The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

August 22, 2007 #3,020 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Don’t Let Kids Grow Into Shoes: WV Podiatrist

Any parent will tell you, a real battle ground is in the shoe department, when it comes to back to school. Here’s a question-- do your kids even need shoes? Are sneakers ok? And is the $5 pair just as good as the pair that's $60? Doctor Seth Stinehour's a podiatrist who says “yes" there is a difference and that difference is $55. Dr. Stinehour said back to school parents can make a big mistake when it comes to your children's feet.

Should you buy shoes your kid will grow into? “No, that's a myth. You want the shoe to fit now, If you have a shoe too big, you're going to put children at risk of falling and tripping because the shoes are too loose,” Dr. Stinehour said.

Source: Bill Murray, WSAZ-TV (WV) [8/20/07]

AZ Podiatrist Prefers Slower Pace of Small Community

As Mary Lou Rullo looks at post surgical x-rays of her foot, Dr. Jarrett Hamilton goes over the images with her. The radiographs are of a surgery that Hamilton performed two weeks ago to correct a painful hammertoe that Rullo had been living with. Despite a pin extending from her recently straightened toe, Rullo, who is all smiles, says she’s no longer in pain and is “extremely happy with the results of the surgery.” “The surgery was two weeks ago today (Monday) and I was in a lot of pain prior to the surgery,” Rullo says with a nod toward the x-rays.

Dr. Jarrett Hamilton (Photo Credit: Ed Honda-Herald/Review)

Hamilton, who is a doctor of podiatric medicine and surgery, is new to this area. Part of Arizona Family Care Associates, he moved to Sierra Vista after serving a three-year residency in California, where he worked for Encino-Tarzana Regional Medical Center and for Southern California Kaiser. His residency program included the full scope of podiatric medicine and surgical training, to include rotations in vascular, general and orthopedic surgery.

Hamilton completed his undergraduate work at Brigham Young University in Provo, Utah, and earned his doctor of podiatric medicine at the California College of Podiatric Medicine in Oakland. Raised in Mesa, Hamilton remembers being aware of a place called Sierra Vista while growing up, “but never really made it down this far.” He and his wife, Holly, enjoyed living in the Los Angeles area, but Hamilton said they both prefer the slower pace of a smaller community and wanted to return to Arizona where they have family. He turned down job offers in Phoenix to come to Sierra Vista, opting for cooler weather and the outdoor activities this area offers.

Source: Dana Cole, Sierra Vista Herald, [8/21/07]

E-mail Means Fewer Patient Calls And Visits: Study

A Kaiser Permanente study showing that physicians who e-mailed with patients saw a drop in visits, raises the specter that online communication might reduce revenue.

But doctors who were early adopters in e-mailing patients -- and who didn't participate in the study -- say that even though such communication might keep some patients out of the office, it opens up more space for patients who might have a more pressing need to come in. And they say patient e-mail reduces the amount of time they spend on the telephone with patients -- which Kaiser's study also found to be true.

Some physicians have been reluctant to start e-mailing due to the unwillingness of insurers and patients to pay for it. Some insurers do pay doctors for e-mail consultations, but it's an idea that has been slow to catch on. Most insurer projects are still in the pilot stage or have rolled out to a limited number of physicians.

Source: Pamela Lewis Dolan, AMNews [8/27/07]

Query: Wired Network Vs. Wireless Tablet PCs

I am investigating several EMR software (Medinotes, etc); I have an average practice, 3 treatment rooms, one assistant, lots of diabetic-wound care-DME-office surgery. Can anyone provide some pros/cons pearls regarding wired network in rooms with desktop (or laptop) in each versus using wireless tablet PC? Is a server mandatory?

Mark K. Johnson DPM, West Plains, MO

Query: Fracture Coding Question

We have a patient with a metatarsal fracture which is being treated with cast immobilization only. The procedure code, CPT 28470 (closed treatment of metatarsal fracture; without manipulation, each), was billed at initial visit along with an E/M code.

When we see this patient back in 4 weeks, take x-rays, and re-evaluate the status of the fracture, can we bill for the x-rays plus the E/M encounter, or does CPT 28470 code include follow-up visits within the fee?

Wayne C. Gould, DPM, Dover, NH

Response: For Medicare, there is a 90-day global period for CPT 28470, therefore, four weeks later you can bill for the x-ray studies and re-application of a cast (and the supplies), but not for an E/M service related to the fracture. Some private insurers may have a longer or shorter global period for that code.

Mark Schilansky, DPM , Catskill, NY

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Danger of Bone Biopsy? (David B. Williams, DPM)
From: Multiple Respondents

Keep in mind your bone biopsy is NEVER performed through the same site as the I&D. Why should any bone biopsy create a nidus for infection? Why not get an MRI if your concern is risking further infection?

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

Dr. Williams raises an excellent point regarding the potential iatrogenic creation of osteomyelitis via implantation of infected soft tissue into non-infected bone. One option, though not always applicable, is to obtain the bone biopsy through a separate, clean entry point. If this is not possible, in a clinical setting where a 1 week history of cellulitis exists without x-ray findings suggestive of OM, several non-invasive diagnostic options exist for detecting OM.

Depending upon the clinical setting, these include: 3 phase Tc bone scan; Leukocyte labeled Indium scan; Pertechnitate scan and MRI. Then, once the suspicion of OM is confirmed, most clinicians across the country treat it as a surgical issue. Appropriate bone debridement creates a specimen that can be cultured for appropriate antibiotic selection. Should one opt to treat medically, the trephine bone biopsy is the best way to establish the organism and antibiotic of choice.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

The obvious risks attending your proposed procedure are the same as for any surgery: patient selection, co-morbidities, etc. As for inducing osteomyelitis, the likelihood is rare. Bone is not so easily infected. There are data to support this point. What promotes osteomyelitis from a focus of infection includes excessive trauma to the bone, poor circulation, and organism virulence. The need to excise the necrotic tissue in your case, given adequate circulation and a stable patient should outweigh the risks of worsening the bone situation.

Inducing OM might be a concern when doing a percutaneous biopsy but with wound excision (debridement), you should have direct or near direct access to the bone so the biopsy should be pretty easy to perform. Also, consider doing the biopsy under C-arm control so as to visualize where the biopsy is being taken within the bone. As a general rule, if the patient has a limb-threatening infection, surgery should be prompt/immediate and management of circulatory problems follows (ASAP).

If there is less urgency to control the infection, then a circulatory and medical workup should precede the surgery. Radiographic evidence of OM lags the clinical picture by about three weeks. Consider an MRI, but a bone biopsy is the gold standard. However, it is not 100% sensitive. Also, at surgery, if the bone surface appears normal, you could elect to hold off broaching the bone. Just cleaning the overlying tissue may be enough. A bone biopsy could be done at a later date, despite the inconvenience to the patient. In any case, the deep tissue should be cultured and appropriate antibiosis provided. Bone tissue should be cultured separately. Finally, decisions on treatment should be reviewed on the basis of the etiology of this infection.

Philip Jay Organ, DPM, Naples, FL, philorgan@comcast.net

RE: Orthotic Sandals (Cynthia Ferrelli, DPM)
From: Multiple Respondents

I currently use Earthwalk Orthotics, Inc. They carry the Naot shoes/sandals and can do a custom foot bed which are interchangeable with other Naot shoes. You can find them at www.earthwalkorthotics.com

Theresa M. Hughes, DPM, Galesburg, IL, tmhughes@galesburgclinic.com

You might want to look at STJ Labs - they have a sandal line. Keep in mind the bed of the sandal is custom but often times your taking a custom bed and placing it in an off-the-shelf sandal. This kind of reduces the actual "customness" of the device.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

Two sandal manufacturers I have personal experience with are Bite and Naot. The sandals and corresponding orthotics are available from these specialty orthotic labs, usually at an attractive price ($170.00 for both the sandals and orthotics).

Naot sandals and orthotics may be purchased directly from Earthwalk, New Gen, Rocky Mountain and other labs. Bite Sandals and orthotics may be purchased from Comfort Fit, Orthotic Group Foot Dynamics and others. You may also (or have your patient) purchase the appropriate orthotic sandals from a local retailer or off the Internet (Zappos.com and many others) and send the sandals to your local lab with your patient’s negative impression.

I have found the easiest way to do this is to show the patients a catalog or give them a labs website where they can preview the sandals which will accommodate orthotics. They can then find them at a local retailer where they can try them on and decide which style and color they wish to purchase. We then order the sandals when we ship out the plaster casts.

Sizing is done in the office (most sandals only come in full sizes) but may be refined by the lab directly from the cast model. Do the lasting of the sandals they should not be grinded to fit the patient's other shoes as they will no longer fit the sandal. Also since sandals may have a variety of lasts, they often cannot be grinded to fit other than the sandal you initially ordered. This may be confirmed by the lab you ordered the sandal from. You also should check with your accountant to see if local laws require collection of sales tax on the sandals.

Paul Kesselman, DPM, Woodside, NY, plesselman@pol.net

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

ASSOCIATE POSITION – CENTRAL VIRGINIA

Two office practice, fully automated, strong referral base, hospital and surgery center privileges. Full scope of foot and ankle care. ABPS –certified/eligible. Competitive salary/percentage structure and benefits. Email letter of intent and curriculum vitae to jdisabato@virginiafootandankle.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

IN-NETWORK ASSOCIATE POSITION – BROOKLYN, NY

Seeking In-Network podiatric physician in downtown Brooklyn, NY. Part-time and or full-time with flexible hours and all aspects of podiatry, including surgery in a modern office setting with EMR, Sonography, and Digital X rays. Please email resume, including list of participating plans to jr11231@yahoo.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

MANHATTAN, NY GENERAL PRACTICE FOR SALE

Great Midtown East location near Grand Central Station. 614-918-3000 or email sell_my_practice@yahoo.com"

SIERRA VISTA, ARIZONA PRACTICE FOR SALE

Doctor retiring and willing to stay for long transition to assure the new doctor does very well. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

PORTLAND, OREGON 2-PRACTICE LOCATION FOR SALE

Doctor retiring soon and leaving country. This opportunity is 70 miles east of Portland with little to no competition! Check out gorge.net for the area. Call American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

Staff Privileges at Certified Surgical Facility Available- NY & LI

Certified operating rooms which qualify under the new NY Patient Protection Law (which will require accreditation for in-office procedures) are available in Manhattan East 60th Street and Plainview, LI. Staff privileges still available. Space for rent, turn-key operation no investment available.Call 516 433-4447 for information or e-mail podo2345@aol.com

CRYOPROBE SALE: PRICE REDUCTION!

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $11,000. This lists for $14,900.00 new. The CryoPac system comes complete with two fully sterilizable Probes. This system has been used less than 15 times and can be used to treat plantar fascitis, neuromas, and other foot pathology. Please email serious inquires to: drsammendicino@gtef.org

IN-NETWORK POSITION – MIDTOWN NEW YORK CITY

Seeking In-network podiatric physician for midtown locations, to provide: Routine Foot Care Therapeutic Treatment , Minor & Surgical Procedures. Please do not reply if not an in-network doctor. Please submit resume to gelus07@yahoo.com

ASSOCIATE POSITION - VIRGINIA

Immediate full time associate position available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889; www.podiatryltd.com

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 9,500 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 9,000 DPM's. Write 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 dekagan@aol.com

• 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.