Reimbursment for "advanced" gait analysis

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I just had a conversation with a colleague in the context of the use of the in-shoe f-scan plantar pressure system in complex cases and reimbursement from third parties such as Workcover and DVA when there is no actual reimbursement code for this.

In the cases discussed, there is probably no doubt that a positive outcome in these complex cases was achieved due to this advanced gait analysis altering the foot orthotic prescription in such a way that would it not have happened without the testing.

What do others do for reimbursement in these sorts of cases?

Is an item number needed to cover this? (and yes I do know the pressure to reduce the number of item numbers).

 

Yes.

I have asked our (WA) council representative involved with private health insurance company liason to request this from WAs largest company HBF. Apparently it is very unlikely to happen.

It seems ridiculous that there is no item number for this.

Rebecca

 

Hi Craig

Interesting and topical question for me, I am just about to attempt negotiation for the same here. One issue I am wresting with my mind is of quality assurance of provider. I am unaware of any accepted form of accredition for using these tools but squirm at what I see from some others touting as legitimate diagnostic approach; red means bad therefore justifies non nondescript foot orthoses.

My sense is that like other emerging techniques eg US, the insurance companies ideally would be provided with legitimate reassurance regarding competency.

The only thing I can think of currently is using MSc module as index of competence and by inference privilege for coverage.

Whilst this might be argued as unnecessary, elitist or inadequate I'd be curious for your thoughts on this.

Cheers

Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

 

Mart,

Good day old friend! This makes a lot of sense. Perhaps CFPM would take this up nationally.

 

Hi Buddy

Now you know me better than trying to get me embroiled in Ontario Politics.

We should have a chat by phone and catch up, I figured that you has earned so much that you had retired to the life of a gentleman farmer.

:drinks

banjoboy!

 

I guess this could be said for any item which some believe is a step forward, but if you think about it it would also require a form of further education.

say there was an item number and I ordered an F-scan got a patient to walk on it charge the health insurance company without having any understanding on what all the measurments mean.

So maybe the 1st step is a Uni backed education program and then go with that and evidence to the health companies after explaining why the tool provides better tx and diagnosis and why this will save them money in the future. Which is really the only reason they will pay you more.

just my thoughts

 

If you read podarena threads which have looked at interpretation of gait data and published studies which examine the accuracy and benefits of gait studies they show a picture of complexity and questionable benefits. So as a generalization the insurance companies may be justified in disregarding the whole affair.

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=37080


I don't believe this is justified unless the same values are applied to everything that is insured and much of what is done falls into the same situation. Look at evidence base for treatment of plantar heel pain and plantar digital neuritis which have been discussed on this forum not just by podiatrists but other healthcare providers.

My feeling, which is also self serving, is that the current level of evidence for much of what is done shifts, and perhaps is never going to be ideal simply because the "truth" is too complex to be able to make valid generalisations for every problem.

The next best thing perhaps is that practitioners are able to demonstrate not simply a level of "technical" awareness, AKA "skill competencies" but also the capacity to apply an established approach to critical thinking.

The existing MSc medicine and surgery programs in the UK do this. I am not an educator so please correct me Craig or whoever but I do not see this capacity in most undergrads I talk to. There seems to be a notion that if a course is good it will teach you most of the skills you need to know and then you go and do them. Much of what we do unless you just cut toenails and callouses demands rigorous critical thinking to do well and I believe an approach to this was lacking in my basic eduction 25 years ago, and this also seems to be true of many of my colleagues who I talk to about how they practice.

A course which looks at gait examination technology, interpretation, and necessary critical thought process exists in the mechanics segment of the MSc program I have taken. I am not an expert in "gait analysis" for doing this and it did little to test specific skill competency to use in-shoe pressure measurement. However it was a peer reviewed process which tested my capacity to think clearly and it examined basic understanding of of kinetic and kinematic measurement.

If I meet resistance from insurers I will develop these arguments and see what happens.

cheers

Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com