The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 23, 2009 #3,734 Publisher-Barry Block, DPM, JD

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IN Podiatrist Encourages Students to Consider Podiatry as a Career

Crown Point podiatrist Michael Nirenberg recently spoke to Indiana University students about careers in podiatric medicine. Professor Atilla Tuncay, a heath professions adviser for the university, arranged Nirenberg's visit with the students.

Dr. Michael Nirenberg

Nirenberg, an American Podiatric Medical Association student mentor, helps educate young people on the benefits of choosing to become podiatrists. With the population aging and most Americans living longer, the need for more podiatrists is greater than ever, Nirenberg told the students.

Source: Gary Post Tribune [12/21/09]

Unlicensed TX Podiatrist Pleads Guilty to Healthcare Fraud

A former employee of a foot care clinic in Pharr/San Juan has pleaded guilty to health care fraud. Manuela K. Alana, 40, of Pharr, pleaded guilty to submitting false and fraudulent claims to both the Medicare and Medicaid healthcare programs for payment of services performed as an unlicensed podiatrist today before U.S. District Judge Randy Crane.  

Alana was indicted in September 2009 along with the licensed podiatrist who owned and operated the Valley Medical Foot Care in the Pharr/San Juan area. Alana admitted that from April 29, 2006 through May 6, 2006, claims totaling approximately $17,069 were submitted to both Medicare and Medicaid for podiatric services that falsely claimed the licensed podiatrist had performed the service when, in actuality, Alana - an unlicensed and unsupervised podiatrist - performed the services.

Overall, since August 2004, more than $536,000 was submitted in false and fraudulent claims to both Medicare and Medicaid for podiatric services performed by Alana. Alana faces a maximum punishment of up to 10 years in prison and a fine not to exceed $250,000 at sentencing which has been set for March 9.

Source: Brownsville Herald [12/21/09]

AMA Backs Senate Healthcare Reform Bill

The nation's largest physician lobby officially supports the Senate's health reform package—which cleared key hurdles over the weekend—after it won assurances from lawmakers that they would work to craft a long-term solution for Medicare payment come January 2010. Appearing with Senate leaders, Cecil Wilson, president-elect of the American Medical Association, cited a number of health insurance and other provisions that stress wellness and prevention as some of the reasons it would back the bill.

Part of the association's support is based on lawmakers shaping a long-term fix to the Medicare payment formula. “We had said from the start that we would not support another temporary fix,” Wilson said. Congress has passed and President Barack Obama has signed a temporary measure to stave off the cuts until late February 2010.

Source: Matthew DoBias, Modern Healthcare [12/21/09]

Holiday Sock Tree

I adopted a tradition in my office that I think I first learned about from PM News a number of years ago. This has been in our office for about six or seven years now. We put up our tree and the train set underneath. When patient bring in socks to donate, we run the train and blow the whistle. It's become such a well-ingrained tradition in our office, that we still have patients who are not active coming to bring socks for the tree every year.

Holiday Sock Tree

Socks go to three separate charities according to age group; one to a pediatric care center, one to a youth halfway house, and the adult socks to a senior center. This year, we added Beanie Babies and some teddy bears. This turned out to be a heartwarming part of the holidays for me, my staff, and our patients.

Andrew Levy, DPM, Jupiter, FL

Query: Sammy’s EMR

Our practice is happy with Sammy's Software and considering upgrading to their EMR package. I would appreciate if practices currently using Sammy's EMR would share their experiences concerning Sammy's Software's ability to interface with digital x-ray systems.
 
Gary Hoberman, DPM, Chicago IL

Query: Hallux Valgus Repair

We are trying to the locate the appropriate code(s) for a hallux varus repair by capsulotomy and Mini-TightRope.

Joy Constanzo, Billing Supervisor, Office of Kirk Koepsel, DPM,
Houston, TX

Response: There is no specific code for this service. You should bill for the actual procedure(s) performed. It this case, your options could include CPT 28270 which is capsulotomy metatarsal-phalangeal joint, or CPT 28313 (reconstruction angular deformity of toes, soft tissue procedure only).

There is no code for the TightRope use. It is a product used in the primary repair procedure. If you feel the work done was significant enough, append a "-22" modifier. The op report should clearly document that work. Be sure to include a letter of explanation.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
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RE: Mal Perforans-Like Ulcer (Alan Berman, DPM)
From: Multiple Respondents

I would first suggest taking a deep culture both aerobic and anaerobic to make sure the wound is not currently infected. Assuming it is not, and the patient is medically stable, I would use a plantar approach, and perform an arthroplasy on the head of the proximal phalanx. Next, I would send one piece of bone for a biopsy and another for C&S. You may still want to place the patient on an antibiotic as a preventive measure until you get the results of the pathology and microbiology studies.
 
Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

Yes, you should be able to access laterally from a medial approach, and excise the excess scar tissue that you encounter. If you don't trust the patient to stay off of it, I would avoid a plantar incision.

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

First of all, if you have a patient who refuses the use of supportive modalities that are needed for his medical condition, I would adamantly include them as part of the treatment, with or without surgery. If the patient still refuses, kindly refer him/her elsewhere.

That being said, Dr. Dockery published an excellent book: Lower Extremity Soft Tissue & Cutaneous Plastic Surgery that should help you select the proper plantar approach and closure.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: Post-Operative Tremor S/P Metatarsal-Cuneiform Exostectomy (Sloan Gordon, DPM)
From: David Tarr, DPM

I’d get an EMG/NCV. This tremor could possibly be due to compression of the nerves from the tourniquet? Maybe it’s just psychological.

David Tarr, DPM, Lowell, MA, tarrdpm1@aol.com

RE: Handling Office Emergencies (Bryan C. Satterwhite, DPM)
From: Dave Williams, DPM, Chris Browning, DPM, RN

Texas does have a Good Samaritan Law. Here it is: Texas Good Samaritan Act Article 6701d, Vernon's Civil Statutes ; Chapter 74, Civil Practice and Remedies Code Section 74.001

LIABILITY FOR EMERGENCY CARE
 (a) a person who in good faith administers emergency care at the scene of an emergency or in a hospital is not liable in civil damages for an act performed during the emergency unless the act is wilfully or wantonly negligent.
(b) This section does not apply for care administered:
    (1) for of in expectation of remuneration;
    (2) by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration;
(3) by a person who regularly administers emergency care in a hospital or emergency room; or
(4) by an admitting physician or a treating physician associated by the admitting physician of a patient bringing a health-care liability claim.

Dave Williams, DPM, El Paso, TX, drdave@runninbunion.com

I have one of those fancy emergency kits with the instructions on the lid for each drug. I pay $150+ renewal fees yearly because the drugs expire, and the manufacturer sends new drugs every year. We have had nothing more than a few falls, one minor seizure, a couple of hypoglycemic episodes, etc. We've had no cardiac arrests occur in our office, but I hear that this happens every couple of months at the...

Editor's note: Dr. Chris Browning's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=31399&start=1

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.

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

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

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

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 - 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

EQUIPMENT FOR SALE - DIAGNOSTIC ULTRASOUND

MINDRAY DP-6600 Diagnostic Ultrasound for sale. 7.5 Mhz linear transducer. Like new condition, less than 2 years old. Comes with mobile stand. Contact robdaughertyddd@yahoo.com or 573-979-1809 for further information.

PRACTICE FOR SALE – NE OHIO

Long established general practice. Grossing $300,000 annually with very little surgery. Modern, well equipped office in desirable location. Large diabetic patient base with DME. Excellent referrals with over 500 new patients per year. Great growth opportunity for surgically trained podiatrist. Owner will stay to introduce. Email: docjoc227@hotmail.com

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

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