The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 06, 2012 #4,351 Publisher-Barry Block, DPM, JD

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Flip-Flops Lead List of Worst Shoes for Your Feet: NY Podiatrist

Heels, flats, flip-flops — some of the trendiest shoes can be the riskiest. According to podiatrist Andrew Shapiro, DPM, a spokesman for the American Podiatric Medical Association, it’s not spike heels or pointy boots. Instead, the worst offender is flip-flops. “They’re meant for the beach and the pool, not for everyday walking, ” says Shapiro.

Dr. Andrew Shapiro

Also bad for your feet are spike heels, pointy-toed pumps, ballet flats, and backless mules. “I see a lot of problems with backless shoes,” Shapiro says. “The toes start to grab the shoe to get support, and a lot of women wind up with hammertoes because of that. You can also develop calluses or breaks in the skin because the shoe is constantly tapping the heel.

Source: Robert Williams, KozMedia via WebMD [1/5/12]

Pilot Failure Caused Crash that Killed NY Podiatrist: NTSB

The failure of a Germantown pilot to maintain control of the jet he was flying in Feburary was what caused a fatal crash into the icy Hudson River, the National Transportation Safety Board has determined. The federal agency issued its final report on Dec. 27 in the investigation of the crash that killed Dr. Michael Faraldi, 38, a podiatrist with a practice in Rhinebeck.

Dr. Michael Feraldi

The report confirmed a preliminary report issued by the safety board in March that found Faraldi was not trained in the flight maneuvers he was performing for friends at the Kingston-Ulster airport on the afternoon of Feb. 26. On its website, the safety board has posted as probable cause of the accident: “The pilot’s failure to maintain airplane control while maneuvering. Contributing to the accident was the pilot’s lack of experience in the accident airplane.”

Source: John Davis, Poughkeepsie Journal [1/4/12]

HHS Sets Standards for Electronic Funds Transfers

HHS has issued an interim final rule with new standards for electronic funds transfers that the department says will reduce provider paperwork and save billions in administrative costs. Mandated by the healthcare reform law, these latest standards follow another final rule from HHS, issued in July 2011, that contained simplified transaction standards for checking patients' health coverage eligibility and the status of claims.

HHS says the new electronic funds transfer standards will eliminate many of the inefficiencies associated with submitting claims for payment. For instance, the new rule requires the use of a trace number that will automatically link bills from providers with payments from health plans, thereby avoiding "costly manual reconciliation that must currently be done," according to the release.

Source: Maureen McKinney, Modern Healthcare [1/5/12]

January 2012 CME

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RE: Osteonecrosis of the Posterior Process of the Talus (Jim Fisher, DPM)
From: Barry Mullen, DPM

It sounds like your patient sustained an old Shepherd's fracture which went onto non-union. Dorsiflexion of the hallux should exacerbate symptoms through pull on the FHL. If so, excise the fragment. If the MRI actually shows necrosis of the posterior body of the talus where the posterior process originally attached, then multiple drill holes with a K-wire for decompression purposes and attempted revascularization are indicated. PRP may also be considered in this clinical setting, though I have never personally injected plasma-rich platelets into bone.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Orthotic Therapy for Hallux Rigidus (John Scholl, DPM)
From: J.C. (Chris) Mahaffey, MS

The American College of Foot & Ankle Surgeons (ACFAS) recently completed its first multicenter trial research study, titled “A Multi-Center Retrospective Review of Outcomes for Arthrodesis, Hemi-Metallic Joint Implant, and Resectional Arthroplasty in Surgical Treatment of End-Stage Hallux Rigidus.” The study’s results will be published in the January/February 2012 volume of the Journal of Foot & Ankle Surgery.
 
The findings show all three of these surgical interventions are viable options for successful treatment. Radiographic and clinical evaluation cited the metatarsalgia as the most common finding for the arthrodesis group (9.8%), bony overgrowth into the joint for the hemi-implant group (28.3%), and floating hallux for the resectional arthroplasty group (30.9%). It was noted that surgeons may want to use this evidence to think about the patient who has failed conservative therapy, and use that knowledge to choose the surgical procedure with the best long-term outcome.
 
Currently, ACFAS is conducting a research study on subtalar arthroereisis for the symptomatic flexible flatfoot to be completed by early 2013.  ACFAS members interested in becoming clinical sites or learning more about the study should see acfas.org/2012study/
 
J.C. (Chris) Mahaffey, MS, Chicago, IL, Mahaffey@acfas.org

RE: Creating Patient E-mail Addresses (Mark Stempler, DPM)
From: Richard A. Simmons, DPM

I am bemused by the comments on this topic. No one has advocated sending PHI as email. Any PHI should be encrypted before it is emailed. There are many ways to accomplish this. Microsoft Word allows encryption of documents (OfficeButton>Prepare>Encrypt Document). There are many Zip programs (e.g., WinZip) that allow encryption of documents.

What my office has done is to create a password that the patient (or responsible party) understands. The document is encrypted and emailed directly to the patient’s email. If your computer is using up-to-date technology, there is no reason why your office cannot send encrypted PHI and not be in violation of HIPAA.

Richard A. Simmons, DPM,  Rockledge, FL, RASDPM32955@gmail.com

RE: Source for Cantharone Plus (Brent Rubin, DPM)
From: Marc Katz, DPM, Jeff Mossel, DPM

Call Charisse at Balanced Solutions Compounding (877-811-6337). They have Cantharidin with 30% Sal Acid and 5% Podophyllin.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

We use Watkins Compounding Pharmacy, 1391 E. Sherman, Muskegon, MI 231 739-7158. Cantherone Plus Topical Solution.

Jeff Mossel, DPM, Big Rapids, MI,  bigrapidsfoot@yahoo.com

RE: Bone Mineral Density Testing (Robert Bijak, DPM)
From: Jon Hultman, DPM

There is a significant “disconnect” that has evolved over the past forty years between scope of licensure and reimbursement. This has occurred because podiatric licensure has not kept pace with podiatric training and education. It was clear forty years ago that a DPM seeing a patient with a systemic disease (such as gout or diabetes) would treat the foot complication and then refer the patient out for the systemic disease. DPMs also encountered patients in whom they suspected gout or diabetes, even making a preliminary diagnosis based on a blood test or joint aspiration, and then referring the patient out for treatment of the systemic disease. In those cases, DPMs were paid for the screening tests and the treatment because they were able to use a foot diagnosis. But what about osteoporosis, diabetes type II, obesity, and a host of other systemic conditions in which the foundation of treatment is walking at least 30 minutes a day? 

This treatment is well within the education and scope of DPMs and significantly augments the medical treatment being provided by other specialists; however, a DPM is not reimbursed for this treatment or for any screening test unless a foot and ankle diagnosis is used. While an insurance company might be technically “correct” in not paying a DPM for a screening test before making a referral to another specialist when there is no foot or ankle diagnosis, or for providing treatment that gets or keeps patients walking to reduce the costly complications of chronic conditions, it doesn’t make it right or even medically sound. Based on the training, education, and performance of today’s DPMs, this no longer makes sense.

Jon A. Hultman, DPM, MBA, Los Angeles, CA, jhultmaned@calpma.org

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

I believe several inaccuracies exist in Dr. D'Angelo's response that need clarification. First, Dr. D'Angelo's Cipro to Naprosyn analogy is not germane to a discussion comparing similar treatments utilized for similar pathologies; yet, he attempts to compare that scenario to 2 different medications, with completely different pharmacokinetics, utilized for completely different indications. There's zero connection.

Second, how do you know a participating lab's product will be inferior until you actually prescribe it? You cannot presume that.

Third, I disagree with the statement that healthcare providers are responsible for...

Editor's Note: Dr. Mullen's extended-length letter can be read here.

RE: Insurance Company Controls (Robert Kornfeld, DPM, Lawrence Lavery, DPM)
From: Dennis Shavelson, DPM

This topic reflects the polarity in our profession. Dr. Kornfeld, is a podiatry/patient advocate, and Dr. Lavery a Blue Cross/Insurance one.

If I were the CEO of BCBS and forced to fly in smaller helicopters, I would be quick to use Dr. Lavery’s models that “the problem is simply that we have not done extensive research to demonstrate the benefit of _________” and demand podiatry to “approach BCBS with randomized clinical trials that were peer-reviewed and published in high level journals to argue (their) case” in order to justify eliminating payment for most covered services.

Can podiatry provide high level evidence for injection therapy (i.e., trigger injections), surgical procedures (i.e., Austin bunionectomy), physical therapy (i.e., stretching), and pharmacology (i.e., Metanx) in addition to orthotics. As a biomechanics guru, I find that Dr. Lavery and others denigrate biomechanics with “the evidence argument” but have blinders on when sitting in their glass houses.

I’m so pleased to see Robert, who has been a champion for “dropping out of the insurance company cesspool” and promoting “integrative medicine”, adding “the orthotic” to his list of thankless causes that I believe will make him more influential in podiatry over time. Larry’s call for a “growing influence of evidence” to determine how and when and by whom we get paid. On the other hand, IMHO, is calling for bigger helicopters and the extinction of podiatry as a respected profession.

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

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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 - LAS VEGAS/HENDERSON, NV

Well-established 22 year practice in   Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to:  lvfootandankle@gmail.com

ASSOCIATE POSITION - TAMPA BAY
 
Well-established, dynamic multi-doctor practice in the Tampa Bay, high-tech with EMR and digital x-rays. Sports medicine, surgery and potential partnership. No NH/ HMOs. Excellent hospital privileges. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle second to none. C.V. to  flpodiatrist@tampabay.rr.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 - 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.

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 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

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 - 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 well trained 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 - 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

SPACE AVAILABLE - NYC & LI

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