The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 06, 2007 #2,954 Editor-Barry Block, DPM, JD

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Less Sturdy Soles Mean Increased Puncture Risk: SC Podiatrist

Just about anything can find its way into your foot if you're not careful. Dr. Stuart Tessler, a Charleston podiatrist who also teaches at the Medical University of South Carolina recalls removing a chicken bone from someone's foot after his dog had chewed it ragged. Ever stepped on a nail? A shard of broken glass on the beach? The mere thought of these wounds should send you scurrying to check if you're due for a tetanus shot. The nervous-system disease is caused by a bacteria found in dust, soil and manure, and a puncture wound anywhere on your body can put you at risk. You were most likely vaccinated as a child, but you need a booster shot every 10 years. Foot wounds also can create a highway for other bacteria to catch a ride into your body.

Dr. Stuart Tessler

Tessler says shoe soles are made of less sturdy materials these days —not the leather-soled clunkers your grandparents wore to hike uphill both ways to school and back — so even wearing shoes is no guarantee of safety. Sometimes, he says, bits of shoe and sock material can get stuck inside a puncture wound. In all cases, you'll need a visit to a doctor to have the wound properly cleaned. If it turns red or begins to drain, that could be a sign of infection that requires antibiotics

Source: Holly Auer, The Post and Courier [6/4/07]

SC Podiatrist Hopes More Women Will Assume Leadership Positions

Dr. Michelle Butterworth, a Kingstree, SC podiatrist, said many of the most common summertime foot ailments are entirely preventable. “The biggest thing is when warm weather comes, everyone switches to sandals, and I see a lot of heel pain,” she said.

Dr. Michelle Butterworth

Butterworth speaks on the subject with authority. She has offices not only in Kingstree, but in Lake City and Manning, and she recently joined the American College of Foot and Ankle Surgeons (ACFAS) as a member of the board of directors. She said the selection process was rigorous and she is honored to have been chosen.

Butterworth expressed amazement that a podiatrist from the small town of Kingstree had been selected to such a position. She said she hopes to continue the trend of more women becoming involved in the profession, especially in positions of leadership.

Source: Jamie Durant, WJBF-TV, Augusta (GA) [6/2/07]

NYCPM Commencement Address Delivered by James Tallon, Jr.

James R. Tallon, Jr., President of the United Hospital Fund of New York, delivered the keynote address to the graduating class of the New York College of Podiatric Medicine (NYCPM) and received an honorary degree of Doctor of Humane Letters-Honoris Causa, during the College’s 96th Commencement Ceremony.

James R. Tallon, Jr., President of the United Hospital Fund of New York, delivering the keynote address to the graduating class of the NYCPM

Louis L. Levine, President and Chief Executive Officer of the College, presided at the commencement ceremony. Mr. Tallon addressed the 69 graduating seniors—who received their Doctor of Podiatric Medicine degrees—and an audience of nearly 1,000 faculty members, parents, family and friends. In addition, S. William Sigler, business executive, entrepreneur and Treasurer of the NYCPM Board, and Thomas V. Taylor, M.D., Clinical Director and Academic Chief of Surgery at St. Joseph Medical Center in Houston, were also awarded honorary degrees.

Mr. Tallon told the graduates that “your knowledge, your service to your patient, and your rigorous dedication to quality and improvement are at the center of any efforts our society undertakes to improve health care.” He concluded by saying, “the new era of health care in America will depend on the engaged, informed patients’ understanding and taking part in the prevention of illness and injury and linking their behavior with their care. That’s where the new professionalism takes center stage, and podiatry will be in the mainstream of that effort.”

Query: Increase in 5th Met Fractures?

In the last four to five years I am seeing an exponential increase in fifth metatarsal fractures. I saw four new ones last week and it was a three-day work week. This in not because of a difference in referral patterns, e.g., more ER/ED referrals than in years past. Is this increase in fractures common to other practices?

Michael DiGiacomo, DPM, Oakland, CA

Query: Medicare Advantage

I am a participating provider in regular fee-for-service Medicare. We are, however, having difficulties with untimely, incomplete payments from Humana Medicare (Medicare Advantage plan) - I have already complained to CMS in writing about this.

If I am not contracted with "Humana" Medicare, am I REQUIRED to accept Humana payments for their contracted Medicare patients, or can I simply bill those patients Medicare allowables for services I render, and let them wrestle with Humana for payment?

Mark K. Johnson, DPM, West Plains, MO

Response: Generally, people are entitled to Medicare benefits through their employment (SSA and Medicare deductions), and are enrolled in the Medicare program through the payment of a Part B premium.

There are now 4 parts of Medicare - Part A or Hospital Insurance, Part B or Medical Insurance, Part C the Medicare Advantage (MA) Program and Part D the Prescription Drug Program. Medicare beneficiaries who choose to enroll in Part C still pay a Part B premium (unless the MA plan pays it for them). They have NOT "signed away their Medicare benefits"...they have chosen to have them administered by a Part C plan.

Part B has payment rules--so does Part C. It's payment rules are fairly relaxed--it's an indemnity plan of sorts. You don't file claims with CMS--you file them with a private insurer that CMS has contracted with to administer those benefits.

Since Medicare Advantage patients have not relinquished their Medicare benefits or entitlement, they are still Medicare beneficiaries. They are simply enrolled in a different plan under Medicare. Hence, they remain protected by the law--and you, as a provider of Medicare services (albeit not a contracted Medicare Advantage provider), remain bound by the law governing Medicare.

Should you see an MA member out of plan, and you have an agreement with them in advance to pay cash, you can't charge a penny more than you could if they had original (regular fee-for-service) Medicare coverage, period. Your participation agreement (if you're Par with Medicare) says that you won't charge more for services to a Medicare beneficiary (and those MA members are still that) than the fee schedule allowance. If you're non-Par, the law says you can't charge a Medicare beneficiary more than the limiting charge. There's nothing in the law that says if they join an MA plan the law is null and void.

Stacey Hernandez, CCS-P, Placentia, CA

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