The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 30, 2010 #3,897 Publisher-Barry Block, DPM, JD

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1) Alaska Practice Management Cruise Sold Out - We thank all those who have registered and are looking forward to a wonderful adventure. 

2) Correction - Derek Pantiel is not the APMSA president, as reported in yesterday's PM News. Zackary Gangwer from AZPOD is the current APMSA president. Derek Pantiel is an APMSA delegate from OCPM.

NY Podiatrist Discusses Plantar Warts

Plantar warts are hard growths that appear on the soles of the feet. According to New York City podiatrist Dr. Oliver Zong of NYC Footcare, they are caused by the human papilloma virus (HPV). HPV thrives in warm, moist environments, which is why it is easily spread at public swimming pools, communal showers, gyms, and locker rooms.

Dr. Oliver Zong

The virus can also enter the skin after having direct contact with someone who is already infected. Unlike other types of warts, plantar warts can be very uncomfortable and are often painful. Because people develop immunity against these viruses as they get older, plantar warts are more common in children than in adults.

Source: Aly Walansky, My Gloss [6/26/10]

VCARE Donates Hi-Tech VST Device to OCPM

VCARE Health Systems, Inc, recently donated a VST MyoDynamic treatment device to the Ohio College of Podiatric Medicine (OCPM).  The device will be used at the Cleveland Foot and Ankle Institute (the podiatric teaching clinic for OCPM), where a study is also expected – pending IRB approval -  to be started later this year. To date, tens of thousands of treatments have been done across many disciplines of healthcare, treating soft tissue injuries and post-surgical conditions. But the biggest point of interest has been physicians utilizing the VST to treat peripheral neuropathy patients – most especially in podiatry.   

Dr. Bryan Caldwell

“OCPM is very fortunate to have the partnership with VCARE and the VST device. The results we are gaining from the device are second to none, and it is proving to be an excellent teaching component for our students” states Dr. Bryan Caldwell, OCPM’s Dean of Clinical Education & Clinic Operations. 

NY Podiatrist Recommends Routine Stretching Before and After Workouts

New York City foot surgeon and podiatrist Dr. Krista Archer recommends stretching to help relieve and heal foot troubles. “Routine stretching is very important to healing plantar fasciitis and tendonitis,” she says. “Most of those affected by plantar fasciitis have decreased flexibility and tight Achilles tendons.

Dr. Krista Archer

I advise patients to perform all stretches twice a day. Hold each stretch for 15 to 30 seconds, then relax and repeat 10 times. Do three sets. If exercising, stretch before and after workouts as well.”
 
Source: Marisa Walker, American Cheerleader Magazine [6/28/10]

Keep Your Web Writing Simple

If you want visitors to your Web site to stick around, the copy on your home page should be at a sixth grade comprehension level. This isn't a reflection of your audience's intelligence. It's a response to studies which have shown that people tend to more quickly absorb information on Web sites if the copy is written at lower comprehension levels.

Even if your site features articles about scientific research or other complex topics for an audience that you know can read at much higher levels, keep your home page simple. For example, offer the highlights of a research paper in an easy-to-read article on your home page, and include a link to the actual paper.

Source: Chris Nodder, Nielsen Norman Group

Query: Cross-Over 2nd Toe

This is a 65 y/o relatively healthy female, 5"8" about 200 lb. She began to develop adduction of the lesser digits at the MTPJ several months after an initial repair in 2008. Her cross-over 2nd toe bothers her now. 

Metatarsus Adductus with Overlapping 2nd Digit

Does anyone have any pearls about how to recognize this complication and what to do about it before the lesser met deformity is obvious clinically? I am planning to revise the lesser MTPJs in a couple of weeks and am thinking about a plantar plate and capsular balance at the MTPJ with 4 weeks of axial pin fixation. I will definitely follow-up with orthoses. Any comments are welcome.
 
Tip Sullivan, DPM, Jackson, MS

Query: CPT 11740 Denial

How do I successfully bill CPT 11740 (evacuation of subungual hematoma) and CPT 11721 on the same claim? I billed CPT 11740-TA (ICD-9 924.3 - contusion of lower limb and of other and unspecified sites; toenail); and CPT 11721 59 (ICD-9 110.1 - onychomycosis - and ICD-9 729.5 pain).

The payer is Medicare (Michigan). They denied the first code stating, "procedure code is inconsistent with the modifier used or a required modifier is missing. Not covered when performed during the same session/date as a previously processed service." They paid CPT 11721. I've also billed the same codes on another claim using modifier "-LT" for CPT 11740, same diagnoses, and got the same result.

Karen, Biller, Office of Isidore Steiner, DPM, Howell, MI

Response: The key to your code pair question lies with the NCCI. When you look up these 2 codes, CPT 11740 is a column 2 to CPT 11721 which is the column 1 code. This means CPT 11740 gets the "-59" modifier, not CPT 11721. Note: some edits just require an anatomic modifier. This should solve your problem.

David J Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found at:
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RE: The Future of Podiatry (Michael Forman, DPM)
From: Leonard A. Levy, DPM, MPH

Dr. Michael Foreman listed several items in his remarks entitled The Future of Podiatry. Certainly, we should continue to improve our relationship with our MD/DO colleagues, something that I think we have improved dramatically over the decades but even now needs to evolve. However, I do not agree that there are too many podiatric medical students or that there is no shortage of DPMs. The facts speak for themselves :

• The number of people with chronic disease is growing rapidly and will do so into the foreseeable future. Almost all of these conditions have significant and often serious manifestations in the pedal extremity.
• The population of people age 65 years and older is exploding and also will continue to do so for decades to come. These people are at major risk for podiatric medical problems.
• There are still many states and regions of the nation that have few podiatric physicians.
• The major concentrations of podiatric physicians are located in states with podiatric medical schools.
• A large percent of the population do not know what a DPM is or, if they do, what they are educated and trained to do.
• In the next 5-10 years, there will be large numbers of podiatric physicians who will be retiring.
• In spite of tough economic times, the data shows that podiatric medicine still is one of the most lucrative professions.

The need for podiatric physicians will continue to escalate. The demand for podiatric medical services, however, will be significantly affected by the way the evolving healthcare delivery and financing system will change. As someone with absolutely no vested interest but with a long history in podiatric and medical education, if I were able to start my career again, there is absolutely no doubt that I would choose to become a podiatric physician.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: The Future of Podiatry (Michael Forman, DPM)
From: Kathy Satterfield, DPM

I agree with the majority of what Dr. Forman says in his letter - the wisdom of smaller classes at schools affiliated with medical schools (such as we have now with Western University College of Podiatric Medicine in Pomona, CA, and in Des Moines, IA, and as he reports, at the College of Podiatric Medicine & Surgery). These students have to keep up with the osteopathic and allopathic students to make the grade.
 
Where we part company, though, is with his statement, "Dr. Jex reiterates what we all know - that there is no shortage of podiatrists in the United States." Many of my colleagues don't know this. In fact, we would argue this as false, and we come bearing facts to prove it. I believe, though, that I know what Dr. Forman is speaking about. He and his friends and colleagues practice in areas that are super-saturated with podiatrists, and it seems as though there are way too many podiatrists graduating right now. I understand that perception.
 
I would counter with this statement: "There is no shortage of podiatrists in the United States practicing in population-dense, practice-dense areas and that there are shortages in low-income and rural areas as well as other areas where new populations are being redistributed." I would like to ask Dr. Forman and others to consider that statement as a possibility. 
 
Kathy Satterfield, DPM, Boerne, TX, vksatterfielddpm@aol.com

RE: Langer and Orthotics (Paul Liswood, DPM)
From: Jason Kraus

The issue raised by Dr. Liswood in his response to my article speaks loudly to some of the points I was attempting to make in the first place. Today, the channels of distribution for foot orthotics are blurry and intertwined, where in the recent past, they were clearly defined. So, while I can’t speak specifically about the patient or shoe store that Dr. Liswood mentioned, I can speak generally about Langer's policies. To clarify, Langer does not knowingly produce custom-made foot orthotics for retail shoe stores. We do, however, fill prescriptions from practitioners of many disciplines, all of whom are trained and permitted to provide them for their customers. Some of these may own or be employed by a footwear entity. Recently, PM News published information about a very successful podiatrist who has a retail store as an extension of his practice. I am sure there are many more. The article attempted to chronicle how we arrived at this point, and perhaps inspire some to become more engaged in preventing further slippage.

Langer has been a resource of great significance for the profession of podiatry for over forty years. Although the number of specialties who prescribe foot orthotics has mushroomed, Langer’s business remains over 90% podiatric.

I am certain that some of the roads that podiatry travels seamlessly on today were paved in part by the effort and commitment of companies like Langer, Burns Lab, and Prolabs, just to name a few. I hope Dr. Liswood was not calling into question the corporate integrity of one of podiatry's iconic brands. I will let my personal contributions and achievements in the podiatric profession over the past 30 years speak for themselves. I have been an unwavering champion of podiatry and strong believer that podiatrists are uniquely qualified to provide comprehensive medical care to the foot-suffering public.

Jason Kraus, Langer Biomechanics, Inc., Jason.Kraus@langerbiomechanics.com

RE: Retail Custom Orthotics
From: Richard H. Mann, DPM

I would like to add my praise with respect to the recently published article "Retail Custom Orthotics: The Big One That Got Away from Podiatry?" authored by Jason Kraus. Mr. Kraus's article delivered an insightful analysis of the intimate relationship, both past and present, between podiatry and the custom orthotics industry. He attempts to lead us toward a brighter future by pointing out how podiatry, the profession which pioneered the field of pedal biomechanics and custom foot orthotics, has allowed its enthusiasm for this discipline to wane, much to the detriment of our patients and our pocketbooks. 

We should expect no less from Jason. He is a true giant in the field. He apprenticed during the infancy of the industry with brilliant Sheldon Langer, DPM, the beloved father of the industry. Jason has continued to improve the industry with his genius for innovation. He has been a tireless educator to our profession in the field of pedal biomechanics. Few people have his breadth of knowledge in the field. We should take our friend's words to heart and thank him for all he has done, and continues to do, for our profession.

Richard H. Mann, DPM, Boynton Beach, FL, rhm123@gmail.com

RE: Retail Custom Orthotics
From: George Jacobson, DPM

We and our associations should protest the use of Scholl's term "Custom Fit."  Their TV ads for custom fit, is not a custom fit. I recall reading about podiatrists in NY in the 1970’s  who were charged with fraud, based on the misuse of this term. The devices they dispensed were not custom. They were modified pre-fabs that they argued were customized. Customized was deemed not to be the same as custom.

This did not cut the mustard then, and Scholl should be excoriated for the use of the term "custom" fit. I have spent time explaining the difference, year after year, only to be undercut by an effective multimillion dollar advertising campaign. They are  misleading and overcharging the public. Remember the public still thinks that Dr. Scholl is an expert foot doctor. It is quite a marketing campaign with well-placed advertisements that I view as targeting your patients and potential patients. When these products  don't work, we still may see those patients, but they are $50.00 lighter in their wallet and more guarded about being burned. I use a lot of strappings, which not only treat the patient, but also demonstrate how they may feel in a custom device.
 
George Jacobson, DPM, Hollywood, FL, FL1SUN@MSN.COM

RE: Medicare Fee Reversal (Peter Smith, DPM)
From: Marc Bendeth, DPM
 
How is it that medicine has become the "whipping boy" of Congress and the Senate? I haven't seen any Senators or Congresspersons suggest that they take a cut in their pay or a cut in all the freebees they enjoy (didn't they not too long ago vote themselves a pay raise of more than 2.2 %?) .

I haven't seen any of them state that they will forego the overly generous health plans that they have, in favor of the healthcare plans that small business persons have (if they can afford one). I haven't seen anyone tell these venerable representatives of the American people that their pay checks will be postponed for a few weeks.

I too was happy to see that the "pay cut" for providers was postponed and a meager 2.2 % "pay raise" was passed, but my landlord, utility company, suppliers, etc. also informed me that if my remittance is late, I will be slapped with late charges, and that the services that they provide to me will be costing more than the 2.2%  "Pay Raise."  When will we wake up?
 
Marc Bendeth, DPM, Hewlett, NY, mlbendeth@optonline.net

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

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

ASSOCIATE POSITION – COLORADO

Excellent opportunity to grow and expand a practice in the northern front range, Great compensation package with buy in potential. Desire individuals with motivation to succeed and grow professionally, Please fax CV and letter of interest to; 970-351-0940.

PRACTICE FOR SALE – NORTH DAKOTA

Established practice grossing over $460,000. One doctor, 24 to 30 hours per week. Minimal surgery at present. Hospital privileges available. No nursing homes. No Medicaid. 22% Medicare; balance primarily BS/BC, private payers. Turn-key. Surgical patient base if buyer wishes to cultivate to readily augment income. EMR in Place. NDFOOTDOC@HOTMAIL.COM

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 - BRITISH COLUMBIA

Beautiful Victoria British Columbia, on the ocean, fast growing area. Associate for multi-office full scope practice. Interviews at APMA meeting in Seattle July 15-18 Reply to dr.cole@shaw.ca or phone 250-516-7440.

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 - 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

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

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.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

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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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