August 11, 2006 #2,651 Editor-Barry Block, DPM, JD

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Congratulations to Vanessa Darmochwal, DPM of Highland, NY, Winner of last week’s survey contest, who will receive one week of classified advertising (Value $75). Want to know how much your practice (or a practice you wish to purchase) is worth This week’s prize is a customized practice appraisal by PM News editor Barry Block, DPM, JD (Value $350). To enter, simple complete our practice survey at www.podiatrym.com and send your name, address, and question #45 from the survey to bblock@podiatrym.com.

All entries are eligible for our grand prize of a one-week Windjammer Caribbean Cruise. Don’t forget to vote for next year’s inductee into the PM Podiatry Hall of Fame. This year, we’ve opened a new category for non-podiatrists.

Dry Feet are Healthy Feet: NY Podiatrist

Podiatrists warn that feet need to be kept dry for optimal foot health -- even in hot weather. "The best thing to do in the summer is to frequently change socks and to use drying powders that take away moisture from the foot," said Dr. Fred DeLucia, a podiatrist at North Shore University Hospital in Manhasset. "Basically, you want to try to prevent fungal infection from starting, and fungus like to thrive where it's dark, hot and moist, and the summertime is prime for that. And you want to restrict the use of sandals," which offer little, if any, support.

DeLucia also recommends drying your feet after a dip in the pool or showering, and to look for causes of fungal infection such as athletes' foot. "Inspect your feet daily, examine in between the toes to see if you have moisture. After a shower, if you stick your foot into a sock, that moisture is going to stay there," he said.

Source: Sophia Chang, Newsday, [8/10/06]

In Its’ 100th Year, MPMS Elects 2006 - 2007 Board

The Massachusetts Podiatric Medical Society (MPMS) has elected James P. Ioli, DPM, as president for the Society's 2006 - 2007 year. Dr. Ioli succeeds Dr. Peter Paicos, Jr. who served as MPMS president from 2004 - 2006. Dr. Ioli is a member of the medical staff and chief of podiatry at the Brigham & Women's Hospital in Boston. He is a past chairman of the MPMS Membership Committee and also currently serves as scientific co-chair for the APMA Region One Conference -- the New England podiatry conference.

Dr. James P. Ioli

On his election as president of MPMS and goals for the year Dr. Ioli comments, "over the past 10 years we have committed a tremendous amount of member’s time, money and resources to passing a bill that would allow qualified podiatrists to treat the ankle medically and surgically, as podiatrists can do in 37 other states currently, and we are very close to achieving our goal. Although we continue to work on other important issues such as establishing assistant x-ray privileges and fighting discrimination against our members, passage of our scope of practice bill remains our number one priority until accomplished."

The following slate of officers/executive committee members and trustees was elected for 2006 – 2007:

Dr. James Ioli, President
Dr. Donald Adams, President-elect,
Dr. Jay Phillips, 1st Vice President
Dr. Michael Biancamano, 2nd Vice President
Dr. Richard Eisner, Treasurer
Dr. Norman Wortzman, Secretary
Dr. Peter Paicos, Jr., Immediate Past President
Mr. Gary Adams, Executive Director

MPMS Trustees: Dr. Jerold Fleishman, Dr. Paul Peicott, Dr. Louis DeCaro, Dr. Teresa Burtoft, Dr. James DiResta, Dr. Stephen Pidgeon

Electronic File Transmission (EFT) Problems for DMERC A

Many providers are utilizing EFT so that Medicare may directly deposit checks into their bank accounts, and receive electronic EOB’s. A switch of carriers from Health Now to National Heritage for DMERC A, has mandated new applications be filed for EFT’s. This will allow National Heritage to send providers their EFT. Most problems with EFT are because of either incorrect or missing information on the application.

Be sure the banks routing number and your bank account numbers are accurate on your application. There is a two week turn around time between submitting the application, testing and implementation. Providers having problems with EFT enrollment should call 781-749-7745

Source: Paul Kesselman, DPM

Query: Lac-Hydrin Boycott

I’m just wondering if the boycott of Lac Hydrin (Westwood-Squibb) is still alive. I recently wrote a patient a script for 40% urea cream. Her pharmacy says the only cream her Medicare D plan will cover is Lac Hydrin.

Norm Wortzman, DPM, North Quincy, MA, footdocnw@aol.com

Editor’s comment: Yes, the boycott is still on. The manufacturers of Lac Hydrin have refused to budget even one cent for this profession. They do not exhibit at podiatric meetings, detail offices, advertise in journals, or support podiatric education. The result has been that Lac-Hydrin, which was once the most prescribed product in podiatry has lost its market share (and several million dollars a year in revenue).

We suggest you contact the patient’s plan and inform them that there are several excellent substitutes for this product which are available for less money.

RE: Congress May Reduce Physician Reimbursement
From: Narmo L. Ortiz, Jr., DPM

I just read with great disgust the news that Congress may reduce physician reimbursement by 5.1% for 2007. Time and time again we encounter the same dilemma of being the ONLY profession in the United States of America the faces payment reduction for the services it provides.

Time and time again I have read, in past issues of PM News, how Medicare should be restructured or fixed, and if not, opt out of it (an idea not feasible for most of us that STILL owe a large debt of student loans or with starting practices).

So I said, let me contribute another idea to the list of proposals that would never become reality due to the "business as usual" politics of Washington, DC: why not have the multibillion dollar industries related to healthcare, mostly pharmaceutical companies, contribute to the healthcare bill by paying a "special tax" to the IRS that would go to the Medicare and Medicaid urns? You would say, then the cost of medications will rise. That may be true to an extent, but, is anyone really complaining out-loud about the price of gasoline going to $4.00 a gallon real soon? I bet not!

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL., mlnortiz@earthlink.net

RE: HMOitis
From: Dennis Shavelson, DPM

Recently I was approached by the administrator of one of the facilities that I perform my foot surgery to consider changing to a less expensive subtalar implant and to consider trying to use less expensive screws or even worse, pins instead of the superior cannulated screws when I am performing foot surgery on patients with Medicare and poorly-reimbursing plans, as they cannot tolerate additional costs and survive.

In practice, I am using cheaper Band-aids, casting materials and hiring staff with fewer skills in order to reduce overhead. I will not sacrifice major care moments with inferior quality but on a daily basis I am suggesting procedures that I know my patients are not covered for because they need them as I try to practice podiatry as I should knowing that the system is sacrificing me and them.

If any of my colleagues has found a cure for HMOitis I would like some input because for me, at this moment, this chronic disease seems to be becoming terminal.

Dennis Shavelson, DPM, NYC, NY, drsha@lifestylepodiatry.com

RE: Sentinel Node Biopsy (Barry Mullen, DPM)
From: Bryan C. Markinson, DPM

In responding to Dr Russel's query on melanoma management, Dr. Mullen stated "The most recent conferences from the American Academy of Dermatology conclusively show that the performance of sentinel node biopsy in malignant melanoma cases improves the overall 5 year survival rate, most interestingly, whether the test's outcome is + or -. Presumably, just the mere fact that the patient is monitored extremely closely, apparently improves the long term outcome." I would like to clarify this to some degree, as it may be misleading. There are three ongoing studies that are evaluating the benefits and utility of the sentinel lymph node biopsy procedure. They are the Multicenter Selective Lymphadenectomy Trials I and II and the Sunbelt Melanoma Trial. (1) Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Ann Surg 1999;230:453–65. 2) Lee JH, Essner R, Torisu-Itakura H, Wanek L, Wang H, Morton DL. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel node dissection for melanoma. J Clin Oncol 2004;22:3677 84. 3) McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol 2004;86:212:23)

These studies are continually adding patients and doing interim analyses of the data. Although it is true that 5 year survival rates are improved, it is also very clear that there is no impact at all on overall survival rates. Specifically, there is a difference between "disease free survival" and "overall survival." Therefore, the data so far does not support increased longevity and many experts in the field believe that the data supports discontinuance of this procedure altogether. Others feel that the prognostic and or diagnostic value remain to be elucidated. In any case, there does not exist the unanimity of opinion that Dr. Mullen's response suggested. Additionally, the staging prognostic breakpoint of .76 mm has been adjusted to 1.00 mm by the American Joint Committee on Cancer. A great review of this is available at: http://www.emedicine.com/DERM/topic257.htm.

Overall, all the responses to Dr. Russel's question offered a thread of very important advice, and that is that care for these patients should be hospital centered.

Bryan C. Markinson, DPM, New York, NY ProfPod@aol.com

ASSOCIATE POSITION – ARIZONA

Seeking an experienced podiatrist versed in all aspects of podiatry with current AZ License. The right person will join as a salary associate leading to partial ownership in the group practice. Podiatry practice is well established over 25 years, successful and a large volume in the Phoenix metro area. Position available immediately. Email CV and inquiries to:pprac4sl@cox.net

EQUIPMENT FOR SALE

Ritter X-Ray machine, Mayo stand, Oxygen mask and tank, Polaroid 8X10 X-Ray processor and cassette, Ritter Clave autoclave, Whitehall JO-140 portable whirlpool, Glass bead sterilizer, Foredom cord drill with hand piece, JanL model 100 nail dust extractor, 3 podiatry cabinets, Polaroid 545 3X5 X-Ray developer, 3 8X10 X-Ray cassettes. The equipment is located in NY. Please call 845-359-1070.

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

ASSOCIATE POSITION - GULFCOAST OF FLORIDA

Great opportunity in rapidly growing practice for a PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548-bed hospital system, new hospital is being built and multiple surgical centers. Candidate should perform rearfoot & ankle surgery, including Charcot reconstruction. Candidate needs to be ethical and motivated and must have a current Florida license. Established practitioner or new practitioner OK. Salary + percentage + benefits including insurance and 401K. Fax CV to (239) 566-8778.

POSITION AVAILABLE-RETIRED OR DISABLED PODIATRIST-DELRAY BEACH FLORIDA

Full or part time position in start up pharmaceutical company. Duties would range from answering phones to publishing scientific papers. Please contact: rhm123@gmail.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

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