The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

March 03, 2007 #2,824 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.

We've just posted the March 2007 CME titled "Surgical Complications and Their Treatments " by Mary Crawford , DPM.

NY Podiatrist Helps Develop New Foot Products for Bikers

Finding that the current marketplace offered no treatments specifically designed for the unique skin damage sustained by today's bikers, motorcycle veteran Todd November teamed up with board-certified podiatrist and fellow biker Dr. Hal Abrahamson to solve the problem.

Dr. Hal Abrahamson

Dr. Hal Abrahamson, a board-certified podiatrist, motorcycle enthusiast, and close friend of November oversaw the formulation process of the full line of Biker Skin Care and Biker Foot Care products. After diagnosing several motorcycle riders with unique foot conditions, he recognized the need for specialized products to treat feet that received prolonged exposure to exhaust fumes.

"Bikers take incredible care of their bikes," explains Dr. Abrahamson. "We feel that that they should treat their skin and feet like they take care of their bikes. Unlike other products, Biker Skin Care Products and Biker Foot Care Products were developed specifically with motorcycle riders in mind."

Source: eMediaWire [3/1/07]

PM News will be posting selected resolutions scheduled for the upcoming APMA House of Delegates (HOD) to be held March 23-26 in Washington, DC. Readers are encouraged to comment on these important issues.

Resolution No. 13-07 (Directive) Single Certifying Board

Resolved, That the American Podiatric Medical Association Board of Trustees reinvigorate its efforts and develop a new approach to bringing together the American Board of Podiatric Surgery and American Board of Primary Podiatric Medicine and Orthopedics for the purpose of developing a plan that is consistent with the objectives of Vision 2015; and

Resolved, That the Board of Trustees report to the House of Delegates on its progress annually.

Sponsored by: Federal Service Podiatric Medical Association

Changes to Stark Rules Will Accelerate EMR Adoption: Report

The recent relaxation of the Stark physician referral law and anti-kickback statute could greatly accelerate the adoption of electronic medical record (EMR) systems by physicians, according to a report released this week by GE Healthcare, a division of General Electric Company. The study also suggests that the change could double the number of physician practices that are willing to acquire or upgrade an EMR system within the next year.

GE Healthcare says it commissioned an independent market research firm to conduct a blinded study of 200 physicians in small, medium and large practices to identify what effects the relaxation of the law might have on whether physicians acquire or upgrade EMR systems over the next 12 to 36 months. Last year, CMS and the Office of the Inspector General created new safe harbors and exceptions to the regulations implementing the anti-kickback statute and the Stark physician referral law. In 2005, a RAND Corp. study found that only 15% to 20% of physician offices had adopted EMR systems.

To view the entire study visit: http://www.gehealthcare.com/usen/specialty/physician_office/di/usen_starkrelaxation.html

Source: Today in E-Health Business [3/1/07]

Query: AFO S/P Amputation

A diabetic patient had an amputation and only the talus and calcaneous is left. If an ankle foot orthosis with a flexible hinge is prescribed to attempt to allow for dorsi-flexion of the partial foot on the leg, and an artificial forefoot filler is used, would there be too much of a tendency to have equinous contractures leading to further possible ulcerations? Any literature references available on this idea adding a flexible hinge to an ankle foot orthotic in a diabetic patient with a amputation would be appreciated.

Daniel Alan Chaskin DPM, Ridgewood, NY

Query: CPT 11044 Site of Service Denial

A patient with a non-healing 4th toe ulcer came to my office with bone protruding from the proximal interphalangeal joint. In my office procedure room, under local anesthesia and sterile conditions, I aggressively debrided the area, including the removal of portions of bone.

A claim was submitted for CPT 11044, debridement of skin, subcutaneous tissue, muscle, and bone. Medicare denied payment saying "the procedure is inconsistent with the place of service."
Is CPT 11044 not payable in an office setting? Why would it be different than an arthroplasty/hammertoe correction office site of service?

Neil Levin, DPM, Sycamore, IL

Response: Wisconsin Physician Services, the Medicare Part B administrator for that area recently (February 16, 2007) revised its local carrier determination (LCD), GSURG-037, on "Application of Bioengineered Skin Substitutes and Skin Grafting," and added an entire section defining and describing wound debridement.

In this revised section, WPS identifies codes, CPT 11043 and CPT 11044 as usually performed in the place of service of inpatient hospital or ambulatory surgical center. Claims submitted with any other place of service will be denied. They do add that to appeal you would need to submit complete medical records and operative report.

While I disagree with this policy as most of us have encountered patients with exposed bone in the wounds that is easily debrided in the office, this is a policy we will have to live with until the involved states' CAC reps and their state associations can change the policy.

Craig Gastwirth, DPM, Detroit, MI

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Diflucan for Onychomycosis (Cynthia S. Ferrelli, DPM)
From: Multiple Respondents

I have been prescribing Diflucan for onychomycosis for at least 15 years. I now prescribe 200 mg. once weekly for 8 weeks. In the majority of patients, you can see the proximal clearing that you see with Lamisil. Sometimes I continue it for another 4 weeks. I cannot speak to the legal aspects of off-label use, but I always inform the patient about that and use common sense with regard to their medical history, etc. My impression is that it is more commonly used in the dermatology profession than in podiatry.

Gwen S. Greenberg, DPM, Allentown, PA, gsgreenberg@mindspring.com

I routinely culture the nail before treating, thereby avoiding the use of Lamisil in a nail growing out a saprophyte. A small percentage of patients I treat will not respond to Lamisil even though they grew out a dermatophyte and when I use Diflucan, 150 mg., 1 pill a week for 8 months, I've never had it fail to clear the nail. When I've treated with Sporonox, I've occasionally had it fail to clear the nail. Once again, Diflucan has never failed me.

Because of the goofy treatment regimen (people find it difficult to remember to take one pill a week) and the long treatment course (8 as opposed to 3 months for the other antifungals), it is not my first treatment of choice, but it is effective. I always do a pre-treatment LFT, repeat it one month later and repeat it every 3 months after that. I also adhere to a regimen of doing a pulse of Lamisil/Sporonox/Diflucan for a week once a year after clearing the nail to reduce the incidence of recurrent infection.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

Prior to the introduction of the successors to griseofulvin (Lamisil, Sporanox), I used Diflucan for treating onychomycosis extensively. It has proven to be an effective treatment. The use is off-label, because the drug’s manufacturer did not choose to spend several hundred million dollars for FDA testing to add that indication to its current list. I use 200 mg per week for 32 weeks; however, there is no definitive consensus as to the proper dosing. To help them remember, I tell my patients to take the pill on “toenail Tuesday” or on “fungus Friday”. It may also be the only oral medication for treating onychomycosis available on some formularies. Fluconazole is a safe drug, commonly given to infants at a lower dose to treat thrush (oral candida).

Evan F. Meltzer, DPM, Browning, MT Evan.Meltzer@ihs.gov

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

I agree with Dr. Mullen. Why are we so insecure about our fees? Why do we get so intimidated once someone questions your fees. If you provided a service for a fair price you should not negotiate. When you undervalue what you do, the world also undervalues you. Do you think that the pedicurists or hairdressers reduce their fees for haricuts(hair streaking oft times >$150) or nail tips($50 -$75) after the fact? In fact they get tipped generously. Some insurance companies also use brokers to negotiate for lower fees . Insurance companies can subsequently lower your customary and usual fees.

As a general rule in my experience fees for podiatric care are extremely reasonable and fair.

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

RE: Lesser Digit Night Pain (Hartley Miltchin, DPM)
From: Rich Eisner, DPM

I may have a possible answer. The fact that this pain occurs while the patient is lying down and has no objective findings at the site of pain, leads me to believe he has a lumbar spine radiculopathy. I am shocked at how much of this I see. You can refer to this patient to a neurologist or order the nerve conduction studies yourself. You might be surprised at what you find.

Rich Eisner, DPM, Salem, MA, docrse@verizon.net

RE: Plica Syndrome of the Achilles Tendon? (Gary Dockery, DPM)
From: Joel Gluck, 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”

Wow, this is a really inflammatory response which you cannot prove or intelligently comment on. Remember, some people think the same about podiatrists. I am sure that insulting an entire profession (regardless of your opinion of its validity) is counterproductive and damaging to the podiatric profession as a whole.

Joel Gluck, DPM, Warwick, RI, JGluc1@aol.com

RE: Burning Lips

A gentleman came in to my office today to pick up a pair of orthotics that we had refurbished for him. While at the register, he tells me of the funniest thing that happened to his wife. Last night, his wife felt that her lips are very dry, so she reached for the "chap stick" that she usually keeps next to her bed and applied a nice amount of "lip balm" to her sore and cracked lips. After a few minutes, she felt a burning feeling and asked her husband to take a look at the "lip balm" for any special usage instructions. Guess what, she used the Pedifix Wart Stick that her husband purchased the other day.

Itamar Rosenbaum, C.Ped., New York, NY

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1yr. Need Florida license. Fax resume to 561-865-2225

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

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. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• 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.