What if…

Close your eyes for a minute and imagine a U.S. healthcare system where there is no coverage for pedorthics. What did your vision look like? Did you envision a landscape in which there is an out-of-work pedorthist panhandling on every corner for spare change, or perhaps meeting in church basements for stale cookies, coffee, and group therapy? Given our current healthcare environment wherein the decreases in reimbursement amounts are seemingly inversely proportional to the increases in documentation requirements, a scenario in which pedorthics is no longer covered by third-party payers is not difficult to foresee. While this is yet merely hypothetical, it is not imprudent to be apprehensive about the future of our profession, at least as it exists currently. In the meantime, the Affordable Care Act has added a number of new enrollees to state Medicaid programs. Although I'm not a Medicaid expert, I know the effects the program had on my own small business. Last year, after years of debate, we made the difficult decision to relinquish our Wisconsin Medicaid provider status. It broke my heart to do so. We have helped thousands of Medicaid patients over the years, many of whom made me feel like a member of their families. Ultimately, since we were losing money with every Medicaid transaction, I felt I had no choice as a business but to cease being a Medicaid provider. The Therapeutic Shoes for Persons with Diabetes (TSD) benefit has provided a similar challenge to our profession. With low reimbursements, we are often unable to provide the patient with what, in our professional evaluation, is the ideal shoe and foot orthosis combination for them if we accept Medicare assignment. Many high-end depth shoes cost me more to purchase and inventory than the Medicare reimbursable allowance for them. So instead I, like many others, find myself obligated to go to the designated "TSD" shoe rack and fit the patient with a shoe that, while it will serve the purpose and certainly do no harm, is not the best solution possible. As far as the foot orthosis, if I decided to accept the standard A-5513 assignment but actually fit the patient with a better quality orthosis instead of a standard "TSD" orthosis, I would be committing Medicare fraud and could be prosecuted for it, as I would be billing something other than what I provided. This current situation colors the vision I see when I imagine an operating environment where third-party payers have ceased providing coverage for pedorthic services and products. The caregiver in me is saddened to know that there would be patients who would not be able to afford our services. On the other hand, the patients whom I would be able to help would get my best every time. I, along with my accountant, management team, business advisors, and colleagues, have long felt that if there were no healthcare coverage for what we do, we would be more profitable. I would likely see fewer people, but I could spend more time with each of them. I could charge a realistic, affordable price for my services if I didn't need to devote a significant portion of my business expenses to pay a billing and collections staff, and then wait for weeks or months for reimbursement. While I am proud of my hardworking, dedicated staff, the composition of that staff is heavily weighted toward staff to support the current reimbursement processes. And, it is difficult to maintain profitability when the support staff outnumbers the practitioners. If there were no coverage, we would compete on a level playing field and the cream would rise to the top. Patients wouldn't be bound by their provider directory when choosing who would make their foot orthoses. I, like many of you, would not only survive this new paradigm, I would thrive because I am confident in my abilities and those of my employees, and we would be unshackled and free to do our best. Dennis Janisse, CPed, is president and CEO of National Pedorthic Services, headquartered in Milwaukee, Wisconsin. He also is a clinical assistant professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin, Milwaukee, and director of scientific affairs for Orthofeet, Northvale, New Jersey.

What if…

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Related posts:

Billing and Collections Q&A

MEC ’14 Boasts Record-Breaking Attendance

UMich Seeking Volunteers for Upper-Limb Prosthetics Survey

O&P JOBS

HH Manager, Orthotics & Prosthetics

Orthotics and Prosthetics Assistant

Certified Orthotist — Full-Time or Part-Time, Pediatric Practice

Get unlimited access!

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