The “Mobility Saves” Study Published in Peer-Reviewed Journal

The study that started the “Mobility Saves” movement has now been published in a peer-reviewed journal. The recent Military Medicine Supplement published the study: “Economic Value of Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study”

Military Medicine is the official journal publication of the Association of Military Surgeons of the United States (AMSUS), and this edition arises in conjunction with the topics covered at the December annual meeting of AMSUS.

This study demonstrates, using four years of Medicare data, that timely O&P intervention saves payers’ money.  Dr. Allen Dobson, the author of this research, presented his work at the AMSUS meeting, and the attached manuscript will make this work widely available for citation for use by payers (including both Medicare and private sector providers), and others to show the value of O&P care (page 18).

This edition also includes the manuscript developed by a Multi-Disciplinary Task Force headed by John Fisk, M.D., with physician representatives from both physical medicine and rehabilitation, and orthopedic surgery, a physical therapist, and certified O&P professionals around key issues on the orthotic treatment team, distinctions between off the shelf (OTS) and customized orthotics, the importance of the orthotist’s notes and records, and other key clinical issues (page 11).  This publication is particularly timely in establishing this valuable consensus viewpoint at a time when orthotic care, and its reimbursement are attracting greater attention and scrutiny.

There are also several reasons why we are especially pleased to see both of these articles appearing in Military Medicine.  This journal is a peer-reviewed medical journal, listed in the Index Medicus, which conveys substantial credibility for these papers, placing it in the top tier for purposes of medical citations, and because of the importance of topics covered in this journal to Congressional Appropriations and Department of Defense matters, Military Medicine is circulated to all Congressional Offices, giving these messages great reach to our lawmakers.

Access the articles online.

‘Bionic spinal cord’ aims to move robotic limbs with power of thought

An exoskeleton prototype used for neuro-motor rehabilitation. IMAGE: BSIP/UIG VIA GETTY IMAGES
Australian scientists hope a device about the size of a matchstick will one day help people with spinal cord injuries get back on their feet.The device, a stent-electrode recording array or stentrode, could allow patients to control powered body armour, known as exoskeletons, or bionic limbs using only their thoughts, researchers announced Tuesday at the University of Melbourne.The stentrode will be implanted in a blood vessel that sits over the brain, and will turn brain signals into electrical commands that could wirelessly move the exterior mechanical technology. Currently, most exoskeletons are controlled by a joystick that is operated manually.

A collaboration between the Royal Melbourne Hospital, the Florey Institute of Neuroscience and Mental Health and the University of Melbourne, the findings were published Tuesday in the journal, Nature Biotechnology.


The stentrode device went through hundreds of design changes before researchers were satisfied it met their requirements of being light, flexible, bio-compatible and small enough to be threaded into a one millimetre blood vessel.


Speaking at a press conference Tuesday, Thomas Oxley, a neurologist at the Royal Melbourne Hospital, said the project began when he had the idea that thought control of bionic limbs could be achieved without implanting a device through open brain surgery.

Preclinical studies have shown that by putting the stentrode in a blood vessel near the motor cortex, a key control centre for the brain, you can get the same recording as people previously obtained by surgically inserting something directly into the brain. He proposed that, using the stentrode, patients will one day be able to control mechanical limbs with their thoughts.

“The idea is the device is much less invasive than previous attempts at doing this and can be implanted longterm,” said Terry O’Brien, head of medicine at the Departments of Medicine and Neurology, the Royal Melbourne Hospital and University of Melbourne. “There is no clinical device that does this at the moment.”


The stentrode can record brain signals from within a blood vessel next to the brain. These thoughts are captured, decoded and passed wirelessly through the skin to enable control of an exoskeleton.

It could also have applications far beyond assisting those with paralysis, he added. The stentrode could be used to record brain waves for those with conditions such as epilepsy, helping to predict when they are about to have an attack. “The applications are incredibly broad, and that’s what makes it so exciting,” O’Brien said.

The device, which has so far been tested on sheep, will undergo its first human trials in 2017. According to a statement from the University of Melbourne, patients will have to, in many ways, learn to walk and stand again by getting familiar with “coding” the signals to their exoskeleton. “With our device, you’ve essentially connected an electronic limb to the patient’s brain, but they have to learn how to use it,” Oxley said, according to the statement.

Nick Opie, a biomedical engineer at the University of Melbourne, told reporters the team hoped the cost of the device, after it has undergone human testing and is ready for market, would be similar to the cochlear implant — around A$15,000 (US$10,567) to A$20,000 (US$14,089). They predict it will be ready by 2022.

It is also hoped the stentrode will be as important to medicine as the cochlear implant, which was invented in Australia. “What cochlear implants have done for hearing, we want to do for mobility,” Opie said.

Interest in bionic limb and exoskeleton technology has been developing rapidly in recent years. Earlier in February, SuitX announced a new Phoenix exoskeleton that aims to replicate human gait.

Female leg amputee becomes the first to complete thru-hike of the Appalachian trail

CMS Issues Final Rule on Medicare Prior Authorization for Certain DMEPOS Including Most Lower Limb Prostheses

On December 29th, the Centers for Medicare and Medicaid Services (CMS) released the long anticipated final rule regarding Medicare prior authorization of certain DMEPOS, including most lower limb prostheses.  The final rule, which will be published in the December 30, 2015 Federal Register, will be implemented 60 days after it publication. AOPA has reviewed the final rule, and offers the following preliminary thoughts and comments regarding the provisions of the final rule. AOPA’s primary concern with prior authorization of prostheses is, and always has been, that it will critically delay timely access to the provision of prosthetic devices that are crucial to the rehabilitation needs of Medicare beneficiaries.  In the final rule, CMS acknowledged that proper access to medically necessary care is of the utmost importance, but indicated that it will use sub-regulatory processes to determine appropriate timelines for making prior authorization decisions.  These sub-regulatory processes are inherently arbitrary in that they do not allow for public input and or comment regarding their appropriateness.  AOPA remains concerned that prior authorization of any kind will only serve to hinder the delivery of medically necessary prosthetic care within reasonable timeframes. Another concern that AOPA expressed in its comments on the proposed rule that was not sufficiently addressed in the final rule is that prior authorization does not equate to a guarantee of claim payment nor does it eliminate the exposure of the claim to additional audits.  While the final rule states that an affirmative prior authorization decision indicates that the required documentation for claim payment is present, it also reiterates that it is not an initial claim determination and the claim may ultimately be denied for technical reasons such as invalid proof of delivery documentation. AOPA met with representatives from the Office of Management and Budget (OMB) in August while they were reviewing the proposed rule and registered concerns about the above issues. The few seeming new wrinkles in the final rule is that implementation will not be immediate and universal, but there will be a Master List of 135 HCPCS codes eligible for inclusion in prior authorization.  It appears there will a phase-in process, meaning not all 135 codes will be subject to prior authorization immediately.  Rather, the final rule indicates that CMS will establish a subset of the master list that will determine which HCPCS codes require prior authorization as part of the initial implementation of the final rule.  While the master list includes lower limb prosthetic HCPCS codes that meet or exceed the $1,000 threshold, it remains to be seen which codes will be included in the initial list of codes that will be subject to prior authorization. While the current list does not include any orthotic codes, AOPA remains concerned that future updates to the master list may include orthotic codes that meet the criteria for inclusion in prior authorization. At first glance, the final rule does not recognize two key facts from Medicare’s own data:

  1. There is not a problem of unnecessary utilization of lower limb prosthetics, and the -14{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} reduction in prosthetics payments over the 2010-13 period proves that;
  2. Today, Medicare prosthetic patients are 35{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} LESS LIKELY to receive an advanced tech prosthetic device than they were just 5 years ago (2005-2009).

In addition, the final rule acknowledges AOPA’s concern regarding the need for a more timely response to prior authorization requests but elects to define these timeframes through sub regulatory processes that do not allow for public comment or input. While AOPA will review the final rule more closely in the coming days, After its preliminary review,  AOPA believes that the final rule fails to address AOPA’s concerns regarding the implementation of a prior authorization program that:

  1. Does not appear to constitute a guarantee of payment; and
  2. Retains the payment threshold of $1,000 for inclusion in prior authorization
  3. Does not assure that providers would not be subject to post-payment/RAC audits on the very same issue of medical necessity; and
  4. Uses sub-regulatory processes to define appropriate timeframes for response to prior authorization requests; and
  5. Exceeds its authority to initiate a limited pilot on prior authorization, done only in selected areas (as was done with power mobility devices) to a national policy impacting all amputee beneficiaries nationwide.

AOPA will provide additional analysis of the final rule as it becomes available.

Medicare Spending on Prosthetics

What has happened to Medicare’s Spending on Prosthetics since 2010?

AOPA has analyzed the data, and the picture is clear. Medicare spent 15{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} less in 2014 than in 2010 on prosthetics.

Medicare spending on advanced prosthetics has trended down 40{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}, while spending on older technologies has trended up – 35{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}. Overall spending has decreased by 14{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} since 2010.2010-2014 medicare data

Year All Prosthetic Spending Year All Prosthetic Spending
2005 $607,797,189 2010 $770,462,739
2006 $628,220,869 2011 $756,265,554
2007 $676,421,628 2012 $710,599,456
2008 $704,604,327 2013 $664,405,441
2009 $753,410,033 2014  $662,585,471


Medicare Spending has INCREASED on antiquated prosthetics and DECREASED on Newer Technologies.

2014 medicare data technolgy

2010 2011 2012 2013 2014 Total {cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} Change  2010-2014
K3 & K4 Feet $90,386,136 $87,863,510 $80,780,898 $61,078,042 $57,205,529 -41.6{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}
K1 & K2 Feet $3,123,856 $3,385,101 $3,815,199 $4,540,293 $4,98,3348 49.9{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}


 glass ceiling medicare  spending since 2010

Data, Hard Work, and Unified O&P/Amputee Community Response Yield PARTIAL WIN on Troublesome, Draft LCD for Lower Limb Prosthetics

The White House just announced that CMS “will not finalize” the July 16, 2015 Draft LCD. That may be clarified further when comparable announcement text from both CMS and from the DME MACs are released and can be analyzed.  The White House report appears to confirm the information that AOPA shared at the recent San Antonio National Assembly that O&P could be confident that the July 16 proposed LCD for Lower Limb Prosthetics would not be enacted in anything close to its proposed form.

Unfortunately, there are aspects of this document which raise concerns.  The announcement on the CMS website reports that CMS is going to convene “…a multi-disciplinary Lower Limb Prostheses Interagency Workgroup in 2016…the Workgroup will be comprised of clinicians, researchers, policy specialists, and patient advocates from different federal agencies.”

A “working group” that would include both government officials as well as stakeholders from the public would have been more promising.  The immediate concern is that this is NOT a rescission of the Draft LCD.  Some might see this as following a too frequent government step of “kicking the can down the road.”  AOPA, the O&P Alliance, the Amputee Coalition and others had made clear that complete rescission was necessary because the draft was so completely out-of-touch with patient needs AND because there was no scientific data in the medical literature to support the draft. But the medical literature actually supports the present LCD—not a revision and tightening of requirements for beneficiaries to secure a prosthesis.

We recognize and believe it is a positive step that the draft LCD will not be implemented at this time.  However, we continue to believe that the draft LCD should be rescinded by the Medicare Contractors and that CMS should provide patient and provider stakeholders with a meaningful role in the development of future coverage policies for lower limb prostheses.

There is a principle “if it ain’t broke, don’t fix it.”  Prosthetic spend for Medicare has declined for each of the past 4 years, by a total of 14{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} since the 2010 high.  Looks like even though they are shelving the LCD, they want to convene a special committee, presumably to craft either a new, or revised LCD.

The foundation and structure within the current LCD is sound but there is an opportunity to improve upon it; there remains a need to establish recognition of the prosthetist’s notes when considering medical necessity. That issue and similar additional requirements to care require continuing efforts to improve beneficiary access.

So, the announcement is a partial win—it means that we will not see the July 16, 2015 draft LCD enacted in its current form. AOPA urges caution in that beyond a White House email, we will need to take the time to examine carefully what the CMS announcement means, to assess any longer term issues/threats, beyond what appears, the near-term assurance that Medicare amputees will not see the kind of immediate degradation in the quality of prosthetic care that the draft LCD would have enforced on them, at least not in the near-term.

AOPA’s leadership and regulatory specialists will review ALL government and contractor communications as they arise, and provide a further analysis once that in-depth review is complete.

The report at this juncture would not be complete without acknowledging with appreciation the hard work of amputees and their O&P providers who supported AOPA, the O&P Alliance and the Amputee Coalition in the all-out effort to stop this LCD from reverting amputees to a 1970’s standard of care.

Read the White House statement.

United Health Care Stops Covering Vacuum Pumps

The Lower Limb LCD Policy Proposal, despite being just a draft proposal, is now being felt in the private sector: United Health Care has now deemed vacuum pumps as not medically necessary, effective October 1, 2015. Read the policy now.

AOPA is pursuing a two part strategy: (a) AOPA partnered with a congressional representative in UHC’s state, who contacted UHC requesting that they set up a high level meeting with AOPA reps; and (b) AOPA is joining in a letter of objection to the policy from the O&P Alliance, together with the Amputee Coalition, due for release this week, challenging the assertion that there is no scientific evidence to support this treatment, and seeking a meeting with UHC’s Medical Director.  We believe the results can be additive and symbiotic, not divisive, in bringing attention to the problem from multiple directions.

We promise to continue to keep you posted on the UHC issues, but we have also received an early indication about another mischievous outgrowth of the commercial sector jumping on the draft LCD as an opportunity for cutbacks–this time from one of the state BCBS plans.  We are waiting to see documentation, but if this proves correct, we will again communicate with the insurer AND communicate to CMS (as we did when the UHC policy first arose) underscoring yet again the need for a quick decision to rescind the draft LCD. Read this news article published in the Minnesota Star Tribune.

Obama White House Disappoints With Interim Response to “We the People” Petition on LCD

Over 100,000 people took President Obama at his word when they shared their names, email addresses and trust in/commitment to government, signing on in 17 days to surpass the 100,000 signatures required to prompt direct White House intervention and action on the draft lower prosthetic LCD. Others were skeptical, seeing the ‘We the People’ process as 90{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} public relations and only 10{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368} substance. Well, the first response from the White House did nothing to dissuade the PR skeptics.

On Friday evening that report did not represent any action by the White Hiouse on the petition as had been promised. Rather, it did precisely what the President frequently criticizes Congress for doing–the White House report simply kicks the can down the road. It engages in a pious promise to eventually do what’s right, without giving either a hint of what the substantive action might entail, or when a final substantive decision will be rendered.

The interim We the People report came:
* exactly 3 months after the LCD was released as a proposal;
* exactly 60 days after the 100,000th signature on the White House petition;
* exactly 50 days after the DME MAC public meeting, the amputee rally at HHS HQ, and the date when top CMS and HHS senior officials met with O&P stakeholder representatives and promised a prompt, fair solution that would assure that all Medicare amputees will receive appropriate replacement limbs;
* it occurs 15 days after the first of an expected stream of commercial payers began embracing this very deficient draft as if gospel, as a premise to invoke the misguided draft’s content as an excuse to cut costs, ramp up profits, and downgrade amputee care. That’s too long! Inaction and failure to rescind this deficient policy now allows it to disenfranchise amputees, sadly in the year when the Administration touted the 25th anniversary of the Americans with Disabilities Act!

While we remain confident that the final resolution of this draft LCD will be a favorable one for the O&P professional and the patients we serve, the question remains… Is the ‘We the People’ promise merely PR fluff, or will it ultimately proves more substantive? Whichever, it clearly does not reflect timely, fairness and responsiveness. Read the response below:

An initial response to your petition on a Medicare local coverage determination:

Thanks for using We the People, and for sharing your concerns about the local coverage determination for lower limb prostheses proposed by Medicare contractors. In order to get the most up-to-date information concerning your petition, we’ve gone to the Department of Health and Human Services (HHS) — specifically, the Centers for Medicare and Medicaid Services (CMS), and the Administration for Community Living (ACL).

You can learn more about LCDs and how they’re determined here.

The coverage determination process is still ongoing, but CMS wants to make clear that they’re committed to providing high quality care to all Medicare beneficiaries. They also wanted to make sure you know that HHS has met with stakeholders on this important issue, and both CMS and its contractors understand the questions that have been raised about access to the right prosthetic care — including related technologies — for Medicare beneficiaries.

We will be in touch with another update.

–The We the People Team

 See the petition and response on the “We the People” website.

CMS’ Own Data Refutes Need for LCD Policy Change

The Data Doesn’t Lie

Medicare Data Shows That:

  1. The 2011 OIG Report, Dear Physician Letter, and RAC Audits, misread an upward trend in prosthetic spending that had already reversed*;
  1. For better or worse, Medicare has practiced medicine and changed the prevailing standard of amputee care for the worse; and
  1. They appear to be completely oblivious to the last 4 years of Medicare’s own data—2010-13 proves that 2005-10 data is outdated and the real picture is a 180 degree reversal of direction—dramatic reversion to less effective, cheaper technologies of 1970s in proposed LCDs would make decline in Medicare quality of amputee patient care that much worse

all prosthetic servcies

k1 and k2

k3 knees
*OIG Report missed that the 2005-10 increases reflected initial private sector availability of quantum leap in technology stemming from Iraq/Afghanistan, federally funded research to improve amputee care. The data proves that related cost increases for 2005-10 had already started to decline before OIG, “Dear Physician and RACs drove down quality of care to try to reduce Medicare expenditures that unbeknownst to them had already started to fall.

Copyright, 2015, American Orthotic and Prosthetic Association. All Rights Reserved.

See all the Media Attention from the Lower Limb LCD Policy and the Rally at HHS

Major stories

  1. Associated Press (as appearing on banner picture
  2. Wall Street Journal
  3. CNN 
  4. The Washington Post 
  5. Read AOPA President Charlie Dankmeyer, Jr., CPO’s Opinion Editorial on the LCD Draft in the  Washington Times 
  6. Associations Now feature on AOPA

AOPA’s Rally footage

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  189. New Mobility magazine –
  190. Healio –{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}7B102d17e5-aa53-40c5-b49a-f0c793be46a3{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}7D/aopa-amputee-coalition-share-impact-of-proposed-lcd-on-amputees
  191. Healio (story #2) –{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}7Be58eb054-a66d-429c-8e9a-3d65954b433b{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}7D/limb-loss-community-speaks-out-against-lcd-proposal-at-open-comment-meeting
  192. O&P magazine –
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  195. National Center for Public Policy Research blog –
  196. Strategic Health Care Weekly e-Bulletin –
  197. WUSA TV/Washington DC –
  198. WFXT TV/Boston, MA –
  199. WHDH TV/Boston, MA –
  200. KVVU TV/Las Vegas –
  201. WSB TV/Atlanta, GA –
  202. KIRO TV/Seattle, WA –
  203. KPTV/Portland, OR –
  204. WTHR TV/Indianapolis, IN –
  205. KPHO TV/Phoenix, AZ –
  206. KLKN TV/Lincoln, NE –
  207. KUSI TV/San Diego, CA –
  208. KCTV/Kansas City, MO –
  209. WPXI TV/Pittsburgh, PA –
  210. WSMV TV/Nashville, TN –
  211. WLWC TV/Providence, RI –
  212. WCSC TV/Charleston, SC –
  213. KGMB TV/Honolulu, HI –
  214. KMPH TV/Fresno, CA –
  215. WAVE TV/Louisville, KY –
  216. WDRB TV/Louisville, KY –
  217. WLEX TV/Lexington, KY –
  218. WBBH TV/Fort Myers, FL –
  219. WHBQ TV/Memphis, TN –
  220. WJAX TV/Jacksonville, FL –
  221. WOKV TV/Jacksonville, FL –
  222. WRAL TV/Raleigh, NC –
  223. WISH TV/Indianapolis, IN –
  224. WOWK TV/Charleston, WV –
  225. WSOC TV/Charlotte, NC –
  226. WCMH TV/Columbus, OH –
  227. KXAN TV/Austin, TX –
  228. WRIC TV/Richmond, VA –
  229. WWBT TV/Richmond, VA –
  230. WTVR TV Richmond VA –{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}206{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}20richmond
  231. WGNO TV/Metairie & New Orleans  –
  232. WKMG TV/Orlando, FL –
  233. WKBW TV/Buffalo, NY –
  234. WDBJ TV/Roanoke, VA –
  235. WWLP TV/Springfield, MA –
  236. ABC15 TV/Phoenix, AZ –
  237. WXYZ TV/Detroit, MI –
  238. KSHB TV/Kansas City, KS –
  239. 10News TV/San Diego, CA –
  240. WMAR TV/Baltimore, MD –
  241. WCPO TV/Cincinnati, OH –
  242. WRTV TV/Indianapolis, IN –
  243. ABC Action News/Tampa Bay, FL –
  244. Good Morning Chattanooga, ABC –
  245. KERO 23 TV/Bakersfield, CA –
  246. WISC TV/Madison, WI –
  247. WBAY TV/Green Bay, WI –
  248. WAVY TV/Portsmouth, VA –
  249. WTEN TV/Albany, NY –
  250. WHEC TV/Rochester, NY –
  251. KTBS TV/Shreveport, LA –
  252. WCAX TV/Burlington, VT –
  253. WHIO TV/Dayton, OH –
  254. WDTN TV/Dayton OH –
  255. Fox 8 TV/High Point NC –
  256. WPSD TV/Paducah KY –
  257. KTUL TV/Tulsa, OK –
  258. WPTZ TV/Plattsburgh, NY –
  259. WKRG TV/Mobile, AL –
  260. KHGI TV/Kearney, NE –
  261. WJHL TV/Johnson City, TN –
  262. WRBL TV/Columbus, GA –
  263. WRBL TV/Columbus GA –
  264. KXLH TV/Helena, MT –
  265. KTRV TV/Great Falls, MT –
  266. WHIZ TV/Zanesville, OH –
  267. WVVA TV/Bluefield, WV –
  268. KSWO TV/Lawton, OK –
  269. KIII TV/Corpus Christi, TX –
  270. KRIS TV/Corpus Christi, TX –
  271. KZTV/Corpus Christi, TX –
  272. WBMA TV/Birmingham, AL –
  273. WSJV TV/South Bend, IN –
  274. WHNS TV/Greenville, SC –
  275. WSET TV/Lynchburg, VA –
  276. WWTV/Cadillac, MI –
  277. KTTC TV/Rochester, MN –
  278. WKOW TV/Madison, WI –
  279. WTOL TV/Toledo, OH –
  280. WBOC TV/Salisbury, MD –
  281. KNDO TV/Yakima, WA –
  282. KWWL TV/Waterloo, IA –
  283. KWES TV/Odessa, TX –
  284. WQOW TV/Eau Claire, WI –
  285. WVIR TV/Charlottesville, VA –
  286. KTUL TV/Tulsa, OK –
  287. WSFA TV/Montgomery, AL –
  288. KFDA TV/Amarillo, TX –
  289. WAFF TV/Huntsville, AL –
  290. WREX TV/Rockford, IL –
  291. KOKI TV/Tulsa, OK –
  292. KTIV TV/Sioux City, IA –
  293. WVNS TV/Lewisburg, WV –
  294. WGGB TV/Springfield, MA –
  295. KBMT TV/Beaumont, TX –
  296. WAOW TV/Wausau, WI –
  297. KTMF TV/Missoula, MT –
  298. WXOW TV/La Crosse, WI –
  299. WFMJ TV/Youngstown, OH –
  300. WDAM TV/Laurel, MS –
  301. KXMC TV/Minot, ND –
  302. KAUZ TV/Wichita Falls, TX –
  303. WTOP AM/Federal News Radio/Washington DC –
  304. KLBJ FM/Austin, TX –
  305. Cybercast News Service –
  306. Salem Radio Network –
  307. WDBO FM/Orlando, FL –
  308. KSL AM/Salt Lake City, UT –
  309. KXRA FM/Alexandria, MN –
  310. WTN Talk Radio/Nashville, TN –
  311. KMJ Talk Radio/Fresno, CA –
  312. KKOH Talk Radio/Reno, NV –
  313. WVNN Radio/Athens, AL –
  314. Newsday (Long Island, NY) –
  315. Arizona Daily Sun (Flagstaff, AZ) –
  316. Aiken (SC) standard –
  317. Akron (OH) Beacon Journal –
  318. Waterbury (CT) Republican-American –
  319. Naples (FL) Herald –
  320. Modesto (CA) Bee –
  321. Napa Valley (CA) Register –
  322. Jackson Hole (WY) News & Guide –
  323. News Tribune (Tacoma, WA) –
  324. Stamford (CT) Advocate –
  325. Lockport (NY) Union-Sun & Journal –
  326. The Pantagraph (Bloomington-Normal, IL) –
  327. Marietta (GA) Daily Journal –{cd9c44e368fb6cee2d09ae9816b0d094fbe47d90389af7031507558183226368}20&id=26828469
  328. Cherokee (GA) Tribune –
  329. Tri-City Herald (Kennewick, WA) –
  330. East Oregonian (Pendleton, OR) –
  331. Norwich (CT) Bulletin –
  332. Independent Record (Helena, MT) –
  333. Imperial Valley (CA) Press –
  334. Observer–Reporter (Washington, PA) –
  335. Pharos-Tribune (Logansport, IN) –
  336. Oswego (NY) Palladium-Times –
  337. Columbus (NE) Telegraph –
  338. Star Democrat (Easton, MD) –
  339. Joseph (MO) News-Press –
  340. Post-Star (Glen Falls, NY) –
  341. Quincy (IL) Herald-Whig –
  342. The Herald (Rock Hill, SC) –
  343. Seymour (IN) Tribune ––Medicare-Artificial-Feet
  344. Greenfield (IN) Reporter ––Medicare-Artificial-Feet
  345. Artesia (NM) Daily Press –
  346. Ledger-Enquirer (Columbus, GA) –
  347. Wayne (PA) Independent –
  348. Beatrice (NE) Daily Sun –
  349. Bradford (PA) Era –
  350. WVUE-TV (New Orleans, LA) –
  351. WCAV-TV/Charlottesville Newsplex (Charlottesville, VA) –
  352. KOTV (Tulsa, OK) –
  353. WCIV-TV (Charleston, SC) –
  354. KWTV (Oklahoma City, OK) –
  355. WKPT-TV (Kingsport, TN) –
  356. WBRC-TV (Birmingham, AL) –
  357. WLNE-TV (New Bedford, MA) –
  358. KOAA-TV (Pueblo, CO) –
  359. WNEM-TV (Flint/Tri-Cities, MI) –