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October 29, 2011 #4,292 Publisher-Barry Block, DPM, JD

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WesternU Students Participate in Cadaver Farewell Memorial Service

Western University of Health Sciences students paid their respects to Willed Body Program donors and their families, a gift that left an indelible impression on their early health sciences education. The student-sponsored Cadaver Farewell Memorial Service on Oct. 26, 2011 at WesternU honored 51 donors, including nine veterans who were recognized with a flag presentation and the playing of “Taps.” First-year College of Podiatric Medicine student Mark Graeber ’15, compared students to the lower lights of a lighthouse -- the smaller lights below the main beam used to guide vessels back safely to harbor at night.

Mark Graeber at WestenU Cadaver Memorial Ceremony

 “All of us are going to be entering a health profession, and we will all be responsible for the safety and the very lives of the patients we are given. This is a tremendous privilege and an honor for all of us,” he said. “Because of the generosity of those who donated themselves as their last gift to people, they have played an enormous role in saving the lives of many. They’ve given us a gift of knowledge, a gift of education, a gift of understanding, and I don’t think there really is a way we can show enough gratitude for this. I think the simplest way is just to say thank you to all those people who donated themselves to us.”

ACFAOM Announces Newly Elected Officers

The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) has announced the following newly elected officers at its Annual Membership Meeting held October 27, 2011 in Orlando, Florida:

(L-R) Drs. Kirk Geter, Kathleen Satterfield, Robert Marcus, and Stephen Albert.

President: V. Kathleeen Satterfield, DPM
President-Elect: Stephen F. Albert, DPM
Treasurer: Daniel P. Evans, DPM
Secretary: Jason Harrill, DPM
Board of Directors: Coleen Napolitano, DPM, Scott Spencer, DPM
Immediate Past President: Kirk Geter, DPM
Retiring Secretary: Robert Marcus, DPM
Executive Director: Norman Wallis 

Most Docs Would Limit Access Under SGR Cuts: Survey

Just 16% of physician practices would maintain current levels of access to Medicare-backed care if physician payments fall 29.5% as scheduled on Jan. 1 under the sustainable growth-rate formula, according to an analysis of online survey responses by the Medical Group Management Association.

The survey responses indicate that 51% of practices would reduce available appointments for new Medicare patients if the statutorily mandated SGR cuts go through, and 33% expressed uncertainty about how the cuts would affect their Medicare patients. MGMA conducted the unscientific survey from mid-September through mid-October and received responses from more than 2,176 practices.

Source: Paul Barr, Modern Physician [10/24/11]

Query: Billing for Multiple Head Resections

Our doctor performed multiple metatarsal head resections for a patient with severe rheumatoid deformities. The operative report notes that he resected metatarsal heads, 2-5, and then fused the 1st metatarsal-phalangeal joint. The resections are of the metatarsal heads only, and not of any bone from the proximal phalanx base.

We were told that we should bill the metatarsal head resections as CPT 28114 (ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal [e.g., Clayton-type procedure]) along with the fusion of the 1st MPJ. Our doctor feels this is not correct because he did not resect the proximal phalanx bases per the code description. He feels the procedures should be billed as CPT 28112 x3 and CPT 28113 x 1, along with CPT 28750 (1st metatarsal-phalangeal arthrodesis). Which is the correct way to bill this?

Response: The billing for each metatarsal and fusion of the 1st metatarsal phalangeal joint is a more accurate reflection of the surgery performed. CPT specifically includes the bases of the proximal phalanx in the CPT 28114 description. Bill each metatarsal head resection and the fusion separately.

Howard Zlotoff, DPM, Camp Hill, PA

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RE: ACell (Saera Arain-Saleem, DPM)
From: Richard Gosnay, DPM

I have found Acell to be an extraordinary advancement in the treatment of wounds. When I was told that it could be used to granulate over exposed tendons and close the wounds, I was skeptical. It did. I told the sales rep, "We just grew grass on concrete."

Dr. Arain-Saleem is the surgeon who is going to be responsible for that bunionectomy. If that patient does not trust Dr. Arain-Saleem's judgment and technique, then she should be encouraged to find another surgeon whom she does trust. In this Oprahfied society of info-tainment, I occasionally have an arrogant patient who wants to tell me how I am to operate. And I cheerfully encourage such a patient to find another surgeon.I have a good imagination, but I cannot come up with a plausible use of any advanced wound closure product for an elective bunionectomy. But the larger issue in this question is the patient who wants to dictate to the surgeon how the procedure is to be done. I believe that we must respect the patient's wishes when it comes to goals and expectations, but I would never allow a patient to tell me how I am to perform any procedure.

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

RE: SuperGroup Formation In Maryland (Ira Baum, DPM)
From: Robert Kuvent, DPM

With all due respect to Dr. Baum and his comments on Supergroups, he may not be looking at the big picture. Negotiating today's insurance reimbursement is only one small part of what we hope to achieve with our AZ Supergroup. We plan to create an entity with superior care and excellent wealth generation for its owners. We will achieve this through various economies of scale and the ownership of revenue producing ancillary services. We will also be well positioned for whatever changes are coming - specifically ACOs.
 
Robert Kuvent, DPM, Chandler, AZ, FtFixr@gmail.com

I don't understand the thought process of some of my colleagues. In a recent posting, Dr. Bijak states, "There is no particular glory in cutting a toenail or grinding an arch support. Be a doctor and delegate, and then you'll get respect." There are many instances where I help elderly patients put on their socks and shoes - I don't delegate this. I see this as an opportunity to do a good deed. 

RE: Defendant's Experts Deserve a Medal (Pete Harvey, DPM)
From: Bryan C. Markinson, DPM

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