The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 19, 2007 #2,793 Editor-Barry Block, DPM, JD

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Childhood Obesity Linked To Foot Pain

Doctors with the American College of Foot and Ankle Surgeons (ACFAS) say they’re noticing more and more overweight and obese children with foot and ankle pain in their examining rooms, mirroring a national epidemic of childhood obesity. Arch pain afflicts many of the children treated by Darryl Haycock, DPM, FACFAS. The northwest Ohio foot and ankle surgeon says the average age of these boys and girls ranges from eight to 12, but he’s treated some as young as four. “The numbers are definitely increasing. I treat four to five overweight children a week,” he says.

Dr. Darryl Haycock

Haycock notes some overweight children suffer foot pain from congenital or inherited foot conditions, such as bunions, hammertoes, pediatric flatfoot and tarsal coalition, an abnormal connection between two or more bones in the back of the foot. Children with these deformities may be less active because of pain. Sometimes a child will complain of calf or arch pain. This results from a flatfoot that is flexible. The collapsing of the arch can require more energy, making it more difficult for a child to walk and run.

Alleged Improper Hammertoe Surgery: Montana

Facts: William Willing, 58, claimed that defendant was negligent in recommending hammertoe surgery, in his choice of surgical procedure, and in post-operative care, and failed to obtain proper informed consent. He claimed that his failure to remove wires holding the toes in place while the bones fused caused ischemia, necrosis, and loss of part of his right second toe. He claimed that the injury led to RSD, which cost him his career as a MANG Colonel and forced him to retire early, losing his chance to compete for promotion to General. His wife claimed loss of consortium.

Defendant contended that Willing had suffered from painful hammertoes/claw toes for years, conservative treatment had failed, and he wanted to proceed with surgery to allow him to perform the activities that his job required. He contended that the arthrodesis surgery he performed was an appropriate procedure and he performed it properly. He contended that the post-surgical complications were recognized complications that Willing had acknowledged on informed consent forms and occurred in spite of his diligent care. Defendant contested Willing's claim that he was unable to work and that his mobility was as restricted as he claimed.

Judge Phillips deferred ruling on Plaintiffs' constitutional challenge to the damages cap on non-economic damages in medical malpractice cases, finding that it was not ripe, although it was an issue worthy of review.

No demand or offer; Plaintiff let Defendant know that he would settle within $1 million policy limits. Jury request, $450,000-$880,000 lost income plus unspecified non-economic damages.

Result: Defendant’s verdict ($0)

Plaintiff's experts: David Widom, DPM, Ft. Lauderdale; DPM Michael DiGiacomo, DPM, Oakland, CA
Defendant's expert: William Wilshire, DPM, Bozeman, MT

Source: Montana Law Week

Initiative to Offer Free e-Prescribing

A coalition of 11 technology companies and healthcare organizations said it will offer free electronic prescribing to physicians through a website, www.nationaleRx.com. The service will be running in about 30 days, officials said. The coalition, known as the National ePrescribing Patient Safety Initiative, includes Aetna, Allscripts Healthcare Solutions, Dell, Google, Microsoft Corp., WellPoint and others.

The coalition said its members would invest $100 million in the service over the next five years. Health plans participating in the initiative will offer physicians a range of incentives to use e-prescribing, according to an Allscripts news release. At a news conference, Glen Tullman, Allscripts’ chairman and chief executive officer, said the project might spur other companies to also offer their e-prescribing products for free. Read the news release.

Source: Jennifer Lubell, Modern Healthcare [1/17/06]

Query: Unethical Practices and a New Associate

I am a new associate in a very busy practice. I am a very well trained, motivated and ethical podiatrist. Since I started practicing, I have heard from a few different doctors in the community that the podiatrist I am working for has a history of unethical billing practices and actually once had to go to court for insurance fraud. Also, I have seen some questionable things in the practice, such as possible "code" violations in the office (no emergency equipment, no handicap accessibility, lack of sinks in one of the offices, lack of proper clean up of blood, etc.)

Does anyone know of any authorities I can contact regarding the above matters? There is a great potential here for me, but if unethical things are being done, I know that I will never be happy becoming a partner here. I do not want to risk losing my license.

Name Withheld by Editor

Editor’s comment: PM News does not provide legal advice. Prior to accepting a position or entering into a partnership with another podiatrist, it is important to do some research. These days, it is easy to check license history online. Additionally, one can contact the state APMA association and ask some questions.

Once one is employed in a practice, one should become well-versed in billing practices and routinely compare one’s chart notes to what is being billed. If irregularities are noted, these must be addressed, and if one is not satisfied with the resolution, one should seek employment elsewhere. Failing to do so may result in one sharing a jail cell with one’s employer or partner.

RE: CME for H & P’s (Rick Burnell, DPM)
From: Peter A. Wiggin, DPM

The Scholl College has a comprehensive course scheduled with the deadline Feb 19th. State-of-the-Art History Taking and Physical Examination Review: Improve Your Clinical Efficiency, March 2-3, 2007

Peter A. Wiggin, DPM, wigone@aol.com

Editor's note: See http://www.rosalindfranklin.edu/scpm/ce/HistoryTakingPhyExam.cfm

RE: Beware of Free DME Products
From: Paul Kesselman, DPM

Several weeks or months ago I posted a warning regarding billing the Medicare DMERC's for products you receive gratis. I continue to receive unsolocited faxes from a company promising 6 free night wraps, or night splints (they coded them as L4396) if one purchased six Actipatches.

Several months ago I sent a copy of this fax to the SADMERC Medicare director and several health care attorneys, as well as a DMERC ombudsmen. I had received information from SADMERC's medical director and other healthcare attorneys that this was contrary to Medicare policy. Others told me of the potential of violation of Medicare policy would be determined on how your bill is itemized.

I would therefore suggest that prior to billing Medicare for any products received free or seemingly free as an incentive to purchase others one ask for a copy of the terms and a sample bill; Consult with an attorney well versed in Medicare health policies.

Paul Kesselman, DPM, Woodside, NY pkesselman@pol.net

RE: State of Hospitals in US
From: Eugene A. Batelli, DPM

It's no surprise that decreasing reimbursements affects physicians, diagnostics, surgical centers, and hospitals alike. What is extremely troubling is the amount of hospital closures throughout the United States. Just yesterday CNN ran a report of patients waiting in excess of 23 hours in ER's in Arizona due to doctor shortages as well hospital closures. I'm from NJ and am really scared with the amount of hospitals closing there. I dread the day that I or a family member will need to use a hospital because they have become so overworked and under staffed that care definately is suffering.

It's also no surprise that podiatric, orthopedic, and GI (endoscopy) outpatient services are paid very nicely. That's the reason for so many free-standing ambulatory surgical centers. CMS is also not stupid and I am sure they are well aware of this. My question is: is there a happy medium to allow these, in my opinion, very patient friendly as well as doctor friendly surgical centers to survive with suffering hospitals. I believe 10-15 yrs ago similar circumstances brought about decreasing reimbursements to free standing facilities in favor of hospitals. Is there a balance to allow hospitals to be profitable and thrive as well as allow these surgical centers to stay open?

Please do not take this as me being pro or anti surgical center, or hospital for that fact. I am just concerned that emergent patient care is going to suffer and lets face it, we all will need these services one day.

Eugene A. Batelli, DPM, Naples, FL, ebatelli2001@yahoo.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Immediate Opening. Busy practice in prime suburban St. Louis location looking for a surgically trained associate, possible partner. Must be honest, ethical and hardworking. ABPS preferred, but not required. Please reply with CV and requirements to mdwrtw@aol.com

EQUIPMENT FOR SALE

1 Whitehall whirlpool JO 140, 1 Whitehall whirlpool P 15 M, 3 Bailey physiotherapy stools. Would prefer to sell as package, but will sell separately. Please respond to Bob Kornfeld, DPM at Holfoot153@aol.com or call 516-869-3338.

ASSOCIATE POSITION - MID-EASTERN, NORTH CAROLINA

Potential partnership - Well-established and extremely respected single location practice. Small city east of Raleigh near coast with excellent fishing, hunting, and outdoor activities. Must be personable & motivated with strong surgical and medical skills. Prefer PSR-24/36 training with active (or in process of obtaining NC license). Send CV to ncfootankle@aol.com

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227

POSITION AVAILABLE-SOUTH FLORIDA/BROWARD COUNTY

Needs 2 or 3-year post surgical training in forefoot and rearfoot
Salary plus incentives Email responses to office email: advfoot@bellsouth.net

EQUIPMENT FOR SALE - METTLER SONICATOR 715 ULTRASOUND

Mettler Sonicator 715 Ultrasound with 5cm2 with delivery head, great in any podiatry office for multiple uses. The cheapest I am able to price this machine new, is on Esurg at $1396.77. My unit was used about 20 times, and is about 2 years old. I will let it go for $650.00 plus shipping. Like new condition. If interested, write deg1@comcast.net

EXCELLENT ASSOCIATE OPPORTUNITY – SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently-trained PSR-24 or PSR-36 foot and ankle surgeon for associate with ultimate partnership opportunity in LA area. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. Only 8% Medicare with No HMO. Email CV to dr4feet@sbcglobal.net

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead, FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com. I can also be reached at 305-331-4501.

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

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

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