Paul Kesselman, DPM is to be commended on his
work on behalf of Podiatric Medicine and his
assiduous attention to the plethora of
regulations required by CMS. It would be good if
we could clone Paul and place a version of him
in each of our offices to assist in the
adjudication of Medicare/DMERC claims and ensure
compliance with the complex web of regulations
forced upon us. The fact of the matter is that
there is a cost associated with such efforts to
comply and when such costs are added to existing
overhead at a time of declining reimbursements,
one must decide if it is worthwhile to continue
such services.
Medicare has inherent structural issues, that
is, benefit design issues which encourage higher
costs. Podiatrists have a long history of being
able to perform a number of procedures in the
office but have shifted such to outpatient
hospital and surgicenters due to the lack of
fair reimbursement for office procedures.
Another more recent example is the radical
devaluation of diagnostic ultrasound services by
CMS which encourages higher utilization of MRI.
APMA really dropped the ball on that one.
Sorry, but I really cannot be more "diplomatic"
on that example but encourage debate.
Paul considers the need for CMS to combat fraud
in the area of diabetic shoes but I contend that
CMS actually encouraged fraud by the manner in
which it administered diabetic shoe coverage in
the first place. What percentage of diabetic
shoes/inlays are dispensed by Podiatric
Physicians? I have heard estimates as low as
30%.
An old friend of mine is an independent sales
rep who relocated from the Seattle area to San
Antonio about 3 years ago. He called me one day
after receiving a job offer from a purveyor of
diabetic shoes. The owner of that outfit told
him that training would take 2 to 3 hours and
that he really "did not need to know anything"
about shoes and foot problems. That company had
mailing and phone lists of diabetics in the
area, performed telemarketing and
home "delivery" of the shoes. They are not an
exception to the rule. My ability to supply
appropriate diabetic shoes has been impaired for
years as patients are often ill fit with
innappropriate shoegear and had their
benefit "used up" by the end of January each
year. A number of such suppliers "rent" space
at the offices of PCPs which ensures that all
the documentation will exist. That modus
operandi has not abated and, in fact, has been
encouraged as legitimate providers of diabetic
shoes have pulled out of the market.
Why does Medicare allow, let alone encourage,
individuals who have no interest nor knowledge
of foot pathology to provide diabetic shoes?
Why does Medicare require paperwork from a PCP
who, most often, has never taken off the
diabetic patient's shoe, to provide required
documentation?
Eddie Davis, DPM, San Antonio, TX,
ed@sanantoniodoc.net
