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PMNews
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PM News |
The Voice of Podiatrists
Serving Over 9,500 Podiatrists Daily
August 08, 2007 #3,008 Editor-Barry Block, DPM, JD
A service of Podiatry Management http://www.podiatrym.com E-mail us by hitting the reply key. COPYRIGHT 2007- No part of PM News can be reproduced without the express written permission of Kane Communications, Inc.
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Aetrex Introduces New iStep Podiatry Kiosk
Aetrex is proud to introduce the iStep Evolution-Rx, the most advanced digital footcare kiosk ever developed for podiatric practices. This patented technology is designed to facilitate and enhance your footwear and orthotic services and features products from many world renowned companies. Designed in conjunction with The Walking Company and leading podiatrists, iStep Evolution-Rx will help you provide a higher level of patient care, generate substantial additional revenue, increase office efficiency and modernize your practice.
To learn more click here http://www.aetrex.com/rx
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PODIATRISTS IN THE NEWS |
Aging Feet, Like Car Tires, Can Be Repaired: NJ Podiatrist
Question, baby boomers: Ever think of your feet as a pair of tires? It's time that you do, now that you're walking/jogging/stiletto-heeling your way through middle age, according to some foot experts.
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Dr. Terry Spilken |
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"Over the course of a lifetime, the tires start to wear down and your feet start to wear down," says Terry Spilken, a podiatrist who has worked with the Alvin Ailey American Dance Theatre and the New York Islanders hockey team.
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"It's part of the natural process. As we get older, things change and we start getting pains where we never had pain before," adds Spilken, of Livingston, N.J. "Just as tires need to be repaired, your feet do, too."
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Source: Meg Nugent, The Star-Ledger (Newark, NJ) [8/4/07]
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DIABETIC FOOT CARE: CONCEPTS & CONTROVERSIES
Cleveland Clinic Live CME, October 5-6, 2007 Fort Lauderdale, Florida www.clevelandclinicmeded.com/DIABETIC07 Activity Key Points: - Diabetic Foot Ulcer Management - Diagnosis and treatment of Charcot Foot - Solutions for therapeutic footwear and orthoses - Surgery in the diabetic lower extremity - Total Contact Cast Hands-On Workshop
EXPLORE FURTHER - www.clevelandclinicmeded.com/DIABETIC07
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AT THE COLLEGES |
OCPM Student Wins Miss Plus America Pagent
Jenna Vaught is a single mother, a third-year student at the Ohio College of Podiatric Medicine and an ongoing dieting success story (she has lost 170 pounds). Last month, the 30-year-old found time to compete in the Miss Plus America pageant and came home with a crown on her head.
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Jenna Vaught |
During her one-year reign as Miss Plus America Elite, the Louisville, KY native plans to promote a platform of diabetes awareness and prevention.
Source: John Campanelli, Cleveland Plain Dealer [8/5/07]
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Dia-Foot Diabetic Shoe Program
Dia-Foot continues to strive to add elite Diabetic shoes to its current selection. Dia-Foot selects shoes from leading manufacturers and offers them to be dispensed to your patients. Dia-Foot offers elite shoes from New Balance, Hush Puppies, Rockport, Aravon, Aetrex, Orthofeet, Soft Spots and Dunham. Dia-Foot manufacturers their own pre-fab and custom inserts. Our custom inserts are produced in just 5 business days. Visit booth 1028 at the APMA Conference to learn about our Diabetic shoe program. You can also visit www.dia-foot.com or contact Gary at 877-405-3668.
Dia-Foot is proud to introduce the New Balance 992 model now SADMERC approved for Diabetics.
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HEALTHCARE LEGISLATION |
New TN Law Makes Doctor Shopping a Felony
The new Tennessee law makes it a crime for people simply to knowingly deceive different medical providers by getting prescriptions for a controlled substance without disclosing that they've already been given a similar prescription within the past month. Controlled substances are drugs that have the potential for abuse or addiction, such as pain relievers OxyContin, Dilaudid and Lortab.
The state recently sent letters to 30,000 doctors, nurses and pharmacists letting them know about the new law and that they can now report people they suspect of doctor shopping. Enrollees did not receive a similar letter. "We sent the letters to providers because that was where the cry was coming from," Faulkner said.
It's now a felony for TennCare enrollees to doctor shop and carries a penalty of one to six years in jail, depending on a person's prior record, said state Rep. Gary Odom, D-Nashville, one of the bill's sponsors.
Source: Claudia Pinto, Tennessean [8/6/07]
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APMA SCIENTIFIC MEETING EVENTS
***NYCPM Alumni Reception *** NYCPM Alumni Reception
The New York College of Podiatric Medicine And The Alumni Association Invite All NYCPM Alumni Who Will Be Attending The 2007 APMA Annual Scientific Meeting In Philadelphia
To a Reception on Friday, August 17th From 6 PM to 7:30 PM At the Downtown Marriott, Salon B
We Look Forward To Seeing You There!
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QUERIES |
Query: Plantar Fascial Pain
I have a 46 yo healthy male with chronic heel pain. He sustained an eversion injury playing basketball in Mar 2003. He was unable to bear weight a few days, but it was left untreated and pain subsided to point that he was able to run a few marathons. He experienced some chronic pain and numerous conservative treatment attempts, including injections, orthotics, night splints, immobilization; all without improvement. MRI revealed some fasciitis with no other pathology. In early 2006 ESWT was performed (Dornier) in-office with no improvement six months later. EPF releasing medial 1/2 of fascia was performed. Pain of fascia insertion resolved, but he continued to have medial heel pain.
X-rays revealed slight spurring of medial calcaneus, which corresponded to clinical area of pain. The heel spur was resected, which resolved the medial calcaneal pain. Now six months post heel spur resection, he continues to have pain about 2-3 cm. distal to fascia insertion plantarly. MRI reveals a 9 mm. wide ovoid area of fascial enlargement in area of question, with no insertional fasciitis. I've adjusted his orthotics countless times. Any thoughts are appreciated.
Steven Block, DPM, Owensboro, KY
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APMA SCIENTIFIC MEETING EVENTS
“Cocktail party: A gathering held to enable people to talk about themselves at the same time. The man who remains after the liquor is gone is the host.” ~Fred Allen
Save the evening of Thursday, August 16 for the Temple University School of Podiatric Medicine Alumni Association in Philadelphia. Renew friendships and reconnect with classmates at the All-Classes Reunion Reception.
For more information contact tuspm.alumni@temple.edu or call 215-625-5248
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CODINGLINE CORNER |
Query: UV Therapy
Has anyone been using UV therapy, CPT 96900 (actinotherapy [ultraviolet light]) for skin conditions (eczema, tinea pedis), and getting paid?
David Sands, DPM, Jamaica Estates, NY
Response: CPT 96900 is specific for actinotherapy (ultraviolet light therapy) used to treat certain skin diseases, such as
Atopic dermatitis; Chronic urticaria; Eczema; Lichen planus; Mycosis fungoides (cutaneous T-cell lymphoma); Pityriasis lichenoides; Pityriasis rosea; Pruritus of renal failure or hepatic disease; Psoriasis; or Vitiligo.
A number of payer plans I have reviewed include actinotherapy as a benefit, but with certain conditions (e.g., http://medpolicy.bluecrossca.com/policies/MED/UV_skin_disorders.html, http://www.empiremedicare.com/newsupda/2001-08/ultroaviolet.htm). The most important issue appears to be the specifics of the conditions/diagnoses being treated.
While eczema (under some circumstances) might be payable for a set course (determined by the plan) of treatment, tinea pedis would not. Before investing in UV therapy equipment, I would recommend you strongly consider
- your practice's ability to attract patients with the above (and other) conditions needing to be treated (or are you planning on trying to attract patients with the above conditons of the foot and/or ankle looking for treatment?); - your specific payer mix, and, at least the major players, policies on actinotherapy payment; and - investigating what will be required in order to perform actinotherapy - equipment, training, staff, space, and time - as well as the liabilities.
Harry Goldsmith, DPM, Cerritos, CA
Codingline subscription information can be found at: http://www.codingline.com/subscribe.htm
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MEETINGS / COURSES
Southwest Foot & Ankle Conference SEPTEMBER 15-16, 2008
DALLAS - Largest Meeting & Exhibit hall in the Southwest!
National Faculty, PICA Risk Management, Wound Care, Biomechanics, Shoe Fitting, H&P, EMR track, Surgical track and more!
Up to 15 CE contact hours. $345 rate for TPMA/APMA/State Affiliated association. $99 hotel rate Westin Park Central. www.txpma.org or 800-TEX-FOOT
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RESPONSES / COMMENTS |
RE: Vancomycin Beads (Will Godfrey, DPM) From: Christopher Formanek, DPM, Marc Katz, DPM
I have had great success with using Osteoset resorbable antibiotic beads manufactured by Wright Medical. The resorbable nature often obviates the necessity for a second procedure in taking out the beads. The beads provide a longer term elution to fight the infection and also have the advantage of repairing bony 64% in osteomyelitis and 98% in non osteomyelitic bone. I had great results in using them in a case where I nearly completely resected an osteomyelitic cuboid bone. In fact the beads filed in some of the defect! You can choose between 3.0 or 4.8 mm beads which you make on the spot in the OR. Contact Wright medical for a booklet in steps for preparing the beads. I find that 0.5 g Vancomycin powder works best although you can also use Tobramycin. It takes about 5 minutes to prepare completely, using the fast cure set. A drain is optional. Christopher Formanek, DPM, Baton Rouge, LA, BRpodiatrist.com
Here is what I use for osteomyelitis after appropriate bone resection. Start with the Osteoset Resorbable Mini-Bead Kit. Get rid of the liquid supplied with the product. In the cup provided add the calcium sulfate powder plus 1 gram of Vancomycin powder. Instead of the liquid supplied, you will be using 3 cc. of Gentamicin liquid. I use 2 Gentamicin 2ml. vials and waste 1 cc. The other 3cc.'s are added to the powder and mixed well and then smoothed into a plastic form that is provided with the kit. Let dry well. I usually make the beads while the scrub tech is setting up and before I start the surgery.
A few tricks. More is not better. If you put too many beads in the wound you will have excess fluid leaking from the area and a lot of maceration. So use a reasonable amount. If you are working with a metatarsal shaft or hole within a bone, push the beads into the bone canals or create some small areas to put the beads. You can also scatter a few in the soft tissue void. I will typically close the wound. If the patient requires several debridements over several days or a week, finish the 2 or 3 debridements and then apply the beads and close.
You can experiment with the medications. I had a patient with osteomyelitis which did not respond to the typical antibiotics. I did a bone culture which grew heavy growth of Aspergillus. In that case, I used Voriconazole(VFEND) and mixed it with the beads. This was in addition to IVAB.
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
Arthrex’s Mini TightRope Hardware (Bruce Williams, DPM) From: David Secord, DPM, Bruce Williams, DPM
I’ve been approached by the Arthrex rep here in my area about this product and found it a nice adjunct in an ankle fracture repair instead of a transmalleolar screw that has to come out, but have hesitated to consider using it for a bunion. My reasons follow the thought that if you have that large an intermetatarsal angle, you probably should be considering a Lapidus procedure or a Fowler procedure or perhaps even a closing base wedge if your typical Austin/Akin won’t get the job done. If any of the more proximal procedures are done adequately, you will get the intermetatarsal correction you seek and correct the hypermobility at the 1st metatarsal base/medial cuneiform area as well.
The second thought is that the picture I was shown of the placement of the tightrope was just about where the perforating artery to the 1st metatarsal is usually located and that can’t be a good thing. The last question was on scarring around the tightrope and the possible entrapment of the afore-mentioned perforating artery and the deep peroneal nerve. The rep in this area for Arthrex really didn’t have any other suggestions, but that the tightrope could get you potentially high intermetatarsal correction without the proximal procedure, setting the patient up for quicker return to weight-bearing. This is nice, but unless I had answers to my other two questions, I don’t think I’d consider it in a bunion. Works nicely in the ankle, however.
David Secord, DPM, Corpus Christi, TX, David5603@pol.net
My thought is that the higher the IM angle in these patients with a flexible deformity, the better it would be to utilize the more proximal placement of the tightrope. In the more proximal area I would expect less use of wire for greater overall distal closure. Then, if necessary, use of a distal osteotomy to finish the job. It makes perfect sense to me that use of a distal tightrope could lead to stress fracture of the second metatarsal, if indeed that is where the wire was placed.
I am not so much concerned about the 2nd metatarsal pulling away from the 3rd metatarsal. I am very interested in how much IM angle closure would be allowed with use of the proximal closure and whether others feel as I do that this would not only be more stable but would tend to be more sound structurally and mechanically over time.
Bruce Williams, DPM, Merrillville, IN, bwilliams@airbaud.net
Editor’s Note: This topic is now closed.
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Case Study #21 -- Sponsored by Atlantic Medical APMA Booth# 619 Patient: Male, 45, Complains pain in the left heel. Ultlrasound imaging report summary: Longitudinal imaging of the medial band of the plantar fascia demonstrates a fusiform hypoechoic mass emanating from the plantar surface of the aponeurosis. The mass does not move with real time imaging and is non-compressible with direct probe pressure. The mass measures 7 millimeters in the long axis and 5 millimeters in the short axis. Impression: Plantar Fibroma Left Foot. Billing: CPT Code 76880 Medicare reimbursement: $88*/unilateral study (2007 average) Equipment cost: $207/month** (** Based on June 2007 pricing) Atlantic Medical LLC is committed to serve all podiatrists with the best ultrasound equipment, training and support. www.atlanticmedicalLLC.com (c21)
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CLASSIFIED ADS |
ASSOCIATE POSITION – GREATER BOSTON AREA
Full-time comprehensive practice with hospital teaching affiliation west of the greater Boston area looking for motivated, ethical, surgically trained podiatrist. Competitive salary and benefits. Call 508-872-9288
ASSOCIATE POSITION - SOUTHERN NEW JERSEY
Busy multi-dimensional practice. 20 minutes from Philadelphia. Board qualified/certified ABPS. Ethical, motivated, personable. Starting 65K plus health, malpractice, CME, bonus incentive. E-mail resume TotalFootCare@aol.com
ASSOCIATE POSITION - LONG BEACH, CALIFORNIA
Busy Long Beach California Practice: Looking for Board certified Associate. Send resume to our Fax@ 562-424-3395
ASSOCIATE WANTED - PHOENIX, AZ AREA
A well established, ethical solo podiatry practice wishes to expand its current surgical services in the near future by hiring a full-time associate with PSR 24-36 training which includes very strong surgical rear-foot and ankle reconstruction, diabetic limb salvage and ER trauma. Successful association may lead to partnership. ABPS Board qualified/certification is required. Applicants must be personable and caring to patients. Practice in an office base within a new state-of-the-art orthopedic surgical hospital environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Email complete CV with current references & photo to footdoc352@cox.net
PRACTICE FOR SALE OR SHARING- CENTRAL FLORIDA
Practice all phases. Wound care, hyperbaric privileges nearby. Excellent building, location, and exposure on busy highway. Outstanding place to live and work; low penetration by managed care. Ample parking and accessibility with 2,000 sq. ft building designed and equipped for podiatry (lease or buy) 7 minutes from hospital. Great price, terms and opportunity to grow. 352-357-7499 - windnwave@earthlink.net
ASSOCIATE POSITION- MEMPHIS, TENNESSEE
A.S.A.P.! Excellent opportunity for well-trained, highly motivated PSR 24/36 or experienced practitioner leading to partnership in one year and complete buy out in five years. Generous salary/benefits first year. Large well rounded practice, heavy in forefoot and rearfoot surgery. Send C.V. - FAX (901) 396-5335 or Email drjoelcook@comcast.net
ASSOCIATE POSITION – MISSOURI
One of our long-term associates needs to relocate due to family reasons. Step into full schedule. Five locations in growing population area without HMO's. Partnership available. Missouridpm@yahoo.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 WANTED – NEW YORK IMMEDIATE OPENING
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
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.”
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
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
WEEKLY SPECIAL - One week of ads (5x) for only $85
PM Classified Ads Reach over 9,500 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 9,000 DPM's. Write 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 dekagan@aol.com
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PODIATRY MANAGEMENT'S AFFORDABLE ONLINE CME You can Earn 30 CPME-Approved CME Contact Hours Online Earn 15 Contact Hours for only $139(Less than $14 per credit) http://www.podiatrym.com/cme.cfm Choose any or ALL (30 CME Contact Hours) from the 20 CME articles posted You Can Now Take Tests and Print Your CME Certificates Online
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Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
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