The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 29, 2009 #3,608 Publisher-Barry Block, DPM, JD

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Toe Popping Over Long-Term Could Cause Damage: FL Podiatrist

An assistant principal in Florida has been told to stop the way he disciplines students. Five high school students have told Tampa officials that Olayinka Alege would pop their toes when their grades slipped. One student said Mr. Alege popped his toes about 20 times.The students said the toe popping didn't hurt, but some told authorities it made them feel uncomfortable. The Hillsborough County Sheriff's office investigated the claims and found there was nothing criminal.

Dr. Barry Blass

Toe popping is similar to knuckle cracking, said podiatrist Dr. Barry Blass, but it can have long-term effects if done repeatedly."If you pull far enough, you could theoretically tear a tendon or a joint capsule," he said. "But you'd have to pull it pretty far and you'd have somebody in significant pain long before it would get to the point of causing damage."

Source: WPTV [7/27/09]

Annual Trip is Mercy Mission for NJ Podiatrist

The village woman had no idea why her 7-year-old grandson had difficulty walking and spent four years in kindergarten. With nowhere else to turn, she brought the boy to the LIGA International clinic in Sinaloa, Mexico in June in hopes that the American doctors volunteering there could provide some answers. One of those doctors was Nancy Kaplan.

Dr. Nancy Kaplan

Mexico has become an annual destination for Kaplan, a podiatrist who practices at Sutter Regional Medical Foundation's Fairfield center.  Kaplan did all she could do for the boy before asking a pediatrician to examine him. That led to the discovery that the youngster has cerebral palsy. The diagnosis was a modicum of relief for an anxious grandmother. She now knows her grandson will receive treatment at the clinic.

For Kaplan, episodes such as these make the seven-hour flight to Sinaloa, Mexico, worth every minute. She first did volunteer work in Mexico as a fourth-year podiatry student in 1992. It was love at first sight. "I've always wanted to do charity work in Mexico -- that was one of my things going into medicine," Kaplan said. "I have spent a lot of time there, so I have a connection with Mexico. The people are real appreciative to have healthcare."

Source: The Reporter [7/25/09]

Encryption is the Key to Patient E-Mail Communications

With the use of health information technology and electronic health records expanding rapidly — and the knowledge that security breaches must now be reported to the government and the media — healthcare organizations now have greater incentive than ever to encrypt data, experts tell Report on Patient Privacy.

Covered entities (CEs) that have been communicating with patients through e-mail or their Web sites, or that will soon be hooked up to a health information exchange, should be taking a close look at their encryption policies.

The security breach notification provision of the HITECH Act requires that CEs notify affected individuals, the government and the media following a breach of unsecured information. But providers don't have to report breaches if protected health information (PHI) is rendered unusable through encryption or destruction, according to HHS guidance released in April.

Source: Eve Collins, Report on Patient Privacy [7/17/09]

Add Uncertainty to Job Interviews

Toss an unexpected question into the mix when you face candidates who have prepared answers to all the common questions. Examples:

•  “Why are you worth your current salary?” Challenge candidates to substantiate the value they bring to their current positions. If they reveal a track record of boosting profitability or reducing costs, they demonstrate their potential worth to your practice.
•  “Can you think of someone you worked with whom you did not respect?” Watch for candidates who pass personal judgment or blame. The best candidates will focus on their own results and discuss the strategies they used to ensure their personal performance standards.

Source: Adapted from “Answering the Curly Ones,” David Wilson, The Age (Melbourne Australia) via Communication Briefings

Query: Dragon Naturally Speaking Problem

Does anyone have a problem with Dragon Naturally Speaking Medical v9.5 giving error messages and shutting down spontaneously after a few dictations followed by MS Office shutting down. I then have to open these programs again and again. I have had to un-/re-install DNS many times but it doesn't seem to help. Do I need to purchase v10?

Bruce Krell, DPM, Chandler, AZ

Query: Autograft From Bunion Repair

Can packing an osteotomy site with bone graft from the medial eminence in a bunion repair be billed as a separate procedure (obtaining autograft)?

Arden Smith, DPM, Great Neck, NY

Response: The code, CPT 28307 (osteotomy first metatarsal with autograft [other than first toe]) is available for those situations that require this technique when independent of bunionectomy procedures.

Please be sure to document the medical necessity. This is not routinely done for bunion repair, but there can be isolated situations when this is necessary.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found at:
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RE:  Measuring Wound Depth (Frank DiPalma, DPM)
From: Roody Samimi, DPM

We were taught to take a cotton-tipped swab and see how stained the tip/stick is (or mark it) and then place this next to a ruler (if needed), at its greatest depth. Measure the length and width at its greatest length and width. All in cm.

Roody Samimi, DPM, Sacramento CA, roody.samimi@gmail.com

RE: Swimmer with Cramps in Arches (Alan Mauser, DPM)
From: Jeffrey Kass, DPM

I have an average arch. I do not pronate. I do not have any foot problems at all. I have never had any type of arch pain. I too, at times when I go swimming, have arch cramps. I would surmise that it is possible being barefoot in the pool uses the intrinsic muscles differently than when walking normally. Or maybe the temperature of the water (being cold) has something to do with it.

My recommendation to Dr. Mauser is to have his patient swim in a heated pool and see if the cramps occur. If it has something to do with musculature, maybe have the patient try wearing the new DARCO night splint with the hallux dorsiflexion attachment to take advantage of the Hicks windlass mechanism.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Midmark 647 (Al Musella, DPM)
From: Jennifer Ryder, DPM
 
I just bought the Midmark 647 last fall. It was expensive, so be sure to get at least 3 different quotes and ask whether the price includes set-up. The motor had to be replaced because the chair would not rise with anyone over 200 lbs. on it, but there was little hassle involved with the repair.

I would recommend getting the wireless adjuster because you can place it across the room and there is less clutter without the cords.  Another advantage over some of the less expensive chairs is that there are more options for height adjustment. This chair goes lower and higher than the others.

I got a Betadine stain on the chair and it actually faded with time, which I was happy about.  The debris tray is larger than some of the older Midmark chairs, which I like too. I would like the foot rest to adjust up and down but it does not. Overall, I'm happy with the purchase and many patients have noticed it and commented on how much they like it.

Jennifer Ryder, DPM, Rapid City, SD, jenbenryder@yahoo.com

RE: X-Ray Processor (D.J. Loiselle, DPM)
From: Brian Kiel, DPM

Rather than spending money on a new processor this is the time to think about digital x-ray. In the long run, you will save money, have less mess, and have better quality x-rays.
 
Brian Kiel, DPM, Memphis TN, footdok4@gmail.com

RE: More Heels From Hell

These shoes have not received the APMA Seal of Acceptance

Source: Submitted by Martin Taubman, DPM

ASSOCIATE POSITION - WASHINGTON — WEST PUGET SOUND

Well-established, two-doctor practice in all phases of treatment looking to replace associate who is leaving the area. Looking for energetic, affable, surgically-trained DPM to take over associate position leading to partnership. Satellite office and adjacent multi-disciplinary ASC available for use and possible partnership. Silverdale rated 92nd in best 100 locations in Money/CNN 2009 poll. See link . Contact and résumé at pwa@kitsappodiatry.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

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 

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.

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 fmassuda@footexperts.com

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.

PRACTICE OPPORTUNITY - CINCINNATI, OH
 
Well-established practice located in medical/professional building minutes from hospital. Many referrals, three satellite clinics and two assisted living facilities to keep you busy. Associate leaving due to family emergency-need to either find an associate or sell ASAP. Contact bjadpm@hotmail.com for more details.

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 ourwebsite

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.

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