The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 29, 2008 #3,232 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.

Women Outnumber Men in Occurrence of Foot Pain: MA Podiatrist

Massachusetts Podiatric Society President Dr. Donald Adams estimates up to 75 percent of Americans will experience foot pain at some point in their lives."It's not normal to have foot pain. It's not a normal part of aging," he said.

Dr. Donald Adams

Adams reports the majority of his patients are women."Probably in my practice, it's two to one females to males. Part of that is probably because of shoe-wear. Women wear shoes that have narrow toe boxes, high heels which do lend themselves to more foot problems," he said. Adams says most foot and heel pain can be remedied by a podiatrist, and surgery is rarely required.

Source: Judy Forton, KTKA.com - Topeka, KS [4/25/08]

KS Podiatrist Dies After Brain Hemorrhage

Siena Medical Clinic podiatrist Phi Van, 33 suffered a brain hemorrhage and was flown to Wichita from St. Catherine Hospital Thursday, according to Janie Wimmer, spokeswoman for St. Catherine and Siena. She said "He was very well liked." After it was determined that he was brain dead, his family requested that he be removed from the respirator on Saturday. He died shortly thereafter.

Though born in Vietnam, Van grew up in Garden City, KS from the second grade through high school, after which he attended the University of Kansas, and then the Ohio College of Podiatric Medicine in Cleveland. He worked for three years in Detroit, but returned to Garden City in 2005 for the clinic position.

Source: Garden City Telegram [4/26/08]

IL Podiatrist Pleads Guilty to Medicare Fraud

A West Peoria podiatrist pleaded guilty Friday to bilking Medicare out of thousands of dollars over the past decade by writing bills for medical procedures he didn't do. The exact amount, however, remains in dispute. Dr. Ernest Nwani's attorney Ron Hamm contends the amount is less than $20,000, which would be for about 20 bogus operations. In an indictment from January, the government is claiming that figure is closer to $270,000.

It matters not just for the amount Nwani would have to repay, but also for how much prison he could face. The charge of healthcare fraud, which he pleaded to, has a maximum prison term of 10 years.

From 2002 until 2006, Nwani submitted claims, which Medicare paid, for 539 surgical procedures of various types regarding 442 patients and claims for the permanent removal of 1,082 toenails from 394 patients, according to court records. Medicare paid $171,760 for the surgeries and $100,180 for the toenail removals. Thirty-three patients were interviewed and of those, "none of the surgeries billed for these 33 patients and for which Medicare paid, could be verified as having been performed," court records state.

Source: Andy Kravetz, Peoria Journal Star [4/26/08]

RE: Office Assistant Paging System
FROM: Will Parker, DPM

I find that I spend way too much time tracking down my clinical assistant in the office to tell her that I need x-rays on Mrs. Jones or that Mr. Smith needs to be fitted with diabetic shoes etc. It is not that she is not busy doing meaningful things but I need a way to let her know that she is needed where I am without me having to leave the room. I do not want a chair-side assistant that does nothing but stand next to me all day but I want more efficiency. I knew a Doc years ago who had a "call button" in his pocket that he would push and his nurse would get buzzed (or something to that effect) and she would come to the room. I do not want an intercom type system but a personal paging system. Any sources or thoughts?

Will Parker, DPM Conway, SC

RE: Medical Nail Technicians (Bryan C. Markinson, DPM)
From: Robert Spalding, DPM

I welcome any podiatrist to inquire, call or email me for more information on the Medical Nail Technicians (MNT) program. It has been 8 years in development and has sound foundation with excellent information. With the advent of “foot care nurses” we really should be extremely proactive in embracing this new opportunity to expand our role in a market that we can excel, profit and lead the way.

Every podiatry office has the ability to meet this challenge and set the standards in a new emerging market. Any podiatrist can get started with this program immediately, and offer this force multiplier to your community with little or no initial investment except your time. We are also encouraged that the podiatric medical assistants can also benefit by this program as well. I welcome your input.

Robert Spalding, DPM, Dunlap, TN, Rts9999999@aol.com

RE: Emotional Distress Over Dystrophic Nail (Hans Blaakman, DPM)
From: Jerry Cosentino, DPM

I have one potential suggestion. While performing a partial matricectomy, using phenol to eliminate painful ingrown nail borders first, I then removed the thickened, dystrophic center portion of the nail plate. I applied the phenol with a wood tip applicator in the central remaining portion of the nail matrix for approximately 20 to 30 seconds. My objective was to thin the dystrophic center area of nail root.

Sometimes it worked, and sometimes it did not. I have not done very many of these and I would be surprised if there was a 50% success rate. Controlling the level of thinning is a pure guess. Streaking defects can occur. However, several of these cases have improved significantly.

The patient must be willing to accept that if there is further nail deformity (which would include longitudinal nail plate defects), a total matricectomy may be the only alternative. The results of your effort will not be realized until six months to one year. There is a possibility that acrylics can be used to fill some of the defects that may occur.

Another problem will be to get the nail plate to adhere to the nail bed. This is not easily done. An occulsive dressing, using Vaseline petroleum jelly, may accomplish this purpose as the new nail grows out, but this will take many months. Some patients will be willing to take this gamble. The potential failure of this procedure should be expressly stated in your consent form.

Jerry Cosentino, DPM, Tampa, FL, gcosenti@tampabay.rr.com

RE: ACFAS Members Vote to Reject APMA Membership Requirement
From: Multiple Respondents

The ACFAS Board has apparently achieved their “victory” However, a pyrrhic one. One that was brought about by obfuscation and deceit. Let me offer a dictionary definition, in case there is some misinterpretation of the word. (Pyrrhic victory - a victory won at excessive cost.)

Representatives of ACFAS asked for help at the APMA House of Delegates to limit the possibility of destructive discussion so as not to hinder the positive and unifying progress they were about to report. It would have been more honest if their request would have been honestly stated something like, “We have this thing so confused that we can come away from the House with an appearance of real unity, since the wording of our coming membership vote on the resolution of our disagreement has been designed to be so contorted that the selfish desires of ACFAS still may succeed, despite our empty words and an impression of agreement for the good of the profession.”

That, obviously, would have been an accurate statement, but not one that would have permitted them to present the image and role of peacemakers. Chamberlain tried that in Europe in 1938 and it represents to the world, to this day, the image of a “sell out,” “capitulation,” “dishonesty,” “isolation,” and “misdirected policy.”

I am truly saddened by the direction ACFAS seems to now follow. I am confident that the Founders of ACFS will turn over in their graves when they view the selfish and destructive philosophy of their organization today. I have already tendered my resignation to ACFAS. I will no longer list the letters denoting such membership after my name at any time, as I once did, proudly. Our profession has been often characterized as “eating our own.” This is but another example of unsatisfied persons attempting to secure prominence for themselves at the expense of others, and in this instance at the expense of an entire profession. I would like to close this letter saying “Fraternally yours” but I cannot.

Irvin O. Kanat, DPM, West Bloomfield, MI, ikanat@maxai.com

I have great respect for APMA President, Ross Taubman, but his comment regarding disappointment of the decision of the ACFAS Board of Directors should be directed to the ACFAS membership and not the BOD. We live in a democracy, and the membership has spoken, in spite of an inappropriate and expensive campaign by APMA to influence the vote of an independent organization.

I would hope that APMA would think carefully and have further discussions with ACFAS before taking any action that might prove to be disastrous for APMA.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, lswsr@aol.com

I would be happy to help start a new group (American College of Podiatric Foot and Ankle Surgeons) if other similarly-minded people in the 47% group are interested. Let ACFAS go its own unaffiliated way. The ACPFAS would have the requirement of continuous, concurrent membership in the APMA.

David Mullens, DPM, Palo Alto, CA, dmullens@earthlink.net

The good that will come out of this exercise is that the both ACFAS and APMA memberships have seen how much importance the profession places on the proper stewardship of our collective future. Was there a chance of reaching the 2/3 majority needed to change an ACFAS bylaw? I feel ACFAS members voted more to protect their dwindling checkbooks than against the APMA, and as such, there was little chance. In a time of economic expansion, the vote might have gone differently. But the dialog that arose, both private and public, surrounding this issue, all served to highlight the facts that we are a small profession, that the wolves are constantly at our door looking to pick us off one by one, and that we can best ensure the survival of podiatry by maintaining a strong unified front.

Alan Sherman, DPM, CEO, PRESENT e-Learning Systems, asherman@presentelearning.com

RE: EMR Without Billing Software (Will Parker, DPM)
From: Multiple Respondents

There are probably hundreds of EMR programs without billing. No sane human could sort all of them out. If you want inexpensive, you could try Amazing Charts $995 for license and $500 for updates and support--this program takes a bit of template development time but works very well with minimal workflow slowdown. For around $5k License and around $750/yr Spring Charts is a little more robust. And SOAPware is well-liked, pricing is variable but you probably are looking at around $3k license 500/yr. Office Ally has a web- based program for $30.00 per month that is very easy to use but needs a lot of input before your workflow will be back up to speed. Others also like medi-notes EMR. When you buy isolated EMR you will generally also have to purchase "Middleware" called X-LINK for about $750 plus another $350 for ancillaries. This links the programs together so you do not have to enter data into both programs separately.

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

There are many podiatry-friendly electronic medical records (EMR) programs on the market that will allow for standalone usage without a "two way" billing component. If you are outsourcing your billing and don't have a system that captures demographics, these programs can act as the repository for information traditionally captured by your practice management software.

If you do have a practice management software package, you may wish to have this system use a "one way" interface to your EMR to avoid the duplicate data entry of name, address, telephone number, etc. There is an article in Medical Economics that talks about CCHIT certification and why it may be important to your buying decision, which can read here.

The Medinotes EMR system can be used standalone or interfaced and has passed both 2006 and 2007 CCHIT certification standards. It is also the most widely used EMR in the field of podiatry.

C. Zac Childress, DarwinTech, Inc., zac@GoDarwinTech.com

I have been using a web-based program that offers both EMR and Billing. I originally was only using the billing component and then added the EMR component. I am able to upload pdf files which include the patient history, surgical consent forms, operative notes, lab reports etc. I am also able to upload JPEG images (digitized x-ray files). It also allows me to create reports to send to referring physicians and includes a scheduling program with it. In all fairness the templates for the EMR are not very podiatry-specific for all that we do, although they are happy to customize new ones at no cost.

While the system is stand alone, and only a high-speed Internet connection is necessary, truthfully I have not heard of anyone using only the EMR portion, although it is definitely possible. They are available online. I know of several other podiatrists in the area who use them as well as several internists and general surgeons. All of us have been pleased, and the cost is relatively inexpensive with no software to purchase

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

In this photo released by the Miami Beach Guitar Festival, guitar maker George Marlin strums on his Big Foot creation at the Miami Beach Guitar Festival.

AP Photo/Miami Beach Guitar Festival, Andy Newman

Submitted by Lori Weisenfeld, DPM

• 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.