P business owners. Applying a lean philosophy can take many forms—from a complete process overhaul to incorporating bits and pieces into overall best practices.

24 Teaming Up Against DiabetesBy Deborah ConnOrthotists and prosthetists are playing critical roles in the nation’s fight against diabetes, adding their expertise to a team approach to diabetic foot care. Physicians, surgeons, endocrinologists, and other specialists are including O&P professionals in a collaborative effort to prevent amputations and provide a continuity of care.

CoLumn

14 Reimbursement Page Medicare as a secondary vs. primary payer

mailto:[email protected]


IN THE NEWS

4 O&P AlmAnAc JANUARY 2013

Publisher Thomas F. Fise, JD

Editorial Management Stratton Publishing & Marketing Inc.

Advertising Sales M.J. Mrvica Associates Inc.

Design & Production Marinoff Design LLC

Printing Dartmouth Printing Company

OP& Almanac

Copyright 2013 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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.

AOPA CONTACT INFORMATION

AmERIcAn ORTHOTIc & PROSTHETIc ASSOcIATIOn (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899www.AOPAnet.org

EXECUTIVE OFFICES

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

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

O&P ALMANAC

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

Josephine Rossi, editor, 703/914-9200 x26, [email protected]

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

Dean Mather, advertising sales representative, 856/768-9360, [email protected]

Stephen Custer, production manager, 571/431-0876, [email protected]

Lia K. Dangelico, contributing writer, 703/914-9200 x24, [email protected]

Christine Umbrell, editorial/production associate, 703/914-9200 x33, [email protected]

MEMBERSHIP & MEETINGS

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

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

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, [email protected]

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, [email protected]

AOPA Bookstore: 571/431-0865

COMMUNICATIONS

Steffanie Housman, content strategist, 571/431-0835, [email protected]

GOVERNMENT AFFAIRS

Catherine Graf, JD, director of regulatory affairs, 571/431-0807, [email protected]

Devon Bernard, manager of reimbursement services, 571/431-0854, [email protected]

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

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

BOARD OF DIREcTORS

OFFIcERS

President Tom Kirk, PhD, Hanger Inc., Austin, TX

President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthot-ics and Prosthetics Center, Ann Arbor, MI

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

Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX

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

Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

DIREcTORS

Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA

Scott Schneider, Ottobock, Minneapolis, MN

Mike Hamontree, Hamontree Associates, Newport Beach, CA

Dave McGill, Össur Americas, Foothill Ranch, CA

Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT

Eileen Levis, Orthologix, LLC, Trevose, PA

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

Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA

Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA

James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI

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IN THE NEWS


Sources: American Diabetes Association; CDC: National Diabetes Fact Sheet, 2011; CDC: “Increasing Prevalence of Diagnosed Diabetes—United States and Puerto Rico, 1995-2010,” Morbidity and Mortality Weekly Report, Nov. 16, 2012.

AT A GLANCE

Diabetes, State By State

Source: Centers for Disease Control and Prevention (CDC): “Increasing Prevalence of Diagnosed Diabetes—United States and Puerto Rico, 1995-2010,” Morbidity and Mortality Weekly Report, Nov. 16, 2012.

The highest prevalence of diagnosed diabetes among adults in 2010 was found in Mississippi, Alabama, Tennessee, West Virginia, Texas, and Puerto Rico

18.8 million

Number of states in which diabetes prevalence increased by at least 50% between 1995 and 2010; 18 states had at least 100% increases.

Total medical and productivity costs associated with diagnosed diabetes in the United States in 2007.

Number of Americans with diagnosed diabetes mellitus in 2010.

Annual percentage of all nontraumatic lower-limb amputations performed on diabetic patients.

7 millionEstimated number of Americans with undiagnosed diabetes in 2010.

8.2%Median age-adjusted prevalence of diagnosed diabetes in the United States in 2010, up from 4.5% in 1995.

60%

42

Age-adjusted prevalence of diagnosed diabetes among adults in 2010

n ≥10.0 %n 9.0-9.9n 8.0-8.9n 7.0-7.9n 6.0-6.9

$174 billion

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IN THE NEWSIN THE NEWS


According to a study published in Endocrine, diabetes-related foot complications are more prevalent in men, and this at-risk group should be provided with additional attention and aggressive treatment.

In a retrospective study, a team of Brazilian researchers evaluated medical records of 496 patients with an estab-lished foot at risk or diabetes-related foot complications, based on age, gender, type and duration of diabetes, foot-at-risk classification, and the presence of deformities, ulceration, and amputation.

Researchers found that diabetes-related deformities were associated with an increased prevalence in patients with neuroeschemic disease and neuropathy when compared to the ischemic-only group, regardless of age, gender, and diabetes duration or type. Men more than women (33 percent versus 18 percent) and those with Type 1 rather than Type 2 diabetes (41 percent versus 24 percent) were more likely to experience ulceration. However, male gender only remained a significant predictor for ulceration in the multivariate analysis.

Amputation also was more significant in men than women (20 percent and 7 percent, respectively) as well as in patients with neuroischemic disease as compared to patients with neuropathy or ischemic disease alone (21 percent versus 9 percent and 6 percent, respectively).

The researchers attribute part of the gender discrepancy to better wound care in women, as men are more commonly involved in heavy physical work activities and dealing with social pressure to not miss work.

Diabetes-Related Foot Complications More Prevalent in Men

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New Material May Improve Prosthetic Fit

A new shape-changing “smart” material that has potential in the medical textiles industries and in making better-fit prosthetic limbs has been developed by a team of research scientists. According to the researchers, who are from the University of Bolton, England; the University of Manchester, England; and Harbin Institute of Technology, China, the new “piezomorphic material” reacts to force; it undergoes dramatic changes in shape on simple stretching or compression.

Potential applications for the material are diverse. The researchers have identified how a piezomorphic lining could respond to pressure applied when, for example, walking, to improve prosthetic fit and comfort. The team also has identified smart bandages as a potential application. A bandage layered with medication, which could be released depending on wound swelling, would allow controlled, condition-dependent treatment without the need for constant wound checking. The material also could be used in the manufacture of advanced composite components for cars and aircraft.

Examples of polymeric (PU) foam and micropo-rous polymer (ex-PTFE) piezomorphic materials are presented.

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IN THE NEWS

TRANSITIONS people in the news


Chris Baughman, CP, BOCO, is the managing practitioner at Ability Prosthetics & Orthotics’ newest patient-care facility in Raleigh, North Carolina.

Sue Borondy, Endolite’s marketing and communication manager, has been elected to the OPAF Board of Directors.

James Button has been named to the Review Board of the Dralla Foundation, a nonprofit organization founded by Allard USA.

Hanger Clinic/Dynamic Orthotics and Prosthetics has named AOPA Immediate Past President Thomas DiBello, CO, FAAOP, as regional director of Texas Gulf Coast and Jason M. Jennings, CPO, LPO, FAAOP, as area clinic manager.

Traci Dralle has joined Fillauer as director of marketing.

Tammy Duckworth (D-Illinois) has been elected to the U.S. House of Representatives. Duckworth is an Iraq war veteran who underwent bilateral lower-limb amputations in 2004, and a former assistant secretary for the Department of Veterans Affairs.

The orthotics and prosthetics program at Eastern Michigan University has announced its incoming class of 2014. In addition, two O&P students, Theresa Field and Angela Kanavel, have been recognized as recipients of the school’s Wyle G. Bonine Scholarship.

R. Scott Hosie, CPO, has been named clinical educator for Motion Control, headquartered in Salt Lake City.

Scheck & Siress, headquartered in Chicago, has hired Jim Kingsley as chief operating officer.

Blake Manufacturing Inc. has hired Nelson LeMarquand MS, CO, LO, FAAOP, as director of sales and education.

Timothy Miller, CPO, has been named president of the board of directors of the American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

Ottobock has hired Gerald Stark, MSEM, CPO/L, FAAOP, as senior upper-limb specialist and as clinical leader of the company’s upper-limb professional and clinical services team.

Claudia Zacharias, MBA, CAE, president and CEO of the Board of Certification/Accreditation, International, has been elected to the Institute for Credentialing Excellence Board of Directors.

CMS Releases 2013 HCPCS CodesThe Centers for Medicare and Medicaid Services (CMS)

has released the new Healthcare Common Procedure Coding System (HCPCS) codes, which take effect Jan. 1, 2013. The full list is available on the CMS website at www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.

The addition of one new L-Code and description changes to four L-Codes are specific to orthotics and prosthetics:

New Code

L5859• Addition to lower-extremity prosthesis, endoskeletal

knee-shin system, powered and programmable flexion/extension assist control, includes any type motors.

Code Description Changes

L5972• New description: All lower-extremity prostheses, foot,

flexible keel.• Old description: All lower-extremity prostheses, flexible

keel foot (safe, sten, bock dynamic, or equal).

L8000• New description: Breast prosthesis, mastectomy bra,

without integrated breast prosthesis form, any size, any type.• Old description: Breast prosthesis, mastectomy bra.

L8001• New description: Breast prosthesis, mastectomy bra, with

integrated breast prosthesis form, unilateral, any size, any type.

• Old description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral.

L8002• New description: Breast prosthesis, mastectomy bra,

with integrated breast prosthesis form, bilateral, any size, any type.

• Old description: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral.

IN THE NEWS


A team of students from Purdue University, West Lafayette, Indiana, has designed a new type of prosthetic leg for Lucas Resch, a 5-year-old boy who was born with proximal femoral focal deficiency (PFFD). The leg uses a gearbox design that enables the prosthesis to move like a real leg.

Resch was born with only a fraction of his left femur, making his left leg far shorter than his right. Conventional prostheses do not give Resch the ability to run and ride a bicycle or play like his friends do, and his parents have been searching for ways to allow him to attain that level of activity as he grows without the need for to rotationplasty surgery.

The new prosthesis, created by a team of Purdue mechanical and biomedical engineering students, uses a gearbox to produce a knee’s range of motion; whereas an ankle joint swivels about 40 degrees, a knee joint moves about 90 degrees. The new design hinges on the innovative gearbox that converts the ankle’s limited movement to the motion of a knee, providing greater mobility.

The Purdue students created a mold of Resch’s shin to make a better fit, and he and his family will return later this year to receive the form-fitted leg. The leg will be adjusted as Resch grows.

University Students Design Prosthesis for Child With PFFD

Muscle Regeneration Therapy May Prevent Amputations

Researchers at the Wake Forest Institute for Regenerative Medicine (WFIRM) are developing an oxygen gel that can be injected into wounded muscles to sustain tissue and limbs. The research is part of the federally funded Armed Forces Institute for Regenerative Medicine. Wake Forest is a co-leader of the $300 million program, which involves 34 universities and is tasked with changing the way wounded soldiers are treated on the battlefield.

The gel would be injected into the muscle, providing a water-based source of oxygen. The idea is to apply the gel to open wounds on the battlefield and save limbs, and maybe even lives, because it buys the soldier crucial time keeping tissue alive until surgery.

One of the overarching goals of the federal program is to identify ways to repair massive muscle loss injuries, according to Dr. George Christ, lead researcher on the project.

“The same way you exercise in a gym, we exercise these [muscles] in a laboratory,” he explains.

In addition to battlefield protocols, some of the WFIRM research will have far-reaching applications. Christ hopes to use the muscle implant therapy in a clinical trial on young patients with cleft lips. Several years down the road, the ultimate goal is to regenerate human limbs.

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A team of Purdue students has designed a new type of prosthetic leg for 5-year-old Lucas Resch, who has a rare birth defect that makes his left leg far shorter than his right. At left are conven-tional prosthetics, which do not give Lucas the ability to run and ride a bicycle or play like his friends. The new prosthetic leg, not shown, uses an innovative gearbox design that enables the pros-thetic to move more like a real leg.

http://r.smartbrief.com/resp/eavHCjymdHCfgdfbCidmrmBWcNAZAj?format=standard




IN THE NEWS

Visual Feedback Helps Upper-Limb Amputees Gauge Grip Force

Erik Engeberg, PhD, University of Akron, Ohio, and Sanford Meek, PhD, University of Utah, Salt Lake City, have concluded through recent research that providing visual feedback about grip force can improve the manipulation of brittle or rigid objects for those using a prosthetic hand. Engeberg and Meek used and rated visual feedback supplied to the user through a bicolor LED mounted to the thumb to communicate grip force requirements.

A hybrid force-velocity sliding mode controller was used with and without additional visual force feedback as part of the research methodology. The results provided a statistically significant improvement in handling brittle objects with the prosthesis when using the visual force feedback.

The results of the research could lead to the implementation of a noninvasive, functional, and cost-effective technique to visually indicate to upper-limb amputees the grip force applied by a prosthetic hand. More information about the study and its methods can be found in Prosthetics and Orthotics International.

TRANSITIONS BUsinesses in the news

Researchers from Marquette University and the Medical College of Wisconsin, both in Milwaukee, received a one-year, $50,000 grant from the Clinical and Translational Science Institute of Southeast Wisconsin to evaluate how patient perception affects the success of prosthetic and orthotic lower-limb devices. The Clement Zablocki Veterans Affairs Medical Center, Milwaukee, will be one of the research sites.

College Park Industries has moved its corporate headquarters to a renovated facility in Warren, Michigan, resulting in a 30 percent increase in manufacturing space.

Hi-Tech Prosthetic in Aguadilla, Puerto Rico, has announced the launch of a Spanish-language O&P website, www.miprotesis.com, where individuals in Puerto Rico and Latin America can download news and interact in a social-network forum.

OPAF and The First Clinics partnered with the Mutual Amputee Aid Foundation to introduce the First Target Archery Clinic on October 28 in Encino, California.

Two new supplier partners have joined OPGA: The vanHalem Group, LLC, an audit and consulting firm; and O&P Solutions, which brings a profes-sional management model to O&P practices.

A prosthetics and orthotics school building recently was inaugurated at the Orthopedic Training Centre in Nsawam, Ghana. The project was funded by Australia’s Direct Aid Program, and the new facility features classrooms for training of O&P technical assistants and a fully equipped technology building.

Össur’s Symbionic Leg has received the 2012 Best of What’s New Award from Popular Science magazine.

Proteor announces the following clarification to the

“Businesses in the News” item from Ergoresearch that appeared in the October O&P Almanac: A distribution agreement between Proteor, France, and Ergoresearch, Canada, was signed for the distri-bution on the Canadian market of an orthotic patented worldwide joint, called ODRA, manufactured by Proteor and used for the fabri-cation of custom-made OA braces.

Specialists in delivering superior treatments and outcomes

to patients with limb loss and limb impairment.

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

Photo: Touch Bionics

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American Board for Certification

in Orthotics, Prosthetics &

Pedorthics, Inc.

abcop.org

(703) 836-7114

Setting the standard for O&P certification

for over 64 years.

ABC is making all certification exams more readily available.Beginning January 2013 all Written and Written Simulation exams will be given every other month, and the Clinical Patient Management exams will be given three times a year. In addition, candidates for the Practitioner Certification exams will have 30 days after the application deadline to complete their residency requirements.

For more information on exam dates and application deadlines go to abcop.org.

SCAN THE CODE TO learn more about ABC certification

You’re going to love this!


n Reimbursement Page

By Devon Bernard, AOPA government affairs department

When the only insurance a patient has is Medicare, determining who to bill

is easy; most of the time, you bill Medicare solely and directly, and you know how much Medicare will pay. When a patient has Medicare and other insurance coverage, where to send the bill first and how much Medicare will pay becomes a little more complex. The patient’s other insurance will either be billed first (making Medicare a secondary payer), or Medicare is billed first and the patient’s other insurance is billed second.

When Medicare is the primary payer, the rules are fairly straight-forward and don’t change: Medicare will always be the primary payer. The rules for when Medicare is a secondary payer are not always that simple; sometimes certain conditions have to be met in order for Medicare to become the secondary payer.

Because the rules and scenarios for Medicare as a secondary payer are a little more fluid, the following provides a brief synopsis of the programs that are primary to Medicare, how you can identify if your patient is eligible for one of the

programs, and a quick tutorial on calculating Medicare’s liability—an easy way to do those calculations.

Before discussing the programs that make Medicare a secondary payer, here is a list of the programs that will always be considered secondary to Medicare:• Medigap or Medicare

Supplemental Insurance. These insurances, provided by private insurance companies, help beneficiaries fill the gaps in their original Medicare plan. If you are a participating provider, Medicare automatically forwards your claim to the Medigap provider after it made its payment.

•Medicaid. This program helps cover the costs for people with limited resources and is a joint federal and state insurance program. Because of the joint effort, each state’s Medicaid program varies, but most health costs are covered if a beneficiary qualifies for both Medicare and Medicaid.

•TRICARE. This health-care insurance is for active duty members of the armed services, retirees, and their families.

How to determine a patient’s primary payer—and what to bill Medicare

Get


Programs Primary to Medicare

Currently, the following six programs always render Medicare to secondary payer status. In other words, if your patient is participating in one of these programs, the patient’s other insurance must be billed first before you may bill Medicare.

•Working Aged. By far the most common scenario, working aged means a person has become entitled to Medicare benefits based on age, but he or she has not yet retired. For patients to be considered working aged, they must be at least 65 and enrolled in their employer’s group health plan (EGHP); the employer must have at least 20 employees. The EGHP also may cover the patient’s spouse, and the spouse would be considered working aged, even if he or she is currently retired. If a patient chooses not to be covered by the EGHP and wants Medicare as a primary insurer, he or she cannot receive any benefits from the EGHP. However, if the patient has a retirement plan provided by his or her employer and is 65 or older, the retirement plan will always be secondary to Medicare.

•Workers’ Compensation. For a workers’ compensation (WC) claim, or a claim that is the result of an injury occurring on the job, Medicare normally will not make payments. But there are times when you may send a WC claim to Medicare. If you don’t agree to accept the WC payment as your payment in full, and your state allows you to collect your full charge, you may submit the WC claim to Medicare for secondary payment. In some cases, a WC claim may involve an arrangement to set aside money to cover the patient’s

current and future medical care related to an injury sustained on the job. When a set aside arrangement has been made, you may not have the ability to bill Medicare, even if the WC claim was long before the patient became eligible for Medicare. Medicare may not be billed or make a payment when a set aside agreement is in place, until you can provide evidence that the money in the set aside agreement has been exhausted, and the money was spent on appropriate medical expenses.

•No-Fault and Liability Insurance Programs. These programs involve coverage by an insurance company, typically involving some type of accident that doesn’t occur at work. No-fault insurance, personnel protection, or medical expense coverage covers expenses due to injuries that occurred on the insured’s property or in the use of the insured’s vehicle, regardless of who is responsible for the accident. Liability insurance applies when someone is found to be at fault for causing an injury and payment is based on the policyholder’s legal liability for injury. The two most common types of liability insurance are auto and malpractice insurance. With liability insurance claims, you can seek a conditional payment too, but you may also seek conditional coverage.

With liability insurance, no-fault insurance, and WC insurance claims, you can seek a conditional payment from Medicare for any covered benefits if you don’t believe the primary insurer will pay your claim in a prompt manner, essentially making Medicare the primary payer. Typically, if after 120 days you haven’t received payment from the primary payer, you may submit the claim to Medicare, and Medicare will make a condi-tional payment. However, if it is determined that someone

else should have paid first or you eventually receive payment from the primary insurer, you must refund Medicare. Keep in mind, you may not seek primary payment from two insurers. So, if you choose to seek a conditional payment from Medicare, you must withdraw any claims you have with the primary insurer and/or drop any liens you may have placed on the beneficiary.

•End-Stage Renal Disease. If a patient is diagnosed with end-stage renal disease (ESRD), he or she is entitled to receive Medicare benefits, even if the patient is under the age of 65. If ESRD is the only reason a patient has Medicare, and he or she is covered by an EGHP, then Medicare will be secondary to the EGHP. The patient also is entitled to all Medicare benefit categories, not just those related to the treatment of the ESRD. ESRD is somewhat compli-cated. Because it will not always be primary to Medicare, certain situations exist when Medicare will become primary. Medicare will be secondary for ESRD patients for a total of 30 months, which is called the ESRD coordination period. The coordination period begins when the patient first becomes eligible for Medicare benefits. After the coordination period ends, Medicare will become the primary payer.



If the patient is under 65 and has Medicare benefits solely because of ESRD, his or her entitlement to Medicare benefits will expire 12 months after the last dialysis treatment or 36 months after a successful kidney treatment. So, if you have a patient who has Medicare coverage due to ESRD, you should routinely check his or her coverage or status because primary and secondary insurers can shift, and the patient may no longer have Medicare coverage.

•Disability Insurance. Medicare offers benefits to anyone who has a permanent disability, other than ESRD, regardless of age. If someone is receiving Medicare benefits because of a disability, Medicare will usually be primary. Certain criteria must be met for Medicare to become the secondary payer for someone with a disability. First, the patient must be under 65, receiving Medicare benefits solely because of a disability; the patient must also

have other health-care coverage under a Large Group Health Plan (LGHP). The coverage from the LGHP may be through the patient’s current employment or the current employment of a family member—mother, father, spouse, and so on. In order for a group health plan to be considered an LGHP, the offering employer must have 100 or more employees or be part of a multi-employer association where at least one member has more than a 100 employees.


If the patient... And… The primary payer is… And the secondary payer is…

Is age 65 or older and is covered by a Group Health Plan through current employment or spouse’s current employment…

The employer has less than 20 employees.

Medicare Group Health Plan

Is age 65 or older and is covered by a Group Health Plan through current employment or spouse’s current employment…

The employer has 20 or more employees, or at least one employer is part of a multi-employer group that employs 20 or more individuals.

Group Health Plan Medicare

Has an employer retirement plan and is age 65 or older…

The patient is entitled to Medicare.

Medicare Retiree coverage

Is disabled and covered by a Group Health Plan through his or her own current employment or through a family member’s current employment…

The employer has less than 100 employees.

Medicare Group Health Plan

Is disabled and covered by a Group Health Plan through his or her own current employment or through a family member’s current employment…

The employer has 100 or more employees, or at least one employer is a multi-employer group that employs 100 or more individuals.


Has end-stage renal disease and Group Health Plan Coverage…

Is in the first 30 months of eligibility or entitlement to Medicare.


Has end-stage renal disease and Group Health Plan Coverage…

After 30 months. Medicare Group Health Plan

Is covered under Workers’ Compensation because of a job-related illness or injury…


Workers’ Compensation (for health-care items or services related to job-related illness or injury claims)

Medicare

Has been in an accident or other situation where no-fault or liability insurance is involved…


No-fault or liability insurance for accident or other situation related health-care services

Medicare

Medicare Second Payer Cheat Sheet



Medicare as a Secondary PayerNow that you know and understand

which programs may render Medicare a secondary payer, the next step is to figure out if a patient has insurance primary to Medicare. The following three tools can help you determine who is the primary payer: • the Coordination of Benefits (COB)

contractor •a patient intake questionnaire•a Medicare secondary payer (MSP)

cheat sheet.

Patient intake is the best time to ascertain if the patient may have a payer primary to Medicare. To assist in that endeavor, the Center for Medicare and Medicaid Services (CMS) has created a question-naire your office can use. The CMS questionnaire was designed to be answered in sequence, and it will prompt the patient to answer questions that apply to his/her situation. The form will not only help you determine if patients have insurance primary to Medicare but also which program they have. This questionnaire takes all the guesswork out of the process, and it is simple and easy to follow; however, it is rather long. You can find the questionnaire in Chapter 3, section 20.2., of the Medicare Secondary Payer Manual: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html.

If you don’t want to have each and every patient fill out a long question-naire, you can create a shorter version, using an MSP cheat sheet, like the one found on page 16. You also may review any insurance information provided to you by the patient and match it against the scenarios on the cheat sheet to determine if Medicare will be the primary or secondary payer.

Lastly, you may enlist the help of the COB. The COB is responsible for handling all aspects/activities of the Medicare secondary payer program, excluding making payments. Those activities include creating and maintaining an insurance coverage

profile on Medicare beneficiaries, which means it collects, manages, and reports all events that can result in a patient having insurance coverage primary to Medicare to ensure Medicare doesn’t make a mistaken payment when multiple insurers are involved. Besides being able to help you determine if a patient has insurance primary to Medicare, the COB also can answer any of your questions about the Medicare as secondary payer program.

The COB customer service line (800/999-1118) is available Monday-Friday, 8 am – 8 pm, ET. If you call the COB about a specific patient, be sure to have the following information ready: your supplier number, patient’s name, patient’s date of birth, and the patient’s Medicare number. The patient also is able to call the COB to verify if he or she has insurance primary to Medicare. Keep in mind, however, if your supplier number doesn’t match what the COB has on file, your questions must be submitted via mail. The COB address is:

MEDICARECoordination of Benefits

P.O. Box 33847 Detroit, MI 48232

How to Determine Medicare’s Liability

If you determine a patient has insurance primary to Medicare, the next step is to determine how much Medicare will pay you. Because Medicare will never pay more than its allowable, be aware that the most Medicare will pay in a MSP claim is its allowable amount. However, to determine the exact amount Medicare will pay, use the following three calcu-lations—and know that Medicare will pay the lesser of the amounts derived from these calculations:

•First, determine the amount Medicare would pay if it were primary, or if it were the only payer.

•Second, calculate Medicare’s liability with regard to the primary

insurer’s payment. That calculation is done by subtracting the primary insurer’s payment (what it actually pays) from either the Medicare allowable or insurer’s allowable (how much it could pay).

•Finally, subtract your submitted charge minus the payment made by the primary insurer.

Rather than doing the calculations yourself—and if you want to determine Medicare’s payment in a MSP claim—AOPA recommends visiting your DME MACs website. Each website has aides or calculators to determine Medicare’s liability in an MSP situation. For example, the Jurisdiction B DME MAC, National Government Services, has an excellent MSP calculator on its website. All you have to do is enter the amounts, and it does the rest. Here’s the link: www.ngsmedicare.com/wps/portal/ngsmedicare/medicaresppandsc.

One insurance program not covered above was Department of Veterans Affairs (VA) benefits. So, are VA benefits primary to Medicare or is Medicare a secondary payer if the patient has VA benefits? If veterans have Medicare and VA coverage, they must choose one of the agencies to handle their orthotic and prosthetic services. A claim can’t be submitted to both agencies for the same date of service and for the same items. a

Editor’s Note: If you want to learn more about MSP and other coding, billing, and reimbursement issues, consider attending an AOPA Coding & Billing Seminar or one of AOPA’s AOPAversity Audioconferences. See page 32 for calendar of events.

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at [email protected].

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html



http://www.ngsmedicare.com/wps/portal/ngsmedicare/medicaresppandsc

http://www.ngsmedicare.com/wps/portal/ngsmedicare/medicaresppandsc


School

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tos:

Ariz

ona

AFO

or a while, it looked as if there was no way for custom fabricator Arizona AFO, headquartered in

Mesa, to grow. The firm had moved into a larger space in 2005, but there still seemed no way to keep up with a growing volume of orders from O&P practitioners.

“There was a time when I didn’t want any more business. We couldn’t handle one more order coming in,” says Vice President Don Pierson, CO, C.Ped. The business seemed to have reached maximum capacity, and O&P clients found themselves waiting longer and longer for their orders to come through.

Then something happened. Within a month the firm cut its production time from 18 days to seven, even while taking on a higher order volume.

What happened is a “lean” philosophical approach to manufacturing that emphasizes efficiency by addressing everything from work flow to production tools to the physical space where workers stand. While lean has been around in the business community

for some time, it is increasingly taking hold among O&P businesses and central fabri-cation companies.

Clear the DecksArizona AFO implemented lean with the

help of Arizona State University Professor Andrew Feller. He consulted with the firm for a month, observing activities and diagramming processes. Then he recom-mended a few simple steps.

“The first thing you find out is that you have a lot of ‘stuff’ you don’t need, stuff that is just in the way. Machinery, boxes—anything that was just in the way—we got rid of all that,” Pierson says. Then a few pieces of the assembly process got shifted.

“We saw that if we could adjust the sewing machine to where it should actually be, as the next step in the line, we saved all sorts of time.”

These kinds of basics represent simple examples of lean thinking in action, but the philosophy of lean runs deeper.

COVER STORY


A “lean” approach to manufacturing offers

processes, reduced turnaround time, and

cost savings for O&P fabricators

By AdAm Stone

Learning from

F

LEAN


“More than just a predefined

method, [lean] gets you together

as a company and teaches you a

communication style to actually

achieve change.”

—Scott Wimberley

At Cascade Dafo, “motion

waste” was dramatically

reduced after the work

area was redesigned into

a U-shaped cell, placing

all needed tools and

materials within easy

reach of the operator.

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“Lean is an operational excellence strategy. It basically enables you to change for the better. More than just a predefined method, it gets you together as a company and teaches you a communication style to actually achieve change,” says Scott Wimberley, operations director at Fabtech Systems, a central fabrication company in Everett, Washington.

A lean enterprise will scrutinize every aspect of its operations. How does purchasing work, and how does it synch with inventory? What are the steps in the manufacturing process and how are they achieved? Are the right tools being kept in the right places? Does a piece pass through multiple hands as it is built, or is a single individual responsible from start to finish?

The net result of all this analysis: “You are able to deliver a higher quality product in less time with less rework and fewer surprises,” says Wimberley.

Business books point to successful lean implementations among very large manufacturers—Toyota is most often cited—but in fact these ideas can yield significant improvements even at much smaller O&P C-Fabs.

“O&P has a stigma that every-thing is personal, everything is customized—and it is. But from a manufacturing and production point of view, it’s all pretty standard,” Wimberley explains. Generic parts can be readily streamlined, while custom elements can be folded into a tight system. It’s like making a pizza: The

basic dough-cheese-sauce assembly is standardized, while the addition of toppings—although customized for each order—still is achieved with great efficiency.

The point is, even a small, mainly custom shop has as much to gain from lean as any bigger manufacturer.

Streamlining the ProcessIt can be easy to view lean more as

an idea than an action, a loose affili-ation of production concepts rather than a concrete set of practices. To understand how it works in the day-to-day, it helps to take a close look at a single example.

Fillauer Companies of Chattanooga, Tennessee, turns out anywhere from 50 to 10,000 parts at a time, with a typical run producing 100 to 1,000 parts. The 78-year-old company has had plenty of time to get good at

this, but present day management is looking to get even better and has implemented a range of lean practices to help speed production and enhance overall efficiency.

“The first thing with lean is cleaning out the clutter,” says Paul Pelletier, machine shop production supervisor. To that end, cutters, drillers, and other machinery have been consolidated in a single warehousing area. This tight organization feeds a streamlined process in which materials are pre-cut and ready to be dropped into place once manufacturing begins.

This process has helped Pelletier deal with challenging situations, for example the notoriously inaccurate casting of knee joints. To address this recurring issue, he has revamped the process to include different machinery, paired with more efficient practices, especially the addition of


“It can’t just be one person’s way or the highway. If

[machinists and operators] are active in the decision-

making process, they are more likely to jump on board.”

—Paul Pelletier

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computer-aided controls. With these changes in place, a product that previ-ously had to be handled seven times now can be handled just once.

“It’s more efficient, and it is a great deal more precise, since the more you handle things the less accurate they are,” says Pelletier.

Improved technologies have driven productivity in other areas, including the cutting of knee lock pieces. In addition to computer-guided milling, Fillauer has upgraded its cutting tools, investing in machines that work 10 to 15 times faster than older models. The entire project cost about $8,000 but it has shaved off production time dramatically. Where it used to take three months to produce 12,000 parts, today the firm can do that in a week and a half.

The lean aspect at Fillauer involves more than just buying new machinery. The infrastructure investments are part of a bigger process in which operations are reviewed globally, in an effort to understand how all the pieces fit together.

It isn’t always easy to generate that kind of thinking. “The challenge is more about personnel than anything,” Pelletier explains.

When a task has always been done a certain way, it can be difficult to change course. Lean requires buy-in at all levels. “Machinists and operators—they have to have the mindset of wanting to do this,” Pelletier says. To get that kind of team spirit going, management has to take a participatory approach. “I have to keep my mind open to everyone else’s suggestions. I don’t always see things the way they do, so we need to have pretty good communications. It can’t just be one person’s way or the highway. If they are active in the decision-making process, they are more likely to jump on board.”

Despite the many advantages of lean, Pelletier says there are some areas of production where close analysis and the reinvention of systems are simply not justified. “There are parts that we have been making for 50 years. They are small sellers, but they are still

necessary. People still want them. But to put a lot of effort and money into re-thinking those, it just isn’t worth it.”

Start with PurchasingFillauer’s lean emphasis has been

on the integration of new technologies, but others taken an even more basic approach, tackling lean not as a product question but rather as a matter of business processes.

Headquartered in Troy, Michigan, Becker Orthopedic employs more than 100 people in the manufacture of

knee, ankle, and hip joints. President Rudy Becker Sr. views lean as a means to a very specific end. “It’s our ability to try and keep the costs down, so we can pass those savings onto customers,” he says.

While others may tackle lean first as a matter of cleaning up the shop floor or organizing to production process, Becker begins with an emphasis on inventory.

“Lean manufacturing starts with purchasing. If you have twice as much raw material in here as you need, then you are carrying too much cost,” he

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“The point of lean

manufacturing is to

control as many costs

as you possibly can.”

—rudy becker Sr.

pieces an hour—enough to nearly double production. The challenge came with improved tools and systems, but ultimately it proved to be a mental shift that carried the day. “People are overwhelmed by having this huge 35 number. It feels like that is all you can do,” Pierson says. “But if you organize it, breaking the big chunks into small chunks, it somehow just becomes a lot easier.”

It keeps coming back to the people: Their understanding, their interest, their buy-in. Lean cannot come from the top down. It has to grow organically.

“We do education and meetings daily to talk about what we do and how we do it. It’s a sizable expense but that expense is well-rewarded,” Wimberley explains. Some meetings focus on a particular aspect of lean theory. At others, employees talk about operations in their areas to identify potentials for streamlining.

Often the daily meeting will look at some shortfall, a run of plastic for example that turned out thinner than expected. While all aspects of the system will be scrutinized, Wimberley says, the solution 80 percent of the time is more training.

Lean has made some inroads among O&P manufacturers, some formally embracing the philosophy, others taking bits and pieces and incorpo-rating them into overall best practices. Wimberley predicts it will become even more deeply entrenched in the near future.

While generally associated with large-scale production, lean has much to offer even smaller-scale C-Fabs.

“With any company, improving what you do and how you do it, becoming more efficient, that is what leads to success,” he says. a

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

says. “We try to be very intelligent in working with our suppliers to make sure we get the parts that we need and we get them on time.”

This focus on smart purchasing is bolstered by Becker Metal Works, a sister company producing knee and ankle joints through a lost wax process.

“That helps a lot in our ability to get stuff right when we need it, so if we have a big influx of orders we can respond to that,” Becker adds.

This tight integration in the supply chain has helped cut lead time from 24 to 30 weeks down to eight weeks for a typical order. Becker can do it in three weeks if necessary.

Purchasing, supplies, inventory: These are not first topics that typically come up in discussions of lean business practices. But that is exactly the point that Becker makes, and experts in the field back him up. Lean is all about processes, and these do not begin or end on the shop floor. A business is a holistic entity and needs to be considered as the sum of all its parts to gain maximum efficiencies.

“There are all sorts of costs in manufacturing. There is the cost of the building you are in, the cost of the electricity, the cost of the inventory you carry, the cost of the labor, and the costs of the materials. The point of lean manufacturing is to control as many of those costs as you possibly can,” Becker says.

A New ViewWith so many variables to consider,

one still has to start somewhere. Cascade Dafo in Ferndale, Washington, starts with cardboard boxes.

Practitioners send the manufacturer of pediatric bracing systems hundreds of boxes every day. In the past it took five people to open them all, and sometimes rush orders would not be discovered until halfway through the day, according to Loretta Sheldon, director of business development and education.

By streamlining the types of equipment needed, reducing the number of steps, and reorganizing the space to cut down on walking-around time, management was able to pare down the process by 20 percent. The project succeeded in large measure because changes were driven by those who were most hands-on. “We gathered the people who were actually doing the work. That is the most important thing, because they know from doing it every day exactly where the waste is,” Sheldon says.

Sometimes, lean can be little more than a mental shift, a way of viewing the work that allows people to adjust their behaviors.

At Arizona AFO, workers had been putting out 35 custom braces per day. As part of its lean review, management asked employees to boost that number substantially, up to eight



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Teaming Up Against DiAbeTes

A continuity of care offers patients promising results


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&P

By Deborah Conn

More than 60 percent of nontraumatic amputations in the United States result from

diabetes, according to the Centers for Disease Control. The CDC estimates that 8.3 percent of the population—almost 26 million Americans—now has diabetes, which is associated with $116 billion in annual direct medical costs alone. Further, more than 30 percent of those costs are the result of peripheral

vascular disease and related neuro-pathic complications.

The good news is that the rate of lower-extremity amputations among patients with diabetes fell significantly between 1996 and 2008; the bad news is that far too many people still risk losing a limb to the disease. Many diabetes patients suffer from peripheral neuropathy. Their inability to sense the discomfort of an ill-fitting shoe or

Charles Crone, CP, conducts an initial fitting of a below-knee prosthesis.


a small cut or blister, combined with compromised vascular systems, can allow such injuries to develop into full-blown ulcers, with devastating consequences.

Almost 100,000 limbs are amputated each year in the United States due to complications from diabetes, according to Christopher E. Attinger, co-director of the Center for Wound Healing at Medstar Georgetown University Hospital in Washington, D.C. A recent study in the United Kingdom found that people with diabetes are 210 percent more likely to have a leg amputated above or below the knee and 331 percent more likely to need part of a foot removed than is the general population.

Taking a collaborative approach to diabetic foot care isn’t new. New England Deaconess Hospital in Boston established the nation’s first foot hospital in the 1920s, and by the 1950s had established itself as a world leader in foot care and treating ischemic foot ulcerations.

What is new, however, is the sophistication and pace of the team-based approach to saving limbs from diabetic-related amputations.

“A team approach to diabetic limb salvage such as that developed at Georgetown University Hospital over the past 20 years can result in a much greater number of limbs being saved,” says Attinger.

At the Madigan Army Medical Center in Tacoma, Washington, the number of diabetes patients increased 48 percent from 1999 to 2003. At the same time, however, the number of lower-extremity amputations dropped 82 percent, from 33 in 1999 to 9 in 2003, according to a recent study published by the journal Diabetes Care. The chief reason? “The value of a focused multidisciplinary foot care program for patients with diabetes,” the study concluded.

After Broadlawns Medical Center in Des Moines established an amputation prevention program with the team approach, the number of limb losses decreased by 72 percent.

While at Broadlawns, Lee C. Rogers, DPM, now co-medical director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles, developed a six-step protocol for diabetic limb salvage that incorporates a wide range of medical specialties. The program, which Rogers teaches at medical facilities nationwide, begins with an acronym, VIP—vascular, infection, and pressure—although not in that order. The first step is to address the infection, which is the most common reason for losing a leg. After that comes vascular management, and then off-loading of plantar pressure. Wound management follows, with debridement, promotion of granulation tissue, and wound closure.

Becoming a Team PlayerThe big difference in treating the

diabetic foot, as opposed to, say, a heart attack, is the need to combine multiple disciplines, says Rogers. “If you go to the emergency room with a heart attack, you see a cardiologist who can do everything you need. When you are at risk of losing your leg, there is no single doctor who can intervene and do everything.”

Diabetic ulcers are a complex problem and therefore require an array of specialties, including infectious disease specialists; podiatrists and foot surgeons, who debride wounds; and vascular surgeons, who address blood flow issues that can contribute to ulcers and slow their healing. Endocrinologists and nutritionists attend to patients’ glycemic levels,

and teams also can include internists, orthopedic surgeons, nephrologists, and plastic surgeons. O&P practi-tioners fit ankle foot orthoses and full and partial prostheses when needed, and pedorthists supply therapeutic footwear. All of those specialties need to be organized, and at the Georgetown Center for Wound Healing, chief residents and nurse managers are the quarterbacks of communicating, says co-director John Steinberg, DPM, ensuring the flow of information and coordination of services.

In addition to the availability of so many relevant specialties at the Georgetown center, what sets the team apart is its egalitarian approach.

“Everyone is empowered,” says Steinberg. “The hierarchy and egos are removed. The patient is the center of the puzzle, not the medical team.”

That spirit of collaboration is one of the challenges to establishing a team approach, according to Rogers.

“Doctors, especially surgeons, don’t have the best reputation for working well together,” he says. “When implementing programs, we have to do a lot of team building and philosophy sharing.”

The Georgetown center provides both inpatient and outpatient limb salvage and wound care. If a patient needs to be admitted, there is a seamless transition and continuity of care. Caregivers meet weekly to review cases and participate in a group learning activity. “Team members attend different conferences and come back with new knowledge,” says Steinberg.

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“The greatest advancement is

availability—that we can actually

talk with all the different

disciplines in the hospital and

blend all the professionals

together and determine the best

course of action.” —ChArles Crone, CP


Nascott Orthotics and Prosthetics, with offices in Virginia, Maryland, and Washington, D.C., is part of the center’s team and sends practitioners each day to the clinic to work with Georgetown staff members and their patients. Charles Crone, CP, clinical director of prosthetics for Nascott, values the easy access to physicians and other health-care providers at the center. “We are able to give our input and unique insight directly to the team and patient while we’re there in the clinic,” he says. “We’re not dictating prescription criteria but offering education on the most appropriate modality. This has been a protocol that has worked well with other providers also.”

In addition to seeing patients in the Georgetown clinic, Crone does inpatient pre-surgical consulta-tions. “One of the best services we can provide is to explain the entire process to prospective amputees and their families,” he says. “When patients understand their options and can coordinate with peer counselors such as from the Amputee Coalition, monthly amputee support group participants, and fellow clinic patients, they feel much better about the upcoming major life-altering surgeries and short- and long-term rehab process.”

Crone says this approach helps him catch potential problems in the clinic and resolve fitting, alignment, or suspension issues. He has prevented needless testing and additional medical procedures by correctly identi-fying the source of a problem. “We can look at the surface of the skin and see that the problem is friction from the device rather than impaired vascular circulation,” he says.

Even in cases where amputation is the proper course, the team approach offers substantial benefits, according to Crone. He cites the example of a patient who wanted a higher-level amputation than physicians initially recommended. The patient received psychiatric counseling at Georgetown, and after weighing all the factors, including the psychological, doctors performed the amputation procedure she desired.

Crone notes that patients are highly satisfied with the seamless nature of the team approach. “They have this continuity of care with all of the paraprofessionals in the same clinic, brainstorming and creating and troubleshooting issues.”

“From the clinical standpoint, this is the future of how wound care is going to be managed throughout the country,” says Joe Jones, C.Ped, CFo, also with Nascott and part of the team at the Center for Wound Healing. “It allows me as a practitioner to have more contact with the physician, and I am able to fine tune devices as we go. And we are privy to a great deal of information that we wouldn’t neces-sarily have without the team approach.”

Georgetown is unusual in having orthotists and prosthetists on clinic staff, according to Lee Rogers, and most limb salvage centers refer patients to outside practitioners. “For some of our more complicated cases, orthotists will come on site to scan or cast the leg and return to the clinic to fit the device.” But whether O&P practitioners are part of a physical, on-site team or a “virtual” team, Rogers regards them as invaluable to the long-term goal, which is to prevent the risk of limb loss from ever happening again.

“Finding an appropriate orthotic or shoe is one of the most difficult parts in long-term prevention,” says Rogers. And, he notes, it requires a real commitment by the practitioner to offer continued follow-up care.

Building Your Own Team

Although the Georgetown Center and Valley Presbyterian Hospital offer exemplary models of the team approach, practitioners can use other means to provide comprehensive and collaborative care to diabetes patients. Crone, for example, has developed a network of other resources that he uses in his practice at Nascott. “I’ve researched who are the best surgeons, therapy departments, skilled nursing facilities,” he explains. “I go out and interview them. That way, when I refer patients, we can work out a well-rounded rehab plan with everyone on the same page.”

”The patient is the center

of the puzzle, not the

medical team.”

—John sTeinberg, DPM

“[The team approach]

allows me as a

practitioner to have

more contact with

the physician, and i

am able to fine tune

devices as we go.”

—Joe Jones, C.PeD, CFo


limb-saving TechniquesBoth the Center for Wound Healing at Medstar Georgetown University

Hospital and Valley Presbyterian Hospital use the latest procedures to treat diabetic ulcers and save limbs, including the following:

• Stages of treatment. At Georgetown, the medical team does not try to complete debridement of the wound in one fell swoop, says John Steinberg, DPM and co-director of the center. Instead, it works in stages to preserve as much healthy tissue as possible and remove all infection.

• Vascular surgery. Surgeons use both open and closed endovascular procedures to restore blood flow to the limb.

• Hyperbaric oxygen. Patients lie in a hyperbaric chamber breathing in 100 percent oxygen while the atmospheric pressure is raised, allowing the oxygen to super saturate their blood. Results include new vessel growth, new tissue growth, and an environment hostile to bacteria. “We can heal a wound with less absolute blood flow than would be required,” says Steinberg.

• Negative pressure wound therapy. This technique uses a vacuum dressing, and new designs also bathe the wound frequently in an antibiotic solution.

• New type of culturing. Polymerase chain reaction culture testing is more sophisticated and faster than traditional methods. “It’s much more sensitive and can pick up a true reading of what’s happening at the wound surface,” says Steinberg.

• New topical treatments. Among them is ultrasound technology, which uses low-frequency sound waves to reduce bacteria and stimulate healthy cells.

• Stem cell therapy. Valley Presbyterian podiatric surgeons are engaged in clinical trials using marrow-derived stem cell therapy and regenerative medicine to heal chronic ulcers

• Bioengineered skin tissue grafts. Surgeons at Valley Presbyterian apply engineered grafts from neonatal foreskins to promote faster healing.

As an independent practitioner, Cathie Norsen, RN, CFo, based in Orlando, Florida, has to work a little harder to be part of a team, but she finds it well worth the effort. Norsen works with home health agencies and nursing homes to help identify appro-priate patients for her therapeutic shoe-fitting services. For example, the fact that a patient uses a wheelchair doesn’t mean diabetic shoes are unnec-essary. “There are shear forces from the foot rests, feet can slip between the rests or get bumped,” she says.

Norsen is quite clear on the relationship between shoes and diabetic foot complications: “The whole point of the 1992 Therapeutic Shoe Bill [providing reimbursement for diabetic shoes] was to reduce Medicare’s amputation budget by paying for better shoes,” she says.

“Poor shoes and poor foot care led to too many amputations. Not only that, but statistics show that once you have a diabetic amputation, you are far more likely to die from the illness within five years.” According to Norsen, the bill has succeeded in both reducing

”if you go to the

emergency room with

a heart attack, you see

a cardiologist, who can

do everything you need.

When you are at risk

of losing your leg, there

is no single doctor who

can intervene and

do everything.”

—lee rogers, DPM

Medicare’s budget as well as the number of amputations.

Norsen works with orthotists, prosthetists, podiatrists, and primary care physicians to serve her patients. Education is a huge component of her work, and she brings in nursing home administrators, home health-care workers, and family members in addition to other health-care providers and the patients themselves. She teaches diabetes patients how to examine their feet for injuries, cautions them to have podiatrists trim their toenails, and explains what to do and whom to call if a problem surfaces.

“Sometimes people don’t like to refer patients to others. I don’t have that problem,” she says. “I feel the more I work as part of a group, the better the outcomes and the more referrals I get.”

Charlie Crone of Nascott Othotics and Prosthetics agrees. “The greatest advancement is availability—that we can actually talk with all the different disciplines in the hospital and blend all the professionals together and determine the best course of action.” a

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


AOPA HEADLINES AOPA WORKING FOR YOU

O&P Wins Big on 2.3% Excise Tax Exemption RulingAOPA estimates $100 million to be saved annually

Although success was a long shot, AOPA couldn’t pass up the opportunity to press for

exempting O&P devices from the 2.3 percent excise tax on medical devices imposed by the Affordable Care Act (ACA). The exemption AOPA secured from the tax, which went into effect Jan. 1, 2013, saves O&P patients, their providers, and suppliers a whopping $100 million a year, based on AOPA’s estimate of what the government would have collected if O&P medical devices were not exempt.

It’s important for members of the O&P community to know how the exemption came about, what it means to the industry, and why it is so important to be unified, have adequate resources, and pursue the right strategy.

The Affordable Care Act and O&P

The ACA was signed into law in March of 2010. During an initial reading of the law, AOPA Executive Director Tom Fise, JD, spotted the provision known as “the retail exemption.” Eyeglasses, hearing aids, and contact lenses are all

medical devices that qualify for the retail exemption and escape the 2.3 percent excise tax. These are all customized products purchased at retail for individual use. Further examination of the law disclosed other parallels between those customized devices and O&P, such as they are prescribed for each individual patient by a physician but don’t require a medical professional to implant the device.

It became clear that AOPA could make a strong case to persuade the U.S. Department of Treasury and the Internal Revenue Service (IRS), the agencies charged with writing regulations to implement the tax, to also include O&P devices in the retail exemption.

AOPA first met with Treasury and IRS officials Feb. 10, 2011. Fise and AOPA representatives Charles Dankmeyer and Scott Schneider were joined by AOPA legislative counsel Stephanie Kennan and Carolyn Smith. This meeting laid the groundwork for the extensive effort that followed, which included submitting comments to Treasury and IRS by a March 4, 2011 deadline.


AOPA HEADLINES

The initial success of this first meeting, follow-up written comments, and subsequent contacts and conversations was reflected in the proposed regulations issued Feb. 7, 2012. They included much of AOPA’s input and clearly applied the same “retail exemption” to O&P devices that eyeglasses, hearing aids, and contact lenses enjoy.

This was a good first step for O&P, but questions remained as to whether componentry manufacturers also would enjoy the exemption. Kennan, an AOPA lobbyist with McGuireWoods, testified at Treasury Department/IRS hearings on May 16, 2012, reinforcing support for exempting O&P devices but also asking for further clarifi-cation on exempting component parts supplied by manufacturers that are used in the exempt devices provided to patients by patient-care facilities.

Another clarification was requested on the phrasing “administered by a medical professional” to ensure this criterion did not adversely affect the O&P device exemption. Kennan reminded Treasury and IRS officials that orthotics and prosthetics require ongoing fitting and adjustment. As a result, the final regulations clarify that the exemption applies to O&P devices that require initial or periodic fitting or adjustment. A new example, Example 8 in the final regulations, relates to prosthetics, clarifying that component parts of an exempt device qualify for the exemption. (See sidebar for more details.)

Dedication and Commitment Pay Off

In the final analysis, the long, hard slog to success vividly demonstrates that securing a regulatory victory is much like building a house: There has to be an overriding plan with a clear view defining what the end result should look like. Many tools must be deployed to make sure the pieces fit together and operate in a harmonious way to achieve the finished product.

What the Tax Exemption Means to You

While the celebration over O&P medical device exemption took place December 5, the payoff of almost $100 million a year in tax savings for O&P patients, providers, and suppliers will continue for years to come provided that industry professionals recognize and understand the specifics of the ruling. Here’s a deeper look.

The technical jargon in the final rule confirmed “prosthetic and orthotic” devices, as defined in 42 CFR 414.202 that do not require implementation or insertion by a medical professional, and “(T)herapeutic shoes,” as described in 42 CFR 414.228(c), qualify for the safe harbor provision “considered to be of a type generally purchased by the general public at retail for individual use” (and thus qualify for retail exemption). AOPA had several meetings and consultations with the Internal Revenue Service and Treasury, beginning nearly two years ago, explaining why O&P devices should be eligible for this retail exemption.

Additionally, the Treasury responded favorably to the specific argument AOPA presented that this retail exemption required that the manufacturers of components (and potentially complete devices) also should be exempt from the 2.3 percent tax because otherwise the patient would be required to “…pay the excise tax as the tax would just be shifted higher up the distribution chain.” This is a dramatically important and favorable outcome for O&P in this final rule. It is clear that companies that manufacture components that are used by a patient-care facility provider to fabricate an exempt O&P device (i. e., one that qualifies under the safe harbor rule above) also are exempt, as to those components, from the medical device excise tax.

The key statement from the final regulations on the component policy is the following example:

“Example 8. X manufactures single-axis endoskeletal knee shin systems, which are used in the manufacture of prosthetic legs. X sells the knee shin systems to Y, a business that makes prosthetic legs. The FDA requires manufacturers of knee shin systems and prosthetic legs to list the items as devices with the FDA. The FDA classifies prosthetic leg components, including knee shin systems, as external limb prosthetic components under Subpart D of 21 CFR part 890.3420 and product code ISH. The FDA classifies prosthetic legs as an external assembled lower-limb prosthesis under 21 CFR part 890.3500 and product code ISW/KFX. In addition, the Centers for Medicare and Medicaid Services have assigned the knee shin systems Healthcare Procedure Coding System code L5810.

“Prosthetic legs and certain prosthetic leg components, including single-axis endoskeletal knee shin systems, fall within the safe harbor for prosthetic and orthotic devices that do not require implantation or insertion by a medical profession(al) that is set forth in paragraph (b)(2)(iii)(D)(1) of this section. Accordingly, both the single-axis endoskeletal knee shin systems manufactured by X and the prosthetic legs made by Y are devices that are of a type generally purchased by the general public at retail for individual use.”


Similarly, this effort required an initial strategy that clearly outlined the objective—an exemption for O&P medical devices—and then assembled all of the tools and firepower to make it happen. At the request of AOPA members and lobbyists, members of Congress generated letters raising questions about imposing the medical device excise tax. Meetings with Treasury and IRS officials humanized AOPA’s position, particularly when AOPA members were part of the conversation, and lent credibility to the argument. Testimony at hearings became part of the record to help support and justify a position the final regulations might adopt; AOPA wanted to make sure the record was clear on how and why this exemption

Is the Device Exempt?

should apply to O&P medical devices.In short, no stone was left

unturned in this ongoing, nearly three-year effort to save O&P patients, their providers, and suppliers an estimated $100 million in excise taxes each year.

When you contemplate the modest investment the O&P community makes in AOPA and the allied organizations, a payday like this exemption represents a whopping return. That’s why AOPA plans to include a reminder in upcoming communications encouraging current members—who have carried this ball, provided the funding, and written the letters to members of Congress—to take one more signif-icant step: To make sure colleagues

AOPA HEADLINES AOPA WORKING FOR YOU

It is important to note that the December 5 ruling is not a universal exemption of any manufacturer’s entire product line; it depends on whether the component goes into a finished O&P device that qualifies for exemption. If every component a company makes is used in an exempt device, then all of its products would be exempt from the tax. Other manufacturers may sell some components that meet the criteria for the retail exemption and other products (e.g., non-O&P devices) that do not qualify for the exemption. They will have to pay tax on the latter products, but not on the former ones.

The example provided above is the “safe harbor” eligibility for the retail exemption, and it appears virtually all O&P devices will qualify under this preferred pathway. A second pathway to exemption—the facts and circumstances test—is open to any type of manufacturer (not limited to O&P) that wishes to argue that the retail exemption should apply to its product(s). This route would take a longer time and have less immediate certainty.

and competitors also are contributing to the O&P community’s ability to achieve these kinds of successes.

To check on whether your colleagues or competitors are stepping up to the plate, just go to www.AOPAnet.org. In the upper right-hand part of the screen, search by state or city for a list of AOPA members. If your colleagues or competitors are missing from that list, it’s time to take action to protect your future interests by urging them to get on board and join AOPA. It may only take a phone call or a casual conversation the next time you meet. But, by all means, make an effort to ensure that every single patient-care provider and all of your suppliers are helping make good things happen for O&P and your business. a


AOPA HEADLINES

Master Medicare: Advanced Coding & Billing Techniques

Join your colleagues March 4-5, 2013, at the DoubleTree by Hilton Hotel Atlanta Airport for AOPA’s “Mastering Medicare: Advanced Coding & Billing Techniques” seminar. AOPA experts will provide the most up-to-date infor-mation to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjust-ments, through interactive discussions 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.

Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

Register online for the “Mastering Medicare: Advanced Coding & Billing Techniques” seminar in Atlanta at https://aopa.wufoo.com/forms/2013-mastering-medicare-atlanta/, or contact Devon Bernard at [email protected] or 571/431-0854.

AOPAversity Secrets to a Successful Audit— Join the Audio Conference January 9

Join AOPA January 9 for the first AOPAversity Mastering Medicare Audio Conference that will focus on the tips and tricks of handling an audit.

How do audits work? Who is auditing your claims? To learn the answers to these and related questions, including how to successfully handle an RAC audit, attend the audio conference.

An AOPA expert will address the following issues:• What is an audit and how does it work?• Who is auditing your claims and why?• What documentation should you use?• What is a timely response?• How do you identify potential problems?

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

Register online at https://aopa.wufoo.com/forms/2013-telephone-audio-conferences/. Contact Steve Custer at [email protected] or 571/431-0876 with registration questions.


AOPA HEADLINES

AOPAversity Understanding the LSO/TLSO Medicare Policy—Join the Audio Conference February 13

Ever wonder what items require a PDAC coding verification? Ever have trouble determining who is responsible for payment? If you have ever faced these challenges, join AOPA February 13 for an AOPAversity Mastering Medicare Audio Conference. This conference will provide you with the tools to help answer most of your LSO/TLSO Medicare Policy questions. The following topics will be covered: • Learn when an LSO/TLSO is covered.• Learn the proper use of the CG modifier.• Learn who is responsible for payment.

AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.

org or 571/431-0854 with content questions.Register online at https://aopa.wufoo.com/forms/2013-

telephone-audio-conferences/. Contact Steve Custer at [email protected] or 571/431-0876 with regis-tration questions.

2013 AOPA Audio Conferences: Mark Your CalendarAOPA has confirmed the dates and topics for its 2013

series of audio conferences. Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1 p.m. EDT.

This series provides an outstanding opportunity for you and your staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions.

Buy the Series and Get Two FREE!Visit the AOPA Bookstore, buy the series, and get

two audio conferences free. AOPA members pay $990 to participate in all 12 sessions ($1,990 for nonmembers). If you purchase the entire year’s worth of conferences, all confer-ences from months prior to your purchase of the set will be sent to you as CDs. Seminars are priced at just $99 per line for members ($199 for nonmembers).

2013 TopicsJanuary 9: Secrets to a Successful Audit

February 13: Understanding the LSO/TLSO Medicare Policy

March 13: Contracting With the VA: Hints for Landing the Contract

April 10: Handling Adversity: Coping With Difficult Patients

May 8: Navigate the Maze: Get to Know the Appeals Process

June 12: Clinical Documentation: Dos & Don’ts

July 10: Networking for the Future: Building Relationships With Referrals

August 14: Don’t Get Stuck With the Bill: Medicare Inpatient Billing

September 11: Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy

October 9: What’s the Word: A Health-Care Reform Update and What You Can Expect

November 13: Advocacy: A Potent Weapon for Change

December 11: What’s on the Horizon: New Codes for 2014


AOPA HEADLINES

AOPA 2012 Operating Performance Report Available Now

Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a compre-hensive financial profile of the O&P industry, including balance sheet, income statement, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 130 patient-care companies, representing 1,050 full-time facilities and 68 part-time facilities.

The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2011 operations.

Purchase the 2012 Operating Performance Report at the AOPA Bookstore, www.aopanetonline.org/store.

Follow AOPA on Facebook and TwitterFollow AOPA on Facebook and Twitter to keep on top of

latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities.

Like us on Facebook at: www.facebook.com/AmericanOandP with your personal account and your organization’s account!

Follow us on twitter: @americanoandp, and we’ll follow you, too!

Contact Steffanie Housman at [email protected] or 571/431-0835 with social media and content questions.

Top 5 Reasons To Follow AOPA:

• Be the first to find out about training opportu-nities, jobs, and news from the field.

• Build relationships with others working in the O&P field.

• Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.

• Hear from thought leaders and experts.

• Take advantage of special social media follower discounts, perks, and giveaways.

Take This BOAT for a Ride

Create your own secure and confidential web pages on the BOAT—a tool specifically tailored to help O&P business owners manage their businesses for greater profit and quality patient care.

By using this tool, you not only will examine the financial fitness of your business, you also will be pushed to identify and better understand your competition, market conditions, referral sources, and internal effectiveness. Use the BOAT to create budgets, track your

finances, and participate in the annual Operating Performance and Compensation surveys.

The new AOPA Patient Satisfaction Survey (required by certi-fying bodies) will be accessed through the BOAT site, which will be free to those firms using electronic data capture devices. All information is confidential and secure.

Members can sign up for the BOAT website by going to www.AOPA-BOAT.com and clicking on the orange “Register for BOAT” button on the bottom right-hand section of the screen. The direct link for the registration page is www.iisecure.com/BOAT/Register.asp.

Once you have registered and logged in, visit the tutorial video on the landing page.

www.aopanetonline.org/store

www.facebook.com/AmericanOandP

www.facebook.com/AmericanOandP



www.AOPAnet.org

-BOAT.com

www.iisecure.com/BOAT/Register.asp

www.iisecure.com/BOAT/Register.asp


AOPA HEADLINES

Log On to AOPAversity Online Meeting Place for Free

Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you.

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

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

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

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

• Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice.Register online by visiting http://bit.ly/AOPAwebcasts.

If You’re Paying More Than 1.9%, You’re Paying Too Much

AOPA has partnered with Bank of America Merchant Services to offer credit card processing rates as low as 1.9 percent to AOPA members. Many members are paying more than 2.5 percent, and if you’re handling $500,000 a year in credit card transac-tions, the 0.6 percent savings is like getting a 200 percent return on your membership dues investment.

To enroll, contact 888/317-5402 or email [email protected]. AOPA encourages members to request an audit of a recent processing statement to identify the savings they would enjoy.

24/7

Coding Questions Answered 24/7

AOPA members can take advantage of a “click-of-the-mouse” solution available at LCode-Search.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions.

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

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

Coming Soon2013 AOPA Products & Services Catalog

AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2013 Products & Services Catalog is coming soon—check the AOPA website at www.aopanet.org.

www.AOPAnetonline.org/education

http://bit.ly/AOPAwebcasts



www.LCodeSearch.com

www.LCodeSearch.com



AOPA HEADLINES

Special Thanks to the 2012 O&P PAC ContributorsAOPA would like to thank the following individuals for their contributions in 2012 to the O&P PAC:

(Continued)

President’s Circle ($1,000-$5,000) Michael Allen, CPO, FAAOP Robert ArbogastKel Bergmann, CPOMaynard CarkhuffRonald Cheney, CPOThomas DiBello, CO, FAAOPMike Fenner, CPO, BOCPO, LPOThomas F. Fise, JD Rick Fleetwood, MPAMichael Gozola, CPRussell Hornfisher, MBAHarry Layton, CPO, LPOJon Leimkuehler, CPORobert Leimkuehler, CPOMark Maguire, CPOGary MahlerPatty PetersenWalt Racette, CPOJohn Roberts Jr., CPOScott SchneiderGordon Stevens, CPO, LPOPaulette VaughnBernie Veldman, COFrank Vero, CPOJames Weber, MBAJames Young Jr., CP, LP, FAAOP

Senator’s Table ($500-$999) J. Martin Carlson, CPOGlenn Crumpton, CPO, C.PedEdward DeLatorreEd Gildehaus III, CPO, C.Ped, FAAOPMichael Hamontree, MBAAl Kritter, CPO, FAAOPEllen LeimkuehlerWilliam Leimkuehler, CPOMarlon Moore, COTed Muilenburg, CPRodney Pang, CPOGerri Price, CFom, C.PedAshlie White Jeffrey Yakovich, CO

Chairman’s Table ($100-$499) Rudy Becker Sr.Robert Biaggi, CPOJeffrey Brandt, CPOGeorge BreeceTerri Bukacheski, CP, LPAlan Burke, BOCOErin Cammarata, RTOKen Cornell, CPCharles Dankmeyer, CPODon DeBoltWilliam DeToro Jr., CPOMark Devens, CPOMartin Diaz, BOCO, C.PedTed Drygas, CPODavid Falk, CPOJim Fenton, CPOMichael Hall, CPOJoe Huntsman, MBA, MAFran JenkinsMarc Karn, CPJohn Kenney, CPO, FAAOPTom Kirk, PhDEileen LevisPam Lupo, COAnn MantelmacherLee Mantelmacher, CPOClyde Massey, CPO

Brad Mattear, CPASteve McNamee, CP, BOCO, FAAOP Steven Mirones, CO, C.PedMichael Oros, CPOJames Price, CPO, C.PedJon Ruzich, CP, LP Mark Smith, CPChris SnellPeter Thomas, Esq.Joan Weintrob, CPOSteven Whiteside, CO, FAAOPJon Wilson, CPOClaudia Zacharias, MBA, CAE

1917 Club (Up to $99) J. Laurence Allen, CPODavid Bow, CPOJim Campbell, CO, FAAOP, PhDMaureen CanterFrank Caruso, COMelvin CunninghamJoe DavantJason EddyJeff Erenstone, CPOTroy FinkJohn Galonek, COCarey Glass, CPO, FAAOPEddy Gosschalk, CPOGarrett GriffithApril Groves, CORita HammerDavid Johnson, CORahul Kaliki, PhDPaul MacySalvatore Martella, CPOKathy Mascola, BOCPO, CO, LPOKevin Matthews, COSean McKale, CONina Miller George Newton, CPODaryl ReuterEric Schopmeyer, COAnthony Squiccuarini, CPO, C.PedJeff Wensman, CPO


AOPA HEADLINES

Rudy Becker Sr. Kel Bergmann, CPOFrank Bostock, COBrightree, LLCKendra CalhounJim Campbell, CO, FAAOP, PhDLuis CarbajalMaynard CarkhuffThomas J. CostinMegan DamewoodDon DeBoltTom V. DiBello, CO, LO, FAAOPTom Fise, Esq.Rick Fleetwood, MPANancy GagneRichard and Marbee GingrasEddy GosschalkCatherine Graf, Esq.Paul GudonisDarlene Hall, C.PedMichael Hamontree, MBAHanger PACRussell Hornfisher, MBAJoe Huntsman, MBA, MAJames Kaiser, CP, LPMarc KarnPatricia Kaviani

Steve KellyMark Kenney, CPOTonya KetteringTom Kirk, PhDAnthony Korjagin, CPAlfred E. Kritter, CPO, FAAOPTerri Kuffel, Esq.Scott LangstonJon P. Leimkuehler, CPO, FAAOPRobert V. Leimkuehler, CPOEileen LevisAnita Liberman-Lampear, MAPedro Llanes, CPORonald Longo, CPPam Lupo, COAlexander Lyons, CPOCatriona MacdonaldRon ManganielloAnn MantelmacherMollie MatthewsDoug McCormackJoe McTernanSteve Mirones, CO, C.PedTina MoranDominique MungoMichael Oros, CPO, LPOEd Peguero, BOCO

Patty PetersenAnthony PotterProteorWalter Racette, CPORick Ramos, CP, LP, C.PedJohn Roberts Jr., CPOLuke Rogers, CO, BOCPRick RileyBradley N. RuhlJoyce SchlemmerScott SchneiderBrian Smith, BOCOChris SnellWilliam C. Snell, CPOJan Stokosa, CP, FAAOPPeter ThomasRandall ValverdeFrank Vero, CPOBen Walker, LPO, BOCPOJames Weber, MBAAshlie WhiteDaryl WilliamsConnie WithersJames O. Young Jr., CP, LP, FAAOPClaudia Zacharias, MBA, CAE

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

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

2012 PAC SupportersThese individuals have generously contributed directly to a political candidate’s

fundraiser and/or have donated to an O&P PAC sponsored event.

(Continued)

Special Thanks!


AOPA APPLICATIONS

The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume:

Level 1: equal to or less than $1 million

Level 2: $1 million to $1,999,999

Level 3: $2 million to $4,999,999

Level 4: more than $5 million.

Atlanta Prosthetics & Orthotics Inc.1100 Sherwood Park Drive, Ste. 220Atlanta, GA 30501770/287-2395Fax: 770/287-2398Category: Affiliate Parent Company: Atlanta Prosthetics &

Orthotics Inc., Executive Park South, Atlanta, GA

Atlanta Prosthetics & Orthotics Inc.869 Walnut Street Macon, GA 31201478/238-6464Fax: 478/254-2019Category: Affiliate Parent Company: Atlanta Prosthetics &

Orthotics Inc., Executive Park South, Atlanta, GA

Bledsoe Brace Systems2601 Pinewood DriveGrand Prairie, TX 75051972/647-0884Fax: 972/660-0946Category: Supplier Affiliate Parent Company: Hope Orthopedic,

Arlington, TX

Center for Orthotic & Prosthetic Care1141 Broadway, Ste. 6Elmira, NY 14904607/215-0847Category: AffiliateParent Company: Center for Orthotic &

Prosthetic Care, Louisville, KY

Center for Orthotic & Prosthetic Care4702 Creekstone Drive Durham, NC 27703919/797-1230Fax: 919/797-1240Category: AffiliateParent Company: Center for Orthotic &


Center for Orthotic & Prosthetic Care166 Springbrook Avenue, Ste. 203Clayton, NC 27520919/585-4173Fax: 919/879-8248Category: AffiliateParent Company: Center for Orthotic &


Center for Orthotic & Prosthetic Care156 Main Street Binghamton, NY 13905607/235-3066Fax: 607/235-3068Category: AffiliateParent Company: Center for Orthotic &


Center for Orthotic & Prosthetic Care21 Railroad Avenue, Ste. 2-5Cooperstown, NY 13326607/547-4066Fax: 607/547-5011Category: AffiliateParent Company: Center for Orthotic &


Central Ohio Orthotic & Prosthetic Center Inc.

248 Badenton Avenue Dublin, OH 43017614/231-4256Fax: 614/231-0127Category: Affiliate Parent Company: Central Ohio

Orthotic & Prosthetic Center Inc., Columbus, OH

Cranial Technologies Inc.11620 Wilshire Blvd., Ste. 200Los Angeles, CA 90025310/231-3406Fax: 310/231-3529Category: Affiliate Parent Company: Cranial Technologies

Inc., Tempe, AZ

CyberKinetics LLC9435 Provost Road NW, Ste. 202 Silverdale, WA 98383360/692-2500Fax: 360/962-1322Category: Supplier Affiliate Parent Company: Cybertech Medical,

La Verne, CA

Dafonte Medical Services LLC1101 Hwy. 6 S. Houston, TX 77077281/498-3566Fax: 281/498-5388Category: Patient-Care FacilityBrandee Wiseman

Membership in AOPA is one

of the best investments that

you can make in the future

of your company.

Welcome new members!

(Continued)


AOPA APPLICATIONS

Frank Javier Lopez/dba Next Step Orthotics & Prosthetics

11731 Sterling Avenue, Ste. H Riverside, CA 92503951/352-9203Fax: 951/352-9205Category: Patient-Care FacilitySandra Lopez

Independence Prosthetics- Orthotics Inc.

1500 S. Columbus Blvd., 2nd Floor Philadelphia, PA 19147215/271-9476Category: Affiliate Parent Company: Independence

Prosthetics-Orthotics Inc., Newark, DE

KMC Pedorthics Inc.86-20 Jamaica Avenue Woodhaven, NY 11421718/441-5621Fax: 718/441-5622Category: Patient-Care FacilityKim Castelli, C.Ped, CFo, CMO

Midwest Technology17530 Dugdale DriveSouth Bend, IL 46635574/233-3352Category: Affiliate Parent Company: Midwest Orthotic

Services, South Bend, IN

Nascott Rehabilitation Services Inc.3333 N. Calvert Street, Ste. 400 Baltimore, MD 21218410/554-4411Category: AffiliateParent Company: Nascott

Rehabilitation Services Inc., Elkridge, MD

Nascott Rehabilitation Services Inc.5445 Loch Raven Blvd., Ste. 107 Baltimore, MD 21239413/444-3280Category: Affiliate Parent Company: Nascott

Rehabilitation Services Inc., Elkridge, MD

Orthocare America, Inc.199 S. Chillicother Road, Ste. 100 Aurora, OH 44202330/562-2455Fax: 330/562-2514Category: Patient-Care FacilityNatalie Prasky

Snell Prosthetic & Orthotic Laboratory

2425 W. 28th Avenue Pine Bluff, AR 71603870/534-1900Fax: 870/534-3187Category: Affiliate Parent Company: Snell Prosthetic &

Orthotic Laboratory, Little Rock, AR

Snell Prosthetic & Orthotic Laboratory

2915 Dave Ward Drive, Ste. 11 Conway, AR 72034501/664-2624Category: Affiliate Parent Company: Snell Prosthetic &

Orthotic Laboratory, Little Rock, AR

Tindal Orthotics & Prosthetics3244 Kimball Avenue Manhatten, KS 66503785/537-8897Fax: 785/537-8893Category: Patient-Care FacilityLisa Tindal

Tropical Brace and Limb, LLC2909 N. Orange Avenue, Ste. 111Orlando, FL 32804407/897-2112Fax: 407/897-2133Category: Patient-Care FacilityChristina Stewart a

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Special

SavingS!

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

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

AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save:

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MARKETPLACE

mODulAR DynAmIc AFO FROm PEl SuPPly

The Modular Dynamic AFO is an extension device that adds all of the features and benefits of the Centri Dynamic Walk, from Fillauer LLC, to any knee orthosis. Available from PEL Supply, the Modular Dynamic AFO prevents distal migration of the knee orthosis while also providing some “toe pick up” to

allow for better ground clearance. The PEEK Rods of the Modular Dynamic AFO allow for virtually unlimited active motion at the ankle joint, thereby providing excellent terrain accommodation.

Product features include:•Thermoformable foot plate•Adjustable height•PEEK Rod available in straight or dorsi-assist•Easily attaches to the knee orthosis•Prevents distal migration of the orthosis.

For more information on this and all products from the Fillauer LLC companies, contact PEL Supply at 800/321-1264, fax 800/222-6176, email [email protected], or order online at www.pelsuppy.com.

PREPREg FROm OTTOBOck

Give your patients the most advanced KAFO technology combined with the most advanced fabrication! Ottobock’s line of KAFOs is now available in prepreg, creating KAFOs up to 40 percent lighter than laminated alternatives. Prepreg also creates more consistent fabrication outcomes that avoid unwanted buildups. Ottobock Fabrication Services offers decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert

services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want.

Visit www.ottobockus.com or call 800/795-8846.

THE nEW TRITOn lOW PROFIlE (lP) FOOT FROm OTTOBOck

We’ve added a new low-profile carbon fiber foot to the popular Triton family! Now patients with lower clearance (2.5 in) can take advantage of the same smooth rollover

and robust function as the original Triton. The multiaxial Triton LP provides excellent dynamics and flexibility for above- or below-knee individuals. A titanium adapter makes the foot waterproof and especially robust (maximum weight 330 lbs, up to K4). With a split toe design for safety, stability, and control, the Triton LP is ideal for all your active patients.

Contact your sales representative at 800/328-4058.

TOTAl knEE® By ÖSSuR®. TOTAlly vERSATIlE.

With K2, K3, and K4 models to choose from, Total Knee enables a broad range of amputees to walk with a smooth, more natural, energy-efficient gait, enhancing their confidence and stability. Key features include geometric locking for stability, plus mid-swing shortening designed to prevent hip-hiking

and reduce the chances of tripping. Each model fits a wide range of amputees and is lightweight and easy to cosmeti-cally finish.

To learn more about Total Knee by Össur, call 800/233-6263 or visit www.ossur.com today.

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MARKETPLACE

PATEnTED kISS® SuPERHERO™ REuSABlE TEST SOckET PlATE

The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs.

Visit www.kiss-suspension.com or call 410/663-KISS for more information.

WRIST ROTATOR FROm mOTIOn cOnTROl, A FIllAuER cOmPAny

•New MC Wrist Rotator

•Two new versions––both mount in forearm

•Standard: use with ProControl 2; Utah Arm 3 and 3+; Utah Hybrid Arm

•ProWrist: use with microprocessor-controlled TDs•2x speed and torque of previous versions• In-hand version also available––built into MC Hand

or ETD.

For more information, call 888/696-2767, email [email protected], or visit www.UtahArm.com. a

http://www.kiss-suspension.com

Increase exposure and save!Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

clASSIFIED RATESClassified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. member nonmemberWords Rate Rate50 or fewer words $140 $280 51-75 words $190 $38076-120 words $260 $520121 words or more $2.25 per word $5.00 per word

Specials: 1/4 page, color $482 $678 1/2 page, color $634 $830

Advertisements and payments need to be received approxi-mately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to [email protected], along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertise-ments and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

JOB BOARD RATESVisit the only online job member nonmemberboard in the industry at Rate Ratejobs.AOPAnet.org! $80 $140

- North Central

- Northeast

- Mid-Atlantic

- Southeast

- Inter-Mountain

- Pacific

Find your region on the map to locate jobs in your area.

JOBS


cPO/lPOBeaumont, TexasGreat opportunities await you in Texas. A Houston-based established practice is looking for a practitioner to run an affiliate office in Beaumont with an opportunity of ownership. If you like small communities with fabulous outdoor activities and a relaxed environment to operate out of, then this is your place. The ideal candidate is an energetic, self-starting, motivated practitioner who processes excellent patient care and communication skills to conduct comprehensive patient evaluations to deliver the best in O&P services and follow-up patient care. If you have a great personality who can conduct in-services and marketing whilst practicing your craft then this is your amazing oppor-tunity. We offer a competitive salary and benefits including health-care coverage, continuing education, paid vacation, and more.

Send resume to: Email: [email protected]

cO/cPOCentral Valley, CaliforniaCompetitive Western United States O&P business seeking a certified orthotist or certified prothetist/orthotist in the Central Valley of California (Fresno area). We are seeking a seasoned practitioner with experience in practice management, clinical expertise in outpatient and inpatient settings, and a willingness to work within a dynamic team. Unlimited business opportunities available in an expanding local market. Competitive salary, benefits, and bonus plan.

Interested parties should email inquiries/resume to:

Email: [email protected]: 888/853-0002

www.AOPAnet.org

YOUR ResOURce fOr the O&P COmmunity

Pacific

Inter-Mountain

jobs.AOPAnet.org

jobs.AOPAnet.org



jobs.AOPAnet.org

www.AOPAnet.org


JOBS

Tina Mann Clinic Manager

Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Tina Mann

Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic. She was so inspired by her experience that she became an orthotic resident with us.

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all are part of Hanger Clinic career offerings.

• 1,000,000+ patients treated annually• 270,000+ orthotic and prosthetic products• 4,500+ employees

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

“

View our current positions and apply online at:www.hanger.com/careers or scan the QR code.

150 YEARS 700 CLINICS 1 VISION

Available Positions:Clinic ManagerAnnapolis, MD Bartlesville, OK Burnsville, MN Tacoma, WA

Waterville, ME Longview, WA Seattle, WA

OrthotistJackson, MSLancaster, PAPhiladelphia, PAGlendale, AZ Springfield, IL Camp Hill, PA Roswell, NM Beaufort, SC Columbia, MO

Mesa, AZ Methuen, MA Parker, COUrbana, ILFairfield, OHHammond, INCary, NCAurora, ILFolsom, CA

Prosthetist / OrthotistLongview, WA Buffalo, NYMayfield Heights, OH Wilkes Barre, PASan Antonio, TXPortland, ORAmherst, NYJohnson City, NYGrand Junction, COMorgantown, WV

Springfield, ILHolland, MINew London, CTNovato, CAOklahoma City, OKKissimmee, FL San Antonio, TXJacksonville, FL Pensacola, FL Tallahassee, FL

ProsthetistWaterbury, CT Brunswick, GA

Easton, MA

cO/cPO, c.PedEasley, South CarolinaImmediate openings for two practitioners in a rapidly-growing, multilocation practice. We need practitioners who are self-motivated with strong clinical skills—five years’ experience preferred. Must share our passion for providing exceptional patient care. We are centrally located in upstate South Carolina, offering convenient access to mountains, lakes, and coastal regions. Very competitive salary and benefits package offered. Come join our team and make a real difference in the prosthetic/orthotic community!

Submit resumes by fax to: 864/855-9331

Email: [email protected]

Southeast

cONovi, MichiganWolverine Orthotics Inc. is seeking a motivated certified orthotist to work in a smaller but busy facility. See patients in our office, hospitals, schools, therapy clinics, etc. Applicant must be willing to learn and manage time. Excellent benefit package with health care and retirement, not bound to pay scale. Performance-based incentive program for marketing and building practice. Pediatric to geriatric patient population. Novi, Michigan, is a metro-politan city.

Send resumes to: Email: [email protected]

North Central

mediakit

Promoting O&P Since 1917

www.AOPAnet.org

2013

American Orthotic & Prosthetic Association (AOPA)

Rates effective Jan. 1, 2013

DiSCOVer mOre AOPAADVertiSing OPPOrtunitieS.Call Dean Mather, advertising sales representative, at 856/768-9360 or email [email protected].



JOBS

Candidates should have the following required qualifications:• Master’s Degree in Orthotics and Prosthetics or in a

related field• Minimum of 2 years O&P Clinical experience post certifi-

cation, five years post certification experience is preferred• Certification by the American Board for Certification (ABC)

in Orthotics• Active membership in AAOP • Two years teaching experience

Responsibilities of Faculty Appointee:• Teach graduate-level courses in Upper and Lower Extremity,

and Spinal Orthotics• Provide primary and secondary supervision of orthotic

technical assignments• Continually review curriculum to ensure content reflects

current practice and technology• Advise graduate students• Oversee student research projects and independent

study projects• Serve on academic and professional committees• Actively participate in professional community service• Demonstrate a commitment to teaching excellence• Maintain an ongoing agenda for research including grants

and publications

A competitive salary will be based on qualifications and experience. Starting date is no later than August 28, 2013. All applications must be made online at https://www.emujobs.com. Applicants should submit a letter of interest, a detailed curriculum vitae, and academic transcripts. At least three letters of reference should be mailed directly to the Search Committee Chair, Mr. Frank Fedel, 318F Porter Building, ypsilanti, MI 48197. Review of applicants will begin on November 15, 2012 and continue until the position is filled. For more information contact Mr. Frank Fedel, Search Committee Chair at [email protected].

Eastern Michigan University, a public, comprehensive university, enrolls nearly 24,000 students who are served by over 2,000 faculty and staff, both on campus, off campus, and electronically. Located in culturally and environmentally diverse southeastern Michigan, characterized by metropolitan growth and economic transformation, the University is an environment rich inaca-demic, research, technological and recreational resources. The School of Health Promotion and Human Performance offers undergraduate programs in Athletic Training, Health Education, Physical Education, Sport Management, and Exercise Science. At the graduate level the School offers degrees in Health Education, Physical Education, Exercise Physiology, Sport Management, Orthotics and Prosthetics and Physician Assistant Studies.

EMU is an equal opportunity employer, and the institution is regularly recognized by U.S. News & World Report for its diversity.

Candidates should have the following required qualifications:• Master’s Degree in Orthotics and Prosthetics or in a

related field• Minimum of 2 years O&P Clinical experience post certifi-

cation, five years post certification experience is preferred• Certification by the American Board for Certification (ABC)

in Prosthetics• Active membership in AAOP • Two years teaching experience

Responsibilities of Faculty Appointee:• Teach graduate-level courses in Upper Extremity and Lower

Extremity Prosthetics• Provide primary and secondary supervision of prosthetic

technical assignments• Continually review curriculum to ensure content reflects

current practice and technology• Advise graduate students• Oversee student research projects and independent

study projects• Serve on academic and professional committees• Actively participate in professional community service• Demonstrate a commitment to teaching excellence• Maintain an ongoing agenda for research including grants

and publications

A competitive salary will be based on qualifications and experience. Starting date is no later than August 28, 2013. All applications must be made online at https://www.emujobs.com. Applicants should submit a letter of interest, a detailed curriculum vitae, and academic transcripts. At least three letters of reference should be mailed directly to the Search Committee Chair, Mr. Frank Fedel, 318F Porter Building, ypsilanti, MI 48197. Review of applicants will begin on November 15, 2012 and continue until the position is filled. For more information contact Mr. Frank Fedel, Search Committee Chair at [email protected].

Eastern Michigan University, a public, comprehensive university, enrolls nearly 24,000 students who are served by over 2,000 faculty and staff, both on campus, off campus, and electronically. Located in culturally and environmentally diverse southeastern Michigan, characterized by metropolitan growth and economic transformation, the University is an environment rich in academic, research, technological and recreational resources. The School of Health Promotion and Human Performance offers undergraduate programs in Athletic Training, Health Education, Physical Education, Sport Management, and Exercise Science. At the graduate level the School offers degrees in Health Education, Physical Education, Exercise Physiology, Sport Management, Orthotics and Prosthetics and Physician Assistant Studies.


Eastern Michigan University

Candidates should have the following required qualifications:

• Master’s Degree in Orthotics and Prosthetics or in a related field

• Minimum of 2 years O&P Clinical experience post certification, five years post certificationexperience is preferred

• Certification by the American Board for Certification (ABC) in Orthotics

• Active membership in AAOP

• Two years teaching experience

Responsibilities of Faculty Appointee:

• Teach graduate-level courses in Upper and Lower Extremity, and Spinal Orthotics

• Provide primary and secondary supervision of orthotic technical assignments

• Continually review curriculum to ensure content reflects current practice and technology

• Advise graduate students

• Oversee student research projects and independent study projects

• Serve on academic and professional committees

• Actively participate in professional community service

• Demonstrate a commitment to teaching excellence

• Maintain an ongoing agenda for research including grants and publications

A competitive salary will be based on qualifications and experience. Starting date is no laterthan August 28, 2013. All applications must be made online at https://www.emujobs.com.Applicants should submit a letter of interest, a detailed curriculum vitae, and academictranscripts. At least three letters of reference should be mailed directly to the SearchCommittee Chair, Mr. Frank Fedel, 318F Porter Building, Ypsilanti, MI 48197. Review ofapplicants will begin on November 15, 2012 and continue until the position is filled. For moreinformation contact Mr. Frank Fedel, Search Committee Chair at [email protected].

Eastern Michigan University, a public, comprehensive university, enrolls nearly 24,000 studentswho are served by over 2,000 faculty and staff, both on campus, off campus, and electronically.Located in culturally and environmentally diverse southeastern Michigan, characterized bymetropolitan growth and economic transformation, the University is an environment rich inacademic, research, technological and recreational resources. The School of Health Promotionand Human Performance offers undergraduate programs in Athletic Training, Health Education,Physical Education, Sport Management, and Exercise Science. At the graduate level the Schooloffers degrees in Health Education, Physical Education, Exercise Physiology, SportManagement, Orthotics and Prosthetics and Physician Assistant Studies.


Tenure-Track Assistant ProfessorPosting # FA1304E - Orthotics

O&P AlmanacSize: 1/2 Page V (4.5” x 7”)Issue: JanDeadline: 11/15Cost: $1,310.00

Eastern Michigan University

Candidates should have the following required qualifications:

• Master’s Degree in Orthotics and Prosthetics or in a related field

• Minimum of 2 years O&P Clinical experience post certification, five years post certificationexperience is preferred

• Certification by the American Board for Certification (ABC) in Prosthetics

• Active membership in AAOP

• Two years teaching experience

Responsibilities of Faculty Appointee:

• Teach graduate-level courses in Upper Extremity and Lower Extremity Prosthetics

• Provide primary and secondary supervision of prosthetic technical assignments

• Continually review curriculum to ensure content reflects current practice and technology

• Advise graduate students

• Oversee student research projects and independent study projects

• Serve on academic and professional committees

• Actively participate in professional community service

• Demonstrate a commitment to teaching excellence

• Maintain an ongoing agenda for research including grants and publications

A competitive salary will be based on qualifications and experience. Starting date is no laterthan August 28, 2013. All applications must be made online at https://www.emujobs.com.Applicants should submit a letter of interest, a detailed curriculum vitae, and academictranscripts. At least three letters of reference should be mailed directly to the SearchCommittee Chair, Mr. Frank Fedel, 318F Porter Building, Ypsilanti, MI 48197. Review ofapplicants will begin on November 15, 2012 and continue until the position is filled. For moreinformation contact Mr. Frank Fedel, Search Committee Chair at [email protected].

Eastern Michigan University, a public, comprehensive university, enrolls nearly 24,000 studentswho are served by over 2,000 faculty and staff, both on campus, off campus, and electronically.Located in culturally and environmentally diverse southeastern Michigan, characterized bymetropolitan growth and economic transformation, the University is an environment rich inacademic, research, technological and recreational resources. The School of Health Promotionand Human Performance offers undergraduate programs in Athletic Training, Health Education,Physical Education, Sport Management, and Exercise Science. At the graduate level the Schooloffers degrees in Health Education, Physical Education, Exercise Physiology, SportManagement, Orthotics and Prosthetics and Physician Assistant Studies.


Tenure-Track Assistant ProfessorPosting # FA1305E - Prosthetics

O&P AlmanacSize: 1/2 Page V (4.5” x 7”)Issue: JanDeadline: 11/15Cost: $1,310.00


2013n JAnuARy 9 AOPAversity Audio Conference–Secrets to a Successful Audit. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n JAnuARy 14-19ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Nov. 1, 2012. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n JAnuARy 27Raleigh, NC. Study gait analysis and evidence-based treatments with orthotic fabrication and taping––while supporting a good cause. Register at www.footcentriconline.com/ for eight credits.

n JAnuARy 29-31WillowWood: OMEGA® Training. Mt. Sterling, OH. Course covers basic and advanced software tool use and shape capture with OMEGA Scanner. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: TBD. Visit www.willowwoodco.com.

n FEBRuARy 1ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email [email protected], visit www.abcop.org/certification.

n FEBRuARy 13 AOPAversity Audio Conference–Understanding the LSO/TLSO Medicare Policy. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n FEBRuARy 20WillowWood 2013 Academy Technical Workshop. Orlando. Caribe Royale Orlando. 1 PM. Fitting and Operating the New LimbLogic System: Learn about new system features which build upon field-proven technology, making the LimbLogic more vigorous and easier to use. Includes new socket design techniques that can decrease fabrication time while increasing system’s longevity. Visit www.willowwoodco.com.

n FEBRuARy 20-2339th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or [email protected].

n FEBRuARy 28WillowWood: LimbLogic® for Practitioners. Mt. Sterling, OH. Course focuses on the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: TBD. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco.com.

n mARcH 1ABC: Application Deadline for Certification Exams. Applications must be received by March 1, 2013, for individuals seeking to take the May 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n mARcH 1WillowWood: LimbLogic® for Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Includes basic operation and hands-on fabrication of LimbLogic adapters. Work with patient models and fabricate a LimbLogic socket. Credits: TBD. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco.com.

n mARcH 1-2Oklahoma Association for O&P Annual Meeting. Tulsa, OK. Marriott Southern Hills. For more information, visit www.okaop.org or contact Jane Edwards at 888/388-5243 or email [email protected].

mARcH 4-5AOPA: Essential Coding & Billing Seminar. Atlanta. DoubleTree by Hilton Hotel, Atlanta Airport. To register, contact Stephen Custer at 571/431-0876 or [email protected].

n mARcH 9-10ABC: Orthotic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n PROmOTE EvEnTS In THE O&P ALmANAc

CALENDAR RATESTelephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

WORDS Member Rate Nonmember Rate

25 or less .................. $40 .................................$5026-50 ........................ $50 .................................$6051+ .................. $2.25 per word ...............$5.00 per word

Color Ad Special:

1/4 page Ad ............. $482 .............................. $6781/2 page Ad ............. $634 .............................. $830

BONUS!Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email [email protected] along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor.

Questions? Email [email protected].

CALENDAR



http://www.willowwoodco.com



www.AOPAnet.org

www.AOPAnet.org




n mARcH 11-16ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Jan. 1, 2013. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n mARcH 13 AOPAversity Audio Conference–Contracting With the VA: Hints for Landing the Contract. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n mARcH 15-16PrimeFare West Regional Scientific Symposium 2013. New Location: Denver. Denver Marriott City Center. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

n mARcH 15-16ABC: Prosthetic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n mARcH 18WillowWood: Alpha DESIGN® Liners. Mt. Sterling, OH. Half-day course teaches how to use OMEGA software files to create custom liners. Attendees can practice with all aspects of the software, including file import, liner creation, liner fabrication and Design liner options. Credits: TBD. Visit www.willowwoodco.com.

n mARcH 21-232013 Annual Meeting of the International African-American Prosthetic Orthotic Coalition. Atlanta. Georgia Tech Hotel and Conference Center. Contact Tony Thaxton Jr. at 404/875-0066 or email [email protected]. Visit www.iaapoc.org for more information.

n APRIl 1ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n APRIl 4-6Rehabilitation Institute of Chicago: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.25 ABC Credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.

n APRIl 10 AOPAversity Audio Conference–Handling Adversity: Coping with Difficult Patients. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n APRIl 13-15National Pedorthic Services, Milwaukee WI. Hands-on Custom Foot Orthosis Fabrication Course. Credits: 18.25 ABC. Contact Nora Holborow at 414/438-6662, email [email protected], or visit www.npsfoot.com.

n mAy 1ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by May 1, 2013 for individuals seeking to take

the July 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or July/August CPM exams for orthotists and prosthetists. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n mAy 8 AOPAversity Audio Conference–Navigate the Maze: Get to Know the Appeals Process. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n mAy 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was March 1, 2013. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n mAy 16 -18PA Chapter AAOP Spring Conference. Sheraton Station Square Hotel. Pittsburgh. Contact Beth Cornelius at 814/455-5383 or Joseph Carter Jr. at 814/455-5383.

n JunE 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email [email protected], or visit www.abcop.org/certification.

n JunE 12 AOPAversity Audio Conference–Clinical Documentation: The Dos & Don’ts. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n July 10 AOPAversity Audio Conference–Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n AuguST 14 AOPAversity Audio Conference–Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n SEPTEmBER 11 AOPAversity Audio Conference–Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

September 18-21O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/431-0876 or [email protected].

CALENDAR









CALENDAR

Company Page Phone Website

ALPS C4 (800) 574-5426 www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics 13 (703) 836-7114 www.abcop.org

DAW Industries 41 (800) 252-2828 www.daw-usa.com

Dr. Comfort 5, C3 (800) 556-5572 www.drcomfortdpm.com

Ferrier Coupler Inc. 40 (800) 437-8597 www.ferrier.coupler.com

Hersco Ortho Labs 1 (800) 301-8275 www.hersco.com

KISS Technologies LLC 9 (410) 663-5477 www.kiss-suspension.com

Motion Control 23 (888) 696-2767 www.utaharm.com

Orthotic and Prosthetic Study and Review Guide 21 ww.oandpstudyguide.com

Össur® Americas Inc. 7 (800) 233-6263 www.ossur.com

Otto Bock HealthCare C2 (800) 328-4058 www.ottobockus.com

PEL Supply 2 (800) 321-1264 www.pelsupply.com

AD INDEX

n OcTOBER 9 AOPAversity Audio Conference–What’s the Word: A Health-Care Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n nOvEmBER 13 AOPAversity Audio Conference– Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

n DEcEmBER 11AOPAversity Audio Conference–What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or [email protected].

2014n FEBRuARy 26 - mARcH 140th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663, x208, or [email protected].

n SEPTEmBER 3-697th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or [email protected].

2015n FEBRuARy 18-2141st Academy Annual Meeting & Scientific Symposium. New Orleans. Hyatt Regency New Orleans. For more information, contact Diane Ragusa at 202/380-3663, x208, or [email protected].

n OcTOBER 7-1098th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or [email protected].

2016n mARcH 9-1242nd Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. For more information, contact Diane Ragusa at 202/380-3663, x208, or [email protected].

n SEPTEmBER 15-1899th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or [email protected]. a

ww.oandpstudyguide.com

AOPA ANSWERS

AOPA receives hundreds of queries from readers and

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

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


New Year, New L CodeAnswers to your questions regarding 2013 coding changes

Q. Were there any changes to the 2013 codes?

A. Yes, the Centers for Medicare and Medicaid Services (CMS) has released

the new Healthcare Common Procedure Coding System (HCPCS) codes. There were a few minor changes for 2013, which will be effective for all claims with a date of service on or after Jan. 1, 2013.

Q. What were the changes to the 2013 HCPCS codes?

A. One new code was introduced, and four codes had their official descriptors

changed. No codes were deleted. The new code is L5859, and it is an addition

code to a lower-extremity prosthesis. The full descriptor for L5859 reads: Addition to lower-extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s).

The L8000, L8001, and L8002 code descriptors were changed to reflect a revision that was made in the External Breast Prosthesis Policy in June of 2012. The revision in the policy provided updated

coding guidelines and stated that L8000 describes a bra, without an integrated breast prosthesis, which has pockets designed to hold mastectomy form/breast prosthesis adjacent to the chest wall, and codes L8001 and L8002 describe mastectomy bras with integrated breast prosthesis.

The L8000, L8001, and L8002 codes also include the following characteristics: may be constructed of any material including but not limited to cotton and polyester, may include any type of closure and the closure may be located anywhere on the bra, may be of any size, and may be constructed with or without integrated structural support, e.g., an underwire. So, in 2013, these three codes now include the phrase “any size, any type,” to reflect the change in policy.

The last code descriptor change was for the code L5972. The new code descriptor eliminated any reference to a particular brand or model. The new descriptor reads: All lower-extremity prostheses, foot, flexible keel.

The full list of HCPCS code changes is available on the CMS website at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.

Q. Did the Medicare Part B deductible change for 2013?

A. Yes. The Medicare Part B deductible for 2013 has increased from $140 to $147, and

the Medicare Part B coinsurance remains at 20 percent of the Medicare allowed charge.

Medicare beneficiaries are required to pay their annual Part B deductible before Medicare will make any claim payments. This is important to keep in mind at the beginning of the year, when a beneficiary may have not met his or her $147 deductible. a


©2012 Dr. Comfort All Rights Reserved

From A Family of Comfort.

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Dr. Comfort offers a comprehensive product line:The Finest Diabetic Comfort Footwear, Our SignatureShape to Fit Compression Wear, Therapeutic Socks,Custom Inserts and Custom Orthotics Laboratory.For more information, call 800.992.3580 or visit drcomfort.com.

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Liner & SleeveExtreme Advantage--

Indicated for Transfemoral OR ACTIVE Transtibial amputees; Reduce on-hand inventory cost and space requirements through application on either TT or TF amputees.

Extreme Cushion

Extreme Contact-- 80% Less Vertical Stretch

As compared to other Alps gel liners, resulting in demonstratively increased contact while stabilizing movement of redundant tissue.

Extreme Suspension-- New GripGEL™ is more tactile than EZGel to gently but fi rmly support the residual limb and sensitive tissues.

Alps New Extreme Cushion Liner has limited vertical

stretch to reduce movement of redundant tissue. Use appropriate for TT or TF

applications.

© 2009 ALPS. All Rights Reserved.

800.574.5426 [email protected]

NOW IN STOCK:

Experience Our Commitment

Alps New Extreme Sleeve seals against the skin without

restricting circulation or causing shear forces. ALPS GripGel helps prevent the

sleeve from rolling down the patient’s limb.

Providing more of what you

want and need!

Extreme Versatility-- Cushion liner available in 3 mm or 6mm Uniform profi le to fi t circumferences ranging from 16-53 cm. Sleeve available in 3mm or 6mm in sizes 20 - 70 cm.

Z Flex LinerE

Experience Our Commitment

Hardly just a pretty face,the EZ Flex Liner

delivers unequaled function without sacrificing anything.

Practical Magic

Unified Flexible Front The unique fabric on the anterior surface provides unlimited stretch over the patella for greater elasticity while reducing pressure on the knee and the amount of energy required to flex the knee

80% Less Vertical Stretch Posteriorly

As compared to other Alps gel liners, virtually eliminating pistoning while minimizing bunching behind the knee during flexion

Antioxidants & EZ Gel Protect Skin--

Antioxidants in EZ Gel help protect the skin from damage caused by free radicals.

ALPS EZGel is perfect for those with poor skin characteristics or sensitive tissues.

Budget Friendly-- No other liner on the market provides this quality, durability and functionality at this price...absolutely no other!

800.574.5426 [email protected]

Alps New EZ Flex Liner (anterior view shown above) is available in 3mm or 6mm Uniform

thicknesses. Eight sizes fit circumferences of 16

cm to 44 cm.

Medial view of the knee in flexion demonstrates the greater elasticity

of the anterior fabric to extend over the front of the knee. Paring it with the limited vertical stretch posterior

fabric reduces the overall effort expended by the amputee to bend the

knee and increases comfort.

NOW IN STOCK:

© 2010 ALPS. All Rights Reserved.

january 2013 almanac

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