The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 05, 2007 #2,929 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

WI Podiatrist Stresses Importance of Shoes for Diabetics

Doctors say no matter where diabetics buy their shoes, they're important.

Dr. Todd Sommer

"Sometimes the foot develops more foot deformities, and subsequently you add that to the component of loss of feeling, standard shoe gear is no longer feasible," Dr. Todd Sommer, a podiatrist and wound care physician with Prevea Health, said.

Source: Kathryn Bracho, WBAY-TV (ABC) [5/2/07]

AAOS Provides Grants to Limit Podiatrists’ Scope of Practice

Recognizing the growing importance of state health policy issues and the vital role that state societies play in dealing with them, the American Association of Orthopaedic Surgeons (AAOS) Board of Directors created the State Orthopaedic Society Health Policy Action Fund. It also provided appropriations of $200,000 for a three-year period beginning in 2005. The Board of Councilors’ (BOC) State Legislative and Regulatory Issues Committee is responsible for distributing the funds. Recently, the committee approved $76,500 in grants for 2007 to assist 12 state orthopaedic societies with their state legislative and/or regulatory efforts. Among them:

Florida Orthopaedic Society
$5,000 – To introduce and pass legislation limiting podiatrists’ scope of practice

New York State Society of Orthopaedic Surgeons, Inc.
$5,000 – To oppose legislation to expand podiatrists’ scope of practice

Source: Susan Koshy, AAOS News Bulletin Mar/Apr 07, via Dave Gottlieb, DPM

www.aaos.org/news/bulletin/marapr07/reimbursement3.asp]

Editor’s note: If you haven’t given to PPAC and your state PAC, this news item is a reminder of the importance of doing so. NY Podiatrists should also make every effort to attend legislative day in Albany on May 8, 2007. Contact NYSPMA at 212-996-4400 for details.

Is it Ethical? Questions to Ask Yourself

Rick Weaver, Principle of the professional coaching firm Lifeteacher offers these guidelines. “When you are trying to made a hard ethical decision, consider these factors:

• Would my staff and family be proud of me?
• Will somebody be hurt by this?
• Do I think it’s fair?
• Would I want this done to me?
• Would I want this on the front page of my local newspaper?

Source: Rick Weaver, Associations Meetings [April 07]

Query: Office Celebrations

Does your office have "celebrations" -- as a form of recognition and appreciation of staff efforts? If so, what have you celebrated -- and what effect did it have on employee morale and motivation?

Bob Levoy, Great Neck, NY

Query: Coding Excision of Warts

What code(s) are acceptable to use for surgical excision of a wart when not simply using cryo, acid, laser, etc?

Are CPT 11305-11308 codes appropriate if the lesion is being shaved or circumscribed and removed sharply with a blade? These codes simply state "the removal of epidermal or dermal skin lesions without a full thickness dermal excision by use of transverse excision or horizontal slicing, suture not required, includes local anesthesia and cautery."
Or does sharp excision still fall under CPT 17110-17111? Also, are these codes appropriate for excision of an IPK?

Amanda Meszaros, DPM , Mansfield, OH

Response: The procedure for destruction of benign lesion (wart) by the technique of curettement is billed as CPT 17110.

The CPT 11305 series are for shaving of epidermal or dermal lesions. These are not considered palliative, but definitive for lesion removal. This series of codes should not be used for "treatment" of warts.

Excising a lesion implies full-thickness excision with the possibility of skin closure.

Tony Poggio, DPM, Alameda, CA

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

RE: Added-Depth Golf Shoe (Bryan C. Markinson, DPM)
From: Multiple Respondents

Dr. Zen manufacturers the only double-depth Medicare approved all day comfort golf shoe. It is designed to be worn on and off the course. It has a natural rubber sole which will wear well. It is shown in the Apr/May issue of Podiatry Management on pg. 119. It comes in Med.,2E and 4E widths and sizes 7-14 women’s and 6 – 13 men’s.

Dr. Zen Double-Depth Golf Shoe

Paul Barattiero, C.Ped., Dr. Zen Products, Inc., paulb@drzenproducts.com

Take a pair of diabetic shoes and have golf type cleats added to the soles.

Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

I find the BITE line of golf shoes are by far the best for extra depth and I'd recommend the Bite (OS) system that have interchangeable insoles to aid with fit. They even have golf sandals. Go to www.biteshoes.com to see choices.

Michael A. DeVito, DPM, Oak Lawn, IL, devitodr2@sbcglobal.net

There are many soft top (uppers) incorporated into golf shoes. Bite has several 'Running Shoe Styles' with mesh uppers and Hi-Tec make several models with varying insole thickness to give more room in the toe box. Bite even make golf sandals -- with an open toe box Otabo in Florida (954 973-9900) are elegant specialized custom shoe makers. They can custom-make a pair of golf shoes for your patient with an extra depth toe box no problem.

Mel Cheskin MBS.,C.Ped., Boca Raton, FL, Melcheskin@aol.com

New Balance makes golf shoes which have a deep toe box. Also Vogel Bootery in NYC will make custom Golf Shoes. I have used them many times for shoes and boots to accommodate orthotics or UCBL's. They make a "paddock boot" that laces a few inches above the ankle and can be dressy enough to wear under a suit and is useful with patients who have PT tendon dysfunction.

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

RE: Long-term Results of Conservative vs. Operative Treatment of Intra-articular Calcaneal Fractures
From: Alison D. Silhanek, DPM

Dr. Hecht introduces a recent study of displaced intra-articular calcaneal fractures treated conservatively versus operatively (IBRAHIM T, Rowsell M, Rennie W, Brown AR, et al. Displaced intra-articular calcaneal fractures: 15-Year follow-up of a randomized controlled trial of conservative versus operative treatment. Injury. 2007; http://amedeo.com/p2.php?id=17445815&s=fra ). He reports that the results are of interest as the authors found no difference in clinical outcome between the two treatment groups. I also found this study interesting, but only because of its deficient methods.

Only 26 patients were included in the study (11 conservative, 15 surgical). This is certainly too small a number to allow adequeate comparison between the two groups. Also, the operative group received open reduction with Kirschner wire fixation. These procedures were performed at least 15 years ago and it has since been established that the best clinical outcomes can only be achieved with exact anatomic reduction and rigid fixation with plate/screws or a combination of internal and external fixation. Even the authors conceded that, "Kirschner wires... are now considered inadequate for intra-articular calcaneal fractures."

The only radiographic parameters examined were Bohler's angle and the height of the calcaneus, and the authors found no significant difference between the 2 groups. Of interest is the fact that the mean Bohler's angle was 10.4 degrees in the conservative group and 16.9 degrees in the operative group, with neither value reaching normal limits (20-40 degrees). If neither group achieved a restoration of normal anatomy, no wonder there was no significant difference in the patient clinical outcome! Furthermore, they did not measure the amount of post-treatment step-off/continued displacement on Broden's views or CT, which may have helped elucidate the results. You see, a study's results are only of interest if the study is performed well. Otherwise, it only serves to confuse an already controversial topic.

Alison D. Silhanek, DPM, Medford, NY, adspod@aol.com

RE: Cash Only Practices (Bob Kornfeld, DPM)
From: Edward R. Nieuwenhuis Sr., DPM, Michael Rosenblatt, DPM

Dr. Kornfeld’s unfounded and unsupported allegation of large amounts of fraudulent claims being submitted by fellow podiatrists is just another example of grandstanding and “yellow journalism." These types of charges hurt us as a profession, and do nothing to foster any confidence in the profession by regulatory agencies and insurance companies.

I do not wish to be an apologist for unscrupulous activities by insurance companies, nor do I want to protect colleagues who may be practicing or billing in a fraudulent manner. I do expect of myself and others who use this forum, to post only that information which is factual, honest, and relevant to the discussion at hand.

Edward R. Nieuwenhuis Sr., DPM, Wyckoff, NJ, Edfeet@aol.com

I have nothing against cash-only practices, but as Dr. Kornfeld said, it takes "years" to develop one that is even close to profitable. It takes years to "re-train" patients about a "policy" that is very different from the other doctors they see. Even my dentist takes insurance. More importantly, I wonder how many of those who are struggling are taking advantage of the knowledge-base of Podiatry Management.

The April/May issue of PM alone, contained at least three articles describing powerful ways of improving your income. And that was only one issue! I respectfully urge those who are having problems to "widen" their point of view. This means actually reading Podiatry Management, and then having the courage to re-invent themselves away from the addiction of routine foot care. It can be done. Considering the costs of time and effort it took you to become a podiatrist in the first place, it is a very easy "transformation."

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

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

OFFICE TO SHARE AND RENT - PLAINVIEW, LONG ISLAND (S. OYSTER BAY RD.)

3 treatment rooms, JACHO certified operating room, MRI extremity unit and x ray equipment on premises, turn-key operation -no investment- call 516- 4761815 or email podo2345@aol.com

ASSOCIATE POSITION – PHILADELPHIA AREA

Looking for licensed motivated medical or surgical podiatrist in Philadelphia or surrounding area to take over a clinic in west Philadelphia. Looking to develop a mutually rewarding relationship. call 215-665-9225 Dr. Smith

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

ASSOCIATE POSITION NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

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 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.

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

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 9,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.