The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 31, 2007 #2,949 Editor-Barry Block, DPM, JD

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Flip Flops and Sandals Can cause Plantar Fasciitis and Sprains: PA Podiatrist

Flip flops, sandals and strappy little shoes may be the look of summer, but while they're cool and comfortable they may not be good for you feet. Dr. Mallory Eisenman, a podiatrist, says one foot problem that can flare up in the summer is plantar fasciitis. “Which is an inflammation along the bottom surface of the foot - a band of tissue that connects from the ball of the foot to the heel,” she said. “What happens is that band of tissue becomes strained and inflamed.”

Dr. Mallory Eisenman

Dr. Eisenman adds that the strain occurs because muscles in your foot have to work too hard to keep the shoe on. Plus, flats can cause more strain because tissue in the foot is accustomed to a slight elevation of the heel. Foot stretches are the best way to both treat and prevent plantar fasciitis, Eisenman says. Also, make sure the sole of a sandal isn't too flexible.

Another danger linked to backless sandals is that they are easy to fall out of. “Once that happens it leads you to either a lateral ankle sprain, you can lead yourself to even a stress fracture or a fracture of the ankle bone,” she adds. And while they might not be the prettiest, Eisenman says that the sandals with the most support are the best for your feet.

Source: KDKA (Pittsburgh, PA) [5/23/07]

Financial Measures for the Medicare DME,Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

The Centers for Medicare and Medicaid Services (CMS) released today the measures that will be used to evaluate the financial stability of suppliers that bid under the new Medicare DMEPOS Competitive Bidding Program. All bids must include certain financial documentation in order for the supplier to be considered for a contract under the program. CMS and its Competitive Bidding Implementation Contractor (CBIC) will evaluate each bidder's financial documentation to determine whether the supplier will be able to participate in the program and maintain viability for the duration of the contract period.

CMS and the CBIC will calculate each bidder's financial ratios using the financial information submitted as part of the bid. CMS and the CBIC will also be utilizing the supplier's credit history in evaluating the financial health of the supplier.

The Centers for Medicare and Medicaid Services (CMS) is now soliciting bids for the first round of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. All bids are due by 9:00 p.m. prevailing Eastern Time on July 13, 2007. The contract period for mail order diabetic supplies is April 1, 2008 – December 31, 2009. The contract period for all other first round product categories is April 1, 2008 – March 31, 2011.

For full details see: http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/

Source: CMS via Paul Kesselman, DPM

Obama Calls For Universal Health Coverage

Sen. Barack Obama (D-IL) called upon the federal government, the business community and American citizens to take the lead personally and financially as key ways to promote universal health coverage. In Iowa City, Iowa, today, Obama outlined his blueprint for universal healthcare by saying that he would eliminate tax cuts favored by the Bush administration while banking on the added efficiencies and cost savings afforded by higher quality of care as ways to pay for his roughly $65 billion per year health program, according to the Associated Press.

Obama said his plan, which keeps the private insurance system intact but in a heavily guarded way, would save the average consumer $2,500 a year. Under the presidential hopeful’s plan, a national health insurance exchange would be created to monitor private insurers in offering the coverage. People who can’t afford coverage would be subsidized according to income. Virtually all business would have to share in the cost of coverage for their workers, the AP reports.

Source: Matthew DoBias, Modern Healthcare [5/29/07]

Query: Archiving Records

Our office has recently moved to an EMR and would like to archive the last 10 years of paper charts. Does anyone know of a company that will come in, high-speed scan all of my charts, and then dispose of the paper in a HIPAA-compliant way?

Marybeth Crane, DPM, Grapevine, TX

Editor’s comment: PM News does not provide legal advice. What you are proposing is probably a very expensive proposition. The first issue is how far back you want to archive. Most experts recommend seven years, which should save you 30%.

You may be better off renting a high speed scanner (basically an advanced copy machine) and having your office staff input charts. You can then hire a a HIPAA-compliant firm to shred and dispose of the charts.

Query: Capsulitits Injection

What are the most appropriate procedure and diagnosis codes to use when injecting the 2nd metatarsal-phalangeal joint for capsulitis?

Lani Smith, Office of Kash Siepert, DPM, Roseburg, OR

Response: I would recommend using CPT 20600 for injection/aspiration of a small joint.

As far as the diagnostic code, ICD-9 726.90 describes a capsulitis NOS. Since this code is labeled NOS (not otherwise specified), if there is a more accurate condition/code (e.g., synovitis, arthritis, etc.), be sure to consider it.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Possible Parasite in Foot (Ira Weiner, DPM)
From: Multiple Responses

This is a situation where an in office sonogram can be very helpful. If there is a live parasite, it can be located under ultrasound guidance and excised, and sent for pathology. I would not let it sit there, especially if you see it migrating. If you are not comfortable, refer the case to an infectious disease specialist.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

Over the years I've had several patients with "creeping eruption" (larva migrans). I found spraying with ethyl chloride seemed to kill the parasites with one application and they were immunologically absorbed. Just a thought IF that's what the critter is.

Robert K. Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net

It sounds like Dr. Weiner's patient may have creeping eruption also known as cutaneous larva migrans. Treatment is thiabendazole (Mintezol - Merck) 25 mg. BID for two successive days. A second course may be given after two days. It may also be used topically. Also effective is freezing the larva with ethyl chloride. Spray for 30 to 60 seconds.

Mike Boxer, DPM, Woodmere, NY, macdpm@aol.com

Please refer to these two articles. Read the second before dismissing the Botfly.

http://www.vexman.com/botfly.htm
http://discovermagazine.com/1999/sep/beastsinthemist1682

Rick E. Sevier BS Ed. C. Ped., Catoosa, OK

I remember treating a Nigerian pilot who contacted a Guinea worm disease and as an alternative to the medicine that CDC suggested I use, Flagyl was considered the alternative drug. The drug proved to be successful.

Dan Klein, DPM, Fort Smith, AR, TOEFIXER@aol.com

OFFICE TO SHARE AND RENT PLAINVIEW LONG ISLAND (SOUTH OYSTER BAY RD.)

3 treatment rooms, JACHO certified operating room, MRI extremity unit and x ray equipment on premises, turn-key operation -no investment- call 516- 4761815 or email podo2345@aol.com

ASSOCIATE POSITION – CALIFORNIA

Permanent associate position for very busy Southern California, two office practice. We offer a competitive salary, bonus plan, and fully paid benefits. Good surgical training is a must, and experience is a plus. Please fax CV to (909) 796-3709, or call (909) 227-5393.

ASSOCIATE POSITION – MISSOURI

One of our longterm associates needs to relocate due to family reasons. Step immediately into full schedule. Partnership available after 2 years and board certification. Missouridpm@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE PODIATRIC SURGEON – TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas . Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

FOR SALE - EQUIPMENT

Boyd chairs, mini x-ray floor unit, Konica developer, ultrasound,Ellman surgitron, Imex 9000, Ille whirlpool, viewboxes, SmartDop, topical oxygen units, office furniture, etc. cast saw, lakeside carts, parafin wax bath, hand instruments. Contact jhallux@yahoo.com or fax (703) 264-7745 for full list.

PRACTICE FOR SALE WASHINGTON, DC

Hospital based 25 y/o practice, Billing 400k/yr/gross 285+. Four tx rooms fully equipped. X-ray, US, THBO, vascular testing. Loyal patient base, Wound care, diabetes, all aspects of surgery. Hospital priviledges. Seller very motivated to move fast. Relocating - $125k (OBO). Contact jhallux@yahoo.com or fax: (703)264-7745.

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA

Associate leading quickly to Ownership Wonderful opportunity to join Kaiser trained podiatrist in a well established, ethical, full scope podiatric practice. Competitive compensation Most be BE/BC Send CV and references to: reversoman@aol.com

ASSOCIATE POSITION – MISSOURI

One of our longterm associates needs to relocate due to family reasons. Step immediately into full schedule. Partnership available after 2 years and board certification. Missouridpm@yahoo.com

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