The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 18, 2010 #4,040 Publisher-Barry Block, DPM, JD

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IL Podiatrist Dispels Misconceptions About Scope of Practice

"We're always educating the public," says podiatrist Dr. Charles Caplis. "I think that, sometimes, there's a misconception of the scope of our practice." Have bunions or warts? Sure, a podiatrist can help you out but they can also do a lot more. From ankle sprains and heel spurs to flatfeet and hammertoes, podiatrists are trained in a wide array of skills. "The profession has really matured and has grown," says Caplis.

Dr. Charles Caplis

We learn from a young age that part of maturing is learning how to work with others. Caplis says that podiatrists know all about cooperation. "We're trained to be part of a medical team," says Caplis. Take diabetes, for example. It's on the rise and can cause all sorts of problems, one of those being low blood flow to the feet. A person with diabetes might have to see a number of doctors, one of those being a podiatrist.

Source: Christopher Nelson, Chicago Tribune [12/18/10]

WA Podiatrist Receives Hospital Physician Excellence Award of Merit

Providence Centralia Hospital has named Dr. John McCord as the winner of the 2010 Physician Excellence Award of Merit. The award was presented to McCord by current PCH Medical Staff President Dr. David Fick (who was the 2008 winner of the award), and PCH Chief Medical Officer Dr. Kevin Caserta. McCord has been an active and integral part of the surgical staff at PCH since that time.

Dr. John McCord (Center) Receives Physician of Excellence Award

McCord’s many accomplishments include serving as previous chairman of the Providence Centralia Community Board, serving on the Board of Directors for Valley View Health Center, and helping lead the initiative to coordinate care between the Emergency Department and Valley View Centralia Clinic. An accomplished pilot, McCord serves as the chairman of the Chehalis-Centralia Airport Board. In addition, McCord has provided many years of outstanding service at both the state and national level with various positions in the American Board of Podiatric Surgery and the Washington Podiatric Licensing Board.

Plan Exit Strategy When Forming Company: MO Podiatrist

Dr. Clifford Holekamp, senior lecturer in entrepreneurship at Olin Business School at Washington University in St. Louis, admits his advice may sound strange, but he speaks from experience. He tells entrepreneurs in an article published this month in Octane, the quarterly magazine of the Entrepreneurs’ Organization, that it’s important to plan how to leave a company while planning to launch it.

Dr. Clifford Holekamp

“When I founded my chain of podiatry clinics in 2001,” Holekamp writes, “I naively believed that I would be running it for the rest of my career. An unexpected buyout offer in 2007 changed those plans. Fortunately, while I didn’t plan on selling, I did plan for selling.” Holekamp is founder and former president of Foot Healers Podiatry Centers, an innovative concept that combines a podiatrist’s office with a foot health products store in a retail setting.

Source: Washington University in St. Louis [12/15/10]

CT Podiatrist Receives Ilizarov Award at Largest-Ever IEFS Symposium

Peter A. Blume, DPM, FACFAS was awarded the Ilizarov Award of Excellence at the 6th Annual International External Fixation Symposium (IEFS) sponsored by the University of Texas Health Science Center on December 10, 2010 in San Antonio, Texas. Dr. Blume practices in New Haven, CT and is a Clinical Assistant Professor in the Departments of Surgery, Anesthesia and Orthopedics and Rehabilitation at the Yale School of Medicine. He is also the Director of the North American Center for Limb Preservation. 

Dr. Peter Blume (Center) receives Ilizarov Award from Dr. Thomas Zgonis (Right of Blume), the IEFS Founder and Co-Chairman. Distinguished international and national faculty members are pictured in the background.

The 6th Annual IEFS attracted its largest crowd ever with 50+ podiatric surgical residents and hundreds of participants coming from Japan, Brazil, Germany, Greece, Mexico, Canada, and Turkey as well as United States representation from across the country. Next year’s symposium (December 8-10, 2011) is expected to be even larger as it moves to downtown San Antonio on the magnificent River Walk.

CMS Plans to Use New Anti-Fraud Tools

The CMS will acquire new tools to prevent wasteful and fraudulent payments in Medicare, Medicaid, and the Children's Health Insurance Program, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced at regional healthcare fraud-prevention summit in Boston. In conjunction with the summit, the CMS will issue a solicitation for what it called “state-of-the art, fraud-fighting, analytic tools” to help in this effort.

The tools will integrate many of the agency's pilot programs into the National Fraud Prevention Program and also complement the work of the joint HHS and Justice Department's Health Care Fraud Prevention and Enforcement Action Team, or HEAT. The CMS is then expected to use the results to take anti-fraud actions before a claim is paid. According to HHS, the Patient Protection and Affordable Care Act provides an additional $350 million over the next 10 years to the Health Care Fraud and Abuse Control Account.

Source: Jessica Zigmond, Modern Healthcare [12/16/10]

An Effective Homepage Greeting Can Dramatically Increase New Patients 

The longer you can hold a visitor on your website, the better is the chance that you will convert that visitor into a new patient. One of the most effective ways to increase visitor conversions to patients is with a homepage greeting video. An effective homepage video should communicate: 

• Who you are, where you're located, whom you treat, and what you treat
• Easy navigation of your website with an invitation to visit your blog and facebook pages
• Availability of free books or other informative items
• A strong call to action instructing visitors to make an appointment now for their foot care needs

The length of your homepage video should be under two minutes for best results. 
 
Source: Gary Ignotofsky

Query: Medicare Reimbursement Vs. Inflation
 
Many readers have complained about Medicare reimbursement not keeping up with inflation. I have used the Bureau of Labor Statistics Consumer Price Index of Inflation Calculator to research this. In my first year in practice after my residency in Pennsylvania, 1981, a mid-level office visit had an approved charge of $20.00 for Medicare. Now in 2010, that approved charge is $65.11 in Minnesota. Using the calculator for inflation, that original $20.00 would now be worth $48.14. I think that the Medicare reimbursement far exceeds inflation. Thoughts?
 
Stephen Doms, DPM, Hopkins, MN

Query: Selective Debridment

Our physicians see patients every Monday at a wound care center. The physicians bring back the history, superbill, and procedures done. I've billed for the selective debridement, CPT 97597, since they are being seen every week for wound care management. Am I missing something I can bill for?

Cristina Marquez, El Paso, TX

Response: I would like to think that the patients aren't being treated exactly the same each encounter at the wound care center.

While CPT 97597 (CPT 97598) would be appropriate for removal of superficial devitalized tissue from wounds, the frequency of use would be based on medical necessity, standard of care, and, of course, the payer's policy. In some cases, I suspect that there would be need for surgical debridement (CPT 11042-11044).

If a patient is primarily being seen for evaluation and work-up, then you would be considering E/M services. Don't routinely add an E/M service code to each encounter when a procedure is being performed.

Paul Kinberg, DPM, Dallas, TX

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RE: Neuroma in 14 Year Old (Michael Levy, DPM)
From: Jay Helman, DPM, Mak Yousefpour, DPM

A neuroma in a child is difficult to accept. I recommend an MRI. Have you considered a foreign body. If there are pets in the house that shed, you might need to consider a hair.

Jay Helman, DPM, Pearl River, NY, footdr80@hotmail.com

You may want to consider giving the injection with ultrasound guidance. If that does not work, I have used Koby Guard System (Osteomed) on an 18 year old female high school athlete. It is a minimally invasive technique, and it decompresses the nerve by cutting the transverse ligament. It is very simple to use and it is done through the inter-space, so there is no scarring on the dorsal or plantar aspect of the foot. I have used this technique on about 15 patients or so. 12 have no more issues and 3 needed full resection of the neuroma. Patients usually get back to work/regular activities in two weeks. Just make sure that the patient does have interdigital nueroma/neuritis by confirming with ultrasound studies and/or MRI.

Mak Yousefpour, DPM, Los Angeles, CA, makdpm@yahoo.com

RE: Austin Complication (Gino Scartozzi, DPM)
From: Simon Young, DPM

I read Dr. Scartozzi's response in detail, and I have a point of disagreement. I believe that, whenever possible, any osteotomy should never be done "freehand." Using some sort of guide assures a more reliable and reproducible outcome. I personally find guides difficult to use, but an axis guide is generally easy to create using a K-wire, and it is very beneficial. When I did Austins freehand, I experienced more shortening. My tendency was to create an osteotomy axis, which tended to go proximal in relation to the second metatarsal.

It must be emphasized that...

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

RE: State Regulation for Off-Label Use of Products (Peter Bregman, DPM)
From: Multiple Respondents

It is perfectly legal for doctors to use FDA-cleared medical devices and drugs for any use that they believe is in the medical best interest of their patients.  These so called “off-label” uses are legal, but it is illegal for anyone to promote these uses.

So, in this particular case, the use of “cold lasers”, “hot lasers” (both nonsense marketing terms) or others that are FDA cleared for any use other than the treatment of toenail fungus, is legal but promotion of that use by doctors is unlawful.

Currently, the PinPointe FootLaser, after years of basic science, clinical research, regulatory processes, and millions of dollars invested is the only medical device cleared for the treatment of nail (toenail and fingernail) fungus.

John Strisower, CEO, PinPointe USA, Inc., john@patholase.com

FDA approves not only drugs, but also specific medical devices in their recognition for safety and for use in clinical treatment regarding certain diagnoses/diseases. Therefore, one foot laser may be approved for onychomycotic treatment, however, another manufacturer's device will not enjoy that FDA-recognized therapy approval. The only laser that I am currently aware of receiving FDA approval (for safety and clinical treatment of onychomycosis,) at this time, is the PinPointe Foot Laser. Other lasers may have advantages over the PinPointe Foot Laser, however, the PinPointe has the approval by FDA for "temporary clearing of fungal nails."

You can use medications and devices "off-label," but I would be inclined to get an informed consent from patients that states that they are acknowledging the device/therapy is "off-label" and/or "not fully recognized/acknowledged as a recognized treatment by the FDA."  Advertisement of medical therapies and/or devices you use without a disclaimer in such advertising, may subject one to complaints, warnings, or corrective actions. 
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

The law seems strange with regard to off-label uses of medications. Gapapentin  for example, has been written up in the literature for the treatment of painful peripheral neuropathy, yet manufacturers are not allowed to advertise its use for that purpose. Companies are also forbidden to subsidize a speaker at a seminar or convention who would lecture on an off-label use of a medication or modality no matter how effective the product may be. The practice of medicine is filled with similar examples, and the public suffers because of this antiquated law.
 
As for laser therapy for the treatment of onychomycosis, PinPointe, beat out its competitors in winning FDA approval, but the game is not over. Near infrared light and other forms of photo therapies have been around and available for a long time. The units are out there, and it is only a matter of time until more and more companies realize that there is a market in using their modalities to treat fungal nails and start offering their products for on or off-label use and at far more competitive prices.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: DUI and Orthotics
From: Multiple Respondents

On early New Year's day in 1981, a classmate of mine (5 months prior to graduation) and his babysitter were killed by a drunk driver while my friend was taking her home. I find it extremely offensive that this attorney would be so desperate so as to possibly blame the orthotics (and possibly you) for his client's inability to pass a sobriety test. I don't blame you for feeling the way you do and not wishing to cooperate. I can just imagine what's next. You are now responsible for the state of disrepair and then somehow blamed for this individual's criminal activity.

However, the reality here is that this is an extremely serious legal matter requiring you to separate your emotions and be sure your rights are properly protected. Under these circumstances, I would seek legal counsel prior to the defense attorney forcing you into a corner by obtaining a subpoena of your records.How you deal with the matter of your daughter and her friend's family brings up some very difficult memories. I wish you the best in this very difficult time for both your family and  that of the victim.

Paul Kesselman, DPM, Woodside NY, pkesselman@pol.net

Based upon 12 years of experience in law enforcement, I can tell you the following. A DUI arrest is based on many factors. How was the suspect driving? Did he have slurred speech or was there the odor of alcoholic beverages? Were there open containers in the vehicle? Was the suspect able to recite the alphabet, and was he oriented to time and place? Did he have a reasonable explanation why his driving was erratic? Whether he could walk a straight line or pass the Romberg test satisfactorily are only parts to the puzzle. Horizontal gaze nystagmus is also part of the field sobriety tests. 

At least here in CA it is not required that a suspect fail all of the tests to arrest and conduct a blood or breath analysis. Did the suspect tell the officer he had worn orthoses or was this an afterthought?  The officer usually asks beforehand if there is any reason why the suspect may have trouble performing the tests. Finally, if you did write the letter, any reasonably intelligent prosecutor would call you to testify and ask you if there are studies in any respected medical journals confirming that old orthoses cause people to fail sobriety tests. The best advice you can give them is to get a better attorney. The best advice I can give you is to tell them that Dr. Hatfield in California is nearly 70 years old and has 33 year-old orthoses, and can still walk fairly straight. 

Art Hatfield, DPM, Long Beach, CA, Afootjob@juno.com

Interesting argument the lawyer offers. My response would be: "If the defendant was so hampered with ambulating due to old orthotics, he should have been more than coherent enough to say, 'Wait a minute, let me take them out.' That is, if he were not under the influence of alcohol or illegal substances, as you suggest."

The bigger question, though, should be if he was indeed sober and not smart enough to realize this, is he smart enough to have a license to drive an automobile in the first place? It's common knowledge that if you're pulled over by a police officer and asked to walk a straight line, they're checking to see if you're drunk.

Brenna Steinberg, DPM, Frederick, MD, docsbnb@aol.com

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - CT (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 and current photo to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.com

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate with PM and S-36 training. Independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary. Email CV to: JLH459@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

ASSOCIATE POSITION - WILMINGTON, DELAWARE
Largest Practice in Delaware - well organized eight doctor multi-office practice. Seeking PM&S36+ trained podiatrist who wants to perform rear-foot surgery, EMR/Digital X-rays/PADnet/Ultra-sound/Surgery Center, etc. Associated with a PM&S36+ residency program. Call Chris Savage, DPM 302-658-1129.

ASSOCIATE POSITION - SAYREVILLE, NJ
Part time position for growing second office, 8 hours a week. Potential for growth and more days/hours. PSR/36 preferred. Can start immediately. E mail CV to advancedfoot1@aol.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well-established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well established multi-office group practice in the Tampa Bay area starting July 1, 2011. We are seeking a hard working, ethical and outgoing physician with Florida license. Salary commensurate with training plus benefits. Please email or fax CV. podiatryfl@yahoo.com 813-254-8262.

ASSOCIATE POSITION - NEW YORK CITY

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

BOSTON UNIVERSITY LIMB PRESERVATION FELLOWSHIP PROGRAM

Boston University Medical Center has a accredited fellowship position. Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, you would be expected to become a knowledgeable expert who will contribute significantly to research, surgical procedures, teaching, and innovation. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in Podiatric Medicine and Surgery. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and  Dr. Vickie Driver Vickie.driver@bmc.org or if questions call 617-414 6821.

PRACTICE FOR SALE - BOSTON, MASSACHUSETTS

40 year old updated practice with outstanding potential. Within 5 miles of Boston hospitals and 5 blocks from train station. Buy the practice, equipment and goodwill for a reasonable price. Excellent opportunity for resident or second location for practicing podiatrist. Multiple referral sources. Email vshdeep@yahoo.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss. Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE SPACE TO SHARE - MANHATTAN

Lic. podiatrist with an active practice to share space in a State-Of-The-Art professional medical office in the Midtown area. Newly renovated, modern office with spacious Tx rooms with cherrywood cabinets and granite countertops. X-ray equipment on site. Please call Dr. Robert H. Singer @ 212-921-5775 to view space.

PM News Classified Ads Reach over 12,500 DPM's and Students

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