The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 12, 2009 #3,647 Publisher-Barry Block, DPM, JD

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We’ve just posted the September 2009 CME titled:

Douglas H. Richie Jr., DPM

You can Earn 30 CPME-Approved CME Contact Hours Online

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Congratulations to Keith Daniels , DPM of Flint, MI , winner of PictZar® Digital Planimetry Software - Wound Measurement on Digital Photographs (Value $850).

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 2010 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.

This week's prize is registration to the 2010 Alaska Practice Management Cruise.  Learn about this once-in-a-lifetime adventure seminar by going to www.podiatrym.com/alaska (Value $495).

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

FL Podiatrist Discusses Ankle Replacement Procedure

77-year-old Joan Rita never imagined a horseback riding adventure would leave her reeling in pain two decades later. "As I was dismounting I got hung up on the stirrup and ended up shattering my ankle," she said. Ever since then, it has been increasingly painful. A couple of months ago, she met Dr. Kyle Kinmon and learned about a new ankle replacement surgery. "This particular ankle replacement is intramedullary-guided, and what that means is we can put it in precisely every time," said Kinmon.

Dr. Kyle Kinmon

"We actually remove the top of the talus which is replaced by this tailor component of the implant. And tibial components are assembled inside the ankle piece by piece," Kinmon added. Few options have been available until now because, according to Dr. Kinmon, past implants were inaccurate and ineffective. He said this new implant can improve mobility and decrease or eliminate ankle pain which is usually caused by arthritis resulting from a fall or car accident.

"Something to that degree can cause crushing of the bones in the ankle and they will quickly develop post-traumatic arthritis that limits the mobility of the ankle joint and causes severe pain with any ambulation, any activity," Kinmon explained.

Source: Cynthia Demos, CBS-4 (Miami) [9/9/09]

Editor’s note: On this, the 8th anniversary of 9/11, we continue our proud tradition of publishing the following note from the editor, which was published in PM News on 9/12/01 and circulated via the Internet throughout the world.

It is just after 3 AM here in New York City and I simply can't sleep. Looking out the window of my bedroom on the 17th floor, there is an unobstructed view of the Manhattan skyline. I search again for the once familiar sight of the two tall white buildings that marked the lower end of the skyscraper-filled island. All I see are some eerie search lights of the rescue crews.

Like everyone else, I have been in shock all day, particularly since I witnessed in real-time the morbid views of the second plane hitting the World Trade Center and the sequential collapse of both towers.

World Trade Center 9/11/01

The gamut of emotions runs from shock, fear, sadness, to anger. Barely one half-century after the Holocaust, despite all our technological advances, man remains uncivilized. The realization sets in that the terrorists who committed this crime could have and still could set off a nuclear bomb, killing millions. The safety and security we have taken for granted in America is and will never be the same.

My phone has been ringing all day. Family and friends call to determine that everyone is safe. My mom calls to tell me my brother was scheduled to be at the WTC at 9 AM and was at the subway station when the first plane hit. Had the plane hit five minutes later, he would have been on an elevator headed for certain death.

Unfortunately, many thousands were not so lucky, including many employees of Blue Cross/Blue Shield, which only a few years ago moved from midtown to this location. There will be many tears shed as the names of those murdered in this horrific disaster become known, many unnecessary funerals to attend. So many innocent lives lost for no reason. So many families destroyed.

Later this morning, my wife and I will donate blood and attempt to do what we can in this time of crisis. We know the entire podiatric community will collectively pray for those affected by this catastrophe and provide whatever support is needed.

Query: Billing Services

What experience do others have with outsourcing to podiatry-specific billing companies?
 
Thomas F. Vail, DPM, Findlay, OH

Query: Diabetic Shoes - Deceased Patient

An elderly woman was seen early this year, and agreed to our recommendation to obtain diabetic shoes and custom molded diabetic inserts. During the period that these were being made, she received diabetic shoes from somewhere else. Consequently, when we billed for the dispensed shoes, our claim was denied. Since then, she has passed away. Is my only recourse to bill the patient's estate?

Steven Block, DPM, Owensboro, KY

Response: "If a custom-made item was ordered but not furnished to a beneficiary because the individual died or because the order was canceled by the beneficiary or because the beneficiary’s condition changed and the item was no longer reasonable and necessary or appropriate, payment can be made based on your expenses. In such cases, the expense is considered incurred on either:

• The date the beneficiary died;
• The date that you learned of the cancellation of the item; or
• The date that you learned that the item was no longer reasonable and necessary or appropriate for the beneficiary’s condition."

In these cases, you can file a "salvage" claim for the custom-made item with the DME MAC. Typically, they will pay only the cost of the item. In your case, get the shoes back from the estate and return them to your supplier for credit if they had not been worn. You didn't say anything about insoles being dispensed. If those were, too, I believe you'll have to "eat" the cost of the insoles since another pair of insoles had previously been dispensed by another practitioner.

I do not believe you can bill the estate for several reasons. First, the patient was only entitled by law to one pair of shoes and three pairs of insoles per calender year. Since those had already been dispensed, you don't have a "legal" claim. Second, you said nothing about having an Advanced Beneficiary Notice signed by the patient prior to dispensing the shoes and insoles. Without an ABN, you have no ability to bill the estate.

Paul Kinberg, DPM, Dallas, TX

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RE: Calcaneal Ostectomy  and Fat Pad (Chris Seuferling, DPM)
From: Bret Ribotsky, DPM, Thomas A. Graziano, DPM, MD

What pops into my mind are two options: 1) destroy the nerve and solve the pain issue (realizing the risk of re-ulcer, etc), 2) consider augmentation of the fat pad. You might want to try pedal soft tissue temporary augmentation (PSTTA) technique prior to surgery in an attempt to add a soft tissue pillow under the heel. PSTTA has been a valuable tool in my practice for about three years, and I shared my results at the last three APMA annual meetings. I hope to have a video of this lecture and technique available at PodiatricSuccess.com in the next few weeks.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

You might consider an abductor hallucis muscle transposition. The abductor has the widest base of origin on the calcaneus, and its neurovascular supply is close to the origin. I've used it for years on chronic calcaneal osteomyelitis secondary to trauma and/or diabetic complications. You can either perform primary closure w/ a rotational skin flap (preferred) or apply a STSG directly over the muscle. I have outlined the steps involved in the procedure in the following references if you’re interested.
 
Graziano, T., and Giampapa, V.  Muscle Transposition in the Management of Chronic Osteomyelitis and Ulceration of the Heel. J. Foot Surg. 28:68-71, 1989.
 
Graziano, T, et. al. A Surgical Alternative in the Management of Chronic Neurotrophic Ulcerations of the Foot. J. of Foot and Ankle Surgery.295-298,1993.
 
There are also additional references in these articles.
 
Thomas A. Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: September 11, 2009
From: Arthur Gudeon, DPM
 
It’s been eight years, but we should never forget. I think it would be appropriate today for us all to take a moment of silence and reflect on that tragic day….and then once again move forward with hope, peace, good health, and happiness.   

Art Gudeon, DPM, Rego Park, NY, afootdoc@ix.netcom.com

RE: PSR-24 Discrimination (Name Withheld)
From: Bryan C. Markinson, DPM

Name Withheld feels so wronged that he fears to name himself. What is that about? He probably thinks that the "administration" in his hospital is making the requirement. Well they are not. The podiatrists already credentialed are fully responsible as they "guide" the administration under the guise of "quality credentialing." These are the same people that advised managed care in the 90's that board certified podiatrists (ABPS) are the best not only for surgery, but for tinea pedis and plantar fasciitis as well.

Now the scam has been adopted by the new crop of PSR-36ers (Not all of them of course, but a cohesive and vicious few), many of whom were taught in their programs by expert surgeons trained years ago in preceptorships. As such, the ones who come out and try to leave their lesser-trained colleagues in the dust have little appreciation for the history of the growth of their profession, only that they are PSR-36ers. I regard them as Chihuahuas with large testicles. Take away the large testicles, they are just Chihuahas.

Plain and simple, I am the chief of podiatry and the sole credentialing officer for podiatrists at an academic medical center in New York City, second to none and superior to many in most fields of medicine. We work in an atmosphere of fraternity, helpfulness, and with high regard by most other surgical services. In this institution, whatever your specialty is, you gain respect by demonstrating that you actually have the goods, not by what you look like on paper.

As healthcare reform approaches, we have limited opportunity to get into it right. Continued fratricide in public by advancing the notion to hospital administrators and surgical chiefs that some of us are better than others is shameful, pitiful, and embarrassing. We should better divert our energies to inclusive credentialing or graduated credentialing according to one's training, experience, and education. We need internal parity before we ever will be successful at Vision 2015.

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

PRACTICE FOR SALE/ASSOCIATE POSITION-COLORADO
 
Established practice in Denver area. Turn-key for immediate possession or associate position. Office located on hospital campus with referral sources in building. Practice evaluation at 275K. Contact Jenifer Davies at 303-947-1869.

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.

ASSOCIATE POSITION - CHICAGO AREA

Well-established, state of the art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

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 – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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

HELP WANTED! NEW JERSEY
 
Busy podiatry practice located in northern New Jersey looking for a full time associate for an excellent opportunity for employment!
Please E-mail resume to njfootdoc@hotmail.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 – LONG ISLAND

Busy Wantagh, NY office. Motivated, preferably board certified, hard working, experienced in all phases of Podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.com

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 – 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.

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