PM News –March 21, 2006 #2,537 Editor-Barry Block, DPM, JD
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-----------Debuting April 1: CodinglinePRINT
Online-----------
Codingline is pleased to announce the publishing of
CodinglinePRINT,
its monthly reimbursement, coding, and practice management
newsletter, on the Codingline site. For those who were
previously
receiving monthly copies dropped off to the office by Dermik
representatives, beginning April 1, CodinglinePRINT Online
will be
available again in the same format, filled with the same
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reimbursement, coding, and practice management information
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podiatrists, foot orthopedists, coders and staff – only now
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CodinglinePRINT Online will be available only by individual
subscription or included as an added Codingline Gold
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For more information contact Harry Goldsmith, DPM at
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---------- OBITUARIES-----------
DR. JOHN P. BERONIO died Friday, March 17, 2006, at Atlantic
Inpatient Hospice Unit in Morristown. He was 66. He attended
St.
Michael's High School in Union City and Case Western
Reserve, as
well as the Ohio College of Podiatric Medicine. He served
his
internship at St. Lukes Hospital in Philadelphia.
He began his practice in Harrison, NJ. He owned his own
podiatric
practice in Parsippany for 15 years before retiring in 1985
due to
an illness. He was president of the Hudson County Podiatry
Society,
a member of the staff at Columbus Hospital in Newark, West
Essex
Hospital in Livingston, St. Clare's Hospital/Denville, and
Morristown Memorial Hospital.
PM News policy is to request that memorial donations be made
to the
APMA Educational Foundation, 9312 Old Georgetown Rd.,
Bethesda, MD
20814.
Source: Daily Record [3/19/06]
---------PODIATRISTS IN THE NEWS--------
FL DPM is Part of Miracle Workers Team on Reality TV Show
A housepainter who has lost use of both his arm and his foot
turns
to the medical dream team for help, on "Miracle
Workers," airing
MONDAY, MARCH 20 (10:00-11:00 p.m., ET) on the ABC
Television
Network.
Miracle Worker regulars Redmond Burke, M.D. and Tamara
Houston, R.N.
worked with DR. JONATHAN M. CUTLER, DPM, Diplomate of the
American
Board of Podiatric Surgery Board Certified Foot Surgery,
Fellow, the
American College of Foot and Ankle Surgeons on Jack's case.
Dr.
Cutler completed his residency at Johns Hopkins and
practices in
Lake Worth, FL.
Lake Worth, FL resident Jack Brown is a fun loving father of
five.
On a recent job he slipped from a scaffold and shattered his
heel.
He has had surgeries on his heel, but is now dependent on a
wheelchair. With five active and growing children, Jack and
his wife
are struggling to get by. They're on the verge of losing
their home,
but support from the community is helping to keep food on
their
table and make ends meet. With advanced material that
replaces skin,
new technology may be able to repair Jack's shattered heel
Source: Reality TV Magazine [3/20/06]
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-------------PODIATRISTS AT PLAY ----------------
PA DPM is Leading Boomerang Expert
No matter how many times he throws them away, they keep
coming back.
And that's the way DR. FREDRIC MALMBERG likes it. Malmberg,
a
podiatrist who has an office in York, PA, is one of the
leading
boomerang experts and builders in the United States.
Dozens of plastic and wooden boomerangs he's collected
over the
years hang on his office walls. They're different colors
and shapes,
including the traditional banana frames and triangular and Y
and X
shapes. "It tends to be a conversation starter,"
Malmberg said. "It
sort of relaxes the patients. I have one patient who calls
them fish
bones." Several of the hanging boomerangs were built
by Malmberg,
whose work has been featured in "About Boomerangs:
America's Silent
Sport, " written by Kelly Boyer Sagert.
Besides a boomerang builder, Malmberg is a member of the
United
States Boomerang Association, which holds various boomerang
competitions. He's known for his throwing skills; he won
first place
for accuracy during a 1996 national competition. In August,
he won
first place overall at the 25th annual Boomerang
Extravaganza at
Cuyahoga Valley National Park in Ohio.
Source: Eyana Adah McMillan, The York Dispatch, [3/17/06]
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------------ MEDICAL FRAUD INVESTIGATION --------------
Numbers Detectives Sniff Out Medicare Fraud
They are an unlikely bunch to be doing detective work -
mathematicians, economists, statisticians, sociologists, at
one
point even a marine biologist. But they all have an aptitude
for
numbers, and that is the basic skill needed for the work
they do:
scouring through millions of medical claims, looking for
patterns
and anomalies that could indicate Medicare fraud. The
roughly 16
data analysts at TrustSolutions, a subsidiary of Blue Cross
and Blue
Shield of Wisconsin, have the job of finding those
aberrations.
Some of the projects are the mathematical equivalent of
fishing
expeditions, such as comparing home healthcare agencies'
claims to
the industry norm. Others are designed to investigate
specific
allegations.
The goal is to find patterns that could suggest potential
fraud,
such as someone who has used 10 different home healthcare
agencies
in one year - a sign that the agencies may be swapping
patients'
Medicare numbers - or a podiatrist who over the course of a
year
removes more nails than his or her patients have toes.
Source: Guy Boulton, Journal Sentinel [3/18/06
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-------------QUERIES--------------
Query: Tiny Piece of Needle Post-op
I am the defense expert in a malpractice case (ongoing) in
which the
plaintiff's expert maintains that post-op radiographs are
required
following a standard, non-fixated 5th toe PIPJ arthroplasty.
I
disagree. If we assume a typical post operative recovery,
of what
benefit are post-op radiographs following uncomplicated
removal of
the head of a proximal phalanx?
Radiographs taken several weeks following surgery
demonstrated a
microscopic piece of a suture needle, superficially located,
in the
toe. When this was noted, the defendant immediately informed
the
patient, who immediately ran to a local foot and ankle
orthopod.
This almost subatomic piece of needle was easily extricated.
There
was no infection or foreign body reaction, or documented
injury from
the retained material.
The plaintiff alleges painful scarring from the retained
foreign
body. The plaintiff's expert has opined that immediate
radiographs
would have revealed the retained foreign body, thus allowing
earlier
removal of this miniscule piece of suture needle, and
therefore
would have prevented pain and suffering in the
post-operative
period. What sayeth the PM News jury?
Allen Jacobs, DPM, St. Louis, MO, allenthepodsbcglobal.net
Editor's comment: PM News does not provide legal advice.
This case
is troublesome on many levels. 1) If a tiny piece of needle
broke
off, the suture manufacturer should probably be impleaded
into the
case as a third-party defendant on a products liability
cause of
action. 2) The decision to remove a tiny foreign body itself
is
questionable (patients have been known to have asymptomatic
WWII
shrapnel in their feet). 3) It is doubtful whether the
post-op
scarring is significantly greater than that from the
original
surgery.
Basically, this type of case should be settled for a nominal
sum of
money, with the majority coming from the suture
manufacturer.
******** PM NEWS REFER A NEW SUBSCRIBER CONTEST*******
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may not be aware of PM News? This month, we invite you to
send us
the E-mail addresses of podiatrists who are not currently
subscribers. For each new member, you will receive one entry
into
our contest. We will conduct a random drawing on April 3.
The winner
will receive a one-week Caribbean cruise aboard the
Windjammer for
two. So don't be shy - ask any colleague, resident, or
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know if they are receiving PM-News. Then send us their name
and E-
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-------- CODINGLINE CORNER --------------
Query: Day Care Facility E/M Service
If a day care program for the elderly provides a medical
treatment
room for patient examinations, can an office visit E/M code
be
utilized if no fee is paid for use of the room?
Michael Heisman, DPM, San Jose, CA
Response: The descriptor for the CPT 9920x or CPT 9921x E/M
codes
is "physician's office or in an outpatient or other
ambulatory
facility." I believe that an adult care facility would
qualify for
the use of this E/M code series. I could not find a specific
place
of service (POS) code for an adult day care facility.
We have previously discussed the regular use by a doctor of
such
facilities to see patients, and the question of whether the
location
should be considered a "second office." If you
are designating the
space you use as an office, and are paying a fair market
rate for
its use, then you would consider the place of service an
office (POS
11). If, however, you are not paying for the use of the
facility,
you should use the POS 99 ("other place of service')
on the claim.
Tony Poggio, DPM, Alameda, CA
Additional responses can be found at http://www.codingline.com
-----RESPONSES / COMMENTS------------
RE: Drug Approval Process (Steven Moskowitz, DPM)
From: Freddie L Edelman, DPM
Unfortunately, today, pre-approvals are a way of life.
Whether this
is intentional on the part of the insurance carriers to set
up
roadblocks and limit access, who can say? However, after 28
years of
practice, I no longer see "nail issues" without
a physician referral
for consultation and treatment. This a)limits the numbers of
this
type of patient allowing me to spend my time doing things
that pay
better to us and b)pays better than the self referred
patient so I
may get paid for filling out the forms. Once the forms are
in (and
they are not that difficult) it is not my problem.
Freddie L Edelman, DPM, Syracuse, NY , footgrp1aol.com
--------
RE: A No-Cost Tort Reform
From: James Michael Petko, DPM
While we wait for the legal system to initiate meaningful
reform or
institute policies to police it's own (yeah right !!) I'd
be happy
to see this no-cost reform. The media should report
plaintiff's
judgments as follows:.
"Yesterday the 9 y/o daughter of Mr.& Mrs Frank
Jones was awarded a
judgment for $660,000 for medical malpractice. Of this
amount, the
family's attorney Mr. Joe Fairplay was paid $300,000
(attorney's
fee: $220,000 + $80,000 in expenses). The Jones family
actually
received $360,000.
James Michael Petko, DPM, Falls Church, VA, footdocerols.com
---------
RE: Query: Diabetic Ulcer Care (Paul Kesselman, DPM)
From: Marc Katz, DPM
With all due respect to Dr. Kesselman, I believe that the
fact that
he is paid by Wright medical to speak about their product is
significant. The fact is that Graftjacket is a dead
"scaffold" and
you could likely place a collagen dressing on the wound and
get
similar results with off-loading. There is much greater
evidence-
based data that is superior for living bi-laminate skin
substitutes. I would especially consider this in a
recalcitrant
wound. I have used all of these products and you need the
growth
factors and live cells, however, healing would likely occur
just
with off-loading. I believe Graftjacket is a nice option for
tendon
repair.
This is just my experience in wound care and not meant to be
contrary. We all have positive experiences with different
products
and that is what makes the world go round, differences!
Marc Katz, DPM, Tampa, FL
----------------
RE: CME Guidelines (Elliot Udell, DPM)
From: Multiple Respondents
Dr. Udell says "Let's be blunt. Medicine is the only
profession
where bribery is not only legal and condoned but
encouraged" Did he
really say this? Maybe he hasn't heard of the legal
profession, or
perhaps he doesn't follow politics closely.
I think all things considered we are squeaky clean by any
objective
comparison.
Ray Brown, DPM Charlotte, NC, raybrownbellsouth.net
In regard to Medicine being the only profession that accepts
bribery; I have friends in business and the
"spiffs," perks, trips,
etc., which dwarf anything we have ever received. They are
selling
computers and computer programs, cleaning products, windows,
cars,
and mutual funds. They steer people towards products
according to
the commission or to win a contest. I have one friend who
gets to
take his best customers on a cruise every year, only the
whole thing
is paid for by the manufacturers of the products they are
buying
from him.
I have friends who are attorneys. They are allowed to
receive a part
of the fee another attorney gets if they refer the client to
them,
and we worry about paying an employed podiatrist a
percentage of the
fee for fear of being accused of fee splitting. Family
financial
planners go to resorts at the expense of funds and insurance
companies to "educate" them of the products
available for their
clients. Believe me, a pen and a dinner is nothing compared
to the
outside world. That being said I do agree that there should
be a
mechanism to channel funds for speakers at CME programs
without the
appearance of bribing us.
Sam Bell, DPM, Schenectady, NY, dpmbellaol.com
My point was that our profession should NOT jump on the
bandwagon in
blind support of the newer guidelines for CME which began
with a few
elite Harvard types who refuse to admit that most physicians
get
their information in this manner. I am personally puzzled
that Dr.
Udell equates a Hershey's Kiss from a vendor to a bribe.
Are we that
shallow and easily manipulated? The Harvard boys say we are,
and
have studies to prove it. I reject it and I am insulted at
the
suggestion. I, like Dr. Smith am certainly impressed by well
done
controlled studies. But it is misleading to state that APMA-
sponsored lectures guarantee absence of bias or influence
just
because they will adhere to guidelines.
We are doctors, and we should be entrusted to evaluate the
value of
a presentation without concern that it's deliverer had a
Kobe steak
as opposed to a slice of pizza (paid for by the sponsor)
the night
before. I fear that lumping the industry support podiatric
medicine
now receives fully with that which is so grossly abusive
would be to
put it at risk. Industry is now fine-tuning their support
activities
because of all the attention it has been getting. We need to
cultivate that support, pay speakers fairly, and judge the
speakers
on their merits. If you disagree or are not convinced by
what a
speaker says, one shouldn't make the automatic assumption
that there
has been an ethical break.
Bryan C. Markinson, DPM, New York, NY, Profpodaol.com
I find the "debate" over CME corporate
sponsorship interesting. Are
the readers of PM so naive as to not understand that a
subset of our
profession enjoys (and has enjoyed for quite some time) a
very large
income by lecturing at our meetings?
Dr. Markinson is correct in that $2,000 is not a great deal
of money
to reimburse an individual in practice and missing several
days of
income. However, the truth is that many of the lecture
circuit
regulars do not have any or much of a practice to miss, and
are very
much required to hop around from meeting to meeting to make
a
living.
Do the PM readers truly believe the suggestion of Dr. Smith,
that
indirect payment of money makes a difference to hired
speakers?
Speakers care only about being payed, not by whom they are
payed.
The solution is for membership to demand to their respective
societies and scientific chairpersons an interdiction of the
same
old advertisement year after year. Whether it is APMA,
ACFAS, your
regional, state, or local meeting....Just Say No! When you
allow
uninspired commercials at your meeting, you have allowed the
commercial bearer to place his/her fiduciary interests above
your
continuing medical education.
The result of corporate dominance of CME activity is a
limited
number of topics, repeated year after year, at some
meetings.
Important topics, such as ethics, research methodology,
non-implant
associated surgical or medical techniques, go undiscussed
because
they are not "sponsorable." If I desire a
commercial, I'll wait
until Superbowl halftime. At least some of those are
enjoyable.
Allen Jacobs, DPM, St. Louis, MO, allenthepodsbcglobal.net
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