The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 24, 2008 #3,176 Editor-Barry Block, DPM, JD

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Achilles Tendon Surgery Advances Speed Recovery

Many Achilles tendon surgery patients are getting back on their feet faster, thanks to new procedures and techniques. The introduction of tissue graft products, bone anchors, radio frequency treatments and new arthroscopic procedures provides patients with less invasive treatments and speedier recovery times. More than 1,000 foot and ankle surgeons are learning about the latest treatments and techniques for foot and ankle conditions at the American College of Foot and Ankle Surgeons (ACFAS) 66th Annual Scientific Conference in Long Beach this week.

"Whether it's getting back to work faster, or getting back to marathon training, these surgical advances will shorten recovery times for many types of patients," says Des Moines, IA foot and ankle surgeon Michael S. Lee, DPM, FACFAS. Lee serves on the ACFAS board of directors.

Dr. Michael S. Lee

Recently-introduced radio frequency technology can slash recovery time for some patients by using radio waves to stimulate healing in the tendon. The procedure requires smaller incisions to insert the wand-like radio frequency device. Smaller incisions mean less damage to skin and muscle, less pain, and lower risk of surgical infections. Patients recover faster.

New arthroscopic techniques can provide a minimally invasive option to removing bone spurs and bursas without significant damage to the Achilles tendon. When the tendon does have to be surgically detached, new bone anchor constructs (screws that are drilled into the heel bone to secure the tendon and tissues) can reattach the tendon, minimizing the chance of a potentially painful knot on the back of the heel.

ACFAS Members Elect New Board Of Directors

The American College of Foot and Ankle Surgeons (ACFAS) has announced its 2008-2009 Board of Directors. The new Board was installed today at the annual business meeting conducted at the ACFAS 66th Annual Scientific Conference.

Dr John M. Giurini

President: John M. Giurini, DPM, Boston, MA
President-Elect: Mary E. Crawford, DPM, Everett, WA
Secretary-Treasurer: Michael S. Lee, DPM, Des Moines, IA
Immediate Past-President: Daniel J. Hatch, DPM, Greeley, CO
Directors: Troy J. Boffeli, DPM, St. Paul, MN, Michelle L. Butterworth, DPM, Kingstree, SC, Jordan P. Grossman, DPM, Akron, OH, Jerome S. Noll, DPM, Naples, FL, Douglas G. Stoker, DPM, Salt Lake City, UT, Glenn M. Weinraub, DPM, Danville, CA
Division Presidents Council Chair: Marc A. Kravette, DPM, Seattle, WA

Huckabee is Best Candidate in the Long Run: TX Podiatrist

A top supporter and fundraiser for Mike Huckabee, who has run two marathons with him, says the trailing GOP candidate will stay in the race until the finish line. "You don't start out in a marathon knowing that you're going to quit," says Dr. Jeffrey Ross, a Houston podiatrist. "You're going to finish the marathon. Probably one of his background feelings is that he didn't start this thing out to quit midstream."

Dr. Jeffrey Ross ad Gov. Mike Huckabee

A Rhode Island Democrat turned Texas Republican Ross, 54, believes Huckabee is undaunted by the mathematical impossibility of wresting the party's nomination from frontrunner John McCain, and will stick it out until the Republican convention.

Ross, who co-chairs Texas Gov. Rick Perry's commission on fitness, says he's supporting Huckabee because of his position on health care and prevention and because of the governor's personal commitment to physical fitness: he lost over 100 pounds after being diagnosed as a diabetic and maintains an exercise regimen. Huckabee opposes mandatory universal health care, which Ross feels will put too much bureaucracy into the medical profession.

Source: Adam Dickter, The Jewish Week [2/21/08]

Query: Discharged Patient Who Refused to Accept Letter

When releasing a patient from the practice, what is the best course of action when the patient refuses to sign for the certified letter? The USPS protocol of multiple delivery attempts was unsuccessful, and the patient failed to visit the post office to sign for the letter. My first thought is to attempt another certified letter. What are the legal ramifications in the event the patient phones the office to make an appointment? Can I stand firm on the original 30-day time frame for continuing care despite the patient's likely deliberate efforts to resist being notified?

Bruce M. Nigro DPM, Barefoot Bay, FL

Editor’s comment: PM News does not provide legal advice. We know of no law which requires the continued treatment of a discharged patient for 30 days. We are also not aware of any law which requires that a patient sign for the certified letter one mails. Check with your state law to see if a specific rule applies.

In general, the law presumes that when U.S. Mail is sent, it will be received. Therefore, when discharged patients call for appointments, they should be told politely, but firmly that the doctor will no longer treat them.

The obvious exception to this policy would be a post-op patient with sutures or with a life-threatening complication, such as an infection, vascular compromise, etc.

Query: Dispensing Collagen Dressings

Are podiatrists who dispense collagen wound dressings getting reimbursed? Currently, Medicare DME is reimbursing around $22 per application.

I have found that other suppliers and home health agencies are furnishing the dressings, and getting reimbursed.

Charles Myers, DPM, Conway, SC

Response: Collagen dressings, like any other wound care products, are eligible for reimbursement under Medicare Part B. In order to determine if this is right for your practice:

1) Perform a cost benefit analysis.

2) Take into consideration the time it will take you to thoroughly
research the local coverage determination (LCD), www.trustsolutions.com, on surgical dressings and develop a flow sheet based on those requirements you'll need to meet.

3) Be sure you know your upfront costs and reimbursement prior to ordering.

4) If necessary, change your vendor in order to make this a profitable service for your practice. Consider a generic product vs. the trade name brands.

5) Inquire about home consolidated billing issue. Does the patient have home nursing, custodial care paid for by Medicare? While you may initially be paid, a post-payment audit may require you to refund the money to Medicare.

Do your homework first as these dressings are quite expensive.

Paul Kesselman, DPM, Woodside, NY

Dr. Kesselman will be attending the Codingline-PM News Coding and Practice Management Seminar at Kona on The Big Island (after the APMA Seminar) as an expert panelist taking Q/As - www.podiatrym.com/hawaii

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

RE: Lateral Cuboid Syndrome S/P EPF (Marc B. Klein, DPM)
From: Jeff Root

In regard to treating lateral cuboid syndrome, Dr. Kline stated ” I have found that a full contact orthotic can help this problem. A full contact orthotic will support the lateral arch which is generally not supported by a traditional Root theory orthotic.” With all due respect, I believe Dr. Kline’s statement is completely false. The methodology for casting the foot developed by Dr. Root involves placing the subtalar joint in the neutral position while simultaneously, fully pronating the midtarsal joint. This non-weight-bearing casting technique captures the inclination angle of the calcaneus. It also captures the lateral column of the foot in its most dorsi-flexed, abducted, and everted position.

A Root-type orthosis absolutely supports the lateral column of the foot. This is especially evident in individuals who have a forefoot valgus foot type, since a properly casted and constructed Root-type functional orthosis will support the lateral column of the foot well above the supporting surface. If necessary, a cuboid pad can be placed on the dorsal surface of the orthosis to increase the dorsi-flexion force on the cuboid beyond that which can be achieved using the foot’s own anatomical relationship.

Jeff Root, President, Root Lab, jroot@root-lab.com

RE: Paying a Percentage of Gross (Name Withheld)
From: Mike Crosby, CPA, Steven H. Goldstein, DPM

The most appropriate way to determine the percentage you should pay is to evaluate your overhead and determine your margin. I would recommend you determine your overhead as a percentage of collections. Then subtract this from 100% and this will be your margin. If you do not want to generate any additional cash flow from this revenue stream then you would use that as the percentage to pay. If you want to generate “some” margin for taking the risk then subtract 5 to 10% from the margin and use it. It will generate a small amount of additional cash flow for the practice.

The key question one should answer is “Is this new or replacement revenue.” If new, then the margin calculation can be used fairly reasonably. If it is replacement (for some of your work and time) then be particularly careful about what percentage you compute. If you pay above your margin rate you will be paying out of your own pocket.

Mike Crosby, CPA, Brentwood, TN, mcrosby@providerresources.com

After having an associate for the past 4 years, I paid the doctor 40% of what was collected on regular things, and 50% on any osseous surgery. In addition, with orthotics or anything we dispense, the rule went like this: 40% less the cost of the item. My associate was quite happy with this arrangement.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: DME Accreditation (Mark M Levine, DPM)
From: Neil H. Hecht, DPM , John Mishasek, CPed

Ed. Note: The following comment was sent in to CMS by Dr. .Hecht.

The following should be considered carefully:

1- It is inappropriate to include any physician or podiatrist in accreditation requirements due to the extensive professional training required to practice medicine and maintain standards of medical practice. It is inconsistent to include any physician or podiatrist with the retail groups offering durable medical equipment. Professional practices dispense necessary durable medical supplies in the ordinary course of practicing medicine in order to care for the patient and are monitored by professional licensure. These standards far exceed those of the retail durable medical suppliers.

2- The accreditation groups authorized do not include any of the recognized medical professional boards or associations to which physicians and podiatrists belong. If accreditation is mandated for the physician and podiatrist, these professional boards and associations must be given both an opportunity to participate and the time necessary to formulate appropriate accreditation standards for the medical professionals.

Neil H. Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

Editor’s note: An extended-length note from John Mishasek, CPed, appears at: http://www.podiatrym.com/letters2.cfm?id=18069&start=1

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

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, 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

ASSOCIATE POSITION – CONNECTICUT

Connecticut- Part time or Full time position available for a PSR 24 trained Podiatrist in the New Haven Area. We are seeking a hard working, ethical, charismatic practitioner for a well rounded established office Please email resumes to Surgeonseven@aol.com. Position available ASAP or July.

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 MRobsonDPM@aol.com

ASSOCIATE POSITION - FLORIDA , NAPLES

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

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

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