Pedorthic Newswire Issue #402

February 2, 2011, Issue #402

DISCUSSION

Send your comments, questions, responses, articles or case studies to Pedorthic Newswire at editor@pedorthicnewswire.com. Your emails will be reviewed by pedorthists and the editors of Pedorthic Newswire, and selected submissions will be posted in an upcoming issue for feedback from other readers. We reserve the right to edit submissions and responses. And please note: the deadline for all submissions and responses is 12 noon Eastern Standard Time on Tuesday for that week's issue.

NEW QUESTIONS OR COMMENTS

Question: What compensation method works the best for a C. Ped. employee at a pedorthic retail shoe store? We have typically used a straight salary, with an occasional spiff program to get our staff focused on bringing out specific shoes to show customers. We have been reluctant to use an incentive-heavy compensation plan, as we worry that it could put the C. Ped. in a position of having to weigh their financial benefit when making a recommendation to the customer. We would like our staff to generate additional revenues when appropriate, but not come across like some of our competitors that seem to push the most expensive option only, when a customer is asking for our professional advice to address their need.

- John Mishasek, BOC Pedorthist, C. Ped., john@valshoes.com

PREVIOUS QUESTIONS AND COMMENTS WITH RESPONSES

Question: I wonder if anyone else who files to Medicare with paper claims is having the amount of mini audits we are getting? Everyone I talk to that files electronically has not had the first mini audit from Medicare. We just got two more in the mail today, which takes the total to 27 audits we have received. Out of those, eight have been denied.

The denials coming back are due to the family physician not documenting the conditions in the patient notes. We now get the notes up front, and if the conditions are not documented in their notes, back they go to the primary physician. Then we have to contact the podiatrist to have them write a new RX, because it now has to be dated after the Certifying Physician Form.

So, what does Medicare have in store for us next? And will we be in business long enough to see it?

- Reggie Swickard, LPED

Response: Reading, hearing and experiencing all the hardships that Medicare, "our" Associations and Boards are putting in the C. Peds' way, wants me to ask them to finally just come out with the truth and just admit it:
You don't like the C. Peds or the therapeutic footwear bill, or anything else regarding C. Peds, and because you have not found a way yet to just shut us completely down, you give us the slow death by enforcing new restrictions, fees, bonds, education requirements, accreditation', new certifications and requirements and whatever else that has hit the C. Ped. in the last few years. No other group has been hit that hard. Just get it over with and give us the final thrust.

- A "tired of it" C. Ped.

Response: I have remained silent on the issue of Medicare and the difficulties that suppliers of all types are having with providing TSD benefits, but it is now time to share what has transpired here since we received the June 17, 2010 email blast from CIGNA DMEPOS. In this email, CIGNA informed all Region C suppliers that it would be conducting prepayment audits of TSD claims. That should not be interpreted that all suppliers will have all claims audited before payment, just that CIGNA is putting suppliers on notice that they may not be paid if a prepayment audit of their TSD claims is made and claims fail the audit.

We had already been monitoring how many calls and faxes it was taking our TSD staff to get chart notes (too many) and how many chart notes had all four required elements that would pass an audit (too few).

Within a week, I had reached the tough business decision to terminate our supplier number voluntarily rather than risk non-payment due to inadequate chart notes (or some auditor's interpretation of chart notes) on what was becoming a very low margin transaction due to the amount of staff time being put in to getting chart notes. Add in the PECOS nightmare we were facing due to the large military retirement community here, and the military clinic physicians refusing in mass to sign up with PECOS, add in the physician signature legibility issue, add in the timing of patient visit with PCP and the signing of the Certifying Physician statement, and any new hurdle that would be thrown at TSD suppliers and enough was enough.

So we walked away from 20% of our overall revenues in one fell swoop. Fortunately, we have always had a separate corporation set up as our Medicare supply company, so our retail corporation was able to avoid certain issues after terminating our supplier number. Since no other shoe store in our area is a Medicare supplier and the brace shops are doing such an atrocious job of servicing TSD referrals, we offered "our" TSD patients the option of self pay for their shoes and inserts. I had found a MEDICARE form (CMS-1490S) online that appeared to be designed for beneficiaries to get reimbursed directly from the DMEPOS.

Given the choice of going to a brace shop with no inventory for proper fitting and long delays in ordering in shoes that did not fit, a percentage of our TSD clients elected to try the CMS-1490S method of getting reimbursed. What followed is a mind boggling mistreatment of these beneficiaries by CIGNA DMEPOS and Medicare. Read the rest of this response here.

- John Mishasek, BOC Pedorthist, C. Ped., john@valshoes.com

Response: More than half of the providers we bill for have had at least one Medicare audit, and we file all our claims electronically. It seems like Medicare is quick to deny as soon as you send in the referring physician's office notes; however, you have 60 days from the date of the Medicare denial to appeal. At Rowan Billing Services, we appeal each claim at no extra charge. We are getting a great response from our appeals, and many claims are paying in less than 30 days from the appeal date.

Susan B. Mills, CMRS, Rowan Billing Services, www.rowanbillingservices.com

PREVIOUS QUESTIONS OR COMMENTS WITHOUT RESPONSES

Question: We are getting an increasing number of GPs who are signing both the Diabetic Rx and the Statement of Certifying Physician (SCP) for Therapeutic Shoes for Diabetics (TSD). Up to now, we have been sending two separate documents and requiring two separate signatures. Of course, there is a lot of duplicate writing involved (name, address, diagnosis, etc).

Does anyone have experience with combining these two documents into one demarcated document to improve efficiency for GPs (i.e. on one page but with a line down the middle to show that there is both an Rx and an SCP on the one page)? By experience, I mean have gone through an audit or a pre-payment review and either been successful with such documentation or specifically failed with such documentation? Since logic seems to have little to do with the TSD, I am really intent on hearing from people who have been tested through an audit. If you want to respond directly, please e-mail me at brett.richey@richeyco.com.

Many thanks.

- Brett Richey

SPONSOR NEWS

HEALTH AND INDUSTRY

AAFA Applauds Themes of State of the Union Address

The American Apparel & Footwear Association (AAFA) welcomed remarks by President Barack Obama during his State of the Union Address outlining his goals to continue rebuilding the U.S. economy, promoting U.S. competitiveness around the world, and creating jobs.

"I applaud President Obama's laudable goals to grow our economy and enhance our ability to compete in the global marketplace," said AAFA President and CEO Kevin M. Burke. "I am encouraged by the President's effort to complete the long-awaited free trade agreement between the United States and South Korea. U.S. apparel and footwear industry workers and hardworking American families stand to benefit from these meaningful market opening agreements, not just with the Korea agreement, but also with the pending free trade agreements with Colombia and Panama." Full Text

Source: fibre2fashion.com

FitFlop Names New CEO

Wellness footwear brand FitFlop has appointed Suzie de Rohan Willner as chief executive officer. She was formerly director of global merchandising retail and head of international headquarters in London for sportswear brand Puma. She has also previously worked at footwear brand Timberland, US casualwear brand Dockers and denim giant Levi Strauss. Full Text

Source:

Eye on Health: Winterize Your Feet

It was a snowy scene across the Tennessee Valley earlier this month. While people bundled up to enjoy the snow and brave the cold weather, Podiatrist Doctor Ira Kraus says its important not to forget to protect your feet.

"I think the biggest problems are the simple problems that people are not wearing those gear foot gear and socks to protect themselves from the weather," says Dr. Kraus.Here are some tips...Full Text and Video

Source: WRCBTV.com

State Legislators will Honor Local Busines

A St. James-based business-Forest City Footwear-will be among 18 outstanding small businesses in Missouri honored by members of the General Assembly Jan. 26, at a business showcase in Jefferson City. The event, sponsored by the Missouri Small Business and Technology Development Centers (MO SBTDC) and the Missouri Procurement Technical Assistance Centers (MO PTAC), highlights the achievements of some of the top performing clients of the two programs. Full Text

Source: St. James Leader-Journal

AETREX iSTEP WEBINARS

View our Full February 2011 Webinar Calendar

DIABETES

Report: Shaking Shoes Good for Diabetics

Vibrating insoles can improve balance in patients with stroke or diabetic neuropathy, a common nerve problem that affects sensation in the feet and elsewhere, Boston researchers report. The vibration, adjusted to a sub-sensory level, appears to "tickle" neurons, making them more sensitive to stimuli that are present during standing, Dr James Collins of Boston University, said. Collins and his team had previously shown that sub-sensory mechanical noise delivered to the feet via the insoles could help people maintain better balance. Full Text

Source: The Nation

Abstract: Motivational Interviewing by Podiatric Physicians, A Method for Improving Patient Self-Care of the Diabetic Foot

Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. (J Am Podiatr Med Assoc 101(1): 78-84, 2011)

Source: Journal of the American Podiatric Medical Association

SPORTS AND FITNESS

Effect of Foot Orthoses Contour on Pain Perception in Individuals with Patellofemoral Pain

Thomas G. McPoil, PhD, PT*, Bill Vicenzino, PhD, MSc, BPhty, Grad Dip Sports Phty {dagger} and Mark W. Cornwall, PhD, PT, CPed*

Background: Foot orthoses have been described as a possible intervention for individuals with patellofemoral joint pain. No study has attempted to quantify the perceived comfort and support of foot orthoses when used as an intervention for patellofemoral joint pain.

Methods: A randomized case-control trial with crossover between contoured and flat orthoses was conducted on ten individuals with patellofemoral pain and ten healthy participants. All of the participants completed a comfort-support assessment and had in-shoe plantar pressure data collected before and after 3 weeks of wear. A 1-week washout period was used to minimize any continued treatment effect between orthotics testing. The patellofemoral pain group also completed a numeric rating scale to assess pain reduction after using each orthosis.

Results: All of the participants perceived that greater support was provided by the contoured orthoses in the heel and arch regions. Even with a 30% difference in material hardness between the two orthoses, all of the participants rated cushioning as equivalent. Six individuals in the patellofemoral pain group reported a clinically significant reduction in knee pain as a result of wearing foot orthoses.

Conclusions: A key factor in the selection of contoured foot orthoses versus flat inserts is the amount of support that an individual perceives in the arch and heel regions. In addition, clinicians using foot orthoses as an intervention for patellofemoral pain should expect an individualistic, nonsystematic response. (J Am Podiatr Med Assoc 101(1): 7-16, 2011)

Source: Journal of the American Podiatric Medical Association

BECOMING CERTIFIED IN PEDORTHICS

Pedorthics is a professional field covering the design, manufacture, modification and/or fit of footwear. Pedorthics encompasses shoes, orthoses and foot devices that prevent or alleviate foot problems caused by disease, overuse, injury or congenital defect. Certified Pedorthists work with patients and their footwear to conform to a doctor's footwear prescription as part of the patient's treatment

To earn certification in Pedorthics, you must take a pre-determined number of course hours in pedorthics and pass a certifying examination overseen by either The American Board for Certification in Orthotics, Prosthetics & Pedorthics® or Board for Certification/Accreditation, Int'l. Both the ABC and BOC are independent certification bodies that set standards for the profession and offer certifications that are recognized by the National Commission for Certifying Agencies.

More information, including FAQ's

The American Board for Certification in Orthotics, Prosthetics & Pedorthics information on the step-by-step process of becoming a certified pedorthist

Board of Certification/Accreditation International information on becoming a BOC Pedorthist.

For information on the Canadian certifying organization visit The Pedorthic Association of Canada.

UPCOMING COURSES FOR CERTIFIED PEDORTHISTS & ALLIED PROFESSIONALS

Submit course listings to: editor@pedorthicnewswire.com

2010 COURSES AND EVENTS

MONTHLY AND ONGOING

Riecken's Orthotic Labs - 800-331-8040; SAFIO Class, Second Friday of every month, at 5115 Oak Grove Rd., Evansville, IN. Four casting stands provided, limited to 8 students. Contact Darlene at the above number for more information.

Traveling Courses To Your Area sponsored by The Robert M. Palmer, M.D., Institute of Biomechanics, Inc. a not-for-profit pedorthic school. Please contact us to discuss your needs at phone: 765-557-7216. Email: pam@pedorthicbiomechanics.org or visit our Web site at: http://www.pedorthicbiomechanics.org/.

The Robert M. Palmer, M.D., Institute of Biomechanics, Inc. a not-for-profit pedorthic school: Advanced Manufacturing - 50 Hour Course - Approved For 49.5 CME's for Pedorthists by the ABC. This course is designed to teach BAPFOL standards in manufacturing functional feet orthoses and provide an introduction to advanced biomechanical posting. Class size is limited to two students. For more information or to customize a course to meet your manufacturing educational needs, please email pam@rmpi.org or phone 765-557-7216. Tuition cost: $2K - includes housing and transportation to and from the airport and school.

The National Shoe Retailers Association is pleased to bring training and CEs directly to you, without the additional cost of travel, food, lodging, registration fees or lost work time. Our affordable WISER Sales Training DVD makes in-house training easy and there's now an online exam for Continuing Education credits from ABC and BOC.

WISER Sales Training provides quality training for new sales associates and re-motivates experienced sales staff. The DVD format makes it easy for employees to train at times convenient for them, and for employers to offer quality training without hiring outside trainers or taking the most experienced staff off the sales floor. ABC's Category 1 CEUs for WISER Sales Training total 21.75 credits (2.5 scientific, 19.25 business), good through year 2010. BOC's credit total is 20.34 (6.42 CPE Category 1, 13.92 Category 2).

Pricing for the program is as follows:

DVD, workbook and guide for trainers Members: $295 (Non-Members $395)

Additional Handbooks: $10 each

Online Test Members: $100 (Non-Members: $200)

For more information or to order, click http://www.nsra.org/wiser_intro.php?ad=pn

or call or email Veanne Lupia at 1-800-673-8446, ext. 7006, veannel@nsra.org.

Aetrex Worldwide Solutions for Foot Pathologies Seminars

Attendees will learn the importance of visual and digital analysis: pressure points, foot type, foot size and gait. Understanding activities and pathologies such as age, medical conditions and injuries (sports, diabetes, arthritis) will be discussed. Common foot pathologies will be reviewed, including methods of treatment utilizing state of the art technology. A hands-on workshop is also included. ABC - 7.75 Scientific Credits; BOC - 8.25 Category I CEU.

For information on Aetrex Worldwide Solutions for Foot Pathologies Seminars, please contact the Aetrex Marketing Department at: marketing@aetrex.com.

2011 Solutions for Foot Pathologies Seminars Calendar:

February

22 Corpus Christi, TX

March

10 Richmond, VA

24 Greensboro, NC

April

5 Dallas, TX

7 Oklahoma City, OK

11 Orlando, FL

15 Teaneck, NJ

22 Manchester, NH

May

5 Murfreesboro, TN

12 Cleveland, OH

June

7 Erie, PA

16 Montgomery, AL

21 Seattle, WA

July

12 Oakland, CA

14 Long Beach, CA

27 No. Kansas City, KS

August

23 Teaneck, NJ

September

13 Atlanta, GA

October

12 Phoenix, AZ

19 Baton Rouge, LA

November

17 Teaneck, NJ

RMPI Advanced Manufacturing Courses: 49.5 CME's. For info contact: online@rmpi.org

Elwood Courses Includes Dormitory Housing & Transportation From Airport To Dormitories & School

Under Development For January, February, March - Connecticut and Texas

· February 4 - 8, 2011 - (Elwood, Indiana)

· March 2 - 6, 2011 (Orlando, Florida)

· April 15 - 19, 2011 (Brea, California)

· May 4 - 8, 2011 (Orlando, Florida)

· June 1 - 5, 2011 (Orlando, Florida)

· July 27 - 31, 2011 (Elwood, Indiana)

· October 5 - 9, 2011 (Elwood, Indiana)

· November 2 - 6, 2011 (Orlando, Florida)

· December 7 - 11, 2011 (Brea, California) To Be Confirmed Soon

CLASSIFIEDS

Seeking to Hire: Wellness Life Systems, a leading national diabetic shoe provider, is seeking highly motivated Certified Pedorthists with excellent communication skills to join our team. We have positions available in many regions across the country. ACHC accredited, inserts created in our own orthotic lab. This unique opportunity allows the right individuals to: Get back to patient care! Perform in-home diabetic foot evaluations, shoe fittings, and deliveries in your local area; Manage your own territory and set your own schedule. Call Frank, 816-268-6857, with questions, or send resumes to jobs@wellnesslifesystems.com Ongoing

Seeking to Hire: Since our company's founding in 1923, Yale Surgical Company has been dedicated to meeting the Orthotic, Prosthetic and Pedorthic needs of Connecticut. We are beginning a new family generation of practitioners and are eager to meet the continuing need in our area. We currently have multiple opportunities for C. Ped., CO, CP, CPO and Orthotic/Prosthetic Techs in our New Haven office. We would love to speak with you to discuss your goals and future plans. Please feel free to look at our website, http://www.yalesurgical.com/ and email your resume to info@yalesurgical.com at your earliest convenience. Comp. salary, 401k etc. - Edward N. Kaufman Ongoing

Seeking to Hire: Experienced Sales Professional. Amfit, an industry leader in equipment and supplies for the manufacture of custom foot orthotics is looking for an ambitious sales professional. If you would like to be a part of a dynamic team that is well respected in the Pedorthic Community, we'd like to hear from you. Please email in confidence to: Arjen Sundman, President: asundman@amfit.co 1/12

Seeking to Hire: FOOT SOLUTIONS, Flower Mound Texas-FULL TIME PEDORTHIST: If you enjoy helping people, FOOT SOLUTIONS offers a unique opportunity unlike any other in the medical retail world. At FOOT SOLUTIONS we offer great hours and very attractive incentive plans. It's a career you can be proud of! As a team member, you will receive training in foot anatomy & pathology and product knowledge. This position offers no nights or Sundays! You must be available Saturdays plus 4 weekdays. Our store hours are 10am to 6pm weekdays and 10am to 5pm Saturdays. This position will require you to be career oriented, a self starter, highly motivated, customer service driven, and strong listening skills. The position requires someone who truly enjoys helping people. You will also possess strong follow-up skills, be goal driven and have a positive attitude. You will be a good problem solver, and have a strong attention to detail. You will have a minimum of 3+ years of face-to-face sales experience and a minimum HS Diploma or GED is required, Bachelors is preferred. Our ideal candidate will have experience in Pedorthics/Cpeds, or a background in Health Management is highly preferred. Competitive Salary commensurate with experience. Please send resume to Foot Solutions, 2321 Justin Rd Suite 205, Flower Mound TX 75028, Attention Mike Carey, C-Ped. or email careylax@aol.com 1/5

Classifieds will run for 90 days unless we are informed that the position has been filled. Thank you!

To place a classified ad, please email editor@pedorthicnewswire.com

STAFF

Editor: Faye Rapoport DesPres, M.S., M.F.A.

Design/Layout: Aetrex Marketing Department

ADVISORY BOARD

Robert Schwartz, C. Ped.		John Mishasek, BOC Pedorthist, C. Ped.
Erick Janisse, C. Ped.		Jerome S. Klein, C.O., C. Ped.
Edith James		Rick E. Sevier BS Ed., C. Ped., BOC Ped.