The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 20, 2008 #3,250 Editor-Barry Block, DPM, JD

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When Choosing Running Shoes, Looks Don’t Matter: GA Podiatrist

Atlanta podiatrist Perry Julien recalls a patient who suffered from plantar fasciitis, a painful foot injury common to runners. Julien asked how old her running shoes were, suspecting that they were chief contributors to her heel pain. "Five years," Julien remembers the reply. "But they still look great." Looks should be the last consideration in selecting (or continuing to wear) a running shoe, says Julien, who has practiced sports medicine podiatry in Atlanta since 1989.

Dr. Perry Julien

Many of the common overuse injuries — heel, shin and Achilles tendon pain — can be attributed to the wrong shoes. Julien, also the assistant medical director for the Peachtree Road Race, said with three times your body weight pounding on your feet with every step, it's important to have the right shoes. "And that's the same if you're a novice or an experienced runner," he said.

Source: Scott Bernarde, The Atlanta Journal-Constitution [05/18/08]

Harkless Transfers His Experience to Western University

For more than 30 years, Dr. Lawrence Harkless directed the podiatric residency program at the University of Texas Health Science Center at San Antonio, earning worldwide acclaim as a leading expert on diabetes and the diabetic foot. In June, he moved to California to take the position as founding dean for Podiatric Medicine at Western University of Health Science in Pomona. But his hard work in Texas was not forgotten. This year, Harkless will be honored with the 2008 Georgetown University Distinguished Achievement Award in Diabetic Limb Salvage.

Dr. Lawrence B. Harkless

In Texas, he founded one of the first multi-disciplinary diabetic foot courses. In 1987, he founded the Foot Care Council for the American Diabetes Association and has since received several other awards and honors throughout his prestigious career. Now, he plans to continue his passion for medical research and repair at Western University. "Our team in San Antonio produced several contributions in diabetes, but I am transferring that experience and knowledge here," said Harkless, 57.

In a humble tone, Harkless said the award highlights work they "should have been doing anyway." "The more you do something, the better you get at it, whether you mow the lawn or put a towel on the floor," Harkless said. Throughout his life, Harkless has seen the affects of the debilitating disease. His grandmother had diabetes for about 50 years and Harkless said he used to give her insulin shots. His grandfather lost an arm to diabetes and his father had the disease, which led to problems with his eyesight. "All of that didn't necessarily get me started in the research, but it did help as I started work at University of Texas," Harkless said. "I am very spiritual and I really think God has a plan for everything."

Source: Red Orbit [5/16/08]

EMR Deadline Does Not Compute, Falling Short of 2014 Goals

In 2004, President Bush set a goal of most Americans using an electronic medical record by 2014. In his vision, doctors by then would be using EMR systems with interoperable standards that would allow them to share lab results, images, computerized orders and prescription information with hospitals and other health facilities.

So how much progress has been made in the past four years? Not nearly enough, many EMR experts say. Although individual physicians have embraced electronic medical record systems, the nation is far from an interconnected, interoperable network. Costs, hassle and a lack of congressional action are among the factors slowing health IT development.

The reasons for the insufficient progress are many, according to the report, "Gauging the Progress of the National Health Information Technology Initiative." They include slow adoption of EMRs by physician practices, the impractical nature of a national health information network, the difficulty of creating interoperability standards and Congress' failure to pass legislation addressing health IT roadblocks.

Source: Dave Hansen, AMNews [5/19/08]

Use the Reverse Side of Business Cards

The back of your business card provides an excellent opportunity to convey additional information about your practice, such as your office hours, insurance plans accepted, or additional services your practice offers. It only costs a few extra dollars to print on the reverse side of your card.

Query: Dermatological Treatment

A 5 year old girl presented with pain in both feet.

Diagnose This Lesion

She has been to dermatologists, orthopods and her PCP, but nobody has improved her condition. Any suggestions for treatment?

Robert M. Gaynor, DPM, Lake Worth, FL

RE: Orthotic Advice Sought (Edmond F. Mertzenich, DPM)
From: Keith L. Gurnick, DPM

Editor’s note: Dr. Gurnick’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=19641&start=1

RE: Contact Dermatitis from Chinese-Made Sandals (Dennis Shavelson, DPM)
From: Elliot Udell, DPM

The photo depicts an obvious textbook case of contact dermatitis. What we should not be lulled into doing is seeking to blame China for putting some toxic ingredient into the product. There is an obvious lack of control over lots of products made in China, but our focus in this case should be to treat the contact dermatitis and, if the patient’s getting recurring attacks, to find out what she is allergic to. Just because she has not had a prior case of contact dermatitis before, does not mean she is incapable of developing one.

I had a case of a patient who had a similar "mean" looking reaction to Dr Scholl’s odor eater pads. At that time, I could have gotten the chemical breakdown from Dr Scholl’s, ordered a testing kit from one of the companies that makes them for allergists, and skin-tested each ingredient they use. Both the patient and I soon realized that after successfully treating the contact dermatitis, with 1 cc. of IM Kenalog 40 and a week of oral steroids, it was easier for him to never use Dr Scholl’s odor eaters than to go through all of the testing. The patient never had another reaction of that nature. This happened 20 years ago and I have not seen any similar reaction to that particular product in any other patient.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Pre-molded Orthotics (Jennifer B. Ryder, DPM)
From: Matthew Richins, DPM

I have tried a handful of companies and have found Foot Steps out of AZ to be the best. The Foot Steps are made of a dense foam so they have some give as opposed to those that have plastic.

I buy them for $18 and sell them for $45. The rub is that they work so well I get few patients who come back for custom devices. However, I tell patients to replace them every 6-9 months and in the long run, I make more than custom devices.

Matthew Richins, DPM, El Dorado Springs, MO, mnmrichins@fourstatesfootclinic.com

RE: Conflicts of Interest
From: Lloyd S. Smith, DPM

I find comments made by all sorts of professionals that do not identify their conflicts unethical and dishonest. Whether the conflict is an honorarium for a lecture, a stipend for a consulting arrangement or a research grant for a particular study is immaterial. The world of medicine has been very guilty of allowing this type of conflict without challenging the individuals involved. That era has ended and the notoriety of many guilty providers has been revealed in major publications in the scientific and lay press.

I encourage those people who chose to post on this list serve to "spill the beans" so we all know what is influencing your comments. I encourage the editor of this list serve to demand no less.

Lloyd S. Smith, DPM, Newton, MA lloydpod@yahoo.com

Editor’s Note: PM News Guidelines require those posting notes to disclose any potential conflict of interest. This guideline is in accordance with the APMA Code of Ethics.

Editor’s note: This the corrected version of a recent note posted in Codingline Corner.

RE: Medicare Unna Boot Application Denial
From: Paul Kesselman, DPM

Can someone help me get paid from Medicare for the application of an Unna boot for a fractured cuboid. The claim was denied stating "This payment is adjusted based on the diagnosis," and "Payment has been adjusted because the information furnished does not substantiate the need for this level of service." The diagnosis code I used is listed as one of the diagnosis codes that support medical necessity on the Medicare website, and I did include the modifier indicating to which foot this was applied.

Can anyone explain the reason the reimbursement was rejected?

Michael Perlstein, DPM, Brooklyn, NY

Response: A review of the local coverage determination (LCD), L6979, from NGS Medicare's website on Unna boot application (CPT 29580) reveals that foot fractures and venous ulcers are the only two indications for which reimbursement is available.

If you billed a surgical CPT for fracture treatment of the cuboid for the same date of service, the Correct Coding Initiative (CCI) would kick out the Unna boot code as being included in the 'surgical' code allowance. If you also bill for an E/M service (CPT 99201 - CPT 99215) for the patient's initial presentation of cuboid fracture, an E/M visit would be allowed. One would need to amend the E/M CPT code with a "-57" (decision for surgery) modifier.

Subsequent Unna boot applications with a diagnosis of cuboid fracture in the global period of the fracture care should be allowed as long as you amended the CPT 29580 with a "-58" modifier (staged procedure).

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your cv to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen 410-580-0255

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

ASSOCIATE POSITION - SOUTH JERSEY

Busy group practice. Digital x-ray, Diagnostic U/S, EMR. Located between Philadelphia and the Shore. Need ABPS Eligible/ Certified, PSR 2-3, hard-working, energetic, team player with good hands. Previous experience a plus. Must be willing and able to provide quality palliative care. Competitive financial package. Resume and references to dalilfeet@aol.com

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 Visit our website

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

ASSOCIATE POSITION – HOUSTON, TX

Seeking a well-rounded resident for associateship in Houston. Candidate must be motivated, personable and goal oriented. Practice is well equipped with excellent support staff. Opportunity for buy-in following attainment of performance goals. Part-time position also available. Please send CV and letter of interest to drvargas@drvargas.com

ASSOCIATE WANTED - KNOXVILLE, TN AREA

Busy multi-doctor, multi office practice heavily weighted in surgery. PSR-24 + experience preferred. Part-time also available. Area consistently ranked in top five areas of country to live, work or retire. Ranked third in country 2008 Boaters magazine for boating destination. First year guarantee $150,000 plus bonuses and benefits. Send cover letter an c.v. to davidphawk@adelphia.net

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

ASSOCIATE POSITION- SAINT LOUIS, MISSOURI

Busy office seeking associate interested in future partnership. Must be ethical, well trained in all areas of podiatry, strong surgical background, board eligible or board certified. Office includes Doppler, ultrasound and digital x-ray, EMR. Competitive salary and benefits. Email CV to stlfootdoc@yahoo.com

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

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

PRACTICE FOR SALE - CORAL GABLES, MIAMI AREA (FLORIDA)

Beautiful location in the heart of Miracle Mile. Excellent opportunity for a starting practitioner. Most insurances accepted. Good mixture of surgical and general podiatry. Fully equipped with low overhead. Located in a professional building, with referrals from other doctors in the same building. Contact zoesar@aol.com or call 786-877-5149.

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