The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 10, 2008 #3,135 Editor-Barry Block, DPM, JD

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TX Podiatrist Stresses Conservative Treatment For Foot Problems

“Take care of your feet, they’re the only ones you will have.” In 1979 Dr. Eric Tepper decided to become a podiatrist. He pursued his goal and graduated from Queens College with honors and then went to medical school at the College of Podiatric Medicine in Cleveland, OH. He came to Texas in 1980 to do his externship and to marry his longtime sweetheart, Leni.

“When patients come to my office, I explain their problems and all the treatment options. That way they understand what treatments are available, and if they want to start with a conservative route that works, they avoid surgery,” Tepper said.

Dr. Tepper advertises his column “Foot Facts” with helpful information each week in The Fort Bend Star newspaper and has for some 15 plus years. This quick witted, keen sense of humor doctor has a passion for podiatry.

Source: Cheryl Skinner, Fort Bend Star (TX) [1/8/08]

GA Podiatrist Reaps Rewards From Treating Seniors

“I get to hear the most amazing stories,” says Dr. La’Genia Mitchell-Smith, a podiatric surgeon who spends her days taking care of seniors in metro Atlanta nursing homes and assisted living facilities. “My patients love to talk about their lives - it’s a journey through history. And, no other age group could be more appreciative of your efforts,” she adds. Dr. Mitchell-Smith is director of Village Podiatry Group’s Senior Care Division. Each day she manages the foot and ankle healthcare of patients in 12 nursing homes and assisted living facilities. Patients are typically over age 65. Currently, her oldest patient is 103.

Dr. La'Genia Mitchell-Smith

Dr. Mitchell-Smith received her doctorate at Temple University School of Podiatric Medicine in Philadelphia , PA . Two intensive years of surgical training followed at Albert Einstein Medical Center/Germantown Medical Hospital in Philadelphia. With her residency completed, in 2005 she accepted the challenge of directing Village Podiatry Group’s new program to provide medical care to seniors.

Dr. Mitchell-Smith says that to work successfully with seniors requires patience, compassion and a gentle touch. She notes that her job is much more than medical care, it is about building relationships. “These patients are lonely; they crave personal interaction,” says Dr. Mitchell-Smith. She finds the most difficult part is when one of her patients passes away. “That is inherent to this job and can be emotionally painful,” she says. “But the rewards are far greater and truly invaluable.”

Source: Atlanta Hospital News [January 2008]

CMS to Expand DME Competitive Bidding Program

Acting CMS Administrator Kerry Weems outlined the coming expansion of Medicare’s plan to reduce fraud among durable-medical-equipment suppliers and drive down prices through competitive bidding. A first round of bid-driven pricing is scheduled to go live July 1 in 10 demographic areas, and this year the CMS plans to lay the groundwork for a second round that will expand the effort to 70 additional areas in 2009—including Los Angeles, where Weems held a news conference discussing the plan.

The program, initiated by the Medicare Modernization Act of 2003, will require all DME providers that want to bill Medicare to apply for accreditation, which Weems said will prevent “the small number of dishonest providers from taking advantage of beneficiaries.” Only accredited companies are allowed to submit bids, so far limited to eight product categories, including oxygen supplies and equipment, powered wheelchairs and hospital beds.

The CMS will establish a “market-clearing price” and exclude everyone that bids above it, though small businesses will get special consideration, Weems said. Selected providers in the 10 first-round regions are expected to be announced in March. The bid process for the second round is scheduled for late 2008, with pricing expected to go into effect in July 2009.

Source: Gregg Blesch, Modern Healthcare [1/8/08]

Query: Humanitarian Efforts in Costa Rica

The many PM News items relating to DPMs doing humanitarian work has been most touching and inspiring. I have an upcoming opportunity to go to Costa Rica and would love to hear some feedback from any colleagues who have experience in this country and all others for that matter.

Michael Lawrence, DPM, Chattanooga, TN

Editor’s Note: The March issue of Podiatry Management will feature a roundtable on this topic. We will also be publishing the experiences of Russell J. Buttars, DPM and David. L. Nielson, DPM in Mexico.

RE: Prescribing Systemic Drugs (Michael J. Schneider, DPM)
From: Elliot Udell, DPM, Jim DiResta, DPM, MPH

I draw a sharp distinction between the use of both as it pertains to whether a podiatrist can and should prescribe either medication.

Nifedipine (Procardia) is a calcium channel blocker which has more peripheral affects than other calcium channel blockers such as Verapmil. It was originally FDA-approved as an antihypertensive agent because it dilates the peripheral blood vessels and capillaries. It is a weak antihypertensive and is rarely used for this purpose. Raynaud's phenomenon is a vasoconstriction of the peripheral arterioles hence Nifedipine and drugs in the same class are perfect medications for the off label, direct treatment and management of Raynaud's phenomenon. They are as specific for this condition as a properly chosen antibiotic would be if you were administering it for an abscess of the same anatomic area. Hence I see no problem with a podiatrist using this to treat severe Raynaud's of the foot. Raynaud's patients do very well with this medication and take minimal dosages all winter long. There is one caveat. Calcium channel blockers in general are contraindicated in certain rare cardiac disorders so if the patient has such, get clearance from his or her cardiologist. In addition always order a serum ANA on all patients presenting with Raynaud's.

The podiatric use of allopurinol is a different story. It does not treat acute gout. It is not an antiiflammatory. It is used to treat systemic hyperuricemia which may but not always leads to acute gouty arthritis. In some cases it can even increase gouty attacks. The analogy in this case is that we as podiatrists treat pedal sequelae of diabetes but we cannot legally give a person insulin to lower his or blood sugar levels. Hence the use of allopurinol would most likely be out of scope for a podiatric physician. There is one addendum here. Podiatrists should order serum uric acid levels after the acute episode subsides and if they are elevated, refer that patient to his or her internist to make the decision about how and whether to manage the hyperuricemia.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I believe the underlying question is whether the podiatrist should be treating the pedal symptoms associated with the presenting systemic disease or treating and managing the disease itself. The argument can be made that a DPM use of Procardia for preventive attacks of Raynaud's for a skier would in my eyes seem appropriate. I certainly don't have any problem prescribing allopurinol for the patient who is returning frequently with gouty attacks and I'm tired of placing him/her on NSAID’s or steroids. I would also feel that the standard of care by state and location would be another important consideration.

Jim DiResta, DPM, MPH, Newburyport, MA, James.J.DiResta.DMS04@Alum.Dartmouth.ORG

RE: Value of Membership in APMA (Jeffrey Frederick, DPM)
From: Frank J. Lattarulo, DPM

I read Dr. Frederick's posting twice because, to me, it had a different meaning. I had lengthy conversations via email with our esteemed Dr. Block as to why I resigned from the APMA several years ago. Dr. Block made me realize (as Dr. Frederick's posting alluded to) we don't always need to agree with every position made by the organization. Nor should actions by a few many years ago (which tainted my feelings) represent the new APMA and ALL the good it has and will continue to do. I was made to realize that there is more here and we should (and I did) see the entire picture.

Since I have recently rejoined the APMA, I have received mailings and info that has already made me regret my initial resignation. Forget the extra 5% savings PICA will offer to members by enrolling in their course on the 24th. There are hardworking people giving their spare time and energy to serve us and better the profession. I wish to be a part of that again.

I am looking forward to returning to the New York clinical conference this year wearing my ID badge that will proudly display "Member" instead of "Non-Member."

Frank J. Lattarulo, DPM, Elmsford, NY, DOCLATT@aol.com

RE: Podiatrists Assisting in General Surgery
From: James Ricketti, DPM

In New Jersey the state board of medical examiners updated the surgical regulations. As a member of that board, I was able to get all podiatrists practicing in New Jersey the privilege of assisting and now it is law.

A podiatrist may assist in ANY surgical case. You must inform your malpractice carrier of the extra exposure. Remember PA’s and nurse practitioners may also first assist in any surgery and they also must carry extra insurance.

James Ricketti, DPM Hamilton Square, NJ, drj4foot2002@netscape.net

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

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

REPRENTATIVES WANTED - OUTCOME MEDICAL

Outcome Medical, (see our ad in Podiatry Management) is looking for reps to call on podiatrists and primary care physicians to market our pain program. Our FDA-cleared technology for pain and circulation is currently used by hospitals and doctors throughout the country. We provide training and technical support. On staff, certified billing, coding, and compliance specialist. Attractive commissions and leads furnished Website, www.outcomemedical.com. Request our representative package by email @ don@outcomemedical.com phone, 770-487-0029; Fax 770-692-0116

PRACTICES FOR CANADA - CANADA

2 DPM practices for sale in metro Vancouver and the Fraser Valley in beautiful BC. Both are well established with healthy client bases over a 30 year practice and can be sold separately. Gross revenues are $190.K and $100.K respectfully with an average net profit of 8% with great potential for increases. Priced at $199,000 & $99,000 to a graduate of any of the 8 USA colleges for approval by local licensing requirements. Contact pearsonhome@telus.net or by phone 1-604-986-0809 or fax: 604-986-0870.

ASSOCIATE POSITION - VIRGINIA

Multi-office practice, EMR, digital x-rays, sonography. Great opportunity for hard-working, personable new or established surgeon. Hospital and surgery center privileges available. ABPS eligible/certified. Full scope of foot & ankle care. Base salary, immediate percentage, and benefits. E-mail letter of introduction, CV and photo to practice administrator at: mtrevor41@yahoo.com

MANUFACTURING ORTHOTICS BUSINESS FOR SALE - CANADA

In Vancouver BC with a average client base of 40 with potential to increase to over 60 clients by calling on MD, ND & Chiropractor practices. Gross revenue averages $230.K over the past 2 years with a 5% net profit after taking a management fee of $12,000. Owner is retiring and will sell for $185,000. Contact Milt at marketime@telus.net or tel: 888-359-2202 fax: 888-303-0017.

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

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High volume, high grossing. 60% routine foot care, 40% surgery. Several nursing homes. Plenty of opportunity for growth. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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

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