Podiatrists have their foot in the door

Introduction

A disproportionate number of those receiving the first batch of incentive payments to install electronic health records are podiatrists, an iWatch News analysis suggests.

Of the 188 different practices and chains that received the first batch of payments in May, 23 were podiatry practices, or about 12 percent — even though podiatrists make up only about 1.5 percent of Medicare physicians and practitioners.

Those numbers are no accident, according to Dr. James Christina, himself a doctor of podiatric medicine and director of scientific affairs for the American Podiatric Medical Association (APMA), the national trade association for podiatrists.

The APMA, Christina noted, has made a “very directed effort” to educate its members about both health information technology generally and how to meet requirements that providers demonstrate “meaningful use” of health IT in order to receive the incentive payments. “These efforts have included webinars, online resources on our website, live lecture presentations at regional and national meetings, and regular e-news type communications.”

Indeed, were it not for the APMA’s efforts, podiatrists might not even have been made eligible under the program. Several types of medical providers — including many behavioral health providers, rural health centers and home-care practitioners — were left out of the HITECH incentive payments. Thanks in part to lobbying by APMA — the group reported spending at least $45,000 to ensure “HIT Incentives for non-MD/DO physicians” and other issues in the first quarter of 2009 — podiatrists were ultimately included among the ranks of the eligible. The APMA has been “very active commenting on proposed rules from CMS, participating in the development and implementation of quality measures, and making sure through the legislative process that podiatrists were included as eligible providers,” Christina said.

In May, the Centers for Medicare & Medicaid Services (CMS) released a list of the first 320 recipients of “meaningful use” incentive payments under Medicare. At least 25 of those were doctors of podiatric medicine, nearly 8 percent. Several payments went to multiple doctors in the same practices and multiple hospitals in the same system. Of the 188 different practices and hospital chains receiving payments, 23 were podiatry practices, or about 12 percent. Joe Kuchler, a CMS spokesman, told iWatch News that podiatrists make up about 15,500 of the roughly 1,022,900 Medicare participating and non-participating physicians and practitioners — only about 1.5 percent.

iWatch News attempted to reach all 25 providers to ask them about the software they are using. Seven practices responded. Of those seven, three said they are using TRAKnet PM – DPM Edition by BioMedix (electronic medical recordkeeping software specifically tailored to podiatrists) and two were using software by MedLink.

Five of the seven indicated that they had installed the system in the time since enactment of the HITECH act in 2009. While part of the legislation’s intent is to provide incentives to encourage new providers to adopt electronic medical recordkeeping, it also allows for incentive payments to those who already had systems in place prior to the bill’s passage. About half of the 55 non-podiatrist providers and facilities who responded to iWatch News inquiries were receiving repayment for software they had already installed prior to the HITECH Act.

For Dr. Laura Pickard, a podiatrist who practices in Chicago, the Medicare incentive payments were “definitely the factor” that caused her to switch from print to electronic health records. She installed the technology in mid-November 2010, she said, and collected patient data for 90 days, as is required in HITECH, to show she was practicing “meaningful use” and should qualify for the stimulus payments.

She was among those who received the first round of payments, and says that although she is still adapting to the technology — causing her patients to have longer waits — her practice has benefitted overall. “I am more acutely aware of all of their health issues [and] medications,” she told iWatch News. “For diabetics I can keep a closer eye on them to help better manage their diabetes and potential complications.”

Some in the medical community are not thrilled to see the podiatrists reaping benefits of HITECH that are not available to some other practitioners. Behavioral health providers, a group not eligible to receive incentive payments for health information technology, say the inclusion of podiatrists reveals the program’s unfairness of excluding all “non-acute providers.” The behavioral health designation includes clinical psychologists, clinical social workers, psychiatric hospitals, substance abuse treatment centers, mental health treatment centers.

During the fast-moving stimulus negotiations, behavioral health advocates focused their lobbying efforts on privacy issues, only to discover once the stimulus was released they were excluded from being eligible to receive incentive payments.

“Had we been given the opportunity, I think we could have said that our patients are as acute and bring as severe medical problems as podiatry patients,” said Al Guida, a lobbyist for behavioral health interests. “A psychiatric crisis is life threatening. I’m not aware of any podiatric conditions that will lead to your demise.”

Dr. David Kibbe, a physician and senior adviser for the American Academy of Family Physicians, said the organization of workflows by podiatrists has always impressed him. “It may well be that the single greatest reason for such high adoption is that podiatrists have their act together,” he said.

He also noted that podiatrists might have an easier time meeting “meaningful use” objectives because they have limitations on the types of procedures they do. For example, “meaningful use” has different lists doctors must fill out for vaccinations, prenatal care and blood pressure.

“The reason could be that podiatrists don’t do a lot of things that are in the objectives, and therefore they can exempt themselves from having to fulfill some of the requirements,” he said.

Not so, says Christina of the APMA. “All eligible providers have the option to report zeros or exclusions where applicable,” he noted. “I do not think being able to report zeros on some quality measures makes qualifying for ‘meaningful use’ any easier.”