The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 22, 2011 #4,141 Publisher-Barry Block, DPM, JD

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Compromised Individuals Should Avoid Self-Diagnosis of Foot Problems: IL Podiatrist

Dr. Allan Shoelson, a podiatrist at the Rush University Medical Center, says “Individuals who suffer from diabetes, poor circulation, or heart problems should have all their foot problems evaluated by a podiatrist instead of trying to diagnose and treat it themselves,” he says.

Dr. Allan Shoelson

He cites the example of warts that often masquerade as a callus. Warts are caused by a virus, which enters the skin through small cuts. “They may look like a callus with the thickened skin. But if the area is mistakenly pumiced, an ulcerous hole in the skin may develop that will lead to infection. And that could result in amputation for someone with diabetes,” he says.

Source: Jean Guarino, Chicago Sun-Times [4/19/11]

GA Podiatrist Provides Advice for New Runners 

Dr. Perry Julien, a sports medicine podiatrist and author of "Sure Footing," says revisiting the basics is important because  so many people are constantly new to running or to exercise. "It's very common for new runners to get themselves into trouble," Julien said. "They do too much, too soon. They're wearing the incorrect shoes. They don't allow time to warm up or cool down. They're not stretching."

Dr. Perry Julien

"One of the effects of exercising - you're creating microinjury to the tissue, which as it heals, it heals stronger," he said. "But the more you injure it, the less potential it has to heal." "If you're walking or running on an injury - exercising on an injury, you can make it worse and you can increase the time it takes to actually heal that injury."

Source: CNN [4/18/11]

PA Podiatrist Running for Re-Election to City Council

Three incumbents and one challenger are vying for three seats on Carbondale City Council. Democratic candidates for the four-year seats are Gerald J. Arnese and current council members Kathleen Connor; Joseph C. Marzzacco, DPM; and Anthony Perri. 

Dr. Joseph Marzzacco

Dr. Marzzacco attributed the growth in tax revenues to increases in the tax rates. "Our tax base has actually not increased," he said. "We must continue to seek to make Carbondale a place where people want to live to get a sustainable increase in revenues."

Source: Caitlin Heaney, The Times-Tribune [4/20/11]

CMS Reports on PQRS, e-Script Bonuses

The CMS paid more than $234 million in Physician Quality Reporting System bonuses in 2009, the agency announced, more than double 2008's $92 million.

In addition, in 2009, the first year of the CMS' e-prescribing incentive program, CMS paid $148 million to 48,354 physicians and other eligible professionals, according to a CMS news release.

The average bonus payment for the e-prescribing program was just over $3,000 per eligible professional and $14,501 per practice, according to the CMS.

Source: Paul Barr, Modern Healthcare [4/20/11]

Query: Finding Out Patients' Deductibles

I recently went to the pharmacy to discover that, in a matter of a few keystrokes, the technician could find out my deductible and how much I had left to pay. Why is this information so readily available in the pharmacy world, yet my staff has to jump through 22 hoops to get this information in a 15 minute telephone conversation? Why do some insurance carriers even use HIPAA as a reason to NOT disclose the outstanding amount of a deductible if it is so readily available in pharmacy?

Steven Block, DPM, Owensboro, KY

RE: Post-op Nail Complication (Brent Rubin, DPM)
From: Alec Hochstein, DPM

This case is quite interesting, and one that anyone of us as podiatrists could be faced with. Although most nail procedures heal within three weeks, there are always the outliers. This case certainly qualifies as being outside the normal healing range. Therefore, it requires asking a few questions. Was the nail infected prior to the procedure? Where on the nail bed was this biopsy performed? Have you re-cultured since original culture was taken? Dr. Rubin states that it looks like a "normal" post-op nail ... Is it still draining? Do you have recent plain films? Is it at all possible that there is a retained nail spicule or foreign material from the procedure?

Alec Hochstein, DPM, Great Neck, NY, greatneckfootdoc@me.com

RE: Pecos Registration (Richard Rees, DPM)
From: Susan M. Weeks, PMAC

I took the liberty of looking up Dr. Rees on the PECOS list, and three Richard Rees were listed. It was my experience that we did not receive any "official" notification, but continually checked the list to see if my doctor's name appeared. The list only contains the NPI#, first and last name of the doctor. This document is currently 16,000 pages long. I would like to compare his NPI# with the ones on the list and save him the money and frustration of hiring an outside agency.

Susan M. Weeks, PMAC, Knoxville, TN, weekssusan@bellsouth.net

RE: Insurance Grandfathering (James M. Petko, DPM)
From: Shari Lee

My understanding is that if you had a policy in effect as of last year, you would have been covered under the Patient Protection and Affordable Care Act (PPACA). If you decided to choose a lower cost plan, your plan would lose its status as being grandfathered under PPACA. PPACA would help keep your costs more controlled, because without being grandfathered, your policy would now have to start following the new laws in healthcare under the Obama plan, e.g., physicals covered at 100%, children covered until age 26, etc., as the law for the changes become effective.

If grandfathered under PPACA, you do not have to follow these laws. Being grandfathered would protect you indefinitely against the rising cost associated with Obama healthcare. It is something you need to consider before changing policies as we don't know what Obama Care is going to do to insurance premiums.

Shari Lee, Columbia, SC, midlandspodiatry@bellsouth.net

RE: Cryoprobe (Mark Aldrich, DPM)
From: David T. Taylor, DPM

I purchased the Cryoprobe about two years ago and returned it after a month of use. It's a well-machined device, however, when it's inverted (treatment end up) the nitrous oxide does not "flow" well. The Cryoprobe will be inverted if you are treating plantar warts unless the patient is in the prone position. In addition, I had to insert a new cartridge for each patient regardless of the number of lesions treated. I don't think the $2,000 device offers a distinct advantage over other methods for cryotherapy.

David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

The following is based upon my use of Cryoprobe for the past year. Histofreeze is CO2, whose boiling point (converts from liquid to gas) is -70 F. Cryoprobe uses NO2, whose boiling point is -127 F, so it's much colder than Histofreeze. But the gold standard for freezing lesions has always been Nitrogen, whose boiling point of - 320 F is almost 200 F colder than even NO2! So even the freezing capability of Cryoprobe is nowhere near that of liquid nitrogen.

This will raise some eyebrows. My personal experience...

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

RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Joseph D. Quattrone, DPM

I have fairly extensive experience with many bone stims. The Exogen 4000 by Smith and Nephew (using U.S. vs Estim) is by far the best. I just had a patient come in after walking on a non-stable 4th met shaft fracture, and within one month, post-20 minute daily use of the Exogen, she was not only healed but nearly totally remodeled as well! This includes all the resorption of the bone callous and laying down of new bone! It was astounding. This female is 59 and is quite osteopenic.
 
As a matter of fact, one of my colleagues used to use this same stim in Ilizarov procedures but quit doing so because it was healing bone too fast. More than likely, you are going to have a problem with coverage, since it is indicated for non-unions or delayed unions more than 90 days old. Your S & N rep may have some assistance for your patients if they are going to be cash pay, but I am guessing that they will balk at a $3,000 to $4,000 out-of-pocket bill. I love the idea though.
 
Joseph D. Quattrone, DPM, Palm Bay, FL, docq1001@yahoo.com

RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (Elliot Udell, DPM)
From: David Finkelstein, DPM

Although I don't take blood pressures on all my patients, I do take them on all nail and wart surgeries done in the office. But one day when a lady was bringing her mother in for nail care, she came up the reception desk and said her mother was still in the car and not feeling well so she was going to take her back home. I insisted that she bring her into the office and seat her in the reception area. Her blood pressure was extremely low and she was lethargic. I called 911 and she was transported to the hospital. She ended up getting a pacemaker, and had she gone home, she would have died. Another life saved by simply taking a blood pressure.

David Finkelstein, DPM, Oak Lawn, IL, dfinkelstein@pol.net

RE: Clarification Lympha Press USA
From: Marv Boren, DPM

I would like to correct an earlier post that I submitted, which in my disclaimer, I mistakenly stated that I was an independent sales representative of Lympha Press USA. I am rather an independent rep of American Compression and Wound Care, LLC which is a distributor of Lympha Press Systems. Lympha Press USA does not have independent reps, nor do they sell directly to physicians or consumers.

Marv Boren, DPM, Canton, OH drboren@smartdrs.com

RE: Still More Malapropisms

I've got pretty decent hearing, and my medical assistant confirmed that I heard right when my patient told me that her heel sperms were causing her terrible pains.

Paul Hilber, DPM

One quote I most remember ... "Doctor, I think I have very close (varicose) veins." And don't you know, they were!

Gino Scartozzi, DPM, New Hyde Park, NY

ASSOCIATE POSITION AVAILABLE - THE BRONX

Excellent hospital based opportunity. Inpatient & Outpatient Care. Busy clinics. Large diabetic population. Practice all aspects of Podiatric Medicine & Surgery. Requires Surgical Skills. CV to nealblitz@yahoo.com

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PODIATRIST NEEDED - NY/QUEENS/LI

Must be min. PSR-3 with excellent training. Experienced in billing, selling non-covered services, products, Patient medical and surgical exp. with good rapport/comm. skills necessary. Unique position working in offices, clinics, hospital with orthopedist, podiatrist, P. therapists. P/T, F/T available. Growth, income potential and partnership opportunity excellent. A chance to use all your skills; foot, ankle and more. Please respond with cover letter and CV to hansfeet@aol.com

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate, two-office practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Must be ethical, highly-motivated with strong surgical and medical skills. Please send CV to palpodiatry@att.net

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today. Dr. Zuckerman is in the Fort Lauderdale area and will demo these lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well-trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Also available are two transferable surgical center partnerships(with distributions). Owner retiring and willing to stay part time during transition. Cover letter/CV to softechpodiatrist@gmail.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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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