What You Need To Know About Dispensing Diabetic Shoes

Author(s): 
Jonathan Moore, DPM

   Success requires aligning identification, evaluation, fitting and documentation procurement along with the right adherence tools. Without attention to detail and proper staff training, diabetic shoe programs will flounder in mediocrity.

   While this article is not for the purpose of convincing the cynic that diabetic footwear is valuable for patients (I assume that the enlightened podiatric physician understands this), this is a primer for how to be successful in starting and maintaining a successful program.

What Do Successful Diabetic Shoe Programs Have In Common?

My definition of success in running a diabetic shoe program consists of the following steps.

   The first step is successfully identifying all patients with diabetes who qualify. Some patients will have already been fit with shoes from other facilities and many more have not ever received shoes. One must train the staff on established protocols in order to identify when the patient last received diabetic shoes and determine insurance eligibility. Additionally, this means performing a thorough diabetic foot examination.

   Second, success is growth. Success means that your program is growing every year. This takes education, excellent service from your office, a good product and recall for those patients who slip between the cracks with appointments.

   Third and most importantly, success means providing a good product and service compliantly. This means proper documentation in the chart along with attention to DME supplier standards.

   So with these things in mind, let me share with you six fundamental pearls for achieving success in maintaining a diabetic footwear program.

Why It Is Important To Designate A Diabetic Shoe Coordinator

In my opinion, success depends on making the program’s success one person’s responsibility and establishing benchmarks at the beginning of the year on how many shoes you will fit. The diabetic shoe coordinator should have responsibility for identifying all qualified patients. If you do not have a diabetic shoe program in your office, you are likely fitting five or fewer pairs of diabetic shoes a month. If you have studied the certifying conditions that qualify one for diabetic footwear, I strongly contend that if you see 100 patients with diabetes in your office in a month, conservatively 75 percent of those patients will meet the Medicare qualification for therapeutic shoes.

   The coordinator should ensure that every patient with diabetes is scheduled for a comprehensive diabetic foot exam. One should allot adequate time to allow for a comprehensive diabetic foot exam, sufficient patient education and time for selecting and measuring their shoes. Offices have the option of providing required forms to the patient to bring to the Medicare doctor. Alternatively, the DPM’s office may fax forms to the MD’s office for signature and dating. The doctor will complete the certificate of medical necessity and place the certificate alongside the comprehensive diabetic foot exam. Then this documentation will get into the hands of the diabetic shoe coordinator. Then one would measure the patient’s feet and show him or her (via catalogue, computer tablet or samples) the shoe type and style recommended by the doctor. Then the staff will mail out the certificate of medical necessity that day, not five days later or one week later.

   Furthermore, the diabetic shoe program will have a spreadsheet that will indicate when the office sent the patient’s certificate of medical necessity, who received it and when the shoes came in.

   In addition to this information, the patient’s shoe style and size would be included along with whether the patient received custom or prefabricated orthotics.

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