The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 15, 2010 #3,910 Publisher-Barry Block, DPM, JD

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The Next PM News will be sent on Thursday, July 15th from the APMA National Scientific Meeting in Seattle, WA.

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Good Foot Hygiene Can Prevent Toenail Infections: CA Podiatrist

Toenail care isn't always as simple as getting a pedicure, said Dr. Roger Johnson, a Visalia podiatrist with Sequoia Foot Care Group. Improper toenail trimming can lead to ingrown toenails, or even infections, he said. His recommendation is for nails to be trimmed straight across and not too short. Too short would be to trim the nails past the nail margin, which is a ridge of skin under the nail. Cutting nails too far back could make it easier for bacteria or fungus to be introduced to the nail.

Dr. Roger Johnson

"Good hygiene is important in preventing infections," he said. "Washing feet daily, drying carefully between the toes and sometimes, if it's needed, using a powder to prevent moisture." Thick toenails, discoloration, and toenails separating from the nail bed are all signs of fungal infections, and a visit with a doctor is necessary to get it treated. Treatment can be a topical cream, or for more persistent infections, oral medication, Johnson said.

Source: Hillary S. Meeks, Visalia Times-Delta [7/12/10]

TX Podiatrist Discusses Whether You Should Exercise Through Pain

Should you exercise through pain? The key is to learn how to measure the pain, says Dr. Allan Sherman, a Dallas podiatrist. Consider when the pain started, the grade and persistence of the pain, and whether it comes with other symptoms such as swelling or bruising.

Dr. Allan Sherman

"Usually soreness that comes from starting a new exercise program or follows a change in exercise will come a day or two after without swelling or bruising, and it won't last long," Sherman says. "If you notice persistent pain that lasts all day long or gets worse with activity, then you really want to seek medical attention."

Source: Lori Price, Dallas Morning News [7/12/10]

"Marriage Ref" To Knock Out Podiatrists at APMA Meeting in Seattle 

They say that laughter is the best medicine—and in Seattle this July, the American Podiatric Medical Association (APMA) will gather over 1,000 of the nation’s podiatrists—foot and ankle physicians, surgeons, and specialists—to take part in educational programs, discussing the newest medical technologies in the field, and have a few laughs along the way.

Comedian Tom Papa

APMA’s 98th Annual Scientific Meeting, being held this year at Seattle’s Washington State Convention & Trade Center from July 15-18, will feature an entertaining opening session address by comedian Tom Papa, host of NBC’s hit show “The Marriage Ref.” Papa has also appeared on Comedy Central, and is sure to complement the scientific program that features educational workshops and presentations on pediatric foot problems, wound care, surgery, and more.

Source: Yahoo News [7/12/10]

CMS Proposes Adding 20 Measures to PQRI

The CMS outlined several potential changes to its Physician Quality Reporting Initiative program, some of which could make reporting easier, and expand participation among physicians. The changes were included in a proposed rule issued in late June that detailed changes to the Medicare physician fee schedule. Of the 198 measures proposed for the 2011 PQRI, 20 are new. They include several measures related to care transitions, risk-adjusted functional status, and proper care of patients with asthma.

Additionally, the CMS proposed further expanding mechanisms for quality reporting by adding 12 measures that can now be submitted using electronic health records. Physicians would have the option to use claims-data reporting, quality registries or EHRs in at least some reporting capacity, according to the CMS' proposed rule. The rule would also lower the sample requirements for claims-based reporting to 50% from 80% of applicable cases. The healthcare reform law extended PQRI incentive payments through 2014 and put in place financial penalties for eligible professionals who do not begin reporting by 2015.

Source: Modern Physician [7/12/10]

To Merge or Not to Merge? That is the Question.

Many physicians say, “I tried to merge before with some other docs, and it just didn’t work out.” In order for mergers to be successful, you have to really have a detailed plan and strategy of why you are merging, and an idea of what your end group will look like as a merged entity. Lack of knowledge and proper planning is what prevents most mergers from happening.

The due diligence process is the most important part of the process and you must have a small group of leaders who are charged with moving the process along. The statement, “ people don’t fail, systems fail!” is true. If you have the right system, your likelihood of success is much higher. An excellent and productive physician employed in a poor and unproductive-based model can have productivity tripled when joining a well-run group practice.  

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC

Keep it Positive

Negativity is contagious, and when you use negative terminology, you convey a message that you may not intend. Consider these examples:

•  “Please do not hesitate to contact me.” The word "not" connotes a subtle negative that can leave contacts with the wrong impression. Better: “Please contact me whenever you need assistance.”
•  “No problem.” The word "no" can focus listeners on the wrong thing. Better: “I was glad to do it.”
•  “That won’t be hard.” The word "won’t" negates the phrase’s can-do message. Better: “It will be easy.”

Source: Adapted from “Are You Positive You’re Not Negative?” Alan Fairweather, The Motivation Doctor via Communication Briefings

Query: Coumadin Patient and Phenol Alcohol Matrixectomy

I have an elderly patient who comes to me several times a year for treatment of ingrown toe nails. He is on high doses of Coumadin for cardiac issues. Today, he inquired about the possibility of my doing a phenol alcohol procedure on him or some other matrixectomy. He said that when he has had to have other non-elective surgeries, his cardiologist temporarily took him off the blood thinner.
 
Has anyone had a similar request from a patient on Coumadin therapy? Is it worth the risk of taking him off the blood thinner for an elective procedure when his condition is well managed three times a year via more conservative therapy? Has anyone done a matrixectomy on such a patient without taking him off the medication? 
 
Elliot Udell, DPM, Hicksville, NY

Query: Patient Who Brings in Wild Child

How do you handle a patient who comes in for a visit with 2-3-4 kids in tow. The youngest is age 3, and won’t sit still. The patient asks about her problem. I explain it, but the obviously distracted patient missed half of my explanation and now asks me to repeat it - very frustrating. I also get distracted because the child is opening drawers and heading toward office equipment . The parent has zero concern. I have run the gamut from explaining things three times to asking the patient to come back in for another visit without the kids. What are some suggestions for this no-win situation?

Alan Berman, DPM, Carmel, NY

RE: Digital Scanners for Orthotics (Dennis Shavelson, DPM)
From: Multiple Respondents

I am a bit confused by a sentence in Dr. Shavelson's posting. He stated, "the recent evidence reveals STJ neutral custom orthotics vs STJ neutral OTC orthotics to be equally effective:" How can an OTC device know beforehand the individual's STJ neutral position? The whole point of a custom orthotic is that one is able to capture a person's STJ neutral when taking a casting.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

A couple of posts have mentioned Dr. Larry Huppin’s lecture on digital foot scanners. He will be presenting an updated foot scanner lecture at ACFAOM’s annual clinical conference in August (acfaom.org/meeting10.html). In addition, he published a review of digital scanners that can be viewed at (lowerextremityreview.com/index.php/issues/technology-choosing-a-digital-foot-scanner)

Disclosure: I am the CEO of ProLab Orthotics.

Paul R. Scherer, DPM, San Francisco, CA, hpoc@aol.com

The digital scanner that I use, made by Langer, allows me to hold the STJ in neutral when I scan the patient. I can also position the forefoot as I wish. Only the podiatrists in my office are allowed to scan or cast a patient. I would not teach any non-podiatrist to hold and position the foot during the scan. I think it is a skill, just like taking a good cast. 

It is the positioning of the doctor, not the scanner that does the important part. Almost all practices in the future will be paperless (EMR) with digital x-rays. I think they will also have scanners. There is nothing wrong with saving time, mess, and getting orthotics faster if the finished product is at least as good.
 
I think that podiatrists' fear of loss of "orthotic business" to other practitioners or shoe stores will not be stopped by only using plaster casts or not using a lab that makes an orthotic for other types of practitioners. Your orthotic business will be based on the many patients who come to you because you have helped their friends with their foot  problems, or their primary care doctor recommended you as a "great podiatrist." It puts much trust in your care and the patient is willing to spend another 100 or 200 dollars for a pair of properly made orthotics by you. Most importantly, if you make orthotics that work, you will get many referrals and patients coming in needing a new pair or a second pair.

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

RE: Software Choices
From: Michael M. Rosenblatt, DPM

I have been watching the arguments about Internet and non-Internet software choices. This is occurring while some podiatrists (incredibly) still hand-write chart notes. Also, most nursing homes still use handwritten charts. 

Government has ideas (which eventually become demands). I don’t blame them. They see Internet-based records as a public health and cost-lowering issue. But, because they want something, does not mean it is good for you. You have to pay for it; and there are still no basic standards. This is typical “flaky” government. It is inevitable that what we use now will be forcibly changed. You purchase a system, get used to it, and then are forced to either purchase a new one or pay an enormous “transfer” fee. Worse, that may happen more than once!

What to do? Use a laptop computer to keep your records with MS Word. It will not offer the features an “Internet-based” system has, but will be compatible with whatever system(s) the future has in store. Almost any (future) system will be compatible with MS Word. Just carry the laptop from room to room (or to nursing homes). You’ll still have paper charts notes your staff will glue-stick into charts. But you’ll have excellent records and will never get behind. You can set up your own template files and cut and paste them quickly. Until government gets its act together, why should you waste money or benefit insurers who want invasive statistics on you? 

If you feel an Internet system is best for you, or will improve your productivity, fine. But I don’t see it being much more useful (for practice management) than a laptop with MS Word. There are no transcription fees, and laptops are cheap. Government and insurers are dropping reimbursements constantly. We must be more mindful of our business expenses. This worked great for me! 

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Podiatry’s Limited License (Michael Forman, DPM)
From: Narmo L. Ortiz, Jr., DPM

While I agree with all the previous posts about the advancements that have been accomplished by our profession, the most important one that we are missing is equality of pay for the procedures we perform. If all the battles that the profession has fought for recognition will lead to that goal, then it will all be worth it, and we just have to be a bit more patient. When I went to podiatry school, no one offered me a discount on my student loans.

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

I agree with Dr. Forman that great things have happened in the field of podiatry over the last 50 years. And in truth, our license does not limit us as specialists...we can treat any and all foot problems that may present to the office, without exception. While it is true that we are not MD's and cannot treat systemic pathology, is that now and has that ever been our raison d'etre? I think not. In my opinion, the only reason this whole issue keeps coming up is that podiatrists…

Editor’s note: Dr. Kornfeld’s extended-length letter can be read here.

RE: Big Brother and EHR
From: David N Sampson, DPM

Yes, big brother may use the information we submit either to an insurance company, billing service, or EHR company. I had an insurance company fax me and tell me that I should put a diabetic patient with a history of heart problems on a statin, ASAP. This was not in any EHR; this evidently was taken from  a claim just submitted to the insurance company. Evidently, the computer or person who generated this fax is unaware that I am not the PCP.

David N Sampson, DPM, Chillicothe, OH, daves_boxter@yahoo.com

PART-TIME, LICENSED PODIATRIST - WEST BLOOMFIELD, MICHIGAN

Immediate opening for treating patients in a nursing facility setting.  If interested, please email drteetime@aol.com

PART-TIME ASSOCIATE - NY LOWER HUDSON VALLEY (PUTNAM COUNTY)

Wednesday's & Saturdays  compensation dependent on collections. Hospital privileges & wound care center available. Excellent relationship with local Drs. including orthopedists- References required. Great opportunity for recent resident to gather cases for ABPS. Reply to PodAssociate@aol.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

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

POSITION AVAILABLE - SOUTHERN CALIFORNIA

Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com

PODIATRISTS NEEDED NATIONWIDE

Podiatry referral company has thousands of diabetic patients nationwide in need of immediate service. We are looking for podiatry practices interested in joining our network to receive referrals. Email coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

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

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

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 - 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

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