The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 09, 2011 #4,085 Publisher-Barry Block, DPM, JD

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Advance Notice - PM News will be taking a mid-winter break and will not be publishing from February 10 - 17. 

WV Podiatrist Wears Many Hats as Osteopathic Medical College President 

The president’s office at the West Virginia School of Osteopathic Medicine contains the requisite imposing desk and wall of bookshelves loaded with weighty tomes. But the whimsical touches, like a miniature tableau of anthropomorphic animals sipping tea around a tiny table, are what define the room as the domain of Dr. Michael D. Adelman.

Dr. Michael D. Adelman

Recently elected president of the West Virginia Society of Osteopathic Medicine, Adelman is a graduate of the Des Moines College of Osteopathic Medicine and Surgery and holds a degree from Pennsylvania College of Podiatric Medicine. He also received a law degree from the University of Toledo in 2004.

Source: Tina Alvey, Register-Herald [2/6/11]

Ontario Patients Facing Extremely Long Wait Times for Foot Surgery

Thousands of people across Ottawa, Canada  are facing wait times of up to two years for orthopedic surgery, causing many to suffer on their feet. Currently there are only two orthopedic surgeons in Ottawa, and only one doctor who removes bunions surgically. They say they can't handle any more patients. "Everyone is frustrated, they can't get in to see me," said podiatrist Dr. David Greenberg. "People say, ‘I couldn't see you for four or five months.' It's not working."

Dr. David Greenberg

Greenberg said that a lot of suffering could be alleviated is there were more podiatrists in Ontario. "We haven't had a podiatrist able to register in Ontario since 1992. This is because of government inaction," says Greenberg.

Source: Carol Anne Meehan, CTV 2/5/11]

Electronic Health Records Can Improve Diabetes Care

A clinic-randomized trial was conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes. Patients were randomized either to receive or not to receive an electronic health record (EHR)-based clinical decision support system designed to improve care for those patients whose hemoglobin A1c, blood pressure, or LDL cholesterol levels were higher than goal at any office visit. Analysis used general and generalized linear mixed models with repeated time measurements to accommodate the nested data structure.

The data showed that an EHR-based clinical decision support system led to modest but significant improvements in glucose control and some aspects of blood pressure control. Primary care physicians reported high levels of satisfaction with the intervention and had high rates of use of the clinical decision support system during the intervention period and continued to use the technology for more a year after incentives and feedback were discontinued, although at a lower rate.

Source: Annals of Family Medicine via DiabetesinControl.com [2/1/11]

RE: Cavernous Hemangioma

The photos below depict soft tissue cavernous hemangioma of the left foot in an otherwise healthy 44 y/o female. Her condition is congenital and has been progressively worsening over time. Significant pain is present - plantar, dorsal, and extending up the leg. She has previously undergone a tumor "de-bulking" procedure in 1995, but the hemangioma returned even larger in size. She is interested in treatment options.

Cavernous Hemangioma

We have discussed two extreme treatments, with one being custom shoes, bracing, or orthotics and the other being below-knee amputation. Is anyone aware of or experienced with any treatment options besides these?  She would like to keep her leg, if possible, but cannot live with the pain.  
 
Chris Seuferling, DPM, Portland, OR

Query: DME Billing Companies

My group is currently using EBI for stock and bill for our pre-fab DME devices. Although it is headache-free, it’s a financial loss from the practice management standpoint. Has anyone had any experience with the DME billing companies that bill insurance carriers and recover rejected claims?

Name Withheld (CT)

Query: Palmetto Medicare G0440 Error

Palmetto (Medicare California) is rejecting all visits after the G0440*, stating that this is still a global code. I called Palmetto and they told me I needed to find the information on their website and appeal.

I'm just letting everyone know to be looking for denials after Apligraft/Dermagraft applications.

Lori Braschler, CCS, Bakersfield, CA

Response: You may be missing the appropriate "JC" modifier to indicate that this is being used as a skin graft, and NOT as a skin covering.

Paul Kesselman, DPM, Woodside, NY

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

RE: Limbrel (Mark K. Johnson, DPM)
From: Hal Ornstein, DPM

Limbrel has been my anti-inflammatory of choice for several years due to efficacy and safe profile:

Efficacy and safety of flavocoxid vs. naproxen - In a randomized, multicenter, double-blinded active comparator trial, 220 subjects were assigned to receive either Limbrel 500mg BID or Naproxen 500mg BID for 12 weeks. All subjects had moderate to severe osteoarthritis of the knee. More than 90% of the subjects in both groups noted significant reduction in the signs and symptoms of knee OA.  The flavocoxid group had significantly fewer upper GI and renal adverse events as well as a strong trend toward fewer respiratory adverse effects.

Limbrel Post-Marketing Surveillance - In data collected on 273,984 patients in the more than 5 years that Limbrel has been on the market, side-effects have been significantly low. Only two patients have reported an upper GI bleed in this time period. The most common side-effects seen have been nausea/upset stomach and diarrhea. Both are transient in nature and often resolve themselves over time.

Disclosure: I am not a consultant or speaker for Limbrel.  

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

RE: Radiographs and Plantar Fasciitis
From: Nicholas D'Angelo, DPM

It is my belief that the decision to take an x-ray for heel pain should be dependent on each clinical presentation, and a final collaboration between the podiatrist and the patient. Your decision should not take into account lawyers or saving a "broken system." Your approach should be consistent, and not dependent on insurance coverage issues. Our obligation is to provide the best care, whether or not it is the "standard of care." This is the way I would expect to be treated by my physician, and thus this is the way I treat my patients.
 
Nicholas D'Angelo, DPM, Brooklyn, NY, skitoast@aol.com

RE: H&Ps for Podiatrists (Steven Block, DPM)
From: Jack E Fisher, DPM

While you should contact your state association and their attorney, I do not believe that The Joint Commission prohibits podiatrists from performing H&Ps. In fact, TJC, as you can see below, states that podiatrists may perform medical histories and physical examinations. Key words are "medical histories" and "physical examinations." Your hospital bylaws, rules and regs, policies and procedures, and the credentialing process define what any member of the medical staff can or can not do.

I suggest that you contact your hospital Medical Staff Office and request a copy of the 2011 Hospital Accreditation Standards put out by The Joint Commission. This book provides standards,...

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

RE: Universal Training of Podiatrists and Parity (Robert Bijak, DPM)
From: Narmo L. Ortiz, Jr., DPM

Dr. Bijak's point concerning our apparent "paramedical" status is well taken. Nevertheless, it is interesting to me how we achieved a physician definition status under Title VIII (Medicare), and not under Title XIX (Medicaid), yet MOST physician specialties DO NOT accept or participate in the Medicaid programs! Now talk about regulatory hypocrisy! Is podiatry still not entitled to equal pay for equal work because of Title XIX? What is then our Constitutional right in the definition of employment law? APMA wake up!

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

RE: Unionized Podiatrists Offer Free Foot/Ankle Care to NFL Players During Lockout or Strike
From: Joel Lang, DPM

I was so disappointed to see this headline in a recent edition of PM News. These NFL players are voluntarily going on strike, or for want of more money, may be locked out of their jobs. Boo Hoo! These are millionaires playing for billionaire owners who are bilking the public with high priced seats, high parking charges, and outrageous food costs at the game. The Redskins charge $5.50 for a cup of coffee and $25 for parking. These players can well afford any care they may need for as long as they may need it.
 
If these 'unionized' podiatrists are so concerned about providing free care for people without insurance or jobs, they need not look very far in the State of Pennsylvania for out-of-work people (both union and non-union) who are genuinely struggling daily to feed their children and pay their rent. Is it only me or did this story strike others the same way?
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: APMA Takes Swift Action on Defamatory Video
From: Bruce Blank, DPM

Here is an edited copy of an e-mail I sent to the leadership of the APMA on January 23, 2011. I wasn't planning to share this with PM News until I read a couple of the comments sent to PM News which agreed with some of the orthopedist's comments.

"Recently, I became aware of the recent Internet video of orthopedist Thomas Joseph, MD who was contrasting the education and training of DPMs to MDs and, particularly, to orthopedists. As you are aware, the video is full of falsehoods which unfairly place DPMs in an extremely unfavorable light by categorizing us as poorly trained charlatans.

I understand that APMA is already evaluating the video and formulating a response. I am very thankful. I am writing to encourage a legal response rather than just...

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

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 - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn  privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION NYC (PART TIME) 
Manhattan (East Harlem) Community Health Center. Experienced podiatrist with commitment to providing quality care. Bilingual Spanish a plus Please forward resume and cover letter including salary requirement. FAX: (212) 360-6149 Email:  orodriguez@boriken.org

ASSOCIATE POSITION - NORTH CAROLINA

Cornerstone Health Care, one of the largest physician-owned and managed multispecialty groups in the Southeast, seeks podiatric physician for office located in the Piedmont Triad of North Carolina. The physician must have three years of training and board qualification in forefoot and rearfoot surgery. Cornerstone has over 290 providers in 75 locations. Physicians benefit from centralized billing, purchasing, and human resources, while maintaining autonomy over office practices. A state-of-the-art EMR system provides instant access to all Cornerstone patient records. Send CV to page.redpath@cornerstonehealthcare.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established podiatric group in Southwest Florida. Multi-office practice with EMR, Digital x-ray, Ultrasound... Seeking full-time associate that is PM&S-36 trained, personable, independent and highly motivated. Must be BC/BS in rearfoot /ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Email CV to: JLH459@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

ASSOCIATE POSITION - CHARLOTTE, NC

Well-established multi-office practice looking for personable, motivated associate leading to partnership. Excellent opportunity in a growing area. Contact charpodiatry@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

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

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, 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. Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. 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

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale.  Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.com

PRACTICE FOR SALE - SW LOUISIANA 
 
Only full-time podiatrist in city of 30,000. Great economic base of oil refineries and numerous petrochemical companies as well as riverboat casinos. Located in sportsman’s paradise. Practice comes with 2600 sq. ft. office building and all supplies. 7 area hospitals. Reasonably priced. Contact FINANCING AVAILABLE peshdpm@pol.net

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

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

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. Weekly ad rates start as low as $109 for a 50-word ad 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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