The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 28, 2008 #3,205 Editor-Barry Block, DPM, JD

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OPMA-Supported Landmark Insurance Bill Signed into Law

On Tuesday, March 25, HB 125 was signed into Ohio law. This legislation was described by the Ohio State Medical Association, who advanced the legislation, as "one of the most sweeping physician-insurance industry contract reform bills in the nation.” This legislation is intended to promote fairness and transparency in the contracting process, and a standard physician credentialing process. OPMA assisted in the lobbying efforts along with several other Health Care Provider Coalition of OH members. James Holfinger, DPM, Chair of the OPMA Insurance Task Force rendered testimony in both House and Senate committees during the 15 hearing sessions that were held on the legislation.

Dr. James Holfinger

This new law is a huge step toward eliminating some of the most bureaucratic, unfair and anti-competitive practices that have been imposed on physicians by Ohio 's HMOs and other health insurers. When this bill takes effect, there will be more balance and fairness in the contracting process between physicians and health insurers.

The bill, which takes effect in 90 days, includes provisions that :

• Ensure physicians get a copy of the full fee schedule from insurers, so they know what they will be paid for their services.
• Ban the selling or renting of a physician's contract to another company unless the rental is disclosed and all of the original contract terms are honored.
• Require all insurers to use the same physician credentialing form, and to credential physicians in 90 days.
• Ban use of clauses in contracts that force doctors to provide services at a lower rate than originally called for in their contract.

NY Podiatrist Provides Foot Care Advice for Mothers of Newborn Children

What does a mother do when she first looks at her newborn? Most will say: “Count every toe.” Yet moms can do far more to assure their child’s proper foot development, says Albany-based Dr. Mark Friedman, president of the Northeast Division of the New York State Podiatric Medical Association—the largest statewide component of the American Podiatric Medical Association.

Dr. Mark B. Friedman

Dr. Friedman is a foot specialist who sees children every day at his Albany offices. During April, Foot Health Awareness Month, he is joining other podiatrists who are members of the New York State Podiatric Medical Association (NYSPMA) in an effort to provide moms of kids of all ages…including mothers-to-be…with valuable information on pediatric foot health. There’s lots of other information available on the NYSPMA website (www.nyfootspecialists.com) he says. And materials are available in Spanish too.

Medicare Hospital Trust Fund to Be Insolvent By 2019: Report

The Medicare hospital insurance trust fund will become insolvent by 2019, according to a report released by the board of trustees for Medicare and Social Security. The report estimates that Medicare spending will increase from 3.2% of gross domestic product in 2007 to 10.8% in 2082. According to the report, Medicare will spend more than the program receives in revenue from taxes this year but will continue to receive significant interest income.

In addition, the report estimates that Medicare expenditures will exceed income by 2010. The report also includes for the third consecutive year a "Medicare funding warning" -- an estimate that federal general fund revenue will finance more than 45% of total program costs within seven years. The warning will require the next president to submit a Medicare savings proposal to Congress.

Source: American Health Line [3/26/08]

Query: Forteo Use in a Partially-Fused Lapidus

I have a patient who is 8 weeks status-post Lapidus procedure. The CT scan shows incomplete arthrodesis, with the superior portion of the tarsometatarsal joint fused and the inferior portion not fused (I am unable to give percentages of each). He has a Mini-Rail external fixator in place along with OsStaple compression staples. The hardware feels rock-solid on exam.

The patient's rheumatologist wishes to dispense the medication Forteo to help advance his healing. Do any PM News readers have experience using Forteo in a similar application?

Nat Chotechuang, DPM, Bend, OR

RE: Is Penlac the Standard of Care? (Jeffrey Kass, DPM)
From: Dan Klein, DPM

Too often I am faced with choices about how to manage and treat fungal toenails. My opinion, for what its worth, is that fungus is like the weeds in your garden and fungus is the weed of the nail bed. It really doesn't matter what you use as long as you use it regularly, trying to get the medicine into the nail bed. I believe by changing the environment in which the fungus grows is the key to success.

I also believe that if the nails are fungus laden then the skin on the foot is also contaminated with fungus and therefore you should use an anti-fungal skin preparation. How long? Forever! Just like the weeds in your garden, if you're going to keep weeds out, you must continually use a anti-weed suppressant. The same for the toenails and skin. I believe once the clinical appearance improves, then once or twice weekly, you should use a nail and skin preparation to keep the fungus from returning.

Dan Klein, DPM, Fort Smith, AR, TOEFIXER@aol.com

RE: Chronic Severe Pain Left Hallux (Bruce Krell, DPM)
From: Simon Young, DPM

If you think it's a deep peroneal nerve, have you considered a M-C exostosis. Maybe the patient tightens her shoe upper too tight. Maybe her shoe upper rides on her instep rather than her forefoot, and compresses the deep peroneal nerve.

I would consider a release and inspection from her instep distally before severing the nerve.

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

RE: ACFAS / APMA Membership Vote (Irvin Kanat, DPM)
From: Multiple Respondents

I don't know or understand the ACFAS Executive Board's agenda in creating this membership fiasco. It appears there are valid arguments on both sides of the coin. However, I do resent the fact that a move of this magnitude was made without complete and total membership input. As I am certain you are aware the proverbial "Pandora's Box" has now been opened. I can only see both sides being injured without a winner.

Barry A. Wertheimer, DPM, Torrance, CA, bwertheimer@cox.net

I find it curious that those who oppose ACFAS’s decision to no longer require continued membership in APMA preach the need for unity and, in the same breath, liken the College to an unruly child.

If unity were a priority, why hasn’t APMA granted ACFAS a voting seat in its House of Delegates? If unity were a priority, why did APMA threaten ACFAS with disaffiliation because of APMA’s policy that prohibited affiliate organizations from promoting the value of Board certification? (I am not making this up.) The real question is – what do we gain from a dual membership?

I am disappointed to hear some members of our profession already talk about our two organizations being divided. We will only be divided if some people want to be divided. The College certainly does not nor is such talk emanating from the College. Despite the slights it has taken from APMA (behind the scenes, unbeknownst to most members), ACFAS has always taken the high road.

Indeed, collaboration with APMA on issues facing our profession is critical. Our organizations have been united on the big issues such as professional parity, CMS H&Ps, and other matters. But to work together simply does not require mandatory dual memberships.

The reality is that voluntary memberships will lead to even more effectiveness and efficiency in both organizations, which will lead to even greater value to the members and, ultimately, a more united profession.

John Stienstra, DPM, Union City, Fremont and Hayward, CA

This opinion reflects the vast majority of our membership in the North Carolina Foot and Ankle Society In response to the recent AMA Scope of Practice Data Series module published by the American Medical Association, our national organizations, the Amercian College of Foot and Ankle Surgeons and the American Podiatric Medical Association (along with every state and local organization) now have the burden of vehemently defending our profession. Together, these two organizations can do this with a stronger voice than they can separately.

Legislation begins at the state level, it is our state component society’s responsibility to monitor this and be prepared to define and defend our scope of practice and professional licensure. Recent events in Texas serve to emphasize this need. Our national organizations, ACFAS and APMA have the responsibility to assist our state organizations in these matters and to address national issues as they arise.

The AMA document and the recent events in Texas demonstrate the importance of cohesiveness in our profession. If anyone doubts that we are under total, constant scrutiny, they need only realize that everything we write, even those things intended for our own profession, are constantly reviewed and can indeed come back against us. Additionally, we must recognize that our “enemies” may masquerade as our “friends” but in truth will undermine our profession to further their own goals. We must assume that “they” understand podiatric medicine and surgery’s two most important professional organizations are at odds with one another and we as a profession are weakened by this divide.

This issue should not be about two organizations who are seemingly at odds with one another. Nor should it be about personal or professional organization finances. We, as a profession can ill afford to be a house divided at this very crucial time; or ever. Every practicing DPM should belong to APMA. Every practicing DPM who performs surgery should also belong to ACFAS.

Tim Vogler, DPM, President (elect), North Carolina Foot and Ankle Society, Timothy.Vogler@cornerstonehealthcare.com

Editor’s note: An extended letter by Name Withheld is posted at: http://www.podiatrym.com/letters2.cfm?id=18681&start=1

RE: Non-Payment By Medicare
From: Gary Smith, DPM

While congress debates the pending 10% cut in Medicare, it should be kept in mind the cuts that have already been made this year. In October of 2007, medical assistance (MA) sent us an EOMB approved for $373 with no check. When we called, they told us it just so happened that they overpaid us that same amount in 2001, and that we would not be getting a check. They would supply us with no further info.

With PA MA, that is a full day’s work. The same thing happened to several doctors in my area of PA, and most of them dropped out of the system. Medicare has now pulled the same thing. They targeted about 60 claims over the last year and just refuse to pay them. No matter how many times and how many ways we send them, they "never receive them" or there is some bogus reason for non-payment. This is the first time in 17 years we have had this happen on such a grand scale.

Gary Smith, DPM, Kane, PA, penndoc@verizon.net

RE: Value of APMA Membership (Bryan C. Markinson, DPM)
From: Multiple Respondents

Maybe this might be the "canary in the mine." It is true that you generally recoup your $2000 and more as a dues member, e.g,. PICA, supplies, seminars, etc., but we need to address and recognize (acknowledge) that many people are struggling. We need to brainstorm and recognize good ideas and try to implement a feasible plan. True, in NYSPMA there is a committee to evaluate hardships, but the process is so humiliating especially to our female members, few choose to take this option.

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

I agree that contributing to APMA is a sound investment and have been a member since graduation. About ten years ago I voluntarily decided to cut back my practice. I have been working part-time and have had a limited income (net profit was $25K last year.) PICA has been supportive and provided what I consider to be a generous rate reduction. My state society unfortunately has not been sympathetic. I have been made to feel less than welcome as a reduced-rate member. Each year I cringe when it’s the time to again request a reduced rate. I wonder if this will be the year I finally drop my membership. If only there were some concrete financial guidelines to follow for reduced rate memberships.

Mitch Silverman, DPM, Boston, MA, mg.silverman@cox.net

I have read these posts in utter shock. First of all, it amazes me how short-sighted some of these doctors have become, for one without a strong APMA and state societies, how well do you think you will be reimbursed then? If not for the APMA and the state societies there would be no legislative voice. I think the problem with doctors who are having trouble making ends meet, new practitioners excluded, is themselves. These doctors never take the time to learn podiatry as a business. Many sign every contract that comes along, are afraid to work together as a group to get better contracts, do not treat their practice as a business yet they whine when they are getting 60% of Medicare. If you do not like the rate, drop it.

Take some business courses, sign up and be a member of the American Academy of Podiatric Practice Management and attend their seminars. Do something to increase your revenue, not taking more patients at a loss. Saying you cannot afford to pay the dues of the organization that helps keep you in business is just an excuse. Show me a doctor that says he can't afford the APMA dues and I will bet when you talk to them they will tell you how "great" they are doing and what new car or toy they just bought, etc. Opportunity is all around, take it!

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com

PRACTICE FOR SALE -ORANGE COUNTY, NEW YORK

Busy, part-time, twenty-two year old practice for sale. Easily expandable to full time. Grossing over $225,000 on three days a week. Great potential for growth. Price negotiable for immediate sale. Please reply to ASB310924@aol.com

PRACTICE FOR SALE - LAWRENCE, KANSAS

Great place to live and raise a family (college town). 250+ K yearly gross with good potential for growth. Good mix of general podiatry, sports medicine, and surgery. Hospital privileges available. 4 treatment/procedure rooms and well-equipped. Fully computerized. Partnership in a 4-office medical building. Partnership is for sale. Inquires to foothlr@sunflower.com 785-841-4225.

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Multi-office practice located in Ocean and Monmouth counties. Lokking for a well-trained PSR 24-36 individual. Must be personable and ethical. Excellent opportunity to join a well-established diverse practice. Please fax resume to (732) 255-9364.

SEEKING RESIDENT FOR PSR-24 - BALT, MD (MERCY MC)

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 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION - FT. MYERS/CAPE CORAL FL

Great opportunity for BE/BC established DPM or podiatric surgical resident with strong surgical skills. Well-established podiatric practice offering high surgical volume, advanced wound care, PT, vascular diagnostics and large diabetic population. Exceptional pay with incentives for high performers. Generous benefit package. Relaxed lifestyle, golfing, boating, fishing, close to beautiful SW FL beaches. Please send CV with references to janekelly331@msn.com

EXPANDING IN SOUTH-WEST FLORIDA

Seeking an associate for a well-established, busy, multiple-office practice. All aspects of podiatric medicine and surgery. Must have completed a 24-36 month residency and at least board eligible in forefoot surgery, preferably in forefoot and rearfoot surgery. Competitive salary with excellent benefit package. If interested, please fax CV to 941-639-0026 or e-mail it to Awilliam33@aol.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, AZ

Multi-location office and soon to start a wound care office in a local hospital. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, Vascular Testing /Nerve Testing Machines and our own ESWT. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com

ASSOCIATE POSITION – CONNECTICUT

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Podiatrist to add to our three-physician Podiatry division based in Hartford. Provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. PSR-36 training and board certification or eligibility and excellent surgical and wound care skills required. We offer competitive salary and productivity bonus, partnership opportunities, excellent benefits, and reasonable overhead. Apply online at https://home.eease.com/recruit/?id=21426 or via our website or fax your CV to 860-524-2653. No phone calls. EOE

ASSOCIATE POSITION NYC AND STATEN ISLAND

Associate needed for NYC and Staten Island. Spanish speaking a plus. Must have 2 years training . Growing practice with possibility of partnership. Please Send CV to Staff@nynjfoot.com

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