The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 15, 2010 #3,884 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

MO Podiatrist Discusses Flatfeet in Adults and Children

Dr. Constantine Kyramarios with Foot Healers says that the problems caused by flat feet aren’t always in the foot. If they do cause a problem, it may be in the form of postural fatigue, back pain, or gait problems. Adult-onset flatfoot will have more problems in the foot itself. Kyramarios sees this more in overweight people. “Often, the person strains the posterior tibial tendon, resulting in pain on the inside of the ankle. That strain can progress to a tear or rupture, so the earlier we treat that, the better,” he says. Depending on the severity, there are different options. For mild pain, stretching and custom orthotics work well. If the problem is moderate or worse, he may prescribe a bulkier ankle-foot orthotic, pronation-control foot­wear, weight loss, immobility to calm the inflammation, and as a last resort, surgery to repair the tendon and restore stability to the foot.

Dr. Constantine Kyramarios

Kyramarios says children have different issues with flatfeet. While normal in toddlers, anything that persists beyond ages 8 to 10 might be an issue. Parents should be very careful to provide well-fitting footwear. Kids’ feet grow very fast and wearing shoes that are too small can cause foot deformities. Children can also have other issues leading to flatfoot. “Kids may have an extra foot bone that leads to flatfoot, or something called tarsal coalition, in which two bones abnormally fuse together, causing a symptomatic flat foot,” says Kyramarios. “We usually notice this by the early teens or catch it on x-ray.”

Source: Mary Jo Blackwood, RN, MPH, Ladue News [6/10/10]

Medicare Compliance Will be Required Under New Healthcare Reform Law

Whether physicians code their own charts or coders do it for them, the stakes are high for scrutiny of coding and documentation. Under the health reform law, every physician group will be required to have an effective compliance program as a condition of Medicare and Medicaid enrollment, and auditing is a core element of an effective compliance program.

“Pulling in a consultant once a year to teach doctors about documenting and coding would not, by itself, be an effective auditing and monitoring program,” says attorney Ed Gaines, chief compliance officer for Medical Management Professionals. Recovery audit contractors (RACs) and zone program integrity contractors (ZPICs) also are targeting physician billing.

Source: Nina Youngstrom, Report on Medicare Compliance [6/4/10] 

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What can podiatrists do to increase the odds of winning a malpractice suit?

Keith Greer, Esq.

Keith Greer, Esq.: You are not going to be able to remember the specifics going on during any specific patient visit unless you have stuck in the chart sufficient documentation for you to understand your thought processes. I can win a case if I can understand what the doctor was thinking. You need to know why the doctor did what he or she did, and then explain it in lay terms to the jury. We are probably going to win a well-documented case because most doctors have very good logical thought processes in their treatment plans and decisions. It is just a matter of recreating that, and the more we have in the chart to help recreate that thought process, the better are our chances of succeeding.  

Dr. Kirk Geter

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features  Dr. Kirk Geter, President of the American College of Foot and Ankle Orthopedics and Medicine (ACFAOM) . You can register for this event by clicking here

Question Patients

Remind your staff that they do not define good patient service. Only your patients can tell you what good service looks like, so ask them. Do not rest if patients say they are satisfied. Ask “What could we do to make you even happier?”
 
Source: Adapted from Communication Briefings

Query: Dragon Questions

I am interested in using a speech recognition program such as Dragon. Do I need the higher priced medical version? Also, could Dragon speech-to-text then be translated by Windows software from English to Spanish? If so, this would be an instant translator in the clinic. 

Dwight L. Bates, DPM, Dallas, TX

RE: Getting My Groove Back (Name Withheld)
From: Art Hatfield, DPM, Michael M. Rosenblatt, DPM

Start small, with arthroplasties, etc., and work with a trusted colleague for pointers.

Art Hatfield, DPM, Long Beach, CA, afootjob@Juno.com

Name Withheld well described the dangers of a “surgical hiatus” that eventually developed into a 10-year “vacation” from it. Now this podiatrist feels that he is no longer qualified to perform many of the procedures routinely done by his colleagues, even those his same age. He is not alone. Some podiatrists who have been burned by severe malpractice cases stop doing surgery, or become “gun shy” as a result.

They convince themselves that a non-surgical practice is best for them. The trouble is, those skills are not automatically a part of your “body.” New procedures require new ways of evaluation and thinking, not just technique. We may even see this in the most famous neurosurgeon, Sanjay Gupta, who has been working as a news anchor now for several years. Neurosurgeons have a short practice life as it is. His may be finished from lack of practice.

This podiatrist should consider taking a 6-month to a year residency or fellowship, and refresh his skills. This is done, even by those doctors who maintain their skills to a sharp point and never took time off. The doctor may have to convince his/her spouse to do so, and that may be the biggest stumbling block, since it is unlikely that such a program will occur locally.

There are real dangers to taking a surgical hiatus. None of us is getting any younger. Above all, we must not allow the legal profession and its hungry practitioners to short-circuit our skills and make us afraid. Once you stop, there is a strong likelihood that you will never return. You and your patients deserve better.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Reaction Mixed to Allscripts, Eclipsys Deal (Michael Brody, DPM)
From: Alan Bass, DPM

While I am biased towards the EMR/Practice Management program that I currently use in my office for the past five years, I think the most important thing for all podiatrists to remember when evaluating any EMR/Practice management program is to make sure that the program is the right thing for their practices. Don’t be lured by big companies with expensive, fancy programs with the hopes of the government “reimbursing” you up to $44,000 for your purchase. 

Make sure the program integrates into your practice, not only for you, but for your staff as well. Take your time and do your homework, and pick a company that works well with podiatry. Look for all the hidden fees. Talk to your fellow podiatrists who currently have an EMR program, ask your state society for advice, and finally look to APMA to see if there is any program out there that they endorse. If I am not mistaken, TRAKnet DPM, by Biomedix, is the only EMR software that has been given the APMA Seal of Acceptance.

Alan Bass, DPM, Manalapan, NJ abassdpm@optonline.net

Disclaimer: I am a consultant for Biomedix Vascular Solution, the makers of TRAKnet DPM

RE: HIPAA HITECH and Meaningful Use
From: Marc Garfield, DPM

Here are some recent “meaningful use/HITECH articles. Simply cut and paste to read.

1) fierceemr.com/story/intermountain-would-miss-36-48-current-mu-requirements/2010-06-10
2) zdnet.com/blog/healthcare/expect-slippage-on-meaningful-use-guidelines-and-dates/3715
3)nytimes.com/2010/06/08/health/policy/08health.html

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: Filing For PECOS  (Susan M Loiselle)
From: Paul Kesselman, DPM

I would be extremely cautious about using a firm who advertises a single flat rate for all PECOS applications or which guarantees your application will be accepted by a given date. Each practice has its own nuances and complexities, requiring a more in-depth study of the practice structure prior to submitting the application. The advantage of paper vs. electronic applications has also now almost reversed for most carriers. The advantage of one vs. the other is now based more on the individual practice than on any other factor.  No two applications are alike, and many of the Tier 1 enrollment specialists at the carriers are as lost as most physicians. They often provide inaccurate information, which may result in your application being rejected or unduly delayed. Medicare carriers now have the additional burden of enrolling dentists, pediatricians, and many others who typically don’t bill Medicare. The backlog that this will create is likely to worsen and make paper applications akin to the horse and buggy.

I have partnered with two individuals who have over 50 years combined experience dealing with Medicare and filing enrollment applications. I provide a free PECOS database search of your practice’s NPI.  Furthermore, I would check your DME claims to be sure you are submitting them correctly as many who are not receiving edits continue to submit DME claims incorrectly.

If you are not in the PECOS database, you will be referred to an appropriate facilitator who will handle your application. More information will be forthcoming in future advertisements in PM News along with free webinars.

Paul Kesselman, DPM Woodside NYpkesselman@pol.net

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time 3-DPM group in South Bay of LA County. Minutes from best living in LA County. Practice is an excellent mix of surgery, general podiatry, diabetic care, and DME. Beautiful office with EMR, Digital X-ray and Orthoses, etc. Please e-mail cover letter, and resume to footcareone@verizon.net

PODIATRISTS NEEDED NATIONWIDE

Seeking a part-time or full-time podiatrists to provide podiatry house call and diabetic shoe fitting services to patients nationwide. We are a podiatry management company and have contracts with clients that have 1,000’s of established patients and all we need are hard-working good doctors to service them. We offer an excellent compensation package with benefits and the opportunity to build a fairly large practice very quickly. coasttocoastpodiatry@yahoo.com

EQUIPMENT WANTED – CR SCANNER

Reina 812 Manual CR Scanner in good condition. Contact: pmh@wffeet.com

ASSOCIATE POSITION – HOUSTON, TEXAS

Full-time, surgically-trained podiatrist needed for multi-office practice in Houston, TX. Ideal candidate must be motivated, dedicated and personable. Practice is a good mix of general podiatry and surgery, no nursing facilities. Must also be willing to do significant networking and marketing to help build the practice. Please e-mail cover letter, and resume to faajobs@gmail.com

PRACTICE FOR SALE – EASTERN OREGON

Recent poor health requires sale of busy 30+ year old practice in Eastern Oregon. Good mix of surgery and general podiatry. Pleasant community with year round outdoor recreation. Major metropolitan center 50 miles away. Current staff and doctor will stay on as needed. sparris@fmtc.com

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com

PART-TIME POSITION - NEW JERSEY

Available for a Board certified/qualified podiatrist. Located in Toms River and Manchester. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Possibly leading to full-time position for the right person. Please fax CV to (732) 349-0228 or email CV to njfeet@aol.com

EQUIPMENT FOR SALE –  PODIATRY CHAIRS

2 podiatry chairs - used Midmark 117 and a Ritter 317. Great condition. $950 each Greenwich, NY Call:518-466-3287. Pick up only.

ASSOCIATE POSITION IN NORTH BROOKLYN, NY 
 
Well-established practice in a multispecialty medical center seeking a self-motivated individual with initiative and leadership skills for a full-time position. Spanish speaking ability a plus. Compensation possibly in six figures with partnership opportunity. Contact/Send resume to: bklypodiatry@aol.com

ASSOCIATE POSITION NORTH CAROLINA - ASHEVILLE/MOUNTAINS

Well established, multi-doctor, multi-office diverse practice has immediate need for associate doctor leading to partnership. Associate doctor will be very busy from day one. Attractive compensation and benefits. Buy-in potential after one year. Contact at smfc2@charterinternet.com or 828-734-1535

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.