Resonses: diabetic shoes and inserts
Nicolas Machi
Description
Collection
Title:
Resonses: diabetic shoes and inserts
Creator:
Nicolas Machi
Date:
5/23/2013
Text:
Following is my original post along with responses received. To summarize,
of 16 responses, 6 facilities no longer provide DM shoes and inserts and
appear pleased with this decision, 3 have drastically reduced the service,
7 continue to provide the service. Thank you all for enriching this
discussion…
Dear colleagues,
There has been much discussion at our facility recently regarding services
related to diabetic inserts and shoes. New requirements have made this
process administratively burdensome and time consuming for our office
staff. I am interested in hearing from other full service O&P facilities.
Do you provide diabetic shoes and inserts? If you have stopped providing
these services, have you noticed any repercussions from your referral
sources? Thank you for your time.
--
As you noted, yes, the regulations on diabetic shoes has become a total
mess, and makes it impossible to safely deliver these to a patient. The
follow up care that is required is out of our hands to make sure the
patient follows through. Then making sure the physician documents the
correct information is also out of our hands. We quit providing diabetic
shoes about 2 years ago, and the referring physicians totally understand
the problems, and so there has been no impact or repercussion from this
decision. I am not a money driven or profit focused kind of owner, but
only want to provide the best quality, most appropriate services and
devices to the patients. But, I have to also share that even when we quit
providing these shoes and inserts, the overall gross income to the business
dropped a little bit, BUT the net was not changed. This let me know
without a doubt, that I was actually often losing money on these shoes. I
spent more time, killing myself, ordering these shoes, returning these
shoes, patients changing their minds, etc....AND then chasing paperwork,
and fighting all of this for just a few dollars at the end of this battle.
Now, with audits and all being a risk, I cannot afford the time do MORE
audits for something like shoes. So, based on all of this, we decided that
shoes are NOT going to be provided here. There is a local Pharmacy that
provides most DME stuff anyway. They have power scooters, wheelchairs,
bathroom aids, canes, walkers, etc. AND they have a full wall of shoes on
display, and some are even in stock, and can be provided right on the spot.
I cannot afford space, or cash, to be tied up trying to keep an inventory.
This pharmacy also has the paperwork and a system in place to get that
all done. I talk to them frequently about my patients who need shoes, and
gladly refer the business to them. They have a c-ped working there...he
was a former clerk there, then a stock boy, and then attended some training
course (which he said was a joke) and then passed some test, and is now a
C-ped with ABC. Anyway, I have NO problems letting this pharmacy take the
risk of delivering and getting paid for this service. And, the patients
also get faster service than what we can provide. So, my suggestion, is to
quit providing shoes. It has given me MORE time to focus on prosthetics
here, and also now I don't have to employ anyone to do this work in my
office. Now I can focus on all the crazy paperwork requirements for
prosthetic legs, and the audits that we are all faced with. This decision
has NOT negatively impacted my business at all. Let someone else take the
risk, and let them deal with the crazy paperwork....that's just my
opinion. Good Luck,
--
Stopped three years ago. Best thing we EVER did. No negatives. We
lost two podiatry referrals who only sent us junk anyway. The Ortho's
were actually surprised we waited so long to quit the shoe business. We
had more time in our schedules, less shoes on our shelves, and somehow the
time filled in with more desirable work. It's magical.
--
We stopped providing diabetic shoes and inserts for Medicare patients only
in October 2012. We agreed that our admin staff spent too much time trying
to get documentation that it was not profitable. The majority of the
prescriptions came from podiatrists, who can no longer prescribe for
Medicare shoes anyway. We still do shoes and inserts for all other
insurances other than Medicare. The only thing it has done was free up our
orthotists to see orthotic patients and do the extreme amount of
documentation that requires. Our office does not miss the hassle of
diabetic shoes and inserts, but we miss being able to serve our patients
properly. Medicare made it too difficult to help them. Stopped doing shoes
and inserts 10 years ago when I thought it was difficult to process. The
only difference I saw was more time for what I think we should be doing.
Custom O AND P. We should stick with what we alone can do best. And do it
to a high level in a timely manner. Regs have changed everything. Timely
and accurate is not important anymore. I say if you dont find it worthwhile
to dispense, follow up and support the device, dont do it. Just like a real
business would do. You can stay home and at least not lose money.
-----
Stopped doing shoes and inserts 10 years ago when I thought it was
difficult to process. The only difference I saw was more time for what I
think we should be doing. Custom O AND P. We should stick with what we
alone can do best. And do it to a high level in a timely manner. Regs have
changed everything. Timely and accurate is not important anymore. I say if
you dont find it worthwhile to dispense, follow up and support the device,
dont do it. Just like a real business would do. You can stay home and at
least not lose money
--
We are having similar problems. We feel we still have to offer diabetic
shoes and inserts, but we have cut our selection down to the choices of one
Men's dress shoe, One woman's dress shoe and a good tennis shoe. Basically
they get two choices, if they want something else they have to go
elsewhere. We still have all the headaches of the new requirements but it
has made it tolerable. The real particular Medicare patients that want
different shoes or a bigger selection go elsewhere (and we are ok with
that).
-----
Doctors in our town are knowledgeable about medicare requirements and won't
sign orders for shoes/insoles unless the patient has seen them within six
months and have problems with feet, or have seen podiatrist within six
months so the burden is on the patient to follow through with care, obtain
the prescription, then it's easy for us to get the certification letter.
We let all our patients know that they have to see a doctor within six
months, most of them will obtain their own prescriptions.
-----
We quit months ago. Some referral sources are displeased as we did great
custom work, but they understand. I don't think we lost any.
-----
Quit doing shoes over 7 years ago. Referral docs get it. Best thing I
ever did.
----
We do provide and yes the requirements are more than ridiculous! My believe
is that all services will reach this level of scrutiny so if we begin to
run from services we will close our doors! The only viable option is to
educate the physician and their staff members. We have seen this
documentation scrutiny over knee braces, and now diabetic shoes. It all
started with power wheelchairs and now has even hit lower limb prosthetics!
So, my point is I don't believe dropping services is going to be the answer
long term!
-----
We too have had some of the same discussions about providing diabetic shoes
and inserts. We have adopted a policy in that we provide the paperwork to
the patient for them to take to the certifying physician and ask that
they obtain the signatures and documentation and then return to us. I guess
in a round about way this may resolve our time consuming issues but I'm
not sure what the repercussions might be. We have a good percentage of
these patients but it seems to be more and more referrals for Medicaid
patients that no one else can bill for in our state (left overs!). Its
interesting that when you read the recent Medicare report, O and P
providers account for approx. 11 (or less) percent of the providers for
this service nation wide.
-----
We have this discussion often & continue to provide the service. We see
many previous shoe patients for other items (AFOs and prosthetics). We
also know that many previous shoe patients are referred elsewhere for
prosthetics, so we have vamped up our education and make sure to tell the
patient to return to OUR facility in the event of limb loss. Many times,
we are the ones desperately making changes to the shoes in an effort to
save the foot, so we see these patients just before the inevitable. We have
severely restricted the options for patients on the shoes (choice of about
30 shoes), which has provided a cost savings in the net cost of the shoes
as well as practitioners learning how these shoes fit. Knowing how shoes
fit allows for better judgments of size and width. We keep none in stock,
so this knowledge helps in reducing shipping costs for exchanges. We order
once a week to group many shoes into one shipment. I have also added
policies such as we will refit shoes once, but if they don't fit on the
second try, we are done. The shipping costs at that point negate any
potential profit. We also send all paper to physicians and make ONE
follow-up call only. If we don't get what we need, we turn it all over to
the patient and make them get everything. Previously, this was too much of
an admin staff burden. We spent years educating our local physicians and
that has truly paid off as we rarely have paperwork difficulties anymore.
If you tighten up your policies and restrict styles, you can turn a small
$10 profit. :) We use it mostly to get them in the door.
-----
We have recently cut back dramatically on shoes and inserts but have
created a list of other companies thst can provide the service. Some where
more then happy to take it on. We also sent out letters to out referrals
with a list of those alternative providers
-----
We too are a full service practice offering diabetic footwear. Your right,
it is becoming a paperwork nightmare not to mention that any margin that is
left is eaten up with denials and appeals. I've thought hard about
discontinuing this service and when discussing with referral sourses, they
would look for another one stop shop so to speak. Now, I justify
continuing the service as a loss leader.
-----
We still provide DM shoes/inserts. Most of the time we give the paperwork
packet to the patients to bring to their Drs with a note to include clinic
notes. This speeds up the process some.
-----
We stopped providing diabetic shoes and inserts almost two years ago and
have not seen any negative impact on our business. In fact, it has been
more positive because when we ran the numbers we were losing money on
every patient. We have not lost any referrals, but instead have more room
to see patients that are profitable.
-----
We do offer diabetic shoes and inserts as many of our referrals come from
podiatrists who very much appreciate the service. It has become
ridiculously time consuming and we have taken to giving a pre-printed
istruction form for the patients primary along with the shoe form and ask
the patient to go back to their doctor and have it completed for us. There
is just no time for us to fax it back and forth or call and beg for the
paperwork. We have probably lost some referrals but there's not much we
can really do about that. I'm pretty sure that was CMS's plan from the get
go, denial of services by paperwork.
--
Nicolas Machi, CPO
Clinician
Certified Prosthetist Orthotist
Victory Orthotics and Prosthetics
2333 Knob Creek Rd. Suite 14
Johnson City, TN
37604
P: 423.461.3320
F: 423.461.3314
VictoryOP.com < <URL Redacted>>
Linkedin < <URL Redacted>>
Victory on Facebook < <URL Redacted>>
of 16 responses, 6 facilities no longer provide DM shoes and inserts and
appear pleased with this decision, 3 have drastically reduced the service,
7 continue to provide the service. Thank you all for enriching this
discussion…
Dear colleagues,
There has been much discussion at our facility recently regarding services
related to diabetic inserts and shoes. New requirements have made this
process administratively burdensome and time consuming for our office
staff. I am interested in hearing from other full service O&P facilities.
Do you provide diabetic shoes and inserts? If you have stopped providing
these services, have you noticed any repercussions from your referral
sources? Thank you for your time.
--
As you noted, yes, the regulations on diabetic shoes has become a total
mess, and makes it impossible to safely deliver these to a patient. The
follow up care that is required is out of our hands to make sure the
patient follows through. Then making sure the physician documents the
correct information is also out of our hands. We quit providing diabetic
shoes about 2 years ago, and the referring physicians totally understand
the problems, and so there has been no impact or repercussion from this
decision. I am not a money driven or profit focused kind of owner, but
only want to provide the best quality, most appropriate services and
devices to the patients. But, I have to also share that even when we quit
providing these shoes and inserts, the overall gross income to the business
dropped a little bit, BUT the net was not changed. This let me know
without a doubt, that I was actually often losing money on these shoes. I
spent more time, killing myself, ordering these shoes, returning these
shoes, patients changing their minds, etc....AND then chasing paperwork,
and fighting all of this for just a few dollars at the end of this battle.
Now, with audits and all being a risk, I cannot afford the time do MORE
audits for something like shoes. So, based on all of this, we decided that
shoes are NOT going to be provided here. There is a local Pharmacy that
provides most DME stuff anyway. They have power scooters, wheelchairs,
bathroom aids, canes, walkers, etc. AND they have a full wall of shoes on
display, and some are even in stock, and can be provided right on the spot.
I cannot afford space, or cash, to be tied up trying to keep an inventory.
This pharmacy also has the paperwork and a system in place to get that
all done. I talk to them frequently about my patients who need shoes, and
gladly refer the business to them. They have a c-ped working there...he
was a former clerk there, then a stock boy, and then attended some training
course (which he said was a joke) and then passed some test, and is now a
C-ped with ABC. Anyway, I have NO problems letting this pharmacy take the
risk of delivering and getting paid for this service. And, the patients
also get faster service than what we can provide. So, my suggestion, is to
quit providing shoes. It has given me MORE time to focus on prosthetics
here, and also now I don't have to employ anyone to do this work in my
office. Now I can focus on all the crazy paperwork requirements for
prosthetic legs, and the audits that we are all faced with. This decision
has NOT negatively impacted my business at all. Let someone else take the
risk, and let them deal with the crazy paperwork....that's just my
opinion. Good Luck,
--
Stopped three years ago. Best thing we EVER did. No negatives. We
lost two podiatry referrals who only sent us junk anyway. The Ortho's
were actually surprised we waited so long to quit the shoe business. We
had more time in our schedules, less shoes on our shelves, and somehow the
time filled in with more desirable work. It's magical.
--
We stopped providing diabetic shoes and inserts for Medicare patients only
in October 2012. We agreed that our admin staff spent too much time trying
to get documentation that it was not profitable. The majority of the
prescriptions came from podiatrists, who can no longer prescribe for
Medicare shoes anyway. We still do shoes and inserts for all other
insurances other than Medicare. The only thing it has done was free up our
orthotists to see orthotic patients and do the extreme amount of
documentation that requires. Our office does not miss the hassle of
diabetic shoes and inserts, but we miss being able to serve our patients
properly. Medicare made it too difficult to help them. Stopped doing shoes
and inserts 10 years ago when I thought it was difficult to process. The
only difference I saw was more time for what I think we should be doing.
Custom O AND P. We should stick with what we alone can do best. And do it
to a high level in a timely manner. Regs have changed everything. Timely
and accurate is not important anymore. I say if you dont find it worthwhile
to dispense, follow up and support the device, dont do it. Just like a real
business would do. You can stay home and at least not lose money.
-----
Stopped doing shoes and inserts 10 years ago when I thought it was
difficult to process. The only difference I saw was more time for what I
think we should be doing. Custom O AND P. We should stick with what we
alone can do best. And do it to a high level in a timely manner. Regs have
changed everything. Timely and accurate is not important anymore. I say if
you dont find it worthwhile to dispense, follow up and support the device,
dont do it. Just like a real business would do. You can stay home and at
least not lose money
--
We are having similar problems. We feel we still have to offer diabetic
shoes and inserts, but we have cut our selection down to the choices of one
Men's dress shoe, One woman's dress shoe and a good tennis shoe. Basically
they get two choices, if they want something else they have to go
elsewhere. We still have all the headaches of the new requirements but it
has made it tolerable. The real particular Medicare patients that want
different shoes or a bigger selection go elsewhere (and we are ok with
that).
-----
Doctors in our town are knowledgeable about medicare requirements and won't
sign orders for shoes/insoles unless the patient has seen them within six
months and have problems with feet, or have seen podiatrist within six
months so the burden is on the patient to follow through with care, obtain
the prescription, then it's easy for us to get the certification letter.
We let all our patients know that they have to see a doctor within six
months, most of them will obtain their own prescriptions.
-----
We quit months ago. Some referral sources are displeased as we did great
custom work, but they understand. I don't think we lost any.
-----
Quit doing shoes over 7 years ago. Referral docs get it. Best thing I
ever did.
----
We do provide and yes the requirements are more than ridiculous! My believe
is that all services will reach this level of scrutiny so if we begin to
run from services we will close our doors! The only viable option is to
educate the physician and their staff members. We have seen this
documentation scrutiny over knee braces, and now diabetic shoes. It all
started with power wheelchairs and now has even hit lower limb prosthetics!
So, my point is I don't believe dropping services is going to be the answer
long term!
-----
We too have had some of the same discussions about providing diabetic shoes
and inserts. We have adopted a policy in that we provide the paperwork to
the patient for them to take to the certifying physician and ask that
they obtain the signatures and documentation and then return to us. I guess
in a round about way this may resolve our time consuming issues but I'm
not sure what the repercussions might be. We have a good percentage of
these patients but it seems to be more and more referrals for Medicaid
patients that no one else can bill for in our state (left overs!). Its
interesting that when you read the recent Medicare report, O and P
providers account for approx. 11 (or less) percent of the providers for
this service nation wide.
-----
We have this discussion often & continue to provide the service. We see
many previous shoe patients for other items (AFOs and prosthetics). We
also know that many previous shoe patients are referred elsewhere for
prosthetics, so we have vamped up our education and make sure to tell the
patient to return to OUR facility in the event of limb loss. Many times,
we are the ones desperately making changes to the shoes in an effort to
save the foot, so we see these patients just before the inevitable. We have
severely restricted the options for patients on the shoes (choice of about
30 shoes), which has provided a cost savings in the net cost of the shoes
as well as practitioners learning how these shoes fit. Knowing how shoes
fit allows for better judgments of size and width. We keep none in stock,
so this knowledge helps in reducing shipping costs for exchanges. We order
once a week to group many shoes into one shipment. I have also added
policies such as we will refit shoes once, but if they don't fit on the
second try, we are done. The shipping costs at that point negate any
potential profit. We also send all paper to physicians and make ONE
follow-up call only. If we don't get what we need, we turn it all over to
the patient and make them get everything. Previously, this was too much of
an admin staff burden. We spent years educating our local physicians and
that has truly paid off as we rarely have paperwork difficulties anymore.
If you tighten up your policies and restrict styles, you can turn a small
$10 profit. :) We use it mostly to get them in the door.
-----
We have recently cut back dramatically on shoes and inserts but have
created a list of other companies thst can provide the service. Some where
more then happy to take it on. We also sent out letters to out referrals
with a list of those alternative providers
-----
We too are a full service practice offering diabetic footwear. Your right,
it is becoming a paperwork nightmare not to mention that any margin that is
left is eaten up with denials and appeals. I've thought hard about
discontinuing this service and when discussing with referral sourses, they
would look for another one stop shop so to speak. Now, I justify
continuing the service as a loss leader.
-----
We still provide DM shoes/inserts. Most of the time we give the paperwork
packet to the patients to bring to their Drs with a note to include clinic
notes. This speeds up the process some.
-----
We stopped providing diabetic shoes and inserts almost two years ago and
have not seen any negative impact on our business. In fact, it has been
more positive because when we ran the numbers we were losing money on
every patient. We have not lost any referrals, but instead have more room
to see patients that are profitable.
-----
We do offer diabetic shoes and inserts as many of our referrals come from
podiatrists who very much appreciate the service. It has become
ridiculously time consuming and we have taken to giving a pre-printed
istruction form for the patients primary along with the shoe form and ask
the patient to go back to their doctor and have it completed for us. There
is just no time for us to fax it back and forth or call and beg for the
paperwork. We have probably lost some referrals but there's not much we
can really do about that. I'm pretty sure that was CMS's plan from the get
go, denial of services by paperwork.
--
Nicolas Machi, CPO
Clinician
Certified Prosthetist Orthotist
Victory Orthotics and Prosthetics
2333 Knob Creek Rd. Suite 14
Johnson City, TN
37604
P: 423.461.3320
F: 423.461.3314
VictoryOP.com < <URL Redacted>>
Linkedin < <URL Redacted>>
Victory on Facebook < <URL Redacted>>
Citation
Nicolas Machi, “Resonses: diabetic shoes and inserts,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235180.
