The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 06, 2008 #3,341 Editor-Barry Block, DPM, JD

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We've just mailed the September 2008 Podiatry Management. This special 244-page contains our annual review of orthotics and biomechanics and is filled with a variety of interesting, informative, and useful articles. You'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

September 2008 Podiatry Management

IA Podiatrist Uses Expertise in Clubfoot Surgery to Aid Needy in Mexico

Dr. Richard Lepird of Estherville, IA told Estherville Rotarians Thursday something that his grandfather told him that has remained with him his entire life: "If you believe in something, stand up and make yourself known." Dr. Lepird, a podiatric surgeon whose surgical procedure for correcting clubfoot still remains the world standard, is still dedicating his life to helping others, even though it's in central Mexico.

Dr. Richard Lepird addresses Rotarians (Photo: Michael Tidemann)

Dr. Lepird is a member of LIGA International, also known as the Flying Doctors of Mercy, a group of physicians of various disciplines, pilots, nurses, and technicians who fly once a month to central Mexico to provide free healthcare to the poor. They don't do it for the money. In fact, the doctors pay $200 each for fuel for the planes while the pilots donate their time and the aircraft.

With clubfoot corrective surgery his specialty, Dr. Lepird has seen more patients with that deformity in Mexico than he did during his entire time in practice in the U.S. He attributes that fact to genetics and poor prenatal care. It's all rewarding, though. The community women cook for them and they sleep in dormitories, and despite the primitive conditions in which they work, the medical teams return to the U.S. with a sense of reward and satisfaction that comes only rarely even in their own practices.

Source: Michael Tidemann, Estherville Daily News [9/5/08]

Ward Receives Service Award from NYCPM

At a recent meeting of the New York College of Podiatric Medicine (NYCPM) Board of Trustees, newly-installed Chairman Stanley S. Mandel presented Maj. Gen. William F. Ward, A.U.S. (Ret.), former Chairman of the Board, with a Crystal Eagle Award from the College, in recognition of his many years of distinguished service to the College. Inscribed on the base of the crystal eagle was the following quotation: "The quality of a leader is reflected in the standards he sets for himself."

Maj. Gen. William F. Ward, A.U.S. (Ret.) (left) receives Crystal Eagle Award from Stanley S. Mandel

General Ward continues his service to NYCPM as Vice-Chairman of the Board of Trustees. He originally joined the Board of the College in September, 2000 and was elected Chairman in June, 2004.

General Ward was appointed by the President of the United States to be Chief, Army Reserve, effective December 1st, 1986, and served until retirement in August, 1991. He graduated from the U.S. Military Academy in 1950 and subsequently earned an M.B.A. degree from Harvard Business School and a Bachelor of Law degree from LaSalle University.

AK Podiatrist Opens Hi-Tech Shoe Store

Dr. Harry Cotler has been a podiatrist on the Kenai Peninsula in Alaska for 13 years. Recently, he and his wife, Lisa, decided to open a business that was right up Harry's alley -- a shoe store. On June 20, the couple opened Foot Flare 'n' Wear in Soldotna."It was just getting frustrating trying to refer a good shoe for a patient in my office when we didn't have anything locally and had to either refer the patient to Anchorage or the Internet," Harry said. "Hopefully we're able to bring to the community what the community wants and needs versus the need to travel."

Dr. Harry Cotler with wife Lisa at new store.

The store offers everything from athletic shoes to dress shoes, Harry said. "We cater to the whole family," he said. "We carry brands that you aren't able to acquire locally." The store has a treadmill for customers to test shoes on. "It's nice to be able to have the treadmill because this way you can really put the shoes on and go," Harry said. "For individuals acquiring athletic shoes, it's nice to be able to get onto the treadmill and run with the shoes."

Foot Flare also has an iStep machine to help customers leave with the best shoe for them, Harry said. "It measures whether or not you have a fat foot, neutral foot, a higher-arch foot. It shows where you have increased pressures on the bottom of the foot and points where your center of gravity is." About opening the new business, Harry said he likes the "satisfaction of people walking out of (the store) happy, and happy with the shoes they have and happy with the care and attention they received."

Source: Mike Nesper, Peninsula Clarion [9/4/08]

Dealing with Poor Service

Despite your best efforts, poor service sometimes makes your patients feel like victims. To deal with it:

• Apologize. When you do, be sure to say "I'm sorry." To a patient, that's more sincere than "we're sorry."
• Act Fast. Acting quickly to right the wrong makes patients feel that you have their best interests at heart.
• Show empathy. Patients first want to know that you care about them. That means you should treat the person first and then deal with the problem. A simple "I know how you feel" will do it.
• Atone. Offer to waive or reduce the fee or co-pay (if it legally permissable). This works best if you do it before patients vent their anger. This shows that you understand the problem and want to correct it.
• Follow up. Ask patients if they're satisfied. This shows them that you care and provides you with feedback on how you handled the problem.

Source: Adapted from The Service Edge by Ron Zemke

Query: Degenerative Changes in 3rd Met-Cuneiform Joint

I have a patient with isolated pain at his 3rd met-cuneiform joint. An MRI reveals degenerative changes at this joint. The patient has some minor pronation, but otherwise has a relatively normal foot. Conservative treatments such as a CAM walker, orthotics, and a steroid injection for his pain have been attempted.

The pain used to radiate throughout the foot, but seems now to be very localized to this joint. Has anyone treated a similar situation? Has anyone tried to inject such joints with any type of biological, e.g., Synvisc? What about an isolated fusion of this joint? Any thoughts would be appreciated?

Jeffrey Kass, DPM, Forest Hills, NY

Query: X-ray Scanners

Can someone recommend an x-ray scanner which provides good images at a reasonable speed for typical podiatry-size (10 x 12) film?

Larry Kosova, DPM, Chicago, IL

Query: Multiple Tendon Injection Coding

When injecting multiple tendon/ligament sites, is it proper to bill CPT 20552 or CPT 20553, or do we list CPT 20550, 20550-59, etc. instead? Since the former two codes do not specifically say tendon or ligament, but rather muscle trigger points, I have not used them. I have, however, recently been getting a number of insurance companies rejecting any of the 20550 codes I bill with modifiers. Which is the proper way to bill?

Bob Kornfeld, DPM, Lake Success, NY

Response: You must bill for what you do. If you administer an injection to a tendon, then bill for the injection of a tendon sheath, CPT 20550, not for a trigger point injection that has no relationship to a tendon. You can be reimbursed for multiple tendon injections when the injections are administered to different locations.

In New York State, the Medicare LCD states "Multiple injections per day, at the same site, are considered one injection and should be coded with NOS 001. Injection of separate sites (i.e., tendon sheath, ligament or ganglion cyst) during the same encounter should be reported on a separate line of coding, and must have the modifier "-59" appended. Multiple surgical rules will apply. The modifier "-50" should not be reported with CPT 20550, 20551 , . . . "

Also, in New York, you must include the "J" code for the medication injected whenever you bill CPT 20550.

Mark Schilansky, DPM, Catskill NY

Codingline subscription information can be found here

RE: State Association Website (Name Withheld)
From: Multiple Respondents

My recommendation is to keep things simple initially and work in phases. Website technology is constantly changing and improving so your investment cannot be thought of as a one time endeavor. I find requirement-creep is the biggest challenge to manage.

Michelle Clemovich, IT Consultant, APMA, MMClemovich@apma.org

About 20 APMA state component executive director members of the American Society of Podiatric Executives (ASPE) will be attending our fall meeting in two weeks and we would be happy to put your request for more information on websites on the agenda. I believe all of the states represented currently have websites.

In Massachusetts, we have a special promotional arrangement with Chicago-based website company, Officite, the largest provider of websites to podiatrists in the country. Under this arrangement we offer our members a special discounted price and promote Officite as an official Massachusetts Corporate Sponsor and Officite provides us with very low-cost website development and hosting services. We are very happy with our site (massdpms.org) and the services provided by Officite.

My best advice would be to go with a good size, well-established website development company that has experience with developing and hosting State Podiatric Medical Association Websites - it should not cost several thousand dollars. Please let me know if you would like the ASPE executive directors to provide feedback to you after their meeting in two weeks. I would be happy to talk further with you about your website project - I can be reached by calling the Massachusetts Podiatric Medical Society at 978-646-9671.

Gary Adams, Executive Director, Massachusetts Podiatric Medical Society, gadams@massdpms.org

Deciding on a Web designer is tough. The costs can be from $5K-$50,000. Yes the cost depends on the bells and whistles you choose. There are some excellent designers (referrals on request) at reasonable costs. The key to look for is someone who will work with you and push you to decide what you need and or want before designing and producing the product. Remember today the most important issue is it should be simple and available for you to update - not the Web designer or consultant. Annual update costs should be very minimal if at all.

I recommend paying only for what you need. If the site is done correctly you may not need the consultant much if at all. Finally, I recommend you house the server off-site, unless you have the staff to keep up with the latest and greatest and don't care if you are off line from time to time. There are many great companies that will act as the server for your site at very reasonable dollars.

David M. Schofield, DPM, Past President, APMA, david.schofield@yahoo.com

RE: Dangers of Speaking to Government Investigators (Michael M. Rosenblatt, DPM)
From: Richard W. Boone, Sr.

The readers of this list would be well advised to heed to Dr. Rosenblatt's advice. It is exceptionally good advice, indeed. Making a false statement during an investigation is, in and of itself, a criminal act. You can go to jail for fibbing to the Feds even though you aren't guilty of any substantive offense. Remember Martha Stewart and "Scooter" Libby?

When the government comes knocking at your door (1) Call your lawyer and (2) Shut your mouth (and all other mouths around you). There are no exceptions to this rule.

If you then tell investigators that you wish to speak with your attorney before you respond to any of their inquiries or information requests, they are required to honor that request. As my sainted Mother used to say: "A closed mouth gathers no feet."

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

IMMEDIATE POSITION AVAILABLE TN/GA

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

ASSOCIATE POSITION AVAILABLE – OCEAN COUNTY, NJ

Seeking a full-time associate for well-established practice in Toms River. Searching for a hardworking, ethical and well-trained individual. MUST be willing to do all aspects of Podiatry. Competitive salary and benefits package. Immediate opening available. E-mail CV to NJFeet@aol.com

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 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

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. dtarsky@gmail.com

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