DVA Medical-Grade Footwear Modification Prescriptions

Monday, July 18, 2022

Just Comfort Shoes will continue to provide footwear under the DVA Medical Grade Footwear program as before, but has decided to discontinue handling footwear modification prescriptions.

Below in dot points are a summary of the reasons for our decision and an outline of a replacement process for footwear modifications. Below that is a more complete explanation of our decision and the reasons why the new process is similar to the old but may be able to provide better outcomes for clients.

In summary, the reasons for our decision are:

Just Comfort Shoes adds little value to the DVA MGF modification process by acting as a go-between for prescribers and shoemakers (eg pedorthists).
DVA’s allowances don’t cover our costs to arrange standard types of modifications.
The additional steps of having a go-between can cause delays and/or miscommunication of requirements for clients.
Dealing directly with DVA-registered shoemakers should require only minimal adjustment to work processes for prescribers.

The replacement process will be as follows:

Prescribers will send Just Comfort Shoes prescriptions that are only for supply of shoes, not for modifications. Modifications include maintenance such as repairs of wear and tear, or re-soling to extend the life of the shoes. (Warranty issues such as faulty shoes are different, and can still be handled by Just Comfort Shoes, of course.)
After receiving shoes from us and checking the suitability and fit with the client, prescribers will send modification prescriptions and the shoes directly to a DVA-registered practitioner.
DVA-registered practitioners can be found on the following government web page in the link to the Excel document called “MGF Suppliers List”: https://www.dva.gov.au/providers/health-programs-and-services-our-clients/medical-grade-footwear-providers-and-suppliers#contracted-suppliers. Relevant suppliers are those indicated as offering Custom Made footwear. (The Just Comfort Shoes listing will be updated to remove this indicator.)
The DVA-registered shoemaker can claim from DVA for the shoe modification work, and also for postage if the shoemaker arranges that.
For postage, alternatively, prescribers may be able to claim for postage they arrange themselves - please check with DVA if you do not already have relevant information.

The following explains the reason for our decision more fully.

Just Comfort Shoes has no shoemaker or repairer of its own, and has acted only as a go-between to arrange modifications and repairs with relevant practitioners. As such, it has added little value to the shoe modification process except to provide a one-stop-shop for prescribers who need both a shoe and a modification for their client.

To achieve this, we have most often used the shoe repairer geographically closest to us to do much of the modification work despite that he is not DVA-registered himself. This has been possible because we, as a DVA-registered footwear supplier, have handled the prescriptions, liaised with the shoe repairer and taken responsibility for the quality of the work ourselves.

The advantages for prescribers in having us act as a one-stop shop have been limited. The non-DVA-registered shoe repairers we have used don’t do all types of modifications, requiring some shoes to be sent to DVA-registered shoemakers further away from us. We have generally sent shoes to prescribers to check the suitability and fit prior to modification work, which is usually the only way to avoid risking the wastage that would occur if unsuitable shoes were modified. This means shoes needing modification were already being sent back to prescribers before being sent out for modification anyway - except in cases where the shoe variant was already known to suit the client (eg because the client already had a pair).

There have also been problems with our acting as a one-stop shop. One is that the DVA MGF program’s allowances for standard types of modifications are well below real-world costs, which means we have effectively subsidised DVA for five years while handling modification prescriptions. We have lobbied DVA multiple times requesting more appropriate allowances, but annual increases have generally not been higher than CPI. DVA-registered shoemakers who handle modification prescriptions directly are required to do standard modifications for the listed price and can claim directly from DVA.

Non-standard modifications require a quotation sent to DVA for approval, which for us requires price information from a shoemaker, who may sometimes first need to see the shoes, requiring an extra step after we receive the shoes back from the prescriber. This adds complication and potential delay for clients. A DVA-registered shoemaker handling a modification prescription directly can determine a price and send a quotation to DVA more quickly, and if needing to see the shoes in person first, can determine a price as soon as the shoes arrive from the prescriber, without having to send the shoes elsewhere first for a quotation.

The best approach to meeting the footwear needs expressed in a DVA MGF prescription starts with an in-person fit and/or measure with the client. This applies to ready-made footwear, custom-made footwear and modifications. But an in-person meeting is not always practical because clients are often too far away from DVA footwear providers and shoemakers. This is why we use foot tracings and measurements sent by prescribers to supply shoes to non-local clients.

However, sometimes under this arrangement, we do need to send an alternative style, size or width before shoes are issued. This reflects the fact that any layer of abstraction increases the chances of an unsuitable result. And not only is this also true for modifications, but unsuitable modifications can be more problematic because the shoes may be wasted. (This is why we already previously discontinued providing measurements of local DVA clients to a non-local custom shoemaker. Measurements don't provide a complete picture and always require some degree of interpretation, and the results were often less than ideal.)

But some potential problems, such as miscommunication of the work requirements, can be minimised by ensuring that any necessary communications occur directly between the shoemaker and the prescriber and/or client, and this is especially helpful for clients who can't visit the shoemaker in person if any discussion is necessary beyond the clinical needs mentioned in the prescription.

I trust that the above explains why ceasing to handle DVA MGF footwear modifications is not only a necessary business decision for Just Comfort Shoes, but also in the best interests of MGF clients.

If you need any clarification of how footwear modifications will work without the involvement of Just Comfort Shoes, please feel free to contact me on 0432 307 672.

James Brecknell
Director