The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 23, 2009 #3,603 Publisher-Barry Block, DPM, JD

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FiveFingers Shoe Health Claim is Nonsense: NY Podiatrist

Looking for a new sole mate this summer? Vibram's new FiveFingers shoes make an interesting statement -- if you're strong enough to brave the skeptics who will stare at your feet and judge you. Vibram claims the shoes are beneficial to your lower leg and foot health, as they improve the range of motion in your ankles, feet and toes. They're also supposed to promote proper posture and spine alignment.

Vibram's FiveFinger Shoe

Nonsense, say some doctors. "These offer relatively no support," says Dr. Rock Positano, a foot specialist at the Hospital for Special Surgery. "They do not support the arch well and may lead to postural problems that not only can adversely affect the ankles and feet, but also the shins, knees, hips and back."

Dr. Rock Positano

Positano suggests wearing them "around the pool or at the beach," but adds that wearing them on long walks is not a good idea.

Source: Alisa Wolfson, NY Post [7/21/09]

CA Podiatrist Sponsors Shoe Giveaway

Just over 400 people showed up for a free shoe giveaway Saturday morning at St. Mary's Interfaith Community Services. The charitable organization has been collecting donations of new and used shoes to give out at their 7th annual event, said Edward Figueroa, spokesman for St. Mary's. The event was sponsored by Dr. Craig Garfolo, a local podiatrist who generously donates his time in St. Mary's medical clinic, said Figueroa.

Dr. Craig Garfolo

Over 1,700 pairs of shoes were on display as men, women and children in severe need of shoes, lined up to find their size. "There was a mixture of people, about 60 percent of them are actually homeless, and 40 percent are working poor families with kids, who just can't afford to buy new shoes right now," said Figueroa.

Source: Lesha Ruffin, News 10 (ABC) [7/19/09]

Half of Physicians Don't Know How Much is Owed

A recent survey found that about half of physicians couldn't tell patients how much they owed at the time of care, beyond the co-payment.

How Physicians Collect for Services

Experts say this may mean doctors have a harder time collecting what is owed and spend more money to do so.

Source: NaviNet, Inc. via AMNews

Promote Staff Camaraderie

Doing something fun and interactive with your staff helps promote unity and lift spirits. At the holidays, we take our staff out for a dinner. We have a “White Elephant” gift exchange. Each person brings a wrapped gift valued at under $20 and places it in a pile. We draw numbers to determine in what order each person will pick a gift.  It’s not fair to feel or shake a package. As each person takes a turn, they can either pick a gift from the pile to open or steal a gift that someone else has already opened. This continues until everyone has had a turn. 

We usually provide the nice gift that everyone wants to steal, while most bring a gag gift that provides the laughter. I still have the pirate coconut head from three years ago. This has become a tradition with our office and is an enthusiastically anticipated event. 

Source: Jon Purdy, DPM, For information on the American Academy of Podiatric Practice Management click here.

Panel Making Headway on Reform Package: Baucus

Senate Finance Committee Chairman Max Baucus (D-MT) said that a bipartisan team of negotiators have locked down “two major issues” that will be part of the broad framework for healthcare reform, but declined to provide details. “We're making significant headway,” Baucus told reporters. “I'm probably more upbeat and optimistic now compared to where we were earlier.” Emerging from a closed-door meeting, Baucus said the group focused on insurance issues, including cost and coverage questions that have arisen over individual and employer mandates.

Meanwhile, the committee is searching for ways to bridge about a $100 billion to $200 billion gap in financing the legislative package, which likely will cost around $1 trillion over the next decade.
 
Source: Matthew DoBias, Modern Healthcare [7/21/09]

Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery

Background: The Agency for Healthcare Research and Quality ranks prevention of venous thromboembolism (VTE) as a top priority for patient safety; however, no guidelines or population-based research exist to guide management for podiatric surgery patients. The objective of our study was to determine the incidence and risk factors for postprocedure VTE in podiatric surgery.

Methods: A 5-year retrospective analysis of patients undergoing podiatric surgery in a large not-for-profit health maintenance organization serving > 485,000 members in the Pacific Northwest from 1999 to 2004.

Results: We identified 16,804 surgical procedures in 7,264 patients and detected 22 symptomatic postprocedure VTEs. The overall incidence of postprocedure VTE was 0.30%. Three risk factors were significantly and independently associated with VTE in podiatric surgery: prior VTE (incidence, 4.6%; relative risk, 23.0; p < 0.001), use of hormone replacement therapy or oral contraceptives (incidence, 0.55%; relative risk, 4.2; p = 0.01), and obesity (incidence, 0.48%; relative risk, 3.0; p = 0.02).

Conclusions: We identified a low overall risk of VTE in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, periprocedure prophylaxis should be considered. Until a prospective study is completed testing recommendations, guidelines and care decisions for podiatric surgery patients will continue to be based on retrospective data, expert consensus, and clinical judgment.

Source: Andrew H. Felcher, MD; Richard A. Mularski, MD, MSHS, MCR, FCCP; David M. Mosen, PhD, MPH; Teresa M. Kimes, MS; Thomas G. DeLoughery, MD; Steven E. Laxson, DPM in Chest via Medscape.

Query: Chronic Sub-Hallux Ulcer in Diabetic

I have a middle-aged, moderately obese, chronically non-compliant, diabetic male patient with a chronic ulcer under his hallux IPJ. He has failed all conservative treatment so far, including serial debridements, dressing changes with a variety of topicals, diabetic shoes and inserts, and total contact casting. He has been to a wound care center (where the TCC was done). His history includes a few local soft tissue infections, and past care also included x-rays, MRI, labs.  He has been through infectious disease consultations and treatments several times before. He is no stranger to digital amputations, as partial toe amp's 2nd and 3rd have been done before on the same foot, and once included an inpatient hospital stay. 

He has asked me a few times lately for an amputation of his hallux.  I want to save this toe since I know the cascade of events that will likely follow a hallux amp, especially in this patient. The wound grows periwound callus quickly due to his weight-bearing, and has a granular base with minimal non-viable tissue at each presentation. I have not considered any of the tissue grafts due to the failure to heal with a TCC and non-compliance history. Do I have more options, or is a hallux amp really my best choice here?  
 
Marc Greenberg, DPM, Miamisburg, OH

RE: Planning for the Future

I am considering options on planning for my practice in the event of my death. It is not a fun topic, but one I need some input on. I have already consulted lawyers, accountants and financial planners, but would appreciate PM News readers' thoughts, plans, and ideas.

What about having another DPM take a life insurance policy out on me with the thought that person would use the policy to buy my practice?

Name Withheld

RE: Podiatry Office Compliance with the Red Flags Rule
From: Dan Klein, DPM, Bret Ribotsky, DPM 
 
My understanding is this has to do with identity theft. We are going to have to gather personal information about our patients identity such as a pictured ID, drivers license or similar picture ID. We must document how we identify our patients, and have a written plan in effect for this program. I believe APMA has put together an example plan. I seem to remember that this identity crisis was exemplified by an individual having some expensive surgical procedures or hospital care and using another person’s identity. Wow! I guess we must consider all people corrupt until proven otherwise. This is going to create more paperwork and more time away from patient care. 
 
Dan Klein, DPM, Fort Smith, AR, TOEFIXER@aol.com

Once again, Bravo to APMA  for posting important information on the red flag rules.  These new rules that go into effect for all of our practices on August 1, 2009.

This adds to APMA’s HIPAA Manual, OSHA guidelines, Medicare Compliance Manual, and many more benefits.  APMA is clearly the best value for all practicing DPM's.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.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, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

ASSOCIATE POSITION - CHICAGO AREA

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-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-CHICAGO AREA

Podiatrist is needed in multiple office practice part or full- time in  Chicagoland area. Please email resume to: anthony.spitz@gmail.com or call 847-971-5926

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

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Contact Dr. Ilona Barlam at 206-661-9644.

ASSOCIATE POSITION - WINDSOR, ONTARIO, CANADA

Full-time/part-time podiatrist or chiropodist position available. Please send letter of interest and CV to info@toezone.com

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

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.

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