The Voice of Podiatrists

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January 05, 2008 #3,134 Editor-Barry Block, DPM, JD

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NJ Podiatrist Helps Saves Limbs at Wound Center He Helped to Establish

For most people a small cut is no big deal. A little antiseptic, ointment and a Band-Aid are all that's needed. That's what Joe Urbanowski thought in June 2005 when he stepped on a small piece of glass. But the wound did not heal and a few weeks later his right foot throbbed and started to swell. Dr. William A. Freundlich, who heads the Wound Center at St. Mary's, was the third doctor to examine him. After three operations and a two-month stay in the hospital, Urbanowski's five toes and a portion of his foot were amputated.

Dr. William A. Freundlich

Urbanowski, who takes pills daily to treat his diabetes, says St. Mary's picks him up each week for the appointment with Freundlich. "He wants to save and treat my lucky right leg. The others just wanted to hack things off," says Urbanowski. Freundlich says Urbanowski is a good example of how well the center serves patients. He came in as a charity care case, the doctor says. "He dodged a major bullet two years ago. I intervened in the case and was able to save his leg," says Freundlich, who is also a podiatric surgeon.

Freundlich says about seven or eight years ago he realized there was a need for a wound center at St. Mary's, which he started with another doctor. It has grown to seven doctors and operates five days a week. There is no other facility like it in Passaic County, he said. Freundlich says the hospital has the equipment and resources, which are not available in a physician's office. Patients are treated on an inpatient and outpatient basis.

Source: Diane Haines, Herald News [1/1/08]

Most Uninsured Diabetic African-Americans Have Not Seen A Podiatrist: APMA Study

A recent national survey conducted by the American Podiatric Medical Association found nearly ten percent of the 3.2 million African-Americans with diabetes are uninsured. Of those, 75 percent have NOT seen a podiatric physician for diabetes treatment reportedly due to no health coverage, compared to 45 percent of those with insurance who do see a podiatrist.

Dr. Christian Robertozzi

"Podiatric physicians are a critical part of a diabetes management team," said Dr. Christian Robertozzi, APMA president. "Because a person with diabetes can experience circulatory problems and even loss of sensation in the feet, it's critical that they receive proper foot care to avoid complications, such diabetic ulcers or amputations."

The study, which surveyed by phone 600 African-Americans across the country with diabetes or a family history of the disease, revealed 97 percent of those with the disease regularly visited a doctor. However, 57 percent reported they'd never seen a podiatric physician because many felt, "there is nothing wrong with my feet."

Source: WKTV (Utica, NY) [1/3/08]

Doctors Say Placebo Use is Common: Study

Researchers at the University of Chicago said on Thursday the study raises ethical questions and suggests a need for greater recognition and understanding of placebo use. "It illustrates that doctors believe expectation and belief have therapeutic potential," said Rachel Sherman, a medical student at the University of Chicago, whose study was published in the Journal of General Internal Medicine.

Sherman and Dr. John Hickner, a family medicine professor at the University of Chicago, sent surveys to 466 internists at three Chicago-area academic medical centers. About half, or 231, responded. Of those, 45 percent said they had used a placebo during their clinical practice, a number that surprised the researchers. But 12 percent of those surveyed said placebos should never be used.

Sherman said the practice brings up ethical issues, including whether a doctor has an obligation to provide patients with informed consent. Of respondents who reported using a placebo in clinical practice, 34 percent said they told the patients the substance was something that "may help and will not hurt." About a third gave other information to patients including, "this may help you but I am not sure how it works." Nineteen percent said it was a "medication," and 9 percent called it "a medicine with no specific effect." Only 4 percent of the doctors said, "it is a placebo."

Part of the reason doctors are not forthcoming about giving a placebo is that in order for it to work, patients need to believe it can help, Sherman said. One way around this dilemma is to ask all new patients for their consent in advance. "The patient could say no. Then you avoid any of these ethical questions," Sherman said.

Source: Julie Steenhuysen, Reuters [1/3/08]

Query: Assisting Non-Podiatric Surgeons

I practice in a surgical group with an orthopedic surgeon and a general surgeon at a small rural hospital. We have discussed the possibility of me assisting the other surgeons from time to time, if they need an extra hand and if I am available. We checked with the state regulations and couldn't find anything on DPMs assisting in surgery. I assisted with non-podiatry surgeries in residency, and I don't see why there would be restrictions now that I'm not a resident. Does anyone have any experience with this?

Jared Clifford, DPM Prosser, WA

Editor’s Note: PM News does not provide legal advice. This is an issue which varies from state to state. Therefore, one should initially contact the APMA state component, the state licensing agency or a healthcare attorney. Additionally, one should check with his/her malpractice carrier. A final step would be to check with any insurance carrier to determine in advance if you would be eligible for reimbursement.

PM News welcomes comments from podiatrists who have experience assisting non-podiatric surgeons.

Query: Diabetic Shoe Program Qualifier

Is a Type-1 diabetic with definitive neuropathy bilaterally, but no structural deformity and/or no callus formation entitled to a pair of shoes through the Medicare diabetic shoe program?

Bob Kornfeld, DPM, Lake Success, NY

Response: The decision is not yours. Officially, the determination is up to the physician treating the patient's diabetes.

That doctor has to certify that his/her patient has diabetes, and has diabetes, and

a) history of partial or complete amputation of the foot; or
b) history of previous foot ulceration; or
c) history of pre-ulcerative callus; or
d) peripheral neuropathy with evidence of callus formation; or
e) a foot deformity; or
f) poor circulation.

If the MD/DO physician signs off on the diabetes and checks-off one of the medical conditions, with your prescription the therapeutic shoes and insoles you feel best serves the patient can be filled. If the MD/DO treating the patient's diabetes does agree or feel the patient qualifies, the therapeutic diabetic shoe program will not reimburse the shoes/inserts. Simple enough.

Remember, based on the criteria above, it's the MD/DO's decision to certify the need based on their interpretation of the verbiage given to them by CMS. This is unlike qualifying certain systemic conditions for routine foot care.

Paul Kinberg, DPM, Dallas, TX

Ed. Note: Dr. Kinberg will be on the faculty at the 2008 Hawaii Coding and Practice Management Workshop (July 28-31) www.podiatrym.com/hawaii

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RE: Honey Dressings Can Prevent MRSA Infections
From: Larry Aronberg, DPM

Around 25 years ago, there was an excellent article in the Journal of Southern Medicine by an MD using a mixture of Betadine solution, Betadine ointment and sugar. It's a bit messy, but it does actually seem to work well.

Larry Aronberg, DPM, Lake Worth, FL, lwp01@bellsouth.net

RE: Recycled DME

Ever wonder what your patients do with DME supplies? A new patient complained of heel pain. Upon evaluation, the diagnosis of plantar fasciitis was made. I explained the treatment plan, and mentioned we would be supplying a dorsal night splint. When my assistant began to fit the patient for the splint, the patient stated she already had one. I was called to the room, and I asked where she got the splint. The reply was: I got it for $3.00 at a thrift store!

Peter M Mason, DPM, Largo, FL

ALTERNATIVE PATHWAY TO BOARD CERTIFICATION PETITION

I am seeking to gather the names of my fellow podiatrists who are being denied the opportunity to sit for the board certification exams and would like to join my efforts to petition our leadership for a fair alternative within the system. To join this effort, please email your name and contact information podiatrydoc@gmail.com

ASSOCIATE-TO-PARTNERSHIP OPPORTUNITY NEW HAMPSHIRE

Established practice located 1 hour north of Boston in tax-free New Hampshire is seeking a well-trained graduate of a 24-month surgical/general podiatry residency. This is a practice with a nice mix of surgery, biomechanics, injuries, diabetic and general care. No nursing homes. Very modern office with EMR, US, excellent referral base, and a well-trained staff. E-mail inquiries howardbon@aol.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.

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

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