The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 02, 2009 #3,690 Publisher-Barry Block, DPM, JD

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TX Podiatrist Spearheads Diabetes Fundraiser

Next weekend, more than a thousand San Antonians will be “Stepping Out” to help in the fight against diabetes with a walk in Brackenridge Park. The man who is spearheading this year’s fundraiser knows the disease from two perspectives. He’s both a patient and a doctor. Dr. Joshua Hedman knows feet. The podiatrist with the Foot and Ankle Treatment Center of San Antonio was only 27 years old and a second year resident when he started experiencing strange symptoms.

Dr. Joshua Hedman

“Excessive thirst. Frequent urination. I lost a lot of weight. I was very fatigued,” Hedman recalled. He was diagnosed with type I diabetes, a life-changing moment for him, but one that has given him great compassion for his patients. “It allows you to relate on a more personal level, that’s for sure,” he said. “Before you would get ‘Doc, you don’t know how it feels’ and now they can’t really say that.”

Source: Wendy Rigby, KENS 5 [10/30/09]
 

NYCPM’s Geriatric Foot and Ankle Symposium a Huge Success

Last Weekend, the New York College of Podiatric Medicine presented a resoundingly successful 2009 Symposium on the Geriatric Foot and Ankle. The symposium, held at Weill Cornell Medical College, was attended by more than 160 doctors, and featured twenty outstanding speakers from around the country, representing both podiatric and allopathic medicine, as well as academic research.

(L-R) Drs. Michael Trepal, David George, Robert Eckles, and Anthony Iorio

Keynote speakers included Cynthia Magro, MD, PhD, from Weill Cornell Medical College, who spoke on dermatopathology for the DPM, and Mark Young, MD, from Johns Hopkins, who spoke on pain syndrome. Robert A. Eckles, DPM, served as General Chairman. Michael J. Trepal, DPM, Anthony Iorio, DPM, and Rock G. Positano, DPM, served as The Scientific Co-Chairs.

TX Podiatrist Arrested on Healthcare Fraud Charges

Franklin Beltre, DPM, of Houston was arrested on charges he defrauded Medicare and Medicaid at his clinic in San Juan, Texas, according to a report in The Monitor. Dr. Beltre, who operates Valley Medical Foot Care, is accused of billing for services that were performed by his unlicensed assistant, Manuela Alana, and that were conducted in unsafe facilities that put patients at risk, according to the report.

Dr. Franklin Beltre

According to the eight-count federal indictment, Dr. Beltre and Ms. Alana violated rules of Medicare and Medicaid, including the provision that the billing physician must be on site for all medical procedures. Dr. Beltre allegedly took trips and left pre-signed prescriptions for Ms. Alana, who does not hold a license, to fill out while he was away. She is also accused of performing procedures at adult day care centers in violation of program rules, which state procedures can only be performed at rest homes or nursing facilities, according to the report. If convicted, both could face up to 10 years of prison for each charge.

Source: Becker's ASC Review [10/30/09]
 

Query: Neoplasm of Unknown Etiology
From: Jeffrey J. Luckett, DPM

22 yo female with painful lesion to plantar aspect of left foot that has been present for several years. Previous h/o surgical excision (local only) of lesion approx 10 years ago and states she remembers a "cottage cheese" substance being remove from her foot. Patient states the pain never resolved and the lesion grew back.

Neoplasm of Unknown Etiology

Patient had…..

Editor’s Note: Dr. Luckett's  extended-length query can be read at:
http://www.podiatrym.com/letters2.cfm?id=30078&start=1

Query: TOG Gaitscan

Do any podiatric physicians have working knowledge of the TOG Gaitscan in terms of accuracy, cost, reproducibility for plantar pressure analysis, fabrication of custom orthotics, and gait studies? Company support? Problems with cavus or significant flatfoot?

Mark K. Johnson DPM, West Plains, MO
 

RE: Bunion Surgery (Richard Frost, DPM)
From: Multiple Respondents

It's sometimes difficult to tell by an appearance of an x-ray reproduction on the Internet, but it looks to me that this patient has significant osteoporosis. The trabecular pattern is still intact, but the bone clearly has a "washed out" appearance. This does not in itself contra-indicate corrective surgery, but it does raise some important questions.

Adult, female osteoporosis is a deadly disease. Often podiatrists are in the first position to see this clearly with routine x-rays. I don't know if this patient is taking any medications to try to reverse this, or how active she is. Often a DEXA scan is the first choice for further evaluation.

Prior to doing this surgery, I would write a brief note to her family healthcare provider to apprise him of  this finding. (He/she may already be aware of it.) It doesn't hurt to obtain a second opinion from a gerontologist prior to doing the surgery. Should a dreaded complication occur (of any sort), you will thank the day that you took this special effort.

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

The radiograph shows a large IM, significant osteoathritic change and accommodation at the joint level, as well as valgus rotation of the hallux. It also shows osteopenia. From the radiograph, and from the fact that the 1st MTPJ is "semi-reducible," I would perform the following: A 1st MTPJ arthrodesis, 1st M-C joint capsulotomy as needed (with/without percutaneous pinning), and use an external bone stimulator post-op. Prior to surgery, I would also obtain a bone density scan as well as ABI/arterial ultrasound.

Todd Lamster, DPM, Phoenix, AZ, tlamster@gmail.com

Clearly this patient’s radiographs reveal osteopenia. Probably the T-scores from Dexascan are likely to be consistent with osteoporosis. The hallux is subluxed . My old school simple thoughts would be Keller or Keller with hemi- implant. Check the EHL for tightness intra-op, and try to avoid a first met osteotomy. I don’t think an implant on the first met side would resolve the huge IM angle.
 
George Pattis,  DPM, Greenville, SC, georgepattis@aol.com
 

RE: Sarapin for Morton's Neuromas? (David Alper, DPM)
From: Michael Turlik, DPM

I was interested in Dr. Alper’s posting regarding the use of Sarapin for Morton's neuroma. After a short and incomplete review of the literature, I've enclosed the best reference I could find.(1) It appears most of the literature is written by veterinarians and pain management specialists.

I would recommend the next time Dr. Alper sees his neurologist colleague, he ask him or her the following question: “I am interested in learning more about the use of Sarapin for the treatment of Morton's neuromas. Could you provide me with some recent references?” Based upon my experience, one of two things are likely to happen 1) the colleague will provide references which you will need to evaluate for validity and relevance or 2) he/she will inform you that he/she has been in practice for many years, and has treated many patients with universally good results and no adverse effects. The latter response is usually accompanied with some rapid attitude change. If you find any valid and relevant literature regarding this subject, I would appreciate you forwarding it to me.

1. Pain Physician. 2004;7:59-62

 Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com
 

RE: Effect of Custom and Semi-Custom Orthoses on 2nd Metatarsal Bone Strain (Kevin Kirby, DPM)
From: Michael Lefkowitz, DPM

For readers interested in the use of cadavers to study the biomechanics of the foot and ankle in gait, the apparatus in question is described in a paper published in Clinical Biomechanics, A dynamic cadaver model of the stance phase of gait: performance characteristics and kinetic validation. Neil A. Sharkey*, Andrew J. Hamel, Clinical Biomechanics 13 (1998) 420-433

Michael Lefkowitz, DPM,  Ardmore, PA, poddocmnl@comcast.net
 

RE: Medicare Discontinues Consult Codes
From: Lloyd S. Smith, DPM

In its final rule, published today, Medicare confirmed it will no longer pay for consult codes typically used by podiatrists and other physicians. The rule discusses multiple reasons for this decision.  The dollars saved will be allocated to other EM codes which should increase in tandem with the saved consult dollars.

Podiatrists should monitor this decision closely for the changes required in their billing patterns. In many cases, private insurance carriers follow Medicare in billing and payment decisions. CPT has not changed its consult codes. The resulting confusion should be a challenge for podiatrists in their billing patterns and in compliance with this decision. More details will certainly follow in this and other forums. 
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: PECOS System (Philip E. Larkins, DPM)
From: Paul Kesselman, DPM

There have been much false information and rumors about the PECOS ruling and how it may affect your DME payments. While many of the writers have meant well, they either do not have a full grasp of the situation, and/or are understandably overwhelmed by this complex and developing story. Many committee conference calls sponsored by APMA have been conducted over the last several months regarding this issue. I  have participated in many of these and made several calls to CMS and other supplier organizations in an attempt to provide our members with all the facts. Harry Goldsmith and I are currently working on preparing a PECOS for Dummies for the APMA membership which should be ready for publication by mid-week. Additionally, I will be providing the manufacturers I work with a written plan for their clients.

In the interim, I  urge all the readers of this publication to remain calm and not react to the many false rumors and half-truths that have been published. Many questions still are not answered because of conflicting answers we are receiving from CMS. Many of your state component societies and local Medicare carriers are also not well versed in this issue. The National Supplier Clearinghouse will also not be able to assist you with this issue. I  urge you not to waste your time or burden them with this issue (at least for now). The APMA website currently has a PDF file entitled DME Update on its membership website under the 2009 CAC PIAC presentations. For now, this should begin to help to explain some of the facts to you.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net
 

RE: Custom Latex Bunion Shield (Lorraine Loretz, DPM)
From: Bill March, DPM

Liquid Rubber Appliance Lab is still doing a great job. 45 Valley Way, West Orange, NJ, 07052,  973 325-0174, ask for Anna.
 
Bill March, DPM, Cherry Hill, NJ, footwise51@aol.com
 

RE: PM News Tops 12,000 Subscribers
From: Steve Pribut, DPM

Congratulations to PM News on attaining 12,000 subscribers. I look forward to receiving and looking at it each and every day. I'll bet there are many others who open PM News first, as soon as they see it pop up in their e-mail. The evolution over the years has been outstanding.

Barry, thanks for doing such a great job for so long.

Steve Pribut, DPM, Washington, DC,pribut@earthlink.net

ASSOCIATE POSITION-SOUTHERN CALIFORNIA, INLAND EMPIRE

2-office multi-doctor practice looking for ethical, dependable doctor to work 3-4 days per week. State-of-the-art, long established practice. Needs a team player which may lead to buy-in for the right doctor. Must be ABPS BC/BE. High surgical volume. Send cover letter and CV to bkatzman2@earthlink.net

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 - 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

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 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 – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com 

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

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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