The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 29, 2010 #3,917 Publisher-Barry Block, DPM, JD

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IL Podiatrist Offers Advice to High Heel Wearers

Dr. Paul Bishop, a podiatrist affiliated with Rush-Copley Medical Center, said women especially should be careful about what kinds of shoes they wear during their younger years. High heels are particularly popular right now, especially among younger women, but can cause or simply aggravate foot, ankle and even back problems in the future. Depending on how often a woman wears high heels, she could develop hammertoes. Hammertoes can develop if a woman frequently wears high heels or wears shoes that are too small, preventing her toes from lying flat.

Dr. Paul Bishop

Bishop said it's important for women who frequently wear high heels to do calf stretches so as to not cause permanent damage to muscles and tendons in the ankles and legs. "If you're going to wear a lot of heels, make sure you're getting fitted for your shoes," Bishop said. "Make sure you're going to a good store and that the shoes are a good fit. If you do start having a lot of pain, do see your doctor or a podiatrist."

Source: Celeste Busk, The Beacon News [7/28/10]

Podiatric Care Proven to Cut Amputations: Thomson Reuters Study

Diabetic foot complications are the leading cause of non-traumatic, lower-limb amputation in the United States, according to the National Institutes of Health, but new research indicates that preventative care by a podiatrist can reduce the risk of diabetic amputations by nearly 29 percent. A team led by Teresa Gibson, PhD, searched the Thomson Reuters, MarketScan Research Databases to compare health and risk factors for 32,000 patients with diabetes who had podiatry visits to those who did not. The databases house blinded healthcare claims data that researchers use to understand health economics and outcomes.

Dr. Vicki Driver

According to Vickie R. Driver, MS, DPM, the records indicated that care by a podiatric physician (defined as at least one preventative, pre-ulcer visit) was associated with a nearly 29-percent lower risk of amputation and 24-percent lower risk of hospitalization. “The results of this study undeniably support visits to a podiatrist being critical to a diabetes patient’s health and well being…,” Driver said. “The earlier a podiatrist is included in the diabetes-management team, the better the quality of life for the patient and greater healthcare cost savings for all involved. This study clearly allows us to understand both the clinical and economic value of a podiatrist in the team approach to saving diabetic patients’ feet.”

Source: The O&P EDGE, [7/28/10]

Recovery Audits Expanding to Include Medicaid

The Centers for Medicare & Medicaid Services is working to expand its recovery audit contractor program to all of Medicare and to the Medicaid program by the end of the year, although an agency official told Congress in July that CMS faces challenges in getting that done on time.

RACs are third-party auditors hired by CMS to comb through Medicare claims from hospitals, physicians and others to identify improper payments. A three-year RAC demonstration program that launched in California, Florida and New York in 2005 identified roughly $1 billion in Medicare overpayments, according to CMS.

Source: Chris Silva, AMNews [7/26/10]

The Initial Stages of the Practice Merger Process – Part 1

Once you have gotten your core group together who are interested in merging, you now have to consider the following:

• 1. Establish an experienced merger committee and choose a leader to move the process forward. The members must take this very seriously and be prepared to invest time, money, and effort, or your chances of a successful merger are slim.
• 2. The merger committee needs to decide how the group is going to fund the due diligence process. The worst thing you can do is hire an advisor without adequate funds, and if the deal falls through, someone has to pay this advisor. You could  end up on the hook for all the bills. An initial investment by all merging entities up front must be made before advisors are hired and the process begins!
• 3. The merger committee should appoint a treasurer and  a secretary. The treasurer is the one who collects all the funds and produces a monthly cash flow statement. The secretary takes minutes at every meeting and distributes them to all physician members on a regular basis.

Editor's Note: Part 2 will be printed in the 7/31/10 issue of PM News.
 
Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC

Query: Painful Erythematous Markings

My 49 year old female patient has had the following symptoms for 10 years. These symptoms happen about twice a year, last 5-8 days, but can happen at any time. There are ‘no’ precipitating factors. There are always erythematous markings (1cm x 1cm) on the plantar surface that gradually ‘grow’. Symptoms are similar to heel spur syndrome/plantar fasciitis with post-static dyskinesia, with sharp or burning pain. All erythematous markings are very painful to the slightest of touch, and begin on one foot, and within a day or two, affect the contralateral foot.

There is no elevation, keratosis, irregular margin borders, and there is minimal warmth. The patient reports that all labs are normal. Any comments will be appreciated.

Harry Cotler, DPM, Soldotna, AK

Query: Source for Custom Birkenstock Shoes

I need a reliable, dependable company for patients who want custom Birkenstock or similar shoes. Does anyone have a referral?

Jennifer Ryder, DPM, Rapid City, SD

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

This is a patient who likely is having an issue with a burdened immune system. Look at the epigenome for answers. Diet is the biggest culprit. Get him off of refined carbohydrates, put him on a good probiotic. I would do a work-up for IgG food sensitivities as well as adrenal stress. These patients respond really well to diet changes, immune support, and gentle natural meds that inhibit viral replication. I've done it with adults as well as young people very successfully. In this case, you already see that just attacking the virus at the skin level is not the answer.

Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

My treatment of choice has always been Bleomycin. It is easy to do, consists of one treatment and (given adequate seroconversion of the patient) will result in all the warts on the body (foot and hand) resolving within about 5-6 weeks. If you'd like my treatment method, write to me and I'll send you the .pdf.

David Secord, DPM, Corpus Christi, TX, david5603@pol.net

For multiple recurrent verrucae, effective treatment in younger patients is Tagamet 400mg and laserformalyde topical solution. If the patient is adult size (110 lbs), I prescribe 3 Tagamet daily and once daily application of laserformaldahyde. I debride them after 3 weeks, and then in 4-6 week increments. It is not perfect, but it does have a significant success rate. Be careful; the laserformaldahyde may cause drying and cracking of the peripheral skin, and application may have to be reduced to every other day.

Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Research on Toning Shoes (Arnold Ross, DPM)
From: Cam White

Many of the popular brands of "toning shoes" (Skechers, MBT, Reebok) are designed to induce instability in all planes of motion. They may not be suited for people with ligament laxity or unstable ankles. Some rocker sole shoes (Ryn, Finn Comfort "Finnamic", Sano by Mephisto, etc.) offer exceptional medial/lateral stability, with added depth to accept foot orthotics, if needed. I produced a short video a few months ago, geared toward the consumer, that compares and contrasts "unstable" vs. "stable" rocker sole shoes. Click here for the video.

Cam White, Owner, Total Relief Footwear, camwhite.shoes@gmail.com

RE: MTI Podiatry Chairs (Nat Chotechuang, DPM)
From: Paul J Maglione, DPM

I recently purchased an MTI 527P chair. It’s low enough for easy entrance. It’s very quiet and has no problems lifting my heaviest patients. It’s too soon to talk about reliability, but since I purchased it from Gill Podiatry, I am not too concerned.

Paul J Maglione, DPM, Ossining, NY, drmaglione@aol.com

RE: Criminalizing Doctors - Yet Again
From: Bob Kornfeld, DPM

News has just broken that the US Department of Justice, together with the Idaho Attorney General (note that this is a bipartisan operation), charged a group of Boise orthopedists with a criminal violation of the antitrust laws. What had they actually done? They got together and discussed what to do about the very low fees offered by the State Workers Compensation Program.

Result: thoroughly intimidated doctors signed a draconian ten-year consent decree agreeing to accept the Idaho Industrial Commissions’ price controls. Most of the doctors also agreed to rescind any threats of withdrawing from Blue Cross of Idaho. Keep in mind that Blue Cross is a private insurance company. As such, it is itself exempt from antitrust laws. And state and federal governments are also exempt. It is just the doctors who are subject to it.

If doctors met together and decided what to charge...

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

RE: Supergroup vs. IPA (James J DiResta, DPM)
From: Bret Ribotsky, DPM,  Lawrence M. Rubin, DPM

In answer to the question regarding the different models in putting the "perfect" group together in your area, I did a special interview with David Helfman, CEO of Village Podiatry, where for 20 minutes he outlined the process and the model to begin the path of putting a super group together. The interview can be heard by clicking here.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

I think Dr. DiResta should be applauded for sounding the warning whistle. Podiatrists will either be included in the emerging Medical Home and Accountable Care Organization systems just around the corner in healthcare reform, or face, as Dr. DiRiesta states, “catastrophic consequences.” These organizations will have to include foot care services  – and if there is an area-wide, organized foot care IPA network focused on providing quality care at reasonable charges negotiating with these organizations – who would doubt that it will have an advantage over a solo podiatrist to gain foot care referrals. And if you are in an area where a foot care IPA is negotiating and you are not a part of it... well, forewarned Is forearmed.

In Las Vegas, we are well on the way to developing a podiatry-driven, multidisciplinary IPA with a primary focus on diabetic foot care. We will offer healthcare payers a coordinated care program capable of preventing serious complications and amputations. We are involving hospitals, surgicenters, and wound care centers in our IPA program, and even local and State of Nevada governmental health agencies are showing interest and support for what we are doing. No one has a crystal ball to foresee the future of podiatry – but, the old saying is ever true: There IS power in numbers.

Lawrence M. Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com

RE: The Passing of Godfrey Viegas, DPM

It is truly a very sad week for the SCPM Class of 1990, with the passing of Godfrey Viegas, DPM, who was so young to be taken by pancreatic cancer. His family must be devastated. Godfrey was a very unique person. Not only was he a very talented physician and surgeon, but he had a great sense of humor and was a great musician. Many of us saw him for the last time at the Midwest Seminar this past year. He actually played with his band at our reunion. It’s amazing that you can spend four years with someone, have great memories, separate for twenty years, and it’s almost like time stands still when you hear this tragic news.

I know the SCPM class of 1990 will set up some kind of memorial fund for Godfrey’s family. As we are all running every day in the craziness of life, let's remember to give gratitude and give time to those who are most meaningful in our lives. Although Godfrey and I were not best friends, we had lots of interactions and memories that will stay with me forever! He was a great guy and will be missed by everyone!

David N. Helfman, DPM, Atlanta, GA

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

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

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