APMA News - September/October 2020 - 26

New York Marks Falls Prevention
Month with Launch of Pilot Program

n the September-October 2018 issue of APMA News, Paul
Liswood, DPM, then-president of the New York State Podiatric Medical Association (NYSPMA) unveiled the findings
of a major population health study. Driven by the New
York State Department of Health's public health goals, the
study was designed to align podiatry outcomes with policymakers' key concerns. Among those concerns: falls, a public
health challenge that costs the American health-care system
$50 billion annually.
New York's population health study showed falls prevention was an area in which podiatrists could have a critical
impact, with a potential 36-percent reduction in falls over a
12-month period for at-risk individuals who received interventions from a podiatrist. The finding not only piqued the
interest of New York State policymakers, but also of regulators at CMS. Dr. Liswood raised the findings with CMS during
a meeting about the onerous proposal to separate E/M codes
for podiatry from codes used by other physicians.
"Dr. Liswood brought up the white paper, and as soon as he
mentioned falls prevention, [the CMS representatives'] attitude completely changed," said Vanessa Darmochwal, DPM,
co-chair of NYSPMA's Public and Population Health Task
Force. "They wanted to know more about what we're doing,
and it gave us the message that this is an area we need to focus on with payers and regulators."
NYSPMA's consultant Guidehouse (then Navigant) recommended a pilot program that could help demonstrate the value of intervention by a podiatrist for individuals at risk for
falls, ultimately leading to podiatrists playing a leading role in
value-based care models.
As September's Falls Prevention Month kicks off, NYSPMA's
pilot program also is coming to fruition at Lenox Hill Hospital in New York. "The whole study is based around the podiatric physician being able to assess an at-risk patient," Dr.
Darmochwal said. The study focuses on high-risk patients in
the Medicare population: those 65 and older or who need an
assistive device for ambulation who present in the Emergency
department for any reason. Patients will complete a questionnaire from the CDC's Stopping Elderly Accidents, Deaths &
Injuries (STEADI) program. Based on their responses, pa-

26 APMA News September/October 2020

tients will be assigned a risk score and a podiatrist will conduct assessments to further determine their risk for a fall. The
study will be conducted under the oversight of William Spielfogel, DPM, residency director for the Lenox Hill Hospital-Northwell Health PMSR/RRA.
"The podiatrist will perform tests as needed, take a complete medical history, complete a lower-extremity exam, and
from there will determine what needs the patient has," Dr.
Darmochwal said. Those needs could range from routine
footcare to corrective shoe gear to ambulatory aids. If the patient has vascular or neurological issues, or orthopedic issues
outside of podiatry's scope in New York, they will be referred
out to have those needs addressed. "The real key is that the
podiatrist is responsible for following through with the patient and other members of the care team to be sure needed
interventions occur," Dr. Darmochwal said. The pilot program also includes education for the patient and caregivers.
The goal is to determine how much impact interventions
by a podiatrist can have on number of falls, repeat falls, cost
savings, rehospitalizations, quality of life, and more. Ultimately, the data could be used in any number of ways, from
advocating to remove limits on access to care by a podiatrist
under Medicaid in New York and passage of Title 19 legislation, to advocating with CMS for podiatry-led alternative
payment models and value-based reimbursement.
"I am very proud to be part of this project and the collaboration between NYSPMA and Lenox Hill Hospital-Northwell Health," said Dr. Spielfogel. "Being proactive and participating in projects like the falls prevention study will
show our value and hopefully get podiatry a seat at the table
with policymakers."
"We want to advance the profession and ensure our future by positioning podiatrists as the partner in primary
care of the lower extremity," Dr. Darmochwal said. "We're
demonstrating we can lead and be a key member of a team
of health-care professionals to improve outcomes and reduce complications, hospitalizations, and costs for at-risk
patient populations."
For more information on NYSPMA's population health
study, visit www.nyspma.org. n

http://www.nyspma.org

APMA News - September/October 2020

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