The Voice of Podiatrists

November 05, 2006 #2,732 Editor-Barry Block, DPM, JD

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Regular Checks of Feet is Common Sense: CA Podiatrist

According to Dr. Loris Yadegarian, D.P.M., who, with fellow podiatrists John Halebian and Thomas Clemente, runs SCV Podiatry Associates, even if you don't currently have a foot problem, getting your feet checked out by the time you're in your teens or early 20s is just common sense.

Dr. Loris Yadegarian

That's because you won't feel the effects of many biomechanical problems at that age, though the damage is being done. Getting pre-emptive care can prevent resulting the back, hip, and knee problems. "Ideally, a pediatrician can catch things early," said Yadegarian. "Lots of common problems are addressable early."

"If you know you have foot problems, it's a good idea to see a podiatrist every year," said Yadegarian. "If you're diabetic, it should be every three-to-six months."

Source: Rachel Stern, Santa Clarita Signal (CA) 11/3/06

10 Year Sentence For MT Podiatrist Sex Felon

A former Missoula podiatrist has been sentenced to ten years in prison. Forty-seven-year-old Bart Holt used the Internet to entice a minor into having sex. He also possessed child pornography. Holt was arrested in August 2005. He traveled from Missoula to Billings, to meet with what he thought was a 13-year-old girl, with whom he had been having sexual conversions over the Internet. Instead, he was met by F-B-I agents.

A subsequent investigation showed Holt's computer contained numerous images of child pornography he had received over the Internet. Prosecutors says Holt also admitted to engaging in similar conversations with a 14-year-old girl in Great Falls. Holt was sentenced yesterday by U-S District Judge Richard Cebull in Billings. The ten-year prison term is to be followed by 15 years of supervised released by 15 years of supervised release.

Source: Bozeman KTVM (MT) [11/3/06]

Enrollment of Undocumented Immigrants' Infants Ends

Under a new federal policy, infants born in the U.S. to undocumented immigrants will no longer be automatically enrolled in Medicaid, the Bush administration said on Thursday, the New York Times reports. The new policy -- part of the Deficit Reduction Act signed by President Bush in February – took effect in July, although some states have not begun to enforce it. The change requires parents to file applications to obtain Medicaid coverage for their infants, and they must provide documentation proving citizenship for the children, who legally are U.S. citizens because they were born in the country.

Source: American Health Line [11/3/06]

Query: Retired Doctor Writing Prescriptions For Family Members

There is a doctor that recently willfully retired from our group and left the state. He is no longer practicing podiatry.It has come to my attention that the doctor that retired removed prescription pads from the office and has been writing prescriptions for family members that are not podiatric related. This has happened several times. I have tried to explain to this doctor that I believe this is unacceptable behavior. I would like to know if this is acceptable behavior.

Name Withheld

Editor’s Comment: PM News does nor provide legal advice. Writing prescriptions for non-podiatric-related conditions is considered professional misconduct. Whether the patient is a family member is generally irrelevant, except in term of insurance reimbursement. Irrespective of whether the patient is a family member, a chart must be maintained for every patient seen. The chart must indicate the prescription and the indication for writing it.

Query: Fentanyl (Duragesic) Patch

Does anyone have any experience with, or currently uses Fentanyl patches for their more aggressive, and potentially more painful podiatric procedures? Being that the active chemical in the Duragesic pain patch is released into the body over a three-day period, is this not a better alternative, and would it not provide better pain management in certain cases? Do the risks (for podiatry) outweigh the benefits?

Charles Morelli, DPM, Mamaroneck, NY, charles@themorellifamily.net

Query: Orthotic Repair Codes

What are the correct CPT codes for repair (supplies and labor) of a foot orthotic?

In the past, we used L4205 (repair of orthotic device, labor component, per 15 minutes), and L4210 (repair of orthotic device, repair or replace minor parts). Are these still valid codes? Do most payers reimburse these codes?

Brennan Reed, DPM, Quincy, IL

Response: L4205 and L4210 are currently still valid HCPCS codes. Whether a particular insurance company plan reimburses them is another story.

I have found in a number of cases that insurers do not cover them. In those cases, the patient would be responsible for payment of repairs (outside the warranty of their orthotics).

Tony Poggio, DPM, Alameda, CA

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

RE: Medicare Fee Reduction
From: Multiple Respondents

Despite continuous efforts for years on the part of APMA and other medical organizations, the US Congress will not alter the arcane SGR formula that is responsible for the Medicare fee reductions. I have been convinced that until physicians begin refusing to accept Medicare, as many do for Medicaid, will we be able to force our legislators to act.

APMA was able to alter the statutes recently so that DPMs can opt out of Medicare. It is a business decision for some and one of ethics and responsibility for others. Regardless, participation rates in Medicare by all physicians has been increasing. In fact, the personnel at CMS and I am sure at all the Congressional offices is very aware that access to medical care is at the highest level ever for Medicare beneficiaries.

Do not expect Medicare fees to rise anytime soon!

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

The 5% cuts in Medicare reimbursement for doctors reflect the powerful insurance and pharmaceutical lobby's ability to deflect cuts in their sector of the health care marketplace. These corporations have reached 52-week highs as we have tightened our belts. Since most HMO's pay a reduced percentage of the Medicare fees (i.e., 80% of Medicare), we are experiencing a never ending across the board cut for "In-plan" services.

Assuming a 50% overhead, an annual 5% cut in collections translates into a 10% cut in profits. In order to continue to provide 100% care with rising overhead, what is Dr. Larkin's (and the readership's) plan to increase practice income in other areas in order to offset the continued lost income of HMOitis?

Dennis Shavelson, DPM, New York City, NY, drsha@lifestylepodiatry.com

I would think that the better sign would be the notification that you are dropping out of Medicare because the current reimbursement level is such that you can no longer afford to see them, with the names and numbers of officials at CMS and Congress in that district.

David Secord, DPM, Corpus Christi, TX, Secord@medscape.com

RE: Staff Dating Policy (Richard Boone, Esq., Sam Bell, DPM)
From: Multiple Respondents

Richard Boone's office policy regarding dating seems a little heavy-handed to me. Like Dr. Sam Bell, I'm a bit perplexed about the extent to which we should try to control our staff's social life. According to the policy, if I trimmed a nail on a patient 11 months ago and haven't seen him since, I'd still have to fire my employee if I saw her out on a date with the patient, NO EXCEPTIONS. Ouch. Of course, I wouldn't actually fire my employee because A) I'd be a jerk, and B) my recently-fired ex-employee's new boyfriend might suddenly have severe, debilitating pain that I caused.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

I can't agree with an anti-dating policy for staff. Why risk loosing a good and essential employee over the issue? Or losing the patient as well. To carry it further, would you refuse to treat a potential patient an employee is dating because of a supposed "conflict of interest"? One of my employees met her husband in my office when he was a patient and they have been happily married for 10 years.

Jeff Siegel, DPM, Long Beach, CA, 4petra@sprintmail.com

I have to agree with Sam Bell. Lighten up! We are social beings who meet and interact with others in many settings. To implement such Draconian and arbitrary restrictions on who our staff or ourselves can socialize with is ludicrous in the extreme. In fact, having social relationships with patients can be very beneficial to a practice. Certainly, using one's position in a medical practice to somehow coerce a patient into unwanted social or sexual situations would be totally intolerable and grounds for immediate dismissal, but I think that a little common sense is in order here.

Paul Busman DPM, Troy, NY, BREWERPAUL@aol.com

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

PSR-24 RESIDENCY POSITION SOUTHEASTERN MI

Available for recent graduates or former PPMR/RPR or PSR-12 residents. this is a major teaching affiliate of Michigan State University college of Osteopathic Medicine and serves 17 residency and fellowship programs. Active podiatric clinics in wound care, limb salvage, foot and ankle surgery, medicine and orthopedics. competitive salary and benefit package. meded@pohmedical.org

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