The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 31, 2010 #3,919 Publisher-Barry Block, DPM, JD

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IN Podiatrist Discusses Blister Prevention

Blisters are the direct result of friction, said Dr. Frank Cobarrubia, a podiatrist with Northwest Foot Care in Bend. Reduce the friction and you can avoid the pain. “You have layers of skin, this palisading of different types of tissue,” he said. “It’s like seven layers of different types of felt. You start rubbing across, you’re going to shear. With that shearing force, one of those layers separates, and it fills in with fluid.”

Dr. Frank Cobarrubia

The key to avoiding blisters, Cobarrubia said, is to reduce that friction. That starts with a properly fitted shoe and sock. Because moisture can add to friction, synthetic socks that wick perspiration away from the skin can help. Hikers often wear a thin synthetic liner sock to reduce friction inside a thicker sock that provides cushioning. Cotton socks are notorious for increasing friction when wet. Cobarrubia, who is also an avid triathlete, recommends synthetic, anti-chaffing powder, such as Blister Guard, available at outdoor stores and running shops. “It works great. Anytime I would do a long run, I would put it in my socks,” he said. “Before, occasionally I would get a blister. With this, never.”

Source: Markian Hawryluk, The Bulletin [7/29/10]

IL Podiatrist Seated on Local School Board

Dr. Elizabeth Hofmeister, owner of the Prairie Rock Foot and Ankle Clinic in Manteno, was seated Tuesday as a member of the Manteno Community Unit School District 5 Board of Education. A native of Nebraska, Hofmeister was a podiatrist in Bourbonnais before opening her clinic in Manteno in 1992. She and her husband Dan moved to Manteno two years later. Hofmeister has three children in the district -- John, 15; Bennett, 12; and Emma, 11.

Dr. Elizabeth Hofmeister

"This will be a way for me to be even more involved with district affairs," she said.

Source: Bill Burns, The Kankakee Daily Journal [7/29/10]

FL Podiatrist Booted From Big Brother Reality Show

Andrew Gordon, 39, the podiatrist from Miami who observed Orthodox Judaism, was voted out of "Big Brother" Thursday.  He was on the block with Kathy Hillis, 40 the deputy sheriff who is the oldest member of the household.

Dr. Andrew Gordon (Photo Sonja Flemming)

Andrew's ouster came despite an impassioned speech in which he blamed Rachel Reilly and Brendon Villegas and vowed revenge. (Then he turned around and rescinded his view). Host Julie Chen called his defense speech the best one ever on the show. But if it was, he'd still be inside instead of Kathy.

Roger Catlin, Hartfort Courant [7/30/10]

Providers Have Won Majority of Appealed RAC Claims Denials 

The latest RAC appeals data show the tide turning in favor of providers, who have prevailed in two-thirds of the claims denials they fought to have overturned. The updated data — the first that CMS has released in more than a year — indicate that it’s worth appealing claims denials when hospitals believe they have a strong leg to stand on.

According to CMS’s June 2010 RAC update, 598,238 claims have been subject to RAC overpayment determinations as of March 9. Providers appealed 76,073 of those claims, and were victorious 64.4% of the time, which means 8.2% of the claims were overturned on appeal.

Source: Nina Youngstrom, Report on Medicare Compliance [7/21/10]

The Initial Stages of the Practice Merger Process – Part 2

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

• 4. Depending on the size of each merging entity, each merged practice can have one representative on the merger committee for every five doctors in their group. This ratio is variable, depending on the size of the practices merging together.
• 5. Once you decide to move forward, you will need to put together a merger team, consisting of a healthcare transactional attorney, a healthcare experienced C.P.A., and an experienced consultant to facilitate the process.
• 6. The merger process usually takes six months or longer. Don’t get frustrated, it’s a dynamic process that has many unknowns that usually surface along the way. Persistence and focus are the keys to your success.

Next Week: What documents are needed during the due diligence process?

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC, dhelfman@vpcenters.com

Query: Platinum MD EMR

I would appreciate any comments (pros or cons) on the electronic medical record program called Platinum MD.
 
Harry E. Confer, DPM, West Covina, CA

Query: Platelet Injection with Ultrasonic Guidance

When billing for an ultrasound guided needle injection of platelets to treat plantar fasciitis, do I bill CPT 76942 alone?

Should I bill CPT 76942 in combination with CPT 20550 (injection(s); single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"])?

John Jurcisin, DPM, New York, NY

Response: When performing ultrasonic guidance for needle placement along with the actual injection, you bill both the injection (CPT 20550) and guidance (CPT 76942). Of course, you will be reimbursed only if the payer deems the platelet rich plasma injection to be 1) medically necessary and 2) standard of care based on peer-reviewed published studies. NOTE: You should notify patients that there is a chance that they could be completely responsible for the costs if the payer denies the service as experimental/investigational.

As far as the ultrasonic guidance payment, it will also be subject to medical necessity and standard of care for the injection itself and the use of PRP.

Harry Goldsmith, DPM, Cerritos, CA

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RE: Passing of Mary Gaffney, DPM

Mary A Gaffney, DPM (PCPM class of 1983), passed away on July 22, 2010. Mary started podiatry school at age 40, and struggled during her first year. Never one to give up in the face of adversity, she continued her education and was eventually awarded "most improved student" in her class. Mary's consistent positive attitude, common sense approach to life, humor and warm smile made her a positive role model and friend to her classmates. Practicing in Bryn Mawr and Haverford PA, her many patients became her friends, as she treated them in Marcus Welby fashion.

Mary was an inspiration for her courage and humor, never complaining during her many bouts with cancer. Mary was a passionate golfer, boater, musician, pug owner and lover of the Jersey shore. Her many interests enabled her to interact with that which really fueled her life....her many patients, friends and family. Mary was truly a "people" person. She can be seen online in a You Tube video, "Cancer survivor and golfer, Mary Gaffney"

A memorial service and reception will be held on August 21st at 12 noon at Camilla Hall, a retirement home for the IHM nuns who Mary treated for many years in Immaculata PA. All of Mary's patients, friends, and classmates are invited. 

Bill March, DPM, Cherry Hill, NJ

RE: Orange Nails (Joan E. Schiller, DPM)
From: Leonard A. Levy, DPM, MPH

Joan Schiller, DPM, asks about causes of orange nails. According to Baran and Dauber’s Diseases of the Nails and Their Management, 3rd Edition, chromonychia indicates an abnormality in color of the substance of the surface of the nail plate and subungual tissues.  Pigment may accumulate due to hyperpigmentation (melanin), or storage (copper, various drugs, exceptional hemosiderin), or surface deposition.  

Among the causes of orange as a nail color modification are systemic drugs or chemicals such as phenindione. Topical causes include varnish, hydroquinone, iron, iodochlorhydroxyquinolone (Viaform), Arning’s tincture, anthralin, and chrysarobin.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Painful Erythematous Markings (Harry Cotler, DPM)
From: Barry Mullen, DPM, Roody Samimi, DPM

From the history, it sounds like lesions of discoid lupus. I would work this patient up for SLE, which often presents with exacerbations and remissions of "enthesopathy", particularly about the heel, and coin-shaped erythematous macular lesions.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Anytime I see burning, I think nerve-related. Does this also itch, maybe causing of the redness after scratching? It sounds like a heel pain of neurologic origin. I would try injection (medial approach), change in shoe/orthosis wear, cold/warm therapy. Check Tinel's sign and try to identify a pathologic nerve.

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

RE: Multiple Verrucae (Gary Bjarnason, DPM)
From: Lloyd B. Steinberg, DPM, Jon Purdy, DPM

Curettage of warts, without treatment first to kill the virus, spreads the warts. An easy treatment is electro-desiccation (it works like a Bovie) - then curette.

Lloyd B. Steinberg, DPM, Ocala, FL, cumbia24@aol.com

Although anecdotal, I maintain a 99% cure rate with minimal patient discomfort. I use cantherone plain or plus, and send patients home with an OTC wart application. They return q 7-10 days for debridement and re-application. If there is no significant improvement on each visit, I add either Aldara or Efudex. If there still is no improvement, I dose the patient on cimetidine 35mg/kg/d in divided tid dosing. They make a liquid for the kids. If patients present with too many lesions, I use cimetidine first line. Resistant warts get a trip to the OR for CO₂ laser. I have not done that in three years. The average treatment is four trips to the office.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Substitute for DPM Crème? (Joan E. Schiller, DPM)
From: Avi Kornbluth, Gary Briskin, DPM

I have a lot of doctors who ordered DPM creme and now switched to Gordon's Gormel Creme - which is also a 20% urea crème. They and the patients love it!

Avi Kornbluth, Stone Podiatry/HIS, getavi@aol.com

We have been using a cream called Pedimd (888-300-0084). It is an excellent moisturizing and antifungal option.

Gary Briskin, DPM, Santa Monica, CA, gbriskin@mednet.ucla.edu

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.

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

PART-TIME/FULL-TIME POSITION – MASSACHUSETTS 
 
Looking for extremely energetic physician for nursing home and assisted living facility. Very generous compensation package. Great opportunity for extra cash. Future  potential for part-time work in our practice and/or in house call practice as well. Please call immediately (978) 794-8406 and ask for Blanca for an interview.

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857.

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

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

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

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