June 23, 2006 #2,613 Editor-Barry Block, DPM, JD

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PM’s Survey Data Contradict Premise That Orthotics are Overprescribed

"Are orthotics overprescribed?" said Robert Eckles, a podiatrist and a professor at the New York College of Podiatric Medicine. "I would probably say yes. But look at guys in their 40's and 50's, overweight and riding a $5,000 bicycle though Central Park. Do they need that? Of course not."

Not every podiatrist is convinced that prescription orthotics outperform store-bought ones. David M. Davidson, a podiatrist in Buffalo, N.Y., who focuses on sports injuries, said he solves 99 percent of his patients' problems without a custom orthotic. Stretching, anti-inflammatories and off-the-shelf insoles are treatments he suggests.

A recent survey of 500 podiatrists conducted by Podiatry Management Magazine found that they were not prescribing custom orthotics more now than in the past decade. Those surveyed, in fact, were recommending low-cost prefabricated models at a slightly higher rate than custom ones.

Read full article at: http://www.nytimes.com/2006/06/22/fashion/thursdaystyles/22Fitness.html?pagewanted=1&_r=1

Source: Sarah Tuff, NY Times [6/22/06]

Fake Nails For Temporary Use Only, Says Robertozzi

They are changing people's lives. Fake toenails, that is. Yes, artificial nails, aka "press ons," have migrated southward from fingers to toes. And they're selling like crazy: During the 12 weeks that ended May 13, the artificial toenail segment of nail product sales was up 126 percent compared with the same period last year, according to market research company ACNielsen.

Dr. Christian A. Robertozzi sees a downside to the nails. He's president-elect of the American Podiatric Medical Association, and treats a lot of toenail fungus in his Newton, N.J., practice. "When you block off the air and sun supply it increases the chance of fungus," Robertozzi cautioned. "That's exacerbated on your feet. Socks and shoes on acrylic toenails would make it worse."

He recommended wearing the artificial toenails only temporarily — perhaps a few days for a special occasion.

Source: Dru Sefton, Newhouse News Service [6/21/06]

Off-Label Drug Use Is Common; Lacks Scientific Justification

Of the 725 million total U.S. prescriptions written in 2001, more than 20% went to treat conditions not approved on the drugs' labels, according to a recent journal study that finds most off-label prescribing lacks scientific justification. Health plans acknowledge widespread off-label prescribing continues to raise concerns, and some plan pharmacy executives are advocating greater use of "evidence-based medicine" as a way to ensure the practice doesn't harm patients or waste money.

According to an article in last month's Archives of Internal Medicine, roughly 73% of the 150 million off-label prescriptions written in 2001 had "little or no scientific support" backing up such use. "Efforts should be made to scrutinize under-evaluated off-label prescribing that compromises patient safety or represents wasteful medication use," the report concludes.

Source: Drug Benefit News [6/16/06]

Query: Check-Off Documentation Forms

I am curious, what is the general consensus on check-off examination forms such as Docuforms? Would they stand up to an auditor's scrutiny? I have received referrals from a few local PCP's who use similar forms for their general H&P's and examinations. The info on these forms seems to be very limited. I have played with some of the forms myself and they do cut down dictation time for me.

Matthew Etheridge, DPM, Pensacola, FL,

matthewetheridge@bellsouth.net

Editor’s comment: PM News does not provide legal advice. Check-off forms, if used properly, are a perfectly acceptable method of documenting findings. The key, of course, is that whatever is checked off accurately reflects your examination. When an auditor examines several charts from the same office, he or she first looks to see that each form looks different. In other words, there must be enough customization to offset the feeling that the practitioner has merely “rubber stamped” the forms.

A good pre-printed exam form contains several views of the foot, so the practitioner can circle the area(s) of chief complaint and/or lesions. A properly completed form will withstand an audit far better than illegible hand-written notes.

RE: It's Their Debt, But It's Your Problem (Bob Levoy)
From: Joel Lang, DPM

I think that Bob Levoy is exactly on target about the effects of excessive debt on a person's ability to function. When I left podiatry, I began my financial planning career as a debt counselor -volunteering for the extension service for the University of Maryland.

Unfortunately, there are a lot of scam artists, some of whom a large companies who charge clients exorbitant fees for managing debt. Obviously, this exacerbates their problem instead of solving it.
Debtors can get free counseling from the Consumer Counseling Service of America. They can also look to their local extension service from their local universities.

In most cases where there is significant debt, it does take some level of professional intervention to get people 'well' again. There are methods for effective budgeting and exchanging cards for lower interest rates, etc. Debt is like a rock around the neck of people, trying to swim toward a future of financial security. They are more likely to drown before they reach their goal.

If doctors want happy, effective employees, they need to be a resource for the problems and issues their employees face.

Joel Lang, DPM, Cheverly, MD, langfinancial@verizon.net

RE: Patient Extortion? (Barry Block, DPM, JD)
From: Multiple Respondents

I find the two sides of this argument very interesting. I personally believe in taking the high road and not give in to the patient's demands. The one thing that I have not seen posted about this situation is the fact that if you do pay the patient whatever it is that they are trying to extort, there is still no guarantee that they will not try to sue anyway. If they see that they can get money from you easily, they may decide to get more from your insurance because you won't want to deal with having to go to court and will just settle with them. Don't be so naive to think that they are good people and would not do that.

Richard Burnell, DPM, Camden, SC, burnell_cfc@bellsouth.net

It might appear to be prudent to "pay off" a patient who is suing and avoid costly and emotionally debilitating litigation. This was the policy of many medical practice insurance companies. They had a "hammer clause" built in and were able to force any doctor to accept a settlement over a bogus claim so long as the underwriters felt that they were saving money. This approach however did not work in the long run.

Many years ago I spent a day with a relative of mine who is a partner in a general negligence firm. I was amazed at how much the attorneys and their ancillary staff knew about insurance companies. They knew exactly which firms were quick to pay for any car accident, slip and fall injury or medical mal claim. They were as up on this as we are when it comes to how much insurance companies pay us for our procedures. Now if word gets out to the legal community that we are being soft and will quickly pay out anything in order to "hush" a patient who tries legally extort money from us, we will be open game for every attorney processing any form of bogus claim against us and again our premiums will rise beyond our control.

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

The failure to make reasonable attempts to balance bill patients and collect for rendered professional services is a direct medical compliance violation. This tactic is considered an inducement to procure patients to provide professional services and represents a kickback violation. The exception is a patient who demonstrates, through proper paper trail documentation, a financial hardship. On rare occasions, a healthcare professional may opt to write off a balance as a gesture of good will...but shouldn't do so as part of a consistent office policy.

If one were to succumb to an extortion threat without merit, such as the one depicted in the prior post, especially when treatment plan and outcome were both appropriate and optimum, the practice and its practitioner are harmed in many ways: 1. It breeds further extortion attempts 2. It serves as an unwritten admission of wrongdoing and guilt 3. The community message is horrible- that you, as a person, are weak. 4. It undermines the healthcare provider's future ability to establish meaningful doctor-patient relationships for succumbing to something like this...who could one ever trust again?

While I respect and empathize with Dr. Block's and, in the past, Mr. Boone's sentiments regarding the potential inducement of patient antagonism through balance billing...this must be weighed with common sense and some grit. I can't fathom a scenario where I wouldn't stand up to a patient who is attempting to extort me, or threaten my reputation via meritless slander, or via a nuisance malpractice suit, when I've done nothing wrong, simply to create a deterrent relative to honoring their financial responsibility. If they have that little regard for my professional worth, then I'd have no hesitation and no recourse to immediately dismiss them from my practice, and, still, balance billing them...taking them to collections and placing liens on their assets, if necessary, until their balance is paid.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

Editor’s Note: This topic is now closed.

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.

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

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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