The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 29, 2012 #4,397 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2012- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

MI Podiatrists Form Statewide Group

Sixty-five podiatrists have created the Michigan Podiatric Surgeons Group PLLC, a Berkley-based statewide medical group, to prepare for health care reform, contract with health insurers and join one or more of the dozen accountable-care organizations under formation in Southeast Michigan. The medical group, which includes about 50 podiatrists in metro Detroit, also is contracting with vendors for lower supply and equipment prices and plans to develop best clinical practices for more than two dozen procedures to prove value to insurers, said Dr. Jeffrey Frederick, a podiatrist and chairman of the group. 

(L-R) Drs. Hal Ornstein and Jeffrey Frederick

"This came about because of healthcare reform and the concern we have that accountable-care organizations haven't shown an early need for specialists," said Frederick. "We want to contract with insurers and also position ourselves as a group" to join ACOs as they contract with Medicare and private payers, he said. The Michigan podiatric group is loosely affiliated with a national organization, Podiatric Super Group Management LLC, said Dr. Hal Ornstein, a podiatrist in Howell, NJ, and chairman of the national group. Affiliates are also in seven states, including New Jersey, Texas, Ohio, Delaware, Maryland, and Alabama.

Source: Jay Greene, Crain's Business Detroit [2/26/12]

Shoe Sizes Change With Pregnancy or Weight Loss: UK Podiatrist

Our feet don’t stay the same size all our adult lives. Weight loss, pregnancy and conditions such as arthritis can lead to changes in the shape of our feet. “If you lose weight you can get a slight shrinking, while many women find they are permanently a shoe size larger after having children,” says Judith Barbaro-Brown, podiatrist and teaching fellow at Durham University.”

Judith Barbaro-Brown

Shoe sizes often vary depending on the manufacturer. “It’s always worth trying a half size above and below your usual size to be sure of the best fit,” says Judith.

Source: Laura Jackson, Daily Express [2/28/12[

TX Podiatrist Publishes Research on New Implant for Flat Feet

A local podiatrist’s research on how to better treat flat feet was recently published in a nationally distributed medical journal. Dr. Kelly Walker’s research into the effects of the Maxwell-Brancheau arthroereisis implant was published in the most recent edition of the Journal of Foot and Ankle Surgery. Walker worked with Dr. Steven Brancheau, one of the developers of the implant, as well as with Dr. David Northcutt.

Dr. Kelly Walker (Photo: Phil Banker)

The published study found that the implant, along with accompanying surgical procedures, including the extension of certain foot tendons, is a useful and safe alternative to more extensive procedures to correct flat feet in children and adults.   

Source: Philip Banker, Ennis News [2/24/12] 

MI Podiatrist Supports Romney

Dr. Nicolas Hugentobler, a podiatry resident at a Detroit hospital and originally from Monticello, Utah said Mitt Romney has been targeted from the start. "I think people will latch on to anything that he says," Hugentobler said after attending LDS Church services Sunday at Romney's former ward.

"There's always the group that vote against him. I think a large portion of that is because he's LDS," Hugentobler said. "I feel very confident with his ability to handle whatever criticism comes along." Still, he said, now that the "anti-Romney vote has gone with Santorum," it's going to be tough for Romney. Santorum, Hugentobler said, "is a really good guy. If I wasn't such a Romney supporter, I would look to him."

Source: Lisa Riley Roche, Deseret News [2/26/12]

AMA Supports Bill to Nix IPAB

Noting that the sustainable growth-rate formula for Medicare payment creates "steep Medicare cuts that Congress has had to scramble each year to avoid," the American Medical Association announced its support for legislation to eliminate the Independent Payment Advisory Board. "Adding additional formulaic cuts through IPAB is just not rational and would be detrimental to patient care," according to the AMA.

The measure was introduced by Rep. Phil Roe, a physician and a GOP legislator from Tennessee. It is scheduled to be considered by the subcommittee on Feb. 29. The creation of the IPAB was called for in the Patient Protection and Affordable Care Act. While the healthcare reform law has been criticized in general by Republicans since its passage, the IPAB is a provision in the legislation that has been the focus of specific attacks.

Source; Andis Robeznieks, Modern Physician [2/27/12]

Query: DR X-Ray Equipment

Would the readers please comment regarding their experiences with respect to the various DR x-ray equipment available to us podiatrists in office practice?
 
Neil H Hecht, DPM, Sherman Oaks, CA

Query: Achilles Tendon Repair

The patient presented with an open wound over the distal portion of the Achilles tendon. A suture was visible in the wound. The patient gave a history of surgery in the area (tendon repair?) over ten years ago. The following procedure(s) were performed: Two transverse converging, semi-elliptical incisions were made over the area, excising the wound in toto. The incision was deepened by sharp and blunt dissection, allowing access to the Achilles tendon. It was noted that there were frayed edges to the tendon. In addition, there were two edges of suture (large gauge Tevdek or something similar) noted to be extruding from the tendon itself. The frayed edges of the tendon were resected and the tendon debrided. The tendon fragments were repaired/sutured. A heel lift was fabricated and placed in a Bledsoe boot, in which the patient will be able to ambulate in this equinus position. How would the above be coded?

Neil Scheffler, DPM, Baltimore, MD

Response: The procedure you performed is a repair of Achilles tendon. The only question is, of the several codes available for tendon repair, which one specifically fits your scenario? Since you describe an open chronic wound which was "cleaned up" with excision of the wound periphery to expose the Achilles tendon which was repaired by you, your choices would include:

CPT 27650 - repair, primary, open or percutaneous, ruptured Achilles tendon or
CPT 27652 - repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) or
CPT 27654 - repair, secondary, Achilles tendon, with or without graft

Your op report did not describe a rupture of the Achilles or any acute trauma resulting in your repair. That would effectively eliminate CPT 27650 and CPT 27652 as coding possibilities.

Because this is a chronic wound and the tendon had previously been repaired, I think it safe to say that what you performed was a secondary repair which is coded as CPT 27654. A secondary repair is customarily defined as repair performed after two weeks of injury (or chronic tendon problem, such as degenerative changes, fraying, scarring to the tendon).

Harry Goldsmith, DPM, Cerritos, CA

Editor's Note:  Dr. Goldsmith will be lecturing at the upcoming Greenbrier Coding & Practice Management Seminar, August 20-22 (following the APMA National Meeting. For details click here.

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Plating Choices (Mario Dickens, DPM)
From: Jeffrey Kass, DPM, Peter Bregman, DPM

The posting did not indicate how the fracture occurred, if there is pain, or what conservative treatment was tried to date. This is important information. Historically, a fracture in this region of the bone should heal. So the question in my mind is why hasn't it? Is the patient a smoker? Is there any other relevant medical history? Has the patient's vitamin D levels been checked? Has a bone stimulator been tried?

It is possible all this has been done. If not, I would look into these factors before performing a surgical procedure.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

I am not sure why you want to use a plate on a seemingly healing fracture that is not comminuted or at risk. The plate in that area usually is prominent due to lack of soft tissue coverage. My recommendation is that if you are to do surgery, put a simple Ex-Fix on it. If needed, you can augment it with a biological product of your choice. I like AmnioMatrix. Maybe just NWB and a bone stimulator will be sufficient.

Peter Bregman, DPM, Las Vegas, NV, drbregman@gmail.com

RE: Large Verruca at the Heel (Bruce Krell, DPM)
From: Andrew Levy, DPM, Stephen Musser, DPM

My first recommendation would be to get a good current biopsy. Malignant transformation to verrucous carcinoma, while rare, is a definite possibility that needs to be ruled out before other treatments are entertained.

Andrew Levy, DPM, Jupiter, FL, rcpilot48@gmail.com

As we are all aware, there is no 'sure fire method' of getting rid of plantar warts. Because this patient has an immune issue, I would make her aware that there are no guarantees that any treatment modality will work. Second, if she has a hyperhidrosis problem, you need to address that issue.

If the verruca is minimally painful, I would use a duel combination of Efudex Cream at night and cover with a bandage followed by using Plantar Stat(or something similar) every morning. If the lesion is moderately or severely painful, I would opt to curettage the lesion and if the lesion recurs, I would start the Efudex/ Plantar Stat combination.

Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

RE: Do Runners Need Orthotics? (Robert Bijak, DPM)
From: H. David Gottlieb, DPM

Dr. Bijak, why the use of quotes around custom orthoics in your recent post regarding runners? An insert is either custom or it's not. If the prescription for the orthotic is marked "Post To Cast", then I agree that it's not really a functional orthotic under anyone's methodology.

As to your statement, "if you took the profit motive away from 'custom orthotics', many podiatrists wouldn't go through all the trouble attendant with them." I find that there is very little trouble attendant with prescribing and dispensing orthotics because they work well for the majority of my patients. And as a VA employee, I have no profit motive. My incentive is to fix my patients problems so I can see other patients. I evaluate my patients well, write a customized prescription for each, and explain how they should use them. Some orthotics may need an adjustment, but the overwhelming number do very well. And because they work for me, I use them a lot.

Other podiatrists here don't get good results with orthotics and therefore don't believe in them. They don't use orthotics or they have me do them. I tell our residents and visiting students that if orthotics take up too much time, they are not doing them right. They need to figure out how to do orthotics correctly or don't do them at all.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

RE: The Technological Imperative: A Warning
From: Allen Jacobs, DPM

The most recent issue of "case closed", produced by PICA for the education of insured podiatrists, featured a case in which a Pegasus graft was utilized in the 1st MPJ. It was noted by the reviewing defense experts that this particular graft is not approved for, nor is there literature to support, utilization in the 1st MPJ. The complications which occurred in the surgery performed may or may not have been related to the unapproved use of the Pegasus, but the use of this material in an unapproved manner contributed, shall we say, to the vulnerability of the defendant in this case. The case settled for over $350,000.

I have just completed the review of yet another case of less than adequate outcome following the use of a Pegasus graft in the 1st MPJ, with complications from that surgery resulting in...

Editor's note: Dr. Jacobs' extended length letter can be read here.

RE: Staple in Diabetic Shoe (Jonathan Michael, DPM)
From: Tim Shea, DPM

This is an example of no good deed goes unpunished. The extra effort on your part by going to the patient's house was wise and professional, and probably saved you a whole lot of hassle involved in a malpractice or liability type-suit if the patient had worn the shoes, developed a sore, and subsequently developed non-healing wounds or loss of limb.

That being said, the magic word in this story is you "dispensed" diabetic shoes. As such, you are the same as any dispenser of shoes (shoe store, medical supply, etc.). You are acting as a representative of the shoe company, not yourself as a medical provider, and you are therefore...

Editor's note: Dr. Shea's extended-length letter can be read here. 

RE: Overburdened by Paperwork (Frank Lattarulo, DPM)
From: Alan L. Bass, DPM

While integrating EHR technology into our offices can be a daunting task at the beginning, overall it will allow us to practice more efficiently and collaboratively. In regard to Dr. Lattarulo’s comments regarding entry of patient medications into an EHR, nowhere in the CMS regulations does it state that you must have dosage or frequency. You must enter medications as structured data. If you are able to enter the name of the medication into your EHR as structured data, you have met Core Measure #5. Most EHR programs will have both name and dosage. Certain websites and programs such as Surescripts will download medications and dosages directly into your EHR, but they do not list frequency; there is nothing that states you must have it.
 
I completed my 90 days of meaningful use compliance in 2011, received the CMS incentive payment 8 weeks after attestation, and I am now working on year 2 for completing my collection of meaningful use data. It’s all about a good workflow.
 
Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)
From: Cyril M Gostich, DPM

Having just read that 90%** of post-payment audits show fraud (mistakes do not occur when any provider bills for a service: Contact your local RAC auditor) and 93%** of pre-payment audits reveal the same, I was relieved to post the following message in my waiting room:

"We no longer participate, endorse, recommend or prescribe MediCare Diabetic Shoes."

In my opinion, a physician who participates in ANY aspect of the CMS Diabetic Shoe Progam needs to re-evaluate the level of risk-taking. There exists an overwhelming probability that they may not only be repaying large amount of monies back to CMS, but they may be soon finding their reputations and their very licenses under attack. It is very, very clear that the CMS's ultimate goal is to make every physician a criminal.

** Dr. Gabriel Halperin, Southern California Representative to Palmetto GBA MediCare

Cyril M Gostich, DPM, El Centro, CA, drgostich@sbcglobal.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - CALIFORNIA

V.A. podiatrist closing one day a week private practice in Long Beach, CA. Great location in medical building. Reasonable rent. Basic equipment. Good opportunities for growth. Contact Art Hatfield  at
Afootjob@juno.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references toejema@aol.com

ASSOCIATE POSITIONS - TEXAS

TEXAS licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well-established, unique mobile podiatry practice servicing senior living facilities. Business office location with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com. Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: tolisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - EAST CENTRAL NEW JERSEY

Well established practice needs a career-minded podiatrist for associate position leading to Fast Track Partnership. Competitive salary/benefits. Busy practice. Great location. Board Certification a plus. Part-time or full-time. Immediate availability, but will wait for best candidate. GardenStateDPM@aol.com

EQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or email me at gwdocks@aol.comEQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or email me at gwdocks@aol.com

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

PM News Classified Ads Reach over 13,500 DPM's and Students
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.