Texas Podiatry Scope of Practice

[Feli]

It would depend on the cases. If the DPM is assisting another DPMs case, certain insurances are only reimbursing around 30%. The reimbursement is dependent on the complexity of the case. I will be assisting a vascular surgeon on some cases and the insurance companies verified that they reimburse 60% as an assistant for the procedures that the vascular surgeon is performing.

Ok, that makes more sense. Thanks.

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[NatCh]

It would depend on the cases. If the DPM is assisting another DPMs case, certain insurances are only reimbursing around 30%. The reimbursement is dependent on the complexity of the case. I will be assisting a vascular surgeon on some cases and the insurance companies verified that they reimburse 60% as an assistant for the procedures that the vascular surgeon is performing.

Dang, I only get around 20% assistant's fee.

Medicare cases allow...nothing!

 

[SportPOD]

Dang, I only get around 20% assistant's fee.

Medicare cases allow...nothing!

Once again, depends on the complexity. For podiatry cases, Medicare won't allow anything. But for a vascular case, they will allow 50% assist fee for a lower extremity bypass. (At least here in AZ)

 

[cool_vkb]

Once again, depends on the complexity. For podiatry cases, Medicare won't allow anything. But for a vascular case, they will allow 50% assist fee for a lower extremity bypass. (At least here in AZ)

hey howz the scope of practice in arizona.

When they say, muscles & tendons in leg affecting the function of foot. What kind of ailments or conditions we are talking abt. We had Fundamentals of Podiatry class this quarter and as far as i remmber we never had any lecture dealing with above ankle conditions. can you give any info.

 

[SportPOD]

hey howz the scope of practice in arizona.

When they say, muscles & tendons in leg affecting the function of foot. What kind of ailments or conditions we are talking abt. We had Fundamentals of Podiatry class this quarter and as far as i remmber we never had any lecture dealing with above ankle conditions. can you give any info.

Allowed to do ankles, but cannot do amputations (go figure). There are people putting on complex frames on the foot, ankle and leg, but we're refrained from amputating a 5th toe.

Achilles tendon lengthening, tendon transfers those deal with muscles and tendons originating from the leg.

 

[krabmas]

Allowed to do ankles, but cannot do amputations (go figure). There are people putting on complex frames on the foot, ankle and leg, but we're refrained from amputating a 5th toe.

Achilles tendon lengthening, tendon transfers those deal with muscles and tendons originating from the leg.

So if a DM patient comes in with gas gangrene and foot pussing out and you go do the I & D and woops - the 5th toe and some other fall off in the process... what happens then?

And for a scheduled case - can it be called a radical debridement?

 

[jonwill]

Allowed to do ankles, but cannot do amputations (go figure). There are people putting on complex frames on the foot, ankle and leg, but we're refrained from amputating a 5th toe.

Achilles tendon lengthening, tendon transfers those deal with muscles and tendons originating from the leg.

I was told by a few of my friends that are residents in AZ that they do amputations as "radical debrides". Just hurry up and change the law you lazy slackers!!!

On the other hand, if I ever have to do another amp, it will be too soon. My latest was an open lis franc I did last Friday night. We took it back this week and closed with a choparts.

 

[IlizaRob]

I was told by a few of my friends that are residents in AZ that they do amputations as "radical debrides". Just hurry up and change the law you lazy slackers!!!

On the other hand, if I ever have to do another amp, it will be too soon. My latest was an open lis franc I did last Friday night. We took it back this week and closed with a choparts.

EBM literature shows radical debridements work, but amps dont. Thats why we dont amputate in AZ.

 

[jonwill]

EBM literature shows radical debridements work, but amps dont. Thats why we dont amputate in AZ.

Amps work fine on patients that aren't uncontrolled diabetics with ESRD, neuropathy, and PVD.

 

[cool_vkb]

what do they do with the amputated parts? i mean how is it disposed or buried or what?

 

[SportPOD]

what do they do with the amputated parts? i mean how is it disposed or buried or what?

Ever find Jimmy Hoffa??

 

[NatCh]

what do they do with the amputated parts? i mean how is it disposed or buried or what?

I flush them down the toilet...

They're sent to Pathology, then to the incinerator in the basement of the hospital.

 

[IlizaRob]

what do they do with the amputated parts? i mean how is it disposed or buried or what?

I heard Jonwill makes necklaces out of the toes he amputates. And he always makes sure he wears the Chopart amp necklace when he goes clubin'. Bling, bling.

 

[krabmas]

I heard Jonwill makes necklaces out of the toes he amputates. And he always makes sure he wears the Chopart amp necklace when he goes clubin'. Bling, bling.

I send them to the taxedermist then cudle with them at night. You know they say that all DPMs have foot fettishes.

 

[dpmPOD]

You know they say that all DPMs have foot fettishes.

awwww yea

 

[jonwill]

I heard Jonwill makes necklaces out of the toes he amputates. And he always makes sure he wears the Chopart amp necklace when he goes clubin'. Bling, bling.

You know I'm all bout the BLING

 

[ProZackMI]

Come on, it's Texas...don't be offended by what they say there. You have 49 other states to practice medicine, screw Texas.

Here is something interesting that I came across the PM News in my email box.

Texas Appeals Court Overturns Scope of Practice Definition

Although the Texas Podiatric Medical Association (TPMA) and the Texas State Board of Podiatric Medical Examiners were initially successful in defending the ankle as being within the scope of practice, they were handed a setback on Friday as the Texas Court of Appeals reversed the lower court’s decision.

In their decision the Court said “The statutory authority currently in place limits podiatrists to the treatment of ‘the foot.’ While it may be difficult to define that term for purposes of treatment, whatever the term means, it is clear that "the foot" does not include the full portion of the body included within the definition in the Rule. Compelling arguments might be made as to whether--from a medical standpoint--it is reasonable to allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot. This is a debate to be had at the legislature.”

A gloating Texas Medical Association (TMA) President William W. Hinchey, MD commented “I’m glad the appeals court recognizes that the proper medical care of patients is too important to be left to people who are not adequately trained to perform certain medical procedures. If people wish to practice medicine, they should attend and complete medical school.”

Read the decision at: http://www.3rdcoa.courts.state.tx.us/opinions/HTMLopinion.asp?OpinionID=16620

 

[OSUDDS]

Come on, it's Texas...don't be offended by what they say there. You have 49 other states to practice medicine, screw Texas.

i dont really agree with your opinion

 

[ProZackMI]

i dont really agree with your opinion

1. You could state why.
2. I don't care.
3. I thought DDS meant Doctor of DENTAL surgery, not Podiatric Medicine.

 

[OSUDDS]

1. You could state why.
2. I don't care.
3. I thought DDS meant Doctor of DENTAL surgery, not Podiatric Medicine.

1. why should we lose the ability to practice as we want in a certain state? and whats would stop the other 49 from doing the same? theres no sense in just letting things slide
2. I dont care
3. did you figure that out yourself? you must be very bright
4. why dont you stay in your forum of expertise?
kthxbai

 

[dpmPOD]

1. why should we lose the ability to practice as we want in a certain state? and whats would stop the other 49 from doing the same? theres no sense in just letting things slide
2. I dont care
3. did you figure that out yourself? you must be very bright
4. why dont you stay in your forum of expertise?
kthxbai

I think you're overreacting. I don't think ProZackMi meant anything negative by that comment and I think that you're taking him far too literally. From what I've seen from his posts in other forums he's got no problem with podiatry, and actually holds it in a very positive light compared to some MD's on here. I'd also call him pretty bright--he has a JD and an MD and really there's no reason to attempt to belittle his intelligence. There is no need to provoke a flamewar.

 

[OSUDDS]

I know what degrees he has and I know he's very full of himself. However, I do not think he is the expert on every topic on SDN, despite what he thinks. All, I ask is for him to post on topics where he may be able to knowledgeably add his opinion.
/discussion

 

[Dr. Gangrene]

Can't we all just get along (insert sigh here).

 

[cool_vkb]

he has a JD and an MD and really there's no reason to attempt to belittle his intelligence. There is no need to provoke a flamewar.

Guys seriously, the Dr has a MD & a JD (as said by dpmPOD) . dont be rude to him. With all those degrees imagine how busy he must be yet he takes out time from his precious freetime to come on SDN and that too on Podiatry forums and englightens us on these topics. Common guys we all have to be very greatfull to him

 

[cool_vkb]

I know what degrees he has and I know he's very full of himself. However, I do not think he is the expert on every topic on SDN, despite what he thinks. All, I ask is for him to post on topics where he may be able to knowledgeably add his opinion.
/discussion

halle looya! This is not pre-pod forum where we are giving lecture on Pod-101 class and everyone is invited. This is residency & physicians forum. Let people like jonwill,krabmas, (residents) or natch,sportspod (attendings) etc be the experts here.

 

[dpmPOD]

Guys seriously, the Dr has a MD & a JD (as said by dpmPOD) . dont be rude to him. With all those degrees imagine how busy he must be yet he takes out time from his precious freetime to come on SDN and that too on Podiatry forums and englightens us on these topics. Common guys we all have to be very greatfull to him

I don't see how he was attempting to "enlighten" anyone with his remark.

halle looya! This is not pre-pod forum where we are giving lecture on Pod-101 class and everyone is invited. This is residency & physicians forum. Let people like jonwill,krabmas, (residents) or natch,sportspod (attendings) etc be the experts here.

By your logic here, podiatric residents and physicians shoulden't post on other physician forums as "they're not the experts" on non-podiatry related topics. Seems a little silly to me

 

[cool_vkb]

By your logic here, podiatric residents and physicians shoulden't post on other physician forums as "they're not the experts" on non-podiatry related topics. Seems a little silly to me

And when was the last time you found our DPM attendings or studnets poking their noses in Optometry law suit discussions or Nurse anesthesia debates between Pre-MD, MD and CRNA students, or ever found a DPM student going to DO forum and writing provocative statement.

Take a look at our forums. One controversial post and we have all tommies, dickies, harries running to write oh how we should be patient, oh how we should do this and that or how we should adhere to our basic scope and all crap. Man! we got our own specialists we are happy with them.

yeah if its a general discussion like the ones "What kind of medications DPM can prescribe" and a Dpharm jumps in to give his perspective , its totally welcome. But some MD/JD coming and advising us to "LET IT GO, there are 49 states" and our pre-pods (who kind of hold the future of this profession) are defending them. Hmmm! Now thats really silly and worrysome!

 

[TXDPM10]

Come on, it's Texas...don't be offended by what they say there. You have 49 other states to practice medicine, screw Texas.

As a practicing podiatric foot and ankle surgeon in Texas, I would like to assure everyone that the sky is not falling. The latest appeal won by the opposition is flawed in many ways and is being addressed in the courts. Re-hearing and Texas Supreme Court appeals may be necessary.

We have, in fact, been treating the ankle in Texas for over 30 years. Remember, scope issues may seem like surgical turf wars but our opponents would like to limit us to the talus and below...for everything. No ankle xrays, no ankle sprain treatment, no venous ulcers around the ankle, etc. And if our esteemed colleague from Michigan truly believes what happens in Texas has no bearing on the rest of the country, think again pal. Turf battles for scope are being prepared by foot and ankle orthopods anywhere possible base on the outcome in Texas. So using a version of the NIMBY strategy would be quite foolish indeed. For our Michigan colleague that's Not In My Back Yard.

We will prevail in retaining our scope. Because that is what we are fighting for. We have been accused of attemptng to expand our scope by Board Rule but this is TMA/TOA spin, pure and simple. My privilege lists have not changed in 9 years of practice (other than bringing some of my facilities up to speed with 21st century podiatric medicine and surgery).

So to recap...

Podiatric Medicine in Texas - alive and well.
Scope of Practice Litigation - ongoing

I have an Ilizarov ankle fusion and ankle scope on the books for this week but that pales in comparison to the ankle sprains, PTTD, Achilles injuries, ankle OA, gout, RA and every other joint ailment that can affect the talocrural joint that I may treat this week. Superior foot and ankle care will continue to be provided by Texas pods.

 

[IlizaRob]

I have an Ilizarov ankle fusion

You have one of my fusions?

I highly doubt much will change in Texas either considering the history.