The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

November 17, 2011 #4,308 Publisher-Barry Block, DPM, JD

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Minimalist Shoes are Extremely Risky: NY Podiatrist

They’re designed for barefoot running, a new movement that tries to replicate the unshod experience using barely-there shoes. This practice, which borrows from indigenous peoples who don’t have the luxury of the latest Nikes, supposedly strengthens the foot muscles and allows the feet to move more naturally. But is it safe?

Dr. John Brummer

“If you didn’t grow up running on bare feet, it’s extremely risky, resulting in everything from stress fractures to arthritis,” warns John Brummer, DPM, a spokesperson for the American Podiatric Medical Association, in New York City. Feet not only need protection from hard, uneven surfaces but also require customized support for their unique structure.

Source: Elinor Smith, Fox News [11/11/11]

IFAF Sponsors Two CO Residents for Yucatan Crippled Children’s Project

The International Foot & Ankle Foundation for Education and Research (IFAF) provided an educational grant to the residency program of North Colorado to facilitate its residents to attend the Yucatan Crippled Children’s Project. This exemplifies the ongoing commitment by IFAF to the Barry University’s Yucatan Crippled Children Project.

Dr. Dyane Tower and Ryan Wood

Dr. Daniel J Hatch and two third-year residents Dyane Tower, DPM and Ryan Wood, DPM of North Colorado Podiatric Surgical Residency will attend to many crippled children in two days of surgery at the Orthopedic Red Cross Hospital in Merida this coming February. The YCCP has been in existence for over 15 years.

FL Podiatrist Speaks at State Capitol on World Diabetes Day

To spotlight World Diabetes Day during American Diabetes Month, the Florida Department of Health (DOH) and partners came together in front of the Florida Historic Capitol Museum in Tallahassee, Florida for a press conference which featured speakers who highlighted the importance of diabetes education, prevention, and awareness. 

Dr. Chet Evans with FL State Surgeon General Dr. Frank Farmer

Representing podiatry was Dr. Chet Evans, chair of the Florida Diabetes Advisory Council, a governor-appointed group that advises the Governor and the Department of Health Secretary on emerging diabetes issues affecting care, treatment, and quality of life. Dr. Evans is the Vice President for Medical Education and Program Development and Professor of Surgery at Lake Erie College of Osteopathic Medicine branch campus in Bradenton, Florida. Dr. Evans divides his time as a clinician and an educator to ensure that new podiatrists understand diabetes and its implications.  

Formula 3 President/CEO Killed in Car Crash

A 56-year-old Eaton Rapids man died Saturday when his car left an Eaton County road and struck a tree, officials said. DiMeglio was the sole occupant of the vehicle, a Jaguar, Eaton County Undersheriff, Fred McPhail, said.

Paul J. DiMeglio

Paul DiMeglio, president and CEO of Tetra Corp., was killed in the one-vehicle crash, which happened at about 1:45 p.m. on Bellevue Highway in Hamlin Township, according to the Eaton County Sheriff’s Office. It was clear and sunny at the time, police said.

Source: Kevin Grasha. Lansing State Journal [11/15/11] 

AMA Opposes ICD-10

The American Medical Association's House of Delegates voted today "to work vigorously to stop implementation" of the International Classification of Diseases 10th Revision family of diagnostic and procedural codes, citing the healthcare industry's already full plate for changes and reforms, including the federal push for physicians to adopt electronic health-record systems.

Unlike the federal Medicare and Medicaid EHR incentive payment programs under the American Reinvestment and Recovery Act of 2009, the HHS-mandated upgrade to ICD-10 from the currently used ICD-9 family of codes provides no funds to offset conversion costs to providers, payers and claims clearinghouses.

Source: Joseph Conn, Modern Healthcare [11/15/11]

Set up a Calendar That Works - Part 1

Manage your time effectively in 2012. Choose the right calendar for your work style and plan now how you will use it. Follow these guidelines:

•  Pick one that you can take with you. It doesn’t matter whether you choose a paper or digital calendar, but always carry it with you so that you easily can check your commitments and add appointments. 
•  Use only one. You can’t be in two places at once, so don’t schedule work and personal commitments on separate calendars. Instead, use color coding or categories to distinguish between work and home obligations.
•  Share the openings. Digital calendars make it easier to show people when you are available, either directly through a program such as Outlook or through a Web-based system where you allow people to see your openings and request meetings. If you choose a paper calendar, designate specific times each week that you leave open for meetings, such as Tuesday and Thursday mornings.

Source: Communication Briefings [December 2011]

RE: MRIs and Hardware Placement (David Weiss, DPM)
From: Barry Mullen, DPM

The post-op x-ray demonstrates a faint radiolucent fracture line just proximal to the proximal screw along the dorsal aspect of the 1st metatarsal, dorsal fracture callus, and a loss of the previously achieved capital fragment plantar step down. These radiographic signs intimate secondary bone healing and migration of the 1st metatarsal head from persistent capital fragment micromotion, and reactive ground forces from weight-bearing.

Secondary bone healing is almost always due to lack of far cortex screw thread purchase at the time of surgery, or giving the surgeon the benefit of the doubt, a post-op issue that compromised the osteotomy. Was it something the patient did, or could it possibly be related to the performance of the MRI? hmm.

The first thing I'd do is...

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

RE: Chronic Wound in Type 1 Diabetic (Name Withheld)
From: Jeffrey Kass, DPM

I have a few concerns regarding this diabetic patient with a chronic wound over the styloid process from Name Withheld, namely: 1) On the picture provided, there appears to be peri-wound erythema. Yet, the verbiage in the posting is the wound is "not infected." 2) Name Withheld would like to bring the patient to the OR for bone debridement - I am not sure I entirely agree with this plan. There was no mention of osteomyelits, so why exactly is the reason to remove bone? Is the styloid process hypertrophic in nature?

I think it would be prudent to step back and re-examine the case prior to contemplating removing bone, Maybe ask - Is there an elevated white count? elevated ESR? Is the blood glucose under control? How did the ulcer open to begin with? Are you off-loading, by placing patient in a surgical shoe? Are you sure the wound will heal after you excise that bone? I would consider an oral antibiotic, debride down to the granulation tissue and culture there, take serial x-rays, and consider MRI. I would certainly try Dermagraft or Apligraft prior to considering removing any bone. Hyperbaric oxygen by itself or with PRP can be considered as well. With all these options at your disposal, I don't think the standard of care in this case is to remove bone.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

RE: Medicare Advantage Demand for Repayment
From: Stephen Musser, DPM

About 60+ charts have been audited by a Medicare insurance program. When we called, the company told us that they perform 100% audits on all charts, not just a sampling of patient charts. When we asked specifically if this was a targeted audit, they told us no. Whether you see 2 or 200 charts, they wanted to audit them all. It's been a few weeks now, but still haven't heard back.

Speaking of retaining a good healthcare attorney, how do you go about finding a good one? Any suggestions?

Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

Editor's comment: PM News does not provide legal advice. Although the majority of audits are not targeted, it's often hard to tell when one is. One of the best ways to find a good healthcare attorney is by contacting your state podiatry association.

RE: Diabetic Patient Check-Ups (David J. Kaplan, DPM, Harry Goldmith, DPM)
From: Paul Kesselman, DPM

It sounds like Dr. Kaplan has the PQRS system and CPT coding a bit mixed up. One does not appoint a patient for any examination specifically to satisfy a specific PQRS measure. Reimbursement for a specific evaluation is performed based on a compelling medical rationale for a patient work-up or treating a patient on a specific date. LOPS, as was mentioned by Dr. Goldsmith, may be the exception where a patient may not have any compelling symptoms.

In the real world, for example, a patient presents for at-risk foot care and, while in the office, a practitioner performs PQRS measures. There is no separate CPT code for the exam and one reports the PQRS measure codes which the patient qualifies for.

If, on the other hand, the patient presented...

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

RE: Early Diagnosis of Bunions Can Prevent Foot Surgery (Kevin Kirby, DPM)
From: Robert Bijak, DPM

Dr. Kirby is correct. Rootian biomechanics is "not gospel." It was an ATTEMPT to explain. To date, there is NO accepted proven theory of biomechanical correction through orthotics, except anecdotal, and a few poorly-run studies (ex.- fracture decrease in military trainees). Yet, the schools, labs, and orthotic zealots present arch support theory as dogma.

We need to approach orthotics objectively. Are they significantly different than OTCs (Dr. Scholls)? What degree of benefit is the PLACEBO effect (a universally accepted and recognized effect by ALL scientists). Until we have such studies, I suggest that if the schools still insist on teaching orthotic theory, they present it honestly. 

We all know the scientific fraud in biomechanical measurements. 1 degree for foot varus, 2 degree valgus, perpendicular bisection of the calcaneus without x-ray visualization, on and on. We claim our uniqueness from MD treatments on non-reproducible, essentially meaningless, unproven spatial relations that allegedly determine pathology. "The Emperor wears no clothes." Stop the arch support fabrication and nail cutting, and get on with medicine and surgery. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

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

CPME-CERTIFIED WOUND CARE FELLOWSHIP

Open position available Jan.31, 2012. St. John`s Episcopal Hospital, Far Rockaway New York. State-of-the-art wound care center. All aspects of wound care including hyperbaric oxygen & reconstructive surgery. One year, excellent salary & benefits. Must have completed approved residency and passed boards. Contact Mariann (718) 869-7256

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER ( LUMIX2)

Superpulse 45 watt peak power Laser ( lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPM footcare@comcast.net

EQUIPMENT FOR SALE - CLASS FOUR LASER- USED K-LASERS

I have used K-laser for sale. Still in Warranty. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargeable 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

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 $480K 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 - ARKANSAS
 
Busy, well established practice of 13 years grosses 160K/year for the past 5 years, while working 3.5 days/week. Nursing homes available. 50% Medicare, average of 15 new patients/week. Doctor retiring. Please call 800-983-4194 for more details, or e-mail contactus@podiatrypracticeconsultants.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 CAROLINA

Upstate practice seeking PSR-24/36 trained associate. Full-time position with  partnership opportunity. Must be ethical, highly-motivated with strong surgical and medical skills. Please send CV to palpodiatry@att.net

ASSOCIATE POSITION - ILLINOIS PERMANENT P/T

Podiatrist needed for Medinah Spine/Rehab/Podiatry. Upper middle class suburb multi-disciplinary established office seeks perm P/T podiatrist to service established podiatry practice. Please call SueL 630-529-0077 or fax resume to: 630-529-0087.

ASSOCIATE POSITION – NORTHERN CALIFORNIA / BAY AREA
 
We’re looking for someone entrepreneurial who can help grow our practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. Send your CV and cover letter to cvpodiatrist@gmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager

ASSOCIATE POSITION – NEW YORK CITY/ LONG ISLAND

Seeking an ethical, competent, and responsible associate with a minimum of board qualification, who is proficient in all facets of podiatric medicine, surgery, and biomechanics for a multi-doctor and interdisciplinary medical practice in NYC with suburban NJ/NY satellite offices. Must be able to practice independently with excellent management skills. PT/FT with potential for partnership.ambulatewell@aol.com

ASSOCIATE POSITION - BAKERSFIELD, CA

Busy surgically-oriented group in Bakersfield, CA searching for 4th doctor. Wound care center privileges. All 3 current surgeons have 3+ years post-graduate training. Send letter of interest with CV to: aghams2@aol.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

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. Must be ethical, self starter, hard worker and a team player. Willingness to learn and work as part of a great team is a must. Great ancillaries and surgery facility. Email CV to: susmitad86@yahoo.com

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 - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@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. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV) to northtexaspodiatry@yahoo.com along with a letter of intent

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. 425-643-8901isbinc2006@gmail.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 13,500 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.

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