There has been much in the news lately about the changes to Medicare law and how it affects Podiatry.  "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003" covers a lot of subject matter.  One part that had the podiatry community holding its breath was the "fee increase/fee cut" question.  The ultimate answer was that fees will go up - ever so slightly - over the next two years.   Another portion of the law that held the general podiatric interest was "opting out" of Medicare, something that MDs and DOs were already permitted to do.  Podiatrists, dentists and optometrists now have that choice, too.  There is already much discussion about the complex process that opting out involves, as well as the possible drawbacks, but at least the option is available now. 

The current legislative battle is about defining podiatrists as "physicians", and therefore included in Medicaid, on the federal level.  This seems like it should be understood, because Medicare's definition of physicians does include DPMs.  Instead it is determined by individual states, and inclusion in a given state during one year does not mean automatic inclusion in that state in the future.  This have been an ongoing battle in many states, and there is hope for a new bill that may spell out podiatrist participation in the Medicaid program once and for all.

What does this have to do with podiatric assistants?  If the laws that are passed adversely affect the practice of podiatry, and therefore the individual practices of our employers, the negative impact is most certainly felt by the staff.  Salaries, benefits, hours worked, and even the need for as many staff people, are influenced by the volume of patients seen and the reimbursements for services provided.  If the doctors are not able to participate in the plans, patient volume will suffer, and jobs can be affected.

What can we do?  Ask your doctor about what you can do to help APMA's efforts on behalf of the profession.  APMA's  Legislative Advocacy Department has all the information needed to help their members contact legislators about upcoming issues.  I'm sure they would be happy to share your legislators' email addresses and examples of relevant letters with podiatric staff people who want to make their voices heard.  You can write to the Director of that department, Faye Frankfort, at fbfrankfort@apma.org

It is to our benefit to become more knowledgeable about the profession, what APMA is and does, and to take more interest in our professional future.

  ~ Gayle

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"It is important to let people know what you stand for; it is equally important to let them know what you won't stand for."    -  Unattributed

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From:  Heather Schafer
re:      Updating Medical & Personal Histories (Volume 57)

In regard to Denice and her H&P questions.....we follow the Medicare guidelines for everyone in regard to legitimately charging for re-classifying "purged" patients as "New Patients".....3 years.  We ask every patient that comes in, though, if anything has changed in their medical history and update it regardless of whether we can charge or not.  We update their PERSONAL info at every visit...or that is protocol anyway.  I hope this helps.

Happy Holidays!

Heather

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From:  Linda Casella
re:      Region III  (Volumes 55 & 57)

Gayle,

Last year I went to the Region III meeting even though I am from NH and I want to let everyone know that it was a wonderful meeting and I recommend that all assistants from every region go next year.  The people treated me so well and I took my husband with me and made it a mini vacation.  We plan on attending again next year and I am so glad that the meeting has been put back on the books.  Let's make it a memorable year for assistant attendance.  It's great information, great learning, great connecting with other assistants and you might even win a few dollars too.

Linda Casella
Hampton New Hampshire

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From:  Jenny Gilliland, PMAC
re:      Electronic Billing with MediSoft (Volume 57)

Hi Gayle,
 
In response to the question posed by Sharon Hockinson regarding Medisoft and electronic billing.  Sharon, make sure your accept assignment box is checked.  We don't bill this way yet as we are still all paper but this was all I could think of.  We use the Medisoft program also and as with any program sometimes you just have to step back and ask for suggestions.  That is why I love the FootZine.

Keep up the good work Gayle and Merry Christmas!

Jenny Gilliland, PMAC
Union City, TN

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From:  Gail Bennett
re:      Electronic Billing with MediSoft  and   Surgery No-Shows  (Volume 57)

Gayle, 

An answer for Sharon Hockinson, be sure that the accept assignment is check for each insurance and if you have contracts with the insurance company that is sending the checks to the patients then contact them and ask them why they are doing that?  Is it just one insurance company or many?

For Ryan Hobbs, I think he best check state law and see what he can charge for no shows.  We have a policy of charging a patient for no show appointments only if they make a habit of not showing.  As for cancelling the surgery if it was not a good reason, such as being sick or something serious I would charge the patient the amount of money he would have made if he had seen regular patients during that time.  Of course it's strictly the patient's responsibility and not the insurance companies responsibility.  Hope that helps, if the patient did reschedule I would perhaps just let it ride and consider it part of doing business as you don't want to infuriate a good patient possibility.

Thanks,

Gail
Spokane, WA

JOB NEEDED!!!!!!
Relocating to the Tacoma, Washington area and in search of full time job with medical benefits.  I have worked in podiatry for almost two years in both the front and back office and enjoy both.  Resume upon request.  Please contact Shannon at s_adell_b22@yahoo.com.


Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

In-office dispensing is defined as the selling of products within your office to patients, and in many cases to the public.  This practice has been common for many years in many physician offices, especially those of dentists, dermatologists, and plastic surgeons.  In-office dispensing has gone through cultural changes over the past few years due to economic forces such as managed care and increased overhead, as well as to physicians’ education leading to a more comprehensive approach to treatment.

The attitudes of physicians and changing lifestyles of their patients have hastened the expansion of in-office dispensing.  Most patients are rushing from one appointment to another and appreciate the convenience of not wasting the time to purchase the products at a local store.  The economics of managed care have caused many physicians to look at ethical alternative sources of income while keeping the patients’ best interests in mind and maintaining a professional image and reputation.  These factors have been the driving forces leading to the exponential growth of in-office dispensing, as well as to the patients’ acceptance of the concept and appreciation for the related convenience, delivery of comprehensive medicine, and quality of care.

In podiatry school and residencies, doctors are taught that we are “professionals” and that we must maintain this pristine perception in our community and amongst our medical peers.  So the retail perception that many of us associate with in-office dispensing creates conflict associated with our education and what is called our “paradigm”, also known as our way of thinking.  A common denominator we have seen amongst these successful practices is their ability to open their minds to treatment tools and protocols to benefit their practices.  These include the use of in-office dispensing, and not making the cardinal mistake of thinking for their patients and trying to look from their perch.  Too often we develop mental blocks because of what we think the patient is thinking, such as “they can’t afford that”, “this doctor is just trying to make money” and “what’s this, a retail store?”.

The many benefits of in-office dispensing include:

* Improved patient satisfaction because of convenience and professional quality of product delivered.
* Significant increase in compliance with instructions for use provided by myself and staff with product in hand.
* More complete approach to patient care that our patients greatly appreciate.  They often articulate how great their feet feel due to using the products we use.
* Viable and ethical source of income that has dramatically enhanced our bottom line.
* Profit sharing with our staff, increasing job satisfaction and reinforcing the importance of the team approach.
* More patient contact with my office when they return just for purchase of a product.
* Increased patient referrals by virtue of current patients discussing their satisfaction with products and care with others.
* Very little storage room is needed for your return on investment.  Many simple, inexpensive options are available for effective storage.

In the next issue of FootZine we will discuss the assistant’s important role in a successful (for the patients, doctors and assistants) in-office dispensing program.

Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm

It's been great to see the exchange of ideas and answers lately.  FootZine will be in your inbox again next week, and then will take a couple of weeks off to focus on the people and activities we enjoy during the holidays.  Stay warm and dry, and remember to write!

 ~  Gayle