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March 21, 2012 #4,415 Publisher-Barry Block, DPM, JD

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PA Podiatrist Part of Toe and Flow Team Effort

At 7:30 a.m. on a frigid winter day, the amputation-prevention team gathered in a conference room at Temple University Hospital for their weekly review of the most difficult cases. Podiatrist Andrew Meyr and blood-vessel surgeon Eric T. Choi - the "toe and flow" doctors - led a discussion with five other colleagues. 

Dr. Andrew Meyr examines diabetic patient (Photo: Charles Fox)

Meyr and Choi are key members of Temple University Hospital's year-old Limb Salvage Center. Despite the grim name, it is an uplifting initiative, the region's first multidisciplinary, hospital-based team dedicated to preventing foot and leg amputations in patients with diabetes or other diseases that damage blood vessels.

Source: Marie McCullough, Philadelphia Inquirer [3/19/12]

NYCPM’s Annual Foot Ball - A Party for the Ages

On Saturday, March 10th, the column-embellished lobby of the historic Capitale in downtown Manhattan filled with NYCPM students, faculty, and alumni. This year’s Foot Ball, NYCPM’s annual formal event, rose above and beyond expectations and proved to be a sold-out night that will be talked about for months to come. The evening served as a chance to bid farewell to the Class of 2012, honor esteemed faculty, reconnect with former NYCPM classmates, and show off a few dance moves.

Participants in NYCPM's Foot Ball

Sporting splendid ball-gowns and handsome tuxes, 321 guests began the evening by enjoying a cocktail hour before being ushered into the grand ballroom, where a three-course dinner was served. A highlight of the night was the presentation of the Student Choice Awards to Dr. Peter Barbosa for First-Year Professor of the Year, Dr. Gus Constantouris for Second-Year Professor of the Year, Dr. Khurram Khan for Third-Year Clinician of the Year, and to the Medicine Department for Rotation of the Year. 

APMA Elects New Officers, Presents Awards

The APMA House of Delegates (HOD) have elected the following officers to serve for 2012-3: 

Dr. Joseph M. Caporusso

President: Joseph M. Caporusso, DPM
President-elect: Matthew G. Garoufalis, DPM 
Vice president: Frank A. Spinosa, DPM
Treasurer: Phillip E. Ward, DPM 
Board of Trustees: R. Daniel Davis, DPM, Jeffrey R. DeSantis, DPM, Dennis R. Frisch, DPM, and Sylvia Virbulis, DPM

The following Awards were presented at the HOD:

DSC: HF "Bunny" Brown, III, DPM
Award of Excellence: Charles M. Lombardi, DPM
President's Award: AAPPM
PAC Chair's Award: AAPPM
Kenison Award: Lawrence Harkless, DPM

PA Practitioner Named Podiatrist of the Year

Dr. Kevin T. Naugle, a Cumru Township podiatrist, has received an award as podiatrist of the year, by the Pennsylvania Podiatric Medical Association. 

Dr. Kevin T. Naugle Receives Podiatrist of the Year Award

Naugle graduated from the Ohio College of Podiatric Medicine in 1989 and is president of the Berks Foot and Ankle Surgical Associates Inc.

Source: Reading Eagle [3/19/12]

NY Podiatrist Lectures at AAD and Nail Council Meetings

Last week Dr. Bryan Markinson delivered two presentations. The first was at the Council for Nail Disorders Annual Scientific meeting on March 15th, where over 100 dermatologists and several podiatrists from all over the world attended the meeting, devoted specifically to medical and surgical disorders and treatments of nails.

Dr. Brian Markinson lectures at AAD Annual Meeting

The following day, Markinson presented a lecture entitled "Podiatric Pearls for Nail Problems" to approximately 300 attendees at the American Academy of Dermatology (AAD) meeting. Markinson has been a board of trustee member of the Nail Council for several years.

Query: Socks with Malleolar Padding?

Down here in Mississippi, we have a lot of turkey hunters. This is turkey season. This necessitates lots of walking on uneven ground in rubber boots. I see lots of lateral malleolar blisters from these boots and wonder if anyone knows of a sock that has built-in malleolar padding?
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

Query: Taking X-Rays on Patients with Ingrown Nails

If we took an x-ray on every patient who came in with an ingrown nail, would that be considered normal standard of care? We don't currently do this, but are considering it. How many physicians routinely take an x-ray for patients with ingrown nails?

Name Withheld by Moderator

Response: There are two issues associated with your question.

1) Anything done routinely is suspect. 2) How will this x-ray exam impact your doctor's treatment course? Will he/she do anything different? If not, then, what is the value of doing this x-ray study? Taking x-rays in most - not all - cases are the exception, not the rule. Without specific medically necessary indications, it would be inappropriate to take x-rays in patients with ingrown nails.

Tony Poggio, DPM, Alameda, CA

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RE: Failed Hallux Implant (Alan Berman, DPM)
From: Mort Wittenberg, DPM

Why not take the implant out and see how the patient does? Of course, inform him of the probable additional surgery which may be necessary.

Mort Wittenberg, DPM, Evans, GA, mwittenberg3@comcast.net

All Scripts vs. Practice Fusion EMR (Howard Shapiro, DPM)
From: Elliot Udell, DPM
 
My office has been using Practice Fusion. It is a free program and there are over 156,000 doctors using it. Is it perfect? No, but many programs being sold with high price tags also have features that many doctors do not like. Practice Fusion comes with templates for podiatry and other medical specialties, but in reality, you have to create more of your own or modify what comes with the program.
 
One of the things I like about Practice Fusion is that they have one of the best customer support systems in the computer world. If you do not understand how to use some feature, you can click on a help icon, and a live person comes online with you and walks you through your problem. They also have help webinars all day long. If anyone has any personal questions about my experiences with Practice Fusion, feel free to contact me directly.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Medicare Guidelines for AFO Use [Doug Richie, DPM]
From: H. David Gottlieb, DPM, Josh White, DPM, CPed
 
I usually find Dr. Richie's insights to be quite helpful, but he's wrong in the issue of Medicare and AFO use. You can dispense or prescribe AFOs in any manner you want. That's your right as an independent practitioner. BUT if your patients won't be reimbursed by Medicare, then you need to have them sign an Advanced Beneficiary Notice first, then have the patients pay you upfront.

Medicare and other insurance companies have their rules as to what they will and won't cover. Whether we agree or not is irrelevent to them. Just protect yourself with an ABN.

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

Doug Richie recently posted that there is no specific Medicare coverage for an AFO for fall prevention, and that physicians should not dispense AFOs when the obvious clinic indication does not meet Medicare guidelines. The Medicare LCD states that to be covered, an item must "be reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member."

The Medicare Benefit Policy Manual states that appliances are covered when "used for the purpose of...

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

RE: ICD-10 Preparation (Edmond F. Mertzenich, DPM, MBA)
From: Pete Harvey, DPM, R.D. Teitelbaum, DPM

I agree with Dr. Mertzenich. The sky is not falling in. We are all smart. We will learn the new codes and press on. For most of us already in EHR, the system software itself will provide most answers since it is built in the program. Our company is already coaching us on the conversion. I do not think there is some diabolical plot to deny us payment by any government or private agency. If anything, reimbursement may even be better since the new system more clearly defines what we do.
 
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

If there will be a payment delay of several months, and other undefined costs to practitioners, then the government needs more time. Not the doctors, the government. I would stop right there. If they don't have their 'crosswalks' in place to direct new diagnosis codes to the CPT payment codes, whose fault is that? It's not ours, that's all I can say. With a two year run-up, there should not be any payment delay. If there is, then they do need more time.
 
R. D. Teitelbaum, DPM, Naples,FL, mfvandange@aol.

RE: ABPS Name Change (M. W. Aiken, DPM)
From: Bryan C. Markinson, DPM

I have always believed that the ABPS is one of the best-run entities representing DPMs. When I visit a colleague who has the ABPS certificate on the wall, there is no question that it indicates to me a superior level of dedication and skill that resulted in the attaining of that status.

But my adoration ends there. It seems that most DPMs with the ABPS credential, "the credential you can trust," strongly favor the name change designation to American Board of Foot and Ankle Surgery. The most often stated reason is that it most accurately reflects to the public what those DPMs with ABPS certification most often do. Really?

I am also concerned about the renewed attack on...

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

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