The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 21, 2008 #3,251 Editor-Barry Block, DPM, JD

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CA Podiatrist Debunks Myth About Toxin-Removing Foot Pads

You've probably seen the commercial for the Kinoki Foot Pads. They're said to remove your body of toxins while you sleep. It seems like an intriguing product. The commercial says the product naturally captures toxins from your body while you sleep. The product is placed on the bottom of the foot. According to the commercial, that's the best place for toxins to leave your body. Podiatric physician Michael Orosz said that's not the case because the skin there is different than the rest of our body. "It’s quite a bit tougher. It's a good 2-3 times thicker," he said.

Dr. Michael Orosz

The product contains ingredients which turn it brown when it absorbs moisture. Podiatrist Dr. Michael Orosz said that's not surprising. "The bottom of the foot actually has more sweat glands per square inch than any other area of the body," he said.

When used night after night, the pad is supposed to gradually show less brown color. Orosz said there's a perfect explanation for that as well. He said, "One of the primary ingredients in the pad is the vinegar and vinegar will actually dry your skin. It does shrink the pores and will cause less sweating."

Source: Jon Keimig, KWWL.com [5/16/08]

Doctors Still Can Try For Bonuses as Medicare Expands Quality Reporting

It's not too late for physicians to begin participating in Medicare's pay-for-reporting program. The Centers for Medicare & Medicaid Services has implemented a number of changes aimed at enticing more doctors to give the program valuable quality information while striving for a 1.5% bonus on their Medicare payments.

The Physician Quality Reporting Initiative was in effect for only the last six months of 2007 but runs for the entire year in 2008. In addition, the list of quality measures has expanded from 74 to 119. CMS has added two structural measures -- one that rewards the use of electronic medical records and the other for e-prescribing.

Although nearly half of the year is already over, physicians who have not yet participated in the initiative still can qualify for a full-year bonus. If a physician is able to report at least three measures for at least 80% of the patients to whom those measures apply, he or she could still receive the 1.5% lump-sum bonus on all of their allowable charges for the year.

Source: David Glendinning, AMNews [5/26/08]

Exit Interviews Pay Off

When an employee voluntarily leaves your practice, be sure to conduct an exit interview. You can find out a lot about how your practice helped or failed to meet the employees expectations. This will help you access your practice’s strong and weak points from the perspective of a true insider.

Unnecessarily Aggressive Surgery to Treat Bunion (IL)

Facts: The plaintiff contended that the defendant podiatrist deviated from the required standard of care by selecting the Hohmann osteotomy that involved cutting through the right great toe bone completely to treat the plaintiff's mild bunion. The plaintiff further maintained that the defendant was negligent by advising her that she could place partial weight on the foot only four days following the surgery.

The plaintiff contended that based on pre-operative findings and X-rays, a Hohmann osteotomy was not indicated. There was no need to close the intermetatarsal angle, which measured a normal nine degrees. The plaintiff also contended that rather than elongate the first metatarsal relative to the second, as he purportedly set out to do, the defendant actually shortened it, as a result of the surgical procedure he chose. The plaintiff further maintained that the defendant negligently selected two threaded wires and an absorbable pin as methods of fixation, in conjunction with the Hohmann osteotomy, thereby leaving the right great toe in a most unstable condition.

The plaintiff contended that as a result of the negligence, she suffered a malunion of her right great toe, further shortening of that already shortened toe, a hallux elevatus deformity, in which the toe pointed upward, and the need to remove a joint in her second toe due to shortening of the first toe. Her right foot is now a size four and a-half and her left foot is a size six and a-half.

The plaintiff maintained that, despite consulting with over ten different doctors and undergoing six surgical revisions in her continuing efforts to have her right foot deformity and some residual sequelae corrected, she will permanently suffer pain, disfigurement, and disability. The plaintiff incurred $ 120,000.00 in lost income and $ 55,913.55 in medical expenses.

The defendant contended that plaintiff's intermetatarsal angle was abnormally large, that it warranted the Hohmann procedure and that the procedure was well-recognized and accepted. He further contended that if he had only shaved the bunion down that it was likely to return. He also contended that plaintiff contributed to her own injury by stepping onto a step ladder to paint and by dropping a hair dryer on her foot. The plaintiff would have responded that she only got up on the first step with her left foot, did not put any pressure on the right foot and that the hair dryer was a small, travel size dryer that she dropped onto the top of her foot, not onto any of her toes.

Result: The case settled, at mediation, shortly before trial, for $ 400,000.

Plaintiff's Expert: Harold Schoenhaus, DPM, Philadelphia, PA

Defendant's Expert: Louis A. Sorto, Jr., DPM, Chicago, IL

Source: National Jury Verdict Review & Analysis, Volume 23, Issue 2

Query: Good Samaritan Laws

I recently went on a cruise and a passenger who knew I was a podiatrist told the medical staff who asked me if I could treat a "small" infection on the foot as I was probably more qualified. I regrettably refused because I was not sure of my liabilities at sea and out of the state I practice. Did I handle this correctly? What are our obligations and are we covered under a "good Samaritan" law?

Samuel F. Ruggiero, DPM, Cheektowaga, NY

Editor’s comment: PM News does not provide legal advice. You certainly can’t be faulted for your decision. Not all jurisdictions have good Samaritan laws, and even existing good Samaritan laws vary. In general, these laws are designed to deal with medical emergencies, so the “small” infection in your scenario would likely not apply.

Query: KX Modifier

What is the HCPCS "KX" modifier used for?

Charleen Handzel, DPM, Southlake, TX

Response: The "KX" modifier is added to claims for equipment (represented by a HCPCS code) that once required a certificate of medical necessity (CMN), or for equpment that currently require a written order prior to delivery (WOPD), or for equipment which stipulates that certain documentation for coverage is contained in the medical records of the supplier.

For podiatric practices, the "KX" modifier is most often associated with equipment billed under the Therapeutic Shoes for Diabetic (TSD) Bill. Under the TSD, anytime one bills HCPCS A5500-A5513 codes, the "KX" modifier must be amended to any of these codes billed. In the case of the TSD, the "KX" modifier is required by statute. and stipulates that the supplier has the following information contained in the medical record:

1) A certification from the supervising physician (MD or DO only) which attests that the patient is under a comprehensive plan of treatment for their diabetes. 2) The certification attests that the patient has the required number of local podiatric manifestations. 3) The certification is signed by the MD/DO, and dated prior to the date of service of the supplies covered by the TSD Bill.

In the case of the TSD, do not mistake the "KX" modifier as an indication that the MD/DO was the referring physician. The referring physician is the one who actually writes the order or prescription for the shoes.

Paul Kesselman, DPM, Woodside, NY

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RE: Dermatological Treatment (Robert M. Gaynor, DPM)
From: Marc A Brenner, DPM

Treatment is second after diagnosis. I suggest a biopsy, a good medical history, then afterward possibly publishing an article on the treatment of this unusual condition.

Marc A Brenner, DPM, Glendale, NY, Icare4yourfeet@aol.com

RE: Orthotic Advice Sought (Edmond F. Mertzenich, DPM)
From: Robert S. Schwartz, C. Ped

High top shoes are often the best orthotic device for club feet. External shoe modifications such as lateral flares and wedges can also help. Although he doesn’t need flares and wedges on the right, high tops help provide proprioceptive and mechanical function. Evaluate the wear patterns on his shoes. It will identify the appropriate locations and angles for the modifications.

Robert S. Schwartz, C. Ped., Eneslow Pedorthic Enterprises, Inc., RSS@eneslow.com

RE: Pre-molded Orthotics (Matthew Richins, DPM)
From: Dennis Shavelson, DPM

At the time when surgical revenue is downwardly spiraling and the AMA/Foot Orthopod political agenda is to eliminate podiatry from performing foot surgery by attacking our training and value, I continue to promote the concept that the foot orthotic is the last place we want to use pre-molded devices. The Internet and other deliverers of OTC orthotics such as shoe and sporting good stores, ski shops, pedorthists, orthopods, chiropractors, and physical therapist are armed with the same products as us. Our DPM degree alone no longer justifies placing us on top of the biomechanical pyramid and the patients know it!

La Trobe's (Craig Payne’s work) recent articles prove that Root devices are no better than high-tech OTC devices, so of course Dr. Richins’ prefabs "work so well I get few patients who come back for custom devices."

There are a number of new biomechanics paradigms that address the flaws in Root theory and suggest new and fresh approaches and produce custom foot orthotics that are shorter, narrower and more arched than Root-type devices. New examining, casting, and prescribing techniques have been developed. New language and marketing brochures and presentations explain biomechanics in a more understandable and acceptable light.

I predict that those DPM's that acculturate beyond Root will once again find themselves in the limelight that Root gifted to us 30 or more years ago (that we have let fade) and that functional lower extremity biomechanics will once again put podiatry on the map when it comes to skills, acumen, and success.

I am the medical director of The FootHelpers Lab, the home of Neoteric Biomechanics, one of these new paradigms, but there are others to chose from as well.

Dennis Shavelson, DPM, The FootHelpers Lab,drsha@foothelpers.com

RE: 10 Year Sentence for Investment Advisor Who Defrauded Podiatrists
From: Robert M. Conenello, DPM

The events surrounding the Jeff Lafferty case have severely compromised my family's life. Although part of the sentencing agreement calls for full restitution, Mr. Lafferty has absolutely zero assets. The case is even more complicated in the fact that his business partner, Vincella Ross, who was present at multiple podiatric seminars, has decided to take her case to trial.

I can only hope that my story can help protect other young podiatrists. As I have unfortunately learned, in many instances “so-called” experts have had absolutely no background checks. Do not rely on organizations to always present credible presentations.

Robert M. Conenello, DPM, Orangeburg, NY, rmconenello@aol.com

RE: Conflicts of Interest (Lloyd S. Smith, DPM)
From: Elliot Udell, DPM

The Talmud teaches us never to take gifts when rendering judgment. Gifts blind the eyes of the righteous. I never fully understood what this meant until I would see some of our finest practitioners act like pit bulls on line in the defense of some pharmaceutical product they were being paid to lecture on. Lo and behold as soon as the product went generic and the company no longer sponsored them as speakers, you never heard a peep out of these doctors regarding the product they touted. Money has a way of making a person truly believe in the merits of the product and I truly belief that these doctors are inherently honest people.

Receiving an honorarium from a drug company is only the tip of an iceberg. Doctors are among the most bribed of all professionals. Could you imagine what an uproar there would be if judges in our courts were to get free samples, free lunches, or trips from plaintiff or defense attorneys?

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

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

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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