The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 14, 2011 #4,331 Publisher-Barry Block, DPM, JD

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Tis the Season for Holiday Foot Injuries: FL Podiatrist   

Boca Raton podiatrist Dr. Bret Ribotsky sees it every holiday season -and this year has been no different. From just prior to Thanksgiving to just after New Year's, Ribotsky notes that his practice treats significantly more patients suffering from various - and often preventable - foot, ankle and lower-leg injuries. The reason? 

Dr. Bret Ribotsky

"The holiday season itself creates numerous risk factors that most people never consider," Ribotsky explains. For instance, Ribotsky has coined what he calls the "Butterball break." That is, in preparation for large Thanksgiving and/or Christmas dinner parties, would-be hosts are handling (likely for the first time in at least a year) 15- to 20-pound frozen turkeys and/or hams. "They're working with what are, essentially, bowling balls," Ribotsky says. "Every year, I treat people who drop them on their feet."
 
Source: Steve Dorfman, Palm Beach Post [12/12/11]

OCPM Podiatrist Offers Shoe-Buying Tips

Wearing gels or Foot Petal inserts under the ball of your foot can buy you a little time with less pain, but just a bit. If you plan to use inserts, make sure the shoe's toe box is roomy enough to allow for them, says podiatrist Dr. Marie Blazer, at the Cleveland Foot & Ankle Institute of the Ohio College of Podiatric Medicine.

Dr. Marie Blazer

Many people are wearing the wrong shoe size, says Blazer. Either they always have, or they haven't learned or accepted that their shoe size has changed. "Go to a mom-and-pop shoe store and get your foot measured," she says. "That's the only way you'll actually know. If you wear too small a shoe, you'll get corns on your fifth toe."

Source: Evelyn Theiss, The Plain Dealer [12/12/11]

FL Podiatrist is First DPM Appointed as Osteopathic Medical Board (COMLEX) Test Writer

Leonard A. Levy, DPM, MPH, Associate Dean for Education, Planning and Research/Professor of Family Medicine/Public Health/Biomedical Informatics at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale has been appointed a member of the test committee of the National Board of Osteopathic Medical Examiners (NBOME).

Dr. Leonard Levy

Dr. Levy will be writing test items for the Colleges of Osteopathic Medicine Licensing Examination (COMLEX) in the area of Health Promotion and Disease Prevention and Health Care Delivery. He is the first podiatric physician to be appointed to COMLEX. His first session writing questions was on December 9 and 10 in the Chicago office of NBOME. The COMLEX examination must be satisfactorily completed by all graduates of osteopathic medical schools to obtain a license to practice osteopathic medicine in every state in the nation.

Medicare Auditors Target Place-of-Service Codes

Medicare auditors are bearing down on place-of-service errors at the same time that hospitals are spotting POS problems on their own. Mistakes in this area could cause overpayments and jeopardize the status of provider-based entities. Payment accuracy hinges on physicians informing Medicare where they provided the services, which is where POS reporting comes in. Three codes take center stage: POS code 11 (offices), POS code 21 (hospital in-patient departments), and POS code 22 (hospital out-patient departments, such as provider-based entities).

Using the wrong place-of-service code triggers overpayments because Medicare Part B pays more for certain physician services when they are provided at offices or free-standing clinics rather than at hospital departments, including provider-based entities. The reason: professional fees include overhead when services are provided at practices and freestanding clinics. But Medicare Part B reduces professional fees when physicians treat patients in out-patient departments, because hospitals foot the bill for overhead and recover the money through APC payments for facility fees.

Source: Nina Youngstrom, Report on Medicare Compliance [12/5/11]

Bill Would Require Medicaid to Pay Promptly

Reps. Brian Bilbray (R-CA) and Anna Eshoo (D-CA) have introduced legislation that would require the Medicaid program to reimburse all providers—including nursing facilities, hospitals and community health centers—in a more timely manner.

The bill, known as the Fair Pay to Medicaid Providers Act (PDF), would extend to these healthcare providers a provision that requires Medicaid to reimburse 90% of claims to physicians in 30 days and the remainder within 90 days, according to Eshoo's office.

Source: Jessica Zigmond, Modern Healthcare [12/12/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters

Bret Ribotsky: What are your feelings about having one certifying board? 

Dr. Gerard Saponara

Gerald Saponara: I think that, in the past, we were really never ready to consider one board until there was one training model, which now we pretty much have. I sense that, down the road, there might be a coming together of the boards, allowing people to take their certification in either ABPOPPM or ABPS. It would be maybe one umbrella organization with two separate certification processes under it because your practice patterns should dictate whether you’re board certified in surgery or you’re board certified in orthopedics and primary medicine. 

Dr. Robert Chelin

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is Dr. Robert Chelin, Past President of the  the Federation of International Podiatrists (FIP). You can register for future events by clicking here

Query: Removal of Accessory Ossicle

What is the code for removal of an accessory ossicle (hallux)?

Anna Sanders, Clarksville, TN

Response: I recommend using: CPT 28315 - sesamoidectomy, first toe. While it may not be an exact descriptor, in my opinion, it is close enough to justify this code for the procedure you have described.

Howard Zlotoff DPM, Camp Hill, PA

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RE: Botox for Spastic Contractures (Ray McClanahan, DPM, BS Ed)
From: Brian Kiel, DPM

I have a 70 year old, caucasian female with significant MS symptomatology. She presented to my office with a  contracted, painful right hallux. There were no lesions, and the patient uses a wheelchair. The pain was constant. The contracture was manually reducible, and we tried several splints with no improvement. After looking in the literature and finding nothing, I spoke to her neurologist who felt that there was no reason we could not use Botox. I did explain to her and her husband that the chances of success were unknown.

Using a Tens unit to help identifiy the trigger point of the EHL, I injected 100u of Botox into the EHL muscle. In less that 5 days, the hallux was straight and painless. As of this date, it is still so. Obviously, this is a one time situation, but I and the patient are prepared to re-inject if necessary.
 
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Life-long Maintenance Regimen for Onychomycosis (Bryan Markinson, DPM)
From: M. Turlik, DPM

It was with great anticipation that I read Dr. Zaias’s study as referenced by Dr. Markinson in an earlier post. With all due respect to Dr. Zaias, an international expert on nail disease, and Dr. Markinson, a noted the podiatric expert in dermatology, I do not think that the authors' conclusion in the study is supported by the methods used to gather and analyze the data. The authors describe the design of the study as “a prospective, non-randomized, open study of sequential groups of office patients.” This type of study design does not allow for control of several types of biases which are encountered in therapeutic studies.

In general, this type of study lacks validity and results in an over-estimation of treatment effect. Case reports and case series are seen as hypothesis-generating rather than hypothesis-confirming studies. The correct conclusion should be that terbinafine may be an effective treatment for DSO when pulse-dosed for 7 days every 3 months, but not every 4 months. This needs to be confirmed in a more rigorous trial design.
 
Medicine has moved away from an expert-based system towards an evidence-based system. This movement will only increase in the future. Therefore, it is important for podiatric physicians to critically analyze the data which experts and opinion leaders utilize to make treatment recommendations. This becomes even more imperative when the expert declares a financial conflict.
 
 M. Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Allscripts Vendors are Not Created Equal (Scott Hughes, DPM)
From: John Parmelee, DPM
 
I purchased AllScripts My Way through COSTCO about 3 months ago. They use eTransmedia for their support that is based in New York. I got a much better price through COSTCO than through the local reseller in the Seattle area. The system is not podiatry-specific and requires many hours (100+) of customization. I did my homework and talked to a few practices that were using My Way/eTransmedia, and all seemed good until we started training. The training is online. 

We have two trainers who often did not know what the other one covered. The training jumped all around and did not follow any logical work flow. There was a lot of redundancy, and often conflicting information was given between the trainers. One support person said our 12 year old Lexmark printer would not work, and another was able to modify the settings and get it to print the HCFA forms correctly.

There is no training manual, so we were frantically taking notes while being trained. We had to use the mouse to navigate through the program while trying to take notes. We went live 2 weeks ago but still have billing problems with two of our biggest insurances- Medicare and Premera. I think the program is good, but the training could have been a lot better with much less stress on me and my staff. I had to type our training notes and spent hours rearranging them in a logical sequence. 
 
John Parmelee, DPM, Seattle, WA, parm15@msn.com

RE: MN Podiatrist Supports Statewide Single-Payer Health Insurance System (John Moglia, DPM)
From: John F. Swaim, DPM

The reasoning is flawed on the subject of healthcare being a right and not a privilege. There is a law in the United States that states that any soul entering an emergency department must be seen. This creates a problem, yes? Visits at the ER in Red Bluff, CA start at $775 and go up, depending on tests and treatment. So, you understand that a few of these admissions a day times, seven days a week, becomes a problem and quickly amounts to hundreds of thousands of dollars. I won't mention the Medi-Cal group and lower reimbursements. So, when the hospital takes into account these losses and extracts their 9 to 11% increase annually from Blue Shield, that fine company reaches across the street to dear old Dr. Swaim's pocket and extracts another 12 to 18% per year out of his pocket.

Over the decade last, Dr. Swaim's pocket is becoming empty. What to do? So Dr. Moglia, you are in denial concerning this matter; healthcare is a right in the U.S. If you don't like it, you need to fight for institution of medical bill debtors' prisons and repeal of the care laws that require emergency rooms to accept anyone who can crawl in through their doors. I'll stand beside you waving the flag!

John F. Swaim, DPM, Red Bluff, CA, podtexdoc@aol.com

Codingline & PM News
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The Greenbrier Coding & Practice Management Workshop
(Following the 2012 APMA Annual Meeting in Washington, DC)  August 20-22, 2012

The Greenbrier

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EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER (LUMIX2)

Superpulse 45 watt peak power Laser (lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPM footcare@comcast.net

EQUIPMENT FOR SALE - LASERSCOPE LASER SYSTEM

Laserscope Model Lyra i YAG Laser system with 3 handpieces, eyewear sets, calibration unit, complete manual, foot control and video information, for fungus nails, vein therapy and hair removal. The unit has the attached cooling system and all accessories. flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be a PSR-24 or PM&S-36 trained. 100K start. Must be ethical, self-starter, hard worker ,team player. Willingness to learn / work as part of a team. Great ancillaries & surgery facility. Must be proficient in rearfoot/ankle surgery. Email CV and recent cases to: susmitad86@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV)to northtexaspodiatry@yahoo.com along with a letter of intent

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email:gsherwood@cinci.rr.com.

ASSOCIATE POSITION - BRONX, NY

Multi-office group seeks highly motivated, hard-working full-time associate. All phases of podiatry are performed (Surgery, Orthotics, NCV's, Vascular Examinations, DM Shoes, House Calls) in this well rounded practice. Competitive salary + malpractice insurance + bonus. Send CV to:bronxpodiatrist1@gmail.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA - SAVANNAH

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contactpistone@telus.net or call 250-754-4192.

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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