The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 01, 2007 #3,106 Editor-Barry Block, DPM, JD

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OH Podiatrist Provides Tips For Patients With Diabetes

Diabetes is the leading cause of foot and leg amputations in the U.S. Dr. Lawrence A. DiDomenico of the Ankle & Foot Care Centers, which provides podiatric health care at 20 locations in eastern Ohio and western Pennsylvania, offers tips on how diabetics can keep their feet healthy:

Dr. Lawrence A. DiDomenico

Check your feet every day: Look for cuts, sores, blisters or changes in your skin or toenails. Use a hand mirror to see the bottoms of your feet. Clean your feet daily: Washing will help avoid the buildup of bacteria. Wash in warm water rather than hot, and dry your feet completely, paying particular attention to between the toes.

Source: Youngstown Vindicator (OH) [11/29/07]

Health Plans Target Hispanic, Latino Communities Via the Internet

As the number of Spanish speakers in the U.S. continues to climb, many health insurers are adjusting their Web sites to better reach the Hispanic and Latino populations. And at least one health plan says it provides targeted information on its Spanish-language site, in an effort to focus on health issues more common in this population. The number of people speaking Spanish at home in the U.S. has increased from 30.5 million in 2004 to 34.0 million in 2006, according to U.S. Census Bureau data. And health insurers are taking note of the increase.

Blue Cross of California (BCC), a WellPoint, Inc. subsidiary, says it offers a portal called Nuestro Bien that provides information designed specifically for Hispanics and Latinos. Information on the site addresses health issues that affect the Latino and Hispanic communities to a greater extent than other groups, including such conditions as diabetes, hypertension and childhood obesity, says Sherry Jansen, individual product innovation director at WellPoint.

Source: Health Plan Week [11/29/07]

Query: Radiesse

Can Dr. Ribotsky tell us the amount of Radiesse he uses and the needle gauge as well?

Bob Kornfeld, DPM, Lake Success, NY

Editor's Note: Dr. Ribotsky's extended-length reply appears at: http://www.podiatrym.com/letters2.cfm?id=16822&start=1

Query: Use of Dental X-Ray Machines

Is it okay to use dental x-ray machines in podiatry office? I contacted State Board of Missouri and they said they don't know. I don't know if it is a violation if I do so?

Dang H. Do, DPM, St. Louis, MO

Editor’s Comment: PM News does not provide legal advice. We know of no law which prohibits the use of dental x-ray machines in a podiatrist’s office. In fact, we have visited many podiatric offices in New York which currently utilize such machines. An important caveat is to make sure that the machine has a an approved collimeter which controls the field exposed to x-rays. We suggest you also check with the state and local health departments to determine if they have any rules regulating the use of x-rays machines.

Query: Podiatric Medical Assistant Incident To

The podiatrist I bill for asked if a medical assistant can perform nail debridement and the paring or cutting of corns/calluses, as long as the doctor is "on site."

Is there information on who can perform these services (i.e., routine foot care) on the Noridian Medicare site?

Denise Merrick, North Las Vegas, NV

Response: Although other Medicare carriers may have a different policy, Noridian Medicare has a very specific policy in this matter.

Since patients who qualify for covered routine foot care on the basis of risk are considered high risk, the physician may NOT delegate debridement services to any non-physician. They will not permit such services to be performed "incident to."

So, at least for Noridian Medicare patients, the physician himself/herself must perform these debridement services. I have a reference letter from Noridian in this regard.

Rick Horsman, DPM, Olympia, WA

Codingline subscription information can be found at:
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RE: Orange Tendon (Kathy Riffe, DPM)
From: Barry Mullen, DPM

The picture depicted looks fairly typical of chronic tendon degeneration, which is supported by the pathology report. Here, normal tendon is substituted by fibrous or fibrofatty tissue ("tendonosis"). This generally occurs from chronic repetitive trauma most often encountered during tendoAchilles repair, usually from long standing gastrocnemius equinus and its resultant chronic tensile forces creating repetitive microtears, or an old "healed" acute tear not primarily repaired at the time of injury. It's also commonly observed about the lateral ankle when performing secondary stabilization procedures from old ligament tears since the ligament tissue closely approximates that of tendon.

Metabolically, similar appearance may be observed with tendon xanthomas, though they are usually circular in shape, not generally linearly oriented, as in this picture. Lastly, collagen vascular disorders may cause similar degenerative tendon changes. In the absence of a traumatic history in this patient, it's not a horrible idea to consider a lipid profile (type 2 hyperlipidema being the most common for tendon xanthomas) and a CVD screen; in the absence of other symptoms associated with those disorders, in all likelihood, you may uncover an old traumatic history to that part of the foot that wasn't shared with you by the patient at the time of your initial consult.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Office Dictation Systems (Syed Ahmed DPM)
From: Multiple Respondents

I had been paying a transcriptionist about $300-$375 a month for her typing services. I purchased the Dragon Naturally Speaking v9 for medical practices for about $900.00. I have not spent one cent on outside transcription since. The product is about 98% accurate. I can't believe this product works so well but it does for me!

Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net

I recently used a Dragon system for a year. It takes some discipline to use it but was only efficient for maybe 20 to 25 patients a day . I am back to a transcriptionist and have decided that the savings in money was not worth the effort I had to go through every day when I was seeing 45 to 50 patients. I used a powerful laptop dedicated only to voice recognition

Larry Zimmerman, DPM, Mansfield, OH, zimmysuzie@earthlink.net

I am answering your question in utilizing the Dragon naturally speaking voice dictation software (version 9.0). What I will do is not correct any of my spelling or grammar errors while dictating so you can see exactly how accurate this method of whiskey patient can be. For 20 years now, after having sustained an injury to my right arm which made it very difficult if not very annoying for me to write anything, including patient charts, I began utilizing this software for all of my writing needs. Utilizing this software, combined with the SAMMY system of not only office management but also EMR, has been a godsend for my practice as well as my personal life.

Yes, there is a small learning curve, but once the software recognizes your speech pattern and has memorized your vocabulary, it's an extremely easy and effective way of doing anything you need to do when it comes to chart notes, letters, and prescriptions or even posting a comment on this website. Again, I am purposely not correcting any grammar, spelling and punctuation errors while dictating. ("whisky patient" should have been "dictating").

Charles Morelli, DPM, Mamaroneck, NY, charles@themorellifamily.net

RE: Dr. Neal's Success in Foot Surgery Seminar (Adam Teichman, DPM)
From: Trevor Neal, DPM

Dr. Teichman states you can purchase a manual at JCAHO to help achieve accreditation. My response is, if you try to get JCAHO accredited with just their manual you will LITERALLY spend hundreds and hundred of man hours trying to devise forms, contracts, policies and procedures trying to meet their standards. It can be done but I have already removed all the frustration.

I have divided the accreditation into sections with ALL the necessary forms, contracts, policies, etc.

There are several podiatrists who are currently getting their accreditation in less than six months after attending my Boot Camp. It should also be noted that getting JCAHO accreditation is only a SMALL part of what my Boot Camp involves.

One last thing...my Boot Camp comes with a guarantee. Just read the previous testimonials (11/28) or go to my website. For information get my FREE report at: www.renegadedoctor.com

Trevor Neal, DPM, Sturgis, MI, info@renegadedoctor.com

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only please

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High Volume. 65% routine foot care, 35% surgery. Several nursing homes. Plenty of opportunity for growth. Grosses over $450,000.00 yearly. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE POSITION - SOUTHERN ILLINOIS

Tired of Nursing Home Care? Ready to join a well-established practice with 2 Board Certified Foot Surgeons? If you are a personable, ethical and responsible, hard-working podiatrist with interest in conservative care, including sports medicine, this may be the position for you. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

ISO SOUTH JERSEY AREA OPPORTUNITIES

ABPS Certified with 20 years of experience looking to relocate to South Jersey/South Central Jersey. I am looking for a practice that appreciates and understands the value of experience and integrity. I am willing to discuss ALL options, including employment, partnerships, buy-ins, practice purchases, etc. All info will be kept confidential. E-mail panel32@comcast.net

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

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