The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 03, 2010 #3,900 Publisher-Barry Block, DPM, JD

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CO Podiatrist Discusses Stress Fractures in Runners

Stress fractures of the foot are becoming more common in runners, especially first-time marathoners, according to the American College of Foot and Ankle Surgeons. If a break is suspected, Denver foot and ankle surgeon John McGarry, DPM, FACFAS, advises runners to immediately follow the RICE protocol —Rest, Ice, Compression and Elevation. If pain and swelling last longer than a few days, a visit to a foot and ankle surgeon for an x-ray and diagnosis is in order. In most cases, treatment includes rest and immobilization with casting of the foot. Surgery may be required in certain instances to repair and stabilize a stress fracture that has progressed into a full fracture.

Dr. John McGarry

Runners can take action to prevent repetitive stress injuries in their feet by wearing supportive athletic shoes and slowly building up their activity levels according to their abilities. “If a runner suffers from abnormal mechanics in the foot, such as overpronation or hypermobility, custom orthotics can also be helpful to prevent these injuries,” Dr. McGarry adds.

Source: Health News Digest [6/20/10]

WesternU College of Podiatric Medicine Joins AACPM

The Board of Directors of the American Association of Colleges of Podiatric Medicine (AACPM) is pleased to announce the admittance of the Western University of Health Sciences College of Podiatric Medicine (CPM) into membership in the Association on July 1, 2010. The College welcomed its inaugural class of 38 students in August 2009.

Dr. Lawrence Harkless

CPM Dean Lawrence Harkless, DPM, said he is looking forward to interacting with other deans and sharing his knowledge with others. “This will really allow me to see what the vision is for AACPM and where WesternU fits into that process,” he said. “This is an opportunity to learn and grow, and share my 30 years of experience in an academic health science center, and my excitement and passion for health sciences education.”

IL Podiatry Clinic Giving Out Free Pedometers

Cortese Foot & Ankle Clinic in Normal, IL is participating in a statewide campaign to fight obesity by giving away a free pedometer to any resident who contacts the office.

Cortese Foot & Ankle Clinic

The “Keep Illinois Walking,” program is sponsored by the Illinois Podiatric Medical Association and encourages residents to take up a walking program as a way to exercise more and lose weight. Information on how to start an effective walking program also will be distributed.

Source: Pantagraph.com [6/29/10]

Query: Initial Visit Denial

I performed a matrixectomy on the same day as the patient's initial visit. UnitedHealthcare is refusing to pay the office visit with the procedure. I thought the first visit was always paid, without a modifier, even if a procedure is done. Are there any documents I can send to them? They have denied the appeal. What else can I do?

Donald Carlson, DPM, Hermiston, OR

Response: UnitedHealthcare does not pay for E/M services and procedures on initial visits. They have sent out notices that come in the type of bulk mailings that we generally throw out.

Even with 2 ICD-9 codes and a "-25" modifier, they are not paying for working up and evaluating the patient prior to deciding on and performing a procedure.  If there is a trick to appealing this, let me know. I am seeing the same issue with some Cigna, Aetna, and Medicaid plans.

Marc Garfield, DPM, Williamsburg, VA

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Query: Discharging a Neo-Nazi

I have cared for a young diabetic patient who has been my patient for about a year. Recently she had non-healing diabetic ulcer and I took her to surgery. Just before surgery, as the weather warmed, she wore more revealing outfits and I noticed swastikas tattooed on her upper arms. During surgery, needless to say, there were multiple tattoos of the same symbol noted.

During the post-operative time, her boyfriend accompanied her to the office and he also has the same symbols tattooed on himself, along with the SS symbol. As it turns out, during this last post-operative visit, she also brought her new born son with her...his name is Aryan. This is morally offensive as I am Jewish. 

When this post-operative period is over, can I legally discharge her from my practice for all this? If so, how? Over 30 years in practice, I have discharged many patients for many reasons from just being obnoxious to the staff, to non-compliance. This is the first time I want to discharge a patient for being morally offensive. Can this be done?  To be honest, outside of her obvious beliefs, she has been a reasonably good patient.

Name Withheld

Editor's Comment: PM News does not provide legal advice. Diagreeing with one's political beliefs, no matter how offensive, is not grounds to dismiss a patient. Since your name is not obviously Jewish sounding, it might be best to merely inform the patient that you are Jewish. If she is a true neo-nazi, it is unlikely that you will ever see her again,

RE: Undiagnosed Nail Disorder (Kevin Lam, DPM)
From: Multiple Respondents

I would still run an HLA B-27 for psoriasis. Also, don't forget that she is 8 y/o. Has she been playing with super glue or had any other chemical exposure, internal or external?

Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net

I like the mnemonic "VINDICATE" for a diagnosis: vascular, infectious, neoplasm, drugs, inflammation, congenital, autoimmune, trauma, environment (toxins). What is the birth history/delivery method? What is the patient's family history? What medications is she on? Footgear issues? Do you suspect any toxins, or new fabric softener her mother is using? Have you checked the patient's mouth for ulcers? Have you taken plain films? Have you tried a punch biopsy of the nail bed?

Have you ordered blood work, including a rheumatic panel, ESR, and CRP. If I were to guess, high on my differential would be one of the HLA - B57's, or SLE. Lower on the list is viral/atopic dermatitis/repetitive trauma secondary to poor-fitting shoes/environmental toxins.

Jefferson J. Mennuti, DPM, Orange City, FL

The photo of the fingernails gives the appearance of shiny trachyonychia,where the nail plate is associated with small punctate depressions. Not all nails may be affected, although a common name is "twenty nail disease." It is associated with psoriasis, lichen planus, eczema, ichthyosis vulgaris, atopic dermatitis, and a host of other problems. Idiopathic trachyononychia of childhood is benign and will spontaneously return to normal. It does not produce nail scarring and there is no treatment other than tincture of time.

Randolph C. Fish, DPM, Tacoma, WA, rcfish1@juno.com

RE: Adducted Lesser Digits (Tip Sullivan, DPM)
From: Robert Bijak, DPM

Along with biomechanical considerations, look at the cysts in the 1st and (I think) the 2nd metatarsal heads (the wax pencil markings prevent a good radiological observation, and are not consistent with good technique). In an obese woman with metatarsal cysts and adduction, we should consider an R.A. type condition. I'd consider to R/O a serologic arthritis as a cause of the adduction and run appropriate hematological studies. Arthritic inflammatory conditions can also cause this type of deformity and biomechanics is pretty much irrelevant if this is a systemic metabolic disease.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: The Passing of Steven Z. Buzermanis, DPM
 
Steven Z. Buzermanis, DPM, 42 years old, of Briarwood, NY died suddenly at his home of an apparent heart attack on June 29th. Dr. “Buz”, as he was affectionately known, graduated from the New York College of Podiatric Medicine in 1997. He went on to complete his residency training at St. Joseph’s Hospital in Flushing, NY before becoming an Associate at Advanced Foot Care in Rego Park and Plainview, NY. He also worked as a staff podiatrist at Preferred Health Partners in Brooklyn.
 
Dr. Buzermanis served on the staff and trained future podiatrists at Forest Hills Hospital, a member of the North Shore – Long Island Jewish Health System. Many of his past residents remember him as a caring and nurturing teacher who always went the extra mile for his patients. He was an avid outdoorsman who loved sports and working out at the gym. He was a devoted father of 3 boys. He married Tracy less than three weeks ago, and celebrated their honeymoon in the Dominican Republic.
 
On a personal note, I am glad to have had the opportunity to have known and work with him for over 10 years. He was always friendly and had a smile on his face. He had a great sense of humor and always had our staff laughing. He was an integral part of our family and practice. He will be sorely missed by his colleagues, staff, and patients.
 
Funeral Arrangements:  Chapey & Sons Funeral Home, 1225 Montauk Highway, West Islip, NY, 631-661-5644. Viewing: Monday July 5th 2 PM -4:30 PM and 7 PM -9:30 PM. Funeral: Tuesday July 6th at 12:30 PM Chapey & Sons Funeral Home

Hal Abrahamson, DPM, Plainview, NY

RE: Arrested Podiatrists
From: Bob Kornfeld, DPM, Meyer Arbit, DPM

It really bothers and concerns me that so many of my colleagues are indicted and accused of misdoing. Is our profession ripe with robbers and evil doers? What is going on? It is disgusting to see that our profession has so many practitioners who don't know how to be honest and upright. Did they not take the podiatric oath? If they wanted to be robbers and thieves, why didn’t they just become bank robbers? That's where the money is. I don't want to be thought of as someone on a high horse, but enough is enough of that type of behavior.

Meyer Arbit, DPM, Boynton Beach, FL, ARBITDPM@aol.com

Every time I see a podiatrist being arrested for some illegal activity, I shudder from the bad publicity. It is tragic. This is a sad commentary on the behavior of certain individuals, but I think it may also be a sign of a much bigger problem. Are DPM's becoming this desperate to earn more money? Maybe it is time for a poll. If we see how many of you are having a hard time financially, we have more concrete evidence to move forward in a different direction. 

It may be important for our APMA officers and delegates to see the full scope of an ever worsening problem. It can certainly be anonymous so please do not worry about the stigma. I would think Dr. Block can collect anonymous statistics for us to see. So, I ask Dr. Block to respond to this post and ask him for his input on whether or not we can do this. I hope so because I think it is really important to know how many of us are really struggling to make a living and pay our bills.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

Editor’s response: PM conducts a practice management survey which we publish each February.  The statistics show that although the median net income was $113,200 (above that of the average attorney), 13% of podiatrists net under $50,000 and 28% net under $75,000.  Considering the high cost of podiatry school, it’s extremely problematic to have over a quarter of the profession earning “blue collar” wages.   
 
Nevertheless, lack of practice management skills does not justify ethical and legal violations. A podiatry license is worth at least five million dollars. PM News runs legal stories to remind podiatrists of the risks and consequences of exercising poor judgment.

RE: Elastic Shoe Laces (Chuck Ross, DPM)
From: Multiple Respondents

Dr. Ross can find these (as well as other aids to daily living) at the following Sammons Preston URL: (pattersonmedical.com/app.aspx?cmd=get_product&id=75832)

Mitch Silverman, DPM, Dorchester, MA, mg.silverman@cox.net

When my mother became disabled, we started receiving catalogs from every purveyor of aids and accessories, mobility devices, and assisted living facilities that you could imagine. Among them were several that offered elastic shoe laces that allow wearers to put on and remove shoes without untying the laces.

One of these is Life Solutions Plus, a company that also has a handy website at (lifesolutionsplus.com) I imagine that they would offer a discount for a quantity order. Right now they are running a special anyway. Instead of the usual $4.45 price per pair, they are currently selling for $3.50. These are a godsend for people who have suffered a stroke, or just have trouble reaching or dealing with laces.

Kathy Satterfield, DPM, Boerne, TX, vksatterfielddpm@aol.com

We do not stock it, but we have in our system elastic shoe laces 24"(unstretched) in white and brown, 2/pkg.
 
Avi Kornbluth, Henry Schein Foot & Ankle, avi.kornbluth@henryschein.com

RE: Dragon Medical 11
From: Larry Kosova, DPM

There has been some interest in Dragon speech recognition lately. I am posting a site that Nuance has for suggestions on the upcoming Medical Version 11,  which will be released most likely in Dec. 2010, or Jan. 2011. You should see Standard, Professional, and Preferred versions a month or two prior to that. 
 
This is a site to add suggestions on how you would like to see this version become better. The more involvement, the better the chance that you will see a change to something you want.
 
Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

RE: Retail Custom Orthotics
From: Jason Kraus, DPM, Robert Scott Steinberg, DPM

I have to question Mr. Kraus's sincerity after reading his statement that said, in part, "We do, however, fill prescriptions from practitioners of many disciplines, all of whom are trained and permitted to provide them for their customers." He says 90% of his business is from podiatrists, but I guess the other 10% are from the many other disciplines.

I am trained, very well trained. Non-podiatrists are not, as a whole, very well trained, but Mr. Kraus's little "gotcha" is..."permitted to provide them for their customers." Mr. Kraus, why did you use the word "customer" instead of "patient"?
 
It is not my intention to pick on Mr. Kraus. Other labs also fill orders from non-podiatrists. We are the science behind the treatment with functional orthotics. We put this on the map, and made the top labs the top labs. Did we really expect any loyalty in return? Well, yes, I know I sure did.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@FootSportsDoc.com

It's not a matter of loyalty. It's a matter of law. I have been advised by attorneys many times over many years that I cannot refuse to fill prescriptions because I am pro-podiatry or anti- whatever. This is restraint of trade. I called them "customers" because that is what they are...and sometimes they are patients too. Coincidentally, the patient/customer mentioned in Dr. Liswood’s  post was originally referred to the pedorthist by another podiatrist. Go figure!

While our industry cannot fully control who it sells its products to, it can fully control whom it chooses to educate and market its products to. In this regard, Langer allocates all of its budget against the podiatry market. The 10% of Langer’s non-podiatry business is comprised mostly of raw materials and not custom-made appliances.
 
Keeping its standards high and using the substantial training that Dr. Steinberg spoke of will ultimately be podiatry’s best protection and provide it with competitive advantages. 

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

RE: Loss of Medicaid for Podiatric Care (Gregory B. Nellis, DPM, Elliot Udell, DPM)
From: Narmo L. Ortiz, Jr., DPM

I read an article today in the Hispanic Business magazine's June 2010 issue: "In Down Economy, Molina Healthcare Rises to New Heights." This article describes how Molina Healthcare, Inc.  rose to the top of the Hispanic Business 500 Directory, posting revenues in 2009 of $3.7 billion. What do they do? They provide managed healthcare to low-income people covered under Medicaid and others dependent on government assistance. Molina Healthcare employs about 2,800 people.

Consider this: if all things were equal, each one of Molina's employees would be worth about $1.3 million. The article describes how about a third of all unemployed Americans are eligible for Medicaid and how Molina Healthcare saw a 14 to 15 percent growth in their number of patients last year. They expanded to 15 states in 2009, of which I am sure Arizona would be included, since the company is based in Long Beach, CA.

Last, but not least, the article stated, "Molina is poised to benefit from the sweeping new healthcare law, named the Affordable Health Care for America Act. This is largely because the new law in 2014 will significantly expand Medicaid, boosting the total number of beneficiaries to about 75 million from the current 60 million." So there you have it, Medicaid is wonderful for corporate America, but not for patients and the physicians who have to treat them.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.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 - 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

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

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

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

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

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