The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 18, 2011 #4,088 Publisher-Barry Block, DPM, JD

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Early Detection of PAD is the Key to Saving Limbs: TX Podiatrist

Approximately nine million Americans over the age of 50 are living with a disease that affects their legs and raises their risk of having a heart attack. Unfortunately, many with the disease do not even know they have it. February is Heart Month, and the Vascular Disease Foundation and its P.A.D. Coalition are urging Americans to listen to their legs and be alert to the signs of peripheral arterial disease, or P.A.D.

Dr. Joseph Caporusso

"Often, people think leg discomfort or slow healing sores are just a part of aging, yet they can be signs of a serious disease,” stated Joseph Caporusso, DPM, Chair of the P.A.D. Coalition. “Through early detection and proper treatment, we can reduce the devastating consequences of P.A.D. and improve the nation’s cardiovascular health.”

Source: Newswise [2/17/11]

CA Podiatrist is Skeptical About "Shape Up" Shoes

Ever wonder if those shoes that claim to tone you up without a workout really work? An Ohio woman says that they can be harmful. Now, she's suing one of the makers - Skechers. They're called "shape up" shoes or sometimes "toning" shoes.

Dr. Steven Ginex

Coachella Valley foot doctor Steven Ginex says he's skeptical of these shoes because no matter what shoes you wear, walking will shape you up. And he worries that the toning shoes may put a lot of stress on the Achilles tendon. "What I found interesting is (the shoes) force your heel back into the ground and that, in my opinion, is not the way your foot normally functions when it hits the ground," said Ginex. Ginex did say that while some of his patients have complained about shape up shoes, others love them and cannot do without them.

Source: KPSP Local 2 News [2/16/11]

MI Podiatrist Charged With Medicare Fraud

Twenty medical providers from across Metro Detroit were charged today in federal court with billing Medicare for fraudulent charges. The 20, including an Oak Park podiatrist who federal prosecutors say billed Medicare for more than $700,000 in fraudulent toenail treatments, are the latest defendants ensnared in a nationwide crackdown on Medicare fraud.

The podiatrist, Dr. Errol Sherman, is among 20 people accused of orchestrating schemes to cheat Medicare. During a four-year period ending in 2006, Sherman submitted false claims to Medicare for toenail services that were never performed, according to an indictment filed today in U.S. District Court in Detroit. In one case, Sherman billed Medicare for 20 nail removal treatments on three toes of one patient, according to the indictment. Each treatment cost $110.

Source: Robert Snell, The Detroit News [2/17/11]

NY Podiatrist Arrested For Healthcare Fraud

A Manhattan podiatrist has been arrested for stealing more than $100,000 from a health insurer by submitting claims for treatments that never occurred and then asking patients to lie to investigators. Dr. Alan Shulman, 61, of  New York City, was arrested after an investigation by the New York State Insurance Department’s Frauds Bureau.

Shulman is accused of using the patient information of at least five individuals to submit the claims to CIGNA Insurance Company. Investigators allege that in two instances Shulman accepted payment for claims he filed on behalf of patients who could never have been treated. The two patients were on vacations in Europe and Disney World when the treatments ostensibly occurred. Investigators said they obtained evidence that Shulman urged patients to lie about receiving treatments after he learned that he was being investigated.

Source: North County Gazette [2/14/11]

Medical-Liability Bill Approved by House Committee

Members of the House Judiciary Committee on Wednesday voted 18-15 to approve the medical liability reform bill that physician Phil Gingrey (R-GA) introduced late last month. Picking up where they left off last week, committee members considered the remainder of numerous Democrat-sponsored amendments to the tort-reform bill known as the Help Efficient, Accessible, Low Cost, Timely Healthcare—HEALTH—Act of 2011, and accepted only one.

That measure, sponsored by Rep. Bobby Scott (D-VA), strikes the section of the bill that says in any healthcare lawsuit involving injury or wrongful death, any party may introduce evidence of “collateral source benefits,” or compensation from other sources. Ultimately, the law would limit non-economic damages to $250,000 and makes each party liable only for the amount of damages that is directly proportional to that party's percentage of responsibility.

Source: Jessica Zigmond, Modern Healthcare [2/17/11]

Set Up a Practice YouTube Channel

A fantastic way to beef up your social media network is by setting up your own practice YouTube channel and uploading patient testimonial videos. Be sure to title your videos to reflect the topic being discussed. For example: "Patient Discusses Laser Treatment for Fungal Toenails." Also add a complete description of the patient's diagnosis, treatment, and outcome along with an invitation to visit your website for more information.

When listing your website, include the full URL of your website to ensure that it will send visitors to your website when clicked on. Your YouTube account can also be programmed to share videos with your Facebook, Twitter, Reader, Orkut, and MySpace accounts automatically.  

Source: Gary Ignotofsky

Query: P&A on a Toddler?

I have a 2 1/2 year old patient who was born with a split, dystrophic toenail. His mother states he has tugged at it and fussed with it since birth. We have tried many palliative treatments, but the problem recurs. Fungal cultures are negative. The boy's mother and I have agreed that removing the nail permanently is a good option. My question to my colleagues is whether they would use phenol on such a small child, and if so, what variations from the usual post-operative course should be expected? Otherwise, I am considering excising the matrix.  Any thoughts would be greatly appreciated.
 
Peter Smith, DPM, Stony Brook, NY

Query: Instrument Warranty
 
How would you interpret this statement of warranty?: "XXXXXXX (company name removed) instruments are guaranteed for life against manufacturing defects of material and workmanship. This guarantee is void if instruments are not maintained or repaired properly, or if they are not used for their intended surgical purpose. Tungsten carbide inserts on scissors, needle holders, and wire cutters are guaranteed for three years. Replacement parts, such as springs, are guaranteed for one year."

I have a few German-made, stainless steel nail clippers where the jaws have snapped off while cutting toenails. The company told me that they will replace them this time, but not in the future, because this is considered normal wear and instruments have to be replaced eventually. They also inferred that I was using it improperly. I use them to cut toenails! When I purchased them, I was told that they had a lifetime warranty. Would you think this type of damage should be covered under the warranty forever? Also - for the parts that are guaranteed for one year - how do you keep track of the age of your instruments? I have a lot of these clippers. They all look alike. I buy a few new ones every year and they are all mixed together.
 
Al Musella, DPM, Hewlett, NY

Query: Deucleating an IPK

What is the correct procedure code for surgically denucleating a pre-ulcerative porokeratosis or intractable plantar keratosis (IPK)-type lesion, followed by topical chemical cauterization with silver nitrate solution?

Steven Brotsky, DPM, Hallandale Beach, FL

Response: CPT 11055 represents the paring or cutting of a solitary hyperkeratotic lesion. In a Medicare patient, if the patient qualifies for reimbursable palliative foot care, you would append the appropriate modifier or ICD-9 code.

In a Medicare patient, if the patient does not qualify, you would append a "-GY" (statutorily non-covered) modifier, and collect payment from the patient.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here APMA Members: Click here for your free Codingline Silver subscription

RE: EHR/EMR Gouging (JM Cortez, DPM)
From: Michael J. Ryan, DPM, Jeffrey Kass, DPM

We had a recent demonstration on an EMR and practice management software program from one of the larger companies. I found it more than coincidental that when they gave us a breakdown of costs,  the expense worked out to be almost exactly the same as the incentive payments we may receive from the government. If the incentives were not offered, the expense would be significantly reduced so they could sell their products. 

Michael J. Ryan, DPM, Charlotte, NC, michaeldpm@bellsouth.net

The answer to Dr. Cortez's question is yes. The fees are ridiculous, and it's because they can get away with it. Is it the APMA's responsibility to help keep down the costs? I don't know the answer as I am not sure of The APMA's actual responsibilities. I can tell you at the local level, at my division meetings, we seem to be more concerned on whether or not a member can bring his wife who happens to be his office manager, to the meeting. This is what seems to be of most importance. I side with you on your issue, and I side with the podiatrist who wants to bring his wife to the meeting. I am not sure how it will help you where you are located, but I will bring up your issue tonight at my division meeting and see what kind of response I am given.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Low-Cost Lasers? (Jack Ressler, DPM)
From: John Strisower

What is your intended use and expectation for a laser? Saying you want a low-cost laser is like saying you want a low-cost car or house.  Cost is only one factor and probably one of the least important in terms of safety and efficacy for an intended use.

Most lasers are not capable of (or cleared for) use for most indications; that is, a general purpose laser is probably poor for all uses. The old saying "jack of all trades, master of none" is appropriate here.

There are used lasers available even on PM News classified right now. Beware that these are likely lasers that the current owner got for an intended use and then found out that they are not cleared for that use or good at it.

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

RE: H&Ps for Podiatrists (James C Ricketti, DPM)
From: Robert Bijak, DPM

I disagree with Dr. Ricketti on several counts. First, I am not crying in public. I'm stating an opinion based on 30 plus years as a podiatrist. Second, I believe I have a moral obligation to the public to factually state what a podiatrist is. The truth should not be hidden or bent to massage an ego. Dr. Ricketti can have a board of 100 Nobel prize winners saying it's okay for podiatrists to perform H&P's. The facts are, we don't even take individual courses in major medical areas like OB/GYN, psychiatry, or cardiology.

With the preponderance of foot patients being women, it's ironic. Rotating as a foot doctor through various departments without being formally tested...

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

RE: H&Ps for Podiatrists (Robert Bijak, DPM)
From: Charles M Lombardi, DPM, Adam Budny, DPM

I too would not want Dr. Bijak performing a medical evaluation on a podiatry patient because he never had the training to begin with. Since he is apparently not involved in podiatric education in this day and age, he should not comment on today's graduates. He believes the MD degree would make all the difference in the world when, in reality, it makes no difference. Although our students may come from podiatry school lacking in some clinical skills in medicine, that is "back filled" in the first year....our residents are on internal medicine for six months and must pass skills in a simulation lab....they are as good as any other PGY-1 resident at the hospital. They then maintain that skill in the remaining four years of training by doing all the H&P's on podiatry admissions.

Do allopathic residents start with more medical skills? Yes, but our residents know...

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

With all due respect to Dr. Bijak, who posts regularly on this newsletter, and likely has many years of clinical experience, I have to disagree with his opinion about the ability of a DPM to perform an H&P. It may or may not have been many years since he went through a residency or medical rotation, but I can guarantee that my residency and that of many others put us on par with our MD/DO colleagues.

Having an "MD" does not make one omnipotent; each doctor will have areas of expertise and...

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

ASSOCIATE POSITION - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION NYC (PART TIME) 

TEXAS- WONDERFUL OPPORTUNITY!

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.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

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

ASSOCIATE POSITION - CHARLOTTE, NC

Well-established multi-office practice looking for personable, motivated associate leading to partnership. Excellent opportunity in a growing area. Contact charpodiatry@gmail.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.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 to ohiodoctors@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

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

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale. Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.com

SPACE AVAILABLE - BRANSON, MO

Great opportunity to develop a podiatry practice in a four condominium Branson office building with a growing ophthalmology practice along with a well established optometry practice and a multi-disciplinary ambulatory surgery center in Branson, a top ten retirement destination.The available condominium is a grey box so it can be build out to specifications. Rental and/or ownership options are available for this condominium. Practice development financing and ASC ownership available for the right doctor. Great schools and affordable lakeside or golf course living available. Contact Dr. James Bureman @ jbureman@missourieye.com or 417-861-5839

SPACE AVAILABLE- NYC & LI

Office to sublet and share with DPM and chiropractor, 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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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. 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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