July 07, 2006 #2,624 Editor-Barry Block, DPM, JD

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Buying Stylish Shoes “OK To A Point” : MI Podiatrist

An American Podiatric Medical Association survey of 1,700 people found 35 percent buy shoes by style. That's OK, to a point, says podiatrist Dr. Patricia Guisinger, who being an occasional high-heel user, said it's unrealistic to expect women to ditch the fashionable footwear. "People can wear these styles for a short period of time, out to dinner or to church on Sunday," she said.

But too much style can cause trouble: In the summer months, she said, more patients visit her office with injuries. So what's a comfort-loving shoe-wearer to do?

"You want a fairly stiff sole, you want something that cups your heel so your weight is distributed evenly across the foot," Guisinger said. "You need a toe box that's wide enough to accommodate the foot, so a bunion or hammertoe might request a wider shoe."

Source: Elizabeth Slowik, Grand Rapids Press (MI) [7/4/06]

Injured Julien Still Treats Runners at Peachtree

The perennially cheerful Dr. Perry Julien helped treat patients in the medical tent Tuesday at the Peachtree Races while on crutches and wearing a brace. Julien, a local podiatrist and co-medical director, shattered his left leg in a skiing accident March 6. His recovery restricted his ability to work leading up to the race. "My biggest concern was there are runners not being taken care of," said Julien, a marathoner and mountain climber who had just returned to competitive alpine skiing when he had the accident.

Dr. Perry Julien

He got about 400 get-well cards. "They said, 'We're sorry about your injury, but what can we do about my plantar fasciitis?' " he said. His doctors say it will difficult for him to resume running, but Julien is hoping to be well enough to run Peachtree next year.

Source: Craig Custance, Karen Rosen, Andre Shannon, Atlanta Journal-Constitution (GA) [7/5/06]

Healthcare Costs Continues to Rise at a Fast Pace: Studies

According to a study released last week by Milliman, healthcare for a family of four in the U.S. will cost about $13,382 this year, a 9.6% increase from 2005. In addition, two studies released last week by Watson Wyatt Worldwide find that many U.S. companies plan to reduce health and pension benefits for current and future employees.

The Wall Street Journal on Wednesday examined how the studies indicate "that healthcare costs are still rising at a fast pace – despite slowing from double-digit growth in recent years -- and that businesses expect to curtail or limit retiree medical benefits." According to the Watson Wyatt studies, most companies that provide retiree health benefits "plan to continue," although "retirees should expect to pay more for their coverage," the Journal reports.

Paul Fronstin, director of health research for the Employee Benefit Research Institute, said, "Both of the studies are reverifying the fact that health care is becoming more expensive," adding, "We've seen this trend since the 1990s"

Source: Jilian Mincer, Wall Street Journal via American Health Line , [7/5/06]

Query: E-Clinical Works

Our office is having lots of difficulty in implementing the E-Clinical works EMR system in our podiatric practice. Any advice would be greatly appreciated.

Jim DiResta, DPM, MPH, Newburyport, MA, jsdiresta@comcast.net

Discharging a Difficult Patient (Deborah DeRose, DPM)
From: Elliot Udell, DPM, David E. Gurvis, DPM

We had a similar case many years ago. A patient came into our office and demanded that we do all sorts of appeals to help her collect from not only secondary insurance companies but third insurance companies and the money she was fighting for was less than eight dollars. Every time she came in and was treated there ensued constant hounding from her over the appeals for the 7 dollars and change. Yes, we had to write letters and make phone calls. We finally woke up and realized that it was costing us far more in staff time than it was worth. We never dreamed of discharging this patient from our service. She was a compliant patient and quite pleasant to work with. Her demands on our time were unreasonable. We simply leveled with the patient and told her that she is a valued patient, however we no longer will be able to chase after tertiary carriers on her behalf. Because of this, she opted to go elsewhere for podiatric care and we did not feel that we lost anything.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

First, let me say I am “honored” to see an old form I use for discharging a patient be recycled and published again. I was always taught that providing three other podiatrist’s names was required. Seeing that it isn’t, I plan on deleting that part of the letter myself.

Don’t ever let a patient bully you, or your office staff. If something is non-covered, then it is non-covered. If the patient insists or demand, I can bill it and allow the insurance company to issue their denial. IF that company is Medicare, there is an appropriate modifier –GY. Otherwise, I will not file appeals, or make phone calls on items I know to be non-covered and waste my time doing something I am not required by law to do. Period: End of discussion. If the patient still insists, I have been known to simply tell him/her that “that is the way it is” and if you really want to see it changed, become politically active, and make it happen. It just isn’t my problem. I find, over time, these patient’s “fire themselves”, i.e., quit my practice.

I don’t actually say it in a mean fashion, and I am sort of careful whom I say it to, and I know, should they file come complaint against me, my chart notes are well done, and I am covered. I often will have a side – non-medical- note in my chart indicating the financial discussions I have had with the patient. Life is short, don’t let the grouches make it shorter for you.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Richard Baerg, DPM, MPH

I have been in Podiatry since 1975 and my path crossed Dr. Baerg many times. He was a true visionary an the most dedicated man to serve our profession. He was one of the first podiatrists to get us recognition in the public health arena besides Dr. Levy and Dr. Helfand. He also served at the VA at a level of excellence, a college president, and the Executive Director of ABPOPPM. He was an educator and acted as a pioneer breaking down barriers for podiatry everywhere he went.

He edited many of my papers and projects, especially a booklet that Scott Yates and I wrote for children. He was the first one to bring "The BIG FOOT" to the classrooms of America. He was a real Renaissance man I every aspect of his life. We will still need his energy to keep the fight going. He will be missed terribly!

Francine G. Schiraldi-Deck, DPM, MS, MD(hon), Williamsport, PA

ASSOCIATE POSITION – TEXAS

Full time associate position for a PSR-24 podiatrist to join established dynamic medical and surgical practice in Central Texas. Looking for a personable, motivated, ethical, hardworking individual to join our board certified group. Please send resumes or CV to Centrexfootdoc1@aol.com

ASSOCIATE POSITION- LAUREL, MARYLAND (SUBURBS WASHINGTON DC)

Great opportunity for a hard working, ethical podiatrist to join a vibrant, successful podiatric medical and surgical practice. ASC on site . Practice has dedicated, supportive staff with marketing knowledge. Board eligible/certified referred . Surgical residency. Competitive salary with bonus. Fax CV to 240 465 0332

PRACTICE FOR SALE--BUFFALO, NY

Part time practice with full time possibilities. Mix of conservative, biomechanics and diabetic foot care. Good surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. erfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact
ccipinc@ccipinc.net

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE - WALLA WALLA, WASHINGTON

32 year old established podiatry practice for sale immediately. 2 treatment rooms, 1 surgical suite, x-ray room, sterilization equipment, and private office area. Located at busy intersection, only 2 blocks from major hospital. $50,000 or Best Offer. Please call 509-525-2863 or email darcycharlesDPM@charter.net , if you are interested.

EQUIPMENT FOR SALE - ESWT - BEST OFFER CONSIDERED NOW!!!!

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-491-9994.

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