The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 21, 2010 #3,889 Publisher-Barry Block, DPM, JD

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Stresses of Life Show Up in The Feet: TX Podiatrist

Whether or not you believe the feet are the window to the soul, doctors say there is something to the notion that the stresses of life can show up in your feet. "I think of the fast pace of life we live, we tend to wear things that are more convenient,” said Dr. Harold Malofsky, a Fort Worth podiatrist. “And convenience ends up to being open-backed shoes, such as mules, flip-flops for women, and sandals for men -- and that leads to a lot of poor support for the foot."

Dr. Harold Malofsky

And it can lead to nerve problems, trauma to the toes and nails or even stress fractures," Malofsky said. Doctors say that those with foot issues that cause pain or discomfort should see a medical professional for care.

Source: WDFW [6/16/10]

Texas Supreme Court Declines To Hear Podiatrist Licensing Board Authority Case

The Texas Supreme Court has decided not to hear a very important case regarding the authority of a professional licensing agency to interpret the laws regulating its profession. At stake in the lawsuit is the validity of a rule adopted by the Texas State Board of Podiatric Medical Examiners clarifying that the practice of podiatry includes the treatment of ailments and injuries of the foot and ankle.  Since 2001, this rule has provided important guidance for the public, hospitals, the insurance industry, and other healthcare practitioners.

Dr. Samuel Nava, Jr.

“We are disappointed that the Supreme Court would not hear this very important case. By reaffirming the broad authority of our licensing agency to define technical terms in the statute governing our profession, the Court could have removed some of the confusion regarding the scope of practice for podiatrists in Texas,” said Samuel Nava, Jr., DPM, President of the Texas Podiatric Medical Association. “We will file a motion for rehearing, urging the Court to accept this case for review.  If our efforts are unsuccessful, we will support other legislative and regulatory options that will assure that podiatrists may continue to offer their expertise to treat and manage diseases and conditions affecting the foot and ankle.”

Senate Passes Six-month SGR Fix

The U.S. Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent this afternoon. This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through Nov. 30, in lieu of the 21 percent cut scheduled for 2010.

Unfortunately, the U.S. House of Representatives is not scheduled to hold any floor votes until the evening of June 22. As a result, the Centers for Medicare and Medicaid Services (CMS) is instructing its carriers to lift the hold on processing claims for services provided on or after June 1, and to begin processing them under the law’s negative update requirement. In other words, claims will begin to be paid today at the 21 percent lower rate on a first-in/first-out flow basis.

Once H.R. 3962 is passed by the House and signed by President Obama, CMS will retroactively adjust any June claims that have been paid.

Source: AMA E-Voice Alert [6/18/10]

ONC Issues Final Rule on Certification Program

The Office of the National Coordinator for Health Information Technology at HHS has issued a final rule outlining a temporary program by which it will select and designate not-for-profit organizations to test and certify electronic health-record systems under the stimulus law. The final rule released today deals with the temporary process in which both testing and certification can be performed by a single entity. It will become effective upon publication in the Federal Register. A companion final rule for the permanent certification program is expected to be published this fall, according to the ONC statement.

"By purchasing certified EHR technology, hospitals and eligible professionals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our healthcare system," Blumenthal said in a news statement.

Source: Joseph Conn, Health IT Strategist [6/18/10]

Query: Medicare Pay Cut
 
Why are we all not collectively getting together and making a decision as a podiatry/medical society to forego seeing any Medicare patients (except emergency patients) since Congress has decided not to overide the 21 percent pay cut? What are we afraid of? Is the next effort for all physicians and surgeons to work for free? Interesting how my rent and all expenses continue to rise, yet Medicare consistently decreases the amount of reimbursement to doctors. I would appreciate your feedback and the posting of this note.
 
Randy Lisch, DPM, Austin, TX, drumpire@gmail.com

RE: Integrative Podiatric Medicine
From: Arnold B. Wolf, DPM

I find it interesting whenever anyone tries to "reinvent the wheel" by copying the original design premise and then ultimately "spitting out" the same product that originally existed. I see this with "integrative podiatric medicine"...in other words, "same stuff, different wrapper". Call it for what it is and in common parlance what it is normally referred to: "alternative medicine". For those who practice it, have the "stones" to embrace it for what it is...an alternative...don't create a euphemism to make it sound different than what it is.
 
Medicine, by its current design, is based on science and the dreaded "double-blind" investigational protocol. Manufacturers of homeopathic and naturopathic products purposely avoid the "medical product" claim because of the heightened demands that that classification would place upon their product(s). Personally, I prefer scientific medicine over "anecdotal" medicine (perhaps that may be a better name than "integrative podiatric medicine", i.e. less confusing). It is scientific knowledge that makes us better, not "anecdotal evidence". Let's see the integrative podiatric medicine people do the science and then, maybe I'll become a believer.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

RE: Integrative Podiatric Medicine (Elliot Udell, DPM, Bob, Kornfeld, DPM)
From: Dennis Shavelson, DPM

I wish to point out that Dr. Udell’s point of view is backed by evidence that has been produced using small numbers, poor controls, high deviations from acceptable error, lack of double blindedness, and summarily is not very valuable or applicable in EBP.  He is as biased and passionate about allopathy as Dr. Kornfeld is about holistic care. Does Elliot really believe that the cancer treatment used by the allopath would have provided a guaranteed cure, and more importantly, isn’t he pointing out the same anecdotal allegory that he implies of Dr. Kornfeld’s as worthless?

Every practitioner has in practice, a self-contained artistic and scientific environment that uses his/her training, skill set, the evidence, and the specific concerns of individual patients that he/she becomes more expert with over time. Every practitioner is gathering personal evidence that is used in practice and weighed against the research and anecdotal experience of our peers (EBP). 

I have cured bunion pain and deformity concerns of my patients both non-operatively and operatively in my career. I have seen many failed surgical bunions and many patients who were told to never have foot surgery crippled by their progressive pathology. Whose licenses should we take away and who sits in a position of judgment? Medicine is both an art and science and we are not dealing with inanimate or predictable subjects when rendering care. “If The apple falling from the tree had an engine, a mind, and a desire not to fall, Newton would have remained an unknown, and the apple would have been a bird.”

Dennis Shavelson, DPM, NY, NY, DrSha@footworldusa.com

RE: Integrative Podiatric Medicine (Marc Katz, DPM, Robert Kornfeld, DPM)
From: Richard A. Simmons, DPM

From reading Drs. Katz's and Kornfeld's posts on PM News, what I understand is that as practitioners, we need to consider other alternatives to writing prescriptions all the time. I never got the impression that all prescription medications were bad from either of them. Even so, let me offer this story: In the 1990s...

Editor’s Note: Dr. Richard A. Simmons’ extended-length note can be read here.

RE: Integrative Podiatric Medicine (Michael Turlik, DPM)
From: Bob Kornfeld, DPM

Dr. Turlik, I am not your enemy; I am your friend. We are both working hard to improve standards of care, albeit it somewhat differently. First of all, these principles are not based on my personal belief system, but they definitely resonate with it. The proof that it works has been borne out in the application of this practice paradigm by me for nearly 25 years. The results achieved are not imagined. I would not still be in practice doing what I'm doing if it did not work for my patients.

I know I made it clear in my post yesterday that...

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

RE: Problems With Eclypsis (Jeff Bean, DPM)
From: Elliot Udell, DPM
 
Kudos to Dr. Bean for keeping this problem with Medinotes and EMR programs on the front burner. I too have been burnt by what Eclypsis did to Medinotes. Dr. Bean asks if there is legal protection. Can a company sell you a software product for thousands of dollars and suddenly discontinue supporting it? Unfortunately, according to authorities I queried in my state, there is no protection under the law, and what we see happening with Eclypsis and Medinotes might be small potatoes compared to what some experts are predicting will happen with other EMR programs.

The EMR software business is extremely volatile, with new companies jumping on the bandwagon every day. Many, if not most, will go under and at this point in time have no legal obligation to their customers. With the actual notes being stored in cyberspace, a physician or hospital could lose all of the records if a company goes out of business. Even big companies can be affected by this volatile market. Eclypsis itself is being taken over by Allscripts. Other companies might merge or go out of business entirely. If the government is pushing doctors to use electronic medical records in their practices, they should pass some form of legislation protecting the doctors who invest in them. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Dragon Questions (Burton Katzen, DPM)
From: Gary Lieber, DPM

I have been using Dragonspeak 10.1 for several years and find it to be a wonderful product.  I dictate letters with it and add additional notes to templates in my EMR. 

Every voice recognition program has a learning curve, so you must spend some time correcting your errors using the program protocols. I heartily recommend the retail version of  Dragonspeak 10.1 which is less than $200.

Gary Lieber, DPM, Delray Beach, FL, richd3668@gmail.com

ASSOCIATE POSITION - FREDERICK, MARYLAND 
 
Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION  -  PALM BEACH COUNTY FLORIDA

Well-rounded growing practice seeks 3-year surgically trained podiatrist for an associate position. Must be hard-working, personable, and eager to work in a variety of settings. Some exposure to trauma/major reconstruction is preferred. Email CV to tburnam80@gmail.com

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

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 e-mail mchad500@gmail.com for more information.

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

LIMB PRESERVATION RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center offers a unique fellowship position. Be part of this unique opportunity at a major internationally-known teaching medical center. During this time, he/she will become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Annual Salary: Year 1 $61,000, Year 2 $66,000 plus excellent benefits. Submit a CV and letter of interest to: Erin Springhetti @ erin.springhetti@bmc.org and Dr Vickie Driver @ vickie.driver@bmc.org

ASSOCIATE POSITIONS – 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

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.

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

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