Pedorthic Newswire Issue #469

May 16, 2012, Issue #469

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 AND COMMENT

Question: We have an 80 yr. old Medicare patient with a LLD of 3 in. and a foot length discrepancy of 1 size. From a clinical standpoint there is going to be an issue with proper foot (specifically ball) alignment if a prefabricated pair of therapeutic shoes will be dispensed with the same size for both feet shoe. The Medicare LCD for therapeutic shoes states the following: A custom molded shoe (A5501) is covered when the patient has a foot deformity that cannot be accommodated by a depth shoe.

Is a foot length discrepancy considered a deformity that warrants a pair of custom shoes for a diabetic patient? Must we supply 2 pairs of prefab shoes instead & who is responsible for the cost of the 2nd pair? Will Medicare pay for 2 prefab shoes in the above situation? Could the LLD be taken in to the equation for custom shoes?

-Judah Rosenberg C.Ped.

Comment: We would like to share this press release from the Pedorthic Association of Canada regarding Clinical Practice Guidelines Manual of Best Practice.
This is the first ever Clinical Practice Guidelines which was launched at the annual symposium of PAC in April 2012.

Please click here to view the Best Practices Guidelines.

-Kirsten Parker

PREVIOUS COMMENT WITH RESPONSES

Comment: I was wondering if anyone read the review for the second quarter regarding the Therapeutic Shoes for Jurisdiction D? Out of 455 claims submitted 440 were denied. A total of 69 claims were denied for no response to the additional documentation request. This is an error rate of 97%. Because it is so high, NAS will continue with the widespread complex review. I know that it requires a lot of work to get the documentation needed for the patient to get their shoes and inserts, but if we take the time to explain to our Doctors what we need they will get used to providing the documentation to us. Right now the Doctors are providing this information for a wide range of products like hospital beds, mattresses, wheelchairs, scooters, ankle braces, and lift chairs.

This is the wave of the future to come on all the products that Medicare covers, so all

of us need to start thinking in this direction. When we do not comply on the documentation requirements this puts us into a review status portraying where we are today. We will stay stagnate until we understand what is needed and supply it to Medicare. This goes for billing assigned or unassigned.

Let's change our way of thinking for the good of all of our customers and ourselves.

-MEK, L.PED.

Response: Regarding the need to educate physicians about the documentation requirements for Medicare diabetic shoe supply, the problem faced by all TSD suppliers is the relative complexity of this documentation that allow an auditor to find one mistake in a physician's patient file and recoup and extrapolate the payment. One would hope that anyone who is a TSD supplier after all these years of having access to documentation articles and seminars and DMEPOS information that the supplier's charts would be found perfect in an audit. It is the physician's chart that is causing the recoupment's from a post-payment audit and/or slow payments from prepayment audits.

Further complicating the matter is that many primary care physicians managing the individual's diabetes is the lack of knowledge about foot conditions that are considered a risk factor. Before we dropped our supplier number, we had a patient with an extreme bunion as their foot deformity risk factor and indicated such on the paperwork sent to the physician. He returned paperwork unsigned and with notations that patient did NOT have bunion. Add in the challenge of a primary care physician documenting peripheral neuropathy AND callusing. DPN is very common but recognition and documentation of callusing by the non-podiatric physician is next to impossible to find in patient records when requested prior to delivery. Now I do not mind educating a referral source about documentation requirements but at what point does the cost of training a physician on foot anatomy and conditions become cost prohibitive considering there are still 20 other ways the paperwork can be imperfect and at risk to audit recoupment.

The issue of the majority of TSD claims failing audits has been around for 4-5 years now. AOPA reported data at least 4 or more years ago about a TSD claim audit that 100% of claims failed a post-payment audit. Every region appears to have published data about 90%+ failure rates. So the education of physicians about TSD medical necessity documentation requirements seems not to be making any progress. There is "no wave of the future" per MEK's posting - this medical necessity documentation has been an issue for many years. And the added, uncompensated "work" of education physicians drains any potential net profit out of the TSD supply. Does a person really think that they can convince a physician that neuropathy alone is not sufficient as a risk factor?

-John Mishasek, BOCPD, C.Ped

Editors Note: In last weeks issue of the Pedorthic Newswire we included a response from Wendy Miller, BOCO. We would like to point out that her title is Director, Facility Accreditation, BOC

SPONSOR NEWS

HEALTH AND INDUSTRY

If the shoe fits; the importance of footwear

By: Dustin Bonk

A good pair of shoes is important for maintaining healthy feet... especially if you're a runner. At Johnson's Superior Shoes in Marquette, they conduct a minor foot exam to make sure they understand your foot's needs. Many shoe shoppers make a bee line to their favorite brand, but brand name and appearance should be the last factors in your decision. "You have function and you have fit, and those are the two things that have to go into choosing a shoe," said John Thomsen, partner at Johnson's Superior Shoes in Marquette. Everyone's feet are different, so it's important that you find new shoes based on your needs. The arch of your foot is an important factor. Full Text

Source: Upper Michigan Source

Know how to prevent, treat foot ailments, from heel to toe

By: Shirley DeAcetis

Human feet are truly amazing. Your feet contain a quarter of all the bones in your body. Individually, each foot has 26 bones, 33 joints and more than 100 tendons, muscles and ligaments. As we age, our feet become wider and longer and the natural padding under the feet begins to thin. Years of walking and standing stiffen feet and ankles and flatten arches. Your feet eventually will begin to feel the effects of daily wear and tear. Often, you can take measures to care for foot problems yourself, but some will require medical treatment. See a podiatrist if you have persistent pain, swelling, stiffness, redness or numbness. Here is a look at some common foot problems and what might help. Full Text

Source: Modesto Bee

Small step in high heels; a giant leap for prosthetics?

Women in stilettos and ostriches have unwittingly contributed to scientific advancement by showing researchers how to design a prosthetic leg better adapted for walking, said a study published Wednesday. The best prosthesis for above-knee amputees, and for humanoid robots, would work nothing like the human leg, scientists found, but like that of an ostrich or the synthetic limbs used by South African amputee sprinter Oscar Pistorius. "It now appears that making prosthetic feet for walking at least copying human feet too closely can be a mistake," study author Jim Usherwood of the Royal Veterinary College in London told AFP. "If you want to make a good prosthetic foot but don't care what it looks like, you should put the motor in this case the ankle -- as far up the leg as possible." Full Text

Source: NY Daily News

AETREX iSTEP WEBINARS

Visit our full May 2012 Schedule

DIABETES

National Womens Health Week: Gestational diabetes more dangerous than we assume

By: Janice D'Arcy

The morning after my second daughter was born, I, like any woman fresh from labor and delivery, was famished. Before me sat a tray with a metal dome that concealed an awaiting entrée. As I reached toward it, I imaged a feast of eggs and sausage, maybe a few sautéed vegetables. I had developed gestational diabetes during the pregnancy, and I expected that, like all my meals in the previous three months, this one, too, would be devoid of fruit, bread or anything that might trigger an unhealthy spike in my blood glucose level.

My endocrinologist had warned me to keep following the strict dietary guidelines until she could test me after the delivery and make sure my gestational diabetes had not developed into long-term diabetes. On my last visit to her before the birth, she said something along the lines of, "Call me when things settle down and we'll schedule a follow-up." Full Text

Source: Washington Post

Pay attention to your diabetes or face long-term problems

By: Susan J. Smith

Why spend my time paying attention to my diabetes? I feel fine, I don't have any symptoms and yet my doctor tells me to come back in three months for a follow-up? Diabetes is one of our silent diseases. We can feel fine for months, even years until the damage is advanced to the point that there are some symptoms or changes in our body. Full Text

Source: Visalia Times

Can you exercise away your diabetes symptoms?

By: Jenny Hall

A professor in the Faculty of Kinesiology and Physical Education and an associate scientist in physiology and exercise medicine at the Hospital for Sick Children, Wells is at the forefront of the new field of exercise medicine, which investigates the use of physical activity to treat and prevent chronic disease. What's the relationship between type 2 diabetes and physical activity? Type 2 diabetes and obesity are closely linked. We know that if we intervene with physical activity there is an improvement in physiology. If we intervene with nutrition and physical activity, the combined effect appears to be amplified. That's a critical factor in the successful treatment of type 2 diabetes. It isn't exercise alone, it isn't diet alone, it's the combination of exercise and good nutrition. Full Text

Source: Medical Express

SPORTS AND FITNESS

Fitness Tips: Choosing the Best Exercise for You

Our increasing knowledge about exercise, coupled with creative exercise programming, means there are more ways than ever to get in shape. For some people, this is enticing news. For others, it's frightening. With all the choices, how can you choose a program that suits you? When you're beginning to think about starting regular exercise, it helps to group your options into three major categories: exercising in your home, exercising outdoors and exercising in an organized program or at a fitness center. Full Text

Source: News Olio

Pro Golfer and Sports Nutrition Expert Tee Up Healthy Snacking Tips for Peak Performance

Whether you're a professional golfer or a weekend warrior, feeling hungry on the green can weaken your performance, but what you eat before and during the game can help improve your score. To help golfers stay on top of their game, Sports Nutrition Expert Robert Yang and PGA Professional Golfer D.A. Points are teaming up to share their go-to eating plan on game day and ways to build better eating habits on and off the course. In addition, Yang and Points are announcing a chance to win a three-day "California Almonds Pro Golf Getaway" in San Diego, California."Beginning with breakfast and from the first tee through the back nine, golfers need to keep their energy up with good nutrition," said Robert Yang, R.D., founder of The Performance Lab. "Going for a healthy snack like almonds makes sense because they're packed with six grams of protein and three grams of fiber in every serving." Full Text

Source: Market Watch

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.

Robert M Palmer 2012 Schedule

June

Brea / El Monte, California TBD - June 23 - July 2

August

Elwood, Indiana - August 18- 27

September

Orlando, Florida - Sept 8 - 17

Elwood, Indiana - Sept 29 - Oct 8

Fall 2012

Malaysia TBD -

November

Elwood, Indiana - Nov 10 - 19

December

Brea / El Monte, California - Dec 8

RMPI Pre Certification Training- PEDORTHIC PRE-CERTIFICATION EDUCATION
PFA Scholarship Value @ 70% Savings
Published Tuition 2010 - $4K, "Powerstep Scholarship" Tuition Total $1500
(does not include travel / books / meals)
Must Enroll Before April 30, 2012
Attendance Date Flexible - CAPE/NCOPE Compliant - Levels 1,2,3
Courses Held In Elwood, Indiana Include Dormitory Housing & Shuttle Service
By prior reservation on a first-come-first-serve basis
To learn more about our courses or how you can share our vision, visit us at:
www.rmpi.org

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.

Pedorthic Pre-Certification Training Course July 30th - August 12, 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 during July 30th, 2012 to August 12th, 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.

For more information on ABC Clinical Practice Requirements, please go to www.abcop.org.

Please contact Sarah Goldberg at epi@eneslow.com or 212-477-2300 x211 for more information. Pedorthic Pre-Certification Course - $3,995

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

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

UPCOMING COURSES FOR CERTIFIED PEDORTHISTS & ALLIED PROFESSIONALS

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. Click Here for More Info

May

Elwood, Indiana- Two Courses: May 18 - 22

Advanced Manufacturing Course 49.5 CME