November 23, 2013 #4,923 Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com E-mail us by hitting the reply key. COPYRIGHT 2013- No part of PM News can be reproduced without the written permission of Barry Block
PODIATRISTS IN THE NEWS
MO Podiatrist Provides Winter Foot Care Advice
As winter approaches, our feet need more care than usual. Podiatrist Dr. Annessa Blackmun, provides some tips about keeping your feet healthy. "First, it's important to examine the bottom of your feet for any cuts or abrasions. You don't want to create a portal of entry for any fungi or bacteria to enter into your body," says Blackmun.
Dr. Annessa Blackmun
Next, you have to look in between your toes, especially between the 4th and 5th toes, which is a common area for athlete's feet to develop," says Blackmun. "Finally, check your toenails. Are they thick? Are they smelly? Are they discolored?" These could all indicate a fungal nail infection, says Blackmun.
Source: Tim Ezell, Fox-TV [11/21/13]
PM NEWS QUICK POLL
FINAL DAY TO VOTE
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Which brand of pre-fabricated orthotic do you dispense in your office?
Diabetes is a Disease of Second Chances: PA Podiatrist
If diabetes is left uncontrolled, patients risk winding up in front of Dr. Kathya Zinszer, a podiatrist who works in limb recovery. "If I never see another wound that's from diabetes, I will be the happiest person because we can prevent it,” Dr. Zinszer says. “And when I have to tell a patient there's nothing left to do because you came too late and you're losing your limb, that's devastating because I know our future doesn't have to hold that."
Dr. Kathya Zinszer
But, Zinszer calls diabetes a disease of second chances. By changing your lifestyle you can actually control the outcome of what can happen from diabetes,” she explains. “So moderating what you're eating, exercising, lowering your blood sugar -- and it's one of the few diseases that you get that chance, and can literally be drug-free and live a healthy life."
Source: Matt Paul, WITF [11/21/13]
APMA COMPONENT NEWS
AAPPM Announces New Board
The American Academy of Podiatric Practice Management (AAPPM) has announced the election of its 2013-2014 Board of Trustees. The following podiatrists will serve and represent the AAPPM membership:
Dr. D. Charles Greiner
Chairman – Hal Ornstein, DPM,
President – D. Charles Greiner, DPM
Vice President – Benjamin W. Weaver, DPM
Treasurer – Jonathan B. Purdy, DPM
Secretary – Andrew J. Schneider, DPM
Trustee – Animesh (Andy) Bhatia, DPM,
Trustee – Melissa Lockwood, DPM
Trustee – Jonathan Moore, DPM, MS
Immediate Past President - William N. McCann, DPM
Executive Director - Derek Dalling, Kindsvatter Dalling & Associates, Lansing, MI
PODIATRISTS AND FOOTWEAR
Long-Term Effects of High Heels Irreversible - IN Podiatrist
They are sleek, they are sexy, and they may be bad for you. Heels are all the rage among the fashion conscious, but wearing those six-inch heels can have unintended consequences. “You add a little height, you look a little thinner,” said podiatrist Dr. Lynn Stafford of Aboite Podiatry. But these pricey pumps can have costly effects. “Oh it’s wonderful for my business!” said Dr. Stafford.
Dr. Lynn Stafford
Stafford is a Fort Wayne podiatrist who knows heels and feet perhaps better than her male counterparts – because she also wears them—in moderation, of course! “The long-term effects are irreversible. That doesn’t mean you can’t wear high heels. I wear them, but it’s knowing when to wear them,” she said.
Source: Rachel Martin, WISE-TV [11/19/13]
PODIATRISTS AND THE LAW
SD Podiatrist Found Not Negligent in Malpractice Case
An Aberdeen podiatrist was not negligent when he performed foot surgery in 2008 on a Bath man and provided subsequent care, a Brown County jury determined Thursday. Gordon "Butch" Downing had filed a malpractice lawsuit against Dr. Chad Stapp, of Avera Medical Group. But after deliberating for about 90 minutes, jurors determined Stapp met the proper standard of care in treating Downing. Downing's attorneys had suggested that Downing was entitled to more than $1 million in damages resulting from lost income, difficulty walking and sleeping, anguish, pain and suffering.
Source: Scott Waltman, Aberdeen News [11/21/13]
PODIATRIC PRODUCTS IN THE NEWS
MA Podiatrist Named Director of Applied Podiatric Biomechanics at Noraxon USA
Noraxon USA has announced that Dr. Jay Segel will be collaborating with Noraxon USA as the Director of Applied Podiatric Biomechanics. Dr. Segel is a private practice podiatrist in Martha’s Vineyard and a member of the American Podiatric Medical Writers Association. In the past 30 years, he has seen many treatable foot concerns evolve into long-term problems due to lack of care; the majority of these issues being not only fixable but often preventable.
Dr. Jay Segel
Dr. Segel believes in both the static and dynamic quantification, interpretation, and analysis of the musculoskeletal system. He has mastered therapy and training regarding event timing and force distribution assessments, thereby diminishing micro-trauma through the use of pressure analysis solutions like the Noraxon Force Distribution Measurement Treadmill (FDM-T).
QUERIES (CLINICAL)
Query: Non-Union of Hallux IPJ
A 76 year old very active, athletic man presented status post 11 months after an attempted IPJ fusion of the right hallux. The patient currently has some footgear irritation because of the position of his digit.
Non-Union of Hallux IPJ
Neurovascular status is intact. Non-union of the IPJ is noted with lateral deviation of the distal phalanx. Revision options would be greatly appreciated.
CODINGLINE CORNER
Query: Getting Paid by Medical Assistance for Consult
Any recommendations on how I can get paid by Medical Assistance (MA) for seeing one of their patients as an inpatient consult? I've tried billing the CPT 99223 (initial hospital care) and CPT 99232 (subsequent hospital care) codes before without success. All I get is a rejection from MA saying, "This provider type/provider specialty may not bill for this service."
Adam Silverman, DPM, Baltimore, MD
Response: If you saw a Maryland Medicaid patient as a result of a true consult, have you tried billing the inpatient consultation codes? In other words, CPT 99251-99255. I realize that it sometimes seems like Medicare calls all the shots in the world of coding and reimbursement, but in reality Medicare can only dictate what a provider must do when billing Medicare. You must follow the rules of the payer you're billing -- and in this case, I suspect that your state Medicaid program didn't jump on Medicare's bandwagon back in 2010 when Medicare said (for traditional Medicare patient's only) that they wanted consulting physicians to use the initial inpatient encounter codes (CPT 99221-99223). It's important to remember that those codes, by CPT definition, are only supposed to be reported by the admitting/attending physician. Unless a non-Medicare payer has issued a formal written policy that says that you're supposed to follow Medicare coding rules when you perform consultation codes, you're supposed to be reporting your services by CPT definition.
Joan Gilhooly, CPC, CHCC, Lebanon, OH
Codingline subscription information can befound here
APMA Members: Click here for your free Codingline Silver subscription
Without the benefit of having biopsy results, I would use a combination of a urea compound (40 or 50%) with either a high potency steroid ointment or a moisturizing cream, and see the patient back in 3-4 weeks. Protective footgear is advisable as well.
Heavy alcohol use is an extremely significant factor in a tremendous amount of pathology. This patient type is at risk for toxicity syndromes as well as nutritional deficiencies. In addition to a CMP and CBC, you should look at RBC fatty acids. I have found this type of derm presentation to be associated with deficiency in Omega 3 fatty acids coupled with dehydration (which is the case with most heavy drinkers since alcohol inhibits ADH).
Topical therapies will not succeed. This patient needs to get into rehab as well.
I have been in practice for a little over four years. I practice in a different region of the country, but my answer would be the same if I were practicing in California where I attended school or in Utah where I completed my residency training. Without a doubt, we should all be making referrals for problems outside of our scope of practice. That's why people make referrals to us. They are sending care to us that is outside of their general practice in most cases.
Making referrals has led to better relationships with my physician peers, and most importantly to better overall healthcare for my patients. We treat "people with feet and ankles" not "feet and ankles with people" so I feel a responsibility to refer, document, and follow through with any health complaint that my patient may have. When I make a referral, I remind the patient that it is their responsibility to check with their insurance provider regarding any requirement that the referral come from their assigned primary care provider and to determine who is within their network.
With regard to Dr. Udell’s question about documentation on referrals for outside of the scope of podiatry practice, the answer is yes. Any time that a medical professional makes a referral, regardless of the reason, that needs to be noted in the progress notes. The underlying issue of liability is that the patient asked you based on your professional status and knowledge; it was not a casual inquiry of general public conversation.
You are to some degree liable for the referral. If you know the practitioner to be unprofessional or impaired or controversial, that referral could come back to haunt you if your patient experiences an adverse outcome linkable to the referral. Again, the patient asked you for referral advice based on your professional status. If you are unsure whom to refer to, advise your patient to communicate with his/her primary care physician or to obtain a referral from the local hospital – and even then, document that into your progress notes.
I had purchased a NeuroMetrix (Waltham, MA) NC-Stat hand held device which is used to get an objective reading on diabetic neuropathy. It basically does a nerve conduction test on the sural nerve. It is part of my normal work-up and I do not bill this. For each test, one needs a one-time use electrode, so there is a cost on top of the original cost of the device. After purchasing a large amount of these as recommended by my rep (lower cost for more electrodes), I became aware that many were not working - and found out that they have a "shelf life" and are no longer useable. I was not told this by my rep when he took my order. My rep is no longer with the company.
When I brought this up with the Neurometrix company, they distanced themselves and said that the strips have an expiration date on them, and they will not take back the old expired ones and provide me with new ones. The "strips" do not have an expiration date on them as I have examined them closely. It's a good product, but a bad policy. The company does not want your business, just your money.
Recently, our long battle against an arbitrary change by Horizon Blue Cross/Blue Shield of New Jersey (“Horizon”) in its reimbursement policy with regard to extracorporeal shock wave therapy for the treatment of plantar fasciitis/fasciopathy ended in a trial-level court granting Horizon a judgment.
The theory behind our case against Horizon was quite simple. Under a medical policy with an effective date of February 23, 2001, Horizon deemed ESWT to be “investigational.” However, this policy was reviewed and revised on October 26, 2001, and ESWT was deemed “medically necessary” for the treatment of...
Editor's note: Dr. Bass' extended-length letter can be read here.
I share the frustration of Dr. Robert Creighton who wishes that any spokesperson for our profession would advocate the comprehensive role that the podiatric physician can play in the prevention of traumatic falls in the elderly. While the wearing of proper footwear has been well documented to prevent falls, numerous studies have demonstrated that the podiatric physician can intervene in many ways to prevent falls in the elderly population.
A recent study published in the prestigious British Medical Journal demonstrated that a multi-faceted falls prevention program, using numerous podiatric interventions, will produce a success rate equivalent or better than other programs published thus far (Spink, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: A randomized controlled trial. BMJ 2011;342:d3411 doi:10.1136/bmj.d3411).
Yes, this program did involve footwear modification. No, this program did not implement so-called "Falls Prevention Braces." Our profession needs to step up and promote all legitimate findings of stellar, peer-reviewed research which validates the role of the podiatric physician in the prevention of traumatic falls in the elderly.
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Choose any or ALL (50 CME Contact Hours) from the30+ CMECategory-1 articles posted
CLASSIFIED ADS
PODIATRIST WANTED - SOUTHERN CALIFORNIA
Podiatrist for practice in long-term care facilities. Facilities include Skilled Nursing, Assisted Living and Board and Care homes. Professionally managed. Email interest and CV to: ZbubblesZ@aol.com
ASSOCIATE POSITION -TAMPA BAY AREA
Excellent opportunity to join a well-established multi-office group practice in the beautiful Tampa Bay area starting July 2014. We are seeking a highly motivated, ethical and outgoing physician with Florida license to join our growing practice. Competitive salary, excellent benefits, bonus structure with partnership opportunity. Please email CV: Kpontious9@yahoo.com
POSITIONS AVAILABLE - BUFFALO AND CONNECTICUT
Looking for podiatrists to see residents in nursing homes in Buffalo and Connecticut. Great opportunity for supplemental or full time income. Email inquiries to phasetwopodiatry@gmail.com
ASSOCIATE POSITION- ARKANSAS
Ethical, highly motivated, enthusiastic associate needed to join successful, well-established practice located in Northwest Arkansas. Certified/qualified by ABPS with rearfoot training preferred. The practice has an excellent working relationship with a high referral base from local PCPs and other specialists. Well-rounded practice incorporates general podiatry, surgery, wound care, and sports medicine. Salary plus excellent bonus potential for the right individual. Send CV to: footdocmanager@yahoo.com.
PART-TIME ASSOCIATE POSITION – CHICAGO, IL
part-time opportunity in Chicago to provide treatment to homebound patients. You can create your schedule- logistical support provided. Reimbursement is 40% of collection. If interested, please call 312-375-6430.
ASSOCIATE POSITION- DAYTON, OHIO
Join an established group practice in Dayton, Ohio excellent reputation, large referral base. Base Salary$120,000, benefits and bonus structure. EMR;diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to: Ohiomedical@aol.com
ASSOCIATE POSITION– CONNECTICUT (HARTFORD AREA)
Available immediately. Looking for a Board Certified Surgeon with strong RF and ankle skills. This 20 year established practice offers EHR, digital x-ray and Noveon laser. All dues, malpractice and health insurance paid as well as 401K available. Excellent compensation. email lynnleblanc@cox.net
PART-TIME ASSOCIATE POSITION- ILLINOIS
Part-time podiatrist wanted for Franklin Park, IL office to begin December 2013. Please contact Dr. Ballard at 630-307-7463 and fax vitae to 630-529-0087 to apply.
HOUSE CALL DOCTORS WANTED - NYC
A well-established practice with an elaborate house call service is seeking responsible, ethical and compassionate doctors to treat patients in Manhattan, Bronx, Queens and Brooklyn. Create your own schedule, full support, excellent compensation. Send CV to WPerez1000@aol.com or call Dr. Perez 917-757-1921 for more information.
ASSOCIATE POSITION - CENTRAL FLORIDA
Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future. To apply please go to www.yourcareerinpodiatry.com
ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND
Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rearfoot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual. Send CV to: dpmkthomas@gmail.com.
ASSOCIATE POSITION –DALLAS/FT WORTH, TX
Dynamic, busy practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified podiatrist, PSR-36 preferred. Excellent salary and benefits compensation package, for the right candidate, who is motivated to work hard. Contact/Send resume to: jmh6122@yahoo.com
ASSOCIATE POSITION - CT (GREENWICH, FAIRFIELD AND NORTH HAVEN)
Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to: Dr.Kassaris@yahoo.com
DIABETES MANAGEMENT FELLOWSHIP - CENTRAL KENTUCKY
CVs and letters of interest are being accepted now for the most unique and well-rounded fellowship in podiatric medicine. This non-accredited, 1-year fellowship starts in July of 2014 and offers a wide variety of training opportunities that focus on diabetes, including diverse pathologies and unique medical and surgical opportunities. Regular surgical case load, intensive practice management, and the best prep for real world practice. Work with our on-staff certified orthotist, physical therapist, shoe store staff, MRI director, etc. Generous stipend, benefits, and free housing. Learn more at www.myhappyfoot.com (click the Fellowship Tab). Send CVs to jmoore@aappm.org.
PRACTICE FOR SALE – SOUTHWEST QUEENS, NEW YORK
Busy, well established , fully equipped , newly redecorated office in good neighborhood. Grossing approximately $500k. Doctor relocating, but will stay on through July. Contact dfoot35@gmail.com
PRACTICE FOR SALE - CONNECTICUT
Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com
EQUIPMENT FOR SALE - PADNET
Barely used PadNet machine for sale. Purchased in 2010 for $22k seeking $9,900 includes shipping. If interested email Dr. Eric Jamrok at drjamrok@yahoo.com
EQUIPMENT FOR SALE - PADNET
Padnet vascular testing machine with updated security software (purchased in 2012). Perfect condition only used for training. We do not have the patient population to provide this valuable diagnostic tool. Purchased for 20K, asking 12K (and we will pay for shipping costs). Please contact vcrismali@gmail.com
EQUIPMENT FOR SALE– USED PINPOINTE LASER AND 2 USED Q-CLEAR LASERS
Used Pinpointe Laser for Sale! $17,500. 2 Used Q-Clear Lasers for sale $9,000 each. Please call 202-255-6236 or email: cosmedresources@verizon.net
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Publisher-Barry Block, DPM, JD
