The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 25, 2010 #3,789 Publisher-Barry Block, DPM, JD

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Those writing comments to PM News are reminded that they have an ethical responsibility to disclose any financial ties they have with products or services that they comment on.

NJ Podiatrist Receives Best Father's Day Gift Ever - His Daughter's Kidney

Dr. Alan Gurwood is cashing in the Father's Day present his daughter gave him last year. The gift from Stacey Gurwood-Fink was a framed coupon good for "one free kidney." Now, father and daughter are scheduled for a kidney transplant Tuesday morning at Thomas Jefferson University Hospital in Philadelphia.

Dr. Alan Gurwood with Daughter

Gurwood, 62, a podiatrist with offices in Vineland and Bridgeton, has had kidney problems for the past 15 years. The health issue hasn't hospitalized him or greatly impacted his life. But without further treatment, Gurwood said, he'd have to go on dialysis -- and future failure would result in high blood pressure, anemia and other problems. "I'm at the point where I need a kidney soon," he said, adding his kidneys are functioning at about 10 percent and could diminish further.

Source: Joel Landau, The DailyJournal.com [2/22/10]

AZ Podiatrist to Lecture at Endovascular Intervention Congress

On March 2, 2010, Richard Jacoby, DPM of the Scottsdale Neuropathy Institute will present the preliminary findings of a ground-breaking blood flow study to the International Congress XXIII on Endovascular Intervention during its annual meeting. His presentation "The Neurovascular Evaluation of the Triple Nerve Release of the Lower Extremities" is expected to provide a greater understanding of the impact of blood flow in diabetic neuropathy.

Dr. Richard Jacoby

The study is a joint collaboration with the Arizona Heart Institute (AHI), with Dr. Jacoby conducting the study and Dr. Venkatesh G. Ramaiah, of the Arizona Heart Institute, evaluating the blood flow rates. This is the first formal study conducted that investigates the link between neuropathy and blood flow. "Blood flow is the missing link to why patients are losing legs," Jacoby said. "This study is the first step to solving the riddle of why people with diabetes end up with amputations."

Source: Comtrex via Investor's Daily [2/22/10}

OK Podiatrist Keep Treasure Chest of Lifetime of Service Memories 

Muskogee podiatrist Dr. James Crotty looks at merit badges earned in the Boy Scouts with fond memories of camping trips to the wilderness. Earning those merit badges also meant spending time learning things he knew little or nothing about before being a Scout.

Dr. James Crotty

Crotty has a little treasure chest of sorts where he keeps his Scouting memorabilia. He spread out a map of the entire wilderness area that he took from the bottom of the goody box. Scouting promotes service to others, he said. While attending the University of Oklahoma, Crotty joined Alpha Phi Omega, a service fraternity.

Source: Muskogee Phoenix [2/22/10]

Query: Avascular Necrosis of the Navicular in an Adult
 
I have a 52 y.o. healthy male who is on active duty in the Coast Guard who has AVN of the navicular bone documented by MRI. He has tried immobilization, orthotics, and meds. He has been symptomatic for 10 years with no specific traumatic event. Over the last 5 years, his pain has been progressing. The bone is not fragmented and appears “normal” in contour and shape. He can no longer run, can’t tie his shoelaces tight (painful), and as he puts it, his quality of life has deteriorated. Suggestions on surgical treatment? Any article citations would be appreciated.

Vince Marino, DPM, San Francisco, CA

Query: Using Website to Recruit New Employees

Does anyone use their practice website to recruit new employees with special material geared to potential job applicants? If so, how is it working for you?

Bob Levoy, Great Neck, NY

Query: Comprehensive Diabetic Foot Exam

A number of insurance companies are now requiring that an annual comprehensive diabetic foot exam be done. What is the correct way to bill for this service?

Chris Robertozzi, DPM, Newton, NJ

Response: There is no distinct CPT code which accurately describes the comprehensive diabetic foot exam (CDFE). One should choose an appropriate E/M code to bill for the CDFE. However, predicting E/M coding based on the patient's medical history, review of systems and physical findings is quite challenging. It can be made far more predictable if one uses time as the major decision factor in choosing the correct E/M code.

Since a significant effort should be made at counseling the patient, I recommend using time (>50%) as the primary element in choosing an E/M. Additional questions which should be addressed are what the key requirements are necessary to conduct a CDFE, and how they accurately may predict further ulcerative breakdown. More information on the CDFE can be found at Visual Foot Care Technologies (VFT), and by reviewing several articles in October's Podiatry Management.

Disclaimer: Dr. Kesselman is on the Advisory Board of VFT

Paul Kesselman, DPM, Woodside, NY

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RE: Smart Toe Implant Complications
From: Andrew Rice, DPM, Robert Fridman, DPM

I am very pleased with my results with use of the Smart Toe implant. We should remember, as with any implant, patient compliance and careful review of pre-operative radiographs are necessary to anticipate size and phalangeal anatomic variation. Anatomic variation may prevent the seating of the implant within the proximal or middle phalangeal intramedullary canal and is the key to avoid improper seating of the Smart Toe implant.  

Andrew Rice, DPM, Norwalk, CT, andrewrice2@me.com

I am currently in the process of reporting our group's short-term results with our first consecutive 100 MMI Smart Toe implants. We have had significant success with the implant and patients tolerate them very well. They are very happy with not having any exposed wires from their toes and the complications that come along with them (pin-tract infections, breakage, weight-bearing issues, compliance, showering, etc.). I have noticed a decrease in post-operative swelling as motion at the arthrodesis site is prevented; unlike with traditional K-wire end-to-end fusions. Also, if there is a healthy DIPJ, there is no violation of the joint with the Smart Toe.

To date, we have had 3 fractured implants and one proximal phalanx cortical fracture (these numbers are...

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

RE: An Open Letter to CPME RE: Document 320 (Rich Hofacker, DPM))
From: Elliot Udell, DPM

Dr. Hofacker says it all when he points out instances where some residents in surgical programs do not want to treat mycotic nails or give patients comfort who suffer from painful tylomata. When I  lecture on podiatric medicine at many of our seminars, I am amazed that there are colleagues present who admit that they are not  trained in how to do some of our basic therapeutic injections. When it comes to physical medicine, unless it's ultrasound, many will choose to send their patients to other professionals rather than perform the treatments in their own offices. Others are duped into buying certain therapeutic modalities at conventions which are either overpriced or minimally effective.
 
The American Society of Podiatric Medicine advocates for the non-surgical aspects of our profession. Our goal is not to exclude surgery from our profession. We are all surgeons. Our purpose is to promote lectures and seminars at conferences, residencies, and seminars that deal with the medical aspects of podiatry. These  enable all of our colleagues to be up on the latest thinking, techniques, and available modalities in areas which comprise the majority of  what we treat in the course of any given day.
 
Elliot Udell, DPM, President, ASPM, Elliotu@aol.com

RE: Dependence on Medicare Ruined Me (Name Withheld (GA) by Editor)
From: David Helfman, DPM, Deborah Wehman, DPM

It's unfortunate and you will end up back on your feet again. I think a very big lesson to all of us is that you should not be too leveraged by one payor population in your practice. This is a perfect example of what can happen if that payor lowers their fees or changes their policy toward podiatry. I had a similar business experience that was heavily dependent on Medicare reimbursement, and when Medicare cut the fee by 35%, our entire operation suffered. We bankrupted this company, took our losses, and moved on. Was it painful? Yes, Was it the end of the world? No. Make your learning bigger than your experiences, as my coach always preaches.

Unfortunately, healthcare is a regulated business, and we are not at the mercy of the free markets like many other businesses. All it takes in Washington is a stroke of the pen to change a policy, and all your profits can disappear overnight. Look what happened in the nursing home sector years ago when Medicare changed their reimbursements, and all of a sudden, they were all going bankrupt. On a final note, if you sue, you can never win a fight against the government! 
 
David Helfman, DPM, Atlanta, GA, dhelf18809@aol.com

Editor's Note: Dr. Wehman's extended-length letter can be read here.

RE: CA Podiatrist Sees 35% Rise in Insurance Premium
From: Juliet Burk, DPM

This “sudden” hike in rates sounds like a PR ploy on behalf of insurance companies who are desperate for the new healthcare reform to go through. It seems as though they are trying to swing public opinion toward reigniting healthcare reform by arbitrarily gouging patients in time to affect a vote. They would LOVE to get more people buying insurance as the new laws would mandate.

I am HIGHLY suspicious of the efficacy of health reform legislation that has such strong support from the insurance lobby. If the goal is truly to help people make healthcare more affordable, then where is the discussion of tort reform? And if we are truly so altruistic as to want to provide basic services for the uninsured middle class, then why are hospitals built to compete for patients like luxury car producers with shiny private rooms as well appointed as hotels? We can’t reconcile competitive private healthcare with public needs without bankrupting either patients (who can spend 10’s of thousands of dollars a day in a hospital stay), or doctors (whose reimbursement will be slashed) or the system (as it feeds the unrestrained greed of insurance companies).  

The only way I can see doctors able to support receiving less money for services is via a combination of tort reform and streamlined collections. I could give up 8% of my practice income if I could get paid without needing to hire a billing service. Single-payer system, anyone? Or how about a law prohibiting how much profit an insurance company is allowed to make without dividing and giving back its gain to the insured? Anyone else want to just go to Washington and rewrite the whole &$^% thing?

Juliet Burk, DPM,  Muskogee, OK,  juliet-burk@cherokee.org

ASSOCIATE POSITION – BROOKLYN, NY

Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with  EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

PRACTICE 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.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. E-mail: drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614. 

ASSOCIATE POSITION – NEW YORK
 
Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome.  Please call 212-704-4310 for additional information and fax your CV to 212-704-4311.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

ASSOCIATE POSITION - MONTANA

Great opportunity for a PSR 24 or 36 residency trained individual to join a dynamic two doctor group with physical therapy. Needs good FF surgical skills, RF a bonus. Beautiful office and great area of the country for outdoor recreation-minded individuals. Opportunity for partnership after employment. Please reply to: jclough@bridgemail.comASSOCIATE 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 VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

ASSOCIATE POSITION - INDIANAPOLIS, INDIANA

Hospital clinic practice with a large volume of all patient types. In need of 1-2 podiatrists, willing to work as a team and make a career in Indianapolis. One - two year residency training can be medical or surgical. Excellent income and ownership possible. Curriculum vitae to twz1001@sbcglobal.net

ASSOCIATE POSITION - MARYLAND/D.C AREA

We are looking for an energetic and well-trained podiatrist to join our rapidly growing group; we have offices in Maryland and D.C and are in need of someone who is hard-working and growth-oriented. This candidate must be a graduate of a PM&S 36 residency program or have the equivalent in practice experience. We are looking for the person that wants to make this area their home and become an integral part of our group. If interested, e-mail your CV and cover letter to washingtonpod@aol.com

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry practice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

SPACE AVAILABLE With MRI– NYC/LI

Turn-key office space, East 60th and 22nd St. Manhattan and Plainview, Long Island. Available extremity M.R.I and dynamic ultrasound (East 60th St Manhattan and Plainview, LI). Tests are run by DPM and read by board-certified radiologist. Call for rental agreement. Satisfies Stark laws (516) 476-1815.

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