The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 11, 2010 #3,881 Publisher-Barry Block, DPM, JD

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We've just mailed the June/July 2010 issue of Podiatry Management.  This 244-page issue includes a special section "New Ideas in Clinical Podiatry ".  In addition, you'll  find our usual assortment of features, including our columns, and a CPME-approved CME.

June/July 2010 Podiatry Management

CT Podiatrist Uses PRP for Acute and Chronic Soft Tissue Injuries

PRP, otherwise known as platelet-rich plasma, is being utilized today as a method of "autologous blood therapy." This means that a patient's own blood components are used to create a healing effect to their own injured tissues. "Our bodies use platelets and white blood cells from our blood to further create the healing process. Our platelets are known as growth factors that go to work during an injury," said Dr. Bob Weiss, a Connecticut podiatrist.

Dr. Robert F. Weiss

"We have been utilizing the PRP therapy for acute and chronic soft tissue injuries and some joint injuries, including the following: plantar fascilitis, Achilles tendonitis or partial tears, ankle sprains, peroneal tendonitis, bursitis, and muscle injuries. At one time this procedure was done only in the operating room, but now as a modern technique, we are performing this procedure in the office," said Weiss.

Source: The Hour [6/8/10]

New CMS Unit Urged to be Flexible, Act Quickly

Commonwealth Fund researchers are calling on a new federal organization to be “inclusive and flexible” in developing new payment reforms, and to rapidly disseminate such initiatives if they're found to be successful. The Center for Medicare and Medicaid Innovation, which begins full-scale operations as part of the CMS in 2011, will be responsible for developing at least 18 reform models specified under the new health reform law, including patient-centered medical homes; promotion of care coordination through salary-based payment; community-based health teams to support small-practice medical homes; use of health information technology to coordinate care for the chronically ill; and salary-based payment for physicians.

In a new article in Health Affairs, Commonwealth Fund researchers recommended that the new center adopt a flexible approach in which new programs are implemented and continued as long as they demonstrate improvement of quality and value, and achieve desired outcomes. “This would represent a significant shift from the current process for developing, testing, and evaluating new programs, which often is lengthy and cumbersome,” according to the article.

Source: Jennifer Lubell, Modern Healthcare [6/8/10]

Reaction Mixed to Allscripts, Eclipsys Deal

Allscripts-Misys Healthcare Solutions' announcement that it will buy Eclipsys in a $1.3 billion deal has received varied reactions from healthcare industry executives. For Allscripts, "It's a great deal," said Vinson Hudson, a healthcare IT consultant at Jewson Enterprises, Austin, TX. William Bria, a physician who is the chairman of the Association of Medical Directors of Information Systems, sees the deal with some skepticism. Bria said that with the advent of the federal government's multi-billion-dollar IT subsidy program, the pressure has increased on vendors to have an integrated product offering for use in the hospital in-patient environment and in the physician office. Many healthcare IT companies have built their two-way systems as Allscripts is attempting to do, through acquisition, but that's no guarantee they'll succeed, Bria said.

The companies project $25 million in cost savings in 2011 and more in subsequent years. The transaction is expected to close in four to six months and is subject to regulatory approval, as well as the completion of a secondary offering and share buyback that will reduce Misys' stake in Allscripts to minority status. Misys acquired a 54.5% stake in a 2008 transaction that merged the company's healthcare division with Allscripts.

Source: Gregg Blesch, Health IT Strategist [6/9/10]

Shore Up Team Trust

Successful collaboration rests on a bedrock foundation of trust. The following are tried-and-true methods of solidifying team members’ trust in you and in one another:

•  Meet others’ expectations. State what you intend to do and then do what you say you will do.
•  Establish credibility. Tell the truth and follow through. Your statements should be honest, accurate and verifiable.
•  Take care of your reputation. Build trust relationships with others and refer to those mutual experiences when you make plans with staffers.
•  Stress the benefits of trust. Mutual trust works to both parties’ advantage. Show that trusting you is less hazardous than the potential costs of not working together.

Source: Adapted from Mastering Business Negotiation, Roy Lewicki and Alexander Hiam, Jossey-Bass via Communication Briefings

Query: iPhone Apps for Podiatry

I have just purchased an iPhone and wondered if readers could recommend their favorite iPhone "apps" for podiatric/medical and personal use. Any description would be greatly appreciated. 
 
Mark A. Lambert, DPM, Pensacola, FL

RE: Another Use for a Dermatoscope
From: Elliot Udell, DPM
 
A patient presented to my office with a history of having stepped on something. She felt she had a splinter in her left foot. I looked at it, palpated it, shined a light on it, but saw no sign of a foreign body. In desperation, I took my inexpensive dermatoscope and placed it over the area where the patient felt pain, and lo and behold, there was a very small metallic filament only visible under the magnification of the scope. I even took the dermatoscope off and examined it again with the naked eye. Nothing was visible. I even had a member of my staff take a look. She too saw nothing. Yet again, it was visible with the dermatoscope. I debrided the area, and only then did the foreign body become visible to the naked eye. The patient left pain-free. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Sleep Apnea, Restless Leg, and LE Pain (Pete Smith, DPM)
From: Bob Kornfeld, DPM

I have found an association between excitatory neuotransmitter dominance/adrenal stress and restless legs. In many cases, elevated epinephrine/norepinephrine, low serotonin, and elevated cortisol secondary to Th2 dominance is usually the cause. This will lead to peripheral vasospasm (especially at night as the cortisol levels rise through the night). Needless to say, couple vasospasm with elevation, and you will surely have oxygen deprivation at a microscopic level. Neurotransmitter urinalysis and salivary cortisol testing should be done. 
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

Sleep apnea is certainly a cause of restless legs and leg pain via the following mechanism. The apnea causes increased CO₂ retention which has an adrenergic sympathetic vasoconstrictive effect on the vasculature. This, of course, causes a mild ischemia leading to cramps, pain, and leg movement as a result of the two. In the same way, sleep apnea causes increased blood pressure systemically and is one of the reasons that patients with sleep apnea have a higher incidence of stroke and morning heart attacks.

The sleep apnea doctor was correct. I suggest a study of the relationship with non/slower healing ulcers in the diabetic population who may have undiagnosed sleep apnea. With this added ischemic burden, CPAP machines may be of benefit to those patients. We use hyberbaric oxygen on the same physiologic basis, improve oxygenation, and increase vasodilatation.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Golf Shoes for Hallux Limitus (Joe Boylan, DPM)
From: Sloan Gordon, DPM

I suggest a Mephisto golf shoe (rigid heel counter and flexible forefoot). I also recommend Michael Tosci shoes which come with a semi-flexible graphite orthoses built in. Of course, STJ also makes an excellent golf orthosis with a Morton’s extension.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Central Vacuum System (Bryan C. Satterwhite, DPM)
From: Pete Harvey, DPM, Scott Evans, DPM

You can build a central vacuum system yourself with a plumber’s help. Run 2” PVC pipe to the rooms required. Attach to a ball valve and then to a stepdown polytube available at Lowes or Jan-L.

Build-it-Yourself Vacuum System

Attach this to the stainless steel adaptor available from Jan-L. Attach the 2” PVC to a vac from Lowe’s, etc. Vent the vac outside the building.
 
Pete Harvey, DPM, Wichita Falls TX, pmh@wffeet.com

I use a central vac for my two rooms and am very happy with it. The vac machine is probably 50 feet down the hall in a closet of our clinic so I don’t really hear it, but it’s loud when you get close. If you have a small office, that might be a concern. 

Scott Evans, DPM, Tucson, AZ, sevans@tucsonortho.com

RE: Capturing Additional Income From Non-Covered Services (Bret Ribotsky, DPM, Jeffrey Kass, DPM)
From: Bob Kornfeld, DPM

Dr. Ribotsky speaks of revenue increasing pearls, but what he is really saying is that he is looking outside the box of conventional thinking for answers to a growing problem. As you say, the problem with insurance companies is OUR FAULT. We gave them the power to control us, and now we have fallen prey like helpless victims.
 
While I agree that you should be paid, have a right to be paid for everything you do, as long as it is something that the insurance contract mandates to be a bundled service, then that is what it will always be. They do not pay according to your treatment or your expenses. They pay according to a formula that nets them the biggest profits that they can rake out of the premiums they collect. They are not in the "healthcare" business.
 
Dr. Kass's reference to old school podiatry is just that...old school. The changing paradigm of medicine holds many answers for all forms of pathology. The new paradigm of personalized, systems-based medicine is the medicine of the future. If you fast forward into the new paradigm of medicine, integrative medicine, you will surely find many new ways to help your patients in a much more profound way, and at the same time, enjoy many new "revenue-increasing pearls." Right now, you can do this. Tomorrow, you can do this. It is up to you to look outside the box.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

EQUIPMENT FOR SALE –  PODIATRY CHAIRS

2 podiatry chairs - used Midmark 117 and a Ritter 317. Great condition. $950 each Greenwich, NY Call:518-466-3287. Pick up only.

ASSOCIATE POSITION IN NORTH BROOKLYN, NY 
 
Well-established practice in a multispecialty medical center seeking a self-motivated individual with initiative and leadership skills for a full-time position. Spanish speaking ability a plus. Compensation possibly in six figures with partnership opportunity. Contact/Send resume to: bklypodiatry@aol.com

ASSOCIATE POSITION NORTH CAROLINA - ASHEVILLE/MOUNTAINS

Well established, multi-doctor, multi-office diverse practice has immediate need for associate doctor leading to partnership. Associate doctor will be very busy from day one. Attractive compensation and benefits. Buy-in potential after one year. Contact at smfc2@charterinternet.com or 828-734-1535

EQUIPMENT WANTED – CR SCANNER

Reina 812 Manual CR Scanner in good condition. Contact: pmh@wffeet.com

PODIATRISTS NEEDED NATIONWIDE

Seeking a part-time or full-time podiatrists to provide podiatry house call and diabetic shoe fitting services to patients nationwide. We are a podiatry management company and have contracts with clients that have 1,000’s of established patients and all we need are hard-working good doctors to service them. We offer an excellent compensation package with benefits and the opportunity to build a fairly large practice very quickly. coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION – HOUSTON, TEXAS

Full-time, surgically-trained podiatrist needed for multi-office practice in Houston, TX. Ideal candidate must be motivated, dedicated and personable. Practice is a good mix of general podiatry and surgery, no nursing facilities. Must also be willing to do significant networking and marketing to help build the practice. Please e-mail cover letter, and resume to faajobs@gmail.com

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

LOCUM TENENS WANTED - MANHATTAN

Due To Family Emergency looking for locum tenens for the month of July and August 1-2 days per week. Office located in Manhattan Upper West Side Fax CV to 212 362-9896. For more information you can call 212 724-4457. frottenberg@juno.com

ASSOCIATE POSITION – QUEENS & NYC

Part-time podiatrist needed for multi-office practice in Queens and NYC. PSR- 24+ a must. Experience preferred. Willing to train the right new graduate. Must be punctual, very personable, ambitious, and ethical. Job will involve usual podiatric medicine and surgery. Will also include significant networking and marketing to help build the practice. You must be well-trained and have people skills for this position. Possible full-time position leading to partnership for the right person. Please e-mail cover letter and resume to hansfeet@aol.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION – NEW YORK

Great Opportunity - NY podiatric practice – multiple locations –seeks well trained, ethical DPM Per Diem and full-time positions available. Competitive salary. Send resume and CV to: info@advancedfootcare.org

PART-TIME POSITION - NEW JERSEY

Available for a Board certified/qualified podiatrist. Located in Toms River and Manchester. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Possibly leading to full-time position for the right person. Please fax CV to (732) 349-0228 or email CV to njfeet@aol.com

ASSOCIATE POSITION- MONROE, MICHIGAN

Excellent opportunity to join a modern, growing 3 doctor/2 office practice located in SE Michigan between Detroit and Toledo. Responsibilities will include a mix of surgery, office, hospital and nursing home/housecalls. Salary, bonus and benefits. Learn more about us at monpod.com. If you are a personable, reliable team player with solid skills and a patient first attitude please contact dr.hughes@comcast.net for more information.

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking PSR 36 surgically trained, and/or Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Must have Texas license. Contact/Send resume to: jmh6122@yahoo.com

TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)

Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or email mchad500@gmail.com for more information.

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