The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

March 10, 2008 #3,189 Editor-Barry Block, DPM, JD

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We've just mailed the March 2008 Podiatry Management. This 226 page issue is filled with interesting, informative, and useful articles. We also announce the next inductees into the PM Podiatric Hall of Fame, plus you'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

Podiatry Management, March 2008

Going Paperless Has Many Advantages: VA Podiatrist

Dr. Ross Girvan grabs a digital tablet as he starts his day at Fredericksburg Foot & Ankle Center. The podiatrist uses the 3 1/2-pound electronic device, which is about the size of a sheet of letterhead, to pull up patients' charts and check any notes before entering an examining room. "When I went to digital X-rays in December of 2004, I was so impressed by how organized everything was," Girvan said. "I realized this was the way to go."

Dr. Ross Girvan (Photo ChristopherWehling)

As he soon discovered, creating a paperless office has decided advantages. Not only does it increase productivity by giving him and his staff instant access to everything from appointments to x-rays, it also improves accuracy and frees up the time and space that he had needed to manually create and store files. "It saves us an employee since we spend no time on filing," Girvan said. "Kelly [Stanley, his receptionist] used to spend the bulk of her time filing, pulling files and refiling, then reconciling bills with checks from the insurance company, things that we now do in three or four seconds."

Girvan's already looking to the next phase of going paperless: replacing handwritten prescriptions with ones done on his tablet. They can be printed out for patients or faxed electronically to a pharmacist. "We can load in their existing prescriptions and it will help us spot drug interactions," he said. "We've priced a system and done a demo. We may add it in the next two weeks."

Source: Cathy Jett, The Free Lance-Star [3/7/08]

NY Podiatrist Leads 8th Annual Shoes For the Needy Drive

The eighth annual Shoes for the Needy drive in Orange County has raised over $4,000 for the needy and provided footwear for hundreds of kids in need. The brainchild of shoe store owner Gary Groo and podiatrist Dr. Michael Wodka, thousands of pairs of shoes are collected with many being donated to the needy.

Dr. Michael Wodka, NYS Assemblywoman Annie Rabbitt, and Gary Groo, owner of Groo's Shoes, load a trailer with donated shoes.

Dr. Wodka said people are more than willing to donate. “Just because you’ve got something in your closet that does not fit, you may have not worn it in a while or the style is a little older, why not give it to someone who needs it,” he said. “We realize what are handy-me-downs is someone else’s treasure.”

Source: Mid-Hudson News Network [3/8/08]

Rules Aim For Better Patient Safety Through Confidential Error Reports

Federal regulators have proposed sweeping patient safety rules to give physicians and others a confidential, voluntary way to report medical errors and near mistakes. Several healthcare organizations applauded the release of the long-awaited regulations, but want a closer look before making a final judgment.

The rules, published Feb. 12 by the Agency for Healthcare Research and Quality, would implement the Patient Safety and Quality Improvement Act of 2005. The law, supported by the American Medical Association, authorizes creating patient safety organizations to which doctors, other health professionals, hospitals and other institutions could report mistakes.

The proposed regulations contain provisions protecting the confidentiality of data contained in reports to patient safety organizations and deliberations about whether to report. These safeguards include:

• Banning discovery or subpoena of the data and its admission into evidence in most civil, administrative or criminal proceedings in federal, state, local or tribal courts.
• Exempting the data from Freedom of Information Act requests.
• Penalizing disclosure of the data with fines of up to $10,000.

Source: Dave Hansen, AMNews [3/10/08]

Query: Amerigel S/P NaOH Matrixectomies

The doctors in our practice all perform NaOH matrixectomies with consistently good results. Our post-op regimen includes saline (saltwater) soaks and Cipro-HC Otic solution until healed. Although we retail very little out of our practice, we are considering the Amerigel kit as part of our procedure. What kind of experience have others had combining NaOH matrixectomies and Amerigel? Have your patients been receptive to purchasing the Amerigel wound care kit?

Greg Caringi, DPM, Lansdale, PA

Query: Staff Bonuses

What kind of staff bonus programs are people using? We are looking at three options: 1. Provide a certain dollar amount per position; 2. Set specific goals for each one of our offices and if the goals are met, then provide a bonus; or 3. Provide a dollar amount per office location and have the chief operating officer and one of the partner physicians determine the amount of money each person receives in the office. Which one of these, if any, has been successful in your practice and/or which other types of staff bonus programs have been successful?

Joey Resnick, Tampa Bay, FL

RE: New Topical Anti-fungal AN2690 (Bruce Lebowitz, DPM)
From: Maria A. Kasper, DPM

AN2690 is still in the pipeline of clinical research. The plan is to start phase III clinical trials by the end of 2008.

Maria A. Kasper, DPM, State College, PA, m_sano@yahoo.com

RE: Non-Compliant, Drunk Patient (Name Withheld)
From: Sloan Gordon, DPM

I had a similar experience with a patient who showed up several times to the emergency center inebriated. It took awhile to understand that she was inebriated and therefore could not take her pain medication. She developed an infection, which resolved without complication. We had serial blood tests that showed very high levels of alcohol. However, as is usually the case, she did find an "ambulance-type" attorney to file the suit before much discovery; ultimately the case was non-suited. But, I will have to list that case for the rest of my life. I hope that doesn't happen here. I agree that exemplary records help, but there is always a hungry lawyer with $37.50 to file a case, at least in this jurisdiction. That's part of what's wrong with the justice system; it ain't just!

An even more interesting turn of events in the case is that I forgot to list it on a hospital application (as it was 10 years ago). The hospital found the case in a courthouse search, however I could not recall the details and contacted my liability carrier at that time. They called me back and said since they don't sell liability insurance to podiatrists any longer, they have "disposed" of all the records. That amazed me as I thought lawyers had a certain statutory period before they could destroy records; a local defense attorney told me "there is no time period and lawyers typically do not destroy records."

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Podiatric Assistants Performing Routine Foot Care (Michael Forman, DPM)
From: Bryan C. Markinson, DPM

I work in a hospital that houses a nationally recognized premier geriatric care practice. It trains fellows in geriatric medicine. It runs one of the best attended annual geriatric board review courses. Several (not a lot), but more than a casual amount of the attendings do podiatric nail care on their patients. They do it as part of the visit. They do not charge for it. Some, after they do that task, then send the patient to me for a "look at that hammertoe." Sounds ideal, doesn't it.

In my mind, anyone afraid that trained podiatric assistants will work in MD offices fails to see the grand picture. I wish that every referring internist that ever sends me patients, hires a trained podiatric assistant. My practice will instantly have the lowest paying portion of it removed, and I will have more time to cultivate podiatric medicine. Those trained assistants will double my referrals out of those office, as there will be a foot-focused provider finally having their foot looked at. I would run meetings for them to learn about skin diseases, tumors and orthopedic pathology.

But for today, this is a dream....and lately I am puzzled why readers are totally ignoring the fact that we have just been told in a study contracted for by the APMA that virtually no one wants to go to podiatric medical school, or worse, that 85% of those who apply are accepted. Could it be possible that podiatrists do not believe that there are too few of us?

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Are Those Orthotics Really Custom-Made? (Jeff Root)
From: Jack Glick, DPM, Dennis Shavelson, DPM, Paul Kesselman, DPM

Jeff Root makes sense. Many of the podiatric patients can get relief with just an arch support (mass produced). However, how many of those patients have already tried the OTC-type and did not get the results they wanted? That may be why the patient is in the office. My research has indicated that 20% of the negative molds we receive exhibit a low lateral arch and these may be the patient that cannot use the OTC device. We also have to consider that anything you can stick in a shoe can, and is called an orthotic. It is time to straighten out the confusion and it should be coming from the podiatry colleges.

Jack Glick, DPM., MHA, AFO Lab, afolab@att.net

In today’s belt-tightening world, there are many podiatrists willing to rationalize away our ability to produce a truly custom orthotic that provides additional care for our patient with the high ticket of the custom orthotic lab fee. I have no argument that there are $50 devices that will help many people biomechanically to some extent but I feel that these devices (which can be dispensed by anyone with less professional education, clinical experienced and input then a podiatrist) offer an opportunity for less trained individuals to proclaim their care they offer equitable to ours.

My real discomfort is towards DPM's who purchase these customized, off-the-shelf devices for $50 and then charge $500-$800 for them as if they involved the same cost and skill to cast, prescribe and dispense as custom orthotics. I think that $200 would be a more appropriate fee (along with a CPT code that reimbursed lower) and that would end the debate.

I dare any podiatrist practicing in this manner to fully reveal to the foot suffering public (or an insurance company for that matter) how they are casting their orthotics, the level of sophistication that their prescriptions reflect and how their lab is making their custom orthotics. Do you think patients would continue to pay him/her $500?

If you haven’t the time, training or skill to cast, prescribe and dispense custom foot orthotics, then there are many ways that any podiatrist can invest time and resources to quickly close the gap. That is how professionals remain above the rest of the crowd. Simply earning a degree and then utilizing it to justify your skills and products is a misuse of your degree and reduces its value (as well as mine).

Dennis Shavelson DPM, The Foot Helpers Lab, drsha@foothelpers.com

Editor’s note: an extended-length letter by Dr. Kesselman appears at: www.podiatrym.com/letters2.cfm?id=18334&start=1

COLORADO PRACTICE OPPORTUNITY

inquiry@axint.net This is an auto response. Thank you.

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

TEXAS - SEEKING ASSOCIATE TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

ASSOCIATE POSITION - MONTANA

Two Doctor group seeks individual with three years of surgical training with emphasis on the forefoot. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

PRACTICE FOR SALE - DALLAS TX

10 year old general podiatry practice, including, geriatric care, diabetic care, surgery, biomechanics, etc. Grossing approximately $185,000 part-time, can be made full-time. Hospital privileges available. Will stay for transition. Please reply to: footdoc8390@yahoo.com

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION MASSACHUSETTS-BOSTON NORTHERN SHORE AREA

Innovative Practice on Boston’s North shore seeking motivated associate to join high, energy doctor to assist in growing practice. Competitive compensation package and partnership after two years. consulting@providerresources.com

ASSOCIATE POSITION - NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

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.

WEEKLY SPECIAL - One week of ads (5x) for only $85

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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 10,800 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 Ext 110.

Established satellite practice. In urban metropolitan area on a busy commercial street corner - commercial building with an attached retail store that allows easy advertising of the podiatric medical practice. Gross $170K+ at 2 ½ day per week. Great potential for growth. 260 402-7490

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

PRACTICE FOR SALE - EASTERN WASHINGTON

Established practice located in the fastest-growing city in the state of Washington. Enjoy the lifestyle available in the area. Practice is directly across the street from the hospital - surgery center located within the hospital, and podiatric surgical privileges are not restricted. Gross $200K+ at 4 days per week. Can easily grow. 260 402-7490

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