The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 19, 2008 #3,276 Editor-Barry Block, DPM, JD

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TX Podiatrist Provides Advice for Keeping Aging Feet Young

Although your baby boomer feet may have lost their blush of youth, there’s still hope. With some TLC and foot care knowhow, you can turn back the clock and put the spring back in your step. Dry skin and callused heels are by far the most common foot complaints. These conditions not only make feet look older and less attractive, but they can pose a significant health risk.

Dr. Glen Beede

Dr. Glen Beede, a podiatrist in Fort Worth, Texas, says that dry, cracked heels can fissure, causing pain or even tissue wounds. Left untreated, calluses continue to grow thicker and, if they become infected, they may require antibiotics. But, with a little know-how and some due diligence, you can keep your feet healthy and looking great, no matter what your age. Here are some important tips:

* Give your feet a bath. Soak your feet in lukewarm water mixed with moisturizing soap.
This helps heal calluses and tender spots, and a warm footbath is so relaxing at the end of a day.
* Don’t use razor blades. The American Podiatric Medical Association warns that razor blades should never be used to cut corns or calluses.
* Keep an eye on your feet. Along with proper foot care, monitoring the condition of your feet is one of the simplest ways to ensure foot health and beauty at any age.

Source: The Inter-Mountain (WV) [6/17/08]

NY Podiatrist is First Resident at Parkway Hospital

The New Parkway Hospital's new podiatric residency program in conjunction with New York College of Podiatric Medicine, welcomed its first podiatry resident.

Dr. Lakisha Taylor

Lakisha Taylor, born and raised in Memphis, knew diabetes ran strong in her family, and wanted to do something about it. She graduated from New York College of Podiatric Medicine on May 28. While at the New Parkway Hospital as a podiatric surgical resident, she will be under the supervision and direction of Dr. David Mehl.

Source: New York Daily News [6/16/08]

AMA Issues First-Ever Performance Report On Medicare, Seven Health Insurers

Insurers' failure to properly process and reimburse physicians costs the U.S. $200 billion annually, according to a report released on Monday by the American Medical Association, the Los Angeles Times reports. AMA released the report at its annual meeting in Chicago to coincide with the launch of its "Cure for Claims" initiative to reduce inefficiencies in payment claims.

The report examined claims billed to Medicare and seven insurers: Aetna, Anthem Blue Cross Blue Shield, Cigna, Coventry Health Care, Health Net, Humana and United Healthcare. According to the report, Medicare paid contracted fees 98% of the time, compared with 71% of the time for Aetna and 62% of the time for United Healthcare. Coventry paid in compliance to its contracts 87% of the time. Coventry also made its first payments within four days -- the shortest time of the eight health plans -- compared with the industry standard of 10 to 14 days.

In addition, Coventry made requests for further information or asked physicians to resubmit their claims within five days, a contributing factor to faster payments. Humana took 22 days, followed by Cigna at 20 days and Health Net at 17 days . Medicare was the most likely to deny any part of a claim at a 6.9% rate, followed by Aetna at 6.8%, according to the report. Other insurers' denial rates ranged from 2.7% to 4.6%, the report found.

Sources: Lisa Girion, Los Angeles Times via American Health Line [ 6/17/08]

Select Your Words Carefully

Instead of calling the initial employment period "probationary," consider substitute terms such as "trial," or "provisional." There's something about the word "probationary" that turns people off.

Source: Palmer Practice Bulletin

Query: Hallux Extensus

I am treating a 57 year old active male patient who had a cheilectomy with a plantar-flexory 1st metatarsal osteotomy 2 years ago to treat hallux limitus. His hallux does not purchase the ground and as such has developed severe lesser metatarsal head pain particularly at the 2nd and 3rd met heads. His articular cartilage is relatively healthy. Recent x-rays demonstrate excessive plantar-flexion of the metatarsal head. Additional surgery is being contemplated. Any suggestions for type of procedure?

Larry Dorman, DPM, Miami, FL

Fungus Nails on the Rise: MA Podiatrist
From: Elliot Udell, DPM

Dr. Harris is correct. It’s not possible with absolute certainty to tell if a patient contracted a case of onychmycosis from a salon treatment. Sure, nail salons are not held to same degree of sterility that podiatrist are, but I would not blame a nail salon for a patient's foot condition without proof. The fact that the patient blames the nails salon is a human way of blaming someone for something bad that happens in his or her life. We all do this from time to time in different situations. Many of us will even support the patient's anger at the salon because we feel personally threatened by nail salons. Humans are meaning- making machines and blame is a way of ascribing meaning to something bad that happened.

What I tell my patient's is that fungal spores travel and that there might be a lack of localized immunity in the actual nail bed that allowed the fungi to proliferate. I also advise patients who are concerned with sterility at salons to bring their own instruments and I even offer to sterilize them in my autoclave after they are used. What the patients find even more intriguing when I dispel the notion of blame, is when I point out that even though the toes are right next to each other in a closed environment, not every nail develops onychomycosis. Some are spared for a lifetime, while others are near impossible to treat.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Charging for Prescription Renewals (Alan Mauser, DPM)
From: Multiple Respondents

My ENT has instituted the following policy which is posted in each treatment room. "A request for a prescription refill not made at the time of the visit will incur a $20 fee, payable in advance by credit card, check, or cash." I see no reason for not charging a fee as we are continuing the risk without the benefit of a visit. Patients will try anything to avoid a visit if necessary.

Richard Benjamin, DPM, Washington, DC, RSBenjamin@aol.com

Sounds like a bad idea to me. Refilling prescriptions in a timely fashion should be a part of patient care. If you haven't seen the patient in "quite a while", then perhaps an office visit for a checkup and meds review is in order, but other than that, just give the refill. But what do I know? I'm retired from podiatry.

Paul Busman DPM, RN, Cohoes, NY, BREWERPAUL@aol.com

I practice in a large office with several FPs, and the office policy is that prescription refills require an office visit. It sounds harsh on the surface, but we explain verbally and in writing that the purpose of a prescription with refills is to allow the patient enough medication until it is time to have the condition for which you prescribed the medication to be reassessed.

For example, I'll give three or six months worth of Lyrica to a painful neuropathy patient with a follow-up exam scheduled for just before the prescription runs out. Of course, there are always a few exceptions which the individual docs handle on a case by case basis. For justifiable exceptions, patients are given enough medication (anywhere from a few days to a month supply) to get them through until they can get into the office again.

The key for a policy like this to work is to communicate the necessity of reassessing the safety, need or effectiveness of a medication to your patient. A strict yet reasonable refill policy also seems to help with overall compliance. The office adopted it about two years ago and it has done wonders at reducing the number of call-backs and pharmacy faxes.

Dean Clement, DPM, Chandler, AZ, dlmeb5@yahoo.com

RE: Laser Smoke Evacuator Filter (Michael Saginaw, DPM)
From: Alan Berman, DPM

Here is a company that manufactures filters -- I have a Xanar XSE-500 smoke evacuator & they will make replacement canisters Surgimedics: Phone: 800-840-9906 Fax: 814-774-0778 • Order Fax: 814-774-3482

Alan Berman, DPM, Carmel, NY, Anbdpm@aol.com

RE: A Potent Pencil

Today a patient's husband informed me that his wife accidentally removed her entire nail when trying to only trim it. This caused significant bleeding that he stopped with her "septic pencil."

Marc Greenberg, DPM, Dayton, OH

PRACTICE FOR SALE WA STATE: BELLINGHAM - WITH ASC 8x

Located by hospital and medical community. Owner will carry part of financing. Potential for increased revenue abounds. This is a value that should not to be overlooked. Bellingham is rated in national magazines as one of the most desirable places to live or retire. 386 597-5766.

IMMEDIATE OPENING – CHATTANOOGA, TN

Excellent opportunity for a young well-trained personable podiatrist to join a rapidly growing practice. $100,000 salary. PSR-36 minimum required. Live, work and play in a beautiful area with many recreational opportunities including rock climbing, hang-gliding, whitewater paddling, fishing, boating, etc. Option for partnership/ownership track. No nursing homes. No weekends. E-mail cover letter and CV to drsegler@anklecenter.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

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

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP NY/PA

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at 85,000.00 with bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

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 full-time podiatrist in a multi practice location in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

ASSOCIATE POSITIONS – CALIFORNIA

Coast to Coast Mobile Podiatry Group, California's premier provider of mobile on-site health-care services is seeking hardworking, caring Associates to provide excellent health-care to the greater Los Angeles areas, Organge County, San Bernadino County, Riverside, San Diego, and Santa Barbara. Salary and benefits available. Please email you CV and salary request to coasttocoastpodiatry@yahoo.com

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

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