June 26, 2006 #2,615 Editor-Barry Block, DPM, JD

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PA DPM Provides Advice on Fungal Infections

Dry, itchy feet likely mean you have a fungal skin infection (a.k.a. athlete's foot). Yellow, thick toenails indicate the fungus has invaded your nails. Heavy winter socks and rain boots create a dark, humid environment, which facilitates fungal growth. You can also pick up the fungus at the gym or during a salon pedicure if the instruments or footbath weren't sterilized properly, says Tracey Vlahovic, D.P.M., a podiatrist at Temple University in Philadelphia.

Once a fungal infection spreads to the nails, it's much more difficult to get rid of, so start treatment right away. Vlahovic recommends using an OTC antifungal cream such as Lamisil. If you have a nail infection, see your podiatrist, who will likely prescribe an oral version of Lamisil. But know that it can take up to a year before your toenails look normal again.

Source: Nicole De Coursy, Redbook

Barry Holds Rite of Passage Ceremony

Barry Students at Rite of Passage Ceremony

"As the next generation of podiatric physicians, it is up to you to keep the profession progressing in quality, educational standards, professionalism, and recognition as equal partners in the healthcare delivery system," advised Dr. Jay R. Newman to the 46 Barry University podiatric medical students participating in the recent Rite of Passage ceremony on the Miami Shores campus. Dr. Newman served as the keynote speaker and presented his daughter, Laura Newman, with her white coat marking the beginning of her clinical experience.

The Rite of Passage ceremony, narrated by Jeanna Van Pelt, president, Class of 2009, continues a tradition at Barry University for podiatric medical students. Each student was presented with their coat by Michael Siegel, PhD, associate academic dean; Ramjeet Pemsingh, PhD, chair of basic medical sciences; and John Nelson, DPM, associate dean of clinics.

Over 500 family, friends, students, and members of Barry's faculty and staff attended the program to celebrate this important milestone and recognize the accomplishments of the podiatric medicine and surgery Class of 2008.

Marti Solomon, DPM, Class of 1995 delivered an inspiring alumni address recommending to the Class of 2008, "the one thing that will set you apart from the average doctor is a strong moral ethical character based on kindness, respect, honesty, and love for self and others." Diana Rogers, president, Class of 2008, indicated, "We are now student doctors and we represent Barry University and the great profession of podiatric medicine. We are armed with the knowledge to heal people. Now, go and make your class, your university, and your profession proud."

Docs See Decline in Real Income: Study

Average net income for doctors dropped 7% after adjusting for inflation from 1995 to 2003, according to a new survey by the Center for Studying Health System Change. Officials blamed flat or declining fees from both public and private payers for the decrease. According to the report, increases in Medicare payments over that period amounted to 13%, or well below the 21% rate of inflation over that time span. Commercial fees to insurers stood at 1.43 times the Medicare payment rates in 1995, but fell to 1.23 eight years later.

Primary-care physicians took the biggest hit to the wallet, a 10.2% decline in real income over that period. Real income for surgeons, meantime, fell 8.2%, while other medical specialists' real income remained essentially unchanged, according to the nationally representative telephone survey of patient-care physicians. For all patient-care physicians, the average salary in 1995 was reported to be $180,930. Based on 1995 dollars, according to the report, the inflation-adjusted average salary for these doctors was $168,122 in 2003. In current dollars, net income for all patient-care doctors stood at about $203,000 in 2003, according to the report.

Source: Michael Romano, Modern Healthcare [6/22/06]

Make more money while increasing staff, patient, and physician satisfaction by attending a power packed one-day practice management meeting being held by the American Academy of Podiatric Practice Medicine http://www.aappm.org on Saturday, July 22, 2006 (optional and complimentary comprehensive coding and billing session Sunday morning) at the Pittsburgh Airport Marriott. What makes this THE ultimate meeting of the year? A wide array of practical topics presented by podiatric experts, inexpensive room rate for premier Marriott Hotel, low-cost registration, peer exchange and roundtable discussions, workshop specifically to address maximizing billing and coding, no weekday away from the office, and special reduced rates for residents and new practitioners. See program brouchure at www.aappm.org

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Lawsuit From Residency

I am currently in private practice pretty fresh out of residency (1 year). I am currently involved in a lawsuit from my residency. The attending is being sued, and my name is on the lawsuit, as well as the medical institution. The patient is a private patient of the attendings; the only time I interacted with her was during the surgical procedure (bunion). I never saw her again.

The medical institution has appointed me a lawyer who I have been dealing with. Pretty soon I have to give a deposition. I would appreciate anyone who has experience in these matters to answer the following questions: Do residents usually get dropped from the case eventually, and if they do not, what are the ramifications on my permanent record.

New Practitioner

Editor’s comment: PM News does not provide legal advice. In typical situations, residents are dropped from the suit, but one should never assume this. Fortunately, you have a lawyer who should both prepare you for your testimony and seek to have you removed from the suit.

In the worst case scenario, the case goes to trial and a plaintiff’s verdict is rendered with your name listed. Under the theory of contributory negligence (which applies in most states), the jury would then determine what percentage of the negligence is attributable to you. Hopefully, the institution has a policy or is self-insured, so you wouldn’t have to pay.

You would however, have to report this action on license and credentialing applications. In that case, you should attach a note explaining your limited involvement.

Query: Date Last Seen

I just heard from my staff that the requirement for the date a patient is last seen by their primary care physician only has to be an "approximate" date. This would be part of a qualification for covered routine foot care on systemic conditions listed with an astrisk (*). My staff member told me she learned this at the New York Clinical Conference.

I always thought the date needed to be the EXACT date that the patient with a condition marked with an astrisk last saw their primary care doctor. Getting the exact date has always been a problem in our office. No matter how many times we tell the patient that they need to give us the specific date, most of them never seem to know it, and either have to call us later (IF they can remember to do that) or require us to call their MD/DO to get it.

With the information obtained from the New York Clinical Conference regarding only needing the approximate date the patient was last seen by their primary care physician, it takes a lot of burden away...now is this true?

PM News Subscriber, New York

Response: Your staff member probably heard that from me. There is no question that an approximate, and not exact date is acceptable.
The exact wording from the Coding Guidelines on the Empire Medicare
Website www.empiremedicare.com/newypolicy/policy/l3107_final_guideline.htm
is: "The approximate date in an 8-digit (MM/DD/YYYY) format when the beneficiary was last seen by the MD, DO, or qualified non-physician practitioner who diagnosed the complicating condition (attending physician) must be reported in Item 19 of the CMS-1500 claim form or the electronic equivalent."

The requirement is "for these diagnoses, the patient must be under the active care of a doctor of medicine or osteopathy (MD or DO) or qualified non-physician practitioner for the treatment and/or evaluation of the complicating disease process during the six (6) month period prior to the rendition of the routine-type service or if the patient had come under a physician’s care shortly after the services were furnished."

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Competitive DME Bidding Crisis
From: Barry H. Block, DPM, JD

Podiatry faces yet another crisis emanating from the fact that we stubbornly cling onto our DPM degree. This means we will once again collectively expend our resources, including time and money to fight to be included with MD’s and DO’s. Hopefully, through the efforts of APMA leadership, staff, and members, we will once again prevail.

Unfortunately, there will be more crises in the future because we refuse to address the etiology of the problem, and instead look for the quick fix. We refuse to accept the reality that the only viable way to achieve parity in the MD/DO world is to change our degree (not our specialty).

Ironically, the podiatric community (not the MD’s and DO’s) is responsible for holding us back. It is us who are afraid that somehow changing our degree will destroy the profession or that existing podiatrists will become second-class citizens. We heard these same sentiments when Irv Kanat first proposed board certification. Can anyone now dispute the value of establishing board certification?

It’s time for this profession to remove its “present-oriented” tunnel vision and start planning for the future. It’s time to stop rationalizing why podiatry can’t or shouldn’t be a traditional MD/DO specialty and just do it. Once we achieve this consensus, and remove the obstacle we ourselves have built, the pathway to parity will be far easier than anyone can imagine.

Barry H. Block, DPM, JD, Forest Hills, NY bblock@podiatrym.com

RE: Proposed Changes in Medicare Reimbursement for 2007 ( Richard Rettig, DPM)
From: S. Rosenkrantz, DPM

I have seen over the past 25 years that I have been in practice systematic erosion in fees for podiatric services. I often wonder why the podiatry profession has become the target of CMS discrimination. We have upgraded the schools, increased the residency training and the overall level of competence of our graduates. I used to work with several ALFS and found that the home health nurses were getting paid more than I was for simply following the wound orders I gave and the bulk of the liability resting on my decisions. The editor’s thoughts on this and those of others would certainly interest me. Why has our profession been so complacent in regard to fee discrimination?

S. Rosenkrantz, DPM, footdr@earthlink.net

Editor’s comment: APMA has been anything but complacent in addressing fee discrimination by CMS and others. In fact, they have expended huge sums of money on this issue, which could have been spend on badly needed funding of research, as well as public relations. We are discriminated more because we hold a DPM degree than because we are podiatrists.

We are stuck in this vicious cycle because in the past, most of our college and APMA presidents have wrapped themselves in the false pride of the DPM degree, when the true pride should be that we are podiatrists. It’s not the DPM that makes us podiatrists, it’s the totality of out training, including residencies, fellowships, etc. We were still podiatrists in the 60’s with Pod.D and DP degrees. We will still be podiatrists with MD or DO degrees.

Hopefully, the future college and APMA presidents will demonstrate the courage and wisdom to change the current paradigm.

RE: Diabetic Footwear Data (Jengyu Lai, DPM)

I was co-author on a paper in Clinics in Podiatric Medicine and Surgery published in 1998. That issue focused on diabetic foot problems (wound care, infections, etc.) The exact reference is "The healed diabetic foot, What next?", Clin Podiatr Med Surg, 1998 Jan; 15 (1): 155-74. Crane M, Branch P. Be sure to get a printout of the bibliography to reference back to a number of articles that should give you plenty of ammunition.

Palmer Branch, DPM, Chattanooga, TN, mailto:drcuboid@aol.com

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

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--NEW YORK CITY

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in Manhattan and Queens. Must be willing to perform all aspects of podiatry. Must presently have New York license. Position available immediately for the right candidate looking for a future partnership opportunity. Fax resume to 212-753-3521 scottlurie@eastsidepodiatric.com

PSR-24 RESIDENCY POSITION - SOUTHEASTERN MICHIGAN

The P0H Medical Center (POH), Pontiac, MI has an opening in its Podiatric Medicine Residency Program. POH is a major teaching affiliate of Michigan State University College of Osteopathic Medicine. This is an excellent opportunity for a highly focused individual, who just graduated or has already completed a PPMR/RPR and or a PSR-12 program. POH offers an excellent learning environment with three high volume surgical venues and two busy foot/ankle clinics, including a limb salvage and wound clinic; as well as a competitive salary and benefit package. For further information, please contact S.J. Goldstein, DPM, POH Medical Center (248) 338-5392 FAX – (248) 338-5567

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.

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

WEEKLY SPECIAL - One week of ads (6x) for only $75

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Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

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