The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 07, 2009 #3,513 Publisher-Barry Block, DPM, JD

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Patient Education Necessary to Prevent Amputations in Diabetics: TX Podiatrist

Dr. Juan Gonzalez, a podiatrist, said that because of the city's high rate of diabetes, it's important to educate diabetics about the dangers of poor foot care and possible alternatives when amputation might seem to be the only hope.

Dr. Juan Gonzalez Treats Patient with Diabetes (Photo: Mark Lambie / El Paso Times)

The El Paso Diabetes Association estimates that 13.3 percent to 16 percent of El Pasoans older than 18 have diabetes. While many El Paso doctors and agencies work to reduce the rates of diabetes, some, like Gonzalez, focus on minimizing the problems caused by the disease. "If a patient takes good care of their feet," he said, "those feet should last their whole life."

Diabetics need to control their illness and be vigilant about inspecting and cleaning their feet, taking care to cut their toenails straight across and keep pebbles out of their shoes. Gonzalez said visits to doctors in his field are also important. "Especially men think this is like going to a pedicurist. In reality, it's not, especially if we're dealing with a diabetic patient that might also have poor circulation," he said.

Source: Erica Molina Johnson, El Paso Times  [04/05/09]

APWCA Meeting Breaks Attendance Records

If you’re looking for evidence that podiatry is approaching parity with other allopathic specialties, you need look no further than last week’s National Clinical Conference of the American Professional Wound Care Association (APWCA) in Philadelphia. The world-renowned faculty of wound care experts packed the voluminous ballroom. Most pre-conference workshops were sold out and many exhibitors were turned away for lack of space.     

Attendees at APWCA (Photo: Randy Fish, DPM)

Of note is the fact that this meeting, which has grown every year, is the brainchild of podiatrists Steven Kravitz, DPM (APWCA founder and executive director), Robert Gunther, DPM (APWCA president), and Larry Schuster, DPM  (Synergy editor). Throughout this interdisciplinary meeting, podiatrists interacted with physicians, nurses, and other wound care team stakeholders.

Patti Labelle Receives APWCA Outreach Award from Drs. Robert Gunther (L) and Steven Kravitz (R) (Photo: Randy Fish, DPM)

One of the highlights of the meeting was the presentation of the APWCA Outreach Award to legendary entertainer Patti Labelle. Labelle told attendees that she is a diabetic whose own mother had her legs amputated. APWCA announced the formation of the American Wound Care Foundation, a charitable non-profit organization dedicated to supporting patient education programs to help save limbs.

PA Podiatrist Captains Team in Long Distance Relay Race

On April 24, runners from 42 states and foreign countries will pass through Washington Township as part of the American Odyssey Relay Run Adventure, and 24 of them will be representing the greater Waynesboro area. Two teams of 12, captained by John Kelley and Dr. Stephen Bui, both of Waynesboro, will compete in the inaugural 36-leg race from Gettysburg to Washington, D.C.

Dr. Stephen Bui

When word of the American Odyssey Relay first broke, Don Baldwin, area coordinator for the race from South Mountain to Smithsburg, wanted to gather a local team to run. In August 2008, Dr. Stephen Bui of Advanced Foot and Ankle Care in Waynesboro began to pick up running as a sport. Baldwin, who was one of Bui’s patients, heard Bui was running the Philadelphia half marathon and saw an opportunity to find an Odyssey runner.

“He came to me and asked me if it was something I would be interested in,” said Bui. The doctor joined Baldwin in hunting down other participants and promoting the relay. “What I found out is that there’s a small group of people here who have been running together for a while,” Bui said.

Source: Matt McLaughlin, The Record Herald [3/28/09]
 

Medicine Slams FTC Over Forcing Physicians to Police Identity Theft

Organized medicine and the Federal Trade Commission continue to joust over the application to physicians of new identity theft prevention rules. With a May 1 compliance date just around the corner, neither party shows signs of capitulation.

The FTC regulations require a variety of business entities -- mainly financial and banking institutions -- to implement a written program for preventing identity theft as well as detecting and responding to warning signs of such incidents. The commission maintains that when physicians defer payment for services, they become creditors -- entities that regularly extend, renew or continue credit -- under the "red flag" rules. Failure to comply could mean administrative penalties or up to $2,500 in fines per violation. To be compliant, physicians must:

• Identify relevant warning signs of potential identity theft. Such red flags may include suspicious documents or billing activity, or notices from law enforcement authorities.
• Establish policies and procedures to detect red flags in day-to-day operations. These may include verifying a patient's identity and insurance information, or reviewing medical records for discrepancies. Implementing the process requires senior management approval and appropriate staff training.
• Prevent and respond to incidents of identity theft or suspected fraud. This might entail changing account numbers or contacting an insurance carrier to deter the misuse of stolen information. The response also may include notifying the patient of any potential fraud.
• Update the program periodically to help identify and respond to new risks.

Source: Amy Lynn Sorrel, AMNews [4/6/09]

Query: Ehlers-Danlos Syndrome

I have a 23 year old male patient who presents with a significant hallux valgus deformity and flat foot deformity secondary to Ehlers-Danlos Syndrome. The patient's primary concern is the bunion deformity as it is difficult for him to wear enclosed shoes.

Ehlers-Danlos Syndrome

With the ligamentous laxity, what would be the appropriate treatment plan for this patient; a Lapidus bunionectomy, midtarsal fusion, subtalar fusion, or triple arthrodesis?
 
R. Denis Russell, DPM, Fountain Valley, CA
 

Query: Child without Health Insurance

I was wondering if anyone could help me with a dilemma. I have a child that I have seen with a mass on the dorsum of his foot. I have performed an MRI which shows some bone erosion associated with the soft tissue mass but reads the mass as a probable benign process. The child was scheduled for excision of mass with biopsy, but the family recently lost health insurance. I would gladly perform the procedure without a charge but have no hospital that would eat their cost. What are some of my options and what is the best way to protect myself? Any suggestions would be appreciated.

Adam Cirlincione, DPM, Glen Cove, NY
 

RE: Purchasing Absolute Alcohol (Art Korbel, DPM, MD)
From: Multiple Respondents

SpectrumRx has what you need. They can be reached at: spectrumrx.com
 
Chris Majewski, DPM, Silver Spring, MD, christofeet@yahoo.com

You can obtain dehydrated alcohol injection for neurolysis procedures from your supplier (e.g., Moore Medical). I find that it would be cheaper to obtain them through your hospital pharmacy department.  They have volume discount, plus you can just buy a few vials rather than the whole box.

Stephen Bui, DPM, RPh, Waynesboro, PA,  DrBui@advFAC.com

I would advise against mixing your own, although I know most podiatrists do. I have purchased vials (source forgotten)... but to crack open the ampule, mix the proper concentration, and be consistent is technically difficult.  For many years now, I have had my compounding pharmacist mix a 50ml vial for me, and I  have always used 5%. I have him draw 2.5 ml out of the 50ml vial of .5% Marcaine with epi, and replace it with the anhydrous ethyl alcohol, to achieve the 5% mix. The compounded vial is good for one year, and I believe my cost is much less, and I am assured of sterility, and also consistency from injection to injection.  
 
Carl Ganio,  DPM, Vero Beach, FL, drcarlganio@bellsouth.net

RE: Scanners for Orthotic Fabrication (David E. Gurvis, DPM)
From: Pete Harvey, DPM, Dennis Shavelson, DPM

The scanners must work well enough for mass marketing. A local drugstore has teamed with a major podiatric supplier to provide shoes, scan the foot digitally, and dispense orthotics with the shoes. Next, you can buy “custom” orthotics at Sears. Yes, they can legally do this.
 
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

Arch supports of the pre-Rootian era were produced by everyone from a shoe salesperson to a professional such as a podiatrist. Dr. Root developed a working strategy that placed podiatrists as the biomechanics authorities. We have years of coursework, clinical practice and a working relationship with  orthotic labs that involved the labs producing a positive cast, an orthotic shell and additions, and modifications to a DPM’s Rx. Years of complacency, a focus on surgery, and insurance pressures on billing have reduced the time available to remain educated and experienced about orthotics.

A major selling point of the scans beyond reduced mess is that "we can teach one of your staff in 5 minutes to take the scan." The scan that lives in the mall already exists, and the DPM’s defense, "I am a doctor and so I make a better orthotic" is fast becoming ludicrous. I take an accurate plaster cast based on years of training and experience, know the plastics, the fillers, build a clinical picture, and expand that into a custom semi-rigid foot orthotic Rx that justifies my fees and my expected great results. If I am not using my skills, education and experience to remain the best at delivering care, then my scan is no better than that  of a shoe store.

It is time to wage professional war against “simple, fast, clean and requiring little education and skill” to what Dr. Root gifted us with. We are the closed-chain specialists of medicine.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab, drsha@foothelpers.com

RE: E-Prescribing (Howard Gale, DPM)
From: Glenn B. Gastwirth, DPM, Marc Katz, DPM

I wonder how many APMA members are taking full advantage of the free webinar archived on the APMA's members web site that provides simple instructions on how to receive a 2% cash bonus on your total annual Medicare reimbursements for a full year. The average DPM (2005 BMAD data) receives $104,000 per year from Medicare.

The 2% cash bonus for ePrescribing would equal more than $2,000. Also, look for the free APMA member webinar for PQRI reporting. This program was also made available to DPMs only through the advocacy efforts of APMA. Participation in the quality reporting initiative provides another 2% cash bonus on your annual Medicare reimbursement. These two programs more than pay for APMA and state component memberships dues. There is true value in being an APMA member.

Glenn B. Gastwirth, DPM, Executive Director and CEO, APMA, GBGastwirth@apma.org

I have been using National Erx since the  middle of 2008. This is a stand-alone web program. It is free and simple. You do not have to write all of the details of the insurance as the pharmacy has the information, just basics, including date of birth. My staff puts in all of the information. So, you do not need to spend the time. I have made a listing within the on-line program of all of the drugs that I use and their dosages and SIG. So, it is easy for my staff to pick the proper medication, dosage and instructions. The program will also notify you if there are problems or interactions. You can also run reports.

Here is the site to sign up: nationalerx.com/prescribers.htm If you want to integrate into your EMR, be prepared to pay a hefty fee. I did not go that route. You can then send the G codes to Medicare and receive 2%.  It all adds up! The G codes are as follows, no diagnosis required. You must report 50% of your patients. That's it, easy.

If ALL of the prescriptions generated for this patient during this visit were sent via a qualified e-prescribing system: REPORT G8443

If NO prescriptions were generated for this patient during this visit: REPORT G8445

If SOME or ALL of the prescriptions generated for this patient during this visit were printed or phoned in as required by state or federal law or regulations, due to patient request, or due to the pharmacy system being unable to receive electronic transmission; OR because they were for narcotics or other controlled substances: REPORT G8446 STEP 3: Repeat steps 1 and 2 for at least 50% of the Medicare FFS (Part B) patients.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment at Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER, 2009. Must have completed PSR-36 or similar. Submit applications to: Adam Landsman, DPM, PhD alandsma@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: May 1, 2009.  Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers. Women and minorities are particularly encouraged to apply.

ASSOCIATE POSITION - HENDERSON, NEVADA

Associate wanted for thriving, well-mixed 3-doctor digital office, leading to partnership. Surgery, diabetic, pediatric, and general podiatry. Great office and location, fun area to live. Need 2+ years surgical residency. Must be energetic, self motivated, great patient skills. Salary plus bonuses. Email CV to gtorgesen@yahoo.com

PODIATRIST NEEDED FOR MIAMI-DADE COUNTY

Multi office practice needs doctor of podiatry for full time and/or part time for private office, clinics, and nursing homes. Great opportunity to grow with and unlimited income potential. Offices in Miami, Hialeah, Westchester, and Cutler Ridge. Email to feetdoctor@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

Seeking a well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call. Opportunity for partnership at 2 surgery centers. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing Machine. Excellent referral base, and a well-trained staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to  FootAnkleAZ@aol.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PART-TIME NON-SURGICAL PRACTICE FOR SALE - NORTH JERSEY    
 
23 yo practice recently relocated to a spectacular newly-constructed and equipped storefront next to a busy supermarket with ample parking and senior citizens in vibrant downtown. Accepting Medicare and Blues only with great potential. Perfect for expanding to full-time, a second office or new practitioner with means and office experience.  Priced to sell. Financing possible. E-mail interest with contact to Mikedup1215@yahoo.com

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