The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 02, 2007 #2,926 Editor-Barry Block, DPM, JD

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MO Podiatrist Stresses Importance of Daily Foot Inspections

Authorities on foot health say that keeping an eye on your feet is just as important as keeping an eye on your overall health. Your feet can signal problems with undiagnosed diabetes, cardiovascular disease, kidney disease and even cancer, they say. That means that watching your foot health can help you catch undiagnosed conditions before they do permanent damage.

"I teach my patients daily foot inspections," says Dr. Christopher Sloan, a podiatrist practicing at the Desloge Foot Care Center in Desloge, MO. "By doing that, you know what you have, and you know what it looks like.”

Diabetes is the disease that most shows itself in your feet. And undiagnosed or ignored diabetes can lead to foot amputation. "I diagnose 30 to 40 cases of diabetes a year for people who didn't know they were diabetic," Sloan says.

Source: Harry Jackson Jr., St. Louis Post-Dispatch, [04/23/07]

No Magic Bullet for Plantar Fasciitis: FL Podiatrist

Plantar fasciitis is a repetitive motion injury, often caused by feet that roll inward when you stride. Runners and athletes are particularly at risk; for example, St. Louis Cardinals slugger Albert Pujols has struggled to play through the nagging pain. But weekend warriors and regular folks are also susceptible, particularly if they have flat feet or unusually high arches. The American Podiatric Medical Association estimates that 18.6 percent of Americans reporting a foot ailment have experienced plantar fasciitis pain (heel pain).

Dr. Cary Zinkin

“It takes time and effort to beat plantar fasciitis — there isn’t a magic bullet. But pain is not normal,” says Cary Zinkin, DPM, a podiatrist based in southern Florida. “If pain is constantly ruining your day, you really need to see a podiatrist.”

Zinkin always starts by examining his patients’ shoes. He cautions against wearing flip-flops or going barefoot and encourages sufferers to opt for supportive sneakers. “Go to a store that caters to runners, where the salespeople tend to be knowledgeable about foot problems and your shoe options,” he advises.

Source: Lisa Renaud and John Rosenthal, Continental Magazine [May 2007]

AMA Presses Congress on Payment Formula

The American Medical Association in a “Dear Colleague” letter to Congress today urged lawmakers to replace Medicare’s “flawed” formula for calculating physician payments. “Access to high-quality healthcare for seniors is in peril due to the looming meltdown of Medicare’s payment mechanism for physicians, which will cause payments to drop by 10% in 2008,” wrote Michael Maves, AMA executive vice president and chief executive officer. Additional reductions of more than 40% will ensue by 2015, if the sustainable growth rate, or SGR, which is tied to the health of the economy and used to calculate physician payments, is not replaced.

The Congressional Budget Office has projected that replacing the SGR with annual updates based on inflation would increase payment rates for physicians by about 2% annually, but would cost the federal government $262 billion over 10 years, plus $70 billion in higher costs for beneficiaries.

Source: Jennifer Lubell, Modern Healthcare [4/30/07]

Query: PAS vs. Grocott Stain

Can anyone enlighten me on the difference between a PAS stain and a Grocott stain when ruling out fungus in a nail. Is one more accurate then the other?

Jeffrey Kass, DPM, Forest Hills, NY

Query: Billing E/M Services Based on Time

I spent 31 minutes counseling a patient on proper shoe wear. The patient was a difficult patient in that she had very poor hearing and memory. This was not a usual case.

I was going to code the case a level 4 established patient evaluation and management (CPT 99214). What modifier do I need to use to show the evaluation and management code was based on time?

Charles Myers, DPM, Conway, SC

Response: If the discussions on proper shoewear was directly related to the dispensing and fitting of shoes, then, while it may seem unreasonable, the discussion and fitting of the shoes would be included in the allowance for the shoes and inserts (look at it this way, if the shoes were dispensed by a pedorthist, there would be no way for them to bill Medicare for anything, but the shoes and inserts).

If this was not connected to shoe dispensing and fitting, a reviewer would surely balk at anything more than a CPT 99212 for this type of encounter.

E/M services based on counseling and coordinating care revolve around the point that more than 50% of the typical time of a visit was spent face to face this is a proxy for the three key components.

Ken Malkin, DPM, Caldwell, NJ

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RE: Chronic Weakness and Atrophy, Right Lower Leg (Jennifer Sartori, DPM)
From: Greg Mowen, DPM

Hopefully the neurologist has ruled out Charcot-Marie-Tooth, so now look for a lesion that would involve both the tibial and common peroneal. Most often when back issues have been ruled out, I would get an MRI of the knee. There have been numerous documented cases of ganglions and Baker's cyst\synovial cyst, pressing on the nerve in the posterior part of the knee causing progressive weakness and even drop foot.

Greg Mowen, DPM, Ventnor NJ, gregmowen@comcast.net

RE: Long-term Results of Conservative vs. Operative Treatment of Intra-articular Calcaneal Fractures
From: Neil Hecht, DPM

I came across this article of interest:

The following study reviews a 15 year follow-up regarding the long-term results of conservative vs operative treatment of intra-articular calcaneal fractures. Based on this study at long-term follow-up, neither the clinical nor radiographic outcomes were different between conservative versus operative treatment.

IBRAHIM T, Rowsell M, Rennie W, Brown AR, et al. Displaced intra-articular calcaneal fractures: 15-Year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury. 2007;. http://amedeo.com/p2.php?id=17445815&s=fra

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

RE: Pruritis in Well-Controlled Diabetic (John Spina, DPM)
From: Multiple Respondents

If patient is not neuropathic a chest x-ray to R/O lymphoma would be prudent. Generally the pruritus is more widespread but I would leave no stone unturned.

Ira E Bennett DPM, RPh, irarob1@verizon.net

ASSOCIATE POSITION – BOSTON, MA

20 year old, well established, modern practice with 2 locations just out of Boston, looking for associate, P/T or F/T, motivated 24/36 trained or ABPS-Certified or eligible to start immediately. Strong surgically-based practice. Looking for motivated individual, able to practice all facets of podiatry practiced. Electronic scanning for orthotics and voice activated EMR already in office. Fax CV to (617) 567-0822

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

MICHIGAN- DETROIT NORTHWEST SUBURBS

Associate/Partner wanted for busy group practice. Opportunity for exceptional pay and benefits for hard working, well-trained person of integrity. Enjoy full scope of practice while working with progressive and team oriented colleagues. Historically patient flow has allowed for obtaining enough cases for boards in less than 2 years. PSR-24/36 or practice experience needed. Please e-mail resume to nmoz@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

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

DETROIT MEDICAL CENTER RESIDENCY PGY1 AND PGY2 NEW POSITIONS

Detroit Medical Center PM&S-36 program is accepting applications for additional PGY1 and PGY2 slots. The DMC and Wayne State University Medical School sponsors 900+ residents. Highlighted rotations include: Orthopedic Trauma, Pediatric Orthopedics, and Plastic Surgery. With over 100 attendings, surgical volume is tremendous. Please call Beverly at 248.651.0162 if interested.

PODIATRIC SURGEON POSITION – DES MOINES, IA

Full-time position available in busy county hospital-based foot and ankle group. Two year residency trained, BE/BQ, minimum. Private practice experience preferred. Competitive salary and benefit package. Inquiries to: Denise Mandi, DPM, Section Chief Broadlawns Medical Center, Des Moines, IA. dmandi@broadlawns.org

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

NORTHERN CALIFORNIA- PRACTICE FOR SALE

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; Biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

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

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

EQUIPMENT FOR SALE + FREE JAPMA (1971-96)

1. Wall mount -Sanko x-ray, 55KVP, 7MA. $800 or best offer, 2. A/T 2000M Film Processor. $500 or best offer 3. Two gallon x-ray development dip tanks with hangers - best offer 4. One gallon xray development dip tanks with hangers - best offer 5. 30 years of JAPMA Free (You pay shipping). 704-892-7301 or 704-663-0094 raybrown@bellsouth.net

Harvard Podiatric Reconstruction and Research Fellowship Available July 1, 2007

Beth Israel Deaconess Medical Center is accepting applications for a 2-year fellowship, focusing on reconstruction of complex deformities, and an associated substantial research project. Requirements: 3+ years CPME-approved surgical residency, research interests, recommendation from residency director, CV, letter of intent, MA License. pbasile@bidmc.harvard.edu by 5/15/07.

PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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 - MICHIGAN-DETROIT AREA

Great opportunity-must be hard-working, reliable, responsible and good with patients & staff-surgical training a plus-partnership after 1 yr. Michigan license required fax resume to 248-478-1370

General practice for sale. This well established muiltple location practice is grossing over $1M. Potential, potential, potential! Professional sports, acedemia, dining, and entertainment galore. Nice mix of commercial insurance, cash, Medicare. Staff willing to stay making this a true "TURN-KEY" opportunity. Contact AMERICAN DOCTOR SALES at 614-918-3000 or email sell_my_practice@yahoo.com www.americandoctorsales.com

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

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.

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