The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 15, 2008 #3,141 Editor-Barry Block, DPM, JD

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IN Podiatrist Provides Advice on Sweaty/Smelly Feet

"The most common cause of foot odor is hyperhydrosis, or excessive sweating," said Dr. Brandt Dotson, a podiatrist at Welborn Clinic. "And when feet spend the day macerating inside socks and shoes, it provides a perfect setting for foot odor to develop. That environment can also lead to bacterial infections."

Dr. Brandt Dotson

While sweaty, stinky feet are generally harmless (except, perhaps, to those who have to smell them), they can sometimes indicate a more serious problem. For example, excessive sweating can mean that the fight or flight response has been triggered, causing blood pressure and heart rate to rise. While you can't always eliminate foot odor, Dotson said, there are steps you can take to control it.

"Inserts, such as Odor Eaters, can be helpful," he said. "Soaking your feet in Epsom salts will dry them out. If that doesn't work, there's a prescription product called Domeboro that's very effective."You should wear white cotton socks and leather shoes," he added. "Even better, wear sandals sometimes so that your feet are more open to the air."

Source: Madonna Yancey, Evansville Courier and Press [1/14/08]

TN Podiatrist is Foot Soldier for Ron Paul

If Tennessee is a primary battleground, these are the foot soldiers. People like Therese Tlapek, a Nashville podiatrist who wears a peace symbol on a chain around her neck and likes to buttonhole her patients while they’re sitting in her chair for a chat about her candidate of choice, Ron Paul.

Dr. Therese Tlapek

For months, she’s been writing letters, distributing yard signs, canvassing local businesses and donating to the campaign. She even gave money to rent a blimp to float Paul’s logo up to Boston for the anniversary of the Tea Party.

Source: Jennifer Brooks, The Tennessean [1/13/08]

Software Compiles Transcripts of Physician-Patient Interactions

The Philadelphia Inquirer on Monday examined software developed by Verilogue, a startup technology company in Pennsylvania, that analyzes real-time patient-physician interactions from digital recordings submitted electronically by physicians, compiles transcripts and places the recordings and transcripts in a database, which clients in the health care industry can use for research purposes. Physicians who participate obtain consent before they digitally record their interactions with patients, and the recordings and transcripts remain confidential and anonymous -- with names, ages and any identifying information removed to meet standards required by the Health Insurance Portability and Accountability Act medical privacy rule.

According to the Inquirer, the database allows pharmaceutical and biotechnology companies to "hear first hand" from patients and "get a glimpse of the patient's state of mind, progression of disease," and their opinions about medical products and services. Verilogue officials said that the database has attracted an increased number of pharmaceutical and biotech companies and that the company plans to make the information available to the broader health care industry, as well as patients and physicians who participate.

Source: Linda Loyd, Philadelphia Inquirer via American Health Line, [1/14/08]

Query: Congenital Overlapping 5th Toe

Eight months ago I performed an aggressive joint and extensor tendon release of the 5th MPJ, syndactilized the 4th and 5th toes, and pinned the 5th digit through the MPJ for 5 weeks on a 17 year old female for a congenital overlapping 5th digit. The result was great until a gradual reoccurrence began a month or so ago. The reoccurrence is not nearly as bad as the original deformity, but it is certainly not desirable. Any suggestions for additional treatment? I was considering a wedge excision of skin from the plantar sulcus area?

Neil Levin, DPM, Sycamore, IL

Query: Medicare Replacement Chart Review

I am repeatedly getting requests from Medicare replacement (Unicare, Humana, Aetna) requests for chart notes or to come to office to do a review. Humana has requested the same charts three times. The last time I sent them registered mail so that when requested again (all within 6-8 month time) I called and faxed them the receipt. Their response is "we didn't receive them." They haven't responded yet to the registered mail receipt yet. Now a colleague of mine is also stating she has been getting a lot of these and ones that want to come to office and review. These are requests for all type of care-nail removals, bunion surgery to wart care. Is this just work they have to complete to be 'replacement' policies? How many times do you have to send the same notes or have repeated plans keep requesting?

Mary C White, DPM, Rockford, IL

Editor’s comment: PM News does not provide legal advice. All copies of chart notes should be sent via U.S. certified mail, return receipt requested. Never send original copies of anything.

RE: MicroVas (Peter J. Bregman, DPM)
From: Ian S Goldbaum, DPM

I have been using the Micro Vas therapy system for several years. I have found it to be beneficial in treating my lower extremity ulcers and diabetic neuropathy patients. As we all know that it is a systems approach to ulcers and neuropathy cases and the use of oral and at times topical medications, injections, debridement and physical therapy is needed in many cases . One modality or treatment usually does not work on its own. I started with one machine and had positive results from my patients. It has been extremely positive and now I have three machines. It will only make you a better practitioner and allow you more choices of treatments. In Florida, we do get paid for using the machine under PT codes for 16 treatments as long as they have not used up their physical therapy allowance.

I do not work or have any affiliation with the 'Micro Vas' company.

Ian S Goldbaum, DPM, Delray Beach, FL

RE: Windswept Toe Deformity (Thomas Graziano, DPM)
From: Simon Young, DPM

I reviewed Dr. Graziano's response and in general agree, but I have some concerns. Although the long second metatarsal possibly contributes to the pathology osteotomizing it prophylactically without an underlying hyperkeratotic lesion or metatarsalgia. The 2nd metatarsal osteotomy is so difficult to control. What if she gets postoperatrive transfer lesion or metatarsalgia. This instability in my experience is usually due to shoe or a previous undiagnosed and untreated predislocation syndrome

An IP fusion with MPJ medial release and lateral capsuloraphy with Ethibond has worked for me, in addition to a flexor/extensor transfer if needed. I make sure to use a 1st innerspace spacer to buttress the toe and appropriate footgear. If problem recurs, I have less trepidation with an osteotomy.

Simon Young, NY, NY, Simonyoung@juno.com

RE: Demand For Repayment of Overpayment
From: David Mullens, DPM , JD

Recently, I contacted many podiatrists by email about “repayment of overpayment” demands from the insurance companies. Many of these podiatrists responded positively, saying they wanted to be class representatives for a potential class-wide lawsuit. However, most of these podiatrists had not protested the demands for repayment of overpayments and, therefore, they have no damages. You must protest every single demand for “repayment of overpayment” within 30 days of receiving the demand. If you fail to protest, the courts will regard your conduct as agreement that you owed the repayment to the insurance company and, therefore, it was okay that the insurance company confiscated the overpayment amount from your future earnings.

David Mullens, DPM , JD, Palo Alto, CA, dmullens@mullenslawoffice.com

RE: Presidential Endorsement
From: Jeffrey Kass, DPM

A patient came to my office with a referral from their PCP written on the HMO's standard referral form. I saw and treated the patient and was not paid for my services. I was told I did not have an authorization number. I called the HMO to inquire if I need an authorization number why do I need the referral. Each HMO seems to have their own set of rules. I am starting to believe this is done on purpose so that invariably you will make some sort of mistake and this way they can deny payment.

I am officially endorsing any presidential candidate who will rectify this situation somehow. I believe HMO's or any insurance company needs to be fined when they pull "nonsense."

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

ASSOCIATE POSITION - MICHIGAN

Successful and expanding multi-office practice. Up to date technology, EMR, digital x-rays, ultrasound, APC SmartPReP. Great opportunity for a hard-working, personable new or established surgeon. Hospital and surgery privileges are available. ABPS eligible/certified. Full scope of foot and ankle care including wound care. Partnership opportunity. E-mail letter of introduction, photo and CV to: michfootdr@yahoo.com

PRACTICE FOR SALE - PHILADELPHIA, PA

Six year-old well established practice averaging 300K over the past three years. Suitable for surgical podiatrist. Large referral base and surgical care. I am looking to relocate. I will stay during transitional period. Excellent Philadelphia location. Practice is still growing, allowing instant and increasing income. Hospital and Surgical Center privileges. Equipment included. Fax 215-665-9242 for details

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

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

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

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only, please

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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