The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 15, 2007 #3,041 Editor-Barry Block, DPM, JD

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Congratulations to Dino Kyramarios, DPM of St. Charles, MO, our weekly survey contest winner, who has won a Oral-B Professional Care 9100 Triumph by Braun (Value $89). .

Waikoloa Village Resort Hotel, Kona, The Big Island of Hawaii

This week's prize is a free registrartion to the 2008 HAWAII CODING AND PRACTICE MANAGEMENT WORKSHOP. Register now at www.podiatrym.com/hawaii and save up $200. 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.

Busy IL DPM Finds That Podiatry Provides Needed Flexibility

If you want to see a busy woman, just look at Dr. Lori Knutstrom, a local podiatrist. She is a faithful volunteer at the Will-Grundy Medical Clinic. She is also the in-house provider of podiatric care for four local assisted-living facilities and four Housing Authority of Joliet buildings. And that's in addition to having a busy family life and activities in other community groups.

Dr. Lori Knutstrom

Knutstrom, a graduate from Scholl College of Podiatric Medicine, did her residency at a now-closed hospital in Kankakee. She's been in practice in Joliet for 17 years and shares a practice in Joliet with her husband, fellow podiatrist Dr. James Derk. Derk has a practice in Kankakee, and also sees WGMC patients on an emergency-referral basis in the Joliet office.

"I knew I wanted a medical career," she says. "I was searching for a specialty that would be flexible and allow for a family in the future. I also wanted something rewarding. I shadowed a podiatrist for a couple of weeks and I loved it. I enjoy the variety of patients I see, and I am thrilled with the fact that I can make them feel better and can contribute to their overall health."

Source: Joliet Herald News [9/13/07]

MD Podiatrist Receives R.I.S.E.S. Award

Shady Grove Adventist Hospital (GGAH), Rockville, Maryland has announced that Amir Assili, D.P.M. is the Physician R.I.S.E.S. award winner for the second quarter of 2007. Dr. Assili, a TSPM graduate in private practice, is the podiatrist for the SGAH Wound Care Center, and is the recently elected Podiatry Section chairman at the hospital.

Dr. Amir Assili

This award recognizes physicians who exemplify the hospital's values of respect, integrity, service, excellence, and stewardship, and is given to physicians who reflect these values in their practice.

Dr. Assili was nominated for the award by staff members of the hospital. Their comments on his professionalism, skills, respect for his patients, and friendly rapport made him an excellent choice for the award.

OCPM Board Members Team Up for the Podiatric Community

The Ohio College of Podiatric Medicine (OCPM) has two outstanding members of the Board of Trustees who are making a difference in the podiatric field. Steven J. Berlin, DPM and Robert C. Alberhasky, MD, have joined forces to provide diagnostic services to the podiatric community through their new company called Podia™ Podiatric Pathology. Together, both men have decades of experience combined with their knowledge of cutting-edge technology that has been brought together to create a foot and ankle pathology laboratory for the 21st century.

Drs. Steven J. Berlin and Robert C. Alberhasky

Podia’s specialty includes image reports, PAS testing fungal cultures, and consultations. Podia’s pathology director, Dr. Robert C. Alberhasky, has 20 years of experience in podiatric pathology. Dr. Steven J. Berlin, Podia’s consulting clinical podiatrist, is known throughout the podiatric world as a pioneer in foot and ankle pathology.

E-Prescribing: Supporters Recommend Requirement in Medicare

Use of electronic prescribing in Medicare could prevent as many as 1.9 million medication errors and save the program as much as $29 billion over the next 10 years, Mark Merritt, CEO of the Pharmaceutical Care Management Association, said on Wednesday, CQ HealthBeat reports. According to supporters, e-prescribing could help prevent medication errors related to illegible prescriptions, overuse and adverse reactions. Merritt said that Congress this fall would consider legislation to require physicians who participate in Medicare to use e-prescribing.

A study published on Monday in the Archives of Internal Medicine found that deaths from adverse medication reactions have almost tripled since 1998, and the results could help "fuel efforts on Capitol Hill" to include such a requirement in legislation to prevent a 10% reduction in Medicare physician reimbursements scheduled for next year, according to CQ HealthBeat.

Source: CQ HealthBeat via American Health Line [9/14/07]

Query: KobyGard System for Neuromas

I would like to know if anyone is using the KobyGard system to treat neuroma's and/or fasciitis? What pre and post-op protocol is being used? What has been your success rate?

Paul Galluzzo, DPM, Rockford, IL

Query: Excising a Metatarsal-Phalangeal Joint

I have a patient with a non-healing ulcer over the lateral aspect of the 5th metatarsal head left foot due to diabetes and peripheral vascular disease. The lateral aspect of the 5th met head was exposed.

I took the patient into surgery, and made an elliptical incision over the ulcer, did a through-and-through osteotomy at the base of the proximal phalanx and a through-and- through osteotomy at the 5th metatarsal, removing the metatarsal-phalangeal joint completely (leaving a gap). Subcutaneous tissue was closed as well as skin. What is the best code for this?

Mafutaga Tagaloa-Tulifau, DPM, Lakewood, CA

Response: Your description of surgery performed, in my opinion, should be coded as:
CPT 28126 - resection, partial or complete, phalangeal base and CPT 28113 ostectomy, complete excision, 5th metatarsal head. The soft tissue work done would be incidental, and should not be billed separately.

Howard Zlotoff, DPM, Camp Hill, PA

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RE: Low Insurance Payments (Mark Levine, DPM)
From: Multiple Respondents

I reached the same conclusion Dr. Levine did 7-8 years ago after listening to a compelling lecture by an OB-Gyn. He advised getting rid of one insurance company a year so as not to upset the apple cart.

Just pick your worst payer and get rid of 'em. Since that payer contributes so little to the bottom line as a percentage of total practice revenue, it's not a big deal. (really) Once you see the sky isn't going to fall, then do the same thing next year.Just pick the worst one and get rid of 'em. It's just that easy. You may get to like the process so much you'll get rid of two in a year...that's what I did.

My income has gone up substantially ever since I started this process (really) and here's the real kicker...practice life has improved significantly. I rank this as one of the 3 best decisions since entering this profession 22 years ago. By the way: for crummy PPO policies dropped (that still offer out-of-network benefits) we still accept the patients, but we tell the patients we don't participate with them.

James M. Petko, DPM, Falls Church, VA, footdoc@erols.com

All practitioners need to review their contracts and decide if it’s really worth caring for patients whose insurance coverage are an economic drain on their practices. If they are then what are you working? Lower wages, increased stress and increased exposure!

To be promised payment at a significantly reduced rate two years after performing a procedure is the height of Chutzpah!. The fear of losing patients who are an economic drain should be replaced by the ability to spend less on variable expenses and increase your profit margin. It should also allow you to spend more time on the patients who are a positive economic force and who may very likely refer other patients who are a positive influence on your bottom line.

The way to send the insurance companies a message is not with letters or phone calls pleading for payment of a pittance of what your true worth is. The only effective message will be felt by using that part of your body podiatrists knno best. Get up on your feet and have the courage and strength to walk away!

Paul Kesselman, DPM. Woodside, NY, pkesselman@pol.net

I truly empathize with Dr. Levine’s predicament. I am part of the herd which participates in many plans. I am also frustrated with the slow political process even though I have been part of it for > 15 years. Even with low insurance reimbursements the co-pays are getting so high people are curtailing visits to their DPM. I feel Medicare part D also impacted podiatry negatively. Less MCR/ Medicaid and now they oft time need to pay a copay with their replacement HMO carrier. They rather go to local community clinics, PCP's, and other medical specialties i.e., surgery, rheumatology, pain management to name a few.

Why anyone would choose HIP or Magnacare is even beyond my scope of understanding. Analyzing HIP's contract you essentially get approx. $150 per 6 months for all visits and surgery is inclusive. I am shocked at how many DPM's are on their panel. I only consider their diabetic portion which pays MCR fees except for x-rays(70%) for now. These companies pay much better for out-of-network practitioners.

I am sick and tired of everyone bashing our society. I agree with Dr. Levines feelings but I know firsthand our leaders are trying. Even the state legislators are handcuffed with these insurance companies. This needs a political solution and you won't get one until we act in unison. Individually, you or I will accomplish nothing and the insurance companies will continue to prevail. Our elected officials will seek guidance from representative organizations such as our state society, and even educational entities. That's why everyone has to be participate in our society and be a part of the solution.
My advice is to slowly leave these companies panels one at a time and analyze its impact on you business before proceeding.

Simon Young, DPM, New York, NY, simonyoung@juno.com

UNIVERSAL PROCEDURE CHAIR FOR SALE

Blue with doctor's stool. Like new. Great for any specialty. Can be used as a podiatry chair or in office surgery. Asking price: $1,000. Photos Available. Please contact doccapo@yahoo.com

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

ASSOCIATE POSITION (NON-SURGICAL) HOUSTON, TX

Full time non-surgical podiatrist needed for the Harris County Hospital Clinics. A Baylor College of Medicine staffing will be obtained. Competitive salary and benefits. Fax CV to G. Lepow 713 790-9320 or email CV to lepowft@cs.com

ASSOCIATE POSITION – MISSOURI

Due to growth, we will have a position available about February or March for an experienced podiatrist. Should have significant cases toward board certification or be board certified. Partnership available. Missouridpm@yahoo.com

ASSOCIATE POSITION - WISCONSIN

Our group practice is seeking caring DPM's for FT & PT opportunities available in the Eau Claire, Wausau, and Stevens Point regions. We offer an excellent compensation package and a family-friendly flexible schedule. Please fax or email resume to (920) 468-1235 or caringwi@healthdrive.com, or please call Dianna DeMond at (920) 366-6762.

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

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

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