The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 17, 2012 #4,464 Publisher-Barry Block, DPM, JD

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Annual Comprehensive Diabetic Foot Exam a Must: SC Podiatrist

Diabetes is a growing epidemic. "60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet. This places them at tremendous risk of developing an ulceration or open wound of the feet," says podiatrist Dr. Scott Werter.

Dr. Scott Werter

"It's important for patients with diabetes to see a podiatrist at least once a year for an annual comprehensive diabetic foot exam. During that exam, the skin is examined to see if there are any dermatalogical problems, the nerve supply to the feet evaluated to see if there are any neurological problems, the circulation measured, and the foot structure examined to see if there are any orthopedic problems," says Werter.

Source: SC Now News 13 [5/14/12]

BioMedix Partners with WesternU to Promote Amputation Prevention

BioMedix, a leading provider of collaborative healthcare IT solutions, has joined with Western University of Health Sciences (WesternU) to promote amputation prevention through awareness and early detection of Peripheral Artery Disease (P.A.D.). Through an educational grant from BioMedix, the WesternU College of Podiatric Medicine will have access to BioMedix PADnet, a user-friendly test for the early detection of P.A.D.

Dr. Jonathan Labovitz

“Our partnership with BioMedix and the use of PADnet technology will support the success of a new Amputation Prevention and Wound Care Center at WesternU,” said Jonathan Labovitz, DPM, FACFAS. Dr. Labovitz is associate professor and department chair of Medicine, Surgery, and Biomechanics in the College of Podiatric Medicine, and Medical Director of the Foot & Ankle Center at WesternU. “The Center will be an important addition to the WesternU campus that will allow us to appropriately diagnose P.A.D. and improve outcomes through decreased amputations and improved quality of life.”

Different Foot Types Require Different Running Shoes: MI Podiatrist

Everyone's feet are different, so it's important that you find new shoes based on your needs. The arch of your foot is an important factor. "If you have a high arch foot, which means your arch doesn't collapse, you really want to focus on getting a shoe that has more cushion instead of stability," said Dr. John Niemela, podiatrist and foot and ankle surgeon at Baraga County Memorial Hospital. 

Dr. John Niemela

If you have a flat foot, then look for shoes with arch support. Another option is custom orthotics, where podiatrists can create a mold of your foot to provide the best possible arch support. Otherwise, you need to make sure that when your shoes get old, you find new ones.

Source: Dustin Bonk, WLUC TV 6 [5/14/12]

IL Podiatrist Sued for Not Paying Back Student Loans

Student loan debt in the United States is rapidly approaching one trillion dollars. Five million Americans are delinquent on their student loans. One of them is David Gunzel, a Carbondale foot doctor. Dr. Gunzel owed up to $363,000 before the federal government sued him to collect on the debt that was insured by the U.S. government. The records in his case show that the private student loan company sued to collect his debt in 2004. The federal government filed suit 4 years later after taking over the debt. In 2010, a federal judge issued an order garnishing Gunzel's wages.

Source: Craig Cheatham, KMOV.com [5/14/12]

DPMs Earn $44 Million for Meaningful Use

In the latest Medicare Incentive Program update, CMS reports that podiatrists have received more than $44 million in CMS incentive payments for meaningful use. Only family practice, internal medicine, and cardiovascular specialists have received more incentives. APMA has been active in educating members about meaningful use and how to take advantage of incentives.

Source: APMA Weekly Focus [5/15/12]

RE: Soft Tissue Mass (Gino Scartozzi, DPM)
From: Gino Scartozzi, DPM, Bryan C. Markinson, DPM

To clarify my previous post, the fact is that the MRI is an incomplete study. I recommend repeating the study with contrast. In light of the fact that the clinical impression to a radiologist is consistent with synovial carcinoma or giant cell tumor, an open incisional biopsy should be performed followed by a wide excision if malignancy is determined intra-operatively. Pre-operative surgical staging via PET Scan is recommended to determine if surgical course would benefit the patient. An oncology consultation is highly recommended pre- and post-operatively.

Giant cell tumors, although benign, have a histological appearance identical to pigmented villonodular synovitis and have rarely been reported in the medical literature to convert to malignancy. I hope this clarifies my posting which was put together with poor construct and expression.

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

I appreciate Dr. Scartozzi’s willingness to clarify yesterday’s post. However, one statement in his correction also needs clarification. The statement: “In light of the fact that the clinical impression to a radiologist is consistent with synovial carcinoma or giant cell tumor, an open incisional biopsy should be performed followed by a wide excision if malignancy is determined intra-operatively,” is not quite right.

First of all, radiologist impressions should guide the performance of a biopsy, not the definitive surgery. The biopsy result defines the definitive treatment plan: surgical, medical, or both. If open incisional biopsy reveals malignancy, most people in the field would correctly get the patient staged first before they did a wide excision. That would mean an oncology referral and PET scanning. Let’s say, for instance, that the wide excision would cause a hallux amputation….you would not want to do that on someone who has six months to live because the tumor is already in their lungs and/or liver. Imagine causing someone in the terminal stages of an illness to deal with an ablative surgical wound and healing for no reason!
 
Lastly, if you find yourself seeking advice on the surgical management of a soft tissue mass (that may be malignant) in PM News, I am reasonably sure you may get some great information. But I am positive that the patient could be in better hands. 
 
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Stabilizing the Medial Column (David Weiss, DPM)
From: Douglas Richie, DPM

I am curious how Dr. Weiss determined that this patient had "hypermobility" of the 1st ray?  Furthermore, I am not aware of any published study, using modern biomechanical measurement techniques which have demonstrated that any surgical procedure can correct this presumed "hypermobility".  How do static relaxed stance weight-bearing x-rays demonstrate function of the human foot, and specifically the 1st ray, during dynamic gait?
 
Douglas Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: What You Need to Know About PDAC
From: Robert M. Gaynor, DPM

PDAC stands for Pricing, Data, Analysis and Coding. PDAC is based in Fargo, ND and is a government contractor. PDAC is responsible for analyzing products from manufacturers, giving them codes and pricing them. PDAC gives every product a full description. Manufacturers have to produce their products to meet the specifications of PDAC. Some items need to be PDAC-approved before you can bill for the item and some do not. Examples include A5500 which do not have to be PDAC-approved, but A5512 and A5513 do have to be PDAC-approved. L1906 has to be PDAC-approved, but codes like L1940 and L1970 do not have to be PDAC-approved. The Medicare LCD will tell you if a certain product has to be PDAC-approved prior to dispensing.

According to PDAC, the supplier is ultimately responsible to make sure that the product meets PDAC requirements. This is why many manufacturers get their products PDAC-approved. I do not know of any supplier that would dispense a pair of diabetic shoes that is not PDAC-approved, even though the shoes do not have to be approved. I spoke with PDAC, and they suggest that any product dispensed should be PDAC-approved. I would copy and paste this website in your browser: dmepdac.com. This website will give you all the codes, pricing by state, and tell you what manufacturers have their products approved by CPT code.
 
Robert M. Gaynor, DPM, Wellington, FL, NAILCUTTER@aol.com

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

Dr. Raducanu rightly points out that one cannot bill under another's name and should not ever bill under another's name unless the other doctor is actually present. I would take it three steps further:
1) You should agree that the services billed were actually performed;
2) The services were documented.
3) You can sleep at night knowing your signature is on that chart.

There are arrangements where one can have the payments re-assigned to another tax identifier. Under this arrangement, only the party who bills the service must have performed the service and actually signed the chart. However, this is usually done when an employed podiatrist renders the service and the employer/employee arrangement is for the employer to receive payment, because the employee is salaried. The arrangement originally posed here is just the opposite. I agree that the employed podiatrist should seek legal counsel prior to agreeing to the proposed arrangement.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Editor's Note: Dr. Raducanu now practices in Philadelphia, PA

RE: Sterilizing Bits Between Debridements (Warren Joseph, DPM)
From: Robert Spalding, DPM

Dr. Warren Joseph's note confirmed the importance of the sterilization of burrs and any instrument used to treat fungal nails or provide routine foot care. Podiatrists who have not been following this sterilization approach could be as big of a factor as nail salons in contaminating the general public. First, tossing "dirty burrs" back into a liquid disinfectant to be re-used 5 or 10 minutes later on another patient is also a guarantee to infect your next patient. The heavy layer of bioburden trapped in the cutting recesses of a burr will not be sterilized even by gluteraldehyde in...
 
Editor's note: Dr. Spalding's extended-length letter can be read here.

RE: Shorting a Hunt Brother

Somebody top this for an embarrassing moment. When I was new in practice, I was referred a new patient - it was Bunker Hunt, the famous oil/silver baron. Word has it that the series “Dallas” was based on the Hunt family. I believe the fee for the visit was 75 bucks and he gave us a hundred dollar bill. We didn’t have any petty cash. I looked through my wallet and there wasn’t even a bill in it. So I had my office person go downstairs to the pharmacy for change. She returned with 10 ten dollar bills.  A lot of good that did…we still needed a five! I could have killed her.  So Hunt said, “If you’re a betting man, I’ll flip you for it.” I told him that would be okay, so I looked through my pockets and couldn’t even find a quarter to flip! So imagine my embarrassment – here was one of the richest men on the planet with me – the “doctor”, with no bill in my wallet and not even a penny in my pocket! 

Somehow, we found a nickel and flipped.  I won.

Carl Solomon, DPM, Dallas, TX

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ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com

ASSOCIATE POSITION - BEAUTIFUL LONG ISLAND

Business-oriented, mature Board eligible/certified podiatrist who is not just looking for a job, but a secure future. Buy-out of practice will be available. Practice does in excess of $500K. 2 hospitals available. No nursing homes, no Medicaid. Competitive package. Please fax CV to 631-581-0857.

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 – ANCHORAGE, ALASKA

Associate wanted for hospital-based podiatry group practice. Full scope of practice. Surgical residency 24month+. Outstanding opportunity, work environment, and recreational pursuits. Fax CV to 907-562-5195, please call 907-562-4958, e-mail us at contactus@alaskapodiatry.com

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 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

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.

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