The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 12, 2011 #4,061 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2011- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We've just mailed the January 2011 issue of Podiatry Management. This 212-page issue includes our  cover story on fall prevention, as well as the usual assortment of features, including our columns, and a CPME-approved CME.

January 2011 Podiatry Management

Vibram Five Fingers Should Not be Marketed to Runners: CA Podiatrist

Dr. Kevin Kirby, who teaches biomechanics at the California School of Podiatric Medicine has posted multiple accounts of runners who had developed stress fractures after running in FiveFingers. “This is definitely not for the majority of runners,” Kirby said.

Dr. Kevin Kirby

“The Vibram FiveFingers are boat shoes; they were never meant for running, and it seems like there’s a strong correlation [between] running with them and stress fractures. They should be banned from being marketed to runners, because they are causing injuries – not preventing them.”

Source: David Abel, Boston Globe [1/9/11]

NY Podiatrist Selected as Grand Marshall for St. Patrick's Day Parade

A longtime West Brighton podiatrist famous for making house calls has been tapped to be the grand marshal of the Staten Island St. Patrick's Parade March 6. Island native Dr. Craig Campbell, 47, a veteran member of the Ancient Order of Hibernians, said he is "extremely honored, extremely humbled" to have been selected. "It's the biggest event on Staten Island," said Campbell, "and a great event for the Irish to show their pride in their heritage and in all we have done in America."

Dr. Craig Campbell

A podiatrist for two decades, Campbell is a member of the Knights of Columbus and the Kiwanis Club and sits on the boards of directors of the Alice Austen House and the Greenbelt Conservancy. He graduated from Monsignor Farrell High School before earning degrees from Muhlenberg College and the New York College of Podiatric Medicine. Parade committee chairman James Haynes said Campbell was chosen as grand marshal for his "sense of community and his dedication to the Irish on Staten Island."

Source: Judy L Randall, SILive.com [1/10/11]

Dr. Comfort to Sponsor Tour de Cure to Stop Diabetes

Dr. Comfort, a leading footwear provider in Milwaukee, has joined forces with the American Diabetes Association as a sponsor for the 2011 Greater Milwaukee Tour de Cure. “The number of Americans with diabetes continues to grow every year,” states Eric Lorenz, the President and COO of Dr. Comfort. “Many diabetic individuals suffer from foot health complications.” 

Eric Lorenz

Taking place Saturday June 18th, the Greater Milwaukee Tour de Cure is a cycling fundraiser for the American Diabetes Association that includes four different routes ranging from 10 miles to 100K for all levels of cyclists. Dr. Comfort first became involved with the American Diabetes Association by participating in the 2010 Greater Milwaukee Tour de Cure. They brought a team of about a dozen riders to the event and since then have attended and participated in almost 10 American Diabetes Association events in various cities around the country.

Million Dollar Summit Kicks Off AAPPM's 50th Anniversary Year

The American Academy of Podiatric Practice Management (AAPPM) held its 3rd Million Dollar Summit at Lago Mar Resort in Ft. Lauderdale, Florida this past weekend. The select crowd of podiatric physicians and podiatric executive managers came to Florida to hear, over the three days, an action packed program from 15 of the leading practice management faculty presenters and professional practice consultants.

Attendees at 2011 AAPPM Million Dollar Summit

AAPPM President Jeffrey Frederick, DPM, announced to the attendees, “The Midwinter Meeting March 2-6, 2011 in Pittsburg will be the Kickoff of the AAPPM’s year-long 50th Anniversary celebration of the Association's accomplishments and advancements.”

Query: Verruca Needling Technique

I would like to learn more about verruca needling technique. Are there any published resources? What is specific protocol? Is the procedure done using a  local anesthetic? What gauge needle is used? What is the depth of penetration?
 
John Moglia, DPM, Berkeley Hts, NJ

Query: Credit Card on File

I would like to require that patients keep their credit card on file. What are offices doing when a patient refuses to give their credit card information? Do you have them pay for their visit up-front, then submit their own billing? Are you just refusing to see them? How do you handle this dilemma?

Joe Gonzalez, DPM, East Lansing, MI

Query: Staged Wound Care

Can a "-58" modifier (a surgical/procedure modifier) be used with CPT 97597 (active wound care management; selective debridement)? If not, how would one code for staged wound care during a global period (e.g., planned, extensive, long term, frequent, wound care- debridements) following resection of osteomyelitic bone or amputation?

Arden Smith, DPM, Great Neck, NY

Response: You would not apply a "-58" (staged procedure) modifier when billing CPT 97597 in a global period. In my opinion, in order to use the staged procedure modifier, you would need to document in the medical record the medical necessity for "staging" a procedure(s). That documentation should be instituted as soon as you realize you will need to perform additional surgery in order to achieve the results you and the patient desire. That hopefully would be prior to the first surgery.

An example would be a guillotine-type transmetatarsal amputation secondary to osteomyelitis with the thought that once the associated soft tissue infection has resolved, the resultant wound from the amputation will be closed primarily. All of that discussion would need to be in the medical records before the amputation was performed. Any additional surgical debridements that were necessary could be coded with a "-58" modifier. Once that had been accomplished and the wound was clean and ready to be closed, the delayed primary closure should also have a "-58" modifier appended.

With the necessary medical records documentation, you should have all that will be necessary to substantiate the medical necessity of your decisions.

Paul Kinberg, DPM, Dallas, TX

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

RE: Bunion in RA Patient (Mario Dickens, DPM)
From: Simon Young, DPM, David Arkin, DPM

In reviewing the radiograph submitted, the  patient does have a severe HAV and a dorsally dislocated 2nd MPJ. I see no MPJ erosions. I would choose a 1st MPJ fusion and relocation of the 2nd MPJ via possibly a Weil-type osteotomy. Joint-preserving procedures in immuno-compromised patients with a systemic joint destructive arthritic process fail over the long run.

Are there any other joint involvements, e.g. hands, knees, hips, etc.? Are they on any immunosuppresive drugs, e.g., steroids, methotrexate, humera?

There is nothing wrong with staging either. Explain to the patient your long-term concerns and let her decide if she can accept staging.

Simon Young, DPM, NY, NY, simonyoung@juno.com

It has been suggested that a second metatarsal shortening osteotomy be performed in a rheumatoid patient with a chronic dislocated second MTP joint. I have concerns with this approach. While it may effectively reduce the deformity, the joint is most likely of poor quality and may remain painful following the surgery. I recommend a second MTP joint implant arthroplasty. I prefer the Swanson double-stem hinged implant from Wright Medical because of the stability it provides post-operatively. I agree with the recommended first MTP joint arthrodesis and second toe proximal IP joint arthrodesis for long-term stability. 
 
Disclaimer: I have no financial or other connection with the Wright Medical Company.
 
David Arkin, DPM, Big Flats, NY, docarkin@stny.rr.com

RE: Recalcitrant Verraca (Michael J. Ryan, DPM)
From: Michael Forman, DPM, Thomas Graziano, DPM, MD

I have been using Dr. Simon Young's method of treating verruca(e) for the past year. I am getting well over 90% resolution. You need to find a pharmacy that is willing to carry all of these meds. If it were not for PM News, I never would have found out about it.
 
As far as wide excision, I have done a few of these. Often, we see small verrucae developing along the incision site. It's not pretty. E-mail with your FAX number for a copy of our patient instructions. 

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

A biopsy demonstrating verrucae does not rule out an underlying malignant condition. I have had a similar case where two biopies were performed by both a podiatrist and a dermatologist. The biopsy demonstrated verrucae. A more extensive excisional biopsy proved squamous cell carcinoma. Adults who manifest with recalcitrant verrucae are, in all likelihood, in an immune compromised condition. As we know, verrucae present in patients with immunosuppression. You can also see them in patients who have an underlying malignancy brewing. Forget about treating the "verrucae" topically for now and refer this patient out for a thorough medical evaluation.
 
Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: EHR Recommendation
From: Charles F. Ross, DPM

Having read the recent posts regarding EHR/EMR, I feel compelled to respond with my own experience. I have selected a company that GUARANTEES 100% that their EMR will meet "meaningful use." This company was founded in 1979, and the three founders are still majority stockholders in what has been called the largest IT company in the country and is not likely to go out of business or be bought out. This company has a $100 million data center that houses clients' data with additional back-up and their OWN servers to store, save, and retrieve data at any time. The Dept. of Defense also stores data at their center.
 
The initial fees are minimal and ALL services that I have cost around $600/month. I believe they can provide you with your own individual back-up for an additional fee, but this is not a necessity with their system. The EHR company is Cerner, which is a McKesson company.

Disclaimer: I do not own stock or work for them.  

Charles F. Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com

RE: What Goes Around Comes Around

This morning, I opened some mail containing a huge placard with probably a dozen different Mastercard/VISA/Discovery decals intended to be plastered on the reception room window. It was early in the morning, and I was up front alone with the office staff (I thought), I blurted out, "I'm not going to stick this shit all over our window!" Then I noticed the window was open and a little old lady had shown up quite early and obviously heard me. Needless to say, I was red-faced.
 
So, after she was placed in the exam room, I introduced myself and asked how I could help her with her foot. She told me she had a painful lump on it. I looked at it rather carefully, then kiddingly told her I knew what her diagnosis was..."you have a painful lump." To which she replied "No SHIT!"...then corrected herself "No kidding."
 
Carl Solomon, DPM, Dallas, TX

ASSOCIATE WANTED - CENTRAL FLORIDA

Well-established Multi-practice Central Florida Office is seeking an associate. Look for a personable, energetic individual who is self-motivated and conscientious. We offer a Competitive salary with full complement of benefits. Excellent opportunity for a promising future. Please submit CV to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION - BOSTON

Board certified podiatrist (ABPS, ABPOPPM) wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established podiatric group in Southwest Florida. Multi-office practice with EMR, Digital x-ray, Ultrasound and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Email CV to: JLH459@aol.com

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA

Eight-physician podiatry group with six locations in South Central Pennsylvania looking for a ninth full-time associate with a minimum of a three-year surgical residency and interest in future partnership. We offer a very busy, fast paced environment with an excellent support team. State-of-the-art practice with our own physical therapy department and surgical center. We offer a six figure salary with competitive bonus incentives, CME allowance, 401K, paid malpractice insurance, as well as established patient base. Persons interested in pursuing this opportunity, email CV to: MFATRANS@AOL.COM

ASSOCIATE POSITION – CENTRAL VIRGINIA

Immediate opening. Multi-office practice, completely automated, hospital and surgery center privileges available, ED call, full service foot and ankle practice. Competitive salary/incentive structure and full benefits. Investment opportunities include practice partnership and two surgery centers. Submit letter of interest and CV to Rex Wilson, Practice Administrator at www.silverjet21@hotmail.com

ASSOCIATE POSITION - WISCONSIN

Seeking a surgical podiatrist in Central Wisconsin. Great salary and benefits. Potential for partnership. Busy, well-balanced practice in a rapidly growing area. Email interest to ftsurg@yahoo.com or fax resume and cover letter to 715-241-8102.

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY 

  Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well established multi-office group practice in the Tampa Bay area starting July 1, 2011. We are seeking a hard working, ethical and outgoing physician with Florida license.  Salary commensurate with training plus benefits. Please email or fax CV. podiatryfl@yahoo.com 813-254-8262.

TEXAS- WONDERFUL OPPORTUNITY! 

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.com

ASSOCIATE POSITIONS – TEXAS

Looking for podiatrists to join group to work in nursing facilities in Texas (Ft. Worth, Dallas, and Houston) Please respond to: doconcall02@aol.com

ASSOCIATE POSITION - FLORIDA

Three physicians providing comprehensive podiatry services to Jacksonville, FL. Senior partner retiring after 37 years is seeking associate with 3-year residency trained in reconstructive foot and ankle surgery. Salaried position leading to buy-in. Send letter of interest and CV to padler@adlerpodiaty.com

BOSTON UNIVERSITY LIMB PRESERVATION FELLOWSHIP PROGRAM

Boston University Medical Center has a accredited fellowship position. Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, you would be expected to become a knowledgeable expert who will contribute significantly to research, surgical procedures, teaching, and innovation. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in Podiatric Medicine and Surgery. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and Dr. Vickie Driver Vickie.driver@bmc.org or if questions call 617-414 6821.

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Be an owner not a worker. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PODIATRY PRACTICE FOR SALE - DENVER, COLORADO 

Turn-key operation with very low overhead in a multi-disciplinary office. Young patient population. Physician’s office building affiliated with a prestigious hospital. Very low buy-in/buyout. Expected transition of about two years. Perfect for family. Contact podpracsale@hotmail.com

PRACTICE FOR SALE- SOUTHERN CALIFORNIA

An extremely well-run, paperless  office on sale.  Owner moving out of state due to family reasons. State-of-art EMR system, trained staff. Office across from main hospital. From 2005-2009, average gross was ~500 K with potential of grossing a lot higher. For more details contact: podiatry-practice4sale@hotmail.com

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.