The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 06, 2009 #3,589 Publisher-Barry Block, DPM, JD

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Heel and Arch Pain is Number One Complaint: TX Podiatrist

Dr. Gene Reister has been practicing podiatry in Dallas for 31 years, and says this is the time of year when you can prevent foot injuries. “The number one reason adults come to my office is heel and arch pain, which is usually due to excess stress in the plantar fascia ligament in the arch of the foot,” he said. “Next to going barefoot, flip-flops offer the least amount of support.”

Dr. Gene Reister

“If you just wear flip-flops around the pool, or for a limited amount of walking, people run a low risk of foot problems,” said Reister. “Children are going have fewer problems, because they put less pressure on their feet than full grown adults. We have an expression: ‘Big people have bad feet.’ If you are not overweight or not going to be engaged in strenuous activities, you should be fine.”

While foot health is rarely on the forefront of the typical flip-flopper’s mind, happy feet do equal happy people. “It affects the quality of life,” said Reister. “If your feet hurt, it limits your physical activities. Summer should be about outdoor fun without foot pain.”
 

APMA Funds Orthotic Research Study

A new study being conducted at one of the nation’s top podiatric medical colleges looks to better understand a device that many podiatrists prescribe every day in their practices—customized foot orthotics, also referred to in the medical community as orthoses. The three-year study, funded by the American Podiatric Medical Association (APMA), is currently investigating the success rate of foot orthotics in the treatment of patients suffering from plantar heel pain—an ailment that many podiatrists are able to treat successfully with prescription orthotics.

Dr. James Wrobel

The study, which will focus on a total of 300 patients, ages 18-75, is also comparing prescription orthotics to over-the-counter, prefabricated insoles—another common recommendation for managing heel pain. "We are trying to better understand how well custom foot orthotics prescribed by podiatric physicians compare with over-the-counter insoles and pre-fabricated insoles to reduce or eliminate heel pain, and improve a patient’s quality of life," said Dr. James Wrobel, podiatrist and interim director of Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science in North Chicago.

Dr. Wrobel added that this research study is the first of its kind to measure how specific foot types, such as low and high arches, respond to certain specific treatments, including custom orthotics.   

Source: Fibretofashion.com [7/3/09]

Physicians Snared by Growing Medicare Fraud Strike Team

Just weeks after the government publicized an expansion of a collaborative Medicare anti-fraud enforcement team, federal officials announced their first strike. It's likely to be the first of many to involve heightened scrutiny of physicians, according to legal experts.

As part of an ongoing effort, senior officials from the Depts. of Justice and Health and Human Services on June 24 announced criminal charges against 53 individuals -- including doctors, beneficiaries, and healthcare company owners and employees -- for allegedly scheming to submit a total of more than $50 million in false Medicare claims in the Detroit area.

So far, most of the fraud targeted has been in the area of infusion therapy and durable medical equipment, but some physicians have been accused of participating in the crimes. The latest indictments -- which name at least four physicians -- centered on infusion therapy, as well as physical and occupational therapy services provided in several clinics.

Source: Amy Lynn Sorrel, AMNews [7/6/09]

Hold on to Staff

Watch for “poachers” who might use economic uncertainty to lure away your talented employees. Let those workers know how much you appreciate their contributions, and offer non-monetary perks if you cannot offer cash.

Examples: more vacation time or something simple like better office or computer equipment.

Source: Adapted from “How to Move Up When the Economy’s Down,” by Zach Anchors via Communication Briefings

Editor's Note: This is the first part of a series by healthcare attorney, David D. Mullens, DPM, JD

Part 1: Why Now and Why You? 

The answer to: “why now?” should be obvious. Even before the collapse of our economy, the Federal government was looking at all potential sources of income, and that included getting back money already paid for services.  Now that things are even deeper in the tank, the government will be looking even harder. In addition, the contractor can enhance its relationship with CMS by successfully recouping payments from providers.

The answer to: “why you?” is not so obvious. First, if you provide podiatric services in a geographic area considered “rife” with Medicare fraud, it is more likely all of the local podiatric physicians will be treated in this fashion. Second, if your podiatric practice has a high rate of previously denied claims, you may show up on the contractor’s radar more prominently.  Third, the Federal government, through CMS, wants to reduce the dollar amount of claims from podiatric physicians – especially in areas like Southern California. An effective way of doing this is by frightening the podiatric physicians into a pattern of  CPT self-censorship.  In other words, the Federal government wants to beat you into submission so you will down-code your claims.

Next: Part 2- How to Cope With This.

Query: Digital X-Ray Systems

I plan on buying a digital x-ray system. I would appreciate some feedback on equipment that PM News subscribers have been pleased with.

James E. Rogers, DPM, Nashville, TN
 

RE: Surgical Closure of First Metatarsal Growth Plate to Correct For a High IM Angle (Nick Tanner, DPM)
From: Multiple Respondents

Epiphysiodesis is well described in McGlamry's textbook. However, this 11 year-old is approaching skeletal maturity and she may not have enough long bone growth remaining to fully correct the IM angle.  If you feel her hallux valgus deformity requires a proximal metatarsal procedure, such as a base wedge or Lapidus fusion, wait a year or so until the growth plates close. 

David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

This may be a good procedure however, you may want to consider how long until the patient reaches skeletal maturity. She possibly has only 10-12 months left to grow. You may want to do a base wedge or wait until she reaches skeletal maturity and do a fusion.

David L. Nielson, DPM, Roanoke, VA,  pampantla@hotmail.com

Dr. Leonard's comments, "No evidence exists in our profession to remotely support performing closing of a growth plate to achieve correction of juvenile HAV." I suggest he read the study by Dr. Sieberg, Dr. Donald Green, and Dr. Richard Green (JAPMA Vol. 84 No. 5 1994) showing that hemi-epiphysiodesis is a legitimate procedure for juvenile HAV. Also, see a chapter in the book Pediatric Foot and Ankle Surgery.

I also encourage anyone interested to check out McGlamry chapter 19, page 616 which devotes some ink to this. Also, please note hemi-epiphysiodesis procedures have been performed since the 1930's. Hemi-epiphysiodesis is a "staple" (pardon the pun) in current pediatric surgery today. During my fellowship with Dr. Dror Paley, I participated in over 150 of them in one year. So, in experienced hands, this should more than adequately reduce this deformity as well.

Philip Wrotslavsky, DPM, La Jolla, CA, drphilipw@msn.com

Switching From DSL to Cable (Stephen Bennett, DPM)

I made the switch about 4 years ago. In those 4 years, we have lost phone service twice, each time for about 10 - 15 minutes. Cable Internet is much faster. So far, so good.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

DIAGNOSTIC ULTRASOUND FOR SALE

Mindray 6600 with Sony thermal printer. Machine comes with a 10 Mhz linear probe. Split screen allows two images on one screen. All digital machine. Comes with factory warranty for 1 year from Atlantic Medical LLC. Price when new is close to $11,000.00. Price for this machine with printer is $5,500.00. For further information see website 

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to comf-massuda@footexperts.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – SOUTHERN CALIFORNIA 
 
Flexible, Part-Time or Full-Time opportunity with growing podiatric medical group in busy offices in Southern California. CURRENT DME supplier number a plus. NO nursing homes. Most days are available with flexible hours available. If interested, e-mail scpods@yahoo.com

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

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