Diabetic Shoes and Inserts – Why Team Effort is Essential  

For diabetic patients with diabetic foot complications, getting diabetic shoes and inserts can be challenging for patients and suppliers. When patients, provider and suppliers are familiar with the program and what their own responsibilities are, obstacles that can prevent a diabetic patient from getting his/her shoes can be avoided altogether. Too often, patients, primary care physicians and even suppliers don’t understand what steps must be taken before those shoes are dispensed. 

Patients who qualify for diabetic shoes and inserts must have diabetes (pre-diabetes does not qualify a patient for diabetes) AND one of the qualifying foot conditions. Before going to the provider who will be ordering your shoes, you must have had a recent diabetes-related exam with the Certifying Physician aka; the provider who is treating your diabetes. This can be your primary care physician or an endocrinologist. If you usually see an MD or DO in either of these practices, they can certify all necessary forms. If you see an ARNP or PA, any exams or forms they sign must also be agreed upon and signed off by the MD or DO in most cases. When booking appointments for your diabetes, try to request the MD or DO to perform your exam to limit the number of signatures required on your paperwork. 

Certifying Physicians are required by Medicare and Medicare replacement plans to sign, co-sign, and provide documents to suppliers before diabetic patients can receive their diabetic shoe sand inserts. CMA provides a Dear Physician Letter on their website to educate physicians who may not be aware of what is required of them. Most primary physicians treating diabetics already acknowledge and accept research that has shown that diabetic shoes can help prevent ulcers and amputations in diabetics. Often those same physicians even take the time to examine and document the patient’s qualifying foot condition(s) in their own exam notes, so they don’t have to sign off on another provider’s exam such as a podiatrist.

 Suppliers can be podiatrists or orthotic & prosthetic providers. Podiatrists can perform the foot exam and dispense the diabetic shoes right in their office. If the podiatrist is documenting the qualifying foot condition, their notes must be co-signed by the Certifying Physician. Suppliers should always take the time to get the correct name and the correct contact information of the physician treating the patient for diabetes. Again, it can be a primary care physician or an endocrinologist. Keep fax covers requests and co-signature wording short and simple. Remember Certifying Physicians must agree and co-sign exam notes with the qualifying foot conditions unless they have documented it in their own diabetes exam note. Primary care physicians are burdened with signing off multiple documents including, prior authorizations, medicine refills, EHR documentation, plans of care, performance measurement and reporting, chart reviews, patient callbacks, not to mention all the face-to-face exams done in a typical day. Encourage your patients to be patient and provide them with a realistic time frame.  Some suppliers involve their patients in obtaining compliance documentation. 

To conclude, acknowledgement of the Therapeutic Shoe Program and communication between suppliers, patients and Certifying Physicians is an essential step for success with the Therapeutic Shoe Program.