The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 16, 2008 #3,221 Editor-Barry Block, DPM, JD

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NBPME Embarks On Strategic Planning Mission

The National Board of Podiatric Medical Examiners (NBPME) has undertaken a strategic planning process which will position the board and its mission in concert with Vision 2015. NBPME's President, Dr. Jeffrey Gerland stated that the examination process itself has been subjected to independent evaluation and he feels confident that the NBPME is ready to 'take the exams to the next level' through the use of increased technology.

Dr. Jeffrey Gerland

Dr. Gerland further stated that the planning process included discussions on board membership, offering the examinations more often, and a job analysis which will gear Part III towards a completion of a one-year residency program. When asked if he has any concerns about the examination as a whole now or in the future, Gerland said “test security and integrity are always of paramount importance.”

Gerland congratulated the American Podiatric Medical Students Association (APMSA) "as they have developed an 'Honor Code' specific to the National Board examinations that will be signed by candidates. Gerland stated: "the students, as stakeholders, obviously understand the importance of maintaining test integrity in a high stakes testing environment."

Kuwait Diabetic Foot Symposium Examines Care in Persian Gulf Region

Several hundred delegates from around the Persian Gulf were on hand to hear the latest in research in wound healing, vascular surgery and amputation prevention at the Kuwait Diabetic Foot Symposium, held April 13-14. David G. Armstrong, DPM, PhD, Professor of Surgery at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, highlighted the numerous initiatives made between his unit and countries throughout the region.

Dr. David G. Armstrong

"We have been pleased to have been working closely with countries all over the world on training programs,” Armstrong noted. “This is particularly true in and around the Gulf States, where the prevalence of diabetes is approaching an astonishing 30 percent."

The meeting, held at the world-renowned Dasman Center for Diabetes (http://www.dcrtd.org.kw/ was organized under the Kuwait Ministry of Health and co- chaired by Professors Abdullah Ben Nakhi and Massimo Benedetti, Deputy Director and Director of the Center, respectively. The center is actively involved in training of podiatry and foot specialists to counter the growing burden of lower extremity pathology throughout the region.

HHS Altering Fraud Self-Disclosure Rules

Providers who voluntarily report potential fraud to HHS’ inspector general’s office will now be required to supply a fuller explanation of what’s being disclosed in order to win leniency under the so-called self-disclosure protocol in place since 1998.

Four new requirements of initial disclosures are included in a letter to providers that HHS Inspector General Daniel Levinson issued today: a complete description of the conduct; the laws potentially violated; the results of an internal investigation; and an estimate of the damages and methodology behind the number. If the last two aren’t available, the provider must commit to delivering them within three months.

Providers who fulfill the requirements and cooperate with the inspector general’s office stand to be rewarded with the chance to walk away without a corporate integrity agreement, Levinson said in the letter. “A provider’s submission of a complete and informative disclosure, quick response to OIG’s requests for further information, and performance of an accurate audit are indications that the provider has adopted effective compliance measures.”

Source: Gregg Blesch, Modern HealthCare [4/15/08]

Query: Molluscum Contagiosum

A patient has been diagnosed with molluscum contagiosum. He was successfully treated with numerous modalities. He now questions whether he should have his shoes treated also.He does not wear socks, and consequently is concerned that the organisms may lie dormant in his shoes. He was advised by two different dermatologists to 1. do nothing 2. use bleach, or Lysol. What is the correct method of treating the shoes or is no treatment needed?

S. Meyer Arbit, DPM, Boynton Beach, FL

Query: Ace Insurance

I was quoted a very reasonable malpractice insurance premium from Ace Insurance. Has anybody had any experience or knowledge of this company?

Charles Spatz, DPM, Middletown, NJ

Query: New ABN: What-How-When-Where?

My staff has approached me on a new ABN (advance beneficiary notice). The recent version has been released this past month and put out by Medicare. Do we have to use the recent version? Has anyone seen any information on a new ABN form?

Charles Myers, DPM, Conway, SC

Response: The new form was released in March 2008. The new form is listed as "CMS-R-131 (03-08)". All providers MUST use the new form as of September 1, 2008. However, providers can use the new form now.

The new form includes a mandatory field in which the provider indicates the estimated cost of the services. It also includes a field which can function as the "Notice of Exclusion from Medicare Benefits."

The form cannot be altered - even to translate it into another language. A Spanish version is in the works, but not currently available.

Rick Horsman, DPM, Olympia, WA

Codingline subscription information can be found by clicking here:

Conscious Sedation (David S. Wolf, DPM)
From: Brian Kashan, DPM, David E. Gurvis, DPM

Conscious sedation, specifically nitrous oxide, may be defined as a general anesthetic by your state law. As such, it may not be in your scope of practice to administer a general anesthetic.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

I used this for my first several years in practice, having been instructed in its use in school. The good point is that it works for anxiety. The rest is not worth it. I sold mine to a dentist. The patient needs to be monitored by yourself or staff and it takes more time than what you can adequately be paid for. Because of the above, you need to charge appropriately for its use. Does, "I’m not paying for that stuff doc, my insurance covers everything", ring any bells? I spent more time explaining to patient that it wasn't covered, and they had to pay, than it was worth.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Powerpoint Lecture (Sandy Schustek, DPM)
From: Multiple Respondents

I recommend contacting your local APMA representative for a copy of the Powerpoint presentation regarding podiatry to be emailed to you. I gave a well-received presentation utilizing their Powerpoint. You can also request for pamphlets to give out.

Atoosa Kashani, DPM, Purcellville, VA, toos2004@yahoo.com

The American Academy of Podiatric Practice Management is an excellent resource for these items. They have 2 different PowerPoints that are on general podiatry. These can be modified, as needed for pictures or custom slides. There is common foot and ankle problems and diagnosis and treatment of common foot and ankle problems. As a member of the organization, you would have access to these plus a multitude of other presentation through sharing with other members. .

Benjamin W. Weaver, DPM, Wichita, KS, Dr.weaver@ksfootdoc.com

Have you checked the Podiatry Institute's Website? I have used several of their resources back when we still used slide projectors to talk to several groups and they have numerous lectures geared towards the audience you wish to reach.

David Dragoo, DPM, Harry S. Truman VA, David.Dragoo@va.gov

RE: Podiatrists Vs. Orthopods
From: Jim Giannakaros, DPM

A 65 year old male presented to my office a week ago for routine DM foot care. Upon presentation, I noticed that his hands were markedly swollen, and also very painful. He said his hand surgeon noted spurring on x-rays and wanted to perform surgery. Upon further questioning, I noted that he had psoriasis, and that this could possibly be psoriatic arthritis. I sent him for an HLA-B27 study which was positive, and he is now under the care of a rheumatologist. This is not meant to bash orthopedists, but to show that we do know our medicine. If the shoes were switched, orthopods would be the first to question why we missed this diagnosis. Needless to say, the patient will not be seeing his hand surgeon anymore.

Jim Giannakaros, DPM, Manahawkin, NJ, Jimpody3@aol.com

After 28 years of active surgical center practice, seeing the results of MD trained foot and ankle surgeons, and comparing them to DPM's, several features stand out. I would like some comments from DPM's here:

1. MD foot and ankle surgeons tend to "select" more rear and mid-foot stabilization procedures than podiatrists, and use more screws and plates.
2. MD foot and ankle surgeons tend to operate more often bilaterally, rather than staging patients and relating their disability to work related issues.
3. MD foot and ankle surgeons are exceeding uncomfortable with post-operative complications (unless they can blame them on a DPM), and almost always refer complications to other providers for aftercare.
4. The complication rate for MD foot and ankle surgeons is probably higher, since they select more Draconian procedures, in an "all in one" effort to "cure" patients.
5. The rate of complications for DPMs can also be high, when the DPM pushes aside the necessity for conservative care prior to selecting surgery, even if the procedure itself is less traumatic than the one the MD would have selected.
6. When a new MD foot and ankle surgeon appears on the horizon, their colleagues will break with traditional referrals and send all cases to the MD, instead of the DPM. Over a period of time (5-8 years), the local MD's will return again to their DPM referrals.
7. Most DPMs "embrace" complications and take them to heart, providing very deeply thought-out and extensive efforts to palliate the complaints.

In any situation of generalizations, we naturally see exceptions. But I believe there are truths to these.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: Duty to Provide Interpreter Under ADA (Randy Bernstein, DPM)
From: Tip Sullivan, DPM, David Gurvis, DPM

I have been in the same situation. The issue here is communication with the patient. One can easily do that with a large tablet, a marking pen, and TIME. I have found that you must spend more time with these patients. In my experience they are all happy for the attention and extra time that you spend with them. You also then have a record of your care. I would think that if you or the patient were blind or could not write for some reason, then you may actually need some help. I am not writing this to down play or speak against the disability act but to make the point that the important issue is quality of patient care. If these people are looking to sue someone they probably have a history of this behavior and as long as you show that you provided extra time and provided excellent care I don’t think any court would prevail in a lawsuit.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

I see a few deaf patients on a regular basis. It does hurt my bottom line each time I see them, but it is just one of those duties you take on in life, unpleasant financially or not.

I will ask the patient each time I see them if pen and paper is okay, or would they like an interpreter. If they want an interpreter, I follow up by asking if a family member is willing and able. I will stay late for them if necessary to bring a family member so I don't put the rest of my schedule off kilter. I will also often schedule them at a slow time for the same reason. Whoever wrote and said they only offer an appointment 2-3 months down to road, knowing the patient will shop around and leave his practice....to be blunt....go check the oath you once took back when you wanted to help people -before you became blinded by money and lost your way. But when the situation becomes more complicated, such as surgery, then I want a certified medical signer to make absolutely certain what I am saying comes across clearly.

I have had patients insist on an interpreter from a local agency who charges 2x as much as the fellow I have used for years, and I have refused. I have been threatened, but nowhere does it say I have to provide the patient's favorite interpreter, just an interpreter.

Check your local high school, your hospital, and deaf agencies/schools, and shop around. The guy I have used for years is certified, and independent, and charges much less than the specialized agencies.

David Gurvis, DPM, Avon, IN, deg1@comcast.net

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes, Please fax a letter of interest, CV, and references to 850-862-5470, e-mail ecpodiatry@aol.com

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

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

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Caring, hardworking podiatrist needed to join our busy practice. We offer great pay and benefits. Must be highly motivated, have a great bedside manner and superb surgical skills (forefoot and rearfoot surgical training a must). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about here

ASSOCIATE POSITION- LOS ANGELES AREA

Dynamic well established practice in brand new office building with surgery center, adjacent to hospital, seeks energetic rearfoot and ankle trained associate with partnership aspirations. E-mail CV to dr4feet@sbcglobal.net.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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

PRACTICE FOR SALE – WESTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

ASSOCIATE POSITION - MONTANA

Two Doctor group seeks individual with 3 years of surgical training. This well-quipped office deals with all types of reconstructive foot surgery. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on-site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

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

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 - NORTH CAROLINA

Beautiful area; Thriving economy. Seeking Nice, Well Trained Associate who can Work Independently (experience a plus). Unique "Associate Security" Clause so that you control your destiny. Send resume and cover letter to greatpodjob@yahoo.com

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