The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

December 08, 2012 #4,633 Publisher-Barry Block, DPM, JD

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Cosmetic Foot Surgery for Fashion is Just Crazy: IL Podiatrist

Fashion-conscious American women are getting their pinky toes lopped off so they can fit into expensive high heels. “Why don’t we call it what it is: mutilation for fashion,” said podiatrist Dr. Michael Byrnes. “Thank God it’s not being done in Illinois. We have very responsible podiatrists in Illinois. I won’t do it, and no podiatrist I know would allow it. This started as an East Coast thing, then it became a West Coast thing, but not here. Not in Chicago.”

Dr. Michael Byrnes

He explained that sometimes the pinky toe is cut down. And other times the bones in the longest toes are removed, “although if you remove too much, and try to put a sock on, your toe could fold over and you wouldn’t know it. “Some people need such surgery, to repair structural damage, to relieve pain,” he said. “But we don’t do it for fashion to fit into fashion shoes.” Yet aren’t Chicago women as stylish as the flyover people from New York and LA.? “Sure, they’re fashionable,” said Byrnes. “They’re just not crazy.

Source: John Kass, Chicago Tribune [12/6/12]

Stilletto Heels Not for Everyday Use: CA Podiatrist

The hottest accessory for women on the red carpet this season, along with killer stilettos, is a table-turner of a trend: having a shorter man hanging on their arm. The days of female arm candy appear ancient when you observe multitudes of couples in which the ladies are virtually towering over their powerful men in Louboutin and Jimmy Choo 5-inch-plus spike heels.

Dr. Noreen Oswell

And while it’s easy to salivate over feet enclosed by sculpted, jeweled, and wildly expensive heels, what no doubt was originally intended to encourage foot fetishes of all kinds also can be a real pain. Podiatrist Dr. Noreen Oswell of The Foot Center at Cedars-Sinai is always seeing hammertoes, bunions, and damage to the balls of the feet. “My big tip,” she says, “is not to wear high heels all day or you’ll wind up in my office. My red carpet patients have one great secret: They take them off under the table.”

Source: Merle Ginsberg, Hollywood Reporter [12/6/12]

FL Podiatrist Lectures at International Foot Conference

Joseph Quattrone, DPM was an invited guest by Julphar Pharmaceuticals and Rashid Hospital, to lecture at the 3rd International Diabetic Foot Conference held in Dubai, UAE.  There were 400 attendees, including physicians, surgeons, and nurses from the Middle East and North Africa. Dr. Quattrone lectured on 'The Latest Trends in Osteomyelitis.'  Preceding the conference, he gave another lecture and surgical demonstrations on cadavers at the First Middle East Diabetic Foot Course, held at Sharjah University Medical School.

(L-R) Dr. Joseph Quattrone and Suliaman Al Riyami, a wound care specialist from Oman

"The United Arab Emirates ranks number two in the world in diabetes and related problems.  It is essential to teach evidence-based medicine with a focus on podiatric education to help reduce the amount diabetic foot-related problems and amputations occurring in this country. The associated morbidity and mortality is on the uprise and is already way too high," Dr. Quattrone explained.

WA Podiatrist Accused of Stealing Thousands from Insurers

The trial for a local doctor accused of stealing thousands of dollars in Medicare and Medicaid began in federal court Wednesday. Dr. Curtis Holden is the founding physician of Advanced Podiatry, a foot treatment and surgical practice in Yakima. The U.S. Attorney's Office indicted Holden last year. According to court documents, he's facing 56 counts of healthcare fraud. The indictment claims Holden had been doing this since 2004 to the tune of $765,000, most of that money coming from Medicare.

Source: Aaron Hif, KNDO KNDU [12/5/12]

CA Legislator's Bill to Allow DPMs to Perform Some Primary Care Functions 

Democratic state senator and doctor Ed Hernandez says there's already a shortage of primary care doctors in California. "Fortunately we're going to have the Affordable Care Act implemented in 2014, but unfortunately, you're not going to have enough workforce to address it by 2014." He says part of preparing for broader access to coverage should involve employing existing healthcare workers more efficiently. So, he says, he's going to introduce a package of bills next year that would empower nurse practitioners, podiatrists, pharmacists, and others to perform some of the tasks of primary care doctors.

"You need to allow them perhaps even the ability to diagnose. You need to allow them the ability to treat and to prescribe as well as work collaboratively with standards of protocol with physicians." Hernandez says changing the way health professionals practice is only part of the strategy - he also wants more medical school education, and more doctors seeing Medi-Cal patients.

Source: Pauline Bartolne, KXJZ [12/5/12] via Dr. Wenjay Sung

Doc-Office Use of Basic EHRs Hits Nearly 40%: Survey

Nearly 4 in 10 office-based physicians are now using an electronic health-record system with a basic level of functions, according to the latest estimates from an annual federal survey, up from about 1 in 3 a year ago.

The National Center for Health Statistics at the Centers for Disease Control and Prevention has placed basic EHR adoption for office-based physicians—excluding anesthesiologist, pathologists and radiologists—in 2012 at 39.6%. That's an increase from the 33.9% adoption rate in last year's survey and not quite twice as high as the 21.8% EHR adoption rate found by the survey in 2009, when the American Recovery and Reinvestment Act passed, creating federal programs under Medicare and Medicaid to boost EHR adoption and their meaningful use.

Source: Joseph Conn, Modern Healthcare [12/6/12]

Query: Sequential Compression Pumps and Sleeves

Can anyone provide a source for sequential compression pumps and sleeves for patients with post-lymph node resections who develop severe unilateral leg lymph edema? Are these pumps now covered for peripheral edema under Medicare?
 
Dale Smith, DPM, Oak Lawn, IL

Query: CPT 97597 CCI Edit
 
I billed the following to Medicare and received a rejection stating that "the procedure code is inconsistent with the modifier used, or a required modifier is missing." I can't find a CCI edit for CPT 97597 (selective debridement). How would I bill CPT 97597 with CPT 29540?

Laurie Bodo, Office of John Arsen, DPM Lake Orion, MI

Response: When billing wound care, there are certain procedures, such as strappings and application of Unna boots that are considered included/bundled in the allowance for the debridement. No modifier would be appropriate in that case.

If the procedures billed are unrelated (e.g., performed on different feet), then they could be payable with the "-59" modifier applied to the appropriate code.

Tony Poggio, DPM, Alameda, CA

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RE: A1c and Elective Foot Surgery (Allen Jacobs, DPM)
From: Pat Caputo, DPM

We all know that the hemoglobin A1C test measures the average blood glucose control for the past 2 to 3 months and is a good general measure of glycemic control during that period. Due to the nature and definition of glycosylated hemoglobin, it only needs to be performed 3 times per year. I am not so sure it should be considered or classified as standard of care to order a hemoglobin A1c prior to all elective foot surgery, unless it hasn’t been checked in over 3 months. It is, however, a very useful tool in predicting increased risk. Studies have shown that “Elevated pre-operative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery” (Halkos, M et al., Journal of Thoracic and Cardiovascular Surgery. 2008. 136(3) 631-640.)

The surgeon has to determine  how extensive the planned surgery is and measure all other co-morbidities and factors (obesity, smoking, patient compliance, etc.). A HgA1c level of >9% represents an obvious high level of risk that I wouldn’t want to have my diabetic patient exposed to. A target A1c of under 7% is the most appropriate. As the A1c increases, so does the risk of complications. Like most everything we do, your medical decision is how much risk is worth the benefit.

Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com

RE: A1c and Elective Foot Surgery (Allen Jacobs, DPM)
From: Brian Crispell, DPM, Robert Wunderlich, DPM

Our hospital just covered this topic at our last department of surgery meeting on Tuesday December 4th. The chairman of surgery at Lankenau Hospital, Dr. Scott Goldman, advised that nothing above 7.5 should be allowed for elective surgery.

Brian Crispell, DPM, Ardmore, PA, bdcrispell@hotmail.com

Evaluating hemoglobin A1c every 3 months is the standard of care for diabetic patients, whether or not they are scheduled for elective surgery. In my community, the test is typically ordered by the patient's primary care physician (or whoever is actively managing the patient's diabetes).  In their pre-operative assessment, if the primary care physician is satisfied that the patient's diabetes is stable and controlled, I wouldn't have a problem performing elective foot surgery (assuming there are no other contraindications to surgery).  Generally speaking, these patients will have a recent HbA1c around 7% or less.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Warning to EMR Users
From: Allen Jacobs, DPM

Recently, at the Kilo Diabetes meeting, healthcare attourney John Irwin reviewed  meaningful use laws relative to EMR. There was a  stern warning issued by him relative to cloning  of records which must be considered by PM News readers.

From my experience in reviewing medical records, it is clear that doctors have fallen into the habit of ritualistically using the same note for visit after visit, and on patient after patient. The same vascular exam, neurologic exam, etc.

Cloning refers to...

Editor's note: Dr. Jacob's extended-length letter can be read here.

RE: Source for Urea Liquid or Gel (Steve Block, DPM)
From: Susan Papp-Mlodzienski, DPM, George Jacobson, DPM

Kera- 42 (42% Urea cream) Clinical Therapeutic Solutions  (ctsrx.com)  -  For in-office it dispenses for approximately $25, retail. 

Susan Papp-Mlodzienski, DPM, Philadelphia, PA, papp.mlodz@comcast.net

Look up Stratus Pharm. Inc. Miami, FL.  They have a 15cc 40% gel with an applicator brush.  They also have urea cream in all strengths. 
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

ASSOCIATE POSITION - NEW YORK CITY / BROOKLYN

Full time office locations. Excellent opportunity for a motivated, ethical and enthusiastic associate to join a successful, well established hospital affiliated practice. Must be residency trained PSR 24/36.Board eligible/certified by ABPS preferred. Must be competent in forefoot and rearfoot surgery. Competitive salary with incentives. Email CV to DRSTEVEMENNA@GMAIL.COM

ASSOCIATE POSITION - CT (GREENWICH, FAIRFIELD, AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - MICHIGAN

Multi-doctor practice looking to add associate for two offices in Flint, MI. Partnership opportunity for right person. Needs to be proficient in forefoot surgery. Two docs already proficient in rearfoot/ankle surgery. Competitive salary, paid vacation and seminars. Patient schedule available “now” from retiring associate. Email resume flintfootdocneeded@gmail.com

ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND

Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rearfoot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual. Send CV to dpmkthomas@gmail.com.

ASSOCIATE POSITION – WISCONSIN

Growing, innovative practice with multiple locations in South Eastern Wisconsin seeks an outgoing, team-focused podiatrist. Must be board certified/eligible, compassionate, professional, and flexible. Competitive salary and benefits, busy independent practice with large amount of new patients. Please send CV & letter of introduction to: Milwaukee.podiatrist@gmail.com

ASSOCIATE POSITION - PORTLAND, OREGON

Busy office with good steady referral sources looking to expand. Areas of expertise wanted: wound care, surgery of all aspects, knowledge of running an office. Please come with good personality and hard work ethic. New main and satellite offices. Email: office.pfac@gmail.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Busy multi office practice with latest in technology EMR, digital X-rays. Looking for BQ/BC by ABPS. Must be able to handle rearfoot / ankle trauma and reconstructive cases. Paid vacation, health insurance and partnership available. New or experience practitioners welcomed. Email resume to: mny1029@gmail.com

ASSOCIATE POSITION - KANSAS CITY

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - NC PIEDMONT

Excellent opportunity for highly motivated, ethical, and personable PSR 24/36. This well established, 3-physician practice has excellent rapport with physician community, multiple office locations, and hospital privileges. Intent is an associate leading to partnership for the right individual. Competitive salary & benefits. Email CV to dpmassociatenc@gmail.com.

ASSOCIATE POSITION - SOUTH FLORIDA

Busy multi office practice needs 3 year surgically trained Podiatrist to join five doctor practice. Benefits include Salary, Bonus, Health Insurance, Pension Plan and CME. Digital x-Ray and EMR in all offices. If interested please send a CV and letter of interest to alvatore1@gmail.com.

ASSOCIATE POSITION - NASSAU COUNTY, NEW YORK

Exciting Opportunity! Associate position. Must be Board Qualified. Joining all Board Certified Doctors in foot surgery and reconstructive rear-foot and ankle surgery. Respond to: Podiatryoffice@doctor.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Welcome to paradise! Immediate opening in a busy, multi-location practice. Six figure income potential possible for the motivated individual in the first year. Surgical training a plus. Hospital privileges available, depending on training. Must be Florida licensed. Great benefit package. Send CV and cover letter to 1foot.ankle@gmail.com.

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to : practiceforsaleswfla@gmail.com

EQUIPMENT FOR SALE - USED Q-CLEAR LASER

Still under warranty . New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to mook863@comcast.net

EQUIPMENT FOR SALE - IMAGING

MinXray X-ray-Stationary Podiatry System with orthoposer. Excellent condition. Best offer. Fluroscan officemate. This Mini C-Arm has excellent resolution; it is totally automatic and comes in a 4” Field of View. This system includes a printer. Very good condition - $7000
Email Dr Cohen for details and photos. jr11231@yahoo.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815.

PM News Classified Ads Reach over 14,000 DPMs and Students

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