The Voice of Podiatrists

September 26, 2006 #2,698 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.

Congratulations to Glenn C. Berkin, D.P.M. of Miami Shores, FL, the winner of a one-week Windjammer Caribbean Cruise (Value $2000.00). We wish to thank the hundreds of podiatrists who took the time to participate in our annual survey. The survey http://www.podiatrym.com/survey1.cfm, which provides valuable information to the podiatric community, will be open until Friday. Part of the survey is your opportunity to vote for the next inductee to be enshrined in the PM Podiatry Hall of Fame.

FL Podiatrist Praises Device For Visualizing Deep Leg Veins

Healthcare workers who handle patients with hard-to-find veins are getting a little help from a new device that offers something like x-ray vision to make precise needle sticks. Diomed hopes that the VeinViewer Imaging System it is marketing will put an end to patients feeling like human pincushions. The instrument, which costs roughly $20,000, uses a pulse of near-infrared light to paint a vein map on the skin, allowing for more precise needle sticks.

Vein lights, the standard tool used by doctors treating spider veins, are unable to detect veins deep below the skin. The VeinViewer does, said a podiatrist who specializes in vein treatment who has no financial connection to Diomed.

``I think it's a great device," said Dr. Jodi Schoenhaus, a member of the American Podiatric Medical Association who practices in Boca Raton, FL.

Dr. Jodi Schoenhaus

Still, she hasn't committed to purchasing a VeinViewer. ``It is a great product, and you can see so much through it," Schoenhaus said. ``But it's big. It's cumbersome."

Source: Diedtra Henderson, Boston Globe, [9/25/06]

Heavy Book Bags Pose Health Risk: GA Podiatrist

With book bags topping out at about 40 pounds, the weight of the books has become too much for some students to shoulder, said Todd Herron, an area podiatrist whose daughter attends eighth grade at Hilsman Middle School. Herron's daughter, who has a slight build and weighs about 85 pounds, routinely carries a book bag that weighs about 35 pounds, Herron said.

That amount of weight might be OK for kids who've started to physically mature, but many seventh- and eighth-graders haven't, he said. Hauling around a book bag that's one-third of your weight can cause life-long chronic back pain or scoliosis of the spine, Herron said.
"Kids at this age are still developing," Herron said. "There bones are still growing and start to set, so any damage that happens to their backs now can cause chronic back problems in adulthood."

Herron said his older daughter, who attended W.R. Coile Middle School in the late 1990s and now attends the University of Georgia, still experiences back pain from carrying her book bag around Coile.

Source: Merritt Melancon , Athens Banner-Herald [9/21/06]

NYCPM Welcomes Class of 2010 With White Coat Ceremony

The New York College of Podiatric Medicine (NYCPM) recently welcomed the students of its Class of 2010 with the College’s annual White Coat Ceremony, in which the future Doctors of Podiatric Medicine symbolically don their white coats and together recite the Hippocratic Oath. Bob S. Biller, D.P.M., delivered the keynote address to the assembled college community and guests.

Dr. Bob S. Biller addresses NYCPM Class of 2010 at White Coat Ceremony

Dr. Biller has been a member of the New York State Board for Podiatry since 1999, and currently serves as its Chairman. He is a 1978 graduate of the New York College of Podiatric Medicine, and has been an Adjunct Associate Professor of Orthopedics at NYCPM since 1992. In addition, since 1991 he has been Chief of the Section of Podiatric Surgery, as well as Attending Surgeon and the Director of Podiatric Medical Education, at Long Beach Medical Center, in Long Beach, Long Island. He has also been Attending Surgeon in the Section of Podiatry at St. John’s Episcopal Hospital, in Far Rockaway, New York since 1995.

Some Facts about the NYCPM Class of 2010

95 new students entered September. Forty-two percent of the Class of 2010 is female, and fifty-eight percent is male. African Americans comprise sixteen percent of the class; students of Asian background, thirteen percent; and students of Hispanic background, five percent. The members of the Class of 2010 come from twenty states, as well as Canada and Egypt. Three students have foreign medical degrees, one has a D.D.M. degree, and three have D.V.M. degrees.

PM News Editor Barry Block, DPM will be lecturing at the following venues

Oct 22, 2006 – 2006 Symposium on the Geriatric Foot and Ankle, NYC, NY (The Future of Podiatry)

Nov 11, 2006 - AAPPM – Fall Practice Management Workshop Ft. Lauderdale, FL (10 Ways to Supercharge Your Practice)

Nov 19, 2006- American Academy of Continuing Podiatric Education, Teaneck, NJ (The Future of Continuing Medical Education)

Jan 14, 2007 – Super Bones/ Super Skin Bahamas (Learn More/ Earn More)

Jan 18, 2007- Codingline Seminar NY (Pre Clinical Conference), NYC, NY (Multiple topics)

Feb 10, 2006 -New Mexico Podiatric Medical Association, Albuquerque, NM (Multiple topics)

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Digital Scanning For Orthotics

Does anyone have any input or thoughts on digital scanning for orthotics and diabetic shoe inserts? Any info. would be appreciated on type of system used and quality of product. Some systems scan weight bearing neutral vs. sub-talar joint neutral non-weight bearing.

Richard Silverstein, DPM, Havre de Grace, MD

Query: Shoes for Child With Sensory Integration Problems

What shoes are recommended for a 4 year old with sensory integration problems that have led to gross motor skills delay in walking (gait when running and walking is still a bit immature, and the patient still has a hard time with climbing). I am looking for recommendations of shoe types/brands for balance teaching for kids and for heel-to-toe walking.

Noah A. Blumofe, DPM, Santa Monica, CA

RE: Synvisc for Ankles (Michael Zapf, DPM)
From: Multiple Respondents

I have not used Synvisc but I have used Supartz (Smith and Nephew) with very good results. The results were actually better than I expected. I used the pre-filled syringes weekly for 5 weeks. One patient that comes to mind had a 5 year old comminuted non-union of the talar body. Bone stim for 8 weeks and immobilization. Upon consolidation, I started the injections. The crepitus is markedly decreased and the patient no longer uses a wheel chair when she goes shopping. The patient states that the treatment is a success.

I also have used Supartz in 2 patients with DJD/hallux limitus. I preformed an Austin osteotomy to decompress and plantar-flex the 1st MT. After 8 weeks I started Supartz 1 cc weekly for 5 weeks. This 38 year old patient is doing fantastic and is pain free without an implant. I hate to harp on this subject but let’s start doing some papers on this stuff so guys like me who use these drugs "off-label" get some backing for our community.

Eugene A. Batelli, DPM, Naples, FL, ebatelli2001@yahoo.com

I use a series of 3 weekly injections (1.5-2.0cc) of Supartz (sodium hyaluronate) in cases of mild to moderate osteoarthritis of the ankle. I have had varying levels of success. I have had tremendous success in ankles that have mild narrowing of the mortise and mild marginal spurring. As the osteotarthritic changes to the ankle joint worsen, I have had less success. I like this treatment in patient's with early osteoarthritic changes as it delays the need for corticosteroid injections, which can be further damaging to the joint with prolonged use.

I have observed the Supartz injections provide relief from 3 months to a year depending on the severity of the arthritic changes to the joint. I bill CPT 20605 (arthrocentesis of the ankle). Supartz does have a J code (J7317). I have billed the J code with varying degrees of success. I have 1 or 2 private insurances that pay well on this J code. Most insurances barely cover the cost of the Supartz ($90-$100) and a few have rejected the code all together due to off label usage. I find in most cases it is easier to script out the Supartz and let the patient bring the medication to me.

Patrick Campbell, DPM, Wadsworth, OH, drcampbell@wadsworthfootandankle.com

Bob Salk, DPM and Thomas Chang, DPM have presented their research on Synvisc at the Annual Meeting of the American Association of Orthopedic Surgeons in 2005 and have published their data more recently in JFAS.

Lowell Weil, Jr., DPM, MBA, Des Plaines, IL, WeilJr@aol.com

RE: List of “Podiatry-Friendly” Carriers
From: Paul Bishop, DPM

With all the "planned" reductions of Medicare and the sure to follow reductions by our private payors based on a Medicare percentage, I believe it is time to ask the question of the profession as a whole and not individual practitioners what we can do about it.

I know that federal and state laws prevent price fixing and collusion by physicians to fix a price of a service, but would it be within legal limits for the APMA to put together a list of “podiatry-friendly" insurance companies that would allow the practitioners to help make decisions on accepting or dropping a company. ERISA laws be damned, if they're not going to play by the rules, then maybe we shouldn't take it anymore. Perhaps as medical malpractice companies and certain vendors are endorsed by the APMA or ACFAS, we could do the same of insurance companies. I understand that local and state payments vary, but in general we all know who cuts us to the bone on reimbursement and those that choke us with paperwork and pre-certifications, appeals, and then still underpay or pay us not as other specialties for the same work.

Personally, I have made the decision that if Medicare does make ANY price drop, I will significantly reduce my Medicare patient load and eliminate new Medicare patients from my practice. I would also take a hard look at dropping plans/companies that lower their pricing on the back of Medicare.

Perhaps if insurance companies found themselves on a list about to lose several thousand providers around the country, they may listen. I know there are no guaranties that this wouldn't backfire on us, but I think I could go the way of the dentist and still make a great living.

Paul Bishop, DPM, Yorkville, IL, PBishop82@aol.com

RE: Comfort Level for H & P’s
From: Raymond R. Botte, DPM

My hospital permits podiatrists to do the H&P for Class I & II patients and I do this for almost all my surgical patients. I co-admit patients otherwise with the MD to provide the best and most prudent medical care for patients with more complicated medical conditions and in particular for in-patient care. As I see it, there are two groups of podiatrists in this issue. The first group of podiatrist just does not feel qualified or comfortable to do the H&P, and in deference to their referring MD, have the MD do the H&P on their patients. They also desire to ingratiate the relationship with the referring MD, to ameliorate medical-legal risk, and to decrease their work load.

The other group of podiatrists does feel competent to do the H&P and desires to facilitate more complete and expeditious management of their surgical patients; at least that's how I feel. When in doubt or more concerned, I consult with the MD, and on some occasions have worked with the MD's physician assistant or nurse practitioner. That way I feel like a member of the medical team and I am perceived as such. I think that it boils down to your level of comfort and particular practice situation.

Raymond R. Botte, DPM, Scottsdale, AZ, acupodaz@hotmail.com

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

Established busy practice for sale in hospital's medical building. Fully equipped. All aspects of podiatric medicine/surgery. Large diabetic practice with wound care clinic. Large referral base. Hospital to be renovated and expanded. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving - will stay for transition. Associateship until purchase. Unbelievable potential to expand. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

PRACTICE FOR SALE – 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

IMMEDIATE ASSOCIATE NEEDED - PHILLY SUBURBS

High volume office-based practice suburban Philadelphia. Full-time office, near hospitals for surgery, consults, and in-house pt. care. Candidate must be hard-working dedicated to pt. care and well-trained. Needs to be personable. PSR12/24/36 Board Certified/Eligible required for a fast-paced, fun atmosphere to work. Email CV and contact info to: mrgpod@hotmail.com Or fax CV to 610-668-5175.

NURSING HOME ASSOCIATE NEEDED- PHILA AREA

Extremely high volume nursing home and home care practice. Well-established and respected Suburban Philadelphia practice seeking an associate who is hardworking. Full-time or part-time available. Very busy practice which can be worked every day and be very lucrative for a hard-working individual. No nursing home further than ½ hour away from office. Email CV and contact info to: mrgpod@hotmail.com or fax CV to 610-668-5175

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

EQUIPMENT FOR SALE - Computed Radiography System

SCANX 12 digital imaging system is a computed radiography system (CR). Replacing film and plates can be reused thousands of times. Saves images to your computer. CPU and monitor included. Purchased 2004. Asking $15, 000. Call 970-232-1717 for additional information. Product information found at www.allproimaging.com

ASSOCIATE POSITION - ARIZONA

Excellent opportunity for an experienced DPM looking for a change or young podiatrist looking to jumpstart their practice. Practice is well- established over 25 years, successful and a large volume in the Phoenix metro area. Current AZ license preferred as position is available immediately. The right person will join as a salaried associate leading to partial ownership in the group practice. Email CV and inquiries to: scfcs@cox.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

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

High Income position for ethical hard working podiatrist, great for semi-retired or to supplement office practice, part time. Must have Florida license and active Medicare/Medicaid numbers. FAX CV or Resume to 727-785-4697

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.