May 24, 2006 #2588                                     Editor-Barry Block, DPM, JD

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Alison Dunkerley, a podiatrist at The Podiatry Center in Salt Lake City, suggests that her patients wear flip-flops only for short periods of time to avoid injury. She said too many people are making flip-flops their everyday shoes.  "The problem is that when you're taking something that is meant to be worn just a few paces to the pool and beach and turning it into a regular walking shoe, that's where you encounter problems," she said. "I notice that teenagers in high school, they're all doing the flip-flop thing. People that age are active and are doing sports or walking long distances in flip-flops with little support."

The platform flip-flops that many women wear also are "begging for an ankle sprain," Dunkerley said. She sees people with arch pain and callused and cracked heels which arise, caused by friction from the flimsy shoes. "We tell our patients to look for more supportive shoes," she said. "Try to find a sandal with an arch contour and avoid sandals with material between the toes. That causes irritation because there's nothing to keep your foot against the material of the shoe."

Source: Carey Hamilton, Salt Lake City Tribune [5/22/06]

OCPM Students Wins Half Marathon

One of the great stories of Sunday’s half marathon  was the re-emergence of Kate Steklachich, 23, a third-year student at the Ohio College of Podiatric Medicine, as a premier runner. She won the women's half-marathon in 1:26:42, while Eva Miller, 26, of Hudson was second at 1:27:26.

Steklachich won the Pennsylvania state cross country championship as a sophomore in 1997, but suffered eight different stress fractures in both legs over the past five years. The Mount Union College graduate said doctors advised her to become a recreational runner.

"I've been to so many doctors, but I finally found one who figured out what caused my fractures and treated me properly," Steklachich said. "Now I feel as good as I did at Hickory High School [in Hermitage, Pa.]. I passed Miller at the nine-mile mark, and I felt so good in the light rain I knew I was going to win the first half-marathon I've ever run."

Source:  Pat Galbincea, Cleveland Plain Dealer [5/2/06]

AR DPM Faces 93 Years Jail,  6.5M Fine For Tax Evasion

A 56-year-old Gassville podiatrist who had refused to pay taxes since 1999 was convicted Friday of 25 federal charges involving tax-related charges.  Clifford “Ben” Marston faces of to 93 years in prison and fines up to $6.25 million for income tax evasion, filing false income tax returns and assisting in the preparation and presentation to the IRS of false individual income tax returns, according to a U.S. Department of Justice news release.
Marston, who owns Sunshine Foot Clinic Inc. of Mountain Home and Harrison hadn’t paid some taxes since 1999.

Marston’s defense was his research on the Internet and had bragged about it since at least 2001.  “Personally, I am grieved at the whole income tax process … the massive intrusion at the threat of perjury into the intimate details or our financial lives … contributes to the massive erosion of freedom in this country and is totally inconsistent with the legacy of a Free People,” Marston wrote on an Internet site dedicated to the anti-tax movement.

Source: Mark Friedman,  Northwest Arkansas Business Journal, [5/22/06]

Query: Diabetic Steel Tip Shoes/Diabetic Golf Shoes

Does anyone know where to get protective steel tip shoes with steel on the outside of the shoe? Also, extra-depth diabetic golf shoes?

Dwayne Jacobus, DPM, Florence, SC, footmed@yahoo.com

Query: Class A Finding Question

When billing for routine foot care, a class finding "A" (Q7 modifier) is to be used for "non-traumatic amputation of a foot or integral portion thereof."  Does a transmetatarsal amputation qualify as an "integral portion thereof"?" What about a ray resection or toe amputation?

Bruce Lebowitz, DPM, Baltimore, MD

Response: While class A findings might be further defined/interpreted by individual Medicare carriers - I have personally not seen this - beyond Medicare's national coverage policy, the minimum portion of foot amputated is not specified beyond "integral skeletal portion" - which I would consider to range from a single toe to the whole foot. The key is that events such has vascular compromise (not of traumatic etiology) resulted in the need for amputation.

Tony Poggio, DPM, Alameda, CA

Additional responses can be read at www.codingline.com

Codingline subscription information can be found at
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RE: Bariatric Surgery and Antibiotics( Paul Kesselman, DPM)

From: Elliot Udell, DPM  

I referred Dr Kesselman's important  query regarding whether a person having had the bariatric procedure known as a "band procedure" need have prophylactic antibiotics preceding or following a minimally invasive podiatric procedure. This questions was referred to Dr. Christine Ren, director of bariatric surgery at NYU medical center, who is one of the developers of the band procedure. Her response is as follows: " There is no need for antibiotic prophylaxis. The device is not in touch with the vascular system, therefore is not prone to infection."

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Periodic Medical Exams of Diabetics By Podiatric Physicians

From: Kenneth Malkin, DPM

Is it screening or medically necessary medical care? We have bantered about this subject on Codingline, PM News, and Podiatry Management Magazine over the last few years. I have some new information I would like to share.

Podiatrists are physicians within their scope of practice by state law in many states such as New Jersey. Podiatrists are also considered physicians in to the most widely used definition within Medicare.  Medical care of a diabetic is a covered service under every insurance program I have known. This includes medical care within a podiatrist's scope of practice. It should be clear that covered routine foot care, AKA at-risk foot care, has absolutely nothing to do with the medical care of a diabetic.    By virtue of a patient's diabetes they may develop any number of complications. How does one know when a diabetic patient is developing early retinopathy except by exam of an ophthalmologist? How does one know if a patient has a condition such as LOPS which by definition causes no symptoms? In both cases medical exams are required. In the latter case, it would be by a medical exam that involves using by using a monofilament or other similar modalities. 

How does one know that a patient has abnormal plantar pressure, which is another risk factor for ulceration? Many cases of abnormal pressure do not present with calluses or other skin changes so detection by using PressureStat or other modalities is medically appropriate.  This is not my own opinion but a standard of care for diabetics promulgated by the ADA and other relevant professional organizations.   So the next logical question is how does one get paid for providing these tests? Clearly this is not part of establishing the class findings for diabetics which does not even include LOPS or plantar pressure testing specifically. These tests are medically necessary and not part of establishing coverage for at risk foot care so they must be part of a medically necessary evaluation and management service. Medicare and all payers pay for medically necessary services. It is really just that simple. 

This letter continues at: http://www.podiatrym.com/letters2.cfm?id=9540&start=1

 Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

RE: Medicare Part D Problems (Stephen J Bennett, DPM)

From: Al Musella, DPM, Joel Lang, DPM

The important part of Dr. Bennett's point was why should we have to waste 20 minutes of our time on the phone getting authorization for a patient's prescription. That is more time than a typical office visit.   

It has happened to me enough times that I sometimes think twice about prescribing oral Lamisil on days when I am very busy. That is really crazy - that is exactly what the insurance companies want and we are letting them win.

I would propose that the next major legislative battle address this issue. Either do away with prior authorization, or create a billing code to pay for each minute spent on a telephone call getting authorization. It boggles my mind that we allowed the entire concept  of prior authorization (and referrals) in the first place.   

Al Musella, DPM, Hewlett, NY, musella@aol.com

I think that as a practitioner, you can not take responsibility for the choices of your patient with regard to insurance, nor can you take responsibility for the policies of the insurer.   To change your prescribing policies to conform to the policies (formulary) of the insurer may not only be contrary to the best medical decision making for your patient, but it could be a problem should a medical defense become necessary in the future.  

There has to come a time that patients themselves take the full responsibility for their insurance choices and live with the consequences of that decision. If they want to see changes, it is THEY who need to appeal to their insurers or to their representatives in congress to lobby for those changes. The doctor needs to take the 'third party' role in this process by being a cooperative outside party.   If the patient should need to actually PAY for the prescription, then that is what they need to do - period! That is what the coverage they chose requires them to do.   The doctor needs to go back to doctoring.  

Joel Lang, DPM, Cheverly, MD, langfinancial@verizon.net

POSITON AVAILABLE - WASHINGTON, DC

The George Washington University Medical Faculty Associates, a large multi-specialty practice affiliated with a teaching hospital, is seeking a full-time podiatrist. The practice has a diverse population encompassing inpatient and outpatient surgery, as well as a thriving outpatient clinical practice. Must be board certified/board eligible and have experience in diabetic limb salvage.  Send CV to cdugan@mfa.gwu.edu or fax to (202) 741-2241.

ESWT MACHINE FOR SALE

I have a DolorClast shockwave machine for sale 60% of cost, call 416-545-1166 or dracula65@hotmail.com Thank you

PRACTICE FOR SALE - NEW YORK

FOR SALE - Rockland County. Well established, high-volume practice, general and surgical. Gross $500K, hospital privileges; excellent lease.  All interested parties reply to: metroNYCpodiatry@aim.com

SURGICAL INSTRUMENTS FOR SALE
 
Complete Surgical Instruments, Hundreds;  Stryker Power  Set Electric motor; Reciprocating & Oscillating saw, Roto-osteotomes, also two major bone sets including DePuy osteotomes, several soft tissue sets, etc. Office instruments also. Call for exact items. 
Art Korbel DPM, (MD)  954 753 7621

ASSOCIATE WANTED - NEW YORK

Associate Wanted - Rockland County, Rockland County. Associate with minimum 5 years experience, high volume established general practice.  Reply with CV to nypodiatry111@aim.com

BOOKS FOR SALE
 
22 books-Sold as Set- $ 500.00 Examples are; Foot Disorders – Giannestras, Surgery Foot & Ankle – Johnson, Foot & Ankle Trauma -  Scurran Podiatric Office Management & Procedures - Kane, Schlefman & Vickers,  Minimum Incisional Surgery – Hymes, Foot Surgery  - McGlamry, Textbook of Bunion Surgery -  Gerbert & Sokoloff Disorders
of the Foot – Jahss.  Call Art Korbel DPM, MD (954) 753 3146

ASSOCIATE POSITION RICHMOND, VIRGINIA AREA 

Partnership possible after two years. Two office practice. Palliation; biomechanics/orthotics; woundcare; office/hospital surgery. Must have Virginia license. Associate will do most of the
practice’s surgery.   PSR24/36/Board qualified/certified in surgery preferred. Available SAP. Send CV to: Dr. Marc Jay Pinsky; 9550 Midlothian Turnpike; Suite 104; Richmond, VA 23235;
mjpinsky@juno.com   ; FAX: 804-320-6627.

ASSOCIATE WANTED – HOUSTON, TX

Associate wanted for thriving Houston practice.  Forefoot and rearfoot surgery competency a must.   2 locations, close to hospitals, ambulatory centers, etc.  Good salary with all kinds of
benefit package and incentive bonus.  State-of-the-art equipment. Wonderful staff to work with. good person, with ethics a must. Please call 281-955-5500 or e-mail rubinfoot@aol.com resume. Opportunity of a lifetime.

ASSOCIATE POSITON – TAMPA BAY, FL AREA 

Two associate positions presently open with a large podiatry group in the Tampa Bay area. Salary and benefits are commensurate with applicant’s qualifications. This is an excellent opportunity for a new practitioner to join a strong, existing group with extensive
hospital affiliations and referral patterns. Two-year residency and Fl license preferred.  zachander@aol.com    Fax 813-286-0200   Ph 813-334-2077

ASSOCIATE POSITION – TEXAS

Mature 3 DPM general podiatry and surgery practice in the Rio Grande Valley of Texas is seeking a DPM to fill an Associate position, partnership will be considered after a period of 2-3 years.  Applicants should have at least 2 years of residency training and enjoy diabetic foot and wound care. Diverse patient populations. (VA, Community Health Clinics, Hospitals and 3 offices)  Good practice environment in hospitals and community.  Salary, bonus and benefit package offered.  Interested DPMs should send a letter of  intent along with a current C.V. to Complete Family Foot Care, 812 Lindberg Ave. McAllen, TX 78501.  Fax 956 971-9109

ASSOCIATE POSITION-  NEW ENGLAND      

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base.  Close proximity to hospitals with modern surgical suites.  Opportunity for shared ownership.  Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation.  E-mail CV and particulars to NEAFC3@aol.com

EQUIPMENT FOR SALE - ESWT 

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com   Call 1-856-229-2939.

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