The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 29, 2010 #4,049 Publisher-Barry Block, DPM, JD

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Nutritional Supplements Beneficial for Some Patients with DPN: MO Podiatrist

There is no cure for diabetic peripheral neuropathy (DPN). Tight control of blood sugar will reduce symptoms, but it is not a guarantee of success. "Multiple medications are available for diabetic neuropathy. These medications are designed to control the painful symptoms of neuropathy. They do not cure the condition and do not reverse loss of feeling," says Dr. Jeffrey Boberg, a podiatrist on staff at SSM DePaul Health Center.

Dr. Jeffrey Boberg

"The B vitamins, vitamin D, and a nutritional supplement called alpha lipoic acid have been shown to be beneficial for some patients. Other therapies such as nerve stimulation, infrared light therapy, and surgical nerve decompression appear to be of limited or no value," said Boberg.

Source: St. Louis-Post Dispatch [12/27/10]

Podiatrist and Son Team Up With Panasonic to Introduce 3-D Video Camera

Dr. Gary M. Lepow and his son, Dr. Brian D. Lepow, a podiatric surgical fellow at the University of Arizona’s Southern Arizona Limb Salvage Alliance (SALSA) have teamed with Panasonic to introduce a new three-dimensional video camera and have become the first surgeons to film a live surgical procedure in 3-D. 

(L-R) Dr. Brian D. Lepow, Michael Bergeron (Engineer for Panasonic 3-D program, and Dr. Gary M. Lepow

All participants felt that this emerging technology will significantly improve the teaching of students, residents, and surgeons in all specialties. The Lepows are looking forward to having large groups of surgeons experience viewing the 3-D surgical videos at an upcoming national conference in early 2011.

Pain Contracts Can Undermine Patient Trust, Critics Say

As the misuse of opioids has grown, more physicians have urged patients to sign so-called pain contracts in an effort to prevent medication diversion. But these contracts, also called opioid treatment agreements, can be used indiscriminately and harm rather than enhance the physician-patient relationship, according to an article by a panel of physicians and pain-policy experts in the November issue of The American Journal of Bioethics.

"It is not that any of us disagree with the notion that agreements can, in fact, be very helpful in certain circumstances," said Myra Christopher, co-author of the article. She noted that patients with a history of substance abuse or mental illness may be aided by documents that inform them of the risks and benefits of opioids and set out a care plan. "But," she said, "what is becoming common practice in many pain specialty clinics is using a pre-printed, standardized form that says, 'If we're going to treat or prescribe controlled substances to you, these are the conditions under which we'll do so -- and sign this document, and if you fail to do so, then we'll fire you from our practice.'"

Source: Kevin B. O'Reilly, AMNews [12/27/10]

End The Year on a High Note - Part 1

As you approach the end of another year, take time to reflect with your staff on the events that affected you and your practice, acknowledging the good as well as the bad. Gear your team up for a successful 2011 by resolving to put past mistakes behind you and by focusing on building on 2010’s successes. Turn the page on this year, and set your sights on a bright future using the plan outlined in this series:

Start With the Good

Encourage an enthusiastic mood among staffers by asking them to reflect on the year’s positive developments. During a meeting, ask each person to list one professional accomplishment or event. Do not allow anyone to abstain from listing a positive, but do allow people to “pass” temporarily if they need time to think.

Source: Communications Briefings [December 2010]

RE: Registration for Meaningful Use

Registration for the Medicare and Medicaid EHR Incentive Programs begins on January 3, 2011. You should register for the EHR Incentive Program as soon as possible. You are permitted to register even before you have a certified EHR. Register, even if you have not completed the enrollment in PECOS.

To register, click here.

Michael Brody, DPM, Commack, NY  

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Ethical Dilemma About Miscoding Routine Foot Care (Name Withheld)
From: Dennis Shavelson, DPM

As long as DPM’s continue cutting toenails and billing for them under insurance (without being exposed), we are sheltering them from needed change. These DPM’s remain too comfortable in their ways, preventing them from taking the leap to respectable professional and legal ways to care for the foot-suffering public.
 
Medicare and the State Boards already know about the situation and can create a mass scandal, tarnishing podiatry when they are ready to do so. Name Withheld (and all of us) being compassionate enough to not want to expose this loaded smoking gun in our profession for the sake of not wishing to punish those committing fraud, are making a mistake by not addressing this issue.
 
Perhaps, we should set a 6-month moratorium, allowing RFC DPM’s to develop a plan for the future that eliminates their criminal activity, and replace it with payment by the patient for RTF, and the addition of new income streams. Let’s clean our house of this festering problem before it tarnishes our name and reputation deeper than it already has.
 
Dennis Shavelson, DPM,  NY, NY, drsha@lifestylepodiatry.com

RE: X-Ray Comparison (Michael Forman, DPM)
From: Multiple Respondents

With regard to digital x-rays, the original question, I believe, asked about residual payments, etc. Most systems to my knowledge do, in fact, carry support fees for their systems. I currently use ICRCO's system and I love it. I believe that my yearly support fees are something in the order of 850 dollars. At the time of purchase, this was not told to me. I was surprised when I was sent a bill, as this was something I clearly asked of my salesperson. Having said that, the support is there when I need it, and I am happy with my purchase.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

I had the same concern regarding digital x-rays: cost! In January 2009, we purchased a A2D2 Digital System. I have never been happier with my purchase. It has made my practice extremely efficient. The patients are impressed with the digital images, and now I am able to email, print, measure angles, burn DVD's for the physicians and patients. No more storage problems or searching for lost films. Great support from this company. Don't think twice about this purchase--DO IT!!

Brad Katzman, DPM, Ontario, CA, bkatzman2@earthlink.net

I have not gone digital yet either, and in my analysis, I cannot save money. You do save by not buying film. Maintenance and chemicals for your processor are also gone. Depending on how many films you take and your monthly processor costs, you may lose money, break even, or come out ahead. You do get somewhat better pictures since you can change contrast,  etc.

What burns me is the advertisements stating how, "I made my money back in a year. I take x-rays I never would have taken before."  Well, either those docs are now taking unnecessary films, or in the past, they didn't take an x-ray when they should have. Both are medically and morally wrong. Having said all that, when my processor does finally break down, I will probably go digital at that time.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Parts for Universal X-Ray Machine
From: Jeanne M Arnold, DPM

We had a similar problem with one of our podiatry chairs. There was no local rep or service tech in the area, so I called a local dental equipment repair company. They came to the office and had the screw replaced in 10 minutes. 

Jeanne M Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

RE: PECOS Phase II Delay on CR 6421
From: Paul Kesselman, DPM

A few weeks prior to Thanksgiving, CMS announced that the implementation of ordering/referring/prescribing (AKA PECOS) edits for home health-related services was not subjected to the phase II edit deadline of January 3, 2011. This deadline would be delayed until July 5, 2011. That “Turkey” of an announcement was then followed the day prior to Thanksgiving by the  announcement that PECOS edits for medical/surgical/DME prescription medications would not be implemented on January 3, 2011. However, no date for implementation was provided. The first announcement was quasi-legal, the second was contrary to several ACA and CMS regulations, as no alternative deadline was offered.

Today, CMS finally implemented its own rules by offering a “placeholder” date for implementation of phase II as July 5, 2011. This deadline for medical/surgical/DME prescription drugs coincides with the aforementioned date for Home Health PECOS edits. “Placeholder” designation indicates CMS has not set a firm date for implementing Phase II edits.  But because CMS cannot leave the date open-ended, this announcement simply fulfills a statutory requirement.

The reason for these snafus is that  both CMS and the MACs underestimated the logistics necessary to enroll all eligible prescribers into the PECOS database. It’s the law of unintended consequences. Are you confused? Most Medicare carriers and providers are, I dare say; so are many administrators at CMS. Simply stated, if CMS cannot properly develop and explain policy and then implement and follow their own rules, how are the Medicare carriers and providers expected to? Any private business following CMS’s current philosophy would quickly find themselves out of business.

Paul Kesselman, DPM, Woodside, NY,  pkesselman@pol.net

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate with PM and S-36 training. Independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary. Email CV to: JLH459@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - CHICAGO

Weil Foot & Ankle Institute, Des Plaines, IL (www.weil4feet.com) is seeking associate position in summer 2011. This 15 member podiatric medical and surgical group is internationally acclaimed. Twelve locations throughout Chicagoland, with a 3 operating room surgery center, MRI’s, computerized footprint analysis, orthotic and brace laboratory, radiofrequency coblation technology, extracorporeal shockwave devices, PRP and clinical research program. Successful candidate will have completed a 3-year residency, experience in wound care, trauma, and sports medicine. Competitive salary, bonuses commensurate with experience and training. E-mail letter of interest and CV to Harriet Kass, HR, hkass@weil4feet.com 847-390-7666

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - CT (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume and current photo to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-5984 or e-mail to mets724@gmail.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well-established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

PRACTICE FOR SALE - BOSTON, MASSACHUSETTS

40 year old updated practice with outstanding potential. Within 5 miles of Boston hospitals and 5 blocks from train station. Buy the practice, equipment and goodwill for a reasonable price. Excellent opportunity for resident or second location for practicing podiatrist. Multiple referral sources. Email vshdeep@yahoo.com

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