Query: Affordable Ultrasound Machine
My old ultrasound machine finally died. As much as I would love to get a $16,000 machine, it is impractical at this time. There are a number of lower level machines in the $6,000 range that are probably more technically advanced than my old one. What can my colleagues who use US regularly suggest for a new machine?
Ron Werter, DPM, NY, NY
Query: Billing Service for Small Practice
I am need of a billing service that is willing to work with a small solo practice in IL. Any recommendations would be appreciated.
Gary Trent, DPM, Chicago, IL
Query: Recommendations for X-Ray Systems
We are a busy surgical practice in need of a new x-ray system. Can anyone recommend a system with which they’ve been satisfied? (No rep responses please).
Christopher Stewart, DPM, Charlottesville, VA
Query: Injections for Fibromas
I am considering adding Vitrase (hyaluronidase) and/or Xiaflex (collagenase) to my injection treatment offered for fibromas. I would appreciate any comment on dosage and cost, or information on a supplier for both.
Tip Sullivan, DPM, Jackson, MS
Query: Dealing with Specialists Who Don't Send Referral Letters
For many years. I referred my patients presenting with peripheral vascular disease to a very prominent and respected vascular specialist in my area. He was not only an excellent diagnostician and surgeon, but always sent me timely reports on the management of our mutual patients. Unfortunately, this doctor passed on and all of his patients were turned over to an equally prominent vascular specialist. The only problem is that this new specialist does not send reports nor does he return phone calls.
This past month, one of my patients with recurring ischemic ulcers went back to this doctor at my request. Not only did he not sent me a report, but he did not return phone calls to either me or the patient and the only line of communication is when the patient actually sees him in his practice.
PVD has legal exposure, especially if the patient's condition worsens and s(he) needs an amputation. With no reports or any return phone calls, I am the one who will be left standing without a leg if the patient should decide to sue. Needless to say, I do not refer any new patients to this doctor, but the ones who are already using him have no intention of changing. Our insurance companies warn us to have documentations from specialists but how do we as podiatrists handle cases when a specialist does not believe in sending reports?
Elliot Udell, DPM, Hicksville, NY
Query: Hands-on Refresher Course in Traumatic Ankle Repair?
I am an ABFAS certified podiatrist with training in ankle reconstruction. Because of state laws, I have not done a traumatic ankle repair in many years. Does anyone know of a certified hands-on refresher course to recommend?
Tip Sullivan, DPM, Jackson, MS
Query: Chart Reviews
It seems now that the chart review companies - namely Ciox Health and Change Healthcare which work for Fidelis and Affinity are now getting more aggressive and asking for over 100 charts now at a time or more (in some cases over 200). When I told Ciox that I charge 25 dollars per chart, they said they would tell Fidelis this and they would either lessen the number of charts asked from me which was 115 or pay for the charts. Fidelis called my office and stated, "we don't negotiate and we don't pay [for charts]." It seems that as practitioners, we are at their mercy with no support no defense. Any constructive thoughts would be appreciated. I have left 10 messages and emails with my provider relations rep. with Fidelis and have received no reply.
Query: Podiatrists' Median Income
I am writing questioning podiatrists’ annual median income. I read on PM News from Career Cast's top 10 highest paying jobs that podiatry is #8 at $124,830. My associate is starting his 4th year with me and is asking for a substantial raise. He is already making above this amount. He quoted research that he has done from Salary.com that states the median base salary for our area is $192,738, which I can’t fathom is correct. Can anyone comment on this large discrepancy?
He is generating income for the practice but is falling short on some of his duties. He comes to work late. He works his shift but nothing more. He is not doing any marketing. He is not following protocols. He has a base salary and has a bonus structure. I am having a hard time giving him a raise with the information that I read on PM News.
Editor's Note: The Annual Median income for a solo practitioner reported in Podiatry Management's Annual Survey was $123,250.
Query: ESWT Service in Florida
When I was in the Northeast, I utilized the services of ESWTUSA to provide shockwave therapy for my patients; however, they do not service Florida. Any recommendations for ESWT vendors who will bring the machine to my office and provide treatment for patients?
Jay Seidel, DPM, Deerfield Beach, FL
Query: Problem Obtaining Health Insurance
I was wondering if anyone is having the following problem in obtaining personal health insurance. My wife (who works for the practice full-time) and I were considered a group and were able to get health insurance at the group rate. Now I have to apply as an individual and with 7 children being covered; we are looking at about $2,300 per month with a $13,000 deductible. This is totally unaffordable. Any comments?
Mark Stempler, DPM, Staten Island, NY
Query: Removing False Patient Reviews
What can we do about online reviews that are patently false and malicious? While most reviews are positive, there is one patient review on Google and now other sites attacking my character, surgical skills, and expertise, submitted by a person WHO HAS NEVER BEEN SEEN OR TREATED BY ME. She claims her surgery was in 2007 and she is still posting reviews nearly 12 years later. Realizing “hell hath no fury like a woman scorned,” she has the wrong guy/gal. Can an attorney do something?
Martin V. Sloan, DPM, Abilene, TX
Query: Podiatry's Adjusted Gap Difference
A dentist friend forwarded this chart to me asking why there is so much of a difference between podiatry and the other health professions.
Adjusted Gap in Real Annual Earnings
I do not know. Any ideas?
Neil Scheffler, DPM (Retired), Baltimore, MD
Query: In-room vs. Virtual Scribes
I have a question for those of you DPMs who are using either in-room or virtual scribes. What are the pros and cons of each? Which would be the easiest to implement? I have been looking into virtual scribes, but am not sure which would be the most satisfactory.
Shari Lewis Kaminsky DPM, Florissant, MO
Query: Difficulty Finding Local Anesthetics for Office Purchase
We are unable to purchase any local anesthetics due to the manufacturing shortage, including 2% lidocaine plain. How are other podiatrists handling this situation? Are there any sources/vendors who are still able to get local anesthetics? Any feedback/information would be appreciated.
Margaret Portela, DPM, Union City, NJ
Query: Source for in-Office Dispensing
I am looking for a company to provide my office with products such as skin softeners with urea, topical antifungal agents, and cheaper alternatives to Metanx. Can anyone provide some good options?
Dan Methuselah, DPM, Columbia, SC
Query: Disposable Instrument Kits
I had a rep in the office earlier peddling disposable surgical trays; specifically, one kit that was a nail nipper and an emery board. The other kit he demonstrated was a P&A kit - with an English anvil type nail splitter, elevator, beaver handle, and file. These were fully disposable kits and appeared to be of decent quality. They also are selling a "wound debridement kit". The nail kit was $10. The P&A kit was about $20.
My question is this: is autoclave sterilization "not good enough" anymore? He said that medicine was going to all disposable instrumentation eventually and that fungal spores could survive steam sterilization. I did quick math and figured if I paid $10 for a kit for every nail debridement, and $20 for every nail procedure, my profit margin would really suffer!
R. Alex Dellinger, DPM, Little Rock, AR
Query: The Latest Games with Insurance Companies and Antifungal Medications
Over the last year, our lives have been made more complicated with many insurance carriers not covering topical antifungal creams. In many cases, a patient will go to the drugstore and call us complaining that a small tube of a given medication can only be acquired if they pay a two hundred dollar co-payment. This applies to generics as well as brand medications.
What makes the matter worse is that we think we know what insurance company will cover which antifungal agent, the "landscape" changes, and what would cost a patient a $20 co-payment last week; however, it is now a $200 co-payment. The reverse is also true. How are some of you handling this problem? Should we be dispensing topical antifungals and give up writing prescriptions for them?
Elliot Udell, DPM, Hicksville, NY
Query: Alternative to Doximity Dialer App
I tried to access the Doximity Dialer app which allows one to set up a phone number as your caller ID when calling a patient on your cell phone. The caller ID could list your office and its phone number.
The app says it is free for physicians, NPs, PAs, and pharmacists. I tried to access it only to be told as a podiatrist I don’t qualify to use the app. This was very disappointing. Does anyone know of a similar app we could support?
Tom Czarnecki, DPM, Grafton, WI
Query: Voriconazole Drops for Athletes Feet/Onychomycosis
Does anyone have any information on the use of voriconazole drops used in a foot bath for athletes feet and/or toenail fungus. Apparently, it is used for 10 minutes twice daily. From what I read, it seems to be used more for Candida infections. A pharmacist asked me for information as to whether they should carry it or not, stating that insurances will cover it.
Mark Ray, DPM, Latrobe, PA
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?
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.
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