The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 13, 2011 #4,133 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2011- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We've just posted the following CPME-Approved CME. 

By Peter Vannucchi, DPM.

You can Earn 50 CPME-Approved CME Contact Hours Online

 Earn 15 Contact Hours for only $149

 NY Podiatrists can take up to 25 credits per three-year cycle  

  Choose any or ALL (50 CME Contact Hours) from the 30+ CME Category 1 articles posted
You Can Now Take Tests and Print Your CME Certificates Online

CPMA Elects New Officers and Board

The Connecticut Podiatric Medical Association (CPMA) has announced its newly elected officers and board members. The newly-elected president, Dr. David Mader, has been a board member for over three terms at CPMA. He is actively involved in all facets of governance, including legislative action, membership development, as well as continuing education development at CPMA’s annual symposium. Also elected were:  

Dr. David Mader

President-Elect - Thomas Johnson, DPM
Vice President - Eric M. Kosofsky, DPM
Secretary and Treasurer - Odin de los Reyes, DPM

Incoming Regular Board Members

James M. DeJesus, DPM, Jeffrey DeLott, DPM, Sanjay V. Patel, DPM, and Kristen E. Winters, DPM

First PRESENT Residency Education Summit Conference a Triumph

The first PRESENT Residency Education Summit Conference was held this weekend outside of Chicago to rave reviews, widespread enthusiasm, and general delight. The podiatric residency education community was present in huge numbers: 400+ total attendance, including 185 residents and 70 Residency Directors from 85 programs in 33 states. The faculty, most of whom were residency directors, included program Co-Chairs Harold Schoenhaus, DPM and Robert Frykberg, DPM, MPH, along with Guido LaPorta, DPM,  Larry DiDomenico, DPM, John Guiliana, DPM, and a glitterati of brilliant VA residency program directors.  

One Residency Rumble team pondering a particularly challenging question.

An unexpected highlight of the weekend was the Mentorship Breakout Session, where residents were able to discuss their career options with their more experienced colleagues. Many participants didn't want to break for dinner when the hour-long session ended. The event culminated with the much anticipated live Residency Rumble, an academic game show conceived by PRESENT as a fun, but effective learning experience. Plans are already underway for an expanded event next year, with the addition of a residents-only poster/abstract competition and a hands-on cadaver surgery workshop. 

Bill Seeks Outside Review of Relative Values in Medicare Services

Rep. Jim McDermott, MD (D-WA) introduced the Medicare Physician Payment Transparency and Assessment Act of 2011 on March 30. The bill explicitly would require independent contractors to identify misvalued physician services on an annual basis and recommend adjustments. The national health system reform law already states that the Health and Human Services secretary "may use analytic contractors," but the new measure would make this mandatory.
 
Since 1992, a panel convened by the American Medical Association and representing a wide range of specialties has recommended thousands of pay changes to the individual services doctors provide to Medicare patients. The bill would add a layer of review on top of the 29-member AMA/Specialty Society Relative Value Scale Update Committee, known as the RUC.

Source: Charles Fiegl, AMNews [4/11/11]

Query: Mosaic Wart Treatment

I have a mentally handicapped female who has countless plantar verruca (mosaic and isolated) under her feet and toes, webspaces, etc.. Efudex 5% cream BID was tried for six months without success. I would like to avoid surgical curretage. Does anyone have other suggestions for topical therapy?
 
Stephen Merena, DPM, Essex Junction, VT

Query: Pulse-Dye vs. CO₂ Laser
 
Which laser has been shown most effective? How do you go about getting a pulse-dye laser unit into your local surgical center or hospital?
 
Mario Dickens, DPM, Chattanooga, TN

Query: HIPAA and Doctor Reviews on Websites

It has become commonplace to see websites that encourage reviews on all kinds of products and services. I haven't been able to put a finger on why I'm bothered by the notion of reviews on professionals, until it just occurred to me. The doctor-patient relationship has the potential to become emotionally highly charged, our results are not always predictable, and as we know, poor outcomes come about and are not always the result of negligence. People like to complain. The Internet provides them a voice. In most instances, the provider of the product or service has the opportunity to respond. But if one of our patients is dissatisfied and posts a bad review, how can we respond without violating HIPAA?

Could it be implied that by going public, they are waiving their right to privacy? I'm comparing it to when they bring a friend into an exam room, there's an implied wavier of that right. If not, would there be any cause of action against them legally, since in essence, they're defaming our character without our being allowed to respond?

Carl Solomon, DPM, Dallas TX, cdsol@swbell.net

Query: Physical Therapy Modifier

Does CPT 97035 (physical therapy: ultrasound) need a modifier? If so, which one? The EOB states this procedure code is inconsistent with the modifier used or required modifier is missing. I don't see any modifiers.

Thomas Neuman, DPM, Northridge, CA
 
Response: If this is a Medicare patient, the physical therapy code will need to be appended with a "GP" modifier indicating "services delivered under an outpatient physical therapy plan of care."

And as the modifier indicates, you do need a written plan-of-care as part of your medical records.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here APMA Members: Click here for your free Codingline Silver subscription

RE: Orthotic for Golfer With Met Adductus Foot
From: Brad Makimaa, DPM

You must allow the supination of the left foot and external rotation of the left leg to be able to follow though and not slice the ball. If you restrict this, you will not let him follow through, and he will end up with knee or hip pain and/or many lost balls. The only answer is for him to open his stance (i.e., turn the left foot outward). This will allow follow-through without the torque on the peroneal insertion. It may actually improve his swing. You can debate biomechanics (he probably needs orthotics) all you want, but this is the real answer. He should give it a rest for a few weeks, first in an ankle brace and then work on his putting.

Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net

RE: Chronic Stasis Dermatitis Draining Lymph Fluid (Frank J. DiPalma, DPM)
From Marv Boren, DPM

Compression therapy is very effective in the management of venous stasis, lymphedema, and venous stasis ulcers. By ordering a compression therapy device for your patient to use at home, you will see better long-term results. These devices are covered by Medicare and most insurance plans, and there is no cost to the physician.

Lympha Press USA compression devices provide a pre-therapy mode, sequential mode, and peristaltic mode. An RN is sent to the patient’s home to set it up and instruct the patient on how to use it. The devices are color-coded to eliminate error and have a lock feature to prevent accidental tampering. You continue to treat your patient for ulceration, infection, etc., or simply monitor the edema progress. To order, you or your staff fill out a brief order form and fax it in. Lympha Press confirms insurance coverage and handles all the billing.

Disclaimer: I am an independent sales rep for Lympha Press USA.

Marv Boren, DPM, Canton, OH drboren@smartdrs.com

RE: Celebrex Not Being Detailed to Podiatrists (James Breedlove, DPM )
From: Frank Lattarulo, DPM, Jon Purdy, DPM

I'm not quite sure about your area, but one of the FEW detail reps I see on a very consistent basis is the Pfizer rep. He will never go more than two weeks without a call. If, in fact, I should also need a sample for a patient, he will swing by in between and drop samples off. Granted it's no more than two boxes at a time, but I see him frequently.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

Pfizer reps do detail podiatry. Although I find Celebrex does not perform as well as other NSAIDs, a case can certainly be made for its use with patients taking Coumadin or prophylactic aspirin. According to more recent studies, it is far better to use with a PPI in the at-risk GI patient than with any other NSAID/PPI combination.

Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

RE: Advertisements for Laser Treatment of Onychomycosis
From: Mark Spier, DPM

As a provider of laser treatment for onychomycosis, I feel compelled to respond to some earlier posts. Unless you have a cash-based practice, you are looking at this treatment through the prism of insurance reimbursement, and that mentality doesn't apply to cosmetic, elective procedures. First of all, since when does a treatment have to be 100% effective to be worthwhile or ethical? Do Lasik surgeons have a problem charging thousands of dollars for vision correction which may be temporary? The last time I checked, Botox injections are expensive and, yes, they are temporary. Does anyone guarantee their bunionectomies or phenols?

My patients are fully informed about the chances of success with this revolutionary treatment and are educated enough to make a reasoned determination as to the cost benefit ratio for themselves. Many have failed on oral agents and...

Editor's Note: Dr. Spier's extended-length letter can be read here.

RE: Bill Would Make Medicare Payments Public
From: Jeffrey Kass, DPM

There is a Senate bill that would publish data online letting viewers see how much doctors earn from Medicare. I think this is utterly ridiculous. The once revered doctor of yesteryear is really treated like garbage today.

The idea behind the bill is to curtail Medicare fraud. Does not every Medicare recipient get a copy of the EOB from their visit? How does public disclosure of one's medicare intake help curtail fraud? This seems to be an abusive invasion of privacy.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

 One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today. Dr. Zuckerman is in the Fort Lauderdale area and will demo these lasers on your patients. E-mail footcare@comcast.net

PODIATRY SUPPLIES--CHEAP!

Closing office. Gloves, pads, CAM walkers, casting splints, Powersteps, dressings, Covelets, Elastikon, Zonas, Coban, etc, etc. E-mail for complete list/description. Why pay full price? Huge discount if you take entire inventory. E-mail for complete list/description to goodfeet@hbci.com or call 507-429-7957.

GROWING PRACTICE FOR SALE- PHOENIX ARIZONA

Part of the largest multi-specialty group in Phoenix comprised of approximately 30 referral sources. Selling 50% share in practice grossing 600K. Gross is based on part-time practice but easily expandable to full-time if desired. Active, healthy client population, excellent surgical base, very minimal palliative care. PSR-36 required. Inquire at drlaurel@cox.net

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well-trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Also available are two transferable surgical center partnerships(with distributions). Owner retiring and willing to stay part time during transition. Cover letter/CV to softechpodiatrist@gmail.com

PGY-3 POSITION - NEW YORK CITY

PGY-3 position available starting July 1, 2011 at Beth Israel Medical Center in New York City. Please contact Dr. Richard Frankel at rfrankel@chpnet.org

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

OFFICE TO SHARE- NYC GREAT OPPORTUNITY

6 rooms (1000 sq. feet), Gramercy Park area. Newly renovated, painted, fully equipped and wired. Good for all situations. Available for immediate occupancy. Rental terms are competitively priced based on need. Please contact 157629@gmail.com for more information.

PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad 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.