Dec-11

DPMs Could Lead Hospital Staff Under Proposed CMS Rule

By Brian McCurdy, Senior Editor

As part of the proposed reforms for the Centers for Medicare and Medicaid Services (CMS), podiatric physicians would be eligible to attain leadership positions in hospital staffs.
The rule would change the requirements that hospitals and critical access hospitals must fulfill to participate in Medicare and Medicaid. Under current requirements, hospitals are permitted to assign management positions to MDs, DOs or, when permitted by state law, doctors of dental surgery or dental medicine.

   Noting that the rule does not intend to conflict with state laws that would bar DPMs from serving in leadership capacities, the CMS states that the rule would permit DPMs to serve as the president or an equivalent position of a hospital’s medical staff “in a significant number of states.” The CMS notes in such states, laws support the contention that “the education, training and experience of podiatric physicians are similar to that of their allopathic and osteopathic colleagues with respect to serving in such a hospital leadership position.”

   Neal Blitz, DPM, FACFAS, notes that if podiatric physicians can head hospital staffs, one positive would be the increased integration of DPMs into mainstream medicine as well as parity on the administrative front. Similarly, Andrew Rice, DPM, FACFAS, notes that as podiatrists seek leadership positions, this further validates that podiatric medicine is on par with the profession’s physician colleagues, helping to ensure equality for DPMs at the institutional level.

   Having DPMs in leadership roles at the hospital can also facilitate better patient care, according to Dr. Blitz. He emphasizes that diabetes-related foot problems comprise many visits to hospital admissions and emergency rooms. As Dr. Blitz explains, with podiatrists in charge, there will be less likelihood of the foot being neglected.

   Dr. Blitz and Dr. Rice also acknowledge challenges in integrating podiatrists into medical staffs. Dr. Rice warns that when heading medical staffs, podiatrists may face prejudice from those medical professionals who may view DPMs as ancillary providers and therefore not qualified for a leadership position.

   “It is important to let your peers know that DPMs understand pathophysiology beyond the foot because many hospital administrative issues involve specialty care related issues,” says Dr. Blitz, the Chief of Foot Surgery and Associate Chairman of Orthopedics at Bronx-Lebanon Hospital Center in New York City.

   Dr. Rice notes DPMs have a broad outlook on healthcare as the profession has worked with members of the multidisciplinary team whereas other specialties may have a more narrow focus on their areas of expertise. Furthermore, with most podiatrists being new to these positions, they may be able to provide a fresh, objective perspective when it comes to inpatient and outpatient activities, and hospital governance, according to Dr. Rice, the Chief of Podiatry at Norwalk Hospital in Norwalk, Conn.

   The American College of Foot and Ankle Surgeons (ACFAS) has been working with the Joint Commission to promote the passage of the new rule.

   “This rule solidifies CMS’ recognition that on many medical staffs across the country, the education, training and experience of credentialed and privileged podiatric surgeons is equivalent to their MD and DO partners on the healthcare team,” notes the ACFAS.

   For an exclusive online sidebar, visit www.podiatrytoday.com. For more information on the CMS rule, visit https://www.cms.gov/CFCsAndCoPs/06_Hospitals.asp .

Can A New Topical Treatment Visibly Improve Onychomycotic Nails?

By Danielle Chicano

Authors of a recent Swedish study say a new topical agent may be an effective addition to the treatment armamentarium for onychomycosis.

   The study, published in the Journal of Cosmetics, Dermatological Sciences and Applications, involved 72 patients who were clinically diagnosed with onychomycosis affecting 25 to 75 percent of their big toenail. The staff instructed patients to administer a topical treatment, K101, to the affected areas every evening over an eight-week period. K101 is a combination of propylene glycol, urea and lactic acid.

   Upon completion of the study, 75 percent of patients reported their nails were less thick in comparison with baseline reports, 67 percent noted less discoloration, 45 percent reported less brittle nails, and 71 percent reported softer nails. The study authors concluded that after consistent application of K101, patients observed positive effects and rapid visible improvements.

   Taking into consideration that participants of the study simply reported visible improvements, Tracey Vlahovic, DPM, notes possible shortcomings with this study in reference to treating onychomycosis.

   “This is based solely on the cosmetic appearance of the nail, not mycological results,” explains Dr. Vlahovic, an Associate Professor at the Temple University School of Podiatric Medicine. “The patients judged the appearance of the nail themselves and this was only quantitated by a photograph and patient response. No mycological studies were done.”

   Patients seeking a topical treatment such as K101 may include “those who have concurrent liver disease that would preclude them from taking an oral antifungal, those who don’t want to add another pill to their daily regimen and those who have distal subungual onychomycosis that affects 50 percent or less of their nail,” notes Dr. Vlahovic, who is board certified by the American Board of Podiatric Surgery.

   Dr. Vlahovic believes this specific treatment would be similar to urea nail preparations that are already on the market.

   Alterna recently released its patented formula of K101, Kerasal Nail, as an over-the-counter product in the United States with availability in most major drug stores.

Are Bioabsorbable Screws Better Than Metallic Plates For Calcaneal Fractures?

By Brian McCurdy, Senior Editor

A study recently published in the Journal of Trauma concludes that bioabsorbable screws can result in fewer complications in stabilizing displaced intra-articular calcaneal fractures in comparison to metallic plates.

   The study focused on 97 patients with intra-articular calcaneal fractures who were treated between February 2007 and March 2009. Fifty-two patients received metal plates while 47 received absorbable screws.

   The average follow-up was 23 months. Radiographically, there were no nonunions in either group, according to the study. In the metal plate group, researchers noted six cases of poor wound healing, one case of deep infection and four cases of peroneal tendon irritation. In the absorbable screw group, there was one case of superficial infection and no deep infection and soft tissue irritation, according to the authors.

   The authors concluded that although metallic plates were associated with more complications, the surgical outcomes in both groups were comparable with both fixation methods demonstrating favorable results.

   When using metal plates for fixation, Michael Lee, DPM, says “significant wound complications” can arise from a combination of fracture blisters, significant swelling and the lateral extensile incision used for calcaneal fractures. He notes that other potential complications including significant lateral wound dehiscence. Dr. Lee says this can lead to infection and compromise fixation, regardless of whether one uses traditional metallic fixation or absorbable screws.

   Dr. Lee says new advancements using a limited incision approach to calcaneal fractures will likely reduce the number of soft tissue infections. He notes that such a limited incision would also “have a more profound effect” in minimizing the risk of short-term complications following calcaneal fractures.

   “I have been a slow adaptor with regard to absorbable fixation,” says Dr. Lee, a Past President of the American College of Foot and Ankle Surgeons. “While there may be limited indications, this study clearly demonstrates that (absorbable fixation) does not offer a significant advantage over traditional constructs.”

In Brief

Two students from Barry University’s School of Podiatric Medicine received the Podiatric Insurance Company of America (PICA) Group Scholarship award for 2011. Barry University notes that William Burmeister and Titorya Stover, both fourth-year podiatric medical students, will each receive a $2,500 scholarship used to defray the cost of tuition.