The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 24, 2009 #3,709 Publisher-Barry Block, DPM, JD

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Screening Can Prevent Amputations in Diabetics: WI Podiatrist

More than ten years ago, Jacquelyn Peterson found out she had type II diabetes. She found out that she had diabetes in the worst possible circumstance, after she had parts of her feet amputated. Her podiatrist, Doctor Jeff Chism, knows she's not alone. "That's kind of what you would consider a failure. There should have been something done to prevent this, but it’s not all up to the doctor...the key is up to the patient," says Dr.  Chism, a podiatrist, "You look at the skin quality, you look at the touch sensation, you look at the color, you check for hair growth, and you can check for a lot of things that all add up to whether or not somebody is getting enough blood supply down there."

Dr. Jeffrey Chism

He showed what could happen if an infection is left untreated. "Sometimes, if you have an infection in one of the toes, it could be something as little as a nail that gets infected and ingrown," he says, ""Infection could spread up into the foot, and then you might lose a portion of your foot, and if that got even worse than that, the leg or your life."

Source: Julia Fello, WSAW [11/20/09]

PPMA Presents Special Honors

The Pennsylvania Podiatric Medical Association presented the following awards at its recent House of Delegates Banquet:

Dr. Jeffrey Dunkerley

The Rising Star Award went to Jeffrey Dunkerley, DPM, associate with Martin Foot & Ankle, in York, PA. The Rising Star Award is awarded to a PPMA member in good standing and in practice for no more than 10 years, and in recognition of outstanding state accomplishments in scientific, professional, or civic endeavors, with exemplar service to PPMA.

Dr. Mark Pinker

The Award of Excellence went to Mark E. Pinker, DPM, Past PPMA President 1999/2000. The Award of Excellence goes to those PPMA members in good standing, demonstrating the same accomplishments and service to PPMA as the Rising Star Award.

Dr. Edwin S. Hart, III

The Podiatrist of the Year went to Edwin S. Hart, III, DPM, Past PPMA President 2006/2007.  The Podiatrist of the Year is awarded to a podiatrist for his or her cumulative services to the Association and to the profession, or in recognition of an exceptional contribution made during a given year.

ND Podiatrist Collects Food for Community Pantry

Dr. Ben Felty and Barb Mickelson, a nurse practitioner, stand with some of the non-perishable food items that employees of the clinic collected in a four-week period. The food will be donated to the Community Action’s food pantry. (Photo: John M. Steiner)

Source: Jamestown Sun (ND) [11/22/09]

Senate Democrats at Odds Over Healthcare Bill

Senate Democrats on Sunday sparred with each other over how to fix the nation's healthcare system, the moderates threatening to scuttle legislation if their demands weren't met and more liberal members warning their party leaders not to bend.

The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend healthcare coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill. Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin debate.

"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Nebraska Democrat. Nelson and three other moderates - Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas and Connecticut independent Joe Lieberman - agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.

Source: Anne Flaherty, Associated Press [11/22/09]

Query: Automated Appointment Reminder Systems

I would be interested to receive recommendations for a reliable, outsourced automated appointment reminder system.

Douglas F. Tumen, DPM, Kingston, NY

RE: Metanx and Epidermal Nerve Fiber Density Testing
From: Arthur Lukoff, DPM, Robert Kornfeld, DPM

There appears to be an increased effort to raise the awareness of the prevalence of diabetic small nerve neuropathy, with the accompanying diagnosis and treatment of this condition. The different presentations involve the use of epidermal nerve fiber density testing and the medical supplement Metanx to treat this type of neuropathy.

1. If I test and find out my patient has evolving neurologic deficit, why do a punch biopsy? Why not start the patient on Metanx and look for clinical improvement?
2. All of the published reports I have seen so far are funded by Pamlab, who is the supplier of Metanx, hardly an unbiased source.
3. Dr. Elliot Udell just informed us of a new study showing an increase of cancer with the use of folate, which is a component of Metanx.
 
Does this new information, cause us to contact all our patients on the medication and warn them to discontinue its use?  I would like to hear from DPMs who are using this form of therapy, and what their thoughts are on these developments.

Arthur Lukoff, DPM, Ellenville, NY, Footdoc45@hotmail.com
 
Much is being said about the dangers of folic acid. This is something that I believe is taken out of context. Since B vitamins function synergistically with one another, using any one of them in isolated form as "medicine" is not in keeping with human nutritional needs, creates a functional Vitamin B imbalance, and belies an understanding of how the human body utilizes B vitamins.

I have also read on this forum other negative comments regarding nutritional supplements and natural medicine. What is conspicuously absent from discussion on this forum is...

Editor's Note: Dr. Kornfeld's extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=30667&start=1

RE: Employee Vacation and Personal Days (Charles Morelli, DPM)
From: Renee Kurecki

We have instituted a competitive "package" of paid time off benefits which works well for our employees and our office. It is not based on the relationship we have with them, their quality of work or some other subjective criteria. It is based on length of service and a few simple guidelines. Full-time hourly employees (32 hours/week or more) receive the following paid vacations:

1. After completing 1 year of service...
 
Editor's Note: Ms. Kurecki's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30659&start=1

RE: PECOS
From: Philip E. Larkins, DPM

I received an EOB from Railroad Medicare the other day for routine foot care. The claim was paid, but there was an "N" remark code that said the referring providers NPI was invalid, missing, or incomplete. I can only assume that this is the beginning of a huge medical profession train derailment starting January 4, 2010. It seems Medicare will stop at nothing to find ways to stop paying clean claims that, but for bureaucratic red tape, should and must be paid as submitted.

Once again, Medicare has "gotten it all wrong." Why would Medicare punish providers who are already enrolled in the PECOS system by denying the claims that these physicians submit. Wouldn't it make a LOT more sense to deny the claims for the physicians and providers that ARE NOT enrolled with the new albatross PECOS system?

This huge loss of revenue that will come when ANY claim for ANY services which include a necessary requirement of a referring provider (who is not enrolled in the PECOS system), will do very well with the 21% pay cut that physicians are going to wash down this other bitter pill with. It is no wonder the healthcare system is in the state that it is.  Of course, routine foot care patients will understand exactly zero of this debacle and will want to know why something that was covered in 2009 will no longer be covered in 2010.
 
Philip E. Larkins, DPM, Escondido CA, larko33139@yahoo.com

RE: Healthcare Reform and Our Survival
From: Arden Smith, DPM
 
Can anyone answer why "organized medicine" is so silent and "has gone into hiding" regarding the escalating and "out of control" costs of running a medical practice? Why are they so shy about discussing this topic that much of the general public is unaware of? Where is their PR?

I'm on the staff of three very large teaching hospitals in my geographic area and "run away" overhead expenses is the most common topic of conversation that I hear in the hallways and in the doctor's lounges from doctors of every specialty, including faculty practice docs, who are getting squeezed and pressured by their institutions.

I am constantly hearing about small groups that are merging and squeezing into one of the group's offices as they are laying off staff and sharing equipment. I imagine most of these marriages of convenience will last for a while out of necessity, but I don't think they will be happy ones. Of the billions of healthcare dollars being spent, it sure doesn't seem like much of it is trickling down to the doctors [the people needed to provide the healthcare] relative to their cost of doing business. Well...I guess that I don't have to worry yet as one of my staff just told me that we just sold a couple of skin creams, a gel pad, and an analgesic balm. I am a doctor, not a healthcare provider.

Arden Smith, DPM, Great Neck, NY, digitiquinti@aol.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.

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

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