The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 27, 2011 #4,074 Publisher-Barry Block, DPM, JD

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Foot Health is More Than a Physical Concern for Seniors: CA Podiatist

The golden years are supposed to be a time when you can take life easy and enjoy yourself. But when foot pain and discomfort make simple walking a problem, the loss of mobility becomes more than a physical issue. The loss of mobility can be equated to a loss of independence, a valuable commodity for anyone but especially for elder adults who have been active all their lives. "When foot problems are not treated and corrected, seniors can become depressed by their condition, often relating it to their own mortality, says Alameda podiatrist Jeffrey J.Niccoli, DPM.

Dr. Jeffrey J. Niccoli

"Even simple conditions like bunions, corns, ulcers, or sprains, if not quickly addressed, can create a scenario where elder patients feel like they can’t do anything and give up, not wanting to go out, socialize, or take care of themselves," says Dr. Niccoli. With approximately 87% of senior citizens experiencing foot problems, the diagnosing and treating of their podiatric health conditions is as easy as getting to an experienced and skilled podiatrist.

Source: Arin Dean, Jazzou News [1/25/11]

Three-Quarters of Americans Don't Exercise Because of Foot Pain: Study

A staggering 72 percent of Americans say they do not exercise because foot pain prevents them from doing so, according to a recent survey by the American Podiatric Medical Association (APMA). This finding, when viewed in light of the soaring rates of US obesity, as reported by the Centers for Disease Control, makes visiting a podiatrist and addressing foot pain critically important. "Podiatrists are physicians, surgeons and specialists who treat diseases, injuries and deformities of the foot and ankle," said APMA president Kathleen Stone, DPM. "We should be part of everyone's health-care team, but it is especially important for those experiencing regular foot pain to seek care from a podiatrist."

Dr. Kathleen Stone

The study surveyed 1,000 US adults, ages 18 and older, to gain public opinion on attitudes toward foot health and foot care. Results showed that Americans view their feet as the least important body part in terms of their health and well-being. However, feet were the number one body part to experience pain, even more so than the teeth or skin. 

Source: Marketwire [1/25/11]

Reimbursement for Wound Care 22% Lower in 2011:  CA Podiatrist

The 2011 update in the Centers for Medicare and Medicaid Services (CMS) physician fee schedule is projected to reduce reimbursement for wound care services performed in facilities by 22%. Non-facility reimbursements were also reduced. "Payments for skin substitute applications codes dropped by more than 50% and all but one debridement code were reduced," says Dr. Lee C. Rogers.

Dr. Lee C. Rogers

But the crux of the reductions come from the change to the definition of the debridement codes. Subcutaneous, muscle, and bone debridement codes are now billed by surface area, not by number of wounds debrided. The net of all changes is a significant reduction in reimbursement, which may discourage doctors from performing wound care services and lead to an increase in complications, including amputations. 

Editor's note: Dr. Lee C. Rogers' editorial in Wounds can be read here. 

NJ Podiatrist Opens "Safe Pedicure" Spa

Toetique Medi spa recently opened in the office of Dr. Jason M. Grossman. The spa’s aim is to provide pedicure services that it guarantees to be safe. “I have been seeing a dramatic rise in infections my patients acquire at unclean nail salons,” said Grossman, a board-certified podiatrist in foot and ankle surgery. “I am especially concerned about my diabetic patients and those who have other chronic diseases having pedicures in salons that might not be up to par with their infection control. These infections pose an extreme danger to them, but they still want the pampering and to have pretty feet.”

Dr. Jason Grossman

Grossman said he decided to confront the trend head-on by offering safe cosmetic pedicures in his office. The services are performed by an experienced, certified medical nail technician. Allison Nachman has had advanced education, completed an internship, and passed the required exams to attain certification as a medical nail technician.

Source: Sayerville Suburban [01/26/2011]

Physicians Generally Pleased With Obama's Speech

The nation's physicians and hospitals were generally pleased with President Barack Obama's State of the Union Address, in which he said he's open to fixing certain provisions in last year's Patient Protection and Affordable Care Act, including the much-debated 1099 filing requirement for American businesses.

"President Obama outlined a vision for our nation's future that includes key AMA priorities, such as lowering healthcare costs through medical liability reform, improvements to the new health reform law and investments in biomedical research," Dr. Cecil Wilson, president of the American Medical Association, said in a statement. Wilson also said he is pleased that the president acknowledged that certain improvements should be made to the reform law, such as eliminating the 1099 provision that requires businesses to file a form with the Internal Revenue Service for every vendor with which they have had at least $600 in transactions.

Source: Jessica Zigmond, Modern Physician [1/26/11]

Query: Employee Embezzlement

I got a very disturbing call from a bank manager this morning about an insurance check that the bank was having trouble processing. This was a complete surprise to me since I don't have an account at that bank. The bottom line is that my receptionist, a trusted employee, had opened an account under the practice's name and was regularly siphoning off a few of the checks we received and depositing them in this hidden account. She would then use an ATM card to withdraw the money. I would appreciate any advice my colleagues have on handling this situation.

Name Withheld

RE: All NSAIDs Have Cardiovascular Risks (Al Musella, DPM)
From: Jeffrey Kass, DPM

I did not see length of time for the NSAID provided in the aforementioned link provided by Dr. Musella, and am curious as I would not expect one to be prone to MI or stroke after a 1-2 week course of an NSAID. I think most podiatrists who use NSAIDs use them short-term as opposed to some internists and rheumatologists who seem to have patients on them for years.

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

RE: All NSAIDs Have Cardiovascular Risks
From: Robert Bijak, DPM

Adding to the confusion re: NSAIDs and cardiovascular risks is the variable of concomitant ASA (81mg) administration for anti-platelet activity that is so prevalent in our patients today. It has been stated that Naproxen has a longer term competitive effect with ASA thus negating its protection. Ibuprofen is to said to have about a 4 hour competitive inhibition. So, when determining NSAID involvement with MI & stroke, we must factor in if the patient is on ASA. From that point of view, Ibuprofen would be more efficacious than the cited study would have you believe.

Also, the multiplicity of systemic factors involved with thrombosis and NSAIDs must be considered. One often ignored is the Factor V Leiden Mutation (testable by blood test). There are a multiplicity of coagulapathies. In your patients, consider Waldenstrom's macroglobulinemia (IGM disease), polycythemia, thrombocythemia, cryogobulinemia, and cold agglutinin disease when worrying about their vascularity, whether it be limb salvage or wound healing. There's a lot more than diabetes out there.

Just saying NSAIDs increase cardio- or cerebro-vascular disease without investigating underlying concomitant pathology may give a false impression of NSAIDs' effects on otherwise normal patients. Podiatrists can rise to this challenge by using their hematological knowledge.  

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: Expensive Office Modalities And Reimbusement (Ken Meisler, DPM)
From: Gino Scartozzi, DPM

It is a venue such as PM News that leads to clinical debate and education amongst us all. All this discussion on the necessity of x-rays for plantar fasciitis got me thinking about this post thread when I decided to take an x-ray on this patient. An elderly gentleman came to the office stating previous care by two other podiatrists for intermittent and rare episodes of left heel pain on a scale of 3 (0-no pain to 10-worse pain). Pain is experienced at night with episodes of post-static dyskinesia from a non-weight-bearing state.

Osteoid osteoma

The patient was not sure if radiographs were ever taken. My guess is that the patient had HIP insurance during this time and radiographs were probably not done. The patient did not recall if he was referred out for radiographs. Diagnosis: Osteoid osteoma with concomitant heel spur syndrome/plantar fasciitis.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: E-Scripts Programs (Brent Rubin, DPM)
From: Pete Harvey, DPM

There are a few free-standing eRx programs. However, you need to be sure that the program integrates with your current office management and EMR/EHR program. Otherwise, you will need to fill in all patient demographics with each Rx. Most EHR programs already have the eRx segment built in, and it autofills the patient's information when you bring up the demographics (patient’s name, address, insurance, etc.). I am pretty sure the overall management of eRx is managed by a company called Allscripts which operates in the background. I would shop around for the entire package of an EMR/EHR program of which eRx is already in the recipe.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Universal Training of Podiatrists and Parity
From: Dan Klein, DPM

In regard to the latest CPME survey, equal divisiveness seems to exist between those podiatrists who think that a standard 3-year surgery residency will benefit podiatry and those who think it will not. I believe that a standard 3-year, all-encompassing surgery residency is a must and not an option, whether you do surgery or not.

There has to be a clear understanding that the biggest impediment to parity amongst our peers, MD and DO, is the lack of universal training among podiatrists. The MDs and DOs... 
  
Editor's note: Dr. Klein's extended-length letter can be read here.

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 - SOUTH CENTRAL PENNSYLVANIA

Eight-physician podiatry group with six locations in South Central Pennsylvania looking for a ninth full-time associate with a minimum of a three-year surgical residency and interest in future partnership. We offer a very busy, fast paced environment with an excellent support team. State-of-the-art practice with our own physical therapy department and surgical center. We offer a six figure salary with competitive bonus incentives, CME allowance, 401K, paid malpractice insurance, as well as established patient base. Persons interested in pursuing this opportunity, email CV to: MFATRANS@AOL.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

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 - 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

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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