In August 2011 our regional version of Medicare made significant changes in how podiatry is practiced.  Unfortunately, in my opinion, it is not for the better and I feel obligated to try to explain it to my patients because there is much confusion surrounding the changes.  Before I get started I want to say that these changes affect any professional that provides these services and, in fact, there are many more Medicare changes that are directed at other physicians that I am not discussing today.

In a nutshell, Medicare, in our region, no longer allows the debridement (reduction in thickness and length) of painful mycotic (fungal) toenails for otherwise healthy patients.   They now require a patient to have a qualifying medical disease (list available in my office) for a patient to receive this treatment.  Medicare has provided a list that reasonably contains diabetes, peripheral vascular disease, neuropathies, etc.  I agree that these patients desperately need this care but I disagree that they are the only ones that need it.  From the beginning of my podiatric career a patient could have their toenails debrided and their fungus treated if they were painful or limited a patient’s ability to ambulate.

I believe this is a significant change in policy for Medicare.  Before this change… pain was enough to qualify for care and now pain is not enough.  In my opinion, pain is not normal and requires attention that is often medical.

Additionally, Medicare has decided to reduce how often a qualifying patient may have their toenails cared for.  If I remember correctly, when I began practice thirteen years ago a patient with painful fungal toenails could have them debrided every nine weeks.  Then Medicare changed the frequency to every twelve weeks.  Now the frequency has been changed, per my best understanding, to six times every two years, or basically every four months!  Basically, the highest risk patients must wait four months to get care that may help them avoid infections, ulcerations and amputations.  During a phone call, I asked the Medicare representative if she would please wait four months to trim her own toenails so she could see if this was reasonable and she said there was no way she could do that?  It bothers me that she realizes that her, likely, low risk feet need more care than what Medicare is willing to provide for high risk feet.

If you are a patient of mine and have Medicare, please know that foot pain is not normal and please come and see me.  Yes we are still accepting Medicare and we want to help you.  Please know that most of the time your care is covered and if it is not we will discuss this with you so there are no surprises.  We want to be your foot care specialist.

Please know that to my best understanding this change is currently regional so not all podiatrists are affected, yet.  Typically these changes are “test driven” in a region and then many times if “successful” in lowering costs they are made nationwide.  I see these changes as a bit insidious because our patients are often told their services are not being cut by Medicare but in fact they are being cut for some on Medicare.  Sure the treatment is still available….but only for a more restricted list of patients and on a much more restricted schedule.

Sure, debridement of my patient’s toenails sounds like a small fish in the big ocean of healthcare. I recognize that.  However, small fish like these are schooling in every medical specialty and that should concern us.