The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 25, 2009 #3,529 Publisher-Barry Block, DPM, JD

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Use Common Sense When Wearing High Heels: KY Podiatrist

Dr. Ann Pinski, a Louisville podiatrist, takes a realistic yet practical approach when dispensing advice on women's more extreme footwear. She says, "As a female physician, I understand that women will wear tall heels. I think it's important to be in fashion and to wear what you love." However, she advises: "Vary your heel height often. If you wear 5-1/2-inch heels on Saturday, choose flats for Sunday.When wearing high heels, your calf muscle is shortened, and your body weight is thrown onto the ball of your foot. This puts your feet and ankles in duress."

Dr. Ann Pinski

So, if you plan on braving new heights this season, use some common sense.  Pinski says, "I tell my clients to wear the shoes, look gorgeous — and visit me if you have a problem!"

Source: Kelsey Grizzle, Courier-Journal [4/2/09]

Scholl's Honor Society Hosts Brenner for Grand Rounds

The Delta chapter of Pi Delta Honor Society and Dr. Wm. Scholl College of Podiatric Medicine, with the support of Dr. Comfort and Kerasal, welcomed Dr. Marc Brenner as the Grand Rounds speaker on April 17th, 2009. Dr. Brenner’s lecture, “Exotic Cutaneous Lesions of the Lower Extremity,” was  presented to approximately 120 attendees.

(L-R) Mr. Eric Lorenz of Dr. Comfort, Dr. Marc Brenner, Hope Bante (President), Amanda Ray (Treasurer), Jennifer Buchanan (Secretary), Mike Murdock (Vice President).

The students found the case studies both beneficial and informative. “It was a great honor to have Dr. Brenner come to Scholl for Grand Rounds, said Kati Rush, a first-yearstudent. "His presentation of exotic lesions of the lower extremity was incredibly informative. I thought his lecture provided a wonderful foundation of dermatological conditions which I hope to continue to build upon throughout my future education and clinical experiences,”

Stay Alert to Signs of Deception

People who are not telling the full truth often give away their deception through non-verbal language. Look for these common signs:

• Incongruence. If the person’s voice tone and rapid gestures suggest agitation, you might not want to take at face value the assertion that “Everything is fine.”
• Blinks. Watch the speaker’s eyes—always good advice but especially when you suspect deception. More than 50 blinks a minute should raise a red flag.
• Incomplete gestures. For example, a shrug that uses only one shoulder suggests that you haven’t heard the whole story.

Source: Adapted from “The Truth About Liars,” by Carol Kinsey Goman via  Communication Briefings 

Query: Blister Treatment

I am curious to see how clear blisters are being treated. When I have an intact blister (from rubbing, or venous stasis), I usually use antibiotic ointment and protect the blister and try to prevent its rupture. If the blister is ruptured, I remove the sloughing skin and depending on the depthof  the wound is will dictate how I treat the blister/wound bed. If it is superficial, I continue with the antibiotic ointment and a non-adhering dressing. I do not leave the ruptured blister cap/skin on. I am worried it might enhance bacterial growth. 
 
Wm. Barry Turner, DPM, Royston, GA
 

Query: Coding a Slipper Cast

I have a post-op patient to whom I have applied a slipper cast for hallux abductovalgus. Is there a code we can use to bill for slipper cast, as it is not a BK cast (CPT 29425 or CPT 29405)?

Syed Ghani, DPM, Sterling Hts., MI

Response: There is no code for a "slipper cast" or "forefoot cast" which, post-operatively, is used electively as the outer layer reinforcement of a surgical dressing. The application of a slipper cast for this purpose would be included within the global allowance of the surgery as a variation of typical post-operative follow-up care (i.e., make-up of the post-op dressing).

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Positional Hallux Limitus (Dale M. Smith, DPM)
From: Jeffrey Kass, DPM

Some thoughts to consider:

1) Does your patient have an equinus? If so, contemplate an Achilles lenghening or gastroc release.

2) The x-rays only show  the forefoot part  - take notice of the 1st-met base obliquity - most likely the patient has a hypermobile first ray, causing joint jamming. Consider procedures to control the hypermobility. (If your patient fits the criteria, (one can't tell without full films) sometimes a subtalar arthroesis works well.

3) You must correct the elevatus - consider a Youngswick Austin - it’s a stable procedure and drops the head.

4) Before even contemplating surgery for these patients, I would try a custom-made orthotic, i.e., first ray cutout, maybe even a Cluffy wedge, etc.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Employee Salaries (Tip Sullivan, DPM)
From: Lynn Homisak, PRT
 
I’ve been in many offices where separate incentive plans were initiated for separate job descriptions – for example, billing and collections would get a percentage of how much more money was collected this month/quarter/year than the previous while the staff person responsible for diabetic shoes might get $XX.00 for how many shoes were dispensed. And for some, maybe these types of independent incentives work.  What I have seen, however, is that instead of encouraging a group mentality, it tends to divide staff and cultivate an “I don’t care about my co-workers as long as I get what I deserve” attitude. 

Your staff is your “team” and teams work together for the good of every player.  The fact that revenue may have increased more this “period” over last is not solely due to the biller’s efforts.  It could ALSO be due to the fact that the scheduler is more apt to accommodate (instead of turn away) the patient that requests the last appointment for the day; and/or because the assistant responsible for diabetic shoes knows that generating more shoes increases total revenue, and/or the clinical assistant is doing more hands-on patient care in the back, allowing the doctor to see more patients and keep the patient flow more efficient. If there is a slacker, the “team” is more likely to pull them up to a more productive level because everyone suffers if their work is compromised.

The point is, they should all be encouraged to work together for the good of the practice because when the practice benefits, they all benefit. A group incentive (whereby each employee may get a percentage of increased profits, over perhaps a baseline threshold) promotes group achievement. With the understanding that the bonus structure (whatever model you decide to adopt) represents the outcome of everyone’s participation, each will be motivated to do their part and help each other – and everyone wins in the end!

Lynn Homisak, PRT, Seattle, WA, LynnPRT@msn.com
 

RE: Blood Work-up Protocol? (Jeffrey Kass, DPM)
From: Ken Meisler DPM

For 30 years, I have ordered blood work for patients I suspect have gout. I have never received a complaint from their MD. I always send a consult letter and usually send them back to the MD for follow-up. I think we see more acute gout than primary care doctors and are better at diagnosing it. I would not recommend calling every MD to ask them where the blood should be drawn, except as an excuse to introduce yourself to a doctor you never spoke to. You are making the diagnosis and should use your lab, so you might not have the only copy of the report go to the MD.

Ken Meisler DPM, New York, NY, Kenmeisler@aol.com

ASSOCIATE POSITION - CONNECTICUT

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

EQUIPMENT FOR SALE

Used Acoustic Imaging Diagnostic Ultrasound. Comes with 10 MHZ linear probe. Printer included. Unit is a console on wheels and cannot be shipped, must be picked up. Price includes 3 hours of hands-on and didactic material on podiatric ultrasound. See website www.hurtheel.net for more details. Price: $4,750 Contact Information Henry Slomowitz  E-mail hslomowitz@gmail.com Phone 973-479-6305.

ASSOCIATE POSITION - MIAMI-DADE FLORIDA
 
Partnership w buy out opportunity for the right candidate. Well-established modern practice. EMR, digital x-rays, gait scan, etc. Excellent hospital privilages. SALARY...two options. $40,000 starting, 40% of everything you generate over $120,000. Want a fixed salary instead? $75,000 a year I feed you patients and provide an excellent well-trained staff. Contact doctorinhialeah@aol.com

ASSOCIATE POSITION AVAILABLE GREATER HOUSTON

Looking for full-time associate to work in well established practice with 3 offices in the Houston area. Practice focused on sports medicine, surgery with EMR, Digital X-ray, Musculoskeletal Ultrasound and new office built in 2007. Great opportunity in one of the fastest growing areas in the country that has been least impacted by economic woes. No nursing homes, routine care. Available to start in July/August for PSR 24-36 surgically trained podiatrist, Spanish speaking a plus. Great opportunity with competitive salary along with malpractice benefits. Please send CV and letter of interest to officemanager23@gmail.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

EQUIPMENT FOR SALE

Battery operated K wire driver, Stryker oscillating surgical saw and osteotome (drill) complete set. Ille Extremity whirlpool, Osada drill set, power base (30w), 3 hand pieces, Reece Osteotomy guide, Orthoposer and axial x-ray devices. Send email  raybrown@bellsouth.net for pictures, price, or call 704-892-7301

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please call Dr. Herbert Rosen at 410-580-0255 or e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com 

  
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