The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

December 11, 2012 #4,635 Publisher-Barry Block, DPM, JD

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TN Podiatrists Volunteer to Treat Homeless in Foot Clinic

Every third Thursday afternoon each month, homeless men and women stand outside the Manna House Foot Clinic in Memphis. Inside, a group of volunteers bustles about filling foot baths, preparing a meal, and getting out other supplies. After guests have their feet washed, they are seen by a volunteer podiatrist from Mid-South Foot & Ankle Specialists. Dr. Christopher Hendrix said most of the problems he finds at the foot clinic involve diabetes, arthritis, and blisters. "We try to keep folks in pretty close," he said. "When people have chronic problems, sometimes we'll do a follow-up in our office."

Dr. Christopher Hendrix bandages up sores on patient's feet during the monthly foot clinic for the homeless held at the Manna House. (Photo: Kyle Kurlick)

Hendrix said the kind of care men and women can get at Manna House is unavailable anywhere else. "There is not any other place in the city that does this," Hendrix claimed. "People can go to the emergency room if they are having an acute problem, but that really doesn't solve the problems that we see here."

Source: Kira Dault, Commercialappeal.com [12/8/12]

TX Podiatrist Elected to Gatewate to Care Board

Dr. Gary M. Lepow has been elected to the board of Gateway to Care. The mission of Gateway to Care is to facilitate access to adequate healthcare for underinsured and uninsured patients by establishing a mechanism for healthcare agencies, health service-related coalition and advocacy groups to coordinate common administrative and service delivery requirements to provide a seamless service delivery system.

Dr. Gary Lepow

Dr. Lepow an associate clinical professor at the Baylor College of Medicine and the University of Texas Medical School, is the founder and continues to serve as the chief of podiatry within the Ambulatory services of Harris Heath System (formerly the Harris County Hospital District). He is senior partner with Lepow Foot and Ankle.

AAPPM Western U.S. Billing & Coding Seminar Sells Out

The American Academy of Podiatric Practice Management (AAPPM) returned to sunny Scottsdale, Arizona to hold its second successful seminar devoted solely to billing and coding issues podiatric offices face everyday. The Western U.S. Billing and Coding Seminar had a sellout attendance of 157 podiatric physicians, executive managers, and medical assistants.

Dr. Hal Ornstein

Hal Ornstein, DPM, AAPPM Chairman, said, “The most highly attended sessions at all AAPPM meetings are the billing and coding sessions. The AAPPM has heard for quite some time that the profession needs more time devoted to billing and coding. The profession spoke, and the AAPPM listened.” The AAPPM is already planning its California Dreaming Seminar which will be held December 6-7, 2013 in Santa Monica, California.

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

Bret Ribotsky: What suggestions to you have for a DPM to get a foothold at a local medical school?

Dr. David Mullens

David Mullens: Consider taking the time to take a class at the medical school (even as an audit). It would help you to meet people who make patient care decisions. Consider going to vascular surgery rounds, dermatology rounds each week. This gets you seen, and often lets other specialists know that you’re the expert in your field. Make yourself available to give suggestions in grand rounds that bring value to the discussion.

Meet the Masters is broadcast each Tuesday night at 9 PM (EST). This week's show will feature a surprise guest. You can register for future events by clicking here

Query: Tibial Sesamoid Fracture

I have a 15 year old male patient who is a soccer goalie. He presented in August 2012 with sesamoiditis pain of the left foot with no history of trauma. Initial x-rays revealed what appeared to be a bipartite tibial sesamoid on the left, but not on the right. Treatment has consisted of anti-inflammatory medication and custom prescription orthotics, with no relief. The diagnosis was chronic tibial sesamoiditis secondary to a bipartite sesamoid and overuse.

(L-R) X-rays from August and December 2012

X-rays taken in December 2012 revealed a fracture of the proximal fragment of the bipartite tibial sesamoid. Wearing a removable boot or taking any time off from soccer are not treatment options. Any treatment recommendations? I would like to know if anyone has had success healing tibial sesamoid fractures with the Exogen bone stimulator. If I decide to do surgery, would it be indicated to excise the proximal fragment with the fracture only, or to excise both fragments? Are there any long-term potential complications for a soccer goalie p/o removal of the tibial sesamoid?

Terry Nayfa, DPM, Oklahoma City, OK

Query: Diabetic Socks with Silicone Lining

Does anyone know of a vendor of diabetic socks with a layer of silicone inside? I need a pair (size 12) for a patient.

Bruce M. Vinokur, DPM, Waterbury, CT

RE: A1c and Elective Foot Surgery (Tip Sullivan, DPM)
From: Dan Klein, DPM

I define elective surgery as any surgery that is not limb- or life-threatening. My understanding is that when a diabetic exceeds 160mg/dl, the WBC cells do not function, thereby increasing the risk for post-op infection. I have always required all my diabetics who are undergoing elective surgery to keep their blood sugar to less than 160. I prefer an A1C of less than 7.

Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

RE: A1c and Elective Foot Surgery (Allen Jacobs, DPM)
From: Elliot Udell, DPM
 
Our primary concern in performing surgery on patients with diabetes is whether they will uneventfully heal after the surgery. Abnormally elevated blood glucose levels over a long period of time, which can be measured by testing the hemaglobin A1c, may be one way of deciding whether to exclude elective surgery on a patient with diabetes. Two other causes of potential post-operative problems in these patients are poor pedal vascularity and severe peripheral neuropathy. Hence, prior to considering doing any elective procedures on these patients, a good arterial vascular exam including digital studies should be performed.

In addition, neurological testing, which would include rudimentary tests such as vibratory sensation and light touch testing, can be in done. In addition, good nerve conduction studies should be considered. Many podiatric physicians own the proper equipment and do these studies regularly. For those of us who do not, there are mobile vascular and nerve conduction testing companies that will come to our offices and perform these tests and provide interpretations of the tests by appropriate specialists.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: EMR and Healthcare Fraud
From: Robert Kornfeld, DPM

If you didn't believe me before, perhaps after you read this article, you'll believe me now. This is what the EMR push is all about.

In my world, I discuss the diagnosis and recommended treatment with my patients. We collaborate on a treatment protocol. They pay me. I do not have to "upcode", "downcode", "invent a diagnosis", or "create add-on procedure codes" to get paid. If an insurance company rejects a claim on behalf of my patient, it's not my problem. If they audit claims and want money back, they will have to get it from the beneficiary (the one who pays their premium), not me. Fraud exists for one reason and one reason only - third-party payers.

Many of the physicians in my area are selling their practices to hospitals (because the stress of making a living has become too great), or they are converting to concierge medicine. My own internist just went concierge. I am sticking with fee-for-service because it works for me and my patients.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: The Fiscal Cliff (Michael Forman, DPM)
From: Joe Agostinelli, DPM

The Fiscal Cliff - A term derived by the media to ensure ratings of news organizations and talking political head shows until the last day of December before midnight when the House of Representatives and Senate will avert going over the cliff. The Doc Fix will be another temporary punt of the football down the road.

Interestingly, the "rocket scientists" who are our congressmen and senators agreed last year to these drastic measures in the so-called fiscal cliff to happen if they could not come to an agreement as a means to work together to solve our country's financial problems. Each year for the last several years, we have heard and worried about cuts to our Medicare reimbursements, only to be "saved" by our local congressional people at the final hour for another few months or year until we can worry about it again. Then, we will hear of the need to continue to give monies to these people who we re-elect the vast majority of the time!

Joe Agostinelli, DPM, Niceville, FL, Jmpa21@cox.net

Editor's note: The term Fiscal Cliff was coined by Fed Chairman Ben Bernanke.

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.

ASSOCIATE POSITION - NEW JERSEY

Associate wanted for well respected diverse podiatric practice. Requires professional who would like to develop his/her own practice within practice. Great opportunity for doctor looking for secure future financially and professionally. Send inquires and resume to: tgrazi6236@aol.com

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 - 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 - 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 - FLORIDA

Busy Central Florida 4 office Practice. Full time position available for a podiatrist with 3 years surgical training. E-mail your CV to: Atlanticfootfl@gmail.com

ASSOCIATE POSITION - GRAPEVINE, TEXAS

Do you want to practice in a fast paced office environment? Do you like all aspects of podiatric medicine? Very busy 2 office practice looking for associate to add to our group of 5. If you are a forward thinking, surgically trained podiatrist send your CV to giacalone@faant.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.

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 - 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.

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

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