July 24, 2006 #2,638 Editor-Barry Block, DPM, JD

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Clark Skeptical of High Heel Cream

The makers of Save My Feet said it works through pantyhose and even socks. Users are instructed to apply the cream three to four minutes before putting on shoes. The company said the product works through panty hose or socks and can be used with any type of shoe, not just high heels.

The product has its skeptics, however. Podiatrist Jeffrey Clark said women shouldn't wear high heels at all if they are in pain. "This may be a way they allow themselves to get by this cheating, if you will, to use a lubricant to alleviate the pain they would have otherwise," Clark said.

Source: NBC-TV [7/20/06]

Medicare Beneficiaries to Get Consumer-Driven Health Coverage Via Medicare Advantage In '07

Medicare beneficiaries will be provided with access to coverage through consumer-driven health plans in the Medicare Advantage (MA) program in 2007. Beneficiaries will have access to new Medical Savings Accounts (MSAs) and, through a demonstration program, additional features similar to Health Savings Accounts (HSAs). Medicare would pay for a high-deductible health plan for beneficiaries who enroll and would put money into an account established for the beneficiary, generally at the beginning of the year, a CMS prepared statement explains.

CMS says it will work with health plans to make available a wider variety of MSA products in 2007 and 2008 that more closely resemble HSAs. CMS explains that it does not have the authority to allow plans to offer an MA prescription drug plan as a part of the demonstration, but that plans may offer a stand-alone drug product during that time.

Source: Medicare Advantage News [July 2006]

Query: Medial Calcaneal Nerve Entrapment

I have a patient who underwent a calcaneal spur resection about three years ago and has had classic medial calcaneal nerve entrapment symptoms ever since. There is pinpoint pain right over the most proximal part of the surgical scar (which is a typical horizontal scar of what was a traditional open heel spur resection). Has anybody had any experience with trying alcohol injections to alleviate the medial calcaneal nerve pain as opposed to open resection of the nerve? She has undergone multiple physical therapy modalities and injection of steroids by the previous surgeon.

David Gutierrez, DPM, Bronx, NY, DOCG2100@aol.com

RE: Long-Term Studies on Efficacy of Orthotics
From: Tip Sullivan, DPM

I was trained in biomechanics at CCPM in the late 80’s. I believe that I was exposed to some of the best biomechanical wizards of the times. I learned a lot of useful clinical information and a lot of theory. These days I find the theory aspect much more useful in developing specific surgical approaches to different problems. I find myself not using custom orthoses in the clinic nearly as much as I did 10 to 15 years ago.

One of the questions that I have never had answered to my satisfaction is: why are there no long term (20+ yr) prospective biomechanic studies with a reasonable (n) that indicate whether custom-molded orthoses are effective? What foot types are they most effective on? what symptoms are they are most effective in treating? If I take a pediatric patient with a deformity can I really, practically, expect to halt the progression and avoid future deformities with an orthosis? I am sure there will be anecdotal comments BUT is there any clinically applicable proof, clinical studies?

When some other doctor asks me why I am doing some orthotic management for a patient all I can say is “ well this is the way I was taught and this follows “such and such” theory”. I can’t tell them that there was a double-blinded prospective crossed over cohort study over a twenty-year period that showed “such and such” really does work. I admit that I have been out of the research loop and perhaps these studies are on going or I just missed them. If so, I would appreciate some direction to them. Long-term, well-designed biomechanical studies would be almost impossible for a private practitioner to take on. Why have our colleges not designed and implemented this type of study?

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Evaluation and Management Codes (Ken Malkin, DPM)
From: Michael M. Rosenblatt, DPM

Dr. Malkin, one of our foremost experts on podiatric coding, reminded us recently that E and M codes are permitted by a number of insurers for diabetics. I would expand his statement to include other groups of patients as well. Too often, when podiatrists get so "used" to RFC that they actually forget to ask patients about their present complaint, they miss opportunities to charge medically justified E and M codes.

This is just another reason why some podiatrists have economic difficulties. In my experience, this lack of knowledge is often directly translatable to and from podiatrists who are not members of the APMA and its local DPM societies, and have never attended coding conferences and lectures.

"Leaving coding up to your office assistant" is just one more recipe for disaster. Others include using very similar codes and avoiding modifiers over a large range of patients. After years of expensive educational efforts, it seems all the more tragic when coding and practice style interferes with making a living.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect 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-PARTNER WANTED MICHIGAN-DETROIT AREA WESTERN SUBURBS

Great opportunity-must be hard working, reliable, responsible and good with patients & staff surgical training a plus-partnership after 1 yr. Michigan license required. Fax resume to 248-478-1370 Starting salary $200,000. plus benefits plus percentage. Serious inquiries only

FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations approx 1.5m gross, Buy outright or overtime. Call 561-213-9400 after 7:00 p.m. Serious inquiries only

PRACTICE FOR SALE -ST PETERSBURG, FLORIDA

Well established (27+ years) general Podiatry practice. Great location -surrounded by 4 retirement communities. Must sell quickly due to health reasons. Contact Irwin Ayes DPM at ayesent@earthlink.net or 727-544-5425.

LONG TERM CARE PRACTICE OPPORTUNITY- DOWNSTATE ILLINOIS, & CHICAGO AREA

We specialize in providing conservative ethical care to residents in long term care settings. Immediate part-time positions available in downstate IL, and the Chicago metropolitan region. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300 Fax-773-775-0883.

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

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

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