The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

March 30, 2007 #2,897 Editor-Barry Block, DPM, JD

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Insolia Inserts Can Ease Pain of Wedding Shoes: Dananberg

Whether walking down the aisle, standing in the reception line or dancing until dawn, brides across the country all have one thing in common - aching feet from the high heels they are wearing. For comfort in those high heels, podiatrist Dr. Howard J. Dananberg, pioneer in applying the use of computerized in-shoe pressure testing in his medical practice, has developed small, thin, clear inserts that adjust the position of the foot, shifting the weight back on the heels.

Dr. Howard Dananberg

"Published studies show until now, a woman wearing a pair of two-inch heels experiences 63.9% more forefoot pressure than wearing a pair of sneakers," says Dr. Dananberg. "Pain from her shoes should be the least of a bride's worries on her big day. Women wearing two and 1/8-inch high heels with Insolia Inserts experience only a 22.1% increase in forefoot pressure over a pair of sneakers and that is a significant change."

Source: PR Web [3/29/07]

Trans-Atlantic Healing Collaborative Gets Underway at DFCon 07

An international “healing collaborative” involving medical schools in the United States and United Kingdom has been officially launched, with the goal of developing novel Trans-Atlantic research, educational and clinical opportunities.

Dr. David G. Armstrong

The collaborative is being formed by medical professors at Cardiff University School of Medicine in Cardiff, Wales, and Rosalind Franklin University of Medicine and Science in North Chicago . Spearheading the international program are David G. Armstrong, DPM, PhD, Professor of Surgery, Chair of Research and Associate Dean of the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, and Keith Harding, MB, MRCGP, FRCS, head of the Department of Wound Healing at Cardiff University and Clinical Director for Wound Healing at the Cardiff and Vale NHS Trust.

The collaborative will focus on issues relating to diabetic foot and wound healing research and care. “We hope to create a new level of international cooperation and to help break down therapeutic obstacles that frequently exist between medical communities in different countries and continents,” Dr. Armstrong said. “Our goal is to expand the collaborative to include other medical schools and research facilities in other parts of the world.”

Docs Seek Financial Help on IT Adoption

Practicing physicians yesterday told members of a House subcommittee that Medicare needs to increase its reimbursement rate to help doctors buy and use health information technology, and that the federal government should also offer a combination of tax credits, deductions, loans and grants to help defray ongoing upkeep and training costs.

The panel, which included a mix of doctors from small and rural practices, as well as policy shapers Lynne Kirk, president of the American College of Physicians, and Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, told members of the Regulations, Healthcare and Trade subcommittee that cost and risk are still the dominant hurdles to mass implementation, but vendor selection and staff training also help to squelch widespread adoption.

"Without changes in the way we promote health IT, small physician practices will be left behind the technological curve, and as a result, patients will fail to benefit from the quality of care electronic health records provide," Subcommittee Chairman Charles Gonzalez (D-Texas) said. Overall, though, the physicians said that from a quality and efficiency standpoint, adoption of health IT proved worthy of their investment.

Source: Matthew DoBias, Modern Healthcare [3/27/07]

One Patient, Many Doctors

The typical Medicare beneficiary sees more than one primary care physician and many specialists over the course of a year, with the number increasing for certain diseases or conditions, a recent analysis by the Center for Studying Health System Change found. Such wide care dispersion could make it difficult for a Medicare pay-for-performance program to determine which physician is chiefly responsible for a patient's care. Here are the 2000 figures for the roughly 1.8 million beneficiaries studied.

Source: New England Journal of Medicine, [3/15/07] via AMNews

Query: Checks Being Cashed by Fellow Doctor

I recently found out that some of my checks are being cashed by a family practice doctor in the building next to mine. I found this out when some of our payments (surgeries, office visits, etc.) were not getting paid. When we called the insurance companies for payment, they assured us that the services had been paid. After paying a fee to get the cashed check back, we found the name of a family practice doctor including bank of deposit, etc. on the back of the check. The front of the check plainly had my name on it. I confronted the doctor and he promptly repaid us. Unfortunately, this has now happened over 15 times and it doesn’t seem to stop. He even cashed a check of over $850 for a surgery that I performed. I have kindly sent the doctor a letter asking him , again , to stop this practice. However, these incidents continue to occur. I’ve contacted the police and spoke to a private investigator who basically said I have no recourse. Who is responsible in this case and what recourse do I have? Isn’t opening someone’s mail a federal offense?

Al Kline, DPM, Corpus Christi, TX

Editor’s comment: PM News does not provide legal advice. Yes, opening someone else’s mail is a federal offense, so one step you can take is to contact your local postmaster. An additional step would be to make a formal complaint to your state medical board.

From a practical standpoint, we suggest that you merely change your billing address to a post office box or to your home address. This will ensure that the other doctor doesn’t receive your mail.

RE: Post-op Care for Severe Ankle Laceration (Judd Davis, DPM)
From: Greg Mowen, DPM

This is certainly a very difficult case. I have never seen this extensive of an injury, but I have treated lacerated tibial nerves. If there is still pain and numbness after 6 months, a true neuroma may have formed in the repair site. This would have to be resected and repaired. Usually we wrap it in neurotube which is a pretty good neuromatrix. I havae also seen plastic surgeons repair these extensive injuries with neurowrap which is probably similiar. Neurowrap can also be used to reinforce the tendons and minimalize scar tissue.

Greg Mowen, DPM, Margate City, NJ, gregmowen@comcast.net

RE: Acral Melanoma (Elliot Udell, DPM)
From: Bryan Markinson, DPM

Dr. Elliot Udell comments on podiatrists performing definitive surgery for melanoma, stating, "The only problem is that malignant melanoma is so rare in the lower extremity and so life-threatening that it may be in the patient’s best interest not just to punt to another surgeon but to seek out surgeons with greater training in the medical and surgical management of this type of malignancy."

The notion that melanoma is "so rare" in the lower extremity is completely wrong. In fact, according to most studies, the lower extremities is exactly where melanoma is most commonly, or equal in incidence to occurrence on the abdomen or head and neck. That means that up to 25% of all melanomas occur on the lower extremities, and in women it goes even higher.

Secondly, prognosis for melanomas on the feet are worse, just because the are located on the feet. Additionally, most foot melanomas are diagnosed at deeper depths initially than on other body parts. This does not include diagnoses of atypical nevi, which also demand a level of expertise for management. I personally am involved with approximately two suspicious melanocytic processes a month, and average six melanomas per year consistently over the past three years. In addition, I get 5-10 patients referred by colleagues annually for pigmented lesion management at various levels.

Therefore, podiatrists must remain ever-vigilant regarding pigmented lesions.

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

Editor’s note: The full text of this shortened letter appears at: http://www.podiatrym.com/letters2.cfm?id=13413&start=1

RE: Overpayment Return
From: Ken Malkin, DPM

Last year I received a check with my name on it for over $18,000. The codes were neurosurgery procedures. Well, I have not practiced neurosurgery in at least 20 years, so I was stumped. I called Aetna, with whom I do not participate and I could not believe that rather than be grateful they were rude when I returned the check.

Well, at least I had a fantasy for a day....Imagine 18K for one day's work.

Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

Editor’s note: This topic is now closed.

Athena PowerPeel Medical Strength Microderm Abrasion Machine Model 4000A-110

Retails for $7,500- Weighs only 33 pounds. The exfoliation achieved with this system leaves the skin feeling smooth, soft, and refreshed. Fine lines, calluses, dark spots and post-operative scars, Up to $75 per tx, with at least four tx's ....tested on patients with great results. I now sub-lease to a spa that has their own. $5,200 or best offer 215-665-9225 or docmaasi@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

FELLOWSHIP POSITION AVAILABLE – NEW YORK

Fellowship in Wound Management at North Shore-LIJ Health System is available for the academic year 2007-2008. This is a CPME-approved fellowship and provides training at 3 separate hospitals within the health system. It involves the medical and surgical management of complicated wounds as well as rotations in plastic surgery and vascular surgery. The fellow also participates in wound clinics and hyperbaric centers. For further information please contact Edward Buro DPM, program director, at Mayfairfootcare@aol.com

ASSOCIATE WANTED – BRONX, NEW YORK

Seeking an ethical and personable Board Certified/Eligible residency trained individual (PM&S 24/36). Position available June 1, 2007 to become part of this prestigious and established NYC podiatric practice operating for 25+ years. All aspects of podiatry - Excellent opportunity leading to partnership with unlimited income potential and more. Fax CV to (718) 931-9324. WWW.BRONXFOOTCARE.COM

PRACTICE FOR SALE -CHARLOTTE, NC. EAST SIDE

Long-established fully equipped podiatry practice located in pleasant office park ; Excellent office software with electronic billing; biomechanics, general podiatry with well equipped, in-office OR. Call 704-553-7327 after 7 PM EDT.

PRACTICE FOR SALE - MAINE, SOUTHERN COAST

Established practice with excellent reputation for sale. Practice with well-developed infrastructure and location. Current technology in place. Strong patient flow. Good mix of surgery and office based care. dpminmaine@comcast.net

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mi of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to sher18@yahoo.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

PRACTICE FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations & high gross, buy outright or over time. Call 561-213-9400 after 7:00 p.m.

ASSOCIATE POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

ASSOCIATE POSITION – HOUSTON, TEXAS

Lepow Podiatric Medical Associates looking for board certified podiatrist to join their six location group practice in Houston. Competitive salary and benefits. Email CV to lepowft@cs.com

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