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PM News

The Voice of Podiatrists

Serving Over 18,856 Subscribers Daily


January 12, 2018 #6,100 Publisher-Barry Block, DPM, JD

A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2018- No part of PM News can be reproduced without the
written permission of Barry Block

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PM NEWS QUICK POLL

Last Chance to Vote

Quick Poll

How and where do you store your new patient records?
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PODIATRISTS AND POLITICS
NY Podiatrist Elected President of Monroe County Legislature
 
Legislator Dr. Joe Carbone, of Irondequoit, was elected president of the Monroe County Legislature at a special meeting of the Monroe County Legislature on Jan. 3. Carbone, a lifelong resident of Irondequoit, was first elected to the legislature in 2012. He previously served as vice president of the legislature.
 
Dr. Joseph Carbone
 
Carbone is a doctor of podiatric medicine with an office on Titus Avenue in the town of Irondequoit with a second office in Brighton.
 
Source: The Post [1/10/18]
Redig-thotics

MEETING NEWS
IPED Winter Retreat Features New Format
 
Neither, rain, nor sleet, nor snow, nor gloom of night could not keep attendees away from participating in IPED’s Winter Focus Retreat held January 5-6, 2018 at the Lago Mar Resort.  Despite many travel hiccups, the attendees came from as far away as CA to the winter weary East Coast. This meeting covered the hot topic of practice roll-ups and acquisitions by venture capital groups. Jonathan Lewis, JD of Sheridan Capital explained the process and phases of such scenarios and how to consider the possibilities, prepare for the transition, and what to expect when one changes from the role of employer to employee. 
 
IPED attendees (Photo: Dr. Neal Houslanger via drone)
 
The new meeting format of this retreat was to engage everyone in attendance. This was accomplished through panel discussions with expert moderators and the personal experiences of attendees on topics relating to the business of practicing medicine, especially as the profession is in a constant state of flux. Discussions were informative and personal and well received. As a special surprise, attendees were treated to helicopter rides over the Lauderdale coast line provided by BML Pathology.  
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PRACTICE MANAGEMENT TIP OF THE DAY
What You Need to Know About MSOs - Part 7
 
7. What are compliance risks associated with MSO arrangements? (Continued)
 
In addition to the CPOM prohibition, physicians and MSOs must be mindful of federal and state laws (including the federal Anti-Kickback statute and state law equivalents) that prohibit improper compensation and ownership arrangements between healthcare providers and actual or potential referral sources. Compliance risks with respect to these laws are especially heightened if MSO agreements contain certain red flags, including the following:
  • If the MSO performs marketing or referral procurement services;
  • If the MSO arrangement is exclusive (i.e., the physician practice cannot hire a different MSO); or
  • If the MSO's compensation is directly or indirectly related to referrals or revenues generated by a physician practice.
Whether an arrangement complies with such laws is based on the particular facts and circumstances and is determined on a case-by-case basis.
 
Source: Yulian Shtern, Esq and Leonard Lipsky, Esq, Physicians Practice [12/28/17]
PCC

QUERIES (NON-CLINICAL)
Query: Storing Charts and HIPAA Compliance
 
I am a semi-retired podiatrist. My practice consists of a satellite office and a few independent senior facilities. There is a central medical wellness office where I see my patients at the facilities I go to. Because I only work part-time at all of my locations, I store all of my patient charts (still using paper) at home. To be HIPAA-compliant, what precautions do I need to follow when storing patient charts at home? They are kept in a locked closet. 
 
Name Withheld 
 
Editor's Comment: PM News does not provide legal advice. Under the HIPAA security rules, covered entities must "Identify and protect against reasonably anticipated threats to the security or integrity of the information." The keyword is "reasonability" and a locked closet meets this requirement. Note: HIPAA is a national minimal standard which can be superceded by state law.
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CODINGLINE CORNER
Query: Modifier for CR Imaging
 
Since our office is still using a CR imaging system, what is the appropriate modifier we are to bill with to Medicare? The “FX” modifier seems to apply to film x-ray. Also, based on what I have read so far, the penalty is only on the technical component. Since we normally bill for both the technical and professional components (all in one, no modifiers except for the “RT” and “LT”), do we now need to break down charge and bill separately for the technical and professional components with “TC” and “PC” modifiers?
 
Coleen Merrill, Office Administrator, Office of Evan Merrill, DPM, Medford, OR
 
Response: CMS now requires appending the “FY” modifier to claims for the technical component of a digital x-ray that employs a CR-specific cassette (utilizing an imaging plate to create the image) in place of a traditional film cassette. This “FY” modifier will result in a 7 percent reduction to the technical component (and the technical component of the global fee). This reduction is expected to last until 2023, when the reduction is slated to increase to 10 percent.
 
I suggest “breaking it down” as you described with the same code on two lines, one with a “26” (not a “PC”) professional component modifier (assuming those requirements are met) and the other with both “TC” and “FY” modifiers.
 
Jeffrey D Lehrman, DPM, Springfield, PA
 
For information on Codingline subscriptions, click here
OHIJan818B

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Brian Kiel, DPM, Paul Busman DPM, RN
 
There is a national shortage. I was told that much of this was made in Puerto Rico and because of the hurricane damage there is none being made. I can't be absolutely sure of this as the reason but I do know it is a national problem.
 
Brian Kiel, DPM, Memphis, TN
 
I have a somewhat cynical theory about that. The drug companies make up a "shortage" of common but essential items (I once saw a shortage of 3L bags of saline!), let providers stew a while without it, then manage to meet the "shortage" and return the product to the market. Providers are so happy to get it back that they don't gripe about the fact that the manufacturers have raised the price significantly. This probably isn't true, but these days nothing surprises me. 
 
Paul Busman DPM, RN, Frederick MD
realm

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: William D. Spielfogel, DPM, Vito J. Rizzo, DPM
 
This is an excellent initiative by NYSPMA and it is great that the Board of Trustees is being proactive in its advocacy for podiatry. They are an example of an organization advocating for its membership and trying to get a seat at the table.
 
William D. Spielfogel, DPM, NY, NY 
 
In our rapidly changing healthcare delivery paradigm, it is imperative that there be opportunities to help define what a particular category of healthcare provider can offer to contribute to the problems facing our population. Policymakers need to be educated on the facts as they relate to outcome statistics and verified cost factors. Many of these policy considerations are determined in a federal or centralized system. Podiatry’s first advocate should be the APMA. As experience has demonstrated, podiatry seems to be not permitted “a seat at the table”, and this profession is often caught needing to try to fix policy shortcomings after the fact. This has proven to be bad policy. 
 
I applaud the effort of the NYSPMA, which has been the leading advocate for progressive healthcare policy specifically as it relates to podiatry and to the communities we serve. NYSPMA led the charge, resulting in the Thompson Reuters Study which demonstrated the value of podiatry in the care of lower extremity manifestation of diabetes. NYSPMA has been trying for years to have care measurements developed specifically for podiatry, which could then force payers to better consider podiatry as a key partner in many healthcare scenarios. This effort in population health is the next phase of what has been a multi-year and ongoing effort to demonstrate the need for podiatry’s inclusion in a myriad of ongoing and pressing healthcare issues. The opioid crisis, fall risk, and the ever present concern with the ever rising costs of managing the effects of diabetes are areas where it has once again been shown that with podiatry on the team better outcomes and lower costs result. 
 
I encourage APMA, and all of its individual components, to carefully consider and then support the work of NYSPMA as a national effort. In the big picture, it will help podiatrists and their patients throughout the nation, and not just in New York.
 
Vito J. Rizzo, DPM, Bay Shore, NY
sigma

RESPONSES/COMMENTS (NEWS STORIES) - PART 1
From: Joseph Borreggine, DPM
 
Riddle me this Batman: What looks like a DPM, walks like a DPM, and can do what a DPM can do outside of foot surgery, but is not a DPM? Batman: Great Scott!! Why an NP of course! The tea leaves certainly do not reveal another story based on what Medicare announced yesterday  along with what was posted on PM News
 
Bundled payments are here to stay for Medicare providers and fee-for-service is dead! Voluntary it will be to start, but in a few years it will be the norm. To get this going, CMS will offer monetary incentives to providers who are early adopters. And based on this new policy of reimbursement being implemented, there will no longer be the ability in place for providers to bill for...
 
Editor's note: Dr. Borreggine's extended-length letter can be read here
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RESPONSES/COMMENTS (NEWS STORIES) - PART 2
From: Allen Jacobs, DPM
 
Just a word of advice from an old guy who has been there before. There is some recent early enthusiasm for the use of a polyvinyl alcohol implant in the 1st MPJ. Please remember that the induction period for implant-related pathology can be prolonged. The polyvinyl alcohol great toe implant is NOT synthetic cartilage. We have no long-term data to suggest that the ultimate fate of such implants may not parallel that of Silastic, UHMW polyethylene, or other materials subjected to adhesive or abrasive wear. 
 
The only available studies which I can find were corporate supported case series reports. This implant may or may not be useful in the long term. However, be careful prior to overzealous use of this material as any implant or implant material.
 
Allen Jacobs, DPM, St. Louis, MO
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RESPONSES/COMMENTS (YOU CAN'T MAKE THESE THINGS UP)
From: Keith L. Gurnick, DPM
 
I do not know who the person was who removed the foreign body  (podiatrist, other doctor, nurse, etc.) but please, please, please to all podiatrists, no  matter how simple a procedure may appear to be, please use sterile instruments, do a cleansing and prep the site, drape the foot, and make sure at all times that you wear gloves. The technique seen in this video is below the standard of care in 2018.  
 
There is an obvious foreign body and abscess. Take a proper wound culture. If there was a bad outcome in this situation and along with the video of this technique for removing a foreign body, the lack of sterility would be difficult to defend in a malpractice case. Also, I suggest that you stop allowing patients to video procedures in your office. It can only come back to hurt you later.
 
Keith L. Gurnick, DPM, Los Angeles, CA
richieoct1617

YOU CAN'T MAKE THESE THINGS UP

RE: Outrageous Boots of the Day

Embroidery - not for wet or snowy weather!

Source: Ulla-Stina Wikander via Virtual Shoe Museum

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MEETING NOTICES

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CLASSIFIED ADS PART 1 - PRACTICES FOR SALE OR WANTED, EQUIPMENT FOR SALE
PRACTICE FOR SALE - NEW YORK (BROOME COUNTY, NEAR BINGHAMTON)
 
Well established, 37 year practice. No 3rd party Insurance! Patients pay at time of service. Work 3-4 days/week with average gross $675K/year through 2016. Practice emphasis is biomechanics, using video & in-shoe pressure mapping analysis; & onychomycosis treatment using PinPointe laser. Office and equipment modern & high quality. Ready to retire, so make a reasonable offer.  Reply to: uniquepractice@gmail.com 
 
PM NEWS CLASSIFIED  ADS REACH OVER 18,500 DPMs AND STUDENTS
 
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 18,500 subscribers. For details, click here or write to: bblock@prodigy.net or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at davidekagan@gmail.com  or call (215) 808-0770.
CLASSIFIED ADS - PART 2 ASSOCIATE POSITIONS AND FELLOWSHIPS
ASSOCIATE POSITION  – DAYTON, OHIO 
 
Highly respected and growing, four podiatrists, 4 location practice seeking PSR-36 board certified/qualified foot and ankle surgeon. Must be dedicated, hardworking, poses excellent clinical and surgical skills, high-quality patient care, wound care.  Practice is equipped with certified EMR, digital x-ray, laser, ultrasound guided injections, Cutera Laser, regenerative medicine and PRP all aspects of DME. Meaningful Use attested, MIPS-ready. On staff 4 hospitals, no nursing homes. Highly trained staff. Send CV, salary requirements to ohiosurgeons@gmail.com  Excellent compensation plan, base salary and bonus, 401k plan, medical insurance, malpractice, paid vacation, holidays, CME. Signing bonus, ownership via deferred compensation plan
 
ASSOCIATE POSITION – SOUTH CAROLINA 
 
Physicians Footcare is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary and next exam is June 2018.  Exam application must be submitted 90 days prior to exam date.  If you are ready to earn a comfortable six figure salary; send letter of interest and CV to: scdpmjobs@gmail.com
 
MOBILE PODIATRISTS NEEDED - LOS ANGELES, CA 
 
Full Time Position available for podiatrists to visit home bound patients in the LA area and surrounding areas. Excellent compensation, flexible schedule, dedicated office support staff, cloud based EHR system. Email CV to: homefootcare@hotmail.com
 
2018 GRADUATE ASSOCIATE POSITION - LONG ISLAND
 
Country Foot Care, a Long Island based, well-rounded multiple office group practice seeks 2018 third and fourth year graduating residents or fellows to join our state-of-the-art practices in July. Our practices are affiliated with multiple hospital systems, surgical and wound care centers and a residency program. Requirements: Caring, ethical, board qualified/certified candidates with surgical training and leadership qualities who are willing to live/relocate to the Long Island, NY metro area. Compensation includes biweekly salary, a generous bonus schedule, malpractice and health insurance, paid holidays and PTO. We invite all interested doctors to email their CV to DrLeeb@countryfootcare.com.
 
ASSOCIATE POSITION - HOUSTON, TX 
 
Established, growing multi office, multi doctor practice seeking PSR-36 board certified/qualified foot and ankle surgeon. Must be personable, outgoing and motivated with excellent clinical and surgical skills. Practice is protocol-based, state-of-the-art equipped with the latest technologies and cutting-edge procedures with an extremely competent staff. Send CV, salary requirements to faajobs@gmail.com.
 
PODIATRIST FOR HOUSECALLS - NJ 
 
Well established and fast growing Housecall podiatry practice (www.homefootcareservices.com ) is looking for full-time or part-time podiatrist  to do house-calls for home-bound patients in  New Jersey. We are looking for hard-working, energetic and compassionate doctor.  Please email resume to lana.raginsky@homefootcareservices.com
 
ASSOCIATE POSITION - HARTFORD CONNECTICUT 
 
Great Opportunity: A well-established four doctor practice is looking for a personable, well trained individual to join us in July 2018.  You must be comfortable with all phases of podiatric practice and have three years of surgical training. Board Eligible/Certified.  You will assume the patient care of a retiring partner.  Competitive salary and benefits.  Partnership potential.  Forward your resume to “I am your new associate” at jsk506@aol.com or fax 860-721-6395
 
FULL TIME ASSOCIATE – MANHATTAN 
 
Full-time associate wanted for dynamic surgically oriented multi state practice based out of Manhattan and ever expanding. Applicant must be BQ/BE PM&S 36 or equivalently trained and must have active NY and NJ (or able to qualify to obtain) licensure. Applicant must be team oriented, flexible and personable. Will suit someone looking for a long term position with opportunity to grow in the future. Please send inquiries to daria.nichiforova@deloorpodiatry.com
 
ASSOCIATE POSITION – BROOKLYN, NY 
 
Excellent, growing podiatry practice is seeking a full time podiatrist to add to our current 2 podiatrists. Excellent compensation for qualified candidates. Please send resume to Metropolitanfootcare@gmail.com
 
ASSOCIATE POSITION – PENNSYLANIA 
 
Great part-time opportunity for a board qualified / certified podiatrist. Some office-based experience and an outgoing personality a must. Located in Doylestown Pennsylvania. Digital radiology, EMR, 3D orthotic scanning and on-site therapy.  If you love working with great people and patients then send us your CV now!!! info@qualityfootcare.com
 
ASSOCIATE POSITION - SOUTHERN CALIFORNIA  
 
Very busy practice seeking a full-time, self-motivated and hard-working podiatry associate. Competitive salary offered. Please email CV to: podiatrists@icloud.com
 
PODIATRIST  NEEDED - HADDON HEIGHTS, NJ
 
Well-rounded surgically trained board qualified/certified doctor needed for busy south Jersey practice. Includes hospital work and 2 locations. Must have business sense, a cheerful personality and bedside manner, follow protocols in place, and possess good communication skills.  Practice encompasses all aspects of podiatry. Competitive package. Email CV to hhfootdoc@gmail.com.
 
POSITIONS AVAILABLE - UPSTATE NEW YORK/LAKE GEORGE AREA
 
Looking for podiatrists to see residents in nursing homes and skilled nursing facilities in Upstate New York/Lake George and vicinity.  Great opportunity for part-time income. Positions available immediately!  Send inquiries to: phasetwopodiatry@gmail.com
 
PM NEWS CLASSIFIED  ADS REACH OVER 18,500 DPMs AND STUDENTS
 
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 18,500 subscribers. For details, click here or write to: bblock@prodigy.net or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at davidekagan@gmail.com  or call (215) 808-0770.
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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Barry H. Block, DPM, JD
 
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