The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 16, 2008 #3,142 Editor-Barry Block, DPM, JD

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Infrared Thermometers Warn Diabetics of Infections: Podiatrists

Diabetics, watch out: A hot spot on your foot can signal an ulcer is brewing, a wound that could cost your limb. New research shows that using a special thermometer to measure the temperature of their soles can give patients enough early warning to avoid one of diabetes' most intractable complications. "They've lost the gift of pain," says Dr. David Armstrong of Chicago's Rosalind Franklin University of Medicine and Science, a diabetic foot specialist. "A wound really will heat up before it breaks down," Armstrong explains.

Dr. Crystal Holmes

Patients measure half a dozen spots on each foot. When the thermometer signals a hot spot, they put up their feet for a day or so until the temperature normalizes. Easing pressure before the skin cracks lets the body heal more easily than it can with a full-blown wound. "Heat is one of the most sensitive things, one of the first things that happens when we begin to have tissue breakdown," says Dr. Crystal Holmes, a University of Michigan podiatrist who has begun prescribing the thermometers.

This isn't a standard thermometer, but a $150 infrared one with a tip that digitally measures skin temperature on contact. Treating a simple diabetic foot ulcer can cost $8,000, double that for an infected one and even more for an amputation.

Source: Associated Press [1/14/08]

Craft Your Newsletter Design to the Particular Needs of an Over-50 Audience

How you visually present your message is critical to this age group. Since vision impairments increase with age, time spent organizing your layout and using legible design and typography will more than pay for themselves in increased audience response. Here are four suggestions to improve the legibility of your newsletter or ads for an older audience.

1) Contrast. A greater amount of contrast makes it easier to distinguish an image. This is especially true for the contrast in color between text and paper. Older readers can more readily discriminate among reds, oranges and yellows as opposed to blues, greens and purples. Be careful how you use bright colors. For text legibility, you can't go wrong with black type on an off-white or light ivory paper—uncoated to avoid glare and reflections.

2. Type. Larger print and more sizable images, while easier to see, are not the only considerations. Ornate typefaces and italics clutter the image which makes reading difficult. Choose a serif type. A bit more leading between lines also enhances readability. Avoid extensive use of ALL CAPS .

3. Visual Clues. Indenting paragraphs and use of standard capitalization improve reading. As do smaller blocks of copy ... shorter lines of type and more paragraphs.

4. Margins. Older readers follow copy better with a straight left-hand margin. Right justification seems to have little effect. Margins in excess of 1/4 inch have little impact on readability, as well ... unless it is the interior margin of a bound publication.

Source: Writing That Works [1/9/08]

Query: Width of Margins For Excision of Malignant Lesions

Does anyone have any new information on the width of excision of malignant lesions. I was taught that the width for squamous cell is 4 mm. and melanoma is 1 cm.

Brent Rubin, DPM, Bradenton, FL

Query: Office Attire

What do you wear in the office while treating patients? How many of you wear scrubs as opposed to dressing up and why? I do not wear scrubs. I dress well with a shirt and tie under a lab coat. I feel that is the most professional I can look in representing what I do. What are your thoughts?

Alan Mauser DPM, Louisville, KY

Query: Treating a Pyogenic Granuloma

I applied sliver nitrate to a pyogenic granuloma, and wondered how it should be billed. After the application of silver nitrate, the granuloma was removed, and additional silver nitrate was applied to the lesion base. Any advice would be appreciated.

Daniel R. Brown, DPM , Herrin, IL

Response: CPT 17250 is chemical cauterization of granulation tissue [proud flesh, sinus or fistula].

If performing a nail avulsion/matrixectomy on a nail margin also containing a pyogenic granuloma, the application of silver nitrate would be incidental to the nail procedure.

If you are treating a pyogenic granuloma as a "separate procedure," and the payer has no policy requiring cauterization agents stronger than silver nitrate, you would bill CPT 17250.

Tony Poggio, DPM, Alameda, CA

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RE: Congenital Overlapping 5th Toe (Neil Levin, DPM)
From: Bruce Smit, DPM, Marc Greenberg, DPM

It appears that Dr. Levin attacked the problem in a thorough manner, but with all the cases I've been associated with there has been a marked contraction of the skin associated with this deformity. Was there a plastic procedure done in the form of a "Z" or "V-Y skin lengthening?

Bruce Smit, DPM, Frankfort, IL, footbiz@sbcglobal.net

I've had no problems with a 5th MPJ T&C and an overlying V-Y skin plasty. Dr Levin did a lot more than that, which leads me to the question: What is the current deforming force? There are lot of things you can do, but more aggressive surgery could lead to a more floppy toe, with or without overlapping. He may want to weigh what is "desirable" against what is painful.

Marc Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com

RE: Sweaty Feet & Cotton Socks (Brandt Dotson, DPM)
From: Robert Scott Steinberg, DPM

I have looked, but I cannot find anything in recent history that supports the notion that cotton socks should be used for sweaty feet, or anything that supports the use of any cotton fiber in athletic socks. Why is this myth being perpetuated? To make matters worse, the APMA, in its Skiing and Your Feet Winter brochure, gets it wrong, as well.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: Presidential Endorsement For HMO Clean-up (Jeffrey Kass, DPM)
From: Paul Kesselman, DPM

There is a huge difference between a "referral" from a physician and the pre-authorization requirement from the insurance carrier.

If the HMO requires a further pre authorization (after obtaining a physician referral on their form with a number) for simple procedures such as an office visit, nail avulsions, x rays etc, or requires certain tests be farmed out due to carve out provisions in their contracts, your front office staff should be aware of them. If the carriers requirements are too burdensome (as it seems in this scenario), it’s likely costing your practice too much money to see these patients (even if you are being reimbursed). Have the chutzpah to drop the contract! It's likely not going to matter who is president with respect to this one.

As long as providers sign contracts with losing numbers, the insurance carriers will continue to try and get away with as much as possible.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.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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