Thursday, November 1, 2012
Opening General Session: The Basics of Wound Care
Dr. James McGuire, DPM, C. Ped., PT
The basic wound care types will be discussed along with their characteristics and common dressings used to treat them. Proper handling of patients with open wounds, including protective gear, odor management, and common microbes such as MRSA will be discussed.
A1: Retail (Part 1): Metrics – How do You Stack Up?
Rick Ravel, C. Ped.
This session explores how to set up a business plan and what makes a plan successful. Group discussions about financial health and specific issues will help you know how you compare to other stores or pedorthic facilities.
A2: Radiology of the Foot and Ankle: What Pedorthists Need to Know
Dr. James McGuire, DPM, C. Ped., PT
While it is true that a pedorthist won’t use an x-ray or an MRI to diagnose the condition(s) of a referred patient, they are extremely useful tools for a pedorthist to incorporate into their overall patient evaluation nonetheless. Knowing how to interpret and understand what you are seeing on a foot and ankle x-ray or MRI can be critical to providing your patient with the most efficacious pedorthic modality based on their condition to ensure the best possible outcome. This session will cover basic radiology terminology and foot anatomy, common foot conditions and their radiologic assessment, x-ray techniques and positioning, and several case studies.
A3: Understanding Applied Foot and Ankle Biomechanics
Pam Haig, C. Ped.
Understanding applied foot and ankle biomechanics can be challenging. The differences of intrinsic and extrinsic posting will be defined utilizing props to illustrate that these two techniques do not achieve the same desired outcome(s) in regards to optimal functional position. Thus, the attendee will learn the effects of these posting techniques. A ten-step range of motion series will be incorporated into the discussion of intrinsic versus extrinsic posting, aiding the attendee to more effectually and accurately chose between various theories. The attendee will become more confident in choosing an OTC product, custom product or incorporating a more effective treatment modality to accomplish an intrinsic or extrinsic force within the foot and lower limb.
B1: Retail (Part 2): TURN, TURN, TURN
Rick Ravel, C. Ped.
Inventory is the largest expense of a retail pedorthic facility and usually the least-planned-for. Inventory turnover is the key to a successful business, but how do you figure what inventory turn is right for your business? An Open-to-Buy (O-t-B) plan can address this and other questions, and can make or break a business. Learn what an O-t-B is and how it works in this session.
B2: Pearls of Pedorthics
PFA Board of Directors and COPE
Learn from the PFA Board of Directors and COPE members as they share pearls of pedorthic wisdom in this popular and engaging session. Each two-minute mini-presentation will feature clinical, technical or business advice that you can readily apply to your day-to-day practice. Take home valuable tips and ask questions of these seasoned pedorthic professionals.
B3: The Latest Pedorthic Methods and Techniques to Treat Plantar Fasciitis
Douglas Goodhart, C. Ped.
This lecture will present a new pedorthic method and techniques for plantar fasciitis resolution, producing the highest and most efficient resolution rates currently in the United States. We will also show how these concepts can be transferred and applied to many other conditions pedorthists deal with on a regular basis. Using amongst the most modest means in the industry, we will demonstrate how to sustain consistent resolution rates well into the 90% range and within a two-to-three week period. This method is not brand or product based, but about information and technique. Our intention is to share with pedorthic practitioners the method to achieve these tested results. This presentation will cover the causes of plantar fasciitis, “the Illusion of Comfort – the Evils of Compression”, the missing design flaws, and the method for the resolution for plantar fasciitis.
C1: The Successful Operation of a Pedorthic Business: Staying Compliant, Staying Organized, and Maintaining Communications
Matthew Almeida, C. Ped.
This session will help the pedorthist to gain a better understanding of the business side of the pedorthic practice. Looking at various ways to stay in compliance, stay organized, and keep the lines of communication open between staff members will allow the pedorthic practitioners to have a better understanding of what is involved in the successful operation of the business office. In addition, this session will show the pedorthist some of the options and tools available to help them have not only a successful business office but a successful practice in general. This information is good for those practitioners who operate their own independent practice or work for a larger company.
C2: Essentials of Business Anatomy: An Introduction to Core Structural Aspects – Legal and Tax – of the Principal Life States of a Privately Held Business
Allan J. Weiner, Esq.
With real life case studies, this session will examine how you might decide whether your family or a trusted manager should own and run the business or whether it is time for an outsider to come in. Then, with more everyday examples, you will gain an appreciation of how broad and varied are the ways that these transition events can occur and how the differences will affect the business and tax planning issues you will face. It is never too early to think about the future of your private business. This session will give you the framework to being your plans, including an overview of the essential legal and tax considerations involved with starting a privately held business through its life cycle to the point of selling the property.
C3: Pedorthic Evaluation and Treatment of Equinus Conditions
John P. Galbraith, C. Ped.
As the population ages, various equines deformities of the foot present themselves with some regularity. The tightening of the Achilles’ Tendon and the associated mid-foot and forefoot pathologies cause structural and functional problems with walking. The conditions are often overlooked in the course of a physical examination, yet are very easy to spot once the pedorthist knows what to look for. This session will demonstrate the methods of recognizing and managing equines pathologies. From assessment to follow-up, the session will cover pathomehanics, orthotic management, and footwear and modifications with an opportunity for questions about actual cases.
General Session: AFOs and the Pedorthist
Donald L. Pierson, C. Ped., CO
This session sponsored by Arizona AFO, Inc.
There has been a general misunderstanding regarding the pedorthic use of AFOs/SCFOs, which may have led to underutilization of the full pedorthic scope of practice. This session will review casting techniques resulting in the best fit possible, as well as coding and reimbursement information, all geared toward demonstrating how these devices fit into your practice, thereby enabling the pedorthist to offer their patients to assist them in relieving painful conditions of the foot and ankle.
D1: The Latest in Coding and Billing
Dean Mason, C. Ped., CO, OST, BOCO, BOC Pedorthist, Randy Stevens, C. Ped., COF, BOC Pedorthist
Pedorthic DMEPOS coding, billing and reimbursement is a confusing and ever changing world. This session will provide an update on what every pedorthist needs to know about changes to Medicare’s Local Coverage Determinations and Policy Articles for benefits that pedorthists seek reimbursement from, HCPCS and ICD-10 changes, fee schedules, and much more.
D2: AFOs: A Discussion within the Framework of the ABC and BOC Pedorthists’ Scope of Practice
Donald L. Pierson, C. Ped., CO; representative from ABC, Teresa Alpert-Liebman, BOC; and, Christopher Costantini, C. Ped., NCOPE
This session sponsored by Arizona AFO, Inc.
A follow-up to the earlier general session “AFOs and the Pedorthist”, this session will clarify how pedorthists can utilize AFOs/SCFOs in their daily practice by focusing on how AFO/SCFO utilization is taught in pedorthic pre-certification programs, as well as how they fit into the pedorthic scope of practice. Representatives from the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and the Board of Certification/Accreditation, International (BOC) will review where AFOs fit into their respective pedorthic scopes of practice, and NCOPE’s presenter will review AFO education in the current and new pedorthic pre-certification curriculum.
D3: Bonding Technology and Material Identification in Pedorthics
Dr. Ranier M. Buchholz
How does bonding actually work, and what does one need to know to work with the many different materials that occur in modern pedorthics? This presentation encompasses an introduction to the basic concepts of bonding: adhesion, cohesion, and the different adhesive types (solvent-based, water-based, CR, PU). This topic is presented both from a chemical perspective and under the aspect of application in the pedorthic industry, especially regarding the occurrence of typical allergens and hazardous solvents in adhesives and what alternatives are available. In addition, easy ways to identify, prepare, and bond the different materials encountered in making orthopedic insoles and pedorthic shoe modifications will be presented.
General Session: Pathologies of the Knee and Hip and Their Connection to Foot Pathologies
Michael Forgrave, C. Ped. (C)
Many pedorthists don’t feel that the knee and hip do not fall within their scope of practice. The foot is intricately involved with the knee and hip. Even if you only treat foot pathologies, you may find that your patient returns to you with other problems higher up the kinetic chain.
In this lecture, we will look at several pathologies of the knee and hip, including Osgood Schlatter Syndrome, Patella Tendinopathy, patella femoral pain syndrome and iliotibial band syndrome, Greater Trochanteric Bursitis and Sciatica/Piriformis syndrome. We will examine the interaction of the foot with the knee and hip. We will investigate various treatment methods that can be utilized.
General Session: The Pathomechanics of Ulceration
Capt. James Foto, BSME, C. Ped.
The general approach to prevention and/or recurrence of ulceration in the presence of neuropathy is management using a total contact modality such as a cast, splint, or shoe insert. Knowing the variables involved with plantar pressure can immediately assist the clinician’s medical approach by understanding the mechanics of ulceration. Offloading and pressure distribution are well identified successful techniques, but knowing why establishes the base for well-grounded pedorthic management. Throughout the lecture, these principles will be reinforced to gain practical confidence using this theoretical approach.
Friday, November 2, 2012
General Session: A Firm Footing in Pedorthics: SCIENCE!
Dr. Geza Kogler, Ph. D., CO
Research is a critical element to prove the efficacy of many treatments across the allied healthcare spectrum - including pedorthics - and also enables improvements in education and the development of new products to assist in the treatment of a pedorthists’ patients. Unfortunately, the basics of research are not a topic most pedorthists are familiar with. This session will provide an overview on the necessity and basics of research – the types, the terminology, the uses, etc., - that every pedorthist will be able to utilize in their own practice to enhance patient treatments, as well as on a larger scale to provide necessary factual data to support the work that pedorthists do around the country and around the world.
E1: Applied Biomechanics of the Foot: Fundamental Concepts for Pedorthics
Dr. Geza Kogler
Knowledge and understanding of the basic principles of applied biomechanics and functional anatomy are essential for the successful treatment of foot-related pathologies utilizing pedorthic modalities at the ankle and below. This session will review the fundamental concepts of applied biomechanics as they apply to pedorthists in their evaluation and treatment of foot and ankle disorders.
E2: ABC’s Facility Accreditation Standards and How They WILL Improve Your Business
James Lawson
This interactive session will help you understand and comply with the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) facility accreditation standards and improve your bottom line. Learn how you can provide exceptional patient care while improving your business processes.
You’ll leave this session with answers to the following: compliance with ABC’s accreditation standards; the impact of some products and services on your O & P exemption status; chart documentation that supports treatment and billing, making sure you get paid; patient satisfaction surveys and using that data to improve your business; and, the top ten ways to have a successful onsite survey.
E3: The Enforcers are Coming: But It’s Not Just About Money Anymore
George Breen, Esq.
Last year, the U.S. Departments of Health and Human Services (HHS) and Justice (DOJ) reported recoveries of more than $4.1 billion in “fraudulent healthcare payments”. As significant, the DOJ reported that it filed criminal charges against 1,430 defendants in fiscal year 2011, the largest number of health care fraud defendants charged in a single fiscal year. DOJ obtained convictions of 743 health care fraud defendants in FY 2011, another record, and reported that there are more than 1,800 health care fraud criminal investigations pending.
It is clear that the government’s interest in pursuing health care fraud is not limited to dollars; the headlines are replete with efforts to pursue individuals criminally. Moreover, the HHS Office of the Inspector General (OIG) is increasingly looking to exclude individuals from participation in federal health care programs. Significantly, OIG has almost unfettered discretion to impose exclusion against any officer or managing employee of an entity sanctioned for health care fraud, even without any showing that that individual participated in, had knowledge of or even “should have known” of the misconduct that gave rise to sanction.
Given this backdrop, it is critical that health care entities doing business with the federal government (and with private insurers), need to have protections and processes in place to ensure that they are conducting business in a compliant fashion. The Patient Protection and Affordable Care Act (PPACA), passed in 2010, required health care providers to have a compliance program in place in order to participate in federal health care programs. While a deadline for compliance with that provision has not been set, it is critical, given the current enforcement climate, that providers have in place an active and effective compliance program in order to protect themselves and their businesses. Whether you have an existing program, or need to establish one, this presentation will discuss the critical elements of a compliance program as your first layer of defense against the government enforcers.
General Session: The Top Ten Adult Podiatric Pathologies and What They Look Like in the Podopediatric Patient (Before They Happen!)
Dr. Louis DeCaro, DPM
This session sponsored by the Verne Bintz Company
Even if you do not treat children, this session will open your mind to each and every encounter of “every day adult foot pathologies” that you treat and how those conditions might be linked genetically to your patient’s offspring. This session will also provide an overview of the most common foot and ankle pathologies associated with podopediatrics involving orthotic treatments.
F1: Top Five Pediatric Sports Injuries: How to Prevent Them by Treating the Foot
Dr. Louis DeCaro, DPM
This session sponsored by the Verne Bintz Company
Correcting the biomechanics of the foot and ankle can reduce the chances of ankle and foot injuries. Proper evaluation of foot type with subsequent prescribing of appropriate orthotics will go a long way in preventing many types of foot and ankle injuries. Treating the foot type before the injury happens is the best form of prevention, while eliminating the chance for repeated, chronic injuries.
F2: Orthotic and Shoe Management Solutions for Many Indications
Frank Caruso, CO
This session offers custom shoe options and biomechanics of contributing circumstances resulting in soft tissue dysfunctions in Achilles, PTTD and other conditions involving the foot and ankle. New innovative treatment options will be introduced for achieving goals of reduced pain, gait improvement and better patient outcomes utilizing orthotics, adjustable AFOs and footwear. The session will also offer an overview of current case studies with different clinical indications, and attendees will leave with a new perspective on managing foot deformities, soft tissue injuries and pain with effective techniques to use with patients in their practice.
F3: An Overview of CAD-CAM Orthotic Fabrication
William Meanwell, C. Ped.
This session will review the basic uses of CAD-CAM for orthotic manufacturing. Areas to be reviewed will include a comparison of conventionally produced foot orthotics; 3D scanning versus pressure mats; making corrections with plaster versus the keyboard; wood positives, EVA and polypropylene negatives; posting and grinding; and finally covering. This session will provide attendees with a greater knowledge of CAD-CAM technology, as well as the benefits and control using CAD, and the manufacturing techniques and machinery needs.
G1: The Opportunities and Uses of Rocker Techniques and Technology
John Greco, C. Ped., Alan K. Johnson, Vern Walther, C. Ped.,
Over the past several years, the variety in the manufacturers of rocker sole shoes and those claiming to be rocker sole shoes have flooded the market with confusion. Unsubstantiated claims of toning, weight loss, and cellulite reduction overtook a product base originally focused on medical benefits. Rocker bottom footwear remains a key tool in the pedorthic arena. This session identifies the key aspects of a rocker sole and focuses on identifying the correct rocker bottom for your patient’s/client’s needs. Proper application of OTC rocker bottom shoes help patients/clients reduce pain, activate muscles, increase comfort, improve gait, enhance balance and even improve the alignment of their spine. This session will identify the types of footwear appropriate for different needs. Additionally, we will examine the available literature and clinical studies on the effect of rocker technology footwear on the foot, leg and back. Furthermore, we will discuss the design and construction of various footwear models, illustrating how they produce specific effects for patients/clients wearing them, review proper education and fitting of products to the end client, and, as time allows, view a live demonstration of walking in rocker sole shoes with voluntary participation from the audience.
G2: Physician/Supplier Requirements to Accurately Submit TSD Claims to the DME MAC Jurisdiction C
John Shero, C. Ped., CFO, COF
This session will review the Physician/Supplier requirements needed to accurately submit Therapeutic Shoes for Persons with Diabetes benefit claims to the DME MAC JurisdictionC. This session will look at the coverage criteria for the Certifying Physician and an in-person evaluation of the patient (DMEPOS quality standards published in 2009); coding examples; utilization limitations of coverage; required modifiers; documentation requirements of a typical beneficiary file, orders, Statement of Certifying Physician, and medical records; Comprehensive Error Rate Testing (CERT), which includes the audit process and responding to a request from the CERT contractor; and, DME MAC Jurisdiction C resources and events.
G3: Inside Matters
Zoe Rios, BOC Pedorthist
This presentation will explore how recent footwear research compares to the fundamental structure for proper shoe function in traditional shoes. The studies also look at how the interior shoe surfaces correlate with lower limb injury rates. It will then look at alternative pedorthic modifications that are complementary to alternative shoes choices when considering the specifics of the studies presented. The focus will be on methods and techniques used in traditional shoemaking that have relevance to today’s needs and can be used in manufactured shoes.
General Session: “Hands-on” Demonstrations of Intrinsic and Extrinsic Pedorthic Casting Techniques
Chris Costantini, C. Ped.; Dane LaFontsee, C. Ped.; Jeremy Long, C. Ped.
There are many ways to cast a patient for orthotics and custom footwear depending upon the patient’s pathology, the desired outcomes and more. This “hands-on” session will review intrinsic and extrinsic casting techniques and the conditions that they are best suited for, followed by live demonstrations to create casts appropriate for several given pathologies.
Saturday, November 3, 2012
General Session: The Minimal Shoe Running Craze
Dr. Mark Timmerman; Dr. Craig Young
The trend toward minimal shoe running has created passionate debate, new shoe designs and at least a couple of studies. In this session, two renowned physicians will provide an overview of this current phenomena, explore the medical pros and cons to minimal shoe running, and provide pedorthists with a perspective on what to look for during evaluation and how best to head off or accommodate the injuries that are a result of minimal shoe running.
H1: An Overview of Materials Available for Orthotic Fabrication
William Meanwell, C. Ped.
This session will explore the terminology and technology of materials available for orthotic fabrication, including the use of a Durometer; understanding the Shore A scale; the manufacturing of EVA and other materials; pathology and materials selection; the use of polypropylene, DBX graphite, performance materials and composite materials; friction and shearing issues with material; and, the properties of materials and adhesives.
Attendees will develop a greater knowledge of patient assessment and material selection relative to patient needs; heating and adhesive use with a variety of materials; and the characteristics of thermo-moldable materials.
H2: The Challenges and Successes of a Mobile Orthotics Business
Rachel Eisenfeld, C. Ped.
This session will provide insight into the challenges and successes of owning a strictly mobile orthotic business. While the store front model is shown to be a successful business, many are looking to expand into other lucrative and contemporary avenues. This session focuses on the mobile business model and how successful it can be without a store front as its bread and butter.
Exploring the question “can orthotic businesses go mobile to be more cost effective and affect a broader clientele while maintaining or increasing customer satisfaction?”, the session uses mindful and entrepreneurial inquiry to examine a series of highly effective and lesser impacting business models to maintain and support a successful local mobile orthotic business. In addition, the session will cover clientele, patient satisfaction, cost effectiveness, adaptations for a mobile business, and the future for growth.
H3: BOC Facility Accreditation
Wendy Miller, BOC
The regulatory world in which the pedorthist practices is changing rapidly, with one of the most dramatic requirements being facility accreditation standards for all DMEPOS suppliers and providers. This session reviews the current regulatory environment relative to facility accreditation, provides updates, and reviews the Board of Certification/Accreditation, International’s pedorthic facility accreditation program.
I1: Orthotic Fabrication Techniques
William Meanwell, C. Ped.
This session covers the technologies and techniques of orthotic design, including the use of dual Durometer posting; extending posting to Sulcus; forefoot control of the hypermobile first ray; the Kirby Skive; and, the Blake inverted. Attendees will develop a greater knowledge in the areas of posting and use of material; controlling the hypermobile first ray through forefoot posting; and, utilizing the Kirby Skive and the Blake Inverted orthotics.
I2: Best Practices in the Diabetic Foot Exam from a Podiatric Perspective
Dr. Allison Garten
This interactive session will cover the various components of the diabetic foot exam through the eyes of a podiatrist, including dermatological, vascular, neurological and orthopedic. The session will also review case examples of common areas of skin breakdown based on the various parts of the exam. Attendees will view a diabetic foot exam as given in a podiatric office setting and, finally, attendees will learn how to easily spot areas that are prone to ulceration before they occur.
I3: AFO/Shoe Combos for the Charcot/Severe PTTD/Severe RA Foot Type
Ted Dean, C. Ped.
The Charcot and Severe PTTD foot types present serious challenges to the pedorthic practitioner. This session will review some of the clinical successes that the speaker has had with custom shoes combined with gauntlet AFOs into one unit. Methods of casting, design, fitting, adjusting, and gait accommodation using a Line of Progression rocker sole will also be discussed. Finally, the benefits of the combination of an AFO and shoe versus separate devices will be explored.
Closing General Session: Total Ankle Replacement: What Pedorthists Need to Know
Nancy Naftalin, C. Ped.
In the United States, a significant number of patients have ankle arthritis, 6% have severe enough arthritis to require surgery. Today there are options, and insurance companies are now covering total ankle replacements as one of those options. In my clinic alone, our orthopedic foot and ankle surgeon does about 20+ total ankle replacements a year; if that is our little corner of the world, the total number of TARs worldwide is vast.
As pedorthists, we have a responsibility to keep informed and up-to-date on the procedures offered to the population at large. Total ankle replacements have requirements for footwear, sometimes inserts to protect the patients and extend their quality of life with this type of surgery.
This session will review the footwear needs for total ankle replacement patients, review x-rays of total ankle replacements, and discuss what criteria doctors use for surgical options for an ankle arthorodesis versus total ankle replacement.
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