The Value of a Washington DC Education

By Nicole Ver Kuilen

The following is a firsthand account of lessons learned from the ten-week fellowship I experienced this summer as the Inaugural Fellow of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP).

One year ago this month, I set out on a mission to raise awareness on behalf of millions of amputees like me living in the United States. I quit my job, recruited my family, and decided to take on a 1,500-mile triathlon down the west coast. Inspired by the Tom Hanks film, I called my journey “Forrest Stump.” It was by far the most challenging athletic endeavor I had ever attempted. I was determined to make it across the finish line, but I wondered whether I had a prosthesis that could survive the journey. What began as an effort to raise awareness for amputees has become much larger than I ever anticipated.

My story as an amputee began at age ten when I lost my leg to osteosarcoma. Since then, I’ve pushed myself physically to earn the right to be called an athlete. Yet, I’ve continuously come up against the same obstacle—having a prosthesis designed for walking when all I really want to do is run. The reality is that it is the only prosthesis my insurance covers. I find myself caught in a paradox where technology exists that could erase my disability almost entirely, yet few have access to it. That became the mission driving my advocacy efforts: To expand access to the most appropriate prosthetic technology for all amputees.

ALL ROADS LEAD TO OUR NATION’S CAPITAL

I knew I had a lot to learn about healthcare policy if I was going to make any headway. So, the next stop on my journey seemed like an obvious decision. The best place to immerse myself in policy and to create nationwide change is in Washington. As luck would have it, NAAOP was seeking an individual for their inaugural O&P health policy and advocacy fellowship this summer.

NAAOP believes that “an educated advocate is the most effective advocate,” and through this ten-week fellowship program they guided me in developing a proactive message to take to Capitol Hill. The fellowship provided me the opportunity to learn from the experts, namely Peter W. Thomas, JD, NAAOP’s general counsel, who is a disability lawyer and bilateral amputee; David McGill, JD, NAAOP president, who is an amputee and senior executive with Össur; and George Breece, the founding executive director of NAAOP. Throughout the summer I traveled from Washington for meetings at various clinics and professional organizations around the country to learn what each is doing to advance the field of O&P for amputees like me.

THE GATEKEEPERS OF THE FIELD

Once I arrived, I started to lay the foundation for my Washington education, beginning with a visit with the O&P Alliance. The O&P Alliance is made up of the leading national organizations representing the O&P profession. This includes the American Academy of Orthotists and Prosthetists (the Academy), the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC), the American Orthotic & Prosthetic Association (AOPA), the Board of Certification/Accreditation (BOC), and NAAOP.

Each organization generously hosted me at its office and briefed me on its mission. The organizations’ missions span the scientific, research, professional, business, and quality improvement aspects of the O&P field. As a coalition, they collaborate on important federal and state policy measures. In a sense, they are the gatekeepers of the field.

To succeed in the mission of expanding access to prosthetic technology, it is going to take a collaborative effort by organizations like those belonging to the O&P Alliance to solve the multifactorial issues surrounding lack of access to appropriate care. As a starting point, I have identified four primary barriers the O&P profession must address to improve access to care.

HIERARCHY IN PROSTHETIC COVERAGE

Simply stated, amputees’ access to certain prosthetic technologies, and thus their mobility, quality of life, and functional/athletic potential is determined by their insurance coverage. In my experience, amputees who have the lowest level of coverage are those covered under most commercial insurance plans. These plans typically offer limited coverage for prosthetic care. The second level of coverage is provided by the Centers for Medicare & Medicaid Services (CMS) followed closely by the Veterans Health Administration (VHA). Amputees whose prosthetic care is covered through workers’ compensation, automotive insurance, or other litigation circumstances including injured active-duty military personnel in the Department of Defense (DOD) are often covered at the highest level, meaning their plan or program affords them access to the most advanced prosthetic technologies. However, how you lost your limb should not determine the level of care you receive.

While shadowing Thomas over the past few months, I’ve had the opportunity to meet with CMS, VHA, DOD, and United Healthcare (UHC). As the NAAOP fellow, attending these high-level meetings gave me an exclusive look at our fragmented healthcare system, but it also gave me hope that we can find innovative ways to address our nation’s complex web of coverage, whether through internal pilot programs, federal or state legislation, or healthcare regulation.

For example, the Extremity Trauma and Amputation Center of Excellence (EACE) was formed through legislation to enhance collaboration between the Department of Veterans Affairs (VA) and DOD, which operate separately but have an overlapping amputee population. Additionally, UHC is a large national insurer that covers millions of people with disabilities, including users of O&P care. I had the opportunity to meet with leaders from these entities who are working to expand access to care.

NONPROFIT SECTOR INCREASINGLY FILLS THE INSURANCE GAP

With decreasing coverage and rising costs of healthcare, thousands of amputees are looking to a growing number of nonprofits and philanthropic resources to cover the expense of prosthetic care. Although this does meet a need in the short-term, it is not a sustainable or equitable distribution of resources. To understand why this is happening and what we can do to solve it, we must ask ourselves: Why are we, as a society, choosing to provide uncompensated charity care?, and What are we losing by providing healthcare in this manner?

To answer the first question, I believe it comes back to an equation I learned shadowing Jan Stokosa, CP, board member and past president of NAAOP, at his prosthetic clinic in Lansing, Michigan, as part of my fellowship. The equation is:

Redefining what is possible is what inspires O&P clinicians to provide better care, and it inspires engineers to design technologies and components that better replicate human movement. When parts of this equation are not being fulfilled—such as by a lack of available technology or a prosthetist’s inability to innovate because of increasing administrative burdens—the outcome is limited. That’s why philanthropies have decided to step up in the care of amputee rehabilitations: They want to be part of what is possible.

But, we are also losing critical data and information by providing healthcare in this manner. Millions of dollars in uncompensated care, and potentially improved health outcomes, are not being reported to healthcare payer data systems, comprising important sources of information for future coverage gains. If we cannot prove that prosthetic intervention increases mobility outcomes, then we will not be able to make the case for its coverage.

Two organizations that hosted me this summer are tackling this challenge. AOPA, in partnership with the Amputee Coalition, has commissioned a number of studies by highly respected health economists and researchers, including Dobson DaVanzo and the RAND Corporation, to show O&P intervention saves the U.S. healthcare system money in the long term, providing value not only to the patient, but the payer as well. To showcase the initial Dobson Davanzo study and promote further research, the organizations created the Mobility Saves initiative (www.mobilitysaves.org).

Additionally, Hanger Inc., Austin, Texas, specifically James Campbell, PhD, CO, FAAOP, chief clinical officer, is leading a comprehensive program to capture medical outcomes of patients who use lower-limb prostheses across Hanger’s 800 clinics. Using the independent, scientifically validated PLUS-M instrument and Hanger’s Mobility Empowerment Score Card, Campbell and his research partners have already collected thousands of individuals’ outcomes data and are helping patients assess their own improvements in mobility. The research team has conducted a landmark study known as the Mobility Analysis of Amputees (MAAT I). The largest of its kind, the study measured the correlation of mobility to quality of life and patient satisfaction for people living with lower-limb loss. The findings demonstrated a significant direct correlation.

In the short-term, philanthropy is critical to filling the access gap quickly and showing what is possible for amputees; however, moving forward, we must ramp up our efforts to demonstrate that O&P care increases mobility outcomes and provides value to healthcare payers. To help, nonprofits must take a lead role in communicating their efforts to Congress and having a seat at the advocacy table.

AMPUTEES IN THE MEDIA VERSUS REALITY

There is a widening gap between perception and reality when it comes to amputees’ access to prosthetic technology and care. The stories told in the media focus on a fraction of the over 2 million amputee population in America, highlighting active-duty veterans and Paralympic athletes who typically have greater overall access to prosthetic technology. What the public and amputee community does not understand is that for nearly two decades insurance companies have been restricting coverage of prosthetic devices, diverting spending away from mobility-enhancing prosthetic technology toward less advanced, less costly prosthetic components available decades ago. This information gap has created a false perception that only certain amputees can benefit from advanced technology, and many amputees still don’t realize they need to advocate for a higher standard of care.

While speaking with Carrie Davis, director of patient experience at Hanger Clinic, she stressed the importance of advocating for the “everyday normal.” We need to share more stories of amputees who just want to play with their grandkids, or learn how to cook again, or run with their local running club. An amputee should not have to go to extreme lengths, or fit into the top 1 percent, to be able to access the technology that is designed for a wide range of amputees to help them get back into the community.

For more of these everyday normal stories to be told, we need an army of advocates who recognize the gap in access and are willing to share their stories, at the right time, in the right way, and with the right people. In addition to NAAOP, AOPA, and others, the Amputee Coalition is helping to build this army through a grassroots and lead-advocate program, designed with varying levels of commitment to get involved. For example, amputees can text “ACadvocacy” to 201-21 to send a pre-written letter to their state and federal members of Congress.

Moving forward, it will be absolutely critical for amputees to take charge of their own narrative if we want to close this access gap. When the time comes for this community to speak out in masses to upend this divide, it will be critical that we are informed, educated advocates who can take the right message to the halls of power.

PROSTHETISTS AND ORTHOTISTS AS PROFESSIONALS PROVIDING CLINICAL CARE

As a relatively small segment of healthcare, the O&P profession’s survival is dependent upon its ability to compete for representation in the larger healthcare arena. However, currently, the profession is battling severe misrepresentation, where prosthetists and orthotists are viewed more as suppliers of devices, rather than being recognized as providers of comprehensive clinical services, which happen to include the modality of providing a prosthesis or orthosis to enable function. In order to advance the O&P profession into the 21st century healthcare environment, this needs to change, not only at the policy level, but in the minds of fellow professionals on the rehabilitation team at the local level.

Fortunately, the gatekeepers of the profession, the O&P Alliance members, realize how these policies are perpetuating a misinformed understanding of prosthetists’ and orthotists’ roles in the treatment and care of amputees. Throughout the years, they have also identified a number of O&P champions in Congress and cultivated strong bipartisan support. As a result of these efforts, a bill has been introduced to specifically target the outdated policies, the Medicare O&P Improvement Act of 2017 (H.R. 2499 / S. 1191). The bill would separate O&P from durable medical equipment (DME), restore Congress’ original intent in defining off-the-shelf orthotics for purposes of competitive bidding, and ensure only qualified O&P practitioners can be reimbursed by the Medicare program. One major provision from the bill has already been enacted into law: the provision that recognizes the clinical notes of the prosthetist and orthotist as part of the Medicare patient’s medical record for purposes of determining medical necessity.

As a fellow this summer, I had the privilege of meeting two core proponents of the bill including Senator Tammy Duckworth (D-IL), co-sponsor of S. 1191, and Rep. Glenn Thompson (R-PA-5), sponsor of H.R. 2499.

As the bill’s provisions are enacted, they will set a critical foundation for all future O&P policy efforts and help ensure O&P practitioners are being recognized and rewarded for their education, expertise, skill sets, and scope of practice. However, there is still much to be done at the local level.

THANK YOU FOR THE FELLOWSHIP OF A LIFETIME

As I wrap up my fellowship, I wholeheartedly agree that “an educated advocate is the most effective advocate.” Although I shared many of my summer experiences in this reflection, I could not possibly have included them all. From my 20 Hill visits with the VGM Group, to meeting Minority Leader Nancy Pelosi (D-CA) and Senator Bob Casey (D-PA), to visiting the Children’s Healthcare of Atlanta O&P facility, the list goes on with once-in-a-lifetime experiences. This fellowship program with NAAOP is unique and an incredible way to learn health policy and advocacy from the brightest minds and immerse oneself in Washington life and culture.

I would like to thank NAAOP, all of the hosting organizations, and the donors who made this experience possible. They’ve added another highly engaged and well-trained advocate to the O&P field, and I’m ready to help as a soldier in the consumer movement, a policy advocate, and as a future leader.

Moving forward, I would like to challenge amputees everywhere to get more involved and to aspire to participate in this fellowship opportunity. We need more amputee advocates who can bring our collective voices into the rooms where decisions are made in our nation’s capital. The army has begun to form.

Nicole Ver Kuilen is forming Forrest Stump as a nonprofit advocacy organization with the mission to raise awareness and expand access to the most appropriate prosthetic technology for all amputees. She will be undergoing paratriathlon training at the Olympic Training Center and this fall will attempt to summit Cotopaxi in Ecuador with the Range of Motion Project in honor of the 28th Anniversary of the Americans with Disabilities Act. You can follow her journey at www.forreststump.org.

  • Written by NAAOP

VA Issues Report on Access to New Prosthetic Technologies

On August 27, 2018, the Department of Veterans Affairs, Office of Inspector General, issues a report #16-01913-223, entitled, “Use of Not Otherwise Classified Codes for Prosthetic Limb Components.”  The findings and recommendations in the report are disturbing and, unfortunately, reflect a lack of understanding of coding and pricing of new prosthetic technologies.  The report was triggered by two anonymous employees who challenged the process for assigning reimbursement levels for new technologies under the prosthetic benefit.

The report concludes that the VA overpaid “contract” prosthetists by $7.7 million between 2014 and 2017 because the VA permitted these prosthetists to use “not otherwise classified” or “NOC” HCPCS codes when submitting invoices for new prosthetic technologies to the VA for reimbursement.  The report alleges that this allowed the VA, particularly specific individuals within the VA, to overpay contract prosthetists for prosthetic technologies that the Centers for Medicare and Medicaid Services reimburses at much lower levels.  The report also asserts a lack of sufficient processes, internals approvals, and appropriate oversight for the assignment of these codes and reimbursement values.

The report is seriously flawed in that veterans in need of these new technologies would not have been able to access these innovative components if the VA reimbursed at levels established under existing HCPCS codes.  Veterans simply would not have had access to these new technologies.  Prosthetists would not have provided them to veterans because prosthetists would have taken significant losses in the course of doing so.  The new technologies at issue would have been downgraded to more established, HCPCS-coded components instead.  It is disingenuous for the VA to routinely tout to Congress and the public how it is at the cutting edge of providing advanced prosthetic technology to veterans and then refuse to compensate prosthetists appropriately to design, fit, and fabricate those technologies into a functional limb.

NAAOP will continue discussing this disturbing report with its O&P Alliance partners and will respond to the VA and the House and Senate VA Committees in the near future.  We hope to work with the VA to ensure continued access to new prosthetic and orthotic technologies in the future, despite this most recent VA report.

  • Written by NAAOP

NAAOP Fellowship Farewell and VA Update

NAAOP Says Goodbye to Inaugural Fellow

August 7th was Nicole Ver Kuilen’s last day as NAAOP’s inaugural summer fellow, and we could not have asked for a better experience for the launch of our fellowship program. Over the past 10 weeks, Nicole shadowed Peter Thomas, NAAOP General Counsel, throughout Washington, traveled around the country meeting with various O&P clinics and professional organizations, and was immersed in state government activities. From her 20 Hill visits with the VGM Group on Capitol Hill, to meeting Democratic Minority Leader Nancy Pelosi and Senator Tammy Duckworth (D-IL), bilateral amputee and cosponsor of the Medicare O&P Improvements Act of 2017 (S.1191), Nicole says her highlight reel is full of once-in-a-lifetime experiences. NAAOP would like to thank the organizations that hosted Nicole – Stokosa Prosthetic Clinic, Children’s Healthcare of Atlanta, Hanger, Inc., Orthotic Prosthetic Group of America, and the Amputee Coalition – for the opportunity to expand her learning across the country. We would also like to thank each organization in the O&P Alliance for hosting Nicole, and to our generous NAAOP donors who helped fulfill our vision for this fellowship. In Nicole’s words:

“I would like to thank NAAOP, all of the hosting organizations, and the incredible donors who made this experience possible. They’ve added another highly engaged and well trained advocate to the O&P field, and I’m ready to help as a soldier in the consumer movement, a policy advocate, and as a future leader.”

Nicole has written a first-hand account of the lessons learned as the inaugural fellow, which will be published in the O&P Edge’s September issue. You can also find a photo gallery highlighting Nicole’s experience at http://naaop.org/gallery/2018-fellowship-photo-gallery/

The NAAOP Board Fellowship Committee will meet in Vancouver to discuss the success of the program and look for ways to improve upon and expand on this initial pilot. We look forward to sharing our vision with you for the year to come.

House VA Health Subcommittee Holds “Roundtable” Discussion

Peter Thomas and Nicole Ver Kuilen participated in a Roundtable held by the Veterans’ Affairs Subcommittee on Health to discuss the VA’s proposed rule, which limits amputee veterans’ ability to choose their O&P practitioner. Both Chairman Neal Dunn, M.D., (R-FL) and Ranking Member Julia Brownley (D-CA) expressed concern that the proposed rule would upend the long-standing practice of veteran choice and reduce access to care by substantially redefining medical necessity. The Veteran Service Organizations (VSOs) in attendance agreed with these remarks and were aligned with the position of NAAOP to preserve veteran choice and ensure access to quality care. The VA responded that they valued the partnerships in the room and were willing to alter the language in the final rule.  Peter Thomas also discussed the Injured and Amputee Veterans Bill of Rights (H.R.2322), which received a hearing by the VA Subcommittee on Health earlier this spring. We hope to move forward as expeditiously as possible on that bill and we keep you informed as developments occur.

  • Written by NAAOP

Special Alert: Major Developments in O&P Policy

Over the past two weeks, a number of major, long-awaited developments in O&P policy have occurred. NAAOP and its Alliance partners have been diligently working on these measures over the past few years and we are excited to share an update on the progress that has been made.

  • Issuance of CMS Interagency Workgroup’s Consensus Document: After publishing a DME MACs Draft Local Coverage Determination (LCD) for Lower Limb Prostheses in 2015 that caused enormous public comment and concern, CMS placed that document on hold and formed an Interagency Workgroup in February 2016 to further explore the issues. Last week, CMS published the results of the Workgroup’s efforts. The Workgroup has recommended CMS to take the following immediate actions:
  • Instruct the DME MACs to remove the 2015 Draft LCD and continue coverage for lower limb prostheses under the current LCD, with no changes.
  • Support the establishment of an interagency federal research group in order to create a guidance document to promote industry research standards in the field of lower limb prostheses.
  • Consider creating a National Coverage Determination (NCD) to evaluate the use of microprocessor knees (MPK) for individuals using their prostheses as a limited community ambulator (K2 functional level).

The removal of the draft LCD is a major victory for the O&P community. However, there are still significant areas of concern in the Consensus Document that could be improved. These include:

  • The recommendation that CMS move toward pre-authorization of lower limb prostheses, a process led by the DME MACs.
  • The characterization of prosthetists as “consultants” to the physician for purposes of determining functional level.
  • The conclusion that current literature does not support improved functional health outcomes of power assist ankles and vacuum systems. Nonetheless, these devices may be covered if justified in the pre-authorization request.

Note: On June 21st, the DME MACs announced the retirement of the Draft LCD on Lower Limb Prostheses. This Draft LCD is finally dead.

  • Release of the MEDPAC Report on Orthotics: The Medicare Payment Advisory Commission (MEDPAC) report, filed with Congress last week, includes a substantial section on orthotics and recommends implementation of competitive bidding for off the shelf (OTS) orthotics. However, the report largely focused on abuses of this benefit by non-orthotist providers and even suggested that orthotists, like physicians, should be able to provide OTS orthotics without having a Medicare competitive bidding contract. Importantly, the report did not recommend expansion of competitive bidding to all orthotics and prosthetics, a policy that had been considered prior to NAAOP and its Alliance partners meeting with MEDPAC staff.
  • VA Report by OIG: Over the next few weeks, we expect to see a report from the Office of Inspector General (OIG) of the Department of Veterans Affairs (VA) that may impact coding and coverage of orthotics and prosthetics. We will share this with you when we learn more.
  • Written by NAAOP

Inaugural Fellow Nicole Ver Kuilen

June 4, 2018

Dear NAAOP members:

It has been said that education is the greatest gift we can give to the next generation, a gift so powerful that it has the potential to change the world. I’m on my fourth day shadowing Peter Thomas as NAAOP’s inaugural health policy and advocacy fellow, and I have already witnessed the fruits this fellowship will bring for me and, hopefully, other fellows for years to come.

For 31 years, NAAOP and its committed membership have advocated on behalf of the O&P community, unifying our advocacy and policy efforts to benefit patients like me, who at 10 years old did not have a voice in my care. Now, the charge is ready to be handed to the next generation. This fellowship is a critical part in bridging that hand-off, developing future leaders in the O&P field. I’m excited, and honored, to be part of this endeavor.

Thanks to many of you, I will have some transformational experiences packed into 10 short weeks in NAAOP’s national office in Washington, D.C., as well as the opportunity to travel to:

  • Stokosa Prosthetic Clinic, American Prosthetic Institute, Karoub Associates, and Michigan O&P Association in Okemos, MI, hosted by NAAOP board member and past president, Jan Stokosa, with a special kick-off celebration at his home.
  • Children’s Hospital of Atlanta (CHOA) O&P program in Atlanta, GA through the generous support of ABC, with extensive help from Cathy Carter and Steve Fletcher.
  • Hanger Clinic’s headquarters in Austin, TX, hosted by NAAOP board member Maggie Baumer, where I will be exposed to leading research, outcomes measurement, patient experience, compliance, and the peer visitor program.
  • OPGA in Cedar Falls, IA, hosted by NAAOP board member Todd Eagen.
  • Amputee Coalition’s National Conference in Tucson, AZ, where I will have the opportunity to attend and speak on a panel, hosted by the Amputee Coalition and President Jack Richmond.

Throughout the summer, I will also have the special opportunity to meet the staff and learn the organizational history of the O&P Alliance, including site visits to BOC, ABC, AOPA, and AAOP, as well as NCOPE. Thanks to Ted Kennedy, Jr., I will also have the opportunity to network with other disability interns and learn about the history of the disability rights movement through the American Association of People with Disabilities’ (AAPD) Summer Internship Program. I will also be exposed to countless visits to Capitol Hill, congressional hearings, coalition and think tank meetings, as well as learning state-based and federal public policy.

This line-up is truly incredible. To have such an extensive fellowship program developed in its first year is a testament to the dedication and vision of NAAOP. And it would not be possible without the generous financial commitments from Jan Stokosa, CP, Stokosa Clinic; Todd Eagen, OPGA; Vinit Asar, Hanger; Michael Rayer, Prosthetic Innovations; Claudia Zacharias with BOC; and the very first contributor to the NAAOP fellowship, Dena and George Breece.

I am incredibly grateful to carry the torch as the first NAAOP fellow, to lay a strong foundation for this program. The impact of this fellowship will only continue to multiply for the field, if we choose to invest in the leaders of tomorrow. Thank you for investing in me, and this fellowship for years to come.

In gratitude,
Nicole Ver Kuilen

  • Written by NAAOP

NAAOP Selects Inaugural Fellow: Nicole Ver Kuilen Report on Rehabilitation Trip to China

NAAOP Fellowship Announcement

NAAOP is proud to announce the selection of Nicole Ver Kuilen as NAAOP’s Inaugural Health Policy and Advocacy Fellow for the summer of 2018.  Nicole was selected through a competitive process from a highly qualified pool of applicants.  She begins her Fellowship on May 30th in Washington, D.C. in NAAOP’s national office and will conclude her summer experience on August 8th.

Nicole is a graduate with distinction from the University of Michigan.  She recently completed a 1500 mile triathalon down the coast of California to raise awareness of amputee and prosthetic issues.  She also has extensive academic and work experience in environmental and sustainability issues.  Nicole has a passion for advocacy and O&P policy witnessed by her recent participation in both AOPA’s O&P Policy Forum and the Amputee Coalition’s Washington Fly-In.  Nicole uses a lower limb prosthesis as a result of bone cancer when she was ten years old.

NAAOP’s new fellow will work for the summer in NAAOP’s office, learn about O&P policy and advocacy as well as the broader rehabilitation and disability field.  She will visit a number of O&P organizations including the Academy, ABC, BOC, AOPA, and the Amputee Coalition.  Field trips to several cities will expose her to O&P clinical practice, the business of O&P, and state-based policy and advocacy.  She will also work with coalitions in Washington and advocate directly on behalf of O&P patients and the providers who serve them.

China Visit Illuminates O&P Capacity

On a recent trip to China with a U.S. State Department delegation, Peter Thomas, NAAOP General Counsel, had an opportunity to present to the China Disabled Persons Federation information on the U.S. rehabilitation system, including orthotics and prosthetics.  A site visit of a rehabilitation hospital and its O&P clinical department revealed significant similarities and differences in the care provided in these two countries.  Consistent with the World Health Organization’s Rehabilitation 2030, A Call to Action, and the Convention for the Rights of Persons with Disabilities (CRPD), China has prioritized rehabilitation of persons with disabilities.

The are many opportunities for collaboration between the two counties on these issues in the future and NAAOP will consider its role as follow up discussions develop.

  • Written by NAAOP

NAAOP Selects Inaugural Fellow for 2018

The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) is pleased to announce the selection of Nicole Ver Kuilen as the recipient of the inaugural NAAOP Fellowship. “We are thrilled to have Nicole as our first NAAOP Fellow,” said NAAOP President, David McGill, noting that “the entire applicant pool for the NAAOP Fellowship was incredibly strong.”

The 2018 Fellowship is a 10-week program based in Washington D.C. As the NAAOP Fellow, Ver Kuilen will learn about orthotic and prosthetic policy, advocacy, and how NAAOP and other O&P organizations function on behalf of O&P and within the broader rehabilitation/disability policy and advocacy community at both the federal and state levels. NAAOP General Counsel Peter Thomas noted that “Nicole distinguished herself among several superlative candidates for this inaugural NAAOP Fellowship. We only wish we could have accepted all the candidates and hope an expanded Fellowship program in the future will make room for these and other highly qualified individuals.”

Ver Kuilen lost her leg to bone cancer at age 10. She recently completed a 1,500-mile triathlon down the Pacific coast to raise awareness about challenges amputees have accessing appropriate prostheses. She filmed a documentary about her journey and has taken her message to D.C., educating policymakers about these issues. Ver Kuilen graduated with High Distinction from the University of Michigan Ross School of Business in 2013. She has worked at the Clean Energy Coalition, a nonprofit consulting firm in Ann Arbor, Michigan, and also served as Assistant Director for the University of Michigan School for Environment and Sustainability.

When told of her selection as the inaugural NAAOP Fellow, Nicole said, “I am honored to be selected as NAAOP’s inaugural health policy and advocacy fellow. In the 16 years I’ve been an amputee, I’ve realized our amputee community is systematically being denied the appropriate technology and care we need to live our best lives; this isn’t right. I believe, through our collective efforts, we can create the largest movement in America for mobility rights.”

George Breece, NAAOP Executive Director said, “Nicole was the top selection for each of our Fellowship Committee members. She embodies what the next generation of O&P advocates will be. After her Fellowship experience, we believe Nicole will be an even greater O&P advocate and we know we will be a better organization because she was our inaugural NAAOP Fellow.”

For more information contact:
George Breece, NAAOP Executive Director
georgebreece@naaop.org or 910 583 2161

  • Written by NAAOP

NEWS FLASH: Injured and Amputee Veterans Bill of Rights (H.R. 2322) gets a US House Veterans Affairs Committee Hearing

On Tuesday, April 17th, the House Veterans Affairs Health Subcommittee held a hearing to discuss several pieces of VA legislation.  One of the bills was H.R. 2322, the Injured and Amputee Veterans Bill of Rights.  The VA Bill of Rights is bipartisan legislation introduced by Congressman Tim Walberg (R-MI).  See Congressman Walberg’s statement before the Subcommittee at www.naaop.org.

The same bill passed in 2010 in the House but the Senate did not act.  The bill has since been reintroduced several times but recently, the bill took on much greater importance as the VA announced last fall a proposed regulation that would grant the VA the “sole authority” to determine which prosthetist provides care for each veteran, changing over five decades of VA patient choice.

NAAOP has spearheaded this legislation since Tom Guth, C.P., served as President of the organization.  All of the O&P Alliance organizations (AOPA, AAOP, ABC, and BOC) support passage of the bill, as does the Amputee Coalition.  In fact, the hearing coincided with the Amputee Coalition’s Capitol Hill fly-in and several amputees were front and center in the hearing room during the committee’s deliberations on the bill.

In addition, the Wounded Warrior Project and the Paralyzed Veterans of America support H.R. 2322.  The Disabled American Veterans have not taken a position and the Independence Fund is supportive but offered minor amendments to the bill in their written testimony.  The Veterans of Foreign Wars and The American Legion submitted written testimony opposing the legislation but after outreach from NAAOP before the hearing, both organizations were more conciliatory toward the bill in their oral remarks.  NAAOP will continue its follow up with these organizations to ultimately seek their support.

The next step is to continue working with Congressman Walberg and his able staffer, Mac McKinney, to seek a mark-up of H.R. 2322 in the VA Health Subcommittee.  During the hearing, both the Chairman of the Health Subcommittee, Congressman Wenstrup (R-OH), and the Chairman of the full VA Committee, Congressman Roe (R-TN), spoke favorably about the bill.  In fact, Chairman Roe mentioned that he had recently become aware of H.R. 2322 at a VA field hearing in Fayetteville, North Carolina, home to both Fort Bragg and George Breece, NAAOP’s Executive Director, who attended the field hearing.  This bodes well for the future of this legislation in the House.  And then, on to the Senate……

  • Written by NAAOP

O&P Policy Roundup

Victory on Diabetic Foot Orthoses:

March witnesses a decision from the Center for Medicare and Medicaid Services (CMS) to retain the same reimbursement level for diabetic foot orthoses that are digitally scanned and fabricated through additive manufacturing as foot orthoses that are physically molded to a patient model.  This is a major decision that sets a very positive precedent for more than twenty other orthotic L-codes where technology has permitted these new manufacturing techniques to replace traditional fabrication methods.  The decision relies on the following explanation:  “The fees for code K0903 are set based on the fees for code A5513 because inserts carved from a digitized scan of the patient’s foot were determined to be comparable to inserts made over a positive model of the patient’s foot.”  A5513 is the existing billing code for diabetic foot orthoses using traditional methods whereas K0903 is the newly-established billing code for diabetic foot orthoses that are manufactured using digital scanning technology.

This positive conclusion resulted from coordinated and proactive efforts by a number of O&P organizations including AOPA, the O&P Alliance organizations, the Amputee Coalition and the American Podiatric Medical Association.  NAAOP was pleased to have participated in these efforts and believes the decision bodes well for future coding and payment decisions involving innovative manufacturing techniques used in the O&P field.

Omnibus Spending Bill Omits Healthcare Provisions:

The O&P Policy Forum hosted by AOPA was well timed this year as Congress prepared to pass an Omnibus Spending bill to fund the federal government through the end of Fiscal Year 2018.  NAAOP joined over 100 members of the O&P community in sending a strong message to Capitol Hill to include in that bill two major provisions, implementation of BIPA Section 427 which links Medicare payment with O&P practitioner qualifications, and clarification of the term “minimal self-adjustment” which defines off-the-shelf orthotics that are subject to competitive bidding.

The $1.3 trillion bill finally passed and was signed into law on March 23rd.  Many health care organizations worked hard during February and March to include a wide variety of health care provisions in this legislative vehicle.  The O&P community was one of them.  In the end, Congress could not agree to include a bipartisan bill to stabilize the Affordable Care Act’s individual insurance markets and, once this provision of the bill was not included, virtually all of the other health care provisions were also omitted from the bill.  The O&P provisions were left out of the bill along with dozens of other non-O&P healthcare provisions that were under consideration by Congress.  NAAOP will continue working with its Alliance partners to eventually pass these provisions, hopefully in the next legislative vehicle that addresses health care issues.

  • Written by NAAOP

NAAOP Announces Unique Public Policy
and Advocacy Fellowship

ATTENTION ALL O&P CONSUMERS:  The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is soliciting applications for its inaugural health policy/advocacy fellowship. NAAOP is a national nonprofit association advocating for consumers/patients requiring orthotic and prosthetic care, as well as the providers who serve them.  The NAAOP Fellowship is a paid, 10-week summer program based in Washington, D.C.  The fellow will learn about orthotic and prosthetic (O&P) policy, advocacy, and how NAAOP and other O&P organizations function on behalf of the O&P community and within the broader rehabilitation and disability policy and advocacy community at the federal and state level.  The fellowship also includes exposure to (1) O&P clinical and business settings, and (2) state-based public policy and advocacy at no cost to the fellow.

One fellow will be selected for the summer of 2018 through a competitive process using the application on the www.naaop.org website.  The deadline to electronically submit this application is March 31, 2018 by 12:00 Midnight.  Three finalists will be interviewed via videoconference and one will be selected.  If the finalist selected cannot accept the fellowship for any reason, the next highest ranked fellow will be offered the position.

Selection CriteriaAll applicants must:

  • Personally use a custom fabricated orthosis or prosthesis;
  • Have an interest in public/health policy and advocacy;
  • Demonstrate an interest in advancing O&P care;
  • Have excellent writing, speaking, and analytical skills (see application for additional factors).

The NAAOP Fellow will receive a stipend of $500 per week.  NAAOP will provide the fellow with an office, phone, and computer in its offices at NAAOP’s counsel, the Powers Law Firm, 1501 M Street, NW, Washington, DC 20005.  NAAOP will assist the fellow in exploring inexpensive summer housing options with area colleges for those with no other housing options.  The NAAOP Fellow will be responsible for his/her housing costs.

The NAAOP Fellow will shadow NAAOP’s General Counsel, Peter Thomas, who will assign and oversee the fellow’s health policy and advocacy work.  That work will focus on O&P policy but also include exposure to the broader rehabilitation and disability policy environment.  Other O&P organizations will host the fellow for a day of activities.  The fellow will also be exposed to policy and advocacy speakers, attendance at Congressional hearings, participation in coalition and “think tank” meetings/presentations throughout Washington, and meetings with organizations in the broader rehabilitation and disability field.

Application Deadline:  12:00 Midnight, Saturday, March 31, 2018

Fellowship Selection Announcement:  By the end of April, 2018

Fellowship Term:  10-weeks (late May or early June through early to mid-August)

  • Written by NAAOP