The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 23, 2007 #2,943 Editor-Barry Block, DPM, JD

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Louis "Pete" Morris, DPM, 73

Dr. Louis "Pete" Morris passed away peacefully at home with his beloved family at his side on May 15, 2007. He ended a valiant battle with a chronic disease. Morris graduated graduated with a BS at the University of Washington in 1960 and received a degree in Podiatric Medicine from The California College of Podiatric Medicine, San Francisco in 1964. He practiced his profession in SF from 1966-1969. Returning to Everett, he practiced until 1995.

Dr. Louis "Pete" Morris

It can be said without hesitation that Pete loved his practice, his surgical work and his patients. His genuine compassion and natural caring attitude contributed to a successful and fulfilling profession. He was very involved both locally and on a state level. He was active as a member of WSPMA Board of Trustees, was appointed by the Governor as Chairman of The State Examining and Licensing Board. He was honored by Governor John Spellman with an appointment to head the newly formed State Disciplinary Board. In 1985 he was selected by his peers as WA State Podiatrist of the Year.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation's Student Endowment Fund, 9312 Old Georgetown Rd., Bethesda, MD 20814.

Source: The Herald (Everett) [5/20/07]

MA Podiatrist Cites Reasons Why Diabetic Ulcers Don’t Heal

Jennifer Eddy, an assistant professor with the University of Wisconsin Medical School, is conducting her own randomized study to test the usefulness of topical honey for treatment of diabetic foot ulcers on 40 patients throughout Wisconsin.

Dr. John Guirini

John Giurini, president-elect of the American College of Foot and Ankle Surgeons and an associate professor of surgery at Harvard University, says "A lot of these adjunct therapies have been around for years and years; I remember about 30 years ago when it was topical sugar being used to form a paste for the wound."

Giurini said that, in many cases, wounds don't heal because they've either been treated wrong or something about the ulcer was missed along the way. For example, he said, there are four things that will ultimately prevent any treatment from working: poor blood flow to the foot; an infection that hasn't been treated; not removing unhealthy tissue from the area; and not eliminating pressure on the wound. "Every time the patient takes a step on the foot, they're wearing away any tissue trying to heal the wound," Giurini said.

Source: Kawanza Newson, Milwaukee Journal Sentinel [5/20/07]

Conditioning is the Key to Preventing Marathon Injuries: WA Podiatrist

With the temperatures in the low 50s for Sunday's Capital City Marathon races, no runners were reported to suffer dehydration. Don Hovancsek, a podiatrist in Olympia, was on duty tending to an assortment of blisters, ankle sprains, and one knee strain. He's worked 23 of the 26 Capital City Marathons.

Dr. Don Hovancsek

"We're usually pumping IVs by now," Hovancsek said late Sunday morning with the last of the marathoners crossing the finish line. He's used to caring for runners with feet problems. "I tell my pastor that I've saved more soles than he has," Hovancsek said with a grin. Hovancsek said only three things matter on race day. "Conditioning, conditioning, conditioning," he said.

Source: Gail Wood, The Olympian [5/21/07]

Query: Digital Camera For Office

I have just retired my two digital cameras and am looking for a new one for office use. Can I have some suggestions that are simple, high pixels, data easily transferred to computer or CD, and a macro feature?

Sloan Gordon, DPM, Houston, TX

Query: Orders for Nursing Homes

Is it required to have a physician order every time a patient is seen at a nursing Home for routine foot care, or is there such a thing as a standing order?

Patti Smith , Lake Havasu City, AZ

Response: There needs to be an order in the nursing home chart by the attending/primary care physician requesting you see the patient for an initial treatment or initial consultation.

Once the specialist (e.g., podiatrist) has established a doctor-patient relationship, as an independently licensed practitioner, he/she will not require any additional order from the attending to continue providing care to the patient during THAT admission. If the patient is discharged, and then readmitted, a new order from the admitting physician needs to request, again, that the specialist see the patient.

A standing order (e.g., podiatric care q 60 days) is not acceptable by Medicare. A standing order presumes that REGARDLESS of the patient's medical problems, all new patients have the service or care (i.e., "standing order") included in the patient's chart, and to the patient's care regimen. A standing order does not presume medical necessity because it is universally applied to nursing home patients.

Tony Poggio, DPM, Alameda, CA

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RE: Lesion on Patient With SLE (Thi Pham, DPM)
From: Bryan C. Markinson, DPM

Dr. Pham is involved with a patient with recurrent verrucous carcinoma of the plantar foot. This lesion is commonly recurrent, but rarely metastatic. Most of the morbidity associated with it involves extension to deeper tissues, including bone. It can ultimately be fatal due to either metastasis or local complications. This patient’s history of recurrence makes for a poor long term prognosis.

Since the patient has already had multiple surgeries, and the pre-operative work ups have not been described, I would suggest the following: An MRI will give some information as to the extent of the lesions. A Mohs micrographic surgeon may be able to accomplish a complete excision with more reliable margins, and a consult is in order to determine this. Although not a great option due to skin complications, local radiation also may play a role.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@msnyuhealth.org

RE: Tibialis Anterior Tendon Tear (David O'Brian, DPM)
From: Bob Kornfeld, DPM

I have had excellent success using prolotherapy for any longitudinal tears. Keep the patient in a Ritchie Brace and inject under ultra-sound guidance to insure placement of the solution.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: Therapeutic Shoe Fraud and Abuse (Joel Gluck, DPM)
From: Paul Kesselman, DPM, Shay Fish, DOM

To answer Dr. Gluck's question. The problem with the "you may be eligible for free shoes" ads is that:

1. It takes the patient out of my care.
2. Many Medicare patients with diabetes simply do not qualify (yet) for the benefit. Criteria must be met. It annoys me when I play by the rules, but some home health nurse was apparently able to push it through by apparent fudging of the clinical findings - and that is fraud by any definition.
3. It underscores the notion that we should be the only ones prescribing this benefit, because of the criteria. Most of my PCPs don't fully comprehend the criteria for risk; only the criteria for diabetes.
4. Patients are quick to remind me that I didn't get them a "free" thing (even though we discussed the issue) and may assume I'm not being thorough in other areas of their care.
5 It undercuts the PCP-Podiatrist-orthotist/prosthetist relationship.
6. Patients come back to me when a problem arises from a shoe I didn't prescribe. How do you address that when the wrong type of shoe was prescribed to begin with and the patient has maximized the benefits for a 12 month period?
7. Your reference to the patient actually buying shoes is another matter that I don't have a problem with. The complaints were about patients who got it for nothing.
8. Lastly, you could now be compelled to report the incident(s), implicating some certifying doctor (frequently the PCP) and the supplier (an agency you may already have a tangential relationship with). One now has to play the role of investigator, and people tend to clam up if they stand to lose something. That's not my idea of networking.

On the contrary, the "you may be eligible for free shoes" ads are a big problem. The examples you give are appropriate for those who do not meet the high risk criteria but should be wearing something other than flip-flops.

Shay Fish, DPM, San Antonio, TX, fishdpm@aol.com

While "face-to-face" meetings are not required for all DME services, I would be hard pressed to find out how therapeutic shoes could be dispensed without such encounters. Regardless of the type of insert, a supplier must ensure that the inserts are full contact. One cannot certainly rely on the patient or their family to do so. I would also question the ethics of the prescriber of the shoes/inserts. It would seem inappropriate for anyone to write a prescription for anything without having previously established some relationship with the patient. Perhaps making some significant changes to the Therapeutic Shoe Bill and eliminating all but credible suppliers/prescribers will be a start in resolving this issue.

The unfortunate growth of fraud within DME is a result of an increasing number of non-professional and/or quick buck hustlers abusing the system. The history of this type of abuse is the exact rationale for CMS to develop the current accreditation and competitive bidding policies. System abuse significantly increases expenditures while actually hurting patients and the ability for ethical health care providers to deliver appropriate care.

If ethical health care providers truly care about their patients, as well as their continued participation in the Medicare DME program, they should have no hesitation in reporting any alleged instances of abuse to the appropriate authorities.

The OIG, HHS and several other investigate agencies do collect reports anonymously. The individual DMERC and/or local Medicare carriers should certainly be interested in taking reports of abuse. Contacting the individual DMERC's claims processing manager or provider education council may be more helpful than speaking with a customer service representative.

Paul Kesselman, DPM, Woodside, NY, pkesselman@aol.com

ASSOCIATE WANTED - IMMEDIATE OPENING- NEW YORK

Hudson Valley (NY) for multi-location well rounded podiatric practice including high volume orthotics and reconstructive surgery. Looking for well trained (PSR- 24/36), personable, energetic practitioner to expand practice. Outstanding opportunity to work into partnership. Competitive starting salary, bonus incentives, benefits, and pension. Please submit: CV, letter of intent and references to: footassociate@yahoo.com

ASSOCIATE WANTED – PHILADEPHIA AREA

Opportunity in a high volume office-based practice in suburban Philadelphia.full-time office, close proximity to hospitals for surgery, consults and in-house care. Candidate must be well-trained in all facets of podiatry.PSR24/36 board certified/eligible required. Email CV and contact info to:mrgpod@hotmail.com or fax CV to 610-688-5175.

EQUIPMENT FOR SALE: CRYOPROBE SYSTEM

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $12,000. This lists for $14,900. The CryoPac system comes complete with two fully sterilizable probes. This system has been used less than 15 times and can be used to treat plantar fasciitis, neuromas, and other foot pathology. E-mail serious inquires to: drsammendicino@gtef.org

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

EQUIPMENT FOR SALE – SURGICAL SYSTEM / TOURNIQUET SYSTEM

1) Osada Pedo-30w-electric surgical system with drill handpiece and oscillating saw handpiece. Includes several blades, and sterilizable handpiece rests (2) $2100 plus shipping (9 lbs,6.6 ozs). 2) DELFI Medical P.T.S. tourniquet system. Does not include tourniquet $1500, plus shipping (4 lbs,4 ozs). Both in excellent condition. TEMDPM@CS.com or 814-237-3338.

FOR SALE - EQUIPMENT

Boyd chairs, mini x-ray floor unit, Konica developer, ultrasound,Ellman surgitron, Imex 9000, Ille whirlpool, viewboxes, SmartDop, topical oxygen units, office furniture, etc. cast saw, lakeside carts, parafin wax bath, hand instruments. Contact jhallux@yahoo.com or fax (703) 264-7745 for full list.

PRACTICE FOR SALE WASHINGTON, DC

Hospital based 25 y/o practice, Billing 400k/yr/gross 285+. Four tx rooms fully equipped. X-ray, US, THBO, vascular testing. Loyal patient base, Wound care, diabetes, all aspects of surgery. Hospital priviledges. Seller very motivated to move fast. Relocating - $125k (OBO). Contact jhallux@yahoo.com or fax: (703)264-7745.

PRACTICE FOR SALE : LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA

Associate leading quickly to Ownership Wonderful opportunity to join Kaiser trained podiatrist in a well established, ethical, full scope podiatric practice. Competitive compensation Most be BE/BC Send CV and references to: reversoman@aol.com

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

ASSOCIATE WANTED – NYC

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Associate wanted for practice with offices in Queens and Manhattan. Applicant should be 2-3 year trained, ABPS certified/ eligible. All aspects of Podiatry from necessary routine care to reconstructive rearfoot surgery. Growth potential, partnership potential, benefits available, access to managed care contracts. Send CV to METROFOOTAPPS@aol.com
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PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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