August 05, 2006 #2,647 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

EDITOR's COMMENTS

1) Hall of Fame Luncheon a Sellout Again

Thanks to a late rush, the Podiatry Management Podiatry Hall of Fame Luncheon is now sold out. APMA will be selling a limited number of tickets in Las Vegas to fill any empty seats or late cancellations. Tickets will be required for entrance and meal service. We wish to thank those who purchased tickets, the proceeeds of which will go directly into the APMA Educational Foundation Student Scholarship Fund.

2) Attention AT&T and Yahoo Subscribers - Due to the anti-spam policies of these ISP's, we are forced to send PM News out individually instead of at one time. This can result in delays of from several hours to several days. We encourage AT&T and Yahoo subscribers to provide us with an alternate address.

Ornstein Honored For Katrina Relief Effort

The Howell Township Council recently honored the humanitarian spirit of its residents. During its July 18 meeting, the council awarded certificates of appreciation, Howell's Finest Award, to members of its emergency service units, business owners, teachers and students, all of whom came together to volunteer their time, energy and resources to help a small community some 1,200 miles away that was devasted by Hurricane Katrina.

"Within two days we had a call for action in place," said Hal Ornstein, a business owner and volunteer at Southard Fire Department who helped to form HESHA. "At first we wanted to help out other emergency services, but then it grew into a community-wide campaign. We started with coin tosses for the emergency services and extended to helping residents."

Research was conducted and residents agreed that their efforts would best benefit Tylertown, MS, residents and its evacuees from the Mississippi coast and New Orleans.

An estimated 2,000 Howell volunteers worked to collect more than $100,000 for the HESHA relief effort and some $400,000 worth of supplies, Ornstein said. Fliers listing the most needed items were distributed throughout Howell, fundraising events were organized, and schoolchildren began devising how they could best help their peers in Tylertown, he said.

Source: Michelle Gladden, Asbury Park Press, 8/3/06

Query: Malignant Melanoma

I have a 59-year-old male patient who presented with a bluish black lesion at the tip of the fifth toe. After wide excision pathology report revealed malignant melanoma Breslow level 1.78 mm (Clark's level III). I am considering amputation at the MP joint as well as sentinel node biopsy. I would appreciate any suggestions regarding level of the amputation and the need for node biopsy including prognosis.

R. Denis Russell, DPM, Fountain Valley, CA, rdenisr@gmail.com

Query: Custom-Casted Tennis Shoe for Diabetics

Pertaining to custom-casted diabetic shoes, are there any recommendations on which shoe companies can make a custom pair of diabetic tennis shoes with moderate to high tops?

Steven S Melek, DPM, Chapmanville, WV, drstevenscott@yahoo.com

CODINGLINE CORNER

Query: Coding Transmetatarsal Amputation

One of my physicians is going to do a transmetatarsal amputation on the 1st, 2nd and 3rd, on a patient that has already had the 4th and 5th metatarsals done, in order to even out the parabola. Should this be coded as CPT 28805 for all three metatarsals? If so, how should we indicate that the 4th and 5th were previously done? Or should it be CPT 28805 for each metatarsal? Or is the correct code to use CPT 28810 for each metatarsal separately?

Susan Toulme, Office of Thomasin Hammer, DPM, Spokane, WA

Response: This qualifies as a trans-metatarsal amputation and the separate metatarsals need not be coded. CPT 28805 (once) is just fine.

Walter Pedowitz, MD, Linden, NJ

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

RE: Doing Business With Patients (Elliot Udell, DPM)
From: Andrew Schneider, DPM, Jon Purdy, DPM

I have done business with patients over the years, with varying results. While I don't have a hard and fast rule about it, I've learned to pick and choose who I ask for quotes from. I make sure it’s someone who I have a very good relationship with. I don't usually ask patients for ongoing services (i.e., accountant, physician, dentist, etc.) because ending a relationship if you're not happy is very difficult. I made that mistake with using a patient as an insurance agent.

I suggest that you still get competing estimates when you are planning on using a patient for any service. If your patient's quote comes out much higher than the others, as it was in your case with the curtains, ask them about it. They may be able to tell you why there is such a difference in cost. I'm also wary of a patient who drastically undercuts a competitor's price because I don't want to be beholden to them down the road. A patient should not be offended to know that you received other estimates as they encounter that in the course of doing their everyday business.

When you identify a patient that you don't want to engage in business with, don't even get a quote. If they ever call you on it ("I see you have new curtains, why didn't you call me?"), I just play dumb. ("I completely forgot you were in the business. I'm so sorry I didn't think of you.") This topic was on my mind, as I've been getting quotes for office work that I'm getting done when I'm away at the APMA conference next week. For this job, I'm looking outside my patient base entirely.

Andrew Schneider, DPM, Houston, TX, ajsdpm@aol.com

One should keep clear of doing business with friends and family just as one should stay clear of doing business with patients. Not to say that it can’t work but these type of rules of thumb exist because the potential risks are outweighed by the benefits. If you are the type of person that can easily separate a business transaction from a personal interaction, then you will most likely tend toward thinking others have the same ability. I contend that the majority of people do not posses that type of reasoning.

Therefore a potential disaster can befall the business deal gone bad with a friend, relative, or patient. On the other hand, if a deal turns sour with a business associate then the loss of the deal is the only loss.

I wish I could say that I always follow the advice of minds much greater than mine, but I too occasionally fall into these traps. It does make for a great hands-on lesson. Most recently I allowed a low income patient to iron my shirts since that is “what he does” for extra money. I’m sure you have guessed already, but this was the worst job I have ever seen and I’m thinking of referring him to the eye doctor. Well he is still a patient and a very nice gentleman, but now I am in the position of having to make excuses until he gets the hint. Not a position I like to be in.

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

RE: Beware of Tequin
From: Warren Joseph, DPM, Elliot Udell, DPM

Tequin (gatifloxacin) was pulled by its manufacturer BMS because of problems with causing both hyper- and hypoglycemia in patients. The straw that broke the camel’s back was a study published out of Canada in June in the New England Journal of Medicine. This has been a known problem with this drug for many years and, in fact, is a bit of a “class effect” that can occur with other quinolones also including Levaquin. Anyone interested in the details of the studies can go to www.pubmed.gov and search “gatifloxacin AND hyperglycemia.”

The reason I am replying is to open discussion on two other issues that need to be stated about Name Withheld’s posting.

1. He mentions that he discussed the drug choice with the oncologist. I am all for multidisciplinary, patient centered care but please do not think that the pt’s MD will know anything more about antibiotic selection than you do. In fact, he/she will most likely NOT. The only specialist that can be counted on to know antibiotics is infectious diseases. You may think that you have difficulty keeping up with antibiotics but the average primary care provider or other specialist has more classes of drugs to keep up with than we do. We are, or should be, the specialist on choosing the proper antibiotic for the patient’s lower extremity infection. If you don’t know them…learn them. Discuss the case with the others involved but don’t abdicate your responsibility.

2. I have been preaching about the overuse of quinolones for over 15 years. This class of drugs has problems! Probably more quinolones have been pulled from the market than all other classes of drugs combined. Can you say Trovan, Omniflox, Raxar? Their spectrum of activity is NOT ideal for lower extremity infections with tremendous resistance issues. Yet, these drugs continue to be some of the most common antibiotics written in our profession. I still see pods write for Cipro for surgical prophylaxis! These are useful, potent antibiotics but please use them with your eyes wide open.

Warren Joseph, DPM, Huntingdon Valley, PA, wsjoseph@comcast.net

This message brings up an important topic. When we see ads from negligence attorneys telling patients to come to them if they have side-effects from certain medications, does this mean that these pharmaceuticals should be avoided? I'm talking about drugs that are still on the market. All medications have the potential for side-effects. Look at the PDR. Each and every medication can bring on an ill affect. What kind of exposure does a doctor have when he or she prescribes a medication and the patient gets one of these rare side affects? Do we have to sit down with every patient prior to writing a prescription for an antibiotic or pain medication and go over a long list of potential side-effects?

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

Southeast Florida Podiatrist Needs Top Notch Candidate

South Florida podiatrist looking for an astute, personable, extremely well trained podiatrist with excellent clinical skills and acumen. My practice is busy, rapidly growing, and referral based. Looking for a full time associate to start immediately. Partnership opportunity available. I require someone who can work independently and wants to help elevate this practice to a new level. Email your resume to podiatry49@hotmail.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

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

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• 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.