The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 07, 2010 #3,747 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Pro's and Con's of Barefoot Running

The following comments by Kevin Kirby, DPM have been excepted from a debate on barefoot running which appears in the February 2010 issue of Runner's World.

"I have no problem with people who occasionally run barefoot on a safe surface as a supplement to their normal training. But in today's society, we don't have a lot of grassy fields. We have a lot more asphalt, concrete, glass, and nails. So, I worry that barefoot running is going to produce injuries, such as puncture wounds, infections, and even lacerations of vital structures at the bottom of the foot. I would hate to see someone who wouldn't get injured in shoes go out barefoot running and get a serious injury.

Dr. Kevin Kirby

In my personal experience, back in my cross-country days at UC Davis, we would sometimes run mile repeats around a grassy baseball field. I found that I could run about five seconds per mile faster without shoes. A couple of research studies have shown that you can run about three percent more metabolically efficient, which could be translated into faster running times barefoot than in 12-ounce shoes because of the weight reduction. So, barefoot running is certainly more economical. The question is: What can the runner tolerate? Are you willing to take the risk of going barefoot? How about racing flats that weigh six ounces each? That might be a reasonable middle ground for some."

Source: Amby Burfoot, Runner's World [February 2010]

OH Podiatrist Elected Vice-President of State Medical Board

Marchelle L. Suppan, DPM, MBA of Orrville, OH has been elected Vice-President of the Ohio State Medical Board. Suppan is the Vice President of Medical Affairs at Dunlap Memorial Hospital and serves as Adjunct Faculty at the University of Akron, Wayne College. She is a past president of the Ohio Podiatric Medical Association and a graduate of the Ohio College of Podiatric Medicine. Suppan is an Affiliate member of the American College of Healthcare Executives; Fellow, American College of Foot and Ankle Surgeons; and Diplomate, American Board of Podiatric Surgery.

Dr. Marchelle Suppan

Established in 1896, the Medical Board strives to protect and enhance the health and welfare of Ohio’s citizens through effective regulation of more than 55,000 licensees, including: medical doctors (MDs), doctors of osteopathic medicine (DOs), doctors of podiatric medicine and surgery (DPMs), physician assistants (PAs), massage therapists (MTs), cosmetic therapists (CTs), anesthesiology assistants (AAs) and acupuncturists. The Medical Board is comprised of twelve members: nine physicians, and three non-physician public members.

IL Podiatrist Disciplined for Failing to Get Patient's Written Consent

The Illinois Department of Financial and Professional Regulation has reprimanded Dr. James Olroyd for an "error in judgment" in failing to get written authorization to operate on a patient's left foot in November 2004. According to the state's complaint against Olroyd, he allegedly received only verbal consent from the patient and her mother to continue performing the surgery on the patient's left foot that he began before a nurse informed him the procedure was intended for the patient's right foot. The incident occurred in 2004.
 
Olroyd's attorney, Columbia-based Stephen Buser, said the reprimand of his client's license does not reflect his "stellar" career. "He has performed over 2,000 surgeries in his career and this is the only incident that has come up like that in his 35 years (of practice)," he said of Olroyd, a podiatrist at Memorial Hospital in Belleville. "The man is not perfect but I can tell you, of the numerous, numerous surgical procedures he has performed ... overall, I think it's a tremendously successful record."

Source: Rickeena J. Richards - News-Democrat [1/5/10]

Healthcare Spending Growth Lowest in Decades: CMS

Healthcare spending in the U.S. grew 4.4% in 2008 to $2.3 trillion, the slowest rate of growth in nearly 50 years, the CMS reported.  Spending growth was down from 6% in 2007, as spending slowed for nearly all goods and services, particularly for hospitals, according to the report, “Health spending at a historic low in 2008,” published in the journal Health Affairs.

The economic downturn significantly affected healthcare spending, resulting in more Americans going without care. The recession also made it more difficult for people to afford private insurance. Private insurance benefits and premiums in 2008 grew at their slowest rate since 1967, while public programs such as Medicare and Medicaid grew 6.5%, the same rate as in 2007. Retail prescription-drug spending slowed to 3.2% in 2008 from 4.5% in 2007, reflecting a decline of per-capita use of prescription medications.

Source: Jennifer Lubell, Modern Healthcare [1/5/10]

Query: Chronic Itching and Vesicular Eruptions

This female patient has has chronic vesicular eruptions on the plantar surface of both feet for two years. She has been to several MD's and has tried antifungal topically as well as hydrocortisone. She has changed detergent and socks with no improvement. Her nails and interspaces are clear. I have taken a culture which has not returned as of today. I placed her on bethamethasone ointment with no improvement.

Chronic Itching and Vesicular Eruptions

The only thing that has given her relief is wrapping her feet in Unna boots, and that has soothed the itching. However, she said that when she took off the Unna boot, and the air hit her foot, the itching returned. Any suggestions would be welcomed

Arthur Lukoff, DPM, Ellenville, NY

Query: Premium Increase Due to Malpractice Cases

I was named in two malpractice suits against me in 2006. I have had no prior suits to these. Fortunately, one of the cases was dismissed and the other is currently open, which I intend to defend. The problem is that my insurance carrier has now put me in a high-risk category and my malpractice rates have doubled for this year, despite the open case and the dismissal of the first. Is this standard for insurance carriers? Is there any way to dispute this? Any advice would be greatly appreciated.

Name Withheld (Pennsylvania)

RE: Importance of Doppler Studies (Robert Bijak, DPM)
From: Michael M. Rosenblatt, DPM

Robert Bijak, DPM makes the point that podiatrists are not licensed to “interpret” circulatory studies and guidelines and make medical predictions based upon those interpretations. It is perhaps ironic that this is actually expected of podiatrists when DPMs consider surgical and other treatment options that depend on circulation. The legal profession certainly takes that obligation seriously. Licensed or not, we are held to that standard.

But beyond professional liability, there is a greater public interest. Perhaps that is the very best use of our profession…for the general public itself. Maybe we need to take screening issues more seriously. Of course we refer, as all physicians do. The circulation to the lower extremities is a very important reflector of general physical health.

We are “deluged” from the  press about “unnecessary” tests and procedures. But this particular one is mandated by new data from studies and the demographics of public risk. It could even bankrupt Medicare. The question still stands: “Is the mechanical evaluation of circulation of the lower extremity the most important study the patient will receive all year?”

Michael M. Rosenblatt, DPM, San Jose , CA, Rosey1@prodigy.net

RE: Covered, Then Non-Covered Orthotics (Michael Forman, DPM)
From: Multiple Respondents
 
We've experienced exactly what Dr. Forman has gone through plus some variations which are worse. The insurance carrier tells patients that they are covered for orthotics, initially tells the doctor that the patient is covered, and two months later decides not to pay. When called, the company has a standard line that they use which is "promise of coverage is not a guarantee of coverage." This generally leads to an angry patient who thinks we did not fill out the form properly.
 
A worse scenario is where the patient pays a deposit with the understanding that the insurance company may or may not pay. The insurance company tells the patient as well as us that he or she is covered up to "600 dollars" for orthotics. Two months later, the insurance company sends us a check for the orthotics for exactly twenty six dollars and tells the patient that we were paid in full and that they deserve to have their deposit returned. The patient calls up and is irate and demands the money back. That we lost money on lab fees is irrelevant to the patient and carrier. When we have looked into it, the insurance company appears legally correct. Since we are participating with them, we are obligated to take whatever they dish out and take it with a smile. Theoretically, the insurance company could send us 1,000 patients for orthotics, and after lab fees alone, we would have to declare bankruptcy. Is there any way around this problem? Some of these insurance companies have contracts with orthotists and labs and will pay them a decent fee for their work, but we will only get 26 dollars. We tried (to no avail) to renegotiate this contract. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

The advice given by Dr. Poggio in regard to documentation with names, dates, etc. for pre-authorization of orthotic coverage by an insurance carrier was well stated. In addition, you should inquire about two other facts: are qualifying circumstances existing, and what is the coverage? Some carriers, for example, inform you that "orthotics are a covered benefit" but neglect to inform you that the patient must have, for example, diabetes for such coverage. Additionally, the coverage may not be satisfactory. We recently had an incident in our office which caught my attention due to the principle involved. We were informed (all documented) on two separate occasions by a carrier that orthotics billed as L3000 were not a covered benefit. The patient received and utilized the orthotics to her satisfaction.

When she complained to her carrier months later, she was told that indeed orthotics were a covered benefit as L3030, for a grand fee of $81.35! She, of course, demanded repayment from us and acceptance of the insurance fee which did not even cover the cost of the orthotics! The insurance carrier, of course, sided with the patient. My position was simple: had we been informed that orthotics were covered as L3030 at $81.35, there is no chance that we would have provided that service. I did inform the carrier, however, that should they find a legitimate provider who would offer legitimate orthotics at that price, that I would happily refer patients to such an individual. After all, bankruptcy lawyers need work too!
 
Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

We once had a problem getting paid for orthotics. We now do things a little differently. In my office, we call the insurance company to check coverage. We also have the patient call to check to make sure the patient and the office both get the same answer. We give the patient a sheet of paper that has the following questions for him to ask:
 
1) Is CPT code L3000 covered under my plan?
2) Do I have a deductible for this coverage?
3) If I have a deductible, what is it, and has any of it been met?
4) Are there any limitations to this coverage?
 
On this sheet of paper, we also state the office policy concerning orthotics. The policy is that if we are billing the insurance company, the patient signs a form that has their credit card number, expiration date, and cv number on it; and it states that if the insurance company does not pay for the orthotics or if a co-pay or deductible is due from the patient, that the office can bill the credit card up to $XXX. amount.
 
The patient signs and dates the form. By the way, we also have a form like this for surgeries where the payment is guaranteed by credit card payment. I just feel that if a patient refuses to accept this type of personal guarantee, they do not intend to pay the office if there is a deductable co-pay or refusal by the insurance company to pay. 
 
Jeffrey Conforti, DPM, Clifton, NJ, jconfortiusa@yahoo.com

RE: My New Career as an Orthotist (Michael Rosenblatt, DPM, Ira Baum, DPM)
From: Multiple Respondents

I laud the orthotist/podiatrist for his candor in dealing with the reality of private practice and the difficult decision to move in a different career direction. While Dr. Rosenblatt implies a guilt trip for shunning private practice, he is apparently unaware that, for good reason, most new MD grads gravitate to employed positions. Lucrative private practices for new grads are more rare than Democrats who hate taxes. And while there is a high demand for foot care, there are very few 'jobs' for DPM's. Go figure.

Try to get a bank loan for a new practice with $250,000 in student loan debt. Absorbing more debt without a reasonable expectation of reward can be a career killer. Dr. Rosenblatt disparages the $64,533 salary but, in fact, new DPM grads would jump at a position with that income (don't forget benefits) minus the headache of private practice. I have seen too many DPM's over the years in the same position as the orthotist to ignore the reality of the overwhelming burden and anemic rewards of today’s private practice. The limited opportunities experienced by the orthotist could be reversed with one change in our profession.........a plenary license. 
 
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

I am 100% in agreement with Dr Baum’s viewpoint. First we were a non-surgical profession, then a mix of surgical and non-surgical, and now it has evolved to be a full surgical specialty.

To those without a significant surgical practice or postgraduate residency training, the bus has already left the station. Approx. 60% of the doors have closed. The void when podiatry shifted emphasis away from  primary podiatric biomechanics and primary pod med was partly filled in some areas by orthotists , physical therapists, orthopedic PA’s, PCP’s, and pedorthists. According to two orthotic labs I contacted, they receive 35% of impressions casts from non-DPM providers... Twenty five years ago, this was unheard of. In addition, the Foot and Ankle orthopedists 25 years ago were few and far between, and that fellowship has significantly expanded . So, basically there are two groups in the same pool for foot and ankle cases at a high surgical skills level.

Ask yourself when was the last time your local society quarterly meeting or yearly state meeting had a speaker certified by ABPOPPM with a topic of orthotic modifications? When was the last time you read of a three-month fellowship for a non-residency trained podiatrist (example wound care, biomechanics)? As the bus leaves the station, some DPM’s are driving the bus, some are passengers, some will get run over by the bus, and some will wave goodbye.

George Pattis DPM, Greenville, SC, George.Pattis@northhillsmedicalcenter.com

I have some questions for Dr. Baum: What are patients who are opting for non-surgical care of foot problems, or those with problems not reaching surgical proportions, to do for care in the future? What about preventive care? What about performance enhancement issues for athletes and dancers, or those with quality of life issues? Who is going to take the lead in caring for these huge patient populations?

The answer is biomechanically-oriented DPM’s dispensing custom foot orthotics. There are modern biomechanical paradigms that DPM’s can acculturate to en masse that open up educational, clinical, and research non-operative doors that we have not enjoyed since Root in the seventies and eighties. Why totally re-tool to become an orthotist or paraprofessional working from an MD or podiatry prescription? You can continue to control your destiny by choosing a bright new fork in the biomechanical road, maintaining the non-operative podiatrist as a viable professional.

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

PRACTICE FOR SALE - MAINE

20+ year, full scope, turn-key practice. Retiring seller will assist in transition. Excellent expansion potential, superb place to raise a family. mainefootdoc@yahoo.com

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists.  Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice for sale. Owner desires to sell and relocate. Practice operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Call Mike Crosby at 1-888-776-2430 or email at mcrosby@providerresources.com

ASSOCIATE POSITION - BROOKLYN, NY 
 
Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Excellent opportunity for a three-year surgically trained foot and ankle physician. We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM with ability, and a desire to teach and take ER call. If interested, please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION-CHICAGO AREA

Medical-surgical podiatry practice seeking full-time associate, future partnership opportunity. Start with full schedule. In Elgin, IL 45 minutes from downtown Chicago. Established 75+ years, new state of the art facility. 5 minutes from new, high-tech hospitals. Excellent relationship with other specialties, high physician referral base. PSR-24/36. Email resume to kenjacoby18@gmail.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - MICHIGAN 

Seeking high quality, RPR, PSR1, PSR2, or PSR3-trained associate for a fast-paced, established group practice in Southeast Michigan. This is a secure, long-term position. Emphasis on diabetic foot and wound care. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. MUST have a Michigan license. Partnership possibility for the right individual. If you are highly motivated, ethical, and have good communication and clinical skills, please email your C.V. to mbell6@msn.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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