The Voice of Podiatrists

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November 22, 2008 #3,407 Editor-Barry Block, DPM, JD

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Marvin Ginsburg, DPM

Dr. Marvin E. Ginsburg 73, of Norwalk, CT died Monday in Mount Sinai Hospital, New York. Born in Brooklyn, New York, he was a fifty-year resident of Norwalk with a practice in podiatry in Norwalk . Dr. Ginsberg also had an office in Westport on the Post Road for 30 years.

Dr. Ginsberg was a lifelong member of the American Podiatric Medical Association (APMA) and a member and Past President of Connecticut Podiatric Medical Association (CPMA). He was warmly regarded as the "Medicare Expert." He was also a long time member of Congregation Beth El, Norwalk.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814. Donations may also be made to the New York College of Podiatric Medicine.

Source: Stanford Advocate [11/19/08]

It’s Not Normal to Have Foot Pain: MA Podiatrist

Dr. Donald Adams, president of the Massachusetts Podiatric Society, estimates that up to 75 percent of Americans will experience foot pain at some point in their lives. It is not normal to have foot pain. It's not a normal part of aging.

Dr. Donald Adams

Dr. Adams says the majority of his patients are women. Probably, in my practice, it's two to one, females to males. And part of that is probably because of shoe wear. Women wear shoes that have narrow toe boxes, high heels, which do lend themselves to more foot problems.

Dr. Adams says most foot and heel pain can be remedied by a podiatrist, and that surgery is rarely required.

Source: CNN [11/19/08]

CLEAR Faculty Member Wins National Conference Award

The Center for Lower Extremity Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine has announced that Nancy Slone-Rivera, APRN, CWON, Lecturer of Medicine has won a first place award for poster presentation at the 2008 National Clinical Conference for the American College of Nurse Practitioners in Nashville, TN. This conference, with the theme Shaping Policy, Improving Practice, is one of the largest scientific meetings for nurse practitioners, and included approximately 1,000 attendees. .

Nancy Slone-Rivera

The poster entitled, ”Evolution of a Diabetic Ulcer Risk Classification System” was co-authored with David Armstrong, DPM, MSc, PhD, Professor of Surgery, and Director, Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine.

Query: Surgical Loops

Can anyone give me recommendations on purchasing surgical loops? What magnification is needed for foot surgery?

Patrick Barnes, DPM, Council Bluffs, IA

Query: Post-op Cast Applications

In order to get reimbursed for post-op 'subsequent to the original cast applications' in the office (procedure: post-proximal metatarsal osteotomy), must one bill for the original cast applied in the operating room (which is part of the procedure reimbursement), and get a denial? Or is there a modifier to signify that a cast was already applied 'initially' as part of the surgical procedure, and others applied in the post-op period are subsequent cast applications?

John Moglia, DPM, Berkeley Hts, NJ

Response: No, you don't need to bill for the initial cast application in order to be paid for the subsequent ones. By definition, the initial one is bundled into the surgical procedure, and therefore reporting it just to get a denial would actually be considered "unbundling!"

I suspect, if you're getting denials for the subsequent cast applications performed during the global period, that the carrier is expecting that you bill the subsequent cast applications with a "-58" modifier to indicate it is a "staged" or "planned subsequent" procedure.

In other words, you don't need to tell the carrier a cast was previously applied. What you need to do is tell them the circumstance that is requiring another "procedure" during the post-op period - something that modifier "-58" accomplishes for you.

Joan Gilhooly, CPC, CHCC, Deer Park, IL

Codingline subscription information can be found here

RE: Disposal of Narcotics (Todd Rotwein, DPM)
From: Barry Block, DPM, JD

The following should not be construed as legal advice. Disposing of narcotics is not a simple matter, as federal and state laws generally apply. In the past, physicians were required to mail these drugs to a DEA special agent. This policy has changed. Many states, such as New York allow on-site destruction as long as the destruction is witnessed. It’s best to check with a healthcare attorney or the state health department in your state to make sure that you comply with all necessary regulations.

RE: Time for Single Board Certification
From: John Chisholm, DPM

I hope that the time is right for APMA to finally deal with the problems of dual certifying boards. I firmly believe that having one board for podiatric medicine and orthopedics and another for surgery harms our profession in the long run. Both the public and our allopathic colleagues are confused by our certification process. It sets us apart from other medical specialties. And that's a bad thing.

I know this topic has been covered well in this forum in the past, and I am aware of the problems of disparate training and experience throughout our profession. But we should look to the future, not the past. All newly graduating residency trained podiatrists are complete foot and ankle specialists. There should be a clearly defined path to certification in podiatric medicine and surgery, just like all the other medical specialties. In time, hopefully by 2015, most of the practicing podiatrists will have training in all aspects of podiatric medicine. We, as a profession, should have a single certifying board NOW to welcome these new practitioners into the community of physicians and surgeons. And now seems to be a good time for APMA to start the process.

John Chisholm, DPM, Chula Vista, CA, dr_triguy@yahoo.com

RE: NY Podiatrist Overbilled State: Audit
From: Multiple Respondents

The other way to solve this “problem” is that if you know for sure the podiatrist down the street is routinely waiving deductibles and co-pays, why not turn them into your state APMA component. Let the association discipline the practitioner, as this is obviously a known departure from ethical practice.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

As stated in the article: "Reimbursements for out-of-network providers are typically 77 to 83 percent higher than for network providers..." Who has not submitted their letters of resignation from all the networks yet? Just say no.

James Korponay, DPM, New York, NY, JKorponay@aol.com

Insurance companies are not much different than Wall Street and the now hurting Big 3. They do not operate in efficient manners and there is certainly corruption. To think that they would employ policies that save the system money is just not logical. The delay tactics and their unwillingness to pay for procedures and services is obvious.

One of the biggest mysteries of the insurance companies is the policy of only paying 50% of the bilateral cases and then continuing to reduce fees the more work you do. Do we not do the same work on the first digital fusion as we did on the sixth one? We could be in our office seeing patients rather than spending another hour getting 75 dollars for a hammertoe fusion. This invites doctors to avoid bilateral surgery at all costs (pun intended). This then generates a whole new set of hospital and anesthesia fees (contralateral surgery) of around 4-7 thousand. Multiple this by 30 per busy podiatrist per year and it is in the multiple millions that could be used for better reimbursement for us.

So to assume that an insurance company is looking to make smart changes that help both them and us is not reality. It will only become reality when enough people reach the boiling point and we have a nationwide sickout or have a class action lawsuit against the insurance companies to get what is fair. What is it going to take for us to band together to make this happen? How low must we go? Somehow the radiologists have figured it out with their average 350K per year and 12 week’s vacation and benefits.

Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

ASSOCIATE POSITION –GEORGIA

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 part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ISO CONSULTING/MANAGERIAL OPPORTUNITIES FLORIDA

Established practitioner, with extensive clinical and practice management experience, is retiring to Florida, and is seeking consulting/managerial opportunities within podiatry or in general health care in the Broward County/Palm Beach County area. Could also provide expertise in product/educational development. Please email responses to retiredpod@gmail.com

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we’re in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

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

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

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