American Foot Care Nurses Association

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Dermato Fight Club

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So this is an organization that offers a certification to become a "foot care provider". While this may ultimately be good for us as it takes this stuff away from us, it will only compound the issue of saturation in our profession.

On one hand I'm all for these nurses doing this type of work, but only if we severely limit graduates.

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On one hand I'm all for these nurses doing this type of work, but only if we severely limit graduates.
You have the wrong direction of causation. It will never be "we limit DPM grads ergo nurses need to render foot care." It will be "nurses are rendering foot care ergo the DPM degree is obsolete for this purpose ergo pre-health students will limit themselves from applying to pod school"
 
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I mean I'm not sure that it matters which way it occurs but the APMA needs to be at the front of this and proposing some solutions that doesn't include nurses being "foot care providers" and continuing to graduate 700 podiatrists annually.

I guess this is an identity check for us as a profession. Do we want to provide this care or not?
 
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This could be a boon for podiatrists if CMS/insurances make a clear policy that allows us to supervise and bill for RFC conducted by lower level nurses (i.e. LPN) that get this certification. This may already be possible, I'm not sure. If so, it's not entirely clear and probably varies MAC to MAC. They can't bill insurance on their own, so patients looking for their free 61 day pedicure will still go to their friendly neighborhood Fellowship Trained Foot & Ankle "Definitely a Real Doctor" Surgeon
 
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I am not sure how it works exactly at the place I work but we have several “foot care nurses” who do nails and file down calluses. I think they bill the visit under the supervision of an MD or something. They come and get me occasionally to check on a patient who has a new wound. For my situation I am really glad because I have done 0 nails so far other than ingrowns.
 
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On one hand, RNs have 100 other things they can do that make more money and/or better job quality. As my late residency director would always say "a high school kid could cut nails."

On the other side, podiatry absolutely does depend on nail care. There are nowhere near enough hospital/ortho work to go around with today's numbers of DPMs. We depend nail care directly (RFC codes), and we depend on it to bring in pts who have other issues we can treat. We are saturated with DPMs as it is, even with nail care (which one senior told me is "cheaper than a $50 pedicure shop visit these days"... uh, glad to help?).

...I agree I'm for anyone/anyone doing most nail care, but this issue is just the latest of 800 wake up calls to APMA to quit sending massive nubmers of people with $400k debt into a job with less and less jobs and demand. In an ideal world, we'd have 300 DPMs graduating each year... and many PP pods would have a nail tech (RN or otherwise) in their hospital clinic or employ three in their private office. That's the way Derm, Card, and most MD specialties do it (techs and/or RN and/or midlevels).
 
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On one hand, RNs have 100 other things they can do that make more money and/or better job quality. As my late residency director would always say "a high school kid could cut nails."

On the other side, podiatry absolutely does depend on nail care. There are nowhere near enough hospital/ortho work to go around with today's numbers of DPMs. We depend nail care directly (RFC codes), and we depend on it to bring in pts who have other issues we can treat. We are saturated with DPMs as it is, even with nail care (which one senior told me is "cheaper than a $50 pedicure shop visit these days"... uh, glad to help?).

...I agree I'm for anyone/anyone doing most nail care, but this issue is just the latest of 800 wake up calls to APMA to quit sending massive nubmers of people with $400k debt into a job with less and less jobs and demand. In an ideal world, we'd have 300 DPMs graduating each year... and many PP pods would have a nail tech (RN or otherwise) in their hospital clinic or employ three in their private office. That's the way Derm, Card, and most MD specialties do it (techs and/or RN and/or midlevels).
They need to close the new schools and all other schools limit to 30. If a bunch of academics/etc lose their jobs then tough titty
 
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I think the real question will be if these foot care nurses or associate DPMs are more economical. They'd obviously need a RN salary and benefits, which is nearly what DPM associates usually make (higher salary but less benefits). But DPM associates will keep demanding higher pay, mainly due to inflated tuitions + more interest with fellowships. Podiatry associates are basically on par with PA/NP, but the foot care RNs will be at least a bit cheaper.

The foot care nurse FB group is pretty active with a lotta members. Time will tell if they tend to go on their own (home visit services), work for podiatrists, work for hospitals, MSGs, whatever. I would think their pay will stay in line with most RNs or a bit higher due to fact it's a less desired nursing job type (like home care).

Associate podiatrists always complain about their $125k or $150k or $175 or whatever offers, but at least there are offers out there. Imagine if most podiatry groups that used to hire 3 DPMs as associates instead went to 1 DPM associate and 2 or 3 foot care nurses instead. Podiatry associate salaries would take a dive even further with fewer options and more applicants.
 
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I'm not even done with training yet and each day I'm trying to think of exit plan cause I don't think it's sustainable with the way we're going but I'm stuck cause there's nothing else.
 
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They need to close the new schools and all other schools limit to 30. If a bunch of academics/etc lose their jobs then tough titty
This is by far the best solution to the majority of our problems and every year it doesn’t happen the more hopeless it gets
 
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I'm not really worried about this. The decisions of the profession are already self destructive enough without worrying what some nurses are doing.

How will they be paid? Will they be subject to the same coding rules we are? Will they be going to people's houses? I think these would be interesting questions, but for as much as most of us dislike "nailcare" a 11056 + 11720 currently pays over $100 for an essentially risk free encounter. I think there are a bunch of people out there adding a 99212-99213 onto essentially every visit, putting $150-200 in their pocket for each visit, and wondering why everyone is complaining about the profession. If you bill a 99213 with every 11720 you'll generate near $500 in an hour if you see 4 patients. People say on here that they don't want nailcare to be covered. My suspicion is most podiatrists would have difficulty getting patients to consistently pay what Medicare currently pays for nails/calluses. I also suspect nurses would be willing to cut nails and calluses for significantly less than we are willing to accept.

There was a PM News question posed awhile back about threats to the profession. Obviously they didn't ask about saturation, but the number one threat is payor/Medicare behavior / reductions in reimbursement. Further rate cuts. Tightening of things like 25 modifier visits. Increased penetration of HMO type Obamacare plans and Medicare Advantage plans that fraudulently deny services are terrible for us. Increased private equity penetration is also terrible for individual young podiatrists since it prevents them from ever reaching their income potential.

I had a hilariously hellish week with patients who were scheduled for surgery having acquired marketplace HMO plans that they didn't tell us about. These aren't spouse secondaries. The patient's have BCBS PPO from work, but they acquired secondaries probably because they don't cost anything based on their income on the government market. The patients think - oh, I'll get a free secondary to cover my expenses etc. They didn't tell us they had them and then we didn't have referrals for the HMO secondary and the cases almost got or were cancelled. Even worse, the cases are now worth nothing. I had a stretch awhile back where I said - I don't seem to be experiencing the "prior authorization" / insurance denial trap game. Then I had 4 eternal MRI battles and a series of referral HMO battles. I had a patient who needed to be placed into a skilled after surgery and her MA plan strung her along and of course denied it. Feels like I'm knee deep in insurance hell.

We still have things going for us. There are insurances that make no distinctions on physician fee schedules. No one here likes the APMA but we should all be sending them a check every year for fighting off CMS's plan to create separate E&M visits for us. That would have destroyed the profession over night. We went from a massive downcoding to getting to bill 99214s for all of our sick pathetic patients.

I'm covering a lot of ground, but good luck to the nurses. They can have some dregs.
 
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