The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 23, 2011 #4,091 Publisher-Barry Block, DPM, JD

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UT Podiatrist Provides Shoe-Buying Advice

"The older we get, the more creative our feet get," says podiatrist Dr. Kent Burton. Bunions and hammertoes can change the way shoes fit. While feet may not continue to grow as we age, they still spread as the arch flattens and the toes splay over time.

Dr. Kent Burton

"I have had patients say, 'I have always worn a size six and I will always wear a size six,'" Burton said. The truth is that many of us change shoe sizes - sometimes by one or even two sizes. "Look for shoes that are soft and accommodating, comfortable and made of breathable material," Burton said. "There should be at least a thumb's width from the end of your toe to the end of the shoe."

Source: Kristy Ann Pike, The Spectrum [2/21/11]

NJ Podiatrist Volunteers in to Help Disabled Children in Mexico

Recently, Dr. John Guiliana  joined 90 of the Team BioMedix sales force at a school for disabled children in Cancun, Mexico where he painted two classrooms and buildings, cultivated three gardens while planting 40 trees, and worked with children with Down's syndrome to make pinatas, which they then sell to the community.

Dr. John Guiliana with Team Biomedix in Cancun, Mexico

"By the end of our stay there, while we helped them accomplish a lot, I couldn't help but feel that we all received a lot more than we gave," said Guiliana. 

CA Podiatrist's Life Saved By New Internal Cooling Technique

A new treatment that cools the body from the inside out is saving lives at French Hospital Medical Center in San Luis Obispo. It is only used on patients suffering from something called V-Fib cardiac arrest, which make up about ten percent of cardiac arrest cases. V-Fib is an abnormal heart rhythm. This modern piece of technology saved Dr. Gordon Hamblin's life. He does not remember anything about the day he went into cardiac arrest.

Dr. Gordon Hamblin

Fortunately, there will be more chapters in Dr. Hamblin's life also because of a new device that is able to cool the body's core. Here's how it works: the patient is kept sedated for 48 hours while a catheter circulates fluid throughout the body, which rapidly drops the body temperature from the inside out. V-Fib cardiac arrest patients like Dr. Hamblin are often left in a vegetative state, but months later this podiatrist is back on his feet practicing medicine.

Source: Carina Corral, KSBY News [2/16/11]

Query: Lichen Planus

I am treating a 52 year old Hispanic male who presented to my office with dystrophic toenails, 1-5, of both feet. He came to the office with a history of lichen planus, primarily involving his feet. Nail biopsies revealed changes consistent with the burnt-out phase of lichen planus. Any suggestions for treatment?
 
Larry Dorman, DPM, Miami, FL

Query: Practice Fusion

I realize that there will be reductions in our reimbursement if we don't e-prescribe by next year, and more reductions if we don't change to electronic media by 2014. I'll be 55 this year and the office has been running fine with Medisoft basic. I upgrade every other year for approximately $300. Could anyone comment about your experience with the changeover to Practice Fusion? How long did it take? What do you like about using EMR? What do you dislike? What are you doing with your paper records?

George F Jacobson, DPM, Hollywood, FL

Query: Coding for Dispensing a Bone Stimulator

Is there a code for instructing a patient on use of a bone stimulator when dispensing one?

Mark Stempler, DPM, Staten Island, NY

Response: Approvals and reimbursement can vary from payer to payer. In my practice, it is very common for the bone stimulator company rep to bring in the unit and educate the patient.

In this case, the best you can hope for is a very low level ofice visit IF YOU actually meet E/M requirements (history, exam, medical decision-making) for the encounter. I would not get "credit" for the representative's work. It's just another service provided to your patient.  If you attach and dispense the unit intra-operatively or in recovery, most payers will not separately reimburse you. They will include it within the global allowance of the surgical procedure(s).  If you actually dispense, apply, and educate the patient, you may be eligible for reimbursement under the CPT 20974-20979 codes (electrical stimulation to aid bone-healing; non-invasive [non-operative]). Check with the specific payer to see if they have a coverage policy or guideline on this.

Tony Poggio, DPM, Alameda, CA

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

RE: Orthotic Recommendation (Tyler Brahm, DPM)
From: Allan Fiber

Dr. Brahm's patient needs a relatively soft orthotic that will balance for a plantarflexed first metatarsal base and navicular, not allowing the patient to pronate over the orthotic. While not knowing all the particulars on the patient, I often recommend combining a cork and leather mold with a Spenco covering. The base is supportive (without using plastic). I can add inner heel wedges, and a low medial flange and keep it thick enough for proper balancing. The soft Spenco will make easier to tolerate.
 
Disclosure: I am the owner of Fiber Orthotic Lab.
 
Allan Fiber, Farmingdale, NY, fiberlab@aol.com

RE: Clarification
From: John Guiliana, DPM, MS and Hal Ornstein, DPM

Those who read the recent chapter from our book, 31 1/2 Essentials to Running Your Medical Practice in Podiatry Management should be aware that the discussion regarding compensation was incomplete. It should have contained a statement that the base figures being cited are MERELY TO MAKE THE MATH SIMPLE. By no means do the authors ever make recommendations of that number since experience and training, along with the precise job details MUST be considered in each unique case. "Rules of thumb" are just that...merely examples of models for a starting point and both accounting and legal guidance should follow.

John Guiliana, DPM, MS and Hal Ornstein, DPM

RE: A Call for Unity and Action Against Insurance Companies
From: Denis LeBlang, DPM

I have been a podiatrist for thirty two years and I have always loved what I do. When our class graduated, only about 75% were able to get residencies and the others had preceptorships or started out cold. We were able to put effort in and received rewards, either from patients or their insurance plans. We gave excellent care and were paid a good usual and customary fee for procedures - either surgery,orthotics, diabetic care, or other foot care that needed to be done.

We were doctors, podiatrists, physicians, and surgeons of the foot, and later of the ankle. We were never trained in the business aspect of...

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

RE: The High Price of Medical Equipment (Simon Young, DPM)
From Elliot Udell, DPM

If the U.S. government were to read and seriously take to heart what Dr. Young wrote, and were able to quickly act on it, the healthcare crisis in this country would be solved before the next year. Medical supplies, including instruments, are grossly inflated in price. Last summer, I visited my local hardware store to buy some light bulbs. On the counter was a box of curettes and small files that appeared exactly like the ones we buy from medical suppliers. The medical instruments sell for over 20 dollars apiece; the ones in the hardware store, which were duplicates of the medical instruments, but are marketed to home carpenters, were selling for fifty cents apiece. 

Overhauling the entire system is a pipe dream, but we can control some of our costs by seeking out bargains such as low cost or free EMR's or equipment such as lower costing ultrasonic instrument cleaners that can be used by doctors, but are marketed for a fraction of the price to non-medical professionals. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@Aol.com

RE: EHR/EMR Gouging
From: Jon Purdy, DPM

If there is really gouging occurring, and it seems to stem from recent changes in the market place, only two things are possible. Either the EMR companies are violating anti-trust laws and price fixing (which they are not), or they are responding to a trend in the free market.

Put yourself in their shoes for a moment, and let’s say you own an EMR company.  You feel you'd be best positioned in the market by investing a lot of money to meet meaningful use. You next ask yourself “How do I recoup my investment?” You do that in one of two ways. You either pass along the costs directly to your customers, or you make it up on the backend over time, by keeping your prices low and recouping it through greater market share.

Your company has to size up the competition, and weigh the advantages and disadvantages of capital investment, product price, and market trends. After you place your bets, your private company will either thrive or falter. People will either like your product and price or they won’t. Simple market forces determine what will and what will not work. I don’t begrudge a company for seeing how much profit they can make ethically. YOU, the consumer, dictate the success of the company and no one else.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: H&Ps for Podiatrists
From: Multiple Respondents

Those of us who lived, ate, and breathed hospital-based training in residency, and continued to work in a similar setting after residency, possess the skills necessary to safely clear patients for surgery, period. Those of us who put aside their stethoscope after residency and stopped reading EKG's regularly should not rely on their own physical exam for clearance. Take a refresher course on PE's if you are unsure and stay current on internal medicine. Read JAMA and NEJE every month; doing so stimulates the thought processes associated with successful patient assessment. Just recognize your limits and be honest with yourself. That is utmost here.

John F. Swaim, DPM, Red Bluff, CA,  podtexdoc@aol.com

Plain and simple - Performing a history and physical in a hospital is a privilege, not a right. That privilege is based on one's training or experience, current competence, and ability to perform the privilege requested. Just as not all podiatrists have privileges to perform ankle procedures,  not all podiatrists will be qualified to perform H&Ps. Performing an H&P is not managing the associated medical condition. That is what consultations are for. Final clearance of the patient for any procedure requiring general anesthesia or MAC comes from the anesthesiologist, whether the H&P and clearance for surgery was performed by an MD, DO, PA, NP, or a DPM.

Jack E Fisher, DPM, Gilroy, CA, the.fish@verizon.net

I will make this as simple as I can. If you received the training and experience to perform a pre-operative H&P and wish to perform one, do it (I do). If you have not received such training and do not have the experience, then please do not do them. The DPMs who have the training are more than qualified and, in many cases, may be more comprehensive than one of their allopathic counterparts. Qualified dentists have been doing them for many years, and doctors of any degree with at-risk patients are bright enough to have those patients cleared by the appropriate medical specialist. Also, please do not forget that the anesthesiologist is the ultimate gatekeeper and will cancel a case if the appropriate work-up has not been performed by any surgeon.

These comments about what we should or shouldn't do are the same arguments.....

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

RE: H&Ps for Podiatrists (Tina Sechrist, Jeff Kittay, DPM)
From: Narmo L. Ortiz, Jr., DPM, Steve Mosley, DPM
    
With all due respect to Ms. Sechrist and Dr. Kittay, you both must be living inside a time capsule and boxed-in, not looking at the progress and advances of our profession. If any of you are NOT capable and willing to perform an H&P on your patients, then you have NO business holding a blade to cut into their skin, injecting any chemical into their bodies, or picking up a pen to write for a medication prescription. That being said, how many of you want to go back to chiropody and early podiatry? I think many of you still feel trapped in that box!

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

After reading Ms. Sechrist's comment, I can certainly appreciate your concerns. However, I must respectfully ask you whether you truly believe it is well-founded based on the casual comment made by the podiatrist of whom you spoke. Personally, I wouldn't expect a podiatrist to manage me or any of my patients' general medical care. I likewise would not be performing a medical procedure on a patient who was actively symptomatic with another acutely active medical condition. Frankly, I don't know any podiatrist who would do so.

For me, taking one anecdotal event would not be sufficient to form an argument that seems to be...

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

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

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.com

ASSOCIATE/OPPORTUNITY - PHOENIX 
 
Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com  Must be pursuing or have AZ license.

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

TEXAS- WONDERFUL OPPORTUNITY!

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.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

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.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

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

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

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

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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