The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 23, 2008 #3,227 Editor-Barry Block, DPM, JD

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IL Podiatrist Found Guilty of Sexual Assault

South suburban podiatrist Anthony Overton was found guilty Monday of two counts of aggravated criminal sexual assault by Circuit Judge Michael P. Toomin following a bench trial. He will receive at least 12 years in prison and possibly as many as 60.

Dr. Anthony Overton, Jr.

Overton, 64, of Olympia Fields was on trial in Cook County Criminal Court for allegedly fondling an elderly woman and giving her a vaginal and rectal examination. Prosecutors had argued that Overton was not acting within reasonable medical standards when he administered breast and vaginal exams on a patient seeking treatment for foot pain. The woman, who was 75 at the time, had sought treatment for a sprained ankle in 2006.

Overton explained that he frequently gave full-body physicals to patients to diagnose other problems that might affect their feet. He said it sometimes is necessary to conduct breast, vaginal and rectal exams to check for other ailments.

Source: Robert Mitchum, Chicago Tribune [4/21/08]

U.S. Report Finds Sluggish Increases in Quality of Care

The pace of healthcare quality improvement appears to be slowing, according to the Agency for Healthcare Research and Quality's fifth annual report compiling federal and state data on more than 200 quality metrics.

A composite measure of healthcare quality improved at a 2.3% average annualized rate between 1994 and 2005, with the rate falling to 1.5% from 2000 to 2005. And in a first stab at examining the cost efficiency of the American health care system, AHRQ noted that costs, as estimated by the Centers for Medicare & Medicaid Services, jumped 6.7% from 1994 to 2005.

Source: Kevin B. O'Reilly, AMNews [4/28/08]

Query: Custom-Made Dance Shoes

I have a patient in her early 60s who began ballroom dancing about 2 years ago for exercise. She is having a difficult problem finding dance shoes that are comfortable. She presently uses an open-toe shoe. I have tried applying various materials to her present shoes without success She has a wide forefoot with mild bunions, mild tailor's bunions, hammertoes, and a narrow rearfoot.

Does anyone know of company that manufactures "custom-made" dance shoes? At this point, she is willing to pay any price to continue dancing.

Martin Hersh, DPM, Willow Grove, PA

Query: Rules and Regulations Regarding Physical Therapy

We are considering hiring a physical therapist and starting a physical therapy component to our office. Where can we find someone to help us navigate all the laws that are required? Has someone already done this, and can advise? We checked with the American Physical Therapy Assocation, but they are not interested due to their stance against physician-owned physical therapy offices.

Charles Perry DPM, Cambridge, OH

Response: 1) Your local Medicare should have a local coverage determination (LCD) regarding diagnosis, modalities, and frequency of care. Beware that Medicare has an annual limit on outpatient physical and occupational therapy ($1,810). There are diagnoses that might allow for you to exceed the limits - check your Medicare carrier's website for this
information.

2) Your managed care contracts will stipulate whether or not the physician may provide this service, or if it needs to be referred out and billed by the therapist.

3) In either circumstance, you will need to carefully document the patient's diagnosis and the medical necessities for the specific modalities and treatments you are to provide.

4) You will also need to track the patient's functional outcomes (on a minimum of a monthly basis).

5) I am unfamiliar with the Ohio scope of practice for podiatrists. Check your state Practice Act to see if you can supervise a physical therapist and/or a physical therapy assistant. In some states, only a physical therapist can supervise a physical therapy assistant.

6) Other questions that need to be answered:
- Who is the providing the service?
- Who would be billing for the service?
- Are you going to charge the therapist rent, or are they
going to be a salaried employee?

[If you are charging rent, you must charge the fair market value. I would recommending speaking with a healthcare attorney to be sure you are not violating any self-referral rules.]

Paul Kesselman, DPM, Woodside, NY

[Dr. Kesselman will be a featured speaker at the Codingline-PM News Coding & Practice Management Seminar post-APMA meeting; Kona, The Big Island - www.podiatrym.com/hawaii]

Codingline subscription information can be found by clicking here

RE: Computerized Radiography vs. Digital Radiography (Gary Gugliada, DPM)
From: Multiple Respondents

Although computerized radiography appears similar to the way we now develop x-rays it is "light years" ahead. I am currently using a 20/20 CR system and have used another CR system in the past. The 20/20 system does not require your hands to touch the plates. The speed is dramatically faster than your current developer. The speed of the scanner is much faster than we can take x-rays. The convenience of having the digital x-rays on your computer screen at the click of a mouse is wonderful. You almost never have to retake an x-ray because you can "lighten" or add "contrast" as needed. The quality of the images is excellent.

20/20 has one of the only (if not the only) DR systems designed for podiatry. You do save some time as compared to CR scanning. You also save space not having to use a scanner. It may require an upgrade to your current x-ray unit or a new unit if yours cannot be retrofit. CR has been around for many years and is being used in many podiatric, Orthopedic offices, and hospitals. DR has been extremely costly in the past and 20/20 has recently brought the price down to where it can be bought by most podiatrists. Image quality must also be compared. Podiatrists now have two viable choices for digital imaging, it is definitely time to go paperless and digital with your x-rays.

Kenneth Meisler DPM, Consultant, Digital Imaging, 20/20 Imaging, kenmeisler@aol.com

Dr. Gugliada is correct that the DR bypasses the plate processing. The advantage to this is that 1. You should save time. 2. You do not need a processor or the space it would consume. 3. It cost about the same or less as "Last year’s technology," which may mean that you can pick up a used digital film unit for half of the price as technophiles push forward.

I just purchased the DR 20/20 My office will open around June/ July. I would be happy to share my thoughts on this and/or the EMR/dig fax/computer hardware whirlwind quest with anyone pushing towards a more computerized office.

Marc Garfield, DPM, Hampton, VA, mgarfield1@cox.net

We are buying a CR system. The vendor that does both a CR and a DR flat out told us that the DR image is not yet the same quality as the CR, and they did not know when it would be.

John A. Shoudel, DPM, Springfield, IL, ShoudelDPM@comcast.net

RE: Recommended Work Boot (Frank DiPalma, DPM)
From: Multiple Respondents

I live on a farm and am an avid hunter. When I'm not in the office, I wear Red Wing work boots. Outdoor boots are like golf clubs. You really need different boots for different terrain and seasons. For general indoor/outdoor work though you can't beat a Red Wing boot. Their quality has suffered over the last 8 years like all shoe wear but they still maintain an adequate quality shoe.

One thing I like about Red Wings is that they seem to be quite a bit lighter than comparable boots and the leather is very stiff. This is what you want. Many $150 boots have soft supple leather that breaks down very quickly, especially if you pronate. My orthotics fit well in Red Wings. The Dunham boots in the picture look good, except that they have shoe eyelets the whole way up.

One of the MOST important things in buying work boots is that they must have "speed laces", those little hooks, above the ankle joint or you will not be able to tie them tight enough that they don't loosen at the ankle when walking. The lack of them makes the Dunham boots pictured worthless. All the other wonderful features are like "lace on a pig."

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

I have a work boot shoe store connected to my office. Three boots that I recommend are: Kodiac, Terra or Dunham. Dunham comes in very large sizes. Kodiac are made in Canada. They also have a 60-day guarantee.

Lenord Horwitz, DPM, Bluefield, VA, footpain@comcast.net

My husband is diabetic and wears Durham work boots. He works outside as a security officer at a local mall and absolutely loves this shoe. He pads it with a Dr. Scholl insole, but other than that its very comfortable and supportive. Red Wing shoes are great too, but he found them rather pricey and just not as comfortable.

Carla-Ruth Poma, Howell, MI, Mmbsinc@aol.com

RE: Treating a Patient with Severe Autism (Edwin Oghoorian, DPM)
From: Multiple Respondents

I currently have a patient such as this who also presented with a severe ingrown nail. I received the same such denial from Medicaid, but I called personally and spoke with the reviewer stating the special circumstances. They agreed it was necessary and authorized the procedure to be done in the hospital.

Actually in the hospital it was far less traumatic than I had envisioned since my anesthesiologist was able to make a small "cocktail" that he drank prior to the procedure to calm him down. He had experience with this type of patient and was very comfortable with this.

Medicaid did pay the bill for everyone involved, although not much. The whole family was very pleased. I continue to see both his mother and father for their conditions, as well as him from time to time. The beauty of this is that he trusts me now and I can easily treat him in the office.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

Autism is a growing issue in America (and the world) today. Latest data show 1 in 150 children will be diagnosed with autism, up over two thousand percent from ten years ago. With this prevalence, at some point we will ALL be faced with autistic patients, probably multiple times in our careers. I have many Autistic patients in my practice, and I have developed relationships with them which allow me to treat them with no problem.

Autism is a condition which affects the way the person thinks, feels, and perceives the world. They communicate in a completely different way then we do. As in any case of treating a patient, communication is paramount.

My advice is too late for Dr. Oghoorian, as it takes time to implement. Almost all autistic people are on your state's equivalent of Medical Assistance, so you have to take the case without regard to reimbursement.

People with autism can be treated if the treating doctor has taken the extra effort to learn how to successfully communicate and interact with them. To accomplish this requires the treating doctor self-educate on autism by reading books or taking a course. You will find treating people with autism is very emotionally rewarding, if you are willing to “write off” financial gains.

Brian H. Abrams, DPM, Palm Coast, FL, President, Florida Autism Coalition for Education and Services, brijul1@juno.com

This situation is a dilemma for doctors, but an everyday matter for social workers. Refer the patient’s caregivers to a social worker and they will get MediCal to approve the procedure in hospital on an outpatient basis.

Bryan C. Markinson, DPM, New York, NY, Bryan.Markinson@mountsinai.org

RE: Podiatrists Vs. Orthopods
From: Robert Hall, DPM, Paul Kesselman, DPM

Editor's Note: These notes can be read at: http://www.podiatrym.com/letters2.cfm?id=19125&start=1

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 - SAN FRANCISCO, CA

San Francisco East Bay. Surgical associate needed for expanding 3 board-certified podiatrist multi-location practice. BE/BC in RRA a must, but should enjoy all aspects of podiatric medicine and surgery including teaching. Looking for long-term commitment, potentially leading to partnership. Fax cover letter and CV to 510-581-7779

ASSOCIATE POSITION - CONNECTICUT

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

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

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

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

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

Baltimore County, Maryland Practice seeking motivated and very personable individual with 2 years min. surgical training. Busy practice in great area with hospital grade ASC. Please fax your CV and contact information to: Dr. Maurice W. Aiken 410-602-9781.

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