The Voice of Podiatrists

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June 28, 2008 #3,284 Editor-Barry Block, DPM, JD

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Going Barefoot Not a Problem in Healthy Patients: CT Podiatrist

Can shunning the protection of shoes really be all that good for one's feet? "Generally, I don't see a problem with it," says Marc Lederman, president of the Connecticut Podiatric Medical Association. "A lot of the conditions we treat ... there's no doubt that shoes cause many of those problems," he says.

Dr. Marc Lederman

Going shoeless on occasion does get air to the feet and can strengthen muscles reliant on arch support, says Lederman. But it's not a cure-all for serious foot conditions. And there are certain medical problems for which it wouldn't be wise to go bare, he says -- poor circulation, open skin fissures and diabetic neuropathy, which causes a foot desensitization that increases the likelihood of suffering scrapes, cuts and blisters. But in healthy patients, barefoot living is an individual matter, says Lederman.

Source: Joann Klimkiewicz, Los Angeles Times, [6/25/08]

NYCPM Uses Actors to Test Third-Year Students’ Clinical Skills

Recently, every third-year student at the New York College of Podiatric Medicine (NYCPM) took part in the newly-instituted CAPSTONE Assessment Program, spending nearly 20 minutes apiece in examination rooms at Foot Clinics of New York with each of two different standardized patients – actors trained to simulate particular disease states and to perform as a patient would during an exam. Each student took his or her patient’s history, performed a physical examination, and reached a diagnosis of the complaint when possible.

Kevin T. Jules, DPM, conducts a training session for the standardized patients prior to NYCPM's newly-instituted CAPSTONE assessment.

The focus of the CAPSTONE Assessment Program is on the process of interviewing and performing a physical exam, rather than on treatment. NYCPM faculty members Thomas M. DeLauro, DPM, Professor and Chair, Department of Podiatric Medicine, and Kevin T. Jules, DPM, Professor and Chair, Department of Surgical Sciences, each developed one of the two cases, and drew up a checklist of the minimum competent things students were expected to ask their patients about during the course of each of the two exams.

This type of clinical assessment program is a standard method of assessing students in allopathic and osteopathic medical schools. This year, the program at NYCPM was essentially a trial run but in future years, third-year students will be required to pass the exam in order to be promoted to the fourth year.

CPMA Elects New Officers, Presents Awards

At the recently held House of Delegates, the following officers of the California Podiatric Medical Association were elected:

Dr. Daniel Altchuler

President - Daniel Altchuler, DPM
President-Elect - Stephen Wan, DPM
Vice President - Michael Cornelison, DPM
Secretary/Treasurer - William Tarran, DPM

CPMA added three new Directors-at-Large: Jeffrey Haupt, DPM, Diane Branks, DPM, and Thomas Elardo, DPM.

The following 2008 Major Awards were presented:

Vision Award - Ross Taubman, DPM
Lifetime Achievement - Roderick Farley, DPM
Podiatric Physician of the Year - Randall Sarte, DPM
Distinguished Service - Albert Burns, DPM
Meritorious Service - Stephen Wan, DPM
Society President of the Year - Ami Sheth, DPM
Executive Director Award - Jonathan Labovitz, DPM
Rising Star Award - Heather McGuire, DPM
Volunteer of the Year - Loreen Flaherty, DPM
Excellence Award - Thomas Chang, DPM
Education Award - Neil Mansdorf, DPM
President’s Award - CPMA Staff

Save Time

When someone asks to meet with you, ask them how long the meeting will take. That prompts the person to think through the request and offers you a way to shorten or end the meeting.

Source: Adapted from Communications Briefings [May, 2008]

Query: Narrow or Custom-Made Road Biking Shoes

Does anyone have any recommendations for custom-made road biking shoes? My patient notes he has problems with shoe fit since he has narrow feet and no shoe seems to be appropriate. Which companies are reliable? Have you encountered any problems? What is the approximate cost?

Andy Karpf, DPM, Tel-Aviv, Israel

Query: Automatic Processor

Since Polaroid is no longer manufacturing x-ray film (making Polaroid developers obsolete), I am interested in viewpoints for an automatic processor for a small office. I don’t want to go too high-tech. Any suggestions would be appreciated.

Vincent L.Travisano, DPM, St. Louis, MO

Query: Two Surgeons - *62* Modifier

Does Medicare (New York) ever reimburse a claim with a "-62" (two surgeons) modifier?

Susan Doerner, Office of Richard Goldstein, DPM
New York, NY

Response: New York Medicare does recognize modifier "-62" (two surgeons). CPT instructions for its use are: "Two surgeons (co-surgery) - Under certain circumstances, the skills of two surgeons (usually with different skills) may be required in the management of a specific surgical procedure. Adding modifier 62 to the procedure code used by each surgeon should identify the separate service."

I am not aware of anyone being paid for using the "-62" modifier, however, that really doesn't matter. If you and another surgeon both operate on the same patient, and you feel you've met the modifier definition, including medical necessity, each of you should bill for the procedure you performed, and append a modifier "-62". If one or both of you are denied payment, appeal and make sure you have documented clearly why co-surgery was required.

Mark Schilansky DPM, Catskill, NY

Codingline subscription information can be found by clicking here

RE: Call To Action HR 6331 - TIME URGENT
From: Fay Frankfort

I urge all PM News readers to call the offices of Senate Republicans and ask them to vote YES on HR 6331 immediately.

APMA learned during a meeting with Democratic leadership that the Senate will not be voting on a Medicare compromise bill as reported by many publications, but will vote on HR 6331, the Medicare bill passed by the House on Tuesday by an overwhelming veto-proof vote of 335 to 59. The vote may occur as early as today (Friday), and Senate Majority Leader Reid has pledged not to adjourn the Senate for the July 4 recess until the bill has passed.

This bill benefits podiatric physicians by:
* providing a 0.5% positive fee update for the rest of 2008
* providing a 1.1% positive fee update for all of 2009
* delaying the durable medical equipment, prosthetics, and supplies (DMEPOS) competitive bidding program for 18 months until it can be further reviewed for cost effectiveness and efficiency
* exempting off-the-shelf orthotics from competitive bidding (including items such as cam walkers, aircast boots, night splints, and ankle foot orthoses with the appropriate diagnoses)
* exempting podiatric physicians and other licensed health care providers from DMEPOS supplier accreditation requirement
* authorizing podiatric physicians to perform the face-to-face examination required to prescribe DMEPOS for patients

Faye B. Frankfort, Director, APMA Legislative Advocacy, American Podiatric Medical Association

RE: Ordering 10% NAOH (Bruce Lebowitz, DPM)
From: Multiple Respondents

The product is made by Gordon Labs and I order it from Gill Podiatry. I have been using NaOH for about 20 yrs with excellent results. I follow the application with vinegar.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

I bought mine through Fisher-- a large chemical supply house. It comes in a very large bottle compared to how much you use (I think it was one liter). Also, I ordered plastic small containers to use it from as suppliers to our profession usually ship it in glass and NaOH etches glass, thereby degrading the NaOH over time (I used to be a chemist).

Marc Klein, DPM, Methuen, MA, MAILKlein@aol.com

Any local pharmacy that does compounding can make it for you.

Paul Busman DPM, RN, Cohoes, NY, BREWERPAUL@aol.com

RE: Kudos to Al Burns, DPM
From: Tip Sullivan, DPM

Dr. Venson has some very big shoes to fill as the new Dean at Samuel Merritt. Al Burns was and still is one of my mentors. There have been few in our profession who has influenced so many students. As I look back some 20 years, I like to compare Al with Frank Sinatra, or Sammy Davis, or Dean Martin. Al has been one of the members of the West Coast “rat pack.” That is: one of the best, the most influential, the most innovative, and the most dependable.

Everything Al has produced or been involved with as far as I am aware of has been “the best” : The best papers, the best department, the best residency (I do admit bias), the best ideas, the best for our profession. You can bet that anywhere you see his name it will be associated with something of quality that is good for our profession. Our profession is lucky that he will still be there to teach our future colleagues-I am honored to have been one of his students. To Dr. Burns I say: thank you! Keep it up - our profession needs you!

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

ASSOCIATE WANTED IMMEDIATELY – NEW YORK

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 - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PRACTICE AND EQUIPMENT FOR SALE: RIVERTON, WY

Solo practice of 8 years left without doctor due to illness. Clinic name is still in the phone book with active phone number. Over 4,000 patients on the books. Various supplies and equipment available (ultrasound, xray, processor, Osada drill, mayo stands). Will consider all offers. Contact Sylvia at jefsyl@windstream.net

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

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

Part-time or Full-time for group practice Fast track to partnership. Located in Orange & Sullivan County, NY. Commute from adjoining counties to see how it fits. Monroe, NY office is only 1 hour from Manhattan. All phases of podiatric care. Call Dr Marc Hudes 845-807-8864. Check out our practice website

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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