The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

March 07, 2007 #2,827 Editor-Barry Block, DPM, JD

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Calluses are Sign of Misalignment: Canadian Podiatrist

I've developed a large, painful callus on the ball of one foot. What causes it?

Dr. Scott Hollingsworth / Photo Credit Larry Wong

This is a very common problem, according to Dr. Scott Hollingsworth of the Foot Institute in St. Albert . Usually it's caused from someone who is over pronating -- they roll off the inside of one foot more than the other. Pathological changes over time cause overloading of areas of the ball of the foot, producing a callus.

“People with alignments out on their car, eventually their tires wear and one day the tire blows. With our feet, if we're not aligned perfectly, symmetrically, -- and most of us aren't -- over time you get progressive changes that result in problems such as calluses”.

Source: Chris Zdeb, The Edmonton Journal [3/5/07]

PM News will be posting selected resolutions scheduled for the upcoming APMA House of Delegates (HOD) to be held March 23-26 in Washington, DC. Readers are encouraged to comment on these important issues.

Resolution No. 18-07 (Directive) APMA Balance Billing Policy

Resolved, That the American Podiatric Medical Association (APMA) create a policy on balance billing which includes the following positions:

• APMA supports the right of the physician to balance bill a patient for any care given, regardless of method of payment, where permissible by law or contractual agreement;
• APMA supports health system reform plans that include a true fee-for-service option, including balance billing;
• APMA supports the work of allopathic and osteopathic medical and specialty organizations that advocate 1) physicians be allowed to balance bill Medicare and non-Medicare beneficiaries, 2) seeking national legislation designed to bring about implementation of balance billing of Medicare beneficiaries, as well as national legislation designed to pre-empt state laws that prohibit balance billing; 3) seeking state legislation designed to bring about implementation of balance billing of managed care patients; and
• APMA will work on behalf of its members to regain the right to balance bill non-Medicare and Medicare patients;

Resolved, That the American Podiatric Medical Association (APMA) policy position on balance billing be made available to APMA membership, and by report to the 2008 APMA House of Delegates.

Sponsored by: Harry Goldsmith, DPM

A complete list of current Resolutions can be found at:
http://www.apma.org/s_apma/bin.asp?CID=995&DID=20934&DOC=FILE.PDF

IL Governor Unveils Plan to Cover Uninsured

Illinois Gov. Rod Blagojevich unveiled a $2.1 billion per year plan to cover Illinois’ 1.4 million uninsured adults within three years. The Democrat’s plan would expand eligibility for Illinois-subsidized coverage for low-income parents and launch a state insurance pool with comprehensive coverage offered through private insurers for small employers and low- to moderate-income adults, said Abby Ottenhoff, a Blagojevich spokeswoman.

Businesses that cover at least 70% of employees' premiums and which have 25 or fewer employees would be eligible, according to details at illinoiscovered.com, a Web site launched to promote the plan. Blagojevich also proposed a cap on premiums, based on income, for individuals or families earning between 100% and 400% of the federal poverty line. Ottenhoff said coverage would be mandatory after the initiative’s third year.

The $2.1 billion price tag—the program’s cost once fully implemented—would be partially covered by a tax on employers that fail to offer coverage, Ottenhoff said. Further financing details, including a “sustainable and new source” of revenue, will be released Wednesday, she said. The Chicago Sun-Times reported a proposed gross-receipts tax would provide additional financing.

Source: Melanie Evans, Modern Healthcare [3/5/07]

Query: Associate Who Takes Patient Charts

Last year, I hired an associate to work in my practice. Last month, he left to start his own practice nearby. Today, one of my patients came in with a letter from him inviting her to be treated at his office. When the patient called him, she was told not to worry because he had already copied her chart from my office. I had no written contract with the associate. What options do I have?

Name Withheld by Editor

Editor’s comment: PM News does not provide legal advice. While we certainly feel bad for you for having suffered from this egregious act, you would have infinitely greater options if you had a written contract with the associate. Since situations like this happen, there is simply no bona fide reason for not having a signed contract. Such an instrument would have contained among other things, a restrictive covenant and non-solicitation clauses.

Without a contract, you are basically in a “he said-she said” situation, in which your chances of prevailing in court will be limited. Your best bet may be the fact that the associate copied your records. Check with a healthcare attorney in your state, as this may be a violation of state law and/or may subject the associate to professional misconduct sanctions.

Query: Filling Out an ABN Ahead of Service

Can an advance beneficiary notice (ABN) be filled out in advance (one week) prior to a procedure(s), or must it be filled out on the day of surgery? I have several procedures which I would like to perform on a Medicare recipient, and Medicare will likely not cover them in this patient's circumstance.

Paul Kesselman, DPM, Woodside, NY

Response: An advance beneficiary notice (ABN) can be completed in advance, but the specifics of completing them are fairly rigid. See http://www.cms.hhs.gov/BNI

for copies of the forms (G = general; L = Lab), their specific use, and overall policy. You would use the general form. No other form is permitted. It must be properly completed, and signed by the patient or guardian before the services are rendered.

We advise in cases where it is clear that the service is not covered to collect all or a significant part of the amount owed before the service is rendered. This ensures the patient understands that they are responsible for the cost of the service - if they won't pay before the service, you can bet they won't pay later. The forms are quite simple, and have also been known to treat "Doctor, you said the insurance company would pay" patient amnesia which seems only to be found in the medical industry -- and ABNs and similar documents are the only known vaccination and cure.

With the ABN filled out and signed, you then file the claim with the proper modifier, "GA."

Richard Papperman, MBA, CHBME, Cape May Court House, NJ

RE: APMA Resolution 13-07 Single Certifying Board
From: Multiple Respondents

I am certainly an advocate for the standardization of our profession. Unifying the boards is one way to achieve this. Most residents graduating today are trained under the PM&S system, combining both medical and surgical training. Effort needs to be focused on improving the quality of our residency training. This will enable us (and the public) to have reasonable confidence in the fact that those earning a PM&S 24 or 36 will have had a comparable residency experience regardless of where they completed their programs. As it is now there is a vast difference in quality between residency programs, regardless of there designation.

Gerald Mauriello Jr., DPM, MA, Nutley, NJ, mauriellodpm@gmail.com

We must streamline. We did this with residencies: ROR, POR, PPMR, PSR-12, PSR-24. The medical community and hospital CEO'S didn't understand. Finally, we now have PM&S24 and 36. It’s still confusing, but workable. We need the same thinking with our boards. We must standardize our education process and one path needed to be taken is via one board per Dr. Doms’ suggestions.

Simon Young, DPM, NY, NY, simonyoung@juno.com

The core of the issue is whether we podiatrists are different in the way we treat patients. Do we offer different services that represent different types of expertise. If the answer is yes, then we have to maintain different boards to certify doctors in surgery and in non surgical aspects of the profession. In the medical profession there are multitudes of boards that represent many different specialties. It would not be fare to the public to merge all of the medical boards. A patient, hospital or referring physician would not be able to evaluate a practitioner's competence. The same applies to our profession. Many podiatrists are surgically oriented and do lots of cases and do them well. Others prefer not doing very much surgery and focus on the orthopedic and medical aspects of the profession. We need two boards.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

One solution to the "single certifying board" situation would be to do what the other medical specialties have done: Create sub-specialty certification boards.

You could create a single certifying Board of Podiatric Medicine for which a physician would be eligible after a twelve month residency program or a suitable equivalent. Subject matter for the exam might cover surgical simpler procedures and disease processes.

The next level would be sub-specialty certification which would require longer residency training, such as the twenty four and thirty six month programs or a more stringent requirement for suitable experience. The obvious choice for this is the American Board of Podiatric Surgery. There is likely a real role for the ABPOPPM as well. In addition, there is probably more than sufficient justification for an American Board of Podiatric Sports Medicine and an American Board of Podiatric Wound Care in addition to the two traditional boards. Additional Boards could be added as the profession develops over the years, which is exactly the way every other medical specialty and sub-specialty has evolved.

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

I am currently boarded in both ABPS and ABPOPPM. I believe they should stay separated as they certify different approaches to manage foot problems. I have found that the problems started when some of my ABPS colleagues belittled the Ortho and Primary Podiatric Medicine certification as a sub par certification. When I graduated in 1988 there weren't enough surgical residencies for all students. I was lucky enough to get one. My surgical mentor was also wise enough to tell me that not every patient was a surgical candidate and it was my duty to be as proficient in my non surgical care of all podiatric conditions. I studied just as hard to pass and recertify in both boards, and when my patients ask what all those letters mean after my name I tell them that they mean I have the ability to solve their problem in many ways and will guide them to a solution whether it be surgery or not. I challenge my colleagues to double board certify and ask the boards to find ways to allow more podiatrists to sit for the exams of these fine organizations.

David Gutierrez, DPM, Bronx, NY, DOCG2100@aol.com

Editor’s Note: An additional note by Dr. Markinson can be read at: http://www.podiatrym.com/letters2.cfm?id=13048&start=1

ASSOCIATE POSITION SOUTH JERSEY

Position is available now, but can wait until July. Progressive (EMR, digital x-ray, Diag U/S ), ethical, group practice. Requirements : Good Hands, Sense, Personality, and People skills, Exceptional surgical skills, Motivated team player, Proficient at RFC. Prefer ABPS cert and 24/36 PSR but will take experience into consideration. Competitive benefits / compensation. Email CV and references toetrukr@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 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

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: MONTGOMERY COUNTY, MARYLAND

Three doctor practice has one associate relocating, creating immediate patient flow for new associate. Certified surgery center, up-to-date-diagnostic electronics (US, digital x-ray, voice recognition charting, etc), administrator, and in-house billing. Tremendous opportunity to join busy practice with need for the right podiatrist. Please respond to: associatedpm@comcast.net

LEASE SPACE MANHATTAN/ LONG ISLAND

Are you sending your MRs out? Now you can lease space and run your own MRIs, bill global, and have them read by a board certified radiologist. Two locations to lease, Manhattan East 60th street (near all public transportation) and Plainview, Long Island. Call for details, lease arrangements and reimbursements Email podo2345@aol.com or Call 516 476-1815

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1yr. Need Florida license. Fax resume to 561-865-2225

ASSOCIATE POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

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

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas. Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

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