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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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