August 12, 2006 #2,652 Editor-Barry Block, DPM, JD

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KY Podiatrist Provides Advice About Healthy Shoe Choices

Louisville podiatrist Rhonda Eichenberger said the healthiest shoe choices are tennis shoes with arch support and supportive sandals like Birkenstocks. But if you still insist on a shapely shoe, here's the low-down on how to be nicer to your feet.

Dr. Rhonda Eichenberger

Flip-flops - The popular summer staple allows the heel to slide around and be exposed to the elements, which can cause "cracks and dry fissures in the heel," Eichenberger said. In addition, there is no support or shock absorption, which can cause the foot to twist. The remedy: Choose flip-flops made of natural materials such as soft leather. Make sure your foot doesn't hang off the edge.

High heels, stilettos, wedges -"Anything over 2 inches is going to cause added pressure to the ball of the foot," Eichenberger said. "As women get older, they lose the fat pad under the ball of the foot. It's just bone on skin." Heel height can also make the foot wobble and lead to ankle sprains. The remedy: Use a padded insert to alleviate pressure on the ball of the foot. "You can buy orthotics for dress shoes that are credit-card thin," Eichenberger said. Also, try slightly lower heels to reduce pressure. Shop for heels in the afternoon, as the foot tends to swell throughout the day. Try to stick to chunkier heels that are 2 inches or shorter.

Pointy toes, narrow round toes - Because they tend to squish your feet and make toes overlap, these shoes can result in hammer toes and ingrown nails. The remedy: Look for a shoe style with a deep toe box to avoid hammer toes. Ensuring a proper fit can help prevent ingrown nails. "It needs to be one finger (width) from the longest toe, or they're too small," Eichenberger said.

Source: Maisy Fernandez, Louisville Courier-Journal [8/11/06]

NY Podiatrist Holds Charity Triathalon for Teens

Trying to do well and trying to beat others are two different things," Dr. Jay Kerner blared through his bullhorn to kids before the start of his triathlon at Oceanside Park. "Excellence and victory are conceptually distinct, and are experienced differently." Kerner found this quote in a book on running and hoped it would be equally inspiring to the kids, ages 9 to 14, who were about to dive into the park's pool to signal the start of Dr. Jay's 8th Annual Youth Triathlon.

Dr. Jay Kerner

Kerner included team races this year to get more kids to participate, particularly since they could play off one another's strengths and weaknesses. "For whatever the reasons, the team concept just didn't generate the interest we thought we would have," Kerner said. "I think we would have had more if the weather report were better."

Kerner is an Oceanside native, a Rockville Centre resident and Baldwin-based podiatrist who established his triathlon as a fund-raiser for the Long Island branch of the Cystic Fibrosis Foundation (CFF). His longtime friends, Mitch and Debbie Simon, have a son with the disease. "Cystic fibrosis is one of those charities where the funds go directly into research," said Kerner, whose triathlon raises an average of $2,000 annually for CFF.

Source: Joseph Kellard, Herald Community Newspapers [8/11/06]

Region D: Transition Update

The DME Carrier for Region D will change from CIGNA to Noridian Administrative Services on Sept. 30, 2006. This change is part of the transition from the current DMERC to the new DME Medicare Administrative Contract (MAC) structure.

After 5 p.m. EDT on September 28, 2006, suppliers will need to use Noridian’s contractor ID (19003) on your electronic claims, instead of CIGNA’s ID (05655). If suppliers are using Region D’s Express Plus software, they will need to install a software upgrade, available soon on CIGNA’s Web site. This upgrade must be installed after 5 p.m. on September 28 and before you send any claims electronically.

Also be aware that due to the system switch, you will not be able to send any electronic claims or do anything else electronically (such as checking eligibility or the status of claims)
between 5:01 p.m. EDT and 6 p.m. EDT on September 28.

Visit the Noridian Web site, www.noridianmedicare.com, to obtain contact information, phone numbers, etc.

Source: Paul Kesselman, DPM

Query: Hypopigmentation Following Intralesional Steroid Injections

I am finding hypopigmentation following intralesional steroid injection is a fairly common adverse reaction. Is anyone familiar with treatment, either topical or injectable, for this entity?

Greg Cohen, DPM, Brooklyn, NY, gcohen428@yahoo.com

Query: Medicare Advantage Plan Denials

We are having a lot of trouble with the SecureHorizons MA plan. They are continually denying payment for diabetic and at-risk foot care, stating that these are non-covered services by Medicare. They are also refusing to pay for the insoles for diabetic shoes (HCPCS A5513 with modifier -KX) stating once again that these are non-covered by Medicare. I have sent them copies of Medicare LMRPs for these services to no avail. When I call and ask to speak to a supervisor in the claims department, I am told that they don't have a number for them (claims department is in another state).

I find this situation totally ridiculous! We are not contracted with them and we will not be accepting SecureHorizons any longer. What I would like to know is; is anyone else having these problems? Can I bill DMERC for the insoles they refused to pay for? And can I mplain
to Medicare that this company is not following their guidelines?

Lani Smith Office Manager, Kash Siepert, DPM, Roseburg, OR

Response: Most often, when we discuss MA plans, we're talking about Medicare Advantage HMO plans. My answers will be based on MA HMO plans. If this is another type of MA plan (e.g., Private Fee for Service or PPO plan) these answers may not apply.

You note that you are not contracted with the MA plan. Unless you have an authorization to perform these services (or they were emergency services, which seems unlikely in the case of routine foot care or the provision of insoles) the MA plan is not under any obligation to pay you for these services. All HMOs, MA plan or otherwise, generally have large networks of contracted providers to see their patients.

If you have an authorization to see these patients, then you must follow the appeals processes of the health plan. The plan's website will generally have that information. If you have signed a Memorandum of Understanding (an MOU) to see certain SecureHorizons members, you are, in effect, contracted with the plan. You would then contact their Provider Relations department for assitance in getting your claims paid, if you had authorization to perform the services. You cannot bill the DMERC for services rendered to an MA patient.

If you have have followed all the appropriate procedures, and still are dissatisfied, you can complain to the CMS Regional Office in your area. Be sure to provide them information about authorizations, etc. The Medicare Carrier has no jurisdiction over these type of situations.

Stacey Hernandez, CCS-P, Placentia, CA

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RE: Lac-Hydrin Boycott (Norm Wortsman, DPM)
From: Elliot Udell, DPM

Rather than dwell on whether the makers of Lac Hydrin are good or bad, let’s look into other possibilities. The manufacturers of Lac Hydrin or for that matter, any other pharmaceutical firm, are what they are. Some market more to podiatrists and others market less or not at all. What we should be exploring are what products we can dispense from our offices. I was just at the APMA national convention. There were booths there promoting many uric acid and sal acid creams that we can dispense right from our offices without putting the patient through the hassles of going to a pharmacy and fighting with his or her insurance company for coverage. Most of these products will cost the patient equal or less than a co-payment paid for a pharmaceutical at the drug store and cherry on the cake is that dispensing from the office helps our bottom line as well.

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

RE: Congress May Reduce Physician Reimbursement
From: Mark Levine, DPM

I've read the posts about the 5.1% pay cut Medicare has on the table. It seems every week I'm getting more and more news about cuts. Oxford just cut Austin bunionectomies from $840 to $460.

This is not just podiatry. It's endemic among all branches of medicine. There's no rationale behind these cuts. It's very simple. The insurance companies have been cutting "because they can." It's time for a single payor system in this country. The problem is, nobody seems to want one. The cuts are formulated so it's transparent to the patients. The politicians in both parties continue to bicker among themselves and it seems only the providers seem to see the forest for the trees. I continually write my senators and congressman without even a response.

Even with a 5.1% cut, if everyone had Medicare, we'd know what's expected of us, what the fee schedule is and do have some say with the politicians if we could only unite with all the other health professionals in the country and make our voices heard.

The APMA may be working hard, but it seems to be barking up the wrong tree. These problems we're facing seem to be beyond anyone’s control and they're only getting worse and worse. And as I said before, it's done to us, "cause they can." I'm 51 and hope I can get 10 more quality years out of my chosen profession. If things continue on their current course, I feel very bad for the young practitioners. In the end, the patient suffers the most and no one but the doctors seem to care.

Mark Levine, DPM, Middle Village, NY, mlevine3@optonline.net

RE: HMOitis (Dennis Shavelson, DPM)
From: Jeff Oster, DPM

You’re not alone, Dr. Shavelson. The surgery center where I work (and have no financial interest in the center) has performed cost analysis profiles on each of our surgeons. I’ve been tagged as a high cost provider due to the cost of subtalar joint implants, cannulated screws, etc. But is cost-profiling by the center inappropriate? Not really Actually, I think it’s good business.

There’s a couple of issues to consider; (1) currently, hospitals are able to itemize the cost of an implant while a surgery center cannot. There is pending legislation so that this may change by 2008, but for the short term, surgery centers are forces to write off the cost of an implant and (2) there are some bargains on the market that can save on costs. For instance, we just switched from the CSI subtalar implant ($1200) back to a traditional STA Peg from Sgarlatto Labs ($349). Granted, the STA Peg might take 10-15 minutes more to put in, but as my patient’s advocate, I’m OK with the change.

During the last seminar I went to, I listened to a fellow talk about his method of doing triples. He used a neat little compression staple. So after the lecture, I talked to the rep who had the staple. Each staple was $300. In the lecture, he used 4 staples. Now I’ll get paid $800-1000 for the triple, but the staple maker is going to bill for more than that? Sure, I‘d love to use these cool tools, but we also have to be realistic about costs when we can accomplish the same thing with a few inexpensive screws or Richards staples.

Jeff Oster, DPM, Granville, OH, support@myfootshop.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 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

Seeking an experienced podiatrist versed in all aspects of podiatry with current AZ License. The right person will join as a salary associate leading to partial ownership in the group practice. Podiatry practice is well established over 25 years, successful and a large volume in the Phoenix metro area. Position available immediately. Email CV and inquiries to:pprac4sl@cox.net

EQUIPMENT FOR SALE

Ritter X-Ray machine, Mayo stand, Oxygen mask and tank, Polaroid 8X10 X-Ray processor and cassette, Ritter Clave autoclave, Whitehall JO-140 portable whirlpool, Glass bead sterilizer, Foredom cord drill with hand piece, JanL model 100 nail dust extractor, 3 podiatry cabinets, Polaroid 545 3X5 X-Ray developer, 3 8X10 X-Ray cassettes. The equipment is located in NY. Please call 845-359-1070.

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

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

ASSOCIATE POSITION - GULFCOAST OF FLORIDA

Great opportunity in rapidly growing practice for a PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548-bed hospital system, new hospital is being built and multiple surgical centers. Candidate should perform rearfoot & ankle surgery, including Charcot reconstruction. Candidate needs to be ethical and motivated and must have a current Florida license. Established practitioner or new practitioner OK. Salary + percentage + benefits including insurance and 401K. Fax CV to (239) 566-8778.

POSITION AVAILABLE-RETIRED OR DISABLED PODIATRIST-DELRAY BEACH FLORIDA

Full or part time position in start up pharmaceutical company. Duties would range from answering phones to publishing scientific papers. Please contact: rhm123@gmail.com

Southeast Florida Podiatrist Needs Top Notch Candidate

South Florida podiatrist looking for an astute, personable, extremely well trained podiatrist with excellent clinical skills and acumen. My practice is busy, rapidly growing, and referral based. Looking for a full time associate to start immediately. Partnership opportunity available. I require someone who can work independently and wants to help elevate this practice to a new level. Email your resume to podiatry49@hotmail.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

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