The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

June 08, 2011 #4,181 Publisher-Barry Block, DPM, JD

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IN Podiatrist Urges Common Sense When Wearing High Heels

No doubt about it: High heels look great. A pair of 5-inch stilettos can lengthen the legs, thrust the hips forward for a sexier silhouette and turn any woman into a statuesque beauty. But at what cost? Despite any problems associated with high heels, Dr. Jeffrey Agricola of Prestige Podiatry in Carmel, IN does not want to tell any of his patients what shoes they can and cannot wear. 

Dr. Jeffrey Agricola

"We don't condemn the shoes," he said. "We just try to accommodate the shoes. It mentally takes a toll when a person can't wear the cute shoes they're excited about." Wearing high heels can be done as long as common sense is involved. Think about how long high heels will be worn, and what activities will be done in them.

Source: Jenny Elig, News-Leader.com [6/6/11]

We've just mailed the June/July 2011 issue of Podiatry Management. This 252-page special issue includes our cover story, "Super Groups: The Future of Podiatry" by  Dr. Jon Hultman. You'll also find a roundtable discussion, "Student Debt and Podiatry" as well as an assortment of features, including our informative columns, and a CPME-approved CME. 

June/July 2011 Podiatry Management

Michigan Law Trumps HIPAA in Patient Privacy Case

Legal experts say a Michigan court ruling over disclosing patient names places tighter restrictions on what information physicians can release during legal proceedings. The case stems from a 2009 lawsuit filed by Howell, MI-based podiatrist Isidore Steiner, DPM, of Family Foot Center against podiatrist Marc Bonanni, DPM, alleging that Bonanni "stole" patients in violation of an employee agreement, court records show. His contract prohibited him from soliciting patients if he left the practice.

During discovery, the center requested that Bonanni disclose the names, addresses, and telephone numbers of all patients treated at his new practice since he left the center. Bonanni objected, arguing that the disclosure was protected by state and federal patient privacy laws. An appellate court ruled that the plaintiffs were not entitled to the patient information because Michigan law pre-empts HIPAA. The court said HIPAA applies only if there is not a more stringent state law related to patient privacy.

Source: Alicia Gallegos, amednews.com [6/6/11]

Drug Product Recall Due to Possible Penicillin Contamination

A voluntary recall of multiple repackaged products is underway because of a potential cross-contamination of non-penicillin drug products with penicillin products, according to a safety alert from the U.S. Food and Drug Administration (FDA). Aidapak Services and the FDA notified healthcare professionals and hospital pharmacies of the recall in an announcement this week through the FDA's MedWatch Safety Information and Adverse Event Reporting Program.

According to the alert, there is the "potential for serious anaphylactic reaction in patients with known hypersensitivity to β-lactam or penicillin products that could result from using these recalled products."

Source: Emma Hitt, PhD, Medscape News [6/3/11] via Dr. Paul Kesselman

Lead Others to Think Critically

Help another person think through difficult issues or prepare for critical events, even if you lack expertise on a particular subject. Simply reflect back without pretense what you hear. Consider these examples:

• “You sound uncomfortable with that idea. Are you?”
• “From what I know of you, you tend to be cautious. Are you being overly cautious in this situation?”
• “My sense is that you can trust him. Is there anything making you feel otherwise?”
• “There’s something that doesn’t ring true. Can you clarify the situation a bit more?”
• “From what I’ve heard you say, your confidence seems justified.”

Source: Adapted from The Courageous Follower, Ira Chaleff, Berrett-Koehler Publishers Inc., via Communication Briefings

Query: Botox for Dorsal Contracture of the MPJ

I have a 60 year old female patient with significant MS symptomatology who is non-ambulatory. She was seen in my office for a painful hallux/first MPJ. There is dorsal contracture of the MPJ, and the patient has constant pain. The joint is reducible with gentle pressure. A splint that I made for her does help somewhat. Does anyone have any experience using Botox for a condition like this. If so, please explain.
 
Brian Kiel, DPM,  Memphis, TN, footdok4@gmail.com

Query: MicroVas Therapy Coding

I just started using MicroVas therapy for my patients. I use it to treat neuropathy, fibromyalgia, and chronic non-healing ulcers. How does one code the therapy? Is anyone familiar whether or not New Jersey payers (e.g., Medicare and others) reimburse MicroVas as used to treat the conditions above?

Jonathan Michael, DPM, Succasunna, NJ

Response: Highmark Medicare does not specifically mention MicroVas in its policies. However, a review of their LCDs does not reveal a code for the therapy services you are listing. I would bill the therapy as CPT 97139 (unlisted therapeutic procedure [specify], and have your patients sign an advance beneficiary notice (ABN) understanding that they, in all likelihood, will end up paying for the treatment out of pocket.

You would check with the payers you deal with regarding coverage. A number of payers will not reimburse MicroVas therapy. For example, HealthNet "considers MicroVas investigational and therefore not medically necessary for any indications because there is insufficient peer-reviewed evidence to support its efficacy and safety."

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here
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RE: MRI Evaluation of Recurrent Soft Tissue Mass (Peter Bregman, DPM)
From: Bryan C. Markinson, DPM

Dr. Bregman's advice for Dr. Wu regarding the recurrent soft tissue mass needs some refining. Firstly, he recommends excisional biopsy with frozen section. I hope he meant open incisional biopsy with frozen section, as excising the lesion makes any frozen section moot, and (if malignant) may leave the patient with a bed of resection with no identifiable margins. That can be disastrous. Open incisional biopsy with frozen section and CLOSURE (leaving the rest of the lesion behind) of the wound if frozen reveals a malignancy and is the best way to go.

I would never "prepare" the patient for a partial amputation at the time of this surgery because before any further resection or ablative procedures are done, the patient must be staged. Imagine amputating part of a foot when the tumor is seeded in the lungs and/or liver or elsewhere, not known because a podiatric surgeon thinks removing a lesion is all there is to it. Some malignancies are treated with chemo and or radiation before they are excised.

The management of malignant soft tissue tumors, after the expert diagnosis by a podiatrist as outlined above, is the domain of the musculoskeletal oncologist.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: CPMA Works With CMA and COA to Achieve M.D. License Parity
From: Michael J. Cornelison, DPM

Here is the “joint announcement,” agreed upon between leadership of the California Podiatric Medical Association, the California Medical Association, and the California Orthopaedic Association, as of March 18, 2011. This should make very clear the intention of our Task Force as mentioned in the article appearing in the June 5 edition of the Sacramento Bee:

“The California Medical Association (CMA), the California Orthopaedic Association (COA), and the California Podiatric Medical Association (CPMA) have agreed to launch a joint task force to evaluate the education and training of future graduates of California podiatric schools, with the goal of preparing these students to have the education, training, and certification that would allow them to be licensed as physicians and surgeons in California. The agreement includes an understanding that the California podiatric schools would be expected to be accredited by the Liaison Committee on Medical Education (LCME).”

Michael J. Cornelison, DPM, President, CPMA, drcornelison@sbcglobal.net

RE: Audits, Legal Actions May Net Up to $3.4 Billion: Inspector General
From: Jon Purdy, DPM

These reports really get my blood boiling. Again, our government tries to cast the physician as the villain and the IOG as the hero watchdog for the general public. And again, the public perception is skewed as they receive only one side of the story.

Someone please tell me what is fair and balanced about medical audits? The auditor can go back many more years than the provider is allowed for self-audit and claim adjustment. During an audit, the provider is penalized without ever having the chance for offsets determined through claims that were under-billed, billed improperly resulting in a loss to the physician, not billed at all, or lost in cyberspace transactions. There are many more inequities that are too lengthy to go into.

There was one report done many years back that looked at the error rate in hospital claims submission. The study found that a large percentage were billed improperly, and of those identified mistakes, about fifty percent were overpaid and fifty percent were underpaid, resulting in a net zero balance.

I have always maintained that if investigative audits were done in a fair and balanced manner, we would see that physicians routinely underbill because of fear or ignorance. Coupled with claims processing errors, the auditors would typically find themselves in a net zero audit. Why doesn’t someone propose that legislation so the public doesn’t feel bilked, the physician doesn’t feel impugned, and we can all get some sleep.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: LA Podiatrist Testifies Before Congressional Committee on Health IT (David Gurvis, DPM)
From: Michael L. Brody, DPM

I would like to take the opportunity to address some of the issues that Dr. Gurvis raises.

First, he states that the EHR programs do not speak to each other. As of today, the EHR programs are capable of speaking to each other and are capable of speaking to hospital systems. As of today, they are not required to speak to each other for us to achieve meaningful use.

For Stage 2 of meaningful use, we will be required to connect our EHR software to...

Editor's note: Dr. Brody's extended-length letter can be read here.

ASSOCIATE POSITION - NYC

Opportunity of a Lifetime. Are you the one-in-a-million podiatrist I’m searching for? Do you aspire to greatness? If you have a great smile, great attitude, take initiative, then you should consider this exceptional opportunity. I am seeking a smart, residency-trained podiatrist with great surgical skills to become an associate in one of the top practices in the country. Don’t miss out on this outstanding opportunity! Please email your CV to institutebeaute@aol.com with “Attn: Sophia Johnson” in the subject line.

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

ASSOCIATE POSITION - ILLINOIS PERMANENT P/T

Podiatrist needed for Medinah Spine/Rehab/Podiatry. Upper middle class suburb multi-disciplinary established office seeks perm P/T podiatrist to service established podiatry practice. Please call SueL 630-529-0077 or fax resume to: 630-529-0087.

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Seeking personable, ethical, motivated individual for a growing, well-rounded practice with potential for partnership. Must be PSR 24-36 trained. Competitive salary, incentive and benefits. Email CV to orin915@comcast.net

ASSOCIATE - POSITION- SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE POSITION - CANADA

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311

ASSOCIATE POSITION - CENTRAL NORTH CAROLINA

Well-established, busy podiatric practice is seeking highly motivated, well-trained and personable associate for full-time position. Competitive Salary and Benefits, Buy-in Opportunity. Interested persons must be actively pursuing or have NC license. Send resume and letter of intent to gpagpa530@yahoo.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Southern California practice looking for highly motivated podiatrist for very busy, two location practice. Excellent salary and benefits offered. Please email resume to mrsmcmackin@aol.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM
 

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com 

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is 130K on 2 half days per week. Practice is expandable to full time with increasing hours and marketing. Real estate available for purchase. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - NORTH DALLAS, TX

PRACTICE FOR SALE- HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. softechpodiatrist@gmail.com
 

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