The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 13, 2011 #4,232 Publisher-Barry Block, DPM, JD

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Recent Advances in Orthotic Therapy

This week's prize is a copy of Recent Advances in Orthotic Therapy by Dr. Paul Scherer (Value - $129.95)..  

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

Chemical Neurolysis Improves Neuroma Outcomes: TX Podiatrist

The standard treatment for a neuroma is relatively limited and includes conservative care options such as massage, tape strapping of the foot, functional foot orthotics, changes in shoe type or style, decreased physical activities, and one or more cortisone injections into the involved area. When these conservative measures fail to relieve the patient's symptoms, surgical treatment is often recommended. Complications may include painful or unsightly scar formation, deep painful tissue adhesions, post-operative infection, and chronic swelling. 

Dr. Christopher Taylor

Chemical neurolysis, using a dilute solution of ethyl alcohol, offers a non-surgical alternative for treating a foot neuroma. The procedure, also known as alcohol sclerosing, involves a series of three to seven injections given on a weekly basis. It involves no surgery and up to an 89 percent success rate. “Providing chemical neurolysis has improved our patient outcomes and represents a significant recurrent annual cost savings,” said Capt. (Dr.) Christopher Taylor, Chief of Podiatric Medicine Clinic at Wilford Hall.

Source: Sue Campbell, San Antonio Express, [8/11/11]

Temple Wins IEI Awards

The Innovation and Entrepreneurship Institute (IEI) presented an award to Temple University students and faculty during their 13th annual Innovative Idea Competition Awards Ceremony at Alter Hall. Participants from eleven Temple colleges entered their projects for review by the IEI. The Innovative Idea Competition allows the opportunity for groundbreaking ideas and partnerships to collide in the hopes of creating new technology and business ventures. 

(L-R) Mike Mittelman and Dr. Jason Piraino

Partnerships within these applicants included TUSPM alumni and Assistant Professor Dr. Jason Piraino and Mike Mittelman from the Fox School of Business. Within the award category for graduate and undergraduate tracks, Dr. Piraino and Mittelman received second place within the upper track for their collaboration project, Angulous Orthopaedics. Dr. Piraino and Mittelman were also honored in accepting first place for the People’s Choice Award, which was conducted via live voting at the awards ceremony.

Source: Giovanna Ippolito, Strides

Human Foot is the Mirror of Health: APMA President

Forget aging gracefully. For today's baby boomers, it's more important than ever to stay healthy and active as they age. While growing older causes some unavoidable body changes, more boomers are focusing on healthy lifestyles that can help them prevent problems associated with aging - like mobility issues related to the feet and legs. Impairment of the lower extremities is a leading cause of activity limitation in older people, according to the U.S. National Center for Health Statistics (NCHS). 

Dr. Michael King

"Foot problems are a health concern that can lead to further complications like knee, hip and lower-back pain, all of which undermine mobility," says Michael King, DPM, president of the American Podiatric Medical Association (APMA). "The human foot has been called the mirror of health. Systemic problems often related to age, such as diabetes, arthritis, and circulatory disease often can first be detected in the feet."

Source: The Herald Leader [8/11/11]

Lawsuit Targets Medicare Pay 'Bias' Toward Specialists

Six family physicians in Georgia have accused the Medicare program in a federal lawsuit of illegally relying on a committee of the American Medical Association (AMA), which they hold responsible for paltry reimbursement rates for primary care physicians and inflated ones for proceduralists.

The lawsuit, filed this week in a US district court in Maryland, is the latest sign of a long-standing rift between primary care clinicians and specialists over Medicare compensation. The professional feud has been obscured recently by organized medicine's united efforts to replace the sustainable growth rate formula that Medicare uses to set physician pay.

Source: Robert Lowes, Medscape Family Medicine [8/10/11]

2010 Medicare Electronic Prescribing (eRx) Incentive Program Payment Update

The Centers for Medicare & Medicaid Services (CMS) has announced that incentive payments for the 2010 Medicare Electronic Prescribing (eRx) Incentive Program has begun for eligible professionals who met the criteria for successful reporting. Distribution of 2010 payments for the Medicare Electronic Prescribing (eRx) Incentive is scheduled to be completed by August 31, 2011.

Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or eRx incentive), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2010 eRx incentive payments, the 4-digit code is RX10. This code will be displayed on the electronic remittance advice along with the LE indicator.  For example, eligible professionals will see LE to indicate an incentive payment, along with RX10 to identify that payment as the 2010 eRx incentive payment. Additionally, the paper remittance advice will read, “This is an eRx incentive payment.”  The year will not be included in the paper remittance.

Source: CMS via Dr. Bret Ribotsky

Plan Meetings Like Projects

  Invest  in  the  proper preparation  time for running effective meetings and  follow  a  few guidelines:

•  Define the purpose of the meeting  in  one  to  three  sentences.  Next, divide  the  purpose  into  goal  statements that describe clear outcomes.
•  Determine meeting participants by choosing people directly involved  in  the  project.  Assign  key roles such as meeting coordinator, leader, facilitator, and recorder.
•  Plan and Prepare for the meeting by sharing relevant information and assigning preliminary work. Organize the meeting agenda by focusing on what attendees need to do to reach the goals. Conclude the meeting by setting in place the next steps, such as making assignments or scheduling another meeting.

Source: Adapted from “How to Hold a Lean Meeting,” Matthew May, OPEN Forum, via Communication Briefings

Query: ACell Xenograft Claim

We have been using ACell xenografts in the operating room. We bill for the application and let the hospital bill for the material.

In the office, we bill for the graft material (Q4119) applied to a Medicare patient. Would that claim go to DMERC or our regular Medicare carrier, Highmark? What modifiers should be used?

Brad Toll, DPM, Crofton, MD

Response: In checking the Highmark Medical Services LCD for human skin equivalents (L27549), you will not find either the product (ACell xenograft) or the HCPCS code for that product (Q4119) as a covered item.

Even though this product is a xenograft, most MACs would lump these types of products under the Human Skin Equivalent (or similar) LCD. So I would seriously doubt you would be covered for this product. For those products that are covered, you will bill them to the MAC, not the DMAC carrier.

If you use this product for a Medicare patient, have them prior to the application sign an ABN and file the product code with a "-GA" modifier. When you get your denial, you can then bill the patient. Remember to use the appropriate modifiers on the "Q" code for the graft and the wastage as outlined in the LCD even if it will not be a covered service.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Super Cushioned "Maximalist" Shoes Hit Running Shoe Stores
From: Kevin A. Kirby, DPM

Having been a distance runner for over four decades, I have seen many unique running shoe design ideas come and go. Especially in the last few years of seeing a "minimalist trend" in running shoes, I thought that possibly we were going to be seeing running shoe soles getting thinner over the coming years. That was, until yesterday, when I got to try on and briefly run in two very unique (dare I say revolutionary?) running shoes with very thick, super-cushioned, lightweight midsoles. The French company making these shoes is called Hoka One One (Maori for "fly over the earth").
 
The two Hoka shoes I ran in, the Mafate (a trail shoe) and the Bondi (a road running shoe), are the thickest-soled, most cushioned, and most surprisingly light and stable running shoes I have ever run in.  Even though I didn't buy a pair, I was very impressed that a running shoe could be designed with this much cushion and spring, and with the amount of frontal plane stability that these shoes possess, all at a shoe mass that is less than many traditional running shoes.
 
Even though I have no financial interest in these shoes, I do think that all podiatrists should seriously inspect and try on these shoes to see for themselves what may represent the most significant design breakthrough in running shoes over the past 20 years. Is the “maximalist shoe” the next running shoe buzzword?
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Medical Missions (Andrea Mills)
From: David L. Nielson, DPM

There are several trips you can choose from. A good start is IMVA.org which gives all the organizations in the world. Some specifics are:

Ligainternational.org (my favorite)
Docareinternational.org
Enapha.org

These vary from three days to several weeks. E-mail me if you have any further questions.

David L. Nielson, DPM,  Roanoke, VA, david.l.nielson@gmail.com

RE: Medical Missions (Andrea Mills)
From: Hal Ornstein, DPM

Having had the opportunity to speak with students from all the podiatry schools, it is clear that our future is bright with this young generation embracing volunteerism. Over last few months, I have been asked by students on several occasions about medical missions they can get involved with.

The American Academy of Podiatric Practice Management is putting together a list of all medical missions which we will share with all when compiled through a link posted on PM News. If you have information on medical missions that podiatrists can participate in, please e-mail your response to Shawna at swyatt@aappm.org and please provide as many details as you can. Thank you.
 
Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

ASSOCIATE POSITIONS – MARYLAND

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SPACE AVAILABLE- NYC & LI

SUB LEASING TIME on MRI (NYC)

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Revo arterial Doppler with all accessories, bought in August 2009.  Great revenue and practice builder. E mail advancedfoot1@aol.com for details.

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