The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 08, 2012 #4,404 Publisher-Barry Block, DPM, JD

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OH Podiatrist Upsets Incumbent in Congressional Race

The House Republican Conference will lose Rep. Jean Schmidt, who was defeated by Dr. Brad Wenstrup, a podiatrist and Iraq War veteran, in an upset.

Dr. Ben Wenstrup

Wenstrup, who defeated Schmidt in Tuesday's Republican primary, had the support of Tea Party activists. Schmidt also was one of a dozen incumbents of both parties targeted by a superPAC called Campaign for Primary Accountability.

Source: Frank James, NPR [3/7/12]

Aussie Podiatrist's Practice Focuses on Foot Mobilization Therapy

Gold Coast residents' active lifestyles has prompted South Australian podiatry practice the Foot & Leg Centre to open an outlet interstate. Situated in Southport, the new center will be headed up by experienced podiatrist Matt Maguire. Foot & Leg Center founder Ted Jedynak said his practice techniques focused on foot mobilization (FMT) - a gentle form of manual therapy. "This corrects misalignments in joints, allowing the feet to work as nature intended," he said.

(L-R) Podiatrists Matt Maguire and Ted Jedynak

"I discovered this approach to podiatry in 1994, looking for a better way of treating biomechanical disorders of the feet without needing to prescribe orthotics, drugs, or referrals for surgery." Maguire said that FMT had helped him with a persistent knee problem. "It turned out the cause of the problem was in my foot, not the knee," he said. "For me, this was a turning point in my life."

Source: Alexandra Economou, Adelaide Now [3/7/12]

Alliance Community Hospital Residents Win First Place for Scientific Format Poster

Alliance Community Hospital 3rd-year podiatry residents Dr. Adrienne O'Neill and Dr. Summer Weary, along with their director, Dr. Leslie Niehaus, were awarded first place in a poster competition at the 2012 Annual American College of Foot and Ankle Surgeons Scientific Conference, which took place last week in San Antonio, Texas.  

Drs. Adrienne O'Neill, Summer Weary, and Leslie Niehaus.

Their research and poster, entitled "The Use of Collagenase in the Treatment of Plantar Fibromas," gives promise to the future use of injections - rather than surgical removal - in treating plantar fibromas, a common problem in individuals who have plantar fasciitis. Co-residents Dr. Julian McNees-Lambert and Dr. John Peterson also presented a poster focusing on the correlation between plantar fasciotomies and heel height. Over 300 posters were presented at this premier podiatry conference.

APMA Prepared to Blitz Capitol Hill

The American Podiatric Medical Association is preparing for a three-day blitz of Capitol Hill later this month, where it expects hundreds of its members to lobby up a storm on issues, including Medicaid beneficiary access to podiatrists, physician payment reform and medical liability reform, association lobbyist Peter J. Stein tells PI. The association has confirmed meetings with Sen. Chuck Grassley (R-IA) and Rep. Jason Altmire (D-PA).

The lobbying efforts will coincide with the association’s 27th annual Podiatric Medical Legislative Conference, which is also being conducted in D.C. The association’s government affairs efforts have been on the upswing lately, spending $300,000 on federal lobbying in 2011 — it’s strongest annual output since 2006, federal records indicate.

Source: Politico [3/1/12]

WI Podiatrist Appointed to Medical Examining Board-Podiatrists Affiliated Credentialing Board

Dr. William Weis, who practices podiatric medicine and surgery in Oak Creek and Racine has been appointed by Governor Scott Walker to the Wisconsin Medical Examining Board-Podiatrists Affiliated Credentialing Board. Dr. Weis has a long history of service to the podiatric medical community and this appointment by the Governor extends his commitment to foot and ankle safety, quality, and excellence.

Dr. William Weis

Dr. Weis has been in private practice since 1990. He is board certified in foot surgery by the American Board of Podiatric Surgery and is a Founding Fellow of the College of Certified Wound Specialists. Recently, he chaired the Wisconsin Department of Health Services Diabetes Advisory Committee, implementing an electronic health record system in his practice that successfully met Medicare’s quality standards for meaningful use. Formerly, he served many years as a member of the Wisconsin Society of Podiatric Medicine Board of Directors.

AAPPM Midwinter Conference Biggest, Best Ever!

The American Academy of Podiatric Practice Management (AAPPM) followed up on its successes from 2011 by hosting its most successful Midwinter Conference ever. The AAPPM 2012 Midwinter Seminar in Pittsburgh was completely sold out! Over 250 attendees were presented with the most up-to-date information to help catapult their practices toward success. New to the conference this year was a special medical assistants' track, led by Jon Purdy, DPM, AAPPM Fellow and Trustee, and Cindy Pezza, PMAC, which was praised by all in attendance.  

Dr. Jeffrey Fredrick (L) presents AAPPM President's Award to Rem Jackson with Dr. Hal Ornstein (R)

The AAPPM also recognized Rem Jackson and Jeff Bowman, DPM for their dedication and leadership for the profession. Jackson, a frequent and popular speaker at AAPPM conferences and seminars, was awarded the AAPPM President’s Award. Bowman, a longtime member and volunteer leader with the Academy, received the AAPPM Chairman’s Award.

Query: Re-excise Mass?

I have a healthy 63 y/o female who presented with a hard, well-circumscribed mass in the dorsal first innerspace. I sent her for an MRI and it came back as "solid soft tissue mass. Fairly well circumscribed at 2.5x4.5x1.8cm. MR characteristics not specific. This is a fairly well-circumscribed mass that approximates the second metatarsal, but without osseous involvement." I surgically excised the mass. Further observation showed no involvement or attachment to any structures.

Excised Mass

My hospital pathologist sent it to Mayo Clinic. The path report came back as "By immunohistochemistry, the neoplastic cells are variably positive for desmin, and negative for wide spectrum cytokeratin and smooth muscle actin. This could be a mammary-type fibroblastoma. The other possibility is a very fat poor spindle cell lipoma, another lesion that may show some desmin immunoreactivity. Ultimately, I do not believe that I can confidently label this tumor as one of these two related benign entities and thus believe it would be best to sign this out simply in a descriptive fashion. This lesion may have some capacity for local recurrence and I think it would be reasonable to perform a conservative re-excision at this time."

What would be considered a conservative re-excision? This mass simply popped right out of the subcutaneous tissue and wasn't really attached to anything.

Joe Gonzalez, DPM, East Lansing, MI

Query: Billing For Support Staff

We have an LPN, PMAC (with valid license in NY and PA) working for us now. During the course of the week, she takes care of all of the nail care patients and additionally does initial and follow-up visits for us on patients with varied diagnoses. All of her charting and billing in our EMR is reviewed and co-signed by us in a timely fashion.
 
We have concerns with regard to liability and “fraudulent billing” (for lack of a better term) when she is generating charges while we are not physically present. This situation happens two days a month when we are in the ASC doing cases, and she is in the office generating charges. Is this legal, and what liability concerns does this raise?

Name Withheld (NY)

RE: Lapidus or Fusion (Randall Brower, DPM)
From: Robert P. Thiele, DPM

I have to respectfully disagree with Dr. Brower's assertion that a first MTPJ fusion does not correct the IM angle, with a follow-up comment about a colleague's limitations. A first MTPJ fusion does indeed reduce the IM angle. In fact, it would be the procedure of choice for large bunions of a neuromuscular etiology (i.e,. Downs/spasticity) and is indicated for recurrent bunions, instability of the first MTPJ, and yes, even geriatric hallux valgus, especially with first MTPJ DJD.

I would most likely lean towards a first MTPJ fusion in the case presented vs. the Lapidus because of the DJD of the first MTPJ. Keller is the other option which also provides some IM angle reduction.

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

RE: Painful, Discolored Toe (Chuck Ross, DPM)
From: Connie Lee Bills, DPM, Gary S Smith, DPM

I always have new patients present ALL of their shoes on the first visit. This is the only way to tell if there has been shoe trauma. The patient doesn’t realize it most of the time.
 
Connie Lee Bills, DPM, Mount Pleasant, MI, staff@familyfootcare.biz
 
I have seen many patients with the same discoloration and wrote a note about this several years ago here. If you notice, almost all of these patients are on medicine for hypertension. Beta-blockers like Atenenol and Coreg seem to have the highest incidence. The toe discolorations are precipitated by cool temperatures and not necessarily freezing. The toes can range from spots of purple discoloration to entire toes purple or even black to the point of necrosis. The treatment is to keep them warm. It is my opinion that the vasodilators have the opposite effect on the toes when exposed to cold and they constrict to the point of tissue damage.

I have had patients with arterial insufficiency, and gangrene on their toes in the winter whom I actually treated (with their GP) by cutting or changing their HT medications. The color change and increased circulation to their toes in a matter of seven days is dramatic. I have had patients with true chilblains who are on no medications, but these patients are usually in their 20s when they first present to the office. Those of you who have had these patients in their thirties and older will find, in almost all cases, they are on vasodilators.
 
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: ABPS Name Change (M. W. Aiken, DPM)
From: Allan Evangelista, DPM, MPH, Paul J. Maglione, DPM
 
Heraclitus (a Greek philosopher known for his doctrine of change being central to the universe) once said, "Nothing endures but change." In response to Dr. Aiken's comment, the essence of our identity (as a profession) cannot be diluted to extinction by this name change. But, the name change can significantly improve our public perception (and image) of who we are by providing better pubic understanding of who we are and what we do for our patients. This proposal is supported by a signed petition by several highly-respected individuals in our profession, including 24 former ABPS presidents.

With several years of working on this measure, these are the folks who have sat in the presidential position, and who now have the benefit of hindsight. They stongly believe that this the right thing to do and is long overdue. I agree.

Allan Evangelista, DPM, MPH, MDiv, Hermitage, PA, allevan@hotmail.com

If the ABPS changes to the American Board of Foot and Ankle Surgery, will membership be open to MDs and DOs?

Paul J. Maglione, DPM, Ossining, NY, drmaglione@aol.com

RE: Wound Treatment Coding Question (Kevin Brattain, DPM)
From: Don R Blum, DPM, JD

I contend that whether you are treating an ulceration that is caused by pressure or because of the diabetes would not make a difference. One could have an ulceration caused by pressure, the delay in healing, or complication in the healing could be because of diabetes or vascular condition. The concern by not relating the diabetes to the wound/ulceration could affect your treatment plan. If you decide you want to use Dermigraft or Apilgraf, you need a qualifier in additon to "ulcer"/"wound." If you decide you want to use hyperbaric, the differential from pressure to vascular-related or to diabetic-related could cause a denial in coverage.
 
In my opinion, if you are just doing "debridement", whether excisional or if it falls under "wound care", then coverage would not be an issue. After all, patients with no issue of vascular or diabetes can get ulcerations, such as decubitus, from pressure.

 
Don R Blum, DPM, JD, Dallas, TX, donrblum@sbcglobal.net

RE: Discharging a Non-Compliant Patient (Jeff Mennuti, DPM)
From: Elliot Udell, DPM
 
Many of our colleagues have responded that the best way to deal with the non-compliant patient is to find a legally acceptable way to discharge the patient. On the surface, this seems to be the most cut and dry way to handle a patient who is not adhering to medical advice. Recent studies, however, have shown that non-compliance is a far more complex issue than meets the eye. 
 
In a paper published in a recent issue of the New England Journal of Medicine, there was a study of patients who were sent home from the hospital on life-sparing medications after surviving myocardial infarctions. Less than fifty percent of the patients took their medications prescribed to prevent further heart attacks. The authors went on to show that cost of the medications was only partially to blame for this example of non-compliance.
 
Before summarily discharging every non-adhering patient, it is best to examine other factors such as our doctor/patient relationships as well as numerous other reasons which may play into this dangerous pattern of patient behavior. One method out of England which has had a measure of success is called "Concordance." This  method calls for a sit-down discussion with the patient, and enrolling him or her into being a partner in the management of his or her healthcare. Discharging a patient should be last on our list of options.
 
Elliot Udell DPM, Hicksville, NY, Elliotu@aol.com

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to seattlefootdoctor@yahoo.com

ASSOCIATE POSITION – PORTLAND, OREGON

$120K approx. starting salary plus malpractice and benefits! Long-term possibility with a unique buy-in plan. Busy, well-established private practice has an immediate opening with an established patient base for a dynamic, motivated, surgically-trained podiatrist. Practice is mainly general podiatric medicine and forefoot surgery with very little nail care. Some rearfoot and very occasional ankle and trauma. Prefer PSR 24-36. Call (503) 652-1121 and ask for Dr. John Mozena or email jlmozena@aol.com.

FULL-TIME PODIATRIST NEEDED - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County NY (West Point) area. Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER calls. The applicant has to be trained in all foot surgery and be able to handle advanced Diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking,fishing, skiing, and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go to www.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references to: ejema@aol.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - LOS ANGELES

Multi-specialty group seeking part time podiatrist. Opportunity to transition into full time position. Required: 3 years or surgical residency, including Charcot reconstruction, fellowship or interest in biomechanics, and ability to train surgical residents. Send CV to podiatricri@yahoo.com

EQUIPMENT FOR SALE - SWISS DOLORCLAST ESWT

Swiss DolorClast ESWT. Complete with Cart. Extra hand pieces. Excellent condition. Low hours. Asking $12k. Pictures available upon request. Contact Carol at 708-596-3757 or carol.performance@sbcglobal.net 

EQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or 440-285-2827 or email me at gwdocks@aol.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

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