August 03, 2006 #2,646 Editor-Barry Block, DPM, JD

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1) We’ve just posted the August CME titled “Squamous Cell Carcinoma of the Foot“ by Linnie Rabjohn, DPM, Cornelius Donohue, DPM, Richard Montilla, MD, and Frederick Lavan, MD.

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Have Bunions Evaluated When They Start to Hurt: NY Podiatrists

For Gaby Ciarlo, a top Manhattan stylist, doing her job wells depends not only on her cutting skills but also on her ability to stay on her feet. But a year ago it was time to think about surgery for her bunions. Dr. John Mancuso examined Gaby Giarlo and did surgery on one bunion, the right toe. "This is someone who waited too long before having the surgery and a simple bunion correction taunted into an arthritic bunion correction."

There was serious cartilage damage and that meant a joint prosthesis, a plastic and metal insert that now serves as the joint hinge. But, which will give Gaby relief for possibly the rest of her life. Her recovery was several months of physical therapy. Her other bunion, while large, is not yet giving her pain.

Mary Claude Londa had her bunion surgery just one week before. Like most patients, she's out walking and going through physical therapy immediately. Mary Claude Londa, Bunion Surgery Patient: "It got to where walking was painful and I love to walk." Her podiatrist, Dr. Steven Abramow, says an important variable for surgery is the quality of the toe movement. "It's a dynamic joint we use for walking normally and when you lose flexibility in that joint in affects your ability to walk properly it affects your gait."

A person's age and what effect the bunion is having are variable in decisions for surgery. It used to be said wait as long as long as possible before surgery, but modern thinking says have bunions evaluated if they're starting to hurt.

Source: Jay Adlersberg, WABC-TV (NY) [7/31/06]

NY To Ride Again for Israeli Hospital

Mark Levine, DPM of Middle Village, NY will be participating in his third straight charity bike ride in Israel to benefit Alyn Hospital in Jerusalem. According to Dr. Levine, the ride this year will be from Jerusalem to Eilat in the south and will encompass 250 miles in 5 days. 325 riders from all over the world will participate and will pay their own way for the honor of riding for this worthy cause.

Alyn Hospital is a pediatric rehab hospital with world-renowned doctors, which works with every child, both Jew and Arab, until they reach their full potential. The hospitals in Israel are under-funded and the money raised goes directly to the hospital. Last year close to two million dollars was raised.

Dr. Levine can be sponsored by either sending a check made out to American Friends of Alyn Hospital and forwarding to his office at: Mark Levine, DPM, 67-09 75 St, Middle Village, NY 11379 or, going online at www.alynride.org and following the directions.

HHS Unveils Exceptions, Safe Harbors For IT Sharing

HHS announced new federal regulations that will allow hospitals and some other organizations to donate e-prescribing and electronic health records technology and support services to physicians. The regulations create broader exceptions and safe harbors to federal fraud-and-abuse laws, in terms of qualified donors and recipients, than initially proposed last October. The CMS created two exceptions to physician self-referral law allowing hospitals and other organizations to provide physicians with technology and training used predominately for interoperable e-records and solely for e-prescribing. Under safe harbors in anti-kickback law created by HHS' inspector general's office, recipients must cover 15% of the cost of e-records technology and services.

"Hospitals, health plans and others will take on an active role in putting (e-records) in the hands of physicians," HHS Secretary Mike Leavitt said at a news conference. With the exceptions, "physicians will have a better chance of getting these sooner," Leavitt said. The final regulations will be published in the Aug. 8 Federal Register. They take effect in 60 days.

Source: Andis Robeznieks and Matthew DoBias, Modern Healthcare [8/1/06]

Query: Doing Business With Patients

Over the years I have had some bad experiences with doing business with patients. I first experienced this many years ago when I needed small curtains for one of my offices. Since a good patient was in the business, I thought that it made good business sense to give her the order. I also felt that she might have been offended seeing new curtains hanging in the office put up by one of her competitors. So I gave her the order. I cringed when I received the bill. It was five times higher than not only what I expected to pay, but what other dealers would have charged for the same service. On the other hand, I utilized the electrician services of another patient and I was not only satisfied with the job but quite happy with what he charged.

Has anyone else had experiences with doing business with patients? Should a doctor do any sort of business with a patient?

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Beware of Tequin

I had a patient with a bad case of cellulitis. She had multiple other problems also so I consulted with her oncologist on selection of antibiotic. We agreed on Tequin. She was on it for three weeks, had 95% resolution of the cellulitis, but when she went to renew it for another week, the pharmacist told her it was pulled off the market because it is dangerous Boy, did I look stupid not knowing that. I called the oncologist and he didn't know either. The patient then Googled Tequin and the first thing it turned up was a ad from a lawyer looking for people injured by Tequin. I hope this note may save some embarrassment

Name Withheld by Editor (NY)

RE: DMERC A Bug Bites DMERC B
From: Paul Kesselman, DPM

Similar computer bugs which delayed processing DMERC A claims last
month have begun to crop in DMERC B. This despite NO change in carriers in Region B. Administar has reassured suppliers that this issue should be resolved by August 1.

Readers billing DMERC B should be diligent in checking their electronic validation statements to be sure their claims are being properly processed.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.com

RE: Voice Recognition Software
From: William M. Miller, DPM

In regards to voice recognition software, I have successfully used "Via Voice" by IBM. It comes with specific recognition of 35 medical specialties, including podiatry. Like all voice software it takes about three months to train.

Its cost a few years ago, along with a Dictaphone, was about $1,200, I dictate all day, then come home at night, plug it in to your PC and let it download all of my notes. It is purchased through Crown International http://www.crownaudio.com/ and has a fantastic support division. They also sell Dragon.

William M. Miller, DPM, Bergenfield, NJ, doc421@optonline.net

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

ASSOCIATE POSITION- SOUTH CAROLINA

Associate position available in South Carolina south of Charlotte. Two office practice, with two podiatrists, in a growing area. Well-rounded practice with all aspects of podiatry. Opportunity for future partnership. Please send CV to cathykop@hotmail.com or fax it to 803-396-8657.

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

PRACTICE FOR SALE - BERKELEY CALIFORNIA

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well-established podiatry practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to come on board. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3500 patients without a podiatrist. This is a unique opportunity to be able to work in an extremely busy practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE-PARTNER WANTED MICHIGAN-DETROIT AREA WESTERN SUBURBS

Great opportunity-must be hard working, reliable, responsible and good with patients & staff surgical training a plus-partnership after 1 yr. Michigan license required. Fax resume to 248-478-1370 Starting salary $200,000. plus benefits plus percentage. Serious inquiries only

FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations approx 1.5m gross, Buy outright or overtime. Call 561-213-9400 after 7:00 p.m. Serious inquiries only

ASSOCIATE POSITION- COLLEGE STATION, TX

Full time associate position for a surgically trained podiatrist to join an established growing practice in College Station, Texas. This is a great opportunity for a motivated individual to join the leading podiatry group in a family oriented growing community with a wholesome, small town atmosphere. Good package with opportunity for buy-in within two years. Please send CV to billglaze@brazosvalleyfootcare.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

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