The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 09, 2010 #3,979 Publisher-Barry Block, DPM, JD

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CPM’s Jones Earns APMA’s Award of Excellence

Dr. Lester Jones, Executive Associate Dean of Academic Affairs for Western University of Health Sciences’ College of Podiatric Medicine (CPM) has been awarded the 2011 American Podiatric Medical Association’s (APMA) Award of Excellence for members. The award recognizes those who have demonstrated outstanding national accomplishments in scientific, professional or civic endeavors over a lifetime. Jones will receive the award during the APMA House of Delegates March 20-21, 2011 in Washington, D.C.

Dr. Lester Jones

 “It’s a humbling experience,” Jones said. “You work an entire career trying to achieve excellence, and I don’t really think you grasp the achievements that are occurring right before your eyes. What you see you are doing is your job. I don’t get with the adage of getting something in return for it. It’s the joy of doing a job well done and seeing others advance in scope.”

Want to Avoid Divorce? Marry a Podiatrist

This is the bottom line: If your spouse works at a casino, you'll want to keep a close eye on them. A new study out of the University of Radford has broken down divorce by occupation. It's chilling reading for those who work in the gaming industry. The job with the highest divorce rate? Dancers and choreographers, nearly half (43.05%) of whom have ended a marriage. Others who aren't good at commitment: bartenders, massage therapists, "gaming cage workers," "gaming service workers" and telephone operators.

On the other end of the spectrum, podiatrists are among the professions with the lowest divorce rate (6.81%).

Source: Cathal Kelly, Toronto Star [10/4/10]

Only 1 in 15 Docs e-mails  Patients: Study

Despite indications that e-mail access to physicians increases patient satisfaction, only 6.7% of office-based physicians routinely use e-mail to communicate with their patients, according to a report from the Center for Studying Health System Change. The report is based on a 2008 survey of 4,258 physicians. Only 34.5% of survey respondents said their office was equipped to handle electronic communication about clinical issues with patients, and among them, only 19.5% reported e-mailing with patients routinely.

Barriers to using e-mail included lack of reimbursement and concerns about increased workload, maintaining data privacy and security, and avoiding increased medical liability.  Avoiding e-mail did not necessarily correspond with an avoidance of information technology. The survey also found that 76.6% of physicians had electronic access to lab, radiology or other diagnostic tests, with 61.8% using that application routinely; 56.8% had electronic access to patient notes, medication lists or "problem lists"; and 42.2% had access to electronic prescribing tools.

Source: Andis Robeznieks, Modern Healthcare [10/7/10] 

Query: Loss of Privileges

I have had full unlimited privileges of the foot and ankle at the hospital I operate out of for the last 25 years. This, in a major part, was due to having completed three years of surgical residency. Last week, I received a call from the chief of orthopedics telling me that unless I have performed 10 ankle fusions in the past two years, they would remove my privileges to perform total ankle implants. His logic was that IF something went wrong with the procedure, I would have to fuse the ankle, and I have to show current competence to do so. He explained that my training of 25 years ago was old. I recently took a course for performing total ankles. I explained that doing an ankle fusion was no big deal for me and that I have done them and feel comfortable doing them. I also explained that I have not done any in the past two years. Any advice from the PM News readers? Can my privileges be reduced carte blanche?

Ivar E. Roth DPM,MPH, Newport Beach, CA

Query: Medicare Non-Diabetic Shoe Denial

How do I bill for athletic-type shoes that are covered by Medicaid, which is a secondary payer to Medicare (primary)? How do I get a denial from Medicare that would be sent to Medicaid? Do I need the "KX" modifier or just use a "G" modifier for the denial?

Julie Albrecht, DPM, Des Moines, IA

Response: In all scenarios, you do not want a denial based on medical necessity, but a denial of patient responsibility. Presuming the patient is not a diabetic, you would never use the "KX" modifier. You would use an "RT" and "LT" modifier for each shoe. You would also use a "GY" modifier. No advance beneficiary notice (ABN) would be required.

Your choice of codes includes:
L3215 - Orthopedic footwear, ladies shoes, oxford
L3216 - Orthopedic footwear, ladies shoes, depth inlay
L3217 - Orthopedic footwear, ladies shoes, hightop, depth inlay
L3218 - Orthopedic footwear, ladies surgical boot, each
L3219 - Orthopedic footwear, mens shoes, oxford
L3221 - Orthopedic footwear, mens shoes, depth inlay
L3222 - Orthopedic footwear, mens shoes, hightop, depth inlay

Your diagnosis would be related to the patient's local foot pathology.

Paul Kesselman, DPM, Woodside, NY

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RE: Too Many Stress Fractures in High School Athletes (Shari Kaminsky, DPM)
From: Ira Meyers, DPM, Elliot Udell, DPM

I recommend contacting the coach directly and not going through the athletic director. Most importantly is how you present yourself to the coach. If you appear accusatory, nothing good will happen. Try to find something to evaluate such as what type of shoes  and terrain athletes are training on. If they are doing a lot of running in cleats, you should suggest a change. This can actually turn out to be a good connection for you. I have had coaches ask me to evaluate their training if too many of their kids are injured. Most coaches will appreciate the input, but a few won't change, no matter what you say.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

Dr. Kaminsky mentions that vit. D levels should be taken on patients presenting with stress fractures. This is a keen point. Physicians are finding that a very large percentage of the population is vitamin D deficient and the treatment is not over-the-counter vitamin D, but prescription-grade vit D, 50,000 units once a week for 12 weeks. In our practice, we are ordering vit. D-25 levels on any of our patients presenting with chronic bone pain and with any sign of osteopenia on plain films. At this point in time, there is uncertainty within the medical profession as to what the long-term impact of having low vitamin D levels will be on patients and what the long-range impact will be on raising the serum levels. Dr. Kaminsky deserves to be acknowledged for bringing this up. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Private Practice to Clinic Employment (Name Withheld)
From: David Helfman, DPM, Elliot Udell, DPM

It sounds like Name Withheld is hesitant about becoming an employee and giving up control of his destiny. If he and his colleague are the only podiatrists in that area, why don’t they both merge practices and become stronger as a unit, rather than work for a clinic. Now, I don’t know his age, motivations, or desires for doing this transaction, but if all the clinic is going to do is buy his assets, then he might want to rethink another strategy. With the information he has provided, it’s hard to give real feedback, however, if his reason for joining the clinic is for security and a better quality of life, then he should go for it. However, if his reason for joining is to secure his future for fear that they might higher other DPM’s, then he might want to reconsider his strategy. Whatever he does, I recommend that he and his colleague get together and come up with a plan, since it sounds like he already owns the market!

David Helfman, DPM, Atlanta, GA, DHelfman@villagepodiatrycenters.com

Because of the ever worsening insurance payment environment, physicians in many communities have altered the way they practice, and many are gravitating toward leaving private practice and working for hospital or corporate-owned clinics. One plus of closing your practice and working for a clinic is that you would no longer have to deal with the business end of medicine and could devote your time to treating patients. A negative, however, is that you are no longer your own boss and you will never know who will be dictating the way you should practice. Be assured that the dictates will be based on business rather than on quality of care. 

Many physicians who have joined these practices have complained that they are forced to see many more patients than ever and spend less time with each one. If they spend too much time because a patient needs it, there is a supervisor in the hallway that will  come into the treatment room and end the session. Another problem is that if you give up the security of your private practice and work for the clinic, you can be fired at any time. The clinic may decide to discontinue podiatry or it may decide to hire a podiatrist whom they like more than you; and even if you have a contract with them, they can make life miserable and force you to quit. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Sage Advice From a Podiatric Legend (Robert Bijak, DPM)
From: Tip Sullivan, DPM, Paul Kesselman, DPM

After reading the response that Dr Bijak made to my posting about Dr. McGlamry's advice, I re-read my posting to try to understand what point Dr. Bijak was trying to make and the relevance to my post.  It looks like he was calling me a "politically correct podiatrist." For those who know me, that is a good laugh--and implying that I was admonishing him for something as though I were a "verbal policeman." WHOA horsey! Where did that come from? 

I salute the "forgotten podiatrist"! I am one of those "average" podiatrists. I believe that we average podiatrists can learn from those who have achieved more for our profession than just "average." I am unable to see the "well meaning constructive criticism" in Dr. Bijak's response to my post.

Perhaps it is just a geographical thing, you know, the dumb old southerner vs. the slick New Yorker. Wherever you may be from: North, South, East or, West, I think Dr. Bijak's response to my post still sounds like moaning, groaning, bad mouthing, and definitely not as Dr. McGlamry suggests - showing support and respect for your fellow podiatrists and the efforts they make to better our profession. I hope we can all listen and learn from the people  in our profession who have come before us and have done more than we have. I suggest that  Dr. Bijak and I could both learn more if we would listen more and talk less.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Editor's Note: Dr. Kesselman's extended-length letter can be read here.

RE: Medicare Jibberish  (George Jacobson, DPM)
From: Michael M. Rosenblatt, DPM

Dr. Jacobson wrote that he got a demand for a refund (from Medicare) for routine foot care issues. The amount in question was minor, only $86.56. The doctor questions how much time he should spend "fighting" and defending his issue. He is basing his concern on the amount demanded to be returned. But ANY recoupment request from Medicare must be taken with the utmost seriousness. These small demands are often a prelude for a potentially greater and more far-reaching demand in the future.
 
It is vitally important to fight and thoroughly defend any recoupment demand from any insurer, but particularly the U.S. Government. Thorough documentation of your charges are a necessity, as well as accurate billing, including the use of modifiers. It is impossible to know with any certainly about how, or if, insurers "share" results of audits or recoupment demands. It is my understanding that the results of these audits are NOT protected communications regarding dissemination in the industry.
 
Therefore, the only thing you have left is to fight for your reputation and accuracy. It is essential that you do. If the situation escalates, you must also hire a healthcare attorney to help defend you. In my opinion, waiting to do so is a mistake. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Dealing With Medicare Carrier’s Incompetence (Jeanne Arnold, DPM)
From: Mark S. Block, DPM

Over a number of years, I have served on various committees of my component local, state and national organizations. As a Medicare Carrier Advisory Committee (CAC) representative, Insurance Chairman of my state component, Chairman of the Health Policy and Coding Committees of APMA, I have been exposed to and have worked toward resolving issues confronting our patients and physicians. Consequently, I would like to respond to Dr. Arnold's perspective of the APMA.

The APMA and its state components have been successful through their resources in effecting many changes that would not have taken place had the APMA and affiliated organizations not been in existence. APMA, in fact, is one of the limited number of specialty organizations with a voice in bringing issues to CMS, and in addressing these issues through...

Editor's Note: Dr. Block's extended-length letter can be read here.

RE: Extortion By Patient (Name Withheld, David Secord, DPM)
From: Palmer Branch, DPM 
 
I would like to compliment Dr. Secord on the way he handled his difficult patient, as well as his thorough documentation. We all need to remember that we need to maintain our self-respect. Too often, we worry about coddling difficult individuals and being politically correct. Maybe, we need to do surveys on doctor satisfaction instead of the patient satisfaction surveys we are encouraged to do.

By no means do I mean to say we need to be harsh to everyone or be self-serving, but we must not  be afraid to be firm, professional, and efficient in dismissing patients who are insulting, threatening, grossly non-compliant, or otherwise unrealistic. It is probably just about impossible to have a productive doctor-patient relationship with difficult individuals like the ones mentioned, and is probably in the best interest of both the patient and the doctor to terminate the association when an unwinnable situation arises.
 
I echo the advice of several other writers about contacting your malpractice carrier for situations like we are discussing. Unfortunately, the all too litigious society we are in makes thoroughly protecting your backside a necessity.
 
Palmer Branch, DPM, Cumming, GA, drcuboid@aol.com

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

ASSOCIATE POSITION - TEXAS

Established podiatry practice in Houston, TX has an opportunity for a well-trained associate to start immediately. Great opportunity for a new graduate or established solo practitioner looking to join a successful practice with a fast track to partnership. Practice is modern and offers all of the latest equipment and technological advances available in podiatry. Aside from seeing patients and providing outstanding care, individual must be personable, passionate, and willing to help market themselves to referral sources as part of a plan implemented by our business development coordinator. Salary with bonus and benefits available. Send cover letter, CV and 2 letters of reference to houstonpod@gmail.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - ST. LOUIS, MO 
 
Leading group practice looking to add one podiatrist to established location. Group's podiatrists enjoy incentive compensation plan (production and sharing group profits), benefits including health and malpractice, and supported with integrated practice management and EMR systems. Perfect opportunity for solo practitioner to join group setting. Could also be part time opportunity for the right individual.  Please forward CV to StlPodGroup@gmail.com

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.com

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

PRACTICE FOR SALE - NORTHERN CALIFORNIA
 
Rare opportunity. Busy all around practice, including pediatrics. Hospital guarantee of $200,000 for first year. Ready to retire. Will stay on for transition. Low price of $130K. E-MAIL tracy.podiatry@comcast.net or call: 209.835.4276 

PM News Classified Ads Reach over 12,500 DPM's and Students

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