August 16, 2006 #2,665 Editor-Barry Block, DPM, JD

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UK Podiatrist Overwhelmed By Response for Free Heel Balm Samples

Podiatrist Barry Radivan really put his foot in it when he offered free samples of heel balm on the Internet. The Whitefield foot expert caught the eye of TV money-saving expert Martin Lewis and was swamped with thousands of demands from freebie-hunters. Now, the 42-year-old, his wife, mother-in-law and four children spend most of their time sending samples all over the world.

Barry Radivan

"I managed to contact 7,000 people through his website, it took three days, e-mailing them in blocks of fifty. I told them that if they wanted the heel balm they would have to send a stamped addressed envelope. "Since then I've been getting 500 SAEs a day. I only had a limited supply of the sachets so I had to contact the suppliers, who've sent me another 4,000 samples. It was very scary at first.

Source: Chris Osuh, Manchester Evening News, [6/15/06]

Hospital Admission by CA Podiatrist Constitutes Violation

Stanislaus Surgical, Dec. 9, 2005 Investigation

Incident: A 65-year-old woman with arthritis and hypertension was admitted to the hospital by a podiatrist (a foot specialist.) State law does not permit podiatrists to perform pre-admission assessment of patients.

Correction: Podiatrists on staff were told to have authorized physicians evaluate their patients before admission.

Source: Modesto Bee [8/13/06]

Researchers at Anacor Pharmaceuticals hope a new antifungal drug can go where others can't. "We set about finding a molecule that not only acted against the organisms that cause onychomycosis but that also penetrated the nail and nail bed," says Dr. Karl Beutner, chief medical officer at Anacor. The new drug — a fungicidal, rather than a fungistatic (like many current treatments) — is designed to kill fungus, not just slow its growth. Called AN2690 for now, it works by shutting down the fungus' protein synthesis process, Beutner says.

The drug's small molecules seem to absorb easily into the water-rich environment of toenails, Beutner says. In the lab, researchers applied AN2690 every day for two weeks to detached cadaver fingernails. They found that 16% of the solution seeped all the way through the nails — 200 times the amount that a ciclopirox solution managed under the same circumstances.

Two Phase 2 clinical trials of AN2690 are underway in the U.S. and Mexico. Researchers are looking to see if patients treated with the drug will grow at least 5 millimeters of fungus-free nail over six months. Halfway through the study, preliminary results suggest that 13 out of 24 patients are on track to meet that criteria, showing at least 2.5 millimeters of clear toenail growth, Beutner says.

Other companies are also working to develop topical antifungal treatments. Novartis AG, in Basel, Switzerland, is designing clinical trials in the U.S. and Europe for a new topical treatment containing terbinafine, the same antifungal in its oral medication. And in January, MediQuest Therapeutics of Seattle started recruiting for a Phase 2 clinical trial to test terbinafine and naftifine — an antifungal commonly used to treat athlete's foot — in a new type of gel designed to effectively penetrate the nail.

Source: Regina Nuzzo, Los Angeles Times, [8/14/06]

Planned Medicaid Cuts Cause Rift With States

The White House is clashing with governors of both parties over a plan to cut Medicaid payments to hospitals and nursing homes. A bipartisan group of 50 senators recently urged President Bush to scrap the proposed rules, which were set forth in his 2007 budget and could be issued before year-end. Under the plan, the federal government would reduce Medicaid payments by redefining allowable costs and limit states' ability to finance their share of Medicaid by imposing taxes on healthcare providers. Opponents say the president is doing by regulation what he unsuccessfully asked Congress to do by legislation in the last two years. And they say prior administrations and the Bush administration itself approved many of the state taxes that would be deemed improper under the new rules.

Source: The New York Times via Modern Healthcare [8/14/06]

Query: Seminars in France, England, or Italy

Do you know of any seminars in France, Italy, or England within the next 12 months

Joseph Borden, Reseda, CA, Boosh123@aol.com

Editor’s note: The meetings section of our website lists the following:

November 23 – 25, 2006 - Society of Chiropodists and Podiatrists Annual Professional Conference and Exhibition at The Brighton Centre, UK. Bookings are now being taken online at Hhttp://profile.conference-services.net For Further Info Contact Jessica Canfor Hinfo@profileproductions.co.uk

RE: Source For Women's Double Last Shoes (David Gutierrez, DPM)
From: Mel Cheskin MBS.,C.Ped.

The correct terminology for this fitting of shoe is called "Combination Lasted." It means, as you suggest -- two sizes different from heel to forefoot. Many athletic shoes are made on combination lasts. Dress shoes -- rarely, but a good comfort / orthopedic shoe store (such as Foot Solutions) or Harry's in NYC will advise brands that still make combination fittings. Eneslow is outstanding for advice and service in your area.

Mel Cheskin MBS.,C.Ped., Boca Raton, FL, Melcheskin@aol.com

RE: Anodyne Therapy National Coverage Decision
From: Ken Malkin, DPM

I am sure you all have received correspondence from Anodyne's manufacturer regarding a draft Medicare National coverage decision which would establish that any state Part B Medicare carrier is prohibited from paying for this modality for management of diabetic peripheral neuropathy or wound treatment and in addition should it be instituted would prohibit DMERC from paying for the unit for a patient for use within their home. They are requesting physicians send comments to Medicare opposing this draft decision. .

I will simply say while I have not read all articles on this subject, and decided if this should be covered in my own mind, I do know that reimbursement for a 30 minute treatment of this single modality by Medicare is than $10.00 per session. I cannot imagine why one would prefer this to be a covered service instead of letting patients pay cash for this treatment. There is no way that a PT modality, which according to Medicare must be provided by the physician themselves or a physical therapist , can result in anything but economic loss to a practice. Please help me with this.

Ken Malkin DPM, Caldwell, NJ, drmedicare@aol.com

RE: HMOitis vs. MCOitis (Dennis Shavelson, DPM)
From: Ira M.Baum, DPM

The term HMOitis is too narrow, managed care organizationitis (MCOitis) would be more appropriate. Dr. Shavelson is correct - always treat the patient as well as you can and don't compromise. Having said that, managed care companies have continued to take advantage of the adage "Divide and Conquer," specifically because most of us practice as individuals or in small groups, regardless of how busy we are, we have no negotiating leverage. Managed care organizations for the most part are interested in providing a service for a fee (premium), their primary concern is not the quality of the service (within reason). Therefore, by podiatrists being divided, the MCO's conquer us by taking advantage of Dr.'s integrity and eroding our fees unfairly enabling them to realize enormous profits. The trend has continued for the last 10 years and I'm afraid it will continue until it is no longer cost-effective for podiatrists to treat patients.

Dr. Shavelson's response regarding HMOitis and Dr.'s responsibility to not compromise patient care is like comparing apples to oranges. The apple is the quality of care we all strive to provide, and the orange is the cost of providing it. We all have the option of not accepting low reimbursement from particular insurance companies, but I don' t believe that is the answer to quality healthcare in the USA. The issue is how can doctors leverage an even playing field to negotiate fair fees from MCO's? There are models that have worked and have proven successful in other specialties of medicine. I am from the school that podiatry is nothing more, and nothing less than another specialty of medicine. Regarding fair fees, there are national fee standards that can be used for these negotiations. My interest is not to gouge the MCO's, but to be treated fairly. The difficulty is getting the MCO's to the negotiating table. I don’t see any reason why we cannot stop the reimbursement bleeding and re-establish fair fees.

Ira M. Baum, DPM, Miami, FL, ibaum@cofs.net

RE: Silver Nitrate for Verruca (John Stephens, DPM)
From SuEllen Dercher

In podiatry, silver nitrate solutions are used as one of the cauterant chemotherapeutic methods employed in the treatment of plantar warts. This treatment has been used by podiatrists for many years.

Gordon Laboratories manufactures silver nitrate solution 25% and silver nitrate solution 50% for use in treating such verrucae. A silver nitrate solution 10% is also available, and is used to treat helomas. These pharmaceutical specialty products are prescription strength for professional use only.

Silver nitrate solutions are colorless and odorless, and packaged in convenient 1oz. amber glass bottles. Manufactured by Gordon Laboratories and are available through podiatry dealers.

SuEllen Dercher, Gordon Laboratories, sdercher@verizon.net

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

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