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December 07, 2006 #2,759 Editor-Barry Block, DPM, JD

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Duct Tape Has Placebo Effect for Warts: IL Podiatrist

Sticky duct tape, the wondrous all-purpose fixer, is used in everything from auto and spacecraft repair to fashion. Though largely considered one of those wacky "folk remedies," duct tape stuck it to liquid nitrogen in 2002, when researchers found it outperformed the conventional treatment. And even though the study quality was later criticized - and many common warts disappear within a year or two without treatment - self-respecting dermatologists continued recommending it as a safe, painless treatment, especially for children.

Dr John Grady

Oak Lawn, IL podiatrist John Grady, who often fields questions about duct tape, said it's the placebo effect. "A small percentage spontaneously resolve, and people think it's what they put on the wart," said Grady, a fellow of the American College of Foot and Ankle Surgeons. "But it would go away anyway. The truth is, placebos work well in wart treatment."

Source: Julie Deardorff, Chicago Tribune

Reversal of Medicare Payment Reduction Possible

Congress this week might approve a provision that would reverse a scheduled reduction in Medicare physician reimbursements, according to legislative aides, the Washington Post reports (Weisman, Washington Post, 12/3). Legislative aides said lawmakers this week -- likely the final week of the 109th Congress -- might attach the provision to tax legislation (Washington Post, 12/3).

The legislation has "been tied up in disputes over other legislation all year" and might "run into trouble again if lawmakers try to use the package to gain approval of more controversial items," the New York Times reports (Hulse, New York Times, 12/4). According to a Republican aide, the provision on Medicare physician reimbursements likely would maintain current rates for one year, although a 0.5% to 1% increase is possible.

Source: American Health Line [12/5/06]

Policy Groups Try to Prevent Medicaid Cuts

Healthcare policy groups in Washington made 11th hour efforts this week to stop the Bush administration from cutting Medicaid by billions of dollars through the regulatory process. No one knows what’s going to be in the regulations, “but it could include the entire $12.2 billion cut the administration proposed in its budget earlier this year,” said Susan Feeney, a spokeswoman for the American Health Care Association.

The CMS could specifically act to cut the state provider tax program from 6% to 3%, said Bruce Yarwood, president and CEO of the AHCA. “It’s not clear that CMS has the legal authority to do this,” Yarwood said.

Congress would likely use a tax-extender bill to stop the cuts, although chances are low that the lame duck session would be able to block the regulations, Yarwood said. Proposed regulations could be issued as early as Dec. 8 and implemented next spring, he said. A CMS spokeswoman said there was no specific implementation date for the regulations.

Source: Jennifer Lubell, Modern Healthcare [12/5/06]

Query: Silicon Injections

Now that the FDA has re-allowed use of Silicon implants, is there any hope that we, as podiatrists, can someday be allowed to inject silicon? I did send a number of my patients who could afford the trip down to Dr. Balkin who, until he recently retired, injected silicon. All the patients where happy with the results allowing them to resume activities that they prevously could not participate in due to plantar foot pain usually from atrophy of the panniculosis.

Jim Fisher, DPM Eureka, CA

Query: NPI Source

NPI's will replace UPIN's next spring. There is an on-line source for locating UPIN's by Name/State called www.upin.ecare.com Does anyone know of a similar NPI source in the works?

Robert K. Hall, DPM, Ft. Lauderdale, FL

Query: Geographical Changes in 2007 Medicare Fee Schedule

In the 2007 Medicare Fee Schedule have there been any geographic conversion factor adjustment changes for any particular locations?

Paul Kesselman, DPM, Woodside, NY

Response: The Georgraphic Practice Cost Indices or GPCIs (pronounced 'gypsies') is means of adjusting geographic Medicare payment rates to account for resource cost differences in providing physician services [the relative value of which is determined by work, practice expense, and malpractice components]. Medicare reviews the GPCIs every 3 years, and adjusts them based on their review. The next overall GPCI revision and implementation is scheduled for January 1, 2008.

The Medicare Modernization Act established a "floor" of 1.0 for the work GPCI for any locality where the GPCI would otherwise fall below 1.0. Beginning January 1, 2007, Medicare will drop the 1.0 floor of the work component. While this will not have an effect on most localities, those that were "supported" at the 1.0 floor when, in fact, their actual work GPCI was less than 1.0 will not be supported after January 1, 2007. Translation: the affected areas will have their Medicare reimbursements additionally reduced because of a lower work component GPCI factored in to their formula for Medicare payments. While page 69655-69656 of the December 1, 2006 Federal Register includes a complete list of payment localities with negative percent change with the removal of the 1.0 work floor, here are some of the included payment localities:

South Dakota, North Dakota, Montana, Wyoming, Nebraska, Puerto Rico, Arkansas, Mississippi, Oklahoma, Iowa, Idaho, Virgin Islands, Vermont, Kentucky, New Mexico, North Carolina, West Virginia, South Caorlina, Utah, Tennessee, Virginia, Alabama, Indiana, Colorado, Wisconsin, Arizona, Minnesota, New Hampshire, Ohio, and Beaumont, Texas. And, yes, there are other localities which may represent part of a state that were not mentioned...

Harry Goldsmith, DPM, Cerritos, CA

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RE: Cutaneous Fibromatosis Considerations (Paul Kesselman, DPM)
From: Tip Sullivan, DPM

I have very rarely found it appropriate to perform an arthroplasty on a second digit when there is a concurrent HAV without repairing the HAV. I do not understand the reasoning behind staging this due to concerns of opening a “closed sterile area.” Those are the types of areas I like to open. With regards to “cutaneous fibromatosis” I could not find a lot on perioperative considerations in the brief literature search that I did. I have treated several pts with cutaneous forms of neurofibromatosis. I hope someone would be able to help—I am not sure if these pts are at higher risk of developing incisional fibromas/keloids/hypertrophic scars etc. It should be interesting to hear comments.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Medisoft 1500 Form Upgrade Fee
From: Bill March, DPM

When the HIPAA policy went into effect, we had to update our software to be in compliance. This required new hardware to handle the "better" and "secure" version of a system which worked very well for years. After spending many thousands of dollars on the upgrades and countless hours learning the new system, we are informed we all need new NPI numbers which need to be inserted in a new block on a new 1500 form.

Guess what? The new 1500 form is not yet available on the latest Medisoft version, and users of less than the latest version must upgrade to get it when it is "ready." Could they supply a quick download of the new form for all versions? I bet it would be easy. The upgrades for this are over $1500.

If the old ID numbers are gonna be obsolete, would it not make sense to just put the new number in the old block? This could be accomplished in a minute at no cost. No new forms for paper users, no upgrades for electronic users. Maybe everyone thinks we have so much income that this is no big deal. I don't mind spending my hard earned money to buy new equipment, improve my practice or help my patients, but these changes have been expensive, time-consuming and ill-conceived.

Bill March, DPM, Cherry Hill NJ, Footwise51@aol.com

RE: “Floating” Toe Post-op Osteotomy (F. Don Chantiles, DPM)
From: Michael Lawrence, DPM

I would again recommend making a "V" cut in the plane of weight bearing, doing so with an apical axis guide. This is inherently more stable, removing the rotational aspect, and being equally easy to fixate. Try this on some saw bones, it is not technically difficult. Correction for shortening is regulated by how much you slide posteriorly. Dorsal displacemnt can be altered by feathering the cuts.

Michael Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0027.

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location 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

ASSOCIATE POSITION- MEMPHIS, TN

30 year-old, high volume, multi-office practice in Memphis, looking for 24-36 PSR trained individual. Good opportunity for reconstructive surgery and wound care. No nursing homes or weekends. Potential partnership opportunity. Contact Footdok4@gmail.com.

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