The Voice of Podiatrists

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August 27, 2007 #3,024 Editor-Barry Block, DPM, JD

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OK Podiatrist Provides Shoe Fitting Advice

There are several ways parents can help their children get shoes that offer more than style. Dr. Juliet Burk, a podiatrist with LSI Foot Clinic and LSI Shoe Clinic in Tahlequah, OK suggested useful tests for the best shoe.

Dr. Julie Burk

“While your child is standing, press your thumb on the end of the shoe to be sure there is room the width of your thumb between the end of the toe and the end of the shoe,” she said. “To make sure a shoe is wide enough, have them stand (without shoes on) on a piece of paper. The foot expands while standing on it. Trace the outline of the foot.”

Once the tracing has been cut out, it can be taken to the store and used to check width. “Fit it inside the shoe to make sure it doesn’t curl up too much on the inside,” Burk said. Then, there’s the matter of the shoe providing good support. “It should have a firm heel cup,” Burk said. “Press on the back of the heel and make sure it doesn’t crumble. And, it should be hard to twist from side to side.” If you flex both ends of the shoe upward, it should bend only near the ball of the foot and not at the middle near the arch.

Source: Keith Purtell, Muskogee Phoenix (OK) [8/24/07]

Catalano Elected to MPMS Board of Trustees

Gregory Catalano, DPM, a Concord podiatrist, has been elected as a trustee of the Massachusetts Podiatric Medical Society (MPMS), an affiliate of the American Podiatric Medical Association. MPMS is the commonwealth’s professional society for podiatric physicians and surgeons — foot specialists. Catalano will be serving on the MPMS Public Health Committee.

Dr. Gregory Catalano

Catalano has practiced in Concord since 1992 and also has an office in Westford since 1997. He is a staff member of the Emerson Hospital and the Nashoba Valley Medical Center. He is board certified in podiatric surgery by the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons.

Source: The Concord News [7/23/07]

Romney Unveils Healthcare Plan

Mitt Romney Former Massachusetts governor and GOP presidential hopeful Mitt Romney unveiled a six-point plan that aims to reform the current healthcare sector by using federal incentives to boost competition and expand the private health insurance markets on a state-by-state basis.

Mitt Romney

In a speech made to the Florida Medical Association, Romney said he intends to change the federal tax code to make it cheaper for individuals to buy private insurance. Those same tax reforms would also be used to promote “smart” spending on healthcare, create incentives for states to reform their health insurance markets and support broader medical liability reforms, according to a statement released by the Romney campaign. Aides to Romney told the New York Times that the candidate’s plan would funnel federal dollars now being used to help states cover the cost of uncompensated medical care into programs to help low-income individuals not eligible for federal aid buy their own insurance.

Romney’s proposal would also use health information technology as a driver behind boosting healthcare quality, establishing cost and quality transparency programs and encouraging more consumer-directed health plans, such as health savings accounts and co-insurance products. As governor, Romney spearheaded a high-profile overhaul of the state’s healthcare system,

Source: Matthew DoBias and Jennifer Lubell, Modern Healthcare [7/24/07]

Query: Delayed P & A

When performing a P&A procedure for an ingrown toenail, I generally remove the offending nail border and do the phenol and alcohol procedure immediately. I was curious if the procedure would still work if performing the phenol and alcohol one week later after removing the nail or for some reason is it more effective doing it immediately. My concern for not performing it immediately was a localized cellulitis that I wanted to clear up prior to initiating a chemical burn.

Jeffrey Kass, DPM, Forest Hills, NY

RE: ESWT As “Investigational” (Arden Smith, DPM)
From: Multiple Respondents

Regarding ESWT, FDA approval only indicates a procedure is safe to do what it claims. It does not deem a piece of equipment effective enough to warrant coverage. Insurance companies now require that techniques not only be effective but that they be either equal or less costly that comparable treatments. Insurance companies have determined that ESWT will be vastly more expensive than other comparable treatments.

APMA, during my tenure on the board, met with people from Dornier and Ossatron and urged them to do the double blind studies necessary for coverage. Now, about five years later, studies are being produced, but the decisions made by companies will be very hard to change.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

I perform insurance peer reviews for multiple insurance companies across the US and ESWT therapy is usually denied for the various reasons previously stated in earlier posts. I agree that the main reason driving the denials is monetary. I think that when we started
using ESWT we overcharged tremendously. It is still not unusual in San Diego for podiatrists to charge $3,000 procedure fee, plus $6,000 (usually billed by the equipment provider) for use of the machine. In addition, there often are outpatient surgery center charges. I have seen many bills of $12,000 for total expenses for these procedures.

This isn’t the first time that opportunistic behaviors by the early users of a new modality have tainted its long-term acceptance. I believe ESWT would have been generally accepted by the insurers if we had originally charged the same for ESWT as we did for open or laparoscopic plantar fascial procedures, and the companies providing the equipment had considered much reduced charges for use of the equipment. It is conceivable that ESWT may be accepted in the future, but it will be at rates matching (or less than) other procedures used for surgical treatment the same conditions. There’s a lesson here.

Martin R. Taubman, DPM, MBA, San Diego, CA, mtaubman@san.rr.com

The FDA has one job with regard to medical devices: Quote from their mission statement.
"there is reasonable assurance of the safety and effectiveness of devices intended for human use" They do not guarantee payment.

If you believe ESWT works so well then charge cash for the procedure. When the patient returns, thrilled with the outcome, they will spread the word. Then we will see the real success numbers. No strings attached.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

I just treated four feet this week with ESWT and i think it is a great non-invasive modality. My patients pay cash and we do it in the office. There are some new studies out that justify it usage. I believe that the insurance companies just do not want to pay for it knowing that all of us have hundreds, if not thousands of patients who would benefit from the procedure if it was approved. It was like that in Michigan for the short period when the Blues paid for the procedure. Now it is almost impossible to get a company to bring a machine into our state.

Isidore Steiner D.P.M.,J.D.,M.B.A., Howell, MI, footlaw@hotmail.com

It is not ESWT that insurance companies are after, it is podiatric medicine. Insurance companies almost never cover items considered "experimental" or "investigational" by the FDA. Movies and TV shows have been done about this. So, we do have to wonder what actual standard of care insurance companies are applying FDA-approved modalities like high energy ESWT? I had one medical director cite literature saying ESWT did not work, but when questioned further, he said it was a study, or report, on low-energy treatments. Are we responsible for the blurring of lines as to the difference between high-energy ESWT and low-energy ESWT. Are the insurance companies deliberately using the "blur" to deny coverage of high-energy ESWT ?

Of course, then there is the rapidly decreasing coverage of prescription function foot orthotics, another podiatry mainstay. I am sure you have all received letters from CIGNA stating that this is "experimental" and or "investigational" lacking large population studies. What is "large"? Which groups (quasi professional, and or retail) benefit by these blanket denials? Are we being singled out as a profession?

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

CRYOPROBE SALE: PRICE REDUCTION!

A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $10,500 or best offer. 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 inquires or your offer to: drsammendicino@gtef.org

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

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

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