|
|
|
|
|
PMNews
Browse PMNews Issues
Previous Issue | Next Issue
| PM News | |
The Voice of Podiatrists
Serving Over 15,771 Podiatrists Daily
February 20, 2014 #4,993  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2014- No part of PM News can be reproduced without the
written permission of Barry Block
|
|
| PM NEWS QUICK POLL |
Quick Poll
|
|
In the past year, have you been asked to return money to insurance companies for procedures deemed investigational or experimental? |
 |
|
Click HERE for Results |
|
 >
|
|
| PODIATRISTS AND RESEARCH | |
Nerve Decompression Debate Continues in Diabetic Neuropathy
Adding operative nerve decompression to usual foot-ulcer treatment in patients with diabetic sensorimotor polyneuropathy (DSP) significantly reduces ulcer recurrence compared with patients' own unoperated legs, a new analysis from a multicenter cohort study finds. Results of the 42-patient study are published in the January/February 2014 issue of the Journal of the American Podiatric Medical Association in an article authored by Dr. Nickerson and Andrew J. Rader, DPM, from the Wound Care Center, Memorial and Healthcare Center, Jasper, IN.
 |
|
Dr. Andrew Rader |
But the topic of whether operative nerve decompression is of benefit in DSP is controversial, and the new study may not convince those who say that there is insufficient randomized-controlled-trial evidence to support its use. Critics say that claims of its success are based on imprecise and subjective DSP assessments and flawed assumptions about the prevalence of nerve entrapment and the extent to which it contributes to the condition's morbidity.
Source: Miriam E. Tucker, Medscape Family Medicine [2/17/14]
|
|
| PODIATRISTS IN THE COMMUNITY | |
MS Podiatrist Opens House and Heart to Adopted Children
Dr. Craig William's service in the U. S. Navy led him on a path to become the podiatric consultant to the White House, U.S. Congress, and the U.S. Supreme Court from 1999 to 2002. The end of his service brought him to Oxford, where he has spent the last decade making a difference in the lives of children and the dozens of patients he sees each day.
 |
|
Dr. Craig Williams with his family, which includes five adopted children. |
Williams’ Water Valley home is never dull. He and his wife Robin now have nine children—and typically an exchange student or two. Four of their children are biological, and five are adopted. After the birth of their fourth child, the couple decided not to have a fifth biologically. They decided to look into adoption, and contacted the Department of Human Services (DHS) to become foster parents.
Source: hottytoddy.com [2/17/14]
|
|
| PODIATRISTS AND DIABETES | |
Split-Thickness Skin Grafting Can Be Used for Diabetic Wounds: AZ Podiatrist
Surgeon scientists from the University of Arizona College of Medicine, in the first of its kind study, evaluated reconstructions involving the sole of the foot, yielding surprising results. "Traditional wisdom and teaching has suggested that one should not put a skin graft on the sole of the foot," noted Dr. David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona, the senior author on the study. "The results of this study seem to suggest that, with some degree of common sense, this can actually be an effective treatment."
 |
|
Dr. David Armstrong |
The study was published this week online in the Journal of Vascular Surgery. It builds on findings of the team from the University of Texas Health Science Center in San Antonio who recently compared people with and without diabetes.
|
|
| QUERIES (CLINICAL) | |
Query: Granuloma Annulare?
An 18 year old girl presented with a biomechanical chief complaint. During the exam, a lesion to the dorsal aspect of the right foot was observed. The patient related that it had been present for over one year and has grown in size. Her doctor prescribed a topical steroid cream which had no effect. I believe the diagnosis to be granuloma annulare, which should be self-limiting within two years.
 |
|
Granuloma Annulare? |
I recommended two 2mm biopsies to obtain a pathological diagnosis, but the patient signed an AMA waiver as she does not like needles and is afraid of a biopsy. My questions are: what if a doctor believes this to be granuloma annulare and it is not? What else could this be? Is there any malignant twin to granuloma annulare?
|
|
| QUERIES (EMR) | |
Query: EHR Back-UP of a Cloud System
I have been requesting an annual database copy of my patient records created with eClinicalworks. I have 3 years of past charting and may or may not continue with this program. There is a fee associated with providing the copy and they state that unfortunately the copy that they would provide is going to be in a MS-SQL database format, which is not readable. They recommend that I invest in a locally hosted server, then get an eCW program installed on the server (probably an additional license fee), and use the copy of the database to be restored on the locally hosted server to make sense of the data. This seems quite the challenge, with additional costs to have a copy of the files. What are others doing for a permanent access if needed in a cloud-based system?
Michael DeVito, DPM, Chicago Ridge, IL
|
|
| RESPONSES/COMMENTS (CLINICAL) - PART 1 | |
From: Jamie Yakel, DPM
Because most kids who suffer from calcaneal apophysitis are active participants in sports, a period of rest/immobilization is not an option. Otherwise, they may miss an entire sports season. I think I have immobilized one patient in 17 years of practice for this condition. The use of stretching, icing, heel cups, NSAIDs, etc. may also drag on for several weeks before improvement is seen. The cost of club sports is not cheap anymore, and kids and parents have time and money invested, so missing several weeks of a sport isn't an option to them. In some cases, it's necessary, but I have found that to be few and far between.
What has worked extremely well for me is a custom orthotic with a deep heel cup. Often in approximately 2 weeks, the symptoms are significantly improved or sometimes resolved, depending on the severity of the case. If the patient is still symptomatic on the first orthotic check, add some adhesive felt to the heel cup for additional cushioning; this usually helps.
|
|
Codes for Podiatric Medicine and More! 2013/2014 (26th Edition)
Make the transition this year with minimal stress and ultimate convenience.
This two-volume set contains podiatric medicine specific ICD-9-CM, ICD-10-CM (cross-referenced), E/M, HCPCS, CPT, E/M, E, and V codes, modifiers, guidelines for wound care, diabetic foot care, the Medicare Diabetes Shoe Program, and more.
Telephone and email support is provided at no additional cost for help with your tough coding questions.
Accept no substitutes. My publication is the one that you hear about. Join the thousands of satisfied podiatrists using my coding manuals for over 25 years. Available for immediate shipping!
|
|
| RESPONSES/COMMENTS (CLINICAL) - PART 2A | |
RE: Non-Healing Wound S/P Neuroma Surgery
I performed a neuroma excision in November. I felt the resident did not evert the skin edges, but I let it go. The wound failed to close at eleven days. Local care was fruitless, so I revised the edges, antibiosed, and attempted a second primary closure.
 |
|
Post-Neuroma Dehiscence |
When the wound opened again, I began to shift blame to the patient's diabetes and smoking. In January, I performed an Integra procedure. Now, a month later, the wound is almost closed.
|
|
| RESPONSES/COMMENTS (CLINICAL) - PART 2B | |
From: Tip Sullivan, DPM
I had a similar case that had me scratching my head. Aappropriate cultures and allergy tests were done. There was no metabolic reason for the problem. After two failed closures and a wound that just continued to granulate, I discovered that she had gone to the MS gulf coast shortly after her original surgery. I requested a special stain for mycobacteria. Result: mycobacterium marinum.
I think we are making a simple problem very complicated. The likely cause is aggressive retraction, which often results in this type of post-op incisional issue. This is very common in an anterior ankle approach. A very wise man turned me onto this fact when I was at Temple. Thank you, Dr. Laporta. Expensive wound healing modalities have their place. In this case, I'm not sure we need thousands of dollars of diagnostic testing, etc.
|
|
| RESPONSES/COMMENTS (PM JURY REPORTER) - PART 1A | |
RE: Alleged Improper Diagnosis, Informed Consent, and Improperly Performed Surgery (NY) (Edwin J. Harris, DPM)
From: Alan Sherman, DPM, Robet Bijak, DPM
Seldom have I read so honest and erudite a comment in PM News as Dr. Edwin Harris’ defense of his plaintiff’s testimony, recently under some attack in this publication. I haven’t read the case or his testimony, but his suggestion that all expert witnesses for either side be required to submit their depositions or testimony for peer review by their certifying board is a brave and excellent idea. If done well by the boards, it would serve to improve the credibility of podiatric testimony and raise the standard for expert testimony across all specialties. I am not alleging that podiatric testimony is any more or less credible than that of any other specialty, but we are watched more. Having that testimony peer-reviewed is an honest, forthright, and righteous act. Thanks, Dr. Harris, for this excellent idea. I’d be interested to know if this is currently done by any other profession or medical specialty. I’ve not heard of it.
Dr. Harris states that in order to be an expert for a plaintiff or defendant, one should be a licensed practitioner, certified by some board, and be a member of a state or national society. What possible relevance does belonging to a state or local society have to do with one's ability to be an expert witness!? This appears to me to be a purely political viewpoint with no place in determining one's ability to be an expert witness. The ACFAS wisely distanced itself from indenture to political societies. The continuing myth that you cannot be a credible podiatrist sans the APMA and its local society arm is specious.
|
MEETING NOTICES - PART 1
|
|
|
| RESPONSES/COMMENTS (PM JURY VERDICY REPORTER) - PART 1B | |
From: Lawrence J. Kansky, DPM, Esq, George Jacobson, DPM
I disagree with Dr. Silhanek's and Dr. Steinberg's general criticisms of all plaintiffs' experts. Without brave, intelligent, academically-affiliated plaintiff experts, the podiatry profession would run unchecked. Why should a negligent podiatrist not be held responsible for the harm he or she causes? I recently settled a podiatric malpractice case for a plaintiff client where the podiatrist implanted a novel device in the foot completely backwards. Yes, backwards! The intraoperative x-rays showed this large device just floating inside the foot, serving no purpose except to greedily enrich the podiatrist, and to cause debilitating, chronic, and permanent harm.
In every podiatric malpractice case that I have been involved in as an attorney, the negligently maimed plaintiff would rather have a painless normally functioning foot back, or even their pre-operative foot back than all the money in the world. I have had more than one client talk about suicide as a way to end their suffering. So, kudos to all the great and courageous podiatric plaintiff experts out there. Your podiatric schools and our profession should be proud of you. I know the general public is!
As Dr. Steinberg said, "it's about profit. Experts don't seem to care about what is proper or ethical." In my first year of practice (1985), I reviewed a case against an orthopedic surgeon whose patient ended up with a hallux varus s/p a McBride bunionectomy. All things considered, I felt that this was a well-established complication and not malpractice nor a deviation from community standards of the time. I thought that was the end of it. I was wrong. More than a year later, I got a request for a deposition. Another podiatrist went on a tirade against orthopedic surgeons doing bunion surgery. While the case was percolating, the podiatrist put an implant in the patient, which of course didn't alleviate the severe pain and disability. This podiatrist and his attorney continued to blame the orthopod, and additional subsequent surgeries were blamed on him.
So, in 1985, I decided never to review a medical malpractice case for a plaintiff again. They'll always find someone to testify against the truth.
|
MEETING NOTICES - PART 2
|
|
|
| CLASSIFIED ADS |
EQUIPMENT FOR SALE – DIAGNOSTIC ULTRASOUND MACHINE
Mindray DP6900 Diagnostic Ultrasound Machine. Comes with all operator manuals, stand-off device, CD of Ultrasound lectures and Atlas of Foot and Ankle Sonography. Only lightly used. $2500. Contact: jpk1219@aol.com.
PRACTICE FOR SALE - NORTHERN MARYLAND
Retiring in June 2014. Practice in northern Maryland (near Wilmington, DE) for sale. Grosses over $200k working less than 25 hours a week doing minimal surgery. Ripe for expansion of hours and services. Can stay for patient introductions. If interested contact Ed Strogen at strogdoc@aol.com.
PRACTICE FOR SALE - SOUTHERN ARIZONA
Terrific opportunity! Profitable practice with outstanding growth potential – surgery, lots of physician referrals. Within a medical/professional office complex. EMR system with 3 computer stations. Meaningful use met thru Stage II. Very reasonably priced. Will remain through transition period. Contact 520-304-2443 in evenings (PST) or reflisa@centurylink.net - serious buyers only.
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
PRACTICES FOR SALE - WASHINGTON STATE
Puyallup – South of Seattle. Great practice in perfect location. Oregon: Portland (Tigard) – In Portland suburb with high traffic/great visibility. See more at mpocorp.com or call 386 597-5766
ASSOCIATE POSITION - CENTRAL FLORIDA
Associate wanted for well-established practice in central Florida. Multi Physician Practice – Multi Practice Locations Competitive Salary and Benefits. Experienced support staff. Excellent opportunity for a promising future. To apply please go to www.yourcareerinpodiatry.com
ASSOCIATE POSITION – CHICAGO, IL
Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com
ASSOCIATE POSITION – OH
Join our thriving practice of 3 podiatrists in the fastest growing county in Ohio (Delaware located north of Columbus). We are looking for a motivated, personable, caring doctor with solid training who wants to work in a positive environment and enjoys our profession every day! Contact footandanklewellnesscenter@gmail.com
ASSOCIATE POSITION - SOUTHEAST GEORGIA STATESBORO & SURROUNDING AREAS
Beautiful weather year round. Seeking experienced, Family-oriented, podiatrist looking to build a career & long-term relationship. Must be PSR-24/36 trained. Multiple locations. Full range of services with access to Surgical Center. Willing to live in a College town with rural settings. E-mail cover letter & CV to melissafoot@atlanticfeet.com.
HOUSE CALL OPPORTUNITY - CHICAGO, IL
Chicago-America’s Disabled, a not-for-profit medical group is looking for a podiatrist. You decide when you want to work and we will prepare your schedule. Competitive Compensation ($500-$1000 a day). Send CV to dberliant@totalhealthcaregrp.com or call 773-774-7300.
ASSOCIATE POSITION – SW FLORIDA
Immediate position available in SW Florida. Podiatrist to join a small group. Must be Florida licensed, surgical privileges pending experience. Board Certification or Qualified preferred but not necessary. Some nursing home care and limited travel. Excellent pay and lifestyle. Send CV to: 1foot.ankle@GMail.com
ASSOCIATE POSITION - UPSTATE NEW YORK
Mmulti-specialty, busy practice looking for highly motivated Podiatrist. Outstanding opportunity, excellent salary and benefits, working with three Podiatrists as well as residents, high volume of surgical cases, advance wound care, broad based referrals, and Electronic medical records. Opportunity for partnership. Please submit CV to associateinfoot@yahoo.com or fax 607-723-1567.
ASSOCIATE POSITION - TENNESSEE
Opportunity for fully credentialed podiatrist(s) needed to join or purchase a high-volume practice with enormous growth. Located on the largest medical center/hospital campus in East Tennessee. Please email CV, letter of intent, and references to PodiatryFootAnkle@gmail.com.
ASSOCIATE POSITION - CAPITAL DISTRICT (NY)
Associate position with option to purchase practice. Upstate NY, Capital District. Applicants require NYS podiatric license and Medicare # ,Board certified or qualified. Position available immediately. Salary negotiable. Send CV and inquiries to: Gopodiatry@gmail.com
ASSOCIATE POSITION – WISCONSIN
Experienced podiatric physician and surgeon seeking a motivated associate with the ability and drive to join a multi-faceted, exceptionally busy, and firmly established Midwestern practice located within driving distance of Chicago. Those who apply need be well-rounded yet humble and willing to provide all types of foot and ankle care, from diabetic and neuropathic treatments and biomechanical exams, to minor office procedures and complex surgical corrections. Please send your CV along with a cover letter describing your treatment style along with your desire to grow with a successful practice to Associatematch@yahoo.com.
ASSOCIATE POSITION - CALIFORNIA (SANTA CRUZ COUNTY)
The Foot Doctors of Santa Cruz County is a multi-office podiatric group looking for a self-motivated, committed podiatrist with a CA license. Offices are up-to-date with EMR, digital x-ray, and laser. Duties include all aspects of podiatry including wound care, surgical cases and nursing homes. There is great surgical growth potential. Must intend to reside locally. Send CV to: srfctysc@gmail.com
ASSOCIATE POSITION - KENTUCKY
Immediate opening for palliative/general podiatric care provider in established clinics, nursing home and assistive living settings in beautiful Southern Kentucky. Travel involved, but transportation provided along with ability to provide a wide range of clinical care including DME. Board certification not mandatory, but must be eligible for KY state license. Base salary with incredible bonus opportunity/full benefits. Join Kentucky’s largest and most respected podiatric group. Email CV and letter of interest to: jonkim12000@yahoo.com
ASSOCIATE POSITION – CHICAGO, IL
Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com
ASSOCIATE POSITION - PUERTO RICO
Looking for a well-motivated surgically trained podiatrist for a 20 year-old hospital-based multi-office practice. WILL BE INTERVIEWING PERSONALLY AT 2014 ACFAS MEETING IN ORLANDO Candidate must be personable, ambitious, and knowledge of SPANISH language a must. Hospital surgical privileges available with heavy load of high-risk diabetic foot patients. This position leads to PARTNERSHIP, and eventually ownership. Offices located near San Juan Metro area nearbBeaches, great schools, and major shopping malls. Please send CV to medicopodiatra@aol.com.
ASSOCIATE POSITION - CENTRAL PA
Looking for an associate with strong surgical training. Personal and energetic a must. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to premierfootpa@outlook.com
PM News Classified Ads Reach over 15,500 DPMs and Students
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 15,500 DPMs. for details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451
|
| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
| | Guidelines |
- 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.
| |
|
Browse PMNews Issues
Previous Issue | Next Issue
|
| |
|
|
|
