The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

February 20, 2013 #4,696 Publisher-Barry Block, DPM, JD

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Increase in Peripheral Neuropathy Seen: UT Podiatrist

Dixie Regional’s highly popular health fair is becoming the LiVe Well Expo this year. The expo will offer the same free screenings as in years past, as well as a select number of lab tests and added screening options for children. Podiatrist Dr. Kent Burton and his associates at the Foot and Ankle Institute in St. George have provided free foot screenings at the health fair for many years. According to Burton, the nature of the problems they see has changed over time.

Dr. Kent Burton

“It used to be hammertoes and bunions,” he said. “Today, we still see those problems, but the most common thing is peripheral neuropathy.” Peripheral neuropathy symptoms include pain, tingling, and burning in the feet. “The pain usually starts at the toe and then moves up, like you’re pulling up a sock,” Burton said. 

Source: The Spectrum [2/17/13]

Complaints Continue to Pile Up Against WI Podiatrist

Dr. John S. Lanham, A Milwaukee area podiatrist with a record of cheating patients is still racking up patient complaints at a rate that dwarfs his peers. A FOX6 Investigation has found state regulators have done nothing about it for the past six years. Last spring, Craig Nickelbein went to see Dr. Lanham at his Elkhorn clinic due to nagging foot pain caused by a neuroma. The doctor gave him a pair of cortisone shots and sent Medicare the bill… for more than $10,000!

(L-R) Dr. John Lanham and Steven Frydman

There’s hardly anyone more fed up than Dr. Steven Frydman, Executive Director of the Wisconsin Society of Podiatric Medicine. “There is nothing we can do in an office on an initial visit that is worth that kind of money,” Frydman said. In 2007, the state suspended Dr. Lanham for 270 days due to a pattern of cases involving “fraud and deceit.”  The suspension was lifted after just 90 days. Since then, 58 additional patients have filed complaints against Lanham. In that same time, no other podiatrist in Wisconsin has gotten more than four.

Source: Stephen Davis and Bryan Polcyn, Fox 6 News

CA Podiatrist and Wife Take Voyage Back in Time on Queen Mary

Recently, there  was a Princess Diana exhibit at the Queen Mary. Margaret Katzman, 55, a Claremont nurse, managed to get her husband, Dr. Brad Katzman, a podiatrist, to the evening tea held as part of the exhibition. Two years after Diana's death, the couple went on a memorial tour in the princess' honor.

Dr. Brad Katzman

They stayed at the Ritz Hotel in Paris, where Diana and her boyfriend Dodi Fayed dined the night of her fatal accident. They drove through the Pont d'Alma tunnel, where paparazzi chased the couple and their driver, then traveled through the English countryside to Althorp House, Diana's family estate.

Source: Gale Holland, Los Angeles Times

Alleged Failure Of Podiatrist To Diagnose And Treat Necrotizing Fasciitis - Multiple Surgeries Performed - Below-Knee Leg Amputation (FL)

Facts: The defendant at trial in this medical malpractice action was a podiatrist who treated the plaintiff for foot pain three times in July of 2007. The plaintiff alleged that the defendant negligently failed to diagnose and treat necrotizing fasciitis, also known as flesh-eating disease, thereby resulting in a below-knee leg amputation.

The defense maintained that the plaintiff did not develop the necrotizing fasciitis until after her last visit with the defendant podiatrist. The hospital...

Editor's note: The extended Jury Verdict Reporter can be read here.

Result: Defendant's verdict ($0)

Plaintiff's Expert: Curtis Wagner, DPM, Orlando, FL
Defendant's Expert: Edward Chapnick (infectious disease) Brooklyn, NY

Medicare SGR Repeal Price Tag Plummets

The amount of funding that Congress needs to eliminate the Medicare sustainable growth rate formula that helps determine physician pay has dropped significantly after years of lower-than-expected gains in healthcare spending, according to federal budget authorities.

The dramatically lower offset figure to repeal the SGR as calculated by the independent Congressional Budget Office caught many by surprise on Feb. 5 and led to re-invigorated calls to push forward with permanent Medicare payment reforms. The 10-year cost of stabilizing physician pay rates had approached $300 billion in recent years, but now appears much more within reach.

Source: Charles Fiegl, Amednews [2/18/13]

Healthcare Lags in Moving to Cloud, Survey Finds

Cloud computing is on the march across multiple business and government sectors, but the healthcare industry and state and local government, while in the cloud parade, are bringing up the rear, a recent survey of technology leaders shows. Technology seller CDW, Vernon Hills, IL, asked 1,242 information technology professionals about their views and their organizations' use of cloud computing.

The survey also compared cloud adoption rates by industry sector in 2012 with those in 2011. Of the 156 healthcare IT leaders participating in the survey, 74% were from hospitals or medical centers, 14% from physician offices, and 12% were with long-term care facilities. The growth rates of cloud formation between 2011 and 2012 in healthcare and in small government also tied for the smallest increases at 17% each, the survey showed.

Source: Joseph Conn, Modern Healthcare [2/13/13]

Query: ACOs and Podiatry

I am curious as to the experience my fellow DPMs have had with ACOs. I have been contacted by one in Florida that may be planning on starting one in my area. How has it worked for any of you? Any words of wisdom?

Peter Riznyk, DPM, Orchard Park, NY

Query: Nail Debridment

We are always struggling with how to bill nail debridement. We use ICD-9 110.1 (onychomycosis), ICD-9 250.90 (diabetes with unspecified complication, type II; if the patient has diabetes) and ICD-9 729.5 (pain in limb). We have been using CPT 11721. Is that no longer active?  Are we supposed to be using a modifier with this procedure if it is the only procedure done?

Larami Martinez, Idaho Falls, ID
 
Response: In reading the Noridian LCD, there are two diagnosis listings. One list requires a "-Q7" or "-Q8" or "-Q9" modifier be appended to the CPT code, while the other list does not.

The ICD-9 250.xx codes do require a "Q" modifier. In order to meet that requirement, you must not only have the appropriate "Q" modifier, but also list on the claim the treating physician's (MD/DO/ANP/PA) name and NPI as well as the date last seen. Of course, your medical records would have to substantiate what you've put on the claim form.

The Idaho LCD for the "Symptomatic, Pathological Nail and Its Treatment" covers nails (e.g., fungal) that are either painful or cause limitation in ambulation or function. See the APMA Coding Resource Center for an easy look-up of foot/ankle-related LCDs for your state.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: The Biomechanics of The First Ray in Dance (Barry Mullen, DPM)
From: Michael Forman, DPM

The answer to the question, which muscle is most important in a ballet dancer going "en pointe" is anyone's guess. And that is exactly what it is - a guess. My guess is that all of the muscles that cross the metatarsal-phalangeal joint AND the interphalangeal joint are important. I have no idea which is the most important. The musculature attempts to stabilize the foot in a very unnatural position. However, a more important reason for concern is the pressure applied to these two joints as well as the phalanges themselves when accomplishing this difficult maneuver.

Ballet shoes offer no support for any of the muscles we discussed. The distal end of the shoe is flattened, presumably to give the dancer a larger base of support when on their toes. That being said, I have never been able to fit a ballet dancer with any type of orthotic. Even if we were able to make a device for a ballet shoe, it is not going to have any effect when the dancer is completely on the distal aspect of the toes. 

For this reason, most clear-minded physicians, instructors, and trainers do not recommend the "en pointe" maneuver until the epiphyseal plates are closed.

Michael Forman, DPM, Cleveland, OH, IM4MAN@AOL.com

RE: Etiology of Hallux Varus (Barry Mullen, DPM)
From: Dennis Shavelson, DPM

Dr. Mullen seems mired in 30 year old biomechanics. Modern evidence is proving STJ neutral biomechanics unacceptable at a professional level. The reality is my claims are unproven, right or wrong, yet there is proof rejecting Dr. Mullen's.

The omission in Dr. Mullen's biomechanical foundation seems to be Wolff’s and Davis’ Laws. Maybe that’s because rigid fixation eliminates remodeling and adaptation from occurring at osteotomy sites. A foot maintained in a more optimal position than flat in a shoe will generate...

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

RE: Cryoprobe or Alternative (Michael Forman, DPM)
From: Jennifer B. Ryder, DPM

I too bought a Cryoprobe and was frustrated. It seemed to leak from the trigger chamber. I had to send it back multiple times for repair (they sent me a loaner to use). I realized that when you turn it to lock it into position, you have to keep your fingers off the trigger part and tip (any of the black colored parts). It takes some practice, but I learned how to do it and got used to it. They sent me some cartridges to practice with. They even Skyped with me to demonstrate it and check my technique. It works much better now.

Jennifer B. Ryder, DPM, Rapid City, SD, RyderJB@rcmed.net

PRACTICE FOR SALE - CORONADO, CA

Unique opportunity to purchase a very well established practice in beautiful San Diego. Hospital privileges available. Large and stable patient and referral base with consistent new patient growth. Why not practice where people vacation and retire? Willing to stay for transition. Inquires please email pestibear@gmail.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $560,000. Approximately 1300sqft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND

Established 1974 treating routine, diabetic, wound care, trauma, workman's comp and surgery. Attached accredited and certified surgery center. High volume with new patients with opportunity for expansion. Long established multiple primary care referral basis including University of Maryland health center. All financial information available. e-mail Msugar8364@aol.com.

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

PART-TIME ASSOCIATE - BRONX, NY

Seeking a well-trained, confident, ethical, hard working candidate. All aspects of podiatry performed (surgery, biomechanics, routine foot
care, DME, vascular studies, diagnostic ultrasound). Also, seeking help for house calls in the Bronx and Westchester (mostly routine foot
care, DME). Competitive salary. Please send CV to: docdpm2@gmail.com

ASSOCIATE POSITION - NORTH CAROLINA

Busy, well established five-office practice in Charlotte, NC looking to fill an associate position leading to partnership for the right person. General and surgical podiatry, wound care. Close to beach, mountains - ideal location for outdoor enthusiast. NC license necessary. Competitive pay with incentives. Send resume to charpodiatry@gmail.comASSOCIATE POSITION – NORTH CAROLINA

New associate position available that may lead to partnership. We are a very busy practice providing care in both office and hospital settings. EHR, arterial vascular testing, and ESWT in the office. We are fully integrated in a large tertiary teaching hospital. We are located in the beautiful mountains of western North Carolina. Research opportunities are available. Applicant should be ethical, personable, hard-working, and committed to quality in patient care. We are offering a competitive compensation package and a wide range of benefits. All interested candidates should send a CV to MFAS828@aol.com

ASSOCIATE POSITION - NEW YORK

Looking for a once in a lifetime opportunity to join a state-of-the-art well rounded Long Island practice with hospital privileges? Then our office is what you're looking for. Located 20 miles from NYC, LI offers great schools and lifestyle. Perfect for an experienced practitioner or 2013 residency graduate who is ethical, productive, and board certified/qualified looking to be part of a winning team now and in the future. Want to be a partner in a successful practice or own your own office? Serious motivated practitioners only invited to send their CV and personalized cover letter to: mets724@gmail.com.

PODIATRIC PHYSICIAN/SURGEON - CHICAGO AND SUBURBS

Chicago Podiatric Surgeons is searching for a full-time podiatric physician/surgeon. Prefer ABPS qualified/certified with experience in private practice. Great benefit package and partnership opportunities. Please send letter of interest, CV to dr.tcarr@gmail.com

POSITION AVAILABLE - BALTIMORE MARYLAND

Confident, surgically trained associate position available to join well-established practice locations. Leading to ownership within 3 years! Great salary and benefits. Will train on practice management, business management, and billing. Call 301-514-9781

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - MARYLAND

EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital and physician referral base. Please send cover letter and resume to: newdpm@footandankle-usa.com.

ASSOCIATE POSITION - VA (SOUTH CENTRAL)

Thirty year established practice seeking associate. PSR 24/36 training, must be highly motivated, personable, ethical and willing to provide all aspects of podiatric care. Early partnership opportunity with potential ownership. Competitive salary and benefits. Excellent opportunity for a successful career. Please send CV to footcare2020@aol.com or fax to 804 733-5946.

ASSOCIATE POSITION - SOUTHWEST FL

R U a PM&S36 graduate looking for a bright future in podiatry BUT cannot be afraid to work hard to achieve. Complete from nail care to reconstructive ankle/leg trauma. Attitude + god complexes need not apply. Frames, nails, must be comfortable applying. Work hard for a bright future, our group can help you achieve. Send CV, and letter of intent to mny1029@gmail.com

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

POSITIONS AVAILABLE - SYRACUSE AND BUFFALO

Looking for podiatrists to see residents in Nursing Homes. Great opportunity for supplemental or full time income. Email inquiries to phasetwopodiatry@gmail.com

ASSOCIATE POSITION - MISSOURI – EAST CENTRAL

Podiatric medical group seeks recent graduate or 2013 graduate who is interested in working with former residency director who can enhance your already strong training Full scope practice with the cases to fast track to board certification. We are located close to St. Louis for day use. Exceptional school system in a low crime, low cost of living area. E-mail resume to: drfootski@hotmail.com

POSITION AVAILABLE - WEIL FOOT ANKLE & ORTHOPEDIC INSTITUTE-CHICAGO

Weil Foot Ankle & Orthopedic Institute is expanding their presence in the Chicago metropolitan area and suburbs and is recruiting qualified podiatric surgeons. A three-year residency is required and a podiatric fellowship is preferable. Current practicing podiatric practitioners in Chicago and surrounding area are also welcome to join our rapidly expanding practice that currently numbers 16 DPMs, a neurologist, an orthopedic surgeon, and a primary care sports medicine physician. For more information contact: info@weil4feet.com or call Stephanie Spiegel, COO at 847-390-7666.

ASSOCIATE POSITION - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Plans include new office and EHR System. Hospital privileges. Near Hartwell Lake and the Blue Ridge Mountains. Please send CV to palpodiatry@att.net.

PODIATRIC SPORTS MEDICINE FELLOWSHIP - ORANGE COUNTY CA

July 1, 2012 and ending July 31, 2013. $60,000/year, medical, dental, malpractice, and CME allowance. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Letter of interest, and CV to: Philip Radovic, DPM, Fellowship Director, Email: Info@feetfixer.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - 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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815

EQUIPMENT FOR SALE - CUTERA GENESIS PLUS

Cutera Genesis Plus. 30 months old, low shot count, sku 022012a 1064 ND:YAG With new handpiece Dec.2011 for 1.5mm adapter go to www.thelasertrader.com Price is $35,000. Save over $29,000. Excellent Condition.

PM News Classified Ads Reach over 14,000 DPMs 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 14,000 DPMs. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 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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