The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 22, 2009 #3,629 Publisher-Barry Block, DPM, JD

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Congratulations to Chris Browning, DPM of Nederland, TX, winner of a copy of Foot and Ankle Radiology by Robert A. Christman, DPM  (Value $230)

We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2010 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

Insight Scale

This week's prize is  an Insight scale (Value $79.95).

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame. 

Flip-Flops/Sandals a Major Cause of Plantar Fasciitis: TX Podiatrist

Most flip-flops offer little to no support for the arch of the foot, and their lack of structure can cause long-term damage - some of which can require surgery. "Flip-flops will keep me in business for the rest of my career," said Dr. Damien Dauphinée, a podiatrist at Complete Foot and Ankle Care in Denton, TX.

Dr. Damien Dauphinée

"A lot of the time, plantar fasciitis occurs with women who wear sandals all the time," Dauphinée said. "There are sandals with arch support and if you have good foot structure then they're probably OK; but if you continue to wear them even after you start feeling pain, you're going to have problems."

Source: Heather Jackson, North Texas Daily [8/14/09]

Senate Negotiators Push Forward with Focus on Cost

A team of three Republicans and three Democrats on the Senate Finance Committee has made progress in talks on bipartisan healthcare reform, Committee Chairman Max Baucus (D-MT) announced. Baucus, along with ranking member Chuck Grassley (R-IA) and members Jeff Bingaman (D-NM), Kent Conrad (D-ND), Olympia Snowe (R-ME) and Mike Enzi (R-WY) participated in a teleconference to hammer out remaining differences on the path to reform and potentially avoid steps to push a bill forward without broad Republican support.

Discussions involved “an increased emphasis on affordability and reducing costs, and our efforts moving forward will reflect that focus," Baucus said in a written statement. "We have come a long way, will continue our work throughout August and plan to meet again before the Senate returns in September.”

Source: Jennifer Lubell, Modern Healthcare [8/21/09]

Zip Your Lip When …

As a professional, you need to keep your cool at work, no matter what. And the best way to keep strong emotions such as anger under control is to keep your mouth closed just a little while. Waiting even a few seconds to respond can give you enough time to formulate a more measured response.

The next time you feel angry, buy some time to deliver a constructive response instead of a knee-jerk reaction. Say “Wow, I need to let that sink in, and then I will come and find you so that we can discuss it further” or “I don’t want to overreact to your statement. When I can focus again on our common goals, we need to talk about our plans.”

Source: Adapted from Coaching Made Easy, Mike Leibling and Robin Prior, Kogan Page via Communication Briefings

Query: Faxed Requests from Pharmacies to Refill Prescriptions

Lately, my office has received an inordinate number of faxes from local pharmacies requesting prescription refills. We contact the patients to see if they initiated this request and most times they did not, and they do not need a refill.  Needless to say, it takes time to process this information and to fax the pharmacy that the prescription is not to be refilled. Any idea as to why this is happening and what to do? The majority of these are prescription creams: anti-fungals, etc.

Richard A. Simmons, DPM, Rockledge, FL

Query: Orthotic Allowance Reduction

I recently received two EOBs from an insurance company reflecting a 60% reduction in the approved reimbursement for orthotics. These reductions follow a contract renewal year beginning July 1st. Do I have any recourse? The reimbursement now barely covers the lab fee, and certainly not the fee AND my time for follow-up and possible adjustments. I can't charge a cash fee for a covered service, so what do I do? Do I refuse to make them?

Neil Levin, DPM, Sycamore, IL

Response: If you have a contract with a payer, and that contract includes a foot orthotic benefit with fee schedule, you may be in serious violation of your contract if you "privately" bypass your agreement to balance bill the patient - even a willing patient - the differences between the fee schedule maximum allowance and your regular fees.

I would suggest you contact a healthcare attorney to review your contracts to see if you, as a participating provider, have an option allowing you to ignore the terms of your managed care contract or if your contracts permit you to balance bill patients.

If your contract does not permit you to balance bill or privately contract payments with patients, you can:

1) Write the prescription for the patient to get their DME elsewhere; or
2) Try to negotiate a better fee or balance billing clause; or
3) Terminate the contract; or
4) Dispense the custom foot orthotics at break even or at a loss (not really an option).

The thing you can't do is ignore your agreements. Trust me, even a willing patient will have a wife or son that will complain to the insurance company (Murphy's Law)...

Harry Goldsmith, DPM , Cerritos, CA

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RE: Protocol NaOH Matricectomy (Irwin S. Linker, DPM) 
From: Multiple Respondents

I have been using the following protocol for chemical matrixectomies for over  27 years. I use 3 five-second application of 10% NaOH for partials; and for total nails, I use 4 to 5 five-second applications depending on matrix thickness and dystrophy. Flushing is with acetic acid (white vinegar),  for approximately 10 seconds. 

Angelo J. Bigelli, DPM,  North Providence, RI toedocri@aol.com

After years of using phenol, I decided to try sodium hydroxide this year. After reviewing several protocols I settled on two ten second applications. The inflammatory reaction to sodium hydroxide is much greater than that of phenol. It absolutely must be neutralized with vinegar. I do not agree that healing time is quicker with sodium hydroxide. In fact I've noticed the opposite... healing time is longer! 

Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net

I have used NaOH during my entire career of nearly 30 years. The strength is 10%. It is applied using a tourniquet to ensure a completely dry field. It is applied for 60 seconds using a small pointed q-tip. I blot away any excess immediately after application. It is flushed with plain vinegar. This flushes it out and chemically neutralizes the NaOH. The area is thoroughly curetted to remove coagulated tissue and cleaned. This is effective and safe. 

While it is always possible to over or under treat, with experience, I believe you will find this method to be superior in time and results to the more frequently used phenol technique. Pain is generally mild. I almost never prescribe narcotic analgesics. I recommend very loose shoes or sandals for about 2 weeks to allow healing without shoe irritation. Results have been consistent and effective.  Recurrence rate is very low. Infection rate is very low. I prefer gentle soap and water cleansing with flush using a syringe vs. soaking for care. This can be completed in less time with greater compliance and efficacy. 

Timothy Bernard, DPM, Woodland, CA, tbdpm@aol.com

Re: IME Doctor Liable Despite No Patient Relationship (Steven Solomon, DPM, JD)
From: Paul Kesselman, DPM

Does the New York decision discussed by Dr. Solomon mandate that the malpractice carriers in NYS, e.g. PICA, etc. are now obligated to cover us for professional liability resulting from allegations of injuries resulting from an IME? If so, what is the best method by which to inform PICA, etc. that they are now legally obligated to cover us (if they are)? What implications does this decision have for physicians practicing in other states? Will this adversely affect the premiums of those who conduct IME's and provide an advantage to those who do not?

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

Editor's comment: PM News does not provide legal advice. We posed this question to Jerry Brant, DPM of PICA who informed us that PICA covers incidents "according to state statute" and that as long as the area examined during the IME was within the scope of practice, it would likely be a covered incident. Brant stated, "PICA reserves the right to review any case, but in 30 years, PICA has never denied coverage for this type of case."

WANTED – ASSOCIATE POSITION  – CHICAGO, IL

Hard working and Ethical Podiatric Surgeon looking for Associate/Partnership position in the Chicagoland area. Please contact A773K@aol.com  or cell phone (713) 992-6113. 

ASSOCIATE POSITION - DALLAS/FORT WORTH AREA

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.net

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

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

EQIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

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

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

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.

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 - NEW JERSEY 
 
Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

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

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

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

PM News Classified Ads Reach over 11,500 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 11,500 DPM's. Write to  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 Ext 110

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