The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 18, 2010 #3,961 Publisher-Barry Block, DPM, JD

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Congratulations to Cynthia Cernak, DPM of Kenosha, WI, winner of 15 contact hours of PM's CPME-Approved CME program (Value $139).  

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 2011 issue of PM.

Foot Surgery by CA Podiatrist Saves HS Baseball Career

In nine months, Jonathan Cohn’s journey from being wheelchair-bound after surgery to playing at Dodger Stadium in California has been simply, amazing. Cohn’s promising high school baseball career was side-tracked more than a year ago when pain in his feet got excruciatingly worse and eventually spread to his knees, his waist, and into his lower back. A few visits to various specialists did not alleviate or solve the problem and eventually Cohn had to leave baseball. The pain progressed until he found himself unable to walk or stand for any length of time, thus forcing him to miss school. One day a friend read an article by a podiatrist describing an experience similar to Cohn’s situation. “He told me that when he read the article he thought it was written about Jonathan,” stated Cohn’s mom.

Dr. Ivar Roth

Then we found a podiatrist (Dr. Ivar Roth, Newport Beach) who felt he could possibly reduce or alleviate the pain with a certain surgery technique,” stated Cohn’s mom. Surgery, to remove an extra bone in Cohn’s feet, was performed. Tendons were opened. The extra bone and a small tumor were removed. His arches were raised. “I cried all the way home after surgery, thanking my mom for never giving up and finding a doctor that gave me hope,” stated Cohn. “As time went on, I was pain-free,” an elated Cohn recalled. “I did a lot of light jogging to start getting back in shape.” 

Source: Larry Gabriel Jr., Carbondale News

22 Barry Students Receive APMA Educational Foundation Scholarships

The Barry University School of Podiatric Medicine announced 22 podiatric medical students were selected to receive the 2010-11 American Podiatric Medical Association (APMA) Educational Foundation Scholarships. The scholarships of $1,000 per student will be used to assist students with the cost of tuition at the school.

Receiving the awards: David Auguste, Kristina N. Barreiro,  William C. Burmeister, Alvin J. Cowans, II, Brooke M. Dix, Paul A. Fawson, Hana Finn, Shelby M. Kear, Naghmeh L. Khavari,  Allyssa M. Knowles, John P. Marion, Desiree Mayo, Quynh Tram N. Nguyen, Sofie L. Pinney, Taylor A. Robertson , Tresa L. Sambenedetto Annabelle L. Santos, Jonathan R. Selbst, Pauline S. Seymour, Kelli O. Stevens, Blake A. Weeks, and Stephen Wigley.

Dr. Jeffrey Jensen

"We are very proud of the achievements of our fine podiatric medical students," said Dr. Jeffrey Jensen, dean of the Barry University School of Podiatric Medicine. "They serve as role models for their classmates for their hard work and high level of academic success. This year the APMA Educational Foundation was able to award more than $194,000 in scholarships to 161 students at the schools of podiatric medicine across the country.

OK Podiatrists Volunteer at Homeless Shelter

Mark Booth, who walks daily from the shelter where he stays to the store and the library to use the Internet, has been battling a severe case of athlete's foot for a couple of months. "In June in Oklahoma only two things grow good: athlete's foot and Bermuda grass," said Tim Malavolti, a podiatrist. Malavolti is one of 13 podiatrists who volunteer at the Tulsa Day Center for the Homeless once a month on a rotating basis.

Dr. Tim Malavolti works with Mark Booth, a homeless client at Tulsa's Day Center for the Homeless. (Photo: Mike Simons)

"The homeless often have more foot problems. They're very mobile and are on their feet most of the time and that often leads to foot pain and other problems with their feet," Malavolti said. "We try to give them palliative care that gets them through and keeps them comfortable until their next visit." The podiatrists offer free basic foot care, cortisone injections for painful heels and supportive padding for arches. Everyone who uses the clinic gets a free pair of socks.

Source: Mike Averill, Tulsa World [9/17/10]

Gain Control of Your Practice by Strengthening the Six Key Components - Part 2

Whether you are a small practice group or larger group, you need a very strong underlying management system.

4. The Issues Component: Issues are the problems that come up every day that make it harder to take your business where you want it to go.  An organization's success hinges on its ability to resolve these problems. Do you address your problems as they arise and make them go away forever?

5. The Process Component: Your processes define your way of doing business. Do your people know what your way of doing things is, and are they following it?

6. The Traction Component: Successful businesses and practices execute well. They know how to bring focus, accountability, and discipline to achieving every piece of the vision. Are your people accountable and are they getting the job done?

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

Query: DME Not Furnished - Stuck with Device

I am aware of the rule that if a patient dies or otherwise does not pick up a custom-made device (diabetes mellitus custom-molded PZ insoles), it is billable at the cost price to DME as a "salvage."

Take a look at the Medicare Benefit Policy Manual citation below (Pub 100-2, Chapter 15, Section 20.3 A and B) found on pages 11-12. "If a custom-made item was ordered but not furnished to a beneficiary because the individual died...payment can be made based on the supplier’s expenses. (See subsection B for determination of the allowed amount.) In such cases, the expense is considered incurred on the date the beneficiary died..." "...The allowed amount is based on the services furnished and materials used, up to the date the supplier learned of the beneficiary’s death..."

How exactly is this done? Is there a modifier to indicate this circumstance? Can it be billed electronically? Has anyone actually been reimbursed for this through NHIC (or another DME carrier), and was it worth the effort?

Richard Rettig, DPM, Philadelphia, PA

Response: You cannot do this electronically without having to go through the denial/redetermination route. I recommend you send a separate letter to your DMAC detailing all costs for the custom items and associated incidentals (e.g., room time, expenses with cast materials, shipping and handling, etc.). You are not required to send them a copy of your invoice. I suggest that you bill your full and regular fee.

All correspondence should go to the regular claims office of your respective DME MAC.

Paul Kesselman, DPM, Woodside, NY  

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RE: Recalcitrant Ingrown Nails (Jordan Sheff, DPM)
From: George Jacobson, DPM

After reading all the posts on this subject, we should remember that we are all "Monday morning quarterbacks" here. Circumstances of individual treatment with informed consent and patient understanding of the logic behind the approach of the attempted procedure is the doctor-patient relationship at its best. I've done many Keller's on patients on whom most of you would have done implants. When patients are completely informed and you document the treatment options and they participate in their healthcare choice, we can only cause trouble by second-guessing what was best for that individual. You can incubate a malpractice case when that patient comes into your office and you hear that they had a terminal Symes for an ingrown toenail, and then make some uninformed comment. 
 
They used to remove the 5th toe for a corn. It would have been the only way to guarantee that the lesion would be gone. I'm not advocating that, but we have all seen some patients who would be better off without their 5th toe. This is similar to what Dr. Sheff encountered, or my Keller. After four doctors and four procedure failures, he chose the procedure that gave the patient the greatest assurance that the problem would be solved. Would the patient consent to another matrixecomy? In 1983, I was working for David Jacobson, DPM, (no relation) in Los Angeles. I had just graduated CCPM; I still heed his clinical pearls. Choose the best procedure that no one else will need to improve upon. Dr. Sheff and his patient decided to follow that tried and true advice. 
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: Recalcitrant Ingrown Nails (Jordan Sheff, DPM)
From: Multiple Respondents

I have done only surgical matricectomies for the past 27 years with a less than 1% recurrence rate; this after too many recurrences during my first year in practice doing phenols. I've heard all the pros and cons and recommend that phenolers learn the steel technique and at least try it. I have redone many phenol procedures (mine and other people's) with rare recurrence, and I have seen many with a poor cosmetic  result. GPs will try to do phenols, and I think podiatrists need to do it better. I like a terminal Symes, but I only take the distal tuft and have very satisfied patients with this. The cosmesis of scalpel procedure is far superior, in my opinion, and usually heals in two weeks.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

From an objective point of view, the fact was that a patient had four failed P&A procedures. I think everyone agrees it was therefore a smart decision to try a different approach as the phenol was obviously not working. The question is, "Why not try a cold steel procedure prior to amputating bone?"

In Dr. Sheff's defense, I watched a "nail surgery" video last night on either Zimmer or Stryker's website, and in the review, a terminal Symes procedure was mentioned as an option. Hence, it would appear that the orthopedic community still would classify the procedure within "standard of care" as the video was recent and titled "new."
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

I have had one patient who underwent six phenol procedures and each one grew back. This was from another physician whom I know to do good conscientious work. I did routine nail care on her for a year before she allowed me to repeat that procedure. I felt foolishly confident, since I use NAOH instead of phenol. I just knew that "I was better."  Guess what? It worked for five years, and then the damned thing grew back. I have no idea of the reason for this, but it happens. Dr. Sheff did nothing wrong. I don't know what he could have done differently, but getting unfairly criticized was uncalled for. 

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Michael Marino, DPM
From: Steven J. Berlin, DPM, Lloyd S. Smith, DPM

Dr. Mike Marino was a true pioneer in this profession from politics to education and his generosity to the Pennsylvania Podiatric Medical Association. He was also generous to the Fund For Podiatric Education during his active years, and he will always be remembered by  those he trained at the Pittsburg Podiatry Hospital. He will also be greatly missed by his family and by me personally. 

Steven J. Berlin, DPM, Baltimore, MD

During my tenure as a member and president of the APMA Educational Foundation, Dr. Marino was a faithful and very appreciated member of the Foundation's Board of Trustees. Those years for the Foundation were a struggle, and without the support of legendary podiatrists such as Mike, the Foundation would not have survived and flourished. 

Lloyd S. Smith, DPM, Newton, MA

RE: Remember to Mute Your Mic
From Lynn Homisak, PRT

I wish I was a fly on the wall in the lecture room during a Texas seminar where I presented a couple of years ago. After I finished speaking, I walked out of the room, and without realizing it, forgot to mute my mic! I had more important things on my mind: heading directly into the ladies room! (can you see where this is going?) 

Soon after the next speaker began his presentation, he and the audience became distracted by some strange noises heard over the sound system. It started with some rustling...followed by the flush of a toilet, running water, a faucet, and then silence. Once everyone realized just what was happening, they let out a roar of laughter that could be heard everywhere within ear shot. 

My husband (who was in the lecture room) flung open the door, came to my rescue and pulled my mic off, explaining that I managed to invite the entire audience into the ladies room with me! Fortunately, my bathroom visit was uneventful. I was marched back into the lecture room (wearing a VERY red face) where I was met with roars of laughter and a standing ovation! The audience thanked me for the diversion from “standard” lectures. And of course, everyone said they were happy to know that I washed my hands.

Lynn Homisak, PRT, Seattle, WA in Public Speaking International

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

PART-TIME, LICENSED PODIATRIST - WEST BLOOMFIELD, MICHIGAN 
Immediate opening for treating patients in a nursing facility setting.  If interested, please e-mail drteetime@aol.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(S) - SOUTHERN CALIFORNIA

Podiatrist(s) wanted for long-term care facilities. Please email reply with CV to ZbubblesZ@aol.com

ASSOCIATE POSITION - WEST COAST, FLORIDA  
 
Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY 
 
Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS 
 
Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston) and Delaware. Please respond to: doconcall02@aol.com

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

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 FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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