The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 24, 2008 #3,356 Editor-Barry Block, DPM, JD

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IL Podiatrist Provides Shoe-Buying Advice

“New technology has made it easier for comfortable features -- like memory foam insoles and supportive shoe linings -- to be built into good-looking shoes,” says Marlene Reid, D.P.M., a podiatrist in Westmont, IL. So it’s easier now than ever before to look good and feel good. While high heels are okay for short periods, low, wider heels -- such as kitten heels with a soft, stable sole -- are a more foot-friendly fashion choice, according to the APMA. They offer support and balance while reducing pressure on the ball of the foot and toes.

Dr. Marlene Reid

Shop for shoes later in the day, when feet tend to be their biggest, advises Reid. When standing, be certain there’s at least one-half inch between the end of the shoe and your longest toe (which may or may not be your big toe). Then walk on a hard surface, assessing cushioning, comfort and whether your heel fits snugly (which is a good sign) or slides up and down.

Source: WAGA-TV Atlanta Fox 5 News (GA) [9/22/08]

OH Podiatrist Has Practical Answer to the Energy Crisis

Have gas prices got you down? Are you sick of trying to fit in some sort of exercise in that oh-so hectic life of yours? Orrville podiatrist Dr. Jason Suppan has about a six-mile round-trip commute to his office. He started commuting via his bike about three years ago, when the increase in gas prices got him a little irked. Now he does it for exercise and for fun.

Dr. Jason Suppan

"I was mad when gas prices got to be about $2 a gallon. I started riding my bike by commuting to work but it kind of branched off into competitive cycling and triathlons," Suppan said. "In my opinion, exercise stinks-- it's no fun. To me it's very unnatural to say 'I'm going to wake up at 5 a.m. and run a treadmill and stare at the wall for an hour.'"

He said he treats biking as if he's a kid again because it's "fun and exciting. And contrary to popular belief, you can almost do it year-round. I noticed a huge savings and not just at the gas pump. I've seen the savings in almost every aspect of my life -- I can only imagine what I'm saving now," Suppan said.

Source: Lydia Gehring, The Daily Record [9/21/08]

Doc-Payment Revamping Urged: AMA President

Congress should reset the baseline payment formula that reimburses Medicare physicians to more accurately reflect the cost of caring for beneficiaries, Nancy Nielsen, president of the American Medical Association, told the House Ways and Means Health Subcommittee. Fielding questions from subcommittee Chairman Pete Stark (D-CA), Nielsen urged the panel “to establish a new baseline that erases the sustainable growth rate, or SGR, and resets baseline spending that represents actual appropriate spending.” This would clear the way for a reformed payment system that provides rational incentives “to address value, utilization and quality of care,” Nielsen said.

The SGR formula is tied to growth in the economy and has almost led to payment reductions for the past six years. Legislation approved this past summer halted payment reductions for 18 months, but in 2010 physicians face a 20% cut to their payments unless Congress intervenes.

Gail Wilensky, senior fellow of Project HOPE, offered several options for creating a fairer payment system, including a revised SGR that would operate at the individual physician/practice-group level.

Source: Jennifer Lubell, Modern Healthcare [9/22/08]

Deal With an Out-of-Control Inbox

E-mail messages send and replied to after hours: Are they really necessary - or even a good thing? While instant communication often delivers a benefit, it has a downside as well. Doctors who always feel on duty never truly unplug and relax. If that sounds like you, it's time to establish some e-mail limits:

• Set boundaries. Add a line to your e-mail signature that tells senders the hours during which you respond to messages. You can also turn on the auto-reply function when you leave the office for the day, letting others know that you are away, when you will return, and how to reach you in the case of a bona fide emergency.
• Adjust your own expectations. While you may assume that after-hours e-mailers expect immediate replies, this may not be the case. Check with frequent senders before you automatically e-mail back.

Source: Adapted from It's 11p.m.: Why Are people E-Mailing Me? by Stephanie Whittaker in The Globe and Mail (Canada)

Query: NueMD Medical Software

Is anyone familiar with NueMD Medical Software, an Internet-based medical software? All responses are greatly appreciated.

Linda Allen, Topeka, KS

Query: Akin Bunionectomy Inclusive of Lapidus Bunionectomy

We are getting denials for CPT 28298 (bunionectomy with phalangeal osteotomy) as inclusive to CPT 28297 (Lapidus-type bunionectomy. Should we have billed a CPT 28299 instead?

Sarah Avilleira, Office of Peter Wishnie, DPM, Piscataway, NJ

Response: The description of CPT 28297, and picture in the CPT book indicate the fusion at the metatarsal cunieform joint and a bunionecomty performed at the metatarsal head. CPT 28298 also includes a bunionectomy procedure. Billing the two for work performed on a single foot would be duplication of the primary procedure - the bunionectomy. I would recommend CPT 28297 and CPT 28310-59 if the doctor performed a Lapidus-type bunionectomy with a proximal hallux phalangeal osteotomy on the same foot.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here

RE: Risks of Prescribing Opiates For Chronic Pain, Barry Mullen, DPM
From Richard Gosnay, DPM, Elliot Udell, DPM

Considering my 180 degree disagreement with Dr. Mullen regarding podiatry's role in treating causes of pedal pathology like gout, it may be significant that I could not agree with him more with respect to podiatry and chronic pain. I would only reinforce his argument by noting that, even if a particular podiatrist has special training and experience in treating chronic pain, a podiatry practice is not the proper setting for treating this condition.

I also agree that we need to concentrate on adequately covering our patients after surgery. Rather than treating chronic pain, we should see to it that we are not creating chronic pain patients in the first place. I insist that my patients start with post-op pain meds before their blocks wear off. This is one of the most important components of my post-op regimen.

Pain control centers are equipped to deal with very complex patients. Considerations for emotional and mental health, patient privacy, possible drug dependency, and possible drug-seeking ulterior motives are dealt with constantly at these locations. These are special patients who require pain specialists. Is chronic pain manifested in the feet within our scope of practice? Well, that's beside the point, isn't it?

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

Dr. Mullen is correct in asserting that we should keep pain management specialists on our list of specialists. There is one caveat to this. Pain management and pain management specialists are not in the same class as endocrinologists , infectious disease specialists, vascular surgeons or other specialists we refer to from time to time. The reason being is that there is tremendous disparity in the way pain in managed from clinic to clinic and doctor to doctor. We have had some good relations with some pain management specialists but we have also had some very bad experiences.

Some pain management people gravitate toward the more invasive, high-paying procedures such as spinal stimulators and morphine pumps. Other clinics practice as legal opioid mills, hooking patients on these drugs for life. There are experts in the field of RSD (CRPM) who feel that giving patients morphine derivatives for this condition makes them worse. So, I would seriously recommend that before you send a patient to a pain management specialist you get to know the doctor and way he or she practices.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Wellness Life Systems and Diabetic Shoes
From: David Schlageter

Improperly fitted shoes can be a major health risk to patients, resulting in ulcerations and amputations. Recently, a company called Wellness Life Systems has aggressively targeted the diabetic Medicare Patients via national advertising and an attractive Web site. The purpose is to attract new patients and provide those patients with diabetic supplies and therapeutic shoes. Check out their web site: (wellnesslifesystems.com).

They advertise that they will get a prescription from the referring physician; they will come to the patient’s home and fit them with shoes. The patient may select from a sampling of different diabetic shoes. They will then take an impression of the patient’s feet for custom diabetic insoles. The shoes and custom inserts are then mailed to the patient’s home. It cannot be determined from the website or their ads if there is any follow-up visits to verify fit, as is required by Medicare and third-party insurance companies

As the physician primarily responsible for your patient’s foot care needs, you should be aware of this situation. If you are not now dispensing footwear to your patients, you should make sure that your patients are educated on proper fitting footwear and referred to a local reputable supplier of footwear. You should then make sure that the patient has a follow-up visit with the supplier and your office to make sure the shoes and inserts fit.

David Schlageter, Natural Step Shoes, schlag911@earthlink.net

CASE CONSULTING

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

ASSOCIATE POSITION – ORANGE COUNTY, NY

Immediate need for podiatrist to work a few Saturday mornings a month and possible weekday schedule. No call, No after-hour responsibilities, just a good experienced doctor. Work to full-time status, if desired. A great opportunity for the right person Orange County area. Easy commute from surrounding counties. Contact with resume to Phinster18@hotmail.com

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

EQUIPMENT FOR SALE – ULTRASOUND & PROCESSOR

2004 Shimadzu diagnostic ultrasound system model #sdu-350xl. Includes stand-off pad, carry & carry case. Asking $7500.00. Cordell mxr-14 x-ray film (cold water) processor. $750.00 obo. For more info, call 269 651 1038 or e-mail mcclainjmrs@aol.com

TIMESHARE – MOTIVATED SELLER

Golfer's paradise in Myrtle Beach, S. Carolina! Click here for details! Great for family vacations. Fixed deeded week. Beachfront resort, RCI Exchange, $15,000/or bo. Timeshare points also available. Contact footfixr@consolidated.net or 1-800-366-8397

PODIATRIST POSITION - NORTH DAKOTA

Mid Dakota Clinic is currently recruiting a BE/BC Podiatrist to join our private multi-specialty practice in Bismarck, North Dakota. Full benefit package to include a first year salary guarantee, or the clinic's RVU system whichever is greater, as well as profit sharing. Bismarck is a growing and upscale community and along with our sister city of Mandan the population is approximately 100,000. Please send your CV or contact Jeff Neuberger at 701-530-6113, or jdneuberger@primecare.org

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

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.

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