The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 06, 2010 #3,976 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Improper Footwear Contributes to Back Pain: CA Podiatrist

High heels, shoes without enough arch support, or physical problems like flat feet or high arches all can contribute to back pain. For example, patients with exaggerated arches often experience pain throughout the body, including the back, because their feet don't absorb shock well, says Mark Wolpa, a podiatrist in Berkeley, California.

Dr. Mark Wolpa

Also, a surprising number of people have legs of slightly different lengths. Wolpa says about 80 percent of his patients show signs of "limb length discrepancy," some caused by uneven bone length and others due to long-term positioning problems, where muscles have developed unevenly, shortening one side of the body. This uneven stance throws the whole body off balance, causing one part to compensate for another, often resulting in pain.

Source: Sierra Filucci, Caring.com, [10/5/10]

NYCPM Research Group Publishes Paper in the Journal Clinical Anatomy

This month, a research group led by Anthony D’Antoni, DC, PhD, Assistant Professor in the Division of Preclinical Sciences at the New York College of Podiatric Medicine, and Director of Anatomy at the College, published a paper entitled, “Anatomic Study of the Suboccipital Artery of Salmon with Surgical Significance” in the journal Clinical Anatomy. The paper highlights the clinical relevance of the angiology of the V3 segment of the vertebral artery, and therefore, has great relevancy to orthopaedic surgeons, neurosurgeons, and other clinicians who treat disorders of the cervical spine.

Dr. Anthony D’Antoni

The study was a collaborative effort between several NYCPM faculty members, including Fortunato Battaglia, MD, PhD (a neuroscientist) and Anthony DiLandro, EdD (an anatomist). The group also included  Garrett Moore, a first-year podiatric student at NYCPM.  According to Dr. D’Antoni, “This study was not only an interesting and clinically-relevant investigation, but also demonstrated how NYCPM students can get involved in research.”  

NJ Podiatrists Publish New Practice Management Text

Drs. John Guiliana and Hal Ornstein with Mark Terry have just published a new practice managment textbook titled 31 1/2 Essentials for Running Your Medical Practice. This new book goes beyond textbook theory. Drawing on nearly 50 years of combined experience consulting with and running highly successful private practices, the authors map out practical, turn-key solutions to the harsh realities facing medical, dental, and all healthcare practices, including: tough competition, patient expectations, shrinking reimbursement, litigation, malpractice insurance costs, complex regulations, high rents, soaring utilities, and other challenges.

31 1/2 Essentials for Running Your Medical Practice

John V. Guiliana, DPM, MS is an  AAPPM Board Trustee and speaker.  Hal Ornstein DPM is Chairman of AAPPM. They have announced that the profits from podiatry sales will go to advance podiatric students and residents.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What do you see as the biggest problem on the lecture circuit?

Dr. George Vito

George Vito: There should be more truthfulness on the podium. So many times we show the good cases with pristine results. I show my worst cases. I show cases where things go bad, and I just tell it as it is  because that is what I am being paid to do. I am not going to go up there and lie. Speakers need to say, "this is the problem, this is what I see, and this is what I will try to do to fix it."

Michael Lowe, Esq.

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature healthcare attorney Michael Lowe, Esq. You can register for this event by clicking here

Query: Flu Vaccine Injections

I live in New York and all of the chain pharmacies have big signs in their windows saying that for under 30 dollars they will administer a seasonal flu shot. I asked my local pharmacist to tell me who on staff gives the injections. I thought that maybe they had a nurse or PA or even a part-time physician doing it. He said that any of the pharmacists will give them. I further asked what their training was. He told me that he had to take a two-day course on how to give injections, and it was difficult doing it the first couple of times. He has not had any complications, but if there were to be a complication, he would have to send the patient to the ER or directly to a physician.
 
We, as podiatrists, give injections all day long. We have more expertise in giving injections than most family doctors, let alone pharmacists. Why are podiatrists not allowed to give annual flu shots? Since we see elderly people in our practices who are vulnerable to severe complications if they get the flu, would it not be in the public's best interest if podiatrists were given the right to administer annual flu injections?
 
Elliot Udell, DPM, Hicksville, NY

Query: Puncture Wound Irrigation Services

I have an ER note where the patient was seen for 2 small puncture wounds that were "irrigated with sterile technique in the emergency department with several liters of sterile irrigation fluid. They were thoroughly and meticulously irrigated and dressed with sterile dressings." The physician would like to bill for an incision and drainage. I assume this type of procedure is included within the E/M service, but want to clarify.

Brigitte Rose, Grand Junction, CO

Response: Typically, when a doctor evaluates a puncture wound, they explore the wound site besides irrigating the site. If the doctor did this, then it is a procedure and the correct CPT code would be CPT 20103 (exploration of penetrating wound [separate procedure]; extremity), and it has a 10-day global period.

If he did not do an incision and drainage, you cannot bill it.

David Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Hallux Pain (Darryl Burns, DPM)
From: Multiple Respondents

This is likely a peripheral nerve problem. The neurology consult, while not completely useless as it ruled out other more proximal pathology, was not needed. I recommend doing a hallux block on one side and a deep peroneal block between the 1st and 2nd metatarsal bases on the contralateral side, and see if that helps.  
 
Peter J. Bregman, DPM, Tewksbury, MA, footguru@comcast.net

Subjective, sharp, bilaterally symmetrical pain in the foot that occurs irrespective of weight-bearing is neurogenic until proven otherwise. Bilateral symmetry implies a neuropathy. I am of the belief that your patient exaggerates when he relates alcohol improves it. In actuality, this sounds like the etiology (alcoholic neuropathy), but am also suspicious for an L4-L5 radiculitis. Find out if he has any chronic low back pain, history of MVA, etc.

Sometimes, especially early in the course of neuropathy development, an NCV study may be falsely negative. I'd delve more deeply into this gentleman's personal history to learn how much alcohol he consumes on a daily basis and over what duration. Once his excess consumption is revealed, then go with the clinical impression of alcoholic neuropathy (the fact that he indicates this his symptoms improve is likely a defense mechanism that conveys his denial of his "illness"). While you may treat the underlying neurogenic pain, I'd be more concerned about his liver and the long-term systemic effects excess alcohol consumption has over his internal organs.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

What does his biomechanical exam show? His shoes, foot measures, job description, sport activities? Could it be micro-trauma from his daily activity?
 
Gregory Mangum, DPM, Gregorymangum@aol.com

RE: Best Credit Card Service (Jeff Kass, DPM)
From: Multiple Respondents

Since finally deciding to accept credit cards a few years ago, I could not be happier with the decision (in fact, it was multiple responses from this forum that prompted me to do so). I currently work with First Data. My original company was good, but I found that my current contract is much better, with better rates, and includes some training on securing data and limiting my liability should cc data be stolen from my practice.  My account manager works all of Long Island, so if you would like his name and contact info, please e-mail me directly, and I will give you his contact info directly.  I highly recommend it, and am positive that you will have no regrets.
 
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

For 25 years, we didn't accepted credit cards. I didn't want another level of administration. Boy, was I wrong! We used a free trial from Quicken Merchant Services two years ago.  You do not need any additional equipment. You use your Internet connection. You can key in their credit card numbers. After doing that for a few days, we paid $89 for a card swiper that connected using a USB port. The rate is less for a swiping card, but at least we know we can manually enter card numbers should it fail. It has worked well and we send out fewer bills at the end of the month. The rates at the time seemed less than with other companies. Lastly, there is no long-term contract or large initial investment.  
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

Our practice has been using Mid-West Transaction Group located in Michigan since we started using credit cards in our office many years ago. They have been great to work with, very competitive, and are very service-oriented. Mid-West Transaction Group and the AAPPM organization, (which our practice is a member of)  negotiated an excellent processing rate for members of the Academy organization. This is one of the many benefits of membership in the AAPPM. I am involved with the AAPPM organization.

The phone number for the Mid-West Trans. Grp. is  1-888-599-2209. You can ask for Chuck and he will be able to help you with any questions.

Fay Mushlin, Newtown Square, PA, teegee46@gmail.com

RE: Dealing With Medicare Carrier’s Incompetence (Michael Lawrence, DPM)
From: Jeanne Arnold, DPM

I would contact both CMS and your Congressmen. Nothing will change until individual physicians start complaining higher up the chain, so to speak. APMA has never helped in these matters. If it had, we would not be dealing with Medicare and its bias against podiatry on an everyday basis. 

Jeanne Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

RE: Extortion By Patient (Name Withheld)
From: Alan Mauser, DPM

I too was a victim of extortion by a patient some 20 years ago. I had done bunion surgery on a patient in the spring of that particular year. Her post-op course was essentially uneventful, but she did have some mild restriction of motion. It was just after Thanksgiving that I got a call from the patient stating that it was not fair that I had gotten all the money and she had gotten all the pain. She said I needed to pay her the $1,500 that I had collected. 

After a discussion with PICA, we agreed to pay her and settle. She showed up at the attorney office to settle, but without her spouse.  We would not settle unless he signed off as well. Then she left. A couple of days later, I got a call from an orthopedist office who wanted records. We faxed them over, and within two hours, the patient was calling to settle. I got suspicious and called the orthopedist.  He said " Oh yeah, I'd be tickled pink with that result." 

Anyway, it was a shakedown. For a mere $1,500 and attorney fees paid by PICA, I did not have a claim on my record. Would I do it again? I am a bit more savvy these days and probably would not!

Alan Mauser, DPM, Louisville, KY, afootdr@aol.com

RE: Extortion By Patient (Name Withheld)
From: Michael M. Rosenblatt, DPM

In almost all cases of "extortion by patient", the doctor who is considering paying the claim himself is concerned about reporting it to his carrier for fear of his insurer either raising his rates or dropping him altogether. Ever since one of our major insurers was sold, it is common knowledge that the new owners are enforcing more stringent underwriting. So, this is a real concern.

Even the best of us get sued. In balancing all the risks involved, I side with NOT paying the extortion. If your insurance drops you, it would probably happen anyway. In the meantime, this can be a clarion call for all of us. NEVER change a pre-existing chart, but you have new opportunity to hone your record-keeping skills with each patient you see from today on. This is a resolution worth keeping.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Serious candidates should fax their CV's to (631) 293-5984.

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

ASSOCIATE POSITION - NEW JERSEY

Ambitious podiatrist needed for part-time work in Bergen County office, nursing homes, rehabilitation centers and assisted living facilities. Hours are flexible. PRS 24 needed. Candidate should be hardworking and willing to travel throughout Bergen County. Please send CV to facnj@yahoo.com or fax 201-599-5960.

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a  very busy, well established, diversified practice in Clearwater, Florida. We are seeking an Associate who is BC/BE and highly motivated, minimum PSR24+. We offer a competitive salary and benefits. Please send your resume to Jaye@fdn.com

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

NORTHEAST OHIO PODIATRY OPPORTUNITY

Western Reserve Senior Care, an innovative home visit practice that makes visits to seniors in assisted living facilities and SNF’s, is recruiting for a Part-Time Podiatrist. Make a true difference as you make visits to homebound seniors while managing the full scope of podiatric disease. This opportunity offers a perfect balance of superb lifestyle and excellent compensation. Practice is affiliated with world class health systems in Cleveland, OH. Email CV to wmills@westernreserveseniorcare.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com

PM News Classified Ads Reach over 12,500 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 12,000 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.

• 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.