The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 07, 2011 #4,101 Publisher-Barry Block, DPM, JD

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We've just mailed the March 2011 issue of Podiatry Management. This 220-page special Annual Survey issue includes our  cover story, "Keeping What You Earn: Strategic Decision-Making and Spending Pay Off," a roundtable discussion, "Degree Change: Has Its Time Come?" as well as an assortment of features, including our informative columns, and a CPME-approved CME.

March 2011 Podiatry Management

FL Podiatrist to Serve on AAWM Exam Sub-Committee

The American Academy of Wound Management (AAWM) has selected Dr. Douglas Cohen to serve on the CWSP examination sub-committee. This group will be responsible for the development of future CWSP examinations. Dr. Cohen is one of the elite few in the country to hold the designation of Certified Wound Specialist-Physician. The subcommittee will convene to review submitted items and develop the exam that will be administered in 2011.

Dr. Douglas Cohen

Dr. Cohen is on staff at Regional Medical Center Bayonet Point where he is a member of both the podiatric medical staff and the wound care medical staff. His practice is located in Spring Hill, Florida.

CA Podiatrist Visits AAPPM Club at CSPM

Dr. Tony Poggio, frequent contributor to PM News, visited the campus of the California School of Podiatric Medicine on Thursday March 3rd.  He spoke to the AAPPM club about avoiding some of the common mistakes new practitioners can often make. Dr. Poggio explained how choosing the right type of practice has a large impact on the general happiness of the new podiatrist. Dr. Poggio also shared some of his knowledge about charting.

(L-R) James Wilk, AAPPM club President-elect, Dr. Tony Poggio, and Daniel Jones, AAPPM club President

"He told us to avoid things like unbundling and instead focus on timely billing and straight-forward billing procedures," said Daniel Jones, President of the CSPM Practice Management club.  "Overall, he gave us a lot of pointers on things to look for when starting or buying a practice. This is the type of information that our club members really need."

Stage 2 Meaningful Use Plans Unreasonable: CCHIT Survey

All nine of the proposed Stage 2 meaningful-use measures that were enhancements of the Stage 1 criteria for successful electronic health-record use are considered too aggressive by at least one-third of all participants in a survey conducted by the Certification Commission for Health Information Technology (CCHIT), a federally authorized health IT testing and certification body.

To be paid under the health IT incentive program of the American Recovery and Reinvestment Act, providers must demonstrate that they are meaningful users of an electronic health-record system measured against government-developed criteria. A work group of the federally chartered Health IT Policy Committee released for public comment its initial recommendations for Stage 2 meaningful-use criteria, scheduled to take effect in 2013, and preliminary directions toward Stage 3 criteria, set to take effect in 2015.

Source: Joseph Conn, IT Strategist [3/4/11]

Set Guidelines For On-the-Job Behavior

Insisting that employees show courtesy and respect is not about forcing them to “make nice” with each other. It’s about making money for your practice. No one wins when employees exhibit uncivil behavior. You can reduce incivility and limit its damage by raising awareness and squelching bad behavior when you see it. Start with these basics:

• Set a zero-tolerance policy. Let employees know that rudeness, sarcasm, backstabbing, and similar behaviors will draw a written warning. Be sure to follow through.
• Look in the mirror. Listen to yourself, too. Make sure that you are serving as a positive role model.
• Take complaints seriously. Do not brush them off as whining or act as if complainers merely suffer from “thin skins.” Do not make excuses for offenders, even if they are your rainmakers or protégés.

Source: Adapted from “Zero Tolerance: Business Leaders Who Understand the Cost of Incivility in Their Organizations Make Eliminating Bad Behavior a Priority,” Christine Pearson and Christine Porath, American Executive via Communication Briefings

Query: Painful Hyperkeratosis in 87 Year Old

I am treating an 87 year old female for a chronic painful foot condition. She is in poor health. The base of her right first met head and first cuneiform area is hypertrophied and dropped. She develops painful hyperkeratoses beneath this area and severe pain. Prior treatment has included accommodative orthotics, which help. She has been given injections of lidocaine and dexamethazone and this too helps. 

Painful areas marked with povidine iodine.

The problem is that the patient would like complete relief. She has independently seen orthopedic surgeons and other podiatric surgeons seeking permanent relief. Thus far, no one has recommended surgery.  Any ideas?

Elliot Udell, DPM, Hicksville, NY

Query: Spenco Sandals

Any positive or negative feedback about dispensing Spenco Sandals out of the office?

Mark K. Johnson, DPM, West Plains, MO

RE: Acute Charcot Patient (Andrea Simons, DPM)
From: From: Gino Scartozzi, DPM
 
Dr. Simons, I think that in this situation, the orthopedist is "dead wrong." Despite the fact that the patient has symptomatic relief of the other articulations (other than the fifth metatarsal fracture site), having this patient fully weight-bearing in the midst of an active Charcot disease process is contrary to the long-term needs of your patient.
 
Charcot disease follows the three stages from its inception to resolution.  The first phase is "destruction" (created by hypermobility of joint motion due to neuropathy and the loss of vascular tone which creates hyperemia and bone substance loss). The phase of "healing" will require the patient to be non-weight-bearing or guarded/partial weight-bearing for usually 6-8 weeks. The "coalescence" phase is the residual position that the foot will be found in after healing is complete.
 
The "healing" phase is most critical in determining the long-term prognosis of the patient for future infection development, further fracture injury, subsequent arthrosis progression, and ulceration risks. If there are no gross structural dislocations from this recent Charcot process, surgical intervention is usually not required. However, use of contact casts, CROW boots, wheelchairs, crutches, non-crutch walkers, etc. are all essential considerations to get the patient in a non-weight-wearing or greatly diminished weight-bearing state, dependent on your patient's medical history and physical ability. Pre-mature weight-bearing may place your patient at risk of non-healing or the patient achieving a "coalescence" of bone articulations that may lead to greater issues later.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Fraud and Abuse (David Gurvis, DPM)
From: Chuck Ross, DPM

Medicare will pay for the first visit, regardless of what the diagnosis is, since we MUST have the ability to see what the problem is. That is your initial visit. At that time, I advise my patients as to what is or is not a covered service and allow them to decide where they wish to go for continued care. I have utilized many of the recommendations that have been suggested by responders to PM News. All work well other than on the snow birds, who are of a different generation and have a different thought process.
 
Most patients are willing and able to pay for non-covered services. I recently opted out of BMC HealthNet (Massachusetts answer to mandatory insurance for everyone in the state). Two patients today were advised that I would no longer be able to see them and were referred to another podiatrist who IS participating. You know what their answer was? "I'd rather stay with you and pay you because I like the service." 
 
Isn't that refreshing to know that I finally have learned how to make people comfortable after 38 years of practice? I guess that's why it is called PRACTICE. Keep doing what you do best and be proud of it. People will pay, and those who are not willing to will only cause you grief because, in their eyes, it's free, and you do get what you pay for.

Chuck Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com

RE: Dog Eats Diabetic Man's Three Toes
From: Richard Gosnay, DPM

When I was a student, we were called to the ER to see an uncontrolled diabetic because of lateral foot gangrene. During the H&P, it was established that he had a bilateral orchiectomy. He had passed out after drinking one evening in ill-fitting underwear. And his dog had helped himself. Four years later, an uncontrolled diabetic presented to my practice with two lesser toe ulcers with associated osteomyelitis. During the prolonged recovery (which was a partnership with his PCP to get him healthy while I managed the toes) his lovely, gentle dog helped herself to the still recovering toes and a neighboring toe.

I love dogs. I have three. But I think we need to understand that dogs, while domesticated, are still animals that are governed by instinct. It is prudent to be careful with them, especially when wounds and new infants are introduced to their environment. I suspect that the neuropathic diabetic in the published story may have had a bleeding wound of which he was not yet aware; and that this attracted his dog.

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

RE: Dog Eats Diabetic Man's Three Toes
From: Gino Scartozzi, DPM
 
My advice to the canine culprit: I have heard that one should "never bite the hand that feeds you," apparently the foot must be "fair game!"
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.com

ASSOCIATE POSITION - MARYLAND

IMMEDIATE Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible/Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter, resume, and surgical log (if a current resident) and availability to FootDocMaryland@Gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE OPPORTUNITY - FREDERICKSBURG, VA

Progressive, busy practice seeks personable, ethical, confident associate interested in future partnership. Lucrative opportunity for self-starter with strong work ethic. State-of-the-art office in rapidly growing community with two new hospitals and new surgery center. Practice has excellent reputation with well established referral base. Cover letter/CV to: fredfeet@verizon.net

ASSOCIATE POSITION - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter and CV to Jagerone@aol.com

ASSOCIATE POSITION AVAILABLE - NY

Busy Midtown Manhattan state-of-the-art practice with 2 locations seeking part time/full time associate. Must be in-network Empire BC/BS. Looking for a personable doctor with immediate availability. Residents Need not apply. DrB@myfcny.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

EQUIPMENT FOR SALE

Hausted 825 GMCOO Unicare III stretcher. Approximately 7 yrs old, but rarely used. Great condition. Excellent condition, no rips or tears. $250 PDM J120B Podiatry chair-Used. Navy blue upholstery with some wear. Has Lift, Tilt and Back functions. Foot pedal. Screen and doctor’s stool included. $1,750. Photos on request. 410-768-5800 jferris@chesapeakefootandankle.com

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale. Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.com

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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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