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In office shoe sales

Posted by Pauline on 12/13/01 at 22:52 (066922)

In response to collecting contributions for shoes and orthotics to be given to a poor patient as suggested by another poster, I questioned that idea based on the fact that many Podiatrist have gotten into the shoe selling business (contributing greatly to their income) and saw the selling of shoes and orthotics as a conflict of interest as compared to charitable organizations that are regulated under the Federal Income Tax Code.

The following exerpt is one example of earned income by despensing shoes and orthotics.

My personal experience involves seven years of in office
dispensing (paying patients) and the Medicare therapeutic shoe
program. I dispense 4 pairs of shoes, on average, every week,
each with three pairs of OTC inserts, that I heat mold to the
patient's feet. Those 1400 pairs probably represent 200 patients
since many of them return annually for care.

I cannot conceive that casted orthotics that are 60% more
costly to us, the patient and the system could have better
outcomes and are worth the waiting time and expense especially
with the upcoming changes in the L5502 reimbursement code.

In closing, (I know many of my colleagues hate when I put on my
businessman's hat) this program drives about $200 into the
DPM's pocket for each dispense and so in seven years, I have
banked $240,000 thanks to this program (how many capitates
visits it that).

Charitable contributions made to this podiatrist would be unregulated as compared to those made to a 401C3 non-profit organization.

Re: In office shoe sales

Dr. Zuckeman on 12/13/01 at 23:53 (066929)

Hi ,

I can understand you concern but this can't happen with the program described above. There are a few very important missing elements that this podiatrist hasn't mentioned.

1. This is a Diabetic shoe program where the doctor must document that the patient has poor circulation and or diabetic neuropathy.

2. In addition the patient has to have some kind of foot deformity, amputation of some part of the foot, history of ulceration

3. The podiatrist must also have a signed form from the doctor MD, or DO
that the patient is in fact a Diabetic and has the complications that
I described above that being servere perpherial vascular disease and or severe neuropathy

And last but not least there has to be a signed form by the MD/DO that the
patient has these complications

So the podiatrist can't be the dispenser and at the same time can't write the prescription.

I hope this clarifies the Diabetic Theuraptic Shoe Act.
I really like the program but if you choose the better quality shoes the profit isn't as great as stated. It is really nice to not have to stock all sizes of shoes in your office and at the same time provide this service.

Our office dispenses about three per month to qualified patients

Re: In office shoe sales

BrianG on 12/14/01 at 13:36 (066959)

I did a little quick math, with my calculator, and it looks like this Pod would have to sell about 5 times more shoes than Dr Z every month. Is this something easy to do? It seems like an awfully big number to me. Would their buiness be 5 times larger, or would they just be looking for more patients who qualify. It seems like pretty easy money to me. I wonder if this Pod is running a shoe store, or a Pod's office?

BCG

PS Maybe he got out his medical journels and set up his business in the area with the most diabetics in the country!

Re: In office shoe sales

Pauline on 12/14/01 at 14:28 (066963)

The Diabetic Theuraptic Shoe Act was certainly created for the right purposes, but unfortunately like everything in the Medicare System fraud
has it's way of sneaking in, as it has in this area too. The Department
of Justice and the Office of the Inspector General began an investigation
into the possibility of fraud and sent letters to both Practitioners
and Venders concerning this issue. The investigation is still on going.

It concerns me greatly when you get a physician who used to believe in custom orthotics now providing his diabetic patients with the 'heat and serve' OTC types and reporting how easy it is to add dramaticly to his's income by going into the shoe business and he counts heads as he goes.

This is the fraction of Podiatry that I would like to see cleaned up. Did this podiatrist begin selling shoes to help diabetic medicare patients or did he begin selling shoes to capture a piece of the market as stated in his letter.

He now boasts of being the CEO of Shoe World, adding as he puts it $200 directly into his pocket with each shoe sale. In his article, he goes on to incourage other DPM's to jump on the opportunity.

Just what opportunity is he speaking about the 'opportunity to help
a diabetic patient' or the 'opportunity to pocket $200 with each shoe sale while now only providing the diabetic patient just an OTC orthotic with the expensive shoe'.

What seemingly is missing when I read this type of letter so proudly put in print by one of your colleague's are the reprimand letters from other Podiatrist's. It seems to me their missing response on the subject speaks volumns.

Re: In office shoe sales

Dr. Zuckerman on 12/14/01 at 15:42 (066971)

All I know is the gratitude that I get from the patients that need this service and can't drive to the orthopedic shoe stores or can't find a driver to take them to the orthopedic shoe store and when they get there the store doesn't take assignment.

You are going to have fraud in everything . The government set this program up to save feet from amputation. So if you need shoes and the
you qualify I highly recommend the shoes.

Re: In office shoe sales

Dr. Zuckerman on 12/14/01 at 15:44 (066972)

If you have a very large diabetic practice you could sell alot of shoes.
and you would be doing a great service to your diabetic practice.

Re: In office shoe sales

Pauline on 12/14/01 at 16:20 (066982)

I find no fault with the program, but again unfortunately it's a case of buyer beware. Sadly the most vulnerable are usually the one's taken advantage of. They are the one's that have no way to compare prices or products and are often offered inferior products without knowing it, but
having Medicare billed the higher costs.

With the physician mentioned the diabetic patient is getting an OTC heat and serve orthotic, but the billing code is the same as the custom one. No one knows what the patient received except for the physician.

I'll agree the the program was established to save people from having amputations, but I still question the ethics of many of the physicians involved in the program.

You have to admit for a person with diabetic foot problem it is much easier to sell them shoes from the office mainly because of convience as compared to a healthy person who can shop to compare the cost of all the products that are available.

When dealing with Medicare Patients many feel as long as Medicare is picking up the bill, they are not paying for it so they don't care. The real truth of the matter is that someone is paying for it and we do care that the patient receives the quality for the costs that are billed.

Re: In office shoe sales

Dr. Zuckeman on 12/14/01 at 17:05 (066987)

Here is what I have found about shoes. With the program that I am working with the name is called Surefit. The quality is great. They offer a thirty day return policy. The patient wears the shoe around in the house to make sure it fits and if not the shoe is returned for a new size. It takes alot of time to measure the shoe and to make sure the shoe fits. As for the inserts . They have to be customized with a foam impression. Anything less isn't an insert that qualifiesfor the program. The profit is less then $100 per patient, if you pick a company that is in the best interest of the patients. So yes there is going to be fraud and absure just hope the program doesn't go out of existence cause then I will be back to write a prescription that is some cases never gets fitted. Medicare knows that the average amputation cost is about $30,000 and with these shoes the cost savings is well alot more then the abuse costs. I say this pateints are
stupid.

Re: In office shoe sales

Dr. Zuckeman on 12/13/01 at 23:53 (066929)

Hi ,

I can understand you concern but this can't happen with the program described above. There are a few very important missing elements that this podiatrist hasn't mentioned.

1. This is a Diabetic shoe program where the doctor must document that the patient has poor circulation and or diabetic neuropathy.

2. In addition the patient has to have some kind of foot deformity, amputation of some part of the foot, history of ulceration

3. The podiatrist must also have a signed form from the doctor MD, or DO
that the patient is in fact a Diabetic and has the complications that
I described above that being servere perpherial vascular disease and or severe neuropathy

And last but not least there has to be a signed form by the MD/DO that the
patient has these complications

So the podiatrist can't be the dispenser and at the same time can't write the prescription.

I hope this clarifies the Diabetic Theuraptic Shoe Act.
I really like the program but if you choose the better quality shoes the profit isn't as great as stated. It is really nice to not have to stock all sizes of shoes in your office and at the same time provide this service.

Our office dispenses about three per month to qualified patients

Re: In office shoe sales

BrianG on 12/14/01 at 13:36 (066959)

I did a little quick math, with my calculator, and it looks like this Pod would have to sell about 5 times more shoes than Dr Z every month. Is this something easy to do? It seems like an awfully big number to me. Would their buiness be 5 times larger, or would they just be looking for more patients who qualify. It seems like pretty easy money to me. I wonder if this Pod is running a shoe store, or a Pod's office?

BCG

PS Maybe he got out his medical journels and set up his business in the area with the most diabetics in the country!

Re: In office shoe sales

Pauline on 12/14/01 at 14:28 (066963)

The Diabetic Theuraptic Shoe Act was certainly created for the right purposes, but unfortunately like everything in the Medicare System fraud
has it's way of sneaking in, as it has in this area too. The Department
of Justice and the Office of the Inspector General began an investigation
into the possibility of fraud and sent letters to both Practitioners
and Venders concerning this issue. The investigation is still on going.

It concerns me greatly when you get a physician who used to believe in custom orthotics now providing his diabetic patients with the 'heat and serve' OTC types and reporting how easy it is to add dramaticly to his's income by going into the shoe business and he counts heads as he goes.

This is the fraction of Podiatry that I would like to see cleaned up. Did this podiatrist begin selling shoes to help diabetic medicare patients or did he begin selling shoes to capture a piece of the market as stated in his letter.

He now boasts of being the CEO of Shoe World, adding as he puts it $200 directly into his pocket with each shoe sale. In his article, he goes on to incourage other DPM's to jump on the opportunity.

Just what opportunity is he speaking about the 'opportunity to help
a diabetic patient' or the 'opportunity to pocket $200 with each shoe sale while now only providing the diabetic patient just an OTC orthotic with the expensive shoe'.

What seemingly is missing when I read this type of letter so proudly put in print by one of your colleague's are the reprimand letters from other Podiatrist's. It seems to me their missing response on the subject speaks volumns.

Re: In office shoe sales

Dr. Zuckerman on 12/14/01 at 15:42 (066971)

All I know is the gratitude that I get from the patients that need this service and can't drive to the orthopedic shoe stores or can't find a driver to take them to the orthopedic shoe store and when they get there the store doesn't take assignment.

You are going to have fraud in everything . The government set this program up to save feet from amputation. So if you need shoes and the
you qualify I highly recommend the shoes.

Re: In office shoe sales

Dr. Zuckerman on 12/14/01 at 15:44 (066972)

If you have a very large diabetic practice you could sell alot of shoes.
and you would be doing a great service to your diabetic practice.

Re: In office shoe sales

Pauline on 12/14/01 at 16:20 (066982)

I find no fault with the program, but again unfortunately it's a case of buyer beware. Sadly the most vulnerable are usually the one's taken advantage of. They are the one's that have no way to compare prices or products and are often offered inferior products without knowing it, but
having Medicare billed the higher costs.

With the physician mentioned the diabetic patient is getting an OTC heat and serve orthotic, but the billing code is the same as the custom one. No one knows what the patient received except for the physician.

I'll agree the the program was established to save people from having amputations, but I still question the ethics of many of the physicians involved in the program.

You have to admit for a person with diabetic foot problem it is much easier to sell them shoes from the office mainly because of convience as compared to a healthy person who can shop to compare the cost of all the products that are available.

When dealing with Medicare Patients many feel as long as Medicare is picking up the bill, they are not paying for it so they don't care. The real truth of the matter is that someone is paying for it and we do care that the patient receives the quality for the costs that are billed.

Re: In office shoe sales

Dr. Zuckeman on 12/14/01 at 17:05 (066987)

Here is what I have found about shoes. With the program that I am working with the name is called Surefit. The quality is great. They offer a thirty day return policy. The patient wears the shoe around in the house to make sure it fits and if not the shoe is returned for a new size. It takes alot of time to measure the shoe and to make sure the shoe fits. As for the inserts . They have to be customized with a foam impression. Anything less isn't an insert that qualifiesfor the program. The profit is less then $100 per patient, if you pick a company that is in the best interest of the patients. So yes there is going to be fraud and absure just hope the program doesn't go out of existence cause then I will be back to write a prescription that is some cases never gets fitted. Medicare knows that the average amputation cost is about $30,000 and with these shoes the cost savings is well alot more then the abuse costs. I say this pateints are
stupid.