The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 07, 2012 #4,352 Publisher-Barry Block, DPM, JD

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HI Podiatrist Discusses Minimalist Shoes

“Typically, I’m one to believe if there was a perfect world, people would be wearing the appropriate sneaker for every particular person,” says Dr. Grace Pascual, chief podiatry representative at The Queen’s Medical Center. “Not everyone has the same foot type, even from right to left foot, so for me to actually say this is what you need to wear wouldn’t necessarily work on every particular person. They’d have to have a proper examination.

Dr. Grace Pascual

“We weren’t born with shoes, so this is where the purists come in and say you’re supposed to run and walk barefoot. I’m not a purist because I’ve seen too many deformities and problems with shoes and without shoes, so it really depends on the particular individual. If they feel comfortable and their feet don’t hurt when they’re barefoot, then it’s probably better to at least put something on. But if you start to feel pain, it’s your body’s way of telling you that it’s not the right footwear for you. I have seen foot and ankle sprains, strains of the arches, and tendonitis from people wearing those types of shoes.”

Source: Yu Shing Ting, Midweeek.com [1/4/12]

CA Podiatrist Elected President of American Physicians & Friends for Medicine in Israel

Paul Scherer, DPM has been elected President of the American Physicians & Friends for Medicine in Israel (APF). Dr. Scherer is the first non-MD to serve in this position since the organization's inception in 1951.

Dr. Paul Scherer

The APF is the American organization, working in close association with the Israeli Defense Forces Medical Corps and the Ministry of Health. It maintains the volunteer physicians to Israel for special projects and in times of emergency.

Doctors Feel Helpless Over Patients' Online Slams

Many doctors fret about the power the Internet has given disgruntled patients, competitors - anybody really - to bash practices more efficiently than any town gossip could ever imagine. A growing number of consumer review sites - one expert estimates there are close to a hundred - let patients evaluate their doctors, and the results can be brutal. Then there are the online chats, Facebook pages, and blogs where patients can praise or criticize doctors. The doctors feel they can't fight back publicly because of patient privacy protections.

Not only are the review sites a burgeoning industry, they are also spawning another: companies that help doctors (and other businesses) fight bad reviews and create a more positive online image. Even doctors who don't hire these companies may feel compelled to try blogging, tweeting, and writing Facebook updates. In an extreme effort to protect their reputations, some doctors and dentists have required patients to sign contracts that give medical professionals the right to suppress negative online comments.

Source: Stacey Burling, Philadelphia Inquirer [1/6/12]

Query: Doppler Study for Diabetics

I was recently asked by an endocrinologist about a somewhat well-controlled diabetic patient with palpable pedal pulses who suffered a severe ankle sprain with swelling and echymosis. Within about a week, the foot turned dusky red and, then according to the doctor, gangrenous. The patient ultimately suffered a below-knee amputation. The doctor asked me if there is any clinical documentation of acute limb ischemia being caused by this type of trauma in a diabetic foot with palpable pulses.

He had discussed the case with another endocrinologist who felt that all diabetics should be evaluated with a simple Doppler vascular study (not a duplex scan) instead of just palpating pulses. Question: Could a simple Doppler study or ABI done before the ankle sprain have shown the possibility of the acute ischemia resulting from this type of trauma? Is it documented anywhere?

Ron Werter, DPM, New York, NY

Query: Billing for a Hospital Consult

I just completed a hospital consultation-initial visit as a consultant called in by the patient's primary care physician. I know that the consult codes have gone by the wayside, but the APMA Coding Resource Center still lists the consultation codes. Do I use CPT 99251 (initial inpatient consultation for a new or established patient) when I bill? The CPT 99251 matches the level of E/M service I performed.

Carmen Luciano, DPM, Monroe, CT

Response: The appropriate coding for hospital consults for Medicare patients would be CPT 99221, CPT 99222, and CPT 99223 (initial hospital E/M service codes), depending on the extensiveness of the visit.

The CPT 99251 (initial inpatient consultation for a new or established patient) code you mentioned would be appropriate for commercial carriers which continue to accept CPT consultation codes.

Brent Rubin, DPM, Bradenton, FL

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Special Needs Rotation (Ashley Mychak)
From: Patrick J. Nunan, DPM
 
I am not sure where there is someone who specializes in disability medicine within podiatry. The AAPSM has partnered for many years with Special Olympics to provide screenings for those with intellectual (and many of them have physical disabilities as well) disabilities.  DMU, like many of the podiatric colleges, participates in Special Olympics events which gives some exposure to students over a weekend.

I recommend that you contact the American Academy of Developmental Medicine and Dentistry. Many of their members specialize in disability medicine. Now if you wanted a fun and educational month, I could connect you with a podiatrist in Northern Ireland who specializes in disability medicine.
 
Patrick J. Nunan, DPM, Huntington, WV, pjndpmrun@aol.com

RE: Bone Mineral Density Testing (Robert Bijak, DPM)
From: Sloan Gordon, DPM

One wonders why insurers and others mock our profession. We can't agree, we don't have standardized EBM, and we chastize each other publicly in listservs such as this one. Bone densitometry using the calcaneus is nothing new. See: onlinelibrary.wiley.com/doi/10.1359/jbmr.1997.12.8.1303/full

I believe that if you see a patient with significant osteopenia in the foot and ankle, the DPM has a right, perhaps even an obligation, to treat his/her findings. In addition there is evidence that biphosphanates (Fosamax, Actonel, Forteo) are useful in treating Charcot joints. I know we use them successfully pre- and post-operatively in our Charcot reconstructions.

I am so tired of reading what we CANNOT do by our colleagues; how about using our complete education and training, and thinking out of the box. I am so tired of our negativity towards one another. We are not one another's enemies. And, yes, if you have a calcaneal bone densitometer, you should get paid for your services.  

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

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

The analogy of the two medications was made to stress my point that when one writes an Rx for Cipro, he knows exactly what the patient will receive from the pharmacy...Cipro. When writing an RX for custom-made orthotics, you may not be getting exactly what you intended. That would be the connection.

Secondly, I never assumed in my post that the vendor's product was inferior. I merely stated that...

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

RE: Insurance Company Controls (Larry Lavery, DPM, MPH)
From: Elliot Udell, DPM

Dr. Lavery makes a good point when he writes that there is not enough research being conducted in biomechanics. The fact that our schools, even with experts in biomechanics on staff, publish very little is also deplorable. The problem in a nutshell is that institutions, including our own podiatry colleges, use a business rather than a "society needs it" model to decide on what topics to conduct research. This means that, unless a corporation with deep pockets is willing to fund any given research project, the likelihood of such a project seeing the light of day is nil. Since evidence-based medicine has given birth to a "prove it to me" mentality, unless there is research on the table that proves that orthotics work, many insurance companies will take the path of not paying for them.
 
Since we are not going to change the business model on which most of our research institutions are based, the only solution to this is for podiatry labs to team together and contribute the money so that quality research can be paid for, performed, and published. Only then will our profession be able to force the insurance industry to pay for what we as practitioners already know is a big help to our patients.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

WANTED TO BUY - EQUIPMENT (MICROCASSETTE TRANSCRIBERS)

Want to buy Panasonic microcassette transcribers model RR-930 or other brands of microcassette transcribers. Please reply to paulajn@cox.net

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be PSR-24 or PM&S-36 trained. Excellent salary w bonus. Must be ethical, self-starter, hard worker. Willingness to learn/work as part of a team. Surgery Block time. Must be proficient in rearfoot/ankle surgery. Email CV, photo, LOI to: susmitad86@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 - 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 - 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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