August 2013

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Favorable Ruling On Podiatric Care For Medi-Cal Beneficiaries

By Brian McCurdy, Senior Editor

The 9th U.S. Circuit Court of Appeals has overturned a California state law that denied Medi-Cal beneficiaries podiatric care at designated rural health clinics and federally-qualified health centers. The California Podiatric Medical Association (CPMA) cautions that the ruling has a limited scope and DPMs are still excluded from standard Medi-Cal fee-for-service.

   Due to this ruling, Lee C. Rogers, DPM, notes that patients in affected rural clinics can now expect to see a specialist for their foot care needs. He explains that Medi-Cal does not exclude foot care but only prohibits foot care from being provided by a podiatrist. Dr. Rogers says the CPMA Board and legal team are still evaluating the impact of the decision.

   As CPMA President Carolyn McAloon, DPM, explains, the court decision is due to the fact that the federal laws mandating rural clinics are distinct from the general Medicaid laws. She notes rural clinic laws specifically incorporate the Medicare definition of “physician” but the definition of physician for general Medicaid coverage does not currently include podiatrists.

   “This decision only affects a minority of California podiatrists,” says Dr. Rogers, the Co-Director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles.

   “The fight continues to ensure that all Californians can see a specialist when they have a foot or ankle problem, some as serious as limb-threatening.”

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   Dr. Fife cites an abundance of randomized, controlled trial data that supports the efficacy of HBOT. She also notes that a recent meta-analysis concluded that HBOT improved healing and reduced the risk of major amputation in patients with DFUs. Dr. Fife adds that when it comes to advanced modalities for diabetic foot ulcers, HBOT “stands alone in having RCT evidence of efficacy in Wagner 3/4 grade ulcers and hypoxic wounds.”

   Dr. Fife says HBOT is indicated for patients with DFUs who fail to respond to four weeks of “adequate wound care defined as vascular screening and/or revascularization, treatment of infection, control of diabetes and aggressive offloading.” While the Diabetes Care study has not changed her view of HBOT, Dr. Fife says the study does encourage clinicians to reassess proper patient selection for HBOT.

In Brief

Small Bone Innovations, Inc. has announced that U.S. surgeons have implanted more than 5,000 STAR Total Ankle Replacement Systems since the device received Food and Drug Administration (FDA) approval in May 2009. Small Bone Innovations says the STAR system is the only total ankle replacement system with published, long-term clinical results with 91 percent survivorship at an average follow-up of 9.1 years.

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