The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 03, 2010 #3,921 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Smoker's Feet Reveal Their Addiction: KY Podiatrist

Dr. Benjamin Schaffer could have become a dentist like his father, but he became fascinated with feet. For nearly 30 years, the 55-year-old Louisville podiatrist has been taking care of tootsies, from toddlers' to truck drivers'.

Dr. Benjamin Schaffer (Photo: Matt Stone)

"People are very surprised when they're smokers and I inform them, after looking at their feet, that I can tell that they're a smoker. They can't believe that. The blood doesn't look the same through the skin. It makes your blood have a different color and your tissue doesn't look the same. It also exaggerates hardening of the arteries, so the skin doesn't look like it should. The skin is usually purplish," said Schaffer.

Source: Darla Carter, Courier-Journal [8/1/10]

FL Podiatrist is Co-founder of Save a Leg, Save a Life Foundation

Too many people develop life- or limb-threatening leg problems, such as wounds that don't heal or clots that form deep inside their veins. A growing number are overweight and many have diabetes. Add those factors to an aging population, and lack of awareness about alternatives to amputation, and you know why Dr. Desmond Bell was in Lakeland last week. The co-founder of Save a Leg, Save a Life Foundation came at the urging of wound-care specialists to help them start a foundation chapter here.

Dr. Desmond Bell

"It's open to anyone who has been touched by either the fear of amputation or a wound that hasn't healed," Bell said, One of the non-profit group's goals is to reduce the number of partial or total leg amputations. "More than 50 percent of amputations have not had medical tests done," said Bell, a Northeast Florida podiatrist who focuses on limb salvage. He attributes excessive numbers of amputations, in large part, to lack of awareness by patients and doctors about alternatives. "They just took one look and assumed it had to come off because there was black tissue on the foot," Bell said.

Source: Robin Williams Adams, The Ledger [8/1/10]

WA Podiatrist Running for Congress

David Schirle, DPM, 62  is running for Congress as an independent. Schirle earned a Doctor of Podiatric Medicine from the California College of Podiatric Medicine, and a medic certificate through Special Forces Medic Course at Fort Bragg, NC. "My motto for the campaign is: 'Not one penny more.' That says it all. The federal government consumes 18 percent of the gross domestic product. The truth is they did not just spend the 18 percent. They spent more and went into debt to the tune of $13 trillion. I have a job and I like it. I do not need all the negatives that come with 'this' job. But someone has to stand up and say not one penny more and that is what I intend to do."

Dr. David Schirle

His  priorities include balancing the federal budget, defending the U.S. Constitution, cutting federal spending, repaying the debt, opposing earmarks, reading every bill before voting on it, and pushing to simplify the content of legislation so that each bill deals with only one subject. Schirle ran for the U.S. Senate in 1994 as a member of the Patriot Party which was inspired by Ross Perot's bid for the presidency two years earlier.

Source: Herald Net.com [7/31/10]

Nixed Medicare Consultation Codes Force Doctors to Make Cutbacks

Thousands of physicians say they have been forced to adopt a number of damaging cost-cutting measures as a result of Medicare discontinuing its use of consultation codes, a policy adopted by the Centers for Medicare & Medicaid Services that took effect on Jan. 1. Consultation codes are used most frequently by specialists after patients are referred to them by primary care physicians. Starting this year, Medicare eliminated the use of all consultation codes except telemedicine consults. It directed physicians instead to bill for the visits using only evaluation and management codes that apply.

According to a survey of approximately 5,500 physicians, the vast majority of specialists have seen their revenue stream drop after the change -- most by more than 5% -- and three out of every 10 already have reduced services to Medicare patients or are contemplating other cost-cutting steps that will impact care.

Source: Chris Silva, AMNews [8/2/10]

Speak Strong

Certain words and phrases soften and even nullify your message. You will sound more confident and professional if you avoid wimpy qualifiers like these:

•  As far as I know …
•  Probably.
•  For the most part …
•  Sort of …
•  Pretty much.

Bottom line: Stand behind your words, stating facts and opinions without hiding your convictions behind qualifiers.

Source: Adapted from Presentation S.O.S., Mark Wiskup,Warner Business Books via Communication Briefings

Query: Electronic Health Records (EHR) and ICD-10 implementation

As we know, we can implement usage of EHR this year, however, ICD-10 diagnosis codes will be mandatory in a few years. In quick summary, the ruling requires that the ICD-10-CM code be set by October 1, 2013. EHRs are designed to match the objective phrase in the note with a specific diagnosis code. For example, a phrase such as "the digit revealed non-reducible plantarflexion at the proximal and distal interphalangeal joints" would be tied to ICD-9 diagnosis code 735.5.  All ICD-10-CM codes will consist of seven (7) characters.

In order to make the transition occur more smoothly on January 1, 2012, standards for electronic healthcare transactions change from Version 4010/4010A1 to Version 5010. These electronic healthcare transactions include functions like claims, eligibility inquiries, and remittance advices.  Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. When ICD-10 diagnosis codes are mandatory, it appears to me that an entire rewrite of the EHR system will be necessary. Does anyone have an idea as to how much this is going to cost us?

Richard A. Simmons, DPM, Rockledge, FL, RASDPM32822@aol.com

RE: Orange Nails (Joan E. Schiller, DPM)
From:  Nicholas Taweel, DPM

Although I haven’t the slightest clue as to why his nails and bathtub are orange (sounds like rust), I would recommend a full medical work-up to include tests for liver and kidney function. Since I doubt that his water system was spiked with Tang, I would be very concerned about a toxic substance.

Nicholas Taweel, DPM, Philadelphia, PA, ntaweel@gmail.com

RE: Foot Size as a Growth Indicator? (Bill Zaccardelli, DPM)
From: Philip Wrotslavsky, DPM

The most accurate and easiest method of predicting adult height that I know has been developed by Dr. Dror Paley. He has used this method accurately in limb-lengthening procedures on many, many patients. Below is a link to the study that he used to publish his method. It is also in his book Principles of Deformity Correction. With this method, you can give an accurate prediction, to the centimeter, of a child's expected growth. I do this regularly in my practice. Having done his fellowship, I can say I did not see one parent come in during the time I was there and say that his prediction was inaccurate.

The best way to learn the proper use of his method is either to do the Baltimore fellowship, or attend the Baltimore deformity correction course (ncbi.nlm.nih.gov/pubmed/15502579).
 
A copy of his method can also be found here. Interestingly, He, along with Dr. Brad Lamm, have a formula in predicting adult foot length -  see (ncbi.nlm.nih.gov/pubmed/16791059).

Philip Wrotslavsky, DPM, Poway, CA, drphilipw@msn.com

RE: Documentation on Therapeutic Shoes
From: Paul Kesselman, DPM

I have received many follow-up questions to my recent posting on proper documentation of Therapeutic Shoes. Here are my responses to these questions.

1) The ”Supervisory Physicians Statement” (SPS) is not sufficient documentation. I agree that the PCP is inundated with paperwork and applaud your philosophy of having the patient being the ”messenger.” Also, you should give the patient a copy of their diabetic foot examination along with the SPS, with the appropriate instructions for completion.

2) A patient may be billed for a diabetic foot examination prior to...

Editor's Note: Dr. Kesselman's extended-length letter can be read here.

RE: New Platelet Rich Plasma Code
From: Gregory Mangum, DPM

On July 1st, 2010, the following new category III code for the performance of platelet rich plasma (PRP) injection procedures was published by the AMA CPT.

Code- 0232T - PRP, any site, including image guidance, harvesting and preparation - not to be used in conjunction with other injection codes( 20550,20600, 76942), nor can it be part of a larger surgical procedure. More information can be found at: (lists.aaos.org/t/1224/75855/968/0/)
 
Gregory Mangum, DPM, Houston, TX, Gregorymangum@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

PRACTICE FOR SALE - DALLAS, TX

Prestigious North Dallas location; 24 year old practice; excellent mix of hospital surgery, office surgery, orthotics, general podiatry, web site, electronic claim submission. Retiring owner will stay for transition. Owner financing available. dallasfootdr@yahoo.com

ASSOCIATE POSITION - SW FLORIDA

Golf, Boating and Beaches - Great opportunity to join a well established Podiatry Practice. Excellent mix office/surgery, motivated experienced staff. Seeking full time Associate PSR 12-36. Excellent salary & benefits, early buy-in for the right hard-working, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

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

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

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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.