The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

June 13, 2012 #4,487 Publisher-Barry Block, DPM, JD

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Clinic Offers Preventative Advice: UK Podiatrist 

People with diabetes often get preferential service to rheumatoid-arthritis patients because diabetics’ feet issues can end in amputation. There are a few good-practice models showing how to provide better services. One is the Podiatry Clinic at Salford Royal Foundation Trust, headed by three podiatrists, an orthotist, a physiotherapist, and rheumatologist. They stock boxes of different prescription shoes for patients to try on, as well as catalogues of the styles.

Jane McAdam

Podiatrists are also trained to measure feet for shoe-making. The clinic takes referrals for anyone with foot problems. Principal podiatrist Jane McAdam says, "We get people who simply need advice, and we’re very happy to see people long before they need an orthotic insole or a prescription shoe. We make it a rule never to tell people what they’ve got to wear."

Source: Jane Feinmann, Daily Mail [6/11/12]

WA High School Runner Strives to Be a Podiatrist

Kody Shriver wasn't always thin. "I used to be a butterball," he said. The 17-year-old Kalama High School changed his eating and exercise habits almost four years ago as he entered high school. "I just said, 'I don't want to be fat,'" Kody said. "I just wanted to make some changes." So he started running. He ran a mile in about 8 minutes in the 8th grade. Now Kody can finish a mile in four and a half minutes.

Kody Shriver

Kody's passion also paved his way to college. He received a cross country scholarship from Eastern Oregon University, where he plans to study pre-medicine on his way to becoming a podiatrist. "I deal so much with feet injuries, I've accumulated quite the interest in taking care of my feet," he said. "It would be great to help other people."

Source: Longview Daily News [6/11/12]

PICA Receives High Rating by A.M. Best

A.M. Best Co. has upgraded the issuer credit ratings (ICR) to “a+” from “a” and affirmed the financial strength rating (FSR) of A (Excellent) of the subsidiaries of ProAssurance Corporation (PRA) (Birmingham, AL) [NYSE: PRA], collectively referred to as ProAssurance Group (ProAssurance). The outlook of the FSR has been revised to positive from stable, while the ICR remains positive.

In addition, A.M. Best has affirmed the FSR of A (Excellent) and ICR of “a” of Podiatry Insurance Company of America (PICA) and the FSR of A- (Excellent) and ICR of “a-” of PACO Assurance Company, Inc. (PACO) (both domiciled in Springfield, IL). The outlook for PICA’s ratings is stable, while the outlook for PACO’s ratings has been revised to stable from negative. 

Source: I Stock Analyst [6/11/12]

As Patients' Records Go Digital, Theft And Hacking Problems Grow

As more doctors and hospitals go digital with medical records, the size and frequency of data breaches are alarming privacy advocates and public health officials. Keeping records secure is a challenge that doctors, public health officials, and federal regulators are just beginning to grasp. And, as two recent incidents at Howard University Hospital show, inadequate data security can affect huge numbers of people.

On May 14, federal prosecutors charged one of the hospital's medical technicians with violating the Health Insurance Portability and Accountability Act, or HIPAA. Prosecutors say that over a 17-month period, Laurie Napper used her position at the hospital to gain access to patients' names, addresses and Medicare numbers in order to sell their information. A plea hearing has been set for June 12; Napper's attorney declined comment. Just a few weeks earlier, the hospital notified more than 34,000 patients that their medical data had been compromised. A contractor working with the hospital had downloaded the patients' files onto a personal laptop, which was stolen from the contractor's car.

Source: David Schultz, Kaiser Health News and the Washington Post [6/3/12]

Maintain a Professional Email Image

When writing email, avoid using casual expressions that threaten to undermine your professionalism.
Examples:

•  Replace “Will you guys help me out?” with “Will you help me?”
•  Rather than say “The folks from the pharmaceutical company are here,” say “The people from the pharmaceutical company are here.”
•  Expressions such as “Oh man” come across as juvenile.
•  Substitute informal salutations, such as “Hey” and “Yo” with “Hi” and “Hello.”
•  Use exclamation points sparingly to avoid appearing too emotional and immature. Never use more than one exclamation point at the end of a sentence.

Source: Adapted from “Three Tips for Writing E-mail in Today’s Casual Workplace,” Barbara Pachter, Pachter’s Pointers via Communication Briefings

Query: Two Separate Injections on the Same Day

I recently saw a patient in my office and had to give two separate injections for two different diagnoses. They were as follows:

CPT 64455-RT with a diagnosis of ICD-9 355.6 (Morton's-type neuroma), and CPT 20605-LT with a diagnosis of ICD-9 719.07 (effusion of joint, ankle/foot). Can these injections be given on the same day? If so, how should they be billed?

Jack Ressler, DPM, Lauderhill, FL

Response: The question is about two distinct services, unrelated to each other, on different anatomical locations. They should always be covered.

The next question is: Are you participating or not with the insurance you are billing? If you are, do they have specific policies in place that prohibit these services on the same day? If you do not participate, then you generally do not have to worry about the payer. Your only obligation to the patient is to do the right coding.

Next, does the insurance carrier use the NCCI edit system or some other edit system to adjudicate their claims? Interestingly, there are no edits yet for this code pair under the NCCI system. There is an edit where CPT 64450 is column two to CPT 20605. So, using this as an example when billing the two codes together, I suggest appending modifier "-59" to the CPT 64455 code to keep this in line with other current coding edits. This way you are stating these two codes are distinct and separate, even though you have placed the "LT" on one and "RT" on the other.

David J. Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: DEA Certificate Cost (John Gilfert, DPM)
From: Terry Mueller, DPM
 
I'm surprised that the "War on Drugs" hasn't been mentioned as a factor in the rapidly escalating DEA fees.
 
Congress created a "Diversion Control" fund in the early '90s. This means that, our fees, along with the bounty from the seizure of assets, is a "self-financing" program, controlled by Eric Holder, and is COMPLETELY UNACCOUNTABLE to Congress.
 
Does anyone seriously think that the fees won't continue to escalate? How high must it go before the average physician wakes up?

Terry Mueller, DPM, Florissant, MO, DrTerryMueller@aol.com

RE: "Unified" Post-Graduate Training (Charles M Lombardi, DPM)
From: Robert Scott Steinberg, DPM

While I can't prove ABPS ever told a hospital that theirs was the only acceptable board, ABPS members sure did, and they also did this with insurance companies. UNICARE was one that de-credentialed non-ABPS podiatrists from their provider panel.

I don't know how long Dr. Lombardi has been practicing, so maybe he was not around for this back-stabbing. But plenty of us do remember.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: Success Tips from the Masters (Bryan Markinson, DPM)
From: Gary S Smith, DPM
 
I agree with everything Dr. Markinson said. The majority of hospitals are dropping the board requirement altogether. Where I practice, most of the internists, orthopods, and half of the OB/GYNs are not board certified. Nurse practitioners treat everything we can't. They actually have an online doctorate for them now so their patients can call them "doctor". Half the patients seen by all MD specialties, even rheumatologists and neurosurgeons are seen by physician assistants who have two years of actual medical training.

Every other medical entity is moving to increase access and scope of practice and we, as a profession, move in the opposite direction. Requiring a mandatory three-year residency will be the death of podiatry. Why would anybody attend medical school and a residency (analogous with an orthopod or a general surgeon) which severely limits scope of practice? Over the last 20 years, podiatry board certification has gotten more restrictive and exclusive, while at the same time board certification in general becomes more irrelevant. 

When I told a friend I was taking the board recertification exam he asked, "What can you do that uncertified docs can't?" I was kind of taken aback that I couldn't answer him. I'm glad I took it. I can pat myself on the back and that's enough for me. Three-year residents should be able to do the same.
 
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: Barefoot Running More Efficient (Dennis Shavelson, DPM)
From: Doug Richie, DPM

There are several errors in Dr. Shavelson's post about my inquiry made to Dr. Friedman: 1. My name is spelled "Richie"  2. I never made any claims about the benefit of any type of running shoe design  3. I simply responded to a trend among certain barefoot running advocates who boldly state that this activity and the use of minimalist shoes will strengthen the intrinsic muscles of the foot. 4. This sweeping claim need not be validated by EBM... it only requires a few basic scientific studies. Where are they?
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: Barefoot Running More Efficient (Doug Richie, DPM)
From: Howard E. Friedman, DPM

Dr. Richie is correct that there is a paucity of research about the increase in "foot health" and muscle strength from running in minimalist shoes. A study by Bruggemann, Potthast, et al., "Effect of Increased Mechanical Stimuli on Foot Muscles Functional Capacity" published by the American Society of Biomechanics measured the anatomic cross-sectional area (ASCA) of lower leg and intrinsic foot muscles (in cohorts), of runners in both minimalist and standard footwear over a five month period.

Their research, which was supported by Nike, did show an increase in ACSA in the group running in minimalist shoes. More research needs to be done, I agree, to scientifically validate my statement. A master's student, Liz (Erin) Miller in the Department of Anthropology at the University of Cincinnati, is currently working on her thesis exploring this topic. But while we wait for the research, I submit the following thoughts for consideration:

1. Many people around the globe historically have or are running either...

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

ASSOCIATE POSITION  - BRONX, NY

Full-time highly motivated, ethical, hard-working associate wanted for multiple office locations commencing 8/2012.  All phases of podiatric medicine (Surgery, Biomechanics, DME, Palliative Care). Competitive base salary, malpractice insurance, bonus structure. Please email resumes to bronxpodiatrist1@gmail.com

ASSOCIATE POSITIONS – NEW YORK CITY

Looking for someone with some working experience in a podiatric office. Two sessions (1/2 day) a week for July and August for Upper West Side of Manhattan. References a must. One 8 AM to 12, one 12 to 5 PM. Reply to fabienne.rottenberg@gmail.com

ASSOCIATE POSITION AVAILABLE - NORTH CAROLINA

New associate position available that may lead to partnership. We are a very busy practice providing care in both office and hospital settings. We are fully integrated in a large tertiary teaching hospital. We are located in the beautiful mountains of western North Carolina. Research opportunities are available. Applicant should be ethical, personable, hard working, and committed to quality in patient care. We are offering a competitive salary with bonus opportunities and a wide range of benefits. All interested candidates should send a CV to MFAS828@aol.com

ASSOCIATE POSITION - YORK, PA

Three-office practice with hospital, surgical center & nursing home privileges. EMR since 2000. Digital x-ray, ultrasound, progressive practice. Competitive salary and benefits offered. Practice offers good mix of surgery, wound care, and general podiatry. Open to associate with potential future buy-in. Please forward your information and CV to footdocpa@aol.com

ASSOCIATE POSITION - SAN JUAN, PUERTO RICO

Well-established practice seeking associate with opportunity for buy-in. Must have a minimum of 2 years surgical residency, or have 10 years practice experience with rear foot surgical skills. Great opportunity for growth with in-house surgical center, 2 hospitals within walking distance & more. Puerto Rican License required. Send CV/Resume to admin1@podiatrycenterpr.com

ASSOCIATE POSITION - NEW YORK

WORK SMARTER NOT HARDER. Join a modern, well-established 42-year-old podiatric medical/surgical practice within a multi-specialty office. Located just 20 minutes from NYC. Must be responsible, compassionate, driven, and self-starter. Enjoy cross-referrals from other specialists and support of medical assistants, office managers, and medical billers with over 50 years combined experience. Utilize modern technology: state-of-the-art diagnostic ultrasonography, fluoroscopy, ESWT (machine is owned by practice), physical therapy, x-ray, circulation testing, NCV, and in-office operatory suite. Very strong and effective advertising/marketing program. No nursing homes, No HMOs, No Medicaid, No Medicare. Must be licensed for podiatry in New York. Send cover letter/CV to: linchpindpm@yahoo.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Podiatry office in Central NJ- Looking for a three year surgically trained associate who has entrepreneurial spirit for a very busy office. You will see new patients and have the potential to become board certified in two years. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter." Please fax your CV to: 732-968-8821.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time/Part-time, motivated, outgoing associate wanted for immediate job opening. Multi-office, multi-doctor practice based in Orange County, is looking for hard-working individual to treat wide range of patients. PSR 24 training a must and Spanish speaking a definite advantage. Email your CV toocpodiatryoffice@gmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Busy, two office group practice seeking a full-time, self motivated and hard working podiatry associate. Good mixture of general podiatry and surgery. Applicant should be PMS 36/Board Qualified/Certified. Competitive salary and benefits are offered. Please email CV to: toesrus7@yahoo.com

ASSOCIATE POSITION - MASSACHUSSETTS

Looking for an extremely hard working podiatry associate for part-time work, opportunity for full time. Busy and expanding podiatry practice in the Merrimack Valley. Will work in both office and nursing home setting. In office, we have laser technology, electronic medical records, diagnostic ultrasound, x-rays, etc. Please email us at resumesent11@comcast.net if you have interest in this position. If we find the right person, this opportunity could lead to partnership. Looking forward to hearing from you.

ASSOCIATE POSITION - ST AUGUSTINE, FL

A well-established, solo-physician in St Augustine, FL; is seeking a full-time associate. Applicant should be well-trained with sound surgical skills, applicant must be board eligible/certified. Practice offers a state-of-the-art practice setting, with a good general mix of all aspects of podiatric medicine and surgery. Competitive salary. E-mail resume to drfootwound@gmail.com

ASSOCIATE POSITION - NYC

Full and part-time opportunity available in 40 year old practice in downtown Brooklyn. State-of-the-art office with EMR and digital x-rays. Must be experienced, highly motivated with good clinical skills. Competitive salary. Possible buy-in opportunity available. please email resume to dpm10019@yahoo.com

ASSOCIATE POSITION - OHIO

Ohio practice with excellent reputation and patient base seeks to hire a Podiatric Surgeon. The offices are state of the art including Digital X-Ray, EMR, Diagnostic ultrasound, Padnet Vascular Testing, CO- 2 Lasers all aspects of DME. The base salary is $120,000 with a bonus structure and benefits also would like to have this individual buy into the practice eventually. Please send CV to Ohiopodiatrist@aol.com

ASSOCIATE POSITION - WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice. Visit our website www.centralmasspodiatry.com

ASSOCIATE POSITION - SOUTHEASTERN MICHIGAN

Immediate opening for a full time/part-time PSR 24/36 podiatrist in a 30 year old, well established practice with an excellent reputation and referral base. State-of-the-art office with EMR, digital x-ray, diagnostic ultrasound and beautiful office. Generous base salary, malpractice insurance, health insurance, benefits and bonus structure. A well rounded and energetic podiatric surgeon needed for this group of 4 board certified podiatric physicians and surgeons. Please send CV to: michiganfootandankle@gmail.com

ASSOCIATE POSITION – ANCHORAGE, ALASKA

Associate wanted for hospital-based podiatry group practice. Full scope of practice. Surgical residency 24month+. Outstanding opportunity, work environment, and recreational pursuits. Fax CV to 907-562-5195, please call 907-562-4958, e-mail us at contactus@alaskapodiatry.com

EQUIPMENT FOR SALE

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

EQUIPMENT FOR SALE: EPAT

(Extracorporeal Pulse Activation Treatment) for sale. D-Actor 200. This machine is still new. Purchased in late 2011.( new machines>30K). It is the conservative alternative to surgery. Treats Plantar Fasciitis, Heel spurs, Achilles Tendonitis, Joint pain. Great Buy. $17,995 or best offer. Please call 713-541-3199 for more information. or email contactus@houstonfootankle.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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.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 referred out. Financing available. Call 800-983-4194, or email: contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - HOUSTON, TEXAS

30 year old busy, progressive practice for sale with an excellent reputation and well established, diverse referral base. Well trained, dedicated, supportive staff. Excellent cash flow ($400K net 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. Contact:mcrosby@picagroup.com or call (888) 776 2430.

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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