The Voice of Podiatrists

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October 06, 2008 #3,366 Editor-Barry Block, DPM, JD

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We’ve just posted an October CME titled:

By Doug Richie, DPM

You can Earn 30 CPME-Approved CME Contact Hours Online

IPMA Elects 2009 Officers

The Indiana Podiatric Medical Association (IPMA) has elected new officers to lead the organization of foot and ankle surgeons in 2009. The Association represents doctors of podiatric medicine for the purposes of continuing education and to support improvements in the profession for all practicing podiatrists. There are now 220 members in the state.

Dr. Randall A. Cooper

In action taken during the 83rd Annual IPMA Convention, conducted at Indianapolis:

Dr. Randall A. Cooper, Elkhart, was elected President.
Dr. Andrew J. Rader, Jasper, was elected President-Elect.
Dr. Jane A. Koch, Evansville, was elected First Vice President.
Dr. Derek A. Besing, Vincennes, was elected Second Vice President.
Dr. Patrick A. DeHeer, Columbus, was elected Secretary-Treasurer.
Dr. Christopher S. Grandfield, Merrillville, was elected North Trustee.
Dr. Wendy K. Kennedy, Sullivan, was elected South Trustee.

Delegates and alternates to the American Podiatric Medical Association were also elected: Drs. Marc S. Bruell, Randall A. Cooper, and Patricia A. Moore, Delegates plus Dr. Andrew J. Rader, Alternate Delegate.

CT Podiatrists, Sisters, Die Days Apart

Dr. Margaret O'Neil, "Peggy" to her family, friends and patients, drew her last breath on a warm Sunday afternoon in the living room of her Bridgeport home. Sixty-seven hours and 10 minutes later, on Wednesday, Dr. Alyce Muldoon died in the same room. O'Neil was 88. Muldoon was 86. They were sisters, brought up during the Depression in a big Irish immigrant family, daughters of Patrick and Bridget Connelly O'Neil, who went on to become podiatrists in the 1940s when the number of female doctors still was low.

Drs. Margaret O'Neil and Alyce Muldoon

Soon after Margaret O'Neil died, people started flocking to their house, where they lived for decades and practiced podiatry for almost half a century. In the half-century that the sisters sat hunched over examining thousands of bunions, corns and ingrown toe nails, they knew all of their patients on sight, made house calls up to the last days of their practice. Inside their North End house, patients always knew that if they got there around lunchtime, or stayed beyond their appointment, they could expect to be offered a hearty bowl of homemade soup, a sandwich or whatever else was cooking.

Source: Marian Gail Brown, Connecticut Post [10/4/08]

PA Podiatrist Charged with Disability Insurance Fraud

The Philadelphia District Attorney's Office yesterday arrested podiatrist Michael Schaeffer, 61, of Bustleton, PA who was charged with insurance fraud and theft by deception. Officials accused Schaeffer of filing a false disability claim with an insurance firm saying that, beginning in September 2004, he couldn't work.

An investigation, however, showed that he did work with only brief interruptions. The claim, which would have totaled $360,000, wasn't paid, according to the D.A.

Although Schaeffer never got paid, he stands accused of felonies and could face penalties of 20 years in prison and $25,000 in fines, authorities said.

Source: Bonnie L. Cook, Philadelphia Inquirer [10/3/08]

Take These Steps to Catch a Thief – Part 2

When you have received permission to proceed, share your facts carefully and without passing judgment. Example: "Today I set a $20 bill on my desk. When I went to treat Mrs. Jones and came back, the money was gone. Someone saw you leaving my office. I'm racking my brain to figure out where the money could have gone."

Continue by saying: " Because I can't think of any other explanation for where the money could have gone, I decided that I needed to talk to you about it rather than letting this issue fester between us. And I want you to know that if you did make a mistake, I'm not going to judge you for it." Then ask "did you - for any reason - take the money from my desk?"

Be prepared for a defensive reaction. If you keep the emphasis off the theft and the money and on your relationship, you can repair the damage - and perhaps even recover your property.

Source: Adapted from To Confront a Thief

Query: Vibrating Hallux?

A 67 y/o female, post-Keller with EHL lengthening has successfully returned to high heels and functionally is very pleased with her surgical outcome. However, her hallux, when non-weighted, "vibrates" and is poorly supported in spite of 8 weeks of PT. MRI reveals intact flexor tendons and no ruptures or problems with the dorsal tendons. The surgical trauma is noted, but there is nothing out of the ordinary. What course of action is suggested at this point? I am considering aggressive PT or a physiatrist consult.

Dennis Shavelson, DPM, NYC, NY

Query: X-Ray Interpretation Software

Does anyone use or know of x-ray software that calculates angles, bone lengths, allows manipulation of the image and templating on an x-ray for surgical planning? We are not taking digital x-rays, so the images would be scanned or photographed and placed in the software.

Paul Bishop, DPM, Yorkville, IL

RE: Unusual Case of Cellulitis of the Left Fifth Toe (Elliot Udell, DPM)
From: Dave Samuel, DPM, Keith Gurnick, DPM

I saw this once with a mycobacterium infection. The one I saw was Mycobacterium avium. Similar white, creamy-looking drainage you described. The patient had a history of this in his hand years ago, and it ended up in his foot.

Dave Samuel, DPM, Chester, PA desamuel@pol.net

Check her serum Ca+ level. If you find it necessary to drain again, ask to check for any Ca+ pyrophasphate crystals, found in pseudogout.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: Amfit CAD/CAM (Q Solomon, DPM)
From: Jengyu Lai, DPM

I had the same thought and discussed this with the company during the Midwest Podiatry Conference a few months ago. I was told by the rep that the cost would be higher than the Medicare reimbursement.

Jengyu Lai, DPM, Rochester, MN, jylai99@yahoo.com

RE: Matrixectomy Billing Rules (Karen Hurley, CMM, CPC-I)
From: David Mullens, DPM, Esq,, Harry E. Confer, DPM

With all due respect, I think Karen Hurley has it wrong. The CPT code 11750 is defined as: “Excision of and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal.” In other words, according to the plain and simple meaning of the words, the 11750 procedure refers to a single, continuous surgical site – whether it is a partial or complete matricectomy procedure. On the other hand, tibial and fibular border matricectomy procedures performed on the same nail, with an untouched portion of nail plate and nail bed in between, means you have completely separate surgical sites. You cannot access one surgical site through the other surgical site without disrupting the non-operated nail plate and nail bed between the two surgical sites, and it is not only feasible but common to have a post-infection (complication) at one site without having the other site involved.

So it is not the “size of the body part that would define additional payment”, as stated by Karen Hurley. It is the complete separation of the two surgical sites that gives rise to two separately billable procedures. By analogy, the CPT Editorial Panel got it right by publishing one code for an arthrotomy of one knee compartment (27332) and publishing a different code (27333) for arthrotomy of both knee compartments. The principle is exactly the same here and I have had much greater success fighting for payment by using both the 11750 and 11750-51 codes as opposed to the 11750-22 code.

David Mullens, DPM , Esq., Palo Alto, CA, mullens@mullenslawoffice.com

I suggest going to the dentist for treatment with two cavities on one tooth and then check you bill. You will be billed for two fillings not just one. In years past, it was common practice for the insurers, including Medicare to reimburse for both a medial and lateral matrixectomy on the same toe. Over the years, insurance carriers have bundled many procedures which require more time, more effort with more risk for their own financial savings and our loss. Not only do we suffer financial losses from this change, but now reductions in payment for all procedures, not to mention loss of patients to the numerous HMO programs. Yet, insurance consumers continue to find their premiums increasing along with their co-payments. There seems to be a spiraling effect downward and certainly not in medicine's favor. We are just working longer and harder to achieve the same financial reward. By the way, have a crown done and compare you cost for this dental service with your bunion reimbursement. Dental medicine has gotten it right!

Harry E. Confer, DPM, La Verne, CA, DRHEC@aol.com

RE: OIG Releases 2009 Work Plan (Paul Kesselman, DPM)
From: Michael M. Rosenblatt, DPM

Many thanks to Paul Kesselman, DPM for alerting us to OIG's 2009 plans. I encourage all to look at the web site Dr. Kesselman referred to for further information. OIG has a duplicitous history with podiatry. In past years, despite "promises" to APMA, there was no prior notice of or discussion with our national association when highly critical material was published about podiatrists (a study on routine foot care).

Ordinarily this would be OK, since OIG has no responsibilities to APMA. The problem is that the study in question was incompetent and remains totally undocumented to this day.

It is only a political statement. Given that history, I would respectfully suggest that podiatrists contacted by OIG be extremely wary of providing them with any of your data, unless subpoenaed. If you have a choice, I would not recommend sending them anything. If you do, I would advise that you carefully go over the subpoena with your lawyer and send ONLY the materials specifically requested, in the narrowest possible sense. We cannot anticipate honesty, accuracy or decent science from OIG.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net, fax to 410-486-2049, call r. Herbert Rosen 410-580-0255

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 – 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

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

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

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

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 information contact QVAN@aol.com or 305-975-5516.

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