Therapeutic shoe dealers face uncertainty

Friday, February 28, 2003

WASHINGTON - Region A Medical Director Dr. Paul Hughes admits he jumped the gun by issuing a December bulletin that greatly restricted the kinds of providers who can dispense therapeutic shoes for diabetics.

“CMS said I was right and consistent with the law but that they had some regulatory stuff going on with this, and I thought maybe it would be better if I retracted this pending the regulations,” Hughes told HME News.

Hughes retracted the bulletin in January. In issuing it, Hughes restricted the provision of therapeutic shoes to four Medicare providers: podiatrists, pedorthists, orthotists and prosthetists. “To date, there have been no instructions from the Secretary expanding this list,” the bulletin stated.

If it had gone into effect, the bulletin would eliminated from the Medicare specialty footwear business pharmacists, nurses, physical therapists and other healthcare professionals, as well as DME providers who have been trained - often by shoe manufacturers - to fit therapeutic shoes.

More than a few industry watchers, surmised that Hughes issued the bulletin to reduce the amount of money Region A reimburses for therapeutic footwear.

Not so, said Hughes. There is a ‘’huge utilization in these items,” but nothing unusual. More to the point, he noticed that, contrary to what the Medicare Carriers Manual specifies, providers other than podiatrists, pedorthists, orthotists and prosthetists were furnishing the shoes.

“It struck me that there are a whole bunch of folks out there providing this stuff who aren’t in the delineated categories,” Hughes said. “When I see something like that, I say, ‘We are letting something happen that I’ve got to correct.”’

Industry watchers say CMS is ambiguous on who can provide of therapeutic footwear (see related story). But such a drastic correction, as Hughes proposed, would be a mistake, say therapeutic shoe manufacturers and others.

First, many of the professionals the bulletin identified as qualified to fit the shoes, don’t do so, preferring instead to focus their efforts on more lucrative services. There’s also a lack of these professionals in rural areas. Consequently, much of the Medicare therapeutic shoe business falls to pharmacists, DME providers or others who have been trained to fit the shoes, often by shoe manufacturers. Excluding these providers would create an access problem, say industry watchers.

Indeed, therapeutic shoes “are pretty easy to fit,” said George Karpman, general manager of Memorial Homecare in Springfield, Ill. “Most of the time we get referrals from podiatrists who don’t want to sell the shoes.” HME