The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 12, 2010 #4,009 Publisher-Barry Block, DPM, JD

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Correction

In the story about AAPPM's Cigars with the Stars event, we inadvertantly omitted Top Practices as one of the sponsors of this fundraiser. We apologize for this oversight.

Laser Useful Who Those Who Can't Take Oral Meds: CA Podiatrist

A laser used to treat nail fungus at the Agoura-Los Robles Podiatry Centers was approved last week by the Food and Drug Administration. Although there are several types of laser systems used to treat nail fungus, this is the first approved by the FDA.

Dr. Michael Zapf

“We believe that laser has a role in treating fungal nails, especially if someone cannot take an oral medicine because of a health risk,” said Dr. Michael Zapf, a podiatrist with the Agoura Los Robles Podiatry Centers. “No one method of treating fungus is 100 percent effective, so we do not use the laser exclusively. Instead, we choose the best method for each patient whether that might be the use of a topical medicine, oral Lamisil therapy, the PinPointe fungus laser, or a combination of these treatments.”

Source: The Acorn [11/11/10]

Canadian University Confers Partnership Award On NYCPM

During a ceremony held on Monday, November 8, the Université du Québec à Trois-Rivières (UQTR) conferred its partnership award on the New York College of Podiatric Medicine. The award highlights the vital role played by NYCPM since 1995 in the conception, implementation and development of the undergraduate Doctor of Podiatric Medicine degree offered by UQTR. Through a unique collaborative effort between the two institutions, the program - the only one of its kind in Canada and in the French-speaking world - was launched in the fall of 2004. Dr. Michael J. Trepal, NYCPM Vice President for Academic Affairs and Dean, accepted the award at the ceremony on behalf of the College. 

Signing the Université du Québec à Trois-Rivières (UQTR) Official Book: (L-R)) Ghislain Bourque, Rector of UQTR, Dr. Michael Trepal, and Michèle Laroche, President of Board of Governors of UQTR.

NYCPM faculty often come to UQTR as visiting professors. Thus, UQTR-trained podiatrists obtain reputable training based on the teaching and research carried out at the NYCPM. This award is both a token of appreciation for the NYCPM’s exemplary commitment and a wish for continued and fertile collaboration between our institutions in teaching and research.

CCHIT Creates Alternative Certification  

The Chicago-based Certification Commission for Health Information Technology has announced the Dec. 15 launch of a certification program for electronic health-record systems for hospitals that have either home-grown EHRs or systems developed with component parts that are not otherwise certified as compliant with requirements of the federal IT subsidy program under the American Recovery and Reinvestment Act of 2009.

Systems tested and certified under the new program, dubbed the EHR Alternative Certification for Hospitals, or EACH, will be recognized by the Office of the National Coordinator for Health Information Technology as meeting certification criteria under the stimulus law and be on equal legal footing as commercial systems that have been tested and certified, according to CCHIT spokeswoman C. Sue Reber.

Source: Joseph Conn, Health IT Strategist [11/10/10] 

Scrutiny Sought for Repeat Offenders on Medicare Claims

The OIG has targeted the integrity of Medicare payments as one of the top management challenges facing the Centers for Medicare & Medicaid Services. From fiscal 2005 to 2008, the agency said it located 740 repeat offenders, including physicians and suppliers of medical equipment that had at least one error in each audit year and referred to them as "error-prone providers."

CMS could significantly reduce the incidence of improper payments by focusing on these physicians and suppliers, the OIG said. Specifically, it recommended that CMS:

• Use available error rate data to identify error-prone physicians and medical equipment suppliers.
• Require them to identify the root causes of claims errors and develop and implement corrective action plans.
• Monitor corrective action plans.
• Share error rate data with contractors, such as recovery audit contractors and quality improvement organizations, to assist in identifying improper payments.

  Source: Chris Silva, AM News [11/8/10]

Promote Specialized Procedures

Focus the content on your website to the areas of podiatry you are most noted for or want to promote. For example, if you're looking to promote laser treatment for toenail fungus, link an image on your homepage of the laser in action to a separate page specifically about laser treatment. Engage potential patients further by producing a one to two minute video about laser treatment which runs on the page.

Source: Gary Ignotofsky

Query: Procedure for Flail 4th Toe

My patient is an active 60 y/o female nurse and aerobics instructor. She had a 4th metatarsal head resection done years ago for an apparent sub-4 IPK. Although the IPK is now gone, she has a flail 4th toe, and contracture of the digit. She requests surgery. My advice was a syndactyly of the digit to the 5th toe. She refused.

Post-op Flail 4th Toe

What other surgical options do I have? She wants a "quick recovery"; therefore, I am hesitant to try distraction diastasis or bone grafting with plating. I would hate to offer a 4th toe amputation, but this may be most practical.

David Weiss, DPM, Richmond, VA

Query: EHR Subsidy

In order to qualify for the EHR govenment subsidy, must one be a participating provider and accept assignment on all claims? If not, is the required $24,000/quarter minimum billed amount the approved fee or the non-participating fee?

John Moglia, DPM, Berkeley Hts, NJ

RE: Positional  Reddish/Purplish Blotches (Michael J. Ryan, DPM)
From: Jordanna Baker, DPM 

It sounds like a vasospastic condition. I would consider livedo reticularis, Raynaud’s syndrome or scleroderma. She fits the age range. I would test temperature responses with cold spray or alcohol to elicit a response. Possibly a plain lidocaine injection can elicit a response as well. The pain is usually from the ischemia and constriction of the vessels. Walking barefoot or sitting with the bare feet on the ground may exacerbate this. The lack of neurological response may be from the thyroid condition.

Jordanna Baker, DPM  Myrtle Beach, SC, jbaker@coastalpodiatry.com

RE: Fasciosis vs. Fasciitis
From: Tip Sullivan, DPM 

In 2006, Dr. Stephen Barrett wrote an article which inspired me to look at the way I treat heel pain. I have played around with it for several years using mostly mechanical modalities, which were suggested more for treating the "fasciosis" on some patients, and on others using a strong medical approach to the inflammation component (itis). I did not keep data or design a prospective cross-over study -- just a simple "what happens when I do this" type of thing.

I am sure there will be...

Editor's note: Dr. Sullivan's extended-length letter can be read here.

RE: Three Strikes and You're Out? (H. David Gottlieb, DPM)
From: Robert Kornfeld, DPM, Barry Mullen, DPM

I submit this article appearing in The Lancet. This is certainly food for thought and hopefully many will take pause and reconsider the long-term effects of cortisone injections used on tendinopathies. There are many alternatives out there that relieve pain and inflammation and do not weaken tissues or interfere with successful healing of the tissues. 
 
Robert Kornfeld, DPM, Manhasset, NY  Holfoot153@aol.com

Dr. Gottlieb cites Dr. Lemont's decision to try one steroid injection because he postulates that plantar fasciitis is really a "fasciosis." Doesn't that seem inconsistent to you? Fasciosis implies a non-inflammatory condition. If true, why inject a steroid? What is Dr. Gottlieb's reference that supports that plantar fasciitis is a fasciosis?

I have seen references that postulate that when tension is not relieved on strained plantar fascias, at some point, they progress to...

Editor's note: Dr. Barry Mullen's extended-length letter can be read here.

RE: Federal HIRE Tax Credit For New Employees
From: Palmer Branch, DPM
 
I would like to thank PM News for posting the information about the IRS tax credit for newly-hired employees. I strongly urge any PM News readers who have not done so to look into the Hiring Incentives to Restore Employment (HIRE) Act. My accountant looked into this after I brought it to her attention and found the IRS publication, which is 4865 (6-2010), Catalog 55220Y, available at IRS.gov. As I read the IRS publication, basically, you may claim an exemption from the 6.2 percent share of Social Security tax paid to qualified employees for wages from March 19, 2010 through December 31, 2010. 

You may even be able to do a retroactive claim going back to the date of hire for previous payments in 2010. This will be claimed on Form 941, Employer's Quarterly Federal Tax return beginning with the second quarter of 2010 or the annual 944 form. There is a W-11 form which is an attestation of previous unemployment that the new qualified employee has to sign. To be listed as a "qualified employees," they have to have been unemployed or worked only 40 hours or less during the 60 days prior to beginning employment. There also is a tax credit of up to $1,000 if the employee stays employed for at least a year, and the wages are not significantly reduced in the second half of the year.
 
Disclaimer: I am not a tax expert and have provided the above information for review by you and your accountant or tax advisor(s). Ask them (not me) for any advice on filing.  
 
Palmer Branch, DPM, Cumming, GA, drcuboid@aol.com

RE: Web-Based EMR Systems (Charles Morelli, DPM)
From: Sloan Gordon, DPM

I have read with interest the 'debate' over EHS and EMR. The two main hospitals I work at both have completely electronic systems. They are both relatively easy to use and user-friendly. I would only go with a web-based system as I have more than one office, which makes the system 'portable', including using it at my home.

I had my office data backed up on office servers, and then those darned hurricanes came to Houston and wiped out one of my...

Editor's note: Dr. Gordon's extended-length letter can be read here.

SEEKING EMPLOYMENT OPPORTUNITY - NORTHERN, NJ

Looking to relocate my current position closer to home. I am honest, ethical, punctual and hard-working. PM and S-36 trained with over four years of work experience. Seeking a full-time employment opportunity starting as an associate with the potential for partnership in the future. If interested, please contact footdoctor36@gmail.com

ASSOCIATE POSITION – NORTH, CENTRAL & SOUTHERN ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate to start immediately. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

POSITION AVAILABLE -  NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening for the right candidate. Join a well-established podiatric group in Southwest Florida. We are a multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated individual. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Please respond to JLH459@aol.com

ASSOCIATE POSITION - CALIFORNIA

Busy, surgically-oriented practice in Bakersfield, CA seeks ABPS qualified/certified surgeon to join our existing two surgeons. Must be hard-working and honest. Strong reconstructive surgical practice with trauma privileges and wound care center/diabetic limb salvage center. Starting in December or January. E-mail CV to aghams2@aol.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

PRACTICE FOR SALE - CONNECTICUT

Outstanding solo practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss.Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

ACTIVE PRACTICE FOR SALE - NYC

Part-time practice, capable of expansion to full-time, desirable Mid-town Manhattan location, fully-equipped, established for over 30 years. Doctor is retiring. (212) 247-5148 Fax (212) 581-0148.

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