The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 15, 2012 #4,410 Publisher-Barry Block, DPM, JD

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Extra Weight Adds to Stress on Feet: MA Podiatrist

Every pound you gain adds to the pounding your feet take. "It reminds me of that famous da Vinci quote," says Dr. James P. Ioli, chief of podiatry at Brigham and Women's Hospital, Boston, MA. " 'The human foot is a masterpiece of engineering and a work of art.' When you're overweight or have a high B.M.I., every step you take places extra stress on that exquisite engineering."

Dr. James Ioli

If you already have foot problems, over-the-counter or custom-made orthotics can offer extra arch support. Surgical procedures also can offer solutions, however, these are usually a last resort. In addition to purchasing the right shoe, Ioli explains that it's also important to wear appropriate socks for the type of shoe you're purchasing. "You wouldn't want to wear nylons if you're purchasing a hiking boot," he says. He also recommends having your feet resized once a year, as conditions such as pregnancy can change the length and width of your foot.

Souce: Anna Sachse, Quad Cities Online [3/11/12]

Patients are Casualties of Turf War: Ontario Podiatrist

They're casualties of a foot war among feuding Ontario professions: diabetics who lose feet to amputation because they must wait to see a surgeon while others trained to care for them are forced to the sidelines. So says a London, Ontario foot doctor who spent seven years training in the United States and a few more performing surgery there, only to return to a province that, since 1991, has barred new podiatrists from registering. "Some are waiting more than one year to see an orthopedic surgeon," said Dr. Lara Murphy from a London office where she can only do a sliver of what she was trained to do. 

Dr. Lana Murphy

Murphy isn't alone in her concern. Thirteen podiatrists trained outside Ontario are forbidden from performing surgery here, according to the agency that regulates them, the College of Chiropodists of Ontario. London's only two podiatrists no longer perform surgery, leaving patients waiting for busy orthopedic surgeons, Murphy said. The fight has an audience at Queen's Park, where legislators will next year consider changes to how medical professions are regulated. With elderly podiatrists approaching retirement, the review can't come too soon, Murphy said.

Source: Jonathan Sher, Woodstock Sentinel Review [3/12/12]

Published GA Podiatrist To Be Featured at School Reunion

Memories are expected to fill the air on Saturday, April 7, when former students and teachers of Reedy Creek School join together to turn back the pages of time for a few hours. The annual Reedy Creek School Reunion will feature Dr. Kermit R. “Ted” Ary. 

Grace Freely Given by Dr. Ted Ary

Dr. Ary is a podiatrist with offices in Albany and Moultrie. Having an interest in drama and story telling, he has volunteered with Miller County’s “Swamp Gravy” project of community theater for several years and published a book of poems based on life in the South, Grace Freely Given.

Source: The Moultrie Observer [3/10/12]

Blue Cross and Blue Shield of TN to Pay $1.5 Million in HIPAA Settlement

In the first enforcement action stemming from the HITECH Act breach notification rule, Blue Cross and Blue Shield of Tennessee has agreed to pay federal regulators $1.5 million and enter into a corrective action plan after 57 hard drives were stolen from the insurer.

Blue Cross told government authorities that the computer drives contained unencrypted private health information for more than one million people, including names, Social Security numbers, dates of birth, diagnosis codes, and health plan ID numbers, according to an announcement by HHS' Office for Civil Rights.

Source: Joe Carlson, Modern Healthcare [3/13/12]

RE: Terminated for Being Deceased While Alive
From: Jonathan Michael, DPM
 
We called Horizon BCBS this morning to verify benefits for one of our patients. We were told that our participation with BCBS has been terminated effective Feb. 24, 2012. As we went through hoops trying to find the reason, we were finally told that they had information that Dr. Jonathan Michael is deceased. I was given the name of the podiatry representative in NJ. When I contacted him, he started laughing as he had never heard of such a thing before. He was polite and promised to correct the situation if I send him a letter with my office locations and phone numbers. I was surprised when he told me that possibly a patient called and reported that I am deceased. Now, I can't get referrals from primary medical doctors since I am not in the system. I was told it will take a week to reinstate my credentialing. Who is responsible for this mistake and can they be held liable for interruption of business?
 
Jonathan Michael, DPM, Bayonne, NJ

RE: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Barrett E Sachs, DPM

I really think everyone is over-killing what seems like a simple neuroma. Not all neuromas present the same way, but any sharp shooting pain into the 3rd-4th toes is most likely a neuroma. I've been in practice over 30 years, well before MRIs were around. I had a patient who only had pain in her 3rd-4th toes when she was bowling. She turned out to have one of the largest neuromas I have ever excised. I would try injections (you could even use plain lidocaine) and see if symptoms are alleviated to any degree. It's my guess that simple exploration of the interspace  would yield a neuroma. I always remember that my residency director would say "KISS"  (keep it simple, stupid).

Barrett E Sachs, DPM, Plantation, FL, uncletenose@aol.com

RE: Lapidus or Fusion (Barry Mullen, DPM)
From: Carl Solomon, DPM

In response to some of the rather strong views supporting a Lapidus in this case, I’m concerned there may be a tendency for people to be thrown under the bus every time they get caught doing a procedure that’s not right out of the textbook. The textbook would probably say do a Lapidus. There’s no argument it's the ultimate in achieving correction that’s going to stay. But in some cases, textbook and podiatric dogma need to be abandoned in favor of what happens in the real world. 

Pre- and Post-Op Views

If 1st MTPJ fusions are not capable of reducing 1st IM angles because only proximal osteotomies or Lapidus can accomplish that, I say that’s only true in the textbooks. It is absolutely NOT true that significant IM angle reduction can’t be done by fusing the 1st MTPJ (see illustration). Furthermore, when the 1st I-M angle is increased due to hypermobility, there should even be a better...

Editor's Note: Dr. Solomon's extended-length letter can be read here.

RE: Changing Banks for Medicare Direct Deposit (Joe Borden, DPM)
From: Paul Kesselman, DPM

An EFT application should not require any modification of your Medicare status with your carrier. It should only require a new EFT application. This is a simple form which may also require either a cancelled check or a letter from your bank. For most Medicare carriers, the change should only take about three weeks.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)
From: Edmond F. Mertzenich, DPM, MBA

I read with great interest the figures given for the cost of ICD-10 implementation: $80,000 for a 1–3 provider EHR-equipped practice, $250,000 for a non-EHR equipped practice, and $7,000 per employee to train. My question is where does CMS get these numbers? Using these numbers, it would be impossible for any practice to stay in business. While I know there is a cost to this conversion, and it will not be cheap, this type of discussion reminds me of the Y2K “disaster” that was supposed to destroy all who were not ready. I have had a lot of difficulty getting information on ICD-10, let alone the codes. As I understand it, we are talking about using new codes to describe with greater specificity to various insurance carriers the care we have provided. Coding will take longer because of the accuracy and level of specificity required.

What bothers me is that for a coding system that has been used internationally for many years, there are so few sources in this country to get the actual codes, let along information on how to code properly. It seems to me that there are a few proprietary companies out to make a good profit from this doom and gloom. If these costs are real, maybe providers need to get together, set up a billing company, and share the costs among the many, if that is possible. If I am in error, I would hope someone could enlighten me.

Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com

RE: ABPS Name Change (Mark Wolpa, DPM)
From: Craig Breslauer, DPM

I agree that changing ABPS to ABFAS does have several likely caveats and challenges ahead. However, this will be for ABPS to work out.  This is not a new concept, so I must assume that much consideration has been given behind the scenes by the Board and their legal counsel. That is their job and part of any change.
 
As far as possible conflicts in the name, or trademark challenges, we do have The American College of Foot & Ankle Surgeons! Shouldn’t the corresponding board certification requirements for ACFAS fellow status be The American Board of Foot & Ankle Surgery? Let’s not muddy the waters and add confusion to the real issues at hand. States still determine scope of practice. ABPS offers a process to show competence in our chosen specialty. The name, however, tells the public and officials making policy who we are and what we do.
 
Lastly, we cannot continue to be influenced by The American Orthopedic Foot & Ankle Society and their negative press and assaults on our surgical specialty. These attacks directly affect our abilities to earn a living and provide services to the public in need. Dr. Wolpa, do you want to ask their permission for privileges in foot or foot/ankle surgery only to be given “podiatry privileges”? We are long past this. Let’s move on.
 
Craig Breslauer, DPM, Palm City, FL, cbreslauer@southflaortho.com

RE:  CA Podiatrist Discusses Fungal Infections (Carolyn McAloon, DPM)
From: Dennis Shavelson, DPM

I wish to thank Dr. McAloon for her response to my posting. I will certainly place more emphasis on the source of APMA media quotables when reading them in the future. However, we all realize the power of “helpful hints” on care and prevention of foot problems when delivered from a professional.

My point was that I would ask her to consider delivering quotables on, for instance, tight-toe boxed shoes and the biomechanics of the first ray as being causative. Perhaps then our patients would also be looking for shoe purchase advice or orthotics for care of dystrophic toenails.

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

EQUIPMENT FOR SALE - SHOCKWAVE MACHINE 

D-Actor 200 by Storz Medical. High Frequency Extracorporeal Pulse Activation Treatment (EPAT) System. A little over a year old, excellent results for plantar fasciitis and Achilles tendonitis. Must sell;  practice merger. Selling for 18,000 (new machine >30K) Email: footdoc21@gmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager.

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to:seattlefootdoctor@yahoo.com

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

POSITION AVAILABLE – CENTRAL WYOMING

Well established solo practitioner looking for an associate leading to partnership at a busy, modern practice in a great location. Friendly personality and good communication skills a must. Competitive salary and benefits. Please send letter of introduction and CV to: wyofootdoc@gmail.com

ASSOCIATE POSITION - NEW YORK

WORK SMARTER NOT HARDER. Join a modern, well-established 42-year-old podiatric medical/surgical practice within a multi-specialty office. Located just 20 minutes from NYC. Must be responsible, compassionate, driven, and self-starter. Enjoy cross-referrals from other specialists and support of medical assistants, office managers, and medical billers with over 50 years combined experience. Utilize modern technology: state-of-the-art diagnostic ultrasonography, fluoroscopy, ESWT (machine is owned by practice), physical therapy, x-ray, circulation testing, NCV, and in-office operatory suite. Very strong and effective advertising/marketing program. No nursing homes, No HMOs, No Medicaid, No Medicare. Must be licensed for podiatry in New York. Send cover letter/CV to: linchpindpm@yahoo.com

ASSOCIATE POSITION – BROOKLYN NY

Busy multi-specialty Medical office in Brooklyn, NY is seeking an experienced podiatrist. We are offering great compensation, flexible schedule and great office environment. Our Requirements: Must have Experience Must have Medicaid & Medicare provider. Please respond by email to:ddpropertymgmt@gmail.com

ASSOCIATE POSITION – MIAMI, FLORIDA

Associate with potential for partnership. All phases of foot and ankle care. Bilingual in Spanish helpful. Send Resume and Letter of interest to miamifootandankle@gmail.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - LOS ANGELES

Multi-specialty group seeking part time podiatrist. Opportunity to transition into full time position. Required: 3 years or surgical residency, including Charcot reconstruction, fellowship or interest in biomechanics, and ability to train surgical residents. Send CV to podiatricri@yahoo.com

PRACTICE FOR SALE - JACKSONVILLE, FLORIDA

Gross income >600K. Selling real estate (1,200 sq ft office, 3 treatment rooms) and practice including all equipment, (digital x-ray ultrasound, EMR, etc.) Asking Price is $350K for everything. Can be a turn-key transfer. Averaging over 100 new patients/month with strong referral base. Excellent opportunity!! Reply to Pesplanus1@gmail.com

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

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