The Voice of Podiatrists

Serving Over 14,509 Podiatrists Daily

August 07, 2013 #4,842 Publisher-Barry Block, DPM, JD

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The August issue of Podiatry Management has just been mailed. This special issue includes our cover story, "Podiatry's Residency Crisis: How We Got Here, Why it Matters, What Can be Done", as well as an assortment of features, including our informative columns, and a round table on the residency crisis. 

August 13 Podiatry Management

OH Podiatrist Uses MLS Laser Therapy to Treat Plantar Fasciitis

Dr. Maggie Lisle, who spends a lot time on her feet as an eye doctor, has a condition called plantar fasciitis or heel pain. "I tried orthopedists, which I had tried before, stretches, cortisone shots, physical therapy, and you name it, I tried it." That is until she found Dr. Kristin Titko, a podiatrist who is now treating patients with what's called  MLS laser therapy. "It's actually all infrared light, but this is the only system that has two wavelengths working together to accomplish the results."

Dr. Kristin Titko

MLS Laser therapy can be used for diabetic neuropathy, the heel pain that she has, and other conditions. "We treat acute injuries like tendinitis or an ankle sprain; we treat nerve damage, which may be tarsal tunnel and we may treat a more chronic condition, such as a wound that is not healing," said Titko. That cost covers, in most cases, six to ten treatments. Maggie Lisle says she noticed a big improvement after about the third therapy session. "It's improved about 95 percent. I am running again," she said.

Source: Liz Bonis, WKRC-TV [7/26/13]

IFAF Holds Quarterly Board Meeting

The Board of Directors of the International Foot & Ankle Foundation for Education and Research recently completed their 2013 quarterly board meeting in Seattle, WA. The board approved several new venues for the 2014 educational programs and reviewed the current status of the newly created IFAF Membership category.

IFAF Board (L-R) Drs. Rex Nilson and Cherie Johnson, Tresha Carter, Director of Administration; Drs. Dock Dockery, Byron Hutchinson, Erin M. O'Rourke, Marc Kravette, and Mary E. Crawford.

Membership in the organization is available by going to the IFAF website internationalfootankle.org. The Board of Directors also elected Mary E. Crawford, DPM to the IFAF Board at this session.

NC Podiatrist Re-appointed to Board of Podiatry Examiners

Dr. David Kirlin of Gaston County has been re-appointed to his second term for a licensed podiatrist seat at the Board of Podiatry Examiners. Each term length is three years.

Dr. David Kirlin

Kirlin, a graduate of the Temple University School of Podiatric Medicine, completed his residency at  Metropolitan Hospital in Sringfield, PA. He is Board Certified by the American Board of Podiatric Surgery and was named the North Carolina Podiatrist of the Year in 1998.

Source: Craig Jarvis, News and Observer [8/4/13]

Pennsylvania Consortium Creates Preceptorship/Fellowship Template

The Pennsylvania Podiatric Medical Association, Temple University School of Podiatric Medicine, The Goldfarb Foundation, and the Guild have created a template for a preceptorship/fellowship that may be used in other states. This program was submitted to the Pennsylvania Department of Insurance and the major professional liability carriers. The template is composed of an introduction, suggested curriculum, suggested contract, as well as correspondence that was used in PPMA's interaction with the state insurance department.

Dr. Joseph Pasquino

Dr. Joseph Pasquino, PPMA President stated, "This effort reflects the leadership of nine PPMA members who stepped forward to try to employ an unmatched graduate in some manner. We hope that other states can use these forms to encourage their members to offer a position to these graduates." Pennsylvania does not require a residency prior to licensure, so this program is good within Pennsylvania. A compendium of state requirements for licensure is available at fpmb.org/compendium.asp. An interested state can access its own state requirements and adapt the forms for usage in that venue. The template is available on the PPMA website ppma.org

Query: Hill Podiatry Chairs

I am in the process of purchasing podiatry chairs and I know there has been discussion in the past regarding Hill chairs. My understanding is that Hill has made some improvements. I am interested in hearing the pros and cons from those doctors who have personally used Hill chairs over the past few years.

Marc Katz, DPM, Tampa, FL

Query: Lesser MPJ Implant

What is the correct code for an arthroplasty of a lesser metatarsal-phalangeal joint and insertion of an implant?

Paul Gill, DPM, Severna Park, MD

Response: Unfortunately, there is no code for arthroplasty with implant of the lesser metatarsal joints. This procedure will require using unlisted foot code, CPT 28899, and providing documentation with the operative report attached to your billing. Request peer review, if possible. I also suggest that you contact the insurance carrier PRIOR to performing the operation since many insurance companies consider implants of the foot investigational and will not pay.

Finally, you can consider billing the procedure using:
CPT 28122 - ostectomy, metatarsal or tarsal bone
CPT 28124 - ostectomy, phalanx

While these codes do not reflect the additional work performed when inserting an implant, they accurately describe work done. Use one code or both, depending on exactly what was done in surgery.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Cyclist with Bilateral Forefoot Pain (Mark Aldrich, DPM)
From: Rich Blake, DPM

I have seen that many times in my cyclists. When it is bilateral, you need to think mechanics. What would irritate the nerves going into that area involving all the toes? It has to originate from the tarsal tunnel or higher. Typically, it is from dropping his heel down too far, over-stretching the sciatic nerve/tarsal tunnel nerves. The irritation can be at the ankle, especially if he is over-flexible at the ankle, or at the knee, especially if he tends to straighten the knee too much. Changes in seat, technique, and terrain can help.

Rich Blake, DPM, San Francisco, CA, bbrlb756@gmail.com

RE: Pre-Surgery Questionnaire (Philip Larkins, DPM)
From: Sloan Gordon, DPM

I am personally not aware of such a document. However, that said, we do ask "for medication history, psychological problems, all hospitalizations and all doctors seen."  When we expect someone to be on opioid analgesia (e.g. post-fusion or amputation), we do a routine urine toxicology screen as part of our pre-op work-up to determine if the patient is narcotic tolerant vs. narcotic naïve. For fusion patients, we also screen for nicotine if we suspect they have not been honest about their nicotine use.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Diagnostic Ultrasound (Michael Forman, DPM)
From: Thomas Graziano, DPM, MD
 
I submit that those who use ultrasound for plantar fascial and neuroma injections are doing so for billing purposes. I'm not being critical.  It's fine to bill for advanced technological modalities if you have them at your disposal. But please don't do so under the guise that ultrasound-guided injections are more precise or accurate for these conditions. Let's not kill a mouse with an elephant gun. How about palpating the medial calcaneal tuberosity or the distal intermetatarsal space respectively prior to giving the injection. I think that a "series of 3 steroid injections" are bound to hit their target, even without using ultrasound guidance. Some "with and without" ultrasound guidance outcome studies are probably in order.

Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: Recommendations for Securing Small Business Loans (Daniel T. Hall, DPM)
From: Kathleen Neuhoff, DPM

If at all possible, secure your loan with a local bank that does not "sell" its loans to others.  Be sure you bring to the bank a viable business plan. There are numerous books with templates for producing a plan, and banks will expect that you will be able to show them how you plan to repay their loan and meet your other expenses at the same time.  

Be sure to borrow enough money. Remember to account for your living expenses and remember that most new businesses (even practices) take three years to become profitable. Don't forget to get a line of credit for your new business. There WILL be unexpected expenses!

Kathleen Neuhoff, DPM, South Bend, IN, vetpod@aol.com

RE: Treating Homeless Patients (David Wolf, DPM)
From: Sloan Gordon, DPM

This is a very noble effort. I suspect that is why many of us became involved in medicine. I echo the letter of Dr. David Wolf and add this: we get called from the regular ER and Elder ER to see patients, some of whom are 'homeless' or without the ability to pay.  We take care of them and do our best. We document this. In fact, our hospital has a department dedicated to try to get these folks Medicaid so they may have continued care.

I don't think [obviously not a legal opinion] you have to concern yourself about following up with labs, etc. Many of these patients are grateful to have any care. As podiatrists, I think we do a great job for them.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: APMAPAC Donates $10,000 to CA Podiatrist's Campaign (Russell J. Barone, DPM)
From: Lee Rogers, DPM

Obamacare is not an insurance plan. It is a new set of rules that insurance companies have to abide by. I have and will continue to propose that all federal elected officials be given a choice of Medicare or Tricare for their health insurance. If it's good enough for our seniors and our troops, it's good enough for Members of Congress.

Lee Rogers, DPM, Simi Valley, CA, lee@leerogersforcongress.com

OFFICE AVAILABLE - TACOMA, WA
 
Podiatry clinic available for podiatrist one or two days a week. Current doctor does no bone surgery. Perfect for someone wishing to supplement a current office or a new practitioner looking to get his foot in the door in the Puget Sound area. Email CV and cover letter to 4MYFEET@sbcglobal.net.

NEW PRECEPTORSHIP POSITION NOW OPEN

Philadelphia based multi-doctor practice offering preceptorship. Unique practice blending ‘traditional’ podiatric services with acupuncture, sports medicine and podiatric pain management. Individual must be motivated, personable and have strong computer skills. Please respond by email with resume and  CASPR application. Selection process will be completed quickly, so please respond timely if you are interested. ediamond7@comcast.net

EQUIPMENT FOR SALE - DIOWAVE 15 WATT, PORTABLE 980 LASER

This is a used multiple function laser, plantar fasciitis, Achilles tendonitis, joint pain. nerve pain, post surgical, warts, toenail  problems, two-year plus warranty, MSRP: $25,000. E mail Dr. Zuckerman at: footcare@comcast.net for questions and pricing.

PRACTICE FOR SALE - STAMFORD, CONENCTICUT

Well rounded general and surgical podiatry practice in beautiful Stamford, CT. 35 years. Walk to the hospital and OR. $350k gross / 4 days per week. May lease present office space. Super office manager. Practice offered @ $100k. jefre1@msn.com

PRACTICE FOR SALE - HUNTINGTON PARK, CA

46 years same location. Unsurpassed visibility on corner of major intersection. 3 fully equipped treatment rooms. Perfect opportunity to build a strong practice. Must retire due to age. Selling price $30,000 firm. (323) 588-1179 MTWF. evaonofre@hotmail.com

PRACTICE FOR SALE- CONNECTICUT

Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com

PRACTICE FOR SALE - NORTH CAROLINA

Rapidly growing start up practice in rapidly growing college town in Eastern North Carolina. Excellent teaching hospital nearby with privileges available. Must sell due to health reasons. Serious inquires only. Reply to drcivatte@gmail.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to :practiceforsaleswfla@gmail.com

ASSOCIATE POSITION - CENTRAL PA 

Looking for an associate with 3-year surgical residency. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to stringernyc@hotmail.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - SOUTHEAST MICHIGAN

Seeking a quality-oriented, patient-focused PSR trained associate for a fast paced, established group practice in Southeast Michigan. This is a secure, long-term position. Emphasis on diabetic foot and wound care.  Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. Partnership possibility for the right individual. If you are highly motivated, ethical and have good communication and clinical skill, please forward you C.V. to:cfsdr@yahoo.com 

ASSOCIATE POSITION – PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to: 123bunion@gmail.com

POSITION AVAILABLE - MASSACHUSETTS

Boston Medical Center. Full-time career opportunity: surgery, diabetic foot care, wound care, general podiatry, resident training & research. Split position: (90%) on-site BMC and (10%) off-site health center clinics Boston University School of Medicine Academic appointment. Requirements: Completion of 24-36 month surgical residency. Please forward CV and letter of interest to: Erin.walker@bmc.org

ASSOCIATE POSITION - HUDSON VALLEY NY

Part time position in busy practice leading to f/t. Looking for well trained minimum PSR-12 with great technique and people skills for part time leading to f/t position in fast growing practice. Competitive salary with huge growth potential. Send cover letter, CV and work experience to:PodassociateNY@gmail.com

ASSOCIATE POSITION - DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base.  Base Salary$120,000, benefits and bonus structure. EMR;diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.com

ASSOCIATE POSITION - CONNECTICUT

Looking for an associate with 3-year residency training for a practice in Connecticut. Interested in all aspects of podiatry including  foot/ankle surgery and wound care. Hospital located close by with appointment to staff readily available. Will lead to partnership Please send CV to:dsharnoff@hotmail.com

ASSOCIATE POSITION - ROCHESTER, MN

Rochester Clinic, a multispecialty practice, is seeking a BC/BE podiatric physician. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, primary care, and surgery. Rochester is the third largest city in the state, and boasts top-rated public schools. Please send resume or inquiry to Careers@RochesterClinic.com

ASSOCIATE POSITION – VIRGINIA

Established private practice, strong referral base.  Hospital and surgery center privileges. Two locations with modern offices. ABPS qualified or certified. Competitive compensation package. Potential for position to lead to partnership. To apply, please email a letter of intent and CV to Practice Administrator at: vaposition@yahoo.com

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