Steps Ahead

Welcome to the first web log devoted specifically to streamlining utilization of the Medicare Therapeutic Shoe Program.  Through this channel I will share my  knowledge and that of others, with the hopeof increasing ease of use and ultimately improving patient satisfaction and therapeutic outcomes.  Participants are invited to share their opinions on any topic under discussion as well as bring up anything else related either to the Medicare Shoe Program and shoe fitting in general or to SafeStep in particular.  I am committed to fostering a free exchange of ideas so that we can learn from each other and also to help StepStep be the absolute best company from which to order shoes for your patients with diabetes.

Comments

[Gary Barlow]

Would like to know why a patient would complain of haveing a burning/hot feetand their feet hurt. even though the shoes are of the correct fit.

[Josh White, DPM, CPed]

Thanks for you inquiry regarding causes of burning feet in properly fitting shoes. Most common causes would include hyperthesia frequently present during early stages of neuropathy as well as discomfort from shoes lacking good ventilation. Regardless, this sort of problem, when encountered with shoes fit in the podiatrist's office, speaks to the value of fitting shoes using a try on set. There is no method of foot measuring that beats "what you see is what you get". This approach recognizes the subjective component to shoe fitting that cannot be determined unless one has the opportunity to try shoes on. The 14 shoe display stands featured on the SafeStep website provide the best way of having the benefit of try on shoes without haveing to stock very many shoes.

[Josh White]

I was recently contacted by an insurance company to address an issue that I think portends a trend and potentially bodes well for podiatrists. This insurance company realizes that it is spending increasingly more on diabetic foot problems. While it provides coverage for therapeutic shoes and inserts, utilization remains very low and there are complaints from patients and foot care providers alike. The comapny understands that shoes prevent diabetic foot problems and wants to spend a lot more on footwear. Its concern is to ensure that those who could most benefit get fitted and those not at risk, do not.

It turns out that low shoe utilization is rooted in this insurance company's assumption that shoes are best fit by the Orthotic and Prosthetic dealer that services all their DME needs. It was believed that podiatrists lacked the desire and the capabilty to be effective therapeutic shoe fitters. I to assured them that there are thousands of examples that defy this belief.

Once it was established that podiatrists could and desire to be good shoe fitters, concern shifted towards ways to ensure that patients at risk for diabetic foot problems got shoes and those not at risk did not. This led to the creation of a process for peer review, utilzation review and quality assurance. The bottom line is to create a streamlined approach to ensure that foot care providers are properly trained to properly fit shoes, that only patients at risk for diabetic foot ulceration recieve the shoe benefit and finally that once fit, that patients actually are prevented from costly foot complications and that they are happy with the service (and shoes) that they receive.

The good thing about this situation is that if the insurance company implements my recommendations and the program is successful, a WIN - WIN - WIN situation is created, patients get protection from infecton and ulceration and recieve shoes they like to wear, foot care providers gain additional practice revenue while the insuracne company saves money.

Medicine is moving in an "evidence based" direction. It is important for foot care providers to be mindful of how to provide the best possible care at the lowest cost. Cost effective treatments are going to be more and more mandated by the third party payers that ultimately have a very controlling say in the sort of benefits that patients receive.

[ARZELIA101]

I recently was in the DPM office, Dr. Hyman in Houston, and he had only one shoe catalog for diabetic shoes. Your ad stated you would send a 2006 if requested. I tried the phone # to call 1-888, and it was invalid. I only want your shoe catalog to make my decision about which one I need and want. Is that a valid request?
Mr name is:
Mrs. Grace Cook
15914 Sierra Grande Dr.
Houston, TX 77083-2925
PH: 281/983-5531.
I would appreciate a reply. Thanks
New customer.