June 2010

How Will Healthcare Reform Affect Your Patients And Practice?

Brian McCurdy, Senior Editor

During the protracted battle over healthcare reform, there was no shortage of opinion on either side of the issue on whether the reform would help or hurt patients and doctors. Now that President Obama has signed the reform into law, how will it affect both podiatric patients and practices?

   A recent Podiatry Today online poll may provide some insights into the prevailing thinking. Of the 293 DPMs who responded to the poll, 61 percent said the reform would be detrimental, 10 percent said it would be beneficial and 29 percent said it was too early to tell the effect of the legislation.

   William Fishco, DPM, sees healthcare reform as beneficial for people who are in need of podiatric care.

   “Greater access to healthcare will ensure that chronic conditions are managed better and acute conditions will be treated in a timely fashion,” notes Dr. Fishco, who is a faculty member of the Podiatry Institute. He adds that better access to care may help more patients with diabetes get preventative care to minimize the risk of amputation.

   Anthony Poggio, DPM, also believes more people will have access to podiatric offices. He speculates that patients who may have deferred treatment for foot and ankle conditions due to having to pay out of pocket will now be able to get treatment under insurance plans. However, he offers some caveats. “With the high unemployment rate, some patients who are out of work may still not get access as they do not have a job where they could get coverage,” notes Dr. Poggio.

   With the coverage mandate, Dr. Poggio notes the insurance companies may offer plans that are “affordable” for small employers but the actual benefits coverage of such small business plans is unclear. As he cautions, co-pays may be high, deductibles may be high and covered services may be limited. As a result, “even if a patient has coverage, these other factors may still limit access,” explains Dr. Poggio.

Will There Be Less Reimbursement And Higher Patient Volume?

Drs. Poggio, Fishco and Megan Lawton, DPM, all see busier schedules ahead for podiatric practices. However, Dr. Poggio notes it is unclear as to what services will be covered and at what fee schedule. If the fee schedule is too low, he says some providers may opt out of providing care for patients under certain health plans.

   Dr. Fishco foresees providers being paid less. “If reimbursements are less and we will need to see more patients to make up for less revenue per patient, then becoming more efficient and cost effective will be paramount,” notes Dr. Fishco, who is in private practice in Phoenix.

   Dr. Lawton, who is in private practice in Naples, Fla., agrees that a potential decrease in revenue will go hand in hand with higher patient volumes. “Eventually I could see high volume clinics appearing, potentially sacrificing quality,” she says.

   Dr. Poggio emphasizes that podiatric practices are not only providers of medical care but consumers of medical care as well. As he notes, many practices are small and affordability of insurance coverage for their own employees is an issue.

   “We too will have to offer coverage to our employees and that will increase our expenses, which will offset our potential increase in income,” says Dr. Poggio, who is board certified by the American Board of Podiatric Medicine and the American Board of Podiatric Orthopedics.

Updated Guidelines Emerge For Heel Pain

By Brian McCurdy, Senior Editor

Given the common presentation of heel pain, podiatric physicians may find use in guidelines that incorporate the various treatment modalities that have emerged over the years. The Journal of Foot and Ankle Surgery recently published new heel pain clinical practice guidelines, updating the last guidelines from 2001.

   The guideline authors note the “overwhelming cause” of plantar or posterior heel pain is mechanical although one must also consider the possibilities of neurological, arthritic, traumatic, neoplastic, infectious or vascular etiologies. Accordingly, the new guidelines have a category for “other causes of heel pain.”

   The treatments for plantar heel pain, which occurs in 11 to 15 percent of adults, range from initial solutions such as orthoses, padding and strapping to more advanced techniques such as extracorporeal shockwave therapy, plantar fasciotomy and heel spur resection. The guidelines also discuss the emergence of radiofrequency treatments, both for chronic fasciitis/fasciosis and for nerve related symptoms in the plantar heel, according to guidelines co-author James Thomas, DPM.

   Dr. Thomas says the profession continues to develop insights into the contribution of nerve-related causes of plantar heel pain.

   When it comes to posterior heel pain, the guidelines include surgical treatments such as resection of insertional spurring or resection of the bursa. Dr. Thomas notes the continued improvement of devices to anchor the Achilles tendon back to bone after resection of a posterior heel spur.

   “Recently developed treatments have had a big impact on the guidelines,” notes Dr. Thomas, an Associate Professor of Orthopedics and Director of the Foot and Ankle Service in the Department of Orthopedics at the West Virginia School of Medicine.

   Dr. Thomas says the biggest change for the new guidelines is probably that the treatments are now rated as to the evidence-based medicine (EBM) that is available for each treatment. He notes the emphasis on EBM seems to be the future with all specialty guidelines.

'Meet The Masters' Shares Insights From Podiatric Leaders

By Brian McCurdy, Senior Editor

Podiatric physicians no longer have to travel to faraway conferences to hear the expertise of the best in the profession. Legends in the field and other innovative DPMs offer their expertise in a weekly teleconference call via “Meet the Masters.”

   The mission of the program is “to magnify the podiatric experience to provide and present cutting edge technology and strategies in order to pulsate your career and your experience in the day to day practice of extraordinary health care,” according to “Meet The Masters” organizer Bret Ribotsky, DPM. Every week, Dr. Ribotsky interviews leading podiatric physicians and listeners have an opportunity to submit their questions.

   Dr. Ribotsky selects the speakers by surveying the legends in different areas of the profession, seeking out those from different schools and those who are outspoken.
“These are successful people. They see that opportunity and they take it,” notes Dr. Ribotsky. “They are leaders. They are not waiting for other people to make decisions.”

   The podcasts are archived. The most downloaded “Meet the Masters” lectures so far have been the ones by Lowell Scott Weil, Sr., DPM, David Helfman, DPM, Stanley Kalish, DPM, and Neal Frankel, DPM. There is also the occasional mix of controversy. One of the guests was New Yorker writer Jeffrey Toobin, whom Dr. Ribotsky interviewed after a quote in one of his articles seemed to belittle podiatry.

   One thing in common with the speakers, notes Dr. Ribotsky, is that they all have a sense of positivity about podiatry. He asks the speakers how they define success and has heard a variety of interesting responses.

   “Once you understand their model of the world, then you can understand why they do what they do,” says Dr. Ribotsky.

   For more information on “Meet the Masters” and upcoming speakers, please visit www.podiatricsuccess.com. Live chats are scheduled for 9 p.m. EST on Tuesdays.

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