Best Foot Forward

The Pedorthic Footcare Association defines pedorthics as “the management and treatment of conditions of the foot, ankle and lower extremities requiring fitting, fabricating and adjusting of pedorthic devices.” To that end, board-certified pedorthists often find themselves wearing two hats: health care professional and business manager.

Many pedorthists own their own practices, or they practice pedorthics at comfort shoe stores and O&P facilities. Either way, they are subject to shifting local and national economic conditions, changing markets and evolving technologies — all of which can make or break any pedorthics or pedorthics-related firm.

Strategies for pedorthic success vary, according to veteran board-certified pedorthists Peg Lucas-Swisher, CPed, Rob Sobel, CPed, Chris Stanley, CPed, Bob Schwartz, CPed, Erick Janisse, CPed, CO, and Randy Stevens BOCPO, CFo. However, they all agree that good marketing, innovative staff training and a willingness to change their established business practices are keys to their success.

“We have gone on to do more than pedorthics,” Lucas-Swisher, co-owner of Sole Comfort Shoes in Albuquerque, said. Her business partner is a podiatrist. “We have a lot of leeway and there are no laws governing what can and cannot be done in our state.”

Lucas-Swisher, a former Pedorthic Footcare Association (PFA) executive board member, said her store no longer accepts payment for shoes and orthoses through insurance, “with the exception of workers’ compensation and a contract with one of our [American] Indian reservations.” She said that not having to deal with insurance helps her keep prices low. All other services Sole Comfort provides are cash-and-carry.

“We do biomechanical evaluations on clients, both referrals and walk-ins. We are charging $50 per half hour for our evaluation,” she said.

Beyond the store, Lucas-Swisher markets her services weekly to health care professionals. “Each practice receives a different packet as to what we can do for their patients, which relates to what they do. This way we do not appear to be competition, but allies in their quest for patient care,” she said.

Lucas-Swisher is also beating paths to assisted living facilities and nursing homes. They are working on a concept of in-house fittings for residents. Residents can also sign up to ride a bus to the store for individual fittings. Her practice also is trying to figure out if they can do a mobile unit.

Back at the store, she conducts staff training daily. “Monthly, we review different biomechanical problems. And we keep reading material — both books and trade magazine — in our break area.”

Lucas-Swisher said she is seldom on the sales floor any more. The practice has a pedorthic technician who runs the floor, a contract bookkeeper, a contract social media person, and a backup for ordering and stock management. They also have hired a business coach who she and her business partner meet with weekly. She said her efforts are paying off at the cash register.

“Since making our changes, our business has been up 20% in the last 3 months, and we expect to see greater increases in the future,” she said.

Keep up with changes

Rob Sobel, PFA vice president, sayidhis practice continues to grow, too. He owns Sobel Orthotics and Shoes in New Palz, N.Y.

“Some [clients] with insurance are finding their insurance is not covering all they had hoped for,” he said. “Fortunately, a fair number of them are willing to pay out of pocket for their foot orthoses.”

Sobel said that, like many of his clients, he is always on the lookout for bargains. He tries to buy my materials on clearance whenever possible. Good marketing also helps his business.

“I just keep up relations with prescribing physicians and practitioners. Word-of-mouth seems to be pretty effective for me right now,” he said.

Sobel said he sometimes has to spread the word about Medicare rules to his clients.

“The biggest issue is trying to get patients to understand that without the proper paperwork from their physician, they are not getting their shoes,” Sobel said.

Sobel added that he loves getting new, high-end and unique materials. “This helps us keep ahead of our competition and gives us the ability to offer more diverse and unique options our patients can’t get elsewhere. If you pitch it right, the patient will go for higher quality materials over price almost every time.”

Chris Stanley of Lamey Wellehan Shoes, a six-store Maine comfort footwear chain based in Augusta, said business is improving at his company. He said because Lamey Wellehan is a retail shoe firm, it is not affected by changes in government health care policy.

“We are a family shoe store with a pedorthic influence,” he said.

Stanley said changes in the kind of footwear people seek have boosted business at Lamey Wellehan, notably in the running department.

“Still, all said and done, it is the overall economy that will affect our business.”

Lamey Wellehan does not accept Medicare or private insurance, nor does the company have pedorthic laboratory facilities, said Stanley, a member of the PFA board of directors. They refer patients who need custom work and partner with local cobblers for those who need shoe modifications. He said the orthoses and other foot-care products the company sells are of the conservative over-the-counter variety — but their solid assortment of footwear is their primary tool.

“However, we try to deliver service with a pedorthic perspective,” he said.

Invest in marketing

From a marketing perspective, Stanley said the big challenge is the measurement of the effectiveness of promotional efforts. He has done meet-and-greets and will continue to do them, inviting potential referral sources to a store to have a tour, meet the local cobbler, talking to a certified pedorthist and the store manager. He said Lamey Wellehan expects to start a direct marketing campaign soon.

“We will do a series of large format postcard mailings to promote a different service or product every couple of weeks,” he said.

Company representatives also travel to health fairs and other off site events. Stanley has been to some large industrial accounts’ wellness days as well as programs put on by the YWCA and a local hospital. The company also sponsors many local road races and brings its foot health table to big running expos about 6 to 8 times a year. In addition, he said the company’s pedorthic orientation helps bring in customers from local factories.

“They send their employees to us for work boots or work shoes. One of our bigger accounts had their own wellness fair a while ago and we participated, talking foot health and scanning feet. Someone in their office liked what we were doing and it turned out they were trying to figure out ways to control workers’ compensation issues and work place injuries.

“A program evolved where their employees receive a standardized assessment when they come shopping for work shoes from us. We document the measuring process, ask if they have foot issues, review the flexibility of the foot and properly fit them to the shoe. Their employees are happy, productivity is up, and it is a win-win for everyone,” he said.

Likewise, he said staff training is a win-win for fitters and the fitted.

“When associates are part of a training program, they see that the company really values them and wants to invest in their success,” Stanley said.

Lamey Wellehan has a ShoeFits course that is based on the “When the Shoe Fits” program sponsored by the National Shoe Retailers Association, the PFA and the American Orthopaedic Foot and Ankle Society. After completion of the course, staff members earn a certificate, special recognition on their name tag and a small raise. The company is also developing its own portal on the 3point5 website. Open to all footwear retailers, the website provides vendor-supplied training sessions.

“With this new portal, our managers will be able to view their staff’s progress and their training scores, plus we can have competitions between the stores for the most educated staff, and rewards for the highest score, and so on,” he said.

Pedorthic knowledge on the sales floor

Already operating is the company’s in-house retail pedorthic specialist program. While Jim Wellehan, the company owner, and Stanley attended the Ball State University pedorthics training program, Stanley said “sending associates to pedorthic school just isn’t economically feasible for us. Still, we need to have associates on the floor who have pedorthic knowledge so our culture can continue.”

Like Lamey Wellehan, Eneslow Pedorthic Enterprises in New York City does not accept Medicare, said owner Robert S. Schwartz. But he stressed that “the ‘practice of pedorthics’ remains the cornerstone to Eneslow’s uniqueness as a brand and as a legacy business that has been operating since 1909.”

He said Eneslow is “struggling to reinvent itself so that we are back in a growth cycle, affordably. Reducing costs has been the number one focus. Downsizing is part of that. At the same time, we have invested resources in ecommerce and social media into our marketing mix. We are relentlessly in pursuit of referrals from the allied health care professionals who see people with foot and ankle related problems. We want them to know that we are their nonsurgical pain relief remedy. We take it very seriously; we are the last resort and best resort for generations of New Yorkers and people who visit from all over the world.”

Furthermore, Schwartz said Eneslow stays with the company’s medical and consumer customer base through ecommerce, direct mail and social media. “At store level we are actively soliciting contact information to help us build our database.”

In-store activities also include staff training. New employees are trained in each aspect of their responsibilities and need-to-know in their first weeks on the job. They are provided an employee policies and procedures manual to learn, own and sign.

Schwartz said weekly staff training sessions and meetings are held to formally update staff on policy and procedural changes. New products are reviewed each week. Custom shoe and orthosis cases are reviewed in a team environment to determine the best options and solutions within a particular pedorthic need. Each aspect of the business is treated as a continuous learning curve.

Changes in pedorthics technology are also non-stop, he said.

“The key change we made when we moved to our current location in 2008 was to have high quality equipment in our custom fabrication lab. It allowed us to continue to create and customize people’s footwear in our headquarters on Park Avenue and 32nd Street in New York City, two blocks from the Empire State Building. We partnered with Jos America, who installed and trained us on managing and maintaining the equipment.”

Regulations, documentation take priority

Janisse said keeping up with changing government health care policies is a challenge at Orthotic and Prosthetic Design in St. Louis, where he is clinical director of pedorthics.

“I would say we are fine here. But we won’t stay fine if we are not continually moving to stay current — or, even better, ahead — and compliant with the new rules and regulations that are foisted upon us seemingly daily,” he said.

He said the two most important areas where his firm has had to adjust are in re-evaluating processes, procedures and staffing to ensure maximum efficiency and total compliance and in adopting a work approval process.

“We no longer begin any fabrication until we have each and every piece of required documentation in hand, and it has all been verified as accurate and appropriate,” he said.

At the same time, Janisse said continual presence in the clinics is vital to his firm’s marketing program.

“You know the old saying, ‘Out of sight, out of mind.’ With certain physicians, if you are not physically there with them, the referrals go who-knows-where. We have been fortunate to have been invited to multiple orthopedic clinics, and we staff them at least four days a week,” he said,

He said on a day-to-day basis, Medicare billing and paperwork “is easily the most aggravating part of our practice for all parties concerned. My office staff gets abused on a regular basis by upset patients who don’t understand why their items are on hold while we try to procure the necessary documentation. The reality is that we — like many other providers in our field — pay people who do nothing else all day but make sure all documentation is on file and correct so that we can provide service to these folks,” he said.

Training makes a difference

Staff training takes time, but it is crucial, according to Janisse.

“It is an ongoing process. We have a few key people who attend all of the coding and billing and compliance seminars they can, and then they disseminate the information to the staff during regular organized training sessions,” he said.

O&P Design stresses cross-training. “We have worked hard to streamline our fabrication processes and cross-train all of our lab staff, so that everyone can do everything. We have also created and implemented more and stricter quality controls. Over the last year, we have nearly eliminated re-dos and cut waste dramatically,” he said.

Keeping up with the ever-changing health care environment is also a top priority with Randy Stevens, who owns Randy Stevens Family Footcare in Harrisburg, Pa.

“It is imperative to evaluate the contracts with the third-party payers which you may have, and those so-called high option Medicare plans. We have stayed consistent through the health care changes because we are very much tied in to our referral sources and third-party payer relationships,” Stevens, an ABC-certified pedorthist and past PFA president, said.

He added that renegotiation is always an option with third-party payers.

“Looking at product and services we may provide but not manufacture has been the area which we had to evaluate the most so it doesn’t interfere with the quality of care and service which we provide to our patients,” he said.

Stevens said consistently providing top quality care will naturally increase referrals. “But you need to stay aware of who your referral sources are linked to as far as insurance carriers. Referral sources are always concerned about out- of-pocket expenses to the patients who they send to you.”

Staff training goes hand-in-hand with patient care, according to Stevens. He cited in-house training as well as training help through national organizations like PFA and state organizations like the Pennsylvania Orthotics and Prosthetics Society. He also relies on outside assistance in developing new fabrication methods and adopting new materials.

“We have been fabricating devices for a few years with the continued support of our vendors and other colleagues. This helps to keep us consistent in our quality of devices which we provide.” — by Berry Craig

Disclosures: Lucas-Swisher, Janisse, Sobel, Schwartz, Stanley and Stevens have no relevant financial disclosures.