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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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