The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 22, 2013 #4,776 Publisher-Barry Block, DPM, JD

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Foot Ulcers are Major Reason Why Diabetics Wind up In Hospital: PA Podiatrist

Major diabetes complications include heart disease, kidney failure, eye problems and foot problems, "but of all the things that can go wrong with diabetes, what puts you in the hospital most often is a foot infection," said Dr. Peter Joseph, chairman of the Allegheny General Hospital podiatry department.

Dr. Peter Joseph

Treating a foot ulcer -- beginning with seeing a podiatrist, then proceeding to a lengthy hospital stay and ultimately ending with amputation -- averages about $300,000, with additional costs for sophisticated and costly prosthetic devices, Dr. Joseph said. Eighty percent of amputations start with a foot ulcer. "You want to stop the little red spot before it becomes an ulcer."

Source: David Templeton,  Pittsburgh Post-Gazette [5/20/13]

PM News has begun a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section.

Quick Poll
Do you recommend barefoot running?
Click HERE for Results

Art More Than a Footnote at MN Podiatrist’s Office

For many people, a trip to the doctor’s office can be hard on the nerves. At Otter Tail Podiatry, however, Carole Butcher hopes some art will settle those worries. The office staff has started their first art exhibit on the walls of the reception area, hallways, and treatment rooms. They chose the optimistic “Butterflies, Birds and Blooms” as a hopeful look to spring. “People really like it,” Butcher said. “They like to see things that are different.”

Dr. Marc Butcher

While a doctor’s office is certainly an unusual place for an art exhibit, Butcher said she and her husband, Dr. Marc Butcher were inspired by the arts community in Fergus Falls. Having moved from New York, the thriving art scene in town came as a surprise. “We’ve been amazed and enjoy the art here,” Butcher said. “We really enjoy the town and wanted to do something to fit in.”

Source: Rian Bosse, Fergus Falls Daily Journal [5/20/13]

AZ Podiatrist Delivers Parenti Lecture on Limb Salvage

David G. Armstrong, DPM, MD, PhD, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) delivered a data-driven dose of hope to an assembled audience of physicians, surgeons, nurses, philanthropists, and administrators at the Geisinger Health Clinic this past week.

Drs. John M. Parenti, David G. Armstrong, Nina Porzecanski, Cheryl Bongiovanni, Arturo Porzecanski, Mahmoud Gannoum, and Michael Suk

Armstrong's lecture was named in honor of orthopaedic surgeon, John Parenti. Armstrong reported on data from his SALSA team and others regarding the value of cutting-edge proactive surgical and medical intervention as well as the near-term "revolution" in mobile health (mHealth).

Greater Texas Education Foundation Conquers Tuscany!

The Greater Texas Education Foundation (GTEF) hosted 40 doctors and guests for the 2013 International Meeting May 3-12. The group enjoyed interactive lectures, as well as chianti - while visiting Italy including Florence, Tuscany and Cinque Terre.

Attendees at GTEF Tuscany Meeting

The faculty included: Drs. Mark Hofbauer (PA), Alan Ng (CO), Stan Churchwell (TX), Manish Patel (TX), and Director, Sam Mendicino (TX). This meeting supports the Houston residency programs and the Texas Podiatric Medical Foundation (TPMF) indigent projects.

Query: Documenting Radiological Findings

I recently performed an internal audit with a former RAC auditor of 40 randomly selected charts.

Per this audit, I have been advised that the manner I record x-rays in my notes is insufficient. Per the auditor, "a formal, separate report indicating the specific type of x-ray indications, reason for x-rays, and findings must be documented. This must include the number of views and area of body x-rayed. A written report, signed by the interpreting physician should be considered an integral part of a radiologic procedure or interpretation. The x-ray report should be separate from the other notes for the encounter and clearly delineate that the x-ray was interpreted by Dr. X."

Further comments and direction as to the accuracy of this information will be appreciated.
 
Name Withheld

Query: Wireless Headphones for Staff

I'm looking for a good recommendation for a wireless headset for my office phones. Jabra and Plantronics seem to be the major players in this market. Any recommendations would be appreciated.
 
David L. Kahan, DPM, Sacramento, CA

Query: Diabetic Shoe/Inserts (DME) Wholesale Suppliers
 
Can anyone recommend a full-service wholesale DME supplier who carries multiple lines of diabetic therapeutic shoes, multi-density inserts,  AFOs, crutches, CAM boots, etc.? I'm looking for a company with competitive pricing, simple and easy to use, and invoices customers once per month.
 
Isa Schwarzberg, DPM  Maywood, NJ

Query: Night Splint Codes

What codes do you use for a night splint? At the present time, we are using L4396 for a night splint to be used for plantar fasciitis and equinus. Other practices have used L1930 (AFO, plastic or other material, prefabricated, includes fitting and adjustment) or L2820 (addition to lower extremity orthosis, soft interface for molded plastic, below-knee section). Can someone tell me the difference and what is most appropriate?

Saera Arain-Saleem, DPM, Elmhurst, IL

Response: L4396 (static ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, pressure reduction, may be used for minimal ambulation, prefabricated, includes fitting and adjustment) is the only code one should be using for a plantar fascial night splint.

L1930 and L2820 should only be used for an AFO which will primarily be used during ambulatory activities.

If a product has received PDAC approval for both L1930 and L4396 use, the coding would be determined by the primary use: ambulatory (L1930) or non-ambulatory (L4396).

Paul Kesselman, DPM, Woodside, NY

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RE: Painful Bunion in a 12 Year Old
From: Dennis Shavelson, DPM

It is not a logical progression biomechanically to accept that for a 12 year old with this bunion, “She has a first ray that is stable.” Her bunion is too advanced and fast growing for that ray to be stable. Perhaps you can do a simple functional foot typing of the forefoot, where the first ray is forcibly plantarflexed and then dorsiflexed with a stable fifth ray as the reference point. I suggest that her FF PERM will be plantarflexed, her FF SERM Dorsiflexed, and her SERM-PERM interval will be high.

The reason that this is so important is that if the first ray is unstable, it would then become important for the surgical correction to seek greater “stability” of the first ray when selecting a procedure.

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

RE: How to Decline a Raise Request
From: Jon Purdy, DPM
 
After reading this piece, I wanted to title my response “How to Decline Bad Advice.” If you have an employee whom you feel deserves a raise, you can’t afford not to give this person a raise. Consider that a fifty cents per hour raise will cost you about $1,500 annually, and having to replace that employee will cost on average $10,000 over the next three months.
 
Even if the employee does not leave, you have effectively bypassed your duty to pay your employee what they deserve and created ill-will in your practice. Anyone who finds themselves in this position should be creating goals of practice growth.
 
First, figure out if you are within the normal benchmark of 20 to 25 percent of your gross income attributable to wages. You may find you are overstaffed, however that is usually not the case. If your practice cannot support the necessary employee ratios, and you are not able to determine why, you will need some immediate professional practice management assistance. And if you do find you need this help, let your staff know of your willingness and eagerness to improve your practice situation. It will be an uplifting and motivational event for the entire staff.
 
Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

EQUIPMENT FOR SALE - NEW AEROLASE YAG LASER

Brand new Aerolase Yag Laser Bought Feb 2013- Never Used Paid $35,000. Will sell for $25,000. Contact Kathy (352) 867-1155 or Michael after 7pm (352) 816-1155.

PRACTICE FOR SALE - CALIFORNIA

Unique opportunity to purchase a very busy 50 year old practice in Coronado Ca. Large and stable patient and referral base with consistent new patient growth. Low overhead. Priced to sell. Great staff. Hospital privileges available. Willing to stay on for transition. Inquiries please email foothold@msn.com

PURCHASE NOW OR LATER IN DALLAS, TX 

Turnkey in Dallas’ beautiful and prestigious Uptown neighborhood:   modern, fully furnished office in 24/7 security high rise and large patient base. There is tremendous growth potential in this affluent and diverse area. Perfect for new practitioner, to share, or second office.  afc1dfw@gmail.com

PRACTICE FOR SALE IN CENTRAL FLORIDA  

33 year old practice grossing $550k seeing an average of 40 patients per day.  Possible owner financing for both practice and large office building.  Five year average profit margin of 35%.  New Listing.  For more information call Chas Smith at 863-688-1725 or email Chas@cpalliance.com

PRACTICE FOR SALE - BROOKLYN, NY

28 year old practice in a desirable part of Brooklyn. EHR certified with stage 1 criteria successfully met. Practice has room to grow. Good mix of Medicare hazardous foot care; surgery and wounds. Low overhead. Priced to sell. Email Inquires to: brooklynpracticeforsale@gmail.com

PODIATRIST FOR NURSING HOME CARE - MASSACHUSETTS

Excellent Opportunity. Seeking independent physician for growing nursing home podiatry care Work independently, make your own hours. Must do own billing. YOU KEEP 100% OF PROFITS. Must be personable and have good patient skills. Acquisition fee based position. Please e-mail CV and short bio to: americanmobile@verizon.net

ASSOCIATE POSITION - VIRGINIA

Well-established practice in Arlington Virginia looking for first year associate DPM perhaps leading to purchase of office. Office is one block from metro and has onsite private parking for patients. Present owner is retiring but will aid with smooth transition. This practice has been in the same location for the 40 years and has an excellent referral base. Must be licensed to practice in the state of Virginia. Please contact drmichaelfine@aol.com. Cell Phone 703-582-5999.

PODIATRISTS NEEDED - LOS ANGELES, CA
 
Home Foot Care, Inc. Is looking for motivated podiatrists to provide quality mobile care to our home-bound patients. Flexible schedule, independence, great compensation. If interested, please email resume to homefootcare@hotmail.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - HAMPTON ROADS VIRGINIA

Needs to be highly motivated, INDEPENDENT and surgically-trained to join a successful 40+ year practice surrounded with water sports, beaches and hiking. PSR24/36; well versed in forefoot and rearfoot surgery, diabetic wound care, sports medicine and diagnostic ultrasound. Please email CV & cover letter to fixafoot@cox.net

ASSOCIATE POSITION - LAS VEGAS, NV

Need a Nevada licensed podiatrist to cover IN OFFICE for month of June 2013. Starting Date June 1, surgical experience not a requirement. Salary is negotiable. doctor@viawest.net

FT OR PT ASSOCIATE - SOUTH JERSEY

Great opportunity for FT or PT associate starting July 2013 in established practice in South Jersey. EMR, FDA-approved Lasers for fungus. Will work with Board Certified/Qualified podiatrist. Must have New Jersey License. Diverse practice in a nice area with a pleasant environment. e-mail CV at hhfootdoctor@gmail.com

ASSOCIATE POSITION - MASSACHUSSETS

Located near Boston. Busy multi-office podiatry practice looking to expand. Need extremely energetic dedicated individual. Must be PSR 12-24 trained, EMR, laser, vascular testing the works. Must have sense of humor. MA License, NH License A+! Surgery, sports medicine, pediatrics, shoe store. Please send resumes to resumesent11@comcast.net.

ASSOCIATE POSITION - CALIFORNIA
 
Established foot and ankle specialty group looking for an experienced podiatrist. This position entails making rounds at local hospitals, skilled nursing facilities and having scheduled office appointments. Must be comfortable with all aspects of podiatric care and will be doing no less than the hiring partners. Full-time position with a competitive salary. Looking for someone with a great bedside manner, energetic and will to go the extra mile to make a positive difference. Send CV to administrator@footnankledoc.com

ASSOCIATE POSITION - NEW YORK

Large established podiatry practice 30+ years in New York Hudson Valley/Capital District area seeking associate/partner to eventually take over practice. Also would entertain reasonable offer to purchase one of the two offices. Serious Inquiries may contact: Podiatrygroupny@gmail.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 PODO2345@AOL.COM 516-476-1815.

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