The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 17, 2012 #4,412 Publisher-Barry Block, DPM, JD

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Shoes Should Not Require Break-in Period: CA Podiatrist

Our poor feet. They withstand lots of abuse, quickly carrying us to last-minute outings, pounding the pavement on mind-clearing runs, and being squeezed into impractical (but fashionable) shoes. But we need to take care of them to avoid foot pain, injury, and other ailments. 

Dr. Michelle Summers

Sorry to break it to you, but you're probably not going to break in those painful shoes. "A shoe should feel comfortable when you try it on in the store," says Dr. Michelle Summers, a California-based podiatrist and shoe designer. "If it feels too tight in the store, it will be too tight at home, and may even feel worse after being worn for a little while."

Source: Leslie Quander Wooldridge, US News & World Report [3/15/12]

UK Podiatrist Resigns Over Proposed 10% Cut In Staffing Levels

Jonathan Brighouse worked in the NHS for 25 years as both a clinician and manager of a podiatry service in east London. He resigned the latter post, having become disillusioned after being required to assist McKinsey's – management consultants heavily involved with NHS reforms – with their review of services. It called for a 10% cut in staffing levels across the NHS. 

Jonathan Brighouse

"There is a lot of anxiety in the [podiatry] profession about the bill, particularly because we've been singled out as one of the first services to be put out to tender under the any qualified provider (AQP) initiative, a key part of the reform. The podiatry profession is not against change, but in my view, the PCTs provide a system that works well. They were only recently properly established, and to just throw away all the work they have done seems wasteful," says Brighouse.

Source: Lindesay Irvine, The Guardian [3/14/12]

KSU Votes to Acquire OCPM

Kent State University hiked tuition and room and board rates for next year, approved a new collective bargaining agreement with 360 union employees, and — in what President Lester Lefton called a “historic” day — voted Wednesday to acquire the Ohio College of Podiatric Medicine in Independence. KSU will acquire the Ohio College of Podiatric Medicine (OCPM) in Independence, pending state and OCPM approval later this month.

Kent State logo

The school will become the Kent State University College of Podiatric Medicine and remain at its current location. Only eight accredited podiatric colleges are in operation nationwide, and KSU’s will be the only one associated with a state university. KSU is not paying to acquire the school, which currently has 400 students and 87 employees. A two-year transition period should begin in July.

Source: Paula Schleis, Akron Beacon [3/15/12]

Barry Student is Clinical Skills Patient Encounter Pilot Winner

Cliff Burmeister, of Barry University School of Podiatric Medicine, was among nearly 70 fourth year students to participate in the NBPME pilot examination to evaluate patient encounter skills. He was also the lucky winner of an ipad in a drawing held at the conclusion of the pilot.

Cliff Burmeister

Charles Lombardi, DPM, chair of the NBPME CSPE committee said he was gratified that students from schools across the country participated.

CMS Delays 5010 Enforcement, Again

The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, until after June 30. The deadline for the switch to the 5010 standards was Jan. 1. In November, the CMS announced that although it was not changing the actual deadline for complying with the standards, it would not initiate enforcement action until March 31.

On Thursday, the CMS' Office of E-Health Standards and Services said no action will be taken against noncompliant medical practices, hospitals, and other healthcare entities through June 30. In February, the MGMA-ACMPE (formerly the Medical Group Management Association) requested more time, citing complaints from physicians that the conversion was resulting in "significant delays" in claims payment.

Source: Andis Robeznieks, Modern Healthcare [3/15/12]

Query: Opting Out Of Medicare After A Sabbatical

I am re-rentering the practice of podiatric medicine after a sabbatical. I do not plan to apply for a Medicare provider number and I will expect any Medicare patients who wish to be treated by me to pay me for my services at the time they are performed. As such, will it be necessary for me to “opt-out” of Medicare and, if so, how may I accomplish that task? Alternatively, may I simply decide not to opt-in?

Name Withheld (FL)

Editor's comment: PM News does not provide legal advice. If one does not currently have an NPI number and is not registered as a Medicare provider, it is not necessary to opt out of Medicare. It is recommended, however, that all patients sign a notice indicating that they are aware that the services provided are not covered by Medicare and that no claims can be submitted to Medicare for services rendered.  

Query: Accountable Care Organization (ACO)
 
I'm a solo-practitioner, and I've been asked by one of my local hospitals to join (voluntarily) a new ACO that they are affiliated with. A meeting has been scheduled for staff physicians to address any questions about the ACO. What would be some good questions to ask them?
 
Robert Wunderlich, DPM, San Antonio, TX

All Scripts vs. Practice Fusion EMR

Can anyone offer their experience with either of these EMR systems in terms of set-up, learning curve, ease of usage, and cutomer support . They are both web-based, which I want in order to avoid dealing with a server.

Howard Shapiro, DPM, NY, NY

Query: Destruction of Lesion

Following on the discussion from last year regarding use of salicylic acid on warts, I was curious what the consensus is on using 80% trichloroacetic acid on warts. Would that qualify for 'destruction' of the wart, CPT 17110?

Tom Murphy, Chad Knutsen, DPM, Fort Collins, CO

Response: The code, CPT 17110, describes "destruction" of benign lesion. It does not specify how the destruction is to take place - just that the agent can reasonably be expected to destroy the lesion(s).

Trichloroacetic acid appears to 1) be indicated in the treatment of warts and 2) is "strong" enough to be destructive when applied to warts.

Tony Poggio, DPM, Alameda, CA

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RE: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Multiple Respondents

It may be due to the clutch. Truck clutches are very tight and need extra force to push down. Have them modify the clutch.

Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

Because your patient only has symptoms when he is driving his 'rig', I would check to see if he puts his wallet in his right back pocket. If he does, have him move it to the front pants pocket. Second, have him adjust his seat forward (or back) and see if that makes a difference. As simple as this sounds, these changes may make a difference.

Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

I may have missed something in earlier postings, but the symptoms sound as though they may be related to a positional entrapment of the medial branch of the posterior tibial nerve. This can occur with the foot plantarflexed and, as others have posited, may be related specifically to the seat height or having to reach with the foot to work the truck pedals, resulting in excessive or prolonged plantarflexion. If he is driving for extended periods of time he may even rest the foot in an inverted and plantarflexed position, which can also crowd the tarsal tunnel and porta pedis. Phelan's test is used for carpal tunnel testing, however, the same maneuver can be used in the foot to recreate PTN entrapment symptoms.

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: Lapidus or Fusion (Philip Graham, DPM)
From: Richard Gosnay, DPM

As Dr. Solomon has deftly demonstrated, the first MTPJ fusion can powerfully affect the transverse plane orientation of the first ray. In my experience with the Lapidus procedure, positioning the first metatarsal head over the sesamoid apparatus restores much of the MTPJ alignment but may require a further head procedure, as noted by Dr. Mullen. Dr. Mullen's advice about addressing the goals and expectations of the patient, despite her chronological age, is also wise.

Regarding this particular case, my judgment is driven by the degeneration of the lesser digits and MTPJs secondary to the first ray insufficiency. The Lapidus fusion will restore the sagittal plane orientation of the medial column in addition to correcting the transverse plane deviation of the first metatarsal. A further modified Reverdin procedure may also be required. Of course, the lesser toes would require arthrodeses in order to restore their orientation. The extent of second toe deformity in the sagittal plane suggests plantar plate disruption which is typical of the lesser ray damage seen with long-standing, first-ray incompetence. I would expect that a Girdlestone tendon transfer would also be needed to restore the second toe sagittal plane alignment.

Richard Gosnay, DPM, Danbury, CT glabroushead@gmail.com

RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)
From: Carl Ganio, DPM

I have become aware over the years that the ICD codes are owned by the AMA, not HHS. I am bombarded several times a year with annoying phone calls to purchase every new coding book and guide that they print. You tell me who is making the $, and you must think hard as to why such a small percentage of MDs are active due-paying members of the AMA. 
 
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz

In 2014/15, there will be few, if any, uninsured patients and the cost for a plan to be deemed acceptable by the government will be $10-15K/yr, reducing disposable income of sole proprietors and suppressing growth potential of larger businesses that are not presently covering employees at the acceptable level as their funds will be immediately diverted to healthcare costs.

The notion that we can all opt out of insured medicine may be misguided unless you can offer specialized services not generally sought after in the insured market. Most people simply will not have the funds available. If you look at what happened in Canada after ICD-10 implementation, we can expect...

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

RE: ABPS Name Change (M. W. Aiken, DPM)
From: David McKenzie, DPM, PGY-2

As new foot and ankle surgeons nearing completion of our training and entering our specialty, we have been observing the changes in our profession and specialty. Much has occurred and continues to occur which gives us cause for optimism. We are enthusiastic about the possible name change of our surgical certification organization.

We believe this is a major step forward in our identification and recognition, which allows us a clear statement of what we are training for and what we hope to...

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

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

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

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

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