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February 8, 2012, Issue #455
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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. Please note:the deadline for all submissions and responses is 12 noon Eastern Standard Time on Tuesday for that week's issue.
NEW QUESTION
Question: Pedorthists have always seen a lack of compliance in the Diabetic population. The recent CDC article states that Diabetes amputations are falling dramatically. The article states that foot and leg amputations fell after 1996, and mentions that it was also the decade when Medicare began paying for blood sugar monitoring and for protective shoes and other medical devices for elderly diabetics.
What are you doing as an important team member in teaching your patients compliance and reducing the amount of amputations?
-PNW Reader
PREVIOUS QUESTIONS WITH RESPONSES
Question: I had a Medicare patient come in with a prescription for custom diabetic shoes. I informed the patient about the Medicare Therapeutic Footwear Bill when the patient stated she is not diabetic anymore since her kidney-pancreas transplant. I informed the patient that the first qualification for the shoes/inserts is diabetes and that the shoes won't be covered (Correct?) Patient got really aggravated and had a fit about this and stated there is no way she would pay herself. Her logic was that there was a prescription stating the DX is diabetes with foot deformity and therefore she should qualify. After minutes of back and forth arguments I informed her that I would request a Statement from the Certifying Physician. This calmed her down for the moment.
I requested the Statement with another request to see a copy of the physicians medical documentation (even faxed the "Dear Physician" letter from CMS). The statement came back, signed by the physician and stating this patient has diabetes and a history of partial amputation of the foot. No copy of the medical documentation. I called the physician's office and talked to an Administrator. She informed me that the physician refuses to send me a copy. I informed her that providing this documentation would be in compliance with the HIPPA Privacy Rule. She again told me that I will not get a copy but then told me that the physician's dictation shows that the patient is not diabetic.
How would you proceed? Thank you!
- Cped 2006
Response: I would send a copy of the attached letter from Medicare's Physician letter that explains to a physician his responsibility and the law as it pertains to documentation request and copies of the foot evaluations. If the doctor still refuses, Call Tammy Ewers, CPC of Medicare Part B (425-697-8585) she works with Medicare to train physicians as to what they are responsible to do. She will nicely let them know they are legally required to send documentation to support any Rx they write. I would also have the customer sign an ABN stating she is not diabetic as the reason for likely denial, have her pay upfront and inform her we will bill it to Medicare and leave it up to the review staff there to verify if the shoes are medically necessary (Bill Non-Assigned if you can). I would say that with the documentation you could likely prove a medical necessity, as the client was diabetic and she had to have a transplant, and the likeliness of having a foot amputation being life complicating may be enough. But that again, is for Medicare to decide. If Medicare does decide to pay she would be reimbursed by them. And if they don't pay you have your ABN, and you have done your best to help her while protecting you and your company. Thank You,
-Amber M. Hays, COF
Response: You are pretty much correct in that the only instance I am aware of that Medicare pays for footwear outside of the diabetic realm is if the shoe is integrated with a necessary leg brace.
In cases like the one outlined in your question we always contact the patient and go over the "Dear Physician" letter from Medicare in an effort to educate them as to the required documentation. We explain further what documentation we have received and what is still needed emphasizing that we have requested the docs and that the physician has refused to supply them. I will usually apologize but explain that without the proper documentation you cannot be assured that Medicare will pay the claim. At that point you can choose to have the patient sign an ABN stating that the doctor has refused to supply you with the proper notes, ask for payment with the promise of a refund if/when the claim is paid and move forward or you can tell the patient that you will be pleased to move forward if he or she will go to the doctor and get the proper notes. Most folks will understand when you tell them that you don't make the rules and show them the Medicare letter. Good Luck.
-Russell Dotson, C. Ped.
Response: We have encountered similar comments based upon common misconceptions. I can share diabetes education we've learned to be helpful at our facility. Diabetes mellitus is by nature an insidious disease involving cumulative damage from repetitive high blood sugar induced micro-trauma. Bariatric weight loss surgery or pancreatic transplants offer cures and remissions that my halt further development of diabetes related lower extremity complications. However, damage incurred is generally considered permanent and non-reversible. Complications associated with diabetes are progressive, on-going, systemic complications including damage to the eyes, heart, kidney and feet. Damaged capillary beds present a lifetime potential for impaired circulation. Impaired sensation from diabetic peripheral neuropathy remains, results in injury; untreated injury can progress rapidly into serious infection. Bony deformities remain and frequently progress because of the weakened structural foundation. Lifelong potential for serious diabetes related lower extremity complications continue to exist, even in the presence of a cure as the permanent, residual effects of past events remain a constant factor associated with higher numbers of diabetes related lower extremity amputation.
-Sylvia A Thompson, MS,RN,CFCN,CPED,DE
Response: You have to inform the patient that they are no longer a diabetic and no longer qualify for the diabetic shoe program. In addition I would refuse to accept any further referrals from the physician in question. You are required by Medicare regulations to have the medical documentation of need from the physicians notes either on hand or available for review. As this physician refuses to comply with his responsibilities under this program you cannot provide care in compliance with regulations. Can you afford to have all payments for these referrals taken back by Medicare?
- Ted A. Trower , CPO
Question: The picture for this link is of diabetic shoes and inserts that had been mailed to a patient after he had a visit from a supplier of Diabetic shoes. At the time of the visit, the patient stood on a piece of paper and his foot (left only!) was traced. He then picked a shoe from a catalog and 4 weeks later got the shoes and inserts in the mail.
I saw this because the patient came by the office to have the fit of the shoes checked and because of the too short shoe (his hallux was re-shaping the end of the toe box) had already caused him an ulcer (I took the patient to see a Podiatrist right after evaluation).
The "Custom inserts" consisted of a piece of bi-lam material that was cut out of a sheet and laid inside the shoes. What are your thoughts on a case like this?
- PNW Reader
Response: If you have evidence of improper or fraudulent billing to Medicare you have a legal and ethical responsibility to report it.
- Ted. A Trower, CPO
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HEALTH AND INDUSTRY
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FN PLATFORM at MAGIC Dazzles With A Fresh Collection of Footwear Brands, Shoe Exhibits, Events, Parties And Compelling SeminarsFN PLATFORM, the shoe show at MAGIC will serve up a fresh assortment of footwear brands, shoe exhibits, events, parties and more in Las Vegas this February. The industry's number one resource for discovering new vendors and uncovering trends, FN PLATFORM once again brings together the full gamut of the footwear industry to build business, exchange information and foster relationships. Once again, FN PLATFORM brings together the most influential brands in the industry. New brands in this show include: Rachel Roy, Liebskind and Jorge Bischoff, Isaac Mizrahi, SAS Footwear, Tkees and Fessura, etc. Returning brands include: Camuto Group, Clarks, Stuart Weitzman, ECCO, Merrell, Josef Seibel, Skechers, Steve Madden and many more. Full TextSource: Marketwatch Swollen Feet may Indicate Kidney ProblemsA walk in the fresh April air is an ideal way to participate in Foot Health Awareness Month. "Walking is great exercise for the feet," said Robert Zwolak, MD, president of the Society for Vascular Surgery. Both podiatrists and vascular surgeons agree that good blood flow is essential for foot health. A brisk 30-minute walk every day is just what the doctor ordered. Simple advice for daily foot care include:Improve circulation by walking, bicycling, dancing and swimming. Inspect feet for cuts, sores, blisters, redness, warm spots or swelling. Wash feet in warm water. Moisturize for soft skin. Cut toenails straight across.Wear socks and properly fitting shoes. Full TextSource: Local 10 GPS shoe lets families keep track of elderly relativesBy: Joan Verdon A Teaneck, N.J., shoe maker has joined with a California technology company to create a shoe that uses GPS technology that records where a wearer walks - and can send alerts to caregivers if someone suffering from Alzheimer's disease or dementia wanders away and gets lost. A family in Virginia has been using the shoes for the past month, as part of a trial set up by an elder-care expert, to keep track of an 83-year-old husband and father who scared his wife recently when he wandered away while she was grocery shopping. The man's son now gets alerts on his cellphone showing his father's location. "So if I lose him, I can call my son and he tells me where he is," the man's wife said. Full TextSource: The Republic/ The Record
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DIABETES
| Diabetes: Walk This Way
By: Krisha McCoy
People who have diabetes are at an increased risk of health complications, including heart disease, stroke, kidney disease, visual problems, and nerve problems. Along with a healthful diet and taking insulin along with any other prescribed medication, regular exercise can be an important part of your diabetes management plan. Walking is a great way to stay physically active, since it is easy on your body, convenient, and inexpensive. Full Text
Source: Everday Health
Diabetes quadruples birth defects risk, say researchers
By: James Gallagher
The risk of birth defects increases four-fold if the pregnant mother has diabetes, researchers say. The Newcastle University study, published in the journal Diabetologia, analysed data from more than 400,000 pregnancies in North East England. The risk of defects such as congenital heart disease and spina bifida were increased. National guidelines already recommend having good control over blood sugar levels before trying to conceive. Full Text
Source: BBC News
What your feet could be telling you about your heart
By: Sue Thoms
If you're wondering about the health of your heart, try looking at your feet. The lowly, stepped-on, shoe-squished foot could very well hold clues about the state of your coronary arteries. If your feet show signs of poor circulation - or peripheral arterial disease - your heart could be suffering as well. The feet may not invoke the same romantic notions as the heart - few sonnets or love songs are written in their honor - but they deserve a little love, podiatrists say. The Michigan Podiatric Medical Association, as part of February's heart health emphasis, is urging people to have a simple test to check circulation in their feet for signs of PAD, which occurs when the arteries become narrowed by plaque. Full Text
Source: MLive.com
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SPORTS AND FITNESS
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How to Beat the February Fitness BluesBy: Katie Ryan
If you've been slacking off on your New Years Resolution to loose those extra pounds, you're not alone. During February, gyms across the country see a slowdown in membership. Rebecca Weitzel, a trainer at Crossroads Fitness says it does seem to drop off a bit this time of year. She says the reason is simple. "It's that whole 'it takes 7 weeks to establish a habit (and make it part of your routine)," Weitzel said. So, what can you do to make sure you beat the February exercise blues? First off, trainers tell us you can make fitness a priority by trying something new. Here in the Grand Valley, there is a multitude of group classes and in-door activities you can participate in to keep your heart rate up, and your waist line down. Source: KJCT8
Kids' Sports Injuries: Advocacy Group Wants 'Hit Count' To Protect KidsBy: Nancy Armour Kids playing contact sports are suffering too many blows to the head, and an advocacy group is calling for a "hit count" to total them up before it's too late. Just as Little League pitchers are on pitch counts to protect their elbows, a hit count would prevent the repeated blows that can cause concussions and lead to extreme brain trauma, Chris Nowinski, co-founder of the Sports Legacy Institute, said Friday. Source: Huffington Post
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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.
ONGOING COURSES AND EDUCATIONAL OPPORTUNITIES FOR BECOMING CERTIFIED IN PEDORTHICS
The Robert M. Palmer M.D., Institute of Biomechanics "A Not-For-Profit School" has uniquely designed courses to provide pedorthic education for the retail, clinical or biomechanical knowledge seeking pedorthist. Course dates for Levels 1-3 in a variety of locations in the United States, Hong Kong, Mainland China and Korea are available. Click here to view a detailed calendar including dates and locations, information and pricing.
CFS Allied Health Education: Pedorthic Certification: Exam Review. This review is focused on supplying the student with the skills and knowledge needed to pass the ABC Certified Pedorthic exam by presenting exam-like questions, exploring possible answers, and discussing rationales for correct and incorrect answers. Contact CFS Allied Health Education at (918) 266-3678 or visit http://www.learnpedorthics.com/ for more information.
*ABC and The American Board for Certification in Orthotics and Prosthetics are registered trademarks of the The American Board for Certification in Orthotics and Prosthetics, Inc., which is not affiliated with CFS Allied Health Education and does not endorse this review.
ENESLOW PEDORTHIC INSTITUTE 1-on-1 or Group Tutoring Available; Eneslow Training & Tutoring Program, Individual and Small Group Program
Eneslow Pedorthic Pre-Certification Training Course August 6, 2012 - August 19, 2012
In cooperation with ABC requirements, Eneslow Pedorthic Institute (EPI) is offering the three-level competency training course for aspiring CPEDS. To provide maximum benefit in a minimum of time, a portion of the level one curriculum will be administered through a distance learning program that includes required readings, interactive CD's and testing of all mandatory topics. Upon passing the level one test, students will attend the remainder of the pedorthic pre-certification course at Eneslow Pedorthic Institute for 2 weeks from August 6th to August 19th, 2012. This class completes required education prerequisite to sit for national certification exam. It does not satisfy the requirement of 1000 documented hours of field experience. Please contact Sarah Goldberg at epi@eneslow.com or 212-477-2300 x211 for more information.
To purchase materials for the course, please click here.
BECOME AN ABC THERAPEUTIC SHOE FITTER
For information on Aetrex Worldwide Therapeutic Shoe Fitter Courses, please contact the Aetrex Marketing Department at: marketing@aetrex.com.
Aetrex Worldwide Therapeutic Shoe Fitter Courses
Information on 2012 Aetrex Worldwide Therapeutic Shoe Fitter Courses will be coming soon.
2012 COURSES
2012 FOOT SOLUTIONS PEDORTHIC PRE-CERTIFICATION COURSE SCHEDULE & INFORMATION Foot Solutions is an accredited facility that holds classes four times per year. The course will offer the certificate needed in all three levels so that you qualify to sit for the C. Ped. Exam. The facility is located at 2359 Windy Hill Road, Suite 400, Marietta, GA 30067 February 13 - February 24 May 11 - 1 Day Cram Session (free with attendance of pre-cert class) May 14 - May 25 August 3 - 1 Day Cram Session (free with attendance of pre-cert class) August 6 - August 17 October 8 - October 19 November 9 - 1 Day Cram Session (free with attendance of pre-cert class) For application and fee information, contact: Tracy Strickland 1-866-338-2597 EXT: 206 tstrickland@footsolutions.com Betty Hubauer 1-866-338-2597 EXT: 201 bhubauer@footsolutions.com Dr. William Faddock 1-866-338-2597 EXT: 209 bfaddock@footsolutions.com |
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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
For information on Aetrex Worldwide Solutions for Foot Pathologies Seminars, please contact the Aetrex Marketing Department at: marketing@aetrex.com.
Information on 2012 Aetrex Worldwide Solutions for Foot Pathologies Seminars will be coming soon.
2012 COURSES
NATIONAL PEDORTHIC SERVICES - EDUCATIONAL COURSE
April 27-29, 2012
National Pedorthic Services, Milwaukee WI.
Hands-on Custom Foot Orthosis Fabrication Course - 18.25 CEPUs
Contact: Nora Holborow at (414)438-6662 or visit www.npsfoot.com
E-mail: nholborow@npsfoot.com
May 18-20, 2012
National Pedorthic Services, Milwaukee, WI
A Hands-on Approach to Footwear Modifications - 19.25 CEPU's
Contact: Nora Holborow at (414)438-6662 or visit www.npsfoot.com
E-mail: nholborow@npsfoot.com
August 24-26, 2012
National Pedorthic Services, Milwaukee WI
A Hands-on Approach to Footwear Modifications - 19.25 CEPU's
Contact: Nora Holborow at (414)438-6662 or visit www.npsfoot.com
E-mail: nholborow@npsfoot.com
September 21-23, 2012
National Pedorthis Services, Milwaukee, WI
Hands-on Custom Foot Orthosis Fabrication Course - 18.25 CEPUs
Contact: Nora Holborow at (414)438-6662 or visit www.npsfoot.com
E-mail: nholborow@npsfoot.com
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CLASSIFIEDS
| Seeking to Hire: NEW! Coastal Healthcare Solutions is a Florida based Diabetic Supply company which also specializes in diabetic shoes. We are interested in having contact with fitters in all 50 states to perform in-home diabetic foot evaluations, shoe fittings and deliveries. We have immediate openings in the following states: Hammond Indiana, Dale Texas, Demoines Iowa and Athens Illinois. Call Dan at 321-431-7349, with questions, or send resumes to dkenna@healthsafedme.com Ongoing
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: Midwest Medical Services, a national provider of DME products, is seeking to hire Certified Pedorthists. We currently have multiple opportunities in all regions across the United States. Position would entail performing in-home evaluation and fittings, sale of diabetic supplies and pain management DME, managing your territory, and providing excellent patient care. Must be ambitious, well organized, and dependable. At Midwest Medical Services, we strive to provide the best patient care possible and support those who provide great care in our name. Call Kim, (816) 718-6946, with questions and/or email resumes to hr@midwestmedservices.com. We look forward to hearing from you. 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
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
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Editorial/Design/Layout: Aetrex Marketing Department |
ADVISORY BOARD
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Robert Schwartz, C. Ped. | |
John Mishasek, BOC Pedorthist, C. Ped. | | Erick Janisse,C.O., C.Ped. | | Jerome S. Klein, C.O., C. Ped. | | Edith James | | Rick E. Sevier BS Ed., C. Ped., BOC Ped. |
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ADDITIONAL COMMENTS
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