The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 18, 2009 #3,704 Publisher-Barry Block, DPM, JD

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Schlorff Becomes New President of PPMA

William Schlorff, DPM, was elected as the new President during the House of Delegates meeting and banquet of the Pennsylvania Podiatric Medical Association (PPMA), held at the Loews Philadelphia Hotel, Philadelphia, PA, on Saturday, November 14. Dr. Schlorff graduated from the Temple University School of Podiatric Medicine (formerly the Pennsylvania College of Podiatric Medicine) in Philadelphia in 1989. 

Dr. William Schlorff

Schlorff has been a PPMA Board Member since 2002 and has been in private practice serving the Jersey Shore, PA, community since 1991. He is Board Certified by the American Board of Podiatric Surgery.

"In this period of uncertainty, with Congress currently attempting to create a new health care bill, now is the time that we must all make our voices heard.  It is imperative that each of us contact our legislators for the sake of caring for our patients and our future ability to practice podiatric medicine," says Dr. Schlorff.

AAPPM Event Raises Over $1,500 for APMA Educational Foundation

More than 60 people gathered to partake of the leaf and the grape at the “Wine and Cigars with the Stars” event at the recent AAPPM Fall Practice Management Workshop in Fort Lauderdale.

Attendees at AAPPM Wine and Cigars Under The Stars Fundraiser

The event, which raised over $1,500 for the APMA Educational Foundation, was sponsored by Brad Bakotic of Bako Pathology Labs, Rem Jackson from Top Practices, LLC, and Nancy Cavey from Cavey & Barrett.

House Healthcare Bill Would Increase Anti-Fraud Measures and Funding

The Affordable Health Care for America Act approved by the House of Representatives Nov. 7 provides more evidence that Congress is bent on improving Medicare and Medicaid compliance and reducing fraud and abuse through health reform or perhaps freestanding legislation.

Like other Senate and House reform measures, the House bill (HR 3962) promotes provider compliance while arming auditors and enforcers with more tools to identify and punish misconduct. For example, the bill would require compliance programs as a condition of enrollment and re-enrollment, and establish a provider self-disclosure process for Stark violations. But it also calls for adding $100 million to the Department of Justice/HHS war chest and penalizes an array of new offenses.
 
Source: Report on Medicare Compliance [11/16/09]

Pass Out Smiles to Patients

Everyone on our office TEAM wears a smile button on our lab coats, etc. When patients comment on these, which is quite often, we hand them five or more of the smile buttons and say, “When someone needs a smile, give them one of yours.” 

Smiley Face Buttons

We order the smile pins from Oriental Trading. The cost is $4.99 for forty eight pins

Source: Hal Ornstein, DPM. For infomation on AAPPM click here.

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

Bret Ribotsky: How do busy practitioners benefit from getting involved in research?

Dr. Richard Pollak

Richard Pollak: A perfect example might be athlete’s foot. Athlete’s foot in the office is a one-visit occurrence, usually billed as CPT 99202. Let's say a company wants to test a new generic Loprox medication by comparing it to a placebo or to the current generic Loprox. All of a sudden, you have four patient visits instead of one. You are being paid a multiple of what you would have been paid. I practice in San Antonio, where an office visit for tinea pedis might be $50. But if you are in a study, your reimbursement could be $300 or $400, or even more.

Dr. Guido Laporta

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is PM Podiatry Hall of Fame inductee Dr. Guido Laporta. You can register for this event  by clicking here

Query: Website for Wide Shoes

I have a patient with a size 9 4E cavus foor with a high instep. Is there a specific website that has hard-to-fit shoes? 
 
Joel Morse, DPM, Washington, DC

Query: Hammertoe Repair

How would one code a "soft tissue" hammertoe repair consisting of an extensor tenotomy, capsulotomy at the metatarsal-phalangeal joint, flexor tenotomy (with or without capsulotomy) at the interphalangeal joint, with or without K-wire insertion?

Would one code each of the soft tissue components, or would this still be CPT 28285 (correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) even without "bone work"?

Arden Smith, DPM, Great Neck NY

Response: I would recomend you look at CPT 28313 (reconstruction, angular deformity of toe, soft tissue procedures only [e.g., overlapping second toe, fifth toe, curly toes]) which could be describing the flexible hammertoe deformity you are proposing to correct with soft tissue releases.

CPT 28285 includes the examples of interphalangeal fusion, partial or total phalangectomy). I have never seen an authoritative example that didn't include bone work when describing CPT 28285.

Actually, CPT 28313 is a better opinion for another reason; it has a higher RVU value than CPT 28285.

Tony Poggio, DPM, Alameda, CA

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

RE: Article on The Use of Dietary Supplements in Diabetic Peripheral Neuropathy By Robert G. Smith DPM, MSc, RPh (Lawrence Kollenberg, DPD, D Pharm)
From:  Richard H. Mann, DPM, Jay Kerner, DPM

I would like to compliment Dr. Smith on his recent CME article The Use of Dietary Supplements in Diabetic Peripheral Neuropathy. I found it to be highly informative and well written. I would specifically like to compliment him on the manner in which he explained the mechanism by which benfotiamine, the active ingredient in Neuremedy, safely and effectively reduces the symptoms of diabetic peripheral neuropathy. I would point out that Neuremedy is not a dietary supplement. It is a medical food. Medical foods are held to much higher safety and efficacy standards by the FDA than are dietary supplements.

Disclosure: Dr. Mann’s Company, Realm Labs Distributes Neuremedy.

Richard H. Mann, DPM, Realm Labs, CEO, rhm123@gmail.com

I'd like to recommend a book titled Snake Oil Science - The Truth About Complementary and Alternative Medicine by R. Barker Bausell. It provides an excellent look at the scientific evidence for complementary and alternative medicine (CAM), and the psychological and physiological pitfalls that lead patients, doctors, and researchers into mistaken assumptions.

It's certainly eye-opening how we, as doctors, can easily be misled by false positive results for treatments which may involve nothing more than a placebo effect. Also explained in-depth are the deficiencies of many studies promoting CAM. Are CAM therapies more effective than a placebo? The Next time that your patient brings up the subject, you'll be properly prepared.

Jay Kerner, DPM, Rockville Centre, NY, Aikiman44@aol.com
 

RE: The Application of EBM to Orthotic Therapy (Robert Bijak, DPM)
From: Robert Steinberg, DPM

Amazing! A single DPM making statements like Dr. Bijak does is more than just silly, it is reckless. Does Dr. Bijak really think that he can set his own new standard of care for podiatric medicine? If he sees no differences in impression techniques, then I feel sorry for him. If an orthotic is an orthotic is an orthotic, to Dr. Bijak, then I feel even more sorry for his patients. Who were his instructors?
 
There are plenty of us who are very good at performing biomechanical examinations, and even better at creating the best functioning orthotic. While Dr. Bijak thinks orthotic therapy is "shoe store medicine", it is Dr. Bikak who could be considered violating the standard of care by publishing that he does not follow the standard of care.

Robert Steinberg, DPM, Schaumburg, IL, foot_doctor@sbcglobal.net

I raised the ire of the true believers who believe the "P" in DPM stands for pronation. Chiropractors, physical therapists, pedorthists, prosthestists, "Good Feet" stores, Walmart, and drug stores all provide supports with many satisfied "patients." Podiatry does not have the sole purview of "instant relief", as one responder said, in the non-medical foot care arena. One responder said we are differentiated from other professions by nail cutting and arch supports. I agree. That's why the military classifies podiatrists as allied health providers. There's pay disparity with MD's, and as we saw in a recent post, there is discrimination in privileges.

Many use the term podiatric physician, trying to align with the MD's, but I maintain that nail cutting and arch supports won't bring us the respect that will lead to parity. We have to become closer to them than they do to us. They have the high ground, and we have to climb up their hill. If not, they will continue to look at us as a lesser branch of medicine.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com
 

RE: Positioning Device For Axial X-Rays (Bryant A Tarr, DPM)
From: Avi Kornbluth

An axial positioning device is available (plastic is the most purchased) at Stone Podiatry (914) 261-7905.

Avi Kornbluth, Stone Podiatry, avi.kornbluth@stonepodiatry.com

RE: MIS (Name Withheld) (NY)
From: Multiple Respondents

The Academy of Ambulatory Foot and Ankle Surgery (AAFAS) has never advocated performing surgery without gloves or during “lunchtime.” Many of our members ARE orthopedists! The AAFAS has never advocated fragmented billing.  AAFAS seminars have been given in conjunction with licensed schools of medicine. As a healthcare attorney, I have witnessed much billing chicanery. There is no correlation between the length of an incision and the way a podiatrist bills. None of the last six podiatrists in PM News, who went to jail, were fellows of the AAFAS. Fairy tales might make someone feel better, but they are just that, fairy tales. When properly performed, when indicated, MIS is a valuable addition to the podiatric armamentarium. We should be working together and learning from each other.

Larry Kobak, DPM, JD, Brooklyn, lkobak@optonline.net

I totally agree with Name Withheld, whose statements regarding MIS were and are still correct.

It also deserves stating that flexor and extensor tenotomies were developed by an orthopedist, Dr. David Telson, of  Brooklyn, NY. Earl Kaplan, DPM also made weekend surgeons out of untrained podiatrists, and issued certificates, which podiatrists displayed to document training.

Their main differences were education and training. Sterile technique is mandatory, regardless of what technique is being employed.

Sheldon Marne, DPM, Hendersonville, NC, ncmarnes@msn.com
 
I was 42 years old when I graduated from NYCPM in 1983. I was offered a residency through NYCPM, but opted to do a preceptorship that was approved by NYCPM because the preceptorship allowed me to work evenings as a pharmacist to provide for my family. I could not financially afford to take the residency.

In that era of podiatry, MIS was thought by many …
 
Editor’s note: Dr. Schneider’s extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=30501&start=1

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ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO 
 
PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

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Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - CHICAGO AREA
 
Well-established, state-of-the-art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist. The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

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

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

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