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Essentials For Diabetic Shoe Fitting Success By Josh White, DPM, CPed

I recently visited a team a podiatrist’s office. They have been a part of the Therapeutic Shoe Program and fitting diabetic patients with shoes for many years. I appreciated their interested in learning how they could improve what could be considered a “good” shoe program, and in going from “good” to “better” or even “great.”

All staff members were encouraged to attend, including: the front office person, who is the eyes and ears of the practice, and who reminds the doctors which patients have diabetes and are due for an annual comprehensive diabetic foot exam (CDFE); the fitting person, who measures, fits and laces patients’ shoes – critical to the program’s success.

We reviewed how the Medicare Therapeutic Shoe Program provides win – win – win benefits for all: patients benefit by getting shoes they need for little or no cost, by doing so, they also decrease their risk for ulceration and amputation, and the office makes money while improving patient satisfaction (and Medicare actually reduces costs).

We reiterated the importance of clearly defining each step in the evaluation and shoe fitting process, and confirmed that while there could be more than one person performing each task, there must be a single person responsible for its execution.

And lastly, we defined the metrics for determining the success of each step – as well as for the program overall.

Here are the steps and how to determine successful execution:

  • Determine the number of patients in the practice with Medicare and diabetes. Every patient should have a dedicated visit for an annual comprehensive diabetic foot evaluation (CDFE) scheduled on a separate visit. This visit can performed by or overseen by the DPM and billed as 99213 if a predisposing condition of ulcerative risk is determined and a plan of care prescribed. Printed copies of the CDFE form are available, for free, from SafeStep upon request. Here is a link to the form: http://safestep.net/safestep/PDF/CDFE(Interactive).pdf?id=431. Note: Someone should track the number of CDFE exams performed (on an ongoing basis), and compare it to the number of patients with diabetes in the practice.
  •  Conservatively, 75% of patients with Medicare and diabetes will have a qualifying risk factor and should be prescribed therapeutic shoes. When scheduling patients, either have a shoe fitting person in the practice available to assist on that day or consider OHI’s Central Casting Program, an on-site Pedorthic service availing Certified Pedorthist to assist podiatrists with examining, casting and fitting patients.
  • Every shoe fitter and CPed should use the “4S’s approach to shoe fitting” which are: Size, Shape, Stability, Style to fit and pair the shoes that meet each patients’ aesthetic desires and therapeutic needs. It’s important to have shoe samples in the styles patients most prefer, and to update them periodically. Fitting displays or a small fitting inventory will go a long way to improve fitting success and patient satisfaction. Patients whose fitting needs exceed what’s possible with depth shoes should either be casted for custom molded shoes or referred to a local footwear clinic. The SafeStep website displays the practice’s “Fit Rate”. If not 85% or better, help is available to fit at least as well as is done by the average office.
  • Use SafeStep’s WorryFree DME program to create Medicare compliance documentation and to procure required authorization from the certifying MD physician. SafeStep’s team of professionals and dedicated services help you save time, and build your practice.
  • When dispensing shoes, emphasize to patients the importance of daily footcare and self-examination to check for signs of ulceration. Encourage them to wear their fitted shoes and inserts as a preventative measure, and to return on an annual basis to be re-evaluated for replacement shoes each year.
  • The true indicators of a successful diabetic shoe program is when the number of shoes fitted increases each year, and the number of wounds treated decreases. While some practices have been deterred from fitting shoes because of the effort required and concerns about Medicare audits, many enjoy the success that this preventative care indicative was intended to achieve. Read the article “Keys for Success for Fitting Diabetic Shoes” to learn more.
  • Qualifying patients should be scheduled for an evaluation and fitted with shoes annually. Despite the benefits, most practices refit less than 25% of patients from one year to the next when all it takes is an outreach effort to patients from each year. Your SafeStep homepage displays the practice “Repeat Rate”. There are tools available, including patient lists, which can be used to facilitate a recall program, to ensure that every patient is evaluated annually to be refit with replacement shoes. To better understand the true value to your practice, read “The $40,000, 4 Hour per Week Diabetic Shoe Program”. The article describes how little time is actually needed, if the program is organized effectively, to yield significant benefits to patients and to the practice.
  • Successful practices set goals at the beginning of each year and monitor their performance on an ongoing basis. To recap, key metrics for ensuring program success include:
    1. The number of annual CDFE’s performed on patients with Medicare. Compare to the number of patients with Medicare and diabetes in the practice. Every patient should have at least one annual evaluation.
    2. The number of shoe fit, covered by Medicare. Conservatively, 75% of patients with Medicare and diabetes will have a qualifying risk factor and should be fit with shoes.
    3. Shoe fit rate. Should be 85% or better. Track on SafeStep Members Home Page. If lower than it should be, assistance is available to help improve.
    4. Refit Rate: Should be 75% by end of year.

Successful practices create incentive programs to reward staff members responsible for each of these key metrics.

  • Further assistance is available by scheduling a One-on-One Training Session with a SafeStep DME Specialist. Topics include:
  • “The WorryFree DME Shoe Ordering Process”
  • Diagnosis Specific DME Treatment Protocols for AFOs
  • AFO and Shoe Compliance Documentation
  • 18 Surefire Ways to Improve Your Shoe Fitting
  • Fall Risk Management Made Easy with Moore Balance
  • The CDFE Strategy

I hope you find this article helpful. I truly enjoy writing these articles and working with practices to help them become more successful. Our friendly SafeStep customer service team is available to assist you with your account and all programs, products, services.

Extra-depth Shoes May Help Alleviate Foot Pain for Older People

For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare – the U.S. government health insurance program for people over 65 – will cover most of the cost of the shoes.

Click here to read the full article!

New Patient Brochure Helps Ensure That Patients With Diabetes Get Evaluated For Annual Shoe Fitting

More than 75% of patients with diabetes and Medicare fit with shoes one year are not fit the next.  This, despite annual coverage that offers podiatrists very reasonable reimbursement and that the American Diabetes Association recommends that patients be evaluated annually to determine their level of ulcerative risk.

SafeStep has created a brochure for podiatrists to give to patients with Medicare and diabetes when scheduling an annual Comprehensive Diabetic Foot Exam.  The brochure explains to patients the importance of the exam as well as qualifications for shoes under the Therapeutic Shoe Program.

IMAGE1

IMAGE2The brochure is available personalized with your practice name and address.  Use as both an appointment reminder for patients’ CDFE and to explain to patients its importance.  It includes at-home foot care tips.  It also shows a preview of stylish athletic, dress or casual Medicare-covered diabetic shoes.

Call 866.712.STEP (7837) to order free sample brochures.  Also schedule a FREE Training Session with a SafeStep EXPERT to learn how to ensure that patients with diabetes, fit with shoes are, if qualified, fit year after year.  Let us show you how to ensure that patients in need of care get it and also that your practice does not miss out on revenue opportunities.

At the conclusion of your training session, your SafeStep EXPERT will ensure that you:

  • Determine your “Number”, the number of patients in your practice with Medicare and diabetes.
  • Can track your practice shoe fitting success using the SafeStep Practice Report Card

SafeStep DME Training will help you grow your practice, improve patient care and enhance practice revenue.

 

Shoe Orthoses Reduced Diabetes-Related Amputations

Long-term use of shoe orthoses significantly reduced diabetes-related amputations, according to study results recently presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India.

Researchers studied 114 Swedish patients with diabetes and a risk of developing foot ulcers. Over 2 years, patients wore one of three different types of shoe orthoses.

Results showed that the use of orthoses, podiatry, education and regular check-ups helped patients avoid foot ulcers. Overall, only 0.9% of participants developed new foot ulcers during the first year vs. an industry average of 3% to 8% reported in similar diabetic populations.

Continue Reading…

 

Good Ulcer Management Reduces Amputation Caused by Diabetes

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Amputations caused by diabetic complications can be reduced by at least 50%with the use of proper shoe inserts, podiatry care and regular health checkups, according to a study that will be presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India from Feb. 4-7.

The study, conducted by researchers at the University of Gothenburg’s Sahlgrenska Academy in Gothenburg, Sweden, included 114 patients with diabetes who were at risk for developing ulcers. Each participant wore one of three shoe insoles and was monitored over a 2-year period. The researchers found that only 0 cialis pas cher france.9% of the participants developed a new ulcer during the first year.

Continue Reading on Healio.com

 

Study: Diabetic Footwear Not Worn at Home

Patients with diabetes prescribed to wear custom footwear infrequently wear this footwear at home where the largest amount of walking occurs, according to study results recently published in Diabetes Care.

The study included 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer and custom-made footwear. The researchers monitored footwear use with a shoe-mounted, temperature-based monitor and daily step count with an activity monitor worn on the ankle over a period of 7 consecutive days. Adherence was calculated as the percentage of steps that prescription footwear was worn.

Continue Reading on Healio.com

 

Raising More Awareness of Complications of Diabetic Foot

If you spoke to passers by on the street and asked them what they knew about complications from diabetes, you probably would receive a lot of “Xabier blank stares.

Now, if you asked them about the pink cheap nba jerseys ribbon and the symbolism to breast cancer, more would know and respond.

You see, the problem is there’s not as much awareness about diabetes and what happens beyond “amputations” or “testing blood sugar.”

Yes, there needs to be more awareness on this issue, before it’s too late. Going through my reading list, I came across this really good article on Podiatrytoday.com and thought it wholesale nfl jerseys was one you in should read as well. They do You a good job in detailing the issue and how we can go about creating more Technology awareness to this issue. cheap nba jerseys Check it wholesale nba jerseys out and let me know Arch?ologie what you think.

http://www.podiatrytoday.com/connecting-dots-between-diabetic-foot-ulcers-pad-and-dangerous-complications