The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 30, 2008 #3,311 Editor-Barry Block, DPM, JD

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Hawaii Coding and Practice Management Meeting Exceeds Even Lofty Expectations

Even though the APMA Scientific Meeting has ended, the adventure continues for 70 podiatrists plus staff, exhibitors, and family members on the Big Island of Hawaii at the spectacular Hilton Waikoloa Village Resort.

Dr. and Mrs. Richard Sawicki enjoying the Hilton Waikoloa Village Resort

“This meeting paid for itself after the first hour of lectures” said Dr. Richard Sawicki of Niagra Falls, NY, who is attending with his wife Anne. Attendees enjoyed the relaxed style of morning lectures from national notables such as AAPPM’s Jonathan Moore, PM’s Barry Block, Codingline’s Harry Goldsmith, among others.

In the afternoon, attendees visited the magnificent waterfalls, active volcanoes, played golf on black lava, went scuba diving, or just relaxed in the lush environments of this extraordinary tropical paradise. Even before the meeting ends, many are already talking about the group's planned Post-APMA Cruise to Alaska in 2010.

Baby Boomers with Arthritis Have High Expectations: OH Podiatrist

They danced to the Beatles, the Rolling Stones and disco. They worked out with Jane Fonda and made jogging their national pastime. Now approaching retirement, many members of the "Me Generation" aren't ready to slow down, even if their bodies are. Foot and ankle surgeons say Baby Boomers are more likely than previous generations to seek care when arthritis develops in their toes, feet and ankles.

Dr. Stephen Frania

"This generation has witnessed an explosion of new medical technology during its lifetime," says Stephen Frania, DPM, a Cleveland foot and ankle surgeon. "They have high expectations, sometimes too high."

Surgeons say many Boomers who seek treatment for arthritis assume they'll be able to resume activities such as running or playing sports. Seeking treatment early can improve the odds of preventing irreversible joint damage. For many patients with early-stage foot or ankle arthritis, changes in shoes or advanced custom orthotics can make a huge difference. While there is no fountain of youth for arthritis, surgeons say there are more medical options available to Baby Boomers than ever before.

Medicare Bill Would Improve Transparency in Imaging Services.

Senate Finance Committee ranking member Chuck Grassley (R-IA) recently introduced legislation (S 3343) that would require physicians to disclose their financial ties to imaging services ordered under Medicare when making self-referrals, CQ HealthBeat reports. The legislation is intended to reduce physicians' incentives for referring patients to imaging providers in which the doctor has a financial stake by requiring them to disclose such ties.

The bill would require physicians to provide beneficiaries with a written list of alternative providers when referring imaging services, such as MRIs, CT and PET scans. The measure also would require the list to specify which providers are in proximity to the beneficiary's home. The legislation is based on recommendations from the Medicare Payment Advisory Commission after the Government Accountability Office found that Medicare imaging spending increased about 200% between 2000 and 2006. The Congressional Budget Office did not score the measure, but a Grassley aide said it could reduce Medicare spending.

Source: CQ HealthBeat via American Health Line [7/30/08]

How to Reduce Interruptions – Part 1

Jay Conrad Levinson Doesn’t believe that time is money. He believes it’s more valuable than money. Levinson offers these tips on dealing with interruptions that waste valuable time:

• Insist that those you deal with not interrupt you at certain times during the day.
• Control interruptions by inviting staff, friends, and colleagues to interrupt you at certain times, say 5-6 P.M.
• Be blunt with strangers who interrupt you. Say, for example, “I’m busy now but I’ll get back to you when I finish this task.

Source: The Ninety-Minute Hour by Jay Conrad Levinson

Query: Tablet PC's with Digital X-Rays

Does anyone have any experience using a tablet PC running Windows XP Tablet Edition with Reina 20/20 digital x-ray system to view the x-rays? Will it run with Windows Vista?

Anas Khoury, DPM, Passaic NJ

Query: Home Visit Gas Charge

Due to the rising costs of gas prices, can we (as doctors) bill a Medicare patient (directly) $5 per house call. Since this is a courtesy service to patients, and my heart goes out to the elderly that can't leave the house, I don't mind going and treating them, but not when it cuts into the small allowance we are given.

I know for an E/M service there is an increase in rembursement (over an office encounter), but not so when you do a procedure at a patient's home - the service remburses the same as if it had been performed in the office. One other quesiton (especially for doctors that do house calls), what is your wording in the note that states that they are home bound?

Codingline Archived Question, New York

Response: If the service is covered, and Medicare has been billed and has paid, you can only bill the patient (or their secondary insurance) the 20% copay and/or the deductible. You CANNOT bill the patient anything additional.

The wording in the chart note varies from patient to patient. I simply state why the patient cannot travel to my (or other doctor's) office.

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found here

RE: Bone Stimulators (Simon Young, DPM)
From: Elliot Udell, DPM

Dr. Young in his reply states the following: "I don't understand why you need a bone stimulator for an avulsion fracture of the 5th met. base. In my experience, all have healed.

Thirty-one years ago, when I was a resident at a hospital with a busy ER, our chief held the same philosophy. Subsequently in my years of practice, I have found the opposite. Many fractures of the diaphysis of the base of the fifth metatarsal go on to delayed union or non union. Landorf in his paper published in the Journal of the American Podiatric Medical Association, titled Clarifying Proximal Diaphyseal Fifth Metatarsal Fractures (1) says that these fractures are prone to delayed healing. Other papers published have given similar findings and some but not all authors recommend surgical intervention as a first line of therapy.

I have found that the use of the Exogen bone stimulator combined with immobilization, have enabled all of the fifth met base fractures I've treated to go on to complete healing without delay. As for expense, since the Exogen is FDA-approved for early fractures and since the welfare of my patients is paramount in the way I practice, I see no need to not offer this option to every patient presenting with this condition. The only caveat is that some insurance companies irrespective of whether it is FDA-approved, will not cover it. Then it's the patient's choice.

(1) Clarifying proximal Diaphyseal Fifth Metatarsal Fractures. Karl G Landorf, JAPMA, Volume 89, number 8, August 1999.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Prescription Shoes
From: Bob Kornfeld, DPM

As a doctor who does not dispense shoes from the office, I have been enraged by the fact that shoe stores often receive my prescription for a custom-molded shoe with specifications and dispense off-the-shelf extra-depth shoes, disregarding my prescription. I always make a phone call to the store when this happens and I am told that "Medicare allows for extra-depth shoes as a substitute for custom-molded shoes ordered by prescription for diabetics." Is this true? This has happened with more than one shoe store and is happening more lately.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: A Call From The Next World

I answered the phone before the office staff arrived the other morning, and it was a call from someone...sounded like in India, or something. She said she was a relay operator for a third-party and asked if I would accept the call. So I figured "what the heck", and told her to go ahead. Then she delivered the following message to me from 1/2 way around the world: "Hello, this is Jesus!"

I didn't know how to respond...was it a prank...a religious zealot... someone trying to convert me?...an announcement that the end of the world was on its way...some sort of "come-on"?

Then she said something about a toe that was hurting last night and asked what should be done about it. Then it hit me like a lightning bolt - - The preceding day I treated a hearing-impaired guy whose first name was Jesus (should have been pronounced "Hay-zoose") and he apparently uses a keyboard to type to an out-sourced operator who speaks for him over the telephone.

Carl Solomon, DPM, Dallas TX

UNIQUE OPPORTUNITY FOR THE RIGHT PERSON! - NEW YORK

We’re in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in the Hudson Valley region of New York State. All DPM´s in our group are board-certified and there is a residency program affiliated with our practice. Please reply to HVFA, PO Box 3300, Kingston, NY 12402-3300; or via email to bud@hvfa.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Multi-office group seeks associate in Southern California for general podiatry in office setting. NO nursing homes! Spanish speaking a plus. Full or part-time. Excellent compensation with potential for partnership. E-mail scpodgroup@yahoo.com for more details.

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280

SEEKING ASSOCIATE POSITION - NEW YORK OR CONNECTICUT

PSR-24 trained podiatrist seeking an associate position in New York (Westchester, Putnam or Dutchess County) or Connecticut. Excellent surgical and patient skills. Ethical and hardworking with 3 years of private practice experience. Please contact samalsal@yahoo.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net , fax to 410-486-2049, call Dr. Herbert Rosen 410-580-0255

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice, well-rounded surgery and routine, please email your CV to superrang@bellsouth.net

SATELLITE CLINIC FOR SALE -- CHICAGO, IL

70-75K over last 3+ years working 2 days/week. Devon/California area. Waiting room, x-ray equipment, and offices/treatment rooms updated over last 2 years. Will stay on for transition. (773)761-5381 DrD@globalpodiatry.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

Established practice in beautiful Willamette Valley of Oregon. Provider practices fulltime and has a well established patient base with a strong patient flow. Practice is well-positioned for new growth and development. Doctor will transition after sale providing introductions to local referrals and health care facilities. Surgery privileges at local hospital and surgery center. Contact: Oregonpractice@comcast.net

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. 30-40 hours per week. $100,000+ guaranteed. Please fax resume to (412) 563-0740.

PRACTICES FOR SALE - BROOKLYN & QUEENS

Well-established practices grossing high $200's for sale with approximately 90% C & C and 10% SX. Great locations and visibility. Well-respected doctors and staff willing to stay. Ask about 90-125% financing options with little to nothing down. American Doctor Sales; 614-918-3000 or email us at sell_my_practice@yahoo.com. Please visit us our website

ASSOCIATE POSITION - LONGVIEW, WASHINGTON

Seeking podiatrist for immediate opening in well established podiatry clinic in Longview, WA. Typical podiatric practice, offering biomechanics, surgery, diabetic care, sports medicine. Excellent pay, with incentives for high performers. Malpractice, medical insurance, licensing, CME covered by employer. Please send resume and background references to Michele@nwfootankle.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 for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

Podiatry Chairs - Midmark 117, Hill with surgical screen and 2 Boyd each $1,500. Multiple hand held podiatry instruments - both surgical and non-surgical available. Paraffin Bath $20, X cell unit 1993 works perfect, just $2000. Office equipment-desks, 4-line phone system, add on hold and more available too! Email: ahappyfoot@yahoo.com for more info.

ASSOCIATE WANTED IMMEDIATELY – NEW YORK

Part-time or Full-time for group practice Fast track to partnership. Located in Orange & Sullivan County, NY. Commute from adjoining counties to see how it fits. Monroe, NY office is only 1 hour from Manhattan. All phases of podiatric care. Call Dr Marc Hudes 845-807-8864. Check out our practice website

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