The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 30, 2009 #3,662 Publisher-Barry Block, DPM, JD

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Ten Percent of Foot Problems Related to High Heels: FL Podiatrist

Sky-high heels have been in vogue for quite a while, taking sizable space in most shoe stores. Last year, Monsieur Louboutin said his 6- and 7-inch stilettos were selling so well that he planned to introduce an 8-inch platform this fall. Holy skyscrapers.

Dr. Marc Katz

Keeping up with fashion also can have painful results. Tampa podiatrist Marc Katz said about 10 percent of his patients have problems related to high heels. A few even want surgery to remove the pinky toe to better fit into narrow-toed high heels, a procedure he refuses to do. “For a lot of people, it’s such a fashion thing,” Katz said.

Source: Susan Thurston, St. Petersburg Times [9/27/09]

NY Podiatrist Juggles Many Positions

After more than 40 years in private practice as a podiatrist, David Davidson, DPM, knows a thing or two about feet. In addition to working as a partner in Podiatry Affiliates, PC, Davidson is chief of the Podiatry Section of the Department of Orthopedics at the Kaleida Health System, the medical director of the Center for Wound Care and Hyperbaric Medicine at Millard Fillmore Gates Hospital, and on staff of the Sports Medicine Institute at the University at Buffalo.

Dr. David Davidson

Four decades after starting his practice, how does he juggle that many positions? Davidson joked: “I’m a nutcase and I don’t need a lot of sleep.” That may explain why he just added President of the American Academy of Podiatric Sports Medicine to his resume.

Source: Business First of Buffalo [9/25/09]

Editor's Note: PM News is proud to present excerpts from Meet the Masters. Full versions of these interviews will appear in Podiatry Management Magazine.

Ribotsky: You have been a great proponent of coming up with data and benchmarks and coming up with some guidelines of you know what a practice should do, so you could manage it. Can you share where the data comes from, and then how you use it?

Dr. John Guiliana

Guiliana: To me, one of the most important functions as a practice administrator is to know where you are and to know where you need to be, keeping your fingers on the pulse of the practice through certain data and utilizing benchmarks to compare that data to. Your practice management software is loaded with practice data that should be very valuable to you, and periodically at least annually, I feel that everybody should be performing what is known as SWOT analysis.

SWOT is an acronym; SWOT stands for Strengths, Weaknesses, Opportunities, and Threats. Knowing what your strengths are and what your weaknesses are, is extremely important to know whether you are on target to hit your goals or not, and some of the practice data that I think many people do monitor would include things like your accounts receivable and what your age claims look like as part of your accounts receivable, knowing your CPT codes, and what utilization of those codes are. How many x-rays?  How many P&As? How many new patients? Your coding. Knowing what your per-visit value is, which is basically the number that each patient that sits in your treatment chair contributes to your total collection.

Dr. David Armstrong

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is PM  Hall of Fame podiatrist, David Armstrong, DPM,  a wordwide authority on the prevention and treatment of diabetic foot ulcers. You can register for this event  by clicking here.

TeamSOS Raises Money in 5K Run for Breast Cancer Research

On Sunday, September 27th, SOS Healthcare Management Solutions’ TeamSOS was among the 1,200+ participants in the Alki Beach 5K Run in Seattle to support women battling breast cancer.

Lynn Homisak of TeamSOS Participates in 5K

Among those who participated were Drs. Donald (& Ann) Orminski (WA), Kristen Titko (OH), Howard Schaengold (WA), Hal Ornstein (NJ), Susan Scanlan (WA), David Wolf (TX), Kevin McDonald (NC), Richard Mann (FL), Melissa Robitaille (GA), and other members of the podiatry community: SuEllen Derscher/Gordon Labs, Marlene Kern (NJ), Yolanda Christianson (WA), RuthAnn Donahue (MA), Jean Kirk (NC), Gary & Suzanne Adams (MA), Denis DeBoer (WA) and Susan Kramer (PA) whose contributions helped SOS raise $1,300.

Undoing the Damage From a NPDB Report

Reversing a National Practitioner Data Bank report is no small task, experts say. But physicians do have some recourse.

• Notifications are mailed to physicians once a report is submitted to the data bank, so reports should be reviewed immediately; doctors may request a copy.
• Data bank reports are published as submitted by the reporting entity. To minimize potential disputes, those entities should consult with the doctor under review before submitting a report.
• If the information published in a report is inaccurate, doctors first must contact the reporting entity to request a correction. If the reporting entity declines, the physician may petition the data bank to append a personal statement clarifying the report.
• Doctors also can appeal to the data bank on whether the report was properly submitted according to federal requirements. If the reporting entity does not correct or void the report, or fails to act, doctors can petition the secretary of the Dept. of Health and Human Services for further review.

Sources: Dept. of Health and Human Services, Health Resources and Services Administration, American Medical Association

Trouble Controlling Anger?

If you sometimes have trouble controlling anger when dealing with employees who have blundered, keep in mind: each time you lose your temper, you lose respect - and productivity suffers.

Source: Dr. Harry Levinson, cited in Bottom Line

RE: Intractable Plantar Keratoma Sub 2nd Metatarsal (Gary Gugliada, DPM)
From: Multiple Respondents
 
Assuming it is being caused by the met head, evaluate the plantar condyles radiographically first, and then perform a plantar condylectomy while also arthrodesing the toe. If you are not also going to address the 3rd and 4th toes surgically (which are also contracted), I recommend fusing the toe utilizing the MMI Smart toe implant. It will allow you to accomplish a fusion while maintaining a slight contracture to the toe as the implant is also angulated.  Otherwise, you will have a second toe that is perfectly straight, while the lesser toes are still contracted. Cosmetically, the patient may prefer a less drastic change to the appearance of the toe.
 
Since the parabola is not affected, I would not recommend a Weil in this case.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

The balance inlay is a good concept, but my experience is that the pocket accommodation is NEVER deep enough. Early in my practice years, I used this approach often and was disappointed with the results, not to mention falling short of the patient’s expectations. 
 
Here's my approach today: For patients who are not surgical candidates or who opt for a far more conservative approach, I have employed a Spenco cross-trainer insert.  Mark the lesion precisely with the pencil used to identify patients' casts for your lab. While it is still wet, place the insert in position on the foot. A purple mark will indicate the lesion's location. Simply punch a hole the same size as the lesion through the marked area. Inexpensive punch sets are available from Harbor Freight for as little as $3-$4.
 
I have witnessed relief of pain, and in many cases, the redistribution of body weight has resolved the IPK totally.
 
Bruce Smit, DPM, Frankfort, IL, footbiz@sbcglobal.net

I have used a Dr Jill's Purple pad for this type of lesion and have had very good results. They come in both 1/8 and 1/4 inch thickness and are available in a few different shapes. This pad provides a great alternative to patients not wanting or not a candidate for surgical options. 
 
Jack Ressler, DPM,  Lauderhill, FL, RedWingCrzy@aol.com

RE: Employee Tracking (Mark Stempler, DPM)
From: Marc Katz, DPM,  Richard A. Simmons, DPM

This is an excellent product (webwatchernow.com/Monitoring-Software/Consumer/).
You will need to install it on each computer and then you can go online and get all of the information you need. It is well worth the money. You can also use a camera, if necessary. However, I would say one thing. If you suspect an employee of cheating on time, then confront the employee. Consider giving them a warning, and if it is still happening, then fire them.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

The question was how to monitor the work of an employee on a computer who does billing from a remote location. Since billing is not simply computer input, this may be difficult to track by computer-time productivity. Many claims require research away from the computer. Since there are two employees, it might be better to look at the Explanations of Benefits to get a better idea. For instance, a denied claim can be quickly ignored by one, but take research time by the other. It might be helpful to set parameters for claims. For instance, if the amount due from the patient is less than fifteen dollars, it may not be money-wise to send a bill.

It is hard for me to imagine the efficiency of having the billing of one practice done by two people, remotely, from their homes. Your situation is a textbook example of why an outside billing company would make the most sense: billing companies typically receive a percentage of money collected. If not a billing company, then consider changing them from "employee" to "independent contractor." Talk with your accountant and lawyer about the feasibility of this.

Richard A. Simmons, DPM, Rockledge, FL, rasdpm32822@aol.com

RE: PA Podiatrist Receives Kidney from His Patient
From: Michael S. Downey, DPM

I enjoyed reading the newspaper vignette about Dr. Jay Schnitzer receiving a kidney from his patient, Kim Myers. I'm certainly happy for Dr. Schnitzer as he is a fine man and an outstanding podiatrist.  However, in reading the story, it should be Kim Myers' name in bold letters, not Dr. Schnitzer's. In these times of healthcare uncertainty, she is truly a heroine!
 
Michael S. Downey, DPM, Philadelphia, PA, Dowpod@aol.com

RE: Obama’s Healthcare Plan  (Arden Smith, DPM)
From: Elliot Udell, DPM, John Scheland, DPM

Dr Smith explained it well. What physicians need to do is what I did last month, participate in town meetings run by our congressional representatives and express what Dr. Smith said in his message in public and in front of people who can do something to correct it.  Right now the media focuses on how the US. healthcare system is perceived by patients. Some are happy with their insurance and others who have not needed medical care, have not seen their insurance plans perform in their darkest moments. What the cameras are not focusing on  is what doctors know is going on behind the scenes. If health care is left to the status quo, the 24,000 dollars that Dr. Smith and others are paying a year for personal health insurance will seem small and it will also lead an even larger number of people who will not be able to afford it and will have no choice but to go bare. Bottom line: Doctors need to speak up. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Dr. Smith is falling for the sales pitch for Obamacare. The president’s sales pitch uses the flaws of the best healthcare system in the world as an excuse to dismantle all that is good about it.  Here are some suggestions for your concerns:
 
1. About escalating insurance costs: Presently you are spending too much for your health insurance. Get a high-deductible insurance about $300/mo. and fund the deductible about $5,000. This will total $8,600 per year for the family, not $24,000/ year. Additionally, the $5,000 each year, if not used, can be rolled into an IRA each year. This is one suggestion, not socialized medicine.
 
2. Insurances are not subject to market forces (one of the flaws).  The problem is cultural; patients know more about their TV or car that they purchased than their health insurance. The "investigational" or "uncovered" services would shrink if the public gave better scrutiny to their insurance products. For now, "investigational" services exist; under socialized medicine, they will disappear. Is this how we deal with problems of access - by destroying the options themselves?
 
3. Long-Term care is a challenge. In the U.S., we have a much greater reverence for human life than in Europe. Modeling a system after those who simply quit delivering care to those who are too inconvenient to give it to, is unacceptable to me. But instead of leaving it to bureaucrats, I prefer families make such decisions. 

4. Regarding the economic status of complaining physicians, a government-run system removes the ability for physicians to have a business by which there are multiple avenues to create an income. This increases patient load and decreases reimbursement. The effect? Increased burdens on already stressed practices. Office staff will be let go to offset the reimbursement problem and quality will suffer. Don't turn to government; turn towards yourself and become a smarter doctor/business person.
 
John Scheland, DPM, Clarks Summit, PA, limblengthener@yahoo.com

ASSOCIATE POSITION: MARYLAND (KENSINGTON/ROCKVILLE/SILVER SPRING) 

Very busy, 3-office practice has immediate openings for established practitioners looking to relocate, moonlight or consolidate into our group. Graduating residents, we will need your help in July!  Established, successful associate practitioner has decided to relocate allowing a unique transition to assume a very busy schedule. All the bells and whistles-EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital referral base. Please send cover letter and resume to mddpmassociate@comcast.net 

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA

We are seeking ethical, motivated podiatrists to treat homebound diabetic patients in Central and North Florida. Minimal travel. Must have valid Florida License and Active FL Medicare and Medicaid numbers. FAX CV TO 866- 258-9993 or call 800-779-8551.

EQUIPMENT FOR SALE- ARTOSCAN EXTEMITY MRI

In excellent cosmetic and working condition. Originally an A model, upgraded to a model D. Looking to sell the MRI because additional space is needed in the office. Price to sell. Picture can be seen at by clicking here Contact baileymeans@yahoo.com for any inquiries

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

EQUIPMENT FOR SALE - AMFIT ORTHOTIC MANUFACTURING MACHINE

Includes digitizer, fabricating mill, new updates have been added and enough supplies to pay for the machine in the long run. At $200 per pair = about $28,000. Selling FOR $25,000, O.B.O, F.O.B. americanfoot@email.com or 405-733-2783.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Looking for board certified/board eligible ABPS associate to join a multi doctor practice with 2 offices. May lead to eventual buy-in and purchase. Must have minimum 2-year residency and comfortable with rearfoot procedures and diabetic care, ER call. Must be dependable, honest, ethical individual. Send cover letter and CV to familyfootcenter@earthlink.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

ASSOCIATE POSITION – LOS ANGELES

Well established Los Angeles-based practice seeking a surgically trained, highly motivated, well-trained podiatrist. We have a very busy multi-office practice with state of the art podiatric equipment. Must be dependable, honest, and an ethical individual. This position is available immediately. Send resume and your email address to desierec@kimfoot.com

ASSOCIATE POSITION - MICHIGAN

Seeking quality-oriented, patient-focused RPR or Surgically-trained associate for a fast-paced, established group practice in Southeast Michigan. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. If you are highly motivated, ethical, have a current Michigan License and have good communication and clinical skills, please forward your C.V. cfsdr@yahoo.com

ASSOCIATE POSITION - WASHINGTON, DC

Interested in working in Washington D.C.? Our group is looking to add a highly motivated, hard working, well trained podiatrist to our practice. Must have surgical training. We have a very busy multi-office practice. We practice state of the art podiatry with EMR and digital radiography. Associate to partner on a fast track for the right person. E-mail CV and cover letter to Washingtonpod@aol.com

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PM News Classified Ads Reach over 11,500 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 11,500 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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