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From: Paul Kesselman, DPM


I have provided an in-depth personal response Drs. Rettig and Kerner who were unceremoniously de-activated by the NSC. Unlike when private third-party payers dump you, NSC does allow you to re-activate. There is a lesson to be learned by the misfortunes of these two providers, both of whom will be able to re-establish (Dr. Rettig already has) their enrollment with the NSC - but first some background: 


The NSC has a standard program of 3-year renewals and they claim that they fulfilled their due diligence by mailing you a renewal letter in a very noticeable yellow envelope. The 3-year period was chosen as an initiative by which they claim they can cut down on...


Editor's note: Dr. Kesselman's extended-length letter can be read here.

Other messages in this thread:



RE: New Medicare Card Info for Patients

From: Joseph S Borreggine, DPM


CMS is starting to conduct a major education campaign about the new card for people with Medicare. Help alert your patients by displaying a poster in your office and giving your patients tear-off sheets or fliers.


Register, then order these free color products:

  •  Poster, 11”x17” (Product #12009-P) limit - 10

  •  Pad of 50 tear-off sheets, 4”x 5.25” ( Product #12006) limit - 25

  •  Flyer English, 8.5”x11” (Product #12002) limit -100

  •  Flyer Spanish, 8.5”x11” (Product #12002-S) limit - 50

You can also print these products on 8.5”x11” paper. The poster and tear-off sheets will be available in Spanish later this year.


Joseph S Borreggine, DPM, Charleston, IL



From: Larry Kobak, DPM, JD


This email is in response to Dr. Udell's inquiry if you can sue a patient or social media site that posts an untrue review. The answer is sometimes. If the review merely expresses an opinion, that is protected constitutionally. In NY, if the patient goes further and states something that reflects on the podiatrist's ability, such as "(s)he is a butcher", or inaccurately, such as (s)he lost his/her license last year, that is actionable. I have successfully sued the patient for libel in such cases. Please be warned that there is a statute of limitations in such cases. In NY, it is only one year from the time the review was first published.


Larry Kobak, DPM, JD, Senior Counsel, Frier Levitt



From: Kenneth T. Goldstein, DPM


I totally agree with Dr. Udell. Years ago, when a patient didn't want to pay a bill, they threatened to sue. Now-a-days they threaten to post a "nasty review"(because it will cost them money to hire an attorney). The fact that this patient not only wanted the fees removed, but also a DISCOUNT! is absolutely ridiculous. Should you give in, this person sounds like they will write the negative review anyway and say to themselves - "Gotcha".


You have done all of the correct manners and given more than enough time for this patient to pay. At this point my answer would be - It is out of my hands and the collection company has control of your account.


Kenneth T. Goldstein, DPM, Williamsville, NY



From: Elliot Udell, DPM


Let's broaden the question. What protection is there from any patient who might post untrue malicious information on the Internet about any healthcare provider? If the information posted is untrue and malicious, can a patient or the Internet service he or she posted it on be held liable? It sounds like the patient described in the original query could be guilty of extortion. 


Elliot Udell, DPM, Hicksville, NY



From: Hal Ornstein, DPM


I suggest contacting medical suppliers. Often, they will provide guidance with office design, even if you are not a customer. The devil is in the details when designing an office. I highly recommend using a designer and architect who specialize in medical offices. When you have a rough draft, attend a practice management meeting to ask the attendees for their ideas on the design.   


Hal Ornstein, DPM, Howell, NJ



From: Kenneth L Hatch, DPM


I have been licensed in several states. I do not think that requiring some of the renewal CME to be live is unreasonable. In regard to personal conflicts with attending, most states are on a two-year renewal cycle which should allow one to be able to attend some events in person. Some states such as Florida accept any credit approved by another state (with some requirements).  


If licensees wait until the eleventh hour to scramble for credit, then they are guilty of poor time management and planning. Some credits such as a refresher of local laws can easily be attained online. Obviously, a CPR refresher is best in person with the instructor hands-on.          


One personal complaint is that certain states will not accept an online credit that is less than one hour. There are many excellent programs available free online. I concur with Dr. Bret Ribotsky that the social/direct interaction with instructors and fellow attendees in-person can be quite educational.   


Kenneth L Hatch, DPM, Annapolis, MD



From: Jarrod Shapiro, DPM


I'm writing in response to Dr. Sherman's comments about online CME. I agree with his comments and support the opinion that online CME should be unlimited in all states. Simply put, the content and delivery is the same, the requirements for proof of viewing is higher than at live conferences, and this delivery method is appropriate for adult learners. The various online CME available allows a physicians to receive rapid answers to topical clinical problems using on-demand education services. This format is innovative and able to change with developing technologies. Allowing online CME to flourish is equivalent in the medical community to the progress of the Internet itself. This system must be allowed to develop.


Disclaimer: Dr. Shapiro writes the column Practice Perfect for PRESENT e-Learning Systems.


Jarrod Shapiro, DPM, Pomona, CA



From: Lee C. Rogers, DPM, Ed Davis, DPM


The Internet has made education available to everyone with a connection, without unnecessary time and travel expense. I encourage our state boards of podiatry to modernize their CME requirements to take advantage of these advancements in technology and the renaissance that will be the future of learning.


Lee C. Rogers, DPM, Los Angeles, CA


Dr. Sherman is right concerning the issue of certain states restricting online CME. One can go to a "brick and mortar" CME seminar but no one can ensure that attention to the subject matter presented occurs nor that the attendee is even awake. Online CME generally requires that attendees read the material presented and answer questions to ensure learning.


Ed Davis, DPM, San Antonio, TX



RE: Why Do Some State Boards of Podiatry Still Limit Online CME? (Alan Sherman, DPM)

From: Larry Aronberg, DPM

I completely agree with Dr. Sherman. When I go to a bottoms-in-the-chairs seminar, people wander in and out, tune out the lecture, etc. You just have to sign in and sign out for credit. With online, there is a test you have to pass. You have to learn the material to get the credits. When you also consider travel, lodging, and time away from your practice when attending a seminar, online seems even more logical. I love the hands-on courses at seminars, but would much prefer most of my credits online with just an occasional trip for a distant seminar.


Larry Aronberg, DPM, Lake Worth, FL



From: Hal Ornstein, DPM


Brad has been a gem for our profession for many years. It is safe to say that he is on top of the list of dedication to our profession as well as financial support. What’s most remarkable is his service to students and residents to support their initiatives on a local and national basis. The Rhett Foundation he has created will prove to help thousands and is so much a part of his DNA. You’re a great man Brad.


Hal Ornstein, DPM, Howell, NJ



From: Barbara Hirsch, DPM


In 2015, the Maryland Board of Podiatric Medical Examiners initiated a change in the state regulations to go from 50 CME allowed online to only 25 online CMEs allowed online. I am the only Maryland state licensed podiatrist who commented against this proposed change to the state (during the allowed comment period). I felt it was ridiculous to decrease the amount of online CME allowed for various and obvious reasons, the main one being cost. Even a "local" seminar can require travel costs, lodging costs, and high fees.


I provided examples of what it costs to attend many seminars. I provided an example of the exact same seminar offered online (a taping of the seminar) and live. The only difference was the cost. The state of Maryland has limited CME seminars, and one cannot always attend due to personal reasons.  


The MPMA used to have a "Day of Science" but this has not been done in a few years (it was used as an example of "Free" CME credits for a live seminar as one "excuse" for the change in the requirements. I was not only thinking of myself, I was thinking of anyone else who has monetary issues/concerns, physical issues, family issues, etc. I only wish that other Maryland state licensees had similar concerns for their colleagues. Allowing 50 CME online credits let everyone do what was best for them. Limiting online CME credits to only 25 was a step backwards. 


Barbara Hirsch, DPM, Rockville, MD



From: Bret Ribotsky, DPM


I’ll take the counterpoint to my friend and Boca Raton neighbor, Dr. Sherman. Live CME events are best. Not only have I had the opportunity to have lectured in 49 of the 50 states and many 15 different countries, but I have also been the patient for multiple foot operations. For the months after my accident, I spent many months in rehab, unable to walk, and did many online classes. I collected online training certifications in real-estate, insurance, financial planning, securities series 7, 63, and a bunch more. But... there is nothing as good as live learning. And as a physician, there is so much more to learn at a seminar than what is learned in the lecture hall. I have learned so much in the hallways, and at the bar from my colleagues. Meet the Masters was started 8 years before my injuries, with the idea that learning outside of the lecture hall was priceless.  


I do enjoy online events, but I would hate to miss the yearly get togethers to learn from and with others. As a patient, I know the difference between great and outstanding care; that it comes from those with exposure to many viewpoints which only a live event can deliver.  


Bret M. Ribotsky, DPM, Boca Raton, FL



RE: Why Do Some State Boards of Podiatry Still Limit Online CME?

From: Alan Sherman, DPM


It’s about time that someone spoke out publically about the restrictive policy in a few last remaining states regarding online CME for podiatrists. 60% of State Boards of Podiatry, 30 out of 50, now allow ALL CME Credit to be earned online. This evening, one of my oldest and dearest friends from CCPM reminded me that our home state of Florida still only allows 8 of their 40 required credits every two years to be earned online. That’s 20%. Come on, Florida. 


Why is it important to this guy? Because this year, he has had pneumonia and a GI bleed, and with all the time he has missed from his practice, he can’t afford to attend another...


Editor's note: Dr. Sherman's extended-length letter can be read here.



From: Elliot Udell, DPM


I acknowledge Dr. Bakotic for all of his years of service to the academic podiatric medical community. There are dozens of dermatopathology labs that serve our profession but Brad distinguished himself in not only financially supporting every podiatric medical conference in America but lecturing at all of them. In so doing, he educated doctors on when to raise "red flags" and taught thousands of us how to do skin biopsies and remove suspicious lesions. We can be assured that there are patients alive today as a result of their doctors having taken skin biopsies in a timely fashion as a result of Brad's teaching. Thank you Brad.


Elliot Udell, DPM, Hicksville, NY



RE: An Open Message to My Colleagues

From: Bradley W. Bakotic, DPM, DO


After much internal debate, I’ve chosen to step down as CEO of Bako Integrated Physician Solutions (Bako) and resign from its Board of Directors as the result of principled differences with the company. I will no longer be involved in their educational initiatives or laboratory services. Bako represents the embodiment of my life’s work to this point, and coming to the decision to begin a new chapter in my professional life has been extremely difficult. 


That being said, I have not completely excluded the possibility of a future return to Bako should our differences be hashed out. On the heels of the prior somber news, let me relate a silver lining that is giving me a more altruistic sense of...


Editor's note: Dr. Bakotic's extended-length letter can be read here.



RE: Double Standard on Medicare Incentives

From: Altamonte Springs, FL


It is interesting to note that Medicare Advantage Plans advertise that they will give prospective enrollees a $10.00 gift card to attend a meeting so they can tell you about their plan and hopefully sign you up. If you did this to prospective patients, you would surely get a call from Medicare telling you that it is illegal. I guess there is a regulation that permits Medicare Advantage Plans to do this.


Sherwood A. Weisman, DPM, Altamonte Springs, FL



From: Richard G. Macdonald, DPM


After serving a year as an enlisted man at Walter Reed Hospital, I became the 18th commissioned podiatrist (as a 2nd Lieutenant). I agree with W. David Herbert, DPM. A military podiatrist is now serving in the U.S. House of Representatives. I suggest Col. Michael Thomas Neary, DPM as a reference for any article on podiatrists in the military. Col. Neary is the podiatry consultant to the Army Surgeon General and is very active in the APMA Military group.


Dr. Richard Macdonald Being Commissioned


I served as the podiatrist at West Point over 50 years ago. I went back in 2015 on my 50 year anniversary. Col Neary escorted me for 2 days at the Point per the direction of the Superintendent of U.S. Military Academy. The attached picture with the Maj. General, the commanding officer of Walter Reed Army Hospital, also contains the first podiatrist commissioned by the Army (standing next to my wife).


Richard G. Macdonald, DPM, Tremont, IL 



RE: Podiatrists Serving in the Military

I believe that most of our profession are not knowledgeable about the history of podiatrists who served in the military as podiatrists who were commissioned officers. Osteopathic physicians did not serve as officers until 1967. Some podiatrists served as commissioned officers in the Navy in World War II. In 1957, podiatrists were routinely commissioned in the armed services as podiatrists, but were not actually in the medical corps.

I believe that when podiatrists began serving as officers in the military and began working alongside physicians as fellow healthcare professionals that the image of our profession was improved considerably. I would like to see an article about some of these pioneers in our profession whom I believe have been overlooked. I had three of my four years of podiatric medical school subsidized by the military. I have always been grateful for the military podiatrists who came before me and played a part in making this possible.

W. David Herbert, DPM JD, Billings, MT



RE: Fire Disaster Relief in Sonoma County, CA and Adjacent Areas

From: Jesus C. Vazquez, PMAC 


Sonoma County is very grateful for the support from first responders during the fire disaster affecting our community. Dr. John D. Hollander is going to be providing foot and ankle care at no cost to police, firefighters, utility responders, and paramedics helping our community through this crisis. The office will be providing walk-in and evening appointments to accommodate different working shifts of first responders. 


Jesus C. Vazquez, PMAC, Santa Rosa, CA



From: Burton Katzen, DPM


I bought a simple pay as you go (10c per minute) phone with a different phone number from my cell. I log in all my surgery patients on that phone with phone number, procedure abbreviation (ex.HV), and date of procedure, so I'll know who they are and what I did when they call..


I only call patients from that number so they don't have my personal cell. I keep it on on weekends (I do the majority of my larger surgeries on Fridays), and call them Saturday from that number. Monday through office hours Friday, I call forward that number to my personal cell so I don't miss calls, but they still don't have my personal cell


I always tell the patients they have my cell number, and if they call on the weekend, thanks to caller ID, I say "Hello Mrs. ____. They absolutely love it! They think they have my cell, don't have to go through an answering service, and they get me right away. Total cost -  $50-$75 per year.


Burton Katzen, DPM, Temple Hills, MD



RE: Alternative to Answering Service (John Scholl, DPM)

From: Donald J. Adamov, DPM,


I have used many different answering services, both automated and an actual live service, throughout my career at different practices. I have been mostly satisfied with the way I have it set up right now. I use my phone provider Brighthouse/Spectrum virtual assistant for dealing with after hour phone calls. We have it set up to ring during the day to the office and go to voicemail in the rare instance we are not able to answer. After hours, we have a schedule set up with Spectrum to forward calls to my personal cell phone or voice mail based on urgent hospital or patient matters. That way, I can screen the call and send it to my cell voicemail for immediate playback. If I then need to call the patient back, I simply dial *67 on my cell phone.  


For non-urgent matters and routine consults, another prompt sends to the receptionist phone for voicemail and also my email to allow me to playback (in case of a routine weekend consult).  This way I am not bothered at all with appointment changes and other non-urgent matters after hours. Admittedly, we have had some problems with switching to our night/weekend system as we have Spectrum do this for us, but when we call them, they are usually able to remedy this. Usually, this happens for holiday greetings and we just make sure we check the system is set up properly by simply dialing in.


Donald J. Adamov, DPM, Spring Hill, FL



RE: Invest in Time, Not Money to Sell Your Practice

From: Jack Ressler, DPM


It has been a year since the sale of my podiatric practice. I am semi-retired, keeping a satellite office where I work one day a week along with two retirement facilities. The reason I am writing this letter based on a lecture I attended at the last SAM convention in Orlando this past January. The lecture was given by a person representing a company which brokers the sale of physicians’ offices. 


Simply put, they take your numbers and use a formula to value your practice. I found it very interesting looking around the room where the lecture was given. There were about 50 attendees and there was quite a change in mood at the end of the lecture and Q & A session. What started as an upbeat audience turned into a lot of deflated podiatrists fueled by a...


Editor's note: Dr. Ressler's extended-length letter can be read here.



From: Steven Kravitz, DPM


The Academy of Physicians in Wound Healing continues supporting VA Podiatric Parity. On July 27, 2017, the APWH sent a letter of support to the Chairman of the House Committee on Veterans Affairs, Subcommittee on Health supporting his amendment, HR 1058, known as the VA Provider Equity Act. The bill provides provisions to raise salaries of podiatrists to be equivalent with that of other physicians. 


Last year, on May 31, 2016, APWH submitted a letter in support of Bill S. 2175 which also proposed parity for podiatric and allopathic physicians. At that time, it had passed in the House and was waiting for....


Editor's note: Dr. Kravitz's extended-length letter can be read here.



RE: VA Provider Equity Act Introduced in the Senate

From: Jeffrey Robbins, DPM


Senate Bill 1871 “…to clarify the role of podiatrists in the Department of Veterans Affairs” has been introduced in the Senate and has been referred to committee. The is the next step in the long process of bill approval. Once again, this is the result of our combined efforts with the Federal Services Podiatric Medical Association and the American Podiatric Medical Association. 


Jeffrey Robbins, DPM, Cleveland, OH



RE: WHMC Podiatric Residency Program Featured on HCA Healthcare Brochure  

From: Hope Jacoby, DPM


Recently, (one of the United States' largest healthcare companies) made an addition to their graduate medical education program and community tab with West Houston Medical Center (WHMC) podiatric residents as the face of their programs.


WHMC Residents on Cover of GME Brochure


We are delighted and flattered that HCA chose our program that houses 12 residents, a full medical library and cadaver lab to be the highlight of their GME community.  


Hope Jacoby, DPM, PGY-3, Chief Resident, WHMC PMSR-36