The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 09, 2008 #3,215 Editor-Barry Block, DPM, JD

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Unattractive Feet Can Cause Emotional Angst: PA Podiatrist

In the field of foot care, podiatrists and other experts are acutely aware that unattractive feet can cause significant emotional angst, driving those embarrassed about their feet to seek a solution. Dr. Nicolas Romansky, a Pennsylvania podiatrist, says that he commonly sees patients who hide their feet out of embarrassment. He says, "There's a psychological overlay to foot problems, especially with toenails."

Dr. Nicolas Romansky

Dr. Romansky says the distress resulting from unattractive toenails can be so extreme, he's had married patients who refused to allow their spouse to see their feet for years, sleeping and even having sex with socks on in order to keep their feet hidden.

Source: PR-Net [4/8/09]

The 2008 OCPM Hall of Fame Society Inductees are Announced

The Ohio College of Podiatric Medicine is proud to announce the 2008 OCPM Hall of Fame Society Inductees, who will be inducted on May 24, 2008 at the Glass Slipper Fete. The OCPM Hall of Fame Society is the highest honor given to an OCPM alumnus. The OCPM Hall of Fame Society is designed to recognize OCPM alumni who have demonstrated the highest moral and ethical values associated with podiatry, at least 20 years of dedicated service in the field of podiatry, and a strong appreciation of and loyalty to their alma mater, among other criteria.

Dr. Steven J. Berlin

Steven J. Berlin, DPM, Class of 1966

Dr. Berlin has been a member of the OCPM Board of Trustees since 1997. He has been awarded the Distinguished Service Citation, from the APMA and the Lifetime Achievement Award from Podiatry Management. He is author of over 50 publications, including Skin Tumors of the Foot, and Soft Somatic Tumors of the Foot.

Dr. Richard A. Ransom

Richard A. Ransom, DPM, Class of 1972

Dr. Ransom served as President of the OCPM Alumni Association from 1983-1984 and has been a member of the OCPM Board of Trustees since 1983. He holds an Honorary Degree, "Doctor of Humane Letters" from OCPM and is a Distinguished Practitioner in the National Academies of Practice.

Allan M. Spencer, DPM, Class of 1958

Dr. Allan M. Spencer

Dr. Spencer was a Clinician at the Cleveland Foot and Ankle Clinic from 1958-1997. and a Visiting Professor at Salford University, Manchester, England in 1979. He has an Honorary Degree, "Doctor of Humane Letters" from OCPM and is author of numerous publications, including Practical Podiatric Orthopedic Procedures.

Group Raises Concerns About Equipment Bidding Program

CMS should further delay the implementation of a Medicare competitive bidding program for durable medical equipment because errors made during the initial selection process improperly disqualified hundreds of suppliers from participation, according to the American Association for Homecare, CQ HealthBeat reports. In 2008, the program will operate in 10 of the largest Metropolitan Statistical Areas and will apply to 10 of the top durable medical equipment, prosthetics, orthotics and supplies product categories. In 2009, the program will expand to an additional 70 MSAs and will continue to expand in future years. The program also will apply to additional product categories in future years.

CMS currently pays for durable medical equipment based on a listed price. Under the program, durable medical equipment companies will submit bids to CMS, which will select suppliers based on cost and volume or on the potential savings for Medicare beneficiaries. The 2003 Medicare law mandated the program as part of a larger effort to implement competitive bidding for CMS reimbursements. The program, scheduled to take effect on July 1, likely will result in an average 26% decrease in the prices of medical equipment in the 10 MSAs, CMS said

CMS Administrator Kerry Weems said that the agency received more than 6,300 bids from medical equipment suppliers to participate in the program and will announce the winners of contracts by May. In addition, he said that small medical equipment suppliers, which CMS defines as suppliers with gross annual revenue of $3.5 million or less, accounted for 64% of those that won contracts.

Source: Mary Agnes Carey, CQ HealthBeat, [4/7/08] via American Health Line [4/8/08].

Query: Fracture Care Question

I saw a patient post injury. The x-rays were negative at that time. He was placed into a CAM walking boot as I was suspicious of a fracture. An MRI reveal an acute non-displaced fracture of the cuboid. I just saw this patient back, discussed my finding, instructed him to rest, and remain in the CAM walking boot.

My first visit was an office visit charge, a CAM walking boot charge, and the x-rays. What do I bill on today’s visit. Now that I know he has a fracture, do I bill fracture care. Do I just bill another office visit?

David E. Gurvis, DPM, Avon, IN

Response: Per the CPT and ICD-9 guidelines, you are to code what you know at the time of the encounter. So the first visit would be ICD-9 of signs and symptoms, not rule out or suspected conditions. If you go back and change that appointment, it takes away the medical necessity for the MRI that was ordered. Carriers/payers could determine that if you knew they had a fracture why did you order the MRI.

When the patient returns and there is now a confirmed fracture that is where you now assign the fracture ICD-9 code, and you could report global fracture care if indicated.

You can find this information in the ICD-9 Coding Guidelines as well as several ID-9 Coding Clinics on coding for what you know. And then regarding fracture care there are a couple of CPT Assistants such as the Feb 1997.

Margie Scalley Vaught, CPC, CCS-P, Chehalis, WA

Codingline subscription information can be found by clicking here.

RE: Extremity MRI (Jonathan Rosenblum, DPM)
From: David S. Wander, DPM

Jefferson Center City Imaging in Philadelphia, directly across the street from Jefferson University Hospital recently installed an extremity MRI. The films are read by the radiology department of Jefferson University Hospital. Unlike some of the earlier units, which were relatively "weak", this particular unit is a 1.0 Tesla and they are upgrading to a 1.5 Tesla and the images are excellent.

The patient sits in a chair similar to a podiatric/dental chair and the lower or upper extremity being imaged is placed through the unit. The chair simply rotates and moves to any desired position to allow the extremity to be placed inside the unit, while the remainder of the body sits outside the unit in the chair.

Jefferson is well known for its radiology department and would not purchase any unit that wasn't top notch. I believe that last year Jefferson's radiology residency was voted the #1 radiology residency program in the nation. If you would like me to obtain more information about the details of the unit, email me at padpm@comcast.net, and I'd be glad to help.

David S. Wander, DPM, Philadelphia, PA, dldjwander@comcast.net

RE: Injectible Cortisone Dosage (Jeff Kass, DPM)
From: Multiple Respondents

Dr. Kass raises an important point with regard to the prescribing of Neurontin or Lyrica. Some of these medications have been implicated in increases in suicide especially in younger people. I would go one step further. Other drugs which affect the part of the brain which controls emotions also have to prescribed with caution. By caution I mean taking a short mental health history. We ask every patient prior to prescribing Lyrica or Neurontin and even Cymbalta whether they have ever had any thoughts of committing suicide.

Asking personal questions about a patients emotional life might feel strange, but if you are about to prescribe the above medications, the answers are important. We also ask if they are taking any other medications used to treat mental disorders and if so, I get clearance from their psychiatrist before placing them on Cymbalta which is an antidepressant. All responses much be documented in the patients notes.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

It is interesting that Dr. Moglia has had problems with DepoMedrol 40mg/ml for fascial pain treatment. I’ve had the same experience after changing to DepoMedrol after the BSE (bovine spongiform encephalopathy) scare made getting Celestone Soluspan impossible some years ago. I’ve used 20mg/ml, 40mg/ml and 80mg/ml doses of the DepoMedrol and found that the numbers of patients calling the office with what appeared to be symptomatic of a steroid flare increased proportionately with the concentration. As such, I routinely use the 20mg/ml dosage for fascial complaints and can’t recall the last time I had anyone complain of a problem.

I also use it in a vehicle comprised of 1% Lidocaine with epinephrine, 0.5% Marcaine plain and buffer to physiologic pH with 8.4% Sodium Bicarbonate. I would recommend giving the smaller concentration a try. I’ve also found that the use of DepoMedrol was more effective in pain relief long-term than Celestone Soluspan, Kenalog 10 or Kenalog 40 and Dexamethasone phosphate and believe that the acetates cause more flares than the phosphate preparations. I’d like to hear was others are using.

David Secord, DPM, Corpus Christ, TX, David5603@pol.net

Depo-Medrol is incompatible with other solutions and is not to be mixed with any other medications such as local anesthetics. This is in the literature that the manufacturer supplies with the drug. This may be the reason you are having post-injection reactions. Additionally, if you inject insoluble steroids (acetate drugs) there is a good chance you will have a post-injection inflammatory reaction since acetate drugs have insoluble crystals. The crystals irritate the tissues and are a likely reasons that you are having a problem.

Stick to soluble steroids (phosphate drugs) such as dexamethasone sodium phosphate and the odds of a post-injection flare are almost nil. When using dexamethasone sodium phosphate, mix it in the syringe with one cc of your favorite local anesthetic and use anywhere from one to four mg. of the dexamethasone (it comes 4 mg/cc). If only mild inflammation is present, use one mg and if intense inflammation is present, use 3 or 4 mg. You will not see any post-injection reactions.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

Editor’s note: An extended-length letter from Dr. Kollenberg appears at: http://www.podiatrym.com/letters2.cfm?id=18864&start=1

RE: AMA’s Scope of Practice Report
From: Paul Bishop, DPM

Is the APMA, ACFAS or other podiatry society going to return the favor to the AMA regarding how we, as the most trained specialists treating the foot and ankle, need to protect the public from the undertrained, non-board certified MDs and DOs treating foot and ankle complaints? Find me a single non-orthopedic physician that has taken ONE year’s worth of CME regarding treatment of the foot and ankle. We need to protect the public from the obviously limited scope of training and practice regarding the foot and ankle that our non orthopedic, allopathic counterparts have.

APMA, please produce a white paper on this and provide a consensus decision that we are the foot and ankle caregivers. I was very pleased at the Midwest podiatric seminar last week, when our orthopedic counterparts, both in the US and from Europe, during their lectures frequently cited PODIATRIC literature as reference material. This is something that has for many years been ignored that we can produce top-level literature. Congratulations to us. It was a proud week.

Paul Bishop, DPM, Yorkville, IL,Feetpeople@aol.com

RE: Republican or Democrat? (Mathew M. John, DPM)
From: Jon Purdy, DPM

You won’t find many that are more pro-podiatry than me. My wife and I both practice. Positions we held or currently hold are; state component delegate to the APMA, treasurer of the state society, chairman of the bylaws committee, board member of a podiatric association, and President of the local medical society to name a few. We are constantly active in our community and within podiatric and medical societies on both local and national levels.

The question you raise of how one should consider voting for an elected official is a complex one. I can’t speak for all, nor do I think there is one correct answer. Should one approach a voting booth and pull every lever for the candidate that is pro-podiatry? I think this would be extremely short-sighted. There are many areas of legislation that tangentially affect the practice of medicine one may never consider. Besides, have you ever known politicians to consistently live up to their pre-election promises?

I personally vote for the politician that shares my views on more global issues such as the economy, personal freedoms, foreign policy, and defense. Most important to me is the politician that is fighting to limit their own political power and influence, and at the same time, working to provide incentives to Americans that work hard and “do the right thing.” In other words, giving me back more of what I earn, not taking from me every time a financial transaction is made, creating opportunity, and taking away barriers to success. If this particular person is pro-podiatry, then it’s icing on the cake. When I vote, I not only think of myself, I think of the future of my children and this country.

Jon Purdy, DPM, New Iberia , LA, jpurdy@mindspring.com

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. Fax resume to (412) 563-0740.

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual. Fax CV with hours available to (718) 458-0053

EQUIPMENT FOR SALE- OSTEOPOWER2 SAW, ETC.

I have a Osteomed saw with many accessories! It is in Immaculate condition asking $7,500 firm. Medical office notepads x2 with docking station and keyboard. 3 additional docking stations & keyboards for other rooms. $750 each. $50 each for the extra docking stations. email Harbor_Foot_and_Ankle_Clinic@msn.com Call (360) 533-7388.

PRACTICE FOR SALE - EASTERN WASHINGTON

Established practice located in the fastest-growing city in the state of Washington. Enjoy the lifestyle available in the area. Practice is directly across the street from the hospital - surgery center located within the hospital, and podiatric surgical privileges are not restricted. Gross $200K+ at 4 days per week. Can easily grow. 260 402-7490

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

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 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

ASSOCIATE POSITION - FLORIDA PANHANDLE

We are looking for a hardworking, ethical physician to join our busy practice. We are well-established and looking to expand. Must be a PS24+ with interest in all aspects of podiatric medicine and surgery. Partnership available. Fax resume to (850) 478-5227, call (850) 477-9015 or email PenFootAnk@aol.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PRACTICE FOR SALE - AUSTIN TEXAS

Live and work in the best place in Texas. 14-year established practice which includes beautifully finished office condo. Own a practice AND real estate. Nicest office in town. Located between 2 major hospitals and in the most heavily populated part of town. Major employers including Dell and IBM. Office can support 2 podiatrists easily. Serious inquiries only. mrobsondpm@aol.com 512 585 0242

ASSOCIATE POSITION – CONNECTICUT

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Podiatrist to add to our three-physician Podiatry division based in Hartford. Provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. PSR-36 training and board certification or eligibility and excellent surgical and wound care skills required. We offer competitive salary and productivity bonus, partnership opportunities, excellent benefits, and reasonable overhead. Apply online at https://home.eease.com/recruit/?id=21426 or via our website or fax your CV to 860-524-2653. No phone calls. EOE.

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, AZ

Multi-location office and soon to start a wound care office in a local hospital. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, Vascular Testing /Nerve Testing Machines and our own ESWT. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com

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.

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