The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 14, 2009 #3,622 Publisher-Barry Block, DPM, JD

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IA Podiatrist Appointed Chair of ADA Foot Council

Lee C. Rogers, DPM,  been appointed to serve as Chair of the Foot Council for the American Diabetes Association (ADA) for the next two years. Rogers is a podiatric surgeon at Broadlawns Medical Center of Des Moines, Iowa, and Director of the Amputation Prevention Center at Broadlawns. Rogers has authored more than 50 publications, including several book chapters on diabetic foot disorders, and has been an investigator on more than 20 clinical trials.

Dr. Lee C. Rogers

"My first action will be to complete a position statement writing panel on the definition and diagnosis of Charcot foot, a progressive degenerative condition that affects the joints in the feet, occurring most often in people with diabetes," Rogers added.

In this position, Rogers will be responsible for chairing the panels on diabetic foot complications at the ADA’s Scientific Sessions, which draw over 15,000 scientists, physicians, and other health professionals. He will also chair the diabetic foot section at the ADA annual meeting to be held in Orlando, FL., in June 2010, where he will be responsible for the content and speaker selections for the section.

Source: Gallatin North Missourian [8/12/09]

CPMS Faculty and Students Receive Poster Abstract  Awards

The following students and faculty of the College of Podiatric Medicine and Surgery in Des Moines, IA were acknowledged at the 2009 APMA National Scientific Meeting Poster Abstract Competition.

Kyle Peterson

Kyle Peterson (’10) received the first place award in the Resident/Student Abstract Category for his research project, “Radiographic analysis of Haglund’s deformity: an evaluation of NCSP and RCSP." Co-authors include Nicole Jedlicka (’10), Dr. Vassilios Vardaxis, and Dr. Tim Yoho. 

Tea Nguyen

Tea Nguyen (’10) received the second place award in the Resident/Student Category for her research project, “Load deformation evaluation of lateral radiographic foot measurements.” Co-authors include Adam Lang (’10), Dr. Vassilios Vardaxis, and Dr. John Bennett.

Dr. Roy Lidtke

Associate Clinical Professor Dr. Roy Lidtke (‘91) received the first place award in the Outstanding Poster Abstract Category for his research project, “New technique advances foot orthosis design.”

Dr. Tim Yoho

Dr. Tim Yoho received the second place award in the Outstanding Poster Abstract Category for his research project, “Assessing admission variables and academic performance of podiatric and osteopathic medical students at DMU.” Co-authors Dr. Vassilios Vardaxis and Dr. Kat Comstock (’09).

Realm Labs to Donate $5,000 to Western U

Western University of Health Sciences’ College of Podiatric Medicine will receive $5,000 over the next four months from Realm Labs of Delray Beach, FL, for the College’s Dean’s Scholarship Fund.

Dr. Richard H. Mann

“It is with great pleasure that Realm Labs makes this donation,” said Dr. Richard H. Mann, CEO and Founder of Realm Labs. Mann said College of Podiatric Medicine Founding Dean Lawrence Harkless, DPM, “has a vision to build a podiatric college of excellence at Western University of Health Sciences. Such an admirable goal is worthy of the support of the podiatric profession.
 
Realm Labs, a specialty pharmaceutical and medical food company, distributes Neuremedy, a medical food for the management of peripheral neuropathy.  
 

Query: Bleomycin Protocol

What is the protocol for using Bleomycin on a 65 year old female patient with verruca plantaris who has been unresponsive to Effudex, Aldara cream, and lazerformaldehyde, as well as OTC medications? The patient does not want surgical removal of the wart.

John M. Scholl, DPM, Lady Lake, FL

Query: Referral Fees Under Stark Law

If a patient were referred to me for a non-covered procedure, would the Stark Law still apply and forbid a referral fee paid by me to a referring podiatrist? I am of the opinion the law would still apply, but in this case, a group of us is having a disagreement. Does anyone know for certain?

Name Withheld

Editor’s comment: PM News does provide legal advice. While the Stark laws affects only government-run programs such as Medicare and Medicaid, accepting a referral fee is always problematic.  Under most state laws, it is both illegal and a professional misconduct violation. In short, don’t ever consider any referral fee without consulting a healthcare attorney in your state.

Additionally, it is a violation of the APMA Code of Ethics:

BE2.11 The podiatrist neither accepts nor offers commissions in any form or manner on fees for professional services, referrals, consultations, pathology services, radiology services, prescriptions, or other services or article supplied to patients.

RE: Tarsal Tunnel Syndrome? (Jim Fisher, DPM)
From: Tip Sullivan, DPM, Robert Colligan, DPM
 
In my experience, radiographs, CT's, MRI's, are largely unremarkable in aiding the diagnosis of tarsal tunnel syndrome. The diagnosis is made largely on subjective and clinical findings. I have referred to several neurologists, who have completed an entire battery of lab studies, EMG's, NCV's. Most of those findings return indicating an idiopathic neuropathy, or unremarkable findings. I've also found minimal favorable responses to the various medications available today. Injection of an anesthetic with steroid has had mixed results, but usually offers partial and temporary relief. Orthotics, custom or OTC, also offer about the same results.

With surgery, I have often found very favorable results in the immediate post-op phase. But as scar tissue develops during the healing process, the pain has a tendency to return, usually not to the same severity. And then, as the scar tissue resolves, the pain decreases again. Overall success is perhaps not as high as seen with carpal tunnel releases. I'd estimate approximately 50% success, that being 50% have complete pain relief long-term, the other 50% varies from partial pain relief to no improvement.

The other day, I saw a sign promoting one of the first standing CT's. I thought at that moment, how many compressed discs, herniated discs, compressed degenerated joints, etc. escape detection with non-weight-bearing exams. Podiatrists have figured this out long ago with routinely taking weight-bearing radiographs. How many tarsal tunnel syndromes escape detection because they are performed non-weight-bearing and while asymptomatic. Isn't that about the equivalent of testing for exertional compartment syndrome without exertion? How would a neurologic study differ if the test were performed while performing the Tinel's test?

Robert Colligan, DPM, Norfolk, NE, rcolligan@cableone.net

Editor's note: Dr. Sullivan's extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=28092&start=1

RE: Surgical Options for Hallux IPJ Pain (Richard Frost, DPM)
From: Randall Brower, DPM

This fracture injury is likely to cause post-traumatic arthrosis even if repair is possible. I would excise the proximal phalangeal head and fuse the joint. This is the quickest recovery with the least amount of long-term post-op sequelae.
 
Randall Brower, DPM, Roswell, NM, randoman33@yahoo.com

RE: Tingling and Burning of Toes Under Bedcovers (Bob Hatcher, DPM)
From: Nicholas Sol, DPM

Burning of toes under bedcovers and immediate relief when uncovered sound suspiciously similar to erythromelalgia. The textbook complaint is similar  with relief obtained by standing on a cold surface.

Nicholas Sol, DPM, Colorado Springs, CO, drsol@thewalkingclinic.com

RE: Care Credit (Bruce Pinker, DPM)
From:  Rick Burnell, DPM

I used Care Credit for several years after first opening my practice. I dropped it about two years ago. I found that when I first started with them, it was relatively easy for my patients to get credit for a procedure. After about one year, it became increasingly more difficult to get them approved, until eventually only about one out of every eight to ten people who applied were accepted.

Also, their fees for using MasterCard and Visa were very high. I switched to a local bank for my credit card use and dropped the idea of trying to get credit for the patients. As is customary with most lending institutions, those people who don't need credit are about the only ones who could get it.

Rick Burnell, DPM, Camden, SC , burnell_cfc@bellsouth.net

RE: Yellow Pages Parity (Frank DiPalma, DPM)
From: Carl Ganio, DPM

This discussion can go several ways, and in fact, goes full-circle.  In the past, we had fought for parity with the MD listing. I remember also being listed under podiatrist. We are currently back to being listed under “Physicians and Surgeons, DPM, Podiatrist”.... and no one can find us (of course, we are found at the beginning of the section, as DPM comes before MD...).

I have handed a Yellow Pages to some of my most educated patients, and asked them to find me in the Yellow Pages... and they cannot without prompting. Rather than tracking calls as the sales rep recommends, perhaps that simple test will open your eyes.  
 
 Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

RE: Gary Ceresnie, DPM

It was with great sadness and horror that I read about the the apparent brutal murder of my friend and colleague, Gary Ceresnie. Gary was a very caring and gifted physician. Gary was a kind soul with a big heart and loving nature. His goodness makes the circumstances of his demise that much more horrific. We have lost a special soul.

Richard Mann, DPM, Delray Beach, FL

RE: Obama's Amputation Remarks
From: Paul Bishop, DPM, Gary S. Smith, DPM

The following quote is from President Obama, "If a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, 40, $50,000 immediately the surgeon is reimbursed. But why not make sure that we're also reimbursing the care that prevents the amputation? Right? That will save us money."

I find this appalling and personally insulting to myself and our profession. Why would the single profession who openly combats amputation as aggressively as we do, get slandered like this? As podiatrists, I would guess that we would do the majority of foot level amputations. We have the CLEAR, Georgetown’s center, major teaching centers, wound care boards, and yet it is all totally discounted in politics.

When is the last time that any of you were even paid $1,000 for ANY amputation? How many of you after a 90-day global period think that you made any money at all from that reimbursement? We all see the need to integrate family medicine, endocrine support, and all other specialties in managing our diabetic population, but to lump the ills of an amputation on the laps of surgeons is ridiculous. I am wondering what response to this the APMA, ACFAS, and other boards will have? What are we as individuals doing or are going to do about things like this? I would ask you all to call your representatives and let your voice be heard that we are not to be dismissed as uncaring, monetarily-motivated, non-ethical physicians. It’s time to make some noise.

Paul Bishop, DPM, Yorkville, IL, feetpeople@aol.com
 
I assume there will be many letters concerning this by well spoken physicians, so I'll make this short. When I step foot in the OR, I lose money from being away from my office. Surgical reimbursement is so poor in my area that I would be better off financially if I never did it. The point that should be taken here is that the person overhauling our health system is absolutely clueless about healthcare and the cost of healthcare, and that should scare everybody. 
 
Gary S. Smith, DPM, Bradford, PA, penndoc@verizon.net
 

ASSOCIATE POSITION - MARYLAND (MONTGOMERY COUNTY)

Multi-office, well-established practice with surgical centers, digital x-rays, in-office vascular testing, ultrasound, EMR with voice recognition charting, and many other perks looking for personable, well-trained, motivated individual. Patient base available for immediate in-office productivity. If you are new or ready to change locations, contact us ASAP to discuss opportunities. Send resume and cover letter to mddpmassociate@comcast.net

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com  for quick deal.

ASSOCIATE POSITION - MARYLAND

Harford County, Bel Air, est. 1991, seeking PSR24/36, strong ethics, friendly demeanor. Associate or partnership opportunity for the right applicant. We provide onsite ambulatory surgical center, patient base, strong referral resources, billing, scheduling, and many technologies. Visit our website. e-mail your CV to drhoward@hlsfootcare.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE OPPORTUNITY - CINCINNATI, OH

Well-established practice located in medical/professional building minutes from hospital. Many referrals, three satellite clinics and two assisted living facilities to keep you busy. Associate leaving due to family emergency-need to either find an associate or sell ASAP. Contact bjadpm@hotmail.com for more details.

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

PRACTICE FOR SALE - ALABAMA, GULF COAST

 Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

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