The good news is that practices fitting shoes are on average fitting more shoes each year. The average number of pair fit increased from 37 per year in 2008 to 54 in 2010. Despite this growth, a high percentage of at risk patients fit with shoes one year are not fit the subsequent year.
It would be unusual for patients who qualify for shoes one year to not qualify again. The therapeutic shoe program is designed to replace worn shoes and inserts each calendar year. From one year to the next, a percentage of patients move, die or elect to obtain care from a different foot care provider. Still, the majority of patients in a practice one year, are believed to remain in the same practice the subsequent year. If 100 patients are fit with shoes one year, it is estimated that approximately 75 should be fit with a replacement pair the following year.
While expected that 75% of patients fit with shoes one year should be fit the next, data obtained from a review of 2000 diabetic patients indicates that the actual “repeat rate” is less than 25%. “Repeat Rate” is referred to as the percentage of patients fit with shoes one year who by the end of the next calendar year are fit with a new pair shoes. This low rate of refitting patients on an annual basis is consistent over several years. In other words, when patients are fit with shoes one year, they are unlikely to be fit with shoes again. This unfortunate pattern is resulting in less than optimal care of patients, significant loss of practice revenue and Medicare having to pay for a lot of diabetic foot care that is preventable.
Let’s examine why offices are refitting on average only one of every four patients originally fit with therapeutic shoes and present solutions how to improve:
Issue: Difficultly accommodating all the patients with diabetes and Medicare in the practice. There are on average 316 patients with diabetes and Medicare in every podiatry practice. Most offices have unfortunately not created protocols to ensure that every patient with diabetes is evaluated on an annual basis and when indicated, fit for shoes. Consequently, patients are commonly seen every 61 days for “routine care” but not afforded the opportunity for more thorough risk assessment nor refitting for shoes.
Solution:
- Schedule all patients with diabetes for annual ulcerative risk assessment and allow time for shoe fitting when indicated. Scheduling a separate, dedicated visit will allow sufficient time to discuss with patients the importance of footwear, daily self examination and the selection of appropriate shoe size and styles.
Click Here to Print the CDFE Form
Issue: In many practices there is no clear assignment of responsibility to a person for fitting patients determined to be at risk for ulceration and determined to qualify for shoes.
Solution:
- Assign personnel, under DPM supervision, to perform bulk of CDFE and therapeutic shoe fitting.
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Issue: Lack of training to effectively fit and recommend shoes taking into consideration size, shape, need for stability and available styles.
Solution:
- Shoe fitting is not rocket science but there are most right and wrong ways to perform. The shoe fitter should recommend two or three styles and not allow patients a choice based solely on personal preference. Training is available online, at professional meetings at through manufacturer sponsored Therapeutic Shoe Fitter courses
Click here to register for webinar on how to improve shoe fitting
Issue: Lack of shoe samples reflecting models most popular for practice.
Solution:
- Display shoe samples of styles most popular for particular region.
- Discard sample shoes that have been discontinued or prove unpopular.
- Stay abreast of new styles offered.
- Display a range of manufacturers to reflect models
Click here to see examples of various display stands
Issue: Failure of DPM to monitor establish targeted number of shoes to fit based on number of patients in practice with diabetes and who have Medicare as primary payer.
Solution:
- “If you can’t measure it you can’t measure it”. Its possible to predict at the beginning of each approximately how many patients should be fit by the end of the year.
Issue: Failure to incentivize shoe fitter and patient scheduler if achieve targets for number of patients evaluated and fit.
Solution:
- Many practices track the number of shoes fit and relates to employee compensation.
Issue: Failure to outsource document procurement so as to reduce workload on office staff as well as to ensure Medicare compliance.
Solution:
- Use WorryFree DME to more efficiently and less expensively perform the routine task of compliance documentation procurement.
- Staff time can be better spent fitting shoes and not faxing.
Issue: Failure of DPM to monitor on a year-to-year basis which patients have received shoes and to ensure that they are evaluated to determine need to be fit each subsequent year.
Solution:
- Shoes are covered on a calendar basis. If patients are tracked, they will be more likely to be scheduled for evaluation and fitting.
| Patient | 2010 | 2011 | 2012 |
| Jones, Robert | 3/12/10 | Missed refitting | Missed refitting |
| Wishborne, Carol | — | 5/9/11 | Missed refitting |
| Greenberg, Edward | — | 2/23/11 | Missed refitting |
| Davidson, John | 11/18/10 | Missed refitting | Missed refitting |
| McDonald, Mary | — | — | 7/10/12 |
| Smith, Fredrick | 5/30/10 | Missed refitting | Missed refitting |
Issue: Failure to implement patient recall program to contact patients fit with shoes in years past and not fit in current calendar year.
Solution:
- Offices would benefit by sending reminder notifications to patients fit one year if they are not been fit by second half of subsequent year. It’s important to allow sufficient time to obtain required documentation.