How Will Obamacare Affect Podiatry?

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Author(s): 
Neal Frankel, DPM, FASPS, FACFAS

Podiatrists and patients alike may experience some confusion with the deluge of information regarding the Affordable Care Act (ACA). This author discusses the insurance exchanges and what constitutes a “qualifying health plan” with the ACA, raises questions about potential obstacles with ACA and suggests proactive strategies to help ensure adequate reimbursement in the future.

With all of the news blasting on the television 24/7 about the Affordable Care Act, also known as Obamacare, do you think you have enough information to be ready for the changes in the way your patients receive their insurance coverage and be able to get paid for your services?

   Unfortunately, many of the news stations are very biased in their coverage depending on the station you watch. Fox News blasts the plan at every turn while MSNBC tells its listeners that this law is the next best thing to sliced bread. I hope to give you all of the facts I have been able to compile to date and include my personal opinion as to what you need to do to continue being profitable with all of the changes you will see in regard to patients’ coverage and how you will be reimbursed.

   Many of my sources include high-level healthcare consultants, insurers and government sources. Again, each of them presented the facts as the facts were presented to them but I still detected a definite bias in how they presented these facts. I will first list the definition of the many components of the law and what it means to the patients purchasing these plans. Then I will discuss the reimbursement issues that we will face and how we as podiatrists will be able to treat these patients in the years to come.

   I am sure you have been aware of the government Web site for the federal exchange and its inability to allow access for patients to purchase these plans, but not much is being reported as to what will happen once people are finally able to sign up. To date, it is not clear whether the information the Web site obtains will actually result in patients enrolled in the various plans and whether their personal information collected will have adequate protection. It is also unclear on how the insurers receive subsidies for the money they outlay and how physicians get paid.

A Closer Look At The Insurance Exchanges

There are several types of delivery models that will allow patients to purchase insurance. These include the state health insurance exchange, the federal health insurance exchange and joint-run exchanges. In addition, many insurers have included their plans on their individual Web sites and through insurance agents as they were available before.

   Affordable Care Act state health insurance exchanges can run a number of different ways. States can build a health insurance exchange on their own, partner with one or more other states, run a joint exchange with the federal government or have the federal government build and run the insurance exchange for them. January 1, 2014 was the deadline for all exchanges to be fully operational. Only states that build their own exchange receive full government funding.

   States that set up their own exchange get to directly determine which companies can compete in their exchange and negotiate benefits and prices. In a federal exchange, the U.S. Department of Health and Human Services (HHS) does this for them. In a joint-run exchange, any carrier meeting the minimum federal and state requirements can compete in the exchange.

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Dr.Adam Katzsays: January 4, 2014 at 1:00 am

Nice Article! Going with my practice regardless of Obamacare. http://youtu.be/cxe-1nJi5rk

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Michelle Alex, DPMsays: January 5, 2014 at 12:43 am

With ACA & ICD-10, now more than ever podiatrists need to start changing the way they practice.

Ten years ago, I walked away from the limitations of insurance and started conducting clinical trials. I have never looked back! The majority of clinical trials in the field of foot disorders, foot care and treatment of lower extremity disorders are being conducted by MDs and DOs. Podiatrists are considerably highly qualified and can be considered as experts in the disorders and treatments related to the lower extremity. However, the majority of podiatrists are not taking advantage of the large number of clinical trials available to them.

By incorporating clinical research into your private practice, you increase the value of your business and by that I mean increasing your revenues, profits and equity should you decide to sell your practice or exit in some way.

It's time for podiatrist to discover the lucrative world of clinical research. If you are interested in learning how to incorporate clinical trials in your practice, send me an e-mail.

Michelle Alex, DPM
michelle.alex@renoclinicaltrials.com

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Brian Schultz DPMsays: January 7, 2014 at 3:14 pm

I would be very interested in learning more about the clinical trials.

Thanks,

Brian

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Stefan Zweig, DPMsays: January 5, 2014 at 3:05 pm

I'd like info about conducting clinical trials. Thanks.

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Michelle Alex, DPMsays: January 7, 2014 at 9:52 am

Stefan,

Send me an email and we can talk.

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Lynnsays: March 2, 2014 at 10:48 pm

It's a sad day. I voted Democrat thinking that Obamacare was great to offer everyone insurance. I have type 2 diabetes, $300,000 in student loan debt and I am in private practice. I have managed to run a successful practice for 10 years, based strictly on quality patient care and superior customer service with a top of the line EMR. Due to low reimbursement, increasing overhead and the constant battle to fight and justify to be paid for my service and product, I'm not sure how long I can hold on. Is the private practice doctor being eliminated slowly? I did a 1-year residency, which included a good mix of medicine and surgery, but I am unsure of my future. I LOVE my job! I am sooooo disheartened about the future of podiatry! Any words of wisdom would be appreciated.

My email : mekaboo37@aol.com

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