The Voice of Podiatrists

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January 03, 2008 #3,132 Editor-Barry Block, DPM, JD

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The Need For Podiatric Care Cited By Both Iowa Front-Runners

Podiatry? Yes, podiatry. On this evening in Perry, Iowa, the presidential candidate is passionate about the issue, and connecting with the audience. The topic is the perverse incentives of a health-care system that pays for intervention instead of prevention. Why, the candidate asks, do insurance companies pay for an expensive operation to amputate the foot of a diabetic, but won't reimburse for cheaper preventive visits to a podiatrist that could make surgery unnecessary?

That's Hillary Clinton, right? Yes, but Republican Mike Huckabee also routinely tells this podiatry story to make the exact same point. John Edwards, Barack Obama and the other Democratic candidates are also talking about the backward economics of the health-care industry. Check back in a couple of years and it's a good bet more insurance companies will be reimbursing your local foot doctor for treating diabetics, and the number of amputations may even decrease. That will be a sign that a major transformation of the health-care system toward prevention is underway, courtesy of our much-maligned presidential campaigns.

Source: Jonathan Alter, Newsweek [12/31/07]

Lifestyle Changes Transform MS Podiatrist into Healthy Bodybuilder

David Morgan knew he had to do something. The mirror told him each and every time he walked by it. (Especially when he turned sideways.) And if that wasn't enough, the now 49-year-old Brandon, MS resident got a couple more, far less subtle hints: two emergency trips to St. Dominic/Jackson Memorial Hospital with chest pains associated with complications from high blood pressure and a condition called mitral valve prolapse.

Dr. David Morgan

In March 2006, Morgan chose to live a healthier lifestyle. And Morgan did just that. The results? He dropped from 257 to 195 pounds. And his body fat dwindled from 29 percent body fat to 8.1. "I can actually see my stomach muscles now," said Morgan with a laugh. "I have a six-pack now. Before I had a 40 ounce." And it's those two things (working out and eating right) that Morgan credits for his transformation. Morgan's diet now consists of foods like chicken breasts, turkey, lots of fruit and peanut butter and at least six servings of vegetables each day.

Morgan's commitment has paid off in other ways as well. He had a stellar showing at the first Natchez Trace Classic bodybuilding competition this past July in Natchez. He placed second in the men's heavyweight (over 190 pounds) and men's novice divisions and finished fourth in the men's novice masters (over 40 years old).

Source: Rod Walker, Clarion Ledger [1/1/08]

Two CA Insurers Reduce or Eliminate Drug Co-pays to Improve Compliance

Two large health plans are rolling out new drug benefit programs that reduce or eliminate co-payments on certain medications as an incentive to use low-cost generic drugs and comply with therapies that can avoid more expensive medical complications later on. Blue Shield of California on Dec. 4 unveiled a new program that eliminates or reduces co-pays for generic drugs.

The program is available to employer groups with 51 or more employees. The program offers generic co-pays of zero or $3 at retail network pharmacies. The new option will be available starting January, the company said.

In a similar move, Aetna, Inc. on Dec. 5 said it was launching "Aetna Healthy Actions Rx-Savings," an incentive program for self-funded plans that lets employers pay part or all of certain employees' co-pays.

Source: Drug Benefit News [12/26/07]

Query: Numbness from Growing Mass

I have a patient that has a recurring thick growing bulbous sheath around the tibial nerve in the tarsal tunnel. He complains of severe shooting pain and then numbness in the bottom of the foot. I performed a tarsal tunnel release with a debridement/ biopsy of all the thickened bulbous portion in 2003. The pathology report read like a neuroma "congestive fibro adipose tissue with numerous entrapped peripheral nerves with degenerative changes." The patient’s symptoms resolved, but returned three years later. I performed the same procedure and wrapped the nerve in Neurawrap. The pathology report was the same and his symptoms resolved. The patient now has a growing mass in the medial ankle and numbness in the foot. Any thoughts or options?

Robert M. Przynosch, DPM, Asheville, NC

Query: I & D Blood Blister

Would one bill CPT 10140 (incision and drainage of hematoma, seroma or fluid collection) for the draining of a "blood blister?"

Juan Rivera, DPM, Tampa, FL

Response: Yes, CPT 10140 (incision and drainage of hematoma, seroma or fluid collection) would be the correct code.

Walter Pedowitz, MD, Linden, NJ

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RE: Patients and Nail Polish (Larry Aronberg, DPM)
From: Multiple Respondents

In our office, nail polish is removed using electrical burring. The real problem arises when a patient asks if our staff would apply their nail polish after treatment is done. We have a very simple answer. We tell our patients we will kindly apply polish for a fee of fifty dollars. So far, no takers.

J. Ressler DPM, Lauderhill, FL, RedWingCrzy@aol.com

In our office we don't burr mycotic nails. We stopped many years ago. As an allergy sufferer (even with the use of vacuum devices attached to drills), I still coughed and wheezed after grinding toe nails. There have been reports that have shown that the nail dust remains in the air for many hours after filing nails and if those particles contain fungi or other infectious matter, you can not only infect yourself and your staff but every patient who comes into the room during the next three hours. There are some government regulations that actually forbid the use of the room for several hours after burring infected toe nails. The obvious next problem with grinding nails is that it is not easy or even possible to keep burrs sterile. Hence by mere burring nails all day you may be spreading infection from patient to patient. We have not lost patients because we don't file nails and patients are happy that we care enough about their health so as to not jeopardize their lungs or feet.

As for polish, we ask patients to come back without the polish or if it is one nail involved, we use nail polish remover and then evaluate the nail. If we are treating onychomycosis with topical medications, we apprise the patient that penetration of the medication might be limited because of the polish. Depending upon the severity of the problem, female patients might be willing to forgo treatment until they no longer use sandals or they might opt to wear closed footgear and not worry about polishing their nails until the condition resolves.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: E-Mailing Patients (David Gurvis, DPM)
From: Nat Chotechuang, DPM

I have given my email address to a patient with a post-op infection who lived far away from my office. I extended an invitation to send me pictures of his wound on a daily basis so I could monitor the cellulitis frequently. I also scheduled in-office visits but the pics let me evaluate daily progress from afar. I also gave my email to a patient who claimed his toe turns severely red and swollen occasionally but very transiently (and of course not at appointment time). I asked him to snap a pic on macro setting at high-res and send it to me (so I could view it on a full-size monitor instead of on his camera viewer). Other than those two circumstances I won't practice via email. I think there's too much room for error and it might encourage people to avoid an office visit, which could lead to bad medicine and bad business.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

Multi-location office and soon to open a third location. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. No nursing homes. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing Machine. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com or FAX to 480-782-1290.

FOR RENT AND IMMEDIATE OCCUPANCY ARIZONA

Excellent free-standing location and exposure in Sun City, AZ. Across
from Boswell Hospital. Has been a podiatric office for 15 years with an approved Medicare SurgiCenter w/in the office. Office is a turn-key facility and can include present equipment. 3750 sq ft with 9 tx rooms, large reception and BO area. Email tbirdpod@cox.net or 602-510-2871.

ASSOCIATION POSITION - IOWA

Associate position with potential partnership in a multi-office,
multi-faceted practice, four-physician office. Staff privileges in many hospitals and ASCs. Applicant needs to be personable, skilled, ethical and hard-working. Competitive base and incentive compensation and benefits. Fax CV and letter to 712-255-1389.

ASSOCIATE POSITION/ BUY-IN -COASTAL SE NC

Excellent opportunity for well trained, articulate, hardworking individual competent in all phases of practice. Long term position available with buy-in also an option. Strong salary and benefits. Gorgeous coastal area. Don't miss this one! Contact kinggy@atmc.net

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 -- www.homephysicians.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

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