The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 11, 2007 #3,063 Editor-Barry Block, DPM, JD

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Here are answers to some questions posed by early registrants to the 2008 Hawaii Coding & Practice Management Workshop:

1) How much is the airfare to Kona (The Big Isand) from Honolulu? The airfare is as low as $39 on Go, Hawaii Interisland Airlines, Hawaiian Air, Aloha Air, Island Air or Pacific Wings. It is also possible to fly back to the Mainland directly from Kona on many US carriers .

2) Is the workshop a tax-deductible expense? Yes, your airfare, hotel, meals, and registration are all valid deductions, but we recommend that you check with your tax advisor.

For more information or to register visit www.podiatrym.com/hawaii

Women Suffer From Notion That Feet Should be Small and Narrow: CA Podiatrist

It’s no surprise that nearly half of all Americans will experience foot problems at some point in their lives, according to the American Podiatric Medical Association. And while damage may not show up until later in life, the problem starts earlier and worsens as times goes by, said Jean Turner, a podiatrist in Sebastopol, CA. "The average American adult walks 8,000 to 10,000 steps each day," Turner said. But it’s really the shoes that count.

Dr. Jean Turner

And after decades of punishment — we’re talking about the fashion-conscious, women willing to take a little bit of pain in the name of fashion — something has to give. The foot becomes vulnerable, taking it in the metatarsals and other vulnerable spots, because, Turner said, "the foot is really just a bag of bones."

Turner said women suffer from a notion that their feet should be small and narrow, and if they’re not, they find shoes that give the illusion. Turner has a large clientele of women in their 80s and older who don’t want to give up the heels "they danced in 40 years ago."

Source: Susan Swartz, NYT Regional Media Group [10/8/07]

AMA, AARP, and Democrats Line Up to Support New Medicare Bill

Call it the health insurance companies and nursing homes versus doctors and the AARP, a classic, inside-the-Beltway struggle that erupted when House Democrats sought changes to Medicare. Publicly, all sides trumpeted their concern for older people in the United States and scarcely mentioned their own financial and political self-interests, if at all.

Together, they have spent millions on lobbyists, television ads and polling to influence lawmakers. They stand ready to renew the battle this fall, all the while previewing possible lines of attack for the 2008 elections.

"The bill preserves access for Medicare patients and lowers seniors' out-of-pocket costs," the American Medical Association and AARP said in ads endorsing the Democrats' bill. Not mentioned was that the legislation would put $65 billion more into doctors' pockets over the next decade. Or that AARP, which has 39 million members over age 50, was eager to court favor with Democrats newly in control of the House.

Source: David Espo, Associated Press [10/8/007]

California Blues Plans Say Pay-for-Performance Works

Together, Blue Cross of California and Blue Shield of California awarded more than $100 million in pay-for-performance (P4P) bonuses to providers in 2007. The plans say they are seeing improvements in care that can be attributed to P4P initiatives.

Both plans participate in the Integrated Healthcare Association (IHA) P4P initiative, and both have their own internal metrics for measuring the performance of participating providers. IHA is a California-based not-for-profit organization that coordinates a P4P program with participating health plans and providers. It recently released 2006 provider performance results in the areas of clinical quality, patient experience and information technology (IT). The Blues plans use those results in deciding how much to award providers.

"The reports we get show there has been a steady improvement over the past four years," says Michael Belman, M.D., medical director for clinical quality and innovations at Blue Cross of California. The WellPoint, Inc. subsidiary says it awarded more than $69 million to 176 provider groups for 2006 improvements through its HMO Quality Scorecard program.

Source: The AIS Report on Blue Cross and Blue Shield Plans [10/9/07]

Query: Painful Hallux IPJ Lesions in Diabetic

I have a 17y/o overweight diabetic male who has developed painful lesions on the medial IPJ of each hallux and recently developed a small ulcer. I sent him to his pedorthist to have his diabetic shoes evaluated and modified.

The patient walks with a significantly abducted gait with his weight transfer from the lateral heel to the medial forefoot and hallux due to abduction of his hips. Although there is mild hallux interphalangeus, I don't foresee any procedure in the foot that would reduce the weight and pressure sufficiently to this area. Does anyone have recommendations on shoe/orthotic modifications that would transfer weight off the hallux and not cause any problems in his knees, hips or back?

Michael J. Ryan , DPM, Charlotte, NC

Query: Mac-Based Podiatric Billing Software

I am currently looking for new podiatric billing software. I have been using a Mac-based software program, Softeasy by Softfoot since 1990 and have had no support for the last seven years. I am now not able to comply with the new 1500 claim form. Is anyone currently using either dbc or MacPractice programs, if so, please advise as to what you like and dislike about these programs?

Len Sanchez, DPM, Whittier, CA

RE: Podiatric Biomechanics: Was Schuster Right After All? (September 2007 PM)
From: Jeff Root

I was intrigued by an article in the September issue of Podiatry Management entitled “Podiatric Biomechanics: Was Schuster Right After All?” written by John McNerney, DPM. Much of the article was focused on discrediting the theories and practices of Merton L. Root, DPM rather than on explaining to the reader specifically why Dr. Schuster’s theories, where they differed from those of Root, were logically or clinically superior.

Merton Root recognized that any semi-weight-bearing or full weight-bearing cast of the foot resulted in compensatory motion of the foot which lowers the medial arch height. This is one of the reasons why he endorsed suspension (non-weight-bearing) casting. Ironically, the same issue of Podiatry Management contains an article by Doug Richie, DPM and me on this very subject (A Comparison of Negative Casting Techniques) which demonstrates how weight-bearing forces reduce arch height in casting.

A Root-type functional orthosis is an arch support, a forefoot support, and a rearfoot support. It is constructed based on the science of anatomy and the laws of physics. A functional orthosis is an arch support, while an arch support is not a functional orthosis.

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

Editor’s Note: The complete text of this extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=16064&start=1

RE: David Gutierrez, DPM

I was shocked to hear of the passing of David. The profession has lost a superb and compassionate doctor. He had a great sense of humor and was a lot of fun to be around. We just saw him at APMA-National in Philly. Our thoughts and prayers go out to his family.

Joe Boylan, DPM, Ridgefield, NJ

RE: Telephone Inquiry for Nail Care (Ken Malkin, DPM)
From: Multiple Respondents

This intro has always worked for me: “Mrs. Jones, We'd like to see all our patients' visits get covered!...but that’s a difficult question to answer without actually having the doctor see you first. I can tell you that Medicare will pay for you to come to our office for the first time to have Dr. _____ examine and diagnose your feet. If the doctor determines at that time that you have a covered service, based on the rules that Medicare has put in place for foot care, you will be approved for treatment of your nails as well. If you do not meet the guidelines, Medicare determines this to be “a non-covered service” and will not pay for your nail care at your first or future visits. Of course, we'd let you know either way. Our fee for this service is $______. Do you have any questions and would you like for me to make an appointment for you?”

We do not let our initial message get too complicated on the phone; however, will entertain their questions if asked concerning diabetes, “others who don’t have to pay anything”, "the doctor down the street that doesn't charge to do it," secondary coverage, filing claims, etc.) It is always recommended that the receptionist have (memorize) scripts addressing these types of questions to assist them in giving proper and professional responses and avoid fumbling for answers.

Lynn Homisak, Renton, WA, LynnPRT@msn.com

My staff is trained to tell the patient that the doctor has to evaluate the patient as a "new" patient and then and only then can we know if nail care is covered.

Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

These patients are asking to be treated for free, prior to my examination. This is a frequent call, and is usually adversarial if a line of questioning or extended dialogue ensues. I like to keep it brief; I tell my staff to inform them that "First visits to the doctor are always covered by Medicare." You may argue otherwise, but the patients often have some legitimate concern, and only the examining podiatrist can determine class findings.

Having said that, I follow Medicare guidelines very strictly. To a point where many diabetics are non-covered. If you follow Medicare guidelines VERY closely, you can have diabetics qualify for shoes, but NOT routine care. I inform all patients of these guidelines, and whether or not they meet the minimum required class findings.

Many patients stay in my care, follow every 2 months, and happily pay their $50. I monitor my diabetics closely, and if they eventually meet criteria, I bill Medicare and dutifully accept my salary reduction. I have many patients who decide not to continue under my care "out-of-pocket." I am certainly not bragging, as my colleagues have 2 to 4 week waits to get
a new patient in.... and are much busier than I. My practice has suffered in the short run.

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

In my office the staff questions the patients about their status of eligibility (diabetes, blood thinners, PVD, etc). Then we then let them know Medicare allows coverage for nail care in those with certain conditions and that we will be happy to evaluate them in our office and determine if they meet these conditions. We ask if they have seen another physician for this condition, and ask them please try to obtain copies of their records so that we will know what has been tried, etc.

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@Doctorbret.com

ASSOCIATE POSITION- CAPE COD MA

Multi Specialty Group is seeking to add a General Podiatrist to our well established group. Office Locations on Cape Cod. Unlimited opportunities exist for the right Associate. Also available part time (possible early retirement?) DPM. Please forward your CV to duff910@verizon.net

THE PERFECT CHRISTMAS GIFT

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HOME FOR RENT- CABO SAN LUCAS, MEXICO

For rent: 2 bedroom-3 full bath fractional home on the Sea of Cortez at Grand Regina Westin, Cabo San Lucas, Mexico. Week of December 29, 2006 until Jan 5, 2008. Sleeps 8, full kitchen with washer and dryer. Outside balcony with hot tub overlooking the water. Ideal for family vacation. $5000. Photos available. Contact Amogreg@aol.com

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.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

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

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