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PM News

The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily


August 18, 2009 #3,626 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

PM News

The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily


August 18, 2009 #3,625 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Aetrex Launches Sandalista Program

Allow your patients to experience a revolution in sandal design with the new Aetrex Sandalistas series.Created by renowned footwear designer Susan Ryder this collection features classic double buckle, thong, step in and dual strap patterns in rich seasonal colors in whole and half sizes 5-11.

“ These new sandals from Aetrex have been very well received by our patients. They look great and the foot bed is incredibly comfortable.” Dr. Marybeth Crane, DPM, Grapevine, Texas

A functional custom orthotic for any sandal can also be ordered via a program with Rocky Mountain Orthotic Labs.

The sandals can be viewed at www.aetrex.com/pm-sandalistas or call Aetrex at 800-526-2739 for a catalog or to schedule a presentation with your Aetrex  representative.


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PODIATRISTS IN THE NEWS

This Year's High Heels Taller Than Ever: NY Podiatrist

Thanks to the towering stilettos being introduced this season, there were a multitude of models wiping out on the runways. Just check out YouTube to see some of the carnage. "This year's heels are taller than ever and offer less support — and the higher the heel, the more damage that can occur," says New York City podiatrist Johanna Youner, D.P.M. Over time, the extra weight on your forefoot can lead to pinched nerves and joint problems such as bunions or hammertoes (sexy, huh?). "I've also seen women who literally fell off their shoes, fracturing their foot or spraining their ankle," Youner says.

Dr. Johanna Youner

Do stick with a two-or three-inch heel and a rounded or open toe. This will distribute your weight more evenly and make room for swollen tootsies. "Instead of spindly stilettos, look for wedges, platforms, or thick, stacked heels—as well as a firm back or straps to keep your foot secure in the shoe," Youner says. For extra shock absorption, consider having a leather outsole replaced with a rubber one, and adding a thin gel or foam insole, such as Dr. Scholl's for Her ball-of-foot cushions.

Source: Dennie Hughes, Women's Health [8/17/09]
 

ANNUAL SURVEY NOW ONLINE - WIN VALUABLE PRIZES

Congratulations to Jacqeline Chen, DPM of Waynesville, MO, winner of a TempTouch® Value $99.99)..

We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2010 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

Foot and Ankle Radiology
 

This week's prize is a copy of Foot and Ankle Radiology by Robert A. Christman, DPM  (Value $230) .

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

The PERFECT Diabetic Sock is Here

Dr. Comfort has created the perfect diabetic sock.
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Your patients are looking for a high quality, comfortable diabetic sock. Why not provide them the perfect sock for their diabetic condition? Call 800-556-5572 or email Dr. Comfort  now to learn more.

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AT THE COLLEGES

Cosmetic Foot Surgery Not Worth the Risk: TUSPM Podiatrist

What's the cost of beauty? How about a toe? Those high-heeled pointy toed shoes are fabulous until you put them on your feet and realize your foot isn't pointy. So what do you do? Dr. Tracey Vlahovic, a podiatrist with Temple University's school of Podiatric Medicine, says some women are electing to have foot surgery: “Having their foot toe amputated, having the toes shortened or having what some call a toe tuck to wear these shoes when they didn't necessarily need to have these procedures just to wear these shoes.”

Dr. Tracey Vlahovic

But the gain isn't always worth the pain: There's always a risk with infection, deformity as well as painful scars and things like that with foot surgery.” She suggests women wear a shoe that better resembles the shape of the foot and pull out the stilettos on special occasions.

Source:  Lynne Adkins, KYW, [8/15/09]

AT THE COLLEGES

NYCPM Podiatrist Helps Select Best Children's Sneaker

For kids, not just any sneakers will do. The Good Housekeeping Research Institute put 20 pairs, $60 or less, through their paces. Our Textiles Department sliced each shoe in half to measure for cushion thickness, and bent whole soles forward to record where the sneaker flexed (hoping they'd flex at the toe of the shoe to assist the way a child naturally moves) — both important for active, growing feet. We also asked pediatric podiatrist Russell Volpe to evaluate the shoes for cushioning and heel and arch support.

Dr. Russell Volpe

The runaway winner was the New Balance 630. These sneakers were evaluated in girls' and boys' models. Both did very well in all performance tests, rating excellently in cushion measurement and shoe flexing. Dr. Volpe especially liked the support in the heel and toe areas, but did say the thick cushioning could have had a little more "give." 
             
Source: GoodHousekeeping.com [8/17/09]

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PODIATRISTS AND SPORTS MEDICINE

Running Barefoot Not for Everone: CO Podiatrist

The pavement begins to warm under the summer Colorado sun as Michael Sandler jogs up Flagstaff Road near Boulder. Normally, this shouldn't concern a runner. Sandler, however, is jogging barefoot. "When you are barefoot, you are forced to run the way ancient man ran, which is a soft dance," Sandler said. "Even my upper body got stronger."

Dr. Eugene Rosenthall

He claims he can run farther and with less chance of injury now that he has left his running shoes in the closet. He's far from the only runner who believes so. The number of barefoot runners appears to be a growing niche among the running community. Those who run barefoot maintain it helps them keep a stride that delivers less shock to the foot, helping prevent injuries.

But experts caution that only a small percentage of runners can successfully train sans shoes. "Your muscles, tendons and bones are balanced if your shoe is properly fit and your foot is properly supported," said Eugene Rosenthall, a local podiatrist, who said he would never recommend running barefoot.

Source: Anica Wong, The Denver Post [7/22/09]

ON THE INTERNATIONAL LECTURE CIRCUIT

Podiatry, Vascular Surgery and Limb Salvage Front and Center in Beijing

Hundreds of delegates from throughout Asia convened on the site of a former palace outside the Chinese capital to discuss methods to reduce diabetes-related complications across the region. "This problem can't be overestimated." noted Dr. Robert Frykberg, Chief of Podiatric Surgery at the Carl T. Hayden VA Medical Center in Phoenix, "We need to continue to build teams to fight it."

(L-R)Prof. Ben Lipsky , Dr. Robert Frykberg, Prof. Aziz Nathur, and Prof. David G. Armstrong in Beijing.

This topic was one that fit squarely with the subject matter broached by Frykberg's colleague, Prof. David G. Armstrong of the Department of Surgery at the University of Arizona. Armstrong noted, "What we have to understand, is that, in the fight for amputation prevention, teams trump technology. When we put people together that care about stemming the amputation tsunami, we can literally beat back the tide."
 



E-HEALTH NEWS

Practices See Slow Progress in Instant Claims Adjudication

Real-time adjudication, which allows a claim to be submitted to an insurer and settled before a patient leaves the office, seems like something physicians, patients and insurers can support. Physicians who use it can shorten the revenue cycle and reduce bad debt. Patients like it because they don't get a surprise bill weeks after receiving care. Even insurers like it, because administrative costs of billing and handling inquiries about claims are reduced.

But real-time claims adjudication has barely made an impact. By at least one insurer's reading, fewer than 2% of claims are settled this way. While real-time claims adjudication sounds simple, implementing it can be complicated and can require a physician's office to change how it handles billing and collections.

Those submitting claims for real-time adjudication find that in almost half the cases, the claim cannot be processed immediately and is handled later by the insurer. Although this might not require additional work for office staff, the low yield is a factor discouraging physicians from participating. Meanwhile, without a standard adjudication system, physicians may have to customize their processes for each different insurer.

Victoria Stagg Elliott, AMNews [8/1709]

PODIATRIC TRAGEDIES IN THE NEWS

4 Arrested in Murder of Retired MI Podiatrist

A retired Brighton podiatrist who died after stumbling into a Michigan Avenue restaurant last week was the victim of a robbery scheme by two prostitutes he'd picked up earlier in the day, police said Sunday. Two men and two  women were arraigned today on murder and other charges related to the Aug. 9 death of Dr. Gary Ceresnie, 54, of Farmington Hills.

An autopsy showed that Ceresnie died of a heart attack caused by multiple injuries in a violent assault, according to court records. The autopsy investigator ruled Ceresnie's death a homicide.

Source: George Hunter and Catherine Jun, The Detroit News [8/16/09]

Essence Insolestm are a revolutionary new product designed by KLM Orthotics

Essence Insolestm use the engineered CP-Cobratm shell to form an OTC insert for women’s high heel shoes -- even spike heels and boots.

The CP-Cobratm shape allows the shell to bend smoothly over any shank, regardless of heel height, while maintaining the integrity of the arch. The CP-Cobratm shell is encased between a Prima Leather top cover and Fuschia Suede bottom cover for a stylish look and excellent shoe fit.

Essence Insolestm are designed to reduce stress on ankles, legs, and back while improving balance and stability. 

You will be amazed how well they fit and how much support they provide.

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SureFit™ extends 15% off all BIOFREEZE®

 SureFit is pleased to offer a 15% Discount off all SureFit purchases of BIOFREEZE products through August 31st.

Noted for its use to reduce pain, massage muscles and joints and increase range of motion, BioFreeze is available in Gel Pump, Tube, Spray or Sanitary roll-on.  Promotion is applicable to all sizes and packaging options.  Detailed sizing and part number information is  provided on page 125 of the SureFit Product Catalog Call SureFit Customer Service today at 800.298.6050 to request a catalog or place an order.

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QUERIES (CLINICAL)

Query: Persistent Hot Feet

I have a 41 year old female patient who complains of "hot feet all of the time." They are not sweaty or odorous feet. She says that she has to wear sandals all summer and even prefers to wear these in the winter time, as well. She has trouble sleeping at night because of it, and in the winter needs to go outside barefoot to cool down (we live in Wisconsin). In the summer months, she will soak in cool water several times per day.  

Her only past medical history is hypothyroidism, for which she takes Synthroid. She has had a complete vascular workup, which has come back negative. Negative lab tests for diabetes. She has no other parts of the body which exhibit the same symptoms. This has become progressively worse over the past year or two, to where it happens every day. She has no other foot or general body symptoms other than onychomycosis that is currently being treated with Lamisil therapy (6 weeks in). Any help would be appreciated.

Bob Sage, DPM, Beloit, WI

CODINGLINE CORNER

Query: Denial of Application of Wound VAC 

I am getting a denial secondary to "procedure code is inconsistent with the modifer used or the modifer is missing."

The code billed was CPT 97605 (negative pressure wound therapy [e.g., vacuum assisted drainage collection], including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters) with a "-79" (unrelated procedure or service by the same physician during the postoperative period) and "LT" modifer.

Example: CPT 97605-79-LT What do I need to do to be reimbursed?

Samuel Rameas, DPM, Camillus, NY

Response: We have not been told what the insurance type was (e.g., Medicare, non-Medicare, etc.). We also were not told what [original] procedures the global period was to cover. These are also factors that may affect the proper coding of the claim.

The problem might very well be either the use of a "-79" modifier or the "LT" modifier, or a lack of specific modifier. For instance, under Medicare, application and performance of negative pressure wound therapy is considered under the "Physical Medicine and Rehabilitation (97001-97799)" section. CPT 97597, CPT 97598, CPT 97602, CPT 97605, and CPT 97606 are billed with a therapy modifier (e.g., "GP") when performed by a physician acting within the scope of his or her license with a goal of rehabilitation as a part of a therapy plan of care. Not including a "GP" modifier, if the patient is Medicare, would result in a payment denial.

The "-79" modifier you appended may also be throwing off the payer since you are stating that the negative pressure wound therapy is NOT part of the care/follow-up associated with another procedure performed (for which there is now an established global period). The "-79" modifier designates the therapy to be an unrelated service to that for which there is a global period. If the diagnosis, however, appears "related" in the eyes of the payer to a diagnosis associated with the original procedure (e.g., the same or similar diagnosis), a denial of the claim could be the result.

And, lastly, the use of the "LT" is not necessary since the payment is not based on left or right anatomical treatment locations, but instead is based on total surface area treated.

Harry Goldsmith, DPM, Cerritos, CA,

Codingline subscription information can be found at:
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RESPONSES / COMMENTS (CLINICAL)

RE: Persistent Hot Feet (Bob Sage, DPM)
From: Barry Mullen, DPM, Elliot Udell, DPM

This sounds like erythromelalgia. I have only seen three or maybe four cases of true erythromelalgia in over 30 years. Malignancy should be ruled out by the patient's internist. After that, try placing the patient on a selective seratonin uptake inhibitor. One theory is that the cause of the problem is the same as what causes clinical depression in the brain. 

I've used Zoloft in the past with great success but there are newer medications out. Cymbalta is one such pharmaceutical. Start at the lowest dosage and work your way up to therapeutic levels. If this is successful in blocking the symptoms, the patient will have to stay on the medication for life, and you will have to monitor this patient and order liver enzyme tests three times a year. Erythromelalgia is a very rare condition and there is not a great deal of data nor clinical studies to support any one drug of choice. Hence, we have to rely on anecdotal evidence from practitioners who have seen a handful of cases and have had success with a particular regimen.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

This case sounds like erythromelalgia, a rare disease (Mitchell's disease) characterized by intense vasodilation of the peripheral arterioles due to mild thermal exposure. Primary (idiopathic) and secondary (myeloproliferative disease, collagen vascular disease, mushroom poisoning) forms exist. Oral NSAID's, cyclosporines and some herbal medications have been tried with some anecdotal success. Homeopathic examples include Melgatin, Glemtax, and Mealtab.

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

QUERIES - (NON-CLINICAL)

Query: CT Scan with Air Contrast

Does anyone ever order a CT scan with air contrast? Is this a valuable tool, or is a basic CT scan just as good? Most radiologists in my area do not know what I am talking about when I approach them about it? I was advised by a very good ankle surgeon to consider ordering the CT scan with air contrast.

Lou Nordeen, DPM, Mechanicsville, VA

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MICROMAT NAIL-DRILL SYSTEM
FOR PATIENT COMFORT

Med-Pro Corporation features the Micromat 3000 Nail Drill System for debriding patients' nails by using a controlled water and alcohol combination spray. The spray also keeps the dust away from the doctor and down on the patient's feet, to be wiped away with a piece of gauze. Patients will love this drill as the combination of water and alcohol reduces the friction heat, allowing the doctor to work more aggressively. The Micromat features include variable speed control, spray adjustment, forward and reverse and a foot control. The nail drill system is manufactured in Switzerland. Med-Pro Corp. includes a two-year warranty on both parts and labor and a 30-day, money-back guarantee. All service is performed by Med-Pro Corp in the USA. We have just introduced a new line of autoclavable burrs to be used with the Micromat. However, the Micromat will also accept most standard podiatry burrs. For further information, go onto our website at medprocorp.com or phone us at 800-633-7761.


RESPONSES / COMMENTS (NON-CLINICAL) - PART 1

RE: Medical Mission To San Miguel De Allende Area Needs Volunteers
From: Krista Richter

The Texas Podiatric Medical Foundation sponsors a medical mission 3 times annually to interior Mexico to provide clinical and surgical care for the lower extremity for indigent adults/children. The next trip will be October 10-17. Volunteers receive travel planning assistance, group dinner, and Spanish overview course and a terrific experience! Travel grants for residents/students are available to cover air and hotel. Expenses are subject to business and charitable donation.  Supplies, shoes, and donations also needed. Contact TPMF if interested!  Help us Save Soles! 

Krista Richter, Texas Podiatric Medical Foundation,  krista@txpma.org
 

RESPONSES / COMMENTS (CLINICAL)

RE: Patient With Foot/Ankle Swelling (Theresa Hughes, DPM)
From: Rick Wittock, DPM, Daniel J. Tucker, DPM

Perform a diagnostic arthrocentesis of the joint to see if the patient’s symptoms are eliminated/reduced.  If this works, then scope the ankle; she likely has synovitis in the gutters from the injury, and this is difficult to isolate on MRI due to the associated edema which enhances all t2 images.

Rick Wittock, DPM, Saint Louis, MO, wittockr@sbcglobal.net

Most patients have considerable discomfort and or swelling for up to 2-3 months after an initial twisting injury of the ankle. From the results of the imaging studies you obtained, it would appear that there is no fracture, osteochondral or tendon injury, and no prior history of instability or ligament laxity. Protected immobilization, icing, NSAID use, activity modification, and physical therapy are all reasonable modalities to utilize at this point. 
 
If symptoms were to persist after an appropriate rehab course (6-8 weeks), I would attempt a selective diagnostic injection to decipher whether or not the problem is present "inside" or "outside" of the joint. Stress radiographs are of little value early on after an injury, given that there has not been adequate time for ligamentous healing to occur, and ankle arthrography has essentially been replaced by a good MRI study. 
 
In my experience, the residual complaints after twisting injuries of the ankle fall into 1 of 3 categories: pain, giving way, or combinations of both. Formulating a treatment plan depends on what the underlying etiology is, if after an appropriate course of conservative treatment, these complaints persist.
 
Daniel J. Tucker, DPM, Orange, CA, ReekaT@aol.com
 

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RESPONSES / COMMENTS (NON-CLINICAL) - PART 1

RE: User-Friendly EMR (Judith E. Rubin, DPM)
From: Multiple Respondents

I have helped many doctors select an EMR, and have found that what is right for one, is not necessarily right for the next. EMR's have different styles and work flows, and you need to select the one that best meets the style and work flow of your practice. Most importantly, your staff has to be part of the process since they will also be using the EMR. The proper way to select an EMR is to form a small committee in your office (I would suggest 2 or 3 members) and then have sales reps demonstrate various EMR's to the committee. They can then narrow it down to 2 software packages and present those to the rest of the office.

This method will help to find the EMR that is best for your office and will result in your entire staff feeling involved and vested in the process of moving to EMR. The staff involvement in the selection process will help ensure an enthusiastic attitude toward adoption of EMR in your office and will make the whole process go much more smoothly.

Take your time in the selection. Set time lines and deadlines that give the committee adequate time to make a decision but make sure that they know there is a date when that decision is expected.

Michael L. Brody, DPM, Commack, NY mbrody@tldsystems.com

I have Medinotes-e which is a relatively user friendly system; however, I do not recommend it because it is a stand-alone (or as I prefer to say, "closed-shop") system. That is, I cannot freely receive or share information from this program.  Medinotes was recently purchased by Eclipsys who will no longer support the Medinotes software after 2013 for a very obvious reason: under the proposed guidelines, this type of system will be obsolete.  Rather than looking into an EMR, you should be researching Electronic Health Record Systems (EHR).

In addition to EHR, I would suggest a complete practice management software system that allows you to complete the medical record and do scheduling, billing, etc. The complete guidelines for the federally mandated EHR have not yet been released. After they are released, I would suggest waiting a bit for the programmers to get the systems working correctly. There will be many security issues associated with EHRs (for instance, just how much of a patient's medical record does a podiatrist need compared to an internist?), and then there is that lag time where patients' medical records have to be loaded into the national system, etc.

Richard A. Simmons, DPM, Rockledge, FL, rasdpm32822@aol.com

I have been using PodMed Software Solutions by Leum Software for the last 4.5 years and I am extremely happy with it. I use not only their EMR system, but their full practice management software known as their PM software. It has made my practice run very smoothly. It is extremely user-friendly. Very easy learning curve. You can create your notes several different ways such as templates, building a note from a superbill (meaning you can click on your diagnosis and treatment codes on a superbill and the system can back build a note for you), dictation, use an assembler (if a patient comes in with multiple chief complaints you can handle each separately), use a blank note, or a combination of any of the above. The program was written by a podiatrist and that’s all that PodMed does, podiatry.

Disclosure: I am a paid consultant for Leum Software.

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2

RE: CT Scan with Air Contrast (Lou Nordeen, DPM)
From: Chris Browning, DPM

CT scan with air contrast is usually done as double contrast in an arthrogram to look for ligamentous disruption or capsular damage.  The air is the "negative contrast." Iodinated contrast that lights up on imaging is "positive contrast." You can read about this procedure at this link, which is taken from page 26 of: Imaging of the Foot and Ankle by Julia R. Crim, Andrea Cracchiolo, Reginald Hall.  
 
Chris Browning, DPM, Nederland, TX, chrisbrowning@att.net

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  DESERT FOOT CONFERENCE 2009
6th Annual High Risk Diabetic Foot VA Conference

For podiatrists, nurses, wound care specialists - All welcomed
Weds, Nov 18 - Fri, Nov 20, 2009
The Buttes, a Marriott Hotel, in Tempe, AZ
14 hours state of the art CME from Frykberg, Armstrong, Robbins, Joseph, Wukich, Andersen, Halpern and more
Co-Chairmen • Robert Frykberg, DPM, MPH and Jeffrey Robbins, DPM
•  Building interdisciplinary diabetic foot care teams  •   Improving self-management via educational interventions  •   Maintaining max functional potential after amputation  •  Review latest limb salvage research  •  Bring the family  •  programs for the kids  •  Escape your office routine to learn
Free for VA podiatrists, residents and other VA personnel. $150 for non VA podiatrists
LEARN MORE and REGISTER 
here or contact Nadine Taylor at 800-538-3375


RESPONSES / COMMENTS (NON-CLINICAL) - PART 3

RE: User-Friendly EMR (Judith E. Rubin, DPM)
From: Brian Doerr, DPM

I have been using DOX podiatry for the past 3 years and can tell you that it is the most user-friendly EMR out there. It is designed by podiatrists for podiatrists. The benefits of using DOX are numerous, however, I feel the biggest advantage is the fact that it is constantly being updated and that is included in the monthly fee. You don't have to buy a separate disk every year to get updates. It is a complete system from front office scheduling through the back office component and it integrates directly with Medisoft for billing. Nothing could be easier. One of the other benefits is that it is a web-based system so you don't have to maintain a server. All you need is an Internet connection anywhere in the world and you have access to all of your records. No more carrying around bulky charts.
 
Brian Doerr, DPM, Ft Myers, FL, DocDoerr@aol.com

I agree with Dr. Simmons' advice to wait for the Electronic Health Records guidelines to be published.

On a side note, I personally do not think a national public health record is a great idea or thet it will be fair, but it is the future. Placing the minimal benefits such a system will bring aside, imagine health insurance companies being able to review anyone's records to determine future coverage, pricing, etc. based on their past medical history. Even further, as technology advances, genetic mapping will be included in your record, and even though you may be in perfect health, your genetic predisposition to a disease will be monitored. Welcome to the "Brave New World" everyone.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com
 

RESPONSES / COMMENTS (NON-CLINICAL) - PART 2

RE: Referral Fees Under Stark Law (Richard Boone, Esq.)
From:  Shay E. Fish, DPM, Stanton C. Southward, DPM

I appreciate and value the contributions by Mr. Boone. He cited Virginia Supreme Court Rule of Professional Conduct 1.5, allowing for 'division' of fees among attorneys who are not in the same firm under the following circumstances:
 
(1) the client is advised of and consents to the participation of all the lawyers involved;
(2) the terms of the division of the fee are disclosed to the client and the client consents thereto;
(3) the total fee is reasonable; and
(4) the division of fees and the client's consent is obtained in advance of the rendering of legal services, preferably in writing.
 
This is similar to what takes place in my practice:
 
(1) the patient is advised of and consents to the participation of another physician (referral);
(2) the terms of the division of fees are disclosed to the patient (there is none, so this point is moot);
(3) the total fee is reasonable (because it is typically fixed by government/insurer formula and/or not set by trial); and
(4) the patient's consent is obtained in advance of being treated (allowing each physician to bill only for their service).
 
The fee structure for physicians is further restricted if they are members of the same practice, and when subjected to bundling concepts exerted by government/insurer. The glaring difference here is that it's considered unethical for physicians to do what the ABA says is appropriate for lawyers. I embrace our ethical rules whole heartedly, which makes this such an interesting juxtaposition.
 
Shay E. Fish, DPM
, San Antonio, TX, fishdpm@aol.com

I believe it is proper for the surgeon to compensate the referring doctor in cases where post-op care is provided by the referring doctor. Of greater concern are lawyer fees, contingency fees, fees for phone calls, fees for legal research. These are unheard of in the practice of medicine.

Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net


MEETING NOTICES

NEW ! ADVANCED PERIPHERAL NERVE 3 DAY WORKSHOP + SYMPOSIUM

Looking for something different for CME?  Enhance your practice with peripheral nerve treatment.
September 23-27, 2009 - Omni Hotel, Ft. Worth, Texas
Sponsored by the Association of Extremity Nerve Surgeons. 
Up to 37 ACCME Credits provided by approved provider New Hampshire Medical Society.
Includes:
Sept. 23- 25 = 3 day Hands-On Advanced Workshop with cadaver, didactic and live surgery (5 spaces left)
Sept. 25-27 = Annual Symposium with graft/ conduit lab, lectures, legal & research updates, round tables.
Location: 30 minutes from DFW airport in the heart of historic downtown & stockyards. 
Go to www.aens.us to download brochure or call 512-494-1125  info@aens.us
 


 First Annual TUSPM Alumni Association Foot and Ankle Seminar

October 3-4, 2009 @ 8AM-5PM
Being held at TUSPM-8th & Race Streets  - Philadelphia, PA 19107

Allen Jacobs, DPM, David Novicki, DPM, Justin Fleming, DPM, and More

16 CME Credits

Click HERE for the conference brochure or e-mail alumni.seminar@temple.edu
 

Net proceeds benefit the TUSPM Alumni Association’s Endowed Scholarship Fund.


RESPONSES / COMMENTS (NEWS STORIES)

RE: Obama's Amputation Remarks  (Russell J. Ellicott, DPM)
From: Marc Katz, DPM, Lawrence M. Rubin, DPM

There is no other profession that concentrates on preventing foot and leg amputations like podiatrists. This is a major part of podiatry, with many dedicated podiatrists doing research and studies. Where have you been? I believe that you need to do some research and find out what we do as a profession. Just look at the August issue of Podiatry Management (page 85).  We are known throughout communities all over the country for our skills. 

The president in his ignorance is therefore blasting podiatry.  He specifically said that the amount that goes to the surgeon was 20-40K. This was not just a small mis-spoken word. This was a major mistake. He did not say the total bill to the hospital. It is important in such a high position to get the facts straight. Also, nail cutting for at-risk patient is prevention, another area where we provide the best services and prevent complications. 

Of course, there are abuses in all specialties that need to be reined in to cut costs. Maybe we should be more worried about the fact that this legislation has no mention of tort reform.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

The heated debate in PM News over the interpretation of President Obama’s diabetic foot amputation remarks should not cloud one important fact: The President of the United States has brought prevention of diabetic foot amputations to the forefront of public consciousness. APMA statistics show that 80% of diabetic lower limb amputations can be prevented with an annual foot examination. This is the opportune time for podiatrists to demonstrate our profession’s outstanding ability to identify and eliminate hazardous diabetic foot problems that result in the human suffering and high costs of lower limb amputations. 

In Southern Nevada, we are taking advantage of this opportunity. I have the privilege of working together with the Nevada Podiatric Medical Association, the Southern Nevada Health District, and the Summerlin Nevada Lions Club to spearhead a brand new coalition dedicated to amputation prevention through early detection and prompt treatment of potentially hazardous foot problems. Named the Las Vegas/Henderson Nevada LEAP (Lower Extremity Amputation Prevention) Alliance – we are providing the “Bare Your Soles” Free Diabetes Foot Screening Program. Our mission is to make sure each of the 217,000+ diabetics in Nevada has access to an annual foot screening exam, either from their own podiatrist and/or the physician treating their diabetes, or at one of the “Bare Your Soles” Free Diabetic Foot Screening locations available to the general public.

Lawrence M.  Rubin, DPM, Director, Lower Extremity Amputation Prevention (LEAP) Alliance, lrubindoc@aol.com

RESPONSES / COMMENTS (NEWS STORIES)

RE: IME Doctor Liable Despite No Patient Relationship
From: Paul Kesselman, DPM

As one who conducts IME’s and peer reviews on a fairly frequent basis for a number of third- party payers, I am all too aware of the potential liability issues confronting those of us who conduct these examinations. Many of these patients are “fakers and scam artists” and have had multiple suspicious on-the-job injuries. Others have truly been victims of severe accidents (MVA’s or horrific on-the-job injuries) leaving them in chronic pain, chronically disabled, and often with great financial difficulty supporting their families.

While both groups present their own unique circumstances, the former group is especially worrisome. These patients are looking to add as many names as possible to the list of those they are taking legal action against. The latter group may be looking to get as much of a settlement as they can from anyone they perceive as having deep pockets. Should these patients claim they sustained any pain during your examination which subsequently worsened, this could certainly lead to legal action against your practice.

One of the key issues one must also be keenly aware of is....

Editor's note: The complete text of Dr. Kesselman's note can be read at: http://www.podiatrym.com/letters2.cfm?id=28195&start=1

PODIATRY MANAGEMENT'S AFFORDABLE ONLINE CME

You can Earn 30 CPME-Approved CME Contact Hours Online

Earn 15 Contact Hours for only $139
(Less than $14 per credit)
http://www.podiatrym.com/cme.cfm
Choose any or ALL (30 CME Contact Hours) from the 20 CME articles posted
You Can Now Take Tests and Print Your CME Certificates Online

CODINGLINE CORNER

CURRENT TOPICS BEING DISCUSSED ON CODINGLINE'S LISTSERV INCLUDE:

o Orthotic Allowance Reduction
o Billing for the Removal of Surgical Mesh
o Certificate of Medical Necessity
o Denial of Application of Wound VAC
o Primary vs. Secondary Tendon Repair 
 

Codingline subscription information can be found here


CLASSIFIED ADS

ASSOCIATE POSITION - NEW JERSEY 
 
Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

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

ASSOCIATE POSITION – SOUTH CENTRAL FLORIDA

Multiple offices, in Jupiter, Ft Pierce. Looking for associate who is surgically trained PSR24, willing to travel between offices. Competitive Salary base plus percentage. Position available immediately. Send CV and questions to alfootdoctor@yahoo.com

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

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

ASSOCIATE POSITION - MARYLAND (MONTGOMERY COUNTY)

Multi-office, well-established practice with surgical centers, digital x-rays, in-office vascular testing, ultrasound, EMR with voice recognition charting, and many other perks looking for personable, well-trained, motivated individual. Patient base available for immediate in-office productivity. If you are new or ready to change locations, contact us ASAP to discuss opportunities. Send resume and cover letter to mddpmassociate@comcast.net

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com  for quick deal.

ASSOCIATE POSITION - MARYLAND

Harford County, Bel Air, est. 1991, seeking PSR24/36, strong ethics, friendly demeanor. Associate or partnership opportunity for the right applicant. We provide onsite ambulatory surgical center, patient base, strong referral resources, billing, scheduling, and many technologies. Visit our website. e-mail your CV to drhoward@hlsfootcare.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

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.

PM News Classified Ads Reach over 11,500 DPM's and Students
 
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

CLASSIFIED ADS

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

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

ASSOCIATE POSITION – SOUTH CENTRAL FLORIDA

Multiple offices, in Jupiter, Ft Pierce. Looking for associate who is surgically trained PSR24, willing to travel between offices. Competitive Salary base plus percentage. Position available immediately. Send CV and questions to alfootdoctor@yahoo.com

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

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

ASSOCIATE POSITION - MARYLAND (MONTGOMERY COUNTY)

Multi-office, well-established practice with surgical centers, digital x-rays, in-office vascular testing, ultrasound, EMR with voice recognition charting, and many other perks looking for personable, well-trained, motivated individual. Patient base available for immediate in-office productivity. If you are new or ready to change locations, contact us ASAP to discuss opportunities. Send resume and cover letter to mddpmassociate@comcast.net

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com  for quick deal.

ASSOCIATE POSITION - MARYLAND

Harford County, Bel Air, est. 1991, seeking PSR24/36, strong ethics, friendly demeanor. Associate or partnership opportunity for the right applicant. We provide onsite ambulatory surgical center, patient base, strong referral resources, billing, scheduling, and many technologies. Visit our website. e-mail your CV to drhoward@hlsfootcare.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

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.

PM News Classified Ads Reach over 11,500 DPM's and Students
 
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

Disclaimers
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify me and you are hereby instructed to delete all electronic copies and destroy all printed copies.
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Guidelines
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Barry H. Block, DPM, JD
 
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