May 27, 2006 #2591 Editor-Barry Block, DPM, JD

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CA DPM Instrumental In Israeli Fellowship Program

As the medical field continues to grow in Israel to meet the demand, one organization has remained a cornerstone in helping develop specialized physicians. The non-profit American Physicians Fellowship was created in 1950, and is dedicated to advancing medical education, research and health care in Israel. Bay Area residents have long been involved. Dr. Paul Scherer, a member of the executive board and a San Francisco podiatrist, first became involved with APF in 1985.

APF began offering fellowships and educating Israeli doctors, a move that eventually worked out better than planned. “The fascinating part about the fellowship is that now a great many heads of the medical departments in Israel are past APF fellows,” Scherer said. “It turns out it worked. Who knew?” Fellows generally study in the United States for one year, bringing with them their family in hopes of learning more and bringing back their new expertise to Israel.

When Scherer developed a podiatry program in Israel in the mid-1980s, he said that at that time, there was a need for foot doctors. “Foot care was sort of falling through the cracks in Israel. At a time when type 2 diabetes was a national epidemic in Israel, and it has a primary pathology in the foot.”

“The fellowship program provides access to the American academic medical community to Israeli physicians,” Scherer said. “And that’s huge.”

Source: Jennifer McLain, Jewish New Weekly of Northern California [5/25/06]

IN DPM Urges Adoption of School Drug Testing Policy

Porter Township Schools took another step Tuesday to creating a drugs testing policy. Valparaiso podiatrist Mann Spitler told parents at Boone Grove High School the harrowing story of his daughter's death from heroin addiction four years ago.

Be aggressive and drug test your kids, Spitler urged.

Source: Brian Williams, Northwest Indiana News [5/24/06]

Comparing Payers

Physicians Practice, a business magazine for doctors, used billing tranactions data from Athenahealth, a claims processing company, to determine how efficient insurance companies are in processing charges sent in by physicians. Data is from the 4th quarter of 2005.

Average days from the date of service to the date of payment

Humana - 29.0
Aetna -31.6
Medicare - 34.4
Cigna - 36.2
WellPoint - 36.8
UnitedHealth - 37.4
Champus/Tricare - 41.1

Charges that were paid in full when first submitted

Medicare - 92.0
UnitedHealth - 89.1
Humana - 87.7
Aetna - 86.7
Cigna - 86.6
WellPoint - 86.3
Champus/Tricare -85.1

Source: NY Times via Physicians Practice

Query: Tattooing Of Nail Bed

I have a patient who several years ago had phenol matricectomies, successfully removing her pedal nails. She is now asking if it would be safe to have her nail beds tattooed. Does anyone have any experience with this?

Paul R. Shonka, DPM, Santa Rosa, CA, Shonka@sonic.net

Query: Sharp Shape Scanner

I am considering getting a Sharp Shape scanner in my office for “impression casting” for foot orthoses. Does anyone have any experience with this brand as regards to usability, accuracy and reliability? My lab says it is all of that, and that many labs can accept the files generated by this scanner. I am aware it will not save time or money per se, but it will free up my assistant for other tasks making my office more productive – I hope.

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

Query: Multiple Fracture Sites - One Metatarsal

If the patient has a fracture of the second metatarsal both at the shaft and at the base, should the open treatment be billed asCPT 28485 (open treatment of metatarsal fracture, with or without internal or external fixation, each) or CPT 28485 x2 or CPT 28485-22?

Angela Gottbreht, CMC, CCP, Everett, WA

Response: I would agree with your first consideration: billing the repair as CPT 28485 (open treatment of metatarsal fracture with or without fixation). This code would include the management of both fractured locations of the same metatarsal.

Howard Zlotoff, DPM, Camp Hill, PA

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contact Harry Goldsmith, DPM at hgoldsmith@codingline.com

RE: Stark II Warning
From: Dan DeSena, DPM

Last tax season my partners and I were surprised to discover the Stark II legislation dictates the way we distribute some of our income. In numerous discussions with colleagues, it seems that podiatrists are not generally aware that they may be subject to $15,000 fines per violation for improperly allocated income from Designated Health Services (DHS). This income includes x-rays, diabetic shoes, AFO’s, etc.

According to our tax attorney and accountant, Stark II requires doctors in these practices to identify and isolate income derived from all Designated Health Services (DHS) revenues. DHS revenues include income derived from diabetic shoes and inserts, Air Casts, AFOs, night splints, x-rays, etc. Surgery and office visits are not considered DHS revenue.

Next, this DHS revenue must be disbursed to the partners according to either of two formulas:

1. It may be divided equally, or
2. It may be divided on a prorated basis based on the percent of revenue received by each partner for all non-DHS services (surgery, office visits, etc.).

For example, lets take the case of two doctors who have a partnership; one has a surgical practice and provides no DHS services. The other has a more general practice which includes DHS services. Let’s say that after the DHS revenue is identified and subtracted from the gross revenue, the surgical doctor generates 70% of the combined practice income. Let’s say the second doctor generates $100,000 per year in DHS services. This $100,000 must be split equally between the two doctors, or the $100,000 may be split 70:30 ($30,000 to the doctor who actually generated the revenue).

Failure to distribute revenue this way puts the practice at risk for civil penalties up to $15000 for each service rendered and potential exclusion from Medicare.

Dan DeSena, DPM, Portland, ME, desena@solsticecorp.com

RE: EMR (Bruce Krell, DPM)
From: Frederick R. Fischer

When installing an EMR system you have a choice of either wireless or hard wired interface. A popular choice is wireless tablets because of the flexibility and lower cost than hard wiring. This may not be the best decision in the long run. The chances are that if you are going paperless with EMR you will at some time in the future wish to change from film and chemistry to digital imaging. It is most desirable to be able to show the x-ray images to the patients in the treatment rooms.

Because EMR systems are transmitting relatively low amounts of data, wireless works well. Digital images, however, are extremely data rich so that in many cases delays and even incomplete transmission is possible. It may be a better long term decision to install your EMR with a hard-wired system from the beginning even though that will increase the up front cost.

Frederick R. Fischer, Vice President, ALLPRO Imaging,

ffischer@airtechniques.com

RE: Periodic Medical Exams of Diabetics By Podiatric Physicians (Ken Malkin, DPM)
From: Hal Ornstein, DPM

Performing a comprehensive diabetic foot evaluation (CDFE) is an excellent opportunity to help market your practice and strengthen your relationships with primary care physicians and endocrinologists. We have been performing these for a few years and always forward a copy of the report to their primary care physician and their endocrinologist with a cover page explaining that we perform this exam annually to provide the highest quality of care and thoroughly access their lower extremity as well as reinforcing diabetic foot education. Another benefit is that your patients will appreciate your thorough nature and the comprehensive care you and your staff are providing.

Be sure to explain that you are performing this annual exam to deliver the highest quality of care and focus on keeping their feet healthy. Kudos to my colleague from my home state of New Jersey, Dr. Ken Malkin, for continually working to keep our profession ahead of
the curve and also Dr. Scott Kantro for educating our colleagues about the importance of performing CDFE's.

Hal Ornstein, DPM, Chairman, AAPPM, toetoe@optonline.net

PS. Great job on the new format for PMNews. It's very reader-friendly and the color format is awesome!

POSITION WANTED - NEW YORK

Non surgical podiatrist with 20 years experience is seeking practice opportunity 1-2 days/wk. ABPOPPM board certified, own malpractice insurance, many insurance plans. Please call (516) 557-6862 or e-mail Joelme@aol.com

EQUIPMENT FOR SALE - ESWT

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.ASSOCIATE

WANTED - NORTH CAROLINA

Growing practice in beautiful western North Carolina seeking qualified DPM. Great mix of office and surgery center care. Must have NC license and ABPS qualified/certified. Send cover letter and CV to dpmcareer@aol.com

POSITON AVAILABLE - WASHINGTON, DC

The George Washington University Medical Faculty Associates, a large multi-specialty practice affiliated with a teaching hospital, is seeking a full-time podiatrist. The practice has a diverse population encompassing inpatient and outpatient surgery, as well as a thriving outpatient clinical practice. Must be board certified/board eligible and have experience in diabetic limb salvage. Send CV to cdugan@mfa.gwu.edu or fax to (202) 741-2241.

ESWT MACHINE FOR SALE

I have a DolorClast shockwave machine for sale 60% of cost, call 416-545-1166 or dracula65@hotmail.com Thank you

PRACTICE FOR SALE - NEW YORK

FOR SALE - Rockland County. Well established, high-volume practice, general and surgical. Gross $500K, hospital privileges; excellent lease. All interested parties reply to: metroNYCpodiatry@aim.com

ASSOCIATE WANTED - NEW YORK

Associate Wanted - Rockland County, Rockland County. Associate with minimum 5 years experience, high volume established general practice. Reply with CV to nypodiatry111@aim.com

ASSOCIATE POSITION RICHMOND, VIRGINIA AREA

Partnership possible after two years. Two office practice. Palliation; biomechanics/orthotics; woundcare; office/hospital surgery. Must have Virginia license. Associate will do most of the
practice’s surgery. PSR24/36/Board qualified/certified in surgery preferred. Available SAP. Send CV to: Dr. Marc Jay Pinsky; 9550 Midlothian Turnpike; Suite 104; Richmond, VA 23235;
mjpinsky@juno.com ; FAX: 804-320-6627.

ASSOCIATE POSITON – TAMPA BAY, FL AREA

Two associate positions presently open with a large podiatry group in the Tampa Bay area. Salary and benefits are commensurate with applicant’s qualifications. This is an excellent opportunity for a new practitioner to join a strong, existing group with extensive
hospital affiliations and referral patterns. Two-year residency and Fl license preferred. zachander@aol.com Fax 813-286-0200 Ph 813-334-2077

ASSOCIATE POSITION – TEXAS

Mature 3 DPM general podiatry and surgery practice in the Rio Grande Valley of Texas is seeking a DPM to fill an Associate position, partnership will be considered after a period of 2-3 years. Applicants should have at least 2 years of residency training and enjoy diabetic foot and wound care. Diverse patient populations. (VA, Community Health Clinics, Hospitals and 3 offices) Good practice environment in hospitals and community. Salary, bonus and benefit package offered. Interested DPMs should send a letter of intent along with a current C.V. to Complete Family Foot Care, 812 Lindberg Ave. McAllen, TX 78501. Fax 956 971-9109

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

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