The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 29, 2010 #3,817 Publisher-Barry Block, DPM, JD

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IL Podiatrist Provides Tips on Preventing Tinea Pedis

Newspaper articles and Internet chatter have done a tug-of-war about whether or not Uggs are a breeding ground for stinky-cheese-feet. The final word: “Tinea Pedis, or athlete’s foot, is caused by a fungus that tends to flourish in damp, warm environments,” says Melissa Hong, a podiatrist in Crystal Lake, Illinois, and spokesperson for the American Podiatric Medical Association.

Dr. Melissa Hong

Regardless of brand, she says, going commando (foot-wise) “leads to increased perspiration which may increase your chances of developing foot fungus.”  The warm, wooly lining of this type of boot could be an offender. Her tips to avoid itches: give shoes days off between wearings (to air out and dry), and always opt for socks.

Source: Maria Ricapito, Blisstree [3/25/10]

Retiring Dean Roasted at Scholl Scholarship Benefit and Alumni Reunion

Terence Albright, DPM, Dean of the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, was celebrated with a “Roast” to honor his upcoming retirement at the recent 27th annual Scholl Scholarship Benefit and Alumni Reunion at the Chicago Hyatt Regency Hotel. A sold-out audience of 225 guests saluted Dr. Albright’s distinguished career.  

Dr. Kathleen Stone, ’85, new APMA President congratulates Dr. Albright.

The Scholl College Alumni Association Board of Directors sponsored the event with proceeds supporting the Scholl Scholarship Fund in Dr. Albright’s honor. H.F. “Bunny” Brown, III, DPM ’74, served as master of ceremonies.  Special remarks were made by Joseph Borreggine, DPM ’88; Jerry Brant, DPM ’62; Jondelle Jenkins, DPM ’83; Ronald Jensen, DPM; Irvin O. Kanat, DPM ’56; Karona Mason, DPM; and K. Michael Welch, MB, ChB, FRCP.

Noting Dr. Albright’s enormous contributions to both Scholl College and Rosalind Franklin University, Dr. K. Michael Welch acknowledged Dr. Albright’s “administrative and visionary acumen” as the former President of Scholl College, appointed in 1997, who initiated its merger with the University in 2002. 

FINAL NOTICE   APMWA  24th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 24th Annual Student Writing Competition.

All papers MUST be original and non-technical in nature. Appropriate subjects include practice management, ethics, or any topic that would be suitable for a lay publication. 
 

• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
   
• First prize will be one thousand dollars ($1,000.00) and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
   
• This competition is open to ANY enrolled podiatric student.
   
• Entries must be received by 4/1/10 via e-mail at bblock@podiatrym.com
   
• Entries become the property of APMWA, which may arrange publication of the entry.

Congress Fails to Prevent April 1 Cut in Medicare Physician Payments

On Thursday, the U.S. Senate held floor debate on a bill, H.R. 4851, that would extend a number of expiring programs through April. That bill, which had already passed the U.S. House of Representatives, includes a 30-day extension of current Medicare physician payment rates, postponing once again the 21.3 percent cut scheduled to take effect this year. It also addresses a number of other programs such as extensions of COBRA benefits and unemployment insurance benefits for Americans who have lost their jobs.

Congress failed to act yet again, and as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1. The AMA has contacted the Centers for Medicare and Medicaid Services (CMS), and they will be making an announcement shortly about their plans for handling the situation. Judging from past experience, CMS will not be forced to process claims at the reduced payment rates for 10 business days.

Source: AMA e Voice Alert [3/26/10]

DFCon Diabetic Foot Conference is Another Record-Breaking Success 

The eighth DFCon Global Diabetic Foot Conference, recently held at the site of the Academy Awards® in Los Angeles, attracted record participation from across the United States and around the world. More than 900 diabetic foot specialists from 31 countries attended DFCon at the Renaissance Hollywood Hotel.

Edward James Olmos (4th from left), and current and past Olmos Award winners.

“With doctors and scientists from all over the globe, we addressed the soaring rates of lower limb amputations, and our 42 distinguished speakers from 10 different countries discussed advanced treatments to avoid such complications,” said Co-Chair George Andros, MD. Dr. Andros is a vascular surgeon who is medical director of the Amputation Prevention Center at Valley Presbyterian Hospital in Van Nuys, CA, and founding partner of Los Angeles Vascular Specialists. “The conference was a huge success in every way – in terms of participation, quality education and most of all in getting the word out about how to save limbs,” said Dr. Andros. 

Query: Changing to Billing Service

I am considering switching from in-house billing to using a service.  My main motivation is cost. My current office management software is simply not very good. I have researched many of the popular software packages, including those that include EMR, elec billing, and scheduling. Frankly, I do not wish to invest, nor can I afford $20,000+ in new software and annual tech support, especially given the uncertainty of the future of medicine. I would love to hear from any colleagues, preferably those in small, 1 or 2 doctor practices, who have switched from in-house billing to outside billing services.  Any regrets? Any caveats when choosing a service? Anything that you simply never anticipated or thought of before the switch?

Peter Smith, DPM, Stony Brook, NY

Query: Vascular Testing Certification

I am considering performing vascular exams in my office. Prior to purchasing a testing unit, I reviewed NGS Medicare's "Non-Invasive Vascular Studies" LCD (L27355). Within the LCD is a requirement for documented training: "Providers of interpretations and the technical portion of the examination must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit."

What approved courses have podiatrists taken to meet this requirement?

Michael Fein, DPM, Bethel, CT

Response: The American College of Foot & Ankle Orthopedics & Medicine has partnered with BioMedix Vascular Solutions, Inc., to develop a comprehensive training and certification program focusing on BioMedix’s PADnet+technology. This certification program is overseen by ACFAOM’s BioMedix Advisory Board and Board of Directors.

The requirements for earning the ACFAOM Certificate in Community-Based Peripheral Arterial Testing Competency include:
- Completion of a comprehensive training program
- Passage of a Web-based multiple-choice examination
- Completion of ten tests on patients, reviewed for accuracy and quality of results

Upon successful completion of the certification program, a technician is eligible to receive a Certificate of Competence in Community-Based Peripheral Arterial Testing recognizing the technician’s proficiency and knowledge using PADnet+ for testing for peripheral arterial disease. For more information, go to acfaom.org/cred.html

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: MASS Theory (Calvin Britton, DPM)
From: Multiple Respondents

I find it interesting that Dr. Bijak's response is shrouded in the statement "...one can understand why insurance companies question the efficacy of such devices..." It seems to me that if we default to the "insurance companies" as the ultimate arbiter in determining what is deemed as appropriate treatment, we are all in serious trouble. Regardless of the variety of opinions "out there", orthotics do work when used appropriately. Part of what we do is the "art" of medicine. When properly mixed with the "science" of medicine, appropriate, efficacious, and satisfactory outcomes can be achieved. As one of those "honest brokers", it would seem to be poor practice to remove valid treatment options from my tool box.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net
 
I finally had the opportunity to speak to Dr. Glaser, face-to-face at the Midwest Podiatry Conference. I heard his lecture last year and felt much of his theory violated the basic biomechanics of foot function. I have not changed my mind. In my opinion, he has taken Root and "twisted" it, or maybe a better explanation is that he thinks the supinated foot in mid-stance is functional. It is easy to see he is very committed to "his" theory and can be very convincing, but I just don't see it.
 
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

Dr. Glaser came and spoke to our class a couple of years ago. It was during one of our biomechanical classes for about 1-2 hours. From what I remember, he came so that we could know of other ideas out there about biomechanics/orthotics. That was the only exposure I had to his theory during my four years at Temple.

Jeff Merrill, TUSPM c/o 2010, teflon@temple.edu

RE: Scanning vs. Casting for Orthoses (Robert Bijak, DPM)
From: Keith Gurnick, DPM, Jeff Root

"You can't harm a patient much with a bad orthotic." I do not personally know Robert Bijak, DPM, however, I must disagree with this statement and explain my reasons. I believe what he describes as a "bad orthotic" would either be an improperly manufactured orthotic which can include an improper prescription. One needs to take into account all the things that go into making and prescribing orthotics, including materials selection, size, shape and contours and balancing of the devices, and of course the accuracy of the impressions taken, and how the laboratory interprets and applies the doctor's prescription to the finished product.

First, a "bad orthotic" can cause problems not only to the feet, but also postural problems above the feet. Improper orthotics can harm the soft tissues and bones of the feet, including those same soft tissues and bones we are trying to treat with the orthotics. Secondly, ankle, leg, knee, hip and low back pain can be caused or aggravated in the same manner. Thirdly, and possibly the most common finding caused by "bad orthotics" is the patient has been deprived of the potential benefits of  "good orthotics" and may choose to live with the pain, discontinue healthful activities, discontinue or modify work and life-style, and even undergo unnecessary surgeries, had the orthotic process been done properly.

Fortunately, I have helped thousands of patients over the last 30 years with what I believe to be good orthotics. Unfortunately, all too often I see patients who have been harmed more than "much" with "bad orthotics", and I am certain I am not alone.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

Dr. Bijak’s claim that foot orthoses are relatively safe is supported by the fact that the FDA classifies foot orthoses as class one medical devices, which is the safest of the three classes. It is also important to remember that podiatrists are dealing with a pathological segment of the population. The risk factor for this group is greater than in the general population, especially for those who suffer the deleterious effects of diabetic neuropathy.

In the past, Dr. Bijak has made it abundantly clear that he wants podiatrists to abandon foot orthotic therapy, and is in favor of having “shoe salesmen and pedorthists” provide foot orthotic therapy to the public. Now he states, ”I suggest that doctors of podiatric medicine spend their limited time becoming proficient in conditions and technologies where the sequelae of a wrong treatment or diagnosis causes harm to the patient.”  Dr. Bijak, do you actually believe that these patients would be better served by sending them to non-medical providers for treatment? Really?

I believe that Dr. Bijak has unintentionally made a strong case in favor of better non-surgical training for podiatrists. For many conditions, foot orthoses provide a safe alternative to surgery, which allows some patients to avoid the inherent risks associated with surgery. In addition, foot orthoses are used to address post-surgical complications, often by the very practitioner who performed the surgery in the first place. Biomechanics is a critical educational component for surgical and non-surgical treatment of the foot. These are not mutually exclusive treatment concepts.

Jeff Root, jroot@root-lab.com

RE: Aetna and Out-of-Network Facilities
From: Keith Gurnick, DPM

Yesterday, I received a phone call from a person who said he was a representative of Aetna. I normally don't take such calls, myself but I figured I would answer his questions and not defer them to a second phone call.  The reason for the call: they wanted to know why I had done "some" surgeries at an "out-of-network" facility on "Aetna PPO" patients, since I am an Aetna PPO contracted doctor. He told me that as an Aetna contracted doctor I am obligated to refer "in-network."

I wasn't…

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

RE: Safe Guard, LLC (Michael Rosenblatt, DPM)
From: Lawrence M. Rubin, DPM

Dr. Rosenblatt rightfully stresses the importance of keeping detailed and excellent chart notes to protect yourself from Medicare audit overpayment demands and/or fraud accusations. Equally important -- you should follow the recommendation of the Office of the HHS Attorney General (OIG) to develop and adhere to a written practice compliance plan. One of the elements of the plan should be a section describing the correct coding and documentation protocols you follow for each of your commonly billed services.

Make no mistake, a pattern of what Medicare believes to be intentional upcoding (billing a HCPCS code for a higher level of service than is warranted) or miscoding (billing a code that does not specifically apply to the performed service) can be considered fraud. Going through the process of writing the plan, keeping it up-to-date, and performing periodic self-audits to make sure that your billing and chart documentation stay consistent with the written protocols should keep you out of trouble. But, if post-audit overpayment demands or fraud allegations do happen -- a written compliance plan can (according to the OIG) be a "mitigating factor" in Medicare's determination of what action, if any, it will take.   

Lawrence M. Rubin, DPM, Las Vegas, NV,  lrubindoc@aol.com

RE: The Passing of Dale I. Selby
From: Steven Selby Blanken, DPM

On February 28, 2010, Dale I. Selby, wife of the late Morris L. Selby, DPM, of Washington, DC, and grandmother of Steven Selby Blanken, DPM, of Silver Spring, MD, passed away. She was 91 years old. Mrs. Selby worked in the podiatry practice of Dr. Morris L. Selby over the span of several decades. Mrs. Selby is survived by two grandchildren and five great grandchildren.
 
Steven Selby Blanken, DPM, Silver Spring, MD

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.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.

PRACTICE FOR SALE - MIDDLE TENNESSEE

Turn-key operation ideal for new practitioner. Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking.  Excellent locations and growth potential. All equipment and furniture included. Seller happy to discuss extensive financial and professional information. Priced to sell with good reputation, website, and assistance with transition if needed. Call 931-446-5724 for additional information.

ASSOCIATE POSITION - BALTIMORE/WASHINGTON REGIONAL AREA

Multi-faceted practice (routine care to trauma) seeks associate with Maryland and/or Pennsylvania license. Great opportunity for partnership. Looking for pleasant personality. We have multiple offices. Contact butler@qis.net. or call at 410-848-6800 and ask for Dr. Butler.

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

ASSOCIATE POSITION-BERKELEY, CALIFORNIA

We are seeking an energetic individual to join our multi-office practice in Northern California. PSR 24+ with a California license is required. Partnership position is possible with an excellent long term business opportunity for an enthusiastic and motivated individual. Please send resume to Mwolpafootdoc@yahoo.com

ASSOCIATE POSITION - SW FLORIDA, BEACHES

Well-established podiatry practice with excellent mix office/surgery seeking full-time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment to Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER 1st, 2010. Must have completed PSR-36 or similar. Submit applications to: Dafny Suazo at dsuazo@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: April 30, 2010. Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers.

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-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

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.

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