The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 12, 2011 #4,277 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2011- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

TX Podiatrist Discusses Hallux Rigidus as a Surgical Complication

Although bunion surgery has advanced in the last decade, some complications do occur, according to Dr. Ed Davis, a board certified San Antonio podiatrist. Pain and loss of range of motion in the big toe joint may be associated with a bunion but is more often termed "hallux rigidus" in which long-term joint misalignment leads to the big toe joint "wearing out."  

Dr. Ed Davis

There are four recognized stages of hallux rigidus based on severity. The first two stages can often be treated non-surgically. There are many good procedures to treat the more severe stages of hallux rigidus and the surgeon should present all reasonable alternatives. Fusion of the big toe joint is often utilized but, in the opinion of Dr. Davis, iit is overutilized, There are advanced procedures to restore normal range of motion using cartilage repositioning or joint implants.

Source: KLFY Eyewitness News [10/10/11]

IL Podiatrist Sets Healthy Example for Patients

Healthcare professionals are human too. They might counsel patients to live a disciplined lifestyle, but sometimes they skip workouts, order dessert, and postpone annual checkups — just like the rest of us. We asked a variety of Chicago-area clinicians: What is the one habit they treat as sacred and what do they wish they did more consistently? 

Dr. Stephen Weinberg

Stephen Weinberg, DPM is a doctor of podiatry medicine, at the Weil Foot and Ankle Institute Chicago and North Shore, and an Adjunct instructor at the Chicago Medical School. Non-negotiable health habit: "Walking or jogging one hour a day, no matter how I get it in. I've been a runner since the late 1970s, but when I don't have time, I walk my dog three or four times a day. It's all about maintaining movement."

Source: Bonnie Miller Rubin, Chicago Tribune [10/12/11]

NY Podiatrists Participate in Pancreatic Cancer Research Walk

Sue’s Crewsers, a team headed by Dr. Arthur Gudeon participated in the Lustgarten Foundation Pancreatic Cancer Research Walk for the Cure at Jones Beach on Sunday morning. The team walked in support of Gudeon's wife, Sue who was diagnosed with this disease 14 months ago. 

Drs. Andrew Shapiro and Arthur Gudeon

Among those participating were Dr. Andy Shapiro, his wife Marsha and kids Marin & Griffen, Dr. Tracey Che, friends Fred & Audrey Weiler, Dr. Artie Gudeon and Sue, daughter Andrea (Gudeon) & friend Neal. Donations to Dr. Gudeon’s team for PC research from the walkers and other supporters have totaled well over $10,000.

FL Podiatrist Presents Consensus On Treatment of Diabetic Foot Ulcers at Dubai Conference

Dr. Robert J. Snyder, a wound care specialist and Professor and Director of Clinical Research at Barry University School of Podiatric Medicine recently presented the results of the "Consensus Recommendations on Advancing the Standard of Care for Treatment of Neuropathic Ulcers in Patients with Diabetes" to 700+ physicians, podiatrists, and nurses representing various regions of the UAE. 

Dr. Robert Snyder in Dubai

The symposium entitled the 2nd International Diabetic Foot Conference was held in Dubai. "Complications relating to diabetes represents a serious problem in this part of the world where one in four individuals suffers from the disease. It was an honor and privilege to lecture at such a prestigious conference," said Snyder. Dr. Snyder also facilitated at several workshops and lectures on diagnostics in wound care.

Medicare Tests Monthly Incentives for Innovative Primary Care

Medicare will partner with private insurers to offer physicians patient management fees and the opportunity to share savings under a primary care payment initiative led by the Centers for Medicare & Medicaid Services. Participating practices will receive an average of about $20 per patient per month to coordinate quality care for Medicare and private patients.
 
The Comprehensive Primary Care Initiative is a new collaboration between public and private payers to strengthen primary care, CMS officials said during a Sept. 28 news conference. The Center for Medicare & Medicaid Innovation is inviting insurers to join government health plans in trying a new approach to paying for primary care starting in 2012.

Source: Charles Fiegl, amednews [10/10/11]

A Simple Way to Track Accounts Receivable

Here's a simple way to review all explanation of benefits (EOBs) in your office after they have been processed. When your billing people enter checks into the computer, have them circle the amount they are processing and write a #1, #2, or #3 next to it. 

• #1 means that the insufficient or non-payment is being "written off."
• #2 Means that the co-payment or deductible was paid when the patient was in the office.
• #3 indicates that the patient is being billed.

This gives a bird’s eye view of what you are getting paid by different insurers, shows if co-pays are not being collected, if wrong amounts are being billed to patients, and if incorrect amounts are being written off, or appeals are not being made. 
 
Source: Hal Ornstein, DPM, Howell, NJ

Query:  "GY" or "GA" Modifier?

What modifier is correct when billing Medicare or DMERC for a non-covered service when you want to generate a "PR" (patient responsibility) denial? I have tried the "GY" which is what I thought it was, and did not get a "PR" denial. I have also tried the "GA" modifier. Is one of these correct, or is there another modifier that should be used?

Dawn Mariano, Shelbyville, KY

Response: It is my experience that if the service is statutorily non-covered, you do not need a modifier. You would just bill the code, and it will automatically show "patient responsible".

If you need the claim to show that the service is non-covered because of a specific circumstance, have the patient fill out an advance beneficiary notice and use the "GA" modifier on the code (ABN on file).

Shari Lee, Office of Bryan Davies, DPM, Columbia, SC

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: The Passing of James Revelas, DPM

I am writing this e-mail with a heavy heart. I did my surgical residency with Dr. James Revelas in Youngstown, Ohio (1987-1988). I am shocked and saddened to learn of his passing. My heartfelt sympathy to his family, staff, and patients. Rest in peace, Jimmy.
 
Rich Hofacker, DPM, Akron, OH

RE: Plating System for Fractured 5th Metatarsal
From: Carlos A Rojas, DPM, Carlos A Rojas, DPM

Which plate to use (particularly for this case) does not seem to me as the major component of your pre-operative planning; the medical and social history together with an uncertain post-operative compliance period seems to me of more concern. The major drawback of this fracture is how distal it is. For plate ostheosynthesis, you need more area for cortical fixation of your distal fragment. I have successfully used small low profile plates from Stryker’s Foot Solution tray from Ascension Orthopedics’ Total Foot System tray. For a distal fracture with a spiral component like this, an alternative suboptimal approach is intramedullary pinning with cerclage wire. I do not recommend a minirail system for this particular fracture pattern. I would also consider an Exogen bone growth stimulator from S&N and would definitely reconsider your original weight-bearing recommendations.

Carlos A Rojas, DPM. Miami, FL, crojavec@yahoo.com

I have to add a different thought process to your fracture management plans. In this patient, I think you should stay away from surgery at almost any cost. A smoking neuropathic DM patient who you know is going to go to work is by definition non-compliant and a high risk for failure. When this fails and is an open bone and hardware case, what will you do then? I would put him in a compression stockinette and a high-top CAM walker boot, and instruct him to have his other shoe sole height modified to be equal in height to the CAM walker. I would also see about putting him in a bone growth simulator daily due to the co-morbidities. Looking at the position of the 5th met, it is a bit radical for where an aggressive tailor's bunion surgery might be, but probably would not be a long-term problem for him. If it were a problem after all is healed and done, then when his health and work responsibilities could be optimized, an elective procedure could be considered. DM, BMI, and smoking cessation counseling should also be part of your treatment plan. 

Andrew Levy, DPM, Jupiter, FL, rcpilot48@gmail.com

RE: Painful 1st MTPJ (Brian Timm, DPM)
From: Jeffrey Kass, DPM

After reading all comments on this topic, I feel that all prior advice was practical and logical, but of all the x-ray views, a DP and lateral would have been the more important choices. In cases of hallux limitis, the disease process progresses. It is entirely possible and often happens that either the base of the proximal phalanx or osteophyte to the dorsal first met head will fracture off. In theory, this joint mouse or fracture fragment can be the structure causing the painful crepitis.

My question to those who responded that they would offer a Youngswick or any other procedure other than the fusion is: have you guys had cases of crepitus being present that you didn't fuse, and post-op the crepitus wasn't there? Was increasing the joint space and subchondral drilling successful for you?

It was interesting that none of the readers suggested removing the cartilaginous defect and replacing it with a "plug", ala an Oats procedure. I think that the fusion, as Dr. Timm stated, is the best choice for the reason that there is crepitis, and it gives a predictable result. Finally, many studies in the literature reveal that active people are able to keep to their activities post-op.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

RE: Is Podiatry Turning Away from Biomechanics? (Jeffrey Kass, DPM)
From: Michael Turlik, DPM

As a 25 year full-time clinical faculty member and administrator who once chaired a biomechanics department, I feel uniquely qualified to comment on this subject.

“If only we had a better formal biomechanics curriculum and quality instructors, we could transform podiatric students into lifelong biomechanics learners.”

Podiatry students are adult learners and the fundamentals of andragogy apply when designing formalized instruction for podiatric learners. Much has been written about the influence of the hidden curriculum on undergraduate medical education. Podiatric education, like medical education, is greatly influenced by the hidden curriculum and fits the andragogy model. The main objective guiding the hidden curriculum in podiatry can be summarized by this statement, “how does this experience help me in obtaining the post-graduate experience I desire?” For non-surgical theory and application, the answer is very little. The majority of podiatry students are interested in obtaining knowledge and experiences which will further their goal of obtaining a desired post-graduate experience as defined by the profession. Some carefully collected data and analysis may be better than any opinion on this topic.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

SPACE AVAILABLE - NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

EQUIPMENT FOR SALE - ULTRASOUND, CRYO-PAC, FLOUROSCAN

Ultrasound w/printer, Cryo-Pac w/two probes, Flouroscan w/printer. There may be other surgical equipment as well. Please contact Jolene as young_jolene@yahoo.com

PRACTICE FOR SALE - SOUTHERN OH

Busy, well-established, full-time home visit practice. 100% referral-based. Wound care, pain management, routine care & DME’s. Excellent income, low overhead. Great opportunity for husband/wife business team. DPM relocating out-of-state for family. Contact:nanetter@zoomtown.com

PRACTICE FOR SALE - MOUNT KISCO, NEW YORK

Great opportunity in well-established, turn-key practice (or buy in option available) near Northern Westchester Hospital. Updated office includes four treatment rooms, two private doctor's suites, large waiting room with option to buy co-op. Excellent opportunity for growth. Contact bbrick2@yahoo.com

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA
 
Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480 M per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Priced for quick sale. Real estate available for purchase. Please call 800-983-4194, or e-mailcontactus@podiatrypracticeconsultants.com

ASSOCIATE POSITION  - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA
 
Home of Florida State University. Great university town!  Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION – IOWA CITY AREA

Well-established, rapidly growing practice. Motivated, ethical and personable with well-trained PSR-24/36. Modern office with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package. If interested please email your CV, letter of intent and references to: NHFootDoc@yahoo.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to potential partnership available for a surgeon that is BQ/BC by ABPS. Must be a PSR 24 or PM&S 36 graduate. Salary with bonus. Email CV and samples recent cases done recently to: susmitad86@yahoo.com

SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking associate physician to join practice to cover nursing home facilities. Comprehensive package including Salary, Travel and Bonus benefits. Email cover letter and CV tomelissafoot@pol.net.

ASSOCIATE POSITION - DAYTON, OH

Join a Well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and current photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTH WEST FLORIDA

Full-time associate positions for an established group practice in Southwest Florida. Willing to train the right new graduates. Job will involved all aspects of podiatric care. You must be ambitious, hard-working and should have good people skills. Please e-mail your resume/CV tocontactus@ankleandfoot.net

ASSOCIATE POSITION - NASSAU COUNTY, NY

Podiatrist needed in Nassau county to start immediately. Flexible hours 2 days a week. Please email pittpod@gmail.com with inquiries.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

SEEKING ASSOCIATE POSITION - SUBURBAN DETROIT

ABPS certified podiatrist with several years experience seeking part-time position in suburban Detroit. On staff at area hospitals. Excellent clinical, surgical, and practice management skills. Please respond to michpod@hotmail.com

SELL OR MERGE YOUR PRACTICE - SOUTH FLORIDA

Looking for an exit strategy? If you would like to discuss options such as phasing out, selling your practice, or merging with a larger group in South Florida, please email your interest and contact info to foot369@yahoo.com

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write tobblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.