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February 05, 2008 #3,159 Editor-Barry Block, DPM, JD

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Custom-Made Shoes Can Help Accommodate Foot Deformities: MD Podiatrist

Forget the standard shoe store. Now you can design your own shoes! Pumps, wedges, boots, wing tips... you name it, you got it. And this fancy footwear isn't just the height of fashion; it is one of a kind. With some brands you can pick your own colors and fabrics. With others, you get shoes that fit your feet perfectly.

Dr. Ross Taubman

It's not just about comfort and style, either. Doctor Ross Taubman president-elect of the American Podiatric Medical Association says, of course you should always check with your doctor for any problems. But as for the shoes... "Absolutely the shoe can be beneficial."

Especially if you don't have an average-sized foot or suffer with bunions or hammertoes. Dr. Taubman says made-to-measure footwear can prevent painful rubbing that leads to corns and blisters. "It can be made exactly to the patient's shape of their foot, length of their foot and to accommodate for other deformities," he said.

Source: Susan Kim, WTMJ- TV Milwaukee [2/2/08]

Study's Solution to No-Shows: Overbooking

Just as airlines routinely overbook flights to ensure all seats on the planes are filled, some physicians could overbook their schedules to ensure that all the time slots in their schedules are filled, according to a recent study.

Two University of Colorado researchers published a study that shows how overbooking patients could increase practice productivity and reduce idle time caused when patients don't keep appointments. In January, the study won the 2007 Best Paper Award from Decision Sciences, an academic journal about operations management and decision-making within organizations.

The researchers developed a computerized simulation tool that runs analyses based on specific attributes of the practice, such as size, patient demographics and average length of appointments, to help determine when to overbook, and by how many patients, or if it's even feasible. In many ways, practices already do this through "squeezing in" patients, said researchers Linda LaGanga, PhD, and Steve Lawrence, PhD.

So will physicians, like airlines, soon start offering $100 and a free round-trip ticket to anyone willing to give up their seat in the exam room? Not out of the question, Dr. LaGanga said, though she figures any incentives will be more modest, such as gift cards.

Source: Pamela Lewis Dolan, AMNews [2/4/08]

Query: Rheumatoid Arthritis Caused by Amoebae

Is anyone familiar with the theory that rheumatoid arthritis and other autoimmune diseases are caused by amoebae as outlined in the following article:

www.arthritistrust.org/Articles/Anti-amoebic%20Treatment%20for%20Rheumatoid%20Disease.pdf

Frank DiPalma, DPM, Athens.GA

Query: Videotaping of Surgery

Considering the ease and availability of videotaping these days (think YouTube), has anyone started video-documenting surgical procedures as part of the patient record? One could wear a lipstick camera on one's head during surgery and the video would show exactly what you did if the question ever came up.

Nat Chotechuang, DPM, Bend, OR

RE: Post-op Complication (Name Withheld)
From: Jim Giannakaros, DPM, Dennis Shavelson, DPM

Is it possible that the pain in her foot is not coming from the foot at all, could you be dealing with a tarsal tunnel syndrome or a radiculopathy, refer to a good neurologist for EMG/NCV studies. I would also cover your bases by sending her to a vascular surgeon, she may have palpable pulses, but still have significant vascular disease which could be causing her symptoms.

Jim Giannakaros, DPM, Manahawkin, NJ, Jimpody3@aol.com

Editor’s note: Dr. Shavelson’s extended-length note appears at:
http://www.podiatrym.com/letters2.cfm?id=17781&start=1

RE: Safety of Silicon Injections Debated (David Secord, DPM)
From: Barry Mullen, DPM

Editor’s note: Read this note at: http://www.podiatrym.com/letters2.cfm?id=17782&start=1

Coding Bone Resections (Tony Poggio, DPM)
From: Robert Wunderlich, DPM

I would use the CPT 28122 code for this (Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus)

In your example, the procedure would be coded as follows: CPT 28122 -LT CPT 28122 -59, -LT

Under Medicare, reimbursement would be in the neighborhood of $700 (depending on geographic location).

This would have a 90-day Medicare global. HOWEVER, if you do have to take the patient back to the operating room for additional work during the global period, you can code (and be reimbursed for) any procedures by using the -78 modifier (return to the O.R. for a related procedure during the global postop period).

Dr. Poggio's suggestion to use the CPT 11044 bone debridement code with its 10-day global is appreciated, but as I see it there are 2 issues with this: 1) you would have to generate over $400 in E/M charges between postop days 10 and 90 to be reimbursed more (compared to the CPT 28122 x 2 approach), and 2) "a bird in the hand is better than two in the bush"....if the patient doesn't return for all of those scheduled postop E/M visits, the reimbursement *could* ultimately be less than half of the CPT 28122 x 2 option. It's a bit of a gamble that could work out in your favor, or not.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Charging for Copies of Patient Records (Peter Bregman, DPM)
From: Paul Busman DPM,RN

Is it just me, or does anyone else think that this should be a non-issue. I mean, you have a copier in your office already. If this is a good patient who is going elsewhere because they're moving etc, it's a nice courtesy to do it gratis. If this is a disgruntled patient, charging them for copies, which seriously only cost you pennies, can only aggravate them further. Personally, I always ate the cost of making patient copies and never regretted it.

Paul Busman DPM,RN, Cohoes, NY, brewerpaul@aol.com

RE: Hiring a Foreign Podiatrist as a Medical Assistant (Bret Ribotsky, DPM)
From: Animesh Bhatia, DPM

I am familiar with several such situations involving M.D's. This could work out well for you provided you do your initial work diligently. Have a top notch immigration attorney do the paperwork. Also have your tax advisor do some research because there are different rules for income tax-withholding for H-1B visa holders, and I believe they work out in favor of the employer.

Also, do whatever it takes to get some sort of background check from his native country. Another problem I heard of is that even though they are physicians, they are basically an M.A, so you have to be careful not too get too carried away and let them do too much beyond the scope of your state's M.A provisions.

Animesh Bhatia, DPM, Columbus, OH, asbhatia@hotmail.com

PODIATRIC CONSULTANT AVAILABLE

Board-certified podiatrist with over 25 years experience available on a consultant or educational basis for health-related agency or corporation. To receive a copy of my resume, e-mail havbil@gmail.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

MEDICAL SPACE FOR RENT OR SALE - NEW YORK CITY

305 Second Avenue (17-18th Sts), 3 Treatment rooms, Private office, Lab, Separate Receptionist/Business area, waiting room, bathroom w/ stall shower Deluxe/Landmark/Prime Building and Location, 24/7 security. Multi-specialty condominiums originally designed specifically for podiatry has also been upgraded for dentistry. For further details contact Laura Dobrusin, Ny2azld@aol.com or jdobr@arizonamed.com 480-951-2480 602-980-8457.

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 – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

EQUIPMENT FOR SALE – PODIATRY CHAIRS, ETC.

SELLING quality clean, sturdy well padded exam chairs priced at $500 each, waiting room chairs $100 each, and large desks with rolling chairs at $200 each pair. Email: dr.wright@bigfoot.com or call 609 267 7707

ASSOCIATE POSITION – NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot surgery including Charcot reconstruction and ankle surgery. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - CENTRAL VIRGINIA

Immediate opening. Two office practice, EMR, digital x-rays, sonography. Full scope of foot and ankle care. Candidate needs to be mature, hardworking, and personable. ABPS certified/eligible. Base salary, percentage, and benefits. Submit letter of introduction, CV, and photo to practice administrator at mtrevor41@yahoo.com

SEEKING ASSOCIATE WITH POTENTIAL TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

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