Diabetic Shoes Medicare-The use of diabetic shoes has steadily increased since Bill Shoe Medicare Therapy was passed. For some diabetics, it is important to reduce foot-related foot complications. Unfortunately, overuse of these prescription devices and fraudulent distributions threaten the long-term viability of the program. This article will discuss the proper use of these shoes and how patients and doctors can guarantee the proper utilization and monitoring of these devices.
The Reasons Behind the Use of Diabetic Shoes Medicare:
Medicare begins this benefit to limit the incidence of leg wounds and common injuries caused by the use of properly fitted shoes. Shoes have been the source of many frictions and pressure-related injuries, which cause infection, hospitalization, and possibly amputation. They have also made it possible to irritate foot deformities already present, including bunions and hammertoes.
As many diabetics have some degree of poor sensation (peripheral neuropathy), irritant pain shoes cannot be easily felt and the wound forms easily after a relatively short time. Combined with foot deformities such as bunions and hammertoes, as well as chronic swelling (edema), the potential for harmful shoe-leather shoe increases.
A diabetic shoe is defined as the depth of an additional shoe (especially in the foot box) to reduce the pressure from above on the toes, as well as the right size for width to reduce pressure inside and outside of the foot. It immediately protects the foot with leg defects or bunions, and normal foot benefits as well. Shoe materials generally have to have a construction to limit the seams in the shoe and must last long to last for a year’s worth of daily use. Vital importance is the inclusion of most inserts made of the so-called material Plastizote.
This material reduces pressure and shear forces. It can be heat formed for the legs, or in some cases should be custom molded to the foot if severe foot deformity is present. This severe defect may be from void amputation or a cause fracture disease called Charcot arthropathy. Medicare has defined the minimum thickness of this material, and the use of something less is inappropriate. When the depth of extra shoes and Plastizote inserts are combined, the chances of diabetic complications associated with shoes are significantly reduced.
Diabetic Shoe Abuse:
Unfortunately, diabetic shoes are more exploited outside the medical community. In order for diabetes to require diabetic shoes, they must have some combination of neuropathy, leg defects, calluses or corn (hyperkeratosis), before foot ulcers, amputations, or arterial disease.
If nobody is present, diabetes does not need shoes as a risk to low problems, and Medicare will not cover it. An appropriate medical examination is needed to determine whether this component is present, as diabetes with this condition should be under medical care and podiatric as well.
This can be done by doctors managing diabetes, but foot specialists usually handle this. An appropriate prescription for shoes and determination whether heat is formed or the inserting habits required are made, as well as the determination for any other necessary modifications.
Sometimes, some diabetics have severe leg defects so standard diabetic shoes are on precise, and a special shoe is required. This requires a much different process. Once the prescription shoe is determined, the doctor administers diabetes then declares diabetes treatment and the need for shoes. this documentation is required by Medicare.
The above process is often overlooked when medical supply companies and non-medical entities are involved in the distribution of diabetic shoes. A common scenario occurs when patients are contacted by mail or phone by the company (who are on the call list due to their diabetes), and offers made for “free” diabetic shoes.
These patients are then installed via email based on the size of the shoes they are admitting, or they mail in a foam footprint box that is sent to them. Events are also held where patients go to a hotel or general conference center for a one-day opportunity to be installed. Rarely is a test conducted by the issuing company, which relies solely on certification of treating physicians to be in-line with the Medicare documentation requirements.
Most of these doctors are too busy to research the source of shoes, and just want to provide protection for their diabetics, so they sign it. The patients then shipped the shoes, and no follow-up was done to determine whether it matched up exactly. If a problem develops, there is nothing locally available to check or modify the shoe. At times, the shoe styles used barely fit for diabetics shoes.
Commercially available shoes are often used in place of dedicated diabetic shoes, and the inserts used are of poor quality. Some companies will automatically use special inserts if they are really needed as a custom insert to replace the higher one. All this is done without the input or expertise of the foot specialist, or even the primary doctor.
As if all this is not enough, in most cases the company will write off 20% Medicare does not cover in the event the secondary insurance is absent (or will not cover diabetic shoes) to keep marketing “free” shoes accurate. This is illegal, as providers and suppliers are required by federal law to collect this. The Big Picture: In short, not all diabetics need diabetic shoes.
Those who need shoes that fit properly based on their special feet and the specialists needed to make the recipe and follow-up with the product. Medicare needs to be billed correctly and accurately. The widespread use and fraudulent diabetic shoe for profit threaten the long-term viability of the program.
Determination for use of this device needs to rest solely in the hands of a podiatrist or doctor treating diabetes. Shoes should be dispensed directly from the podiatrist or from a skillful / orthotist pedorthist to ensure quality and proper follow-up of fit and function.