The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

July 02, 2008 #3,287 Editor-Barry Block, DPM, JD

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NY, NJ Podiatrists Say Kids' Crocs Rock for Summer

Crocs are everywhere, from malls to parks to schools across America. With funky color choices like Camouflage, Haze, and Glam, Crocs are probably your child's favorite footwear. But the Crocs shoe craze has hit a bump in the road, as parents -- and schools -- wonder if the loose-fitting style of these cool kicks can actually pose a danger. WebMD asks some experts their opinion on Kid’s Crocs.

Dr. Donna M. Alfieri,

"Crocs shoes do provide protection, compared to going barefoot, or wearing flip-flops or sandals," says Donna M. Alfieri, DPM, associate professor at the N.Y. College of Podiatric Medicine. "They offer some arch support and cushion, the holes in the shoe allow air in and keep the feet from sweating, and the antimicrobial properties of Crocs could help prevent infections in kids' feet." Kids' crocs come in so many different styles and colors, kids everywhere are wearing the shoes that fit their feet and their personality.

Dr. Hal Ornstein

"In addition to the support and protection kids get from Crocs, the great thing is they want to wear them," says Hal Ornstein, DPM, chairman of the American Academy of Podiatric Practice Management. Ornstein, who sells a special therapeutic line of adult Crocs, called Crocs Rx, through his private practice, says that his own children wear Crocs and love them. "My kids wear Crocs all summer long," says Ornstein. "Instead of having to tell them to tie the laces on their sneakers and worrying about them tripping over untied shoes, Crocs are convenient and they like them -- they're cool."

Source: Heather Hatfield, WebMD

UK Podiatrist is Integral Part of Scottish Football Team

It’s a profession more closely associated with the care of elderly patients, attending to ingrown toe nails, corns and bunions. But podiatrist Bill Kerr is an integral part of Hibs' medical team, helping ensure Mixu Paatelainen's players are in the best possible shape for the rigors of SPL football. Astonishingly, despite the obvious importance of players' feet, the Easter Road club is one of the few in the country to employ the services of a podiatrist, Kerr, a lecturer at Queen Margaret University, working on a consultancy basis with Paatelainen's squad.

Podiatrist Bill Kerr

His work, however, isn't simply confined to dealing with problems which may arise but preventing them occurring in the first place, a task which sees each new arrival at Easter Road undergo a full assessment which includes taking a plaster cast of both feet. Kerr explained: "Foot health is essential for footballers but not every club has a podiatrist. Players are running, jumping, twisting and turning and the joints of the lower limb are more vulnerable to damage if there are already structural problems present.

"Often players are totally unaware they have a structural problem but, once diagnosed, it can be corrected to minimize the strain on the joints of the lower limb." Foot problems, Kerr revealed, can lead to other difficulties for players in their knees, hamstrings, hips and backs. He said: "Knee injuries are a particular problem for footballers which may result in them missing training and matches and possible even shortening their careers.

Source: David Hardie, Sport Scotsman [6/30/08]

CMS Delays 10% Cut but Proposes 5% Cut for 2009

Medicare payments to physicians and other healthcare professionals would fall more than 5% under the program’s proposed fee schedule for 2009. The CMS projects it will pay $54 billion to 980,000 physicians and other healthcare professionals in calendar year 2009, down from an estimated $57 billion this year.

A separate 10.6% cut was scheduled to go into effect July 1, but the agency said it would take administrative measures to delay that cut for another two weeks.

The proposed rule would add 56 new measures to the Physician Quality Reporting Initiative, for a total of 175 in 2009. Physicians who participate in the PQRI get a small bonus for reporting on these quality measures. Provided that certain conditions are met, the proposed rule would offer an exception to the prohibition on physician self-referral that would permit remuneration provided by a hospital to physicians on its medical staff under programs that use economic incentives to promote high-quality care, such as value-based purchasing.

Source: Jennifer Lubell, Modern Healthcare [6/30/08]

Tips for New Employee Orientation

Don’t wait for a new hire’s first day to think about orientation. Help him/her make a strong entrance and quickly start to contribute by focusing on three key ingredients:

Create a detailed overview. Go beyond describing the benefits package and making a few introductions. Explain the nuances of what it takes to get things done in your practice.

Remind him/her that it’s all about the patients. Any new position can be overwhelming. Well-meaning new hires may get caught up in the technical details and forget about the real objective: to provide a service to patients.

Take advantage of a new perspective. New hires aren’t limited by your staff’s attitude and habits, so they may challenge procedures and policies. This fresh perspective usually lasts for the first 90 days, so make a point of listening and benefiting from what they see.

Source: Adapted from “Orient Your New Hire for Success” by Don Andersson

Query: Defibrillator in the Office

Does anyone have an AED (automatic external defibrillator) in their office? If so, have you ever used it?

Bob Levoy, Roslyn, NY

Query: Repair of STJ Cyst and Os Trigonum

My patient has a subtalar joint (STJ) cyst located on the posterior facet. In addition, she has os trigonum syndrome due to a severe ankle injury. What codes would I use for repair of the STJ cyst, and removal of the os trigonum?

Scott Morris, DPM, Oklahoma City, OK

Response: I would recommend the following:

CPT 28100 - excision or curettage bone cyst, or benign tumor, talus or calcaneus

CPT 28120 - partial excision bone, talus or calcaneus

Howard Zlotoff DPM, Camp Hill, PA

RE: Protocol for NAOH (Elliot Udell, DPM)
From: Multiple Respondents

After avulsing the nail, I use a tourniquet for hemostasis. The original technique described doing it "wet" and using hemostasis from chemical cautery as indicator for length of application time. I use 2-5 second applications. I curette between applications. I may do it a little longer for bigger nails or total matrixectomies. The matrix tissue will turn a light grey color as the NaOH coagulates the protein. I neutralize by flushing the area several times with dilute acetic acid (white vinegar). Basic chemistry: strong base is neutralized with weak acid.

Dress with antibiotic cream of choice, Telfa, gauze, Kling, and Coban. Remove dressing the next morning. BID saline soaks followed by application of either Cipro HC otic or Cortisporin otic (cheaper) and gauze dressing. There is almost no pain. There is a light serosanguinous drainage for about a week.

This procedure is very reliable. I have never seen a phenol-type reaction. I will not do the procedure if there is an infection. Infection creates an acid medium that neutralizes the NaOH and makes it less effective.

Greg Caringi, DPM, Lansdale, PA, DrGregC@msn.com

For each side of a nail, I used to use two 10% NAOH swabs for about 5 seconds each. More than just the time, I used appearance of the tissue as a guide. The normally pink or red matrix and bed tissue would turn sort of translucent and tannish. At that point, I would flush the area with copious amounts of 5% acetic acid, which is common household white vinegar. I applied this with a syringe (no needle) and also used cotton swabs to scrub the tissues. Triple antibiotic ointment and a light gauze dressing finished up the job. I brought the patient back in a couple of days for a redress and at that time I started them on daily dressing changes, also with triple antibiotic and gauze. I let them shower after that first dressing change, leaving the dressing on during the shower and changing it afterwards.

The major advantage, I believe, is that the NAOH/acetic acid reaction is an acid/base neutralization whereas with phenol/alcohol is just a dilution. These procedures always healed very quickly with minimal pain and drainage -- the patient would progress to a simple Band-Aid dressing within a week and they were usually totally healed in about two weeks. Your results may vary.

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

My protocol is similar to those previously described. Generally, you need less exposure time with NaOH than Phenol. The largest advantage is when the area is already infected. If you do opt to perform a partial matricectomy in the presence of a mild paronychia, the local pH of the tissue becomes acidic, thereby potentially neutralizing phenol's efficacy which theoretically can induce greater recurrence rates. I generally try 1 NaOH matricectomy after a failed P&A in the rare event the patient's body chemistry and phenol are not compatible.

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

RE: SADMERC Changes Name and Contractor
From: Paul Kesselman, DPM

Editor's note: Dr. Kesselman's note can be read at:

http://www.podiatrym.com/letters2.cfm?id=20505&start=1

RE: Senate Rejects Medicare Increase
From: Neal Frankel, DPM, Neil H Hecht, DPM

Please keep in mind that the 10% rate drop just doesn't affect your Medicare reimbursement, but all of your private pay and HMO contracts as well. All contracts unless capitated are usually tied to a percentage of Medicare reimbursement. What can you do about it? Well the first thing you need to do is to get the particular rates and terms on ALL of your contracts. If your contract terms is for multiple years, then you are probably safe as compared to a contract that evergreens, i.e., renews automatically on a yearly basis unless the doctor re-negotiates.

It is important to know what base year your contract is tied to. This means that although you have a 125% of RVRBS it may be tied to 2003 rates. A 10% drop in 2009 rate may not affect you if your contract is not based on current Medicare year. In our group, we negotiate multiple years at a time so we may not be affected in our private contracts this year but hopefully will renegotiate a percentage increase when the contract expires to offset the Medicare drop. Again, this is a benefit of forming a unified group.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com

39 Republicans voted against the Medicare Bill. If each of PM News readers' 11,000 podiatrists pledged $50 to each of their 39 opponents (a pledge of $1,950 per doctor), this would represent a total of $21,450,000 campaign funding to defeat those Republican Senators and equals over $500,000 to each Democratic Senate candidate running to unseat those sitting Republican Senators.

This pledge would likely not come close to the amount we will lose from both Medicare and private carrier sources. Can we afford not to do this? (It’s $37.50 per week for a year for each of us! What do you spend at Starbucks?)

This doesn’t include any of the approximately 700,000 MD/DO physicians, and thousands of durable medical suppliers, hospital corporations, home health nursing companies, durable medical suppliers, registered and vocational nurses, medical assistants, x-ray technicians, laboratories, lab technicians, chiropractors, physical therapists, medical billing companies, and all the other employees of these entities, etc. It is legal to contribute to political campaigns outside of your home state!

Do you think that the current Republican Senators might get the message? Feel free to forward this to all of your physician and other medically-related provider associates and to your local Republican Senator.

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

ASSOCIATE WANTED IMMEDIATELY – NEW YORK

Part-time or Full-time for group practice Fast track to partnership. Located in Orange & Sullivan County, NY. Commute from adjoining counties to see how it fits. Monroe, NY office is only 1 hour from Manhattan. All phases of podiatric care. Call Dr Marc Hudes 845-807-8864. Check out our practice website

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 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

PRACTICE FOR SALE MN: PRIME LAKES AREA

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability

ASSOCIATE POSITION - BALTIMORE, MARYLAND

Seeking surgically trained individual competent in all phases of podiatric care. Outstanding salary and benefits. F/Tor P/T contact email rsher18@yahoo.com

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