The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 16, 2008 #3,169 Editor-Barry Block, DPM, JD

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FL Podiatrist Finds Romance on The Lecture Circuit

Two Boca Raton doctors share more than a personal commitment. They share their expertise with medical people around the world. “We enjoy teaching other doctors – and we have a desire to provide them with the latest information,” said Marta I. Rendon, MD, a board-certified dermatologist and researcher on psoriasis, eczema, alpha-hydroxy acids and the effects of cosmetics on the skin. She and Dr. Bret Ribotsky have spent time lecturing in Singapore, Hong Kong, Malasia, Japan, France and Spain, among other places. Dr. Ribotsky is a podiatrist, board certified by the American Board of Podiatric Surgery and The American Board of Podiatric Orthopedics and Primary Podiatric Medicine.

Drs. Rendon and Ribotsky hamming it up.

Doctors Rendon and Ribotsky – who are significant others – just spent “12 weekends” traveling together – and they loved it. “Sometimes, it is our best time together,” she said. “It’s a combination of work and quality time.” After serving as chairman of the Department of Dermatology at the Cleveland Clinic Florida, she is now in private practice at The Dermatology and Aesthetic Center in Boca Raton. Also in private practice in Boca Raton, Dr. Ribotsky is a graduate of the Temple University School of Podiatric Medicine.

Source: Dale M. King, Boca Raton News [2/14/08]

Bush Administration to Propose Medicare Overhaul Legislation

The Bush administration is planning to propose legislation that would address excess spending in Medicare and go beyond the "trigger" provision in the 2003 Medicare law to healthcare in general, HHS Secretary Mike Leavitt said at a House Ways and Means Committee hearing on Wednesday, CQ HealthBeat reports (Reichard, CQ HealthBeat, 2/13).

President Bush for the first time is required by law to send a Medicare savings plan to Congress after he releases his fiscal year 2009 budget proposal because Medicare trustees last year triggered a "Medicare funding warning." The warning is issued when trustees for two consecutive years predict that federal general fund revenue must be used to pay for 45% or more of total Medicare costs within seven years suggested that the proposal would be in line with the administration's beliefs that healthcare should be a "private market where consumers choose, where insurance plans compete and where innovation drives the quality of healthcare up and may drive the cost down."

He added that the competing vision of healthcare is a "Washington-run, government-owned plan, where government makes the choices, sets the prices and [then] taxes people to pay the bill." Leavitt said Bush likely would have the proposal sent to Congress before Feb. 21.

Source: CQ HealthBeat via American Health Line [2/14/08]

Query: Degloving Toe

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I have a diabetic patient with neuropathy and an ulcer on her toe. Her ulcer is doing well, but two weeks ago her skin around the ulcer sloughed off. I have seen her weekly since and each time she presents the same. Her toe is encrusted with a hard layer of skin like a dried blister. Underneath is what appears to be dark, crumbly dried blood. Deep to that is dark unhealthy looking epithelium with skin lines.

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Degloving Toe

Query: Non-Paying Cash Patient

We have had a situation occur in our office. A patient made an appointment and said that he would pay at time of service. We evaluated and treated him, including x-rays. The patient then said that he did not have his wallet and left... never to be heard from again. How do we handle the patient from the outset? Can we require proof of ability to pay such as a credit card? If the patient leaves without paying, can that be construed as theft of services? Can the authorities be called and charges be filed?

Michael J. Schneider, DPM, Vail, CO

Editor’s comment: PM News does not provide legal advice. From the outset, it’s important to initially obtain as much information as possible about any patient. This includes personal and employment data. Staff should be trained to recognize incompletely filled forms as a red flag.

One must initially trust a patient who ”forgot my wallet.” Such patients should be given an invoice and a self-addressed envelope on the way out of the office. Follow-up with a phone call is recommended.

Not paying a doctor’s bill is not considered theft of services in a criminal sense, but you can certainly send it to collection or file a civil court small claims suit.

Query: Non-Covered Footwear

Would you use the code series, L3215-L3257 (orthopedic footwear), for a Medicare patient who does not have diabetes, but wishes to purchase shoes, and pay cash for them?

Bryan Blanck, DPM, Ada, OK

Response: If the shoe is not a Medicare benefit (statutorily non-covered), and the patient will pay cash, then you are not obligated (unless the patient insists on your submitting the claim to Medicare, or if the patient has a secondary plan you are contracted with) to bill anyone other than the patient. And since you only have the patient to bill, you can bill it to the patient as "shoes" or "oxford shoes" or "therapeutic shoes" - your choice of wording. If you want, you can list out for the patient the specific type shoes (using the HCPCS code) on their receipt/statement:

L3215 (ladies shoe oxford, each) x2
L3216 (ladies shoe depth inlay, each) x2
L3317 (ladies shoe hightop depth inlay, each) x2
L3219 (mens shoe oxford, each) x2
L3221 (mens shoe depth inlay, each) x2
L3222 (mens shoe hightop, depth inlay, each) x2
L3230 (orthopedic custom shoe, depth inlay, each) x2

This may be helpful for them if they are going to include it as a medical expense on their taxes.

Tony Poggio, DPM, Alameda, CA

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RE: Credit Card Processing Company (James Korponay, DPM)
From: Richard A. Simmons, DPM

Many of the large warehouse clubs (e.g., Sams, Costco, etc.) offer this in their business service package for a very reasonable fee. Your bank also offers this, but banks are notoriously expensive.

Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com

RE: Number of Podiatrists Needs to Triple by 2014 (SUNY Report)
From: Paul Kesselman, DPM

A recent report from SUNY Albany reports that by 2014, the number of graduating podiatrists needs to triple in order to meet the demands of the aging baby boomer generation and their parents. I'm not a public health expert, but it certainly seems that an aging population (including many of my colleagues) will certainly guarantee many fellow DPM's will soon be retiring. Most podiatry classes in the late 70's and early 80's had more than 100 students - classes today are far smaller. As my classmates retire, become disabled, or die, it certainly seems that a large number of replacements will be required. It also seems that an aging boomer generation will also require more foot-related services.

These facts aside, however, do not offset the following:

1) Many physicians are so fed up with the system that they retire as soon as financially possible.

2) Many DPM's are having a hard time meeting their financial obligations and are seeking alternative employment opportunities.

3) The cost of obtaining a medical degree is sky rocketing while reimbursements are traveling just as fast in the opposite direction.

4) Most DPM's graduate from school and residencies hundreds of thousands of dollars in debt.

Something needs to be fixed soon, or there will be a need for more than a 300% increase in the number of graduating podiatrists!

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

RE: Universal Healthcare (PM Jan 08 Column by Harry Goldsmith, DPM)
From: Eric Fuller, DPM, Elliot Udell, DPM

The government can't do anything right argument was addressed very well in the original article when Dr. Goldsmith compared Medicare (a government program) to private insurance.

The "it will raise taxes" argument was partially addressed, but I would like to add something. I'm currently paying over 10% of my income for high-deductible policy. I would gladly pay 8% of my income to the government to not have to pay 10 to an insurance company to get coverage similar to Medicare. Medicare's overhead is around 5%. Private insurance overhead is between 17 and 25% depending on who you read.

Currently the U.S. spends way more per capita on healthcare than any other country in the world and by most measures we are not getting our money's worth. Some of those measures are life expectancy, infant mortality rates as well as percentage of population who has access to healthcare. Other countries are able to give all their citizens healthcare and spend less than we do, because their system is more efficient.

Single-payer is a socialism argument: People are reluctant to leave the safety of their jobs with health coverage to start new companies or new careers. The lack of affordable health insurance is stifling innovation and the free flow of labor in our market economy. Sometimes it is more efficient for a single entity to provide a particular service for a community. You don't see four sewer companies competing for your business because it would be inefficient to have four sewer lines under your street. Call it socialism, but I like having a municipal utility district. It works, and as far as I can tell it is efficient and the people who run it answer to the voters.

Kudos to Dr Goldsmith for an excellent essay.

Eric Fuller, DPM, Berkeley CA, fullerpod@lmi.net

Editor's Note: An extended-length letter by Dr. Udell appears at:http://www.podiatrym.com/letters2.cfm?id=17954&start=1

PRACTICE FOR SALE -AUSTIN, TEXAS

15 year established practice with good mix of surgery and clinical patients. Nice office condo for sale with practice or lease. Current female Podiatrist will transition the practice. 300-400K yearly gross. Flexible payment options

ASSOCIATE POSITION – RICHMOND VIRGINIA

Hospital-Based Practice with Tremendous Growth Potential and a Fantastic Opportunity for the Right Doctor. I am looking for someone who will be an associate for a couple of years, then discuss Partnership Buy-In. ABPS Certified/Qualified candidate DOES NOT need significant rearfoot experience, but arthroscopy skills appreciated. Need strong surgery and people skills, with emphasis on wound care, forefoot surgery, diabetic problems, etc. No nursing homes. My office is an extremely busy brand new state-of the-art facility with digital x-rays, computerized EMR, etc. Immediate start available, SALARY commensurate with experience. Please send resume to: podmed@mac.com

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.

PODIATRIST WANTED – MICHIGAN

Busy 2-Office practice looking for the right podiatrist to take the practice to the next surgical level. Fast track to partnership. PSR 24/36 ABPS qualified/certified. Email resume to drflatfoot@yahoo.com

EQUIPMENT FOR SALE - AUTOMATIC PROCESSOR

AFP Mini-Medical/90 automatic X-ray processor. Excellent condition. Purchased in 2003. Have monthly maintenance records. Location: Pasadena, MD. $1000. View at http://www.afpimaging.com/medmini Contact Jayne at jferris@chesapeakefac.com for details.

PRACTICE FOR SALE - PORT ST LUCIE, FLORIDA

The office is 0.2 miles away from the hospital. Good mix of Medicine, Surgery, Wound care, and general podiatric care. Wound care center privileges available. No HMO's. Please call 1-772-475-7920 or derrico@pol.net for details

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

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 WANTED -BOCA RATON-DELRAY BEACH AREA

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

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