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| PM News | |
The Voice of Podiatrists
Serving Over 17,235 Subscribers Daily
March 11, 2016 #5,619  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2016- No part of PM News can be reproduced without the
written permission of Barry Block
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| PM NEWS QUICK POLL | |
FINAL CHANCE TO VOTE
Quick Poll
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Which presidential candidate has the best healthcare plan? |
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| PODIATRISTS IN THE NEWS | |
As Feet Age, Wearing Heels Becomes More Problematic: NY Podiatrist
Not only do foot problems get worse over time, but our bodies also become less able to handle heels. In our late thirties or forties, the fat pad on the bottom of the foot starts to atrophy and we lose some of our natural cushioning, explains Dr. Elisa Kavanagh, a clinical professor of orthopedics at the Mount Sinai Medical School and a board certified podiatrist in Scarsdale, NY.
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Dr. Elisa Kavanagh |
Wearing high heels hastens the fat loss, increasing the chance of developing painful neuromas (nerve inflammation between the toes) and inflammation in general. When high-heel devotees hit their 40s, like Victoria Beckham and Sarah Jessica Parker (who claims that running around Manhattan in her Manolos ruined her feet), they may find that they can’t stay in heels as long as they used to.
Source: Corrie Pikul, Yahoo Lifestyle [3/9/16]
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| PODIATRISTS AND HUMANITARIAN CAUSES | |
POA Podiatrists Return from Mission in Guyana
Traveling to Guyana from March 3-8, podiatrists from the Podiatry Overseas Association (POA) saw a great deal of diverse lower extremity pathology. In total, the group performed a variety of 15 surgeries, from ankle fusions to split-thickness skin grafting. POA, a 501-(c) 3 non-profit, was able to attain donations of just over $13,000 in medical supplies to donate to the Guyana Public Health System.
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(L-R) Drs. Timothy Graham, Mario Cala, Romain Onteniente, and James Stelnicki (Photo: Harshil Patel) |
The POA group traveled side-by-side with CHARM, a plastic surgery non-profit organization. In total, the multi-specialty group traveled with nurses, anesthesiologists, plastic surgeons, and podiatric surgeons.
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| PODIATRICS AND ACADEMIA | |
AK Podiatrist Appointed as Adjunct Professor
Dan Klein, DPM has joined the teaching staff of Western Arkansas Technical Center in association with the University of Arkansas Fort Smith (UAFS). He was appointed an adjunct professor of emergency medicine.
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Dr. Dan Klein |
Dr. Klein previously served as a podiatrist in the United States Air Force (USAF) where he served as a consultant to thr Surgeon General. He is a diplomate of the American Academy of Wound Specialists, a Certified Diabetes Educator, and a Certified Wound Specialist.
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| OUTSIDE INTERESTS | |
OH Podiatrist Presents Beatles Educational Program
More than 40 years after their breakup, music made by four lads from Liverpool still rings in the ears and hearts of Beatles fans. There was no shooshing, just guitars, bass, drums, and vocals as Dr. Joel S. Keller, the “Doc of Rock and Roll,” presented the Beatles’ 20 No. 1 hits on March 6 at the North Ridgeville branch of the Lorain Public Library System.
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Dr. Joel Keller |
“They are only the greatest and most influential act of the rock era ever,” Keller said about the band comprised of John Lennon, Paul McCartney, George Harrison, and Ringo Starr. More than 50 people came out, including a few teenagers and, by their own admission, numerous senior citizens who think like teenagers. “Yes!” said Keller, who by day has worked as a podiatrist and business consultant.
Source: Richard Payerchin, The Morning Journal [3/6/16]
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| HIPAA AND PODIATRY | |
IL Podiatry Group Warns Patients About Computer Records Breach
The Illinois Valley Podiatry Group has announced that it has became aware of unauthorized access to its computer records, believed to have taken place last year. The names, addresses, and Social Security numbers of patients may have been viewed, according to the medical office.
Law enforcement has been consulted with a cyber forensics firm assisting to make sure the intrusion is contained, the medical group noted. While unsure what information has been accessed, Illinois Valley recommends that patients remain vigilant for incidents of fraud and identity theft.
Source: Journal Star [3/8/16]
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| QUERIES (CLINICAL) | |
Query: Diabetic Bullae Dermopathy
This 80 year old diabetic patient presented with this recurring problem. He gets these bullae eruptions which have been going on for about 6 months. Treatment had been Bactroban ointment to treat areas along with steroid creams. I referred him to a local dermatologist who diagnosed diabetic bullae dermopathy but was not helpful in treating this condition.
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Diabetic Bullae Dermopathy |
I can't find any answer to stop these eruptions which seem to pop up overnight. Any thoughts on treatment?
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| CODINGLINE CORNER | |
Query: Insurance Overpayment Request
Cigna is using a third-party to try to recoup monies on claims where the research shows they were not the primary payer on dates going back 2 years. I inquired whether Cigna can make an automatic deduction against receivables on these questionable refund requests. Cigna's response was "no." As a provider, are you liable to refund money due to an insurance error past a certain time period? As we are subject to timely filing, one would think there is some time limitation on these refund requests.
Shari Winkler, Nanuet, NY
Response: I am not sure about New York law, but my understanding of California law forbids insurance companies from trying to recoup payments which they claim were made in error (even if the patient was actually not entitled to the coverage for which they were paid for) as long as there was no fraud involved on the part of the practitioner.
In the case, City of Hope Medical Center v. Superior Court, 8 Cal. App. 4th 633 (1992), "...the Court held that the insurance plan was not entitled to reimbursement from the hospital for payments incorrectly made to the hospital, and the hospital was not unjustly enriched by virtue of such payments, where the hospital correctly billed the plan for services rendered, and did so without misrepresentation or knowledge of the plan’s mistake at the time payment was made. In the present matter, the provider was reimbursed by the plan, for true and accurate claims, which the provider timely submitted to the plan, without misrepresentation or knowledge of the plan’s mistake at the time payment was made. The provider reasonably relied upon such payments as accurate, intentional representations of the rate of reimbursement for those services. Therefore, based upon these facts, and the prevailing case law stated in City of Hope Medical Center v. Superior Court, provider asserts that the claims at issue have not been overpaid, and respectfully declines the related request for reimbursement."
Additionally, "...health plans are allowed to seek reimbursement from a provider for overpayment of a claim, so long as the plan sends a written request for reimbursement to the provider within 365 days of the date of payment on the overpaid claim. The written notice must clearly identify the claim, the name of the patient, the date of service and a clear explanation of the basis upon which the plan believes the amount paid on the claim was in excess of the amount due...If the health plan allows more than 365 days to elapse from the date of overpayment, they are barred from making the request."
Vincent Marino, DPM, San Francisco, CA
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| RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 | |
RE: Fluctuating Prices of Generic Prescription Medications
From: Elliot Udell, DPM
Years ago, when a pharmaceutical went generic, patients breathed a sign of relief because that "ten dollar a pill" medication would now only cost pennies per tablet, and we as physicians would not have to worry about non-adherence due to overpriced medications. To quote Bob Dylan, "The times they are a - changin." Some generics in many cases are financially going through the roof and many insurance companies will either not pay for them or make the patient pay a huge co-payment, which in many cases is enough to dissuade the patient from filling the prescription.
This past week, I received a call from a patient who was very nervous. When he got to the drugstore, he was told that he would have to pay over 200 dollars for a tube of generic Bactroban. I changed the prescription to topical gentamycin which at this point in time was much less expensive. The same is true with generic Spectazole. It was 12 dollars a tube but now in some localities is 250 dollars. With company incentives, brand name drugs such as Luzu or Naftin are coming out far less expensive than their generic antifungal rivals.
Elliot Udell, DPM, Hicksville, NY
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| RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 | |
From: David A. Pougatsch, DPM, Ivar E. Roth, DPM, MPH
Don’t sit there and be frustrated. Find a way to make it an educational experience! Every program has their share of “bad” attendings, and it’s not just limited to podiatry. This I know first-hand from training in a large level-one trauma center and hearing complaints from all residents in all specialties about their “bad” attendings. I put “bad” in quotes as it is relative. These “bad” attendings can be “good” for your education.
If you realized that these procedures are improper or below standard of care, as you’ve already stated in your question, then you have learned not to utilize those techniques when you are out on your own. Residency teaches you how to treat patients who will present to you with a multitude of ailments. You will also learn what not to...
Editor's note: Dr. Pougatsch's extended-length letter can be read here.
I had similar experiences during my program. We had one very dishonest attending whom I turned into Medicare for billing avulsions and matrixectomies on hospitalized patients when all he did was clip their nails (and did a poor job at that). He found out I turned him in and took aim at me as a resident and tried to get me in trouble. He eventually got me in trouble. The other attendings turned their back on me as well as the residency director. In the end, how to react is up to you, but be prepared to be attacked. It takes courage or naivety to do what is correct and just. In the end, I would do it again. It just helped prepare me for the cold, hard world we live in.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
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| RESPONSES/COMMENTS (NON-CLINICAL) - PART 3 | |
From: Paul Busman, DPM, RN
I used Pediplast, or something similar, quite a bit when I was in practice. For interdigital corns, I made a 1/8" felt "mock corn" slightly larger than the real lesion and stuck it in place. I molded the pad as someone else has described. When it hardened, it had a nice pocket which took pressure away from the heloma. I also use this material for toe crests. I made a roll of it thick enough to lift the tips of the digits. This was long enough to bring up in the first and fourth interspaces to hold the device in place.
Paul Busman, DPM, RN, Clifton Park, NY
I use Pediplast on a regular basis for interdigital problems as well as distal digital problems on patients who can not or choose not to have the problem surgically addressed. I charge $5 cash for a mold which takes me at least 30 seconds to make. It looks like I need to charge more! I still have patients who do not want to pay and grumble about paying $5 cash when they can get the silicone pads cheaper, but usually after they use them for a while, they are back in the office wanting more with a smile and a thank you!
Tip Sullivan, DPM, Jackson, MS
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| RESPONSES/COMMENTS (CODINGLINE CORNER | |
From: Lawrence M. Rubin, DPM
Regarding the presence of pain as a qualifier for Medicare payment of CPT 11055 - a somewhat similar situation occurred when I was a consultant to Illinois Medicare carriers at the time the Medicare guidelines for onychomycosis nail debridement were first published. When a patient was not at-risk because of diabetes, atherosclerosis, or some other condition, the following enabled payment: Marked limitation of ambulation, pain, and/or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.
Along with am Illinois Podiatric Medical Association representative, we pointed out to the medical director of the Illinois carrier that it was ludicrous and actually inhumane to have to tell a patient suffering pain from thick mycotic nails that they had to wait to make an appointment for the next debridement until their nails were so painful they caused "marked limitation of ambulation." The carrier agreed and subsequently okayed payment of mycotic nail debridement at specified time intervals on the basis of pain when the doctor documented in his/her medical records "Failure to debrid patient's thickened mycotic toenails on a regular basis can reasonably be expected to result in pain and limitation of ambulation."
Lawrence M. Rubin, DPM, Las Vegas, NV
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| RESPONSES/COMMENTS (NEWS STORIES) | |
Ron Werter, DPM
How do value-based payment systems apply to podiatry? I always assumed that we were always the profession that gave value to our patients and to the healthcare system. Correcting bunions and hammertoes, successfully treating plantar fasciitis, healing diabetic foot ulcers, even providing periodic foot care for at-risk elderly and diabetic patients, and performing the rest of our daily practice are what we do better than any other profession.
Are we going to be asked to prove we can do these things, or prove we are individually better than the podiatrist down the street? Will there be DRGs like the hospitals have for various diagnoses and we'll get paid $750 for treating or "curing" a heel spur and $150 for treating a tinea pedis?
I assume some of our podiatrists are involved in determining these things and I would like to understand what is in the works for the future.
Ron Werter, DPM, NY, NY
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| YOU CAN'T MAKE THESE THINGS UP | |
UK Podiatrist Posts Pictures Online of People Urinating Outside His Clinic
A podiatrist has become so incensed with people repeatedly urinating outside his clinic, he has resorted to posting CCTV images of the culprits online. Chris Norton, owner of Norton Podiatry in Walsall, says at least three members of the public urinate against the brick wall next to his business every day.
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Smile, you're on Candid Camera! |
Exasperated at authorities' apparent failure to halt the flow of people relieving themselves a few feet away from his office, he set up a Twitter account called UrineWatch in an effort to shame those responsible.
Source: Matt Payton, Independent [3/8/16]
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MEETING NOTICES
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PM PODIATRY HALL OF FAME LUNCHEON
July 15, 2015 – PHiladelphia Marriott
Honoring Bret Ribotsky, DPM and James Lamb
Sponsored by Bako Integrated Physician Services (Silver), PICA (Bronze), and Sammy Systems (Bronze)
PM News subscribers are invited to see Dr. Ribotsky and Mr. Lamb inducted in the PM Podiatry Hall of Fame, including roasts by special guests.
All ticket proceeds go to the APMA Educational Foundation Student Endowment Fund. Reserve your tickets now by sending $75 per ticket to: APMA Educational Foundation, 9312 Old Georgetown Road, Bethesda, MD 20814 or via the APMA Meeting registration form.
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| CLASSIFIED ADS - PART 2- ASSOCIATE POSITIONS AND FELLOWSHIPS |
F/T PODIATRIST – PENNSYLVANIA
Expanding, well rounded, multi-site, state-of-the-art group with offices throughout Lehigh County, Pennsylvania. We offer: Competitive salary Benefits Partnership opportunity We're associated with hospitals, wound care centers, and a residency program. Requirements: Hard-working, self-motivated, board qualified/certified, and surgically trained. 2016 graduating residents welcome. Please email CV to: recruiting@foi-solutions.com
ASSOCIATE POSITION - NORTHERN VIRGINIA
Busy practice looking to expand. Looking for a well-trained, well rounded, energetic podiatrist. Should be competent in forefoot, rearfoot and ankle surgical procedures as well as wound care. All aspects of podiatry, pediatrics, orthopedic and surgical. Competitive salary, bonus, benefits and buy-in potential. Send cover letter, CV to footdocva@cox.net
ASSOCIATE POSITION – CALIFORNIA
Podiatry group specializing in long-term care and assisted living facilities seeks podiatrists all over California immediately. Part-time and full-time positions available. Also need a doctor for an office-based practice in Los Angeles area. Must have a good work ethic, easy-going and friendly attitude. Email CV to footdoctor4u@gmail.com
ASSOCIATE POSITION – LONG ISLAND
Large and expanding multi-office state-of-the-art group with offices in Nassau and Suffolk counties, seeking a well-trained F/T podiatrist. We offer a competitive salary, benefits and partnership opportunity. We are associated with outpatient surgical centers, hospitals, wound care centers and a residency program. Requirements: Hard-working, board qualified/certified, self- motivated, surgically trained, willing to live nearby. 2016 graduating residents who would start in July welcome. Please email CV to: drbrook@countryfootcare.com.
ASSOCIATE WANTED - SOUTHWEST OF BOSTON
Well rounded established practice outside of Boston seeking well trained associate BQ/BE to join the practice. Excellent referral base and high volume of new patients. Opportunity for partnership for the right person. Please contact pmlepdpm@aol.com
ASSOCIATE POSITION - EAST TEXAS
A well-established practice is seeking a full time associate podiatrist. Must be BC or BQ by ABFAS. Practice offers a good general mix of all aspects of podiatric medicine and surgery. Competitive salary and benefits/Partnership buy-in. Email CV and letter of interest to office manager at toejob40@yahoo.com.
F/T PODIATRIST – PENNSYLVANIA
Expanding, well rounded, multi-site, state-of-the-art group with offices throughout Lehigh County, Pennsylvania. We offer: Competitive salary Benefits Partnership opportunity We're associated with hospitals, wound care centers, and a residency program. Requirements: Hard-working, self- motivated, board qualified/certified, and surgically trained. 2016 graduating residents welcome.Please email CV to: recruiting@foi-solutions.com
ASSOCIATE POSITION – SOUTHERN CALIFORNIA
Successful, growing full-scope practice with offices in Oxnard, Camarillo, Ventura and Santa Barbara seeking a full time podiatrist with excellent patient skills to add to our team. Competitive salary and benefits offered including health insurance and 401K. Potential for partnership. Please send CV to Kelly@footsurgeon.com.
ASSOCIATE POSITION – SOUTHERN CALIFORNIA
Are you finishing your residency in June? Full-time associate leading to partnership. Immediate position available. Busy office with multiple locations. Full scope practice. ABPS Board qualified/certified. California license required. Benefits included. Inland Empire. Please forward resume to familyfootcenter@verizon.net
ASSOCIATE POSITION – YONKERS, NY
Well established podiatry practice is looking for part-time podiatrist to work 2-3 days per week, including some Saturdays. Will work to get you on as many plans as possible. Competitive compensation package with bonus structure & partnership/ownership opportunity for the right individual. Please submit resume: Podiodoc@gmail.com
ASSOCIATE POSITION - PHILADELPHIA SUBURBS
Excellent opportunity to join our team. Minimum PMSR/36 with RRA training or experienced podiatrist with same qualifications. Candidate should be outgoing, personable, have a strong work ethic and be highly motivated. All aspects of podiatry including wound care. Part-time leading to full-time will be considered. Please send a cover letter and CV to: tricountypods@gmail.com
ASSOCIATE POSITION - CARROLLTON AND VILLA RICA, GEORGIA
Immediate position available. GREAT opportunity to join a 40 year old thriving practice 45 minutes west of Atlanta. One established physician is leaving and another will be retiring in two years, so you will be on the fast track to partnership. If you are energetic, self-motivated, and ready to hit the ground running with a full load of patients from day one, email cv to kdanis@westgapodiatry.com or fax to 770-832-3518.
ASSOCIATE POSITION - CENTRAL NEW JERSEY
Well respected, established practice seeking board eligible/board certified associate. Excellent opportunity for a motivated, hardworking, ethical and personable individual. Must be willing to practice all aspects of podiatric care. 2016 Residency Graduate OK. Practice in a new, modern office. Email CV, njpodiatric@gmail.com
FELLOWSHIP – DIABETIC FOOT & WOUND (TEXAS)
One position for a 12-month TMB-approved Diabetic Foot and Wound fellowship beginning July 1, 2016. Candidate must have completed a podiatric residency/plastic surgical residency/general surgery residency and be eligible for Texas Medical License. Training involves all aspect of diabetic foot management. Curriculum focuses on surgical limb salvage, and medical management of the complex wound patient. Interested candidates should email their CV, personal statement and 3 letters of recommendation to latonya.rosales@utsouthwestern.edu. UT Southwestern is an Affirmative Action/Equal Opportunity Employer. Women, minorities, veterans, and individuals with disabilities are encouraged to apply.
PM NEWS CLASSIFIED ADS REACH OVER 16,500 DPMs AND STUDENTS
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 16,500 subscribers. For details,click here or write to:bblock@prodigy.net or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451.
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| CLASSIFIED ADS PART 1- PRACTICES FOR SALE OR WANTED, EQUIPMENT FOR SALE |
PRACTICE FOR SALE - SOUTHERN NEW HAMPSHIRE
30 year busy solo practice. Close to Boston, mountains and ocean. High growth potential with surgery, diabetic and wound care. Large patient base. Hospitals close by. EHR & ICD-10. $250k gross and asking one year's gross. Please contact officeforsalenh@gmail.com.
PRACTICE FOR SALE – CENTRAL FLORIDA
Practice available in a small town in Central Florida. Podiatrist retiring. Was full 4 day practice but now 2 days due to illness. Easily expanded. Same location over 30 years. Surgical and hospital privileges available but not required. Purchase equipment and assume patient care . Send inquiries to: DDave9388@aol.com
EQUIPMENT FOR SALE - ULTRASOUND
SIUI CTS-5500 with rolling stand with a 7.5 MHz probe is ideally suited for soft tissue and some bone and joint applications. Mitsubishi printer with 5 rolls of thermal paper, plus Sonicgel and US Gel. $5,000 OBO. Please contact Amanda Reidhead @ amandar@aafaz.com or (480) 559-8404.
EQUIPMENT FOR SALE: CAST REMOVAL INSTRUMENTS
Stryker 940 cast saw, Ortho Vac 864 portable vac, 2 new blades, new cast spreader and new cast shear. Excellent condition. Complete package with shipping. $1,800. Please email hjddpm@gmail.com
PM NEWS CLASSIFIED ADS REACH OVER 16,500 DPMs AND STUDENTS
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 16,500 subscribers. For details,click here or write to:bblock@prodigy.net or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451.
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management® Magazine and Podiatry Management® Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
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PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
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employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
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prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
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