The Voice of Podiatrists

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August 03, 2007 #3,005 Editor-Barry Block, DPM, JD

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Consumers Need to be Educated on Nail Salon Safety: IL Podiatrist

Even though infections resulting from carelessness during pedicures are rare, such problems do occur. With the popularity of pedicures on the rise, local experts advise salon clients be wary of improper sanitation. "We're not trying to put nail salons out of business," said Dr. Joseph Borreggine, a podiatrist in Charleston, IL for 15 years. "We're trying to educate our patients."

Dr. Joseph Borreggine

Borreggine said he treats patients with pedicure-related problems only on occasion, but some of the cases have proven quite serious. He cited a diabetic with poor foot circulation who required a leg amputation after a bad pedicure led to an infection. "The fact is, that's how severe it can be," Borreggine said. "It's not something we see often, but when we do see it, you always hear the same story: The patient has gone into the nail salon, and they get an infection."

To lessen the dangers of improper pedicure sanitation, Borreggine recommends that clients bring their own pre-sanitized instruments to the salon. Hernandez believes kits available for purchase designed specifically to address this present their own problems, in that clients sometimes put their used instruments back in a moistened bag that becomes "a little greenhouse, a breeding ground for bacteria."

Source: Nathaniel West, Decatur Herald and Review, [7/29/07]

MD Podiatrist Opens Another Marina and a New Pathology Lab

Dr. Steven J. Berlin and his marina partners (Dr. Selvin Passen, Dan Naor and Ed Hitchcock ) recently cut the ribbon on the new Baltimore Inner Harbor Marine Center 6-23-07. The marina is the most sophisticated marina on the East Coast, consisting of 136 slips. It is geared to handle the largest of all private yachts up to 800 feet. The floating concrete piers sit in the center of the Baltimore Harbor.

Dr. Steven J. Berlin (far right) and his Marina partners with the Mayor of Baltimore City, Sheila Dixon (left).

The marina is owned by the city of Baltimore and was built by the partnership for Baltimore City and the State of Maryland. Dr. Berlin is also a partner in the new Baltimore City Heliport (which is now becoming a public heliport) andThe Baltimore Marine Center, which is the largest marina in Baltimore with over 460 slips. Dr. Berlin recently teamed up with Dr. Robert Alberhasky to form PODIA a new Podiatric Pathology Laboratory.

P4P Demo Pays Off For Medicare, But Not For Most Doctors Involved

Ten large physician practices participating in one of the first Medicare pay-for-performance projects have proven that such programs lead to better performance, according to government officials. But only two practices were able to reduce costs enough to receive any additional pay.

CMS found that all of the participants were able to hit or exceed standards on at least seven out of the 10 clinical quality measures for the treatment of diabetes, the only condition targeted in the project's first year.

But for eight of the large practices, the amount of money they saved Medicare was not enough for them to share in the reward. This means that 80% of the medical groups incurred upfront costs to implement the care management reforms needed to participate but were unable to get money back from Medicare to help pay for improvements. In some cases, the uncompensated investments totaled millions of dollars.

Source: David Glendinning, AMNews [8/6/07]

Query: Portable Recording Doppler

Can anyone recommend a portable, small, recording Doppler for vascular testing that could be used on house calls?

Art Korbel, DPM, Pompano Beach, FL

Query: Biomechanical Exam Code

What CPT code do I bill for a biomechanical exam of the lower extremity?

Julie Rubel, Findlay, OH

Response: There isn't a specific CPT or HCPCS II code assigned for performing a "biomechanical exam" of the lower extremity.

That said, CPT 95851 (range of motion measurements and report [separate procedure]; each extremity) is billed by some podiatrists for the service you are inquiring about. This quantitative report should detail information (complete written report) on the examination for the lower extremity from the hip down. This code is used for each extremity examined.

Other podiatrists do not separately bill for a biomechanical examination, but instead build-in the exam within their orthotic fee.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Foot Scanning Devices (Dan Kasen)
From: Josh White, DPM, CPed

SafeStep features the Aetrex iStep Evolution Rx foot scanner. iStep identifies and analyzes pressure points, accurately measures foot length and width and creates a 3-dimensional image of the foot. Combined with the Mosaic insole that features small removable pieces, pressure can be specifically reduced beneath areas of high pressure. As a patient information tool, the iStep very effectively provides patients with a free, color printout of their feet with pressure distribution.

Josh White, DPM, CPed, President, SafeStep, joshwhite@safestep.net

RE Sanding Discs (Stanley Luksenburg, DPM)
From: R. D. Teitelbaum, DPM

E.C. Moore, Co., Inc also makes an extra coarse disc in the same garnet snap-on style. This may solve your problem. But these discs really do the job and you have to be careful of disc "runaway" which can scorch the skin. There is a learning curve here---but very do-able.

R. D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Tricenturion DMERC Program Safeguard Contractor Region A/B and Results of Audit of Foam dressings such as PolyMem
From: Ken Malkin DPM

If you dispense these type of dressings I highly suggest you follow this link and read the short 2 page report. The picture is not pretty.

http://www.tricenturion.com/content/Doc_View.cfm?type=pac&File=surgical%20dressing%20probe%20results%20article%2020070725%2Edoc

Ken Malkin DPM, Caldwell, NJ, drmedicare@aol.com

RE: Grafting Materials for Venous Stasis Ulcer (Jeffrey Kass, DPM)
From: Philip Jay Organ, DPM, Marc Katz, DPM

Apligraf is an excellent choice for a stasis ulcer and will usually speed the healing process providing key elements are dealt with prior to its application. Venous and arterial Doppler studies will determine if there is correctible vascular disease. If there is unresolved arterial disease mixed with the venous disease, the ulcer may not readily heal no matter what you do. A TCOM study will help to determine local circulation at the ulcer site and will suggest if hyperbaric therapy will be needed in conjunction with the graft. One of the key indicators for HBO is to enhance graft survival. Finally, wound bed preparation needs to be provided. One must assume that the patient has received weekly ‘surgical excision’ of any necrotic tissue (more commonly called debridement) and compression therapy – preferably with a Profore dressing and/or a sequential pneumatic pump device. Continued compression, wound bed preparation and adequate circulation are factors necessary for most insurance reimbursement models.

Philip Jay Organ, DPM, Naples, FL, philorgan@yahoo.com

I have rarely used a split thickness graft for a venous ulcer unless it was totally resistant. It is not true that Apligraf is good for wound bed preparation. It is excellent for complete and rapid closure if there is already a good wound bed. There is no need to harvest a graft and create another wound. I would agree that all of the other skin products are just wound bed preparation collagen material and these have little use in venous ulcers or other ulcers for that matter.

I agree that seeing a vascular surgeon for incompetent saphenous vein closure of perforator closure is also a wise choice for long-term resolution.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor’s Note: This topic is now closed.

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION -CONNECTICUT-NORTH HAVEN

Seeking a part-time associate for a busy, well-established, respected, growing practice. Desiring an ethical, motivated, personable, well-trained PSR12/24/ or 36 podiatrist. Our practice is well-rounded and diverse with a good mix of sports medicine, diabetic care, surgery, podopediatrics, and general podiatry. Email information and CV to Pedy7@aol.com with subject heading “Podiatry Associate.”

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

POSITION AVAILABLE- MANHATTAN, NY

Immediate position for a part associate to work x3 days/wk. Office based OR suite with nitrous and power. Midtown-Park ave. entrance with a total of four treatment rooms and a private office. Candidate must have PSR/24 with experience, Interested parties Fax CV, references and requirements to (770)497-4343.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-486-3548 ---------------------E-Mail sschneider@homephysicians.com -- www.homephysicians.com

NEW JERSEY - OCEAN COUNTY - IMMEDIATE OPENING!

Part time associate wanted. Tentative hours: Tues - AM, Thurs - PM, Sat (every other) - AM Definite growth potential. Looking for an ethical and conscientious practitioner. Competitive salary with incentives. Great working environment! Please fax CV to:(732) 695-0223 or e-mail to shorepodiatry@aol.com

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

ASSOCIATE POSITION – PART TIME - BRONX, NY

Part time associate position available in the Bronx, NY. Two days a week. 30K/yr + incentives. Full-time position may be available shortly. Must be ethical, hardworking, and Spanish speaking a plus. Please email resumes to Scottdeis@aol.com

ASSOCIATE- SOUTH JERSEY

PT/FT wanted for progressive (EMR, Digital x-ray, Diag U/S ), ethical, full scope group practice. A motivated team player with very good surgical and routine skills. ABPS cert and 24/36 PSR preferred but will take experience into consideration. Located between Phila. and the shore. A very fair benefits /compensation package. CV and references Toetrukr@aol.com

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Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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