Query: Osseous Cysts Discovered During Bunion Surgery
The patient is a 56 year old healthy female teacher. A large osseous cyst in the head of the first metatarsal was discovered during scheduled bunion surgery. This cyst was not obvious on pre-op x-rays. It prevented the planned metaphyseal osteotomy of a modified Austin-style bunionectomy (“chevron”) as well as a possible Scarf procedure. The patient did not want a more proximal osteotomy (CBWO, Lapidus, Cotton) that would cause prolonged disability. Demineralized bone matrix was placed in the defect.
What is the consensus of podiatric surgeons in this presentation? I suggested a Mau-type osteotomy to help reduce the abnormal IM angle, thereby avoiding any osteotomy of the capital region. Post-operative weight-bearing on a protected basis would then be permitted. Is anyone performing the Mau procedure?
Query: Alternative to Answering Service
Are there any recommendations for alternatives to answering services which charge monthly fees? I would like to keep my cell phone number private from patients or others who call after hours. My current service is utilized just a few times a month.
John Scholl, DPM, Lady Lake, FL
Query: Stem Cell Therapy
I understand that stem cell therapy is being used to treat foot and ankle problems. Can anyone recommend a CME course or pertinent literature regarding this form of treatment?
Michael Forman, DPM, Cleveland, OH
Query: CMET Certification
Have any of my colleagues taken the CMET wound care certification examination? Any thoughts or counsel on what your experience has been would be appreciated.
Maryann Trivlis, DPM, Belle Harbor, NY,
Query: Inventory Management System
I am a partner in a multi-doctor, multi-office practice. I am looking for suggestions for an inventory management system. This system should be able to keep track of DME as well as smaller items (medical supplies, syringes, injectables, etc.). Ideally, it would alert us to when we are running low on a product so we would know when to order more. Does anyone have a recommendation?
Scott Werter, DPM, Myrtle Beach,SC
Query: CMS Changes
Two years ago, we were told that the global surgery days were to be eliminated. I have not heard any mention of whether this was implemented. Also, does anyone know the status on the exemption limits to the CMS quality assurance program? They currently are $30,000 with up to 100 patients and the proposed change was to $90,000 for up to 200 patients. The latter proposed change was reported here on PM News. This is a very important change for solo small practices. The impact from an elimination of the global surgery days will affect all practices.
George Jacobson, DPM, Hollywood, FL
Query: Pacific Medical for Digital X-Ray System
My office is in the market to purchase a DR x-ray system. I have recently been in touch with Pacific Medical who uses Metron software. I'm not familiar with this company but they do have very good pricing. Does anyone have any experience with this company, and could you inform me as to how happy you are with the DR digital x-ray system?
Peter Riznyk, DPM, Orchard Park, NY
Query: Hospital Call Schedule
The hospital I currently go to is planning on starting a non-paid call schedule. I'm trying to negotiate a paid call schedule because, in my opinion, non-paid is ridiculous. Why should all other specialties get paid while podiatry doesn't? Does anyone else experience this, and do you have any tips to negotiate?
Mike Zuri, DPM, Tampa FL
Query: Non-Allergenic Support Hose
Does anyone know of any support hose that are non-allergenic? My patient has tried several brands with no luck.
Robert Fridrich, DPM, NY, NY
Query: Shoe for Parkinson's Disease
I have a very close friend who has had Parkinson's disease for over twenty years. He is in his early 60s and has been doing relatively well. He does shuffle while walking and sometimes stumbles and trips. His shoes are mostly rubber composite designer footwear. I am researching shoes with less grabbing soles.
I know the SAS line would be good but I would like some other suggestions, especially if there are any designer shoes that would have a more forgiving sole for this type of gait. A leather sole is not an option due to insufficient padding. Any input would be greatly appreciated.
Query: Beneficial Insurance
I just received a very good quote from Beneficial Insurance for my malpractice insurance policy which is coming up for renewal. I have not heard anything, negative or positive about this insurer. I'm wondering if any of my colleagues have had any experience with them?
Deardre Nadel, DPM, Bronx, NY
Query: Options After Residency
I am beginning my third year of residency starting July 1st. I feel very excited and eager to begin my last year of training, however I have a lot of anxiety of the future. I feel completely lost as to when, where, and how I should be looking for a job and any other necessary things to do in order to prepare for the next steps. I am planning to apply for my state license in the state where I hope to work, but other than that, I'm not sure what else to do? I'm writing to see if there is any advice that can be offered. Also, I would like to thank PM News for the job postings. They are very convenient. Are there additional sources?
Query: Hiring a Registered Dietitian (RD)
In an effort to provide complete care to their patients, many hospitals in the area have begun offering diabetic counseling and meal planning sessions with registered dietitians (RD). I was considering hiring a registered dietitian and providing those services (and billing for them) in the office. This will help ensure that patients follow through with the referral, and it would also generate additional income for the practice. Has anyone else set up a similar arrangement? Are there any reasons why this shouldn't work? Would our scope prevent this arrangement or preclude billing for their services, even though the RD is practicing under his/her own license?
Jay Seidel, DPM Baltimore, MD
Query: Endoscopic Plantar Fasciotomy Blade/System
I’m looking to find a reasonably priced endoscopic plantar fasciotomy blade/system? Any help would be much appreciated.
Kyle J. Kinmon, DPM, Boca Raton, FL
Query: Life Coach to Help Rehab Patients
Would you refer patients to a life coach? What would be your thoughts and concerns about such a service? Would it help our patients who require additional reinforcement and support to meet their rehabilitation goals?
A. James Fisher, DPM, Crescent City, CA
Query: Kinesiology Tape?
What is everyone's preferred kinesiology tape to use? Which do you feel gives the best support, is waterproof, and causes minimal skin reaction?
Chad Friedman, DPM, West Chester, PA
We are considering installing a VOIP system in our offices. There seems to be a bunch of companies out there. Can anyone recommend a company? What are your experiences with them?
Nicole Kaiser, DPM, Delran, NJ
Query: Source for ClearNail Pro+
Can ClearNail Pro+ topical anti-fungal be purchased for resale to patients, or is this product discontinued?
Allan Freiberg, DPM, Metairie, LA
Editor's note: The product has not been discontinued. It is available OTC on Amazon for about $40 for a 10ml bottle.
Query: Microscope for KOH Preps
If any colleagues are performing KOH preps in their offices, what type of microscope are you using? I just want to be sure that a $300 scope from Amazon will do the trick.
David Kahan, DPM, Sacramento, CA
Query: Source for Cantharone
Can anyone provide information on a vendor who distributes Cantharone to California? I have been finding it more and more difficult to access. For the treatment of warts, I use a number of different modalities including Cryoprobe, Candida injections, 5-FU, laser, S.A., Adapalene, and duct tape, but have found that Cantharone is still one of the most effective treatments.
Charles Baik, DPM, Tustin, CA
Query: Interstate Licensing
I just read an article in Univadis reporting that interstate medical licensing is now available in 18 states that participate in the Interstate Medical Licensure Compact. There are elegibility requirements and fees (varied by state), and background checks are required. Seven more states and DC have legislation pending to join the compact. There was no mention of the MD vs. DO degree. Does such a movement exist within our podiatric medical specialty to broaden our licensing structure?
Neil H Hecht, DPM, Tarzana, CA
Query: Insurance Eligibility Checking
We try to check insurance eligibility and our participation in our patient’s health insurance program before they arrive at our office. At times, this is done when the appointment is made. Some time can be saved by using a service on line such as Availity, a corporation founded by Humana and BC/BS, for data on deductibles and co-pays. However, details of specific CPT code coverage, i.e., Orthotics L3000, can only be completed via a long and arduous phone call to the patient’s health insurance company. Any suggestions on how to make this process more efficient? Is there a better service for finding this information?
Jerry Cosentino, DPM, Tampa, FL
Query: Non-Staining Disinfectant for Instruments
What soaking solutions are being used for treatment room instruments? We are using Cetylcide-II, but it is staining instruments really badly.
Nick Costidakis, DPM, Lafayette, IN
Query: Missed First Appointments
I have a problem with patients missing their first appointments and wonder if it is acceptable to run a credit card to hold this first appointment so that it isn't missed without notice. Would this be an acceptable practice? Is there anyone else doing this? Are there any other ways to keep the new patient missed appointment from happening?
All my patients sign a waiver which allows me to bill them for their missed appointments, once they are an established patient, and this works well to keep the missed rate down.
Frank J. DiPalma, DPM, Athens, GA
Query: Source for 4% Dehydrated ETOH?
Can anyone give me the name of a company that supplies 4% dehydrated ETOH?
Andrew Carver, DPM, Washington, DC