The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

June 29, 2012 #4,501 Publisher-Barry Block, DPM, JD

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Supreme Upholds Key Part of Healthcare Law

The high court announced Thursday that it was upholding the individual insurance requirement at the heart of the healthcare overhaul.

More details to follow in the next issue of PM News.

Source: Associated Press

Announcing the New AAPC Specialty Coding Certification 

We just posted an article by Dr. Harry Goldsmith on the benefits of obtaining the new Certified Surgical Foot & Ankle Coder (CSFAC™) examination  to be given at the Greenbrier Hotel and Resort on August 21, 2012.

Dr. Harry Goldsmith

This article discusses in detail the importance of achieving this prestigious certification for both podiatrists and their staffs.

AL Podiatrist Discusses Dangers of Going Barefoot for Diabetics 

For many youngsters, kicking off their shoes and going barefoot is a summer rite of passage. There are concerns from parents: stickers, broken glass, fallen arches and more. Dr. Joseph R. Dupper is a practicing podiatrist who said, for the most part, let them be kids. "Most of the time, I don't have a problem with kids going barefoot. Obviously, kids will step on things and there will be a lot of stubbed toes. A lot of kids will snag their nails on things and tear their toenails," he said.

Dr. Joseph R. Dupper

Of course, he said, there are exceptions to this rule. A primary exception would be if that person is a diabetic. He recently had a diabetic patient who stepped on a tack. "Diabetics often have neuropathy, which is when their nerves don't work and the feet get numb. He didn't know it until he took his shoe off and he'd been walking, possibly all day, with a tack in his foot," he said.

Source: Bobby Shuttleworth, WAFF, 6/27/12]

MI Podiatrist Has Family of Skating Champions

The Caicco family has a license plate that says it all, “ALL4SK8.” All four New Hudson residents — Karen and Gene, and their children Aaron, 11, and Grace, 9 — ice skate, and together they have won enough medals to fill a cabinet forcing them to look for another way to display all the medals.

(L-R) Gene, Aaron,11, Grace, 9, and Karen Caicco (Photo: Hal Gould)

Dr. Gene Caicco won his men's division hockey championship for two leagues that he participated in this year. Gene, a podiatrist in Warren, has been playing on hockey leagues in the area since 1994 when he came to Michigan. Karen, won the national silver medal this year with her synchronized skating team, Allegro. Aaron, 11, figure skated in The Michigan Showcase Competition at Hartland Sports Center and won his division. Grace recently won silver medals in her solo program for the Michigan Showcase and in the “Ann Arbor Springtime Invitational” competition.

Source:  Gale Andreassi, South Lyon Herald [6/28/12]

Phase 2 Trial Results in Wound Repair and Regeneration Product Published

Derma Sciences, Inc., a medical device and pharmaceutical company focused on advanced wound care, has announced that full results from its successful Phase 2 clinical trial with the investigational drug DSC127 in patients with diabetic foot ulcers will be published on July 5th in the July 2012 issue of Wound Repair and Regeneration. The article, entitled “NorLeu3-A(1–7) stimulation of diabetic foot ulcer healing: Results of a randomized, parallel-group, double-blind, placebo-controlled phase 2 clinical trial,” provides details on the efficacy and safety outcomes of the study and reviews the apparent mechanism of action of NorLeu3-A(1-7) (DSC127) in healing and includes information about prior pre-clinical work.

Drs. David Armstrong and Alexander Reyzelman

The article’s authors include Peter P. Balingit, MD of Olive View-UCLA Medical Center; David G. Armstrong, DPM, MD of the Southern Arizona Limb Salvage Alliance at the University of Arizona; Alexander M. Reyzelman, DPM of the California School of Podiatric Medicine at Samuel Merritt University, and others.

Source: Business Wire [6/27/12]

WV Podiatrist Receives Suspended Sentence on Drug Charges

A local podiatrist who pleaded guilty to a drug delivery charge was given a suspended sentence Wednesday in Wood County Circuit Court. Dr. Scott James Feathers, 57, was sentenced by Judge Jeffrey Reed to one to five years in prison with credit for one day served. The sentence was suspended and he received three years probation. Feathers was indicted by the January 2010 grand jury on two counts of delivery of a controlled substance, hydrocodone, to a confidential informant.

Source: Jeffrey Saulton, News and Sentinel.com [6/28/12]

Providers May Have Wiggle Room On 60-Day Overpayment Deadline

Although the health reform law requires providers to return Medicare and Medicaid payments 60 days after identifying them, knowing when to begin counting can make or break compliance. Some attorneys say providers can start later than they may think. For example, providers may be able to argue that the 60-day clock on identifying Medicare or Medicaid overpayments doesn’t start ticking until they bring in outside experts to nail down the amount and cause of the error, says Cleveland attorney Alan Schabes, with Benesch, Friedlander, Coplan & Aronoff.

While consultants shouldn’t be used to play a cat-and-mouse game with the overpayment-return mandate, “if there’s a legitimate reason for bringing someone from the outside, I think that a provider would have a basis to argue the 60 days shouldn’t start until after the outside party has come in,” Schabes says. A February regulation proposed by CMS to interpret the law (RMC 2/20/12, p. 1) says that when providers learn about a potential overpayment, they are obliged to make a “reasonable inquiry” to determine whether an overpayment exists.
 
Source: Nina Youngstrom, Report on Medicare Compliance [6/18/12]

Query: Chronic Post-Op Pain

Eight months ago, a healthy 52 year old male presented with fifth MPJ pain. I tried NSAIDs, cortisone shots, PT, orthotics, cast boot, rest, ice, elevation, and finally I performed a tailor's bunionectomy.  He has extreme post-op pain. Uric acid was neg for gout and no gouty crystals were seen at surgery. ID says no bone infection. MRI and ESR are negative. PT is unable to reduce pain. Primary care is unsure and refers the patient to a neurologist. Neuro says let's try Lyrica and see what happens. The patient is groggy but still has pain. A foot orthopedic surgeon says that there is no infection and the foot will will eventually heal. The patient is very upset as expected. Where do we go from here? Who would I refer to other than pain management? Who treats successfully these complicated cases?  

Joe Borden, DPM,  Reseda, CA

Query: Cancelled ADA Visit

My partner has a patient who scheduled a new patient appointment and informed us she was deaf. She DEMANDED an interpreter, and stated she would not write on paper (this is how we normally accommodate deaf patients). I know that the law states providers must make "reasonable attempts" to accommodate Americans with disabilities. Instead of arguing with the patient, my partner, at our expense, got a sign language interpreter for $100 the visit. Of course, we didn't get $100 for her Medicare 99202. Now, she had a follow-up visit scheduled and she cancelled that appointment. Since it was within 48 hours of the scheduled interpreter, the interpreter is still going to charge us $100! Can we bill the patient since she cancelled? How do others handle situations like this?

Alex Dellinger, DPM, Little Rock, AR

RE: Fosamax and Neuropathy? (From: Jeffrey Kass, DPM)
From: Elliot Udell, DPM
 
Kudos to Dr. Kass for mentioning the relationship between peripheral neuropathy symptoms and vitamin D deficiencies. In our practice, we have worked up a number of patients with severe peripheral neuropathy and found incidental findings of vitamin D deficiencies. In all cases, what motivated the ordering of the test was the finding of osteopenea in the met heads. When the patients were placed on vitamin D supplements (either over-the-counter or prescription grade), they had very rapid resolution of their neuropathic symptoms.

Hence, we now add a vitamin D 25 test as part of our work-up when we evaluate patients presenting with painful neuropathy. I want to caution readers not to interpret this as meaning that all cases of peripheral neuropathy are caused by vitamin D deficiencies, however, it should be on your differential diagnosis list when evaluating patients presenting with pedal symptoms of peripheral neuropathy.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: E-Prescribing (Martin G. Miller, DPM)
From: Alan Bass, DPM

You can report the e-prescribing code with any service for this reporting year (2012). It does not only have to be with a 99 series (E&M) code. The only restriction is that G8553 can't be billed as a stand-alone code, and you can't go back to previously submitted claims and attach the code. For reference, APMA members can access the APMA webinar given by Dr. Jim Christina on this topic.
 
Alan Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: NY Assembly Passes Expansion of Scope of Practice Law
From: Evan F. Meltzer, DPM

I was thrilled to learn of the Assembly’s passage of the scope of practice bill. When I served on the New York State Board for Podiatry from 2000-2001, this was one of my major efforts. The main focus of professional boards is to ensure the safety of the citizens of the state and protect them from inferior care. For those of you contemplating the eventual sale of your practices, this scope of practice expansion will considerably expand your opportunities.

Now that I am involved in training 3-year residents, I will be able to recommend New York State as a place where they can consider practicing. I certainly hope Governor Cuomo signs this important piece of legislation - for the common good of all New York State citizens and their podiatrists. I hope Mississippi and other restrictive states are able to follow this landmark legislation as well.

Evan F. Meltzer, DPM, San Antonio, TX, Evan.Meltzer@va.gov

RE: NY Assembly Passes Expansion of Scope of Practice Law
From: Robert Bijak, DPM

Perhaps I don't understand the nuances of this law. In one respect, I see that ABPS certification is required to touch the ankle in NY. Then I read "rear foot" ABPS certification is needed. We are tiering the poor little foot into fiefdoms, and a "foot specialist" is now only a specialist of part of the foot in NY. It seems we have restricted our scope, not expanded it. 

I think that those who are ABPS-certified are now feeling the exclusion that the non-certified DPM feels, if they aren't REARFOOT CERTIFIED. Do MDs parse up the foot like we do? I'm not sure I agree with the other posters who say this is such a great thing for NY podiatry, if you live in this temporal dimension! Hurray for the future or that very limited "rearfoot" DPM today. It truly leaves everyone else flat (footed). When I went to podiatry school, I thought I was going to be a foot specialist with no asterisks around it. I guess the NYSPMA tried to expand our scope, but the legislature is still hung up on that limited DPM degree. 

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: NY Assembly Passes Expansion of Scope of Practice Law (Bryan C. Markinson, DPM)
From: Elliot Udell, DPM
 
Dr. Markinson writes the following  regarding the passage of the expanded scope of practice law: "Those meeting the requirements for osseous ankle surgery will also be the ONLY ones who can biopsy a skin lesion or scrape a wart off the distal leg."
 
If this be the case, I hope that the New York State Podiatric Medical Association will contest this. Many podiatrists such as myself do not intend to train nor to perform ankle surgical procedures, but almost all of us will treat a soft tissue problem that is within the new anatomic scope of practice in New York State. As Dr. Markinson implied, one does not need to know how to perform an ankle fusion in order to do a punch biopsy or remove a wart. We are already trained in how to do these soft tissue procedures. To deny the majority of podiatrists the right to perform these is in injustice to not only the practitioners but to their patients, and it will add on to the cost of healthcare because these patients will have to be referred to other doctors.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

WANTED TO PURCHASE- PINPOINTE LASER

Seeking to purchase Pinpointe used laser. Willing to pay top dollar. Please contact us at: sbalandrano@zapnails.com or (1) 713-541-3764. Product Information: Product: PinPointe (Patholase) Company: Cynosure / PinPointe Type: Nd:YAG Options: Podiatry/Toenail

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 516 476-1815PODO2345@AOL.COM

PRACTICE FOR SALE – KANSA  SOUTHWEST

For sale multi-location practice in beautiful Southwest Kansas. Practice has 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Recently added new office space with digital x-ray. Only surgical podiatrist in 2 of 3 locations. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice, a great location and opportunity for the right doctor. mcrosby@picagroup.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

ASSOCIATE POSITION – VIRGINIA

Two office practice, hospital and surgery center privileges, trauma call, modern offices, EHR, digital x-rays. Excellent compensation package. Position may lead to partnership. Candidate needs to be experienced in foot and ankle reconstruction and trauma. Email letter of interest and CV to Dr. Joe Disabato at jdisabato@vfasa.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-Time Associate needed for busy multi-office locations in LA, Orange, San Bernardino and Riverside counties. SIX FIGURE SALARY PLUS BENEFITS!! Knowledge of Spanish is helpful. Good mix of office patients, house calls, some surgery, etc. NO NURSING HOMES!! Needed immediately. If interested, please send contact information and CV to scpodgroup@yahoo.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Podiatry office in Central NJ- Looking for a three year surgically trained associate who has entrepreneurial spirit for a very busy office. You will see new patients and have the potential to become board certified in two years. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter." Please fax your CV to: 732-968-8821.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time/Part-time, motivated, outgoing associate wanted for immediate job opening. Multi-office, multi-doctor practice based in Orange County, is looking for hard-working individual to treat wide range of patients. PSR 24 training a must and Spanish speaking a definite advantage. Email your CV to: ocpodiatryoffice@gmail.com

ASSOCIATE POSITION – WILMINGTON, DELAWARE

Seeking full time associate, PSR 24/36 Board Qualified/Certified that is personable, highly motivated, ethical and hard working. Established 25 years old, well rounded, and busy practice. In large primary care based medical building with lab, X-ray, CT, ASC and medical aid unit. Multilingual is beneficial. Offering competitive salary with bonus opportunities and wide range of benefits. Partnership potential. Cover letter / CV to: Del.DPM@gmail.com

ASSOCIATE POSITION - DAYTON, OHIO

Seeking motivated PSR 24/36 trained Podiatrist for busy established practice; EMR established; Good surgical opportunity; Competitive salary and benefits. Send CV to:podreply@gmail.com

ASSOCIATE POSITION - MASSACHUSSETTS

Looking for an extremely hard working podiatry associate for part-time work, opportunity for full time. Busy and expanding podiatry practice in the Merrimack Valley. Will work in both office and nursing home setting. In office, we have laser technology, electronic medical records, diagnostic ultrasound, x-rays, etc. Please email us at: resumesent11@comcast.net if you have interest in this position. If we find the right person, this opportunity could lead to partnership. Looking forward to hearing from you.

ASSOCIATE POSITION - ST AUGUSTINE, FL

A well-established, solo-physician in St Augustine, FL; is seeking a full-time associate. Applicant should be well-trained with sound surgical skills, applicant must be board eligible/certified. Practice offers a state-of-the-art practice setting, with a good general mix of all aspects of podiatric medicine and surgery. Competitive salary. E-mail resume to:drfootwound@gmail.com

ASSOCIATE POSITION - BOSTON/CAPE AREA

Boston/Cape Area Practice looking for physician experienced in surgical and medical care in office, clinical, and nursing home settings. Practice will provide opportunity to utilize training immediately. Both surgical and non-surgical applicants. Email CV to: drjaa@verizon.net

ASSOCIATE POSITION- WASHINGTON

A well-established practice with 4 locations in and around Seattle is seeking a full time/part-time associate podiatrist. Position involves clinical, nursing homes, laser therapy. Applicant should be well trained physician and a motivated, energetic self-starter, completed minimum a 24-month residency. Please send inquiries to: isbinc2006@gmail.com

ASSOCIATE POSITION - WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice. Visit our website www.centralmasspodiatry.com

ASSOCIATE POSITION - OHIO

Ohio practice with excellent reputation and patient base seeks to hire a Podiatric Surgeon. The offices are state of the art including Digital X-Ray, EMR, Diagnostic ultrasound, Padnet Vascular Testing, CO- 2 Lasers all aspects of DME. The base salary is $120,000 with a bonus structure and benefits also would like to have this individual buy into the practice eventually. Please send CV to: Ohiopodiatrist@aol.com

ASSOCIATE POSITIONS– MARYLAND

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

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