The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 10, 2007 #2,786 Editor-Barry Block, DPM, JD

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Team Approach Necessary for Diabetic Foot Ulcers: MA Podiatrist

Foot ulcers affect 15% of diabetic patients and is the first sign of a foot problem in 85% of those who eventually require amputation. Preventing recurrence, Dr. John M. Giurini says, “is really the million-dollar question. In my estimation, getting the ulcers to heal or knowing how to get them to heal is the easy part. Keeping them healed and preventing recurrence is the difficult part.” This is where the multidisciplinary team is important, so that the foot and ankle specialist, primary care physician, and others can work together to ensure continuity in patient/family education, feet inspection, and changing foot environment.

According to Dr Giurini, “There is no one person who can take care of diabetic foot problems by him or herself. It involves the cooperation of a foot and ankle surgeon, a visiting nurse, an endocrinologist, and sometimes a vascular surgeon and infectious disease specialist.” Trying to take care of these problems on their own, “from soup to nuts” is “probably one of the worst things that physicians can do,” he warns.

Source: Internal Medicine World Report [December 2006]

After 60 years, NYSPMA’s Dr. Arthur Wolstein receives his World War II Medals

92-year-old Arthur Wolstein, DPM was recently decorated with five shiny World War II medals which arrived belatedly, but deeply appreciated. Wolstein served in the Medical Corps from 1942 to 1946 in England and was honorably discharged as a Staff Sergeant.

Dr. Arthur Wolstein

A graduate of the “First Institute of Podiatry” (now the New York College of Podiatric Medicine) in 1937, he practiced in the Bronx in Parkchester and in Co-op City. His sons Lewis and Peter followed, quite literally, in their father’s footsteps, each becoming
a podiatrist.

The medals he received were: The American Campaign Medal, the European, African, Middle East Campaign Medal, The Good Conduct Medal, The World War II Victory Medal.

Source: The New York Podiatrist [January 2007]

Healthcare Spending Growth Decreases For 3rd Year in a Row

Healthcare spending growth in the United States slowed for the third consecutive year in 2005, increasing 6.9 percent compared to 7.2 percent growth in 2004 and 8.1 percent in 2003, the Centers for Medicare & Medicaid services (CMS) reported today.

The 6.9 percent growth in 2005 marks the slowest rate of growth in health spending since 1999, when growth was 6.2 percent. Healthcare spending reached almost $2.0 trillion in 2005, or $6,697 per person, up from $6,322 per person in 2004.

Spending for physician and clinical services reached $421.2 billion in 2005, an increase of 7.0 percent over 2004. Payments by public sources for physician services, including Medicare and Medicaid, grew more slowly in 2005. Most significantly, Medicaid cost-containment efforts, such as reduced or frozen payments to physicians, contributed to the slowdown. Medicare growth for physician services was 9.5 percent in 2005 (slightly slower than the 10.4 percent growth in 2004) and reflects continued increases in the volume and intensity of services.

Source: CMS

Query: 2007 CPT 17110 RVUs

What are the total 2007 RVUs for CPT 17110 and CPT 17111, the newly designated codes for the destruction of warts?

Darryl Burns, DPM, Monterey, CA

Response: CPT 17110 - 2.38 RVUs CPT 17111 - 2.82 RVUs

The following is non-facility information.

Karen Hurley, CMM, CPC, Waldorf, MD

Codingline subscription information can be found at
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RE: Billing Irregularities (Name Withheld)
From: Michael M. Rosenblatt, DPM

Name Withheld wrote the Editor and complained that EOB's seen from another treating podiatrist "seemed" improper and wanted to know what to do about it, if anything. As a podiatrist who has developed auditing systems for chart notes and statistical methods to review Evaluation and Management services, I agree with the Editor.

The Editor strongly cautioned Name Withheld that EOB's are not by themselves any indication of quality of care, proper or improper billing or any kind of "reasonable barometer" short of charging for services when the patient wasn't actually there.

Patients are notorious for not remembering, understanding or appreciating podiatric care. Podiatrists treat patients in many ways that are very different from other types of doctors. I strongly caution Name Withheld to not judge the EOBs in front of him/her, without supporting data.

It takes real expertise and a thorough systematic approach to make the judgment that specific EOB's are "inappropriate." It is precisely this type of "opinion" that can get a podiatrist in big trouble and end up with huge, unnecessary legal bills after an investigation that turned up nothing. Even when experts review chart notes, "opinion" audits often fail because there is no "objective" systematic approach toward the audit.

I cannot over-stress that prior to any audit of services and EOB's, the responsible auditor must have all the supporting data available and approach the audit with a pre-designed statistical audit methodology. Such methods do exist. Looking at ONLY EOB's is worse than useless. It is dangerous.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: STJ Arthroeresis vs Evans (Tip Sullivan DPM)
From: Multiple Respondents

These procedures are not interchangeable. The procedure of choice depends on the location of the deformity apex and the dominant plane of the deformity. Sliding calcaneal osteotomy, which you stated is not warranted is more interchangeable with arthroresis since they are both for frontal plane deformities. The Evans is for a transverse plane deformity. You should look at the article in Clinics in Podiatric Medicine and Surgery on the Algorithmic Approach to the Pediatric Flatfoot from last year

Jonathan Labovitz, DPM, Torrance, CA, jonathan_labovitz@hotmail.com

There is no cut and paste answer given the situation described. However, the two procedures described should, in my opinion, based on the biomechanics with which the patient presents. The two procedures are not interchangeable. You did not mention adaptive contracture of the tendoAchilles which is a very common occurrence and may need operative treatment.

The indication for an Evans calcaneal osteotomy is primarily for deformities in the transverse plane, arthroeresis for those in the sagittal. Complete details obviously cannot be described here.
Notwithstanding, doing one, when the other is indicated, would not benefit your patient or practice.

Cosimo A. Ricciardi, DPM, Crestview, FL, basewedge@yahoo.com

The first mistake is pigeon-holing yourself into only two options. X-rays showing talar head uncovering, an abnormal calcaneal inclination angle, an abnormal Kite's or Meary's angle, an abnormal talar declination angle or a forefoot abductus/adductus will help you decide. Nothing beats a good physical exam. If you're sure there are no tarsal coalitions then treat the deformity with the procedure that corrects the plane of deformity. I think a big mistake is to put a STJ implant or do an Evans for everything.

I've performed 40 pediatric flatfoot recontructions in the past 2 years and have found that for a large majority of pediatric flatfeet, a procedure to augment a very weak PT tendon is imperative as well as an endoscopic gastrocnemius recession. I prefer the Young's tenosuspension and PT advancement. With these procedures I've had far better long-term results with a supple foot than the arthroeresis which really gives the patient a stiff forefoot.

Randall Brower, DPM, Roswell, NM, randoman33@yahoo.com

Editor’s Note: This topic is now closed.

PODIATRIST WANTED - MARYLAND/WASHINGTON D.C.

Mid-Atlantic Permanente Medical Group (MAPMG) has a full-time position for a board eligible/certified podiatrist to join our team. PSR 24 or PSR 36 preferred. The practice includes all aspects of podiatric medicine, including forefoot surgery, rearfoot and reconstructive surgery, diabetic foot care, limb salvage, sports medicine and general podiatry. Operating under the Kaiser Permanente umbrella, MAPMG is a family of over 800 physicians who proudly serve 500,000 health plan members. We offer an excellent starting salary and full benefits, including professional liability coverage, shareholder opportunities and bonuses based on group performance.

To apply online, go to http://physiciancareers.kp.org or send C.V. to: Pattie Dascenzo at MAPMG, 2101 East Jefferson Street, 3rd Floor East, Rockville, MD 20852. EOE

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

OFFICE SPACE TO SHARE – MANHATTAN / PLAINVIEW, NY

East 60th and or East 22nd in Manhattan and on South Oyster Bay Road Plainview. Turnkey operation, all equipment needed is available as well as an extremity MRI, fluoroscopy, x-ray and surgical equipment. Each office has an operating room with anesthesiologist available for iv sedation. Call 516 476-1815 or email to podo2345@aol.com include a phone #.

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-SOUTH FLORIDA/BROWARD COUNTY

Needs 2 or 3-year post surgical training in forefoot and rearfoot
Salary plus incentives Email responses to office email: advfoot@bellsouth.net

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 POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained individual to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Immediate Opening. Busy practice in prime suburban St. Louis location looking for a surgically trained associate, possible partner. Must be honest, ethical and hardworking. ABPS preferred, but not required. Please reply with CV and requirements to mdwrtw@aol.com

ASSOCIATE POSITION- PALM BEACH COUNTY, FLORIDA )

Excellent opportunity for a hard working, motivated podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Partnership opportunity available. Seeking a board eligible/certified trained foot and ankle surgeon for a well rounded podiatric practice. Position is available immediately. Competitive salary. Please respond to springwm41@aol.com

ASSOCIATE POSITION—NORTH COASTAL CALIFORNIA

Two fully staffed rural offices with continually growing patient load. We take care of all aspects of podiatry: assisted-living centers, palliative care, wound care, biomechanics, surgery, diabetic care. Hospital privileges are available to those properly qualified. If you are interested in challenging and hard work leading to partnership, send your CV to jimf@humboldt1.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 - 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

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