The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 10, 2012 #4,406 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Fungal Infections

If you notice your toenail looks yellow, has white marks on it, or contains debris underneath, chances are a fungus is hanging out under your nail. “It’s a highly contagious infection that’s transmitted from foot to foot, particularly in germy hotbeds like nail salons and gyms,” says Carolyn McAloon, DPM, spokeswoman for the American Podiatric Medical Association. Usually it’s not painful, although wearing a shoe that’s pressing on the infected area can irritate it, she says.

Dr. Carolyn McAloon

Fungi thrive in dark, wet, warm areas. To prevent one from taking hold, wear shoes made of breathable fabrics, like leather or canvas, and be sure to take off your socks and shoes to air out your feet after exercising or working all day. A fungal nail can be treated by trimming and filing any loose areas of the nail, soaking feet in water that contains a few drops of tea tree oil (which is a natural antifungal), using a topical antifungal treatment (if necessary) and bleaching the shower to kill any lingering fungus, says Dr. McAloon.

Source: Jennifer Tzeses, Woman's Day

TX Podiatrist Named Honorary Air Force Commander

Eight civic leaders from San Antonio were appointed as honorary commanders as part of the 59th Medical Wing's Honorary Commanders Program. This Air Force program matches specially selected members of the community with senior military commanders. The civilian executives get a rare, inside look at the Air Force and its people and missions. The program also provides local community leaders an opportunity to raise awareness and create partnerships between the civilian and military communities.

Dr. Marque Allen

The individuals chosen for the 59th MDW Honorary Commanders Program specialize in healthcare and medical research and hold the distinction of being the first for the wing. Representing the 559th Medical Group is Dr. Marque Allen, a podiatric surgeon from Sports Medicine Associates.

Source: Linda Frost, 59th Medical Wing Public Affairs

AZ Podiatrist Lectures in UA Science Series

University of Arizona's Professors David G. Armstrong, a podiatric surgeon, and Janko Nikolich-Zugich, an immunologist, in February became the first physicians invited to take part in the prestigious University of Arizona College of Science Lecture Series. The program, which covers "grand challenge" topics like relativity, climate change, and evolution, this year took on "living beyond 100." 

Dr. David Armstrong

Nikolich-Zugich's lecture: "The Biology of Aging: Why our Bodies Grow Old as They Do" and Armstrong's lecture "Repair, Regeneration and Replacement Revisited" were part of a six-lecture weekly series hosted by Joaquin Ruiz, Executive Dean of the College of Science. They joined professors Shane Burgess, Carol Barnes, Vincent Del Casino, and Paul Cohen in covering the latest on the science, biology, ethics, and geography of our aging world.

Ways and Means Votes to Repeal IPAB

The House panel with jurisdiction over Medicare approved legislation to repeal the Independent Payment Advisory Board (IPAB) created in the Patient Protection and Affordable Care Act. In a voice vote with no “nays,” the full House Ways and Means Committee approved Rep. Phil Roe's (R-TN) Medicare Decisions Accountability Act, which would eliminate the 15-member board that is responsible for suggesting ways to restrict Medicare cost growth. The House Energy and Commerce Committee approved the measure Tuesday.

“Repealing IPAB reinforces that doctors and patients—not a board of unelected bureaucrats—should be making healthcare decisions,” Rep. Dave Camp (R-MI), chairman of the House Ways and Means Committee, said in a statement following the vote. “If left in place, IPAB would threaten seniors' access to healthcare and would be able to do so without answering to Congress or the American people.” According to a spokeswoman for House Majority Leader Eric Cantor (R-VA), the full House is expected to vote on Roe's bill the week of March 19.

Source: Jessica Zigmond, Modern Healthcare [3/8/12]

Query: Topical Antifungals with Colloidal Silver

What experiences has anyone had with the new antifungal nail topicals containing colloidal silver, or with Kerasal Nail topical? All non-biased opinions are appreciated.

David L. Kahan, DPM, Sacramento, CA

Query: Is L4386 Included in Initial Fracture Care?

When a patient is seen for fracture care and requires a cast, can I alternatively bill L4386 (non-pneumatic walking boot) with the initial visit? We usually apply a plaster cast, CPT 29425, and consider that included in the initial fracture (not billing it). We would, however, bill for any subsequent casting. Would L4386 be payable with the initial fracture care?

Laurie Bodo, Lake Orion, MI

Response: Yes, a walking boot is payable outside the surgical global period. It is not included in the global surgical allowance. Obviously, its coverage is based on medical necessity. I am assuming you are not requesting to alternatively bill for a walking boot when the doctor actually applied a below-the-knee plaster or fiberglass cast.

Harry Goldsmith, DPM, Cerritos, CA

Editor's Note:  Dr. Goldsmith will be lecturing at the upcoming Greenbrier Coding & Practice Management Seminar, August 20-22 (following the APMA National Meeting). For details click here.

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

RE: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Michael Rothman, MS, DPM, Elliot Udell, DPM

Pain ONLY while driving his big rig - It sounds like an issue with the truck seat and his immobility while seated for extended periods. The angle his foot and leg make to touch the pedal and the amount of pressure he must apply to the gas can all enter into the equation. Does it occur while he is seated watching TV or eating a meal? 

Michael Rothman, MS, DPM, SWkokie, IL, michael_rothman@sbcglobal.ne

For sure you should order an MRI. It will enable you to visualize the presence of a neuroma. If it is present, you can then consider a series of either 4% alcohol injections or injections of Sarapin mixed with local anesthetic.
 
Ordering  a comprehensive neurological examination could also prove helpful. This past year, we had a patient with foot pain who seemed to be getting temporary relief from injections. After nearly six weeks of unsuccessful treatment, I ordered a nerve conduction study and the report was suggestive of a problem emanating from the patient's lower spine. The patient was referred to a back surgeon who ordered spinal MRIs and ultimately discovered that the patient had a stress fracture of the spinal column, requiring immediate open reduction. She is doing fine now.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Lapidus or Fusion (Philip Graham, DPM)
From: Barry Mullen, DPM

The original query indicated an active 65+ year old patient with hypermobile 1st ray and modest bunion deformity; the key word is active. In addition, clinically, 55 degrees of painless 1st MTP dorsiflexion is available pre-operatively. X-rays show minimal degenerative arthritic changes about the 1st MTP; so, the question begs, why fuse a relatively healthy joint, especially in an active individual? Mild IM angle reduction can be expected from eliminating the retrograde forces about the 1st MTP which would occur with a fusion, but in my opinion, not likely nearly enough to satisfy this patient's complaints.

In addition, fusing the 1st MTP will certainly negatively affect this person's long-term activity level. Assuming the bone stock quality is appropriate, which it appears to be on x-ray, then repairing the deformity at its source, while preserving joint integrity, is the most appropriate surgical choice. Given the x-ray picture presented, a Lapidus fusion with the possible need for Reverdin or Green modification to address a likely encountered intra-op elevated PASA, is indicated. Age, as it pertains to foot surgery and osteotomy/fusion healing parameters should be considered from PHYSIOLOGIC perspectives, not chronologic! There are many 65+ year olds who go on to uneventful healing from aggressive, but necessary, HAV repair. Conversely, I have evaluated many 40 year olds with bunions whom I wouldn't even touch with a 10 foot pole. Treat the patient, not the charted stats!
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Billing For Support Staff (Name Withheld (NY)
From: Michael Forman, DPM

The question of billing for support staff was raised on PM News. I can only answer for Ohio. Ohio's revised code states that tasks can be designated to support staff as long as
    
     1. The duty lies within that physician's authority.
     2, The task us indicated for the patient.
     3. There is an appropriate level of supervision.
     4. The task is within the ability of the designee.
     5. Independent medical decisions cannot be made by the designee.

I think that the assistants working while the doctor is not in the office does not satisfy the third and fifth requirement.  If you wish to see the Ohio law, Google "Ohio Revised Code" and look for rule 4731-23-02.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

RE: Depreciated Value of Equipment (Name Withheld)
From: Donald R. Blum, DPM, JD

There is what is called general accepted accounting principles (GAAP) and the IRS uses this to figure depreciation. The seller should be able to show you from tax records what the equipment originally cost. Then just work the formula for depreciation. Do not forget to include the accelerated write-off one is allowed annually. An alternative is to check on eBay for new and used equipment companies to settle on a value. In Texas, we have property taxes, so the office has a value assessed to it by the county appraisal district; use that value. The buyer would want to pay for equipment because that is depreciable on the buyer's taxes.
 
For the seller, there is regular income and capital gains. Good will is subject to long-term capital gains, while the equipment price is subject to recapture of depreciation. Then it is taxed at a regular tax rate. Both the buyer and seller should get advice from an accountant knowledgeble about taxes, and an attorney knowledgeable about buying or selling a practice. Getting "FREE" advice is worth the price you are paying for it!
 
Disclaimer: This is my opinion, and not meant to be a legal/accounting opinion or a form or offer of representation.
 
Donald R. Blum, DPM, JD, Dallas, TX, donrblum@sbcglobal.net

RE: ICD-10 Preparation (Joseph S Borreggine, DPM)
From: Arthur Lukoff, DPM

I hope this gloom and doom is just that. If the health industry has this shoved down their throats, I can see a lot of health professionals retiring, especially those in smaller practices and serving areas away from metropolitan areas. Most smaller providers will not and should not have to carry that kind of financial burden and put up with that type of payment delay. I hope cooler heads prevail. Or it will be adios to personalized medicine.

Arthur Lukoff, DPM, Ellenville, NY, footdoc45@hotmail.com

RE: ABPS Name Change (M. W. Aiken, DPM)
From: Jeff Mennuti, DPM, Charles G. Kissel, DPM

In regard to the name change, it think this is a prudent step. ABPS is also an acronym for the American Board of Plastic Surgery. I believe each specialty should have their own acronym to avoid confusion. This should not be misconstrued for anything other than obtaining a unique, and separately identifiable acronym.

Jeff Mennuti, DPM, Orange City, FL, dr.mennuti@gmail.com

As a long-time residency director and the father of two sons who are currently training to become podiatrists, I have a significant stake in the future of our profession. I understand the concern of our colleagues that we do not wish to lose our unique identity, and agree wholeheartedly that we must continue to demonstrate that we have a skill set that makes us more qualified to treat patients with foot and ankle disorders than any other type of healthcare provider.

Board certification exists in order to credential its members as competent and qualified in their field. The board does not define "who we are," but exists to certify, "what we do." The name change to the American Board of Foot & Ankle Surgery will define us as the ONLY specialty in Foot & Ankle Surgery with such certification. This will be then clearly identified as such to all entities including government, hospitals, the insurance industry, and the public. It defuses the argument that we are podiatrists, certified "only" in "podiatric procedures" and that other specialists are those qualified in the full range of surgical procedures available to the "Foot & Ankle" surgeon.

I hope that the profession acts as one to support this important change. As "podiatrists" we cannot afford to allow internal conflict to impact the future of our specialty. As we move forward, we should do so arm in arm, together.

Charles G. Kissel, DPM, Warren, MI, ckissel@dmc.org

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

ASSOCIATE POSITION – MIAMI, FLORIDA

Associate with potential for partnership. All phases of foot and ankle care. Bilingual in Spanish helpful. Send Resume and Letter of interest to miamifootandankle@gmail.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - LOS ANGELES
   
Multi-specialty group seeking part time podiatrist. Opportunity to transition into full time position. Required:  3 years or surgical residency, including Charcot reconstruction, fellowship or interest in biomechanics, and ability to train surgical residents. Send CV to podiatricri@yahoo.com 

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to:  seattlefootdoctor@yahoo.com

FULL-TIME PODIATRIST NEEDED - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County NY (West Point) area. Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER calls. The applicant has to be trained in all foot surgery and be able to handle advanced Diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking,fishing, skiing, and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

EQUIPMENT FOR SALE - SWISS DOLORCLAST ESWT

Swiss DolorClast ESWT. Complete with Cart. Extra hand pieces. Excellent condition. Low hours. Asking $12k. Pictures available upon request. Contact Carol at 708-596-3757 or carol.performance@sbcglobal.net 

EQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or 440-285-2827 or email me at gwdocks@aol.com

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