The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 19, 2012 #4,413 Publisher-Barry Block, DPM, JD

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Choose The Right Shoe for Your Sport and Foot Type: NY Podiatrist

It's "extremely important" to find gym shoes designed for your sport of choice because they'll accommodate the actions needed for the specific activity, says Dr. John Brummer, a New York City-based podiatrist. If you're a runner, consider going a step further with a professional fitting, since your gait and range of motion affect the shoe you need, advises the American Academy of Podiatric Sports Medicine. For example, overpronators—runners whose feet rotate too far inward—are steered toward shoes that offer more support. 

Dr. John Brummer

It's not your imagination. Your shoes may no longer fit. "Our shoe size can change from anything such as weight gain, hormonal activity, circulation disorders, or simple aging," says Brummer. If you have diabetes, you should also see a podiatrist at least twice a year, Brummer says.

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

NYCPM and Galway Podiatry College Present Grand Rounds via Videoconference

The New York College of Podiatric Medicine (NYCPM) and the Podiatry College at National University of Ireland in Galway (NUI Galway) recently held a grand rounds case presentation via videoconference.  With faculty members from each institution gathered at their respective in-house videoconference facilities, five grand rounds case presentations were viewed and discussed. Also in attendance at NYCPM was a group of podiatry students from NUI Galway, who were at the College for a two-week program of lectures and rounds at the College and at NYCPM’s clinical affiliate, Foot Center of New York, as well as at several of NYCPM’s affiliated hospitals.  

Grand Rounds Videoconference between NYCPM and the Podiatry Program at National University of Ireland in Galway.

Two NYCPM students who are currently on rotation at the Podiatry College at NUI Galway as part of a student exchange program were also on the videoconference. Also discussed on the call was a joint clinical research project. Both the grand rounds presentations and the visit by the NUI Galway students were initiatives resulting from a recent meeting at NUI Galway between Michael J. Trepal, DPM, Vice-President for Academic Affairs and Dean at NYCPM, and Dr. Caroline MacIntosh, head of the program in podiatry at NUI Galway.

Query: Failed Hallux Implant

A 67 year old male had an implant inserted in 2005. According to the patient, "something" happened and the Dr. re-did the implant surgery in 2008. He presents with a dorsally dislocated hallux and no flexor tendon strength. His complaint is a painful callus under the hallux. When he trims the callus, he can feel the implant. Palliative care and padding keeps him comfortable, but he wants the toe repaired. 

Failed Hallux Implant

I am considering the following - Fusion of the 1st MTPJ with bone graft - either cancellous intramedullary or a tricortical strut. The problem with graft/fusion is the amount of time off-weight-bearing. I do not know if he will be compliant. What are my other options?
 
Alan Berman, DPM, Carmel, NY

Query: Wholesale Source for Lamisil Gel

I am interested in dispensing topical Lamisil gel in my office. Does anyone know of a wholesale source?  

Mark Tracy, DPM, Port Charlotte, FL

Query: Portable X-Rays for Homebound Patients

I recently ordered an x-ray from a local portable x-ray company for a homebound patient. They refused, stating that they only take x-ray orders from MD/DOs. Has anyone else encountered this? They said it was a CMS rule.
 
Doug Dickson, DPM, N Syracuse, NY

RE: Do First MTP Joint Fusions Reduce the IM Angle?
From: Ed Davis, DPM

There are two reasons why an MTP joint fusion may reduce the intermetatarsal angle.

1) There is a reduction in the hallux abductus angle as the MTP joint is fused in mild abduction in the transverse plane; thus reducing the retrograde subluxatory force from the ground into the first MTP joint.

2) The tendons attaching to the hallux, FHL, FHB, EHL, EHB, and adductor hallucis are no longer acting as deforming forces on the joint but act across a stable platform, the fused first MTP joint, to pull the first ray toward the midline of the foot. Abductor hallucis function would not change signficantly. This is more of a dynamic than structural IMA reduction, so the degree of mobility at the first metatarsal cuneiform joint may have a bearing. I am not sure if we have studies on this.

Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net

RE: All Scripts vs. Practice Fusion EMR (Howard Shapiro, DPM)
From: Daniel D. Michaels, DPM, MS

I use Allscripts and like it very much. The product you will use is Allscripts My Way, and it will require a local company to set it up, the one that you are buying it from. You will need to make sure that someone will sit with you for several hours on day one to get it set up for you the way you want.

Make sure you spend at least three hours not seeing patients and working one-on-one with someone to set up your prescriptions and patient education forms as well as your templates. The program works just like an H&P. It would be helpful for them to have someone...

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

RE: Keeping Track of Inventory for Separate Offices (Charles Morelli, DPM)
From: Farshid Nejad, DPM

Traknet EHR offers a robust inventory tracking system with the use of barcodes. You can have a single database that you can access from different offices. It will allow you to set prices and notify you when you are running low on a product.

Farshid Nejad, DPM, Beverly Hills, CA, drnejad@footnankledoc.com

RE: ICD-10 Preparation (Carl Ganio, DPM)
From: Harry Goldsmith, DPM, David J. Freedman, DPM

"I have become aware over the years that the ICD codes are owned by the AMA, not HHS." - Carl Ganio, DPM
 
The ICD-9 and ICD-10 are not owned by the AMA. ICD-10 is owned by the World Health Organization (WHO). The National Center for Health Statistics (NCHS) is responsible for coordination of all official disease classification activities (use, interpretation, and periodic revision) in the United States related to the ICD. NCHS is part of the Centers for Disease Control and Prevention which is part of the Department of Health and Human Services.
 
Harry Goldsmith, DPM, Cerritos, CA, hgfca@verizon.net

ICD (International Classification of Diseases) coding is owned by the WHO (World Health Organization). In the United States, patient diagnosis codes for the ICD10-CM and ICD9 CM are developed and administrated by the CDC (Centers for Disease Control) based in Hyattsville, MD. ICD10 PCS and ICD9 PCS are developed and administrated by CMS (Centers of Medicare and Medicaid) based in Baltimore, MD.

The AMA does not own the ICD, they may publish textbooks and sell them, but they only own CPT. The AMA makes their money off of selling the CPT codes in all forms of media only and interestingly, without CPT, the AMA would probably not exist. We should be promoting the federal government to use both ICD PCS and CM, and then CPT and AMA would have no value in coding of medicine for procedures. This would lead to the downfall of the AMA, but no one is pushing this agenda. In the hospital system, they have to use ICD PCS and ICD CM, so why not the rest of U.S. medicine?
 
David J. Freedman, DPM, Silver Spring, MD, DJFREEDMAN@aol.com

RE: ICD-10 Preparation (Joseph Borreggine, DPM)
From: H. David Gottlieb, DPM, Jack Sasiene, DPM

First, some history. The ICD-10 [International Classification of Diseases, v.10] is developed by the World Health Organization [and can be downloaded directly from their website at who.int/classifications/icd/en/.] It has nothing to do with the U.S. government or insurance companies. It is the standard international ‘language’ of medicine and allows for standardization of medical research and epidemiology. The rest of the world has essentially already adopted ICD-10.

The first ICD was developed in the late 1800’s. From the WHO website you will find “ICD-10 was endorsed by...

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

I am happy to see some doctors writing in about what is going on with Medicare/Medicaid and private insurance. The last postings have quoted $80K for implementation, training costs, putting aside anywhere from 6-12 months of overhead expenses per the expert from UHC and the TPMA president. That's only about $2,631 per month extra you need to start setting aside per every $100K of overhead per year over the next 19 months until Oct 2013. But let's not forget Dr. Brody's statement here on PM News regarding Phase 2 of meaningful use on 3-5-12: "You need to have a fully DICOM- compliant digital x-ray system."

I think I'll just take my money and invest it in healthcare with all the cash they will be holding on claims they just can't seem to process ...without penalty I'm sure. The real concern is that...

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

RE: ABPS Name Change (M. W. Aiken, DPM)
From: J. Barry Johnson, DPM

The name change of ABPS is something long overdue for our surgical specialty. We have our certifying board, ABPS, which has a name that does not coincide with the type of certification ABPS provides, which makes for confusion. As a result, most of us are listed according to our certification board, in “podiatry” or “podiatric surgery” which is confusing and non-descriptive.

This places us at a disadvantage with our hostile competitors. This has been a problem for some time now. We are certified in Foot Surgery or Foot & Ankle Surgery in general, and certification is the thing hospitals and insurance carriers and legislators look at first to help understand what the particular group does.

Certification should not be confused with scope of practice. Changing the name to ABFAS does not mean...

Editor's note: Dr. Johnson'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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