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Tim & Vicki
A Shared Story of Sibling Success

 

It's not often that one of our patient success stories has a personal link to any of our practitioners, but this one does. Our own Tim Riedlinger, LPO, CPO and Clinical Manager at our Columbus office, was inspired to pursue his current profession by the story of his older sister, Vicki.

When Vicki was four years old, an accident on a farm took her left leg from the knee down. She was riding with her grandfather on a tractor as he was transporting silage. When he stopped to unload the silage, Vicki stepped down off the back of the tractor to be with her grandfather. However, she stepped directly on to the spinning power takeoff of the tractor, ripping her leg off at the knee.

At the time, the medical community didn't really have solutions for limb loss in children, or child-sized medical equipment for that matter. Vicki and Tim's dad created a homemade child-sized walker out of copper pipes for Vicki, which she used before  receiving her prosthetic a couple of months after the accident and afterward to help with her gait training. As she grew, her father added more copper piping to the walker.

Now, Vicki has a modern lower limb prosthesis which includes a C-leg microprocessor knee and a High-Fidelity Socket interface. She lives an active adult life, and is one of her brother's patients. Whenever anyone asks Tim about his inspiration to become a prosthetist, he tells them Vicki's story and how it created a passion within him to help those in similar situations.

Vicki showed at a young age that anyone can overcome obstacles, no matter how daunting they may be, and that lesson continues to motivate Vicki and Tim in their everyday lives.  

 

CMS Audits: A Huge Problem for O&P Practices Nationwide

 

Scott Schall
Scott Schall

Unbeknownst to many patients, the main problem plaguing the O&P industry currently is extensive and over-reaching audits from the Center for Medicare and Medicaid Services. These audits are carried out by independent auditors who are paid on a percentage of the amount of fraud and abuse they recover, creating an incentive to audit otherwise medically necessary claims due to potential clerical errors, rather than clinical errors.  This practice has already caused damage to many O&P practices around the nation.

 

Optimus Prosthetics is in no way in danger of closing; the real impact of these audits and unsubstantiated claims comes in our service to our patients. Our co-owner, Scott Schall, recently took part in a hearing with the Small Business Administration, and we want to provide excerpts of his testimony to help other professionals and our patients to understand the problem affecting our industry.

 

CMS auditors are now incorrectly investigating perfectly legitimate Medicare claims that have already been paid as possible fraud or abuse cases. This results in often lengthy and time consuming audits, such as the ones that have occurred at Optimus Prosthetics:

 

"In the last 9 months, we have received 48 audits. As a survival tactic, Optimus has hired additional employees necessary to educate physicians and therapists and to facilitate the new documentation process only to find ourselves at a 20% audit error rate. This is far better than the 50 % national rate; however, it still puts us at a disadvantage as we work through the lengthy appeals process, which can take up to 18 months..."

 

These audits also cause patient care to dip dramatically:

 

"...they have caused a negative impact on our patients' ability to receive the prosthetic care and devices they need to ambulate and/or to function in normal activities such as employment. The lead-time for a patient to receive their prosthesis has been extended by approximately 4 to 6 weeks due to the additional appointments necessary to obtain additional documentation and support of medical necessity from other medical professionals."

 

The main point is that these audits are making both business and patient care matters more difficult for O&P practices in the U.S. The prevailing fear is that if nothing is done, many small O&P practices will be forced to close, meaning that the sole public company, Hanger, will have a near monopoly on the O&P market.


We promise to continue to fight through legislation and advocacy to end these audits so that we can provide the care and service our patients deserve. To learn more about this issue, visit http://www.aopanet.org/, or to tell your story of issues with the CMS, go to http://www.speak4oandp.com/

 

Jim's Corner

Activities for Prosthetic Training 

 

Optimus Prosthetics Jim Scharf
Jim Scharf, PTA

The goal of "Jim's Corner" is to provide helpful information and be a resource for those helping patients fitted with prosthetics learn to use them correctly in order to enjoy a better quality of life as an amputee.

 

In the last issue of Jim's Corner, I mentioned the need to educate the patient on a proper HEP (Home Exercise Program) and contracture prevention, as well as the importance of residual limb hip extension. When I lecture to students I always say, "If you get absolutely nothing done with your amputee patient except educating them on the importance of contracture prevention and they are able to demonstrate it with good follow through, congratulations on a job well done! You have set this patient up for success!"

 

Think about it: if we have full ROM (Range Of Motion) we can always gain strength, but when we lose ROM with a contracture, the patient's potential will be negatively impacted. Strength is not going to do the patient much good if their ROM is limited by a contracture.

 

So, the next question may be what is a contracture? A joint contracture is when the muscle or muscles of a joint have been permanently shortened restricting the normal movement of that particular joint.

 

In my opinion, one element of success for patients is pre-prosthetic preparation, and one of the most important things is the prevention of contractures. Any patient that presents with a hip flexor contracture will be compromised, and any joint contracture will limit their potential of normalized gait. Therefore, we need to help patients strengthen the extensor muscles and stretch the flexor muscles. 

 
flexor muscles - no

 

I am not a big fan of a patient performing a supine SLR, (supine means lying on your back, and SLR is a straight leg raise) as it does not strengthen their residual limb in the way they will use it with their prosthesis, and may increase the chance of a contracture. If this type of exercise is to be performed, I would coach the patient in the following way:

 

Supine Hip Extension

The patient is to lie supine and place a large towel roll or a rolled up blanket under the residual limb.  They are to push the residual limb down into the towel roll while they straighten their thigh at the hip. If it is possible, lift the buttocks up off the surface. Cue the patient not to compensate for hip weakness by over recruiting the back.  

 

Hold for 2-5 seconds. Repeat 5-15 times. Do 1-3 sets.

supine hip extension

 

The Supine Hip Extension helps to strengthen the extensors, but we also want to hit our goal of stretching the flexors. The Supine Hip Flexor Stretch is an easy way to gain some elasticity in the hip flexors.

 

Supine Hip Flexor Stretch

The patient is to lie supine and pull the sound limb knee toward the chest while they keep the residual leg and pelvis flat on the surface.

  • If they are unable to grab the sound leg, try a towel behind the sound limb.
  • You may also place a weight on the residual limb to help stretch.  
  • You may also educate a significant other to assist with the stretch.

Hold 15-30 seconds.Repeat 5-15 times. Do 1-3 sets.

supine hip flexor stretch  

 

Jim Scharf, PTA, Prosthetic Assistant/Gait Specialist

Jim has been a Licensed Physical Therapist Assistant since 1988.  Jim has worked with lower extremity amputee patients throughout his career.  He serves as a Gait Specialist and Liaison when prosthetic patients are meeting with their therapists. Feel free to contact Jim if he can assist you in any way at: jscharf@optimusprosthetics.com.

In This Issue
upcoming

D = Dayton Area

C = Columbus Area

 

Completing Course #1 - "Amputation & Prosthetic Overview"

 

C - Thursday, July 11

Kindred of Pickerington - 12:00

 

D - Wednesday, July 24

Miami Valley Hospital - 12:30

 

C - Wednesday, July 24

Pinnacle Senior Care - 10:00

 

 

Completing Course #2 - "Lower-Limb Prosthetics:  Transtibial"

 

C - Tuesday, July 2 

Columbus Colony - 12:00

 

C - Wednesday, July 10

Rehabilitation and Health Center of Gahanna - 12:00

 

C - Friday, July 12

Laurels of Norworth - 12:00

 

D - Wednesday, July 17

Heartland of Centerville - 12:00

 

C - Wednesday, July 17

Franklin Woods  - 12:00

 

C - Thursday, July 18

Westminster Thurber  - 12:00

 

D - Wednesday, July 24

Hillspring of Springboro - 12:30

 

C - Wednesday, July 24

Scioto Pointe - 12:00

 

 

Completing Course #3 - "Lower-Limb Prosthetics:  Transfemoral"

 

C - Tuesday, July 23

Columbus Rehab and Subacute Institute - 12:00

 

 

Course #4 - "Lower Extremity Amputee/Prosthetic Evaluation & Outcomes Measures"

 

D - Friday, July 19

Shiloh Springs - 12:00

 

D - Tuesday, July 30

St. Ann's Hospital Rehab - 12:00

 

 

Course #5 - "Lower-Limb Prosthetic Gait Training"

 

D - Thursday, July 11

Kindred of Lebanon - 12:00

 

D - Thursday, July 18

Four Seasons - 12:00

 

D - Tuesday, July 23

Otterbein by Atrium - 12:00

 

 

Course #6 - "Lower-Limb Prosthetic Gait Deviations"

 

D - Tuesday, July 2

SpringMeade - 12:00

 

D - Wednesday, July 31

Dayton VAMC - 12:00

 

 

Course #7 - "Upper-Limb Prosthetics"

 

None scheduled

 

 

Course #8 - Prosthetic Advances

 

D - Wednesday, July 17

Crossroads Nursing & Rehab - 12:00

 

 

Course #9 - "Partial Foot, Ankle/Knee/Hip Disarticulation, & Transpelvic Prosthetics"

 

None scheduled

 

 

 

 

 

 

 

 

 

 

 

 

 

Optimus Prosthetics, Dayton
8517 North Dixie Drive, Suite 100/300
Dayton, Ohio 45414
(937) 454-1900

 

Optimus Prosthetics, Columbus
3132 Olentangy River Road
Columbus, Ohio 43202 

(614) 263-LIMB (5462)


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