The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 29, 2008 #3,336 Editor-Barry Block, DPM, JD

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OH Podiatrist Receive 2008 Health Center Hero Award

Dr. William Springer, a Marion, OH podiatrist, has been awarded the 2008 Health Center Hero Award. The Health Center Hero Award is part of National Health Center Week 2008 Aug. 10-16, a national campaign dedicated to recognizing the service and contributions of America's Community Health Centers.

Dr. William Springer

Springer is a graduate of The Ohio College of Podiatric Medicine and completed his residency training at Westbury Hospital, Houston, Texas. He is board certified by the American Board of Podiatric Surgery.

Source: Marion Star [8/27/08]

Failure To Timely Diagnose Charcot's Joints in Diabetic Patient Suffering Peripheral Neuropathy (NJ)

Facts: The plaintiff in her late 50s, a diabetic with peripheral neuropathy, contended that clinical signs including deformations in the bone, the collapse of the arch, an increase in pain and swelling and redness, should have led to a timely diagnosis of Charcot's joints, a degenerative condition that can result in the breakdown of bones and tissues of the foot. The plaintiff also contended, that she was sent for a bone scan three to four months later and that the defendant should have realized that early stages of the condition were evident. The plaintiff maintained that if diagnosed after the bone scan, more conservative treatment modalities such as the use of a total contact cast would probably have enabled the condition to resolve in the absence of surgery and the implantation of hardware which will permanently cause increased pain and difficulties ambulating.

The defendant maintained that the clinical signs prior to the bone scan were consistent with diabetes and peripheral neuropathy and denied that the failure to diagnose the condition this time constituted a deviation.

The defendant also contended that he recognized the early stages of the condition after the bone scan was taken and acted appropriately by prescribing a walking boot and referring her to her family physician. The plaintiff underwent the surgery approximately one year later.

Result: $ 300,000 Settlement

Plaintiff's Expert: Christopher Connor, DPM, Cherry Hill, NJ

Source: Jury Verdict Review Publications, Volume 29, Issue 2

Practical Steps for Dealing with Surprise Visits from Government Agents - Part 1

Here are some issues (provided by Ohio State University Medical Center’s Compliance Director Julie Chicoine) to think about when a government official shows up unexpectedly:

• Identify what agency or agencies the government officials are from. Is it OIG, DOJ, the state Medicaid fraud control unit, etc.? Get copies of their cards, and verify their credentials.
• Call your attorney and report the presence of the agents and the names of their agencies so the attorney can assess the scope of the problem, Chicoine says. Ask the agents for a primary point of contact so you don't have to duplicate medical and other records for each agency, which is time-consuming and expensive.
• Your employees shouldn't take a confrontational approach with government agents who are just trying to do their jobs.
• "If things unravel quickly and agents are very zealous, employees should not attempt to interrupt or interfere with the investigation. It will create problems for you individually and only escalate things," Chicoine says.

Source: Nina Youngstrom, Health Business Daily

Offer Incentives for Great Ideas

Many practices are reluctant to implement ideas that aren't their own. But the not-invented-here attitude comes at a great price. Some of the best practice ideas were borrowed from outside sources. To encourage your employees to "steal" ideas from ununusal places, offer small incentives for the:

• Best idea from a family member
• Best idea from a competitor
• Best idea from a friend
• Best idea from a patient

Source: Adapted from What a Great Idea! by Charles Thompson

Query: Alcohol Percentage and Success Rate

At a recent office visit, a PCP presented to me an article for treating his neuroma with an ultrasound-guided 0.5 cc/20% solution of ethyl alcohol (mixed with 0.25% bupivicaine): Treatment of Morton's Neuroma with Alcohol Injection Under Sonographic Guidance: Follow-Up of 101 Cases. Richard J. Hughes, Kaline Ali, Hugh Jones, Sue Kendall, David A. Connell. It was published in the American Journal of Roentgenology in June, 2007.

100 patients were followed in a prospective fashion and 84% reported complete symptom resolution. It seems like a solid study and conflicts with the 4% solution being advocated by podiatrists. I am curious what percentage of alcohol people are typically using and what success they report?

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

Query: Translator for Hearing-Impaired Patient

We have a hearing-impaired patient who comes to our clinic for routine nail care. She insists on a translator even though we have offered to use a sign board. Each time she comes in, the translator costs more than we get paid for the nail care. We would like to know if we are in any position of legal repercussions if we refuse to pay for the translator, as we have offered a viable alternative.

Jason Surratt, DPM, Tigard, OR

Editor’s Note: PM News does not provide legal advice. The short answer is that under the Americans With Disabilities Act (42 USC § 12101), you are required to make a reasonable accommodation to a disabled patient even if you lose money. If the patient decides to sue you, it will cost upwards of $10,000 to defend it. This cost is not covered by most insurance policies. To read some recent responses on how others have dealt with this situation, see:

http://www.podiatrym.com/pmnewsissues.cfm?pubdate=04/15/2008 http://www.podiatrym.com/pmnewsissues.cfm?pubdate=04/16/2008

RE: Facility Accreditation
From: Josh White, DPM, CPed

According to Barry Bromberg, Division of Provider/Supplier Enrollment, Program Integrity Group, Office of Financial Management, CMS, the National Supplier Clearinghouse has been notified that currently new physician applicants do not require facility accreditation.

Podiatrists whose supplier numbers have expired, who have opened an additional office or opened a new office, can now apply for Durable Medical Equipment numbers without the need to meet any facility accreditation requirements. Podiatrists can get the required 855S form from SafeStep with most of the information filled out as well as other required compliance documentation. Expect it to take Medicare 60 – 90 days to process applications. Please note that unless NPI numbers are correctly linked with DME supplier numbers, claims will reject.

Josh White, DPM, CPed, President, SafeStep, joshwhite@safestep.net

RE: Standard of Care Soft Tissue Masses (Bryan C. Markinson, DPM)
From: Multiple Respondents

I agree with the previous posts suggesting pre-operative imaging when any lesion is suspect or unusual as well as prompt referral to the appropriate oncology center. I recently read the following articles and found them to be a good review and timely for this discussion:

Thacker, MM, et al.: Soft Tissue Sarcomas of the Foot and Ankle: Impact of Unplanned Excision, Limb Salvage, and Multimodality Therapy, Foot Ankle Int. 29:690-698, 2008.

Maheshwari, AV, et al.: Metastatic Skeletal Disease of the Foot: Case Reports and Literature Review, Foot Ankle Int. 29:699--710, 2008.

Craig Breslauer, DPM, Palm City, FL, cbreslauer@southflaortho.com

There is a famous case where two conflicting sets of statistics came out of two respected academic settings. One was from the Mayo Clinic, where they reported that most cases of back pain were the result of herniated discs. The second study came out of a well-respected family practice setting, where their statistics reported the opposite. Both studies turned out to be correct. The analysis was that people who tended to go to the family practice center were those with common back problems. Hence most were not caused by structural problems of the spine. On the other hand, people who wound up at the Mayo Clinic were those with more serious problems, which stumped local sources. Hence, that explained the conflict with both studies.

People who go to institutions like Mt. Sinai or Sloan Kettering tend not be the Johns, Jills, and Joes with common foot problems. When local physicians have a sense of uneasiness about a lesion they are treating, they send them to the likes of the above two hospitals. Hence, it is easy to see why Dr. Markinson would see more serious tumors at his world-renowned teaching hospital than Dr. Jacobs would in his part of the world.

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

Editor's Note: An extended-length letter from Juliet Burk, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=21598&start=1

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