The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 28, 2010 #3,916 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Summer Presents Sunburn Risks for Feet: NY Podiatrist

Summer may seem like the perfect time to let your toes breathe, but there are a lot of hazards, obvious and not so obvious, that could affect your feet. Dr. Lori Weisenfeld, a sports podiatrist in New York City, said that foot issues fluctuate with the seasons, and one key thing people forget in the summer is that feet are susceptible to sunburn too.

Dr. Lori Weisenfeld

"We walk around in the sun all day... I'm talking about walking around the streets all day in our sandals with our feet exposed, and many people do get sunburns on the tops of their feet," she said. Sun damage can occur anywhere on your body, Weisenfeld said. "If you're walking without socks on, in open shoes, put some sunblock on the top of your feet," she said.

Source: Kirstie Hettinga, Accuweather.com [7/19/10]

Dekalb Medical’s Podiatry Institute Holds Commencement 

The Podiatry Institute at DeKalb Medical recently held a commencement ceremony for the graduates of its residency program. Cathy Coker, DPM, Rahn Ravenell, DPM, and Sean Patrick Dunn, DPM completed an intensive three-year educational training experience in podiatric medicine and surgery at the post-graduate level. These ambitious doctors enhanced their training, knowledge, and life experience through anatomic study and participation in various seminars in the United States and Europe.

(From L-R) Drs. Cathy Coker, David Alder (director, Podiatry Residency Program, The Podiatry Institute, DeKalb Medical), Rahn Ravenell, and Sean Patrick Dunn.

During training with the Institute, residents also learn teaching and lecturing skills. Upon graduating from the program, former residents join an international group of peers who have graduated from the program at DeKalb Medical, and then serve as a resource to the Institute’s newer residents. Members of the Institute lead highly acclaimed continuing medical education (CME) workshops, produce training videos, and author leading textbooks on foot and ankle surgery.

Many Physician Groups Doubt Value of PQRI

Proposed changes to the Physician Quality Reporting Initiative, the CMS' effort to aggregate claims-based quality data and reward the physicians who submit them, are meeting with no small amount of skepticism among doctors. Many physician associations and advocacy groups are urging their members to steer clear of the error-prone, claims-based reporting mechanism altogether and to instead put their energy and resources into qualified registries or EHR-based reporting. Clinical registries collect data from their users and report performance directly to the government or other organizations.

One of the biggest issues up to this point, according to the CMS, has been the large number of physicians who participated in the voluntary program using claims-based reporting, but who failed to qualify for bonus payments. In both 2007 and 2008, only about half of the eligible professionals who submitted claims-based quality data actually qualified for payments, the CMS said in the proposed rule.

Source: Maureen McKinney, Modern Healthcare [7/26/10]

Evaluate Résumés Carefully

Evaluate résumés and letters of application as you would evaluate a sales brochure. Is the writing crisp and clear? Does the job candidate offer evidence to support claims? Is the information presented logically? Does it rely on specifics rather than generalities?

Because those documents attempt to “sell” you something — in this case, to convince you to hire the person — you should be wary.

Source: Adapted from Staffing the Contemporary Organization, Donald Caruth and Gail Handlogten, Praeger Publishers via Communication Briefings

Query: Foot Size as a Growth Indicator?

Having coached various youth sports over the last 15 years there is one question that parents ask that I cannot answer accurately. "How tall will my child grow?" My answer is always vague and based on the parents’ height, and also on whether the growth plates appear to be closing. However, I have seen height prediction equations based on many variables. I am sure there must be a reliable predictor of adult height based on foot size and growth plates. Any help will be appreciated.

Bill Zaccardelli, DPM,  Cleveland, OH

Query: MTI Podiatry Chairs

I would like to hear from PM News readers who currently use or have used MTI podiatry chairs, in particular the 527P and 527S models.  Please comment on the chairs' design, function, durability, serviceability, reliability, etc. 

Nat Chotechuang, DPM, Bend, OR

Query: Jones Tendosuspension Procedure Coding

Is there a code for a first metatarsal-phalangeal joint Jones tendosuspension involving transfer of the extensor hallucis longus (EHL) to the first metatarsal, and a hallux interphalangeal joint fusion?

Gregory Still, DPM, Denver, CO

Response: Yes, there is. CPT 28760 - arthrodesis interphalangeal joint great toe with extensor hallucis tendon transfer to first metatarsal neck. This code fits your criteria perfectly.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Multiple Verrucae (Gary Bjarnason, DPM)
From: Multiple Respondents

I posted a very similar case in a 15 y/o female several months ago on PM News.  After reviewing numerous suggestions, I decided to use 5-FU/SA (2% 5-fluorouracil plus 16% salicylic acid) cream. 

Warts (before and after) 2% 5-fluorouracil plus 16% salicylic acid) cream

All verruca resolved and she still remains wart-free. It took 3-4 months, but treatment was pain-free, user-friendly, and without side-effects.  The product (known as Wartpeel) can be ordered through NuCara Compounding. For more information go to (medcara.com/wartpeel/) 
 
Chris Seuferling, DPM, Portland, OR, cseuferling@comcast.net

I recommend off-label cimetidine 25mg/kg/day P.O. in divided doses. Cure rates approximate 85%, with duration of therapy ranging from 3-12 weeks. See prior PM News issues by using the search engine at www.podiatrym.com for references.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Try adding oral Cimetidine 30mg/kg for at least a month, possibly longer to your local treatment regimen. In my experience, it helps slow and prevent spreading, and in some cases has even radically accelerated elimination of the lesions. I also like to use Effudex Cream (5-Fluorouracil) topically and under occlusion.
 
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

RE: Statistical Consideration for Bilateral Cases In Orthopaedic Research
From: Michael Turlik, DPM

“Statistical independence means that one observation is not affected by another; however, the principle of statistical independence is violated if left and right-side measures within a subject are considered to be independent, because they are usually correlated and can affect each other.” In a recent issue of JBJS-A (2010 Aug; 92(8):1732-7), the authors report on a study to “analyze the violation of statistical independence in recent orthopaedic research papers and to demonstrate the effect of statistical analysis that considered the data dependency within a subject.”

Although I do not have any good data, it is my impression that it is common for foot and ankle studies to violate this concept. The authors found fifteen foot and ankle studies violating this principle.
                     
Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Research on Toning Shoes (Kevin A. Kirby, DPM)
From: Multiple Respondents

Regarding comments about the toning shoes: I find them to be unstable in resisting supination and pronation from heel contact and throughout the gait cycle, even in patients with minimal biomechanical abnormalities. The outer soles are too compressible and will not resist abnormal foot motions, with or without foot orthotics.

Arnold Ross, DPM, Los Angeles, CA, asross1@juno.com

Thank you Dr. Kirby for sharing this study with us. The best way to learn about the effects of toning shoes is to study the biomechanics of the styles worn by your patients and learn how they work. Another opportunity is to go into your favorite shoe store, try some on, buy a pair and take them home and personally “study” how they work. Patients are looking for us to guide and direct them to the best options. There are over 20 brands currently on the market, and most of them are different from each other. Some styles provide an “unstable” midsole under the arch; many have good support. Others have more heel spring, or toe spring and different pitch angles from heel to toe. The consumer is interested in this category of footwear.

It is estimated that this category produces over $1 billion dollars in sales. Expertise comes from clinical experience. Studies are useful. So is peer review. Our experience is that when we select the best style and train our clients on how to wear them, and the optimum regimen to build muscle memory, we get the best result. This product, when purchased on the Internet or in a self-service establishment, puts the buyer at risk.

Robert S. Schwartz, C. Ped., NY, NY, rss@eneslow.com

Editor's note: Dr. Lanny Rubin's extended-length letter can be read here.

RE: Substitute for DPM Crème? (Joan E. Schiller, DPM)
From: Mathew M. John, DPM

I now sell Podiamide lotion in my office. It works great. It has a urea and lactic acid combination and is sold by Beta Dermaceuticals. The lotion is podiatry-specific and is labeled “Recommended by podiatrists.”

Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

RE: Supergroup vs. IPA (David N. Helfman, DPM)
From: James J DiResta, DPM, MPH, David N. Helfman, DPM

I would have to disagree with Dr. Helfman's statement that the IPA model has faded away. In Massachusetts, IPAs and PHOs are the driving entities for payment contracting. In fact, many IPAs have joined with larger groups such as Partners and Charitas and BIDPO, which are the IPA/PHO entities that represent MGH, St. Elizabeths, and Beth Israel Deaconess Medical Centers respectively and all their affiliated physicians and health providers.

With the new payment plans threatening to converting to "group payment" models that the Commonwealth of MA and federal health care reform is mandating (capitation revisited with AQC contracts, etc...), all payments will be dispersed through these larger entities. Please, many individual providers do not have enough insight into this development and could be "left out" if they don't belong to an IPA. Saying that the IPA model has faded away is not just misleading, here in MA, which is at the forefront of universal healthcare, it could be catastrophic.

James J DiResta, DPM, MPH, Newburyport, MA, James.J.DiResta.DMS04@Alum.Dartmouth.ORG  
 
Actually, if you read my final thoughts, I said that all three of these models do work, depending on which environment  in which you are practicing. However, I probably should have stated that the IPA model has changed from the early 1990's. However, from a business perspective, I would think the larger super groups would provide much more value to a physician long-term and could participate in all contracts, including hospital-based PHO/ IPA's. I also mentioned that the IPA was really developed for a solo or smaller group to join a larger organization for managed care contracting purposes. I feel that our profession as a whole has been behind the eight ball when it comes to the group practice model when compared to other specialties.

Again, each market has a different dynamic but in most states, I would still argue that the larger super group model will thrive under any market condition or change.

David N. Helfman, DPM, Atlanta, GA, DHelfman@villagepodiatrycenters.com

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS

Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston) Washington, DC, Philadelphia, Northwest Pennsylvania, Delaware, Upstate New York, Massachusetts (Brockton). Please respond to: doconcall02@aol.com

PODIATRY ON CALL - MIAMI-DADE & BROWARD COUNTIES, FLORIDA

Call us for vacations, "unexpected emergencies" and playing hooky. Part-time or Per Diem Basis! Extensive surgical and non-surgical training with Dr. Stanley R. Kalish in Atlanta, Georgia. On call everyday to meet your office needs! Contact: podiatryoncall@gmail.com or 305-342-9797.

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 - SUBURBAN PHILADELPHIA AREA

Full-time associate with opportunity for partnership with group practice. Candidate must be trained in all phases of podiatry including wound care, surgery, and routine podiatric care. Candidate must have a positive and energetic attitude with a desire to grow in our practice. If interested please email your CV to BergD@readinghospital.org

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC  needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

PRACTICE AVAILABLE - WESTERN WASHINGTON

General Podiatry practice in Port Townsend, WA. Nice community, 25+ year old practice, busy 3 days a week with growth potential. Owner leaving area, needs someone to take over the practice, lease and equipment. Contact Jessica at ptpod@yahoo.com or 925-519-0624.

ASSOCIATE POSITION - NEW JERSEY - JERSEY SHORE REGION

Part-time associate wanted. Looking for a motivated and ethical practitioner. Competitive salary with incentives. Tuesday AM - Thursday PM - 2 Saturdays/month. Please respond to: NJSHOREFOOTDOC@aol.com

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

38 yr old general podiatry practice grossing over $550K. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network and well-equipped surgical suite. Retiring owner will stay on as needed. Email - dpmpracticeforsale@yahoo.com

PODIATRY ON CALL - MIAMI-DADE & BROWARD COUNTIES, FLORIDA

Call us for vacations, "unexpected emergencies" and playing hooky. Part-time or Per Diem Basis! Extensive surgical and non-surgical training with Dr. Stanley R. Kalish in Atlanta, Georgia. On call everyday to meet your office needs! Contact: podiatryoncall@gmail.com or 305-342-9797.

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

PART-TIME, LICENSED PODIATRIST - WEST BLOOMFIELD, MICHIGAN

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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.