June 29, 2006 #2,618 Editor-Barry Block, DPM, JD

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Bare Feet Beware: AL Podiatrist

Going barefoot on the beach is one of the delights to look forward to as warm weather approaches. But one nasty puncture wound from stepping on a nail will cure one of any such hedonistic pleasures.

UAB podiatrist James Thomas, D.P.M., said, “Any nail puncture wound requires immediate cleansing with soap and water, followed by evaluation at the local emergency room. Further wound care may be necessary, along with x-rays, antibiotics and possible tetanus update, depending on the date of the last booster shot.” Infection with tetanus causes severe muscle spasms, leading to "locking" of the jaw so the patient cannot open his/her mouth or swallow, and may even lead to death by suffocation.

Source: University of Alabama at Birmingham [6/27/06]

Armstrong Chairs Committee That Updates VAC Guidelines For Diabetic Care

Kinetic Concepts, Inc. today announced the publication of new clinical guidelines around the use of KCI's Vacuum Assisted Closure(R) or V.A.C.(R) Therapy in the treatment of the diabetic foot. The new guidelines were published by a multidisciplinary panel of experts at a consensus conference held in February 2006 in Miami, and are intended to update the findings presented in the 2004 guidelines from the Tucson Expert Consensus Conference (TECC) on V.A.C.(R) Therapy. Specifically, the latest guidelines weigh the most current clinical evidence, refute or confirm current consensus, provide practical clinical guidance and best practices to clinicians treating diabetic foot wounds, and help to direct future research.

"It was a pleasure participating in this outstanding program evaluating a promising modality amongst such a distinguished group of clinician-scientists," said David G. Armstrong, Professor of Surgery, Chair of Research and Assistant Dean of the Dr. William M. SchollCollege of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago, IL. Dr. Armstrong served as Chair of this interdisciplinary panel. "As with the TECC panel in 2004, this group of leading clinician-scientists was convened under the shared objective of evaluating and assembling the latest clinical evidence. And I believe I speak for the consensus panel when I say that the evidence presented in Miami further assists in improving care. Clearly, there is a vibrant, ongoing dialogue happening among practicing clinicians and academia that suggests that this technology holds great potential in the treatment of these most complex patients."

Source: MSN Money Central [6/27/06]

Nationwide Survey Shows Widespread Consumer Confusion over Differences Among Healthcare Providers

New results of a nationwide survey indicate there is significant public confusion about the qualification of healthcare providers. Highlights from the CHART telephone survey of 1,000 U.S. adults show that the American public is unaware of the differences in education and training between limited license health care practitioners and medical doctors.

-- 72 percent believe a podiatrist is a medical doctor
-- 70 percent believe an optometrist is a medical doctor
-- 59 percent believe a psychologist is a medical doctor
-- 56 percent believe a chiropractor is a medical doctor
-- 33 percent believe a dental assistant is a medical doctor

"The Health Care Truth and Transparency Act of 2006 is a significant step forward to end patient confusion about the qualifications and training of their healthcare providers," said American Medical Association (AMA) Board Member Rebecca Patchin, M.D. The AMA is a member of CHART, along with nine other leading physician and dental associations.

Source: PR Newswire [6/27/06]

Query: Eschar Debridement Code

The podiatrist I bill for wanted to know if there is a code for debridement of eschar (a slough produced by burning or by a corrosive application)? Can anyone tell me if this code exists?

Denise Merrick, North Las Vegas, NV

Response: There are several codes to choose from depending on what was debrided.

CPT 1104x debridement codes. The appropriate choice of code is dependent on the level of tissue actually debrided. I would assume by the very nature of an eschar, the debridement would be superficial.

CPT 11000 debridement code. If the skin involved included extensive eczematous or infected tissue - the key words here are "extensive" and either "eczematous" or "infected" skin - then this code can be billed.

In most cases, I would suspect CPT 1104x would be most appropriate.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Richard Baerg, DPM, MPH

It is with sorrow and respect that I comment on the death of Richard. I use the word comment because no matter how much one can write regarding this most versatile podiatrist it would only be a comment on his life so full and varied.

I had the pleasure and opportunity to interact with this gentleman, possessed of a totality of podiatric information. Considering the time of his pursuits, before most, he truly was a visionary of what podiatry should and would become. Public health recognition and participation, reform and improvement of national boards, residency guidelines and criteria development .In most areas of podiatric academia he truly was an active participant. His activity when he headed the podiatry section of VA saw an increase in training slots so sorely needed. His quiet and gentle perseverance brought about changes

Without fanfare, perhaps his personal efforts and sacrifices were only noticed by few of the many colleagues who benefited. He was a champion of quality and ethical practice, yet not judgmental of lesser caring professionals. He left a better world of podiatry than when he entered it. I will miss him and truly appreciate his many and varied efforts on behalf of our profession.

Joe Addante, DPM, Rome, Italy

It saddens me to hear of the untimely death of Richard. He was one of the lucky guys to have the Highland General Hospital Internship. It helped shape him into a visionary and was very responsible for him going after the master in public health degree.

Richard followed me at Highland Hospital as an intern, I became a second year resident at the CCPM Podiatric Hospital and also included time at Highland. We became good friends and shared a lot of dreams and what if's and why not’s together. He had a contagious laugh that I can still hear writing this memorial. He touched a lot of lives in the podiatric world and we are all better for his stay on planet Earth. He was always on a search to make change and to make a difference. Sometimes he was misunderstood, but he was always respected.

Richard, I for one will miss you and for all your dreams and visions, some actually occurred and this profession benefited greatly from them. For our laughs together, committees ad naseum that we shared, I say a very humble job well done.

Tilden H. Sokoloff, DPM Ketchum ID

RE: Letters to CMS Regarding Competitive Bidding
From: R. Alex Dellinger, DPM

I sent my letter to CMS today regarding the bidding program for DME. Having dealt with them several times on several different issues, I believe it is VITAL to provide comments to them. If no one does, or they get very few, they can certainly argue "no one in your profession cared enough to comment." How ironic is it that we choose "PHYSICIAN" under the type of provider who's providing the comments!

R. Alex Dellinger, DPM, Little Rock, AR, raddpm@yahoo.com

RE: MD/DO Degree for Podiatrists
From: Multiple Respondents

I don't know whether a degree designation change will affect reimbursements for podiatrists or not. Regardless of its impact on that issue, I am in favor of change. Six weeks ago, at Region III, I queried Dr. Gastwirth about a physical therapy issue facing many podiatrists.

If we are, by law, in fact, considered physicians, then by law, shouldn't we be entitled to the same "privileges" other physicians have. THIS is what the APMA should be challenging, irrespective of a degree designation change. Since MD's and DO's will apparently, under the new CMS DME guidelines, be allowed to compete with other DME vendors to dispense medically needed DME products for their patients, I fail to see the distinction with DPM's. Likewise, if MD's, DO's and chiropractors are allowed to perform and be compensated for physical therapy service provision, how, as a physician designee, can podiatrists be excluded by 3rd party carriers? It doesn't make sense...and this inequity needs to be challenged on a national level.

Lastly, when was the last time you saw an orthopedic annual cap? While I understand that most recently, physical therapy has now undergone a transformation with respect to eligible annual capped amounts, until now, to my recollection, podiatry stood alone, being singled out, as the only profession subjected to these reimbursement constraints. These issues are all relevant to the same theme. To quote Dr. Weil, "APMA...ball now in your court." I am willing to help in any way I can.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

There remains yet another reason to consider the demise of the DPM degree, and that reason is pure economics. The majority of DPM's today are in private practice. For those seeking employment outside of the private sector, the DPM degree is quite limiting. MDs and DOs can find work almost anywhere as either permanent employees or as temporary locum tenens contractors. There are scarce opportunities for employed podiatrists outside of private practice and there is usually fierce competition for those positions.

Last year I was involved with the training of physician assistants in the Army. One of my PA students asked me about the length of podiatric training. When I explained to him that many podiatric surgical residencies are now 3 years in duration, his comment was, "why not just go to medical school?" Since we do put in the equivalent time and training in residency as some MDs and DOs, why continue to limit ourselves with our limited licensure and degree?

A DPM with a 3-year residency can join an orthopedic group to do foot and ankle surgery, but they cannot take call for general orthopedics. Why should a group hire a DPM if they can hire a foot and ankle orthopedist who can also take call for the group? We are all aware of the competition we face in the wound care and biomechanics business. I have been in this profession for nearly 30 years and am proud of the good work we do. We can continue contributing our unique skills to the foot-sore public while providing ourselves the flexibility and economic freedom our modern training should allow us to have.

Evan F. Meltzer, DPM, Browning, MT, Evan.Meltzer@ihs.gov

Just count the hours, money and Herculean efforts over a 50+ year history of trying to get parity of recognition for a degree that nobody except for podiatry understands and respects. All of those assets could have been spent on vital research and encouraging lower extremity health, butinstead was "wasted" on essential political-survival efforts.

There may be fewer obstacles combining the DPM/DO degree rather than the MD, and still accomplish many or all of the goals of inclusion. While I still strongly support the DPM/MD change, this option should also be considered.

What is "unknown is devalued." That is the legacy of the "DPM" degree.

Michael M. Rosenblatt, DPM, San Jose, CA,

ROSEY1@prodigy.net

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

PRACTICE FOR SALE - NEW JERSEY

Well established practice with modern equipment for sale. Two main offices and two satellite offices included. One podiatrist has been able to make very comfortable living, but also great for two docs looking to start up. Willing to transition over 1 year. This is a great opportunity! contact DOCCAPO@YAHOO.COM

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

PRACTICE FOR SALE - CENTRAL FLORIDA

Well established surgical podiatry practice for sale. Located in a state-of-the art out patient surgical center.Grossed $1,038,000 in 2005. Low down payment. Price negotiable. Contact Camille Todd/Transworld 321 217-3625 or camille@tworld.com

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

EQUIPMENT FOR SALE - ESWT - BEST OFFER CONSIDERED NOW!!!!

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

ASSOCIATE POSITION--NEW YORK CITY

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in Manhattan and Queens. Must be willing to perform all aspects of podiatry. Must presently have New York license. Position available immediately for the right candidate looking for a future partnership opportunity. Fax resume to 212-753-3521 scottlurie@eastsidepodiatric.com

PSR-24 RESIDENCY POSITION - SOUTHEASTERN MICHIGAN

The P0H Medical Center (POH), Pontiac, MI has an opening in its Podiatric Medicine Residency Program. POH is a major teaching affiliate of Michigan State University College of Osteopathic Medicine. This is an excellent opportunity for a highly focused individual, who just graduated or has already completed a PPMR/RPR and or a PSR-12 program. POH offers an excellent learning environment with three high volume surgical venues and two busy foot/ankle clinics, including a limb salvage and wound clinic; as well as a competitive salary and benefit package. For further information, please contact S.J. Goldstein, DPM, POH Medical Center (248) 338-5392 FAX – (248) 338-5567

ASSOCIATE POSITION - NAPLES- FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548 bed hospital system and multiple surgical centers. Candidate should want to perform rearfoot surgery including Charcot reconstruction. Candidate needs to be ethical and motivated and have a current Florida license. Established practitioner or new practitioner OK. Base, percentage, benefits including insurance and 401K. Fax CV to (239) 566-8778.

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-
491-9994.

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