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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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