The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 30, 2008 #3,361 Editor-Barry Block, DPM, JD

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NY Podiatrist Offers Pre and Post-Marathon Advice

Dr. Johanna Youner, a well-known Manhattan podiatrist offers foot-related advice and tips to runners participating in this year’s New York City Marathon that will keep feet in tip-top shape and have them feeling like a champion at the finish line:

Dr. Johanna Youner

If you are prone to blisters, apply Vaseline to problem areas prior to your run or try padded “blister proof” socks like those made by Thorlo. Dr. Youner also suggests applying moleskin to problem areas prevents blisters from forming.

When the race is complete, Dr. Youner prescribes RICE: Rest your feet, Ice feet to keep inflammation and swelling down, Compress with ACE wraps to reduce swelling and Elevate feet to help them rest up for the next big run.

Source: Health News Digest [9/27/08]

PA Podiatrist Finds Success with All-Natural Foot Products

Dr. Maasi J. Smith is the founder and director of Rittenhouse Foot and Ankle Associates. The doors of his private practice opened in 2002 in Philadelphia’s historic Rittenhouse Square, where he developed his complete natural foot care line, Dr. Smith’s Foot Care

Dr. Maasi J. Smith

Smith, who attended Temple University’s School of Podiatric Medicine, found success by combining natural ingredients such as soy, aloe, vitamin E and tea tree oil, as opposed to the prescription formulas which usually include harsh chemical ingredients. This combination of soy, aloe and vitamin E is what makes Dr. Smith’s foot cream so unique. His other products including a deodorizing foot wash, a nail and skin fungus treatment, and a foot soak are all derived from natural ingredients.

The response to his products was so positive that he began mass production in 2006. Dr. Smith used television to showcase his foot care products and has been featured on CBS, Fox, WMCN, as well as print and radio.

Source: North Dallas Gazette [9/25/08]

OCR Releases New Q & A Guidance on Patient Privacy

The HHS Office for Civil Rights (OCR) on Sept. 16 released new guidance on how to interact with a patient's family or friends without running afoul of the HIPAA privacy regulations. The guides are in a question-and-answer format and address common and sometimes confusing situations about when a physician or other medical staff member can share information on a patient's condition with his/her family members. For example, the provider's guide asks, "If the patient is present and has the capacity to make healthcare decisions, when does HIPAA allow a healthcare provider to discuss the patient's health information with the patient's family, friends, or others involved in the patient's care or payment for care?"

The provider may have these discussions if the patient agrees to this, the guide explains. "A healthcare provider also may share information with these persons if, using professional judgment, he or she decides that the patient does not object. In either case, the health care provider may share or discuss only the information that the person involved needs to know about the patient's care or payment for care," OCR says.

However, providers should not reveal past medical problems that are unrelated to the patient's current condition. The provider also could wait until the patient is present or conscious to agree to the disclosure, OCR adds.

Source: Report on Patient Privacy, [9/22/08]

Better Hiring Tip

Hire better candidates by focusing on superior performance before you write your employment ad. Visualize yourself a year from now, giving the new employee a glowing performance review. What do you see the new hire having accomplished? Analyze those accomplishments to determine the skills and talents you should look for.

Source: Adapted from "Is Successful Leadership Based on Employees' Talents?" by Tom Welch from Treasure Chest Business Journal

Query: CaerVision Podiatry TV Network for Waiting Room

We are considering implementing an internal marketing TV product (e.g., CaerVision) for our waiting room and wanted to get some feedback from other offices. What systems people are using and whether or not the information delivered has been well-received by their patients.

Eric Arp, DPM, Mountain Home, AR

RE: Painful. Stiff Toes (Harry Cotler, DPM)
From: Multiple Respondents

The condition described seems to be either a) an early form of ascending lymphedema before it breaks out and affects an ankle/foot, leg and then thigh. If this is the case, early intervention may help to avoid a serious medical tragedy. b) a 'forme fruste' of RSD. Referrals to neurology/PVD specialists would be helpful and risk management protective.

R.D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

I am sure there will be several responses elaborating on systemic arthritis and the addition of ANA and HLA-B27 and the term "sausage toe" may even be thrown in, however, there should absolutely be no discussion until a follow-up x-ray is taken. There is no excuse not to repeat an x-ray. Stress fracture, cyst, neoplasm, osteo or subchondral erosions, hallmarking the systemic arthritis you are looking for, may be seen.

Clearly this may not be as simple as a stress fracture, but we all can attest to the fracture or osteo that we found on a routine x-ray when we were convinced it would show nothing. Don't overlook the obvious, x-ray everything, and repeat if needed. If nothing is there, then proceed with the extensive work-ups. (labs, MRI, better history, etc.)

Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net

This appears to be a classic case of too short shoes syndrome. Her left foot is probably bigger than her right. In surveys taken with shoe fitters in sit-and-fit shoe stores, close to 90% of adults are wearing shoes smaller than their feet. This is supported by my personal experience for the past 35 years. The toe box is probably too shallow as well.

Robert S. Schwartz, C. Ped., NY, NY, rss@eneslow.com

RE: Nerve Conduction Testing In Office (Rory Cohen, DPM)
From: Multiple Respondents

Review various insurance carrier policy statements on nerve conduction studies, e.g., aetna.com/cpb/medical/data/500_599/0502.html. Google "Brevio ncv" for a multitude of insurance position statements on the device. All indicate that the Brevio and other hand-held devices do not meet criteria for reimbursement.

James Korponay, DPM, NY, NY, jKorponay@aol.com

I have utilized Neurometrix testing in my office for many years. I have the ability to perform sensory and motor NCV testing on peroneal and posterior tibial nerves at the ankle, and also sensory nerve testing of the sural nerve as well. I routinely perform a median or ulna nerve test as well, (for reference) just as with performing ABI's for vascular disease. The testing provides a nice 5-page report, that I share with the patient and their primary MD.

The cost of sensors is high, but reimbursement is good, and tests reliable. You can often differentiate between simple neuropathy, and spinal stenosis, radiculopathy, or sciatica. I do not use it for screening and only as medically necessary, following Medicare LCD's for such testing. Pay attention to the details of Medicare's policy regarding these codes. Contact Neurometrix for details( 781) 890-9989. I have no relationship to/with them.

Carl Ganio, DPM, Vero Beach, FL drcarlganio@bellsouth.net

I would be somewhat cautious with regard to these automated NC tests. When reading the policies of many carriers, they are catching on to an overuse pattern and an inability of certain physicians to understand these tests and use them appropriately. Insurance companies are starting to audit these tests. Neurometrix has been under investigation for improper marketing of this product. There is too much to write about but a little research will tell you the facts.

Here's a quote "BCBSNC does not provide coverage for automated nerve conduction tests. They are considered investigational." Medicare suggests that as a physician you must have specific training in this area, perhaps fellowship training. So that's pretty major and a reason for them to come back and audit. I don't know many in our profession with this type of training.

I would feel concerned about the amount of reimbursement for the time spent doing the test. It sounds like an alcohol injection or ESWT scenario to me.

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

RE: Network vs. Non-Network (Mark Levine, DPM)
From: Michael M. Rosenblatt, DPM

There are some network reimbursements that are so poor that joining them is tantamount to not being paid for your surgery. They may not even cover your office overhead. I submit that under these circumstances, you are almost better off doing it for nothing and at least getting "charity" recommendations for it.

The issue is pay/unit time. But refusing to sign on networks is scary to most podiatrists, because their local colleagues will do the cases instead. But they will have to face the enormous responsibility for doing a surgery that goes literally unpaid. You won't.

I suggest a compromise. Take one particularly egregious network in your area and refuse to send in the re-signup. Then, start using patient education FORMS in your office on a regular basis to help teach patients the value of your services. It's time to start being proud of what we do.

You will lose some work. But you can use that time to study new and better paying codes and procedures and expand your patient education information files. Over a period of time, you should be able to make up and highly surpass the loss from network refusal. But it won't work unless you start to educate your patients.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

RE: A Pyrrhic Savings

I'm sensitive to the issue involving patients thinking that physicians' fees are the reason that the cost of healthcare is rising so high, so I was listening the other day when my wife was on the phone with a family member who was outraged at the charges from an orthopedist who treated him. "He was in the room only ten minutes and never even touched my foot!" According to the fee slip, the charge to their insurance company was $845.00! The diagnosis from the first physician he saw for the problem, as expected, was ankle sprain. It turns out he had a fractured metatarsal ($825.25), a savings of $19.75!

The problem is that what she was really reading were the the billing codes, ICD-9 845.00 (ankle sprain) and ICD-9 825.25 (stress fracture).

Marc Greenberg, DPM, Dayton, OH

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

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Live, play and practice in West Central Florida. Associate position available, leading to partnership, in a well-established, expanding, solo practice in the Tampa Bay area. Great pay and benefits in a dynamic medical/surgical practice. Join our caring, compassionate, educated team. E-mail cover letter, CV and references to rvalins18@aol.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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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 – CONNECTICUT

Full or part-time position available for a podiatrist licensed in CT. This practice encompasses wide variety of patients including Diabetic wound care and general podiatric care. Must be willing to cover all aspects of the practice including nursing homes and house calls. Please e-mail CV to RPMDPM@aol.com

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