The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 14, 2009 #3,493 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

MRSA Linked To Infected Ingrown Toenails: FL Podiatrist

Brandi Johnson, DPM, AACFAS, estimates that she treated 20 patients for community-associated MRSA in 2008. The Brandon, FL, foot and ankle surgeon says half of those patients had infected ingrown toenails. Puncture wounds, pedicures and cuts from glass and seashells caused the rest of the infections.

Dr. Brandi Johnson

One of Johnson’s patients was a teenage boy. He waited months before seeing a doctor for an infected ingrown toenail. After the boy’s primary care doctor referred him to Johnson, she ran several tests. Results showed a community-associated MRSA infection. Even worse, it had spread to bone in the teen’s big toe. He recovered after six weeks of intravenous antibiotics.

“I’ve had several high schoolers come in with ingrown toenails during the last six months of 2008,” Dr. Johnson said. “Their pediatricians started them on antibiotics and sent them to my office. Lab results showed they all had MRSA.”

Source: Infection Control [3/4/09]

Donor Stem Cells Successfully Heal Bone in Foot, Ankle

In the first study of its kind, the use of donor stem cells was shown to be safe and successful in healing bone in patients who had failed previous surgeries and were at high risk for non-healing, according to information published in the March issue of  ACFAS'  Journal of Foot & Ankle Surgery.

Dr. Shannon Rush

The study involved 23 patients who had failed previous surgeries. Many had risk factors that contribute to non-healing, such as diabetes or renal disease, which put them at high risk for not healing again, according to Shannon M. Rush, DPM, FACFAS,  Department of Orthopedics and Podiatric Surgery, The Palo Alto Medical Foundation, Mountain View, CA, and principal author of the study.

Of the 23 patients treated with the new technology – called mesenchymal stem cell (MSC) bone allograft – 21 patienst (90.3 percent) achieved bone union and healing. Clinically, healing was defined as patients being able to walk with no or little pain in regular shoes at least six months after their casts were removed. 
 

MA Bans Gifts to Providers; Disclosure Required

The Massachusetts Public Health Council has passed long-debated regulations prohibiting nearly all forms of drug company and medical-device maker gifting to healthcare providers. The new rules also will mandate disclosure of certain types of payments that medical product companies make to providers and ban any payments that aren’t bona fide compensation for services.

Enactment of the regulations places Massachusetts among a handful of states to require that drugmakers disclose their consulting-agreement payments to physicians and makes it the only state to require that devicemakers do so as well. The new regulations also make Massachusetts the first state to require companies to adopt a code of conduct prohibiting a wide range of gifting practices. The gifting regulations will take effect July 1, 2009, and the first public reporting of payments to providers will be made on July 1, 2010, according to a news release.

Under the new regulations, medical product companies are prohibited from paying for providers to attend entertainment events and activities such as sporting events, museum visits and most travel. They are also prohibited from giving complimentary items such as mugs and pens, and meals must be modest and only provided during training or educational events. Companies will still be allowed to sponsor continuing medical educational events under the new rules.

Source: Shawn Rhea, Modern Healthcare [3/12/09]

Responses to ‘Your Fees are Too High’

Whenever patients tell you “I need a discount; your fees are too high,” look them square in the eye, count silently to three and then offer one of these responses:

• “Thank you for sharing that. How much too high are we?”
• “I appreciate your telling me that. Have you found a less expensive doctor?”
• “You are right; we are more expensive than some other doctors. How much did you hope to pay?”
• “I agree.We are not the cheapest. Is price your main consideration?”
• “Thank you for letting me know. I’m curious: How much were you expecting to invest in your health?”

Source: Adapted from “Handling the Dreaded Price Objection,” by Colleen Francis via Communications Briefings

Query: Total Contact Cast

We are now using total contact casts in our clinic for some wound care patients. Is anyone familiar with TrailBlazer's policy on charging for a debridement on the same days that a cast would be applied (and billed), as well as charging for the casting supply code?

Cyndie Pluid, Colorado Springs, CO

Response: This used to be a problem with CMS. They used to deny the cast because all musculoskeletal code allowances include the initial cast application. Now CMS has put the debridement in the integumentary category, and  allows the first cast. I cannot speak to Trailblazer, but this is the argument to use.

Walter Pedowitz, MD, Linden, NJ

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

RE: Indigent Medical Care Program (Will Alexander, DPM)
From: Alan J. Cantor, DPM

Since 2000, I have brought critically ill/injured children from the Caribbean here to the States for "gratis" care.  From severe burns, to crush trauma, and from many isle nations, it is a "blessing" to help if/when called upon.  Over the years, my only "demand" of our facility and colleagues in all specialties:  "NO publicity."  And, I am proud to have refused every print/televised interview set up by various embassies who wanted to showcase our care. Somehow, the "publicity" seems to cheapen the purpose of humanitarian care:  too many surgeons up here always manage to somehow have the "media made aware of a mission to a Third World nation."  

Generally, within 2-5 days of notice, all cases have had "visa issues" expedited, US Embassy and facility coordination for family needs for the child and all other "legal/financial" matters covered. If needed, any Caribbean embassy can/will be contacted personally.

Alan J. Cantor, DPM, East Meadow, NY, ajcdpm@aol.com

Editor’s Note: While we agree that humanitarian help should not be done primarily for publicity, we disagree with the concept of refusing requests for media interviews, etc. We believe that doing so wastes a valuable opportunity to showcase the contributions of podiatry. In these instances, it’s not a matter of self-promotion. It’s a rare chance to let the world know both our skills and our humanism. PM News is always happy to republish these stories as examples of podiatry at its best.
 

RE: Voice Recognition Software (Tom DeBenedictis, DPM)
From: Nat Chotechuang, DPM, Brian Homer, DPM

I had been considering buying the $1,200 Dragon medical version for a while, but I recently ran across the basic Dragon v.10 on sale at an Office Max for $39. I bought it figuring that if it was not adequate, then I was only out a couple of twenties. Lo and behold, it was compatible with my EMR and it already had numerous medication names loaded in the vocabulary, and with minimum of training, has adapted to my speech. It’s the best $39 I've ever spent! I'd suggest trying the basic v.10, just in case it works with your EMR. If it does not, then you can load it on your home computers and use it for e-mail, web surfing, etc.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmai.com

I have been using Dragon Medical since 1999. All of the advice previously provided is very accurate. I would absolutely start off with DNS Medical v10. I also use a modified Sennheiser headset and an Andrea pod.

I would also highly suggest the following website: knowbrainer.com.  The owner, Lunis, is an expert at voice recognition software and their customer service is superb. They sell everything you will need to get started. They also offer an add-on software program to Dragon which has additional command shortcuts. Knowbrainer.com also offers a blog where other members are more than willing to help from the simple common problems to actually writing voice command scripts...at no charge!

I have no affiliation with either company...I'm just a satisfied customer.

Brian Homer, DPM, Clawson, MI,  drbhomer@gmail.com

ASSOCIATE POSITION - SOUTHEAST MICHIGAN ASSOCIATE WITH PARTNERSHIP OPPORTUNITY 
 
Seeking quality-oriented, associate for a fast-paced, established group practice in Southeast Michigan. This is a long term position for the right person; with a partnership opportunity. Emphasis on diabetic foot care, foot surgery and wound care. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. If you are highly motivated, ethical, and have good communication and clinical skills, please forward your letter of intent and your C.V. to fax# 734 981-0487 or e-mail cfsdr@yahoo.com

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

ASSOCIATE POSITION – NAPLES, FL

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

PRACTICE FOR SALE OR ASSOCIATE-SOUTHEAST MICHIGAN-BRIGHTON

Outstanding opportunity. Eleven year established-earn 200K. Excellent location in mid to high income growth area. Turn-key, all equipment and furniture included. High quality 1,350 sf build-out. Large illuminated sign on busy main road, convenient parking. Must sacrifice due to illness. Will stay for transition or partner if wanted. Priced to sell. Call (248) 565-5266. Docpod@aol.com

ASSOCIATE POSITIONS – CALIFORNIA

Three podiatrists needed for busy North Hollywood office. Full-time Monday-Friday 8am-2:30pm.  No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PM Classified Ads Reach over 11,500 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 11,500 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 Ext 110.

• 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.