The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

March 02, 2007 #2,823 Editor-Barry Block, DPM, JD

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We've just posted the article "Billing for Ankle Foot Orthoses" by Paul Kesselman, DPM at http://www.podiatrym.com/pmarticle.cfm?id=105

TX Podiatrist Announces Candidacy For City Council

Dr. Morris Stribling announced his candidacy for the District 8 City Council seat this week, touting a platform based on improving infrastructure and traffic, public safety, health care and campaign finance reform. Stribling, a podiatrist, is one of at least six candidates vying for the seat of term-limited Councilman Art Hall, representing the Northwest Side. Stribling served almost three years on the city's Zoning Commission.

Dr. Morris Stribling

On health care, Stribling said the city, through the Metropolitan Health District, should facilitate the development of secure patient information systems so doctors would be able to access information about patients before treating them or prescribing medication. This would save money by avoiding duplicate tests or procedures, and it could prevent dangerous or fatal mixtures of prescription medication.

Stribling has also served on the boards of the Alamo City Chamber of Commerce and the Greater San Antonio Chamber of Commerce, the Mayor's Blue Ribbon Committee for Economic Development and the Metropolitan Health District advisory board. And he was chairman of the Davis-Scott YMCA board.

Source: Laura E. Jesse, San Antonio Express-News (TX) [2/26/07]

NY Podiatrist Discusses The Most Common Sports Shoe Buying Mistakes - And How to Avoid Them!

That $150 you plunk down for a new pair of sports shoe finances more than celebrity endorsements and cool ad campaigns. Sports shoes are dramatically better than they used to be, says podiatrist Kenneth Meisler, D.P.M., director of podiatry at the Preventive and Sports Medicine Center in New York City

Dr. Kenneth Meisler

“Frequently when runners present with an injury, they wonder whether the cause was a new pair of running shoes. Too often they have bought the "latest or greatest" new shoe based on advertising they have seen, and in many cases the new shoe can be a significant change in running shoe style, such as from a shoe with significant support to a cushioned shoe”, said Meisler.

Meisler always tells patients that if they are doing well with their current running shoe they should either try to get the same running shoe or a very similar one. If they go to a knowledgeable salesperson and their old model if not available, there is frequently a different model # available with only very slight changes. Only if the patient is using an obviously incorrect type of shoe (cross trainer for running or cushioned shoe in a severely pronated foot) would Meisler recommend a patient make a change . As the saying goes "if it ain't broke don't fix it."

Source: Health 24 (South Africa)

CA Single-Payer Bill Reintroduced in State Senate

California’s Senate will again consider a single-payer bill vetoed by Gov. Arnold Schwarzenegger in 2006 after narrowly clearing the state’s Assembly and Senate. “This is not the time to wait patiently for universal healthcare,” said Sen. Sheila Kuehl (D-Santa Monica) at a news conference unveiling S.B. 840.

Kuehl said a universal insurer will deliver savings by cutting administrative costs and using market clout. Schwarzenegger, announcing his veto in September 2006, called the plan overly bureaucratic and unaffordable. The governor's own coverage proposal, unveiled in January with an estimated cost of $12 billion per year, would tax hospitals and physicians and require every Californian to carry health insurance.

Source: Melanie Evans, Modern Healthcare [2/28/07]

Query: Diflucan for Onychomycosis

A friend of my parents was talking about his episode of onychomycosis. His podiatrist prescribed Lamisil tablets, which never worked. Later, his PCP prescribed Diflucan, which cleared his toenail infection 100%. He was thrilled and didn’t have to do any LFTs either. I looked this up in the PDR and see that it is off-label. Does anyone have any experience with this? Plus, what kind of liability does one encounter when prescribing off-label if the physician has clearly indicated documentation of having a specific conversation with the patient.

Cynthia S. Ferrelli, DPM, Buffalo, NY

Editor’s comment: PM News does not provide legal advice. We encourage readers interested in learning about prescribing off-label medications to read the article, What You Need to Know About The Off-Label Use of Pharmaceuticals at: http://www.podiatrym.com/pmarticle.cfm?id=89

RE: Plica Syndrome of the Achilles Tendon? (Norm Wortzman, DPM)
From: G. Dock Dockery, DPM

I think that the chiropractor's diagnosis of a "plica syndrome", in your particular patient with Achilles insertional pain, was typical of this specialty; i.e., throwing out terms with no real basis for the diagnosis. Regarding the plica syndrome of the ankle (talocrural joint), there are some reports indicating that plica-like conditions of the ankle are similar to the knee synovial fold impingements, but they are better described as adhesive capsulitis and localized adhesive lesions.

Gusman, DN and Dockery, GL: Adhesive Lesions of the Talocrural Joint. Arthroscopy, Clinics Pod. Med. Surg., W.B. Saunders, Co., Philadelphia , 11:385-394, 1994.

G. Dock Dockery, DPM, Seattle, WA, Gdockdockery@aol.com

OTC Painkillers Increase Heart Disease Risk, Study Finds
From: Elliot Udell, DPM

The paper titled "Frequency of Analgesic Use and Risk of Hypertension Among Men" by Forman, Rim and Curhan which appeared in today's issue of Archives in Internal Medicine tries to show that there is a link between hypertension and the use of NSAIDS as well as acetaminophen. The authors speculate that the cause might be due to sodium retention and/ or impairment of endothelial function as with non steroidal antiiflammatories or an increase in cellular oxidative stress caused by acetaminophen. At the end of the paper the authors state that they are unaware of common medical conditions that re simultaneously indications for analgesic use and independently associated with hypertension

Wouldn't chronic muscloskeletal pain induce people to be more sedentary? This would lead to increased weight, increased serum LDL and lower HDL levels leading to atherosclerosis. The population studied was a group of men in the early 60's who are more likely to gain weight unless they exercise regularly. People in this age group are also candidates for "hardening of the arteries" with resulting hypertension.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Consumers Can Now Use Web-based Firm to Negotiate Fees
From: Barry Mullen, DPM

I read, with interest, the article pertaining to this web-based billing intermediary.This stimulates some questions that should lead to some interesting discussion; e.g.,: What power/authority does this website possess to exert such an influence over the fee previously billed for a diagnostic study, or any service for that matter, especially AFTER the claim had already been submitted? What would have prompted the imaging center, in this case, to honor the requested discount? Would they have been subjected to any penalty or sanction had they refused to negotiate their fee?

We've probably all been subjected, at one point in time or another, to some type of third-party intermediary who has contacted us in an attempt to renegotiate our fees. Usually, it is with the promise of prompt reimbursement to avoid the collection hassles and opportunity costs associated with tracking and recovering our more expensive service ticket items. Basically, our philosophy has always been that the insurance carrier, by contract and state law, already has a defined time line to honor and remunerate clean claims anyway; so, in essence...what are you really getting for this "discount"? As far as I recall, we are still free to charge OUR usual and customary fees for the services we provide. In this day and age of the shrinking medical market, along with consistent declining reimbursement rates, other than good will, which can be a considerable motivating factor in certain instances, why would anyone want to give up that right? I'd appreciate comments from my astute colleagues on this issue and how they have handled this.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

RE: Shocking Orthotics Paul Busman, DPM, Troy, NY)
From: Simon Young, DPM

I'm not a physicist, but it seems to me the stainless steel orthotics probably saved the patient’s life by efficiently conducting and grounding the electrical bolt of lightning.

Simon Young, DPM, New York, NY, simonyoung@juno.com

RE: Orthotic Pads

A very fashionable lady that came to my office complaining of arch pain. When I asked her what she had done to relieve the pain, she said she put "pads" in her shoes, and upon examining her shoes, this is what I found.

Obviously, feminine hygiene products have more than one function!

Robert A. Boudreau, DPM, Tyler, TX

ASSOCIATE POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

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 - 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

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 PODIATRIC SURGEON POSITION - TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas. Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

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 POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

LEASE SPACE MANHATTAN/ LONG ISLAND

Are you sending your MRs out? Now you can lease space and run your own MRIs, bill global, and have them read by a board certified radiologist. Two locations to lease, Manhattan East 60th street (near all public transportation) and Plainview, Long Island. Call for details, lease arrangements and reimbursements Email podo2345@aol.com or Call 516 476-1815

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

ASSOCIATE POSITION – WASHINGTON, DC

Associateship leading to full purchase or immediate sale. 25 Year old practice located in a hosp. w/ full surg privileges. Large number of diabetic patients and referrals. Fully equipped with x-ray, topical hyperbaric oxy units, 4 tx rooms and more. $400K on only 3 days a week. Will finance with generous terms and stay to introduce. Owner leaving area. Contact R. Benjamin, DPM jhallux@yahoo.com or 202-841-5545

PRACTICE FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations & high gross, buy outright or over time. Call 561-213-9400 after 7:00 p.m.

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

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