The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 31, 2011 #4,247 Publisher-Barry Block, DPM, JD

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NY Podiatrist Provides Nail Salon Safety Tips

You may have a little more trouble relaxing into that massage chair with a magazine after this one -- an unsanitary pedicure could lead to a viral infection (such as warts), bacterial infection from ingrown toenails, and a fungal infection of the skin and nails, among other serious health problems, says Dr. Jackie Sutera, a New York City podiatrist.

Dr. Jacqueline Sutera

Since some salons have better sanitizing practices than others, she recommends that you always bring your own tools (her favorites are Tweezerman), including cuticle nippers, toe clippers, a nail file, nail clippers and, most importantly, a foot file. "That's one of the dirtiest things in that whole salon," she says. "There's a misconception that because they put it in a blue solution or because they put it in a thing that looks like a toaster oven, it's clean -- but it might not be."

Source: Laura Schocker Huffington Post [8/25/11]

NV Podiatrist Heads Non-Profit Amputation Prevention Organization

Feet are not supposed to hurt, says podiatrist Dr. Lawrence Rubin. Retired from his practice, Rubin heads a non-profit group called Lower Extremity Amputation Prevention, or LEAP. He also taught podiatry. Now, he works to prevent foot and lower leg amputations by promoting annual foot exams, especially in diabetics. Diabetes makes people susceptible to foot problems because of loss of nerve sensation. 

Dr. Lawrence Rubin

People tend to ignore foot problems until they get so bad they're hard to heal, Rubin says. "When there are symptoms and people have painful feet, they think it's normal for them to hurt. They think it's because they're getting older or they've been told they have flat feet. Under none of those circumstances should they hurt," Rubin says.

Source: Sonya Padgett, Las Vegas Review-Journal [8/29/11]

Survey Finds ACOs Loosely Defined But Growing

Accountable care organizations, a fashionable name for a loosely defined fix for U.S. healthcare, are the center of debate, gossip, and conjecture among policymakers and healthcare leaders. But the murky state of the model and poorly received draft regulations intended to clarify the sketch included in the healthcare reform law have not deterred plans among some hospitals, medical groups, and payers to make accountable care something real, rather than mere aspiration.

Indeed, the results of Modern Healthcare's first survey of accountable care organizations provide a snapshot of 13 accountable care organizations that executives say could reduce medical errors and waste with financial incentives for quality and lower costs. They include everything from fledgling alliances to detailed agreements. Some already track quality and spending under contracts with commercial insurers. Others have yet to complete physician arrangements. A few have poured capital into ancillary businesses.

Source: Melanie Evans, Modern Healthcare [8/29/11] 

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How do you think second year podiatric students would do on the osteopathic Nationals Boards, Part 1? 

Dr. Christopher Bibbo

Christopher Bibbo: the focus is really completely different. I think that they have to get a different focus on the examinations. Pharmacology and and histology are very similar but, in general, there is a different emphasis. The time spent in medical training is longer and there are more labs involved. 

Dr. Sam Mendicino

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is noted podiatric residency director Dr. Sam Mendicino. You can register for future events by clicking here

RE: CAM Walker for Achilles Injuries
 
What is the best recommendation for a CAM walker/immobilizer for Achilles tendon injuries?
 
Greg Caringi, DPM, Lansdale, PA

Query: ABI Doppler

When using the ABI Doppler on the lower extremity, what diagnosis/diagnoses support the non-palpable pulses for a normal ABI exam in a patient who is a diabetic?

Tamiko Washington, Atlanta, GA

Response: Diagnoses alone are insufficient to support the need for performing non-invasive studies. The patient must also have clinical symptoms which support the need for this type of exam. For example, a patient with non-palpable pulses may have apparent peripheral vascular disease, but with no symptoms or other clinical findings (e.g., claudication, dependency rubor, elevation pallor, foot ulcer/history of foot ulcer, etc.), then the non-invasive vascular study may not qualify for reimbursement.

I suggest you look at your Medicare carrier's local coverage determinations (LCDs), as well as the policies for your non-Medicare payers to determine what the coverage parameters are.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Brachymetatarsia (Eric Edelman, DPM)
From: Roody Samimi, DPM)

I recommend doing a first stage. If you prefer the bone block over the ex-fix distraction method, go with 8 to 10mm. Then perform the second stage for further desired correction. The primary concern is the stress to the accompanying neurovascular structures (by creating a gap and having a skin graft, skin tension is relieved). You would definitely have more flexibility with the ex-fix gradual fixation method as far as getting more than 1 cm correction.

Obviously, you would have to have the right patient (one who follows instructions precisely). You could also consider shortening of the accompanying metatarsals. But with the bone block method, I would do it as two separate surgeries. You'll decide intra-op, after your osteotomy, exactly how much of a block to use, but I would guess 6-12mm initially.

Roody Samimi, DPM, Flushing, NY, roody.samimi@gmail.com

RE: EMR Incentive Received
From: Rhonda Eichenberger, DPM

I just wanted to let the podiatry community know that I did receive my meaningful use incentive money from Cigna Medicare today. I know that in some of the earlier PM News posts that several podiatrists were skeptical about Medicare giving the incentive money, and I was too. So, the money is there for those who have their meaningful use EMR in their practice.
 
Rhonda Eichenberger, DPM, Louisville, KY, footdr4u@hotmail.com

RE: Dragon Medical Practice Edition Version 11 Coming in September (Robert Kuvent, DPM)
From: Howard R. Fox, DPM

I’ve been using Dragon Naturally Speaking for about 10 years now. The best advice I can offer anyone is locate where your voice files are kept on your computer (typically in Program Files/Dragon/Naturally Speaking/Users in XP) and back them up periodically. If you change computers, if they crash, etc., it will save you from re-training the software.
 
Howard R. Fox, DPM, Staten Island, NY, foxhr@yahoo.com

RE: Autoclaves (Elliot Udell, DPM)
From: Jeanne M. Arnold, DPM

We have a Pelton-Crane 10. It has been in use almost every day for 16+ years and has broken down only one time. It is all automatic and only requires minimal maintenance. I would not hesitate to purchase another one. 

Jeanne M. Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

RE: E&M Codes and  CPT 11750.
From: Ivar E. Roth, DPM, MPH

Unfortunately, many podiatrists will play games with the insurance billing to maximize a patient encounter. There is no question that if a patient has a paronychia, at the first office visit, it needs to be treated immediately. I have never had a patient unable to get a toe in the shoe after the procedure was performed. I suggest that if the DPM's excuse for not doing the surgery is the fear of too big a dressing, that s(he) get some help from a fellow DPM on how to accomplish this feat. You should get paid for the new patient evaluation and the matrixectomy; that is only correct, and you should demand payment if the insurance company refuses.

Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

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

APMA and other organized medical societies where podiatrists play a vital role have been discussing this new LCD verbiage and have been preparing for weeks to present a written response to CMS. APMA will be appropriately represented at the August DME MAC conference and presenting to the four Carrier Medical Directors. I have been discussing this issue with the other members of the DME Subcommittee to be sure the word got out to the CAC reps and the local state podiatric components.

In addition, I have read ACFAS' comments and am actively involved in working with the American Professional Wound Care Society in assisting them with preparing a formal response to CMS and the DME MAC's.

So the question is not what organized podiatry has been doing. The real question is...

Editor's note: Dr. Kesselman's extended-length letter can be read here.

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

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.com

ASSOCIATE 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

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.net

EQUIPMENT 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.

PM News Classified Ads Reach over 12,500 DPM's and Students

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