The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 21, 2007 #2,917 Editor-Barry Block, DPM, JD

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Foot is “Mirror of General Systemic Health” - CA Podiatrist

“The foot can be a mirror to general systemic health,” says Christopher Mah, D.P.M., a podiatrist at Washington Hospital. “There are conditions that show up in the foot before they show up clinically in the general body, like diabetes.”

Dr. Christopher Mah

Dr. Mah says that is it not uncommon for someone with a significant problem with his or her feet to feel little or no pain. That is because sometimes poor circulation or a disease like diabetes causes numbness or limited sensation in the foot. A person may have an injury to the foot, a wound that is not healing, toenail problems or calluses that indicate greater health problems.

“People think they have a small sore on the foot which may turn out to be a full-blown infection,” Dr. Mah says. “This can happen with diabetes, and it means there is a problem for the whole body.”

Source: Tricity Voice [4/17/07]

Medicare Fraud Costs Billions Each Year, CMS Officials Testify

Medicare fraud costs billions of dollars each year, according to testimony from federal officials at a Wednesday hearing of the House Energy and Commerce Subcommittee on Health, CongressDaily reports. Acting CMS Administrator Leslie Norwalk said, "The fraudulent business practices of unscrupulous durable medical equipment, orthotics, prosthetics and supplies suppliers continue to cost the Medicare program billions of dollars," adding that CMS "has seen a marked increase in fraud and abuse activities over the past few years that can be directly tied to provider enrollment issues.

" Examples of fraud include paying kickbacks to physicians who prescribe high-cost wheelchairs when lower-cost equipment would be effective and filing Medicare claims for equipment never delivered or not needed. Medicare and fraud prosecutions have resulted in $11 billion in fines and settlements since 1997, according to the testimony of Daniel Fridman, senior counsel to the attorney general. At the hearing, federal officials also testified that the rate of mistakes by Medicare that result in overpayments or other errors is dropping.

Source: Congressional Daily via American Health Line [4/19/07]

Poorly Managed Type-2 Diabetes Costs System an Extra $22.9 Billion a Year

Those costs come from direct medical costs to treat heart, eye, kidney and other serious health problems associated with the disease, diabetes groups reported last week at a meeting of the American Association of Clinical Endocrinologists. Annual health costs for a type-2 diabetic are three times that of the average American without diagnosed diabetes, according to a new report called State of Diabetes Complications in America.

"It is a pretty significant wake-up call for people, or should be. It really points out the importance of managing the disease," said Willard Manning, a health economist at the University of Chicago who worked on the report. "We have tools today. The fact that people are still getting complications means we are not using our tools effectively enough," said Dr. Daniel Einhorn, who serves on the board of the American Association of Clinical Endocrinologists, which sponsored the report.

Diabetic complications cost almost $10,000 per patient each year, with $1,600 of that coming from patients' own pockets for costs not covered by insurance. That figure represents quite a bite for many diabetics, nearly 40% of whom had annual income of less than $35,000 in 2005. Treating type 2 diabetes alone costs about $37 billion a year. When people fail to follow their diet, exercise and drug treatment plans, the disease leads to complications that boost the total health bill to $57.1 billion.

The report estimates that one out of three people with the disease has one other serious health problem. One in 10 has two other serious health problems. One out of 15 has three other serious health problems, and one out of 13 has four or more.

Source: Diabetes in Control [4/17/07]

Query: 6E Rubber-Soled Baseball Shoes

I have a patient who is 72 years old and umpiring baseball and is in need of a rubber-soled baseball cleat-if available- in a size 9 1/2 width 6E. Does anyone have a suggestion as to where these may be obtained?

Charles F. Ross, DPM, Pittsfield, MA

Query: Videotaping Runners

If there is anyone who routinely videotapes runners on the treadmill as part of their sports medicine practice I'd appreciate some advice on the do's and don'ts (both from a medical perspective and a technical/equipment perspective) of establishing this service for my running patients.

James M. Petko, DPM, Falls Church, VA

Query: Billing For Off-Loading Shoe

How do I appropriately bill Darco shoes with Peg-Assist System insoles (www.darcointernational.com/wound/i_pages/peg.html) used for off-loading diabetic heel ulcers? This is a non-Medicare patient.

Neil Levin, DPM, Sycamore, IL

Response: This shoe is currently not classified with its own HCPCS code, however, the wound care shoe and inserts are a close cousin. SADMERC has approved L3260 (surgical boot) for the wound care shoe, and A5510 for the insert. I would suggest using these codes.

These codes are obviously not covered by Medicare, but some commercial carriers may have a coverage decision (pro or con) on these codes. Without a coverage decision you may be asked to submit a letter of medical necessity. If there is no coverage, as I suspect, then bill the patient.

Paul Kesselman, DPM, Woodside, NY

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RE: Psoriasiform Dermatitis? (Tip Sullivan, DPM)
From: Multiple Respondents

These conditions can be a nightmare for patients and doctors. We see a rash of these down here in Louisiana. First, I would assume that an appropriate biopsy was done to classify this condition. It appears that this has been done and it falls into this arm long list of eczematous processes with weird names. We find that the majority come back as a dishydrotic spongioform type.

We have had success with using fluorinated steroids under occlusion in the initial inflammatory/pustular stage followed by Elidel. Definitely consider a course of antibiosis for secondary infection. I would caution the use of systemic steroids for two reasons. One, if this was not properly classified you would not want to institute that therapy with a true psoriasis. Secondly, we have seen aggressive rebound even with the eczematous type dermatitis.

You will want to assess the patient for undue emotional stress and give them advice not to scratch the area, use cool water shower or bath, a 50% moisturizing non-detergent, non-everything soap, and lanolin free moisturizers. I have also had success using a compounded 10% coal tar solution.

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

Often these recalcitrant dermatitis reactions are a result of an overlooked irritant. Before proceeding with any further treatments I suggest a little detective work and review everything the patient is exposing their skin to. I have also found that the very treatments we apply to some of these skin problems propagate the reaction and have seen them clear up by removing all forms of steroids, lotions, creams, etc. Should this fail, I suggest Elidel cream 1% applied bid. While it is indicated for atopic dermatitis, it blocks cytokine production involved in cell-mediated reactions that you may find helpful in these difficult to treat localized skin reactions.

John A. Scheland, DPM, Dunmore, PA, limblengthener@yahoo.com

Many other possibilities come to mind with your photograph, but in essence, the patient may need to accept this as a chronic recurrent condition. Several dermatologists I know would have tried to be more aggressive with other psoriasis treatments despite this not being “real” psoriasis. Having said that, as this will probably be a chronic condition, oral and topical steroids should be avoided except when absolutely needed during a pruritic flair up and moisturizers/emollients used on a daily basis.

One moisturizer I have found to be very good, and also possesses mild anti-inflammatory properties, is unrefined Shea butter. A source of this is WWW.CanyonSunSkinCare.com. Avoid refined Shea butter, as it remains a good moisturizer, but loses any anti-inflammatory properties. (I have a financial stake in this company)

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Lawrence Harkless, DPM Retires from UTHSCSA
From: Tim Vogler, DPM, Ronald S. Lepow, DPM

Dr. Harkless has cut a path, graded a bed, and paved the road for many great practitioners in podiatry. He, as much as anyone in our profession, has served tirelessly to successfully promote podiatry to the medical community. I am thrilled that he will be moving to California to continue his career and influence in academic podiatric medicine.

Tim Vogler, DPM, Treasurer, North Carolina Foot and Ankle Society, Timothy.Vogler@cornerstonehealthcare.com

I would like to add my verse to the chorus of well-wishers and admirers for Dr. Harkless and all his accomplishments. We have been good friends as well as colleagues for almost 30 years. I have seen his commitment to raise the respect bar of our profession to lofty levels in our state, nation and indeed, the world of podiatric and orthopedic medicine. We will surely miss him in Texas but I cannot think of another member of our academic community more qualified or prepared to take on his new and challenging position.

Good luck Larry, We are all proud of you and anxious to support your new and exciting adventure in Pomona.

Ronald S. Lepow, DPM, Houston, TX, doclepow@gmail.com

Editor’s Note: This topic is now closed

RE: Bone Infarct in Sickle Cell Patient (Burton Katzen, DPM)
From: Godfrey Viegas, DPM

Consider 1st MTP primary fusion using intercalary bone graft (bone putty, possibly crushed cancellous graft, and possible autologous platelets). Use of a dorsal "locking" compression plate would work well (Nexa, Wright Medical, Acumed, and EBI). The patient will have a straight and pain-free great toe. Activities will be largely unaffected.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

Editor’s Note: This topic is now closed

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

Seeking Resident who wishes additional training: Baltimore, MD Mercy Medical Center

Resident position CPME accredited either 12 or 24 month commitment for a highly motivated individual 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 rsher18@yahoo.com

PRACTICE FOR SALE - WASHINGTON, DC

Priced to sell, 100% financing available. Owner leaving area. Hospital based 27 yr old practice with large surgical and diabetic population. Four fully equipped rooms. x-ray, topical hyperbaic oxygen units. Hospital privileges - full scope. 600+ new/yr. Will lease to you until final sale. Contact Dr Benjamin at jhallux@yahoo.com or (202) 841-5545 (cell).

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

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1 yr. Need Florida license. Fax resume to 561-865-2225

ASSOCIATE POSITION-YORK, PA

Excellent opportunity for PSR/24-/36 residency trained podiatrist to join 32 year established podiatric practice. Partnership opportunity. All aspects of podiatry, surgical, biomechanical and general podiatry. State of the art practice with up-to-date facility. Call and speak to Troy Wentling office manager or fax CV to 717-854-6519 or e-mail to beechtreepod@aol.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

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

PRACTICE FOR SALE- FLORIDA

A 13 y.o. well established podiatry practice in Tavares, FL ( Lake County ) the 23rd fastest growing county in the nation. This is an opportunity not to be missed. All aspects of podiatry with hospital privileges available. PRICED TO SELL! If interested, contact Susan at (352) 406-2513 or at acrysue@gmail.com

PRACTICE FOR SALE: LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

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

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 816-455-8901PRACTICE FOR SALE – CENTRAL FLORIDA

Well established surgical podiatry practice in Central Florida . Gross 2006 $744,136. Very attractive lease in an outpatient surgery center. Very low down payment. Contact Camille Todd/ Transworld Business 321 217 3625

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 - MANHATTAN

Park Avenue and East 70’s. Excellent opportunity to work with renowned podiatrist/surgeon in beautiful, upscale practice. Seeking candidate with 2-3 year residency program, strong surgical skills. Assist with case documentation Opportunity to buy in. Please send CV and references to iblevinelautin@aol.com

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

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