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
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