The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 29, 2008 #3,258 Editor-Barry Block, DPM, JD

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MI Podiatrist Advocates Cryotherapy For Heel Pain, MA Orthopod Disagrees

Cryosurgery is a simple office procedure in which a tiny probe is inserted in the heel under local anesthetic. It's brought to a freezing temperature, which destroys nerve fibers -- giving relief from pain, says Taylor, MI., podiatrist Lawrence M. Fallat, who pioneered cryosurgery for plantar fascitis about seven years ago. The nerves regenerate in about six months, Dr. Fallat says, but the pain remains at bay. It isn't known why, but he believes it is because the previously irritated and swollen nerves become normal when they regenerate after the freeze.

Lawrence M. Fallat

The incision is about three millimeters wide, so recovery time is minimal. Cost, typically around $500 to $600, isn't covered by many insurers. Potential side-effects include infection of the wound and numbness in a small area of the foot, which podiatrists say is temporary. In a study of 59 plantar fascitis sufferers published last year in the Journal of Foot and Ankle Surgery, Dr. Fallat and his associates found pain decreased on average from 8.38 on a scale of 10 to 1.26 a year after cryosurgery.

Not everybody accepts this new therapy. "I don't think it works," says George Theodore, co-director of the Foot and Ankle Surgery Service at Massachusetts General Hospital and team physician for the Boston Red Sox. "There is no randomized double-blind, placebo-controlled study out there. Most of what we hear is anecdotal." Dr. Theodore, an orthopedic surgeon is author of a study on shock-wave therapy that was funded by a manufacturer of the equipment involved.

Source: Laura Johannes, Wall Street Journal [5/27/08]

NYCPM and Alterna LLC Dedicate Kerasal® Education Center

Alterna LLC, the makers of Kerasal® and the New York College of Podiatric Medicine (NYCPM), the first and largest college of podiatric medicine, today dedicated the Kerasal Education Center at the College’s Park Avenue location in New York. The Kerasal Education Center was renovated earlier this year, and now offers students a modern learning center with state-of-the-art audio visual equipment, hardwood floors and new furniture.

NYCPM President and CEO Louis L. Levine and Steve Cagle, President, Alterna LLC, makers of Kerasal, cut the ribbon at the dedication of the Kerasal Education Center at NYCPM.

“We are pleased to have the opportunity to work with NYCPM and its distinguished faculty and staff,” stated Steve Cagle, President, Alterna LLC, makers of Kerasal. “NYCPM is one of our nation’s most prestigious educational institutions and we are honored to have the opportunity to support it.”

”We are extremely grateful to Alterna for its very generous donation, which has enabled us to create the Kerasal Education Center here at NYCPM,” said Louis L. Levine, President and CEO of the College. “Our students have already begun to benefit from the enhanced learning environment created by this state-of-the-art education center.” Located on the second floor of the school, the Kerasal Education Center is already being put to good use by faculty and students as the spring semester comes to a close.

KY Podiatrist Receives Highest Degree in Scottish Freemasonry

Edward G. Anderson, D.P.M., Henderson, KY received his 33rd degree of the Scottish Rite of Freemasonry during the very first joint session of the northern and southern Masonic jurisdictions held in Washington, D.C. This is the highest degree in Freemasonry and given only to 1.5% of all Scottish Rite Masons. Dr. Anderson has been a member of the Masonic Lodge since 1991 and is a Past Master and a Past District Deputy Grand Master.

Dr. Edward G. Anderson

Last year, he served the Grand Lodge of Kentucky as its Grand Sword Bearer, which is an appointive Grand Lodge position. Along with many other responsibilities, he currently is serving on two committees for the Grand Lodge of Kentucky. Dr. Anderson, a 1989 graduate of the Scholl College of Podiatric Medicine, also has a very busy practice averaging approximately 30 patients per day.

CMS Bans Use of Physician Signature Stamps; Handwritten or Electronic Signatures Now Needed

It appears that CMS has effectively banned the use of physician signature stamps, which means that orders, progress notes and other relevant documentation must have handwritten or electronic signatures, according to Medicare Transmittal 248 (Change Request 5971). Though CMS made the change in the context of medical reviews, physicians inside and outside of hospitals will have to abandon signature stamps because there's no way to predict when a Medicare auditor will show up, experts say. As it stands now, hospitals apparently will face claims denials for services if auditors find any orders (or supporting documentation) with a signature stamp, experts say.

Transmittal 248, which modified the Medicare Program Integrity Manual, says that "stamp signatures are not acceptable." And despite the fact that the transmittal seems to apply only to hospital certifications of terminal illnesses, experts say it’s clear that the ban applies to all documentation subject to prepayment and post-payment medical review.

Issued March 28, the transmittal also states that the "method used [to identify the person who provided or ordered services] shall be hand written or an electronic signature."

Source: Nina Youngstrom, Report on Patient Compliance [5/27/08]

End “Decidaphobia” - The 70% Solution

The phrase “analysis paralysis” describes a common practice management problem: A practitioner’s tendency to mine and massage data in pursuit of a perfect solution.

The Marine Corps battles that tendency by favoring a “70% solution” - If you have 70% of the information, have done 70% of the analysis and feel 70% confident, then move on. The logic is simple. A less-than-ideal action, swiftly executed, stands a better chance of success than no action.

Source: Adapted from Michael Usee, The Go Pointer’s Guide to Unforced Errors

Query: MD Logic or Dox Podiatry

Could someone with experience with MDLogic EMR or Dox Podiatry comment on cost and the ease of note-building?

Josh Prero, DPM, Rockville Centre, NY

RE: Daniel Joseph McCarthy, Jr., D.P.M., Ph.D
From: Phill Ward, DPM

It was with great sorrow that I learned of Dr. McCarthy's death. He was not only my residency director but also was a friend and mentor. I hope that we will all remember Dan McCarthy's many contributions to our profession in the areas of research and education. A true pioneer of our profession has left us and I will miss him.

I plan to make a donation to the APMA Educational Foundation in his memory and encourage everyone he taught to do likewise.

Phill Ward, DPM, Pinehurst, NC

RE: Conflicts of Interest
From: Larry Kollenberg R.Ph, DPM

It is interesting to see the comments that have been placed in this forum about disclosure, the lack of regard to drug company information etc. Here are some interesting facts. The American Diabetes Association recently published the ADA guidelines for all healthcare practitioners (physicians, pharmacists, nurses, CDE's, etc.) with the intent of improving the health and well being of diabetic patients. We have all dedicated major resources to learning training in treating these patients. If you look at the reference articles of these guidelines a large percentage of the hundreds of references were from double-blinded DRUG COMPANY-sponsored research. Granted there are many university and NIH studies as well but if you look further who paid for the information to allow it to get that far? Who is paying the university's to do the research?

NIH grants are a big part, but so is money from private corporations. Who got paid to do the research beyond the universitys at the multiple trial centers? Physicians, pharmacists, and nurses in the clinical community. Look at the American Heart Association guidelines for stroke or the JNVII guidelines on hypertension, or the infectious disease guidelines for treating diabetic infections. Again, who did the research that the "experts" reviewed? Clinicians with everyday people like those you treat. Who paid for it? Some are NIH grants while others are DRUG COMPANY-sponsored studies.

While it is of the utmost importance to maintain ethical guidelines and not give SLANTED information, we all benefit from the information being presented in a fair and balanced way. The utilization of funding that is earmarked towards sponsorship of speakers and CME venues, as long as it is unrestricted, shows that big pharmaceutical manufacturers recognize that we are willing to look at their information and hopefully we are well enough versed to interpret it for what it really is. In a recent medical literature course that I took this year, one interesting statistic was that 72% of ALL medical information that is published in every journal worldwide is sponsored by the pharmaceutical industry. Almost 25% is government-sponsored information. What does that leave if we take those two factors out?

Larry Kollenberg R.Ph, DPM, Jacksonville, FL, lkollenberg@hotmail.com

Editor's note: This topic is now temporaily closed.

INTERNET FOOT THEMED CANDY BUSINESS FOR SALE

Well-known foot-themed chocolate and candy company with over 6,000 customers. Unique products with trademarked names for seasonal (Mistle Toes, Valentoes, etc.) as well as everyday (A Foot of Feet, Twinkle Toes, etc.). Excellent opportunity to generate income from home with an established business. Serious inquiries to Mwolpa@ToeFood.com

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION – LEHIGH VALLEY, PA

Large medical/surgical practice centered in Lehigh Valley, PA looking for exceptionally trained podiatrist. Excellent opportunity for income as well as potential partnership. E-mail resume to jkaufman@lvfoot.com

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

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

EQUIPMENT FOR SALE

Relocating satellite office and selling redundant equipment, all less than 2 years old. Koven Smartdop45 - $2995 Scan X Digital X-ray - $17995.00 SIUI CTS 5500 Diagnostic Ultrasound and cart with printer - $4695 Chattanooga Therapeutic Ultrasound - $495. Please call Priscilla at 281.313.0090 if interested.

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. 30-40 hours per week. $100,000+ guaranteed. Please fax resume to (412) 563-0740.

EQUIPMENT FOR SALE - POLAROID X-RAY FILM

Polaroid 803 x-ray film for x-rays - 41/2 boxes, 2 Cassette holders,
Polaroid processor. doctorcerillo@verizon.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

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