The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 14, 2011 #4,160 Publisher-Barry Block, DPM, JD

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Minimalist Shoes Require Gradual Introduction: CA Podiatrist

Minimalist shoes aren't for everybody. Unlike the Kalahari Bushmen, most Americans grow up wearing shoes. As a result, the muscles in the foot that control the toes aren't fully developed, says Dr. Bobby Pourziaee, a Beverly Hills podiatrist who treats many hikers and skiers. 

Dr. Bobby Pourziaee

He recommends that those who want to wear barefoot shoes start out with 15-minute excursions and build up their stamina over time.
"I would not go out and hike Runyon Canyon without some training," Pourziaee says.

Source: Hilary MacGregor, The Los Angeles Times [5/9/11]

States Eye Public Access to More Doctor Disciplinary Records

A long-running push for increased transparency in the medical profession has led medical boards nationwide to release more information about physicians' professional and disciplinary history online during the last 15 years. Even so, exactly what is publicly available -- both to consumers seeking information online and families inquiring about a specific physician or complaint -- varies greatly. States are hearing from consumers that not enough information is available or easily accessible.

So at least five states have recently passed or are considering legislation that would create more transparency, particularly regarding physician disciplinary records and procedures. The measures would release more physician information, make that information easier for consumers to get, and provide quicker responses on requests to investigate physicians.
 
Source: Carolyne Krupa, AMNews [5/9/11]

Mastering Non-Verbal Cues

When you speak, others read your voice just as they read your gestures. So, if your staffers communicate with one another primarily via telephone, they need to be aware of how verbal emphasis can shade their words’ meaning. Consider this example of four different ways to tell a worker “I think this report is fine.” The italics in each line represent verbal emphasis.

• Unconcerned: “I think the report is fine.”
• Uncertain: “I think the report is fine.”
• Happy: “I think the report is fine.”
• Worried: “I think the report is fine.”

Remember: The best business voice sounds consistently clear, inviting and controlled. It’s usually best to sound warm and upbeat too, although not when you are delivering bad news.

Source: Adapted from What Your Body Says (and How to Master the Message), Sharon Sayler, John Wiley & Sons, Inc. via Communication Briefings 

Query: Bench-Top Orthotic Grinder Finishers

Does anyone know a source for bench-top orthotic grinder finishers?

Rich Rusche, Phoenix, AZ

Query: Peroneal Tendon Rupture

I recently did surgery on a patient with a ruptured peroneal tendon. The tendon was repaired using a Pegasus graft  (synovisorthowound.com/), and the patient is doing well. Does anyone have an idea what the best code is for this procedure? The codes in my book only link the use of a graft to the Achilles tendon. 

Matthew Burrell, DPM, Wolfeboro, NH
 
Response: The repair of the peroneus tendon is coded as CPT 28200 (repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon). While there is a code for obtaining an autograft, there is no code for application of GraftJacket, beyond possible reimbursement for the material itself. I recommend prior authorization for the use of GraftJacket.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here
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RE: Ultrasound-Guided Popliteal Infusion, Post-Bunion Surgery (Brian Kiel, DPM)
From: Bill Trabulsi, DPM

I routinely use anesthesia to do a popliteal block pre-op. If a thigh tourniquet is used, the anesthesiologist will do a sciatic block, which cuts down on the tourniquet pain. Patients are pain-free for about 10-12 hours and are very happy. I would inquire if it is a block or an infusion.

Bill Trabulsi, DPM, Tampa FL, trab3@msn.com

RE: Dorsalis Pedis Artery Aneurysm (Bryan C. Markinson, DPM)
From: Cedric Cooper, DPM

In reply to Dr. Markinson's post, I did not perform an excisional biopsy, but did perform an aspiration of the lesion with a 27-gauge needle. I was not afraid of hemorrhage, as there were no pre-existing conditions in the patient's history (Coumadin, ASA, and any other medications altering the clotting cascade) that would allow me to draw the conclusion that a hemorrhage would have occurred. The general surgeon performed the excision of the lesion. The week that the procedure was scheduled, I asked him if he was considering bypassing the lesion, and he answered no.

I was disappointed by his answer because preservation of the distal course and integrity of the DPA was the reason for referring the patient to him. If I had known that all he was going to do was ligate the DPA and remove the lesion, I would have removed the lesion myself and taken the chance of ischemia of the forefoot (with prior notice to the patient, of course).

Cedric Cooper, DPM, Humboldt, TN, y2kcedric@hotmail.com

RE: Podiatrist's Responsibility When Taking Patients' Blood Pressures (Elliot Udell, DPM)
From: Charles Morelli, DPM

If and when you take a patient's BP in your office and it is "mildly elevated", what makes you assume it is "temporary"? If it was high, then why would you not intervene? By intervene, I mean to inform the patient of the elevated BP with instruction to contact a PCP. You then chart that event. By definition, you "intervened." I can't imagine any person taking another person's BP, getting a high value, and not doing that.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: EMR
From: Gary S Smith, DPM

I have been using the Cerner EMR since January, so my opinions are based on that alone. I think that anybody who gets an EMR system to improve efficiency of records isn't very efficient in the first place. With EMR, the added dictation rarely completes through just a drop-down menu and does the billing, complete with modifiers. This was something that was done by my staff before while I attended to patients. I don't quite understand the argument that this will make it easier to transfer records to other docs and venues, because as I understand it, none of these software programs have the capability to electronically transfer records elsewhere without allowing access to all the records.

I have been dealing with Medicare for 20 years, so I am a little cynical, but I truly believe that the majority of people who get EMR will never qualify for the incentive pay, and because of that, even if you get an EMR system, you will probably have your fees cut. I would be interested to hear from anybody who has successfully attested so far and has been approved for the incentive pay. Medicare has been struggling just to cover fees over the last several years. I don't see them paying this extra if they can get out of it.

Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: The Passing of Rob Roy McGregor, DPM
From: Howard Dananberg, DPM

I was very saddened to hear of Rob Roy McGregor's passing. He was a wonderful mentor who provided me with sage-type advice when I had just graduated from podiatry school. His kind way and gentle demeanor will surely be missed.

Howard Dananberg, DPM, Bedford, NH

RE: Vibram Fivefingers Shoes
From: Philip McKinney, DPM

I have, so far this year, treated four people with stress fractures that I can directly relate to the use of these. Now, granted I have not kept track of the number of stress fractures from other running shoes, but for the most part, those incidences are from changing training patterns or surface.

It is of note, that one of the people I run with, who was not taking my advice, is running in these, and he has a very marked late midstance pronation that I have not noted before with running. It is also interesting to note how rapidly he fatigues when running with these "so called" shoes.

I have never recommended the use of these shoes, and at this point, I cannot see much reason to recommend them; but if you are planning on making the transition from your road shoes or racing flats to track spike, I could see using these for some track workouts as you get yourself track-spike fit.

Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net

RE: AMA to Offer Payment Formula Proposal
From: Jon Purdy, DPM

The title should read, “AMA Proposes the Impossible.” With a Medicare system that is unsustainable, we find that the SRG (Sustainable Growth Rate) is doing what it should, showing that Medicare is paying out way more than it is taking in and therefore, unsustainable. As such, the formula dictates lower reimbursement rates to stay “sustainable.” I guess the thinking here is to find a new formula that reimburses physicians a fair amount for their services, and then worry about how it’s funded later.

Our government is not only sticking it to the physician, the patient is getting hit just as hard. I’m still amazed that...

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

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com

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 - NORTHWEST SUBURBS, CHICAGO, IL

Great Opportunity! Present owner to stay on for transition. Average 20% growth over 3 years while open only 4 half days a week. Excellent growth potential with increased hours. Perfect for a new practitioner or a 2nd location. contact podiatrynwsuburbs@gmail.com for information.

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.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

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

POSITION AVAILABLE - LONG ISLAND PRACTICE (NASSAU COUNTY)
 
looking for part time associate for 8-12 hours/week with room to grow. Please email pittpod@gmail.com with interest (write 'position available' in subject line).

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION - TAMPA BAY, FL

Associate with PSR 24+, needed for a dynamic practice. Well-established high-tech with specialties in sports medicine, surgery, and wound care. No nursing homes or HMOs. E-mail: flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION – NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to:  Podiatry2011@gmail.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE NEEDED - MIAMI, FL

Full-time. Very Busy practice. Rearfoot/forefoot/wound care. Salary + % gross. Send CV to footdoctorinmiam@aol.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

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

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