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EDUCATING SENIORS ABOUT MEDICARE COVERAGE FOR PODIATRY SERVICES

EDUCATING SENIORS ABOUT MEDICARE COVERAGE FOR PODIATRY SERVICES

This blog is adapted with permission from the author at drblakeshealingsole.com

Just as we know we can treat anything in the foot and ankle from ingrown toenails to plantar fasciitis to complex fractures, we know aging adults are prone to chronic foot problems, especially if they have an underlying disease such as diabetes. In a study of diabetic seniors (U.S. National Library of Medicine), it indicates that educating patients about foot self-care encourages routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently. We also know that Medicare doesn’t cover all podiatry services so acting independently to maintain overall foot health is crucial to avoid the need for podiatric Medicare.

Rules of Medicare

Medicare has specific rules for coverage, based on the patient’s diagnosis and proposed treatment. Make sure your physician understands these rules and helps to formulate a treatment plan around these guidelines. This will clarify why certain decisions are made. It also enlightens the patient as to how help can be provided not only for themselves but also for their loved ones now and in the future.

Medicare doesn’t cover routine foot care except in situations in which another health condition requires it and class findings (such as diabetic neuropathy) are met. It may be of benefit to incorporate this information into your initial patient exam. By understanding these class findings, you have a clear understanding as to why it may not be a covered service. If this is in fact the case, you can then follow up for an Advance Beneficiary Notice (ABN) for the non-covered service (MedicareSupplement.com). An ABN, also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.

No Shoes For You

Medicare also doesn’t cover supportive devices, such as orthopedic shoes, unless they are included in the price of a leg brace or when the patient has diabetes. Even when the patient has diabetes, there is a specific algorithm that determines eligibility for this service and it may not include every patient with that diagnosis. Many patients with diabetes erroneously assume they are entitled to “free shoes” when in reality treatment is much more complicated than that. If “free” is not in the cards for you, an excellent alternative to diabetic shoes can be achieved through OTC insoles & inserts that are a fraction of the price while providing useful support needed for your foot.

Medicare will only cover podiatry services that are considered necessary to diagnose or treat a medical condition (Caring.com). Conditions such as hammertoes, heel spurs and bunion deformities yield Medicare coverage for treatment in the form of an evaluation and management visit. However, patients need to understand their evaluation and what to expect when it comes to coverage. Patients need to be made aware that Medicare Advantage plans specifically may require referrals or authorizations for certain services, such as X-rays.

Patients with diabetes may qualify more clearly for services when it comes to foot care because they have a greater risk of developing foot conditions (AARP). However, it is very important for them to understand the role of the podiatrist in their overall health and wellness. They should be seeing the doctor (primary physician or endocrinologist) treating their diabetes within six months of their podiatry visit. It is shocking that this is not routine for some patients with diabetes.

Helping Patients Understand How Medicare Pays For Podiatry Services

As podiatry services are mostly performed in an outpatient setting, Medicare Part B applies. Medicare Part B will pay 80 percent of covered medical costs. The patient is responsible for both an annual deductible and 20 percent of the bill. Many patients are not aware of the yearly deductible and are shocked when receiving their invoice. Optimally, physicians will take the time to educate patients, whether through postings in their office or even a brief conversation with all patients and staff.

If patients require surgery to treat a foot condition and are admitted to the hospital as inpatients, Medicare Part A will come in effect as well. A larger deductible applies here as does the 20 percent co-insurance. This deductible also covers the first 20 days in a skilled nursing facility (SNF) if it is recommended that the patient finish recovery there. Medicare will only cover the SNF stay if the patient was admitted to the hospital for at least three days (Podiatry Today).

When a patient applies for Medicare, he or she may ask what plans are recommended. Although this varies wildly by region, the patient may want to consider supplemental coverage to help pay for things traditional Medicare does not. Medicare plans such as Medigap and Medicare Advantage can help lower some of these costs. Medigap plans can help cover a patient’s Part A deductible and Part B deductible, copays, and coinsurance. Medicare Advantage plans can help lower a patient’s out-of-pocket costs by setting a copayment amount that may be lower than a patient’s normal Part B coinsurance. Medicare Advantage plans also may offer extra podiatry services, such as routine foot care exams. In certain situations, Medicare will also pay for orthotics -custom made as well as pre-fab OTC insoles (MedicareSupplement.com).

In summary, obtaining knowledge about Medicare and related insurance may help you maneuver through podiatry services as it relates to coverage. The confusing and complex aspects of insurance coverage may pose a barrier to obtaining the proper services needed and you want to limit that confusion by discussing with your physician if when available.

 

KEEPING YOUR FEET HEALTHY WHILE AT WORK

KEEPING YOUR FEET HEALTHY WHILE AT WORK

Our feet do the grunt work by supporting our entire bodies every day. They carry us from place to place, from infancy through adulthood, covering upwards of 100,000 miles in our lifetime (Moonwalkers.com). During a normal work day, depending upon the work you perform, the average steps you take can be as little as 6,600 and as high as 22,800. An office worker averages 7,500 steps per day while a waiter / waitress tops the list at nearly 23,000. Nurses, retail workers, farmers, teachers and Tradespeople are all well over 10,000 steps per day, reflecting the need to make sure our feet are well taken care of (Healthline.com-Average Steps by Occupation). Our feet are the very foundation for our bodies but are typically ignored until there’s a problem. Once there’s a problem, it can affect our entire body’s overall health. Since our feet work so hard for us, why don’t we take care of them before any problems begin? Let’s go over some ways we can care for our feet and keep them healthy as they carry us through both our workday and life

Take the Time to Evaluate Your Footwear

Wearing shoes with little to no arch support can wreak havoc on your body. Not only does a good supportive shoe provide a steady foundation and balance, but it also contributes to your overall activity level. Your arch comes under the most strain as you stand and walk. Without support, you may experience back pain, foot pain, and even headaches or stomach aches.

Your shoes need to match the demands of your work, but they also need to match the individual biomechanics of your feet and gait. Understanding the needs of your foot mechanics first will help you select footwear that works well for your feet and your work.

If you are in a work environment that that requires you to be on your feet most of the day such as construction, delivery personnel, beautician or manufacturing shop floor, it is imperative to maintain proper arch support as well as maintaining overall foot comfort. Without proper arch support, you could ultimately be causing improper balance on your lower extremities leading to lower back pain and sore & fatigued legs and feet (Canadian Centre for Occupational Health and Safety).

Even in a corporate setting, it can be challenging to find proper footwear when you work at a desk. Slip on shoes and moccasins provide the least amount of support. If you can wear a shoe with laces at work, choose one with multiple eyelets. The more a shoe has, the more it can conform to the shape of your foot, providing the best support.

Consider Using Footwear’s Little Helper (shoe inserts)

The mechanics of your feet may warrant the need for additional support. This may come in the form of over-the-counter arch supports or custom foot orthotics depending on your needs. Purchasing a good shoe insert is imperative to make even the least supportive shoes more foot health-friendly.

If you stand for longer than 5 hours a day at your job, you should especially consider orthotic inserts (Commercial Construction Mag). By standing that amount of time, it places greater strain on your feet and can increase your risk of developing plantar fasciitis. Plantar fasciitis is an overuse injury to the plantar fascia. The plantar fascia is a broad ligament on the base of your foot which extends from your heel to the base of your toes.

The Wonders of Compression Socks

When you stand for long periods of time, blood pools in your feet and ankles. This causes them to swell and become uncomfortable. Compression socks are designed to help push blood up the legs, towards the heart and back into circulation. This helps increase the efficiency of blood circulation in your feet and legs.

Alternate Your Footwear

Over time, our shoes lose their ability to absorb shock as well as they once did when they were new. This means that our feet and joints must instead take on the extra shock that our new shoes used to provide.

If possible, avoid wearing the same pair of shoes to work each day. By alternating footwear every day, you will increase the amount of cushioning recovery in the midsoles of your shoes and lengthen their overall lifespan.

Practice Stretches Throughout The Day

Use a massage ball to perform performing foot and leg stretches throughout the day. They are great for massaging the tissue in your feet throughout the day, which can help reduce fatigue and promotes circulation (Natural Footgear).

Simply roll the ball under your feet back and forth along the arches. This will help to alleviate tension in the muscles and fascia. You can use your coffee breaks and lunch breaks to stretch your feet and calves.

Moisturize

There are plenty of lotions and creams out there that are touted as the best for your feet. Any of them will do. The real trick to moisturizing your feet is to make sure you are first exfoliating. Get rid of any dead skin cells so that your dry feet will be ready to receive new moisture.

You can use a simple washcloth after soaking your feet, or a loofah or pumice stone for those extra dry, callused areas. Adding some Epsom salt to your bath can help soften the skin on your feet, making it easier to remove any dead skin.

Follow your exfoliation with a lotion or petroleum jelly to seal in moisture. Most of all, be consistent. Your feet crave moisture daily. Make sure your body is also hydrated from the inside by drinking plenty of water and eating a diet rich in Omega fatty acids.

Best 6 Ways to Reduce Pain From Plantar Fasciitis

Best 6 Ways to Reduce Pain From Plantar Fasciitis

Plantar fasciitis is a very common foot ailment that occurs when an inflammation of a thick band of tissue forms and connects the heel bone to the toes (Footwear News). It is usually self-diagnosable & self-treatable. The inflamed tissue runs across the bottom of the foot with the primary symptom being a stabbing pain near the heel. Plantar fasciitis happens a lot with runners and people who have flat feet, high arches, are overweight, or who are on their feet a lot.


With attentive care, the sufferer can often do these 6 things in their daily life to alleviate the pain caused by Plantar Fasciitis and help your foot heal faster (Podiatry Today).

  1. Rest: Sure this one seems most obvious and easiest to implement, but as we know life often gets in the way of taking care of one’s self. General rest is critical when coping with Plantar Fasciitis and it is very important to keep weight off your foot until the inflammation goes down.

  2. Ice: The old standby of ice to treat inflammation still works great , and there are multiple ways that you can implement this.
  • A store bought ice pack always works great. They are relatively inexpensive and most efficient to use. One piece of advice would be to get one of minimal size as you want to focus on icing the heel area and not the entire bottom of the foot. General recommendation is to put it on your heel 3 to 4 times a day for 15 to 20 minutes at a time.

  • Next option would be to make a homemade pack. First wrap a towel around a plastic bag filled with crushed ice or even around a package of frozen corn or peas. As with the store bought ice pack, put the homemade ice pack on your heel 3 to 4 times a day for 15 to 20 minutes at a time.

  • Another option is to fill a shallow pan with water and ice and soak your heel in it for in it for 10 to 15 minutes a few times a day. Remember to keep your toes out of the water as we want to focus primarily on the heel area.
  • Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) can make your foot feel better and help with inflammation. The most prominent NSAIDs are aspirin, ibuprofen, and naproxen, all available over the counter.

  • Stretching and exercise: Stretch your calvesAchilles tendon, and the bottom of your foot. Do exercises that make your lower leg and foot muscles stronger. This can help stabilize your ankle, ease pain, and keep plantar fasciitis from coming back.

  • Night splintsMost of us sleep with our feet pointed down, which shortens the plantar fascia and Achilles tendon. Night splints, which you wear while you sleep, keep your feet at a 90-degree angle. So instead of shortening your plantar fascia, you get a good, constant stretch while you sleep. Although night splints tend to be bulky, they work well and can help relieve pain while you sleep. Once the pain is gone, you can stop wearing them. 

  • Shoe inserts: For the daytime and your daily activities, quality shoe inserts are crucial to use. Most shoes are not factory produced with quality support for your feet. Also called insoles, arch supports, or orthotics, shoe inserts can give you extra cushion and added support that your shoes do not provide. You can get them over-the-counter (OTC) or have them custom made. Typically, your results will be just as good, and less expensive with OTC inserts, but quality is still important when considering. When you choose one, adjustability is key and it is important to make sure that you can achieve a level of firmness that is right for you -- and make sure it has good arch support. Also you should choose a pair of insoles with a good heel cup that provides extra cushion.


Can You Prevent Plantar Fasciitis?

Once your foot feels better, you can make a few lifestyle changes to help keep plantar fasciitis from coming back. These include:

  • Losing weight. Obviously there are numerous advantages to losing weight, but as it relates to plantar fasciitis, if you're overweight or obese, you may put more pressure on the bottom of your feet. That pressure can lead to plantar fasciitis.

  • Make sure all of your footwear has good support. As important as it is to replace your athletic shoes often, it is equally important to make sure you replace your inserts when needed. Most inserts will last between 6-12 months, around the same lifetime of your athletic shoes. Ones you find the insert that works best for you, it is often helpful to buy additional pairs and have them in all of your shoes so you don’t have to move them from your works shoes, to your sneakers to your boots, etc.

  • Stay away from high heels. Wearing them can cause your plantar fasciitis to come back

  • Don’t go barefoot on hard surfaces. This includes your first few steps when you get up in the morning. It's common to feel plantar fasciitis then. So you'll want to keep some supportive footwear by your bed.

  • Do low-impact exercise. Activities like swimming or cycling won't cause plantar fasciitis or make it worse. After you're done, stretch out your calves and feet. For instance, curl and relax your toes and make circles with your feet and ankles.

  • Avoid high-impact activities. These include running and jumping, which put a lot of stress on your feet and can make your calf muscles tighter if you don't stretch them out.

  • Keep doing your leg and foot stretches. Two of these include:
  1. Stretch your calves. Stand facing a wall. Put your hands on the wall. Step one foot behind the other, keeping both feet parallel to each other. Gently lean toward the wall, keeping your back heel on the ground. Hold for 10 seconds, and then switch feet. Repeat several times on each side.
  2. Stretch the bottom of your foot. Sit down and cross one foot over your other leg. Hold your toes and gently bend them backward.
  • Untuck your bedsheets. If your sheets are tucked too tightly and you sleep on your back, your feet will be in a pointed position while you sleep