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November 25, 2008 #3,409 Editor-Barry Block, DPM, JD

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3” Heel Puts 7 Times More Weight on the Forefoot Than 1” Heel: NY Podiatrist

But do you know what those perilous pumps are really doing to your feet? CBS 2 HD went to Manhattan podiatrist Dr. Johanna Youner, herself a slave to fashion, for the answers. She showed us x-rays of her own feet. First she showed them barefoot and we saw normal foot-bones in a nice straight alignment. And then in three-inch heels.

Dr. Johanna Youner

"The areas between the joints are being forced together, so your nerves are being compressed and it's being forced in to a bunion and the toes are being forced into a hammer toe position," Dr. Youner said. "A three-inch rise in heel is seven times the body weight than a one-inch heel on your forefoot. That's a tremendous amount of stress."

Source: Max Gomez, CBS-TV [11/21/08]

PA Magazine Selects 4 Podiatrists as “Top Docs”

Dr. Frank Adamo of Folsom, PA has been named as the “Top Doc” in the specialty of podiatric Medicine. He graduated from the Temple University School of Podiatric Medicine in 2001 and completed a residency at Graduate Hospital. He specializes in pediatric flatfoot reconstruction, diabetic limb salvage, ankle arthroscopy and sports medicine.

Dr. Frank Adamo

Adamo chose this specialty because a childhood injury introduced him to podiatric medicine. He is a physician who stays on top of current treatment modalities and new surgical techniques.

Also noted as “Top Docs” were Bruce Greenfield, DPM, of Havertown, PA, David Samuel, DPM, of Springfield, PA and William Urbas, DPM, of Springfield, PA.

Source: Main line Today [11/16/08]

Query: Botox For Recalcitrant Plantar Fasciitis

Has anyone used (or heard of using) Botox for recalcitrant plantar fasciitis?

Loren Miller, DPM, St. Petersburg, FL

Query: Blue Goo Orthotics

In past years, I have found a need at times to use a specialty orthotic fabricated by Ruch Labs known as a Blue Goo. Now that Ruch has closed its doors, I have not found anyone who makes this type of orthotic. Does anyone know who else makes this product?

Gary N. Friedlander, DPM, Glendale, AZ

RE: Polyarthropathy (Kerry Temar, DPM)
From: Multiple Respondents

I would recommend she see another rheumatologist. With symptoms of polyarthropathy, swelling and stiffness, though x-rays changes are not yet evident, joint destruction will likely follow if she is not placed on Embril or other medication to reduce inflammation.

Allen Sater, DPM, Jupiter, FL, Bunionpain@aol.com

There are many patients manifesting "auto-immune" symptoms who are suffering from food sensitivities. The constant onslaught of food antigens is often a precipitating factor. You should run an IgG 1 and 4 food sensitivity assay as well as a celiac profile. Make sure you are using a lab that routinely runs these tests as they need to be performed in a very specific way to ensure accuracy.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

Editor’s note: Dr. Mullen’s extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=23274&start=1

RE: Bunion Surgery is Last Resort: CA Podiatrist
From: Keith L. Gurnick, DPM

Editor’s note: Dr. Gurnick’s extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=23275&start=1

RE: NY Podiatrist Overbilled State: Audit
From: Multiple Respondents

The in-network gravy train for the insurance companies will continue as long as WE allow it to. Why are non-participating, un-credentialed providers reimbursed 80% more than credentialed, participating providers? Because We allow it. Credentialed, participating providers should be reimbursed more, not less than those who do not meet standards of the Ins. co. This will not happen as long as we all eagerly join their network. Boycott. Terminate. Go out-of-network. But, don't be greedy. Greed kills. (look what's happening on Wall Street). Don't bill $20,000 dollars for a bunion. Few patients will pay the $1000+ deductible if they see that you were way over paid. Bill a reasonable amount ($1,500 - 2500?) and balance bill the patient. If they fail to pay, you will still end up with the equivalent of an in-network payment.

Let the patient know upfront your fee and their responsibility. If they are truly looking for a freebie or discount, let them go elsewhere. Certainly, there are many patients who are not financially equipped to afford, but desire and are entitled to your services for which accommodations should be made. Are financial accommodations / "income edistribution"/ "sharing the wealth" illegal?

James Korponay, DPM, New York, NY, JKorponay@aol.com

The single outstanding fact is that, at least in terms of Federal Law, dropping deductibles and co-insurance fees is illegal. This tactic has been very common in communities with large numbers of elderly retired people, who when they see their doctors (not only podiatrists), have been conditioned to expect not to have to pay anything out of their own pocket. Any doctor who opens or purchases a practice in that demographic area will "expect" this reaction to their billings. It's a matter of educating patients. I recommend that you have a detailed explanation form in the office on this issue, right in your reception room.

It would not hurt for you to specifically mention prosecutions against doctors who have done this and been caught. If the doctors involved have been sentenced in court, you can legally use their names without risk of being sued for slander, since this is public information. In these difficult economic times, you will be under more, rather than less pressure to ignore deductibles and co-insurances. You should consider a formal patient-education response to this issue now, rather than waiting.

The Federal statute involved on this issue is 42 U.S.C. 1320a-7b(b). The statute makes it illegal to offer, pay, solicit or receive anything of value as an inducement to generate business payable by Medicare or Medicaid. Doctors who "persist" in this illegail tactic should understand that it is quite possible that an ex-employee or other provider in their community might be quite willing to "turn them in." The government takes this very seriously. This is considered fraudulent billing.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

Editor's Note: An extended-length note by Dr. Kornfeld appears at:http://www.podiatrym.com/letters2.cfm?id=23284&start=1

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.

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 – 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

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

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

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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