June 2010

Volume 23 - Issue 6 - June 2010
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What Further Reforms Could Benefit DPMs?

Given that actual details of healthcare reform are still being worked out, Anthony Poggio, DPM, notes subsequent elections could alter the balance of power in Congress and possible modifications to the program could occur.

Healthcare reform will benefit different types of podiatric physicians in different ways, according to Babak Baravarian, DPM, FACFAS. He says those with a large number of low-income patients will benefit the most while those with a large private pay practice may see decreases in their reimbursement. Dr. Baravarian notes that about 30 cents of each healthcare dollar spent goes to actual medical care and suggests reining in overhead to decrease costs.

“I think overall very little will change,” Dr. Baravarian says of the reform. “I don't believe the insurance being offered is of much use to those with insurance. It will benefit low-income patients with no insurance but I think a limited number of doctors will accept the insurance.”

There also needs to be control over end of life issues and payment, according to Dr. Baravarian, the Director of the University Foot and Ankle Institute in Los Angeles.

Both Drs. Poggio and Baravarian would like to see more discussion on malpractice reform. Dr. Poggio notes that the practice of defensive medicine is real and does add to the overall healthcare cost. He also sees a possible correlation between the national healthcare systems in other countries and the fact that those countries have very low rates of litigation.

Megan Lawton, DPM, agrees with the need for malpractice reform and also calls for tighter regulations on insurance companies. She favors a provision that would include individual responsibility for one's own health, which would potentially lower some healthcare costs.

William Fishco, DPM, advocates amending Title XIX of the Social Security Act to include podiatrists as physicians. He notes that Arizona has a recent law that excludes podiatry services provided by a podiatrist to Medicaid patients.

“I doubt that primary care physicians, physician assistants, nurse practitioners, dermatologists or orthopedists are going to provide our services (for patients with diabetes),” notes Dr. Fishco. “I am sure that these providers do not have the time or desire to do so.”

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.