The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 14, 2012 #4,436 Publisher-Barry Block, DPM, JD

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MA Podiatrist Hopes to Prove that Music Can Improve Gait

What do you get when you mix a musician with a physician, both on a mission? In the case of Rick Bausman of Edgartown and Dr. Jay Segel of West Tisbury, the hope is to come up with some relief for those who suffer from Parkinson's disease and muscular dystrophy. Dr. Segel has been a podiatrist on the Martha's Vineyard for more than 25 years. Foot and ankle problems, which podiatrists address, are often triggered by the way we walk. By precisely measuring how someone's feet strike the ground, a podiatrist is better able to assess and address biomechanical problems in that person's gait. 

Dr. Jay Segel analyzes gait (Photo Rick Bausman)

What would happen if the subject were measured twice, in rapid succession, with a bit of drumming interspersed between the two? Or, as Dr. Segel put it, "does the program that Rick puts forth in the Drum Workshop help stabilize, improve biomechanics, function, reduce shakiness in a person's gait?" Segel uses a diagnostic device called TOG GaitScan, which measures and records the impact of a foot-strike on a highly sensitive pad on the floor. Dr. Segel sees promise in the protocol. "I am already getting results," he said. "I can tell you that, from the people we've scanned right now, we are cautiously optimistic."

Source: Whit Griswold, The Martha's Vineyard Times [4/11/12]

Misuse of Flip-Flops Leads to Injury Potential: NY Podiatrist

Snow and cold weather have been in short supply in 2012 and this past March was the warmest on record. So it’s no surprise that sandal season is getting an early start. The podiatrists at Hudson Valley Ambulatory Surgery, LLC, advise that while nothing beats sandals for warm weather comfort, wearers of flip-flops, strappy heals, wedges, and sandals for men need to take extra care to keep their feet healthy and safe.

Dr. Gregg K. Atlas

“Flip-flops are extremely popular, and that is bad news for feet,” says Gregg K. Atlas, DPM. “These quintessential summer sandals were designed for the beach and pool, not for everyday walking or summer sports. The lack of arch support can cause foot and heal pain, along with tendonitis.” Dr. Atlas notes that his practice treats more patients in the warm weather months for bruised, sprained, and broken ankles and for damage to ligaments that result from wearing flip-flops.

Ankle Injury Started FL Podiatrist on His Career Path

Dr. Jonathan Cutler, a doctor of podiatric medicine with offices in Royal Palm Beach and Lake Worth, has spent his 25-year career focused on the foot and ankle. He sees patients of every age, from babies to the elderly - including quite a few weekend warriors with sports injuries from overuse.

Dr. Jonathan Cutler

An injury to his own ankle in high school derailed his aspirations of an athletic career and set him on a path to medicine. Cutler studied at the Dr. William M. Scholl College of Podiatric Medicine after graduating from Washington University in St. Louis. He did his surgical residency at Johns Hopkins-Liberty Medical in Baltimore.

Source: Janis Fontaine, The Palm Beach Post [4/12/12]

Valeant Pharmaceuticals Acquires Pedinol

Valeant Pharmaceuticals International, Inc.  has acquired Pedinol Pharmacal, Inc. for less than 1.5 times sales. Revenue for 2011 was approximately $18 million. Farmingdale, New York based Pedinol Pharmacal is a privately held specialty pharmaceutical company focused on meeting the needs of podiatrists and their patients.

Pedinol Pharmacal was founded in 1925 by Dr. Harry Goldwag and purchased by Richard Strauss in 1969. It has been led by CEO Gary Strauss since November 2009.

Source: Tech Finance News [4/12/12]

CMS Backlog Shortchanges Doctors on e-prescribing Exemptions

Some physicians are reporting that the Medicare payments they’ve received for their services in 2012 are being reduced for a failure to prescribe enough electronically in 2011, even though the doctors filed waiver requests seeking special hardship exemptions. The Centers for Medicare & Medicaid Services could not process all hardship application requests before starting to levy the 1% penalty for non-compliant physicians in 2012, officials said.

The agency said it since has approved or denied all of those exemption requests, requiring contractors to reprocess claims for physicians unfairly penalized earlier in the year. CMS now is accepting hardship requests from physicians looking to avoid the 2013 e-prescribing penalty, which will grow to 1.5%. The agency reopened the application website on March 1, and physicians seeking waivers will have until June 30 to file their requests.

Source: Charles Fiegl, AMNews [4/9/12]

Query: Q-Clear Laser
 
I would like to know if anyone is currently using the Q-Clear Laser and what their experience is with the laser. Does it work? Are the treatments painful for patients? Are there any hidden costs associated with it?
 
Bryan Satterwhite, DPM, Southport, NC

Query: Code for Adjusting a Brace

A patient presented for evaluation. He had seen another doctor and bought a brace online. I noted that the brace was too loose, and the upright needed to be heated and adjusted. Is there a code for this adjustment, or is this part of my evaluation and management service? The brace was a DonJoy MS Velocity hinged ankle brace (L1971) that the patient purchased online to avoid paying the other physician's fee, which typically would have included fitting and adjusting the brace.

Allen Sater, DPM, Jupiter, FL

Response: I would offer the patient the opportunity to allow me to fit him with a properly sized L1971 (assuming I agreed that one was necessary) from my office including any required heat adjustment and fitting. That was probably what the first doctor recommended. If the patient refuses, he could figure out how to make his own custom fitting/adjustments to his store-bought brace. I'm sorry, I have a diminishing tolerance for this type of "patient".

Lawrence Horn, DPM, Ridgecrest, CA

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RE: Onychomycosis in a Ten Year Old (Tip Sullivan, DPM)

The query is about using oral Lamisil with a ten year old. I do not own or use a laser, however, this seems to be an ideal situation for its use.  My opinion is that the laser is an excellent modality when oral medications are contraindicated or not otherwise documented.

Richard A. Simmons, DPM  Rockledge, FL, RASDPM32955@gmail.com

RE: Excisional Biopsy (Joe Borden, DPM)
From: Gino Scartozzi, DPM
 
The lesion as described by the practitioner as "pulsatile" concerns me as to whether there has been adequate pre-operative planning. The fact that the lesion easily bleeds and has developed after trauma strongly suggests a granuloma or hemangioma of some variety. A lesion of this size and clinical presentation may be a possible cavernous hemangioma.
 
I recommend prior to performing an "excisional biopsy" on the region of the heel, an MRI be obtained to determine if there is a larger arterial-venous malformation plexus present beneath the skin that may be hidden to the practitioner. If such vascular etiology is found, a vascular consultation may be requested pre-operatively. In addition, the skin coverage on the heel of a lesion as described as 2 cm x 5 mm may require plastics consultation pre-operatively to determine which method of closures are available, since skin mobilization for closure in this region of the foot is more difficult than in other regions of the foot. An "incisional" biopsy, dependent on the MRI results, may be obtained and would be more beneficial to determine the etiology (malignant vs. benign.) When the determination of the lesion's malignancy potential is found, the lesion's skin closure and treatment with an oncologist can be better planned.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: My New Favorite Surgical Instrument
From: Aaron Solomon, DPM

I have found my new favorite instrument, the Synthes screw head grasp. It is basically a forceps for grabbing onto the head of a stripped screw in order to remove it. I know this does not sound that exciting, but when you are removing a 4.0 mm screw from the foot and it doesn't cooperate only a quarter of the way out of the foot, it tends to be a little frustrating. The instrument allowed me to easily remove the stripped screw in a few seconds. 

I recommend to my colleagues to familiarize themselves with the Synthes broken screw removal set, and to have it ready for hardware removals as these can be extremely unpredictable procedures. This is in no way meant to hurt the Allis clamp's feelings as it is now my second favorite instrument. I am sure I will encounter a stubborn soft tissue mass or bone fragment that will bump the Allis back to number 1, but for now, it is the screw head grasp.

Aaron Solomon, DPM, Chattanooga, TN, asolomondpm@comcast.net

RE: No More Paper Medicare Remittance Advice
From: George F Jacobson, DPM

We were just notified from CMS (First Coast) that in 20 days we will no longer have paper explanations of benefits (remittance advice).  We will have to contact our Medisoft vender for instuctions as to how we can access the ERA, which will be sent to Capario, the clearinghouse for our data. CMS will send the data to them. 

Twenty days is insufficient notice to entirely change a system! Has anyone else received this letter? Has anyone been granted access to look up and print out your patients' RA from the ERA? There is free software available, but you need a separate ERA receiver ID. There is a form to request an ERA receiver ID, but I'm afraid that it might cause problems with our clearinghouse's ID and authorization to receive and send data on our behalf. CMS is making practice tiresome! What's next?
 
George F Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: Getting Exempt or Penalized from eRx (Tony Poggio, DPM)
From: David Taylor, DPM

We successfully opted out of the eRx "program". The vast majority of our Medicare patients are diabetic, returning for established problems that do not require an E and M code necessary to to satisfy the eRx requirement. In addition, Allscripts charges $20 per doctor per month to use their app on a smart phone (It is free for a desktop computer).  Check the Medicare website and you will find the information. Once you find the form, you can submit it electronically.
 
David Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

PRACTICE FOR SALE - SOUTH NEW JERSEY

Great practice for sale, lease it, work in practice, rent-free first year, associateship possible. Must have NJ licensure have own TIN participation for Horizon, Cigna, Aetna, etc. Retiring. Anyone is welcome to make offer or come up with other ideas. Contact footcare@comcast.net

PRACTICE FOR SALE - AUSTIN TEXAS

Great opportunity for new practitioner or an additional office. 18 year practice with large patient base. Current physician transitioning to part time then retiring to pursue another business opportunity. Start turn-key without need for a bank loan. Great area to live and work. Susieintx@aol.com (512) 565-6634

ASSOCIATE POSITION - PART TIME - OCEAN COUNTY, NEW JERSEY

Looking for PSR 24/36, board eligible preferred. Busy podiatric practice with up to date EMR & practice management program. Practice currently offers digital x-rays, ultrasounds, vascular studies and laser treatment. Good mix of general podiatry, wound care and surgery. Must be ethical, hardworking and committed to quality patient care. NJ license needed. Competitive salary and benefits. Send cover letter and resume to: AOKNDPM@gmail.com

PODIATRIC SPORTS MEDICINE FELLOWSHIP - ORANGE COUNTY CA

July 1, 2012 and ending July 31, 2013 (13 months). Responsibilities include assisting in all types of foot and ankle surgery, (approx. 500 cases), office and outside rotations including Sports Medicine Orthopedics Family Medicine, Biomechanics and Physical Therapy. Benefits include salary of $60,000/year, medical, dental, malpractice, and CME allowance. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Min. 24-month surgical residency training is a pre-requisite. Letter of interest, and CV to: Philip Radovic, DPM, Fellowship Director, 665 Camino de los Mares Suite 304, San Clemente, Ca. 92673. Ph: 949/493-8020 Fax: 949-488-0868. Email: Info@feetfixer.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

ASSOCIATE POSITION - TENNESSEE/NORTH GEORGIA

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference to mybestnewjob@gmail.com

ASSOCIATE POSITION – VIRGINIA
 
Two office practice, hospital and surgery center privileges, trauma call, modern offices, EHR, digital x-rays. Excellent compensation package. Position may lead to partnership. Candidate needs to be experienced in foot and ankle reconstruction and trauma. Email letter of interest and CV to Dr. Joe Disabato at jdisabato@vfasa.com 

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, Indiana, and Oklahoma. 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 - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - ATLANTA, GEORGIA AND SURROUNDING COUNTIES

Village Podiatry Centers, LLC: Immediate openings for board eligible or certified, 3-4 year trained surgical physicians. Equity based model, Excellent salary and benefits to start depending on qualifications. (Average physician salary is 2-3 times industry median salary).Full benefits included. Access to practice owned surgery centers, pathology lab, imaging center(s), and other in house ancillaries. Very selective process: must be flexible, well trained, and must participate in our "Physician Training Program." You live off income and retire off wealth! Serious inquiries only! E-mail: David N. Helfman, DPM, FACFAS at dhelfman@vpcenters.com

ASSOCIATE POSITIONS, PART TIME - CA & TX

California- San Diego, San Jose, Los Angeles; Texas- Houston, Dallas. The duties include: Diagnosis and treatment of onychomycosis using Pinpointe Laser in our facilities. Office hours are 9am-9pm 7 days a week; schedule for shifts is very flexible. Email CV to ofer@lasernailtherapy.com

ASSOCIATE POSITION - SENIOR CARE DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: Immediate openings for physicians who are interested in caring for the elderly in nursing homes throughout Georgia. Full time position. Excellent salary, benefits, and opportunity for growth. Must understand the coding/billing process and have excellent documentation skills. You don't have to be board certified in foot or ankle surgery for this position.
If interested, please contact Dr. Helfman at dhelfman@vpcenters.com

ASSOCIATE POSITION - ILLINOIS

Established, progressive, busy Chicago practice seeking PSR 24/36 individual with good people skills to join 3 man group. Senior Associate retiring. Excellent opportunity leading to partnership for energetic, motivated, ethical professional. Submit CV to JAF@APLfeet.com

PHYSICIAN FOR CLINICAL RESEARCH DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: If you have experience in running clinical research trials and would like a full time position in managing and overseeing multiple clinical research trials for our growing group, please contact Dr. Helfman @ dhelfman@vpcenters.com. Excellent salary, benefits and equity opportunity for the right individual.

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 – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes. e-mail letter of interest, CV, and references to basewedge@yahoo.com

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