Reference Guide: Custom Prosthetics and Orthotics in St. Louis

P & O Care Brochure - Upload a Document to Scribd

P & O Care Expands South

Prosthetic and Orthotic Care is growing, and many of its new patients have been coming from areas south of St. Louis, like Washington, Jefferson, St. Genevieve, and Perry Counties. So, this provider of artificial limbs and braces has decided to open a new office across from Jefferson Memorial Hospital at 1479-D US Hwy 61, Festus, MO 63028. The new location will enable P&O Care to better serve its current patients and provide more localized service for rural Missourians who otherwise would have to travel to St. Louis. More accessible care means that patients will take a more proactive role in making sure that their devices fit safely and comfortably, and it increases the likelihood that a patient will actually wear their arm, leg, or brace—or actually fill that doctor’s order for diabetic shoes!

Fully staffed during the work week with certified prosthetists and orthotists, and equipped with a full-service fabrication laboratory, the new facility will be known as P&O’s Jefferson County Care Center. The company will also begin referring to their Missouri and Illinois locations as the St. Louis County Care Center and the St. Clair County Care Center. They will continue to operate their outfitted minivans, known as Mobile Care Units, which prosthetists and orthotists can drive to patient’s homes or nursing homes. From Festus, P&O Care will have better access to outlying towns like Potosi, De Soto, Farmington, St. Genevieve, Chester (IL), and Perryville. They will even go to Cape Girardeau.

Jim Weber, President of P&O Care, says he hopes to have the new facility operational by late July or early August. Until then, his company is willing to go the extra mile, even with gas prices as high as they are, to service the entire region south of St. Louis from their St. Louis County Care Center in Des Peres.

View Larger Map

Congratulations Shawn!

Congratulations to Shawn McAdams, C.P., for passing his board exams and becoming an ABC Certified Orthotist. The American Board for Certification in Prosthetics and Orthotics offers the highest certification in the profession, requiring a four-year bachelors degree, training in the fabrication of prosthetic and orthotic devices, a graduate certificate like the one Shawn earned from Northwestern Medical School in Chicago, and finally a year-long residency each for orthotics and prosthetics.

While most states require professional certification and licensure for doctors, therapists, nurses, and hairdressers, currently only eleven require that prosthetists and orthotists get certified and licensed. Illinois does, but Missouri doesn't. Still, all of P & O Care's practitioners on both sides of the river have graduated from Northwestern University, and our residents work under proper supervision until they pass their boards.

Congressional Action On Durable Medical Equipment Could Jeopardize Patient Care For Amputees And Other Disabled Medicare Beneficiaries

Many Americans, even Medicare beneficiaries, may not be aware that Congress is working hard on revisions to the Medicare law.

Under the Congressional rules, all costs to Medicare involved in delaying competitive bidding on the selling of medical equipment like hospital beds, wheelchairs, and oxygen, will have to come from elsewhere in the Medicare system. A spokesperson for DME suggested in Congressional testimony that there be a broad cut to the Medicare DME fee schedule to pay for the delay on competitive bidding - in essence that DME suppliers, being those who will benefit from the delay in competitive bidding, ought to be the ones to pay for it.

Recently, however, the discussions have taken an alarming turn. DME suppliers are the only ones who would benefit from a delay in competitive bidding, but some are suggesting that other Medicare suppliers should help cover the costs through reductions in their fee schedule, including the orthotic and prosthetic (O&P) field. The consequence of such a proposal would mean fee cuts to patient care facilities that provide care to America's amputees and other disabled individuals. This has prompted grave concerns about access to those O&P facilities providing care and restoring mobility to these patients, many of whom are Medicare beneficiaries.

"Americans have been heartened to see that veterans returning from Iraq and Afghanistan are benefiting from the tremendous improvements that are now available for those who have lost a limb, or have impaired mobility due to limb injuries," said Brad Ruhl, President of the American Orthotic and Prosthetic Association. "This proposed change is incomprehensible... prosthetics and orthotics are NOT included in competitive bidding, and it would be profoundly unfair for Congress to pay for a delay in competitive bidding by reducing Medicare payments to amputees and other disabled seniors, including disabled veterans and disabled children who are well-served under the current O&P fee schedule."**

Ironically, this week hundreds of amputees converge on Washington for an annual legislative day conducted by the Amputee Coalition of America (ACA), and plan to ask members of Congress to enact a prosthetic parity bill to assure that all insurers provide the identical coverage for amputee care that is provided for all other medical and surgical conditions. Some insurers have limited coverage to one replacement limb per life, or very meager amounts on how much they will spend for replacement limbs. It is an anomaly to have some in Congress talking about balancing the budget for what they wish to do to help DME, on the backs of these amputees.

"Orthotics and prosthetics have already gotten the short end in prior fee cuts and freezes, so we have lost significant ground to inflation in recent years," says James Kaiser, CP, LP, of Scheck and Siress, a chain of prosthetic and orthotic patient care facilities in the Midwest. "If there is a new round of Medicare cuts to help pay for this totally unrelated DME competitive bidding delay, the approximately 20% of O&P patient care facilities that are already on the edge will close, severely damaging patient access and choice, and assuring longer delays for these Medicare amputees and other disabled patients at the fewer, more crowded facilities that would remain open to serve them."

AOPA, based in Alexandria, Virginia, is the largest non-profit organization dedicated to helping orthotic and prosthetic businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. The association was founded when needs of returning veterans in the aftermath of World War I required a national organization to address the educational and research requirements of the industry.

**This refers to veterans with non-service connected injuries who are covered by Medicare and disabled children covered under Medicare and Medicaid. In addition, it would affect all private managed care contracts that pay based upon a percentage of the Medicare fee schedule.

Practitioner Profile: Shawn McAdams, ABC Certified Orthotist

Shawn McAdams graduated from Northwestern Medical School’s Orthotics and Prosthetics Practitioner Program in 2005, and he has worked in the field since he became an orthotic and prosthetic technician in 2001. He completed his residency in orthotics with C. H. Martin Co. in Macon, GA before joining the care team at P&O Care in St. Louis, MO, in July 2007.

Shawn got into the P&O field to help people just like himself. "In November of 2000, I fell and broke my back so that I could no longer do a laborers job. Through a vocational rehabilitation program, I was able to get retrained, so I went to school to become an orthotic and prosthetic technician. I knew that I wanted to help people directly with their needs rather than in an indirect way with fabrication, so I went back to school for my bachelors degree and then on to Northwestern University to become a CPO.

"First, I became a technician because I wanted to make the tools for people to have a better life. Then, I became a practitioner because I wanted to see the smiling face of the patient using the tools that I had designed. I like to help people achieve peace of mind. When someone is hurting, they tend to focus on that hurt. If I can help relieve that hurt, then they can focus on other things in life that make them happy and fulfilled."

Knee Brace Could Generate Enough Power for Electronic Prosthetics

Just like a hybrid auto engine generates electricity while a car rolls to a stop, a new knee brace works by creating resistance when the leg stops with each step. Already the prototype can power a cell phone. Later versions may be able to power computerized and motorized prosthetic knees on the opposite leg.

Such knees are already on the market. Otto Bock's C-Leg uses a computer chip to control hydrolic fluid, thus regulating the speed and resistance on a prosthetic knee. A much heavier, bulkier knee, Ossur's Power Knee, has a motor that powers the lower leg and bluetooth chips that pick up signals from the sound leg. The problems with all of these designs are that they need to be plugged in overnight and the batteries add weight and bulk, something many older amputees cannot tolerate.

If hopes for this new power-generating brace work out, it would provide the electricity for these devices so they can become much smaller, lighter, and versatile.

John Lartonoix, ABC Certified Orthotist

John Lartonoix (a French name pronounced Lar-ton-wah) became an ABC Certified Orthotist is 2001. To prepare him for this exciting career, John earned a bachelor degree in Exercise Science from Appalachian State University and an associates degree for Physical Therapy Assistant. Then, he interned with an O&P company in the St.Louis area where he met and worked side by side with Jon Wilson, now P&O Care's Clinical Director.

In 2000, John and Jon both attended Northwestern Medical School's Orthotic Program and often talked about working together in the future. However, after graduating John Lartonoix took a residency in Columbus, Ohio, for Columbus Orthopedic, and Jon Wilson returned to St.Louis to form P&O Care. Columbus Orthopedic was later purchased by the Hanger Corporation and was an extremely respected practice. The office serviced all local hospitals including Children's Hospital and the Ohio State University Hospital.

In his patient care, John says he was lucky enough to be exposed to most aspects of the orthotic field. "I worked closely with several doctors from the Children's Hospital developing a strong pediatric background. In 2006 P&O Care developed a need for a certified Orthotist, and I was looking for new career experiences. After meeting with Jon Wilson and Jim Weber, CEO of P&O Care, I found what I was looking for. P&O Care is a group of wonderful people who make for an amazing team. I see such a variety of patients each day, which allows me to help people in many different ways. Being part of the P&O Care team enables me to do my job with care and pride."

Introducing Shawn McAdams

P&O Care is excited to announce the addition of orthotist Shawn McAdams, who brings warm patient care and highly skilled craftsmanship to our profession. Shawn just completed his residency in orthotics with C. H. Martin Co. in Macon, GA. He graduated from Northwestern Medical School’s Orthotics and Prosthetics Practitioner Program in 2005, and he has worked in the field since he became an orthotic and prosthetic technician in 2001. This December, Shawn will be taking his board exams for ABC certification in orthotics. Until then, he will be supervised in all his patient care by P&O Care’s Lead Orthotist, Dennis Richards, who has been an ABC Certified Orthotist since 2004.

MO Medicaid Re-Instates Payment for Orthotic Devices

The Missouri State Legislature has just re-instated payment for orthotic devices, which it stripped from coverage in 2005 in a rash of cuts to the program. A judge ruled last year that Missouri violated federal law in its arbitrary decisions to cover some devices and not others. Just this week, P & O Care received the new fee schedule from Medicaid, outlining how much they will pay for custom braces, boots and shoes, and other orthotic devices.

In 2005, the Missouri State Legislature was also ready to cut prosthetics from Medicaid coverage, but citizens from across the state called their legislators and P & O Care’s Clinical Director Jon Wilson, CPO, our CEO, Jim Weber, and one of our patients testified before a legislative committee. At the time, the trade journal O&P Almanac reported that it was their testimony that saved prosthetic coverage for Medicaid recipients, but unfortunately orthotic coverage was still stripped.

This decision led to the bizarre situation in which Missouri would pay thousands of dollars for a prosthesis but would not pay a few hundred dollars for a custom boot that could have prevented the amputation. Now two years later, we’re thankful that they’ve finally decided to pay for both.

Jennifer Burget, ABC Certified Orthotist

Before she became an orthotist in 2003, Jennifer Burget, CO, worked as an athletic trainer for SLU’s men’s soccer and basketball teams, as well as Washington University’s football team. After graduating from the physical therapy program at SLU, she worked as the Director of Orthopedics for a local DME company.

To gain more practical experience, Burget moved to Beverly Hills, California to work under one of the best, most well-respected orthotists in the field, Max Lerman of Lerman and Son. In California, Burget was one of two orthotists serving the highly respected Cedars Sinai Hospital.

After gaining priceless experience in Beverly Hills, Jennifer was ready to return to the Midwest. When she met with Jim Weber, CEO of P&O Care, Burget knew she had found the perfect fit. “Since moving to St. Louis, I have joined an amazing team of practitioners,” she says. Jennifer is dedicated to helping others and always strives for a perfect fit.

P&O Care Strengthens Orthotic Team and Promotes Richards

This January, P&O Care Strengthened its orthotic program with the promotion of Dennis Richards to Lead Orthotist.

P&O Care now has three certified orthotists serving patients on both sides of the river: Dennis Richards, Jennifer Burget, and our newest orthotist, John Lartonoix.

"I'm excited about our growth," Richards said. "It will enable us to serve more patients even faster than we have before. By making more braces in-house, we should dramatically reduce our turn-around time."

Richards began working with P&O Care in 2002 as an orthotic technician. In 2003, he graduated in the top five percent of his class from Northwestern Medical School's Orthotist Program. He then completed a residency and clinical training, which focused on TLSO applications for spinal deformities and impression techniques for all types of scoliosis.

Dennis received his ABC certification for orthotics in 2004, and since then has designed several new systems including a popular new custom knee brace.