The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 28, 2012 #4,370 Publisher-Barry Block, DPM, JD

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GA Podiatrist Advises High Heel Wearers to Lessen Wearing Time

“No matter what I say, they are going to [wear heels],” said Dr. Jay Spector, of Northside Podiatry, who advises wearing no more than a 2-inch heel ... ever. Serious foot pain related to high heels can develop in as little as one night or a few weeks, he said. 

Dr. Jay Spector

If you must wear high heels, Spector said, wearing them for shorter periods of time, then switching to a shoe with a lower heel can help.

Source: Nedra Rhone, The Atlanta Journal-Constitution [1/20/12]

AR Podiatrist to Receive DSC at APMA HOD

H. F. “Bunny” Brown, III, DPM, a past president of the American Podiatric Medical Association (1195-6) has been selected by the APMA Awards and Recognition Committee to receive APMA's Distinguished Service Citation (DSC). The DSC is the highest honor an APMA member can receive and is awarded in recognition of outstanding sustained accomplishments on the national level in scientific, professional, or civic endeavors on behalf of APMA. 

Dr. H. F. “Bunny” Brown, III

Brown currently serves as the protocol officer at the APMA House of Delegates (HOD). He has been a member of the APMA Bylaws and Procedures Committee for 12 years, participating in the comprehensive revision of the document in 2000. He will receive this award at this year's HOD in March.

PA Podiatrist Goes from Operating Room to Courtroom

Dr. Larry Kansky practiced surgical podiatry for 24 years. In 2007, he was accused of wrongdoing and found it difficult to get through the legal system. After the charges were dropped and his record expunged, he decided to pursue a legal career so that he could help others.

Dr. Larry Kansky

Kansky graduated with honors from the University of Baltimore School of Law in January, 2011. Because of his medical background, Kansky is able to help personal injury lawyers read medical records and better understand their client's medical conditions. He now specializes in personal injury law and criminal defense.

Source: Noberta M. Kosin, Mountain Peaks [1/26/12]

Efficiency a Key Factor in Top Practices: MGMA-ACMPE

Better-performing medical practices are distinguished by high physician productivity boosted by support staff, quicker collections and higher patient satisfaction, according to a new report from the MGMA-ACMPE, formerly known as the Medical Group Management Association.

Among multispecialty, single-surgical specialty, single-medical specialty (excluding general internal medicine) and single primary-care specialty practices, the better-performing practices posted between $6,900 and $14,000 less in bad debt due to fee-for-service activity per physician, according to the report. Better-performing practices also helped ensure high physician productivity by hiring more physician assistants and other non-physician providers as well as more support and ancillary staff per doctor, according to a news release.

Source: Andis Robeznieks, Modern Physician [1/25/12]

Query: Securing Patient Information

A patient fills out the requisite patient information forms, either at the office or online. Those forms contain the patient’s name, address, birth date, social security number, driver’s license, photo, and much medical information. The patient then asks, “How do I KNOW this information is SECURE?”
 
The staff can go through all the machinations of many explanations, but the patient still poses the question. It is a very legitimate question given rampant identity theft, etc. In an office with a large staff of five, ten, fifteen employees who may have access to this information, there could be many breaches. Then, there is the concern of online sharing of information with hospitals, colleagues, insurance companies, etc. Is trust and trust alone the only assurance?
 
Pete Harvey, DPM, Wichita Falls, TX

Editor's comment: Every week, we read of major corporations having breaches of security, the latest being Zappos, the largest Internet retailer of shoes. So, the answer is that no one can guarantee absolute security of information. The best you can do is to describe to patients some of the methods you employ to protect information and to convey that your office considers it the highest priority.

Query: Apligraf Application Denial by Medicare

We recently submitted a claim to Medicare for CPT 17275 for application of skin substitute to the foot. The EOB came back with non-payment, stating, "payment is denied when performed by this type of provider." How can this be corrected on the Medicare end?

Tony Quinton, DPM, Idaho Falls, ID
 
Response: The denial was probably a failure on the part of your carrier to correctly update the codes to include all the provider types potentially going to use it.

If you ever receive a denial with the "payment is denied when performed by this type of provider" explanation, and you are performing a procedure/service within your scope of practice, contact your licensing board for a copy of your practice act. Draft a letter to Medicare appeals and copy the medical director, your state CAC rep, and your state podiatric medical association. This software problem can be easily corrected at the carrier level.

Harry Goldsmith, DPM, Cerritos, CA 

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RE: Achilles Tendon Problem (Richard I Polisner, DPM)
From: Geoffrey Bricker, DPM

Ruptures can occur spontaneously as we all know, so with an 8-week interval, I don't think the Sarapin is to blame. I always mix in 50% dextrose as this stimulates blood flow to the area. I have never had a rupture with this injection; the only complications are pain after the injection and some (15%) treatment failures necessitating surgery (I mostly use the Topaz microtenotomy). After the injection, when the pain subsides, add calf-strengthing (low weight, high reps) to increase tendon strength, which should be done thrice weekly for a year, then at least twice weekly to maintain strength.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

RE: The Use of Uloric vs. Allopurinol in the Management of Gout (David J Kaplan, DPM)
From: Barry Mullen, DPM

Dr. Kaplan raises an interesting point regarding the generic perception of PCP under-hyperurecemia medical management, especially as it relates to therapy timing relative to initial gout attacks. He's not alone in that thought process, especially when comparing the medical management dichotomy which exists relative to other systemic diseases. For instance, PCPs in all areas always aggressively manage cancer once detected. More germane to everyday podiatric practice, once an acute diabetic episode is witnessed, or DM diagnosis established, PCPs always become aggressive in long-term hyperglycemia medical management.

So, what is it? Why the seeming medical management disparity with hyperurecemia? Do PCPs simply downplay its significance relative to its adverse medical sequellae? Are those deemed less significant when compared to other illnesses? Do PCPs ever witness renal uric acid stone formation and hypertension escalation from associated renal compromise from chronic hyperurecemia? A healthcare provider's attitude towards systemic disease management is directly proportionate to...

Editor's note: Dr.Mullen's extended-length letter can be read here.

RE: Exparel Extended-Release Anesthetic (Tip Sullivan, DPM)
From: Keith Gurnick, DPM

The launch of this new drug is set for 4-1-2012. It will only be available initially in 20 cc. 1x use vials without preservative. I am told the case of 10 vials cost will be close to $3,000, thus costing just under $300 per vial. This means that if you use Exparel for a post-op bunion anesthetic injection, the increased cost for just the injection is $300. Currently, there is no designated "J" code for Exparel.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: New MD Shoe Company Tells People to "Ditch Your Orthotics"
From: Kevin Kirby, DPM

A new shoe company, OESH, founded and owned by Casey Kerrigan, MD, has some interesting language on their new website where they make the following claims: "Ditch Your Orthotics: Just as traditional shoe design is flawed, so is the concept of immobilizing the foot with an orthotic. Orthotics are not only worthless, but actually harmful. Whether flexible or rigid, made of foam or plastic, an orthotic detrimentally increases joint torques and pressures. Even a minimal, flexible, off-the-shelf orthotic increases knee joint torques and forces that are associated with knee osteoarthritis." (oeshshoes.com/technology/)
 
Of course, Dr. Kerrigan's shoe company isn't shy about making other claims: "OESH is the first and only footwear with a midsole that provides compression and release, when and only when it should."
 
I find it interesting that an academic MD would not only totally ignore all the prospective and retrospective research that shows that foot orthoses are very effective at reducing the pain and disability from many musculoskeletal pathologies, but would then fabricate stories about foot orthoses being "harmful"....just to sell more of his company's shoes.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: GA Podiatrist Uses Sculptra to Treat Metatarsalgia
From: Jason Grossman, DPM

Those injections seem like great marketing for the office, but are there any peer-reviewed articles? What about the protocol? What are the side-effects and risks associated? Will malpractice carriers defend you if sued for a complication or reaction? Where can you learn how to do them?

Jason Grossman, DPM, Old Bridge, NJ, jasgross@hotmail.com

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