The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

December 29, 2012 #4,651 Publisher-Barry Block, DPM, JD

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High Heels Are Leading Cause of Ingrown Toenails: IL Podiatrist

Cramming your feet into tight-fitting shoes with inches-long heels on the bottom can hurt your feet. High-heel-wearing is linked to ingrown toenails. While an ingrown nail often is just an annoyance, it can get infected and even require surgical removal of the entire nail.

Dr. Rodney Stuck

To avoid the pesky problem, Dr. Rodney Stuck, a professor of podiatry at the Loyola University Health System, recommends buying less-tight-fitting heels, and ditching the fashion statements on days when you plan to do a lot of walking and standing.

Source: Stephanie Pappas and Jeanna Bryner, Fox News [12/26/12]

South African Podiatrist Discusses Barefoot Running

Running without shoes could mean the end of injuries, but it is a skill that takes time to learn. "If your feet are not conditioned [to running barefoot], your intrinsic foot muscles will not be strong enough to absorb the shock," said Nelfrie Kemp, spokesperson for the Podiatry Association of South Africa.

Nelfrie Kemp

She suggests deciding what kind of running you will likely end up doing: Do you want to do hardcore barefoot running, or are you interested in adopting a new category of shoe. A "minimalist" shoe gives the runner the all-important contact with the earth through a thin and very flexible sole, enabling him or her to do trails on which a totally bare foot might flinch from injury on stones and other obstacles.

Source: Mandi Smallhorne, Mail & Guardian [12/21/12]

FL Podiatrist Embraces Quality of Life of Her Profession

From the time she was 10, podiatrist Dr. Shelly Garrow knew she wanted to be a doctor. "I just didn’t know exactly what kind. My actual original plan was family practice, but I worked in a small-town family practice office as a receptionist, and I watched them get divorced and not see their kids grow up because they were always on call, always working. I thought, okay, that’s not for me. ... I decided to look into specialties that would give me the quality of life that I wanted and let me help people."

Dr. Shelly Garrow (Photo: George White)

"Podiatry is a really nice specialty because there’s medicine and surgery involved. It gives me the quality of life I want. I’m always on call for my practice, but we don’t get that many after-hour emergencies. The other really nice thing about podiatry is that a lot of times someone will come in with pain and they can walk out with almost immediate relief. There are so many things that we can do to give, at minimum, short-term relief and further address the problem."

Source: George White, Florida Today [12/26/12]

Doctors Call For Evidence-Based  Criteria for Elective Procedures

Many of the most common inpatient surgeries in the United States are performed electively. These surgeries are expected to significantly increase with the enactment of the Affordable Care Act. In a new perspectives article, published in the Dec. 27 edition of The New England Journal of Medicine, a team of Weill Cornell Medical College researchers are recommending the nation's healthcare leaders and medical community join forces to establish evidence-based appropriateness criteria to determine which patients are most in need of elective procedures, such as joint replacement surgery, to slow the projected surge in demand and rising costs.

Currently, there are no appropriateness criteria for most of the common elective procedures. "The purpose behind establishing criteria is to use evidence-based metrics to prioritize patients most in need," says lead author Dr. Hassan M.K. Ghomrawi, assistant professor of public health at Weill Cornell and an outcomes research scientist at Hospital for Special Surgery. "We don't want to sacrifice necessary care when thinking of cost-containment."

ONC Lays Out Health IT Safety Plan

Acknowledging that new health information technologies can create patient-safety risks, HHS' health IT office is inviting healthcare providers, vendors, and the public to comment on its recently issued national Health Information Technology Patient Safety Action & Surveillance Plan.

"Just as health IT can create new opportunities to improve patient care and safety, it can also create new potentials for harm," the plan, released by the Office of the National Coordinator for Health IT, states. The plan's authors cited "poor user interface design or unclear information displays" as potential contributors to dangers such as physicians ordering the wrong drugs for patients. "Health IT will only fulfill its enormous potential to improve patient safety if the risks associated with its use are identified, if there is a coordinated effort to mitigate those risks, and if it is used to make care safer," the authors wrote.

Source: Joseph Conn, Modern Healthcare [12/26/12]

Query: CAM Walker Payment

Is L4386 (walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment) billable to Medicare for the treatment of plantar fasciitis? If not, how would you code it?

Barry Rosen, DPM, Bayside, NY

Response: Under the AFO LCD, the only limitations for treatment of plantar fasciitis are listed under the non-weight-bearing devices, specifically L4396. There are no specific restrictions for the use of a non-pneumatic walking boot (L4386) or pneumatic walking boot (L4360). As with all other services and or DMEPOS provided, if there are no specific diagnostic restrictions within an LCD, the coverage would be subject to medical necessity and standards of care.

Be careful about using CAM boots as an initial or primary treatment for plantar fasciitis. This is likely not the standard of care and could potentially subject you to a DME audit, if you are considered to be an outlier. Certainly, I would not refrain from using a CAM boot if the patient has documented failure of more conservative treatments or medical contraindications to those therapies.

Paul Kesselman, DPM, Woodside, NY

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RE: Strapping Denial When Injection Given (Ira Baum, DPM)
From: Robert Kornfeld, DPM

I take exception to Dr. Baum's remark that "most patients won't pay" when strapping is performed at the same time as an injection. This is simply a defeatest attitude that de-values our services. Patients need to know what is covered and what is not. Podiatrists need to charge for what is not covered (unless half a treatment is okay with you or providing full services and getting paid for half of them is as well). The time has come to stop "tip-toeing" around insurance company policies that interfere with potent patient care.

When you believe in the services, you are providing and value your own expertise; your patients will pay you. If they refuse (which is rare when you explain everything to them), then they do not deserve your expertise. Let them go elsewhere.

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

RE: Efficacy of Compounded Drugs (Allen Jacobs, DPM)
From: Michael S. Downey, DPM
 
I have read with interest the on-going discussion regarding compounded drugs, including the comments of Dr. Jacobs, Dr. Markinson, and others. I regularly use compounded drugs in my practice, particularly for their topical anti-inflammatory effect and topical pain management. To my knowledge, the extemporaneously compounded topical medications are NOT reviewed by the FDA for quality, safety, or efficacy. 

In a recent post, Dr. Jacobs stated that "The overall FDA approval process is through the Pharmaceutical Compounding Accreditation Board (PCAB)...."  I do not believe that the PCAB is in anyway affiliated with the FDA, and is, in actuality, a voluntary, quality accreditation designation for compounding pharmacies. As part of their accreditation process, the PCAB requires certification that a pharmacy uses ingredients from FDA-registered and/or licensed sources.

I think it is important for PM News readers to realize that the greatest safety for patients is achieved when FDA-approved medications are used whenever possible. As many PM News readers have pointed out, there are certainly places for compounded drugs, but although these compounded drugs may contain FDA-approved medications, the compounded agent itself is not FDA-approved and also should not be considered a generic equivalent. Some additional liability issues can arise for the prescriber of an extemporaneously compounded topical medication, if untoward side-effects result from its use.
 
Michael S. Downey, DPM, Philadelphia, PA, michael.downey@uphs.upenn.edu

RE: Rising Patient Deductibles Spell Trouble for Doctors (Elliot Udell, DPM)
From: Allen Jacobs, DPM

Will people postpone necessary medical care because of high deductibles? The answer is no; for the most part, people will continue to see real doctors for real problems.

Will they postpone paying for you to cut their toenails, trim calluses, do laser fungus treatment, pay $600-$800 for an orthotic, buy in-office dispensed lotions and potions, or pursue other unproven therapies like low intensity laser, US-guided injections, FAST heel pain treatment? You betcha.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

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.

ASTORIA PODIATRY OFFICE FOR RENT/SHARE

BEST ASTORIA location. 30TH AVE./32nd ST. Turn-key operation with 4 fully equipped, built-out exam rooms, private Drs.' Office/Consult room, X-ray, cryo-therapy, beautiful waiting area, large staff area, Shockwave, Multiple Lasers etc. Perfect for NEW PODIATRIST or SATELLITE location. ALL you need is a PHONE and COMPUTER! RENT includes all other standard expenses (utilities, cleaning, waste disposal etc.) P/T, $2500. F/T., $3500. Please send inquiries to hansfeet2@gmail.com.

NYC PODIATRY OFFICE FOR RENT/SHARE

BEST NYC location. FIFTH AVE/42ND ST. Turnkey operation with two fully equipped, built out exam rooms, third exam room if needed , X-ray, Shockwave, lasers etc. Perfect for NEW PODIATRIST or SATELLITE location. ALL you need is a PHONE ,and COMPUTER! Even has in-office Physical Therapist for you to work with! RENT includes all other standard expenses (utilities, cleaning, waste disposal etc.) P/T, $2250. F/T., $3000 Please send inquiries to hansfeet2@gmail.com.

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

PRACTICE PRICED TO SELL OR ASSOCIATE POSITION - 20 MINS NORTH OF BOSTON MA

Well-established practice & beautiful modern 3500sqft office & equipment in great location. X-ray, EMR, ultrasound. Well-rounded practice was grossing over 600K. Strong emphasis on surgery & sports medicine. Selling price is at substantially reduced cost. Send CV or interest in buying practice to footguru@cox.net

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.

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

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 – NORTHERN CALIFORNIA/SF BAY AREA

We’re looking for someone entrepreneurial to join our growing practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. No nursing home visits. Send your CV and cover letter to: cvpodiatrist@gmail.com

PODIATRISTS WANTED - NORTHERN AND SOUTHERN CALIFORNIA

Excellent opportunity for independent, professionally managed practice in skilled nursing facilities. E-mail interest and CV to ZBUBBLESZ@aol.com

ASSOCIATE POSITION - FLORIDA

Associate wanted for well-established practice in central Florida. Experienced support staff, six figure salary, malpractice coverage and health insurance provided. Excellent opportunity for a promising future, this position will provide for the possibility of partnership in the future. To apply please go to www.yourcareerinpodiatry.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 - MARYLAND

If you are a graduating resident, in July, or an established practitioner (available now) and you are enthusiastic, personable, motivated and well-trained, we would be delighted to discuss an associate position in our group with you. We are a 17-doctor group, with 12 locations. Significant patient flow already in place to keep you busy from the start! All the bells and whistles-EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital and physician referral base. Please send cover letter and resume to newdpm@footandankle-usa.com. We look forward to hearing from you.

ASSOCIATE POSITION - ORANGE COUNTY, NY

Full-Time or part-time. Looking for a highly motivated, surgical trained podiatrist in Orange County, NY (West Point). Hospital, wound center and surgical center affiliated. A busy practice that covers hospital in-patients, wound center, and ER calls. Must be trained in all foot surgery and be able to handle advanced diabetic wound care. 1 hour car ride from NYC and close to hiking, fishing, skiing and state parks. Email CV and contact info to: clsp4@yahoo.com

ASSOCIATE POSITION - NEW YORK

Established and modern podiatry practice seeking well trained podiatrist for our two offices located in the Hudson Valley. Individuals must be highly motivated, ethical, and have PM & S-36 training. Partnership potential! Please see our recruitment video (845) 471-2243, esims@simspodiatry.com

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 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

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