The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

March 20, 2013 #4,720 Publisher-Barry Block, DPM, JD

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104 Applicants Not Matched for Residency Positions 

According to Edwin Wolf, DPM, residency genesis facilitator of the American Association of Colleges of Podiatric Medicine (AACPM), the "perfect storm" has occured. When the residency matches are announced on Wednesday, 104 applicants will not be matched. This is a result of many factors, including the closure of many hospitals, a higher than normal National Boards Part II pass rate, and the first graduating class of WesternU College of Podiatric Medicine.

(L-R) Drs. Ed Wolf and Michael Trepal

Michael Trepal, DPM, chair of the American Association of Colleges of Podiatric Medicine (AACPM), said that this is not a time for finger-pointing. The APMA House of Delegates adopted a resolution calling for "implementation of preceptorships and/or temporary educational opportunities contingent on applicable state law and professional liability requirements for graduates who have not yet secured an entry level residency position."

PM News has begun a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section. Straw polls are not scientific and do not represent standards of care.

Quick Poll
Are you in favor of the training of podiatric assistants to do routine foot care?

APMA Officers and New Board Members Elected

The American Podiatric Medical Association (APMA) held its annual election for officers and trustees during the APMA House of Delegates. The results:

New Trustee Dr. Larry Santi

Frank A. Spinosa, DPM, Elected president-elect
Phillip E. Ward, DPM, Elected vice president
R. Daniel Davis, DPM, Elected treasurer
David G. Edwards, DPM, Re-elected to Board of Trustees
Ira H. Kraus, DPM, Re-elected to Board of Trustees
Laura J. Pickard, DPM, Re-elected to Board of Trustees
Lawrence A. Santi, DPM, Elected to Board of Trustees

AZ Podiatrist "Adopts" Haitian Orphanage

Flagstaff was one of hundreds of cities across the world that sent disaster relief teams to Haiti after a powerful earthquake struck the country in 2010. While most other cities have long-since stopped aid to Haiti, Flagstaff remains, and is now one of the leading cities in the world for sending volunteers to a country still rebuilding. Foyer Renmen is an orphanage in Bon Repos, Haiti.

Dr. Kelly Reber

Dr. Kelly Reber is a podiatrist from Flagstaff. He first came to Haiti a few weeks after the earthquake to do medical relief work through the Northern Arizona Volunteer Medical Corps, or NAVMC. But when he saw how many children had been left orphaned in the poorest country in the western hemisphere, Reber decided the group should - essentially - adopt Foyer Renmen and make improvements there. "You just can't help but think about the lives of these children you're holding", Reber says. "There's no immediate fix for Haiti, but there is a fix for small groups of people in Haiti. You pick one place to start."

Source: Gillian Ferris Kohl, KNAU [3/18/13]

Special Awards Presented at APMA HOD

The following awards were presented on the last day of the APMA House of Delegates:

Executive Director’s Award: John Crosby, JD, Executive Director, AOA

President’s Award: Jaime Torres, DPM, Health and Human Services Regional Director

Dr. Patricia Nicholas receives Humanitarian Award from Dr. Joseph Caporusso (now immediate past president of APMA)

Humanitarian Award: Patricia Nicholas, DPM

Query: Correct Modifier?

I submitted  CPT 28296-SG , CPT 28285-SG-T4, CPT 28285-SG-T9 * SG - Ambulatory surgical center (ASC) facility service

The payer reimbursed the first line, but not the last two. They said that the last two are included in the price for the first line. I was told I needed a modifier. I mentioned a "-59", and was told that wouldn't work. Any suggestions?

Larami Martinez, Idaho Falls, ID

Response: From the coding perspective, instead of billing with the "SG" modifier, substitute the "-59" modifier on both CPT 28285 codes. The anatomic modifier should also be applied to each procedure code.

As for non-payment, this may be a policy problem with the payer. I don't know whether or not the payer is commercial or a Medicare/Medicare Advantage plan. The former may not be applying or recognizing the NCCI edits the same way Medicare does. Check your contract. In order to obtain payment, you may need to submit this claim manually along with the operative report. The operative report and a short appeal letter should be all the proof you need to show that these three procedures were not performed on the same anatomical site, and thus should be reimbursed.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Long-Term Pain, Right Foot (Edmond F. Mertzenich, DPM, MBA)
From: Richard Gosnay, DPM

This is obviously a very complex case. My ideas are only based on the detailed history and radiograph that were provided. I do not think that the history of the burn is the cause of this patient's pain. Such a burn is most likely to cause anesthesia. And the location of the pain is exactly where the osseous deformity is seen on the radiograph.

Even the most successful TEV surgery can leave a patient with some residual deformity later in life. The atrophied calf muscles are so common in these patients that I expect to see them. This patient likely has residual adducto-varus deformity, which causes him to walk on the plantar-lateral aspect of his foot and elevate his first ray. And he obviously has the pathologic talo-navicular joint.

The navicular is impinging on all of the proximal, dorsal soft-tissues. At the very least, all of the dorsally prominent navicular needs to be resected. The remaining navicular should then be fused to the talus. Before the bones are fused, an attempt should be made to dial in the proper alignment of the forefoot to adjust the frontal and transverse planes. It is most likely that an inadequate amount of correction will be available, as this foot has been rigid for years. If this is the case, a triple arthrodesis will be needed to allow the re-alignment of the foot.

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

RE: Long-Term Pain, Right Foot (Edmond F. Mertzenich, DPM, MBA)
From: Tip Sullivan, DPM

The obvious answer, given the info, is a midfoot fusion. Also consider a STJ fusion due to the muscle imbalance, and you can correct any frontal plane issues in the calcaneus. Don’t forget to check the gasto-soleus complex. You can address some of the anterior aspect of the cavus and get the patient in some sort of custom shoe post-op.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Forefoot Surgery on an 84 Year Old (Joseph Borreggine, DPM)
From: Barry Mullen, DPM, Neil Levin, DPM

What you describe is more of a textbook repair for a young, active individual. Yes, we're all taught to treat physiologic rather than chronologic age...but, I'd still be concerned about compromised healing of multiple osteotomy sites. How active is this 84 year old? How severe are the symptoms? My gut thought is if surgery is necessary, a 1st MTP fusion and Clayton-Hoffman pan met head resection, with appropriate digital arthroplasty where necessary, would serve a patient of this age and that deformity well, with far reduced risk.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Dr. Borreggine failed to provide any general medical history information that might play into the decision-making in an 84 year old patient. Let's look at the risk vs. reward ratio. If his chief complaint is the hammertoe, I would amputate the 2nd digit, leaving a small buttress of toe to prevent further medial migration of the lesser digits, and call it a day. If you sit down with the patient and truly discuss the possible morbidity of all that you are describing, I venture to say he would go for the amputation, and be back in a regular shoe in 2 -3 weeks.
 
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

RE: Forefoot Surgery on an 84 Year Old (Joseph Borreggine, DPM)
From: Scott Hughes, DPM, George Jacobson, DPM

How about a 2nd toe amputation? - problem solved.

Scott Hughes, DPM, Monroe, MI, dr.hughes@comcast.net

If your patient has gotten around for 84 years and his chief complaint is that he can't wear a closed shoe, there are still custom-molded and extra-depth shoes available as an option. If that fails, then I'd still be cautious.
 
I wouldn't want to depend on primary bone healing, fixated or not. If there is a place for keeping it simple, this may be it. I don't know your patient. A simple Keller, with or without a 2nd toe arthroplasty or amputation, requires only soft tissue healing. I wouldn't "over-surgerize" an 84 year-old foot no matter how great your surgical skills are. What is the patient's social situation? Can he be compliant with your post-op instructions? The patient may need transportation and domestic help, etc. If those are discussed and planned as well as the surgery, and are consented non-issues, then you only have to worry about healing.
 
George Jacobson, DPM, Hollywood,FL, FL1SUN@MSN.COM

RE: St. Louis Podiatry Seminar Celebrates its 25th Year
From: Mark K. Johnson, DPM

Kudos and many thanks to Dr. Allen Jacobs for another seminar of useful information, updates, and an emphasis on podiatric medicine and surgery. With gratitude.

Mark K. Johnson, DPM, West Plains, MO, ddr004@centurytel.net

RE: The Passing of Jack Lee Morris, DPM

Jack Lee Morris passed away on March 12th after a valiant and courageous battle with chronic cardiac and pulmonary disease. Jack graduated from the California College of Podiatric Medicine in 1970, while working full time to support his family. After a successful private practice of 15 years in Washington state, Dr. Morris returned to the College of Podiatric Medicine as a professor. While chairman of the Biomechanics Department, he published some of the most insightful scientific articles on biomechanics in his profession. In 1990, Jack married Joni Murphy, and found his life re-invented. During retirement, he enjoyed travel, his grandchildren, telling jokes, and being a consultant in his profession.

Joni Morris

PRACTICE FOR SALE - LOS ANGELES, CA

Practice is in Boyle Heights area since 1998. 70%MM the rest consist of Cash/PPO/HMOs. Last 4 years grossed between 200-350k in a down economy. Constant referrals from PCPs in the area. Includes Padnet, and all podiatry equipments. Asking 130k. Please email me only footdoc525@yahoo.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - WEST PALM BEACH FLORIDA

Well established successful West Palm Beach practice grossing $475K with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E-mail wpbfootdrs@gmail.com

ASSOCIATE POSITION NEEDED FOR CENTRAL FLORIDA

FT/PT associate needed for nursing home work. Great compensation and a great way to supplement your income. Must be willing to travel. Contact us at (786) 975-2090 or fax to (847) 674-2113 you may also email to feetwork@aol.com.

ASSOCIATE POSITION - N.E. INDIANAPOLIS (FISHERS/ANDERSON)

Full or Part-time associates to join board-certified podiatrist in diverse, modern podiatry practice in hospital and office settings. EHR, digital x-rays, PADnet, Cutera Genesis Plus laser, Pinpointe Laser, ESWT, mini-C-arm, all aspects of DME, and hospital affiliations with three networks. Limited wound care. No nursing homes. Current Indiana podiatrists welcome. Tremendous potential for individual(s). Send C.V. with salary and benefit expectations: john.lloyd@lloydpodiatry.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Requiring full-time podiatrist (PSR-24 or greater) in established Practice situated in a foothill community of Southern California. There is an existing patient base and a strong support team. Compensation is performance based with practically an unlimited earning capability. A possible buy-in is negotiable. Send resume to office@uplandpodiatry.com , titled, "Podiatrist".

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION – PHILADELPHIA SUBURBS

Seeking an outstanding, highly motivated candidate with top-notch personal, clinical and surgical skills and training to join established & highly esteemed diverse practice. Full privileges available for entire podiatric spectrum of practice. Great opportunity with long term career potential. Respond with Resume, Photo, C.V. and references to footandankle22@aol.com.

ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND

Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rearfoot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual. Send CV to dpmkthomas@gmail.com

POSITION AVAILABLE - WEIL FOOT ANKLE & ORTHOPEDIC INSTITUTE- CHICAGO

Weil Foot Ankle & Orthopedic Institute is expanding their presence in the Chicago metropolitan area and suburbs and is recruiting qualified podiatric surgeons. A three-year residency is required and a podiatric fellowship is preferable. Current practicing podiatric practitioners in Chicago and surrounding area are also welcome to join our rapidly expanding practice that currently numbers 16 DPMs, a neurologist, an orthopedic surgeon, and a primary care sports medicine physician. For more information contact: info@weil4feet.com or call Stephanie Spiegel, COO at 847-390-7666.

ASSOCIATE POSITION- SUBURBAN PHILADELPHIA

Full time, PSR 24-36 month trained podiatrist needed for busy suburban Philadelphia group practice. Multidimensional, multi-office group treating a wide range of patients including forefoot, rearfoot & ankle surgery, diabetic wound care, sports medicine, and workrelated injuries. Office & diagnostic equipment state-of-the-art. Full benefit package included with bonus incentive. Position available starting July, 2013 excellent opportunity leading to partnership. Please email to: bailliemw@gmail

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 12/24 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.

ASSOCIATE POSITION - HOUSTON, TEXAS

PSR 24+/ Equiv. DPM, Texas license, Busy diverse practice. Greater Houston Area, Guaranteed Salary and benefits All Aspects of Podiatric Medicine and Surgery. Board eligibilty, Bilingual A Plus. Send CV to Randal Lepow at rmldpm1@att.net

ASSOCIATE POSITION - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County, NY (West Point area). Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER call. The applicant has to be trained in all foot surgery and be able to handle advanced diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking, fishing ,skiing and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE/PARTNERSHIP MIAMI/KENDALL FLORIDA

Podiatrist with interest in foot and ankle surgery and comprehensive foot and ankle care. Pathway to partnership/ownership available. Send CV and information: ibaumdpm@bellsouth.net

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 PODO2345@AOL.COM 516-476-1815

EQUIPMENT FOR SALE - COMPLETE AMFIT ORTHOTIC FABRICATION SYSTEM

Complete Amfit Orthotic Fabrication System with Footfax SL Contact digitizer-3 years old. System includes milling machine, 2 PCs, all cords, parts, hardware and assorted insole blanks. $45K New, Asking $10K. E-mail inquiries to: sportsmed@fdfac.com

EQUIPMENT FOR SALE - USED Q-CLEAR LASER

Still under warranty. New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to footcare@comcast.net

ACADEMIC POSITIONS - SCHOLL COLLEGE

The Dr. William M. Scholl College Podiatric Medicine is seeking up to three full-time academic podiatrists to train and lead the next generation of podiatrists in an interprofessional, multicultural learning environment. Applicants must be board qualified with preference for board certification in foot surgery and reconstructive rearfoot/ankle surgery. Salary and academic rank will be commensurate with scholarly credentials. Contact Robert Joseph DPM, PhD at Robert.joseph@rosalindfranklin.edu or (937) 479-1793. Rosalind Franklin University of Medicine and Health Science is an Equal Opportunity/Affirmative Action Employer. The administration, faculty and staff embrace diversity and are committed to attracting qualified candidates from historically underrepresented groups.

PM News Classified Ads Reach over 14,000 DPMs 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 14,000 DPMs. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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