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Strong Bipartisan & Outside Support Strong en has physicians podiatric to access patient for barriers Removing It and in one of the major mark of the Deficit Reduction Act of 2005 group in 2009. It is also supported by a diverse proposals health reform Asso stakeholders including the American Osteopathic of health-care Cost an estimate of the bill (CBO) provided Budget Office The Congressional since the assump- must be revisited the estimate in 2009. However, was $200 estimate tions used at the time have changed. The previous that would result million over ten years, but did not examine savings of low the avoidance of unnecessary hospitalization or prevention from joyed strong bipartisan support in Congress, with bill language previ with bill language bipartisan support in Congress, joyed strong ously garnering and 220 House cosponsors. 32 Senate cosponsors ciation and the American Public Health Association. expanded Medicaid- amputations and assumed a greatly er extremity eligible population. and for diabetic foot ulcers range between $7,439 costs Treatment a limb amputation are $20,622 per episode. Estimated costs for over a lifetime. The po $70,434, and can cost as much as $500,000 access to podiatrictential and very significant cost savings of ensuring Medic system—including of the health care physicians in all sectors aid—cannot be disregarded.

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for the Medicaid program—for save lives, limbs, and money for the Medicaid program—for trist prior to a foot ulcer diagnosis had a had diagnosis ulcer foot a to prior trist lower risk of hospitalization of amputation and a 26-percent than those not seen by a podiatrist; • Patients 9312 Old Georgetown Road, Bethesda, MD 20814, 301-581-9200, 9312 Old Georgetown with questions. Contact [email protected] www.apma.org. Prepared by the American Podiatric Medical Association, by the Prepared Columbia, but it is not always covered when provided by a Doctor of by provided when always covered is not but it Columbia, limits Medicaid beneficiaries’ law effectively Podiatric Medicine. Current by podiatrists provided services cost-effective access to the quality, medical professional and discriminates against the type of licensed Medicaid patients might see for foot and ankle care. The Equity and Access for Podiatric Physicians Under Medicaid Act would per both states and the federal government. A higher-than-average Background as is covered care Essential medical and surgical foot and ankle the District of in all 50 states and a benefit by Medicaid programs Thomson Reuters, which provides industry expertise and critical in- Thomson Reuters, which provides accounting, and tax legal, financial, in makers decision to formation year study (accessible at: conducted a three areas, and health-care ) that arrived at, among others, the following www.tinyurl.com/trstudy conclusions: sponsor “The Equity and Access for Podiatric Physicians Under Med Under Physicians for Podiatric Access “The Equity and sponsor (R-NE) and by U.S. Reps. Lee Terry introduced icaid Act,” soon to be (D-NY) and Schumer Charles Sens. and U.S. DeGette (D-CO), Diana Charles Grassley (R-IA). foot and ankle. of the cluding in most cases medical and surgical care by a provided physician is limited to care the definition of a However, as defined in 1861(r) medical doctor (MD) or doctor of osteopathy (DO) (1) of the Social Security Act (SSA). in Medicaid not specifically defined “Podiatric Services,” which are (Title by a Doctor of Po to mean services provided presumed XIX) but are that fact the despite optional, considered are (DPM), Medicine diatric the perform licensed to and trained, educated, are physicians podiatric Doctors of po services as MDs and DOs. same foot and ankle care [1861(r)(3), statute diatric medicine have been defined in the Medicare as provid covered than 40 years and are SSA] as physicians for more TRICARE, the including ers in nearly all other federal health programs, the Indian Health Service. and Health Administration (VA), Veterans related at risk for diabetes and centage of Medicaid beneficiaries are lower limb complications. Problem Medicaid (TitleThe current in XIX) statute covers physician services, The American Podiatric Medical Association (APMA) requests you co Medical Association (APMA) requests The American Podiatric Under Medicaid Act Medicaid Under Request The Equity and Access for Podiatric Physicians Physicians Podiatric Access for and The Equity The Majority of Foot/Ankle Care in the U.S. is Performed by Podiatric Physicians but Medicaid Patients May Not Have Access

- PODIATRI C PHYSICIAN ORTHOPEDI S T ALL OTHER s growing physician shortage s growing ease by driving patients to a more expen to a more ease by driving patients ISSUE BRIEF ISSUE sive point of service (e.g., hospital emergency rooms) (e.g., hospital emergency rooms) sive point of service for the same services. Costs incr It exacerbates America’ physi- utilizing the full range of by not appropriately cian specialists. the physicians It denies patients the option of seeing care best trained for the foot and ankle who are they seek.

1. 2. 3. Whenever public or private health insurance programs or private health insurance programs Whenever public are there physicians, podiatric to access patient preclude delivery system: our health-care adverse impacts on

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0 10 20 30 40 50 60 70 80 90 100% COMMON FOOT & ANKLE PROBLEMS TREATED BY PHYSICIANS PROBLEMS TREATED COMMON FOOT & ANKLE Bunion Surger y Amputation of Toe Ulcer Debridement Hammertoe Repai r Remove Ingr own Nail Repair Achilles T endon Ankle Fractur e Open Fi x Metatarsal Fractur e Open Fi x 9312 Old Georgetown Road, Bethesda, MD 20814, 301-581-9200, 9312 Old Georgetown with questions. Contact [email protected] www.apma.org. Prepared by the American Podiatric Medical Association, by the Prepared Source: Thomson Reuters Market Scan survey data for 2010 commercial health insurance claims commercial Thomson Reuters Market Scan survey data for 2010 Source: Even though foot and ankle care is generally a covered is generally a covered and ankle care Even though foot out teases currently benefit under Medicaid, the program “optional” for pa- a separate podiatry benefit as being rather than of services, tients, focusing on the provider regard care ensuring coverage of medically necessary Patients May Not Have Access Patients May issues, most Americans seek out For foot and ankle typically a Doctor of Podiat care, specialists for their The orthopedist, or other physician. ric Medicine, an of the foot and ankle is care majority of medical performed by podiatrists. furnishing such care. less of the qualified professional arbitrari discriminates and can Thus, Medicaid effectively patient access to a licensed and credentialed ly preclude the services they specialized physician class even though benefit. a covered and ankle care—are provide—foot Performed by Podiatric Physicians but Medicaid Medicaid but Physicians by Podiatric Performed The Majority of Foot/Ankle Care in the U.S. is the U.S. is in Care Foot/Ankle of The Majority The Congressional Budget Office (CBO) Should Revisit pre-PPACA Estimate ofThe Equity and Access for Podiatric Physicians Under Medicaid Act

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each $1 invested in care by a podiatrist re each $1 invested in care sults in $27 to $51 of savings for the health-care health-care sults in $27 to $51 of savings for the delivery system. ings of $19,686 per patient with diabetes can be re ings of $19,686 per patient with diabetes one least at is there if period three-year a over alized diabetic a preceding year the in podiatrist a to visit insur ulceration. Among patients with commercial ance, $4,271 per patient with diabetes can be realized can be realized $4,271 per patient with diabetes is at least one period if there over a three-year ulcer visit to a podiatrist in the year preceding patients, eligible Medicare Among ation. invested in care by a podiatrist results in $9 by a podiatrist results invested in care to $13 of savings. • Among • Among set of a foot ulcer. set of a foot ulcer. Conservatively projected, these per-patient numbers these per-patient Conservatively projected, support an estimated $10.5 billion in savings over sees a years if every at-risk patient with diabetes three the on preceding podiatrist at least one time in the year ling 2011 study conducted by Thomson Reuters Health ling 2011 study conducted Podiatric (published in the Journal of the American care Medical Association for patients with diabetes treated by podiatrists versus versus by podiatrists treated for patients with diabetes and physicians: professionals by other health care care , ------

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—The House leg . —which would define podia —which would define 150 percent of the Federal Poverty 150 percent of the Federal Poverty Affordable Health Care for America Act Affordable Health will reduce overall Medicaid spending by $289 will reduce Expansion population is smaller billion over 10 years. islation upon which the 2009 CBO estimate was estimate CBO 2009 the which upon islation to all in based called for the expansion of Medicaid women, pregnant dividuals under age 65 (children, with and adults without dependent children) parents, incomes up to Act (ACA) as enact Care Level (FPL). The Affordable Medicaid expansion ed into law stipulates a reduced only to 133 percent of FPL. based on the Expansion is optional—Additionally, Med that the statute’s ACA ruling Court’s Supreme states, for optional be must expansion program icaid that about 6 million fewer people will CBO projects in Medicaid. CBO believes the Court rul be enrolled ing • • Medical Care by Podiatric Physicians in the Treatment of Diabetic Foot by Podiatric Physicians in the Treatment Medical Care Ulcers,” Journal of the American Podiatric Medical Association 101 (2011): 93-115, accessible at: www.tinyurl.com/trstudy Ginger Carls et al., “The Economic Value of Specialized Lower-Extremity of Specialized Lower-Extremity Ginger Carls et al., “The Economic Value 9312 Old Georgetown Road, Bethesda, MD 20814, 301-581-9200, 9312 Old Georgetown with questions. Contact [email protected] www.apma.org. Prepared by the American Podiatric Medical Association, by the Prepared 1 CBO analysis should take into account that care by CBO analysis should take into account that care complications and thus saves a podiatrist prevents podiatric involve Savings from expenditures. future fect scoring assumptions. a compel- ment in Medicaid can be extrapolated from to recent changes to Medicaid coverage which would af changes to Medicaid coverage which to recent APMA believes the federal budgetary impact of defin of impact budgetary federal the believes APMA Physicians Under Medicaid Act Under Medicaid Act Physicians (CBO) scored Budget Office In 2009, the Congressional HR 3962, the impact budgetary a included estimate The introduced. as Physi Podiatric for Access and Equity of The analysis Act cians Under Medicaid under Medicaid—indicating as part trists as “physicians” to related the legislation that budgetary table of a larger federal spending by $200 podiatrists would increase million over 10 years. Medicaid would ing podiatrists as physicians under CBO analysis be significantly lower under a new The Equity and Access for Podiatric Podiatric Access for and of The Equity Estimate pre-PPACA The Congressional Budget Office (CBO) Should Revisit Revisit (CBO) Should Office Budget The Congressional ISSUE BRIEF

Fact Sheet: Studies Prove Podiatrists Prevent Complications, Provide Savings

According to the CDC, nearly 26 million Americans live visit to a podiatrist in the year preceding ulcer- with diabetes. Diabetes is the leading cause of non- ation. Among Medicare eligible patients, each $1 traumatic lower-limb amputation; however, amputa- invested in care by a podiatrist results in $9 to tions can be prevented. Two peer-reviewed published $13 of savings. studies evaluated care by podiatrists for patients with • Conservatively projected, these per-patient num- Fact Sheet: Studies Prove Podiatrists Prevent Complications, Provide Savings diabetes and demonstrated that compared to other bers support an estimated $10.5 billion in savings health-care professionals, podiatrists are best equipped over three years if every at-risk patient with dia- to treat lower extremity complications from diabe- betes sees a podiatrist at least one time in a year tes, prevent amputations, reduce hospitalizations and preceding the onset of an ulceration. provide savings to our health-care delivery systems.

Access to a Podiatrist Can Lead to Savings for Care by a Podiatrist Can Reduce the Risks and US Health-care Delivery Systems Prevent Complications from Diabetes

According to a study conducted by Thomson Reuters According to an independent study conducted by Duke 2 Healthcare (accessible at: www.tinyurl.com/trstudy) University published in Health Services Research : that compared outcomes of care for patients with diabetes treated by podiatrists vs. care provided • Medicare-eligible patients with diabetes were less by other health care professionals and physicians likely to experience a lower extremity amputation if a published in the Journal of the American Podiatric Medi- podiatrist was a member of the patient care team. cal Association1: • Patients with severe lower extremity complications who only saw a podiatrist experienced a lower risk • Among patients with commercial insurance, a of amputation compared with patients who did not savings of $19,686 per patient with diabetes can see a podiatrist. be realized over a three-year period if there is at • A multidisciplinary team approach that includes least one visit to a podiatrist in the year preceding podiatrists most effectively prevents complications a diabetic ulceration. Diabetic ulcerations are the from diabetes and reduces the risk of amputations. primary factor leading to lower extremity amputa- tions. Among patients with commercial insurance, each $1 invested in care by a podiatrist results in $27 to $51 of savings for the health-care delivery system. • Among Medicare-eligible patients, a savings of $4,271 per patient with diabetes can be realized over a three-year period if there is at least one

1 “The Economic Value of Specialized Lower-Extremity Medical Care by Podiatric Physicians in the Treatment of Diabetic Foot Ulcers”, Journal of the American Podiatric Medical Association, Vol. 101, No 2, March/April 2011.

2 Sloan, F. A., Feinglos, M. N. and Grossman, D. S. , RESEARCH ARTICLE: Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly. Health Services Research, no. doi: 10.1111/j.1475-6773.2010.01157.x

Prepared by the American Podiatric Medical Association, 9312 Old Georgetown Road, Bethesda, MD 20814, 301-581-9200, www.apma.org. Contact [email protected] with questions. Podiatric Medicine: Expertise in Foot and Ankle Care

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Part E—Miscellaneous Provisions

Social Security Act Title XVIII (Medicare) Definition of Physician

SEC. 1861. [42 U.S.C. 1395x] For purposes of this title—

(r) Physician The term “physician”, when used in connection with the performance of any function or action, means (1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action (including a physician within the meaning of section 1101 (a)(7) of this title), DPMs (2) a doctor of dental surgery or of dental medicine who is legally authorized to practice dentistry by the defined as State in which he performs such function and who is acting within the scope of his license when he “physicians” performs such functions, for more than (3) a doctor of podiatric medicine for the purposes of subsections (k), (m), (p)(1), and (s) of this 40 years section and sections 1814(a), 1832(a)(2)(F)(ii), and 1835 of this title but only with respect to (SSA §1861 (r)(3)); functions which he is legally authorized to perform as such by the State in which he performs Medicare them, access (4) a doctor of optometry, but only for purposes of subsection (p)(1) of this section and with respect to ensured the provision of items or services described in subsection (s) of this section which he is legally authorized to perform as a doctor of optometry by the State in which he performs them, or (5) a chiropractor who is licensed as such by the State …

Social Security Act Title XIX (Medicaid) Definition of Physician Services

SEC. 1905. [42 U.S.C. 1396d] For purposes of this title—

(a) The term "medical assistance" means payment of part or all of the cost of the following care and services…… (5) (A) physicians' services furnished by a physician (as defined in section 1861(r)(1)), whether furnished in the office, the patient's home, a hospital, or a nursing facility, or elsewhere, and (B) medical and surgical services furnished by a dentist (described in section 1861(r)(2)) to the extent such services may be performed under State law either by a doctor of medicine or by a doctor of dental surgery or dental medicine and would be described in clause (A) if furnished by a physician (as defined in section 1861(r)(1)); ……

DPMs not included in definition of “physician services.” Medicaid may deny patient access by teasing out separate “podiatry services,” even though specific care DPMs provide – foot and ankle care – is a covered benefit, and they are licensed by the state to provide independent medical and surgical care without any requirement for supervision or collaboration

MEMBERS OF 112th Congress NO LONGER SERVING Cosponsors: H.R. 3364 (88) and S. 1309 (8) The Equity & Access to Podiatric Physicians under Medicaid Act

ARKANSAS KENTUCKY NEW YORK (continued) Rep Mike Ross (D) (1) Rep Ben Chandler (D) (9) Rep Louise Slaughter (D) Rep Geoff Davis (R) (10) Rep Paul Tonko (D) CALIFORNIA Rep Brett Guthrie (R) Rep Edolphus Towns (D) (16) Rep Joe Baca (D) (2) Rep Hal Rogers (R) Rep Brian Bilbray (R) (3) Rep Ed Whitfield (R) NORTH CAROLINA Rep Judy Chu (D) Rep John Yarmuth (D) Rep Brad Miller (D) (17) Rep Anna Eshoo (D) Rep Bob Filner (D) (4) MAINE OKLAHOMA Rep (D) Rep Michael Michaud (D) Rep Dan Boren (D) (18) Rep Jerry McNerney (D) Rep Chellie Pingree (D) Rep Laura Richardson (D) (5) OREGON Rep Dana Rohrabacher (R) MARYLAND Rep Suzanne Bonamici (D) Rep Lucille Roybal-Allard (D) Sen Ben Cardin (D) Rep Earl Blumenauer (D) Rep Linda Sanchez (D) Sen Barbara Mikulski (D) Rep Peter DeFazio (D) Rep Adam Schiff (D) Rep Dutch Ruppersberger (D) Rep Kurt Schrader (D) Rep Mike Thompson (D) Rep John Sarbanes (D) Rep Greg Walden (R) Rep Maxine Waters (D) Rep Chris Van Hollen (D) Sen Ron Wyden (D) Sen Jeff Merkley (D) COLORADO MASSACHUSETTS Rep Diane DeGette (D) Rep John Olver (D) (11) Rep Richard Neal (D) Rep (D) (19) CONNECTICUT Rep Michael Doyle (D) Rep Joe Courtney (D) Rep (D) (20) Rep Chris Murphy (D) SENATE Sen (D) Rep (R) Rep (R) Rep (R) FLORIDA Rep (D) (12) Rep Bill Posey (R) Rep (D) RHODE ISLAND Rep Dennis Ross (R) Rep (R) Rep James Langevin (D) Rep Ileana Ros-Lihtinen (R) Rep (D) TENNESSEE GEORGIA MISSOURI Rep Phil Roe (R) Rep Sanford Bishop (D) Rep Russ Carnahan (D) (13) Rep Hank Johnson (D) TEXAS Rep John Lewis (D) NEBRASKA Rep Charles Gonzalez (D) (21) Rep Lee Terry (R) UTAH Rep Judy Biggert (R) (6) NEVADA Rep James Matheson (D) Rep Luis Gutierrez (D) Rep Joseph Heck (R) Rep Jesse Jackson, Jr. (D) (7) VIRGINIA Rep Jan Schakowsky (D) Rep James Moran (D) Rep Frank LoBiondo (R) IOWA Rep Frank Pallone (D) WEST VIRGINIA Rep Leonard Boswell (D) (8) Rep Steven Rothman (D) (14) Rep Shelley Moore Capito (R) Rep Bruce Braley (D) Rep Albio Sires (D) Sen Charles Grassley (R) WISCONSIN Sen Tom Harkin (D) NEW YORK Rep Tammy Baldwin (D) SENATE Rep Tom Latham (R) Rep Gary Ackerman (D) (15) Rep Ron Kind (D) Rep David Loebsack (D) Rep Tim Bishop (D) Rep Gwen Moore (D) Rep Steve King (R) Rep Eliot Engel (D) Rep Tom Petri (R) Rep Steven Israel (D) Rep Reid Ribble (R) Sen Charles Schumer (D) Updated: 01/8/2013

(R) – Republican (D) – Democrat (I) – Independent Energy & Commerce Committee Ways & Means Committee Senate Finance Committee Senate HELP Committee

111th Congress Cosponsors: H.R. 1625 (173) and S. 654 (24) The Equity & Access to Podiatric Physicians under Medicaid Act ALABAMA IDAHO MICHIGAN OHIO Rep Spencer Bachus (R) Sen Mike Crapo (R) Sen Debbie Stabenow (D) Sen Sherrod Brown (D) Rep Jo Bonner (R) Sen James Risch (R) Rep (D) Rep Marcy Kaptur (D) Rep Bobby Bright (D) Rep Michael Simpson (R) Rep Vern Ehlers (R) Rep Mary Jo Kilroy (D)

Rep Artur Davis (D) ILLINOIS Rep (D) Rep Tim Ryan (D) Rep Michael Rogers (R) Rep Carolyn Kilpatrick (D) Rep Zack Space (D) Sen Roland Burris (D) ARIZONA Sen Richard Durbin (D) Rep Thaddeus McCotter (R) Rep Betty Sutton (D) Rep (R) Rep Charles Wilson (D) Rep John Shadegg (R) Rep Judy Biggert (R) Rep Gary Peters (D) ARKANSAS Rep Danny Davis (D) OREGON Rep (D) Sen Blanche Lincoln (D) Rep Luis Gutierrez (D) Sen Jeff Merkley (D) Rep (D) Rep Marion Berry (D) Rep Phil Hare (D) Sen Ron Wyden (D) Rep (R) Rep Michael Ross (D) Rep Jesse Jackson, Jr. (D) Rep Earl Blumenauer(D) Rep Timothy Johnson (R) MINNESOTA Rep Peter DeFazio (D) CALIFORNIA Rep Mark Kirk (R) Rep James Oberstar (D) Rep Kurt Schrader (D) Rep Xavier Becerra (D) Rep Daniel Lipinski (D) Rep Collin Peterson (D) Rep Greg Walden (R)

Rep Howard Berman (D) Rep Bobby Rush (D) Rep David Wu (D) Rep Mary Bono Mack (R) MISSISSIPPI Rep Jan Schakowsky (D) Rep Lois Capps (D) Sen Roger Wicker (R) PENNSYLVANIA

Rep John Shimkus (R) Rep Judy Chu (D) Sen Robert Casey (D) MISSOURI Rep Anna Eshoo (D) INDIANA Rep Jason Altmire (D) Rep Russ Carnahan (D) Rep Sam Farr (D) Rep Andre Carson (D) Rep Robert Brady (D) Rep Peter Visclosky (D) NEBRASKA Rep Chris Carney (D) Rep Bob Filner (D) Rep John Garamendi (D) IOWA Rep Adrian Smith (R) Rep Charles Dent (R) Rep Lee Terry (R) Rep Michael Doyle (D) Rep Jane Harman (D) Sen Tom Harkin (D) Rep Barbara Lee (D) Rep Leonard Boswell (D) NEVADA Rep Tim Holden (D) Rep Jerry McNerney (D) Rep Bruce Braley (D) Rep Shelley Berkely (D) Rep Tim Murphy (R) Rep Laura Richardson (D) Rep Steve King (R) Rep Dina Titus (D) Rep Todd Platts (R) Rep (D) Rep Dana Rohrabacher (R) Rep Tom Latham (R) NEW HAMPSHIRE Rep Ed Royce (R) Rep David Loebsack (D) Sen Jean Shaheen (D) RHODE ISLAND

Rep Linda Sanchez (D) KANSAS Rep Paul Hodes (D) Sen Sheldon Whitehouse (D) Rep Adam Schiff (D) Rep Dennis Moore (D) Rep Carol Shea-Porter (D) Rep Patrick Kennedy (D)

Rep Maxine Waters (D) Rep James Langevin (D) KENTUCKY NEW JERSEY COLORADO Sen Jim Bunning (R) Rep Rob Andrews (D) SOUTH DAKOTA Rep Diane DeGette (D) Sen Tim Johnson (D) Rep Ben Chandler (D) Rep Rush Holt (D) Rep Stephanie Herseth Sandlin (D) CONNECTICUT Rep Geoff Davis (R) Rep Frank LoBiondo (R) Rep Joseph Courtney (D) Rep Brett Guthrie (R) Rep Frank Pallone (D) TENNESSEE Rep Rosa DeLauro (D) Rep Hal Rogers (R) Rep William Pascrell (D) Rep Bart Gordon (D) Rep John Larson (D) Rep Ed Whitfield (R) Rep Donald Payne (D) Rep Phil Roe (R)

Rep Chris Murphy (D) Rep John Yarmuth (D) Rep Steven Rothman (D) TEXAS

DELAWARE LOUISIANA Rep Albio Sires (D) Rep Lloyd Doggett (D) Rep Chris Smith (R) Rep Michael Castle (R) Rep Charlie Melancon (D) Rep Charles Gonzalez (D) NEW MEXICO Rep Gene Green (D) DISTRICT OF COLUMBIA MAINE Rep Martin Heinrich (D) Rep Eleanor Holmes Norton (D) Rep Michael Michaud (D) UTAH FLORIDA Rep Shelley Pingree (D) NEW YORK Sen Robert Bennett (R)

Rep Allen Boyd (D) MARYLAND Sen Charles Schumer (D) Sen Orrin Hatch (R) Rep Corrine Brown (D) Sen Ben Cardin (D) Rep Gary Ackerman (D) Rep Rob Bishop (R) Rep Katherine Castor (D) Sen Barbara Mikulski (D) Rep Michael Arcuri (D) Rep Jason Chaffetz (R) Rep Alcee Hastings (D) Rep Tim Bishop (D) Rep James Matheson (D) Rep Roscoe Bartlett (R) Rep Ron Klein (D) Rep Elijah Cummings (D) Rep Eliot Engel (D) VERMONT Rep Bill Posey (R) Rep Donna Edwards (D) Rep Brian Higgins (D) Sen Patrick Leahy (D) Rep Ileana Ros-Lehtinen (R) Rep Dutch Ruppersberger (D) Rep Steven Israel (D) Rep Peter Welch (D) Rep Debbie Wasserman-Schultz (D) Rep Christopher Lee (R) Rep John Sarbanes (D) VIRGINIA Rep Robert Wexler (D)-Resigned Rep Carolyn Maloney (D) Rep Chris Van Hollen (D) Rep James Moran (D)

Rep CW Bill Young (R) Rep Eric Massa (D)-Resigned

MASSACHUSETTS Rep Carolyn McCarthy (D) WASHINGTON GEORGIA Rep Michael Capuano (D) Rep Gregory Meeks (D) Sen Patty Murray (D) Rep John Barrow (D) Rep Stephen Lynch (D) Rep Jerrold Nadler (D) Rep (D) Rep Sanford Bishop (D) Rep Edward Markey (D) Rep Rick Larsen (D) Rep John Lewis (D) NORTH CAROLINA Rep John Olver (D) Rep Cathy McMorris Rodgers (R) HAWAII Rep Walter Jones (R) WEST VIRGINIA Sen Daniel Akaka (D) Rep Mike McIntyre (D) Rep Shelly Moore Capito (R) Rep Brad Miller (D) Rep Abercrombie (D)-Resigned Rep Mazie Hirono (D) WISCONSIN Rep Tammy Baldwin (D) Rep Steve Kagen (D) Updated 11/29/10 Rep Ron Kind (D) Rep Gwen Moore (D) Rep Thomas Petri (R) (R) – Republican (D) – Democrat (I) – Independent Energy & Commerce Committee Ways & Means Committee Senate Finance Committee Senate HELP Committee Recruitment & Retention Issues within Veterans Health Administration

------to include include to Physician and Dentist Pay in statute physicians ISSUE BRIEF ISSUE Physician and Dentist Pay Schedule it would give the facility the flex directors give it would defining doctors of podiatric medicine as capacity of the Department of Veterans Affairs to Affairs Veterans capacity of the Department of recruit and retain doctors of podiatric medicine by and retain recruit APMA seeks support for legislation to enhance the enhance seeks support to legislation APMA for Schedule Strong VA Support VA Strong VHA in 2011, at with senior clinical staff a meeting After established Robert A. Petzel, Undersecretary of Health, Dr. of status assess the current VHA to within a working group and rec attrition levels, review physicians, podiatric for pay also communicated Petzel actions.Dr. ommend corrective to “fix” supportVHA legislative a for is there that APMA to modify the less attractive than what is offered in other practice set is offered than what less attractive tings, especially the private sector, which has resulted has resulted which sector, especially the private tings, VHA. within problems and retention in recruitment senior practi of composed is workforce sician and difficulties retirement, for tioners eligible quali and retaining in recruiting been documented have to and retirements of these in anticipation fied providers VHA has needs. podiatric physician and future meet current succession strategic acknowledged develop the need to continu knowledgeensure transfer, to plans and initiatives clinicians and the numerous ity of services, replace to and retire. to eligible are that the system across administrators under the diatric physicians phy VHA podiatric proportionA significant of the proactively initiate VHA needs to competative, remain To if similar, physicians of podiatric recognition appropriate medicine has been established for what to not identical, is a very Because small this pool of providers and dentistry. VHA (less in providers physician of the total percentage 330 podiatrists system-wide), than 5%, or approximately little impact on will have and the savings both the costs include po to VHA were if However, budget. the overall podiatric physicians. Additionally, there is overwhelming there Additionally, podiatric physicians. of staff and chief medical officers chiefs VA support from this ongoing issue. solution to a legislative for ibility to help resolve retention and recruitment obstacles. obstacles. recruitment and retention ibilityresolve help to

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www.apma.org. Contact [email protected] with questions. [email protected] with questions. Contact www.apma.org. Prepared by the American Podiatric Medical Association, Medical Association, the American Podiatric by Prepared Bethesda, MD 20814, 301-581-9200, Road, 9312 Old Georgetown Background package compensation podiatric physician VHA The those for 1976, except unchanged since has remained Title 38, USC Section 7404 Clini in the changes reflected cal Podiatrist and Optometrist Salary Tables that include that Tables Salary and Optometrist cal Podiatrist Senior clinical Rate adjustments. and Locality Basic Pay local receiving regions of the 39% in physicians podiatric capped Rate of Pay the legislatively reached ity have pay compensa The Schedule limit. IV Executive the Level for has become VHA podiatric physicians tion package for As Congress continues to address healthcare reform, there there reform, healthcare address to continues Congress As is an impending shortage and other health of physicians Problem The American Podiatric Medicine Association (APMA) re (APMA) Medicine Association American Podiatric The and recruitment ongoing resolve to assistance quests your under employed podiatric physicians issues for retention (VHA). asks that Health Administration APMA Veteran’s the Phy the modify to legislation pass and introduce Congress doctors Schedule include of po to Dentist Pay and sician diatric medicine. veter meet the needs of the nation’s to professionals care the in delivering key role a play physicians Podiatric ans. and ankle foot servic medical and surgical or better, same, doctors (DO) medical doctors and osteopathic es that (MD) excluded frequently are podiatric physicians Yet, provide. development such workforce provide that programs from and as performance loan repayment, bonuses, incentives results ultimately exclusion This scholarship opportunities. attrition rates and increasing enrollment decreasing in ever and experienced among willing residents VHA facilities at opportunities as they pursue ad podiatric physicians for VHA. service through them to to not available vancement act fails to correct this recruitment to If Congress the podiatric physicians, for issue and retention foot of the quality of net effect will be the lowering veterans. the nation’s for and ankle available care in bills introduced enhancement VHA workforce Several recognize last session failed to both the House and Senate defi doctors podiatric medicine - either in the physician of podiatric hospital-based of recognition the in used, nition train of institutions that or in the recognition residencies, podiatric physicians. Veterans Health Administration Veterans Request Resolve Recruitment & Retention Issues within Issues within & Retention Recruitment Resolve

APMA Federal Legislative Advocacy Priorities for the 113th Congress ------Congress th that affect patient care, enabling physicians to advocate for to advocate enabling physicians care, affect patient that the patient- and reinforcing their patients for quality care relationship. physician their elected officials. Podiatric physicians and other doc and other physicians Podiatric their elected officials. they will bear a disproportionate that concerned are tors cuts because hospitals reimbursement of Medicare share cost-cutting not subject IPAB’s and nursing homes are to year 2020. fiscal until recommendations Medical Liability Reform supports im strongly to medical liabilityAPMA reform the cost reduce and to care, to access safety, patient prove compelled are physicians that reveal Studies of health care. themselves protect to and procedures tests more order to supports APMA balanced medical liability lawsuits. from speedier resolu promoting through tortfederal reform, courts, to and maxi access maintaining disputes, tions to a quarter to mil awards of damage recovery mizing patient lion dollars. Reform Antitrust increasing about extremely concerned members are APMA as regulatory barriers well that as consolidation, plan health actively APMA together. ability work to restrict physicians’ health-care allow profession to supports legislation federal terms regarding plans health with negotiate jointly to als IPAB Repeal (HR 351) IPAB unaccount an unelected, Act created Care Affordable The only a minority - where of members 15-member board able Medicare the to cuts make to - health-carebe can providers InThe on arbitrary based program global budget targets. is empowered Advisory (IPAB) Board Payment dependent - without full Medicare changes to make substantial to seniors and American’s to transparency and accountability ADVOCACY AGENDA ADVOCACY ------

Prepared by the American Podiatric Medical Association, Medical Association, the American Podiatric by Prepared Bethesda, MD 20814, 301-581-9200, Road, 9312 Old Georgetown [email protected] with questions. Contact www.apma.org. but their many tens of millions of patients. tens but their many cal professional groups to ensure that the non-discrimina that ensure to groups cal professional its goal of fairness and equal treat accomplishes tion law profession which will benefit not only the involved ment, health plan discrimination against whole classes of provid supports strongly APMA including podiatric physicians. ers, is working and in concertthese provisions with other medi The contains new federal provider non- provider federal Act new contains Care Affordable The Health 2706 of the Public (Sec. discrimination safeguards Service the harmful practice eliminating of Act) aimed at Preserving Provider Non-Discrimination Pro Provider Preserving tections by repealing the sustainable growth rate (SGR); enacting(SGR); rate growth sustainable the repealing by up payment physician Medicare annual adequate, stable, to care. access continued and ensuring beneficiaries’ dates; Payment System (SGR) System Payment supports program Medicare the strongly improving APMA provided by podiatrists. podiatrists. by provided Physician of Medicare’s Reform Permanent that our nation’s vulnerable Medcaid population has access Medcaid has access vulnerable population our nation’s that the important and ankleto services foot care specialized added expense for our health-care system. Federal legis Federal our health-care system. for added expense under physician of definition the align to needed is lation ensure helping to thereby Medicaid of Medicare, with that they like and for any reason. This is happening today all is happening today This reason. any they like and for causing not only disruptions in critical the country, across but also and ankle who need foot services care, patients for been recognized as physicians in Medicare but not in Med in Medicare as physicians been recognized to medical and beneficiaries access can deny States icaid. time any physicians podiatric services by surgical provided Removing Barriers for Patient Access to Podi to Access Patient BarriersRemoving for atric Care doctors have of podiatric medicine than 40 years, more For atric Medicallegislative Association priorities (APMA) in advocates the 113th on Congress numerous include: federal legislative and regulatory issues. APMA’s primary federal fewer and shorter, and theWith health-care the primary system objectives saves ofbillions enhancing of dollars access annually. to, and quality of, foot and ankle care for our patients, the American Podi America’s 15,000who aredoctors dedicatedwhen of podiatric podiatrists to improving medicine are healthpart (DPMs) of care administering arequality podiatric and medical practicing physicians and effective surgicaland surgeons, footand andefficient also ankle known care, health as outcomes podiatrists, care. Evidence are better, shows hospitalizations that Federal Legislative Advocacy Priorities for the 113 the for Priorities Advocacy Legislative Federal

APMA Advocacy Priorities for Student and Post Graduate Issues in the 113th Congress ------APMA urges Congress to protect graduate med graduate protect to Congress urges APMA Background education GME is the hands-on phase of physician training a license doctors obtain to is mandatorythat for order in physi college, of years four After practice. independent for of undergrad years another four complete cians-in-training earn their medical or physician to medical education uate GME (or residency) to training. then proceed and degrees, five to lasts three varies in length but generally training This initial specialty training. for years Medical Education Direct its Graduate through - Medicare hospitals teaching - compensates system (DGME) payment training to directly related of the costs share Medicare’s for Indirect (IME) is a patient-care Medical Education residents. because they hospitals teaching made to funding program ser and provide population patient complex a more treat others cannot. that vices com with the physician work to continue hospitals to For they must the country, the doctorsmunity train across to part and an integral of stable funding, adequate first have medical tomorrow’s train GME to from this funding comes professionals. Protect Graduate Medical Education (GME) (GME) Medical Education Graduate Protect Funding Request: Problem best doctors America has the world’s One of the reasons hospi the best teaching have and nurses is because we tals. However, cuts to GME jeopardize the ability of medical GME jeopardize cuts to However, tals. nurses, physicians, train hospitals to schools and teaching as limit critical ser as well and other health-care providers, a time at training physician Cutting the community. to vices a critical shortage faces when our nation of doctors threat ens the health of all Americans. ical education (GME) funding. funding. (GME) ical education ADVOCACY AGENDA ADVOCACY ------which

The Access to Frontline Health introduced by Rep. Bruce Braley (D-IA). Braley Bruce Rep. by introduced Congress th APMA requests congressional support congressional through requests APMA The Access to Frontline Health Care Act of 2013, www.apma.org. Contact [email protected] with questions. [email protected] with questions. Contact www.apma.org. Prepared by the American Podiatric Medical Association, Medical Association, the American Podiatric by Prepared Bethesda, MD 20814, 301-581-9200, Road, 9312 Old Georgetown cosponsorship of H.R. 702, “ 702, of H.R. cosponsorship H.R. 702 would place new emphasis on interdisciplinary new emphasis co place H.R. 702 would centives for recent graduates in healthcare fields to practice fields in healthcare graduates recent for centives similar Inin underserved of the nation. a process areas rural Health Service the National of the legislation that to Corps, pro loan repayment providers a new frontline will create practice in to commits provider which a healthcare in gram for in exchange years least two at an underserved for area providers Participating assistance. loan repayment student deter an area Scarcity Area,” “Frontline in a be placed would Departmentand Human Ser of Health the U.S. mined by proficient shortage a providers have to of healthcare vices in multiple fields of medicine. which doctors through a new pathway and offers operation needed services urgently of podiatric medicine can provide in underserved areas. addresses America’s physician shortagenew in creating physician by America’s addresses Background H.R. introduced (D-IA) Braley recently Bruce Representative 702, Problem underserved the country significantly across are areas Many supply of medical profes an adequate of having in terms Request: H.R. 702/The Access to Frontline Health Care Health Care Frontline to Access H.R. 702/The Act of 2013 various health-care services. the Af As provide sionals to critical to more it is even Act implemented, is Care fordable are of providers number and range an adequate that ensure communities, including rural in everyavailable community, Ameri demand of those increased meet the anticipated to of some type. coverage insurance cans who will soon have the 113 Advocacy Priorities for Student and Post Graduate Issues in Issues Graduate and Post Student for Priorities Advocacy Care Act of 2013,”