July 13, 2006 #2,629 Editor-Barry Block, DPM, JD

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NY Podiatrist Offers Training Tips

Whether you walk a few leisurely miles a week or are training for a marathon, the feet bear the brunt of these activities. "Whatever kind of exercise you do, from lifting weights to tennis, feet provide support and absorb most of the impact, so they can easily become abused," says Oliver Zong, D.P.M., New York City podiatrist and cosmetic foot surgeon. "Many of my active patients end up coming to me with a foot problem that could have been prevented early on."

To keep your feet fit so you can keep on your fitness track, Dr. Zong offers the following tips:

-- Start Slow - Many people take up a fitness routine to help lose weight and get in shape, however, the heavier you are, the more pressure there is on your feet - a result of pure gravitational force. "To get started, try low impact exercise where foot impact is less of a factor, such as swimming or biking," says Dr. Zong.

-- Proper Gear - Make sure you get comfortable shoes/sneakers that are appropriate for the activity you'll be doing. "Before you jog ten miles with a new pair of running shoes, break them in a bit," explains Dr. Zong. However, if sneakers aren't comfortable at the time you purchase them, chances are they won't become comfortable, so don't bother buying them.

-- Stretch the Tootsies - "Keeping the muscles, ligaments and tendons of the feet stretched and warm is an important way to avoid foot injury," says Dr. Zong. Stretch feet, ankles and toes before and after workouts.

Source: Business Wire [7/11/06]

Wernick Retires After 38 Years at NYCPM

Volpe Chairs Newly-Reconfigured Department Of Orthopedics/Pediatrics - Logan Named Deputy Chair for Orthopedics

Drs. Volpe (L) and Wernick (R)

Justin Wernick, D.P.M., Professor and Chair of the Department of Orthopedic Sciences at the New York College of Podiatric Medicine (NYCPM), has retired after teaching at the College for thirty-eight years, beginning in 1968, and also serving as the Chair of the Department of Orthopedic Sciences from 1998 through June, 2006. The NYCPM departments of Orthopedic Sciences and Pediatrics have been combined following Dr. Wernick’s retirement, and Russell G. Volpe, D.P.M., has been appointed chairman of the newly-reconfigured Department of Orthopedics/Pediatrics. Loretta M. Logan, D.P.M., has been named Deputy Chair for Orthopedics.

Dr. Wernick has dedicated his life to the ongoing education of other medical practitioners in the field of gait. He is a Diplomate in the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, a Fellow in the American College of Foot and Ankle Orthopedics, and a Certified Pedorthist. In addition to his many years on the faculty of the New York College of Podiatric Medicine, he is Director of the Eneslow Pedorthic Institute and Chief Medical Director at Langer, Inc., in Deer Park, NY.

Russell G. Volpe, D.P.M., is an orthopedic and pediatric foot and ankle specialist. He is a 1983 cum laude graduate of the NYCPM.and has been Board Certified by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine since August of 1988. In January, 1993, NYCPM formed an autonomous Department of Pediatrics, and Dr. Volpe was appointed Chairman. He currently holds the rank of Professor of Orthopedics and Pediatrics. Dr. Volpe is also Chair of the College’s Admissions Committee. .

Loretta M. Logan, D.P.M., M.P.H., is Associate Professor of Orthopedic Sciences and Deputy Chair for Orthopedics in the newly-reconfigured Department of Orthopedics/Pediatrics at NYCPM. Dr. Logan received a B.A. in Biology from Barnard College in 1984; earned her D.P.M. degree from the New York College of Podiatric Medicine in 1989; and received an M.P.H. degree from Hunter College School of Health Sciences in 1995. Dr. Logan joined the NYCPM faculty in 1991.

Medicare to Offer Consumer-Driven Plans in 2007

Medicare will begin offering beneficiaries the option of consumer-driven health plans for the first time in 2007, a move likely to accelerate the push for cost and quality data on providers. The CMS said Medicare Advantage enrollees will have access to medical savings accounts and to more flexible, health savings account-like plans through a demonstration program. The CMS has no projections for initial enrollment. Under the MSA option, Medicare will pay for a high-deductible insurance plan and put money into a tax-free MSA for participating beneficiaries. After the annual deductible, the insurance plan will pay for Medicare-covered services; amounts not used in the MSA will carry over year-to-year for use on future qualified medical expenses.

The HSA-type plans, while similar, will have more flexible benefit designs that could make them more attractive to Medicare beneficiaries and employers with existing HSA options for pre-Medicare employees and retirees, the CMS said. Medicare's contribution will be the same for both options, but HSA-type plans will offer coverage of preventive care, a separate limit on out-of-pocket costs and other features. Medicare Advantage insurers offering an HSA-type plan will be required to provide enrollees with healthcare cost and quality information and other tools, the CMS said.

Source: Laura B. Benko, Modern Healthcare [7/11/06]

Query: Research Observation

I have a request from a future podiatry student to observe current research. Are there any projects currently on going or in the offing this fall? He would be most interested in the greater Baltimore or Washington, DC areas.

Bruce Lebowitz, DPM Baltimore, MD, blebowit@jhmi.edu

Query: How Did the DO’s Achieve Parity?

I certainly appreciate the passion this forum has for a degree change and Dr. Block's passion in continuing to push the issue to the forefront of our profession. Certainly the introduction of HR 5688 in the US Congress really brings this issue to light. I read in a previous posting that at one time the MD community considered DOs a "quackery" profession, or at the least did not acknowledge their expertise. What did the DO community do to be accepted by the MD community? They did not change their degree to MD, but now they seem to be accepted as physicians or "real doctors." What changed? Is there a way for us to do the same without changing degrees?

Mike Tritto, DPM, Rockville, MD tritto@erols.com

Editor’s comment: You can read about some historical information at http://www.aacom.org/OM/history.html and http://history.osteopathic.org/reccalif.shtml

Much of the success of AOA is attributable to strong leadership which was not afraid to confront the AMA in both the legislative and legal arenas. Unfortunately, our DPM degree is limited in anatomical scope, which despite our advanced education and residency training, prevents us from achieving the same type of parity that osteopaths obtained.

Changing our degree will not be a panacea to the many problems all physicians face in this healthcare environment. It will, however, mean recognition as a specialty within the allopathic/osteopathic communities, thus ending the wasteful expenditure of APMA recourses in the never-ending battle to achieve parity.

Query: Non-Diabetics - CPT 11055 Series Billing

For my Medicare carrier, the CPT 11055 (paring or cutting of benign hyperkeratotic lesion) series codes require a "Q" modifier and ICD-9 700 (corn, callus) or a similar diagnosis, and ICD-9 250.60 (or similar systemic condition) as a secondary diagnosis for successful billing of qualified routine foot care services.

According to our local coverage determination (LCD) policy
pertaining to routine foot care, Medicare also accepts arteriosclerosis obliterans and/or Buerger disease as examples of alternate supporting systemic condition diagnoses. Would we also have to use the class findings "Q" modifiers for non-diabetic cases?

Vadim Glukh, DPM, Richmond Hts, OH

Response: The "Q" codes apply to vascular-related ICD-9 codes which qualify a patient for routine foot care coverage under your carrier's local coverage determination or national coverage determination policies.

"Q" codes do not specifically apply to patients with diabetes.

By the way, when I reviewed your carrier's (Palmetto Ohio) website, I found no current active routine foot care policy. I did find a retired policy. Is there one I can't find?

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
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RE: Orthoses Research “Study” (Eric Teeman, DPM)
From: Craig Payne

I can only assume that Eric Teeman, DPM has not read the study that he chose to make such ill-informed comments about it. Where did he get the information about the small sample size? The study was not underpowered, so why does he consider the sample size small? What has being published in any particular journal have to do with the quality of the study, especially one as prestigious as the Archives of Internal Medicine?

Why does he consider the conclusions ridiculous? - they are exactly what the data supported (however, what was reported in the Reuters press release was not quite accurate compared to the publication, however, Dr. Teeman would know that if he bothered to read the publication before commenting.) Dr. Teeman is also showing a lack of understanding of and the purpose of randomized controlled trials - the research question was asking about the effectiveness of foot orthoses, so what does the "use of concurrent anti-inflammatory measures (ice, NSAID's), stretching, activity modification" have to do with it? Dr. Teeman also comments that "Failure to use and/or control such variables clearly precludes an accurate finding." - a randomized controlled trial controls perfectly for those factors, so its silly to say that.

Of all the studies on foot orthoses and plantar fasciitis, this study probably has the soundest methodology. For those wanting more on this study, there is discussion here, including several responses from the author: Effectiveness of Foot Orthoses to Treat plantar fasciitis. http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2330

Craig Payne, Department of Podiatry, LaTrobe University
Australia, C.Payne@latrobe.edu.au

RE: Off-Loading Healed 5th MPJ Ulcerations (Itamar Rosenbaum, C.Ped.)
From: Dennis Shavelson, DPM

Mr. Rosenbaum suggests a rocker sole, a spring steel toe bar, a high-top shoe and an internal metatarsal bar to prevent fifth metatarsal head ulcer recurrence. Although this solution will prevent ulcer recurrence, so would complete bed rest. How productive and active will this patient be for the rest of his life once restricted to this type of footgear?

This cosmetically stigmatizing, function depriving and biomechanically inept care should be a last resort and used as salvage when conservatively treating this type of lesion. If I am wrong, why isn't the general public wearing rocker bottom, high top (in summer?) metal reinforced shoes to live their everyday lives?

In thirty years involving aggressive and heroic care of ulcers, infections and gangrene, I have never used a rocker bottom shoe, I have written for less than a dozen molded shoes and I have been around three BK amputations.

If there is a fly on the wall, you can use a flyswatter or a cannon. I hope that every DPM with three years of functional lower extremity biomechanics as a foundation would utilize a combination of biomechanical control and weight distribution techniques housed in a conventional shoe as a first line of care instead of shooting patients in the foot.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab
drsha@footworldusa.com

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 816-455-8901HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO/NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

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

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.

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 centexfootdoc1@aol.com

EQUIPMENT FOR SALE – SONOCUR ESWT

I have a Siemens Sonocur shockwave FDA-approved machine for sale $70,000. Call 416-545-1166 or email: dracula65@hotmail.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.

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