Portsmouth Foot & Ankle - Blog
There are many gratifying aspects to my job,
- getting patients feeling better quickly
- having same day treatments available
- seeing a variety of foot ailments making two days never the same
But one of my favorite things is how rarely I have to utter the words “today we HAVE to do __________treatment” to a patient. Podiatry offers so many opportunities for shared decision-making (the practice of an informed patient participating in treatment decisions) and as a physician I really enjoy the highly collaborative treatment planning.
When see a new patient my goal is to not only give them a timely and accurate diagnosis but to tailor a treatment plan that works for them. Most of my patients know that following all the questions I ask regarding their symptoms comes, “What do you do for work? What is your day to day like?” I enjoy getting to know each of my patients and arming them will a full gamut of options to help treat their foot pain.
Let’s take plantar fasciitis (or heel pain) for example. I can see upwards of 10 patients a day, either new or in follow-up for heel pain, and each of them are at a different stage in their treatment and have chosen different treatment paths. Some are in physical therapy, others for a cortisone injection, or our EPAT (shockwave) therapy and one post-operatively after a plantar fascial release. None of these patients I treated the same because every one of them has different goals and lifestyles.
By giving my patients all the treatment options available to them I can create a truly patient focused treatment regime, aimed at getting each individual person better on their terms. Every day I am delighted to work with my patients and actively involve them in the decision making process regarding their foot pain versus saying, “this is what you have to do”.
I believe that an informed patient is a happier and in the end healthier patient and many industry executives agree…
Real Word Example: Why Value-Based Care Must Include Shared Decision-Making : Shared decision-making is a key patient engagement strategy, but not yet widespread. By Sara Heath (February 26, 2018) - via, patientengagementhit.com
Shared decision-making integrates the patient into the healthcare process and gives the patient more claim in her wellness journey.
Shared decision-making has shown to reduce preventable hospital readmissions among cardiac patients by at least 19 percent, and can also decrease patient anxiety and healthcare costs.
“Although shared decision-making has been around for quite a few years, and although there is a significant evidence basis about the expected outcomes of shared decision-making interactions, it is really more the exception than the rule in clinical practice today,” Goldbach said in a recent interview with PatientEngagementHIT.com (Peter Goldbach, Chief Medical Officer for Rite Aid’s RediClinic and Health Dialog).
“There are islands of excellence that do exist, specifically people that have taken an interest in shared decision-making,” Goldbach added, making a nod to SDM researchers and specialists.
Some medical professionals do believe they are practicing shared decision-making, but when Goldbach spends more time with the provider and breaks down the details of shared decision-making, it becomes clear that the art has not yet been perfected.
The healthcare industry landscape has never been conducive to integrating shared decision-making, Goldbach explained. Although shared decision-making has fairly clear benefits, evolving healthcare initiatives such as emerging technologies and reporting requirements have made it hard for providers to adopt the technique.
“Shared decision-making has not been part of providers' education,” Goldbach noted. “It's not part of the current culture. And people who practice medicine today are beset by a very busy, difficult environment where they have a lot of new requirements and a lot of new operating systems distracting them. That is a difficult environment to bring in new ways of working with patients.”
The time is ripe for more widespread adoption of shared decision-making, Goldbach added. Healthcare professionals are becoming more comfortable with new technologies, and strategies have emerged to enhance, not distract from, shared decision-making.
Shared decision-making has a considerable human component to it – educating and partnering with patients for better care is an important part of the patient experience and puts patients in control of their own health.
We support and encourage collaborative medicine at Portsmouth Foot and Ankle. It is our goal to offer patient focused care and to encourage our patients to make informed decisions about their treatment options.
Will My Nail Care Be Covered By My Insurance?
Many patients come to us for routine foot care. During these appointments nails are trimmed or debrided and calluses cared for. Unfortunately, many patients, especially the elderly or those with mobility issues have trouble performing this care themselves. We are always happy to help out those who need. However, insurance doesn’t always cover this care.
Below are some scenarios under which nail care would or would not be covered.
I’m a diabetic, is my nail care covered?
If you have diabetes with no other complications such as neuropathy or PVD (peripheral vascular disease) routine foot care is NOT covered.
- Generally we try and see our diabetic patients 1-2 times per year for a diabetic foot check.
- At your appointment the doctor will assess for any sensation loss (neuropathy) or poor blood flow (PVD).
- They will then discuss these topics with you and ways to prevent issues.
- If you meet the criteria for neuropathy or PVD your nail care may be covered.
I have poor blood flow, is my nail care covered?
- This depends on a couple of factors that will be assessed during your appointment.
- The doctor will check your pulses and peripheral blood flow along with your skin and even your lower legs for signs of PVD
- If adequate signs are met your nail care may be covered.
My nails are thick and hard to trim, is my nail care covered?
- Generally speaking nails that are painful, cause an inability to walk and are greater than 3mm in thickness are covered for routine foot care.
My nails are normal but I can’t trim them myself, is my nail care covered?
- Generally speaking no. Unless you meet one of the above criteria your nail care would not be covered.
We have made the following chart to help you determine if your nail care will be covered -
Please do not hesitate to call our office for more information. Please note that we cannot determine or guarentee coverage over the phone. An evaluation by the doctor is always necessary to determine coverage. Please use the scenarios and chart above as a reference - they are not a guarantee of coverage. Every insurance company is different and we cannot guarantee coverage without a medical evaluation.
Natasha Baczewski, DPM is a podiatric surgeon at Portsmouth Foot and Ankle (Portsmouth Office). She currently accepts new patients. To read more about Dr. B or to make an appointment with her please use the following links: Dr. Natasha Baczewski | Appointment Request
Frostbite is a real danger in New England. Hands and feet account for 90% of all cold related injuries. Men are affected by it more than women by a ratio of 10:1.
Frostbite occurs when the tissues of the body are reduced to a temperature that stops blood flow. As fluids in the body cool they can slow to a halt.
When the core temperature of the body decreases significantly, the body reacts by shunting blood away from non-vital organs and limbs. As the fingers and toes are the furthest from the center of the body, they are easily cooled. Without blood reaching the tissues the affected parts begin to die. In extreme cases of frostbite in children, growth plates are affected resulting in abnormal growth of bones.
Frostbitten fingers and toes may be salvaged if re-warmed and cared for properly. It is important to get the person to warm place where they do not risk becoming cold again. Medical attention is absolutely necessary. There are medications and procedures that can improve outcomes if sought out in a timely manner. The degree of irreversible damage is more closely related to the length of time that tissue remains frozen rather than the absolute temperature change.
Things to be careful of when going into cold temperatures:
Tight shoes, tight ski boots, standing in the snow or ice, smoking. Be sure to keep your fingers and toes warm with thick socks, keep your feet dry, wear protective shoes that are waterproof. If you have neuropathy in the feet be extra careful and warm your feet regularly.
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.