June 21, 2006 #2,611 Editor-Barry Block, DPM, JD

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HI DPM Provides Advice On Travel Shoes

We asked podiatrist Robert Lareaux of Kailua, HI how to tell when a travel shoe fits well enough to walk in all day. He recommends trying shoes on at the end of the day. Feet can get one-half to one size bigger during the course of a day. A properly fitted shoe will allow one thumb's width between the longest toe and the end of the shoe. "You should be able to pinch the material on top of the shoe behind the toes," Lareaux said. "It shouldn't be so taut that you can't pinch it, or it's too tight."

The three things to look for in a travel shoe, Lareaux said, are shock absorption, stability, and motion control. "If you don't have a history of foot problems, look just for shock absorption." If you do have a history of problems, Lareaux said, an arch support can really help when you plan to walk a great deal. He recommends Dynastep supports by Dr. Scholl's (around $20). "Put them in your shoes, and it immediately upgrades the shoes. When traveling, you can take one pair of arch supports and move them around in any pair of shoes," he advised. "Just look for shoes with removable foot beds."

Lareaux, also qualified as a pedorthist, or shoe-fitter, has a shoe shop attached to his clinic. Specializing in diabetic, orthopedic comfort shoes, he calls it DOC's Shoes. "Covering the foot on all six sides will clearly control and support more than a sandal," Lareaux said, but many Island folks refuse to wear anything but sandals. For them, he recommends finding the best support possible from manufacturers such as Mephisto, Birkenstock, Dansko, Naot and Finns, which he carries in his store.

Source: Paula Rath, The Honolulu Advertiser [6/16/06]

CMS to Block Payment in 2007 for 'Medically Unbelievable' Services

Providers should prepare for a new breed of edit — for "medically unbelievable" services — and consider testing their systems to check whether they would catch them.

CMS will deploy the plan to implement medically unbelievable edits (MUEs) no later than Jan. 1, 2007. They block payment for services that make no sense based on "anatomic considerations" or medical reasonableness when it involves the same patient, same date of service, same HCPCS code and same provider.

Unlike other National Correct Coding Initiative (NCCI) edits, MUEs can't be overridden by a modifier. Presumably that's because there will never be a scenario where the physician had a good reason to submit a claim for removing a second appendix from the same person. CMS unveiled this edit before, but rescinded it, and this time around is getting provider input before deployment.

Source: Report On Medicare Compliance

Query: PressureStat

I am trying to obtain a "Pressure Stat" device which visually demonstrates the distribution of a person's weight in stance. Apparently, none of our usual vendors carry this item. Does anyone know of a distributor for this product?

Kevin McDonald, DPM, Harrisburg, NC, mickeyfeats@yahoo.com

Editor’s comment: The company that manufactures PressureStat™ is Foot Logic, Inc. http://www.footlogic.info/ (866) 385-6442 or contact Scott Kantro, DPM at mailto:skantro@footlogic.info

RE: Patient Extortion? (Barry Block, DPM, JD)
From: James J DiResta, DPM, MPH, VA DPM

In the editor’s reply to the query on extortion he replied "You did the correct thing in notifying your malpractice carrier. While we would send a single bill, we would not further provoke this patient by sending her account to collections."

I have read similar comments the editor has made when either the patient was blatantly wrong or hurtful and accusatory. What is wrong with doing what is right here? I hate to think what would happen if we all turned the other cheek and allow such activity to amplify. Let's stop the wrong in its tracks. How frightening to think such activity will continue because we don't want to "rock the boat."

James J DiResta, DPM, MPH, Newburyport, MA,
James.J.DiResta.DMS04@Alum.Dartmouth.ORG

Editor’s response: We are reminded of the classic poem “Here lies the body of Mike O’Day. He died defending his right of way. He right was clear. His will was strong. But he’s just as dead as if he’d been wrong.”

In life “discretion is often the better part of valor.” If you aggravate a patient enough, he or she has the option of filing either lawsuits or complaints against you. Even if you successfully defend against these actions, you still lose because of the wasted time and aggravation. But if you insist on waging idealist battles based on principle, it’s certainly your right…and your time.

I too, had a similar experience, when after a surgical procedure, a patient threatened to sue me if I did not reimburse him for all of his out-of-pocket expenses and time he missed off work. I thought of doing nothing, because I felt his grounds we're obviously unfounded but called my malpractice carrier to inform them, like I'm supposed to. They reviewed all the information and felt he had no claim, but since he was asking for so little money I should pay him because "You never know what a jury would do.”

Well there was no way I was going into the national data bank. I did nothing, and soon there after I received a letter from the patient stating he felt bad and dropped his demand.

The problem now is that I have a claim on my malpractice record, just like you will have. It's reported at the time of all my reappointments and application. I would have been better off not reporting the incident at the time .

VA DPM

Editor’s Comment: PM News does not supply legal advice. In general, a “claim” means that a lawsuit has been formally filed and assigned an index number. In the aforementioned scenario, the patient has merely made a “complaint” which need not be reported on re-appointment applications, etc. It is important to read applications very carefully. If you have a question as to what legally has to be answered, you should consult a healthcare attorney in your state.

RE: Severe Cramping of Feet & Legs (Jean Bainbridge, DPM)
From: Cynthia Ferrelli, DPM

Statins, typically Lipitor, deplete the body of Coenzyme Q10 which functions in the Krebs cycle, where we produce ATP. Instead of going through a myriad of tests re: the cramping, see if the patient can stop the statin for a bit & typically they will go away, or supplement the patient with CoQ10 50-100 mg Q D. If you are interested in a really eye opener article re: side effects & statins, send me a forwarding address for the article.

Cynthia Ferrelli, DPM, Buffalo, NY, drfoot@localnet.com

EQUIPMENT FOR SALE-X-RAY DEVELOPER

Near-new podiatry/medical x-ray developer for sale. All-Pro Model 2010. Excellent condition. $2500. Call (216) 261-7662 or email: fergusondpm@aol.com

TEMPORARY POSITION – LONG ISLAND

Doctor broke arm and needs a NY-Licensed DPM to cover for a period of time. (516) 637-2671 Mel2222@peoplepc.com

EQUIPMENT FOR SALE - ESWT

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

ASSOCIATE POSITION - NAPLES- FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548 bed hospital system and multiple surgical centers. Candidate should want to perform rearfoot surgery including Charcot reconstruction. Candidate needs to be ethical and motivated and have a current Florida license. Established practitioner or new practitioner OK. Base, percentage, benefits including insurance and 401K. Fax CV to (239) 566-8778.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

ASSOCIATE POSITION – MIAMI DADE COUNTY FLORIDA

Part time work available. Clinic sessions-nice environment / assistants supplied 8am-12pm / 1pm-5pm. Miami Dade County. Hourly Salary. E-mail response to: podoffice@aol.com

PRACTICE FOR SALE - NORTHWESTERN US

Selling 3 well developed satellite offices with substantial potential of continued growth. All offices in areas of abundant outdoor recreational activities including skiing, fishing, hiking, etc. These offices are priced to sell quickly! Please only serious inquires only and contact via e-mail: offmgr4464@hotmail.com

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-
491-9994.

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

RESIDENCY POSITION - HOUSTON, TX

RPR, PSR-24, Houston Podiatric Foundation, Starting ASAP. Must have successfully completed PARTS 1 & 2 of National Boards. Contact: Dr. Randal M. Lepow, Director (281-348-3338) (713-725-8988)

PRACTICE FOR SALE - COLUMBUS, OHIO AREA

Fully furnished practice, open ONLY 14 hours a week with an average yearly gross of 235K. 75% primary care, 20% surgical, 5% Nails. Plenty of opportunity for growth and surgery. Changing locations. Financials available upon request. Kyle_DPM@Yahoo.com

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