The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 18, 2009 #3,548 Publisher-Barry Block, DPM, JD

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ID Podiatrist Provides Children’s Shoe-Buying Advice

Chances are you've pushed, pulled or shoved your child's feet into too-tight shoes. Maybe your child had an overnight growth spurt. Maybe you bought the wrong size in the first place. Or maybe you're just trying to eke out a little more mileage.

"There are no two feet on a human body that are the exact same size. So both feet should be measured. And then the shoes should fit the larger foot," said Dr. Scott Graviet of the Podiatry Center of Idaho. "Some kids will tell you if the shoe doesn't fit. But some kids will just keep cramming their toes into the shoe," Potter said. "You can feel the end of the shoe, but if they have their toes curled up, you won't always notice they're too small."

When it comes to individual brands and shoe styles, simple and natural is often preferred. "Look for a seam or a stitch line that may be at an irritating spot on the shoe," Graviet said.

Source: Brenda Gutierrez, McClatchy Newspapers [5/5/09]

Weavers Keynote at MWU AAPPM Practice Management Club

Dr. Benjamin Weaver, secretary of AAPPM, and his wife, Brooke, his office practice manager, completely engaged the first, second, and third year students at Midwestern University  (MWU) in Glendale, AZ. by sharing some key pearls for planning, establishing, and maintaining a successful practice. The Weavers’ enthusiasm was contagious. They shared strategies such as the importance of goal-setting and making a plan, keeping a journal of likes and dislikes throughout medical school and residency, and tips on organization to optimize time management, to name just a few.

(L-R) MWU AAPPM Practice Management Club VP, Keith Arbuckle; President, Julie Chatigny; Treasurer, Isaac Palacios and Dr. Benjamin Weaver

It has been an exciting year for the podiatric medical program at MWU “It’s been one year since the graduation of our inaugural class of podiatric medical students, nine months since the founding of the MWU American Academy of Podiatric Practice Management (AAPPM) Student Practice Management Club, and now, on May 7, 2009, our very first keynote address,” said Club president Julie Chatigny. “We at MWU are truly grateful to the AAPPM, and Dr. Les Appel, for their dedication to furthering the education, development, and success of podiatric medical students,” said Ms. Chatigny.

Query: Posterior Tibial  Tenosynovitis

I treated a 58 y/o lady with HTN, for posterior tibial  tenosynovitis successfully with immobilization and  Voltaren; and followed up with functional orthotics for her abnormal pronation. She has had the orthotics since 2/09 and was doing well in March. She returned in early May compaining of  severe pain in her feet in spite of wearing the orthotics. She says the pain is different and in different areas; not always the same. She further describes pain as “burning shock sensation.” Her MD ran RA, Vit D, Lyme and thyroid tests; all normal/negative. She has more pain with more activity and it is worse without the supports. She denies any rashes or other spontaneous bodywide muscle-skeletal pain.

I found no pedal inflammatory signs on recent exam and no pain triggers, including in the PT tendons, plantar fascia, or lateral sinus tarsi. I would like thoughts on further work-up. I am considering ordering a bone scan to confirm local inflammatory process vs. non-pedal/neuro cause for the symptoms.

Mark Aldrich, DPM, Antigo, WI
 

Query: Post-op Follow-up Care Billing

If you perform surgery (90-day global) on a patient in a hospital operating room, you see him post-operatively every day for a week while he remains in the hospital, and then follow him for a week in a nursing home when he gets transferred, do need to submit follow-up care claims to Medicare even though that care is included in the global allowance and not reimbursable? In other words, is there a Medicare requirement that post-op follow-up care and services need to be submitted even though that care is included in the global and won't be paid?

Mark Gasparini, DPM, Massapequa, NY  

Response: I have never seen an absolute requirement for billing non-reimbursable (included in the global allowance) post-operative care. CPT, however, for completeness sake, did include the opportunity to do so.

CPT 99024 - post-operative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a post-operative period for a reason(s) related to the original procedure

This code allows the payer (and the provider via their computer software reports) to collect data on the care of the patient post-operatively. Since there may be a cost to the provider to submit a CPT 99024 only claim, unless there is some requirement I am not aware of, why add to your costs?

Harry Goldsmith, DPM, Cerritos, CA

RE: Disease of Toenails in 3 Year Old (H. Ashley Ledger, DPM)
From: Frank Lattarulo, DPM

My recommendation is to ask the mother for her Dremel tool and then disable the motor. How foolish.

Frank Lattarulo, DPM, New York, NY, doclatt@aol.com

RE: Osteotomy? (Margaret Portela, DPM)
From: Lou Nordeen, DPM

I have had many patients with Sub-2nd metatarsal pain pre-operatively in conjunction with the bunion deformity. Performing the 1st metatarsal osteotomy and plantar-flexing the metatarsal slightly will take the pressure off of the second metatarsal. If you correct the 2nd digit hammertoe also, perform a flexor tendon transfer with the arthroplasty which will further off-load the 2nd metatarsal head (by correcting/eliminating the retrograde force on the 2nd met caused by the hammer toe contracture). The 1st metatarsal osteotomy correction alone can help alleviate the 2nd met.

Lou Nordeen, DPM, Mechanicsville, VA, onefoot7@gmail.com
 

RE: MediNotes and Eclipsys (Mark Light, DPM)
From: Michael Brody, DPM, Joseph Borreggine, DPM

What Eclipsys has done is common in the computer industry; in fact, Computer Associates is well known for it. When you contact the company, you will likely get a response similar to, "We will upgrade you to XYZ (their other EMR product) for a nominal fee. They will also give you an upgrade version of the new product that will be able to import the Medinotes aatabase. This way, Elipsys will only need to support and develop one EMR product.

The EMR industry is getting quite interesting and you can expect more merger and acquisition activity.  Software entrepreneurs with deep pockets will purchase EMR packages to acquire their user bases and convert that user base to the their platform. When they provide you with an easy path to convert such imports your previous data, you are most likely to stick with the new platform, rather than start from scratch. This is one of the reasons I happen to like open source software.

When dealing with commercial EMR software, your best protection is to buy from a vendor whom you can trust; one who knows our profession and understands that providing us with quality service is what keeps them in business.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

I contacted Eclipsys and they stated that they are going to support MediNotes products up until 2013. They stated that MediNotes database platform is limited and that is why they will not be supporting the product beyond 2013. They do have an EMR/Billing software suite that is available to replace the current product.

Understand that Electronic Health Records (EHR) products must all have certification through Certification Commission for Health information Technology (CCHIT) which is a federal government regulatory commission for Health Information Technology (HIT). So,  your query, while important and timely to our profession, may be unfounded. All EMR software vendors are scrambling to see exactly what CCHIT wants from them so their EMR products can be certified.  Once the regulations are approved by the federal government (which have not been at this time), then EMR vendors can have a better understanding of what type of programming parameters their software will need to have to be compliant. Your current EMR product may be compliant as it is now and after CCHIT certification rules are formulated. Patience is of upmost importance during this time of HIT challenges.

Beware of any vendor trying to persuade you into buying or upgrading an EMR product at this time. Wait until CCHIT provides the proper EMR certification criteria before you purchase anything. The incentive program for reimbursing any newly implemented CCHIT approved EMR software will start in 2011 and end in 2016.

The potential amount available as an incentive refund for CCHIT-approved EMR's through the federal government for Medicare and/or Medicaid providers could be up to $44,000 from 2011-2016. Penalties will be assessed after that time if physicians who see Medicare and Medicaid patients do not have a CCHIT-approved EMR. Further information can be found in the recent APMA News publication for May 2009.

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

RE: New Patient Ethical Dilemma (Chris Seuferling, DPM)
From:  David E. Gurvis, DPM

Over the years, I have been in practice, I have also run into my share of bigoted patients. I have had them in my treatment chair, just in general conversation start using the N word for blacks, or the K for Jews, and so on. I will stop what I am doing, look up and tell them clearly that those words and / or attitudes are not welcome in my office.  They can choose to discontinue their use, or they can look elsewhere for care. I have not discharged them, but instead, left the decision to them.

We have told them the same when they have inquired on the phone if I'm Black, Arab...and so on. At that time, my staff will tell them, nicely, that we will not tolerate bigotry in the office, "and is Wed at 2 in the afternoon a good time for your appointment." Some get the message and make an appointment, and some decide to not appoint. In either case, they know those attitudes are not allowed in my office.

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

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

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

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

SEEKING PODIATRIST FOR SUNDAYS - HOWELL, NJ
 
Our practice of over 18 years is looking for a DPM to provide treatment on Sundays at our Howell office located approximately 1 mile from Lakewood , NJ. Speaking Hebrew preferred, but not required.  Please reply by emailing a CV and cover letter to: toetoe@optonline.net or by faxing to 1-888-645-0241.

BIOMECHANICS FELLOWSHIP – NEW YORK CITY

Neoteric Biomechanics 3-6 Month Fellowship: At The Foot Typing Center in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $1,000 a Week Stipend. New York License Required. Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

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

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