The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 09, 2007 #2,806 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Bradley, Willens to Receive DSC’s

The American Podiatric Medical Association (APMA) has announced that Charles Bradley, D.P.M. and Sheldon Willins, D.P.M. will receive Distinguished Service Citations (DSC) at the upcoming APMA House of Delegates (March 23-6, 2007) in Washington, DC. The DSC is the highest honor that the association presents.

Dr. Charles Bradley

Dr. Charles Bradley served as President of the APMA from 1974-5 and was instrumental in the founding of the podiatric section of the National Academies Practice.

Dr. Sheldon Willens

Dr. Sheldon Willens served as President of the APMA from 1996-7 and served as a director of the Podiatry Political Action Committee ffrom 1985 to 2005.

Dr. Daniel Bareither Receives APMSA’s Kenison Award

The American Podiatric Medical Students’ Association has selected Daniel Bareither, PhD, to receive the APMSA’s most distinguished honor, the Kenison Award. Dr. Bareither, Associate Dean of Curriculum and Assessment and Professor in the Department of Basic Biomedical Sciences at Scholl College of Podiatric Medicine, has done much to advance the profession of podiatry since his career began at the College in 1972.

Daniel Bareither, PhD

Dr. Bareither’s contributions to the profession include appointments to the Council on Podiatric Medicine and Education, the National Board of Podiatric Medical Education, and the American Association of Colleges of Podiatric Medicine

The APMSA Kenison Award, named for Nehemiah Kenison, a visionary and leader in the profession of chiropody in the mid 1800’s, recognizes individuals who have made outstanding efforts and contributions to podiatric medical students and the profession.

Anti-Fraud Measures Are Coming to Electronic Health Records Systems

Electronic health record (EHR) systems may soon contain features that will assist in the prevention and detection of billing errors and fraud. Fifteen proposed anti-fraud requirements have been drafted under the auspices of the U.S. Office of the National Coordinator (ONC) for Health Information Technology, and could be headed for inclusion in EHR systems.

The requirements cover a range of risk areas. There is a requirement for evaluation and management coding, which says the system may inform physicians when their E&M codes don't match their documentation, but they can't tell physicians to add documentation. "It is appropriate for EHRs to calculate an evaluation and management (E&M) code from the encounter data which has been entered and to indicate the basis for that calculation. However, it is not appropriate to suggest to the provider that certain additional data, if entered, would increase the level of the E&M code," the draft states.

In addition, there is a requirement on copying notes (also known as cloning or cutting and pasting). When physicians copy an existing note about a patient and paste it into another chart entry as a shortcut with updating required, they must retain the date, time and user stamp of the original author, the requirement states. If it's copied from another patient, the original patient ID should not be kept. The draft rationale: "Copying and pasting all or a portion of a previous note is a provider efficiency tool. This process can be abused by appearing to attribute observations made by a previous provider to the current provider. If the intent is simply to provide common terminology or phraseology for reuse, templates or defaults may be used for this purpose."

Source: Report on Medicare Compliance [2/5/07]

Query: Exertional Compartment Syndrome

I have a 16 year old female sprinter and pole vaulter who has been seen by an orthopedist and given a tentative diagnosis of exertional compartment syndrome. It is only present (for the last two years) when she trains or exercises, and is in the deep posterior compartment of her leg, possibly the soleus muscle. She has seen a physical therapist and deep massage and Biofreeze helps alleviate her pain, but it comes back whenever she begins high intensity training.

On exam, she has only minimal discomfort medial and laterally along her soleus near the myotendinous junction of her gastrocnemius. She is currently in orthotics for moderate pronation, but cannot wear these at competitions due to pole vaulting regulations. She has not anterior leg pain with or without her orthotics. Besides rest and change of activities, is there any other non-surgical treatment that anyone has found effective for this exercise-induced problem.

Cory Pilling, DPM, Twin Falls, ID

RE: Radiographs for Nail Pathology (Allen Jacobs, DPM)
From: Multiple Respondents

When presented with an infected ingrown toenail greater than 10 days, I will usually obtain digital radiographs and place the patient on oral antibiotics. If less than 10 days, I will simply perform a partial nail avulsion without oral antibiotics and without films. I have come across radiographic changes only once and take them more as a baseline in "in case."

I have a hard time accepting that 15% show "bony changes", this number seems much too high. If radiographic changes for osteo lag 10-14 days. I can't make sense of these findings. I find the biopsy results even more puzzling.

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

I rarely take x-rays for a paronychia regardless of the time it has been present. When I do it is when the morphology of the nail is suspicious for a subungual neoplasm, subungual hemorrhage is noted, a suspicion of CVD or seronegative arthropathy exists or the clinical picture demonstrates a more virulent infection (sinus tracts, massive edema, proximally extending cellulitis).

I keep it simple, I treat the patient. If the infection does not improve after a partial nail avulsion/I&D in a patient with normal vascular status and immune system then I look for zebras. To take x-rays routinely seems purely, as one poster stated, as a way to increase revenues. As to the 15% of patients I must be missing with osteomyelitis, geez my nail avulsion technique should be investigated since it seems to cure bone infections.

The morphology of the distal tuft can be quire variable and we must use caution when making the diagnosis of possible osteomyelitis radiographically and subjecting them to unnecessary antibiotics, imaging, surgical biopsy, or worse.

Samuel S. Mendicino, DPM, Houston, TX, DrSMendo@aol.com

I do not know Dr. Allen Jacobs very well, but I believe him to be a very straight shooter who is not afraid to state what he believes. Having said that, I would bet that his last two posts on the cryotherapy s/p surgery on the smoking diabetic with PVD and this last one on the nail pathology radiology studies are perhaps a little "test" of what his colleagues "think."

He poses a 15% bony involvement issue with nail infections greater than 10 days old. I am certain that in the past 10 years, I have seen more nail unit tumors attendant to non-healing nail infections than I have seen any type of bone pathology, and the number of tumors I have seen is easily less than one out of a hundred. As an aside, I have even considered doing some kind of study as to why very serious and long term(months) nail infections in otherwise healthy individuals NEVER in my experience have progressed to osteomyelitis. I believe routine radiology for "nail pathology" is overkill, and even in the presence of an exostosis, most often the nail procedure is enough.

Quite co-incidentally, I have on my schedule this week a case of a very successful phenol matricectomy performed by me which failed to relieve the patient's pain. X-ray revealed quite a large exostosis, which I will be excising. Had I had the radiographs before the phenol surgery, I would have proceeded in the same way. In any case, Dr. Jacobs, do I read you correctly?

Bryan Markinson, DPM, NY, NY, Bryan.Markinson@msnyuhealth.org

Osteitis associated with chronic nail infection may be identified by the use of GOOD QUALITY radiographs, which frankly many offices do not obtain. Cortical breaks or irregularity, not massive dissolution of bone, is the main finding. I am certain that unrecognized cases in otherwise healthy people go on to uneventful healing, with or without antibiotics or surgical intervention.

Nevertheless, the anatomical proximity of the phalanx to the soft tissue infection is such that if sought, osteitis/localized osteomyelitis is not at all uncommon. Such infections when present are easily treated by simple distal extension of the classic Winograd/Frost type of toenail correction, extended C+S directed oral antibiotic monitoring, and careful observation.

Allen Jacobs, DPM, St. Louis, MO, Allenthepod@sbcglobal.net

ASSOCIATE WANTED - NORTH CAROLINA , CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

ASSOCIATE POSITION -MINNESOTA – PRIME MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with potential partnership opportunity. Looking for PSR 24+ individual. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION – NEW YORK & CONNECTICUT

Opportunity to be a part of a prestigious and well-established large Orthopaedic and Rehabilitation practice, with locations in Stamford, CT and West Harrison, NY. Looking for a podiatrist to join an already busy practice with opportunity to build. We have state-of-the-art offices with MRI, digital x-ray, paperless charts, physical and occupational therapy. Applicants should be Board Certified or Board Eligible. Competitive salary and benefits. For further information on the practice, log onto WWW.NYCONNORTHO.COM Interested candidates should forward their C.V. to: Cliff Katz, Executive Director ckatz@nyconnortho.com

ASSOCIATE POSITION- WEST CENTRAL FLORIDA

Position available for PSR 24/36 trained DPM to join the Podiatry Service of the largest multi-specialty Rural Health Group Practice in Florida. Good salary/incentive compensation and excellent fringe benefits plan, which includes paid vacation days, CME dollars and much more. EOE/DFWP Send CV and letter of interest to: MCRHS, P.O. Box 499, Parrish, FL 34219 or fax to (941) 776-4013.

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA-PM & S 36

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net

WEEKLY SPECIAL - One week of ads (5x) for only $75

PM Classified Ads Reach over 9,000 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 9,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• 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.