The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 24, 2011 #4,340 Publisher-Barry Block, DPM, JD

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HAPPY HOLIDAYS

Ultimate Goal is to Save Limbs and Lives of Diabetics: GA Podiatrist

When Chef Charles Mattocks found out he had diabetes, he decided to change the way he ate. Now he wants to inspire others, too, especially those who are at risk. Now he's filming a mini documentary series called "Diabetic You", and one of his subjects is Arthur Lemon, who stepped on a nail and didn't realize it was lodged in his foot for 12 hours because he has lost feeling as a result of diabetes. 

Dr. Jeffrey Frenchman Treats Arthur Lemon

He's at risk for losing his foot, but his podiatrist, Dr. Jeffrey Frenchman, at the Atlanta Veterans Affairs Medical Center checks his wound every week and hopes to prevent an amputation. "The ultimate goal is to save individuals' limbs and, on the bigger scope, save their lives," Frenchman said.

Source: CBSAtlanta.com [12/21/11]

NY, PA Podiatrists Published in Diabetic e-Book

Two prominent podiatrists have written chapters in the recently released eBook, Global Perspectives on Diabetic Foot Ulcerations by Thanh Dinh. This 278-page hard cover book can be downloaded for free.   

(L-R) Drs. Arthur Helfand and Dennis Shavelson

The chapters from podiatrists are: "The Biomechanics of the Diabetic Foot" by Dennis Shavelson, DPM and "A Protocol for Primary Podogeriatric Assessment for Older Patients with Diabetes Mellitus" by  Arthur E. Helfand, DPM.

Ring in the New Year with Great Appreciation for Your Team

Take advantage of a simple and inexpensive way to show how much you appreciate your office team. Purchase reasonably-priced bottles of champagne and attach a handwritten note listing ten reasons it has been a great year in your office. The first item on the list should read “Because of You!” You can also attach two one-dollar scratch-off lottery tickets. A couple of days before New Year’s Eve when all the office team has left, leave one bottle for each in their work area. They will love you!
 
Hal Ornstein, DPM, Howell, NJ

Query: Partial Non-union Subtalar Joint Arthrodesis
 
This 64 y/o diabetic female underwent subtalar fusion about one year ago by another surgeon. She has had chronic pain/edema there ever since. On exam, she has severe pain with attempted subtalar inversion/eversion, but there is no motion evident. There is +2 edema and pain on palpation of the surgical site.

Partial Non-union Subtalar Joint Arthrodesis

X-rays show some sclerosis and partial visibility of the joint space.  CT scan has demonstrated trabeculation of the medial 25% of the joint only, mostly around the middle facet. About 90% of the posterior facet remains unfused. I wonder if a partial non-union like this could be the cause of her pain, and if so, the best way to remedy this?
 
Judd Davis, DPM, Colorado Springs, CO

Query: Selling Old X-Rays for Silver

Does anyone know of a reputable company that will purchase old x-rays for their silver value? I have received a number of faxes touting companies, but none of them seem legitimate.

Michael J Felicetta, DPM, Toms River, NJ

Editor's Note: PM News does not provide legal advice. If you do sell x-rays, you must first remove patients' names to be in compliance with HIPAA and state privacy laws.

Query: Medical Waster Removal Contract

I have been using Stericycle for medical waste disposal. I just started the third year of a three-year contract. They now want over 500 dollars a pick up. I'm a single Doc practice and they say this is their minimum. I've now contacted other firms that will do the same pick up for 35 to 50 dollars. Stericycle will not let me out of the final year of the contract. Does anybody know of a way that I could get out?
 
Robert Bronfman, DPM, Herndon, VA

Editor's comment: PM News does not provide legal advice. First, read the terms of the contract you signed. In general, one party cannot unilaterally modify the terms of a signed contract. If the contract did not mandate a minimum number of pickups, simply do not order any from them. If the contract did not clearly stipulate that they could increase the price to $500, you should contact an attorney to assert your rights.

Query: Ulcer with Nails Payment Denial
 
I just received a Medicare denial for CPT 11721-59 when billed CPT 97597. My diagnoses were ICD-9 707.14 (ulcer of heel and midfoot) and ICD-9 250.60 (diabetes with neuropathy manifestation) billed with CPT 97597; and ICD-9 110.1 (onychomycosis) and ICD-9 729.5 (pain) billed with CPT 11721-59.

I received a CO-16 explanation: "Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)." Any suggestions?

Patrick Grisafi, DPM, Jamaica Estates, NY

Response: There are other remark codes (M, N codes) on the EOB that you need to look at. These may give additional information as to what is being missed. CO-16 is rather broad and vague, and could include incorrect provider information, beneficiary information, place of service, etc. You can ask your provider helpline as to what information line is lacking. It could be that something simply did not transfer across via cyber-space. Make sure that each CPT code was pointing to the proper ICD-9 code for each line on the claim form.

Tony Poggio, DPM, Alameda, CA

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RE: Chronic Rash in 14 Year Old (Bruce Krell, DPM)
From: Multiple Respondents

Granuloma annulare appears most likely to be the problem. Do a biopsy.
 
Chris Orlando, DPM, Hartsdale, NY, cao252@aol.com

It appears that this may represent subcutaneous T-cell lymphoma. Therefore, multiple biopsies through the subcutaneous fat are imperative.

Robert J Snyder, DPM, MSc, Tamarac, FL

At a bare minimum, obtain an epidermal curettage from both feet. The technique is simple: use a sterile, disposable 3 mm curette and scrape the surface of each lesion. Gather the epidermal scrapings into a specimen bag and send to the laboratory for a biopsy report.  If this is non-conclusive, then do at least one 2 or 3 mm punch biopsies of each foot. You must biopsy, especially since this has been ongoing for more than one year.

Richard A. Simmons, DPM,  Rockledge, FL, RASDPM32955@gmail.com

RE: Orthotic Therapy For Hallux Rigidus (John Scholl, DPM)

From: Ron Bar, PhD, Elliot Udell, DPM

A cut-out of the orthotic under the hallux reduces the need for dorsi-flexion at the 1st MP joint, alleviating pain in cases of hallux rigidus or limitus. This should be accompanied with shoes that offer a substantial toe-spring, which also enable the foot to move forward without the need for extensive dorsi-flexion. The problem is – it is impossible to determine if a shoe features a toe-spring, or it is made with a dorsi-flexed last, as from the outside, we can only see the clearance under the toes, but cannot tell how the shoe is constructed. Shoes with a true toe-spring are made with a sole which is thick at the midfoot, and gradually becomes thinner towards the tip of the toes.

In the case of shoes that are built on a dorsiflexed last, and normally don’t feature soles that become thinner towards the tip of the sole, the digits are pushed up, causing excessive dorsi-flexion at the 1st MP joint, and pain for people with hallux rigidus. Most running shoes come with soles that feature a true toe-spring design. All Orthofeet shoes, including men’s and women’s dress shoes feature Ergonomic Stride TM design with a true toe spring.

Ron Bar, PhD, Orthofeet, Inc. orthofeet@aol.com
 
My clinical impression, based on the AP radiograph submitted, is that  there appears to be enough cartilage present to allow for a greater degree of dorsiflexion. There is joint narrowing, but I see worse in my office every day. It is likely that the cause of the problem is locking due to the spurs present  which are visible on the lateral view. These may have to be surgically removed. If you want to try conservative measures first, take a role of adhesive-backed 1/8th inch felt, which is available from any podiatry supplier, and make a Morton's extension and tape it on to the affected foot. Have the patient try it for a few days to see if it works. Have the extension go to the tip of the hallux.

If this helps, then order an orthotic and make sure the lab incorporates exactly what worked with the felt into the actual orthotic. Having the patient do exercises where the toe is pulled forward dorsiflexed to max and then plantarflexed to the max, may also help. My gut feeling, however, is that nothing will help until those eburnations are surgically removed.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Holiday Staff Bonuses (David Gurvis, DPM)
From: Lloyd Nesbitt DPM

For all those who were happy to read Dr. Gurvis’ comments, I can say that I was delighted to give each of my staff $350 each during our annual Christmas lunch at a fine restaurant today. Interestingly, it’s not about my productivity, or whether it was a good year or not.  It is all about showing how I appreciate the way they run the office. 

My staff have been with me for years, and say they couldn’t work anywhere else. My patients love how caring and nice they are on the phone and in person. I suggest that DPMs be extra nice to their staff and it’ll come back ten-fold. They may expect it next year, and they’ll deserve it then too.

Lloyd Nesbitt, DPM, Toronto, Canada, lloydn@rogers.com

RE: Standard of Care - Neuromas (Michael DeBrule, DPM)
From: Peter Bregman, DPM

I think it is important to try to set the standards and treatment guidelines for nerve pathology from a surgeon's standpoint. First, let me state that a neuroma is not a normal nerve by definition. The only way you can call a nerve condition a neuroma in an interspace is if there has been prior surgery that resulted in damage to that nerve that created the neuroma and/or injury to the nerve occurred.

So, in fact, these are nerve entrapments as indicated by Dr. DeBrule and not neuromas and thus should be treated differently. Dr. DeBrule implies that...

Editor's Note: Dr. Bregman's extended-length letter can be read here.

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PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER (LUMIX2)

Superpulse 45 watt peak power Laser (lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPM footcare@comcast.net

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be a PSR-24 or PM&S-36 trained. Excellent start salary with bonus. Must be ethical, self-starter, hard worker, team player. Willingness to learn/work as part of a team. Great ancillaries & surgery facility. Must be proficient in rearfoot/ankle surgery. Email CV with letter of intent to: susmitad86@yahoo.com

ASSOCIATE POSITION - NEW JERSEY

Associate/Partnership available to energetic doctor(s) or willing to merge into larger group/multi-specialty practice. 25% Medicare, 75% Privates/HMOs, No Medicaid. 8,500 visits per year. Diversified hospital/office wound care, hospital/ASC surgery, and general podiatry. 27 years of excellent local reputation. 2,700 sq ft office opposite hospital in desirable Monmouth County. capstops@aol.com

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." toDrgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - TEXAS

Practice in Houston is looking for PSR 24/36, BE/BC trained doctor. We are situated in an affluent area with a large medical community with EMR, diagnostic ultrasound, digital x-ray, multi use laser and our own surgery center. We seek a highly skilled surgeon, well-trained in trauma, wound care and rear foot reconstructive procedures willing to learn and incorporate into our “system.” Must be outgoing, goal-oriented, motivated and positive. Partnership available after successfully attaining the first year’s goals. Compensation includes excellent salary, health benefits, paid vacation and CMEs. Please send CV, references and letter of interest to faajobs@gmail.com

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.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 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 13,500 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 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad 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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