The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 02, 2009 #3,586 Publisher-Barry Block, DPM, JD

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MD Podiatrist/Author Provides Tips for People with Diabetes

One of the greatest fears for people with diabetes is that they are going to lose a foot or leg. Dr. Neil Scheffler is an author and podiatrist. His book is titled 101 Foot Care Tips for People With Diabetes.

Dr. Neil Scheffler

“There are two main foot problems for people with diabetes,” says Scheffler.  One is that the feet become numb. This is referred to as diabetic neuropathy. The second concern is circulation. People with diabetes have poor circulation as compared to those in the general population.”

101 Foot Care Tips For People With Diabetes

In his book, Scheffler stresses  preventive steps. “One of the things diabetics should do is to examine their feet every day. They should look for changes such as cuts, scrapes, or bruises. If they see something wrong, they should go to their podiatrist for evaluation”, says Scheffler.

Source: Good Morning Baltimore (ABC-TV) [6/30/09]

Dr. & Mrs. Stephen Wittenberg "Name" Student Services Lobby at OCPM

After being honored for 40 years in the podiatric profession at the 92nd Annual OCPM Commencement, Dr. & Mrs. Stephen Wittenberg were able to attend the Post Commencement Reception and take a tour of the new OCPM campus. After seeing the new campus, Dr. Wittenberg felt a strong passion and a feeling of immense pride for his alma mater and for the podiatric profession.

Dr. & Mrs. Stephen Wittenberg

Wanting to give back to OCPM, Dr. and Mrs. Stephen Wittenberg pledged $25,000 to OCPM to name the "Dr. Stephen & Sandra Wittenberg Student Services Lobby."

Source: OCPM Newsletter

NYSPMA Urges Legislators to Expand Scope of Practice

New York's current law includes one of the nation's most restrictive definitions of podiatry, according to the New York State Podiatric Medical Association (NYSPMA). New York podiatrists are urging elected officials to amend the current scope-of-practice law to include the treatment of conditions of the ankle and the soft-tissue structures that affect the function of the foot and ankle. NYSPMA says that most other states already allow podiatrists to do this.

Dr. Roy DeFrancis

As of now, New York podiatrists are allowed to work up to the bottom half of the ankle only, says Dr. Roy DeFrancis, immediate past president of the NYSPMA, who is a practicing podiatrist in Buffalo. "When patients come in with an ankle sprain or something, and we do X-rays, if it turns out there's a problem with the bottom half of the ankle, we can treat it," DeFrancis says.

If the problem involves the top half of the ankle, the podiatrist would need to refer the patient to another specialist, he says. New York is one of six states that doesn't currently permit podiatrists to treat conditions that arise from foot problems but are centered outside the foot, like in the upper ankle, according to the state podiatrists' group. DeFrancis believes an updated law will increase the number of podiatrists currently practicing in New York.

Source: Eric Reinhardt, Central New York Business Journal [6/22/09]

Query:  Forefoot Striker With LLD

My patient is a 40 y/o male runner with limb-length discrepancy. His right limb is 2 cm. shorter than the left. I fitted him with a 1 cm. heel lift in his right shoe. Two months later, he said he is doing much better in his walking and day-to-day activities, but still has pain when running. Upon further questioning, he stated he was a "forefoot striker" runner. I reasoned with him that likely a heel lift alone does not have any effect on LLD with forefoot striker runners. I recommended a full-length in-shoe lift in order to "lengthen" the limb at the forefoot level during contact phase. Question #1: Is my biomechanical thought process accurate in this situation? Question #2: If so, how much full length in-shoe lift would be ideal? Will 1 cm. still be effective or does he need 2 cm.?
 
Chris Seuferling, DPM, Portland, OR

Query: Discontinuing Services at an Assisted Care Facility
 
I would like to know what is the proper procedure for discontinuing my services at an assisted living facility. Other than notifying the administrator of the facility, do I need to send a letter to each patient notifying them of my discontinuation of care?

Stacy A. Resnick, DPM, Easton, PA

Editor’s comment: PM News does not provide legal advice.  In general, patients at an institution are considered the facility’s patients, and not those of the physicians on staff. Therefore, a simple letter of resignation to the facility should be sufficient notice. It’s a good idea to provide adequate advance notice so that the facility can fill your position.

Query:  MSP Coverage for Diabetic Shoes 

We have a diabetic patient with an insurance plan primary and Medicare secondary. The patient wants diabetic shoes, but his primary insurance company does not cover them. Will Medicare cover them even though his primary won't?

Jim Licandro, DPM, Bettendorf, IA

Response: My suggestion would be to contact your DME MAC's secondary payer office, and provide them with all the information on your specific patient, including the non-coverage issues by the primary. My experience with MSP is that if the primary carrier won't pay you because it is not covered to podiatrists (carve out), Medicare Secondary may handle this differently than if it is a non-covered service altogether.

Since you would be expending a great deal of money prior to even submitting a bill, I would want specific answers to specific questions prior to providing any equipment.

In the past, I have been paid for shoes and custom inserts on one patient who had Medicare secondary to a large primary group payer. But since the rules are so complex and their eligibility in this system are so complex, we called our DME MAC's secondary payer office and received the specific information we required on this patient prior to providing the products.

You may have to dig a bit to get the answers you need, but it may save you much grief!

Paul Kesselman, DPM, Woodside, NY 

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RE: Chronic Ulcer with Plantar Fibromatosis Lesion (Dang H. Do, DPM)
From: Jeffrey Kass, DPM

I would contemplate a few things: 1) Why is the ulcer present? The arch is usually non-weight-bearing unless there is a severe pes planus deformity. 2) There was no mention made of the vascular status of the patient - This should obviously be taken into account. 3) "Inflammatory atypia" - I am not sure what is meant by that. Is that suspect for a malignancy? Is this the reason for wanting to excise the lesion?
 
Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

RE: Peeling on Heels (Patrick J. Nunan, DPM)
From: Jeffrey Kass, DPM

Taking a biopsy is always a good idea.  If the patient was applying topical antifungal agents, a biopsy taken right away may yield a false negative result. Hence, one must stop applying the antifungal for a period of time. (I am sure the length of time is probably debatable) I think 3 weeks should be safe. 
 
Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

RE: Melanoma in Situ (Paul Hilbert, DPM)
From: Bryan C. Markinson, DPM

Dr. Hilbert's presented case demonstrates how good clinical acumen can save lives. Not at all meaning to be critical, I would like to add some protocol information that should be considered:

Firstly, it should always be attempted to have the sentinel node biopsy performed at the same time (same operative session) as the wide local excision of any invasive melanoma. This will provide the most reliable path of radioactive tracer to the sentinel node. If the procedure is done any time after the wide excision, it is only a best guess as to what spot on the skin represented where the lesion was; in fact, that spot no longer exists and theoretically, the path of the tracer can end up in the "wrong" sentinel node. The sentinel node procedure is based on the premise that every spot on the skin has a unique path to a specific regional node.

Second, the wide excision performed need not always be an elliptical one, raising the concern of a very long central axis when a 3cm margin of resection is needed. I have found the circular excisions with skin grafting to work very well. Even on the plantar heel, these have been very durable, and with minimal complications over the long-term.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Converting Billing Database (Steven Block, DPM)
From: Marc Garfield, DPM, Philip E. Larkins, DPM

This is frequently the problem with ASP-based software; you get the disk, but could potentially have to pay hundreds of dollars to access it and use it. What some offices do is get the disk and either print all records and scan them back in or print CUTE PDF files (skips the print to paper phase). But then the files have to be either carefully arranged and/or renamed to be usable. Try to convert the files to an Access or Excel file if an option for this exists on the disc. If you do not think that you will be using them regularly, the Fujitsu scan snap runs $350-$500. It scans about 30 double-sided pages per minute and creates a visual filing system to retrieve the scans, which can be easily renamed. 

Your new software company can usually convert your old data for about $2,500-$4,000, so it will be accessible from the new system, saving time and therefore money. However, many people have found the data conversions to be weak and still need the original files for some information after dropping a few grand. Most reputable PM/Billing software can do the data conversion. Before you switch, make sure you know what you are getting.  
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

The best solution is to import all of the Comp A data into a database management program that you know how to use and how to manipulate the fields. This will allow you to hold the data in a usable format forever, callable when you need what parts you need. OR, more simply, have an SAS programmer do this for you for a consultant fee. This person can extract all of the fields and show you how to access them at a later date. Rather simple really.

Philip E. Larkins, DPM, Escondido, CA, larko33139@yahoo.com

RE: Answering Service (Anas Khoury, DPM)
From: Charles F. Ross, DPM

I have utilized almost every means of after-hours communications. What has worked best, for me, is a simple message on my answering machine that indicates we are not in the office, but "if this is an emergency, please call my cell number, which is provided." 
 
I have rarely been disturbed by other than emergent-type calls, and they are rare. I believe most people do respect your privacy and time, and when faced with a "true emergency", will still apologize for calling. I provide all surgical patients with my home and cell number for emergency, and stress that I would rather they call and allow me the opportunity to decide if this is, in fact, urgent or not.  I understand that it may not work in all areas of the country.

Charles F. Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com

RE: DC Podiatrist Supports Public Healthcare Option (Paul Busman, DPM,RN)
From: (Douglas Pacaccio, DPM)

I think it is a shame that the talking points always seem to gravitate towards what we as physicians make in income. There are plenty of other reasons to be skeptical of a government run (insert desired industry here): retirement fund- social security is on the way to insolvency, healthcare- Medicare and Medicaid in my LCD will not pay for Integra graft placement on a foot wound, but never deny a below-knee amputation, citing "pt has not yet failed limb salvage attempts", securities oversight- does anyone feel good about the relationships ALL these politicians have with Wall Street. How about mortgage lending- Fannie Mae @ $0.58 per share, Freddie Mac @ $0.61 per share and the housing market is doing great thanks to the Community Reinvestment Act. If you think all we are giving up is a couple dollars, I think you should take a second look at what is really being proposed. Of course why should we? Congress doesn't even read the bills they pass. 

I don't think anyone in this forum wishes for people to NOT receive healthcare. Just because they don't agree with the US government administering care does not correlate with their personal ideology on healthcare. To simplify opposition to the public option as only having to do with money, at least in my circle of colleagues, is way off the mark. I would propose that most doctors are talented enough and smart enough to do reasonably well in business industries focused solely on margins and profits. I'm willing to bet most doctors would take less money if actually getting paid wasn't such a circus. There are better ways to make money and if that is the only reason anyone is practicing medicine, might I suggest a career change.

Douglas Pacaccio, DPM Yorkville, IL, pacman25@hotmail.com
 

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – SOUTHERN CALIFORNIA 
 
Flexible, Part-Time or Full-Time opportunity with growing podiatric medical group in busy offices in Southern California. CURRENT DME supplier number a plus. NO nursing homes. Most days are available with flexible hours available. If interested, e-mail scpods@yahoo.com

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

INTERESTED IN JOINING A DYNAMIC GROUP PRACTICE?

That treats all patients ethically · That offers an academic environment with an exceptional residency program· That will improve your clinical and surgical skills· That offers a strong case load to get you Board Certified fast· That provides a guarantee for growth and advancement. Does this sound unusual and refreshing? IT IS! Do NOT miss this incredible and exciting opportunity- apply now to: Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

PRACTICE FOR SALE - FLORIDA

Who wants to continue making good money in a down economy, and who would like to live in Florida on the coast? I have been working for over 45 years and have had enough. My business grosses over $940,000 dollars a year and my net is over $250,000. I see approximately 40 patients a day in a coastal Florida town and am sitting on a little gem. Office is 2000 sq. ft. Hospital very close with surgical center. Large scope of practice in Florida. Contact me if you are ready to step up. $585,000 dollars. Contact me at: hagen5644@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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