The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

June 08, 2013 #4,791 Publisher-Barry Block, DPM, JD

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The June/July 2013 issue of Podiatry Managment has just been mailed. This 228-page issue includes our cover story, "Reaching Out: Social Media and You" , and an interview with APMA's new president, as well as an assortment of features, including our informative columns, a round table on the art and science of dealing with patients, and a CPME-approved CME.

June/July 2013 Podiatry Management

LAST DAY TO VOTE

Quick Poll
Should podiatric assistants be allowed to perform routine foot care (as defined by Medicare)?
Click HERE for Results

Kiwi Podiatrist Discusses Pluses and Minuses of High Heels

Killer heels may cause crippling damage for some long-term wearers, but that isn't deterring Kiwi women - and there may be an upside, says a foot expert. While the downsides of high heel wearing are well known, there is a lesser-known upside, said Auckland podiatrist Simon Speight. "I often see people with arch pain, and the women wear a modest high heel shoe, and it can actually resolve it [the pain] because they've been wearing really loose, floppy loafers or street fashion shoes, and they put their feet into these and the pain abates," he said.

Podiatrist Simon Speight

Corns, ingrown toenails, and bunions were common complaints from women who often wore high heels, but these effects "just becomes part of their lifestyle" for those who love wearing heels, said Mr. Speight.

Source: The New Zealand Herald [6/5/13]

RE: Recurring Skin Lesions
From: Name Withheld (MS)

I initially saw this healthy 51 years old patient in 2011. Her only medical issue is being treated with Lexapro, Wellbutrin, and Xanax by a local psychiatrist. She has no family history of associated problems. History of problem: Approximately 5 years before I saw her, another local podiatrist performed surgery on this patient’s 3rd toes (arthroplasty PIPJ, removal of skin lesion, and flexor tenotomy). 

Recurring Skin Lesions

She had (and still has) painful single punctate hyperkeratosis on the plantar aspect of both 3rd toes at...

Editor's note. This extended-length query can be read here.

Query: Coding for Onychomycosis Treatment

I was recently rejected when billing for treatment of onychomycosis. I used the diagnosis codes ICD-9 110.1 (onychomycosis) and ICD-9 250.0 (diabetes, uncomplicated), and the treatment code, CPT 11721 with a "Q8" modifier. The referring physician was included. Is the code for diabetes not the proper one?

Helene Manno, DPM, Cliffside Park, NJ

Response: You are correct, Dr. Manno. It seems that you need to purchase a subscription to the APMA's Coding Resource Center to be sure you have the latest and most accurate codes, or at least the three coding books (CPT, ICD-9, and HCPCS) each and every year.

All the current diabetes codes are and have been 5 digits, beginning with 250.xx  But not to worry, ICD-10 is only 15 months away. Those codes too are only 5 characters and begin with an "E."

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Facility Fees (Tip Sullivan, DPM)
From: Martin V. Sloan, DPM

There is likely no rational explanation for fee discrepancy, just as there is no rationale for other areas of reimbursement. Here's another: Medicare will NOT pay for functional orthotics when medically necessary, yet they WILL pay for accommodative diabetic inserts ANNUALLY when medically necessary. So, over a ten-year period in a diabetic's life, they will pay approximately $2,000 for A5513 (@$200/year) but they WON'T pay $400 for a pair of well-made orthotics that should easily last ten years.

Martin V. Sloan, DPM, Abilene & Rockwall, TX, mvs32154@gmail.com

RE: Compounding Pharmacies (Marc Katz, DPM)
From: Larry Kosova, DPM
 
We have used a company called Total Pain Solutions for about 3 years. I have not had the same experience that Dr. Katz has had. It has been nothing but mostly good results. My practice is mainly sports/performance injuries, and the compounds let these patients compete or perform when all else had failed. If something is not working, we can also talk to the pharmacists, and they will assist in making a new formulation and send it to the patient, gratis. I have actually used the products myself and see huge benefits. The regional rep's name is David Jones at 1-877-608-4995. I think you will see a difference just by talking with him.
 
Just like anything else, there are good companies trying to have the best products possible, and there are those trying to rip off us and insurance companies.

Disclosure: I have no affiliation with this company.
 
Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

RE: Compounding Pharmacies (Marc Katz, DPM)
From: Allen Jacobs, DPM

Dr. Katz's letter expressing his concern over the present costs of compounded topical pharmaceuticals is reflective of medicine in general, and his concerns are not unique to the compounding industry. How much does Dr. Katz charge for orthotics? Probably more than he gets for a digital arthroplasty. How about CAM walkers? Probably more than he gets for a level-2 office visit. And how many orthotic labs bid for our business?

The assertion that these pharmacies add components to drive up the cost is ridiculous. The pharmacies may only dispense what...

Disclosure: I have lectured for TPS and Bellevue pharmacies on these subjects.

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

RE: Podiatric Residency Crisis - Where are We? (Robert Steinberg, DPM)
From: Name Withheld

The minute a program director does not "jump through hoops" and comply with multiple ridiculous requirements made by CPME, the program/director is placed on probation and threatened to have its program accreditation removed.

I run a residency program at a busy level-1 trauma. Our residents run the entire Orthopedic Division as there are no ortho residents. We have over 5,000 ER visits to podiatry/ortho combined per year. I have been on probation different times for things like:

1. The diplomas used a dash instead of a slash
2. The residents did not complete every single box on a biomechanical exam form.
3. The schedule followed  was not the same exact schedule as on the manual.
4. One resident forgot to hand in his ACLS certificate, etc., etc., etc.

Despite these obstacles, this year I managed to convince the hospital to fund one more spot and have already hired a graduate.

Name Withheld

RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Randall Brower, DPM)
From: Michael W. Lawrence, DPM

I take issue with the views of Dr. Brower regarding "minimal incision surgery", though earlier in my career I would have thought much the same. Of course, back then, there were a lot of things that I did differently and my views have changed. Small incisions to release the plantar fascia vs. opening it all up and unnecessarily taking off the spur? How about other percutaneous approaches that fit into our surgical selections to our benefit, and more importantly, the benefit of patients? Advancing technologies in foot surgery? I didn't learn those in my training, long ago.

I am not well versed in minimally invasive foot procedures, but I am intrigued. It is my impression that there are many of our colleagues, orthopods too, who "trained open" and have learned and are embracing such procedures and have great success with them. They are now aided in visioning by fluoroscopy. How many times have we damaged a perfectly good joint just because of our aggressive opening? I am certain that I have done so. As always, selection of patients and the type of surgery are key. In addition, I find it always helps to ask myself, "would I recommend this for my loved one?"

Michael W. Lawrence, DPM, Chattanooga, TN, ftdoc@joimail.com

RE: Staff Performing Routine Foot Care
From: Margie Plon, DPM

Palliative care will always be a vital part of the services we provide to the public as not all patients need or, more importantly, are candidates for surgical intervention. Although our profession has expanded in scope of  practice and post-doctoral training over the years, there are still many of our colleagues who practice palliative care, in part or totally. To diminish their value by allowing a non-DPM to perform this service diminishes the value of our whole profession. 

I urge those who have no interest in providing this service to refer it to one of your colleagues who considers palliative care their area of expertise. I pose this question - Following your aortic valve replacement, would you feel it appropriate to have your ongoing cardiac care followed by a non-medical staff member of your cardiac surgeon or would that best be handled by a cardiologist?
 
Margie Plon, DPM, Elkins Park, PA, margieplon@comcast.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.

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

ASSOCIATE POSITION IN CHICAGO

Full- or part-time to do house calls; make your own schedule; logistical support provided. Contact dpms2@hotmail.com

ASSOCIATE POSITION - BEAUTIFUL VICTORIA, BRITISH COLUMBIA CANADA

On the ocean, fast growing area, Associate for multi-office full scope practice. Will be at the Seattle Conference June 27-29th. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - TEXAS

Dynamic, busy practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist, PSR-36 preferred. Excellent salary and benefits compensation package, for the right candidate, who is motivated to work hard. Contact/Send resume to: jmh6122@yahoo.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. 

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