The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 21, 2009 #3,707 Publisher-Barry Block, DPM, JD

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AAPPM Creates New Executive Management Group Track

The American Academy of Podiatric Practice Management (AAPPM) has announced the newest addition to the AAPPM practice management workshops - the Executive Management Group Track. A group of about 20 non-DPM practice managers met formally for the first time in a daylong meeting at the recent AAPPM Fall Workshop in Ft. Lauderdale.Topics discussed included insurance appeals using ERISA, employment issues, and new marketing technologies. Topics planned for upcoming meetings include organization skills, cost savings, and staff management skills. 

Brooke Weaver and Fay Mushlin

The new Executive Management Group was founded to address the specific needs of non-DPMs managing podiatric practices according to group co-leaders, Brooke Weaver and Fay Mushlin, both Fellows of the Academy. “Some of our needs are quite different than those of our doctors and it’s great to now have a forum at AAPPM meetings to discuss our challenges and experiences with our peers,” said Ms. Weaver. “Living up to the Academy’s motto of “learning through sharing,” we are sharing what each of us has learned in the daily management of a podiatric practice not only at the meetings but also continuing on as a resource and support group after the meetings,” said Ms. Mushlin.

IPMS Elects State Officers and Directors

The Iowa Podiatric Medical Society membership elected three new directors and re-elected two directors at the 2009 Annual Business Meeting that was recently held in Des Moines.

Dr. Eugene Nassif, Jr

Eugene Nassif, Jr., DPM became President of the IPMS Board of Directors. Mark Lucas, DPM was selected as Vice-President, and Greg McCarthy, DPM was selected as Secretary-Treasurer of the IPMS Board of Directors.

Christopher Considine, DPM, James Mahoney, DPM, and Scott Torness, DPM were all elected as Directors. Paul Dayton, DPM and Mark Lucas, DPM were both re-elected to a three-year term on the board. Current Board members include: Gregg Corrigan, DPM,  Vincent Mandracchia, DPM, Past-President; Philip Morreale, DPM, Michael Ward, DPM and Robert Yoho, DPM.

FL Podiatrist Lectures at Annual Mexican Podiatry Congress

Jose' M. Concha, DPM, recently spoke at Mexico's 23rd Annual Podiatry Congress held at la Universidad Autonoma de Nuevo Leon, in Monterrey, Mexico. He lectured to over 400 Mexican podiatrists and students at the country's largest podiatric conference. Topics presented included:  Rotational and Torsional Deformities of the Lower Extremity,  Biomechanics of the Diabetic Lower Extremity, and A Review of Traditional vs. Alternative Treatments of Tinea Conditions. Dr. Concha also held a lab including digital exostectomies and hammertoe correction.

(L-R) Dr. Arturo Sosa, President of the Mexican Federation of Podiatrists and Dr. Jose Concha

Mexican podiatrists are viewed as technicians in their country with only two years of post-graduate training, but they are striving to be more like their American counterparts. They are instituting a third year program in their schools focusing more on biomechanics and surgical skills.

House Passes H.R. 3961—Legislation to Permanently Repeal the SGR

By a vote of 243-183 today, the U.S. House of Representatives passed H.R. 3961, a bill that repeals the current Medicare physician payment formula, known as the sustainable growth rate (SGR), and replaces it with a new framework. Michael Burgess, MD, (R-TX), a former AMA alternate delegate was the sole Republican to vote for final passage.

This legislation would replace the SGR with a new formula that creates two updates: GDP +2 for Evaluation and Management services and GDP + 1 for other services. Additional technical changes will avoid the accumulation or compounding of debt that occurred with the SGR formula.

The battle now shifts back to the Senate. While action to permanently repeal the SGR was blocked in the Senate last month, the Obama administration and several senators support a permanent replacement of the SGR formula.

Source: AMA Health System Reform Bulletin [11/19/09]

Surgeons Oppose Senate Healthcare Bill

The Hill reports that the American College of Surgeons and 19 other groups representing surgeons delivered a letter on 11/04/09 to Senate Majority Leader Harry Reid (D-NV) stating their opposition to the Senate's healthcare reform legislation. The letter states that "We are writing today to reiterate our serious concerns with several provisions that were included in the health care reform bill that was considered by the Senate Finance Committee and to let you know that if these concerns are not adequately addressed when a health care reform package is brought to the Senate floor, we will have no other choice but to oppose the bill."
 
The article also stated, "The surgeons object to funds for surgeons being redirected to primary care physicians; a proposal to create an independent commission on Medicare payment policy that would not require congressional action to take effect; requirements that doctors participate in a quality measurement program. Furthermore, the groups protest the Senate's decisions to not enact a permanent reform to the Medicare payment system and to not enact limits on lawsuits for medical malpractice."

Source: The Hill via Medical Industry News [11/19/09]  

Query: Rocker-Bottom Tennis Shoes for Hallux Limitus

Has anyone used the newer rocker- bottom tennis shoes to treat hallux limitus?
 
Michael Forman, DPM, Cleveland, OH

Query: Malpractice Insurance Options

As premiums continue to rise, we are interested to know what malpractice insurances are being used by podiatrists who have had favorable results (lower premiums, good coverage, good service).

Keith R. Reber, DPM, St. George, UT

Query: Billing for Austin/Keller Bunionectomy

I performed an Austin/Keller-type bunionectomy, a second metatarsal head resection, arthroplasties 2-4, and 2-4 metatarsal-phalangeal joint releases for contracted tendons on a Medicare patient. How would one bill this?

David Sands, DPM, Great Neck, NY

Response: I would suggest the following:

CPT 28296 for the Austin bunionectomy
CPT 28112-59 for the second metatarsal head resection

I can only assume that by "arthroplasties" you are referring to hammertoe corrections. If that is the case, then you would also bill (for example, right foot)

CPT 28285-T6-59
CPT 28285-T7-59
CPT 28285-T8-59

With regard to the metatarsal-phalangeal joint work, at the second metatarsal-phalangeal joint, all soft tissue work at the site would be included in the metatarsal head resection allowance. As for the other 3 metatarsal-phalangeal joints, you did not include enough detail to determine whether the tendon releases were percutaneous or open. If a complete capsulotomy/tenorrhaphy was performed, the procedures would be reimbursed as CPT 28270. If a simple release was performed, many payers will include the allowance within CPT 28285.

Tony Poggio, DPM, Alameda, CA

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RE: Pediatric Foot Deformity (Theresa Hughes, DPM)
From: Dennis Shavelson, DPM

Is it possible that (after ruling out Marfan’s, Ehlers-Danlos, etc.) in addition to STJ pronation, this child’s pronation in gait exists in the forefoot, and there may be a component of met adductus in play. If so, this patient needs MTJ vaulting and custom forefoot centering coupled with motor control therapy in order to strengthen and train posterior tibial, peroneus longus, FHL, and the core intrinsics back to normal.

I suggest a consultation for this patient with a DPM who focuses practice on modern functional lower extremity biomechanics, or that Dr. Hughes invest in upgrading her biomechanical skills so that she can provide gold standard care.

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: Increased Cancer Risk Associated With Supplements Containing Folic Acid (Elliot Udell, DPM)
From: Allen Mark Jacobs, DPM, Jeffrey Kass, DPM

Insulin has been demonstrated to be associated with increased cancer risk and accelerated tumor growth. Does Dr. Udell suggest stopping insulin in diabetic patients?? The article to which he refers was for all mortality in patients with cardiac pathology. It was a study in a population without folate dietary supplementation. Other studies have demonstrated reduced carcinogenesis with folate. The fact is that folate increases nitric oxide which increases blood flow to all tissues including neoplastic tissue. Ditto Pletal, Viagra, Regranex, etc. The suggestion of Dr. Udell that Metanx is associated with increased tumor risk is unsupported in fact. Folates have long been used to prevent neural tube defects, for depression management, etc. No associated tumor risk has been reported.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

While I did not yet read the article quoted by Dr. Udell, there are studies already out there that concluded the same thing. I have come across them in the past while Googling the topic. I questioned my Metanx rep about this and the answer I received back was that folic acid and L-Methlyfolate are two different substances. L-Methlyfolate is the bioactive form of the vitamin and folic acid goes through 4 conversion steps before reaching this active form. The breakdown of the folic acid to the active form is what causes the negative problems. About 20% of the population are not able to break down folic acid into the active form as they are missing the necessary enzymes.

This must be taken with a grain of salt, as this is coming from a rep, and not from any scientific publication. 
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Candidal Injections (Lynn LeBlanc, DPM)
From: Roody Samimi, DPM

Consult an infectious disease specialist for an anti-candidal medication. Is this a compromised or HIV patient?

Roody Samimi, DPM Sacramento, CA, roody.samimi@gmail.com

RE: Hill Chairs (Dennis Frisch, DPM)

Hill Chairs, I would say, is a good bang for your bucks. We have one office with all MTI and the other office with all Hill Chairs. Hill chairs are lightweight, which can cause tipping over if the patient sits at the end of the foot rest. The footing is metal and scratched the heck out of my new vinyl floors until I bought some coasters. 

Lifting, tilting, color all look great. Durability to be seen. Service has been a problem with ordering Hill Chairs though.  Nobody came to install the chairs, etc. There is a quality difference, but for the money, it is just fine. I would buy more Hill Chairs, but service remains an issue.
 
Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

RE: Positioning Device for Axial X-Rays (Bryant A Tarr, DPM)
From: Tom Silver, DPM

I went to a fabric shop and bought a block of hard foam-10" x 10" & 3" thick. They cut a V-wedge 2" deep across the foam about 1" from the distal end, and  beveled the prox. end of the V slightly. It cost about $10-15 and has worked great over the years for perfect axials (providing the patient can bend the toes).

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.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.

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

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

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 - PHOENIX, ARIZONA

Part Time/Full Time, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/Trauma. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, ABI Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.com

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 - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.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

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com

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