July 29, 2006 #2,642 Editor-Barry Block, DPM, JD

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We’ve just mailed the August issue of Podiatry Management. At 260 pages, it’s our largest August issue yet, and chock full of interesting and informative articles, as well as our usual variety of stellar columns and features.

NY Podiatrist Sees Rise in Yoga-Related Fungal Infections

Greg E. Cohen, a podiatrist at Long Island College Hospital, hears the same story a lot: women complaining about a flaky red bump or a persistent itchy patch on a foot. By the time he sees them, they’re embarrassed and horrified. A few years ago, Dr. Cohen, who also has a private practice in Brooklyn Heights, didn’t know what to make of it, but these days he doesn’t blink an eye.

“The first thing I ask is, ‘Do you do yoga?’ ” he said. As often as not, the answer is a resounding “yes.” In the last two years, Dr. Cohen said, he has seen a 50 percent spike in patients with athlete’s foot and plantar warts. The likely culprit? Unclean exercise mats, he said.

Gyms have long been hothouses for unwanted viruses, fungi and bacteria, a result of shared equipment, excessive sweat and moisture in locker rooms. Many facilities provide disinfectant so clients can wipe down machinery, but they are often less diligent when it comes to exercise mats. It’s common to see staff members clean a stationary bike. It’s rare to see them disinfect a mat.

Because yoga is more popular than ever, it could well be a coincidence that health-care professionals like Dr. Cohen are seeing more infections. In 2005, 16.5 million people practiced yoga nationwide, up 43 percent from 2002, according to Yoga Journal.

Source: Abby Ellin, NY Times, [7/27/06]

FDA Approves New Antibiotic Against “Superbugs”

The US FDA has approved Tygacil™ (tigecycline), a novel IV antibiotic with a broad spectrum of antimicrobial activity, including activity against the drug-resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA). Tygacil is indicated for the treatment of complicated intra-abdominal infections (cIAI) and complicated skin and skin structure infections (cSSSI) in adults. Approval of this first-in-class product comes at a time when the need for new antibiotic options to combat serious, resistant infections is increasing.

TYGACIL can be used as an empiric monotherapy to treat a variety of cIAI and cSSSI, both hospital- and community-acquired, including complicated appendicitis, infected burns, intra-abdominal abscesses, deep soft tissue infections, and infected ulcers. TYGACIL provides clinicians with a novel, broad-spectrum option that can be used at the onset of treatment when the specific bacteria present are not yet known. In addition, TYGACIL does not require dosage adjustment in patients with impaired renal function, and is conveniently dosed every 12 hours.

Source: Medical News Today [7/27/06]

Query: Silver Nitrate for Verruca?

Has anyone heard of using silver nitrate as a primary treatment for verruca? I was speaking with a nurse and she related that she had heard silver nitrate cautery was an effective treatment for verruca. I have never heard this before and believe silver nitrate is used primarily as a cautery agent for pinpoint bleeding. Other then on the applicator sticks how would you be able to get enough to cover the verruca?

John Stephens, DPM, Hillard, OH, johncstephens@sbcglobal.net

Query: Daily Injections For Osteomyelitis

I am wondering if anyone is aware if Medicare will reimburse for daily Gentamycin injections at the site of osteomyelitis due to a diabetic ulcer. This would be administered at the patient's home for a one week period as the patient is non-ambulatory. Any help or advice regarding billing/reimbursement is appreciated.

Michael Plerstein, DPM, Brooklyn, NY

Response: The delivery of IV antibiotics is NOT covered in the home by Medicare. If the patient has a Medicare Advantage Plan, Medicaid, or some secondary insurance, they may cover IV administration and an IV setup and infusion.

In so far as local irrigation, or applicaton, this would be something that you would need to discuss with the Home Health Care agency which would be servicing the patient's wounds. If you personally were going to use the product on the patient during your house call that may be considered incident to your services and not otherwise be covered.

I would suggest you contact a medical director at Empire Blue Cross Medicare. I have not been successful at securing payment for local infiltration of antibiotics.

For future reference:

There is a HCPCS code and fee for Gentamycin. J1580 for up to 80 mg of Gentamycin, the July 2006 allowance is $1.08. If you find its not covered and not incident to your services, and the patient's secondary won't cover it, have the patient pay you.

The last question: Is it worth all the paperwork, letters, phone calls etc. for the $1.00 worth of medicine you are going to use per day?

Paul Kesselman, DPM, Woodside, NY

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

RE: Bruce Frankel, DPM

I too, deeply morn the passing of Dr. Bruce Frankel. From the very beginning of my tenure as New Jersey's Executive Director, Bruce made me feel welcomed and part of the podiatry family. He and his wife Bobbi were always available to answer a question, give an opinion or assist the New Jersey Society without reservation. All I ever had to do is ask and Bruce would say "Done." His steadfast concern for the New York School and the podiatry profession was paramount. I will miss his humor, his friendliness, and his warmth. My sincere condolences to Bobbi and the Frankel family.

Herman Hammerschmidt
New Jersey Podiatric Medical Society

RE: CPT Code for GraftJacket
From: Paul Kesselman, DPM

In Podiatry Management's June 2006 issue, an article on human skin equivalents presents two different coding scenarios for the use of Wright's GraftJacket. Those were the use of either of the following sequences of CPT codes: 15330-15336 or 15170-15176. The first sequence of codes describes the application of an acellular Dermal allograft, whereas the second sequence is used to describe the use of an acellular dermal replacement.

I received word from Wright Medical, the manufacturer of GraftJacket, that they had received the following confirmation from the AMA. "Per the co-chairs of the CPT Skin Substitute workgroup, application of the Graft Jacket would be reported using codes 15330-15336. Graft Jacket has been listed in the table that is to be published in the CPT Assistant Newsletter article in September 2007."

While I have not yet had the opportunity to review the rationale for this decision, it would seem that the committee decided that GraftJacket was a "graft" and not a "replacement" for the skin it is to replace.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Dragon Dictate (Simon Young, DPM)
From: Multiple Respondents

Dr. Young's hits the nail on the head and remains the last piece of the puzzle that escapes most practitioners. We have been Dragon users since V4.0 and are currently at V 8.1 professional. Although it’s not perfect, it works just fine for us. After some time using this software, we realized that there were no real cost savings with the change to voice recognition. The only difference was that we were not hand writing our notes. That’s it, nothing more.

Let us be perfectly clear. Voice recognition software, in and of itself, saves very little money when you examine the true costs of persisting with paper charts. If you doubt this statement then ask yourself this question: "What costs have I eliminated or reduced with the use of voice recognition software?" The answer for most is likely NONE.

To truly leverage voice recognition and the technology available today, practitioners need to invest in creating a environment that eliminates the costs associated with the paper chart.(i.e., the purchase of file, print and application servers, laptops, workstations and infrastructure that produces a safe secure and solid local area network) Until these investments are made, we fool ourselves into thinking voice recognition offers any real cost savings.

The expense side of the ledger, not the income side of the ledger, is where we need to focus our attention. Our incomes certainly aren't growing at any great rate. Employee (staff) costs are tremendous and ripe for pruning. For us, our ROI was about 2.5 years. We were able to eliminate 1.5 FTE (full time equivalent) clerical staff and although there are recurring charges and some headaches with paperless, they pale in comparison to money we are saving year after year. Money we don't spend improves our bottom line and as the saying goes............ cash is king.

Mark J. Tuccio, DPM, Jamestown, NY, drtuccio@netsync.net

If one is getting only 85-90% accuracy, then something is wrong with the system or microphone. You might need to remake a new user and start fresh. Out-of-the-box with version 8, you should be at least 95% and get better from there. Enunciating your words better also will help. Having the proper microphone and sound cards if needed will aid in a marginal improvement also.

Larry Kosova DPM, Chicago, IL, lkosova@yahoo.com

While voice dictation is certainly an upgrade over handwriting, here are several reasons why EMR has an advantage for its users. Voice dictation users may forget to dictate something they did, where EMR has the items in a template that can be made to prompt the user for documentation.

Most EMR systems have an E & M “calculator”. The system will suggest the proper coding level based on your level of documentation. Voice systems generally do not. If the dictation is being dropped to paper and placed in a chart, the issue of pulling charts, filing charts and looking for the missing chart is still there. With EMR, all your charts and the information in them are at your fingertips.

The clicks you make in EMR are stored as data points. Data points can be used to run reports. You could query your database to find a list of all patients who have a were diagnosed with a diabetic ulcer, who have a family history of diabetes, who have a system review admitting recent bleeding problems, who is taking a certain medication… The point being you can use data to perform outcome studies, recall patients to the practice who have been non-compliant with their treatment plan, etc. Doing this on paper would be extremely difficult. .

C. Zac Childress, President, DarwinTech, Inc.

PRACTICE FOR SALE - BERKELEY CALIFORNIA

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well-established podiatry practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to come on board. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3500 patients without a podiatrist. This is a unique opportunity to be able to work in an extremely busy practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

ASSOCIATE POSITION- COLLEGE STATION, TX

Full time associate position for a surgically trained podiatrist to join an established growing practice in College Station, Texas. This is a great opportunity for a motivated individual to join the leading podiatry group in a family oriented growing community with a wholesome, small town atmosphere. Good package with opportunity for buy-in within two years. Please send CV to billglaze@brazosvalleyfootcare.com

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

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

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

Practice For Sale - Berkeley California

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well-established podiatry practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to come on board. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3500 patients without a podiatrist. This is a unique opportunity to be able to work in an extremely busy practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

ASSOCIATE POSITION- COLLEGE STATION, TX

Full time associate position for a surgically trained podiatrist to join an established growing practice in College Station, Texas. This is a great opportunity for a motivated individual to join the leading podiatry group in a family oriented growing community with a wholesome, small town atmosphere. Good package with opportunity for buy-in within two years. Please send CV to billglaze@brazosvalleyfootcare.com

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

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

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

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