Two Federal Bills Seek To Define Physicians As DPMs Under Medicaid

By Brian McCurdy, Associate Editor

   Since Medicaid does not recognize podiatrists as physicians, beneficiaries of the federal program may not receive podiatric care for their foot and ankle conditions. However, recent bills in the Senate and House aim to define podiatrists as physicians under Medicaid. The bills’ proponents, including the American Podiatric Medical Association (APMA), say the change will enhance preventive patient care and possibly prevent states from making cuts in podiatric services during budget crises.

   Foot and ankle care provided by a MD or DO is covered as a “physician service” under Medicaid but similar care provided by a podiatric physician may not be covered.

   If podiatrists are not considered physicians under Medicaid, Michael Downey, DPM, believes there may be negative consequences for patients as they would not be able to see podiatrists for foot and ankle emergencies. He says this would be a particular problem in emergency rooms or for diabetic patients, especially in urban areas, where many Medicaid patients who require podiatric services would either be referred to other physicians or not receive care. Podiatrists see many Medicaid patients in hospital ERs when other medical specialists will not, adds Dr. Downey, the Chief of the Division of Podiatric Surgery at the University of Pennsylvania Medical Center-Presbyterian in Philadelphia.

   Podiatrists provide the majority of foot care to high-risk Medicaid patients such as diabetics, according to Dr. Downey. If these patients cannot have access to podiatrists, Dr. Downey says this could lead to a rise in amputations and other problems that arise from not receiving proper diabetic foot care. Both he and Ronald Jensen, DPM, believe such a lack of care would actually increase Medicaid costs over time. However, Dr. Jensen, the Chairman of the Legislative Committee of the APMA, points out the cost of including the estimated 15,000 DPMs as physicians under the Medicaid definition would be nominal.

Can Redefinition Under Medicaid Protect DPMs From Budget Cuts?

   Despite the fact that Medicaid does not classify podiatrists as physicians, Dr. Jensen notes 46 states and the District of Columbia do reimburse podiatrists for physicians’ services under Medicaid. However, he expresses concern that during a budget crisis, states may modify or eliminate services provided by podiatrists as these services are considered “optional” by Medicaid. However, Dr. Jensen notes that no such cuts can be made to services provided by “physicians” as defined by Medicaid. Dr. Jensen says defining DPMs as physicians may prevent cutbacks or elimination of podiatric services to Medicaid beneficiaries.

   Dr. Jensen’s concern has become a reality. Although most cost reductions have been in fees, prescription benefits and other areas, Dr. Downey notes some states are eliminating podiatry services as part of their budget cuts. He points out that New York and Missouri have recently proposed excluding podiatrists from Medicaid to save money. Dr. Downey believes other states will follow suit to save money unless Medicaid redefines podiatrists as physicians.

   Defining podiatrists as physicians also would affect reimbursement as DPMs would continue to see Medicaid patients, according to Dr. Downey. While he notes that Medicaid reimbursement is low compared to that for Medicare or private insurance, Dr. Downey says podiatrists would prefer low reimbursement to no reimbursement and many DPMs wish to serve the Medicaid population. (Medicare does define DPMs as “physicians.”)

   Dr. Downey, a Fellow of the American College of Foot and Ankle Surgeons, also foresees a negative impact on residency programs as Medicaid patients comprise the majority of patients with severe deformities, emergency room visits and diabetic foot conditions. If the Medicaid issue is not resolved, Dr. Downey says residency programs will “suffer significantly.”

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