04/27/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
From: Richard A. Simmons, DPM
I have used Cetylcide-II for more than 20 years without staining. Two things to always do: 1) use distilled or de-ionized water and 2) use “Anti-Rust Powder” that is manufactured by Gordon Laboratories (one oz to one gallon of solution).
Richard A. Simmons, DPM, Rockledge, FL
04/24/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar Roth, DPM, MPH
The policy that we instituted requiring a credit card for first time patients has worked extremely well. Our front desk can figure out when an elderly patient says they do not have a credit card and they act accordingly. This policy is for the tire kickers or potential new patients who abuse the system. We used to get a few that would give us a false credit card number. Now that we actually charge the card beforehand, we know if the card is good or not. These tire kickers know we are on to them and hang up or do not make an appointment, which is good.
Our no-show rate with our new policy for new appointments is about zero now. As far as us being on time, we are. We run a tight ship.
One caveat, I run a concierge practice where we do not take any insurance.
Ivar Roth, DPM, MPH, Newport Beach, CA
04/24/2017
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell, DPM
Many doctors and dentists penalize patients for missing appointments irrespective of whether it is the first or a subsequent visit. One rheumatologist in my area is even bolder. If a patient misses a single visit, he sends them a letter letting him or her know that he or she is persona non grata in his practice and should find another rheumatologist. I know he does this because two patients recently were upset at me for referring them to this doctor. Because of his behavior, I am now reluctant to refer any more patients to him.
Several years go, I missed a dental appointment and his office manager called me and told me they are charging me a hundred dollars. I let the dentist know that I would pay him what he asks, but would no longer use his services. He retracted the fee and since that time he has done a number of crowns for me as well as other dental work. Had he gotten the hundred dollars out of me, he would have lost thousands.
The bottom line is that if you are prepared to penalize a patient for missing a visit, you should also be prepared to suffer the consequences of angering a patient. In my practice, when this happens, I bury my ego, give up being right, and continue rendering podiatric care to my patients.
Elliot Udell, DPM, HIcksville, NY
06/27/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: TRAKnet Charges (Marge Portela, DPM)
From: Joseph Cortez, DPM
It is highway robbery. I over-estimated them and assumed they would not take advantage of a government-mandated situation. $3,000 a year for updates and to connect to their servers to e-prescribe? You have to be kidding me. How many updates does that guarantee me a month? I find it ridiculous that they say you will not be able to use your TRAKnet if you do not have a service agreement. It seems to me they are putting the pressure on their clients, forcing them to comply or be left out in the cold.
Joseph Cortez, DPM, Simi Valley, CA, jmcdoc@roadrunner.com
05/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
Re: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Lynn Homisak, PRT, Carl Ganio, DPM
I have to be honest, I cringed when I read your post because if what you say is true…that you suspect the receptionist and OM are in cahoots and deliberately not scheduling patients…and that they did not accommodate the diabetic caller with a same day appointment (even though they were instructed to)…these are NOT the people you want working for you. In fact, it sounds more like they are working against you! How many other potential patients (besides your “planted call”) were turned away? To answer your question, yes, there is a way to record phone calls for “quality control” AND quality training purposes.
I have never been a proponent of “spying” on staff by using their mistakes and errors as a means of reprimand. I am more of the belief that...
Editor's note: Ms. Homisak's extended-length letter can be read here.
My advice would be to replace that person or persons, as they are becoming too territorial with your patients. They have a sense of entitlement that empowers them to act in their own best interest...not yours. I had a patient sheepishly return to my office after having surgery with another podiatrist. She told me, that when she called my office for a consultation, the front office told her "Doctor Ganio no longer does surgery." This particular ex-employee did not like all the additional work associated with scheduling a surgery. It is undetermined how many people she misdirected in this manner.
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz
05/24/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Staff Makes it Difficult to Get Appointments
From: Michael Robinson, DPM, MPH, JD, Elliot Udell, DPM
It is very easy; your staff doesn't care about your policies or practice needs. It is time to replace them and get staff who listen and do what you want. This advice is short, not sweet, but it is what you need to do.
Michael Robinson, DPM, MPH, JD, Brookline, MA, drmrob@aol.com
The scenario that you describe makes my "blood boil" because many times I have referred patients and close relatives to specialists for urgent medical care and some front office person answering the phone refused to give the person a timely appointment. I still remember referring a patient to a hematologist for an urgent visit and the patient was told that the earliest appointment was in three months. I met this doctor a few days later in my local hospital and he lamented that his office was very slow and he can't figure out why.
The bottom line is that it does not take staff too long to realize that they have a vested interest in keeping a practice slow. It's less work for them. They will have fewer patients to contend with, less paperwork, and they will take home the same pay check irrespective of whether the office is busy or slow. The only way to address the issue long-term is to either monitor every call or offer them some kind of financial incentive that makes it worth their while to book patients.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
05/11/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
RE: Smart Patient With Smart Phone (Bret Ribotsky, DPM)
From: Jeffrey Kass, DPM
I had the exact situation occur in my office that Dr. Ribotsky describes.
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com
05/02/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Purchasing a Digital X-Ray System (Michael Brody, DPM)
From: Kenneth Meisler, DPM
After 30 years in the same office, I moved to a new much larger office in 2007. I decided to switch to digital x-rays and go totally paperless with EMR at that time. EMR was relatively easy, digital x-rays were EXTREMELY easy.
I disagree with Dr. Brody recommending a CR system for digital x-rays. In 2007, I tried to save some money and bought one of the most popular podiatry CR systems. After one year...
Disclosure: Disclosure: Dr. Meisler is a paid consultant for 20/20 Imaging.
Editor's note: Dr. Meisler's extended-length note can be read here.
05/01/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Neil Levin, DPM
I recently purchased a Konica Sigma Pilot CR digital x-ray system. My X-Cell machine is 20 years old and did not have to be modified at all. The system is perfect for a solo practitioner office. It has all the bells, whistles, and tools you will need. The images are terrific. The support has been excellent, and if you don't want to buy computers/monitors for all your rooms, you can bring the image up on a laptop or I-pad and bring it room to room. (It is a little bit of a hassle if you are busy, but works well). The system is also more affordable than others I considered.
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com
12/05/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: CMS to Now Cover Obesity Counseling (Robert Bijak, DPM)
From: Michael M. Rosenblatt, DPM
It is a relief that legendary physician, Elliott Proctor Joslin, MD, did not have the same contempt for podiatry that Robert Bijak, DPM apparently has. Dr. Joslin took it as a matter of almost religious importance that care of diabetes mellitus be a professional group-project. In Dr. Bijak’s attack against Dr. Jon Hultman, DPM, MBA, Dr. Bijak suggests that Dr. Hultman would not first obtain cardiac clearance before suggesting an exercise program.
It is common and accepted practice for professionals who recommend exercise programs, including walking as therapy, to obtain cardiac clearance first. More to the point, podiatry has a great deal to offer diabetic patients at risk of ulceration and gangrene. Our profession, (from Dr. Dennis Shavelson and others who are experts at biomechanics) has recommended that diabetic patients obtain podiatric evaluation for their specific “foot typing” so that risks of damage from walking/exercise can be minimized.
That type of evaluation, treatment, and counseling is firmly within DPM licensure and complements diabetic care. I can see Dr. Joslin enjoying the contribution of biomechanical foot typing in his life-long pilgrimage to be inclusive of multi-specialty diabetic care, as well as knowledgeable counseling on exercise programs, even if by podiatrists.
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
09/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Cantharidin Plus (Beetle Juice) (James Stough, DPM)
From: Joan Schiller, DPM, Carl Ganio, DPM
Try Canthacur from paladin labs (info@paladin-labs.com)
Joan Schiller, DPM, Euclid, OH, Joan.Schiller@UHhospitals.org
I have purchased from Lee Pharmacy in Fort Smith, Arkansas in the past. Their number is 877-285-3379. I believe it is canthradin, podophyllin, and Sal acid in the componded mixture. I have found it to be very potent, and effective.
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@veropodiatry.biz
08/10/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Walking: Saving Lives: Protecting People, Saving Money Through Prevention (Leonard A. Levy, DPM, MPH)
From: Robert Creighton, DPM
Dr. Levy points out an important public health role for foot and ankle specialists. His advice to “encourage walking by preventing or treating conditions causing disorders of the pedal extremities” goes back to the roots of our profession, and as podiatric physicians, we also need to take our eyes off the feet, and encourage walking, as well as other forms of exercise-movement, specifically for their potential benefits on metabolic health, including blood pressure, lipids, insulin sensitivity, weight control, etc.
The potential lower extremity vascular benefits with improved endothelial function and the musculoskeletal benefits of exercise for our aging population in an effort to prevent falls and maintain independence into senior years are other areas where we have a key role to play. ACSM’s Exercise is Medicine would be a good model for our profession to follow.
Robert Creighton, DPM, St. Petersburg, FL, rcreightonjr@hotmail.com
08/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
RE: Affordable Care Act (Obamacare) Perk (Jon Purdy, DPM)
From: Jason Kraus
Dr. Purdy hit the nail on the head in identifying why there is such a deep ideological divide in our country today. Dr. Purdy's hope that he still lived in a world that was founded in 1776 and his narrow view of capitalism, juxtaposed with those who believe that we don't really live in that world any longer, and that unbridled capitalism cannot solve all of today's very real challenges, has created an ever-widening abyss.
While I think most Americans still place their faith in the foundational pillars established by our founding fathers, many have come to realize that the unimaginable changes that have taken place in the past 230 years require us to reflect on the needs of our modern world and adapt in ways that preserve our democracy and advance society. Those who insist on harkening back to the days of yore will always be at odds with those who believe that our nation is best served by constantly evolving in a changing world in a manner that preserves our core beliefs as a nation.
Jason Kraus, Deer Park, NY, jason.kraus@langerbiomechanics.com
05/29/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: VST Myodynamic (Neil Burrell, DPM)
From: Marc Katz, DPM
I have firsthand knowledge and have used this therapy. I began treatment about a year ago. I talked to several other podiatrists and they were having excellent results. They were even getting excellent coverage by insurance! So all sounded great.
I purchased the device and was given a comprehensive turn-key operations manual including verified very specific codes and protocols developed by "experts." Of course, there are standard disclaimers but they had done the research and promised it was all perfect with insurance. I have come to learn after speaking to a number of doctors that they have had nasty audits, have hired attorneys, and have refunded large sums of...
Editor's note: Dr. Katz's extended-length letter can be read here.
05/28/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Unethical Behavior By Foot Solutions (Peter Mason, DPM, Louis Nordeen, DPM)
From:Elliot Udell, DPM
If what Drs. Mason and Nordeen wrote bothers you, a visit to the FootSolutions.com website will make your blood boil. They are offering "solutions" for pain associated with plantar fasciitis, ingrown toe nails, bunions, diabetic neuropathy, and a host of other foot conditions too long to enumerate. Apparently, this national chain is no longer marketing themselves as shoe stores with pedorthic services, but as foot healthcare centers for people seeking primary help for a host of foot problems. On their website, they actually invite readers to come in and consult with their "foot specialists." Hence, we are no longer perceived as allies who refer patients to them but as their competitors. It would therefore follow that people working in local stores might harbor resentment toward us and display this hostility in what they say to our patients.
I hope that some of our podiatric medical societies would evaluate the "Foot Solutions" website and local marketing to determine if it does or does not translate into giving podiatric medical advice. If they have legally not crossed this line, then all we can do is practice to the best of our training and hope that patients will realize that we offer more and can produce better outcomes.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
05/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1A
RE: Sterilizing Bits Between Debridements (Warren Joseph, DPM)
From: Gary S Smith, DPM
I agree with everything Dr. Joseph has said about what is cultured from un-sterilized bits. I did, however, attend a lecture by Dr. Joseph about 20 years ago where he told us that research had been done where people had been purposely exposed to fungus spores and there was no increase incidence in onychomycosis. In other words, it was like with warts. Many people are exposed to the pathogen, but only those already pre-disposed become infected. The likelihood of giving somebody onychomycosis by using a bit that has been wiped or soaked as opposed to autoclaved is pretty much nil.
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net
05/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry Chair Repair (Elliot Udell, DPM)
From: Jeanne M. Arnold, DPM
If you can't find anyone who will fix the specific brand of podiatry chair you have in your area, try a dental maintenance company. We have used Patterson Dental to make repairs on our chairs. There are many similiarities between podiatry and dental chairs. They have done a good job and are in our local area. I assume there are dental companies in your town as well.
05/07/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry Chair Repair (Elliot Udell, DPM)
From: Multiple Respondents
Look in The Yellow Pages for Dental Equipment Repair. The smaller independent repair companies are willing to service podiatrists.
Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com
On Long Island, I would highly recommend Revitalize Equipment Services (Anthony Passalacqua) His phone #: 646-409-4843.
Andrew Shapiro, DPM, Valley Stream, NY, DrShapBark@aol.com
Local home appliance repair services for washers, dryers, etc. can usually handle most podiatry chair problems at far less than half the cost. Warranties for most chairs are only good for a year, so there is no voiding of the warranty. I was charged over $600 for a 'medical' chair repair service to take a look at my chair. 1 1/2 hours drive time each way, 15 minutes diagnosing the problem at $200/hr. He would then need to return to repair the chair after he ordered the faulty part. The appliance repair man I called was a little surprised to be asked to take a look at a podiatry chair, but he did a good job at far less cost. Podiatry chairs are less complicated than most home appliances.
Thomas H. Nolen, DPM, Centralia, IL, nolendpm@yahoo.com
04/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Sterilizing Bits Between Debridements (Elliot Udell, DPM)
From: Jack Ressler, DPM
With all do respect to Dr. Udell's protocol of not burring nails after debridement, he brings up an excellent point concerning the hazards that apply to patients, assistants, and doctors concerning the development of pulmonary problems associated with the nail burring. In addition, he talks about OSHA regulations. To the best of my knowledge, there are no OSHA regulations pertaining to the inhalation of nail dust by podiatric assistants.
We as physicians are forced to implement strict OSHA regulations, some of which are just plain silly, but when it comes to protecting our staff from breathing in nail dust, I have not seen any OSHA regulations that require assistants to even wear a mask. I have used nail dust extractors in my office for over 26 years and am proud to report no respiratory problems with myself or my staff. I have had the same two assistants for over 17 years without their having any respiratory medical history. Using an effective cold sterile solution for the burrs (I use Control 3) and a nail dust extractor, your patients and staff will be happy and healthy.
Disclaimer: Dr. Ressler is the CEO of J-Vac System, Inc.
Jack Ressler, Delray Beach, FL, redwingcrzy@aol.com
04/04/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Accessing Digital X-Rays on a Wireless Tablet (Neil H Hecht, DPM)
From: Pete Harvey, DPM
I can only mention the method I use without comparing tablets. I use an iPad with the GoToMyPC app. That connects to my office computer desktop. Once there, I can access EMR or my radiograph program which is OnyxRad. The process can be slow, but overall, it works pretty well.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
03/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: ICD-10 Preparation (Edmond F. Mertzenich, DPM, MBA)
From: Pete Harvey, DPM, R.D. Teitelbaum, DPM
I agree with Dr. Mertzenich. The sky is not falling in. We are all smart. We will learn the new codes and press on. For most of us already in EHR, the system software itself will provide most answers since it is built in the program. Our company is already coaching us on the conversion. I do not think there is some diabolical plot to deny us payment by any government or private agency. If anything, reimbursement may even be better since the new system more clearly defines what we do.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
If there will be a payment delay of several months, and other undefined costs to practitioners, then the government needs more time. Not the doctors, the government. I would stop right there. If they don't have their 'crosswalks' in place to direct new diagnosis codes to the CPT payment codes, whose fault is that? It's not ours, that's all I can say. With a two year run-up, there should not be any payment delay. If there is, then they do need more time.
R. D. Teitelbaum, DPM, Naples,FL, mfvandange@aol.
03/16/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Changing Banks for Medicare Direct Deposit (Joe Borden, DPM)
From: Thomas Neuman, DPM
Everything with Medicare is a problem. I sent in my forms to change bank accounts for EFT. I'm still waiting six months later for them to deposit money in the new account. Consequently, I have two different bank accounts still open for one office.
Thomas Neuman, DPM, Northridge, CA, footguy1@pacbell.net
03/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1b
RE: ABPS Name Change (M. W. Aiken, DPM)
From: Gary R. Bauer, DPM
There is wisdom in support of changing the surgical certifying board of the podiatric medical profession to The American Board of Foot and Ankle Surgery. As a requisite to procuring surgical hospital privileges, board certification/qualification defines a level of minimal competence in the anatomic area of a recognized surgical specialty, that being foot and ankle surgery. This, coupled with our professional degree as Doctors of Podiatric Medicine, will clearly define our position in the mainstream medical community as the pre-eminent providers of healthcare for this anatomic realm.
We are not losing our identity, but reinforcing and clearly defining our scope of expertise. This will have positive repercussions not only in our hospital stature, but in validating our inclusion in legislative policies, healthcare reform, and our public image. I am confident that the Board will choose the correct course of action as we are at a crossroads, and this opportunity cannot be wasted.
Gary R. Bauer, DPM, Philadelphia, PA, garyrbauer@yahoo.com
03/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1a
RE: ABPS Name Change (M. W. Aiken, DPM)
From: Craig Breslauer, DPM
I respectfully disagree with Dr. Aiken. The proposed ABPS name change is of paramount importance and is long overdue. It is not about where we have been or where we came from as a profession. It is not about you and me today as much as it is about our future practitioners and the challenges they will face.
We need much wider public awareness as to the skills and services modern podiatric surgeons offer. For example, I walked into a treatment recently to see an established patient of mine for an ingrown nail. I asked her about the Swedo brace on her ankle, only to learn that she recently suffered an inversion sprain. When I advised her that I would have been happy to help her with that problem as well, she stated, "Oh, I thought podiatrists only treated toenails." Then, after being thoroughly insulted, I learned that she saw one of my orthopaedic partners the day before for treatment of her ankle.
To the average person, ABPS might indicate that we are certified in toenail surgery. The American Board of Foot & Ankle Surgery leaves zero room for ambiguity. We do not need surgical board certification for the valuable services we provide day-to-day in our offices. However, we do need this certification to communicate to the public and insurance carriers that we are the most qualified physicians to address foot and ankle pathology in the OR as well as the hospital.
Craig Breslauer, DPM, Palm City, FL, cbreslauer@southflaortho.com
03/06/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry Chairs (Robert Lagman, DPM)
From: Nat Chotechuang, DPM
Hill chair pros: Reliable; Light enough weight that one person can move it around the room fairly easily; price is right
Hill chair cons: The seat portion of the Hill chair when in a flat or "fully-down" position is pitched forward ever so slightly. When one sits in this position, one wants to slide forward. One has to tilt the seat up a few degrees to achieve a comfortable position. Unfortunately, there is no pre-set or memory for the "right" position.
I was told by the sales representative that the foot rest might not be strong enough to support a very heavy person who sits on it, and for whatever reason, if I leave the foot rest extended, half of my patients want to sit on it instead of sitting on the seat portion of the chair. I must therefore lower the foot rest after seeing each patient, and then raise it again for the next patient to prevent them from sitting on the foot rest and possibly breaking it or falling onto the floor in a big crash.
The foot extension is manually adjusted rather than motor-driven. All of these nuances cost extra time and energy. Having to do it a few times per day is not a big deal. Having to do it dozens of times a day would get annoying.
Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com
