The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 20, 2007 #3,045 Editor-Barry Block, DPM, JD

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Disease-Related Foot Problems Often Overlooked: DC Podiatrist

While many people associate foot problems with certain diseases, they don’t usually know exactly how much a foot exam can reveal. “They know diabetes, but they don’t know or don’t want to know about some of the complications,” said Kirk Geter, DPM, chief of the division of podiatry at Howard University Hospital and president of the National Podiatric Medical Association. “A loss of sensation can sometimes cause sores and breakdowns in the skin. Poor circulation can lead to gangrene and possible amputation."

Dr. Kirk Geter

Geter told BlackAmericaWeb.com people often overlook foot problems because they don’t make the connection to a bigger threat and seldom go to the doctor if the inconvenience is minor. “They don’t want to go (to the doctor) because they don’t see anything wrong, but the doctor may be able to recommend some changes - - different shoes, changes in shoewear,” he said.

Source: Jackie Jones, Black America Web [9/19/07]

TX Podiatrist Awarded Research Fellowship Grant

Dr. Melissa Brawner has been awarded a research fellowship grant that is jointly funded by the American Podiatric Medical Association and the American Diabetes Association. The grant will fund Dr. Brawner’s research fellowship training for two years under the direction of Dr. Lawrence Lavery, Professor of Surgery at Scott and White Hospital and Texas A&M University College of Medicine. The research program has been awarded approximately $4M in extramural research funding over the past two years including a three year study funded by the ADA to evaluate the epidemiology of foot complications in dialysis patients.

Dr. Melissa Brawner

Dr. Brawner completed her residency training at the University of Texas Health Science Center at San Antonio under directors Dr. Lawrence Harkless. She received her doctorate degree from Temple School of Podiatric Medicine. Dr. Brawner has had an interest in research since she began her undergraduate training, which led to a Master’s Degree in kinesiology and biomechanics at Indiana University.

Top Five Changes Related to Stark III

In its third regulatory go-round of the Stark self-referral law, CMS made all kinds of moves — some modest and some more consequential for physician financial relationships with hospitals and other entities. Absorbing them will require providers and lawyers to go back and forth between the three sets of final rules and preambles that CMS has served up over the past six years to flesh out the 1993 Stark self-referral law known as Stark II. Attorney Bob Wade cites some of CMS's major revisions to the Stark physician self-referral law's regulations.

(1) Personal service arrangements will now have a six-month "holdover" period.
(2) The physician recruitment exception has substantial revisions, the most important of which is that reasonable practice restrictions can be imposed on the recruited physicians, including covenants not to compete.
(3) The $329 non-monetary compensation exception now recognizes continued compliance even if gifts and benefits in excess of the limit are exceeded by no more than 50% as long as the physician repays the excess.
(4) Hospitals can sponsor one formal event (i.e., Christmas party) for their medical staff members per year without having to track expenses under the $329 non-monetary compensation exception.
(5) The fair-market-value "safe-harbor" definition has been eliminated.

Source: Report on Medicare Compliance

Query: Assistance to the Elderly

We have a local nursing home that has developed a habit of dropping off patients for appointments with no accompanying assistant to complete paperwork or help patient. The nursing home will provide a list of medications, but no power of attorney information or anyone to help with patient prior to visit. The patient or a guardian is required to sign all office forms to allow us to bill her insurance company. Often times these patients are unresponsive to oral commands and need assistance with restroom, oxygen, coughing spells, vomiting, etc. We have repeatedly asked the nursing home to provide an assistant for the patient prior to them being seen, or bring a family member. Am I obligated to provide all aspects of assistance for these elderly patients prior to them being seen? Are there legal issues in sending patients back to the nursing home for not having any help with them?

Steven Block, DPM, Owensboro, KY

Editor’s Note: PM Does not provide legal advice. In general, you are not obligated to treat patients unless they present on an emergency basis. In this healthcare environment, however, many podiatrists would be happy to have patients dropped off at their offices by nursing homes. That being said, it seems logical to write a carefully-crafted letter to the nursing home apprising them of the situation, and providing a checklist of requirements, including 1) proper documentation and authorizations 2) An attendant or family member.

RESPONSES / COMMENTS (CLINICAL)

RE: Management of a 5th Met Non-Union (Sandy Schustek, DPM)
From: Steven H. Goldstein, DPM

Based on the patient's past history, I would recommend an Exogen bone stimulator from Smith and Nephew, which is FDA-approved for fresh fractures. These fractures are normally difficult to heal as the blood supply to that portion of the bone is poor. Contact your rep and have them get the approval from the patient’s insurance company. This will be of benefit to you and your patient.

Steven H. Goldstein, DPM, Wayne, NJ, Stevefootdr1@cs.com

RE: Clinton Unveils “Insurance For All” Plan
From, Marc Katz, DPM

Apparently there is no mention in her plan about malpractice attorneys. She doesn't get it. Be afraid of this plan. Our interests are non-existent in this plan. This will be one big HMO with Drs getting the short end of the stick. Believe or not, it can get worse.

Podiatrists need to take the advice of previous posts and regain control. We need to say no to those insurances that are not beneficial to us. Fee for service is not a bad thing. We need to rewrite the rules. But everyone has to step forward. Crawl out of your bubbles! We can't live in fear. It's time, now or never.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Low Insurance Reimbursement (Allen Jacobs, DPM)
From: Multiple Respondents

I must take exception to some of the comments by Dr. Jacobs. A perfect time to limit patients with low insurance reimbursement is today. Never in my practice career are well-trained DPMs in greater demand. Those of us who have fought daily for recognition deserve to exclude patients with insurance that fails to measure up.

Will you lose some patients? Yes, but you will ultimately replace them with better ones. You will make a statement to the insurance carriers that well qualified podiatrists should be compensated fairly. I have done this with 1 major insurance company recently and will never look back.

Don't be afraid to speak up for fair and reasonable reimbursement for your services.

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

Accepting low insurance reimbursements rates not only devalues your professional services but devalues the professional services of all DPM's. As Dr. Hultman has pointed out, why would an insurance company pay any more for a service when the highly trained and experienced professional accepts a low rate. Would you pay more for a service than you have to? Of course not. Dr. Jacobs is advocating you take any low reimbursement, even one that you loose money? just to stay in the loop.

There are DPM's that are accepting rates that are 15% of Medicare rates. We cannot accept rates that MD's or DO's wouldn't accept, that is not consistent with parity or equivalency. Do not devaluate yourself or your profession with contracts that are below that which your MD or DO counterparts would accept. Leave room in your schedule for the higher paying patient or they will be closed out of your busy office that can't make ends meet.

Jan David Tepper, DPM, Upland, CA, jdtdpm@aol.com

I must respectfully disagree with Dr. Jacobs. Using the rise of competition as an excuse to stay on panels that do not pay a fair reimbursement is in and of itself faulty reasoning. It is this very mentality that insurance companies rely upon to continue to cut their allowables.

First, do not feel threatened by these "white coat" pedorthists. When the patient comes to your office still with pain and $500 lighter, your value will be better appreciated.

Second, foot and ankle orthopods and vascular surgeons are having the same problem we are having, that is, we ALL are being taken advantage of by the insurance companies. If Dr. Orthopod down the road wishes to work 110hrs/wk to make up for the poor reimbursement, then God bless him. However, quality of care will be lost and when the patient comes to my office paying the non-par difference but had the opportunity to actually spend time with me then, again, my value is better appreciated.

For me, doing more with less patients does not mean an ethical compromise. Unnecessary procedures can be performed by anyone taking any insurance and thus selectively choosing panels I wish to participate in becomes a time management issue.

Patient flow through the office is not paramount to financial success, quality is. Quality cannot be achieved by a 2-minute visit. I will give the patient the time he/she needs depending on the severity and complexity of their problem. That time MUST be paid for and selectively choosing panels is one of the tools I use to ensure this happens. It is this quality that fills my schedule not taking any and every insurance available. The patient whom purchased a bad product can only know that their insurance is a bad product when they have no Dr. to see. Unfortunately, this is the only real way to educate the public.

John Scheland, DPM, Clarks Summit, PA, limblengthener@yahoo.com

Editor’s Note: Extended length notes from Jon Hultmand, DPM, MBA and Barry Mullen, DPM appear at:
http://www.podiatrym.com/letters2.cfm?id=15745&start=1

PRACTICE FOR SALE - HARRISBURG, PA

Well established, very profitable, full time surgical and general podiatry practice available. Looking for a highly motivated individual for a turn key operation. Owner willing to stay on and to teach and train the right individual to run a successful practice. Multiple financial and employment options are available. E-mail blkdmddoc@aol.com

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual . Fax CV with hours available to (718) 458-0053.

ASSOCIATE POSITION – CINCINNATI, OH

This is your once in a lifetime opportunity to join one of the largest, most successful practices in the United States. Start immediately with a six-figure income. If you are motivated, and knowledgeable in practice management, your income is unlimited. Please fax resume to: 513-577-7261

IN-NETWORK PODIATRIST WANTED – MANHATTAN

Busy Manhattan Office (2 locations) needs IN-NETWORK PODIATRIST, Can start immediately-Do not reply unless you are in with all plans Please respond to gelus07@yahoo.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 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

PAIN RELIEVING DEVICE FOR SALE

Matrix pain device, upgraded with latest Sanexas software. Great working order, operating manual, and programs to treat nerve and muscle pain, edema, circulation, inflammation, and other health problems. $28,000 new, will sell for $12,000. Covered by Medicare, most all insurances, coding and billing information provided. Photo can be seen at http://www.outcomemedical.com/matrix E-mail don@outcomemedical.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

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