The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 10, 2010 #3,927 Publisher-Barry Block, DPM, JD

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The quotes attributed to Dr. Kevin Kirby in the August 9th edition of PM News were actually made by Dan Lieberman, professor of human evolutionary biology, Harvard, Cambridge, Massachusetts. We have reprinted the correct quotes made by Dr. Kirby in the section "Podiatrists and Sports Medicine" which appears in today's edition and we have retracted the incorrect quotes attributed to him. We apologize to Dr. Kirby for this error.   

Platforms are Better Than Stillettos: NY Podiatrist

"In the short term, there is the possibility of increased ankle instability which may lead to a higher incidence of ankle sprains and fractures," says Dr. Maria A. Branca, podiatrist on staff at St. Joseph's Medical Center, and a private practitioner in Yonkers. "There is increased pressure to the ball of the foot and the forward pressure can lead to trauma to the toenails as well."

Dr. Maria A. Branca

But ladies, this doesn't mean that you have to say goodbye to your favorite pair of Jimmy Choos or toss those BCBG platform wedges into the trash. If you must wear heels, says Branca, those with a platform are a better option than stilettos. "Platform shoes may be easier to balance in, due to the fact that they have more of an even lift in the front, and the height of the platform actually decreases the height of the heel," she says.

Source: Sarah Calandra Fine, LoHud.com [8/3/10]

Risk in Wearing Flip-Flops is How You Wear Them: NY Podiatrist

They're everywhere when the weather turns warm, but a podiatrist warns that flip-flops carry more risks than blisters and stubbed toes. Dr. Rock Positano, the director of the Non-surgical Foot and Ankle Service at the Hospital for Special Surgery in New York City, says the risk is not that people wear flip-flops — it's how they wear them.

Dr. Rock Positano

"I have no objection when patients ask, 'What is the best way to wear these types of shoes?' I always say, 'Look, use your head — if you're hanging out by the swimming pool or hanging out on the beach, they really cause no damage or no problem,'" Positano tells NPR's Michele Norris. "When people develop problems is when they wear them in an usual situation — such as 5-mile hikes or standing on their feet for 5 to 10 hours on a trip." Positano says that's when he sees tendinitis, heel problems, Achilles tendon issues, ankle injuries — as well as injuries in other parts of the body.

Source: NPR 8/4/10

No Scientific Evidence that Barefoot or Minimalist Running is Best: CA Podiatrist

“Barefoot running is good for some, but not for everybody. There’s no scientific evidence showing that barefoot or minimalist running is best, and for some, it could lead to more injury than if they had the proper shoe. If you’re on grass, barefoot is great, says sports podiatrist Kevin Kirby .

Dr. Kevin Kirby

"People who seem to have the easiest time running barefoot are those who grew up walking barefoot. Also, someone who is lighter is going to have less impact on the ground. If you look at who is sponsoring barefoot running talks, it’s Vibram. There’s money to be made,” says Kirby.

Source: Elizabeth Bromstein, Now [8/5/10]

Thousands of ‘Subcontractors’ May Soon Have to Comply With HIPAA 

Perhaps the biggest surprise in HHS’s July 14 proposed rulemaking was a concept that went beyond language contained in the HITECH Act, namely the appearance of the term “subcontractors” in the list of organizations that would have to comply with the same privacy and security regulations as business associates. These subcontractors are one tier further down on the chain of those who handle protected health information. Subcontractors are akin to business associates of business associates. They do for BAs what BAs do for CEs.

Whether it is necessary to include them in the HIPAA regulations can be debated, and it remains to be seen whether they make it into the final rule. But for now, the concept is giving BAs and HIPAA experts a huge headache.

Source: Report On Patient Privacy [8/9/10]

Myths That Hold Leaders Back

If you are charged with leading others within your practice, you need to understand the reality behind these two common myths:

•  “Some people are natural leaders.” Do yourself a favor: Stop limiting your leadership potential with that false belief. Nearly every person alive leads something or someone— projects, tasks and outings or children, family and friends. The only limits to your leadership potential are those you accept.
•  “Training is the answer.” Sadly, training is not the silver bullet some practitioners seem to think. Yes, training and development opportunities can inspire, inform, teach and build confidence, competence and skills. Yet those things do not make leaders; you also need the desire to lead and the commitment to draw out your leadership potential.

Source: Adapted from “The 7 Lies of Limiting Leadership,” Ian Williams, via Communication Briefings

Query: Athena Health EMR

We would appreciate any feedback on Athena Health EMR/PM software (web-based). 

Marc Klein, DPM, Methuen, MA

Query: When The Insurance Carrier Asks You to Return the Check

There have been times when a healthcare provider has received a check in the mail and the insurance company later on asks for a refund. Perhaps the healthcare provider may possibly be a holder in due course and afforded protection under the Uniform Commercial Code against an insurance company asking for a refund. The Bottom line is the provider relied upon the mistake of the healthcare insurance company and made it more difficult to collect the debt from the patient because more time went by. If a collection agency goes after the provider and if that provider then goes to court, doesn't it then depend upon what the judge decides? Why should a provider immediately give up instead of going before a judge for a judicial opinion in small claims court, or request that the collection agency take the matter up in small claims court?

Daniel Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

Editor’s note: PM News does not provide legal advice. In Triffin v. Cigna Insurance, the court held that even though Cigna had stopped a check to a provider, as long as that check did not have an expiration date, the check was valid to the "holder in due course." Using this rationale, any provider who relies on an insurance carrier’s assurance that a check for services performed is valid, should contest a later request from that carrier for the return of that money. Since every case is different, and state laws vary, it is advisable to consult a healthcare attorney in these situations. Small claims courts are generally held at night and are an inexpensive option for those who wish to proceed without legal counsel.

Query: DME Rules About Shoes

I have been presented with a proposal from a friend of mine. He is a chiropractor who is also certified in electrodiagnostic studies; therefore, he works with a number of different types of physicians. He has proposed that we set up a business to distribute diabetic shoes through the PCP offices. We would send a trained fitter to the PCP office to size and fit the shoes. My only role in this would be the use of my DME license for billing purposes. Each PCP would get a portion of the collection, enticing them to promote these shoes. The chiropractor would take a share, and I would get some as well.

My problem with this is two-fold. 1) I would never actually see the patient, and 2) I believe there is a "no kick-back" rule with regard to PCP's. My gut tells me this will not be legal/ethical, but then how do pharmacies get away with it? Is their license different from ours? Am I being too conservative or am I correct in thinking there is something wrong here? 

Michael S Presti, DPM, Havre de Grace, MD, mspdpm@yahoo.com

Editor’s Note: PM News does not provide legal advice. As a general rule, anytime someone approaches you with a scheme such as this, you should consult a healthcare attorney. Allowing someone to use your Medicare or DME number to bill for a patient whom you never see is problematic at best, and in most cases, downright illegal.

RE: Plantar Fasciitis and Ultrasound Guidance (Ivar Roth, DPM MPH)
From: Martin E. Wendelken, DPM, Henry Slomowitz, DPM

Dr. Roth's interest is a healthy look on Dr. Jurcisin's use of diagnostic ultrasound. The fact is that those patients who are not responding to conservative care should be evaluated with ultrasound.  Those patients who do not respond to standard care (taping, NSAIDs, orthotics, and standard heel injection) need to be evaluated.  Consider that the plantar fascia may be torn, and if so, injection is contra-indicated. The use of this technology has greatly helped those who need an injection into the fascia and not just a "shot in the heel." Injecting directly into the fascia has greatly helped reduce patient pain and provided a better result than just injecting into the patient's "heel."  

As to the statement of an injection causing a "potential rupture", this is not caused by the injection. It would be the failure of the patient not heeding the physician's instructions to refrain from excessive exercise or other such activities after the injection. The requirements for documentation have been well-defined. You must image the structure in its entirety in both the longitudinal and transverse axes. Images must be recorded and be available for review. Measurements, along with identification of the structures within the scan, should be labeled. A report describing the equipment, area scanned, the findings as described under the ultrasound exam, along with the clinical impression should be reported.

Martin E. Wendelken, DPM, Bronx, NY, drmew@optonline.net

As to the statement that the Dr. should not bill the patient or the insurance company utilizing ultrasound because it is the doctor’s call, I fully agree, as long as the doctor does not charge for the x-ray he took prior to giving the injection. As far as I know, the x-ray is totally useless in diagnosing or treating plantar fasciitis.

I hope Dr. Roth gets a chance to do some ultrasound-guided injections so he can experience the increase in success that I have in my practice. I would like to give him an invitation to visit my office at any time that is convenient to him to watch me do what I do. The profession will benefit greatly by embracing this technology.

Henry Slomowitz, DPM, Paterson, NJ, minggao@optonline.net

RE: Plantar Fasciitis and Ultrasound Guidance (Ivar Roth, DPM MPH)
From: Robert Scott Steinberg, DPM, Simon Young, DPM

I cannot understand how a podiatric surgeon can claim being afraid of hitting the plantar fascia, as if he can actually do this and not know it. If he cannot take measurements from a lateral x-ray to determine the exact point to inject, it raises a number of concerns. 
 
Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

There is no standard heel spur injection. This implies that it's a routine surgical procedure.
No surgical procedure is routine. I assume by reading this post that Dr. Roth has no experience utilizing ultrasound-guided injections for heel spurs or other joints.  MD's utilize it on a regular basis with no qualm or perplexity about cost because it works. Interventional radiology is reliable, more effective, and gives better patient outcomes, resulting in less patient visits, saving the insurance companies money.

Utilizing ultrasound guidance, you can inject the steroid with pinpoint accuracy to the area involved, and simultaneously get documentation to confirm your diagnosis (no guess work). I have diagnosed plantar fasciitis, and ultrasound indicated that it was not plantar fasciitis, requiring another diagnosis to be considered in my differential. Your diagnosis can involve heel spur, joint inflammation, tendonitis, periostitis, stress fractures (very sensitive after initial injury), etc.
 
Prior to owning an ultrasound unit, I thought my exam and x-rays, as well as my topographical knowledge of anatomy was enough, but I was wrong.  In my opinion, ultrasound examination is an indispensible tool in order to diagnose and treat many pedal pathologies and issues. This  modality validates, documents, and confirms or elucidates pedal pathology. We tend to be pompous and "all knowing."  We tend to minimize our contributions to patient care. Nothing we do is routine and we must embrace this. We continue to treat anecdotally, but in reality, this attitude must change and ultrasound can help. 

Simon Young, DPM, NYC, NY, simonyoung@juno.com

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

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

TN PRACTICE FOR SALE (LAWRENCE COUNTY)

Active, established practice includes office building and property ( appraised at 110k) with all equipment and shelf stock included. Great referral network with an excellent scope of practice. Patients on schedule 1 day/ week grossed over 250k last year. 125k OBO Call 931-446-5724 or email mchad500@gmail.com for more information.

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 - 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

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 - 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 FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789  for details.

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS

Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston) Washington, DC, Philadelphia, Northwest Pennsylvania, Delaware, Upstate New York, Massachusetts (Brockton). Please respond to: doconcall02@aol.com

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

 IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN) 
 
Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

PODIATRY EQUIPMENT FOR SALE 

Several items taken from working office. Whitehall whirlpool in great condition $750, Podo-spray Sa5 nail grinder $500, Quick seal autoclave bag sealer $70, Dermo-jet/Mada-jet skin anesthesia injector $200, Allpro 2010 Film Processor in great condition $2000, 12 x-ray film cassettes (several different brands) $20 each, X-ray orthoposer $100, x-ray lead body (2)shield $30, 4 Wolf x-ray view boxes $75 each, Star x-ray duplicator $200, star safe light x-ray spotlight $50, several lead shield x-ray covers $25. Actual shipping will be charged or pick in mid-Michigan available, email for more details and pictures. fentonfootcarefd@gmail.com

ASSOCIATE POSITION – KENTUCKY 
 
Very well established podiatry practice in Louisville, KY seeks a motivated, ethical practitioner trained in all phases of podiatry including routine care, surgery and wound care to join 2 other podiatrists. By joining our practice you will receive a competitive salary with a bonus structure and benefits. Our practice is equipped with DME, PadNet, Gait Scanner and on site retail store. There is a huge potential to grow your practice with our ideally located facility that has strong affiliation with leading area hospitals as well as 2 local residency programs. For immediate consideration, please forward CV to Samuel10530@yahoo.com

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

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 - 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

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