The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 30, 2008 #3,337 Editor-Barry Block, DPM, JD

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Lower Extremity Diabetes Care Standards Lacking: Study

Researchers at The University of Arizona College of Medicine participated in a groundbreaking study of clinical practice patterns in lower-extremity care of diabetes that suggests standards of quality care are not being met nationwide. The Southern Arizona Limb Salvage Alliance (SALSA), the Department of Veterans Affairs, and Rosalind Franklin University of Medicine in Chicago also participated in the study, published Aug. 11 (ahead of print) in the online edition of the journal Diabetes Care.

Dr. David G. Armstrong

"I think the bottom line is that clinicians, for a variety of reasons, are not practicing what is preached," said the study's senior author David G. Armstrong, DPM, PhD, professor and director of SALSA in the UA Department of Surgery and the Southern Arizona VA Healthcare System. "The simple task of using the right technique to take pressure off of the bottom of the feet is being practiced in the majority of cases by fewer than 2 percent of the reporting centers. In a time when every 30 seconds someone loses a limb due to diabetes, this is unacceptable." Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers, the authors stress.

Dr. Stephanie Wu

The three-year study evaluated nearly 900 diabetic foot clinics across the nation. Stephanie Wu, DPM, MSc, assistant professor of surgery at Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University and the first author of the study, voiced similar sentiments. "We must marry effective reimbursement with effective care. Right now, most insurance plans will pay for an amputation, but not for the boot or cast that would heal the wound and prevent the amputation."

FL Podiatrist Helps Raise 16K for Histiocytosis Association

More than 100 exotic cars assembled on a recent Saturday morning at Toll Brothers' Jupiter Country Club, the starting point of this summer's Exotic Car Run to benefit the Histiocytosis Association of America (HAA). The event raised more than $16,000 to help fight the rare blood disease.

Dr. Virginio Vena (Top Right) with exotic cars.

In his 27 years of living in South Florida, event organizer Dr. Virginio Vena said he had never seen so many exotic cars driving on Jupiter's Indiantown Road.

"I think we accomplished our goal with this event: raising money for research for kids with hystiocytosis," the podiatrist said. "I look forward to planning another fund-raiser in 2009."

Source: Palm Beach Post [8/28/08]

McCain Taps Palin, a Backer Of Market-Based Reform

Alaska Gov. Sarah Palin, announced as the vice presidential pick for the Republican ticket, has a record of supporting market-driven healthcare reforms in line with the ones promoted by the party’s presumptive presidential nominee, Arizona Sen. John McCain.

Gov. Sarah Palin

Palin, 44, who was elected in a three-way race in 2006, convened a task force to propose healthcare strategies, and the effort led to a proposed law creating a state office that would provide consumers with price and quality data, as well as end the state’s certificate-of-need program. In her “state of the state” address this year, Palin said that “Alaskans want healthcare in the hands of doctors, not lobbyists and lawyers.” The legislation failed.

Her gubernatorial campaign website offers a straightforward glimpse of her approach to healthcare: “I support flexibility in government regulations that allow competition in healthcare that is needed, and is proven to be good for the consumer, which will drive down healthcare costs and reduce the need for government subsidies. I also support patients in their rightful demands to have access to full medical billing information.”

Source: Gregg Blesch, Modern Healthcare [8/29/08]

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.
• 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

Query: Proper Modifier in Global Period

I performed a ray resection with soft tissue debridement, right foot. Two months later, I applied Apligraf to the wound. The Apligraf was applied at the wound center of the hospital. Since it was applied during the global period without returning to the operating room, can I get reimbursed for the application of Apligraf? What would be the proper modifier?

Michael Fein, DPM, Bethel, CT

Response: If this second procedure was a pre-planned closure or subsequent procedure, you would use "-58" modifier.

If the Apligraf application was due to complications (such as non-healing wound), and, instead of the clinic, you needed to return to the operating room, then a "-78" modifier may be the better modifier.

What will determine the correct modifier in this scenario is defined pretty much by the intent and circumstances of the subsequent procedure that you're doing.

Leslie Johnson, CPC, Fort Wayne, IN

Codingline subscription information can be found here

RE: Alcohol Percentage and Success Rate (Lloyd Smith, DPM)
From: Michael Turlik, DPM

In reference to the article written by Hughes R, et.al. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Am. J. Roent.188; 1535, 2007. This is a descriptive study and as such is useful to generate hypotheses rather than to test hypotheses. Anecdotal information based on practice experience is even less useful in determining treatment efficacy.

In addition, descriptive studies which measure pain as a primary outcome are highly susceptible to the placebo effect. The literature is replete with very promising results from descriptive studies which disappear under more controlled conditions. Therefore, without a fair comparison group, any conclusions with regard to treatment efficacy would be premature.

My conclusions based upon the methods and results reported in this study are: alcohol injections may be useful in the treatment of Morton's neuroma, sonographic guidance may be useful in the injection process and that there were no major complications of this procedure.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Translator for Hearing-Impaired Patient (Jason Surratt, DPM)
From: Joseph Borreggine, DPM

The following useful information on this topic appears on the website of the Podiatry Insurance Company of America (PICA):

http://www.podiatrym.com/letters2.cfm?id=21625&start=1

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

PRACTICE FOR SALE – CALIFORNIA

Practice is available immediately for sale in sunny Capitola, CA. The office space is available for lease or month-to-month for $750/month. The practice has a loyal patient base which is mostly home visits and skilled nursing facilities in Santa Cruz county. The practice can be moved to another location or merged with an existing practice. Asking price $35,000.00.

ASSOCIATE POSITION AVAILABLE- NEW YORK

Full-time associate position in our well-established Midtown Manhattan and Forest Hills practices. Well-rounded practice with hospital based surgery and all phases of podiatric care. We are seeking PSR 24/36 trained podiatrist with good surgical background. Compensation to also include malpractice expenses. Forward CV to slurie@papapc.net or Fax to # 212-753-3521

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

PODIATRY ASSISTANT - SOUTH FLORIDA

Attention podiatric assistants relocating to South Florida We are looking for an experienced podiatric assistant to work in a busy geriatric podiatry practice. Our office provides a very warm and friendly atmosphere. I am looking for a person who is dependable, mature, friendly and caring. Office hours are from 8:30 to 5:00 with an hour for lunch. Friday's are from 8:30 to 1:30. Job description includes: Patient histories, brief charting, assisting with procedures and minor surgeries, filing nails, applying pads, creams, and tapings, X-ray set-up, dispensing diabetic shoes, etc. Please call;(954) 650-8637 or e-mail resume to REDWINGCRZY@AOL.COM

PRACTICE FOR SALE -TEXAS

10 year old Dallas practice for sale. General podiatry practice including: surgery, routine care, orthotics, diabetic care, etc. Grossing $185,000 on 3 days per week, can easily be made full time. Middle to upper income area with great hospitals nearby. All serious offers considered. Please respond to: footdoc8390@yahoo.com

ASSOCIATE POSITION - NAPLES

Immediate opening for full-time associate position in SW FL. Surgical practice seeking PSR 24+ trained individual who is self-motivated and must be BQ/BC in Rearfoot and Ankle Surgery. Current FL license a plus for immediate start. Ilizarov or AO fellow a plus. Please email CV to: KLAMDPM@hotmail.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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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

ASSOCIATE POSITION - WV/KY

Huntington WV Ashland KY area associate wanted with reasonable buy-in; great chance for growth; established patient base with all aspects of podiatry great for the established practitioner or new residency graduate. Any interest please respond to greatteayspodiatry@gmail.com

ASSOCIATE POSITION - NORTH TX

North Texas practice looking for motivated, hardworking, personable individual with minimum PSR/24 training. The practice has been well-established in the community for over 20 years. Our practice offers a large self owned office, State-of-the-Art Surgery Center, excellent hospital involvement, and competitive salary with profit sharing. Send CV with references to info@ntfootcare.com, or fax to 903 868-2975.

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.com

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