The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 19, 2010 #3,809 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

NY Podiatrist Discusses What to Look For in a Good Heeled Shoe

We checked in with Dr. Jacqueline Sutera, doctor of podiatric medicine and surgery, and a spokesperson for the American Podiatric Medical Association, to find out what to look for in a great pair of shoes. Lucky for us, Sutera knows her way around a four-inch heel, so she was able to tell us how to maximize comfort and style while minimizing pain and damage to our feet.

Dr. Jacqueline Sutera

“The three major things you want with a shoe [are] arch support, cushioning, and shock absorption,” Sutera says. She recommends shoes with extra cushions in the heel and front part of the shoe, as well as opting for cork heels whenever possible. “[Cork] is one of those materials that helps absorb shock.” Sutera also says women should avoid spending a full day in pointy-toed shoes. “You’ll be better off if you limit your time spent in that particular shoe.” Sutera recommends looking for heels with deep toe boxes to avoid crushing your toes, and chunkier heels to help distribute your weight across the shoe more evenly.

Source: Kathryn H. Cusimano, BettyConfidential.com

FL Podiatrist Named Most Valuable Physician (MVP) at Hospital

Every quarter, Broward Health North Broward Medical Center recognizes two outstanding doctors as Most Valuable Physicians (MVP). This quarter’s MVP recipients are Phillip Decubellis, DPM, and Sherika Newman, DO.

Dr. Phillip Decubellis Receives MVP Award

Dr. Decubellis has been a podiatrist and wound care physician at North Broward Medical Center since 2006. He received his undergraduate degree from the University of South Florida before earning a Doctor of Podiatric Medicine degree from Ohio College of Podiatric Medicine in Cleveland, OH. He completed his residency at the University of Southern California in Los Angeles, CA. His nominations praised his compassion and dedication to always doing what’s best for the patient.

Source: Kacie Main, Westside Gazette [3/17/10]

Durbin Will co-sponsor Equity and Access for Podiatric Physicians Act

U.S. Senator Richard Durbin (D–IL) told a gathering of podiatrists that he will co-sponsor long sought legislation that puts podiatrists on equal footing with other healthcare providers under Medicaid. The remarks came during the Midwest Podiatry Conference in Chicago, which is attended by 1,400 podiatrists from several Midwestern states. Illinois State Senator John Cullerton followed Durbin’s speech with an update on legislative matters in Illinois.  In his introduction, Cullerton was lauded for his work on behalf of podiatrists and he followed that up by stating his historic support for insurance reform and regulation as well.

Sen. Richard Durbin at Midwest Conference

Durbin’s announcement was well received by the crowd as a sign podiatrists will be treated more equitably in many states across the country.  Organized podiatry has lobbied for passage of SB. 654: Equity and Access for Podiatric Physicians Under Medicaid Act, which amends title XIX of the Social Security Act to cover physician services delivered by podiatric physicians to ensure access by Medicaid beneficiaries to appropriate quality foot and ankle care. “Podiatric physicians are the only profession specially trained to perform these services (such as Diabetes preventive foot screenings), and this meeting made it obvious that this bill should pass so I’m joining Senators Mikulski and Bunning  as co-sponsors of the legislation,” he told the crowd.

Query: Shelf Life of Phenol

Can someone tell me the shelf life of phenol? I have a small practice and it seems that I always have to buy such a big bottle of phenol that lasts forever. I don't see any expiration date on the bottle.

Amy Wahl, DPM, Pittsburgh, PA

Query: HIPAA and Minors
 
A local hospital often has nursing students from a university observe my surgical cases. Today, when I entered the OR, there was a 16 year old high school student observing. I asked her to leave and told the staff that I did not want them in my room because I didn't think a person under 18 being in the OR was HIPAA-compliant whether they signed a form or not. They told me her mother signed it for her. I still don't think that is valid. Has anybody come across this before?
 
Gary S Smith, DPM, Bradford, PA

Editor's Comment: PM News does not provide legal advice. HIPAA privacy rules require that "reasonable" steps be taken to protect PHI. It's usually a judgment call on behalf of the covered entity and is determined on a case-by-case analysis. Therefore, it would matter for instance if a 16 year old was observing an abortion of a neighbor vs. observing a bunion of a complete stranger. In the final analysis, the physician has the right to take reasonable steps to protect patient privacy.  

Query: Vascular Visualization Software

I was asked by my hospital to pick the best software for their new magnetic resonance imaging angiography( MRA), which is being installed to evaluate PAD/blockages of the lower extremities. They want to know what I thought would be the software that would give them the best visualization of the arteries or a blockage to stent later. Where would I get this information?
 
Tom Cerillo, DPM, Bronxville, NY

RE: Israel Scope of Practice Act
From: Richard Jaffe, DPM

It is my pleasure to announce that after 25 years of persistent work, the law officially recognizing the profession of podiatric medicine and establishing the scope of practice for American-educated and trained doctors of podiatric medicine passed its first reading in the Knesset on Monday, March 15. 

This is the first of three readings before it is completely adopted.  However, since this law was presented by a Knesset committee with the cooperation of the Ministry of Health and the Israel Medical Association, the continuation and conclusion of this process is expected to proceed smoothly.

Requirements for being granted a license will follow shortly. It can be safely stated that formal surgical training will be required. Forefoot and rearfoot surgery are allowed, but ankle surgery has been excluded.

We of the Israeli Podiatric Medical Association would like to express our gratitude and appreciation to all those podiatrists who have visited and worked or lectured in Israel over the past four decades. Their contribution to the progress of our recognition cannot be over-estimated.

Richard Jaffe, DPM, Israel, footsurg@netvision.net.il

RE: Unscrupulous Billing of Routine Care (Michael Munson, DPM)
From: Multiple Respondents
 
I ponder, on a daily basis, the duties of informing patients why their care is or is not covered. Here would be some prime examples. Let’s say that RFC has been determined to not be covered. It is required that I have them sign a waiver BEFORE providing the service. What do you do when the patient is a senile nursing home patient who has a power of attorney that is not present, and doesn’t even live in the same state?

Clearly this patient is not qualified to sign their own waiver.  How many times have you asked your mycotic nail patients if their nails hurt while wearing shoes and/or ambulating, and the responses are: "not that much, not that bad, I can tolerate it, well yeah when they get too long, if I bump it?" Is “not that much” pain still considered pain?  Also, when patients know that pain is a qualifying criteria, their “not that bad” pain becomes a lot more painful, interestingly enough. 

I just tell patients you have to be honest with me and I have to be honest with you, I can’t bend the rules, nor should they.  But I am amazed how such a service can be so complicated, and the more we try to define it, the worse it gets. Also, what is absent pedal pulses? Does that mean absent to the examiner, or does that mean absent in Doppler exam? I had one primary physician tell me that a Doppler exam would be “required” in order to determine absent pulses. The interpretation of these rules are just too wide open.

Robert Colligan, DPM, Norfolk, NE, rcolligan@MidwestHealthPartners.com

I tend to agree with Dr. Munson. Nail debridement is a very confusing and agonizing process. Some of us go to bed wondering if we billed too many CPT 11721's at the office that day? Were there really more 11720's?  Will we be fined or put into the slammer when our office notes are examined?  Yet, other colleagues may have billed Q-modifiers, & 59-modifiers on the same patients, and make about triple the dollar amount (of course, with the appropriate office note documentation). Was there "really" enough pain in that sixth toe nail to qualify for a glorious 11721? Were the 5th and 6th nails "really" thick, yellow, crumbly...? When you take 3 x-rays, you bill 73630 - PERIOD! It is totally ridiculous the kind of hoops that podiatrists have to jump through, when you know the MD's  and DO's who attempt to debride nails in their offices, simply bill an 99213 or 99214.  Double good grief!
 
Rich Hofacker, DPM, Akron, OH, Cavsdoc26@att.net

Editor's Note: Dr. Lawrence Rubin’s Extended-length letter can be read here.

RE: Medicare Payment - Subtalar Arthroereisis (Lloyd S. Smith, DPM)
From: Lowell Scott Weil, Sr., DPM, Barry Mullen, DPM

During the winter meeting of the American Orthopedic Foot & Ankle Society, a symposium on adult flatfoot included a presentation on the performance of a subtalar arthroereisis to augment "flatfoot osteotomies." During the discussion portion of this symposium, the moderator posed a question to the audience as to whether a CPT code would be beneficial for arthroereisis of the subtalar joint. A show of hands was affirmative, and it appears that the sub-specialty of the AOFAS may submit this to CPT in the coming year.

Dr. Lloyd Smith posted that the subject came up, but he never stated what the debate was and whether he had any input into the discussion and what his input involved? Did he contact ACFAS for advice and background material? Apparently not, since he stated that this would never go through unless the AAOS approves.

So, what is the purpose of having a representative on CPT? The Token DPM? Podiatry in the USA was the first to use a commercial arthroereisis of the subtalar joint for children in 1975. There are at least seven different devices commonly used in the USA and both Spain and France have used the devices in children and adults for over 40 years. Folks, we need representation from experienced foot & ankle surgeons on these committees that determine whether a CPT code is appropriate or not. EPF was able to get a CPT code thanks to Stephen Barrett. Arthroereisis deserves one as well.

I use arthroereisis rarely in my treatment of children or adult flatfoot, but I do believe that the procedure has merit in those cases with appropriate indications.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, Weil4feet@aol.com

Does the current inability to procure a legitimate CPT code for subtalar arthroeresis render the 20+ years of "podiatric anecdotal success" completely irrelevant? Prior podiatric literature does exist pertaining to this procedure's efficacy. What, relative to those prior studies, is lacking...

Editor’s Note: Dr. Barry Mullen’s extended-length letter can be read here.

RE: Collagen Injections Can Ease Foot Pain: Scholl Podiatrist
From: Brent Nixon, DPM

We injected collagen into feet in the mid 80's without any long-term success. The late, great Dr. Saul Balkin injected feet with silicone with unheralded success for many years.

Brent Nixon, DPM, Atlanta, GA, bcopter@yahoo.com

RE: Maryland Podiatrist Opens a New Shoe Store (Robert Bijak, DPM)
From: Multiple Respondents

I don't understand Dr. Bijak's antipathy to a podiatrist owning a shoe store and especially his thought that MD's are laughing at it. Have you been in a dermatologist's office recently? Or a plastic surgeon’s office? Or even to many OB-GYN offices? They are filled with skin care products and look like the inside of Macy's cosmetic department, and they are laughing, all the way to the bank!
 
Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

C-peds are board certified in orthotics and AFOs. Podiatric education and post-graduate training does not provide these certifications. The only reason MDs are laughing is because we get paid so poorly for surgery and so well for diabetic shoes.
 
Dale Feinberg DPM, CPed  Yuma, AZ  hd5bl@aol.com

I am sorry that Dr. Bijak is sick to his stomach about the Maryland podiatrist who recently opened a shoe store. I commend the physician for wanting to improve and add to his profession. Who better to provide the best shoe possible? Though we don’t carry orthopedic shoes, we carry top of the line, quality dress, sport, casual, and active shoes, apparel, bags, etc. We opened in June 2008. There were many reasons for opening, primarily professional. I do not feel that in doing so I diminish my quality as a podiatric physician. My wife and I are the rave of the town and the whole community. Maybe Dr. Bijak should consider the same!  

Harry Cotler, DPM, Soldotna, AK, footdoc@alaska.net

I must be misinterpreting Dr. Bijack's posting. What is wrong with someone enhancing their education or business? He writes it is an embarrassment that a "specialist" goes on to become a CPed. Where is the embarrassment in that? A podiatrist and a CPed are 2 different specialties. A CPed to me has the ability to fabricate the device themselves with the caveat they can also be reimbursed from an insurance company.

I don't know of too many podiatrists in New York who are fabricating their own devices in New York and getting reimbursed as DME vendors. I am, however, aware, of two podiatrists who are also CPeds and are making a tidy profit from their dual licensure.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com 

ASSOCIATE POSITION - FLORIDA

Associate needed for a dynamic practice in the West Palm Beach, Florida area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, specializing in sports medicine, surgery and trauma. Excellent hospital privileges available. Excellent salary and benefits for the right candidate. Contact/Send resume to springwm41@aol.com

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit our website to apply.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE - FLORIDA CENTRAL/SOUTH

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.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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.