June 2022 Update

Breece Fellowship:  After a 2-year delay due to the pandemic, NAAOP is excited to announce that Nikki Grace-Strader has started her tenure in Washington, DC, as an NAAOP 2022 Breece Fellow.  Nikki will spend 10 weeks in DC and another Breece Fellow, Lucas Deluca, will start in DC for an abbreviated fellowship in July. Fellows will spend time shadowing Peter Thomas, NAAOP General Counsel and O&P Alliance Counsel, learning about advocacy and policy issues impacting orthotics and prosthetics, as well as the broader rehabilitation field. Throughout the summer, fellows will have opportunities to meet with elected leaders and Hill Staff to promote NAAOP’s priorities including the Medicare O&P Patient-Centered Care Act (H.R. 1990 and S. 2556) and educating policy makers on the issue of osseointegrated prostheses.

 

Todd Eagen:  In Memoriam:  The start of this year’s Fellowship has been bittersweet as our dear friend and beloved board member, Todd Eagan, passed away unexpectedly last week.  Todd led the OPGA and was the Secretary/Treasurer and a board member of NAAOP.  We deeply mourn Todd’s passing.  Todd was a thoughtful, kind, and generous person and extremely dedicated to the O&P profession and community. He will be greatly missed by many in the O&P field and his loss will be acutely felt at NAAOP.  In fact, one of Nikki’s first fellowship assignments was to travel to Iowa to visit OPGA as a guest of Todd Eagan and his colleagues at VGM. During her time in Iowa, Todd arranged for meetings with former senators and congressmen from Iowa and Kansas in addition to many meetings, discussions, and dinners. Todd and the OPGA family went above and beyond to help Nikki kick off her fellowship.

 

Osseointegration:  Nikki is an above-knee amputee and has been living with osseointegration (OI) for four years. After sustaining a spinal cord injury in 2009, complications in her recovery led to her amputation however, the significance of her spinal cord injury made success in a traditional prosthetic socket difficult. Nikki currently works for Osseointegration International as the Director of North American Operations and she is passionate about sharing her experience with osseointegration to educate amputees, clinicians, and practitioners about OI. As part of the fellowship, Nikki will help lead NAAOP’s efforts on OI and will work alongside the O&P Alliance advancing the issue on behalf of the profession.  Nikki and NAAOP will also host a briefing at Walter Reed Army Medical Center in Bethesda, Maryland in July for the benefit of O&P leaders, elected officials, hill staff, CMS staff and other policy makers, including the viewing of an OI surgery.

 

Virtual Congressional Lobbying Day:  The two Breece Fellows will take a lead role in organizing the NAAOP virtual Congressional Lobby Day in July to encourage Congress to pass the Medicare O&P Patient-Centered Care Act and to educate policy makers on osseointegration.

  • Written by ITOperations

 NAAOP Announces Webinar Series

NAAOP Announces Webinar Series

NAAOP will host two webinars, one in May and one in June addressing audit-ready patient files and how to win appeals.  The webinars will be free of charge as a member benefit.  Non-members are encouraged to join NAAOP and participate.  Active Q&A will be encouraged during both webinars.  Please join us for this informative webinar series!

Webinar I:  Creating an Audit-Ready Patient File for O&P Claims
Date:  May 25, 2022 from 1:00 to 2:00 pm, Eastern Time
Key Topics to be Addressed:

  • Overview of O&P Audit Environment
  • Interplay between CMS and the Medicare Administrative Contractors (MACs)
  • Rules of Medicare Coverage and Payment
  • Recognition of O&P Clinician Records to Demonstrate Medical Necessity
  • Creating an Audit-Ready Patient File
  • Importance of Physician Records
  • Corporate Oversight and Process Improvements to Improve Patient Records
  • Documenting Medical Necessity Effectively
  • Best Practices for Comprehensive Patient Records

Register here: https://www.eventbrite.com/e/336494041737

Webinar II:  Audits, Appeals and How to Challenge Denials of O&P Care
Date:  June 14, 2022 from 1:00 to 2:00 pm, Eastern Time
Key Topics to be Addressed:

  • Independent O&P Practices’ Experience with Audits
  • Audits, Investigations, Extrapolations, and Appeals
  • Understanding the Process and How to Negotiate Challenges to Denials of Claims
  • When Overpayments Become Allegations of Fraud and Abuse
  • Using Electronic Health Records to Perfect Your Claims
  • How Participation in the Limb Loss and Preservation Registry (LLPR) can Demonstrate Value over Time
  • How to Engage the Patient in Demonstrating Medical Necessity and Challenging Appeals
  • Leveraging the Patient’s Engagement in Working with Physicians
  • Priming the Pump for the LLPR Through Patient Engagement

Register here: https://www.eventbrite.com/e/336537842747

REGISTRATION:  You must register for each webinar individually using these links:  We hope you will join us.  Thank you for your support of NAAOP! 

Webinar 1 May 25, 2022 1:00 – 2:00 pm: https://www.eventbrite.com/e/336494041737
Webinar 2 June 14th 2022 1:00-2:00 pm:  https://www.eventbrite.com/e/336537842747

  • Written by ITOperations

Joint Statement on Direct-to-Consumer Delivery Models of O&P Care

Joint Statement on Direct-to-Consumer Delivery Models of O&P Care

This week, NAAOP, in conjunction with its O&P Alliance partners, AAOP, AOPA, BOC, and ABC, issued a joint statement on direct-to-consumer delivery models for custom orthotic and prosthetic care.  The full consensus statement can be read here.

NAAOP believes that the provision of limb prostheses and custom-fabricated and custom-fitted orthoses to individuals with limb loss or limb difference requires care from a trained clinician following a prescription from a treating medical provider. This clinician should be a certified and/or licensed orthotist or prosthetist who provides care as part of an overall treatment plan. This constitutes the optimal, time-tested system of orthotic and prosthetic care.

NAAOP has a long history of embracing technology and strongly supports the adoption of innovations that can assist practitioners in providing safe, effective, high-quality care.  While O&P technology has improved dramatically over the past several decades, improvements in technology alone cannot and should not replace the patient-provider relationship.

Advances in technology include additive manufacturing, 3D printing, new material applications, and new ways to take impressions and measurements of patients’ anatomy.  Orthotists and prosthetists routinely utilize these technological innovations; however, these developments have fueled a growing trend toward direct-to-consumer models in the provision of custom O&P care.

Direct-to-consumer delivery models tend to omit the involvement of the physician, the certified or licensed O&P clinician, and largely operate outside of the medical care continuum.  They also shift the burden to the patient or caregiver to perform clinical tasks and tend to commoditize O&P care.  Another characteristic is reliance on cash payments from patients rather than third party payments.

NAAOP and the other four national organizations that comprise the O&P Alliance stand in strong opposition to any direct-to-consumer delivery model for the provision of custom prostheses or orthoses as they circumvent the necessary, direct working relationship between the patient and an appropriately credentialed O&P clinician as part of an overall plan of care.

For these reasons, NAAOP:

  • Supports the delivery model that preserves the meaningful person-to-person relationship between the patient and an appropriately credentialed O&P clinician.
  • Rejects direct-to-consumer delivery models for the provision of custom O&P care.
  • Supports the use of technology but does not believe that technological advances should replace the clinical expertise of the orthotist and/or prosthetist.
  • Recommends that third-party payers reject claims for O&P care provided through direct-to-consumer models.
  • Encourages the enforcement of state O&P licensure laws requiring a licensed O&P practitioner to provide orthotic and prosthetic care.
  • Written by ITOperations

NAAOP O&P Capitol Hill Update for March 2022

NAAOP O&P Capitol Hill Update for March 2022

 The Centers for Medicare and Medicaid Services (CMS) recently issued two new regulations that impact patient access to orthotic and prosthetic (O&P) care, one on benefit category determinations (BCDs) and pricing decisions and one on prior authorization (PA).  The first regulation improves the process for CMS to make BCDs and pricing decisions on new O&P technologies.  The Health Care Common Procedure Coding System (HCPCS) Work Group at CMS will now make these determinations.  The new process will be more transparent than under the current system, where decisions have been made in the halls of CMS with no public scrutiny.  O&P innovators and manufacturers will now receive a preliminary determination on these important decisions, be granted a public hearing where supporting evidence can be presented, and questions will be able to be posed by the HCPCS Workgroup.  It is not clear whether this system will produce better results, but it is certainly more publicly accountable.

In addition to an appropriate HCPCS code, an appropriate BCD or pricing decision on new technology is critical to ensuring that patients have access to O&P innovations.  For instance, a new family of powered orthoses are entering the market.  If CMS determines these orthoses are considered “durable medical equipment,” practitioners will have to demonstrate that they are medically necessary in the patient’s home—a DME requirement that does not apply to O&P—and could be paid on a rental basis rather than on a lump sum basis.  This makes little sense for custom fabricated powered orthoses, but CMS’s decision on this issue is still pending.

On prior authorization, CMS also announced additional HCPCS codes that will be added to the list of items subject to PA.  CMS implemented PA last year on a small number of advanced technology prosthetic components.  Despite initial concerns, by all accounts, the program has been regarded by O&P practitioners as favorable, especially given the alternative of recoupments and long delays for ALJ hearings for denied claims.  Now CMS is phasing-in application of PA to certain OTS orthoses, some of which are already subject to competitive bidding.  These include two lumbar-sacral orthoses (L0648 and L0650) and three knee orthoses (L1832, L1833, and L1851).  Some of these OTS orthoses are typically available and needed by patients at the point of a provider encounter and may not lend themselves to a delay in authorization under the PA program.  More information is needed from CMS on this issue to ensure that this development does not compromise access to patient care.

Finally, NAAOP is proud to be working with our new President, Maggie Baumer, JD, who started her tenure on January 1st and would like to sincerely thank Glenn Crumpton, CPO, for his term as NAAOP President.  NAAOP will host two Breece Fellows this summer, Nikki Grace-Strader and Lucas DeLuca, both of whom will be onsite in Washington, DC to absorb the intricacies of policy-making and O&P advocacy.  NAAOP also plans to host a Virtual Congressional Fly-In this summer, where the Breece Fellows will play a key role in promoting the Medicare O&P Patient-Centered Care Act.

Thanks to all NAAOP members for their critical support in 2022

  • Written by ITOperations

2022 New Year Message from NAAOP

Hear a brief message from our incoming president Maggie Baumer, JD.

Please help us in supporting the Medicare Orthotics and Prosthetics Patient Centered Care Act. Happy New Year and many thanks to those who made 2021 a successful year.

  • Written by ITOperations

Glenn Crumpton, CPO, LPO, reflects on his term as NAAOP President

Glenn Crumpton highlights three key NAAOP priorities during his tenure as President, the Medicare O&P Patient-Centered Care Act, the NAAOP Breece Fellowship, and the 1st Inaugural NAAOP Congressional Advocacy Day.

 

  • Written by ITOperations

Diversity & Inclusion in the O&P Profession with Regina Weger and Lisa Lodyga-Uhl

NAAOP invited Regina Weger, President, Products and Services, Hanger, Inc. and Lisa Lodyga-Uhl, Vice President, Chief Diversity & Inclusion Officer, Hanger, Inc. to share by video this important initiative on Hanger’s behalf.

 

Additional Resources:

Hanger Diversity & Inclusion Pledge

Hanger Diversity Scholarships

Managing Bias

 

  • Written by ITOperations

Senate Introduces S. 2556:  Medicare O&P Patient-Centered Care Act

The Medicare Orthotics and Prosthetics Patient-Centered Care Act has been introduced in the United States Senate and referred to the Senate Committee on Finance.  This is companion legislation to H.R. 1990, an identical bill in the U.S. House.  Both bills are bipartisan with the Senate bill being introduced by six original sponsors of the legislation, including:

  1. Senator Mark Warner, a Democrat from Virginia who serves on the Finance Committee;
  2. Steve Daines (R-MT), also a Finance Committee member;
  3. Tammy Duckworth (D-IL), a champion of the O&P profession and prosthetic user;
  4. John Cornyn (R-TX), a senior Republican on the Finance Committee;
  5. Bill Cassidy (R-LA), a physician on the Finance Committee, and
  6. Charles Grassley (R-IA), former Chairman of the Finance Committee and long-time champion of O&P legislation.

The bill would accomplish four key priorities for the orthotic and prosthetic profession:

  • Distinguishes durable medical equipment (DME) from clinical O&P care
  • Limits the definition of “off-the-shelf” (or “OTS”) orthotics to devices that truly require only “minimal self-adjustment” by the beneficiary only
  • Bans drop-shipping to patients of custom fit and custom fabricated orthoses and prostheses to ensure access to clinical care, and
  • Exempts licensed and certified O&P practitioners from OTS competitive bidding, treating them similarly to physicians and therapists by allowing them to provide OTS orthoses to their patients without a contract at the competitive bidding rate.

Now we need YOUR help to build support for this legislation.  Please visit our action page to easily email your Senators and ASK THEM TO COSPONSOR THIS BILL simply by filling in your contact information and selecting your Senators. We urge you to take the time to customize your message to inform your Senator how this bill impacts you and your colleagues in the state.

If you have not contacted your Congressman, please take this opportunity to also reach out to that office and encourage them to cosponsor companion legislation in the House, H.R. 1990.  You can identify your Congressmen, Senators, and learn how to easily communicate with them at www.NAAOP.org.

NAAOP thanks the American Orthotic and Prosthetic Association (AOPA) for its efforts in getting this bill introduced in the Senate.  We also thank our O&P Alliance partners for their support of this important bill.

Finally, thank you for your continued support of NAAOP and policies to advance the O&P community!

 

  • Written by ITOperations

Virtual Advocacy Offers O&P Community New Tools to Advance Legislation

 

The COVID-19 pandemic’s lasting effects will be felt world-wide and its impact on Washington advocacy is no exception.  Flying to Washington to walk the halls of Congress will return over time as the primary way to impact legislators, but virtual advocacy, in some form, is here to stay and it offers the O&P community new tools to achieve its legislative objectives.  We urge practitioners and patients alike to go to www.NAAOP.org and access the “Congressional Action Center” to connect with your representatives.  You should feel empowered to directly seek a videoconference with your Member of Congress or staff to promote two important bills:

  1. Medicare Orthotics and Prosthetics Patient-Centered Care Act (H.R 1990)

Representatives Mike Thompson (D-CA), GT Thompson (R-PA), GK Butterfield (D-NC), and Brett Guthrie (R-KY) have re-introduced this bipartisan bill in the House.  A Senate companion bill is expected to be re-introduced in early June.  NAAOP strongly supports this legislation and we need to demonstrate support for this bill by adding Congressional cosponsors to it. The bill is identical to the House version of the bill (H.R. 5262) introduced last year, which means we can build on the awareness and support for the bill from the previous Congress.

The bill would accomplish four key priorities for the orthotic and prosthetic profession: (1) Distinguish durable medical equipment (DME) from clinical, service-oriented O&P care in the Medicare statute and regulations, (2)  Limit the definition of “off-the-shelf” (or “OTS”) orthotics to devices that truly require only “minimal self-adjustment” by the beneficiary him- or herself, (3) Ban drop-shipping to patients’ homes of custom fit and custom fabricated orthoses and prostheses to prevent fraud and abuse and ensure patient access to clinical O&P care, and (4) Exempt licensed and certified O&P practitioners from OTS competitive bidding, treating them similarly to physicians and therapists by allowing them to provide OTS orthoses to their patients—without a contract—at the competitive bidding rate (not the higher fee schedule amount).

  1. “Triple A” Study Act (S. 1089 and H.R. 2461)

Senators Tammy Duckworth (D-IL) and Marsha Blackburn (R-TN) and Representatives G.K. Butterfield (D-NC-01) and Brett Guthrie (R-KY-02) recently introduced the Access to Assistive Technology and Devices for Americans Study Act, known as the “Triple A” Study Act.  This bill is identical to the Senate (S. 4343) and House (H.R. 8581) versions of the bills introduced last year, which means we can build on the awareness and support for the bill from the previous Congress.  The bill would direct the Government Accountability Office (“GAO”) to craft a report evaluating appropriate coverage and provision of health care services to people with limb loss or limb difference, including access to care, policies for matching specific devices to individual needs, affordability, and more. In addition, it would create an “apples to apples” comparison of coverage policies and usage across different payers, including Medicare, the Veterans Health Administration, and the commercial insurance market.

We urge all NAAOP members and friends to contact their legislators and ask them to cosponsor both of these important bills.  Thank you for your advocacy on behalf of the O&P profession.

  • Written by ITOperations

NAAOP and Range of Motion Project celebrate Limb Loss Awareness Month

NAAOP is proud to partner with the Range of Motion Project (ROMP) for Limb Loss Awareness Month as part of their national component collection drive.

 

Launching in April, and continuing throughout this spring, ROMP is collecting new and gently used prosthetic components from clinics, manufacturers, and individuals throughout the United States to ensure ROMP’s clinics in Guatemala and Ecuador can continue to provide high-quality prosthetic care to access-limited people with amputation. This is part of ROMP’s Components for a Cause (C4C) year-round component recycling program.

 

Nicole Ver Kuilen, NAAOP’s Inaugural Fellow and Consumer Vice President, is helping to lead this effort with ROMP. Ver Kuilen shared, “April is Limb Loss Awareness Month and it’s critical we acknowledge the fact that 9 out of 10 amputees worldwide do not have access to prosthetic care. This month, we can do something about that.” 

 

ROMP will cover the cost of shipping and donated components will go directly to use in changing someone’s life. It’s as simple as signing up and requesting a free shipping label! Recently, ROMP implemented a QR code tracking system to increase transparency and impact. Every knee, foot, and liner donated is tracked all the way to the patient, so donors know exactly who they’ve helped become mobile.

 

“What better way to help those with limb loss during this important month for the O&P community than through this project that our first Fellow is working on. NAAOP and our Board of Directors congratulate every organization and individual involved in making the lives better for those with limb loss worldwide,” shared George Breece, Executive Director of NAAOP.

 

ROMP now has over 150 clinic partners in the United States who have joined the movement for equitable access to prosthetic care. This represents just 5% of clinics nationwide, which is why ROMP is calling for hundreds more to join in the effort. In 2020, ROMP collected over 5,000 pounds of components and hopes to collect 7,000 pounds in 2021. 

 

Dave Krupa, CPO and ROMP Executive Director and Co-Founder shared, “Since 2005, ROMP has been working with the most marginalized individuals in the Americas who would otherwise not have access to prosthetic care. We are proud to share that we just surpassed our 4,000th prosthesis delivered in 2021. This journey would not be possible without ROMP’s C4C donors and partners like NAAOP who are dedicated to breaking down economic and systemic barriers that keep individuals from obtaining the freedom that comes from mobility. We believe in mobility for all.”

 

About NAAOP

The National Association for the Advancement of Orthotics and Prosthetics is a non-profit trade association dedicated to educating the public and promoting public policy that is in the interest of the O&P patient. Since 1987, NAAOP has shaped positive results in healthcare legislation and regulation through strong government relations advocacy and education of policymakers. NAAOP serves the profession by representing and partnering with only those providers of orthotic and prosthetic services who truly believe that the patient must come first. For more information please visit: https://naaop.us/

 

About ROMP

The Range of Motion Project is a global, non-profit organization dedicated to improving the mobility of people with amputation. ROMP realizes its mission by providing high-quality prosthetic care, follow up services, community-based rehabilitation, and product innovation through its permanent operations. Since 2005, ROMP has delivered over 4,000 custom-made, high-quality prosthetic devices in Guatemala, Ecuador, and the U.S., and conducted over 10,000 patient visits. In the next 5 years ROMP plans to raise $5 million dollars to deliver 5,000 prosthetic devices to those in need. To learn more or help advance their mission, please visit https://www.rompglobal.org/.

 

  • Written by ITOperations

National Association for the Advancement of Orthotics and Prosthetics (NAAOP)