The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 17, 2007 #3,095 Editor-Barry Block, DPM, JD

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TUSPM Students and Faculty Team Up With Patti LaBelle to Raise Diabetes Awareness

Faculty members and students from the Temple University School of Podiatric Medicine recently gave free foot screenings and educational information at a diabetes awareness event, “A New Attitude about Diabetes,” sponsored by Health Partners, a Philadelphia-based medical assistance plan. The event featured singer and diabetes spokeswoman Patti LaBelle, who discussed her own battles with the disease.

Third year podiatry students Alexis McKeown (far left) and Celia Storey (far right) assisted Dr. Kathya Zinszer, associate professor of podiatric medicine (second from left) with a foot screening on Patti LaBelle at the recent diabetes awareness (photo Jeanne Lockner)

Dr. Kathya M. Zinszer, associate professor of podiatric medicine and director of community outreach, was on hand to assist with foot screenings, and stressed the need for diabetics to pay special attention to their feet and to get regular screenings by their podiatric physicians.

While diabetes affects several different parts of the body, Zinszer noted that the feet are most often overlooked, because many diabetics simply don’t think about them. “It’s important for diabetics to get into the habit of checking their feet and shoes every day,” said Zinszer. “Today, you might have feeling in your feet, but in 10 years, you might not.”

NY Podiatrist to Join New York Diabetes Coalition Board

Dr. Bruce Pinker, a Westchester-based podiatrist and a member of the New York State Podiatric Medical Association, will serve on the board for the New York Diabetes Coalition, headquartered in White Plains, for a two-year term. The term will run through September 31, 2009.

Dr. Bruce Pinker

The New York Diabetes Coalition is a unique collaboration of volunteer representatives from health plans, professional medical societies, state and local departments of health, community based organizations, quality improvement agencies, healthcare providers and diabetes care vendors to improve the health of people who live with diabetes. The New York State Podiatric Medical Association represents over 80% of the Empire State’s podiatrists.

“Part of NYSPMA’s mission is to educate patients and healthcare providers about the importance of proper foot care in the treatment of diabetes,” Dr. Pinker remarks. “Our hope is to share our expertise with the team of experts serving on this board,” he adds.

Universal Coverage Only Part of Solution: Report

It’s going to take more than universal health insurance to reform the healthcare system, according to a report released by the Commonwealth Fund. The report, A High Performance Health System for the United States: An Ambitious Agenda for the Next President, issued by the fund’s Commission on a High Performance Health System, made several recommendations to the next U.S. president.

The report highlighted the fact that universal coverage is just one part of the solution. In addition, the incoming president should establish health policies to reform provider payments, such as rewarding high-quality care; better organize and coordinate care delivery; and invest in an electronic information system over a five-year period as well as other quality and efficiency tools, such as public reporting and evidence-based medicine.

Source: Jennifer Lubel, Modern Healthcare [11/15/07]

Query: Chart Audit

We received a call from Horizon Blue Cross Blue Shield of New Jersey stating that they will be visiting our office next month to review 7 charts and they gave us the names of the patient charts they will be reviewing. This will be conducted by a company called MedAssurant and they are out of Maryland. That is all they said. They did not specify what they will be looking for. The cases are all assorted and involve nail procedures, plantar fasciitis, bunion surgery and nail debridement. Any advice or if anyone has had experience with these people or any information would be appreciated.

Name Withheld by Editor

Query: Chemical Matrixectomy

A patient presents with nail spicules remaining from a previous surgery. The spicules were removed using a curette and ronguer, followed by phenol (x3) and an alcohol flush. Can you please tell me how to code this? Do you code the procedure plus the curettement of the spicules?

Deb Carr, CCS, Enola, PA

Response: Whether removing nail spicules or partial nail plate or whole nail plate, you would only bill CPT 11750 (excision of nail and nail matrix, partial or complete, for permanent removal).

Tony Poggio, DPM, Alameda, CA

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

RE: MRSA Prevention Guidelines (Ronald W. Hines, DPM)
From: Phil Organ, DPM

Our wound center uses the following policy that may be useful for you. Universal precautions dictate hand washing or foam sanitization of hands and use of gloves in all patient encounters.
1. Hands sanitized every time a person (physician or nurse) enters the room. We do this conspicuously so that the patient sees it being done. Also, we have a sign in each treatment room advising the patient to ASK the doctor if he/she washed their hands (no one ever actually asks except in humor). By policy, we are supposed to re-sanitize on leaving the treatment room.
2. On entering the treatment room, if you anticipate handling the patient in any way during the encounter, sanitize hands and put on gloves.
3. For patients diagnosed with MRSA, the RNs and physicians wear a plastic disposable isolation gown.
4. For the treatment room, staff sanitize the exam chair before the patient enters, and after the patient exits the room.
5. Naturally, all body fluid contaminated dressings, tissues, gloves and gown are disposed in 'red-bag' containers.
6. Any other equipment (chair, wheelchair, or other equipment used by the patient) is sanitized with germicide cleanser after the encounter.
7. Patient's identified as MRSA positive are screened for infection of the anterior nares with a culturette swab, rotated several times in the anterior portion of each nares. If the anterior nares are dry, moisten the tip of the culturette with sterile 0.9% normal saline prior to obtaining the culture.
8. We have a high-risk-type list for those to be screened at the time of admission to the wound center (i.e., those from nursing homes or those with an MRSA diagnosis).
9. For MRSA-positive individuals, we use a decolonization and a re-screen protocol.

NOTE: please feel free to contact me for a complete description of our protocol.

Phil Organ, DPM, Naples, FL, philorgan@comcast.net

RE: Billing Services (Ray Brown, DPM)
From: Michael Forman, DPM, Paul Kesselman, DPM

I use PBG out of New Castle PA. There is no minimum. The fee is a 5% total charge on received money. We have only had them for two months, but things look promising.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

I am unaware of any billing service without a monthly minimum. Some billing services will charge a $1 per claim or up to $1 per line of claim, which can quickly add up to a tidy sum of money. You would be best served to look for an in house billing program which provides comprehensive office management. I have been using Sammy 2000 myself for well over 10 years. Previous to purchasing Sammy, I was using a billing service and paying far more than what I paid for the program and annual support. The rates are commensurate with others in the industry and they offer a no interest payment plan. The billing software is easy to learn and is kept up-to-date on local Medicare and other third-party billing requirements.

In summary, I think in the long run purchasing a software program to manage your office will be far more effective and cost you far less money.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Title XIX (Al Musella, DPM)
From: Multiple Respondents

I would like to comment on the 2 suggestions that have been put forth: podiatrists contacting their legislative representatives and patients contacting their legislative representatives. I think that personal contact with our representatives should not be pushed aside as was suggested by one writer. Although I am sure there is a certain amount of bologna involved, a New York State Senator told our group that there is often legislation that they are really not familiar with and hearing from all parties before (not after to complain) it is acted upon is important.

In New York State, podiatry is excluded from the Medicaid program except for some special circumstances such as being secondary to Medicare. Then we get paid 20% of the 20% -- whoopee! I don't think I could find 10 patients who would lobby their representatives for Medicaid inclusion of podiatry (with our property taxes being so high and Medicaid being a significant portion of those taxes) and I question if there are many podiatrists in my area who would lobby to be put back in Medicaid. I know some have made the argument that if we are cut out of one program it will have a domino effect, but it has been over 20 years since we were cut out of Medicaid in New York and so far that hasn't happened. Yes, the insurance industry is screwed up, but not from this. I am interested to hear how this legislation will help podiatry.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

The many issues facing podiatry in particular, and medicine in general, have solutions that are rooted in the legislative process. Title XIX is certainly the one that is our priority. The suggestion that all podiatrists should be moved to act is welcome. This Bill will affect all of us in our capacity to continue to treat our patients. Passage of Title XIX will accomplish something that we are all striving for: recognition. It will mandate podiatric care in federal Medicaid programs and identify Podiatrists as Physicians in this program. This will certainly have short term impact, but may also be important as we seek parity in all that we do.

In New York State we have a lot of support by our representatives in Congress. The problem is in the workings of the federal legislative process. We must have this Bill attached to others in an attempt to get it passed.

For members of the APMA, go to the website for information on how you can help. For non-APMA members, Isn't it time you joined with your profession? Strength is in numbers. Be part of the solution

Vito J. Rizzo, DPM, Trustee NYSPMA, vjrizzo@optonline.net

As a group of professionals, we can through unity and numbers bring about change. The phone call I was referring to was a list of Congress people who had already signed onto the particular bill in the last congress. The Bill is identical with no changes. The calls are requests/reminders if you will to let them know to get back on board. While having patients make calls is definitely a good idea - the purpose of my posting was ignite a call to arms and for the profession to be a little more proactive.

I am an APMA member. However, I strongly want all podiatrists to participate in avenues to strengthen our profession. I don't know if non-APMA members are abreast of Title XIX or other legislature that is important for us. I received over 100 emails regarding my previous posting from both APMA and Non-APMA members. Some key points;
1) We must involve non-APMA members. The profession is small, we need everyone involved.
2) The APMA sends out a "blast email" when important things are happening yet only approximately 50% of APMA members receive these emails. I encourage all APMA members to give the APMA your email. You need to know what is going on.
3) I received emails from students in each of the 7 colleges. The students want to know how they can help. Have they been an untapped resource until now?
4) The APMA needs an even larger membership? At my last local hospital meeting - a quick survey revealed more non members than members?
Dr. Musella - yes, by all means it would be great to get our patients involved, but if podiatrists are not involved or don't know about a particular bill or proposal, how are their patients supposed to know?

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual . Fax CV with hours available to (718) 458-0053.

ASSOCIATE POSITION NEWPORT BEACH BEVERLY HILLS CA

Do you have a dream of treating movie Stars and the rich and famous? Outstanding opportunity for PSR36 graduate to join Solo practitioner Summer 2008. Must have passion to practice at the highest level of Podiatry all aspects. Partnership in the future a must. Please send resume to Ifabs@earthlink.net

LOOKING FOR ABPS BOARD CERTIFIED/QUALIFIED PODIATRIST - VIRGINIA

Hospital-Based Practice with Tremendous Growth Potential and a Fantastic Opportunity for the Right Doctor. I am looking for someone who will be an associate for a couple of years, then discuss Partnership Buy-In. This practice is currently solo-DPM – but I am turning away patients each day “because doctor is too busy.” Currently, I am in the OR 2 full days a week. Qualified candidate DOES NOT need significant rearfoot experience, but arthroscopy skills appreciated. Need strong surgery and people skills, with emphasis on wound care, forefoot surgery, diabetic problems, etc. No nursing homes. My office is a brand new state-of the-art facility with digital x-rays, computerized EMR, etc. Immediate start available, SALARY commensurate with experience. Please send resume to: podmed@mac.com

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

ASSOCIATE POSITION - WEST COAST, FL

Outstanding opportunity for PSR-36 graduate to join highly successful group podiatry practice in Summer 2008. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@ips-med.com

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

PRACTICE FOR SALE - MISSISSIPPI GULF COAST

Near Casino's and beaches. Busy Practice with no HMO's and good insurance coverage. Hospital and Surgical Center privileges available. Call (228) 762-9531 or email me at jwbenus@yahoo.com

PART-TIME LONG-TERM CARE OPPORTUNITIES- Chicago, Peoria, & East St Louis areas

We specialize in providing conservative care to residents in long-term care settings. Immediate part-time positions available. Very flexible scheduling. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300, or Fax resume to 773-775-0883

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