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The Voice of Podiatrists
Serving Over 9,000 Podiatrists Daily
February 24, 2007 #2,818 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.
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FREE YOUR SOLE
NALFON(tm) 200 (fenoprofen calcium 200mg capsules).
Pedinol Pharmacal Inc. introduces Nalfon(tm) 200: * Rapid pain relief * Non-selective NSAID with over 25 years of clinical experience in the U.S. * Possesses both analgesic and anti-inflammatory properties * Generally well tolerated * Rx only Nalfon(tm) 200 is available in 200mg capsules. For full prescribing information on Nalfon(tm) 200 go to http://www.nalfon200.comNalfon(tm) 200. Foot pain doesn't wait. Why should relief?
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PODIATRISTS IN THE NEWS |
PA Podiatrist Uses Online Appointment Service
People can already go online to book a flight, make hotel reservations, buy movie tickets, watch television shows and shop for groceries. Jonathan Straub thinks people will also embrace using the Internet to make and prepay for doctors' appointments -- even if it means paying a small "convenience" fee to do so. Straub is president of business development for DoctorsDirect.com, a new company that has just started test marketing its online physician appointment service in Philadelphia, as well as in Los Angeles and San Francisco.
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Dr. Michael Grossman |
Dr. Michael Grossman, a podiatrist at the Main Line Foot and Ankle Center in Ardmore, is among five Philadelphia-area physicians who have already signed up to be listed on the DoctorsDirect Web site. Grossman, who is also the chief of podiatry at Lankenau Hospital in Wynnewood, said he was attracted by the company's "cutting-edge" technology.
"The niche I believe they're after is reserving spots for clients who find it difficult to schedule appointments," he said. "There are more and more business people who can't, for whatever reason, find the time to make the phone call and find a time that will fit into their schedule. With DoctorsDirect they can go onto their Internet or use their Blackberry and book a guaranteed time."
Source: John George, Philadelphia Business Journal
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New Stylish, Washable, Elastic Shoes
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Orthofeet is introducing attractive, elastic shoes that are designed for diabetic patients, who need extra protection, but do not want to compromise on appearance.
The new elastic shoes are designed with unique features:
- Non-binding elastic vamp provides a loose fit at the forefoot, and ease pressure on swollen feet, bunions and hammer-toes.
- Firm heel counter offers excellent rearfoot support and stability.
- Washable: The shoes are made of synthetic materials that can be washed in look warm water.
- Four widths, including Women's Extra-Extra-Wide and Men's Narrow.
- Competitive prices- Shoes: $4200; Prefab inserts: $895; Custom inserts: $2200
For more information call 800-524-2845 or visit our website: www.orthofeet.com
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PODIATRIC STUDENT NEWS |
AAPSM Publishes 3rd Edition of Student Handbook
The American Academy of Podiatric Sports Medicine (AAPSM) has just published the 3rd edition of the AAPSM Student Handbook. This reference guide features chapters from students at several podiatry colleges. Students at Scholl wrote about the foot; students at OCPM wrote about the ankle; students at Temple the leg; and students at CSPM covered the knee and other specialty topics.
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AAPSM Student Handbook |
Dr. Doug Richie, along with AAPSM board members Tim Dutra, Matt Werd and Bruce Williams, edited the content and worked with the students on preparing articles for publication, which was sponsored by Brooks Sports, Inc. Copies of the handbook are available for $20 through Rita Yates at ritayates2@aol.com
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DR.COMFORT
THE BEST JUST GOT BETTER ….. A LOT BETTER! OUR DISPLAY IS NOW ONLY $99!
One in four Americans will develop foot complications due to their diabetes. It is crucial that professionals recognize their importance in reducing these risks. We can help.
For a limited time only, Dr. Comfort will offer our complete display kit including the attractive display rack, 24 pairs of shoes for sizing and display, a customized Brannock device and the best marketing collateral in the business. All this for only $99, plus shipping!
Dr. Comfort shoes are made from the finest leathers and are scientifically designed for the diabetic foot. Call us now at 800-556-5572 to experience exceptional quality and profitability with our exclusive turn key program for your podiatric practice. Call today and together we can reduce the risks of diabetes. Please visit us on the web at www.drcomfortdpm.com
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HEALTHCARE NEWS |
Employers Expect 8% Increase in Healthcare Costs This Year: Survey
Employer healthcare costs last year increased by 8%, and companies expect the same rate of growth this year and in 2008, according to a survey released on Wednesday by Watson Wyatt Worldwide, the AP/Detroit News reports. The survey, which Watson conducted with the National Business Group on Health, included responses from 573 employers with at least 1,000 employees. According to the survey, more employers said they have begun to offer programs to help employees maintain healthy lifestyles in an effort to reduce healthcare costs.
The survey found that 72% of respondents said they offer employees health risk evaluations, compared with 66% last year. In addition, the survey found that 23% of respondents said they offer onsite health clinics and that 14% of respondents said they offer onsite pharmacies. Based on an initial analysis of the survey results, employers that offer programs to help employees maintain healthy lifestyles have a lower rate of growth in health care costs than employers that shift more of the costs to workers Source: Theresa Agovino, AP/Detroit News via American Health Line, [2/22/07]
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MEETINGS / COURSES
The 2007 Annual Cherry Blossom Dermatology Seminar will be held in Washington DC at Washington Hospital Center on the weekend of April 28 and 29th. The meeting is sponsored by the American Society of Podiatric Dermatology.
Highlights will include lectures by Richard Scher, MD past president of the American Academy of Dermatology, Elizabeth Dugan, MD head dermatopathologist of WHC Melanoma Center. We are also very excited that we have the top podiatrists to discuss everything dermatology. They include Dock Dockery DPM, Harvey Lemont, DPM, Warren Joseph, DPM, Mark Kosinski, DPM, and John Steinberg, DPM, Wayne Caputo, DPM and more! We also have lectures by Todd Perkins, MD, Yolanda Holmes, MD, Ben Lockshin, MD and dermatology coding by David Freedman, DPM .
For further information and registration contact Dr. Joel Morse at foxhallfoot@aol.com or call 202-966-4811. The ASPD website will be up shortly.
For a list of all meetings go to: www.podiatrym.com/meetings.pdf
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QUERIES |
Query: Podiatric Band/Orchestra From: Paul Kesselman, DPM
I've come across many DPM's and those who service the podiatric community who are avid amateur musicians (myself included having played in a Klezmer band, synagogue band, etc.) Here in NYC there is a professional orchestra of MD physicians who perform regularly. If anyone in the NY area would be interested in starting up a DPM band/orchestra just for fun or to play at fundraisers or club dates, I'd be interested in hearing from you.
Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net
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PedAlign Costs Less Than Plaster
“Plaster casting was a waste of time and the pressure technologies resulted in poor quality orthotics –I started with PedAlign about a year ago and have been very impressed with the system and the quality of orthotics. Many of my patients are runners who have tried different orthotics over the years. Most everyone seems to like the PedAlign system of scanning and their orthotics best. I recommend PedAlign to all podiatrists without reservation.”
Jaryl G. Korpinen, DPM, Plano and McKinney, TX
PedAlign: the most sophisticated digital prescription interface to an orthotics lab ever created. There is simply no other choice for fast simple and high quality orthotics: Don’t compromise: Modernize: www.pedalign.com; 866-733-2544, info@pedalign.com
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CODINGLINE CORNER |
Query: CMS X-Ray Payment Guidelines
For as long as we have been billing Medicare, we have received the full global payment for x-rays (e.g., CPT 73620) when billed along with an E/M service, regardless of whether there are separate and distinct diagnoses or not. One of our Medicare replacement plans states that they pay according to CMS guidelines, and if Medicare is paying us the global fee in these cases, they are paying it wrong.
Can anyone tell me exactly what the CMS guideline is on this? I have tried the Trailblazer website, but cannot find a clearly stated policy.
Elayne Gordon, Houston, TX
Response: You are going to have to press the Medicare "replacement" plan to show you in writing how you have been wrong. When you speak to them, be sure to let them know that, in fact, Medicare does reimburse the global (both professional and technical components) to physicians that own their x-ray units, take and process the x-rays in their offices, and perform the professional reading. This constitutes the requirement for global payment (when billing the global code, do not append a "-26" or "TC" modifier; the x-ray study code without those modifiers represents a global service).
There is only one exception to the above that I can think of, and that is if the patient you are taking x-rays of resides in a skilled nursing facility, and has been brought to your office for evaluation and treatment. Medicare - your regular carrier - would only reimburse you the professional component of the x-ray study because the skilled nursing facility is paid from Part A for the technical portion. You would need to collect - presuming you have a written arrangement - payment directly from the nursing facility.
If the patient doesn't fall into that category, the rep from the Medicare "replacement" plan is wrong. You should try to get them to confirm in writing what they are saying, and take it to a supervisor, and report it to your state association for action.
Harry Goldsmith, DPM, Cerritos, CA
Codingline subscription information can be found at http://www.codingline.com/subscribe.htm
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PODIATRY MANAGEMENT'S AFFORDABLE ONLINE CME
You can Earn 15 CPME-Approved CME Contact Hours Online for only $139(Less than $14 per credit) http://www.podiatrym.com/cme.cfm Choose any or ALL (30 CME Contact Hours) from the 20 CME articles posted You Can Now Take Tests and Print Your CME Certificates Online
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RESPONSES / COMMENTS |
Editor’s Request: PM is planning a story on the use of I-Pods in podiatric medicine. Unfortunately, the writer's computer crashed, so the notes from those who previously replied were lost. We ask those podiatrists to resend their notes. If others would like to share your experiences as part of this article, please write Laura Gater at lsgater@earthlink.net Thank you.
RE: Cosmetic Foot Surgery (Martin V. Sloan, DPM) From: Simon Young, DPM
I can empathize with Dr. Sloan’s position. I find myself in similar circumstances, but I see nothing wrong with "cosmetic foot surgery." As long as the patient is fully informed with proper disclosure, insurance companies are not involved, and the practitioner is competent, I don't know why the consumer needs to be weary.
Simon Young, DPM, New York, NY, Simonyoung@juno.com
I found the posting of Dr. Sloan, regarding cosmetic foot surgery, somewhat concerning. Let me begin by stating I practice in an inner city location populated by patients that I have difficulty getting to pay their co-pays, let alone a cosmetic non-covered procedure.
Although I am not an advocate and do not perform "cosmetic" foot surgery, as it is intended to be, I, nonetheless welcome new ideas, new techniques, and new marketing strategies that bring podiatry to the forefront.
I do not assume that just because I do not perform a specific type of procedure, or even disagree with the concepts, that it does not have its place. Like any surgery or procedure, if the patient is well informed as to the outcome and expectations, they have the choice to proceed or not. Almost all of our surgery is elective, and all of us have had patients shy away from surgery, even in cases of pain and deformity. Also, all of us have seen misuse of surgery, under the guise of deformity, over-utilized or performed inappropriately. So, in my opinion, believing that those performing these procedures are automatically using "snake-oil tactics", is a huge generalization.
In conclusion, let us not put down what others may be doing because we may not choose to do it. We should focus on the quality of what ALL of us do, regardless of if we agree or disagree with the concept. Perhaps some of what the "cosmetic" procedures entail can be utilized by those of us doing traditional procedures and improve our results.
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net
Editor's note: The complete text of Dr. Kashan's letter can be read at: http://www.podiatrym.com/letters2.cfm?id=12883&start=1
RE: Perioperative Anlalgesia (Scott Hughes, DPM ) From: Multiple Respondents
I use Lyrica routinely in my practice for neuropathy, neuritis assoc with tarsal tunnel and neuromas, chronic pain, etc..., but never post-op. I am quite curious how many others are using this regimen that Dr. Hughes has outlined.
Lyrica reaches peak levels 1.5 hours after administration and is dose dependent. Its half-life is 6 hours in non-renal impaired patients. Lyrica reaches steady state plasma levels 24-48 hours after repeated dosing. My personal experience is that it takes 3 to 5 days to become effective and I dose it quite high (100-150 mg tid in diabetics with severe neuropathy). Basically, one dose pre-op and 2 days of Lyrica use should not work all that well.
I am not a huge fan of Toradol so if this regimen of Lyrica can work on its own (Dr. Hughes stated he also uses 60 mg Toradol IV followed by PO use) or possible combined with Celebrex, this really could be a huge breakthrough for post-op analgesia. Lyrica is quite safe and really has no drug-drug interactions. It does potentiate opiates and benzo's but this could lead to much less narcotic use post-op.
I hope Pfizer reads this and possible can get a study started involving podiatric surgery and not rat models or hip replacements. Dr. Hughes, I will be trying your regimen and thanx for peaking my interest.
Eugene A. Batelli, DPM, Naples, FL, ebatelli2001@yahoo.com
For some years now, I've used a mixture that used to be called "Supercaine" at one time. This is a mixture of 0.5% Marcaine with epi mixed with 1% Pontocaine. In most patients, the feedback I receive is between 24-36 hours of anesthesia to the site after the block, but have had a few patients report 48 hours or so. My experience has been that most post-operative pain lasts for the first 24-48 hours and with the local block, Cold Therapy circulating through the pad integrated into the dressing and elevation of the extremity, that a fair number of my patients report not having to take the narcotic I've written for them.
As Pontocaine is no longer used for spinal anesthesia due to radicular irritation, you may have a difficult time getting it into the hospital. It also needs to be refrigerated and the toxic dose is 6mg. As each ampule contains 2 cc., you obviously can't inject very much of this, but as an ankle block, 10 cc. mixed of "Supercaine" is usually enough to make patients comfortable.
David Secord, DPM, Corpus Christi, TX, David5603@pol.net
My regimen used to be Bextra 20 mg 2 hours pre op and then 1 daily x 7 days. The patients noted profound post operative analgesia and I noted the diminished use of narcotics, etc. for pain management.
These days I use a pre-emptive block (ankle or sciatic) plus a post op pain pump (no brand specified on purpose), which I fill with ropivicaine w/o vasoconstrictor. I think this is a thought-provoking subject and perhaps one that would be article worthy for the magazine. For example, legal issues aside, I'd like to start using a Cox-2 inhibitor, e.g. Celebrex pre-op again.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
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CLASSIFIED ADS |
ASSOCIATE POSITION – PORTLAND, OREGON
Immediate opening in beautiful Portland, OR. Busy, well-established private practice is seeking a dynamic, motivated, surgically-trained podiatrist. High volume of primary care referrals. Work with a well-trained support staff in one of the most efficient offices in the area. Surgically-oriented practice. Competitive compensation package including malpractice and benefits. Call (503) 652-1121. Ask for Dr. John Mozena or email jlmozena@aol.com
SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD
Mercy Medical Center -Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com
ASSOCIATE POSITION – NY & 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
SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED
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.
POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA
Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com
ASSOCIATE POSITION - EAST/CENTRAL TEXAS
Practice in East Central Texas has an opportunity for an associate to join as an associate leading to partnership. Hospital supported practice which has two doctors seeking a third for new office. Practice is leading provider in market and offers an outstanding compensation and benefit package. This position is targeted to be an equity partner within two to three years. easttxdpm@comcast.net
ASSOCIATE POSITION - SANTA FE, NM
Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com
ASSOCIATE WANTED FOR SOUTH MIAMI AREA
Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead , FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com
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 WANTED - MICHIGAN-DETROIT AREA
Great opportunity-must be hard-working, reliable, responsible and good with patients & staff-surgical training a plus-partnership after 1 yr. Michigan license required fax resume to 248-478-1370
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
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
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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.
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