The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 09, 2009 #3,722 Publisher-Barry Block, DPM, JD

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NJPMS Sues Insurer Over Changes in Coverage

The New Jersey Podiatric Medical Society and its president, Hamilton-based podiatrist, Steve Maffei, have filed suit against Horizon Blue Cross/Blue Shield of New Jersey and one of its contractors, CareCore National, alleging that the two companies are putting their own profits above the good of patients.

Dr. Steve Maffei

The suit challenges Horizon's recent decision to stop reimbursements to its participating podiatrists for certain diagnostic tests that fall, traditionally, under the scope of podiatric medicine as defined by the state's Board of Medical Examiners. As part of an expanded relationship with CareCore, which provides radiology and other imaging services to Horizon customers, patients would be required to have these screenings, no longer covered at their local podiatrists, at hospitals or general imaging centers.

"The New Jersey Legislature has entrusted the state Board of Medical Examiners with the authority to define scope of practice, not health care insurers," Maffei said in a statement. "Acceptable diagnostic testing for the ankle and foot is clearly within the practice of podiatry."

Source: Matt Fair, The Trenton Times [12/8/09]

Cash Flow Squeeze: 2012 IRS Rule Will Withhold Some Medicare Pay

A little-known provision tucked into a 2005 tax bill requires the Internal Revenue Service, starting in 2012 at the earliest, to withhold 3% of payments to any contractor doing work for federal, state or local governments. The Medicaid program is excluded because it provides services based primarily on patient need. But Medicare, which is age-based, is not exempt.

That means physicians, hospitals and others who bill the government could receive only 97% of what they are owed from Medicare, starting in 2012. That 3% hit would be on top of any across-the-board cuts required by the Medicare physician payment formula.

Source: Chris Silva, AMNews [12/7/09]

Match Verbal and Non-Verbal Messages

Consistency builds trust. Build both by matching your words to your tone of voice and body language.

Example: When you say, “That’s great” with a smile and an excited tone, you appear to mean what you say, because your verbal message matches your nonverbal message. Yet, if you say, “That’s great” with a frown and a hesitant tone, your message is mixed and could create confusion or bad feelings. To communicate consistently in that case, instead say“I see some problems with that approach.”

Source:  Adapted from “Improving Your Workplace Communication,” Harriet Meyerson, The Confidence Center via Communication Briefings

Query: Bone Scan
 
How long after a successful midfoot arthrodesis (screws + allograft) will a bone scan continue to be "hot"?
 
Charles Morelli, DPM, Mamaroneck, NY

Query: National Pathology Services

We have been using National Pathology Service (NPS) in Pittsburgh, PA, for lab specimens. They have recently failed to return phone calls for a week or so. Does anyone know if they have closed? They have pending lab specimens on dozens of our patients. Any idea what to do?

Steven Block, DPM, Owensboro, KY

Query:  Coding a Flexor Tendon Transfer

What would be the proper code for doing a flexor tendon transfer of the second digit, left foot?

Arnold Beresh, DPM, Hampton, VA

Response: There is no specific code for tendon transfers in the foot. Therefore, I would recommend one of two options:

CPT 28285 - hammertoe correction or CPT 28899 - unlisted procedure, foot/toe (if done as an independent procedure).

Be sure to provide a copy of operative report with your bill and request peer review.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Heel Pain in Marathoner (Scott Whitman, DPM)
From: Multiple Respondents

I don't see how this patient will complete his marathon with such acute plantar fascial pain. Maybe a 5k race, but 26 miles, 385 yards? Highly doubtful. Also, why risk a fascial rupture? Any steroid injection would increase that risk, as well as just running this race. Also, why did this patient wait five months to get treated for the heel pain? That decision, for me, makes his case for running this marathon untenable.  He will be disappointed, but will not damage himself any further.
      
I have always been surprised and impressed with our profession's ability to treat heel pain with such success while the patient bears full weight on the injured part. I am also impressed with our willingness to aid athletes in the realization of their sport fantasies. This fantasy does not qualify for podiatric assistance.
 
R.D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.,com

1) Order a bone scan and/or MRI to rule out stress fracture or bone marrow edema.
2) Do not inject a steroid 5 days before a marathon because if he later ruptures his plantar fascia, you will be participating in a marathon with his attorney.
3) Do you know how to apply a really good low-Dye strap? If so, tape him, and see how  it helps his activity pain.
4) Suggest and document that you advised he not participate in this marathon due to his injury. He will not take your advice, but at least you can document the discussion.

Keith Gurnick, DPM, Los Angeles, CA, l keithgrnk@aol.com

I see this situation often. If he wants to run that badly, and often runners do, I inject 3-4 days prior to the race. I inject 1.25cc 1% lidocaine plain and 0.25cc Kenalog 40 at the origin of the plantar fascia. I explain to patients that the fascia may rupture, and by masking the pain, you do increase the risk. Of course, it can rupture without the injection. Is it good medicine? No. And you are putting yourself at risk. However, I do practice what I preach and have many similar instances where I received an injection myself.

Having run several marathons and winning a few has helped me gain many patients' trust for these scenarios. Patient education is extremely important. However, I do not inject any tendons. The fascia is essentially torn if surgery is done, so you are less likely to have any negative long-term sequelae. I do not recommend taping, as the tape often becomes loose and very irritating.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

RE: Late-Arriving Employees (Name Withheld)
From: Multiple Respondents

This is an office procedure manual issue and should be addressed there first. For many years, I did not use a time clock. About ten years ago, an employee consistently abused the privilege and did as your employees are doing. A time clock not only solved the immediate problem but was later invaluable when she attempted unemployment with Texas Workforce Commission. A successful filing against you can increase your taxes significantly in Texas. I purchased my clock and time cards at Office Depot. However, there are several online time clocks now available. As to the “best” one you might try asking PayCycle which is an extremely valuable online payroll service.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

I, too had this problem, and with a smaller office, it was hard to find a solution until I was at the APMA Convention last year. I purchased the software System "Count Me IN/Timecard Monitor." It has been a great tool and there are different levels you can buy depending on what you need. I now use it, tied into Quickbooks, to do payroll in-house. It is a sensor pad that is connected to your computer and the employees use the finger touch pad to log in when they arrive and depart; they also must clock out if the lunch is not a paid break. There are no questions since all their reports are very concise and give complete timecards. It has made even my most persistent late employee on time, since they are paid for what the time cards state.

Gina M. Saffo, DPM, Lanham, MD, drsaffo@verizon.net

We are in a recession, and there are literally millions of people looking for a job. What you can do is fire your employees who are taking advantage of your kindness and good will, and hire people who want to work for you.
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com
 

ASSOCIATE POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. Fax cover letter & CV to (843) 208-3348 or E-mail to melissafoot@pol.net
 

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.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 - HUDSON VALLEY, NY

Excellent opportunity for a three-year surgically trained foot and ankle physician. We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM with ability, and a desire to teach and take ER call. If interested, please forward CV to: healthyfeet4ever@yahoo.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 - 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 f-massuda@footexperts.com

ASSOCIATE POSITION - NASHVILLE TN

Excellent practice opportunity-associate leading to partnership for PSR-36 trained physician. Well-established and growing state-of-the-art practice located in Nashville area. Hard-working, personable, highly-motivated individual needed. Bilingual-Spanish/English a huge plus.  Great opportunity with excellent salary and benefits. If interested, forward CV to NashvilleFootDoc@gmail.com

PRACTICE WANTED- NYC/LI AREA

I am an ABPS board certified podiatrist seeking to purchase a well established practice. I am looking for the current practitioner to help with the transition. All offers will be considered. Complete confidentiality will be upheld. Please contact poddr45@yahoo.com for more information. This advertisement is not affiliated with a broker.

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

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- TAMPA BAY AREA, FL 

Excellent opportunity for a hard working, ethical and outgoing podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. A Florida license and a minimum 2-year residency are required. Salary commensurate with training plus benefits. Email CV to podiatryfl@yahoo.com

PRACTICE FOR SALE - CENTRAL SOUTH CAROLINA

Practice grossing $400,000 annually based on one full-time doctor with two offices. Surgery is currently about 10-15% but can easily be increased. Medicare makes up 52% of revenues. May be able to take over practice with no money down. Interested parties email to footdocsc@gmail.com

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