bonvivant07

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I am curious about this, how does the entire system work?

1. Medicaid, Medicare: Do PODs use the RVU same as Physicans?

2. What about insurance? I keep hearing how PODs are paid less for the same procedure than if an Ortho. Do insurance companies use a different reimbursement chart for PODs?


Thanks
 

PADPM

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The idea that DPMs receive a lower reimbursement for the same procedure performed by orthopedic surgeons, MDs or DOs is simply an urban legend.

Whether or not a particular insurance company reimburses via a RVU based system or other system, I know of NO insurance company in my 20+ years of practice that has a "different reimbursement chart" for DPMs.

DPMs receive the exact same amount for the identical procedure as any other medical provider.

The ONLY time this may differ is when a DPM accepts a "capitation" plan where the doctor signs a contract to accept a pre-set fee per patient/per month for a set number of patients, regardless of whether the patients are seen a hundred times or whether you never see the patient. Different specialties sign different types of capitation contracts depending upon utilization rates, but that's an entirely different story.
 

Marry2Pod

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Forgive me (in case this is an ignorant question) but if DPMs are reimbursed the same as MD/DOs, does that mean that Podiatrists and Foot and Ankle Orthos have roughly the same salary? Or do F&A Orthos different procedures than Podiatrists? Just curious!
 

krabmas

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Forgive me (in case this is an ignorant question) but if DPMs are reimbursed the same as MD/DOs, does that mean that Podiatrists and Foot and Ankle Orthos have roughly the same salary? Or do F&A Orthos different procedures than Podiatrists? Just curious!
Some states do not have parity laws (same work = same pay regardless of trade). So this can lead to DPMs being reimbursed differently for the same procedure.

Podiatry and foot and ankle ortho, ortho trauma, general ortho all bill the same ICD-9 (diagnosis codes) and CPT (procedure codes) for procedures or office visits. What the insurance reimburses is based on what each practice has worked out with the insurance company. Some larger practices regardless of degrees (MD or DPM) have negotiated for higher reimbursements.

F&A orthos generally make more than pods for many reasons...

1. some take general ortho call and still see general ortho cases for their practice so they are not exclusively F&A.

2. the ones that are exclusively F&A are part of a large F&A practice that runs like a well oiled machine with lots of support staff so the doc can see 70-80 patients a day (assembly line medicine)

3. some are exclusively F&A and part of a small practice... they also employ lots of support staff to keep the patient encounters high

The orthopedic community understands the need for support staff and delegating work that the doc does not need to do. The doc should decide the treatment plan, but not all treatments need to be performed by the doc (like casting, setting up for procedures, drawing injectables...)
I think the more successful podiatry practices also follow this model of lots of support staff. you have to spend money to make money.
 

PADPM

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Krabmas,

If there are still states in existence that pay DPMs on a different pay scale than other professionals, I am not aware of those states, and I'd be curious to learn which states that apply to those rules.

IF that is true, the podiatric state societies in those states should be challenged as to their effectiveness.
 

Podfather

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Krabmas,

If there are still states in existence that pay DPMs on a different pay scale than other professionals, I am not aware of those states, and I'd be curious to learn which states that apply to those rules.

IF that is true, the podiatric state societies in those states should be challenged as to their effectiveness.
PADPM Texas has different reimbursements. Believe it or not this idea came from the PA medical association a long time ago. Many DPMs do not know it happens. I discovered it accidentally when I called an insurer and asked for an updated fee schedule. The title said DC/DPM fee schedule. Further research uncovered this was the norm. Equal pay laws are tough to pass since it is opposed by the state AMA group and the insurance lobby. An agent friend said even in equal pay states they will pay DPMs lower and only fess up when busted. I suspect with the huge war on the horizon between ANP and MDs ( all ANP will have a doctorate and can be called doctor sound familar?) we will see a huge push for more disparity in pay and supervision "for patient safety" Ha Ha. There are bills in various states as to who can call themselves doctors (not physician but doctor) and depending on he politics the MDs want us as allies or include us with the nurses, PTs, psychologists, optometrists etc.).
 
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