The Voice of Podiatrists

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April 26, 2008 #3,230 Editor-Barry Block, DPM, JD

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Florida Medical Association President Pledges to Help Forge Deal With FOA

The Sarasota County Medical Society (SCMS) recently met in a social setting to discuss current topics of importance. Attendees included Florida Medical Association (FMA) president Karl Altenburger M.D. and SCMS members Robert Cropper D.P.M., Jason Nolan D.P.M., and SCMS Board of Governors member Michael McCormick, D.P.M.

From Left: Robert Cropper, DPM, Karl Altenburger M.D., Jason Nolan, DPM, and Michael McCormick, DPM

After discussions about the scope of practice battles being fought at the Florida legislative level, Dr. Altenburger agreed that valuable resources are being wasted by both sides on these issues. He pledged to serve as an intermediary between the Florida Podiatric Medical Association and the Florida Orthopedic Association to help forge a deal between the two parties after the legislative session ends.

Many Physicians Do Not Use E-mail To Communicate With Patients

The AP/Long Island Newsday on Tuesday examined how, although U.S. patients increasingly "want the convenience of e-mail" to communicate with physicians, many physicians do not use the technology for that purpose. A survey conducted last year by Manhattan Research found that only 31% of physicians in the first quarter of 2007 used e-mail to communicate with their patients.

According to the AP/Newsday, some physicians have raised concerns regarding using e-mail to communicate with their patients, including a potentially larger workload, compromised patient privacy, fear of lawsuits and receiving urgent messages that they are unable to answer promptly. In addition, most insurance companies do not reimburse physicians for consulting with patients via e-mail. However, many patients have said they can avoid "phone tag" with a physician or taking time off for work for an office visit by using e-mail for "routine matters," including asking for a prescription refill, receiving laboratory results or scheduling an appointment, the AP/Newsday reports.

The American Medical Association has recommended that physicians avoid use of e-mail as a substitute for in-office patient visits and inform their patients about its limitations.

Source: AP/Newsday Via American Health Line [4/24/08]

Query: Emotional Distress Over Dystrophic Nail

I recently had a 34 yo female with complaint of simply a thick "ugly" great toenail with NO pain. She had her toenail removed twice previously once when she was 14 years old (by a PCP) and again in her mid twenties (by a podiatrist). The nail has grown back more dystrophic than fungal in appearance (no culture has been taken). X-rays reveal a subungual exostosis. Due to the previous nail removals, I am not convinced that resecting the exostosis with or without avulsion of the nail will "normalize" the toenail upon regrowth. This hallux toenail is causing her emotional and psychological distress as she wishes to wear pretty summertime shoes and sandals. She is willing to travel anywhere to have "plastic surgery" for her toenail. I have discussed all the normal options (permanent removal with OTC artificial nails, avulsion with nail culture and possible oral anti fungal, resection of exostosis, etc.). Even with nail polish she is embarrassed and hides her toes. She is interested in a permanent-- "toenail transplant.” Is there such a thing and what other options (if any) are available?

Hans Blaakman, DPM, Gaffney, SC

Query: HCPCS Code for Hyalgan Supply

I have injected an osteoarthritic ankle with Hyalgan previously approved by the patient's insurance with code, J7820. After having had this code rejected, is there a recommended code I can use?

Cyril Gostich, DPM, El Centro, CA

Response: J7321 - Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose. J7320 was deleted.

Hyalgan, except when used in the knee, is considered investigational by many insurance carriers. Make sure it is not only the code that resulted in the claim denial. You should attempt to get a pre-authorization for injecting the ankle.

Tony Poggio, DPM, Alameda, CA

Editor's note: Dr. Poggio will be joining the expert panelists at the Codingline-PM News Hawaii Reimbursement and Practice Management Seminar - www.podiatrym.com/hawaii - informally available to answer your questions.

Codingline subscription information can be found by clicking here:

RE: Standard of Care – MRSA (Jeffrey Kass, DPM)
From: Eric J. Lullove, DPM

The standard of care when treating a wound that cultures out MRSA varies by state, but you can use this guideline in your treatment of wounds that are MRSA (+):

Wound without local inflammation or exudate: Topical wound treamtents w/o topical or oral abx.

Wound with local inflammation or exudate < 2 cm: Topical antibiotics with local wound care guidelines (e.g. Gentimicin, Mupirocin)

Wound with local inflammation or exudate > 2 cm but less than 5 cm: Oral Abx to treat for community acquired MRSA (Bactrim DS 2 tabs po 2x/day, Doxycycline 100 mg po 2x/day, Zyvox 600 mg po 2x/day or Rifampin with Bactrim/Doxy 300 mg po 2x/day)...also refer the patient for an ID consult at this point especially if wound is not responsive to topical antibiotics and there is increased erythema.

Wound with purulence and local inflammation > 5 cm: admit the patient to the hospital or ER for IV antibiotics.... As I said, this is just a guide, it’s not meant to be the "bible" for everyday wound contaminations or for every ulcer.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

RE: Medical Nail Technicians
From: Bryan C. Markinson, DPM

Editor’s note: This extended-length note can be read at:
http://www.podiatrym.com/letters2.cfm?id=19173&start=1

RE: Disability Agreement Between Solo Practices (Pete Smith, DPM)
From: J. David Skliar, DPM

Coverage for disabled practitioners by fellow podiatrists is an old concept that worked very well if all involved shared the same altruistic attitude. It was first utilized on Long Island , N.Y. in the late 1950’s. A large group of solo podiatrists formed what we termed a “PIP” (Practitioners Insurance Panel). If a participating doctor became ill or disabled for greater than 5 days, the panel was automatically activated to give coverage five days a week, up to six months, if necessary. We had enough participants so that doctors practicing geographically close to one another were skipped in the order of those activated. Those “skipped” were placed on top of the list for the next necessary coverage. No monies were taken by the covering doctors. All income went to sustain the overhead of the practice. If insurance was involved, which was not common in those days, since cash was the common method of payment then, the doctor on call would turn it over to the ill doctors practice. In the years that I participated in a PIP, no ill doctor had a complaint of how his patients and staff were treated.

Elective surgery was not permitted, but all other treatments were performed. The greatest satisfaction members received was in the unfortunate case wherein a member died the PIP kept the practice going, and the overhead paid, until the family could sell the practice to an incoming podiatrist. We were not permitted, by verbal agreement, to allow patients to come to your own office after the ill doctor returned, even if the patient insisted, for a period of six months. When I relocated, my practice eight years later the PIP concept followed with me to my new location, 300 miles away for about ten more years. Fortunately, I never needed the services for myself, and I never regretted the time I donated to an ill or deceased colleague.

J. David Skliar, DPM, Spring Hill, FL, dskliar305@bellsouth.net

RE: Sol Balkin, DPM
From: Jeffrey Kass, DPM, Howard Dananberg, DPM

I was saddened to read about the passing of Dr. Balkin. He has got to be one of the "podiatric legends". He has dedicated a good part of his life to injectable silicon. When I once asked a question on this forum regarding Keragen and the likes, Dr. Balkin responded to me with a personal email. There was a follow up phone call from him which truly surprised me. When I informed him I thought I was well read in podiatry, but was unaware of his work, he e-mailed a list of his publications. There had to be a 100 articles authored on this topic. Needless to say, I was humbled and felt embarrassed. My thoughts and prayers go out to his family.

Jeffrey Kass, DPM, Forest Hills, NY

I was very saddened to hear of the death of Sol Balkin. I knew him for many years, and the passion with which he pursued his work was certainly an inspiration to me and many others. His enthusiasm was a real plus to podiatry and what we could offer the suffering public. He will surely be missed.

Howard Dananberg, DPM, Bedford, NH

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

PRACTICE FOR IMMEDIATE SALE- MT. VERNON, NY

Great opportunity Centrally Located on Busy Street corner in Fleetwood, Mt. Vernon. 15 year old practice... 2 days a week... May easily be expanded Low overhead ... Computerized billing. Fully equipped 2 treatment rooms Grossing $80,000 Call 914-572-3624

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 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

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