The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 14, 2009 #3,674 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Rocker Bottom Shoes Limit Normal Motion in the Foot: IL Podiatrist

"Rocker-bottom shoes are not new," says Marlene Reid, a podiatrist in Naperville, IL, and spokeswoman for the American Podiatric Medical Association. But in the past, they were sold as therapeutic footwear for people with medical problems, including arthritis in their feet, she says.

Dr. Marlene Reid

Reid says the shoes might help people who stand for long hours or need to improve posture. But she worries: "The shoes limit normal motion in the foot. So you may be under-using some muscles and overusing others." She also notes that shoes requiring good balance might make some people fall.

Source: Kim Painter, USA Today [10/12/09]

OCPM Hosts 5th Annual Residency Fair

Recently, the 5th annual OCPM Residency Fair welcomed 44 residency programs from 14 states. Approximately 215 OCPM students, including 105 third-year students attended the fair.
 

Students at OCPM Residency Fair

The fair served as an excellent opportunity for students to explore options for post-graduate studies, specifically residency programs and clerkships. Representatives of residency programs gained exposure by promoting their programs and interacting with a new population. Many of the representatives were impressed by the level of interest and knowledge possessed by OCPM students. Several residency representatives commented that they looked forward to the fair because it is well organized and a beneficial investment of the program's time and money.

NY Senator Calls for State Ban on Pedicure Fish

It’s a practice popularized in parts of Asia that has made its way into salons here in New York State. Fish pedicures, as they’re known, involve the aid of small fish to eat away dead skin from the feet. The practice was first brought to the US by a Virginia spa last year. But State Sen. Jeff Klein (D-Bronx) calls the practice unsanitary and inhumane, and unveiled legislation Monday that would ban the practice throughout New York. Other states have enacted heavy restrictions and bans on the practice.

Dr. Dennis Arnold

The late Dennis Arnold, a podiatrist who headed the International Pedicure Association, told the Associated Press last year he doubted the practice would become widespread, adding that he thought most people would be afraid of it.

Klein’s office said the use of fish can spread fungal and bacterial infections. Some fish used in the practice can grow teeth and bite hard enough to draw blood, according to the office. Klein’s investigation also found the fish used have to be partially starved because they don’t eat dead skin under normal circumstances.

Source: Chris White, WRGB-TV [10/12/09] 

Reform Measures Would Hike Premiums: AHIP Report

The Senate Finance Committee's reform package would more than double premium costs over the next decade while doing little to tamp down the overall cost of care, according to a new report by PricewaterhouseCoopers and sponsored by the insurance lobby. Backed by America's Health Insurance Plans, the report says the average American family's premiums would rise to $25,900 by 2019 from the $12,300 it pays today. Individuals would see their premiums rise to $9,700 from $4,200.

AHIP President and CEO Karen Ignagni said that as written, the committee's bill would make coverage less affordable “for individuals, families and employers,” and ultimately drive up costs faster than if the system were left untouched. “I think Congress too early gave up the goal of bending the cost curve,” Ignagni told reporters in a conference call.

The report cites four main provisions in the bill that would increase the cost of coverage, including insurance market reforms paired with a scaled-back coverage mandate, a new tax on high-cost health plans, cuts in Medicare payments and new taxes on medical devices, pharmaceuticals and other health-related industries.

Source: Matthew DoBias, Modern Healthcare [10/12/09]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky:  Would you be in  favor of an MD degree for new podiatry graduates?

Dr. David Armstrong

David Armstrong: Yes, I would. I would absolutely because I do not think the degree defines me anymore than it should define you or anyone listening, or any of my colleagues. But when someone has to take so much time to explain what a specific degree entails, that just takes time from what we could be doing, which is helping people. So, my take on this is that I love this profession, but I do not think we are defined by a degree. I think we are defined by how we take care of people, and I think our profession is bigger than that.

Dr. Steven Subotnick

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is Steven Subotnick, DPM,  author of the Running Foot Doctor. You can register for this event  by clicking here

Query: RFC and Box 19 

NGS Medicare requires NPI and the approximate date when the beneficiary was last seen by the MD/DO or qualified non-physician practitioner who diagnosed the complicating condition to be reported in Box 19 of the CMS-1500 claim form or electronic equivalent. Previously, we used Box 17 (name of referring provider), 17a, 17b (NPI). Why was this change necessary? Where else do other Medicare carriers require this information?

Michael Fein, DPM,Bethel, CT

Response: This new requirement is, as far as I know, unique to NGS. I know that the New York State Podiatric Medical Association is aware of this change, and is looking for the answer to your question ("Why was the change necessary?"). Since Connecticut and New York both have NGS as their Medicare contractor, it would probably be a good thing for you to contact the CPMA, and have them also press NGS for an answer.

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Life Expectancy of Swanson Implant (Nathan Schwartz, DPM)
From: Lowell Scott Weil, Sr., DPM

There is no literature that I am aware of on the "life expectancy for the Swanson 1st MPJ, double-stem, no grommets implant"  other than retrospective papers and anecdotal reports. My experience of 39 years of implanting Swanson Implants; single stem (base); Angled toe (base); Hinged toe-double stem; no grommets (we were a research site for these at Northlake hospital in the early 70's); and finally Double Stem, Hinged Toe with grommets has led me to believe that there were three rules that made the difference.

1. Patient choice - initially these implants were commonly used for "arthritic or subluxed  hallux valgus" and in my opinion, this is where the problems developed. The indication for double stem implants should be hallux rigidus with a normal IM angle in the appropriate patient.
2. The grommets "seemed" to make the difference in the life of the implant. However, discussion with Bruce Lawrence, DPM revealed that his vast experience using the Lawrence implants without grommets had a similar survival as my experience with grommets.
3. For every 90 hinged-toe implants, with grommets that we implant, we remove or replace 1 or 2 (We may not be seeing ALL of our failed implants).

Hinged toe implants remain a viable procedure and I recommend the use of grommets.
 
Disclosure: I am a consultant for Wright Medical and Tornier Orthopedics
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

RE: Message from a Fulbright Scholar (Leonard A. Levy, DPM, MPH)
From: Robert Chelin, DPM

On behalf of the global podiatry community, I would like to congratulate Dr. Levy on being the first podiatrist to receive the Fulbright Scholarship. As Dr. Levy said, the globe is shrinking, especially when it comes to communication and educational sharing. It is imperative that we must elevate the level and status of our profession worldwide for its global recognition. We must also address the issue where there is no presence of podiatry in countries like Africa and India, and to deal with the impending epidemic of diabetes.

If podiatry does not fulfill these shortfalls, other health disciplines will do it for us. The newly formed FIP, International Academy of Podiatric Educators (APME) has been established to address this and the many other educational issues that affect out practitioners, globally. Since Dr. Levy was on the initial working group that established the FIP International Model of Podiatric Medicine, I am sure his continued involvement in the Academy will be the catalyst for further change.

Robert Chelin, DPM, President, FIP, ft-biz@rogers.com

RE: Internet-Based EMR Storage (Tamara Allen, DPM)
From: Zac Childress
 
Off-site backup of your data is an important part of your information technology plan. What the end-user of programs like Carbonite and Mozy needs to understand is that the low-cost versions of these programs will not back up SQL and other file types that are open.  When they come to a file that is open, it gets skipped. Even if you don't have the program in use, the database could be running on the server machine. Unless you have made some other arrangement for an internal backup file to be created, these types of programs could skip your EMR and Practice Management software files, negating your back-up efforts. The higher end or more expensive versions of these products often make allowances for open files. Make sure your computer support department understands this. The consequences could be disastrous.
 
It is true that a properly implemented off-site, back-up lessens the need for external drives or flash drives. However, in the event of a hard drive or server crash, a copy of the data can be restored from the local drive quicker than having to download several gigabytes worth of data from the off-site service.  
 
Zac Childress, zac@godarwintech.com

RE: Qualifying Routine Foot Care (Greg Amarantos, DPM)
From: Multiple Respondents

I hope everyone getting PM News takes the time to read Dr. Barry Mullen's wonderful post from a couple of days ago, and I just hope APMA is listening. We all need to get RFC out of anyone's definition of care. It is time.

Richard Rees, DPM, Bellair, TX, richardrees47@msn.com

The routine foot care issue has become prominent lately on PM News. This is a cyclical situation that rears its head every few years when some of us feel threatened economically and we are forced to realize that a large clump of our practices depend on these services, regardless of our pronouncements that they do not. In 1987, I wrote the famous “An Epitaph for the Term Routine Foot Care.” It is as useful today as it was then, in spite of the fact that nothing has been accomplished on this front. Blaming the APMA is useless, as the routine foot care prohibitions are embedded in the Social Security Act creating Medicare, not in CMS guidelines. It will actually require an act of Congress, much like the Title XIX matter, to ever get reasonable change to these outrageous guidelines and discrimination against the footsore.  

Bryan C. Markinson, DPM, NYC, NY, Bryan.Markinson@mountsinai.org

While we're on the subject of routine foot care and Medicare coverage (which is a 40 year old problem we've been dealing with), what about orthotic coverage? Please explain to me why there is anything in our armamentarium of services that should be deemed "non-medical" or "not medically necessary." It's an absolute outrage that essential, prudent preventative services are not covered.

How much pathology could we prevent if decisions to provide services were left to our own medical judgment? Medicare won't pay for services provided simply for the "comfort" of the patient. Shouldn't gastroenterology services then be non-covered for the medical treatment of gastric ulcers which are provided for the comfort of the patient. Should dermatology services be covered for eczema when they only provide a decrease in the uncomfortable itch? Why cover treatment of migraines? Why do all of these patients need to be kept comfortable? Come on! This is simple prejudice in its worst form.

Kudos to all of our colleagues who are mobilizing to speak out against the nonsense. It is not acceptable to operate on the insurance forms to get your patients covered!! Let's do this right. The time is now. 

Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com
 

RE: Obama’s Healthcare Plan 
From: Stephen Peslar, BSc,DCh

As a Canadian, I can make many comments about how the Canadian Medicare system works and about the times (not excessive) my family and I have had to wait for treatment. I would rate the Canadian Medicare system at 8 out of 10.
 
One example, if a treatment or diagnostic test is medically necessary, then I will receive it at no cost. I have seen patients with MRIs done on their feet and their total charge was 0. The MRI was ordered by their MD, but they did wait a few weeks to have the procedure done. If it was an emergency or stat situation, the wait would be an hour or less depending on why the info is required by the attending physician at the hospital or in the ER.
 
For anyone with time, you can do a little research with a search engine and read an extensive report about the advantages and weaknesses of the Canadian healthcare system. Put Building on Values: The Future of Health Care in Canada or Romanow Report into your favorite search engine. You will find the original report and a number of comments about it. This may give you a better understanding of how Medicare functions in Canada. I can add that the report was published in November 2002, and to date, not all of the recommendations have been fully implemented by the federal or provincial governments. 
 
Stephen Peslar, BSc,DCh, Toronto, Canada, pezpied@hotmail.com

ASSOCIATE POSITIONS - INDIANA/OHIO

• 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.