... I will say that one of the frustrations of some podiatrists is that PCP’s think we should be cutting every single patient’s nails and a lot of the patients will not meet the billing criteria. Even if they have diabetes.
...I will say I see less referrals from MD/DO for fraudulent nails compared to NP/PA referrals.
Not to dig at the NPs or PAs but I dont think they are educated well in this subject.
Seems to be a lot of blanket podiatry referrals for nail care from them regardless of any qualifying health factors.
Correct. The big podiatry demand is, in the vast majority of setups, still for RFC. It creates a patient expectation.
Refers for that routine type nail/DM care outnumber any other pathology in 95% of pod clinics.
PCPs don't know the MCR criteria; they simply know
podiatry cuts toenails (not derm or F&A ortho or etc).
It's not PCP's job to know nail care Q-quals... how would they know? I don't know when I send someone with blur vision and recent weight gain if they will definitely receive diabetes Rx or what Rx it might be. If a person asked me for a plastic surgeon in the area, I wouldn't know if they met micromastia criteria (insurance vs cash pay with Plastics). Personally, I'm just happy the MD/DO are sending and involving us in the care overall.
It's a catch-22, thorough and through:
#1) Podiatry basically started because physicians didn't want to cut corns and calluses. Over 100 years after good old NYCPM founded, most of our podiatry refers and "demand" are still for RFC. It's what we do. It's what we're expected to do - by patients and docs alike. And yeah, that's how it is, despite what APMA might try to sell to students or what 21s century DPM picture that ACFAS paints.
#2) Now, in the day of 3yr residencies or even more training and "foot and ankle surgery," a lot of podiatrists don't want to do nail care...
The ortho group or MSG or hospital DPMs often try to wiggle out of nail/callus care and say pts don't qualify, try to get a nail care RN or tech or midlevel or whatever. The PP pods will generally do it, qualify the pt some how (Q mods or pain or both)... some dump nail debride mostly to MAs. Basically, we have a lot more skills than nail/callus care 100 years later, and most of us logically want to use those skills instead of what we were founded on: busting crusties.
...So, when in doubt, refer to meme thread (ya, he won for a diff one that year, but I honestly do think
this one is the GOAT meme):