The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 10, 2010 #3,954 Publisher-Barry Block, DPM, JD

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CO Podiatrist Discusses Climbing Boots

Despite your best efforts, the repeated act of forcing your feet into tight shoes may take its toll. “The biggest foot problems climbers have are associated with compression and friction,” says Dr. Thomas Shonka, attending podiatrist at the Boulder Center for Sports Medicine. Spot-stretching can help climbers with these and other issues (such as swollen nerves caused by repetitive movement) made worse by restrictive shoes.

Dr. Thomas Shonka

Any shoe-repair or ski-boot shop should be able to make the modifications. Dr. Shonka also recommends silicone pads to alleviate pain caused by hot spots. “You want to be sure to put more pressure around a pressure point than over it,” he says. In other words, encircle problem spots in little doughnuts of relief.

Source: Kate Nelson, Climbing [9/4/10]

Three DPMs Compete at World Duathlon Championships

Amol Saxena, DPM of Palo Alto, CA, Troy Vargas, DPM of Stillwater, MN,  and Kirk Herring, DPM of Spokane Valley, WA all competed in Edinburgh Scotland in the World Duathlon Championships, an event incorporating running and cycling (10km run, 40km cycle, and 5km run completed with transitions between each section, but with no breaks).

Drs. Amol Saxena and Troy Vargas

Saxena finished 42nd in his age-group, while Vargas and Herring finished 52nd and 32nd in their respective age groups.

Little Change Expected in Health Spending Due to Lower Reimbursements

The latest projections for U.S. healthcare spending through 2019 show little change from an estimate released before Congress passed health reform laws to expand insurance to 32 million uninsured. The CMS said health spending under the laws' many provisions will climb 6.3% per year, on average, compared with 6.1% per year prior to the law, a 0.2 percentage point increase. The projections were released online by the policy journal Health Affairs.

The cost of expanded insurance enrollment is largely offset by reduced payments to Medicare providers and Medicare Advantage plans and the cost-containment efforts of the Independent Payment Advisory Board, said Stephen Heffler, director of the CMS National Health Statistics Group. Also offsetting costs of fewer uninsured are “relatively lower prices” for patients who gain benefits from the safety net insurer Medicaid, the CMS authors said. Half of the newly insured will gain coverage from expanded Medicaid eligibility.

Source: Melanie Evans, Modern Healthcare [9/9/10]

How do you make sure you have the right people for the right positions? - Part 2

Ask yourself the following questions:

1. Do they share the core values of your practice?
2. Do they get it? Do employees or physicians understand their roles and job function in the practice?
3. Do they want it? Does this employee or physician truly want to do this job or is he or she there for a paycheck?
4. Do they have the capacity to do it? Do employees or physicians have the capacity and capability of doing their job function?

If the answer is yes to all of the above, you are in good shape with your team. Note: You cannot be objective about others until you gain an objective view of yourself. The corollary is that if you have an unbalanced view of yourself, you will tend to have an unbalanced view of others.

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC, dhelfman@vpcenters.com

Query: Recalcitrant Ingrown Nails

I have a 15 year old male patient who has had five phenol matrixectomies on both borders of bilateral halluces by three different podiatrists. I attempted to resolve his ingrowns during his fifth phenol matrixectomy; however, the ingrowns returned on all four borders. I then scheduled him for surgical matrixectomies (Winograd procedure) in the office. Three of the four borders returned with very large nail spicules growing 90 degrees perpendicular to the remaining nail plate.

This patient plays football and the spicules cut into the flesh of his toes. I avulsed the nail spicules in the office this past Tuesday, however, I wanted to know if anyone has had such resistant ingrowns, and get any advice on what I should do now. I believe that phenol just doesn't work on this patient. 

Arti Chopra Amin, DPM, Anaheim, CA

Query: Mini C-arm Purchase

My surgery center is looking at refurbished mini c-arms. Presently, we are considering a 2004 Hologic Premier Encore mini C-arm. It is certified and updated by the manufacturer. Do any readers have input regarding this unit or others to help with the decision process?

Craig Breslauer, DPM, Palm City, FL

Query: Changing a Medical Record Under Threat

The patient's H&P notation taken at the time of initial evaluation indicated that the patient said symptoms were present for approximately six months. The patient's insurance carrier did a pre-existing review and subsequently denied the claim as pre-existing. The patient called and said that we must have made a mistake because her symptoms were not present for that length of time. The chart was notated with an addendum indicating that the patient believes that a miscommunication occurred at the time of service and that the patient's recollection is that the symptoms were only present for, at most, six weeks prior to her first visit. The carrier is still reviewing to determine if they will overturn the original denial of the claim.

The patient's husband called yesterday and demanded that we "change" the record. He said that we needed to "redo" the record and erase any mention of a six-month history of symptoms. It was explained to him that we cannot "change" a record, that to our knowledge the only thing that could be done would be the notation that was already made to the chart. He offered to pay the claim 100% in exchange for our "correcting" the record. Then he became very angry and  threatened to "report" our office for insurance fraud, stand in front of the office with flyers describing our refusal to "properly document", sit in the waiting room and tell our prospective patients not to be seen at our office, and trash the doctor on the Internet in any way possible, and/or sue. What should we do?
 
Aimee Judy, PMAC, Office of Brian Shwer, DPM, Bartlett, TN

Editor's Comment:  PM News does not provide legal advice. A medical chart can be changed when a mistake or omission is discovered, as long as that change is dated and initialed, and the original notation is left intact with a single line through it. Based on the information provided, you acted correctly in this matter. The patient's husband did not. You need to document his behavior in your chart and contact the district attorney in your jurisdiction. It's ironic that the patient's husband wants to report you for insurance fraud!

RE: Pearls For Periungual Fibromas (Jeffrey Kass, DPM)
From: Corinne Kauderer, DPM

Periungual fibromas have a very high recurrence rate in general. To try to reduce this issue, I use silver nitrate sticks to cauterize them post-excision. Patients return for two more visits for additional application of the silver nitrate, and they are informed that the fibromas might still recur.

Corinne Kauderer, DPM, Brooklyn, NY, drkauderer@aol.com

RE: Osseous Malformation (Greg Caringi, DPM)
From: Neil Levin, DPM

The malformation Dr. Caringi sees is probably an aborted developmental supernumerary metatarsal. In the few instances I have seen this, the conditions were asymptomatic and was only an incidental finding.
 
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

RE: Scanning X-Rays (Barry Rosen, DPM)
From: Pete Harvey, DPM

If you are already using an EHR (EMR) program, the program support system should have recommendations to convert hard copy to digital. Barring that, call your local hospital department of radiology. They have been doing this for years and perhaps they could do it for you.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE:  PICA Case Closed Volume 16 Issue 3 Summer 2010 (Ira Baum, DPM)
From: Richard W. Boone, Sr., Esq.

I can think of several reasons why a physician faced with a frivolous malpractice claim, (or for that matter even a meritorious claim), might want to invest the time and personal expense required to defend it.
 
First, most malpractice suits filed against doctors (all doctors, not just podiatrists) are WON, not lost. Even when the case is closed by a settlement or by a verdict against the defendant physician, the defendant and the defendant's insurer can often times fairly consider it a win because the act of putting up a good defense has dramatically reduced the ultimate payout to the plaintiff.
 
Second, there are collateral consequences which are incurred when a payment is made to a patient who claims to have been injured by a physician's neglect. The payment is always reported to the National Practitioner Databank and, in many states, to the physician's licensing board which will conduct an investigation into the circumstances of the case for possible action against the doctor's license. The databank reports are, in turn, disclosed to medical staff credentialing agencies which evaluate them when the doctor applies for new or renewed privileges. The materials developed through a vigorous defense of the case are almost always sufficient to protect the doctor's license and access to hospital privileges.
 
Third, this is one of the times in life when size really does matter and the inevitable downward effect of a vigorous defense upon the ultimate payout to the patient almost always justifies the effort put into the defense. Stated bluntly, it's much easier to explain a $100,000 adverse verdict to the credentials committee than it is to explain a $2,000,000 default judgment.
 
Cases like the one detailed in the PICA report are dangerous and should be avoided by the adoption of the simple and effective risk management tips offered by the PICA article. But cases like that are relatively few and far between. No lawsuit filed against you is a good thing. But most aren't nearly as bad as the case under discussion.
 
Richard W. Boone, Sr., Esq. Fairfax, VA, RWBoone@aol.com

RE:  PICA Case Closed Volume 16 Issue 3 Summer 2010 (Ira Baum, DPM)
From: Pete Harvey, DPM

Every now and then an insurance company takes a hit on the chin. This is one of those cases. The admirable point with this case is that the insurance company vigorously defended the client right down to the wire. It is stated that the defense team considered the case carefully before the decision to go to trial was made. That decision at that dollar amount is not made lightly. Several states are fortunate to have worked hard to obtain caps through state legislatures. However, many doctors practice in states without those caps and they carry limits of 1M/3M or even higher. Those limits are generally guided by the venue in which a doctor practices, which is not mentioned in this situation. In those cases, the company must meet its contracted obligation. That is what PICA did in this case, and they should be applauded for it. A MedMal case is like a fingerprint. No two are alike.

A doctor defends a malpractice case for several reasons. The primary reason is because he is convinced he did nothing wrong. Another is to defend the honor of the entire profession. If every case that was filed settled without a fight, then the entire profession could never come up with enough funds to cover all those cases. The attorneys would have a field day. If the plaintiff attorney knows he must expend all the resources to develop a case, he will think twice before going forward. Another reason to defend is the databank which reports to the hospital. The credentials committee may overlook one or two cases. They will not overlook several cases. Another reason is the reportable event to the state board.

CRPS can be a lawyer’s dream case. Unfortunately, that happened in this case.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: The Passing of Sean Liffiton, DPM

I was deeply saddened by the news of the passing of Sean. He was the first person I met at podiatry school and my first year roommate. I had lost touch with him for a number of years but had a chance to catch up a little via Facebook. I always remember Sean as being easy-going, fun loving, and friendly. He was a caring and compassionate practitioner and has undoubtedly left a lasting impression on all the lives he has touched. He has left us far to soon, and will be greatly missed.
 
Paul J Betschart, DPM, NY, NY

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

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established 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

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 – NEW MEXICO

Enjoy the outdoors? Enjoy sunshine? Enjoy beautiful vistas? Come to the Land of Enchantment. Albuquerque position: Move into a ready-made practice, full ownership in five years when I retire. Board certification is necessary for hospital staff privileges. Recently renovated office with digital imaging, diagnostic ultrasound, EHR in process. Contact fitz@abqpodiatry.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

POSITION AVAILABLE - NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: podiatry2011@gmail.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.

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.

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