The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 02, 2009 #3,535 Publisher-Barry Block, DPM, JD

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It’s Not Enough to Just Keep Feet Clean: NJ Podiatrist

At the beach, at the pool or just walking in sandals, it’s the season where your feet get to breathe. But how do you keep your feet healthy as you expose them to dangers like athlete’s foot and other maladies that can make your feet itch, swell or just look ugly?

Dr. Maureen Jennings

“It’s not enough just to keep your feet clean,” said Dr. Maureen Jennings. “A lot of people tend to ignore their feet, and as a result they expose them to all kinds of infections and problems that can cause them to be both unhealthy and unsightly. The last thing you want during the summer is to be forced to hide your feet because they’re red, itchy or inflamed. And let’s face it guys, wearing socks with sandals is one quick way to make the ‘loser’s list’ with the ladies.”

Source: Habla News [4/24/09]

UA Study of ‘Water-Scalpels” Recommends Precautions Against Bacteria

Researchers from The University of Arizona Southern Arizona Limb Salvage Alliance (SALSA) and the University of Manchester College of Medicine in the United Kingdom took away the top poster award at the Symposium for the Advancement of Wound Care (SAWC) in Dallas. Their study evaluating the use of sophisticated "water-scalpels" used in surgical reconstruction suggests that precautions against bacterial contamination need to be made during their use.

Dr. David G. Armstrong

"The data from this study surprised us," said David G. Armstrong, DPM, PhD, professor of surgery, SALSA's director, and senior author on the study. "In a highly controlled mock-operating room environment, tiny bacteria can be released that stay in the air over a prolonged period of time. We should be mindful of this to avoid increasing the risk of contamination."

The surgeon-researchers suggest tips to reduce this transmission, like using additional operating room equipment to shield the area during surgery. "We believe this work challenges what we do everyday and helps us get better so we can further improve promising technologies to heal more wounds," Dr. Armstrong said. The "water scalpels" use water forced through a precision instrument at thousands of pounds per square inch to precisely remove dead tissue.

FL Podiatrist Creates Disposable Foot Covers for Airport Security  

Though the thought of walking over a carpet that countless other washed and unwashed feet have previously traversed probably gets glossed over for most of us, leave it to a podiatrist to obsess about it — and come up with a solution. Dr. Kyle J. Kinmon, a podiatric surgeon and physician from Boca Raton, Florida, will never forget the first time he had to remove his shoes in the airport security line.  He couldn’t help but ponder the conditions he’s treated over the years and how they can spread from walking barefoot or even while wearing socks.  And once the foot goes back into the shoe, the microorganisms can multiply faster than rabbits.

Dr. Kyle J. Kinmon

“Flesh-eating bacteria is all over the news, yet everyone seems to comply with taking off their shoes at airport security without concern,” says Dr. Kinmon. “I’m amazed that in this day and age we would be asked to do such a thing.” He initially responded by walking through airport security on the edges of his heels and curling his toes, but then he teamed up with Lisa Guarini, who ran a company called SmartBroad and who also shared his concerns. Together, they decided to do something about it and created Airport Sani-Feet®, a disposable foot cover that creates an impermeable barrier to guard against bacteria and toxins. 

Source: Lisa Rogak, Tips from the T-List - Vancouver, BC, Canada [4/27/09]
 

Inflation Outpaces Medicaid Rate Increases: Report

While some states have increased their Medicaid reimbursement rates for primary care and obstetric services, in general, rate increases did not keep up with the rate of inflation between 2003 and 2008, according to a report from the Washington-based Urban Institute and published on the Health Affairs Web site.

On average, Medicaid fees increased 15.1% during that period or about 2.6% a year. In comparison, the Consumer Price Index grew 20.3%, an annual average of 3.4%. Researchers collected information supplied by individual states on reimbursement rates for primary care, obstetrics, hospital visits, radiology, psychotherapy, laboratory tests and surgeries. Statewide averages were used in Alabama, Utah and Wisconsin where rural providers are reimbursed at a higher rate.

During the study period, reimbursement for primary care grew 20%, while obstetrics grew 8.8%, and all other services increased 8.7%, according to the report. New Jersey, whose reimbursement rate is only 58% of the national average, has the lowest rates, while Alaska had the highest, at 205% of the national average. Minnesota and New York were the only states that did not increase their rates during the study period, while increases of less than 5% were reported in Alabama, Alaska, Arkansas, California, Florida, Hawaii, West Virginia and Wisconsin.

Source: Andis Robeznieks, Modern Healthcare [4/29/09]

Query: Medicare Compliance Audit

All of us go to various CPT coding seminars and are inundated with how to measure history and examination points in order to bill a CPT 99212 or 99213 office visit, and so on. We listen, read, and practice....and wonder. I try to self-audit my own charts to see if I am following the rules, trying not to under or over-code. But self-inspection can be a difficult thing. Has anyone heard of or aware of a service that will take a sampling of redacted charts, for a reasonable fee, and review them for coding accuracy. This would add some peace of mind that I was neither losing money with under-coding, or verging on fraud with over-coding.

David E. Gurvis, DPM   Avon, IN

Editor’s note: PM News does not provide legal advice. While we can’t recommend a particular individual or service, we can say that an independent Medicare compliance audit is one of the best investments a practice can make. While you still might be subject to civil penalties, such an audit generally insulates you from any criminal liability. 

RE: Nocturnal Leg Cramps (Richard Mann, DPM)
From: Multiple Respondents

Straight leg and bent knee stretches before bedtime will resolve many nocturnal leg cramps within two weeks. Have patients try that before starting them on medication.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

Supplementing with calcium/magnesium can be very helpful in managing nocturnal leg cramping. Normal daily dose for a male is 1000 mg. calcium combined with 500 mg. magnesium, taken in two divided doses; AM and one hour before bedtime. Some patients do get loose stools from excessive Mg, but this is not common at the recommended dose.  

Howard J. Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

Quinine sulfate is still available; unfortunately, it is now under name brand - Qualaquin 324mg tab; unfortunately for the patients they now have to pay large amounts of money for a product that was available generically and inexpensive for many years; be aware that in researching the product, it will say not indicated for nocturnal legs cramps as it still is and always was an off-label use; I continue to use this in patients with same good results with the now new inflated price.

Marc Sabo, DPM,  Williamston, NC, dmrmas1@juno.com

RE: Ingrown Nails in 3 Month Old
From: Jeffrey Kass, DPM

Ingrown nail in newborn - About 5 years ago, I was called by a referring internist to see his new baby born with an ingrown toenail. I discussed with the internist about giving local anesthesia to the infant. I then turned to him and said look your son just had a "bris" (circumcision) and no anesthesia was used. I can do the partial nail avulsion quicker...a few minutes later and a dab of wine on the daddy's pinky into the infant's mouth and the nail avulsion was completed. If it was my own child, I think I would prefer this route than general anesthesia. Obviously, all cases and scenarios are different, but I do think this is an option. 
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com
 

RE: Gifts to Patients for Patient Referrals (Brian Homer, DPM)
From: Dan Waldman, DPM , Elliot Udell, DPM

I have been providing gift certificates to locally owned restaurants to patients who refer to me and on special occasions (birthdays, holidays, etc ).  Patients love it and so do the locally owned establishments.  Everyone wins.  Heaven help us if Big Brother starts dictating that we cannot even do this for our patients. 

Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com
 
If anyone has legal advice on whether Dr. Homer can send a gift to a patient for referring a new patient to his practice, perhaps he or she can broaden it and answer whether you can even send a thank-you card to a referrer of a patient. Would letting a referrer know that a person he or she recommended, showed up for an appointment violate any of the HIPAA confidentiality laws? Case scenario: You send Mr. J a present or a letter thanking him for referring Mr. B to your practice. The letter or gift with a note arrives at Mr. J's home. It’s on his kitchen table, opened up and now everyone in his family, including his kids, knows that Mr. B came to you for medical care. Could Mr. B legally bring an action against you for violating his confidentiality?
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Editor’s note: PM News does not provide legal advice. Under HIPAA, thank-you notes are generally not a problem. When a patient lists a referral source he or she has, in essence, waived his privacy to that fact. The important take-home message is that thank-you notes should be general in nature and not mention any diagnostic or treatment information. 
 

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

ASSOCIATE POSITION - CONNECTICUT

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.

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

ASSOCIATE POSITION - CENTRAL VIRGINIA

Join a solo surgeon in a two office private practice, modern facilities with EMR and digital x-ray, reconstructive and trauma surgery.  Excellent starting salary and benefits. Position leads to partnership. Submit letter of introduction and CV to jdisabato@vfasa.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

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 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

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