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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,

Other messages in this thread:



Query: DME Reimbursement for Podiatrist Whose Pay is RVU-Based 


I work for a multi-disciplinary clinic. My pay is based on RVUs. Because there are no RVUs assigned to things like prescription orthotics, diabetic therapeutic shoes, and other DME items, I do not get reimbursed anymore for a patient that I prescribe custom orthotics for than someone I treat the exact same way but do not prescribe orthotics. My clinic makes a great deal of revenue from the orthotics, diabetic shoes, and other DME items that my patients receive, yet I am not reimbursed anything for providing the expertise, prescription, and know-how of getting patients the appropriate device to help them.


Furthermore, if follow-up or adjustment is needed for that device, I am the one who has to provide it. Is there a common way that clinics reimburse their providers for bringing in the huge revenue involved with all of these DME items? 


Name Withheld



Query: CO2 Laser for Nail Matrixectomies


I am looking for advice on using the CO2 laser for nail matrixectomies. Does anybody have pearls on how long the nail bed should be cauterized and what wattage should be used for optimal results? I read an abstract from 2005 from Japan that advocates the staining of the nail bed with methylene blue before cauterization. They claim when the blue color is eradicated with the laser, the nail bed has been sufficiently cauterized. Does anybody have experience with this method?


Joel Greenwald, DPM, Edison, NJ



Query: Source for X-ray Label Holder


Somehow, we managed to lose one of our x-ray label holders and I am having a difficult time finding a place that sells them. In particular, I would prefer to find one similar to the attached picture that has a swivel pointer for left or right.  


X-ray Label Holder


Having my named engraved isn't a must, but is preferred as well. Does anybody know where I can buy some?


Dan Methuselah, DPM  Irmo, SC



Query: Source for Extra Large CAM or Bledsoe Boot


I have just had, for the first time, a patient I was unable to fit with a CAM or Bledsoe boot secondary to lower obesity. This patient has absolutely massive calves but a normal foot size.  The boot fit, but the Velcro liner, not to mention the retaining straps will not wrap around her leg.  Has anyone found a brand for obese persons that I could stock for “emergencies”?


David E Gurvis, DPM, Avon, IN



Query: How to Avoid Short-term Associate Hires


I'm currently in solo practice and looking to expand by adding a physician to meet growing demands. I'm looking to avoid the classic short-lived associate hire and interested to hear from my colleagues who have been through less than ideal situations. What actions should I avoid, particularly if I onboard a physician directly out of residency? I can understand that certain situations, such as requiring a few weeks of shadowing prior to seeing patients, while well intentioned, are terribly received and undermine the confidence of new physicians. Other actions, such as cherry-picking cases or handing over problematic patients are also likely received poorly. In short, I'm looking to foster a lasting partnership and avoid a revolving door of classically disgruntled employees. Any advice is greatly appreciated. 


Name Withheld



Query: Computerized Orthotic Lab 


For many years, I have been very pleased with custom orthoses with customized top covers that were fabricated from computerized standing and walking gait scans from two Canadian orthotic labs; the most recent one being The Orthotic Group. For some reason, in the recent past, our receipt of new custom orthotic orders and repairs/modifications has been delayed due to customs matters between the U.S. and Canada. I would appreciate it if my colleagues could advise me as to whether there are any orthotic labs in the U.S. that provide this type of technology and who also offer quality customer service.  


Richard M. Cowin, DPM, Orlando, FL



Query: Digital X-Ray Systems


We are currently deciding between Televere (Tigerview) and 20/20 digital x-ray systems for the office. Wondering if anyone has any comment or experience with either system regarding usability and customer support.


Leonard Kuzmicki, DPM, Spring Valley, IL



Query: Extra Depth Steel-Toed Shoes


Does anyone know of an extra-depth steel toed shoe/boot? I have a diabetic patient with hallux malleus and the top of the toe keeps ulcerating and work doesn't allow a work around other than  padding his toe, which only  moderately helps.


Charles Halverson, DPM, Columbus, NE



Query: Repair of Simon Digital X-Ray System


I have a Simon digital x-ray system which needs repair. The system is a little over five years old. Unfortunately, the company (Simon DR)  went out of business shortly after installation. The quality of the images has gradually deteriorated and are no longer sharp and clear. I have called local digital x-ray companies who recommend “trashing the system” and installing a complete new system at a cost of $25K+. This system was sold to many podiatrists in the U.S.  I need help repairing the system rather than replacing the entire system. Any input would be greatly appreciated.  


Samuel D. Beitler, DPM, Glen Burnie, MD



Query: Local Anesthetic Shortage


The staff member who orders my supplies has informed me that our usual venues for lidocaine and bupivacaine are claiming they are unavailable, possibly until the next calendar year. Does anyone have a reliable source for these injectables, or do I operate under ethyl chloride anesthesia?


Brad Shollenberger, DPM, Reading, PA



RE: Is BNA Burz Still in Business?

From: Jerome E. Reeves, DPM


I brought some bur machines from BNA Burz, and have one unit in need of repair. I was unable to reach this company via telephone or email addresses. If anyone can tell me if this company has gone out of business, or how to contact them, it would be greatly appreciated.


Jerome E. Reeves, DPM, Hollis, NY


Editor's Note: It appears that BNA Burz is no longer in business. If any PM News subscriber has an alternate source for repairing these machines, please post that info on this site.



Query:  Experiences with Digital X-ray Companies

Has anyone experienced software or hardware problems with their digital x-ray systems? If you dropped the yearly support package, did you start having problems with your systems?

Robert Scott Steinberg, DPM, Schaumburg, IL



Query: Cyber Security Insurance 


It has often been said, "you can’t have too much insurance," but what is considered reasonable coverage amounts for cyber security insurance? Some professional liability companies are including $50,000 to $100,000 coverage for their professional liabilities clients, but is that enough? 


Joe Boylan, DPM, Ridgefield, NJ



Query: Instrument Sharpening Service

Where do podiatry practices send scissors, nippers, chisels for sharpening? Good quality and quick turnover wanted. 

Billie A. Bondar, DPM, Rochester, NH 



Query: Collection Agency for Medicare Deductibles

I am looking for a reputable collection agency for a very small number of patients. The common denominator in my practice is the very few who refuse to pay their Medicare deductible. Why isn't there any recourse doctors have that would allow them to report these patients to Medicare. I scratch my head every year wondering why our government doesn’t just take the yearly deductible out of every beneficiary's Social Security check at the beginning of the year. It would save a ton of aggravation, time, and money from our already financially squeezed practices, not to mention saving the government a large sum of money. It is very frustrating to think there is a very simple fix to a yearly problem many Medicare participating practitioners have.

Jack Ressler DPM, Delray Beach, FL.



Query: MBT Shoes


Does anyone have experience with MBT shoes? I have a patient asking about them and I'm totally unfamiliar with them.


Larry Aronberg, DPM, Lake Worth, FL



Query: Technical Support for an Alara CR T220 Digital X-ray Reader


Does anyone know who can give me technical support for an Alara CR T220 digital x-ray reader and more specifically the CRystalview software that it uses? It seems Alara is no longer in business nor is the imaging company that sold the system to me.


Sean Connolly, DPM, Everett, MA



Query: How are DPMs Dealing with Increasing Overhead Expenses?


My accountant read me the "riot act" when he was at my office last week. He does not understand why my overhead expenses are rising so astronomically. I am not just talking about rent, insurances, and payroll. The biggest rise seems to be the cost of supplies. I haven't changed vendors and yet my accountant was able to show to me my expense increases from year to year. Everything I buy is essential to day-to-day practice. How have some of you dealt with this insidious rise in the cost of day to day supplies. Are any of these "group buying" companies a viable answer? 


Elliot Udell, DPM, Hicksville, NY



Query: Repair of Micromat 3000


My Micromat hand piece needs repair and Med-Pro Corporation is no longer in business. It is a Nouvag Swiss spray drill hand piece with a sprayer attachment for grinding nails. I would like to get it serviced but am not sure where to get it repaired.


Catherine Yack, DPM, Huntsville, AL



RE: CA Podiatrist Publishes 600th Issue of Practice Perfect

From: Alan Sherman, DPM


This week, Jarrod Shapiro, DPM has reached the milestone of completing his 600th issue of Practice Perfect. Over the past 12 years, Dr. Shapiro has delivered 600 consecutive weeks of professional insight and mentorship to a generation of podiatrists and those working in the podiatry profession. From the importance of checklists in clinical practice to communication issues to what it means to think like a surgeon to truly enjoying your professional life, Dr. Shapiro has taken us on an introspective examination of our podiatric lives and challenged us to live and practice in a more examined, deliberate, and fulfilling way. Along the way, we have all grown with him. Thanks Jarrod  for sharing your prodigious and active mind with us.


Alan Sherman, DPM, CEO, PRESENT e-Learning Systems



Query: Time Clock, Attendance, and Scheduling Software


Our practice now employs 27 team members and our current facial recognition program is really poor. We tried a fingerprint system before that with similar results. Does anyone utilize a program that imports the data direct to Quickbooks and has features to change employee schedules, monitor tardiness, keep track of PTO (paid time off), and is reliable to use?  I would like employees to be able to log in and out with their computers and/or phones but also make sure they are within a reasonable distance of the office. I have looked at Ximble and Humanity and it looks like Humanity might even remind me of employees' birthdays and work anniversaries.


Jane Graebner, DPM, Delaware, OH



Query: Recommendations for Billing Companies


Can anyone provide me with any contacts and names of billing companies with whom you have had a good relationship, and with whom you are satisfied with both the quality of their work and the fees that are charged for their services?


Dave Williams, DPM, El Paso, TX



Query: Recommendations for 4-Line Phone System


Can anyone recommend a 4-line phone system? All the systems I’ve researched have too many cons, i.e., no caller ID, etc.  I’d prefer a corded system.


Jay Kerner, DPM, Rockville Centre, NY



Query: Bringing an PA/NP into Practice


My practice is expanding and I'm considering bringing on a part-time midlevel provider (PA/NP) to aid in patient care. I recognize that state laws ultimately dictate legality of employment, but I would love to hear the opinions of my colleagues out there who employ or have employed PAs/NPs in their practices. 


P David Applegate, DPM, Katy, TX 



Query: Lidocaine Shortage 


Does anyone have a reliable U.S. distributor with a solution to the current local anesthetic shortage?


Paul Kesselman, DPM, Woodside, NY

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