July 19, 2006 #2,634 Editor-Barry Block, DPM, JD

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MBT Shoes are Well-Made and Comfortable, But Won’t Tone: Pagliano

FOR $235 (and up!) you can buy a funny-looking pair of shoes to make you stand up straight, work your "core," elevate and shape your buttocks and, perhaps ladies, burn some extra calories to eliminate those dimpled saddlebags. Introduced in the U.S. three years ago, the Masai Barefoot Technology, or MBT, as the shoes are known, sport a thick, convex sole, a soft, squishy heel and — under the arch — a hard center.

Physicians, perhaps not surprisingly, are skeptical of the shoes' toning properties. "It does exercise some of the tiny muscles in the feet," said Dr. John Pagliano, a Long Beach-based podiatrist who specializes in sports medicine. "But you don't really need them much. They really are just stabilizing muscles."

Pagliano says he had never heard of the shoes until his college-age daughter bought a pair and they showed up on his credit card bill. He was so furious about the price he had to check them out. The podiatrist, who is also a member of the American College of Sports Medicine, said the shoes are well-made, but dismisses most of the studies on MBTs as so small they "are really not significant." But the shoes are comfortable, he conceded. "I hate to tell you this," he said. "But I think I might buy a pair."

Source: Hilary E. MacGregor, Los Angeles Times [7/17/06]

Patton Appointed as Director of MPH Program at Barry

Richard T. Patton, MA, MPH

Richard T. Patton, MA, MPH, CHES, has been appointed to serve as the new director of the Barry University Professional Master of Public Health Program and director of the Institute for Community Health and Minority Medicine by Dr. Chet Evans, vice president for medical affairs. Patton's duties will include teaching courses in the MPH program, overseeing all administrative responsibilities for both the MPH program and the Institute, leading the planning, development, and implementation of the Institute's research for expanding Barry University's efforts to train minority health professionals and reduce the barriers to care for minority and medically underserved individuals.

Patton holds an MPH from the University of North Carolina and an MA in nutrition from the University of Florida. His research interests are in the standards of practice for diabetics and in behavior change strategies for obesity. "Students enrolled in the professional MPH program at Barry University will be looking at health from a different perspective, working diligently on public health issues, and having fun because public health is amazing as well as amusing," according to Patton.

Medicare Angst Over Proposed Reductions for Complex Procedures

Some hospitals, physicians and, patient advocacy groups raise concerns over a proposal by CMS to revise Medicare reimbursements to hospitals that would reduce payments by 20% to 30% for many complex procedures and new technologies.

CMS in April announced the proposal, which includes the closure of loopholes used by specialty hospitals and a plan to replace the current charge-based reimbursement system with a cost-based system. According to a coalition of advocacy groups that includes the Parkinson's Action Network and the Society for Women's Health Research, the proposal "could have a devastating impact on payment for critical treatments for seriously ill patients." HHS Secretary Mike Leavitt maintains that the proposal would make the reimbursement system more accurate.

Source: American Health Line [7/17/06]

Query: Medicare Post Op Cast Application Denial

I continue to be denied by Medicare for CPT 29405 done in the office in the post-op period. The Medicare phone reps tell me that ALL cast applications are included in the global payment for the surgery. I was told, however, by our Medicare training specialist that follow-up (after the initial) cast applications should be paid separate from the surgery. Which is correct? What should I do?

Deena Rolicheck

Response: Cast material and subsequent (after the initial) application of casts are not part of the global surgery package.

I would recommend you add a "-58" (staged procedure) modifier to the cast application code when one is applied during the post op period. You should receive payment using that modifier.

Denise Paige, CPC, Long Beach, CA

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Patients Who Steal Supplies (Joel Lang, DPM)
From: Jon Purdy, DPM, Art Hatfield, DPM

I take a different approach to this scenario and have unfortunately had to do so in the past. There is a term for the case where supplies are missing after a patient or patient's guardian was in a room, this is called "theft."

If you and another office person witnessed the disappearance of your items only after a particular patient was in the room, that would be evidence enough for me to confront the patient.

In my case, our staff noticed some of our supplies in a bag the patient brought into the room. The patient was there with her son. The son left the room when the patient was getting x-rays. When this was brought to my attention, I waited in the room for the return of the patient. I asked her directly how my supplies ended up in her bag. Of course she blamed it all on her son who was no longer there. I took my supplies back, and informed her of my policy on theft. She was informed that she would no longer be able to be accompanied by anyone, her treatment room door would be left open, except during treatment, and if I ever caught her or anyone with her stealing from me again, I would call the police and have them arrested. She left with a cast on her leg and I never saw her again.

I don't care about the cost of the item being stolen. Theft is theft and I will always confront the thief.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

Within the past two months I caught a patient stealing gauze rolls. I was walking down the hall and heard the metal lid of the glass container closing. When I walked in the room the patient was walking away from the treatment cabinet. I asked him what he had done. He denied anything. When I asked him what the bulge was in his pocket he removed the gauze rolls and apologized. It angered me that a patient would steal from me. It also irritated me that I had to re-sterile the whole contained as he likely removed the gauze by
Reaching in with his contaminated hand.

As I have stated several times in this form, some patients are not worth the trouble. Since he is a non-compliant patient I was hoping he would be to embarrassed to return. I was wrong he still comes to me, but thankfully his wounds are mostly healed. I disagree with Dr. Lang. Why would anyone want a patient who has so little respect for you that they would steal from you?

Art Hatfield, DPM, Long Beach, CA, AFOOTJOB@juno.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. 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 - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

MEDICAL EQUIPMENT FOR SALE- PENNSYLVANIA

4 Micromac 300 "Podo spray" Nail Buzzers-- ($1500- retail) $100 each. 1 X-ray processor- Good condition- $500 each. 3 X-ray View boxes-Fair condition- $50 each. As Is. Shipping will be added. Questions or Interest, Email: barb@martinfootandankle.com

ASSOCIATE POSITION – TEXAS

Full time associate position for a PSR-24 podiatrist to join established dynamic medical and surgical practice in Central Texas. Looking for a personable, motivated, ethical, hardworking individual to join our board certified group. Please send resumes or CV to centexfootdoc1@aol.com

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. erfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact
ccipinc@ccipinc.net

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

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