The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

June 25, 2011 #4,190 Publisher-Barry Block, DPM, JD

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CA Podiatrist Describes How Dogs Can Be a Risk to Diabetics

An Iowa woman found out the hard way that a peckish pooch and a foot made numb by diabetes-related nerve damage make for a very bad combination. Her Jack Russell terrier chewed off part of her infected big toe as she slept. "She didn't feel it at all," Dr. Lee C. Rogers, a podiatrist who treated the Des Moines woman, told CBS News. "When she woke up, there was blood everywhere. The dog had been tracking it all over the place." 

Dr. Lee C. Rogers

Rogers, who now directs the amputation prevention center at Valley Presbyterian Hospital in Van Nuys, CA said he eventually had to amputate the woman's leg - leaving her a double amputee. The three-year-old case, which Rogers described in the May-June 2011 issue of the Journal of the American Podiatric Medical Association, is an unusual one. But he said it serves as a reminder that patients with diabetic neuropathy should cover their feet and any wounds while sleeping.

Source: CBSnews.com  

TPMA Elects New President

The Texas Podiatric Medical Association (TPMA) has elected Damien M. Dauphinée, DPM, as president of the association for 2011-2012. Dr. Dauphinée practices in Denton, Texas, in a group practice of three podiatric foot and ankle surgeons. He has been practicing in Denton County for 12 years and focuses his practice on peripheral nerve surgery and diabetic limb salvage. He is a founding member of the Board of Directors at North Texas Hospital in Denton and serves as co-medical director of the Center for Wound Healing and Hyperbaric Medicine at the facility. 

Dr. Damien M. Dauphinée

Dr. Dauphinée is board-certified in foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery and is a board-certified wound specialist. He is a past president of the Association of Extremity Nerve Surgeons and Dallas County Podiatric Medical Society. He serves on the medical staff at North Texas Hospital, Denton Regional Medical Center, Presbyterian Medical Center at Denton, Medical Center of Lewisville and Presbyterian Hospital of Flower Mound.

FL Podiatrist Lectures at International Cosmetic Surgery Congress

With physicians from throughout Latin American and the world gathering at the Congreso Internacional de Dermatolgia Cosmetica, Laser y Pelo meeting in Mexico City in June, the audience of over 500 was exposed to the newest area to treat, the foot. “The foot has always played an important role with Latin women," says Dr. Francisco Perex Atamoros, President of the Congress, “and having Dr. Bret Ribotsky join our faculty was an honor to learn how to help these patients.”   

Dr. Bret Ribotsky in Mexico

Ribotsky, a past president of ACFAOM and host of Meet the Masters shared his techniques, and experience on the use of PSTTA (Pedal Soft Tissue Temporary Augmentation).  From the stage and via live demonstrations. the audience was educated on a new technique for an old problem.

Build on Excitement

Excitement is one characteristic of successful workplaces. Excited workers show abundant energy and willingness to complete projects and assignments. They have faith, hope and passion. However, workers who are too excited may need your assistance to calm down, take stock, and move from excitement to action. To focus staffers’ energy, ask questions like these:

•  What do we need to do to harness this energy and turn it into a concrete action plan? What is the first thing we should do?
•  What needs to change so that everyone around here feels as excited about this as we do?
•  What parts of the plan or its execution do we feel a little less excited about?
•  Whom do we need to involve so that we can stay excited about this?

Source: Adapted from Moving out of the Box: Tools for Team Decision Making, Jana Kemp, Stanford Business Books via Communication Briefings

ONC Offers Health IT Teaching Materials

A trove of free health information technology teaching materials for higher education has been opened to the public by the Office of the National Coordinator (ONC) for Health Information Technology.

The $10 million, ONC-funded Curriculum Development Centers Program produced the materials, which have been in use since last fall by members of the 82-school ONC Community College Consortia Program. The community colleges operate six-month, health IT certificate training courses. The goal of both programs is to close an estimated 50,000-employee shortage in the nation's health IT workforce.
 
Source: Joseph Conn, Health IT Strategist [6/24/11]

Query: Wart Peel

Does anyone have experience with Wart-peel, the compounded medication for verrucae that is advertised in our journals? What is the cost to the patient, its efficacy, and are there any patient issues or concerns with it?. 

Howard J. Bonenberger, DPM, Nashua, NH
 

Query: CPT 97597 Denial

I have recently received a refund request from Medicare on procedure code, CPT 97597 (select debridement) for patients in a skilled nursing facility (SNF), stating the denial was for 'consolidating billing'.

Can anyone give me any suggestions? If the debridement codes were replaced with therapy codes, how are we to get paid?

Debbie Keller, Office of Mark Pinker, DPM, Carlisle, PA

Response: CPT 97597, as a therapy service, is part of consolidated billing which means that this service is included in the overall payment made by Medicare Part A to the nursing facility. Therefore, there is no separate payment made (to you). Consolidated billing also applies to diagnostic studies such as the technical component of radiology services, therapy, and DME (including diabetic shoes/inserts).

Your only avenue for payment (you cannot bill the patient) is through the nursing facility. Medicare has encouraged providers to contact the administrators of the nursing facilities and set up an agreement for direct payment to the doctor for services or items listed under consolidated billing.

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Scarf Complication (Name Withheld)
From: Gino Scartozzi, DPM

One can certainly understand the frustration of having to deal with a surgical complication created from patient non-compliance. I would respectfully suggest that any "perceived" abandonment of the patient may actually lead to a larger "headache" for this practitioner. It may lead the patient (or an attorney) to believe that "if you could not handle a potential complication with the surgery performed, you should not have performed it in the first place."

I am not stating that this is a valid argument, but...

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

RE: Clinical Success with Poor Radiological Result
From: B. T. Sullivan

Just a note regarding the post-op x-ray that I posted as a poor result previously: Apparently, most see this as poor technique, which is possible but unlikely given the numbers of these I have done over the years. At the completion of the surgery in the O.R., the first metatarsal head was over the sesamoids. The changes that are depicted occurred in the year following the surgery. I have 22 years of experience in private practice and have done untold numbers of these-- I do not believe my technique has changed.

Of course, as one of my esteemed colleagues has said, "It could have been just one of those off days." but I do use a "C" arm to confirm position and fixation on...

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

RE: e-Prescibing Deadline (Greg Caringi, DPM)
From: Neil B. Levin, DPM

You are a little late at this point, but you do not need integrated EMR to have e-prescribed 10 patients by June 30th. I do not have EMR. Allscripts is a free online service that lets you e-prescribe easily and quickly. It maintains a database of patients you have entered, their medications, their pharmacy of choice, and your commonly prescribed medications. I am sure you had at least 10 Medicare patients whom you wrote prescriptions for this year.
 
Neil B. Levin, DPM, Sycamore, IL, drfeet1@aol.com 

RE: More Malapropisms

When asked if he exercised, my patient replies that he used his threadmill occasionally.

Joan Sciller, DPM, Euclid, OH

EQUIPMENT FOR SALE- DIAGNOSTIC ULTRASOUND UNIT

Biosound Esaote, 12” monitor, printer, portable stand, carrying case, especially useful for podiatric musculoskeletal. Excellent condition, one owner. (only used for 2 years) See photos on request. Can be shipped. Contact Dr. Jim Cancilleri at 609-364-4862 (South Jersey) or via email at DrCancilleri@aol.com, Great buy at $3595.

PRACTICE FOR SALE - DENVER, COLORADO

Very low overhead in a multi-disciplinary setting within medical building at a prestigious hospital. Young patient population. Low purchase price/immediate availability. Tremendous growth potential. Present doctor will stay for transition. Perfect for family person or new practitioner. Contact podpracsale@hotmail.com

PRACTICE FOR SALE - KENT, WASHINGTON

Established satellite practice, easily expandable to suite your needs. One day/week $50K gross, low overhead!! Includes reupholstered Midmark 417 (4 position keypad), Excel X-ray, Processor, Ritter M9, Miltex/Bianco instruments, Lakeside cart, cast cutter, etc. Shared office with 2 Referring Family Practitioners. Price $25K. Reply: practiceforsale18@yahoo.com

PRACTICE FOR SALE - MISSOURI

Well established, but still growing. Grossed over $300,000 last year. Located in a thriving medical community. Good payer mix. All aspects of podiatry needed in the area. Do not let this opportunity to own your own practice pass you by. Contact footdoc2002@yahoo.com for more information.

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity. Located at Mission Regional Hospital. Sale price $205,000 including supplies. Gross income 2010 was $340,000. Gross income 2011 estimate $420,000. Approximately 1200 sq ft with 3 treatment rooms, digital x-ray and fully computerized. A/R available at 50% discount. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Practice is expandable to full time with increasing hours and marketing. Real estate available for purchase. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross $760K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - WASHINGTON STATE - SUBURBAN SEATTLE

16 year established part time practice. Includes Midmark 417 (4 position keypad), Excel X-ray, processor, Ritter M9, instruments, bandaids, etc. 1 Day/week $50K gross. Professional Business appraisal at $48K. Asking $35K. Shared office with 2 FP's. Easily expandable. Reply: practiceforsale18@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Seeking associate for busy, growing practice located in Toms River, Ocean County. Looking for PSR 24/36, board eligible doctor. Basic podiatry a must. Practice has a up-to-date EMR and practice management program. Digital x-rays, ultrasound, laser, vascular studies. Excellent opportunity for highly motivated and ethical DPM. Send CV to toesec@aol.com

ASSOCIATE POSITIONS – NEW YORK CITY

Looking for someone with at least 2 yrs of working experience in a podiatric office. Two sessions (1/2 day) a week for July and August for Upper West Side of Manhattan. References a must. One 8 AM to 12, one 12 to 5 PM. Reply to fabienne.rottenberg@gmail.com

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Seeking personable, ethical, motivated individual for a growing, well-rounded practice with potential for partnership. Must be PSR 24-36 trained. Competitive salary, incentive and benefits. Email CV to orin915@comcast.net

ASSOCIATE POSITION/PART TIME - ORANGE COUNTY CALIFORNIA

Experienced podiatrist - 2-3 days/week, two office locations in beautiful south Orange County California. Exceptional opportunity for seasoned semi-retired practitioner. Fax or e-mail Resume and LOI to 949-488-0868 Info@feetfixer.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

ASSOCIATE POSITIONS: NW INDIANA & CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

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 516 476-1815 PODO2345@AOL.COM

STORE FRONT OFFICE SPACE AVAILABLE - NASSAU COUNTY NEW YORK

Office Space available for sublet or long-term lease. Nassau County established podiatry location for over 30 years. Fully equipped, and no investment required. Excellent Opportunity!!! Reply to: rrranch7@yahoo.com

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

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