The Voice of Podiatrists

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January 03, 2012 #4,348 Publisher-Barry Block, DPM, JD

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Diabetic Complications Preventable Among African-American Men: PA Podiatrist

Leg-amputation rates for men are four times higher in Philadelphia than in Montgomery County, said Dr. Ronald Renzi, a podiatrist at Abington Memorial Hospital who recently completed a study on amputation rates. Many believe socioeconomic status plays a strong role in the higher rates, he said. Older African-American men, who are a larger percentage of Philadelphia's population, are generally under-insured, or have no insurance. Many of them also mistrust the health system, Renzi said. 

Dr. Ronald Renzi

He recently spoke to the Enon group about proper foot care for diabetics. "We want everyone to know about these racial disparities and that these complications are completely preventable with consistent healthcare practices," Renzi said. Among them: getting the pulse in the feet checked regularly.

Source: Anna Nguyen, The Philadelphia Inquirer [1/1/12]

TX Podiatrist's Invention Eases Chronic Pain in Boy

For Joseph Martinez, 2012 is already shaping up to be a thousand times better than 2011. The 14-year-old Torrance resident has missed more than a year of school due to a mysterious disorder that had him writhing 24/7 in chronic pain from head to toe, rendering him bedridden and immobile. When conventional treatment failed, the family devised a new plan that involved traveling to Texas to see a podiatrist — a foot doctor — who some have come to see as a kind of chronic-pain miracle worker.

Dr. Donald Rhodes

That podiatrist, Dr. Donald Rhodes, has invented the VECTTOR machine, that has yet to earn either the respect of the medical establishment or the approval of the FDA, but over the years has turned many patients into fervent believers. Justin and Susan Martinez credit the device for saving their son's life. The family bought a machine for $4,500 and administered treatment twice a day - once in Rhodes' office by morning, and once in their Texas hotel room by night.

Source:Rob Kuznia, The Daily Breeze [[1/1/12]

3 Words to Avoid

Refrain from saying “should,” “ought” and “don’t” when you give advice or instructions to others. You still can state your needs directly and politely; “Please” and “Thank you” can work wonders. Here are two more tips:

•  Phrase requests as questions to break down resistance. “Have you thought about doing _____?” is better than “You should do _____.”
•  Use “I” or “me” statements. “I find it works best when I …” and “I usually like to …” make it seem like you are offering a helpful perspective instead of a command.

Source: Adapted from “Important Communication Tips for Managers,” Andrew Schwartz via Communication Briefings

Queries: Osteonecrosis of the Posterior Process of the Talus

I have a 22 year old patient who has been in severe "ankle" pain since she was five years old when she sustained a blunt trauma to her posterior, superior ankle. X-rays were negative, but the MRI revealed an osseous body in the posterior ankle joint and "osteonecrosis of the posterior process of the talus." I have not tried to inject the ankle. Ultrasound gives a modicum of relief. A BK walker provides about 50% reduction of pain. Are there any surgical remedies for the osteonecrosis? 

Jim Fisher, DPM, Crescent City, CA

RE: Orthotic Therapy For Hallux Rigidus (Arthur Lukoff, DPM)
From: Michael Forman, DPM

Just a comment on the etiology of hallux limitus. I think several of the responders "mis-spoke". I believe that a first ray cut-out or Dananberg Kinetic Wedge does NOT promote first ray dorsiflexion, but rather allows for first ray plantarflexion. This plantarflexion of the first metatarsal then allows the proximal phalanx to slide over the first metatarsal head, thereby increasing great toe motion (Root). I taught that an osteotomy (except opening osteotomies) shortens the first metatarsal, thereby raising the head which would cause a decrease in plantarflexion. To offset this dorsiflexion, the first metatarsal must be plantarflexed.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

RE: Creating Patient E-mail Addresses (Mark Stempler, DPM)
From: Robert Lagman, DPM
 
I have been using Practice Fusion for 1.5 years. I do not believe it is a HIPAA violation to create the email address for the patient. No PHI is given via the email address. It is just there to have the instructions sent on how to access the patient portal for Practice Fusion. In order to access this patient portal, you need a password to go along with the link in the email. This password is generated in the office and handed to  patients before they leave.
 
Robert Lagman, DPM, Mandeville, LA, rlagman@drlagman.com

RE: AEDs in Podiatry Offices (Bob Levoy)
From: Brian Kiel, DPM

We have had defibrilators in our offices for several years and fortunately have had no need for them. When you purchase them, you should have training included for you and your staff.
 
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Bone Mineral Density Testing
From: Joe Agostinelli, DPM

In the orthopaedic practice that I work in, we are fortunate to have many ancillaries, such as MRI, vascular analysis, physical therapy, and bone mineral density testing (DexaScan). All of these ancillaries provide for reimbursement in the state of Florida for DPMs except the bone mineral density exam. My orthopaedic surgeon partners are reimbursed for this.

I know that many of you treat patients who need a bone mineral density examination to assess for healing of bone reconstructive surgeries and to assess risk for fracture. We also see patients with moderate to severe osteopenia as seen...

Editor's note: Dr. Agostinelli's extended-length letter can be read here.

RE: Medicaid Change for Orthotics in NY (Alan Silverstein, DPM)
From: Nicholas D'angelo, DPM

One is never obligated to write a prescription, especially if you feel that the prescription will not be filled as you intended. Educate your patients on the necessity of performing the services yourself, and the benefits of doing so. If you ultimately write the prescription, be sure to evaluate the final product. If it does not meet your standards, have patients keep going back with the inferior product until they receive a satisfactory product.

Have patients become their own advocates and suggest that they appeal to their insurance plans. Always keep in mind that ultimately, you as the podiatrist, are responsible for the outcome, although you did not provide the custom orthotic. Would one give a prescription for Cipro if the pharmacy provided Naprosyn instead?
 
Nicholas D'angelo, DPM, Brooklyn, NY, skitoast@aol.com

RE: Selling Old X-Rays for Silver (Michael J Felicetta, DPM)
From: Walter Perez, DPM

I used Two Brothers Scrap Metal before, and I had a good experience with them. Their number is 631-845-8188. They cover the tri-state area.

Walter Perez, DPM, Brooklyn, NY, WPerez1000@aol.com

Codingline & PM News
In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop
(Following the 2012 APMA Annual Meeting in Washington, DC)  August 20-22, 2012

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Earlybird Bonus Save $50

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ASSOCIATE POSITION - LONG ISLAND, NY

Full time associate position available with well rounded multi-office group on Long Island. Ideal position for July 2012 graduating third
year resident who wants to practice and live on Long Island. Candidates must be board qualified or board certified, and welltrained in all phases of podiatry including surgery, biomechanics, wound care and palliative care. Compensation includes salary,malpractice insurance, paid vacations and surgical incentives, with a future partnership opportunity available for the right candidate. Interested doctors are encouraged to submit their CV's in response to:  mets724@gmail.com.

ASSOCIATE POSITION - CHICAGO, IL

Established, progressive, busy Chicago practice seeking PSR 24/36 individual with good people skills to join 2 man group. Senior associate retiring. Excellent opportunity leading to partnership for energetic, motivated, ethical professional. Submit CV to JAF@APLfeet.com

ASSOCIATE POSITION - NC PIEDMONT

Excellent opportunity for highly motivated, ethical, and personable PSR 24/36. This well established, 3-physician practice has excellent rapport with physician community,multiple office locations, and hospital privileges. Intent is an associate leading to partnership for the right individual. Competitive salary & benefits. Email CV to dpmassociatenc@gmail.com.

ASSOCIATE POSITION - HAWAII (OAHU)

Full-time position available. Join this fantastic practice in paradise. Diagnostic ultrasound, Digital X-Ray, EHR, Surgical Privileges, Competitive Salary plus benefits package. Send CV to:  yoleven316@yahoo.com.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to   Drgordon@gulfcoastfootcare.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA 

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

SPACE AVAILABLE - NYC & LI

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