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Medicare. An administrative viewpoint

A E Helfand1

  • 1Department of Community Health and Aging, Pennsylvania College of Podiatric Medicine, Philadelphia.

Clinics in Podiatric Medicine and Surgery
|April 1, 1993
PubMed
Summary
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Medicare legislation initially aimed to ensure access to podiatric care for high-risk patients. However, current system modifications, particularly through health maintenance organizations, may violate the program's original intent for direct patient podiatric care.

Area of Science:

  • Health Policy
  • Podiatric Medicine
  • Healthcare Access

Background:

  • Medicare, established as a foundational health insurance program, initially covered the elderly and later expanded to include chronically ill individuals.
  • The legislation recognized podiatric medicine services as equivalent to those of other practitioners, reflecting a congressional mandate for podiatric care.
  • State laws and practice acts, reflecting the will of the people, govern the scope of practice for podiatrists.

Purpose of the Study:

  • To analyze the evolution of Medicare's coverage for podiatric services.
  • To examine how fiscal intermediaries and local guidelines impact Medicare regulations for podiatry.
  • To assess whether current payment options, specifically Health Maintenance Organizations (HMOs), align with the original legislative intent of Medicare regarding podiatric care access.

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Main Methods:

  • Review of Medicare legislation and its historical context.
  • Analysis of the role of fiscal intermediaries and state-specific Medicare guidelines.
  • Examination of patient payment options under Medicare, including assignment, direct payment, and managed care plans.

Main Results:

  • Medicare's original intent was to ensure availability and access to podiatric care for patients.
  • Fiscal intermediaries administer the program, establishing local guidelines that modify Medicare regulations.
  • The option of joining a Health Maintenance Organization (HMO) may compromise a patient's right to direct podiatric care, potentially violating the original legislative intent.

Conclusions:

  • Modifications to the Medicare system that alter the original intent of providing direct access to podiatric care, without legislative changes, raise ethical and legal concerns.
  • The current system's structure, particularly concerning payment options, requires scrutiny to ensure alignment with the foundational goals of Medicare for podiatric services.
  • Preserving the original intent of Medicare is crucial for maintaining patient access to necessary podiatric care.