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AOPA in Advance
Breaking News for O&P Professionals
 
April 17, 2012
Volume 16, Number 8
Willow Wood March 2012

Click here for more information

In This Issue
O&P NEWS:
- O&P Alliance Representatives Encouraged by Meeting with CMS Administrator Tavenner
- AOPA Releases Detailed Report on the EHB State Benchmark Plan, A Valuable New Members-Only Benefit
- Amputee Coalition Announces President Obama's Designation of April 2012 as "Limb Loss Awareness Month"
- Policy Forum Being Held Today and Tomorrow in Washington D.C.: A Special Thank You to Sponsors
- AOPA National Assembly: Seeking Presenters with Experience in Processing Claims for High-Tech Devices
- AOPA National Assembly: Donations Needed for Wine Tasting and Auction to Support Government Relations Outreach
- Time Still Remains to Register for the Chicago Essential Coding & Billing Techniques Seminar
- O&P PAC Corner
- Register for AOPA's May Audio Conference, "Contracting 101"
- 95th Annual AOPA National Assembly and Combined NE Chapter Meeting Historic Downtown Boston -- The Place to Be September 6-9
O&P RESOURCES FROM AOPA
- Online Membership Management Available
- Check Out the AOPA Job Board for New Opportunities in O&P
- 2012 Products Catalogue Now Available
O&P INSIDER'S TRACK:
- People in the News
- Businesses in the News
- Send Us Your News!

Contact Us

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION
 
330 John Carlyle St., Suite 200
Alexandria, VA 22314
 
Phone: (571) 431-0835
Fax: (571) 431-0899
 
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We invite your comments and questions. Please contact Steven Rybicki at srybicki@AOPAnet.org or (571) 431-0835.
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O&P NEWS
O&P Alliance Representatives Encouraged by Meeting with CMS Administrator Tavenner

On Monday afternoon, April 16, a contingent representing the O&P Alliance had a 30-minute meeting with CMS Administrator Marilyn Tavenner, in a meeting coordinated by AAOP Executive Director Peter Rosenstein.  The following are the participants, agenda and spokespersons assigned to respective topics:

1.     Peter Rosenstein, AAOP Executive Director-- Introduction, appreciation, overview of O&P as a profession, not DME, stand along patient care, licensure statutes in 13 states, and defining the O&P Alliance

2.     Mark Hopkins, Clinician, Dankmeyer Inc., Linthicum, MD--Overview delivery of clinical care, not just devices, but who are patients, and extends invitation to Administrator Tavenner to visit their facility.

3.      Peter Thomas, Counsel to O&P Alliance--presented as advocate and patient, concerns about O&P being recognized as an essential health benefit, overview of some prior meetings at CMS.

4.     Wendy Miller, BOC--Reviewed the role of accreditation and certification, its history dating back to 1948 and section 427 of BIPA.

5.     Thomas Fise, AOPA Executive Director--Overview of S. 2125/H.R. 1958, the Medicare O&P Improvements Act, fraud summary, and H.R. 4175/S. 773 The Insurance Fairness for Amputees Act, and physician documentation, the letter from Senator Ben Cardin, actions of contractors following up on previous discussions initiated by AOPA lobbyist Stephanie Kennan with Administrator Tavenner and her Chief of Staff.

 

Administrator Tavenner seemed relatively well-briefed on O&P issues, initiated the recognition of the difference of O&P from DME, and personnel from Baltimore were connected by teleconference.  Ms. Tavenner indicated that HHS would soon be going beyond the Bulletin issued in December on essential health benefits into a proposed rule, where some concerns and questions could be fleshed out.  She asked about accreditation under the heading of the legislation, and her Chief of Staff wanted clarification that some of the controversy between O&P and OT/PTs that had characterized efforts on accreditation years ago, now seems to have found some common ground.  Administrator Tavenner acknowledged the quality of co-sponsors for the legislation, and she especially probed deeper about the physician documentation issue, acknowledging the earlier discussions on this topic involving her Chief of Staff, the role and positions maintained by CMS contractors, the bona fide, respective roles of the O&P professional and the physician, how the detailed work order, signed by physician was utilized, and the impact underscored by Senator Cardin's letter on timely, hassle-free patient access.  Ms. Tavenner indicated that CMS needs to have further internal discussions on attaining a reasonable position on this topic.

 

Click here for the group photo Left to Right - Thomas, Hopkins, Miller, Rosenstein, Tavenner and Fise

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

AOPA Releases Detailed Report on the EHB State Benchmark Plan, A Valuable New Members-Only Benefit

Everyone in O&P is keenly interested in the HHS deliberations on essential health benefits, and inclusion of orthotics and prosthetics within that vital category-it is a game changer, and without it O&P could find itself out of business.

 

In mid-December, the Department of Health and Human Services announced publication of EHB guidance. Clearly, there is a range of opinion on the ACA, and whether it should have been enacted in the first place, or now repealed, or overturned in the courts. However, this issue is so critical for O&P because of the way the law was written and enacted, and the fact that the terms used in the law are not "orthotics and prosthetics," but "rehabilitative and habilitative services and devices." If O&P had not succeeded in convincing HHS policymakers that O&P fits within the term, "rehabilitative and habilitative services and devices,"  there would be no requirement (and therefore no assurance) that insurance plans operating under the federal law would have to include any provision whatsoever for O&P benefits.

 

The HHS EHB Bulletin left many scratching their heads, though. Many members of Congress, including the then Chairs of the six House Committees and sub-committees that had jurisdiction at the time the ACA was adopted felt HHS would be setting a national policy on what are and are not "essential health benefits."  And these folks were troubled by HHS having passed a lot of the power to determine essential health benefits to the states, because there is a huge value in having one, well-understood national policy.

 

HHS has chosen to take a "benchmark approach" to defining what are essential health benefits, in essence, punting to the states and allowing them to select from 4 different permutations of leading plans to extract what is an essential health benefit for that state.  This approach transformed the EHB issues into a moving target-what is an essential health benefit in New York may not be an EHB in Utah.  Instead of telling plans what must be offered, this allows these very same plans to define the requirements of the federal plan by what they include in the private sector plans on a state-by-state basis

 

Four Benchmark Plan Types

 

Our analysis of offerings that exist today suggests that the following four benchmark plan types for 2014 and 2015 best reflect the statutory standards for EHB in the Affordable Care Act:

(1) the largest plan by enrollment in any of the three largest small group insurance products in the State's small group market;

(2) any of the largest three State employee health benefit plans by enrollment;

(3) any of the largest three national FEHBP plan options by enrollment; or

(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.

 

HHS intends to assess the benchmark process for the year 2016 and beyond based on evaluation and feedback, per their EHB Guidance Bulletin.

 

"To reflect the State flexibility recommended by the IOM (Institute of Medicine), under our intended approach, States are permitted to select a single benchmark to serve as the standard for qualified health plans inside the Exchange operating in their State and plans offered in the individual and small group markets in their State."

 

The only direct reference to orthotics and prosthetics is a very good one. In the bulletin, on the carry-over paragraph from page 4 to page 5 it is stated:

 

"For example, across the markets and plans examined, it appears that the following benefits are consistently covered: physician and specialist office visits, inpatient and outpatient surgery, hospitalization, organ transplants, emergency services, maternity care, inpatient and outpatient mental health and substance use disorder services, generic and brand prescription drugs, physical, occupational and speech therapy, durable medical equipment, prosthetics and orthotics, laboratory and imaging services, preventive care and nutritional counseling services for patients with diabetes, and well child and pediatric services such as immunizations. As noted in a previous HHS analysis, variation appears to be much greater for cost-sharing than for covered services."

 

This decision, in stating that O&P is among services like physician visits as benefits that "are consistently covered," marks a victory for all of O&P-patients, patient care facilities and suppliers. 

 

But, recognizing that the 'devil is in the details,' AOPA recognized the need to ferret through the several hundred benchmark plans to help AOPA members determine which of the benchmarks include O&P and which do not.  This would allow O&P providers to become actively engaged in their states in pushing for the outcome that is right for their businesses and their patients.

 

So, AOPA has partnered with the public affairs firm, McGuireWoods, in developing the Report of the State Benchmark Plans identified by HHS in the EHB bulletin. It has been a tortuous road, because insurers consider the contents of their plans to be proprietary, and it is not always possible to just look at the insurance policy and determine what is included and what is not. We cajoled HHS about this and in response they provided a partial compendium of the plan documents. Still, many policy documents remain unavailable, despite contacting national and state insurance commissioners, insurance networks like Linkia and others. Even when you have documents, they are shrouded in ambiguity, and many of the plans cover O&P as a subset of DME, which all of us knows is a very misguided premise.  No stone was left unturned, and we are confident that the attached document is the most comprehensive compilation of data on O&P coverage within the up to 8 benchmark plans for each of the 50 states that exists relative to O&P coverage.  So, we offer it for the education, information and benefit of our members, knowing that we can make no claim that this information is perfect.  Far from that, we must explicitly disclaim-this is our best effort, reflecting what we could learn about the content of the plans at this moment in time.  This information is very susceptible to misunderstandings of a fine point of insurance, or change by the carriers.  While AOPA cannot be responsible for its absolute accuracy, we believe it does accomplish its intended purpose-to provide you with a detailed and broad overview that will help you in your efforts to have an impact on how the essential health benefit package decision is implemented in your state, hopefully to the benefit of your practice and your patients.

 

Click here to download the document (you will need to enter your AOPA member username and password in order to begin the download).

 

Obviously, the battle on essential health benefits goes on.  We believe the italicized language above makes it clear that HHS expects that EVERY plan that hopes to meet the HHS criteria for essential health benefits will need to include coverage for orthotics and prosthetics.  We will keep you informed of significant new developments, and we hope that the AOPA Report on the EHB State Benchmark Plans will be very helpful to every AOPA member.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

Amputee Coalition Announces President Obama's Recognition of April 2012 as "Limb Loss Awareness Month"

Last week, the Amputee Coalition (AC) announced that President Obama has issued a letter recognizing April 2012 as Limb Loss Awareness Month. The AC highlighted portions of the President's remarks:

 

As a nation, we must remain committed to ensuring that those living with limb loss have the support they need to reach their greatest potential... We must also provide those at risk with information that can help prevent this condition. Greater public knowledge of the causes and warning signs is essential to decreasing the rates of preventable limb loss... and by working with the limb loss community, we can help reduce new cases.

 

Click here to read the full letter from the President.

 

President and CEO of the AC, Kendra Calhoun commented on the announcement saying, "We are thrilled that President Obama has taken the time to shine a light on this critical public health crisis. Nearly 60 percent of amputations are paid for by Medicaid and Medicare, costing taxpayers more than $5.2 billion in 2008.  Many of these amputations can be prevented and we appreciate the White House's support in this vital awareness campaign."

 

  

Policy Forum Being Held Today and Tomorrow in Washington D.C.: A Special Thank You to Sponsors

As members of the O&P profession gather today for extensive briefings regarding crucial legislative challenges on state and national matters, AOPA would like to thank the following 2012 Policy Forum Sponsors for all their support of this very important event.

This year's Policy Forum with nearly 100 participants engaged AOPA members in more than 400 appointments with legislators and staff.  Here's the agenda that provided background on the various issues and "Talking Points" for guiding the issue discussions.  The "Talking Points" can be helpful information when you make an effort to see your legislator or staff in your Congressional district office or Senator's state office.

 

Click here to read the Policy Forum Agenda.

 

Click here to read the Talking Points distributed to attendees.

 

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AOPA National Assembly: Seeking Presenters with Experience in Processing Claims for High-Tech Devices

The National Assembly Business Education Workgroup is seeking individuals who have significant experience and successes with processing claims for high-tech devices with third-party payers.  If this describes you and you are interested in sharing your experiences with attendees at the National Assembly (Sept 6-9, 2012 in Boston), please send an email to Tina Moran at tmoran@AOPAnet.org with your contact information and why you would be the ideal participant on this panel.

 

The combined AOPA National Assembly and New England Chapter Meeting will be held September 6-9 at the Hynes Convention Center in historic downtown Boston.  Registration opens on May 1.  Check www.AOPAnet.org often for updates.

         

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AOPA National Assembly: Donations Needed for Wine Tasting and Auction to Support Government Relations Outreach

During the 2012 National Assembly in Boston AOPA will once again be hosting a spirited event, which provides attendees with an unique opportunity to mingle, network, learn about and taste a variety of wines, but most importantly raise awareness of and funds for AOPA's Government Relations outreach.  For the fifth year in a row we look forward to the Wine Tasting & Auction being one of the most anticipated Assembly events, but we need your help.  So please join the fun, the "good cause" and add to the continued success of the Wine Tasting & Auction.

 

Donations for the Wine Tasting & Auction are now being accepted. Your donation may be one of the gems of your cellar, jewelry, artwork, wine glasses, a bottle of your favorite spirit, cigars, etc.  We also have a team of personal shoppers who can locate that perfect item for you.


If you would like to make a donation please click here to access the Wine Donation Form.

 

Thank you in advance and we look forward to seeing you in Boston and hopefully at the 5th annual Wine Tasting & Auction.

  
Questions? Contact Devon Bernard at dbernard@AOPAnet.org or (571) 431-0811.

 

Time Still Remains to Register for the Chicago Essential Coding & Billing Techniques Seminar

It is not too late to register for the second Essential Coding & Billing seminar of 2012 being held at the Westin O'Hare in Chicago on April 23-24.

 

Don't miss the opportunity to experience two days of valuable O&P coding and billing information, and earn 14 continuing education credits.

 

The Essential Coding and Billing Seminar includes breakout sessions for practitioners and administrators that will focus on each group's specific interests and educational needs including: how to create a chart audit, how to code for repairs/replacements, what modifiers to use, how to use an ABN and much more.

 

With the new revitalized format of the seminar, you now have the ability to submit your specific questions ahead of time and the AOPA experts will be sure to answer all these questions. Register for the seminar now to learn what you want to learn and what you need to learn.

 

Click here to register for the April 23-24 AOPA Essential Coding and Billing Techniques Seminar.

 

Questions? Contact Stephen Custer at (571) 431-0876 or scuster@AOPAnet.org or Devon Bernard at (571) 431-0854 or dbernard@AOPAnet.org.

 

O&P PAC Corner

The O&P PAC Corner provides updates on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has supported. The O&P PAC recently received donations from the following AOPA members*:

  • Robert E. Arbogast
  • Robert Biaggi, CPO
  • Melvin Cunningham
  • Jason Eddy
  • Mike Fenner, CP, LPO
  • Jim Fenton, CPO
  • Rick Fleetwood, MPA
  • Ed Gildehaus, III, CPO, FAAOP
  • Mark Maguire, CPO
  • Claudia Zacharias, MBA 

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

In order to participate in and receive information about the O&P PAC, federal law mandates that you must first sign an authorization form.            

 

Click here to view and sign an O&P PAC authorization form.    

 

*Due to publishing deadlines this list was created on 4/10/2012 and includes only donations received between 2/16/2012 and 4/10/2012.  Any donations received or made after 4/10/2012 will be published in the next issue of the AIA.

 

Questions? Contact Devon Bernard at dbernard@AOPAnet.org  or (571) 431-0854, or Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

Register for AOPA's May Audio Conference, "Contracting 101"

Negotiating favorable contracts can make a huge difference in the success of your business. Join AOPA on May 9 2012 at 1:00 PM EST for an AOPAversity Mastering Medicare Audio Conference that will focus and cover the basics of negotiating contracts with insurance companies, hospitals, skilled nursing facilities, and other payers. Learn strategies and techniques. An AOPA expert will address the following highlighted topics on the audio conference: 

  • Understanding the impact of competitors in the market place
  • Emphasizing Quality over Quantity
  • Negotiating   from a position of power
  • Separating yourself from your competition
  • Addressing unfavorable contracting terms 

The audio conference begins at 1 PM (EDT). The cost of participating is $99 per line for AOPA members ($199 for non-menbers) and any number of employees may listen on a given line. Listeners 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.

 

Questions? Contact Stephen Custer at scuster@AOPAnet.org (571) 431-0876.

 

  

95th Annual AOPA National Assembly and Combined NE Chapter Meeting Historic Downtown Boston -- The Place to Be September 6-9

Boston is the place to be as we build on our historic heritage and learn to prepare for the rapidly changing healthcare environment.  The clinical committee has been working hard to ensure the sessions will provide cutting edge science with clinical correlation to help expand our skills and improve patient care.  The meeting will kick off on Thursday, September 6 at 8:00 AM with two tiers of workshops or the option to partake in the Annual Fall Thranhardt Golf Classic.  All will meet back at the Hynes for the opening reception in the exhibit hall on Thursday evening.

 

The National Assembly is the country's oldest and largest show for O&P and the New England Chapter Meeting is considered one of the very best state meetings in the profession.  The combined efforts are sure to be of historical proportions.

 

Who Should Attend? O&P Practitioners, pedorthists, physicians, technicians, fitters, students, educational instructors, facility owners, marketing personnel, physical therapists, residents, office managers, billing specialists, researchers, engineers, manufacturers, distributors and suppliers of O&P products and services should come to Boston to stay on the cutting edge of their profession and to mix and mingle with other top professionals from across the country and around the world. Earn over 30 CE credits while learning at a fun, historical event. 

 

The 2012 combined meeting will be held at the Hynes Convention Center and adjoining Sheraton in historic downtown Boston.  The Hynes and connecting Sheraton hotel are located in the Back Bay neighborhood, which is considered affluent Boston at its best, boasting landmarks like Copley Square, the Prudential Center, and Fenway Park. Peruse boutiques on Newbury Street, stroll down Commonwealth Ave., or spend your evening out at one of the local lively bars or restaurants.

 

Boston-The Place to Be! Click here for more information.

 

Questions? Contact Stephen Custer at scuster@AOPAnet.org (571) 431-0876.


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O&P RESOURCES FROM AOPA

Online Membership Management Available

Are you taking full advantage of your AOPA membership benefits?  Are your employees receiving their own copy of the AOPA In Advance Newsletter; does your staff know about the free online learning videos; white papers and monographs on various topics are also available. Make sure you and your staff are in the know by updating your membership record today.  We can add your company logo to the online membership directory just for the asking. Visit www.AOPAnetonline.org/profile to update your membership account.  If you do not know your username and password contact email us at info@AOPAnet.org.

 

Check Out the AOPA Job Board for New Opportunities in O&P   

If you need a position filled at your business or are interested in looking at other job possibilities within the O&P field, check out the AOPA Online Job Board. The online job board sports a freshly updated look and an easy-to-navigate profile creation system. Job seekers can: 

  • Search Jobs -- Access the newest and freshest jobs available to professionals seeking employment.
  • Post a Resume -- Post your resume online today! Whether you're actively or passively seeking work, your online resume is your ticket to great job offers!
  • Personal Job Alert -- Create Job Alerts and never let a matching job opportunity pass you by! New jobs that match your search criteria will be emailed directly to you.
  • Access Your Job Seeker Account -- Login to your account to begin managing your job search. Create and manage job alerts and view job offers from employers. 

Managers and recruiters can:

  • Post a Job -- Reach the most qualified candidates by posting your job opening on our online Career Center
  • View Resumes --Check out our resumes and only pay for the ones that interest you!
  • Products and Pricing -- Regardless of your staffing needs or budget, we have a recruitment product that's right for your business.
  • Access Your Recruiter Account -- Login to begin managing your online recruiting account. Post jobs to our site and browse candidates interested in your positions.

And remember: if you advertise on the Online Job Board and decide to also advertise in the O&P Almanac, then you'll receive a 5 percent discount on the cost of advertising in the Almanac and on the Job Board.

 

Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or (571) 431-0835.

 

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2012 Products Catalogue Now Available

Don't miss out on all your AOPA membership has to offer--take a moment to peruse the 2012 Products and Services catalog to view all the education, products, services and more that AOPA offers there members.  Don't miss out on the many items available to members at no charge, including education, white papers, video's, and posters.

 

Click here to see AOPA's 2012 Products and Services Catalogue.

 

Questions? Contact Michael Chapman at mchapman@AOPAnet.org or (571) 431-0843.
 
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O&P INSIDER'S TRACK
The Only Up-to-the Minute O&P Newsline
  
People in the News

Hanger Clinic announced that Dan Strzempka, CPO, Area Practice Manager for Hanger Clinic and Kevin Carroll, MS, CP, FAAOP, Vice President of Prosthetics for Hanger Clinic were both recognized at the third annual Tribeca Disruptive Innovation Awards.

 

SPS announced the addition of Eric Fuller and Bill DiNapoli to the SPS management team.

 

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Businesses in the News

The Barr Foundation and the Rotary Club of Coronado, California announced their sponsorship of the "Limbs of Freedom" Clinic in Ensenada, B C Mexico with Alfredo Aguilar, MD.

 

OPAF, the Orthotic & Prosthetic Activities Foundation announced that Hanger Clinic has become a 2012 Bronze level sponsor.

 

Health Evolution Partners, a healthcare privateequity firm, announced that it has acquired a majority interesin  FreedomInnovations,LLC.

 
Send Us Your News!
The next AOPA in Advance will arrive in your inbox on May 1. So if you have a new employee or a new office, tell us! Share your news with the over 15,000 readers of the O&P Almanac and AOPA In Advance newsletter. Contact Steven Rybicki at srybicki@AOPAnet.org Back to Top

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899
www.AOPAnet.org