The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 09, 2008 #3,319 Editor-Barry Block, DPM, JD

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We encourage you to particpate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2009 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

Principles and Practice of Podiatric Medicine (2nd Ed.)

This week's prize is a copy of Principles and Practice of Podiatric Medicine (2nd Ed.) by Leonard Levy and Vincent Hetherington (Value $235) .

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

NV Podiatrist is Investigator in Phase 2 Clinical Trial of Excellerate

Las Vegas resident and diabetic, Michael Hanson, doesn't know how or when his latest foot ulcer developed. But he does know enough about diabetes to have it looked at right away. "And all of a sudden there was a blister there. And by the next day, it started to get worse, so I came in and saw the doctor," he said. While she's tending to his wound, podiatrist Cyaandi Dove tells Hanson that he might be a candidate for a clinical trial that's testing a new medicine. It's a topical gel called Excellarate. It consists of bovine DNA attached to a form of flu virus.

Dr. Cyaandi Dove

"And the purpose of this treatment is to stimulate the growth of new blood vessels and new tissue," said Dr. Dove. Dr. Dove says Excellarate is now in a phase 2 clinical trial -- and must pass two more trials to prove its safety and effectiveness. And considering that 15-percent of diabetics develop foot ulcers, the more tools doctors have to work with, the better off patients will be.

"typically, these chronic wounds are stagnant and you see no improvement. It's not getting smaller. So when we have a new therapy such as this type of therapy, DNA-based, hopefully we'll start to see new tissue formation and more rapid closure of the wound." It could be another four years before the treatment is approved. In the meantime, Dr. Dove suggests diabetics get in the habit of inspecting the bottom of their feet daily.

Source: CBS TV (Las Vegas, NV) [8/6/08]

OCPM Introduces 1st Year Class at White Coat Ceremony

On August 3, 2008, the Ohio College of Podiatric Medicine (OCPM) introduced their 1st year class of 122 students at the annual OCPM White Coat Ceremony. Over 400 people were in attendance which included students, parents, relatives, friends, and OCPM staff and faculty. Dr. Edweana Robinson, OCPM professor, conducted the ceremony while the guest speaker was OCPM alumnus Dr. Patrick Campbell, class of 2001. Dr. Campbell gave a testimonial of his experiences during podiatry school, as well as a personal story of his life and what the profession of podiatry means to him and his family.

OCPM Class of 2012 at White Coat Ceremony

The White Coat Ceremony is a ritual and/or “rite of passage” for new students who enter medical school. It symbolizes the transition of becoming a member of the medical profession.

BCBSNC Offers $1,000 Incentive for E-Prescribing

Blue Cross and Blue Shield of North Carolina (BCBSNC) last month expanded its e-prescribing program. On July 22, the plan said it had launched an e-prescribing Website through which providers will have access to free Web-based software, vendor sources for discounted hardware and connectivity, as well as other e-prescribing technology options.

BCBSNC also is offering a one-time $1,000 incentive to network providers who want to participate in the program. To qualify for the incentive, providers must be registered with a certified e-prescribing vendor and must access medication history for a minimum of 20 patients in the fourth quarter of 2008. Incentives will be paid in first-quarter 2009. In return, health plans estimate that e-prescribing can generate cost savings of roughly $250 per doctor per month because of increased use of generics, avoidance of unnecessary or inappropriate prescriptions and other inefficiencies.

Source: Drug Benefit News [8/1/08]

Are Your Objectives Useful?

Apply this simple series of questions to find out:

Does the objective only state ends, and not include any means, methods, activities or resources?

Does the objective state a purpose in measureable performance terms?

Is the objective based on documented needs, that is, gaps in results?

What result is to be accomplished and under what conditions will the result be observed and measured?

Source: "Objectives - Are They Useful? A Quick Assessment" by Stephanie Moore, James B. Ellsworth, CPT, and Roger Kaufman, CPT, in Performance Improvement [August 2008]

Query: Coding a Supramalleolar Orthotic

I have to make a true supramalleolar orthotic (SMO) for a child. I am not sure what HCPCS code to use to obtain authorization. I checked the APMA Coding Manual but could not find any info. Any help would be appreciated.

David Sands, DPM, Great Neck, NY

Response: A true custom-fabricated supramalleolar orthotic should be coded as L1907 (AFO, supramalleolar with straps, with or without interface/pads, custom fabricated). Straps and interface soft tissue pads for this device are included with the base code, L1907, and are not separately reimbursed.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here

RE: Traumeel for Posterior Heel Pain (Mark Aldrich, DPM)
From: Bob Kornfeld, DPM, Jeffrey Kass, DPM

I will be speaking on this subject at Temple University School of Podiatric Medicine on Sept. 27th, sponsored by Heel, Inc. There are a couple of issues that you would need to address before undertaking any injection protocol. First, it is essential that you rule out any partial tears or degenerative changes in the tendon. Second is to investigate why this particular patient has failed all other forms of care. The answer(s) will be found in a functional medicine analysis of immune function and physiology. You are most likely dealing with a patient with a burdened immune system that is not capable of efficient cellular repair.

Once these mechanisms are discovered and addressed, you would then need to apply the proper injectable. Traumeel is indicated for non-degenerative conditions of inflammation where humoral defense systems are intact. If it proves to be degenerative, Zeel would be a better medicine. However, if there is evidence of partial tear, a prolotherapy protocol would net the best result. None of these meds are fibrolytic so it is perfectly safe to inject tendons. Injection protocols are supported by essential enzymes and nutrients. This paradigm of medicine, when practiced properly and prudently, will net profound results. But first, it is important to get the proper training. I am launching The Institute for Integrative Podiatric Medicine this month. I invite all podiatrists who are interested in learning more, to consider joining the Institute.

Bob Kornfeld, DPM, Lake Success, NY, holfoot153@aol.com

I have tried Traumeel for Achilles tendonitis) and didn't have success with it. For clarification purposes, I did not inject my patients one time. They were given a series of the Traumeel injections. I honestly don't think it works.

I think if orthotic therapy has failed and the patient is not into surgery, you might want to look into ESWT or PRP injections. Maybe acupuncture?

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Botox for Flexible Hallux Malleus (Brian T. Maurer, DPM)
From: Ed Wiebe, DPM, Dennis Shavelson, DPM

A minimal incision flexor tenotomy and capsulotomy at the hallux IP joint may be a more effective long- term fix for healing of a distal ulcer. There is no sutures, no downtime, rapid healing, and the ulcer disappears! I do this for diabetics on all toes, as sometimes you end up chasing adjacent digits. The patient does not get a disabled gait from this simple surgical release.

Ed Wiebe, DPM, Flagstaff, AZ, elw520@hotmail.com

What about trying Neoteric Biomechanics for this patient's problems? I am concerned that in light of the fact that LOPS is in play?, there are negative compensatory problems that Botox may produce that will need to be addressed? If I am wrong, why not do a percutaneous EHL tenotomy instead of the Botox or fusion?

In functional foot typing, this is a rigid rearfoot, rigid forefoot foot type and if so, a forefoot orthotic posting of 2-4 degrees valgus with an aggressive 1st ray cutout of both the shell and a full extension would provide compensation for abnormal 1st ray mechanics as well as a place in shoes for the hallux to occupy with much less dorsal and distal pressure. Limb-length should also be corrected since this apparently is a unilateral problem.

My solution would upgrade and improve shoe fit and purchase and overall quality of life in addition to hopefully healing the ulcer. If unsuccessful, then neurology consultation for Botox or a fusion becomes a much more needed option to exercise.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab, drsha@foothelpers.com

RE: Projections of Supply and Demand for Podiatric Physicians
From: Justin C. Jex, DPM

I would like to respond to the projections given in the July/August JAPMA concerning the need for more podiatrists. In Houston, it seems that there are enough and more so. I don't think there is anyone that is turning away any business. I cannot imagine how it would be in the states with 5.0-8.0 or 8.0-12.7 podiatrists per 100,000.

I also note the quality of the podiatric physician is under constant assessment by our "friendly orthopods", at least here in Texas. I remember that in the cold war, the Russians had a philosophy of "there is a certain quality in quantity." If this is the case, remember who won the cold war. Maybe I am wrong, but I think a supply-side shortage would be good for the profession, not bad.

Justin C. Jex, DPM Houston, TX, jcjex@juno.com

ASSOCIATE POSITION OPPORTUNITY IN MULTI SPECIALITY GROUP PRACTICE - ILLINOIS

Christie Clinic is a large Multi-Specialty Group practice located in
Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or
Board Eligible podiatrist to join a well established Podiatry
department. Must be competent in all phases of podiatric care, Surgical
and Conservative. This position will involve rotating through multiple
office locations with surgical privileges available at two medical
centers and two outpatient surgery centers. Very competitive salary,
bonus plan, vacation, and health/mp insurances. Forward CV to
wpierce@chrisiteclinic.com

ASSOCIATE POSITION WITH POTENTIAL FOR PARTNERSHIP - NJ

Associate needed for multiple location practice in Bergen County N.J. Full or Part-time hours available. Reply by E mail to dr_toefu@hotmail.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

PRACTICE FOR SALE WA STATE: BELLINGHAM - WITH ASC

Located by hospital and medical community. Owner will carry part of financing. Potential for increased revenue abounds. This is a value that should not to be overlooked. Bellingham is rated in national magazines as one of the most desirable places to live or retire. 386 597-5766.

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – CALIFORNIA

Coast to Coast Mobile Podiatry Group Seeks Podiatrist with Nursing Home contracts! Join our group and let us handle the back-breaking task of billing and managing your patients. This will equal great compensation for you. Please email us back at coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - BEVERLY HILLS, CA

After 48 years in practice, it's time to retire. My current practice is 1 1/2 to 2 days per week and generates a six-figure gross. An excellent choice as a srart-up or for semi-retirement in beautiful Beverly Hills. MUST HAVE BACKGROUND IN BIOMECHANICS AND SURGERY. Will stay to train and introduce. Price negotiable. Call Bill Orien at 310-271-1944.

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

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