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06/13/2018    enjamin J. Wallner

Podiatrists Now Defined as Physicians in VA (Charles Lombardi, DPM, Joseph Borreggine, DPM)

RE: Podiatrists Now Defined as Physicians in VA
(Jeffrey Robbins, DPM)

I would like to address a few misconceptions that
have appeared in the discussion of the VA MISSION
Act over the past few days. Dr. Lombardi’s
conclusion that only ABFAS-certified podiatric
surgeons will receive an increase in pay as a
result of the passage of the VA MISSION Act is
fundamentally incorrect. Board certification is
just one of many factors in determining market
pay at the Veterans Health Administration. The
section of the handbook that he has quoted refers
to how the VA determines whether a physician or
surgeon is board certified—not how the physician
or surgeon is paid.

The bureaucratic machine that is the VA looks at
myriad sources to determine pay, including
Sullivan and Cotter, MGMA, Bureau of Labor
Statistics, among a whole host of other sources.
The podiatry section at the VA now faces the
formidable task of implementing this legislation
and determining, using local market value,
appropriate pay ranges for podiatrists at
individual VA clinics. While local factors and
individual training, experience, and
certifications will play a role in determining
those pay ranges, every podiatrist will be paid
under the physician pay band and given the same
opportunities for leadership and career
advancement as their MD and DO colleagues. Surely
Dr. Lombardi understands that not all MDs or DOs
are board certified and that the VA employs them
all under the same pay authority! What’s
important in this bill is that a DPM is now
included under the heading of physician as a
podiatric surgeon whether he or she performs
office-based procedures or procedures in the OR.

Dr. Borreggine also has made an incorrect
assumption. The section “Inclusion as Physicians”
appears immediately following the title of the
bill. Podiatrists are now identified under VA
statute as “podiatric surgeons” and listed within
the same physician authority as MDs and DOs. We
also have the same opportunities for advancement,
and we are included in the same pay tables. How’s
that for parity! Dr. Borreggine asks if we worked
with the dentists. The simple answer is no. We
worked with the orthopedic surgeons—our peers—to
pass this bill.

When engaging in advocacy efforts, it’s important
to understand the drivers in Washington, DC, and
right now, all eyes are on costs. I bring this up
because to change the definition of “physician”
under Medicaid for podiatrists will cost,
according to the Congressional Budget Office’s
most recent score of our HELLPP Act, more than
three-quarters of a billion dollars over 10
years. That’s just for podiatrists, and there are
only 18,000 of us in the US. Add the optometrists
and estimate how much the bill’s costs would
balloon if we included them in our efforts. If
members of Congress are hesitant to pass our bill
because of its costs, what do you think they
would say if we partnered with optometrists?

APMA is incredibly proud of this victory for
every podiatrist employed at the VA. This win was
the first piece of a larger strategy for parity
at the federal level, and I thank everyone who
contributed to it, whether through APMAPAC
contributions, meetings with legislators, or use
of our eAdvocacy site. I would encourage every
podiatrist to help advance our momentum by
continuing to play an active role in advocating
for your profession.

Benjamin J. Wallner
APMA Director, Legislative Advocacy and APMAPAC

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