12/14/2023    Robert D Teitelbaum, DPM

A 40-year Retrospective (David Secord, DPM)

David Secord's posting recently about
"allopathic" medicine and how DPM's are allopathic
doctors was a great lesson in the real meaning and
the corruption of common words that we use to
describe our professional status. I would also
like to bring up three words that have held us
back professionally and consistently for 40 years
and I have not seen them much talked about. Those
three words are Routine Foot Care.

My thesis is this:

1.There is no complaint about foot pain that is
routine. A patient who realizes that her bent 2nd
toe has a painful corn on the first joint that
hurts in all shoes is in distress. They need
someone to counsel them on the choices they may
face and the treatments that are relevant. The
patient wants our experience, knowledge and
ability to communicate. They want a plan of
action--in other words they want E/M services. But
if something is categorized as 'routine' as in
'trivial' and non-reimbursable, that patient is
now a cash patient and their Medicare insurance is
useless. The E/M services are fraudulent if
Medicare is billed. To me, that is ridiculous, and
I am sure I am not alone.

2. There is nothing "routine" about a painful corn
or callus. There never was. Something that bothers
people is real and if they are going to turn
themselves in to the medical establishment which
is difficult these days, they don't want to be
told they have a trivial and non-reimbursable
condition.

3. Is there a symptom or sign that a primary care
physician is presented with that is 'routine' in
the sense it has been used against podiatrists?
The answer is no. Everything has an equal
significance as well it should be.

4. The conditions or diseases that justify RFC are
mostly arcane and/or never seen in practice and
leave out many common conditions that if patients
have them---no one would want them to do RFC on
themselves (or have non-professionals do it)
because it would be dangerous for them. After all,
Medicare patients are elderly patients with all
that implies. At the back end of life, they are
more fragile, less perfused, more neuropathic for
many reasons, and more susceptible to infection.
Conditions that should be reimbursable, maybe at a
lower rate, would be blindness or severe sudden
vision problems, spinal arthritis, CVA's (not
every jurisdiction allows RFC with anticoagulant
therapy), morbid obesity, severe respiratory
conditions and arthritis of the dominant hand and
Parkinson’s disease.

5. Why do podiatrists have to attest every six
months to the status of a disease that hardly ever
disappears? While there are some patients who
lose the 50 pounds and attain normal blood sugar
levels it is pretty rare. And type 1 diabetes is
not going away. PAD can be treated and improved
and not be limb threatening, but rarely approaches
normality. I think this goes back 50 years to
when these RFC rules were formulated and Medicare
put podiatry and chiropractic in the same basket.
And basically we were not to be trusted. A lot has
changed since then and the CMS needs to know this.

6. Lastly, how about fear and anxiety. There are
many patients who are pathologically afraid to
treat any pedal condition. That's an underlying
cause of patients who have not gotten care for six
or more months -- difficult cases all. An entire
pharmaceutical effort exists to treat nervous and
anxious patients, who take medications that are
often frought with nasty side effects--the doctor
visits and drugs are covered by Part D (somewhat),
but if they go to a podiatrist with their feet,
they are on their own. When it comes to fear, feet
don't count.

Robert D Teitelbaum, DPM, Naples, FL

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