The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 16, 2010 #3,885 Publisher-Barry Block, DPM, JD

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MO Podiatrist Uses Titanium Implants For Non-Responsive Flatfeet 

While many people with flat feet do fine, Dr. David Amarnek with the Foot and Ankle Center says 80 percent of the population has some kind of foot problem. Very few have a ‘normal’ foot. Flatfeet are more susceptible to other structural foot problems like bunions, hammer toes, and plantar fasciitis. People with flat feet over-pronate, putting more pressure on the inside of the foot. Treatment often depends on age. For younger patients, he may prescribe Achilles tendon stretches, and arch supports. Younger patients who are still symptomatic may benefit from surgery or even an implant.

Dr. David Amarnek

"We insert a titanium implant into the space between the ankle and heel bones in the subtalar joint, the joint responsible for the side-to-side motion of the foot,” explains Amarnek. “Sometimes, we have to use the implant in adult-onset flat feet when conservative measures aren’t enough.” He stresses one message: It’s not normal for your feet to hurt. Pain should be checked out by a podiatrist earlier rather than later.

Source: Mary Jo Blackwood, RN, MPH, Ladue News [6/10/10]

Podiatric Foundations Donate to Barry's Yucatan Crippled Children’s Project 

Barry University’s Crippled Children’s Project (YCCP) received a gift of $24,575 in grant support from three separate foundations recently. Two $10,000 donations came from the Frank J. Lewis Foundation of Riveira Beach, FL, and the International Foundation of Fairfield, NJ. The Northwest Podiatric Foundation donated $4,575.

(L-R) Dr. Charles Southerland shown here with Drs. Pedro Abrantes and Nelson Gonzalez, graduates of BUSPM, after treating a 5-year-old girl with cerebral palsy.

The Yucatan Project, now in its 14th year of operation, has rendered treatment to more than 6,700 crippled children in Mexico. All operations are performed by podiatric physicians and surgeons from Barry’s School of Podiatric Medicine. “These magnanimous gifts have changed the lives of thousands of young, underprivileged crippled children and enables them to live normal and productive lives,” said Dr. Charles Southerland, director of the YCCP.

Bunion Surgery by CA Podiatrist Puts UK Runner Back on the Winning Track

Watching Paula Radcliffe win a marathon, you would never imagine that until recently, she suffered from bunions, a common foot condition that afflicts an estimated one million Britons. Paula finally decided to consult podiatric surgeon Dr. Amol Saxena, who works at California's Palo Alto Medical Foundation's Sports Medicine Department. Dr. Saxena concluded that the bunion caused Paula's injuries, and that her style of running had changed to accommodate it.

Dr. Amol Saxena

Dr. Saxena said, "Paula had a dislocation of the toe joint and a broken second metatarsal. As a result of the bunion, she was also overloading her second and third toes. During a two-hour procedure, I cut the bones and repositioned them, realigning them with screws and pins." The pins are absorbable, and the titanium screws are usually left in the foot. Paula also needed a tendon transfer. Within six months of the surgery, she won the New York half-marathon last August.

Source: Gary Edwards, Daily Mail [6/13/10]

NY Podiatrist Lectures on Integrative Podiatric Medicine

This past weekend, The Institute for Integrative Podiatric Medicine (Robert Kornfeld, DPM, founder and director), hosted its first Integrative Podiatric Medicine Initiative Seminar on Long Island, NY. Kornfeld lectured to the attendees who were interested in expanding their practice paradigm and incorporating integrative medicine principles into their podiatry practices. "This will need to become an integral part of every medical practice going forward", asserts  Kornfeld.

Dr. Robert Kornfeld

Dr. Kornfeld introduced the integrative medicine model, the functional medicine model of inflammation, and took the participants on a journey through nutrigenomics, nutritional medicine, homotoxicology, prolotherapy, and herbal medicine. The doctors were taught how to apply functional medicine laboratory analysis to the presenting podiatric pathology and were walked through numerous case histories to see how these principles apply to specific podiatric patient pathology through homeopathic injection therapy, prolotherapy, nutritional medicines, herbal medicines, and epigenomic refinement.

NY Podiatrist and Patient Share Unexpected History

While the faces have matured, so too has this patient and doctor relationship.  Little did they know how much they had in common. A decade ago, Frank Archibold first met Dr. Richard Sawicki at a local podiatry clinic where he was being treated for foot complications secondary to diabetes. There, he saw several doctors on a rotational basis. Two years ago, when Frank was seeking the consistency of care from one doctor, he saw a picture of Sawicki in a local newspaper and showed up at Niagara Cerebral Palsy’s Podiatry Clinic in Niagara Falls.

(L-R) Frank Archibold and Dr. Richard Sawicki

What started off as the typical patient-doctor visits, soon changed. Through Frank’s conversations with clinic staff, it was discovered that he shared a history of memories with his doctor from almost 30 years ago. At that time, Frank lived in Bensalem, PA. It happened to be that Dr. Sawicki was finishing a surgical residency at Frankford Hospital in Philadelphia. They lived a couple of miles from each other on opposite sides of Philadelphia Park Race Track. Frank and Dr. Sawicki realized that they traveled the same streets, shopped at some of the same stores, and ate at the same restaurants, all while never meeting.

Source: Shari Kaminski, Niagara Gazette [6/13/10]

Query: Hardware Failure With Removal

A Scarf osteotomy was performed with screw fixation on a Medicare patient. At the first post-op visit, it was apparent that the hardware failed and the osteotomy site toggled. The patient was taken back to surgery within 5 days. At the time of surgery, the 2 screws were removed, the position of the fragment readjusted, and 2 larger screws were used to fixate the bone.

Should I only bill for the hardware removal (CPT 20680 - removal of buried, deep hardware) with diagnosis of hallux valgus (ICD-9 735.0), or can the insertion of the new hardware be billed as well?

Gary Trent, DPM, Chicago, IL

Response: I would bill for a open repair of fracture, first metatarsal, which I believe is what you are doing.

I would not bill for the hardware removal as that would be incidental to the principal procedure. The insertion of hardware would be included in the repair code allowance.

Tony Poggio, DPM, Alameda, CA

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RE: Traumeel as an Analgesic (David Secord, DPM)
From: Bob Kornfeld, DPM

Again, it appears unfortunate that an RCT was done in a fashion that ignores the patient. I am not here to argue the "results." However, what is important here is that Traumeel is NOT an analgesic medication. It is a diluted blend of phytoalexins, designed to stimulate the immune system and modulate cytokine and kinase activity. That being said, there are many reasons why this gentle form of hormesis will "fail" on its own. However, if the proper pre-operative evaluation is done on each patient, and immune system de-regulators are identified and corrected, then a surgical outcome will be more predictable. In this way, Traumeel can be extremely helpful in facilitating desired healing.

I will also say that its main use is to assist in the conversion of chronic inflammation to the primary pathway which detoxifies and repairs cells under stress. My long experience with integrative medicine has taught me that if you want to evaluate outcome, evaluate the patient first.

Bob Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com

RE: Dragon Questions (Dwight L. Bates, DPM)
From: Burton Katzen, DPM

I have used the regular Dragon for over a year and found it to be adequate as long as you speak clearly and train properly. If you look at some of us Dragon users' earlier posts on PM News, you can get some very entertaining dictation, so check it carefully. When it goes unchecked, it is an endless source of entertainment. My brother physician has the more expensive medical version, and he says he still has to check it thoroughly for mistakes. One easy way around mistakes is to do as many templates as you can, and use them whenever feasible. Also, get a high quality microphone.
 
PS. I recently purchased a new computer and called the company about transferring files. The representative told me that it hasn't been announced yet, but Dragon 11 (regular and medical) is being released in mid-July, so you may think about holding off for a while. If you have already purchased ver. 10, I assume you will be able to transfer your files.
 
Burton Katzen, DPM, Temple Hills, MD, DrburtonK@aol.com

RE: Reaction Mixed to Allscripts, Eclipsys Deal (Michael Brody, DPM)
From: Marc Garfield, DPM, Sloan Gordon, DPM

I agree that you should ensure that a system will integrate well into all facets of your office, and I have no doubt that TrakNet is that product for many docs. But you should pass on organizational endorsements of products. Find someone else who sees a similar mix and number of patients as you, who is using the system you are interested in, and do an on-site visit. If you are interested in a system that cannot be seen firsthand and reviewed without the bias of a company rep., then visit docs using another program, even if it is one that you would never buy. 

Find out the features that make that product worth having for them, and then determine if that would be necessary in the system that you would actually purchase. The following links offer some free, minimally biased reviews to determine some comparison points for your EMR shopping. Most podiatry systems will not show up here. But you should consider an on-site visit for the top products to get an idea of how certain features interfere or assist a physician’s workflow. Then see what the vendor of a podiatry system has to offer. They all take time to customize. A podiatry-specific system with built-in content may make implementation easier. But then what? Hopefully it works well for you and your office.

cchit.org/products/ambulatory
klasresearch.com/
delivery.sheridan.com/downloads/FlashPrint/AAFP_160708_FP.swf

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

You have fallen in the black hole. Don't expect things to get better with this company. I have researched EMRs for three years. Find a company that is CCHIT-certified, find a FREE e-scrips company (there are several). There are many good companies around and I'm looking at EHS, Internet-based, monthly fee, etc. This company is owned by DPMs (called IPS), and they cater to us and have a solid balance sheet.

Dallas has formed a group [see previous PM News] using IPS (ips-med.com), which offers EMR and PM systems that are compatible and comprehensive. Don't believe all the claims out there. Remember that if it's too good to be true, it's bogus. In Houston, we are looking at forming a group with the same company. The time has come.

Disclaimer: I have no financial relationship with IPS.
 
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Medicare Compliance Will be Required Under New Healthcare Reform Law
From: Lawrence Rubin, DPM

The June 15, 2010, PM News post, "Medicare Compliance will be Required Under New Healthcare Reform Law" should motivate every practicing DPM who is not following the provisions of a written practice compliance program to start developing a program now. The OIG has urged physicians in individual and small group practices to develop a practice compliance program since October, 2000. Those DPMs who have done this voluntarily have protected themselves against Medicare accusations of fraud and abuse. Now, having an acceptable practice compliance program will be mandatory under healthcare reform. (See Federal Register information about developing the OIG Individual and Small Group Practice Compliance Program.

Your practice will have to go through an organized process to develop an acceptable compliance program. You cannot just buy a compliance manual from some vendor and put it on your bookshelf to gather dust.  In fact, in Medicare's view, having a written compliance program and not adhering to its provisions, is just as bad, or worse, than not having a program at all. You may choose to develop a program yourself, or, you may choose to work with an experienced compliance consultant who will develop a program with you. The important thing is to get started on a compliance program if you don't already have one.

Lawrence Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com

RE: Foot High Heels

Romanian shoe designer Mihai Albu has created a shoe that will raise you up an entire foot. What woman wants to be a whole foot taller? And talk about hard to walk in – they’re a lesser version of stilts (albeit much better looking)!

Foot High Heels

The tall shoes seem to come at a tall price, as well: $1,525, which is approximately three times the monthly wage in Albu’s homeland of Romania.

Source: Katie Gioia, Signature 9 [10/14/10]

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

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 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

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time 3-DPM group in South Bay of LA County. Minutes from best living in LA County. Practice is an excellent mix of surgery, general podiatry, diabetic care, and DME. Beautiful office with EMR, Digital X-ray and Orthoses, etc. Please e-mail cover letter, and resume to footcareone@verizon.net

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

EQUIPMENT WANTED – CR SCANNER

Reina 812 Manual CR Scanner in good condition. Contact: pmh@wffeet.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 – EASTERN OREGON

Recent poor health requires sale of busy 30+ year old practice in Eastern Oregon. Good mix of surgery and general podiatry. Pleasant community with year round outdoor recreation. Major metropolitan center 50 miles away. Current staff and doctor will stay on as needed. sparris@fmtc.com

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com

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

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.

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