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06/03/2013    Robert Spalding, DPM

Staff Performing Routine Foot Care (Name Withheld)

Obviously, there is a great deal of controversy
about assistants helping doctors with routine foot
care. For those podiatrists who choose not to use
an assistant to perform routine foot care, then
don’t use one. However, 50% of DPMs do use one,
and a recent online survey found that 60% of DPMs
believe this is appropriate. That is not going to
change.

There should be universal training for this
service. Our colleagues in dentistry have learned
to use assistants effectively and safely for
cleaning and other routine oral care without
hiring an associate with a DDS to perform the same
services. Not all states and not all insurance
carriers allow these services. So don’t bill if it
is not appropriate. Many patients come to DPMs
because they can’t reach their feet anymore not
because they are all diabetic with neuropathy.

Most patients don’t meet the criteria to bill
insurance and so they pay out of pocket for these
services anyway. That doesn't require the scrutiny
of billing issues, and you have options. I have
been told by more than one residency director “not
to perform routine foot care in your office, you
don’t want to be known for that kind of
services…….send them to a salon down the street”.

But that was when bunionectomies were generating
$2400! I have seen podiatrist after podiatrist go
from bed to bed at nursing homes with only one set
of clippers and never cleaning them. Yet that is
accepted as good podiatry care based on the DPMs
$100,000 education. Like so many things in life,
different paths are going to be taken by many DPMs
who see the bigger picture to this, and other,
issues we face as a profession. We all have
choices, and as long as we abide by federal and
state laws we have a lot of flexibility to provide
services needed by our patients, including routine
foot care by trained assistants.

Robert Spalding, DPM, Signal Mountain, TN,
rts9999999@aol.com

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