APMA Pushes For Medicaid Bill To Define DPMs As Physicians

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By Brian McCurdy, Associate Editor

Podiatrists looking for an even playing field when it comes to Medicaid reimbursement may be interested in a resolution that is making its way through the House of Representatives. As this issue went to press, Congress is considering a resolution to expand the definition of “physician”in the Medicaid program. House Resolution 2959 would amend Title XIX of the Social Security Act to include podiatrists as physicians in Medicaid, making it consistent with Medicare’s definition of physicians. Physician is now defined by Medicaid as MDs and DOs. The American Podiatric Medical Association (APMA) lobbied for the change, according to APMA President-Elect Lloyd Smith, DPM. As the association notes, if the resolution passes, state podiatric bodies will no longer have to fight Medicaid on this issue in state legislatures. Dr. Smith says the resolution would be “historic legislation.” He notes that with the redefinition, “(reimbursement for) podiatrists would no longer be (considered) optional and, as a result, all state Medicaid programs would need to allow patients access to DPMs in the same manner as they do for MDs and DOs.” Stephen Monaco, DPM, explains that, under the current statutes, if a patient has Medicare as a primary insurer and Medicaid as a secondary insurer, Medicare would cover podiatric services but Medicaid can deny such payments. If Medicaid redefines physician, Dr. Monaco notes DPMs will get paid for their services regardless of whether Medicaid is listed as a primary or secondary insurer. “It appears discriminatory to deny payments for a covered service (in the Medicaid system) based upon the provider’s degree,” explains Dr. Monaco. The resolution, introduced in the House in July, has been referred to the Subcommittee on Health. The APMA is seeking a sponsor for a companion bill in the Senate. Florida Caps Noneconomic Damages At $500,000 By Brian McCurdy, Associate Editor Florida has joined Texas as the latest state to enact caps on noneconomic damages from malpractice lawsuits. The state legislature has adopted a $500,000 cap on such damages in suits against practitioners. The cap went into effect Sept. 15. The cap for suits against multiple practitioners for noneconomic damages was set at $1 million and the cap for non-practitioners was established at $750,000. Another provision of the bill is the freezing of malpractice insurance rates as of July 1, 2003 so new rates can be devised to take into account the legislation’s impact. New insurance rates must take effect by Jan. 1, 2004. The American Medical Association has identified Florida as one of 19 states in a malpractice crisis, which is echoed in the language of the new bill. Gov. Jeb Bush and some physicians had supported a $250,000 noneconomic damage cap. Timothy Tillo, DPM, President of the Florida Podiatric Medical Association, says it is “unfortunate” such a cap could not be part of Florida reform as it has worked well in other states. Dr. Tillo feels the cap compromise will “have a limited effect” on the state’s malpractice crisis and notes the cap can be pierced in certain circumstances. A provision of the legislation says the cap can be pierced in cases of wrongful death or a permanent vegetative state, in which the cap increases to a total of $1 million for all physicians and $1.5 million for non-practitioners. He feels pre-lawsuit reform would reduce the number of frivolous suits. “The malpractice crisis will have an adverse effect on patient access to medical care,” says Dr. Tillo. “High-risk patients such as diabetics or patients with chronic wounds or complex orthopedic deformities may have difficulty in finding a physician to render the appropriate care.” Dr. Tillo adds that physicians are opting out of types of care in some areas. The Florida Medical Association has a 90-page report of physicians of different types who have had to curtail services due to malpractice issues. A study commissioned by the Florida Governor’s Select Task Force on Healthcare Professional Liability Insurance determined Florida’s average malpractice insurance premium per doctor in 2002 was 55 percent above the national average. Since 1996, average premiums in the state have increased 64 percent while average premiums have increased only 26 percent in the rest of the country, according to the study.

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