The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 07, 2008 #3,135 Editor-Barry Block, DPM, JD

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We've just mailed the latest 2008 issue of Podiatry Management. At 244 pages, this is our largest January issue ever, and is filled with interesting, informative, and useful articles. You'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

January 2008 Podiatry Management

Topaz Procedure More Effective Than Open Surgery: IL Podiatrist

It's not unusual for your feet to feel a little run down at the end of the day, but when feet become persistently painful, it's time to see a podiatrist. Some experts say up to 40 million Americans have heel pain. Now doctors have a new treatment in their arsenal that provides relief to this painful condition.

Dr. Marlene Reid

"The band of tissue at the bottom of the foot gets inflamed and it pulls and it gets tight and that causes pain," said podiatrist Dr. Marlene Reid. And that pain can be debilitating. "I've had patients that have told me they crawl," said Dr. Reid. "It's so painful to walk that they crawl."

Now Dr. Reid is healing heels with radio-frequency energy. "You go through the skin without actually opening it up, without actually doing an incision," said Dr. Reid. After mapping out the target points, Dr. Reid delivers the radio-frequency energy with a wand. It breaks up scar tissue and increases blood flow. "The success rate so far is much greater than open heel surgery," said Dr. Reid. Called the "TOPAZ Procedure," it takes less than 20 minutes. "It's changed their lives," said Dr. Reid. "TOPAZ literally changes people's lives."

Source: Denise Dador, KABC TV [1/2/08]

NBPME Plans to Implement Changes Geared Towards Vision 2015

Incoming APMA President and Chair of Vision 2015 Ross Taubman, D.P.M. and Vision 2015 committee member Bruce McLaughlin, D.P.M. met recently with The National Board of Podiatric Medical Education (NBPME’s) President Jeffrey Gerland, D.P.M. and NBPME’s Executive Director Charles W. Gibley, Jr., Ph.D. to discuss the role of the NBPME in relation to the APMA's Vision 2015 initiative.

Left to right: Charles W. Gibley, Jr, PhD., Bruce McLaughlin, DPM, Ross Taubman, DPM, and Jeffrey Gerland, DPM.

With the advent of a positive result from a recent independent audit, which validates the NBPME testing protocol, the group felt that the Board is well-positioned to test podiatric medical students in accord with vision 2015.

The National Board will begin a strategic planning process towards Vision 2015 at our mid-winter meeting in April, 2008. That will include a comparison of the content of NBPME’s Part I and II Examinations and the content of Steps 1 and 2 of USMLE. In a continuing evolution of our testing process, beginning in 2008, three new item formats will be used for the Part I and II examinations (in addition to the standard 4-choice, single answer, multiple-choice item). Any of the following types of formats may appear on a single examination: 1) A “check-all-that-apply” format. 2) A “drag and drop” format. and
3) An “image-click” format.

Query: MD Programs for Podiatrists

What programs are available for a podiatrist who wishes to obtain an M.D. degree?

Name Withheld

RE: Doctors Say Placebo Use is Common: Study
From: Elliot Udell, DPM

One common placebo that is used to treat many conditions comes under the name "homeopathic medicine." If anyone reads the label of a pure homeopathic product sold in a local drug store, you will see various X's, C's and other letters next to the "active" homeopathic ingredients. signifying how much the "active" ingredients were diluted. A kid taking high school math can easily determine from these dilutions that there is more of the product in an ounce of water from the Atlantic or Pacific oceans than in the bottle of product that the consumer is paying so much money for.

When Dr. Hanneman, the inventor of homeopathy in the 1800's was asked how a product can be therapeutically effective if the dilution is so great so as to render it nonexistent (below Avagadros number) . His response was that even though the product is not really there, it has the "spirit" of the product. Some people feel they get relief from these bogus products and even worse there are practitioners and pharmacies that charge people lots of money for them. The article about the placebo affect may explain why some people say these products work. I still would never prescribe such a product for a serious infection or for any condition where legitimate medications have proven effective. The same would apply to pure placebo pills.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Assisting Non-Podiatric Surgeons (Jared Clifford, DPM)
From: Susan Scanlan, DPM, Richard W. Boone, Sr

The Washington State Podiatric Medical Board does have a policy against assisting in surgery out of the scope of practice of Podiatric Medicine.

Susan Scanlan, DPM, Executive Director WSPMA/Region VII, Seattle WA, NWPODIATRY@aol.com

In my experience when a DPM who is not a resident or trainee physician assists at out-of-scope surgery the same rules apply to the podiatrist as would apply to any unlicensed surgical technician in the state you're in. That would apply to both the rules about whether the assisting is permissible and whether it is reimbursable. Further, I expect that the same rules about credentialing apply. In other words, if the hospital in question credentials surgical techs (which it probably should) then the assisting podiatrist would need to be credentialed as a surgical tech before assisting with the procedure.

Malpractice liability and insurability for the assisting podiatrist is more complicated to determine. If I were the assisting podiatrist's attorney I would caution him against assuming that his podiatry policy would cover him in the assisting role. My suspicion is that it would not. Malpractice liability caps probably don't apply either.

Once a podiatrist moves beyond the scope of practice in his or her own state, he or she is no longer a licensed health care provider. The podiatrist is a civilian, pure and simple. The benefits and protections provided by the podiatry license no longer apply.

Richard W. Boone, Sr., Esq, Fairfax, VA, RWBoone@aol.com

Editor's Note: Because of an error in yesterday's Codingline Corner, we are reprinting a corrected version along with a reader's comment and a Codingline response.

RE: Diabetic Shoe Program Qualifier
From: Multiple Respondents

Officially, the determination as to if a patient is qualified for the therapeutic shoe program is up to the physician treating the patient's diabetes. That doctor has to certify that his/her patient has diabetes, and has diabetes, and
a) history of partial or complete amputation of the foot; or
b) history of previous foot ulceration; or
c) history of pre-ulcerative callus; or
d) peripheral neuropathy with evidence of callus formation; or
e) a foot deformity; or
f) poor circulation.

If the MD/DO physician concurs that the patient has diabetes, and checks-off one of the medical conditions being present, with your prescription the therapeutic shoes and insoles you feel best serves the patient can be filled. If the MD/DO treating the patient's diabetes does not agree or does not feel the patient qualifies, and refuses to sign the certification, then the therapeutic diabetic shoe program will not reimburse the shoes/inserts. Simple enough.

Remember, based on the criteria above, it's the MD/DO's decision to certify the need based on their interpretation of the verbiage given to them by CMS. This is unlike qualifying certain systemic conditions for routine foot care.

Paul Kinberg, DPM, Dallas, TX

I found the response by Dr. Kinberg to Dr. Kornfeld's question concerning diabetic shoe qualifications interesting. While we know that it is true that the MD/DO is the responsible party regarding the certification of patients for the Medicare diabetic shoe program, I find myself with several questions for discussion:

1) In the event of an audit, are patients ever examined independently to assure the stated findings are in fact present?

2) If the stated findings do not exist, would not Medicare recoup payment from the podiatrist, since it is the podiatrist who receives payment.

3) As podiatric physicians, don't we have an ethical responsibility to refrain from being a party to fraud, and to report fraud if we think it clearly exists?

Norm Wortzman, DPM, North Quincy, MA

Response from Codingline

If an audit occurs, you can count on the OIG or Medicare to 1) examine the MD/DO certifications, 2) examine the prescriptions, and 3) contact the patients or their guardians - all to validate whether all the "i's" were dotted and the "t's" crossed. If a certification was not signed by the MD/DO or otherwise incomplete, money paid will be refunded by the supplier (e.g., podiatrist dispensing the shoes/inserts). If no prescription was written or otherwise incomplete, money paid will be refunded by the supplier (e.g., podiatrist dispensing the shoes/inserts). If patients say they never received, for example, a custom shoe and inserts billed, money will be refunded by the supplier (e.g., podiatrist dispensing the shoes/inserts)...and the investigation widened. Will an audit include examination of patients? Sure, sometimes (Murphy's Law: presume in your case, every time).

If a supplier dispensed shoes and inserts, having received a valid prescription and certification qualifying the patient, only to find out in an audit that one or both are incomplete, invalid, or false, the supplier - assuming there is no wrongdoing on his/her part - will be asked to refund the money paid. If the issue is possible fraud, then the parties will be investigated and those responsible for any fraud discovered will be held accountable.

Harry Goldsmith, DPM, Cerritos, CA, hgoldsmith@codingline.com

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High volume, high grossing. 60% routine foot care, 40% surgery. Several nursing homes. Plenty of opportunity for growth. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ALTERNATIVE PATHWAY TO BOARD CERTIFICATION PETITION

I am seeking to gather the names of my fellow podiatrists who are being denied the opportunity to sit for the board certification exams and would like to join my efforts to petition our leadership for a fair alternative within the system. To join this effort, please email your name and contact information podiatrydoc@gmail.com

ASSOCIATE-TO-PARTNERSHIP OPPORTUNITY NEW HAMPSHIRE

Established practice located 1 hour north of Boston in tax-free New Hampshire is seeking a well-trained graduate of a 24-month surgical/general podiatry residency. This is a practice with a nice mix of surgery, biomechanics, injuries, diabetic and general care. No nursing homes. Very modern office with EMR, US, excellent referral base, and a well-trained staff. E-mail inquiries howardbon@aol.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

Multi-location office and soon to open a third location. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. No nursing homes. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing Machine. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com or FAX to 480-782-1290.

FOR RENT AND IMMEDIATE OCCUPANCY ARIZONA

Excellent free-standing location and exposure in Sun City, AZ. Across
from Boswell Hospital. Has been a podiatric office for 15 years with an approved Medicare SurgiCenter w/in the office. Office is a turn-key facility and can include present equipment. 3750 sq ft with 9 tx rooms, large reception and BO area. Email tbirdpod@cox.net or 602-510-2871.

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