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Serving Over 12,000 Podiatrists Daily

December 02, 2009 #3,716 Publisher-Barry Block, DPM, JD

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KS Podiatrist Discusses Treatments for Tired, Achy Feet

Mail carriers, food servers, security guards and anyone else who works long hours on their feet — would do well to heed the advice of podiatrist Phyllis Ragley. “The foot bone’s connected to the head bone, and there’s a definite correlation with how the feet feel and how the rest of us feels,” she says.

Dr. Phyllis Ragley

Ragley says tired, achy tootsies respond well to a variety of therapeutic treatments. “Just soaking in warm, soapy water and doing a little range-of-motion exercises afterwards helps,” she says. “The warmth helps to increase the circulation and give a little bit more flexibility to the joints.”

You needn’t spend a lot of money on special foot products to make your soles whole again. “A really simple and inexpensive thing people can do — especially people who have problems with plantar fasciitis — is to roll their arch on a tennis ball,” Ragley suggests. “It’s soft enough, and yet it will give you some resistance as opposed to something that’s just too hard. And there’s nothing like a good old-fashioned foot rub.”

Source: Cathy Hamilton, Lawrence Jouurnal-World & News [11/30/09]

Barry University Salutes Successful Alumni

Diners lined up, dozens deep, for a chance to try the gourmet offerings during Barry University's Top-Chef-meets-Alumni-Award ceremony at the Westin Diplomat Hotel & Spa in Hollywood this month. Supporters of the private university in Miami Shores paid $100 a plate to sample and rate the food of five local chefs and to offer a round of applause to this year's distinguished alumni.

Dr. Bradley Bakotic

Among this year's four chosen Distinguished Alumni was Dr. Brad Bakotic. Bakotic flies to Miami weekly to teach as an adjunct professor at the university. He graduated from Barry's School of Podiatric Medicine in 1992 and recently started his own podiatric pathology lab in Alpharetta, GA. Bakotic recently donated $100,000 to the university to build new anatomy labs. "Barry did things for me," Bakotic said. "It's an added motivation to give back."

Source: Christina Veiga, Miami Herald [11/29/09]

PA Podiatrist Named Chief of Podiatric Surgery at Mercy Hospital

William M. Brown, DPM, has been named chief of the division of podiatric surgery at Mercy Hospital. A North Scranton native, he graduated from Bishop Klonowski High School and received his undergraduate degree, cum laude, from the University of Scranton in 1986. In 1992, he earned his Doctor of Podiatric Medicine from the Temple University School of Podiatric Medicine.

Brown serves as panel physician with the Mercy Wound Care Center and Hyperbaric Medical Services. He lives in Clarks Summit with his wife, Nancy, and their four children, Ellen, Kelsey, Abby, and Will.

Source: The Times-Tribune [11/29/09]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: One of your 12 success points is pride. How does that play out?

Dr. Barry Block

Barry Block: You really should be proud of your profession. You should tell everybody that you know that you are a podiatrist. You should wear foot-related objects. For example, I am always walking around in a Podiatry Management T-shirt or hat. You should should have a bumper sticker that says you are a podiatrist. You should not keep it a secret. I think it is one of the greatest ways to professionally market your practice.

Richard Boone, Esq and Dr. Jay Grife

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features a debate between noted podiatric malpractice defense attorney Richard Boone and podiatrist turned plaintiff's attorney Jay Grife. You can register for this event  by clicking here

Query: Hyperpigmentation Over Toe Joints

How do you treat those unsightly hyperpigmentation marks that develop over the PIPJs and DIPJs that generally develop from friction on the toe box. I'm talking about those cases where there is little or no hammertoe deformity. I generally see these in young girls with elongated 2nd and 3rd toes that buckle in shoes or tight socks.
       
Joel Greenwald, DPM, Tsur Yigal, Israel

Query: Expedited Negotiation Fees

Recently, I received several faxes from insurance companies (MultiPlan, United Healthcare, Meritan, MN) asking me to sign the fax to accept their new expedited negotiation (lower) fees for our services. They mention that if we sign, then they will expedite payment. However, it does not mention what happens if we don't sign it. Has anyone else received these faxes and how have you answered them? Is this a new way for insurance companies to delay or lower payments?     

Stephen Bui, DPM, Waynesboro, PA

Query: Physical Therapy Questions

I have questions regarding physical therapy performed in our office.

Question 1: Can the doctor start the ultrasound therapy (CPT 97035 - application of a modality to one or more areas; ultrasound, each 15 minutes) which requires direct (one-on-one) patient contract by the provider, and then have the medical assistant finish it? Or does the physician have to perform the entire ultrasound therapy to correctly bill?

Question 2: CPT 97014 (application of a modality to 1 or more areas; electrical stimulation [unattended]), the performance of this does not require direct (one-on-one) patient contact by the provider. I assume a medical assistant can perform this instead of (for) the doctor, correct? I want to bill this code when ESWT is performed.

Question 3: I found, on the Internet, "Physical Therapy by Physicians - an OIG Study Finding," and it stated, "In 2005, CMS implemented a regulation that requires staff who render physical therapy in physicians' offices to have the same training as licensed physical therapists. They do not need to be 'licensed' - but they must be physical therapists if they are performing physical therapy 'incident to' the physicians services." Is this ruling just for Medicare, or is it for all payers?

Laurie Bodo, Lake Orion, MI

Response: For Medicare--- the physician MUST perform the entire service (i.e.,not just get it started and pass the baton). For Medicare, the ONLY exception is if the physician has an employee within his/her office who is a trained or licensed physical therapist. According to Medicare and CMS, this has been a source of gross overutilization and abuse in the past, so they have restricted it accordingly.

Non-Medicare payers may very well have different rules, and those rules may be subject to state regulations regarding who can and cannot perform, even incident to, physical medicine/therapy services.

Rick Horsman, DPM, Olympia, WA

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RE: Unilateral Spasm (Thomas Graziano, DPM, MD)
From: Multiple Respondents

I had a similar case 25 years ago following an impingement exostectomy of the ankle. At cast removal, two weeks post-op (we didn't have CAM walkers in those days), this 23 year old female had no problems and was sent to three sessions of PT. At the 2nd session, she presented with a spastic varus deformity of her subtalar joint. After some typical treatment with a local block in the ankle and muscle relaxants, there was no improvement. I had her put under IV sedation at an ASC and the foot became supple. I then casted her in subtalar pronation for three weeks. Upon removal of the cast, she did well for a week and then reverted to the spastic condition.

My differential was RSD (no CRPS then either) or some form of hysterical spasm, although she seemed well adjusted. I referred her to a psychiatrist who diagnosed her with conversion hysteria secondary to "her identical twin sister having become engaged to be married." The psychiatrist opined that the "loss of her sister to someone else was a shock to her psyche."  Although I was afraid to keep in contact with the patient for fear that I would be blamed for the problem (my conversion hysteria), I ultimately found out from the psychiatrist that she had a complete recovery after about 4 months of therapy.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

Consider dystonia musculorum deformans. I treated a similar problem years ago. The diagnosis was made by relaxing patient under general anesthesia. Once awake, the spasm will recur. I recommend a neurosurgical referral to a major medical center that treats this pathology.
 
D. Steven Ostendorf, DPM, Cape Coral, FL, DSOSTEN@aol.com

The history of hemolytic uremia may suggest defective renal excretion of inorganic phophate which would contribute to a low calcium and spasms. They would not necessarily be bilateral, especially if they were invoked by a stimulus, in this case tripping over a rock. Seeing this patient is so young, I would consider an inborn error of metabolism, perhaps Fanconi's syndrome. I'd be interested in knowing the thyroid, CA& PO4. A urinary glucose & phosphate would be helpful to rule out Fanconi's. Could the previous tremors have been a carpo-pedal type phenomenon?

 Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: EBM and Fallacies Regarding Level-1 Evidence (Michael Turlik, DPM)
From: David E. Gurvis, DPM, Bryan C. Markinson, DPM 
 
Although I do believe in EBM level-1 evidence as one manner in which to reach a scientific conclusion as to which method of treatment in a disease process is more appropriate than another, there are fallacies involved which can split the scientific community. Those who steadfastly adhere to only treatments reaching Level-1 EBM are foolish, as are those who eschew the entire system of EBM. I suggest the truth can....

Editor's Note: Letters on this closed topic by Drs. Gurvis and Markinson can be read at: http://www.podiatrym.com/letters2.cfm?id=30871&start=1

RE: Joseph D. Fletcher, DPM
 
Joseph D. Fletcher, DPM passed away on November 13, 2009 in Punta Gorda, FL. He was a second generation podiatrist, son of Thomas Fletcher, DPM. Joe graduated from the Ohio College of Podiatric Medicine in 1952 and practiced his entire career in New Castle, PA. He served in multiple capacities for the Pennsylvania Podiatric Medical Association, including president.
 
He was instrumental in obtaining Blue Cross/Blue Shield reimbursements for Pennsylvania podiatrists. He also served for many years on the Region III planning committee. He is survived by three daughters, Lynn Wetherall; Dianne Del Pizzo; Jody Jovenall; eight grandchildren and 8 great-grand children.

He will be greatly missed by his family; his friends and his patients.
 
D. Steven Ostendorf, DPM, Cape Coral, FL

RE: TX Podiatrist Donates $100K to New Medical School (Michael M. Rosenblatt, DPM)
From: Kathy Satterfield, DPM

I grinned when I read the criticisms of Dr. Marque Allen's generosity on behalf of his mentor -  $100,000 to establish a scholarship in his name at an allopathic medical school associated with Dr. Allen's undergraduate college. I guess it is true! No good deed goes unpunished.
 
What I would say to anyone is that my friend and former University of Texas Health Science Center at San Antonio colleague is known for his generosity. But you won't read about it here 99% of the time. So don't assume that this is his only gift or that this is his last gift. Marque is a private person and he doesn't brag about charitable donations or other kind things that he does for people. The receiving institution chose to make this gift public.
 
We recently had a discussion about the importance of mentors. Among other wise things he said were these words: "I agree mentors are what makes us and shapes us and I have always surrounded myself with people who are better than me to give me something to aspire to." Now do you understand why Marque honored this man when he could do so? Knowing Marque, I am sure that you ain't seen nothing yet! But I'm also sure that you won't hear about it. Let's put the pressure on ourselves and not someone else. I know I need to step it up and will give even more after being inspired by the generosity of Dr. Allen. I applaud Dr. Rosenblatt and Dr. Wittenberg as well. To each his own. Give from the heart.

Kathy Satterfield, DPM, San Antonio, TX, vksatterfielddpm@aol.com

ASSOCIATE POSITION – PORTLAND, OR

Busy foot and ankle clinic located in Portland, OR. Multi-offices. Excellent referral base. Good mix of conservative care and surgery. Emphasis on and known for diabetic foot wounds. Brand new office/equipments. Excellent supportive staff. Seeking well-trained foot and ankle surgeon. Prefer at least 2 years of training. Best quality is eagerness and willingness to learn, and the ability to adapt. cyberpod@yahoo.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 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 - 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

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

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

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