The Comprehensive Diabetic Foot Exam (CDFE) & Shoe Fitting

A Comprehensive Approach to Diabetic Preventative Footwear

Presented by Josh White, DPM, CPed

Objectives

• Document and determine patients' risk status for risk of foot complications.

• Document foot exam findings.• Determine the need for therapeutic footwear

and qualification for the Medicare Therapeutic Shoe Program.

• Review self-management education.

Where do you begin?

Identify

• Determine the number of patients who have Medicare and Diabetes (ICD9 = dx. 250).

• Each of these patients should be scheduled for an annual foot exam at least once each year.

CDFE Patient Brochure

Performing a CDFE

Use SafeStep custom CDFE form

Implementing a Shoe Fitting Protocol

Step by step…

• Designate a "Shoe Fitter”• Schedule separate visit• Performing the CDFE, bill for visit IF documentation

verifies change in patient's condition• Use a shoe display• Select shoes using 4 S's: Size, Shape, Stability, Style• Streamline document procurement• Be compliant...fit shoes before 3 month expiration of

documentation (DME Dashboard)• Have an effective patient retention program

The shoe fitter…

Designate one person as the lead. This person should be responsible for all fitting and ordering shoes.

GWC!

Get it…Want it…Can do it!

The shoe fitter must…

• Have confidence • Be knowledgeable about shoes and sizing• Have a desire to fit diabetic shoes• Be goal oriented

Shoe Fitting - Step by Step

1. Talk to the patient. Explain what diabetic shoes are and how they’re different. “These are NOT just a free pair of shoes every year."

2. Explain that diabetic shoes…1. help prevent calluses,

corns and ulcers2. are intended to be worn3. are part of a comprehensive plan of care

Shoe Fitting - Step by Step3. Explain shoe features and fit

Shoe Fitting - Step by Step

4. Even if the patient received shoes last year check shoe fit and measure their feet again.

5. Explain to patient that there needs to be 1/2" space beyond end of longest toes.

6. Determine fit using try-on shoes based on fit of old shoes and measured size.

Shoe Fitting - Step by Step7. Shoe width can only be determined by fit of try on shoe, NOT by using measuring stick.8. Custom inserts appropriate to accommodate plantar prominences.

Shoe Fitting - Step by Step9. When fitting an amputation, consider custom molded shoes. Trace foot in addition to taking mold. Size depth shoes to length of longer foot.

Shoe Fitting - Step by Step10. Explain process to the patient. “I need to get some paperwork signed from the doctor who is managing your diabetes. I will then fax the shoe order to the shoe company.”11. Make SURE the patient understands they need to come back in for the fitting and that shoes need to be worn with appropriate socks. i.e. if athletic shoes, bring athletic socks. Note: Shoe selecting should only take 15-20 minutes and is best done on same visit as is CDFE.

• Sometimes shoe fitting problems are related more to a patient’s head than their feet.

• For difficult to fit personalities, refer patients out to where they can try on an assortment of shoes.

• "2 strikes and you're out"

NOTE: Cherry-pick Patients

Use WorryFree DME

Enter onto SafeStep website:o Patient name o Certifying Physician infoo CDFE findingso Shoe style and size

• Relieves office personnel of the recurring task of contacting primary care physicians by doing the faxing as though from you, for you.

• “Fitting better than faxing”o 50% success within 1 weeko 90% success within 3 weeks

Document Procurement with WorryFree DME

Shoe Dispensing - Documents

1. Written order, Prescription2. Statement of Therapeutic Necessity (CMN)3. CDFE Report Findings (Relevant Medical

Records) signed and dated by the PCP4. Supplier in-person evaluation (CDFE)5. Dispensing SOAP notes6. Certificate of Receipt

Shoe Dispensing – Step by Step

1. When shoes come in, double check shoe size and style. Call patient to set appointment. Remind patient to bring socks appropriate to shoes being fit.

2. Shoes must be dispensed within three months of when MD signs documents.

3. Print out dispensing paperwork.

4. Put inserts in the shoes and let patient try them on.

5. Feel the width and length of the shoe. You should have approximatley 1/2" from end of toe to tip of shoe.

6. If shoes fit properly with prefab inserts, out remove and flip them over.

7. Heat up prefab inserts with heat gun until you can leave a fingerprint on bottom.

8. Have patient stand on prefab inserts to shape them to the feet.

Shoe Dispensing – Step by Step

Shoe Dispensing – Step by Step

9. Repeat with other two pair of inserts. 10.Have Patient sign Certificate of Receipt.

Explain break-in period, checking feet, etc. 11.Give patient copy of

Receipt and Medicare 30 Supplier Standards

12.Schedule follow up appointment to check shoe fit.

Promotion!• $100 off any display… (Use Promo Code STARTUP100)

• April 7 – “Ensuring Medicare Compliance with WorryFree DME”

• April 14 – “Essentials for Making Your Shoe Program a Winner”

Remainder of the Series…

Learn more at SafeStep.net

Questions?

Thank you