The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 08, 2008 #3,136 Editor-Barry Block, DPM, JD

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MA Podiatrist is Walking Role Model For Patients

Jane Arlander logs about 6,000 walking miles per year, most on a route that begins on Salem's historic Federal Street, crosses the downtown business district (which includes a pedestrian mall), and goes to Salem Commons. There she joins hundreds of others who walk laps around the park. On warmer days, she might extend her walk to Bridge Street, Salem Willows, and perhaps the Derby Wharf Light.

Arlander, a podiatrist, has patients from Swampscott and Nahant who love to walk along Lynn Shore Drive, and she's found that Beverly offers some surprisingly walkable areas, particularly the paved path and green space on the Bass River that crosses Elliott Street to Shoe Pond, but also in the downtown and adjacent neighborhoods heading to the ocean.

As both a doctor and someone with back problems, the 54-year-old Arlander can appreciate the benefits of walking. She cited statistics that showed levels of obesity are lower in the Northeast than in the Midwest, "because people walk," she said. "Walking's very important," she said. "You don't need special equipment to walk, and there are a lot of advantages to it. It always feels better to be outdoors, and does help with the pain."

Source: David Rattigan, Boston Globe [1/6/08]

CA Podiatrist Nominated as Favorite Doctor

The Bakersfield Californian asked its readers to nominate their favor doctor.

Dr. Thomas Nelson is absolutely a jewel. He not only is a wonderful, caring doctor, he is a very polite, caring human being with a wonderful family. He has done a couple of surgeries on my mother’s feet (she gets infections very easily). He calls and checks on her regularly and goes by her house to doctor her feet, as he knows sometimes she can't get into town to see him. (She lives a good distance from town.) He bothers to take the time to just sit and visit with her. He sent her flowers when she was in the hospital.

Dr. Nelson truly is interested in his patients’ well being. I truly believe this helps her stay healthy. We can call him day or night; it doesn’t matter to him. He always calls us back promptly. I wish every doctor had his caring attitude. So, if you ever need a foot doctor (or a friend), give Dr. Thomas Nelson a call.

Referred by: Jackie Carter

Source: Bakersfield Californian [1/4/08]

CMS Delays Until 2009 Changes to Anti-Markup Provisions for Some Diagnostic Tests

CMS is delaying some parts of the revised anti-markup provisions for certain diagnostic tests until 2009 due to public comments indicating that some aspects are unclear and could disrupt patient services, according to a final rule published in the Jan. 3 Federal Register. The amended anti-markup provisions would apply to the technical and professional components of diagnostic tests that are billed for by a physician or supplier who ordered the tests.

When the "diagnostic test is either purchased from an outside supplier or performed at a site other than the office of the billing physician or other supplier, the payment to the billing physician…for the technical component or professional component of the diagnostic test may not exceed the lowest of the following amounts": the performing supplier's net charge to the billing physician or other supplier, the billing physician or other supplier's actual charge, or the fee-schedule amount for the test that would be allowed if the performing supplier billed directly, CMS says.

The confusion comes from the definition of "office of the billing physician or other supplier," CMS says. This is the medical office space where the majority of care is provided. CMS says physician groups who submitted comments alleged that "in situations in which they are subject to the anti-markup provisions and are limited to billing Medicare for the amount of the net charge imposed by the performing supplier, because they will not be able to realize a profit and will not be able to recoup their overhead costs, they will not be able to continue to provide diagnostic testing services to the same extent that they are currently providing such services."

Source: Report on Medicare Compliance [1/7/08]

Query: Certification for DME Dispensing

I have heard that podiatrists have to be certified in order to continue to dispense shoes in our offices. I was informed that the deadline is Sept. 2008 and this will be a charge of $3,000+ for certification, and this will need to be renewed every three years. So many times we are scared about new legislature only to have it reversed at the last minute. What are the odds of this being reversed?

Karen Malley, DPM, Thomasville, GA

Editor’s Note: The following response previously appeared in Codingline.com

CMS will ensure that suppliers meet the quality standards through an accreditation model. Two organizations reaching out to podiatrists include: CARF (www.carf.org) and the American Board for Certification in Orthotics & Prosthetics (www.abcop.org). All DMEPOS Suppliers, including podiatrists must become accredited eventually if they intend to continue participating in the Medicare program, even if they do not participate in competitive bidding. It is not known when CMS will enforce this accreditation requirement by discontinuing Medicare payment to suppliers who are not accredited, but this is likely to be years away.

At present, only a small percentage of Medicare's DMEPOS suppliers are accredited. You may be contacted by one or more of the 11 accrediting organizations selected by CMS urging you to avoid delay in becoming accredited. At this point in time, it is important to keep informed of new developments through the APMA, and to keep the implementation of these new policies in perspective.

I hope that this lessens the confusion surrounding these issues. We share your frustration with the uncertainties and misinformation and will continue to inform you of developments as they occur.

Josh White, DPM, C.Ped, New York, NY

RE: MD Program for Podiatrists
From: Thomas A. Graziano, DPM

I am currently enrolled in such a program leading to the M.D. degree. The program has a 20-year history and is out of the British West Indies. The name of the school is the University of Health Sciences, Antigua. The program requires that you complete the core clinical rotations (i.e., internal medicine 520 hours, surgery, 520 hours, pediatrics 260 hours, OB/GYN 360 hours and psychiatry 260 hours) in addition to the courses associated with these rotations. The other requirement is the completion of elective rotations. The thing that makes this program novel is that you are able to do all the rotations here in the U.S. and the course work is administered on-line by MDs from the states as well. It takes about two years to complete if you are diligent.

I have been in the program for the last 16 months and I can tell you it is no joke. I have had to juggle my office practice to accommodate my rotations and its been very difficult. Aside from that it has been a wonderful learning experience for me. I don't plan on changing my profession. I just wanted to expand my knowledge base and be a better overall physician. It’s been a great experience.

Thomas A. Graziano, DPM, Clifton, NJ, TGrazi6236@aol.com

RE: Assisting Non-Podiatric Surgeons (Jared Clifford, DPM)
From: Jon Hultman, DPM, MBA, H. David Gottlieb, DPM

As part of a practice act change in California several years ago (Assembly Bill 932), podiatric scope expanded to include assisting on non podiatric surgical procedures. Because this privilege is included in California's podiatric practice act, it is covered by podiatric malpractice insurance and it is reimbursable. For those states interested in changing their practice act to include assisting on non-podiatric surgeries, implementing this provision was the least controversial of the changes we were seeking in AB 932, and it was unopposed by organized medicine/orthopedics. I think this privilege is especially important for new practitioners and podiatric physicians who practice in orthopedic or multi-specialty groups.

Jon Hultman, DPM, MBA, Los Angeles, CA, jonhultman@verizon.net

I decided to leave retirement and resume podiatric practice via residency training. I was told by the state board that even though I was still fully licensed as a podiatrist the only way that I could legally perform the requirements of modern residency training [which involves many activities above the ankle] would be to also have a limited training license. The license under which residents function allows us to assist other surgeons under their direction without violating the state practice act.

It would be illegal as well as uncovered by any malpractice policy to assist in any surgery that was not within the appropriate state's scope of practice for a podiatrist.

If you are assisting in an operation within your states' scope of practice then there should not be any problems.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

REPRENTATIVES WANTED - OUTCOME MEDICAL

Outcome Medical, (see our ad in Podiatry Management) is looking for reps to call on podiatrists and primary care physicians to market our pain program. Our FDA-cleared technology for pain and circulation is currently used by hospitals and doctors throughout the country. We provide training and technical support. On staff, certified billing, coding, and compliance specialist. Attractive commissions and leads furnished Website, www.outcomemedical.com. Request our representative package by email @ don@outcomemedical.com phone, 770-487-0029; Fax 770-692-0116

PRACTICES FOR CANADA - CANADA

2 DPM practices for sale in metro Vancouver and the Fraser Valley in beautiful BC. Both are well established with healthy client bases over a 30 year practice and can be sold separately. Gross revenues are $190.K and $100.K respectfully with an average net profit of 8% with great potential for increases. Priced at $199,000 & $99,000 to a graduate of any of the 8 USA colleges for approval by local licensing requirements. Contact pearsonhome@telus.net or by phone 1-604-986-0809 or fax: 604-986-0870.

ASSOCIATE POSITION - VIRGINIA

Multi-office practice, EMR, digital x-rays, sonography. Great opportunity for hard-working, personable new or established surgeon. Hospital and surgery center privileges available. ABPS eligible/certified. Full scope of foot & ankle care. Base salary, immediate percentage, and benefits. E-mail letter of introduction, CV and photo to practice administrator at: mtrevor41@yahoo.com

MANUFACTURING ORTHOTICS BUSINESS FOR SALE - CANADA

In Vancouver BC with a average client base of 40 with potential to increase to over 60 clients by calling on MD, ND & Chiropractor practices. Gross revenue averages $230.K over the past 2 years with a 5% net profit after taking a management fee of $12,000. Owner is retiring and will sell for $185,000. Contact Milt at marketime@telus.net or tel: 888-359-2202 fax: 888-303-0017.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.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

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