The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 01, 2009 #3,663 Publisher-Barry Block, DPM, JD

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PA Podiatrist Praised for Limb-Saving Diagnosis

As a podiatrist, Dr. Richard Stuempfle knows the importance of good foot care, especially with regard to those suffering from diabetes. So, when his longtime patient Anna Stitcer, 80, of Lock Haven developed a diabetic ulcer on her toe, he treated and kept a close watch on it before deciding it might require more serious attention.

(L-R) Dr. Richard Stuempfle, Anna Stitcer, and Dr. Mohammed Islam (photo - Mike Reuther)

"Had Dr. Stuempfle not picked this up at the right time, she could have lost her leg," said Dr. Mohammed Islam, a Lock Haven Hospital vascular surgeon. Vascular testing revealed that an artery in one leg was clogged, stopping the flow of blood. Islam determined that Stitcer was a good candidate for cryoplasty, which combines cold therapy with angioplasty. "It was critical that she have this done," Stuempfle said.

Although Islam performed the actual procedure, he credited Stuempfle with making his patient and him aware of the situation. Stuempfle, for his part, said physicians who get to know their patients can often make a big difference in proper care. "I've been treating her for 15 years for diabetes foot care," he said.

Source: Mike Reuther, Sun Gazette [9/22/09]
 

SVS Endorses APMA's Title XIX Initiative

As further evidence of the developing collaboration between APMA and the Society for Vascular Surgery (SVS), APMA received a letter on September 28 from society president Anton S. Sidawy, MD endorsing podiatric medicine's Title XIX initiative.

Anton S. Sidawy, MD

Source: APMA Daily eNews  [9/29/09]

Query: Toe Fracture Treatment

I am treating a 57 y/o lady with DM, for previously unrecognized fractures of the right 3rd proximal phalanx base and 4th met head. I first saw her about 3 weeks after the unrecognized injury. She is now about 7 weeks since injury. Her met head compression Fx is healing, but the proximal phalanx Fx is not, and it has displaced. 

Displaced fracture of the proximal phalanx

She has swelling and of course not much pain. The toe will not heal as it is. I would like my colleagues’ opinions as to whether to try to fixate the Fx fragments or remove the base of the phalanx and try to stabilize the toe by tendon work.

Mark Aldrich, DPM, Antigo, WI

Query: Uncooperative Daughter

I have an 82 y/o demented patient who is brought to the office by her daughter, and is often accompanied by the homecare giver. The patient has an arteriosclerotic ulcer with resolving cellulites on her 2nd toe. The patient was sent for 3-phase scan and ABI's prior to vascular referral. The daughter took mom for the 3-phase scan but then refused to take the patient for the ABI. I made a vascular referral appointment, but the daughter refuses to take mom to that appointment until she recovers from her own knee replacement surgery in 6-8 weeks.

I planned on having the daughter sign a release stating she was putting her mom in danger by not getting her to these appointments (and the home caregiver is not empowered to take the patient) but the daughter is away until she recuperates from her surgery. I know I cannot terminate a patient relationship in the middle of treatment. Any suggestions?

David E. Gurvis, DPM Avon, IN

Query: Qualifying Routine Foot Care

Dr. Goldsmith noted in his "Meet the Masters" presentation that having dorsalis pedis and posterior tibial pulses on one foot typically allows routine foot care coverage/qualification for both feet.

My question is, what about if both the posterior tibial pulses are absent, but both dorsalis pedis pulses are present? Would bilateral posterior tibial pulse absence qualify routine foot care?

Chuck Perry, DPM, Cambridge, OH

Response: If you have absent posterior tibial pulses bilaterally with palpable dorsalis pedis pulses bilaterally, you have qualified only 1 of the 3 (absent posterior tibial pulses) required class B findings (you need 2 of 3). Unless you have other findings to qualify this patient for "at risk" foot care, this patient's palliative care would not be eligible for reimbursement under Medicare. The service would be routine foot care which is statutorily non-covered. If the patient does not meet criteria, do not force the issue. Cash is good.

Tony Poggio, DPM, Alameda, CA

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RE: Unannounced Inspection for DME Compliance (Get Ready)
From: Bret Ribotsky, DPM

Today, I received a unannounced visit from Overland Security working on behalf of The National Supplier Clearinghouse (NSC) for an inspection as a DME provider. Fortunately, since I have taught this subject for many years, I was ready. I am sure that the many who have attended my lectures over the years and have the forms I have suggested in your DME compliance box will also be ready.

The inspector had detailed records as to how many...

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

Editor's note: The complete text of this letter can be read at: http://www.podiatrym.com/letters2.cfm?id=29232&start=1

RE: CCHIT Certification and "Meaningful Use (Michael Brody, DPM)
From: Phillip L Forni, DPM

Concerning the article recently published: "Update on CCHIT Certification and "Meaningful Use.": the information contained within that letter is very misleading. CCHIT certification will be irrelevant in 2011. In fact, many vendors that have paid the $30,000 will not have a certified EMR program recognized by HHS or ONC, the only organizations that matter.

The most important player in the game (and the only one anyone should be reading) is at healthit.hhs.gov. This is the ONC website (Office of the National Coordinator for HIT). Just go there and check out the Meaningful Use link. I think you will find very different information. There are many, many misleading websites out there, interestingly enough, owned by people who want you to certify yourself with them. 

Phillip L Forni, DPM, Harwood Heights, IL, drpforni@sbcglobal.net

RE: Employee Tracking (Mark Stempler, DPM)
From: Brian Kashan, DPM

I have found that it is human nature to exaggerate the hours an employee logs when working from home. They may take a break, take a personal call, etc., and certainly do not log in and out every time for every interruption. When it comes to billing/collections performed from an employee’s home, it is important to monitor the work and the results for several reasons. #1 is to see if it is working. That is, are you collecting?
 
The best method I have found for work from home is to pay based on results. I pay someone to do collection work from home, and pay them on a percentage of collections. No collections, no pay. For regular insurance billing and follow-up, you may consider seeing what your current collection rates are, aging of A/R, and pay based on increased productivity and collections.
 
Otherwise, evaluate why you are paying someone to work from home at all. You may be better off hiring someone to do the work on-site, where they can fill in as needed, answer a phone, and serve other roles when needed.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

RE: Obama’s Healthcare Plan  (Arden Smith, DPM)
From: Bob Kornfeld, DPM

Dr. Arden hits the nail on the head. I am wondering why we all sit idly by while our own health insurance costs are skyrocketing and coverage is decreasing. Also, our professional reimbursements are plummeting daily. We are being regulated at every turn, but insurance companies are having a party on our hard work. Running a medical office has become one of the great challenges of the new millennium. Now we will be required to purchase EMR software (at our own expense, of course) just to make it easier for insurance companies to oversee our every move. Medicare is proposing cuts that will be catastrophic to healthcare delivery and is certain to put many podiatrists and other physicians out of business. Expenses are climbing radically while our income is shrinking at astronomic rates. We are forced to compensate and re-compensate our approach to healthcare.

Doctors have become the scapegoat of our economic crisis. They want us to have 8 years of college, 3 years of residency, fellowships, CME's and an unwavering dedication to patient care. The only problem is, they do not want to pay us what we are worth. Ours is the only profession where hard work and dedication are not enough to ensure a successful career. Reimbursement is completely independent of our own individual practice expenses. It seems we are always getting good counseling on how to be good little  compliant children, but the best it seems we can muster up is a hands in the air, woe is me attitude. Excuse me for venting, but my forecast for the future is that we will have millions of lawyers with no doctors to regulate.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk. 30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

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 - 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

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

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