PODIATRY & FOOTWEAR
Obamacare and
the Fitting of Therapeutic
Footwear
The ACA will offer DPMs significantly increased opportunity
for providing needed diabetic care.
By Josh White, DPM, CPed
© Karen Roach | Dreamstime.com
W
hether
you
are in favor of
ObamaCare or not,
the impact of this
2010 law is increasingly impacting patients, physicians, hospitals, insurers, and most
every other part of the healthcare
industry. While politicians continue to debate the law’s merits and
opponents hold onto the hope that
it will be repealed, two things that
are not a matter of opinion are that
there is going to be a huge increase
in the number of elderly people in
the U.S. and there is a desperate need
to improve the cost-effectiveness of
our current healthcare system. This
is not a political discussion about
ObamaCare but rather an attempt to
sift through the nearly 11,000 pages
of regulations to present how the law
will impact patients with diabetes,
and show how ObamaCare may offer
www.podiatrym.com
podiatrists increased opportunity for
providing needed care.
While the Patient Protection and
Affordable Care Act (PPACA), also
known as the Affordable Care Act
(ACA) and ObamaCare, has run into
more than its share of bumps in the
and with it, increased fitting of therapeutic footwear.
Description of the Patient
Protection and Affordable Care
Act (PPACA)
The ACA’s key provisions include
Beginning in 2014, physicians
who do not submit measures to PQRS will have
their Medicare payments reduced.
road, the program promises better
healthcare coverage for people with
diabetes, with expanded Medicaid
coverage, a ban on denial of coverage for pre-existing conditions, and
an emphasis on preventive care. As
such, it offers the opportunity of increasing utilization of podiatric care,
measures to eliminate patient exclusion due to pre-existing conditions
and to stop insurance companies
from dropping coverage for people
who become sick. The law expands
Medicaid and creates state-specific
health insurance exchange marketContinued on page 82
OCTOBER 2014 | PODIATRY MANAGEMENT
81
PODIATRY & FOOTWEAR
PODIATRY & FOOTWear
Obamacare (from page 81)
places where low-to-middle-income
people can shop for free or low-cost
health insurance. The law works to
curb the growth in healthcare spending which had until recently been
rising at an unsustainable rate.1
Drivers of Need for Cost-Effective
Care of People with Diabetes
According to the National Diabetes Information Clearinghouse, in
2010, diabetes affected around 25.8
million people, which represents
8.3% of the U.S. population.3,4 It is
estimated that 33% of Americans will
have diabetes by 2050.
82
Diabetes Is an Expensive Disease
to Treat
Diabetics spend, on average, 2.3
times more than healthy people do
on medical care each year. In 2007,
the treatment of diabetes and its complications cost the United States—in
direct medical care and in lost productivity, disability, and premature mortality—approximately $174 billion.
Healthcare costs linked to the
treatment of foot ulcers comprise an
estimated 33% of the direct healthcare costs associated with the treatment of diabetes and its complications. Studies estimate the healthcare
costs associated with individual ulcer
episodes from as low as $3,600/year
to as high as $28,000/year.5,6 The lifetime healthcare costs for a person
with limb loss are especially dramatic
given the estimated five-year mortality rate of between 50% and 74%.7
ObamaCare’s Impact on Medicare
Beneficiaries
ObamaCare expands existing coverage for seniors, including preventive care and wellness visits, without charging for the Part B co-insurance or deductible. Seniors no longer
need to put off preventive care and
check-ups due to costs. Over the tenyear period between 2013 and 2022,
ObamaCare will cut Medicare by
$716 billion by reducing reimbursement to doctors, hospitals and private insurance companies. All money
cut must be used to increase Medicare solvency, improve its services
and reduce beneficiary premiums.
Re-allocating $716 billion is intended to help fix what is wrong with
Medicare and ensure that it remains
sustainable while providing quality,
affordable healthcare to seniors.
modify the coverage of any currently covered preventive service in the
Medicare program to the extent that
the modification is consistent with
U.S. Preventive Services Task Force
recommendations and the services are
These products can facilitate performance and help
How the ACA will Increase the
not used for diagnosis or treatment.
in injury prevention and recovery.
Use of the Comprehensive Diabetic
Foot Exam and Fitting Shoes By Ben Pearl, DPMPromotion of Standards of Care
Among Patients with Medicare
Sec. 3003. Improvements to the
is wicked through
or drawn
ocks have
beenprovisions
a
usedfeedback
in many wool blends
for higher Ex There
arealways
many
in thethe fiberphysician
program.
into it. The coefficient of friction incritical component to the
performance and durability.
Affordable
Care Act
that are
not
comphysician
creases
with
moisture onpands
the skin;Medicare’s
modern athlete’s
wardrobe.
Polypropylene
is a cheaper resource
matetherefore, blisters are more likely to
Recently, the consumer
rial that is hydrophobic and used in
monly
known
but
that
pertain
to
imuse
feedback
program
to
provide
for
occur with socks that do not provide
sports medicine marketsome sports synthetic socks. Nylon,
97
moisturefor
management.
place
has begun
to offer a number
by contrast,
hydrophobic, and nor- reproving
Medicare
specifically
peodevelopment
of isindividualized
The Evolution of Socks
and Compression Sleeves
S
of sock designs to help prevent and
treat injuries. Back in the late ‘70s,
the confluence of the running boom
and a robust economy in the ‘80s
inspired sock manufacturers to start
thinking about ways to improve sock
construction and design. Interest in
sock research and development led to
advancements in four areas: wicking
materials, materials with decreased
friction, pressure management, and
compressive support. Recently, compressive sleeves in the ankle and shin
have spun off from the core sock
business as additional sock-related
garments to help with injury prevention and workout
recovery.
Compressive sleeves in the ankle and shin
have spun off from the core sock business as additional
sock-related garments to help with injury prevention
and workout recovery.
Currently only 50%
of patients with diabetes receive foot care
from
a podiatrist.mally blocks the moisture. Today,
When combining hydrophobic
qualities and mechanical fiber qualities, the fibers that wick moisture
are, from best to worst: CoolMax ®
(Figure 1), acrylic, polypropylene,
wool, and cotton.
If you are using
high-grade mateSock Fibers
rials, a two-layIn order to
er system can be
examine the charmore effective with
acteristics of sock
CoolMax ®, a polymaterials, one must
ester fiber, as the
first understand the
outer layer. Cooldifference between Figure 1: CoolMax® socks.
Max® has its roots
“hydrophobic,”
in the concept writwhich refers to wicking water through
ings of DuPont scientists in the ‘20s.
the fiber, and “hydrophilic,” drawing
Dacron, a precursor polyester fiber,
water to the fiber. These terms can be
was later modified and renamed Coolused conjointly when describing the
Max®, which is unique in its four-layfluid dynamics in socks, as some fibers
er hydrophilic construction.
have characteristics of both compoAcrylic is a material that has good
nents. The key is that whatever sweat
heat retention and hydrophilic properor moisture is produced needs to be
ties, only slightly less than CoolMax®.
moved away from the foot, whether it
Acrylic is another less costly material
ple with diabetes. The ACA contains
10 titles, each addressing a different
aspect of healthcare reform. Title III,
Improving the quality and efficiency
of healthcare, includes most of the
changes to Medicare.
Focus on Prevention as a Means of
Reducing the Impact of Diabetes
Sec. 3002. Improvements to the
physician quality reporting system.
While there are approximately seven
million Medicare beneficiaries with
diabetes, in 2012 only 170,000 had
www.podiatrym.com
PQRS measure 2028F “Foot Exam”
reported by a podiatrist. Beginning in
2014, physicians who do not submit
measures to PQRS will have their
Medicare payments reduced.
Sec. 4103. Medicare coverage of
annual wellness visit providing a personalized prevention plan. Provides
coverage under Medicare, with no
co-payment or deductible, for an annual wellness visit and personalized
prevention plan services. Such services would include a comprehensive
health risk assessment.
Sec. 4104. Removal of barriers to
preventive services in Medicare. The
ACA waives beneficiary coinsurance
requirements for most preventive services, requiring Medicare to cover
100 percent of the costs.
Sec. 4105. Evidence-based coverage of preventive services in Medicare. Authorizes the Secretary to
OCTOBER 2014 | PODIATRY MANAGEMENT
there are moisture treatments that
can change the aqueous nature of
some fibers, like nylon, making them
hydrophilic. Although this can be an
expensive process, Polypropylene is
a cheaper material more frequently
used by manufacturing companies
supplying discount sporting goods
items. Also, spandex, the fiber used
to optimize fit and stretch, is quite
critical to sizing. Most higher-end
performance or diabetic sock products will offer multiple sizing as compared to cheaper brands.
Wool is one of the oldest natural
fibers used in socks and offers excellent wicking properties in product
lines such as Smartwool. One of the
downsides is that it wears out more
easily. Therefore, some companies,
like Darn-Tuff, offer lifetime warranties for their combinations. Smartwool extends a performance guar-
ports. Reports compare the per capita
utilization of physicians (or groups of
physicians) to other physicians who
see similar patients.
Currently only 50% of patients
with diabetes receive foot care from
a podiatrist. This measure stands to
highlight this underutilization of an
ADA standard of care and change it.
Sec. 3013. Quality measure development. Authorizes $75 million over
5 years for the development of quality
measures at AHRQ and
the Centers for
Continued on page 98
Medicare and Medicaid Services (CMS).
OCTOBERAmerican
2014 | PODIATRY
MANAGEMENT
Current
Diabetes
Association Standards of Care include annual
performance of ulcerative foot risk assessment and fitting with therapeutic
shoes when risk factors are present.
Sec. 3014. Quality measurement.
Provides $20 million to support the
endorsement and use of endorsed
measures by the HHS Secretary for
use in Medicare, reporting performance information to the public and
in healthcare programs.8
Medicare Reform to Cut What’s
Not Working and Increase What Is
Sec. 3007. Value-based payment modifier under the physician
fee schedule. Directs the Secretary
of HHS to develop and implement a
budget-neutral payment system that
will adjust Medicare physician payments based on the quality and cost
Continued on page 84
www.podiatrym.com
PODIATRY & FOOTWEAR
PODIATRY & FOOTWear
Obamacare (from page 82)
of the care they deliver. Quality and
cost measures will be risk-adjusted
and geographically standardized.
84
Promotion of a Collaborative
Approach to Care
Accountable Care Organizations
(ACOs) are groups of doctors, hospitals, and other healthcare providers, who come together voluntarily
to give coordinated high-quality care
to their Medicare patients. The goal
of coordinated care is to ensure that
patients, especially the chronically
ill, get the right care at the right time,
while avoiding unnecessary duplication of services and preventing
medical errors. When an ACO succeeds both in delivering high-quality
care and spending healthcare dollars
more wisely, it shares in the savings
it achieves for the Medicare program.
Sec. 3022. Medicare shared savings program. Rewards ACOs that
take responsibility for the costs and
quality of care received by their patient panel over time. ACOs that meet
quality-of-care targets and reduce
the costs of their patients relative to
a spending benchmark are rewarded with a share of the savings they
achieve for the Medicare program.
Sec. 3021. Establishment of Center for Medicare and Medicaid Innovation within CMS.
The ACA encourages development of new Patient Care models
by establishing within the Centers
for Medicare and Medicaid Services
(CMS) a Center for Medicare & Medicaid Innovation. The purpose of the
Center will be to research, develop,
test, and expand innovative payment and delivery arrangements to
improve the quality and reduce the
cost of care provided to patients in
each program. Dedicated funding is
provided to allow for testing of models that require benefits not currently covered by Medicare. Successful
models can be expanded nationally.
Cost-Effectiveness of Preventative
Diabetic Foot Care
Knowledge of evidence-based
practice models supports efforts to
develop, evaluate, and disseminate
paradigms and practices that improve
care of patients with diabetes, lower
that provides intelligent information
the likelihood of ulceration, and prefor businesses and professionals
vent amputations.
concluded:
The Veterans Health Administra • Patients with diabetes seen by
tion (VHA) Preservation/Amputation
a podiatrist prior to a foot ulcer diagCare and Treatment (PACT) program
nosis had a 20% lower risk of ampuThese products can facilitate performance and help
uses patient medical records to assess
tation and a 26% lower risk of hosin injury prevention and recovery.
amputation risk based on the prespitalization than those not seen by a
By Ben Pearl, DPM
ence of particular conditions, diagnopodiatrist.
sis or procedure codes in the medical
• Medicare-eligible patients with
is wicked
through
or drawn seen
ocks and
have always
been
a
used in
wool blends for
higher
record,
offers
some
insight
onthe fiberdiabetes
bymany
a podiatrist
had
a 23%
into it. The coefficient of friction incritical component to the
performance and durability.
how modern
to create
models
amputation
and
a 9%
creases with that
moisture onlower
the skin;risk of
athlete’s practice
wardrobe.
Polypropylene
is a cheaper
matetherefore, blisters are more likely to
Recently,
the consumer
rial that is hydrophobic and used in
reduce
preventable
amputation.
lower
risk
of
hospitalization
compared
occur with socks that do not provide
sports medicine marketsome sports synthetic socks. Nylon,
moisture management.
place
begun
to offer aPACT
number program
contrast,
is hydrophobic,
and nor- 97
has
The
VHA’s
prowith thosebynot
seen
by a podiatrist.
The Evolution of Socks
and Compression Sleeves
S
of sock designs to help prevent and
treat injuries. Back in the late ‘70s,
the confluence of the running boom
and a robust economy in the ‘80s
inspired sock manufacturers to start
thinking about ways to improve sock
construction and design. Interest in
sock research and development led to
advancements in four areas: wicking
materials, materials with decreased
friction, pressure management, and
compressive support. Recently, compressive sleeves in the ankle and shin
have spun off from the core sock
business as additional sock-related
garments to help with injury prevention and workout
recovery.
Compressive sleeves in the ankle and shin
have spun off from the core sock business as additional
sock-related garments to help with injury prevention
and workout recovery.
Fitting 441 pairs of shoes
would earn a practice approximately
$88,000 profit. mally blocks the moisture. Today,
When combining hydrophobic
qualities and mechanical fiber qualthere are moisture treatments that
ities, the fibers that wick moisture
can change the aqueous nature of
are, from best to worst: CoolMax ®
some fibers, like nylon, making them
hydrophilic. Although this can be an
(Figure 1), acrylic, polypropylene,
expensive process, Polypropylene is
wool, and cotton.
a cheaper material more frequently
If you are using
used by manufacturing companies
high-grade mateSock Fibers
supplying discount sporting goods
rials, a two-layIn order to
items. Also, spandex, the fiber used
er system can be
examine the charto optimize fit and stretch, is quite
more effective with
®
acteristics of sock
critical to sizing. Most higher-end
CoolMax , a polymaterials, one must
performance or diabetic sock prodester fiber, as the
first understand the
ucts will offer multiple sizing as comouter layer. Cool13
®
difference between Figure 1: CoolMax® socks.
pared to cheaper brands.
Max has its roots
“hydrophobic,”
Wool is one of the oldest natural
in the concept writwhich refers to wicking water through
fibers used in socks and offers exings of DuPont scientists in the ‘20s.
the fiber, and “hydrophilic,” drawing
cellent wicking properties in product
Dacron, a precursor polyester fiber,
water to the fiber. These terms can be
lines such as Smartwool. One of the
was later modified and renamed Coolused conjointly when describing the
downsides is that it wears out more
Max®, which is unique in its four-lay9
fluid dynamics in socks, as some fibers
easily. Therefore, some companies,
er hydrophilic construction.
have characteristics of both compolike Darn-Tuff, offer lifetime warranAcrylic is a material that has good
nents. The key is that whatever sweat
ties for their combinations. Smartheat retention and hydrophilic properor moisture is produced needs to be
wool extends a performance guarties, only slightly less than CoolMax®.
moved away from the foot, whether it
Acrylic is another less costly material
Continued on page 98
vides a model of care for patients at
risk for amputation and for those who
have already had an amputation. The
PACT program incorporates an interdisciplinary care management approach including primary care and diabetes, and nurse, podiatrist, vascular
surgeon and rehabilitation teams. Since
implementing this program, the amputation rate among patients with diabetes has decreased by more than 50%.
In another study demonstrating
the potential efficacy of prevention
efforts, people identified with diabetes
www.podiatrym.com
and peripheral artery disease who had
early intervention saw a 67% decline
in the rate of lower-limb amputation
from diabetes-related complications.10
Coupled with the ACA is the
Health Information Technology for
Economic and Clinical Health (HITECH) Act. It commits $29 billion
over 10 years to support the adoption
and “meaningful use” of electronic
health records, with the intent of improving quality of care and reducing
costs, including supporting clinical
care decisions.11,12 Applying lessons
of the VA PACT program and other
studies to resources created by HITECH offers great promise for the
use of technology to improve health
while reducing costs.
The Opportunity for Podiatrists
A three-year study by Thomson Reuters, a leading research firm
OCTOBER 2014 | PODIATRY MANAGEMENT
• For the general population, each
dollar invested in care by a podiatrist
results in up to $51 of savings.
• For the Medicare-eligible population, each dollar invested in care
by a podiatrist results in up to $13 of
savings.
Footwear: An Underutilized Part
of the Standard of Care
According to the Center for Disease Control, in 2011 an estimated
10.9 million people age 65 or older
had diabetes. 70% or 7.6 million of
2014 over
| PODIATRY
peopleOCTOBER
65 and
areMANAGEMENT
in traditional
Medicare programs; 30% in Medicare
Advantage plans. Of the 7.6 million
people with diabetes in traditional
Medicare plans, only half or 2.8 million even see a podiatrist.
The Bureau of Labor Statistics
states that in 2010, there were 12,900
podiatrists in the U.S. Given the larger number of patients with Medicare
and diabetes, there is the opportunity
for every podiatrist to see, on average, 217 such patients with traditional
Medicare and diabetes. Conservatively, three quarters of the 7.6 million
with Medicare and diabetes, 5.7 million, have risk factors for ulceration
qualifying them for therapeutic footwear under the Medicare plan.
If recommended treatment protocols were fully enacted and 5.7 million pairs of shoes were fit by podiContinued on page 86
www.podiatrym.com
PODIATRY & FOOTWEAR
PODIATRY & FOOTWear
Obamacare (from page 84)
atrists each year, it would translate
into each podiatrist fitting, on average, 441 pairs per year or approximately 2 pair per day. Fitting 441
pairs of shoes would earn a practice
approximately $88,000 profit. This
2
http://www.diabeteseducator.org/
shoes that integrate GPS connectivexport/sites/aade/_resources/Advocacy/
ity so that distance traveled could
AADE_Affordable_Care_Act_Flyer.pdf
be tracked. Fitness programs could
3
Centers for Disease Control and Prebe assessed based on their efficacy
vention, National Diabetes Fact Sheet:
of motivating people to walk a pre“National estimates and general inforscribed distance each day. Material
mation on diabetes
These products can facilitate performance
and help and pre-diabetes in
could be integrated into insoles to
therecovery.
United States, 2011.” In: Services USin injury prevention and
decrease shear, a key component of
DoHaH, editor. Atlanta, GA: Centers for
The Evolution of Socks
and Compression Sleeves
Disease Control and Prevention; 2011.)
4
Boyle J, Thompson T, Gregg E Barkis wicked through the fibererorL,
drawn
ocks have always been a
used in many
wool blends forof
higher
Willianson
D. “Projection
the year
into
it. The coefficient of friction incritical component
to the
performance and durability.
In 2012, podiatrists dispensed 35%
of diabetic
shoes
2050 burden
of diabetes in the US adult
creases with moisture on the skin;
modern athlete’s wardrobe.
Polypropylene is a cheaper matetherefore, blisters are more
likely to
Recently, the consumer
rial
that is hydrophobic
andofused
in
population:
Dynamic
modeling
incidence,
paid by Medicare, medical supply
companies
occur with socks that do not provide
sports medicine
marketsome sports synthetic socks. Nylon,
mortality, and
prediabetes prevalence.” Popmoisture management.
place has begun to offer a number
by contrast, is hydrophobic, and nor- 97
ulation Health Metrics 2010;8:29.
sock designs to help prevent
and
provided 21%, and oftreat
pharmacies
12%.
5
injuries. Back in the late ‘70s,
Harrington C, Zagari MJ, Corea J,
the confluence of the running boom
CompressiveKlitenic
sleeves J.
in “the
shin of Diabetic
A ankle
Cost and
Analysis
and a robust economy in the ‘80s
inspired sock manufacturers to start
have spun off fromLowerthe core
sock business
as additional
Extremity
Ulcers.”
thinking about ways to improve sock
6
ulceration. Thermal sensors
on in- garments
doesn’t even include billing for the
Ramsey
SD,injury
Newton
K, Blough D
sock-related
to
help with
prevention
construction and design. Interest in
sock
research
and development
to
soles
could
detect led
small
changes in and
comprehensive diabetic foot exam or
McCulloch
DK, Sanhu N, Reiber GE, Wagworkout
recovery.
advancements in four areas: wicking
skin surface
temperature,
indicative
any other products or services that
ner EH. “ Incidence, outcomes, and cost
materials,
materials with
decreased
friction,
pressure management,
of foot ulcers in patients with diabetes.”
of a wound
likely toandoccur, promptcould result from such a visit. This
When combining hydrophobic
compressive support. Recently, commally blocks the moisture. Today,
1999;22(3):382-7
ing appropriate
care.
contrasts with the reality that in 2012
qualities and mechanical Diabetes
fiber qual- Caree
pressive
sleeves in the ankle
and shin
there are
moisture treatments that
7
ities, the fibers that wick moisture
have spun off from the core sock
can change TR,
the aqueous
Dillingtham
Pezzinnature
LE, ofShore
ACA
initiatives
are
already
workthe number of shoes dispensed as
are, from best to worst: CoolMax
business as additional sock-related
some fibers, like nylon, making them
AD.
“Reamputation,
Mortality
and
garments
help with injury
hydrophilic. Although this can be Healthan
(Figure 1),
acrylic, polypropylene,
ing toto change
ourprevenhealthcare
system
part of the therapeutic shoe program
tion and workout
Polypropylene
is
wool, and
cotton.
care
Costs expensive
Among process,
Persons
with Dysvascufrom one that provides a smorgas- If you are using a cheaper material more frequently
was approximately 850,000 pairs—
recovery.
lar
Lower
Limb
Amputations.”
Archives
used by manufacturing companies
matebord of free services to patients andhigh-grade
approximately 304,000 pairs by poSock Fibers
discount
goods
rials, aoftwo-layPhysicalsupplying
Medicine
andsporting
Rehabilitation
reimburses
I n o r d e r t o providers not based on
items. Also, spandex, the fiber used
er system can be
diatrists. This is down from 310,000
2005;86(3);480-6.
examine the charto optimize fit and stretch, is quite
effective with
8
the number
of wounds treated andmore
in 2008. In 2010, 5676 podiatrists fit
http://care.diabetesjournals.org/
acteristics
of sock
critical to sizing. Most higher-end
CoolMax , a polymaterials,
one
must
performance or diabetic sock prodester
fiber,
as
the
amputations performed but rather
an average of 54 pairs of shoes and
content/37/Supplement_1/S14.full.pdfirst understand the
ucts will offer multiple sizing as comouter layer. Coolbased
on
how
effectively
they
are
earned a profit of $10,800.
f+html
difference between Figure 1: CoolMax socks.
pared to cheaper brands.
Max has
its roots
9writ“hydrophobic,”
Wool is Task
one of the
oldest natural
in the concept
Limb Loss
Force/Amputee
prevented and healed. ings
Current
re With an obesity epidemic and
which refers to wicking water through
fibers used in socks and offers exof DuPont scientists in the ‘20s.
Coalition,
Roadmap
Preventing
the
fiber, andis“hydrophilic,”
cellent
wicking for
properties
in product Limb
a precursor polyester
fiber,
search
makingdrawing
use ofDacron,
technology
10,000 baby boomers turning 65
water to the fiber. These terms can be
lines such Recommendations
as Smartwool. One of the From
was later modified and renamed
LossCoolin America:
to help
patients
assume
responevery day, demographers predict that
used
conjointly
when describing
the more
downsides is that it wears out more
Max , which
is unique in its four-layTasksome
Force.
Knoxville,
fluid
dynamicsfor
in socks,
as some
fibersof their
easily.Loss
Therefore,
companies,
er hydrophilic
construction.the 2012 Limb
sibility
the
care
diabethe number of people with Medicare
have characteristics of both compolike
Darn-Tuff, offer lifetime warranAcrylic is a material that
has good
Tennessee;
2012.
tes,The
and
healthcare
providers
tohydrophilic properand diabetes will quadruple over
nents.
key isfor
that whatever
sweat
ties
for
their
combinations.
Smartheat retention and
10
Burrows
GreggguarEW, Alor moisture is produced needs to be
wool
extends aNR,
performance
ties, only slightly less than CoolMaxLi
. Y,
ensure that patients are
following
the next 20 years. How then can it
moved away from the foot, whether it
Acrylic is another less costly
materialA, Geiss LS. “Declining
Continued on page
98
bright
Rates
of
prescribed treatment protocols. Probe that podiatrists fit fewer diabetic
Hospitalization for Nontraumatic Lowwww.podiatrym.com
OCTOBER 2014 | PODIATRY MANAGEMENT
motion of even very modest walking
shoes in 2012 than in 2008? People
er?Extremity Amputation in the Diabetic
programs with the confidence that
with diabetes develop ulcerations, get
Population Aged 40 Years or Older: U.S.,
the feet will be protected from amamputations, and die much sooner
1988–2008.” Diabetes Care February 1,
2012;35(2):273-7.
putation holds the potential for far
than they need to. Podiatrists, be11
Blumenthal D. “Wiring the Health
reaching impact, both in terms of
cause they are not treating patients as
System ? Origins and Provisions of a New
patient quality of life and for the afcomprehensively as they should, are
Federal Program.” The New England Jourfordability of health insurance for all.
not earning as much as they could.
nal of Medicine 2011;365(24):2323-9.
The Affordable Care Act contin While significantly underutilizing
12
Blumenthal D, Tavenner M. “The
ues to evolve and may look entirely
therapeutic footwear, podiatrists are
‘Meaningful Use’ Regulation for Electronic
different after the 2016 elections. As
the specialists providing more of this
Health Records.” The New England Jourit stands now, though, millions of
critical part of care than any others.
nal of Medicine 2010;363(6):501-4
13
people with diabetes are getting betIn 2012, podiatrists dispensed 35%
http://www.apma.org/files/Fileter insurance coverage for care than
of diabetic shoes paid by Medicare,
Downloads/TR-JAPMA-Article.pdf
By Ben Pearl, DPM
S
86
®
®
®
®
®
®
medical supply companies provided
21%, and pharmacies 12%.
We are standing on the cusp of
a revolution in healthcare where initiatives in place will very soon have
the means to track implementation of
preventative care programs. Rewards
will go to providers who can demonstrate improved care while decreasing costs. Imagine protective walking
was possible in the past. Podiatrists
should be able to benefit as the most
therapeutically and cost-effect providers of lower extremity care. PM
References
1
Obamacare and Diabetes: What You
Need to Know. December 17th, 2013.
Muchnick,Jeanne. http://www.type2nation.com/treatment/obamacare-and-diabetes-what-you-need-to-know/
OCTOBER 2014 | PODIATRY MANAGEMENT
Dr. White is a certified pedorthist and is
president and founder
of SafeStep. He is an
expert panelist for Codingline. And member of
Member, APMA’s DME
Sub-Committee.
www.podiatrym.com