June 06, 2006 #2,598 Editor-Barry Block, DPM, JD

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Summer is Season to Show Off Healthy Feet: NJ DPMs

When warm weather arrives, the quest for a beautiful foot begins — and specialists are overrun by patients. Dr. Emanuel Haber, a podiatrist, has seen the quest go to extremes. Some patients have asked him to narrow their feet, while others want him to shorten their toes so they look better in pointed shoes or sandals. About 25 percent of Haber’s patients — mostly women — come for cosmetic rather than medical reasons. But legitimate medical problems require attention. Lesions, blisters, corns, warts, calluses, and skin cracks should be remedied immediately.

Fungal nail infections and athlete’s foot are a major problem among podiatrist Jeffrey L. Simon’s patients. "A lot of people coming in say, ‘I want to show off my toes," he said, "but I’ve got this yellow fungus." An oral anti-fungal medication used over several months is effective, Haber said. Haber tells his patients to go easy on nail polish, which traps fungus. Patients who want healthy toenails and feet should use it only for special occasions, he said.

Simon also advises that people don’t wear the same pair of shoes two days in a row during the summer. Shoes need to air out, he said. "I’ll guarantee," he said "I could take a culture of any shoe and grow anything out of it, especially during summer."

Source: Bob Groves , The Record (Hackensack, N.J) [6/3/06]

Blues Plans Add New Features, Services to Electronic Health Records Initiatives

Three Blue Cross and Blue Shield plans are expanding efforts to develop electronic health records (EHRs) for members and providers, working with other health industry stakeholders to improve access and add new features such as e-prescribing services and interoperable records. EHRs are created using patient-specific information from claims data, including lab results and medication histories, to capture a full picture of a patient's health services across all providers and treatment categories.

This year, Blue Cross and Blue Shield of Louisiana launched an electronic prescribing pilot program with 500 physicians. One goal of that initiative is to increase adoption of health information technology among small to mid-sized physician groups, W Ob Soonthornsima, senior vice president and chief information says. The Louisiana Blues plan also is developing a personal health record that would be portable from insurer to insurer. The records would allow members to maintain a reliable source of health information, and would permit providers to access consistent health information from patients.

Meanwhile, Blue Cross Blue Shield of Alabama plans to expand personal health record's capabilities and make the data more comprehensive. The insurer also intends to deploy e-prescribing technology directly to pharmacies throughout the state.

Horizon Blue Cross Blue Shield of New Jersey also is developing an electronic medical record, says Richard Popiel, M.D., vice president and chief medical officer. The system, dubbed Prism Reach, supplies a quarterly health report record for patients that includes discussion points for their next physician visit. A similar, but more clinically complex, report is sent to physicians.

Source: The AIS Report on Blue Cross and Blue Shield Plans [May 2006]

Friday July 14- Sunday July 16, 2006.

See The Samoset Resort Website http://www.samosetresort.com/ for beautiful photos of the golf course directly on the Atlantic Ocean. 18.5 CME hours pending with focus on Diabetic Foot Care and Surgery. Come join Dr. G. Jolly, Dr. P. Flanigan, Dr. B. Bakotic, Dr. L. Harkless and others. Contact Dr. John Perry at drperry@atlanticfootankle.com or call 207-773-5800 for more details.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Valuing a Practice

I am thinking of buying a practice and would appreciate help. I realize evaluation is as much art as science, and that there are many different methods of evaluating. I would like some rules-of-thumb. The method being used is 3-year average net times 1.5 (this includes equipment, but no long-term practice location, so there is a chance I may have to relocate just months after the purchase). Upon checking, this produces a figure lower than the minimum the seller says he will accept so I'd like to compare some other evaluation methods to see how far apart we really are. The practice is primarily Medicare, .i.e,, onychomycosis, etc.

Name Withheld

Editor’s comment: You are correct in assuming that valuation is much more than applying formulas. Until recently, we have started with the premise that a typical practice is worth 2x the average net for the past three years plus the depreciated value of equipment. Because of the smaller graduating classes of the past few years, however, there is a currently a buyer’s market for practices. One must always remember that the economic laws of supply and demand ultimately factor in the pricing of a practice. The real value of a practice is what someone is willing to pay for it!

Remember though that a rule-of-thumb formula is only a starting point. Is the practice growing? Is the location improving? How long is the remaining lease? What have similar practices sold for? Is the doctor’s billing pattern similar to yours? These are just a few of the many questions you need answered in determining the fair value of the practice.

RE: Familial Keratoderma (Elloit Udell, DPM, Al Musella, DPM))
From: Dennis Shavelson, DPM

Dr. Udell’s statement that “There are dermatologic and rheumatologic conditions that cause hyperkeratosis on the feet and have no biomechanical cause” overlooks the impact of closed-chain function and underlying foot type-specific biomechanical pathology upon the morbidity of every corn and callus.

Consider the different microscopic and clinical presentations of verrucae vulgaris and verrucae plantaris. The open-chain lesion sits above the level of the skin superficially, and the closed chain-lesion develops in predictable locations and has been driven deep due to weight-bearing forces.

The fact that familial keratoderma causes weight-bearing callus to be revealed in foot type specific locations at such a young age serves as the tip of the iceberg as to how foot types manifest into foot and postural pathology for most of us. Is the juvenile bunion any different?

I predict functional equinus, functional hallux limitus, bunions, 2nd and 5th toe corns, functional hallux extensus, thick toenails, (microtraumatic), plantar fasciitis, late L-4/L-5 and shoe fit problems and an inability to perform athletically at a high level for this five year-old and many who live on his genetic tree unless foot type specific orthotics are plaster cast- corrected and custom-prescribed by a podiatrist that is Functional Foot Typing.

Dr. Udell’s comments live inside the biomechanical box that Dr. Root gifted us thirty years ago. Functional Foot Typing allows DPM's to step out of that box and offer exceptional diagnostic and treatment options to this five year-old boy and the foot suffering public. The question remains, are there enough holes in the Root theory as it has been molded in the last thirty years by those controlling functional lower extremity biomechanics to warrant change? I think this fascinating, well-presented query of Dr. Musella speaks for itself.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab
drsha@footworldusa.com

ASSOCIATE POSITION - OHIO

Associate needed for high volume practice with eventual buy-in. Requires highly motivated individual with immediate high volume patient load. Competitive salary with bonus, malpractice, and health insurance. Send resume to rubwalk@hotmail.com or fax to 419-473-1230

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

ASSOCIATE POSITION - PALM BEACH COUNTY, FLORIDA

Excellent for upcoming residency grad. Well rounded practice- 2 podiatrists. Fax resume: 561-637-9596.

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.

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

ASSOCIATE WANTED - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

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

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