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08/05/2015 Joseph Borreggine, DPM
Obamacare and Podiatry (Chet Vahovius, DPM)
This recent PM News post was quite interesting with respect to the viability of a podiatric practice in the Obamacare insurance environment. I also enjoyed reading the form letter included as a response that was written by Michael Rosenblatt, DPM.
I must agree with both Drs. Vahovious and Rosenblatt. Time is ticking and the reality of our future as a profession is upon us. These last 5 years have been challenging to say the least.
I saw from the recent on-line PM News poll last week that our profession is feeling the financial pinch and revenues are dropping, as compared to last year, for 33% of the DPM's polled. I am a part of that statistic.
With ever increasing co-pays, deductibles, and out-of-pocket expenses burdened on the patient population at-large, the facts are simple: making a living in medicine is getting more and more difficult.
I believe that with ICD-10 coding it will get worse. With the recent CMS response on the ICD-10 policy being posted on PM news along with the APMA news and Codingline, I fear that there will be many more predicted initial rejections of claims after Oct 1, 2015. This is will compound the already existent problem of the downward trend in revenue collection in medical practices. ICD-10 must be delayed until we know that it will work for real.
This ICD coding change, in turn, will hurt more the independent practitioner, such the podiatric physician, as compared to the corporate or employed physician since they will be insulated by the salaries they get as opposed to fee-for- service.
I have investigated switching careers and even considered getting a degree as a nurse practitioner or a physician assistant, but the expense involved in restarting a career at my age (52) would be cost-ineffective.
So, it looks like I will have to weather the storm along with the rest of the profession who are in my same situation.
I just hope I can come through it with some financial nest egg and have the ability to retire, if not, then I hope Social Security will still be there when its time. I hear that Medicare after these last 50 years and having 55 million lives insured through in the program will be broke in the year 2030.
Again, the future of medicine as an independent practitioner is bleak.
Joseph Borreggine, DPM, Charleston, IL
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08/05/2015 William Deutsch, DPM
Obamacare and Podiatry (Chet Vahovius, DPM)
Chet Vahovius lays it out pretty well. The private practice is being phased out. Participation with various panels is tenuous. The podiatrist is being marginalized and those who provide ethical care are being squeezed by reduced payments, high deductibles that cause patients to forego elective treatment and the failure of insurers to see the preventive value of timely foot care.
Dr. Vahovius also indicates that patients are gaming the system as have physicians in the past. Insurers will find ways to force legislation to prevent the losses such gaming entails.
The concierge model or refusal to accept insurance coverage is a big step for most private practitioners. Those big billers who make the most of diagnostic services will probably find themselves either audited into non-existence, or find coverage for diagnostic services reduced or eliminated when provided by podiatrists. It was apparent in reviewing the services provided by the highest CMS podiatry billers that podiatric care was almost completely absent from the services provided by those billing in the high six figures or seven figures. It's just a matter of time before that avenue is closed.
So the question in my mind is whether or not simply being a podiatrist is enough in today's health care market? I really think that it isn't and that a medical license is necessary to insure the survival of the profession and the professional. As podiatry care is being farmed out to the orthotist and the PA and podiatric assistant what's left for the licensed podiatrist?
Apparently Dr. Vahovius sought relief out of the profession. I'm sure many doctors are viewing their options and possibly honing their entrepreneurial skills in the event a successful living is no longer available in podiatry.
It would also be wise to study how podiatry fared in countries where national health insurance has been the model for many years.
PPACA was implemented with little concern for the physician as its aim was to get more bodies covered and to eliminate pre-existing condition exceptions for those needing the most care. While that goal was met somewhat, at what cost to the quality of care and to those physicians providing the care?
William Deutsch, DPM, Valley Stream, NY
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