Election Update and Limb Loss Registry Appeal for Participation

The mid-term elections will have a profound impact on the health care policy landscape, including the impact they will have on orthotic and prosthetic (O&P) policy.  The Limb Loss and Preservation Registry (LLPR) is in high gear as the registry prepares to launch as a free-standing entity.  Both issues are the subject of this November update.

Election Results and Impact as of November 17th:  The so-called “red wave” did not materialize as many experts and pollsters expected, but Republicans took control of the House of Representatives nonetheless.  This creates divided government for the first time under the Biden Administration.  The predicted total is 222 Republicans to 213 Democrats (although these estimates may change), a margin of four votes to pass legislation in the House.  This is similar to the margin of victory in the current Congress on the Democratic side of the aisle.  With the Freedom Caucus flexing its muscles, corralling enough Republican votes to pass legislation will be very difficult.  Kevin McCarthy and Steve Scalise were nominated by the Republican Conference for the position of Speaker of the House and Majority Leader, respectively, for the 118th Congress which begins in January.  However, Cong. McCarthy must get the votes of at least 218 of his colleagues and he only secured 180 Republicans for his nomination.  On the Democratic side, Nancy Pelosi and Steny Hoyer will step aside from their leadership positions and open up a whole new, untested slate of Democratic leaders in the House.

Democrats held control of the Senate by at least the margin they currently hold.  A run-off election in Georgia on December 6th will determine whether the Senate is again split 50-50 or Democrats will have a 51-49 margin.  Either way, bipartisanship will be necessary in most instances to move any significant legislation.  The lame duck session of Congress will begin in earnest after the Thanksgiving holiday.  December 16th is the deadline for Congress to pass a bill to fund the federal government or the federal agencies will shut down. This is considered must-pass legislation and will provide a legislative vehicle on which to attach other legislative priorities, such as telehealth extensions, fixes to the Medicare physician fee schedule which is slated to be cut by 4.47% in 2023, and other health care priorities.  NAAOP is working hard with its sister O&P organizations to promote inclusion of key provisions in the Medicare O&P Patient-Centered Care Act in this end-of-the-year package, but it’s a serious challenge.

Limb Loss and Preservation Registry:  The past month has witnessed a flurry of activity involving the LLPR.  Mayo Clinic currently runs the registry through a $5 million contract with the NIH and Department of Defense.  Hospitals, hospital systems, and especially O&P clinical practices are signing up for participation in the registry and NAAOP strongly encourages its provider members and friends to join the LLPR as soon as possible.  A strong reservoir of data will enable the O&P profession to benefit from an evidence-based platform to improve patient care, enhance quality outcomes, and assist practitioners and patients in making optimal O&P treatment choices.  The LLPR has approximately $1.6 million and the next 14 months to launch into a free-standing entity that will serve the O&P and broader health care community.  NAAOP urges all O&P clinicians and owners of clinical practices to join the registry today!  For more information and to join the LLPR, please contact Bernhardt.Kathie@Mayo.edu.

Happy Thanksgiving from NAAOP to all our members and friends!

  • Written by ITOperations

New NAAOP Board Members and Congressional Midterm Update

New NAAOP Board Members and Congressional Midterm Update

NAAOP elected four new board members at its in-person board meeting in San Antonio, Texas in late September: Ben Auzenne, Jeff Cain, MD, Adam Miller, and Steven D. Miller, CPO/L.

Ben Auzenne:  Ben is the North American vice president, Blatchford US, Miamisburg, Ohio. He has an master’s degree in organizational diagnosis and change management from the Regent University School of Global Leadership and Entrepreneurship and a bachelor of science degree in biology from the College of William and Mary.

Jeff Cain:  Dr. Jeffrey Cain is a family physician and clinical professor at the University of Colorado School of Medicine, a past president of the American Academy of Family Physicians, and a past chair of the board of directors of the Amputee Coalition. After leading the effort to pass the nation’s first parity law in 2001 in Colorado, he was the founding chair of the Amputees Coalition’s Advocacy Committee whose efforts have resulted in the passage of prosthetic access laws in 21 states and the introduction of bipartisan federal prosthetic insurance legislation.

Adam Miller:  Adam Miller is president of the Orthotics Prosthetics Group of American within VGM & Associates, Waterloo, Iowa. He has a Bachelor of Arts degree in public relations from the University of Northern Iowa.  Adam graciously steps in after the untimely passing of Todd Eagan, a leader in NAAOP for many years.

Steven Miller:  Steven Miller is the regional vice president southeast for Hanger, Austin, Texas. He has been with Hanger for 25 years serving in numerous leadership roles. He is a graduate of Southwestern Medical Center in Dallas and is nationally recognized as an expert in rotationplasty and has two patents for prosthetic products. He is a Georgia Society Orthotics and Prosthetics board member, a Georgia Composite Medical board member, and a graduate of Georgia Southern University with a bachelor’s degree in kinesiology.


Mid-Term Elections on the Horizon:  The changing dynamics surrounding the mid-term elections are expected to impact the ability to advance health care legislation in a significant manner.  Conventional wisdom is that the party of the President usually loses seats in the House and Senate during mid-term elections and, with the balance of power being split so evening, even a minor net gain for Republicans will shift leadership away from one-party rule.  The Senate is currently split 50-50 so one net gain for Republicans will have an enormous impact on the second half of President Biden’s current term in office.  The House is not much different, where Republicans only need a net gain of 5 seats to gain the majority.


However the election turns out, the “lame-duck” session of Congress is expected to be very active.  Congress will need to pass a massive omnibus spending bill to fund the federal government by December 16th or, in the alternative, pass another continuing resolution to keep the lights on at federal agencies.  This legislation provides a must-pass piece of legislation before the 117th Congress adjourns for good.  And this means the O&P community has one last shot to get Congress to pass parts or all of H.R. 1990, the Medicare O&P Patient-Centered Care Act.

  • Written by ITOperations

Farewell to the 2022 Breece Fellows

The 2022 NAAOP Breece Fellowship comes to an end after a productive summer. View the video here where Lucas DeLuca & Nikki Grace-Strader summarize their experiences in O&P and healthcare advocacy on Capital Hill and thank the O&P profession for your sponsorship and support.

  • Written by ITOperations

Maggie Baumer and 2022 Fellows visit O&P facilities on July 21,2022

On Thursday, July 21st, NAAOP President, Maggie Baumer, traveled to Washington, DC to meet with our 2022 George and Dena Breece fellows, Lucas Deluca and Nikki Grace-Strader. Each summer, part of the fellowship itinerary includes a visit or visits to local orthotic and prosthetic clinical care settings so that our fellows get the opportunity to see the world of O&P through a provider lens. During this year’s visit, the two fellows accompanied Maggie to the National Rehabilitation Hospital to meet with CPO and NAAOP member, Austin Davids, at the Hanger Clinic location within the hospital. The group was able to attend an AFO casting appointment with a long-time patient who had suffered from a stroke. Both fellows are people with limb loss or limb difference and currently utilize prosthetic limbs for mobility, so they are keenly aware of prosthetics from the patient point of view. However, neither wears an orthosis, nor had attended an orthotic patient appointment before. Both remarked on the complexity and skill required of the orthotist, as well as the importance of the orthotist-patient relationship and the particular empathic quality that Austin exhibited with his patient. In addition to visiting this unique setting within a rehabilitation hospital, the fellows also visited the Hanger location at 1133 21st Street NW, Suite 150 downtown to see a more typical O&P practice in a city environment. Each location highlighted unique aspects of O&P clinical settings. Special thanks to Austin Davids for hosting our fellows and to Ben Higgs, Area Clinic Manager, DC at Hanger Clinic for setting up the visit.

  • Written by ITOperations

NAAOP Welcomes Second Breece Fellow for Summer Advocacy

Virtual Congressional Advocacy Day:  In late July, the two Breece Fellows this summer will take a lead role in organizing the NAAOP virtual Congressional “Fly-In” to encourage Congress to pass the Medicare O&P Patient-Centered Care Act (H.R. 1990 and S. 2556) and to educate policy makers on impending policy issues involving osseointegration.

The Medicare O&P Patient-Centered Care Act would accomplish key priorities for the orthotic and prosthetic profession which would help distinguish O&P clinical care from durable medical equipment (DME):

  • 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.

Breece Fellowship:  After a 2-year delay due to the pandemic, NAAOP is excited to be working with two fellows this summer, the most recent of which is Lucas DeLuca.  Lucas is an individual with above-knee limb loss from birth and began his fellowship in Washington, DC, on July 11th.  Lucas will be doing an abbreviated four weeks in DC with his counterpart, Breece Fellow, Nikki Grace-Strader.  Both 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 and disability fields.  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.

Diversity, Equity, Inclusion, Accessibility (DEIA):  As a congenital above-knee amputee, Lucas has been living with a prosthetic limb since he was two years old. Growing up with limb loss and frequenting several different hospitals and prosthetists, Lucas learned the importance of patient-centered care from a young age. Throughout his experiences in sports, education, and theater, he focused on ways to minimize or remove barriers to access while bolstering inclusion of people with disabilities in all aspects of life. Today, Lucas works as the Director of a Disability Services office in Washington State providing accommodations to students with a range of different disabilities. As part of the fellowship, Lucas will help lead the NAAOP’s efforts on DEIA practices and will work to create more resources dedicated to enhancing prosthetist and patient experiences.

  • Written by ITOperations

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

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