The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

June 22, 2011 #4,187 Publisher-Barry Block, DPM, JD

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Fifty Percent of Adults Suffer from Tired, Achy Feet: TX Podiatrist

Standing on your feet all day can take a toll on your body, causing foot discomfort that can really impact your day-to-day life. The average person takes 8,000 to 10,000 steps a day, according to the American Podiatric Medical Association. While this is considered healthy activity, maintaining foot comfort can be a challenge for some. 

Dr. Leslie Campbell

"Fifty percent of adults suffer from tired, achy feet, especially if they have jobs that keep them on their feet all day," says Dr. Leslie Campbell, a podiatrist and consultant for Dr. Scholl's. "Many aren't getting the relief they need, but there are simple ways to help relieve foot discomfort to keep you on your feet longer."

Source: Roanoke Rapids Daily Herald 06/14/2011]

IL Podiatrist Appointed to Joint Commission Advisory Committee; 2011 APMA Hotel Deadline Extended

APMA Health Systems Committee Member and Illinois podiatrist Neal Frankel, DPM, has been appointed as APMA's representative to the Joint Commission's Ambulatory Care Professional and Technical Advisory Committee. PTACs were created to advise each accreditation program on proposed standards changes. 

Dr. Neal Frankel

Members of the six PTACs include professionals from each respective field who represent national associations as well as advocates. Each PTAC is composed primarily of individuals nominated by selected professional associations. Health Systems Committee Chair and APMA Trustee, Laura Pickard, DPM, continues to serve as the APMA alternate representative to the Ambulatory Care PTAC.

APMA has announced that the deadline for the special group rate of $230 for rooms at the Sheraton Boston has been extended until Friday, June 24th. Reservations can be made by calling  888-627-7054. 

Source: APMA News Brief 6/20/11]

NJ Podiatrist Attends Tribute to E-Street Band Saxophonist  

Hundreds of the E-Street band's fans, including some who drove from hours away, gathered at the Stone Pony to remember Clarence Clemons who died Saturday at age 69 of complications from a stroke. The gathering Sunday afternoon juxtaposed bereavement and festivity. Fans milled around, drank beer, and sang along to Springsteen tunes as they talked about what Clemons' music meant to them.

Dr. Val Van Cleef, a 27-year-old podiatrist from Ocean Grove, said her parents never tire of talking about the time they sat next to Clemons at a restaurant when she was a baby. Clemons overheard it was the child's birthday and performed "Happy Birthday," the family story goes.

Source: Associated Press [6/20/11]

AMA Says Claims Errors Cost $17 billion

Claims-processing errors among commercial insurers add about $17 billion in unnecessary administrative costs to the healthcare system annually, according to the American Medical Association, which released its fourth annual National Health Insurer Report Card in conjunction with the group's annual delegates meeting in Chicago. The 2011 report card is based on a random sampling of about 2.4 million electronic claims for approximately 4 million medical services submitted in February and March 2011 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, the Regence Group, UnitedHealthcare and, for comparison, Medicare, according to the AMA. The claims were gathered from more than 400 physician practice groups in 80 medical specialties in 42 states.

The average claims-processing error rate for the six commercial insurers that were analyzed in 2010 and in 2011 was 19.3% this year—an increase of 2% over last year, according to an AMA news release. That increase is expected to add $1.5 billion in administrative costs over the course of this year, according to the AMA.

Source: Jessica Zigmond, Modern Healthcare [6/20/11]

Query: Calcification of Vessels 

There are some anecdotal treatments that I have read about including vit K2, chelation, and even hyperbaric oxygen that reportedly decrease calcium deposition in tunica media of arteries (Monkeburg's sclerosis) that we see all too often in diabetics. I have a relatively young (35) diabetic patient (D.M. x 8 years) who has a remarkable amount of calcific deposits in his pedal vessels. He has had problems with wound healing in the past and has had two ray resections due to osteomylitis by a local orthopedic/wound care physician. Apparently, he is compliant and keeps his glucose relatively controlled; other hematological parameters are normal.

Dopplers show pulsatile flow, although diminished, at DP and PT. Capillary fill time is about 4 seconds. He has moderate neuropathy with SW 5.07, not intact distally (digits), but intact proximally. I want to get volume pleth to help assess healing ability, but I am concerned that the expense of the test might outweigh its functionality. I believe that his calcified vessels are a large contributing factor to his poor wound healing. ls anyone aware of any definitive treatment (metabolic or invasive) to reverse or reduce vascular calcification?
 
Tip Sullivan, DPM, Jackson, MS

Query: Who is Responsible for a 19 Year Old?

My patient is 19 years old, clearly at the age of consent here in Indiana. The parents did not accompany the patient to the office. Do you still see the patient? When you have to balance bill, do you have any recourse against the parents for the bill if they were listed as the responsible party, but never signed the office financial forms stating so.

David Gurvis, DPM, Avon, IN

Editor's comment: PM News does not provide legal advice. In general, once children reach the age of majority, they are no longer the financial responsibilty of their parents. You can examine and treat these patients, however, without a signed financial from the parents, you have no recourse against the parents, even if they were listed by the patient as the responsible party. 

Query: New Modifiers for Ulcer Care?

I had a diabetic patient with peripheral neuropathy. I billed a CPT 99212-25 office visit, along with CPT 11721-Q9 for the mycotic nail debridement, as well as CPT 97597-59-RT for debridement of an ulcer.
This was denied.

Medicare told us to look at the most recent guidelines and modifiers. Any assistance would be appreciated.

Mark Ray, DPM, Latrobe, PA
 
Response: There are no new modifiers.

CPT 99212 was billed appropriately with the "-25" modifier.

CPT 11721 should have been appended with the "-59" modifier, not the CPT 97597 code.

Lastly, the use of the "RT" modifier was incorrect. The new debridement codes are based upon total aggregate size of wounds, so "RT" or "LT" and "T" modifiers no longer apply for those codes. Incorrect use of a modifier can get a claim denied as well.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here
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RE: Clinical Success with Poor Radiological Result (Tip Sullivan, DPM)
From: Pete Harvey, DPM

Fortunately, this patient is happy. Let’s hope she remains so until after the statute of limitations.

I hope podiatry plaintiff experts are reading this. I hope ALL podiatrists are reading this. Just because the post-op radiograph doesn’t look textbook perfect does not necessarily mean that there is a poor result. There are TOO many self-styled experts out there who are all too willing to take the stand and testify.

Unless “meaningful” tort reform is enacted soon at the federal level, there isn’t enough money out there to pay all the podiatry claims that result from less than perfect results.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Attestation Fraud (JM Cortez, DPM)
From: Michael Brody, DPM

Medicare has already acknowledged that they expect there will be fraud. They have already made provisions for random audits to ensure that the docs who get the money have met meaningful use.

The bottom line is, if you are going to ask for the check, please make sure you have met all 15 core and 5 of the 10 menu measures of meaningful use. With all of the work that is being done to educate our profession about this program, it would be a shame if a podiatrist ended up in the news for defrauding the system.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: Practice Fusion
From: Justin H. Sussner, DPM

I am currently a happy user of Practice Fusion. I and other users received notification in the past week that PF is now fully certified. I just felt that the news should be published so other doctors could take a look.

Disclosure: I have no financial interest in Practice Fusion.

Justin H. Sussner, DPM, Suffern, NY, jsussner@optonline.net

RE: FL Podiatrist Sees Home Visits as the Next Big Thing
From: Becca Hames

I think Dr. Gabe might be onto something. I have seen an increase in the number of podiatrists who routinely do home visits. Podiatry is an essential part of care for the elderly, and getting them out of their homes can be a huge inconvenience. Many physicians have great success in building and maintaining a substantial home healthcare practice. Some doctors have done this with only one or no staff members. With profit margins decreasing, this seems like a great way to differentiate yourself.
 
Disclosure: I am the Director of Operations for Appointment Desk, Inc.      

Becca Hames, Frisco, TX, adminoffice@appointmentdesk.us

STORE FRONT OFFICE SPACE AVAILABLE - NASSAU COUNTY NEW YORK

Office Space available for sublet or long-term lease. Nassau County established podiatry location for over 30 years. Fully equipped, and no investment required. Excellent Opportunity!!! Reply to: rrranch7@yahoo.com

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

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 - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity. Located at Mission Regional Hospital. Sale price $205,000 including supplies. Gross income 2010 was $340,000. Gross income 2011 estimate $420,000. Approximately 1200 sq ft with 3 treatment rooms, digital x-ray and fully computerized. A/R available at 50% discount. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Practice is expandable to full time with increasing hours and marketing. Real estate available for purchase. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.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 $760K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - WASHINGTON STATE - SUBURBAN SEATTLE

16 year established part time practice. Includes Midmark 417 (4 position keypad), Excel X-ray, processor, Ritter M9, instruments, bandaids, etc. 1 Day/week $50K gross. Professional Business appraisal at $48K. Asking $35K. Shared office with 2 FP's. Easily expandable. Reply: practiceforsale18@yahoo.com

ASSOCIATE POSITION/PART TIME - ORANGE COUNTY CALIFORNIA

Experienced podiatrist - 2-3 days/week, two office locations in beautiful south Orange County California. Exceptional opportunity for seasoned semi-retired practitioner. Fax or e-mail Resume and LOI to 949-488-0868 Info@feetfixer.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - NYC

Opportunity of a Lifetime. Are you the one-in-a-million podiatrist I’m searching for? Do you aspire to greatness? If you have a great smile, great attitude, take initiative, then you should consider this exceptional opportunity. I am seeking a smart, residency-trained podiatrist with great surgical skills to become an associate in one of the top practices in the country. Don’t miss out on this outstanding opportunity! Please email your CV to institutebeaute@aol.com with “Attn: Sophia Johnson” in the subject line.

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

ASSOCIATE POSITION - ST. LOUIS 

Group practice looking for podiatrist to join group and solely take over one location. Group's podiatrists enjoy incentive compensation plan (personal production and sharing group profits), benefits including health and malpractice. Perfect opportunity for solo practitioner to join group setting. Please forward CV to StlPodGroup@gmail.com

ASSOCIATE POSITIONS: NW INDIANA & CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - CENTRAL NORTH CAROLINA

Well-established, busy podiatric practice is seeking highly motivated, well-trained and personable associate for full-time position. Competitive Salary and Benefits, Buy-in Opportunity. Interested persons must be actively pursuing or have NC license. Send resume and letter of intent to gpagpa530@yahoo.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Southern California practice looking for highly motivated podiatrist for very busy, two location practice. Excellent salary and benefits offered. Please email resume to mrsmcmackin@aol.com

ASSOCIATE POSITIONS – NEW YORK CITY

Looking for someone with at least 2 yrs of 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 POSITIONS – TEXAS AND FLORIDA

Looking for podiatrists to see patients in nursing facilities in Texas and Florida. Please contact me at doconcall02@aol.com

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Seeking personable, ethical, motivated individual for a growing, well-rounded practice with potential for partnership. Must be PSR 24-36 trained. Competitive salary, incentive and benefits. Email CV to orin915@comcast.net
 

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