What’s in a Name? How the Pedorthic Footcare Association Has Evolved from a Footwear to a Footcare Model

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By Betta Ferrendelli

When an organization changes its name, the reasons for doing so vary from changes in its core function to better aligning the organization's name with what it does. The Pedorthic Footcare Association (PFA) recently changed its name from the Pedorthic Footwear Association, but since its inception more than 50 years ago, PFA hasn't evolved from a footwear model to a footcare model, per se, according to its executive director Brian Lagana.

"Pedorthic footcare has always been dependent [upon] pedorthic footwear, a conservative, [non-surgical] treatment for lower-limb conditions," Lagana says.

What has evolved, however, is the professionalism of the organization. PFA has grown and matured in response to the changing needs of the footcare specialists it serves. The organization has shown greater flexibility in responding to changes, mostly regulatory, that have occurred over the last several decades, says Lagana, who has been PFA's executive director for eight years. He has been in association management at the executive director level for more than 13 years and has worked in the association sector, mostly in legislative and regulatory capacities, for 22 years.

But that evolution hasn't come without the usual growing pains associated with change.

Over the years, there has been a general misconception about the work that pedorthists do and, as a result, the type of professionals PFA serves. Essentially, the general public and referral sources have traditionally thought of pedorthic professionals as just a bunch of shoe peddlers. This perception is incorrect, according to Kristi Hayes, CPed, and current PFA president.

"While it's true that a small percentage of our membership practices out of retail-type facilities, pedorthists are pedorthists regardless of the practice setting," she says.

History of PFA

Lagana

Lagana

PFA began as a trade organization in 1958 called the Prescription Footwear Association. PFA's first pedorthic educational conference was held shortly after the organization formed. Thirteen Midwestern shoe manufacturers and seven local retailers joined forces to sponsor a weeklong footwear education conference. At the conclusion of that conference, six local business people formed a group called the Certified Prescription Footwear Applicators (CPFA), which had a mission of establishing and encouraging high standards in fitting and merchandising basic and prescription footwear.

PFA has evolved into a nonprofit professional organization with roughly 1,700 members-and these professionals do much more than sell footwear out of strip malls, Hayes says.

"Our scope of practice encompasses the entire foot below the ankle," says Hayes, a second-generation pedorthist who has spent the last 18 years using her knowledge in business management, sales, and marketing to consult with pedorthic facilities nationwide.

According to the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC), of its roughly 2,500-plus credentialed pedorthists, 34 percent work in a retail-type setting, 19 percent work in a pedorthic practice, and 16 percent are employed with an O&P practice. Forty-eight percent of patients who are treated have diabetes, 14 percent have arthritis, and 12 percent have posterior tibial tendon dysfunction (PTTD).

Hayes

Hayes

Pedorthists, according to Hayes, provide premade and custom-made orthotics, custom, customized, or supportive or corrective footwear and modalities.

Identity Crisis

However, over the last five years or so, the pedorthic profession has gone through an identity crisis of sorts as a number of mergers happened. In 2006, the Board for Certification in Pedorthics (BCP) merged with ABC, and in 2009, the Commission on Accreditation of Pedorthic Education (CAPE) merged with the National Commission on Orthotic and Prosthetic Education (NCOPE). These mergers left some members of the pedorthic community wondering where they stood within the larger allied healthcare landscape. But, as the saying goes, change is good.

"Every profession evolves, and it is necessary for the organizations representing these groups to keep pace," Lagana says. "Otherwise you would have a 21st century profession with a 20th century organization representing it."

Zafatter

Zafatter

In 2008, PFA's volunteer leadership conducted a strategic planning session to discuss PFA's identity, physical look, and membership, among many other topics and factors, Hayes says. PFA usually conducts strategic planning sessions every two to five years, depending on what is needed for the organization, she says. Another session is planned for later this year. In order to prepare for these sessions, PFA surveys its membership and, with the help of a professional consultant, uses the survey results to plan the sessions' agenda.

After the 2008 strategic planning session, PFA's staff, along with its marketing, communications, and editorial committee went to work, and the results of the 2008 strategic session have begun to materialize, according to Hayes. That includes the completed redesign of PFA's magazine Current Pedorthics and a new logo to accompany the membership-approved organization name change from Pedorthic Footwear Association to Pedorthic Footcare Association.

"Believe it or not, a proper name goes a long way in changing perspectives," says Hayes, who has served PFA since 2005 as a member of its board of directors, as the marketing, communications, and editorial committee chair, and as a member of the Council on Pedorthic Education (COPE) committee.

Each time PFA members have voted on a name change for the organization, the decision has been a difficult one, and this time was no exception, she says. "Each time a change was proposed, it was done so for the betterment of the industry and, historically, many, many names [were] thrown down."

The bottom line to PFA's new name, says Jay Zaffater, CPed, BOCPD, a former high school teacher and a 1989 Louisiana Tech University, Ruston, graduate, who has been providing footcare services in Louisiana for the last seven years, is that it is "the best name we've ever had in our history."

Was it necessary to change the name of the organization? Without a doubt, members say yes. Over the course of its history, PFA members have come to the realization that foot problems are often not limited to the foot.

"Pedorthic Footcare Association better reflects the fact that pedorthists provide pedorthic footcare and not just footwear," Lagana says.

It isn't just about the shoes and inserts, he says. "It's about the education, training, and experience that goes into becoming a credentialed pedorthist and the professionalism and services that they bring to patient care."

It is like saying a physician is just about tongue depressors, needles, and drugs and not taking into account their education and knowledge in patient interface and treatment, Lagana says.

Zaffater says the organization's old name no longer carried the appropriate meaning.

"Pedorthics is about the design, manufacturer, and fit of footwear and orthoses," he says. "And we provide foot-appliance modalities for ambulation. Our old name did not reflect our population of professionals."

Hayes agrees, saying that the organization's old name had become obsolete. "It was a hindrance," she says. "It limited the vision of what we do to those who only saw the name. To appropriately market a profession via its professional organization, the organization's name should appropriately reflect what the industry is about. We are footcare, plain and simple, whether it's preventative footcare or footcare provided after a disease, ailment, or injury has occurred."

Refreshing PFA's image will accomplish a great deal, according to Hayes. Namely, the new image will help enhance perception and recognition with referral sources, the public, decision makers at the state and local levels, as well as among other allied healthcare professionals, she says.

Changing its name and image to better reflect what the organization does as a whole and improving its print and online products is only a portion of what PFA has done to re-energize the profession.

"Since PFA's inception, it has always marketed the profession and the credentialed pedorthist, lobbied on their behalf and fought for their right to practice, and provided the best continuing education possible to its members," Zaffater says. "These things are PFA's mission, and the mission has always been the same. The vehicles may change as technology advances, but the goals are the same."

According to Lagana, in addition to PFA's rebranding project to provide a more professional look in all of its member and public-facing products, the organization has also taken the lead in advocating for more advanced pre-certification education standards, which will go into effect next year. (Editor's note: For more information, read The Pedorthist Education Debate, The O&P EDGE, November 2010; www.oandp.com/articles/2010-11_02.asp) PFA also continues to be a leader in providing the profession with networking opportunities and continuing education opportunities, he says.

But PFA is limited by what it can do, Hayes and Lagana agree. They say it is now up to PFA members to continue to support its profession and its efforts to advance pedorthics.

"PFA can only do so much to advance the profession without the members of the profession actually stepping in to help do the same at the local level," Lagana says. "PFA has long advocated that pedorthists get involved in their community, networking with other healthcare professionals."

Hayes encourages members to use the tools PFA has developed to promote greater awareness of the profession to the general public. Otherwise, she says, "All the work to rebrand PFA, to advance pedorthics through its governmental affairs efforts, and to provide high-quality, continuing education [will be] in vain."

Betta Ferrendelli can be reached at



A PFA Regulatory Update

PFA

The O&P EDGE asked the Pedorthic Footcare Association (PFA) what issues might impact the pedorthic profession on the legislative and regulatory fronts, and Brian Lagana, PFA executive director, provided the following update:The Centers for Medicare & Medicaid Services (CMS) has recently required its jurisdictional Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to conduct pre-payment claims determinations in an effort to reduce by 50 percent the national claims payment error rate for this product category as mandated by the Patient Protection and Affordable Care Act (PPACA). The contractors conducting the audits for CMS are incentivized by rejecting claims for payments, providing a significant challenge to pedorthists when it comes to challenging the appropriateness of the rejection.

Though PFA applauds efforts to reduce waste, fraud, and abuse in the Medicare system, PFA believes the supplier should not be held accountable for the lack of documentation on the part of the certifying physician concerning the content, appropriateness, or correctness of the physician's clinical notes. Medicare Part B does not allow for a pedorthist or other supplier to be held accountable for a physician's lack of appropriate documentation and clinical notes.

It is nearly impossible for pedorthists to determine whether the patient notes provided by the certifying physician accurately reflect the patient's medical condition. CMS is essentially forcing the pedorthist, or other supplier, to diagnose and confirm the patient's medical condition that the certifying physician has already determined and certified, all of which is outside of the pedorthist's, and other supplier's, scope of practice. This places pedorthists and other suppliers at significant risk of liability by compromising their professional code of ethics and could possibly lead to patient malpractice suits.

CMS also fails to consider that physicians are not always responsive to suppliers' requests for documentation to substantiate the claims of their Medicare patients, even though the physicians are legally required to provide the documentation on request and that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows such transfer of patient information to suppliers.

PFA has suggested the following steps to CMS to help mitigate the consequences that pedorthists and other providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are now facing:

  1. CMS should undertake programs to better educate the physician community about its responsibility to patients and allied healthcare partners concerning documentation and the HIPAA allowance for information sharing and effectively enforce these requirements so that the certifying and prescribing physicians comply with all reasonable supplier documentation requests needed to process patient claims.
  2. CMS should not hold the supplier-usually a small business with no ability to police the documentation efforts of the prescribing or certifying physician-financially accountable. In other words, CMS should not deny a claim if all good-faith attempts at securing the necessary documentation from the prescribing and/or certifying physician have been ignored.
  3. CMS should allow the prescribing physician's patient notes to support medical necessity.
  4. CMS should clarify the ability of the pedorthist/other supplier-in the case of a denial of payment based on non-medical necessity-to be able to either bill the patient for the items that were dispensed upon the order of either the certifying or prescribing physician, or be able to take back the non-medically necessary items from the patient.
  5. CMS should change the definition of qualified supplier to include only those practitioners who have the appropriate experience and qualifications for evaluating, fitting, and fabricating therapeutic shoes and inserts (including follow-up). This will ensure that Medicare beneficiaries are receiving the best quality of care and items possible and that the integrity of Medicare's Therapeutic Shoes for Persons with Diabetes (TSD) benefit is being maintained.

PFA believes that CMS took a significant step backward last year, however, in ensuring that only qualified suppliers fit and dispense diabetic shoes and inserts to this most vulnerable population. In July 2010, and reaffirmed in December 2010, CMS instructed the National Supplier Clearinghouse (NSC) to allow suppliers to provide diabetic footwear as long as the supplier could illustrate that some type of training had been received until CMS defines the term "other qualified individual" in Section 1861(s)(12)(C) of the Social Security Act (SSA). In the instruction, CMS did not quantify or qualify the type of training that a supplier needs to show.