The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

September 08, 2011 #4,254 Publisher-Barry Block, DPM, JD

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PA Podiatrist Offers Tips on Treating Aching Feet

Walking gives the biggest workout to your most distant body part - the foot. My feet have no problem complaining loudly when I've abused them by wearing old shoes that have lost their cushioning, or forced them into "cute sandals" that didn't provide support and rubbed them the wrong way. Podiatrist Catherine Moyer, DPM has five tips to fix your aching feet. 

Dr. Catherine Moyer

Her first tip is to use moist heat. "Sometimes aching feet are simply the result of overstressed muscles and connective tissue due to excess activity or weight-bearing. One of the best remedies for relaxing sore muscles is a foot bath. Soak your feet in a basin of warm water or in a store-bought foot spa for 5-10 minutes. Try adding epsom salts to the water for an added soothing effect. Use approximately 1-2 tablespoons per gallon of warm water. If your feet are swollen, hot, or tired, use cool water instead of warm and elevate your feet for a half hour or more after the soak," says Moyer.

Source: Wendy Bumgardner, About.com [9/2/11]

AZ Podiatry Student Wins AENS Grant

The Extremity Nerve Research Foundation in cooperation with the Association of Extremity Nerve Surgeons (AENS) has established the Scott Nickerson, MD Peripheral Nerve Annual Grant open to 4th year medical/podiatry students and medical/podiatric residents. Applicants submitted a maximum 2,000 word paper encompassing peripheral nerve treatment and disorders.  

Nathan Larson

This year's winner was Nathan Larson, a 4th year student at Midwestern University School of Podiatric Medicine-Arizona. He submitted a paper on "Posterior Post-Operative Heel Pain Caused by Multiple Etiologies -Including a Neuroma in continuity of the Posterior Branch of the Sural Nerve: Case Report,"  He will present the paper at the AENS Annual Symposium, November 5-6 in Las Vegas.

NY Residency Recognized for First Practice Management Curriculum

Hal Ornstein, DPM, Chairman and Education TEAM Chair of the American Academy of Podiatric Practice Management (AAPPM) recently presented a plaque to Ron Guberman, DPM, residency director at Wyckoff Heights Medical Center in Brooklyn, New York. The plaque recognizes their residency program "for their outstanding commitment to podiatric education by creating and teaching the first residency practice management curriculum." 

(L-R) Dr. Ron Guberman accepts plaque from Dr. Hal Ornstein

Two-hour presentations are held monthly, as well as regular webinars and required reading of specific books and articles. “It is incredibly gratifying to know we are making such a difference for these young colleagues and greatly appreciate the faculty for their deep and passionate commitment and time for the success of this curriculum,” Ornstein said. The program has been expanded by Andrew Schneider, DPM to include the podiatric residency at West Houston Medical Center and Kingwood Medical Center in Houston, Texas.

NH Podiatrist Co-Chairs Hospital's New Wound Care Center

Patients who suffer from lingering wounds now have a new local resource available to them. Nearly two months ago, Memorial Hospital opened its state-of-the-art Wound Care and Hyperbaric Medicine center on its North Conway campus. The center's co-chairs, Dr. W. Stuart Battle, MD, and podiatrist Alan S. Goldenhar, DPM and staff hosted an open house tour of the new facility. 

Dr. Alan S. Goldenhar

Drs. Goldenhar and Battle noted that many patients who have Type 1 or Type 2 diabetes suffer from chronic wounds brought on by poor circulation and other issues. “For most people,” said Goldenhar in a hospital press statement, “cuts and scratches will heal within a few days or weeks. However, for individuals who suffer from diabetes or poor circulation, their natural healing process is hampered. A simple sore can become a complex medical problem that can significantly alter a person’s quality of life.”

Source: Tom Eastman, The Conway Daily Sun [9/5/11]

Medicare Unveils Bundled Payment Models to Start in 2012

Physicians and hospitals will be collaborating to bid on providing high-quality, low-cost inpatient and post-discharge care to Medicare patients under a new payment option starting in 2012, the Centers for Medicare & Medicaid Services said. Hundreds of interested hospitals and groups of physicians are expected to coordinate patient care under the new bundled payment initiative. Bundling payments is one of several models that physicians in organized medicine have encouraged the Medicare agency to use in place of traditional fee for service.

Under the initiative, created by the health system reform law, physicians and hospitals would come up with a plan and submit a bid to participate. Two of the bundled payment models focus on inpatient stays, a third involves post-discharge services only, and a fourth combines inpatient and post-discharge services.

Source: Charles Fiegl, AM News [9/5/11]

Query: Professional Attire

I'm curious about what everyone wears in the office. I prefer to dress with a shirt and tie under a lab coat. I know some docs like to wear scrubs in the office while seeing patients. I am not sure that is the most professional attire.

Alan Mauser, DPM, Louisville, KY

Query: Meeting Meaningful Use Requirements

In order to achieve meaningful use, 15 core meaningful use measures and 5 of 10 elective measures must be met.  Included as one of the 15 core measures is "clinical quality measures" (CQM) of which there are 3 "required" core (hypertension, smoking cessation, and adult weight screening), 3 "alternate" core (weight assessment for children, flu vaccinations for patients over 50, and childhood immunizations) and 38 additional CQM's from which EPs must also select 3. Regulations state that If an EP reports "0" for one or more of the "required" core CQMs, he/she must then report on up to 3 "alternate" core CQMs.
 
Of those members who have attested to meaningful use and received stimulus money, I would like to know which core/alternate CQMs they reported and which of the 38 additional CQMs they reported. Did you claim exclusions for all 3 core, all 3 alternate, and 3 elective CQMs?
 
Additionally, if you attested to and reported adult weight screening as one of the "required" core CQMs, did this preclude you from attesting to an exclusion of the "record vital signs" core measure due to the fact you recorded weight, and thus would also be required to record height and BP in order to fulfill the "record vital signs" measure?  More simply stated, has anyone received stimulus money who has attested to and reported adult weight screening as one of the "required" core CQMs and attested to an exclusion of the "record vital signs" core measure?
 
Paul Yungst, DPM, Sarasota, FL

RE: Cycling-specific Orthotics (Jeffrey A Petrinitz, DPM)
From: Nat Chotechuang, DPM, Deb Wehman, DPM

One other thing to rule out is a problem with the cycling shoe itself.  Some cycling shoes have a flat spot, some have a protruding bulge, and some even have prominent screws on the interior of the toebox due to the cleat mounting hardware being located directly beneath the 2nd-4th metatarsal head region. Slide your hand inside the shoe to check for any pressure points. If you find a pressure point, then the patient should shop for new shoes before you try orthotics.

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

I am a long distance cyclist with sesamoid and IT band problems.  I finally had orthotics made by Allied/OSI  in Indianapolis that are a thin graphite full-length device. I first spoke with a rep about what I wanted; something that would take up very little space was of utmost importance. I then accommodated it myself with 1/8 inch cork under the met heads 2-5 in a valgus-like wedge (also a dancer’s pad-type accommodation). I had to tweak it a couple of times to make it “perfect”, but it has lasted now for about three years. I’ve also done the same thing for several patients and know that very minimal accommodations make a big difference.
 
Deb Wehman, DPM, Richmond, IN, DSWehman@comcast.net

RE: You Mean I Have to Pay? (Bret Ribotsky, DPM)
From: Robert Kornfeld, DPM

As a podiatrist who graduated over 30 years ago, I have experienced first-hand improvement in treatment outcomes thanks to progress in technology and research over the years. It is truly incredible how far we've come. The problem is that we are no longer viewed by the public as saviors. Rather, we are viewed by the public as money hungry, looking to prey upon their pain and suffering so we can drive fancy cars and live in big houses.

Dr. Ribotsky's light-hearted report from the hospital parking lot should not be taken lightly. We now have a public that puts very little value on their medical care. Thanks to managed care insurance, the public has been successfully conditioned to expect medical care for the price of a co-pay. Not only that, but the accepted current "standard of care" is dictated by these very same insurance companies. Interesting to note that the public is paying more for everything including MEDICAL INSURANCE. Seems that at least the insurance companies are cashing in on medical care - the medical care that you and I are delivering.

What we have to look forward to is... 

Editor's Note: Dr. Kornfeld's extended-length letter can be read here.

RE: New NLRB Rule Requires Notification of Employee Rights to Organize
From: Tip Sullivan, DPM

Uncle Sam says that our small business employees can DEMAND better working conditions and pay, etc.! We HAVE to inform them of their RIGHTS or potentially suffer the consequences. I can see the day I have to fire an employee and end up with a fat federal fine for not posting a freaking piece of paper on the wall and taking a freaking picture of it because that person I fired got even and "turned me in."

I, as an employer, want to demand better employee education and more efficient workers, but I can't have a union to demand it! This is just another example of how the federal government is choking us with regulations. It is ridiculous and the only way that we have to stop this crap is to educate ourselves about the national and local political candidates' agendas and get out and campaign/vote for the people who are going to get these people off of our backs.

Sure, I'll post those rules! Where I post them I will not say, but I don't think a picture of it would be appropriate.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: APMA Nixes MD/DO Referendum
From: Jon Purdy, DPM

Ted Turner built his empire based on a gap he identified in the area of public service. He knew a public demand was there before the public did, similar to that of the practicing podiatrist. He initially approached the big networks with proposals of inclusion. When he was rejected, he essentially told them they could join or step aside. At the time, he was likened to the kid on the corner with a fruit stand telling the local grocery he was about to put them out of business – and he did.

Just as the ASPS was born out of the defiance of ACFAS, the APMA may find itself left behind in the near future if it doesn’t quickly identify and keep pace with the changes occurring in the medical service industry. Polls have shown the APMA membership to be well in tune with these changes. Our podiatric schools may also find a new competitor on the block if they don’t integrate with allopathic medical schools as some already have.

If I’m not mistaken, there has been stagnation in the number of practicing podiatrists in this country over the past 15 years or more. This should say something very profound to all podiatrists and podiatric schools. There’s no paucity of examples of failure in industries resting on their laurels, and the “we’re too big to fail” attitude.  Although APMA has begun to identify and integrate needs in the areas of practice management and allopathic integration, its Vision 2015 may end up being very short-sighted.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Outrageous Shoe of the Day

Shoes and Ladders?

Source: Kobi Levi, Israeli shoe designer, submitted by Dr. Stuart Steinberg

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

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Asking $100K. Real estate available for purchase. Please call 800-983-4194, or e-mailcontactus@podiatrypracticeconsultants.com  

PRACTICE FOR SALE - ARKANSAS

Busy, well established practice of 13 years grosses 160K/year for the past 5 years, while working 3.5 days/week. Nursing homes available. 50% Medicare, average of 15 new patients/week. Doctor retiring. Please call 800-983-4194 for more details, or e-mailcontactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - SOUTHERN OH

Busy, well-established, full-time home visit practice. 100% referral-based. Wound care, pain management, routine care & DME’s. Excellent income, low overhead. DPM relocating out-of-state for family. Contact: nanetter@zoomtown.com

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 mail footdoc71@aol.com or call 781 279-2332.

ASSOCIATE POSITION - PORTLAND, OREGON

Busy office with  good steady referral sources looking to expand.  Areas of expertise wanted: wound care, surgery of all aspects, knowledge of running an office. Please come with  good personality and hard work ethics. New main and satellite offices. mail: office.pfac@gmail.com

ASSOCIATE POSITION - UPSTATE NEW YORK
 
Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com  

ASSOCIATE POSITION – IOWA CITY AREA

ASSOCIATE POSITION - SOUTH CENTRAL PA

Martin Foot and Ankle, largest provider of foot and ankle care in South Central Pennsylvania, is seeking a full-time associate interested in future partnership. Practice facilities and technologies include: Surgical Center, in-office Physical Therapy, six appointment locations, in-office MRI, digital x-ray, PSSD and PVR testing, diagnostic ultrasound, and Electronic Medical Records. We are looking to hire candidates with a minimum of a three-year surgical residency. Experience in rear foot and forefoot reconstruction, including complex nerve releases of the foot and leg, Charcot arthropathy, and arthrodesis is helpful. E-mail CV to mfatrans@aol.com.

ASSOCIATE POSITION - OKLAHOMA

Looking for OK licensed podiatrist to take over half of a million dollar/year practice in Central Oklahoma. Transition for full takeover by Jan 1, 2012. Will interview in OKC Saturday Sept 3rd and in Tulsa , Saturday, Sept 10th. Great opportunity. Call (918) 931-1425.

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 - NORTH OF BOSTON

Seeking part-time podiatrist for both office and nursing home work. North Andover, MA (North of Boston) Could lead to possible partnership for the right person. jmclaughlin19@yahoo.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

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

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