It is a challenging, common situation: wound care patients require offloading devices for diabetic and/or neuropathic plantar ulcers, but there is no insurance coverage for those items. You explain that they will bear the cost of the product(s), but they believe the expenses should be covered by you. When you offer to sell the product(s) directly or suggest the patients purchase them elsewhere, they refuse. Ultimately, their wounds worsen or don’t improve.
It is well documented that shoe-based offloading approaches are used more frequently than any other modality in the treatment of plantar diabetic foot ulcers (DFUs).1,2 It is equally well established that supporting data are limited.3 Additionally, since there is no reimbursement for shoe-based offloading, the products and materials that physicians select to create offloading structures may be based as much on acquisition cost and availability than on any empirical review. When a DFU is the sole indication, the only offloading options that are routinely covered by Medicare (or insurance) are total contact casting and Crow walkers, both of which are used infrequently and are not “accepted” by many physicians or patients.1,2 The result of this disconnect between modalities that are reimbursed versus approaches that most physicians use is that there is no broadly recognized standard of care and actual care is highly variable from facility to facility …
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