The Voice of Podiatrists

Serving Over 13,000 Podiatrists Daily

September 17, 2011 #4,262 Publisher-Barry Block, DPM, JD

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Morton's Toe Can Also Lead to Diabetic Ulcers: FL Podiatrist

Diabetic ulcers are wounds that may start out small, but because of out-of-control blood sugar and other diabetic complications, they become large wounds that can be very difficult to heal properly. This is one reason amputation is commonly associated with diabetes. One of the most powerful weapons against diabetic ulcers is to properly manage blood sugar levels. "Uncontrolled blood sugar can lead to neuropathy, which is a condition that causes diabetics to lose feeling in their extremities, particularly the feet," says podiatrist Dr. Burton Schuler.. 

Dr. Burton Schuler

While Schuler agrees that monitoring your skin and blood sugar levels are critical behaviors for ulcer prevention, he also cautions that foot problems may be caused by something other than blood sugar levels that decrease foot circulation. He specifically cites a condition called "Morton's Toe." Morton's Toe—or short first metatarsal bone—causes a range of foot problems due to overpronation caused by the short first toe bone.

Source: Expert Click [9/16/11]

Barry Podiatric Faculty Honored for Scholarships to Students

The faculty at the Barry University School of Podiatric Medicine is so dedicated to their students that they have contributed $539,621 in scholarships to deserving podiatric medical students since 1993. Barry’s podiatric clinical faculty was recognized for their contributions during the School’s Rite of Passage ceremony held at the Broad Center for the Performing Arts. Dr. Jeffrey Jensen, Dean and Professor of Podiatric Medicine and Surgery for the School of Podiatric Medicine presented a plaque to Dr. John Nelson, Associate Dean and Professor of Podiatric Medicine that acknowledged and thanked the clinical faculty for their generous support of more than one-half-million-dollars in clinical scholarships to their students at Barry. 

Dr. John Nelson (right) accepts the award from Dr. Jeffrey Jensen on  behalf of the faculty  (Photo: Michael Murphy)

The plaque will be installed in the lobby of the School of Podiatric Medicine and will hang as a permanent tribute to the following clinical faculty: Dr. John Nelson, Associate Dean of Clinics, Dr. Albert Armstrong, Associate Academic Dean, Dr. Jacqueline Buchman, Associate Professor of Podiatric Medicine, Dr. Jaqueline Brill, Assistant Professor of Surgery, Dr. James Losito, Professor of Podiatric Biomechanics and Orthopedics, Dr. Thomas Merrill, Professor of Podiatric Surgery and Residency Director Barry University/Mercy Hospital Residency Program, and Dr. Charles Southerland, Professor of Orthopedics and Biomechanics.

PA Podiatrist Speaks in Favor of Hospital Takeover 

On Tuesday, Easton Hospital's Dr. Stanley Walker appeared before the Phillipsburg Town Council. He was there to present the offer to purchase Warren Hospital made by Community Health Systems Inc., which owns Easton Hospital. 

Dr. Robert Diamond

One St. Luke’s doctor had this advice to doctors at Warren. “You should welcome St. Luke’s with open arms,” said Dr. Robert Diamond, a podiatrist who has been at St. Luke’s for 29 years. “It will not be an impediment, but a huge improvement for them.”

Source: David Foster, Easton Express Times [9/16/11]

CT Podiatrist Moves Out of House Just  in Time to Avoid Hurricane Irene

Dr. Jennifer Tauber and her husband, Hayes, closed on their new home in New Canaan on Aug. 24 — just in time for Tropical Storm Irene. They hurriedly moved in. And despite the ominous drone of warnings about the coming storm, they ordered a couple hundred dollars’ worth of groceries from Peapod to stock their refrigerator. 

Jennifer and Hayes Tauber with Ellerie, 5, and Adeliese, 3 (Photo: Judith Pszenica)

It was not until their third night in the house that Irene made landfall. That’s when the Taubers began to feel anxious about the timing of their move. “Saturday night we were lying in bed listening to the wind howling, and crossing our fingers that none of the trees would fall on the house in the middle of the night,” said Ms. Tauber, a podiatrist. As it turned out, it was their previous home in New Canaan, the one they had just moved out of, that suffered tree damage.

Source: Lisa Prevost, The New York Times [9/15/11]

 Medicare Overpaid Docs $28.8 million: Auditors

Auditors estimate that Medicare overpaid physicians $28.8 million in 2008 and 2009 for ambulatory and outpatient services that were performed in hospitals instead of doctors' offices, according to two reports released Friday. But federal officials say they may not investigate because of the cost of reviewing paid claims.

Under Medicare, the entity that provides the space for a medical procedure is compensated for its overhead costs. Physicians, or their independent billing consultants, can increase Medicare reimbursements by claiming to have provided space for the services that were actually done at hospitals or freestanding ambulatory surgery centers. Investigators with HHS' Office of the Inspector General reported that they found more than one million Medicare claims for which both hospitals and physicians were paid for providing facility space for the same procedure on the same day for the same patients in 2008 and 2009.

Source: Joe Carlson, Modern Physician [9/16/11]

Spark Enthusiasm in Seconds

Energizing your staff doesn’t take months of planning formal events. Do it every day with these actions:

•  Ask questions. Show interest in what they are doing, and listen for what they are passionate about.
•  Reinforce their interests. Talk about what they find important.
•  Praise. A few sincere words, like “Super job!” can boost an employee’s entire day.
•  Show your respect. Ask for an employee’s advice and you’re also saying “I value your expertise.”

— Adapted from “8 Simple Things You You Can Do to Encourage Others,” Dave Cheong via Communication Briefings

Query: TigerView Digital Radiography

Does anyone have experience with TigerView Digital Radiography. How is their product? Is their after-sale service acceptable ?   

Jim Clark, DPM, Salinas, CA

Query: Extended Medial Column Arthrodesis

A surgeon performs an arthrodesis fusing the talonavicular, naviculocuneiform, and intercuneiform joints, as well as the 1st, 2nd, and 3rd tarsometatarsal joints. Is all of this work covered by a single code, CPT 28730 (arthrodesis, midtarsal or tarsometatarsal, multiple or transverse)?

Heidi Stout, CPC, New Brunswick, NJ 
 
Response: When reviewing the existing code options, CPT 28730 does fit the procedure description you gave, but certainly doesn't properly reflect the work done when so many fusion sites are performed. I don't think it would be appropriate to bill PCT 28730 multiple times; besides, it would in all likelihood be kicked out by the computer as duplicate billing.

You have, I believe, two options: 1) the addition of modifier "-22" to CPT 28730 indicating that the services were significantly greater than those usually required by the code or its value; or 2) code the entire surgery as an unlisted foot procedure, CPT 28899, and provide a detailed operative report and letter of explanation. Be sure, regardless of your choice, to request individual consideration by peer review.

Howard Zlotoff, DPM, Camp Hill, PA

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

RE: Professional Attire (Alan Mauser, DPM)
From: Randall Brower, DPM

Regarding scrubs and the OR and infections. A vast majority of the things we do to prevent infections in the OR, INCLUDING wearing home laundered scrubs are traditional and truly have little bearing on true infection control. What makes the physician lounge couch any more sterile than my car seat on the way in to the OR? We are taught to wash our hands a specific way even before going into the OR; then we rinse them under city water. 

We wear masks in the OR but the patient doesn't because their breath is sterile? We even glove those hands and gown those scrubs, but the part of our bodies closest to the "sterile field" - our face - is right over the wound. We should be required to exfoliate our face prior to surgery, and, of course, rinse under city water. All this sterility and my infection rate is still less than .05%. Guess I'm lucky.

Randall Brower, DPM, Avondale, AZ, footdoctor33@yahoo.com

RE: APMA Nixes MD/DO Referendum (Narmo L. Ortiz, Jr., DPM)
From: Robert Bijak, DPM

I disagree that a degree change will "cannibalize podiatry." The addition of the MD would raise awareness of podiatry as a subspecialty to general applicants that many applicants presently ignore. If you really do not want to practice podiatry, no degree will force you to.

The majority of the profession has spoken on this issue and favor a degree change. The only steps now are 1. formal proclamation of the intention and 2. constructing the mechanics of implementation, some of which have already been presented to this forum. It's now up to the APMA, CPME, and the colleges.  

Robert Bijak, DPM, Clarence Center, NY rbjijak@aol.com

AK Town On the Lookout for Another Toe-Sucker

There's nothing illegal about a little foot fetish, but police in Conway, Arkansas, are looking for a toe-sucking man they said has crossed the line into assault. Police have received two complaints in the past week about a man who seems desperate to suck women's toes -- whether they want him to or not.

It is not the first time that Conway has dealt with this sort of complaint. The town's run-in with its first toe-sucking man eventually escalated to threatened violence. The 1990's assailant, Michael Robert Wyatt, pretended to be a podiatrist in order to fondle and suck a Conway woman's toes at a clothing store. He received probation, a fine, and court-ordered therapy. But his probation was revoked after he was arrested in another town on similar charges.

Source: Suzi Parker, Reuters [9/15/11]

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 to ddavidphawk@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Experienced podiatrist wanted – Position available for per diem podiatrist (weekly and vacation coverage) in Park Avenue office. Seeking experienced, kind and well-trained podiatrist with out-of-network capability. Starting at $50/hour. Please fax CV to 212-889-6150.

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 - LONG ISLAND, NY

Immediate Position Available for motivated individual in well established, diverse office. South Shore of Long Island. New Graduates will be considered. Send CV to dsmith4177@gmail.com

FULL-TIME ASSOCIATE POSITION – NORTHEASTERN PENNSYLVANIA (LEHIGH VALLEY)

Well-established, rapidly growing practice with multiple offices. Motivated, ethical and personable with well-trained PSR-24/36. Modern office’s with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package with partnership opportunity. If interested please fax your CV, letter of intent and references to: 610-432-4887.

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

OFFICE TO SHARE - NYC (GRAMERCY)

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

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. Priced for quick sale. 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 - NORTH DALLAS, TX

Great opportunity; 26 year old solo practice, reasonably priced. General practice consisting of hospital surgery, office surgery, orthotics, children, adults, geriatrics. Turn-key office located in medical building inside Loop 635. Will consider owner finance with down-payment.dallasfootdr@yahoo.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

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