The Voice of Podiatrists

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July 09, 2008 #3,293 Editor-Barry Block, DPM, JD

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DC Podiatrist Adds Honey Dressings to His Wound Care Toolbox

In the department of plastic surgery at Georgetown University Hospital in Washington D.C., Medihoney is the only honey-based product used by doctors, says John Steinberg, a doctor of podiatric medicine.

Dr. John Steinberg

Most patients have wounds like diabetic foot ulcers that have not responded to the body’s natural healing process or conventional therapies, he says. “We use Medihoney in combination with other medicines. It adds to our toolbox.”

Steinberg says the dressings have become an important option in treating “medically complicated” patients with allergies to ingredients in topical medicines. “It helps to keep the wound clean without complex drugs or chemicals,” he says. The hospital is not having problems getting reimbursed for using Medihoney products from payers including Medicare, Medicaid, and private insurers, says Steinberg.

Source: Thomas Gaudio, NJ Biz, [7/7/08]

GA Podiatrist’s Office is Mecca to Professional Athletes

Dr. Lou Pack’s office may as well be a bona fide sports museum. In the comfortable corner at Lake Oconee’s MCG health facility, Pack surrounds himself with reminders. There are, of course, images of athletes everywhere. Tom Glavine graces the wall. Former Georgia Coach Vince Dooley wrote a nice note. Matt Stinchcomb, All–American from Georgia, shares space with Auburn stand–out Takeo Spikes. Ryan Howard, the stalwart Philadelphia Phillies slugger, stopped by two weeks ago. The Cincinnati Bengals Willie Anderson left a pair of his shoes. Like a quiet Mecca in a lost part of the world, they’ve all come to seek Pack.

Dr. Louis Pack

Pack, and his Precision Sports practice, has changed the lives and performances of these athletes with a unique approach to sports medicine. A board certified podiatrist, a Fellow of the American College of Rheumatology and a faculty member of the U.S. Sports Academy, Pack has treated Olympic athletes and helped slumping professionals heal faster, and more importantly, run faster. It’s one of the reasons Georgia Tech recently named him to its new Orthotics and Prosthetics faculty. All from a man who admits when it comes to playing a game, “I can’t catch a ball.”

Source: Patrick Yost, Morgan County Citizen [7/3/08]

$300-M Grant Could Prompt Growth of Community Provider-Ranking Programs

A $300 million grant awarded by the Robert Wood Johnson Foundation (RWJF) this month could have a profound effect on the growth of ranking programs used by some health plans to evaluate network physicians. While physician groups have long criticized such ranking programs as being inaccurate or too closely tied to cost, industry observers say the RWJF initiative could spawn greater reliance on third parties that pool claims data from all health plans in a community.

While physicians generally like to know how they stack up against others in their field, there is a different level of concern when such information is made public by a health plan, says Nancy Nielsen, M.D., president of the American Medical Association (AMA). "We don't want to keep rankings from happening, but reputations are at stake and doctors need some recourse if the information is inaccurate."

One of the key complaints physicians and medical groups have had with health plan rankings is that it often is difficult to correct misleading or inaccurate data."From my own experience I know that a doctor might receive a completely different ranking from two insurers," says Nielsen. "And that might be simply because a physician doesn't have enough patients with a particular condition with one insurer." Physicians also are concerned that health plans might be more interested in ranking them on cost rather than on quality and efficiency, she adds.

Source: Steve Davis, Health Plan Week [7/8/08]

Employee Appreciation

If you hand out employee appreciation certificates, consider spending a bit more to frame them. The added expense will pay dividends in appreciation from the recipients who will hang the the awrd on a wall instead of possibly filing it away.

Source: Adapted from Carolyn Cone Weaver

Query: Nursing Home Patient in the Office

If I see a nursing home patient in my office instead of the facility, do I need to have an order signed by their primary physician for nail care to follow Medicare guidelines?

PM News Subscriber, South Dakota

Response: Just to be safe, I would suggest re-reading your Jurisdiction's local coverage determination (LCD) on "Routine Foot Care." That being said, in my opinion, the answer is "no."

The patient has asked you to perform care by presenting to your office. The way most LCDs are written, patients can asks for care regardless if orders are written by the attending physician.

All the other "covered" or "non-covered" routine foot care LCD rules will apply, however, and are not dependent on site-of-service.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here

RE: Nail Bed Inflammation (Dana Giacalone, DPM)
From: Christopher Formanek, DPM

I would recommend avulsing the affected toenail and ordering a toenail culture. I had a similar patient, a 20 y/o, placed on PO Lamisil twice by her PCP and also failed topicals. She too had the appearance of a second nail root developing. It turns out her culture was positive for mold and yeast. A three-month pulse dosing course of Sporonox resolved the condition as seen post-operative 9 months. You might consider Sporonox, as it has much broader spectrum than Lamisil.

Christopher Formanek, DPM, Baton Rouge. LA, cformaneaux@bellsouth.net

RE: EHB as a Spacer for Keller Procedure (Greg Caringi, DPM)
From: Lee C. Rogers, DPM, Michael Forman, DPM

On a few occasions, I have encountered poor capsule not suitable for interposition and have utilized GraftJacket acellular matrix (Wright Medical) with good result. I cut a strip of GraftJacket and attached the end to a K-wire inserted through the hallux (or retrograded through) and allow it to wrap around the spinning wire as I am driving it into the metatarsal head.

GraftJacket as a spacer

This acts as a spacer and the wire prevents motion until the sutures are removed at about 3 weeks.

Lee C. Rogers, DPM, Des Moines, IA, Lee.C.Rogers@gmail.com

Dr. Caringi asks a great question, that is, using the EHB as a spacer during a Keller procedure. The EHB is rendered useless after a Keller bunionectomy. I also feel that it is one of the most deforming muscles in HAV development and many times I would sacrifice this tendon in other HAV procedures. I also would like to recommend an article by Jim Ganley in the JAPMA which discusses modifications of the Keller procedure.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: How to Stop Telemarketers ( Cynthia Ferrelli, DPM)
From: Multiple Respondents

You can register any phone number with donotcall.gov. If you receive an unwanted call, you can quickly file a complaint on line, and those calls will cease.

Evan F. Meltzer, DPM, Jackson, MS, Evan.Meltzer@va.gov

I use a very inexpensive device called a "Telezapper." I use it at home and what it does is stop computer-generated calls and bounces them back to the "server." It’s the best device I've used. You can find it at telezapper.com Give it a try, it’s under $40.

Frank J. Lattarulo, DPM, NY, NY, doclatt@aol.com

It is unfortunate that many younger podiatrists have never had the great pleasure of attending a lecture by Bob Levoy. It goes back many years but Bob had several solutions to your problem. If the marketer is selling something, you merely tell him that your bother/sister/father, etc. are in the same business and you must do your business with them for family harmony. They have no answer to that one.

When you are on a call that you wish to terminate, simply start a sentence and then gently hang up mid-sentence. Since no one hangs up on themselves, you must have been disconnected. If the party calls back, have you assistant tell them you have returned to patient care and cannot be disturbed. Thank you, Bob for all of your wisdom over the years. .

I will also give you one of my own. Ask a solicitor of funds if they are a volunteer or a paid solicitor. They must answer the question and most are paid. Simply tell them you never give funds when a part of your gift goes to the solicitor or his company. You can always give directly to the organization if you wish. I find this ends this type of call.

Barry C. Blass, DPM, Tampa, FL, footdoc@verizon.net

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