The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 01, 2010 #3,946 Publisher-Barry Block, DPM, JD

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Congratulations to  Lori Weisenfeld, DPM of New York, NY,  winner of a one night stay at a Hotel Monaco located in Chicago, Denver, Portland Salt Lake City, San Francisco, Seattle, or Washington, DC (value $229). 

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 2011 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.

The Sky Hotel, Aspen, CO

This week's prize is a two-night stay at a Kimpton Hotel located in Atlanta, Aspen, Baltimore, Chicago, Denver, Los Angeles, New York, Portland, San Diego, San Francisco, Salt Lake City, San Francisco, Seattle,  Washington, DC, and Elsewhere (value $558). 

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

MO Podiatrist Discusses Hammertoe Deformities

Dr. Greg Kranzusch of Foot and Ankle Center says the biggest thing people don’t realize is that hammertoes are a progressive deformity. They should see a doctor early when the hammertoe is still flexible and they have only a small red area on the top of the toe. “Ten to 20 percent of the population has hammertoes; it is four or five times more common in females because of their footwear,” he says.  

Dr. Greg Kranzusch

“If you notice a toe joint bent upward and it’s sore, see a podiatrist to determine the cause.” He says the most common cause is muscle-tendon imbalance. A high arch, flat foot or excessive pronation can make the tendon stretch or tighten to compensate, causing the toe to contract. The condition can be genetic. You can be born with hammertoes or develop it later if it runs in your family.

Source: Mary Jo Blackwood, RN, MPH, Ladue News [8/26/10]

DC Podiatrist Recommends Foot Strengthening Exercises

Barefoot running is a hot topic in running circles these days. Even if you have no intention of ever parting with your cushy soles, you'll still benefit from shoeless strength training. Barefoot training develops the muscles of the toes, midfoot, heel, and ankle—26 muscles in all. "Foot muscles can atrophy if you're in shoes all day long," says Stephen Pribut, a podiatrist in Washington, D.C.

Dr. Stephen Pribut

Strengthening your feet and ankles enables the rest of your running parts - knees, hips, and back to function their best and reduce injury risk. So, after you run, slip off your shoes and socks, and do a few simple exercises: calf raises, jumping jacks, balancing on one foot.

Source: Adam Bean, Runner's World  [September 2010]

TX Podiatrist Publishes Paper on Chronic Kidney Disease and Diabetes

Dr. Lawrence Lavery, et al. recently had a paper published titled "The Impact of Chronic Kidney Disease on Survival After Amputation in Persons with Diabetes." This manuscript is a 10-year evalaution of mortality after lower extremtiy amputation-the longest follow-up in the literature. It is a collaborative project with the Manchester Royal Infirmiry in Manchester UK. This work will help to understand the epidemiology and prevention treatments that are currently provided for high-risk diabetics who require dialysis.

Dr. Lawrence Lavery

This article provides a foundation to plan interventions to reduce the incidence of amputations. Dialysis patients have about a 10-fold increased risk of amputation and 290% increased risk of death following amputation. The authors believe prevention programs will reduce amputations and improve survival of these very high-risk patients.

OH Podiatrist on Mercy Mission to El Salvador

Howard Kimmel, DPM, residency director of the Louis Stokes Cleveland VAMC, recently participated in a mission to El Salvador sponsored by Medwish International. He was the lead physician for any podiatric or orthopedic problems, and also functioned as a primary care physician on occasion. 

Dr. Howard Kimmel in El Salvador

He is pictured above examining a child after his mother waved down his convoy. Kimmel is board certified by the American Board of Podiatric Surgery and is the Clinical Director of the Podiatry Service of the Cleveland Free Clinic, for which he volunteers on his own time.

Keys to Great Goals

Give motivating power to your team goals by expressing them in measurable terms. Each goal should have three essential parts:

• An action statement. State the goal as if it has already happened: “I answer incoming calls …”
• A defined target. Include a number: “… by the third ring …”
• A definite time frame. Vague goals have little power, so put them in context: “… starting today.”

Source: Adapted from The 1001 Rewards & Recognition Fieldbook, Bob Nelson and Dean Spitzer, Workman Publishing via Communication Briefings

Query: Billing Medicaid Patient in NY

Podiatrists do not take call at my hospital, but I do get called from time to time because there are many times when neither ortho nor plastics agree to see a particular patient. Their reason is either it is a "podiatry problem" or in this most recent case, the ER was told that "plastics does not take care of the foot." Regardless, I was called to the ER Friday night. The patient had her foot run over by a car and she sustained a degloving type injury of the dorsal right foot. She was treated in the ER for two hours (debridement, copious lavage, antibiotics and some suturing to cover small sites of exposed bone), bandaged and released.

This patient has Medicaid and I do not expect to get paid for what I did in the ER.  She will need to be seen weekly for a long period of time and may need a graft at some point. I am having her come to my office to be followed up. Legally, can I bill this patient for services performed in my office?  Should I refer her back to a hospital clinic where Medicaid is accepted?
 
Charles Morelli, DPM, Mamaroneck, NY

Editor's comment: PM News does not provide legal advice. Dr. Morelli's question underscores the need to either have podiatrists included in Title XIX (Medicare) or change our degree to MD or DO. In NY, podiatrists cannot bill Medicaid for treatments. Nothing, however, prohibits the billing of Medicaid patients for cash. The problem, however, is that most Medicaid patients will not be willing to pay you for podiatric services provided. This means that you likely need to refer the patient back to a hospital clinic, which ironically will probably bill Medicaid more than you would have charged for the same services. 

Query: Keller with Chondroplasty

A Keller-type bunionectomy with hemi-joint replacement was performed. During the surgery, it was noted that the damage to the metatarsal head cartilage was more extensive than usual. In addition to the hemi-joint replacement, the 1st metatarsal head was drilled and resurfaced using GraftJacket. Any suggestions on how to bill this?

Vito J. Rizzo, DPM, Bay Shore, NY

Response: The implant procedure would be coded as CPT 28293.

The drilling of the metatarsal head would be incidental to the CPT 28293 procedure performance. As far as the use of GraftJacket, many of the payers I am aware of would deem that portion of the procedure to be investigational/experimental. If you want to try to bill it, it would need to be submitted as either an unlisted code (CPT 28899) or with a "-22" modifier on CPT 28293.

Tony Poggio, DPM, Alameda, CA

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

RE: Disposing of X-Rays (Alan Berman, DPM)
From: Paul Kesselman DPM 

As with any part of the medical record, be sure you are in compliance with all Federal (Medicare) and state regulations and check the birthdates on these patients. Regulations for maintaining those records of minor patients are even more extensive than for adults. You may also want to research the potential for selling these films to a silver recycling facility which recycles x-rays. Be sure they you have a HIPAA business agreement with them.

If you have 20+ years of x-rays, chances are you have quite a few pounds to recycle. You’ll make a few bucks and spare the environment at the same time.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: The Residency Shortage (Lloyd Smith, DPM)
From: Robert Scott Steinberg, DPM

The-cart-before-the-horse method applied by the CPME, shows one of two things. 1) It's a lot of wishful thinking, out-of-touch reality. 2) Just plain arrogance on their part.

Using the lame excuse that not all students are guaranteed a residency, and at the same time, requiring a 3-year program to be able to practice all aspects of our very narrow scope-of-practice profession, and then not guaranteeing those spots is dishonest, unethical, and not fair to all concerned.

CPME, You are not gods. Get off your throne. Face reality. Be practical. Be honest. Have some integrity.

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

Dr. Smith has weighed in before with his assertions that this is a recurring supply and demand problem. He asks that we all act "positive." He ignores the most dreaded fact, however, and that is we have the first students who will be graduated into the Vision 2015 era. He does not appreciate that, in times past, a podiatry graduate could at least work, regardless of his or her residency status. Those days are GONE, and when 2015 is in full swing, and you graduate without a spot, your future is completely uncertain, and as the shortage increases (which is already expected, according to COTH), you will be forced to compete with the next year's graduates.

What would Dr. Smith have these students do? I guess they should be "positive." Residency genesis at best, with all on board, progresses at a snail's pace. Although we need that, it cannot answer our current and future needs for the next few years, in view of our current CRISIS, which is unlike any time in the past. I am dismayed, but understand the anemic student response. I am ashamed that more practicing DPMs have not weighed in here at this forum. The immediate solution is a temporary (or permanent) reduction in the numbers requirements, or elimination of them entirely in favor of a different evaluation system, so all graduates can be absorbed in existing programs.

I hope for any credible fair solution as soon as possible. Until then, I ask that Dr. Smith, CPME officials, APMA officials, Deans, ABPS officials, ABPOPPM officials, and residency directors pick one of the schools to go to on residency match day and explain to those stranded that there is any justification for their predicament.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

ASSOCIATE POSITION - SAN ANTONIO, TX

Immediate Opening for motivated podiatrist with good people skills.  Associateship leading to partnership for the right applicant to help develop fast growing Northside San Antonio Texas practice. Attractive office and beginning income. CV and letter of interest to sadpmoffice@gmail.com

MANHATTAN - FULL-TIME POSITION

Available for a Board certified/qualified podiatrist (PSR-24, PM&S-36 ). Located in Downtown Manhattan in a multi-specialty Orthopaedic office. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Contact fscudese@seaportortho.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full-time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - BLOOMFIELD, NEW JERSEY

Part-time office part of larger practice looking for associate with well-rounded podiatric skills. Board qualified a must. Ground position leading to partnership. Please email CV to doccapo@yahoo.com 

ASSOCIATE POSITION - SW FLORIDA GOLF, BOATING & BEACHES 
 
Great opportunity to join a well established podiatry practice.  Excellent mix office/surgery, motivated experienced staff. Seeking full-time Associate PSR 12-36. Salary $100 Thousand + bonus package with benefits, early buy-in available to right candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

PODIATRY POSITION AVAILABLE – WISCONSIN

Affinity Medical Group, an integrated health care organization in East Central Wisconsin, is seeking a BC/BE Podiatrist for our Appleton location. This is a General Podiatric practice opportunity including routine care, sports medicine, and surgery. The Appleton area offers a unique quality of life, combining a family centered, university community with all season recreation, a nationally acclaimed educational system, and a diverse and growing economy and population. For information, contact or send your CV, to: Sara Roth, Affinity Medical Group, Physician Recruitment, Phone: 800-722-9989; Fax: 920-727-4350; E-mail: sroth@affinityhealth.org Visit our website at: www.affinityhealth.org EOE.

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

We have a very busy, well-established, diversified practice in the Tampa Bay area of Florida. We are seeking an Associate who is BC/BE and highly motivated. We offer a competitive salary and benefits. Please send your resume and current photo to Jaye@fdn.com

ASSOCIATE POSITION- MONROE, MICHIGAN

Excellent opportunity to join a modern, growing 3 doctor/2 office practice located in SE Michigan between Detroit and Toledo. Responsibilities will include a mix of surgery, office, hospital and nursing home/housecalls. Salary, bonus and benefits. Learn more about us at monpod.com. If you are a personable, reliable team player with solid skills and a patient first attitude please contact dr.hughes@comcast.net for more information.

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION- DAYTON, OHIO

Join a Well-established modern practice in Dayton, Ohio with an excellent reputation and referral base. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers. Providing patients with all aspects of DME. Seeking a surgeon that is well-trained, personable, and a highly motivated individual to join our group of 3 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send resume and current photo to Ohiodoctors@aol.com

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

Full-time 38 yr old podiatry practice with state licensed surgical center. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network, and well-equipped surgical suite. Retiring owner will stay on as needed for transition. Email dpmpracticeforsale@yahoo.com

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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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