The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 03, 2008 #3,288 Editor-Barry Block, DPM, JD

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FL Podiatrist Uses Sculptra to Treat Metatarsalgia

Metatarsalgia, which is not generally serious, causes pain and inflammation in the balls of the feet, especially when walking barefoot on a hard surface. Some people might experience numbness or tingling in the toes. Some people, especially those who like their high heels, have turned to Sculptra, which is biodegradable and FDA-approved for restoring facial fat loss in people with human immunodeficiency virus.

Dr. Cynthia Marzouka-Losito

Dr. Cynthia Marzouka-Losito, a podiatric surgeon at ProTech Sports Medicine in South Miami, administers Sculptra injections for about $1,000 per foot. It "replaces fat pads and adds pillows to the feet," she says. "It's safe for the face; it's safe for the feet." Results last from eight months to a year.

Sculptra does not have FDA approval for use in the feet. A spokesperson at the American Podiatric Medical Association, who did not want to be quoted, said the APMA has no stance on the issue. A common question Marzouka-Losito's patients ask is not about safety. They want to know: "Do I need a bigger shoe?" The answer is no.

Source: Desonta Holder, Miami Herald, [7/1/08]

Annual NYCPM Faculty Retreat Features State-of-the-Art Workshops

On a recent Friday, the faculty of the New York College of Podiatric Medicine gathered off-campus for the annual NYCPM Faculty Retreat. After a welcome by Michael J. Trepal, DPM, NYCPM’s Vice President for Academic Affairs and Dean, the entire four-hour morning session was given over to Susan Jacovino, Ph.D. and David Swanson, Ph.D., psychometricians from the National Board of Medical Examiners, who gave presentations and conducted workshops on current concepts in medical written examinations and on developing state-of-the-art assessment instruments.

Mark H. Swartz, MD, Professor of Clinical Medicine and Vice President, Medical and Professional Affairs at NYCPM (at podium), introduces David Swanson, Ph.D., and Susan Jacovino, Ph.D.

Andrew Shapiro, DPM, a member of the Board of Trustees of the New York State Podiatric Medical Association, spoke briefly about the importance of membership in the state and national associations. NYPCM President Louis L. Levine spoke next, welcoming everyone. He and Joel Sturm, VP Administration, then gave out faculty and administration service awards for those with service anniversaries ranging from five to thirty years.

Mark H. Swartz, MD, Professor of Clinical Medicine and Vice President, Medical and Professional Affairs at NYCPM, spoke about the assessment of clinical competencies. Following Dr. Swartz’s presentation, the day concluded with a presentation by a lecturer from New Horizons Computer Learning Centers, on the effective use of PowerPoint presentations.

RAC Program Begins Nationwide Audit of Doctors

Aggressive tactics, vague charges, interrupted patient care, drained staff resources, and administrative headaches. These are some of the problems doctors say they encountered during their experiences with Medicare's newest breed of auditor.

The Centers for Medicare & Medicaid Services this spring wrapped up a three-year pilot program in which "recovery audit contractors," or RACs, scoured physician and hospital claims in three states to find overpayments and to recoup those dollars for Medicare. Thrilled by the project's financial success, lawmakers ordered CMS to expand the program to all 50 states by 2010. The agency plans to choose four national contractors to administer the program this summer. A new round of audits could start right away. On average, Medicare spends about 20 cents to recover each dollar in overpayments.

The number of medical records requested from each practice will be limited, and the firms will be required to use standardized demand letters to avoid confusing doctors. Contractors will be unable to look back more than three years for overpayments, and at the outset, no earlier than October 2007. If a physician or hospital appeals and has the overpayment determination overturned at any level of the process, the RAC will be required to refund its contingency fee. Before conducting a medical necessity audit, the RACs will be required to receive CMS approval.

Source: David Glendinning, AMNews [7/7/08]

Dealing With Annoying People

Listen more, not less to people who annoy you. When you tire of listening to a known complainer, don't start to ignore that person. Instead, ask for more imformation, detail, clarification, or explanation. Often, you will come to understand that person's perspective and situation.

Source: Adapted from Management Malpractice: How to Cure Unhealthy Management Practices That Disable Your Organization by Craig Hickman.

Query: Large Post-op Shoe

I will be performing surgery on a male size 18 foot. Does anyone know if there is a post-op shoe large enough to accommodate this size foot? If not, what have others done for post-op care on a large sized foot?

Jeffrey Kass, DPM, Forest Hills, NY

RE: Alternate Device for Limb Compression (Frank DiPalma, DPM)
From: Jay Callarman, DPM, Michael Forman, DPM

Normatec produces a patented lower extremity pneumatic compression device that utilizes peristaltic compression therapy. I participated in a product demonstration and was thoroughly impressed with the results. It is not like other pneumatic compression devices and produces far better results.

Jay Callarman, DPM, Pasco, WA, doctoej@gmail.com

In our experience compression hose are optimal, however, we have had patients such as the one described who could not wear compression stockings. We use a sequential compression device that they can wear for several hours per day. It is much easier to put on than the stockings. I would describe my results with this modality as "fair."

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

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

The original article (Japma early 1980's) and a follow-up claimed that the average was about 30 seconds using three 10-second applications.

Marc Klein, DPM, Methuen, MA, MAILKlein@aol.com

I would recommend that anyone purchasing NaOH be careful that what they get is 10% solution and not 10 normal.

Michael Nachlas, DPM, Shawnee Mission, KS, heelsntoes@aol.com

Just a few words for reflection. I am already tired of listening to other colleagues write "I use ..." , "In my experience....", etc. In this particular case of nail surgery, I see that different doctors proposed different protocols. That's really not the wat it should be. I have no doubt that this is done with good intentions, but it does not help to increase scientific knowledge about the profession of podiatry. For that, I recommend that all of us do more research work in our field. I recommend surgical treatments for ingrowing toenails based on: C Rounding, S Bloomfield. Cochrane Database of Systematic Reviews 2008 Issue 2 (2008), The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Marta Losa Iglesias, Spain, marta_losa_iglesias@hotmail.com

RE: Senate Rejects Medicare Increase
From: Multiple Respondents

Call your Senators’ offices and register your opinion on the 10% Medicare cut. Let them know how you feel, and do it each and every day. Leave it on a Post-It note next to your computer screen so you see it every day. November is only 5 months away.

Robert M Cropper, DPM, Sarasota, FL, Ftdrbob@aol.com

The bottom line is that Medicare Advantage plan,which takes private funds to run, is at the root of this. If the 10.6% doesn't go through then MA will lose millions. It already is being overly criticized by the GAO and the National Health Policy Forum for costing more than Medicare, and providing more services at higher premiums. The GAO found in a recent study from Feb 2008 that the beneficiaries on these plans are not saving very much as was once predicted.

President Bush has loyalty to MA since it was his "baby" and hence Senate Republicans feel the same way. House Republicans do not! Let's see patient access versus MA's insurance product, American's Health Insurance Plans (AHIP) which is a huge lobby has backed MA and certainly has lobbied more Senate Republicans than Democrats. Hopefully, this will all be settled by 7-10-08 or I believe physicians will stop seeing Medicare patients, Hippocratic Oath or not!

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

Editor’s Note: An extended-length note from Dr. Kass can be read at: http://www.podiatrym.com/letters2.cfm?id=20527&start=1

ASSOCIATE POSITION - CALIFORNIA

Central Valley/Southern CA. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish. Offering a permanent position/partnership in a multi-million dollar hi-tech practice. E-mail CV to: Tonya@wetreatyourfeet.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 full-time podiatrist in a multi practice location
in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

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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