The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 02, 2009 #3,638 Publisher-Barry Block, DPM, JD

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APMA Demands Retraction From Arizona Congressman

In an interview last week with FOX News' Neil Cavuto, Congressman John Shadegg (R-AZ) said podiatry was an "esoteric demand that most people don't have or don't need," during a discussion on health care reform. The American Podiatric Medical Association (APMA) finds the congressman's remarks egregious and uninformed. Doctors of Podiatric Medicine (DPMs) are uniquely qualified among medical professionals to provide essential foot and ankle care based on their education, training and experience. Podiatry is not irrelevant - it is essential medical care - especially to the nearly 18 million Americans diagnosed with diabetes.

Dr. Ronald Jensen

"It is appalling to find someone who serves on the House Republican Health Care Task Force uninformed about the valuable role of the podiatry profession in the delivery of essential medical and surgical foot and ankle care," said APMA President Ronald D. Jensen, DPM. "We are on the front lines of diabetes management. Without our services and comprehensive diabetes foot care, lower-leg amputation rates would soar."

Source: Investor's Business Daily [8/29/09]

Take Time to Examine Children's Shoes Before Purchase: IL Podiatrist
 

Before you pick out that Hannah Montana backpack, Jonas Brothers T-shirt, or sparkly headband your little one has got to have for the new school year, be sure to think about the shoes and sandals that will be hitting the playground, pavement, and hallways this coming school year, the Illinois Podiatric Medical Association advises.

Dr. Paul Brezinski

"Ensuring a child wears a shoe that fits properly is paramount to keeping feet healthy during the school year," said the association's president, Dr. Paul Brezinski, a doctor of podiatric medicine. "By taking just a few extra minutes to examine a shoe before purchase, parents can rest assured that their child will be keeping their feet safe to and from school, as well as during the busy school day."

Source: Annie Getsinger, Herald & Review [8/19/09]

CA Podiatrist Sentenced to 5 Months Jail for Medicare Fraud

A Poway, CA podiatrist was sentenced to 5 months in prison and fined $5,000 for Medicare fraud: billing the government for "incision and drainage" operations when all he did was cut patients' toenails. Dr. Clifford J. Wolf also will have to serve 5 months of home detention, federal prosecutors said.

Dr. Clifford J. Wolf

Wolf, 60, pleaded guilty to one count of healthcare fraud, admitting he defrauded Medicare of $66,347, the U.S. Attorney's Office said.

Source: Courthouse News Service [8/31/09]

Query: Posterior Tibial Neuropathy

A 40 Yr old male has been experiencing pain in his forefeet for the past month. The pain has been located on the plantar aspect of both MTPJ and arch areas --worse on the right foot and present at all times, but aggravated by weight-bearing. He insisted on using crutches to ambulate at work with complaints that the pain was most severe after prolonged weight-bearing. He has been to other docs, including: a podiatrist who fitted him with orthotics that didn't help, a GP who injected his forefeet with steroid (without relief), and an orthopedist who, after performing nerve conduction and EMG testing, insisted that he needed a tarsal tunnel release. A nerve biopsy was negative for small fiber disease and the patient failed to respond to Lyrica and Cymbalta.

He was referred to a neurologist who listed the diagnosis listed as right tibial and possible bilateral posterior tibial neuropathy without evidence of slowing across the tarsal tunnel. This diagnosis included a follow-up nerve conduction and EMG testing which revealed an absent plantar sensory response in the right without delay in motor latency across the tarsal tunnel. Needle EMG of the intrinsic foot muscles showed no fibrillations, but decreased recruitment and re-innervation. Is anyone familiar with this condition's etiology and treatment?

Frank DiPalma, DPM,  Athens, GA

Query: Membership in Medical Discount Buying Group

I recently received a solicitation to join the MDBG started by Joel Lerner, DPM in New Jersey. This is a podiatric buying group for medical and office supplies that only requires that you are a member of the ACFAS. I would like to know of other colleagues’ experiences with membership in this buying group. Are the savings substantial?

Mark Aldrich, DPM, Antigo, WI

Query: Getting Paid for Dispensing Wound Supplies

We have been dispensing wound care supplies for patient home use, and billing private insurance plans using the various "A" HCPCS codes. These insurance carriers are denying the reimbursement of the supplies, saying they are bundled into the in-office procedure allowance, and telling us that the "patient is not responsible."

Is there another way to bill the supplies that we dispense to patients for home use?

S. Pfeiffer, Las Cruces, NM

Response: Wound care supplies applied to the wound while the patient is in your office could possibly be considered part of the reimbursement for the debridement or E/M code billed. Supplies dispensed to the patient for use at home should never be bundled with the office procedures.

If the patient's insurance plan would pay for supplies dispensed by pharmacy or DME suppliers, give the patient a prescription, and let them fill it outside your office. If, however, the insurance company would not reimburse the patient for supplies purchased outside your office, give the patient the option of getting the supplies from your office or from a neighborhood pharmacy, supplier, etc., and if the patient wants the supplies before they leave your office, CHARGE THE PATIENT.

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Dealing With Depressed Patient (Donna M Alfieri, DPM)
From: Alan J. Cantor, DPM

My policy is call 911. This patient may not have been mentally competent to refuse her advice, and may have needed police custodial care to mandate transport to a hospital for psychological evaluation.

Even if the patient is deemed capable by medics of refusing medical attention, ("RMA"), a clinician is given a rather significant layer of verification by agencies with their own documentation independently from the caring clinician.

Nothing is "100% indemnity-proof." However, I have found during 27 years in fire rescue that when we are called to a situation with a depressed, suicidal, mentally unstable individual, the majority of these patients are transported to a hospital for psychiatric examination.

Alan J. Cantor, DPM, Long Island, NY, ajcdpm@gmail.com

RE: Statins For All Pre- And Post-Operative Patients?
From: Michael M. Rosenblatt, DPM
 
Podiatrists frequently encounter patients who are taking statin drugs as a part of their regular treatment regimen for cardiovascular disease. In a review of data (from multiple sources) in an article published in The British Journal of Anesthesia, the authors suggest that statins provide a “protective effect” that reduces the peri and post-operative risks from a variety of complications, including both sepsis and cardiovascular.
 
The benefits are so pronounced that they raise the questions: “Should all patients undergoing invasive procedures be put on statins pre and post-operatively? And if so, for how long? ”
 
The authors stop short of data indicating statin use for EVERY case. But they clearly point to maintaining patients on statins they’re already taking, and not discontinuing them without significant reasons, such as untoward side-effects. We have recently talked about podiatrists temporarily stopping certain drugs pre-operatively and the risks associated with that. This article adds statins to the list of medications that should be maintained during our pre- and post-surgical treatments. 
  
Michael M. Rosenblatt, DPM, San Jose , CA, Rosey1@prodigy.net

RE: Podiatric Surgeons and Generalists (Arden Smith, DPM)
From: Jeff Merrill

Dr. Smith inquires about it being time, "to change our paradigm for podiatric surgery and have fewer 'surgeons'..." That's not going to happen. With Vision 2015 calling for all residencies to be minimum PM&S 36-month forefoot/rearfoot surgery and already over half of all current programs being PM&S-36, the next generation almost has no choice but to be a surgeon. I have only heard of one case (and there perhaps are more) where a recent student took his boards, skipped the 36-month residency, started a general podiatry practice and seems to be doing well. 

I have also seen recent graduates of 36-month residencies who don't ever do general podiatric care. The way I have been "brought up" in the profession leads me to believe that I'm being trained to be a surgeon who can offer general podiatry care. It appears also that the seeking of parity with MD/DO's requires us to at least do a 3-year residency. It would be interesting if there was ever a 3-year residency for primary podiatric medicine and students could choose to do general or surgical podiatry. The way it is currently set up, I have the choice to do either or both.
 
Jeff Merrill, TUSPM ’10, teflon@temple.edu

RE: Surgical Expectations
From: David E. Gurvis, DPM

We are all aware that the best of surgical outcomes can be felt to be poor, to the patient’s way of thinking, by our not realizing or addressing the patient's expectation of the surgery prior to the procedure. At the recent American Psychiatric Association Meeting, surgical expectations and outcomes were measured against personality traits as they relate to post-operative total knee replacement satisfaction. I think the conclusions are interesting in that more extroverted patients were generally more satisfied with the outcome vs. introverted patients. The summary is worth reading, probably can be carried over to podiatric surgery, and can be found at:
http://podiatrym.com/go.cfm?n=408

David E. Gurvis, DPM, Avon, IN deg1@comcast.net

RE: Addante Receives FIP Lifetime Achievement Award
From: Mort Wittenberg, DPM

It has been my good fortune to have as a good friend for 40 plus years, Dr. Joe Addante. I have been with him on two occasions, for several weeks in Italy. I know what a terrific teacher he is to young podiatrists and students of podiatry.

The award could not have been given to a more worthy person. Joseph Addante is a real "mench." Congratulations!

Mort Wittenberg, DPM, Evans, GA, mwittenberg3@comcast.net

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net.

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

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.

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.

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 - 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

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

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