The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

November 21, 2006 #2,745 Editor-Barry Block, DPM, JD

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Non-Supportive Shoes May Lead to Tenditinitis: CA Podiatrist

Running without a properly supportive shoe may lead to problems with tendinitis, according to Dr. Bob Baravarian, a podiatrist at the Foot & Ankle Institute of Santa Monica. In addition, landing on rocks, pebbles or rough material can cause wounds that may be difficult to heal.

Dr. Bob Baravarian

Not every runner needs supportive shoes, Baravarian adds, but most require some level of support for long runs in order to avoid problems, particularly if they have low arches. Baravarian has misgivings about the increasing popular practice of barefoot running. Yes, he says, it's done in some African tribes, but most of these practitioners have run barefoot since childhood and their feet have adapted to the running surface.

Source: Janet Cromley, LA Times, [11/20/06]

TX Podiatrist Provides Free Care to 15-20% of Patients

Rosa Price couldn't afford surgery on her pained feet. Four years ago, she said, God heard her pleas for help and placed Neil Burrell, a Beaumont, TX podiatrist, in her path. While searching for a foot doctor in the Yellow Pages, Price's fingers landed on his name, a doctor who would care for her whether she could pay or not.

Dr. Neil Burrell

"If you met him, you would fall in love with him," said Price, a former janitor at Ogden Elementary in Beaumont. "And, I don't say that lightly." Burrell repaired torn Achilles tendons on Price's feet. The surgery cost several thousand dollars, which Price paid off in monthly payments. When she still had a balance of about $2,000, Burrell asked, "Do you have a hard time paying your bill?" Price said. When she answered "yes," Burrell told her not to pay him anymore - "Your bill is paid in full," he said.

Burrell, a 46-year-old doctor who grew up in Southeast Texas, estimates that about 15 percent to 20 percent of the medical care he provides is charity work for patients like Price. "I'm not in this business to become a millionaire," Burrell said. "I'm in the business to help people and make them better."

Source: Jamie Reid, The Enterprise [11/19/06]

Hospitals Give Yellow Light to IT for Physicians

Despite getting a green light from HHS's Office of Inspector General (OIG), some hospitals may want to treat giving a physician practice software, hardware and IT services as a yellow light instead. In August, OIG and CMS issued two final regulations aimed at allowing hospitals and certain other organizations to provide e-prescribing and electronic health records technology to physicians without fear of violating anti-kickback laws (TEHB 8/03/06).

The final rules created new exceptions and "safe harbors" to two federal fraud-and-abuse laws for arrangements involving the donation of certain electronic health IT and services. But not so fast: According to Internal Revenue Service (IRS) regulations, such donations to physician practices could endanger a hospital's tax exemption. Although the IRS hasn't taken an official position on these donations, the agency's regulations state that tax-exempt organizations are allowed to make only donations that have "a public benefit or help them further their charitable missions," reports AMNews. However, the publication says it's unclear whether donations to doctors would be seen as having a private benefit instead.

Source: Today in E-Health News [11/14/06]

Query: Flouroscan/ Mini C-arm

I am planning to purchase a new x-ray unit (and processor) but also considering fluoroscan or Mini C-arm for office/OR. I would appreciate any feedback from DPM's who have used fluoro in the office.

Ken March, DPM, Schenectady, NY

Query: Binding Arbitration

I have heard that some doctors are having patients sign binding arbitration agreements. For what purpose? Limit medical malpractice? Billing disputes? Is this common place and is it legal?

Alan Mauser, Louisville, KY

Editor’s comment: PM News does not provide legal advice. Binding arbitration agreements are most commonly used in contractual situations. They generally benefit both parties by reducing legal costs.

The use of a binding arbitration agreement regarding malpractice is problematic. One would first need to check if this practice was legal under state law. Additionally, one would need the approval of the professional liability carrier.

Before implementing any legal agreement, a healthcare attorney in your state should be consulted.

Query: Billing Bilateral CPT 20550 Administration

What is the proper way to bill procedure, CPT 20550 [injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")]when performed on the right foot and left foot same day/session? A coding book I have indicates that modifier "-50" (bilateral procedure) is appropriate to use. I have tried billing it on one claim line using "-50"; I have tried it with two claim lines with "-RT" and "-LT," respectively.

I have received rejections from Blue Cross of Michigan stating this procedure can only be billed once per day. Our Blue Cross rep stopped by the office, and said he is investigating this for me. Does anyone have advice on coding CPT 20550 when it is performed bilaterally?

Laurie Bodo, Lake Orion, MI

Response: I'd suggest billing it as CPT 20550 on the first line, and CPT 20550-59 on the second line. Although Medicare likes the "RT" and "LT" modifiers, some carriers edits are based on the traditional definition of modifier "-59" so that's the modifier they wish to see when the procedure is performed again in a different anatomical location.

Also, you may wish to do this as a manual appeal, and send in the procedure notes that demonstrate that procedure was performed once on each foot. That all said, though, Blue Cross Blue Shield of Michigan has some odd edits, and you may still get a denial stating that they'll only pay for you to treat one foot per day. If that's the case, I'd suggest getting your state podiatric society involved - and do whatever makes most sense clinically as well as operationally until the issue is resolved.

Joan Gilhooly, MBA, CPC, Deer Park, IL

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RE: AdvancedMD (Gregory Rouw, DPM)
From: Philip Gianfortune, DPM

We went to AdvancedMD and AdvancedEMR in our teaching clinic here at Scholl in July. We like the system very much. The students are especially fond of the electronic medial records. It is simple to use and easy to customize. The University’s general medical clinic is using the system for scheduling and billing as well. I think you will be pleased with the system.

Philip Gianfortune, DPM, Professor & Chair, Department of Medicine, William M. Scholl College of Podiatric Medicine, Philip.Gianfortune@rosalindfranklin.edu

RE: 2007 Medicare Cuts
From: Al Kanegis, DPM

I am completely baffled, as are all the other physicians in our country, regarding the proposed cut in fees that CMS is proposing to impose January 01, 2007. My conversations with physicians in different aspects of health care fields is that the doctors are not "making a lot of money" in practice. That which is earned requires more time and effort of the part of the practitioners than ever before. In fact some doctors are finding it difficult to make ends meet.

On the other hand, the insurance industry categorically states that they are "losing money" and then the government pays them more money to run the Medicare program for them. The insurance industry is "losing so much money" that the CEO's are receiving record high salaries, bonuses and perks than ever before. Something does not make sense.

Where do we, as doctors, turn for relief?

Al Kanegis, DPM, Westbury, NY, AJKANEGIS@aol.com

Editor’s comment: The APMA, along with powerful AMA and other specialty groups are well-organized to fight these cuts, but it will take the efforts of every practitioner to get Congress to act. This means that every podiatrist must call and/or write their Congressional representatives. The APMA has an excellent and easy way to do this on the E-advocacy section of www.apma.org

Additionally, every podiatrist must encourage every Medicare patient to contact his/her senators and representatives. If we depend on “others” to do these simple things, and merely complain, we will all suffer.

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multilocation practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

PRACTICE FOR SALE – ASPEN COLORADO

Part-time practice seeing patients between 2 and 4 days per month. Grossing over $100k. Low Overhead . Last year when staffed 4 days a month, consistently grossed $140k. Fully equipped rooms in approximately 600 sq. feet. Open to any offers. 970.471.2049 mjs10vail@aol.com

EQUIPMENT FOR SALE - Stryker Command II

Set is in excellent condition. Includes console with cable, model 2296-88 wire driver, oscillating, reciprocating, and sagittal saws and 50k drill with hand switch control, 5/32" Jacobs chuck, 0.7mm -1.8mm wire collet, and 2.0mm - 3.2mm pin collet. $5,000. (Lists for $20,000) 503-313-1196 or cseuferling@comcast.net

ASSOCIATE POSITION - NEW ENGLAND

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

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