The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 25, 2011 #4,072 Publisher-Barry Block, DPM, JD

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Fashion Conscious Women Often Commit "Shoeacide" - NY Podiatrist

The average heel height of fashion shoes has surged from three to five inches in the past few years, with the tallest shoes typically boasting forefoot platforms, said Phyllis Rein, senior vice president of The Fashion Footwear Association of New York. For women, who already represent 65 percent of podiatry patients, wearing such towering shoes is a clear case of “shoeacide,” explained Dr. Jacqueline Sutera, Manhattan podiatrist and podiatric surgeon. “You know it’s bad for you. You do it anyway. And you wind up with an injury.”

Dr. Jacqueline Sutera

Most common are stress fractures of the toes or metatarsals from the high-impact pounding taken by a steeply declined forefoot. Plantar fasciitis — an inflammation of tissues on the bottom of the foot   and neuromas, which are an inflammation of nerves in the forefoot, are also frequent. Women can even suffer dreaded “avulsion fractures,” in which wrenched ligaments and tendons detach pieces of bone.

Source: Sheila Anne Feeney, AM New York [1/20/11]

All NSAIDs Have Cardiovascular Risks

New data showing non-steroidal anti-inflammatory drugs (NSAIDs) have cardiovascular risks are putting the well-known pain relievers back in the headlines. Investigators evaluating available evidence report they have found little to suggest that any of the investigated options are safe. Regulatory agencies have already pointed to cardiovascular signals with NSAIDs, but these concerns are based mainly on observational evidence. This new study provides a comprehensive analysis of all randomized controlled trials of the drugs.

During an interview with Medscape Medical News, senior investigator Peter Jüni, MD, from the University of Bern in Switzerland, said his team expected to see an increased risk but was surprised by the magnitude of the signal. "We never thought we'd see 2- and 4-fold increased risks," he said. "The doses were admittedly high," he pointed out, "however, this is clearly clinically relevant."

Source: Allison Gandey, Medscape [1/12/11] via Dr. Chris Albritton

CMEs Focused on Physician Behavior

Each year, physicians are caught crossing the lines of appropriate practice behavior and are reported to regulatory boards. Their actions may not warrant revoking a medical license, but they signal poor judgment and a lack of understanding about rules governing medical practice. Hoping to curtail such behavior and prevent it from leading to more serious offenses, state licensing boards, hospitals, and medical groups are turning to continuing medical education programs for help.

CME classes similar to those that doctors take to maintain a medical license are being used as a disciplinary tool when physicians get into trouble. In such instances, mandated CME course topics may include physician-patient communication, anger management, maintaining appropriate boundaries between professional practice and personal life, and proper prescribing and recordkeeping. Courses are designed to help physicians avert future transgressions.

Source: Carolyne Krupa, amednews [1/24/11]

HealthCare Fraud Prevention and Enforcement Efforts Recover Record $4 Billion

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli today announced a new report showing that the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in Fiscal Year (FY) 2010.  This is the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers.

Federal prosecutors opened 1,116 criminal healthcare fraud investigations as of the end of FY 2010, and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes during the year. In addition, HHS today announced new rules authorized by the Affordable Care Act that will help the department work proactively to prevent and fight fraud, waste and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). 

Source: CMS [1/24/11]

Query: Concierge Fee

I received a letter in the mail today inviting me (as a patient, not doctor) into a medical group...the letter goes on to state membership costs $199. They state they participate with most HMO's etc...is this not a clear violation of EVERY plan? membership fees? The $199 fee is "to support our practice."
 
They are informing you that you can communicate with your doctor through email and get longer more personalized visits. It is apparent that doctors are finding the need to be creative as fees drop. However, this practice seems illegal to me. Something to ponder is if premiums continually rise and physician fees continually lower - where does the money go? When one realizes it lines the pockets of CEO's, the question begs, how much longer will doctors not realize their value?
 
Jeffrey Kass, DPM, Forest Hills, NY

Editor's comment: PM News does not provide legal advice. Charging a $199 fee for personalized services may not necessarily be illegal if you do not accept insurance, but it certainly raises ethical issues. As physicians, we are obligated to provide the highest level of care to our patients, regardless of what type of insurance (if any) they have.

Legally, charging an extra fee to patients who have Medicare, Medicaid, and many other types of insurance is problematic at best. Before instituting a concierge program, a healthcare attorney should be consulted.

RE: Article in New York Times about Orthotics (Kevin Kirby, DPM)
From: Paul Langer

The NY Times has had a bias against custom-made foot orthotics for decades. This article is no exception. It is poorly researched and provides a false picture of orthotics. Here are the facts:

Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.

There are many studies published in peer-reviewed medical journals showing...

Editor's note: Mr. Langer's extended-length letter can be read here.

RE: PM's January Issue Editorial (Robert Bijak, DPM)
From: Narmo L. Ortiz, Jr., DPM

I agree with Dr. Bijak's post commenting on the possibility of podiatry obtaining parity with the MDs if allowed to take the USMLE or COMLEX exams. Nevertheless, an important point is always missed: When are we going to achieve national parity for podiatry itself? The article by Ms. Silberstein on the advantages of CME programs only brought to light the huge disparity that exists among all states of the nation where podiatry is concerned.

According to the table provided in the article, while Michigan podiatrists are required to take 150 CME credits within a 3-year period, Rhode Island requires as little as 15 credits within a 2-year period, and Vermont requires NONE! Of course, we all know of the disparity in scope of practice as well! While I respect the "independence" of each state to make their own laws, who are they really serving? Medical practice laws should be a federal national  issue, not a state one, or are patients really different from state to state? Until the APMA addresses this issue, how are we even dreaming of achieving parity with the MDs?

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: Expensive Office Modalities And Reimbursement (Ken Meisler, DPM)
From: Michael Turlik, DPM

I think that the pre-test probability of mechanical heel pain on an initial visit of a patient presenting with localized plantar heel pain without trauma or inflammation is at least 90% or better. For a benign, self-limited disease such as mechanical heel pain, I think 90% passes the test/treat threshold (1). Should patients present with atypical symptoms or signs or not respond to treatment after some reasonable time, diagnostic procedures are indicated. Otherwise, the diagnosis of mechanical heel pain is made on the basis of an H&P.

I am having difficulty in locating valid literature which determines the diagnostic accuracy (sensitivity/specificity, likelihood ratios) of commonly performed tests used to evaluate mechanical heel pain, either initially or after failed conservative care. It is difficult for me to judge the usefulness of these tests without this information.

1. Richardson W.S. and Wilson M. The Process of Diagnosis in Users’ Guides to the Medical Literature, chapter 14.

M. Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Expensive Office Modalities And Reimbursement (Ken Meisler, DPM)
From: Elliot Udell, DPM, John Moglia, DPM

Dr. Meisler, in his reply indicated that he would not fault a colleague for not taking a set of radiographs in the initial treatment of a patient presenting with plantar fasciitis. This leads to another question. Should podiatrists take a set of x-rays on every new patient, no matter what his or her initial chief complaint might be? Many of us, would not consider taking an x-ray on a patient who presents solely to have a case of dermatophytosis evaluated and treated. On the other hand, might we be missing serious, but currently asymptomatic pathology which can best be managed if picked up early on x-ray evaluation?

Dentists, by and large, will always take a set of x-rays on every patient annually, irrespective if the person's teeth hurt or not. Foot disorders such as early osteopenea, arthritis, biomechanical imbalances, and other conditions might be missed if a podiatrist does not take a set of routine x-rays on every patient. A recent x-ray taken at our office to evaluate another matter turned up an incidental finding of severe osteopenea in a patient. The etiology turned out to be a severe vitamin D deficiency. In our office, we do not take routine radiographs on every patient. Should we change this aspect of the way we practice?  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

It comes back to the lawyers. You can't get sued for taking an unnecessary x-ray. You can get sued for missing a tumor or stress fracture. I have seen patients who went to orthopedic surgeons who x-ray a foot for plantars warts! This is understandable when you read that the number one reason orthopods get sued for is undiagnosed fractures.
 
John Moglia, DPM, Berkeley Hts, NJ, drjohnmoglia@aol.com

Editor's note: While you may not be sued for taking too many x-rays, you can certainly be subject to professional discipline for doing so.

RE: Super Groups Clarification (Lawrence Rubin, DPM)
From: David Helfman, DPM

After reading Dr. Rubin’s comments on my letter to editor about Super Groups, I need to give some clarification. I have said that PHO’s and IPA’s are regionally based and I am very familiar with ACO’s as the potential model for controlling our healthcare dollars. I think saying that Massachusetts is the “forefront of universal healthcare” and then saying that “no one has a crystal ball to see the future of podiatry” is a bit confusing and contradictory.

I will agree that no one, not even the healthcare lawyers know...

Editor's note: Dr. Helfman's extended-length letter can be read here.

RE: Sclerosing Injections (Harry Goldsmith, DPM)
From: Kenneth Meisler, DPM 

I agree with Dr. Goldsmith that you should not bill for sclerosing when using alcohol solutions that are not even close to 40%. However, I did try using the code he recommended CPT 64450-peripheral nerve block, therapeutic, but had many rejections. The carrier stated that this code can only be used with injections in the back.
 
Kenneth Meisler, DPM, NY, NY, kenmeisler@aol.com

RE: This Song Gives You Chills
  
My patient was coming for weekly injection therapy for his plantar fasciitis. I always precede the injections with a spray of ethyl chloride. This particular day, he didn't see me reaching for the bottle and asked me, "Hey, where's the cold stuff? I like when you use it." So I told him I totally understood because when I was a little boy, my pediatrician always used it and I was never afraid of injections as a kid. I told him as a matter of fact, when I was an intern, I used to take a bottle of ethyl chloride from my Dad's office and bring it to clinic, and all the other students used to ask me if they could use it because my patients weren't screaming.

He then asked me what it was called and I said "ethyl chloride", to which he jokingly said, "Sounds like you and ethyl have had a love affair for a really long time". Unbeknownst to me, he went home and wrote this song for me. I hope that you enjoy it as much as I did.

Source: Submitted by Robert Kornfeld, DPM

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 - 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

GREAT OPPORTUNITY AVAILABLE- PHOENIX, AZ
 
A great opportunity to join and gain ownership interest in a well-established, diversified practice in Phoenix. Seeking motivated, ethical, well trained, personable AZ licensed DPM with excellent office management and clinical skills in all phases of podiatry. Practice is state-of-the-art and encompasses all phases of podiatric care. New and established practitioners are welcome, or someone open to merging a smaller practice with ours. Board Qualified/Certified required. Please send CV  phxpod@gmail.com

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

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

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 - CONNECTICUT 

Well-established, well-rounded, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Please fax resumes to 203-439-7916.

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 - 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 - OHIO/INDIANA

PrimeSource Healthcare, a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created a need for traveling, independent contractors of podiatry services in Ohio/Indiana. Earn between $175k and $225k per year. E-mail CV to Kris Wright, kwright@pshcs.com. 847-580-5960. Visit us at pshcs.com.

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

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

EQUIPMENT FOR SALE - MICROVAS UNITS

Two lightly-used microvas units, 16-lead machines (included) , $7,000 each or best offer for both. Great therapy modality: edema, neuropathy pain, increases peripheral flow, increase soft tissue healing. Great practice from vascular surgeons sending patients for treatment, pays for itself. Unit will come with the charger. jhalvorsen@familyfootandlegcenter.com

EQUIPMENT FOR SALE - COOL TOUCH LASER 
 
Cool Breeze Cool Touch CT3 plus laser used for fungus toe nail infections Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. E-mail footcare@comcast.net

SHOCKWAVE MACHINE FOR SALE

D-Actor 200 by Storz Medical. High Frequency Extracorporeal Pulse Activation Treatment (EPAT) System. A little over a year old, excellent results for plantar fasciitis and Achilles tendonitis. Must sell;  practice merger. Selling for $18,000 (new machine >30K) Will include onsite training if necessary. Email footdoc21@gmail.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

PRACTICE FOR SALE - SOUTHERN CALIFORNIA

Strong & diverse local economy, in a beautiful beach community. Well-rounded, established since 1983, fully equipped. Grossing over $600K, with continued yearly growth. Many types of insurance, reimbursement, and revenue sources. Local hospitals allow full scope of podiatric care. Terms available.  mcrosby@providerresources.com

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

SPACE AVAILABLE- NYC & LI

Office to sublet and share with DPM and chiropractor, East 60th Manhattan, and Plainview long island.  access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.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. 

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