The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 31, 2009 #3,636 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.

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

Heel Pain Can Be Treated Conservatively 80% of the Time: MO Podiatrist

Fortunately, most patients are able to overcome heel pain with conservative treatments, says Dr. John Dailey, a podiatrist with The Missouri Foot & Ankle Institute in Washington, MO. “We begin by evaluating the patient through radiographs and by looking at their gait,” he says. “We can help reduce inflammation with steroid injections, but the secret is in controlling the way the foot moves and functions.” Physical therapy and orthotic shoe inserts that position the foot correctly can be very helpful.

Dr. John Dailey

More than one treatment is often needed, but heel pain tends to subside over time with continued stretching exercises and proper footwear. If heel pain does not improve, “we use a computerized gait lab to help evaluate patients and see if there is another underlying issue, such as a leg length difference, that can cause stress on the plantar fascia on one or the other foot,” Dailey says.

Only about 20 percent of patients with heel pain will need any sort of corrective surgery, he adds. “Surgery involves removing bone spurs and releasing the plantar fascia. It’s done at the hospital, and patients are generally walking the same day. They remain bandaged for a couple of weeks.”

Source: Connie Mitchell, Ladue News [7/30/09]

Security Breach Notification Rule Issued by HHS; Sept. 23 Deadline Set for Reporting ‘Significant Risk’

In interim final regulations released on Aug. 19, HHS fleshed out the requirements of security breach notification for unsecured protected health information (PHI). The regulations explain when HIPAA covered entities must notify individuals of breaches, which is one of the supercharged privacy and security requirements enacted in the HITECH Act, signed by President Obama in February.

The HITECH Act, which was part of federal stimulus initiatives, created a new federal breach reporting requirement for HIPAA-covered entities and their business associates. It requires them to notify people whose unsecured PHI has been accessed, acquired or disclosed because of a breach, which is defined as “the unauthorized acquisition, access, use or disclosure of PHI.” Breaches affecting more than 500 people must also be reported immediately to HHS and the media.

The rule, which takes effect Sept. 23, tracks the statute in terms of definitions, receipt, delivery, content and time frames for the notice. However, it also adds refinements to make it easier to understand who is covered and what is required. For example, the preamble makes clear that HIPAA-covered entities and their business associates are subject to the HHS rule, not the Federal Trade Commission “Health Breach Notification Rule,” which was released on Aug. 18, although the two rules parallel each other.

Source: Nina Youngstrom, Report on Medicare Compliance [8/27/09]

Query: Ascending Cellulitis and Antibiotics

I had a patient who presented to my office for the first time with c/o athlete’s foot infection after working outside all day. He was at his doctor's office the day before. On presentation, the patient had edema, redness to the foot with interdigital macerations, and ascending cellulitis up the leg to the level of the knee. I advised him to go to the ER and get admitted for IV antibiotics the same day. Patient went and was given one dose of IV and sent home with "stronger" PO antibiotic. Is there a time or situation when a patient with ascending cellulitis up the leg does not need to be treated with more than one dose of IV antibiotics?

Vilayvanh Sysounthone, DPM, Wayne, NJ

RE: DME Surety Bond Scam
From: Rick Burnell, DPM

I think that we are all aware by now that we do not need to get a "Medicare bond" to be able to dispense DME from the office. However, I just received a new post card from a company called Starway Agency stating that we are required to get the $50,000 bond by October 2, 2009. PM News readers should be aware that this new scam is circulating.

Rick Burnell, DPM, Camden, SC, burnell_cfc@bellsouth.net

RE: C Arms (Tip Sullivan, DPM)
From: Multiple Respondents

Currently, I am using an "Orthoscan." This is from a new company, and is a very lightweight machine (about 70 lbs.). It produces 4 inch and 6 inch images, and has a large hard drive. The images can be stored or transferred with a flash drive. If it is used C arm you desire, check out Amber diagnostics; they have some great used systems.

Greg Mowen, DPM, Ventnor, NJ, gregmowen@comcast.net

Try calling "Jerry" or George Ellis at XiScan 860-627-7500 x328, or try e-mailing them at service@xitec.com. We had a similar problem several years ago. We followed their phone instructions and ran some tests to pinpoint the problem. They called in a repairman, Jeff Pfeffer of DataScope (800) 288-2121 x 8144 who resolved the problem rather quickly. You're right. Parts are scarce, but maybe not impossible to find. Ultimately, when the unit acted up again, we purchased a used model of a newer version which worked well for us until we sold the unit and the surgery center.
 
Gerald I. Falke, DPM, Hagerstown, MD, falkeg@hotmail.com

We have 6 Mini fluoroscopy units at the Weil Foot & Ankle Institute; some from 20 years ago. Contact me for information on repair and replacement.

Lowell Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

RE: Doctors Must Provide Every Relevant Alternative and Risk
From: Michael M. Rosenblatt, DPM
 
In two separate state rulings, in both Maryland and Wisconsin State Supreme Courts, the requirement that doctors provide “every” alternative treatment and risk was made. But these rulings go even further. Plaintiffs now have the ability to sue for “informed consent” claims even in the ABSENCE of proof of negligence. This is a new high water mark against healthcare providers. Unfortunately, without tort reform, it is unlikely that these issues will be solved. At this time, tort reform is absolutely off the table.
 
Podiatrists now (already) try to seriously provide extensive information and obtain informed consent for procedures. But with the bar higher now, it will probably mean that podiatric physicians inform their patients about attendant risks of many non-surgical treatment choices, like injection and drug therapies. Remember, it will no longer be necessary for your patient to prove “negligence” if you practice in either of these states.
 
Since I am not an attorney, I cannot provide legal advice. However, I would suggest that carriers that presently insure podiatrists take heed of the new rulings, and try to prepare their insured against this new threat. This might start out with patients’ signing informed consent for injection therapy and various drug therapies, including potent antibiotics that podiatric physicians routinely order.
 
Michael M. Rosenblatt, DPM, San Jose , CA, Rosey1@prodigy.net

RE: Income Per Patient (Jonathan Purdy, DPM)
From: Bret Ribotsky, DPM

We must never lose track of what is best for our patients. Becoming board certified by ABPOPPM and ABPS, and becoming a fellow in AFCAS/ASPS and ACFAOM over one’s professional career will provide much more value and income than learning anything at a marketing meeting. This has been proven year after year in PM Magazine's Annual Survey.  On Tuesday Night's Meet The Master's series, Allen Jacobs commented that within his practice, he could not generate receivables anywhere close to $90 dollars per patient. 

While I have lectured at AAPPM meetings many, many times, and I have found these seminars a great asset for all practitioners, they are no substitute for the excellent scientific seminars that are granting CPME credits throughout this country. On a clinical note, if I know clinically that a patient has a neuroma, I do not need an ultrasound to confirm it. Always do what is best for patients and treat each person as if s/he is part of your family, and success will come to you in many, many ways.
 
Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com>

RE: Buy Children's Shoes for Fit, Not Size: IN Podiatrist
From: Paul Busman DPM, RN

Good advice, but I'd expand that to include adults too! How many times have we told patients that their shoes are too tight, only to have them indignantly reply, "But I've ALWAYS worn that size!"?

Feet change, and shoe sizes vary from brand to brand and style to style. I always told my patients to regard the size on the box as a rough guide to how those shoes might fit; more for the convenience of the store clerk selecting sizes than as an actual guarantee of a good fit. 

Paul Busman DPM, RN, Clifton Park, NY, brewerpaul@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.

ASSOCIATE POSITION WANTED- METRO NEW YORK AREA

Associate position wanted for full-time or part time. Diverse practice to include general podiatry, as well as surgery. Hospital privileges available. E-mail CV along with cover letter to rrranch7@yahoo.com

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

ASSOCIATE POSITION - CHICAGO, IL

Hard-working, personable, motivated associate is needed for full or part-time position to work in well established 2-office practice in Chicago and NW suburb. Competitive compensation. New podiatrists are encouraged to apply. Send CV to: anthony.spitz@gmail.com or call 847-971-5926.

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

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 - 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.

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