The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 12, 2011 #4,231 Publisher-Barry Block, DPM, JD

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We've just mailed the August 2011 issue of Podiatry Management. This 220-page special issue includes our cover story, "Innovations, Opportunities, and Challenges: Surgical Podiatry 2011" by  Dr. Lowell Scott Weil, Sr. You'll also find a roundtable discussion, "Surgical Podiatry" as well as an assortment of features, including our informative columns, and a CPME-approved CME.

August 2011 Podiatry Management

Very Few Runners Benefit from Minimalist Shoes: GA Podiatrist

Traveling by foot 6.2 miles, with little to no foot cushion, makes Peachtree medical co-director Dr. Perry Julien wince. “With glass and metal on the road, you can hurt yourself very badly,” he said. “Our environment is not the jungles of Mexico.” Julien has seen a growing number of patients at his podiatry practice with stress fractures, pain in the ball of a foot or Achilles tendon, or plantar fasciitis because they ran too far too soon in a minimalist shoe. 

Dr. Perry Julien

“People say, ‘But that shoe can’t hurt me. It’s helping me!'” Julien said. “Then why are you in my office?" I say. "Within one to two weeks of changing their shoes, they stop having problems. My guess is that these shoes have a place for a very small percentage of runners, but saying these will change your life is a dangerous statement.”
 
Source: Michelle Hiskey, Atlanta Journal-Constitution

Elderly Should be Treated for Poor Posture: UK Podiatrist

Pat Turnball has been invited to speak at a Pedorthic Footwear Association Conference in Albequerque, NM to help improve the quality of life of elderly people around the world. The podiatrist, who has a surgery center will be talking about the effect of medical and neurological problems on the way we walk. She said, “There are a lot of problems that can be reversed. A lot of older people are bent over their walking stick. This constricts their lungs and heart and nothing works properly.” 

Pat Turnbull

Pat told the Guardian that she would like to see road signs that show elderly people hunched over walking sticks banned. She said, “It’s terrible as there’s no need for to depict older people with bent, stooped posture. “We want to get to people before they get to that stage. Education could solve a lot of problems. There will soon be more people over 50 than under 50, yet it’s a subject that isn’t addressed.”

Source: David Morgan, Knutsford Guardian [8/9/11]

Study Finds Wide Interest in EHR Incentives

Most Florida doctors caring for Medicaid patients would be interested in applying for federal electronic health-record incentives, according to a study published in this month's issue of Health Affairs. More than 60% would be interested in the incentives payments, according to research presented by Dr. Nir Menachemi, associate professor in the department of healthcare organization and policy at the University of Alabama at Birmingham. Of those already using EHR, 86% replied that they would apply for incentives.

The Health IT Economic and Clinical Health Act of 2009 established the federal meaningful-use criteria, which cited improved healthcare quality and better organization. However, doctors are slow to move toward those standards. The study showed 69% of physicians worried about the cost of adoption, while 42% needed more information about the incentives and another 42% are confused on which EHR system to buy

Source: Ashok Selvam, Modern Healthcare [8/10/11]

Do You Really Need an Office Manager?

Management consultant Keith Borglum says that the need for an office manager depends on the medical practice's size and the amount of management responsibility physicians are willing to accept. In Borglum's experience, small practices of one to three physicians do not need an office manager, as they are sufficiently small and simple that the physicians should be the managers. Not having an office manager can lead to lower overhead, and a small practice can manage without one by having physicians and staff convene once a week to talk about practice issues.

Practices that add a fourth provider probably will need an office manager. Among reasons for installing an office manager is the need for someone to inspire staff to exceptional performance, and to seek ways to improve. An office manager is typically someone who provides data and answers, guards the office’s internal and external information, and guarantees the practice' adherence to regulations and statutes. Borglum also points out that office managers make and implement decisions so that doctors do not have to.

Source: Keith Borglum, Modern Medicine [07/25/1]) via This Week @ ACFAS 

RE: Clinical Summaries (Michael J. Hodos, DPM)
From: John Sherman, DPM
 
My clinical care group has used an EMR called Epic Care for the last 15 years. Since 2008 or so, there has been an initiative to provide all patients with an after-visit summary on completion of each visit. This basically consists of current medications, upcoming appointments with all providers in the group as well as the next appointment with me, new tests or medications ordered that day, and any instructions deemed necessary for the patient. This is customized by either the provider or assistants as needed, printed and reviewed with the patient on discharge.
 
On occasion, patients will present a form from their group home or assisted living facility looking for details of their visit. Instead of trying to write legibly on their one page form, I print an encounter summary which provides all information from the visit including my note, test results, and the after-visit summary. This is much more convenient for me and provides more accurate data for the given facility providers that anyone can read.
 
This EMR has been an invaluable tool in time management, reduction of paperwork, as well as collation and clarity of documentation.

John Sherman, DPM,  Medford, MA, John_Sherman@vmed.org

RE: Clinical Summaries (Michael J. Hodos, DPM)
From: Jeffrey Kass, DPM

When the idea of EMR/EHR came out, I was under the impression this would be a "green idea." I was under the impression that it would reduce the amount of paper, hence save trees and be good for the environment. Dr. Hodas brought up "clinical summaries." I see a lot of senior citizens who do not deal with computers. Even, my younger patients get enough e-mail and prefer not to get anymore. This leaves me printing outpatient summaries. The program I am using is currently printing out the summary on two pieces of paper. I am not sure what is going on in other offices, but I have been purchasing more reams of paper than ever before since I began going "paperless."

What I don't understand is what purpose the clinical summary achieves if I have to document that I took or obtained patient height, weight, and B.P. and I can attest that I reviewed this information. Why can't a doctor attest that he reviewed the patient medications and whatever info is in the clinical summary?

Additionally, I was informed one only needs to list one allergy (if the patient has one) and one medication to qualify for meaningful use. If this is correct, then it isn't even a complete record anyway, and so what value is there in the clinical summary anyway?
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Medical Missions (Andrea Mills)
From: Krista Richter

Two of the societies I work with offer mission trip options:
 
1) Assn of Extremity Nerve Surgeons - Ecuador - leprosy patients and extremity nerve surgeries only.
* Space very limited and students would be allowed upon approval of experience .
* Costs would be covered by volunteer, unless grants are given for the trip for residents/ staff/ students.
* Since this is advanced surgery and MDs also provided hand sx, it is rare students go, unless they have done externships.

2) Texas Podiatric Medical Foundation -
San Miguel de Allenda, MX Mission - July annually. 2012 pending travel safety issues. Travel grants provided for students and residents and based upon availability. Submit request via e-mail with professor referral. Spanish a plus. Provide clinic, surgery to adults and children for lower extremity care. Also provides shoes to three orphanages.
Santo Domingo, Dominican Republic - NEW mission this year - Aug 17-21, and will return Feb 2012 dates TBA. August mission is full .  Volunteers have to be approved by government 3 weeks prior. We will provide clinic and sx for adults and children through the government hospital there. Travel grants will be available for 2012 trips for students/residents, Spanish a plus.
 
3)  Honduras Mission - Dr. David Cavallaro, Oklahoma.
The TPMF is affiliated with this mission and helps provide supplies  The missioon to San Pedro Sula, Honduras provides predominantly surgery for adults for lower extremity care. Volunteers pay their own way unless travel grants are given. Dr. Cavallaro runs the mission, and it goes twice a year: Jan. & July. His phone is 405-631-2333.

Krista Richter, Director, Texas Podiatric Medical Foundation, krista.richter@yahoo.com

RE: Medical Missions (Andrea Mills)
From: Jefferson J. Mennuti, DPM

There is a grassroots medical mission to Cameroon being started here. It will be around March, 2012. If you are interested, you can e-mail me.

Jefferson J. Mennuti, DPM, Orange City, FL, Instfootankle@gmail.com

RE: NY Podiatrist Develops New Cosmetic Approach to Bunion Procedure
From: Leonard Vekkos, DPM

I was knocked off my chair when I read the news item regarding the podiatrist in NY who developed a “New” approach (medial incision) for bunion surgery and actually trademarked the name, Slimline Bunion Surgery. And we sometimes wonder why the medical profession (orthopedic) develops their misplaced opinions about podiatry. Does PM News print these articles because they believe this represents the finest our profession can produce or to stimulate discussion?

I enjoy the input from our colleagues and learn quite a bit from PM News. But this “new” technique smacks of self-promotion gone awry. Thanks PM News for this morning’s jolt. I won’t need coffee for the rest of the day.
 
Leonard Vekkos, DPM, Woodridge, IL, drvekkos@footandanklewellness.com

Editor's response: The function of the "Podiatrists in The News" section is not to educate (although it sometimes does) but rather to highlight podiatrists who have appeared in the media. We don't necessarily approve or endorse any concepts discussed. Since the APMA has limited funds to market podiatry, our profession must rely on practitioners to promote the profession. If we don't promote ourselves, nobody else will.

RE: RAC Program Collects $233 Million
From: George F Jacobson, DPM

If you do the work and document correctly, you will not lose money.  You will get paid and even recover underpayments. Even though their request to my practice was less than $200 last year, my notes spoke for themselves, and I won each challenge. It would have been less time-consuming not to review each claim, but it could be an admission that something was wrong with my submissions. I wanted to be vindicated. I wonder how much of the $233 million was just conceded out of frustration. Maybe we should start a new program called ANTI-RAC to defend honest, hard-working doctors.
 
George F Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

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Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. $10,000 advance incentive to help move & immigration and work contract. Reply to dr.cole@shaw.ca

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