November 2011

Brian McCurdy, Senior Editor, and Danielle Chicano

Two DPMs Running For Congress In 2012

By Brian McCurdy, Senior Editor

Two podiatric physicians are on the Congressional ballot in 2012 and each cites malpractice reform and Medicare issues as part of his agenda.

   Brad Wenstrup, DPM, is running as a Republican in the 2nd Congressional District in Ohio. He is an Iraq Army Reserve combat surgeon veteran and practices at Wellington Orthopaedic and Sports Medicine in Cincinnati. Lee C. Rogers, DPM, is a Democratic candidate in California’s 25th District. He is the Co-Director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles.

   As state laws govern podiatric scope of practice, Dr. Rogers does not foresee any “national scope of practice” legislation under consideration but says Congress can prevent pay discrimination of providers when providing the same services. He points out that reimbursement decisions, like the recent draft local coverage determination from Medicare on pneumatic compression devices (PCD), are discriminatory.

   “This basically makes a national scope of practice decision for podiatrists by stating that PCDs are beyond the scope of practice of a podiatrist. This is just not true for every state,” says Dr. Rogers.

   Dr. Wenstrup is opposed to states imposing seemingly arbitrary (since the rules vary from state to state) restrictions on doctors who receive excellent training beyond a specific state’s scope of practice. He calls for uniformity for doctors across the nation.

   “While the issue is more state driven, I believe I can be a leader at the national level to shine a spotlight on the issue,” he says. “Certainly, on the federal level, the issue impacts doctors in the military and Veterans Affairs (VA) system and that’s an area I’ll work to fix.”

Sharing Views On Medicare And The Sustainable Growth Rate Formula

Dr. Wenstrup acknowledges the amount of work necessary to reform Medicare to ensure that a corps of doctors is available and that it is financially feasible for them to treat patients.

   “We can’t maintain our current spending habits and expect massive programs like Medicare and Social Security to remain solvent. We must cut spending and make smart reforms to ensure these types of programs survive,” says Dr. Wenstrup.

   Although Medicare is predicted to become insolvent in 2024, Dr. Rogers warns that the federal program faces more immediate threats because some members of Congress want to convert it to a voucher system. He cites an estimate by the Congressional Budget Office that vouchers will cost seniors $6,000 more per year out of pocket. He advocates making the tax code more equitable to continue to fund Medicare at its current level.

   Furthermore, Dr. Rogers notes that MedPAC has proposed a replacement for the Sustainable Growth Rate formula that will reduce specialist pay by 17 percent over three years and then freeze reimbursement for seven more years.

   “This poses many problems, not the least of which will be specialists leaving the program, forcing patients with complex conditions back into primary care offices,” says Dr. Rogers.

   “Anyone who refuses to even consider reforming Medicare is essentially sentencing the program to death,” adds Dr. Wenstrup.

Where The Candidates Stand On Malpractice Issues

As far as malpractice issues go, both candidates support reform of the system. “The practice of defensive medicine increases costs by overutilizing tests and specialists. We have special courts for bankruptcy, divorce and taxes,” Dr. Rogers argues. “Why shouldn’t we have special courts for medical malpractice? That would help to reduce lawsuits without merit from advancing.”

   Dr. Wenstrup says the conversation on malpractice reform was lacking during last year’s healthcare reform debate. He opposes having young doctors accrue substantial debt attaining education and licensing and then using a major portion of their revenue for malpractice insurance. Rather than spending huge amounts to insure doctors, he advocates reforms to eliminate frivolous lawsuits.

   “If a doctor acts unethically or unprofessional and it hurts a patient, (he or she) deserves scrutiny,” he says. “But good doctors with clean records shouldn’t have to live under the constant fear that a lawyer will talk a patient into a lawsuit for the lawyer’s — not the patient’s — benefit.”

   Regarding the “Obamacare” health reforms, Dr. Wenstrup supports having a fresh start with a new plan to encourage healthcare savings and portability for consumers. The focus should be on patient-based solutions, he argues, “rather than putting healthcare and insurance decisions in the hands of unelected bureaucrats.”

What About Other Issues?

Outside of healthcare, Dr. Wenstrup’s top priorities are jobs and the economy. He supports reducing spending and red tape in order to encourage job growth.

   “It’s not the government’s responsibility to create jobs but it’s certainly the government’s responsibility to remove impediments that keep small business owners from doing so,” notes Dr. Wenstrup.

   Dr. Rogers supports ending the wars in Iraq and Afghanistan. He cites war costs of over $10 billion a month as well as a human cost with the numbers of physical and emotional injuries far exceeding the medical profession’s abilities to care for them.

   “Our troops did their job. Let’s reward them by bringing them home to unite with their families. We should be spending our money and efforts building our own nation and protecting our borders here,” he asserts.

Can Changes In Plantar Fascia Thickness Correlate To Treatment Effectiveness?

By Brian McCurdy, Senior Editor

A recent study in the Journal of the American Podiatric Medical Association concludes that measuring plantar fascia thickness via ultrasound can be an accurate gauge of the efficacy of treatment.

   The study involved 39 feet with plantar fasciitis in 30 patients. Researchers used ultrasound to assess the thickness of the medial band of the plantar fascia both before and after patients underwent conservative treatments including corticosteroid injections and stretching.

   The authors note that 29 feet experienced a decrease in both plantar fascia thickness and pain. Four feet had a thicker plantar fascia and no change in pain while one foot had a thicker plantar fascia and greater pain, according to the study. The average reduction in fascia thickness was 0.82 mm and the average improvement in pain was 3.64 ± 2.7 as measured on the Visual Analogue Scale, according to the study.

   Study co-author John Grady, DPM, notes that efficiency in diagnosing plantar fasciitis is an advantage of assessing the thickness of the fascia. With ultrasound assessment, he notes one can attain real-time analysis of the patient’s condition and see small tears of the fascia. By objectively measuring the thickness of the fascia, Dr. Grady says one may be able to rule out other causes of heel pain such as fibromyalgia, stress fractures or malingering.

   The use of ultrasound assessment can save money in comparison to other imaging modalities, according to Dr. Grady, who is a Fellow of the American Society of Podiatric Surgeons and has a private practice in Oak Lawn, Ill. Although ultrasound can be time consuming to perform correctly, he says the accuracy of the modality outweighs the time expended in preventing a missed diagnosis or prolonged use of ineffective modalities.

Study Says Poor Footwear Is Common In Gout Patients

By Danielle Chicano

A recent study in Arthritis Care and Research concludes that one should consider proper footwear when managing patients with gout.

   The cross-sectional study focused on footwear among 50 adult patients diagnosed with a history of gout in accordance with the American College of Rheumatology classification guidelines. Researchers evaluated six aspects of footwear: fit, general age, general structure, motion control properties, cushioning and wear patterns.

   The study authors pointed out that more than 60 percent of shoes had no cushioning and only 36 percent had heel/forefoot cushioning. The authors also noted a lack of shock absorption, inadequate stability and shoes aged over 12 months among many patients. Keith Rome, PhD, the lead author of the study, emphasizes the importance of certain characteristics when choosing proper footwear.

   “The lack of shock attenuation has the potential to increase loads on plantar tissues, potentially leading to foot pain,” explains Professor Rome, who is affiliated with the Division of Rehabilitation and Occupation Studies at AUT in Auckland, New Zealand. “Hence, footwear that has inadequate stability, poor cushioning and limited stability may exacerbate foot pain in patients with gout.”

   Poor footwear, according to the study, includes shoes such as sandals, flip-flops, slippers and moccasins. Participants of the study reported that fit, comfort and cost were important factors in choosing footwear, according to Professor Rome. He notes that poor shoe choices may be due to financial restrictions.

   Nicholas Romansky, DPM, acknowledges that shoe choice plays an important part in managing gout but believes higher priced shoes are not necessarily the proper choice. Dr. Romansky recommends changing shoes twice a day, avoiding old shoes and paying attention to the flex point of shoes.

   Dr. Romansky, a Fellow of the American College of Foot and Ankle Surgeons, explains patients with gout can benefit from a shoe with a high, smooth toe box or shoes with mesh, such as sneakers. In regard to wearing sandals, Dr. Romansky says certain sandals may give adequate support. However, if a sandal has no shock absorption and a poor flex point, then he considers it a poor choice. Both Dr. Romansky and Professor Rome note that proper structural support, adequate shock absorption and adequate motion control play fundamental roles in managing pain in patients with gout.

   “Future research should be focused on assessing the role of competitively priced footwear with adequate cushioning, motion control and sufficient width at the forefoot,” notes Professor Rome, who is conducting a clinical trial looking at different shoes based upon costs and footwear characteristics.

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