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Class of 2021

Discussion in 'Podiatry Students' started by DexterMorganSK, Jul 13, 2017.

  1. de Ribas

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    I have read through and it says that podiatrists and dermatologists are most affected. Everyone will be affected in some way.

    I read that they are trying to decrease amount of paperwork and provide more time for physicians to spend with patients.

    Isn't it a good thing? Isn't it what all physicians want?
     
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  3. DexterMorganSK

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    Yeah, that's the good part about the changes.
    The bad part is that they want to "require podiatrists to use different E/M codes than all other Medicare physicians, which would reimburse at a significantly lower rate" (so, DPMs will get much lower payment for the same procedure vs if a family med doc does it).

    Let me post the letter that is being sent out to CMS from everyone concerned:


    Dear Administrator Verma,

    I write as a student of podiatric medicine (DPM) to ask CMS not to finalize its proposal to single out podiatric physicians by requiring DPMs use a separate and unique set of evaluation and management (E/M) codes that are different from what other Medicare provider uses, for the same E/M services, at a significantly lower rate of reimbursement. And, I oppose the proposal to collapse the existing E/M codes of 99202 through 99205 and 99212 through 99215 into two flat reimbursement payments for Medicare providers generally (except for DPMs). I also request that CMS not finalize the proposal to reduce reimbursement by 50% for the least expensive procedure or visit that the same physician (or a physician in the same group practice) furnishes on the same day as a separately identifiable E/M visit.

    I will provide the exact same E/M services as my MD/DO colleagues, and I will be recognized as a physician on equal footing with MDs/DOs under Medicare, within my scope of practice. CMS’ proposal for separate payment for podiatric E/M services amounts to differential payment by specialty for the same E/M services provided by DPMs. CMS provides no explanation on how the evaluation and management required for patients seeking care from DPMs is distinct from that provided to patients seeking medical care from an MD/DO. Furthermore:

    1. If a patient saw an MD/DO for a foot and/or ankle complaint, they would not be required to use these special codes.
    2. The same documentation standards would apply for the new codes as those proposed for other providers’ office and outpatient E/M visits, suggesting that the services and clinical expertise provided in podiatry visits is comparable visits with other physicians.
    3. CMS does not suggest that DPMs’ level of medical decision making is less than MDs/DOs, yet proposes this as a standalone basis for documenting E/M visits.

    These factors clearly demonstrate that separate payment for E/M services provided by DPMs is not warranted, and that DPMs should be paid in the same manner and amount as all other Medicare physicians.

    CMS’ proposal to collapse payment across Level 2 through 5 visits would reduce access to care for many vulnerable patients, leading to significant patient harm. I support CMS’ efforts to reduce administrative burden but I do not believe that this proposal would achieve this goal. Physicians will still spend the same amount of time with their more complex patients. CMS’ per visit payment would be insufficient to capture the full costs of furnishing this care. Thorough medical records are still necessary for these patients for purposes of completeness, safety, continuity of care, and risk management. None of that will change by decreasing CMS documentation requirements. These complex patients, a significant part of the Medicare population, frequently have multiple complications and require significantly more time and attention to properly treat. If this proposal goes through, the unfortunate reality is that many specialty Medicare physicians will likely face strong incentives to either limit care or require complex patients to return for multiple visits. CMS’ approach would apply a blunt payment that does not allow for more tailored care delivery. It would not decrease the amount of time I will spend with my future patients to thoroughly document their conditions or complaints.

    I do not believe CMS has considered its proposals’ impacts on individual clinicians or practices. CMS only provided estimates broken down by specialty. However, patient health and population vary widely by region, even within a specialty. Practices that regularly manage or treat the most complicated patients would be especially harmed by insufficient reimbursement for complex visits.

    CMS should continue its longstanding policy of providing consistent payment to all physicians, regardless of specialty and it should retain the current levels of E/M coding.

    I also disagree with CMS’ assertion that separately identifiable visits occurring on the same day as a 0-day global procedure have significant overlapping resource costs. I strongly urge CMS to rescind this proposal.

    According to CPT guidelines, modifier 25 is used to indicate a significant, separately identifiable, and medically necessary E/M service provided on the same day as a procedure. Providing medically necessary, separate, and distinct services on the same date of service allows physicians to provide effective high-quality care. Such services should be reimbursed appropriately and in accordance with established coding guidelines, whether used on the same date or different dates. This ensures that payments are sufficient to cover costs and leads to improved outcomes. More importantly, it makes it easier for patients who can avoid additional trips to the office and allows them to receive care that they need.

    Thank you for your time and consideration.
     
  4. de Ribas

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    New CMS Proposed Rule On E/M Coding Could Reduce Podiatry Reimbursement | Podiatry Today

    The Centers for Medicare and Medicaid Services (CMS) on July 27 released its plan to reduce paperwork and improve patient care.
    What CMS is proposing is to combine the evaluation and management (E/M) codes—that currently have four to five levels of codes with specific documentation requirement for each level of code and four to five levels of reimbursement—to a single payment level for a new patient and a single payment level for an established payment. The CMS notes this could have an impact on the 40 percent of Medicare payments that are for E/M services.

    As CMS Administrator Seema Verma, MPH, wrote in a July 17 letter previewing the proposal: “We’ve proposed to move from a system with separate documentation requirements for each of the four levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients … Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden.”2

    This proposal is open for comment until September 10. Most of us would not be opposed to reduced paperwork. I have read that although the reduction in documentation could save a minute or two per appointment since many of us use an EMR, the reduced reimbursement would not offset or reduce the burden CMS seeks to help us manage. The rule change will definitely reduce the reimbursement we will see for the higher level of visits that are often required to take care of more complicated patients.

    As Policy and Medicine points out, obstetricians and gynecologists would experience the biggest potential increase of 4 percent from the proposed E/M changes.3 In contrast, podiatry and dermatology would take the biggest hit with 4 percent decrease.

    The CMS argues the negative financial impacts will be offset by the reduction in administrative burdens as outlined in the proposed rule. As noted, this reduction of administrative activity would be miniscule per patient visit and a reduction of paperwork involved could not compensate for reductions of payment received.

    CMS believes that podiatrists would be seeing a 12 percent increase in reimbursement throught this change, and that hand surgeons and dermatologists would see a 4 to 6 percent increase with the code consolidation. With this information, CMS has proposed to release G codes for podiatrist to use specifically for our E/M services with reimbursements reduced further.
     
  5. de Ribas

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    So, why CMS believes podiatrists will actually have highest increase and other think it decrease reimbursement?

    Why so opposite views?
     
  6. DexterMorganSK

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    this should answer your ques. CMS "believes" there will be a pay increase but it won't.

    NYSPMA | NYSPMA President's Message
     
  7. med2345

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    If it is established, what would be the good to come from it? I skimmed above but i don’t entirely understand if you could summerize
     
    #256 med2345, Aug 3, 2018
    Last edited: Aug 3, 2018
  8. de Ribas

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    It is good to see them acting aggressively and even hiring a law firm to help APMA.

    Looks like NY got very involved.
     
  9. Weirdy

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    Money is money.

    Would you like to be reimbursed less than the guy next to you?
    When providing the same energy, time, and level of care?
     
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  10. J29622

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    This is discrimination, plain and simple. There is no justifiable reason why we should need to use different codes, which reimburse less, for the same exact diagnoses and procedures as our MD/DO colleagues. I'm all for streamlining the process, but singling out podiatrists in this fashion is unwarranted and quite frankly unethical. It's good to see that the APMA is against this and aggressively opposing it. We need all the people we can to fight this off - we have good momentum after the VA changes but things like this threaten to set us back as a profession.

    My bud who is heavily involved with OFAMA (Ohio podiatry organization) as a student says they're also getting heavily involved in opposing this as well. They don't seem to think it will go through as it's still in its infancy as a proposal, but it'll only be stopped through an organized effort.
     
    #259 J29622, Aug 3, 2018
    Last edited: Aug 3, 2018
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  11. DexterMorganSK

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    In simple terms, it means dealing with less paperwork so that you can spend that extra time on patient care. But, I fail to see this benefit if Medicare will not compensate Pods fairly for the same diagnosis as any other Physician.

    We moved a step forward with the passage of the VA-equity bill, but if this happens..we will take 3 steps back!!!

    Thus, to all, submit that letter, and ask others to do the same. As students, that's the least we can do. Thanks!
     
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  12. med2345

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    is there any word on the chances or likelihood that this does happen?
     
  13. J29622

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    It's hard to say as of now. I want to say that odds are decent that it won't go through given the strong opposition to it and the fact that this is merely a proposal and is still a ways from being official policy, but nothing is guaranteed at this point.
     
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  14. DexterMorganSK

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    To add to what J29622 said above, we, everyone in this profession, have until September of this year to make our case against the proposed changes. I don't really know when we'll find out if this happens or not but the hope is it won't :xf:

    :yawn:
     
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  15. de Ribas

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    I would not like that. I was just asking why CMS sees increase while podiatry world sees decrease.

    So, guys, please help me understand. Basically, CMS is proposing to eliminate 4 codes that were reimbursed for administrative work involving documentation of various levels of patient visits? Right?

    So, they are proposing to replace 4 with 2 codes? If, like it was said in a link, podiatrists almost never billed for levels 4 and 5, than how would that decrease reimbursement much?

    Would 2 new codes get better pay than codes for levels 1 and 2 used previously?

    Thanks
     
  16. Weirdy

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    Each code is associated with an RVU-- Relative Value Unit.

    You get paid based on that RVU.

    Podiatrists may code for the same thing other physicians use-- but their RVUs would be less than other professions--- despite using the exact same code.
     
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  17. med2345

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    It’s so blatantly discriminatory for no reason I wonder what genius came up with this, unless it’s different coding for all specialties. I’m surprised yet I know I shouldn’t be because ya know Medicare and Medicaid *sigh*.. only a matter of time until more and more docs start denying it as health insurance.
     
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  18. Weirdy

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    Quite a head scratcher.

    What gets dreamt up in corporate doesn't work in real life.
     
  19. Podstar

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    I hope second year is going well for everyone so far!
     
  20. DexterMorganSK

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  21. GypsyHummus

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    How is second year compared to first year?
     
  22. de Ribas

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    Why there are 39 unfilled positions if there are students that didnt get into residency? 7 from class of 2018 and so on.

    I am confused.
     
  23. Weirdy

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    Can't speak for other programs but in general much much busier.

    Felt less stressful for me even if it was crazier workload. Get a hang of how to study, how to portion time, slowly add on more hobbies and things you like to do, maybe even research. It felt less stressful because I went in knowing I could do it. Went in more confident, went in knowing I wasn't just stupid or something was wrong with me.

    Clinicals started for us so 2 days of the week we're in clinic or hospitals and its a time sink, but you learn so much and it makes me work harder to pass in class because I know I'll see that stuff again and it matters in the real world.
     
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  24. justici

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    I may be totally wrong, but I am going to guess that some of these positions were from programs that did not have enough students that applied and/or rejected certain applicants for a variety of reasons and have unfilled spots because of it.
     
  25. de Ribas

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    Is there some type of scramble in podiatry residency? Because 7 students from class of 2018 did not end up anywhere and there are still unfilled spots.

    Seems logical to fill all the spots.
     
  26. DexterMorganSK

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    You have to consider the date that was published...after the residency placements were over, those unfilled positions got filled and all of the 9 schools had a 100% match rate for this year.
     
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  27. DexterMorganSK

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    +1 to what Weirdy said. Our days are divided between clinics and classes and there is hardly time to study for exams anymore. It's fun and all and very interesting clinical stuff but wish there were more breaks. In any case, its good to be here :)
     
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  28. de Ribas

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    That's why DMU says they dont have clinicals for first 2 years to make sure students do well in classes and boards.

    When I have seen Scholl's schedule, i thought it was cool that they start their students with clinical hours from day 1, but now I think that I'd rather do academics only and some volunteering for the first 2 years.

    We have Clinical Medicine course that has weekly labs where we learn how to use equipment and practice some on each other and SPAL. We had our first SPAL exam this week.
     

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