The Voice of Podiatrists

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November 24, 2008 #3,408 Editor-Barry Block, DPM, JD

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Bunion Surgery is Last Resort: CA Podiatrist

Dr. Carl Wagreich of Torrance, CA says, "The foot is an incredible architectural structure, but if it is out of alignment, it can create such as problems as sciatica and bunions." From flat arches to bunions to pinched nerves, Carl Wagreich works to make his patients' feet easier to walk on. A practicing podiatrist since 1979, Wagreich decided on his profession after spending a day with a neighbor who was a foot doctor.

Dr, Carl Wagreich (Photo: Steve McCrank)

Wagreich, 58, earned his degree at the Illinois College of Podiatric Medicine. The Rolling Hills Estates resident also spent the past 20 years working with the Medical Board of California as a consultant, evaluating medical complaints and monitoring podiatrists on probation.

"My philosophy is as well-trained as I am in surgery, surgery is always the last resort. For bunion patients, what I'll do is make them an orthotic first. So I'll get them into the right shoe. About 90 percent of the time, if they're compliant, they don't go on to need bunion surgery."

Source: Muhammed El-Hasan, Torrance Daily Breeze (CA)[11/20/08]

Query: Polyarthropathy

I have a 39 y/o female patient who has obvious swelling and stiffness of both hands (at the MPJ's and PIPJ's), both wrists, both feet (MPJ's and PIPJ's), and pain in both ankles and knees. She also has a scaly lesion on her abdomen and had one on each foot (they were gone when I met her). The onset was in February. She has morning stiffness, which gets better after an hour or so, but never really goes away. The x-rays of her feet show no obvious signs of RA or psoriatic arthritis. Her rheumatologist told her she had psoriasis, but gave her no treatment options. Her dermatologist did a skin biopsy which revealed pytoriasis rosea. She was told by her PCP not to go on steroids, as she would become dependent on them. I did blood work (ANA, ESR, CRP, HLA-B27, RF). Any other ideas or suggestions?

Kerry Temar, DPM, Maineville, OH

Query: Marketing to Pediatricians

Can someone suggest some ideas to market directly to pediatricians in an effort to increase the pediatric patient population in our practice. What are some efforts that have been successful?

Chad Schwarz, Howell, NJ

RE: Surgical Loupes ( Patrick Barnes, DPM)
From: Multiple Respondents

I have been using surgical loupes for many years. I had first ordered them through "Designs for Vision" and found them to be good quality, although VERY expensive, and the customer service virtually is non-existent. After I had LASIK surgery, my Rx changed, and I needed another pair. I looked online and ordered a pair from a company called LoupeDirect dot Com. These were 3x mag, which was perfect for foot surgery - especially neuromas, tumors, and even for wound surgery. I paid less than $700 for them, and they are a superior quality than the Designs for Vision set - which were over $2,000. I bought a second pair with a 5x magnification, which was really amazing - but remember the more magnification, the less field of view and the MORE light is needed. Nevertheless, it makes the world of foot & ankle medicine so much more fascinating!

David Weiss DPM, Richmond, VA, podmed@mac.com

In 2000, I used Designs for Vision in New York. It has 2x power. If you go with a higher magnification, you'll need to add a wider field which adds to the price. A rep came to the office and measured me.

Jennifer B. Ryder, DPM, Rapid City, SD, jenbenryder@yahoo.com

I have been using Design for Vision for over 20 years. I find either the 2.5 or the 3.5 extended view lens great for what we do. They're a little expensive, but since this investments lasts a career, it’s worth the extra few dollars. And since I have my name engraved in the temple area, I am not worried about them being stolen.

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@yahoo.com

RE: Jim Skesavage

James S. Skesavage passed away Friday, November 14th. He founded JMS Plastic Supply Inc. in 1981 and served as president until his death.

Jim was the type of man who was just as interested in the health of your business, as he was in his own. He revolutionized the material supply business for orthotic manufacturers and podiatrists. Together over the years we had many long conversations about business, his grandkids, and our boats. I considered him a friend first, and then a supplier. The industry will miss his innovative ideas and compassion for life.

Jim Rothberg, American Orthotics Lab.

RE: Time for Single Board Certification (John Chisholm, DPM)
From: Diane Branks, DPM

One certifying board, one standard of podiatry training, one APMA-affiliated educational college, one standard of residency training to practice, one profession standardized nationally to the same levels as an MD or DO -- to me that is Vision 2015. SIMPLICITY!

We will never get parity unless we pull ourselves up by our boot-straps and recognize the holes in our profession, no matter how painful or embarrassing it is to acknowledge it. We are 20-30 years behind the times compared to our MD and DO colleagues. It is unbelievable that there are still states in the USA that do not require residency training in order to practice. That is archaic! It is no wonder we are continued to be criticized as a profession and not seen to be on par. We may argue that the MDs and DOs have many levels of programs. They, however, are dealing with many body parts. We are only dealing with one part of one body that we first and foremost must understand to the same level as the MD and DO.

We must get into the mindset that we are one profession and visualize what defines the future podiatrist. Whatever we end up doing, it is imperative that we continue to support the APMA as our nation's unifying body under Vision 2015.

Diane Branks, DPM, Baldwin Park, CA, barrydiane@hotmail.com

RE: NY Podiatrist Overbilled State: Audit
From: MultBryan C. Markinson, DPM, Brian Kashan, DPM

This is only the tip of the iceberg. About six months ago, state auditors uncovered a group of Long Island surgical centers that routinely forgave deductibles and co-payments for out-of-network cases, because much of the time, as everyone knows, out-of-network reimbursement is much higher even with forgiving these charges. It was only a matter of time before they started looking into physicians doing the same thing. The reason it is only the Empire plan at the moment is because this is a state-funded insurance program, directly paid for by taxpayers.

Everyone knows that the success of practicing out-of-network for most podiatrists involves forgiving of these charges in large measure. The fraud aspect is that the charges you bill for are not actual, but a fantasy when you do not balance bill the patients. State law is not very clear on the mandate for billing deductibles and co-payments, but federal law is. However, the attorney general's big bite can be under the heading of unfair business practice, which forgiving these charges really is. It is therefore only a matter of time before private insurers begin to do what the state has done. The "out-of-network" gravy train is therefore over...unless practitioners really start collecting a fee that the patient is aware of and consents to before the procedure is done.

Bryan C. Markinson, DPM, New York, NY, Bryan.Markinson@mountsinai.org

When patients ask me why they have to pay when they come to my office when their friends go down the street to another doctor and "never have to pay," I answer them as follows.

"I am not sure what services your friends are being provided. Nor do I know their medical history or conditions. However, these laws apply to everyone. I am not going to prison so you don't have to pay to have your toenails cut, and if you want to have your services here, you will need to pay." I try to say this almost jokingly and not demeaning.

Then, if I get similar comments about the same doctor,I call the doctor and ask him directly, "What criteria are you using for your patients for covered and non-covered footcare?" Frequently, the doctor is billing correctly and the patient was in error. If that is not the case, at least the doctor knows that word is getting out about what he is doing and he will be more diligent.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

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 part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION –GEORGIA

ISO CONSULTING/MANAGERIAL OPPORTUNITIES FLORIDA

Established practitioner, with extensive clinical and practice management experience, is retiring to Florida, and is seeking consulting/managerial opportunities within podiatry or in general health care in the Broward County/Palm Beach County area. Could also provide expertise in product/educational development. Please email responses to retiredpod@gmail.com

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we’re in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

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

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

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