The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 19, 2009 #3,473 Publisher-Barry Block, DPM, JD

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Barry Dedicates Pedinol Student Resource Room

Scores of students, faculty and staff from Barry University’s School of Podiatric Medicine and Physician Assistant program celebrated a dedication and ribbon cutting ceremony honoring the opening of the edinol Student Resource Room. The resource room, housed at the Center for Community Health and Minority Medicine, was made possible by a generous donation of $25,000 from Pedinol Pharmacal Inc.

Barry University provost, Dr. Linda Peterson, Lucila Ramirez, Pedinol representative, and Dr. John (Jack) Nelson, School of Podiatric Medicine interim dean, cut the ribbon at the dedication ceremony of the new Pedinol Student Resource Room.

More than 60 national student leaders comprised of delegates and student body presidents from the American Podiatric Medical Students’ Association (APMSA) were also in attendance and held their House of Delegates Meeting in Miami.

“We are very pleased to be able to support Barry’s podiatric medical students through the Pedinol Student Resource Room,” said senior sales representative Lucila Ramirez, MBA. “Pedinol recognizes the importance of podiatric medicine to the health care of the nation and we believe the students are our future.”

NJ Podiatrist is Also Famed Musician and Composer

Dr. Garry Sherman has got to be the only person on the planet who can say he's played on a hit record with Van Morrison and worked on the feet of top athletes. "I did everything I ever dreamed of," said Sherman, who still composes and plays music but works full time as a sports podiatrist in Morristown.

Dr. Garry Sherman (Photo Dawn Benko )

Sherman, who began playing piano at age 4, said that he can recall hearing symphonic music in his head as a child. He was recruited by universities for his musical talent but studied medicine while continuing to work as a musician. His best known musical work was in the 1960s when he worked on such songs as: "Brown Eyed Girl," (1967) "She Cried"(1962), "Only in America" (1963) and "Cry to Me" (1963). He also composed soundtracks for the "Heartbreak Kid," "Alice's Restaurant," and "Money Talks", among others.

Sherman moved into podiatry because he saw the music industry becoming too electronic, he says. As a podiatrist, he works out of Morristown and treats mostly athletes. He has developed his own techniques, using computer models to examine how feet distribute weight in a particular sport. Torque, acceleration, deceleration and propulsion are all forces which he examines during sessions with patients that typically last about an hour and a half.

Source: Matt Kadosh, Daily Record, [2/17/09]

PA Podiatrist Pleads Guilty to Medicare Fraud

A Scranton podiatrist pleaded guilty Tuesday to taking between $10,000 and $30,000 in Medicare payments for services he did not provide. Dr. Thomas Rittenhouse entered a guilty plea to one count of making a false statement in a health care matter. The charge carries up to five years in prison and fines of up to $250,000.

At a plea hearing Tuesday, Assistant U.S. Attorney Barbara Kosik-Whitaker said the doctor filed claims with Medicare between January 2003 and June 2008 and was paid for services he never provided. In court paperwork, Dr. Rittenhouse is accused of claiming to have performed nail avulsions, a procedure in which a toenail is removed, but actually just provided “routine foot care.”

Under the plea agreement forged with prosecutors, Dr. Rittenhouse admitted the amount lost was between $10,000 and $30,000. An exact amount has yet to be determined, but it is likely the doctor will be ordered to pay back the money he earned through filing the phony claims.

Source: Erin L. Nissley, The Times-Tribune [2/18/09]

Reference Checking Plus

Ignore references on applicants’ résumés. They are likely to have little to say that is not 100% positive.

Tell candidates about an area you would like to explore, and ask whom to contact. Example: “I am interested in learning about the events you have organized. Whom should I call?”

Source:  Adapted from The Boss’s Survival Guide, Bob Rosner, Allan Halcrow and Alan Levins, via Communication Briefings.
 

Query: RSD Post-Neuroma Surgery

My patient is 40ish y/o F, healthy, PMH only significant for migraines 2-3X per year. In early 2006, she had foot pain that was consistent with neuromas in her L forefoot. I injected her 2nd and 3rd interspaces separately which gave her immediate relief. In 2007, an orthopedic foot surgeon surgically explored the 2nd and 3rd interspaces and excised a large neuroma in the 3rd IS and found a normal nerve in the 2nd which was left intact. I began seeing her again late 2008 when she claimed that she did not get any relief after the surgery. I diagnosed early RSD which has been confirmed by neurology, pain management, and orthopedic consults. 
 
She now has much more pain in her 2nd interspace. MRI scan was not conclusive and diagnostic ultrasound shows scar tissue in both interspaces. When I block her interspaces with 0.5% Marcaine + dexamethasone acetate, she gets up to 80% immediate improvement when the 2nd is blocked and 20% when the 3rd is blocked. She still has active RSD which is not improving or getting worse with typical temp changes, color changes and pain out of proportion. Aggressive PT helps for a short duration but the pain continues to return. The question is: If you have an RSD patient who has a single isolated source of pain, is it rational to surgically alleviate the source of the pain (.i.e, neurectomy or neurolysis)?  
 
Tip Sullivan, DPM, Jackson, MS
 

Query: Computer Forensics

I am doing a case review in a podiatric med mal case. It appears that the office notes which are computer-generated were written after the suit was filed. I have recommended that the hard drive be examined to determine when the notes were generated. How does one go about getting this accomplished and are there any particular laws that have to be dealt with to get this information?
 
Name Withheld

Editor’s comments: PM News does not provide legal advice. Increasingly, hard drives are being subpoenaed as part of discovery proceedings in malpractice cases. Additionally, when Medicare fraud is suspected, the FBI gets involved  for this type of forensic examination. Most practitioners are not aware that every addition of deletion to a computer leaves a time stamp stored in a hidden file in the computer.

Companies such as SunBlock Systems of McLean, VA specialize in this type of examination. The lawyer involved in this case can subpoena the hard drive in question.

Query: Injecting Platelet-Rich Plasma

What codes are providers using for injecting platelet-rich plasma (PRP) into a tendon or fascia of the foot? Specifically, this would be treatment of a patient who presents with a chronic Achilles tendinitis or plantar fasciitis or other such pathology? Their blood is drawn, spun down, and separated with the PRP injected into those structures under local anesthesia.

Alan Feldman, DPM, Stratford, CT

Response: I would recommend the following: CPT 86999 (unlisted transfusion medicine procedure). This code would be used for obtaining the plasma, and its preparation. CPT 20550 (injection single tendon sheath, or ligament, aponeurosis [e.g., plantar fascia]). The latter code is for the actual injecting of the gel into the plantar fascia for treatment of plantar fasciitis.

Some warnings: Medicare and many other third party payers do not cover procedures involving platelet gel as they are considered "investigational." Many require a steroid HCPCS "J" drug component to be billed on the same claim as the CPT. Without the HCPCS "J" code, the claim for CPT 20550 may very well be rejected.

You might find, however, a few non-Medicare payers that may cover the procedure on a policy by policy basis. The above codes are a starting point for your facility to use when inquiring on coverage.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Mucoid Cyst (Bonnie Tatar, DPM)
From: Multiple Respondents

From the picture, the lesion appears to be a synovial cyst. As for treatment, put a needle into the cyst and puncture the lesion by making a few needle holes subcutaneously. This will allow the gelatinous fluid that is in these lesions to escape. Then deposit 0.25 cc of lidocaine with 2 mg of triamcinolone. These lesions require an insoluble steroid. An insoluble steroid will stay in the cyst and prevent refilling. Repeat the procedure two more times at weekly intervals. Use an elastic Band-aid to apply compression after each procedure.

Sometimes just breaking the cyst without doing anything else can affect a cure. They are like miniature ganglions and have similar gelatinous fluid in them. Conservative care is more effective than surgical excision since they tend to recur post-op. Some are resistant to treatment and persist even after the series of injections.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

I have had excellent surgical results using a Shrudde-type rotational flap, either 2 or 3 lobes. The long-term cosmetic results are excellent and generally and there is no recurrence as long as you perform bone work at the same time.

Paul Valenza, DPM, Kerrville, TX, kerrfoot@ktc.com

The 5th toe is not a common site for a mucoid cyst and it looks pretty large for one on the photo. I had a similar one over the hallux IP joint that did aspirate some fluid, but recurred. I then biopsied it and the report came back squamous cell CA. I recommend that you biopsy it.

James Hatfield, DPM, Encinitas, CA jphatfield@sbcglobal.net

RE: Reason to Dismiss? (Larry Aronberg, DPM)
From: Multiple Respondents

I wholeheartedly agree to dismiss a patient for lack of respect for you or your staff. My question is what if the person in question is not the patient, but their spouse or relative who accompanies them to their office visits? I have been treating a diabetic patient for the past few years; his wife recently had a misunderstanding with my receptionist regarding the patient's appointment. The patient's wife made very crude, profane and disrespectful comments to my receptionist over the phone and hung up on her. The next time I saw the patient, he apologized to me and then to my receptionist for his wife's behavior. In an instance like this, would you have to disallow the patient's wife from attending future office visits with her husband? Or do you dismiss the patient based on his wife's actions (guilty by association)?
 
Anas Khoury, DPM, Passaic, NJ, khoury@optonline.net

As physicians, we have to rule out the possibility of a medical, neurologic, hormonal, emotional or oncological etiology to the inappropriate behavior of this patient.
 
Consider a referral to a psychiatrist or  family physician for further evaluation.
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net
 

Editor's Note: An extended-length letter from Dr. Richard Gosnay appears at: http://www.podiatrym.com/letters2.cfm?id=24646&start=1

RE: Heel Spurs Don’t Cause Pain: IL Podiatrist
From: Multiple Respondents

In response to Dr. Reid's comment that heel spurs do not cause pain.  I am in total agreement. I have not removed a heel spur in 15 years, and getting great results with alternative treatment(s).

James E. Rogers, DPM, Nashville, TN, drjimbob@comcast.net

I am somewhat surprised by Dr. Reid's comment regarding heel spur surgery. I graduated 25 years ago (no EPF, nor instep fasciectomy, they were always an open procedure) and NEVER were we educated to simply remove the spur. Having done a 2-year surgical residency, I can tell you I personally never witnessed nor heard any teacher or attending take a patient to the operating room to simply remove the spur. It never was an option. 

As for the statement "it's a calcium deposit" again, it’s not entirely true. When the rare occasion arose to take a patient to the O.R. for surgery the pathology report never came back calcium deposit. It came back "bone."

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

RE: CA Podiatrist “Changed” From Humanitarian Visit to India
From: Robert Scott Steinberg, DPM
 
Dr. Holly Spohn-Gross' trip to India is a stunning example of what can be done to ease suffering. Eradicating polio in the world has been a project of Rotary International since the mid 1980s. It was heartwarming to read about Rotarian, Dr. Holly Spohn-Gross' trip to India. These National Immunizations Days must be repeatedly carried out due to the prevalence of chronic diarrhea. Rotarians travel, at their own expense, to some of the deepest parts of third-world countries, many times hand-carrying vaccines that must remain cold until use.
 
Thank you, Holly,
 
Robert Scott Steinberg, Schaumberg, IL, foot_doctor@sbcglobal.net

GREAT OPPORTUNITY- ATLANTA, GEORGIA

Forget getting paid by percentage or a salary, be your own boss. Great opportunity to have your own office with patients without major financial burden. Well-established practice/ office, fully equipped, five treatment rooms, x-ray room, lab, kitchen, doctor’s office, large street sign on a main road, office location and doctor's name is well-known in the community, lease or lease to buy. The doctor is cutting back on this location to become semi-retired. E-mail superrang@bellsouth.net

PRACTICE FOR SALE – ANDERSON, INDIANA

Well established office in Anderson Indiana for sale. Seller currently works 3 half-days per week and gross over $200K. Excellent locations and growth potential. Very podiatry-friendly community. All equipment and furniture included. Seller is willing to help with transition. Contact seller at mddpm@sbcglobal.net for more information.

PODIATRY ASSOCIATE WANTED – NJ

Northern NJ. Bergen County Must be well-trained. No nursing homes or house calls. Modern well-equipped office. Digital x-ray and ultrasound. Excellent pay and opportunity. Must have NJ license. Call 973-472-4700.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION NORTHERN CALIFORNIA

Need associate in busy office in two locations. Hospital privileges
available. Emphasis on wound care. All aspects of Podiatric Medicine and Surgery. Associate position to lead to partnership and buyout. Please contact jimf@humboldt1.com

ASSOCIATE POSITION – BRONX, NY

NYNJ Foot & Ankle Associates www.nynjfootandankle.com is a rapidly growing practice that was started 12 years ago. All aspects of foot and ankle services are provided including large surgical volume, diabetic wound care, trauma and general podiatry. We are now hiring part-time for our Bronx, NY location. Excellent salary opportunity for the proper candidate.  A partnership track is available for the proper candidate. Fax CV to 718-547-9232

ASSOCIATE POSITIONS - CALIFORNIA

Three podiatrists needed for busy North Hollywood office.  Full-time Monday-Friday 8am-2:30pm.  No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

OFFICE SPACE FOR RENT - SEATTLE, WA

Full-service, state-of-the-art podiatry office is offering office space for an independent podiatrist or podiatry group. We have digital X-ray, PADNET, physical therapy equipment, all podiatry equipment and staff to assist you to make the most out of your podiatry practice. Our office is conveniently located close to North West and Stevens Hospital right across from North Gate Mall. You can send your letter of interest to: seattlefootdoctor@yahoo.com or call 425-223-9588

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once-in-a-lifetime opportunity to join one of the most successful practices in the United States. No seniority system. If you are motivated and have completed a PSR24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Fax resume to: 513-577-7261 or E-mail resume to Kroesch4poh@aol.com

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

NEEDED  CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

  
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