The past five articles have attempted to provide a crash course on AFOs. This is a very challenging subject. The simplicity of the material presented in these articles does not in any way intend to diminish the skill set of other professionals in meeting the needs of these often-complex patients who present with many challenges. Pedorthists and particularly Orthotists undergo extensive training in biomechanics, material science and fabrication techniques. They often participate in post graduate training and it may take years before they understand all the challenges faced by many of our patients.
Nevertheless, even if you have no intention on providing a custom AFO, it is important for podiatric physicians to at a minimum understand the needs of these patients. This will allow you to at least have the skill set to understand the basic needs of the patient, allowing for writing a proper prescription. It is doubtful that any physician would have a discussion with a pharmacist and say give the patient an NSAID or anti inflammatory agent, without specifying a name, dose and frequency.
If your choice is not to provide but prescribe, the prescribing physician (DPM, MD/DO), must provide the pedorthist or orthotist with a “Standard Written Order” (SWO) so that the pedorthist or orthotist may be paid.
The SWO must contain the following elements:
Order Date
Patients Name or Medicare ID
General Description of the item
For single items no quantity is required
Doctors Signature
Doctors Name or NPI (Printed Name is suggested)
Without a SWO, the supplier (pedorthist or orthotist) would fail any audit and either not be paid or be asked to repay Medicare.
While this has been noted before, a SWO is not required if you the physician are providing the AFO. In addition to a proper workup, the information noted above, must be in the chart. One can simply modify their Kevin Root order form to include the above information.
If instead you choose to refer the patient to a DPM colleague who will fabricate the AFO, a SWO is not required. What is required is that your patient be referred as a patient for an evaluation.
Example: Please evaluate Mr. Smith for Posterior Tibial Tendon Dysfunction and non-improvement with foot orthotics.
This allows the referred physician to continue to do their own workup and determination of what is required. Sending test results to the referred physician and copies of your notes is also suggested.
If instead the referred colleague receives chart notes and an order reading such as:
Please fabricate a custom AFO for Mr. Smith, they are simply acting as the supplier, they would be required to have meet other expensive accreditation and Surety Bonding expenses.
Developing a good relationship with a colleague who may be more well versed in both understanding both the nuances of the needs of the patient and fitting is invaluable.
This is also true if you are the more experience practitioner and wish to reach out to other colleagues (DPM, MD, DO) in your area.
Of course, this assumes there is mutual trust on the part of both practitioners, that one will not “steal” the patient. This is akin to the general dentist referring to an orthodontist or endodontist, with the latter two assuming a narrow focus of care and referring the patient back to the general dentist for other care. You may have talents or services which you provide which the AFO caring podiatrist does not.
Choosing the correct referral source and obtaining a good result should be your primary concern and will allow this and other areas of your practice to grow.
