August 15, 2006 #2,654 Editor-Barry Block, DPM, JD

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TOPAZ Tendon Surgery Superior to Traditional Techniques: VA Podiatrist

Rosemary Brastrom was an active mother of four and a lifeguard when a car accident damaged both of her Achilles tendons, so she underwent a new type of tendon surgery called TOPAZ. The method is aimed at mending the torn tendons and ligaments people get from playing sports or doing daily activities, without the trauma that previous sufferers might have endured. "There's less pain and quicker return to activities than ever before," said Dr. Ross Girvan, a podiatrist with the Fredericksburg Foot & Ankle Center. "The size of the incision we have to make is getting smaller and smaller."

Dr. Ross Givan

The majority of the surgeries in which Girvan has used TOPAZ were for either Achilles tendinitis or plantar fasciitis. The surgery is performed with a microdebrider, a small wand, while the patient is under mild sedation. Girvan said the reason the surgery is better than previous treatments is that it actually initiates the healing process. "The tool just puts a small hole into the tendon at a low temperature, which releases some of the pressure," he said. Girvan said this means there is increased blood flow. He explained that the reason tendons and ligaments used to take so long to heal is that the damaged area was removed, but then the tendon or ligament would have to be stitched up and heal naturally. With TOPAZ, "it's really less about removing the damaged parts and more about creating the healing process," Girvan said.

Girvan said he is one of a number of podiatrists in the area who use TOPAZ. Girvan said that while TOPAZ and other forms of Coblation do cause some tissue damage, it is less than the damage caused by traditional surgical methods. "The TOPAZ wand works at about 30 degrees Celsius [about 50 degrees Fahrenheit], " he said. "Coblation is less invasive, so therefore it does less damage."

Girvan said one of the biggest advantages he's found is that TOPAZ helps get through surgery quicker. "Surgery for heel pain would usually take awhile, but now it takes about seven minutes," he said. Not only is the surgery time shorter, but the healing time is, as well, he said.

Source: Ellen Biltz, Fredericksburg Free Lance-Star [8/13/06]

PA Podiatrist Invests in Family Recreation Center

As children walk through the giant silver Slinky — it’s no longer pink — and enter Slinky Action Zone, they are greeted by inflatable characters such as Cookie Monster, Scooby-Doo and Winnie the Pooh. Other changes have been made since DVJ — Dr. Alan Kivitz, rheumatologist; Dr. Gary Raymond, podiatrist; and Don Delozier, contractor — purchased the business, which opened in 1996. More than $150,000 has been poured into renovating the 7,000-square-foot recreational facility.

Dr. Gary Raymond

“There was a need to continue with the Slinky tradition,” Raymond said. “It also was a good opportunity from a business standpoint to continue to provide recreation for families and for gatherings.”

Source: Walt Frank, Altoona Mirror (PA) [8/13/06]

New House Bill Would Scrap Payment Formula and Result in Slight Increase

Lawmakers hoping to negotiate long-term physician payment reform that more closely aligns Medicare rates with the costs of administering care have a new piece of legislation with which to work.

Rep. Michael Burgess, MD (R, Texas), late last month introduced the Medicare Physician Payment Reform and Quality Improvement Act of 2006, which, starting in 2007, would scrap the sustainable growth rate formula that helps determine doctor pay. Instead, the Burgess bill would ensure positive annual updates by tying rates to the Medicare Economic Index. The MEI is an indicator of how much doctors' cost of caring for patients is increasing.

If lawmakers and the White House can approve the measure before Congress adjourns for the year, physicians would start receiving yearly updates equal to the MEI percentage minus 1%. Instead of a projected 4.7% cut in January 2007, doctors would receive an estimated 1.5% increase in their Medicare rates.

Source: David Glendinning, AMNews [8/14/06]

Query: Source For Women's Double Last Shoes

Does anybody have a resource for women's double last shoes (i.e., double-A heel and a wide forefoot.) I have heard that there are shoe companies make these double lasted shoes for retail sale.

David Gutierrez, DPM, Bronx, NY, DOCG2100@aol.com

RE: Aetna
From: Dale Smith, DPM

I'm surprised that no one has mentioned the recent letter from Aetna "offering" to continue to include me in their list of providers as long as I sign the enclosed form with the "new and revised" fee schedule for podiatrists. I would sure like to know if this is also intended for orthopedists. Comparing it to the recent Medicare fee schedule I note that it pays from 22% to 45% less. The rates are rapidly approaching public aid rates. If we're going to boycott something it should be insurers that pay their CEO's in the tens of millions while balancing their P&L sheets on our backs!

Dale Smith, DPM, Chicago, IL, DMSmithDPM@aol.com

RE: Hypopigmentation Following Intralesional Steroid Injections (Greg Cohen, DPM)
From: Elliot Udell, DPM

Injected steroids and in some cases overuse of topical steroids can cause hypopigmentation of the skin. Other side affects can include Skin atrophy, purpura and striae. The latter can lead to pruritis. Quick acting as opposed to long acting injectable steroids carry less of a risk.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Podiatrists, Lawyers, and Money (David M. Schwartz, DPM, R.Ph)
From: Michael M. Rosenblatt, DPM

David M. Schwartz, DPM, R.Ph, wrote that he is now pursuing a law degree because podiatry has “too many forces limiting” podiatrists’ income. The fact that he is also a pharmacist suggests that he has a very high interest in obtaining degrees. Obviously there is nothing wrong with this, but the editor’s advice suggesting that all we really have is “time” is right on the mark.

Having knowledge in the law is essential. Perhaps all of us should take a “year” of law school. But there are many thousands of lawyers competing for the same rare legal dollars. Instead of spending another 3 years in law school and gathering even more scholastic debt, I’d respectfully suggest an alternative: Make the same studious effort to become an expert on coding and practice management. Then, take that money you would ordinarily spend on law school and look to purchase rental real estate properties.

If you can amass 6-8 rental properties over a 12-15 year period, your lifetime income and retirement will be assured. Even non-professionals with much more restricted earning potential have accomplished these goals. The earlier you start the better. Real estate prices are now in a downswing. The times have never been better.

Ultimately, as a lawyer, you may be representing investors in property purchases who became far wealthier than you did with much less education, struggle and disruption to family and personal life.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: HMOitis (Dennis Shavelson, DPM)
From: Simon Young, DPM

I agree with my colleagues that patient care should never be compromised. If you feel it is, then contact the medical director or appeal the insurance company’s decision. Unfortunately we are relegated to do this demeaning task. Also contact the state insurance fund. In NY, it’s the Attorney General’s office. At least in NY, representatives are aware of the problem.

We must provide cost-effective care. For example, needing bone stimulators for osteotomies, $3,000 cervical plates for Lapidus procedures, expensive hardware such as Herbert screws for Austins when an inexpensive K-wire will suffice.

On the other hand, if you feel the item is a necessity, do not compromise patient quality of care or your ethics. If the patient realizes they need it, they will either pay for it or at least question the insurance company or plan administrator. Remember the insurance company oftentimes is a middle man. If need be, contact the plan administrator who is the payer to the ins. co. and who is more interested in the best patient quality of care. The plan administrator can override the insurance carrier and pay if needed. The plan administrator can be gotten from human resources by the patient or is listed somewhere on the insurance card. The patient is the consumer and will have more leverage with the insurance companies.

We must be allowed to provide the best possible cost effective care for the patient and be part of the solution.

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

ASSOCIATE POSITION - NEW JERSEY

Seeking associate for practice in Ocean County area. Seeking a hardworking, ethical, energetic and well trained (PSR 24/36) individual. MUST be willing to do all aspects of podiatry! Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

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.

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

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

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

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

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