The Voice of Podiatrists

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October 08, 2007 #3,060 Editor-Barry Block, DPM, JD

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FL Podiatrist Lectures At World Congress of Dermatology

There was no crying in Argentina this week as the World Congress of Dermatology gathered over 10,000 dermatologists from all corners of the world. This event which occurs once every four years is considered one of the top meetings for those physicians who treat the skin. Dr. Bret Ribotsky, one of the only podiatric physicians in the world participating in the conference, said “the experience to share on such an international level is truly an opportunity to further the value podiatric medicine on a global level.”

Dr. Bret Ribotsky

Ribotsky presented the results of some of his research on tinea pedis and onychomycosis. Dr. Gonzalo Munita of Santiago, Chile said “It was the best presentation he has ever seen.”

Ribotsky, the medical director of “Advanced Medical & Surgical Treatment of the Foot and Leg” in Boca Raton, Florida is a past president of the American College of Foot and Ankle Orthopedics and Medicine.

NYCPM Welcomes Class of 2011 with Annual White Coat Ceremony

The New York College of Podiatric Medicine (NYCPM) recently welcomed the students of its Class of 2011 with the College’s annual White Coat Ceremony, in which the future Doctors of Podiatric Medicine symbolically don their white coats and together recite the Hippocratic Oath. Lt. Col. Timothy Duffy, D.P.M., Chief of the Podiatry Service at Keller Army Community Hospital, located on the grounds of the United States Military Academy at West Point, delivered the keynote address to the assembled College community and guests.

Michael J. Trepal, DPM, NYCPM Vice President for Academic Affairs & Dean, presents White Coat Ceremony keynote speaker Lt. Col. Timothy Duffy, DPM with a plaque and a golden apple, as NYCPM President & CEO Louis L. Levine looks on.

Lt. Col. Duffy has been Chief of Podiatric Medicine at Keller Army Community Hospital since 2003, also serving in that position from 1996 to 2001. During his Army career, he has also served as a Staff Podiatrist and later Chief of Podiatric Medicine at General Leonard Wood Army Community Hospital, in Missouri, and as Chief of Podiatric Medicine at Guthrie Army Health Clinic, in Fort Drum, NY. Lt. Col. Duffy received his D.P.M. degree from the Ohio College of Podiatric Medicine, and his B.S. degree from Canisius College, in Buffalo, NY.

Forty-three percent of the Class of 2011 is female. The members of the Class of 2011 come from nearly twenty states, as well as Korea. One student has a foreign medical degree, five have M.S. degrees, two have M.P.H. degrees and one has an M.B.A. degree.

Ambulatory Surgical Center Groups to Merge in 2008

The American Association of Ambulatory Surgery Centers and FASA agreed to merge, the groups announced. The two largest ASC trade groups will become one organization on Jan. 1, 2008—the same date a new payment system for ASCs will kick in under Medicare, setting a new compensation rate of 65% of what hospital outpatient departments get paid. Some ASCs will see their payments drop dramatically under the new system.

The new association will be headquartered in Alexandria, VA, where FASA is based, and will be governed by a board of directors and other leaders that will fully incorporate the expertise of both the AAASC and FASA. Kathy Bryant, current president of FASA, will assume the role of chief executive officer of the new association. After supporting the transition, Craig Jeffries, executive director of the AAASC, “will step aside from any staff responsibility.”

Source: Jennifer Lubell, Modern Healthcare [10/5/07]

Query: Choice of Bunionectomy

I have a 63 year old patient who ten years ago had an orthopedic surgeon perform a Lapidus procedure, left with a resultant negative IM angle and a huge hallux varus. She has a 3+ bunion, right because she was afraid to repair the other foot.

Post Lapidus

She wishes surgical correction in order to relieve transfer pains laterally and to provide shoe fit. MRI shows advanced degeneration to the plantar plate and the medial side of the 1st MP Joint. My question is whether a Keller procedure is enough to establish relief and shoe cosmesis or do I need a reverse Austin incorporated or is (are) there another procedure(s) that would be better (but not more heroic).

Dennis Shavelson, DPM, New York City, NY

Query: Service Dogs and the ADA

Today a new patient arrived at my office with a small dog. When my staff pointed out that there was a dog in the reception area, I went out to ask the lady to remove the dog, and she told me that she is disabled and this is a service dog. She did not appear to be blind, but I did not want to break any ADA rules or laws. So I had her roomed and asked her what her disability was and she told me that she has severe separation anxiety disorder and must have her dog. I understand that mental illness is a protected disability, but I am allergic to dogs.

Do I ask her to prove that she has a doctor's order to take her dog everywhere? She might have that letter. Do I just tell her that I am allergic to dogs and that she should find a podiatrist who is not allergic to dogs? Am I in any trouble if I won't let her back into my office? What people have done in similar situations.

Michael Cohn, DPM, Albuquerque, NM

Editor’s Comment: PM News does not provide legal advice. Under the Americans with Disabilities Act (ADA), businesses and organizations that serve the public must allow people with disabilities to bring their service animals into all areas of the facility where customers are normally allowed to go. This federal law applies to all businesses open to the public, including medical offices.

You may ask if an animal is a service animal or ask what tasks the animal has been trained to perform, but cannot require special ID cards for the animal or ask about the person's disability. Allergies and fear of animals are generally not valid reasons for denying access or refusing service to people with service animals. Violators of the ADA can be required to pay money damages and penalties.

Source: U.S. Department of Justice, Civil Rights Division, Disability Rights Section

RE: Medicare Deductibles to Rise
From: Paul Kesselman, DPM

A synopsis of The Federal Register October 5, 2007: Annual Medicare deductible for 2008 and Medicare Premiums

The annual Medicare deductible will be $135.00 (up $4 from the current $131). The standard premium for 2008 is 96.40 in 2007 it was $93.50. These are base rate premiums which are actuarially calculated to cover 25% of the programs costs. From this base rate the premiums will go upwards based on the enrollees ability to pay.

For those lucky rich folks with income thresholds of greater than $82,000 (filing single) or $164,000 (filing jointly), there will be a sliding scale escalating premium. Once the adjustments are fully phased in, and depending on income and tax filing status, a beneficiary could now be responsible for 35, 50, 65, or 80 percent of the estimated total cost of Part B coverage, rather than 25 percent.

The end result of the higher premium is that the Part B premium subsidy is reduced and less general revenue financing is required for beneficiaries with higher income because they are paying a larger share of the total cost with their premium. That is, the premium subsidy will continue to be approximately 75 percent for beneficiaries with income below the applicable income thresholds, but will be reduced for beneficiaries with income above these thresholds.

Paul Kesselman, DPM, Woodside, NY, Pkesselman@pol.net

RE: Restrictive Covenant
From: George R. Vito, DPM, MBA

You need to look at your area, and determine what is the norm. A five mile radius from each location is not uncommon, therefore enforceable, however, the three year, may be a little too much, however, a one year to two year is enforceable. However, once again, if the norm is three years in your area, you will need understand your responsibility to the contract.

Also, if you choose to sign and leave within the contract period, without abiding by the contract, at the minimum, it will cost you about $35,000 to defend yourself in a lawsuit, once your employer finds out that you have broken the contract.

The covenants are a protection for the practice and for the investment in which the physician is making to bring you into the practice. The policy protects practices from physicians coming into a practice, forming a relationship with the established or new patients (in which the practice has accumulated an expense to get the new patient and to maintain the current patients) in order to leave the practice and taking the new patients and the current patients that he has seen.

Simple rules, simple logic, which many young podiatrists coming out of residency programs seem to lack.

George R. Vito, DPM, MBA, Macon, GA, georgevito@aol.com

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

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ASSOCIATE POSITION – CENTRAL FLORIDA, ORLANDO AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well established multi-office practice. Applicant must be bilingual in English and Spanish, well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.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 -- www.homephysicians.com

PRACTICE FOR SALE-BEAUTIFUL SOUTHERN COASTAL MAINE

Minimal managed care in well established, very profitable office. Turn-key operation. Contact Podiatrist1111@yahoo.com

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