The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 20, 2009 #3,550 Publisher-Barry Block, DPM, JD

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Athletic Shoes are Best Option for Vacationers: TX Podiatrist

Dr. Bruce Scudday, a podiatrist, said many of the summer foot injuries he sees have less to do with the shoe than the wearer. He sees lots of ankle inversions, or twisted ankles, from accidents such as slipping off a curb, he said. Many times, alcohol was involved.

Dr. Bruce Scudday (Photo: Rudy Gutierrez)

Scudday said summer also brings in people with wounds from stepping on objects while barefoot. He said athletic shoes are almost always the best option to protect feet on vacation, except during those days at the beach when going barefoot becomes powerfully tempting.

"Probably the best time to wear sandals is when you'd rather be barefoot," he said. The sandals, Scudday said, will protect you from glass or other objects that can cut or puncture feet.

Source: Erica Molina Johnson,  El Paso Times [5/18/09]

Retired GA Podiatrist Still Stays Active

Among the four personalities in practice at Augusta's oldest podiatry office is the retired 83-year-old founder, who often cruises the hallways at Augusta Foot and Ankle Group on Laney-Walker Boulevard.

Dr. Morton Wittenberg and Dr. Kile Kinney (Photo: Annette M. Drowlette)

"I left on medical reasons 16 years ago; couldn't stand going up and down those halls 80 times a day, standing in the ER for hours a day," Dr. Morton Wittenberg said. He now spends most of his professional time seeing prisoners at Augusta State Medical Prison. That's only twice a week and doesn't require a lot of running. "All I do is sit on my butt and consult," Dr. Wittenberg said.

He also refers patients for surgery to Dr. Kile Kinney, the senior partner in the group, who led the practice after Dr. Wittenberg's sudden departure. "He's a good surgeon and my friend and my first partner," Dr. Wittenberg said. "We still have a good working relationship."

Source: Tim Rausch, Augusta Chronicle [5/18/09]

Accounting for Disclosures in EHR Could Be a Time Bomb Waiting for HIPAA-Covered Entities

Covered entities (CEs) are stemming their panic for now regarding the new accounting for disclosures requirements for electronic health records (EHRs) that were part of the HITECH Act, at least until they see guidance from HHS, which is due in August, consultants and privacy officials tell RPP.

The new accounting of disclosures requirements for EHRs under the HITECH Act dictates that providers log all disclosures made through EHRs — including those made for treatment, payment and health care purposes — and report them to patients when requested. Formerly, HIPAA required that providers log when protected health information (PHI) is disclosed for purposes other than treatment, payment or health care operations.

The new requirements are a ticking time bomb for covered entities mainly because so much has yet to be defined, says Frank Ruelas, privacy and compliance trainer for CEs. "So many people are reading the [provisions], which are saying 'You must do X, Y and Z — and by the way, we'll let you know what X, Y and Z are later,'" he contends.

Source: Eve Collins, Report on Patient Privacy [5/18/09]

Query: Scheduling Nail Debridements

I was wondering if anyone has any suggestions for scheduling nail debridements. I have a diverse podiatry practice, yet it seems i am getting an abundance of nail debridement patients clogging up my schedule. I have tried to limit it to one nail debridement per hour, but now there are too many.

I am thinking of blocking one spot per hour for nail debridement, and switching to a "country club" type-format" where you can only get your appointment by calling one week prior to the appointment date for those spots. Otherwise, all these nail debridements are taking the place of patients with pain and other problems. Any other suggestions would be greatly appreciated!

Joe Gonzalez, DPM, East Lansing, MI
 

RE: EMLA Toxicity
From: Philip Wrotslavsky, DPM

With regard to the discussion of topical anesthetics such as EMLA, I am reminded of what Dr. John Herzenberg used to teach us before doing tenotomies on Ponseti-cast clubfeet. EMLA has a toxic dose and we need to be aware of that. EMLA- lidocaine2.5% + prilocaine 2.5% toxicity of lidocaine –methemoglobinemia MHG precipitated by Tylenol, phenytoin, toxic dose (< 3months) = 1gram/10cm2/hour Typical tube = 5 grams RX for methemoglobinemia = methylene blue.

There are reported cases of EMLA toxicity.Here is one (just Google "EMLA toxicity" for the rest) 2004: Parker James F; Vats Atul; Bauer Greg EMLA toxicity after application for allergy skin testing. Pediatrics 2004;113(2):410-1. Lidocane toxicity may be observed at 6 mcg/mL 1 cc of 1% Lidocaine = 10 mg 4 kg baby… 12-20 mg… 1-2 cc only! The bottom line is whether you believe children have pain or remember pain, know well what you are giving them.

Philip Wrotslavsky, DPM, La Jolla, CA, drphilipw@msn.com
 

RE: Orthotics Over-prescribed in the General Population
From: Multiple Respondents

I was dismayed to see Dr. Eckles’ quote regarding orthotics being over-prescribed. I also disagree that orthotics will not be beneficial if the patient is overtraining or overweight. I have many patients who are overweight and use an orthotic successfully. In fact, if it weren’t for the rigidity of a custom orthotic, they probably would not be able to function at all. These patients may have a collapsed foot structure that the orthotic helps support and align. OTC devices would flatten in about 10 minutes and are worthless.
 
Overtraining, in itself, may be pathologic. But, overtraining with an inherent imbalance in the foot, is definitely pathologic. Orthotics can accommodate, support, align, and balance the pathologic foot to allow the patient to train without additional or unwarranted risk. We all know that our patients can be OCD with their training. I have seen orthotics allow these patients to continue their training/exercise/activities, much to their benefit, and without pain. To even think that an OTC device can come close to the benefit of the orthotic is ludicrous.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

Dr. Eckles is correct. Many doctors overprescribe orthotics and this causes these patients undo expense. It has also triggered most insurance companies to stop paying for this invaluable medical service. I often run into a situation where patients with painful and/or structural foot conditions caused by abnormal pronation or other pedal biomechanical problems will refuse to invest in othotics because of out-of-pocket expense. 

In some cases, I can succeed in treating them with good off-the-shelf orthotics, such as Powerstep orthotics which can even be posted in the office. In other cases, I have to level with the patient or the parents, if the patient is a minor and let that patient  know that unless he or she invests in a good, well-made set of custom orthotics, he or she is going to be facing a life of painful foot problems. Casting for and prescribing good orthotics when needed, is something that we as podiatrists are highly trained to do and we should not let this slide from our armamentarium of treatment modalities. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I would like Dr. Eckles to provide the statistical data for his statement that orthotics are over-prescribed and that they do not help the overweight and over-trained.

Michael J. Schneider, DPM, Vail, CO, MJS10Vail@aol.com
 

RE: Becoming a Professional Corporation (Name Withheld)
From: Josh White, DPM, CPed

SafeStep provides free expert help to set up DME billing when becoming a new professional corporation.

First, you must get a new Tax ID number. Then, it is necessary to obtain a Type-2 organizational NPI number. It is very important that your legal business name and physical location address match any supporting IRS documentation when applying for your NPI number. We will then send a new CMS-855S form to assist you in obtaining a new DME supplier number and can provide assistance when completing the application.

After the DME supplier number is set up, we will send Electronic Data Interchange (EDI) enrollment forms that will enable electronic processing of your Medicare Claims.

Josh White, DPM, CPed, President/Founder, Safestep, joshwhite@safestep.net
 

RE: MediNotes and Eclipsys (Joseph Borreggine, DPM)
From: Michael Brody, DPM

The information provided by Joseph Borreggine, DPM is incomplete and could result in confusion by your readers.

In order to qualify for the incentive bonuses of $64,000, the software not only needs certification (CCHIT is currently the only certifying body), but it also has to meet the definition of "Meaningful Use."

CCHIT Certification is valid for 3 years, but Medisoft will probably not be upgraded to meet the definition of "Meaningful Use."

In order to achieve the maximum incentive of $44,000, you must have software that is both certified and used in a meaningful manner by 2012. After that date, the amount of incentive you are eligible for decreases.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

ASSOCIATE POSITION- HUDSON VALLEY REGION, NEW YORK

Unique opportunity for the right person! We’re looking for a personable, motivated individual who is seeking opportunity and security in a high end multi-office group practice. This is an incredible position for the right person. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

DIAGNOSTIC ULTRASOUND FOR SALE

Mindray 6600 with Sony thermal printer. Machine comes with a 10 Mhz linear probe. Split screen allows two images on one screen. All digital machine. Comes with factory warranty for 1 year from Atlantic Medical LLC. Price when new is close to $11,000.00. Price for this machine with printer is $5,500.00. For further information see website

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com 

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com 

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

SEEKING PODIATRIST FOR SUNDAYS - HOWELL, NJ
 
Our practice of over 18 years is looking for a DPM to provide treatment on Sundays at our Howell office located approximately 1 mile from Lakewood , NJ. Speaking Hebrew preferred, but not required.  Please reply by emailing a CV and cover letter to: toetoe@optonline.net or by faxing to 1-888-645-0241.

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