The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 16, 2012 #4,437 Publisher-Barry Block, DPM, JD

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Botox Can Relieve Foot Pain: NY Podiatrist

People with aching feet are opting for Botox—even though it’s not approved for treating the problem. Small cushions of fatty acids that protect feet from torque and shear are decidedly crucial as we pound through life. But wearing high heels can wear out the fat pad at the base of the toes. And thin-soled athletic cleats and steroid injections for plantar fasciitis (a frequent cause of chronic heel pain) can sometimes shrink padding under the heel and on the outer arch contact area. Aging, having diabetes, or being overweight also put feet at risk. 

Dr. Alan Berman

“Pain occurs when areas of the feet are subjected to unaccustomed strain as the padding deteriorates,” explains New York podiatrist Alan Berman. Botox injections may relieve pain for about three months or the amount of time the drug remains in the system, according to ongoing research. Plumping up sore feet with newer skin fillers (Juvederm, Sculptra) also seems promising. “Wearing supportive insoles such as Lynco or Spenco inserts and well-fitting shoes remain the gold standard for lasting relief,” advises Dr. Berman.

Source: Wendy Braun, Saturday Evening Post [4/12/12]

Internationally-Known Diabetes Expert Lectures at NYCPM

Benjamin Lipsky, MD, internationally-known expert in Infectious diseases and management of diabetic foot infections, visited NYCPM on Friday, April 13 to deliver a distinguished guest lecture, “Update on the Assessment & Management of Diabetic Foot Infections." Dr. Lipsky is Professor of Internal Medicine and Infectious Diseases, University of Washington School of Medicine. He is author or co-author of 176 peer-reviewed publications. 

(L-R) Drs. Thomas DeLauro, Chair, Dep't of Medicine, Mark Kosinski, Professor, Dep't of Medicine, Benjamin Lipsky, Michael Trepal VP for Academic Affairs & Dean, and Mark Swartz,  Professor, Dep't of Medicine and VP, Medical and Professional Affairs.

Dr. Lipsky was extremely well received by a packed lecture hall consisting of students, residents, and faculty

IL Podiatrist Volunteers for 10th Year at Radio "Shar-a-thon"

Dr. Joseph Borreggine with WBGL DJ Pam Peoples

Dr. Joseph Borreggine served as volunteer answering phones this week in WBGL's annual "Shar-a-thon" which raises money for this totally listener-supported Christian radio station. This is Borreggine's 10th year volunteering. The monies raised are traditionally used to support missions, the poor, special projects held throughout the year sponsored by the station, and to help supplement operating expenses.

Simple In-Office Test Can Detect Diabetic Neuropathy: CA Podiatrist

About 60 percent of all diabetics in the United States have some degree of neuropathy, though many aren’t even aware of it, according to the National Diabetes Information Clearinghouse. A simple test in the doctor’s office can determine if a person has neuropathy, says Karen Farac, DPM, a podiatrist in Vallejo, CA, and director of the Haight Ashbury Medical Clinic in San Francisco.

Farac teaches her students from the California College of Podiatric Medicine that poor circulation, structural deformities of the foot, skin or nail conditions, previous infections or ulcers, and even an abnormal gait can also put diabetics at risk for foot problems.

Source: Newsolio [4/13/12]

‘Monetary Enforcement’ Is the New Aim Of OCR

The $1.5 million settlement that the Office for Civil Rights recently reached with BlueCross BlueShield of Tennessee heralds a new era of “monetary enforcement” by the agency, in contrast to its long-standing approach of what OCR Director Leon Rodriguez termed “hand-holding.” In an interview with Report on Patient Privacy, Rodriguez discussed the settlement and OCR’s plan to refocus its enforcement in pursuit of what he called “high-impact cases.”

Rodriguez emphasized, as well, that covered entities (CEs) and business associates (BAs) in the future will face sanctions on all lapses discovered during an investigation regardless of whether they are directly related to the incident that sparked OCR’s attention in the first place. And it’s not just CEs that will be the agency’s target. After the final business associate regulations go into effect, OCR will be able to impose settlements and penalties on BAs, but not to the exclusion of CEs, Rodriquez said.

Source: Report on Patient Privacy [4/13/12]

Query: Podiatry-Specific Version of Dragon

Which version of Dragon contains the most podiatry-specific terminology? 
 
Greg Caringi, DPM, Lansdale, PA

RE: Onychomycosis in a Ten Year Old (Tip Sullivan, DPM)
From: Bryan C. Markinson, DPM

The following summarizes the work of Gupta, et al., establishing the safety and dosing for terbinafine, itraconazole, and fluconazole in children. Keep in mind that these agents are not approved for use in children for onychomycosis. It is absolutely mandatory to have laboratory confirmation of the organism before starting therapy: 

Dosage Recommendations for Children

The following are dosage regimens for children with onychomycosis:

Terbinafine: If patient weighs less than 20 kg, dose is...

Editor's note: Dr. Markinson's extended-length note can be read here.

RE: Excisional Biopsy (Gino Scartozzi, DPM)
From: Simon Young, DPM, Hilaree Milliron, DPM
 
Dr. Scartozzi brings up a valid point. This could be done with an ultrasound. Check compressability. Use a duplex Doppler component to check for vascularity.

Simon Young, DPM, NY, NY, simonyoung@junocom

I suggest pre-operative imaging to delineate margins, depth of involvement, anatomic detail, and mass characteristics, etc. An MRI, with and without contrast, should be sufficient. Many assumptions can be made as to benign/malignant characteristics simply from imaging.  Those characteristics and anatomic detail will be altered post-operatively. Please image and have it read by a reputable radiologist before you even consider biopsying suspicious lesions. 

Hilaree Milliron, DPM, Jacksonville Beach, FL, millirondpm@gmail.com

RE: Medicare Giving Us More Work to do to Get Paid
From: Bret Ribotsky, DPM

For anyone using Medicare First Coast (Florida) starting April 16th, all use of the "24" modifier will require you to provide documentation in advance of payment. Thus, if your patient has a procedure performed on one foot/toe that has a global period of 10 or 90 days and you see that patient again for a completely new problem on the other foot, you will need to send in your documentation and wait, wait ,wait for your money. Check it out. 

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@gmail.com

RE: Code for Adjusting a Brace (Allen Sater, DPM)
From: David E. Gurvis, DPM

I would tell the patient that if I get and fit an ankle brace, and make an adjustment, it is covered in my original fee.  If I were to make an adjustment to a brace bought online and something goes wrong (breakage?), I cannot be responsible.  I have them sign a waiver to that effect. I then estimate the amount of work involved in the adjustment, and tell them how much it is going to cost CASH. Otherwise, I cannot do the adjustment. The adjustment is ala carte and not covered in the office visit.
 
David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: MA Podiatrist Hopes to Prove that Music Can Improve Gait

What an incredibly imaginative and fertile idea. Hats off to Dr. Segel. It will be fascinating to see if this process proves fruitful.
 
Howard Lepolstat, DPM (Retired), Sun City West, AZ, TeachrComp@aol.com

Codingline & PM News
In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop - August 20-22
(Following the 2012 APMA Annual Scientific Meeting in Washington, DC)  

The Greenbrier, White Sulphur Springs, WV

Speakers: Harry Goldsmith, John Guiliana, Barry Block, Michael Brody, Paul Kesselman, Jonathan Moore, Rem Jackson, Chad Schwarz, and other nationally-known authorities. 

Tax Deductible for 2012 

Click Here for information or to Register

RE: Nd-YAG Laser 90% Effective Eradicating Toenail Fungus: IL Podiatrist
From: Bryan C. Markinson, DPM

The "Podiatrist in the News", Part 2 - PM News 4-13- 2012 highlights Dr. Kevin Gavin and attributes to him the following quotes regarding onychomycosis therapy: "Topical medications require application twice daily and work less than half of the time. Oral medications can be toxic to the liver and are no more effective." Really?

Oral medications are no more effective than topicals? The article continues with this quote: "The Nd-YAG Laser at the Foot & Ankle Institute requires no anesthetic, no medications, and has proven itself to be 90% effective in eradicating toenail fungus for many patients in my practice over the last year." WOW! 90% effective for MANY patients? Does anyone know...

Editor's note: Dr. Markinson's extended-length note can be read here.

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 tomybestnewjob@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

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) 565-6634PRACTICE 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

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.

Midtown Manhattan Office Space Available
 
Office space available Wednesdays & Fridays (possibly Saturdays) on 46th & Madison. 2 Exam Rooms + Reception Space. Share with General MDs, Chiropractor & PT's. Potential for cross referrals. Downtown space at Fulton & Nassau also available on Thursdays. Call Kathy @ 646-483-1337 for more details.
 

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

PM News Classified Ads Reach over 13,500 DPM's 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 13,500 DPM's. 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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