The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 20, 2006 #2,770 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Adding bblock@podiatrym.com to your address book will assure Delivery of PM News

Recently some of our subscribers have reported that they are occasionally not receiving PM News. This is often caused by spam detection systems such as those utilized by AOL, Yahoo, MSN, and Comcast, which often incorrectly label PM News as spam. One of the easiest ways to ensure that your will receive every issue of PM News is to add bblock@podiatrym.com to your address book.

Barefoot Airport Security Checks Pose Risks: TX Podiatrist

Barefoot stuff is a health hazard. We went to one of the busiest airports in the country, Dallas-Fort Worth, to find out. Even a doctor doesn't mince words. "It's disgusting," said podiatrist doctor Dana Giacalone. That's because we're not just talking about a little dirt on the floor. "We are talking about warts, plantar warts. We're talking about athlete's foot. We're talking about nail fungus," said Giacalone.

Dr. Dana Giacalone

"Here at DFW, they'll give you a pair of disposable foot covers. But so far, we haven't seen any takers." Flip flop wearers usually go naked, often spreading a nasty surprise no one wants to think about. "I try not to." "Oh, it's highly likely," said Giacalone.

But the solution is simple. "You won't pick up anything as long as you have something covering your feet" according to Giacalone. Mom always told you to wear clean underwear. Now there's something else you should add to the list. "I wear socks all the time." Here's one more suggestion from airport security, if you don't want to use the disposable foot covers, carry a pair of ankle socks with you.

Source: KXAS-TV, Dallas, Texas [12/19/06]

Berlin Endowment Doubles Student Writing Prize to $1,000

Dr. and Mrs. Steven Berlin recently completed a $25,000 endowment to the APMA Educational Foundation. The interest from this generous donation will allow the American Podiatric Medical Writers Association (APMWA) to double its existing $500 Annual Student Writing Competition prize to $1,000.

Dr. Steven Berlin

Dr. Berlin is a charter member of APMWA and has made significant contributions to podiatric literature. He is winner of APMWA’s Golden Quill Award and a member of Podiatry Management’s Podiatric Hall of Fame.

The APMWA Student Writing Competition is open to all students. Details can be obtained by writing to bblock@podiatrym.com

Speakers: Barry Block, DPM, JD (Sponsored by Doak Dermatologics); Harry Goldsmith, DPM (Sponsored by Officite); Mark Schilansky, DPM (Sponsored by Organogenesis); and Paul Kesselman, DPM (Sponsored by Wright Medical).

Click on www.codingline.com/events-ny.htm for details and registration information.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: The Massachusetts Plan

Can someone familiar with or from the Commonwealth of Massachusetts tell us how podiatry fares under this model plan?

Dale Smith, DPM, Chicago, IL

Query: Partners/Associates Dispensing DME

Our practice has 4 physicians and multiple office locations. Each physician covers multiple offices. My question concerns this scenario: DPM1 discusses with a patient diabetic therapeutic shoes or the need for a Richie Brace, then measures and casts for the item. The device is ordered, but due to DPM1 being out of town (or for the patient's convenience), the DME is dispensed by DPM2 in our practice.

Can we bill the dispensing of the DME under DPM1's name, or must the claim be submitted under DPM2's name?

In our practice revenue generated determines salary and bonus so payment credit is important to our doctors.

Tammy Daugherty, Chattanooga, TN

Response: The scenario which you describe sounds like a group practice where all four doctors are billing under one supplier number, and one tax identification number (for each location). If this is the case, then there is no problem with doctor2 dispensing the item(s) for which doctor1 did the casting and measuring.

If, however, all four doctors are sharing the office, but with individual supplier numbers, this would create a problem as only the doctor dispensing the item can actually bill for it.

Your software system could have some entry code which would reflect your accounting requirements for salary, etc.

For further information, on scenarios I may not have covered, I would suggest you contact the National Supplier Clearinghouse at 1-866-238-9652.

Paul Kesselman, DPM, Woodside, NY

[Dr. Kesselman is a featured speaker at the Codingline-NYSPMA 2007 "Strictly Coding*" Seminar, January 18, New York - www.codingline.com/events-ny.htm]

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

Difucan Dosing (Larry Dorman, DPM)
From: David Secord, DPM, Joe Sciandra, DPM

Years ago, I used Diflucan for onychomycosis before Sporanox and Lamisil came to market. We used it off-label after we learned at an international dermatology conference that the European MD's were using it.

After many dosing trials over three years, the consensus was 150 mg. once weekly for up to a year, but minimum eight months. Entry level LFT's, CBC/ Diff, recommended and repeated every 8 weeks, if normal, with the second blood test done somewhat sooner. If prior bloods exist that were within one month, AND the patient had a good/favorable medical profile, then these can be substituted for the entry level blood work.

Diflucan has a much shorter reservoir effect and needs to be kept up longer (8-12 mo.) than Lamisil or Sporonox, but is quite effective. Remember that this will be off-label treatment.

Joe Sciandra, DPM, Buffalo, NY, SDRJOE@aol.com

The protocol I've used over the years on approximately 80 patients
who failed on Lamisil Diflucan is 150 mg each week for 8 months. As fluconazole at higher doses may be a potent inhibitor of enzyme CYP 3A4, it is contraindicated in patients on 'statin-type' drugs, including Lipitor, Mevacor, Zocor and the like. It can also cause hypoglycemia via activation of enzyme CYP 2C9 and interact with oral sulfonureas.

That is why I use a once a week dosing regimen and always run pre-treatment LFT's with follow-up LFT every other month. More information on this is found in an excellent article by James Q. Del Rosso, DO, FAOCD, entitled: Oral Antifungals, What You Should Know
About Interactions. If you'd like the paper, contact me and I'll attach it as a .pdf to you.

David Secord, DPM, Corpus Christi, TX, Secord@medscape.com

RE: Peroneal Brevis Split (Dale M. Smith, DPM)
From: Joseph Sciandra, DPM

I had this exact case on a 45 yr. old who did not want surgical intervention if possible. I put him in an off weight cast with the foot in eversion and mild dorsi-flexion, for five weeks, followed by soma short period rehab, strengthening course and had a successful outcome.

Joseph Sciandra, DPM, Buffalo, NY, SDRJOE@aol.com

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227.

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE POSITION – SOUTHERN WISCONSIN

Thriving Southern Wisconsin practice looking for an ethical, hard-working and highly trained podiatrists for an associate position at a well-established practice. Applicants must have completed a 2-year residency and be trained in all aspects of podiatric medicine. Strong potential for future partnership opportunity. Please fax CV and cover letter to (608)829-1319 or e-mail us at footdr@madisonpodiatrists.com.

ASSOCIATE POSITION - FINGER LAKES REGION UPSTATE NY

Leading regional group practice seeking ABPS residency-trained associate with partnership in mind. Excellent compensation/benefit package. Associate to see the same patient mix as partners, and will be involved in expanding the practice. State-of-the-art wound care center. Surgical privileges in nearby PA. Great opportunity for a well-trained, ethical podiatrist to work in a beautiful area that is great for family. NewYorkAssociate@comcast.net

ASSOCIATE POSITION – NEW YORK CITY

Looking for an enthusiastic well-trained foot and ankle surgeon to join busy Manhattan/Brooklyn practice leading to partnership. Candidate must have completed a minimum two-year surgical residency program, demonstrate qualities of self-motivation and have impeccable skills in forefoot and rearfoot surgery. Package includes malpractice ins. health ins. plus salary. Terms negotiable. Email Manfootcare@aol.com or call 917-756-3686

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

ASSOCIATE POSITION- MEMPHIS, TN

30 year-old, high volume, multi-office practice in Memphis, looking for 24-36 PSR trained individual. Good opportunity for reconstructive surgery and wound care. No nursing homes or weekends. Potential partnership opportunity. Contact Footdok4@gmail.com

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 9,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.