The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 16, 2012 #4,463 Publisher-Barry Block, DPM, JD

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CA Podiatrist Stresses Early Detection and Tight Blood Glucose Control

In observance of Neuropathy Awareness Week, Dr. Lee C. Rogers, one of the specialists at Valley Presbyterian Hospital’s Amputation Prevention Center, called today for Americans to guard against the potentially debilitating effects of this disease with early detection and by maintaining tight blood glucose control if they are diabetic.

Dr. Lee Rogers

Dr. Rogers said patients with neuropathy have either “positive” or “negative” symptoms of neuropathy. The positive symptoms of neuropathy are abnormal signals from the nerve to the brain that result in sensations of burning or pain. Negative symptoms are numbness or muscle weakness and wasting.

Source: Morningstar [5/14/12]

Neuropathy Often Misdiagnosed and Misunderstood: NJ Podiatrist

During Neuropathy Awareness Week on Monday, May 14 through Friday, May 18, Dr. Anthony Enrico Jr., a New Jersey-based podiatrist with over 25 years of experience, hopes to spread awareness to the community about peripheral neuropathy and encourage early detection. According to The Neuropathy Association, more than 20 million, or 1 in 15 Americans, has peripheral neuropathy but many people aren’t aware they have it. 

Dr. Anthony Enrico, Jr.

“Neuropathy is often misdiagnosed and is greatly misunderstood, but unfortunately nerve damage cannot be reversed. Nerve health can be maintained however, and that’s where the importance of early detection comes into play,” says Dr. Enrico. “It’s absolutely vital to seek medical attention before symptoms escalate.”

Light Jogging Does Not Cause Arthritis: NZ Podiatrist

Confirmed couch potatoes might highlight the stress jogging could cause to the body, including possible shin splints, tendinitis, stress fractures and the early onset of arthritis. Registered podiatrist Anna Kendall said those excuses did not stand up to scrutiny. "Problems I see mainly include blisters and black toenails or strain injuries. But a lot of these are due to people wearing the wrong shoes, not warming up properly, or trying to do too much too soon; so that's not the fault of the exercise itself."

Common strain injuries included Achilles tendinitis - especially in men over 30, as the blood supply to the Achilles tendon diminishes in men of that age - and plantar fasciitis. But light jogging, such as that recommended by the research, did not cause arthritis, added Kendall.

Source: James Fuller, Bay of Plenty Times [5/14/12]

MI Podiatrist Clashes With School Board Over Cell Phone Usage

Tension between new Farmington school board member Dr. Murray Kahn and the rest of the board surfaced during Tuesday's board meeting when it came to a school board code of ethics that is being updated and expanded. New items in the code include that board members “refrain from using any and all electronic communications” by and amongst themselves, and to and from members of the public during board meetings. 

Dr. Murray Kahn

The new item, it seems, was prompted by Kahn looking at his phone during meetings. Board members believe he is texting during the meetings. Kahn, a podiatrist, told the board he doesn't text, but he does look at his phone for work messages. “As I am a physician, I check it constantly, all day long,” he said. “If it's an important call, I'll take it.”

Source: Susan Steinmueller, Observer & Eccentric [5/13/12]

Query: AFO Policy Update

I recently read Dr. Kesselman’s AFO policy update in Podiatry Management. As a result, my office staff has contacted our various vendors to request certification that the DME products we dispense have been approved. To date, we have not had any luck obtaining this documentation.
 
If I understood the article correctly, each DME item that we dispense and bill to Medicare must have been presented to the SADMERC committee and approved (cast boots, AFOs, soft ankle supports, etc.). If a 2012 certification to this effect is not available, we should dispense and invoice the item as non-covered. Do I have my facts straight?
 
Craig Breslauer, DPM, Plam City, FL

Query: Global Period

Where can I find out the global period of coverage for surgical procedures? I used to search the Federal Register for them, but I cannot find them any longer.

Mark Davids, DPM, DeLand, FL

Response: The first and easiest is the APMA Coding Resource Center (apmacodingrc.org). Not only does this site give you the global days, but it also contains so much more: NCCI edits, RVUs, links to all the Medicare LCDs, etc.

The second site is the Medicare fee schedule database: cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx and bring up the payment policy indicators. A third site is the general CMS Medlearn site on global surgery which can be found at: cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//GloballSurgery-ICN907166.pdf

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Stabilizing the Medial Column (David Weiss, DPM)
From: Jeffrey Manway, DPM

While a midshaft chevron with intercuneiform stabilization may or may not be appropriate in some scenarios, a Lapidus is the procedure of choice in this patient. First, I'm making the assumption that this is a weight-bearing x-ray. Regardless of the 1st ray hypermobility, this is a severe hallux abducto valgus deformity with metatarsus primus adductus and an IM greater than 16. The patient also has a notable atavistic cuneiform and a long first metatarsal. Not only will the Lapidus accomplish reduction of the 1-2 IM angle and 1st ray stabilization, this will also restore a normal metatarsal parabola. If intercuneiform splay/instability is a concern, a Lisfranc or intercuneiform screw with or without intercuneiform preparation would certainly be acceptable.
 
Jeffrey Manway, DPM, Pittsburgh, PA, jeffrey.manway@gmail.com

RE: Soft Tissue Mass (Rob Lagman, DPM)
From: Gino Scartozzi, DPM

Since visualization of the tumor is poorly defined within the existing MRI study, I recommend repeating the MRI study with contrast in light of the radiologist's diagnostic impression of synovial sarcoma or giant cell tumor of the tendon. In this situation, wide excisional resection of the tumor would be indicated rather than incisional biopsy or partial excision. An inadequate or partial resection of a giant cell tumor of the tendon would predispose the patient to development of malignancy of this tumor type. Coordination with an oncologist is strongly advised.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Hand Instrument Repair (Michael DiGiacomo, DPM)
From: Ken Hatch, DPM

If the instruments were manufactured by Miltex, send them back. They are guaranteed for life. 

Ken Hatch, DPM, Annapolis, MD, KLHDOC@aol.com

RE: Billing Under an Associate's Insurance Number (Name Withheld)
From: Yaron Raducanu, DPM

There are MANY issues with the above. The best advice is to consult your attorney. I'm not an attorney, but the first thing you need to do is protect yourself. Are you an employee of this new doctor/practice? You likely assigned your receivables to the practice you currently work for, and not with this new corporation that this new doctor has set up for himself. Unless new contracts are drawn up about the relationship between you and this new doctor, he CANNOT bill under your number without your consent. Period.

The other issue is that this doctor cannot bill under your number without you being physically present and countersigning his or her records stating that you were there and agree with the care provided to these patients. That is quite a leap of faith. Once again, PLEASE protect yourself and consult with an attorney ASAP. Don't get taken for a ride as it may affect you now and down the road as well.

Yaron Raducanu, DPM, Virginia Beach, VA,  kidsfeet@gmail.com

RE: Sterilizing Bits Between Debridements (Edmond F. Mertzenich, DPM, MBA, DPM)
From: Warren S Joseph, DPM

I have been following the thread on nail burrs but not responding despite "itchy fingers" (fungal infection from a non-cleaned burr perhaps?). To me, it is as simple as asking yourself the question: Would you treat your (wife, husband, mother, kid...fill in the blank yourself) with a burr you used to debride a number of patients' fungal infected toenails, or would you use a freshly cleaned burr? If it is good enough for your patients, why not a close family member?
 
But what has moved me to answer was the comment by Dr. Mertzenich about the APMA needing to "form a taskforce" and come up with suggestions. How many of you are aware that the APMA HAS done just that? I was an invited member of a special task force, mostly consisting of members of the Clinical Practices Committee of APMA.  We developed guidelines for disinfection and sterilization of instruments. For APMA members, just log on to apma.org, go into the "Members" section, and use the search term "Sterilization" to find the document. We recommended cleaning and disinfection of burrs between each patient use. Also, note that there was a paper published in JAPMA a number of years ago from NYCPM that looked at burrs. They found that after a single use on a single fungal nail, 100% of all burrs grew fungal organisms. Think about that next time you feel you shouldn't have to clean your burrs!
 
Warren S Joseph, DPM, Huntingdon Valley, PA, wsjoseph@comcast.net

RE: Is it Time to Bring Back Chiropody? (Richard Jaffe, DPM)
From: Robert Scott Steinberg, DPM

This is just another attempt to dumb down our profession. Dr. Jaffe rightly points out the results of unintended consequences. Podiatry is not necessarily our kind of podiatry in many other countries. That fact is being looked into in Australia where podiatrists are not allowed to be called doctors, and rightly so.

In the USA, colleges of podiatric medicine are approved by the CPME, as are our residency programs. Australia may be considering the acceptance of DPMs as doctors if they completed a CPME-approved program. I would be in favor of doctors of podiatric medicine being called doctors of podiatric medicine, as it means we are physicians and surgeons of the foot and ankle, and we are trained to a much higher level than many podiatrists in the rest of the world!

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.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. 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

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 - HOUSTON, TEXAS

30 year old busy, progressive practice for sale with an excellent reputation and well established, diverse referral base. Well trained, dedicated, supportive staff. Excellent cash flow ($400K net income after overhead). EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. Contact:mcrosby@picagroup.com or call (888) 776 2430.

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is referred out. Financing available. Call 800-983-4194, or email: contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - AUSTIN TEXAS

Great opportunity. 18 year practice with large patient base. Current physician is retiring. Start turn-key. Will owner finance with a down payment. Will stay to help transition. EMR based office. Great place to live, work and raise a family. E- mail susieintx@aol.com or call to schedule a look at the office 512-719-4545.

ASSOCIATE POSITION - NEW JERSEY

Immediate opening for a full-time podiatrist in a rapidly expanding multi-office practice in central New Jersey. Well established referral base with full admitting hospital privileges. Availability to become part owner of a multi-room, multi-specialty ASC. Excellent opportunity for the right doctor with potential to achieve $200K in the first year. Wonderful working conditions. Applicant must have at least PSR-24 surgical training. Valid NJ license and Medicare number is required. Applicant should also be familiar and competent in biomechanics, trauma, ESWT, PRP, wound care, and ultrasound diagnostics. Participating insurance #'s a plus. Please fax resume to:(609) 259-6637.

ASSOCIATE POSITION - ILLINOIS

Full and Part-time opportunity to provide conservative, ethical podiatric care to residents in long-term care throughout Illinois .  Full time position includes health, disability, 401, auto/travel expenses. Ideal Full-time candidate would be willing to travel 2-3 days per month, or be located in central or downstate IL. We have a 30 year history of providing exceptional care and service, with appropriate reimbursement. Please email queries or resumes to  gh@podiatryplus.net.

ASSOCIATE POSITION - FLORIDA

Great opportunity for new practitioner or experienced physician looking to relocate to Florida. Practice currently owned by physicians with a solid patient base after over 12 yrs of practice in this area. Current physicians transitioning to part-time (and eventual retirement from the practice) in order to pursue other business opportunities. Seeking a friendly, dependable, independent ‘go-getter’ who can transition in as seamlessly as possible with staff and patients while maintaining the high-quality foot/ankle care on which our reputation was founded. Start turn-key without need of a bank loan. For more information or to express your interest, please forward your CV to: podiatristsearch@gmail.com

ASSOCIATE POSITION -  WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice.  Visit our website www.centralmasspodiatry.com 

ASSOCIATE POSITION - VICTORIA, BC

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

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 - SOUTHERN CALIFORNIA

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977

ASSOCIATE POSITION - OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - CALIFORNIA

Office and hospital-based podiatry group in Bakersfield, CA seeks highly-trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV to: aghams2@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Arkansas, Kansas, Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, 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

ASSOCIATE POSITION - ST. LOUIS

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Starting salary ($100k), plus incentive comp plan, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to: jmurray@foothealers.com and visit our website www.foothealers.com

PM News Classified Ads Reach over 13,500 DPM's and Students

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