The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 22, 2008 #3,354 Editor-Barry Block, DPM, JD

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NY Podiatrist Provides Advice on Pedicure Safety

Dr. Dina Tsentserensky, a podiatrist in New York says "I definitely see patients that have had problems as a result of getting a pedicure," she said. "I guess the most common is fungal nails."

Dr. Dina Tsentserensky

Tsentserensky's chief advice is to be on high cleanliness alert. "I tell patients to make sure that the bathtubs are being cleaned properly, that they are using enough time in between so the disinfectant has time to work," she said.

But it's not just the tubs that need to be clean. So do those instruments. "Make sure that instruments are getting sterilized properly," Tsentserensky cautions, "they are using a sterilizer or an autoclave to properly sanitize the instruments or using the liquids for the proper periods of time."

Source: Linda Saether, CNN [9/19/08]

Lepow, Munsey to Receive DSC Award

The American Podiatric Medical Association (APMA) has announced that Ronald S. Lepow, DPM of Houston, TX and William F. Munsey, D.P.M. of Lewis Center, OH have been chosen to receive the Distinguished Service Citation (DSC). This is the highest award that APMA bestows in recognition of outstanding sustained accomplishments on the national level in scientific, professional, or civic endeavors on behalf of APMA. These awards will be presented at the 2009 APMA House of Delegates.

Dr. Ronald S. Lepow

Dr. Lepow is former president of the APMA and is the only American podiatrist to ever serve as the President of the Federation Internationale des Podologues (FIP). He completed his two-year term in 2005.

Dr. William F. Munsey

Dr. Munsey is former president of the APMA and has served as Speaker for the APMA. Dr. Munsey is a longtime columnist for the APMA News.

Court OKs Health Net Deal Over Out-Of-Network Pay

A federal judge's approval of a $255 million settlement in a case alleging that Health Net used a faulty database to underpay members for out-of-network care may bode well for physicians in their fight against the managed care industry's widespread use of the database.

The agreement resolved three class-action lawsuits targeting Health Net's reliance on Ingenix, a UnitedHealth Group subsidiary that sells a database used by most insurers to determine the usual, customary and reasonable charges for out-of-network services. Plaintiffs alleged that Ingenix underset UCR rates and that Health Net used the database to shortchange patients on medical bills.

Health Net promised to:

• Establish a process for health plan members to obtain accurate cost estimates before treatment.
• Negotiate fees with physicians ahead of time to avoid balance billing.
• Set up an independent appeals process allowing patients to contest excessive claims.

Source: Amy Lynn Sorrel, AMNews [9/22/08]

Better Late Than Never

You should have returned a person's telephone call two weeks ago, but you kept putting off the task. Now you are wondering if it's too late to call - because calling now might make things worse.

Suggestion: It is never too late to call. Make an effort to reconnect, and start by offering an apology for dropping the ball. Most people will forgive you. Continue by asking how your contact has fared since you last spoke. When the person begins speaking about personal challenges or triumphs, any leftover anger should dissipate and you can return the relationship to its former level.

Bottom Line: At the least, you will feel better knowing that you finally called.

Source: Adapted from If You Forgot to Follow-Up- These Simple Steps Relieve the Pain by Elinor Stutz

Query: Quicken Enhanced Payroll Plus

Have any of my colleagues had any experience with Quicken "enhanced payroll plus"? It runs about $300 as a stand-alone, and I think it also comes as a part of Quicken Quickbooks. The program box states it calculates payroll, and fills in all Federal and State tax withholding forms, and can even submit them electronically with payments from your bank. Currently, I pay an accountant to come in every quarter and fill out these forms, which I then mail in with a check, if needed.

The program costs less than one quarter's payment to the accountant! I realize that at the end of the year, I will still need an accountant to do corporate returns, etc, but for now the only quarterly requirements are the Fed and State tax withholding forms. I would love to cut the accounting cost down, but obviously don't want to do it if the program can't deliver.

Peter Smith, DPM, Stony Brook, NY

RE: Foot Pain From Use of Growth Hormone? (Ayne Furman, DPM)
From: TA Brosky II, DPM

Somatropin is known to cause joint pain and an inflammatory response to tendons. I have treated several athletes taking it and this can be a side-effect. Cessation decreases symptoms usually in about 2-4 weeks.

TA Brosky II, DPM, Oakwood, GA, dr.brosky@charter.net

RE: Hyperbaric Oxygen Chambers
From: Multiple Respondents

I stand corrected. As we all know, our scope of practice varies wildly from state to state, and I was not aware that DPMs can be reimbursed for CPT 99183; "supervision of HBO treatment."

Nonetheless, considering Dr. Gonzalez's orginal inquiry, I would like to re-iterate that he should work with his hospital-based WCC, as opposed to opening an HBO clinic himself. I also suggest consulting with a wound care center management company (diversifiedclinicalservices.com/ and nationalhealing.com/) are two leading companies in the US), which can provide expertise, chambers, technicians and up-front investment in opening up an HBO clinic. To my knowledge, HBO clinic can be very profitable for the hospital, If they have multiple chambers and WHEN they have full-ulitization of the chambers. HBO will save limbs and lives for your patients.

Kazu Suzuki, DPM, Los Angeles, CA, kazu88@gmail.com

Three years ago, there was a scenario where the MD's in our hospital attempted to forbid me from "supervising" HBOT dives. Their "argument" was it was "out of scope" for a DPM.

I contacted every expert/educational/governing body......obtained case laws....excellent Supreme Court verdict in Texas...and: "so long as the problem falls within the scope of practice of the DPM, then the supervision of systemic HBOT is no different from prescribing any "systemic medication."

As a major multi chambered unit, supervising osteoradionecrosis of the face/jaw, failed grafts on the "non foot region" of the body, not permitted to be supervised by myself as an Attending HBOT. I had no disagreement. Many patients indeed experience diverelated illness and it is not a recognized medical matter for a DPM to be "in charge of complications of a patient with a cancerous-related jaw issue".

There is very clear opinion from courts, state educational departments and the Underwater Hyperbaric Society. Indeed, attempting to not allow a certified DPM to supervise foot-related dives is cause for legal recourse for any colleague: I fought this and won.

Alan Cantor, DPM, East Meadow, NY, ajcdpm@aol.com

Dr. Long's letter concerned me in respect to podiatrists not being paid for a service that they are legally allowed to perform, especially in regard to insurance. Can insurance carriers refuse to pay a physician, just because he is a podiatrist?

I have been paid for supervising full body hyperbaric oxygen therapy for lower limb pathology since 2002 by every insurance carrier that I participate (that provides HBO coverage). Please be aware, that having your patient take penicillin is more dangerous and potentially life-threatening than HBO therapy. Hyperbaric oxygen therapy needs to be more available to wound care patients and it can be offered cheaper and more efficiently in free-standing wound care centers. I am not paid an exciting amount when you look at the overhead cost, but I do get amazing results with my wounds.

In Georgia we are allowed to perform full history and physicals, including ears and lungs. At Barry University School of Podiatric Medicine, we were trained to examine the entire body.

Wm. Barry Turner, RN, DPM, Royston, GA, claret32853@gmail.com

RE: Dealing With Employees Who Forget to Punch In and Out (Cheryl Martinetti, PMAC)
From: Shari M. Lee, PMAC

First and foremost there should be an employee handbook that covers all policies in the office. In our office we have a policy, however, that if an employee begins to have problems remembering to use the time clock, I will write a notice for the employee to sign that states when the time clock does not get used properly their time will be edited by me. They will be clocked in by my time, not theirs, and if misuse continues - hours will be lost completely, as they did not clock in, therefore they were not here.

Also, I have a form with each employee’s hours with their signature and mine. If they forget to clock out, it does not cost me because I can use this as a guideline, if needed. This is always in writing and I will also post a sign above the time clock giving notice of the consequences. Normally, this takes care of the matter. If not, you may want to consider how important this employee is to you. Remember to follow your state guidelines on notification and make sure both you and the employee sign the notifications.

Shari M. Lee, PMAC, Midlands Podiatry, PA, midlandspodiatry@bellsouth.net

RE: Hurricane Ike
From: Allen Sater, DPM, Neil A Burrell, DPM

My office is covered with State Farm, and I have a loss of income rider that I have had to use twice, in 2004, with hurricanes Francis and Jeanne. My policy only covered a loss of business during the time frame for which there was a mandatory evacuation. They take your annual gross income and divide it by days worked for the year, and you get that amount paid to you during your period of covered loss. Once the all-clear was given, after the storm, even though the office was without power for a period of time, there were no further benefits available. I empathize with you and hope you have a speedy recovery financially.

Allen Sater, DPM, Jupiter, FL, Bunionpain@aol.com

We went through this 3 years ago with our insurance company. They had a fancy formula in place and also mentioned the patients would come back. I told them that I wanted the same amount of money that we brought in last year (not charges, but actual income) same period. They bickered back and forth for about 6 months until they sent me a check for what I had asked. Of course, we had to get an attorney friend to send them a letter. Don't give in and stay after them. We will start the same process soon but unfortunately dealing with the insurance company on the loss of half my home. Hurricanes are hell on earth.

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

RE: Chiropractors and Orthotics (Bob Kornfeld, DPM)
From: Jason Kraus

The foot orthotic genie has long been out of the bottle, and like most genies, can't be put back in. There are probably more devices prescribed and dispensed outside of the podiatric profession than there are in your offices. The reasons for this are varied, but chief among them was the lack of intellectual and scientific commitment to the science of podiatric biomechanics, the lack of a comprehensive approach to patient assessment and the willingness to trade innovation and high technical standards for low orthotic prices.

In the majority of offices that I visit, DPM,s are not even asking their patients to stand up and/or walk as part of their evaluation. It's hard to claim a leadership position in the evaluation and treatment of mechanically caused (or influenced) lower extremity conditions when shortcuts are taken and a comprehensive and coherent biomechanical assessment is not performed. The best way to gain or regain a competitive advantage over other disciplines is to use all the knowledge that you have,or should have, and to provide patients with a level of care and expertise unmatched by other practitioners. Free markets always reward excellence.

Jason Kraus, Jkraus65@gmail.com

Editor's note: This topic is closed

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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

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

PRACTICE FOR SALE - CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional info contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE - OREGON, WILLAMETTE VALLEY

Established practice in beautiful Willamette Valley of Oregon. Provider practices fulltime and has a well-established patient base with a strong patient flow. Practice is well-positioned for new growth and development. Doctor will transition after sale providing introductions to local referrals and healthcare facilities. Surgery privileges at local hospital and surgery center. Oregonpractice@comcast.net

PRACTICE FOR SALE - MAINE, SOUTHERN

Well-established practice located in Southern Maine seeking an associate. This is the only podiatric provider in the community. All services are office and hospital-based. No nursing homes. Senior doctor desires to bring an associate in to become partner. Strong patient base with very small amount of palliative care. southernmainepractice@comcast.net

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

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