The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 24, 2009 #3,477 Publisher-Barry Block, DPM, JD

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Armstrong Presents First-Ever Tele-Conferencing Lecture at NYCPM

Last week, students and faculty members at the New York College of Podiatric Medicine (NYCPM) participated in the first-ever video tele-conferencing lecture to a school of podiatric medicine. 

Dr. Armstrong Conducts Teleconference to NYCPM Students and Faculty

The title of Dr. David Armstrong’s lecture was “Diabetic Limb Salvage: A Combination of Team, Technology and Tenacity.” Armstrong, who is Professor of Surgery at the University of Arizona College of Medicine, and Director of the University’s Southern Arizona Limb Salvage Alliance (SALSA), discussed how the “toe and flow” team approach can help reduce amputation rates, and also talked about some of the new and exciting techniques regarding the diabetic foot. 

The video conference was presented by the NYCPM Pi Delta Honor Society, Gamma Chapter, as part of its ongoing lecture series, and spearheaded by Khurram Khan, DPM, who is the Pi Delta faculty advisor and Assistant Professor in the department of Medicine at NYCPM, and by Albert Samandarov, NYCPM Pi Delta Honor Society chapter President. 
 

UK Foot Specialist 'Lied About Knowledge'

A London foot specialist lied about his knowledge of minimal incision surgery to boost his professional status, a misconduct hearing was told today. Amin Sain placed an ad in the Yellow Pages claiming competence in the cutting-edge surgical technique, despite not having the right qualifications to practice it, the hearing heard. He also falsely claimed membership of the General Podiatric Surgery Council on a website, a panel of the Health Professions' Council (HPC)  in South London was told.

Sain admits practicing keyhole surgery but denies that this constitutes misconduct. He also denies a second charge that his fitness to practice is impaired. Sophie Kemp, for the HPC, said Sain's claims were misleading and of concern to the regulatory body. She said keyhole, or minimally invasive surgery, required an extensive knowledge of surgery, anatomy and pharmacology - none of which Sain had to the right level. "Anyone who's practicing this type of surgery should have advanced training to perform safely," she said.

Sain claims he has the appropriate experience from time in the US, France, and Spain, and is even a leader in the field. If the charges are proved, he could be thrown out of the podiatric profession.

Source: Nottingham Evening Post (United Kingdom) [2/23/09]

Healthcare Costs are Top Challenge: Obama  

President Barack Obama called rising healthcare costs “the single-most-pressing fiscal challenge we face by far” and said that work is already under way to go “line by line” through the federal budget to cut wasteful and inefficient programs to halve the federal deficit in four years.

The discussion comes just four days before the Obama administration is expected to release a 10-year budgetary blueprint that likely will include spending cuts in Medicare and Medicaid. In opening remarks, White House budget director Peter Orszag said that the Obama administration is committed to healthcare reform this year. “The single most important thing we can do to put this nation back on a sustainable long-term fiscal course is slow the growth rate of healthcare costs,” he said, adding that “healthcare is the key to our fiscal future.”

Source: Matthew DoBias, Modern Healthcare [2/23/09]

Failure To Diagnose Melanoma (Indiana)

Facts: On May 24, 2004, Renee Flora went to see defendant for a lesion growing on her left great toe. Defendant recommended a biopsy that was consented to. A biopsy was taken. Renee Flora saw defendant for three follow-up visits after the biopsy and was assured everything was fine.

In the spring of 2005, the lesion began to return. Plaintiff went to see Dr. Weiger, who was a podiatrist who lived closer to her home. Defendant's office had faxed plaintiff's medical records to Dr. Weiger. The consent for a biopsy was sent to Dr. Weiger, but no biopsy results accompanied the records. Follow-up by Dr. Weiger revealed that no biopsy results were available. Dr. Weiger recommended a biopsy that was ultimately performed by Defendant. The biopsy revealed that plaintiff had Stage IIIC melanoma.

In discovery, Defendant produced an operative report dated May 24, 2004, wherein he claimed he could not do a biopsy on May 24<th> because the lesion "fell off." Ultimately, due to discrepancies, the plaintiffs moved to forensically examine the computer where the medical records were stored. While this was pending, in 2007, Defandant was deposed. It was then learned that the May 24, 2004 operative note was actually dictated on July 8, 2005 after Defandant learned that plaintiff had cancer.

Discovery further revealed that on May 25, 2004, Defendant began moving his office to a new location. The move was performed, in part, by a high school baseball team. The plaintiffs contended that the biopsy sample was lost during the move of the office.

The case was submitted to a Medical Malpractice Review panel, which unanimously found that Defendant breached the standard of care in failing to secure tissue for biopsy on May 24, 2004. No offer to settle the case was made by the defendants, and the case proceeded to trial.

Result:  $8.1 million dollar verdict

Plaintiff’s Expert Witnesses: Robert J. Steele, MD, Indianapolis, IN; David F. Ray, DPM , Portage, IN.;  Gary Thomas, DPM ;  Julie Wieger, DPM

Defendant’s Expert Witness: Harold Schoenhaus, DPM, Philadelphia, PA.

Source: Verdicts, Settlements & Tactics

Query: EBM to Support “Experimental” Treatments

It seems to me that medical treatments with podiatric applications have been evolving. This, of course, is expected. My concern is that evidence-based medicine for these treatments is lagging. I have been finding this burdensome in my treatment regimen and was wondering how my colleagues are dealing with similar issues. Case in point: I am finding it almost impossible to get ESWT covered by any insurance company. Here in NY, I find platelet-rich plasma injection grafts for musculoskeletal injuries to be scarcely covered as well. Does anyone have any evidence-based medicine articles on either of these treatments that one can base an appeal on? I find it ludicrous that in certain regions of the country these treatments are covered and in others they are not. 
 
Jeffrey Kass, DPM, Forest Hills, NY

Query: US Guided Aspiration

We billed Medicare for an ultrasound guided aspiration of a ganglion, CPT 76942. No modifier (e.g., "LT") was appended. Medicare denied the claim citing, "payment denied when performed or billed by this type of provider."

Documentation in the chart was very clear as to why and how. Any suggestions on a redetermination as far as modifier? Has anyone else had trouble with this?

James Webb, DPM, Bartlesville, OK

Response: With the change over to the Medicare J4 MAC by TrailBlazer, I think there have been some growing pains. I believe ultrasonic guidance was one of those areas. Although you didn't say when you performed the services, I believe those problems were corrected by TrailBlazer in the past month or so.

You might try to refile your claim or you can contact your Oklahoma podiatry CAC rep for some help with the carrier medical director to be sure our specialty was added to that series of codes in Oklahoma as it was in Texas. For some reason with their system, each state stands on its own, and has to be changed individually state-by-state.

Paul Kinberg, DPM, Dallas, TX

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RE: Chloro-preps and Infections (Eugene A. Batelli, DPM)
From: Anuj Singh, DPM, James Judge, DPM

I use two Chloro-prep sticks. One prior to “scrubbing” and then one after. The Chloro-Prep needs to dry fully prior to any sterile draping (this can take up to three minutes, depending on location of prep). It seems to be working well.

Anuj Singh, DPM, New York, NY, nujie@nyc.rr.com

I have had only one patient complain about a mild rash type reaction to the Chloraprep. This was a non-issue with this individual, but certainly extensive dermatitis over a surgical area could be problematic. The company states that this should be an issue with anyone allergic to the color components, i.e., green #6. It is probably a relationship with how long the prep stays on the skin, which is ironically why it works so well against infections. I would be cautious with  individuals who have histories of skin reactions/allergies.

I cannot comment on Dr. Batelli's infection rate with the prep. Its documented infection control is excellent and in our cases seems very comparable with chlorahexidine and Betadine. The green color btw, made mycotic nails look particularly horrible for months.

James Judge, DPM, Wake Forest, NC, jjandleah@kindnblue.com

RE: Instrument for Incurvated Toenails (Vincent L. Travisano, DPM)
From: Marta Losa Iglesias, PhD

The metallic wire for treating ingrowing toenails is old-fashioned in Europe. Sometimes we use rigid plastic plates over the incurved nail. You can find the device from Canada on this webpage: orthoactive.com/downloads/pdf/footcareProducts-Luga.pdf

Luga Clip System—Correction of Ingrown Nails

The Luga CLIP SYSTEM expands the possibilities of ingrown nail treatment, especially for bloodless applications in cases of irritated nails, extremely sensitive edges or purulent and ingrown nails. It corrects the curvature of the nail in the most effective and least obtrusive manner with minimal trauma.

The Luga CLIP is made of a special material that has the capability of keeping its initial structure when glued to the nail. The fiber tends to keep its initial structure when a deformation force is applied to the nail, pulling its edges upward.

Marta Losa Iglesias, PhD (Spain), marta_losa_iglesias@hotmail.com

RE: Nail Dust Extractor (Robert Charnam, DPM)
From: Marc Klein, DPM

I have used Jan-L vacuums and handpieces for many years and have been very happy with the quality. 

Marc Klein, DPM, Methuen, MA, MAILKlein@aol.com

RE: Is Podiatry a Profession or a Medical Specialty? (Barry H. Block, DPM, JD)
From: Evan Meltzer, DPM

I have strong feelings regarding Vision 2015, and I agree wholeheartedly with Barry Block’s April editorial.

There is a current emergent example of how podiatry should be considered a medical specialty instead of a profession. Congresswoman Eddie Bernice Johnson representing the 30th Congressional District of Texas has just introduced the Veterans’ Medical Personnel Recruitment and Retention Act of 2009. The legislation will raise salaries for nurses, physicians, dentists and executives who work for the VA system. Podiatry is NOT mentioned in this bill. I have contacted Ben Wallner of APMA regarding this legislation, as he was previously unaware of it. Senator Daniel Akaka has sponsored a similar bill, S. 252.

Because we are still considered a separate profession like dentistry, we must be specifically named as podiatry to be included. It would be much easier if the American Medical Specialty Board would include us in their list of specialists. This is probably unlikely without the degree change to MD/DO. 

Evan Meltzer, DPM, Jackson, MS, Evan.Meltzer@va.gov

RE: WI Podiatrist Among First to Use PinPointe FootLaser
From: Allen Mark Jacobs, DPM

I would like to see the published references for the 88% "cure rate" for onychomycosis utilizing the new laser technology mentioned in the last issue of PM online. One year ago, I reviewed the alleged data, and it was not quite as impressive. In fact, it was non-existent. I was merely provided with a list of podiatry "consultants" whom I was told were involved in "research" with the device.
 
Show me the money..let's see the actual data. I have no doubt that DPM's, dermatologists, PCP's, etc will lease the machine and the toe lasers used for treatment.  As I recall, it is a cash basis treatment, not covered by any insurance, just the thing for today's economy. It was also rather expensive.
 
88% cure rate for onychomycosis? Infecting organism's matter? Type of onychomycosis matter? Extent of disease matter? References please, Dr. Milkie.
 
Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

PRACTICE FOR SALE – DALLAS, TX

10 year old part-time podiatry practice for sale in North Dallas. Middle to high income area. Could easily be made full-time. Great potential! please reply to: footdoc8390@yahoo.com

ASSOCIATE POSITION - TX

Successful, multi-physician, multi-office practice in The Woodlands, Texas is seeking Podiatric Physician Specialist in Biomechanics, Sports Medicine, Gait Analysis, and Orthotics Laboratory. Please email current CV to kelley.glazier@yahoo.com

OFFICE SPACE/ MRI RENTAL – NYC, LI  

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

IMMEDIATE OPENING – MIAMI, FL 
 
Part-time and Full-time position available now. Massive growth potential present in an expanding group practice. June graduates are welcome to apply. Send CV and LOI to qvan@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION -SOUTHERN NEW JERSEY 

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

GREAT OPPORTUNITY- ATLANTA, GEORGIA

Forget getting paid by percentage or a salary, be your own boss. Great opportunity to have your own office with patients without major financial burden. Well-established practice/ office, fully equipped, five treatment rooms, x-ray room, lab, kitchen, doctor’s office, large street sign on a main road, office location and doctor's name is well-known in the community, lease or lease to buy. The doctor is cutting back on this location to become semi-retired. E-mail superrang@bellsouth.net

PRACTICE FOR SALE – ANDERSON, INDIANA

Well established office in Anderson Indiana for sale. Seller currently works 3 half-days per week and gross over $200K. Excellent locations and growth potential. Very podiatry-friendly community. All equipment and furniture included. Seller is willing to help with transition. Contact seller at mddpm@sbcglobal.net for more information.

PODIATRY ASSOCIATE WANTED – NJ

Northern NJ. Bergen County Must be well-trained. No nursing homes or house calls. Modern well-equipped office. Digital x-ray and ultrasound. Excellent pay and opportunity. Must have NJ license. Call 973-472-4700.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION NORTHERN CALIFORNIA

Need associate in busy office in two locations. Hospital privileges
available. Emphasis on wound care. All aspects of Podiatric Medicine and Surgery. Associate position to lead to partnership and buyout. Please contact jimf@humboldt1.com

FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

  
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