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.
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
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.
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.
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.
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.
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.
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.
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
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
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.
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
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
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
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
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.
My friend Dr. Robert Hatcher is absolutely dead on about "working smarter, not harder." There is no question that we should all strive for life balance and more efficiency in our practices. But "working smarter, not harder" is predominantly an empty sentiment....but only us old timers get it. I teach students, residents, and young colleagues on a regular basis. One of my most common points is "the days of 9-5 are long gone." If you want to coach little league and catch every ballet recital, and go to "mommy and me", you may need to settle for a three bedroom house instead of a 5 bedroom house. If you don't get what I am saying, advice on office efficiency and life balance is wasted on you.
CMET has the only physician-specific organization certifying all prescribing MDs, DOs, and DPMs. CMET is different from the other certifying bodies in that they do not certify physical therapists, CNPs, or nurses in wound care. CMET certification is well accepted and respected, and an important certification for hospital and wound center privileges. If you want, you can go to the website for the Academy of Physicians in Wound Healing and sign up for their review course before sitting for the exam.
I took both CMET and American Board of Wound Healing exams. Even though both exams are for physicians, CMET questions are generated and beta tested by physicians - MDs/DOs/DPMs. Additionally, since CMET does not offer exams for mid-levels, nurses or allied professionals, you can wholeheartedly trust that this certificate is for physicians. It is not carved out from a pool of questions for all levels of professionals. It gives me the confidence when I present the certificates to other providers and patients.
Even though ABWH seems to be endorsed by the American Professional Wound Care Association and American College of Hyperbaric Medicine, those are two sister organizations. CMET is recognized by the Academy of Physicians in Wound Healing (the only wound care organization exclusively for physicians - MDs/DOs/DPMs), American College of Lower Extremity Surgeons, and the Israel Wound Care Society.
I don't think it would hurt to have more certificates. But if you plan to take only one exam in wound care, CMET should be the choice.
Jengyu Lai, DPM, Rochester, MN
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Millennial Expectations
From: James E. Koon, DPM
For some time now, patients have been researching their doctors on the Internet. I am consistently told by new patients that they chose me based on my Internet reviews. Word of mouth referrals are still a mainstay of my practice. I have never advertised.
My experience has been that all patients’ expectations are rising. Everyone wants everything given to them and they all want their insurance to pay for it. Many come in with pre-conceived ideas of what they have because “Dr. Internet” has seeded their minds. Many come in wanting...
Editor's note: Dr. Koon's extended-length letter can be read here.
The city hospital in my town did this to a group of DPMs a few years back. We were on call there for years taking all kinds of pro bono and indigent cases. The burden became so large that all specialties finally demanded pay for call. The hospital decided to pay all specialties for call except for podiatry, and would not let us out of the call responsibility. Talk about discrimination! A lawsuit ensued which went for over a year, costing both sides a lot of money, and ended in a draw. We resigned our hospital privileges the next day and never looked back.
A year later, the hospital had to hire on two podiatrists to take care of their patients. I can provide no advice on negotiating as even our attorney got no where with them. You would think there would be some laws against discriminating like that, but apparently not. You should be prepared to find another hospital to work at and resign from that one if need be. Feel free to contact me if you want more info.
Judd Davis, DPM, Colorado Springs, CO
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Time Wasted
From: Larry Schuster, DPM
An insurance company just requested we fill out and attest to demographic information on our practice. We have done this many times for many insurance companies. We usually look at a page of pre-filled info, and if no changes, click approve. It takes 5 minutes maximum. If you need passwords, etc. to get on the site, it takes a little longer. .
We are seeing more complex forms every day to the point of craziness. Today, I received a request to fill out such a form with the recommendation that I attend a 30-minute webinar on how to fill out the form. I will have to do this after finding my sign-on credentials.
In response to Dr. Freireich's recent post, I am compelled to respond to all issues pertaining to the MACRA/MIPS conundrum that we are facing. MACRA/MIPS is "supposedly" all about creating an environment of cost-effective and efficient delivery of healthcare services. Of course, this is being constructed by our federal government...a highly inefficient, wasteful organization. We, once again are the victims of their ineptitude. I liken their skillset to an orchestra conductor who can't read sheet music...and we're forced to play on. MACRA/MIPS is like all the other poorly concocted schemes foist upon physicians under the guise of trying to make healthcare delivery more efficient.
I submit that the additional data collection and additional data mining is a waste of time. Issues of meaningful use, quality measures, MACRA/MIPS and the like are created for one reason only...to reduce reimbursement. Collectively, medicine is the only "government contractor" (recipient of public tax dollars under Medicare, Medicaid, FEP...) that gets "incentivized" by not getting "penalized". By submitting the data bundled in our insurance billings, we are providing more than ample information as to our individual practice patterns and utilization. That, in fact, should be enough. After all, it really is all about how much less we can get paid, and not how well we do our jobs. It would be nice if all doctors could resume the practice of treating patients and not focus on treating their computers.
The brotherhood (sisterhood) of our profession is so amazing. Thanks to the closeness that PM News has created, we are a village. Paul Kesselman’s assistance to his fellow DPMs is yet another example of the value of this medium. A special thank you to all members of the village we call podiatric medicine and surgery.
Since this topic has come up again, I would like to remind everyone of a posting that I wrote on 03/05/2016. You can search it in the PM News archives. In a nutshell, here is the main excerpt, "We received a letter from Palmetto GBA stating that they have received information from the National Supplier Clearinghouse (NSC) indicating that we have not billed the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) within the last four consecutive quarters."
I went to the website that Dr. Kesselman referenced in his response, and after putting in my NPI, it correctly identified me and my specialty (podiatry), but it only said revalidation: TBD. I assume this means "To Be Determined". I guess I have to keep checking back to see if any date actually shows up. It would be far more helpful if the actual date was given.
Martin G. Miller, DPM, Freeport, NY
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