The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

June 07, 2013 #4,790 Publisher-Barry Block, DPM, JD

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NJ Podiatrist Discusses Prom Shoes

Now that the tulips are blooming, young women (and men) are getting set to graduate and attend proms. The majority of women prefer to wear high-heeled shoes while going out for any formal event. "Unfortunately, high-heeled shoes can cause pain, deformities and damage to the feet that can remain problematic for years to come," says podiatrist Dr. Ujjwal K. Datta.

Dr. Ujjwal K. Datta

"If a heel higher than two inches is a must, make sure that the heel of the shoe sits more or less directly under the heel counter and not anterior to it. Also, make sure you have enough room in the toe box and ensure that the shoe is appropriate in width," says Datta.

Source: The Sentinel [6/5/13]

Aussie Podiatrist Uses Photodynamic Therapy to Treat Fungal Nails

You might not like to talk about it, but Toowoomba podiatrist Nelson Gonzalez believes we need to face the facts about foot fungus. The common ailment affects eight in every 10 people which now, thanks to a new German technology, can be alleviated. The James Street Footcare Centre is the first clinic in the Toowoomba where people can access photodynamic therapy.

Podiatrist Nelson Gonzalez (photo: Nev Madsen)

Gonzalez said the treatment is an alternative to drugs and topical treatments. It works by exposing the fungus, bacteria, or virus to a specific light wavelength. Targeted cells are then painlessly killed, without harming healthy tissue. "It is an alternative to oral medications which can cause damage to the liver and kidney in some people, and topical applications like creams," said Gonzalez.

Source: Anthea Gibson, The Chronicle [6/5/13]

Query: Facility Fees

Twelve years ago, I  built a free-standing single specialty surgical facility which is licensed by my state and approved by Medicare. For those of you who are not in this situation, you should realize that single specialty outpatient facilities, multi-specialty outpatient facilities, and hospitals are reimbursed differently for the same surgical procedure. The question that I have is: Are hospital-based OUTPATIENT surgical centers reimbursed for facility fees differently than in-patient hospital centers for surgeries?

I would love to hear the real reason facility fees are different. You would think that insurance carriers would be in favor of more outpatient work, and thus reimburse at least equally. I can do a flat foot reconstruction at a hospital and am able to use whatever hardware I think is THE BEST. The hospitals are reimbursed. If I have to do the same procedure at an outpatient multi- or single- specialty facility, I am restricted to Steinman pins or some other “cost-effective” fixation! Are there any rational explanations for this?
 
Tip Sullivan, DPM, Jackson, MS

RE: Diabetic Shoes for Medicare Patients
From: Ed Davis, DPM

The changes in Medicare documentation requirements for diabetic shoes have made the provision of this service challenging. APMA held a webinar on this topic in January and mentioned that it was working on a satisfactory resolution to ensure coverage/compliance. I have not heard anything further from APMA since then.

The most difficult requirement is obtaining information within the body of the PCP progress notes documenting the need for diabetic shoes. It is unclear as to what those notes must...

Editor's note: Dr. Davis' extended-length letter can be read here.

RE: Compounding Pharmacies (Marc Katz, DPM)
From: Elliot Udell, DPM, Ivar E. Roth DPM, MPH

These companies should be turned into the insurance commissioners office. What a rip-off. Something is wrong here. Do any pharmacists out there have comments for us?
 
Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net 
 
Dr. Katz is rightfully concerned that certain compounding pharmacies have found ways to milk the healthcare system and charge close to 2K for a prescription. While this is odious, it is only the tip of the "iceberg." Many healthcare providers as well as hospitals have found "Innovative" ways of billing, which are bringing our nation's healthcare system to the brink of bankruptcy. An expose on the front page of this past Sunday's New York Times showed that some gastroenterology groups, using surgical centers they own, have billed some insurance companies up to 18 thousand dollars for a routine colonoscopy.

An expose on CNN several months ago, showed how some hospitals rack up charges, causing bills for fairly short hospital stays to be hundreds of thousands of dollars. A physician I know who was not insured, fractured his hip and received personal bills from the orthopedists and hospital for close to a quarter of a million dollars. If these near-crooked billing practices are not brought under control, it will lead to a collapse of our healthcare system, which would not make any of us happy.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Podiatric Residency Crisis - Where are We? (Ivar E. Roth DPM, MPH)
From: Robert Scott Steinberg, DPM

Your offer proves that there are still gracious doctors out there who would go out of their way to help with this crisis, any way they can. Dr. Roth, I would not take the "run around" you are receiving, personally. I can only imagine the panic these students are living. The "run around" you are experiencing is proof how scared they are. Without a doubt, a year preceptorship could provide invaluable experience, but they are still not moving any closer to getting their license.

I am frightened for these unmatched grads, because I see the huge failure that falls squarely at the feet of the colleges, APMA, and CPME, with their inability to solve the problem, that we all know, is going to grow. In the now seemingly blind quest for parity, these unmatched grads are facing the unintended consequences of Vision 2015.

I can't really blame the residency directors for all of this. They jump though many hoops to keep CPME happy, as it is, and may feel somewhat unappreciated by our leaders. I propose that residency directors be given VERY SPECIAL BADGES for all conferences they attend, so the profession can identify who our true heroes are. Further, though residency directors are the last ones needing additional CME, since their teaching far exceeds all state CME requirements, they should be comped registration fees for state and national conferences. Maybe a show of appreciation will nudge them in the direction of adding one more residency slots, along with CPME's modification of some of the requirements.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

Podiatric Residency Crisis - Where are We? (Ivar E. Roth DPM, MPH)
From: Michael M. Rosenblatt, DPM

Dr. Ivar Roth presented an opportunity for training for some DPM graduates who were not matched for residencies. Dr. Roth agreed to provide "excellent training" and also payment for recent graduates. This is a generous and deeply kind offer. Dr. Roth was "disappointed" and more than a little angry when those people he accepted placed a higher value on residency.

This puts the issue of a clerkship/associateship training vs. active, real residency on the table. One of the issues involved is whether or not...

Editor's note: Dr. Rosenblatt's extended-length letter can be read here.

RE: Medicare Calling Patients
From: Name Withheld (FL)

I had the situation of a patient presenting to me with no fungus toenails who had not used any medication ever to treat fungus toenails and does not meet Medicare criteria for routine foot care; however, she states that she has been under the active care of a podiatrist for the past two years, and the podiatrist trims her toenails and gets paid by Medicare. I asked her to provide me with records of the previous podiatrist's treatments, and to my surprise, she delivered to me a computer printout of all of her charges. There were twelve charges, each was 99213 and each had the diagnosis of 703.8 only. It is my guess that it is billing such as this that is getting the attention of the Medicare auditors.

Name Withheld (FL)

RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair
From: Randall Brower, DPM

Here we are again with minimal incision bunion surgery in the news. I shake my head. So how does Dr. Khosroabadi, through a 5 mm incision check for metatarsal head cartilage defects, sesamoids groove chondral defects, joint capsule thickening, true PASA (inspection of real effective cartilage, dorsal bony hypertrophy, joint mice, etc?), no less one K-wire fixation in this litigious world?

Just because you can do something through a small hole, should you do it? What a huge disservice this is to the patient and to our profession. Yet another thing to keep orthopedists shaking their heads. Stop the salesmanship, stop boutique podiatry, and do right by your patient, and quit trying to sell them on surgery.

Walk on a bunion and one K-wire at three days. Do you see the large bone callus that forms when you do that? Talk about severe sesamoid dysfunction post-op. I thought that generation was retiring...no offense.

Randall Brower, DPM, Avondale, AZ, footdoctor33@yahoo.com

RE: NY Podiatrists Named to Head Residency Program
From: Jeffrey Kass, DPM

Congratulations to both Drs. Hertz and Gordon on their new positions. Honesty, integrity, and ethical conduct have finally been restored.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

PRACTICE FOR SALE - CHICAGO

Three-office practice; newly furnished; all offices are within 20-30 min of driving; great for one Dr. coverage; well-rounded surgical/diabetic/sport medicine practice; grossing up to $500K/year; can be purchased with real estate or separately. only serious inquiry to dpms2@hotmail.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 - WEST PALM BEACH FLORIDA
 
Well established successful West Palm Beach practice grossing $475K with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E- mail wpbfootdrs@gmail.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to:practiceforsaleswfla@gmail.com

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

IMMEDIATE OPENING OR PURCHASE 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

PODIATRIST NEEDED: NYC/QUEENS IMMEDIATE OPENING!

P/T Leading to full-time and partnership. PSR-36+ Min. Three office locations; NYC, ASTORIA & SUNNYSIDE QUEENS. All phases of podiatry; including Med., Forefoot, Rearfoot & Ankle SURGERY. Modern offices with all the Hi-Tech. equipment available. Candidate MUST have the skills & knowledge expected, ambitious, hard-working, ethical, detail-oriented and organized. A vibrant patient and staff-friendly personality a MUST! Good base salary, malpractice and % bonus incentive. You should easily surpass your bonus %. Reply with cover letter and C.V. to hansfeet@aol.com.

ASSOCIATE WANTED - MANHATTAN AND NORTHERN NJ

For group practice. Excellent opportunity to be the first podiatrist to join our team! PT/full-time negotiable. Convenient on-site surgical center. Current licensure in NJ and/or NY required. Call Gina 212-223-0716 or email CV to gina@premiersurgicalpavilion.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future, this position will provide for the possibility of partnership in the future. To apply please go to www.yourcareerinpodiatry.com

ASSOCIATE POSITION - PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to 123bunion@gmail.com.

ASSOCIATE POSITION - BAKERSFIELD, CA

Office and hospital-based podiatry group seeking a highly trained surgical associate to compliment our 3-doctor group. Minimum PSR-36 trained with rear-foot reconstructive experience required. Must have CA license and x-ray and fluoroscopy license. Previous practice experience is preferred. Competitive salary and benefits package. Please forward cover letter and CV to modpm@aol.com

WANTED: ASSOCIATE PODIATRIST  - ILLINOIS

4 Days per Week Chicago Practice - will perform all phases of podiatric medicine Accredited JCAHO Surgical Suite. Benefits will cover Malpractice and Health Insurance. Six Figure Base Salary. Inquiries Contact:  Dr. J. B. Jenkins - 773-374-5300

ASSOCIATE POSITION - KENTUCKY

Immediate opening in beautiful Southern Kentucky with 8-provider group with excellent reputation, full-time physical therapy, MRI, CPED/CO on staff along with a full schedule awaiting.  Wonderful place to raise a family, excellent schools and phenomenal quality and cost of living. Excellent compensation package, full benefits, and buy-in opportunity after 2 years. Email a letter of interest and CV: jonkim12000@yahoo.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 - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

ASSOCIATE POSITION - NASHVILLE TENNESSEE

Want to live and practice in the "It City" Nashville, TN? ISO  well-trained (PSR-36) individual. Located in suburb of Nashville. Hospital and Surgery Center privileges. Rearfoot and Ankle allowed. Base pay, bonus incentives, and benefits. Send resume to Mendozadpm@comcast.net. $1,000 finder's fee paid to referring individual with hiring.

ASSOCIATE POSITION – VIRGINIA
 
Established private practice, foot and ankle reconstruction and trauma management, strong referral base, ED trauma call. Hospital and surgery center privileges. Two locations with modern offices. ABPS qualified or certified. Competitive compensation package. Potential for position to lead to partnership. To apply, please email a letter of intent and CV to: vaposition@yahoo.com

ASSOCIATE POSITION- DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base. Base Salary$120,000, benefits and bonus structure. EMR; diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.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. 

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

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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