The Voice of Podiatrists

September 21, 2006 #2,694 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Air-Pump Pump Shoe May Be of Benefit: PA Podiatrist

Cole Haan has unveiled a line of high heels that have embraced Nike's air pump technology, which aims to make the shoe far more shock absorbent and comfortable. To counterbalance the pressure women put on their feet when they wear high heels, Cole Haan incorporated Nike's "Zoom" air bag system of pressurized air and Tencel, a fiber made from wood pulp cellulose.

Tivona Air Sling

Comfortable or not, Dr. Alan Catanzariti, director of the foot and ankle residency program at West Penn Hospital in Bloomfield, believes that extremely high heels are not conducive to foot health. In flatter shoes, the body's weight is distributed more evenly throughout the surface of the shoe's sole. In a high heel, "that markedly smaller surface area has to accept a larger amount of weight," Dr. Catanzariti said. "The higher the heel, the greater amount of pressure you place on the ball of your foot."

Dr. Alan Catanzariti

Many of his patients, including doctors, lawyers and legal assistants, insist on wearing high heels and Cole Haan's approach, he added, sounds reasonable. "The shoe you're describing might be of some benefit. It sounds like they are increasing the shock absorption capacity of the shoe. I think that might have some benefit for people who have lower back problems or who have a higher arched foot and they really want to wear those type of shoes," Dr. Catanzariti said. People with lower back problems have difficulty walking on rigid, hard surfaces. A person with a higher arched foot has a much lower ability to absorb shock, the podiatrist said.

Source: Marylynne Pitz, Pittsburgh Post-Gazette [9/19/06]

OPMA Announces New Executive Director

The OPMA Board of Trustees has announced the appointment of Jimelle Rumberg, Ph.D., CAE as executive director of the OPMA. Dr. Rumberg, who has served as the executive director of the West Virginia Psychological Association (WVPA) for the past eight years, will assume her duties on October 9.

Jimelle Rumberg, Ph.D., CAE

After an extensive national search, the board is excited to have selected Dr. Rumberg to lead the OPMA. Jimelle has nearly 30 years of professional experience including 10 years in association management to bring to our organization. She led the expansion of two state associations by increasing membership, securing grant funding, creating new educational programs for members, and building financial growth. Dr. Rumberg attained her Ph.D. from the Union Institute & University concentrating in Organizational Behavior and Development with an emphasis in Nonprofit Association Management; a M.A. in Speech Communications from West Virginia University; and a B.S. in Dental Hygiene from West Virginia University.

Debbie Bratka, CAE will continue to serve as the acting executive director during the interim.

APMA Publishes Private Insurance Resource Guide

The American Podiatric Medical Association (APMA) Health Systems Committee has just unveiled the "Private Insurance Resource Guide." The Guide is an exhaustive, on-line resource containing practice management information and state laws pertinent to the practice of podiatric medicine and surgery.

The Guide provides invaluable practical and easily accessible information for insurance related challenges that may arise from when a patient sets foot in the office to when the podiatric physician receives the appropriate reimbursement for care rendered. The information provided is an accumulation of experiences in dealing with private insurers. Heretofore, podiatric physicians would have needed to consult several resources to find information that is now available in one place at http://www.apma.org/PrivateInsuranceResourceGuide.

This is a free member benefit. Similar resources from the American Bar Association and other commercial ventures are priced from $200 to $350.

Query: Legal Implications of Off-Label Use of Drugs

I was wondering what the medicolegal ramifications are for using drugs/ medications off label and a patient having an adverse reaction to the medication. Does anyone have a parent/patient sign a consent for off-label use for drugs with possible adverse reactions and all available FDA-approved alternatives? Is this recommended?

Adam Cirlincione, DPM, Glen Cove, NY

Editor’s Comments: PM News does not supply legal advice. Posted on PM’s website is the article “What You Need to Know About The Off-Label Use of Pharmaceuticals” at http://www.podiatrym.com/pmarticle.cfm?id=89

This article discusses the questions raised. When dealing with children, it’s an excellent idea to have a consent form signed.

Query: Ulnar Deviation Diagnosis Code

What would be the diagnosis code fo ulnar digital deviation in a patient with arthritis?

Jon Hyman, DPM, Houston, TX

Response: Ulnar deviation is probably more apropos for the upper extremity...but assuming you are referring to lateral deviation of the digits of the foot [as found in rheumatoid arthritic patients], then you want to look at the following:

ICD-9 818.47 - contracture of joint, ankle/foot
ICD-9 736.70 - unspecified deformity of ankle and foot, acquired
ICD-9 736.79 - other acquired deformities of ankle and foot; not
otherwise classified
ICD-9 738.8 - acquired deformity of other specified site
ICD-9 738.9 - acquired deformity of unspecified site

There is no specific deviation of a digit at the metatarsal-phalangeal joint or interphalangeal joint ICD-9 code.

Choose the code(s) from the above list that best fits your patient's particular finding. Also, don't forget to include the specific ICD-9 for the presenting arthritis type.

Harry Goldsmith, DPM,Cerritos, CA

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

RE: Lamisil for 12-year-old
From: Palmer Branch, DPM

After following the intense discussion about whether or not to use Lamisil on this pediatric patient, I would like to offer another option that I have not seen mentioned. Has a temporary avulsion of the nails under local anesthesia bee considered? The case mentioned indicates that only the great toes are presently involved, rather than all of the nails. The avulsion should be followed by application of a topical antifungal cream or gel as the nails regrow.

I use this treatment option frequently on pediatric cases or for patients cannot take or do not wish to take Lamisil or an alternate oral agent. I would estimate that my success rate with this protocol is 90% or higher and have not seen any problems with the nails growing back with a dystrophic appearance. I personally agree that Lamisil is also a good option if an adolescent patient is otherwise healthy and appropriately monitored with liver function testing. I generally give the parents and patient the option in cases such as this and most have chosen the nail avulsion route when only one or two nails are involved.

Palmer Branch, DPM, Chattanooga, TN, DrCuboid@aol.com

RE: Scope of Practice
From: Barry Finkelstein, DPM

I am a strong advocate for change in our scope. I am constantly amazed at our advances in foot and ankle surgery and the respect we earn for our expertise. On the other hand, I often find our limited scope to be an impediment to proper patient care and sometimes find it to be a source of embarrassment.

The other day I was doing a bunion and hammertoe surgery on a healthy patient who had received medical clearance, lab work and EKG from his PMD. As it happened, JCAHO was making its annual check that day and had chosen my case as the one that would be scrutinized. I was shadowed by the hospital's medical director, director of nursing, the guest from the JCAHO and other dignitaries.

I had filled out the pre-op H&P, as I have done for years on all my cases, unaware that podiatry was not credentialed to perform the H&P at our hospital. It was an embarrassing situation as calls had to be made to see if a PA or orthopedic attending or resident could do the H&P. This was overshadowed by the confusion of those around me who could not understand why I am credentialed with surgical privileges to perform the most complex surgical cases, but could not perform an H&P. The inability to perform this routine task compromises my credibility as a foot and ankle surgeon and our entire specialty suffers.

I feel that the extensive nature of our training and ability is often misunderstood in the medical community because they make a logical assumption that if we have a limited scope of practice, we must have limited training. It is therefore essential that we unlimit our scope, not because we aim to be cardiologists, but because we aim to be foot and ankle surgeons.

Barry Finkelstein, DPM, Bronx, NY, NYNJfootandankle@aol.com

Editor’s note: PM News does not supply legal advice. In New York, Podiatrists are allowed to perform H & P’s. NYSPMA members can receive documentation for this by contacting NYSPMA Exec Len Thaler lthaler@nyspma.org

PRACTICE & BUILDING FOR SALE – SOUTHERN CALIFORNIA

30 year established practice in southern California. Includes Medicare certification, modern surgery center building, attached office and treatment rooms, equipment. 2.5 days office hrs per week –gross 240K per year. Can expand to 5 days. $1.5 Million. Contact Dr. Beal (951) 780-4782 or email rbeal10269@aol.com

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

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.

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

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

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,500 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.