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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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