The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 22, 2009 #3,602 Publisher-Barry Block, DPM, JD

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Some "Cosmetic" Procedures Rooted in Medical Necessity: IL Podiatrist

Dr. Marlene Reid, a podiatric surgeon, said she would never amputate a toe to make it easier for someone to sport a pair of stilettos. It's a rare surgery that has been denounced by the American Podiatric Medical Association. But Reid, a member of the APMA and an expert in heel and tendon pain, said women should be able to wear the latest high-heeled fashions if they want. To that end, she said she has shortened toes.

Dr. Marlene Reid

She stresses, however, that many procedures that may appear cosmetic also are rooted in medical necessity. "I've had women who come in and say their second toe is too long and they don't like the way it looks," she said. "But a long second toe can be a problem when wearing any type of shoe and could cause irritation or a hammertoe, and it's not normal. I have no qualms doing the procedure" to shorten the second toe.

Source: Dawn Turner Trice, Chicago Tribune [7/20/09]

MI Podiatrist Wears Crocs at Office

Dr. Chad Chambers of North Avenue Podiatry Services said the key to healthy feet, for most people, is supportive shoes. So, what does he wear around the office? Crocs - those flimsy, foam clogs with the holes on top.

Dr. Chad Chambers

The 38-year-old Battle Creek podiatrist said they're not as bad as they seem. "Actually, for most people, they're not too bad at all, especially for walking around indoors. I don't know if I would wear them out of the office. Although, I shouldn't say that. I do once in a while mow with them on, because they work great for that. If you get them dirty, no problem."

Source: Elizabeth Willis, The Battle Creek Enquirer, [7/20/09]

Medicare Overpaid Physicians for Incorrect Place-of-Service Codes: OIG

Physicians are paid a higher Medicare Part B rate if they perform services in their office versus an outpatient hospital department or an ambulatory surgery center (ASC). The higher rate accounts for the increased overhead expense the physicians incur when procedures are performed in their offices, OIG explains. Physicians are required to enter a place-of-service code on Medicare claims to ensure that Medicare isn’t paying for the overhead portion if the service takes place in a facility setting.

OIG sampled 150 claims during the period from January 2005-December 2006 and found that only 21 were correctly coded by physicians, the report says. Auditors took the sample from more than 850,000 physician-coded claims that matched outpatient hospital or ASC claims for the same service provided to the same patient on the same day. The other 129 claims had the office code when services actually were performed in hospitals or ASCs. OIG estimates that contractors nationwide made about $20.2 million in overpayments to physicians during the two-year period.
 
Source: Report on Medicare Compliance [7/20/09]

Don’t Amplify Negative Feedback

Even if others have complained to you about a co-worker’s habits, behavior or appearance, speak only for yourself:

“I need to talk to you about …”

If you say “Others have complained about …,” you heighten the person’s embarrassment and damage team relationships.

Source: Adapted from “How to Hold a Difficult Conversation,” Susan Heathfield via Communication Briefings

Query: Warts in an HIV Patient

I have a patient who was sent to me from the dermatologist for plantar warts that are painful. These have been treated in multiple ways over the 15 years that they have been giving him episodic problems. They are several single isolated lesions under weight-bearing metatarsals b/l from 0.4 cm. to 1.0 cm. that are very painful. This patient currently appears healthy. He has been HIV + for 15 years and currently has undetectable virus and T cell >800.

He also has Hep "C" which has been treated and is now undetectable with normal LFTs. He has had the warts on his hands surgically removed and they have returned, but he claims that this was the most effective treatment. He has been treated with Aldera without success for his hands and feet. He states that it seemed to have worked better on his hands. He has requested that I surgically remove his plantar warts. I was wondering if there are any clinical pearls that I could pick up regarding this subset of patients and treating recalcitrant warts.

Tip Sullivan, DPM, Jackson, MS

Query: Ordering/Referring Docs

According to a CMS Transmittal dated June 26, 2009 and June 29, 2009, effective October 5, 2009, CMS is expanding claim editing to meet Social Security requirements to verify that the ordering/referring provider on a claim is both enrolled in Medicare and is eligible to order or refer.

Does this mean that if we submit a claim for a service that requires a referring provider to be listed on the claim and that referring provider is not enrolled in the Medicare program, our claim may be denied?

Medicare does provide a physician directory which indicates whether a provider is participating or non-participating, but this will create an additional administrative and financial burden to practices? Can anyone tell me if I am interpreting this Medicare article correctly?

Lisa Borscha, Oak Park, IL

Response: Medicare, for a while now, has been requiring the NPI on the claim (prior to that, they required the UPIN), and you get an NPI when setting up with Medicare. I don't think par and nonpar has anything to do with it - as par and nonpar doctors both have NPIs.

Don Self, Whitehouse, TX

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RE: Free Internet Access at APMA Meeting Hotel
From: Rachel Wood, DPM

If you are going to the APMA National in Toronto, staying at the Fairmont Royal York, and bringing laptops, you might want to call 1-800-441-1414 and enroll in the Fairmont President's Club (membership is free). One of the benefits is complimentary high-speed Internet access during your stay (otherwise the charge is $14.65 per 24 hours.).
 
Rachel Wood, DPM, Milpitas, CA, rwoodfoot@hotmail.com

RE: PQRI and E-Prescribing (Neil H Hecht, DPM)
From: Marc Garfield, DPM

This is almost a silly program until you realize the intentions of Medicare. The goal here is to get you on an electronic medical records system that has these features built-in. Using e-prescribing without computerized EMR/PM is futile and will cost you more than you save and will exceed the benefits of any incentives.  As much as I hate CCHIT systems, it’s what you have to have to make this work. Whether or not these incentives are worth it is not the question. You will have to have a CCHIT system for your records and you will need a robust practice management program to accompany your CCHIT EMR by 2011, or by 2015 at the very latest. 

It should take you a year to evaluate programs before you make a decision on which is right for you. Though the title does not ring of critical import to your day-to-day practice, please read Dr. Brody's article in PM MGMT about CCHIT systems. If you are looking for an inexpensive quick fix, I would highly recommend dipping your toe in the water with Amazing Charts EMR. Now that this program has obtained CCHIT cert, you can't go to wrong, though you may seek an integrated PM/EMR program in the near future. If you already love your present practice management software, you would be well-served with Amazing Charts.  
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: On-Line Back-up (Lynn LeBlanc, DPM)
From: Marc Katz, DPM

I use the local tech company that put in my server and helps with problems. He does the back-up off-site and is able to do a full restore. I get an e-mail report each day telling that the back-up was successful. A word of caution regarding back-up on tape and/or a hard drive; these are both unreliable. They may serve you well for a secondary back-up or for a few documents. If your office is destroyed and you leave the hard drive or tape, you're done. You also have to realize that the hard part can be restoring the data, depending on your set-up.  To restore from a tape or hard drive can be a nightmare. If you have electronic records, you must have multiple back-up options and restore options. It is well worth the money for an online or alternate site back-up.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: More Heels From Hell

These shoes have not received the APMA Seal of Acceptance

Source: Submitted by Martin Taubman, DPM

ASSOCIATE POSITION - CHICAGO AREA

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

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-CHICAGO AREA

Podiatrist is needed in multiple office practice part or full- time in  Chicagoland area. Please email resume to: anthony.spitz@gmail.com or call 847-971-5926

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

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Contact Dr. Ilona Barlam at 206-661-9644.

ASSOCIATE POSITION - WINDSOR, ONTARIO, CANADA

Full-time/part-time podiatrist or chiropodist position available. Please send letter of interest and CV to info@toezone.com

ASSOCIATE POSITION - BOSTON, MA 
 
Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

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

Established 30+ year old practice. Well respected podiatrist in beautiful Westchester County Owner ill and needs a quick sale. Mixture of surgery and general podiatry. Hospitals in close proximity. Will lease office to buyer. Call Mali McGrinder at 914-434-1663.

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