Query: Source for Bupivacaine w/Epi
Does anyone know the availability status of bupivacaine 0.5 % with epinephrine? I'm told that it is back ordered from the company.
Paul A. Galluzzo, DPM, Rockford, IL
Query: Holding Credit Cards on File
If your office is holding credit card numbers (safely offsite, in a cloud, etc.), do you charge off the balance of the account after 30 days or 60 days, or do you create a payment plan at the time of service?
Nicole Freels, DPM, Lexington, KY
Query: Repair of Midmark Equipment
After years of reliable service, we recently experienced a power surge that knocked out two Midmark 417 podiatry chairs and our R9 UltraClave. I need a recommendation for a reliable service company for these products in the Philadelphia area.
Greg Caringi, DPM, Lansdale, PA
Query: How Often to Change Benz-All Instrument Disinfectant Solution
Can anyone tell me how often we should be changing the Benz-All instrument disinfectant solution in the Bard-Parker trays. Is there literature to cite?
Ed Dos Remedios, DPM, Providence, RI
Query: Template for Credit Card Collections of Deductibles
Our practice is looking for a method to collect on high deductible patients via pre-authorized credit cards once the insurance company has concluded the claim. Does anyone have a template of a form they use in this regard?
Amy Sepehri, Practice Manager, Chicago, IL
Query: Formula for Value of a Practice
I am in the process of entertaining a bid for the purchase of my now second generation practice. What formula have others who recently sold their practice used to calculate a sale price? There are several rather complicated accounting methods floating around, but I was hoping for a more simple starting point, say X% of gross or X% of net. I recognize that there are a lot of variables in the negotiating process, but was hoping for a simple place to start and perhaps circle back to after the accountants and lawyers churn the pot.
Editor's comment: PM News does not provide legal advice. In a rapidly changing healthcare environment, there is no magic formula that works for all practices. One thing though is certain. Any formula you start out with MUST be based on a percentage of net. Gross income is a useless figure because three practices with the same gross, e.g., $300,000 can have three radically different net incomes. Net income is the only true measure of how long a prospective buyer will take to repay the loans necessary to purchase a practice.
Query: Online Bills to Patients
Does anyone know whom I can deal with to set up online bills to send to patients' emails?
Jill Hagen, DPM, Englewood, NJ
Query: Keeping Track of Employee Hours
How are offices keeping track of employee hours? A time clock machine? Each person filling out a weekly time sheet? Or something else?
Olga Luepschen, DPM, Sebring, FL
Query: Rationale for Penalizing CR X-Ray Technology
What is the reason for penalizing someone with CR x-ray technology? What makes DR technology deserving of a higher reimbursement?
Jeffrey Kass, DPM, Forest Hills, NY
Query: Storing Charts and HIPAA Compliance
I am a semi-retired podiatrist. My practice consists of a satellite office and a few independent senior facilities. There is a central medical wellness office where I see my patients at the facilities I go to. Because I only work part-time at all of my locations, I store all of my patient charts (still using paper) at home. To be HIPAA-compliant, what precautions do I need to follow when storing patient charts at home? They are kept in a locked closet.
Editor's Comment: PM News does not provide legal advice. Under the HIPAA security rules, covered entities must "Identify and protect against reasonably anticipated threats to the security or integrity of the information." The keyword is "reasonability" and a locked closet meets this requirement. Note: HIPAA is a national minimal standard which can be superceded by state law.
Query: Difficulty Getting Local Anesthetics
Does anyone know why I am having trouble getting Marcaine, Carbocaine, and Xylocaine (proprietary or generic)? I am being told there is a back order and it will be several months. No one seems to know why.
Sam Bell, DPM, Schenectady, NY
Query: Plug-in for Credit Cards
We have been using Spark Pay for several years, which is a plug-in for your phone or tablet to process credit cards with no terminal needed. I just received notification that Capital One is discontinuing Spark Pay on January 31, 2018. Square is a popular alternative, but it has the worst reviews. I ordered PayPal's device but upgraded (for $79) to a unit that will accept the chip, swipe, Apple Pay, and Android payments. It is also wireless to our phone, computer, or tablet. They charge 2.7%. Does anyone have a good or bad experience with Paypal, Square, or other plug-ins?
George Jacobson, DPM, Hollywood, FL
Query: Best Way to Study for 10-Year Forefoot Boards
Can anyone recommend what is the best way to prepare for the 10- year surgical forefoot boards?
Dean Spellman, DPM, Bronx, NY
Query: Joint Venture with Vascular Surgeon
We have been in touch with a vascular surgeon regarding a potential joint venture. In the past, we did a joint venture with a primary care group, but that business model failed. Our vascular doc insists that they have a lot to gain by having podiatry on their team. Are there any successful models for collaboration? Any advice would be appreciated.
Query: Board Re-Certification Study Strategies
I am in the group of individuals who takes the self-assessment exam every 10 years for ABFAS re-certification. I understand that it is an educational process, but I still hope to do well on the exam. When I took the re-certification exam 10 years ago, I was surprised that there was a whole section with highly technical questions about bone lengthening (distraction osteogenesis). I never expected that this was a common enough procedure in our profession to have prepared to answer how many mm/week the distraction device should be advanced.
I believe I practice at a high level and keep up with the current literature. I am hoping that colleagues in my age group and experience can direct me to those topics that might be part of the current practice of podiatry, but were not taught or even known 30 years ago. Any suggestions are appreciated.
Greg Caringi, DPM, Lansdale, PA
Query: Recommendations for Pathology Lab with a Fast Turn-around
I am looking for recommendations for a pathology lab with a streamlined process and fast turn-around time. Any suggestions?
Daniel Methuselah, DPM, Columbia, SC
Query: Waiting Room Informational/Educational Videos
Does anyone have a resource on companies that produce "looped" video that can be displayed in your waiting room? It would be ideal if this could be customized to feature our docs and some of the specific services we provide.
Steven Merckx, DPM, Madison, WI
Query: United Health Care Compliance Call
I received an after hours call from United Health Care this evening that was a compliance call. Essentially, UHC calls the office and times how long it takes for the doctor to call back. I've never heard of this or had this happen before. Does anyone know anything about this? I plan to check my contract to see if practitioners are obligated to comply. Any information would be appreciated.
Amy Walsh, DPM, Spring, TX
Query: ABPM Certificate of Added Qualification
Can someone clarify a notice that I received from the ABPM asking to apply for a "Certificate of Added Qualification in Amputation Prevention and Wound Care"? I asked my former residency director and was told that this was not an approved certificate by the CPME or JCRSB even though it is given by an approved board.
Query: Doctor Jousting
There is an orthopedist in my city who routinely badmouths me and most other podiatrists directly to patients. He seems to focus much of it towards my patients in particular. He informs patients that their care or surgery was substandard, complications were the podiatrist's fault, etc. This has the effect of creating some really angry patients and nasty phone calls from them. I am concerned that he is purposely trying to send a malpractice suit my way. An attorney told me that a phone call or letter from them would only likely inflame the situation. Any other ideas how I can resolve this?
Query: Foot Roller
I recently saw an ad on TV for a "Foot Roller" to ease all types of foot pain. This device has been promoted/recommended by the "#1 podiatrist" in the U.S. How does one get to be the #1 podiatrist in the country and by whose determination? Also, can anyone comment on the efficacy of the "Foot Roller"?
Charles F. Ross, DPM, Pittsfield, MA
Query: Standard of Care for Electric Debridement of Nails
What is the current standard of care in podiatry with regard to use of electrical drills for dystrophic toenails? Are podiatrists still doing this? If so, are the drill bits individually sterilized and used only once? Is the use of drills to debride dystrophic toenails still taught in the podiatry schools?
Norm Wortzman, DPM, Boston, MA
Query: Using a Call Center
I’m looking for recommendations for a call center to cover the phones during normal business hours? What are the positives and negatives in your experience?
Debra Manheim, DPM, Rego Park, NY
Query: Answering Service Capable of Making Patient Appointments
I am looking for a company to answer phones and make patient appointments when I am outside of the office. Is anyone aware of such a service?
Hal Ornstein, DPM, Howell, NJ
Query: Patient in Collections Threatening To Post A Negative Online Review
We have a patient whose account was sent to collections 7 months after treatment, and she is now threatening to post a "horrific" online review of our practice. How would you handle this situation?
We have our patients sign a financial contract that clearly states that past due amounts beyond 90 days will be turned over to a collection agency and an additional 38% will be added to the balance (30% collection costs, 8% interest). Statements were sent to this patient at 30, 60, and 90 days, and phone calls to the patient were documented by my accounts manager at 60 and 90 days. At 4 months, a "pre-collections" letter was sent to the patient.
She received 2 additional monthly statements before her account was sent to our collection agency. Within 5 days of the account being sent, she contacted my accounts manager and threatened to post a negative review if we didn't remove the collections fees and discount her remaining balance. My accounts manager explained to her that we had already been generous with the time she was given to pay and that she was responsible for the full amount. We are awaiting payment from the collection agency and anticipating a negative online review.