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12/23/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Holiday Staff Bonuses
From: David Gurvis, DPM
I am not an expert in how to formulate your staff bonuses, or even if you should give one. They can be based on productivity, or collections, or simply out of the goodness of your heart. But let me relate a "fact" of life bestowed upon me by my accountant years ago and that is, once you give a bonus, it is expected. It may forever after be called a bonus, but it isn't. It becomes an expected gift. If you have a bad year, and thus give no bonuses, expect to see staff disgruntled.
So, be sure you want to go this way, and if so..then you need to figure out what and how much.
David Gurvis, DPM, Avon, IN, deg1@comcast.net
Other messages in this thread:
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
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.
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
02/24/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Switching to Comcast for Phones and Internet (Barrett E Sachs, DPM)
From: Mathew M. John, DPM
I have been using Comcast business class for the past three years now and have been very happy with them. Switching has cut my phone/Internet costs by half, and I now get cable TV as a bonus. The one time that our phones/Internet were down, Comcast had a crew that day working on the line that was damaged, and it was fixed within two hours. Other than that one time, I have had no problems here in Atlanta. I would make the switch.
Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com
01/03/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: AEDs in Podiatry Offices (Bob Levoy)
From: Brian Kiel, DPM
We have had defibrilators in our offices for several years and fortunately have had no need for them. When you purchase them, you should have training included for you and your staff.
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
01/02/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: ACOs and Patient Satisfaction
From: Steven J. Kaniadakis, DPM
The AMA is conducting webinars on Accountable Care Organizations aka "the ACO initiative." It's "not just clinical quality" measures; it's more about improving the patient experience. This will be a much more important factor than in the past in this upcoming model for practice management and accountability.
To prepare for the future, I recommend that everyone conduct patient satisfaction surveys (wait time, staff competence, treatment, podiatrist competence/bedside manner, payment/accounting). After all, it's all about the patients. If you get into an ACO, then this will be valuable data to present. You can be sure that the ACO will be gathering this information, and you'll be the wiser one with your own backup survey results. I propose that every podiatrist think hard about doing this.
Steven J. Kaniadakis, DPM, Saint Petersburg, FL, stevenkdpm@yahoo.com
12/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Selling Old X-Rays for Silver (Michael J Felicetta, DPM)
From: Ken Hatch, DPM
Try Esquire Trading (954- 484-7755). They are located in Florida, but pick up in Eastern U.S.
Ken Hatch, DPM, Annapolis, MD, KLHDOC@aol.com
12/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Holiday Staff Bonuses (David Gurvis, DPM)
From: Lloyd Nesbitt DPM
For all those who were happy to read Dr. Gurvis’ comments, I can say that I was delighted to give each of my staff $350 each during our annual Christmas lunch at a fine restaurant today. Interestingly, it’s not about my productivity, or whether it was a good year or not. It is all about showing how I appreciate the way they run the office.
My staff have been with me for years, and say they couldn’t work anywhere else. My patients love how caring and nice they are on the phone and in person. I suggest that DPMs be extra nice to their staff and it’ll come back ten-fold. They may expect it next year, and they’ll deserve it then too.
Lloyd Nesbitt, DPM, Toronto, Canada, lloydn@rogers.com
12/20/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Advanced Composite Materials in Podiatric Medicine
From: Keith Gurnick, DPM
The use of Kevlar in foot orthotics is not indicated or worth the cost of the material. Other materials that offer strength are more durable and easier to work with. It is a very difficult woven fabric to grind, because it sheds fibers. If you are adjusting orthotics in your office, it would probably be deemed unsafe without proper protection such as a face mask and proper ventilation.
The use of graphite and graphite-thermoplastic laminate composites have been used for foot orthotics for at least 20 years and yields strong, durable, and relatively thinner orthotics. Stress fracture and ulcer prevention usually comes down to proper shoes, and then the use of medically-necessary foot orthotics with soft tissue supplementary covers and extensions. This has little or nothing to do with the composite material that is used to make up the orthotic shell or module. Thus, carbon fiber is good, Kevlar not good, and the advantage is a durable custom orthotic that can be less bulky. Graphite and resins also can be difficult to grind, difficult to heat-adjust, and one should employ protection to the skin to avoid allergic reactions, and also to the eyes. If grinding, protect the mouth and nasal openings to avoid inhaling particulates.
Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
12/06/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Return Shipping Charges for Shoes (Alan Berman, DPM)
From: Ron Bar, Joe Boylan, DPM
A few companies that offer diabetic shoes, including Orthofeet, offer free returns on shoes – no questions asked.
Ron Bar, Orthofeet, Inc., Northvale, NJ, orthofeet@aol.com
We have been using Safestep for about 8 years. Safestep provides a return shipping UPS label that we use once a month, if needed. We place all returns in one box and send monthly. Our goal in the office is to keep the returns to a minimum.
Joe Boylan, DPM, Ridgefield, NJ, Drb0327@aol.com
10/28/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: SuperGroup Formation in Maryland (Ira Baum, DPM)
From: David N. Helfman, DPM
I have mentored physicians around the country and have received literally hundreds of calls from podiatrists about the SuperGroup model over the past two years. I have seen the flaws, the pitfalls, and misconceptions that many podiatrists are led to believe when signing on with a consultant or fellow colleague in our profession.
First, I have stopped marketing our model because the demand is so great that we are building up our infrastructure and methodically assessing each market and state to make sure it fits the criteria for a super group model. I would caution all of you to ask the following questions when you are considering putting together a SuperGroup model:
1. Why are you...
Editor's note: Dr. Helfman's extended-length letter can be read here.
10/25/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: PAs and Podiatrists (Seema Ramcharitar-Amante, DPM, RPA)
From: Elliot Udell, DPM
What is most significant to this discussion is not that there are good and bad PAs. It's that private patients are often not given a choice either at a large primary care or specialty practice about who is treating them and knowledge as to what the PA's level of training is. As I mentioned, my preference when I go to my allergist is to choose the PA. He is highly trained in allergy and upper respiratory problems. Many other patients feel the same way.
On the other hand, while under anesthesia, having a delicate cardiac procedure done by a PA who is has not had that "three weeks or more of training" in doing the procedure is perfectly legal, but morally unfair to the patient. If a patient has a poor outcome during a surgery or has to spend for another outpatient primary care visit, because a doctor or hospital is thinking more about making money rather than in rendering excellent medical or surgical care, something is wrong with the laws that allow it.
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
10/06/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrist Lands on Front Page of AARP Convention Issue
From: Michael M. Rosenblatt, DPM
To my great dismay and embarrassment, a podiatrist was on the front page of the AARP Newspaper in September for Medicare fraud. This was not just an RFC issue. This doctor had billed Medicare for patients who were dead or had no extremity upon which he billed. This was a "showcase" article for AARP on Medicare fraud. According to the article, he faces prison and will soon be sentenced.
Even though I disagree with many political stances taken by AARP, my wife and I did go to the convention in LA. Their newspaper was all over the place. I don't know what its circulation is, but I assume it is in the millions. This was very sad and made me feel uncomfortable. Of course, other doctors commit fraud. Recently, a large group of MDs from Florida were indicted. This was not mentioned by AARP.
AARP is not without fault either. They hype their insurance plans very aggressively, and signing up for them can be confusing and poorly disclosed. One of our personal friends ran into trouble on this issue and ended up paying for an expensive operation herself. She had thought she was covered. I assume AARP gets a nice cut from their insurers, or at least gets hundreds of millions in advertising fees. I don't expect AARP will publish the letter I sent in describing my regret for this podiatric tragedy or their own areas of suggested improvement.
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
09/24/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Support DPM Candidates for Congress (Bret Ribotsky, DPM)
From: Marc Garfield, DPM
A few months ago, I heard a DPM (now candidate Lee Rogers) speak at a scientific conference. His podiatric insight and experience are a great contribution to our profession. I found it disturbing however that he saw fit to quote George Bernard Shaw (An early 1900s advocate of Fabian socialism) during a scientific discussion. I am therefore prompted to request caution when supporting candidates for federal office who may support an agenda that brings much more to the table than support for podiatry.
Let these candidates express how they are going to improve our country while maintaining fair reimbursement for medical services. Nine times out of ten, we can’t agree on how to treat a bunion, despite the fact that we are all podiatrists, all with valid points and intentions. I see no reason for us to support political candidates collectively, just because we are all podiatrists.
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net
Editor's Note: The quote Dr. Garfield refers to is, "I marvel that society would pay a surgeon a large sum of money to remove a person’s leg ...but nothing to save it." George Bernard Shaw
09/14/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Posting Cases On-Line (Barry Mullen, DPM)
From: Tip Sullivan, DPM
I always enjoy the contribution that Dr. Mullen makes to this forum, but I did get distressed regarding part of his last post which seemed to slam this forum. He writes, "Every week, on this website, in one breath, I read some of our colleagues providing opinions on various medical conditions...some of which are just dead wrong...in some cases, laughable, especially when discussing conditions that mandate multi-specialty involvement, like CRPS as one example...while in the next breath, other colleagues ask opinions about certain conditions, or seek help in establishing diagnoses for given sets of signs and symptoms. If you have to ask...DON'T TREAT...REFER!"
One of the reasons that I participate in this forum is to get other opinions about some of the problems I see in my little world of feet. I do not find comments made here "laughable"--except for the ones intended to be so. I may not agree with some medical or foot-related opinions and I may think some are incorrect. This is a forum to share with our colleagues, the good, the bad, and even the ugly. I do not believe that listening to others' opinions on a difficult problem should be interpreted as "this person doesn't know what to do so he/she is asking for help." I will continue to post interesting cases here and ask for my colleagues' opinions as long as I am allowed, and would ask Dr. Mullen to do the same. I promise I won't laugh.
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net
08/30/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
Dragon Medical Practice Edition Version 11 Coming in September (Robert Kuvent, DPM)
From Carl Solomon, DPM
I have to agree with Dr. Kuvent's comments to Dr. Kasova's post regarding Dragon voice recognition software. I concede that I haven't used the more expensive Medical version, but cannot justify its markedly increased cost over the "Premium" version. The reason is that one of the options for training its vocabulary is to direct the software to somewhere on your computer (a file, a folder, a drive, a CD, etc.) with documents that contain words that you typically use. That could be your previous dictations, a CD that your transcription service might give you with old dictation, op reports...whatever. Dragon will scan them and grab all the words it doesn't recognize, then offer them to you one at a time to pronounce. It may require an hour or so of your precious time, but once done, it has all of your medical (podiatric) words in its vocabulary. I can talk faster than conversational speed, and it doesn't have any more trouble transcribing "periosteal proliferation at the proximal shaft of the fifth metatarsal" than the word "cat."
The only problem I'm aware of is the possibility that there used to be one or two practice management software programs that were only compatible with the Medical version. That was the case when I checked a couple of years ago, but has probably changed. The full retail price of Premium (and you can find it for less) is a couple of hundred bucks. An older version, if you want to test the water and upgrade later, can probably be found on Ebay for less than $100. I've found its performance to far exceed anything I ever expected.
Carl Solomon, DPM, Dallas TX, cdsol@swbell.net
08/29/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Autoclaves (Elliot Udell, DPM)
From: Lowell Scott Weil, Sr., DPM
MidMark 11 is great - we have several. We also have several of the earlier models that have held up for years. Check the used medical equipment market on the Internet for great buys, and with the history of Midmark, it's a good value.
Lowell Scott Weil, Sr., DPM, Des Plains, IL, weil4feet@aol.com
08/26/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Digital X-Ray Company That Supports Podiatry (Dan Michaels, DPM, MS)
From: Alan L. Bass, DPM
I am in the process of combining my office and joining with an office that recently switched from a CR digital imaging system to a DR system from Ann Arbor Digital Devices (A2D2). Even though they had a perfectly good system from 20/20, when they looked at the savings and productivity gains from the A2D2 system, it was a no-brainer for them. The first thing that caught their eye was not having to handle and process cassettes in the DR system. This reduced the amount of time to take 3 views from over 6 minutes to under 2 minutes. In a busy office like theirs, that 4+ minute savings for each and every X-Ray case really adds up to big labor savings.
Another deciding factor was that A2D2 does not charge any support or upgrade fees for the software; this alone saved the office over $1,200. The software is podiatry-specific, easy-to-learn, easy-to-use, and offers features that put it miles ahead of all the others. Finally, another reason was that this is a podiatry-friendly company and a big supporter of podiatry and the AAPPM.
Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net
08/17/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
Re: Difficulties Implementing EHR (Joe Borden, DPM)
From: Richard A. Simmons, DPM
Dr. Borden is concerned about complicated, hard-to-use EHR software that is affecting patient flow. The computer proficiency of the doctor and the staff are key issues here. If the office is attempting to go from all paper to EHR, that is the most difficult and will be the most time-consuming. If the office is transitioning from EMR to EHR, then the transition most likely is seamless. Essentially what happens for all of us is a general slowdown as we learn the limitations of our programs and tweak the programs for our specific practices.
Once learned, the program will be invaluable to you, so be patient. To maintain patient flow, you may need to implement the program initially with every other patient, but input those other patients’ charting later. Naturally, if you have a lot of routine care patients in your practice, these repetitious notes can be handled quickly with the EHR. Inputting the data for new patients is very time-consuming, but can be less labor intense for your office if your program has a patient portal. Unless your objective is to collect $14,000 this year, there is no reason to rush.
My office has made a relatively smooth transition from Medinotes EMR to Practice Fusion.
Richard A. Simmons, DPM Rockledge, FL, RASDPM32955@gmail.com
07/07/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Organized Medicine and Office Visit Costs
From: Deborah S. Wehman, DPM
I recently read three books at the suggestion of a family practice MD who teaches at the University of MN in the family practice division. They give a different view of current medical practice and give plenty of food for thought. Podiatry is not mentioned specifically. Reading them was informative for my own personal healthcare decisions and makes me less leery of cost and care in the future. It puts some power back in the hands of the patient.
They are: Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch, MD, Worried Sick: A Prescription for Health in an Overtreated America by Nortin Hadler, MD, and Disease, Diagnosis, and Dollars: Facing the Ever Expanding Market for Medical Care by Robert Kaplan. It would be an interesting vein for discussion.
Deborah S. Wehman, DPM, Richmond, IN, DSWehman@comcast.net
05/21/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Vacuum System With an Umbrella Burr? (Ivar E. Roth DPM,MPH)
I use a Promed Filestream system. It uses whatever burr you choose, and it does do a good job controlling the dust.
Jeanne M. Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com
05/11/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Athena Health EMR (Daniel Cohen, DPM)
From: Name Withheld
I have just terminated my contract with AthenaHealth. But in all fairness to them, it just wasn't the correct fit for my practice. I have several friends who are very happy with AthenaHealth. So I will touch on some of the things that you should know about it before you decide.
1. The program was cumbersome and slow to navigate. Every place of service is entered as...
Editor's note: Name Withheld's extended-length letter can be read here.
03/21/2011
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Replacement Product for Panafil (Theresa L. Schinke DPM)
From: Multiple Respondents
I also used Panafil for years. I have now been using Santyl ointment, with fairly good results.
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net
Panafil (as well as Accuzyme and several other papain/urea-based debriding agents) was taken off the market in 2008. As far as I know, the only currently available active enzymatic debriding agent is Santyl (collagenase), which is manufactured by Healthpoint.
Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com
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