1. Presented by Josh White, DPM, CPed
The Comprehensive Diabetic Foot Exam (CDFE) & Shoe Fitting A Comprehensive Approach to Diabetic Preventative Footwear
Presented by Josh White, DPM, CPed
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2. 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.

3. Where do you begin?

4. 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.

5. CDFE Patient Brochure

6. Performing a CDFE
Use SafeStep custom CDFE form 

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9. Insert slide that lists reasons for performing CDFE:
American Diabetes Association standard of care
PPQRS measure 127 Diabetic Foot Exam
Determination of qualifying risk factors for diabetic shoes to be sent to Certifying Physician
Medicare Therapeutic Shoe Program requirement for evaluation of patients old shoes 
Billable as if determination of change in patients condition

10. Implementing a Shoe Fitting Protocol

11. 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

12. 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!

13. The shoe fitter must… Have confidence
Be knowledgeable about shoes and sizing
Have a desire to fit diabetic shoes
Be goal oriented
add image of bright eyed, responsible looking young person.

14. Shoe Fitting - Step by Step
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."
Explain that diabetic shoes…
help prevent calluses, corns and ulcers
are intended to be worn
are part of a comprehensive plan of care
please make words show on top of image
Better image is to show assortment of shoes
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15. Shoe Fitting - Step by Step
Explain shoe features and fit
include image of shoe feature icons from catalog.  This is in shoe fitting presentation.

16. Shoe Fitting - Step by Step
Even if the patient received shoes last year check shoe fit and measure their feet again.
Explain to patient that there needs to be 1/2" space beyond end of longest toes.
Determine fit using try-on shoes based on fit of old shoes and measured size.

17. Shoe Fitting - Step by Step
7. 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.
show foot with bumpy bottom as appropriate for custom molded inserts
Numbering is off

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

19. Shoe Fitting - Step by Step
10. 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 minutes and is best done on same visit as is CDFE.

20. NOTE: Cherry-pick Patients
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"

21. Use WorryFree DME Enter onto SafeStep website: Patient name
Certifying Physician info
CDFE findings
Shoe style and size
insert slide that shows where each of the 6 documents comes from
Show slide of person entering info onto computer

22. Document Procurement with WorryFree DME
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”
50% success within 1 week
90% success within 3 weeks

23. Shoe Dispensing - Documents
Written order, Prescription
Statement of Therapeutic Necessity (CMN)
CDFE Report Findings (Relevant Medical Records) signed and dated by the PCP
Supplier in-person evaluation (CDFE)
Dispensing SOAP notes
Certificate of Receipt

24. Shoe Dispensing – Step by Step
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.
Shoes must be dispensed within three months of when MD signs documents.
Print out dispensing paperwork.
Put inserts in the shoes and let patient try them on.
show image of package being delivered.
Indi

25. Shoe Dispensing – Step by Step
Feel the width and length of the shoe. You should have approximatley 1/2" from end of toe to tip of shoe.
If shoes fit properly with prefab inserts, out remove and flip them over.
Heat up prefab inserts with heat gun until you can leave a fingerprint on bottom.
Have patient stand on prefab inserts to shape them to the feet.
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26. Shoe Dispensing – Step by Step
Repeat with other two pair of inserts.
Have Patient sign Certificate of Receipt. Explain break-in period, checking feet, etc.
Give patient copy of Receipt and Medicare Supplier Standards
Schedule follow up appointment to check shoe fit.
Add slide that shows poster, show brochure given to MDs to promote referral for foot care and foot risk assessment.
Insert slide that promotes next three webinars
Insert slide that promotes shoe display promo; $100 off Apex / OrthoFeet displays.  Apex wall display $199 thats refunded after mount on wall. 

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

28. Remainder of the Series…
April 7 – “Ensuring Medicare Compliance with WorryFree DME”
April 14 – “Essentials for Making Your Shoe Program a Winner”

29. Learn more at SafeStep.net

30. Questions?

31. Thank you