How Will Obamacare Affect Podiatry?

Neal Frankel, DPM, FASPS, FACFAS

   As I previously mentioned, patients earning less than 400 percent of the federal poverty level would possibly be eligible for tax credits. What this means is some patients who are under a certain income level would receive subsidized premiums but may pay more in out-of-pocket expenses with increased deductibles. Early reports have deductibles around $6,000 for individuals and $12,000 for families.1,2 I learned that the out-of-pocket expenses will include items that were not covered before such as pharmacy costs, etc., so the idea is the patient will reach these out-of-pocket levels sooner.

   The insurers’ point of view is that because of the ACA, more people than ever before will have access to health insurance, thus adding increased numbers of insured individuals. Since there are no preexisting condition restrictions or lifetime maximum limits under the law, insurers feel we will be able to get greater access to these patients than we were before.

   There is a threshold of coverage under the law that requires insurers to spend 80 percent of every premium dollar on actual care and refund providers if providers pay any greater amount. What I feel this actually means is in order to not go over the threshold, payments to providers will be reduced. In fact, the new networks forming under these exchange plans will receive a level around 60 to 70 percent of Medicare with smaller panels of physicians. We are already hearing of doctors getting deselection notices from plans in certain markets. One thing I can say for certain is doctors contracted as individuals will be terminated before doctors who are contracted in a group. Those of you who know me know that I was the developer of the original podiatric supergroup back in 1994. I believed the group concept was viable when managed care began and believe this even more now.

   Out of the four available plans offered — bronze, silver, gold and platinum — the insurance companies are leaning toward the silver plan. According to some high level insurance executives, under the silver plan, the insurance company pays the co-insurance that the patient normally pays. In turn, the federal government reimburses the insurance company. The interesting thing about this is according to statements made by Congress, there is no mechanism to accurately determine how much reimbursement the insurers should receive so these payments are to be estimated and accounted for at a later date.

Pertinent Insights On Potential Problems With Health Care Reform

So what could possibly go wrong with this scenario? The feeling among insurers is we should be very happy with this arrangement since there is less that doctors would have to collect from the patient because the co-insurance goes directly to the doctors. What they fail to mention is the deductible will likely be higher so, in reality, we will probably have to collect more from the patient.

   Patients can get information about various plans directly from the insurance company sites but can only get subsidies through the government Web site. Since the cutoff date for January 1, 2014 effective coverage was December 23, as this issue went to press, it is unclear how everyone would be able to obtain coverage with the government Web site not performing optimally. (As this issue went to press, uninsured patients would not face a penalty if they registered by March 31.) The reason the premiums are reportedly higher for younger patients is the ratio of premiums between young, healthy patients and older, sicker patients has gone from 7:1 to 3:1, which does reduce the costs for the older patients but increases the premiums for the healthier patients. This is also why you are not seeing a lot of younger patients signing up.


Nice Article! Going with my practice regardless of Obamacare.

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

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



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


Send me an email and we can talk.

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 :

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