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2018 - A Year of Notable Progress for Podiatrists
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When it comes to the New Year and looking back on the events of the past year it often seems that changes come slowly and quietly. However, for 2018, this year was politically a bit of a roller coaster.
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Take a look back on a few of the notable events affecting podiatrists in 2018.
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The growing role of and controversy behind the Lapidus bunionectomy. The controversy over the ever-expanding role of this surgical procedure continues unabated, centering mostly around the contribution of frontal plane correction. Podiatric leaders such as Douglas Richie, DPM, Lawrence DiDomenico, DPM, and Patrick DeHeer, DPM have debated the myths and realities online with most of us not quite certain of the truth. A recent article by Campbell and colleagues re-sparked the debate1. This simulated weight-bearing pilot CT study of patients with HAV found increased eversion of the first metatarsal in relation to the second but no relationship between eversion of the first metatarsal and the intermetatarsal angle. There will be much more to come on this topic in the future.
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Defeat of the CMS Medicare coding changes that would have created a separate G-code for podiatrists. I wrote about this topic in Practice Perfect 616 with the hope podiatrists would rally and prevent this from passing. With a lot of work by others in our community, such as the APMA, this nightmare scenario of separate and not equal will not occur.
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Podiatry VA parity bill passes U.S. Congress. The VA Provider Equity Act has created an environment where VA podiatrists are considered equal to their MD and DO colleagues with respect to salary considerations and professional advancement. This is clearly another podiatric win, and I applaud the APMA for its hard advocacy work. For those of us not employed by the VA, this might not seem to affect us, but it, in fact, does. This is a national U.S. governmental organization now considering podiatrists on par with our other medical colleagues, creating a precedent – perhaps even a springboard – for other equity-based future initiatives.
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Increased awareness and regulation of pain management with opioids. If you haven’t heard about this one, then either you’re not a medical provider or you live in a box without windows. The opioid crisis has reached the point where medical providers are being increasingly regulated. We are now required to use our state databases to first check our patients’ opioid use. I can’t wait to see what 2019 will bring on this front.
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These events demonstrate the strength of our profession when we come together and advocate for ourselves in a unified fashion. Imagine what we could do if we generalized this approach to all challenges and threats to the profession. Let’s take the biggest threat, the decreasing number of podiatric medical school applicants. This one situation affects every podiatrist practicing in the United States, whether working with trainees or in solo practice. No students equals no schools equals no new residents equals no new podiatrists equals a loss of power and representation for the profession. All this equals the death of podiatry as a profession. It seems to me this is a no-brainer issue around which the entire profession should unite; yet we hear very little and all parties involved point to the others to take up leadership on this. The political hot potato is going to become a nuclear bomb killing podiatry if we don’t get ourselves together.
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Let’s finish off our consideration of 2018 with a few upcoming changes in 2019:
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Evaluation and Management (E/M) coding starting 1/1/192:
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Established patient notes can focus on only what has changed since the last encounter with no need to repeat any information. The physician must indicate in the note that the prior information was reviewed and verified.
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For follow-up and new patient encounters the physician does not need to re-enter the chief complaint or history that the staff has already written. The physician must indicate in the note that the prior information was reviewed and updated.
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Teaching physicians do not need to repeat the information their trainees have already documented.
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You do not have to document the medical necessity of a home visit.
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CMS will delay implementation of its E/M reimbursement changes to 2021. This change will combine most of the current E/M level codes from the current 99201-99205 (and associated follow-up patient codes) to 99201, 99202, and 99205. Providers will receive the same reimbursement amounts for codes 99202-99204. This is going to have a major effect on podiatrists since most of our coding is within this range. It’s good to see the delay, so we have time to see how this falls out and advocate for more equitable changes.
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Campbell B, Miller MC, Williams L, Conti SF. Pilot Study of a 3-Dimensional Method for Analysis of Pronation of the First Metatarsal of Hallux Valgus Patients. Foot Ankle Int. 2018 Dec;39(12):1449-1456.
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Lehrman, J. Video: Four E/M Documentation Updates for 2019. Nov 19, 2018.
Follow this link
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