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Should Podiatrist Prescribe & Provide Foot Orthoses?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Graham, Nov 23, 2009.

  1. Graham

    Graham RIP

    Members do not see these Ads. Sign Up.
    The Canadian Pedorthic Association is lobbying the Insurance and benefit providers in Canada to remove Podiatrists from their "provider" lists, as they perceive the current Prescriber/Provider staus as a conflict of interest and suggest that they, as the biomechanical and orthotic specialists of Canada, should be the preferred providers of foot orthoses.

    What say you?
  2. Craig Payne

    Craig Payne Moderator

    How do you think any rational government will react when one profession goes to them to ask that restrictions be placed on another profession when that profession will benefit from the lack of competition?

    Where is the public benefit for what the CPA are claiming?
  3. Graham

    Graham RIP

    From teh pedorthic Association of Canada:

    Controlling Foot Care Benefit Costs in Canada:
    An Open Letter to Insurers and other Third Party Payers

    The Pedorthic Association of Canada (PAC) shares your concerns regarding the escalating use of
    this benefit, the increased costs incurred by plan sponsors and the inconsistent quality of foot
    care that your clients receive. It is our perspective that the increasing use of footcare benefits by
    subscribers has been strongly influenced by two major factors:

    • an influx of non certified footcare providers who see financial benefit in providing foot care
    products; and,

    the lack of an independent gatekeeper to ensure the medical necessity of care, complicated by
    the fact that some prescribers are also service providers.

    PAC recognizes the need to ensure quality of care, optimal standards and evaluation of practice
    and cost control. It is our position that:

    • treatment should be reimbursed only if the care is provided by a recognized foot care specialist
    • separation of the provider / prescriber relationship is critical in eliminating conflict of interest
    • primary care and specialist physicians, trained in full body diseases, should be the
    prescribing/referring agents as they are best able to:

    • provide appropriate differential diagnoses
    • rule out global pathologies
    • determine if pharmacological, diagnostic or rehabilitative recommendations are
    • determine whether orthotics are a reasonable medical expense based on the clinical
    evidence and an holistic consideration of the clinical findings
    • pedorthists effectively assist physicians, through physical and biomechanical
    evaluation, to confirm the need for orthotics and determine the amount and type of
    correction and/or accommodation required

    E-mail: info@pedorthic.ca
  4. Graham

    Graham RIP

    More from the Pedorthic Association of Canada:

  5. Craig Payne

    Craig Payne Moderator

    They just want the law changed so they can get more business and have less competition. As less competition does not benefit the consumer, the government should be laughing at them.
  6. joejared

    joejared Active Member

    What? A podiatrist can't wear two hats? Wait, it's really one hat. Podiatrist serves patient. Where's a used cow food pile icon when we need one anyway?
  7. efuller

    efuller MVP

    There are a couple of insurance companies around here who require that the orthotics be sent out to a third party who has contracted with the insurance company. So, when the podiatrist thinks that a patient needs orthotics they have little control over how they are made. (Although I've been tempted to write a very very detailed order and send it back for them to remake when it doesn't fit every detail of the order.)

    The real problem with the pedorthist making the orthotic is the hassle that the patient has when the orthotic needs an adjustment. There is an inherent conflict on who is responsible for adjusting the orthotic.

    It appears that the CPA is claiming that they are better at making devices than podiatrists. Is the pedorthic training in Canada longer than the two weeks that is here in the states?


  8. Grover

    Grover Member

    I've always found the term "Prescription" to be a loaded word.
    Most of the time in the orthotic world I find the term is used as "I give you permission to have orthotics". In fact many a person sees me with their GPs Rx saying "orthotics" or if I'm lucky "Pes Planus, Orthotics" . I give much more info so their insurance plan will cover it.

    To me Prescribing an orthotic has types of plastics/coverings/accommodations, lengths/widths/depths, oh yeah and maybe some angles so the device will do what I want it to do.

    The problem is that if I give a detailed Rx that includes a Suspension plaster cast and the unregulated "Pedorthists" uses The Orthotic Group 2D Gait Scan mat instead and gives a library system insole (with a lovely met pad I'm sure) I have no quality control. I want my mistakes to be mine not some Kinesiologist with a one year post grad program in Manufacturing devices.

    The problem is that dispensing pays better that only prescribing (us) or only manufacturing (them). The way the system works in this part of the world taking dispensing orthotics away from Podiatrists/Chiropodists would potentially bankrupt many a practitioner

    Peter Grover Greaves D.Ch.
  9. Bennepod

    Bennepod Active Member

    Perhaps it is time to introduce the "lab only fee" foot orthoses. The prescriber "podiatrist" would charge seperately for the assessment, casting etc. This way there would be a clear difference between the $300.00 device from a Podiatrist who is providing diagnostics and rx., with the device and the Pedorthist who for the same price is providing just a device.
  10. bpod

    bpod Active Member

    Interestingly some insurance providers are now requiring a podiatrist or an orthopedic surgeons prescription and gait analysis ONLY for reimbursement. The general MDs script is no longer sufficient. You can bet the pedorthists don't like that. Many of the pedorthists that work around here don't require referrals to be seen and then ask the family doctor to do a script after they have cast for an orthotic....how are the insurance providers going to stop that from happening? How are pedorthists qualified to do a general health exam, biomechanical exam, diagnose AND physically make the device? As far as I can see they want what we have. The MDs don't have the time or as most would admit I think, the expertise to do a quality biomechanical exam and diagnosis.:wacko:

    Sue Davidge
  11. Mart

    Mart Well-Known Member

    Interesting to learn about this Graham. In Manitoba there is currently a major overhaul of health care providers legislation which includes the "Reserved Acts" eg restriction of acts which can be performed on the public to protect their safety.

    The issue of foot orthoses use/prescription was broached and rejected as a reserved act on grounds of there being insufficient sciemtific evidence to harm, which seems reasonable.

    I think that the insurers are likely to be less concerned about harm and more concerned regarding conflict of interest, ie if and how the prescriber benefits from the presciption financially. If this is true then there would need to be consistency in how the chain of profit works. If we consider eyeglass and dental prescription as far as I understand things the presciber may have legally vested intersted in profitting from the prescription.

    I think that Craig is right that; a rational responce from the insurers would reject the notion of restrictive coverage but perhaps we should not assume a reasonable responce. It seems quite a predatory initiative from the pedorthists and I feel that a well informed premtive review of the implications for the success of this is warrented and I presume is your intent with this post.

    Taking the moral high ground:how do we as prescribers deal with concerns regarding profit from prescription, or is that irrelevant? My optometrist has a retail outlet associated with the diagnostic facility. I am informed - here is your prescription you can fill it here or go elsewhere. My dentist bills for the lab fee for my crown in the same way that most practionsers bill for their foot orthoses. So there is no difference on the surface as far as I am aware.

    Is there any discussion from the podiatrist community in Ontario on this issue or is it wait and see?



    The St. James Foot Clinic
    1749 Portage Ave.
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
  12. Graham

    Graham RIP


    I know the Ontario society of chiropodists is active with this. I'm not sure about the Podiatry Association in Ontario though.

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