The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 26, 2011 #4,073 Publisher-Barry Block, DPM, JD

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CT Podiatrist Warns Against Barefoot Running on Man-Made Surfaces 

Dr. Michael Sabia Jr., a podiatrist from Stamford Podiatry Group, advises against barefoot running. He said it is okay to run barefoot on packed earth, but not on man-made, hard surfaces.

Dr. Michael Sabia Jr.

"The foot really needs help to run around on concrete and hard surfaces ... it's not designed to do that," Sabia said. "You have some yielding that comes with the earth or football field. There is a natural cushioning that say a good running shoe would provide. Obviously asphalt, concrete, or steel does not yield."

Source: Elizabeth Crowley, Bridgeport Connecticut Post [1/24/11

ACFAS Awards Research Grant to Study MRI Utilization in Plantar Plate Injury

The American College of Foot and Ankle Surgeons (ACFAS) recently awarded its Clinical and Scientific Research Grant to Wenjay Sung, DPM; Lowell Weil, Jr., DPM, FACFAS; and Lowell Weil, Sr., DPM, FACFAS, for their study entitled: Prediction of Plantar Plate Injury by Magnetic Resonance Imaging with Correlation to Intra-Operative Findings. The study will assess utilization of magnetic resonance imaging (MRI) in evaluating injury to the plantar plate and determining whether conventional MRI is a reliable tool for diagnostic evaluation, referencing the surgical findings.
 

(L-R) Drs. Lowell Weil, Sr, Wenjay Sung, and Lowell Weil, Jr.

“The study leaders should be commended for undertaking a study of this important patient care issue,” says American College of Foot and Ankle Surgeons President Michael S. Lee, DPM, FACFAS. “It is extremely important that all foot and ankle surgeons continue to contribute to the body of evidence-based research to help advance the profession and ensure the best care possible for our patients,” he added.

It's All in the Family for Twin MA Podiatrists

Walking into Daly Foot Care is like following in the Daly family’s footsteps. Memories of their grandmother’s foot problems helped lead 40-year-old twin brothers Albert and Jack Daly to a career in podiatry and to open a family practice in the town where they live. Few fields of medicine give a doctor the immediate gratification of seeing a patient walk in feeling pain and walk out feeling great, Albert said. Podiatry is one of them.

Drs. Albert and Jack Daly

After they graduated from Boston University in 1992, they went to New York, where Albert began the next four years as a student at New York College of Podiatric Medicine and Jack opened a gas station in Brooklyn, helping to pay Albert’s tuition. Jack followed Albert to podiatry school two years later. When Jack finished his surgical training, he and Albert moved back to Massachusetts to start their careers.

Source: Linda Thomas, Westwood Press [1/24/11]

Medical Liability Reform Bill Introduced in House

Dr. Phil Gingrey (R-GA) and two other U.S. House members introduced a bipartisan medical liability reform bill to try to lower healthcare costs and strengthen the relationship between physicians and their patients.

Gingrey, Lamar Smith (R-TX), and David Scott (D-GA) are co-sponsors on the Help Efficient, Accessible, Low-cost, Timely Healthcare Act, or the HEALTH Act. Gingrey said in a news release the bill would save billions of dollars each year in federal taxpayer dollars by reducing the need for so-called defensive medicine. He also said it would encourage health practitioners to maintain their practices, while reduce costs for patients.

Source: Jessica Zigmond, Modern Healthcare [1/25/11]

Add Value to Staff Meetings

Love ’em or dread ’em, you’re sure to spend a fair share of time in meetings this year. If you are the one planning and running the meetings, use these tips to make sure that you—and all attendees—spend that time wisely.

• Set objectives. Before you write out an agenda, write down one or two phrases to complete this sentence: “By the meeting’s end, I want the staff to …” Use those objectives as you plan the meeting, and you will develop a more focused agenda.
• Share the agenda. Give a copy to all participants before the session begins. The agenda should include a brief description of the meeting objectives, a list of topics to cover, and a brief description of who will address each topic and for how long.

   Source: Adapted from “6 Tips for More Effective Meetings,” via Communication Briefings

Query: E-Scripts Programs

Does anyone have any suggestions for an e-scripts program?  

Brent Rubin Bradenton, FL 

Query: Comprehensive Diabetic Foot Exam

What is the correct code to use when performing a comprehensive diabetic foot examination on a housecall patient, CPT 99347 or CPT 99348?

Mark Stempler, DPM, Staten Island, NY 
 
Response: There is no automatic CPT code - E/M service code or otherwise - for a diabetic foot exam at any level for any place of service. If performed as a screening, the diabetic comprehensive foot examination is not a reimbursable event. Coding is based upon history, exam, and decision-making. The diabetic patient referred to your office without any evident foot problem or complaint just because the primary care physician diagnosed the patient to be a diabetic, would not qualify most payers as a payable service if you or your office is aware (at the time of scheduling or the patient showing up) that there is not a foot problem or complaint.

If the patient is a diabetic (or a patient with a sensory loss or clinically significant vascular compromise), and makes an appointment because of a foot or ankle problem, you would work up the patient to determine the nature of the problem(s) presented, and initiate management of the same. The E/M service level billed (and paid) would be determined based on the principles/criteria of E/M coding...and your documentation.

Performing a comprehensive diabetic foot examination on your diabetic patients is good medical practice, but may not be reimbursed beyond other approved services or procedures paid for evaluation and/or treatment of foot complaints or problems or qualified services.

Tony Poggio, DPM, Alameda CA  

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

RE: Expensive Office Modalities And Reimbusement (Ken Meisler, DPM)
From: Paul Kesselman, DPM

Perhaps the old ”horse’s hooves” mentality needs to be implemented here. After almost thirty years of practice, I can count on less than ten fingers how many ”surprises” I’ve had with x-rays taken for heel pain. In the overwhelming majority of cases with heel pain, the history and physical can provide the diagnosis of fasciitis, while the x-rays are of little, if any, value.

Stress fractures, osteomyelitis, tumors and other diffferentials ought to be excluded. However, the case presentations for these are almost uniformly different than for fasciitis. Your history and examination should be sufficient to exclude these more troubling diagnoses.

I disagree that every patient who has fasciitis should not receive some imaging. It is far less costly...

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

RE: Servicing for X-Cel X-ray Machine (Greg Caringi, DPM)
From: Jason Gross, MHA

I am not familiar with the regulations governing PA when it comes to using an x-ray servicing vendor, but in NC, we are required to use a vendor that is recognized by the state; otherwise the completed service will not be accepted.  

There should be a website available in your state that lists all of the approved vendors. 

Jason Gross, MHA Forest City, NC, jgross@footandanklenc.com

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

Ya'll are preaching to the choir. We all know about orthoses; they need no defense in our corner. We should be refuting this article publicly, even if means taking out an ad in the paper -- APMA should help.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: All NSAIDs Have Cardiovascular Risks
From: Al Musella, DPM

The report on the article is a little misleading... not all NSAIDs are the same. Here's the link to the full article. Naproxen actually had a beneficial effect. It slightly reduced heart attacks, and slightly raised risk of stroke - but the overall cardiovascular risk was slightly beneficial.
 
When I had my heart attack, my cardiologist recommended Naproxen if I ever needed to take a NSAID.
 
Al Musella, DPM, Hewlett, NY, musella@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 - 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.

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 - BRANSON, MO

Great opportunity to develop a podiatry practice in a four condominium Branson office building with a growing ophthalmology practice along with a well established optometry practice and a multi-disciplinary ambulatory surgery center in Branson, a top ten retirement destination.The available condominium is a grey box so it can be build out to specifications. Rental and/or ownership options are available for this condominium. Practice development financing and ASC ownership available for the right doctor. Great schools and affordable lakeside or golf course living available. Contact Dr. James Bureman @ jbureman@missourieye.com or 417-861-5839

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

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