The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

November 02, 2011 #4,295 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2011- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

CA Podiatrist Diagnoses Non-Hodgkins Lymphoma

In 2009, Pat McKnight went to her general practitioner over foot swelling concerns and was referred to podiatrist Dr. Nancy Kaplan. A few PET scans later, she heard Kaplan tell her she was going to need her family, as the tests showed a cancerous growth. "Dr. Kaplan is a very caring person and she was very concerned about how I was going to take this news, but she didn't realize how strong I am and how much stock I put into positive thinking," McKnight said.

Dr. Nancy Kaplan

On March 18, 2010, McKnight had surgery to remove a nine-inch tumor from her foot that was unlike anything the surgeon had ever seen. It was sent to the Mayo Clinic for a biopsy, and about a week later, she received a diagnosis of non-Hodgkins lymphoma.

Source: Ryan Chalk, The Reporter [10/30/11]

Marathon Runners Need Long and Slow Mileage Build-up: DC Podiatrist

Sports medicine specialists say that predicting and preventing running injuries is an inexact science. But a long and slow increase in long runs is generally safer than a quick escalation, says Dr. Stephen Pribut, a Washington, D.C. podiatrist, marathoner, and past president of the American Academy of Podiatric Sports Medicine.

Dr. Stephen Pribut

"Six months to build up mileage is better than two," he says. Ideally, long runs ought to at some point include a 20-miler—if not longer—and two 18-milers, each long run spaced two weeks apart, Dr. Pribut says. What is the shortest long run acceptable for a would-be marathoner? "It depends on age," says Dr. Pribut. "A 22-year-old can get away with a shorter training run than a 50-year-old," he says.

Source: Kevin Helliker, Wall Street Journal [11/1/11]

GA Podiatrists Provide Care for Breast Cancer Walk

Volunteers from the Ankle and Foot Centers of Georgia recently took part in the 9th annual two-day Breast Cancer Walk which raises funds and awareness for breast cancer research. The walk is hosted by It's The Journey, a local non-profit organization dedicated to helping those affected by breast cancer. Volunteer doctors examined and treated walkers with foot ailments, which included everything from sprained ankles to blisters. 

Dr. Joseph Giovinco

"The fight against breast cancer is not a single battle," Dr. Joseph Giovinco said. "It's an ongoing struggle that is faced with courage and determination. After taking part in such an extraordinary event, we will think of those who have walked their course or simply could not complete their journey in the fight against breast cancer."

At 65, NM Podiatrist is Among Top Drivers at Dirt Tracks

Pardon Dr. Dave Deetz if he doesn't shake your hand. Nothing personal, he's just a bit banged up. Last month, he broke his right thumb. The tape job on it resembles something you might see in some old NFL Films footage. Just a day in the life of a racer. The speed and minor collisions in dirt track racing can make the steering wheels jerk with great force. Unfortunately for Deetz, a longtime local podiatrist, his thumb was precariously perched on the wheel, and its sudden movement caught him by surprise.

Dr. David Deetz

He said it's a common injury among racers, and Deetz would know. At 65, he's among the top drivers in his division at the area dirt tracks — predominantly the Southern New Mexico Speedway and El Paso Speedway Park.

Source: James Staley, Las Cruces News [10/29/11]

CA Physicians Decry 10% Medicaid Pay Cut

The California Medical Association (CMA) will go to court again to block the latest cut to already stingy Medicaid reimbursement rates in that state, a CMA leader said today. The association contends that the 10% reduction in provider reimbursement will drive more physicians out of the program and make it harder for the poor to receive medical care, violating federal requirements that govern the Medicaid program.

California is 1 of 14 states cutting physician reimbursement in the current fiscal year to make ends meet as they cope with higher Medicaid enrollment, declining tax revenues, and the loss of federal stimulus funds, according to a survey released this week by the Kaiser Family Foundation.

Source: Robert Lowes, Medscape News [10/28/11]

Eliminate the Drain of Negativity

Block the negative attitudes that can suck the life out of a workplace. Foster a positive mindset with these habits:

• Confront Complainers. Put chronic complainers on the spot by asking, “What would you do to resolve this?” Train them to think of solutions.
• Criticize in person. Dashing off an e-mail or leaving a voice-message when you deliver negative feedback can make it seem extra harsh. Deal with the issue face-to-face, so you can head off any potential misunderstandings.
• Stop to praise. When you continually focus on what is next, you may neglect to congratulate employees on a job well done. Without a few positive words from you occasionally, your employees will think that you are impossible to please.

Source: Adapted from Jon Gordon, “Worn Out at Work” Twelve Common Behaviors that Drain Everyone’s Energy – and How to Purge Them in 2011" via the Organized Executive.

Query: eRx Prescribing Exception

I wrote to CMS for a hardship exemption for eRx subscribing, using the reason that I work part-time (20 hours), have limited prescribing activity, and insufficient use of the measure's denominators. I received a phone call from CMS stating that I did not have a hardship based on the lack of use of the denominators and that this will automatically be determined by CMS. Does anyone know if this is the way it will be done, or should I still push for an exemption response?

Thomas Zoldowski, DPM, Toledo, OH

Response: I am concerned that you may be confusing two programs

The eRxing threshold in 'Meaningful Use' which is a percentage. If you write less than 100 prescriptions per year, you can be exempt from this threshold, and the eRxing Incentive Program which, though it has a significant overlap with 'Meaningful Use', is a separate stand-alone program.

If you did not report code, G8553, at least 10 times prior to June 30 you are set up for a 1% reduction of your Medicare fees in 2012.To avoid that, you need to fill out a specific exemption request form. When you fill out that form, you are told to expect a reply within 30 days. Currently, there are so many exemption requests they are backlogged and do not expect to get back to doctors within that 30-day time frame.

Please visit here to request an exemption from the Medicare fee cut if you did not get G8553 reported 10 times.

Michael L. Brody, DPM, Commack, NY

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Excellent Article on MRI Over-Usage in Sports Medicine (Rich Retig, DPM)
From: Elliot Udell, DPM
 
Kudos to Dr. Retig for quoting that New York Times article showing that MRIs should not be used as the be all and end all of making clinical diagnoses. What Dr. Andrews said in the article is something that the chief of orthopedics at my hospital has been saying at meetings for years. Very often MRIs are used to justify surgeries when other clinical evidence is lacking.
 
Several  years ago, a patient came to my office for the treatment of an ulcer beneath his left hallux. In the course of therapy, I ordered an MRI and the radiologist sent a report to both his vascular specialist and me saying that the patient has osteomyelitis of the left fourth toe. There were no signs of inflammation, edema, or infection in that digit. His vascular specialist immediately wanted to amputate the digit, based on the MRI. I stood my ground and the patient never lost his toe.
 
Elliot Udell, DPM, Hicskville, NY, Elliotu@aol.com

RE: The Allopathic Podiatrist (Paul Kruper, DPM)
From: Brian Timm, DPM
 
Why is it that every so often I have to read another alarmist outlook which seemingly dooms our profession? It's obvious that we are not going anywhere, not only as a subspecialty but as an intricate component to any limb salvage team. Daily, I am told by numerous physicians such as infectious disease and vascular surgeons in town where we practice that they are glad to have us on the case, because without us, the patient will lose a leg or foot. We are not the only ones getting "cuts" by Medicare, and it has nothing to do with the governing bodies cutting the profession. It is just cutting healthcare.
 
Get over it, for anyone who thinks that a DPM is a dead-end degree. I feel that this is a major reason why there are so many bitter practitioners in podiatry: you are a DPM and if you foresee this degree becoming obsolete, LEAVE the profession entirely. It is not helpful to think that you can convert your degree to a DO or an MD. IF you wanted to do that, you should apply for the said school offering this degree. Students and residents who read this mentality will  only plant seeds of ignorance and bitterness towards what will otherwise be a fruitful and rewarding career as a podiatrist.
 
Brian Timm, DPM, Naples, FL, drtimm@familyfootandlegcenter.com

RE: Early Diagnosis of Bunions Can Prevent Surgery (Brian Kiel, DPM)
From: Dennis Shavelson, DPM

Dr. Kiel represents colleagues who have chosen to shy away from biomechanics EBM practice for years, yet still consider themselves grandfathered authorities on the subject. He is probably discussing subtalar joint neutral biomechanics with intrinsic forefoot posting and a 3 degree varus post, the default in orthotic casting and prescribing that many DPMs, chiropractors. PTs, scanners, and Walmarts tend to provide, evidenced as substandard.

I believe that he lacks the enthusiasm or commitment to...

Editor's Note: Dr. Shavelson's extended-length letter can be read here.

RE: Defendants' Experts Deserve a Medal (Elliot Udell, DPM)
From: Name Withheld

I was quite pleased to see the comments about defense experts getting some credit for the work we do for the profession; then there was the comment by Dr. Udell. I'm sure there is some truth in his thoughts about managed care, but the lawsuits I am seeing have little to do with "...massive, often unnecessary, elective foot surgeries."  In almost all the cases that come across my desk, the allegation is for one procedure. Defense experts have a great deal to do with successful verdicts and deserve [anonymous] credit for what we do.  While we are at it, the lawyers that I work with deserve a big "atta boy" as well. 

In my experience, many of the experts against me are qualified with credentials. I have my thoughts why they are so quick to testify against other podiatrists but obviously I can't prove them. I have been an expert for close to 30-years and have seen just about everything. I feel quite strongly that practically all podiatric surgeons are trying to do the right thing for their patients, but obviously "shit happens." As you know, a bad result does not have to equate to malpractice. I wish some of the plaintiffs' experts knew that.

Name Withheld

EQUIPMENT FOR SALE -  REVO VASCULAR SYSTEM

REVO vascular system for sale, 3 years old, excellent condition, all probes and digit sensors in excellent working condition. Asking $4,000 or best offer. Please contact drkhoury@nefas.us

EQUIPMENT FOR SALE – 2 MICROVAS UNITS

2 used Microvas units (approximately 5 years old) for sale at $6,,000 each plus shipping. Each unit includes 1 carrying case, 8 flex cable leads, 1 battery charger. Paid $16,000, for each machine. Great way to add therapy modality to your practice. Contact: DrBlatstein@comcast.net

EQUIPMENT FOR SALE - (2) MICRO-VAS UNITS
 
Less than one year old. Barely used and in excellent condition. We have seen remarkable improvement in Diabetic neuropathy, tendonitis, fibromyalgias, and atypical neuropathies. Also works great to reduce limb edema. Can be used for acute & chronic conditions. Selling $10K each, or both for $17.5K. Contact: coastalmgr@gmail.com

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

EQUIPMENT FOR SALE - ENTIRE PUTNAM COUNTY, NY OFFICE

Moving from location. 3 PDM chairs, 3 cabinets, sterilizer, waiting room chairs, surgical light, Stryker power equipment, x-ray view boxes, and all other office furniture. Priced to sell. Available after December 23rd. email marshall39@hotmail.com

EQUIPMENT FOR SALE - CRYOPAC, LASER UNITS

1 Cryopac unit for cryosurgery with 3 probes for sale at $1,000 - 1 Class III ML830 nm laser for sale $1,000 - used for pain management and inflammation control, great cash generator.. Contact: klamdpm@hotmail.com

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480 M per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

PRACTICE FOR SALE/LEASE - NORTHERN, NJ

Part-time practice for sale or lease. Flexible terms, will consider lease with option for sale. Structured for a fast sale, first option on real estate. Great opportunity for a start-up or satellite with immediate income. Call 201-573-0555 or 551-574-0776 billfeet@aol.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA - SAVANNAH

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA

Home of Florida State University. Great university town! Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION - NORTHERN, NJ
 
Well-rounded practice. No Nursing Homes or House Calls. All phases of foot and ankle care. Must have good surgical skills and like treating patients. Applicants must take care when doing both Surgery and/or Routine Foot Care. Must be ethical, logical and thoughtful when treating patients. This position can lead to purchase of practice. Send CV to ToeBizCenter@Yahoo.com

ASSOCIATE POSITION - MARYLAND

Multi-office group seeks highly trained surgical associate to join us. Prefer person with frame and trauma experience. Our practice is state-of-the-art and has all modalities: EMR, PadNnet, on-site billing, diagnostic US, PRP, digital x-ray, etc. Excellent salary, bonus structure and benefits with partnership available. Please forward CV and letter of intent to docsbnb@aol.com

ASSOCIATE POSITION - SOUTH WEST FLORIDA

Full-time associate positions for an established group practice in Southwest Florida. Willing to train the right new graduates. Job will involved all aspects of podiatric care. You must be ambitious, hard-working and should have good people skills. Please e-mail your resume/CV to contactus@ankleandfoot.net

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to potential partnership available for a surgeon that is BQ/BC by ABPS. Must be a PSR 24 or PM&S 36 graduate. Salary with bonus. Email CV and samples recent cases done recently to: susmitad86@yahoo.com

ASSOCIATE POSITION - NYC and SW CONNECTICUT

If you are hard-working, motivated, loyal, honest, well-trained, have some common and business sense, and have good interpersonal skills, I have a good job for you. Position is PT to start in NYC, and full-time w/CT license (or when you obtain CT license). Must be ABPS certified/ qualified. We treat from skin-to-bone and from toe-to-ankle. Work w/ nursing homes, multi-specialty medical, and orthopedic practices. Well-respected by the medical community for what we do as DPMs. Potential long-term stable career position for the right person. $50/h to start ($104K for 40h week). Email CV & letter of interest to DPMAssociate@gmail.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM
   

PODIATRY OFFICE TO SHARE - SEATTLE, WASHINGTON

 Fully equipped podiatry office in North Gate area of Seattle. Office located in medical professional building near I-5. Office has 3 treatment rooms, 3 physical therapy rooms, direct digital x-ray, PAD- net, NCV testing equipment, physical therapy equipment. Please contact us: website Tel. 425-643-8901 isbinc2006@gmail.com

FOOT SKELETONS FOR SALE

The Anthropology Department at St. John Fisher College (Rochester, New York) has many sets of specimen-quality, disarticulated human foot (and hand) skeletons. The department (NYDOH licensed) is selling them to institutions that will use them in medical research or instruction to support an endowed fund for a lectureship series. Contact:  Dr. John Rhoades, Chair, Anthropology Department, St. John Fisher College, Rochester, NY 14618 jrhoades@sjfc.edu

SUB LEASING TIME on MRI (NYC)

Don't refer out $$ when they can go into your pocket. Beautiful state-of-the-art 5th Avenue medical office is offering lease time on a .31 tesla Esaote extremity MRI, complaint with Stark laws. This particular magnet is the only one accepted by insurances and Medicare as of 2012. For more information email dri@myfcny.com.

PM News Classified Ads Reach over 13,500 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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.