The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

June 08, 2009 #3,565 Publisher-Barry Block, DPM, JD

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AZ Podiatrist Provides Shoe-Buying Advice

Buying shoes is a fabulous way to spend an afternoon — for a friend of mine. For me, it is Mission Impossible. So, I consulted with AZ podiatrist Barbara Aung. Remember that sizing varies by manufacturer. As Dr. Aung says, "A Nike size 8 doesn't translate to a New Balance size 8."  Not only that, not all styles made by one manufacturer will fit your foot.

Dr. Barbara Aung

Be prepared to try on lots of shoes. "You may have to try on 100 pairs before you find ones that fit you the best," Aung says. And, she adds, try not only your measured size, but also sizes a bit larger and a bit smaller.

Source: Rosalie Crowe, Arizona Star Daily [6/5/09]

Query: Shadowing Students and HIPAA

I have had several college students request to 'shadow' me at the office and hospital. Are there any HIPAA concerns?

Joe Burckhardt, DPM, Kingwood, TX

Editor’s comment: PM News does not provide legal advice. Under HiPAA, Covered Entities (CE’s) are required to take reasonable steps to protect the private health information (PHI) of patients. This responsibility extends to all personnel associated with the CE, including employees. Thus, a college student shadowing a doctor needs at least basic training in patient privacy.

If you frequently have students shadowing you, include a disclosure statement as part of your initial HIPAA Notice of Privacy Rules. In addition, it is good policy to introduce students and ask patients for permission to be present during the examination and treatment.

Query: Tarsal Coalition ICD-9 Coding

I need to know the correct ICD-9 code for a talocalcaneal coalition or a calcaneo-navicular coalition (assuming they are the same)?

Charles Morelli, DPM, Mamaroneck, NY

Response: The correct code for tarsal coalition is: 755.67

755.67 Anomalies of foot, NEC

Astragaloscaphoid synostosis, calcaneonavicular bar, coalition of calcaneus, talonavicular synostosis, tarsal coalitions

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Sandal Suggestions for an Elderly Patient with Flatfeet
From: Multiple Respondents

Image Orthopedic Lab, Inc can incorporate a patient's orthotics into the sandal of her choice for a very reasonable fee. They are located in Santa Ana, CA. Alternatively, there are many "clog-style" sandals with a deep heel cup (e.g., Earth Shoe sandals) which will accommodate functional orthotics, particularly if you grind off the rearfoot post and narrow the shell a bit.

Martin V. Sloan, DPM, Abilene, TX, mvs321@suddenlink.net

I recommend Birkenstock;  I do not own stock in this company but I should. 

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

I have used sandals that I can remove the foot bed from. Most commonly: Bite and Naot

Philip McKinney, DPM, Eugene, OR , opodiatry@oregonpodiatry.net

RE: Calcific Mass of the Plantar Heel (James Anderson, DPM)
From: Bryan C. Markinson, DPM, Palmer Branch, DPM

The best way to handle this mass is to schedule an open incisional biopsy in a hospital OR. Expose the lesion and take a small sample of it for frozen section by the hospital's musculo-skeletal pathologist, who should be alerted if he is not on call for frozen that day. If the lesion is benign, then continue to remove it. If it is malignant, close the wound and refer the case to a musculoskeletal tumor specialist for definitive surgery and/or oncology management.

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

Careful surgical planning is essential with large masses.  Careful consideration of patient health factors (e.g., diabetes, vascular status, etc.) should, of course, first be addressed. An MRI would be helpful in determining the exact size and shape of the mass as well as whether or not the mass is adhered to the skin. Judging by your x-ray, this is a possibility (less likely if the mass is readily movable under the skin). If the mass is adhered to or incorporated into the deep dermis, you may need to excise the overlying skin as well. Be careful in handling the skin and during your post-op care to prevent skin necrosis. If you believe you may have to excise a significant portion of skin, carefully plan in advance about complex closure (e.g skin rotational flap, bi-winged/hurricane closure, etc.) or coverage of the defect with GraftJacket, Alloderm, or a similar product.

I always like to use a VAC unit when I use these skin products to facilitate adherence of the graft and healing. Contact your local reps to have these products on hand at the time of surgery if you feel you might need them. Split-thickness skin grafts tend to break down with weight-bearing later in this location. A bulky compression dressing and splint with the foot in gravity equinus can help prevent skin breakdown if the skin is closed in surgery, particularly if you have to do a complex closure.

Palmer Branch, DPM, Cumming, GA, DrCuboid@aol.com

RE: Orthotics and Evidence-Based Medicine  (Elliot Udell, DPM)
From: Doug Richie, DPM
 
I fully agree with Elliot Udell, who points out a disturbing trend in the scientific programs at podiatric conferences. Not only is the subject of podiatric biomechanics vanishing from our major symposiums, but the choice of speakers on this subject is influenced by commercial interests and sponsorship, rather than featuring experts with valid credentials.  

If podiatric practitioners want to learn about a large volume of credible original research in foot orthotic therapy, they should attend the 12th Annual International Conference on Biomechanics and Foot Orthotic Therapy presented by the Prescription Foot Orthotic Laboratory Association. The PFOLA Conference which will be held in Atlanta, GA from October 2-4 2009 can be found at:  www.nvo.com/pfola/ and has emerged as the premier lower extremity biomechanics conference in the world. Attendees will hear speakers from multiple disciplines, who will present original research on a myriad of topics relevant to foot orthotic therapy including athletic shoe design, sports medicine, diabetes,multi-segment foot modeling, and postural control.
 
Doug Richie, DPM, Scientific Co-Chair, PFOLA  Conference, DRichieJr@aol.com

RE: Contract Re-negotiation (Name Withheld)
From: Multiple Respondents

I am sure this topic will generate the usual polarized viewpoints about podiatrists eating their young, the cruel treatment of associates, and the greed of employers, and the counterpoint of how expensive it is to run a practice, look how much they made their first year, etc.  This case brings both viewpoints into perspective. The associate is working outside the office in nursing homes and other facilities. That is a situation where NO overhead is expended. This is a unique situation, and warrants a different reimbursement methodology. I believe the associate probably should be paid a higher amount, as he is generating a lot of revenue with little cost to the employer. (However, if the doctor is doing a lot of diabetic shoes or other DME dispensing that has significant costs, that is another issue).
 
The counterpoint is that he made about 150k his first year (based on 35k a month for 12 months and 35% payment rate). I don't know many first-year associates who were able to hit those numbers. The fact that Name Withheld has debt is really not an issue in the negotiation. Your employer can easily counter that with his own fiscal issues. The argument should be based on work and productivity only, leaving personal issues out of the discussion.
 
This is a win-win for both parties. Neither party should want to mess this up.  If the case is based on numbers and productivity, in an appreciative manner, I am confident that the employer will be reasonable and increase the percentage accordingly.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

There is no time like the present as opportunity knocks only once. As far as I am concerned, Name Withheld is getting paid too little now. I gave my new associate 40% on routine services and 50% on any surgery. If she made orthotics. we deducted our cost and then she still got 50%. This also applied to diabetic shoes. There can be additional bonus money paid for bringing in over a certain pre-determined amount for each month. Name Withheld can do better; if not he/she can look for another position.

Steven Goldstein, DPM, stevefootdt1@yahoo.com, Royal Palm Beach, FL

Without knowing the cost side or whether there is a partnership option on the table for the practice in question, it is hard to give an adequate response to the question. Assuming Name Withheld is currently collecting $30K - $40K a month, and is receiving 35% of this amount as income, the average collections of $35K a month should generate an annual “salary” of $147K. That’s not too bad for the first year out. 

With no other information, a “safe” way to re-negotiate the contract would be to create a “win-win” by receiving a higher percentage of the money generated beyond a certain target amount. Because there is no information on the overhead, a “safe bet” would be to use 2.5 times your 147K “salary” as the target amount. In this case, Name Withheld would receive a higher percentage of the dollars generated above $367K in receipts. This would be good for him/her and the owner because the marginal profit on these dollars is higher. While this is a short-term “solution,” given the productivity level in the first year, Name Withheld should be discussing mechanisms for eventual partnership in the practice.

Jon Hultman, DPM, MBA, Los Angeles, CA, jhultmaned@calpma.org

ASSOCIATE POSITION - NORTHWEST IOWA

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION - TEXAS

Full-time podiatrist(s) needed in Austin or San Antonio. Current Texas license required. Unique mobile podiatry practice. Better pay, fine working conditions with excellent support staff. Check out our website www.footmobile.com. Reply to footcenter1@sbcglobal.net

ASSOCIATE POSITION- HUDSON VALLEY REGION, NEW YORK

Unique opportunity for the right person! We’re looking for a personable, motivated individual who is seeking opportunity and security in a high end multi-office group practice. This is an incredible position for the right person. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

SALES REPRESENTATIVES WANTED

SureFit has immediate openings for three sales representatives – one for Midwest, Mid-Atlantic and Southeast territories. Responsibilities include but are not limited to obtaining new business, executing sales strategy, initiating contact with customers, identifying their needs and selling appropriate products to meet those needs. Ideal candidate will be enthusiastic, highly motivated individual with a positive attitude who prefers a team environment. Minimum requirements include Bachelor’s degree, 3+ yrs sales experience, preferably in Podiatry and/or O&P Industries. Position requires up to 70% travel with residency in each territory. Please e-mail resume and references to: James R. Grady, Director of Sales SureFit jgrady@surefitlab.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

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

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

EQUIPMENT FOR SALE - NEW X-RAY MACHINE
 
MIN-x-ray Mobile system Model PM200R40. Brand new. Less than 1 year old. Never used at all. I was opening a new location that fell through. Completely brand new. Paid $11,000. Will sell for $6,500. Located in the Bronx, NY- call 914-714-0667

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com 

EQUIPMENT FOR SALE

Amfit Orthotic Making System. Includes new computer, recently updated digitizer, and orthotic mill, and $2,500.00 in supplies (which would generate about $20,000.00 in orthotics). skip the middleman. Cost $35,000.00. Asking $23,000.00 OBO AMERICAN FOOT CLINIC 405-733-2783 OR 405-820-6887 americanfoot@email.com

PRACTICE OPPORTUNITY - DALLAS TEXAS AREA

New practice started in Irving Texas by two 15 year established podiatrists from Austin. We've decided to stay in Austin and travel only for research. Opportunity for new practitioner podiatrist to start practice immediately with no money out-of-pocket. Write to MRobsonDPM@aol.com

PRACTICE FOR SALE -BRIGHTON, MICHIGAN

Outstanding opportunity to purchase 12 year established general podiatry practice. Now working one day per week seeing approx. 20 patients. with 3-4 new patients per week. Steady flow of returning patients. Selling because of disability. Turn-key.  First quality equipment, furniture, and build-out. Priced to sell for the value of the equipment.  Call (248) 538-5958. e-mail: DocPod@aol.com

PRACTICE FOR SALE - FLORIDA

Part-time non-surgical practice for sale Palm Beach County Florida. Established practice (32 years) for sale. Fully-equipped office in area heavily populated with seniors. Storefront location with excellent exposure. Practice includes one nursing home. Great opportunity for expansion. To inquire, please call  561 965-3300

 
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