Archive for Medicare
Medicare Changes on Toenail Debridements
Posted by: | CommentsIn August 2011 our regional version of Medicare made significant changes in how podiatry is practiced. Unfortunately, in my opinion, it is not for the better and I feel obligated to try to explain it to my patients because there is much confusion surrounding the changes. Before I get started I want to say that these changes affect any professional that provides these services and, in fact, there are many more Medicare changes that are directed at other physicians that I am not discussing today.
In a nutshell, Medicare, in our region, no longer allows the debridement (reduction in thickness and length) of painful mycotic (fungal) toenails for otherwise healthy patients. They now require a patient to have a qualifying medical disease (list available in my office) for a patient to receive this treatment. Medicare has provided a list that reasonably contains diabetes, peripheral vascular disease, neuropathies, etc. I agree that these patients desperately need this care but I disagree that they are the only ones that need it. From the beginning of my podiatric career a patient could have their toenails debrided and their fungus treated if they were painful or limited a patient’s ability to ambulate.
I believe this is a significant change in policy for Medicare. Before this change… pain was enough to qualify for care and now pain is not enough. In my opinion, pain is not normal and requires attention that is often medical.
Additionally, Medicare has decided to reduce how often a qualifying patient may have their toenails cared for. If I remember correctly, when I began practice thirteen years ago a patient with painful fungal toenails could have them debrided every nine weeks. Then Medicare changed the frequency to every twelve weeks. Now the frequency has been changed, per my best understanding, to six times every two years, or basically every four months! Basically, the highest risk patients must wait four months to get care that may help them avoid infections, ulcerations and amputations. During a phone call, I asked the Medicare representative if she would please wait four months to trim her own toenails so she could see if this was reasonable and she said there was no way she could do that? It bothers me that she realizes that her, likely, low risk feet need more care than what Medicare is willing to provide for high risk feet.
If you are a patient of mine and have Medicare, please know that foot pain is not normal and please come and see me. Yes we are still accepting Medicare and we want to help you. Please know that most of the time your care is covered and if it is not we will discuss this with you so there are no surprises. We want to be your foot care specialist.
Please know that to my best understanding this change is currently regional so not all podiatrists are affected, yet. Typically these changes are “test driven” in a region and then many times if “successful” in lowering costs they are made nationwide. I see these changes as a bit insidious because our patients are often told their services are not being cut by Medicare but in fact they are being cut for some on Medicare. Sure the treatment is still available….but only for a more restricted list of patients and on a much more restricted schedule.
Sure, debridement of my patient’s toenails sounds like a small fish in the big ocean of healthcare. I recognize that. However, small fish like these are schooling in every medical specialty and that should concern us.
Diabetic shoes for diabetic feet in Nacogdoches and Carthage Texas
Posted by: | CommentsThe diabetic shoe bill provided through Medicare is a great program. This bill provides diabetic patients on Medicare an opportunity to get one pair of shoes and three sets of inserts annually. Like all Medicare programs, there are abuses of this coverage by providers, suppliers and patients but overall I find it rewarding to prevent future severe foot complications in situations where the shoes are needed. Not all patients qualify for the shoe bill. Diabetic patients who have diabetes with peripheral vascular disease, neuropathy, a history of amputation or many variances from these basic qualifiers are allowed to participate. My blog today is not so much about the program’s operations but more about the shoes provided.
The primary purpose of the program is to provide shoes that reduce pressures on the foot and therefore reduce the risk of ulcerations that often times lead to infections and amputations. In my book, this is a worthy goal. However, if I am allowed to rant a bit today, I feel that too often diabetic shoes are made so soft and “squishy” (lol) that patients begin to have additional problems with their feet. Particularly those patients who happen to have the qualifying conditions to get the shoes but are still very active. It is almost like walking around on pillows all day or spending many hour walking the beach barefoot.
Our feet need some help. Particularly when they have spent a lifetime in a supportive environment such a good leather lace-up shoe with an arch support or when arthritis has begun to show itself. To take that foot, and then one day put it in a soft foam-like upper with a heat mold-able plastic insole (plastazote) gives the foot little help and leads to fatigue, contracture of the lesser toes trying to stabilize the foot and can ultimately increase pressure in some spots.
My request for each of you considering diabetic shoes is to make sure they are as supportive as possible considering your foot condition and as functional as possible considering your activity level. If you are active it is very likely you will need additional arch support in your new shoes and not just cushions! I’m talking about semi-rigid plastic, cork, felt and many other material options that will help you propel more efficiently and reduce stress and strain.
Be sure to find an expert in diabetic shoes and ask questions about the shoes that are being made for you because they should help your foot situation…not make it worse.
