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July 13, 2007 #2,985 Editor-Barry Block, DPM, JD

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Thomas Joins University of Florida College of Medicine Faculty

The University of Florida College of Medicine, Jacksonville has announced that James L. Thomas, D.P.M., formally of the University of Alabama, has joined the faculty as an Associate Professor in the Department of Orthopaedic Surgery. Dr. Thomas will be joining his podiatric colleagues, Dr. Stephen Meritt, Dr. Joseph Sindone, and Dr. John Harris.

Dr. James L. Thomas

The University of Florida and Shands Jacksonville Medical Center currently has a PM&S 36 program with six podiatric residents integrated with an orthopedic residency program with 20 residents. The opportunity to work and teach in this combined program attracted Dr. Thomas who is a past president of the American College of Foot and Ankle Surgeons. Dr. Thomas assumed his duties in Jacksonville on July 1, 2007.

Barry University's Yucatan Project makes 54th trip to Mexico

On July 19-22 Barry University podiatric physicians, residents and alumni will travel to Merida, Mexico to offer life-altering medical treatment to poor children as part of BU's Yucatan Project. More than 5,000 crippled children in the Yucatan Peninsula of Mexico have received treatment as a result of the project. In addition, more than 75 physicians and 50 residents have volunteered over 20,000 hours to the project, which marked its 10th year of operation at a celebration in Merida, Mexico Nov.18.

Dr. Charles Southerland, director of the Yucatan Crippled Children's Project, shown here with Dr. Pedro Abrantes and Dr. Nelson Gonzalez, graduates of BU's School of Podiatric Medicine, treat a 5-year-old girl with cerebral palsy

The Yucatan Project is the brainchild of Dr. Charles Southerland, a podiatric surgeon at Barry’s School of Graduate Medical Sciences. Inspired by the Baja Project for Crippled Children in Baja, Mexico, Southerland and the physicians from Barry first made contact with officials in Yucatan in 1992 but it wasn’t until 1996 that the first surgeries were performed.

A typical four-day trip for the Barry team, which includes a trip director, often Southerland himself, and three residents or an attending physician, involves a demanding schedule of surgeries and consultations. Although their work has benefited thousands of children and adults in the Yucatan, Southerland says the benefits to the medical students and physicians who make the trip are inestimable.“Anyone who goes down and comes backs, never comes back disappointed,” said Southerland, who noted the podiatric residents who go on the Yucatan trips often get a chance to observe and treat deformities, such as, club feet that are usually screened at birth in the United States.

AMA Seeks More Oversight of Retail Clinics

Citing concerns that retail-based clinics may be too much retail and not enough clinic, the AMA House of Delegates at its Annual Meeting last month approved resolutions that call for an investigation into the growing industry. During testimony before the reference committee addressing medical practice, many AMA members expressed concerns with patients getting prescriptions written and filled under the same retail roof.

The AMA house adopted policy that calls for state and federal probes into a possible conflict of interest between the clinics and the pharmacies that own or host them. The new policy also opposes the waiving of state and federal regulations for retail clinics that do not comply with standards for medical practice facilities, and opposes the practice of insurers reducing or lowering co-pays to encourage the use of the clinics.

In July 2006 there were approximately 90 clinics across the U.S. Today there are more than 400. As the clinics grow in popularity, some retailers, such as CVS Corp. and Walgreens, have stepped beyond the role of host and bought out entire chains.

Source: Pamela Lewis Dolan, AMNews [7/16/07]

Query: Complex Regional Pain Syndrome

I have a surgical patient five weeks post-Austin bunion and hammertoes 2,3, and 4. Clinically, I think she is an early reflex sympathetic dystrophy [complex regional pain syndrome]. Other than ankle blocks 3 times a week, what else is recommended?

Jim Clark, DPM, Salinas, CA

Query: CMS Audit

I just received a notice from CMS for an audit of 36 charts from my two-man group practice in California. It was labeled a "PCA" review as well as being a "Probe Review as part of our routine audit."

Is this a common occurrence asking for this many charts? I was asked for only 4 of my charts, but my associate had 32 charts requested. I am not worried about documentation, we have been using an EMR since 1997, and a quick review reveals all documents present and accounted for.

Is there any action that I should take before sending them off? Are there specific "pearls" that anyone can give that will make this audit proceed smoothly? Has anyone gone through one of these? I have been in practice 24 years, and have never had a request for more than documentation of a part of one chart.

Name Withheld by Moderator

Response: A request for 36 charts is considered problematic, and not routine.

Minimally, you need to have these charts reviewed by a coding expert in your area. After he/she reviews them, you must decide whether to consult a healthcare attorney. If you need more time, ask for an extension.

Be sure to mail copies (never originals) of charts via certified mail, return receipt requested. If your charts are handwritten, you should send along a typed transcript of each chart entry, along with any supplemental material, such as x-rays, lab reports, etc.

Barry H. Block, DPM, JD, Forest Hills, NY

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RE: Vascular Testing Performed by Medical Assistants
From: Ken Malkin, DPM

I have noticed in an increase in marketing by companies which state "Any medical assistant can conduct tests in 20 minutes or less."

Please check your Medicare local policy on vascular testing (found on the carrier's website), which more often than not states that vascular tests must be performed by the doctor or a person certified as a vascular technician. This includes NY and NJ and many other states. In fact, in some states that the carrier has stated that even the doctor cannot perform this test unless they are certified. The latter circumstance has been a subject of protest by the states and APMA. .

In addition, please realize screening tests are simply not payable by Medicare and that there must be clear clinical signs or symptoms elicited from the patient that leads one to suspect PAD. I am certain there has been a large increase in this testing which will result in surveillance by Carriers sooner than later.

Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

RE: Foot Numbness After Plantar Fascia Rupture (Philbert Kuo, DPM, 7/12/07)
From: Amol Saxena, DPM, Kevin A. Kirby, DPM

It is not uncommon, especially with tearing of the lateral band. As was noted with plantar fasciotomies that transected this region, lateral nerve damage can occur, since in essence the patients perform their own surgery.

Keeping the patient non-weight-bearing for 3 wks in a boot will help decrease the likelihood this will linger, otherwise you can consider giving an injection. Like most neuropraxias, this could linger for 2-3 mos, so I would wait until after that time period. Brian Fullem & I reported on the successful treatment of plantar fascia ruptures in the May 2004 issue Am J of Sports Medicine.

Amol Saxena, DPM, Palo Alto, CA, Heysax@aol.com

Even though I haven't specifically seen lateral plantar nerve symptoms after acute plantar fascial rupture, I participated in an interesting case of segmental neuropathy of the lateral plantar nerve in an athlete over 15 years ago that may be of interest.

I was asked to consult on a 37 year old, 340 lb male power lifter with lateral plantar nerve symptoms (i.e. numbness/tingling in the lateral-plantar forefoot) when he lifted up to 500 pounds during his workouts. He was considering quitting the sport due to his foot symptoms. I told the referring physical medicine and rehabilitation physician that the athlete needed foot orthoses since I felt the increased flattening force on the foot from his power lifting activities was likely causing compression of the lateral plantar nerve as it passed deep to the abductor hallucis muscle belly and that foot orthoses had a good chance of relieving the symptoms. Within three weeks of receiving his foot orthoses, the power lifter was able to resume training nearly pain free and within 7 weeks, the patient was asymptomatic.

The most interesting aspect of this case for me was that, before foot orthosis treatment, nerve conduction testing revealed that the distal motor latency of the left lateral plantar nerve was 6.9 msecs, and after orthosis treatment, the distal motor latency of the lateral plantar nerve became 5.5 msecs (normal range 4.7-6.3 msecs). I believe that this is the first and only published case report of foot orthoses positively affecting nerve conduction velocity in an athlete (Johnson ER, Kirby KA, Lieberman JS: Lateral plantar nerve entrapment: Foot pain in a power lifter. Am J Sports Med, 20 (5):619-620, 1992).

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PRACTICE FOR SALE - NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; Biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

PODIATRISTS NEEDED - CHICAGO - BALTIMORE -NW IN

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago, Baltimore and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-486-3548 ---------------------E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE POSITION – BOSTON, MA

20 year old, well established, modern practice with 2 locations just out of Boston, looking for associate, P/T or F/T, motivated 24/36 trained or ABPS-Certified or eligible to start immediately. Strong surgically-based practice. Looking for motivated individual, able to practice all facets of podiatry practiced. Electronic scanning for orthotics and voice activated EMR already in office. Fax CV to (617) 567-0822

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