The Victories The APMA Won In 2018 And The Battles To Come

The end of the year is a time for reflection and thanksgiving. The year 2018 was an extraordinary year for the American Podiatric Medical Association (APMA) and the podiatric profession. The amount of money APMA either made or saved DPMs this year alone was substantial. Most importantly, APMA lived up to its mission statement: “APMA advances and advocates for the specialty of podiatric medicine and surgery for the benefit of its members and the health of the public.”¹ However, key APMA victories have gone without due celebration.

Recall that the proposed Centers for Medicare and Medicaid Services (CMS) rule changing certification requirements for podiatric physicians furnishing and fabricating prosthetics and custom orthotics was withdrawn due to the advocacy efforts of APMA and a targeted member-driven grassroots campaign in 2017. Yet, the awareness of this victory is underwhelming. If this proposed rule was had been implemented, podiatric physicians would not have been able to dispense orthotics and prosthetics to Medicare patients until the creation of a pathway.

Currently, for physicians, no pathway exists for certification from the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) or the  Board for Orthotist/Prosthetist Certification International, Inc. (BOC).  If a path for certification were to be established, the certification expense would be $2,000.

Thankfully, looking at the top ten Durable Medical Equipment (DME) codes according to 2016 Medicare Part B Annual Data (BMAD) data, podiatric physicians as a whole still earn more than $100 million because they are not impeded by this certification requirement.

Furthermore, the 2019 Medicare Physician Fee Schedule final rule regarding podiatry-specific evaluation and management (E/M) codes may be the single most significant win for the podiatric profession to this date. Simply speaking, the victory signifies a successful grassroots campaign in which more than 11,000 individuals commented on the proposed rule (including 6,400 DPMs, 1,500 podiatric students and 3,100 non-DPM allies).

Additionally, the outstanding efforts of the New York State Podiatric Medical Association (NYSPMA), led by NYSPMA President Paul Liswood, DPM, demonstrates how podiatry’s central role in population health combined with APMA’s multifaceted campaign led to a historic outcome.^2,3 Beforehand, DPMs were facing a 4 percent reduction in E/M reimbursement. However, for 2019, DPMs are expected to receive a 2 percent increase (6 percent total change). Assuming the average podiatrist bills about $125,000 for Medicare part B, this would represent a savings of about $7,500 on average due to the APMA’s efforts.

On another note, the APMA registry allows members to submit attestations promoting interoperability and clinical practice improvement activity components of the Merit-based Incentive Payment System (MIPS) for the 2018 performance year. Additionally, registry participants can use the member-exclusive APMA MIPS app to complete their quality measure attestations for 2018.⁴ Registries typically charge $300 to $600 to submit to CMS but this submission is free for members using the APMA registry. Additionally, the APMA MIPS app is a $399 value that is free to APMA members.

Finally, recall that Anthem rescinded its proposal to reduce reimbursement significantly for E/M services billed with a 25 modifier. This success was due to the coordinated efforts by the APMA, the California Podiatric Medical Association (led by Franklin Kase, DPM, Chair of the CPMA’s Health Policy Committee), American Academy of Orthopaedic Surgeons, American Academy of Dermatology, American Medical Association, and other specialties.⁵ It is estimated this landmark victory alone saved DPMs over $100 million per year.

The APMA is working diligently to provide value for its members going into 2019 with exciting, innovative ideas. The APMA will be launching a podiatry-specific electronic health record (EHR) for members of APMA members. The EHR will be developed with the podiatrist in mind and fully integrated into the APMA Registry and MIPS app. Although there will be a cost associated with the EHR, it will be competitively priced. Fundamentally, the data gathered from the registry will be critical to demonstrate podiatry’s value to the healthcare system.

Here is the thing: thinking the E/M proposed rule by CMS is an outlier is naïve. The E/M proposed rule was the CMS’s opening salvo. More challenges and direct attacks are coming coming for the profession. Whom do you want protecting your career, your bottom line, and your profession? As a result, are you okay with colleagues not paying their fair share when battles must be fought while they are benefitting from the victories?

No organization protects the profession like APMA. Podiatry is a small profession. We are stronger together. It is no longer acceptable for non-members to benefit from the hard work of APMA members. Not being a member of APMA can no longer be tolerated. If you are a member, thank you. The profession needs more from you and will reward you favorably. However, you must seek out your colleagues who are not members and convince them that they weaken the profession by sitting on the sidelines.

If you are not a member, the profession, your career, and your bottom line require your membership and participation. Do it now by clicking https://www.apma.org/applications/Forms/FormDisplay.aspx?FormID=75732

Dr. DeHeer is a Trustee on the APMA Board.

References

1. American Podiatric Medical Association. Available at https://www.apma.org/AboutUs/content.cfm?ItemNumber=1211 .
2. American Podiatric Medical Association. Victory on E/M/ codes: Medicare physician fee schedule final rule released. Available at https://www.apma.org/News/NewsDetail.cfm?ItemNumber=31879 . Published Nov. 1, 2018.
3. New York Foot Health. Available at https://www.nyfoothealth.com/nyspma .
4. American Podiatric Medical Association. Available at https://www.apma.org/PracticingDPMs/content.cfm?ItemNumber=24999& .
5. American Podiatric Medical Association. Anthem’s proposed reduction to Modifier 25 rescinded fully. Available at https://www.apma.org/News/NewsDetail.cfm?ItemNumber=29217& .