The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 18, 2011 #4,163 Publisher-Barry Block, DPM, JD

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Faulty Biomechanics Increases Risk of Developing Plantar Fasciitis 

Plantar fasciitis is an inflammatory condition of the tissue on the bottom of the foot. Plantar fasciitis is the most common cause of heel pain, affecting about 2 million Americans every year. It can be difficult to treat, but it is almost always curable through conservative measures. 

Dr. Stephen Pribut

Anyone can develop plantar fasciitis, but faulty biomechanics increases your risk. “Overpronation (landing on the outside of your foot and rolling in) causes a lot of tension when the heels and toes lift off the ground,” says Stephen Pribut, DPM, a Washington, D.C., podiatrist and past president of the American Academy of Podiatric Sports Medicine. Movement problems at the hip or trunk can also lead to compensation patterns.

Source: Nicole Adamson, Experience Life

Heroic Actions of IN Podiatrist Save the Life of Trapped RV Driver

On May 12, podiatrist Dr. Richard Reilly, Jr. was returning to his Blairsville office when he pulled off Route 422 bypass to check on a group of people who seemed to be in distress as they clustered around a smoking RV. The five occupants, all between 60 and 88 years old, had rushed to relative safety after smoke and flames had started shooting from the air-conditioning vents, said Gary Bothun, one of the passengers.  Checking the bottom of the RV, Reilly spotted fire and phoned 911. 

Dr. Richard Reilly, Jr.

"I told them all to get away from the smoking vehicle. I could tell something bad was going to happen," Reilly explained. "They were in shock. I could see it in their eyes." All but one started climbing the grassy hillside to get clear of the RV. Northcott, the driver, had trouble. He uses a walker to get around and Reilly urged him to step faster. "Finally I just threw him over my shoulders and ran with him back to his party, about 40 to 50 yards away," Reilly said. "I was not going to leave him by that RV any longer." The RV, containing propane tanks, erupted into flames. Reilly's act of heroism saved Northcott's life.

Source: Chauncey Ross, The Indiana Gazette [5/16/11] 

AR Podiatrist Scores Hole in One

Thomas Werner, DPM of Russellville, AR got an unexpected treat while attending this weekend's Oklahoma Podiatric Medical Association’s Spring Scientific Seminar in Tulsa, OK. During a golf tournament called A Shot in the Dark at the Page Belcher Golf Course, Werner aced hole #8 (131 yards), using an 8 iron. Fortunately, the shot was witnessed by the food and beverage cart attendant because it was not only a closest to the pin hole, but won Werner a golf vacation package as a prize.

Dr. Thomas Werner

Also playing in the foursome was Darren Elenburg, DPM (Oklahoma City), Trent Smith, DPM (Oklahoma City ), and Jeff Root  (Meadow Vista, CA). The tournament was co-sponsored by Root Laboratory and Doctors Partner (an EMR and practice management company).

Query: Substitute for Colchicine?

I have been prescribing colchicine 0.6 mg in varied amounts for decades. I was told the product is on indefinite back order by both CVS & Walgreens. Did this go the route of quinine sulfate? Is there an equivalent alternative for acute gouty flares?

Robert K Hall, DPM, Ft. Lauderdale, FL

Query: Correct Use of ABN

What is the correct use of the advance beneficiary notice (ABN)? I have several patients who have Medicare and come in for non-covered foot care. Do they have to fill out an ABN at each visit? I also have a patient who insists my office bills Medicare knowing it will be rejected, but hoping the secondary will pick it up. Do we accept cash at the visit, then refund the difference if the secondary picks up?

Saera Arain-Saleem, DPM, Schaumburg, IL

Response; You are not mandated to use an advance beneficiary notice (ABN) when the service is statutorily not covered such as non-qualified routine foot care.If the patient wants a statutorily non-covered service billed to Medicare, you would apply a "GY" to the routine foot care code. You can collect the fee for the service from the patient at the time of service.

However, in cases where the service is a benefit of the Medicare program under certain circumstances (e.g., qualified routine foot care), but a patient doesn't qualify, you would have the patient sign an ABN acknowledging that point, and agreeing to be financially responsible for payment. The claim would be billed to Medicare with a "GA" modifier. You can collect the fee for the service (no greater than Medicare's fee schedule allowance) from the patient at the time of service.

Tony Poggio, DPM, Alameda, CA

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RE: Ultrasound-Guided Popliteal Infusion, Post-Bunion Surgery (Brian Kiel, DPM)
From: William A Sachs, DPM

We are fortunate enough at our surgi-center to have very skilled anesthesiologists who regularly perform ultrasound-guided blocks as well as infusion pumps that allow for anesthesia for periods of up to three days. This is especially useful with involved rearfoot cases as well as pediatric cases such as tendo-Achilles lengthening and STJ arthroeresis. The patient can then pull the tiny catheter out at home.

Ultrasound guidance ensures proper placement of the block and catheter. Our guys also use a small nerve stimulator attached to a needle to confirm placement, that way ensuring the block will be effective with the least amount of anesthesia. I recommend this practice to anyone who wants their patients comfortable after surgery. After all, it ultimately makes our life a lot easier!

William A Sachs, DPM, Shrewsbury, NJ, wmasachs@gmail.com

RE: Surgical Scrub (David Gurvis, DPM)
From: Daniel Michaels, DPM

There is significant evidence now that Hibiclens (chlorhexidine gluconate) used initially, and then followed with 70% isopropyl alcohol, is the superior way to prevent surgical infection. I use this during my cases and in my ASC. These chemicals are applied to gauze and rubbed on the foot from distal to proximal, usually 3-4 times with Hibiclens and one or two times with the alcohol. It doesn't stain and is readily available but should not be used on mucus membranes - not that we operate on mucus membranes. Technicare is indicated for mucus membranes.

Daniel Michaels, DPM, Hagerstown, MD, danieldm@pol.net

RE: Attaining Parity in California (Ira M. Baum, DPM)
From: Leonard A. Levy, DPM, MPH

While I feel humbled by the comments of Ira M. Blum, DPM, citing me as a pioneer in the company of Drs. Tilden Sokoloff, Lowell Weil, Sr., and Harold Vogler, time is long overdue for a major strategic planning effort by podiatric medicine to once and for all establish its direction. If such an effort concludes that the profession needs to declare its intent to become integrated into the mainstream of medicine (allopathic and/or osteopathic), then a specific plan must be set to accomplish that goal not just in our best interest, but in the interest of the health of the public we ultimately serve.

Indeed by virtue of what we do, the responsibilities that we already accept to prevent, diagnose, and treat people with problems affecting their pedal extremity with virtually no limitation, podiatric medical practitioners need to be established as physicians within their specialty. Let us stop dancing around what we already are and come to that inevitable conclusion.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: CMS Attestation (Chris Browning, DPM)
From: Pete Harvey, DPM

Even though CMS opened for attestation in April, there is no way you could attest unless you were attesting to one of the quarters in 2010 or the first quarter of 2011, Before you can go through the process of attestation, you must first testify that you have been using your EMR in a meaningful way for at least 90 days. So, the fields you enter must be those OF the ninety day period you are reporting. You can’t go past that portion of the questionnaire until you have completed the required 90 day period. If you just started using EMR in 2011, then you probably can’t attest yet. If you are reporting a 90 day period in 2010, then the program should let you continue.

Your EMR provider should be helping with each field as you wind through the entire process. If your EMR support is not helping you through this process, then it will be difficult. All of the EMR providers are learning each day, just as we are. CMS guidelines are a moving target. I would contact the tech support of your EMR provider to help through the process. Remember, your particular EMR must also be certified by Drummond or other companies which have already been vetted by CMS. If your EMR hasn’t been vetted or certified, then you will not be able to be certified  either. Before purchasing an EMR, be sure that they already have their certification number granted by CMS.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Bench-Top Orthotic Grinder Finishers (Rich Rusche)
From: Trudi Traister

In addition to the other tools and equipment we carry to produce custom foot orthotics, we carry a very suitable bench grinder for finishing work. Additional information can be found on our website or contact us via email or phone 800.356.3668 x264.

Trudi Traister, Amfit, Inc., ttraister@amfit.com

RE: EMR (David T. Taylor, DPM)
From: Alan L. Bass, DPM

While I respect Dr. Taylor’s opinion regarding web-based EMR programs like Hotmail and Yahoo, these companies also do their due diligence when it comes to backing up, security, server/hardware failure, updates, maintenance, etc. Small businesses like ours should also do the same. I can only assume that while DPM’s may have had other computer-based systems in the past, they also performed maintenance like discussed above.

If a podiatrist chooses to purchase an EMR system, it should be after doing due diligence. Make sure it is right for you. And remember, don’t let the $44,000 carrot that the government is dangling in front of you in the incentive program be the reason for purchasing an EMR/EHR system. A certified program will not only allow you to receive the incentive dollars if used in a meaningful way, but these programs also allow you to practice more efficiently, and that will allow you to make so much more money in the end than the government will ever pay you.

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Podiatrist's Responsibility When Taking Patients' Blood Pressures (Elliot Udell, DPM)
From: Richard W. Boone, Sr., Esq

Dr. Udell wrote "By the mere fact that we are now taking blood pressures, could we be swept into the net of a legal action brought against every physician who had anything to do with the diagnosis and management of the patient's hypertension?"

The short answer to Dr. Udell's question is "yes." If you undertake to perform a medical service or test upon a patient, whether you had the duty to perform it or not, you are obligated to perform the test correctly and pursue the appropriate follow-up care as indicated by the test results. If the patient's test results indicate the need for follow-up care, and that care is beyond the scope of your licensure, then you are legally obligated do everything you can reasonably do to initiate the needed follow-up care by a qualified provider. If you do not do so and the patient is harmed by the lack of appropriate follow-up care, then you are potentially liable to the patient for that harm.

Richard W. Boone, Sr., Esq. Fairfax, VA, RWBoone@aol.com

RE: The Passing of Rob Roy McGregor, DPM
From: Doug Richie, Jr, DPM

I echo the tributes paid to Rob Roy McGregor by Lloyd Smith and Howard Dananberg. Like them, I was inspired by this pioneer of podiatric sports medicine who personally sought me out and offered advice and support early in my career. He, along with Dr. Dananberg, are one of the few in our profession who innovated a technology which was incorporated into a line of running shoes. Etonic was proud to promote their "foot cradle" as a podiatric invention from Dr. McGregor. During the running boom of the '70s and '80s, Rob Roy McGregor was a key player in a movement which launched podiatric physicians into the limelight as the premier authority for treatment of the running athlete. Those were the days!

Doug Richie, Jr, DPM, Seal Beach, CA

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

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K 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. softechpodiatrist@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.

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/OPPORTUNITY - PHOENIX (EAST VALLEY)

Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com Must be pursuing or have AZ license.

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 - 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 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 POSITION - SOUTHERN MI  (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION- NEVADA

Well established 22-year practice in Las Vegas/Henderson, Nevada seeking full-time  associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@gmail.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 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

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

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