Since January, we have divided our standard newsletter into three publications: (1) DPMs, (2) vendors/exhibitors, (3) meeting planners & organizations. Each is different for obvious reasons, however, my hope is that you will find the articles below useful as a physician too!

Check 'em out...

Sarah Breymeier: beheard@podiatrymeetings.com

First, the concept I was reminded of from this book, is to stop focusing on the GOAL and instead focus on the PROCESS. Results are derived from the concept of compounding actions.

I used to direct the marketing for an orthotics lab and in doing so, I was involved heavily in meetings with the sales team. Every month, our boss would get frustrated if the sales team hadn't met its sales goals; so he would make the goal higher. This confused me.

I remember a specific conversation with him and said, "you could make the goal $100 a month or $1 million a month and it won't matter if we don't equip each sales rep with a process of how to get there."

What I was trying to explain was the result is completely out of anyone's control. We can only control our actions and the process we employ to achieve a particular result.

Because I'm a tennis player, I used a tennis match as an analogy.

I told him..

Ultimately, if you raise the goal each month but provide no change to the process, this is likely an unwinnable battle and you're setting your team up for failure. Instead of focusing on the result - change your mindset to focusing on the "how" we get there by implementing tactics within our control.

A couple of weeks later I was watching "Full Swing" on Netflix, which is a series that follows a group of professional golfers and documents their personal experiences on the PGA Tour.

I was so pumped to witness and hear coaches/caddies of the players describe exactly this point! So I simply want to share a couple of clips and and teasingly say... seeeeee, I told you so. ;)

Sarah Breymeier: beheard@podiatrymeetings.com

Launched in 1996, the Richie Brace® has become the most respected brand in lower extremity bracing. The Richie Brace® was the first AFO to embody podiatric biomechanical principles with a balanced functional orthotic footplate. 

The Richie Brace® is ordered from a network of premier custom orthotic laboratories who add a variety of products and services which are not available from any other AFO company:

The IMIFAS faculty is made up of the top MIS surgeons from around the globe. Attendees can expect to receive in-depth training from experts including: Stephen Isham, MD DPM; Carmen Naranjo Ruiz, DP; Borys Markewych, DPM; Mario Juanto, MD...

Your level of hands-on training doesn't get higher than this; especially when every single attendee has their own specimen to train with!

Not only will you have the unique experience to learn from the world's best in MIS, but you will get to train on a more personal level with a 1:5 instructor to attendee ratio. This event is limited to 90 attendees.

THIS EVENT IS LIMITED TO ONLY 90 ATTENDEES

Intoe-walking can be explained mostly by 5 differential diagnoses. The first 3 are the “obvious ones” because they have to do with bone structure. Femoral anteversion (structural from the hip), Internal tibial torsion (structural from the lower leg) and mettaductus (structural from the foot) are easily identified with x-rays and gait/static measurements. The 4^th causation however is not as obvious. Functional muscle weakness and imbalance can play a major cause of intoeing. These weaknesses and imbalances can come from the hips and core. These are identified while watching the patient walk and observing motion in the swing and stance phases of gait. We must also pay careful attention to the orientation of the kneecap during all phases of gait. And of course is extremely important to mention that connective tissue disorders (while sometimes not a primary factor) can play a major factor as well in influencing the amount of intoe-walking and laxity seen in all gait exams. The 5^th differential diagnosis we will go over when we discuss toe-walking.

The “Premature E Foot type” is a very common, underdiagnosed, undertreated, and mis-understood condition which can both produce intoe-walking and toe-walking. (Attached is a link to an article I published on this important topic which helps explain exactly what the E foot type is-for important reference) Simply put The E foot type (structurally identifiable at age 10) is made of of both rearfoot and forefoot varus. Under the age of 10 however the forefoot (while positioned in its varus position state already) is flexible. This flexibility can cause a child to intoe (the forefoot “falls in” and intoeing is seen) and/or toe walk (the forefoot is” falling in” so much the child can’t balance and thus comes up on their toes and toe walks. 

LEARN MORE ON THIS TOPIC FROM DR. DECARO IN OUR NEXT PRACTICE PARTNER ACADEMY... CLICK HERE FOR MORE DETAILS & TO REGISTER

THERAPEUTIC SHOES & INSERTS FOR PATIENTS WITH DIABETES TOP 3 COMPLIANCE ERRORS: DON'T LET THIS BE YOU!

Medicare’s “Therapeutic Shoes for Persons with Diabetes” program is a phenomenal benefit to patients, with a robust library of peer-reviewed literature supporting the facts that these therapeutic shoes / inserts decrease pathology and prevent complications in patients with diabetes, leading to improved outcomes for our practices. Just like every other service we provide, there are compliance guidelines that need to be followed when participating in this program. Fortunately, when it comes to this service of therapeutic shoes and inserts, these requirements are publicly available and published online^[1],[2].

In addition to publishing the requirements, the most commonly committed compliance errors associated with this program are also published^[3]. Reviewing this list allows providers to ensure they are not committing any of these errors. The top three errors on this list consistently involve the documentation requirements associated with supplying therapeutic shoes / inserts. Two required documents associated with this program are the Statement of Certifying Physician For Therapeutic Shoes and the Documentation of Medical Necessity. The Statement of Certifying Physician For Therapeutic Shoes form must be completed by the MD or DO who is managing the patient’s diabetes and must state that the patient has diabetes, the patient has one or more of the conditions required for coverage of therapeutic shoes and inserts, is under the active management of that MD or DO for diabetes, and that provider’s certification that the therapeutic shoes / inserts are medically necessary for that patient. The Documentation of Medical Necessity form must contain a complete lower extremity exam, documentation that the patient has one or more of the conditions required for coverage of therapeutic shoes and inserts, and that therapeutic shoes / inserts are medically necessary for that patient. This Documentation of Medical Necessity form may be completed by the prescribing physician, must be signed by the MD or DO who is managing the patient’s diabetes, and must be returned to the prescribing physician.

One Medicare Contractor reports that during the final calendar quarter of 2023, the #1 error committed in submitting payment claims for therapeutic shoes/inserts was the Documentation of Medical Necessity form was either not completed at all, did contain the required complete lower extremity exam, or was completed but was not signed by the MD or DO who is managing the patient’s diabetes. In many cases, the supplying provider actually completed the form and sent it to the MD or DO who was managing the patient’s diabetes, but the form was never returned to the supplying provider. This is one error that can be avoiding when aligning with Surefit® for the provision of therapeutic shoes/inserts. Surefit® provides its customers with its Medicare Document Management (MDM) System. Through this system, Surefit® helps its customers ensure that all documentation related to supplying therapeutic shoes/inserts is complete and compliant. As it relates to this #1 error, Surefit® will help ensure the Documentation of Medical Necessity form is complete and signed by the MD or DO managing the patient’s diabetes before dispensing takes place, thereby not allowing their customers to commit error #1.

The second most common error in this report was failure to include the Statement of Certifying Physician For Therapeutic Shoes form which is described above. This must include documentation of that provider’s management of the patient’s diabetes. In some cases the form and its accompanying documentation is completed by the MD or DO managing the patient’s diabetes, but there is no discussion of that MD / DO managing the patient’s diabetes in the documentation shared. This is yet another screening performed by Surefit® with its MDM program. Not only doesSurefit® ensure the required documentation is present, they also ensure it contains what is required.

Medicare’s Therapeutic Shoes for Persons with Diabetes program helps us to serve our communities, fulfill our oaths, and achieve excellent outcomes. Payer requirements should not discourage us from participation. Instead, knowledge of these requirements should only motivate us to learn the rules, follow the rules, avoid errors, and partner with entities like Surefit® that help us to succeed.

Dr. Richie is a Clinical Associate Professor at the California School of Podiatric Medicine. He has authored many original articles published in peer-reviewed medical journals as well as several chapters in respected textbooks of foot and ankle surgery. Dr. Richie recently published his own textbook titled Pathomechanics of Common Foot Disorders which is available at https://link.springer.com/book/10.1007/978-3-030-54201-6. Dr. Richie is a Fellow and Past President of the American Academy of Podiatric Sports Medicine and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Richie designed and launched the Richie Brace®line of custom ankle-foot orthoses in 1996 which are now distributed in seven countries around the world.

Louis J. DeCaro. DPM is a Podiatric Physician who is an international lecturer and authority in pediatrics with a special interest in sports medicine and biomechanics for both adults and pediatrics. Dr. DeCaro shares a patent on foot types. He has helped identify 24 unique foot types and how that can help predicts, prevent, and treat many orthopedic conditions. Dr. DeCaro is President and fellow of the American College of Foot & Ankle Pediatrics (ACFAP). Dr. DeCaro is a Board-Certified Diplomate of the American Board of Multiple Specialties in Podiatry. Dr DeCaro has been named one of the top 150 most influential podiatrists in the country. In 2023 his practice received its 10^th straight Best podiatry practice award for Massachusetts.

Shaun Zaken is the President and owner of Blue Orchid Marketing, a leader in podiatry marketing services for 23 years. Blue Orchid Marketing specializes in unique, personalized marketing solutions that actually work and help your practice grow, including Email & SMS Marketing, Social Media, SEO, Websites, Local Listings, Reputation Management, Print Newsletters and Postcards. Shaun can be reached at Shaun@BlueOrchidMarketing.com or 203-746-5901. Learn more about B.O.M. at BlueOrchidMarketing.com

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