The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 24, 2007 #2,818 Editor-Barry Block, DPM, JD

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PA Podiatrist Uses Online Appointment Service

People can already go online to book a flight, make hotel reservations, buy movie tickets, watch television shows and shop for groceries. Jonathan Straub thinks people will also embrace using the Internet to make and prepay for doctors' appointments -- even if it means paying a small "convenience" fee to do so. Straub is president of business development for DoctorsDirect.com, a new company that has just started test marketing its online physician appointment service in Philadelphia, as well as in Los Angeles and San Francisco.

Dr. Michael Grossman

Dr. Michael Grossman, a podiatrist at the Main Line Foot and Ankle Center in Ardmore, is among five Philadelphia-area physicians who have already signed up to be listed on the DoctorsDirect Web site. Grossman, who is also the chief of podiatry at Lankenau Hospital in Wynnewood, said he was attracted by the company's "cutting-edge" technology.

"The niche I believe they're after is reserving spots for clients who find it difficult to schedule appointments," he said. "There are more and more business people who can't, for whatever reason, find the time to make the phone call and find a time that will fit into their schedule. With DoctorsDirect they can go onto their Internet or use their Blackberry and book a guaranteed time."

Source: John George, Philadelphia Business Journal

AAPSM Publishes 3rd Edition of Student Handbook

The American Academy of Podiatric Sports Medicine (AAPSM) has just published the 3rd edition of the AAPSM Student Handbook. This reference guide features chapters from students at several podiatry colleges. Students at Scholl wrote about the foot; students at OCPM wrote about the ankle; students at Temple the leg; and students at CSPM covered the knee and other specialty topics.

AAPSM Student Handbook

Dr. Doug Richie, along with AAPSM board members Tim Dutra, Matt Werd and Bruce Williams, edited the content and worked with the students on preparing articles for publication, which was sponsored by Brooks Sports, Inc. Copies of the handbook are available for $20 through Rita Yates at ritayates2@aol.com

Employers Expect 8% Increase in Healthcare Costs This Year: Survey

Employer healthcare costs last year increased by 8%, and companies expect the same rate of growth this year and in 2008, according to a survey released on Wednesday by Watson Wyatt Worldwide, the AP/Detroit News reports. The survey, which Watson conducted with the National Business Group on Health, included responses from 573 employers with at least 1,000 employees. According to the survey, more employers said they have begun to offer programs to help employees maintain healthy lifestyles in an effort to reduce healthcare costs.

The survey found that 72% of respondents said they offer employees health risk evaluations, compared with 66% last year. In addition, the survey found that 23% of respondents said they offer onsite health clinics and that 14% of respondents said they offer onsite pharmacies. Based on an initial analysis of the survey results, employers that offer programs to help employees maintain healthy lifestyles have a lower rate of growth in health care costs than employers that shift more of the costs to workers

Source: Theresa Agovino, AP/Detroit News via American Health Line, [2/22/07]

Query: Podiatric Band/Orchestra
From: Paul Kesselman, DPM

I've come across many DPM's and those who service the podiatric community who are avid amateur musicians (myself included having played in a Klezmer band, synagogue band, etc.) Here in NYC there is a professional orchestra of MD physicians who perform regularly. If anyone in the NY area would be interested in starting up a DPM band/orchestra just for fun or to play at fundraisers or club dates, I'd be interested in hearing from you.

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

Query: CMS X-Ray Payment Guidelines

For as long as we have been billing Medicare, we have received the full global payment for x-rays (e.g., CPT 73620) when billed along with an E/M service, regardless of whether there are separate and distinct diagnoses or not. One of our Medicare replacement plans states that they pay according to CMS guidelines, and if Medicare is paying us the global fee in these cases, they are paying it wrong.

Can anyone tell me exactly what the CMS guideline is on this? I have tried the Trailblazer website, but cannot find a clearly stated policy.

Elayne Gordon, Houston, TX

Response: You are going to have to press the Medicare "replacement" plan to show you in writing how you have been wrong. When you speak to them, be sure to let them know that, in fact, Medicare does reimburse the global (both professional and technical components) to physicians that own their x-ray units, take and process the x-rays in their offices, and perform the professional reading. This constitutes the requirement for global payment (when billing the global code, do not append a "-26" or "TC" modifier; the x-ray study code without those modifiers represents a global service).

There is only one exception to the above that I can think of, and that is if the patient you are taking x-rays of resides in a skilled nursing facility, and has been brought to your office for evaluation and treatment. Medicare - your regular carrier - would only reimburse you the professional component of the x-ray study because the skilled nursing facility is paid from Part A for the technical portion. You would need to collect - presuming you have a written arrangement - payment directly from the nursing facility.

If the patient doesn't fall into that category, the rep from the Medicare "replacement" plan is wrong. You should try to get them to confirm in writing what they are saying, and take it to a supervisor, and report it to your state association for action.

Harry Goldsmith, DPM, Cerritos, CA

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Editor’s Request: PM is planning a story on the use of I-Pods in podiatric medicine. Unfortunately, the writer's computer crashed, so the notes from those who previously replied were lost. We ask those podiatrists to resend their notes. If others would like to share your experiences as part of this article, please write Laura Gater at lsgater@earthlink.net Thank you.

RE: Cosmetic Foot Surgery (Martin V. Sloan, DPM)
From: Simon Young, DPM

I can empathize with Dr. Sloan’s position. I find myself in similar circumstances, but I see nothing wrong with "cosmetic foot surgery." As long as the patient is fully informed with proper disclosure, insurance companies are not involved, and the practitioner is competent, I don't know why the consumer needs to be weary.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

I found the posting of Dr. Sloan, regarding cosmetic foot surgery, somewhat concerning. Let me begin by stating I practice in an inner city location populated by patients that I have difficulty getting to pay their co-pays, let alone a cosmetic non-covered procedure.

Although I am not an advocate and do not perform "cosmetic" foot surgery, as it is intended to be, I, nonetheless welcome new ideas, new techniques, and new marketing strategies that bring podiatry to the forefront.

I do not assume that just because I do not perform a specific type of procedure, or even disagree with the concepts, that it does not have its place. Like any surgery or procedure, if the patient is well informed as to the outcome and expectations, they have the choice to proceed or not. Almost all of our surgery is elective, and all of us have had patients shy away from surgery, even in cases of pain and deformity. Also, all of us have seen misuse of surgery, under the guise of deformity, over-utilized or performed inappropriately. So, in my opinion, believing that those performing these procedures are automatically using "snake-oil tactics", is a huge generalization.

In conclusion, let us not put down what others may be doing because we may not choose to do it. We should focus on the quality of what ALL of us do, regardless of if we agree or disagree with the concept. Perhaps some of what the "cosmetic" procedures entail can be utilized by those of us doing traditional procedures and improve our results.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

Editor's note: The complete text of Dr. Kashan's letter can be read at: http://www.podiatrym.com/letters2.cfm?id=12883&start=1

RE: Perioperative Anlalgesia (Scott Hughes, DPM )
From: Multiple Respondents

I use Lyrica routinely in my practice for neuropathy, neuritis assoc with tarsal tunnel and neuromas, chronic pain, etc..., but never post-op. I am quite curious how many others are using this regimen that Dr. Hughes has outlined.

Lyrica reaches peak levels 1.5 hours after administration and is dose dependent. Its half-life is 6 hours in non-renal impaired patients. Lyrica reaches steady state plasma levels 24-48 hours after repeated dosing. My personal experience is that it takes 3 to 5 days to become effective and I dose it quite high (100-150 mg tid in diabetics with severe neuropathy). Basically, one dose pre-op and 2 days of Lyrica use should not work all that well.

I am not a huge fan of Toradol so if this regimen of Lyrica can work on its own (Dr. Hughes stated he also uses 60 mg Toradol IV followed by PO use) or possible combined with Celebrex, this really could be a huge breakthrough for post-op analgesia. Lyrica is quite safe and really has no drug-drug interactions. It does potentiate opiates and benzo's but this could lead to much less narcotic use post-op.

I hope Pfizer reads this and possible can get a study started involving podiatric surgery and not rat models or hip replacements. Dr. Hughes, I will be trying your regimen and thanx for peaking my interest.

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

For some years now, I've used a mixture that used to be called "Supercaine" at one time. This is a mixture of 0.5% Marcaine with epi mixed with 1% Pontocaine. In most patients, the feedback I receive is between 24-36 hours of anesthesia to the site after the block, but have had a few patients report 48 hours or so. My experience has been that most post-operative pain lasts for the first 24-48 hours and with the local block, Cold Therapy circulating through the pad integrated into the dressing and elevation of the extremity, that a fair number of my patients report not having to take the narcotic I've written for them.

As Pontocaine is no longer used for spinal anesthesia due to radicular irritation, you may have a difficult time getting it into the hospital. It also needs to be refrigerated and the toxic dose is 6mg. As each ampule contains 2 cc., you obviously can't inject very much of this, but as an ankle block, 10 cc. mixed of "Supercaine" is usually enough to make patients comfortable.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

My regimen used to be Bextra 20 mg 2 hours pre op and then 1 daily x 7 days. The patients noted profound post operative analgesia and I noted the diminished use of narcotics, etc. for pain management.

These days I use a pre-emptive block (ankle or sciatic) plus a post op pain pump (no brand specified on purpose), which I fill with ropivicaine w/o vasoconstrictor. I think this is a thought-provoking subject and perhaps one that would be article worthy for the magazine. For example, legal issues aside, I'd like to start using a Cox-2 inhibitor, e.g. Celebrex pre-op again.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

ASSOCIATE POSITION – PORTLAND, OREGON

Immediate opening in beautiful Portland, OR. Busy, well-established private practice is seeking a dynamic, motivated, surgically-trained podiatrist. High volume of primary care referrals. Work with a well-trained support staff in one of the most efficient offices in the area. Surgically-oriented practice. Competitive compensation package including malpractice and benefits. Call (503) 652-1121. Ask for Dr. John Mozena or email jlmozena@aol.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center -Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION – NY & CONNECTICUT

Opportunity to be a part of a prestigious and well-established large Orthopaedic and Rehabilitation practice, with locations in Stamford, CT and West Harrison, NY. Looking for a Podiatrist to join an already busy practice with opportunity to build. We have state-of-the-art offices with MRI, digital x-ray, paperless charts, physical and occupational therapy. Applicants should be Board Certified or Board Eligible. Competitive salary and benefits. For further information on the practice, log onto WWW.NYCONNORTHO.COM Interested candidates should forward their C.V. to: Cliff Katz, Executive Director ckatz@nyconnortho.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net.

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 - EAST/CENTRAL TEXAS

Practice in East Central Texas has an opportunity for an associate to join as an associate leading to partnership. Hospital supported practice which has two doctors seeking a third for new office. Practice is leading provider in market and offers an outstanding compensation and benefit package. This position is targeted to be an equity partner within two to three years. easttxdpm@comcast.net

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.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

ASSOCIATE WANTED - NORTH CAROLINA , CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

ASSOCIATE WANTED - MICHIGAN-DETROIT AREA

Great opportunity-must be hard-working, reliable, responsible and good with patients & staff-surgical training a plus-partnership after 1 yr. Michigan license required fax resume to 248-478-1370

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with potential partnership opportunity. Looking for PSR 24+ individual. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

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

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