02/10/2009
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Healthcare Networks of America, LLC (David Zuckerman, DPM)
From: Paul Kesselman DPM
I signed up with them many years ago when they initially came to NYC and had no sign-up fee. After one year and not a single patient referral, they began to demand an annual fee. I continue to get letters from them threatening to discontinue my presence on their panel. Of course, I have never sent them a dime, they have never sent me a letter of termination nor have I ever seen a patient referred from them.
HNA and companies like them, thrive on poor unsuspecting physicians. They market the concept that they can provide a huge influx of patients from a wide number of insurance panels into your practices with ease. It simply isn’t that easy. The demographics of many of these insurance companies in your area may not live up to their marketing material. Many of these carriers are small and may not have a large population density in your practice area. If HNA, and other companies like them were successful in getting patients to your practice, they would also get a percentage off the top of your fees and not from the insurance carrier. Nowhere in their brochure or contract do they promise you a higher fee than you could negotiate on your own directly with the carrier.
Other significant issues to consider are: Who pays your claim, HNA or the carrier? What happens if your claim is paid incorrectly, to whom do you appeal the claim, the carrier or HNA? How will ERISA or your state insurance department or attorney general’s office deal with any interruption of payment? Most of the companies advertised by HNA as being on their panels are really providing union welfare benefits as they are not true insurance carriers. Any company who markets themselves in this manner is not worth the time it takes to read their brochure.
Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net
12/13/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Approaching Podiatric Patient Care in the Current Recession (Elliot Udell, DPM)
From: Steven Goldstein, DPM
I am sympathetic to the premise; however, everyone, including Dr. Udell is affected. Many of these patients still go on vacations and eat out weekly. Most have a credit card, so they can pay their credit card bill over time. Does your landlord want his rent? Will the phone company shut your phone off if you fail to pay your bill? If you extend credit to everyone who gives you a sob story, you will be closing your doors shortly. Patients will always make excuses not to pay. Be careful who you believe.
Steven Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com
11/22/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Disposal of Narcotics (Todd Rotwein, DPM)
From: Barry Block, DPM, JD
The following should not be construed as legal advice. Disposing of narcotics is not a simple matter, as federal and state laws generally apply. In the past, physicians were required to mail these drugs to a DEA special agent. This policy has changed. Many states, such as New York allow on-site destruction as long as the destruction is witnessed. It’s best to check with a healthcare attorney or the state health department in your state to make sure that you comply with all necessary regulations.
10/31/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: 7 NJ Podiatrists Named as Top Docs
From: Sloan Gordon, DPM
Congratulations to all those chosen. There are not enough magazines that give credit to our best practitioners. I'm glad to see this group noticed and awarded such an honor. I'm very proud that my classmate, Wayne Caputo was chosen - he was a great student and is justifiably honored by his peers.
Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net
10/25/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Digital Scanning System (Mark K. Johnson, DPM)
From: Tatiana Wellens-Bruschayt, DPM, PhD
We have 4 physicians in our practice utilizing Aetrex scanning system (we had it for about 2 years) and we love it. We have looked at many others but found quality, service as well as overall patient satisfaction to be the highest with them. We did try several others prior to purchasing this one.
Tatiana Wellens-Bruschayt, DPM, PhD, Winter Haven, FL, tanyafoot@aol.com
10/18/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Feedback on Staff (Mark Gotfryd, DPM)
From: Barry Block, DPM, JD
There are several effective ways of obtaining patient feedback about staff. The most cost-effective is to print up brief surveys and provide them to patients, along with a stamped self-addressed envelope sent to your home address or to a post box. Attach a short note such as “This office prides ourselves on the high quality of patient service we provide. Kindly fill out and mail back this anonymous survey, so we can better serve you.”
Ask a few objective questions, such as, “How long did you have to wait before being seen?” as well as some subjective questions, such as “Was the staff friendly to you?”
Barry Block, DPM, JD, Forest Hills, NY, bblock@podiatrym.com
10/07/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Matrixectomy Billing Rules (Karen Hurley)
From: Lloyd S. Smith, DPM, Lowell Weil, Sr., DPM
CPT 11750 has been RUC reviewed and valued in recent years. As such, the values for the code are well accepted and frequently referenced when other codes, including all CPT codes, are reviewed. The value for the code is determined by a vignette that only discusses one border being mentioned. However, and this point is central to this debate, RUC allows and understands that more than 1 border could be done and has provided an allowance in this code for that possibility.
CPT 11750 should only be billed one time whether 1 or 2 borders are done. You should note that I am the appointed RUC member by APMA and am the only podiatrist to ever have a formal RUC vote.
APMA might want to submit a code proposal to CPT to add a code but if that occurred, the value we currently get for 11750 would decrease.
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com
The "sterilization" of the fibular and tibial side of a nail border should be treated no differently than performing a proximal interphalangeal arthroplasty for a hammertoe and a concurrent distal interphalangeal arthroplasty for a mallet toe on the SAME DIGIT. There are NO statements in CPT to preclude this method of coding and they certainly fall within the definition of Modifier -59. The key words in the -59 definition, different procedure, different site, separate incision all are present when sterilizing a border on an incurvated nail.
From a surgical standpoint, I would think that all podiatric physicians who perform this procedure would agree that there is more work, time, and potential complications by doing two borders rather than one border.
On the other hand, I can understand why a professional coder may treat this differently which only goes to prove that coding rules should be established by a combination of input from practicing surgeons who do the work, professional coders, and evidenced- based medicine indicating the efficacy, risks and complications of various procedures.
‘59’ Distinct Procedural Service: Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available and the use of modifier 59 best explains the circumstances should modifier 59 be used. (paraphrased from AMA CPT coding rules 2008)
Lowell Weil, Sr., DPM, Des Plaines, IL, lswsr@aol.com
10/06/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Amfit CAD/CAM (Q Solomon, DPM)
From: Jengyu Lai, DPM
I had the same thought and discussed this with the company during the Midwest Podiatry Conference a few months ago. I was told by the rep that the cost would be higher than the Medicare reimbursement.
Jengyu Lai, DPM, Rochester, MN, jylai99@yahoo.com
09/27/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Network vs. Non-Network (Mark Levine, DPM)
From: Multiple Respondents
The most obvious answer is to drop the plans. My question to those who have chosen this option is: are they billing the patients their high out-of-network deductibles and copayments, or are they just writing them off? Are they being honest with their patients when asked if they take a plan, even though what the patient is really asking is if they participate in-network?
I have come the conclusion that fees will elevate if patients no longer have access to the care because they cannot find an in-network doctor to do it. This is because the fee is so low that they cannot find an out-of-network doctor to write off the deductible. In other words, patients really do not have in-network coverage for a procedure because they cannot find a doctor willing to do it in-network. If patients want services, they have to PAY out-of-network.
Patients can still get procedures done without paying, because in-network doctors are still doing them at losses, and they can still find out-of-network doctors to do it without paying. I believe this will eventually change as doctors cannot afford to continue practicing this way, thus we will see fee elevation.
Paul Liswood, DPM, Brooklyn, NY, dr.liswood@verizon.net
Editor's note: Extended-length letters by Drs. Goldstein and Larkins appear at: http://www.podiatrym.com/letters2.cfm?id=22191&start=1
09/23/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Quicken Enhanced Payroll Plus (Peter Smith, DPM)
From: Multiple Respondents
Quickbooks Enhanced Payroll Plus is well worth it. I think there is a cheaper "less comprehensive" option as well, which is a bargain in Quickbooks, but I can't be sure. Some of the states supposedly have the option of being able to e-mail in the quarterlies, although the last time I checked, California didn't support the e-mail send-in option. But the forms come out right, and it will even remind you to send the forms in.
Philip E. Larkins, DPM, Escondido, CA, larko33139@yahoo.com
I have been using Quicken Payroll for a few years and I find it very useful. I calculates the payroll and prints the checks. It calculates and prints the 941 quarterly report and W-2's at the end of the year. Mine doesn't print the state quarterly reports, but will give the information needed - perhaps the enhanced version does the state reports too. Every so often, the program takes me on-line to download any changes in withholding or other tax info it needs. I find this program to be terrific. Also, I use Turbotax to do the annual federal and state corporate income tax report.
Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com
I am currently using PayCycle for payroll. It is a web-based payroll service. All federal and state taxes are paid electronically. I am emailed due dates for taxes, also when I log into the account, I can easily view when the next tax payments need to be paid. I can offer direct deposit for my employees. Tax forms can be filed electronically. The data is downloadable into my Quicken software.
I compared the cost of PayCycle and the cost of doing payroll myself with Quicken. Payroll only takes a few minutes to complete. PayCycle costs me half of what my accountant charges for doing payroll. I like the peace-of-mind knowing my tax forms are filed and filled out correctly. I read all the reviews of the company I could find before joining. I have no financial interest in the company. PayCycle can be found at paycycle.com.
Brian D. Battles, DPM, Waco, TX, battlesbrian@hotmail.com
09/22/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Dealing With Employees Who Forget to Punch In and Out (Cheryl Martinetti, PMAC)
From: Shari M. Lee, PMAC
First and foremost there should be an employee handbook that covers all policies in the office. In our office we have a policy, however, that if an employee begins to have problems remembering to use the time clock, I will write a notice for the employee to sign that states when the time clock does not get used properly their time will be edited by me. They will be clocked in by my time, not theirs, and if misuse continues - hours will be lost completely, as they did not clock in, therefore they were not here.
Also, I have a form with each employee’s hours with their signature and mine. If they forget to clock out, it does not cost me because I can use this as a guideline, if needed. This is always in writing and I will also post a sign above the time clock giving notice of the consequences. Normally, this takes care of the matter. If not, you may want to consider how important this employee is to you. Remember to follow your state guidelines on notification and make sure both you and the employee sign the notifications.
Shari M. Lee, PMAC, Midlands Podiatry, PA, midlandspodiatry@bellsouth.net
09/20/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Dealing With Employees Who Forget to Punch In and Out (Cheryl Martinetti, PMAC)
From: Joel Lang, DPM
The employees are not 'forgetting' to punch in or out - they are showing you that they resent the process. Paying by the hour is the fairest way to compensate employees in my opinion, but you need to respect their honesty until proven otherwise.
I suggest you have a time-sheet that you photocopy for each pay period and have employees notate their time in and out by hand. If someone forgets, establish a default number, either for the time in or out, or the number of hours credited for that day. They will appreciate the trust you show in them. The blanks of the sheet will encourage employees to remind each other to sign in or out. With the clock, they do not know who has or who has not.
You may find that an occasional employee will try to take advantage of the system by a few minutes each day, but the confidence you show your staff as a whole will more than make up for it. Eventually, that individual will be found out.
Joel Lang, DPM, Cheverly MD, langfinancial@verizon.net
09/18/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Risks of Prescribing Opiates For Chronic Pain
From: Larry Kollenberg, RPh, DPM, Elliot Udell, DPM
The profession of podiatric medicine and surgery has a privilege like all physicians of prescribing medications. Those medications are, by law, to be written within the "scope of practice" of that practitioner. Your license is a limited license to practice medicine. The question for you to ask yourself about any Rx, is am I writing that particular Rx within the scope of my practice? If a patient has chronic pain in the lower extremity, and you feel that it is in your purview then technically, you are within your scope of practice.
Are you trained in chronic pain management? Do you have a narcotic contract with that patient? Today, physicians are board certified in pain management. Why not refer the chronic pain patient to the pain management specialist? Are you familiar with the potential drug interactions and complications of chronic pain management? Do you monitor your patient appropriately for those drugs? What effect will drug X have on the CYP 3A4 system in the liver? Perhaps it may affect the C2D systems of metabolism. How much Tylenol is in that drug? Does your patient have other factors that may be affecting the metabolism of the drug? Beyond the Rx, what are you doing for medical management of that patient's pain? If your medical record shows that you are managing your patient within scope of practice and providing appropriate medical care (based upon chart review) for the drug in question, then write the Rx.
What do you think your local supermarket, CVS, Walgreens, etc pharmacist is going to do with an Rx from you for large quantity opiates? Will they just fill it “no questions asked?” Like you, the pharmacist has worked for many years to gain a license.
Larry Kollenberg, RPh, DPM, Jacksonville, FL, lkollenberg@hotmail.com
The issue of prescribing opiates for chronic pain, in terms of legal investigations, is complex. We live in an era where "big brother" watches what prescriptions we write and the government looks with a virtual magnifying glass at doctors whose data sheets indicate they are prescribing opiates for chronic pain. A close friend of mine who is a hematologist prescribed opiates for a patient who presented at his NYC hospital. The patient was suffering with severe pain secondary to sickle cell anemia. The medical literature at that time was divided on whether these drugs should be used for pain associated with sickle cell anemia and the investigators who pressed charges against him felt that he should not. The hematologist won the case, but spent many sleepless nights over it and it cost him a chunk of his life savings defending himself.
On the other hand, I know MDs who are pure pain management specialists who write for opiates every day with seeming immunity from investigation and prosecution. So where does this leave us? I would recommend not prescribing opiates for chronic pain. If word gets out that you do, drug addicts from all over will find their way to your door and very quickly. There are other ways to treat chronic foot pain that are more effective and less addicting. This is my professional opinion, but I would defend those who exercise their professional right to prescribe opiates.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
09/17/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
Restrictive Covenant (Name Withheld)
From: Ivar E. Roth DPM, MPH
For what it is worth, the buyout seems very reasonable and this Dr. signed the document when he started work for this practice. From my perspective, there is NO question that this Dr. is obligated to pay what he contractually signed for. I would like to hear why he thinks that he should not pay?
Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net
09/16/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Chiropractors and Orthotics (Bob Kornfeld, DPM)
From: Multiple Respondents
The problem with orthotics is that the word is generic, used widely and open to inaccurate interpretation. Because the profession of podiatric medicine is responsible for the vast knowledge of lower extremity biomechanics and is the most informed in the creation of foot orthoses, it is a shame that the profession has not trademarked or copyrighted a term that specifically identifies an APMA-certified, biomechanical foot device. If the AMA can copyright the CPT codes, certainly the APMA can come up with something. Notice how chiropractors have "Foot Levelers" as theirs?
Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com
Foot Levelers donate a large amount of money to the chiropractic colleges. I think we have all seen foot inserts dispensed by DC's that are nothing more than pre-made devices. When they don't help, or as often is the case, make a patient's foot or ankle condition worse, they find us. When a "real" orthotic (think posted and functional) is necessary, and I find that the DC has already billed for a pair, and another has to come out of a patient's pocket, I ask for the patient to bring in their EOB for the orthotics from their DC. Do you know what I find? Most of the time they have billed for L3000, when all they dispensed was something in the correct size.
I then call the DC and tell them I found a mistake in their billing that is preventing me from giving the patient a functional, custom-molded to a patient model, orthotic and say they need to refund the patient. If they are hesitant, I tell them I will write the patient a letter stating that the DC billed improperly. As for who is the expert, who do you think? Go ahead, take a look at Foot Levelers and decide for yourself (foot levelers.com).
Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com
Being that Dr. Kornfeld and I both practice in the same geographic area, we both hear stories from our patients that their chiropractors interceded and tried to tell the patients that the orthotics they make are better than the orthotics we make. Unless we can prove to the patients themselves that the orthotic made by the chiropractor is not helping their feet, there is little we can do. Chiropractors, orthotists and many others have the right to dispense orthotics. The advantage we as podiatrists have is the advanced training we have in biomechanics and our ability to choose different types of orthotics and materials for different foot conditions.
Many years ago, a major podiatry orthotic lab tried to get involved in teaching chiropractors biomechanics so that they would use their lab and dispense the same products that we did. Outcry from the profession put a stop to that, but it could happen again.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
09/10/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Podiatrists With Outside Interests (Daniel Mendoza, DPM)
From: Multiple Respondents
.
Our editor wrote: "Think how boring it would be just to read about billing, coding, and clinical issues."
Really? I looked at some of the other e-newsletters I received last week. Not a single one included anything related to billing, coding or clinical issues, so I look forward to PM News to fill that void. If you find a news article that is very different than ones we have seen before, publish it, sans photo.
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com
Dr. Mendoza you should lighten up. Maybe what you need to do is lighten up your patient load and enjoy the fruits of your labor. You should be glad that you have a busy practice that occupies as much of your time as you let it. Not all of us are that lucky. Without outside interests and hobbies life becomes pretty stagnate.
PM News provides a wonderful service and is a well-rounded forum. Very simply, if you don’t like a section, don’t read it. At the very least, you don’t seem so overwhelmed as to not have time to comment on things you think are wasteful of your time. You should take that energy and put it into something that you feel passionate about and use it to your advantage. If it all has to be work with you, then think of his entering a pie-baking contest as podiatric marketing to the community – which it is.
Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com
The key to successful practice and a fulfilling life is to have outside interests. You will become more productive and will find that your practice becomes streamlined and more successful. I make time for my family and also play guitar, blow glass, scuba dive and do group meditation. Work hard and play hard! Life is more than a foot. Go ahead, live a little and read about others that live and you will be inspired.
Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com
09/08/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: State Association Website (Name Withheld)
From: Daniel Chaskin, DPM
There is no need for search engine optimization for such a website because society members will spread info about the website by word of mouth. Therefore, the price of the website should be lower. One can always do a search of Google for podiatry websites or podiatrist websites and see if there are any other options available. I like the design and look of websites by Officite.
Daniel Chaskin, DPM, Ridgewood, NY, Podiatrist1@optonline.net
09/06/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: State Association Website (Name Withheld)
From: Multiple Respondents
My recommendation is to keep things simple initially and work in phases. Website technology is constantly changing and improving so your investment cannot be thought of as a one time endeavor. I find requirement-creep is the biggest challenge to manage.
Michelle Clemovich, IT Consultant, APMA, MMClemovich@apma.org
About 20 APMA state component executive director members of the American Society of Podiatric Executives (ASPE) will be attending our fall meeting in two weeks and we would be happy to put your request for more information on websites on the agenda. I believe all of the states represented currently have websites.
In Massachusetts, we have a special promotional arrangement with Chicago-based website company, Officite, the largest provider of websites to podiatrists in the country. Under this arrangement we offer our members a special discounted price and promote Officite as an official Massachusetts Corporate Sponsor and Officite provides us with very low-cost website development and hosting services. We are very happy with our site (massdpms.org) and the services provided by Officite.
My best advice would be to go with a good size, well-established website development company that has experience with developing and hosting State Podiatric Medical Association Websites - it should not cost several thousand dollars. Please let me know if you would like the ASPE executive directors to provide feedback to you after their meeting in two weeks. I would be happy to talk further with you about your website project - I can be reached by calling the Massachusetts Podiatric Medical Society at 978-646-9671.
Gary Adams, Executive Director, Massachusetts Podiatric Medical Society, gadams@massdpms.org
Deciding on a Web designer is tough. The costs can be from $5K-$50,000. Yes the cost depends on the bells and whistles you choose. There are some excellent designers (referrals on request) at reasonable costs. The key to look for is someone who will work with you and push you to decide what you need and or want before designing and producing the product. Remember today the most important issue is it should be simple and available for you to update - not the Web designer or consultant. Annual update costs should be very minimal if at all.
I recommend paying only for what you need. If the site is done correctly you may not need the consultant much if at all. Finally, I recommend you house the server off-site, unless you have the staff to keep up with the latest and greatest and don't care if you are off line from time to time. There are many great companies that will act as the server for your site at very reasonable dollars.
David M. Schofield, DPM, Past President, APMA, david.schofield@yahoo.com
09/05/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: HR 6631 and Open Door Forum on MIPPA (Paul Kesselman, DPM)
From: Gerald Peterson, DPM
I appreciate Dr. Kesselman's kudos to those members mentioned but I think he forgot to mention the hundreds of contributors to APMAPAC who made it possible to have an audience with the legislators who voted to move this issue to the forefront of the agenda and pass this most important and vital legislation to all podiatric physicians.
I would like, on behalf of the APMAPAC Board of Directors, to thank all of the faithful supporters of the PAC who contributed to APMAPAC this year and last, who helped make this possible. They are the unsung heroes of our profession and deserve our kudos too.
Our job is not over however. Title XIX here we come!
Gerald Peterson, DPM, Chair, APMAPAC, DRP@ifixft.com
09/03/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Obligation to Treat Medicaid Patient (Name Withheld)
From: Jeffrey Kass, DPM
Since the posting was from "name withheld", we don't know the state in which the doctor practices. In New York, podiatrists were removed from the Medicaid system many years back. (Medicaid as a secondary can be paid at 20% of the 20% rate.)
I think children under 18 can still be seen. Due to this fact, it is not the insurance which won't pay well, it is that you won't get paid at all. If someone calls my office with Medicaid, I respond by telling them no private podiatrist accepts Medicaid as a primary insurance and I inform them their insurance is accepted by hospital clinics.
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com
08/14/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Gas: The New Workplace Perk (Bob Levoy)
From: Multiple Respondents
I give one full-time employee a $120 gas card per month. This is because of the considerable distance she has to travel and that she is the office manager. Everyone else gets a $25 gas card. This has increased staff moral considerably. It shows them that I appreciate their difficulties and I am on their side.
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com
We have not reimbursed our staff for gas but a few weeks back to show our appreciation for their great efforts each and every day we gave them all a one hundred dollar gas card with a thank you note. They loved it! I always say, it's not our customer who is #1, it's our staff.
Hal Ornstein, DPM, Howell, NJ, hornstein@aappm.org
We don’t provide a gas allowance but we do have one valuable, hard-working employee in our business office who lives 45 miles away with two very young children. We set her up on gotomypc.com. She telecommutes 3 days a week and comes to the office 2 days a week. She works whatever odd hours of the day she chooses and her hours have decreased while her output has increased. Since she is doing our insurance most of the time it does not matter where she is. If she calls patients from her home we cover her phone bill for those calls if they are long distance. It has been win-win.
Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu
08/11/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Projections of Supply and Demand for Podiatric Physicians (Justin C. Jex, DPM)
From: Ross E. Taubman, DPM, Carl Solomon, DPM
It is important to note that the study in the July/August edition of JAPMA, done by the Work Force Center at the State University of New York at Albany, demonstrated that DPMs currently provide only 40% of the foot and ankle care in the United States. If there are fewer DPMs, one could argue that the remaining DPMs might be busier in their practices. But at what cost to the profession? A decreasing market share for DPMs that will lead to other, less qualified providers of foot and ankle care providing a greater proportion of that care.
This is an ominous sign for all of us that should awaken the profession to greater promotion of the expert services that podiatric physicians provide and a need for each of us to help recruit the most highly qualified applicants for our schools. If each APMA member recruited just one highly qualified applicant per year to our schools, we would have an applicant to matriculant ratio of 180 to 1! This would make our schools the most highly selective of all medical schools.
Ross E. Taubman, DPM, President, APMA, retaubman@apma.org
Surveys and statistics can bolster either side of the argument of whether there's a demand for more podiatrists. I don't have very strong feelings one way or the other, but here's a way to cut through all that and find out, at least in a given area. Call a bunch of offices and tell them you have a bunion or hammertoe that you need fixed. See if you can get an appointment in a day or two. If most of those offices can get you in that fast, there's no demand for more providers.
Carl Solomon, DPM, Dallas TX, cdsol@BaylorHealth.edu
08/08/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Pedorthist Representing Himself as a Doctor
From: Multiple Respondents
The so-called “pedorthist’s” behavior described by Dr. Taylor is unforgiveable. Is the “pedorthist” a certified pedorthist, or just someone calling himself a “pedorthist”? If he is certified by either ABC or BOC, both of these agencies have ethics committees and the person’s behavior would violate the ethics rules of both. I would also suggest writing a letter to those entities and/or giving them a call. Speaking as a C.Ped, I don’t want people like that tarnishing my credentials—that’s why we have the cannon of ethics.
Brett Richey, C.Ped, Charlottesville, VA, brett.richey@richeyco.com
The patients should a written complaint with the Texas State Board of Orthotics and Prosthetic, Mail Code 1982, P.O. Box 149347, Austin, Texas 78714-9347, E-mail: op@dshs.state.tx.us, Telephone: (512) 834-4520, Fax: (512) 834-6677 ATTN: Texas Board of Orthotics & Prosthetics
Paul Kinberg, DPM, Dallas, TX, drkinberg@sbcglobal.net
There are two issues here. One is whether a non-podiatrist can prescribe and dispense orthotics. The other issue is whether a pedorthist can present himself to the public as being a physician. Both issues seem clear-cut. Pedorthists who are licensed in some, if not all, states and trained to dispense shoes, braces and orthotics are not physicians and Dr. Block is correct; contact your state authorities and apprise them of this.
The other issue is something we have to face and accept whether we like it or not. Virtually anyone can dispense orthotics with or without a medical license. In my area which is Long Island, NY, there are shoe stores that advertise that they make orthotics to address all sorts of foot problems and they have the right to do so. There are mail order firms that will send people casting foam boxes, have the patients take their own impressions and then mail them custom orthotics.
The one and only thing we can do is to educate our patients about the level of our own education as it pertains to biomechanics and the casting for orthotics. Once patients understand the level of our training and that the final product that they will receive will have four plus years of training incorporated into it, hopefully they will make the wise choice to have us be the provider for their custom-made orthotics.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
08/07/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: Ace American Insurance
From: Multiple Respondents
We have been using Ace American for about 10 years. Our rates have been consistently lower than other insurance providers who have solicited our business. We do not have any claim experiences but I feel confident that they are reputable due to their rating.
Michael J. Schneider, DPM, Vail (Avon)-Frisco, CO, MJS10Vail@aol.com
I have been covered by Ace American Liability policy for the past seven or eight years since I was canceled by AIG for one suit that we won in court. I have not had to use them, yet. Before purchasing this insurance I checked their ratings, premium to pay out ratio, and their reserves. They compared favorably with other malpractice insurance carriers.
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com
I have had this insurance for several years and enjoyed a reduction of greater than 40% when I renewed two or three years ago. Also, within the last month, I have enjoyed an additional 10% reduction in premium by completing an online risk management course which did not take much time but was certainly worthwhile. I am grateful that I have not had to call upon Ace to implement my malpractice coverage but have always found them to be responsive, courteous and informative when I've needed attention.
Frances Callamari, DPM, West Paterson, NJ, FrancesCallamariDPM@verizon.net
08/06/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE - PART 1
RE: The Dis-connect Of Professional Courtesy from Professional Ethics
From: Robert D. Teitelbaum, DPM
There are two local incidents here in Naples that illustrate this point:
1) A new practitioner, without any type of notice or warning, moves into a space that is fifty feet from another, established, practitioner's practice. Albeit, the area is an office-type complex and not straight retail---but……
Editor’s note: To read the full text of this letter go to: http://www.podiatrym.com/letters2.cfm?id=21128&start=1
