The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 09, 2009 #3,592 Publisher-Barry Block, DPM, JD

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Canadian Podiatrist Discusses Salon Public Safety Measures

Robert Chelin, president of the Federation of International Podiatrists, says he has treated many patients with infections resulting from botched pedicures. Experts like Chelin are looking to government regulation to enforce three standards in the industry that are required in other health professions -- training, sterilization, and proper instrumentation.

Dr. Robert Chelin

Chelin says more questions need to be asked by both the patron and the pedicurist. Patrons should ask the employees to sterilize the nail kit, or put together their own kit and bring their own polish. At the very least, he says, people should bring their own base coat. And it's important not to shave for a few days before a pedicure because it opens your hair follicles to infection.
 
Source: Sunny Freeman, The Canadian Press, [7/8/09]

SMU Students Mentor At-Risk Teens about Pursuing a Career in Healthcare

For the next five weeks, several Samuel Merritt University podiatric students have volunteered to tutor more than three dozen middle and high school students from the Oakland Unified School District area about basic vital signs, diabetes, and healthy living. The program, called Youth in Medicine, allows at-risk students between the age of 11-15 to have an up-close look at how simulation-based education, human anatomy with lab, and clinical skills are integrated into academic programs at the University. 

(L-R) Dr. James Townson, Arthuaro Diaz (SMU student), Dr. Barrie Buey, Donnie Jones (SMU student) and teenager Ian Alexander

Nishi Singh, a second-year DPM student, says working with the teens and explaining about anatomy, podiatry, histology, and operating room situations allows her to practice her communications and teaching skills. “Many of us can relate to these kids and their background,” says Singh. “They are all very intelligent and curious about what has led us to study podiatric medicine. I know by exposing them to all of this at their young age, we are having a positive impact.”

ICD-10 Will Reduce Payment Errors and Claims Denials and  Help Fraud Investigators

Payment errors should be reduced significantly under ICD-10 diagnosis and procedure codes, which must be implemented by Oct. 1, 2013. Experts say that improvements over ICD-9 — including less ambiguity, more specificity, standardized terminology and combination codes — will help hospitals improve their compliance. But at the same time, fraud investigators may also benefit from ICD-10 when it's deployed with electronic anti-fraud tools.

"This is a boon for compliance," said Rita Scichilone, director of practice leadership at the American Health Information Management Assn. (AHIMA). With 35% of overpayments identified during the recovery audit contractor (RAC) pilot related to coding errors, the new system could have a huge ripple effect, Scichilone said at a recent audioconference sponsored by the Health Care Compliance Assn.

Source: Nina Youngstrom, Report on Medicare Compliance [7/2/09]

Part 4 - Now let’s ask and answer some key questions. By David Mullens, DPM, JD

1. How is a Medicare overpayment “recouped” by the contractor?

“Recoupment is a term-of-art that means the contractor (e.g. Palmetto GBA) withholds future Medicare payments until the demanded overpayment and accrued interest are paid. When Palmetto gets a check from the provider for the full overpayment demand amount (don’t ever do this!), that is not a recoupment. When Palmetto gets a check from the provider for a negotiated, reduced amount (this should be a last resort), that is not a recoupment. A recoupment only occurs when Medicare takes your future earnings to pay the overpayment + accrued interest amount.

Here is the surprise. Allowing recoupment is the best course of action when you have a defensible case, because the ALJ will make the contractor refund the full amount taken from you along with the accrued interest for each and every claim on which you prevail.

2. Why should you NEVER respond by writing the check for the full overpayment demand amount, even when the amount is small?

If you were an employee at Medicare, sending out demands for repayment of overpayments to providers, and a provider responded immediately to your demand by writing out a check for the full amount of your demand, what would you think?  That’s right. You would think that a provider knows he/she is “guilty” and that is the reason the provider paid immediately and without protest.

Even if you think the amount in question is so small that it is not worth the fight, your implied admission of guilt inherent in the immediate and full payment of a demanded overpayment jumps off your check and screams: “I’m guilty, I’m guilty and there is more money where that came from! So please, audit me again and again, and I will send you check after check…”

Query: Recurrent Bunion

I am interested in surgical treatment options for a 70 y.o. active female with painful recurrent bunion deformity. PMH includes asthma, osteoarthritis of the knees with right knee replacement scheduled for this September. She had previously undergone a left bunionectomy in 1984 and now has had progressive dorsal and medial bunion pain x 3 years.

Recurrent Bunion

She has limited dorsiflexion (40 degrees) at 1st MTPJ with hypermobile 1st ray. She has not had symptomatic relief with orthosis and is quite active, but has worsening discomfort. Any suggestions?
 
Richard Frost, DPM, Spokane, WA

Query: KTP Laser

I am looking to buy a laser for treatments of warts. I am interested in a KTP laser. Does anyone have experience with this laser?

Frank Harton, DPM, Holland, MI

RE: Skin Lesion Associated With Heel Pain (Harry Cotler, DPM)
From: Samuel B. Pearlstein, DPM

In your differential, please include pressure urticaria. If the OTC insoles produced excessive pressure at the site that is irritated, I am unsure if a custom-molded orthotic would be any more beneficial than the OTC device.
 
Samuel B. Pearlstein, DPM, Fayetteville, NY, sbpdpm@hotmail.com

RE: Surgical Closure of First Metatarsal Growth Plate to Correct For a High IM Angle
From: Barry Mullen, DPM, Thomas Brosky II, DPM

I agree with those colleagues who stated this particular child is too close to pedal skeletal maturity for an effective IM angle reduction by epiphyseodesis. In addition, an 11 year old presenting with a relatively high IM angle and atavistic 1st metatarsal-cuneiform articulation does signify forefoot hypermobility as Dr. Morelli so eloquently stated. As such, I agree with his opinion that a Lapidus fusion is the procedure of choice here.

While SCARF osteotomies have their place in hallux valgus correction, they don't address hypermobility, and would likely not adequately address this juvenile bunion deformity. I'd just wait about 6 months to a year until the 1st metatarsal growth plate closes, and then do the fusion. I'd also check to see if this patient harbors the various determinants for ligamentous laxity. My hunch is she does.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

I believe we owe it to our patients to treat them like family. If this were your son or daughter, would you perform an unpredictable epiphysiodesis? The answer is NO. A CBWO has been done historically with much more predictable results. Keep it simple on this type of deformity.   

Thomas Brosky II, DPM,  Oakwood, GA, drbrosky@gmail.com

RE: CryoProbe Hand-Held Device (Michael A. DeVito, DPM)
From: Multiple Respondents

CryoProbe can be purchased straight from Cryosurgical Concepts. Go to cryo-surgical.com for more info. The vice-president is a retired podiatrist, Dr. Sheldon Willens, and will be more than happy to answer any of your questions. Regarding pricing - there are now 3 different models of units and I believe 3 different types of cartridges, so it's best to get updated pricing directly from the source. I have the original model and I do like it. I don't find that it works all the time. However, I don't know any treatment that is effective on warts 100% of the time.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

I have used a first generation CryoProbe for a couple of years now, and find it indispensable. Cartridges run about $3 or so. After trimming the wart's callus, I apply the probe's N2O and inform the patient that the area may be sore for a day or so. I'll often combine the treatment with QD home use of PlantarStat (TriPod Labs). It may take visits every few weeks for resolution, but so far my success rate is above 90%. Sure beats that old CO2 laser, whew what a stink! I highly recommend the CryoProbe.

Dan Waldman, DPM, Asheville, NC, dpmcareer@aol.com

I have been using the CryoProbe since 2007 with good results. It is much easier to use and keep than liquid nitrogen. The company stands behind the instrument, with excellent follow-up service. I believe that I paid somewhere in the neighborhood of $1,500. The cartridges are fairly reasonable. I purchased it from Dr. Sheldon Willens who demonstrates its use at a number of podiatric meetings. 
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: Medicare Demand For Overpayments (Bryan C. Markinson, DPM)
From: Lloyd S. Smith, DPM

I know and respect Dr. Mullens.  His comments are on target and reflect a well-documented effort by CMS to target all provider groups that have demonstrated patterns of fraud and abuse. If anyone were to read the OIG work plans of the past 20 years.. I have read them all..  the things that podiatrists do are targeted and the word podiatry is often mentioned. I led an APMA meeting with the OIG regarding onychomycosis and its treatment. The APMA comments were ignored. If one were to review the current CMS proposed final rule, the pattern continues.
 
I do not feel that podiatry is being singled out but certainly feel that CMS and other insurance companies recognize that podiatrists can be reviewed with minimal effort and maximum recoupments. For those of us who work in small office practices, this threat is real and frequently felt, with requests for records and demands for substantial financial payments. Nothing in practice is more unnerving than this kind of letter. I know many of my fellow DPMs have felt this pain.  

 Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com
 

RE: Sign of the Times
From: Peter Bregman, DPM

An elderly veteran came to see me yesterday. I had not seen him in a few years. He had been seeing my associate who usually performs the diabetic "routine" foot care in the office. The patient wanted to see me instead of my associate. When I saw him, he said that the other doctor did not want to handle his ingrown toenail that had been bothering him for years. So, I performed a partial matrixectomy and debrided the rest of his nails, and we talked baseball. 

Just before I performed the procedure, he tried to pay me an extra $50.00 for seeing him instead of his having to see my associate. I told him that was silly and to put his money away. He then took out  $20, and before I could stop him, placed it down on my sterile field. I gave that back to him and used a new sterile field, and told him that he did not have to pay me extra. I thanked him for his service to this country.

I bring this up because I think the man lived in a time when doctors were thought of as healers and not so much as the business people  that we have to be sometimes. Even though I have only been in practice for 13 years, I feel that a lot of people treat doctors like car dealers rather than the healers that most of us attempt to be. I wonder where we are headed now?  

Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

ASSOCIATE POSITION - CHICAGO AREA

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

OFFICE SPACE/ MRI RENTAL – NYC, LI  
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

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