The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 04, 2010 #3,922 Publisher-Barry Block, DPM, JD

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Flip-Flops Can Irritate Calf Muscle: NJ Podiatrist

Dr. James Walsh, a Cape May County podiatrist, said he sees an influx of flip-flop-related problems every summer. “They create an imbalance,” he said, adding that the problem goes beyond the flat bottom on the more cheaply made varieties. “The prong between the toes is a problem if you’re in flip-flops all the time. If you have an inclination towards problems with your arches, if you need support, than flip-flops are probably not your best choice.”

Dr. James E. Walsh

Walsh noted that researchers at Auburn University, studying the bio-mechanics of flip-flop use compared to that of athletic shoes, found the distinct change of gait among sandal-wearers puts strain on the arch, ankle, even the hips and lower back. Researchers noted that there is a larger angle in your ankle when wearing flip-flops. “Your feet are trying to grip all the time, and that tightens your calf muscle,” Walsh said.

Source: Ann Richardson, Shore News Today [8/2/10]

NJ Podiatrist Plays Trumpet in Rock and Blues Band

The BassBoards, a classic rock and blues band based in Ringoes, will be performing at the Hunterdon County Library headquarters on Wednesday, Aug. 4. Founded in 2004 by East Amwell Township resident John Caruana, the band is the serious hobby of 12 New Jersey residents, including drummer Allan Conover, sports editor at the Hunterdon County Democrat; trumpet player Steven Dribbon, a podiatrist at Hunterdon Medical Center; and Mike Machnik, the director of instructional technology at Raritan Valley Community College, who sings and plays electric guitar.

Dr. Steven Dribbon

The band has an extensive repertoire of rock, blues and Motown songs, including Bon Jovi’s “Living on a Prayer,” Jerry Lee Lewis’s “Pink Cadillac,” Tina Turner’s “Proud Mary,” several Blues Brothers’ songs, and dozens more.

Source: Hunterdon County Democrat [7/28/10]

Medicare Will Save Under Reform: CMS

Provisions under the four-month-old health reform law that hit the provider and payer communities the most are expected to save Medicare $7.8 billion through 2011 and $418 billion over the next decade, according to a report released by the CMS.

The report focuses primarily on the scores of measures aimed at changing how care is delivered and paid for, and which made up the spine of the massive legislative package passed this year. Programs meant to reduce the number of hospital re-admissions, reshape how hospitals and doctors are reimbursed and those that target fraud and abuse are expected to reduce Medicare spending by tens of billions of dollars.
   
Source: Matthew DoBias, Modern Healthcare [8/2/10]

What documents are needed during the due diligence process? – Part 3a

You have now selected the key group of initial practices interested in coming together into a super group model. It’s vital that some key decisions be made before you move forward. We are assuming that you have already identified a qualified facilitator to run the process. Keep in mind:

1. How will you fund the pre-merger costs? The easiest way is to just charge each physician in the merger process an equal amount of the start-up costs. These costs will be used to fund the entire due diligence on each practice and determine the feasibility of the process.

2. A confidentiality agreement must be signed by each physician or practice since you will be sharing some very personal information on each practice.

3. Each physician practice must hire their own attorney to represent them, and the group must hire an attorney to represent the new practice group. The merged practices will have different tax consequences depending on how the practice is merged into the new entity. Do not rely on good intentions and handshakes. This will be your most costly error.  Do not let the attorneys drive the transaction. Your leadership team must drive the transaction.

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC, dhelfman@vpcenters.com

Shout Out to Employees

One of the best ways to improve your staffers’ morale is to  compliment your employees. Saying “You did a good job today” or  “It was a busy day, but with your help, we pulled it off” are examples of easy, but effective peer recognition.

Encourage staffers to voice their appreciation for and admiration of the good things, big and small, that they see others doing in the workplace. While the point of the exercise is peer recognition, compliments from the doctor add to the morale boost.

Source: Adapted from “Co-Workers’ Compliments Help Improve Morale,” Same-Day Surgery via Communication Briefings

Query: Dark pigmentation in All Fingernails and Toenails

I have a 72-year-old Asian female with a three-year history of a darkish gray and black discoloration under both her fingernails and toenails. This does not resemble melanocytic pigment, nor subungual hematoma, particularly because it also affects fingernails. Medications include Paxil, Protonix (on her initial presentation 2008), which has switched to Nexium, Pravachol, Nasacort aerosol spray, and Advair HFA.

Could a biopsy pinpoint a particular cause? How can you test for heavy metal or other pigment-producing compounds in the nail plate? Are there any blood tests for particular chemicals that would be of value?

Richard Steinmetz, DPM, Westbrook, ME

Query: IUHS and MD Degree

What have been the experiences of those DPMs who have attended the International University of the Health Sciences and received an MD degree?

Philip Graham, DPM, NY, NY

Query: AFO Modifier

I received a rejection for an L1951 (ankle foot orthosis, spiral, [Institute of Rehabilitative Medicine type], plastic or other material, pre-fabricated, includes fitting and adjustment) from DMERC. This is for a Peromax AFO from Euro International (eurosportsmedicine.com/peromax.html). It was dispensed for post-stroke drop foot.

When we called DMERC, the rep said we needed a modifier that states that "requirements specified in the policy have been met." What modifier is that? We tried "-32" (mandated services), and that came back as "invalid."

Neil Levin, DPM, Sycamore, IL

Response: The "KX" modifier is required on ALL lines of ALL AFO claims, in addition to your "RT" and/or "LT" modifiers. Be sure to put the "KX" modifier first.

The "KX" modifier is only to be used when there is sufficient medical documentation on file which is required by the AFO LCD. If the diagnosis or symptoms or stipulations listed in the LCD have not been documented, then use of the "KX" modifier could be construed of as abusive or fraudulent.

For example, if the AFO is being used primarily to off-load a wound, then the "KX" modifier cannot be used. Additionally, the HCPCS code being billed may also need to be changed to one which is non-covered.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here
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RE: Dragon Naturally Speaking 11
From: Larry Kosova, DPM

Dragon Naturally Speaking announced tentative plans to release all versions of Dragon Naturally Speaking 11 towards the end of this month. Dragon Medical is only halfway through the upgrade process, so look towards December or January 2011 for its release. Dragon Preferred is now called Dragon Premium and Dragon Standard is called Home.

Many vendors can give a discount until about Sept 30th for upgrades. If you are using Dragon Preferred, this might be a good time to upgrade to Dragon Professional. I am not a vendor. Here is a comparison chart with version 11 added:  (nuance.com/naturallyspeaking/products/product-matrix.asp).

Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

RE: Electronic Health Records (EHR) and ICD-10 Implementation (Richard Simmons, DPM)
From: Ken Katz

“When ICD-10 diagnosis codes are mandatory, it appears to me that an entire rewrite of the EHR system will be necessary. Does anyone have an idea as to how much this is going to cost us?”

I can only speak for our system, SammyEHR – the answer is $0.00. That’s what our clients pay support for.

Ken Katz, ICS Software, Ltd, Ken.Katz@Live.com

TN PRACTICE FOR SALE (LAWRENCE COUNTY) 
 
Active, established practice includes office building and property ( appraised at 110k) with all equipment and shelf stock included. Great referral network with an excellent scope of practice. Patients on schedule 1 day/ week grossed over 250k last year. 125k OBO Call 931-446-5724 or email mchad500@gmail.com for more information.

ASSOCIATE POSITION - BROOKLYN, NY

Full or part-time position available for a busy well-established podiatry practice in Brooklyn with possible buy in opportunity.  Modern  office with a networked EMR, diagnostic ultrasound, digital x- ray, orthotic scanner, in office surgical suite, and with a great  support staff. Must be Experienced, highly motivated with good clinical skills. Must be participant with Medicare, Advantage Medicare plans (managed Medicare), and managed Medicaid plans in Kings County. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

POSITION AVAILABLE - SOUTHERN CALIFORNIA

Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com

PRACTICE FOR SALE - DALLAS, TX

Prestigious North Dallas location; 24 year old practice; excellent mix of hospital surgery, office surgery, orthotics, general podiatry, web site, electronic claim submission. Retiring owner will stay for transition. Owner financing available. dallasfootdr@yahoo.com

ASSOCIATE POSITION - SW FLORIDA

Golf, Boating and Beaches - Great opportunity to join a well established Podiatry Practice. Excellent mix office/surgery, motivated experienced staff. Seeking full time Associate PSR 12-36. Excellent salary & benefits, early buy-in for the right hard-working, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - NEW JERSEY - JERSEY SHORE REGION

Part-time associate wanted. Looking for a motivated and ethical practitioner. Competitive salary with incentives. Tuesday AM - Thursday PM - 2 Saturdays/month. Please respond to: NJSHOREFOOTDOC@aol.com

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA AREA

Full-time associate with opportunity for partnership with group practice. Candidate must be trained in all phases of podiatry including wound care, surgery, and routine podiatric care. Candidate must have a positive and energetic attitude with a desire to grow in our practice. If interested please email your CV to BergD@readinghospital.org

PRACTICE AVAILABLE - WESTERN WASHINGTON

General Podiatry practice in Port Townsend, WA. Nice community, 25+ year old practice, busy 3 days a week with growth potential. Owner leaving area, needs someone to take over the practice, lease and equipment. Contact Jessica at ptpod@yahoo.com or 925-519-0624.

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

PART-TIME/FULL-TIME POSITION – MASSACHUSETTS 
 
Looking for extremely energetic physician for nursing home and assisted living facility. Very generous compensation package. Great opportunity for extra cash. Future  potential for part-time work in our practice and/or in house call practice as well. Please call immediately (978) 794-8406 and ask for Blanca for an interview.

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857.

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

38 yr old general podiatry practice grossing over $550K. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network and well-equipped surgical suite. Retiring owner will stay on as needed. Email - dpmpracticeforsale@yahoo.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

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