The Voice of Podiatrists

September 18, 2006 #2,691 Editor-Barry Block, DPM, JD

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Diabetics Not Good Candidates For Pedicures

A lot of women and even some men can't live without it.. regular trips to the nail salon for a manicure or a pedicure..... But if you are not careful Podiatrist Dr. Robert Spalding says the nice looking hands and feet could come at a high cost... serious infections.

Dr. Robert Spalding

Dr. Spalding says people with certain health conditions like diabetes are not good candidates for manicures and pedicures. While amputations are not very common and death is rare... doctors do see a lot of infections.

Dr. Spalding wrote a book "Death By Pedicure.. The Dirty Secrets Of Nail Salons." He says a lot of nail salons don't properly sanitize their instruments.. and that is what can lead to serious health risks.

Source: WRCB-TV, TN – [9/14/06]

Podiatry Listed Among “The Worst Jobs With Best Pay”

Average pay: $125,663 (Salary.com)

High average salaries and reasonable, flexible hours make podiatry look like a pretty attractive career choice—at least for those who don’t squirm at the thought of dealing with bunions, ingrown toenails, and pus-filled foot ulcers. There’s also the (lack of) prestige factor to consider: Because podiatrists are DPMs (Doctors of Podiatric Medicine), not MDs, they face the same “not a real doctor” stigma as chiropractors and optometrists. Getting started in the field can also be difficult, especially for those without surgical training—loan default rates for podiatrists are among the highest in medicine.

Source: Kerry Miller, Business Week [9/14/06]

Doctors Decline Thomas' Offer to Increase Reimbursements

The American Medical Association and other doctors' groups on Thursday rejected an offer from House Ways and Means Committee Chair Bill Thomas (R-CA) to block a scheduled reduction in Medicare physician reimbursements in exchange for participation in a quality-of-care program, CQ HealthBeat reports. Thomas' offer would have blocked a 5.1% reimbursement cut currently scheduled to take effect in January 2007.

Thomas' proposal also would have increased reimbursements by between 2.5% and 2.8% in June 2007 for doctors who agreed to report quality-of-care data to the government. Under the proposal, doctors who did not sign up for the quality-of-care program would have faced a reimbursement cut in 2008 in accordance with the Medicare physician payment formula.

Source: American Health Line [9/15/06]

Query: Burning Foot Syndrome in an Adolescent

Has anyone seen burning foot syndrome in an adolescent, and if so what did they do for the condition?

Steven Tager, DPM, Monterey, CA, setdpm@yahoo.com

Query: E/M Staistics

Does anyone know how I could obtain the national statistics for evaluation and management (E/M) data? Specifically, I am looking for the percentage of CPT 99212 services billed versus CPT 99213 services billed.

Linda Killmeyer, Mentor, OH

Response: Go to www.apma.org, and under the "Member’s Only" section (your member username and password are needed), look for section that lists BMAD (Part B Medicare Data). This section gives a wealth of information, state by state, letting you compare your practice to the norms.

For example, it will tell in any particular state for a particular year how many CPT 99212, CPT 99213 and CPT 99214 were billed. You can compare your ratio to those figured using the BMAD. You can look up just about any codes podiatrists bill, such as CPT 11720 and CPT 11721 as well as CPT 11040, CPT 11041, CPT 11042 and CPT 11043, etc.

If your state has a ratio of CPT 11721 to CPT 11720 of 4:1, and your office data reveals a ratio of 20:1 (which I have seen this ratio or higher looking at many practices) realize you are way above the radar and a high audit target for CPT 11721.

Hal Ornstein, DPM, Chairman, American Academy of Podiatric Practice Management, Howell, NJ

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Lamisil for 12 Year Old (James M. Petko, DPM)
From: Multiple Respondents

I don't have huge numbers of patients on oral antifungals, but I did have one pediatric case a number of years ago. The Lamisil rep provided me with European studies which indicated that there was a good safety record for the medication even though it's not officially recognized for pediatrics in the US. I gave the 8 yr old patient the medication and had excellent results with no adverse affects whatsoever. Years later, her Mom is still thrilled.

Paul Busman, DPM, Troy, NY, BREWERPAUL@aol.com

I don't mean to sound harsh, but parents who are unmoved by safety issues in contrast to a purely cosmetic problem are simply unfit. Tell them they must wait until the child is 18, period. Frankly, I would personally question their priorities, undoubtedly creating friction between us, but that is just too bad for them. I would not let my own children do anything that is not safe, nor would I even consider helping someone else put their child in harms way (whether real or perceived).

Peter Smith, DPM, Stony Brook, NY, drpetersmith@optonline.net

I have a 12 year old with juvenile onychomycosis who, with Dr. Bryan Markinson's guidance, I am successfully treating, using pulse therapy Lamisil. This child's life was made hellish by his peers and the ignorant mothers of his peers who wouldn't allow him in their backyard pools. You can imagine how persistent parents will be when their child faces such discrimination and torment. I was the 10th doctor this child's mother sought, and as far as she is concerned, I may have just as well saved her boy's life for clearing up a condition that, to the rest of the "usual" population we deal with, is merely a minor annoyance.

Howard R. Fox, DPM, Staten Island, NY, foxhr@yahoo.com

Despite the PDR's lack of evidence regarding Lamisil's efficacy and safety in children, I don't believe there is much reason for concern initiating treatment for pediatric patients. In healthy individuals, over the course of time, Lamisil has proven to be an extremely safe and effective medication when properly utilized and monitored. We have several years of experience treating patients as young as 6 years old and have not witnessed side-effects not previously reported in adults, nor with any increased frequency. In children less than 40 kg, we utilize 1/2 the adult dose. I suggest you use the same medication monitoring protocols you've utilized for adults.

Additionally, I recommend you communicate with the pediatrician to inform them that you are initiating treatment. This should help ensure no other occult contra-indications exist. I also recommend you take some time to educate the parents regarding the lack of clinical evidence of Lamisil's safety and use for children. Thoroughly document this. If medico-legal trepidation still exists initiating non-FDA sanctioned therapy for a given clinical situation, consider having the parents sign a waiver of medical liability which should serve as additional protection should the child sustain an adverse event.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

I have used Lamisil a couple times in young children with good results. I think most important is getting the pediatrician on board prior to doing anything. Some pediatricians are "funny" when you try to put their kids on medicines like Lamisil.

Daniel Tellem, DPM, Rochester, NY, liadant@frontiernet.net

I assume a PAS stain or culture was performed to confirm that it's onychomycosis. Since Lamisil should not be be used in patients under 18 years old, I would suggest Gris-peg. Gris-peg is FDA-approved for onychomycosis and tinea pedis and can be used in children over 2 years of age, it is dosed by weight at 3.3mg /lb/day. This is a safe drug and is frequently used by pediatricians and dermatologists to also treat tinea capitis.

William Spielfogel, DPM, New York, NY, wspielfogel@aol.com

RE: Scope of Practice Legislation (Richard W. Boone, Sr)
From: Tilden Sokoloff, DPM

Tim Vogler is absolutely correct. I Chaired the Scope of Practice Committee of Project 2000, as well as being the legislative Chairman of the California Podiatric Medical Association when we changed our practice act to its present form. It was a five year journey and very costly. The verbiage in the Project 2000 report will not be anything that Federally would be enacted in our lifetime for all the reasons stated by Dr. Vogler.

The MD degree option is the fix for our profession. Nothing is easily accomplished, but this is the "cure" to practice limitations, reimbursement, training opportunities, and just plainly stated, our rightful place in the medical hierarchy.

Tilden Sokoloff, DPM, Alamo, CA, THsokoloff@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

FOR SALE - ORTHOTIC LAB EQUIPMENT

Supreme Dual Vacuum Press from Gateway with Gast Vacuum Pump, silencer and filter. full description of features upon request. Originally $1200, Like New $ 750 drmorse@northpod.com

PRACTICE FOR SALE - BERKELEY CALIFORNIA

Well-established office in professional medical building; Biomechanics, Geriatrics and General Podiatry; Excellent growth potential for surgery; Payor base MC, PPO, and self-pay (NO HMOs); Reliable referrals from local physicians; Electronic billing in-house; Transition terms negotiable. Send letter of intent to: foot4sale@sbcglobal.net

ASSOCIATE POSITON - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

EQUIPMENT WANTED - X-RAY Machine

I am looking for a used x-ray unit, preferably no older than 15 years. EXCEL units or units of this type are appropriate for my needs. If you have a unit, with or without the stand, please e'mail a picture and relevant information to me at drkarendpm@aol.com I can also be reached at 619-892-3549. Shipping would be to Southern CA.

ASSOCIATE POSITION – NEW ENGLAND

Opportunity in growing New England practice. Well established and respected practice with large office and surgicenter, latest technology, great staff, loyal patients and solid referral base. Close proximity to hospitals, full scope practice. Opportunity for partnership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and contact info to: Footdoc-office@usa.net

ASSOCIATE WANTED - SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

SEEKING ASSOCIATE POSITION IN TEXAS, DFW AREA

PSR-24 trained podiatrist seeking a FT associate position with possibility of future partnership. Trained in all aspects of podiatric medicine including forefoot and rearfoot surgery, and diabetic limb salvage. Email: fixfeet@hotmail.com

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

Florida License / Medicare and Medicaid numbers in effect and active. High income potential for hard working, ethical and honest DPM great for semi-retired. Transportation a must. FAX CV or Resume to 1-727-785-4697.

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