The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

December 05, 2009 #3,719 Publisher-Barry Block, DPM, JD

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MA Podiatrist Featured at APHA Annual Meeting

Dr. James DiResta of Anna Jaques Hospital in Newburyport and the Massachusetts Podiatric Medical Society presented his work on two projects during the Podiatric Health Section scientific sessions that were part of the annual meeting of the American Public Health Association in Philadelphia.

Dr. James DiResta

DiResta spoke on the Massachusetts public health committee's ongoing work with several public health initiatives in the state. He also joined Drs. Emily and Jeremy Cook of Beth Israel Deaconess Medical Center to present the state society's Amputation Prevention Initiative, a study that has been an ongoing joint program partnering the Massachusetts Podiatric Medical Society with the Massachusetts Public Health Association.

In addition to leading the public health committee at the Massachusetts Podiatric Medical Society, DiResta is chairman-elect of the Podiatric Health Section of the American Public Health Association. He is a graduate of Boston College and Temple University School of Podiatric Medicine in Philadelphia and has a master's in public health from Dartmouth Medical School in New Hampshire.

Source: The Daily News [12/4/09]

IN & LA Podiatrists Battle Diabetes in Haiti

In the poverty-stricken country of Haiti, diabetes is rampant, often bringing in its wake amputation and early death. In November, local Ochsner (LA)  podiatrist, Dr. Tim Syperek, was one of two U.S. physicians who went to Haiti to help physicians there fight the battle against diabetes.

(L-R) Drs. Patrick DeHeer and Dr. Tim Syperek with Haitian patient.

The situation is grim. “In Haiti, most diabetics don’t live past 40,” Syperek said. Syperek went to Haiti with his colleague Dr. Patrick DeHeer, of Indianapolis, IN. DeHeer, a podiatrist who works with the Johnson Memorial Hospital Wound Healing Center, near Indianapolis, has traveled to Haiti many times. He began there by working with infants born with clubfoot, a condition in which the foot turns inward. During the course of that work, he began seeing “how many diabetic foot problems there were.”

Source: Ellyn Couvillion, Advocate [12/2/09]

Northwest Podiatric Foundation's Yucatan Seminar A Big Success

On November 19-21 The Northwest Podiatric Foundation held the Yucatan Pediatric Lower Extremity Seminar, in Merida, Yucatan, Mexico. The seminar was designed to promote the Barry University's Yucatan Crippled Children Project and featured 20 hours of lectures on pediatric conditions involving the lower extremities.

(L-R) Drs. Nitza Rodriguez, Jeffrey Page, Stephen Mariash, Richard Goad, Jeff Korab, Alejandro Ojeda, Arturo Rios, G. Dock Dockery, Byron Hutchinson, Charles Southerland, Edward Glaser, Keith Kashuk, Cherie Johnson, Mary Crawford and Daniel Hatch.

The meeting was introduced with welcoming remarks by the Mayor of Progreso, Yucatan, Rena Quintal Recio and the President of the DIF Organization, Profra. Mercedes Recio Vera. The meeting was hosted at the beautiful Hyatt Regency Merida.

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Source: Communication Briefings

Query: Seminar on H&Ps

Does anyone know of any upcoming seminars on how to do history and physicals?
 
Stephen Kinard, DPM, Rocky Mount, NC
 

Query: Coding a Flexor Tendon Transfer

What would be the proper code for doing a flexor tendon transfer of the second digit, left foot?

Arnold Beresh, DPM, Hampton, VA

Response: If the tendon transfer is being performed to correct a hammertoe deformity, the AOFAS advises reporting code as CPT 28285.

If the transfer is being performed to correct some other angular deformity of the toe, consider code, CPT 28313 (reconstruction, angular deformity of toe, soft tissue procedures only).

Heidi Stout, CPC, New Brunswick, NJ

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Cimetidine Side-Effects (Harold Koehler, DPM)
From: Barry Mullen, DPM

Of interest is that Seth Orlow, MD reported no cimetidine side-effects in his original 1993 manuscript, though his series only contained 36 children. A side-effect table exists in the body of my 2002 JAPMA manuscript. Gynecomastia, like any other very rare side-effect from any other prescribed medication, is not specifically reviewed with parents. Since 1995, my series now approximates 750 children and this side-effect has not occurred. A question does arise with cimetidine and whether it interacts with testosterone in some way because the largest pediatric failure group documented in 2002 occurred in pubescent males. To date, my adult series remains relatively small and is difficult to draw conclusions from. The success rate is well below that seen in children. This is most likely due to the fact that one cannot achieve the required 25 mg/kg/day dose in adults over 150 pounds without exceeding the FDA's daily maximum allowance which I won't breach.

From my perspective, the largest cimetidine concern is its potential drug interaction with medications metabolized in cytochrome p450 where competitive inhibition is known to occur. Close drug monitoring by the pediatric specialist who prescribed the other medication is necessary to ensure its levels are not adversely affected. Such was the lone documented case of my concurrent use of cimetidine with Depakote.

I requested that the pediatric neurologist monitor this particular child's Depakote levels from Day One of cimetidine initiation. It had to be discontinued the very next day when those levels significantly dropped.

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

RE: Prophylactic Antibiotics for Bunion Surgery (Theresa Hughes, DPM)
From: Michael E. Munson, DPM, Marc S. Greenberg, DPM

To me, the key phrase in the SCIP document appears under "Role  Description."  It states; "if no antibiotic is indicated for surgery, please document in patient's chart." I may be naive here but doesn't that clear things up for you?  If you are doing a Keller bunionectomy, it should be easy to document the lack of need for prophylactic antibiotics vs. a total hip replacement.  There is nothing in the SCIP document that even closely approximates bunion surgery.  The closest is hip/knee arthroplasty. For any administrator to read that document and determine that it demands antibiotics before all bunion surgeries is a quite a leap. 

Michael E. Munson, DPM, Columbia, SC, bigmig19@yahoo.com

Editor’s Note:  Dr. Greenberg’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30961&start=1

RE: Variations of Practice Patterns in Podiatric Medicine
From: Multiple Respondents

There are probably many more than 12 different treatments for verrucae. The one treatment that has been shown to work in 75% of the cases is the tried and true method of weekly debridement combined with an application of some form of topical acid. Blaine Labs and Tri-pod labs both sell sal acid wart remedies with added ingredients that be dispensed to our patients from our offices. 
 
The problem is with the 25% of cases that do not respond to topical acid therapy. We all see many of these patients because they are frustrated and tend to go from doctor to doctor seeking "the true cure." 
 
Elliot Udell, DPM, Hicksville, NY,Elliotu@aol.com

Dr. Turlik’s list regarding the need for Level-1 EBM to determine the standard of care includes:  Are some treatments more effective than others? Do some treatments cause more harm than good? Do they all cost equally as much?

I would add to Dr. Turlik’s list:  Are we to eliminate viable treatments in podiatry clinically comparable or better than those with EBM success? Are treatments that do not easily conform to EBM (orthotics, foot surgery) testing, yet clinically effective and safe, being denied payment as “experimental” or unproven by the insurance industry? Who is willing to perform needed research for clinically effective treatments without recompense? Does this mean that only Fortune 500 companies control treatment options? Does compensated research open the door for findings that are skewed and later proven to be worse (or even fatal) than anecdotal care?

And worst of all: Are we forcing practitioners to become robotic by eliminating the artistry that has fostered medicine to new heights in care by denying our ability to practice (and that means getting re-imbursed) treatment options that peer podiatry asserts is effective and safe over time until EBM Level-1 vilified? Finally, I wonder what Dr. Turlik uses to treat warts?

Dennis Shavelson, DPM, NYC, drsha@lifestylepodiatry.com

Editor’s Note: Dr. Mullen’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=30960&start=1

RE: Expedited Negotiation Fees (Stephen Bui, DPM)
From: Ron Werter, DPM

I have gotten these requests in the past and, on occasion, called the insurance company number and told them am not interested. They are obligated to pay you, whatever they are going to pay you, within 45 days anyway so do you want them to pay you 15 days sooner for 25% less? I have found, that even though I have said no to their expedited payments, that they still reduce my payment and I have to call them and repeat that I am not interested.

So, in effect, they will try to screw you no matter what you say, and you will still get your money when they decide to pay you.

Ron Werter, DPM, NY, NY, hawkeyedpm@aol.com

ASSOCIATE POSITION - NASHVILLE TN

Excellent practice opportunity-associate leading to partnership for PSR-36 trained physician. Well-established and growing state-of-the-art practice located in Nashville area. Hard-working, personable, highly-motivated individual needed. Bilingual-Spanish/English a huge plus.  Great opportunity with excellent salary and benefits. If interested, forward CV to NashvilleFootDoc@gmail.com

PRACTICE WANTED- NYC/LI AREA

I am an ABPS board certified podiatrist seeking to purchase a well established practice. I am looking for the current practitioner to help with the transition. All offers will be considered. Complete confidentiality will be upheld. Please contact poddr45@yahoo.com for more information. This advertisement is not affiliated with a broker.

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.

ASSOCIATE POSITION- TAMPA BAY AREA, FL 

Excellent opportunity for a hard working, ethical and outgoing podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. A Florida license and a minimum 2-year residency are required. Salary commensurate with training plus benefits. Email CV to podiatryfl@yahoo.com

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

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk .30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

PODIATRISTS 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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.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 f-massuda@footexperts.com

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