The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 17, 2009 #3,677 Publisher-Barry Block, DPM, JD

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AAPSM Hosts A Day of Sports Medicine at OCPM

Recently, the American Academy of Podiatric Sports Medicine (AAPSM) offered A Day of Sports Medicine, a continuing medical education program, in conjunction with the Ohio College of Podiatric Medicine (OCPM) at the new OCPM campus. The program was attended by OCPM students as well as several podiatrists from Ohio, Pennsylvania, and North Carolina. 

Howard Dananberg, DPM of the AAPSM presents at A Day of Sports Medicine.

A Day of Sports Medicine was presented in OCPM’s newly completed classroom, the H. Darrel Darby, DPM Lecture Hall. OCPM welcomed speakers Stanley Beekman, DPM; Howard Dananberg, DPM, Patrick Nunan, DPM; Bruce Williams, DPM; and Jamie Yakel, DPM. At the end of the program, AAPSM awarded a $1,000 Robert Barnes Memorial Student Scholarship to Corry Appline, the Vice President of OCPM’s AAPSM student chapter.  
 

AZ Podiatrist Named President of AENS

Richard Jacoby, DPM, President of Valley Foot Surgeons and the Scottsdale Neuropathy Institute, was named the 2010 President of the Association of Extremity Nerve Surgeons (AENS) at the organization's 7th Annual Scientific Symposium in Fort Worth, Texas.

Richard Jacoby, DPM

"It is a tremendous honor to lead the AENS and its members into the next year," Jacoby said. "My goal as President for 2010 is to further the work of Dr. A. Lee Dellon in conquering diabetic polyneuropathy. We are embarking on multiple different research projects that should produce major breakthroughs in the next year."

IN Podiatrist Warns Others of Tax Relief Scam

A local doctor says he fell victim to a tax scam. He’s sharing his story to try to keep it from happening to other people in a similar situation. The website for a company called American Tax Relief uses a celebrity to make it seem legitimate, and even has a link to commercials that have aired on TV. Those strategies are drawing in people from all walks of life.

Dr. Clinton Scott, Jr.

Clinton Scott, Jr. is a local podiatrist. He says he's a hard-working man, but through honest mistakes, he fell $23,000 behind on his taxes. “Basically, they’re saying that you can reduce your taxes,” he said of American Tax Relief. “Not only will [they] get rid of the penalties, [they’ll] get rid of the interest,” he said of the companies promises.

So, when Scott saw a TV commercial for American Tax Relief and thought the company's website looked legit, he gave it a try. They said, "We can do it for $4700,” he recalled, showing WSBT his paper trail with the company. Scott said he paid them and also sent dozens of important financial documents like his stocks, bonds, bank and credit card statements. But when the company said it didn't get his information in a timely manner, Scott showed another request from the company for $3,000 in additional fees. That’s when he said he knew something wasn’t quite right.

Source: Kelli Stopczynski, WSBT [10/14/09]

OH Podiatrist Debates Cincinnati Mayor

Democratic incumbent Mayor Mark Mallory and his opponent, podiatrist and Iraq War veteran Brad Wenstrup, faced off during a debate sponsored by WCPO-TV and The Cincinnati Enquirer.

Dr. Brad Wenstrup during televised debate

"If my opponent is elected, we will see a major loss in experience, and it's experience we're talking about, the ability to lead, the ability to set forth a vision and to bring people together to pull that vision off," Mallory said.

"I think I have more experience than most people in politics have, especially if they've spent their whole life in politics. I've been a business owner for 23 years and I ran my own practice for 12 years," Wenstrup said.

Source: WLWT.com [10/13/09]

Senate to Consider Dumping SGR Formula

The Senate, next week, is set to consider a measure that would effectively wipe out the Medicare physician payment formula, reversing years of threatened cuts and clearing the way for a new reimbursement structure.

The American Medical Association, the American College of Surgeons and about a half-dozen more physician groups met with Senate and White House leaders to lend their support to a measure being pushed by Sen. Debbie Stabenow (D-MI).

Under her proposal, the sustainable growth-rate formula—which annually calls for steep, double-digit physician pay cuts—would be replaced with a new formula being implemented at some point, according to a source who attended the meeting. Erasing the SGR would add about $240 billion to the deficit over the next decade, giving some lawmakers pause.

Source: Matthew DoBias, Modern Healthcare [10/15/09]

Query: Treatment for Saprophytic Fungi Onychomycosis

I have a 30 year old female patient with Fusarium in one toenail. She failed one course of Lamisil, and topicals, and the new nail was re-cultured and positive for the same organism. The nail continues to lyse with each new growth. Does anyone have any other suggestions? Sporanox was not indicated for these organisms.

Laura Lefkowitz, DPM,  Beverly Hills, CA
 

Query: PICA Distribution Check

How will the distribution check to all podiatrists be treated? Will it be a long-term capital gain, short term gain, return of equity, or something else?

George F. Jacobson DPM, Hollywood, FL

Editor’s comment: PM News does not provide legal advice. According to PICA, over 95% of recipients supplied them with a W-9 as requested and will receive a 1099. This income is reportable as a long-term capital gain. PICA withheld money from those who did not supply the W-9. This income is reportable as ordinary income for 2009. These individuals can submit additional material to the IRS to recoup the withheld money.

Query: Ankle Gauntlet L1902 Coverage

What is the criteria is under Medicare for coverage for L1902 (AFO, ankle gauntlet, prefabricated, includes fitting and adjustment)? Is this a payable service by Medicare? What diagnosis codes are typically associated with this device?

Robert Lee, DPM, Westwood, CA
  
Response: L1902 is covered if your medical necessity documentation conforms with that listed in the LCD. From a coding perspective, you must use the "KX" modifier (use of this stipulates you have the met documentation requirement in the LCD), and either an "RT" or "LT" modifier.

Diagnosis codes are too numerous to list here. Some diagnostic examples would include ankle instability and ankle sprain. 
 
Paul Kesselman, DPM, Woodside, NY

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RE: Cryoablation for Plantar Fibroma (Greg Caringi, DPM)
From: Steven Goldstein, DPM

Although we have had some personal correspondence, the FDA 510K approval is for peripheral sensory nerves. I then can conclude its use on plantar fibromas is off-label. If you type “cryosurgery” into a search engine like Google, it brings up that its number one use was for prostate cancer tumors. To my knowledge, I was the first to use it on plantar fibromas, and I have trained many others who purchased a Cryostar or Cryopac from Cryomed or Cryotec LLC. The results were fascinating, as many large fibromas would eventually disappear or become asymptomatic over a 2-3 month period. Maybe some of my fellow cryosurgeons could expand on what they have found with their treatments.

Steven Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

The Cryostar is not FDA approved for fibroma and there is really no research. There are a few articles written by pods but they are more case histories and provide little information. So, it is off-label. I have performed a number of procedures, but would not go out of my way to use the Cryostar for this application. Cryoablation for the foot is best for death of nerve tissue. Cryo is being used to freeze tumors in the liver and in prostate applications; however this is a totally different unit. Also, it is not covered by insurance and would be a cash procedure.
 
If you do use cryo for fibroma, I would recommend that you carefully review the anatomy. I have received a number of calls from Drs. and lawyers, with reports of significant damage to the medial and lateral plantar nerve during fibroma freezing. This is a significant complication, so I recommend the use of Doppler ultrasound to clearly visualize the neurovascular structures.
 
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Evidence-Based Medicine
From: Patrick J. Nunan, DPM

In the Cincinnati paper this week, there was an article about a high school male who was born with a rare disease in which many of his facial bones did not form. So, the surgeons at Children's Hospital used a new and experimental technique using cadaver bone, his own bone, stem cells and several other implants to reconstruct his facial bones. The surgery was a success, so now they will start clinical trials. You see, these doctors remembered one important thing, we treat people, not statistics, not evidence, not what the insurance will approve. 

Sometimes we have to think outside the box. If this had been my child, I would not have worried about double-blind studies, is it evidence-based, does it stand up to scientific review. The bottom line is it worked. They knew the risks, yet the doctors treated the patient. Yes, we do have to have some standards, but we also can't paint ourselves in a corner. Creative thinking is what has lead to many scientific discoveries. 

Patrick J. Nunan, DPM, West Chester, OH, pjndpmrun@aol.com

RE: Routine Foot Care
From: Ronald D. Jensen, DPM

I have watched with interest the postings on Routine Foot Care (RFC) and I would like to respond to the several requests for APMA action that have been posted.  APMA deals with billing and reimbursement issues on a daily basis that relate to all aspects of the practice of podiatric medicine and surgery. Among the issues commonly addressed are challenges to the provision of “Routine Foot Care”.

APMA prefers the term “At-Risk Foot Care”, however, the term “Routine Foot Care” as well as the restrictions that exist for the provision of RFC were created by an act of Congress, and yes it would take an act of Congress to make changes. In today’s political and economic climate, I doubt that any requests for changes to RFC would result in increased reimbursement or decreased regulation. Regional differences in RFC exist because Congress intentionally allowed the Medicare Administrative Contractors to “interpret” the Medicare Guidelines for all types of treatment from head to toe in an effort to find cost savings related to the provision of medical care.

Over the years, APMA has held multiple meetings with HCFA and CMS officials bringing in other APMA staff, board members, committee members, attorneys, Guild representatives, lobbyists, health policy consultants, and other physicians. This activity has been particularly intensive over the last 6 months, and next week APMA will once again meet with CMS in an effort to resolve the continuing concerns we all share. Meetings of this type are difficult to arrange with CMS, and occur only after months of hard work by your fellow APMA members who volunteer their time with the direction of APMA staff to help defend our ability to practice.

Each state has nominated a Carrier Advisory Committee (CAC) representative to help address issues related to Medicare, and APMA is one of only a small handful of organizations that has organized its CAC members on a national level. This weekend is the annual meeting when the CAC representatives share ideas and are educated on the resources that APMA provides to empower the CAC representative to better serve you. Contact your CAC representative and take advantage of their knowledge and experience when difficulties arise.

I would encourage everyone to take advantage of the many resources that APMA has created to help improve your practice. I would also ask you to read the communications from APMA that we use in an effort to notify our members of critical developments on this and many other issues.

Ronald D. Jensen, DPM, President, APMA, rdjensen@apma.org
 

RE:  The Science Behind Orthotics (Robert Bijak, DPM)
From: Mr. Jeff Root

Robert Bijak, DPM wrote: “The medical community and the insurance companies realized long ago the weak science behind orthotics. They literally weren't buying it. This stands the murky alchemy of podiatric biomechanics on its head and rightfully shows if we are to be doctors, let's let this type of treatment return to C. PEDS and shoe salesmen.”

On the Podiatry Arena’s forum, in response to an inquiry from another podiatrist about whether a pediatric patient should continue or discontinue use of his orthoses, Dr. Kirby wrote: “Treat the boy with over-the-counter orthoses with heel lifts initially and have the boy start gastrocnemius and soleus muscle stretching 3 times a day and always have him wear shoes with no barefoot walking/running since the rest of his complaints are most likely mechanical in nature, until proven otherwise”. 

On September 17, 2009, in response to Dr. Kirby’s recommendations, Dr. Bijak wrote: “Treating as you say without laboratory investigations and X-ray 's is negligence in my opinion.”  Dr. Bijak’s is completely contradicting himself as to whether foot orthoses are medical devices or not. If dispensing prefabricated foot orthoses may constitute medical negligence, then why would Dr. Bijak advocate having C. Peds and shoe salesmen take over foot orthotic therapy?

Mr. Jeff Root, President, Root Lab, www.root-lab.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

ASSOCIATE POSITION - AUSTIN AND SAN ANTONIO AREAS

Seeking well-trained ABPS board certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - MANHATTAN, KANSAS

Seeking full-time associate to start January 2010. Will start with full schedule. Must be dependable, honest, ethical individual. E-mail CV/resume to: mtrandpm@cox.net

EQUIPMENT FOR SALE - MINXRAY P200R24 X-RAY UNIT

Unit was bought brand new in 2003 and, in April 2009, we stopped using it because another doctor joined the practice with an extra x-ray machine. Asking for $4K, OBO. Pictures are available. E-mail: mtrandpm@cox.net

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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