The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 16, 2011 #4,109 Publisher-Barry Block, DPM, JD

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MO Podiatrists Discuss Foot Problems Caused by Furry Boots

"They're very comfortable and warm, but there's not much support in them," says Dr. Hugh Protzel, podiatrist at Foot and Ankle Centers of Southeast Missouri. Wearing these popular boots may lead to heel pain, foot aches and arch pain, especially if you have flat feet. "I wouldn't go for a long walk in them," says Protzel. You may want to get a prescription insert for added support, says Protzel.

(L-R) Drs. Hugh Protzel and Robert Daugherty

As for the furry lining, doctors don't see any relationship between the material and foot fungus. "If someone already has a problem with excessive foot sweating, they could have a problem with foot fungus. But for the average person, there shouldn't be any kind of issue," says Dr. Robert Daugherty of Advance Foot & Ankle Center.

Source: Robyn Gautschy, Southeast Missourian [3/15/11]

GA Podiatrist is Ultramarathoner

"It's a pitch-black winter night and Dr. Troy Espiritu, 35 is in the middle of a forest somewhere in western Georgia. Espiritu, a compact, wiry man with close-cropped hair, jogs along the wilderness trail with a steady, dogged pace, his face a mask of exhaustion. He has been on the run since yesterday morning, nearly 20 hours ago, and he's utterly spent. Shivering uncontrollably from the cold, he notices that the trees on the margins of his headlamp beam seem to be falling on him. I'm hallucinating, he realizes. He has already run the equivalent of three consecutive marathons, and he has a fourth left to go. If he can keep pace, he'll cross the 100-mile mark just as the sun rises.

Dr. Troy Espiritu

Ultramarathons like this one are among the most grueling competitions ever devised, defying conventional notions of what the human body can do. But Espiritu, a podiatrist,  is tough: He has completed four 100-mile races. And what's even more remarkable is that just five years ago, he was an ordinary guy who couldn't jog more than two miles at a stretch.

Source: Jeff Wise, Psychology Today [3/15/11]

WA Podiatrist Presented With ACFAS Service Award

Dr. Mary E. Crawford was presented with an award for her six years of service to the Board of Directors of the the American College of Foot & Ankle Surgeons (ACFAS) by outgoing President, Dr. Michael Lee, at the 69th Annual ACFAS Scientific Conference in Ft. Lauderdale, FL, March 9-12, 2011. Dr. Crawford was the college's first female President and continues to be active within ACFAS. 

Dr. Michael Lee prersents Dr. Mary Crawford with ACFAS Service Award

Dr. Crawford currently serves as the Director, Board of Medical Advisors, International Foot & Ankle Foundation for Education and Research. She practices at the Ankle & Foot Clinic of Everett, Washington.

PA Podiatrist's Business Manager Pleads Guilty to Medicare Fraud

A Plains Township man accused of stealing from Medicare has agreed to pay back more than $700,000 as part of a plea agreement reached with federal prosecutors. Paul Chromey, 55, was charged Monday with one count of theft in connection with healthcare. Chromey's plea agreement says the total loss was $764,758, but the U.S. Attorney's Office reduced the amount of the loss to just $100 for purposes of the plea, which means the charge is classified as a misdemeanor, as opposed to a felony.

The case marks the second time Chromey has been charged with Medicare fraud. In 1999, he was charged with fraudulently billing the federal healthcare fund $89,260. Authorities said Chromey, who served as business manager for a podiatrist who had offices in Old Forge and Exeter, billed for services that were not performed. The podiatrist in that case was not charged with any crime.

Source: The Times Leader, Wilkes-Barre, PA [3/15/11]

CMS Announces New Screening Program for DMEPOS Providers

As a part of its ongoing effort to reduce fraud and abuse, the Centers for Medicare & Medicaid Services (CMS) announced that effective March 25, newly enrolling and revalidating providers and suppliers will be placed in one of three screening categories—limited, moderate, or high. Each category represents the risk level that CMS estimates the supplier/provider poses to the Medicare system and determines the degree of screening that the Medicare Administrative Contractor (MAC) will perform when processing the enrollment application.

According to a March 3 CMS listserv announcement, screening procedures for the limited-risk category will largely be the same as those currently in use. Providers in the limited-risk category include (among others) physicians, non-physician practitioners (other than physical therapists), and medical groups or clinics.

Source: CMS via Bret Ribotsky, DPM

Query: Central Hypotonia

Today, I saw a 3.5 y/o Hispanic child who was sent to me for her flat feet. Her diagnosis according to her father is central hypotonia from some unknown origin. She has difficulty walking independently. Bracing in shoes helps her walk. She has slight ptosis of ther right eyelid.

LEPE: flexible pes planus, severe weight-bearing on talar head B/L. Gait - child can ambulate with braces and with help holding a hand, unstable in standing alone in or out of braces, almost a steppage gait. Neuro-could not illicit a Babinski sign due to patient's temperament. Mild but definite hyper-reflexia at the Achilles, could not illicit patellar tendon reflex. Epicritic sensation is grossly intact. Muscle strength to the inverters, plantarflexors, and dorsiflexors seemed normal, but the patient was unable to control these muscle groups on command (i.e., She would contract her PTT against resistance occasionally, but not consistently.
 
I have sent her back for some more aggressive bracing and discussed possible future surgical stabilization of her feet, depending on the consult/discussion with her pediatric neurologist. Constructive comments and experiences are welcomed.
 
Tip Sullivan, Jackson, MS

Query: Choosing a Medical Billing Clearinghouse

What is the best way to choose a clearinghouse? What are some questions to ask? Pitfalls?

Lori Weisenfeld, DPM, New York, NY

Query: Anticoagulation Meds & At-Risk Care

Regarding patients taking anticoagulation medication and having at-risk foot care, I am aware that a patient must be considered at-risk, as demonstrated by the presence of class findings. Is there a list of medications considered qualified anticoagulants (e.g., warfarin, heparin, Lovenox, aspirin, Plavix, etc.) by CMS? If not, what is your opinion on medications that would likely qualify?

Richard Wolff, DPM, Oregon, OH

Response: Not all Medicare contractors include anticoagulation therapy as a qualified risk factor for routine foot care. If it is covered, it would be listed in your routine foot care LCD. In California (Palmetto, Jurisdiction 1) our "at-risk" qualifiers include anticoagulant - heparin or coumadin - therapy.

I don't believe Ohio currently has a routine foot care LCD.

Tony Poggio, DPM,Alameda, CA

Codingline subscription information can be found here APMA Members: Click here for your free Codingline Silver subscription

RE: Comminuted Fracture S/P Ex-Fix  (Name Withheld)
From:  Multiple Respondents

Part of your problem is that the Smart Toe implants have dislodged from digits 2 and 3 (at least it appears that they have from the images I see), and the PIPJs are subluxed. I see you also chose to fuse the 5th toe. We can agree to disagree on this one. Remove the ex-fix, add 1cc of Trinity and plate it. Use a bone stimulator. Cast NWB.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

This patient clearly needs to be returned to the OR. Ex-fix and remaining hardware need to be taken out. Reduce the fracture and provisionally stabilize the foot in an anatomic position with threaded pins (this should be done with fluoroscopy). Bridge the fracture with one of the many locking plates that are commercially available. Any co-morbid conditions that may impede bone healing should be addressed if possible (cessation of tobacco). Depending how far out from surgery, a bone stimulator may be beneficial, as well as Intra-operative use of PRP, DBM, or whatever you have available to assist in this fracture healing.
 
Michael H Theodoulou, DPM, Washington, DC, michaelhtheodoulou@msn.com

While none of us is immune to potential post-surgical complications, proper patient screening, pre-operative planning, and selection of internal and external fixation is of utmost importance to minimize complications.  Without pre-operative x-rays and a more detailed history from Name Withheld, the only comment I can offer is that the selection of a hinged and/or "ball and socket" type external fixation mini rail is unstable and inappropriate when allowing weight-bearing.

Do you know for a fact that your patient was wearing the post-op shoe when re-injured? Judging from the distraction and dislocation of the Smart Toe implant from the 2nd PIPJ, it is more likely the patient was barefoot. Consider a revision of the procedure with removal of the 2nd PIPJ implant, removal of the dislocated screw from the 1st met., and removal of the hinged ex-fix mini rail. You may use a bone graft to aid in remodeling of the 1st met, and re-application of a rigid straight mini rail ex-fix.

Consider an alternative fixation method for the 2nd PIPJ. If you do not trust this patient, place her  NWB in a posterior splint for 2-4 weeks, and then progress her to a CAM walker boot, modified to accommodate the ex-fix. If trust is a major issue, do not use an ex-fix at all, but use alternative fixation.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: Sending Patient Accounts to Collection (David Weiss, DPM)
From: Gino Scartozzi, DPM

In the situation that is faced from this practitioner of sending patients to collection, I have found "an ounce of prevention is worth a pound of cure (or headaches, in this case!) Some suggestions that I have found helpful in my practice:

1. For all new patients or existing patients: at the beginning of the new year, verify insurance information, eligibility, and benefits levels PRIOR to their appointments. Advise those patients that all deductibles, co-insurances, and co-pays will be due AT TIME OF VISIT. Should a patient object, advise the patient that this is done to facilitate and not delay care options for the patient on their initial visit and to secure a referral if required for their plan. This has become increasing true even if...

Editor's comment: Dr. Scartozzi's extended-length letter can be read here.

RE: Homeopathy is a Safe Way to Complement Treatment Choices: IL Podiatrist
From: Al Musella, DPM

I hate it when articles like this appear in newspapers... it paints podiatry as a fringe field of lunatics. I would like to see a survey by PM News to see how many podiatrists feel that homeopathy is a legitimate option.
 
Al Musella, DPM, Hewlett, NY, musella@aol.com

Editor's note: PM News readers can vote on this question by clicking here. 

RE: The Affordable Healthcare Act of 2010 /Obamacare (Carlos Montes, Jr., DPM, MS)
From: Robert Bijak, DPM

I don't know what constitution Dr. Montes, Jr. is citing when he starts his very first sentence INCORRECTLY by saying, "Promoting the general health and welfare is indelibly written in our constitution." NOWHERE in the Constitution of the United States of America is HEALTH mentioned AT ALL!  Not in the Preamble, not in the body, not in the Amendments, not in the Declaration of Independence.

Although I appreciate that he has a passion for government-run healthcare as a single payer system, many, including myself, are not so quick to abrogate control to ONE body, no matter how convenient it is for billing. PS: I found it interesting that in Article V (regarding double jeopardy), the term LIMB is actually written in the Constitution, giving those with leg laws some STANDING! 

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

PODIATRISTS NEEDED - TEXAS, EASTERN, PENNSYLVANIA

Looking for podiatrists to cover three or four nursing homes in Eastern Texas (Rusk & Tyler). Also in Upstate New York (Syracuse and Buffalo) and Pennsylvania (Meadville, Hillsdale, and State College). AVAILABLE IMMEDIATELY. E-mail doconcall02@aol.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 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 POSITION - NYC, NY

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 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 – PHILADELPHIA, PA

Philadelphia surgical podiatrist, seeking surgical or non-surgical trained podiatrist to help expand practice hours. Located in a busy medical building. Clinic area is multi-specialty. Looking for someone to work expanded hours, days and some Saturdays. Call 215-665-9225 Dr. Smith, fax CV 215-665-9242 or email mybadfeet1@yahoo.com
 

ASSOCIATE POSITION - KENTUCKY
 
Very well-established podiatry practice in Louisville, KY seeks a motivated, ethical practitioner trained in all phases of podiatry including routine care, surgery and wound care to join 2 other podiatrists. By joining our practice you will receive a competitive salary with a bonus structure and benefits. Our practice is equipped with DME, PadNet, Gait Scanner and on site retail store. There is a huge potential to grow your practice with our ideally located facility that has strong affiliation with leading area hospitals as well as 2 local residency programs. For immediate consideration, please forward CV to Samuel10530@yahoo.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

EQUIPMENT FOR SALE - COOL TOUCH LASER
 
Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

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 - NORTH DALLAS, TX

Reasonably priced. 26 year old solo practice, centrally located. Includes 1 Ritter & 1 Midmark chairs, Excel x-ray, electronic claims submission, website, all supplies and instruments. Retiring owner will stay for transition. Will consider owner finance. dallasfootdr@yahoo.com

PRACTICE FOR SALE - WASHINGTON STATE - SUBURBAN SEATTLE

16 year established part time practice. Includes Midmark 417 (4 position keypad), Excel X-ray, processor, Ritter M9, instruments, bandaids, etc. 1 Day/week $50K gross. Professional Business appraisal at $48K. Asking $35K. Shared office with 2 FP's. Easily expandable. Reply: practiceforsale18@yahoo.com

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

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

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