The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 21, 2010 #3,937 Publisher-Barry Block, DPM, JD

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Cosmetic Foot Surgery is a Matter of Semantics: NY Podiatrist

"Calling foot surgery cosmetic is just a matter of semantics," says New York City podiatrist Krista Archer. "Bunion surgery has been around since 1881. It's really a matter of form and function. By narrowing the feet, we are actually improving the appearance of the foot while allowing it to function better." 

Dr. Krista Archer

"New surgical techniques, such as incisions on the sides of the toes, can also provide better aestheic results for hammertoes," say Archer.

Source: Good Morning America (ABC-TV) {8/16/10]

Lowered Risk of Amputatation When Podiatrists are Involved: Study

People with diabetic foot problems can lower their risk of leg amputation by relying on coordinated care that includes a podiatrist, according to a recent study. For instance, those with diabetes-related foot ulcers can reduce their risk of amputation by 31 percent. In a study published online in the journal Health Services Research, researcher Frank Sloan, Ph.D., and colleagues looked at six years of Medicare claims data on nearly 190,000 diabetic patients with foot problems. The study included about 118,000 patients diagnosed as stage one, about 32,000 in stage two, 31,000 in stage three, and 55,000 in stage four (some participants experienced more than one stage).

Dr. David Armstrong

“This study shows that coordinated care substantially reduces amputation rates,” said David Armstrong, DPM, a podiatrist and co-founder of the Southern Arizona Limb Salvage Alliance. “We already knew that when care teams are developed to prevent amputation, in every case, we see success. The study documents that this is true across the country.” Armstrong has no affiliation with the study.

Source: Elaine Zablocki, Health Behavior News Service [8/19/10]

TX Podiatrist Charged with Tax Evasion

A Hondo podiatrist was indicted Wednesday on charges of cheating on his taxes. A federal grand jury in San Antonio indicted Dr. Donald E. Robinson on four counts of subscribing to a false income tax return or statement, marking the latest exchange in his dispute with the Internal Revenue Service. Robinson, 66, has fought with the IRS for several years, court records show. The government filed civil cases against him in federal court in San Antonio in 2006, accusing him of failing to turn over records the IRS sought or to present himself for questioning.

In February 2007, U.S. District Judge Xavier Rodriguez jailed Robinson for 30 days until he complied with the IRS' requests. His indictment came after the IRS checked the information it requested. The indictment said he signed off on tax returns that significantly under-reported his income for 2003, 2004, 2005 and 2006. The indictment alleges, in part, that he denied having any interest in or signatory authority over financial accounts in foreign countries, when he actually did.

Source: Guillermo Contreras, San Antonio Express [8/18/10]

Three Little Questions Can Improve Patient Service

Improve service by seeking three pieces of information from patients.
Ask them to tell you:

1) What you are doing that they like.

2) What you are doing that they don’t like.

3) What they wish that you would do.

Source: Adapted from “If You Think Excellence, It’s Easier to Perform Excellence,” Kay Millar, Indianapolis Business Journal via Communication Briefings

Query: ICD-9 Codes When Monitoring Meds

I recently ordered a liver panel for a patient who is taking an oral antifungal. On the laboratory requisition form, I provided diagnosis codes, ICD-9 110.1 (onychomycosis) and ICD-9 110.4 (tinea pedis). The lab informed me that the patient's insurance would not pay for a hepatic panel with those codes. Is there a more appropriate code to provide when monitoring for side-effects of antifungals or any other meds?

Lori Weisenfeld, DPM, New York, NY

Response: When I bill for this, I use V58.69 (long-term use of other medications). You are monitoring for the use of the antifungal medication treatment, not the onychomycosis.

Theresa Hughes, DPM, Galesburg, IL

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

Painful Venous Conformation (Robert Fridman, DPM)
From: Multiple Respondents

Regarding Dr. Fridman's case, it would be helpful to know if your patient has more proximal venous issues.  In order to be more comprehensive, you could refer your patient for Duplex ultrasound to assess whether or not he has reflux in the greater or small saphenous vein.  In the office, you can get an idea if reflux is present by placing a hand-held Doppler over the saphenous vein. With the patient standing, hold the Doppler below the knee medially and squeeze the calf. If you're over the vein, you should here a swooshing sound.  If, when you let go off the calf, the swooshing stops, it's an indication that the valve is closing and no reflux is present. 

If on the other hand, the swooshing is prolonged, there is, in all likelihood, reflux in the vein. If the above tests rule out reflux, I would attempt to sclerose the vein with any of the available sclerosing agents (e.g., polidocanol or sotradecol), followed by compression. If you feel uncomfortable, refer the patient out to a vein specialist. He/she can perform all the necessary testing, sclerotherapy and/or phlebectomy, if indicated.
 
Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

Over the years, I have surgically removed many venous superficial thromboses along the course of the fascial edge. That is what I am seeing when I look at the MRI provided. With all respect to the other podiatrists' recommendations, I don't see any interventional radiologist being able to reach that far. This is a superficial venous anomaly of the foot, not the leg or calf. The ones that I have removed have given the patient immediate relief and have had no post-operative complications. Pathology comes back as a thrombosed superficial vein or veins. I am feel confident that a vascular surgeon would simply excise a lesion at this location, but it would never hurt to get one (radiologist or vascular ssurgeon) to look at it and give you their opinion though. I'll bet the advice will be to surgically remove it.  
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

I would hesitate to make a diagnosis from just the MRI of the mass as presented, but recently I had a similar case of a slow-growing plantar foot lesion. Initial biopsy was returned as a hemangiopericytoma with abnormal spindle cells. It was then excised, with a complete frozen section performed with diagnosis of sarcoma, low-grade. The patient required wide excision (8x8 cm), free vascularized tissue flap. I wouldn't hesitate to get an MR angiogram to map the tumor, and consider biopsy for a diagnosis before definitive treatment.

Jared K Remmers, DPM, Portland, OR, JRemmers@LHS.ORG

RE: Swiss Compression Technique (John Swangim, DPM)
From: Elliot Udell, DPM

An advertisement saying that a person can have bone surgery on Friday and be back to work on Monday implies that miraculous healing will occur in less than three days. Sure, the patient may be able to return to work but may not be able to dance around the office or do hard manual labor if the job demands it. This type of advertising could lead to unfulfilled expectations by  patients and ultimately to some very happy negligence attorneys.

Years ago, when minimal incision surgery was first developed, many podiatrists advertised painless surgery and lunchbreak bunionectomies. Patients were misled. As a result, the profession was swamped with medical malpractice cases, and we all paid the price with rapidly increasing insurance premiums. Our profession has since matured and podiatric surgeons do excellent work utilizing open or closed techniques, but are careful not to leave patients at the pre-operative consultation with false promises. This key factor has helped stabilize insurance premiums. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: The Residency Shortage Crisis
From: Gregg Young, DPM

As you are probably aware, we have a crisis within the profession. We currently have 12 students from the class of 2010 who don’t have a residency training program, and to our knowledge, there are no vacant first-year spots in the country. This situation is going to be worse for 2011 as we anticipate 50 more graduates. This is not a case of colleges taking too many students as we actually need an additional 100 graduates per year above the 2011 number to replace the graduates from the '70s and '80s. A profession can’t shrink its way to success.

We have a Developing a Podiatric Residency Training Program kit which is available at COTHweb.org. This site requires a login which is available by emailing Carol Jensen CarolJ@AACPM.org. There are sample materials available for almost all of the documents, which must be personalized for your institution. There are experienced directors available to answer questions and help you through the process. We can arrange for someone to speak with your CEO, if necessary.  Fiscal ’08 Medicare Reimbursement Data for your institution is available. Now is the time to step up and give something back to your profession by assisting in the residency development process.

After you contact our office, we will be able to offer you assistance in developing a plan for identifying and securing the resources needed for a training program. If applicable, we can connect you with others in your area who have expressed interest so that you might support one another.  Please help us to move forward to address this shortage of training positions. 

Gregg Young, DPM, Chairman, Council on Teaching Hospitals,
gregg.young@va.gov  

RE: Forefoot Measuring Device
From: Jeff Root

I have been contacted numerous times by practitioners and students who were attempting to locate a source where they could purchase a forefoot measuring device. I thought these devices were no long available.

Bikefoot Forefoot Measuring Device

I recently located a source for a forefoot measuring device that is similar to, but not identical to the original. The company is called Bikefit (bikefit.com/products.php) The primary difference between the two devices is a wooden handle and a window in the heel section that enables the practitioner to easily see the heel bisection line drawn on the foot. The Bikefit device could easily be modified to replicate the original forefoot measuring device by having a slot cut into the heel section and by attaching a handle to the pre-drilled hole where the handle is normally attached. These devices cost $39.95 plus a small shipping charge. 

Disclosure: I have no relationship with this company

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

RE: Referral Source Analysis

A new patient presented to the office yesterday for diabetic foot care. She neglected to fill out the spot on the intake form to indicate who referred her to the office. When my assistant asked who referred her, the nice lady answered “The Lord.” While examining her, she spoke about having had a bad experience with another podiatrist a few years ago, but was in need. She put “the book” on her table and prayed over it for a couple of days. She then opened the book and found my Yellow Pages ad. Clearly, a good marketing investment in the Yellow Pages ad, but where do I send the thank-you note to encourage more such referrals?

Brandon Macy, DPM, Clark, NJ

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS 
 
Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston), Philadelphia, Northwest Pennsylvania, Delaware, Upstate New York, Massachusetts (Brockton). Please respond to: doconcall02@aol.com

MANHATTAN - FULL-TIME POSITION

Available for a Board certified/qualified podiatrist (PSR-24, PM&S-36 ). Located in Downtown Manhattan in a multi-specialty  Orthopaedic office. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Contact fscudese@seaportortho.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 - 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

PODIATRY POSITION AVAILABLE – WISCONSIN

Affinity Medical Group, an integrated health care organization in East Central Wisconsin, is seeking a BC/BE Podiatrist for our Appleton location. This is a General Podiatric practice opportunity including routine care, sports medicine, and surgery. The Appleton area offers a unique quality of life, combining a family centered, university community with all season recreation, a nationally acclaimed educational system, and a diverse and growing economy and population. For information, contact or send your CV, to: Sara Roth, Affinity Medical Group, Physician Recruitment, Phone: 800-722-9989; Fax: 920-727-4350; E-mail: sroth@affinityhealth.org Visit our website at: www.affinityhealth.org EOE.

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

ASSOCIATE POSITION - MANHATTAN

Associate needed in Upper West Side area one day a week for house calls. Earn reasonable income with virtually no overhead. Immediate employment available. Call me ASAP 201-491-2173 or email myfootdoctor2@aol.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

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 

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.

FELLOWSHIP OPPORTUNITY - OHIO

UH Richmond Medical Center is announcing a Podiatry Fellowship: INFECTIOUS DISEASE/WOUND CARE. Accepting applications now for the one year (9/1/10 to 8/31/11) fellowship. Fax a letter of intent and CV to 440-585-6141 attention Donna Ayres. Applicants must have completed a PM&S 36 or equivalent. Interviews are scheduled 8/20/10. This fellowship includes all aspects of a multidisciplinary faculty and clinical opportunities in medical and surgical wound management. Weekly schedule includes surgery, fellow’s clinic time as well as journal club and one research project. The Fellowship has been approved with provisional status by the Council on Podiatric Medical Education.

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

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.

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

MEDICAL SPACE AVAILABLE- MANHATTAN

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.

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