The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 14, 2010 #3,957 Publisher-Barry Block, DPM, JD

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 PA Podiatrists Treat Veterans Who Lack Insurance

U.S. Marines don't get pedicures. But Vern Farmer sure didn't mind the doctor trimming his toenails and scraping off his thick calluses.  At the Stand Down event, veterans who aren't part of the VA medical system receive a full physical and mental exam, blood work, and information about accessing routine care through the government. Others in the system are sent directly to the specialists' tents.

Drs. Susan Gamble and Anne Sonoga

At the podiatry tent, the two doctors saw a lot of athlete's foot and calluses, which in diabetics can lead to infections and amputation, said Dr. Susan Gamble, chief of podiatry for Philadelphia's VA Hospital. Farmer, who uses a walker, had never seen a podiatrist before Friday. Dr. Anne Sonoga diagnosed him with a hammertoe, a bunion, and potential nerve damage affecting the bottom of his feet. She suggested that on his next visit to his VA doctor, he mention the foot problems.

Source: Jo Ciavaglia, Phillyburbs.com [9/12/10]

Mile High Orthotics Lab & Delcam Healthcare Solutions Donate Scanner to OCPM

Mile High Orthotics Lab and Delcam Healthcare Solutions recently donated a Delcam Health Solutions iQube 3D Scanner and OrthoModel CAD/CAM software unit to the Ohio College of Podiatric Medicine (OCPM).  The $45,000 scanner and software system will be used within the Cleveland Foot & Ankle Institute (CFAI) which is the clinical teaching and training facilities of OCPM. 

OCPM faculty members, along with Mile High and Delcam representatives at the College

Besides utilizing the iQube scanner in the clinics, OCPM will be incorporating the software into its biomechanics educational practices.  This donation symbolizes an expected long partnership between Mile High, Delcam, and OCPM to provide students a high-tech, educational experience.  

PA Podiatrist Spearheads Gas Drilling Coalition

What was it that transformed a mild-mannered podiatrist into an aggressive environmental activist? "‘Mild-mannered podiatrist’ — I don’t know that I’d call myself that. I’ve done a lot of crazy things: I have a pilot’s license, I ride a motorcycle,” Dr. Thomas Jiunta said, laughing, during a recent interview in his Kingston office, Foot & Ankle Associates.

Dr. Thomas Jiunta (Photo: Mark Moran)

Actually, it was something in the water that led Jiunta to become a founder of the Gas Drilling Awareness Coalition. Something he fears could end up in the water: pollution from natural gas drilling. As a physician, Jiunta is particularly concerned with drilling-related pollution and its health risks. There are five other medical practitioners in the Gas Drilling Awareness Coalition who are considering forming a sub-group, “Doctors Against Drilling,” he said.

Source: Elizabeth Skrapits, Citizensvoice.com [9/12/10]

Query: On-line Radiology CME
 
Can anyone recommend an on-line source for radiology CME? I need 3 units for renewal of my radiology operator certificate in California.
 
Scarlett Kroencke, DPM, Davis, CA

Query: Employee with Hepatitis

I'm interested in the collective advice of my colleagues on this question. One of my employees told me this morning that she has hepatitis C. Are there any rules/regulations about having this employee remain involved with patients? What if she has hepatitis B?

Name Withheld (FL)

Editor's comment: PM News does not provide legal advice. The rules and regulations on dealing with infected employees vary from state to state. Therefore, it is advisable to immediately contact your state's health department, and apprise them of the situation.

Query: *J* Code for Celestone Soluspan

What is the "J" code for Celestone Soluspan?

Gary Trent, DPM, Chicago, IL

Response: J0702 is the HCPCS code. If the vial you've purchased is one that contains 6 mg/ml (3 mg/ml of each of the two drugs that make up this suspension), then 1 ml equals one unit of J0702.

Be sure that your documentation supports the total dosage given and that the correct number of units is reported on your claim.

Joan Gilhooly, CPC, CHCC, Lebanon, OH

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

RE: Bromhydrosis/Hyperhydrosis (Darryl Burns, DPM)
From: Dave Williams, DPM, Avi Kornbluth

I use "On Your Toes". It works great, patients love it, and you can sell it in your office instead of writing a prescription. You can read more about it at footodor.net

Disclaimer: I have no affiliation with this company.

Dave Williams, DPM, Alamogordo, NM, bdavolley@hotmail.com

Two products by Gordon Labs, Formadon and Forma-ray are available to treat bromhydrosis/hyperhydrosis. Formadon is a 10% formalin solution and Forma-ray is 20%. According to podiatrists who have purchased this product, the majority of patients will have good results with Formadon. 
 
Avi Kornbluth, Stone Podiatry/HSI, avi.kornbluth@henryschein.com

RE: Recalcitrant Ingrown Nails (Jordan S. Sheff, DPM)
From: Jeffrey Conforti, DPM, Charles Morelli, DPM

For ingrown nails, I use bi-chloro acetic acid, not phenol. I have not had a patient's ingrown nail come back since I started using it 10 years ago.  Also, I use this for spicules that patients have when they have had the P&A done elsewhere. I also use it for peri-ungual fibromas. After I remove the fibroma, I apply bi-chlor to the area where the fibroma was.
 
Jeffrey Conforti, DPM, Clifton, NJ, jconfortiusa@yahoo.com

If four P&A s have been unsuccessful, then I suggest you either buy a new bottle of phenol or I respectfully suggest you consider honing your technique. That being said, I too have had my share of regrowth after a P&A, but nothing that a properly performed Winograd could not address - a procedure that should have been performed after the 2nd failed P&A, not the 4th. But to say that you performed a terminal Symes amputation for a recurrent ingrown nail and that the patient was "very happy with the result" seems a bit extreme, even for me.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Recalcitrant Ingrown Nails (Dennis Shavelson, DPM))
From: Elliot Udell, DPM
 
Dr. Shavelson  makes an excellent case for the incorporation of biomechanics and orthotic therapy in the treatment of chronic onychocryptosis. The only problem is that in the original case described by Dr. Amin and subsequent cases described by Drs. Steinberg and Sheff, the matrix of the offending spicules had been chemically ablated, and hence if the surgeries  were successful, there should be no biomechanical rationale for recurrences. If there is no longer a nail growth plate, faulty biomechanics should have no impact on the growth of the nail.

Perhaps, we should not be looking at biomechanics as the culprit in the cases described but on shortcomings in the actual procedures employed. Could the patients described have had genetic resistances to phenol, requiring a longer period of exposure or the use of a stronger concentration? Was the phenol used beyond its recommended shelf-life? Were the portions of nails totally excised prior to the application of the chemical obliterating agent? 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com  

RE: Scanning X-Rays (Barry Rosen, DPM)
From: Marc Garfield, DPM

The problem with scanning x-rays, is that dumping them into an ADF on a scanner capable of scanning x-ray film will leave them unlabelled. Each set of films will have to be done individually to ensure that they can be retrieved by name, date, and/ or patient number. With this in mind, I suggest taking digital photographs of x-rays hung on a light board using the photo capture feature of your EMR. If you do not have an EMR, I would doubt that scanning x-rays is worth the time and expense. Remember that most EMRs require a camera with a TWAIN driver. Call the software vendor about recommended cameras if what you already own is not compatible. 

If you are doing this just for new and existing follow-up patients, have your staff take the patients' ID photos and x-ray pictures into the EMR before putting patients in the exam room. If you are moving to digital x-rays, contact the vendor about import utilities within the software or conversion services. If you do not have an EMR, but are looking at general digital storage for documents, consider a Fujitsu Scansnap. The included Scansnap organizer software has an excellent organizational system. X-rays scans are fair (Images are readable - better than most x-ray copy film - with slight artifact formation like subtle streaks and slight dulling of the image). However, you will find it very useful for everything you currently use a filing cabinet for and the import feature will help organize the photos of x-rays.

The Scansnap works like you always thought a scanner should work, but its efficiency is limited to PDF formats. It is not a TWAIN device and therefore will generally not work with an EMR. It is for copies of insurance contracts, licenses, leases, employee records, etc. The more expensive TWAIN-compatible Fujitsu scanners will not produce a useable x-ray scan. 

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE:  PICA Case Closed Volume 16 Issue 3 Summer 2010 (Tip Sullivan, DPM)
From: Ira Baum, DPM, Mark Edmunds, DPM

I understand Dr. Sullivan’s opinion. I have fought many battles for podiatry, although less as I get older. My point was the personal risk one takes to defend a case when a malpractice case is about nothing but money. If a malpractice insurance company felt as strongly as the physician does about the defense, then why doesn’t the malpractice insurance company agree to defend the physician to include judgments beyond the limits of their policy? I think the answer is self-evident.

On a personal note to Dr. Sullivan, I too would sigh a breath of relief that you didn’t have to go to court and face a judgment, because if you had and you didn’t prevail, who would have come to your financial rescue?

Ira Baum, DPM, Miami,  FL, ibaumdpm@bellsouth.net

Despite our best efforts to defend against lawsuits, ludicrous judgments can and do exist. We can protect our assets against judgments that exceed our insurance limits. One firm that can help is Legally Mine, Inc. (legallymine.org). I have no financial interest in this company. I heard them speak at my state's podiatry meeting and am in the process of covering my assets.

Mark Edmunds, DPM, Hopkinsville, KY, medmunds@hesenergy.net

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@verizon.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

ASSOCIATE POSITION (P/T) - NEW JERSEY

Podiatrist needed for nursing home and assisted living facility work in Monmouth and Somerset counties.  May lead to part-time associate position in office. Chance to supplement your income. Can be flexible on days, but must be reliable and personable. Please fax resume to (732) 866-0044. EOE.

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

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 

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

ASSOCIATE POSITION - 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 - 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

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.

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

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