The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 12, 2007 #3,090 Editor-Barry Block, DPM, JD

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Cosmetic Foot Surgery More Fraught With Problems: SC Podiatrist

For some people, surgery can be a life-saving or life-prolonging event. For others, it's purely cosmetic. One growing type of cosmetic surgery is the "footlift." Mindy Smith, an employee of an Upstate bank is changing her life, one foot at a time. Smith elected to have a bunionectomy, an operation to remove tissue from the edge of the foot, narrowing it. Smith said that she is having the procedure done for two reasons -- because her feet hurt and because it will allow her more choices in footwear.

Dr. Gregory Bentzel

Dr. Gregory Bentzel performed the operation. Popular ways to change feet include correcting hammertoes, having a "toelift," or adding collagen to smooth skin and get rid of wrinkles. Another procedure is called a "toetuck," where toes are made thinner, so patients can slip into pointy, high-heeled shoes. "I know in other parts of the country, it’s becoming more in vogue to shorten toes, because they look too long, and things like that," Bentzel said. In extreme cases, some patients are electing to have their little toe removed altogether

"Foot surgery is a little more fraught with problems than having some cosmetic work done somewhere else," Bentzel said. "The foot has to absorb a tremendous amount of pressure and stress so you should enter into cosmetic foot surgery a little more (cautiously) than you would some other types of surgery."

Source: WYFF [1/18/07]

NYSPMA's Diabetes Outreach Targets African-Americans

In New York City where one in eight residents has diabetes, black New Yorkers have the highest death rate, dying from the disease at three times the rate of white New Yorkers. “African Americans are also almost three times more likely to suffer from lower-limb amputations compared to Caucasians,” says Dr. Wilma Hunt-Watts, an African American New Yorker, a trustee for New York Podiatric Medical Association and chair of the organization’s 2007 Knock Your Socks Off campaign.

Dr. Wilma Hunt-Watts

This year the NYSPMA’s diabetes outreach is aimed squarely at African-Americans because they are considered at such high risk for type-2 diabetes. “It’s important to know that something as simple as a foot exam can reveal the first warning signs of diabetes and could save a limb,” Dr. Hunt-Watts says. The campaign begins in November, Diabetes Awareness Month, and will continue throughout the year.

Podiatry to be Included in AMA's New Health Care Careers Directory

The American Medical Association’s Health Professions Career and Education Directory will be expanded to include the following professions: Dentist, Nurse, Optometrist, Pharmacist, Physician, Podiatrist, Psychologist, Veterinarian, Veterinary Technologist and Technician.

To reflect the book's new focus, it will be renamed the Health Care Careers Directory beginning with the 2008-09 edition. Reasons for expanding the Directory include consumer demand, the need for awareness of career opportunities in a variety of healthcare fields, troublesome health workforce shortages, and the ever-changing definition of "allied health."

Source: AMA Health Professions e-Letter [November 2007]

Query: Botox for Muscle Imbalances

I recently saw a patient with a residual clubfoot that a local orthopedist had suggested Botox injections for to decrease the progression of positional and structural changes. I have given some thought to the prospects of Botox injections in the intrinsic muscles of the foot for the same “theoretical” reason. I was wondering if any of my avant-garde colleagues have used Botox in this arena (not simply for hyperhydrosis) to manage intrinsic muscle imbalances or to augment surgeries, especially tendon transfers?

Tip Sullivan, DPM, Jackson, MS

Query: Epic EMR

Our hospital is installing Epic EMR. They will be providing space on their server for private offices to use this EMR program (following Stark II guidelines). Has anyone had any experience with Epic EMR in a podiatry practice? If so, how has this program worked for you?

Stanton Cohen, DPM, Yuma, AZ

RE: Coming 10% Medicare Cut (Robert D. Teitelbaum, DPM)
From: Multiple Respondents

I read with interest Dr. Teitelbaum's posting regarding the impending 10% cut for the Medicare Physician Fee Schedule. Clearly, if enacted, this will have a devastating affect on the entire system of reimbursement for physicians. The bottom line is what can and will we do about it? APMA is currently involved with our coalition partners to convince Congress to fix this fee cut with a modest increase this year.

Additionally, we are working with our coalition partners to convince Congress to replace the flawed SGR process that is responsible for the current 10% decrease and predicted decreases for the foreseeable future. These are political battles that must be waged until a permanent change in the way we compensate physicians is determined. All of us have a responsibility for political activism. The APMA needs our grassroots membership to contact your Senators to urge them to act now to prevent the decrease from occurring. You can access your Senators via the APMA eAdvocacy website by visiting www.apma.org. This is an effective way to let them know that a fee cut is unacceptable.

Ross E. Taubman, DPM, APMA President-Elect, Clarksville, MD,
retaubman@apma.org

I couldn’t agree with Dr. Teitelbaum more. One thing we are all forgetting, or not aware of, is this concept: If the government or the insurance companies are already telling us what to prescribe, where we can send our patients for surgery or lab work, how often they can visit us, or if they have to get a referral before they see us AND determine what they will pay us, are we not considered employees? If we are considered employees, then are we not entitled to benefits?

I'd be very happy for them to pay for my malpractice, supplies, health insurance for my staff and family, paid vacation and retirement. Our colleagues will look at this say " Oh yea, right, that'll never happen" Well, we never thought it would get this far, but it did. I do believe we only have a few options: 1.Keep takin' it until they choke us. 2. Take it back. But this is nearly impossible and too much ground to make up.3. Fight for the right to benefits, because we are already employees

John Roseman, DPM, Massillon, OH, roseman@sssnet.com.

I think Dr. Teitelbaum is clearly stating the obvious to all of us who practice each and every day... We should all support APMA in their quest to change the flawed formula that each year keeps lowering our reimbursement. I just have a different take on how to survive. My article in PM Magazine earlier this year "Surgery's Fun...... But Fungus Pays the Bills" is a tongue and cheek title, clearly looking at the BIG picture. Re-engineering of us practice is the only way to survive. If you practice today the same way you practiced 5 years ago, you’re in trouble. New ideas, new technologies and new protocols are needed.

I earn more double the total income today per patient than I did years ago. I leverage DME, ancillary tests, home nursing and others all to generate more income. Podiatry is a wonderful way to earn a living, you just need new "glasses" to see it !

Bret M. Ribotsky, DPM, Boca Raton, FL, Ribotsky@Doctorbret.com

Editor’s note: Dr. Ribotsky, a nationally-known speaker will be part of the 2008 PM News/Codingline/AAPPM Coding and Practice Management Seminar in Kona, Hawaii. See www.podiatrym.com/hawaii for details.

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.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

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