The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 21, 2012 #4,442 Publisher-Barry Block, DPM, JD

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Diabetics with Non-Healing Ulcers Need a New Approach: CA Podiatrist

Diabetic patients with foot ulcers that have not begun healing in six to eight weeks should ask their podiatrist if a new approach to caring for the ulcer is warranted, according to a California podiatrist presenting data at the Midwest Podiatry Conference.

Dr. Doug Richie, Jr.

Douglas H. Richie Jr., DPM is associate clinical professor, Department of Applied Biomechanics at California School of Podiatric Medicine. He presented his findings at the Midwest Podiatry Conference in Chicago on Thursday, April 19th.

IN Podiatrist Discusses Types of Orthotics

There are generally two types of customized orthotics: rigid (functional) and soft (accommodative). A rigid orthotic is typically used to correct problems, such as pronation or supination, by putting the bones of the subtalar joint in the neutral position, relieving pressure, says Michael G. Lacey, DPM, from Friendly Foot Care in Crown Point. 

Dr. Michael Lacey

"A soft orthotic serves as a shock absorber to the foot," he says. "This type is commonly used to help ease pain associated with arthritis or diabetic foot ailments. The soft orthotic also supports the arch, whereas a more rigid orthotic is used to control foot dysfunction such as plantar fasciitis."

Source: Sharon Biggs Walker, NWI Times [4/19/12]

Bike-a-Thon Planned to Support the Yucatan Crippled Children’s Project  

Dr. Edward Glaser of Sole Supports, Inc. has partnered with Dr. Charles C. Southerland, the founder of the Yucatan Crippled Children’s Project and a member of the Barry University School of Podiatric Medicine to hold an annual Bike-a-Thon of the 444 mile Natchez Trace Parkway beginning May 15th in Nashville, TN and lasting 9 days. 

(L-R) Drs. Ed Glaser and Charles Southerland

The goal is to fundraise and publicize the need for life-changing donations to support treatments and surgeries of the children of the Yucatan Peninsula who otherwise would be left in need. The ride will end in downtown Natchez, Mississippi on May, 23rd to celebrate the Sole Supports Bike-a-thon mission to help children walk, and their ongoing mission to make people better.

GA Podiatrist Named as Finalist in Entrepreneur Of The Year® Award

Ernst & Young LLP has announced the finalists for the Ernst & Young Entrepreneur Of The Year® 2012 Award in the Alabama / Georgia / Tennessee Region. The awards program recognizes entrepreneurs who demonstrate excellence and extraordinary success in such areas as innovation, financial performance, and personal commitment to their businesses and communities. 

Dr. David Helfman

Among the finalists is Dr. David N. Helfman, CEO – Extremity Healthcare, Inc./Village Podiatry Group and a lecturer on the SuperGroup Model. Award winners will be announced at a special gala on June 7, 2012 at the InterContinental Hotel, Buckhead, in Atlanta, Georgia.

VA Podiatrist Faces Challengers in School Board Election

Three incumbents are vying to keep their seats on the Newport News School Board for another 4-year term. Each faces challengers. In the North District, incumbent Bill Collins, a podiatrist, has served on the board since winning a three-way race in 2004. He ran unopposed in the last election. 

Dr. William Collins

His challengers are Valerie Young and Darian Scott, who both have children in the school system. Dr. Collins is chief of the podiatry clinic at the McDonald Army Health Center in Eustis, VA.

Source: Samieh Shalash, Daily Press (VA) [4/18/12]

Query: Compounded Antifungal

I treated a patient today who told me he had been prescribed 2% fluconazole in DMSO for toenail fungus. He thought it worked quite well, and would be returning to the dermatologist for another prescription. I wondered if anyone had experience with this compounded Rx? What would the compounding instructions say?

Bruce Lebowitz, DPM, Baltimore, MD

Query: Billing for an Aircast Airheel

We billed for an Aircast Airheel using code, L2999 (lower extremity orthoses, not otherwise specified) with "KX-RT" modifiers. The claim was rejected using CO-16. "Claim/service lacks information which is needed for adjudication. At least one remark code must be provided (may be comprised of either the NCPDP reject reason code, or remittance advice remark code that is not an ALERT)." What are they looking for?

Dennis Frisch, DPM, Boca Raton, FL

Response: L29999 is a miscellaneous orthotics and prosthetic code. This product code will not be paid if sent electronically. You may try submitting this claim manually with a product description. But even this effort may fall short and CGS may refer you to the PDAC for a specific product coding.

You may run into another brick wall because the PDAC may have already assigned the miscellaneous code to this device, and refuse to assign a price; or the PDAC may assign a specific price to this one device which may not satisfy you. You may wish to contact the PDAC directly or Aircast. In the future, when you have a device which is advertised to be coded as miscellaneous HCPCS, it's because that's what the advertiser received from the PDAC. You can bet that is not what the advertiser wants to advertise! My best advice is to charge patients cash for devices which cannot be coded, because it's almost going to be impossible for you to obtain reimbursement for these devices.

Paul Kesselman, DPM, Woodside, NY

Editor's note: Dr. Kesselman will be lecturing at the Greenbrier Coding & Practice Management Workshop on August 20-22nd.

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RE: Charcot Foot (Tip Sullivan, DPM)
From: Barry Mullen, DPM
 
"Look before you leap." Yes, TNJ Charcot changes are present on x-ray...but, so are: 1) an elevated white count in a known diabetic; 2) radiolucent lesion in the base of the 3rd metatarsal w/ dorsal periosteal reaction visualized on lateral projection; 3) cardinal signs of infection at and just proximal to the ankle; 4) modestly elevated SED rate. All the above seem more suspicious for a Brodie's abscess and concomitant acute cellulitis than an acute Charcot arthropathy. Rule out OM prior to surgical intervention.
 
In the presence of an acute Charcot arthropathy, an MRI and Tc scan would both light up, so an Indium-labeled white scan is likely the best test to rule out Osteomyelitis. OM, if present, changes your entire surgical plan. Another diagnostic option is to trephine the base of the 3rd metatarsal and submit the specimen for bone biopsy and bacterial analysis. That has the advantage of not only ruling in/out OM, but also bug ID which would greatly assist your infectious disease personnel's IV antibiotic choice if indicated. Lastly, acute Charcot remains in the differential, so your Indium scan would be negative. In that scenario, why operate? It sounds like immobilizing the foot throughout the acute phase is the best treatment option.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Elliot Udell, DPM

The most serious public health concern associated with burring mycotic nails is the infectious aerosol that is projected into the air. If you go on to Pub Med and type in "nail dust", you will see numerous papers published in the US and the UK on this occupational hazard. The health risk is not only to podiatrists, but to podiatric assistants and probably to patients because some of the studies indicate that the infectious nail dust aerosol remains in the air for a half hour or more after infected nails are drilled.

Surveys of podiatrists taken in this country as well as in the UK have shown that a statistically significant number of our colleagues who routinely drill nails have developed a host of pulmonary problems associated with this practice. There may even be OSHA regulations which restrict the use of a room for a period of time after mycotic nails have been burred.
 
I have not burred any nails in my practice. On rare occasions, a patient will say to me "Doc, why don't you drill my toe nails? The podiatrist down the block does." When this happens, I show the patient the literature and gently say, "Mrs. Jones, if I burr nails, not only will you be breathing in your own nail dust, but the infected dust of every other patient whose nails were burred in this office this morning." In most cases, this is well understood and appreciated.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Urgent Care Clinics (Larry Kansky, DPM)
From: Stephen M. Meritt, DPM, Bret M. Ribotsky, DPM

With all due respect to Dr. Kansky, there is a huge difference between a PhD nurse passing herself/himself off as a doctor in a situation where a patient will think they are a physician and a DPM who is a physician. We are, by state law and training, physicians in Florida where Dr. Ribotsky practices.

Stephen M. Meritt, DPM, Jacksonville, FL, smeritt@aol.com

A nurse practitioner serves a valuable purpose in our healthcare delivery system, as does every member of the team. Additionally, I believe nobody should misrepresent themselves to patients. In Florida, it is the law that only an MD or DO can use Dr. to identify themselves alone. Non-MD/DOs must identify who they are. Example, if a podiatrist's lab coat says Dr. Smith, it must say podiatric physician, or podiatrist. So must an NP. Other states do not have these rules. 

I believe my position regarding this profession is unwavering. I am critical when anyone who is disingenuous, whether it's a DPM claiming 90% cure rates for laser nails, or Jeffrey Toobin writing in the New Yorker Magazine that  "Podiatrists are three steps below dentists." I speak up and take action. The real question is, why don't we all?

Bret M. Ribotsky, DPM, Boca Raon, FL, ribotsky@gmail.com

RE: TPMF Hosts Resident Case Competition
From: L. G. Lefler, DPM

I enjoyed the story regarding the retreat at Bandera, TX. Years ago, I attended that meeting when it was organized and conducted by Louis T. Bogy, DPM, who was my classmate. Thanks for sending out the information.
 
L. G. Lefler, DPM, Fremont, NE, Lglefler1@aol.com

RE: OH Podiatrist Discusses Celebrity's Neuroma
From: Dale Feinberg, DPM

I've  been following Steven Tyler's foot problems for years and always suspected that he had a neuroma by his pain description, long before he came out with it in his book or Rolling Stones interview. The best part of the story is that he blames his neuroma for his relapse to drug addiction after twelve years of sobriety. When he finally couldn't stand the pain any longer, he went to the best doctor he could find for his condition -an orthopedic surgeon in Boston. He should have consulted a podiatrist first. Maybe  he wouldn't have fallen off the stage in Sturgis, South Dakota. I keep a copy of his Rolling Stones cover and neuroma description in my office and show it to patients who have a neuroma.

Dale Feinberg, DPM, CPed, Yuma, AZ, Hd5bl@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

PODIATRIC SPORTS MEDICINE FELLOWSHIP - ORANGE COUNTY CA

July 1, 2012 and ending July 31, 2013 (13 months). Responsibilities include assisting in all types of foot and ankle surgery, (approx. 500 cases), office and outside rotations including Sports Medicine Orthopedics Family Medicine, Biomechanics and Physical Therapy. Benefits include salary of $60,000/year, medical, dental, malpractice, and CME allowance. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Min. 24-month surgical residency training is a pre-requisite. Letter of interest, and CV to: Philip Radovic, DPM, Fellowship Director, 665 Camino de los Mares Suite 304, San Clemente, Ca. 92673. Ph: 949/493-8020 Fax: 949-488-0868. Email: Info@feetfixer.com.

ASSOCIATE POSITION - TENNESSEE/NORTH GEORGIA

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference to mybestnewjob@gmail.com

ASSOCIATE POSITION – VIRGINIA

Two office practice, hospital and surgery center privileges, trauma call, modern offices, EHR, digital x-rays. Excellent compensation package. Position may lead to partnership. Candidate needs to be experienced in foot and ankle reconstruction and trauma. Email letter of interest and CV to Dr. Joe Disabato at jdisabato@vfasa.com

ASSOCIATE POSITION - PART TIME - OCEAN COUNTY, NEW JERSEY

Looking for PSR 24/36, board eligible preferred. Busy podiatric practice with up to date EMR & practice management program. Practice currently offers digital x-rays, ultrasounds, vascular studies and laser treatment. Good mix of general podiatry, wound care and surgery. Must be ethical, hardworking and committed to quality patient care. NJ license needed. Competitive salary and benefits. Send cover letter and resume to: AOKNDPM@gmail.com

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, Indiana, and Oklahoma. 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 - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com

ASSOCIATE POSITION - SENIOR CARE DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: Immediate openings for physicians who are interested in caring for the elderly in nursing homes throughout Georgia. Full time position. Excellent salary, benefits, and opportunity for growth. Must understand the coding/billing process and have excellent documentation skills. You don't have to be board certified in foot or ankle surgery for this position. If interested, please contact Dr. Helfman at dhelfman@vpcenters.com

ASSOCIATE POSITION - ATLANTA, GEORGIA AND SURROUNDING COUNTIES

Village Podiatry Centers, LLC: Immediate openings for board eligible or certified, 3-4 year trained surgical physicians. Equity based model, Excellent salary and benefits to start depending on qualifications. (Average physician salary is 2-3 times industry median salary).Full benefits included. Access to practice owned surgery centers, pathology lab, imaging center(s), and other in house ancillaries. Very selective process: must be flexible, well trained, and must participate in our "Physician Training Program." You live off income and retire off wealth! Serious inquiries only! E-mail: David N. Helfman, DPM, FACFAS at dhelfman@vpcenters.com

PHYSICIAN FOR CLINICAL RESEARCH DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: If you have experience in running clinical research trials and would like a full time position in managing and overseeing multiple clinical research trials for our growing group, please contact Dr. Helfman @ dhelfman@vpcenters.com. Excellent salary, benefits and equity opportunity for the right individual.

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.com

PRACTICE FOR SALE- AUSTIN TEXAS

Great opportunity for new practitioner or an additional office. 18 year practice with large patient base. Current physician transitioning to part time then retiring to pursue another business opportunity. Start turn-key without need for a bank loan. Great area to live and work. Susieintx@aol.com (512) 565-6634

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Be an owner not a worker. 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 - SOUTH NEW JERSEY

Great practice for sale, lease it, work in practice, rent-free first year, associateship possible. Must have NJ licensure have own TIN participation for Horizon, Cigna, Aetna, etc. Retiring. Anyone is welcome to make offer or come up with other ideas. Contact footcare@comcast.net

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