![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
|
|
|
|
PMNews
Browse PMNews Issues
Previous Issue | Next Issue
PM News |
The Voice of Podiatrists
Serving Over 12,000 Podiatrists Daily
July 17, 2010 #3,912 Publisher-Barry Block, DPM, JD
A service of Podiatry Management http://www.podiatrym.com E-mail us by hitting the reply key. COPYRIGHT 2010- No part of PM News can be reproduced without the express written permission of Kane Communications, Inc.
|
EDITOR'S NOTE |
PM News Goes on a Cruise - July 18-25th
There will be NO issues of PM News from July 18 - July 25th. Readers can still send in queries and comments. We will resume publication on July 26, 2010.
|
|
DOX PODIATRY – Electronic Medical Records
NOW WITH INTEGRATED BILLING
JULY ONLY SPECIAL: 50% OFF 2010
Over 500 Podiatry Offices and Growing
Call 877-270-3518
PRACTICE LIKE THE BEST
MAKE MORE MONEY - SAVE TIME - DOX PODIATRY
DOX Podiatry is the leading web-based EMR solution designed by Podiatrists for Podiatrists that enables you to make more money in less time. Let us show you how in a quick, 40 minute, web-based demonstration.
• COMPLETE PODIATRY SPECIFIC MEDICAL DATABASE
• NO CUSTOMIZATION REQUIRED • EVERYWHERE ACCESS
• READY TO USE DAY ONE • CERTIFIED SAFE & SECURE
http://www.DoxEmr.com
$44,000 Economic Stimulus Article at: http://doxemr.wordpress.com/
CALL 1-877-270-3518 OR EMAIL INFO@DOXEMR.COM
|
|
PODIATRISTS IN THE NEWS |
IL Podiatrist Questions Heel Pain Study's Conclusions
Women who habitually wear high heels have shorter muscle fibers in their calves and thicker Achilles' tendons than those who walk in flat shoes, researchers say. The result? The heel lovers’ tendons stiffen and become harder to stretch, which could explain why walking hurts after kicking off the Jimmy Choos, according to a small study published in the Journal of Experimental Biology. The researchers found that wearing heels affected muscle fiber length--the high heel wearers' muscle fibers were 13 percent shorter than those who wore flat shoes. For some women, once the heels come off, the pain starts because the muscles can't stretch enough, the researchers said.
|
Dr. Stephen Weinberg |
Wearing a variety of different types of shoes and stretching may help alleviate the pain, according to the study authors. But Chicago podiatrist Steve Weinberg, who was not involved with the study, questioned whether it's possible to stretch the Achilles tendon enough to make a clinical difference. "If women are going to wear high heels, they should be prudent—stand or walk in them for a short time,” said Weinberg, a podiatrist at the Weil Foot & Ankle Institute and the longtime chief podiatrist for the Chicago Marathon.
Source: Julie Deardorff, Chicago Tribune [7/16/10]
|
|
AT THE COLLEGES |
Barry Professor Serves Migrant Farm Workers
Every Tuesday afternoon, Dr. Steve Maynard drives 100 miles to The Open Door Health Center in Homestead where he is known as "the doctor who doesn't say too much but likes to whistle." Open Door Health Center provides care to as many as 3,500 uninsured, the majority of them migrant farm workers. Largely Hispanic and poor, his patients at Open Door are at a particularly high risk for developing Type 2 diabetes with its ensuing complications.
|
Dr. Steve Maynard |
Maynard, an adjunct professor in the School of Podiatric Medicine, manages all foot traumas at Open Door as well as all disorders of the feet - especially ulcers, infections, and even gangrene, resulting from diabetes and its concomitant numbing of nerves in the lower extremities.
Source: Elizabeth Hanley, Barry Magazine
|
|
MEETING NEWS - PART 1 |
APMA National Meeting One of Largest Ever
Nearly 1,400 podiatrists convened in Seattle this week, making it the second largest meeting ever held in the West Coast and nearly eclipsing the Las Vegas event held in 2006. Even the weather cooperated, with sunny skies and temperatures in the 70's.
|
Crowded Exhibition Hall During APMA National Scientific Meeting |
Attendees enjoyed APMA's state-of-the art lectures and roamed through the well-designed exhibit hall packed with 225 podiatric suppliers. Kudos to APMA leadership and its hard-working staff for presenting another first-class event.
|
|
MEETING NEWS - PART 2 |
Lynn Homisak and Allen Jacobs Inducted into PM Podiatry Hall of Fame
In what has been a must-attend event at the APMA National Scientific Meeting, Lynn Homisak, PRT and Allen Jacobs, DPM became the latest inductees into the PM Podiatry Hall of Fame. Over 250 attendees enjoyed a delicious luncheon along with a hilarious roasting of the honorees.
|
Lynn Homisak Receives Lifetime Achievement Award from PM Editor, Dr. Barry Block |
Lynn Homisak, Podiatry's best known podiatric assistant was roasted by Jason Kraus of Langer Biomechanics and her former boss, Dr. Roy LaBarbera. The funniest parts included out-takes of some of Ms. Homisak's practice management videos.
|
Dr. Allen Jacobs Receiving PM Lifetime Achievement Award |
Dr. Jacobs was roasted by long-time friend and colleague, Dr. Joseph Crisafulli, but turned the tables of the roast by hilariously slinging barbs at many of the Hall of Fame members on the dais, as well as many podiatric celebrities in the audience. The often-controversial Jacobs pulled no punches, even telling the audience, "Dr. Barry Block's Podiatry Management Magazine is best-suited for those who are beyond reading comic books, but not quite ready for peer-reviewed literature."
|
|
MEDICARE NEWS |
Expanding RAC will be a Stretch: Official
The CMS faces some challenges ahead in expanding the Recovery Audit Contractor program to all of Medicare and to Medicaid by the end of the year, an agency representative told a Senate panel. The RAC program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper. Currently, it conducts audits only in fee-for-service Medicare, but provisions in the new reform law call for an expansion of the RAC program to Medicare Parts C and D and Medicaid by Dec. 31.
Such a task will not be easy, admitted Deborah Taylor, director and chief financial officer of the CMS' Office of Financial Management, who testified before the Senate Homeland Security and Governmental Affairs' Subcommittee on Federal Financial Management, Government Information, Federal Services and International Security. Phasing in RAC audits for Medicare Advantage “is going to be tougher for us,” given that the CMS already has a contractor that gets paid to conduct audits for Medicare Part C, she said. “We don't want to duplicate our efforts.”
Source: Jennifer Lubell, Modern Healthcare [7/15/10]
|
|
QUERIES CLINICAL |
Query: Multiple Fractures vs. Charcot Foot?
I have a 40 y.o male diabetic patient with neuropathy. I was seeing him for an ulcer on his right lateral malleolus. He came in for follow-up and told me that his left foot was killing him, more than his right ankle. The foot was red, hot, and swollen. My differential included: gout, cellulitis, and Charcot foot. The patient had no pain at all on palpation around the 5th met base, but did have pain in the medial longitudinal arch. He was placed on oral antibiotics and NSAIDs and dispensed crutches.
The patient has a normal white count, but elevated uric acid. MRI revealed a vertical fracture of the navicular (non-displaced) and fractures of the second and third met bases, as well as the 5th met base fracture. How does one differentiate between multiple fractures and a Charcot foot?
Jeffrey Kass, DPM, Forest Hills, NY
|
|
QUERIES NON-CLINICAL |
Query: Non-Partipating vs. Opting Out
Can anybody explain the difference between opting out of Medicare and being a non-participating provider? Which would be best?
John Swangim, DPM, LaPorte, IN
Editor's comment: PM News does not provide legal advice. Non-participation merely means that, instead of accepting payment directly from Medicare, you collect your full payment (at non-partipating rates) from the patient. The patient then receives payment from Medicare, less any deductible or co-payment.
Opting out is a complex process where both you and all your patients execute bi-annual contracts in which all parties agree to neither bill nor accept payment from Medicare. Opting out means that you can charge patients any fee that you wish. It also eliminates the possibility of a Medicare audit, since you are no longer part of the system. Opting out works best for podiatrists with so-called "boutique" or "concierge" practices.
|
|
CODINGLINE CORNER |
Query: Plantar Fasciitis and Ultrasound Guidance
When billing for an ultrasound-guided needle injection to treat plantar fasciitis, do I bill CPT 76942 alone? Should I bill CPT 76942 in combination with CPT 20550?
John Jurcisin, DPM, New York, NY
Response: The CPT code descriptor for these two codes reads: "CPT Code 76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation" and "CPT Code 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar 'fascia')".
Breaking these two CPT codes down, CPT 76942 is an imaging code that lets you visualize what you are injecting. It is important to document why the imaging was necessary for this type of injection. Typically, a plantar fascia injection does not require ultrasound guidance.
CPT 20550 is a procedure code. When medically necessary, you can bill both in combination. I would document why an infiltrative injection requires imaging guidance (medical necessity).
David J. Freedman, DPM, CPC, Silver Spring, MD
Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription
|
|
RESPONSES / COMMENTS (CLINICAL) - PART 1a |
RE: Coumadin Patient and Phenol Alcohol Matrixectomy (Elliot Udell, DPM)
From: Multiple Respondents
I have been in practice for 27 years and have done nail surgery on numerous patients on Coumadin. I have always told then about the potential bleeding and additional aftercare that may be necessary. I have had no problem with this treatment plan; in fact, I tell the patients, for a nail procedure, it will probably be more risky if they go off the medication. Some of the patients will elect not to do the procedure, but many, due to the pain and difficulty with shoes, will complete the surgery.
Gene Sherwood, DPM, Fairfield, OH, gsherwood1@cinci.rr.com
"High doses" of Coumadin, I believe, is irrelevant, Coumadin has a very narrow therapeutic range, and some patients reach that level with low doses and others with higher doses. Whatever is needed to achieve that therapeutic level, it's all about the INR. That being said, I do not hesitate doing a chemical nail matrixectomy (I use NaOH) on Coumadin patients; without stopping the Coumadin, I instruct them to leave the dressing on longer than normal, usually 24 hours. My concern with Coumadin patients is not the medication but the medical reason they are on Coumadin, with A-Fib as the reason. I would not hesitate to do the procedure if all other parameters are normal.
Angelo J. Bigelli DPM, N. Providence, RI, toedocri@aol.com
I have done many chemical or surgical matrixectomies on patients receiving Coumadin or Plavix. I do NOT take them off those medications. Risk of hemorrhage is minimal, especially with phenol which helps cauterize. Any hemorrhage can be controlled with dressings. I generally apply a moderately compressive dressing and have the patient return the next day for a dressing change. I would rather deal with the highly unlikely complication of hemorrhage than with DVT or pulmonary embolism.
Kathleen Neuhoff, DPM, North Bend, IN, vetpod@aol.com
|
|
RESPONSES / COMMENTS (CLINICAL) - PART 1b |
RE: Coumadin Patient and Phenol Alcohol Matrixectomy (Elliot Udell, DPM)
From: Multiple Respondents
I have done hundreds P&A's on patients on Coumadin therapy without any complications at all. In fact, I have never had a "bleeder" after the procedure. I would not hesitate at all to do this. I do use NaOH instead of phenol, simply because it's far cheaper (our local compounder charges me about $10 for a 30 mL bottle of 10%). I do think NaOH coagulates the tissues/capillaries better than phenol.
R. Alex Dellinger, DPM, Little Rock, AR, raddpm@yahoo.com
Editor's note: Additional notes by Drs. Paul Kesselman and John Swaim can be read here.
|
|
RESPONSES / COMMENTS -(NON-CLINICAL) - PART 1 |
RE: HITECH HIPAA Regulations
From: Michael L Brody, DPM
Regarding the recent comments on HIPAA regulations. HIPAA does require that all workstations be password-protected, but it does not require that all applications be password-protected. We can all continue to use our word processing software to generate letters to patients, referral letters to other doctors, or even create our chart notes with no concern about being in violation of HIPAA.
HIPAA also specifies rules regarding encryption of data, especially data that is stored on removable media such as thumb drives. So, if you wish to utilize a word processor to store patient data, when you back up your word processor data, you will need to configure the encryption of your removable media yourself.
There are additional rules regarding security and passwords for software to be certified for the incentive payments. But, if you are using a word processor as your EMR, you are not eligible for the incentive; so in this case, these rules are moot.
Michael L Brody, DPM, Commack, NY, mbrody@cmeonline.com
|
|
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2 |
RE: Patient Who Brings in Wild Child (Jon Purdy, DPM)
From: Pat Caputo, DPM, Frank J. Lattarulo, DPM
My favorite story regarding a solution to the problem of an unruly child was when my (ex)-partner told the 5 year-old patient, “If you don’t behave, the Easter Bunny isn’t going to come to your house.” The kid cried and carried on even more, and the mother was mortified. She later said to me, "He doesn't have any kids, does he?"
Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com
As a parent (and a proud one) of a child who has suffered and battled with ADD, I take extreme offense to Dr. Purdy’s remarks. My son's pediatrician, along with his child psychologist, have struggled for two years to find the correct dosing of his medication. Although my child struggled for several years without a correct diagnosis as well as correct dosing of medication, he always knew right from wrong.
If, in fact, these children do have a disease process, try to find it in your heart to have a little more patience, and a better understanding of what these children and parents are trying to cope with. Maybe Dr. Purdy needs to be educated a little more, and no, the parents do not need medication. They need your support and understanding. You, as a doctor, should know this, but alas you obviously don't. No, these parents do NOT need medication, just a little understanding and compassion.
Frank J. Lattarulo, DPM, NY, NY, DOCLATT@aol.com
|
MEETING NOTICES - PART 1
|
|
|
RESPONSES / COMMENTS (NEWS STORIES) |
RE: FL Podiatrist Survives First Cut on Big Brother (Barry Blass, DPM)
From: Shari Lee, PMAC
I agree that Andrew has a chance to talk about podiatrists, what we do and the battles we face. He also can explain that podiatry has just as big schooling bills as other doctors, yet we are not on the top of the pay list. Maybe, he could dispel the misconception that just because someone is a doctor, that means they don't need money. He could have also taken this time to educate the public about the Medicare pay issue. I guess he had the game only on his mind, and not what he could have done with the opportunity.
Shari Lee, PMAC, Columbia, SC, midlandspodiatry@bellsouth.net
|
|
|
CLASSIFIED ADS |
PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)
38 yr old general podiatry practice grossing over $550K. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network and well-equipped surgical suite. Retiring owner will stay on as needed. Email - dpmpracticeforsale@yahoo.com
PODIATRY ON CALL - MIAMI-DADE & BROWARD COUNTIES, FLORIDA
Call us for vacations, "unexpected emergencies" and playing hooky. Part-time or Per Diem Basis! Extensive surgical and non-surgical training with Dr. Stanley R. Kalish in Atlanta, Georgia. On call everyday to meet your office needs! Contact: podiatryoncall@gmail.com or 305-342-9797.
ASSOCIATE POSITION - SOUTHEAST GEORGIA
Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net
PART-TIME, LICENSED PODIATRIST - WEST BLOOMFIELD, MICHIGAN
Immediate opening for treating patients in a nursing facility setting. If interested, please email drteetime@aol.com
PART-TIME ASSOCIATE - NY LOWER HUDSON VALLEY (PUTNAM COUNTY)
Wednesday's & Saturdays compensation dependent on collections. Hospital privileges & wound care center available. Excellent relationship with local Drs. including orthopedists- References required. Great opportunity for recent resident to gather cases for ABPS. Reply to PodAssociate@aol.com
ASSOCIATE POSITION - FREDERICK, MARYLAND
Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com
POSITION AVAILABLE - SOUTHERN CALIFORNIA
Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com
PODIATRISTS NEEDED NATIONWIDE
Podiatry referral company has thousands of diabetic patients nationwide in need of immediate service. We are looking for podiatry practices interested in joining our network to receive referrals. Email coasttocoastpodiatry@yahoo.com
ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS
Immediate full-time amd part-time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889
TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)
Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or e-mail mchad500@gmail.com
PRACTICE FOR SALE – MAINE
25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com
MANHATTAN MEDICAL SPACE AVAILABLE
Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.
PM News Classified Ads Reach over 12,000 DPM's and Students
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.
|
Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
| Guidelines |
- To Post a message, send it to: bblock@podiatrym.com
- Notes should be original and may not be submitted to
other publications or listservs without our express written
permission.
- Notes must be in the following form:
RE: (Topic)
From: (your name, DPM)
Body of letter. Be concise. Limit to 250 words or less). Use
Spellchecker
Your name, DPM City/State
- Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.
|
|
Browse PMNews Issues
Previous Issue | Next Issue
|
|
|
|
|