Therapeutic Shoe Benefit
“You’re only as good as the care
you can measure…”
New for 2010 –
The Visual Footcare™
Comprehensive Diabetic Foot Exam (CDFE)
The American Diabetes Association (ADA), American College of Foot and Ankle Surgeons (ACFAS) and others have all published recommendations concerning the need for performing a CDFE on all patients with Diabetes. Essentially, the purpose of the CDFE is to identify the primary risk factors associated with diabetic foot complications —neuropathy, high plantar pressure and history of previous ulcer or amputation.
Physician Quality Reporting Initiative (PQRI)
PQRI represents CMS’s first step towards “Pay for Performance” reimbursements. PQRI, a voluntary program available to all eligible healthcare professionals, rewards providers for submitting data that can be used to evaluate patient outcomes and approximate the quality of care delivered. In exchange for this information, CMS will pay physicians an end of year bonus. Learn More.
View PQRI Measures 126, 127 and 163.
CMS Documentation Requirements
CMS has also recently mandated a face-to-face foot exam and charting documentation to prove the need and adequate implementation of a comprehensive program of care, including self-management and assessment training to patients and caregivers. A Centers for Medicare & Medicaid Services (CMS) senior official released a letter to physicians in February 2009 detailing the coverage and documentation requirements for diabetic shoes.
View DMEPOS Quality Standards, October 2008.
The new Comprehensive Diabetic Foot Exam (CDFE) can help you “check all the boxes” to comply with the new regulations and recommendations and dramatically increase practice revenues.
Visual Footcare Enhances Therapeutic Shoe Program Utilization and Documentation
- It has been estimated that in any given practice only 10% of patients with Diabetes have therapeutic shoes and many of those that have therapeutic shoes do not make changes with the frequency that they should in order to avoid negative consequences of diabetic foot ulcers.
- Through consistent implementation of our standardized CDFE and use of diagnostic/educational tools such as PressureStat and TempStat, more patients will be identified for Therapeutic Shoes and educated to better self-manage their condition.
- PressureStat and TempStat are simple-to-use tools that provide clear documentation to payors as to the needs of the patients and the necessary actions taken by the provider.
- Through outstanding patient care and progress reports to primary care physicians, Podiatrists can significantly increase/solidify their referral base.
The measurement of plantar pressure is clinically relevant and integral not only to the required Comprehensive Diabetic Foot Examination for PQRI reimbursement, but also to the appropriate selection and proper fabrication of therapeutic shoes, insoles and orthotics for people with diabetes and neuropathy.
The visual aspect of plantar pressure measurement provides a patient education tool which demonstrates to a high risk beneficiary the rationale for utilizing their therapeutic footwear to ambulate at all times.
It is now required that semi-quantitative plantar pressure assessment (measurement) be documented in the medical record as an element of the qualifying comprehensive diabetic foot risk assessment and stratification exam and considered when prescribing the appropriate type of footwear and insole/orthotics solutions for a specific patient.
There is no better documentation than PressureStat prints in the patient chart!
Dermtological Assessment and Patient Self-Management
Studies indicate that temperature assessment and monitoring is a viable diagnostic tool which is capable of providing an indication of abnormalities in the diabetic foot even before the occurrence of ulceration or other tissue damage.
Data suggest that using a plantar temperature monitoring system at home on a daily basis to detect sites of inflammation in the same manner that home glucose meters are used to monitor glucose levels can be very effective in preventing ulceration. Patients with diabetes may be able to learn to adjust their activity just as they do their insulin. In addition, skin temperature monitoring can be used as an effective self-management tool to identify problems with footwear or other prosthetic devices as well as to monitor the progress of therapy for ulcers and Charcot's arthropathy.
How can you send your patients home with new therapeutic shoes and ask them to let you know in a few days if “they feel ok” if they don’t feel anything at all?