The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 02, 2010 #3,947 Publisher-Barry Block, DPM, JD

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CA Podiatrists Concerned About Infections From Pedicures

Doctors have concerns about pedicures. Dr. John Ciccone, who runs Pacific Beach Podiatry, said three or four times a month, patients come in with infections likely contracted during pedicures. Ciccone blamed foot spas, which received national media attention after they were linked to bacterial outbreaks in California.

(L-R) Drs. John Ciccone and Donald Triolo

Dr. Donald Triolo, who runs Alvarado Podiatry Center, cautions about fungal infections, which attack nails from the outside and don't need an open wound to fester. “These salons, boy, they're a breeding ground,” Triolo said. “Some people disinfect tools after using them. Others just throw stuff in a drawer and use it from person to person.”

Source: Brooke Williams and Danielle Cervantes, San Diego News

Scholl Students Complete Summer Research Fellowships

It has been another outstanding year for CLEAR’s NIH-funded summer research fellowship. This year, eleven students participated in projects covering a great breadth of topics. Some participated in benchtop work looking at animal-based models of diabetes. Others worked in CLEAR’s Human Performance (Gait) Lab evaluating various types of footwear and their impact upon gait and functional status, or efforts investigating motor learning in association with balance. 

(L-R): Back row- Darshan Nagesh, Fraaz Sayeed, David Arens, Allison Ippel, Cory Jacoby, Front Row- Jessica Minder, Henry Hilario, Maureen Allanson, and Anna Peterson.

Some students were also involved in clinic-based studies on topics such as venous insufficiency, wound bioburdens, and comparative investigations of surgical procedures. It is anticipated that a number of the students will go on to present their work at various national conferences throughout the upcoming year.  This summer’s trainees were: Maureen Allanson, David Arens, Elizabeth Barnica, Henry Hilario, Allison Ippel, Cory Jacoby, Jessica Minder, Darshan Nagesh, and Anna Peterson.

MI Podiatrist Scores Sanctions in Cryomed Patent Fight

A Michigan podiatrist won sanctions as well as a default judgment in his suit accusing Cryomed LLC of defamation and infringing his patent covering a method of treating foot and ankle pain after the company dragged its feet in the discovery process.

Dr. Lawrence M. Fallat

Citing Cyromed's failure to respond to Dr. Lawrence M. Fallat's motion for sanctions and to comply with an order compelling discovery, Judge Lawrence P. Zatkoff signed off on his order for default judgment in the U.S. District Court for the Eastern District of Michigan on Monday. The judge also awarded Fallat costs and attorneys' fees.

Source: Megan Stride, Law360 [8/31/10]

Formation of Physician Committees

As the group forms, you should set up as many of these committees as possible so all the physicians feel part of the process. You will eventually get too big to run by committee, but until you produce about 30 million dollars in revenue or so, you want to try to keep these committees alive. These committees are very important at the onset of your new group and will be key in refining your structure.

a. Marketing
b. Finance
c. Development, Ancillary, and New Practice
d. Billing and Coding
e. Customer Service/Training

Once you get to the 30-50 million dollar level, you will need to be run more by the board of directors and executive team. You might want to lessen the role of some of the other committees.

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC, dhelfman@vpcenters.com

Query: Ultrasound Training Course

My group just purchased a Mindray M5 ultrasound unit. I'm interested in obtaining training for lower extremity applications. Can anyone offer advice? 
 
Gerald Mauriello, Jr., DPM, MA, Freehold, NJ

Query: Keller with Chondroplasty
RE: Jeffrey M. Kittay, DPM

I know that I'm from the old school, but why would one resurface a metatarsal head with GraftJacket, or anything else, if one is putting in a hemi-implant for the phalangeal base? I regard this as overkill. All of the hemi-implants that I am familiar with are intended to move freely over any type of damaged metatarsal head, albeit perhaps with some remodeling for better contour. That is the entire purpose of a hemi. Adding an expensive and unnecessary implant serves no clinical purpose but does serve to make your claim stand out for audit by the insurer. Let's save the high-tech work for the cases where it's really needed, not just put it in to inflate the bill or provide the resident with more experience.
 
Jeffrey M. Kittay, DPM, Boston, MA, twindragons2@verizon.net

RE: Skechers Shape-Ups and Plantar Fasciitis (Doreen Raudenbush, DPM)
From: Elliot Udell, DPM
 
During my 30+ years of being a podiatrist, I have seen shoe fads come and go. The promoters  always have the upper hand  by being able to spend millions of dollars promoting the fads, along with theories aimed  to explain why the new shoe gear should help people's feet. With the case of "Shape-up" shoes, they have an additional PR advantage because they are convincing the public that wearing the shoes will lead to weight loss. Note the ads. They  promote  the cosmetic aspects of weight loss which is a big selling point. 

Whether these shoes will lead to foot problems, prevent foot problems, or not affect people's feet can only be evaluated at this time based on theoretical models. The real test will come in a year or more, when and if people wearing these shoes present with any form of pathology associated with its use. Only time will tell, and we as foot care providers will be the first to know and hopefully the first to speak out.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Billing Medicaid Patients in NY (Charles Morelli, DPM)
From: Multiple Respondents

Dr. Morelli described a common problem that many private practitioners face in New York. Strongly consider sending your patient with Medicaid to a hospital that FULLY supports podiatric surgery and one where podiatry is integrated within the medical institution. This is especially important in New York for the obvious reasons. There are plenty of patients with Medicaid who travel from all over the city to come to our hospital in the Bronx because of the situation that you just described.

Neal M. Blitz, DPM, Bronx, NY, nblitz@bronxleb.org

The question from an ethical standpoint would have been more intriguing if Dr. Morelli stated he worked in the clinic as a clinician. I do not know whether he does or doesn't. A second point to consider and maybe the editor can chime in - while podiatrists in NY can't bill Medicaid as a primary insurance, Dr. Morelli may actually have a Medicaid number which he uses to bill Medicaid as a secondary. If this is the case, is it still allowed for him to charge a Medicaid patient or does that negate anything?

If this is allowed - I think the right thing to do is to simply explain to the patient that you can be seen in the clinic for free or in the office for a fee.  Sometimes, you will be surprised that someone actually does value your service. The bigger problem here is the fact that podiatrists do not have the authority/capability for billing Medicaid services.

Jeffrey Kass, DPM, Forest Hills, NY, jeefckass@aol.com

Some hospitals that I have been associated with are willing to pay physicians a flat rate to care for an indigent or Medicaid patient. This way, the hospital can be in compliance with their needs to care for all patients, irrespective of insurance, and still ensure that they have the proper staff to provide the professional care. This amount may be negligible (e.g., $200) but it is better than nothing. The other issue here is whether the other physicians who do take emergency call can legally refuse to care for Medicaid or indigent patients. In the various ER call and hospital staff credentialing contracts which I have signed over the years, it mandates that you cannot refuse caring for a patient because of insurance status.

One hospital's privileges stated if you (or your staff) asked any hospital staff (e.g. nurse, resident etc.) what type of insurance the patient had prior to coming to the ER or to the in-patient unit and evaluating the patient, your staff privileges could be revoked and a report would be filed with the NYS Office of Professional Conduct. It is utterly amazing that the very same MD/DO colleagues who lambaste our training and fight our hospital credentialing, will suddenly refer patients who cannot afford to pay. Yet, they say that we are not adequately trained to treat those who can afford to pay.

If the plastic/orthopedic surgeons refuse to care for Medicaid/indigent patients, claiming they don’t treat the foot, the hospital's by-laws should not credential them to treat the same conditions when patients have “Cadillac” insurance. Furthermore, these physicians should be sanctioned by the hospital. As the editor stated, it does underscore the need for Title XIX to be changed in order for podiatrists to be defined as physicians.  

Paul Kesselman, DPM, Woodside, NY,pkesselman@pol.net

RE: The Residency Shortage
From: Multiple Respondents

Maybe the solution to the residency shortage problem should be tying the number of students matriculated to the colleges of podiatric medicine to the number of residency slots available. This would vary from year-to-year and could be proportioned by each school as a percentage so that no school is unduly affected. This would ensure that the "investment" made by incoming students will pay off when they graduate. This may also get the colleges more involved in developing residency programs by encouraging their graduating students to become involved in residency genesis following their graduation from residency. This seems a simple solution to the residency shortage and would hopefully prevent future crises.

Gerald Peterson, DPM, West Linn, OR, DRP@ifixft.com

I was the person in charge of changing an existing PPMR/PSR-12 into a 3-year PM&S-36. I understand intimately how difficult and time-consuming this process becomes. How can anyone expect to create new program spots overnight without any base? What needs to be done is to have the preceptorships and fellowships re-instituted ASAP as emergency backups with a guarantee that these people will enter a residency the following year or two. We can never guarantee the number of spots, since the number of graduates changes every year, and the rulings have been that if a residency spot is not filled within two consecutive years, it closes (at least this was true in the past). 

What needs to be done is to bring back the back-door programs for those who cannot win the residency lottery. I am sure that there are many of us practicing out there today who would be happy to have someone come through their office. Split the time between doctors. For every preceptor/fellow, we would need at least five DPMs taking turns. Teach them podiatry. By the way, modern podiatry schools do NOT train the students to be podiatrists; they train them to become residents, expecting the residency to train them to be podiatrists. It's a sad but true fact. I trained residents for five years, and I saw it first-hand, as well as when I was a student.

Noah A. Blumofe, DPM, Santa Monica, CA, dr.blumofe@gmail.com

Editor's note: Dr. Allen Jacobs extended-length letter can be read here.  Dr. Richard A. Simmons' extended-length  letter can be read here. 

RE: Blaze Destroys Office of NY Podiatrist
From: Frank Lattarulo, DPM

I am truly saddened to hear about my classmate Larry's devastation. I have not seen Larry since graduation due to our geographic locations, but for those of us that do know him, we remember both his presence as well as his academic and clinical intelligence. Larry is a strong person, and will eventually overcome this. My prayers will be with him. I ask that the whole podiatric "family" pray for Larry, his family, and his patients. He truly deserves it.

Frank Lattarulo, DPM, New York, NY, DOCLATT@aol.com

RE: Cosmetic Foot Surgery Debate Continues (George Vito, DPM)
From: Charles Morelli, DPM, Bret Ribotsky, DPM

Dr. Vito's comments and individual situation notwithstanding, I can't help but feel that we are missing one important aspect of not only "cosmetic" foot surgery, but what and who we are as a country.  Yes, I am actually making that leap in this discussion. Let's not forget that we are a free country with the freedom to do with our bodies what we want (abortion and prostitution also not withstanding). Tattoos, breast augmentation, plastic surgery, earlobe stretching, piercings, Botox, liposuction, etc. The list is endless. Whether you choose to perform these procedures is not the point, but it is your right to either perform the procedure or elect not to. Taking bunions and hammertoes as the example (and not cosmetic limb-lengthening), where scope of practice is not a concern, a patient has the absolute right to have his or her foot altered. Don't they? Is there something here I don't understand? If the foot is non-painful, you inform them of the risks, benefits and alternatives of the planned procedure, have a detailed consent form signed by all parties, and make sure your chart reflects all of this.
 
I performed a classic "forefoot smash" on a 16 yo female last week whose left foot was hurting her due to her deformities. Now that her foot looks "normal", she wants her right foot to "look like her left one." She has a similar deformity on the right side, but it has never hurt her to the extent that her left foot did. Do I say to this patient that I cannot do her surgery because if her foot doesn't really hurt her as much, it would be more cosmetic than functional?  No. I do exactly what I have just suggested and go ahead with the procedure - after I have made sure that both she and her parents understand the risks. 
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

I think I may speak for the silent majority who would be willing to correct a bunion for a patient with "limited" pain, and willing to pay CASH for the procedure. I have used PSTTA (pedal soft tissue temporary augmentation) as elective non-covered treatments with dermal fillers for almost 5 years and have not really considered if this procedure is "cosmetic" or "therapeutic" under the legal definition.  
 
Reading George Vito's comments about what he endured has placed my paranoia on high. Dr. Vito is a great leader of our profession, one who has shared unselfishly for years, and his story needs to be shared. Dr. Vito will be my guest on Meet the Masters on September 21. 

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

POSITION AVAILABLE - NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: podiatry2011@gmail.com

ASSOCIATE POSITION - SAN ANTONIO, TX

Immediate Opening for motivated podiatrist with good people skills.  Associateship leading to partnership for the right applicant to help develop fast growing Northside San Antonio Texas practice. Attractive office and beginning income. CV and letter of interest to sadpmoffice@gmail.com

MANHATTAN - FULL-TIME POSITION

Available for a Board certified/qualified podiatrist (PSR-24, PM&S-36 ). Located in Downtown Manhattan in a multi-specialty Orthopaedic office. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Contact fscudese@seaportortho.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full-time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - BLOOMFIELD, NEW JERSEY

Part-time office part of larger practice looking for associate with well-rounded podiatric skills. Board qualified a must. Ground position leading to partnership. Please email CV to doccapo@yahoo.com 

ASSOCIATE POSITION - SW FLORIDA GOLF, BOATING & BEACHES 
 
Great opportunity to join a well established podiatry practice.  Excellent mix office/surgery, motivated experienced staff. Seeking full-time Associate PSR 12-36. Salary $100 Thousand + bonus package with benefits, early buy-in available to right candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

PODIATRY POSITION AVAILABLE – WISCONSIN

Affinity Medical Group, an integrated health care organization in East Central Wisconsin, is seeking a BC/BE Podiatrist for our Appleton location. This is a General Podiatric practice opportunity including routine care, sports medicine, and surgery. The Appleton area offers a unique quality of life, combining a family centered, university community with all season recreation, a nationally acclaimed educational system, and a diverse and growing economy and population. For information, contact or send your CV, to: Sara Roth, Affinity Medical Group, Physician Recruitment, Phone: 800-722-9989; Fax: 920-727-4350; E-mail: sroth@affinityhealth.org Visit our website at: www.affinityhealth.org EOE.

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

We have a very busy, well-established, diversified practice in the Tampa Bay area of Florida. We are seeking an Associate who is BC/BE and highly motivated. We offer a competitive salary and benefits. Please send your resume and current photo to Jaye@fdn.com

ASSOCIATE POSITION- MONROE, MICHIGAN

Excellent opportunity to join a modern, growing 3 doctor/2 office practice located in SE Michigan between Detroit and Toledo. Responsibilities will include a mix of surgery, office, hospital and nursing home/housecalls. Salary, bonus and benefits. Learn more about us at monpod.com. If you are a personable, reliable team player with solid skills and a patient first attitude please contact dr.hughes@comcast.net for more information.

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

Full-time 38 yr old podiatry practice with state licensed surgical center. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network, and well-equipped surgical suite. Retiring owner will stay on as needed for transition. Email dpmpracticeforsale@yahoo.com

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

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