PM News –May 5, 2006 #2,573 Editor-Barry Block, DPM, JD
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---------PODIATRISTS IN THE NEWS--------
Neuromas Caused By Narrow-Styled Shoes: CT DPM
"My feet are killing me." It's not an uncommon
refrain from women,
especially women in high heels. And it's no wonder, says
DOUGLAS
ALBRESKI, D.P.M., director of Podiatric Dermatology Services
at
UConn Health Center. High-heeled shoes put the feet in an
unnatural
position, Dr. Albreski explained, and prolonged walking in
heels
places unnecessary stress on the back and neck. All of which
can
lead to permanent changes in posture.
"High-heels with pointed toes and thin soles cause
crowding of the
toes and offer little if any support," said Dr.
Albreski. "Women can
experience pain in the balls of their feet, and develop
blisters,
corns, calluses, back pain, and aching heels. The pressure
on the
toes can lead to deformities, such as bunions, claw toes,
corns and
thickening of the nails."
According to Dr. Albreski another problem, almost exclusive
to
women, is neuroma, caused by tight and narrow styles.
"When the shoe
pushes your foot in tighter and pinches a nerve, tissue
grows around
that nerve and cause severe pain," said Dr. Albreski.
"This occurs
between the third and fourth toes or along the sole of the
foot. In
extreme cases, surgery may be required."
Source: Jane Shaskan, University of Connecticut Health
Center
[5/2/06]
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----------------PROFESSIONAL MISCONDUCT--------------
WV DPM Faces 38 Drug Charges and Weapons Count
State Police arrested a West Virginia podiatrist on
Wednesday on
numerous drug charges for allegedly selling prescriptions
for $90
apiece to patients he sometimes didn't see. DANNY LEE
JOHNSON, 57,
of Chapmanville, was charged with 38 felony counts of
delivery of a
controlled substance and one count of possession of a
concealed
weapon.
Police contacted one of Johnson's employee who told them
Johnson
was "delivering each day's prescriptions prior to the
start of each
business day for those individuals who were scheduled for an
office
visit on said day." Johnson would also "prepare
a patient record for
said individuals indicating that [he] had examined the
individuals
prior to prescribing the controlled substances,"
according to the
complaint.
When he was arrested on Wednesday, Johnson had a black fanny
pack at
his feet that contained a loaded .38-caliber revolver,
according to
another complaint. Johnson was being held in Southwestern
Regional
Jail on $150,000 bond.In 1995, Johnson's medical license
was placed
on probation for two years for unprofessional conduct,
according to
the West Virginia Board of Medicine Website. -Two years
later, he
settled a malpractice case for $100,000 in Logan County
Circuit
Court.
Source: Dave Gustafson, Charleston Gazette [5/4/06]
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-----------PODIATRISTS IN THE COMMUNITY ---------------
MT DPM Competes in Spaghetti Sauce Competition Fundraiser
After today's school elections, Havreites will have another
important vote to make - which Havre Public Schools official
makes
the best spaghetti sauce. Among the chefs is board member
DR. JOSEPH
MARINO. The spaghetti feed will benefit Havre High School
special
education teacher Kim Kirby, who was diagnosed with liver
cancer in
February.
The competition is as heated as the sauce they are
preparing. Marino
said he is going to prepare "Grandma Marino's Special
Sicilian
Sauce." He learned the "age-old" recipe in
the 1970s when he was a
firefighter in New Jersey. He added a few special
ingredients from
the kitchen of his grandmother, Brooklyn native Cecelia
DiFede. He
said he knows the sauce is excellent because "in
sticky situations,
those guys brought me back safe so I could cook for
them."
The podiatrist said he "might have a bit of a
following" because he
has served his sauce at local benefit dinners including
fundraisers
for the Hi-Line Therapeutic Riding Association, which
provides
therapeutic and recreational horseback riding for
individuals with
physical, mental or behavioral challenges, and Hope on the
Hi-Line,
a group formed to relocate those who were made homeless by
hurricanes Rita and Katrina to the Havre area.
Source: Angela Brandt, Havre Daily News [5/2/06]
--------- MEETING NOTICES/ COURSES --------------
SAVE THE DATE!!
19th Edition Foot and Ankle Institute Seminar
and
Third Annual TUSPM Alumni Reunion
September 15 - 17, 2006
The Clarion Hotel and Convention Center
Cherry Hill, New Jersey
A great opportunity for all doctors to satisfy their CME
requirements! For updates, send your e-mail address to:
andreaha temple.edu or watch your mailbox!
Seminar Information: Angel Haldeman, (215) 625-5361
Reunion Information: Sarah Lyons, (215) 625-5248
------------
For a list of all meetings go to:
www.podiatrym.com/meetings.pdf
-------------QUERIES--------------
Query: S/P Stress Fracture Worse With Imitrex
A patient was referred to me after tarsal tunnel release
which did
not relieve her pinpoint pain over the medial aspect of the
medial
cunieform. Radiographs and tri-phasic bone scans were
positive for
stress fracture of cunieform. After six weeks of
non-weight-bearing
cast immobilization, the patient still has some tenderness
on
palpation, but patient now relates that pain becomes severe
after
she takes Imitrex for migranes. Any ideas?
Pat Dwyer, DPM, Bedford, NY, pat.dwyer3verizon.net
------- CODINGLINE CORNER --------------
Query: Coding for Excision of Inclusion Cyst
I excised an inclusion cyst on a patient that had a
phenol-type
matrixectomy procedure done last year by another doctor. I
have been
looking for an appropriate code, but have not been able to
settle on
one yet. The incision was closed using sutures. This was
done in the
office. Also, can I also charge for a surgery tray?
Sean Henning, DPM, Elkhart, IN
Response: I would recommend using CPT 28092 (excision of
lesion,
cyst or ganglion, toe). It would be a good idea to submit
specimen
for pathology report in case the payer ever wants
confirmation that
a cyst was removed.
I have found that most insurance carriers will not pay for a
surgical tray with procedures done in an office setting.
Howard Zlotoff, DPM, Camp Hill, PA
Additional responses can be found at http://www.codingline.com
-----RESPONSES / COMMENTS------------
RE: Fungus Pays the Bills (Michael Cohen, DPM)
From: Multiple Respondents
I guess I really hate this kind of advice. Does anyone want
to be
known as the podiatric expert in fungus? Does anyone really
think
your reputation and status in your medical community will be
elevated by this behavior? Does anyone think the payers will
not
begin to wonder what an aberrant practice pattern your
billings
would appear to be? I don't.
I also strongly feel that a well-rounded DPM that provides
full
service medicine and surgery offers you the best chance at
success,
both financial and image-wise. Your referrals will come from
all
sources. Your patients will recognize you as the expert in
foot and
ankles issues in your community.
Being in the OR gives me satisfaction and elevates my image
in the
hospital. I can usually earn more by seeing patients all day
but
that can be a drag at times. I also feel I am a better
physician for
my patients by being able to see the big picture and provide
all the
services DPMs are trained to offer.
Lloynessto, DPM Newton Center, MA, lloydpodyahoo.com
Michael Cohen, DPM and lecturer Bret Ribotsky, DPM are
absolutely
correct about the financial value of treating fungous
conditions.
But there is more.
Many skin, deep (ulcer) tissue and nail lesions should be
evaluated
microscopically. This allows the podiatrist to become a real
hero
and sometimes catch a cancer as well as learn what a lesion
REALLY
is. Some podiatrists have local dermatopathologists to send
their
specimens. When you remove these lesions, you can often get
a biopsy
code fee. When you get the results and go over it with your
patient,
you can get a good E & M code.
We have an extraordinary asset in podiatry: The Laboratory
of
Podiatric Pathology (I am not associated with them). Their
website:
http://www.foo
tpathlab.com/contact.htm
They have a large array of services to help your bottom line
and
provide you with valuable diagnostic information for your
patient.
Their detailed reports can also be exceedingly valuable in
case your
charts are audited.
I think it is worth publishing their name here. It's
certainly worth
using their services, strictly on a "selfish"
level. Too often we
allow our school loan payment to "walk out" our
doors.
Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1prodigy.net
My husband and I are both exclusively non-surgical
practicing
podiatrists - a rare breed, indeed! We each personally
elected to
pursue non-surgical training (under the excellent guidance
and
training of Podiatry Hall of Fame inductee, Warren Joseph)
and are
ABPOPPM board-certified. After completion of our PPMR-24 in
1999, we
opened our own practice completely cold in a city we had
never been
to.
We each work part-time (alternating days), rarely work
evenings past
5:00, have never worked on a Saturday or Sunday, and have
never
taken call. We each only work one 1/2 day per month in an
assisted
living facility and spend the rest of our time in a single
office
location. Last year our practice grossed over $175,000, and
we are
on par to gross over $200,000 this year. When you factor in
the
hefty non-surgical discount for malpractice insurance and
the
revenue gained by being in the office most days as well as
regularly
treating patients without global periods, I must admit that
based
upon the results of the annual PM survey, our bottom line is
often
on par with many of our surgical counterparts.
We highly respect and work very closely with our surgical
colleagues
and are staunch supporters of podiatric surgery and the
profession
in general. But I think my testimony demonstrates rather
clearly
that there is a life (and a rather enjoyable one) beyond the
OR.
Heather Snyder, DPM, Charlottesville, VA, physiciansaffa-
podiatry.com
---------------------
RE: MediNotes EMR Software (Stuart Goldman, DPM)
From: Jeff Oster, DPM, C.Ped
We've been using MediNotes, and in particular, MediNotes e,
since 3-
1-06. MediNotes e is the newest release and a complete
redesign of
the older version that was called Charting Plus. We chose
MediNotes
because they know podiatry. The founder of MediNotes is a
podiatrist and MediNotes e comes packed with podiatry
templates. So
one distinct advantage is that MediNotes training and
support are
very familiar with your needs. Also, MediNotes support and
training
are very good.
MediNotes is a relational database program made
user-friendly. But
to use MediNotes, you need to know the program cold. You
can't begin
to use it and assume that you'll learn as you go. It'll
take you 20
minutes just to print out a work release for a patient. And
while
you do that, you get backed up. The key to success is that
you need
to be prepared to learn the program and customize it. To do
so,
you'll need to dedicate many hours to template building.
Implementing MediNotes for me was very stressful. It
completely
changed my office workflow. I lost an employee who didn't
have
sufficient computer skills. In terms of patient care, I
initially
found EMR very distracting. Computer input took me away from
direct
patient interaction. But EMR seems to be the wave of the
future and
we chose to implement an EMR to get out ahead of the curve.
EMR is in its infancy. But as it becomes more common, EMR
will
evolve into integrated records that will include your
referring
doctors, your hospital, pharmacies, etc. If you're not in
the loop
and a part of that development, you'll simply be left
behind. Now's
the time to get into an EMR and MediNotes is a good choice.
Jeff Oster, DPM, C.Ped., Granville, OH, supportmyfootshop.com
The most comprehensive forum I've found online is at:
http://w
ww.emrupdate.com/forums/default.aspx Medinotes has been
reviewed. Type it into the search function and you will see
many
opinions. Be aware of when they were written as EMR's is a
very
rapidly changing business. Last years' version is very old
for most
companies.
Alan Kalker, DPM, Middleton, WI, ajkalkerfacstaff.wisc.edu
-----------CLASSIFIED ADS--------
OFFICE SPACE TO RENT – Bronx, NY
Office space for rent in the Bronx. Share office with
MD/General
Practitioner. Podiatrist leaving in June. E-mail dturkeeaol.com
for more info.
-----------
ASSOCIATE POSITION –MANHATTAN
Wanted full-time associate for busy surgical practice with
a focus
on ambulatory surgery. We are willing to train in all
aspects of
office-based procedures. Please respond to Gary4baol.com.
------------
PODIATRY PRACTICE FOR SALE - NYC NASSAU/QUEENS BORDER
40 year old Practice General Care - Net $300K Good practice
for
Partnership 1 Partner in place. All information to be
e-mailed
Serious Inquiries Only!!!! Email: DPM1111optonline.net
---------
Associate Position-Kansas City, MO
Excellent opportunity for a hard working, ethical podiatrist
to join
a vibrant, successful and growing podiatric medical and
surgical
practice. Dedicated, supportive staff with strong marketing
and
medical knowledge. Must be board eligible/certified.
PSR/24.
Partnership opportunity. Competitive salary, bonus
structure,
benefits. Wonderful place to raise a family. Fax CV to
816-455-8901.
----------
ASSOCIATE POSITION- PORTLAND, MAINE
Associate wanted to start immediately. Will lead to rapid
partnership. Diabetics, biomechanics, sports injuries and
surgery.
Buy-in for office condo a possibility. Office podiatry
skills
(residency experience, office observation or work)
important.
Surgical training with focus on core skills (bunions, met.
osteotomies, neuromas/neurolysis, tendon repairs) Contact
Robert
Kuvent, DPM, FACFAS FtFixrHotmail.com, please leave
day/evening
number, hospital name and residency director's name.
------------------
PRACTICE FOR SALE – Kansas
Lawrence, Kansas, 30 miles west of Kansas City. Well
established
practice, general and surgical. Gross 250K, Hospital
privileges,
Partnership in medical building. All interested parties
reply to
foothlrsunflower.com
-----------
ASSOCIATE POSITION- NEW ENGLAND
Associate wanted to start this summer. Routine care,
diabetics,
biomechanics, sports injuries and steady surgery. Buy-in
for
partnership and ownership of building a possibility.
PSR-24. Office
podiatry skills (residency experience, office observation or
work)
important. Surgical training with focus on core skills
(bunions,
met. osteotomies, neuromas/neurolysis, tendon repairs, some
rearfoot) is important. facne11aol.com, give evening
number (not
cell), hospital name and residency director's name.
-----------
EQUIPMENT FOR SALE - ESWT
If you are using or thinking of using ESWT, I have a new
machine
that has only been used twice. There is no Orbasone in the
country
priced like this one. Will provide training and
installation. Take a
look at http://www.orbasone.com.
Call 1-856-229-2939.
---------
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