The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 21, 2009 #3,551 Publisher-Barry Block, DPM, JD

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Athletic Shoes Need Right Amount of Support: MO Podiatrist

Along with flip-flops and sandals, athletic shoes also see more action when the weather's warm. When choosing an athletic shoe, Springfield podiatrist Geoffrey Bricker said, it's important to find one with just the right amount of shock absorption--"a little shock absorption, not a lot," he said.

Dr. Geoffrey Bricker

Although a shoe with a stiff sole can cause foot problems, Bricker said, a shoe with too much shock absorption won't support the heel well enough when the wearer is in motion. Alternatives like Z-CoiL shoes, which have a steel coil spring shock absorber under the sole, work well for some but not for others, he said. Crepe or rubberized soles and good arch supports are also qualities to look for in an athletic shoe, Bricker said.  "The best shoes will have a removable footbed," he added, so it can be replaced with a better arch support.

Source: Susan Atterberry Smith, Springfield News-Leader [5/18/09]

MA Podiatrist Elected as APHA Podiatry Section Chair-Elect

Newburyport podiatrist James DiResta DPM, MPH, was selected to serve as chair-elect of the Podiatric Health section of the American Public Health Association. Dr. DiResta is an active member of the Massachusetts Public Health Association and the Massachusetts Podiatric Medical Society. He is an active medical staff member of Anna Jaques Hospital, where he serves on the medical staff bylaws committee. He is also a board member of the local physician organization, the Whittier IPA, and serves on the steering committee of Wellport, an electronic health information network.

Dr. James DiResta

Dr. DiResta is a Board of Trustee member of the MPMS and chairman of its public health committee, and was recently elected second vice president of the organization. He also serves the American Podiatric Medical Association as a member of the Public Health and Preventative Medicine Committee. Dr. DiResta holds a master's degree in public health from Dartmouth Medical School.

Source: The Daily News (Newburyport, MA) [5/19/09]

Query: Digital Processors

Our office is in the market to purchase a digital processor and we are investigating different companies.. Could the readership give an overview of  their processors with respect to ease of set up, overall cost to install and use, quality of product, and response to problems, if any?
 
Barry A. Wertheimer, DPM, Redondo Beach, CA
 

Query: Adjustment of a Gauntlet Brace

I recently dispensed an Arizona-type brace. The patient returned several weeks later complaining that it did not fit right. I sent it back to the lab, and they modified it, returning it with a bill for $150. How would I bill this to recoup the repair/adjustment costs?

Charles Perry, DPM, Cambridge, OH

Response: Since this was within the first 90 days of your dispensing the device to the patient, this is included in the global allowance for the HCPCS codes of the item.

In the unlikely circumstance that the device was altered to now include modifications not described by those HCPCS codes initially billed, those additional codes could now be billed.

Assuming your casting technique and initial Rx were correct, I would take strong exception to paying an additional 50% of the going rate of a new device for modifications. This is unacceptable, and if this is a pattern, you might wish to change labs.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at:
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RE: Edward Imko, DPM
From: Mackie J. Walker, Jr., DPM

It is with a heavy heart that I miss my beloved friend and colleague and mourn the passing of Dr. Ed Imko. I recall his wonderful mind and intellect moving faster than his ability to articulate his passion, and his famous chicken scratch faxes of yesteryear, before the age of e-mail. We will all miss him greatly. 

Dr. Edward Imko

I spoke with Dr. Tom Miller yesterday and was moved by his comments about Ed. As he noted, and all of us senior members remember, Ed, at great personal sacrifice of time, energy, effort and his own limited financial resources gave well beyond his share to our profession and particularly the SCPMA! His efforts in the state legislature, his service on the Executive Committee, as President of the SCPMA, and his service as APMA delegate for many years laid the groundwork for our efforts today. He was in Columbia as much as most legislators, all at his own expense and time from his office, long before we had a budget and a legislative committee or PAC.
 
Mackie J. Walker, Jr., DPM, Aiken, SC

RE: Orthotics Overprescribed in the General Population
From: Robert Eckles DPM, MPH

I have been away from the PM News for about 2 weeks and on my return find that comments I made to a New York Times reporter (and later a reporter from Oprah magazine) some years ago have apparently resurfaced. Let me clarify my position. I am a believer in the efficacy and validity of prescription orthotic therapy. I was taught by and mentored by some of the greatest biomechanical minds in this profession, and I continue to press the importance and the singularly identifying role that orthopedic medicine has in our profession with the students I currently work with.

In my interview with the NYT reporter, I made the comment that orthoses were BOTH over - and under-prescribed. I consider the use of prescription orthoses amongst diabetic patients, the obese, the elderly and many others to be far too low. I also believe that we now live in an era of advanced reconstructive surgery that in many instances offers, in comparison to even a decade ago, surgical options which in a realistic and practical way, change functionality and improve the quality of life for many- without orthoses.

In the span of my career, I have been able to see evidence-based literature, in step with technology, validate exactly what prescription orthoses actually do in both clinical and quantitative terms. I do feel that there is efficacy in non-prescription devices at the appropriate time, and I doubt this is controversial. Unfortunately, the full extent of my comments were not printed by the Times/Oprah writer(s) who appear to have had a specific agenda in researching the subject.

Robert Eckles DPM, MPH, Dean, Graduate Medical and Clinical Education, NYCPM, reckles@nycpm.edu

RE: Scheduling Nail Debridements (Joe Gonzalez, DPM)
From: Stephen H. Zimmerman, DPM, Dave Samuel, DPM

I have two potential solutions: First, as awful as it sounds, block out an entire morning or afternoon (or 2 if needed) for foot care only.  With the proper help, you should be able to move those patients in and out fairly efficiently and see 4 to 6 an hour. This would take care of 20 to 25 pts., and if you do that every week, you can accommodate 100/mo easily, if you have that many.  Another option would be to hire a nail tech. You come in and say "Hi" to Ms. Jones and make sure she has no new complaints, then the tech comes in and does the work.  That's no different than the dental hygienist coming in to clean your teeth.  You can selectively schedule when that employee works, and at an hourly rate you should easily pay for them because you're freed up to see other patients.  Obviously, you should check with you state laws about having someone work like this under your supervision.

Stephen H. Zimmerman, DPM, Memphis, TN, drzimmerman@poplarpodiatry.com

I also have a 'diverse' practice. Basically, I think we are podiatrists, right? Our practice does it all, from all kinds of surgery to 'nail care.' Does that sound like your practice? When I found my practice getting 'clogged' up with work, I hired another doctor. We see a few hundred patients a week and make a fine living doing nail care as well as everything else. If you ask around, you will find strong busy offices do not feel nail care clogs up time, especially if you get paid to do it. Your problem is simple;  work more hours or hire someone to handle all that 'waste of time' stuff you seem to feel about nail care. Another idea is pass your feelings on to some of the podiatrists in your area who feel nail care is as important as anything else they do on a daily basis and I am sure they will be happy to open some additional hours in their schedule to take some of this problem stuff off your hands. Joe, you’re a podiatrist. Sounds like you have a busy office. Be happy and do podiatry. I wish you much success.

Dave Samuel, DPM, Chester, PA, desamuel@pol.net
 

RE: MediNotes and Eclipsys (Michael Brody, DPM )
From: Marc Garfield, DPM, Michael Brody, DPM

I am not an expert on this, so investigate my statements further.  However, I believe Dr. Brody is wrong. There is NO defined standard of certification or "meaningful use." CCHIT is trying to be that organization and probably will be. Keep in mind, CCHIT costs a vendor $200,000+ and does not presently mean anything. If you are using a program that is not committing to comply with HITECH standards, then you should begin looking for a vendor that will commit. The upcoming systems WILL be required to meet the "PQRI" standards, of which, most systems have little or no means of satisfying right now even if they have CCHIT certification. Given the input that GE has in formulating EMR policies, Centricity will probably be the standard for such a system. 

Be careful before you leap into a new system, but do not wait to start looking. 2.5 years is not a lot of time to compare $20-100,000 pieces of software. There is to be some kind of announcement on healthcare reform on 7/31/09. Maybe this will provide some answers. I would not buy anything, until the government tells us the minimum standards of what we will have to use (Or be reimbursed at a penalty). Also keep in mind that the point of PQRI is to collect results, so that standards of care and cost analysis can be performed so that they can ultimately separate essential from non-essential care and treatment; so that they can begin trimming the fat.  While we are all piling on to gather that $44K bonus, eventually the government plans on taking that right back out of your reimbursements, but that will happen anyway. Get your 44K while you can, and try not to spend $100K to get it.  
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

Editor’s Note: Dr. Brody’s extended-length response appears at: http://www.podiatrym.com/letters2.cfm?id=26412&start=1

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP

Monrovia, California. Applicant must be a licensed podiatrist and have completed a podiatric residency program. Monthly Stipend $4,000 to $5,000. Please email your curriculum vitae to victoriamanagers@gmail.com Thank you for your interest in our Program.

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.

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.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 

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Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110. 

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