The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

November 01, 2008 #3,389 Editor-Barry Block, DPM, JD

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NY Podiatrist Discusses Sever’s Disease

Does your young athlete complain of heel pain? Although it may not be a serious condition, it can certainly slow them down. It's a fact, kids are playing more sports and to prove it, younger kids are feeling the aches. "A lot of children are actually playing a lot more than one sport these days and because of that, it is putting a lot more stress and strain from these activities," said podiatrist Dr. Jennifer Hutton.

Dr. Jennifer Hutton

Before kids hit age 16, growth plates are still fusing and if you have a child who plays a sport on soft turf, they could be at risk for a heel pain caused by Sever’s disease. What's happening in young active children where they are playing a lot more sports or getting a lot more running or activities and putting more stress on your Achilles tendon, it constantly pulls at the back of the heel and that pulling can lead to inflammation of the actual growth plate of the back of the heel," said Dr. Hutton.

Treatment is basic . "Lots of rest. Lots of ice. We sometimes give an anti-inflammatory and sometimes we have to put in a lift in the shoe to take some of the pull off the back of the heel bone so this way it can rest," said Hutton.

Source: Marcie Fraser, Capital News [10/31/08]

25% of Diabetic Amputees Should Have Seen Podiatrists Sooner: Study

An APMA study, conducted by an independent research firm, has found that 25 percent of 600 people surveyed who had suffered an amputation from diabetes said they should have seen a specialist – such as a podiatrist – sooner. Thirty percent of amputees said that paying closer attention to the warning signs, such as “hot spots” and foot ulcers, would have encouraged them to visit their physician before signs worsened.

In total, 75 percent of all survey respondents had been diagnosed with type-2 diabetes. The remaining 25 percent were considered at high risk for developing the disease. Results showed that Hispanic Americans were the least likely group to be tested for diabetes, compared to their African-American and Caucasian counterparts. Those surveyed cited the reason for not being tested was primarily due to normal blood sugar levels or not having noticeable symptoms.

Dr. Ross Taubman

“This survey shows just how immensely important it is for those diagnosed with diabetes, and those at risk, to have their feet examined by a physician during their annual checkup,” said Dr. Ross Taubman, president of the APMA. “Regardless of one’s ethnic background, taking a proactive approach to your health in asking your physician to check your feet can save both your limbs and your life.”

CMS Finalizes 2009 E-prescribing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) today announced a new initiative for physicians to trade in their prescription pads and improve efficiency and safety when ordering drugs for patients with Medicare. The initiative is included in the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2009.

Physicians and other eligible professionals who adopt and use qualified electronic prescribing (e-prescribing) systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Thus, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.

To earn the incentive payment, physicians must successfully report one of three codes for the e-prescribing measure when submitting claims for specified types of medical visits, indicating either that:

• They did not prescribe any medications during the visit;
• They used e-prescribing for any medications prescribed during the visit; or
• They did not use e-prescribing for a prescription because the law prohibits electronic prescribing for the specific type of drug, such as a controlled substance.

Source: CMS

Reverse Employee Turnover - Part 1

The cost of replacing an employee averages between one and two times the person's salary plus benefits. Worse, the loss of productivity can be devastating. Use exit interviews as a way to stem the flow of employee talent. Ask open-ended questions like these:

• "Why are you leaving?" Are these factors you can control?
• "What sort of new job are you planning to take/look for?" Notice if employees are taking better positions or simply jumping ship at any opportunity.
• How will you new benefits differ from ours?" Learn how your benefits stack up against what the competition is offering.
• How well did you get along with your co-workers here? Discover how interpersonal relationships boost or detract from morale.

Source: Communications Briefings [December 2008]

Query: Non-Payment to Associate

I am a young associate doctor and worked part-time for a podiatrist. The podiatrist decided not to pay me my wages during my 3 month employment period. I have tried amicably to discuss this with him over the past several months. However, he has refused and we ended up yelling at each other. I have contacted a lawyer and his advice was to try to settle without proceeding to small claims court. I have gotten nowhere and I have not been compensated for $3,700. What are your suggestions as a last resort?

Name Withheld

Editor’s comment: PM News does not provide legal advice. One of the most important lessons that young associates must learn is to obtain a written employment agreement. When properly drafted, this document protects both parties.

One option which may be available is filing an ethics complaint with your APMA state component. Failing any relief, Small Claims Court is a viable option. To win such a case you must be prepared to present some form of documentation as to the hours you worked. Even if you can’t prove how much the original agreement was for, most courts will award damages on the basis of a legal doctrine called quantum meruit, by which the law infers a promise to pay a reasonable amount for labor and materials furnished, even in the absence of a specific legally enforceable agreement between the parties.

RE: PICA Group Will Become Part of ProAssurance
From: Multiple Respondents

Editor’s Note: We have received many letters on this topic, several of which appear below. Most contain questions or concerns about this demutualization. In the near future, PICA will be posting answers to these questions, as well as the entire 100-page proxy document which will provide the material details of this transaction. We will be providing URL links to these materials. PICA and PACA policyholders will also be receiving direct correspondence on this matter. We urge all readers to wait until this information is disseminated before making any decisions.

The news of the proposed "sale" of PICA to Proassurance is the major issue affecting our malpractice insurance in over 25 years. The release of this announcement, coming on this forum, surprised me. As a mutual company, I would have preferred a letter, perhaps a ballot, to express my views after knowing the details of the transaction.

I will get an opportunity to vote, as all shareholders will, but it would have been nice to know what was going on, how it was developing, and how the shareholders felt about it. I am reserving my opinions for the time being, but I think that some time should be given, on this forum, to educate, inform, and listen to our colleagues about this major development that will affect many of us for years to come.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

Watch yourself PICA! Whenever you join forces with another entity, somehow that entity has a tendency to dilute the power of the other. The whole becomes more important than the part, and the policyholders may suffer as a result. I am retired and have no axe to grind. In fact, early in my career, PICA was a Godsend for podiatry. We didn't have much choice in the 80's for malpractice and hence PICA was originated. I worry about the future of OUR malpractice insurance company. Bigger is not better (usually) in business !

Charles T. Martin, DPM, Milford, OH, marteedoc@yahoo.com

PICA is wonderful in that they told me they were owned by podiatrists and run by podiatrists. I believe that the security of knowing this should carry on. The plan of demutualization provides a total of $15 million in premium credits to eligible renewing PICA policyholders beginning in 2010 and spread over three years. ProAssurance will pay cash to purchase the PICA stock authorized in the demutualization; PICA will then use that cash to fund the cash distribution and premium credits to be paid to its policyholders.

How can any cash payment be worth the peace of mind and confidence that we had when PICA was run and owned by podiatrists? Many of us do not intend on retiring soon. Anyone can say they will be behind podiatrists, yet a more concrete security blanket is the knowledge that a company is owned and run by podiatrists as a mutually owned company.

Daniel Alan Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: Fixation S/P Fracture (Dale Berkley, DPM)
From: Multiple Respondents

Since this fracture is non-displaced and in good alignment with minimal sagittal plane angulation, at 6 weeks post injury, I respectfully suggest delaying ORIF in favor of electric bone stimulation. The lack of fracture callus may simply be indicative of lack of motion about the fracture site, particularly if the patient has been compliant with their cam walker wear and if they've been non-weight-bearing. There's no radiographic evidence of sclerosis or rounding off of the fracture margins to intimate progression to non-union.

That said, lack of fracture callus may be a sign of compromised bone healing which, in this patient, is more likely a result of impaired micro-vascularity, not uncommon in diabetics, even well-controlled ones, rather than lack of interfragmental compression. If the patient's vascular status is intact, cont'd immobilization w/ electric bone stimulation should heal the fracture and obviate the need for surgical intervention. My opinion is to be a bit more patient with this one.

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

Review the literature. 2nd met base fractures are not dissimilar to a Jones fx. Be patient. Delayed healing at this site is common. Explain this to the patient. Allow much more time, protected mobilization and definitely a bone stimulation.

J. Korponay, DPM, Whitestone, NY, JKorponay@aol.com

I would recommend continued immobilization assuming there is no displacement on the lateral view which was not posted. I would get the patient an external bone stimulator. The fracture is minimally displaced and should heal without surgery. I think that if the patient were to develop a post-op complication s/p ORIF, some "professional" would say that the surgery was not necessary.

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

RE: Hospital Credentialing (Edwin Oghoorian, DPM)
From: James J DiResta, DPM, MPH

I am not an attorney, but when my hospital decided to go the board certification route I did seek outside legal counsel. My understanding is that there are times when using Medicare policy can be advantageous to podiatry, as with Medicare COPs regarding H&Ps being performed by DPMs. But when it comes to board certification, I don't believe Dr. Oghoorian’s argument holds IF the board certification requirement is across-the-board, i.e. for MD, DO, DPM, DDS/DMDs.

I serve on the bylaws committee of my hospital, which has board certification as a requirement for staff membership with grand-fathering for those providers who had privileges at the time of the new bylaw change. The hospital sought an opinion by legal counsel before enacting this regulation which is now a part of our bylaws. The argument you make, at least in the Commonwealth of Massachusetts, was brought forward and we were advised would not overturn this bylaw change.

James J DiResta, DPM, MPH, Newburyport, MA, jsdiresta@comcast.net

RE: 7 NJ Podiatrists Named as Top Docs
From: Steve Goldstein, DPM

NJ podiatrists finally get the recognition they deserve. I have written letters to the editors of New York Magazine and NJ Monthly for the past three years as to why the podiatric profession has never been included in their top docs. Maybe it finally had some impact! I am proud of those who were selected. They all deserve praise from the profession.

Steve Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

EQUIPMENT FOR RENT - EXTREMITY MRI

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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 full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

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

SUBLET SPACE WANTED - NORTHERN NEW JERSEY

I am looking to sublet space in the Tenafly, Teaneck, Fair Lawn or general area. I need the office two 1/2 days per week or 2 full days, whichever is available. I can supply equipment, if needed, but prefer a turn-key operation. 516 476-1815 podo2345@aol.com

PODIATRISTS NEEDED - 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 Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail Visit our website

PRACTICE FOR SALE – DALLAS TEXAS

10 year old practice for sale. All phases of podiatry: routine care, diabetic foot care, surgery, etc. Grossing $185,000 on three days per week. Could easily be full-time. Located in busy shopping center. Great Potential. Start making money from day one!! Owner will stay for transition. All serious offers considered. MUST SELL!! please respond to: footdoc8390@yahoo.com

WEEKLY SPECIAL - One week of ads (5x) for $89 One month of ads (20x) for $340 .

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