The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 25, 2007 #3,023 Editor-Barry Block, DPM, JD

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Congratulations to Gene Mirkin, DPM of Kensington, MD our First weekly survey contest winner, who has won CARMD, an easy-to-use handheld diagnostic tool which tells you what’s wrong with your car when the “service engine” light comes on (value $89.95)

ACME MADE Designer Slim Computer Bag

This week's prize is an ACME MADE Designer Slim Computer Bag (Value$149.95) Colors may vary. To enter the contest, complete the survey at www.podiatrym.com and send us question #45, along with your name and address. Be sure to vote in the survey for the 2008 inductees in the PM Podiatry Hall of Fame. All entries are eligible for the grand prize of a one-week Windjammer Caribbean Cruise.

Many Options Available to Prevent Amputations: IL Podiatrist

Dr. Christopher Moore, a podiatrist at Southern Illinois Foot and Ankle Clinic, is adamant that new medications and technology can help more diabetics avoid amputation, but only if they seek treatment as soon as they discover a problem. "We can help diabetics care for their feet in many ways, and even prevent amputation in more cases than one would think," Moore says. "There are therapeutic vitamins that may help restore feeling in the feet. If their circulation is still good, we may be able to do some pre-emptive surgery to fix an orthopedic abnormality, such as a hammertoe or bunion, before the circulation gets worse. We can fit them with diabetic shoes."

Dr. Christopher Moore

Moore encourages people not to believe anyone who says that diabetics can't heal or that diabetic neuropathy means certain amputation. He cites one patient who was resigned to losing his toes or foot because another healthcare provider had said that would certainly happen. "We tested that patient's circulation when he came to us and it was excellent," Moore recalls. "So we started him on some medication that could reduce some of the numbness, gave him a preventative care plan, and had him come back for a follow-up. He still has his toes."

Source: Joanna Gray, Southern Health [8/23/07]

NJ Podiatrist Pleads Guilty to 1.2 Million Medicare Fraud

A podiatrist pleaded guilty Friday to defrauding Medicare by billing for things like toenail clipping and foot massages and agreed to pay $1.2 million in restitution. The plea bargain for Ming C. Tung will settle criminal and civil cases brought by federal authorities, the U.S. Attorney's Office said.

He pleaded guilty to a single count of healthcare fraud. He faces up to 10 years in prison and a $250,000 fine when sentenced Dec. 7, although the actual term will be considerably lower, in part, because he pleaded guilty. He also improperly obtained reimbursement for home visits that were not medically necessary, prosecutors said.

Tung, 63, of East Brunswick, admitted that from 2001 to 2005, he fraudulently billed the Medicare program for routine services, such as toenail clipping and massage. To get reimbursement, Tung made it appear that the patients suffered from systemic problems, such as diabetes, that qualified.

Source: Associated Press [7/24/07]

Rising HealthCare Costs Pose Challenge, CBO Report Says

The Congressional Budget Office in a report released Thursday said that the steady growth of U.S. health care costs is making the long-term budget outlook "daunting," even though the 2007 federal deficit is projected to be lower than last year's, the AP/San Francisco Chronicle reports. According to CBO, the deficit for the fiscal year ending Sept. 30 will be about $158 billion -- $90 billion less than it was in 2006.

The report said, "The long-term fiscal outlook continues to depend primarily on the future course of health care costs." CBO Director Peter Orszag noted that Medicare and Medicaid take up 4.6% of the U.S. economy, a figure that is projected to rise to 5.9% by 2017 (If healthcare spending continues to grow at its current rate of 2.5 percentage points faster than the economy as a whole, spending for the two entitlement programs could exceed 20% of the gross domestic product (Rubin, CQ Today, 8/23). Healthcare costs continue to put the U.S. "on an unsustainable fiscal path," Orszag said, adding that policymakers have "done much too little" to remedy the problem.

Source: Various Sources via American Health Line [7/24/07]

Query: Binding Arbitration

Recently, I came across a copy of a physician-patient binding arbitration agreement for medical malpractice claims made in a patient's x-ray binder. It got me thinking again about this issue. I would like to ask whether this type of agreement can accomplish any of the following goals: 1. Lower malpractice premiums. 2. Lower claims made of frivolous or paltry medical lawsuits.
3. Lower a physician’s personal potential medical malpractice exposure.

Philip E. Larkins, DPM, San Marcos, CA

Editor’s Comment. PM News does not provide legal advice. If binding arbitration were easily implemented, it certainly would be more widely used. Not all states allow for binding arbitration. In 1975, California's MICRA law, now codified in California Code of Civil Procedure, section 1295, provided a specific contract for arbitration of medical malpractice disputes. This voluntary, mutually binding contract has remained unchanged since 1975. Since each state handles such arbitration differently, you would need to consult an attorney in your state to ensure that the arbitration agreement that you use will be legally enforceable. A more important hurdle is whether your malpractice carrier approves of the policy

While it’s probable that an arbitration agreement will reduce the possibility of claims made, as well as the monetary awards granted (arbitrators tend to be more objective than juries), it also raises the whole specter of negligence in the patient’s mind, which could potentially undermine confidence in you, or cause patients to refuse to sign the agreement

Query: Surgical Treatment of Freiberg*s Infraction

What code should be used to do a implant to fix a Freiberg's infraction at the 2nd metatarsal-phalangeal joint?

Melinda Hefti , Concord, NC

Response: There is no code for this procedure. I would suggest unlisted foot code, CPT 28899.

You should 'suggest' in an accompanying letter an existing code in the the foot (or even the hand) section of CPT that is similar in work effort and follow-up. That way, the payer will have a frame of reference to value your unlisted procedure (along with reviewing the op report) in terms of complexity.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
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RE: ESWT As “Investigational” (Arden Smith, DPM)
From: Multiple Respondents

Dr. Smith hit the nail on the head. I believe the insurance companies may have colluded to “kill off ESWT.” 90% of the claims now state that “ESWT is investigational and experimental”. If you check all the major insurers web sites, they all state the exact same wording regarding ESWT. Very suspicious! ESWT is FDA approved! Therefore, it is not investigational or experimental! The insurance companies can decide not to cover a particular therapy, but they can’t legally call ESWT experimental when it is FDA approved. We need to consider, as a group, what legal recourse we may have against the insurance companies to stop this unfair action against ESWT.

Howard A. Stone, DPM, Glenview, IL,justus313@comcast.net

I have used ESWT in my office for cases of intractable heel pain for over two years. We had mixed results with both the high-powered, one-treatment modalities, as well as with the low-powered modalities that require three treatments. Some patients reported that the treatment really helped them, while others said that it did nothing. Oddly enough, we used ESWT on a patient with a Morton's Neuroma in the third interspace, and it alleviated her symptoms. It did not eliminate the pain in her heel. I have colleagues of mine that report a much higher rate of success in the treatment of heel pain than we found. Yet the technicians sent by the company were the same.

At the recent APMA Scientificl convention, Dr Lowell Weill Jr. presented cases where ESWT was used at his clinic to treat neuroma pain and he had gratifying results. At his clinic, they showed using double blinded studies that ESWT was effective.

Because the treatment is virtually harmless, I see no reason why it should not be tried after other forms of therapy have failed. On the other hand, the rental of the equipment along with trained technicians, makes ESWT treatment very expensive, and it is understandable why insurance companies might not want to pay for a treatment that has not be proven effective by all doctors. Further research should be performed at multiple locations to determine if ESWT is effective in the treatment of heel pain, neuroma pain, as well as other causes of foot and ankle pain.

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

We have been using ESWT (Dornier) for intractable cases of plantar fasciitis and achillies tendinitis for about 5 years with excellent results. We recently used it ( one month ago) to treat a Morton's Neuroma with positive results thus far.

We are all aware that the insurance providers are on a mission to lower reimbursements and not pay for treatments that they can deem experimental. I do not know how a carrier can reverse acceptance of previously authorized and paid on procedures. It just might be how the CEOs of the managed care companies are making tens of millions of OUR dollars in compensation every year.
Personally, I've done the research and am not surprised.

Michael J. Schneider, DPM, Vail-Aspen-Frisco, CO, MJS10Vail@aol.com

RE: Wired Network Vs. Wireless Tablet PCs (Larry Kosova, DPM)
From: Al Musella, DPM

I disagree with the Dr. Kosova’s comment about using cat 5e cables. The biggest expense in wiring is the labor, which cost the same for running cat 5e or cat 6. The additional expense of cat 6 cable and connectors is nothing compared to the cost of labor. It won't give too much benefit now, but it won't become obsolete as fast.

I recently rewired my office to move from 10 mbs to gigabit (1,000 mbs). It makes a huge difference. Cat5e can barely handle a gigabit network now, but the next step up will probably require cat 6.

Al Musella, DPM, Hewlett, NY, musella@aol.com

Editor’s note: This topic is now closed.

CRYOPROBE SALE: PRICE REDUCTION!

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $10,500 or best offer. This lists for $14,900.00 new. The CryoPac system comes complete with two fully sterilizable Probes. This system has been used less than 15 times and can be used to treat plantar fascitis, neuromas, and other foot pathology. Please email inquires or your offer to: drsammendicino@gtef.org

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE POSITION – CENTRAL VIRGINIA

Two office practice, fully automated, strong referral base, hospital and surgery center privileges. Full scope of foot and ankle care. ABPS –certified/eligible. Competitive salary/percentage structure and benefits. Email letter of intent and curriculum vitae to jdisabato@virginiafootandankle.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

IN-NETWORK ASSOCIATE POSITION – BROOKLYN, NY

Seeking In-Network podiatric physician in downtown Brooklyn, NY. Part-time and or full-time with flexible hours and all aspects of podiatry, including surgery in a modern office setting with EMR, Sonography, and Digital X rays. Please email resume, including list of participating plans to jr11231@yahoo.com

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-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

MANHATTAN, NY GENERAL PRACTICE FOR SALE

Great Midtown East location near Grand Central Station. 614-918-3000 or email sell_my_practice@yahoo.com"

SIERRA VISTA, ARIZONA PRACTICE FOR SALE

Doctor retiring and willing to stay for long transition to assure the new doctor does very well. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

PORTLAND, OREGON 2-PRACTICE LOCATION FOR SALE

Doctor retiring soon and leaving country. This opportunity is 70 miles east of Portland with little to no competition! Check out gorge.net for the area. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

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