The Voice of Podiatrists

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November 09, 2007 #3,088 Editor-Barry Block, DPM, JD

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African-Americans at Higher Risk For Type-2 Diabetes: APMA Campaign

Considered high risk for type-2 diabetes, African-Americans are almost three times more likely to suffer from lower-limb amputations as their Caucasian counterparts. For this reason, the American Podiatric Medical Association is urging African-Americans to take off their shoes and socks at every doctor's visit to check the feet for signs and symptoms of the disease as part of its “Diabetes is a Family Affair” (DIAFA) campaign.

Dr. Christian Robertozzi

Focusing on the impact that the disease can have on the entire family, APMA will launch a national effort educating consumers that something as simple as a foot exam can reveal the first warning signs of serious diseases, such as diabetes and maybe even save a limb.

“Because diabetes can run in the family, it's important that families discuss the disease and its warning signs,” said Dr. Christian Robertozzi, APMA president. “Family members can also ensure a person with diabetes maintains a proper diet, increases exercise, performs daily foot inspections and keeps a positive outlook.”

Source: The Auburn Citizen [11/6/07]

Surgical Specialties Come Together in Korea around "Shared Vision of Limb Salvage"

A novel "Meet the Professor" session was held Thursday, November 1 in Seoul, Korea that brought together leading minds in orthopedics, plastic surgery, and podiatry for a single reason: to prevent foot amputations.

Drs. Armstrong and Woo

The session, co-chaired by Jin Woo Lee of Yonsei University Department of Orthopaedics and Chang Wung Oh, Chief of Orthopaedics at Kyungpook National University Hospital, Daegu, Korea, featured keynote speaker David G. Armstrong, Professor of Surgery and Associate Dean at Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science and the James A. Lovell Federal Healthcare Center in Chicago.

"The concept of shared techniques and strategies is a very potent one that, if allowed to cross borders, can make a difference. I think that's what happened tonight," noted Armstrong. "This talented group of surgeons shows that passion and ability, when combined, are a force to be reckoned with."

IN Podiatrist Elected to Hospital Board of Directors

Gerry Hash has joined the Monroe Hospital Board of Directors. His addition, coupled with the resignations from the board of co-founding physicians Dan Grossman and Kamal Tiwari and former interim Chief Executive Officer Mike Soisson -- brings the total number of board members to seven.

Dr. Gerry Hash

Hash is a Bloomington podiatric surgeon and was a board member since the hospital's inception, then left the board when Tiwari and Grossman stepped down. He has since been voted back onto the board by his peers.

Source: Herald-Times (Bloomington, IN) [11/06/07]

RE: Level of Amputation (David Gurvis, DPM)
From: Jon Purdy, DPM

We work closely with excellent vascular surgeons associated with CIS (Cardiovascular Institute of the South). When I have a patient with a questionable success rate following a level of amputation we talk with the vascular surgeons. After sending them over for evaluation and treatment, we get a detailed report with the findings and outcomes.

Make sure you have surgeons that are able to perform some of the latest treatment in revasularization of vessels below the trifucation. Ours may do laser, angio, stent, or bypass procedures. Taking into consideration the patient's co-morbidities, infection, trans cutaneous finding, nutrition, compliance, the clinical picture, etc, you then have a decision to make. My vascular surgeons and I have each other's cell numbers and they are very good at communication. They do not do amputations and admittedly do not know what the most likely outcomes of amputations will be when it is on the edge. They ask me what I think based on my experience and their findings after intervention. There is not always a clear cut picture, as there is much more involved than just blood flow.

If the picture is iffy, I have a long talk with the patient and tell them I will make one attempt if I feel there is a 50/50 or better chance of healing. I also tell them they have to talk me into doing the procedure. I never let them give me an answer that day in the office. I have them call me the following day. Other than that I will not do it. I also give them the "get on with your life BKA" scenario. If my amputation fails, we will both be highly disappointed, but no one will be surprised.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Employee Theft (Name Withheld)
From: Tip Sullivan,DPM, Steven N. Solomon, DPM, JD

I can admit that the same situation has occurred in my practice. Basically I will never know the extent of the embezzlement, but once that person was gone my numbers increased by at least 15%! What to do? I reported the issues but after seven years nothing has been done to my knowledge. Recovery of money? The attorney who advised me basically said that the process to recover any money, including attorney fees, forensic accountant fees, time, etc. in most cases is just not worth it. He said that unfortunately there are people out there that do this repetitively. The process to catch them and prosecute is so cumbersome that it is rarely successfully pursued. It is a tough lesson to learn!

My ex-office manager of 15 years was a trusted employee. I became so use to her handling things that I allowed my system of checks and balances to slip. I guess the lesson here is that regarding running the office you are in ultimate control. People, even trusted long-time employees can succumb to temptation. If you don’t have some type of monitoring system, you need one. I went to my accountant for help. Now, if my accountant and my office manager got together—I could be in trouble. Stay vigilant with your system, whatever it is!

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

It is always sad when the trust of a long time employee comes into question. As the editor suggested, contact your local District Attorney and have them investigate this matter. Also contact your bank and deny permission for your office manager to access your account. You should also restrict access to your office financial records so as to prevent any tampering and you may also wish to restrict access to all other records.

As your manager is most likely an "at-will employee," you may wish to sever her employment. I would consult with an attorney beforehand just to make sure that you do not violate any employment laws. I would also make sure that any firing that you do is done privately so as to prevent a potential slander lawsuit. Hire a forensic accountant, as they typically have more experience tracking down illegal or questionable activity. It is also imperative that you create a system that allows you to reconcile your payments with what is deposited.

At a minimum, every office should undergo a professional audit every year or so. Additionally, do a surprise inspection of one or two accounts every month. Holding monthly meetings with whoever is handling the money is also a good idea. Any employee who claims that they are insulted that they are being checked up on or claims never to have the time to review the finances with the doctor must be told that this is how the practice is to be run and that this is just business.

Without simple oversight of the finances and procedures, practices are put at a greater risk of illegal or improper activity which can cost them some of their hard earned income. I hope that this is a wakeup call for everyone to make sure that their house is in order.

Steven N. Solomon, DPM, JD, New York, NY, LegalFoot@yahoo.com

RE: Cerner Wisdom Software (Carl Ganio, DPM)
From: Multiple Respondents

We also have had WISDOM software for 20 yrs+- now Cerner. We had some initial problems with NPI but they were able to trouble shoot it. I bet most of the software companies had some issue to resolve in the transition.

Gregory Mangum, DPM, Houston, TX, gregorymangum@aol.com

I have been W/ Cerner/Wisdom/Vital Works/DR Software for many years throughout all of their takeovers and have recently opted out. Their support became a major problem. I would like to highly recommend the software co. that I stumbled upon during the NY conference. The name is Sammy 2000. They are a software company that is based strictly for podiatry and I believe chiropractic. It has made life very easy for billing, collections and for me a beginning for electronic notes. It has been very exciting.

Robert F. Weiss DPM, Darien, CT, Rfw350@aol.com

We have had Cerner's Wisdom software for the past year and a half and it has been a total nightmare. The original DR program was fine. The problems began when Cerner took it over. The problems we've had are too numerous to list. Customer service is a joke. The conversion process was not easy, either. I would love to throw the whole thing into the ocean and start over, but it would be about a $12,000 loss. Needless to say, I would not recommend Cerner for anything.

Doug Milch, DPM, Asheville, NC, LDMilch@cs.com

DPM-PT POSITION AVAILABLE - NEW JERSEY

Podiatrist/Physical Therapist dual-degree (DPM-PT) needed to join expanding 2 DPM practice and develop an internal Physical Therapy department with strong emphasis to all phases of Podiatric PT; including foot/ankle surgery, sports medicine, peripheral neuropathy and advanced wound care. Will hold position for right candidate. CV/Questions: pat_caputo@alumni.rutgers.edu

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

PRACTICE FOR SALE - MISSISSIPPI GULF COAST

Near Casino's and beaches. Busy Practice with no HMO's and good insurance coverage. Hospital and Surgical Center privileges available. Call (228) 762-9531 or email me at jwbenus@yahoo.com

M.R.I FACILITY FOR RENT - NYC and LI

Extremity machine, reads are performed by board certified radiologist, global billing performed by D.P.M location; 121 East 60th street, NYC (Manhattan) 459 South Oyster Bay Road Plainview NY. Call for information and questions. 516 476-1815

PART-TIME LONG-TERM CARE OPPORTUNITIES- Chicago, Peoria, & East St Louis areas

We specialize in providing conservative care to residents in long-term care settings. Immediate part-time positions available. Very flexible scheduling. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300, or Fax resume to 773-775-0883

PRACTICE FOR SALE -VENTURA, CA

Satellite office in Ventura, CA. Located very close to the hospitals and referral sources. Potential for further future growth. Nice coastal community and nice weather all year around. Inquire at tkhk@sbcglobal.net

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