The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 25, 2009 #3,631 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. 

VT Podiatrist Discusses Plantar Fasciitis

Kevin McNamara is a doctor of podiatric medicine and holds a fellowship in podiatric sports medicine and is on staff at Gifford Hospital. We asked him about plantar fasciitis.

Dr. Kevin McNamara

"Plantar fasciitis is treatable. Though there can definitely be a long recovery time, if you catch it early on, it is quick to resolve," McNamara said. "Unfortunately a lot of people don't treat it early because, though the pain is there, it is not disabling and they tend to delay treatment."

Interventions prior to surgery include support (shoes, orthotics, and tape), stretching, massage, anti-inflammatory medications, and possibly a cortisone injection. Runners and people who stand all day at work (such as sales or manufacturing jobs) are particularly at risk.

Source: Linda Freeman, Rutland Herald [8/23/09]

How to Reduce Your Practice's Credit Card Fees

Surveys show that more and more physicians no longer accept credit and debit cards, in large part because of the expense. But these charges can be contained by shopping around, paying attention to added fees, and processing in the most secure manner.

Merchant service organizations charge approximately 2% to 5% of the value of a transaction, and experts say it is possible to keep these costs on the low end. A practice can reduce this expense by approximately $800 to $1,200 per physician per year. Physicians may be able to get lower rates by calling several processing companies to compare costs, and use the information to negotiate lower fees.

Smaller practices may get better deals by joining with other small businesses and using a processor linked to a local chamber of commerce or a professional association. The American Medical Association, for example, has an arrangement with First National Merchant Solutions for its members.

Source: Victoria Stagg Elliott, AMNews [8/17/09]

Query: Income Per Patient

Thank you for exposing me to the Meet the Master’s series by Dr. Ribotsky. I just spent a few hours listening to the lectures this weekend while I was fishing, and I must say what a great way of gaining knowledge. There was one item discussed by Dr. Guiliana last week that I would like to query my fellow colleagues on PM News. Dr. Guiliana said that the average income per patient seen over the year should be about $90.

I asked my wife (who runs my office) what our income per patient was. She took total deposits over the past twelve months and divided it by total number of encounters and the result was just under $64 dollars. Can I ask the other readers of PM News to share what their numbers are and give suggestions what I can do to reach the $90/per patient encounter.
 
Michael Cohen, DPM, Sarasota, FL

Editor's note: To hear the interview of Dr. Guilana and the otrher masters, click here To register for the Podiatric Success series, click here.  This week's guest (Tuesday night at 9 PM (EST)  is Allen Jacobs, DPM.

RE: Purchasing NaOH (Shari Kaminsky, DPM)
From: Multiple Respondents

We have been purchasing NaOH for years from Gordon Laboratories. It is inexpensive and can be purchased through most podiatric suppliers. We have found use of NaOH versus phenol causes much less redness, inflammation, and drainage when performing a matrixectomy. 

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

NaOH is commonly used in the microbiology department of most hospitals. The 10% solution can be easily mixed, and once constituted, must be kept in a dark bottle. It is denatured by light and has a one year shelf life. Most hospitals will provide this service to their attending docs. This product is commercially available through Gordon Labs and most pharmacies.

Frank DiPalma, DPM, Athens GA,  Fivetoes1946@aol.com

I purchased NaOH from Moore Medical, however, I have not yet concluded as to whether phenol or NaOH is the best product for the cauterization of nail matrix. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Protocol NaOH Matricectomy (Irwin S. Linker, DPM) 
From: Marc S. Greenberg, DPM

So, there are lots of DPMs who use NaOH and have great success. Great. Nobody's disputing that. Some like it better than phenol, some don't. Not a big deal. We all have our preferences. What is concerning is the apparent lack of a standard procedure based on the responses from the readers. I'm not necessarily saying all these DPMs need to change what they are doing if they are getting great success. They should, however, consider what their response would be when a student, resident, attorney, etc. asks them why they do exactly what they do. "Because it works for me" or "because I've always done it that way" might not suffice. 

In the case of phenol, there is at least a study (JAPMA 2002, Scientific Analysis of Phenol Nail Surgery, Boberg et. al.) looking at timing and histologic analysis of phenol matrixectomies. This is the study I have referenced in the past when somebody asks me about my application timing of phenol. Evidence-based medicine. What do you do?
 
Marc S. Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com

RE: Timing of Charging for Orthotics (Lowell Scott Weil, Sr., DPM)
From: Kenneth T. Goldstein, DPM,  David J. Freedman, DPM

We charge at the time of casting. The reason is, we bill for "casting & fabrication" of orthotic devices.

We specifically use that phrase when requesting authorization (if necessary) from the insurance company.
 
Kenneth T. Goldstein, DPM, Amherst, NY, KTG13@aol.com

The simple survey provided should have excluded Medicare. There are no strict private insurance guidelines that prohibit one's practice from submitting DME charges at the time of casting or at the dispensing of the actual device. There are strict guidelines from Medicare that indicate that charges for the DME device(s) can only be billed when dispensed.

David J. Freedman, DPM, Silver Spring, MD, djfreedman@aol.com

Editor’s note:   The results of our quick survey show that about 85% of podiatrists bill for orthotics at the time of casting. 

RE: We're Medical Doctors (Alan Sherman, DPM)
From: Lee C. Rogers, DPM

I don't think Dr. Sherman insinuated that we had 'medical degrees', but rather podiatrists were considered the same as any other specialist. Likewise, DOs were in that same classification, but do not have 'medical degrees.' I'd like to point out that I have met several doctors from India who call themselves podiatrists. They are mostly general surgeons who have spent extra time internationally training on the care of the diabetic foot.  They use the designation "podiatrist" on their business card.  We should be proud that our profession is so highly regarded in the care of the diabetic foot, that international surgeons desire the designation.

Lee C. Rogers, DPM, Des Moines, IA, Lee.C.Rogers@gmail.com

RE: Orthotic Reimbursement (Neil Levin, DPM)
From: Neal Frankel, DPM

First of all, if Dr. Levin were aware of the contract renewal date, he could have negotiated this before the carrier just "put it in." Now, I would try to get the VP of network development to show him you cannot continue providing the service at a loss. I would then draft a letter addressed to the patients of that insurance company and make sure the VP of the insurance company sees it. You can then refer these patients to an outside company like many of the orthopods do.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.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.

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 - 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

ASSOCIATE POSITION - BOSTON, MA

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

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

LOOKING FOR ASSOCIATE POSITION  – CHICAGO, IL

I am a 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 - 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

PM News Classified Ads Reach over 11,500 DPM's and Students
 
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