The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 20, 2007 #3,097 Editor-Barry Block, DPM, JD

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FL Podiatrists Expand Wound Care Practice

Wound care is a growing specialty. Dr. Richard Brietstein, along with his partner Dr. Neil Strauss and new associate Dr. Jorge Rivera, all podiatrists, have developed a strong interest in this area. Brietstein’s group is based at University Hospital in Tamarac, but soon will be opening an additional office in eastern Broward County to service patients in that area.

Dr. Richard Brietstein (R) and Dr. Neil Strauss

Brietstein was responsible for opening the first wound care center in Broward County approximately 17 years ago at Florida Medical Center. "We are very specific in our approach to care," Brietstein said. "Our heal rates have been very satisfactory. Patients are pleased when we can save a limb that previously would have been lost to amputation. We have the ability to salvage limbs, prolong patients’ lives and allow them to live more productive lives." Brietstein often accomplishes this through a multi-disciplinary approach with vascular surgeons, plastic surgeons, infectious disease specialists, endocrinologists, and other medical specialists.

Dr. Brietstein is an adjunct clinical professor at Barry University School of Podiatric Medicine. Brietstein along with his partner Dr. Neil Strauss are also adjunct clinical professors in the Department of Geriatrics at Nova Southeastern University College of Osteopathic Medicine. Brietstein is Clinical Director at the University Hospital Wound Care and Hyperbaric Center. He is a Diplomate of the American Board of Podiatric Surgery, Fellow American College of Foot and Ankle Surgeons, Diplomate American Academy of Wound Management, and Fellow American Professional Wound Care Association.

Source: David Volz, South Florida Hospital News [November 2007]

CA Podiatrist Cited for Philanthropic Work

For Dr. Holly Spohn-Gross, practicing medicine in the underserved communities of the Kern River Valley lets her make an immediate difference. The podiatric surgeon's philanthropic work complements her professional passions. She supports the Women's and Girls' Fund of Kern County.

Dr. Holly Spohn-Gross

"I have passion for helping our youth," she said. The Kernville resident donated to the fund because "I want to invest in our future, I believe that's where you start." Her giving is just one example of developments in women's philanthropy -- giving circles and funds that focus on women and children -- emerging in Kern County that reflect national trends.

Source: Jenny Shearer, Bakersfield Californian [11/16/07]

Legislation Targets Drugmaker Gifts, Incentives to Physicians

Thirteen states this year have seen legislative proposals aimed at limiting financial relationships between physicians and drugmakers. Most bills failed to pass, due to heavy pressure from pharmaceutical lobbyists, experts said, but new efforts are afoot.

The latest proposals include a Michigan bill that would make that state the second in the nation after Minnesota to place a limit -- $100 -- on the total value of gifts a drugmaker can give a physician in a year. Michigan and Massachusetts are considering so-called sunshine laws requiring drug companies to publicly disclose any gifts, payments, subsidies or incentives worth more than $25. The bills proposed this year exempt drug samples and payments for clinical trials from reporting requirements or gift limits. In September, a bipartisan U.S. Senate measure was introduced that would list gifts of more than $25 in a public, national database.

The American Medical Association's ethical code says gifts from industry should be of insubstantial value and primarily benefit patients. The AMA has not taken a position on the congressional or state legislation.

Source: Kevin B. O'Reilly, AMNews [11/19/07]

Query: MSRA and the Media

Over the years I have treated thousands of wounds. I culture them and from time to time have received reports that one of the micro-organisms involved was a methicillin-resistant staph. I never panic because in the majority of cases, the infections responded to topical antimicrobials, and in rare cases when they did not, I have prescribed oral Zyvox or intravenous Vancomycin, which cured the infection. I don't think my experiences in this regard are that different than most of my colleagues.

What does scare me is that if this hype by the media gets out of hand and the government gets too involved. I could just see a patient with a minor foot infection being unnecessarily hauled off and quarantined in a state hospital and being subject to picking up a nosocomial infection that might be worse. Perhaps some of the ID experts who read PM News can weigh in on this subject.

Elliot Udell, DPM, Hicksville, NY

Query: Lytec EMR

My group is looking to more fully integrate our separate EMR system (Medinotes) into our current practice management software (Vital Works/Cerner/Wisdom). We are also considering starting all over and have looked at Lytec to completely integrate EMR, billing, and other applications. Does anyone use Lytec and what has been your experience? Would anyone recommend another software management company.

Sandy Schustek, DPM, Charlottesville, VA

RE: Chart Audit (Name Withheld)
From: Michael M. Rosenblatt, DPM

Avoid ANY temptation to change any of the charts. Be co-operative but do NOT volunteer information. If they ask you questions, ask them to put them down on paper and you will respond to them later in writing. If there are two auditors present, it may mean that the second person is there to listen to your comments and testify against you (possibly) in the future.

Auditors are not typically allowed to go into your file cabinets. You should provide them with a quiet room to do their audit. There is always a temptation to ask them what they are looking for. This is NOT a good idea. Your presence is not even required during the audit. The less you say, the better.

If you have any questions about your audit, you should contact a healthcare attorney who specializes in medical representation. You will get an audit report, (most likely) demanding money back. There will be a time limit for response and payment. You need to have your attorney (and associated experts) examine the demand carefully, to respond.

Even if you pay what they demand within the time limit, a non-response might indicate to them that you have "other" things to hide, and may open you to audits by other carriers, so a defense is essential. Auditors are under no obligation to inform you that they "contact" other insurers, or Medicare.

I have written two articles published in PM on this subject. One is located at: http://www.podiatrym.com/search3.cfm?id=383 Dr. Block has an excellent article on Medicare audits at: http://www.podiatrym.com/pmarticle.cfm?id=12
There are a wealth of other articles and letters on this subject at http://www.podiatrym.com After you get to that site, type in "Audits" on the search section.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

RE: Billing Services (Ray Brown, DPM)
From: Richard Gosnay, DPM

I opened up cold 4 years ago. It didn't make sense for me to pay a minimum fee or invest in the things I needed to bill when I had approximately zero patients. I was fortunate to have been introduced to a biller who works out of her home. I researched and found the typical fee to be 6% of collections. Whether it's a good month or a bad month, I can always afford 6% of collections. For that, she does everything. All I do is decide what code to bill and possibly add a modifier.

She bought her software, she pays for the updates/subscription. She even uses her own envelopes, stationery, and stamps when she balance bills my patients. She can give me all kinds of analysis statements if I request them. She even gives me totals to work with for my taxes. It might be different for a big practice with several doctors, but I just can't justify having an employee do my billing. At 6%, I pay a flat $6,000 for $100,000 of collections. What would I have to pay an employee for that? Not to mention the taxes, training, and other costs associated with an employee. Not to mention the software and supplies I would need to buy and maintain.

I suspect that there are similar people who are available to do medical billing everywhere in the country. Maybe I just got lucky. If any podiatrist would like to use my biller via fax and the Internet, he or she can email me and I will give you her contact information.

Richard Gosnay, DPM, Danbury, CT, beautifulbaldhead@hotmail.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

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

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

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