The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 12, 2010 #3,802 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Use of OTC Products Often Delays Treatment of Foot Problems: MA Podiatrist

Dr. John Swierzewski, a podiatrist/surgeon at Holyoke Medical Center, said he believes that the plethora of over-the-counter remedies for foot-related health issues make some people further delay seeking professional help with their feet. "There are a lot of over-the-counter things to fix your feet, and some of them work, but a majority of them don't," he said. Untreated foot problems can start affecting the way one walks and put strain on other joints and muscles.

Dr. John Swierzewski

Swierzewski added that the feet themselves can be affected by delaying treatment of certain problems. "In the case of, say, plantar fasciitis, if you wait over six months, it gets a lot harder to treat," Swierzewski said. Foot problems come in two basic categories, genetic, such as bunions, and non-genetic, such as sports injuries.

Source: The Republican [3/10/10]

WesternU Dean to Receive The John Boswick Memorial Award

College of Podiatric Medicine Founding Dean Lawrence Harkless, DPM, will receive the Annual John Boswick Memorial Award and Lectureship at the 23rd Annual Symposium on Advanced Wound Care and Wound Healing Society Meeting in Orlando, FL on April 17-20, 2010.

Dr. Lawrence Harkless

"The award winners in the past have been giants in the field," said Robert S. Kirsner, MD, PhD, chairman for the SAWC Symposium. "This year's naming of Larry Harkless is no different. He's been the leader of podiatric medicine and wound care in the United States."

Harkless built a tremendous podiatric medical residency training program at the University of Texas Health Science Center at San Antonio, and is now the founding dean of the College of Podiatric Medicine at Western University of Health Sciences. He helped develop the University of Texas diabetic foot wound classification system, providing the clinical pathway for how the diabetic foot is treated.

Source: Earthtimes [3/10/10]

Famed NJ Podiatrist/Photographer To Exhibit in CA

Like John James Audubon's famous double-elephant folio "Birds of America," the original edition of "Botanica Magnifica: Portraits of the World's Most Extraordinary Flowers and Plants" featured large-scale images of rare and exotic plants and flowers. It consisted of five hand-bound volumes and was limited to just 10 copies. Those 10 sets cost between $500,000 and $800,000 to produce.

Jonathan Singer in front of his photograph of a Hippeastrum "Toscana,' a new hybrid amaryllis. Photograph by Howard Schatz.

The collection of Jonathan Singer's remarkable flower photography is now available in a slip-cased baby-elephant version. More than a coffee table book, "Botanica Magnifica" is an homage to Audubon, a celebration of biodiversity and an eloquent plea for conservation.

Singer, a podiatrist in New Jersey, began his remarkable catalog years ago. He shot the photos with a Hasselblad in very low light to capture every subtlety. As he told CBS "Sunday Morning" last year, "I'm trying to show you a glimpse into creation."

Source: Los Angeles Times [3/10/10]

Obama to Use High-Tech Bounty Hunters to Fight Healthcare Fraud

President Barack Obama said Tuesday he'll bring in high-tech bounty hunters to help root out health care fraud, grabbing a populist idea with bipartisan backing in his final push to overhaul the system. The bounty hunters in this case would be private auditors armed with sophisticated computer programs to scan Medicare and Medicaid billing data for patterns of bogus claims. The auditors would get to keep part of any funds they recover for the government. The White House said a pilot program run by Medicare in California, New York and Texas recouped $900 million for taxpayers from 2005-2008.

Obama is placing a heavy emphasis on battling waste and fraud in his final healthcare push. The repackaged bill, he announced last month, contained more than dozen anti-fraud ideas. A common theme linking them is the increased use of technology to spot suspicious billing patterns and keep track of service providers with a track record of problems.

Source:Ricardo Alonso-Zaldivar, Associated Press [3/10/10]

Give More Info When You Network

At networking events, remember that people usually respond in kind to your greeting. So if you say “Hi, I’m Carlos Garcia,” they are likely to say something like “Hi, I’m Anita Perez.” That is hardly an auspicious start to the conversation.

Better: Give more information to inspire new contacts to share more information with you. Say: “Hi, I’m Carlos Garcia and I am a podiatrist.  This is the first time I have attended this group’s meeting.”

Your new contact is likely to say something like this in return: “Hello, I’m Anita Perez and I work with XYZ Inc. I have been coming to these meetings since last August and I have met a lot of interesting people.” Now that gives you a foundation for a productive conversation.

Source:  Adapted from Power Phrases! The Perfect Words to Say It Right and Get the Results You Want, Meryl Runion, Power Potentials Publishing via Communication Briefings

RE: Topical Tolnaftate for Onychomycosis (Mark K. Johnson, DPM)
From: Multiple Respondents
 
Our practice has been using Formula -3 for about six months. We have had moderate success and our patients seem to be happy. There are many patients who, for whatever reason, are either unwilling or medically unable to take oral meds.  Fromula-3 is a great alternative. I have also been using Formula-3 in conjunction with my other treatment regimens (oral, laser) and it has helped to improve our outcomes.

Disclosure: This is a personal clinical opinion. 

Ira Kraus, DPM, Chattanooga, TN, ikraus@sprynet.com

Overall, my patients and I have been very pleased with Formula 3 and its results. Along with daily use, and periodic debridement, significant improvement has been seen in as little as a few months.  The oil-based formula penetrates easily into the nailbed, where the fungal infection begins, unlike other topicals that simply sit on top of nail. Patients understand this concept as they start noticing results and are happy to purchase the "physician only formula" conveniently at the time of their visit. And, when you factor in the no-questions-asked, money-back guarantee, it's a win-win situation.  
 
Scott M. Aronson, DPM, Stoughton, MA, s_aronson@yahoo.com
 
I have been dispensing Formula 3 for about a year now, and I have been following, very carefully, one of my patients, my girlfriend. The progress is amazing over the past 8.5 months. One thing I believe that increases its effectiveness is that I curette the underside of the nail and gently curette the nail bed on a regular basis. I will compare her results with my other patients, but my patients using Formula 3 comment that they are seeing improvement.

Robert Scott Steinberg, DPM, Schaumburg, IL, foot_doctor@sbcglobal.net

RE: Post-op Numbness Status Post EPF (Neal Kramer, DPM)
From: James Fagan, DPM, Allen Mark Jacobs, DPM

The lateral plantar nerve, anatomically is  slightly more posterior and inferior as it exits the distal tarsal canal. If the incision had been made more anterior than expected, or if the foot is in more of a cavus attitude, it is entirely conceivable that the lateral plantar branch was violated. I would expect if there was damage to the nerve, that on MRI, one would see atrophy of the intrinsics supplied by the lateral plantar nerve such as the quadratus plantae. I personally have not felt confident in being able to track the medial and plantar nerve to be able to determine if it is severed. 

If sharp/dull sensation is intact, then it is likely that the patient has neuropraxia and that the numb sensation should dissipate. Neurotemesis would be represented by absent sensation and can be associated with significant pain along the distribution of the nerve. As noted, time will give the diagnosis.

James Fagan, DPM,  Oakland, CA,James.Fagan@kp.org

The onset of signs and symptoms of nerve pathology following EPF, in-step, percutaneous, or in fact any plantar fasciotomy does NOT imply per se that a  nerve was "nicked" or cut during surgery, or that an incision was poorly placed.
 
Nerve injury can occur immediately following surgery secondary to cutting of the nerve, but may also occur in...

Editor's note: Dr. Jacobs' extended-length letter can be read here.

RE: Unscrupulous Billing of Routine Care (Dan Klein, DPM)
From:  Multiple Respondents
 
When I have a patient who claims to have had Medicare coverage for routine foot care, I simply ask the patient to provide me with a copy of the treatment notes and billing codes from the previous podiatrist. I am sure we have all looked at the LCD for routine foot care and have seen the hundreds of eligible diagnoses, each with its own caveat. Honestly, I cannot remember all of them and have been pleasantly surprised by the treatment notes of other podiatrists who have been savvy enough to match an eligible diagnosis to a patient. 

My typical billing is very basic. I mostly use the Q7 (amputation) and Q8 modifiers. I rarely bill with a Q9 modifier, but I imagine that I could (for instance, Q9 criteria could be met with: thick nails, shiny/thin skin, decreased hair growth, cold feet, and edema). It's just that the menu gets more complicated to figure out and it appears more subjective. A suggestion is to include all of the routine foot care diagnoses on the review of systems form that your patient fills out and signs. Rather than lose a potential patient, let your patient be your advocate.
 
Richard A. Simmons, DPM, Rockledge, FL  RASDPM32822@aol.com

This is common among demographic situations where a large population of Medicare age is located, and a relatively large percentage of podiatrists exists to treat them. Ultimately, some podiatrists will “modify” RFC bills.  In the past, I admit it was somewhat "easier" to do this.

In my practice, I considered this free care, or I asked the patient to pay for it. I explained that this was not covered under Medicare statutes, but that I would offer it free if they or their family were unable to pay for it. This generated considerable good will. I also said that I had a “limited" time I could dedicate for this, implying that if they sent all of their friends for free service, I might not be able to comply.
 
It is illegal to fabricate billings to generate Medicare coverage for an excluded service. In the past, I have recommended that podiatrists keep copies of news articles of other podiatrists (local or not) who have been indicted for Medicare fraud, to show their patients (or families) who demand this. Once such an article reaches the press, it is okay for the names of the miscreants to be disseminated.
 
Before we can expect “good behavior” from patients, we have to educate them. Sometimes, this is uncomfortable, but our society has been “educated” to expect government entitlements. I fail to see the logic of putting oneself at enormous risk to substantiate this. Let those who demand it go elsewhere. You will lose little in the “bargain”, since they are likely to be complainers and malcontents. If you are suffering financially from doing too much RFC, you need to refresh your practice and go to practice improvement seminars, rather than fabricate illegal billings. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

Editor's note: Dr. David Gurvis' extended-length letter can be read here.

RE: Defeat of Podiatry in NJ Diagnostic Ultrasound Case (Henry Slomowitz, DPM)
From: Brian Kiel, DPM, Pat Caputo, DPM

As a former member of the NJPMS Board of Trustees and dues-paying member since 1984, I was always under the impression that we had on retainer one of the pre-eminent medical-legal teams in the country. I don’t want to read in the next month’s minutes of my NJPMS Division that this is a compromise or partial victory (so that we may take ankle x-rays). As I understand this, all physicians without radiology certification in ultrasound (includes orthopods, rheumatologists, and other specialties) are denied payment for this service. 

Do you really think that a radiologist can read a foot ultrasound better than a skilled DPM, who can read it in real-time and correlate with the history?  Real-time is the key. I am old enough that I never had formal training in MRI at PCPM, but today I confidently read MRIs and frequently call the radiologist to have him re-write a report “correlating with the history and plain films.” Will this be my standard now in sending out diagnostic ultrasounds? Get the report back and then call him/her, review the case, and issue a re-write? What a waste of time and money! 

So, the NJPMS legal dream team’s excuse will be that the decision does not single out podiatry. Still, our legal counsel losing this battle vs. Horizon is a weak swing and miss. Or do the defenders of the NJPMS blame me (and my many other outraged colleagues) for not knowing all the specifics of the case? Res ipsa loquitur.

Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com

As a very interested, but not directly involved party to the problem in New Jersey, I seem to have a slightly different perspective on the issue. It seems to me that many of those affected are upset that an insurance company is trying to limit what a podiatrist can do by licensure. I do not see that. What they are doing is refusing to pay for the procedure as a covered service. There is nothing to stop you from performing ultrasound and charging the patient for the service. Please, before you string me up, hear me out, as I…

Editor’s Note: Dr. Kiel’s extended-length letter can be read here.  

RE: Laser Holds Hope for Treating Onychomycosis: (Lowell Weil, Sr., DPM)
From: Michael A. Uro, DPM

First, let me disclose that I have trained doctors on the use of the PinPointe FootLaser for the past 20 months. Most have been from the U.S., but I have also trained doctors from the U.K., Turkey, Australia, Canada, and Guam. I have performed over 1,200 procedures in that time. We recently completed a retrospective study in my practice which has been submitted to the FDA. A panel of three independent physicians retrospectively collected and prospectively evaluated 73 patients or 128 toes for effectiveness and safety. The photo-rating sessions were prospective, randomized, and blinded. The photo raters used validated planimetry measurement software. The study demonstrated 79 % efficacy at six months. Furthermore, the procedure was found to be safe. There were no side-effects.
 
There is no device or medication that I am aware of that will provide a permanent cure. Patients with this condition simply must practice daily prevention or they will most likely become re-infected. Yes, the procedure is not inexpensive, but neither is Lasik surgery. In the majority of cases, it is a cosmetic issue. Patients have long waited for a procedure that is reasonably successful and without risk. The majority of patients whom I have treated are those who never wanted to take orals or their primary care physicians refused to prescribe them.
 
We have long been under the thumb of managed care and have forgotten how to ask for money. In the meantime, our M.D. colleagues have been supplementing their incomes with a variety of cosmetic procedures. So why not us?
 
Michael A. Uro, DPM, Sacramento, CA, michaeluro@aol.com

RE: $1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot (Allen Jacobs, DPM)
From: Tip Sullivan, DPM

Dr. Jacobs wrote yesterday, "The diabetic patient with a Charcot's deformity is at no greater statistical risk for amputation than the diabetic patient without such deformity."
 
While I have no doubt of the truth of Dr. Jacobs' statement, I would be very concerned about telling my Charcot patients that they have "statistically" an equal chance of amputation as any other diabetic. I would respectfully ask Dr. Jacobs, Where was this published? What statistical analysis was used?  How was the study designed? Does he think that these statistics are clinically relevant?
 
I would like to simply say that statistics are simply that - "statistics." They are not really questionable in themselves, BUT how they are obtained and applied is!

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit  our website to apply.

HOME FOOT CARE PHYSICIAN NEEDED - LOS ANGELES, CALIFORNIA

Honest, caring, hard-working podiatrist needed to make visits to homebound patients, facilities, etc. for Home Foot Care, Inc. Part time position, flexible hours, independence and excellent compensation. If interested email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION (PART–TIME) WHITE PLAINS, NY

Part-time associate wanted for busy 22 year old White Plains office. Call 914-325-9198 for further details.

PRACTICE FOR SALE - FLORIDA CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

FULL-TIME PODIATRY OPPORTUNITY -  BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com
  
OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. Kindly forward C.V. to e-mail drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to 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

• 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.