The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

March 17, 2007 #2,836 Editor-Barry Block, DPM, JD

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Coral and Cattle Part of Foot and Ankle Surgeons’ Toolkit: CT Podiatrist

Look inside a foot and ankle surgeon’s operating room these days and you’re just as likely to find marine coral and cattle collagen as you are scalpels and sutures. These bone substitutes are increasingly being used to treat patients with difficult-to-heal bones. Bone substitutes provide a frame on which new bone can grow. Foot and ankle surgeons use natural and synthetic substances to fill gaps in bones caused by serious or traumatic fractures, arthritis, tumors, infected bone, and previous fractures that failed to heal correctly.

Dr. Gary P. Jolly

"Using a bone substitute is similar to caulking a hole or crevice in your house," says Gary P. Jolly, DPM, FACFAS, a foot and ankle surgeon from Hartford, CT. Jolly and other foot and ankle surgeons are meeting in Orlando this weekend for the American College of Foot and Ankle Surgeons 65th Annual Scientific Conference, where the keynote address focuses on fracture healing and bone substitutes.

There are several types of bone substitutes. Some species of marine coral can be processed as bone substitutes because they are made of calcium phosphate, a primary component in human bone, and will not be rejected by the immune system. Man-made bone substitutes may appear as pellets or putty, and can be molded or injected. Other techniques allow foot and ankle surgeons to harvest bone marrow and trigger marrow stem cells to grow new bone.

Another animal-derived bone substitute used in foot and ankle surgery is bone morphogenetic protein (BMP). When a bone is broken or injured, the body produces this growth factor to stimulate healing. Since it’s not species-specific, BMP can be extracted from the bones of cattle. This bovine collagen can then be implanted in feet or ankles to help stimulate and accelerate bone growth. Bone substitutes are an alternative to bone grafts and provide several advantages over them, including reduced recovery time, lower cost and less risk of infections and complications.

Singapore Conclave Suggests Amputation Prevention Progress Being Made Worldwide

Last week, Singapore was the venue for a gathering of physicians, surgeons, industry personnel and policymakers from around South Asia for a series of workshops on amputation prevention. “This was a rather important meeting,” noted Professor David G. Armstrong of Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science in North Chicago who, along with Dr. Stephan Morbach, President of the European Association for the Study of Diabetes’ Diabetic Foot Study Group, presented one of two keynote addresses to the gathering. “The data shown here seem to be suggesting that diabetic foot clinics are having an impact on amputation prevention in both the developed and developing world.”

Drs. Mosbach and Armstrong (R)

Teams from both Europe and India presented data using a simple test devised by members of CLEAR that divides the number of major (leg) amputations by the number of minor (toe) amputations. The results were encouraging, showing that centers that employ foot clinics perform far more limb-sparing procedures than high-level amputations. Armstrong concluded: “It seems that these initiatives are having an impact  not only in preserving limbs, but potentially prolonging life in this very high-risk population, worldwide.”

AAPPM Elects Dr. Jeffrey Frederick as President

The American Academy of Podiatric Practice Management (AAPPM) has elected Jeffrey Frederick, DPM as president for the Academy’s 2007 - 2008 year. He succeeds Dr. William McCann , who served as AAPPM president from 2005 - 2007. Dr. Frederick has served as a member of the Academy's education team, been a frequent speaker at Academy meetings and tracks and served on the AAPPM executive committee for the past two years. Dr. Frederick has also been active in the Michigan Podiatric Medical Association serving as chair of the insurance committee, as a board member and currently as president-elect. He has been in practice 23 years and is in a group practice with offices in Berkley and Holly Michigan. Dr. Frederick and his wife Gail, live in Franklin , Michigan .

Dr. Frederick (L) receives gavel from Dr. McCann

The following slate of officers and trustees was elected for 2007 – 2008:
AAPPM Executive Committee
Dr. Hal Ornstein , Chairman
Dr. Jeffrey Frederick, President
Dr. William McCann, Immediate Past President
Ms. Lynn Homisak, Vice President
Dr. Harvey Lederman, Treasurer
Dr. D. Charles Greiner, Secretary
Mr. Gary Adams, Executive Director

AAPPM Trustees: Dr. Barbara Aung, Dr. Craig Conti, Dr. John Guiliana, Mr. Jason Kraus, Dr. Jonathan Moore, Mr. Raymond Posa

Doc-Office Fees Jump

Fees charged at physician offices rebounded again in February, jumping 3% after a 1.3% rise in January and compared with a 0.1% increase in the year-ago period, according to the preliminary Producer Price Index from the Bureau of Labor Statistics. For the 12-month period, the physician PPI skyrocketed 5.4%, compared with 0.9% in the year-ago period. Meanwhile, hospital prices declined 0.1% in February, slumping after a 0.8% rise in January and compared with a 0.1% increase in the year-ago period. For the 12 months ended in February, the hospital PPI was up 3.4%.

The PPI measures the average change over time in the selling prices received by producers of goods and services.

Source: Cinda Becker, Modern Healthcare [3/15/07]

Query: OsStaple Removal

Does anyone have experience removing an OsStaple from a prior surgery? I would assume it might be more difficult due to the compression effect of the arms. Any technique tips would be appreciated.

Daniel Tellem, DPM, Rochester, NY

Query: Copies of Nursing Home Charts

Since a nursing home, hospital, or clinic can sometimes fire a podiatrist for any reason and at any time, should a podiatrist treating patients in such facilities be keeping a second set of charts or can a podiatrist rely upon entry into the patients record at the said facility?

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

Editor’s Comment: PM News does not provide legal advice. First of all, depending on the institution and the contractual arrangements, a podiatrist often retains due process, so he or she cannot be arbitrarily dismissed.

It is always a good idea for a podiatrist to retain at least a cursory record of the treatment rendered in a facility. In many institutions, physician consults are made on NCR duplicate or triplicate forms, making this process easy. In any case, you are always entitled to a copy of your record. In the event of an audit or malpractice suit, the entire facility record of a patient should be submitted.

Query: Dispensing TENS Units

I have been advised that if I dispense TENS units, I can bill CPT 64550 (application of surface [transcutaneous] neurostimulator for fitting, and CPT 97014 (application of a modality to one or more areas; electrical stimulation [unattended]) for each 15 minutes of training by the representative. Can anyone advise on the validity of this, and the medical necessity required to dispense the units? .

Charles Perry, DPM, Zanesville, OH

Response: While CPT 64550 is the correct code for the application of a surface (transcutaneous) neurostimulator, such as a TENS (transcutaneous electrical nerve stimulation) unit, and billing it when you - the doctor - initially apply the electrodes for the dispensing the unit to a patient is correct, medical necessity/insurance coverage for TENS use will determine whether CPT 64550 is paid. TENS is used to mask pain. Its use and payment is determined by the patient's insurance plan guidelines for TENS - which are generally very narrow, with many payers not reimbursing its use. CPT 64550 is billed a single time when the unit is dispensed for patient home use.

As far as CPT 97014 billing, no, it cannot be billed when the representative for the TENS unit company "trains" the patient. This is not a "training" code. It is a physical therapy treatment code subject to a comprehensive plan of electric stimulation treatment - not TENS. CPT 97014 would be performed 2-3 times per weeks - again, not TENS.

The representative of the TENS company is asking you to misrepresent your billing (fraud). By the way, why would any insurance company pay you for a TENS company representative to train the patient on TENS use?

Harry Goldsmith, DPM, Cerritos, CA

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RE: Air Bags Linked To More Foot, Ankle Trauma: AL Podiatrist
From: Stanley N Rosen, DPM

Eight years ago I sustained a minor low impact accident where my air bags went off. At the same time, a rupture of the oblique head of the adductor hallucis occurred. Knowing how difficult a procedure to reattach it would be, I left it alone. I now have a mild hallux hammertoe, but otherwise no problems.

Stanley N Rosen, DPM, Scottsdale, AZ, drstanfoot@aol.com

RE: IL’s Proposed Healthcare Plan
From: Joseph Borreggine, DPM

This note, which exceeded PM News’ 300-word limit appears at: http://www.podiatrym.com/letters2.cfm?id=13203&start=1:

RE: Who Owns Patients? (David Secord, DPM)
From: Philip E. Larkins, DPM, Jack A. Reingold, DPM

This is yet another classic example of podiatrists eating their young and other related nonsense. I liken going to facilities like walking on broken glass. I was "kicked out" of a facility because... I am rather ashamed of saying this... I made the nurses and staff actually do some 'doctor support work.' That made me think twice about actually trying to be a good doctor by ordering lab tests, requesting old charts, etc.

I think actually doing work irked them madly and they championed my ousting. I am sure that at some point I will get kicked out of every other facility that I go to for similar reasons. Who cares really? The administrators of these facilities are only concerned for themselves, no matter what they may say/do. If it isn't your friendly neighborhood podiatrist trying to shove you, it is the staff...

My advice: try to avoid all facilities like the plague, if your pocketbook can possibly allow. And if your pocket book doesn't allow, find some other kind of work to do that will make you proud to be a human being and some form of work where people may actually say "thank you" at the end of the day. And if you are 'forced' to go to them, rule with an iron fist... They won't like you or respect you anyway...

Philip E. Larkins, DPM, San Marcos, CA, larko33139@yahoo.com

I had a similar situation to what happened to Dr. Secord happen to me several years ago. The home was one of 5 by the same owner. The young administrator and I became casual friends. We played tennis and I even had him and his mother over my house on a holiday. He got bumped up the chain to overseeing all the homes. The new administrator basically told me the same thing, see all patients with out billing them, even if they had a HMO or did not qualify. I think this may be against Medicare rules (federal law) and refused. Shortly thereafter I received a notice of termination. I called the former administrator, who was now her boss. He told me that he "could always get a podiatrist, but it was hard to get an administrator." Nerveless, I never spoke with him again.

Jack A. Reingold, DPM, San Diego, CA, footdoc@san.rr.com

Editor’s note: This topic is now closed.

ASSOCIATE POSITION - VICTORIA, B.C. CANADA

On beautiful Vancouver Island, 3 office practice. Full scope practice, owner near retirement. Future buy-in Exams for B.C. given in June. Willing to sponsor for immigration. Dr.Cole@shaw.ca 1-250-516-7440

PODIATRY PRACTICE FOR SALE - PRIME LAKES AREA, MN

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well equipped in owner occupied building (for sale or lease). lakespod@charter.net

ASSOCIATE POSITIONS - VIRGINIA

Immediate/July full time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889; www.podiatryltd.com

ASSOCIATE PODIATRIC SURGEON POSITION - TEXAS

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

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mi of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

2 ASSOCIATE POSITIONS AVAILABLE IN WYOMING

We need 2 associates to work in our Wyoming offices. We are a growing multi office (podiatry only) group. We are the largest podiatry provider in the region. 100K+ potential. Percentage salary, malpractice and medical paid, CME allowance yearly. Great outdoor locations and activities. Email CV and for more information. craig@enotesoftware.com

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

ASSOCIATE POSITION- MINEOLA, NY

Excellent opportunity in fast-paced well-established podiatry practice for full time associate, all phases of podiatry including surgery, biomechanics, orthotics and routine foot care. Begins July 2007. Includes competitive salary and benefits. Please send CV and letter of interest to: cfcsteve@optonline.net

PRACTICE FOR SALE SAN DIEGO, CALIFORNIA

5 y/o LaJolla Ca (San Diego) office collecting $289.5K with mostly soft tissue office procedures, biomechanics, general care, and no HMOs. Affluent community with great schools. Major opportunity for growth. Selling due to age and health. Call 858-405-4780 before 8PM PDT. Serious only, please.

ASSOCIATE POSITION AVAILABLE - OCEAN COUNTY, NEW JERSEY

Immediate position avaliable. Desiring a hardworking, ethical, motivated and well trained individual. Minimum PSR 24. State of the art practice offering EMR, digital xrays, ultrasounds. Must be willing to do all aspects of podiatry. Competitive salary and benefits package. E-mail CV to NJFEET@aol.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

PRACTICE FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations & high gross, buy outright or over time. Call 561-213-9400 after 7:00 p.m.

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 – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in Burbank, California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

ASSOCIATE POSITION SAN ANTONIO OR AUSTIN, TEXAS

Wonderful place to live. Great climate and much culture. Full or part-time podiatrist with current Texas license. Better pay. Unique mobile podiatry practice and mobile wound care clinics, in addition to office locations Check out our website at www.footmobile.com Fine working conditions with excellent support staff E-mail to footcenter1@sbcglobal.net or fax to 210-495-6484.

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.

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