The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 23, 2012 #4,443 Publisher-Barry Block, DPM, JD

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Diabetics Should Wear Compression Socks: FL Podiatrist

Diabetes so dramatically affects the body’s circulatory system that the feet become far more vulnerable than they otherwise would be. What’s more, explains Boca Raton podiatrist Dr. Bret Ribotsky, “Because of the decreased circulation to the feet, diabetics can’t rely on their pain sensors to alert them that something might be wrong.” Therefore, any wound, skin irritation or other foot abnormality has the potential to mushroom into a dire situation if not caught early.

Dr. Bret Ribotsky

Diabetics should strongly consider wearing “compression” socks to aid their circulation (Dr. Ribotsky calls such footwear “bras for your feet”). They help prevent swelling in the feet, as well as the formation of varicose veins. Without the compression, edema and stretching of the skin can happen, and sometimes the skin tears, which can leave an ulceration that’s vulnerable to infection.

Source: Palm Beach Post [4/19/12]

OH Podiatrist Featured in Dinner With the Docs

Hundreds of area residents on Thursday did what any of us would do if given the chance to dine with six doctors — pick their brains. Physicians welcomed general questions at Hillcrest Hospital's 12th annual Dinner with the Docs, but attendees at the Executive Caterers-hosted event framed their queries in a timely fashion.

Dr. Edward Nemet (C) (Photo: Brandon Baker)

Though the event provides a social platform for some attendees, its purpose is no laughing matter. Karla Lindsey, Hillcrest's coordinator of community outreach, said the event grew from about 70 people to nearly 400 because people value talking to physicians in a relaxed environment. Dr. Edward Nemet, a podiatrist answered foot- and ankle-related questions.

Source:  Brandon Baker, Beachwood Patch [4/20/12]

"Haiti Still Needs Help" - OH Podiatrist

Dr. Edna Jean, a Toledo podiatrist, and Michelle Y. McCaster, a certified registered nurse anesthetist also known as a CRNA, were part of a team headed by Dr. Robert Paat, an internal medicine physician at St. Luke’s Hospital in Maumee that visited the small Caribbean nation ravaged by the Jan. 12, 2010 earthquake.

Dr. Edna Jean

Jean, who is in private practice, performed medical procedures on the feet of patients. “Haiti still needs help,” Jean said. “By far, it’s not finished.” Jean and McCaster said they plan to return to Haiti before January, which is the third anniversary of the deadly earthquake.

Source: Darryl Tucker, The Toledo Journal [4/20/12]

OR Podiatrist Reports Unauthorized Disclosure of Patients' Information

Nancy Shepherd of Cottage Grove said her parents, both of whom are in their late 70s, received a troubling notice from the office of Dr. Rex Smith, a podiatrist. Dr. Smith, a Eugene podiatrist with a practice on Chambers Street, sent the letter to Shepherd’s parents. The first paragraph said, “…my staff and I have discovered an unauthorized disclosure of your personal and health information, which may compromise the privacy and security of that information.” 

Dr. Rex Smith

Eugene police confirmed that on Feb. 19, someone broke into Dr. Smith’s office and stole medication and a computer. According to Dr. Smith’s letter, the computer contained personal information for many patients including names, birth dates, and social security numbers.

Source: Ty Steele, KVAL [4/19/12]

Almost $4.5 Billion in EHR Payments: CMS

Nearly $4.5 billion in federal incentives to implement electronic health-record systems has been paid out thus far, with program enrollments and payments still increasing in the first quarter of 2012, according to an analysis of the CMS' latest data.

There are now more than a quarter of a million (225,765) actively enrolled participants in the Medicare and Medicaid EHR incentive programs created under the American Recovery and Reinvestment Act of 2009, according to the CMS. Hospitals can receive payments under both the Medicare and the Medicaid programs, and most do, but physicians and other professionals can participate only in one program or the other.

Source: Joseph Conn, Modern Healthcare [4/20/12]

Query: Co-pays and Balance Obligations
 
Many doctors are now faced with patients who have co-pays that are greater than the insurance allowable. If a patient’s co-pay is greater than the allowable, what is the financial obligation of the physician regarding the balance?
 
Ira  Baum, DPM, Miami, FL

Editor's comment: PM News does not provide legal advice. Co-pays and allowable charges are separate and distinct entities. In general, providers are legally required to collect co-pays regardless of what the balance is. 

Query: Practice Brokers

I am interested in selling my podiatry practice. Can somene recommend  a good broker or selling agent whom I could work with?

Name Withheld

RE: Charcot Foot (Tip Sullivan, DPM)
From: Ross B Feinman, DPM

I agree with Dr. Sullivan's Charcot assessment, and treating the Charcot should be your priority. If there is a high WBC, which there is, and edema and redness which there also likely is, I would likely have the patient on an antibiotic. I think the WBC elevation justifies it. Simple gram positive coverage would be my choice. Those x-rays are most consistent with Charcot.

Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

It appears that the gentleman's foot is in an active or Eichenholtz stage one (acute) process. Has a total contact cast been applied or has the patient been placed into a CROW walker? Does he have any lesions? Is his foot stable? I would place him in a CROW walker which he can ambulate in and let the foot "calm down." Let the Charcot go through the next 2 phases and re-evaluate him with serial x-rays every 2 weeks. When the foot reaches its remodeling phase, some of the gapping may fill in, and then you can decide about fusion, ex-fix, and dorsal ostectomies.

Ross B Feinman, DPM, Farmington Hills, MI, rbfeinman@aol.com

RE: Compounded Antifungal (Bruce Lebowitz, DPM)
From: Peter Smith, DPM

There is a compounding pharmacy located in Florida. They make several creams that I like, as well as the antifungal/DMSO prep (which I have not used yet). They have a few reps around the country. They can send you a pad with all the different preparations, which you just fax in (preparations are modifiable), and the meds will be delivered to the patient.
 
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Estelle Albright, DPM

You have got to be kidding me! Not sterilizing/changing sterile bits between patients? That's like a dentist not changing drill bits between patients. This is the kind of thing that gives podiatry a bad name. It is, however, a way to ensure a continuing annuity of nail fungus patients into perpetuity. And who is still using Dremels, anyway?  They belong in your woodworking kit, not your podiatry office.

Estelle Albright, DPM, Indianapolis IN, estellealbright@hotmail.com

OSHA has numerous regulations on this, and grinding nails is a health hazard. Grinding nails is a practice that should be stopped along with the utilization of dirty whirlpools. It is a good idea to use an instrument rinse, manually scrub the instruments, use an ultrasonic cleaner on the instrument for an hour with a sterilization solution, and then autoclave. The autoclave used should be regularly maintained and have weekly biologic and spore testing performed as well. 

Daniel D. Michaels, DPM, MS, Frederick, MD, danieldm@pol.net

RE: IN Podiatrist Discusses Types of Orthotics
From: Susan Bartos

Dr. Lacey has accurately defined both functional and accommodative orthoses, their purpose and their therapeutic value – to control and accommodate. Having 16 years of experience, and working with podiatrists hailing from every state, I have found some common misconceptions among practicing DPMs, when choosing an appropriate orthotic style for their patients. 

We consider ourselves a pathology-driven lab. In other words, of the 17 different orthotic styles we offer, a style should be chosen based on the patient’s lifestyle. We find, that if the appliance fits in to the majority of shoes already owned by the patient, the chances of getting valued therapy hours from the devices are much greater. Once a style is matched to the patients' most-common shoe type, then the appropriate pathomechanical properties are put in to the orthotic to address their deformity. 

Most orthotic laboratories work through hundreds of biomechanical cases each week, and will be able to offer assistance for your patient’s dysfunction.  With this in mind, prescribing physicians should be able to work through any Rx with a trusted member of their chosen lab, to ensure that a good choice is made for every patient.
 
Susan Bartos, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com

RE: Minimalist Running is Good, but Minimalist Education is Bad": IN Podiatrist
From: Charles Morelli, DPM
 
The constant posts about this topic and the clear confusion about whether or not it is safe or dangerous point to the clear fact that no one has the answer, and many of those commenting may or may not know what they are talking about. Or, maybe they just want to "cash in" on getting something published with their name on it (like the podiatrist who "invented a new way of walking") - Really? In this article, Dr. Sommer states that "barefoot running is more doable for those with a normal to high arched foot." 

My anecdotal findings (and I profess no expertise here) are that the last 6 stress fractures that I have seen in my office have been from runners using minimalist shoes. All have had high arch, rigid foot types. I have not had a runner with a flexible flatfoot present in my office with a foot-related problem associated with minimalist running. Have others had a similar experience?
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.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) 565-6634

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.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

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

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.

ASSOCIATE POSITION - NEW YORK

Full-time position available immediately in Capital District multiple doctor practice. Good salary with percentage. All phases of podiatry. NYS license required. Email resume to Lchittenden68@gmail.com or call Lori at 518-577-6171

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 to his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.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 - 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

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 - 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 - 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

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

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