The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 22, 2010 #4,043 Publisher-Barry Block, DPM, JD

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Improper Sterilization at Nail Salons Can Be Deadly: TN Podiatrist

In the right hands pedicures can be bliss, but in the wrong hands pedicures can lead to infections and even death. The family of a Texas woman, Kimberly Kay Jackson, sued a nail salon in 2006 after she died of a heart attack triggered by a staph infection. The family said her heel was cut by a pumice stone during a pedicure, and the wound wouldn't heal.

Dr. Robert Spalding

"Most of what causes trouble can't be seen," said Dr. Robert Spalding, a Chattanooga, TN, podiatrist who has written a book called Death by Pedicure. People who do pedicures are supposed to disinfect their equipment between clients, including the bowls people bathe their feet in, or throw them away. Two states, Iowa and Texas, require using an autoclave to sterilize tools with steam. Pedicurists in other states use hospital-grade disinfectants.
 
Source: Sarah Okeson, News-Leader (MO) [12/20/10]

OCPM Student Lounge & Game Room Named the “Pedinol Student Lounge”

A donation of $50,000 was made to the Ohio College of Podiatric Medicine (OCPM) by the Richard & Sondra Strauss Family Foundation on behalf of Pedinol Pharmacal Inc. The OCPM Student Lounge and Game Room will be named the “Pedinol Student Lounge.”

Dr. Thomas Melillo, president of OCPM, and Ed Pitlak, area business manager of Pedinol.

The Pedinol Student Lounge is a 1,200 square foot room that consists of a billiards table, foosball table, ping pong table, two chess/checker tables, a 42” flat screen LCD cable TV, two web/e-mail kiosks, and multiple couches and chairs. The Pedinol Student Lounge is a popular place within the college for students to relax and unwind between classes. “Pedinol is very proud to associate our name with one of the premier podiatric colleges in the country,” stated Gary Strauss, CEO of Pedinol.

Podiatry and Small Town a Good Mix of Surgery for AR Podiatrist

Taking care of  feet is a daily feat for Harris Hospital’s newest doctor, and the 31-year-old surgical podiatrist is thrilled to be a part of the staff there. Dr. Jason Smith was raised in a small town and already feels right at home in Newport, despite only living here for six weeks. “I grew up in Booker, TX, which is a tiny, little town up in the northeast corner of the panhandle,”  Smith said. “I was looking for a new job, and I wanted something in a smaller community when I found this one." Smith is an avid outdoorsman, and that is his favorite thing about his new habitat.

Dr. Jason Smith (Photo: Chris Walker)

“This is a really great hospital, especially for a small community like this one,” said Smith, who received a doctorate of podiatric medicine from Temple University in Philadelphia and chose to specialize in podiatry because it allows him to do work he enjoys. “I knew I wanted to do surgery, and the majority of the surgery we do is orthopedic in nature,” Smith said. “I also really like working in a family practice, and podiatry is a good mix of the two.”

Source: Chris Walker, Newport Independent [12/16/10]

Medicare Auditors Probing Deeper into Medical Decision-Making

Complex reviews are getting a whole lot more complex, as some Medicare reviewers reportedly wade deeper into medical decision-making. DRG validations and medical-necessity audits are being performed at a level never seen before, several experts say. Some recovery audit contractors, RAC-like auditors, Medicare administrative contractors (MACs) and Medicare quality improvement organizations (QIOs) are denying claims because they disagree with the physician’s conclusions about a patient’s condition or the need for a procedure. In some cases, claims are being denied because the physician didn’t base the diagnosis on clinical guidelines, even when their use is not required by Medicare, sources tell RMC.

“In the past, auditors focused on whether charts contained physician orders, and whether they were signed and dated and specific to the services delivered,” says Kevin Cornish, national director of the healthcare dispute, compliance and investigation practice for Navigant Consulting. “Now it’s what was the diagnosis, what was the history, what tests were run, what decisions were made in terms of the procedures performed, and was it consistent with Medicare requirements?’”

Source: Nina Youngstrom, Report on Medicare Compliance [12/20/10]

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

Bret Ribotsky: What do you think podiatry should be doing to prepare for the upcoming healthcare environment?

Dr. Martin Pressman

Martin Pressman: I think we are positioned fairly well. The problem, for instance, is that in Connecticut, podiatrists are not in Medicaid. Podiatrists were taken out to save money. If the new healthcare reform is going to put 30 million people in Medicaid and we are not in it, I think that is a problem. I think it a precedent that is not a very good one, and so I am hoping that APMA can do something about that on a national level.

Dr. Stephen Barrett

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature podiatric surgeon, author, and inventor Dr. Stephen Barrett. You can register for this event by clicking here

Query: Resorbed Sesamoid

A 35 y.o. Hispanic female (no medical or any other underlying problems) was seen two weeks post-trauma to the plantar aspect of the first met head. X-rays revealed a tibial sesamoid in several fragments, with the largest being about 1/2 its original size. She was placed in a walking boot due to her need to be semi-ambulatory, and she related no pain. She was seen six weeks post-trauma with only mild discomfort while weight-bearing. New x-rays revealed a total absence of the tibial sesamoid. I have never seen total resorption before. Does anyone have an explanation why it would resorb so quickly?   

Chuck Ross, DPM, Pittsfield, MA

Query: Chartlogic
 
I would appreciate any users of Chartlogic EMR to chime in on the pros, cons, and other issues they have experienced.

Tejas R. Pandya, DPM, Troy, NY

Query: DMERC Number for New Podiatrist

Our office is incorporated and has recently hired a newly-graduated podiatrist. We currently have a DMERC number. Do I need to get one for the new doctor, or would he bill under our corporate NPI and DMERC number? The application for the NSC only has a place to get a number for either a corporation or a sole supplier. Since he is an employee, I am not sure what I need to do. Any advice would be appreciated.

Lani Smith, Office of Kash Siepert, DPM, Roseburg, OR

Response: The new provider would need his own NPI number. You would then just add him to your existing DMERC number.

Anna Sanders, Clarksville, TN

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RE: Radiesse or Other Injectable Implants (Peter Schaffer, DPM)
From: Ron Worley, DPM, Bret M. Ribotsky, DPM

Podiatrists who wish to use injectable fillers should take a course from someone very experienced.  Suzanne Levine, DPM in NYC offers these courses. Dr. Levine has many years experience with fillers and was the first podiatrist to be using them in feet, as far as I know. It is an off-label use.
 
There are many details in the learning curve with fillers:  handling, placement, differences in fillers, their in-vivo behavior and degradation, and the treatment of side-effects and complications. This treatment should not be considered a simple injection. Anesthesia is commonly performed via PT blocks. Patients may choose to have the procedures performed with sedation. About 3cc per forefoot fat pad is a common volume that can be adjusted up or down for foot size and defect dimensions.
 
Podiatrists may not order fillers from the manufacturer directly due to their FDA clearance for facial defects only. Currently, only plastic surgeons, facial plastic surgeons, and dermatologists may order according to the information I have.
 
Ron Worley, DPM, La Jolla, CA, drrdworley@yahoo.com

I have been using Radiesse and other pedal soft tissue temporary augmentation (PSTTA) for over five years (please search PM News' past letters at www.Podiatrym.com for PSTTA) and you can see the many comments over the years. 

My results for Radiesse injection are as follows: 
1. For Interdigital HM's in young patients (under 60), average of 2.2 years of pain free from one injection.
2. For Interdigital HM's in the 60+ y.o. patient.  Zero reoccurrence in 5 years.
3. For IPK's in 20-40 yo, Average of 8.3 months pain free.
4. For IPK's in 41-60 yo, Average of 14.1 months pain free.
5. For IPK's in 60-70, Average of 11.7 months pain free
6. For IPK's in 71+,  So far, zero reoccurrence
The variables of orthotics, change of shoes, and/or surgery has complicated the data's ability to be directly compared - but I hope the above is a good guide.
 
I hope to have a video available soon on this topic. The technique has undergone a few revisions over the years. I have found that control of the direct pressure is needed for 10-14 days to prevent migration of the products.
 
Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

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

My point continues to be - use an axis guide. It's irrelevant which acceptable reference point you use, 2nd or 5th (I prefer using the 2nd metatarsal). Dr. McGlamry quite effectively demonstrated that CBWO made perpendicular to the plantarly declinated 1st met causes iatrogenic elevatus, and that an osteotomy perpendicular to the weight-bearing surface results in no elevatus.

I don't get Dr. Kass's point. If someone can draw a 60% angle on paper, that doesn't translate to a 60% osteotomy on the bone. We need to standardize surgical outcomes for everyone, not a select few. Even if you are able to be so accurate, you should still use a guide, whether a K-wire or a commercially available unit. By the way, the guide can also help prevent a terrible complication whereby the head of the 1st metatarsal fractures.

Why do we resist simple, safe, easy, and effective techniques which can improve our outcomes? Are we so pompous as to believe that we  are infallible or that our procedures are so easy and inconsequential. To me it's a no-brainer.

Simon Young DPM, NY, NY, simonyoung@juno.com

RE: X-Ray Comparison (R. Alex Dellinger, DPM)
From: Kenneth Mesiler, DPM

I have been using digital x-rays for more than four years. I was unhappy with the image quality of the first system I bought. After two years, I sold that unit, switched to 20/20 imaging, and haven't looked back. 20/20 Imaging has supported digital imaging in podiatry for nine years. Its cassetteless DR (direct) system is the only DR system designed specifically for podiatry, and is the only cost-effective DR system.

Image quality is of utmost importance in choosing a system. Many conditions--such as early stress fractures,...

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

RE: Medicare Reimbursement Vs. Inflation (Stephen Doms, DPM)
From: Multiple Respondents

Dr. Doms' financial analysis is somewhat over-simplified and does not take into account the inflation rate of running a medical practice. In additon, he needs to look at ALL fees to make his analysis valid. Surgical fees have been hacked to death by Medicare over the past 30 years. Guidelines for certain services are extremely narrow and limited. Other services are not paid for at all. Perhaps, if he looks at his expenses in the year 1981 and compares them to today, he will see that the rate of inflation of his medical practice was not met by Medicare, not by a long shot. Do not be misled by inflation rates in general. They do not represent what has happened to us. 

But the biggest issue we have which seems to be ignored by many is that medicine is now an industry where hard work and determination leads to mediocre or less income as well as Medicare audits. Hold on to your hats. What is looming is the most aggressive Medicare recovery campaign you have ever seen. Why do you think they are pushing EHR? Audits will become commonplace instead of rare. The income you think you are making will be recalled. The government is now desperate. The Medicare coffers are running very thin, and more and more Baby Boomers are now turning 65. What better way to keep things afloat than by criminalizing doctors and recovering money. Good luck. I have no regrets for opting out, and I will not be looking back. 
 
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com 

PODIATRIST NEEDED -  NYC/ QUEENS 
 
SPANISH SPEAKING Podiatrist. PSR-24 +. Experience in Current office billing,  interpersonal skills,  business and staff operational skills, knowledge of Ins. policies, ability to sell non-ins. covered products/treatments, well-trained and confident from basic RFC to Surgery, respectful & honest to  patients and staff all a must. Position includes non-paid training as well as paid office sessions. P/T with real potential for growth, full-time position/partnership. Multi-Office practice looking for help towards  growth and expansion. Please call 631-270-4724 and fax cover letter and C.V.

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 - 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 - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

ASSOCIATE POSITION - CHICAGO 

Weil Foot & Ankle Institute, Des Plaines, IL (www.weil4feet.com) is seeking associate position in summer  2011. This 15 member podiatric medical and surgical group is internationally acclaimed. Twelve locations throughout Chicagoland, with a 3 operating room surgery center, MRI’s, computerized footprint analysis, orthotic and brace laboratory, radiofrequency coblation technology, extracorporeal shockwave devices, PRP and  clinical research program. Successful candidate will have completed a 3-year residency, experience in wound care, trauma, and sports medicine. Competitive salary, bonuses commensurate with experience and training. E-mail letter of interest and CV to Harriet Kass, HR, hkass@weil4feet.com 847-390-7666

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

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

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) 293-5984  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

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

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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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