The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 30, 2011 #4,246 Publisher-Barry Block, DPM, JD

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Congratulations to Joseph Park, DPM of Burbank CA, winner of a two-night stay at the Pala Mesa Resort, including 2 rounds of golf (value $640.00).  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 2012 issue of Podiatry Management. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer is necessary) to bblock@podiatrym.com along with your name and address.

The Greenbrier, White Sulphur Springs, WV

This week's prize is a free registration to the 2012 Greenbrier Coding & Practice Management Workshop to be held August 20-22, 2012 (follwoing the APMA Annual Meeting). This workshop is brought to you by Codingline and PM News in conjunction with the American Academy of Podiatric Practice Managment  (Value $395).  

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

MA Podiatrist Honored by Italian University

Lifelong Fitchburg resident and international podiatric surgeon Dr. Joseph Addante was recently honored by an Italian medical university recently for his lifetime of work and innovation in foot medicine. Around 1997, the time he retired from his private practice of 43 years, Addante, had been traveling to Italy three times a year as a visiting professor at Sapienza University of Rome. As recognition for his work there, he was presented with the "Recognition and Appreciation" pergomena. A pergomena is a kind of parchment made from sheepskin. 

Dr. Joseph Addante

Addante is licensed to practice medicine in America, Canada, Italy, England, Spain and New Zealand. He is a distinguished visiting professor at the New York College of Podiatric Medicine and a visiting lecturer at the London Foot Hospital and School of Podiatry. He has taught at Harvard Medical School and the University of Massachusetts Medical School, where students dubbed him "The Podfather."

Source: Michael Hartwell, Sentinel and Enterprise [8/28/11]

IA Podiatrist Joins Regional Medical Center

Cuyuna Regional Medical Center and Riverwood Healthcare Center announced a new podiatry service with the addition of Dr. Bradley McCusker, podiatrist. McCusker will begin seeing patients in Aitkin and Crosby in early September. 

Dr. Bradley McCusker

McCusker, an Iowa native, obtained his bachelor’s degree from Minot State University from the Iowa Physician Assistant Program, and his doctor of podiatric medicine degree from the College of Podiatric Medicine and Surgery in Des Moines. Board-certified in foot surgery, he has 19 years of experience in treating patients with a variety of foot problems. He has lived and provided foot care to the people of Minot, N.D, and Iowa City, Iowa.

Source: Brainerd Dispatch [8/27/11]

Avoid Confusion When Drafting Documents

Avoid confusion when you write a document such as an instruction manual for people who will be unable to ask you questions directly. Ask someone else to review your draft and highlight areas that are unclear.

Source: Adapted from “Share Your Confusions,” Seth Godin, Seth Godin’s Blog via Communication Briefings

RE: New Prospective, Randomized, Controlled Research Demonstrates Custom Foot Orthosis Efficacy in Treating Running Injuries
From: Kevin Kirby, DPM

A prospective, randomized controlled trial that studied custom foot orthoses from a group of German researchers has been recently published which provides further evidence for the treatment of running injuries with the use of custom foot orthoses.  A total of 99 patients with unilateral running injuries were studied and were split into an orthosis group (N=51) and a control group (N=48).  Pain, disability and orthosis comfort were measured with three validated outcome measurements before, during, and after the 8-week study period.
 
In the orthosis group, the pain and disability score decreased after 8 weeks, but increased in the control group, indicating a mean reduction of pain and disability of 58% in the orthosis group and a mean increase of 23% in the control group (P<0.001).  The orthosis group showed a continuous decrease in pain from weeks 2-8, with the control group showing an increase in pain during the same time period.  The authors concluded that “the results of our study justify the prescription of orthoses as a single-measure approach for runners who are still able to continue their training activity. The majority of participants responded well without any side treatments and reported high comfort wearing the orthoses” (Hirschmuller A, et al:  Clinical effectiveness of customized sport shoe orthoses for overuse injuries in runners: A randomised controlled study. Br J Sp Med, doi:10.11136/bjsm.2008.055830).
 
This Level-1 study will add significantly to the research evidence that supports our continued use of custom foot orthoses for our injured athletic patients.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Brachymetatarsia (Eric Edelman, DPM)
From: Gerald Mauriello, Jr., DPM, MA

I believe using a bone graft in this case (2 cm) is a mistake.  Distraction osteogenesis with ex-fix is the technique I would consider.  A bone graft of that size is likely not to incorporate, not to mention the acute stretching of the neurovascular bundle.  A gradual stretch of soft tissue and callus distraction with a mini-rail is the way I'd go.

Gerald Mauriello, Jr., DPM, MA, Freehold, NJ, drmauriello@gmail.com

RE: Chronic Bruising of Foot  (Dawn Foster, DPM)
From: David E.Gurvis, DPM

When I suspect factitial injury, I do something to prevent the patient from reaching the area. An Unna boot works well in these cases. Occasionally, a CAM walker is applied in a way that the patient cannot remove without your knowledge. I do this with either a roll of cast material similar to an instant contact cast over the CAM boot or I put a long cable tie around the boot, so if it were removed, I can tell.
 
If the bruising goes away, and recurs when the device or Unna boot is removed, a factitial injury is likely. This disorder requires a psychiatric referral.
 
I have seen:  self-pinching to bleeding, self-injection of fecal material to produce infections (not my patient, but interesting case of the family docs who sent the patient to me.), cutting, self-burning with boiling water. It's not as rare as you might think.
 
Keep in mind also, this can be a result of domestic violence: spousal abuse or elder abuse.
 
David E.Gurvis, DPM, Avon, IN deg1@comcast.net

Dragon Medical Practice Edition Version 11 Coming in September (Robert Kuvent, DPM)
From Carl Solomon, DPM

I have to agree with Dr. Kuvent's comments to Dr. Kasova's post regarding Dragon voice recognition software. I concede that I haven't used the more expensive Medical version, but cannot justify its markedly increased cost over the "Premium" version. The reason is that one of the options for training its vocabulary is to direct the software to somewhere on your computer (a file, a folder, a drive, a CD, etc.) with documents that contain words that you typically use. That could be your previous dictations, a CD that your transcription service might give you with old dictation, op reports...whatever.  Dragon will scan them and grab all the words it doesn't recognize, then offer them to you one at a time to pronounce. It may require an hour or so of your precious time, but once done, it has all of your medical (podiatric) words in its vocabulary. I can talk faster than conversational speed, and it doesn't have any more trouble transcribing "periosteal proliferation at the proximal shaft of the fifth metatarsal" than the word "cat."

The only problem I'm aware of is the possibility that there used to be one or two practice management software programs that were only compatible with the Medical version. That was the case when I checked a couple of years ago, but has probably changed. The full retail price of Premium (and you can find it for less) is a couple of hundred bucks.  An older version, if you want to test the water and upgrade later, can probably be found on Ebay for less than $100. I've found its performance to far exceed anything I ever expected.

Carl Solomon, DPM, Dallas TX, cdsol@swbell.net

RE: E/M Codes and CPT 11750 (Lowell Scott Weil, Sr., DPM)
From: Randy Brower, DPM

I couldn't disagree more. In the case of a painful ingrown toenail, a patient is coming for relief. It should be removed that first visit. While I agree with practice management, how can you feel comfortable taking someone's co-pay and charging their insurance and having them walk out of your office with the same easily fixable painful problem they walked in with? The only way that would be ethical in my book is if they had a raging paronychia. Then I'd still remove the offending border the first visit, give Rx for antibiotics, then do the chemical after the infection resolves.

With cryptosis, fixing the patient's pain immediately is the best practice management we could give. And by the way, the dressing doesn't have to be so bulky that it can't fit in a shoe. I got into this profession to help people, not to turn them for an extra dollar. Ask yourself, is that how I'd treat a loved one?  We need to separate ourselves from the strip mall chiropractor.

Randy Brower, DPM, Prescott Valley, AZ, footdoctor33@yahoo.com

RE: Effects of Laser Treatment for Nails Only Temporary: DC Podiatrist (Bryan Markinson, DPM)
From: Marc Katz, DPM

Dr. Markinson makes the point that our profession needs to hear.  First, let me say that I perform about 8-10 laser procedures per week. I believe that it is an excellent treatment and I believe, based on experience, that all patients require multiple treatments. 

Podiatrists do lose credibility when they don't tell the patients the truth. It will be the downfall of this treatment. Patients need to understand that they need an initial set of treatments possibly combined with other treatments which may or may not include Lamisil, nail removal, and will include topicals and precautions. All patients should be informed that there is no cure and that the treatment may not work.  In addition, I discuss that this is a chronic infection and will require ongoing treatment that will likely require periodic laser treatments beyond the initial treatments. My patients get the truth and are coming in for maintenance treatments because they are informed.

Why are we so scared to be upfront. When the chronic bronchitis patient sees the pulmonologist, they understand that this is a lifelong problem that can have flare-up infections and they will require antibiotics, hospitalization, etc. The laser hair specialist tells their patients that they will need to pay for maintenance treatments in the future. Imagine your dentist saying that he will treat your cavity and you will never have another cavity in your mouth ever!

Tell it like it is; don't be so scared! The patient can then make a choice and have treatments being fully informed. Podiatrists - do what's right and let us be the physician leaders and innovators of this technique.

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

RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Mak Yousefour, DPM)
From: Lloyd Smith, DPM

So, APMA does nothing, hmmm? If DPMs fully realized how much effort is made by APMA about these issues! Once announced, The APMA monitored Carrier Advisory Committee (CAC) listserve was mobilized and queried. Data is being gathered regarding the multiple facets relative to the ruling. These issues occur daily regarding multiple local, state, and national coverage and payment policies. No other organization representing DPMs can or actually does this. The CAC rep volunteers are appointed by their APMA state component and intercede for DPM members and non-members of APMA.

They coordinate their efforts with the component, other state components who have the same carrier, and APMA. The annual CAC meeting, coordinated by APMA for more than 10 years brings these people, many national speakers, CMDs and CMS representatives to a multi-day forum to meet and exchange ideas. 

My comments could go on for many pages explaining the successes, the failures, the incredible volunteers, and the simple fact that APMA and state component dues pay for this work.

Yes, it is easy to be a critic. It is much harder to be a volunteer working on a daily basis to solve the issues of our profession.

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

SPACE AVAILABLE- NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.netEQUIPMENT FOR SALE – PRE-OWNED DIGITAL X-RAY SYSTEMS

Currently in use Reina-20/20 Extreme CR scanner (OEM iCRco) systems for sale. System includes CR scanner, 4 cassettes/imaging plates, and image acquisition software. Perfect for the low-medium volume practice or satellite office. E-mail Melanie Murdock for details and pricing.melanie.murdock@2020imaging.net

PRACTICE FOR SALE - BOSTON AREA

8 miles north of Boston with sublease available in a modern medical building. Presently working 3 days/week, grossing $300,00 annually with easy potential for full-time. All office and podiatric equipment, instruments, digital x ray, furniture, etc. are included. Turn-key operation. Please e mailfootdoc71@aol.com or call 781 279-2332.

ASSOCIATE POSITION - NE GEORGIA

Immediate opening in established practice for PSR-36 or experienced doctor who is ABPS qualified or certified. Hosp./ASC privileges available. Excellent opportunity for partnership or purchase of practice. Contact dpm1942@hushmail.comASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume toddavidphawk@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Busy upper east side podiatry practice seeking In-Network Podiatrist. Please email CV toinstitutebeaute@aol.com "Attn: Podiatrist" in the subject line.

ASSOCIATE POSITION – ANNAPOLIS, MARYLAND

Incredible opportunity for the right person to integrate long-term into a well established practice. Must be personable, highly motivated and bright individual with outstanding surgical and non-surgical ability. Excellent salary and benefits. Email CV and salary requirements to Marylandfootcare@live.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION – IOWA CITY AREA

Established podiatric clinic looking for an associate to join our team, 4 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume toseattlefootdoctor@yahoo.com

ASSOCIATE NEEDED - SO. CAL

Position open for podiatry associate in Southern California. Applicant must be highly motivated and available for long term employment. This practice is extremely busy and requires a hard work ethic and desire to practice in a group practice environment. Excellent salary and benefit package offered. Please e-mail resume to footcare4all@aol.com

PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write tobblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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