The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 23, 2009 #3,708 Publisher-Barry Block, DPM, JD

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NY Podiatrist Concerned About Three Year Old in Heels 

The latest image of three year old Suri Cruise in heels was on a rainy November afternoon in Boston. As her mother wore a winter coat and rain boots, Suri stumbled through puddles in the open toe shoes without socks, even losing her footing at one point. This concerns Manhattan podiatrist Oliver Zong for several reasons. First, if she has trouble maintaining her balance, she could take a dangerous fall and sustain a serious injury. Second, she could potentially damage a growth plate with unforgiving shoes.

Dr. Oliver Zong

“With an adult, [high] heels that don’t fit properly can lead to hammertoes or bunions, but an adult’s growth plate is closed. With a child that young, her growth plate is still open, so a pair of heels that is too tight could damage the growing bones of her feet.”

According to Zong, a child’s foot size can change in just one month, so it's important for parents to constantly check the child’s foot size. Suri has been photographed in the same pair of heels several months apart. “A child’s proper growth could face serious problems if a growth plate is crushed,” Zong said.

Source: Fox News [11/20/09]

NYCPM is Part of Renamed NuHealth

The parent company of Nassau University Medical Center has renamed itself in hopes of connecting with its community in a new way. In September, the board of directors for the Nassau Health Care Corporation (NHCC)  – which consists of Nassau University Medical Center (NUMC), the A. Holly Patterson Extended Care Facility and five Family Health Centers – became the NuHealth System.

Louis L. Levine, CEO and President of NYCPM

Not only a presence in the local Nassau community but throughout New York, NuHealth is academically affiliated with the North Shore-LIJ Health System, SUNY Stony Brook, the New York College of Osteopathic Medicine, and New York College of Podiatric Medicine, among others.

According to Louis L. Levine, president and CEO of the New York College of Podiatric Medicine, this relationship is “strong and valuable.”  Said Levine, “The New York College of Podiatric Medicine has an excellent relationship with Nassau University Medical Center, one that is valued on both sides. We are hopeful that NYCPM can do even more with them in the future.”

Source: Rachel Shapiro, Hicksville Illustrated News [11/20/09]

NY Podiatrist Discusses Healthcare Legislation

Dr. Roger Hans, a podiatrist with Astoria Advanced Foot Care and Sunnyside Family Footcare doesn’t believe the bill will make it past the intense scrutiny it will be subjected to by the Senate. “It’s a specious bill — to claim that more healthcare services will be offered to everyone and they are going to save money at the same time,” Hans said. “They are basing it on being able to reduce fraud and abuse in the system, but if they couldn’t do it before, what makes them think that they are going to be able to do it now?

Dr. Roger Hans

Hans asserted that the money will have to come from an increase in taxes or a reduction in the reimbursement received from insurers.  “Americans should have healthcare insurance, but you can’t just give it away,” he said.  Hans, who reported seeing his malpractice insurance more than double over the last three years, from $20,000 in 2007 to $41,000 in 2009, says one of the most important aspects of healthcare reform is tort reform, which he says was hardly discussed during the creation of the bill.

Hans said he doesn’t want payouts to be limited for people who deserve them, but would like a better vetting process to ensure that people aren’t allowed to sue “just because they feel like it.” “Overall, it will be a disaster,” Hans said of the bill as it is currently written. “Hopefully, they will get tort reform and illegal aliens paying into the system.”

Source: AnnMarie Costella, Queens Chronicle [11/19/09]

CT Podiatrist Concerned About Carrier's Loss of Data

The Shelton, CT-based insurance carrier HealthNet admitted Thursday that it has lost a hard drive with information on over 440,000 state residents and an unknown number in the Torrington area. According to HealthNet, the hard drive contains private personal and financial information, such as names, addresses, and social security numbers of 446,000 customers in Connecticut as well as customers in Arizona, Connecticut, New Jersey, and New York.

Dr. Robert Crovo, a Torrington based podiatrist with a practice on New Litchfield St., is one of them. Crovo said his own practice, which is largely paid through Medicare, would not be affected but said he was concerned about a possible violation of patient confidentiality.

According to Crovo, a patient typically provides a number of otherwise confidential information to his insurance carrier every time he or she pays for a medical procedure, everything from the patient’s name, address, and date of birth to medical diagnosis, procedure, and treatment. “If nothing else, this is a breach of the HIPAA” Crovo said.

Source: Alex Taylor, The Register-Citizen [11/20/09]

Medical Organizations Protest CMS PECOS Policy

Fifty-six medical organizations, including the American Podiatric Medical Association, have signed onto a letter protesting a new CMS policy that, starting Jan. 4, 2010, will not pay claims for services when the referring physician is not in its enrollment database.

According to the Medical Group Management Association, recent Medicare claims have been marked for non-payment if the healthcare provider had enrolled in Medicare before the database, known as the Provider Enrollment, Chain and Ownership System or PECOS, was developed. The letter stated that this affects as many as 200,000 of the more than 793,000 physicians and other healthcare providers enrolled in Medicare.

Source: Andis Robeznieks, Modern Healthcare [11/10/09]

Query: Transdermal Verapamil

I have a patient with a documented plantar fibroma of the distal third of the plantar fascia, medial band. She presented to my office inquiring about a topical, transdermal Verapamil 15% gel made by PD Labs, for non-surgical treatment of her condition. The only literature I have read was product information put out by PD Labs. Does anyone have any experience using this, and if so, would you share your findings?

Eric J. Abrams, DPM Eatontown, NJ

Query: Employee Vacation and Personal Days
 
I realize this can be a very personal matter, depending on the relationship you have with your employees; how long they've been with you, the quality of their work, etc.), but I would like to know how others deal with the issue of paid vacation as well as personal/sick days for your full-time employees. 

I'd like to get a better handle on what is appropriate. One week paid vacation plus sick days as needed? Two weeks paid vacation plus personal or sick days? Paid personal days? Paid sick days? No paid personal days, etc. 
 
Charles Morelli, DPM, Mamaroneck, NY

RE: Candidal Injections (Lynn LeBlanc, DPM)
From: Marc Mizrachy, DPM

I have been performing candidal injections for warts for approximately 7-8 years. Occasionally, I will see a reaction similar to what your patient had. It is not a bacterial or fungal infection, but rather a significant immune response. I've had patients get a fever as well. Assuming you used the correct dose and performed the correct placement of injection, this will resolve all by itself. I have found that if the injection is near a joint (like with your patient) that the joint does seem to remain a little swollen or stiff for several weeks or even a couple of months. This immune response is how this treatment works, so I always find the wart goes away quickly after the treatment.
 
Marc Mizrachy, DPM,  Hillsborough, NJ, marcmiz@optonline.net

RE: Increased Cancer Risk Associated With Supplements Containing Folic Acid (Allen Jacobs, DPM)
From: Elliot Udell, DPM

The analogy of Metanx for neuropathic pain to Insulin for diabetes is ludicrous. Insulin-dependent diabetics will die without it. Metanx, at best, is being used by podiatrists as a possible treatment for pain associated with neuropathy and even that is controversial. The benefit of insulin in patients who need it far outweighs risks. In light of the current published findings, one cannot make the same claim for folate supplements.
 
In the paper just published in the Journal of the American Medical Association,  Dr. Jacobs is correct in citing that the population studied was that of folate deficient patients. The authors called for further studies in populations non-deficient in folate. They also advised doctors to be cautious with prescribing folate supplements in general. The morbidity and mortality was not from cardiac pathology, but from cancer. One theory was that increased folate leads to increased size of tumors. Methotrexate, which is an early chemotherapeutic drug, worked as a folate antagonist. Since diabetic neuropathy patients tend to be older, there is a greater risk of them having early stages of tumors exacerbated by folate. I don't feel morally okay about prescribing folate for my patients. There may even be medical-legal ramifications of this as well. Cancer is a life-threatening disease. DM neuropathic pain interferes with the quality of life.
 
At this point in time, based on the study in JAMA, I will halt  prescribing these supplements and will apprise any patients who I have placed on these supplements of the study in JAMA. Should further research on equally large populations prove the opposite, then and only then, will I feel comfortable prescribing folic acid to my patients.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Malpractice Insurance Options (Keith R. Reber, DPM)
From: Sam Bell, DPM

For the first 13 years of my practice, the profession (at least in New York State)  went through at least six different malpractice insurance companies. Some went out of business (but we were covered by the state insurance pool), and some went out of business leaving some podiatrists with claims and no coverage. It was a disaster. For the past 24 years, I have had OUM, now PICA, with very good coverage and service. Also the price has remained pretty steady for quite a while. One thing I can tell you from all of this experience is that "good coverage and good service" is what is most important, and "low price" is not a criteria to be concerned with.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

PRACTICE FOR SALE - CENTRAL SOUTH CAROLINA

Practice grossing $400,000 annually based on one full-time doctor with two offices. Surgery is currently about 10-15% but can easily be increased. Medicare makes up 52% of revenues. May be able to take over practice with no money down. Interested parties email to footdocsc@gmail.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - PHOENIX, ARIZONA

Part Time/Full Time, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/Trauma. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, ABI Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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