The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 03, 2010 #3,770 Publisher-Barry Block, DPM, JD

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In a recent story about the recipients of PICA Scholarships at Barry University, the incorrect students were identified.

Shamir Bhikha and Lauren Karger

The correct students were Shamir Bhikha and Lauren Karger.     

Scholl Alumni Association Elects New Officers and Board

Jack W. Hutter, DPM ’81, was elected the new President of the Alumni Association Board of Directors of the Dr. William M. Scholl College of Podiatric Medicine. 

Dr. Jack W. Hutter

Dr. Hutter, a 1977 cum laude graduate of the University of Wisconsin-Milwaukee, graduated with honors from Scholl College. He has managed a successful podiatric medical practice for 27 years in Oconomowoc, WI. Joining him on the Scholl College Alumni Association Executive committee are:

Kert W. Howard, DPM ’77 (ID) Immediate Past President
H.F. “Bunny” Brown, III, DPM ’74 (AR) President-Elect
Richard C. Wilson, DPM ’80 (FL) Treasurer
Cynthia Cernak, DPM ’89 (WI) Secretary

Members-At-Large:

Kathleen Neuhoff, DPM ’93 (IN)
Mark F. Rogers, DPM ’77 (UT)
Brandon Hawkins, DPM ’01 (CA)
Joseph Kiefer, DPM ’87 (FL)
Matthew Garoufalis, DPM ’82 (IL)
Corbett Toussaint, DPM ’04, Faculty Representative
Carolyn Kelly, Class of 2011, Student Representative

FL Podiatrist Among The First to Aid Haitian Earthquake Victims

Dr. Philip Organ, a wound care physician at Naples Physician's Regional Hospital, cleans and dresses the legs of a woman at General Hospital of the State University in Port-au-Prince on Saturday, Jan. 16, 2010, in Port-au-Prince.

Dr. Philip Organ in Haiti (photo:David Albers)

Organ was one of three doctors and four nurses mobilized to the earthquake-ravaged capital by the Naples-based Hope for Haiti.

Source: Naplesnews.com [2/1/10]
 
Editor's note: Dr. Organ's account of the Haitian relief effort will appear in the April issue of Podiatry Management Magazine.

AZ Podiatrist is Special Guest on NPR Fundraising Campaign

Podiatry and limb salvage were front and center yesterday during the annual spring fundraising drive at National Public Radio's Arizona Public Media Bureau. David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance, hosted an hour of programming with both NPR and classical radio.

Dr. David Armstrong at the NPR/Arizona Public Media Bureau

 "I think it is wonderful when we can play hookie from clinic for an hour and support media that supports us", noted Armstrong. "It also affords us to get the word out in depth-- beyond the soundbites-- about the importance of foot care and amputation prevention." This is Armstrong's second tour at NPR, following a very successful drive in October, 2009.

IN Podiatrist Creates Glass Bra for Charity Event

David Powell has done a lot of interesting things, but until recently, designing a brassiere was not among them. Powell, a partner in the Evansville podiatric firm, First Podiatry, is also a glass artist. His glass bra will be among those featured at "Mardi Bras," an art exhibition, sale and style show Feb. 14 at the Casino Aztar Executive Conference Center. More than three dozen locally made, one-of-a-kind art bras and bustiers will be modeled and auctioned as a fundraiser for the AIDS Resource Group.

Dr. David Powell in his workshop (Photo: Erin McCracken)

The brassiere made by David Powell is made of cobalt blue glass chips and silver wire. The bra was an interesting challenge for Powell, who works with a sturdy type of glass called borosilicate. "Think Pyrex," Powell said, adding he does more melting and molding than actual glass-blowing, using a technique called "lampworking."

Source: Sara Anne Corrigan, Evansville Courier & Post [2/1/10]

Query: Unilateral Derm Condition

My patient is an 83 y/o male. His condition has been present for decades without change. It appears nowhere else on his body. Several topical meds have been tried (He doesn't remember which) without resolution. Skin scraping shows hyphae, but no growth on culture so far (several weeks).

Unilateral Derm Condition

Note the numerous keratotic plugs. At his age, I don't want to consider an oral antifungal; and it obviously isn't deadly (after decades), so I don't want to biopsy and put a painful hole in his foot. Any suggestions?

Larry Aronberg, DPM, Lake Worth, FL

Query: EMR Stimulus

Is the whole mandated EMR issue etched in stone, or is it up in the air pending passage of Obama’s healthcare reform package? I am confused. I am primarily referring to qualifying for the 5 year stimulus money, the largest portion of which is in 2011. I want to qualify for the most reimbursement possible without jumping the gun.
 
Neil Levin, DPM, Sycamore, IL

Editor’s comment: PM News does not provide legal advice. The ability to receive up to $44,000 for implementing EMR is part of the previously passed economic stimulus bill. The legislation is unrelated to the healthcare reform bill currently being debated on Capitol Hill. To receive the full benefit of the EMR Medicare reimbursement, it’s best to start with an approved EMR  system no later than 2011. For the maximum benefit, however, you should already be using an EMR system to take advantage of the e-prescribing and PQRI incentives, which are being phased out.

Those practitioners who are late adopters will not only miss out on these large bonuses, but pay a 1% Medicare penalty in 2015.

Query: Foot Orthotics Billed

I billed custom foot orthotics as L3000, CPT 29515 (application of short leg splint [calf to foot], and A4580 (cast supplies [e.g., plaster]). On the L3000 codes, I appended the "-59" modifier.

I received a denial stating that the modifier code does not correspond with the procedure code billed. What modifier should I be using?

Thomas Fitzgerald, DPM, Rohnert Park, CA
 
Response: You did not mention what insurance company you are dealing with, and whether orthotics are a covered benefit. If they are not covered, then the impression casting wouldn't be covered either. It is a good idea to contact your major payers to find out what their coverage and billing guidelines are.

Some points to consider. Billing A4580 (cast supplies [e.g., plaster]) implies that you are using a roll of plaster for application of cast (not an impression cast). Generally, any minimal supplies used are included, either in the allowance for the casting or the foot orthotics themselves.

The use of the "-59" modifier implies that you performed multiple procedures that are distinct from each other. You would not append a "-59" modifier to a supply...which is all L3000 is. You add "RT" and "LT" to each L3000 billed.

You note that you billed CPT 29515 - application of short leg splint (calf to foot) - but you are not applying a short leg splint. The use of CPT 29515 is inappropriate if you are claiming to be taking an impression cast.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
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RE: Derm Condition in Diabetic Patient (David Sands, DPM)
From: Multiple Respondents

It's always a good idea to biopsy a lesion that is not responding to treatment. I once treated a similar lesion that on biopsy was diagnosed as verrucous carcinoma, a form of squamous cell carcinoma.

Gary Friend, DPM  Glenview, IL,gjfriend@gmail.com

In regard to the patient demonstrated, it is indeed possible that the use of multiple emollients/moisturizers have so occluded the skin that the patient may have a tinea pedis infection and/or bacterial infection. This may especially be true if this patient is a poorly-controlled diabetic, being immunosuppressed, with concomitant  onychomycosis as the focal source of his foot skin infection. I would stop the use of emollients/moisturizers for a period of one week with the patient to return in one week for a skin biopsy at the periphery of the dermatitis and over the hyperkeratotic region. Also, a PAS on skin shavings of this dermatitis should be considered to rule out fungal etiology.
 
Gino Scartozzi, DPM, New Hyde Park, NY, gsdpm@aol.com

There appear to be some pustules distal to the keratotic skin. Does the patient have any other symptoms suggestive of keratoderma blennorrhagicum caused by reactive arthritis (Reiter's syndrome)? Other forms of psoriasis can also be in the differential. It is more likely, however, since the history is that it has been progressive, that the cause is renal disease, causing severe drying and cracking. The reason why winters are worse is that the heat is on and the air dry. Heavy footgear can cause sweating and further drying of the skin.

A punch biopsy would probably help with the diagnosis, but if the patient has vascular disease associated with diabetes, inflicting a wound could lead to an ulceration. You might want to treat it symptomatically. One set of products is called Salvax duo. They are two prescription foam-based products. One has 6% sal acid and the other a 40% urea foam. One is applied in the morning and the other at night. There are other urea and sal acid products that can also be tried. You might also add a topical steroid if you think there is an inflammatory component.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Lateral and Dorsal Splaying of a Fifth Digit (Mark Williams, DPM)
From: Jonathan Haber, DPM

A much simpler and guaranteed approach is to partially syndactylize the 4th and 5th digits. This will prevent any transverse or sagittal plane recurrence. Bone surgery is not necessary.
 
Jonathan Haber, DPM, Caldwell, NJ, JHaber4932@aol.com

RE: PICA Demutualization (Scott Werter, DPM)
From: David N. Helfman, DPM

PICA paid out monies to each physician and sent each physician a 1099. This income is considered ordinary income based on what we have been advised by our accountants and therefore, you will need to pay ordinary income tax on these funds.
 
David N. Helfman, DPM, Atlanta, GA, dhelfman@villagepodiatrycenters.com

RE: Time to Act (Robert Bijak, DPM, Russell Trahan, DPM)
From: Multiple Respondents

In exchange for criticizing our profession, Dr. Bijak is attacked personally. Assaulting the messenger does not evaporate the message. Advancements in podiatry have been fantastic, but the limited license will restrict those advancements into a shrinking box. How many more bunion procedures can we invent? Many of us are ready for a plenary license and we have earned the right to complain that the profession is not moving in that direction.
 
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

As far as "limited license" to describe podiatrists, I agree with Dr. Trahan.  For over 20 years, I have fought that term when dealing with two different hospitals over privileges, scope of practice, and the usual discriminatory issues. The attorneys representing the hospitals instead used the term "plenary license." They state unequivocally that a podiatrist is not a "plenary licensed physician", and have used that term to block certain upgrades for DPMs, and have usually prevailed on a local level. 

The APMA has helped, and the NJ State Society has lobbied some changes in law, but the grunt work (i.e., time and money and aggravation) to formulate change starts with each of us on the forefronts: the hard-working community-based DPMs.  When you can effect a working change from the status quo, and educate some of the "plenary licensed physicians" along the way, it is worth the effort. My regret is that I have not changed more, nor has the deep support of my community DPM colleagues.

Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com

Dr. Bijak has made some provocative statements regarding our profession. Personally, I agree with some and disagree with others.  For the current and past presidents of the colleges of podiatric medicine who read PM News posts, please respond to Dr. Bijak's concern that the interests of the colleges are self-serving. The issue may not be the quality of the education, but it may be the institutions themselves that may be one of the factors contributing to podiatry's position in the healthcare arena. I'm sure most podiatrists would be interested to hear from the leaders of the colleges discussing their positions regarding the future of podiatry and how they would address many of the issues and concerns that have been brought up by Dr. Bijak and others.

Ira M. Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

RE: The Passing of Gary Jolly, DPM
From: Robert G. Frykberg, DPM, MPH, Joseph T. Hogan, DPM

I am extremely saddened by the death of my friend, Gary Jolly.  I knew him for 25 years or so and served on numerous programs and Boards with him, including  Region I APMA and ACFAS. While his professional career has been well-extolled by others, it was his personal side that mattered most.  He was a gentleman as well as a scholar and teacher, a generous father and husband, as well as a friend who always had a smile on his face upon a chance meeting.

Although I had not seen nor spoken to him in several years since learning of his illness, his passing has certainly had a deep effect on me as well as his many other friends. Gary was one of the shining lights in our profession and will be missed by many. Nonetheless, his memory will shine on for years to come.

Robert G. Frykberg, DPM, MPH, Phoenix, AZ

Dr. Jolly served as an inspiration and friend to me. He was always "pushing the envelope", working to discover why and how something occurred. This man will be sorely missed in our profession, health care professionals all over the world and among our fellow human beings. I am a better person for having known Gary Jolly. Now we must carry on representing his name and legacy.

Joseph T. Hogan, DPM, Binghamton, NY

PRACTICE FOR SALE - NORTHWEST CHICAGO SUBURBS

17 year-old surgical practice for sale. Practice sees a wide variety of foot and ankle pathology and is largely referral especially regarding surgical patients. Two offices fully equipped. Lease or purchase of office condo also possible. Doctor willing to stay Please email inquiries to crystallakefootandankle@live.com

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry pPractice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - VICTORIA, B.C.

Beautiful Victoria, B.C. Canada on the ocean, fast growing area, Associate for multi-office full scope practice. Interviews in Orlando, February 20th and 21st, Reply by email to orthotic4D@shaw.ca

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.

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net

ASSOCIATE POSITION - MARYLAND

Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible / Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter and resume and availability to FootDocMaryland@Gmail.com

SPORTS MEDICINE FELLOWSHIP

The Palo Alto Medical Foundation Surgical/Sports Fellowship Aug 1, 2010 - July 31, 2011. Applicants must be able to obtain a California license. Responsibilities include assisting in all types of foot and ankle surgery, (approximately 500 cases), seeing patients in the sports clinic and must complete 2 papers/research projects. Benefits include salary of $56K/yr, medical, dental, malpractice, and CME allowance. Interviews will be at the Midwest Podiatry Conference March 11-13, 2010, but on-site visit is preferred. Minimum 24-month surgical residency training pre-requisite. Applicants should send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM, 650/853-2927 HeySax@AOL.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 – 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 - MASSACHUSSETTS

Full-time/Part-time podiatrist needed for a busy nursing home practice. Please send inquiries to debbierobertsm4@hotmail.com

ASSOCIATE POSITION – MISSOURI

Expanding multi-location practice seeks motivated individual to contribute to growth. Practice enjoys strong reputation and name recognition. Prefer candidates with interest in partnership opportunity. Established locations available for PSR 24+ and includes incentive comp with benefits/coverage. Please send CV to jmurray@foothealers.com or call John Murray at 314.842.3875

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 – 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

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

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

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