What You Need To Know About Dispensing Diabetic Shoes

Jonathan Moore, DPM

Having a diabetic shoe program can offer great therapeutic value to your patients and also grow your practice. Accordingly, this author details essential steps toward running and maintaining an effective diabetic shoe program.

Developing and maintaining a fully optimized diabetic footwear center of excellence is not easy. Few in podiatric medicine achieve this. In fact, as fewer podiatric physicians are developing and maintaining their diabetic shoe business, more and more pharmacies and durable medical equipment (DME) companies are finding footholds in our own backyards. While some of these non-physician shoe suppliers do an adequate job, I have found that many do not and as a result, physicians and patients become cynical about the benefits of diabetic footwear.

   Having lectured and written on this topic for many years, I have noted a wide spectrum of thought among physicians regarding diabetic footwear. Some think that the diabetic footwear program is way too much trouble. Others find it valuable but enter into it with mediocre effort and training, resulting in bad outcomes.

   Many podiatry practices function with the illusion that the doctor alone can achieve and maintain success in a healthy diabetic shoe program. This approach is self-defeating for many reasons that I will explore below. If the doctor is responsible for ordering shoes, completing the certificate of medical necessity (along with the comprehensive diabetic foot exam), mailing the information to the certifying physician and then having to deal with back orders and all of the patient communication that is necessary while patients wait on their shoes and paperwork, failure and frustration are most certain.

   This scenario is common among podiatric practices and is why many podiatrists who fit shoes fit, on average, only five pairs a month. Many of these offices have in excess of 100 office visits per month from patients with diabetes on Medicare.

   The self-limiting practice or misperception about maintaining a diabetic shoe program is that the “product” is not important. Many doctors do not ensure that they have shoe styles and types that are reasonable for the range of foot types and pathology.
Another common error among practices is a complete and utter lack of patient recall year after year among patients who have received diabetic footwear in the past. A surprising number of patients with diabetes in an average practice get fit for shoes one year and then somehow are forgotten about the next year.

   Either the patient did not receive an appropriate follow-up appointment or did not get education about the need for follow up. In some cases, many patients will miss an appointment or have an accident and simply not get another appointment. Those are the patients who need reminders about their need for a diabetic evaluation and comprehensive diabetic foot exam.

   Practices that allow patients to slip between the cracks year after year suffer for this economically while the patient suffers therapeutically.

   Having protocols to identify qualified patients and ensure they are scheduled for a separate comprehensive diabetic foot assessment each year is fundamental. Such an approach will allow the physician to determine any changes in ulcerative risk status, qualification for shoes and, furthermore, allow for Physician Quality Reporting System incentive requirements. Many doctors find themselves too busy to train their staff or educate their patients. Accordingly, little gets done and few are fit for shoes. Additionally, without educated staff, adherence and documentation often suffer.

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