The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 27, 2012 #4,395 Publisher-Barry Block, DPM, JD

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Dirty Salon Instuments Spread Bacteria nd Fungi: FL Podiatrist

You could end up in your doctor's office with a fungal infection after getting a pedicure if your salon doesn't clean its instruments properly. Vera Occhipinti gets a pedicure every other month. This time when the dark red nail polish came off, her podiatrist found something she never expected. "A slight fungus under the dark nail polish," said Occhipinti. While Occhipinti has no idea how she got the fungus, she says it easily could have come from her nail salon.  

Dr. Elena Cibula

Dr. Elena Cibula says Occhipinti is not alone. The podiatrist has treated several patients with fungal and bacterial infections that came from dirty salon instruments like nail clippers, whirlpools, even the brush of the nail polish. "If they use an instrument on one person who had a fungus infection and do not disinfect it, it can spread," said Cibula.

Source: WBBH (NBC) [2/23/12]

PA Podiatrist Provides Shoe-Buying Advice

What can you do to prevent your body and feet from suffering? Here's Philadephia podiatrist Dr. Bruce Zappan’s advice: Avoid wearing too-high heels for long periods of time. If you have a special event on a weekend that requires you to wear fabulous stilettos for three to four hours, that’s no big deal. It’s when you start wearing towering heels all day, every day, that there’s cause for concern. Zappan advises wearing walking shoes to work and changing into more fashionable footwear after you’ve arrived. Wearing high heels while sitting at a desk puts much less strain on your feet than your full body weight pounding on cement sidewalks. 

Dr. Bruce Zappan

It’s crucial to purchase shoes that actually fit you. “Feet can change like any other part of the body, and you should have your shoe size checked once a year,” says Zappan, pointing out that many women purchase shoes a half-size too small so their feet will appear smaller (bad idea). He advises buying shoes in the afternoon, since feet swell as the day goes on and you want to get shoes that fit your feet at their average size.

Source: Julianne Mele, Philadelphia Magazine [2/24/12]

Diabetic Patient Credits NC Podiatrist for Saving His Foot

Diagnosed with diabetes at the age of 23, Thomas Moody of Lumberton, now 45, knows what it’s like to live with diabetes. For treatment and guidance, Moody turns to Southeastern Regional Medical Center’s Diabetes Community Center and Southeastern Wound Healing Center. The knowledge and professionalism of the wound healing center staff and Moody’s physician, Dr. Matt Thompson, who is one of a number of physicians who serve on the center’s panel of physicians, are assets he finds most impressive. 

Dr. Matt Thompson examines Thomas Moody's foot.

“The staff goes above and beyond to care for me,” Moody said. "Dr. Thompson would drop what he’s doing just to care for his patients’ needs and, to me, you just don’t see that in doctors,” Moody said. “If it hadn’t been for him, his care and his expertise, I’m sure I would have lost half of my right foot.”

Source: Christina Nguyen, The Robesonian [2/25/12]

NJ Podiatrist/Mayor Explains His Right to Drive a City-Owned Car

Passaic Mayor Alex D. Blanco has been rolling in and out of town in a brand new Chevy Tahoe, one of the 13 new vehicles recently purchased by the Police Department. Police Chief Richard Diaz said he is proud of the fact that by using grants and money confiscated from drug busts, "the new cars didn't cost the taxpayers a dime." Blanco said he has been driving the SUV out of town to his day job as a podiatrist at the Veterans Administration Hospital in East Orange — while taxpayers have been buying the gas and paying for the insurance.

Dr. Alex Blanco

"I'm the police director, and I am on call 24 hours a day," Blanco said. "I'm the mayor 24/7, and I'm entitled to have a car." Blanco also said he has never given himself a raise as mayor. "I haven't had a raise in five years," Blanco said. Blanco reduced the mayor's salary from $121,000 to $72,000 after his election to the office in 2009. 

Source: Richard Cowen, Northjersey.com [2/24/12]

Proposed Stage 2 Requirements Raise the Bar for Providers

The proposed Stage 2 meaningful-use requirements raise the bar for hospitals and eligible professionals on the use of computerized physician order entry, electronic prescribing and electronic recording of several patient-health measures, according to CMS officials. On Thursday afternoon, the proposed requirements were published on the Office of the Federal Register's website. They are slated to be published in the Federal Register on March 7.

Under the proposed Stage 2 standards, hospitals as well as eligible professionals—the latter category includes physicians not employed by hospitals—would have to use CPOE for more than 60% of medication, laboratory and radiology orders, double the share required under the Stage 1 standards. The CPOE requirement is one of more than a dozen core objectives that hospitals and EPs would have to meet as part of demonstrating their meaningful use of electronic health-record systems, which would make them eligible to receive federal health IT incentive payments.

Source: Christine LaFave Grace, Modern Healtcare [2/23/12]

Query: Large Verruca at the Heel

I treated a new 59 year old female patient today with a large 3.0 cm wart on her right heel with duration of over 6 years. This wart has been treated by topical medication, cryo, surgical excision, and even with beetle juice extract.

Large Recurrent Verrucae on Heel

She was sent to me by an MD allergist who is concerned about her immune system. She is said to have a globulin deficiency. Each time the wart is knocked down in size, it comes back with a vengeance. Any treatment suggestions?

Bruce Krell, DPM, Chandler, AZ

Query: Pre-Payment Audits for Therapeutic Shoes

Medicare is conducting pre-payment audits on most all therapeutic shoe claims that we are submitting. All of my supporting documentation is in place, including certification from the PCP. The problem is that Medicare is also requesting notes from office visits from the PCP to support qualifying findings. Many of the PCPs do not even look at the patient's feet and have no supporting documentation, and therefore our claims are denied.

I send a copy of my note to the PCP for his or her records, however, there still may be no specific documentation from the PCP. The result is that the patient is dispensed shoes, we do not get reimbursed, and cannot bill the patient. Does anyone else have any experience dealing with this? How can you convince your referring doctors to document more thoroughly?
 
David Dowell, DPM, Joplin, MO

RE: Hallux Rotation S/P Bunionectomy (Scott Hughes, DPM)
From: Seth J. Steber, DPM

I have found that after correction of the IM angle with a persistent rotational deformity of the hallux, a simple, appropriately-designed Akin osteotomy will correct this problem consistently.

Seth J. Steber, DPM, Kingston, PA, acpwc@ptd.net

Editor's note: To find the original or referenced note of this or any other response, simply click on the underlined subject heading. 

RE: Do Runners Need Orthotics? (Robert Bijak, DPM)
From: Robert Scott Steinberg, DPM

I look at running shoe selection from two points: 1) If the runner over-pronates, I recommend a shoe that does not add to that pronation by being too soft and flexible. 2) If the runner is going to wear a prescription functional orthotic, I recommend a shoe that is stable side-to-side, so the orthotic can maintain a STJ neutral position. A cushioned/"neutral"/minimalist shoe just can't cut it, for these runners.

My patients get a list of running and walking shoes in both the stability and motion control categories, with my 1st, 2nd, & 3rd suggestions highlighted. The best shoe for the foot type may be all my patient needs, along with things like stretching, etc. And, if their plantar fasciitis, ankle or knee pain do not improve enough, then I look to control the abnormal biomechanics via an orthotic. Remember, an excessively pronating foot is not controlled by the sock liner that comes with the shoe.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

RE: The Cost to Podiatry for ICD-10 in 2013
From: Bruce Krell, DPM

I read a recent article in one of the podiatry journals that the cost to adopt ICD-10 for each individual podiatry practice will be well over $80,000. How is this remotely possible? Could we have a discussion on what this dollar figure is actually attributed to and how we all are to pay for this? If I had to put out that kind of money next year to upgrade with my EMR service provider and billing company, I might as well call it quits. Besides, I'm still waiting on my first meaningful use check. I worked my butt off to do that!

Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net

RE: Overburdened by Paperwork (Josephine Borreggine, DPM)
From:  Richard A. Simmons, DPM
 
Dr. Borreggine wrote that a patient cancelled before the first visit because of the burden of paperwork. The tone of the cancellation notice blamed the doctor for the burden. Years ago, I pre-empted this type of response by placing the following heading on my office paperwork, “For the service to be paid for by your insurance (including Medicare Part “B”), the 1995 and 1997 Correct Coding Initiatives (CCI) require completion of all pages of this form.”

When there is a complaint, the potential patient is always told they have the right not to participate in Medicare (or any insurance coverage) and simply be a cash-paying customer. I have found that when people understand that the burden was imposed on me and not imposed by me, they empathize with me about where this nonsense originated.

Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Jeanne Arnold, DPM

Ah, you say tomato, I say "tomoto"; he's a podiatric physician and surgeon; she's a podiatrist. The fact remains that we all practice the same profession. Respect among our medical colleagues and patients is earned, not bestowed by a title. Regardless of what you call yourself, if you practice honestly, ethically, and to the best of your ability, you will find yourself treated well in the general medical community, and your services will be sought after by patients. And remember, it's not just podiatry that is dying; the entire medical profession is along for the ride.

Jeanne Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

RE: Staple in Diabetic Shoe (Jonathan Michael, DPM)
From: Jeffrey Kass, DPM

Dr. Michael - you're a good man. You drove to your patient's house; you are a concerned human being. Two thumbs up. Your patient has every right to be mad, but there is no injury - I'm not sure what he wants to be compensated for. The fact he is demanding something - I would stay out of it.

I would contact the shoe company and inform them about what occurred and what the patient stated to you. Maybe they will offer him something that he will be happy with. This might be in their best interest after all. Had he developed gas gangrene or osteo, they would be in much worse shape. I don't think you have any obligation to worry about what Medicare will do or not do to the shoe vendor.
 
Technically speaking - the question may be - as the fitter should you have examined the inside of the shoes before dispensing? Personally, as a fellow doctor, I say no. I have NEVER stuck my hands in a new shoe looking for a tack or staple. I don't believe this to be standard of care. But, I am not an attorney, and another podiatrist who would disagree with me will swear to it in court. 
 
Jeffrey Kass, DPM, Forest HIlls, NY jeffckass@aol.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - 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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - EAST CENTRAL NEW JERSEY

Well established practice needs a career-minded podiatrist for associate position leading to Fast Track Partnership. Competitive salary/benefits. Busy practice. Great location. Board Certification a plus. Part-time or full-time. Immediate availability, but will wait for best candidate. GardenStateDPM@aol.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with patients located in facilities, homes, office, etc. Flexible hours, independence, and great compensation. If interested email CV to or call Terri at  323-353-8103  homefootcare@hotmail.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY 

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references to ejema@aol.com 

ASSOCIATE POSITIONS - TEXAS

TEXAS licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well-established, unique mobile podiatry practice servicing senior living facilities. Business office location with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com. Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-Time Associate needed for busy multi-office locations in LA, Orange, San Bernardino and Riverside counties. SIX FIGURE SALARY PLUS BENEFITS!! Knowledge of Spanish is helpful. Good mix of office patients, house calls, some surgery, etc. NO NURSING HOMES!! Needed in July, 2012 or sooner. If interested, please send contact information and CV to scpodgroup@yahoo.com

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