The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 15, 2009 #3,596 Publisher-Barry Block, DPM, JD

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After 15 Years,  Albright to Retire from Scholl

Dr. Terence Albright has announced his intention to retire as Dean the Dr. William M. Scholl College of Podiatric Medicine on June 30, 2010. In reference to Albright's contributions to his College and the University, K. Michael Welch, President and CEO of Rosalind Franklin School of Medicine said, "He undoubtedly saved Scholl with the administrative and visionary acumen he brought to the position of President before the merger with the University. Under the new structure, he returned his College to a pre-eminent position among colleges of podiatric medicine."

Dr. Terence Albright

Welsh went on to say, "For the first time, Albright introduced a research agenda for the College, embraced inter-professional education, transitioned to a four-year allopathic curriculum, and made sure that his College was an integral part of the growing success of Rosalind Franklin University. His College enrollment rebounded to a full complement, and its academic credentials returned to their previous high standard. During this time, he also took the College through the accreditation process required of the major change in its status and obtained full accreditation."

Children’s Feet Need to Be Measured Regularly: ID Podiatrist

If you're a parent, chances are you've pushed, pulled or shoved your child's feet into too-tight shoes. Maybe your child had an overnight growth spurt. Maybe you bought the wrong size in the first place. Or maybe you're just trying to eke a little more mileage out of a pair of shoes you bought at the beginning of the season.

Dr. Scott Graviet

"There are no two feet on a human body that are the exact same size. So both feet should be measured. And then the shoes should fit the larger foot," said Dr. Scott Graviet of the Podiatry Center of Idaho.

"I don't get too haired out with shoes. But shoe size can be an issue," Graviet added. "Parents just need to make sure they do measure them frequently."

Source: Brenda Gutierrez, Sun Sentinel, [6/30/09]

Part B Drug Proposal Would Curtail Medicare Pay Cuts After 2010

The typically bleak outlook that marks the proposed Medicare fee schedule for the upcoming year was significantly brighter this time around for physicians looking for relief from impending pay cuts.

In a major policy reversal from the previous administration, the Centers for Medicare & Medicaid Services has proposed removing physician-administered drugs from the calculation of the Medicare physician payment formula. Doctor pay is reduced across the board when spending on all physician services -- a category that includes Part B drugs -- exceeds annual targets. Removing the costs of the drugs would lessen the extent to which spending would exceed targets and trigger cuts.

The CMS proposal, announced July 1, would not reduce next year's planned 21.5% across-the-board cut. But it would reduce the number of years after 2010 that physicians face reductions under the payment formula, and it also would decrease the size of the cuts that remain. Over the next five years, projected doctor pay updates of between -6.3% and -5.4% would be replaced with updates of between -3.1% and 1.4%, said Jonathan Blum, director of the CMS Center for Medicare Management.

Source; Chris Silva, AMNews [7/13/09]

Part 8 - How should you present your arguments at the ALJ Hearing? By David Mullens, DPM, JD

Before the Hearing, write out, in outline form, all of the facts and all of the evidence you want to present in the order to be presented. Ask one of your employees to listen to your presentation - and speak slowly. The entire presentation should not take longer than five minutes.

1. If your employee does not understand something you are saying, the ALJ will not understand it either. 

2. Skip all the big words. Don’t say things like “hallux abducto valgus” when you can say “bunion.” Don’t use phrases like “midstance pronation” when you can say, “the patient walks flatfooted.”

3. Tell your story as you would tell it to a high school graduate of moderate intelligence who has no prior medical training.

The ALJ must understand what you are saying and what you are saying must make common sense to the ALJ. When you are finished telling the story about that patient, you must give the ALJ the legal basis (LCD reference) the judge can rely upon in his/her decision.

Query: Foot Surgery on Patient with a History of CRPS

I am very interested in knowing if anyone has had experience on doing foot surgery on a patient who has a history of CRPS. I have a new patient that has a soft tissue mass on one foot and a very painful neuroma on the other. The neuroma side has had the CRPS due to a fractured ankle. This occurred about 4 years ago. He struggled with this for over a year before recovering. I know that anything can trigger the CRPS and I am hesitant to do any aggressive treatment. Any suggestions?

Doug Mason, DPM, Freeport, IL

Query: PDR Website

Is anyone using an online PDR site? What are other favorite drug informational sites? It is difficult to find the "how supplied" information.
 
George F Jacobson, DPM, Hollywood, FL

RE: Fluid-Filled Mass (Calvin Britton, DPM)
From: Bryan C. Markinson, DPM

If Dr. Britton is considering surgical intervention, ultrasound examination is not adequate. Plain films and an MRI with contrast will allow as best as possible for the determination that the lesion is entirely cystic or not, and hemorrhagic or not. If, after these investigations, it is determined that the mass is entirely cystic, the surgery should proceed with excision of the lesion out of and INCLUDING surrounding tissue and fascia, so as to attempt to include in the excision tissue that is NOT the mass itself, but encasing the mass. Then, five samples of surrounding fascia, fat, or other tissue, labeled separately, and diagrammed for exact location in the wound, spaced evenly around the wound bed, are sent for frozen section. If all come back "clear," you can close the wound.

If any of those sections comes back from frozen with evidence of malignancy, clip the involved areas so that the eventual surgeon doing any further required excision will be able to locate the bed of surgery. Then close the wound.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Call to Action - Title 19
From: Jeffrey Frederick, DPM

There is an issue that will define our generation as podiatrists that needs your immediate attention. That is, passage of Title 19 to define podiatrists as physicians in the Medicaid law. The importance of this reaches far beyond just the Medicaid program. It reaches into the very future of what we are and will become as doctors. Without this, our progress and growth as a profession will truly stagnate.
 
My concern as a president of a state association is that we as a profession are not giving this issue the importance that it requires. There will be no greater cause in our generation to advance podiatry. This opportunity is not being taken seriously by many of our peers and members (just look at the % of doctors that have contributed to APMAPAC).
   
We are certain that Congress and the Obama administration will enact health care reform this summer. This is the perfect vehicle to include Title 19. This is a window of opportunity that needs our action. Given this importance, the Michigan State Podiatry Association is donating $10,000 to the APMA Government Education Fund immediately. I have also personally donated to APMAPAC. I respectfully challenge your state and you to do the same. I know we all struggle with our personal and state's budgetary issues, but the importance of passage of Title 19 far exceeds that need. 
 
In the end, we will be defined as the generation that got Title 19 passed or failed to do so. Please consider helping podiatry. As presidents of our state associations, we need to take the lead. Together we can truly make a difference.
 
Jeffrey Frederick, DPM, President, Michigan Podiatric Medical Association, jeffreyfrederick@sbcglobal.net

RE: Sign of the Times (Peter Bregman, DPM)
From: Elliot Udell, DPM

We tend to view what is happening out there to medicine through very narrow lenses. It’s not just about what is happening to podiatry. In my area, three highly successful internists just gave up their office to join another already crowded office. Overhead expenses and a lowering of their income forced that decision on them. Patients tell me the new waiting room feels like a crowded bus stop. A seemingly very busy endocrinologist in my area went out of business and a seasoned ophthalmologist closed her office and is now renting space part time from another doctor.

My own physician told me that in order for him to make a living, he flipped his practice into a "boutique practice" and in order for me to keep seeing him for my annual physical exam  and any other health-related matters, I have to pay an annual fee of 1,500 dollars plus the cost of any visits. He assured me that without that added income, it did not pay for him to stay in practice. Another well-liked family practitioner in a more rural area let her patients know this week that within a year, she will be forced to close. The "sign of the times" is that the practice of medicine in this country is spiraling downhill very fast and unless there are quick and serious reforms out of Washington, our system of healthcare may start resembling what is available to people in the worst of the third world. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: OIG's Targeting Podiatrists (David Mullens, DPM, Michael Rosenblatt, DPM)
From: Bryan C. Markinson, DPM

I appreciate Dr. Rosenblatt's comments. I also appreciate Dr. Mullen's efforts at enlightening us to valuable information, even indispensable information. However, running your practice on the guessed current posture of the OIG ("friendly or not") is still too paranoid for me...

Editor’s note: Dr. Markinson’s extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=27427&start=1

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Full-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

PRACTICE FOR SALE – WESTCHESTER COUNTY, NY

Established 30+ year old practice. Well respected podiatrist in beautiful Westchester County Owner ill and needs a quick sale. Mixture of surgery and general podiatry. Hospitals in close proximity. Will lease office to buyer. Call Mali McGrinder at 914-434-1663.

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 150,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail
totalfootcareva@hotmail.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

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

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.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 a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to .comf-massuda@footexperts

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