The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 21, 2010 #3,759 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

DE Podiatrist Discusses Walking Programs

Pain in the shins and heels are common complaints of people starting a walking routine. The discomfort can feel like throbbing or tenderness below the knee all the way to the ankle. It's usually the result of tightness in the hamstrings and calves, said Raymond D. Dipretoro, chief of podiatric surgical services at Christiana Care Health System. Taking longer strides than normal also can be the culprit. Adding a stretching component to your workout may  be the culprit. Adding a stretching component to your workout may relieve this pain, he said.

Dr. Raymond D. Dipretoro

If the pain is in the knee or hip, the problem could be the position of your foot. An insert -- available at most sporting good stores -- can be put in the shoe to support the arch of the foot and relieve the problem. But if you make these changes and the pain persists, consider making a doctor's appointment to see if the problem is structural, Dipretoro advises.

Source: Kate Bothum, The News Journal [1/19/10]

Republican Wins Senate seat in MA - Healthcare Bill in Jeopardy

In an apparent blow to national health reform efforts, Republican Scott Brown defeated Democrat Martha Coakley in the U.S. Senate race to fill the late Sen. Edward Kennedy's Massachusetts seat. The loss of a Senate seat for Democrats knocks them down to a caucus of 59—one shy of the 60 needed to break a filibuster. It also puts in jeopardy the Senate's ability to pass a sweeping healthcare overhaul bill. The Senate passed its bill last month, needing all 60 of its members to do so. Without the seat once occupied by Kennedy and held by Sen. Paul Kirk in the interim, it's unlikely that the bill could pass again. Brown has said that he would vote against the measure.

Several options on how to move forward have emerged inside the Beltway, though lawmakers have so far publicly declined to comment. One scenario has the House passing the Senate's bill, but with the promise of changing it in the near future. But House Democrats were split on that option late Tuesday night. "If that's the only option in town, maybe that's what we ought to do," Rep. Baron Hill (D-IN) said.

Source: Matthew DoBias, Modern Healthcare [1/19/10]

Four Words That End Arguments

End arguments by saying, “You might be right.” When you acknowledge the possibility that you are in the wrong, you show that you are listening and that you respect the other person’s position. That opens the door to positive communication.

Source: Adapted from “Communication: Four Words That Can Instantly Diffuse Any Argument" via Communication Briefings 

Query: Ingenix Chart Review

I recently received a letter from Ingenix. They appear to be working for HealthNet, Americhoice, EverCare and/or Secure Horizons and are now requesting medical records for a "risk adjustment chart review." Has anyone heard about this, and why are they randomly engaged in review of medical records? The letter also states that "Enterprise Consulting Solutions, Inc. (ECS) has been engaged as the vendor to review medical records selected as part of this chart review. We have already been asked to fax over records and patient information sheets to this company. I feel a little like "big brother" is really watching me.
 
Al Kline, DPM, Corpus Christi, TX

RE: Hallux Limitus/Rigidus Implants (Craig Aaronson, DPM)
From: Multiple Respondents

It appears that you are getting a jamming of the 1st MPJ during gait. To avoid this, I remove slightly more of the proximal phalanx base than the company suggests. I remove slightly more than ½ the thickness of the implant. In this case, I would remove the implant, remove more from the base of the phalanx and re-insert the implant. It appears on the x-rays that the implant may be slightly too large for the joint (I always go smaller), but the motion is coming from the fact that not enough bone was removed.

If you choose to re-do the procedure, get the patient to an outside physical therapist for early range of motion exercises.

David M Davidson, DPM, Buffalo, NY, ddavidson7@verizon.net

It appears that the implant is well-seated, however, it appears to be angled relative to the 1st MPJ and a little tight. The few Arthrex hemis I have done have all been a little stiff, but not painful. You may want to consider either re-doing the hemi and taking a little more bone and angling your cut to decompress the joint, and make it more congruent or use a total implant. Say what they will about totals......the motion is good and pain-free.

William Sachs, DPM, Toms River, NJ, wmasachs@gmail.com

It looks as if the implant was put in perfectly from a technical standpoint. It appears that there is no space between the implant and the head of the first metatarsal, with most of the proximal phalanx remaining. I suggest removal of the implant and resecting more of the base of the proximal phalanx, then reinserting the implant to see if you get better range of motion. I would also drill some holes with a K-wire where the cartilage was damaged. One would want to start ROM exercises immediately after surgery. I am sure you will get many different ideas, however, I personally do not like to fuse a first MPJ in a 58y/o female.
 
Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

Editor’s Note: Dr. Peter Bregman's extended-length letter can be read here. Dr. Barry Mullens' extended-length letter can be read here.

RE: Practice Websites (Mark K. Johnson DPM)
From: Multiple Respondents

Our practice has had our own website since 2005. The benefits are numerous. Our patients can get door-to-door directions, download new patient forms, read information about common podiatric problems, and we have many links to diabetic information. Having patient forms available online is a tremendous time-saver when cycling new patients though the office for an initial visit.

Prior to 2005, we did have a site that was maintained by our local phone/Internet provider. When we decided to expand our site, we found it much more cost-effective to buy the software program and do it ourselves. If you have anyone in your office that is computer savvy, it is much better to build and maintain your own site. I used Dreamweaver to create ours and the cost at the time was $400 or there about. I do use a stat counter to track who is searching and how they are searching for us. This information is very valuable and by changing your key words, you can come up very high in the most popular search engines. I would never pay for any click services that promise to put you “on top.” With a little research you can do this for free.

All we pay is $30 or so monthly to maintain our domain and service. It is by no means a flashy site but it is effective and a good source for new patients. If you would like to check it out, here is our link: diabeticfootsolutions.com

Marcia Ellis, Southern Ohio Foot & Ankle Associates, sofaa@diabeticfootsolutions.com.

My brother, Mitchell Tracy, designed my website. He has 30 years of experience in the computer industry. Check out my website, drmarktracy.com and see what you think. I am #1 or #2 when people search for a podiatrist in my geographic area.

Mark Tracy, DPM, Port Charlotte, FL, goldenpheasant2001@yahoo.com

Today a website is a necessity. It is the best investment in your practice. The website provides a wealth of information about who you are, what you do, where you are located, (you can have directions and a map) and you can design it to have your intake forms available for a patient to download and fill out prior to the first visit. Even requesting an appointment can be done from the website. There are too many things to list here, but my recommendation is to contact a web designer. We have used Officite for many years, they are located in Illinois. Their phone number is 800-908-2483.

One great feature of their web design is you have the flexibility, if you want, to make changes on your own  after the website is up and running. The cost is fair, and as far as the search engines, we are on top consistently. You will be able to blog and even be on Facebook. We are living and working in a highly technologic world. Our website has been great for our practice.

Disclosure: I have no financial interest in this company.

Fay Mushlin, Newtown Square, PA, teegee46@gmail.com

RE: Limitation of Privileges (James Breedlove, DPM)
From: Allen Mark Jacobs, DPM, Michael Laliberte, DPM

Credentialing requirements must be equally applied by the medical staff. Some years ago, one of our hospitals had a new chairperson of orthopedics who decided to place a minimal number performed on ankle fractures in order for a podiatrist to maintain ankle ORIF privileges. As chairperson of podiatry, I agreed, so long as ortho had to demonstrate an equal number of bunionectomies, tarsal tunnel decompressions, etc. to maintain their foot DOP. They objected of course, as they were "fully trained orthopods" and could do anything from toe to spine. I argued the same for my profession "toe to ankle". We took that to the MEC. We prevailed. In fact, the ortho ended up resigning!! They looked ridiculous saying that what was good for the goose was not for the gander.

A failure to equally apply credentialing requirements might be construed as discriminatory, trade restrictive, or conspiratorial to create a monopoly. Do not back down on demanding equivalent credentialing. If a spine surgeon, total joint guy, hand-shoulder orthopod, or others has not done an adequate number or, in fact, ANY bunions (or other foot surgeries which require expertise) in years,  demand that for patient safety, institutional protection, and responsibility to public safety, the institution remove their DOP for doing such procedures.

Remember, if just being an orthopod was good enough, they wouldn't need a foot and ankle fellowship.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

Based on my years on credentials, risk management and executives committees, I can tell you that JCAHO looks for the medical staff to make rules that meet federal standards. Typically, the by-laws committee writes the rules which permit each specialty to define their core privileges. In the case of podiatric surgery, the current standard is based on a 2 or 3 year residency which meet board qualifications. It is expected that residents will be exposed to many more procedures than they will do in the first few years of practice.
 
Upon re-credentialing, each surgeon must demonstrate continued aptitude and experience regardless of specialty. Most re-credentialing processes take into consideration generalized skill sets required for "types" of procedures rather than a specific procedure. The general consensus is that, other than for core procedures, a minimum 5-8 operations of a skill set in a re-credentialling period is acceptable. Procedures can become obsolete and it is impossible to keep up numbers.
 
I suggest that you and your fellow staff podiatrists become active participants in the decision-making process so that rules are not imposed on you by others who may not have your best interest at heart. Get information from other hospitals and teaching facilities in your area to support your position. Define what your own core privileges are.
 
Michael Laliberte, DPM, Ocoee, FL, drlaliberte@westorangepodiatry.com

RE: Surgery and Podiatry (Barry Drossner, DPM)
From:  Multiple Respondents

Dr. Drossner has painted a picture in which the real world and that of fantasy collide. There is no question regarding ...do what's best for the patient, but not for the purpose of showcasing your skills to ancillary help in a hospital or surgical center to market yourself. The door of risk and benefit swings both ways: one way for the patient and the other for the surgeon. I suggest that you develop a practice or asset protection plan in which reimbursement minimally contributes to the option you discuss with the patient. If you do, then you will have leveled the playing field of risk vs. benefit that is acceptable to you, and the concern of reimbursement becomes a mute point.
 
Ira M. Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

My fellow podiatrists, our fees have not been cut. You are just accepting what the insurance companies are offering you. If you feel that your fee should be $5,000 for a bunion, by all means, charge what you feel you are worth. As a concierge podiatrist, that is exactly what I do every day in practice. I get paid what I feel the surgery is worth and I am getting busier by the day with patients wanting my "expensive" services. Life is great and the profession of podiatry is wonderful. I enjoy my practice every day and my patients are satisfied and happy.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

I hope someone at the colleges is telling students that they may be able to help a lot of people doing foot surgery, but if anyone is telling them they will make a lot of money doing foot surgery, they are misleading these future foot docs. I practiced during the time that one could make a lot of money doing foot surgery (1970 PCPM). Back then, the surgical fees were four times what we get now, and the cost of living was four times less than it is now. The one thing that hasn't changed in all these years though is that if you do what is best for your patient in a skillful manner, you can still make a decent living and increase the quality of life for your patients. That is still a good feeling to have at the end of the day.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE - NEW JERSEY

Part-time practice for sale. Located in Bloomfield, NJ. Great location in professional building. All modern equipment including digital x-ray. Please contact doccapo@yahoo.com

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION - MARYLAND (Kensington/Rockville/Silver Spring) 

If you are a graduating resident in July, or an esablished practitioner, and you are enthusiastic, personable, motivated and well-trained, we would be delighted to discuss an associate position, in our group, with you. Established practitioner relocating. 5-doctor, 3-office practice with significant patient flow already in place to keep you busy from the start! All the bells and whistles-EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital and physician referral base. Please send cover letter and resume to mddpmassociate@comcast.net We look forward to hearing from you.

PRACTICE FOR SALE – MAINE

20+ years, full scope, turn-key practice in the same medical building location. Podiatrist-friendly hospitals just down the street, wonderful, appreciative and cooperative patients await. Excellent expansion potential. Maine offers an enjoyable life style, recreation abounds, reasonable housing costs, excellent school systems, low crime rates. Colleges and universities nearby as are cultural opportunities. Retiring seller will stay for transition. Please contact: mainefootdoc@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - SOUTH FLORIDA

Ft. Lauderdale/Miami office locations seeking associate leading to partnership for the right person. Active modern busy practice needs help. Competitive salary + benefits + incentives. Send resume to podiatrydoctor@aol.com

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

ASSOCIATE POSITION IN WESTERN NORTH CAROLINA
Well diversified growing podiatry practice with good mix of office, surgery center and hospital procedures seeking a full-time associate. Must have NC license or taking state exam this year. Candidates should have excellent bedside manner equal to their medical skills. E-mail a cover letter and CV to DPMCAREER@AOL.COM

PRACTICE FOR SALE - ALABAMA, GULF COAST

26 year old practice for sale. Owner desires to sell. Practice operated 25 hours per week. Surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Contact Mike Crosby at 1-888-776-2430 or mcrosby@providerresources.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

PM News Classified Ads Reach over 12,000 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 12,000 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.