The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 10, 2009 #3,593 Publisher-Barry Block, DPM, JD

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CT Podiatrist Provides Advice on Choosing Proper Athletic Socks

“The key factors to choosing proper athletic socks are stitching and materials,” said Dr. Joseph DiFrancesca, a Norwich podiatrist on the Backus Hospital Medical Staff.

Dr. Joseph DiFrancesca

The best socks are those that have no stitching since these serve as a source of irritation. He agrees that materials should be both wicking and antimicrobial. DiFrancesca recommends socks made from merino wool since they have natural wicking properties and silver-based fibers that reduce infection and odor.

Source: Anthony Alessi. MD, The Norwich Bulletin [7/7/09]
 

Court Rejects Physician Challenge to Change in Self-Referral Rule

A federal trial court turned down a challenge brought by a group of physicians and physician-owned entities to a recent change in the federal self-referral rules that doctors worry could harm patient care.

The Stark law generally prohibits physicians from referring patients to entities in which they have a financial stake. Centers for Medicare & Medicaid Services rules now interpret an entity to include only the party that directly bills Medicare for designated health services. But as of Oct. 1, CMS will use the term entity more broadly to include those providing the services billed to Medicare. This policy change was detailed in a final rule released in August 2008.

Some legal experts say the ruling leaves in place a new rule likely to invalidate many physician-hospital arrangements and diminish patient care. The decision also could make it more difficult for doctors to challenge related Stark law regulations in the future, they say.

Source: Amy Lynn Sorrel, AMNews  [7/6/09]

A One-Word Tactic to Beat Negativity

Take this simple step to greatly decrease negativity in your workplace:

Replace the word “problem” with “situation”: What difference will that make? When you have a “problem,” you feel stuck with it. When you have a “situation,” it seems temporary and solvable.

Source: Adapted from “Magic Words That Change Negative to Positive,” Harriet Meyerson via Communication Briefings

Part 5 -  More answers to some key questions. By David Mullens, DPM, JD 
 
3. How do you appeal a demand for repayment of an overpayment?

Overpayments are appealed exactly the same way underpayments are appealed. However, and this is a huge “however”, in order to stop the recoupment process in its tracks during the Redetermination appeal, you MUST submit your Redetermination appeal within 30 days of receiving the notice of overpayment. Similarly, in order to stop the recoupment process in its tracks during the Reconsideration appeal, you must submit your Reconsideration appeal within 60 days of receiving the Redetermination decision. In either case, if you exceed the statute of limitations, the contractor will start recoupment of the full overpayment amount, plus interest, from your future earnings.  Don’t let them do this! Get your appeals in early.

4. What are the chances the contractor will decide in your favor at the Redetermination appeal level?

Zero. The contractor gets to pocket a portion of the overpayment amount recovered.

5. What are the chances the QIC will decide in your favor at the Reconsideration appeal level?

Close to zero. The QIC wants to keep CMS happy so the QIC can get to keep the lucrative CMS contract.

6. What are the chances that the ALJ will decide in your favor at the ALJ Hearing appeal level?

Excellent. The Administrative Law Judges are truly neutral parties who are not bound by the decisions of the contractor or the QIC.  Your Hearing is a ‘brand new trial’ and the ALJ will consider all the evidence as though being presented for the first time. Moreover, with rare exceptions, the ALJs are not only fair, they also understand the financial motivation of the contractors as well as the difficulties inherent with record-keeping in the day-to-day practice of medicine.  Your records do not have to be perfect, they just have to legibly show what you did and why you did it – in a way that makes sense to the ALJ.

Query: Bone Lesion of Hallux

A 47 y/o male presented to my office with complaint of a painful lump on his L hallux of 4 years duration which occurred after a "jamming" impaction-type injury. PMH is negative. He never sought treatment until now. There is pain with direct pressure on the area and there is nail dystrophy (thickening and incurvation on the lateral border). According to the patient, the lesion has been unchanged in size over the last 4 years. 

Bone Lesion of Hallux

X-rays show what appears to be an expansile, loculated, cystic-type bone lesion. I would appreciate any suggestions as to what type of tumor this may be, as well as treatment recommendations? I am concerned that without some type of bone grafting, excision/curettage of the lesion may lead to instability. Any recommendations for grafting/fixating this?

Judd Davis, DPM, Colorado Springs, CO

RE: Recurrent Bunion (Richard Frost, DPM)
From: Multiple Respondents

Dr. Frost’s patient has hallux limitus (evidenced by uneven narrowed 1st MTP joint space and clinical presentation of decreased 1st MTP ROM). Her bone stock looks pretty good on film, so I'd perform a traditional step-wise hallux limitus repair w/ sesamoid release from the plantar metatarsal head and Youngswick 1st metatarsal osteotomy. In addition, the capital fragment can be laterally transposed to address the residual mild IM angle. This should address the residual bunion and 1st MTP joint stiffness. You can follow w/ PT for aggressive post-op passive ROM exercises.

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

I have seen similar patients over the years. The joint is arthritic on x-ray. Even with 40 degrees of motion, I have performed many 1st MTPJ arthrodeses on similar feet. This operation is especially effective in ligamentously lax patients with a clinically-evident hypermobile first ray. I favor a single interfragmentary screw placed from the phalangeal base medially to the MT head laterally, and a 4 hole Acumed 3.5 locking plate. Patients are appropriately off-loaded for 6 weeks in an “ortho-wedge” shoe. X-rays typically confirm consolidation of the fusion at 6 weeks, when normal weight-bearing is permitted in a gym shoe or Croc. Patients are rendered pain-free with a straight great toe, and really have a high degree of surgical outcome satisfaction.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

The first metatarsal appears long and the cheater Akin didn't help the MTPJ. Is there an elevatus? How active is this patient? An arthrodesis may be necessary due to degenerative changes to the joint. Shortening the first, as the late Irv Pischker used to say, may also help to decompress the joint if there is any salvageable cartilage left.

David Dragoo, DPM, Mexico, MO, daveftdr@aol.com

RE: Sign of the Times (Peter Bregman, DPM)
From: Ivar E. Roth, DPM, MPH, Michael M. Rosenblatt, DPM

Dr. Bregman wonders why a patient would view a doctor as a "car salesman" and not a "healer." Easy answer. Treat the patient as someone in need of care, not as someone to whom you are selling something. Be caring and concerned. Be professional. Act like a healer, not a salesperson. Start concentrating on meetings that teach you to be a better doctor and not a better salesman. Maybe your associate needs to read this letter.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.com

I agree with Dr. Bregman concerning his assessment of what patients see us as. My take on the current consumer thinking is that instead of being thought of as car dealers, we have become a commodity, just plug this Dr. in for another.

It was nice to see that this patient realized that there is a difference between doctors. I think the younger population sees us as all the same. I explain to my patients that Drs can be classified as A,B, C, doctors. As a concierge podiatrist, my patients get this concept and seem to understand that like everything else, we are all different and that we are not commodities like a car, where a Chevy is a Chevy, etc.

For those of you out there practicing who feel different and want to be treated and work in a “better” environment, I would strongly suggest looking into being a concierge podiatrist. Practice is great every day.

Ivar E. Roth, DPM,MPH, Newport Beach, CA, ifabs@earthlink.net

RE: OIG's Targeting Podiatrists (Lloyd Smith, DPM)
From: Michael M. Rosenblatt, DPM

Dr. Lloyd S. Smith discussed OIG's "targeting" of podiatrists. Even though he states that OIG does not specifically target podiatrists (compared with other providers), we are an "easy target."   OIG audits should not go un-questioned. I questioned one on nail care and I believe successfully debunked it. I think OIG was shocked at my response (which was scientifically based), identifying their "report" as politically biased nonsense. (My rebuttal is published in Podiatry Management Online: http://www.podiatrym.com/pmarticle.cfm?id=44)

Dr. Smith is correct that "requests" from OIG can be unsettling. If you receive a request from OIG, you must first determine whether you are obligated by law to satisfy it. You should hire a healthcare attorney FIRST. You will typically be given a time frame to respond, and as long as you stay within that, you should have no problems.

If your attorney advises that you have "no legal obligation" to respond, I would tell you if it were me, I would ignore it. (I cannot provide legal advice). If you are subpoenaed for documents, you should stay within strict guidelines of their demand, sending in nothing extraneous, satisfying only minimum documentation requirements.

APMA has told us several times that they don't trust OIG. Dr. Smith reiterated that same advice in his most recent letter to PM News.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Medicare Demand For Overpayments (Bryan C. Markinson, DPM)
From: Dennis Shavelson, DPM

Dr. Mullens completed Dr. Marvin Steinberg’s and Dr. McGlamry’s residency programs in the 1970’s. He has been a teacher, author, and now that he has complemented his DPM degree with a law degree, serves our profession from a special perspective. David can make a living with or without offering his advice and expertise to us.

There are few who wish to offer the profession opportunities to be educated, acculturated, and upgraded in order to practice in a healthier environment. Dr. Mullens is giving us a great deal of information and his time for free. Let's appreciate that.

Dennis Shavelson, DPM, NYC, NY, drsha@lifestylepodiatry.com

PRACTICE FOR SALE – WESTCHESTER COUNTY, NY

Established 30+ year old practice. Well respected podiatrist in beautiful Westchester County Owner ill and needs a quick sale. Mixture of surgery and general podiatry. Hospitals in close proximity. Will lease office to buyer. Call Mali McGrinder at 914-434-1663.

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 - 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 .comf-massuda@footexperts

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

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