The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 05, 2007 #2,782 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Diabetics at Greater Risk In Winter: NV Podiatrist

Diabetics are at risk for having reduced blood flow to the lower extremities. And winter time can be especially hazardous, according to Las Vegas podiatrist, Jodi Politz. One reason is, the feet are covered up for longer periods of time and aren't being checked as often as they should.Dr. Politz says, "They really should pull their shoes and socks off to look at their feet to make sure, one, their shoes aren't tight causing any kind of friction rubbing. Which would be more of a reddened spot on the top of the toes or on the sides of the bones. They should definitely be checking their heels as well."

Dr. Jodi Politz

Cold weather exacerbates circulatory problems by further reducing blood flow and by indirectly reducing exercise. "A lot of people too in the winter have a tendency to be a little bit more sedentary. They're not walking around as much. They're sitting around their houses which will make their feet and ankles swell a little bit more," Dr. Politz said.

The doctor adds that this time of year, she sees more burns on the feet of diabetics, from heating pads or hot water. "Try to steer clear from the heating pads, the warming blankets, the hot footbath whirlpools people are putting their feet in. If you're going to do that, check the water with the elbows. You don't lose feeling in your elbows as you would with your fingers and toes."

Source: Paula Francis, KLAS-TV (Las Vegas) [1/3/07]

Medicare Fix Could Worsen Docs’ 2008 By 10%

Toenails Hold Tobacco Carcinogens

A carcinogenic chemical in tobacco products was found in toenails of smokers and non-smokers exposed to secondhand smoke, U.S. cancer researchers said.

The findings demonstrate clippings subjected to sensitive testing could be used to learn about the role chronic tobacco smoke exposure plays in cancer in humans, said Irina Stepanov, a researcher at the University of Minnesota Cancer Center. NNK is a cancer-causing agent in tobacco products. In humans, NNK is converted to the chemical compound NNAL.

"Numerous studies have quantified cotinine and NNAL in the urine and blood of smokers, smokeless tobacco users, and non-smokers exposed to secondhand tobacco smoke," Stepanov said. "Our study is the first to show these agents also become part of the toenail composition."

Stepanov said she thinks studying toenails offers another way of determining negative effects of secondhand smoke in non-smokers. She said toenails grow more slowly so they reflect cumulative exposure over a relatively long period. They also are less likely than fingernails to become environmentally contaminated.

Source: UPI via Robert Steinberg, DPM [1/2/07]

Query: Gold Standard for Osteomyelitis

Our local radiologists insist that MRI is the "gold standard" for detecting osteomyelitis. According to our boards and literature, radio-labled scans are the "gold standard" for detecting osteomyelitis. What is the current "gold standard" and what literature can I present to radiology to convince them otherwise.

James Breedlove, DPM, San Luis Obispo, CA

RE: Inappropriate Use of L1902
From: Paul Kesselman, DPM

Previous DME for DPM articles noted the inappropriate use of L1902 (ankle gauntlets). Despite the notification of previous audits which resulted in restitution to DMERC C regarding L1902 this practice seems to be continuing.

Recently, the Program Safeguard Contractor (PSC) for DMERC Region C conducted an audit for ankle gauntlets (L1902). They continue to find a significant inappropriate utilization of ankle gauntlets.

Results of the audit revealed insufficient documentation of an orthopedic ankle/foot problem to substantiate the use of this type of device. Additionally some of the products that are billed using code L1902 are being promoted as providing warmth, increasing circulation, providing protection and comfort, assisting in pain relief from diabetes, arthritis, Raynaud’s disease, or other conditions, treating joint stiffness or swelling, treating disuse atrophy, etc. These are statutorily non-covered uses of an ankle gauntlet. Some suppliers are providing two ankle gauntlet wraps on a routine basis when they provide therapeutic shoes for diabetics. This would be a statutorily non-covered use.

It would be interesting to find out how many DPM's are involved in this practice. I would urge anyone supplying L1902 to bill these devices to Medicare only for those conditions listed in the PSC LCD. More information may be found at:

http://www.palmettogba.com/palmetto/providers.nsf/(Docs)/85256D580043E7548525725700662838?OpenDocument

Paul Kesselman, DPM, Woodside, NY, pkesselman@aol.com

RE: Why I Recommend Against Testifying As a Subsequent Treating Physician
From: Richard Boone, Esq.

Because a number of readers have inquired about them, let me try to express my reasons for strongly recommending against testimony as a standard of care expert if you are the plaintiff patient's subsequent treating physician.

By way of introduction, let me make it clear that "subsequent treating physician" means that you are actively treating the plaintiff patient and trying to fix what the predecessor doctor may have damaged.

1. Testimony in this situation makes YOU a prime target for a negligence claim arising out of YOUR care of the plaintiff patient.

An astute defense lawyer will try to neutralize your testimony against his client by using the "SODDI" defense (It stands for "Some Other Dude Did It.") In this scenario, the defendant will try to blame all of the plaintiff patient's current problems on YOUR treatment, not his or her own treatment. In such cases you will quickly find yourself on trial. Frequently, you will be on trial as an actual defendant because the plaintiff patient's attorney, in search of a paycheck for himself, will amend the lawsuit to sue both the original defendant and you.

On occasion, you may find yourself in trial in the capacity of a "third-party defendant" because the defendant has sued you for what is known as "contribution" or perhaps "indemnification." On other occasions, you will be on trial as what we call an "empty chair" defendant (i.e., you won't actually be a formal party to the litigation -- yet -- but the defense will blame it all on you anyway). In any event, your treatment will become the focus of an effort to show that you were negligent and you will either have to defend yourself (if you're formally brought in as an actual party) or at least respond to all of the criticisms.

Editor’s note: The complete version of this letter appears at:
http://www.podiatrym.com/search3.cfm?id=12228

Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

RE: Podiatric Staff Salary Survey – Last Chance
Lynn Homisak, PRT

In case you missed my initial posting in PM's issue dated 12/19/06, you are invited to participate in podiatry's first time Podiatric Staff Salary Survey. I am conducting this survey in an effort to determine a national benchmark for podiatric staff salaries for your/our profession, taking into consideration your location, type of practice and amount of staff training (among the requested criteria.) I know you are all very busy, but the survey should take you no longer than 90 seconds and I would very much value and appreciate your participation. It is completely anonymous. The overall results will be posted in an upcoming issue of Podiatry Management Magazine.

Only one response per office is requested, so if you have already taken the survey...thank you! If not, you can just click on:
http://www.zoomerang.com/survey.zgi?p=WEB225YAWBU3UT ASAP to get started.

Lynn Homisak, Renton, WA, LynnPRT@msn.com

ASSOCIATE POSITION - NORTHEASTERN PA, POCONO REGION

Looking for an enthusiastic, personable, well-trained foot and ankle surgeon to join busy practice. Candidate must have completed a minimum two-year surgical residency program, demonstrate qualities of self-motivation, high morality and good surgical skills. Package includes malpractice ins. health ins. and competitive compensation. Terms negotiable. Email LT1525@aol.com Or fax CV with cover letter to 570-476-6839.

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

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITIONS - VIRGINIA

Immediate/July full time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889; www.podiatryltd.com

ASSOCIATE POSITION - MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227.

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead, FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com. I can also be reached at 305-331-4501.

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

WEEKLY SPECIAL - One week of ads (5x) for only $75

PM Classified Ads Reach over 9,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.