Diabetic Footwear

A Foothold in Building Patient Relationships

Many providers are looking at how they can get a foot into diabetic footwear. In a time when Medicare funding cuts are driving down revenues and margins, diabetic footwear has been identified as a solid source of new revenue. With it, a provider can make roughly $200 a patient, and because it is an annual benefit that revenue comes back year after year.

Medicare’s basic diabetic footwear benefit is that a patient can get one pair of shoes, and three inserts per year. The shoes are designed to promote circulation, and the inserts are accommodative, rather than corrective, and designed provide full contact at the arch to prevent the sort of shearing that the diabetic patient might not feel due to peripheral neuropathy. Also, in terms of Medicare funding, it’s worth mentioning that diabetic footwear is not included in competitive bidding.

However, to an HME provider that is supplying bigger ticket items, the basic reimbursement for diabetic footwear might not seem incredibly attractive, especially if they are worried about their ability to handle enough volume. Those providers must reconsider that thinking. New diabetic patients are worth far more than the basic $200 fudning. The average diabetic patient spends into the thousands of dollars with Medicare each year on a wide range of health products and services.

Moreover, diabetic footwear an effective lure for those patients, because it represents something the patient wants to have. Where glucometers, testing strips and similar items are things that patients have to have, diabetic footwear is an apparel item that the patient wants, and will want to renew and replace as fashion trends and personal tastes evolve. Who doesn’t like a new pair of shoes? And if patients keep returing to that provider year after year, chances are they will stick with that provider for a full range of DME needs.

That said, HMEs wishing to provide diabetic footwear need to consider several factors before they take their first steps into serving this important patient segment.

From a numbers standpoint, the market is huge. Fewer than 20 percent of diabetic patients that have a medical need for diabetic shoes are actually getting them. And of that growing market, Baby Boomers represent a key segment. Boomers are starting to come into Medicare, and as they get older, those with diabetes will increasingly need diabetic footwear. Providers need to concentrate on attracting that market, so laying a foundation with referral partners such as diabetic educators is critical.

Referral Partners

In terms of referral relationships, a good place to start is with building relationships with diabetic educators and start getting referrals from them. Diabetic educators work with physicians to educate patients on how to manage their conditions and care, but they typically don’t spend a lot of time talking about shoes. So if the provider can work with diabetic educators to let newly diagnosed patients on Medicare know that they have this benefit available to them, then they will create a very effective referral relationships. Other key referral partners include primary care physicians, endocrinologists, podiatrists, and long-term care facilities that let providers give presentations and perform on-site fittings.

Product and Support

Partnering with a solid manufacturer is a critical element in diabetic footwear success. Providers want to ensure that they are offering top-quality shoes that come in a wide range of styles. Remember, this is an apparel item, and ensuring that vendors are constantly refreshing their line to suit current tastes and trends is critical. A good vendor partner will offer not only quality product, but also support to the provider in the form of education, marketing support, catalogs, brochures and displays. Manufacturers can show interested providers how to get a foothold in the marketplace, and offer training to help staff understand all the elements in providing the right kind of care and footwear.


In terms of hard assets, diabetic footwear providers need a complete fitting inventory, and a sizing tool, such as the familiar metal Brannock device we’ve all seen in shoe stores. Diabetic shoes are required to be made in a full range of sizes, including half sizes and three different widths, so the provider isn’t expected to have a full inventory on site. Instead, the provider will measure the patient, fit them, and then order the shoe for the patient. Mid-weight and athletic compression socks often work well for geriatric patients since the soft and thick fabric is easier to get on and is gentler on their fragile skin. These types of stockings will also do a far better job of addressing edema than the hospital TEDs.

Staff Expertise

The level of staff expertise, education and certification required to provide diabetic footwear varies, depending on state laws, and from a Medicare perspective the Medicare requirements are that the provider have a “qualified individual” on staff. But even if a provider’s manufacturer offers a certification program, the smartest move for a provider to make is to start with its accrediting organization to determine which certifications are needed on staff. For example, the AO might say the provider needs a Certified Fitter of Therapeutic Shoes on staff, or it might say that the provider is limited to providing heat moldable inserts, but if it wants to do custom inserts, then it needs a Certified Pedorthist on staff.

Points to take away:

  • Diabetic footwear might initially seem like a small reimbursement, but it creates relationships with patients seeking a much wider range of products.
  • Providers must partner with the right kinds of referral partners, such as diabetic educators.
  • Seek vendors that offer a wide range of shoes that are regularly updated, as well as training and marketing support.
  • Seek vendor certification programs, but also look for state requirements, and especially requirements from accrediting organizations.

Learn more:

The American Board for Certification in Orthotics, Prosthetics & Pedorthics offers Certified Fitter of Therapeutic Shoes and Certified Pedorthist credentials. Find out more at www.abcop.org.

This article originally appeared in the June 2012 issue of HME Business.


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