The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 11, 2010 #3,928 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2011 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

Podiatric Marketing and Practice Management

This week's prize is an autographed copy of the out-of-print classic Podiatric Marketing and Practice Management  by Barry Block, DPM, JD (Value- Priceless)..

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

Key to High Heels is Changing Heights During the Day: NY Podiatrist

Many can’t live without them. But living in your high heels all day, and almost every day, can come with a price. “Clearly, wearing high heels for long periods of time will cause arthritic changes in the knees,” says Dr. Suzanne Levine, a podiatric surgeon at Institute Beauté. “It will cause some serious problems, back problems, lots of injuries that we’re seeing with the extreme shoes. These are shoes four inches and women that are wearing them for longer than eight hours a day.”

Dr. Suzanne Levine

With that said, unlike some podiatric surgeons, Dr. Levine doesn't want to keep you out of your heels. She wears them herself, and loves them so much that she even has a vintage collection on display in her office that would make Carrie Bradshaw flush. But she cautions that there's a way of feeding our shoe addiction without having to put our feet into rehab. “What happens is that certain muscle groups become very weak in wearing heels, so I change my shoes maybe three times a day,” she says. “I'll go from a four-inch heel, to a three-inch heel, to flats. The key is to really changing the heel height.”

Source: Kafi Drexel, NY1, [8/8/10]

Barry Students Receive White Coats

More than 400 family, friends, students, and members of Barry’s faculty and staff attended the program to celebrate the passage of 50 members of the Class of 2012 from their didactic courses to their clinical training beginning fall 2010. The Rite of Passage ceremony, narrated by Dr. Sanjay Sesodia, a Barry professor of physiology, continues a tradition for Barry podiatric medical students. Each student was presented with a white coat by Dr. Bibi Singh, DPM, 04, assistant professor of anatomy and podiatric medicine along with Dr. Kaloian Ouzounov, DPM, research director for the Barry University School of Podiatric Medicine.

Dr. BiBi Singh, assistant professor of anatomy and podiatric medicine with Class of 2012 president, Blake Weeks.

Blake Weeks, president of the Class of 2012, congratulated his classmates for their diligence and hard work in completing 31 classes up to this point in their medical education. He thanked all the family and friends for attending and all the support and encouragement they have given to the students. Dr. Dennis Frisch gave the keynote address, and Dr. Bradley Haves presented the alumni address to the Class of 2012.

CA Podiatrist Discusses Prevention of Runner’s Toenail

According to Dr. David Hannaford, a San Rafael sports podiatrist, ultra-marathoner, and co- author with Jeff Galloway of Running Injuries Treatment and Prevention, prevention starts with the correct shoe. You want to select a shoe that has the right length and shape for your foot. The toenail will catch if the big toe is squeezed in the shoe. The outer toes will rub on the outside of the shoe if they are not properly accommodated. Since nails grow at different rates, some need a trim every week, and others every three weeks. 

Dr. David Hannaford

Dr. Hannaford recommends that nails be trimmed back to the skin junction. Since ingrown nails result from trimming too short, more frequent trimming is best. After trimming each nail, move your finger from the top of the front edge of the nail back. If you feel the leading edge, it will likely catch on your sock or liner since the foot slides slightly in the shoe with each step. Use a pedicure file to thin or bevel the nail from rear to front on top of the nail so the forward part of the nail becomes very thin. Some runners will even “duct tape” their toes for long races. Dr. Hannaford recommends paper tape because it is thin and sticks well. Be careful not to place the tape near the rear of the toes because blisters can form where the toe meets the foot!

Source: Pacing Petaluma [8/5/10]

Quick Tips on Visual Aids

When designing and planning to use visuals for your presentation, remember these key rules:

•  Keep them simple but make them clear. Use different colors, shading, or type size to highlight key information.
•  Place or project the visual where everyone can see it. Do not stand in front of it, blocking the audience’s view, as you explain the material. If you have to say, “I know you cannot see this, but …” your visual is not large enough to be useful, and you should omit it from your presentation.
•  Speak to the audience, not the visual. Maintain eye contact with your listeners as you discuss the information that you are displaying.
•  Don’t let the visual become a distraction. Display it only when you are discussing it. Showing it too early or leaving it up too long can distract your audience.

Source: Adapted from How to Make Winning Presentations, Paul Timm, Career Press via Communication Briefings

Query: Growths on 2nd Digit

My patient is a 67-year old female with growths on her 2nd toe of a "few months" duration. She is starting to get similar growths on the 3rd toe and on the 2nd toe of the other foot.

Growths on 2nd Digit

The distal and proximal lesions feel "spongy." The central nodule is very firm. X-rays appear unremarkable. Any ideas on diagnosis and course of treatment?

Patrick Barnes, DPM, Council Bluffs, IA 

Query: Gout Diagnosis

I have been denied payment for using ICD-9 274.0 & 274.9. Does anyone have a different diagnosis code for gout that would be payable by Medicare?

Craig Sapenoff, DPM, West Palm Beach, FL

Response: There are now newer and more specific codes:

Acute attack of gout or acute gouty arthropathy (274.01)
Chronic gouty arthropathy without tophus (274.02)
Chronic gouty arthropathy with tophus (274.03).

Unspecified code (274.00) is used to code an unspecified gouty arthropathy.

Charles Langman, DPM, King of Prussia, PA

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: New Test for Potential Plavix Patients
From: Robert Bijak, DPM

I thought I would let that part of the profession that prescribes Plavix (clopidogrel) know of a new test being offered by Quest Diagnostics.  It is contingent on the fact that there are 3 types of patient responses to Plavix. First, recall that clopidogrel is changed into the active metabolite in the liver to be effective.  As such, the cytochrome P 450 system is utilized. The first type of patient is called the "extensive metabolizer." They convert the drug effectively and should see the best platelet inhibition response.

The second type of patient is the "intermediate responder" who has less than optimal platelet inhibition, but does have some benefit.

The last group is the "poor responders" who have a genetic defect in the CYP2C19 system, producing no or very little clinical response. The point is that it is now possible and recommended that BEFORE you place your patient on Plavix, you run a blood or saliva test to determine the CYP2C19 variant. If your patient is positive, they should NOT be placed on Plavix because their chance of MI, stroke and other vascular events will be unchanged and give a false sense of treatment.

Quest Diagnostics has a blood/saliva test called "Accutype CP" which can determine this genotype. DPMs may score a few points with PCP's and vascular providers when encountering these patients but, most importantly, you would be doing the patient a service.

Robert Bijak, DPM, Clarence Center, NY, rbikaj@aol.com

RE: Plantar Fasciitis and Ultrasound Guidance (Henry Slomowitz, DPM)
From: Multiple Respondents
 
I found the statement interesting by Dr. Slomowitz: "...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." Is there anyone out there who attempts to diagnose fasciosis via radiography? I do an x-ray examination to help rule out other causes (fracture, tumor, seronegative arthropathy, etc.). I also charge for that film.

David Secord, DPM, Corpus Christi, TX,

I must take exception to all who think that ultrasound-guided injections are the "doctor's call" and therefore should not be paid for. It is my customary practice to charge for everything I do. And yes, it is always my call. I am in charge of MY practice. It seems that many of my colleagues run scared of insurance claim rejections and therefore shy away from technology that improves diagnosis and treatment outcome. When did we all allow insurance companies to set the standard of care? It is my very strong opinion that WE, not they, set the standard of care. They have a vested interest in not paying us.

Why would we ever give them the power to set the standard of care? In addition, I included this in a post last year on this subject, but I attended a radiology seminar for radiologists on musculo-skeletal ultra-sound a few years back. Even then, the attendees were told that ALL injection therapy was going to mandate ultrasound guidance in the near future. I honestly feel so disappointed that our profession is not taking control of its destiny. I, for one, will not be led quietly to the slaughter. 
 
Bob Kornfeld, DPM, Manhasset, NY, holfoot153@aol.com

Dr. Slomowitz is wrong about x-rays being unnecessary. You still need to evaluate the osseous structures for neoplasms, and erosions, among other things. We can’t be overly confident of our physical exam about any diagnosis, no matter how often we treat it. We still need to utilize diagnostic modalities such as blood work, x-rays, US (cheaper than MRI), MRI, etc.

US-guided injections are not the cause of increased medical costs. Aetna just posted a 42% profit. Insurance companies will continue to increase rates, in-network and out-of-network deductibles, increase co-payments which all equal to increased healthcare costs, more profit, and increased taxes.

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

RE: Plantar Fasciitis and Ultrasound Guidance (Ivar Roth, DPM MPH)
From: Richard A. Simmons, DPM

I can appreciate Dr. Roth's skepticism of using ultrasound guidance for heel spur injections. His comments are based on logic and common sense; however, this is 2010, where we as physicians are supposed to have as much information as possible. We are a profession that over-utilized the argument, "How do you know?" when it tore down minimal incision surgery. It is from this precedent that we move forward.

Most of the daytime television shows are inundated with ads from attorneys. Unfortunately, all of our logic and common sense will be blown apart because there is some super-credentialed expert willing to testify against us.

The fact that Dr. Roth already knows doctors who "claim they need to use ultrasound because if they injected into the fascia, it would cause undue risk for a potential rupture," may be a legal precedent. Many tests are performed because of our medico-legal environment. Absolutely, I would keep a copy of the ultrasound study. There is an old expression: Knowledge is power. Perhaps ultrasound-guided injection for heel spurs will soon become the standard of care.
 
Richard A. Simmons, DPM, Rockledge, FL, rasdpm32955@gmail.com

RE: When the Insurance Carrier Asks You to Return the Check (Daniel Chaskin, DPM)
From: Vince Marino, DPM

Regarding the returning of money to the insurance company: for those practitioners in California, there was a Court of Appeals case that specifically addressed this question. The case was City of Hope Medical Center v. Superior Court. 8 Cal. App. 4th 633 (1992). The court specifically ruled that if there was no fraud committed in obtaining the money and the services were performed on a good faith basis, then the practitioner was under no obligation to return any money paid to him/her by the insurance company. This is especially the case where the insurance company claims they mistakenly paid for something that should have not been a covered benefit.The court stated that the insurance company should seek reimbursement from their insured and not the practitioner. I have used this case to refuse repayment to an insurance company, and after citing this case, their requests stopped.

Vince Marino, DPM, San Francisco, CA, drmarino@marinofootandankle.com

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com or fax 607-723-1567.

ASSOCIATE POSITION – WEST VIRGINIA

Parkersburg orthopedic group seeks established podiatrist or a 24-36 surgically-trained physician. Group offers stability, autonomy and a collaborative environment. Comprehensive benefits and competitive salary starting at $105K with production bonus. Send CV to Mary-MOR@columbus.rr.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.

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

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

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

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

• 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.