The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 10, 2009 #3,671 Publisher-Barry Block, DPM, JD

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The two individuals injured in the boat crash, as reported in yesterday's PM News, were in fact, Tom and Laura Soluri. Tom Suluri is the brother of podiatrist Raymond Soluri. We regret this error, which was based on incorrect information provided to us.  

We've just mailed the October  2009 Podiatry Management. This special 220-page issue contains seven major articles on footwear, and is filled with a variety of interesting, informative, and useful articles, including an interview of Governor Mike Huckabee. You'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

October 2009 Podiatry Management

CA Podiatrist Stresses Problems of Childhood Obesity

"Our nation's children have entered a perfect storm for becoming obese - consuming diets that are high in fat, sugar and salt, while engaging in an increasingly sedentary lifestyle where television, video games and computers have replaced biking, swimming slides, swings and monkey-bars," said Dr. Stephen Wan, California Podiatric Medical Association (CPMA) President. Dr. Wan points out that obesity affects almost every organ in the body, and its impact is even more detrimental in children in that their bodies are still growing and developing.

Dr. Stevan Wan

"A child who is obese will have a more difficult time losing weight as an adult and is open to increased disease, including increased rates of diabetes, asthma and sleep disturbances including sleep apnea, increased digestive and liver problems, orthopedic problems including degenerative joint disease of the back, hips, knees, ankles and feet. There is also an increase for cardiovascular disease including high blood pressure, heat attack and stroke."

Source: Diana Martinez, San Fernando Valley Sun [10/8/09]

KY Podiatrist Wins Coker College Young Alumni Award

Podiatrist Dr. Phillip R. Dowdy, Jr. is Coker College’s 2009 Outstanding Young Alumni Award winner. He graduated from Coker in 1999 with a degree in chemistry and is currently practicing in Somerset, KY. Dowdy earned his doctor of podiatric medicine from Barry University School of Graduate Medical Sciences in 2006 and specializes in foot and ankle surgery, foot and ankle sports medicine, and diabetic wound care.

Dr. Phillip R. Dowdy, Jr. accepting Coker College’s 2009 Outstanding Young Alumni Award from Dr. Robert Wyatt, president of the college.

Dowdy completed his residency in podiatric medicine and surgery at Henry Ford Wyandotte Hospital in Michigan. In addition to his work at the hospital, he routinely volunteered at a clinic for the working uninsured and provided free foot screenings at health fairs. The Henry Ford Hospital presented Dowdy with its Outstanding Humanitarian Service Award in 2006 for his dedication and commitment to his profession.

Source: SCNow.com [10/7/09]

Query: Internet-Based EMR Storage

Can anyone advise of a good Internet-based storage facility to back up EMR records?

Tamara Allen, DPM, Annapolis, MD
 

RE: Antibiotics for MRSA
From: Bret Ribotsky, DPM

This week on Meet the Masters, Warren Joseph gave a stellar performance (download the audio at PodiatricSuccess.com). There was a discussion that developed from a question asked by Dr. Chuck Perry that developed regarding escalation antibiotic therapy verses de-escalation therapy. For example, an acute paronychia with cellulites in my office might leave with an Rx for Keflex, and when the culture report came back in 48 hours and MRSA was indentified, I would escalate the Rx to an antibiotic that treats MRSA. 

Dr. Joseph provided an  update on his teaching on this topic, and said that TODAY if you live in a large community where MRSA is common, then we should start using a MRSA drug like dicloxacillin initially, and if the culture report does not support MRSA, then de-escalate to a drug like Keflex. While I found this pearl practice-altering and clearly valuable, I was wondering if others are aware and have made this shift in regard to current practice.
 
Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

Query: Surgery Coding

How would this be coded?

1. Excision, soft tissue mass, 3rd metatarsal interspace, left
2. Release intermetatarsal ligament between 2nd and 3rd metatarsal heads, left foot (to release compression on intermetatarsal nerve/neuroma)
3. Excision, soft tissue mass, 3rd metatarsal interspace, right
4. Release of ligament between 2nd and 3rd metatarsal heads, right

Lisa Goodman, Clearwater, FL

Response:

CPT 28080-LT (excision, interdigital [Morton] neuroma, single,
each)
CPT 28080-RT
CPT 29999-59 (unlisted procedure, arthroscopy)
CPT 29999-59 (unlisted procedure, arthroscopy)

The incision of an intermetatarsal ligament is an unlisted procedure when performed as a comprehensive procedure or independent of any other procedure. I would recommend you contact the payer for preauthorization...and be ready to appeal any denial with references to publish studies regarding the endoscopic incision of an intermetatarsal ligament for the treatment of symptomatic neuromas. As with any unlisted procedure claim, include the op report and a letter of explanation.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Scope of Practice to Treat Obesity (Lowell Weil, Sr., DPM)
From: Paul R. Scherer, DPM

Dr. Weil asks "are the kids obese because they have flatfeet and they cannot participate in sports or exercise?" A study by Garcia-Rodriquez in 1999 studied over 1,000 children, and found that overweight children had an increased prevalence of flatfoot, but also found that 2.7% of the population had flatfeet who were not overweight. If the obesity was caused by flatfeet, a larger percentage of flat-footed children would be obese. A study by Pfeiffer in 2006 concluded that there are three co-factors to the flatfooted children: age, gender and weight. The International Association for the Study of Obesity studied 24 developed countries in 2006, and found that obesity in school children was the lowest in Lithuania 5%, and highest in Malta 26%. The second worst was the United States at 25% of our children with a BMI over 25.0. 

A study by Dowling in 2001 stated, “It is postulated that foot discomfort, associated structural changes, and increased forefoot plantar pressures in the obese foot may hinder obese children from participating in physical activity.” A study by Mickle in 2006 stated, “…their (obese children) midfoot may be exposed to increased stress and in turn vulnerable to boney fatigue and soft tissue damage.”  His later study stated that “the lower arch height in obese children suggests that the characteristics of obese preschool children may be caused by structural changes in their foot anatomy…” It is postulated that these structural changes might be exacerbated in excess weight-bearing continues throughout childhood into adulthood.

Paul R. Scherer, DPM, San Francisco, CA, hpoc@aol.com

RE: A Comparison of Negative Casting Techniques Used for the Fabrication of Custom Ankle-Foot Orthoses (Michael Turlik, DPM)
From: Mr. Jeff Root

Editor's note: Mr. Root's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29471&start=1

RE: Qualifying Routine Foot Care (Tony Poggio, DPM)
From: Greg Amarantos, DPM

I've been in practice for 26 years and heard scores of differing opinions on the interpretation of the routine foot care guidelines. No wonder the patients are confused and podiatrists are getting audited. If 20 years of a formal education and residency training are not enough education to allow us to interpret the guidelines exactly the same, there is a problem with the guidelines. As I have opined for years, if it is a crystal clear presentation, it is covered. If not, no gray area and it is not covered. Why would podiatrists put themselves in the position to be audited or red-flagged for the miniscule reimbursement allowed by Medicare?

How about a simple solution: If a patient is diagnosed as a diabetic (still needing referring MD UPIN on claim), they are allowed five visits per year for "routine" foot care, debridement of nails and calluses, PERIOD. Forget the other criteria, diabetes only, not PVD, thin, atrophic skin, rubor, etc...Patients sign a form at each visit acknowledging they understand they are allowed five visits per year for these services.  This would cut the fraud and abuse and confusion.

I feel it is time for the leadership of the APMA to explain to the policy-makers of CMS as to why the LCD for routine foot care does not work. I am willing to volunteer to make a presentation to CMS.  Presently, the system is full of confusion, fraud and abuse. 

Greg Amarantos, DPM, Lake Forest, IL, amogreg@aol.com

RE: Obama’s Healthcare Plan  (Scott Whitman,  DPM)
From: Multiple Respondents

The discussion of healthcare reform is relevant to us because we are healthcare providers and whatever happens with regard to healthcare in Washington will affect all of us. Many, if not all medical journals, have articles and discussions on this topic.
 
One thing that would make this discussion more powerful and more relevant is if we could restrict our discussion to facts as well as our opinions and eliminate any  personal attacks against each other or the use of political buzzwords designed to engender hostile feelings. Telling a colleague that he has "selective memory loss" does not serve the cause of academic discussion. Using  "hot button" terms such as "Obamacare" or the use of other disparaging terms leads to resentment and does not serve our best academic interests.
 
While most of the letters on this topic either pro or con, were respectful and professional,  a small number of discussants used terms which seem to be taken right out of talk radio or political television shows where fomenting hostility and anger is what drives up their ratings. When we discuss controversial subjects very relevant to all of us, we need to maintain the conversation on a much higher professional level. 
 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

“Reform Bill Might Require Doctors to Participate in The Public Plan.” Doesn't this again sound like socialism? What happened to capitalism? Wasn't this country founded on those principles? What's next, waiting on line for cheese and bread?
 
The real issue is let’s stop importing everything from foreign countries and encourage businesses to bring production back to the USA. Why is the Dell computer that I am typing this e-mail on made in Malaysia rather than Silicone Valley, California? This would stimulate jobs, bring health insurance to those who are working these jobs, and restore the economy. 

E. Batelli, DPM, Clifton, NJ, ebatelli2001@yahoo.com

I don't remember where I (recently) read this, but, in this never-ending debate, it is useful to realize that, like everything in life, there are two equal and opposing forces in life, the yin and the yang. “Capitalism builds the automobiles; socialism builds the roads the automobiles use ... capitalism builds the houses; socialism builds the sewage systems (or mandates the septic tanks) connected to the houses ... capitalism produces the trash consumers throw out; socialism picks up the trash that would otherwise land in the nearest gully.  And so on..."
 
Alan Silverstein, DPM, New York, NY, alel@optonline.net

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.

ASSOCIATE POSITION, VICTORIA, BC

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - CHICAGO AREA
 
Well-established, state of the art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

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

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

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

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must  have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website  

EQUIPMENT FOR 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 - 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

EQUIPMENT FOR SALE - HISTOFREEZER H60

170 ml gas, 30 2mm, 30 5mm applicators in original box, never used. Retail $299, only $225! I have five to sell. Closing satellite office. Other items available. 30 ga 1” and ½” BD needles only $15.00/box, retail $25.00. 941 922-3840

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 - 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.

ASSOCIATE POSITION - AUSTIN AND SAN ANTONIO AREAS

Seeking well-trained ABPS board certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group.  Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.net

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

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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