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 Note: HIPAA is a national minimal standard which can be superceded by state law.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.
Query: New Medicare Numbers
On April 1, 2018, CMS will start changing Medicare numbers to different ones to protect patients from identity theft. I understand that there will be a grace period for the change-over. My question is this: Are we supposed to start changing the ID numbers in April 2018 and then bill Medicare accordingly for services rendered? If so, then will beneficiaries (patients) know to present the new Medicare number to us? Or will we need to start inquiring at that time? What about any nursing home patients that we may see?
Joseph Borreggine, DPM, Charleston, IL
Query: Source for Office Plans
I am looking to build a basic podiatry office and wanted some suggestions on where to obtain office plans that would meet general podiatry needs. I have some ideas but wanted some thoughts from people who have built an office.
Charles Myers, DPM Conway, SC
Query: Volunteering/Working as a Podiatrist in Peru
I am inquiring about information or advice regarding volunteering/working as a podiatrist in Peru.
Rachel George, England
Query: Lunula Laser
I would appreciate any feedback on people’s experience with the Lunula laser with respect to fungal nails.
Samuel Rosenwald, DPM
Query: Osseous Cysts Discovered During Bunion Surgery
The patient is a 56 year old healthy female teacher. A large osseous cyst in the head of the first metatarsal was discovered during scheduled bunion surgery. This cyst was not obvious on pre-op x-rays. It prevented the planned metaphyseal osteotomy of a modified Austin-style bunionectomy (“chevron”) as well as a possible Scarf procedure. The patient did not want a more proximal osteotomy (CBWO, Lapidus, Cotton) that would cause prolonged disability. Demineralized bone matrix was placed in the defect.
What is the consensus of podiatric surgeons in this presentation? I suggested a Mau-type osteotomy to help reduce the abnormal IM angle, thereby avoiding any osteotomy of the capital region. Post-operative weight-bearing on a protected basis would then be permitted. Is anyone performing the Mau procedure?
Query: Stem Cell Therapy
I understand that stem cell therapy is being used to treat foot and ankle problems. Can anyone recommend a CME course or pertinent literature regarding this form of treatment?
Michael Forman, DPM, Cleveland, OH
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,