The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 04, 2008 #3,211 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

NPI Glitch Causing Payment Delays

A change in the way the federal government identifies doctors for billing purposes is costing some physicians in New York and nationwide thousands of dollars, largely because of a government administrative glitch. Doctors said their Medicare payments have been delayed — sometimes weeks and months — as they transition to a new identification number required by the Centers for Medicare & Medicaid Services, known as the National Provider Identifier.

One doctor in the Bronx, Dr. Enid Goris, said the government currently owes her $20,000. She recently tapped her children's savings accounts to pay some bills. "I shouldn't have ever touched it, but I had no choice," the 39-year-old physician said. Untangling the problem could take between two and four months, which is time she does not have, she said. "I don't have any money," she said. "I have to pay my bills."

Dr. Arthur Gudeon

Other doctors shared similar stories: "We have no cash flow," a private practice physician in Queens, Dr. Arthur Gudeon, said. His office manager has about 200 rejected Medicare claims on her desk, he said. His staff has cut back on ordering office supplies, and he has not taken a salary in nearly four months, he said. "I really have not had much of a choice," he said.

To read complete story click here

Source: E B Solomont, New York Sun [3/28/08]

WV Podiatrist Sentenced to Jail for Probation Violations

A local podiatrist who skipped out on his patients will now have to go to prison. A West Virginia judge sentenced Robert Knox to six months in prison, three months home confinement and more than four thousand dollars in fines after he violated his probation. One of four violations occurred when Knox failed to report to he was buying two podiatry practices last year.

Under the terms of his probation, Knox was required to report to the probation officer and “submit a truthful and complete written report within the first five days of each month.” He was also “prohibited from incurring new credit charges or opening additional lines of credit without approval of the probation officer.” Officials say Knox violated the terms by entering into the agreement to buy the practices.

It was a deal Knox later broke when he failed to pay Dr. Margaret Meredith for the two practices and failed to show up to see his patients. Knox was put on probation in 2006 after pleading guilty to an illegal distribution of a controlled substance. That probation has been revoked.

Source: Dawn Jefferies, WSLS10, [4/2/08]

Query: Symptomatic Treatment of Peripheral Neuropathy

I recently had a 66y/o M IDDM x 20 years with significant peripheral neuropathy who was started on carbidopa/levodopa (sinemet) by his primary care physician for his peripheral neuropathy. He does not have Parkinson’s disease.. He had been recalcitrant to amitriptyline, gabapentin and pregabalin which I was previously trying on him and is my “routine” medication regimen of choice for peripheral neuropathy not responsive to good glucose control. After reportedly a month on sinemet he had some subjective improvement and actually objectively had restoration of his protective threshold (SW 5.07) on my exam. He can attribute his improvement to nothing other than the medication.

Does anyone routinely use sinemet for tx of peripheral neuropathy of DM?

Tip Sullivan, DPM, Jackson, MS

Query: Potential Suicidal Patient

I had a surgical patient tell me she had a problem in the past with drugs and asked me to be careful in prescribing. The patient underwent bunion surgery and was given Lortab for pain. She is now 3 weeks post surgery, and presented to the office and told me she tried to OD this past weekend, not on the Lortab, but on Xanax.

She is better today and requests no more pain meds. My questions are: How do I chart this? Is this information part of the medical record or should it be kept separate? Also, she is a camp director working with kids. Is this something I should report to someone?

Alan Mauser, DPM, Louisville, KY

Editor’s Note: PM News does not provide legal advice. As to charting, it is a physician’s responsibility to chart everything a patient relates which pertains to treatment. Thus, this incident should be properly documented. This patient clearly would benefit from psychological counseling, and it would be appropriate to recommend this.

As to reporting, this has to be a judgment call on your part. If you feel that this patient is an imminent threat to herself or others, you have an ethical responsibility to report this to the health department or other governmental agency.

RE: Great Toe Fracture (Rick Burnell, DPM)
From: Bradley J. Makimaa, DPM

This patient obviously has a limited DF of the IP joint. With competitive soccer he will need all the motion he can get. If not the dorsal fragment will continue to re-fracture will each severe flexion (i.e., back-peddling and then a quick jump forward planting hard off the back foot) This will then progress to a degenerated joint similar to a hallux limitus.

I would remove the fragment and if more than 50% of the extensor attachment is lost with the removal I would add a mini anchor to secure the available tendon. This should be very successful as the joint space is still clear and motion should be fully restored. Trying to fixate the fragment will only create a larger bony mass, decrease motion and increase the dorsal prominence.

I would also get him some orthotics for that excess pronation for true peak performance and injury reduction.

Bradley J. Makimaa, DPM, Key West, FL, drmak3@comcast.net

RE: Testimony of Ivar Roth, DPM
From: Multiple Respondents

Here is the true story on my testimony. I was hired to provide testimony and evidence that history and physicals by podiatrists are within our rights to perform. I did significant research to prove that we, as Podiatrists have the legal authority and right to perform full H & P's on our patients. This right includes the performance of pelvic, rectal and breast exams.

What is untrue about this article is that Dr. Overton "massaged the breasts and then inserted his finger into her Vagina and anus." The records, the opposing expert and the victim herself in cross-examination all said that a complete breast, rectal, and vaginal exam was done. Additionally, the patient gave consent to be examined and there were positive findings in the physical exam on the abdominal portion of the exam with pain and tenderness of lower right quadrant and a recent chronic vaginal infection to warrant a pelvic and rectal exam.

Lastly, those that doubt we have these privileges and that we should not do these exams, I would refer to the JACHO ruling that all doctors who do a history and physical on an admitted patient, that patient must have a pelvic within 30 days for a woman and a rectal for a male. Therefore, any podiatrist that now does pre op H&P's for either inpatient or outpatient hospital admissions is required to do these exams by law.

I took this case because Dr. Overton as a podiatrist did this exam within his legal rights. The prosecutions stand was a podiatrist did not have the right to do an H&P period. Dr. Overton was accused of sexual misconduct, this could not be farther from the truth as he performed a medical examination on the patient, not a massage of the breasts and sticking his finger in her privates.

I feel strongly that we must support our rights that the profession has worked so hard to obtain. It will be up to the judge to determine if Dr. Overton is guilty of any misdoing, but at least he was shown evidence that podiatrists have the right to perform full H&P's if the situation is warranted.

Ivar E. Roth DPM,MPH, Newport Beach, CA, ifabs@earthlink.net

I know Ivar Roth. He is a decent human being and a very innovative and dedicated podiatrist. Let’s not make him the bad guy. He is not on trial. He is defending another podiatrist in what may be a test case on how extensive a pre-op physical exam can be.

What is behind all of this is that some hospitals and insurance carriers allow podiatrists to do pre-op physical screenings. The American Society of Podiatric Medicine in association with Dr. Len Levy and Southeast Nova College of Osteopathic Medicine just offered a course in full body histories and physicals. There was a similar course given in New York City and one at a podiatry college in Ohio. There is momentum in parts of our profession to do full body exams. The question is what constitutes a full body pre-operative exam? Is it just listening to the heart and lungs, and taking a patient’s blood pressure or should it also consist of a rectal, prostate and vaginal examination ala what a man or woman would get by his or her internist at an annual physical check up. I personally do not do any full body examinations. Neither does my allergist, ear nose and throat specialist or ophthalmologist. For those of us who do want to do full body pre-op, physicals, I personally feel that examining a person's sexual organs or rectum, will not impact on whether to clear the person for elective foot surgery.

On the other hand, who am I to decide how intense other doctors can go in doing a complete physical. This should be left to the courts and local law making bodies to decide and both sides need their expert witnesses in order for the outcome to be fair. I salute Ivar Roth for taking the heat and making himself part of the judicial process. It may appear on the surface that Dr. Roth is sticking his neck out to defend a sleaze, but the outcome of the trial will impact many parts of our profession for years to come

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

While I agree that podiatrists should be trained to perform a full body physical exam, the actual performance of any examination and/or treatment must be medically justified. I don't see the medical justification of performing a genitalia examination of any patient whose only complaint is a sprained ankle. The need to practice any procedure just to be ready “in case”, is far from adequate justification to perform any medical procedure. I don't hear anyone advocating for widespread application of mouth-to-mouth, CPR the Heimlich maneuver on healthy individuals just so one will be more adept when it is absolutely necessary.

A woman with recurrent tinea infections of the foot and who also complains of pruritis of the intertriginous areas of the breasts and thighs might well be suited to have these areas examined. These should be done in a professional manner and would not likely require an internal genital examination. These areas may also be exposed when performing hip range of motion examinations, shoulder and chest examinations, etc. This can be minimized with appropriate shielding in order to provide the patient with an appropriate amount of dignity.

In cases where female patients have complaints which justify genital examinations, it must be witnessed by a female medical assistant, with the patient placed in an appropriate examination gown so as to limit the amount of exposure at any one time. If the patient did not voluntarily ask for this examination and their medical history justifies such an examination, the reason for this type of examination should be explainrd.. If refused, the patient would be appropriately referred. If the patient consented, the examination would only be conducted if properly witnessed and in the aforementioned manner.

I haven't heard justification for an internal pelvic examination for orthopedic-related injuries of the foot and ankle from any internist or gynecologist.

Being a "Real Doctor" doesn't give you the right to examine a patient from head to toe in any manner you see fit. An “RD” has acquired both the skills required to perform medical procedures and the necessary decision making process to determine when its performance is required. Unless both are used judiciously, one can and should be held accountable.

Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.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

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

EQUIPMENT FOR SALE- OSTEOPOWER2 SAW, ETC.

I have a Osteomed saw with many accessories! This is in Immaculate condition asking $15,000 or best offer. Medical office notepads x2 with docking station and keyboard. 3 docking stations and keyboards for other rooms, $1500.00 each. $75.00 each for the the docking stations. OBO email Harbor_Foot_and_Ankle_clinic@msn.com Call 360-533-7388

ASSOCIATE POSITION - NORTHWEST INDIANA

Full-time podiatrist wanted for Northwest Indiana (4 offices) 30-40 minutes away from downtown Chicago. Busy hospital and office based practice. Must have 3 year surgical residency. For more information please email footdocml@gmail.com

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.

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

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, 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- 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.

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,800 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 10,800 DPM's. Write 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 Ext 110.

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.

• 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.