The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 12, 2008 #3,296 Editor-Barry Block, DPM, JD

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IL Podiatrist Offers Advice on Calcaneal Apophysitis

Summertime sports and activities can be brutally painful for children who develop overuse foot injuries. A frequent site for such injuries is the back of the heel. This painful condition is called Sever's disease or calcaneal apophysitis. Sever's disease most frequently occurs in active boys and girls between the ages of 9 and 14.

Dr. Paul R. Kasdan

Because Sever's disease can be related to foot and Achilles tendon abnormalities, recurrences may occur until these problems are addressed," states podiatrist Dr. Paul R. Kasdan. To effectively treat and prevent Sever's disease, doctors frequently recommend using custom-made sports orthotics. These biomechanical devices help prevent recurring attacks of this debilitating disease.

Dr. Kasdan, suggests: Rest to limit the pull of the tendon on the heel. Comfortably apply ice to the back of the heel to reduce growth plate inflammation and pain. Wear a shoe with a higher heel to lessen the pull of the Achilles tendon. Wear an open-backed shoe.

CA Podiatrist Learns Firsthand That Politics Can be Dirty

CIGA critics aren't the only people questioning Insurance Commissioner Steve Poizner. Meet Ivar Roth. Around March, Roth, an accomplished Newport Beach podiatrist, requested a meeting with the insurance commissioner. Roth is concerned about the practices of insurance companies and said he wanted to discuss the matter with Poizner, "eyeball to eyeball." Roth said his schedule was wide open – whenever the commissioner had a free moment in Southern California, he'd be available. But the commissioner's staff wouldn't promise a meeting with Poizner himself.

Dr. Ivar Roth

Roth learned how he could get a meeting with Poizner. For a price. Roth was put in contact with Jon Fleischman, a prominent Republican operative in Orange County. Noting his "good personal and professional relationship with Steve Poizner," Fleischman promised Roth he could arrange a meeting with the commissioner. No problem. All Roth had to do is pay him $2,500.

"It made me feel like the system is dirty," Roth said several weeks ago. "There should be a way a citizen should be able to meet with a public official."

Source: Brian Joseph, The Orange County Register [7/3/08]

Medicare Bill Includes E-prescribing Bonus

Eligible physicians can expect some financial relief courtesy of the federal government simply by adding a jolt of modern technology to their practice. Under a measure approved by the Senate, doctors who are paid by Medicare would become eligible for bonus payments just for filing prescriptions electronically rather than writing them out by hand. The e-prescribing requirement, which also covers a reporting initiative, is part of a broader Medicare bill that first cleared the House in June.

The bill allows for a stepped-down system of bonus payments, running from 2009 through 2013. At the outset, doctors would be eligible for a 2% bump in reimbursement dollars for e-prescribing, which would gradually decrease over time as the technology becomes more common and less expensive. Conversely, physicians who don’t e-prescribe would start to see a reduction in pay starting in 2012. The Senate measure also requires the Government Accountability Office to study the effectiveness of e-prescribing, culminating in a comprehensive report by late 2012.

Source: Matthew DoBias, Modern Healthcare [7/10/08]

Writing an Effective Press Release - Part 1

Focus on the lead. The first paragraph in a press release should be able to stand alone as a news item.

The best leads include the 5 W's: who, what , when, where, and why.

Answer all those questions in the first paragraph and you have done your job admirably.

Source: 6 Proven Secrets to Writing a Trash-Proof Press Release by Bill Stoller.

Query: Freiberg’s Infarction

I have an 11 year old female gymnastic-oriented gal with a Freiberg's on her 2nd met head.

Freiberg's Infarction in 11 Year Old

I’m wondering if anyone has surgically altered this disorder in this young a patient with any success. Any other options would be welcome.

Peter J. Bregman, DPM, Tewksbury, MA

Query: Surgery Center Ownership

I have been presented with an opportunity to purchase shares in the corporation which will be taking over ownership in the surgery center where, as it happens, I perform outpatient surgery. The amount of ownership would be minor (<5%), and is dependent on how much stock I purchase.

Other than communicating my ownership in the surgery center to my patients (verbally), and offering them an alternative site if they wish to go elsewhere, do I have any other obligations to avoid Stark or other anti-trust anti-kickback violations?

Name Withheld by Moderator

Response: I believe the Stark laws have what they call a "one-third provision." This means that at least 1/3 of your surgery is done on an outpatient basis, and you would be required to perform at least one-third of your outpatient surgery at the surgery center. The thinking to this is that you would not be "selling" outpatient surgery from your practice to make your investment successful. Rather, the volume is already there, and you are just utilizing that particular surgery center.

Consult the surgery center or a healthcare attorney for the complete Stark rules. They should provide you with a more comprehensive explanation of this concept.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found here

RE: Custom-Made Supportive Flip-Flops (Barrett E Sachs, DPM)
From: Multiple Respondents

You can try Vasyli Medical 865-748-8562. They have created a product line of flip flops that have an orthotic built in the shoe itself. Two DPMs helped create this product. They are stylish, in my opinion.

Zenobia Bowen, DPM, Tampa, FL, ZeeBowen@hotmail.com

STJ labs makes custom flip-flops.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

These flip-flops are not custom but they are supportive. Check out yoursole.com

Steve Bennett, DPM, NYC, NY, drsteve5@verizon.net

RE: EHB as a Spacer for Keller Procedure (Greg Caringi, DPM)
From: Samuel Cox, DPM

I too, back in the mid 1990's, started using a spacer that would eventually resorb and allow for a natural biological spacer or at least that was the goal. I used Gelfoam, which comes in a small rectangular piece that I would fold in half and just put into the space created by the phalangeal base removal. It fit perfect and it eliminated the need for me e to purse-string the capsule or create a split thickness capsule or U shaped capsule. It has worked great for me.

The best thing is that I don't see the shortening I have seen long-term with the other capsular closures, anatomically the 1st ray looks good, and there is good motion and no pain, (good toe purchase). Patients have loved it. I generally will put either 1 or 2 K-wires (depending on the quality of bone, to prevent pistoning) in the hallux and through the 1st ray. I leave them in for generally 3 weeks. Then I have the patient do ROM exercises as directed 2-3 x day.

I have never seen a wound dehiscence from this procedure. I am able to close the capsule back without problems. The only real complication I have had is that in two of cases I got a full fusion of the 1st MPJ in sedentary patients. However, both fusions were in a perfect position and neither case caused any trouble.

Samuel Cox, DPM Goodyear, AZ scoxdpm@gmail.com

RE: APMA Wins Medicare Victory (Paul Kesselman, DPM)
From: Multiple Respondents

I will add my "here, here" to Dr. Kesselman's comments. Though I can often find fault with the APMA, and how they may spend my money at times, they do come through for us in a pinch. This is exactly why we should all belong. To those who don't....well, you still get to ride the coat-tails of us who pay our dues, and perhaps you will reconsider your stance.

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

While I too applaud APMA's efforts, I can't help but fast forward to December 2009 when this all happens again. The flawed Medicare formula needs to be corrected, not patched up every 12 to 18 months in the last week of Congressional sessions with everything else tied into the Bill or Act. We need to demand more from them to ensure the future. All medical organizations need to continue to work together to address this now so we do not face this again and again.

Michael A. DeVito, DPM, Oak Lawn, IL, devitodr2@sbcglobal.net

Kudos and Congratulations go out to the leadership and members of the APMA for spearheading the passage of this very important piece of legislation. Accomplishments like this indicate how important it is that we have and maintain a vibrant and enthusiastic presence in Washington DC and in our own state capitals. The key factor for all to remember is that , far in excess of what we is covered by the dues structure of the APMA, and huge amount of activity is volunteered by the same members who are paying those dues. It is only through the mixture of these important activities that we continue to progress as an influential member of the healthcare political process.

As always, there will be those who think that this type of accomplishment happens in some sort of vacuum, and who will continue to not support or belong to the APMA and its local chapters. But if you fail to see the effect of not incurring a 10%+ cut in your fees from the Federal health program, and its domino effect on private insurers, then you are a poor business person, and the old adage "penny wise and pound foolish" ,applies immensely.

I hope all podiatrists in the country will take this opportunity to make sure they have a current and valid membership in the APMA, and for those who do, congratulations.

Tim Shea, DPM, Concord, CA, tsheapodiatry@yahoo.com

EQUIPMENT FOR SALE

Recently closed practice looking for quick sale on equipment: one Midmark 117, 2 Midmark 417, stools and an x-ray processor. Please email SeanRosenblum@optonline.net with any questions.

ASSOCIATE POSITION - NORTHWEST CHICAGO AREA

Immediate opening for full-time podiatrist in busy practice, potential for partnership. This practice has been established for over seventy-five years, with current owner for over twenty-five years, and treats a wide range of pathology ranging from conservative through surgical care. Hospital and surgical center privileges are available. Applicant must have 3 year residency, ABPS qualified, hardworking, and enthusiastic. Anyone interested and qualified for this phenomenal opportunity should send resume to gkjaco@aol.com and mark subject "podiatry position."

EQUIPMENT FOR SALE – MIDMARK CHAIR

Midmark 417 Chair, pea green. Bought approximately 8 months ago as an extra chair, barely used, perfect condition. Retail price (new) is $5,500. Offered for $3,500. Please email institutebeaute@aol.com with queries, or call 212-535-0229.

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

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

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