The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 28, 2009 #3,686 Publisher-Barry Block, DPM, JD

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OH Podiatrist Receives AAPPM Chairman's Award

The American Academy of Podiatric Practice Management (AAPPM) Chairman, Dr. Hal Ornstein, presented Dr. Richard Berkowitz with the AAPPM Chairman's Award this past weekend at the annual Cleveland Super Saver Conference. The plaque read – “In Grateful Appreciation of Your Many Years of Outstanding Service in Promoting the AAPPM Mission and Membership Development.”

Dr. Richard Berkowitz (Left) receives AAPPM's Chairman Award from Dr. Hal Ornstein

Dr. Berkowitz has included an AAPPM practice management track in his Super Saver Conference for the past several years and has been instrumental in scores of new members joining the American Academy of Podiatric Practice Management.

Two CPMS Students Awarded $2,500 Scholarships from PICA Group

Two fourth year CPMS students, Valerie Tallerico and Noah Oliver, have been awarded $2,500 scholarships from the PICA Group. These students were selected by the CPMS Faculty based on their outstanding achievements, service, and leadership abilities. 

Noah Oliver and Valerie Tallerico

Podiatry Insurance Company of America (PICA) is the nation’s leading provider of professional liability insurance for podiatric physicians in the U.S.  The PICA Group has been a leader for many years in supporting podiatric medical education in the form of student scholarships.
 

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

Bret Ribotsky: How do you define success?

Dr. Harry Goldsmith

Harry Goldsmith: J. Paul Getty defined a formula for success for him, which was to rise early, work hard, and strike oil, which I thought was really great. I prefer looking at things just a little bit differently. I think that a person of success is a person of value. A person of value does valuable things, and I think that is how I have tried to live my life. When I was in practice, I tried to create value for my patients. In my family life, I try to create value for my family. I feel that if you do things that are of value, that defines success.

Dr. Glenn Gastwirth

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest  is Dr. Glenn Gastwirth, Executive Director of the American Podiatric Medical Association and PM Podiatry Hall of Fame Inductee.  You can register for this event  by clicking here

Query: National Diabetic Center

Are any DPMs familiar with the National Diabetic Center, which refers diabetic patients to podiatrists' offices for evaluation for therapeutic footwear and discussions of a proprietary glucose meter? Any pros, cons, or concerns? 

Mark K. Johnson DPM, West Plains, MO

Query: E/M Services at Assisted Living Facilities

I am new to practice. I just got a position to examine and treat patients at an assisted living facility. What E/M service codes would be used for an initial visit? What are the codes for an established patient E/M service?

Jeremy Thomas, DPM, Cary, NC

Response: CPT 99324 - CPT 99328 are the codes used to identify a new patient evaluation and management service in an assisted living facility (domiciliary or rest home visit for the evaluation and management of a new patient).

CPT 99334 - CPT 99337 are the codes used to identify an established patient evaluation and management service in an assisted living facility (domiciliary or rest home visit for the evaluation and management of an established patient).

These codes are subject to the standard E/M service guidelines, policies, and rules (e.g., established patient: the patient's condition required a significant, separately identifiable E/M service above and beyond any other service provided. If you are performing an established service, such as routine foot care, you would not be able to bill for an E/M service just because you had to make the trip to see patients away from your office).

An assisted living facility place of service is "13."

Harry Goldsmith, DPM, Cerritos, CA

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

RE: Perceived Ingrown Toenail Problem (Hans Blaakman, DPM)
From: Multiple Respondents

Have x-rays been taken? There may be spurring below where the ingrowing portion of the nails used to be. 

Paul Busman, DPM,RN, Clifton Park, NY, brewerpaul@aol.com

Whenever you have hyper-sensitivity of the great toe or toes with a feeling of an ingrown nail and no clinical findings,  you must consider a lower back (lumbar) impingement. Even if there is no lower back pain, I would still do an X-ray and MRI of the lumbar region. Other neuropathic causes must be considered as well including diabetes, chronic alcohol use and marijuana.
 
Gary S. Smith, DPM, Bradford, PA, penndoc@verizon.net

Dr. Blaakman’s pictures are not too clear, but there seems to be some callus formation at the distal half of the medial sulci (especially the left). I would be inclined to carefully debride any callus with a D 15 scalpel and also conservatively debride any toenail that might be resting against the callus. If this greatly reduces the symptoms, then restrictive footwear is the most likely source of the problem. I have seen female patients who have had great surgical results but go back to slip-on shoes too early and restart irritation in the sulcus with the new nail border.

Paul Gabriel Scullion, FCPodS, Dublin, Ireland, biofoot@indigo.ie

RE: Don’t Overlook the Potential Negative Role of Vitamins and Minerals (Paul Kesselman, DPM)
From: Bob Kornfeld, DPM, Bret Ribotsky, DPM

Dr. Kesselman brings up a critically important point. Over the years of practicing integrative podiatric medicine, I have come across hundreds of patients who have self-prescribed vitamins, minerals, and herbs to the tune of toxic doses. In addition, I have patients who are taking logical supplement dosages, but are causing interactions with OTC and prescription meds. It is so important to include supplements as part of your work-up on all patients. It is equally important to have an education in nutritional and herbal medicines so you are able to do what Dr. Kesselman did. Kudos to you Paul!
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

Great Job Dr. Kesselman --- I wonder how often we all get in a pattern of quickly bypassing complaints above the lower extremities when the patient is being managed by other physicians. Taking time and getting a good history are the benchmarks of being a good physician. Dr. Kesselman proved that; and his going above and beyond to call the other physicians with his research and discovery is clearly why he has earned the respect of all his colleagues, patients, and community physicians. I hope that the acuity for zinc toxicity is raised in all of us. - Thank you Paul.

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

RE: Recommendations for Bunionectomy ( Alan Berman, DPM )  
From: Multiple Respondents

Revisional hallux valgus reconstruction can certainly be challenging. In this instance, given the significant joint incongruency and high intermetatarsal angle, a distal first metatarsal osteotomy would likely be ineffective in restoring alignment. I have had good success in these tough cases with first metatarsocuneiform arthrodesis. If there is residual increase in the DMAA (PASA), then a distal realignment osteotomy may be required. An Akin phalangeal osteotomy could also be used to further realign the toe. I would caution against a fibulae sesamoidectomy in a younger patient.

Daniel J. Tucker, DPM, Orange, CA, reekat@aol.com

It's a good thing the 1st met is somewhat long. The IM is too high to perform a DMO. You really should consider a Juvara CBWO and then possibly a crescentic head procedure for the PASA; or an opening wedge at the base and a Reverdin-type procedure at the head for the PASA. Shortening and transfer metatarsalgia are big concerns with this patient.

Randy Beckman, DPM, Houston, TX, rbeckfeet@sbcglobal.net

With all due respect to Dr. Berman, if his patient has no pain and is participating in weight-bearing physical activities without problems, you may be doing a surgery too many. That being said, the procedure selection by the surgeon who operated in 1987 did not address the high IM angle, and there is no mention of a possible 1st met-cuneiform hypermobility.

In addition to a Reverdin-Laird osteotomy, if there is hypermobility at the 1st met-cuneiform joint, it should be fused while correcting the IM angle and without the need of a fibular sesamoidectomy. If there is no hypermobility, a closing base wedge, or a crescentic base osteotomy should be selected.

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

Editor’s Note: Dr. Mullen’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=29966&start=1

RE: Effect of Custom and Semi-Custom Orthoses on 2nd Metatarsal Bone Strain
From: Robert Bijak, DPM,  Michael Turlik, DPM

Dr. Kirby makes a leap of faith, not science, in reveling over the "custom vs. semi-custom orthotics article. First, the study he quotes was limited to only 8 examples. Not a credible number. Second, plaster casts were made on cadaver feet. Finding neutral positions and ROM is NOT correlative to a living person. Do the researchers believe that "watching the cadaver walk" without the rest of the body attached to it, is at all representative of reality? If so, forget  pelvic tilt, spinal scoliosis, discogenic disease, limb-length discrepancies, etc.

I know podiatrists have a limited license, but look above the ankle sometimes. This is a major study flaw. The article involves a  physical therapist. Who cast, who measured, who prescribed the arch support for the dead foot? What kind of lab made the "custom" insert? If podiatrists are the "sine qua non" of biomechanics, then should it not be at least a totally podiatric endeavor to eliminate another variable?  And, the conclusion said both custom and non-custom orthotics modified bone strain, and did not definitively say it would avoid fractures, just that it may. “May” is not a scientific word.

Dr. Kirby speaks of all the scientific literature that substantiates orthotics. The problem is, much of it, like this report, is weak science full of design errors that wouldn't pass muster in a good university's masters program. To me, 8 dead feet walking by themselves do not justify $300 for an arch support.

Robert Bijak, DPM, Clarence Center, NY,  rbijak@aol.com

Editor's note: Dr Turlik's letter appears at: http://www.podiatrym.com/letters2.cfm?id=29969&start=1

RE: Vascular Testing Systems (Tamara Allen, DPM)
From: Ronald Werter, DPM
 
I have a Smartdop 45, which I use on a regular basis, The differences between the Smartdop and the Padnet are...

Editor's note: Dr. Werter's extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=29971&start=1
 

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist.  The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)  

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community  www.siouxlandchamber.com. Fax  CV, resume, three references to 712-258-9977.

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 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.

PRACTICE FOR SALE- SEATTLE, WA

Beautiful office for sale in the heart of Seattle, WA. Newly renovated, 2,500 sf, new digital x-ray, vascular lab, state of the art physical therapy equipment, paper-less system, all new podiatric furniture and equipment, popular podiatric products store and beautiful diabetic shoe display. Office is located in the medical building and open 3 days a week. Great opportunity for expansion to full-time. Please send us a letter of interest to the: podiatrygroup@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, CA

Busy 2 office multi doctor practice looking for dedicated, dependable, honest doctor to work 3-4 days per week. Must be ABPS BC/BE. Send cover letter and CV to bkatzman2@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.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

ASSOCIATE POSITION – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@yahoo.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

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.

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

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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