January 6, 2018
Make clear to staff that once the process for fitting diabetic patients with shoes is created that it is to be followed by all.
Patients with Medicare and diabetes are entitled to be fit with a pair of shoes and three pairs of inserts each calendar year based on evaluation and determination of medical necessity. While it seems logical that patients at risk for foot ulceration would look forward to a new pair each year, in reality once patients are fit they are not refit for a second pair. This happens often despite the shoes being available at little to no out of pocket cost to the patient.
While oftentimes shoes have effectively reduced the incidence of ulceration, too many patients do not get the message about the important role that footwear plays in preventing ulceration and that properly fitted, protective shoes should be worn both outside and at home. Patients must have best fits and in styles that best meet their therapeutic needs and aesthetic desires. After all, there’s no benefit in getting shoes that are not worn.
Every patient with diabetes should be scheduled for an annual comprehensive diabetic foot evaluation. If ulcerative risk factors are determined to be present, therapeutic footwear should be prescribed. Office personnel who are part of the shoe fitting program must be trained on shoe fitting, Medicare compliance and the importance of footwear in preventing foot ulceration.
List the major steps needed to ensure that patients fit with shoes one year are fit year after year after year. Have the practice’s shoe fitter record the major steps entailed in fitting diabetic shoes. Each major step should be supported by 1-5 sub-points defining the who/what/where/when/how. Keep it simple (the 20/80 approach); the process should be fully documented in 1-5 pages. Review and approve—every member of the leadership team must agree this is the right way to fit shoes every time
Once the shoe fitting process has been defined for the practice, roles must be assigned and expectations set. Some examples:
Following this “3-Step Documentation” approach, the practice will experience the benefits of having a consistent, agreed-upon way of managing priorities. Keep the benefits going by continuing to review and update protocols on an ongoing basis.
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