The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 21, 2008 #3,278 Editor-Barry Block, DPM, JD

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IL Podiatrist to Investigate Non-Resorbable Dermal Filler

Chicago-based podiatrist, Dr. Mary Olszewski has initiated a new clinical study to evaluate the use of ArteFill to reduce foot pain caused by fat pad loss within the plantar metatarsal area, commonly known as the ball of the foot. Dr. Olszewski reports that she is conducting this study to evaluate ArteFill for the reduction of pain and impact on activity level caused by fat pad loss in the plantar metatarsal area in patients who have pain in their feet, and who have failed the use of traditional conservative therapies such as pads, shoe wear, orthotics and/or possible use of other temporary injectable dermal filler materials.

Dr. Mary Olszewski

Under the clinical study protocol, ArteFill will be injected sub-dermally over the entire metatarsal area, and patients will return at bi-weekly intervals to document level of pain, level of activity and work and recreational activities. After study completion, these findings will be submitted and are expected to be published in a peer-reviewed podiatry journal.

Dr. Olszewski said, "Based on my years of experience in the field of podiatry and my understanding of the composition of ArteFill as the first and only FDA- approved, non-resorbable dermal filler, I believe that the use of ArteFill may offer the potential to significantly reduce foot pain and discomfort for patients suffering from podiatric disorders."

Source: Genetic Engineering & Biotech News [6/10/08]

Mandel Elected Chairman of NYCPM Board of Trustees

Insurance industry and healthcare executive Stanley S. Mandel, President and Chief Executive Officer of Arista Investors Corporation and former Chairman of the Board of Kingsbrook Holding Corporation and Executive Vice President of Kingsbrook Jewish Medical Center, was recently elected as Chairman of the Board of Trustees of the New York College of Podiatric Medicine (NYCPM). Mr. Mandel has been a member of the Board of Trustees of the College for the last five years. His two-year term of service as Chairman will be effective on July 1, 2008, when the term of the current Chairman, Maj. Gen. William F. Ward, A.U.S. (Ret.), ends.

Stanley S. Mandel

Stanley S. Mandel holds Bachelor’s and Master’s degrees, in both mathematics and economics, from Brooklyn College. Mr. Mandel has served as a senior executive in the insurance industry, in a series of increasingly high-level positions.

“I am very proud that a man of Stanley’s stature has agreed to serve as Chairman of the Board of our institution,” said Louis L. Levine, President and Chief Executive Officer, NYCPM. “Stanley brings invaluable business and healthcare experience to the Chairmanship of our Board at a time when it is particularly critical that medical institutions work effectively to gain the support of their key constituencies.”

Senate GOP To Offer Pared-Down MD Pay Patch Measure

Senate Finance Committee Republicans announced they would offer a pared-down bill that would eliminate a 10.6% reduction to Medicare physician fees, CQ Today reports. According to CQ Today, Senate Republicans are "apparently losing faith in Democrats to produce a Medicare bill by the end of the month." The fee cut is scheduled to go into effect on July 1. The draft measure, which will be introduced by Finance Committee ranking member Chuck Grassley (R-IA), would extend some Medicare programs for 18 months and replace the fee reduction with a 0.5% increase in 2008 and a 1.1% increase in 2009.

The cost of the bill would be offset by cutting indirect medical education payments under Medicare Advantage and "moving around funds" in an account for Medicare physician payments, CQ Today reports. According to CQ Today, the fee increases and the offsets are similar to another measure (S 3118) by Grassley. Senate Minority Leader Mitch McConnell (R-KY) said, "With the deadline for action approaching at the end of next week, we should pass a bill."

Source: CQ Today via American Health Line [6/19/08]

Trick Yourself Out of Procrastination

Try this sneaky way to trick yourself out of procrastination.

1) Do absolutely nothing for 15 minutes.

2) Force yourself to stare at the papers on your desk until the urge to do something overtakes you.

Rationale: We often allow ourselves to procrastinate by finding busy work to distract us from the important task at hand. Don't allow yourself to fall into this trap.

Source: Lester Bittle, Right on Time

Query: Removing a StayFuse Device

Does anyone have any tips on removing a StayFuse device from a toe? Any information would be greatly appreciated.

John L Etcheverry, DPM, Bakersfield, CA

Query: High Quality Korex or Rubber Butter Orthotic

Which lab, small or large makes a great custom-molded leather and Korex or rubber butter full-length orthotic? I do not care how much it costs. I just want a great properly-made device from a cast to replace a worn out set made in New York some 20 years ago. Any names and phone numbers will be appreciated.

Keith L. Gurnick, DPM, Los Angeles, CA

Query: Anesthesia By Surgeon

I had heard that we can now bill for anesthesia injection with our procedures. For example, when billing for CPT 11750, repeat the code on the next line and add a "-47" modifier.

Does anyone know if this is being paid, and at what rate?

Charles Perry, DPM, Cambridge, OH

Response: Usual and customary anesthesia performed for a matrixectomy is a digital block. CPT surgical guidelines note

"In defining the specific services 'included' in a given CPT surgical code, the following services are always included in addition to the operation per se: - local infiltration, metacarpal/metatarsal/digital block or topical anesthesia."

Although one might be able to argue that a digital block is a regional block, most, if not all, payers would not reimburse a "-47" modifier applied to a procedure code like CPT 11750.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found by clicking here

RE: Post-First MPJ Arthrodesis Lack of ROM (Steven S. Melek, DPM)
From: Steven H. Goldstein, DPM

The only way that seems logical to approach this problem is with reversional surgery. The first thing is to eliminate the arthrodesis and then try using a total first MPJ replacement of your choice. You must be careful to resect a minimal amount of bone to have the implant fit properly. Remember, you can always resect more as need be. You will also be able to resect that medial eminence on the right foot. For the left foot you also need to address the dorsi-flexion of the proximal phalanx.

Obviously a total implant would not allow you to do anything further across the IPJ of the hallux. You could put a head replacement in the first MPJ and the fuse the IPJ of the hallux. You could weaken the extensor tendon with an IPJ tenotomy and capsulotomy or a flexor tendon transfer.

This is a difficult surgery to get optimal results. Placing implants in such a young person always becomes an issue. If he were much older, a Keller bunionectomy would simplify the situation.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Multi-Function Digital Scanner (John Moglia, DPM)
From: Ira Weiner, DPM, Zac Childress

There are multiple devices on the market from extremely high end laser devices to rather inexpensive inkjet devices. We have a totally paperless office and use EMR which includes all scanned patient forms as well as digitized x-rays on the EMR program, which is a web-based program.

We have three of these devices in the office but only one of them is hooked up to the fax and it is an inkjet device. We have 3 Brother MFC devices which are available in most office supply stores for less than $150. They scan rather quickly and high-yield ink cartridges run less than $15 if you use the refill programs many office supply stores have. Depending on the fax volume, they will last from 2-3 weeks.

One caution, is that if you are using a Windows Vista program, make sure the device is compatible. If not you will have to buy a program from nuance.com known as paper port 11 to scan and stack your files to PDF format which runs about $200. XP is not a problem. At $150 each, they are basically throwaways, although I have been using one of mine for over 2 years with no problem.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

There are many Multi-function scanner, printer, copier and fax units that are in the $125-350 range. If you are going to be doing a high number of scans daily or weekly, you and your staff will probably find these units to be highly inefficient due to the speed of scanning and the fact that they only scan one side of a document at a time. For high-speed scanning, we use a Fujitsu 5120C that scans 25 pages per minute (or 50 images per minute in duplex mode to capture both sides), has an automatic document feeder that can handle 50 sheets at a time and will also handle an insurance card with raised lettering. We also use this model because our EMR requires the scanner to be TWAIN compliant. It is around $850. If you are not scanning into an EMR, look at the Fujitsu ScanSnap S500, which goes for around $450-475. It is a little slower and is not TWAIN-compliant, but is a good unit for high-speed scanning.

I have no affiliation with Fujitsu

Zac Childress, Oxford, MI, zac@godarwintech.com

RE: Charging for Prescription Renewals (Dean Clement, DPM)
From: Multiple Respondents

It makes sense both morally, ethically and probably legally to not keep giving prescriptions to patients without seeing them. How often they need to be seen varies with what is being treated. There are some chronic or seasonally recurring conditions such as those caused by fungi, which are well maintained by topical applications of certain medications. A patient might call and say, "doc, that athletes foot condition that comes back every summer is here again, can you prescribe that same cream that always takes care of it for me?" If you are busy you might be tempted to tell your office manager to call it into the pharmacy." Our policy is see these patients at least once a year and we are firm about this, even if it means losing the patient.

There are other chronic conditions for which patients are taking ongoing meds, which absolutely require that they be seen several times a year. Patients who are taking Cymbalta for example, might feel that they only need the refill, however drugs in that class require monitoring of liver enzymes three to four times a year. It is imperative that these people be examined quarterly in your office to make sure that their liver enzymes are fine, and they have no other overt signs of liver damage. We have the patients go to the lab prior to the visit and then sit down with them and go over the blood test results when they are in the office. In a busy office, it is possible by refilling prescriptions without seeing the patients to have serious pathology slip through our fingers and this can lead to serious problems.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

On a similar note, my dentist started charging ALL patients a five dollar fee to cover increased costs associated with medical waste removal. A stack of flyers on his reception desk explained that this was not a service covered by your insurance. He was nice though and since he treated all four members of my family, he only charged us ten dollars, instead of twenty.

Craig Herman, DPM, Bronx, NY, foothealer@aol.com

Would an attorney's refusal to give legal advice based on a patient's refusal to pay for the advice be considered an abandonment (hence, malpractice) if the client is subsequently harmed due to the lack of the needed legal advice? A "refill" implies an extension of treatment, but without seeing that patient, one cannot determine if the patient has the same problem or a new one. What happens if you refill a prescription and it is the wrong medication for the problem and a patient is injured?

Patients have no right to demand any medication without being evaluated first. That protects the patient and me.

Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

ASSOCIATE POSITION - BALTIMORE, MARYLAND

Seeking surgically trained individual competent in all phases of podiatric care. Outstanding salary and benefits. F/Tor P/T contact email rsher18@yahoo.com

ASSOCIATE POSITION – LONG ISLAND

Busy Wantagh, NY office. Motivated, preferably board certified, hard working, experienced in all phases of Podiatry. F/T, P/T hours available. excellent salary, call 516 242 7540 or Fax Resume 516 826 9036 or email jobke@aol.com

PRACTICE FOR SALE - MINNESOTA PRIME LAKES AREA

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner occupied building (for sale or lease). 260 402-7490.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

IMMEDIATE OPENING – CHATTANOOGA, TN

Excellent opportunity for a young well-trained personable podiatrist to join a rapidly growing practice. $100,000 salary. PSR-36 minimum required. Live, work and play in a beautiful area with many recreational opportunities including rock climbing, hang-gliding, whitewater paddling, fishing, boating, etc. Option for partnership/ownership track. No nursing homes. No weekends. E-mail cover letter and CV to drsegler@anklecenter.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP NY/PA

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at 85,000.00 with bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

ASSOCIATE POSITION – CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

ASSOCIATE POSITIONS – CALIFORNIA

Coast to Coast Mobile Podiatry Group, California's premier provider of mobile on-site health-care services is seeking hardworking, caring Associates to provide excellent health-care to the greater Los Angeles areas, Organge County, San Bernadino County, Riverside, San Diego, and Santa Barbara. Salary and benefits available. Please email you CV and salary request to coasttocoastpodiatry@yahoo.com

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