The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 11, 2007 #2,958 Editor-Barry Block, DPM, JD

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NYSPMA Bars Expert Witness Testimony by BOT Members

The 111th Annual Meeting of the New York State Podiatric Medical Association (NYSPMA) was highlighted by the passing of a resolution which reads that "any member of the Board of Trustees of NYSPMA may not be involved as an expert to review or testify as a plaintiff’s expert in any malpractice action involving a member of NYSPMA and further resolved that the Foundation for Podiatric Medicine be urged to adopt a similar policy."

The rationale behind this groundbreaking resolution is podiatric leaders are elected to serve the best interests of members, and by accepting plaintiff’work, they would in conflict of interest to that fiduciary duty.

NYSPMA Elects New Officers and Trustees

The following officers and trustees were elected at the 111th Annual Meeting of the New York State Podiatric Medical Association (NYSPMA):

President- Robert Rampino, DPM
President-Elect – Roy DeFrancis, DPM
Vice President – Mark Schilansky, DPM
Treasurer – Robin Ross, DPM

Board of Trustees
William Spielfogel, DPM (re-elected)
Andrew Shapiro, DPM (re-elected)
Wilma Hunt-Watts, DPM (new)

Compliance Risks Grow With Electronic Medical Record Systems

Physicians love electronic medical record (EMR) templates because they make documentation faster and easier, but abuses, such as cloning and "exploding" notes, are jeopardizing reimbursement and compliance, experts say. If too much information is replicated from one EMR to the next, there is little to distinguish patient encounters, and that undermines physician attempts to establish medical necessity — the foundation of Medicare reimbursement — and perhaps implicates quality of care.

While CMS has not taken a position on templates, the agency has conveyed that they are meant to prompt physician documentation, not do the lion's share of it. Medicare carriers, meanwhile, have been warning against cloning for years, saying claims supported by cloned documentation will be denied unless medical necessity is established independently. A cloned chart in isolation looks great, but line up 10 charts, and they're nearly identical — even if patients have presented at their physicians' offices for different reasons, experts say.

Compliance officer Holly Louie, who serves on a committee advising HHS on EMR standards and using EMR in fraud identification encourages physicians to customize medical records "to the greatest extent possible, even in a templated system, so it's obvious to [auditors] that they are not carbon-copy records," she says. Document the patient's chief complaint, which should carry through to the physical exam and the history, and that should support decision making and medical necessity

Source: Report on Medicare Compliance [5/28/07]

Query: Local Gigantism

I have a 45 year old male patient with what he claims is "local gigantism" in his right foot. He has had seven surgeries over the years and wishes to have another surgery to stop the pain of walking on the bone and to decrease his foot size. The second and third rays are affected at the metatarsal bases, MPJ's and toes. The second and third toes are three or four times normal size today, in spite of the previous surgeries. My question is where to send him for help. I would like to send him somewhere that has treated similar conditions with success.

Mark Rindlisbacher, DPM Anchorage, AK

Query: Scope of Practice Question

One of the vascular surgeons at my hospital wants to show me how to do split thickness skin grafts so I will be able to obtain privileges at my hospital to do them on my own. We have discussed this w/ the surgical privilege granting committee and they are ok w/ me obtaining the graft myself from the thigh once appropriate training/proctoring has been done. My concern is that this might be considered "practicing outside of my license" since I would be obtaining the graft from above the knee. Could this be a potential liability issue? I would like to do the procedure but not at the cost of potentially losing my license to ractice podiatry.

John Renard, DPM, Kimberly, WI

Editor’s Comment: PM News does not provide legal advice. The fact that a hospital will grant you privileges for a specific procedure does not mean it is within the scope of practice in your state. That determination should be made by contacting your state licensing board in writing. Additionally, you would need to get a written assurance from your malpractice carrier.

RE: Prolotherapy to Strengthen Ligaments? (Carroll Kratzer, DPM)
From: Lenord S. Horwitz, DPM, Eric Widen, DPM

I teach prolotherapy (ligament enhancement therapy) at the University of Wisconsin School of Medicine yearly. I have also authored chapters on prolotherapy of the foot and ankle in four published books. You may be aware that there is an international organization promoting this type of therapy with classes throughout the United States and Europe. The American Academy of Orthopedic Medicine’s website can be foundat http://www.aaomed.org/ Prolotherapy is a safe and effective means of treating ligament dysfunctions in the foot and ankle. This must be followed by other modalities that we as podiatrists are familiar with and use in our practice on a daily basis.

Lenord S. Horwitz, DPM, Bluefield, VA, footpain@comcast.net

I have used prolotherapy for several years with very good results. It is excellent for conditions where ligament and tendon insertions are involved. It is extremely important that the patient understands the procedure. Basically you are stimulating the area involved to initiate the healing cascade. Temporary painful episodes are common following the procedure which dramatically diminishes in a few days.

Eric Widen, DPM, Marietta, GA, chiropod@aol.com

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