The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 25, 2009 #3,478 Publisher-Barry Block, DPM, JD

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1st EBM Neuropathy Guidelines Will be Huge Help: FL Podiatrist

David Herrmann, MD, director of the Peripheral Neuropathy Clinic at Strong Memorial Hospital and 18 other physicians developed the first evidence-based guidelines to diagnose distal symmetric polyneuropathy -- the most common type of peripheral neuropathy -- and they were published in December in the journal Neurology.

Dr. Dennis R. Frisch

Dr. Dennis R. Frisch, a Florida podiatrist who's part of the government-funded National Diabetes Education Program, said the guidelines will be a huge help if physicians know of them and use them because neuropathy is tricky: "The earlier you can treat it, the better you have a chance of success."

The neuropathy guidelines are intended to direct physicians to which of the many possible tests will provide the most useful information. They call for three initial blood tests to identify the cause of neuropathy. The tests measure levels of blood glucose, vitamin B12 and specific proteins. The guidelines also call for genetic analysis in some cases to specifically identify inherited forms, such as Charcot-Marie-Tooth neuropathy.

Source: Chris Swingle, Democrat & Chronicle [2/18/09]
 

DOX Podiatry and ACFAS Kick Off Campaign to Donate Socks for DC's Homeless

    
DOX Podiatry, joined by podiatrists and surgeons from across the country, will make donations of thousands of pairs of socks for the homeless during the 67th Annual Scientific Conference of the American College of Foot and Ankle Surgeons (ACFAS) at the Gaylord National Resort and Convention Center to be held the first week of March. The National Coalition for the Homeless will distribute the socks at D.C.-area soup kitchens and shelters. "Socks are like gold to the homeless population," says Michael Stoops, executive director of the Coalition.

Dr. Micharl Vaardahl

“Homeless people are prone to developing bacterial, fungal and viral infections that result from excess moisture when older socks, or no socks, are worn,” according to Michael D. Vaardahl, DPM, FACFAS, chairman of the ACFAS Consumer Education Committee.

DOX Podiatry, a leading podiatry-specific electronic medical records and office management solution, is the title sponsor for the sock drive.  We believe it is everyone's responsibility to give back to our community.  Since our customers make their living by helping people's feet, we thought this is a perfect opportunity to give back,” said Stuart Finn, chief operating officer for DOX. The ACFAS hopes to turn the sock drive into a regular event.

WI Podiatrist Again Investigated for Billing Practices

A state review committee has recommended that a local podiatrist be investigated for potential fraud and for possibly violating a state order meant to regulate his billing practices and other professional behavior. Public Investigator first wrote about John S. Lanham in November 2007 after discovering that he bills his patients much more than the average doctor. In one case, he billed $1,700 for medicine that costs $15 or less. A former patient reported receiving a $4,500 bill for treatment that most podiatrists say costs a few hundred dollars.

Lanham insists the state is trying to hold him to too stiff a standard. He also said the monitoring firm hired to review his records has been inconsistent in its recommendations. In the meantime, Lanham said he has lowered his charges in the past two years. "You are picking on a little guy who is struggling to make a living," he said.

Lanham had his license suspended in 2006 after state investigators said he created false bills and submitted false claims to insurance companies. The state also found that the podiatrist billed for procedures he did not perform, according to a final decision and order filed by the state. In settling with the state, Lanham denied that he knowingly submitted false claims for payment. He acknowledged that he had "reckless coding errors in his billings," according to the stipulation.

Source: Ellen Gabler, the Milwaukee Journal Sentinel [2/17/09]

Add Value to Low-Cost Rewards

During lean times, expensive rewards may be beyond your reach. With a little creativity, you still can recognize employees’ efforts using low- or even no-cost rewards. Here’s how:

• Skip the apologies. Never say “I am sorry that I cannot offer you more.” A statement like that only diminishes the reward’s value. Instead, say: “I would like to buy you lunch today. Your performance lately has been extraordinary .”
• Tap your creativity. A small gift card is an inexpensive way to recognize outstanding workers. On the other hand, you could create “official certificates” using office supplies and your computer to jazz up the awards. The certificates could entitle the recipients to take a long lunch, claim a prime parking spot, or enjoy some other kind of “freebie” recognition. The impact on morale can be quite large when others see their co-workers basking in the pleasure of being recognized for their efforts.
• Mix it up. Employees may start to take rewards for granted if you become mired in a rut—always offering an early departure on Friday afternoon, for example. Vary the rewards you offer to keep recognition meaningful.

Source: Adapted from “Employee Rewards for Nothing,” The Weekly Perk via Communication Briefings

Query:  Plantar Fibroma in a Child
 
I have an 8 y/o child with a painful mass to plantar left foot. This lesion has been present for two months and is painful after and with activity (running, jumping, etc). MRI shows a plantar fibromatosis that is 4.8mm (L) x 4 mm (W) x 2.6mm (D) in the medial band of plantar fascia. How, if at all, should the treatment of this patient differ from that of an adult?  
 
Scott Hanegan,  DPM,  Meridian, MS

RE: Chloro-preps and Infections (Eugene A. Batelli, DPM)
From: Daniel J. Tucker, DPM

I would refer Dr. Batelli to 2 recent articles in the literature in regard to the current recommendations for patient preparation and surgical scrubs in foot and ankle surgery.
 
Ostrander, et al. conducted a prospective study of 125 patients undergoing foot and ankle surgery where each lower extremity was prepared with one of 3 randomly-selected solutions: DuraPrep, Techni-Care and ChloraPrep. They found that of the 3 solutions tested, the combination of chlorhexidene and alcohol (ChloraPrep) was the most effective for eliminating bacteria from the forefoot prior to surgery. (See Ostrander, RV, Botte, MJ & Brage, ME; "Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery, JBJS, Am, 2005;87:980-985).
 
Fletcher, et al., reinforced that the current literature strongly suggests that chlorhexidine gluconate is superior to povidone-iodine for pre-operative antisepsis for patients. It provides a prolonged reduction in skin contamination with less skin toxicity and irritation. (See Fletcher, N, Sofianos, D, Berkes, MB & Obremsky, WT; "Prevention of Perioperative Infection", JBJS, 2007;89:1605-1618.
 
Betadine is not the current pre-operative skin preparation of choice for foot and ankle surgery.
 
Daniel J. Tucker, DPM, Orange, CA, ReekaT@aol.com

RE: EBM to Support “Experimental” Treatments (Jeffrey Kass, DPM)
From: Elliot Udell, DPM

Dr. Kass presents a problem that is important to all of us. Why do some insurance companies pay for certain treatments such as extra corporeal shock wave therapy or platelet-rich plasma injections for skeletal injuries and others consider them experimental and deny payments for them? The subject becomes even more near and dear to those of us who might invest thousands of dollars into buying or leasing a new therapeutic or diagnostic modality only to find that after using it for a while and getting good clinical results along  with handsome insurance reimbursements, the insurance industry has a change a heart and refuses to pay for the treatment or test.

The answer may have little to do with "evidence-based medicine." In virtually all cases, the FDA approved the modality based on credible data submitted to them.  An answer is that rarely will you find all studies performed on the efficacy of a diagnostic or therapeutic modality to have the exact same outcomes. Insurance companies, which have a financial interest in denying payments for expensive new therapies or diagnostic modalities, will quickly gravitate toward studies that yield negative or equivocal results rather than to studies that show that a particular modality is effective. This is in spite of FDA approval.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

RE:  Is Podiatry a Profession or a Medical Specialty? (Barry H. Block, DPM, JD)
From: Bob Kornfeld, DPM, Tilden Sokoloff, DPM, MD

I have spent the past 22 years of my career as a member of many organizations in integrative medicine. I have renewed memberships many times. To this day, any time I renew a membership, every imaginable allied healthcare degree is listed, except DPM. I frequently have to join as "other." In many instances, podiatry is listed as a "non-medical" specialty. In addition, as a member of Medscape, podiatrists are blocked from certain literature as "non-physicians."

There are many situations I have encountered where podiatry is either conspicuously omitted or we are relegated to non-physician status. I am of the mind that as long as podiatry exists as a "profession", rather than a specialty of medicine, this will never change. Our training and expertise is crying out for inclusion and we are worthy of it. Our time has come.

Bob Kornfeld, DPM, Lake Success, NY, holfoot153@aol.com

Editor’s note: An extended-length note by Dr. Sokoloff appears at: http://www.podiatrym.com/letters2.cfm?id=24779&start=1

RE: Ultrasound-Guided Aspiration
From: Dave Mullens, DPM, Esq.

In regard to the Medicare denial of payment for ultrasound-guided aspiration of a ganglion; whenever you receive the denial rationale, "payment denied when performed or billed by this type of provider", the first thing you want to do is to contact your State Board of Podiatric Medicine. Get it in writing - from the Director of your State Board - that the procedure/service in question falls within the scope of practice for podiatric physicians in your state. The second thing you want to do is to research the Local Carrier Determination (LCD) policy for that procedure/service. The LCDs are available on the Medicare website.

A clear statement from your State Board of Podiatric Medicine that the service/procedure is within the scope of practice for podiatric physicians, coupled with the applicable Medicare law (the LCD), will enable you to prevail at the Administrative Law Judge Hearing level of appeal. One caveat: you will have to be able to explain why you needed ultrasound guidance to put the needle into a ganglionic cyst.  Because most ganglions are visually apparent on the foot and ankle, you will have to have a good explanation in response to this question from the ALJ, or more likely from the ALJ’s “neutral” medical expert, at the time of the Hearing.

I think the absence of an –LT or –RT modifier had no effect on the denial of payment of this claim. 

Dave Mullens, DPM, Esq., Palo Alto, CA, dmullens@mullenslawoffice.com

RE: WI Podiatrist Among First to Use PinPointe FootLaser
From: Calvin Britton, DPM, John Strisower

Our office looked at the new laser for nail fungus from Patholase. This laser appears to be widely used in dentistry. I believe the data quoted to us was that of the (X) number of patients treated (I think it was about 100), 88% responded favorably or were cured.  The procedure is very simple and is virtually painless. The one patient we treated did not show any improvement and wanted her money back.  We believe that even if future testing supports their claims, the economic downturn and marketing costs for promoting the laser will make it difficult to make it profitable in our area.  
 
Calvin Britton, DPM, Alex Dellinger, DPM, Little Rock, AR, foot.doctor@yahoo.com

Editor’s Note: An extended-length note from John Strisower, CEO of Patholase appears at: http://www.podiatrym.com/letters2.cfm?id=24791&start=1

RE: Not as Gory as a Polar Bear Bite 

Submitted by Scott Newcomb, DPM

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

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.

PRACTICE FOR SALE – DALLAS, TX

10 year old part-time podiatry practice for sale in North Dallas. Middle to high income area. Could easily be made full-time. Great potential! please reply to: footdoc8390@yahoo.com

ASSOCIATE POSITION - TX

Successful, multi-physician, multi-office practice in The Woodlands, Texas is seeking Podiatric Physician Specialist in Biomechanics, Sports Medicine, Gait Analysis, and Orthotics Laboratory. Please email current CV to kelley.glazier@yahoo.com

OFFICE SPACE/ MRI RENTAL – NYC, LI  

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

IMMEDIATE OPENING – MIAMI, FL 
 
Part-time and Full-time position available now. Massive growth potential present in an expanding group practice. June graduates are welcome to apply. Send CV and LOI to qvan@aol.com

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

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

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.

  
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