The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

October 27, 2007 #3,077 Editor-Barry Block, DPM, JD

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LA Podiatrist Fights Peer Review Abuse

Dr. Richard B. Willner’s crusade began seven years ago with an e-mail. In it, Dr. Brian Gale described his battle with the North Dakota Board of Podiatric Medical Examiners. Gale maintained the dispute began when he left another doctor’s practice to begin his own. That doctor sued Gale, and the board filed disciplinary charges against Gale. The resulting ordeal was at the eight-year mark when Willner got involved. By that time, Gale had run through seven attorneys and burned through more than $500,000 in legal fees, only to lose at the state Supreme Court.

Dr. Richard Willner

“I asked him to send me a copy of the source documents,” Willner said. “He sent me 29 pounds worth. I went through them. I saw he was 100 percent truthful, and I did not understand how a state board could terrorize a licensee. I volunteered to help him.” Three years later, every board member had resigned from the North Dakota board, Willner said.

“You’ve got a guy, a middle-aged man who said, ‘You know, I don’t really want to do another hammer toe surgery again. I’ve had enough,’” Willner said. “I want to do something better. I want to do something dynamic.” He founded The Center for Peer Review Justice Inc. The center now has offices in Kenner and Dallas. Eventually Willner retired as a podiatrist.

Source: Ted Griggs, Louisiana Medical News [10/25/07]

TX Podiatrist Practices Integrative Medicine

Floyd Atkins asks everyone who enters the Center for Wellness and Healing the same question: Do you know what you're putting in your body? Dr. Floyd and Dr. Pam, as their patients call them, took a leap of faith away from traditional medicine when they opened their integrative health center in 2003. Floyd Atkins, a podiatrist, had been a surgeon in the Rio Grande Valley, where some of his patients were losing their feet to diabetes. Increasingly, he urged patients to avoid processed foods and infuse their diets with fresh greens and grains. At the same time, his wife, family practitioner Pamela Brewer Atkins, was working as an emergency room physician, watching the same people return with the same afflictions.

Dr. Floyd Atkins

Together, the doctors determined to create a place where they could get to know their patients and treat them, if possible, without prescription drugs. At their center on Binz — with its hard wood floors, soothing green walls and jazz music playing in the background — they offer wellness education, herbal detox and nutritional counseling.

The couple also practice what they preach. They changed their own eating habits in 1998, clearing their pantry of boxed and canned goods and restocking it with dried beans, organic brown rice, spices and oils for seasoning raw or lightly sauteed vegetables. Although they are plugged into the organic food and farmers market communities, they wish Houston offered a greener environment. As Floyd Atkins says, "What you put in your body affects your mental, physical and spiritual well-being."

Source: Maggie Galehouse, Houston Chronicle [10/24/07]

Grassley Proposes One-Year Delay of MD Payment Cut

Senate Finance Committee ranking member Chuck Grassley (R-IA) on Wednesday said committee Republicans favor a one-year, rather than a two-year, suspension of a 10% reduction in Medicare physician reimbursements scheduled to take effect on Jan. 1, 2008, CongressDaily reports. Grassley said that lawmakers would have less difficulty with passage of a one-year suspension of the scheduled reduction in physician reimbursements, with a two-year delay likely to cost $20 billion.

Committee Chair Max Baucus (D-MT) has proposed a $25 billion to $30 billion Medicare package that would suspend the scheduled reduction in physician reimbursements for two years and provide subsidies for rural and low-income beneficiaries. According to congressional sources and lobbyists, Baucus has proposed at least $8 billion to $12 billion in reductions in reimbursements to private Medicare Advantage plans to help offset the cost. Sen. John Kyl (R-AZ) said, "I don't think there's any appetite" for such reductions in reimbursements to MA plans, adding, "There is not bipartisan agreement on this" (Johnson, CongressDaily, 10/25).

Source: CongressDaily via American Health Care [10/25/07]

Query: Source for UAM Burrs

Our office has used the UAM brand round burrs and reciprocating saw blades that were notched special for the Stryker TPS System. Our supply has now run out. The telephone number on the UAM Catalog is not in service. Does anyone know of a source for these items?

Cosmina Dragomir, DPM

RE: OTC Dispensing for Chemical Nail Post-Op (Michael B. DeBrule, DPM)
From: Narmo L. Ortiz, Jr., DPM, Hal Ornstein, DPM

Our practice typically dispenses a post op kit after nail avulsion surgery that contains a tube of Amerigel, 10 Band-Aids, and instructions on its use. You could also include some gauze with the Band-Aids. Amerigel typically sells for $10 a tube, so you could sell your kit for $20 to $30 each. Most patients prefer this convenience rather than soaking their feet.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

I have been using Amerigel red following nail surgeries for several years now and have experience great success with both my patients and practice. Since switching to Amerigel, I no longer have my patients soak post-operatively and therefore no longer need Betadine or Epson salt soaks. I used to build my own post-op kits, including gauze pads and band-aids but recently switch to the Amerigel Post-op kit. I feel the new post-op kit not only provides the patients everything necessary for their post-op care but also promotes my practice in a more professional light than the zip lock bag had previously provided.

I charge my patients $35 for the post-op kit because if a patient used their co-pay ($20-25) for a prescription and purchased a thirty day supply of gauze and fabric bandages, they will end up spending more at the pharmacy. I use Polymem in my practice but due to the full-thickness requirement for reimbursement, I do not use this product for my nail procedures. I always recommend podiatrist support companies who support podiatry and Amerx has shown throughout the years to be an avid podiatry supporter and has made their post-op kit exclusive to podiatrist only.

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

RE: Medication Use for Diabetic Peripheral Neuropathy (Marc Katz, DPM)
From: Elliot Udell, DPM, Alan Kalker, DPM

Dr. Katz's statement that the pharmaceuticals used to treat neuropathies are all poisons is totally devoid of fact. Drugs such as Gabapentin, Lyrica and Cymbalta have excellent safety profiles if used in a proper manner and monitored properly. The statement that peripheral neuropathies are all caused by deficiencies remedied only by "whole food" vitamins is more than misleading. Such an approach can be negligent. Peripheral neuropathies have many etiologies and many of them are unknown. From what we do know about diabetic neuropathy, a lack of vitamins is definitely not its cause . Some peripheral neuropathies are caused by structural problems such as spinal stenosis or herniated discs. Giving a patient vitamins instead of sending a person for a neurologic work-up can cause a patient a great deal of harm.

Lastly, those who ascribe to the way of thinking that diabetic neuropathy is caused by elevated homocysteine levels and recommend vitamin compounds such as Metanx to lower homocysteine levels, be advised that you are medically trained doctors. Serum homocysteine levels can be monitored with a simple blood test. Treating elevated homocysteine levels without taking bloods is akin to giving a patient medicine for hypertension without taking his or blood pressure.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Can Dr. Katz cite published, well-controlled, double-blinded studies demonstrating that the methods he has embraced actually work? The medical community has often ignored "natural" medicine not because it doesn't work but because of a lack of data showing it does. "Natural" substances also have adverse effects, many of which also go undocumented due to the lack of appropriate research. So, knock Big Pharma all you like - and they do often deserve the knocking. But provide links to good science backing up your recommendations.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

RE: Phones and Multiple Offices (Daniel Reznick, DPM)
From: Scott Hughes, DPM

We have 3 offices. The satellite offices ‘call forward’ to assigned roll-over lines at the main office when they aren’t staffed. When the roll-over lines ring at the main office the staff can usually know it’s a call from the satellite office. If it’s long distance to call between offices it can add up but it’s probably cheaper than your current arrangement.

Scott Hughes, DPM, Monroe, MI, dr.hughes@comcast.net

RE: PM News Passes 10,000 Subscriber Mark
From: Michael J. Schneider, DPM, Hal Ornstein, DPM

Just a note to thank Dr. Block once more for PM News and Podiatry Management. He affords our profession a veritable wealth of knowledge and keep us up-to-date on the important issues of the day. Kudos to you Barry!

Michael J. Schneider, DPM, Vail, CO

When reading today’s PM News, I noticed that the top now reads “Serving Over 10,000 Podiatrists Daily.” Congratulations on this achievement and for helping to provide information for enhanced patient care, improved quality of life for podiatrists and their staff and tools to add to our bottom line. I read every one of your issues and as I say in my presentations around the country “Knowledge is Power.”

I profess that to have the edge, read all you can in podiatry, especially a fantastic tool like PM News which is an easy read and dynamic in nature with most up-to-date information and news. PM News is the brainchild of Dr Block, which he does as a labor of love to the profession. And for that, I and MANY say THANK YOU!

Hal Ornstein, DPM, Chairman, American Academy of Podiatric Practice Management

IMMEDIATE ASSOCIATE NEEDED - SOUTH MIAMI

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PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mix of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 170K. Willing to stay through transition. Call 716-432-7092.

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