The Voice of Podiatrists

September 30, 2006 #2,702 Editor-Barry Block, DPM, JD

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Walking is Best Bargain Around: CA Podiatrist

"Walking is just about the best health bargain around," said Dr. Ernest J. Hook, president of the California Podiatric Medical Association. "Walking is a great way for adults and kids to be active, and research supports the long-standing belief that taking just a few extra steps a day can improve the lives of all Americans."

Dr. Ernest Hook

Lack of physical activity is a major cause of chronic illness and death for our country's adults, added Hook. "Being overweight can cause health problems like diabetes during childhood, and research shows that physically inactive kids are more likely to grow up to be physically inactive adults."

Source: Coalinga News [9/27/06]

Podiatrist Makes Aliyah to Israel

"You can walk through a door a thousand times, but until you're ready, you'll never see what's on the other side" is the way that Avraham Zimberg, 64, describes how the events in his life have all fallen into place. Avraham, came to Beit Shemesh via Detroit and then Toronto, where he met his wife Ruth.

He has a fully-equipped podiatry clinic in his house and also does home visits. He fits in his ADD clients between patients, and has a unique way of coaching them. "Several of my family members have ADD, so I understand it very well. Avraham's day begins with prayer at 7 a.m.. He sees his Israeli patients during the day and evenings. At night, he coaches clients in Israel, the USA and Canada by telephone at hours convenient to them.

Avraham looks forward to all of his children visiting the family in Israel. Someday he'd love to run a bed and breakfast combining his love of both cooking and gardening. He'd also like some goats to make his own cheese. But if they just continue in their harmonious lives, "dayenu," he and his wife Ruth say, that will be enough.

Source: Dvora Waysman, The Jersusalem Post [9/28/06]

Lawmakers Promise New Doc-Pay System by Year-End

Members of the House Energy and Commerce Committee said they will push to avert an impending Medicare physician rate cut of 5.1% by year-end. The cut is scheduled to take effect Jan. 1. Committee Chairman Joe Barton (R-TX) said he is "100% committed" to enacting legislation this year to reform Medicare's physician payment system and favors "totally scrapping" the current sustainable growth rate formula.

Barton and Rep. Nathan Deal (R-GA) have proposed raising physician rates and paying them a bonus for reporting quality data to the CMS, similar to the system in place for hospitals. Testifying before the committee, American Medical Association Board Chairman Cecil Wilson said his association wants two years of larger updates to offset higher practice costs rather than three years of modest updates. The hearing was the committee's fifth on Medicare physician rates in the past 12 months.

Source: Matthew DoBias, Modern Healthcare [9/29/06]

Query: Treating Patients via the Internet

I am curious if anyone is treating patients via the Internet, if they are billing for it, and more importantly, is it being paid? We have a fair number of patients that are established and work for prolonged periods out of state and country. By treatment, I imagine it would encompass instruction, filling a prescription, making a referral, or filling out paperwork via fax. I fully understand the medical liability aspect of rendering treatment without physically seeing the patient. I am wondering about other legal aspects of this type of treatment as well as the billing.

Jon Purdy, DPM, New Iberia, LA

RE: Scherosing Veins (David Gurvis, DPM)
From: Jodi Schoenhaus, DPM

This technique is considered the gold standard of care for reduction of spider veins, telangectasias and small to medium-sized reticular veins. I have a leg vein center in Boca Raton, FL and I have been practicing sclerotherapy for quite some time. I trained by various vascular surgeons and ob/gyns who have experience in this area. I would be happy to recommend someone in your area. It was difficult for me to find a training course and I spent a lot of money learning the skill
.
If you are serious about performing sclerotherapy and practicing leg vein procedures, understanding of venous pathology is paramount. Visit, www.phlebology.org which can help. Here are some basics: Sclerosing agents that are FDA approved are Sclerodex, saline, and sodium tetradecyl sulfate (STS otherwise known as Sotradecol). Polidocinol is not yet FDA-approved. You can get STS from a compounding pharmacy and dilute it which is safe and effective. STS is becoming more widely used.

Risks and complications include:
1. Ulceration, too strong a solution or too much, penetration into the soft tissue and not in the vein
2. Matting- vascularization that occurs due to too strong a solution. Usually seen on Skin types I-II. This is difficult to treat and is treated with laser or IPL
3. Staining- sclerotherapy, meaning "to harden" hardens the vessel and finally the body breaks it down as the vessel wall is damaged. The vessel can get blood trapped inside and if this is not released you can get staining of the skin- very similar to hemosiderin deposition- this is self limiting and resolves in one year or you can use topical bleaching agents such as epiquin micro or 4% hydroquinone. The best way to prevent this is to have a patient come back for a two week f/u visit and remove any trapped blood. This technique is taught during any training class.
4. Recurrence, one must get the feeder vein. very critical for successful care.
5 . Bruising

Jodi Schoenhaus, DPM, Boca Raton FL, jschoenhaus@hotmail.com

RE: Query: Digital Scanning For Orthotics
From: Stephen D. Palmer, DPM,

Our practice has been using the 'Pedalign' scanning system for custom orthotics and for diabetic shoe inserts. This system has generally been promoted as a weight bearing scan system however we have also found that it is also easily used in the capacity of semi-weight bearing and non-weight-bearing (neutral). The computer system and software is very user-friendly. I was a bit skeptical at first about the weight-bearing scan technique however the product has been extremely reliable. Our return percentage for changes has been minimal. The company has a very good product and competitive pricing as well.

It is important to research the various types of digital scanning devices available and the scanning/camera technology that each of them uses. Some are much more complex than others.

Stephen D. Palmer, DPM, Clarksville, MD

spalmer@columbiafootandankle.com

POSITION WANTED - SOUTHEAST

Seeking position as associate, partner or to purchase practice. Licensed in FL, GA, AL, and TN. 35+ years of active practice in all aspects of podiatric medicine and surgery. Available immediately (770) 403-2874 or handor@aol.com

PRACTICE FOR SALE - TEXAS

Practice for sale in fast growing suburb of Dallas, TX. Fully furnished office in medical building on busy street. General Podiatry, including routine care, orthotics, surgery, etc. Currently part-time office, can be full-time. Hospital privileges available. Excellent Opportunity. Must sell fast. Please respond to: P.O. Box 796757, Dallas, TX 75379 or fax contact info to: (972)267-1815.

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

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

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established podiatry practice in Mt. Airy, North Carolina that is either for sale or in need of an associate/partner to come on board to take over patient care. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3,500 patients without a podiatrist to care for them. This is a unique opportunity to be able to begin work in an extremely busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.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

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