01/12/2018    Joseph Borreggine, DPM

CMS Launches New Voluntary Bundled-Payment Model

Riddle me this Batman: What looks like a DPM,
walks like a DPM, and can do what a DPM can do
outside of foot surgery, but is not a DPM?
Batman: Great Scott!! Why an NP of course!
The tea leaves certainly do not reveal another
story based on what Medicare announced yesterday
along with what was posted on PM News. For
further information click here:
https://www.cms.gov/Outreach-and-
Education/Outreach/FFSProvPartProg/Provider-
Partnership-Email-Archive-Items/2018-01-11-
eNews.html#_Toc503329517

Bundled payments are here to stay for Medicare
providers and fee-for-service is dead! Voluntary
it will be to start, but in a few years it will
be the norm. To get this going, CMS will offer
monetary incentives to providers who are early
adopters.

And based on this new policy of reimbursement
being implemented there will no longer be
ability in place to for providers to bill for a
particular diagnosis ad infinitum. The fact is
that "Diagnostic Related Groups" or "DRG's” will
be the "new" payment model for all Medicare
providers from here on out. That is, one fee
paid per diagnosis. This will be capitation for
all medical services to be provided and hence
over utilization will possible finally be
quelled or it will be a good start.

Yes, in my riddle and answer I was being
sarcastic and maybe a little trite, but in the
not so distant future we, as DPMs, maybe carved
out of the Medicare. Why do I say this? Well
with MACRA and MIPS and all the data mining that
has been occurring over the last decade on
behalf of CMS with meaningful use our days maybe
numbered if we do not change our scope of
practice to a full license.

Why do I say that? Well, look at it this way CMS
needs and wants to save money and DPMs are
really considered outliers in the healthcare
system. Yes, we are a necessity, but if we
continue to be unaffordable and someone else
like an Nurse Practitioner or another type of
ancillary health care provider (PAC, APN) can do
cheaper and faster, but not necessarily better,
then why would CMS continue to pay DPMs the way
they have been?

The MIPS/MACRA are looking at high quality and
low cost and not anything else and if we cannot
prove this to be true as a profession as a
whole, then economics steps in a throws a heavy
blow and removes the line item that costs too
much. Does the APMA have any statistic how this
profession fares with respect to “high quality
and low cost” metrics? This financial
examination of all providers has been occurring
and will continue to occur as long as it reveals
that cost savings can be elicited based on that
data obtained.

So, why do I push the whole "expanding the
scope" and "unlimited license" in our profession
when a number of us are not wanting to even
considering treating a patient for blood
pressure let alone anything else medical? I
stress this point because the longer we wait to
make this move the less likely we are going to
be in existence as a profession. It will no
longer be economically feasible for podiatrist
to make a living whether in private practice
(that a whole another story) or employed by a
hospital or multi-specialty group because one
bundled payments truly kick in it will be very
to continue doing what we do and make money.

Now if we were able to expand our services
medically because of scope and license, then
that would be a different story. With these
additional medical services that we could
provide to a patient population, I would opine
that a potential replacement of lost income
could be secured. But even with that said, there
is another unfortunate statistic looming that
will deter any of this from happening. The fact
is interest in this profession is waning. As of
December 15, 2017 the applicant pool for the all
9 podiatry schools for 2018-19 is around 180
applicants. That speaks volumes! If this is
true, then what I am saying here is moot. If I
am wrong then someone correct me. Even if the
applicant pool number was double that, then that
still is not good for the profession.

Why the lack of interest in becoming a DPM? I
can probably surmise why in this case, but that
is a discussion for another day. I call out CPME
and all the podiatry schools to start to change
our podiatric medical education to truly be in
parity with our allopathic/osteopathic
colleagues so that we can be ready and waiting
for the changes that are upon us rather than
play music while the ship is sinking.

Joseph Borreggine, DPM, Charleston, IL

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