February 2012

ACFAS And AMA At Odds Over Permitting Podiatrists To Head Hospital Staffs

By Brian McCurdy, Senior Editor

The American Medical Association (AMA) is opposing the Conditions of Participation of the Centers for Medicare and Medicaid (CMS) that would allow podiatrists to hold leadership positions at hospitals.

   The AMA notified the CMS of its objection in December. “We are concerned about the precedent that this proposal sets,” says the AMA statement. “Practitioners who are not medical doctors or doctors of osteopathy should not be authorized … to hold leadership positions on the medical staffs of all hospitals.”

   Michelle Butterworth, DPM, the President Elect of the ACFAS, disagrees. She notes an absence of data suggesting that there are safety concerns in regard to podiatric physicians heading hospital staffs.

   “These are elected positions by our peers on the medical staff who know us best,” says Dr. Butterworth. “If there are concerns about any member of the medical staff’s competence, those should be dealt with through the medical staff bylaws.”

   “It is not about safety as there is no decision making regarding patient treatment,” concurs Lawrence DiDomenico, DPM, FACFAS. “In my experience with hospital administration, it is more about being a leader, delegating and running the staff efficiently.”  

   In some cases, DPMs are already heading hospital staffs, points out Dr. Butterworth. She says this is due either to confusion about the CMS’ Conditions of Participation or that the medical staff had foot and ankle surgeons working in another official capacity to comply with the regulations. She was the Chief of the Medical Staff at Williamsburg Regional Hospital in Kingstree, S.C. from 2005 to 2007. She now serves as the Vice Chief of Staff of that hospital.

   For Dr. DiDomenico, the Section Chief of Podiatry at St. Elizabeth’s Hospital in Youngstown, Ohio, the big advantage to DPMs heading medical staffs is visibility.

   “Once the medical staff sees a DPM running the medical staff and hospital efficiently and well, I believe they will obviously have more respect for the individual and the profession,” says Dr. DiDomenico. “When a DPM can ‘get a seat at the table,’ this allows for more accurate information to be communicated about the profession and a better understanding about the training and education of DPMs.”

   As Dr. Butterworth notes, the ACFAS and its 14 regional divisions did submit formal comments to the CMS. These comments are available at www.acfas.org .

   “ACFAS has actively promoted to CMS and the Joint Commission that DPMs should be allowed to serve in the role of medical staff president or its equivalent, like their MD/DO/DDS colleagues are currently permitted,” reads the ACFAS statement. “Many hospitals were simply not even aware that current regulations do not allow DPMs to serve in this capacity, thus depriving the medical staff of its right to choose one of its own members to serve as its leader.”

   The ACFAS also notes that no state precludes a DPM from functioning as the President of the Medical Staff.

   “The CMS recommended change to allow DPMs to formally serve as the head of a medical staff is only an affirmation of modern day medical practice and the healthcare team approach the AMA also endorses,” says Dr. Butterworth.

Can Radiofrequency Thermoneurolysis Abate The Pain Of Morton’s Neuroma?

By Danielle Chicano

A recent study in the Journal of Foot and Ankle Surgery concludes that radiofrequency thermoneurolysis therapy can be effective in alleviating the painful symptoms of Morton’s neuroma.

   The study focused on 32 feet in 29 patients whose neuroma symptoms did not resolve despite receiving between four and eight weeks of conservative therapy. A surgical team then administered radiofrequency thermoneurolysis at the site of maximum pain in the affected foot at a temperature of 85ºC with impedance values between 350 and 550 for 90 seconds total.

   Upon completion, 24 patients expressed complete relief one month after the therapy. The remaining five patients reported minimal to no relief and none of the patients claimed they experienced more pain. The study notes one complication of cellulitis, treated with oral antibiotics. All patients returned to normal shoe gear and activities within two days, according to the study.

   Based upon their results, researchers concluded that radiofrequency thermoneurolysis is a minimally invasive alternative to open surgical intervention for patients with neuromas who do not respond to conventional treatment.

   Two of the lead authors in the study, Jeffrey Cohen, DPM, FACFAS, and Ritchard Rosen, DPM, FACFAS, believe this therapy will be a beneficial addition to their treatment armamentarium. They cite numerous advantages that the treatment leaves no surgical site to heal, is less painful and that the treatment does not preclude going back to remove the neuroma surgically if radiofrequency thermoneurolysis is not effective. The possible complications include infection (the risk of which is less than with surgery) or inadvertent tissue burn or damage, note Dr. Cohen, the Chief of Podiatric Surgery at Englewood Hospital and Medical Center in Englewood, N.J., and Dr. Rosen, the Chief of Podiatric Surgery at Holy Name Medical Center in Teaneck, N.J.

   Dr. Cohen and Dr. Rosen often recommend this type of treatment to patients who do not respond to conservative treatment prior to initiating surgical intervention.

   “Many of these patients benefit from conservative care consisting of either 4% alcohol sclerosing injections or steroid injections or shoe modifications including orthotics,” say Dr. Cohen and Dr. Rosen. “If conservative therapy fails, we either try radiofrequency thermoneurolysis or surgical removal of the neuroma.”

   Drs. Cohen and Rosen believe their research on radiofrequency thermoneurolysis may help decrease the need for surgical interventions for the treatment of neuromas.

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